Rehabilitation of patients presenting with covid-19 and hemiparesis: A case series

BACKGROUND AND PURPOSE: The novel coronavirus disease (COVID-19) has many unique features in its presentation. One increasingly noted symptom is the incidence of hypercoagulability whichmay lead to ischemic stroke. Physical therapists are an integral component of the medical team, and contribute to the early identification of stroke-like symptoms in patients with COVID-19. CASE DESCRIPTION: This case series will describe the rehabilitation process of three patients who survived critical illness due to COVID-19 and had secondary complications including right hemiparesis while in critical care. Patients received rehabilitation by physical therapists (PT) and occupational therapists (OT) on average six times per week with interventions focused on recovery of strength, functional mobility, neurological re-education, and cognition. Mobility status was assessed with the Perme ICU Mobility Score. OUTCOMES: Neurologic examination by the PT revealed concerning neurologic signs and symptoms consistent with stroke. Only Patient 2 was definitively diagnosed with stroke via radiological imaging on hospital day 44. All patients improved in their neurologic examination, strength, and functional mobility after receiving PT and OT services for four to five weeks in the hospital COVID-19 unit. DISCUSSION: Patients who present with COVID-19 need careful screening for neurological impairment. Conventional means to diagnose stroke, such as radiological imaging, can be difficult to obtain in these unique circumstances due to infection control measures. Physical therapists can assist in early identification of neurological impairment in the absence of traditional diagnostic methods through identification of deficits in abilities such as mobility and balance.