Letter to the Editor
The future of neurorehabilitation after the SARS-CoV-2 pandemic
Futuro de la neurorrehabilitación tras la pandemia por el SARS-CoV-2
A. Juárez-Belaúndea,f,
, C. Colomer Fontb,f, S. Laxec,f, M. Ríos-Lagod,e,f, J. Ferri Camposb,f
Corresponding author
a Unidad Avanzada de Neurorrehabilitación, Hospital Los Madroños, Madrid, Spain
b NueroRHB, Servicio de Neurorehabilitación, Hospitales Vithas, Valencia, Spain
c Servicio de Medicina Física y de Rehabilitación, Hospital Clinic de Barcelona, Barcelona, Spain
d Unidad de Daño Cerebral, Hospital Beata María Ana, Madrid, Spain
e Departamento de Psicología Básica II (UNED), Madrid, Spain
f Junta Directiva Sociedad Española de Neurorrehabilitación, Spain
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The epidemic outbreak in China rapidly spread over a period of months into the current pandemic, which has changed the lives of the world’s population.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Like other respiratory viruses, SARS-CoV-2 initially affects the respiratory system. Among other reasons, its high morbidity and mortality rates are explained by the exaggerated inflammatory response triggered in many patients, as it is a novel pathological agent for immune systems.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Little is known about the disease today, but the unprecedented efforts made in scientific research and publishing have enabled us to expand our knowledge of the condition over the past 3 months. However, although it is still too soon to know the long-term consequences, we already know that the disease affects many systems.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While the cardiovascular system was one of the first systems to be studied, the neurological system is not one of the least affected.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Considerable prevalence of neurological complications has been reported (45% to 48%, depending on the methods used, in the few studies published to date). Complications affect both the central nervous system (confusional syndromes, stroke, encephalopathies, encephalitis, secondary epilepsy, etc) and the peripheral nervous system (critical illness polyneuropathy, Guillain-Barré syndrome, cranial neuropathies, etc.), with associated muscular disease (critical illness myopathy).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> Neurological sequelae are not limited to the functional level (loss of ventilatory/pulmonary capacity, generalised weakness and postural problems, secondary pain) but also include dysphagia, dysexecutive syndrome, apraxia, cognitive impairment, and such psychiatric disorders as depression, anxiety, and post-traumatic stress disorder, among others.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As with other respiratory viruses, several hypotheses are emerging around the pathway by which it enters the central nervous system. It may enter through a trans-synaptic pathway involving the vagus nerve, which innervates the lower respiratory tracts, through the nasal epithelium and olfactory nerve; and/or through the haematogenous pathway, crossing the blood-brain barrier. Neurological involvement is likely to be caused by 2 mechanisms: hypoxic brain lesions and immune-mediated damage caused by the cytokine storm.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Furthermore, the virus usually has more severe effects in vulnerable populations and patients with multiple morbidities. It is now known that the typical cardiovascular risk factors in patients with acquired brain damage are also risk factors for complications of SARS-CoV-2 infection, and therefore may lead to admission to intensive care units (ICU), with high mortality rates.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Prolonged ICU stays lead to new comorbidities that significantly affect patients’ functional and cognitive capacities. We must also consider mood and behavioural aspects associated with the stress caused.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A percentage of patients attended in ICUs and with prolonged stays in hospitalisation wards present sequelae that require specialised rehabilitation therapy. Many also initially need to be transferred as inpatients to neurorehabilitation centres to recover from moderate to severe sequelae, with specific physiotherapy, occupational therapy, speech therapy, and neuropsychological care.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, despite a reduction in the number of strokes and other acquired brain injuries attended at emergency departments and acute care hospitals, thought to be explained by fear of contracting the virus at hospital (among other reasons), the prevalence of these pathologies has not changed over time; a new increase in the incidence of these disorders and the demand for neurorehabilitation therapy is expected as soon as the epidemiological situation resolves.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,10</span></a> Therefore, specialised neurorehabilitation units will need to adapt their facilities and resources to enable better management both of patients with sequelae after SARS-CoV-2 infection and their usual patients; and to make use of new tools, in which we have specialised faster than expected. These tools, which include telemedicine for consultations and follow-up (teleconsultations), subsequent outpatient rehabilitation therapy, and the use of specific software (telerehabilitation), also enable adequate communication with the families of hospitalised patients while observing safety measures and avoiding unnecessary visits. We are also able to provide emotional support to patients and to ensure appropriate adaptation of homes and preparation of family members by teleconference prior to discharge.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,9,11–13</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In short, like in many other areas of social care, SARS-CoV-2 has shown the resilience of neurorehabilitation professionals. Furthermore, with regard to involvement of the nervous system in particular and the possible medium- and long-term consequences, this area of healthcare has become fundamental in the recovery of the affected population.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Juárez-Belaúnde A, Colomer Font C, Laxe S, Ríos-Lago M, Ferri Campos J. Futuro de la neurorrehabilitación tras la pandemia por el SARS-CoV-2. Neurología. 2020;35:410–411.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Considerations for postacute rehabilitation for survivors of COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.M. Sheehy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2196/19462" "Revista" => array:5 [ "tituloSerie" => "JMIR Public Health Surveill." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 0 | 9 |
| 2024 October | 22 | 4 | 26 |
| 2024 September | 40 | 16 | 56 |
| 2024 August | 31 | 7 | 38 |
| 2024 July | 25 | 10 | 35 |
| 2024 June | 20 | 6 | 26 |
| 2024 May | 16 | 2 | 18 |
| 2024 April | 22 | 7 | 29 |
| 2024 March | 24 | 4 | 28 |
| 2024 February | 31 | 4 | 35 |
| 2024 January | 17 | 7 | 24 |
| 2023 December | 42 | 11 | 53 |
| 2023 November | 32 | 17 | 49 |
| 2023 October | 32 | 9 | 41 |
| 2023 September | 11 | 2 | 13 |
| 2023 August | 15 | 4 | 19 |
| 2023 July | 33 | 18 | 51 |
| 2023 June | 12 | 6 | 18 |
| 2023 May | 34 | 9 | 43 |
| 2023 April | 17 | 10 | 27 |
| 2023 March | 19 | 6 | 25 |
| 2023 February | 24 | 4 | 28 |
| 2023 January | 28 | 3 | 31 |
| 2022 December | 40 | 12 | 52 |
| 2022 November | 36 | 18 | 54 |
| 2022 October | 36 | 9 | 45 |
| 2022 September | 35 | 7 | 42 |
| 2022 August | 49 | 11 | 60 |
| 2022 July | 29 | 11 | 40 |
| 2022 June | 27 | 10 | 37 |
| 2022 May | 27 | 13 | 40 |
| 2022 April | 35 | 12 | 47 |
| 2022 March | 58 | 16 | 74 |
| 2022 February | 42 | 4 | 46 |
| 2022 January | 43 | 14 | 57 |
| 2021 December | 43 | 12 | 55 |
| 2021 November | 53 | 16 | 69 |
| 2021 October | 73 | 27 | 100 |
| 2021 September | 88 | 28 | 116 |
| 2021 August | 53 | 21 | 74 |
| 2021 July | 33 | 15 | 48 |
| 2021 June | 59 | 27 | 86 |
| 2021 May | 81 | 29 | 110 |
| 2021 April | 189 | 45 | 234 |
| 2021 March | 121 | 39 | 160 |
| 2021 February | 93 | 36 | 129 |
| 2021 January | 93 | 40 | 133 |
| 2020 December | 55 | 17 | 72 |
| 2020 November | 61 | 15 | 76 |
| 2020 October | 42 | 22 | 64 |
| 2020 September | 72 | 28 | 100 |
| 2020 August | 40 | 23 | 63 |
| 2020 July | 8 | 11 | 19 |
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