Early Neurorehabilitation Shows Promise in Disorders of Consciousness after COVID-19

1) In a study, 21 adult patients participated in a neurorehabilitation program that included serial Coma Recovery Scale-Revised (CRS-R) assessments and access to brain injury specialists. Interventions included multimodal sensory stimulation therapies and neurostimulant medications. Researchers compared clinical features of patients who did and did not recover to the minimally conscious state (MCS) or better, defined as a CRS-R total score (TS) greater than or equal to 8, before discharge. The team also examined factors associated with best CRS-R TS, last CRS-R TS, and time on mechanical ventilation. ADAPTED FROM: Neurocritical Care, 2021 Oct 5;1-15.

Study findings showed that patients had CRS-R assessments a median of 6 times before discharge, beginning a median of 48 days from admission, and 12 patients (57 percent) recovered to minimally conscious (MCS) before discharge, after a median of 8 days off continuous sedation. Recovered patients had lower body mass index (BMI), lower C-reactive protein levels, higher arterial pressures, and earlier fentanyl discontinuation. CRS-R scores fluctuated over time, and the best CRS-R TS was higher than the last CRS-R TS (median 8 versus 5). Earlier fentanyl and neuromuscular blockage discontinuation correlated with a higher last CRS-R TS. ADAPTED FROM: Neurocritical Care, 2021 Oct 5;1-15.

Study researchers conclude that early neurorehabilitation of patients with prolonged unresponsiveness after severe COVID-19 can be accomplished in the intensive care unit (ICU). Hypoxia, systemic inflammation, sedation, and neuromuscular blockade may impact diagnostic assessment and prognosis. Consciousness fluctuations make serial assessments essential. Further research should investigate longer-term neurologic recovery and benefits of early rehabilitation. ADAPTED FROM: Neurocritical Care, 2021 Oct 5;1-15.