Expert View: Clinical Director Michelle Kudhail on the neurological and rehabilitation impact of Covid-19

Inspire Neurocare’s Director of Clinical Excellence, Michelle Kudhail, explores the emerging understanding of the chronic, long-term neurological impacts of Covid 19 and the neurorehabilitation requirements arising from this new virus.

Since Covid-19 first hit the headlines in early 2020, the global healthcare community has faced significant challenges to keep people safe and mitigate the impact on the health sector as cases continued to rise. With an estimated global total of 21m cases, in the United Kingdom, over 319,000 individuals[1] have so far tested positive for the virus.

For many people, Covid-19 is a mild illness, but emerging global evidence continues to demonstrate the significant neurological and cardiovascular complications of the virus in those patients who experience serious symptoms.

Exploring the evidence: the neurological impact of Covid-19

Though we have long known that viral infections can cause serious damage to nervous system, leading to infections of the brain like encephalitis, since April 2020, the link between Covid-19 and significant neurological implications has been identified and explored by doctors and researchers.

Researchers in Beijing[2] have identified a direct link between Covid-19 and encephalitis, confirming the presence of SARS-CoV-2 in the cerebrospinal fluid of patients with the virus. Patients with mild encephalitis may develop headache, dysphoria, mental disorder, and delirium. Seriously affected patients may experience loss of consciousness, coma, and paralysis.

In April, The European Academy of Neurology [3] highlighted the both challenges faced by patients leaving ICU, with the need for respiratory rehabilitation and strength training. This rehabilitation Is required to counteract the consequences of a prolonged stay in intensive care as well as the increasing need for rehabilitation in patients with syndromes varying from stroke to Guillain-Barré and illnesses causing nerve and muscle damage. In June, the New England Journal of Medicine^[4] highlighted a link between Covid-19 and Guillain-Barré syndrome– causing difficulties with walking, swallowing, and breathing.

An observational study of over 20,000 patients published in the British Journal of Medicine[5] in May characterised identified a cluster of musculoskeletal symptoms experienced by patients, which included myalgia, joint pain, headache, and fatigue. Overall, of those patients observed, 17% required admission to high dependency or intensive care units; of these, nearly half continued to require care after 14 days. Of those receiving mechanical ventilation, 46% remained in hospital after 14 days. The study.

In June, another observational study published in The Lancet[6] explored the neurological and neuropsychiatric complications of Covid-19 in 153 patients. Doctors reported 31% of patients had altered mental status, which included 13% with encephalopathy (6% had encephalitis), and 18% with a neuropsychiatric diagnosis, including 8% with psychosis, 5% with neurocognitive (dementia-like) syndrome, and 3% with an affective disorder.

The National Hospital for Neurology and Neurosurgery and University College Hospital (UCL)[7], and hospitals in New York[8] have also seen an increase in younger adults experiencing strokes post Covid-19 infection, caused by “large artery occlusions”, and high levels of blood-clotting markers. UCL doctors found raised blood levels of a protein fragment called D-dimer, which is associated with abnormal blood clotting.

A perfect storm for the neurorehabilitation sector

An increase in patients requiring specialist neurological support post-Covid-19 is complicated by the need to address the backlog of community and outpatient rehabilitation put on hold during the lockdown, for individuals already requiring support for brain injuries and neurological conditions unrelated to the pandemic.

The British Society of Rehabilitation Medicine highlighted this in April, in its report into the impact of Covid-19 on the sector. In Rehabilitation in the wake of Covid-19 - A phoenix from the ashes[9], the Society address the challenges facing the sector due to the increasing demand for specialist neurorehabilitation and care due to both delays to rehab for existing and non-Covid-19 patients, plus those requiring support due to the cardio-pulmonary, musculoskeletal, neurological, psychological and psychiatric complications of the virus.

In June, Italian research explored the impact on the rehabilitation sector.[10] Though caution must be taken when comparing to the UK, according to European standards, Italy has a complete and well-developed rehabilitation system in place. One key issue highlighted in this research is the tension between the contrasting needs of reducing contacts/exposure for patients and continuing to provide services for people experiencing disability (to prevent future disability), or persons with disability or frailty.

Inspire Neurocare: well-placed to respond to Covid-19 with expert neurocare and rehabilitation

More so than ever during this pandemic, it is clear that successful rehabilitation and care is heavily dependent on strong, cooperative relationships between acute NHS services, independent rehabilitation services and community care providers.

Over the coming weeks, we will welcome new patients to Inspire Neurocare – some of whom will be facing a long path to recovery following the complications of Covid-19 infections. From physical symptoms linked to long stays in intensive care and assisted ventilation to psychological symptoms including sleep disorders, fatigue, anxiety, depression, and PTSD, our interdisciplinary team of experts can support.

Make a referral

For patients experiencing the direct neurological complications of Covid-19 or those looking for rehabilitation due to the impact of brain and spinal injuries and complex neurological disabilities, Inspire Neurocare’s leading team is ideally placed to help patients.

Inspire Neurocare’s stylish, contemporary community-based service is the ideal environment for rehabilitation and recovery – not only is it purpose-built for people with neurological symptoms - with a physiotherapy gym on site - strict infection control protocols mean the service is a safe environment.

Care commissioners, NHS and health and social care colleagues, individuals and family members are encouraged to get in touch with the team or find out more about our approach to post-Covid recovery here.