Inpatient rehabilitation of a person with Guillain-Barré syndrome associated with COVID-19 infection: An expert interdisciplinary approach to a case study.

BACKGROUND AND PURPOSE: Several cases of Guillain-Barré Syndrome (GBS) associated with a COVID-19 infection have been recently reported. Rehabilitation might be a key player in the recovery of these highly complex patients however, results are yet unknown. This case report aimed to describe the effects of an inpatient rehabilitation program, with an interdisciplinary team approach, in a patient with GBS in the context of a COVID-19 infection. CASE DESCRIPTION: A 58-year-old man with GBS after COVID-19 started an inpatient rehabilitation program focused on reducing dyspnea and fatigue symptoms; improving muscle strength, balance, aerobic and functional training; practicing activities of daily living and energy conservation techniques; swallowing training; emotional support and patient and family education about daily routines. An expert interdisciplinary team delivered the intervention, approximately 5 h/day, 5 days/week for 6 weeks. OUTCOMES: Improvements were observed in dyspnea, fatigue, nocturnal ventilation, muscle strength, balance, walking capacity, functional status, and swallowing function. CONCLUSION: This clinical case report illustrates the impact of a tailored and interdisciplinary rehabilitation program, on promoting recovery in multiple health domains of a patient with GBS associated with COVID-19 infection. Our experience might be useful to guide other inpatient rehabilitation programs to successfully manage these highly complex patients.

[Psychosocial characterization of a Portuguese lower limb amputee population]. / Caracterização Psicossocial de uma População Portuguesa de Amputados do Membro Inferior.

OBJECTIVE: This study aims to describe psychosocial status in lower limb amputees referred to a Physical and Rehabilitation Medicine (PRM) department of a central Portuguese Hospital. METHODS: Cross-sectional study of 45 consecutive patients with lower limb amputation, referred to PMR consultation after hospital discharge. Of the initial sample, two patients were excluded from the analysis, and four patients refused to participate in the study. The socio-demographic, medical and surgical history were obtained through structured questionnaire, and clinical information regarding the characteristics of the amputation was abstracted from medical records. Functional capacity was assessed with the Amputee Mobility Predictor (AMP), quality of life through short-form 36 (SF36), and depressive and anxious symptoms by the Hospital Anxiety and Depression Scale (HADS). RESULTS: Out of 39 patients analyzed, 32 (82.1%) were men, aged [average (standard deviation): 67, 6 (12.57)] years, 28 (71.8%) were married, 30 (76.9%) were retired, 3 (7.7%) were unemployed, 4 (10.3%) were on sick leave, and 2 (5.1%) were active. Regarding the cause of amputation, 36 (92.3%) were of vascular etiology, 1 (2.6%) caused by an infection, and 2 (5.1%) due to bone tumours, 23 (59%) had a transfemoral amputation, 10 (25.6%) had a transtibial amputation, and 6 (15.4%) had foot amputations of the foot. In the sample studied, 14 (35.9%) had pathological levels of anxiety (HADS-anxiety ≥ 8) and 15 (38.5%) had clinical depression (HADS-depression ≥ 8). The evaluation of quality of life and general perception of health status, showed lower than average score especially in the physical dimensions with a physical component summary score of the SF36 [P50 (P25-P75): 31.4 (26.8-39.4)], and in the mental component summary of SF36 [P50 (P25-P75): 41.9 (31.8-48.3)]. In this sample, the data showed the AMP score [P50 (P25-P75): 8 (4-16)], ranging from 0 to 27. CONCLUSION: This sample has a high prevalence of depressive/anxious symptoms. Considering that these mood changes have a major impact on the adherence to the rehabilitation program, functional outcome and quality of life, its early identification and treatment should be part of their overall management.