Open AccessExercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic
Author(s) -
Kevin Moncion,
Lynden Rodrigues,
Marilyn MacKay-Lyons,
Janice J. Eng,
Sandra A. Billinger,
Michelle Ploughman,
Damian Miles Bailey,
Michael Trivino,
Mark Bayley,
Alexander Thiel,
Marc Roig,
Ada Tang
Publication year - 2021
Publication title -
neurorehabilitation and neural repair
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.651
H-Index - 106
eISSN - 1552-6844
pISSN - 1545-9683
DOI - 10.1177/15459683211054175
Subject(s) - stroke (engine) , rehabilitation , medicine , pandemic , physical therapy , disease , intensive care medicine , physical medicine and rehabilitation , covid-19 , infectious disease (medical specialty) , mechanical engineering , engineering
Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.