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Case report: Personalized adapted motor activity in a COVID-19 patient complicated by critical illness polyneuropathy
Oscar Crisafulli1, Marta Baroscelli1, Luca Grattarola1
1CRIAMS-Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy.
Insights
Adapted motor activity (AMA) improved respiratory and metabolic functions in a COVID-19 patient with critical illness polyneuropathy (CIP) and myopathy (CIM). AMA enhanced patient autonomy and quality of life, but did not alter neuromuscular function.
Area of Science:
- Rehabilitation Medicine
- Pulmonology
- Neurology
Background:
- COVID-19 can necessitate intensive care unit (ICU) admission, often leading to critical illness polyneuropathy (CIP) and critical illness myopathy (CIM).
- Developing effective rehabilitation strategies for post-ICU COVID-19 survivors is crucial due to the pandemic's global impact.
- This case study focuses on a patient experiencing residual CIP and CIM after COVID-19 hospitalization.
Purpose of the Study:
- To evaluate the efficacy of a supervised adapted motor activity (AMA) program in a deconditioned COVID-19 patient with residual CIP and CIM.
- To assess the impact of AMA on pulmonary, metabolic, and neuromuscular functions.
- To determine the effect of AMA on patient autonomy and quality of life.
Main Methods:
- A 61-year-old male COVID-19 patient with residual CIP and CIM participated in a 1-year supervised AMA program.
- The AMA program included aerobic, strength, gait, and balance training, with 2 sessions per week.
- Pulmonary function (spirometry), metabolic status (indirect calorimetry, bioimpedance), and neuromuscular function (electromyography) were measured at baseline and after 1 year.
Main Results:
- Significant improvements were observed in spirometric parameters: vital capacity (+40%), total lung capacity (+25%), and forced expiratory volume in 1s (+28%).
- Metabolic parameters, including body water and phase angle, normalized, returning to physiological ranges.
- While clinical and functional status improved significantly, leading to enhanced autonomy and quality of life, electromyographic parameters remained largely unchanged.
Conclusions:
- Adapted motor activity (AMA) is effective in improving respiratory and metabolic impairments in COVID-19 patients with residual CIP and CIM.
- AMA contributes to enhanced functional capacity, patient autonomy, and overall quality of life.
- AMA does not appear to significantly alter neuromuscular function in this patient cohort.
Abstract:
Background: COVID-19 may require hospitalization in an intensive care unit (ICU) and is often associated with the onset of critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Due to the spread of the disease around the world, the identification of new rehabilitation strategies for patients facing this sequence of events is of increasing importance. Case presentation: We report the clinical presentation and the beneficial effects of a prolonged, supervised adapted motor activity (AMA) program in a highly deconditioned 61-year-old male COVID-19 patient discharged from the ICU and complicated by residual CIP and CIM. The program included aerobic, strength, gait, and balance training (1 h, 2 sessions per week). Measures: Pulmonary (spirometry), metabolic (indirect calorimetry and bioimpedance), and neuromuscular functions (electromyography) were evaluated at baseline and after 1 year of training. Results: Relative to baseline, an amelioration of several spirometric parameters such as vital capacity (VC, +40%), total lung capacity (TLC, +25%), and forced expiratory volume in 1 s (FEV1, +28%) was appreciable. Metabolic parameters such as body water (60%-46%), phase angle (3.6°-5.9°), and respiratory quotient (0.92-0.8) returned to the physiological range. Electromyographic parameters were substantially unchanged. The overall amelioration in clinical parameters resulted in a significant improvement of patient autonomy and the quality of life. Conclusion: Our results highlight the importance of AMA for counteracting respiratory, metabolic, and functional but not neuromuscular impairments in COVID-19 patients with residual CIM and CIP.
