COVID-19 is a contagious respiratory illness and if symptoms persist this is called Long COVID or post COVID symptoms. Symptoms vary from mild to severe illness and affect people in very different ways. COVID-19 research is ongoing but there seems to be a similar story for a small portion of COVID-19 survivors. It is estimated that 10% of COVID-19 survivors fall into a category currently known as the COVID-19 long haulers. Common complaints of long haulers are fatigue, shortness of breath, dizziness, cough, headaches, brain fog, depression, rapid heartbeat, sleep problems, and difficulty concentrating. These symptoms all combine to cause difficulty in performing daily activities. These persons are returning to work and finding it difficult to perform at the level that they did prior to COVID infection. They are seeking medical doctors and rehabilitation to return to their prior level of function. Clinical studies are underway to research the best ways to improve patient’s lives who suffer from Long COVID. Other studies are ongoing which will look at a link between COVID-19 infection and vestibular hypofunction, multisystem inflammation, and autoimmune diseases. The more that we can understand about the mechanism of action behind the symptoms the more efficient we can be about rehabilitation protocols.
Persistent concussion syndrome (PSC) is classified as ongoing concussion symptoms lasting longer than 1 month from injury. Symptoms can include headache, dizziness, difficulty concentrating, impaired sleep, fatigue, memory impairments, depression, anxiety, exercise intolerance, neck pain, and/or POTS. Concussion can be caused by falls, motor vehicle accidents, sports injuries, or trauma. Symptoms with PCS diagnosis make it difficult to keep up with the fast pace of todays lifestyle. Patients have difficulty working full time, caring for themselves or others, and functioning in busy environments. Extensive research has gone into understanding concussion and guiding rehabilitation. Physical therapy, occupational therapy, speech therapy, and cognitive behavioral therapy have shown effective influences in minimizing symptoms and returning patients back to living life. Rehabilitation is the best course of action for recovery and must be based on individual findings to create an appropriate treatment plan.
While COVID-19 is still being researched for evidence-based guidelines the crossover of symptoms makes me to believe that the area of the brain that is injured is the same. In concussion research post-concussion syndrome is linked to changes on fMRI within the brainstem. Clinical examination of both are so closely similar. Patients have difficulty quickly moving their eyes to targets, converging and diverging their eyes, moving their head while their eyes remain on an object, regulating their autonomic nervous system, and coordinating their body in space. All of these impairments tax the body, causing fatigue and “brain fog”. I have done extensive continuing education in the area of concussion rehabilitation, I’ve seen many patient’s post-concussion, and know what to expect on their examination. No 2 patients are the same but I do know which tests will be sensitive to their subjective complaints. Even with this knowledge the 2 clinical presentations are so similar that I do not think I would accurately be able to distinguish someone who presents with Long COVID versus someone with post-concussion syndrome. I need their history to be able to properly determine the correct diagnosis.
Using concussion protocols for rehabilitation we have a starting point for long COVID treatment plans. The assessment allows us to determine individual deficits and build a treatment program.
Things to include in long COVID testing:
- Oculomotor assessment
- Vestibular testing with infrared goggles as this is no longer acute testing and the goggles remove visual fixation
- Exercise intolerance
- Coordination (high level with brain involvement)
- Function using 6 minute walk test or 2 minute step test
More research needs to be done to determine the effectiveness of treatment in this patient population. As research evolves I think we will see more referrals to rehabilitation services to promote recovery.