Case report: Personalized adapted motor activity in a COVID-19 patient complicated by critical illness polyneuropathy and myopathy

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.

Keywords: AMA; CIM; CIP; case report; post-COVID-19.

FIGURE 1

Execution of (A) frontal walk without sticks or braces; (B) side walk without sticks or braces; and (C) shoulder press with kettlebell. Next to the patient, an operator supervises the progress of the exercise; (D) alternating waves with a rope. All exercises refer to the third phase of the AMA program (with permission from the patient).

FIGURE 2

Mean values (SD) of the (A) post-exercise saturation and (B) the mean recovery time. Black and white columns refer to the mean values recorded in the first and last 2 months of the second phase of intervention, respectively.