One in a Million: A Case Report of Stiff Person Syndrome

Stiff person syndrome (SPS) is a rare autoimmune disease caused by lack of inhibition to excitatory neurotransmitters in the central nervous system (CNS) leading to inappropriate motor unit firing. The pathophysiology is incompletely understood; however, high titers of antiglutamic acid decarboxylase antibody (anti-GAD Ab) are strongly associated with this disease. We present a 50-year-old woman with a history of ongoing gait and balance issues for 5 years with multiple negative workups. She recently had an acute exacerbation which left her bedbound, unable to move her legs or turn from side to side. After a negative workup at an outside hospital, the patient was discharged to a subacute rehabilitation facility. She then presented to our institution due to worsening of her condition and was ultimately diagnosed with SPS which was successfully treated. We review the case presentation and treatment options in the context of a severe disabling disease presentation.

Intensive rehabilitation programme for patients with subacute stroke in an inpatient rehabilitation facility: describing a protocol of a prospective cohort study

IntroductionRehabilitation is recognised as a cornerstone of multidisciplinary stroke care. Intensity of therapy is related to functional recovery although there is high variability on the amount of time and techniques applied in therapy sessions. There is a need to better describe stroke rehabilitation protocols to develop a better understanding of current practice increasing the internal validity and generalisation of clinical trial results. The aim of this study is to describe an intensive rehabilitation programme for patients with stroke in an inpatient rehabilitation facility, measuring the amount and type of therapies (physical, occupational and speech therapy) provided and reporting functional outcomes.Methods and analysisThis will be a prospective observational cohort study of patients with subacute stroke admitted to our inpatient rehabilitation facility during 2 years. A therapy recording tool was developed in order to describe the rehabilitation interventions performed in our unit. This tool was designed using the Delphi method, literature search and collaboration with senior clinicians. Therapists will record the time spent on different activities available in our unit during specific therapy sessions. Afterwards, the total time spent in each activity, and the total rehabilitation time for all activities, will be averaged for all patients. Outcome variables were divided into three different domains: body structure and function outcomes, activity outcomes and participation outcomes and will be assessed at baseline (admission at the rehabilitation unit), at discharge from the rehabilitation unit and at 3 and 6 months after stroke.Ethics and disseminationThis study was approved by the Medical Research Committee at Hospital del Mar Research Institute (Project ID: 34/C/2017). The results of this study will be presented at national and international congress and submitted for publication in peer-reviewed journals.Trial registration numberNCT04191109.

COVID-19 Outbreak at a Geriatric Rehabilitation Facility: The Silent Threat of Asymptomatic Patients with High Viral Loads

Data about outbreaks of nosocomial COVID-19 disease within geriatric rehabilitation facilities are scarce. In this retrospective case series analysis, we describe such an outbreak, determine the proportion of a-/presymptomatic patients, the median time before symptom onset among presymptomatic patients and investigate whether the viral load differs between patients with and without symptoms. Typical and atypical symptoms were retrieved from the electronic medical records of patients who tested positive for COVID-19 disease during their stay at a 95-bed geriatric rehabilitation facility. The viral load at the time of diagnosis was estimated on cycle threshold values of the rRT-PCR test. Overall, 34 patients (median age, 87 years; range, 66–98; 67% female) tested positive for SARS-CoV-2. During the same period, 19 health care workers were also diagnosed with COVID-19. Among the 27 patients who provided consent, 20 (74%) were symptomatic at the time of testing. Among the remaining seven patients, six developed symptoms after a median of 2 days. A viral load > 106 copies/mL was observed in 20 out of the 27 patients, including five out of the seven initially asymptomatic patients. The rapid transmission of SARS-CoV-2 and the prevalence of initially asymptomatic patients with high viral loads support an extended screening strategy at such facilities.

Rehabilitation Outcomes in Subjects with West Nile Neuro-Invasive Disease

West Nile Virus (WNV) is the most common mosquito borne cause of viral encephalitis in the United States. Physical and neuro-cognitive recovery from WNND may be prolonged or incomplete leading to chronic cognitive inefficiencies and functional decline. There continues to be no effective treatment of WNV and current management is primarily supportive. The objective of this review is to evaluate the functional outcomes and role of rehabilitation services in subjects with WNND. The charts of five subjects admitted to an acute inpatient brain injury rehabilitation facility from June to December 2012 were retrospectively reviewed. (Mean, Range)-Age (64.8, 43–78 years), Admission Functional Independence Measure (FIM) (45.2, 14–63), Discharge FIM (82.2, 61–100), FIM score gain (37, 24–60), Cognitive FIM gain (7, 1–18), Mobility FIM gain (17.4, 13–20), ADL FIM gain (12.6, 4–23); acute brain injury inpatient rehabilitation facility length of stay (LOS) (17.8, 14–21 days); acute hospital LOS (15, 10–22 days). Of the five subjects, three were discharged home, one was discharged to a skilled nursing facility, and one was discharged to an assisted living facility. Subjects with WNND have significant functional decline across all FIM subcategories and may benefit from a course of brain injury-specific acute inpatient rehabilitation.

Safety, Feasibility, and Outcomes of Frequent, Long-Duration Rehabilitation in an Inpatient Rehabilitation Facility after Prolonged Hospitalization for Severe COVID-19: An Observational Study

Objectives The objective of this study was to evaluate safety, feasibility, and outcomes of 30 patients within an inpatient rehabilitation facility following hospitalization for severe COVID-19 infection. Methods This was an Observational Study of 30 patients (ages 26–80) within a large, metropolitan academic hospital following hospitalization for complications from severe COVID-19. Ninety percent of the participants required critical care and 83% required mechanical ventilation during their hospitalization. Within an inpatient rehabilitation facility and model of care, frequent, long duration rehabilitation was provided by occupational therapists, physical therapists, and speech language pathologists. Results The average inpatient rehabilitation facility length of stay was 11 days (ranging from 4–22 days). Patients averaged 165 minutes per day (ranging from 140–205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty eight of the 30 patients (93%) discharged to the community. One patient required readmission from the inpatient rehabilitation facility to the acute hospital. All 30 patients improved their functional status with inpatient rehabilitation. Conclusion In this cohort of 30 patients, inpatient rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in frequent, long duration rehabilitation with nearly all patients discharging to the community. Clinically, inpatient rehabilitation should be considered for patients with functional limitations following severe COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of inpatient rehabilitation following hospitalization for critical illness. Frequent, long duration rehabilitation shows promising potential to address functional impairments following hospitalization for severe COVID-19. Impact Statement Inpatient rehabilitation facilities should be considered as a discharge location for hospitalized survivors of COVID-19, especially severe COVID-19, with functional limitations precluding community discharge. Clinicians and administrators should consider inpatient rehabilitation and inpatient rehabilitation facilities to address the rehabilitation needs of COVID-19 and critical illness survivors.