Early Intensive Rehabilitation for Post-COVID-19 Neurological Sequelae

Case Diagnosis: A 52-year-old male with severe post-COVID-19 polyneuropathy and dysautonomia who underwent early intensive neurorehabilitation with significant functional recovery.

Case Description or Program Description: After 32 days of ICU care with intubation and ECMO support, the patient developed severe neuromuscular weakness, dysautonomia (POTS-like symptoms), and cognitive deficits. He underwent 10 weeks of intensive rehabilitation, including neuromuscular re-education, autonomic training, and cognitive therapy, leading to functional gains and improved independence.

Setting: Rehabilitation took place in an inpatient neurorehabilitation center, followed by home-based telerehabilitation with telemonitoring for autonomic dysfunction and a structured progressive exercise program.

Assessment/Results: Functional Independence Measure (FIM) improved from 60 to 105. Orthostatic intolerance resolved, and MoCA score increased from 18 to 25. Patient reported increased energy and mobility with no adverse events. Gains were maintained at 6-month follow-up, indicating sustained neurological and autonomic recovery.

Discussion (relevance): Post-COVID neurological dysfunction presents unique rehabilitation challenges, requiring a multidisciplinary approach. This case highlights the effectiveness of early, high-intensity rehabilitation in improving functional independence and autonomic stability. It also emphasizes PM&R’s critical role in post-viral recovery, addressing long-term neurological and autonomic sequelae.

Conclusions: Early intensive rehabilitation significantly improved neuromuscular and autonomic function in a severe post-COVID-19 case. Findings support structured rehab protocols for post-viral syndromes, emphasizing PM&R’s essential role in long-term neurological recovery.