Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has now infected over a million people around the world. This pandemic is stressing intensive care unit (ICU) capacity due to critical illness from coronavirus disease 2019 (COVID-19). Survivors of critical illness from acute respiratory syndrome and the prior SARS epidemic suggest that critically ill COVID-19 survivors may experience a wide range of sequelae, resulting in long-lasting physical, cognitive, and psychological dysfunction. Early rehabilitation can mitigate these complications and improve the quality of life. However, early rehabilitation of critically ill COVID-19 patients is challenging due to patients' severity of illness, the need for strict infection control measures, staffing issues, and scarcity of personal protective equipment. During this public health emergency, navigating rehabilitation of critically ill COVID-19 patients is crucial to allow timely transition of patients across different levels of care. Such timely transitions are vital for improving outcomes and freeing ICU and hospital beds within acute care hospitals. In this review, we discuss the challenges and potential solutions for rehabilitation of critically ill COVID-19 patients throughout the continuum of care.

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in the treatment of hematologic cancers such as leukemias, lymphomas, and myeloma and for other hematologic disorders such as primary immunodeficiency, aplastic anemia, and myelodysplasia. Allo-HSCT entails a conditioning regimen of frequent high-dose chemotherapy in combination with total body irradiation, followed by infusion of donor-harvested bone marrow or peripheral blood stem cells. As an aggressive and demanding medical therapy that profoundly impacts patient quality of life (QOL), allo-HSCT is associated with numerous treatment-related physical, psychological, and psychosocial side effects. The procedure can result in decreased respiratory and balance function, skeletal muscle strength, and exercise capacity. Thus, as physical exercise has been shown to positively affect physical and psychosocial function and QOL in allo-HSCT patients, it is a recommended intervention for improving essential functions and offsetting lost exercise capacity after the procedure. Furthermore, recent evidence has shown that physical exercise can influence survival rate and mortality in allo-HSCT patients. This review provides an overview of the current research on the effectiveness of physical exercise for allo-HSCT patients.

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Since the beginning of 2020, COVID-19 infections have increased exponentially, overwhelming health-care services globally. Survivors of this infection have significant disabilities due to the debilitating weakness and compromised lung function. Unfortunately, rehabilitation services are scarce due to diversion of rehabilitation clinicians to emergency medical care. This manual aims to bridge this gap by providing a self-directed home care and graduated exercise program which does not require any special equipment. The exercises were carefully selected based on research by the authors on self-directed home exercises in frail, elderly patients.

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Objectives and Design: Prospective interventional trial. Setting: An university hospital emergency department. Patients: Two hundred consecutive persons admitted for back pain before, during, and 6 months after the process was begun. Interventions: Institution of a coordinated process of Emergency physician and patient education, standardized intake and order protocols, and rapid access to Physiatry and physical therapy. Patient characteristics, ED evaluation, ED orders, and 1-month rate of return were measured. Main Outcome Measures: Change in medication, imaging, referral to Physiatry and therapy, and 30-day readmission. Results: Most patients had red flags for danger and yellow flags for disability risk, 19-25% had objective radicular signs, and 14-24% had a second non-spinal complaint. There were no important demographic or pain characteristic changes. Compliance with study paperwork was low (20% patients, 6% physicians). There were significant increases in Physiatry and therapy referrals and a decrease in work restrictions. Medication prescriptions decreased overall, notably NSAID and diazepam prescriptions. Imaging orders did not change significantly. Return visits to the ED for back pain decreased from 16% to 4%, P = 0.02. Physician belief that patients had sciatica decreases (10% to 3%, P = 0.02), and detection of actual dangerous disease increased (3.5% to 6.5%). Conclusions: Even without full compliance with the protocol, this complex consultation process changed emergency management of back pain, most significantly by detecting more dangerous diseases, altering medication prescription habits, and decreasing return visits.

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Homer's Odyssey, one of the major Greek epic poems, tells the story of the hero Odysseus (or Ulysses in Roman versions) and his journey home to his wife Penelope. An epic poem is a long, narrative poem that is usually about heroic deeds and events that are significant to the culture of the poet. In keeping with this classic storytelling style, we describe the journey that the Upper Limb International Spasticity Study (ULIS) program has taken. The program was started in 2008 and has encountered a number of trials and obstacles along the way. This article sets out the history of development through its 10-year “Odyssey.” We use the benefit of hindsight to discuss how conducting large-scale, international observational studies can inform and influence routine practice in an area as diverse and complex as spasticity rehabilitation. We focus on the clinical pearls found within the now extensive ULIS dataset and how continually building upon the insights from each study can provide a real impetus for change.

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Physical medicine and rehabilitation (PMR) is evolving in low- to middle-income countries. Although established as a separate specialty in Bangladesh 40 years ago, there has been no formal documentation of the history and current state of PMR, or associated disability issues in Bangladesh. The aim of this review is to provide a brief overview of the health-care system in Bangladesh, to discuss the available disability statistics, legislation for persons with disability (PWD), and current system(s) of disability management in the country. The evolution of PMR is presented along with an exploration of future perspectives. Data sources included an online literature search (English language only; 1970–2018) with predefined keywords. Official government websites were examined for disability-related statistics, and informal interviews with Bangladeshi government officials and rehabilitation professionals provided further insights. The reported disability prevalence in Bangladesh varies widely from 5.6% to 16.2%. Currently, there are 130 physiatrists, and over 1400 physiotherapists, 190 occupational therapists, and 200 speech and language therapists. A developing economy, illiteracy, maldistributions of wealth, and a rising prevalence of chronic diseases add to the burden of the existing disability. Legislations have been passed with an aim to protect the rights and dignity of PWD, but there are major barriers in implementing the acts. Social stigmatization of PWD remains largely unaddressed, with low rates of community reintegration. PWD also face mobility barriers and accessibility issues. PMR and other rehabilitation services are improving, but disability management is largely considered a social issue rather than a medical problem. There is a need to involve all stakeholders in disability management to strengthen medical rehabilitation and improve service delivery, while advocating for the rights of PWD.

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The global pandemic of coronavirus (COVID-19) is a major public health issue since identified in Wuhan, China in December 2019. It creates unique challenges from the perspective of cancer survivors, as they often require complex cancer treatments during the disease trajectory, disease surveillance, and rehabilitation. Given the vulnerability of this population, there is an urgent need to address the impact of such a pandemic on cancer rehabilitation. This article presents a narrative overview of the issues highlighted for rehabilitation services providing cancer care in this context, for risk mitigation, and for continued operation during this unprecedented public health crisis.

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Platelet-rich plasma (PRP) is a regenerative therapy strategy used to address surgical wounds, dermatological conditions, and musculoskeletal conditions, such as lateral epicondylosis. However, there exists significant uncertainty and speculation about antiplatelet agents' effects on PRP and optimal approaches to cessation of agents such as aspirin prior to PRP therapy. We present a rare case report that provides an example of temporary antiplatelet agent cessation complications in the context of a PRP therapy regimen for lateral epicondylosis, which was followed by microemboli to the brain. Given Class B evidence for PRP for lateral epicondylosis, we feel that this case of a nontraumatic brain injury sequelae can present more frequently given the increased popularity of this regenerative strategy, particularly if certain precautions are not evaluated.

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Background: In December 2019, China reported a severe upper respiratory failure syndrome caused by a new virus identified as coronavirus COVID-19. Aims and Objectives: The aim of this exploratory study is to outline the current state of pulmonary rehabilitation in Latin American (LA) countries during the COVID-19 pandemic. Materials and Methods: A total of 1162 rehabilitation professionals (rehabilitation medicine specialists and residents, physiotherapists, occupational therapists, and speech therapists) from 20 countries in LA answered a 34-question online survey related to the current state of pulmonary rehabilitation in LA during the COVID-19 pandemic. Results: More than half of the professionals reported the absence of pulmonary rehabilitation services in their work centers, limited or non-existent pulmonary rehabilitation materials or equipment, and little or no training by their multidisciplinary team and themselves. Regarding COVID-19, 49.2% of the respondents indicated not receiving the necessary material for the protection against COVID-19, and more than half reported limited equipment to perform interventions in patients hospitalized by this disease, and not to have clear about the recommendations to prescribe pulmonary physiotherapy in these patients. Moreover, almost all the professionals did not feel capable of treating patients with lung disease from COVID-19 and felt anxiety doing it. Conclusion: Pulmonary rehabilitation is vital for providing optimal care for respiratory impairments, and this relationship has been magnified by the COVID-19 pandemic. This manuscript highlights the limited professional training and resource availability in LA and provides recommendations to improve the current situation.

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Introduction: Coronavirus disease 2019 (COVID-19) pandemic has affected the physical and rehabilitation medicine (PRM) specialty globally. The effects of this pandemic on PRM residents in 14 countries of the Americas are described in this study. Materials and Methods: This study is based on the international survey done by the World Youth Forum of the International Society of Physical and Rehabilitation Medicine. The cross-sectional data obtained were analyzed for a point-of-view study (August 2020). Results: PRM residents reported multiple challenges in their training program including mental health issues during the pandemic. In all the countries, there was either complete or partial closure of services provided by PRM specialists at the height of the crisis. In some areas, there was a necessity to temporarily transform the rehabilitation service into a COVID-19 unit and to assign residents to medical and intensive care units. Residency programs in 13 countries introduced virtual lectures and examinations. The duration of residency will probably increase in three countries, may not be affected in another six, and is still undetermined in five. The specialty licensing examination was temporally suspended/postponed in four countries, administered in a modified way in one, and has not been affected yet in four. Conclusion: COVID-19 pandemic adversely affected the training of PRM residents in the Americas. Despite the efforts to overcome this, the residents need more support including well-being programs. Every country and training program should continue to evolve to adapt to the crisis and anticipate additional challenges in the near future.

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Objective: There is heterogeneity in the management of spinal cord injury (SCI) patients requiring mechanical ventilation (MV). This survey's objective was to study the current practices of ventilator management and weaning in adults with SCI. Methods: We conducted a cross-sectional, self-administered global electronic survey of providers caring for adults with SCI on MV. Recruitment was accomplished through direct E-mailing, social media posting and sharing amongst qualifying providers. Respondents were divided into acute care (AC) and rehabilitation (rehab) groups based on their work setting and specialty. Results: Overall, 137 respondents with a majority from North America (50%) were included. Assist Control mode was the most frequently reported mode (33%) in AC and the rehabilitation setting (RS). Most (72%) in AC use predicted body weight (PBW) to determine the tidal volume (VT); it varies widely in the RS. The highest VT (median [interquartile range]) reported by AC was 10 (8–10) cc/kg pbw compared to 13 (10–15) cc/kg pbw (P = 0.001) in the RS. Application of positive end-expiratory pressure and keeping the tracheostomy cuff inflated are commonly reported practices in AC, whereas there is inconsistency with these practices in the RS. Regarding factors to initiate weaning, physicians in the AC mostly relied on arterial blood gas (70%) findings, whereas in the RS, physicians relied on vital capacity (73%). Conclusion: We found significant differences in practices between “AC and RS” and “within RS,” which warrants further investigation of optimal ventilator settings and weaning practices for people with SCI.

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Elective orthopedic surgeries are often deferred or declined due to concern about the patient's elevated body mass index (BMI). The study team conducted a literature review of studies focusing on the relationship between BMI and outcomes of elective orthopedic surgical procedures. The literature review found that overweight and obese patients have similar gains in function and pain reduction as do patients with normal weight, with adverse perioperative outcomes more evident in the higher levels of obesity. These data suggest a need to review the current policies concerning surgical eligibility based on BMI. These data suggest that restrictions of surgical procedures based on BMI may be too restrictive and should be revised based on the current literature.

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Spinal muscular atrophy (SMA) is an autosomal recessive disorder with symptoms of progressive skeletal muscular atrophy which requires multidisciplinary medical care. The advent of nusinersen treatment has created a paradigm shift in rehabilitation treatment for SMA. However, the principles of rehabilitation remain the same for the respiratory, musculoskeletal, gastrointestinal, and speech and nutrition care which are all required. Patient education based on multiple sources of easily available evidence-based information has improved quality of life and has changed treatment goals. Functional assessment is critical before rehabilitation is commenced. In general, SMA patients are classified as “nonsitter,” “sitter,” and “walker.” This review provides an update on rehabilitation provided in contemporary SMA centers.

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