Disclosures: James B. Meiling, DO: No financial relationships or conflicts of interest

Objective: COVID-19 tractopathy is a new diagnosis associated with a recent SARS-CoV-2 virus infection and injury to the tracts that lie within the spinal cord. Although previous case reports have described post-COVID transverse myelitis, spinal cord infarctions, and Guillain-Barre Syndrome, this is the first reported case series on rehabilitation outcomes for COVID-19 tractopathy.

Design: This retrospective case series describes four patients with COVID-19 tractopathy who received acute inpatient rehabilitation at an academic medical center in 2021. Retrospective review of medical records was performed to collect patient data.

Setting: Academic inpatient rehabilitation service

Participants: Patients with COVID-19 tractopathy who were admitted to the inpatient rehabilitation service.

Interventions: Physical therapy, occupational therapy, and medical management

Main Outcome Measures: Demographic characteristics, length of stay, discharge destination, and functional data

Results: Three male and one female patient between the ages of 56-61 years with a history of COVID-19 infection and radiographic evidence of signal change within the lateral and/or dorsal columns were admitted to acute inpatient rehabilitation. All patients presented with incomplete paraplegia. Between rehab admission and discharge, the mean improvement in lower extremity motor score (LEMS) was 9.5. No patients were functional ambulators on rehab admission; one patient was a functional ambulator at the time of discharge. Four patients experienced spasticity that required pharmacologic treatment. One patient had neurogenic bladder, managed with intermittent catheterization; three patients voided volitionally. All patients received methylprednisolone, plasmapheresis, and oral steroids prior to their rehab admission; two received rituximab, and one received IVIG. Inpatient rehabilitation length of stay ranged from 9-43 days (mean = 23.5 days). All patients were discharged to home.Conclusions: While the underlying mechanism is yet to be elucidated, in rare cases a COVID-19 infection can lead to a tractopathy, presenting as weakness, sensory deficits, spasticity, and neurogenic bladder/bowel. Patients with COVID-19 tractopathy would benefit from inpatient rehabilitation to enhance their functional mobility and independence.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/inpatient-rehabilitation-outcomes-in-patients-with-the-new-diagnosis-of-covid-19-tractopathy/