Neurorehabilitation of Post-acute COVID Syndrome and Functional Neurologic Disorder: A Scoping Review and Treatment Recommendations

Research Objectives: To investigate current knowledge and understanding of neurorehabilitation in patients diagnosed with post-acute COVID syndrome (PACS) and functional neurologic disorders (FND), to summarize treatment recommendations and knowledge gaps toward the advancement of research.

Design: PubMed and Google Scholar were searched on 26 July 2024 with the following search terms: 'neurorehabilitation' OR 'rehabilitation' AND 'functional neurologic disorder' OR 'functional movement disorder' AND ‘post-acute covid’ OR 'post-covid' OR ‘long covid’ OR ‘long-haul covid’ OR ‘long-hauler covid’ OR ‘chronic covid’ OR ‘prolonged covid’. Reference lists of selected articles were also hand-searched. Inclusion criteria were articles published in the English language; PASC (or equivalent term reflecting persistent symptoms following a COVID-19 infection); report of at least one neurological symptom. Only articles published in academic journals in English were retrieved.

Setting: Settings captured in the review include primary care, medical centers, and ambulatory or hospitalized care.

Participants: Scoping review of findings ranging from multicenter cohorts (e.g., n = 1865) to case series.

Interventions: Recommended interventions in neurorehabilitation and psychotherapy (e.g., CBT) in concert with physical, occupational, and speech therapy.

Main Outcome Measures: Findings and recommendations in neurorehabilitation to improve neurocognitive, psychological, functional ADLs, and QoL among individuals diagnosed with PACS and functional neurological disorder.

Results: This scoping review was unable to identify research studies specifically addressing neurorehabilitation for populations co-diagnosed with PACS and FND. As such, a recommendation is to build on the burgeoning literature base of all rehabilitation efforts in PACS (i.e., neuropsychology, PT, OT, SLT). Evidence-based neurorehabilitation interventions include neurofatigue pacing, executive functioning training, mood management techniques (e.g., behavioral activation, self-soothing, and cognitive restructuring), and coping strategies (e.g., acceptance and commitment therapy). There are also promising clinical trials underway, such as the NIH RECOVER-NEURO trial, which is testing a web-based brain training program called BrainHQ.

Conclusions: Studies suggest FND is rarely a diagnostic consideration among patients with PACS. Challenges and inconsistencies among research studies may reflect methodological differences, as well as intermittent course and fluctuating severity among FND and PACS symptomatology.

Current findings underscore the urgent need for research in PACS, separately and in tandem with FND. Future investigations should strive for uniform methodologies in clarifying pathophysiological mechanisms specific to PACS, given the limited progress in understanding FND. Further research and replication studies in neuropsychological assessment of PACS are also needed, as neuropsychological profiles of PACS phenotypes serve to inform diagnostic clarification and neurorehabilitation efforts.

Author(s) Disclosures: The author reports no conflicts of interest. There was no specific funding involved in this review.