Gait analysis of a patient with severe motor impairment post- intensive care due to COVID-19: 1 year follow up and physical therapy

Abstract

Introduction: Viral infections, such as infection by SARS-CoV-2, can affect gait biomechanics, but this effect can be overlapped by consequences of critical illness and time in intensive care unit. Objective: To report biomechanical alterations during the clinical evolution of a post-COVID-19 patient who presented severe motor impairment after intensive care. Methods: Data was collected from the patient’s chart at José Silveira Foundation and previous medical reports from the hospitalization period. The patient was wheelchair bound, with physiotherapy twice a week, and by the end of 1-year follow-up was able to walk independently. Three-dimensional gait analysis with kinetics and electromyography were conducted at three time points. Results: All spatiotemporal gait parameters, kinematic, kinetic and electromyographic data was importantly altered when compared to the normal range of values. With physiotherapy, gait quality indicators showed important improvements and all muscles presented a significant increase in the magnitude of the electromyographic signal (at least a two-fold increase). Trunk kinematic alterations decreased significantly during this period. Kinetic and kinematic changes perceived in the hips, knees and ankles showed approximation to the expected pattern, however still without normalizing, and patient's muscle coordination improved over time. Conclusion: This report has great clinical importance, as it describes, using an instrumented gait laboratory, the evolution of a patient with severe motor impairment post intensive care due to COVID-19, a condition in lack of description in the literature, which will help health professionals in the planning of rehabilitation strategies.