• Because of the coronavirus epidemic, stroke survivors may not be receiving rehabilitation in time
• Rehabilitation should be started within three months of a stroke
• The pandemic has prompted professionals to deliver rehabilitation services in creative ways

Timely rehabilitation is crucial for stroke survivors, but some may not be receiving it due to the coronavirus pandemic, experts say.

Rehabilitation can help the 795 000 stroke survivors in the United States achieve the best possible recovery, according to the American Stroke Association (ASA).

That’s why it’s critical to begin rehabilitation within three months of a stroke, when the brain most quickly adapts to stroke damage and survivors are best able to learn new ways to do things.

“After a stroke, a person may need therapy to learn to walk or talk again, relearn skills needed to be independent, recover communications and cognition skills, and address other consequences of stroke,” said Dr Joel Stein, vice-chair of the ASA’s Guidelines for Adult Stroke Rehabilitation and Recovery.

Rehabilitation an important step

“Unfortunately, during the Covid-19 pandemic, some recent stroke patients may be going without rehab during this important ‘golden’ time and other survivors may also be forgoing helpful therapy,” he said in an association news release.

The pandemic has forced rehabilitation professionals to get creative to deliver services. Steps include video calls, teaming up with organisations providing in-home support, and the use of personal protective equipment for staff and patients at in-person visits.

“Rehabilitation is an important step in a stroke survivor’s recovery,” Stein said. “Knowing how important it is and how to best support someone who has recently had a stroke during the pandemic may be one of the most impactful things you can do as a caregiver.”

The association recommends that stroke survivors ask their doctor for an assessment of the physical and mental challenges they face and a plan to address each one. Patients should then work with their doctor on steps to manage risk factors to prevent another stroke. Those steps could include more physical activity, not smoking and managing blood pressure.

Stroke survivors should start rehabilitation as soon as they get the go-ahead from their medical team, the ASA said.

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• Damage to the lungs can lead to a puncture, causing lung collapse which is called a pneumothorax
• This is happening in about 1% of hospitalised Covid-19 patients
• Most younger patients with punctured lungs survive, but older patients are at greater risk

Punctured lungs occur in as many as one in 100 hospitalised Covid-19 patients, a new study finds.

Before the pandemic, this problem was typically seen in very tall young men or older patients with severe lung disease. But some British researchers noticed that several patients with Covid-19 developed the condition and decided to investigate.

“We started to see patients affected by a punctured lung, even among those who were not put on a ventilator,” said Stefan Marciniak, a professor at the University of Cambridge Institute of Medical Research.

“To see if this was a real association, I put a call out to respiratory colleagues across the UK via Twitter,” Marciniak said in a university news release. “The response was dramatic – this was clearly something that others in the field were seeing.”

Increased risk of death

The researchers noted that damage to the lungs can lead to a puncture. As air leaks out, it builds up in the space between the lung and chest, causing lung collapse. This is also called a pneumothorax.

For the study, Marciniak analysed data from 16 hospitals in Britain. He found that 0.91% of their Covid-19 patients had developed a punctured lung.

Of those patients with a punctured lung, 63% survived, but older patients had an increased risk of death. The survival rate among those younger than 70 was 71%, compared with 42% among those who were older, according to the study. The results are in the 9 September European Respiratory Journal.

Patients with abnormally acidic blood, called acidosis, also had poorer outcomes. Acidosis can result from poor lung function.

Diagnosis by chance

“Doctors need to be alert to the possibility of a punctured lung in patients with Covid-19, even in people who would not be thought to be typical at-risk patients,” Marciniak said.

“Many of the cases we reported were found incidentally – that is, their doctor had not suspected a punctured lung and the diagnosis was made by chance,” he noted.

The researchers said there are a number of ways that Covid-19 could lead to a punctured lung, including the formation of cysts in the lungs.

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