Acute Rehabilitation of a Patient With COVID-19 Myocarditis: A Case Report

Objective. The purpose of this case report is to describe the acute rehabilitation of an individual with severe COVID-19 complicated by myocarditis, focusing on both facility-wide and patient-specific strategies. Methods. A 50-year-old male presented to the emergency department with progressive dyspnea and confirmed COVID-19. He developed hypoxic respiratory failure and heart failure requiring prolonged mechanical ventilation. Mobility was limited by severe impairments in strength, endurance, balance, and cognition. The referral, screening, and rehabilitation of this patient were guided by a COVID-19 Service Delivery Plan designed to maximize the effectiveness and efficiency of care delivery while minimizing staff exposure to the virus. Coordinated physical and occupational therapy sessions focused on progressive mobility and cognitive retraining. Progress was monitored using a series of standardized outcome measures, including the Activity Measure for Post-Acute Care, Timed Up and Go test, and the Saint Louis University Mental Status examination. Results. Rehabilitation was initiated on day 18, and the patient participated in 19 treatment sessions, each approximately 30 minutes, over the remaining 30 days of his hospital stay. His Activity Measure for Post-Acute Care mobility and function scores both improved from 100% to 0% disability, he experienced substantial improvements in both Timed Up and Go (Delta = 4.2 seconds) and Saint Louis University Mental Status (discharge score = 25). There were no adverse events. He was discharged to home with his family and home rehabilitation services. Conclusion. COVID-19 contributed to severe declines in mobility and function in this middle-aged man. He experienced substantial gains in his function, mobility, and cognition during his in-hospital rehabilitation, which was guided by a facility-wide plan to prevent virus transmission. Impact. The rehabilitation of individuals with severe COVID-19 presents significant challenges, both at the level of the individual patient and the whole facility. This report describes clinical decision-making required to manage these individuals in the setting of a global pandemic.