Neurorehabilitation of severe acquired brain injury in the time of COVID-19: impact of the absence of caregivers



Introduction. During the COVID-19 pandemic, several restrictions were imposed to limit the circulation of the infection within communities. Hospitals denied access to the family and friends of inpatients, and thus to caregivers. This observational study evaluated the impact of the physical absence of caregivers during the lockdown period due to the COVID-19 emergency on the neurorehabilitation of inpatients with severe acquired brain injury (sABI).

Methods. The functional outcome at discharge was measured in 25 inpatients with sABI through the DRS, GOS, and LCF standard scales after neuropsychological rehabilitation in an Adult Inpatient Neurorehabilitation Unit for Post-coma. Fourteen patients were directly assisted by their informal caregivers physically present in the neurorehabilitation ward. Eleven patients were indirectly supported via remote connection because during the lockdown period (from March to July 2020) caregivers could not be admitted to the rehabilitation hospital. The Caregiving Impact on Neuro-Rehabilitation Scale was also used to evaluate both the change since the admission and the impact of the caregiver from the perspective of the cognitive therapist. Demographic characteristics, time since injury, injury severity (duration of impaired consciousness measured by the time to follow commands), level of functioning at the beginning of the neurorehabilitation, and duration of the neurorehabilitation treatment were comparable between the groups.

Results. Both groups improved after the treatment; however, the improvement was consistently greater in the group directly assisted by the caregivers. The results showed that although the caregivers ensured their virtual presence at distance, their physical absence played a role in hindering the functional outcome of the patients.

Conclusions. The role of the caregiver of patients with sABI is underlined in being not only a person handing out generic aid, cares, and affection, but also an integral part of the neurorehabilitation process.


Keywords: Brain injuries, Neurorehabilitation, Informal caregivers, COVID-19 pandemic, SARS-CoV-2, Lockdown


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Maria De Luca - IRCCS Fondazione Santa Lucia

Valentina Bandiera

Elena D'Aviero

Benedetta Onofri

Fabiana Mungiello

Giulia Ferri

Manuela Iannetti

Susanna Lucatello

Rita Formisano

Umberto Bivona

How to Cite
De Luca, M., Bandiera, V., D'Aviero, E., Onofri, B. ., Mungiello, F. ., Ferri, G., … Bivona, U. (2022). Neurorehabilitation of severe acquired brain injury in the time of COVID-19: impact of the absence of caregivers. Annali dell’Istituto Superiore Di Sanità, 58(4), 236–243. Retrieved from
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