Abstract
The current COVID-19 pandemic presents unprecedented new challenges to public health and medical care delivery. To control viral transmission, social distancing measures have been implemented all over the world, interrupting the access to routine medical care for many individuals with neurological diseases. Cognitive disorders are common in many neurological conditions, e.g., stroke, traumatic brain injury, Alzheimer's disease, and other types of dementia, Parkinson's disease and parkinsonian syndromes, and multiple sclerosis, and should be addressed by cognitive rehabilitation interventions. To be effective, cognitive rehabilitation programs must be intensive and prolonged over time; however, the current virus containment measures are hampering their implementation. Moreover, the reduced access to cognitive rehabilitation might worsen the relationship between the patient and the healthcare professional. Urgent measures to address issues connected to COVID-19 pandemic are, therefore, needed. Remote communication technologies are increasingly regarded as potential effective options to support health care interventions, including neurorehabilitation and cognitive rehabilitation. Among them, telemedicine, virtual reality, augmented reality, and serious games could be in the forefront of these efforts. We will briefly review current evidence-based recommendations on the efficacy of cognitive rehabilitation and offer a perspective on the role of tele- and virtual rehabilitation to achieve adequate cognitive stimulation in the era of social distancing related to COVID-19 pandemic. In particular, we will discuss issues related to their diffusion and propose a roadmap to address them. Methodological and technological improvements might lead to a paradigm shift to promote the delivery of cognitive rehabilitation to people with reduced mobility and in remote regions.
Highlights
Disorders of cognitive functions are frequent following neurological damage of different etiology, with a significant impact on independence, social relationships, school attendance, and employment opportunities, leading to reduced quality of life
Cognitive rehabilitation encompasses a wide range of therapeutic cognitive interventions to achieve functional changes by reinforcing, strengthening, or reestablishing previously learned patterns of behavior or establishing new patterns of cognitive activity or mechanisms to compensate for impaired neurological systems [1]
The current health system contingency due to the COVID-19 pandemic requires an acceleration in the use of telemedicine to enable cognitive neurorehabilitation outside the traditional settings and in an ecologic environment
Summary
Disorders of cognitive functions (language, perception, attention, memory, executive functions, and praxis) are frequent following neurological damage of different etiology, with a significant impact on independence, social relationships, school attendance, and employment opportunities, leading to reduced quality of life. Cognitive rehabilitation encompasses a wide range of therapeutic cognitive interventions to achieve functional changes by reinforcing, strengthening, or reestablishing previously learned patterns of behavior or establishing new patterns of cognitive activity or mechanisms to compensate for impaired neurological systems [1] These interventions are based on psychological theories and models of behavior and behavioral change and on neuropsychological models of brain–behavior interactions [2, 3], and can be conducted with paper–pencil tools, computer programs, or, more recently, virtual reality (VR). In the absence of an effective treatment against SARSCoV-2, the outbreak containment strategies mainly rely on hygienic measures, extraordinary sanitization, and reduction of interpersonal contacts through social distancing and quarantine for infected people and their contacts [14] In this scenario, healthcare systems need to reorganize quickly and deeply both in the wards hosting COVID-19 patients and in the services for patients with chronic diseases. Employs wearable devices Allows the adaptation to patient’s performance High patient engagement Available for home-delivered care
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