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COVID-19 pandemic is rapidly spreading all over the world, creating the risk for an healthcare collapse. While acute care and intensive care units are the main pillars of the early response to the disease, rehabilitative medicine should play an important part in allowing COVID-19 survivors to reduce disability and optimize the function of acute hospital setting. To share the experience and the international perspective of different rehabilitation centers, treating COVID-19 survivors. Not applicable. COVID-19 survivors. A group of Physical Medicine & Rehabilitation specialists from eleven different countries in Europe and North America have shared their clinical experience in dealing with COVID-19 survivors and how they have managed the re-organization of rehabilitation services. In our experience the most important sequelae of severe and critical forms of COVID-19 are: 1) respiratory; 2) cognitive, central and peipheral nervous system; 3) deconditioning; 4) critical illness related myopathy and neuropathy; 5) dysphagia; 6) joint stiffness and pain; 7) psychiatric. We analyze all these consequences and propose some practical treatment options, based on current evidence and clinical experience, as well as several suggestions for management of rehabilitation services and patients with suspected or confirmed infection by SARS-CoV-2. COVID-19 survivors have some specific rehabilitation needs. Experience from other centers may help colleagues in organizing their services and providing better care to their patients.

Introduction: Botulinum toxin is considered a first-line treatment for focal spasticity after stroke, and its peripheral effects have been well documented. We set out to demonstrate and describe any effects it may have in the central nervous system, using fMRI to record brain activation patterns before and after its administration. Materials and Methods: 17 subjects comprising 7 ischemic stroke patients affected by upper limb spastic hemiplegia, and 10 healthy controls were recruited and underwent three fMRI scans while performing a motor imagery task (finger tapping). Test subjects underwent fMRI before botulinum toxin therapy (T0), 4 weeks later (T1), and after 8 weeks (T2), and untreated control subjects were tested at 0, 4 and 8 weeks. The finger-tapping task was performed twice each session in both groups. Both test and control subjects performed only daily passive muscle stretching exercises between T0, T1, and T2 MR scans. Results: fMRI confirmed the technical feasibility of the “motor imagery” paradigm in activating the motor areas in healthy subjects. While second-level analysis of the control group showed no modification in the pattern of brain activation during the finger-tapping imagery task between T0, T1, and T2, increasing focalization of mean brain activation, accompanied by a gradual reduction in secondary motor area activation after treatment (SMA and Brodmann 6) in the test group. Conclusions: This confirms the efficacy of motor imagery as an fMRI paradigm to open a “window” into the brain that enables us to study the processes of motor function recovery after stroke in vivo. Our data show that peripheral injection of botulinum toxin alone brings about a progressive alteration in the reorganization of cortical activation after stroke, thereby confirming its therapeutic and central effects. The progressive reduction and greater focalization of activation seen continued over time, in line with the latest “small world network” theories on cortical and subcortical reorganization of cerebral functions after stroke.

A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis(1,2). Here, we restored this communication with a digital bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals(3) and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking(4-6). A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.