Barriers leading to increased disability in neurologically challenged populations during COVID-19 pandemic: a scoping review

The objective of this scoping review was to get an overview of barriers emerging across the globe from the pandemic that are likely to increase the level of pre-existing disability status of neurologically challenged populations. Database searches (PubMed/MEDLINE, CINAHL, ProQuest, Ovid, Scopus, and Web of Science) updated to December 2020 were conducted. Articles that identified challenges or barriers to neuro-rehabilitation, impact on disability status and health care services were included. Full-text articles limited to the English language with no restrictions on study design were included. Data was synthesized based on recurrent themes that were identified. Thirty-seven studies were included in this review. Neurological populations considered: stroke, multiple sclerosis, amyotrophic lateral sclerosis, parkinson’s disease, autism, developmental disabilities, and those who required neurosurgical care. Barriers were grouped into categories as increased disease risk and complications, delayed or restricted access to neuro-rehabilitation, limited hospital access, telerehabilitation limitations, and shutdown of special centers of aid. COVID-19 pandemic has given rise to barriers that affect almost every aspect of healthcare and rehabilitation in neurologically challenged populations prompting an increase in their disability level. This can assist policymakers in designing mitigation strategies to minimize the detrimental effects on this vulnerable population.Implications for rehabilitationPandemic has led to the worsening of existing motor and non-motor symptoms, which need to be monitored, assessed and managed medically, and through rehabilitation in neurologically challenged populations.Notable decline of cognition and physical activity in neurologically challenged populations needs to be assessed and efforts to reverse these outcomes should be attempted.Rehabilitation services, hospital care and centers of aid need to be made more accessible for neurologically challenged populations with COVID-19 precautionary measures.Telemedicine and telerehabilitation need to be upgraded to enhance further face to face like interactions and for tracking of progressive disease. Pandemic has led to the worsening of existing motor and non-motor symptoms, which need to be monitored, assessed and managed medically, and through rehabilitation in neurologically challenged populations. Notable decline of cognition and physical activity in neurologically challenged populations needs to be assessed and efforts to reverse these outcomes should be attempted. Rehabilitation services, hospital care and centers of aid need to be made more accessible for neurologically challenged populations with COVID-19 precautionary measures. Telemedicine and telerehabilitation need to be upgraded to enhance further face to face like interactions and for tracking of progressive disease.

本范围综述（scoping review）的目标是全面梳理全球范围内新冠疫情期间涌现的各类障碍，这些障碍可能会加重神经功能障碍人群（neurologically challenged populations）原有的残疾程度。研究检索了截至2020年12月更新的PubMed/MEDLINE、CINAHL、ProQuest、Ovid、Scopus及Web of Science数据库。纳入探讨神经康复（neuro-rehabilitation）所面临的挑战或障碍、对残疾程度及医疗服务产生影响的文献，且仅纳入英文全文文献，研究设计无任何限制。研究基于识别出的核心主题进行数据综合。本综述共纳入37项研究。所涉及的神经功能障碍人群包括脑卒中、多发性硬化症、肌萎缩侧索硬化症、帕金森病、孤独症、发育障碍患者，以及需接受神经外科治疗的人群。研究将各类障碍归纳为以下类别：疾病风险与并发症升高、神经康复服务延迟或受限、医院就医渠道有限、远程康复（telerehabilitation）存在局限，以及特殊援助中心关停。新冠疫情所催生的障碍几乎波及神经功能障碍人群的医疗与康复服务的各个层面，导致其残疾程度进一步加重。该综述可为政策制定者制定缓解策略、减轻这一脆弱群体所受的不利影响提供参考。

【康复领域启示】
疫情加重了神经功能障碍人群现有的运动与非运动症状，需对其进行监测、评估，并通过医疗手段与康复干预进行管理。神经功能障碍人群的认知水平与身体活动水平出现显著下降，需对该情况进行评估，并尝试采取措施逆转这一不良结局。需结合新冠疫情防控措施，提升神经功能障碍人群可及的康复服务、医院诊疗及援助中心资源。需升级远程医疗（telemedicine）与远程康复服务，以进一步增强类面对面交互效果，并用于追踪病情进展。
疫情加重了神经功能障碍人群现有的运动与非运动症状，需对其进行监测、评估，并通过医疗手段与康复干预进行管理。神经功能障碍人群的认知水平与身体活动水平出现显著下降，需对该情况进行评估，并尝试采取措施逆转这一不良结局。需结合新冠疫情防控措施，提升神经功能障碍人群可及的康复服务、医院诊疗及援助中心资源。需升级远程医疗（telemedicine）与远程康复服务，以进一步增强类面对面交互效果，并用于追踪病情进展。