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A new study published in the Journal of NeuroEngineering and Rehabilitation identified the cause of — and hope for the potential prevention of — nerve injuries in patients treated in the intensive care unit for severe COVID-19.
The study’s lead author, Colin Franz, MD, PhD, physician-scientist, said the research identified two novel findings: first, it implicated both “mechanical loads” (stress-caused compression and stretching) and COVID-19 as the causes of the nerve injuries; and second, it identified the possibility of using wireless sensors to detect and prevent similar injuries among patients in the ICU.
Other current Shirley Ryan AbilityLab clinicians who co-authored the study are Dom D’Andrea, laboratory technician; Leslie Rydberg, MD, attending physician and Henry and Monika Betts Medical Student Education Chair; and R. James Cotton, MD, PhD, physician-scientist. Additionally, a pair of 2021 graduates from the Shirley Ryan AbilityLab residency program — Ellen Farr, MD (now a physical medicine and rehabilitation specialist at the Mayo Clinic) and Ross Malik, MD (now an attending physician at Mass General Brigham in Boston) —were instrumental contributors and co-authors on the study.
The team’s innovative research built on a 2020 quality improvement study (authored by Dr. Malik with other Shirley Ryan AbilityLab collaborators) that identified surprisingly high rates of nerve injuries in patients in the ICU with severe COVID-19. This study identified nerve injury “hot spots”: the 6 out of 20 locations on the body that accounted for more than 80% of all nerve injuries in patients with severe COVID-19. With this data, they provided best practices for positioning to prevent those nerve injuries from occurring in places like knees and elbows.
After further research by research teams at other institutions confirmed a link between COVID-19 and nerve damage, Dr. Franz and his collaborators sought to expand their scope.
“This follow-up study — a multicenter effort between researchers at Shirley Ryan AbilityLab, Marianjoy and Northwestern University — is the largest single study of its kind. We looked at 34 new cases and re-analyzed another 58 patients from published case reports,” he said.
Their findings show that both severe COVID-19 infection and ICU treatments and positioning are the main factors behind these nerve injuries.
“Based on the locations and clinical patterns we discovered, we hypothesized that most of the nerve injuries occurred from mechanical loads in these patients who were unusually susceptible to nerve damage,” said Dr. Franz. “Nerve injuries were more than 10 times more likely to occur in these patients with severe COVID than in non-COVID inpatient rehabilitation patients.”
Dr. Franz said the new research also provides “proof of concept” for the use of wireless sensors for real-time monitoring of patients to prevent nerve injuries from even occurring. (Prevention, Dr. Franz said, is especially important because healing from nerve damage can take as long as two years and most often results in permanent impairments.)
“The answer to ‘when’ use of wireless sensors will be used in practice depends more on industry partnership and healthcare policy than on our preclinical science,” he said. “For example, we track pressure injuries to skin acquired in hospitals so there’s a lot of clinical effort and technology deployed to prevent them. However, mechanical nerve injuries are not well monitored or tabulated as a matter of routine clinical care, so the first step to implementation of this technology is for healthcare systems and policy makers to recognize the issue.”
