Cognitive Rehab: One Patient’s Painstaking Path Through Long Covid Therapy - The New York Times
Dec 03, 2021 4 mins, 19 secs

Samantha Lewis is relearning some basic aspects of her daily life after struggling with brain fog and other lingering symptoms for more than a year since being infected by the virus.

Samantha Lewis, who has grappled with symptoms of long Covid for over a year, practiced exercises to improve her balance during a physical therapy session at Shirley Ryan AbilityLab in Burr Ridge, Ill.Credit...

— There is sobering evidence of Samantha Lewis’s struggle with long Covid on her bathroom mirror.

Lewis, 34, has learned from “cognitive rehab,” an intensive therapy program for Covid-19 survivors whose lives have been upended by problems like brain fog, memory lapses, dizziness and debilitating fatigue.

Nearly two years into the pandemic, advances have been made in treating Covid itself, but long Covid — a constellation of lingering health problems that some patients experience — remains little understood.

While some physical symptoms of long Covid, like shortness of breath or nausea, can be addressed with medication, cognitive issues are more challenging.

“I can feel that things are off,” she told a neurologist at Northwestern Memorial Hospital’s Neuro Covid-19 Clinic in Chicago who evaluated her and recommended cognitive rehab.

There, an occupational therapist, physical therapist and speech-language pathologist gave Ms.

Studies estimate that 10 to 30 percent of coronavirus patients may develop long-term symptoms and post-Covid clinics are beginning to characterize the experience.

One year after infection, 63 percent of 156 patients at Mount Sinai Health System’s post-Covid program reported cognitive problems like trouble with short-term memory and planning.

Of more than 1,000 patients from around the country evaluated by Northwestern’s neuro-Covid clinic, many were previously multitaskers with busy jobs, said Dr.

Joshua Cahan, a cognitive neurologist at Northwestern, said.

But, he added, the cognitive symptoms have proved especially “noticeable to people who are having demanding lives.”.

Before Covid, Ms.

Lewis was an avid roller skater with the roller derby nickname “Savage Siren”; after Covid, her balance became so unsteady, she used a walker and then a cane.

Lewis said.

Lewis said, lamenting that ringing and buzzing in her ears makes sounds so painful she sometimes has to ask Mariah, who loves to talk, to be quiet.

“My cognitive stuff is a little broken,” she told Mariah.

In September, she drove Mariah to autism therapy on the wrong day.

“You’re not stupid, Mom,” Mariah said.

Lewis in late July, soon after she started cognitive rehab.

Lewis said.

Forty-two percent of the Northwestern clinic’s first 100 patients previously had depression or anxiety, though such patients might simply be more comfortable seeking neurological treatment, doctors said.

Lewis experienced depression as a teenager, was briefly diagnosed with bipolar disorder in college and has since been intermittently treated for depression and anxiety, although she wasn’t taking psychiatric medication before Covid and hasn’t needed it since, she and Dr.

Her history also included occasional asthma and possibly an underlying autoimmune condition, psoriatic arthritis, which was diagnosed after Covid, Dr.

Mariah said she asked, “Are you OK?” three times, becoming tearful, before Ms.

Two days later, a hospital found no brain injury, she said, but a doctor there suggested she see several specialists, saying her symptoms resembled those of some of his hospital’s nurses who had struggled with long Covid for months.

Lewis said.

On the cognitive assessment he administered, she scored “significantly lower than average” in processing speed, attention and executive function, he said, and barely average in the remaining category, working memory.

Lewis said, she called a camel a “desert llama” and when asked to count backward from 100 by seven, “I say 93 and I’m just stuck.”.

Biden’s winter Covid plan.

For months, many public health experts have opposed plans to roll out Covid booster shots to all adults.

He recommended cognitive rehab, writing: “I think problems with processing speed are impacting many other cognitive domains.

Doctors say that a concussion from her kitchen fall possibly made things worse, but that several of her symptoms are more consistent with long Covid.

“We think that Covid-19 is causing her cognitive ability problems, and we’ve seen that time and again in more than 800 patients,” Dr.

She kept the door open, turned on television news and eventually held sessions in the bustling physical therapy gym.

Lewis worked earnestly to arrange playing cards by suit in ascending order and flip numbers spelled with a “T,” like “two.” Simultaneously, Ms.

Since for some patients physical or cognitive exertion exacerbates symptoms, Dr.

Roth said the AbilityLab urges patients to “push themselves as much as they can, but not beyond.”.

Lewis said.

Asuncion said she was actually experiencing double vision, so the physical therapist, Adam Burns, began eye coordination exercises.

Lewis: “There has been some improvement with time, rehab therapies and medication.”

Many patients have cycles where they improve “and then they sort of level off.” Therapists recommend ending rehab when patients’ goals are met or improvement plateaus

Steven Jackson, AbilityLab’s administrative director of outpatient therapy services, said data on patients’ results was being analyzed, adding that most were “reporting improvement in their ability to function and manage daily tasks, but not necessarily complete resolution of their symptoms or deficits.”

As the October anniversary of her Covid diagnosis approached, Ms

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