This article explores affectivity, temporality, and their interrelation in patients who contracted COVID-19 during the first wave of the pandemic in Sweden and with symptoms indicative of post-COVID-19 Condition (PCC) that remained one year after the infection. It offers a qualitative phenomenological philosophy analysis, showing how being ill with acute COVID-19 and with symptoms indicative of PCC can entail a radically altered self-world relation. We identify two examples of pre-intentional (existential) feelings: that of listlessness and that of not being able to sense what is real and not real, both of which, in different ways, imply a changed self-world relation. We offer an analysis of intentional feelings: how the fear of not “returning” to one’s previous self and the hope of such a return weave together the present and the absent, as well as the past and the future, in ways that make the future appear as constricted, disquieting, or lost. We argue that a phenomenological differentiation among experiences of living with symptoms indicative of PCC—through attention to the way intentional affectivity and pre-intentional affectivity help shape the embodied self’s attunement to the world—is apt to yield a better understanding of the variations within these experiences and contribute to clinical practice.

Post COVID-19 Condition (PCC) is a complex condition presenting significant challenges for patients. Individuals suffering from severe PCC are often assessed in rehabilitation medicine departments or specialized post-COVID centres, where their condition is evaluated using the International Classification of Functioning, Disability and Health (ICF). The ICF framework primarily focuses on functional impairments, disabilities, and restrictions in participation, with an emphasis on the concept of “functioning.” However, a critical question remains: how does this notion of functioning relate to the well-being of these individuals? This paper explores this issue by examining three fictionalized but typical case studies of PCC patients in relation to two distinct theoretical approaches. First, we engage with theories about well-being from the philosophy of well-being emphasizing the individual’s perspective. Second, we explore relational approaches in bioethics and their theoretical underpinnings, which emphasize how people are situated, considering context and relations rather than purely individual conditions. The paper highlights the potential tensions between these approaches while arguing that a more comprehensive understanding of well-being can emerge by integrating insights from both traditions. Through the examination of PCC patient cases, we propose that well-being can be better understood when approached from multiple angles, enriching the understanding of patient outcomes in rehabilitation medicine. 

There is mounting evidence of the long-term effects of COVID-19 on the central nervous system, with patients experiencing diverse symptoms, often suggesting brain involvement. Conventional brain MRI of these patients shows unspecific patterns, with no clear connection of the symptomatology to brain tissue abnormalities, whereas diffusion tensor studies and volumetric analyses detect measurable changes in the brain after COVID-19. Diffusion MRI exploits the random motion of water molecules to achieve unique sensitivity to structures at the microscopic level, and new sequences employing generalized diffusion encoding provide structural information which are sensitive to intravoxel features. In this observational study, a total of 32 persons were investigated: 16 patients previously hospitalized for COVID-19 with persisting symptoms of post-COVID condition (mean age 60 years: range 41–79, all male) at 7-month follow-up and 16 matched controls, not previously hospitalized for COVID-19, with no post-COVID symptoms (mean age 58 years, range 46–69, 11 males). Standard MRI and generalized diffusion encoding MRI were employed to examine the brain white matter of the subjects. To detect possible group differences, several tissue microstructure descriptors obtainable with the employed diffusion sequence, the fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity, microscopic anisotropy, orientational coherence (Cc) and variance in compartment’s size (CMD) were analysed using the tract-based spatial statistics framework. The tract-based spatial statistics analysis showed widespread statistically significant differences (P < 0.05, corrected for multiple comparisons using the familywise error rate) in all the considered metrics in the white matter of the patients compared to the controls. Fractional anisotropy, microscopic anisotropy and Cc were lower in the patient group, while axial diffusivity, radial diffusivity, mean diffusivity and CMD were higher. Significant changes in fractional anisotropy, microscopic anisotropy and CMD affected approximately half of the analysed white matter voxels located across all brain lobes, while changes in Cc were mainly found in the occipital parts of the brain. Given the predominant alteration in microscopic anisotropy compared to Cc, the observed changes in diffusion anisotropy are mostly due to loss of local anisotropy, possibly connected to axonal damage, rather than white matter fibre coherence disruption. The increase in radial diffusivity is indicative of demyelination, while the changes in mean diffusivity and CMD are compatible with vasogenic oedema. In summary, these widespread alterations of white matter microstructure are indicative of vasogenic oedema, demyelination and axonal damage. These changes might be a contributing factor to the diversity of central nervous system symptoms that many patients experience after COVID-19.

OBJECTIVE: To report vision-related symptoms and neuro-visual clinical signs in patients approximately 4 months after discharge from hospitalization after COVID-19 infection. To report on coexisting functional and activity limitations.

DESIGN: The study is part of an ambidirectional population-based cohort study.

SETTING: An outpatient setting in a hospital environment.

PARTICIPANTS: Patients from a population-based cohort study including all patients with laboratory-confirmed COVID-19 admitted to hospital during a 3-month period in a health care region in Sweden. Among patients who, based on a standardized telephone interview, were identified as having persisting rehabilitation needs 4 months after discharge (n=185), several (n=57) reported vision-related symptoms. All 57 patients were invited to a neuro-visual examination. Six patients declined, 6 were unavailable, and 3 did not fulfil the inclusion criteria. Thus, 42 patients were included in the analysis (N=42).

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Vision-related symptoms, neuro-visual function, and coexisting impairments affecting activities of daily life and participation.

RESULTS: A total of 31% of patients with rehabilitation needs after COVID-19 reported vision-related symptoms. Reading-related issues (73.8%), blurry vision (69.0%), and light sensitivity (66.7%) were the most common symptoms. Patients with reading-related issues showed a higher level of eye strain (P<.001). Neuro-visual deficits were found in 83.3% of the patients, mainly concerning eye teaming (23.1%-66.7%) and eye movement (28.6%-30.8%) functions. Patients with vision-related symptoms reported fatigue and 18 other coexisting symptoms to a greater extent (P≤.0001 to .049).

CONCLUSIONS: Neuro-visual symptoms and signs should be considered when assessing rehabilitation needs after COVID-19. The association between vision-related issues and coexisting symptoms with an effect on body function and activity and/or participation underlines the need for multiprofessional rehabilitation assessment and intervention.

OBJECTIVES: To assess the prevalence of residual trans-lesion connectivity in persons with chronic clinically complete spinal cord injury (discompleteness) by neurophysiological methods.

PARTICIPANTS: A total of 23 adults with chronic sensorimotor complete spinal cord injury, identified through regional registries the regional spinal cord registry of Östergötland, Sweden.

METHODS: Diagnosis of clinically complete spinal cord injury was verified by standardized neurological examination. Then, a neurophysiological examination was performed, comprising electroneurography, electromyography, sympathetic skin response and evoked potentials (sensory, laser and motor). Based on this assessment, a composite outcome measure, indicating either strong, possible or no evidence of discomplete spinal cord injury, was formed.

RESULTS: Strong neurophysiological evidence of discomplete spinal cord injury was found in 17% (4/23) of participants. If also accepting "possible evidence", the discomplete group comprised 39% (9/23). The remaining 61% showed no neurophysiological evidence of discompleteness. However, if also counting reports of subjective sensation elicited during neurophysiological testing in the absence of objective findings, 52% (12/23) showed indication of discomplete spinal cord injury.

CONCLUSION: Evidence of discomplete spinal cord injury can be demonstrated using standard neurophysiological techniques in a substantial subset of individuals with clinically complete spinal cord injury. This study adds to the evidence base indicating the potential of various modes of cross-lesional sensorimotor functional restoration in some cases of chronic clinically complete spinal cord injury.

Spinal cord injury (SCI) challenges many aspects of life. Common secondary health conditions are sensorimotor impairments, autonomic dysfunction affecting bowel, bladder, sexual and cardiovascular function, pressure ulcers, pulmonary dysfunction, pain and psychological distress. Primary rehabilitation and lifelong follow-up from a specialized interdisciplinary rehabilitation team is needed to attain and maintain maximum functioning and participation in all aspects of life, and to reduce the risk of complications in the acute and chronic phases after SCI. Most of the almost 300 people who sustain a SCI in Sweden each year can today be expected to live long lives. However, the growing population of people aging with long-term SCI and the increasing number of older adults sustaining an SCI are major challenges for the health care system.  Important research areas are improved neurological diagnostics, regenerative research and long-term consequences of aging with SCI.

Ryggmärgsskador är ovanliga och mångfasetterade och påverkar flera organsystem.

Vanliga följdtillstånd är sensomotorisk funktionsnedsättning, autonom dysfunktion med påverkan på tarm-, blås-, sexual- och kardiovaskulär funktion, nedsatt andningsfunktion, smärttillstånd och psykologiskareaktioner.

Interdisciplinär teamrehabilitering medför att personer med ryggmärgsskada kan leva ett rikt och aktivt liv utifrån förutsättningarna som skadan innebär.

Utmaningar för vården är att allt fler äldre drabbasoch den växande population som åldras med skadan.

Viktiga forskningsområden rör förbättrad neurologiskdiagnostik, regenerativ forskning och långsiktiga konsekvenser av att leva med en ryggmärgsskada.

Background: Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic "Rehab-Compass," a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients rehabilitation needs in clinical practice. Methods: A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-Compass (TM) was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross sectional study with 48 patients at 5-month follow-ups after subarachnoid hemorrhage. Results: The Rehab-Compass (TM) identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-Compass (TM) appeared to be feasible and time efficient in clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-Compass (TM) graph. In the studied stroke patients, the Rehab-Compass (TM) identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems. Conclusions: The graphic Rehab-Compass (TM) seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-Compass (TM) more concise and evaluate the instrument among different stroke subgroups.

Objective: To explore self-reported health problems and functional goals in community-dwelling individuals with spinal cord injury in Sweden. Design: Cross-sectional descriptive study that used a survey designed by an experienced peer mentor with spinal cord injury. Subjects: Community-dwelling individuals with spinal cord injury from Sweden. Methods: The survey was distributed online by the community peer-based organization RG Active Rehabilitation. Results: A total of 203 individuals (55% males, 90% acquired spinal cord injury) from all regions in Sweden completed the survey. Of these, 33% reported living with amp;gt; 2 unbearable physical or psychological problems. While some problems (e.g. problems related to bladder and balance) were consistently ranked to be common across all years since injury and type of spinal cord injury, distribution of some other unbearable problems (e.g. type of pain, excessive weight) varied between subgroups. Years since injury, level of acquired spinal cord injury and sex, but not age-group or type of spinal cord injury, explained some of the variation in the goals. Conclusion: The high proportion of reported "unbearable" problems point to the stronger need for systematic, comprehensive, life-long, multi-disciplinary follow-up for people with spinal cord injury. The high rate of goals related to improving strength and fitness across all participants independently of their characteristics highlight the important role of community organizations that offer such lifetime services.

[No abstract available]