177 - Inpatient Rehabilitation for Cognitive Impairment Following Major Neurosurgery and Post-Acute Sequelae of COVID-19

Case Diagnosis: 47-year-old male with persistent cognitive decline secondary to post-acute sequelae of COVID-19 (PASC) in the setting of decreased CNS reserve s/p medulloblastoma resection.

Case Description: 47-year-old male with PMHx of medulloblastoma, PASC, A. fib, HTN, and DVT/PE presented from home s/p medulloblastoma resection and chemoradiation. Patient underwent resection two years prior to admission, and COVID-19 infection/conclusion of chemoradiation occurred four months prior. Upon admission to inpatient rehabilitation (IPR), he presented with impaired attention, focus, and cognitive endurance, left upper extremity ataxia, and mild dysarthria. He ranged from max to touch assist for ADLs and dependent to partial assist for transfers and locomotion tasks. Plan focused on improving attention and cognitive processing through neurostimulant trials. Patient was initially started on modafinil, then switched to methylphenidate 5 mg BID after no significant improvements. Subsequently, speech therapists and patient both reported increased focus, and dosage was increased to 7.5 mg BID for remainder of stay. After four weeks of inpatient therapy patient improved to fully independent for most ADLs and supervision/touch assist for most transfers and locomotion tasks.

Discussions: Many sequelae or interactions of multiple sequelae can cause cognitive decline, and it is often unclear what the optimal treatment plan is for regaining cognitive function. In this case, we show that the IPR setting was an effective environment for this patient’s recovery, as it allowed for frequent progress monitoring of his medication trials while concurrently participating in intensive physical, occupational, and speech language therapy.

Conclusions: Patients with cognitive decline and complex past medical history often have many medical and rehabilitation needs that must be addressed. This case provides evidence that the IPR environment can aid such patients in achieving their functional goals and overall recovery.