COVID-19 AND BRAIN INJURY - AN INFORMATIONAL SERIES

The contents of this page are for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding this or any other medical condition.

Steven Flanagan, M.D.

Howard A. Rusk Professor and Chair of Rehabilitation Medicine,
NYU Robert I. Grossman School of Medicine
Medical Director, Rusk Rehabilitation, New York University Langone Health

My family member is no longer receiving his/her regular schedule of therapy. We are very worried that long term outcome will be negatively impacted. How concerned should we be and how can we prevent regression during this time?

A good approach to take is to speak to your family member’s therapist and physician for guidance.  Recommendations for exercises at home along with other advice will help mitigate the effects of postponing therapy. 

We have always visited our family member frequently in the rehab facility and visitation is no longer allowed. I am very concerned about his/her physical and emotional wellbeing. How concerned should I be and how can I reassure both the patient and my family? 

Support of loved ones is invaluable during times of stress.  But these are extraordinary times that require equally extraordinary measures. Staying in touch and being supportive comes in many venues: phone calls, skype, video calls, etc.  It also important to appreciate the value of not adding the risk of additional Covid exposure by visiting your loved one while they are medically vulnerable. 

My family member has a range of deficits, not including respiratory, from a brain injury a few years ago. As a brain injury survivor, is he/she more susceptible to a severe case of COVID-19 or is the risk the same as the general population? 

This is a very good question with the answer being specific to any one person’s situation.  Being less physically active and other brain injury related problems can put some people at higher risk for other medical problems like heart and lung disease.  Those can make people more susceptible.  Practicing physical isolation , avoiding ”face to face” gatherings with anyone outside of those you live with, regular handwashing, avoiding touching your face, etc will help mitigate the spread of Covid and lessen the chance you or your loved one will contract it.

Our family member is in an inpatient rehab facility and we are very worried about transmission of COVID-19. What extra precautions are being taken? 

Health care personnel are on the front lines of both treating people with COVID and preventing its spread.  Every unit in every hospital in the region is taking extraordinary precautions to protect their patients as well as themselves. Infection control measures, while always in effect, are at its highest level of enforcement during this time.   

My family member takes multiple medications since his/her stroke two years ago. Are there any medications that I should speak to my doctor about to find out if they should be stopped or adjusted because of the possibility of complications were he/she to contract COVID-19? 

Everyone should take their medicines as prescribed by their physician.  Therefore don’t stop a medication out fear or concern regarding Covid unless directed by your physician.  If anyone has concerns that a specific medication may impair a person’s immune system, it is reasonable to communicate with your physician to understand the rationale of using the medication and to ask questions.  The only bad question is the one you don’t ask.

David J. Biderman, PhD

Supervisor of Psychology
Brain Injury Day Treatment Program
Rusk Rehabilitation - NYU Langone Health

My family member is not receiving the usual cognitive therapy. We are really worried this will impact the long term prognosis. How long can a person go without therapy before it impacts outcome? How can we prevent regression during this time?

Please don’t worry if cognitive and/or psychological treatment has been interrupted. Research and clinical experience have shown that as long as the individual with the brain injury is interested in picking things up where they left off, there will be no long-term impact on the person’s recovery.  

In fact, many professionals are gearing up (some are ready now) to provide the same services through video telehealth.  For the individual and family at home, a computer with webcam or smartphone or IPad type device, and a private space is all that is needed to continue treatments.  Make sure to have somebody tech-savvy on hand to test the system, as well as the first time it’s used, for tech support.

To prevent moving backward, contact the professional/s you have been working with and ask them to create a single page sheet with reminders of do’s and don’ts to practice in the meantime.  The main care giver should ask the family member with the brain injury how best to remind them (what words to use) to look at the page and read it and keep practicing, with the goal of helping them get better according to their wishes.

My family member has cognitive deficits and is constantly asking why there is no therapy, why he/she cannot leave the house etc. How can we explain the situation and what can we do to ease their frustration?

Anyone who has sustained a brain injury or who has a family member with a brain injury has experienced many challenges and fears. Perhaps worse, they have no doubt also experienced many, many periods of uncertainty. For the past several weeks, we have all been living with the consequences of the COVID-19 virus. We all have a fear of catching it and being hospitalized or worse. Others are worried about the financial burden or food shortages. Of course, we all worry about our family and friends, especially those who are older or have medical conditions. So there are many things to worry about. Thankfully, the vast majority of us are resilient. Some of us know it while others don’t see it until it is pointed out with an example or two. Others are less resilient and need frequent reminders that they are safe… and that’s OK.

Uncertainty, for a person who has sustained a brain injury, is as off-putting as a change in schedule, and often leads to a neurologic-based significant level of anxiety. If that state of uncertainty (with shifting schedules) stays too long, the anxiety can be replaced or co-exist with depression, which will very likely have significant consequences on the family. It will certainly affect the primary caregiver even more and those particularly heroic individuals will need much more help from the rest of the family.

The good news is that there is more family at home now to help, but they may need to be asked to help and shown just what to do. Don’t assume that they don’t want to help if they don’t volunteer. Also remember that showing is a much more effective teaching tool than just describing. Create and post a daily schedule for the individual (davening, chores, meals, social time, exercise, recreation and of course learning if possible) and respectfully remind the individual with the brain injury to use it. In order to remind the individual with the brain injury what is going on, you may try writing a brief note to give or read to the person when they ask questions, so that the same words are used and more likely to “stick”. You can say/write: There is a dangerous new type of flu going around. Everybody is being careful not to catch it and get sick, so we are staying inside to stay safe. This will only be going on for a few weeks. You can add one or more: Let’s say Tehillim, learn Chumash, do a page of addition, talk to the grandkids, do a crossword puzzle, play a game, read to the children, take a walk to the corner and back, clean this cabinet for Pesach, etc.

My family member has impulsivity and lack of understanding since a TBI 5 years ago and is ignoring recommendations for social distancing and going out and about. What can I do about this?

If you have a family member who is reluctant or too impulsive to listen, find a person that individual trusts absolutely, perhaps an uncle, a Rav or Rebbe, or an old friend.  Tape a message from that person onto the individual, i.e. to help do a mitzvah today for themselves and their family and stay “daled amos” (several feet) away from each other at all times, until they are informed to go back to regular contact.  They should also be told that they certainly may not go out without an OK from their primary caregiver. If possible, they may be given permission to walk around a yard or park once a day with their caregiver’s permission. 

We can no longer visit our family member in rehab and we have concerns as to how this is impacting his/her mood. We are particularly worried that this will impact his willingness to participate actively in therapy. Do you have any suggestions?

Every medical and religious authority agrees that not visiting patients in a rehab center/nursing home is not only the right thing to do but is in fact a matter of life and death. The possibility that your loved one will contract the COVID-19 virus from people visiting other patients is practically guaranteed if families would be allowed to visit. Unfortunately, rehab and nursing homes are ground zero for spreading the virus once it gets in; not because of poor care, but because so many of the patients have a compromised immune system. 

Contact whoever you can to set up a system for regular video chats, perhaps the nurse in charge of the unit or someone in administration. 

As an Orthodox Jew, I know that we feel safer having the benefit of looking at the long picture.  That there is a plan. That we have survived much, much worse. That Ha-Shem will protect us. 

My father, who is a Holocaust survivor, has reminded me during other times of uncertainty and fear that the only thing we can do is take it one day at a time.  Make time each day or every other day, to take a break, even for 15 minutes, to take care of yourselves. Find a reliable news source or two that is not trying to scare you in order to grab your attention. 

Lean on each other.  Talk your fears through with people you trust.  Don’t let it stay bottled up inside. Talk to people who will respect your thoughts and have a balanced sense of the news and of course, Daven.   Stay in contact with the excellent staff at BINA for ideas and help. 

May we all stay healthy and safe.