SpringerLink
Log in

Efficacy of dual-task augmented reality rehabilitation in non-hospitalized adults with self-reported long COVID fatigue and cognitive impairment: a pilot study

  • COVID-19
  • Published:
Neurological Sciences Aims and scope Submit manuscript

Abstract

Background

Cognitive impairment and chronic fatigue represent common characteristics of the long COVID syndrome. Different non-pharmacological treatments have been proposed, and physiotherapy has been proposed to improve the symptoms. This study aimed to evaluate the effects of a dual-task augmented reality rehabilitation protocol in people with long COVID fatigue and cognitive impairment.

Methods and materials

Ten non-hospitalized adults with reported fatigue and “brain fog” symptoms after COVID (7/10 females, 50 years, range 41–58) who participated in 20 sessions of a 1-h “dual-task” training, were compared to 10 long COVID individuals with similar demographics and symptoms (9/10 females, 56 years, range 43–65), who did not participate to any rehabilitation protocol. Cognitive performance was assessed with the Trail Making Test (TMT-A and -B) and Frontal Assessment Battery (FAB), and cardiovascular and muscular fatigue were assessed with the fatigue severity scale (FSS), six-minute walking test and handgrip endurance. Finally, transcranial magnetic stimulation (TMS) investigated cortical excitability.

Results

The mixed-factors analysis of variance found a significant interaction effect only in cognitive performance evaluation, suggesting TMT-B execution time decreased (− 15.9 s, 95% CI 7.6–24.1, P = 0.001) and FAB score improved (1.88, 95% CI 2.93–0.82, P = 0.002) only in the physiotherapy group. For the remaining outcomes, no interaction effect was found, and most parameters similarly improved in the two groups.

Conclusion

The preliminary results from this study suggest that dual-task rehabilitation could be a feasible protocol to support cognitive symptoms recovery after COVID-19 and could be helpful in those individuals suffering from persisting and invalidating symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Anonymized data can be requested upon reasonable request to the corresponding author.

References 

  1. Nalbandian A, Sehgal K, Gupta A et al (2021) Post-acute COVID-19 syndrome. Nat Med 27:601–615. https://doi.org/10.1038/s41591-021-01283-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Buoite Stella A, Furlanis G, Frezza NA et al (2022) Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study. J Neurol 269(2):587–596. https://doi.org/10.1007/s00415-021-10735-y

  3. Ortelli P, Ferrazzoli D, Sebastianelli L et al (2021) Fatigue and “brain fog” in the aftermath of mild COVID-19: a neuropsychological and TMS study. J Neurol Sci 429:119854. https://doi.org/10.1016/j.jns.2021.119854

  4. Michelutti M, Furlanis G, Buoite Stella A et al (2022) Sex-dependent characteristics of Neuro-Long-COVID: Data from a dedicated neurology ambulatory service. J Neurol Sci 441:120355. https://doi.org/10.1016/j.jns.2022.120355

  5. Jennings G, Monaghan A, Xue F et al (2022) Comprehensive clinical characterisation of brain fog in adults reporting long COVID symptoms. J Clin Med 11(12):3440. https://doi.org/10.3390/jcm11123440

  6. Kavanagh E (2022) Long Covid brain fog: a neuroinflammation phenomenon? Oxf Open Immunol 3(1):iqac007. https://doi.org/10.1093/oxfimm/iqac007

  7. Furlanis G, Buoite Stella A, Biaduzzini F et al (2023) Cognitive deficit in post-acute COVID-19: an opportunity for EEG evaluation?. Neurol Sci 44(5):1491–1498. https://doi.org/10.1007/s10072-023-06615-0

  8. Manganotti P, Michelutti M, Furlanis G et al (2023) Deficient GABABergic and glutamatergic excitability in the motor cortex of patients with long-COVID and cognitive impairment. Clin Neurophysiol 151:83–91. https://doi.org/10.1016/j.clinph.2023.04.010

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ortelli P, Ferrazzoli D, Sebastianelli L et al (2021) Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: insights into a challenging symptom. J Neurol Sci 420:117271. https://doi.org/10.1016/j.jns.2020.117271

    Article  CAS  PubMed  Google Scholar 

  10. Ajčević M, Iscra K, Furlanis G et al (2023) Cerebral hypoperfusion in post-COVID-19 cognitively impaired subjects revealed by arterial spin labeling MRI. Sci Rep 13:5808. https://doi.org/10.1038/s41598-023-32275-3

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  11. Guedj E, Campion JY, Dudouet P et al (2021) 18F-FDG brain PET hypometabolism in patients with long COVID. Eur J Nucl Med Mol Imaging 48(9):2823–2833. https://doi.org/10.1007/s00259-021-05215-4

  12. Belli S, Balbi B, Prince I et al (2020) Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation. Eur Respir J 56(4):2002096. https://doi.org/10.1183/13993003.02096-2020

  13. Azcue N, Gómez-Esteban JC, Acera M et al (2022) Brain fog of post-COVID-19 condition and Chronic Fatigue Syndrome, same medical disorder? J Transl Med 20(1):569. https://doi.org/10.1186/s12967-022-03764-2

  14. Calabria M, García-Sánchez C, Grunden N et al (2022) Post-COVID-19 fatigue: the contribution of cognitive and neuropsychiatric symptoms. J Neurol 269(8):3990–3999. https://doi.org/10.1007/s00415-022-11141-8

  15. Versace V, Ortelli P, Dezi S et al (2023) Co-ultramicronized palmitoylethanolamide/luteolin normalizes GABAB-ergic activity and cortical plasticity in long COVID-19 syndrome. Clin Neurophysiol 145:81–88. https://doi.org/10.1016/j.clinph.2022.10.017

  16. Garcia Estevez D, Lopez Perez A, Gomez Vazquez H, Juanatey-Garcia A (2022) Approach to the treatment of fatigue and brain fog in long-COVID-19 with hyperbaric oxygen therapy: a case series. Eur J Neurol 29:393–393

  17. Kuut TA, Müller F, Aldenkamp A et al (2021) A randomised controlled trial testing the efficacy of Fit after COVID, a cognitive behavioural therapy targeting severe post-infectious fatigue following COVID-19 (ReCOVer): study protocol. Trials 22(1):867. https://doi.org/10.1186/s13063-021-05569-y

  18. Estebanez-Pérez MJ, Pastora-Bernal JM, Martín-Valero R (2022) The effectiveness of a four-week digital physiotherapy intervention to improve functional capacity and adherence to intervention in patients with long COVID-19. Int J Environ Res Public Health 19(15):9566. https://doi.org/10.3390/ijerph19159566

  19. Morrow A, Gray SR, Bayes HK et al (2022) Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise—CISCO-21. Trials 23(1):660. https://doi.org/10.1186/s13063-022-06632-y

  20. de Sire A, Moggio L, Marotta N et al (2022) Impact of rehabilitation on fatigue in post-COVID-19 patients: a systematic review and meta-analysis. Applied Sciences (Switzerland) 12(17):8593. https://doi.org/10.3390/app12178593

  21. Gidoni M, Russo R, Alessandro P et al (2023) Virtual and augmented reality training on digital mirror D-wall. Case study: long Covid-19 rehabilitation protocol. Arch Phys Med Rehabil 1104(3):e63. https://doi.org/10.1016/j.apmr.2022.12.184

  22. Ilardi CR, Menichelli A, Michelutti M et al (2023) Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia. Neurological Sciences 44(1):159–170. https://doi.org/10.1007/s10072-022-06422-z

  23. Mannocci A, Di Thiene D, Del Cimmuto A et al (2010) International Physical Activity Questionnaire: validation and assessment in an Italian sample. Italian Journal of Public Health 7(4):369–376. https://doi.org/10.2427/5694

  24. Tuena C, Borghesi F, Bruni F et al (2023) Technology-assisted cognitive motor dual-task rehabilitation in chronic age-related conditions: systematic review. J Med Internet Res 25:e44484. https://doi.org/10.2196/44484

  25. Gradidge PJL, Torres G, Constantinou D et al (2023) Exercise reporting template for long COVID patients: a rehabilitation practitioner guide. Arch Phys Med Rehabil 104(6):991–995. https://doi.org/10.1016/j.apmr.2023.01.025

  26. Siciliano M, Chiorri C, Battini V et al (2019) Regression-based normative data and equivalent scores for Trail Making Test (TMT): an updated Italian normative study. Neurol Sci 40(3):469–477. https://doi.org/10.1007/s10072-018-3673-y

  27. Aiello EN, Esposito A, Gramegna C et al (2022) The Frontal Assessment Battery (FAB) and its sub-scales: validation and updated normative data in an Italian population sample. Neurol Sci 43(2):979–984. https://doi.org/10.1007/s10072-021-05392-y

  28. Siciliano M, Chiorri C, De Micco R et al (2019) Fatigue in Parkinson’s disease: Italian validation of the Parkinson fatigue scale and the Fatigue severity scale using a Rasch analysis approach. Parkinsonism Relat Disord 65:105–110. https://doi.org/10.1016/j.parkreldis.2019.05.028

    Article  CAS  PubMed  Google Scholar 

  29. de Azevedo Vieira JE, Mafort TT, Monnerat LB et al (2023) Assessment of short- and long-term functionality and quality of life in patients with post-acute COVID-19 syndrome. J Back Musculoskelet Rehabil 36:541–550. https://doi.org/10.3233/BMR-220308

    Article  PubMed  Google Scholar 

  30. Galluzzo V, Ciciarello F, Tosato M et al (2022) Association between vitamin D status and physical performance in COVID-19 survivors: results from the Gemelli against COVID-19 post-acute care project. Mech Ageing Dev 205:111684. https://doi.org/10.1016/j.mad.2022.111684

  31. Rossini PM, Burke D, Chen R et al (2015) Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: basic principles and procedures for routine clinical and research application: An updated report from an I.F.C.N. Committee. Clin Neurophysiol 126(6):1071–1107. https://doi.org/10.1016/j.clinph.2015.02.001

  32. Shaffer L (2022) Lots of long COVID treatment leads, but few are proven. Proc Natl Acad Sci U S A 119(36): e2213524119. https://doi.org/10.1073/pnas.2213524119

  33. Ariza M, Cano N, Segura B et al (2023) COVID-19 severity is related to poor executive function in people with post-COVID conditions. J Neurol 270(5):2392–2408. https://doi.org/10.1007/s00415-023-11587-4

  34. Gunnarsson DV, Miskowiak KW, Pedersen JK et al (2023) Physical function and association with cognitive function in patients in a post-COVID-19 clinic—a cross-sectional study. Int J Environ Res Public Health 20(10):5866. https://doi.org/10.3390/ijerph20105866

  35. Gavelin HM, Dong C, Minkov R et al (2021) Combined physical and cognitive training for older adults with and without cognitive impairment: a systematic review and network meta-analysis of randomized controlled trials. Ageing Res Rev 66:101232. https://doi.org/10.1016/j.arr.2020.101232

  36. Torres-Castro R, Núñez-Cortés R, Larrateguy S et al (2023) Assessment of exercise capacity in post-COVID-19 patients: how is the appropriate test chosen? Life 13(3):621. https://doi.org/10.3390/life13030621

  37. Tanriverdi A, Savci S, Kahraman BO, Ozpelit E (2022) Extrapulmonary features of post-COVID-19 patients: muscle function, physical activity, mood, and sleep quality. Ir J Med Sci 191(3):969–975. https://doi.org/10.1007/s11845-021-02667-3

  38. van der Sluijs KM, Bakker EA, Schuijt TJ et al (2023) Long-term cardiovascular health status and physical functioning of nonhospitalized patients with COVID-19 compared with non-COVID-19 controls. Am J Physiol Heart Circ Physiol 324(1):H47–H56. https://doi.org/10.1152/ajpheart.00335.2022

  39. Landi F, Martone AM, Ciciarello F et al (2022) Effects of a new multicomponent nutritional supplement on muscle mass and physical performance in adult and old patients recovered from COVID-19: a pilot observational case–control study. Nutrients 14(11):2316. https://doi.org/10.3390/nu14112316

  40. Tosato M, Ciciarello F, Zazzara MB et al (2022) Nutraceuticals and dietary supplements for older adults with long COVID-19. Clin Geriatr Med 38(3):565–591. https://doi.org/10.1016/j.cger.2022.04.004

  41. Manganotti P, Garascia G, Furlanis G, Buoite Stella A (2023) Efficacy of intravenous immunoglobulin (IVIg) on COVID-19-related neurological disorders over the last 2 years: an up-to-date narrative review. Front Neurosci 17:1159929. https://doi.org/10.3389/fnins.2023.1159929

Download references

Acknowledgements

The authors want to thank the participants for volunteering for the study.

Author information

Authors and Affiliations

  1. School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy

    Manuela Deodato, Caterina Qualizza, Miriam Martini, Laura Mazzari, Alex Buoite Stella & Paolo Manganotti

  2. PhD Program in Personalized Medicine and Innovative Therapies, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy

    Miriam Martini

  3. Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy

    Alex Buoite Stella & Paolo Manganotti

  4. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada Di Fiume 447, 34149, Trieste, Italy

    Giovanni Furlanis, Alex Buoite Stella & Paolo Manganotti

Authors
  1. Manuela Deodato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caterina Qualizza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miriam Martini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Mazzari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Furlanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alex Buoite Stella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Manganotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alex Buoite Stella.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

All the participants and their legal guardians were requested to sign an informed consent. All procedures were approved by the ethical committee of the Comitato Etico Unico Regionale del Friuli-Venezia Giulia.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 38 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deodato, M., Qualizza, C., Martini, M. et al. Efficacy of dual-task augmented reality rehabilitation in non-hospitalized adults with self-reported long COVID fatigue and cognitive impairment: a pilot study. Neurol Sci 45, 1325–1333 (2024). https://doi.org/10.1007/s10072-023-07268-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-023-07268-9

Keywords

Search

Navigation