Growing evidence indicates that many people who have chronic post-acute sequelae ofSARS-CoV-2 infection (PASC) will experience ongoing neurological and musculoskeletalimpairment that can affect gait and balance. Identifying the factors contributing tothese impairments and how they influence functional mobility is the first step towardscreating effective evaluation and treatment protocols. In this study the investigatorswill examine cognition, vision, proprioception, muscle strength, gait and balance inpersons with and without PASC to understand how PASC may impact functional mobilitythrough a cognitive-sensorimotor lens. Gait and balance will be studied in environmentsthat stress cognitive and sensory abilities. Study outcomes will be critical for thedevelopment of evidence-based Veteran Health Administration diagnostic andstandard-of-care protocols to address gait and balance dysfunction in Veterans with PASCfor restoring their functional mobility and independence.
As many as one in seven COVID-19 survivors will experience symptoms that persist more
than two months after their acute illness has resolved. Growing evidence estimates that
up to 30% of people who experience this chronic post-COVID disorder (aka post-acute
sequelae of SARS-CoV-2 infection (PASC)) will exhibit gait and balance dysfunction. The
consequences of impaired mobility are of considerable concern for the Veterans Health
Administration (VHA) given that mobility is closely related to quality of life for older
adults and almost half of Veterans are 65 years or older. There currently is no
established VHA standard-of-care for PASC. The critical first step towards development of
comprehensive clinical protocols to identify and treat PASC-related gait and balance
dysfunction is understanding the contributing factors. PASC is characterized by diverse
multi-organ system effects that has made it difficult to identify the causes of
dysfunction. However, new data suggests frequently reported neurologic issues related to
cognitive and sensorimotor impairment may be potential contributors to gait and balance
dysfunction. While cognition, sensation, and muscle function can be measured in
isolation, the effects of cognitive and sensory impairment on gait and balance are best
detected using dual task tests (e.g., count backward by 7's while walking) that pair
cognitive and motor function or tasks performed in complex environments that limit
sensory feedback and/or stress sensory-motor integration (e.g., maintaining standing
balance with eyes closed). However, such assessments are not included in the current
recommended PASC gait and balance screening guidelines, thereby leaving a clinical gap in
knowledge when evaluating and treating Veterans and non-Veterans with PASC-related gait
and balance dysfunction.
Therefore, the proposed project will evaluate the effect of PASC on isolated
cognitive-sensorimotor function (Aim 1), and cognitive-sensorimotor contributions to gait
(Aim 2) and balance (Aim 3) dysfunction in COVID-19 survivors through an observational
cross-sectional study design. Aim 1 will assess cognition, vision, proprioception, and
muscle strength independent of functional task in COVID-19 survivors with and without
PASC using established methods. Aim 2 will perform an instrumented assessment of gait
performance of participants under a dual task scenario to stress cognition. Aim 3 will
perform an instrumented assessment of postural balance under different conditions that
challenge sensorimotor integration by compromising certain sensory modalities (vision,
vestibular, somatosensory). A non-instrumented clinical outcome measure will also be
performed as a secondary measure to evaluate a potential clinical screening tool. Based
on emerging evidence, the investigators hypothesize that COVID-19 survivors with PASC
will exhibit worse cognitive-sensorimotor function, dual task gait performance, and
sensory-interaction balance performance than those without PASC when accounting for age,
sex, and time since acute infection. PASC-induced gait and balance dysfunction has
significant clinical implications as it could compromise mobility, long-term health, and
quality of life of Veterans if left unaddressed. Outcomes from this study will generate
new knowledge on PASC-induced gait and balance dysfunction as related to
cognitive-sensorimotor impairment, This information is critical for informing VHA PASC
standard-of-cares that are currently being developed to ensure inclusion of appropriate
gait and
Inclusion Criteria:
- Older than 18 years of age
- Positive PCR or Rapid COVID-19 test in the past
- Onset of COVID-19 illness greater than 3 months prior to their participation in the
study
- Self-reported ability to walk 10 meters with or without external assistance prior to
COVID-19 illness
Exclusion Criteria:
- Presence of severe cardiovascular and pulmonary disease and/or neurological and
musculoskeletal disorders unrelated to COVID-19 (e.g., amputation, stroke, spinal
cord injury)
- Cognitive impairments precluding ability to provide informed consent.
- Severe acute COVID-19 infection requiring hospitalization or diagnosed
post-intensive care syndrome.
- Presence of musculoskeletal, inflammatory, or neurological conditions mimicking Long
COVID-19 symptoms (e.g., concussion within last 5 years, Chronic fibromyalgia,
Myofascial pain syndrome, etc.)
Jesse Brown VA Medical Center, Chicago, IL
Chicago, Illinois, United States
Investigator: Israel Rubinstein, MD
Contact: 312-569-6129
Israel.Rubinstein@va.gov
Investigator: Matthew J. Major, PhD
Matthew J Major, PhD
(312) 569-6166
Matthew.Major2@va.gov
Keith E Gordon, PhD
(708) 202-8387 - 28387
Keith.Gordon2@va.gov