All right. Well, hello, everybody. Thank you for joining us today. We've got a real treat this afternoon, or I guess the morning for people who are out West. This year, we're doing things a little bit differently, having this spotlight on some of our research and having these brief presentations where you can interact with our researchers and they can share in a little more detail what they've been doing. And so here we have some really great presentations and they're all gonna be about the pandemic. So I'm gonna first introduce Dr. Evan Zeldin, and here he goes. Thank you, Dr. Mortimer. You could advance to the next slide. So good afternoon, everyone. My name is Evan Zeldin. I'm a PGY-4 resident physician at East Carolina University. I'm excited to present this case that I worked on with some of my colleagues, the title of which is COVID-19 Complications, a Presentation of Multisystem Inflammatory Syndrome in Children, also known as MIS-C. I'd like to start off by noting that this was a team approach with authors in both the Department of PM&R and Pediatrics and that we have no relevant financial disclosures. Next slide. So our patient was a five-year-old female with no significant past medical history and was functionally appropriate for her age who presented to the emergency department with a week-long history of fevers, cough, and shortness of breath. She was initially normotensive, but tachycardic and tachypneic with a fever of 103 degrees Fahrenheit. Initial treatment with dexamethasone and albuterol failed to improve her respiratory function. She subsequently developed febrile seizures, became hypotensive, and developed acute hypoxic respiratory failure, necessitating intubation and admission to the Pediatric Intensive Care Unit. PCR and antibody testing were positive for COVID-19. And further laboratory workup revealed an elevated C-reactive protein of 215, an erythrocyte sedimentation rate, or ESR, of 69, an acute kidney injury, and elevated troponin levels. An echocardiogram showed myocarditis as well as acute heart failure with reduced left ventricular ejection fraction of 40%. Her echocardiogram and chest X-ray are shown on the right side of this slide. With this presentation, she was diagnosed with multisystem inflammatory syndrome in children, also known as MIS-C. Next slide, please. So MIS-C is an acute, rare complication of COVID-19 that develops in children. The current CDC case definition is an individual aged less than 21 years old presenting with a fever of duration greater than 24 hours with laboratory evidence of inflammation, such as a CRP, ESR, fibrinogen, procalcitonin, D-dimer, ferritin, lactic acid dehydrogenase, or LDH, or interleukin-6, and evidence of clinically severe illness requiring hospitalization with multisystem, meaning greater or equal than two, organ involvement, cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurological, and no alternative plausible diagnoses, and most importantly, positive for current or recent SARS-CoV-2 infection by PCR, serology, or antigen test, or exposure to a suspected or confirmed COVID-19 case within the four weeks prior to onset of symptoms. So the symptoms generally present as a Kawasaki-like illness, and patients can present with severe neurologic, pulmonary, and cardiac manifestations, including encephalopathy, muscle weakness, brainstem and or cerebellar signs, cardiac arrhythmias, myocardial dysfunction, and respiratory failure resulting in prolonged hospitalizations. This multisystem disease requires a multidisciplinary approach. For physiatrists like us, this likely includes cardiopulmonary and or neurological rehabilitation in order to make functional progress towards a hopeful return to the prior level of function. And as the pandemic progresses, there will likely be an increasing number of MIS-C cases that require rehabilitation and multidisciplinary, multispecialty care. Next slide, please. So this patient was treated by a multidisciplinary team due to the multiple organ systems impacted. She was treated with a variety of medications for the multi-organ system involvement, including milrinone, intravenous immunoglobulin, aspirin, anticoagulation, and steroids. She also required, but was eventually weaned off continuous renal replacement therapy, or CRRT, due to the acute renal failure. The patient subsequently had normalization of her heart function and ejection fraction on serial echocardiograms, and she was stabilized medically and admitted to our pediatric rehab facility. So for her premorbid functional status, her dad stated that she was an active, typical five-year-old with interests of riding her bike, jumping on her trampoline, and playing with dolls. So on admission to the inpatient pediatric rehabilitation unit, her functional status with therapies demonstrated minimal assistance with ambulation of about 80 feet without any assistive device, and she required minimal assistance to ascend four six-inch stairs, requiring a railing for stability. On the pediatric balance scale, she scored a 25 with her average score for age and sex of a 54.4. For transfers, her requirement ranged from current contact guard to minimal assistance. And additionally, she had decreases in both activity tolerance and balance from her prior baseline and required frequent cuing for improvement. So following a course of acute inpatient rehabilitation, the patient was able to ambulate over 300 feet independently and required only supervision assistance with mobility. Her score on the pediatric balance scale improved from a 25 to a 54, which was now an appropriate score for her age and sex. So ultimately, MIS-C is a problem that physiatrists will likely encounter as the pandemic continues. Hopefully, the recent approval of vaccines for the pediatric population will help reduce the rate of this condition. I'd like to thank everyone very much for attending and listening to our case presentation, and please check out our poster in the gallery. Thank you. Wow, well, thank you for that. Wow, just a case, great case. I did see a question come through, and we will have time at the end for questions, probably about 10 minutes if we time everything right. So you can put those in there and we can address them then, or we can always talk about them at the end. And now we'll go over to Dr. Guzel. All right, thank you. So my presentation is about critical illness myopathy in post-COVID rehabilitation, electrodiagnostic correlates. Next slide, please. And so this is a collaboration with multiple members at the Shirley Ray Inability Lab. One of my co-authors is Prav Deo, and he's the director of the Shirley Ray Inability Lab. And so he's going to talk a little bit about his co-authors is Prav Deo, who Dr. Deo will be presenting as well in this spotlight presentation on an additional research. And I do want to thank, it was a great collaborative effort. And so my co-authors below, Dr. Adewoi, Dr. Deo, Dr. Roy, Dr. Oswald, Dr. Frantz, and Dr. Rydberg were instrumental in getting this off the ground. Next slide. So we found in the course of our post-COVID rehabilitation unit that some patients with kind of this long haul COVID had critical illness myopathy. So this case series came about through the post-COVID rehabilitation unit and patients that were very weak and had clinical signs and symptoms of CIM were referred to our electrodiagnostic testing lab while they were still in inpatient rehab. And so our study design is a retrospective case series. This is a level four evidence. The setting is our freestanding inpatient rehabilitation hospital. And then the dates that the electrodiagnostic testing was done was between September of 2020 and March of 2021. And just as a refresh on critical illness myopathy, as you know, it's a primary myopathy, it's a muscular disorder, not a myopathy. It's a muscular disorder, not anything secondary to denervation classically. And it has some distinct electrophysiologic and clinical features. Electrophysiologically, what we look for are on the needle EMG, you have motor unit action potentials with short duration, low amplitude. You could have early or normal recruitment. It wouldn't have a decremental response and repetitive stimulation. And then there was just general muscle in excitability. Next slide. So in these two tables, I kind of walk you through our findings from this case series. The first table on the left shows our characteristics of the patients. So as you can see, the age were middle-aged around 59 years old with a range to 40s and 70s. They coincidentally all happened to be male. A number of them, as you can imagine, had at least two pre-existing comorbidities. And then also you can think about how critically ill these patients were. A reflection of that is seven out of the nine had required a tracheostomy. Four of them had even spent time at a long-term acute care hospital prior to coming to acute rehab. And those kind of variables are reflected really in that duration of the time from their initial COVID diagnosis to the electrodiagnostic testing, which ranges anywhere from like 50 days to almost a year out from the initial diagnosis. Turning our eye to table two on the left reveals our results of electrodiagnostic testing. So we found all of nine of the patients had low amplitude units, which one would expect with the confirmation of myopathy. They also had polyphasic units. The vast majority had early recruitment, positive sharp waves, many had fibrillation potentials, and then least represented were short duration motor unit action potentials, which were found in only three of the nine patients. Next slide. Interestingly, we found in every single patient additional diagnoses of either a peripheral polyneuropathy or a focal mononeuropathy, sometimes both. So this diagram shows in red kind of the areas of proximal weakness that were consistent with the critical illness myopathy, and the areas in blue are showing those additional superimposed either mononeuropathies or peripheral polyneuropathies. And so this really begs the question of, could, you know, there's been research by Malik et al in 2020 of, you know, suggesting that prone to injury, this prone positioning could be leading to some peripheral nerve injuries. I think the mechanism action is really consistent for particular ulnar or fibular ones. The other peripheral nerve injuries, though the etiology remains unclear, it's likely multifactorial. I think it begs the question of, you know, COVID itself being a risk factor for developing a neuropathy. So as you kind of, you're welcome to come browse my poster in the gallery, and then please let me know, have you had patients with any features concerning for critical illness myopathy after COVID infection? I'll take any questions in the chat, and thank you very much for your time. Thank you. Wow, thank you, Dr. Guzel. So, so interesting as well. Wow, I'll look forward to hearing what the questions are later, but why don't we then, I guess you already kind of gave us the segue, but we'll segue into Dr. Deo and his work. Hi, everyone. My name is Prabhav Deo. I'm a fourth year resident physician at Northwestern University in the Shirley Ryan Ability Lab, and thank you for that shout out, Dr. Guzel. I worked on this, sorry, I don't quite see my slides yet. Next slide. There we go. Thank you very much. Today, I'll be speaking about the impact of the early COVID-19 pandemic on inpatient clinical experience for PM&R resident physicians. The COVID-19 pandemic has affected all aspects of the healthcare system, and we now know that COVID infection, and in particular, severe COVID infection, is associated with significant morbidity, and many of these patients can benefit from inpatient rehabilitation. At our hospital, residents perform a bulk of the inpatient duties. So we were most interested in studying any potential pandemic-related impact on resident education by looking at inpatient clinical experience. In order to do this, we compared pre-pandemic patients admitted from January 1st to July 30th in 2019 to patients admitted during the same time period of January 1st to July 30th in 2020. We found that it's difficult to truly capture the inpatient clinical experience. Coordination of care is such a vital part of what we do, and this is hard to track. So we decided to focus on quantifiable variables that really try to capture what residents do on a day-to-day basis. We know in broad terms that residents admit patients, respond to medical emergencies, and if there's any acute medical change, they also help out with transfers, especially when they're on call. So specific outcome variables that we looked at were the average number of daily admissions to rehabilitation, the total number of admissions in each diagnostic category, the average number of medical emergencies, the average number of transfers, as well as the average number of work hours on a rotation that's primarily admitting-based, and averages were performed over each month. Moving on to the results, in figure one, we can see that there was no statistically significant difference for average number of daily admissions when comparing 2020 to 2019, with the exception of April of 2020, in which there were 7.6 average admissions per month compared to 10.2 in April of 2019. Moving on to figure two, this reflects the number of patients admitted with a diagnosis of medically complex or debility in 2020 and 2019. Again, we see that there is no statistically significant difference with the exception of one month, which is June. In June of 2020, we admitted 70 patients with this diagnosis compared to just 29 in 2019. For all other admitting diagnoses that we looked at, we found that there was no significant month-to-month difference in total number of admissions when looking at 2020 and comparing it to the previous year of 2019. In tables one and two, we've outlined the average number of medical emergencies and the average medical transfers. And we found that there was no statistically significant difference between 2020 and 2019. In figure three, we looked at work hours on a primarily admitting rotation. For all months that we looked at in 2020, work hours were slightly less than they were in 2019. However, statistical testing could not be performed, so we're not sure if this is a statistically significant difference. Moving on to figure four, this reflects the number of admissions to the post-COVID unit. Our post-COVID unit opened up in April of 2020. And from April of 2020 to June, we admitted 94 patients. The most common admitting diagnosis was medically complex or debility followed by stroke. Medically complex patients that were admitted to the post-COVID unit made up 29, 41, and 38.6% of all patients admitted with this diagnosis in April, May, and June, respectively. The decrease in admissions that we saw in April of 2020 reflects a nationwide decrease of inpatient admissions that were also seen in acute care hospitals. Temporarily, we found that this lines up with national and state mandates that were issued to shelter in place or stay at home during the beginning of the pandemic. We see that there is a return to a normal level of admissions following the April, which also follows what happened on a national scale in acute care hospitals. We found that resident physicians learned to care for a new population of medically complex post-COVID patients without a significant increase in the number of medical emergencies or transfers that they were involved with. Furthermore, residents were able to do this while maintaining their exposure to traditional inpatient rehabilitation diagnoses, such as stroke, brain injury, spinal cord injury, and post-orthopedic rehabilitation. To our knowledge, this was the first study to quantitatively analyze the impact of the pandemic on inpatient experience for PM&R resident physicians. To conclude, we found no substantial impact of the pandemic on inpatient clinical experience for PM&R resident physicians in our hospital, as seen by comparable admission numbers, a preserved diagnostic case mix, and unchanged medical emergencies or transfers. Work hours were slightly less in 2020 during the pandemic compared to the previous year, but we're unclear if this is a statistically significant difference. And finally, there was a significant increase in the number of patients with a medically complex or debility diagnosis in June of 2020, which we feel, in part, was driven by the influx of patients requiring rehabilitation after the COVID infection. Thank you very much. I worked on this project with Dr. Sliwa, Dr. Kosherginski, and Liki Chen, and thank you all very much for listening to my presentation. Wow, that is just so amazing to think about. In two months, you had 90 people with a diagnosis you hadn't even heard of three months earlier. It's just, I know it's still in the middle of it, but it seems pretty unbelievable to me. So thank you for presenting this. I'm sure we'll hear more from you as you keep looking at this data, because it's really important stuff. So thank you so much. I think we're going on now to Dr. Zhao, and we'll see what you have. Hello, everyone. I'm Steven Zhao. I'm a PGY-3 here at MedStar Georgetown University National Rehabilitation Hospital. We can go to the next slide. So this is a project I worked on with Dr. Doshi, who's with the Infectious Disease Department, Sameer Desail, who's our statistician, and Dr. Malmot, who's my mentor, and attending at NRH. So she was the one who really spearheaded this project with me, and our project focused on work-related stress and the psychological toll that physical therapists, occupational therapists, and speech-language pathologists faced during the COVID-19 pandemic. There have been multiple studies that have looked at the mental health impact on healthcare providers, but there was nothing that looked at specifically the mental health impact on the therapists in an inpatient rehabilitation facility. As we know, the therapy that patients get varies widely, and can vary from an acute care hospital to especially an inpatient rehabilitation facility. Typical treatment sessions that these therapists face include extended interactions in close proximity with patients that often require physical contact. So this includes assistance with toileting, bathing, wound care, especially therapy tailored for COVID patients with respiratory secretion clearance, all that increased exposure to COVID-19 for these therapists. So the aim of our study was to evaluate the impact of the pandemic on stress and anxiety and depression in these therapists. So to do this, we created a 26-item questionnaire. This included the PHQ-9, which is a validated screen for depression, and GAD-7, which is a screen for symptoms of anxiety. And in addition, we actually added a mix of multiple choice and open-ended questions about potential stressors that the therapists may have encountered during the pandemic. So these included if they had children at home or were living with parents. We also asked them kind of what discipline they are in, as well as what age group they belong to. And we tried to see if there are any correlations between any of these stressors and their GAD-7 and PHQ-9 scores. So our overall analysis demonstrated, as you see in the bottom left figure, that the mean PHQ-9 score was 5.1, and the mean GAD-7 score was 5.6. These corresponded with mild symptoms of depression and anxiety. Again, this survey was administered in November of 2020. And our surge of COVID admissions was in March and April. So that could have been one of the reasons why these scores were on the more mild side. But we had also found a statistically significant correlation with therapists under the age of 30 to have higher GAD-7 scores when compared to therapists between age 30 and 39. So through the descriptive analysis as well, we were able to ascertain that therapists reported increased stress around performing job duties. They often took roles outside of their typical job duties. This included communicating with family members outside of therapy hours, delivering meals to patient rooms, doing patient laundry, so things that they weren't typically doing, and lack of access to PPE, as well as lack of access to their therapy equipment and space that they were often using were also reported by them. Lastly, they also talked about the necessity for a clear leadership and policy regarding changes in COVID-19 protocols. So with this study, we were able to address potential stressors going forward as the pandemic progresses that therapists were concerned about, as well as target a potential age group to maybe tailor more resources towards. And lastly, as physiatrists who are leaders in these inpatient rehabilitation facilities, we can take a larger role in addressing our therapists and staff with up-to-date changes in COVID-19 protocols, as well as up-to-date news about the pandemic. So some of the limitations regarding our study was a lack of a control group. We did have a relatively small sample size and a moderate response rate. We also focused on work-related stressors and did not account for personal variables that may have affected their psychological wellbeing. So I think with this study, we can tailor our inpatient rehabilitation facility protocols to kind of cater to these stressors and to assist our therapy staff when needed. Thank you very much for listening to our talk. Wow, thank you so much. Just thinking about the effect on our colleagues and how that affects us all and how that affects our patients, I think is super important as well. Thank you for sharing that. So in this session, we do have one final, sort of last but not least kind of person. So Dr. Lewis will be presenting next. Hi, my name is Chris Lewis. I'm a resident of the Shirley Ryan Ability Lab. We can start our presentation. So yeah, today I'll be going through our study on the discharge destinations for individuals who were admitted with a COVID-19 infection. So we can go on to the introduction and methods. So yeah, just looking at specifically some data here from the CDC. So between February, 2020 and May, 2021, here, these are some estimates of COVID-19 infections and subsequent complications. So approximately 120 million patients were estimated to contract a COVID-19 infection. About 102 million had symptoms, 6.2 million were hospitalized and approximately 767,000 patients were estimated to total deaths from this pandemic. And as you can see here, there's really a significant variance in how people are reacting to this virus. And we're gonna go through a couple of factors that are really important to that. And we're gonna look at those factors to see how it is impacting their discharge destination after they're hospitalized with COVID. So we're gonna go through a couple of different things and specifically demographics. So patients based on their demographics, we can move to the next animation. Perfect, so demographics, patients with specific demographics, such as if they're male, older age, race, socioeconomic status, these are known to be important when you're thinking about how patients are going to do with a COVID-19 infection. And then next we have comorbidities. So patients, depending on what they have before their infection, whether they have asthma, COPD or other factors, we know that patients who are immune compromised, they have more severe outcomes. And then another thing that we can consider thirdly is their complications they develop after their infection. So sometimes patients have pulmonary embolus, myocardial infarction, strokes, this really affects their overall outcomes from the infection. And altogether, moving on to the next topic, we can think about their hospital course. So how do all these factors impact their hospital course? And then subsequently, how does their hospital course and all these factors impact the rehabilitation they receive? So that would be the final part here. And that's really the next, the final thing that we're focusing on for this project is looking at how patients' demographics, comorbidities and the complications from their infection affect their hospital course and subsequently where they go after their hospital course. So the next figure here is just going to focus on our methods of how we develop this. So we exported and had a query for data from Northwestern Memorial Hospital to create a retrospective cohort study that we were gonna look at to determine where patients go after they're hospitalized. And you can see here that there are specific categories, whether they're going home with or without services, to a skilled nursing facility, long-term acute care hospital, inpatient rehabilitation facility or acute care. So at the next slide, we'll talk about the results of this study. So with our query, we were able to get 4,011 patients who were diagnosed with PCR-confirmed COVID-19 infection. And we had some exclusion criteria that we used to really select the patients that we were gonna be able to do our analysis with. So that left us with an analysis cohort of 3,010 patients. We excluded patients if they were missing their COVID PCR date. If we didn't, if their COVID PCR positive date was greater than 14 days from their admission date, we also excluded them. If we didn't know where they went after they were hospitalized, then we excluded them. And we also excluded them if they didn't have data on their medical comorbidities. So this left us with our analysis cohort of 3,010 patients. And you can see that it subsequently divided into two groups, whether they went home or to a post-acute care facility. So home included patients who went home with and without services. You can see that this was 86% of our cohort. And then post-acute care facilities was 14%. And that included the skilled nursing facility, long-term acute care hospital, inpatient rehab, acute care, and then patients who were discharged to hospice or expired. So with this cohort, we then looked at the variables we were talking about in the table that comes next. So in this table, you can see each row is a different variable. So we start with, we have sex, race, age at COVID diagnosis, length of stay in the hospital, and then how many comorbidities each patient had. And we're gonna go through each of these individually. And so looking first at sex, we noted that patients who were male were more likely to go to a post-acute care facility. And so we can move to the next there. Perfect. And then additionally, patients who were older also were more likely to go to a post-acute care facility. And then next, based on length of stay, patients who had a longer length of stay were more likely to go to a post-acute care facility. And finally, based on medical comorbidity data, patients who had two or more medical comorbidities were also significantly more likely to go to these facilities. Perfect. So we can move on to the next figure, which is figure two. Perfect. Thank you. So this is where we're doing a univariate logistic regression and multivariate logistic regression analysis to calculate the odds ratio for these different variables. So really what we're looking at, just to put it in a little simpler terms, as we move right on this forest plot, which you see in the figure, as you move further to the right, it's a logarithmic scale. As the dots move further, the points move further to the right, patients are more likely to go to a post-acute care facility versus home. So we have the same variables here going down from the top on the left. The data represented in the graph on the right is also shown to the left in the table. And you can see that in the top row, male sex, patients with the male sex were 1.3 times more likely to go to a post-acute care facility compared to female patients. And the dotted line for one on the right represents, if the point crosses one, then it's no longer, it's not considered statistically significant. So you can see which variables are statistically significant there. Moving down, we also noted that patients who were identified as Asian in the export were less likely to be discharged to a post-acute care facility and more likely to be discharged home. Patients who were older were 2.3 times more likely to be discharged to a post-acute care facility compared to younger patients. Patients with a longer length of stay, you can see as those points move further to the right, as the stay becomes longer. And then finally, patients who had more than two or more comorbidities were also two times more likely to be discharged to a post-acute care facility compared to patients who were discharged home. So moving on to the discussion, in summary, most patients, I think it's notable that most patients were discharged home. So 86%, which is reassuring that, we're able to take care of a significant number of patients and we are able to get patients to the post-acute care facilities they need for the 14% that weren't able to be discharged home. Factors that were associated with post-acute care facilities were patients who were male, older age, longer hospital stay, and having multiple comorbidities. Patients who were actually more likely to be discharged home were patients who were identified as Asian race compared to white patients. And so I think at the high level, a lot of the factors that were associated with going to a post-acute care facility are actually associated additionally with patients who typically have a lower functional status. So patients who are older have a longer hospital stay. So anticipation with this dataset, we hope to look at more specifically patients' functional status as they're going to an inpatient rehabilitation facility and see if how these factors are associated with their recovery after their COVID-19 infection. Finally, I'd like to thank Dr. Jaya Balan and Dr. Goodman for their mentorship on this program and this project. Dr. Sean Dreyer, a co-resident who worked on this project, as well as Elizabeth Gray, who was our biostatistician, and Aish Baiju, who was a research scientist on the project. So a large multidisciplinary approach and really a lot of work from everybody. And finally, references are listed here. Happy to take any questions if anyone has any, and thank you for your time. Wow. Thank you so much for that. We are going to open it up to questions if you have any. I wanted to first say two things. One is that these posters are available for your view. You can go on the poster section of the conference site and look at them. They're up there, and the data might be easier to see or if there's something you wanted to look at in more detail. Secondly, I just wanted to, you know, hats off to all of you. You're all trainees, yet you are leading this work in a brand-new diagnosis, a brand-new disease that it's affected your training. I'm sure it's affected all of your lives very much as well. So thank you for taking the time to put these together and learn more about it and share it with us today. So now what we'll do is open it for questions. We have until 1.30, so if there's some you want to put in the chat or if you want to kind of, I don't know, I'll have to ask Sean if people get unmuted or how that works. Maybe put them in the chat first, and we'll get it from there. Yeah, the suggestion is for everyone to submit questions into the chat panel. I don't know who, maybe I could just start with one, maybe asking Dr. Guzel, I'm so interested in the myopathies and the neuropathies, and I was just wondering, you know, I hear this a lot from our clinicians, do we think most of it is from the positioning that people went through in the ICU, or do we think a lot of these issues are primarily from COVID itself? Oh, I think what we came to is it's a mixed picture. I think the peripheral mononeuropathies, one could explain from a positioning, but the critical illness myopathy itself, as well as some of the peripheral polyneuropathies, we think it's sort of kind of this inflammatory state of COVID that predisposes to nerve injury, much the way we think about diabetes or hypothyroid as an independent risk factor for a neuropathy. Well, thank you. I don't know if there's any other questions. I can keep going all day here, but Dr. Zeldin, I know we were talking about the children, and I guess you saw that in your pediatric rotation, but I'm just wondering, as we move through this, do we have a sense of how common this multisystem inflammatory syndrome is going to maybe end up being? It's still a pretty rare complication. I'm trying to look up the incidence of it. I mean, I know we've seen in our pediatric, we have about a 2 million patient base, obviously not all of those are children. We've probably seen like 12 admitted to our rehab unit, and those are just the ones that came to our rehab unit. So it's not horribly uncommon, but it's definitely not a common presentation of COVID. I mean, overwhelmingly children present asymptomatically with COVID or with a common cold-like presentation. Right. Right. And then I was wondering about the seizures. Will they need long-term treatment for the seizures, or is that a- Yeah. So this patient had, they went with the febrile seizures route. So they think it was not secondary to the COVID that it was just a febrile seizure. So fortunately that patient won't need long-term seizures, but yeah, there are some patients who are developing that as a complication. And just like with the ischemic events that patients are seeing due to COVID-19 going home on long-term anticoagulation, a lot of these patients are going home on long-term anti-epileptics and things like that. Wow. It's life-changing. Yeah. Absolutely. Again, I can go on. I don't know if you have any questions for each other. Maybe I'll just ask Dr. Deo not to put anyone on the spot. I'm just so interested in these issues and what residents' experiences have been. So maybe either based on your data or just based on how you've kind of gotten through this, do you have any insights as how residents are handling things or anything that we could do better to support residents or any of that? So I think our program was very supportive. What we studied was specifically the inpatient clinical experience, and we found there wasn't a significant impact, at least when we look at objective numbers. One thing we didn't look at was outpatient clinical experience. I do think that there was a significant impact on that because for a while, our outpatient clinics were canceled. Some of the procedures weren't being done, and I think that did have a pretty big impact on resident education. So I think that would be sort of the next step and the next thing that we'd be interested in studying, specifically looking at how was the outpatient education impacted by COVID. I think that would be really interesting in how people are kind of handling that, you know, if they're applying for things and they don't have enough numbers or, you know, what are we doing to support them? But I just think, again, amazing how you had all of those patients with a brand new diagnosis and didn't have any extra complications, just unbelievable. And I do see a question come in, it looks like Dr. Sieben's, great presentations. For Dr. Lewis, we were able to group hip fracture patients into three clinically distinct groups based on admission FIM and with difference in recovery trajectories. Maybe that will be of interest of you. So I think that would be interesting, like when you're looking at things from these different functional groups, is that something you might want to try or any ideas about that, I guess? Yeah, that sounds fantastic. I think we're hoping to get a sense of the trajectory of functional recovery during inpatient rehabilitation. So definitely take a look at that paper. Thank you so much. Yeah. And I think it's going to be interesting to see how this sort of fits into our field, right, with function and how we're going to look at it. So I love that. We can kind of use what we already know and then keep learning more. So thank you, Dr. Sieben's for sharing that. I was wondering, Dr. Zhao, I thought that was just such an incredible idea, how you even got that idea, or if there's anything else you wanted to share about how we can better support our therapists and our team members. I love how you said, give them all the information we have and all of that, but if there's anything else you wanted to share. Yeah, I think navigating COVID, especially during the inpatient year, our PGY-2 year is pretty heavy with inpatient. And so communicating just daily with the therapists, they really voiced their concerns and with us about just the dynamic changes in COVID policies and protocols. And I think it felt like every week there was a policy change. So we wanted to kind of objectively and qualitatively describe these stresses. And I think as physiatrists, when we lead these daily team conferences, we have the opportunity to take a large role in disseminating accurate and up-to-date changes in protocols and policies for the rest of the staff. I think we have the opportunity to talk to infectious disease colleagues, and we're oftentimes talking to administration. So I think getting everyone on the same page, especially our hospital is a freestanding rehabilitation hospital, I think that can boost the morale and just take a lot of stress off the staff. I really appreciate that. I know here, one thing we've had was, you know, because our team meetings became virtual, you don't realize how much you spend, you know, interacting with each other and how much we get from each other. So I really appreciate you thinking of the team and looking into that. I think we have about only another minute, but Dr. Gerber had put in a question, again, not to put anyone on the spot, but Dr. Giselle, she was wondering if there are any critical factors that might tell you if it's post-ICU versus post-COVID ICU. Yeah, thank you, Dr. Gerber, for the question. I think it's a very good one. I think we have a lot of overlap in our patients. I mean, my understanding of the post-ICU syndrome, it's very holistic. I was really focused on a very specific electrodiagnostic finding. And as we know, post-ICU syndrome encompasses a large psychological component that I imagine our patients, having been through as much as they have, would probably qualify for both. As far as other things that are specific to a global post-ICU COVID syndrome, I think we would need to have a larger data set, to say more definitively, which sounds like a good collaboration with Dr. Lewis and his data set. Well, perfect ending there. There is so much more for us to learn and so much more for us to do, but we really appreciate everything that you have done and presented. And again, anyone can go to the poster sessions, take a look at them, and let us know if you have any questions. And thank you for all your participation today, and we'll look forward to the rest of the conference. Thank you.

COVID-19 pandemic

multisystem inflammatory syndrome in children

critical illness myopathy

post-COVID rehabilitation

inpatient clinical experience

work-related stress

mental health

discharge destinations