From the Guidelines
Autonomic testing is highly recommended for patients experiencing balance and dexterity issues after COVID-19, as these symptoms could indicate post-COVID autonomic dysfunction, which is a common feature of long COVID, affecting a significant proportion of patients 1.
Autonomic Dysfunction in Long COVID
Autonomic dysfunction, including postural orthostatic tachycardia syndrome (POTS), is a well-documented complication of long COVID, with symptoms persisting for years and potentially being lifelong 1. The exact mechanisms are not fully understood but may involve immune dysregulation, persisting reservoirs of SARS-CoV-2 in tissues, and autoimmunity 1.
Testing for Autonomic Dysfunction
Testing for autonomic dysfunction typically includes:
- Heart rate variability assessment
- Tilt table testing
- Sudomotor function tests
- Quantitative sensory testing These tests evaluate how well the autonomic nervous system is functioning by measuring responses like blood pressure changes when standing, sweating patterns, and heart rate variations during breathing exercises 1.
Management and Recovery
Patients experiencing balance and dexterity issues after COVID-19 should consult a neurologist or autonomic specialist to determine appropriate testing and management based on specific symptoms. While waiting for evaluation, patients should:
- Stay hydrated
- Change positions slowly to avoid dizziness
- Maintain a consistent sleep schedule Recovery from autonomic dysfunction varies but often improves gradually with proper management and time 1.
Importance of Early Detection and Management
Early detection and management of autonomic dysfunction are crucial to prevent long-term complications and improve quality of life. Given the potential for cognitive impairment, neurological symptoms, and other systemic effects associated with long COVID, a comprehensive approach to diagnosis and treatment is essential 1.
From the Research
Autonomic Testing and COVID-19
The patient's recent recovery from COVID-19 and current issues with balance and dexterity may be related to autonomic dysfunction, which has been suggested as a possible complication in post-COVID individuals 2.
Balance and Dexterity Issues
Studies have shown that patients with post-acute COVID-19 exhibit balance deficits in both dynamic and static conditions, similar to those with chronic obstructive pulmonary disease 3. This suggests that balance and mobility physiotherapy may be necessary to prevent falls in these patients.
Autonomic Dysfunction
Autonomic dysfunction, including orthostatic hypotension and postural tachycardia syndrome, has been found in post-COVID patients 2, 4. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a validated tool to assess dysautonomic symptoms 2. Heart rate variability (HRV) has also been used to indicate autonomic imbalances in individuals with Long COVID 5.
Key Findings
- Post-COVID patients may experience autonomic dysfunction, including orthostatic hypotension and postural tachycardia syndrome 2, 4
- Balance deficits are common in post-acute COVID-19 patients, similar to those with chronic obstructive pulmonary disease 3
- HRV can indicate autonomic imbalances in individuals with Long COVID 5
- The COMPASS-31 questionnaire is a validated tool to assess dysautonomic symptoms 2
Testing and Assessment
Autonomic testing, including HRV and the COMPASS-31 questionnaire, may be useful in assessing autonomic function in post-COVID patients 2, 5. Additionally, balance and mobility assessments, such as the Mini-BESTest and the Timed Up and Go test, can help identify balance deficits in these patients 3.