Reconciling the threat of COVID-19 on physical health with the threat of quarantining on mental health in neurorehabilitation patients

There’s no question that quarantine has taken a toll on the mental health of many Americans over the course of the last 9 months. Many of us don’t feel secure, physically or financially, and we can all agree that our lack of access to novel stimulation has not been a great help in counteracting the effects of such a morbid and stressful time in our history. We’re discouraged from traveling, from visiting our loved ones, many of our outlets like gyms are made inaccessible, social gatherings are limited and frowned upon, and even watching TV proves tedious as we’ve likely watched everything worth watching at this point in our quarantines and nothing new is being released.

The phrase, “if you don’t use it, you lose it”, comes to mind. Not everything is just like riding a bike. You may have learned French in high school but can many people say that they’ve maintained much of it without practicing it? More pertinently, imagine how many times a day you make a facial expression indicative of your true thoughts that you never would have made if it weren’t for the mask covering your face? This absent minded lack of inhabitation is just one example of the social skills we may have to relearn in a post-pandemic world.

So what else are we losing for lack of novel stimulation?

Our most consistent source of novel stimulation as of late may have been the reportings of political unrest across the country in news outlets and on social media alike. While this constant influx of controversy may serve to entertain us and even challenge us, the overwhelmingly negative reportings do little to improve an already negative state of Ming. Picture your conservative Grandma holed up inside her house for fear of catching COVID, watching Fox News on loop, and having nothing to distract her from the distress of the news until she calls you in a fit of fear for the state of our country.

Well, I’ve never gotten Grandma’s political views, anyways. I’ll tell her to take a walk around the neighborhood to clear her head.

But what of the Americans who can’t just go out for a walk? Or make a phone call to their family members when they’re feeling overwhelmed? What about the Americans whose privileges were already in the hands of others and have been further limited by this pandemic? What is their outlet? How do they let off steam? How do we HELP them to let off steam?

I speak in regards to my personal experiences as health care professional working at a neurorehabilitation facility but this question is not limited to the residents in my care.

Individuals being cared for in adult foster care facilities are used to living a habitual lifestyle. Their daily activities are often scheduled out weeks in advance. But as most of their neurological deficits are due to injury, many of them recall their lives as they were before: their own. Being used to a habitual lifestyle does not equate to being happy with it and being used to a habitual lifestyle does not equate to being used to a lack of novel stimuli. So this particular group of people is one that was already yearning for new experiences. Before quarantine, they’d ask their staff when the next time they’ll be taken to the grocery store or out to eat would be. They’d look forward to the simple pleasures that most people enjoy on a weekly basis. They’d look forward to a break in the monotony.

Now, my patients aren’t allowed to leave our campus at all for fear of exposure and rightfully so; many of our patients also suffer from immunodeficiencies in addition to their brain or spinal injuries. So novel stimulation can only be introduced to them by the staff that cares for them.

This responsibility belongs primarily to our therapeutic recreation staff. These are the employees who hold sessions with groups or individuals both on and off of campus. Assuming that the patient’s insurance covers these sessions, common activities include going to a local park, art projects, card games, trivia, reading horoscopes or the news, etc. You may recognize these as common suggestions that have circulated the internet to fend off boredom in those who are acclimating to life in quarantine. To our patients, this is just life.

Off-campus activities are suspended so our patients are exhausted of card games and art projects. Therapeutic recreation staff no longer reads our patients the news because it’s come to do more harm than good.

Many brain injury patients suffer from lack of motivation or depression as a byproduct of their injuries. The main job of therapeutic recreation staff is to help patients get to a place of mental wellness so that they can fully engage in their rehabilitation to promote independence and a higher quality of life in the future. But if even the staff members are becoming bored of the same activities, day in and day out, how can neurorehab patients be expected to draw anything valuable from them other than distraction? If employees are lacking novel stimulation in their daily lives, how can they bring novel stimulation to people living within a facility that limits their activities even more than ours are limited living in our homes?

Behaviors are often regarded as symptoms in neurological patients and I have observed very real changes in the behaviors of my patients during the past few months of this new reality. Some have declined more rapidly than others. Patients with strong friendships that have leaned on each other in the past have come to quarrel in the common areas. The most polite and docile of my patients have become prone to outburst of anger. Some patients have experienced increasing difficulty with memory recall or spatial recognition. One of my patients used to exercise diligently despite his injuries and he has only just stopped in recent weeks for the first time in his life.

Quarantine isn’t just making them bored- it’s having serious cognitive effects. I admit, I’m no physician and I’ve conducted no studies to ascertain the correlation between my patient’s lack of stimulation and what I’ve perceived to be their cognitive declines. But there is a general consensus among the staff on campus, many of whom have worked in this field for decades, that quarantining is contributing to the decline of their mental health and cognitive abilities. Lack of stimulation can have a direct effect on cognitive ability but so can mental health. If the patient is not motivated to rehabilitate, they will further decline.

So how do we help them to break up the monotony? How do we reconcile the threat of COVID to their physical health with threat of quarantining to their mental health and cognitive recovery?

I can only bring my cat in to work so many times so please, if you have any advice, I’m all ears.