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These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. +Model ARTICLE IN PRESS Neurología xxx (xxxx) xxx—xxx NEUROLOGÍA www.elsevier.es/neurologia LETTER TO THE EDITOR Neuropsychological tasks to be completed during each session and adjusting the difficulty through a combination of parameters (num- rehabilitation program for ber of stimuli, type of stimulus, speed of presentation, task patients with post-COVID-19 duration, etc). The platform’s task plan addresses several syndrome: a clinical cognitive domains (attention, memory, executive function, experience夽 and language, among others). We present the results from 50 patients with no history of neurological disease who completed our neuropsychological Programa de rehabilitación neuropsicológica rehabilitation programme between June 2020 and January en pacientes con síndrome post-COVID-19: 2021. una experiencia clínica Mean age (SD) was 53.3 (12.78) years (range, 26-76). Women accounted for 54% (n = 27) of the total. Level of edu- cation was low (≤8 years of formal schooling) in 9 patients, Dear Editor: average (9-12 years) in 14, and high (≥13 years) in 27. The mean time elapsed between the first positive PCR test and Most patients with SARS-CoV-2 infection recover within inclusion in the neurorehabilitation programme was 24.18 days or weeks. However, symptoms persist in some 10% of weeks (SD: 7.91; range, 12-37). A total of 31 patients (62%) patients.1 Post—COVID-19 syndrome, as it has been called, is were admitted to hospital (either to the intensive care unit a series of symptoms that appear during or after SARS-CoV-2 or to other wards). Significant differences were observed infection, persist for longer than 12 weeks, and cannot be between hospitalised and non-hospitalised patients in sex explained by other causes. It usually presents as a combina- (P < .001) and age (P = .001). Men accounted for 67.7% tion of symptoms that frequently overlap and may fluctuate of hospitalised patients (n = 21), whereas 89.5% (n = 17) and change over time, affecting multiple systems.2 of non-hospitalised patients were women. Non-hospitalised Patients with post—COVID-19 syndrome may present patients were younger (mean [SD] of 45.6 years [10.2], vs memory and concentration problems, brain fog, anxiety, 58 [11.9] years in hospitalised patients). and mood disorders.3 These alterations have a negative Patients were administered a short assessment test bat- impact on the patient’s performance in family, social, or tery before and after completion of the neuropsychological work settings. Neuropsychological rehabilitation may help rehabilitation programme, including the following tests: for- these patients to recover brain function, improve functional ward and backward digit span, Rey Auditory Verbal Learning capacity, and increase emotional well-being. Test (RAVLT; learning, recall, and recognition), a formal In June 2020, Institut Guttmann started an 8-week out- phonemic fluency task (PMR), and the Hospital Anxiety and patient neurorehabilitation programme for patients with Depression Scale (HADS). Pre- and post-treatment results post—COVID-19 syndrome. The programme includes respi- were compared with the Wilcoxon test for related samples ratory therapy, physical therapy, and neuropsychological (␣ < .05). Effect size was calculated with the Pearson cor- rehabilitation (mood intervention, compensatory strategies, relation coefficient. Effect size was considered small for and cognitive therapy). Patients received cognitive ther- r ≈ 0.10, median for r ≈ 0.30, and large for r ≈ 0.50.5 apy at home, using the Guttmann NeuroPersonalTrainer® In neuropsychological rehabilitation, and in neuroreha- platform (5 sessions/week of one-hour duration). The bilitation in general, observing psychometric changes after programme’s planning assistant designed the intervention an intervention inevitably leads us to question whether based on pre-treatment assessment results,4 selecting the these differences reflect a true change (recovery) or rather constitute a consequence of the practice effect (change or improvement resulting from practice or repeated expo- sure to an assessment test). We attempted to minimise the 夽 Please cite this article as: García-Molina A, Espiña-Bou M, impact of the practice effect on post-treatment results by Rodríguez-Rajo P, Sánchez-Carrión R, Enseñat-Cantallops A. Pro- correcting raw scores according to the procedure used by grama de reha-bilitación neuropsicológica en pacientes con Lubrini et al.,6 which is in turn based on a study by Calamia síndrome post-COVID-19: una experiencia clínica. Neurología. 2021. et al.7 https://doi.org/10.1016/j.nrl.2021.03.008 2173-5808/© 2021 Sociedad Española de Neurología. Published by Elsevier Espa?a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). No. of Pages 2 +Model ARTICLE IN PRESS A. García-Molina, M. Espiña-Bou, P. Rodríguez-Rajo et al. In the group of non-hospitalised patients, significant References differences were observed between pre- and (corrected) post-treatment scores in the backward digit span (P = .048; 1. Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. r = 0.32), RAVLT-learning (P = .004; r = 0.47), RAVLT- Management of post-acute covid-19 in primary care. BMJ. recall (P = .002; r = 0.5), RAVLT-recognition (P = .004; 2020;370:m3026. r = 0.46), HADS-anxiety (P = .021; r = 0.39), and HADS- 2. COVID-19 rapid guideline: managing the long term effects of depression (P = .046; r = 0.34). In the group of hospitalised COVID-19. Available from: www.nice.org.uk/guidance/ng188. [Accessed 9 March 2021]. patients, significant differences were observed in RAVLT- 3. Shah W, Hillman T, Playford ED, Hishmeh L. Managing the long learning (P = .005; r = 0.36), RAVLT-recall (P < .001; r = 0.5), term effects of covid-19: summary of NICE, SIGN, and RCGP rapid RAVLT-recognition (P = .033; r = 0.27), PMR (P = .042; guideline. BMJ. 2021;372:n136. r = 0.25), HADS-anxiety (P = .002; r = 0.42), and HADS- 4. Solana J, Cáceres C, García-Molina A, Opisso E, Roig T, Tormos depression (P = .001; r = 0.46). JM, et al. Improving brain injury cognitive rehabilitation by per- All patients included in the neuropsychological rehabili- sonalized telerehabilitation services: Guttmann Neuropersonal tation programme performed better on memory tasks after Trainer. IEEE J Biomed Health Inf. 2015;19:124—31. treatment. Hospitalised patients also performed better on 5. Dominguez-Lara S. Magnitud del efecto, una guía rápida. Edu- the phonemic fluency task after the intervention (this test cación Médica. 2018;19:251—4. is sensitive to alterations in executive control, particularly 6. Lubrini G, Viejo-Sobera R, Periáñez JA, Cicuendez M, Castaño AM, González-Marqués J, et al. Evolución de las alteraciones response initiation and maintenance, inhibition, organisa- cognitivas tras un traumatismo craneoencefálico: ¿hay mejoría tion, cognitive flexibility, and monitoring). Pre-treatment tras controlar el efecto de la práctica? Rev Neurol. 2020; HADS scores revealed symptoms of anxiety and depression 70:37—44. in both hospitalised and non-hospitalised patients. After the 7. Calamia M, Markon K, Tranel D. Scoring higher the second time intervention, the likelihood of presenting symptoms of anx- around: meta-analyses of practice effects in neuropsychological iety or depression decreased significantly. assessment. Clin Neuropsychol. 2012;26:543—70. Our study did not include a control group due to its practical nature and the circumstances surrounding the A. García-Molina a,b,c,∗ , M. Espiña-Bou a,b,c , implementation of the rehabilitation programme. We are P. Rodríguez-Rajo a,b,c , R. Sánchez-Carrión a,b,c , aware that this limits the possibility of extrapolating our A. Enseñat-Cantallops a,b,c results on the effectiveness of this intervention. However, a Institut Guttmann, Institut Universitari de our experience suggests that neuropsychological rehabili- Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, tation is useful in the treatment of cognitive and mood Spain disorders in patients with post—COVID-19 syndrome. Stud- b Fundació Institut d’Investigació en Ciències de la Salut ies with longer follow-up periods are needed to determine Germans Trias i Pujol, Badalona, Barcelona, Spain whether improvements persist in the medium and long term. c Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain ∗ Conflicts of interest Corresponding author. E-mail address: agarciam@guttmann.com Guttmann NeuroPersonalTrainer® is in part property of (A. García-Molina). Institut Guttmann. García-Molina, Rodríguez-Rajo, and Sánchez-Carrión participated in the theoretical and concep- tual development of the platform. 2