Background: Rehabilitation programs applied in cases of COVID-19-related stroke should
counteract not only the effects of the stroke but also the effects of long-term COVID-19.
As the molecular processes underlying these cases are still not fully understood,
and evidence-based clinical outcomes are scarcely documented, there is a valid need
to gather information and develop rehabilitation strategies for these patients. The
risks, already clarified in the case of stroke, need to be assessed taking into account
the coincidence of the two diseases. Endothelial injuries and emboli that develop
after the hypercoagulable state of COVID-19 may take longer to heal, and complications
may occur during exercise. This case study attempts to determine what the rehabilitation
of a COVID-19-related stroke patient should include. The participant was a 64-year-old
male with ischemic right middle cerebral artery stroke, left-side hemiplegia, and
middle cerebral artery stenosis, and the CT showed a well-defined area of hypoattenuation
in the basal ganglia territory involving the right lentiform nucleus, the anterior
and posterior limbs of the internal capsule, and the dorsal part of the external capsule.
His NIHSS score was 14, and he registered 15 points on the Barthel index. The patient
had a COVID-19 infection two weeks before the stroke event. Methods: Conventional
physical therapy was combined with adaptive ballistic strength training, a high-intensity
interval training regimen, and manual treatment for myofascial release throughout
the chronic recovery phase. Our primary goals were gait rehabilitation, muscle strengthening,
weakness management, as well as spasticity reduction, while three different rehabilitation
approaches were adopted in a single rehabilitation program to improve the outcome
and long-term functional recovery of the patient. Results: The patient progressed
in almost every aspect of the assessment criteria. This combined approach’s main success
was improved gait speed, gait quality, and improved cardiovascular fitness. Take-away
message: In the case of a stroke caused by COVID-19, where the endothelium cells are
compromised, HIIT may be questionable due to the poor vascular condition. Based on
our results, the low-volume HIIT approach proved appropriate and effective.