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Post-COVID-19’da Nörolojik Etkilenimlerin Pulmoner Rehabilitasyon Yaklaşımları Açısından Kısıtları

Yıl 2022, Cilt: 2 Sayı: 1, 20 - 26, 15.01.2022

Zeynep Yıldız Kızkın Ufuk Yurdalan

Öz

Bu çalışmanın amacı, COVID-19 sonrası nörolojik etkilenimin de eşlik ettiği durumda pulmoner rehabilitasyon uygulamaları açısından oluşturduğu kısıtları ortaya koymaktır. İlgili çalışmalar, PubMed, Google Scholar, Cochrane, PEDro ve CINAHL veritabanlarında elektronik aramayla belirlenmiştir. Aralık 2019-Haziran 2021 tarihleri arasındaki makaleler herhangi bir dil kısıtlaması uygulanmadan taranmıştır. Veritabanlarında SARS-CoV-2/COVID-19, nörolojik etkilenimler ve tedavileri ile ilgili terimler MeSH değerlendirme kriterlerine uygun olarak seçilmiştir. Baş ağrısı, baş dönmesi, tat ve koku bozuklukları ve konfüzyon en sık tanımlanan semptomlardır. Yanısıra inme, Guillain-Barre Sendromu, ataksi, polinöropati/miyopati ve ensefalopati de enfeksiyon sonrası klinik tabloda görülmektedir. Ayrıca enfeksiyon öncesi nörolojik hikayesi bulunan hastalarda enfeksiyonla birlikte mortalite ve morbidite oranları da artmaktadır. Nörolojik etkilenimli hastalarda özellikle yorgunluk ve egzersiz intoleransı semptomlarında yüksek şiddetli egzersiz programlarından kaçınılmalıdır. COVID-19 hastalarında sık görülen nörolojik etkilenime göre rehabilitasyon kısıtlarının dikkate alınması uygulama başarısı açısından klinik anlamda önemlidir.

Anahtar Kelimeler

COVID-19 nörolojik etkilenim yorgunluk egzersiz intoleransı

Kaynakça

  • Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  • Ribeiro R, Brandão D, Noronha J, Lima C, Fregonezi G, Resqueti V, et al. Breath-stacking and incentive spirometry in Parkinson's disease: Randomized crossover clinical trial. Respir Physiol Neurobiol. 2018;255:11-6.
  • Meinhardt J, Radke J, Dittmayer C, Franz J, Thomas C, Mothes R, et al. Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci. 2021;24(2):168-75.
  • Abdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Afamefuna Victor E, et al. Neurological and Musculoskeletal Features of COVID-19: A Systematic Review and Meta-Analysis. Front Neurol. 2020;11:687.
  • Esler M, Esler D. Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic? J Hypertens. 2020;38(5):781-2.
  • Doblan A, Kaplama ME, Ak S, Basmacı N, Tarini EZ, Göktaş Ş E, et al. Cranial nerve involvement in COVID-19. Am J Otolaryngol. 2021;42(5):102999.
  • Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem Neurosci. 2021;12(4):573-80.
  • Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020;382(20):e60.
  • Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. Guillain-Barré syndrome related to COVID-19 infection. Neurology - Neuroimmunology Neuroinflammation. 2020;7(4):e741.
  • Camdessanche JP, Morel J, Pozzetto B, Paul S, Tholance Y, Botelho-Nevers E. COVID-19 may induce Guillain-Barré syndrome. Rev Neurol (Paris). 2020;176(6):516-8.
  • Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med. 2020;382(26):2574-6.
  • Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020;19(5):383-4.
  • Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38.
  • Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chemical Neuroscience. 2020;11(7):995-8.
  • Whittaker A, Anson M, Harky A. Neurological Manifestations of COVID-19: A systematic review and current update. Acta Neurol Scand. 2020;142(1):14-22.
  • Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, et al. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clin Med (Lond). 2021;21(1):e63-e7.
  • Trejo-Gabriel-Galán JM. Stroke as a complication and prognostic factor of COVID-19. Neurologia (Engl Ed). 2020;35(5):318-22.
  • Fasano A, Cereda E, Barichella M, Cassani E, Ferri V, Zecchinelli AL, et al. COVID-19 in Parkinson's Disease Patients Living in Lombardy, Italy. Mov Disord. 2020;35(7):1089-93.
  • Sorbera C, Brigandì A, Cimino V, Bonanno L, Ciurleo R, Bramanti P, et al. The impact of SARS-COV2 infection on people in residential care with Parkinson Disease or parkinsonisms: Clinical case series study. PLOS ONE. 2021;16(5):e0251313.
  • Ehgoetz Martens KA, Hall JM, Georgiades MJ, Gilat M, Walton CC, Matar E, et al. The functional network signature of heterogeneity in freezing of gait. Brain. 2018;141(4):1145-60.
  • Stillman MD, Capron M, Alexander M, Di Giusto ML, Scivoletto G. COVID-19 and spinal cord injury and disease: results of an international survey. Spinal Cord Ser Cases. 2020;6(1):21.
  • Brownlee W, Bourdette D, Broadley S, Killestein J, Ciccarelli O. Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic. Neurology. 2020;94(22):949-52.
  • Kubota T, Kuroda N. Exacerbation of neurological symptoms and COVID-19 severity in patients with preexisting neurological disorders and COVID-19: A systematic review. Clin Neurol Neurosurg. 2021;200:106349.
  • Abonie US, Sandercock GRH, Heesterbeek M, Hettinga FJ. Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: a meta-analysis. Disabil Rehabil. 2020;42(5):613-22.
  • Torjesen I. NICE advises against using graded exercise therapy for patients recovering from covid-19. Bmj. 2020;370:m2912.
  • Davis SL, Jay O, Wilson TE. Thermoregulatory dysfunction in multiple sclerosis. Handb Clin Neurol. 2018;157:701-14.
  • Jason LA, Sunnquist M. The Development of the DePaul Symptom Questionnaire: Original, Expanded, Brief, and Pediatric Versions. Front Pediatr. 2018;6:330.
  • Stussman B, Williams A, Snow J, Gavin A, Scott R, Nath A, et al. Characterization of Post-exertional Malaise in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Neurol. 2020;11:1025.
  • Tverring J, Åkesson A, Nielsen N. Helmet continuous positive airway pressure versus high-flow nasal cannula in COVID-19: a pragmatic randomised clinical trial (COVID HELMET). Trials. 2020;21(1):994.
  • Despres C, Brunin Y, Berthier F, Pili-Floury S, Besch G. Prone positioning combined with high-flow nasal or conventional oxygen therapy in severe Covid-19 patients. Crit Care. 2020;24(1):256.
  • Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020;90(1).
  • Buccafusca M, Micali C, Autunno M, Versace AG, Nunnari G, Musumeci O. Favourable course in a cohort of Parkinson's disease patients infected by SARS-CoV-2: a single-centre experience. Neurol Sci. 2021;42(3):811-6.
  • Montero Ferro A, R PB-V, Moreira Mello RL, Sanches Garcia-Araujo A, Gonçalves Mendes R, Costa D, et al. Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson's disease: Randomized controlled clinical trial protocol. Physiother Res Int. 2019;24(3):e1777.
  • Reyes A, Castillo A, Castillo J, Cornejo I. The effects of respiratory muscle training on peak cough flow in patients with Parkinson's disease: a randomized controlled study. Clin Rehabil. 2018;32(10):1317-27.
  • Martin-Sanchez C, Calvo-Arenillas JI, Barbero-Iglesias FJ, Fonseca E, Sanchez-Santos JM, Martin-Nogueras AM. Effects of 12-week inspiratory muscle training with low resistance in patients with multiple sclerosis: A non-randomised, double-blind, controlled trial. Mult Scler Relat Disord. 2020;46:102574.
  • Guillén-Solà A, Messagi Sartor M, Bofill Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil. 2017;31(6):761-71.
  • Chen PC, Liaw MY, Wang LY, Tsai YC, Hsin YJ, Chen YC, et al. Inspiratory muscle training in stroke patients with congestive heart failure: A CONSORT-compliant prospective randomized single-blind controlled trial. Medicine (Baltimore). 2016;95(37):e4856.
  • Oh D, Kim G, Lee W, Shin MM. Effects of inspiratory muscle training on balance ability and abdominal muscle thickness in chronic stroke patients. J Phys Ther Sci. 2016;28(1):107-11.
  • Zheng Y, Zhang Y, Li H, Qiao L, Fu W, Yu L, et al. Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2021;102(3):423-30.
  • Walgaard C, Lingsma HF, van Doorn PA, van der Jagt M, Steyerberg EW, Jacobs BC. Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain-Barré Syndrome. Neurocrit Care. 2017;26(1):6-13.
  • Shin JC, Han EY, Cho KH, Im SH. Improvement in Pulmonary Function with Short-term Rehabilitation Treatment in Spinal Cord Injury Patients. Sci Rep. 2019;9(1):17091.
  • Schilero GJ, Bauman WA, Radulovic M. Traumatic Spinal Cord Injury: Pulmonary Physiologic Principles and Management. Clin Chest Med. 2018;39(2):411-25.
  • [Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;17(0):E020.

LİMİTATİONS OF NEUROLOGİCAL INFLUENCES İN TERMS OF PULMONARY REHABİLİTATİON APPROACHES İN POST-COVID-19

Yıl 2022, Cilt: 2 Sayı: 1, 20 - 26, 15.01.2022

Zeynep Yıldız Kızkın Ufuk Yurdalan

Öz

Aim of this study is to determine the limitations of pulmonary rehabilitation interventions applied in COVID-19 in the neurological involvement. Relevant studies were identifed through electronic explorations of PubMed, Google Scholar, Cochrane, PEDro and CINAHL. Articles between December 2019 and June 2021 were scanned without any language restrictions. Databases were selected in accordance with the MeSH evaluation criteria for terms related to SARS-CoV-2/COVID 19, neurological manifestations and treatment. Headache, dizziness, taste and smell dysfunctions, and impaired consciousness were the most frequently described symptoms. Besides, after infection, stroke, Guillain-Barre Syndrome, ataxia, polyneuropathy/myopathy, and encephalopathy are also common. Also, infection increases mortality and morbidity rates in individuals who have had a neurological history prior to infection. Patients with neurological involvement should avoid high-intensity exercise programs, especially in the symptoms of fatigue and exercise intolerance. Considering the rehabilitation constraints according to the common neurological involvement in COVID-19 patients is clinically important for the success of the application.

Anahtar Kelimeler

COVID-19 neurological involvement fatigue exercise intolerance

Kaynakça

  • Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  • Ribeiro R, Brandão D, Noronha J, Lima C, Fregonezi G, Resqueti V, et al. Breath-stacking and incentive spirometry in Parkinson's disease: Randomized crossover clinical trial. Respir Physiol Neurobiol. 2018;255:11-6.
  • Meinhardt J, Radke J, Dittmayer C, Franz J, Thomas C, Mothes R, et al. Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci. 2021;24(2):168-75.
  • Abdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Afamefuna Victor E, et al. Neurological and Musculoskeletal Features of COVID-19: A Systematic Review and Meta-Analysis. Front Neurol. 2020;11:687.
  • Esler M, Esler D. Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic? J Hypertens. 2020;38(5):781-2.
  • Doblan A, Kaplama ME, Ak S, Basmacı N, Tarini EZ, Göktaş Ş E, et al. Cranial nerve involvement in COVID-19. Am J Otolaryngol. 2021;42(5):102999.
  • Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem Neurosci. 2021;12(4):573-80.
  • Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020;382(20):e60.
  • Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. Guillain-Barré syndrome related to COVID-19 infection. Neurology - Neuroimmunology Neuroinflammation. 2020;7(4):e741.
  • Camdessanche JP, Morel J, Pozzetto B, Paul S, Tholance Y, Botelho-Nevers E. COVID-19 may induce Guillain-Barré syndrome. Rev Neurol (Paris). 2020;176(6):516-8.
  • Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med. 2020;382(26):2574-6.
  • Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020;19(5):383-4.
  • Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38.
  • Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chemical Neuroscience. 2020;11(7):995-8.
  • Whittaker A, Anson M, Harky A. Neurological Manifestations of COVID-19: A systematic review and current update. Acta Neurol Scand. 2020;142(1):14-22.
  • Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, et al. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clin Med (Lond). 2021;21(1):e63-e7.
  • Trejo-Gabriel-Galán JM. Stroke as a complication and prognostic factor of COVID-19. Neurologia (Engl Ed). 2020;35(5):318-22.
  • Fasano A, Cereda E, Barichella M, Cassani E, Ferri V, Zecchinelli AL, et al. COVID-19 in Parkinson's Disease Patients Living in Lombardy, Italy. Mov Disord. 2020;35(7):1089-93.
  • Sorbera C, Brigandì A, Cimino V, Bonanno L, Ciurleo R, Bramanti P, et al. The impact of SARS-COV2 infection on people in residential care with Parkinson Disease or parkinsonisms: Clinical case series study. PLOS ONE. 2021;16(5):e0251313.
  • Ehgoetz Martens KA, Hall JM, Georgiades MJ, Gilat M, Walton CC, Matar E, et al. The functional network signature of heterogeneity in freezing of gait. Brain. 2018;141(4):1145-60.
  • Stillman MD, Capron M, Alexander M, Di Giusto ML, Scivoletto G. COVID-19 and spinal cord injury and disease: results of an international survey. Spinal Cord Ser Cases. 2020;6(1):21.
  • Brownlee W, Bourdette D, Broadley S, Killestein J, Ciccarelli O. Treating multiple sclerosis and neuromyelitis optica spectrum disorder during the COVID-19 pandemic. Neurology. 2020;94(22):949-52.
  • Kubota T, Kuroda N. Exacerbation of neurological symptoms and COVID-19 severity in patients with preexisting neurological disorders and COVID-19: A systematic review. Clin Neurol Neurosurg. 2021;200:106349.
  • Abonie US, Sandercock GRH, Heesterbeek M, Hettinga FJ. Effects of activity pacing in patients with chronic conditions associated with fatigue complaints: a meta-analysis. Disabil Rehabil. 2020;42(5):613-22.
  • Torjesen I. NICE advises against using graded exercise therapy for patients recovering from covid-19. Bmj. 2020;370:m2912.
  • Davis SL, Jay O, Wilson TE. Thermoregulatory dysfunction in multiple sclerosis. Handb Clin Neurol. 2018;157:701-14.
  • Jason LA, Sunnquist M. The Development of the DePaul Symptom Questionnaire: Original, Expanded, Brief, and Pediatric Versions. Front Pediatr. 2018;6:330.
  • Stussman B, Williams A, Snow J, Gavin A, Scott R, Nath A, et al. Characterization of Post-exertional Malaise in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Neurol. 2020;11:1025.
  • Tverring J, Åkesson A, Nielsen N. Helmet continuous positive airway pressure versus high-flow nasal cannula in COVID-19: a pragmatic randomised clinical trial (COVID HELMET). Trials. 2020;21(1):994.
  • Despres C, Brunin Y, Berthier F, Pili-Floury S, Besch G. Prone positioning combined with high-flow nasal or conventional oxygen therapy in severe Covid-19 patients. Crit Care. 2020;24(1):256.
  • Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020;90(1).
  • Buccafusca M, Micali C, Autunno M, Versace AG, Nunnari G, Musumeci O. Favourable course in a cohort of Parkinson's disease patients infected by SARS-CoV-2: a single-centre experience. Neurol Sci. 2021;42(3):811-6.
  • Montero Ferro A, R PB-V, Moreira Mello RL, Sanches Garcia-Araujo A, Gonçalves Mendes R, Costa D, et al. Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson's disease: Randomized controlled clinical trial protocol. Physiother Res Int. 2019;24(3):e1777.
  • Reyes A, Castillo A, Castillo J, Cornejo I. The effects of respiratory muscle training on peak cough flow in patients with Parkinson's disease: a randomized controlled study. Clin Rehabil. 2018;32(10):1317-27.
  • Martin-Sanchez C, Calvo-Arenillas JI, Barbero-Iglesias FJ, Fonseca E, Sanchez-Santos JM, Martin-Nogueras AM. Effects of 12-week inspiratory muscle training with low resistance in patients with multiple sclerosis: A non-randomised, double-blind, controlled trial. Mult Scler Relat Disord. 2020;46:102574.
  • Guillén-Solà A, Messagi Sartor M, Bofill Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil. 2017;31(6):761-71.
  • Chen PC, Liaw MY, Wang LY, Tsai YC, Hsin YJ, Chen YC, et al. Inspiratory muscle training in stroke patients with congestive heart failure: A CONSORT-compliant prospective randomized single-blind controlled trial. Medicine (Baltimore). 2016;95(37):e4856.
  • Oh D, Kim G, Lee W, Shin MM. Effects of inspiratory muscle training on balance ability and abdominal muscle thickness in chronic stroke patients. J Phys Ther Sci. 2016;28(1):107-11.
  • Zheng Y, Zhang Y, Li H, Qiao L, Fu W, Yu L, et al. Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2021;102(3):423-30.
  • Walgaard C, Lingsma HF, van Doorn PA, van der Jagt M, Steyerberg EW, Jacobs BC. Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain-Barré Syndrome. Neurocrit Care. 2017;26(1):6-13.
  • Shin JC, Han EY, Cho KH, Im SH. Improvement in Pulmonary Function with Short-term Rehabilitation Treatment in Spinal Cord Injury Patients. Sci Rep. 2019;9(1):17091.
  • Schilero GJ, Bauman WA, Radulovic M. Traumatic Spinal Cord Injury: Pulmonary Physiologic Principles and Management. Clin Chest Med. 2018;39(2):411-25.
  • [Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;17(0):E020.
Toplam 44 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Zeynep Yıldız Kızkın 0000-0002-2510-5410

Ufuk Yurdalan 0000-0003-0985-0100

Yayımlanma Tarihi 15 Ocak 2022
Gönderilme Tarihi 14 Ekim 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 2 Sayı: 1

Kaynak Göster

APA Yıldız Kızkın, Z., & Yurdalan, U. (2022). Post-COVID-19’da Nörolojik Etkilenimlerin Pulmoner Rehabilitasyon Yaklaşımları Açısından Kısıtları. Journal of Health Sciences and Management, 2(1), 20-26.
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