Table 1

A table to show the impact of changes to normal practice resulting from COVID-19, on the rehabilitation process and on the patient and his carer

Change to normal practice because of COVID-19	Impact on rehabilitation	Impact on patient/carer
Visitation to hospital suspended, replaced with virtual contact using iPad	Unable to involve family/carer in rehabilitation process Fewer family meetings with carer and wider family therefore less opportunity to provide education and support around adjustment to life after stroke	Patient unable to engage in virtual contact due to aphasia Carer felt isolated and unable to gauge the extent of communication difficulties
Restrictions on community staff accessing hospital wards	No in-reach to support discharge and consider medication management/early liaison with GP. May have avoided rehabilitation breaks due to unmanaged pain and low mood	Difficulty adjusting to life at home following discharge from hospital which team could have supported through in-reach
Use of PPE—facemasks and visors	Eliminated therapist directed visual articulation cues during apraxia of speech rehabilitation and multidisciplinary rehabilitation tasks	Increased burden on partner to be involved in multidisciplinary rehabilitation as she was not required to wear a mask in the home Increased frustrations when the patient was unable to understand therapists
Community clinic spaces closed	Limited opportunity to progress difficulty of rehabilitation in home environment Reduced access to equipment and group classes to facilitate social interaction and communication strategies	Patient was limited to home environment but due to progressing quickly wanted to increase the intensity and difficulty of his rehabilitation. Being unable to do this increased his frustration and impacted his mood Increased carer stress supporting patient with low mood, unable to have breaks for self-care
Local lockdowns and public health restrictions closing local community resources	No access to local facilities and groups to support discharge planning which increased length of stay Unable to practice functional and higher-level tasks outside of home environment Increased requirement for team to support patient and carer as wider family not able to visit during lockdowns	Unable to access local groups (patient and carer groups) for peer and carer support Unable to practice speech strategies outside of therapists and partner Unable to access personal assistant support through social services at start of rehabilitation, increased carer stress/burden
Virtual support groups	Technical issues often limited access to virtual support groups Increased team involvement to provide additional support to patient and carer in the absence of functioning local groups	Patient mostly excluded from these groups due to communication impairment Neither patient nor carer use technology so could not see the value in accessing these groups. Eliminated valuable peer support

GP, General Practitioner ; PPE, personal protective equipment.