The face-to-face assessment of and training for dysphagia are considered aerosol-generating procedures, and thus are contraindicated for patients who are positive or suspected of having severe acute respiratory syndrome coronavirus 2 infection. Considering the extremely infectious nature of the virus, transmission to other individuals during rehabilitation is possible. Some patients in the intensive care unit and those who are on endotracheal intubation and mechanical ventilation often have dysphagia. Therefore, assessment and training for oropharyngeal dysphagia are provided by rehabilitation professionals to restore normal feeding before patient discharged. Thus, we aimed to explore the advantages of telerehabilitation in dysphagia management during the coronavirus disease 2019 (COVID-19) pandemic. An infected 50-year-old man admitted to the hospital underwent extracorporeal membrane oxygenation rescue therapy and tracheostomy. Upon gradual respiratory status stabilization, extracorporeal membrane oxygenation therapy was discontinued, and he was weaned off the ventilator. He had difficulty swallowing and coughed after attempting to drink fluids. We considered the application of telerehabilitation for managing dysphagia while minimizing the risk of infection and usage of personal protective equipment. A videoconferencing software on a tablet device provided contactless telerehabilitation, thus reducing the risk of infection and preventing personal protective equipment shortage. Moreover, it facilitates discussion on the issues related to the evaluation of oropharyngeal dysphagia telerehabilitation. We highlight important considerations for the application of telerehabilitation in the assessment and treatment of dysphagia during the COVID-19 pandemic.

Objective: Direct swallowing rehabilitation assessment in patients with highly infectious diseases, such as COVID-19, is not recommended. We aimed to explore the feasibility of using telerehabilitation for managing dysphagia in patients with COVID-19 in isolated hospital rooms.Design: Open-label trial.Subjects/patients: We examined 7 enrolled patients with COVID-19 who presented with dysphagia and were treated with telerehabilitation.Methods: Telerehabilitation was performed for 20 min daily and included indirect and direct swallowing training. Dysphagia was assessed before and after telerehabilitation using the 10-item Eating Assessment Tool, the Mann Assessment of Swallowing Ability and graphical evaluation using tablet device cameras.Results: All patients showed significant improvement in swallowing ability, evaluated by the range of the upward movement of their larynxes and the Eating Assessment Tool and Mann Assessment of Swallowing Ability scores. The change in swallowing evaluation scores was correlated with the number of telerehabilitation sessions. There was no infection spread to the medical staff treating these patients. Dysphagia in patients with COVID-19 was improved using telerehabilitation while ensuring a high degree of safety for clinicians.Conclusion: Telerehabilitation might eliminate the risks associated with patient contact and has the advantage of infection control. Its feasibility needs further exploration. LAY ABSTRACTWe explored the feasibility of using telerehabilitation for managing dysphagia in patients with COVID-19 in isolated hospital rooms. We enrolled 7 patients with dysphagia. Telerehabilitation was performed for 20 min per day and included indirect and direct swallowing training. All patients showed significant improvement in their swallowing ability, evaluated by the range of the upward movement of their larynxes and the Eating Assessment Tool and Mann Assessment of Swallowing Ability scores. The change in swallowing evaluation scores was correlated with the number of telerehabilitation sessions. There was no spread of infection to the medical staff who treated these patients. Dysphagia in patients with COVID-19 was improved using telerehabilitation while ensuring a high degree of safety for clinicians. Telerehabilitation might eliminate the risks associated with patient contact and has the advantage of infection control. Its feasibility should be explored further.

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UNSTRUCTURED Direct swallowing rehabilitation is not recommended for patients who is positive or suspected for the severe acute respiratory syndrome coronavirus 2（SARS-CoV-2），because SARS-CoV-2 is extremely infectious and may transmit to the individual performing rehabilitation. Some of patients in the intensive care unit and on mechanical ventilation undergo the swallowing difficulty. To feed normally again and be discharged, an assessment of dysphagia and eventual targeted swallowing training by specialized rehabilitation professionals are provided. We analysis the benefit of telerehabilitation, and we experienced the case with COVID-19 of contactless swallowing rehabilitation using video conference software on the tablet-type devices. Telerehabilitation offers the risk reduction of infection and the prevention the shortage of personal protective equipment. Protecting the medical staff from nosocomial infection of COVID-19 is therefore extremely important, and we suggest telerehabilitation as a useful approach in the swallowing rehabilitation.

Background: Prosopagnosia is a rare form of apraxia, in which a person has normal memory and vision, but has impaired cognition of human faces that are manifested through symptoms such as not being able to recognize the face of a familiar person, one has known or not being able to remember the face of a person. Here, we report the case of a patient with transient prosopagnosia associated with brain metastasis from epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma who was treated with tyrosine kinase inhibitors (TKIs). Case Description: A 52-year-old right-handed man with lung adenocarcinoma was introduced to our department because brain metastasis. On admission, he complained that he could not recognize his wife’s face, but he could recall her face based on her voice. MRI revealed a right temporo-occipital enhancing lesion with perifocal edema and dissemination that were indicative of brain metastasis from lung adenocarcinoma. Two weeks after open biopsy, he was started on TKI therapy with osimertinib at a dosage of 80 mg/day. An MRI scan taken 1 month later revealed shrinkage of the metastasis. In addition, he had recovered from transient prosopagnosia and returned to normal life. Conclusion: In this study, the TKI osimertinib was administered to a patient with brain metastasis of EGFR-mutated lung adenocarcinoma who presented with prosopagnosia, and the patient’s lesion shrunk and his symptoms were reversed with this treatment.