key: cord-1015999-3wylszuw
authors: Kolakowsky-Hayner, Stephanie A.; Goldin, Yelena
title: Sex and Gender Issues for Individuals with Acquired Brain Injury During COVID-19: A Commentary
date: 2020-09-03
journal: Arch Phys Med Rehabil
DOI: 10.1016/j.apmr.2020.08.004
sha: fa20d837e1b990200490552abb6732d534566fdd
doc_id: 1015999
cord_uid: 3wylszuw

Worldwide, the rehabilitation community has been impacted by the Corona Virus Disease 2019 (COVID-19). This impact has been disproportionately devastating for individuals with disabilities, and particularly individuals with acquired brain injury (ABI) due to injury-related cognitive and/or sensory/physical difficulties. Many physical and psychological symptoms of COVID-19 are already well known issues for individuals with ABI. Even in a fully functional social and healthcare system, post-ABI deficits can pose greater challenges to women and other marginalized groups, such as lesbian, gay, bisexual, transgender, gender-nonconforming, and queer/questioning-identified (LGBTQ+) individuals. The restrictions and changes brought about by COVID-19 have the potential to broaden the existing disparities and limitations. This commentary highlights three key areas to attend to during this pandemic to help assuage such disparities and limitations.

disabilities, and particularly individuals with acquired brain injury (ABI) due to injury-related 23 cognitive and/or sensory/physical difficulties. Many physical and psychological symptoms of 24 COVID-19 are already well known issues for individuals with ABI. Even in a fully functional 25 social and healthcare system, post-ABI deficits can pose greater challenges to women and other 26 marginalized groups, such as lesbian, gay, bisexual, transgender, gender-nonconforming, and 27 queer/questioning-identified (LGBTQ+) individuals. J o u r n a l P r e -p r o o f penetrating injury) and non-traumatic (e.g., aneurysm, anoxia, stroke, tumor) injury, frequently 59 results in persistent and debilitating physical, cognitive and emotional deficits and long-term or 60 permanent disability. [1] [2] [3] [4] [5] [6] [7] According to the Global Burden of Disease Study in 2016, incidence of 61 traumatic brain injury in North America was 1,221,494 and 27,082,033 across the globe. Women and LGBTQ+ individuals with ABI are faced with greater social and economic 121 disparities, as well as general and technological accessibility issues, which are expected to be 122 worsened by the current pandemic. Women and LGBTQ+ individuals with ABI are more likely 123 to be affected by poverty social isolation, lack of familial support, lack of transportation, and 124 lack of community resources. 12 Further, women report more symptoms of depression, anxiety, 125 fatigue, and sleep disturbance than men with ABI. 28 The social and healthcare system 126 services deemed nonessential 30 ) are likely to magnify the inequities in the accessibility of 128 necessary services among women with ABI. While all individuals with ABI may experience 129 greater challenges in accessing essential services in light of the shift in how these services can be 130 accessed (e.g. changes in business operations, social distancing guidelines, greater reliance on 131 the internet, curbside pick-up may not be wheelchair accessible, limited public transportation 132 may limit the ability to get to medical non-cancelled appointments, medical transportation 133 services may be extremely limited or also cancelled.), women with ABI are more likely to lack 134 the resources (internet access or even a computer) and support (family member, caregiver) to 135 help them navigate these increased challenges. 136

Along these lines, with the majority of essential services and everyday activities, 137 including shopping, healthcare, and even social interactions, transitioning to electronic online 138 formats, individuals with cognitive and sensory deficits are faced with navigating these complex 139 and unfamiliar environments that are rarely accommodating to their unique post-ABI challenges. 140

In the setting of social distancing, they may be left without much-needed technical assistance. 141

Even when individuals are able to access in-person healthcare services, the landscape of these 142 services is significantly altered. Having an aide or family assistant attend appointments with the 143 individual with ABI to offset their cognitive difficulties in the provision and gathering of critical 144 information is limited or completely disallowed. Mental health services may be limited to 145 telehealth (which has accessibility limitations noted above) or unavailable, which could further 146 increase suicide rates. 31 147 ABI leads to chronic debilitating physical, cognitive, and emotional difficulties that 148 compromise daily function and contribute to long-term disability in a large proportion of 149 disproportionately affected by poorer outcomes, many of which are systemic. The restrictions 151 and changes brought about by COVID-19 have the potential to broaden the existing disparities 152 and exhaust the limited functional resources of these individuals. Special attention and 153 intervention is warranted in the areas of 1) intimate partner violence, especially in the current 154 environment of greater social isolation and less accessible resources for physical escape and 155 psychological support; 2) accessibility of basic goods and healthcare services, especially with 156 regard to use of technology and web-based forums that are not optimized for individuals with

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