Neuromuscular Control and Motor Learning in Long COVID Across the Adult Lifespan: A Narrative Review

Long COVID is characterized by persistent symptoms and functional impairments long after acute SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 infection. Among these neuromuscular deficits and motor control impairments impact daily functioning however their nature across adult age groups remains poorly understood. The objective of the review is to synthesize current evidence on neuromuscular control impairments and motor learning deficits in Long COVID across the adult lifespan highlighting key neuromuscular symptoms balance and gait abnormalities motor learning issues and age-related differences. We conducted a narrative review searching electronic databases 2020ndash2024 for studies of neuromuscular outcomes motor performance or motor learning in adults with Long COVID. Key findings from relevant studies were organized thematically neuromuscular impairments balancegait outcomes age differences. Long COVID is associated with a high prevalence of fatigue and muscle weakness along with evidence of peripheral nervous system involvement e.g. myalgias neuropathic symptoms. Objective studies have demonstrated persistent muscle strength deficits reduced endurance and post-exertional malaise linked to mitochondrial dysfunction in skeletal muscle. Balance and gait disturbances are commonly reported posturography and mobility tests reveal increased postural sway and slower gait speed in post-COVID individuals compared to controls. Emerging data also indicate impaired procedural motor memory consolidation in Long COVID patients despite intact initial learning. Notably the burden of Long COVID neuromuscular and cognitive symptoms affects both young and older adults. Older survivors often exhibit greater physical deconditioning whereas young and middle-aged adults disproportionately report neurologic symptoms like ldquobrain fogrdquo and fatigue. Long COVID results in significant impairments of neuromuscular control and challenges to motor learning across adult age groups. These findings underscore the need for targeted rehabilitation strategies addressing persistent weakness balance deficits and motor relearning with consideration of age-specific needs.