Physical therapy rehabilitation for COVID-19 recovery

COVID-19, or the coronavirus, has placed unprecedented pressures on our healthcare system. Thanks to front-line healthcare workers, many who were seriously ill have survived. With the passage of time, however, post-recovery effects are becoming evident.

The National Institutes of Health has warned of the potential increase in “long COVID”, which refers to the post-acute stage of SARS-CoV2 infections.

Some long COVID symptoms include difficulty breathing, weakness and fatigue, palpitations and dizziness, all which can have potential impact on mobility and return to full function. Long COVID symptoms can be present, not just in individuals who are hospitalised but also in those who are recovering at home. Locally, we have just started to talk about improving the health status of those who may have persistent symptoms after COVID-19 infection.

The good news is that physical therapists, working closely with the medical team, can help with recovery from these COVID-19-related symptoms. Physical therapists spend at least four years in training to become experts in the design and delivery of exercise prescriptions and are familiar with the management of respiratory symptoms as well as movement-related problems. Their medical skill set is particularly relevant in the context of COVID-19 where rehabilitation needs may be amplified by underlying health conditions, as well as diminished health associated with the ageing process.

In the hospital setting physiotherapy plays an important role in the acute phase of COVID-19 hospitalisation by offering both respiratory and mobility care. Respiratory physiotherapy uses specific interventions to reduce shortness of breath, improve lung capacity and even to aid in reducing the impact of respiratory symptoms on mental health.

Techniques include breathing exercises to adjust the breathing rhythm; techniques to strengthen the chest muscles and expectoration training, which helps to clear mucus from the airways. Unconscious patients are treated with vibration and manual techniques to loosen congested airways.

CHALLENGE

The preservation of motion and strength in the confines of a bed or small hospital room poses challenges to patients, especially those who may be on a ventilator. Physical therapists perform passive movements on ventilated patients who are unable to move their own limbs. This keeps the joints mobile until they are able to move their own limbs again. For those who are able to move, the therapist guides them through manageable exercise which will help preserve muscle strength and lung capacity.

Ultimately, by getting the patient moving and breathing better they can be discharged from hospital care, which is especially critical in the context of hospital bed shortages.

Moderate to severe cases of COVID-19 often have persistent rehabilitation needs after they test negative. These syndromes can be related to the direct effect of the virus on the lungs as well as the consequences of being on a ventilator, prolonged inactivity and bed rest. These individuals present with varying degrees of incapacitation due to impaired lung function; physical deconditioning and muscle weakness.

To determine the status of the individual, the physical therapist does a comprehensive assessment and personalised plan of care tailored to meet the needs of each patient. At this stage their response to exercise has to be closely monitored as they are often weak and easily fatigued since their lung capacity may not yet be able to handle the demands of overexertion.

This underscores the importance of having a medically trained rehabilitation professional, working as part of the medical team who is skilled not just in scientifically determining the exercise needs of the individual but also who, by objective monitoring, is responsive to changes in respiratory rate, blood oxygen levels, blood pressure, as well as the client’s perceived response to exertion.

LONG-TERM REHABILITATION

Whether recovered in the hospital or at own home, most will return to normal health without the need for rehabilitation. For some, however, there may be need for physical therapy due to the lasting effects that COVID-19 can create, even after the body fights off the virus.

As in the hospitalisation phase, there may be the persistence or the late onset of symptoms including fatigue, weakness, poor mobility, and difficulty breathing. Physical therapy offers the rehabilitation resources to cautiously guide post-COVID-19 patients through this next phase of their recovery to ensure a smooth transition from home to safely and effectively resume work and other activities.

Exercise in long COVID should be approached with care to minimise risk and to ensure exercise programmes are restorative and do not make the individual’s symptoms worse by overexertion.

During this phase, the therapist again assesses the individual and cautiously does aerobic exercise training to improve heart and lung health, strength training to restore muscle bulk and function and endurance training to reduce fatigue and promote participation in pre-COVID-19 activities. Some clients may require balance training to reduce fall risk. All this is performed in a safe environment with the necessary monitoring, pacing the exercise so there .

We look forward to a time, post-COVID-19, when we will all be able to move about freely again. In the meantime, we encourage those who are recovering to seek out the rehabilitation resources that are available to restore their health to a place where they will once more experience the best quality of life.

Dr Bernadette Bryan-Frankson has over 40 year years of experience in the field of physical therapy. She owns and operates at Physical Therapy Solutions.