COVID-19 June 12
A new day for rehabilitation therapies
How COVID-19 is forcing a fresh approach to PT, OT and ST services
We’ve all seen the moving videos and snapshots of healthcare professionals clapping as patients are discharged from hospital care and reunited with families after being treated for COVID-19. People recovering from COVID-19 and going home to their families should be celebrated, but the story doesn’t end there. The CDC has outlined guidelines to follow for discharging a patient, focused primarily on isolation and transmission issues. The reality is, many of these patients require physical, occupational or speech therapies beyond their hospital stays to help them in their long-term recovery. And even beyond those affected by the virus, patients in need of ongoing therapies—along with others who just need to move and are restricted because of transmission concerns—are facing challenges like never before.
Practitioners and academics alike are writing about the broader effects of post intensive care syndrome (PICS) on COVID-19 patients who have been released from the ICU.1 In general, people who have experienced critical illness have ongoing physical impairments and could benefit from physical or other therapy services after hospital discharge. However, both a lack of awareness of PICS, coupled with the strain on the healthcare community in general, may lead to scarce attention when it comes to rehabilitation services.
In light of this, therapists are rising to the occasion, spotlighting the need and implementing telehealth and other strategies to give their patients the best care. But there’s no doubt about it—all of these services are impacted. And those dedicated therapists, working to help the most vulnerable, they’re struggling, too.
The COVID-19 patient: what happens after they’re discharged
As indicated by the CDC guidelines referenced above, for most patients, the first steps after treatment for COVID-19 are generally focused around minimizing the risk of exposure and transmission once discharged from the hospital. But as introduced above, discharge doesn’t equal being “A-Okay.” Patients are left with wide-ranging problems that, if not treated correctly, can have long-lasting implications:
- Decreased endurance
- Poor strength
- Decreased pulmonary function
- A cognitive “fog”
If patients were intubated or in the ICU, they can have even greater challenges, such as dysphagia and cognitive deficits. Therapists and assistants across physical and occupational services as well as speech language pathologists play a vital role in helping patients return to their prior level of function following this virus.
Physical therapy goals: the shift to pulmonary rehabilitation
With an emphasis on early mobilization, strengthening and endurance, closely monitoring and gradual progression is key. Physical therapists, as well as occupational therapists, are employing education and various exercises to help a patient as their lungs continue to heal. These exercises include, but are not limited to:
- Airway clearance techniques
- Breathing exercises to enhance lung function and respiratory muscles, including
- diaphragmatic breathing
- pursed lip breathing
- coughing training
- Handheld respiratory muscle trainers for resistance training
- Flexibility routines that help to improve posture and maximize lung function, especially due to increased periods of sedation
A recent randomized control trial looked at the effects of a six-week respiratory rehabilitation program in elderly patients with COVID-19. Results found improvements in respiratory function, quality of life, and anxiety and depression in patients—patients who were positive without chronic obstructive pulmonary disease (COPD)—who underwent the respiratory program.2
Occupational therapy goals: addressing the daily cognitive impact
In addition to the physical reminders of critical illness, it’s also important to assess cognition and memory loss in these patient’s rehabilitation plan of care. As previously stated, patients who have admissions to ICUs are at increased risk for PICS, meaning they are more likely to suffer increased physical and cognitive effects, as well as psychological. Occupational therapy can help people with all types of activities of daily life (ADL) training, such as self-management skills, task-specific training and recovering from the traumatic impact they have experienced.
Occupational therapists can also help support assistive technology for a variety of means, both practical and emotional—enabling patients to engage with loved ones, effectively improving the social and emotional strains on mental health.
In April, the Centers for Medicare & Medicaid Services (CMS) made the decision to allow occupational therapists to open Medicare home health cases.3 This was made retroactive from the date of March 10, 2020 and extends through the end of the emergency declaration. Read more here in the CMS Fact Sheet. And later, CMS made the provision for physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services.4 These types of decisions, along with broader exceptions for rehabilitation services in acute and post-acute cases, as well as telehealth opportunities, are critical for long-term health and wellbeing.
Speech therapy goals: the recovery process after intubation
Both occupational and speech therapists are important for memory, cognition, and improving communication—all functions that can be compromised after COVID-19. But speech therapists are often overlooked, even though they’re critical to the recovery process.
Speech therapists play an integral role as a patient’s respiratory symptoms improve and as they come off ventilatory support. Therapists can screen for risks of aspiration and post-intubation complications, such as dysphagia, a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. At that point, functional rehabilitation picks up pace as speech therapists help with speech, language and dietary changes.
The goal, ultimately, is to return patients to their previous level of function and with an ability to be independent again. This process can take weeks or even months, and it’s impossible to overestimate its significance.
Patients without the virus
Although it’s crucial to consider COVID-19 patients with respect to therapy and rehab, what about rehabilitation patients who are high risk but don’t have the virus—those who continue to need therapy? Throughout the country, a variety of steps have been implemented to keep residents in acute settings, post-acute treatment or long-term facilities as safe as possible. These include:
- Therapy in a patient’s rooms or under stricter safe-distancing requirements within the therapy gym or clinic
- A heightened emphasis on the types of tools therapists utilize to keep their patients from exposure or transmission, such as:
- Single-patient use items
- Cost-effective items that can be left in the room or at home for individual patient use
- PPE equipment that is worn throughout treatment
- Portable and easily disinfected equipment for room or home visits
Even patients/residents who aren’t in need of physical therapy are at risk for complications. They’re not able to interact with friends or family, and they can’t move about freely because of the fear of exposure. Here are a few things to consider:
- A regular movement routine to help prevent falls, generalized weakness, and emotional fatigue for those not affected by the virus
- Visits to the room by an activities director or other rehabilitation specialists
- Personalized plans to keep patients focused on both their physical and mental health
Just as people everywhere are finding hacks for their fitness regimen and well care during this pandemic, creativity and resourcefulness play an important role for therapists, too. For example, if a patient is doing telehealth, or their rehabilitation is relegated to a small room, they may not have the right equipment or space they’d normally have in a gym. To answer these challenges, therapists are quickly adapting exercise and instruction to focus on what is accessible for each person.
The critical role of innovation
Of course, the right tools are vital for success, and Medline is constantly innovating as a healthcare partner to provide therapy and rehabilitation providers with a broad range of products and solutions.
- For the physical therapist, that might include disposable items to reduce contamination, like handheld respiratory muscle training devices, which help strengthen inspiratory and expiratory muscles, or other portable equipment that can be used for in-room visits.
- For physical and occupational therapists, a portable system like the NeuroGym can be brought to the patient and only requires one therapist for assistance, effectively diminishing the need for multiple people in a room or setting.
- For the speech pathologist, an electrotherapy system such as VitalStim (for dysphagia) helps increase strength, restore function and remap the brain for swallowing.
In all cases and settings—thanks to our status as an essential industry, which has allowed our distribution warehouse network to work at full stride—supply facilities are open and working to give healthcare professionals their most-needed supplies. And our MedTrans trucks have reliably and quickly delivered products for providers in acute, post-acute, home health and long-term facilities. Our partnership with you keeps us focused on collaboration, innovation and supply chain operations, so that you can focus on the people who need you most.
For more insight into how we can provide solutions for your unique therapy and rehabilitation needs in both acute and post-acute settings, call your Medline Representative or call 1 800 MEDLINE.
2. “Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study.” Kai Liu. Complimentary therapist in clinical practice vol. 39 (2020): https://www.sciencedirect.com/science/article/pii/S1744388120304278