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COVID-19 AND PHYSICAL THERAPY MANAGEMENT

 Severe and critically ill patients suffer from varying degrees of dysfunction e.g. respiratory insufficiency, dyskinesia and cognitive impairment during both acute and recovery stages

REHABILITATION THERAPY FOR CRITICALLY ILL PATIENTS

The goal of early rehabilitation intervention is to reduce breathing difficulties, relieve symptoms, ease anxiety and depression and lower the incidence of complications.

PROCESS OF EARLY REHABILITATION INTERVENTION

The process of early rehabilitation intervention is;

  • Rehabilitation assessment
  • Therapy
  • Reassessment and position management

REHABILITATION ASSESMENT

Based on clinical assessment, especially functional evaluation including respiratory, cardiac status, motion and ADL should be emphasized. Focus on respiratory rehabilitation assessment which includes the evaluation of;

  • Thoracic activity
  • Diaphragm activity amplitude
  • Respiratory pattern and frequency

REHABILITATION THERAPY

The rehabilitation therapy of severe or critically ill COVID-19 patients mainly include;

  • Position management
  • Respiratory training
  • Physical therapy modalities

POSITION MANAGEMENT

  • Postural drainage may reduce the influence of sputum on the respiratory tract, which is especially important to improve patient’s V/Q. Patients must learn to tip themselves into a position which allows gravity to assist in draining excretion from lung lobes or lung segments.
  • For patients using sedatives and suffering from consciousness disturbance, A standing bed or bed head elevation (30◦-45◦-60◦) may be applied if the patient’s condition permits.
  • Standing is the best body position for breathing in a resting state, which can effectively increase the patient’s respiratory efficiency and maintain lung volume.
  • As long as patient feels good, let the patient take a standing position and gradually increase the standing time.

RESPIRATORY EXERCISE

  • Exercise can fully expand lungs, help the excretions from pulmonary alveoli and airway expel into the large airway so that sputum would not accumulate at the bottom of lungs. It increases the vital capacity and enhances lung function.
  • Deep slow breathing and chest expansion breathing combined with shoulder expansion are the two major techniques of respiratory.
  • DEEP SLOW BREATHING
  • While inhaling, the patient should try his/her best to move the diaphragm actively.
  • The breathing should be as deep and slow as possible to avoid the reduction of respiratory efficacy caused by fast shallow breathing.
  • Compared with shallow breathing, this kind of breathing needs less muscle strength but has better tidal volume and V/Q value, which can be used to adjust breathing when experiencing shortness of breath.
  • CHEST EXPANSION BREATHING COMBINED WITH SHOULDER EXPANSION
  • Increase pulmonary ventilation, when taking a deep slow breath one expands his/her chest and shoulders while exhaling.
  • Due to special pathological factors of viral pneumonia, suspended breathing for long time should be avoided in order not to increase the burden of respiratory function and the heart, as well as oxygen consumption.
  • Meanwhile, avoid moving too fast. Adjust the respiratory rate at 12-15 times/min

ACTIVE CYCLE OF BREATHING TECHNIQUES

It can effectively remove bronchus exertion and improve lung function without exacerbation of hypoxemia and airflow obstruction. It consists of three stages

  • Breathing control
  • Thoracic expansion
  • Exhalation

How to form a cycle of breathing should be developed according to patient’s condition.

POSITIVE EXPIRATORY PRESURE TRAINER

  • The pulmonary interstitium of COVID-19 patients has been severely damaged. In mechanical ventilation, low pressure low tidal volume is required to avoid damages to the pulmonary interstitium. Therefore, after the removal of mechanical ventilation, positive expiratory pressure trainer can be used to help the movement of exertion from low volume lung segments to high volume lung segments, lowering the difficulty of expectoration.
  • Expiratory positive pressure can be generated through airflow vibration, which vibrates the airway to achieve airway supporting. These excretions can be removed as the high speed expiratory flow moves the excretion.

PHYSICAL THERAPY MODALITIES

This includes;

  • Ultra-short wave
  • Oscillators
  • External diaphragm pacemaker
  • Electrical muscle stimulation

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