Jaime Stoffer

For many patients recovering from COVID-19, discharge from the hospital is only the first battle in their recovery. Patients are left with symptoms that range from decreased endurance, poor strength, decreased pulmonary function and a cognitive “fog.”

If patients were intubated or experienced a stay in the ICU, this can bring on further challenges with dysphagia and cognitive deficits. Therapists and assistants across physical and occupational therapy, as well as speech language pathologists, are playing a vital role in rehabbing patients to their prior level of function following this virus.

With COVID-19’s complications, therapists’ goals are shifting to how they can address pulmonary rehabilitation. Here is a look at the role physical and occupational therapy is playing to help improve endurance and pulmonary function.

Lung-healing techniques

Therapists are employing energy conservation education and airway clearance techniques to help a patient cope while their lungs heal. Breathing exercises to improve lung function and respiratory muscles may include diaphragmatic breathing, pursed lip breathing, and coughing training. Some facilities are implementing handheld respiratory muscle trainers for resistance training of inspiratory and expiratory muscles. Flexibility is important to improve posture and maximize lung expansion, especially with increased periods of sedation.

A recent randomized control trial looked at the effects of a six-week respiratory rehabilitation program in elderly with COVID-19. Results found improvements in respiratory function, quality of life, anxiety and depression in patients that were positive without COPD that underwent the respiratory program.1

It is also important to assess cognition, memory and any possibilities of dysphagia in these patient’s rehabilitation plans of care. Patients that have admissions from ICU’s are at increased risk for post-intensive care syndrome, meaning they are more likely to suffer increased physical and cognitive effects as well as psychological. Occupational therapy can help patients with self-management, task specific training, activities of daily living, and improving the overall functional impact from such trauma.

Working on technological solutions to keep in touch with loved ones, can make a big impact on a patients mental health.  Speech therapy can screen for risks of aspiration and post-intubation complications. Both professions are important for memory, cognition, and improving communication.

Continuing to address therapy needs for non-COVID-19 patients

We must not forget the patients that are high-risk, who continue to need therapy but are not recovering from COVID-19. Nationwide, a variety of steps have been implemented to keep residents as safe as possible. Due to the pandemic, therapy is often being delivered in a patient’s room or only when safe social distance can be maintained within the therapy gym. This has placed an increased importance on the types of tools a therapist utilizes to decrease exposure.

Single-patient use items and cost effective items that can be left in the room, personal protective equipment, and portable and easily disinfected equipment have all become an important part of delivery therapy services. Creativity and resourcefulness plays an important role as well as therapists try to utilize what is within a patient’s room to meet their needs.

Therapy has quickly adapted to meet the needs of their patients as all three disciplines work to help their patients return to life before COVID-19.

Liu, Kai et al. “Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study.” Complimentary therapist in clinical practice vol. 39 (2020): 101166. Doi:10.1016/j.ctp2020. 101166.

Jaime Stoffer is clinical program development manager for Medline’s rehabilitation and therapy division.