Physiotherapist and COVID-19

Introduction- Introduction Physiotherapists often first direct contact practitioners, means they position to take responsibility for early identification of infectious disease and/or managing workload in primary care settings.

The physiotherapist’s role in intensive care helping patients in their recovery after they have critically unwell with COVID-19, involves patient assessment, goal setting as well as prescription of mobility and rehabilitation treatments, work alongside a large multidisciplinary team. Early rehabilitation and mobilization involves helping to get patients up and moving.

The role of physiotherapist become also essential in a context where huge number of patients required ICU hospitalization, and in several cases, use of invasive mechanical ventilation. The main goals in this case are optimizing ventilation and oxygenation; improving compliance and ventilation/perfusion mismatch, reducing work of breathing; decreasing ventilator dependence and improving residual function; improving respiratory muscle strength and reducing complications.

Benefits of early mobilization and rehabilitation of mechanically ventilated Shortly after beginning of mechanical ventilation, mobilization and rehabilitation can play an essential role in decreasing both the duration of mechanical ventilation and hospital stay, improving patients’ return to functional independence. Active mobilization and rehabilitation in ICU have no impact on short- and long-term mortality, but they may improve mobility status, muscle strength, days alive, and out of hospital to 180 days.

Physiotherapists, therefore, will have a key role in providing exercise, mobilization, & rehabilitation interventions to COVID-19 survivors in order to enable a functional return to home, crucial importance of rehabilitation has led to creation of innovative approaches during pandemic.

Physiotherapy for critically ill COVID-19 cases :-
Physiotherapy starts from ICU in aiding recovery of COVID-19 patients, can facilitate more energy-conserving techniques of breathing and mobilization, which not only promote an enhancement in oxygenation required for patients who have low oxygenation due to breathing problems, but also helps in boosting their immune system which will in turn help them fight against disease, Airway clearance techniques to clear lungs from secretions and to keep lungs clear Positioning and early mobilization of such patients performed by physiotherapist which help in prognosis of COVID patients.

Physiotherapy in Post Critical COVID-19 Cases :-
According to leading physiotherapists, after COVID-19 patients are discharged from intensive care, there is de-conditioning. They can develop post ICU syndrome which basically leads weakness or wasting of muscles, along with emotional & mental symptoms. They trained to develop progressive exercise protocols for such patients to counter weakness of muscles & optimize their functional outcomes. Moreover, physiotherapists can motivate such patients to create sense of well-being in them.

Physical Exercise is Key :-
As we move from lockdown to unlock phase, it is of utmost important to be active. The effects of exercise on our bodies are well-known, but question is if they are being done with correct techniques and postures. Leading cardio-respiratory therapist recommends moderate intensity exercises rather than high intensity exercises for enhancing pro-inflammatory response in body, which eventually helps in fight against virus by boosting immunity.
Physios can educate people about ergonomically correct postural patterns to reduce load on spine & joints. Regular exercise maintains joint integrity & circulation which prevents muscles and joints from getting stiff.

Breathing Exercises Must During Pandemic :-

Breathing exercises help reaching full capacity of lungs and incorporating them into lifestyle can prove beneficial during pandemic.

To fight medical, financial and social stress in current times, simple breathing exercises like Diaphragmatic Breathing Technique, Purse Lip breathing, and thoracic expansion exercises promote much needed relaxation.
● Since diaphragm does 70-80 percent of breathing, performing diaphragmatic breathing regularly is key to stimulating it. Sit comfortably on chair with relaxed shoulders and place hands on diaphragm. Now inhale through nose, allowing stomach to go out and then exhale through mouth. Performing it 3-4 times at stretch and 2-3 times a day will stimulate diaphragm. Pursed Lip breathing technique is to sit comfortably on chair with relaxed shoulders, take deep breath from nose & hold it then exhale slowly via mouth with pursed lips. This will create small positive pressure which prevents collapse of airway.

● In thoracic expansion exercises, one has to inhale deep breath from nose while taking hands outwards & bringing back hands while blowing air out from mouth, helps in promoting expansion of thorax and eventually creates more space for air to enter.

Nose breathing regarded as normal physiological mode of breathing for human beings due to its potential health benefits, breathing techniques help in opening airways and improve blood circulation in matter of minutes. These are more direct & tailored as per requirements of individuals for different age groups which involves timing how comfortably breath hold can be performed after exhalation. Goal of this is to reach control pause of 40 or more seconds which is considered as being normal for lungs. It can also be tool to test functionality of lungs.

Dr. Kanchan Kholiya, Assistant Professor, Department of Physiotherapy, Career Point University, Kota

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