Role Of Physiotherapy In Covid-19 Patients


Introduction- Coronavirus Disease 2019( Covid-19 ) , caused by Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2), is a single-stranded ribonucleic acid (RNA) encapsulated corona virus and is highly contagious.

High Risk Population :-
1.Diabetes
2.Cardiovascular disease
3.Chronic respiratory disease
4.Cancer
5.Hypertension
6.Chronic liver disease.

Role Of Physiotherapy-
Physiotherapy is an important intervention that prevents and mitigates the adverse effects of prolonged bed rest and mechanical ventilation during critical illness.

Acute Phase :-In the early stages of COVID-19 and respiratory distress, care is advised when planning a treatment program. Common modalities often used by respiratory physiotherapists may be contraindicated in the acute phase as they may further compromise the increased work of breathing.

Contraindicated Interventions Include :-
1.Diaphragmatic Breathing
2.Pursed Lips Breathing
3.Bronchial Hygiene/lung Re-expansion Techniques (PEP Bottle, EzPAPĀ®, cough machines, etc.)
4.Incentive Spirometry
5.Manual Mobilization Techniques or Stretching of the rib cage
6.Nasal Washings
7.Respiratory Muscle Training
8.Exercise Training

Weaning Phase :-When the patient is awake, cooperative and in the weaning stage, consider the use of the active cycle of breathing techniques well as lung volume recruitment procedures (e.g. breath stacking) combined with positioning to ensure the patient is involved in his/her treatment.

Manual Techniques :- There is controversy about the effectiveness of manual techniques in general. There is minimal evidence for percussion. There is some evidence for expiratory vibrations to mobilize secretions and manual assisted cough to improve cough effectiveness and aid mucocillary clearance if required. This could be an adjunct and safe to use with patients who are both mechanically ventilated and extubated provided adequate PPE is use.

Rehabilitation Phase :-This is where we will see the main role of the physiotherapist in the management of the patient with COVID-19.
1. Passive, Active Assisted, Active, or Resisted Joint Range of Motion Exercises to maintain or improve joint integrity and range of motion and muscle strength.
2. Mobilization and Rehabilitation (e.g. bed mobility, sitting out of bed, sitting balance, sit to stand, walking, tilt table, standing hoists, upper limb or lower limb ergometry, exercise programs).

1. Prevention of Complications : Physiotherapists can play a key role in the prevention of a range of complications including ventilator-associated pneumonias, secondary infections, contractures or pressure areas/sores.

2. Reduced Days of Mechanical Ventilation : Use weaning protocols or development of individual weaning plans. Assessment of spontaneous breathing capacity and readiness for extubating, including involvement in daily sedation holds and spontaneous breathing trials.

3. Reduce the Incidence of Ventilator-Associated Pneumonia :- It is really important to reduce this risk because any secondary infection will increase the number of days the patient is intubated and ventilated and thus their overall time in the ICU, taking up bed space for longer than should be required and reduce flow through the hospital.

Mr. Nadeem Khan, IV Year, BPT, Department of Physiotherapy, School Of Health & Allied Sciences, Career Point University, Kota

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