Physiotherapy for COVID 19

Physiotherapy treatment is very important to treat COVID patients. WHO and World Physiotherapy also giving priority Physiotherapy for COVID patients.



ICU

In-Patient on Mechanical Ventilator

•Positioning – Prone positioning / propped up (60 degree)

•Chest Physiotherapy:

vibration, percussion (if D - Dimer normal)

intercostal stretch

•Limb Physiotherapy:

General limb movement as much as tolerated by the patient

Active Mobilization (if possible, by patient)

Post Extubation in ICU

Diaphragmatic breathing

Pursed-Lip Breathing

Alternate Nostril breathing


•Patient not in ventilator

•Positioning prone (12 to 16 hours) propped up

•Chest Physiotherapy

vibration with proper assessment

percussion with proper assessment

slow deep breathing

ACBT as tolerated

Incentive spirometry as tolerated

•Limb Physiotherapy

AROM

Bedside sitting

Dynamic quad

Sitting on bed / chair

Bedside ambulation if tolerated

•General ward

•Positioning

conscious proning (12 – 16 hours)

propped – up positioning (2 – 4 hours)

Chest Physiotherapy:

Slow deep breathing

ACBT

Segmental expansion

Coughing out if congestion present

Chest percussion if congestion present

Chest vibration if congestion present

Incentive spirometry (inhalation only)

stream inhalation

•Limb Physiotherapy:

AROM exercises

Isometric exercise as tolerated

Graded functional exercise

Ambulated as tolerated

For stable patient (General ward)

  • Diaphragmatic breathing

  • Lung expansion technique

  • Manual mobilization to the rib cage

  • Respiratory muscle training

  • Incentive spirometry

•Exercise after leaving Hospital

•Improve fitness

•Reduce breathlessness

•Increase muscle strength

•Improve balance and coordination

• Improve your thinking • Reduce stress and improve mood

• Increase confidence • Improve your energy


•Warm-up exercises

•Warming up prepares your body for exercise to prevent injury. Your warm-up should last around 5 minutes, and at the end you should feel slightly breathless. Warm-up exercises can be done in sitting or in standing. If you do your warm-up in standing, hold on to a stable surface for support if needed. Repeat each movement 2-4 times


•Fitness exercises

•You should aim to do fitness exercise for 20-30 minutes, 5 days each week.

•Some examples of different types of fitness exercises are described below, but any activity that makes you feel moderately to almost severely breathless can be counted towards your fitness exercise. Time your fitness exercise and gradually build up the amount of time you can manage. This may be in small increases such as an additional 30 seconds or 1 minute of activity. It may take a while to return to the level of activity you were normally able to do before you became unwell.


Walking — Use a walking frame, crutches, or stick if needed — Choose a route that is relatively flat

•Progressing this exercise: — Increasing the speed or distance you walk, or if accessible

- include walking uphill in your route

When you might choose this exercise: — If you can get outdoors to exercise


Jogging or cycling — Only do jogging or cycling if it is medically safe for you

•When you might choose this exercise: — If walking is not making you out of breath enough — If you could jog or cycle before you became unwell


Strengthening exercises

•Strengthening exercises will help improve muscles that have become weaker as a result of your illness. You should aim to do three sessions of strengthening exercise each week. Strengthening exercises will not make you feel breathless in the same way as fitness exercises. Instead, your muscles will feel like they have worked hard.

•You should aim to complete up to 3 sets of 10 repetitions of each exercise, taking a short rest in between each set. Do not worry if you find these exercises hard. If you do, start with a smaller number of repetitions in each set and build up to achieving sets of 10. As you get better with the exercises, use heavier weights to make your muscles work harder. You can use tins of food or bottles of water as weights.

•Some strengthening exercises for your arms and legs are described below, which can be done in sitting or standing. These can be done in any order. Keep a good posture, with your back straight and your tummy tucked in, and complete the exercises slowly.

•Remember to breathe in as you prepare to do the hardest part of the exercise and breathe out as you make the effort.


•Endurance exercises (when tolerated)

•Phase 1 / Initial Phase

•Phase 2 / Intermediate Phase

•Phase 3 / Final Phase

•Cool down exercises

•Cool down exercises allow your body to return to normal before stopping exercise. Your cool down should last approximately 5 minutes, and your breathing should be back to normal by the end. Try working through all these suggestions, but if you cannot manage all the exercises or stretches, do the ones that you can.

  • Start with low pace

  • Walking at a slower pace or gently marching on the spot, for approximately 2 minutes

  • Repeat the warm-up exercises to move your joints; these can be done in sitting or standing

•References

  • https://www.youtube.com/watch?v=QmrZkV4AOMM

  • Post Covid-19 physiotherapy advice and exercise programme by NHS

  • Support for Rehabilitation Self-Management after COVID-19- Related Illness by WHO

  • PHYSIOTHERAPY MANAGEMENT FOR COVID-19 IN THE PRIMARY, COMMUNITY AND ACUTE (HOSPITAL) SETTINGS GPA Preliminary Guideline for COVID-19. Version 1.0 April 23, 2020.

  • COVID-19 Proning for Self care by Ministry of Health & Family Welfare Government of India

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