For a significant proportion of people, covid-19 leads to medium to long term effects that can have a significant impact on quality of life. Some symptoms may linger or recur for days, weeks or months following initial recovery while some patients develop medical complications that may have lasting lifetime health effects. Recovery time is different for everyone.
While short term effect include fatigue, cough, cold, congestion, shortness of breath, loss of taste/smell, headache, body ache, nausea, chest pain, abdominal pain confusion. Prolonged and persistent symptoms due to disruption in body systems and affected organs is also something that recovered patients have faced over time. Long term impact including damage to heart muscle, heart failure, lung tissue damage, restrictive lung failure, anosmia, pulmonary embolism, stroke, cognitive impairment, anxiety, depression, PTSD, sleep disturbances, muscle/joint pain, chronic fatigue, breathlessness, chest pain can severely impact a patient’s future if not treated properly.
Often, such Covid-19 patients need a level of medical care and rehabilitation that is difficult to achieve at home. Some of them need continuous monitoring and non-invasive clinical intervention supervised by a medical expert even after they have recovered. This is possible with a comprehensive and planned post -Covid-19 rehabilitative program that we have put into place at Sukino continuum care facility at Bangalore and Kochi.
Once the patient is admitted, a detailed assessment in carried out by the Doctors. Physiotherapist, Occupational and Respiratory therapists and they map out the therapy sessions and fine-tune a goal-oriented treatment plan depending on the condition of the patient. Over the course of the treatment, the progress of the patient is assessed on a weekly basis with the Borg Dyspnea Scale, six-minute walk test, 12-minute walk test, TUG scale and the Cough Sputum Score. The treatment is an amalgamation of Physio, Occupational and Respiratory therapy.
Physiotherapy is carried out in three phases. Phase 1 comprises of diaphragmatic breathing exercises to encourage oxygen exchange, slow down the heartbeats and, stabilize the blood pressure. Thoracic expansion exercises to help loosen secretions from the lungs. Thoracic mobilization exercises to clear the secretions from the lungs. The teaching of relaxed positions to ease breathlessness. All the above exercises are done at the patient’s bedside. In phase 2, the focus is on strength and endurance training to improve exercise tolerance using dumbbells and Thera bands, activities on the stepper, staircase training, hurdle training and bicycle ergometer without resistance for the initial days and resistance added as the patient regains efficacy. In Phase 3 which is also known as the maintenance phase, the patient is given enough education to carry on the exercises with the list of dos and don’ts at home.
Occupational therapy teaches patients how to conserve their energy and avoid fatigue through certain adaptive postures while performing daily activities. This is specific to each patient. For instance, adequate breaks while taking the stairs, tying a shoelace in a sitting position rather than bending, to name a few.
Respiratory therapy makes use of devices like Acapella and Flutter, which play a major role in lung secretion clearance. Resistance training with the help of power breaths, incentive spirometry, respiratory muscle training are among the few exercises that help the patient recover and restore their respiratory health in the most optimal manner.
To improve physical strength and function, it is advisable to not stay in bed all the time. Patients should try and sit for meals and go for short walks. Some simple exercises like seated knee extension, seated hip flexion, sit-to-stand, shoulder press, shoulder strengthening, sideways leg lift, and straight leg raise can be done by patients themselves without hurting and over exerting themselves. Exercising safely and correctly is important.
Optimal care is crucial for speedy recovery and early return to normal life at home after discharge from the hospital. A rehabilitative care program acts as the bridge between the hospital and the home, delivering out-of-hospital care that enables the patients to achieve optimal recovery in a best suited environment. Such a customized program takes a holistic view of the patient’s health needs and tailor-makes the solution to suit the patient’s specific health status.
On a concluding note, while the world is still feverishly negotiating and coming to terms with the potential long-term effects of COVID-19, we at Sukino are doing our bit by assisting patients overcome the effects of the deadly disease and heal during this toughest times of their lives.
- The author of this article is Mr. Rajinish Menon, Founder & CEO, Sukino Healthcare