Treating the long-term effects of COVID-19 with rehabilitation

Are you or someone you know experiencing the long-term effects of COVID-19? On April 22^nd, I joined Louisa Simpson, Physiotherapist (PT) and Rob Tyndall, Occupational Therapist (OT) for a webinar about our COVID-19 Rehab and Recovery Program.

Together, we discussed the various issues and symptoms associated with the long-term effects of COVID-19, what treatment plans for recovery may look like from a physiotherapy and occupational therapy perspective, as well as different approaches to returning to daily activities, work, and life.

The points below are a summary of some of my conversation with Rob and Louisa.

From your experience, what do we know about the long-term effects of COVID-19?  

Louisa, PT:

The long-term effects of COVID-19 can consist of a range of symptoms originating from different systems in the body such as the lungs, the heart, and the nervous system. 

You don’t have to have been hospitalized to have persistent symptoms. Some individuals who were thought to have had a mild illness initially can also have lingering symptoms that affect their daily lives.

For example: one of my patients presented with drop foot after recovering from a severe bout of COVID-19 and came in for rehabilitative treatment. Another patient whose initial symptoms were milder came to see me looking for exercises. They wanted to start living a healthier lifestyle as this illness was an awakening for them in that they needed to take better care of their health.

Rob, OT:

Many who require critical care may develop psychological, physical or cognitive impairments following viral clearance. These issues may impact people in a multitude of ways including reduced quality of life and emotional distress. Clinical management of COVID-19 survivors requires a whole patient perspective. 

As a new disease, much about the clinical course of COVID-19 remains uncertain – in particular, the possible long-term health consequences.

Using a multidisciplinary approach, we assess and treat the impacts of the individual’s symptoms and work to support people in returning to their chosen daily, work and life activities. 

What are some common symptoms or issues that a rehabilitation professional or team can help with?  

Louisa, PT:

The most common symptoms that I’ve been seeing range from a general cough, breathlessness, and generalized fatigue / reduced physical strength.

Other symptoms include chest pain and tightness, increased susceptibility to headaches, tingling and numbness, rashes, and musculoskeletal symptoms. All of which I and my team are well equipped and regularly support individuals in recovering from.

Sometimes due to ongoing symptoms, patients have been unable to attend in-person appointments. Because of our experience and ability to deliver virtual care, I have been able to continue treating patients and guiding them on their road to recovery while they were dealing with skin rashes or coughs. 

Rob, OT:

Sleep disorders have been very common. Loss of energy and concentration, loss of feelings of control, brain fog, depression and gastrointestinal issues have been some other issues that I’ve addressed.

What is occupational therapy and what role can it play to address the long term effects of COVID-19?

Rob, OT:

An occupation is defined as anything that occupies us. This can be divided into a few different categories: self care, leisurely occupations and activity fulfillment, as well as productivity occupations like work.

From an occupational therapy standpoint, we start by finding out what the patient’s current baseline is. We do a lot of home practice – this can include asking people to journal for me, requiring them to track what they do during the day and what time they get up and go to bed.

We use this information to build goals and plan activities using a points approach, splitting them up according to what the priorities for recovery are. A lot of occupational therapists use mindfulness approaches to help with motivational issues in order to remind people how their recovery is progressing as well.

Recovery involves breaking things down into small goals. For example, I had a patient who had difficulty going up the steps because he became winded so easily. So we started breaking it down – focussing on things that provided him with enjoyment like walking more, playing music, and organizing things around the house. It really helped him get back into it. Now he’s back to work and is able to do his chosen activities. 

It’s encouraging to see the power of this kind of approach. We build a plan so the individual can gradually return to work over time and take a multidisciplinary approach with other team members to help someone return to whatever it is they’re doing or want to do.

How you help patients stay motivated?

Louisa, PT:

A physiotherapist’s job as part of a multidisciplinary team is to help someone establish their abilities. This includes finding out what they can and can’t do and what they feel comfortable doing.

We want to make it safe for someone to transition back to work and we take measures to be able to identify and show someone where they can start and how they’re progressing. We’re here to see them through that and support them.

Can you help people prepare to return to work?

Louisa, PT:

From a physiotherapy perspective, we start by developing an individualized treatment plan based on their current symptoms, work responsibilities, and current level of ability. Generally, we look at 6-8 weeks as we identify what someone’s restrictions are. We talk to employers to make sure that work activities and tasks are within the patient’s abilities.

We continuously support the patient’s transition back to work. This gives them confidence to go to work knowing that we have their backs as they return to their jobs.

Rob, OT:

When it comes to the long-term effects of COVID-19, returning to work is a big question a lot of people have. We take a holistic approach depending on someone’s situation. We have to bridge the gap between what the job is and what an individual’s current capacities are.

A big part of this is communication with the employer. We look at things like modified duties and virtual or on-site job coaching, as well as ergonomics and process changes. It depends on the physical and cognitive demands of the individual. It is encouraging to see what improvements and successes we are seeing as people return to work after treatment.

There are other syndromes associated with COVID-19. How do they impact rehabilitation?

Louisa, PT:

Knowing what other syndromes are associated with the long-term effects of COVID-19 are helpful in guiding someone’s individualized assessment and approach to recovery and symptom management.

For example, if someone was dealing with postural orthostatic tachycardia, I would be using a heart rate monitor to examine behaviour under different levels of exertion. This would then be used to monitor responses to treatment.

We also use evidence based outcome measures that can help set individuals at a certain level. These measures are designed to involve the patient in their individualized treatment regime. As we go through this, we take the patient’s goals and motivations into consideration and make sure they are a part of their own treatment and recovery.

Rob, OT:

It comes down to the individualized component in order to find out where someone is at in their recovery. Cognitive and psycho-social issues come hand in hand with a lot of these different syndromes.

When you start talking about brain fog and impacts on other areas of cognition, there are some fantastic ways to approach that - starting off with working on deficit areas with cognition and how patients can be successful with daily functions.

 How can physiotherapy help deal with symptoms?

Louisa, PT:

Physiotherapists have a myriad of skill sets that can help in every situation. Physiotherapy is not just about ankle sprains, strains, and exercises.

Physiotherapists have education, training and expertise in assessment and rehabilitation of cardio-respiratory issues (breathlessness, cough), neurological conditions (numbness, tingling, pain, dizziness, balance issues etc.) as well as musculoskeletal and physical strength and stamina (fatigue management). 

There is no cookie cutter approach to treatment as there are no two clients that present with the same issues. I use the tools I have to take care of my patients as best as I can.

Who is the Lifemark program for apart from those that have had COVID-19?

Louisa, PT:

You don’t need a COVID-19 diagnosis to seek out Lifemark rehabilitative or supportive services. If you or anyone you know is facing a challenge, symptoms or limitations in a physical, emotional, cognitive, psychological or social aspect of life, please reach out! 

A treatment regime for an individual can include one discipline or a wide array of disciplines, such as physiotherapy, occupational therapy and kinesiology, depending on their needs. In the event that they do require another discipline for treatment, we can connect patients with professionals across the country using virtual care to help them.

If someone is not comfortable with or able to come to a clinic, can they still receive treatment?

Rob, OT:

The big piece is looking at it virtually or in-person. Some people are not going to feel comfortable going into a clinic for treatment. This is where virtual care comes in. For example, I was able to help someone who wasn’t able to leave their house with virtual care.

I saw them online weekly and they were able to make significant progress. Eventually they felt comfortable going into the clinic to continue treatment with a hybrid model of care.

If you or someone you know is dealing with the long-term effects of COVID-19, consider booking an appointment with Lifemark by calling 1-855-485-1344.

Learn more about the Post COVID-19 Rehab and Recovery program.