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Over the past year the use of rehabilitative therapies has been an integral part in treating Post-Acute Sequelae of COVID-19 (PASC) symptoms.
These rehabilitative therapies are a cornerstone of MedStar Health’s COVID Recovery Program, with physical therapy (PT), occupational therapy (OT), and speech and language pathology (SLP) playing an essential role. Our PTs, OTs, and SLPs work with each patient, virtually or in person, to help them overcome symptoms and achieve their treatment goals. These three specialties work in tandem while also following their own unique methods to bring about successful recovery.
All three of these specialties treat a vast spectrum of PASC symptoms including fatigue, cognitive symptoms, and post viral deconditioning. Patients may also be referred at various points in their post-infection trajectories.
Treatment with PT, OT, and SLP in the program may involve working with their therapist 1-2 times per week for several weeks, depending on individual needs and symptom severity. Treatment plans are often individualized and can be tailored towards those who are working to regain basic functioning to those aiming to return to work or vigorous exercise.
What do each of these therapies look like?
In our program, physical therapists report treating a variety of symptoms. Kimberly Agan –a Physical therapist at MedStar Health-has been working with several PASC patients and reports the main symptoms she helps treat include:
- Decreased cardiovascular capacity—involving deconditioning of the aerobic system, low O2 levels, and difficulty breathing
- Vestibular issues—including dizziness and difficulty with balance
- Muscle fatigue and weakness
A typical PT appointment can include cardiovascular exercises to rebuild physical strength and endurance, breathing exercises to improve respiratory capabilities, as well as manual therapy to relax the muscles of inspiration. Other techniques include balance and eye exercises to improve vestibular senses. PT programs for PASC include many at-home exercises as well, including self-massage techniques or further breathing techniques that patients are able to perform themselves. All patients have access to an online exercise portal and are provided with instructions and tutorial videos.
Our program’s PTs track and monitor progress to help direct therapy and ensure patients are meeting their goals. Completion of PT usually occurs when the patient has made substantial progress towards their physical goals and is able to continue a therapeutic program on their own. PTs in the program advise that being committed and consistent in doing at-home exercises is one of the biggest steps to take towards achieving the ultimate goal: a return to pre-COVID function.
Over the past year, the use of rehabilitative therapies has been an integral part in treating long term COVID-19 symptoms. Learn how physical therapy and more can help via the #LiveWellHealthy blog: https://bit.ly/3BOqmeh.Click to Tweet
In our COVID Recovery Program, OTs may help patients struggling with symptoms of fatigue, energy deficits, and challenges that can interfere with activities of daily living.
One of the most common techniques for management of fatigue is energy conservation planning, in which the OT helps patients structure their schedules and environment in ways that minimize fatigue. Developing cognitive fatigue management strategies is another central component. OTs help patients recognize physical signs that occur before they experience fatigue and then develop a plan for how to proceed after those signs occur. Adopting strategies such as scheduling pre-emptive rest periods at crucial times, building in cognitive breaks, or putting tasks in a strategic order can maximizes energy usage. Reduce distracting environmental stimuli, such as limiting ambient background noise and controlling strong lighting are also effective strategies.
Adjusting the home or work environment in order to use the body more efficiently are also ways OT’s help with energy conservation. Examples include sitting down when brushing your teeth, utilizing adaptive equipment such as a shower chair, or delegating tasks to friends or family members.
Similar to PT, the main goal of OT is to return patients to their original pre-COVID functioning levels. Karen Gragnani, occupational therapist at MedStar Health, recommends “keeping an open mind for treatment strategies, and to be willing to try new techniques along the way. It is also important to be kind and forgiving towards oneself, be willing to take breaks and not push progress too hard, and most importantly to be patient and trust the process.”
In our program, SLPs help to address cognitive symptoms, which can include:
- Attention: difficulty focusing to read, quickly losing energy when focusing on a task
- Word-finding: inability to choose the correct word to express oneself
- Memory: forgetting things quickly, being overwhelmed by large amounts of information
- Organization: difficulty managing schedules, medical referrals and medications, finances and bill payments, deadlines at work
They also help with other COVID-related symptoms such as voice changes—hoarseness or weakness, as well as chronic cough.
SLP centers around education, in which the therapist works to teach people about how their brain works. Understanding how attention, memory, problem solving, and cognitive endurance function can help patients manage and overcome specific weaknesses. Similar to OT, SLPs also help patients develop compensatory strategies such as making to-do-lists or implementing an organizational system to manage daily tasks.
SLPs also have patients practice and strengthen their cognitive abilities on their own. For example, reading a complex passage in a book or listening to a podcast, and then eventually adding in distractions and additional tasks to perform simultaneously--such as cooking.
Unlike physical injuries, it is sometimes difficult to identify the limits cognitive fatigue causes in daily life, and hard to recognize its exact manifestations. Patients can often feel trapped and discouraged by living within the limits of their cognitive fatigue. SLP works to encourage patients that progress is possible, and the cognitive limits can certainly be overcome. Breanne Reynolds, a Speech-Language Pathologist with MedStar Health, reinforces this by encouraging her patients to “give themselves some grace,” and to remember that “recovery is complicated and does not follow a single straight path.” She tells them to “be open to adjusting your expectations and getting away from judging yourself.”
Similarities and differences.
PTs, OTs, and SLPs assisting our program all share the same objective of partnering with each individual to personalize and maximize their recovery process. While the methods they employ to achieve it are unique to each therapeutic specialty, they all work in pursuit of the same goal: returning patients to their pre-COVID capabilities.