Rehabilitation & Covid-19


 

COVID-19 Protocol for Physical Therapy and Occupational Therapy

We are here to get you back to your strength, endurance and function that you may have lost due to the COVID-19 pandemic.  Many patients have lost their strength, and lost essential functional activities that they would have normally had regardless of the fact if they have not been moving around. Reddy Care is aware and prepared to treat patients who have and who have not contracted COVID-19. (Post Covid-19 Protocol) 

Patients who have not contracted Covid-19

We understand the importance of being safe and are currently taking precautions during this time.  Our physical and occupational therapists are trained and updated on the guidelines and precautions from the CDC and are universally applying them to prevent and manage the COVID-19 situation.  The following are photos of the equipment that the therapists bring to you and also have in one of our state of the art clinics.

KN95 STANDARD RESPIRATOR MASK

This mask is an industry standard and means that the mask provides the intended effectiveness of filtering 95 percent of particles with a mass median diameter of 0.3 micrometers. Therefore, this mask can protect you well from PM10, PM2.5, and even smaller particles. The mask adheres to industry-class standards of GB2626-2006 on respiratory protective gear and protects against small particles including respiratory droplets (such as from coughs and sneezes) and particles over PM2.5

 

 

Face Shield

Face Shields are used to help protect the eyes and face against certain impact and airborne hazards, while offering full face protection!




Gloves

 

Thermometer

Cleaning Supplies

Blood Pressure Cuff

Our physical and occupational therapists will see you with all the above equipment and the following protocols every session.  Additionally, our therapists will give you a KN95 mask to ensure safety in patient and therapist interaction.   

 

Post COVID-19 patients are those who were tested for the virus and found to have a positive test result or are assumed to have had the virus but were never tested. They may or may not have been hospitalized. These patients have been experiencing varying symptoms including cough, shortness of breath, fever, chills, fatigue, weight loss, loss of appetite, diarrhea, and headache. Our role is to return these patients to their baseline level of functioning at their pace.  

 cdc logo

 

CDC GUIDELINES

DISPOSITION OF PATIENTS WITH COVID-19

Patients can be discharged from the healthcare facility whenever clinically indicated.

If discharged to home:

The decision to discontinue Transmission-Based Precautions should be made using a test-based strategy or a non-test-based strategy (i.e., time-since-illness-onset and time-since-recovery strategy). Meeting criteria for discontinuation of Transmission-Based Precautions is not a prerequisite for discharge.

 

In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. Considerations for care at home include whether:

  • The patient is stable enough to receive care at home.
  • Appropriate caregivers are available at home.
  • There is a separate bedroom where the patient can recover without sharing immediate space with others.
  • Resources for access to food and other necessities are available.
  • The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene);
  • There are household members who may be at increased risk of complications from COVID-19 infection (. e.g., people >65 years old, young children, pregnant women, people who are immunocompromised or who have chronic heart, lung, or kidney conditions).

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PROTOCOL

  • Personal Protective Equipment (Each session): NOTE: PATIENTS WILL ALL BE GIVEN THEIR OWN MASK
    • KN95 mask
    • Gown
    • Gloves
    • Goggles/Face Shield 
  • Vital Signs (log kept in home)
    • Blood pressure
    • Heart rate
    • Oxygen saturation level
    • Respiratory rate

 

Personal Protective Equipment: Risk assessment for Health care
personnel using CDC guidelines

 

           Currently patients who are being discharged post COVID are not getting a negative test due to shortage of tests in NY. CDC has guidelines for health care professionals who are coming in contact with patients with personal protective equipment including masks and gloves without a gown or an eye protection are at low risk of exposure and there are no work restrictions for asymptomatic health care professionals. And this risk also decreases when health care professionals wear a gown and protective eyewear. Remember these guidelines are for therapists who are seeing COVID patients when they have been tested positive. Patients that will be seen in the home setting will be post COVID. Patients must always be wearing a facemask during the whole session when they are in contact with the therapist. The aides, family members of post COVID patients must also be wearing a facemask during the whole session with no exceptions.  

 

Please see below table to assess risk classification for health care personnel 

 

Epidemiologic Risk Classification1 for Asymptomatic Healthcare Personnel Following Exposure to Patients with Coronavirus Disease (COVID-19) or their Secretions/Excretions in a Healthcare Setting, and their Associated Monitoring and Work Restriction Recommendations

table

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

 

 Therapists working with Post COVID patients must monitor their symptoms and check their temperature at least twice every day and report to their clinical director. Checking body temperature is mandatory for all therapists irrespective of whether they are treating post COVID patients. 

 

Correct way to remove gloves after treatments as per CDC:

how to remove gloves

 

 Hand washing- Please make sure to wash hands before and after PPE is worn and avoid touching any surfaces after washing your hands. 

 

PHASES OF REHABILITATION for those patients deconditioned due to post Covid -19 diagnosis OR patients who have been disabled/injured due a related health issue but is NOT Covid -19 positive:  

  1. Improve respiratory status and endurance (PT and OT)
  2.     Home assessment/DME Recommendations
  3.     Deep breathing, pursed lip breathing, blowing
  4.     Posture
  5.     Increase time out of bed
  6.     Gentle exercises
  7.     Scapular protraction/retraction, shoulder elevation/depression, elbow flex/ext, digit flex/ext, knee flex/ext, ankle pump
    • Sit to stand as tolerated
  8. Gradual progression to standing to avoid orthostatic hypotension and careful monitoring of O2 saturation levels during exercises

Respiratory Health: Considering the impact of COVID on respiratory health in hospitalized patients, it is important that therapists evaluate a patient's breathing efficiency and pattern. Re-education of breathing patterns through relaxed diaphragmatic exercises. Teach patients breathing exercises to improve abdominal breathing and reduce engaging of accessory muscles during inspiration. Progression must be focused to help patients perform the correct pattern of breathing in different positions. Typical progression would be from sitting- standing- walking to advanced ADLs with patients being able to breathe with an improved pattern during complex ADLs with minimal cues. 

Also, the therapist will teach patients deep diaphragmatic breathing exercises to induce relaxation. Patients will be educated on the importance of deep breathing exercises as part of HEP. 

Postural reeducation- Therapists must also include postural training to ensure efficiency of movements is promoted. Engaging core muscles during ADLs and strengthening of spinal extensor muscles to prevent undue fatigue which will also have an overall positive effect of respiratory status.

Build strength and endurance

             
PT

  1.           Increase standing tolerance
  2.           Ambulation as tolerated
  3.           Increase level of difficulty with exercises
    1. Increase sets/reps
    2. Add more difficult exercises
  4.         Hip flexion, straight leg raises, hip abd/add in supine, knee extension with 5-10 sec hold, shoulder flex/ext, shoulder abd/add, punches, trunk flex/ext, lateral trunk flex/ext
  5. Core strengthening exercises- Bridges, abdominal isometrics 
  6.  Bed mobility

 
OT

  1.      Energy conservation techniques
  2.      Seated ADLs
  3.   Brushing hair, donning/doffing shirt, feeding
  4. Begin standing ADLs as tolerated
  5.  Donning/doffing pants, brushing teeth at sink, toileting
  6.   Instruct in use of adaptive equipment as needed, such as hip kit
  7.  Simple IADLs
  8.  Washing a dish, getting food from fridge
  9.  Dynamic sitting balance 
  10.  Bed mobility

 Increase functional mobility and ADLs (patient should be out of bed most of the day)

PT ADLs

  1.  Increase ambulation distance to 50-75% of baseline distance 
  2.  Incorporate effective breathing techniques and exercises during ADLs and ambulation
  3. Stair training
  4. Standing balance activities
  5. Standing exercises as tolerated
  6. Hip flex/ext, hip abd/add, heel raises, squats

OT ADLs

  1.     Donning/doffing socks and shoes, pants
  2.     Toileting
  3.     Sponge Bathing or showering
  4.     Tub transfers
  5.     Washing dishes
  6.     Heating food in the microwave
  7.     Loading washing machine

 

Return to baseline (work toward these goals) 

PT

  1.            Able to ambulate pre-COVID distance with least restrictive device
  2.            Able to climb stairs with same level of assist as baseline
  3.            Independent with HEP without SOB, c/o fatigue or desaturation
  4.            Functional standing tolerance for ADLs
  5.            Pre-COVID sitting and standing balance

OT

  1.            Able to perform ADLs at pre-COVID level with or without adaptive equipment
  2.            Able to perform IADLs at pre-COVID level
  3.            Independent with HEP without SOB, c/o fatigue, or desaturation
  4.            Able to perform bed mobility at pre-COVID level

 *Your PT/OT continuously check oxygen saturation levels throughout the session and do breathing exercises to increase sets if necessary

*Your PT/OT will monitor for fatigue and provide rest periods as needed

Covid Rehab and Precautions


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