Introduction: Clinical Practice Guidelines for Covid-19 Rehab Management (07:01)
Theresa Schmidt introduces the topic of the interactive webinar and recites a board required disclaimer. She asks attendees about their background, how they prepare for a crisis, and how they recover with resilience.
Professional Judgement (10:26)
Approximately 45% of owners report at least temporarily closing clinics due to COVID-19. Schmidt discusses symptoms of the disease and maintaining safety per CDC guidelines. She asks attendees for their top three challenges.
Coronavirus Disease of 2019 (07:49)
Follow your professional associations. COVID-19 testing uses throat and nasopharynx samples. In the acute setting, 80% of cases are mild to moderate, 15% are severe, and 5% are critical. Schmidt cites symptom, fatality, and economic impact percentages.
COVID-19: Treatment and Testing (07:17)
The FDA approves Remdesivir for treatment; Regeneron is for high risk patients. Most patients isolate, hydrate, rest and use OTC medicine. Monitor the CDC and NIH websites for updates. Schmidt identifies those who should be tested for COVID and test types.
Rehab for People With COVID-19 (08:10)
Check CDC and NIH websites for updates. The core outcome measures are cognition, quality of life, strength, function, and endurance. Review the cardiovascular system, neurology, mental health, and pulmonary system before beginning an exam. Sequence testing according to expected difficulty level.
Prior to Exam: Comprehension (02:20)
Use commands to test a patient's cognitive ability. Use the Richmond-Agitation-Sedation Scale or Confusion Assessment Method for those with suspected delirium.
Prior to Exam: Cardiovascular Risks (03:40)
Use the ASCVD Risk Estimator Plus before endurance or exercise testing. Screen for thromboembolism; hypercoagulability is common with COVID-19. Schmidt discusses what may contribute to blood clots.
During and Post Core Outcome Measures Exam (05:59)
Monitor patient vitals; check the algorithm for progression guidelines. Use the Dyspnea Scale and the RPE Borg Scale. Use the Ankle Brachial Index to check for peripheral artery disease. Schmidt identifies steps to take after completing the exam; secondary outcome measures are under development.
Neurology Considerations (04:53)
Sensory and coordination tests include TUG, FTT, and Stroke EDGE. The APTA Academy of Neuro has specific clinical guidelines. The core outcome set includes the Berg Balance Scale, Activities Specific Balance Confidence Scale, functional gait assessment, and five times sit to stand.
Hospital Based Patients (03:19)
Schmidt provides tips to prevent glasses from fogging while wearing a mask and cites COVID-19 clinical practice guidelines for minimizing risk to clinicians.
Phase A: Unconscious Patient (02:26)
Therapy for the critically ill in ICU includes teaching nurses how to prevent contractures with positioning, splinting, and ROM; there is no active mobilization or respiratory support.
Phase B: Conscious Cooperative Patient (05:14)
Patients are less sedated, have a RASS score of two or more and a S5Q score of three or more. Active mobilization begins with an emphasis on bed mobility. Assess patient vitals and monitor red flags for each mobilization session. Schmidt cites relative contraindications to rehab.
Critically Ill Patients in the COVID Ward (12:22)
Therapy for the conscious patients focuses on preventing deconditioning. It includes respiratory support and step-by-step active mobilization. Use ACSM exercise guidelines, Borg RPE, a modified Borg Dyspnea Scale, and Sommers criteria. Monitor for complications.
Discharge, PT, and Respiratory Guidelines (10:08)
Determine what environment the patient is transitioning to and provide support to clinicians. Review WCPT NAPT respiratory and rehab guidelines and WCFT initiation criteria for adults in the acute phase; monitor vitals.
COVID-19 Rehab During Stable Period (03:56)
Inactivity contributes to physical and mental deconditioning. Schmidt cites elements of the pre-therapy assessment. Focus on respiratory training, airway secretion clearance, abdominal breathing, exercise therapy, resistance training, balance training, and psychological support.
COVID-19 Rehab During Recovery Period (06:16)
Therapy must address fatigue, weakness, poor endurance, and psychological impact. Assessment evaluations include general clinical, symptomatic, muscle strength, ROM, functional, balance, endurance, and ADL. Conditioning includes aerobic exercise, and resistance, balance, and breath training. Schmidt cites post-COVID considerations.
PM&R for Patients With COVID-19 and Burnout (02:36)
The goals are to decrease disability, dyspnea, anxiety, and complications. Use a multidisciplinary approach with a focus on breathing and stretching exercises, open airway, pulmonary clearing, supplemental O2, posture, manual therapy, nutrition, and physical conditioning. Schmidt discusses PT frequency associated with mobility status.
Clinician Burnout (18:58)
Schmidt asks attendees to share their top three concerns related to COVID-19 and their experiences with clinician support. She defines professional burnout, shares anecdotes about 9/11, and provides tips to manage burnout. Resilience builds immunity.
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