In 3 sentences: Dr. Prashant discusses the role of physiotherapists in COVID-19 rehabilitation, outlining a 3-phase approach including ICU, ward-based care, and post-acute care. Common exercises prescribed include breathing, coughing, mobilization, and strength exercises. Advice is given for managing symptoms like breathlessness at home through positioning, relaxation, and breathing techniques.

1. CENTRE FOR PROFESSIONAL AND
ADVANCED STUDIES.
PHYSIOTHERAPY DEPARTMENT
SCHOOL OF MEDICAL EDUCATION,
GANDHINAGAR, KOTTAYAM.

2. ON AIR (MPT 2ND YEAR)
PRESENTED BY: SHEM DASAN,SME(KTM)

3.  Hello good morning everyone, its your RJ Praveena.
 Welcome to public health talks
 In this episode we are going to talk about the physiotherapy and its role
in covid-19.
 We have Dr. Prashant, consultant physiotherapist, Andrew hospital
 Welcome sir

4. Thank you Praveena
Very glad to be on
your show.

5. Sir, as we know, covid 19 pandemic is widespreading throught the
world. As a physiotherapist what all are your roles, in covid rehab?

6.  See praveena, many people don’t know how well rehab through physiotherapy
can help you recover from after effects of covid-19.
 There are studies, showing importance of PMR, considering the extensive
disabilities being encountered such as:
• Respiratory symptoms
• Deconditioning
• Critical illness myopathy
• Neuropathy
• Joint stiffness, pain

7. So once the patient is diagnosed positive of covid-19, when
will your role as physiotherapist start ?

8. Our role starts as soon as the patient is stable with his respiratory as
well as his haemodynamic function.
Our rehabilitation is mainly done in three phases:
 ICU (PHASE 1)
 WARD BASED (PHASE 2)
 POST-ACUTE PHASE (PHASE 3)

9. Sir, can you just give us a brief outline of these
phases?

10. Oh yes for
sure

11. ICU (PHASE 1):
• Patients in ICU are in risk of developing ICU acquired neuromuscular weakness
due to prolonged periods of protective lung ventilation, sedation and use of
neuromuscular blocking agents.
• Aim of rehabilitation in icu setting is to minimize disability and optimize
functional capabilities in form of aerobic exercises, strength training and balance
training.
• WHO recommends active mobilization of patients with covid 19 early in the
course of illness, when it is safe to do so.
• Fatigue is present in 40% of cases and this should be taken into account on
rehabilitation. While weaning from ventilator caution should be taken not to
overload the respiratory system
• Inspiratory muscle training reduces ventilator weaning time and provides much
good results.

12. WARD BASED(PHASE 2):
 Phase 2 are those who have been discharged from ICU to ward or those who did
not required ICU. These patients mostly have high o2 requirement or be
dependent on NIV ( via face mask).
 In this phase physiotherapist will play a good role in weaning of ventilator
supports, o2 therapy and airway clearance techniques will also be beneficial to
those who are unable to clear secretions independently
 Physiotherapist will prescribe exercise individualized to patient without
overloading the respiratory or cardiovascular system.
 Aim will be disability prevention through use of ROM exercises to maintain/
improve joint integrity and strength.

13. POST-ACUTE(PHASE 3)
 Phase 3 consists of patients who have progressed from a critical care stay to sub-
acute wards/ rehab unit or those who are admitted directly to acute medical ward
for medical management of covid 1 / coinfections. Eg: community acquired
pneumonia.
 Early mobilization reduces the length of stay in adults hospitalized.
 Patient should have an individualized assessment in order to document immediate
needs.
 Assessment should include muscle strength, mobility, balance,
dysponea,fatigue,pain and a neurological assessment to assess for critical illness
neuropathy.
 Exercises should be individualized according to assessment.

14. Sir what are the commonly done exercises in hospital for
them?

15. So as I already told exercises differ individually to each patient.
Common exercises to do in hospital :

17.  Sir, till now we where talking about management at hospital,
so what about after discharge?

18.  Yes, so what I have to advise after discharge is that try maintaining a good
emotional as well as mental health.
 It is normal to feel tired, weak or short of breath after you are discharged from
hospital, however being active can help you recover quicker.
 Energy saving techniques like sitting on a stool while doing ironing,gardening or
preparing will help save energy.
 When trying to get rest try to get into prone position, which promotes better
oxygenation.
 Exercises like walking are simplest way to begin regain your strength and fitness.

19. Other exercises to do at home:

21. OK sir.
Sir the other questions that comes to peoples mind is how
much exercises should I do or when to stop?

22. YES, that’s an important question Praveena.
 Start slowly and introduce new activities gradually
 Rest when feeling tired
 Do not compare yourself to others
 Listen to your body. It may take some time to reach back to normal.
 It is important to monitor your breath when you exercise. You should exercise at a
level whereby you are slightly out of breath but still able to talk
 Try to bring balance in your daily activities(preparing a schedule for everything).

23. Taking walking as an example how to progress should be somewhat like this, which
again will vary from individual to individual:

24. Ok sir
Many people face breathlesness, how to manage it?

25. Breathlesness is a common symptom of covid 19.
Feeling breathlessness can make you feel panicked/ anxious. This can make
it even more worse.
In early stages you may experience it even when you are doing minimal
activity for eg: while getting dressed, walking, showering etc.
It will be their for certain time after your illness and you may even have
lost your strength.
During this time it is important to slow down and pace yourself.

26. Managing
breathlesness:
Certain positions will
help you ease you from
shortness of breath.
Try and relax in these
postion, a good way to
do is to focus on
relaxing muscles in neck
and shoulder while
doing this:

27. Practising a good breath control will also help you recover from this:
Relaxed tummy breathing:
 this breathing technique will help you when you are out of breath after
doing an activity.
 breathing from tummy often does not come naturally.
 you should practise relaxed tummy breathing when you are not
breathless then only you will master it.
 Before practicing make sure you are in comfortable position with
head and back supported and shoulder and upper back relaxed.

28.  Place hands on your tummy. Feel tummy rise and expand as you
breathe in and relax down as you breathe out.
 Breath gently when practicing, there should be only a slight
movement of tummy at rest.
 Try breathing a rectangle:

29.  Pursed lip breathing:
 you may find this helpful if you are very breathless, become anxious or if you
find tummy breathing is difficult.
 This type of breathing allows more time for the air to leave your lungs, making it
easier to take next breathe in.
 Choose one of the ease positions as told before, relax your shoulders. Breathe in
through your nose then breathe in a relaxed fashion through you pursed lip
(tightened lip).
 Continue until you feel your breathing is under control.

31. Sir, due to covid lockdown people are working from home and
students having online clases, any suggestions for them?

32.  Many people will be working from home and clases at home, primary
problem due to that is poor ergonomics which many people are not
aware of which may lead to poor postures, resulting in pain, stress etc.
 So to handle that settting up a good workstation is very important:

34.  After setting up another thing to watch is not sitting continuously for
not more than 30 minutes, take adequate breaks along with some
exercises in regular intervals and also be well hydrated.
 Some exercises you can do in between work,
repeat all exercises 3-5 times and hold for
10-15 seconds each.

36. Long chat with you sir, last one question sir, for people who
have not yet been exposed to the corona virus, any suggestions
for them?

37. Yes Praveena, what I will suggest to them is maintain a good healthy
life with good diet and exercises. Avoid junk foods and find some
time for exercise.
Studies down in this lockdown had found that the sleep pattern of
many people have been disturbed, many people sleep late. Sleep has a
very vital role in building a strong immunological component. So
prepare a proper schedule for sleep and work.
If you have any other problems like asthma, diabetes etc, have
medicines on time.
Stay emotionnaly healthy and avoid stress.

38. Thank you sir, for your valuable time with us and such
an informative session

39. My pleasure
Thank you,Praveena

40. ‘
Okay everyone its
you RJ Pravenna
signing of.
See you soon