Covid-19 and Physiotherapy!
Covid-19 with a new variant of virus erupted like anything and is still going haywire with new mutant virus emerging every now and then. This being a totally new disease with ever changing symptoms and course of disease, getting a sure shot treatment is highly unlikely.
Every field of medicine is trying to save patients by practicing various methods/medicine/therapy. Sometimes symptomatic treatment to some drugs which showed promising result in previous disease to whatever works best for the patient considering what outweighs more benefits to the cure of patient. Each and every treatment right now is on trial basis. Even the remdesivir and tocilizumab for which people are running over are not the sure shot treatment but they seem to work well in some patients to reduce the hospital stay.
Even guidelines are changed every month by critical care specialist depending on mass response of patients towards the treatment, changes in presentation of symptoms and new research coming over.
Same goes for physical therapy.
We Veraval civil physiotherapists are working in Covid wards/ICUs since over a 1 year now. With all the guidelines and our experience with the treatment of patients, patient’s presentation of symptoms and patient’s response towards the treatment; these are some of the findings that we have observed and the treatment we are providing based on that.
First we categorize patients on the basis of their vitality or stability.
In ICU mainly patients are on biPAP or cPAP mode of ventilator. In stable ward, patients are on NRBM or Nasal cannula. While in day care wards, all patients are on Room Air.
Now after assessing patients and their general condition, we plan their treatment.
If patient is on biPAP/cPap and GCS is poor, positioning (side lying/sims position) is only form of physiotherapy treatment we prefer apart from some passive movements (if needed). Intubated patients may sometime require chest physiotherapy due to presence of chest secretions especially in patients taking remdesivir or tocilizumab they have secretions. In such patients percussion or cupping is required.
If patient is on biPAP, GCS is good and can achieve sitting position or can do some of their body movements, then with positioning; we teach them breathing control exercises, chest exercises along with active/active-assisted range of motion exercises. Cupping or percussion if secretions are present.
Now in stable ward, mainly we see patients performing well with NRBM or NC, so we go for breathing exercises like Diaphragmatic Breathing Exercise, Pursed Lip Breathing Exercise, Slow relaxed breathing, Chest Expansion Exercise, Active body movements and end the session with nebulisation, And ofcourse, prone positioning post nebulisation.
In day care wards, room aired patients are all fun, we can give every possible cardiopulmonary Physiotherapy exercises which keeps their weakness at bay and maintains the air entry.
Prone position and breathing exercises are two of the most effective treatments and works wonders along with the medical treatment.
Although, we might not be perfect with our treatment as per others but every therapist has his/her own experience and we do try our best to provide our patients with best possible treatment. Also, no one treatment is perfect. Everyone has his or her way of treating patients with different techniques and it is perfectly alright unless and until it isn’t contraindicated in certain patients.
We are doing our bit in every way possible and working and praying for everyone’s safety and well being!
Dr. Girish Vala(MPT Neuro)
Dr.Krima Tanna (MPT Cardio-Pulmonary)
Co-founder The Brown Wine