Healing Through Rehab

Each year more than four million adults survive a stay in the Intensive Care Unit (ICU). Following discharge, many experience new or worsening physical disability, mental health problems and/or cognitive impairments, known as post-intensive care syndrome (PICS).

Characteristics of PICS include:

• Cognitive impairments

• Anxiety/depression

• Physical impairments

• Neuromuscular complications that often result in poor mobility and falls

Without intervention, these complications can last for months or years. Many ICU survivors, including those recovering from COVID-19, could benefit from physical, occupational and speech therapy services after hospital discharge. *1

Post-Acute COVID-19 Rehabilitation

Complications from COVID-19 can often lead to admission to an Intensive Care Unit (ICU). A common assumption is that once a patient is discharged from the hospital and tests negative for COVID-19, the problem is resolved. But physical complications after critical illness may occur in approximately 70% of people and include pain and impairments in:

• Skeletal muscle strength

• Pulmonary function

• Walking ability

• Activities of daily living (ADL’s)

• Instrumental activities of daily living (IADL’s)

Along with inpatient healthcare utilization, survivors of critical illness also frequently require ongoing outpatient medical and rehabilitation services.*

Healing Through Rehab

Rehabilitation has a positive effect on health outcomes of patients with COVID-19 and can include physical, occupational and/or speech therapy for impairments related to:

• Long-term ventilation

• Immobilization

• Deconditioning

• Other related impairments—respiratory, neurological, musculoskeletal, cognitive

While monitoring the patient’s respiratory and hemodynamic state during rehabilitation, specific interventions can include:

• Active range of motion followed by progressive muscle strengthening

• Neuromuscular electrical stimulation to help with strengthening

• Aerobic reconditioning with walking, cycle or arm ergometer, NuStep or similar crosstrainer

• Progressively increasing aerobic exercise

• Education on energy conservation and behavior modification

• ADL retraining

• Cognitive Retraining

Through a holistic approach, the physical, occupational and speech therapists at Memorial Hospital’s Therapy and Sports Rehab outpatient center can help address the physical, cognitive, psychosocial and sensory aspects of recovery from long stays in the intensive care setting and the aftermath of COVID-19.

SOURCES:

1. *James M Smith, Alan C Lee, Hallie Zeleznik, Jacqueline P Coffey Scott, Arooj Fatima, Dale M Needham, Patricia J Ohtake Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome Physical Therapy, Volume 100, Issue 7, July 2020, Pages 1062-1073,

2. *van der Schaaf M, Beelen A, Dongelmans DA, Vroom MB, Nollet F. Poor functional recovery after a critical illness: a longitudinal study. J Rehabil Med. 2009;41:1041-1048

3. *Ruhl AP, Huang M, Colantuoni E., et al. Healthcare utilization and costs in ARDS survivors: a 1-year longitudinal national US multicenter study. Intensive Care Med.2017;43:980-981