Physical Therapy and Occupational Therapy Guidance for Post-COVID Syndrome (PCS)

Little did I know when Dr. Vanichkachorn from the Division of Public Health, Infectious Disease, and Occupational Medicine, contacted me with a quick question in April of 2020, our work rehabilitation team would be starting a whole new program. As we began to see more patients with PCS a similar story was being told. Our patients were struggling to function in their daily lives. Simple tasks were now difficult. Family responsibilities were placed on hold. Return to work seemed a distant possibility as they described concerns that were not only physical, but also included emotional and cognitive symptoms.

Developing a program to meet the variable needs of these patients became a priority. It was obvious that this program would require multiple areas of expertise. Dan Neveau, OT, and Steve Higgins, PT, were brought in to help develop a Physical/Occupational Therapy Protocol for PCS.

One of the primary challenges is determining how much activity a patient can do without having their symptoms worsen.  The modified Borg Perceived Exertion and Dyspnea Scales are used to assist in determining how hard a patient is working during different activities.  In physical therapy, the goal is to keep the patient at a score of 3 (moderate) when initiating a strengthening and conditioning program.  This program can be adjusted based on a patient’s response 12-24 hours after the activity.  A graded exercise approach is essential with an awareness that modifications may be needed.

Occupational therapy offers a holistic approach that begins with getting back to the basics. A patient is encouraged to develop the consistent use of a daily planner to focus on self-cares and a return to some household chores, leisure, and social activities. Individualized activity goals are established with an emphasis on moderation. For many patients, prolonged symptoms from COVID-19 has led to a complete disruption in their life roles. Stress levels can be very high. Occupational therapy provides instruction in stress management and the use of diaphragmatic breathing and relaxation techniques. For those experiencing brain fog, a referral to our Brain Rehabilitation team is often considered.

As expected, returning to work is a high priority for our patients. Physical and occupational therapy help the referring providers better understand their patient’s abilities and readiness for work. As tolerance improves, the addition of work-specific functional simulations is recommended. Ergonomic recommendations can also be made as needed. Appropriate work restrictions with an emphasis on a gradual return to work can be developed as a team.

Recovering from COVID-19 can take a physical and emotional toll on an individual, especially when the symptoms are prolonged.  Understanding how to manage symptoms and staying active can help with the recovery process and provide a sense of well-being.

Authors: Mike Trenary, DPT, Dan Neveau, OT, and Steve Higgins, PT

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