Coming back from COVID: Rehabilitation therapists are key
BY JIM HOWE
Rehabilitation therapists play a key role in helping patients with lingering medical problems after a COVID-19 infection.
After the initial infection has subsided, from 10% to 30% of patients will experience debilitating symptoms for weeks or months, such as fatigue, shortness of breath and “brain fog,” trouble concentrating, remembering and focusing.
Some estimates suggest up to 80% of patients will later experience fatigue and/or brain fog, especially those who were hospitalized.
This collection of symptoms, highly variable and not well understood, is called by various names, such as “post-COVID,” “long COVID,” “long-haul COVID” or “post-acute COVID.”
Caring for these patients usually falls to a primary care provider – such as a family doctor, pediatrician or internist – who will likely send the patient to rehabilitation specialists: physical therapists, occupational therapists and/or speech therapists. Other specialists may also be called in as needed for specific problems.
Taking aim at specific problems
Rehabilitation therapists work out plans to help patients deal with or overcome their particular problems, whether it’s tiredness, lack of stamina or trouble with breathing, speaking or thinking straight.
A patient is often dealing with several symptoms at once, which means that even simple daily tasks can be exhausting, says physical therapist Matt Bowman. Bowman worked at Upstate before recently taking a position as a clinical assistant professor at Binghamton University.
“What often happens is ‘energy debt,’ where people with long COVID only have a certain amount of energy for the day,” he says. This means having to stop therapy exercises if the patient gets too tired, Bowman said.
Kim Brown, a speech/language therapist at Upstate, notes that “all of my patients are fatigued by the end of a session and say they are going home to take a nap. Many even have a headache afterward.”
Brown, Bowman and Upstate occupational therapist Beth Rolland note that some post-COVID symptoms they have seen resemble those of concussion, traumatic brain injury, stroke or even dementia, such as patients struggling to do simple arithmetic, to remember to take their daily medication or even to name everyday household items.
That observation is echoed by Claudine Ward, MD, a specialist in brain injury and medical director of the Upstate Concussion Center.
Ward adds that the “invisible effects” of post-COVID symptoms mean that others may not believe the patient is really sick, because there is no visible sign, such as a bandage or a wheelchair. This can lead patients to become anxious, depressed and ashamed, even to the point of avoiding treatment, she notes, so medical experts should be “validating their symptoms, letting them know they aren’t alone, meeting the person where they’re at and trying to get them out of that box they’re feeling in.”
Elizabeth Asiago-Reddy, MD, agrees. She is the chief of infectious disease at Upstate. “A huge part of treating post-COVID patients is reassurance, validating that what they are experiencing is very real, that they aren’t alone, and that we will look at the symptoms they are struggling the most with to seek a plan moving forward.”
Asiago-Reddy has treated patients with acute COVID infections as well as post-COVID problems; she and Ward both see similarities to symptoms that can follow other viral infections.
“My experience overall with post-COVID as well as with other post-infection syndromes is that people will get better over time. In the meantime, how can I best help the patient sitting before me to take the time and seek the help they need to recover?” says Asiago-Reddy. The medical experts also stress the need for individualized treatment plans, since each case offers a unique set of symptoms.
Where to go for treatment
Upstate’s Regional Rehabilitation Center, which provides physical, occupational and speech/language therapy at several sites, offers individualized treatment for post-COVID symptoms (as well as other illnesses).
For example, if a patient needs to conserve energy to make it through a day, Rolland will design therapy with that in mind. “We adapt their activities in various ways, such as how to manage fatigue, what are we going to spend energy on, and come up with a plan for that,” she says.
This might involve breaking large tasks into smaller tasks, or getting a ride to the grocery store to avoid adding the stress of driving to shopping.
Plans to address each patient’s needs and goals can include exercises and activities designed to help patients with a wide range of activities, including endurance, breathing, daily tasks, driving, concentration, speech, swallowing, sleep, depression and anxiety.
Upstate offers physical therapy for post-COVID patients in Camillus, East Syracuse, Manlius and two sites in Syracuse: Western Lights (4671 Onondaga Blvd.) and the Institute for Human Performance, or IHP (505 Irving Ave., a few blocks from Upstate University Hospital).
Occupational and speech/language therapy are only offered at the IHP.
Masking and other disease-prevention protocols are followed at all the treatment sites.