Rehabilitation proves crucial for COVID-19 patients

For COVID-19 patients who need critical care in Michigan Medicine’s intensive care units (ICU), recovery from the illness can be a slow, lengthy process. And it involves dozens of care team members, including physical and occupational therapists.

In his years as a physical therapist, Evan Haezebrouck said this group of ICU or critical care patients is the sickest he has seen. He and his fellow physical and occupational therapists work in the RICU, donning all the necessary personal protective equipment (PPE) such as a gown, N95 mask and face shield, to work alongside nurses and physicians to care for the special population.

“Many COVID-19 patients spend weeks on ventilators. These machines keep patients alive but the immobility associated with mechanical ventilation, deep sedation and advanced treatments including neuromuscular blockade and prone positioning has long-term implications,” Haezebrouck said. 

For instance, patients may experience muscle weakness, lack of endurance, loss of range of motion and cognitive declines. 

“Simply sitting up in the bed, moving their ankles and standing up can be difficult and tiring for these patients,” said Kevin De Bear, staff occupational therapist.  “When patients are beginning to wean off the ventilators, we start working with them in the ICU.”

Such care involves physical and occupational exercises, but include other, less obvious measures. For instance, therapists set up the room so that patients know the difference between daytime and nighttime, such as turning lights on during daytime hours and playing music or shows to stimulate wakefulness.

“It’s important that patients get on normal sleep and awake cycles,” said De Bear. “That helps to have a purposeful interaction with the world around them.”

Getting ready for discharge

Depending on their level of need, when patients are discharged from the ICU, they could be sent to inpatient rehabilitation units, skilled nursing facilities or home. 

Patients with more cognitive difficulties may have difficulty managing their medications, paying bills, preparing meals and other independent living activities.

“The longer patients on the ventilator, the higher chance that they will not be able to go home immediately,” said De Bear. “But no matter their destination, our teams will work to get them prepared for whatever lies ahead on their road to recovery.”

Moving forward

Working with COVID-19 patients has encouraged more collaboration and teamwork across disciplines, as the needs are so complex.

“Our physical therapists have been communicating more openly with members of the occupational therapy and speech-language pathology teams, as well as medical teams (in particular, Physical Medicine & Rehabilitation) to ensure close management and follow-up,” said Haezebrouck. “For those nearing hospital discharge, open communication with family members (who have become caregivers) has been vitally important.”

As the health system prepares to open up care for more patients, De Bear and Haezebrouck plan to utilize the skills they have learned while working in the ICU with other patient populations.

“Though this is not an experience any of us would have hoped for, there has been some good in terms of my development as a clinician,” De Bear said. “It has helped me understand what patients go through during their entire hospital stay and across their continuum of care. When I return to the inpatient rehabilitation team, there will certainly be aspects of my practice that have changed in response to my new experience. And that will only improve care in the long-run.”