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From Brain Fog to Heart Damage: Rehab After COVID – In-Depth Doctor’s Interview

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By on Health News Medical News

Kat Aksamit, PT, DPT, NCS, Senior Physical Therapist at the University of Colorado School of Medicine talks about the intricacies of rehabbing COVID-19 ICU patients.

I was blown away by how long the rehab is and how much these patients need. What are you seeing?

Kat Aksamit: Many of our patients recovering from COVID had prolonged ICU and hospital stays and then required a few additional weeks of acute rehabilitation which included physical, occupational and speech therapies. After their discharge from rehab, they had ongoing therapy needs which were addressed with home or outpatient therapies. Basically, these patients required a lot of time, which is consistent with the prolonged intubation and immobility many of these patients experienced while in the hospital.

What happens when someone is intubated and what will they need in rehab?

Kat Aksamit: Due to intubation, many of these patients experienced cognitive impairments, decreased aerobic capacity and critical illness myopathy which weakened their muscles profoundly and affected their endurance to do basic activities such as walking. For these reasons, these patients required intensive, multidisciplinary rehab.

Did you have to change or create new ways to rehab these COVID patients?

Kat Aksamit: Absolutely. First and foremost, we relied on our acute therapy team to identify and prepare the incoming patients to be able to tolerate up to 3 hours of therapy a day on rehab. Then we had to collaborate with the infectious disease specialists to help create safe PPE donning and doffing procedures that would enable our patients to safely leave their rooms (many for the first time) to enter the rehab gym.

Have you ever been involved with something that hits you so much and challenges you in every way?

Kat Aksamit: I haven’t seen anything like this yet. This was a very challenging and uncertain time for the patients and the clinicians alike. It was incredibly rewarding to receive a patient in their weakest state, at the point when they needed up to two peoples help to stand and take steps, and then watch them walk out of rehab using just a walker or no walker at all. Lastly, the best part was that you were never alone during the process. There was so much support from the

entire team, and that made it easy to meet all the patients’ complex needs.

Did you have to create a special rehab for COVID?

 Kat Aksamit: Yes. I think the biggest hurdle was just ensuring safety and PPE conservation during this uncertain time. It forced us to be creative and really come together as a unit.

We’re already a very collaborative unit, but this really tested us and it was rewarding to be part of this because we came together and really helped each other out – nursing, therapy, physicians, and the handoff from the therapists in the ICU to rehab – just that kind of communication.

Since you have been through this from the beginning, what has been the most surprising thing about COVID for you?

 Kat Aksamit: How deconditioned the patients were when they got to the rehab unit, the high levels of oxygen some required and the additional neurological and cognitive impairments they were experiencing. In addition, many of these patients needed supplemental oxygen for their entire stay and many went home needing continued oxygen. The oxygen needs were variable but what I think what was most unique to this patient population is how quickly the oxygen needs would increase from rest to activity. It was surprising how much oxygen they required when it came to remarkably simple tasks. We really had to skillfully monitor their oxygen levels during activity and exercise.

How low did you see the oxygen levels go?

Kat Aksamit: On our unit, the patients would wear devices to continuously measure their blood oxygen levels. This enabled our therapists, nursing staff and physicians to always know what the oxygen status of a patient was and it allowed us safely push the patients during therapy. At times we would see the oxygen drop to the low 80s. In cases like that we would have the patient stop and rest as the task was likely too demanding for the patient or adjust the oxygen levels with collaboration from the medical team.

Deconditioning, explain what that is?

Kat Aksamit: Deconditioning is a term used to describe the effects of bed rest. Deconditioning is decreased stamina, tolerance, and strength. It is usually a side effect of immobility, which is inevitable with an ICU stay.

Does it take part of your team to get them back in condition?

 Kat Aksamit: There were so many people involved in these patients care. They received speech therapy, occupational therapy, and physical therapy. In addition, there were respiratory therapists involved, psychologists, nursing staff, physicians, residents, and hospitalists. It really required an entire village to take care of one person, and all of us working collectively to facilitate recovery and enable the patient return home safely to family.

Interview conducted by Ivanhoe Broadcast News.

END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

If you would like more information, please contact:

Jessica Berry Jessica.Berry@uchealth.org

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