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Interprofessional Education

From a Doctor of Physical Therapy candidate's words

  • High blood pressure is something PTs must take into consideration when treating patients. PTs are movement specialists, and our job is to get people moving. When it comes to acute care settings (in-patient hospitals, ICUs, SNFs, etc.), blood pressure is taken before, during, and after most treatments. 

  • Asthma treatment through PT can vary for each patient. Treatment options focus on improving the quality of breathing or the efficiency. Breathing techniques can be practiced and prescribed, such as diaphragmatic breathing or pursed lip breathing. The muscles used for breathing can be strengthened through neuromuscular education, using a device that provides a resistive load against inspiration, or even aquatic exercise. The water in a pool will provide resistance against inspiration, but this will need to be monitored as it can be too restricting on patients especially if they already had breathing difficulties.

  • Other considerations for asthma treatment are if the patient has mucus build up in their respiratory system. There are percussive treatments and postural drainage techniques that PTs can use to help clear the lungs based on where the mucus has built up. There are also techniques to help the patient cough most effectively to clear mucus. One such way is using a very quick cryotherapy application. Taking an ice cube in a quick swipe to the patient's back can cause the expiratory muscles to fire and produce a cough.

  • Lifestyle changes for patients with asthma include limiting exposure to respiratory irritants, like dust, smoke, pet dander, etc. Postural education and correction can also benefit those with asthma. Poor posture can limit the ability of the respiratory muscle to function properly/efficiently and can limit the amount that the lungs can expand while breathing. This can include stretching tight muscles and joints and strengthening others, depending on the presentation of the patient.

  • We have not had much discussion on COVID-19 specific treatments within the realm of physical therapy. Assisting patients in sitting, standing, and walking as tolerated will benefit their condition or at least limit the negative impact of symptomatic COVID-19.

From a Doctor of Osteopathic Medicine candidate's words

  • Pulmonary: Although COVID-19 is asymptomatic for most, patients can get very sick with symptoms. In a study conducted in the United States, 20% of people with diagnosed COVID-19 developed acute respiratory distress syndrome, and 12.3% of them needed mechanical ventilation to stay alive. (See "Coronavirus disease 2019 (COVID-19): Critical care and airway management issues", section on 'Clinical features in critically ill patients'.)

  • Cardiovascular: Other complications arising from COVID-19 infections also include heart-related issues, such as arrhythmias, acute cardiac injury, and shock—likely to do with the lung ventilation issues that could lead to hypoxia or the strong immune responses associated with COVID-19 infections [27,66,122,123]. One of the most surprising findings is an increase in risk for pulmonary embolism and acute stroke for those with COVID-19, even if they are under the age of 50. In a series of 21 severely ill patients admitted to the ICU in the United States, one-third developed cardiomyopathy [122].

  • Thromboembolic complications, including pulmonary embolism and acute stroke (even in patients younger than 50 years of age without risk factors), have also been reported [124-130].

  • Neuro: Encephalopathy, or disease affecting the brain, is also a common and unique side affect to the COVID-19 infection, with some studies reporting encephalopathy in up to a third of hospitalized patients. Out of all the neurological symptoms, loss of smell, inability to taste, and muscle weakness are common, while stroke, movement disorders, motor and sensory deficits, ataxia, and seizures occur less frequently.

  • Inflammation: Some patients with severe COVID-19 have laboratory evidence of an exuberant inflammatory response, with persistent fevers, elevated inflammatory markers (eg, D-dimer, ferritin), and elevated proinflammatory cytokines; these laboratory abnormalities have been associated with critical and fatal illnesses [25,132,133].​​

  • Sources:

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