We all are aware of the new pandemic Corona virus disease (COVID- 19) is an infectious diseases caused by a SARS-CoV -2 resulted in the outbreak of respiratory illness known as COVID -19 viruses. That can cause illness from common cold all the way up to more severe respiratory illness.
The disease causes respiratory illness with symptoms such as cough, fever, tiredness and difficulty in breathing in severe cases.
The incubation period is estimated to be 2 and 15 days but transmission from asymptomatic cases has been reported.(1)
The transmission cases were reported from individuals within the same family member and from health workers who were in direct contact with confirmed cases and with suspects.(2)
Up to date there is no vaccine to prevent COVID -19 and the work on treatment is ongoing.
According to data uploaded till april 10-2020, the total number of confirmed cases worldwide has reached to 1700816 with deaths 102787 and in india confirmed case reached to 7600 with deaths 249.(3)
Various Stages of infection of COVID 19
1. MILD
2. MODERATE
3. SEVERE
4. COVID SUSPECTS
Physio A Primary Ventilator
Breathing exercises is the key that physiotherapist should use to work as a primary ventilators. Studies indicate that breathing exercises are the fundamental interventions for the prevention of acute and chronic pulmonary diseases. They are helpful to alert a patient’s rate and depth of ventilation .These techniques are used to improve the pulmonary status and increases patients overall endurance. By adding the breathing exercises in the management of COVID Patients we can control the mortality rate and decreases the worsening of respiratory system. It will also motivate the other medical professionals to save lives of patient as they have more time in present stage of illness for treatment.
By keeping severity, time duration and best protocol in a mind. COVID 19 Patients Should Be classified into given 4 categories so the better results can obtained.
1. Ventilatory patients
2. Symptomatic patients
3. Asymptomatic patients
4. Home Quarantined
According to the above mentioned categories , suitable and effective exercises for these categories are :-
⮚ Ventilatory patients :- Glossopharyngeal Breathing .
⮚ Symptomatic patients :- Pursed lip breathing
Segmental breathing.
⮚ Asymptomatic patients :- Segmental breathing ,Diaphragmatic breathing.
⮚ Home Quarantined patients :-Deep breathing, diaphragmatic breathing along with other exercises like yoga with inhale and exhale practices.
EXPALATION OF BREATHING EXERCISES (4)
● For Ventilatory Patients
Glossopharyngeal Breathing
It is for ventilator dependent patients due to absent or incomplete innervations of diaphragm.
It is means of increasing patient’s inspiratory capacity when there is severe muscle weakness of inspiration.
Glossopharyngeal breathing with inspiratory action of muscles can reduce ventilatory dependence or can be used as an emergency procedure for malfunctioning of ventilator.
PROCEDURE :-
Patients take several gulps of air (2 to 4) then by closing the mouth the tongue pushes the air back and trap it in pharynx the air is then forced to lungs when the glottis is opened.
This increases the depth of inspiration and patients inspiratory and vital capacity.
● For Symptomatic Patients
1. Pursed lip breathing
2. Segmental breathing
1.Pursed lip breathing
It is a strategy that involves lightly pursing the lips together during controlled exhalation.
Helpful to control the episodes of dyspnea.
It helps to improve ventilation and releases trapped air in lungs.
It moves old air out of the lungs and allow new air to enter the lungs.
Keeps the airway open longer and prolonged exhalation slows the breathing rate.
It can be applied as a 3-5 rescue exercises or an emergency protocol to counteract acute exacerbations or dyspnea (shortage of air or breathlessness).
PROCEDURE :-
Patients in a comfortable position and relaxed, explain the patients about the expiration phase it should be relaxed and passive.
Abdominal muscle contraction must be avoided (Therapist should check for abdominal contractions).
Ask the patients to breathe in slowly and deeply through the nose and then breathe out gently through lightly through pursed lip (blowing the flame of candle).
By providing the slight resistance an increased positive pressure will generate within the airway which helps to keep open small bronchioles that otherwise collapse.
2.Segmental breathing
It is performed on a segment of lung, or a section of chest wall that needs increased ventilation or movement.
Hypoventilation can occur in certain areas of the lungs because of chest wall fibrosis, trauma to chest wall or any infection, pneumonia.
Therefore it is important to emphasize expansion of such areas of the lungs and chest wall.
Techniques:-
Lateral coastal expansion
Posterior basal expansion
Right middle lobe expansion
Apical expansion
PROCEDURE FOR LATERAL COASTAL EXPANSION
The patients may be sitting or in a hook lying position.
Place your hand along the lateral aspects of the lower ribs.
Ask the patient to breathe out, and feel the rib cage move downward and inward.
As the patients breathes out place firm downward pressure into the ribs with the palms of your hands.
Just prior to inspiration, apply a quick stretch on the external intercostal to facilitate their contraction. These muscles move the ribs outward and upward during inspiration.
Apply light manual resistance to the lower ribs to increase sensory awareness as the patients breathes in deeply and chest expands.
When the patients breathe out, assist by gently squeezing the rib cage in a downward and inward direction.
The patient can perform this maneuver independently; ask him to apply resistance with his hand or with a towel.
● For Asymptomatic Patients
1.Diaphragmatic Breathing
2.Segmental Breathing
1.Diaphragmatic breathing
Diaphragm is the primary muscles for breathing (inspiration).
Diaphragm controls breathing at an involuntary level, a patient with primary pulmonary disease can be taught breathing control by optimal use of diaphragm and relaxation of accessory muscles.
PROCEDURE:-
Prepare the patients in relaxed and comfortable position in which gravity assist the diaphragm such as semi flowers position.
Stop accessory muscle activation if seen do relaxation techniques.
Place your hands over the rectus abdominis just below the anterior coastal margin ask the patients to breathe slowly and deeply via nose by keeping the shoulder relaxed and upper chest quiet allowing the abdominals to rise now ask him to slowly let all the air out using controlled expiration through mouth.
Have him practice this 2-4 times if finds difficulty in using diaphragm have the patients inhale several times in succession through nose by using sniffing action this facilitates the diaphragm.
After he understands and able to do the controlled breathing using a diaphragmatic pattern keep the shoulder relaxed and practice in verify various positions( supine ,sitting standing) and during activity (walking and climbing stairs ).
2.Segmental Breathing
Explained above in symptomatic patients section.
● For Home Quarantined Patients
Patients who are home quarantined can do this by own or take advice by therapist through online or by telehealth.
Practice deep breathing.
Do yoga and pranayama.
Try various breathing techniques like extend exhale.
1.Diaphragmatic Breathing
Explained above in Asymptomatic patients section.
2.Deep Breathing
It promotes relaxation and relives stress and improves the strength endurance coordination of the muscles of ventilation.
It helps to calm down, relax and support correct posture by sending message to brain.
When your body is fully oxygenated it carries and absorbs nutrients which help to improves immunity.
Procedure:-
Get comfortable lie on back .
Breathe in through nose, let belly fill the air.
Breathe out through nose.
Place one hand over belly as you breathe in feel your belly rise.
Repeat and take more deep breaths.
3.Extend exhale
Breathe in through the nose for 5 counts, pause and then breathe out through nose for 7 counts, repeat it.
❖ Precautions Taken
Never allow the patients to force expiration it may increase the turbulence in the airways
Do not allow the patients to initiate inspiration with accessory muscles.
Advise him that upper chest should be quiet during breathing.
Observe and access the patient spontaneous breathing pattern while at rest and during activity.
Allow the patients to perform deep breathing only for 3-4 times.
Avoid prolonged expiration it causes the patients to gasp with the next inspiration and the breathing pattern become irregular and inefficient.
❖ Therapist self-care
PPE Should be used when in contact with the COVID Patients.
Use of gloves and mask during the treatment.
Hand sanitization before and after treatment.
Anjali Triapthi
BPT Final Year
Uttar Pradesh university of medical sciences
Refrences
1. Tang B, Wang X, Li Q, Bragazzi NL, Tang S, Xiao Y, et al. Estimation of the Transmission Risk of 2019-nCov and Its Implication for Public Health Interventions. 2020. Available at SSRN 3525558. Available from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3525558.
2. Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. N Engl J Med. 2020 Feb 27;382(9):872–4. Adopted from: https://www.nejm.org/doi/full/10.1056/NEJMc2001272.
4 CAROLYN KISNER PT,MS (2007), Therapeutic exercises foundation and techniques chapter 25 (5edition, page no 861-866)
Comments