Introduction

In this video I’ll be talking about physiotherapy role in covid19 cases and what
exercises you should do to prevent codvid19
Keep watching till the end, very very interesting content you never know coming
up
Chanel intro
Shot-1
first, I’ll be talking about physiotherapy role in covid19
Many respiratory physiotherapy interventions are potentially AGPs
AGPs means Aerosol generating procedures which can create an airborne risk of
transmission of COVID-19.
While there are insufficient investigations confirming the AGPs of various
physiotherapy interventions, the combination with cough for airway clearance
makes all techniques potentially AGPs
Therefore, there is a risk of creating an airborne transmission of COVID-19 during
treatments.
In the guidelines which will be specified. it states that Physiotherapists should
weigh up the risk versus benefit to completing these interventions and use
airborne precautions.

Shot - 2
Physiotherapist work in different kinds of settings in a hospital.
Physios who work in Cardiopulmonary ICU settings and who are specialized in this
field are involved in the team of treating covid19 patients.
Respiratory physiotherapy interventions may be indicated if patients who have
suspected or confirmed COVID-19 and who are concurrently or subsequently
developing exudative consolidation, mucous hypersecretion or if a patient is
unable to clear secretions of respiratory system.
Where AGPs are indicated and considered essential, they should be undertaken in
a negative-pressure room, if available, or in a single room with the door closed.
Only the minimum number of required staff should be present, and they must all
wear PPE as described.
Shot-3
According to a journal released on 23- March 2020
Which was endorsed by
 World confederation of physiotherapy
 International confederation of cardio respiratory physical therapist
 Australian association of physical therapy
 Canadian association of physical therapy
In which guidelines were given depending on the various symptoms and
conditions of codvid 19 patients and relative physiotherapy treatments.
Shot-4
I will be describing these guidelines in 7 different scenarios
In first scenario the affected patients might have mild symptoms without any
respiratory compromise
for example :-
 fever,
 dry cough,
 no significant chest x ray changes.
In such cases physiotherapy is not advisable
Shot 6
In scenario no – 2
The patients might have pneumonia presenting features
 Such as :- non- productive cough
 Low level of oxygen supplementation required
  Patient able to produce cough and clear secretions of throat and have clear
respiratory system
 No other comorbities
In such scenario physiotherapy treatment are not required
Shot 7
In scenario no – 3
The patients might have mild symptoms or/ pneumonia and co-existing
respiratory or neuromuscular complications
Such as :-
 COPD,
 cystic fibrosis,
 neuromuscular disorders,
 bronchiectasis etc..
And they will have difficulty in clearing secretions
In these cases physiotherapy treatment is advisable for airway clearness.
Shot 8
In scenario no – 4
Patient might have mild symptoms / or pneumonia and evidence of consolidation
in lungs and difficulty or inability in clearing lung secretions
 Example :- weak , ineffective and moist sounding cough
 Wet sounding voice
 Tactile fremitus on chest wall
In such cases physiotherapy treatment is advisable for airway clearance
Shot –9
In scenario 5
Patients might have severe symptoms suggestive of pneumonia and lower
respiratory tract infections in such cases
They’ll have
 fever,
 increased oxygen supplementation,
 difficulty breathing,
 Frequent,severe, or productive cough
 Chest x ray,CT,Ultrasound suggestive of consistent consolidation and
secretion retentions
In such cases physiotherapy is advisable for airway clearance.

Shot 10
In scenario 6
Patients might have or may develop any significant functional impairments
Such as: -
 patients who are weak and having multiple comorbidities impacting their
independence.
 If there's any prolonged onbed icu acquired weakness
 Patients who got functionally declined and require mobilization, exercise,
rehabilitation in icu.
In such cases physiotherapy is advisable for functional mobility.
Shot 12
In scenario 7
It is reported in few cases that patients severely affected will lead into ARDS
which means
ACUTE RESPIRATORY DISTRESS SYNDROME
In this syndrome due to infection of virus there will be disturbance in lung
function and leading to alveolar-capillary membrane leak and a non-cardiogenic
pulmonary edema.
Which is in simple terms lung inflammation.
In worst cases it will lead to mechanical ventilation

Shot 13
When the patient is on mechanical ventilation physiotherapist are involved in
positioning of the patient as in ARDS prone position is to be known effective.
When the virus and its effects subside, patient should be removed from ventilator
support.
Physical therapy interventions facilitate the weaning process from mechanical
ventilation by optimizing airway clearance and lung function.
Balancing the patient’s energy expenditure during the weaning process with the
added energy required for performing functional mobility activities or exercise is a
challenging work which involves physical therapist.
Airway clearance techniques are an important part of the weaning process. These
techniques along with spontaneous breathing should be employed prior to the
patient’s specific weaning trials if presence of excessive secretions are impeding a
successful wean.

Shot 14
Breathing strategies, including manual hand placement on the abdomen for
recruitment of the diaphragm, can be utilized in conjunction with watching the
tidal volume monitor on the ventilator.
Which will be biofeedback screen for the patient giving the patient visual
feedback from his inspiratory efforts.
Breathing exercises with encouragement of slow, deep breaths and positioning
can be used to normalize the breathing pattern and to keep the respiratory rate
within preset limits.
Inspiratory resistance training has been demonstrated to improve respiratory
muscle strength and endurance in patients with respiratory failure and has
facilitated increased weaning from mechanical ventilator.
Shot 15
Mechanical advantage of the diaphragm muscle is used by various positioning
methods. These positionings will decrease the work of breathing and facilitate an
efficient breathing pattern.
Optimal positioning for the patient will vary with different individuals, with
options including
 dangling at the edge of the bed,
 sitting in a chair,
 reverse Trendelenburg position and
 semi- to high Fowler position.
Timing of the physical therapy treatment is essential for optimizing patient
success and meeting functional goals.
Discussing with team of health care professionals—namely, the physician, nurse,
and respiratory therapist, —during the weaning process is crucial for coordination
of care.

Shot 16
Examples of physiotherapy led respiratory interventions (or chest physiotherapy)
include:
• 1) Airway clearance techniques. For example,
 positioning,
 active cycle of breathing,
 manual and/or ventilator hyperinflation,
 percussion and vibrations,
 positive expiratory pressure therapy (PEP),
 mechanical insufflation-exsufflation (MI-E).
• 2) Non-invasive ventilation (NIV) and inspiratory positive pressure breathing
(IPPB). For example,
 IPPB for patients with rib fractures,
  NIV application as part of airway clearance strategies, or in the
management of respiratory failure, or during exercise.
• 3) Techniques to facilitate secretion clearance. For example,
 assisted or stimulated cough maneuver's, and airway suctioning.
• 4) Exercise prescription and mobilization.
Shot 17
Physiotherapists are responsible for the management of musculoskeletal /
neurological / cardiopulmonary rehabilitation tasks which including:
• Passive, active assisted, active, or resisted joint range of motion exercises to
maintain or improve joint integrity and range of motion and muscle strength
• Mobilization and rehabilitation (e.g. bed mobility, sitting out of bed, sitting
balance, sit to stand, walking, tilt table, standing hoists, upper limb or lower limb
ergometry, exercise programs)
Shot 18
Now we’ve finished physiotherapy role in covid 19 cases, speaking about the
exercise regime for covid 19 prevention.
Generally, for codvid 19 prevention optimal lung functioning and immunity
without any history of lung diseases is very important.
The link between exercise and immunity was studied and published through a
journal from Appalachian state university,north carolina USA.

In these studies The summarized research discoveries within 4 areas of exercise

immunology:

acute and chronic effects of exercise on the immune system,

clinical benefits of the exercise & immune relationship,

nutritional influences on the immune response to exercise,

and the exercise effect on immunosenescence.

It was evident that immune system is very responsive to exercise, with the extent
and duration of physiological stress in control.

Shot 19

Key exercise immunology discoveries since 1980 include the following.

 Acute exercise (moderate-to-vigorous intensity, less than 60 min) is now

viewed as an important immune system therapy, to stimulate the ongoing
exchange of highly active immune cell subtypes, between the circulation
and tissues.
 In particular, each exercise bout improves the antipathogen activity of
tissue macrophages in parallel with an enhanced recirculation of
immunoglobulins, anti-inflammatory cytokines, neutrophils, NK cells,
cytotoxic T cells, and immature B cells.
 With near daily exercise, these acute changes operate through a
summation effect to enhance immune defense activity and metabolic
health.

Shot 20

 In contrast, high exercise training workloads, competition events, and the

associated physiological, metabolic, and psychological stress are linked with
transient immune Changes by decreasing immune cell metabolic capacity.
 Illness risk may be increased in case of athletes when an athlete competes,
goes through repeated cycles of unusually heavy exertion, and experiences
other stressors to the immune system.
 Other illness risk factors for an athlete include high levels of depression or
anxiety, participation in unusually intensive training periods with large
fluctuations, international travel across several time zones, participation in
competitive events especially during the winter, lack of sleep, and low diet
energy intake.

Shot 21
  Randomized clinical trials and epidemiologic studies consistently support
the inverse relationship between moderate exercise training and incidence
of Respiratory Tract Infections.
 Several epidemiologic studies also suggest that regular physical activity is
associated with decreased mortality and incidence rates for influenza and
pneumonia.
 Regular exercise training has an overall anti-inflammatory influence
mediated through multiple pathways. Epidemiologic studies consistently
show decreased levels of inflammatory biomarkers in adults with higher
levels of physical activity and fitness.

Shot 22

 There is increasing evidence that the circulation increase in cells of the

innate immune system with each exercise bout and the anti-inflammatory
and antioxidant effect of exercise training have a summation effect over
time in modulating cancer leading diseases, blood clot leading diseases, and
other disease processes.
 Immunosenescence is defined as immune dysregulation with aging.
Emergent data support that habitual exercise is capable of improving
regulation of the immune system and delaying the onset of
immunosenescence.

Shot 23

 Physical activity may lower rates of infection for other types of viral and
bacterial diseases, but more data are needed. Several epidemiologic studies
suggest that regular physical activity is associated with decreased mortality
and incidence rates for influenza and pneumonia which is associated with
covid 19.
 These findings are in accordance with rodent-based studies (or) rat family
based demonstrating a positive link between chronic exercise and
improved host responses to influenza and pneumonia infection.
 There is also increasing support for improved antibody responses to
influenza immunization in elderly adults who engage in regular exercise
training regimens.
Shot 24
By these data and evidences we can conclude that with moderate exercise up to
60 mins which involves cardiovascular or strength training may boost the immune
system which Is necessary for the prevention of covid 19.
If you want guidance for different cardiovascular and streghth traning done by a
physiotherapist check out youtube chanel of persisa sherlyn follow her videos
there are plenty of exercise videos.
Ending greetings
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Take care & Hasta la vista everyone!!

Disclairmair
This is only for informational purposes; it is not recommended for one’s
misunderstanding that each and every content is mandate by any nor compulsory
to be followed in professional settings