Covid-19 and Physiotherapy

Physiotherapy as a primary ventilator

We all know that the new pandemic coronavirus disease (Covid-19) is an infectious disease resulting in the outbreak of respiratory illness known as Covid-19 viruses, that can cause illnesses from the common cold to more severe respiratory illness.

Various stages of infection of Covid-19

• Mild
• Moderate
• Severe
• Covid suspects

“Breathing Exercises” are the key exercises a physiotherapist should use to work as the primary ventilators. Studies indicate that breathing exercises are the fundamental interventions for the prevention of acute and chronic pulmonary diseases. These techniques are used to improve the pulmonary status and increase the patient’s overall endurance. By adding breathing exercises to the management of Covid patients, we can control the mortality rate and decrease the worsening of the respiratory system.

Covid-19 patients can be classified into four categories:

• Home-quarantined patients
• Asymptomatic patients
• Symptomatic patients
• Ventilatory patients

According to the categories mentioned above, the suitable and effective exercises are:

• Home-quarantined patients: Relaxed diaphragmatic breathing exercises and other exercises like yoga techniques with inhale and exhale practice.
• Asymptomatic patients: relaxed diaphragmatic breathing, segmental breathing, and active coughing techniques.
• Symptomatic patients: Relaxed diaphragmatic breathing, pursed-lip breathing, segmental breathing, and coughing (active or passive) techniques make the patient independent and ambulant, without any exertion.
• Ventilatory patients: Chest physiotherapy (clapping, vibration, etc.,), depends on the mode of the ventilator. Active breathing exercises must be taught.

Chest physiotherapy exercises are as follows:

Glosso pharyngeal breathing: With inspiration action of muscle can reduce ventilator dependence.

Procedure: The patient takes several gulps of air (2-4), then by closing the mouth, the tongue pushes the airbag and traps it in the pharynx. The air is forced to the lungs when the glottis is opened. This increases the depth of patient inspiration and vital capacity.

Pursed lip breathing: It involves lightly pursing the lips together during controlled exhalation. It moves air out of the lungs and allows new air to enter the lungs. It can be applied 3 – 5 as rescue exercises.

Procedure: The patient is in a comfortable position and relaxed. Abdominal muscle contraction should be avoided. Ask the patient to breathe in slowly and deeply through the nose and breathe out gently and lightly through pursed lips (like blowing the flame of a candle).

Segmental breathing: It is performed on the segment of the lung or a section of the chest wall that needs increased ventilation or movement.

Procedure: For lateral costal expansion, the patient 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 patient breathes out, place firm downward pressure into the ribs with the palm of your hands. When the patient breathes out, assist the gentle squeezing of the rib cage in the downward and inward direction. The patient can perform this independently. Ask to apply resistance with hand or with a towel.

Diaphragmatic breathing: Diaphragm is the primary muscle for breathing (inspiration.) The diaphragm controls breathing.

Procedure: The patient should be in a relaxed and comfortable position. The patient should breathe slowly and deeply via the nose by keeping the shoulder relaxed and the upper chest quiet. Allowing the abdomen to rise, ask the patient to slowly let all the air out using controlled expiration through the mouth. The patient can practice this 2-4 times.

Deep breathing:- Patients who are home quarantined can do this by own or take advice from a therapist. Practice deep breathing. It promotes relaxation, relieves stress, and improves the strength endurance co-ordination of the muscle of ventilation. It helps to calm down, relax, and support correct posture. When your body is fully oxygenated, it carries and absorbs nutrients that help to improve immunity.

Procedure: Get comfortable. Lie on the back. Breathe in through the nose. Let the belly fill the air, Breathe out through the nose. Place one hand over the belly. As you breathe in, feel your belly rise. Repeat and take deeper breaths.

Incentive spirometry: An incentive spirometer is a device that helps to maintain/increase lung capacity. Repeat it 15 times every 2‐3 hours.

Caution: Spirometer should not be shared with others.

There are other devices, which improve lung capacity. Acapella, Power Breathe, Shaker Deluxe, cough-assisting device etc. can be used with the guidance of a respiratory physiotherapist.