Pam King Sams
For many, beating coronavirus is just the beginning. Here's what post-COVID rehab looks like.
By Julie Garcia, Houston Chronicle, June 17, 2020
Robert Martinez couldn’t take a deep breath on March 26.
The next morning, he was taken to the hospital and tested positive for COVID-19. He spent the next several weeks in critical care in the intensive care unit at HCA Houston Hospital in Tomball.
Martinez, 62, is a success story — a recovery from the novel coronavirus. But the weeks in a hospital bed and on a ventilator left his body with considerable damage, both internally and externally.
He had no control over his left hand, which is his dominant one; he lost considerable muscle mass; and he had trouble remembering things. He knew if he tried to go home right away after being discharged, he “would be in trouble.”
So he went to a rehabilitation program developed by TIRR Memorial Hermann and the Memorial Hermann Rehabilitation Network for individuals treated for COVID-19. The therapies depend on the patient’s needs once they’ve recovered from the virus — physical therapy for movement and muscles, respiratory therapy for breathing, and sometimes music therapy for cognition.
“I really couldn’t do a whole bunch when I got there. Being laid up for a month, I didn’t realize how much you lose as far as strength goes,” Martinez said. “In the beginning, I couldn’t pick myself up off the floor to stand up.”
COVID-19 damages more than the lungs; it affects all organ systems, said Dr. Jacob Joseph, attending physician at TIRR Memorial Hermann and UTHealth. And because this coronavirus strain is so new, doctors are still learning the long-term effects, and who will suffer from what and why.
“What we’re seeing at TIRR is an effect on the entire body,” Joseph said. “It affects people after recovery from their initial lung injuries. It causes damage to their muscles, nerves and even their brain in terms of cognitive dysfunction.”
Hospitalizations for COVID-19 patients have spiked again in June, a month after the state began reopening businesses in phases. As of June 15, the statewide total of coronavirus cases was increasing by more than 1,000 cases per day. In Harris County, there has been an increase of more than 150-300 new cases per day for most of June.
A growing number of recovered COVID patients need continued rehabilitation before returning to their normal lives. A multi-disciplinary team of therapists and doctors start their initial assessment when a patient is still in the ICU, which helps offset the physical decline and promote mobilization before their hospital release.
The team is already trained to help people who have suffered from severe strokes and other cognitive disorders. But there’s no one-size way to approach the patient’s recovery, so the program has to be customized, Joseph said.
Safety continues to be the top priority for patients, doctors and therapists at TIRR. Every person has their temperature screened once they walk through the door before they fill out a short survey; social distance is practiced in the hallways; and everyone is fully masked at all times unless the patient is alone in their room.
Rehabilitation isn’t a socially distant practice, but it is essential, Strahn said. Therapists have readjusted how they do their jobs, much like every other essential worker during the pandemic.
“We work in close physical proximity with our patients, but we are doing what we can to keep as safe as possible,” she said. “Ultimately, we have to be able to touch our patients to help them get best. It’s a balance of safety and doing our absolute best to get people independent and functional as they can be before they leave.”
Respiratory therapists are heavily involved from the beginning, said Dr. Jessica Straughn, a neurological physical therapist. Patients frequently arrive requiring supplemental oxygen, and the respiratory therapists help them with breathing treatments and coughing strategies.
Patients are visited by therapists depending on their individual needs, which can include physical, speech and language, occupation, recreation or even music, which helps promote cognitive function, Joseph said.
The goal is for the patient to be mostly independent, and for their families to understand the scope of their needs upon discharge.
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Patients come to the program with more than coronavirus-induced issues; they also experience pressure sores and a syndrome called ICU delirium, , a severe state of confusion among patients who stay in critical care units for weeks, in which the patient can’t think clearly, has trouble paying attention and may see or hear things that aren’t there.
Patients may also experience trauma just by going through the virus itself, Straughn said. Therapists noticed one patient had trouble moving forward because she was so anxious about contracting the virus a second time.
Straughn worked directly with Martinez during his week-and-a-half stay in the in-patient program. He was confused when he arrived after weeks of being in critical care, she said.
Part of Martinez’s rehabilitation was speech therapy to help his recall ability. It was painful at times, he said.
“(The therapist) helped me by giving me tasks or tests, like small, short stories,” Martinez said. “I would read them, and then she would ask me questions about it to see if I could remember who did what. It’s their job, but they made it fun.”
Martinez came in with one major request: getting up from the floor on his own. Standing from the floor is a great strengthening activity, especially for people who are weak and haven’t done it in a long time, Straughn said.
It’s better when patients set their own standards for recovery, like walking without any aids, she added.
Though she’s trained to work with stroke patients, Straughn said it’s difficult to understand the full scope of coronavirus from start-to-finish because it is a multi-system virus. Rehabilitating patients doubles as continuing education, she said.
“We know more about this emerging virus than we do about other emerging viruses, and we’re learning how devastating and unique it is,” she said. “For instance, there are certain processes in the virus that make people more prone to clots. A handful of individuals I’ve seen have had strokes in addition to the virus. It’s a really devastating combination.”
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Before June’s spike in infections, Joseph said fewer than 20 people had been admitted to the inpatient program — “still a relatively small number as opposed to our colleagues in critical care and in the emergency room,” he said.
“Thankfully, it’s only a subset — the severely affected — that have needs for our services,” Joseph said.
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