Rehabilitation of COVID 19 Patients, Bangladesh Perspective

The global outbreak of COVID 19 has created an unprecedented challenge to the society. America, Europe and India were catastrophic sufferers from this virus next to China. They had highest number of daily morbidity and mortality in the global context. Bangladesh is facing terrible experiences of dealing with this pandemic and making a tremendous turmoil in health and economic sector. Our healthcare system is overburdened with critically ill patients. Disability arising out of neurological, pulmonary, neuromuscular, and cognitive complications, need to be addressed by rehabilitation professionals. Many patients presenting with COVID-19 will have no specific airway clearance needs.There have been no reports of COVID-19 positive patients having high secretion loads that would require intensive chest physiotherapy or postural drainage. In Bangladesh in ICU settings physiatrist or physiotherapists are not directly involve in respiratory care management. In mild to moderate cases advice about a post-acute care breathing exercises, other musculoskeletal exercises, bed positioning and pressure sore care are helpful. In Bangladesh medical care facilities are not adequate in corona care hospitals especially in peripheral medical college or hospital. Many patients are dying of shortage in oxygen supplies and lack of availability of ICU. Post discharged plans of comprehensive rehabilitation are grossly neglected in discharged certificate. Our national guidelines on corona management do not have any instructions on rehabilitation management at any point. The objectives of this fast review article on corona pandemic are to highlight the global scenario and our limitations in the rehabilitation management of COVID 19 patients particularly post discharged patients and patients with long COVID complications. J Bangladesh Coll Phys Surg 2022; 40: 52-56

Medical rehabilitation strategies in complex assistance of people with COVID-19. Literature review

Covid-19 infection is a challenge for the medical system. The development of programs and strategies for the rehabilitation of people in different stages of the disease is relevant and current. The study is a bibliographic synthesis that aimed to analyze the methods and strategies of medical rehabilitation of patients with the new “coronavirus infection”. Data were collected from the academic databases PubMed, PubMed Central, Google, collecting relevant articles from 2019-2021, using the keywords: [“Covid-19” or “Covid 19” or “2019- CoV” or “SARS- CoV” or“ new coronavirus” or “SARS-CoV-2”] and [“rehabilitation ”or“ physical medicine”]. Th e aim of the study was to estimate the consequences of COVID-19 and to identify methods of recovery treatment. Because Covid-19 severely affects the respiratory system, pulmonary rehabilitation interventions with respiratory techniques and postural drainage combined with other physiotherapeutic methods may be used for a patient with COVID-19. The wide range of clinical manifestations in COVID-19 reveals the importance of adapting the rehabilitation program to functional deficits and patient needs. Multifactorial programs combined with active and supportive methods (physical therapy, exercise, occupational therapy, reflex therapy) are effective and can be used in the complex care of patients with COVID-19 at all stages of treatment.

Pengelolaan Bersihan Jalan Napas Tidak Efektif pada Anak dengan ISPA di Desa Kebondowo Banyubiru

Ineffective airway clearance is a disease characterized by a buildup of secretions in the airways that causes airway insufficiency. This writing aims to provide a description or description of the management of ineffective airway clearance in children with ARI in the village of Kebondowo Banyubiru. The type of management is descriptive with a case study approach in the form of assessment, data analysis, formulating nursing diagnoses, planning, implementation, and evaluation in the handling of ineffective airway clearance. The population is toddler age children with ineffective airway clearance. The sampling technique is 1 person. With the criteria of toddler age children, experiencing cough and cold, composmentis awareness, the patient or patient's family is able to communicate verbally and cooperatively. Ineffective airway clearance management was performed for 3 days in An. A with data collection techniques using interviews, physical examination and observation. Then the nursing plan is carried out, namely chest physiotherapy, postural drainage, percussion, vibration. The final result was RR: 32x/minute, auscultation: vesicular, percussion: sonor. Based on the nursing actions taken, it can be concluded that the ineffective airway clearance has been resolved. It is expected that the community or patient's family always maintains cleanliness and can carry out nursing actions for acute respiratory infections (ARI) independently and utilize health facilities for treatment. Abstrak Bersihan jalan napas tidak efektif adalah penyakit yang ditandai dengan adanya penumpukkan sekret pada jalan nafas yang menyebabkan ketidakpatenan jalan nafas. Penulisan ini bertujuan untuk memberikan deskripsi atau gambaran tentang pengelolaan bersihan jalan napas tidak efektif pada anak dengan ISPA di Desa Kebondowo Banyubiru. Jenis pengelolaan deskriptif dengan pendekatan studi kasus berupa pengkajian, analisis data, merumuskan diagnosa keperawatan, perencanaan, pelaksanaan, dan evaluasi dalam penanganan bersihan jalan napas tidak efektif. Populasi adalah anak usia toddler dengan bersihan jalan napas tidak efektif. Teknik pengambilan sampel 1 orang. Dengan kriteria anak usia toddler, mengalami batuk pilek, kesadaran composmentis, pasien atau keluarga pasien mampu berkomunikasi secara verbal dan kooperatif. Pengelolaan bersihan jalan napas tidak efektif dilakukan selama 3 hari pada An. A dengan teknik pengumpulan data menggunakan wawancara, pemeriksaan fisik dan observasi. Kemudian dilakukan rencana keperawatan yaitu fisioterapi dada, postural drainage, perkusi, vibrasi. Didapatkan hasil akhir RR: 32x/menit, auskultasi: vesikuler, perkusi: sonor. Berdasarkan tindakan keperawatan yang dilakukan, maka dapat disimpulkan bersihan jalan napas tidak efektif sudah terata. Diharapkan masyarakat atau keluarga pasien selalu menjaga kebersihan dan dapat melakukan tindakan keperawatan infeksi saluran pernafasan akut (ISPA) secara mandiri dan memanfaatkan fasilitas kesehatan untuk berobat.

Addition of the combination of sims technique and semi-fowler positioning to cardiorespiratory exercises in patients with myasthenia gravis: case report

Myasthenia gravis (MG) is an autoimmune disorder characterized by fluctuating muscle fatigue, worsening with increased activity, and improving at rest. Physiotherapy plays a role in reducing symptoms such as shortness of breath, respiratory muscle weakness, and airway obstruction due to decrease the sputum in the lung lobes and prevent of the exacerbation. Respiratory training and postural drainage techniques are part of intervention that given by physiotherapy for patients diagnosed with MG and had symptoms hospital acquired pneumonia (HAP). A male, 28 years old patient diagnosed with HAP and had history of MG hospitalized a month with dyspnoea and disable to do activity daily living. Physiotherapy treatment that given to the patient from 18th July 2018 till 28th July 2018 are respiratory training included breathing exercise, cough exercise, shoulder expansion, Active Range of motion (ROM) exercise, stretching of respiratory muscle and home program exercise that helped by nurse and caregiver. Patient had medical treatment from all medical team by pulmonologist, neurologist and nurse too. Combined this new technique postural drainage and all physiotherapy programs showed significant in patient such as dyspnoea decreased.

A Physiotherapeutic Approach Along with Bronchodilators to Control Bronchial Asthma in a 35 Year Old Adult: A Case Report

Background: Bronchial asthma is a common disease characterized by the generalized narrowing of intrapulmonary airways accompanied by breathlessness and wheezing, which differs in severity spontaneously or as a result of treatment. Asthma is caused by bronchial wall inflammation and constriction due to the hyper-reactivity of their smooth muscle, resulting in a series of spasmodic wheezing attacks and shortness of breath (SOB). Case description: The patient was a 35 year old female presented with a complaint of dry cough with mucoid expectoration and chest pain since 3 weeks. The cough was progressive and aggravating while walking or while doing any sort of activity and it use to relieve at rest. She also complained of Modified Medical Research Council (MMRC) grade 2 breathlessness along with palpitation while doing household work. She had chest pain while coughing on left side over the 2nd intercostal space which was gradually progressive and 7/10 on VAS. She also had low grade fever, cold with chills and night sweats. The patient had a history of seasonal variation, dust allergies and biomass exposure. She was given medications but was not relieved so she was referred for physiotherapy. Physiotherapy treatment was started. Patients sleep was disturbed. The patient had no past history. Family history is not present. Diagnosis: The patient was diagnosed with bronchial asthma. Outcomes & conclusion: This case study showed that breathing exercise, postural drainage and proper relaxation of the patient may reduce the symptoms associated with bronchial asthma also the peak flow values may increase with breathing retraining. Pain reduces with reduction in cough and episodes of dyspnoea. Also educating the patient about prevention of asthmatic episodes help the patient in many ways. Along with bronchodilators physiotherapy plays an integral part in treating the patient with bronchial asthma.

PENYULUHAN FISIOTERAPI DADA TERHADAP PEMELIHARAAN FUNGSI OTOT PERNAFASAN PADA PASIEN GANGGUAN SISTEM PERNAFASAN DI RUANG PARU RSUD M.ZAIN PAINAN

Gangguan pada sistem respirasi seperti Penyakit Paru Obstruksi Kronik (PPOK), Pneumonia Tuberculosis (TB) merupakan kasus yang banyak di jumpai pada pasien yang menjalani perawatan di Rumah Sakit dengan angka 87%. Pada kebanyakan pasien yang mengalami gangguan sistem respirasi pernafasan seperti PPOK, TB dan Pneumoni sering terjadi peningkatan produksi sekret, sputum atau lendir yang mengental, sehingga diperlukan upaya untuk pengeluaran sekret salah satu tindakan yang dapat diberikan adalah teknik fisoterapi dada. Fisioterapi dada merupakan satu cara pengobatan untuk mengembalikan fungsi organ pernafasan dengan cara postural drainage, perkusi dan vibrasi dada (Potter&Perry,2009). Dengan pemberian fisioterapi dada pada pasien yang mengalami retensi sekret dan gangguan oksigenasi respon yang diharapkan penumpukan sekret dapat dicegah, drainase trakheobronkhial dapat ditingkatkan dan ventilasi dapat diperbaiki (Asih&Effendy,2004). Kegiatan dari pengabdian ini adalah untuk meningkatkan pengetahuan pasien dan keluarga untuk pengeluaran dan mengurangi produksi sekret pada pasien gangguan respirasi di Ruang Paru RSUD M.Zain Painan. Metode yang digunakan ceramah dan demonstrasi. Kegiatan ini berjalan dengan lancar dan peserta sangat aktif mendengarkan dan melakukan fisioterapi dalam membantu pengeluaran sekret yang menghalangi jalan nafas.

The role of physiotherapy in the respiratory management of children with neuromuscular diseases: A South African perspective

Background: Respiratory morbidity is common in children with neuromuscular diseases (NMD) owing to chronic hypoventilation and impaired cough. Optimal, cost-effective respiratory management requires implementation of clinical practice guidelines and a coordinated multidisciplinary team approach.Objectives: To explore South African physiotherapists’ knowledge, perception and implementation of respiratory clinical practice guidelines for non-ventilated children with NMD.Methods: An online survey was conducted amongst members of the South African Society of Physiotherapy’s Cardiopulmonary Rehabilitation (CPRG) and Paediatric special interest groups and purposive sampling of non-member South African physiotherapists with respiratory paediatrics expertise (N= 481).Results: Most respondents worked in private healthcare, with 1–10 years’ experience treating patients with NMD. For acute and chronic management, most participants recommended nebulisation and 24-h postural management for general respiratory care. Percussions, vibrations, positioning, adapted postural drainage, breathing exercises and manually assisted cough were favoured as airway clearance techniques. In addition, participants supported non-invasive ventilation, oscillatory devices and respiratory muscle training for chronic management.Conclusion: Respondents seemed aware of internationally-endorsed NMD clinical practice guidelines and recommendations, but traditional manual airway clearance techniques were favoured. This survey provided novel insight into the knowledge, perspectives and implementation of NMD clinical practice guidelines amongst South African physiotherapists.Clinical implications: There is an urgent need to increase the abilities of South African physiotherapists who manage children with NMD, as well as the establishment of specialised centres with the relevant equipment, ventilatory support and expertise in order to provide safe, cost-effective and individualised patient care.

Is open window thoracostomy the only method to control infection in patients with an empyema following pulmonary resection for primary lung cancer?

Summary A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed: Is open window thoracostomy (OWT) the only method to control infection in patients with an empyema following pulmonary resection for primary lung cancer? Altogether 442 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Empyema following anatomical lung resection (excluding pneumonectomy) is an uncommon complication but one that remains a challenge to treat effectively. Chest tube thoracostomy and intravenous antibiotics remain the initial steps to management, but evidence is lacking with regard to the best ongoing strategy. Conservative options including chest cavity irrigation, postural drainage and vacuum-assisted closure have been attempted with some success, even in the presence of a broncho-pleural fistula. However, the very limited number of patients on which these various management strategies have been trialled on prevents recommendations and clear guidance being given.

Airway Clearance Techniques: The Right Choice for the Right Patient

The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders, neuromuscular disorders and patients undergoing either thoracic or abdominal surgery. The purpose of this review is illustrate to the reader the different ACTs currently available and the related evidence present in literature. Alongside methods with a strong background behind as postural drainage, manual techniques or PEP systems, the current orientation is increasingly aimed at devices that can mobilize and / or remove secretions. Cough Assist, Vacuum Techniques, systems that modulate airflow have more and more scientific evidence. Different principles combination is a new field of investigation that goes toward an increasing of clinical complexity that will facing us.