Hard cases of a disease of COVID-19 result in need of rehabilitation of patients, it is connected with consequences of both directly artificial ventilation of the lungs, and long stay in a motionless state on a hospital bed. In particular, dysfunction of lungs, physical disadaptation and muscle weakness, delirium and other cognitive disturbances, disturbance of deglutitory and communicative function and disturbance of mental health and also the need for psychosocial support can belong to such consequences. It is obvious that the need for rehabilitation can be increased owing to the available chronic diseases and age deterioration in health.
Now collection of information on rehabilitation in the conditions of COVID-19, including development of recommendations by the international and national professional associations in the field of physical therapy and rehabilitation medicine is conducted. In this aspect development of programs for rehabilitation of patients with severe forms of a koronavirusny infection is of particular importance. Especially at an acute stage rehabilitation actions with patients with a severe form of COVID-19 demanding respiratory support as a rule demands existence of a certain set of the skills acquired during special preparation.
Patients with a severe form of COVID-19 need hospitalization and respiratory support. As COVID-19 — a new disease, short and long-term consequences for the patients who transferred the severe form of a disease which demanded the direction in ORIT are at the moment estimated, proceeding from the general experience of an intensive care, in particular, of patients with ORDS. Artificial ventilation of the lungs in combination with use of sedative drugs and the neuro and muscular block and also potentially long stay in motionless situation in a bed can make negative impact on a musculoskeletal system, including decrease in an animal force and physical disadaptation. Disturbances of respiratory, cognitive, deglutitory and communicative functions and also possible mental disorders can belong to other consequences. In the long term various manifestations of a syndrome of PITAS which can be observed within many months or even years after an extract can also include increased fatigue, decrease in independence in everyday life and deterioration of life in connection with the state of health.
The patients with a severe form of COVID-19 who are not directed to invasive artificial ventilation of the lungs if such opportunity is absent or disease severity does not demand its use, too can experience physical disadaptation or disturbances of breath and also psychosocial problems owing to a disease and hospitalization. The needs for rehabilitation connected with a severe form of COVID-19 can be aggravated with the diseases which arose earlier and old age.
The role which is played by rehabilitation specialists during the work with patients with a severe form of COVID-19 and also distribution of interventions on various disciplines can vary depending on a context. Respectively, these instructions should be interpreted and applied taking into account local cast and local practice.
In particular, while patients with a severe form of COVID-19 are on respiratory support, rehabilitation specialists can give support in treatment of acute states and also in support and improvement of work of lungs to accelerate recovery. Further. in a subacute stage when the patient is in hospital chamber or in auxiliary establishment, or for patients from whom weight of a course of a disease did not demand the direction in ORIT and which underwent treatment in hospital chamber, rehabilitation interventions can be directed to the solution of the problems connected with the current restrictions of mobility, respiratory, cognitive, deglutitory functions and food and also disturbances of communicative function.
After an extract rehabilitation specialists can realize sets of exercises, provide training in rational expenses of energy and change of behavior, change of house conditions and the supporting products and also to carry out individual rehabilitation according to needs of the specific patient. At a stage of long-term recovery the pulmonary rehabilitation directed to elimination of physical disadaptation and restoration of respiratory function and also a combination of a set of exercises, training, daily activity and psychosocial support can be useful to the patients who transferred a severe form of COVID-19.