Rehabilitation Treatment for Moderate Patients

Moderate patients are those who meet the diagnostic criteria for suspected/ confirmed cases of Notice on Issuance of COVID-19 Diagnosis and Treatment Protocol (7th Trial Edition). Patients are those with fever, respiratory symptoms, and imaging manifestations of pneumonia.

9.3.1.2.1 Objectives of Rehabilitation Treatment

The main objective are to treat clinical symptoms and clean the airway; establish a good breathing pattern, reduce respiratory energy consumption, and reduce breathing work; maintain or improve the patient’s respiratory function; prevent the occurrence of acute respiratory distress syndrome; avoid deep vein thrombosis and other complications, and improve their exercise endurance and daily activity ability; adjust their psychology and build up the confidence to overcome the disease.

The intensity of exercise activities during the rehabilitation of patients should not be too large, and the timing of intervention and withdrawal should be carried out under the guidance of rehabilitation physicians.

• 9.3.1.2.2 Rehabilitation Treatment Method
• 1) Position management: This helps diaphragm activity and reduces the adverse effects of supine position on lung ventilation and perfusion. Proper positioning helps to optimize arterial oxygenation and Ventilation to blood perfusion (V/Q) ratio. The method is the same as mild ones. It is feasible to use sputum retention techniques to perform postural drainage for the affected lung (perform corresponding postural drainage according to the different parts of the lung that are affected).
• 2) Airway cleaning technology: Using the expansion method during deep inspiration can be adopted. At this point, avoid using vibration expectoration machine to not cause blood oxygen saturation and the risk of arrhythmia.
• 3) Respiratory control training: Patients with dyspnea in bed can sit in a 60° position on the bed, and a pillow can be placed under the knee joint to ensure the knee joint is bent and slightly higher than the hip joint. Patients who can get out of bed can do the activity in the sitting position. Relax the auxiliary inspiratory muscles of the shoulder and neck. Inhale slowly through the nose, exhale slowly through the mouth, and observe the chest expansion. Hie intensity is between rest and light physical activity, two times a day. It should take place 1 hour after meals for 15-45 minutes per time. It can also be intermittent.
• 4) Position change training: During the position change training, first left, then right, from the supine position to lateral position, prone position, and then return to the supine position. Next, the patient should move from the supine position to the long sitting position on the bed, from the long sitting position on the bed to the bedside sitting position, and finally from the bedside sitting position to the bedside standing position. Hie patient should stay in each position for about 5 seconds and then walk around the bed. Complete the above five changing positions as a group two to three times a day, step by step, gradually changing the position movement. Patients should start with one group per time and move up to three groups per time. Patients with shortness of breath and Borg score > 3 should stop to rest and then proceed again after the feeling of fatigue disappears.
• 5) Progressive activities and exercise training: Patients who cannot stand can choose sitting/semirecumbent/recumbent position and perform activities such as clenching, arm raising, ankle pump, heel sliding, leg raising, quadriceps and gluteus isometric contraction under the guidance of educational videos and brochures. When the patients condition is stable, exercises such as sitting up, standing up, waist stretching, leg lifting, striding, and cross-walking can also be arranged and broken into small self-observation sections. Strive to accumulate more than 1 hour of daily activity and strictly avoid fatigue.
• 6) Physiotherapy: It can be continued to improve the disease condition.

a. Ultrashort wave therapy: Lung antithesis with no heat or microheat, 10-15 minutes each time, once a day, and 10 times for a course of treatment.

b. Ultraviolet therapy: Irradiate chest or back skin by weak erythema, once a day, and four times as a course of treatment

• 7) Occupational therapy: Hie designed selective self-relaxation activity can block the shortness of breath caused by mental and muscle tension, help to break patients’ vicious circle, and improve their hypoxia state. Methods can be slow and include deep breathing, natural swinging of the upper limbs while sitting or standing, music therapy, etc.
• 8) Patient education: Continue to strengthen publicity and education so that patients can have a further understanding of the disease knowledge, enhance their confidence in overcoming the disease, and maximize compliance.
• 9) Psychological intervention: In this type of patient, the clinical symptoms and dysfunction are more severe than those in patients with mile cases. Patients with more obvious psychological problems such as fear, anxiety, anger, depression, insomnia etc., or failure to cooperate or abandon treatment should be given attention in a timely manner and psychological intervention. If necessary, continue to seek psychological professionals or psychological hotline intervention.