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Maximizing Recovery for Hospitalized Patients

Maximizing Recovery for Hospitalized Patients

Patients hospitalized with COVID-19 can experience debilitating physical changes — extreme fatigue, difficulty breathing and muscle weakness. To maximize their recovery while in the hospital, staff members in the Johns Hopkins Department of Physical Medicine and Rehabilitation (PM&R) have implemented several new therapy approaches. 

The approaches include using new metric-based criteria to determine the frequency of rehabilitation. As part of a comprehensive evaluation, rehabilitation therapists perform the Activity Measure for Post-Acute Care assessment to gauge a patient’s physical capabilities. Administered every day, this evaluation provides a score that, along with consideration of a patient’s physical capabilities before hospitalization, guides the path of rehabilitation. 

Patients with low scores follow a plan that includes brief activities in the hospital room. “That’s really all they can do for the first few days — stand up from a chair and walk over to the bed — and it feels like a marathon because they are fatigued and debilitated,” says physiatrist April Pruski. Patients with midlevel and higher scores receive daily therapy — potentially multiple times per day. 

When inpatients are able to complete physical activities without assistance, therapists deliver virtual therapy to conserve personal protective equipment and limit potential spread of the virus. 

At this stage, many recovering patients use an iPad, tablet stand and speakers — all provided by the hospital — to engage with their therapists. A typical session might demonstrate ways to conserve energy, says occupational therapist Annette Lavezza. “Because these patients are easily fatigued, we give them techniques to make tasks easier,” she says. 

The PM&R team has also incorporated a computer program to provide rehabilitation through a video gamelike experience. A motion-detecting camera captures movements, and the program provides real-time feedback to patients about their form. Therapists can monitor the sessions remotely. 

When patients no longer require immediate medical care but need continued rehabilitation and medical monitoring, they may have inpatient rehabilitation at The Johns Hopkins Hospital. 

Because these patients do not always clear the infection by this point, Pruski worked with the Division of General Internal Medicine to secure rooms in a negative air pressure area of the hospital. There they receive customary levels of inpatient rehabilitation in an environment that doesn’t spread contaminated air. 

“This puts them in a better position to continue their recovery at home,” Lavezza says. “We want patients to be as strong as possible when they leave.”  

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