COVID-19 Rehabilitation Resources
Our outpatient clinics are operational and accepting patient referrals. After a telemedicine evaluation, our providers will determine whether an in-person visit is needed or if appointments can continue by video or phone. To schedule an appointment, please call (443) 997-5476 if you haven't been previously seen by our department. Existing patients can also request an appointment through MyChart.
Keeping Our Patients Safe and Healthy at Johns Hopkins
In the News
Coronavirus: Recovery After a Hospital Stay
“While much remains to be determined about the coronavirus,” says Ann Parker, M.D., Ph.D., a pulmonary and critical care physician, “there is also a lot that we already know about recovery from a respiratory disease like COVID-19.”
Coronavirus and COVID-19 Recovery: Theirrien’s Story
Theirrien “Tee” Clark, a 56-year-old Maryland man, survived a severe case of COVID-19 that required a multidisciplinary effort and a 46-day hospital stay to get him back on his feet.
Coronavirus Recovery: Breathing Exercises
COVID-19 affects the lungs and respiratory system, which can lead to significant damage. “Working toward recovery starts simple: with a focus on breathing,” says Johns Hopkins physical therapist Peiting Lien. She offers a series of breathing exercises to aid in recovery.
Featured COVID-19 Research
- What Now for Rehabilitation Specialists? Coronavirus Disease 2019 Questions and Answers
- Managing the Rehabilitation Wave: Rehabilitation Services for COVID-19 Survivors
- Speech-Language Pathology Guidance for Tracheostomy During the COVID-19 Pandemic: An International Multidisciplinary Perspective
- Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global Multidisciplinary Approach
- Moving Forward with Dysphagia Care: Implementing Strategies During the COVID-19 Pandemic and Beyond
- Survivorship After COVID-19 ICU Stay
- Dysphagia Care Across the Continuum: A Multidisciplinary Dysphagia Research Society Taskforce Report of Service-delivery During the COVID-19 Global Pandemic
- The Long-term Effects of COVID-19 on Dysphagia Evaluation and Treatment
- Coronavirus Disease 2019 (COVID-19) Cuts Ties with Patients' Outside World
Resiliency and Well-being Resources from Our PM&R Team
PM&R Is Resilient is our internal newsletter that aims to serve as a resource to support clinical teams and promote their well-being during the COVID-19 response period. Each issue is a PDF you can view.
View Resources By Topic
Be kind to yourself and others. This is a difficult time for all of us. Feeling worried, sad, and other uncomfortable emotions during this time are normal, expected and OK. It is OK to feel. Accept there are things we cannot control in this situation. In addition to acceptance there is action…
Communication is key in a crisis.
Be clear and positive. Communicate with colleagues clearly and in an optimistic manner. Identify mistakes or deficiencies in a constructive manner and correct them.
Compliment each other—compliments can be powerful motivators and stress moderators. Share your frustrations and your solutions.
Respect Differences. Some people need to talk while others need to be alone. Recognize and respect these differences in yourself, your patients and your colleagues.
Take time to calm your mind and body. Stress causes us to hold our breath and our mind to race. Consider starting a mindful breathing practice. There are apps, such as the Calm app, that provide resources for daily meditation, sleep tools, skills for managing anxiety, stress, and creating a sense of peace.
Take Breaks. Whenever possible, allow yourself to do something unrelated to work that you find comforting, fun or relaxing. Taking a walk, reading a book, or talking with a friend can help. Recognize that taking appropriate rest leads to proper care of patients after your break.
Information – use it wisely. Rely on trusted sources of information, such as your organizations’s internal communications. Limit media exposure. Graphic imagery and worrisome messages will increase your stress and may reduce your effectiveness and overall wellbeing.
Listening to music has well documented therapeutic benefits. Find ways to incorporate relaxing or uplifting music throughout your day (e.g. as background music when you are working at your desk, or as a means to relax between meetings or patient care). Feel free to share your favorite playlists with your colleagues!
Coronavirus Sanity Guide: This is a free resource for healthcare workers with several short and longer meditation practices focused on dealing with stress and anxiety in the context of the COVID pandemic. It is updated daily with new resources and talks.
Relieve stress and promote sleep with aromatherapy. Aromatherapy uses extracted oils from plants to balance body, mind and spirit. These oils can be diluted and sprayed into the air, placed in a diffuser or simply rubbed on the body. Some studies have shown that specific oils can reduce stress and promote better sleep, they include lavender, lemon, bergamot, Ylang Ylang, clary sage and jasmine. Some people may have negative reactions to oils. Please contact your health care provider for further guidance.
Use a grounding technique to manage feelings of stress or being overwhelmed. This technique can ground you in the present when your mind is bouncing around between various thoughts. Acknowledge and/or say:
- FIVE things you see around you
- FOUR things you can touch around you
- THREE things you hear
- TWO things you can smell
- ONE thing you can taste.
Know what you can and can’t control. The challenge is to separate these things so that you can take reasonable steps to protect yourself, but also let go of worries and anxieties that get in your way.
- Things we CAN control and should focus on: turning off the news, finding fun and relaxing things to do at home, following CDC recommendations and guidelines, keeping our social distance, limiting our social media use
- Things we CANNOT control and can let go of: how long this will last, how others react, predicting what will happen
Try this 7-day mental wellness challenge.
- Monday: Send a positive text to 3 people stating your gratitude.
- Tuesday: Meditate for 5 minutes in the morning.
- Wednesday: List 3 things you want to achieve for the day.
- Thursday: Make someone laugh by telling a funny story.
- Friday: Replace an unhealthy food choice with a healthy alternative.
- Saturday: Clean and organize your living space.
- Sunday: Go for a walk outside.
Grieving during a time of crisis: Encountering loss of someone or something during the COVID-19 pandemic can be psychologically taxing. It’s not uncommon to feel a fluctuation of emotion such as sadness, guilt, disbelief and anger. These reactions are normal. Consider using grief support services such as Grief Share to help manage these emotions.
Try journaling to improve mental health and well-being. Writing in a journal helps with organizing ideas, establishing goals and expressing feelings, and can also help alleviate depression, anxiety and stress.
Quarantined or working from home? It’s not atypical to feel lonely or isolated. There are hotlines and online support communities that provide emotional support, such as these:
- Warmlines are free and confidential emotional support telephone hotlines. Callers can speak to peer-specialists that will listen to the caller unpack their feelings. Access the directory here.
- 7 cups: Free online chat that is available 24/7 and managed by trained volunteer listeners to provide emotional support.
Reflection. Maintaining our perspective and practicing the Mindfulness skill of gratitude can help us be calm and grateful. Here is a timely reflection by Jeanne Rikkers, human rights activist:
“Prayer for a Pandemic"
May we who are merely inconvenienced,
Remember those whose lives are at stake.
May we who have no risk factors,
Remember the most vulnerable.
May we who have the luxury of working from home,
Remember those who must choose between preserving their health or making their rent.
May we who have flexibility to care for our children when their schools close,
Remember those who have no options.
May we who have to cancel our trips,
Remember those that have no safe place to go.
May we who are losing our margin money in the tumult of the economic market, Remember those who have no margin at all.
May we who settle in for a quarantine at home,
Remember those who have no home.
As fear grips our country,
Let us choose LOVE.
Finding joy every day. Join us in finding a piece of joy daily. Make a list of ten things, big or small, that you can do/see/hear in your day to day life. Then use this week to work on checking off that list. Every time you find joy in something, it will make you smile. Smiling helps with releasing those “feel good” hormones to help us in this uncertain time.
Taking time recreate and “re-create”. Vacation and time away from work is when we recreatedo what we enjoy- whether that be visiting with friends and family, travelling, relaxing at home or doing that home project. It is also a time to “re-create”- recharge our energy and make life that is not work focused. For many the pandemic has led to the cancelling of events and scheduled vacation plans. Others are having to use PTO for childcare or other responsibilities, and still other families are dealing with time off from work due to reduced hours. Talk with the important people in your life about how you will recreate as the weather gets warmer and we traditionally plan time off. Whether that be a staycation- with a walk around your hometown, a day trip as stay at home is gradually lifted, a self-care day with just doing nothing or time spent on planning a trip for the future. We cannot wait for the pandemic to past to rest and recreate. We can use time off whether planned or unexpected to improve our health and well-being.
Building mental toughness: To be mentally tough refers to the ability to stay strong despite being faced with adversity. Mental toughness starts with you taking notice of negative thoughts, without identifying with those thoughts, and replacing it with optimism or positivity. Try these 5 techniques to build your mental toughness.
- Positive thinking: Put a positive spin on a negative thought.
- Goal setting: Write down 3 goals that you want to accomplish each day.
- Visualization: Spend 5 minutes mentally rehearsing a desired outcome.
- Anxiety Control: Take deep breaths by inhaling and exhaling slowly.
- Attentional Control: Turn off any external distractions and focus on a specific task.
Helping our Children. Children may respond to stress in different ways such as being more clingy, anxious, withdrawing, angry or agitated, or bedwetting.
- Respond to your child’s reactions in a supportive way, listen to their concerns and give them extra love and attention.
- Keep to regular routines and schedules as much as possible.
- Provide facts about what has happened. Explain what is going on now and give them clear information in words that they can understand. Talk to them about how to reduce their risk of being infected by the disease: hand washing, coughing etiquette, etc.
Camping in the backyard: This is one fun activity for the whole family. The great thing about backyard camping is that it takes almost no planning, all you need to do is check for good weather. The experience is a great way to bond as a family. No backyard? Consider a family sleepover in the living room or basement!
Stay Connected: Reach out to family, friends, colleagues and your favorite community groups for social contact. Call, Facetime, Zoom, Skype or try Google Hangouts to reduce your isolation. Meaningful and fun connection, emotional support and healthy problem solving are vital to your health and well-being. Consider joining another family or friend for a meal by social media to reduce isolation for everyone.
Sesame Street’s “Caring for Each Other:” This site was created to help families adapt to the “new normal.” It includes a video of a virtual hug from Elmo, family activities, help to create a daily schedule, and self-care tips for parents.
- Here is one great tip: Get a nice big glass of water and find a comfy spot to sit. Let your child know, “I’m just going to sit and (read/think/breathe) while I drink this glass of water.” Explain that you’ll be available once the glass is empty. Children have difficulty keeping track of time—this is a concrete way to help them understand that you are taking a few minutes to yourself.
Quality time with our furry family members. Walking the dog has been a popular diversion for many enduring the coronavirus quarantine, with pets playing an important role in helping humans get through this difficult time. Having a pet increases exercise motivation, increases serotonin levels and has an effect on stress control. One fun activity to try with your cat or dog is the ##levelupchallenge.
Been thinking about a furry addition to your family? Look up your local animal shelters and rescues – many are still able to facilitate adoptions during this time.
As we are experiencing communal grief and destabilization of systems we depend on, it’s important to know that support is available to us during these times. It’s also important to recognize that we must explore activities that are challenging and fun to not only improve our health but to distract us. It’s okay to be distracted, as we wait for stability to return.
Brain games: These are activities that stimulate thinking, like puzzles, chess, Sudoku, and bridge, as well as creative endeavors such as learning a language, painting, or playing an instrument. Challenging yourself can be an effective strategy to improve your mood and coping skills. There is convincing evidence that brain games improve thinking skills, and reduce stress and anxiety. Recognize that challenging cognition can be fun and have the added benefit of improving well-being.
Gardening feels so good. Since it’s spring and the weather is warmer, it’s a good time to garden. Gardening is an enjoyable and productive activity with many positive results:
- Self-esteem: improving mood by enjoying produce and tending to plants
- Improve fitness: activities such as mulching, hoeing, and weeding.
- Fun time with family: spend time with family maintaining the garden.
- Building positive habits: develop patience, hard work, and care.
- Healthy environment: creating a natural habitat for insects, birds, and small animals.
Keep moving through quarantine. Don’t sit all day! If watching TV, get up during every commercial (or periodically) and do a lap around your home or an active chore. Throw some clothes in the laundry, do the dishes or take out the garbage. Feel productive after just one show! While at work, add in some short stretch and walk breaks between patients or Zoom meetings!
Walk and Wave at Lunch. Even though we need to keep a safe distance we can still get out and walk and wave at others. Whether you are working at home or in the usual clinical space. Take time to walk at lunch. Top reasons to walk:
- Your health - benefits of a simple, brisk walking routine are well-established.
- Sitting all day is bad for you. Extended time sitting at your desk isn’t good for your body and may even counteract that effort at the gym. We’re designed to move! Small bursts of activity during the day go a long way toward improving your health.
- Nature! While moving at lunch is good for your body, getting out in nature on your break could be good for your soul. Many studies point to a positive relationship between time spent outdoors and mental well-being.
- Your brain (and your boss) will thank you. Taking a walking break can help improve your focus once you get back to your desk.
Can’t get to the gym?
- The YMCA launched free on-demand exercise and youth programs called YMCA 360, which include barre, boot camp, yoga and more to support the health and well-being of everyone staying home.
- CorePower Yoga is offering free access to a limited collection of online yoga and meditation classes. Yoga and mindfulness help improve flexibility and strength and impact social, emotional, mental and physical health.
- Orangetheory Fitness is sharing a new 30-minute workout video each day, featuring some of its most popular coaches from around the world. Exercising for 30-minutes a day can lead to enormous benefits in terms of your mood, health, weight, and the ability to live an independent and fulfilling life.
- Take a dance break: see if your local fitness center is offering online classes such as zumba or Nia dance. Nia is a feel-good fitness for the body, mind, and soul. It is a cardio-dance fitness practice that blends energizing soul-stirring music with choreography that is easy to follow and designed to move the whole body.
- There are many online exercise programs out there but the Peloton app is one that has it all and is available for a 30-day free trial. You don’t need to have their bike to get the most out of this app, as they offer meditation, yoga, cardio, dance classes, strengthening classes, outdoor run and walk audio training and much more.
When searching for fitness apps, it’s difficult to search for features that are appealing. Especially when most of those apps appear homogeneous. Simplify your fitness app search by narrowing down the top 10 sought-out functions.
- Tracking progress
- Estimate caloric expenditure
- Quick workout options
- Synced music
- Muscle strengthening
- Amp up indoor cycling
- Workout videos
- Charitable connectivity
Lung Health: We all know that exercises is good for us – bone, muscle, cardiovascular, weight management, etc. but it is also great for lung health! Per the American Lung Association: “As your physical fitness improves, your body becomes more efficient at getting oxygen into the bloodstream and transporting it to the working muscles. National guidelines recommend that all adults get 30 minutes of moderate physical activity five days a week.” Some examples of breathing exercises (some have already been highlighted): pursed lip breathing and diaphragmatic breathing.
Save time with a workout by performing a circuit: Circuit training involves several aerobic and anaerobic exercises in rapid succession with a short break in between exercises. Perform 3 circuits (all 6 listed below are considered 1 circuit) for a total of 7 minutes in total.
- Jumping jacks – perform for 30 seconds
- Break – 10 seconds
- Push up’s – perform for 30 seconds
- Squats – perform for 30 seconds
- Break – 10 seconds
- Planks – perform for 30 seconds
Goal Setting. Having trouble achieving your exercise goals? Set SMART (specific, measurable, achievable, relevant and time-bound) goals for exercise. The SMART method helps push you further, gives you a sense of direction, and helps you organize and reach your goals.Couch to 5k Training. There are many guides out there. Find one that works for you – here are two examples found on this page. Make sure you are FIT TO RUN and not RUNNING to GET FIT. This is a big mistake that many will make as the temperature starts to rise and people get more excited to be outside.Steps to start:
- Are you healthy enough to run?
- Consult with PCP prior to starting a new workout routine
- Have you completed lower level exercises?
- Walking programs where you attempt to walk 7-10k steps per day
- Bodyweight exercises prior to starting this program
- Do you like to run?-If in two weeks you hate it, quit! No shame. Not everyone enjoys it. Check it off and move onto another activity
- Proper attire?
- FUEL: make sure that you are getting enough calories IN to fuel your body for the increase in exercise
- Set mini-goals – hold yourself accountable!
- Set an end goal – find a 5K to train for 2-3 months away from your start date. We hope that we will be able to start these races up again, but if not, you can still hold yourself accountable that day and run it on your own!
Resistance training to improve health: Individuals of all ages who perform regular resistance exercises reduce risk of many diseases, improve quality of life, and reduce mortality. You can perform resistance exercises by using free weights, bands, machines, or body weight. No matter what training you do, you need to challenge the strength of your muscles to experience health benefits. It is recommended by the American College of Sports Medicine to perform resistance exercises 2-3 times per week and to incorporate 8-10 multi-joint exercises that challenge major muscle groups. This week, try to perform resistance training by performing deadlifts using dumbbells, squats using resistance bands, or body weight push-up’s.
Have a place in your house where you work, and another where you relax: Avoid working from the couch, instead designate a table or desk as the working area. A place with a good source of natural light is ideal. Keep it clean of clutter to avoid distraction, and try decorating with flowers to make the environment feel fresh.
Figure out the tech set up that works for you. If you own Apple products, try using your TV as a second monitor via Apple TV + AirPlay. You can use your phone or an iPad during video meetings in addition to a laptop, that way you can take notes without switching screens.
Maintain as normal a routine as possible. This will create a sense of normalcy and facilitate implementation of healthy habits.
- Maintain a regular bedtime and wake time.
- Make time for pleasant activities every day.
- Maintain healthy habits, which may require adaptation for social distancing (e.g., exercise, healthy eating).
- If working from home, get dressed and ready as if you were going to work in person: looking and smelling your best goes a long way.
Take care of your basic needs: Ensure rest and respite during work or between shifts, eat sufficient and healthy food, engage in physical activity, and stay in contact with your support system, family, and friends.
Work Space Ergonomics. We all know that moving to more telework has been a little stressful and we are here to support you. Something that can be missed a lot of times when transitioning to a home setup is the actual space and setup of your work. OSHA has a few great handouts and checklists that will provide you with ideas on how to set up your workspace for success. We tend to be more productive in a comfortable space. Other things to consider: noise in the area, proper lighting (natural sunlight or overhead/desk lamps), and temperature.
Stay Hydrated. It's one thing to know you need to drink enough, but it's another thing to make sure you're consistently consuming enough liquids. Here are some simple suggestions to help you stay hydrated every day:
- Don't wait until you're thirsty. Try to sip something regularly throughout the day or, at least, drink a glass of water before and in between meals.
- Eat fruits and vegetables.
- Carry a reusable water bottle with you..
- When you're feeling hungry, drink water.
- Drink before, during, and after exercise. When you sweat, that's fluid escaping your body, and you need to replace it. Make sure to drink
Healthy Alcohol Use. Whether it is Zoom Happy Hours with friends/family or Quarentinis while reading the paper or watching TV, what started out as a way to relax can become a habit. In moderation, alcohol use is not problematic. Experts define moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men, as they metabolize alcohol differently. Find more info by visiting this NIH portal. Enjoy and be healthy.
Don' t overindulge in unhealthy self-soothing. Wine, candy, chips, soda. All are fine in moderation. When humans are under stress (including isolation) we go into selfsoothing strategies. Self-soothing strategies are ways that we calm ourselves down when under stress. Though alcohol or junk food may help your mental health in the short term, it will affect your physical health, and therefore your body's resistance to infection. Limit drinking and consumption of sugary or processed foods.
Maintain your sleep routine. Sleep is essential in keeping you healthy in the face of COVID-19. Make sure you're practicing good sleep hygiene, keeping your sleeping environment cool, dark, and quiet. Limit blue spectrum light before bed with special glasses or programs like Nightshift on Macs, iPhones and iPads, and f.lux on PCs and smartphones.
Get sun. Vitamin D is important in the immune response. Getting sun will increase your vitamin D reserves. Opening shades and windows, sitting in sunny areas of your home, and even getting outside when social distancing is possible (maintaining 6 feet between yourself and others).