ROLE OF OCCUPATIONAL THERAPY IN SARS-CoV/ SARS -CoV-2
ROLE OF OCCUPATIONAL THERAPY
IN
SARS-CoV/ SARS
-CoV-2
- INTRODUCTION:
·
Severe
acute respiratory syndrome (SARS) is a communicable viral disease, caused by
a new strain of corona virus, which differs considerably in genetic structure
from previously recognized corona virus. The most common symptoms in patient
progressing to SARS include fever, malaise, chills, headache myalgia,
dizziness, cough, sore throat and running nose. In some cases there is
rapid deterioration with low oxygen saturation and acute respiratory distress
requiring ventilator support. It is capable of causing death. In as many as 10
per cent cases (1).
- PROBLEM STATEMENT:
·
The
earliest case was traced to a health care worker in China, in late 2002, with
rapid spread to Hong Kong, Singapore, Vietnam, Taiwan and Taranto. As of early
August 2003, about 8,422 cases were reported to the WHO from 30 countries with
916 fatalities (2)
- EPIDEMIOLOGICAL:
·
Health care workers, especially
those involved in procedures generating aerosols, accounted for 21 per cent of
all cases. Maximum virus excretion from the respiratory tract occurs on about
day 10 of illness and then declines. The efficiency of transmission appears to
be greatest following exposure to severely ill patients or those experiencing
rapid clinical deterioration, usually during the second week of illness. When
symptomatic cases were isolated within 5 days of the onset of illness, few
cases of secondary transmission occurred. There was no evidence that patient
transmits infection 10 days after fever has resolved. Children are rarely
affected by SARS. To date, there have been two reported cases of
transmission from children to adults and no report of transmission from child
to child. Three separate epidemiological investigations have not found any
evidence of SARS transmission in schools. Furthermore, no evidence of SARS has
been found in infants of mothers who were infected during pregnancy.
International flights have been associated with the transmission of SARS from
symptomatic probable cases to passengers or crew. WHO recommends exit screening
and other measures to reduce opportunities for further international spread
associated with air travel during the epidemic period.
- INCUBATION PERIOD:
·
The
incubation period has been estimated to be 2 to 7 days, commonly 3 to 5 days (1)
- MODE OF
TRANSMISSION:
·
The
primary mode of transmission appears to be through direct or indirect
contact of mucous membranes of eyes, nose, or mouth with respiratory
droplets or fomites. The use of aerosol-generating procedures (end tracheal
intubation, bronchoscope, and mobilization treatments) in hospitals may amplify
the transmission of the SARS corona virus. The virus is shed in stools but the
role of faecal-oral transmission is unknown. The natural reservoir appears to
be the horseshoe bat (which eats and drops fruits ingested by civets, the earlier
presumed reservoir and a likely amplifying host). The SARS virus can survive
for hours on common surfaces outside the human body, and up to four days in
human waste. The virus can survive at least for 24 hours on a plastic surface
at room
temperature, and can live for extended periods in the cold.
- CASE STUDY (4)
·
The case definition is based on
current understanding of the clinical features of SARS, and available
epidemiological data. It may be revised as new information accumulates. Case
definition for notification of SARS under the international health regulation
(2005) In the period following an outbreak of SARS, a notifiable case of SARS
is defined as an individual with laboratory confirmation of infection with SARS
corona virus (SARS-CoV) who either fulfils the clinical case definition of SARS
or has worked in a laboratory handling live SARS-CoV or storing clinical
specimens infected with SARS-CoV.
Clinical case definition of SARS:
·
A history of fever, or documented
fever
·
One or more symptoms of lower
respiratory tract illness (cough, difficulty in breathing, shortness of breath)
·
Radiographic evidence of lung
infiltrates consistent with pneumonia or acute respiratory distress syndrome
(ARDS) or autopsy findings consistent with the pathology of pneumonia or ARDS
without an identifiable cause No alternative diagnosis fully explaining the
illness.
Diagnostic
tests required for laboratory confirmation of SARS:
·
Conventional reverse transcriptase
PCR {RT-PCR) and real-time reverse transcriptase PCR (real-time RT-PCR). Assay
detecting viral RNA present in:
·
At least 2 different clinical
specimens (e.g. nasopharyngeal and stool specimens) OR The same clinical
specimen collected on 2 or more occasions during the course of the illness
(e.g. sequential nasopharyngeal aspirates)
OR
·
A new extract from the original
clinical sample tested positive by 2 different assays or repeat RT-PCR or
real-time RT-PCR on each occasion of testing OR
Virus culture from any clinical specimen.
2.
Enzyme-linked immunosorbent assay (ELISA) and immunofluorescent assay
(IFA)
·
Negative antibody test on serum
collected during the acute phase of illness, followed by positive antibody test
on convalescent-phase serum, tested simultaneously OR
·
A 4-fold or greater rise in antibody
titre against SARS-CoV between an acute-phase serum specimen and a
convalescent-phase serum specimen (paired sera), tested simultaneously.
·
In the absence of known SARS-CoV
transmission to humans, the positive predictive value of a SARS-CoV diagnostic
test is extremely low; therefore, the diagnosis should be independently
verified in one or more WHO international SARS reference and verification
network laboratories. Every single case of SARS must be reported to WHO.
STUDY:2
·
Corona viruses are a large family of
viruses that are known to cause illness ranging from the common cold to more
severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe
Acute Respiratory Syndrome (SARS).
·
A novel corona virus
(COVID-19) was identified in 2019 in Wuhan, China. This is a new corona
virus that has not been previously identified in humans. This course provides a
general introduction to COVID-19 and emerging respiratory viruses and is
intended for public health professionals, incident managers and personnel
working for the United Nations, international organizations and NGOs.As the
official disease name was established after material creation, any mention of
nCoV refers to COVID-19, the infectious disease caused by the most recently
discovered corona virus.(6)
·
The 2019 novel corona virus
(SARS-CoV-2) outbreak and spread of the associated disease (COVID-19) is a
rapidly evolving situation. To manage the threat of continued SARS-CoV-2
infection and the risk to public health caused by COVID-19, health
professionals need up-to-date information and guidance on global surveillance,
infection control measures and identifying and caring for people with COVID-19.
This resource area brings together information about the outbreak and COVID-19
content from ERS and ELF
What is the novel corona virus:
·
Corona viruses are a large family of
viruses that can cause illness ranging from the common cold to more severe
diseases like Middle East Respiratory Syndrome (MERS) and Severe Acute
Respiratory Syndrome (SARS).
·
The 2019 novel corona virus, called
'SARS-CoV-2' (previously referred to as 2019-nCoV), is a new strain that has
not been identified in humans before. The disease that is caused by SARS-CoV-2
is called 'COVID-19'.
OUTBREAK SUMMARY:
·
On 31 December 2019, the World
Health Organization (WHO) was informed of several cases of viral pneumonia of
unknown cause detected in Wuhan City, China. The outbreak has rapidly evolved,
affecting other parts of China and many countries worldwide in Asia, Europe,
North and South America, Australia and Africa. On 11 March 2020, WHO labelled
the COVID-19 outbreak as a pandemic.ERS recommends consulting the WHO's daily
situation reports for the latest updates on the number of people who are being
treated for COVID-19 and the geographic spread of SARS-CoV-2
Clinical
features:
·
The WHO reports that human-to-human
transmission is occurring with a preliminary R0 estimate of 1.4–2.5. Current
estimates of the incubation period of the virus range from 2–14 days, and the
virus seems to be transmitted mainly via flu-like symptoms and respiratory
droplets that people sneeze, cough, or exhale.
·
Typical symptoms of COVID-19
include fever, cough, difficulty breathing, muscle pain and tiredness. More
serious cases develop severe pneumonia, acute respiratory distress syndrome,
sepsis and septic shock.
·
Generally, older people and
those with underlying conditions (such as hypertension, heart disorders,
diabetes, liver disorders, and respiratory disease) are expected to be more at
risk of developing severe symptoms.
·
The evidence from analyses of cases
to date is that COVID-19 infection causes mild disease (i.e. non-pneumonia
or mild pneumonia) in about 80% of cases and most cases recover; 14% have more
severe disease and 6% experience critical illness.(7)
- INVESTIGATION:
·
Chest
X-ray findings typically begin with a small, unilateral patchy shadowing, and
progress over 1-2 days to become bilateral and generalized, with
interstitial/confluent infiltration. Adult respiratory distress syndrome has
been observed in a number of patients in the end stages.
- COMPLICATIONS:
·
As with any viral pneumonia,
pulmonary decomposition is the most feared problem. ARDS occurs in about 16%
patients, and about 20-30% of patients require intubation and mechanical
ventilation. Sequelae of intensive care include infection with nosocomial
pathogens, tension pneumothorax from. ventilation at high peak pressures, and
non-cardiogenic pulmonary edema.
- PROGNOSIS:
·
The overall mortality rate of
identified cases is about 14%. Mortality is age-related, ranging from less than 1 % in persons
under 24 years of age to greater than 50% in persons over 65 years of age. Poor
prognostic factors include advanced age, chronic hepatitis B infection treated
with lamivudine, high initial or high peak lactate dehydrogenase concentration,
high neutrophil count on presentation, diabetes mellitus, acute kidney disease,
and low counts of CD4 and CD8 on presentation. Many subclinical
cases probably go undiagnosed. Seasonality, as with influenza, is not
established (5).
- TREATMENT:INTERDISCIPLINARY APPROACH
·
Rehabilitation
has been defined as "the combined and coordinated use of medical, social,
educational and vocational measures for training and retraining the individual
to the highest possible level of functional ability" interdisciplinary team approach the involves disciplines such as
physical medicine, occupational therapy, physiotherapy, social work,
vocational guidance and placement services. The following areas of concern in
rehabilitation have been identified:
1.
Medical rehabilitation -
restoration of function.
2.
Vocational
rehabilitation - restoration of the capacity to earn a livelihood.
3.
Social
rehabilitation - restoration of family and social relationships.
4.
Psychological
rehabilitation restoration of personal dignity and confidence (15,16)
·
As there is no vaccine against SARS,
the preventive measures for SARS control are appropriate detection and
protective measures which include:
1.
Prompt identification of persons with SARS,
their movements and contacts
2.
Effective isolation of SARS patients in
hospitals 3. Appropriate protection of medical staff treating these patients
3.
Comprehensive identification and
isolation of suspected SARS cases
4.
Simple hygienic measures such as hand-washing
after touching patients, use of appropriate and well-fitted masks, and
introduction of infection control measures
5.
Exit screening of international travellers
6.
Timely and accurate reporting and
sharing of information with other authorities and/or governments.
10.1. OCCUPATIONAL THERAPY: domains are
included in the Practice Framework
1. Performance Areas
2. Performance
Skills
3. Performance
Patterns
4. Context
5. Activity
demands
6. Client
Factors(14)
PREVENTION:
1. PRIMORDIAL:
1. Phase: Underlying
economic, social, and environmental conditions leading to causation
2. Aim: Establish and maintain conditions that minimize
hazards to health
3. Occupational
therapy role:
Ø
Preventive
education
v
Health communication
1.
Mass
approach ( TV, Radio, news paper, printed
material, direct mailing, Internet)
2. Group approach : (lecture ,demonstrating)
3. Individual: (home visit, personal letter )
2. PRIMARY PREVENTION:
1. Phase: specific causal factors
2. Aim: reduce the incidence
3. Occupational therapy role:
Ø
Self management skills education
Ø
Home management skiills education
Ø
Environmental adaptation
3. SECONDARY PREVENTION:
1.
Phase:
Early stage of disease
2. Aim:
Reduced the prevalence
3. Occupational
therapy role: (Based on severity of the illness)
Ø Patient
and family Education (regarding disease process and recovery)
Ø Preventive
techniques: Adjunctive
methods (bed sore, bed
position, feeding techniques,
patient handling method, dyspnoea control posture, etc....)
Ø Graded
respiratory exercises program
Ø Increase
knowledge of approximate metabolic cost of activities METs
Ø Maintained
or improve ROM, strength, and Cardio pulmonary endurance
Ø Self
management education
Ø Psychological
adaptation
Ø Energy
conservation techniques
Ø Work
simplification techniques
Ø Joint
protection techniques
Ø Self help skills adaptation and modification
Ø Environmental adaptation and modification
Ø Home adaptation and modification
4. TERTIARY PREVENTION:
1.
Phase:
Late state of diseases
2.
Aim:
Reduce the number and
impact of complication
3.
Occupational
therapy role:(Based
on severity of illness)
Ø
Psychological adaptation
Ø
Environmental
adaptation and modification
Ø
Home
adaptation and modification
Ø Preventive techniques. Patient and
family Education (regarding disease process and recovery)
Ø Preventive
techniques: adjunctive methods
(sore,
bed position, feeding
techniques, patient handling method, dyspnoea control posture, etc....)
Ø Graded
respiratory exercises program
Ø Increase
knowledge of approximate metabolic cost of activities METs
Ø Maintained
or improve ROM, strength, and Cardiopulmonary endurance
Ø Self
management education
Ø Energy
conservation techniques
Ø Work
simplification techniques
Ø Joint
protection techniques
Ø
Self
help skills adaptation and modification(8,9,10,11,12,13)
DETAILED ABOUT ROLE OF OCCUPATIONAL THERAPY
IN SARS-Co V/ SARS
-CoV-2:
1. Preventive technique:
adjunctive method
These
positions are helpful when you have shortness of breath during activity,
emotional excitement, the prevention of primary complication and exposure to
adverse weather condition.
POSITIONING:
Sitting
1.
Rest your feet flat on the floor.
2. Lean
your chest forward slightly.
3. Rest
your elbows on your knees or rest your chin on your hands.
4.
Relax your neck and shoulder muscles.
-OR-
5.
Rest your feet flat on the floor.
6. Lean
your chest forward slightly.
7. Rest
your arms on a table.
8. Rest
your head on your forearms or on some pillows
Standing
1.
Stand
with your feet shoulder width apart.
2.
Lean
your hips against a wall.
3.
Rest
your hands on your thighs.
4.
Relax
your shoulders, leaning forward slightly and dangling your arms in front of
you.
-OR-
1.
Rest
your elbows or hands on a piece on furniture, just below shoulder height.
2.
Relax
your neck, resting your head on your forearms.
3.
Relax
your shoulders.
Sleeping
1.
Lie
on your side with a pillow between your legs and your head elevated with
pillows. Keep your back straight.
-OR-
1.
Lie
on your back with your head elevated and your knees bent, with a pillow under
your knees.(18)
Prone
1.
Close
eyes and protect with gel or pad.
2.
Place
the patient's palms against their thighs, thumbs upwards, elbows straight and
shoulders neutral.
3.
Slide
the patient to the edge using a Sliding sheet.
4.
Roll
patient into the lateral position using the underneath sheet.
5.
Roll
patient into prone.
6.
'Swimmers
position' - elbow in which the head is semi-rotated should be flexed to no more
than 90° to avoid ulnar nerve stretch, and the other arm internally rotated by
the side.
7.
Ensure
that women's breasts or men's genitals are not compressed.
8.
Place
two pillows under each shin to prevent peroneal nerve stretch, positioning them
to avoid knee and toe pressure from mattress. (17)
2. GRADED BREATHING
EXERCISE PROGRAM
BREATHING ACTIVITY:
Pursed lip breathing
1.
Its
been shown to reduce how hard a person has to work to breathe.
2.
It
helps release air trapped in the lungs.
3.
It
promotes relaxation.
4.
It
reduces shortness of breath.
5.
Practicing
this technique 4 to 5 times daily can help.
6. While keeping your mouth closed, take a deep breath in
through your nose, counting to 2. Follow this pattern by repeating in your head
“inhale, 1, 2.” The breath does not have to be deep. A typical inhale wills do.
Put your lips together as if you are starting to whistle or blow out candles pursed,
slowly breathe out by counting to 4. Don’t
try to force the air out, but instead breathe out slowly through your mouth.
DIAPHRAGMATIC BREATHING
Diaphragmatic or abdominal breathing helps
to retrain this muscle to work more effectively.
1.
While
sitting or lying down with your shoulders relaxed, put a hand on your chest and
place the other hand on your stomach.
2.
Take
a breath in through your nose for 2 seconds, feeling your stomach move outward.
You’re doing the activity correctly if your stomach moves more than your chest.
3.
Purse
your lips and breathe out slowly through your mouth, pressing lightly on your
stomach. This will enhance your diaphragm’s ability to release air.
4.
Repeat
the exercise as you are able to.
COORDINATED BREATHING
1.
Inhale
through your nose before beginning an exercise.
2.
While
pursing your lips, breathe out through your mouth during the most strenuous
part of the exercise. An example could be when curling upward on a bicep curl.
DEEP BREATHING
Deep breathing
prevents air from getting trapped in your lungs
1.
Sit
or stand with your elbows slightly back. This allows your chest to expand more
fully.
2.
Inhale
deeply through your nose.
3.
Hold
your breath as you count to 5.
4.
Release
the air via a slow, deep exhale, through your nose, until you feel your inhaled
air has been released.(19)
3. INCREASE
KNOWLEDGE OF APPROXIMATE METABOLIC COST OF ACTIVITIES:
MET: 1.0 to 1.4
1.
ADL and mobility: sitting, self-feeding, wash
hands and face, bed mobility transfers progressively increase sitting tolerance
2.
Exercise:
§
Supine
= A or AA exercise to all extremities (10-15x per extremity)
§
Sitting
= A or AA exercise only neck and LEs include deep breathing exercises
3.
Recreation: reading, radio, table games
(noncompetitive), light work
MET: 1.4 to 2.0
1.
ADL and mobility:
§
Sitting
= self-bathing, shaving, grooming, dressing in hospital unlimited sitting
§
Ambulation
= at slow pace, in room, as tolerated
2.
Exercise:
§
Sitting
= A exercise to all extremities (increasing repetitions per MD) NO ISOMETRICS
3. Recreation:
§
Sitting
= crafts (painting, knitting, sewing, mosaics, embroidery) NO ISOMETRICS
MET: 2.0 to 3.0
1.
ADL and
mobility:
§
Sitting
= showing in warm water, homemaking tasks with brief standing periods to transfer light items, ironing
2.
Exercise:
- Sitting = wheelchair mobility, limited
distances
- Standing = A
Exercise to all extremities and trunk (increasing repetitions per
MD) May include balance
exercises Light mat activities
without resistance
- Ambulation = begin progressive ambulation at 0%
grade and comfortable pace
3.
Recreation:
§
Sitting
= card playing, crafts, piano, machine sewing, typing (per MD
MET: 3.0 to 3.5
1.
ADL
and mobility:
1.
§
Standing
= total washing, dressing, shaving, grooming, showering in warm water;
kitchen/homemaking activities while practicing energy conservation (light
vacuuming, dusting, and sweeping,
washing light clothes)
2.
Exercise:
2.
ii.
Standing
= continue all previous exercise, progressively increasing repetitions, speed
of repetitions may include additional
exercises to increase workload up to 3.5 MET, balance, and mat activities with
mild resistance
iii.
Ambulation
= unlimited on level surfaces in and/or outside (per MD) progressively
increasing speed and/or duration for
periods up to 15-20 minutes or until target heart rate is reached (per MD)
iv.
Stairs
= may begin slow stair climbing to patient's tolerance up to 2 flights.
v.
Treadmill
= 1 mph at 1% grade, progressing to 1.5
mph at 2% grade (per MD) cycling = up to 5.0 mph without
3.
Recreation:
candlepin bowling, canoeing (slow rhythm, pace), golf putting, light gardening
(weeding and planting), driving (per MD
MET: 3.5 to 4.0:
1.
ADL
and mobility standing = washing dishes, washing clothes, ironing, hanging light
clothes, and making beds
2.
Recreation:
swimming (slowly) light carpetry golfing (using power cart) light home repairs
3.
Exercise:
§
Standing
= continue exercises in stage IV progressively increasing repetitions and speed
of repetitions may add additional
exercises to increase workload up to 4.0 MET
§
Ambulation
= as in stage IV, increasing speed up to 2.5 mph on level surfaces (per
MD)
§
Stairs
= as in stage IV and progressively
increasing patient's tolerance
§
Treadmill
= 1.5 mph at 2% grade, progressing to
1.5 mph at 4% grade up to 2.5 mph at 0% grade (per MD
§
Cycling
= up to 8 mph without resistance (per MD) May use up to 7 to 10 lb weight for
upper and lower extremity exercises in sitting
MET: above 4.0
1.
ADL
and mobility:
- Standing = showering in hot water, hanging
and/or wringing clothes, mopping, stripping and making beds, raking
recreation: swimming (no advanced strokes) slow dancing ice or roller skating (slowly) volleyball
badminton table tennis (noncompetitive) light calisthenics
- Standing = continue exercises in stage IV
progressively increasing repetitions and speed of repetitions may add additional exercises to
increase workload up to 4.0 MET
- Ambulation = as in stage V, increasing speed to
3.5 mph on level surfaces (per MD)
- Stairs = as in stage IV and progressively increasing
patient's tolerance
- Treadmill = 1.5 mph at 5 to 6% grade
progressing to 3.5 mph at 0% grade (per MD)
- Cycling= up to 10 mph without resistance May use up to 10 to 15lb weight in UE
and LE exercises in sitting.(20)
4. EXERCISE OR ACTIVITIES
MAINTAINED ROM, STRENGTH, AND CARDIOPULMONARY ENDURANCE:
Passive ROM
Indications
for PROM
·
A
patient is not able to or not supposed to actively move a segment or segments
of the body, on complete bed rest, movement is provided by an external
source.
Goals for
PROM
1.
Maintain
joint and connective tissue mobility
2.
Minimize the effects of the formation of
contractures
3.
Maintain
mechanical elasticity of muscle
4.
Assist
circulation and vascular dynamics
5.
Enhance
synovial movement for cartilage nutrition and diffusion of materials in the
joint
6.
Decrease
or inhibit pain
7.
Assist
with the healing process after injury or surgery
8.
Help
maintain the patient’s awareness of movement Other Uses for PROM
9.
When
a therapist is examining inert structures, PROM is used to determine
limitations of motion, to determine joint stability, and to determine muscle
and other soft tissue elasticity.
Active and Active-Assistive ROM
·
Patients
gain control of their ROM, they are progressed to manual or mechanical
resistance exercises to improve muscle performance for a return to
functional activities .AROM can be used for aerobic conditioning
programs
Goals for AROM
1.
Maintain
physiological elasticity and contractility of the participating muscles
2.
Provide
sensory feedback from the contracting muscles
3.
Provide
a stimulus for bone and joint tissue integrity
4.
Increase
circulation and prevent thrombus formation
5.
Develop
coordination and motor skills for functional activities(21)
EXERCISE:
Warm-Up Period:
Physiological Responses During this period there is:
1.
An
increase in muscle temperature. The higher temperature increases the efficiency
of muscular contraction by reducing muscle viscosity and increasing the rate of
nerve conduction.
2.
An
increased need for oxygen to meet the energy demands for the muscle. Extraction
from hemoglobin is greater at higher muscle temperatures, facilitating the
oxidative processes at work.
3.
Dilatation
of the previously constricted capillaries with increases in the circulation,
augmenting oxygen delivery to the active muscles and minimizing the oxygen
deficit and the formation of lactic acid.
4.
Adaptation
in sensitivity of the neural respiratory center to various exercise
stimulants.An increase in venous return. This occurs as blood flow is shifted
centrally from the periphery.
Purposes:
The warm-up also
prevents or decreases:
1.
The susceptibility of the musculoskeletal system to injury.
2.
The occurrence of ischemic electrocardiographic (ECG)changes and
arrhythmias.
Guidelines:
The warm-up should be gradual and sufficient
to increase muscle and core temperature without causing fatigue or reducing
energy stores. Characteristics of the period include:
1.
A
10-minute period of total body movement exercises,such as calisthenics, and
walking slowly.
2.
Attaining
a heart rate that is within 20 beats/min of the target heart rate.
Aerobic Exercise Period:
·
The
aerobic exercise period is the conditioning part of the exercise program.
Attention to the determinants of intensity, frequency, duration, and mode of
the program, as previously discussed, has an impact on the effectiveness of
thevprogram. The main consideration when choosing a specific method of
training is that the intensity be great enough to stimulate an increase in
stroke volume and cardiac output and to enhance local circulation and aerobic
metabolism in the appropriate muscle groups. The exercise period must be within
the person’s tolerance, above the threshold level for adaptation to occur, and
below the level of exercise that evokes clinical symptoms.
1.
In
aerobic exercise, submaximum, rhythmic, repetitive,dynamic exercise of large
muscle groups is emphasized.
2.
There
are four methods of training that challenge the aerobic system: continuous,
interval (work relief), circuit,and circuit interval.
Continuous Training
1.
A
submaximum energy requirement, sustained through out the training period, is
imposed.
2.
Once
the steady state is achieved, the muscle obtains energy by means of aerobic
metabolism. Stress is placed primarily on the slow-twitch fiber
3.
The
activity can be prolonged for 20 to 60 minutes without exhausting the oxygen
transport system.
4.
The
work rate is increased progressively as training improvements are achieved.
Overload can be accomplished by increasing the exercise duration.
5.
In
the healthy individual, continuous training is the most effective way to
improve endurance.
Interval Training
Interval training tends to improve strength
and power more than endurance.
1.
The
relief interval is either a rest relief (passive recovery) or a work relief
(active recovery); and its duration ranges from a few seconds to several
minutes. Work recovery involves continuing the exercise but at a reduced level
from the work period. During the relief period, a portion of the muscular
stores of ATP and the oxygen associated with myoglobin that were depleted
during the work period are replenished by the aerobic system; an increase in .VO2
max occurs.
2.
The
longer the work interval, the more the aerobic system is stressed. With a short
work interval, the duration of the rest interval is critical if the aerobic
system is to be stressed (a work/recovery ratio of 1:1 to 1:5 is appropriate). A
rest interval equal to one and a half times the work interval allows the
succeeding exercise interval to begin before recovery is complete and stresses
the aerobic system. With a longer work interval, the duration of the rest is
not as important.
3.
A
significant amount of high-intensity work can be achieved with interval or
intermittent work if there is appropriate spacing of the work–relief intervals.
Thetotal amount of work that can be completed with intermittent work is greater
than the amount of work that can be completed with continuous training.
Circuit Training
Circuit
training employs a series of exercise activities. At the end of the last
activity, the individual starts from the beginning and again moves through the
series. The series of activities is repeated several times.
1.
Several
exercise modes can be used involving large andsmall muscle groups and a mix of
static or dynamic effort.
2.
Use
of circuit training can improve strength and endurance by stressing both the
aerobic and anaerobic systems.
Circuit-Interval Training
1.
Combining
circuit and interval training is effective because of the interaction of
aerobic and anaerobic production of ATP.
2.
In
addition to the aerobic and anaerobic systems being stressed by the various
activities, with the relief interval there is a delay in the need for
glycolysis and the production of lactic acid prior to the availability of
oxygen supplying the ATP.
Cool-Down Period:
A cool-down
period is necessary following the exercise period.
Purpose:
1.
Prevent pooling of the blood in the extremities by continuing to use the
muscles to maintain venous return.
2.
Prevent fainting by increasing the return of blood to the heart and
brain as cardiac output and venous return decreases.
3.
Enhance the recovery period with the oxidation of metabolic waste and
replacement of the energy stores.
4.
Prevent myocardial ischemia, arrhythmias, or other cardiovascular
complications.
Guidelines:
Total-body exercises such as calisthenics and static
stretching are appropriate.
The period
should last 5 to 10 minutes.(22)
5. STRESS MANAGEMENT :
Belly breathing
1.
Sit
or lie flat in a comfortable position.
2.
Put
one hand on your belly just below your ribs and the other hand on your chest.
3.
Take
a deep breath in through your nose, and let your belly push your hand out. Your
chest should not move.
4.
Breathe
out through pursed lips as if you were whistling. Feel the hand on your belly
go in, and use it to push all the air out.
5.
Do
this breathing 3 to 10 times. Take your time with each breath.
6.
Notice
how you feel at the end of the exercise.
4-7-8 breathing
1.
To
start, put one hand on your belly and the other on your chest as in the belly
breathing exercise.
2.
Take
a deep, slow breath from your belly, and silently count to 4 as you breathe in.
3.
Hold
your breath, and silently count from 1 to 7.
4.
Breathe
out completely as you silently count from 1 to 8. Try to get all the air out of
your lungs by the time you count to 8.
5.
Repeat
3 to 7 times or until you feel calm.
6.
Notice
how you feel at the end of the exercise.
Roll breathing
Roll breathing helps you to develop full use
of your lungs and to focus on the rhythm of your breathing.
1.
Put
your left hand on your belly and your right hand on your chest. Notice how your
hands move as you breathe in and out.
2.
Practice
filling your lower lungs by breathing so that your "belly" (left)
hand goes up when you inhale and your "chest" (right) hand remains
still. Always breathe in through your nose and breathe out through your mouth.
Do this 8 to 10 times.
3.
When
you have filled and emptied your lower lungs 8 to 10 times, add the second step
to your breathing: inhale first into your lower lungs as before, and then
continue inhaling into your upper chest. Breathe slowly and regularly. As you
do so, your right hand will rise and your left hand will fall a little as your
belly falls.
4.
As
you exhale slowly through your mouth, make a quiet, whooshing sound as first
your left hand and then your right hand fall. As you exhale, feel the tension
leaving your body as you become more and more relaxed.
5.
Practice
breathing in and out in this way for 3 to 5 minutes. Notice that the movement
of your belly and chest rises and falls like the motion of rolling waves.
6.
Notice
how you feel at the end of the exercise.
MORNING BREATHING
1.
From
a standing position, bend forward from the waist with your knees slightly bent,
letting your arms dangle close to the floor.
2.
As
you inhale slowly and deeply, return to a standing position by rolling up
slowing, lifting your head last.
3.
Hold
your breath for just a few seconds in this standing position.
4.
Exhale
slowly as you return to the original position, bending forward from the waist.
5.
Notice
how you feel at the end of the exercise(23)
6. PSYCHOLOGICAL
ADAPTATION:
1.
Autogenic
Training
2.
Biofeedback-Assisted
Relaxation
3.
Deep
Breathing or Breathing Exercises
4.
Guided
Imagery
5. Progressive Muscular
Relaxation
6. Coping strategies
7. SELF MANAGEMENT:
1.
Occupation
Based Self Management intervention
2.
Motivational
Interviewing to promote lifestyle change
3.
Culturally
Tailored Healthy Lifestyle training
4.
Evidence
informed, theory-driven practice
5.
Interventions
to address health disparities
6.
Client
driven action planning and goal setting
7.
Environmental
modification to promote engagement in meaningful occupations
8. Translation of health recommendations to the client’s
everyday life(24)
8. ENERGY CONSERVATION PRINCIPLES AND TECHNIQUES:
Organization:
1.
Planning
ahead
2.
Prioritize
your work
3.
Analyze
the work to be done
4.
Eliminate
all unnecessary steps
5.
Combine
tasks or activities
6.
Consider
making changes to tasks or activity
Balance Rest and Activity:
1.
Frequent
short rests are of more benefit than fewer longer ones
2.
The
amount of rest you need and the amount of activity you can do will vary day to
day
3.
Plan
your work so difficult tasks are done during your best time of day and are
distributed throughout the week
4.
Avoid
activities which cannot be stopped immediately if they become too stressful
5.
Rest
before you tire
6.
Plan
a balance of work, recreation, exercise, and rest
7.
If
possible, lie down to rest
8.
Practice
breathing techniques
9.WORK SIMPLIFICATION TECHNIQUES:
1.
Cancel
tasks that are not really necessary
2.
Delegate
responsibilities to others
3.
Simplify
your methods of work
4.
Sit
to work whenever possible
5.
Adjust
height of work surfaces to allow for good posture
6.
Use
equipment when necessary to conserve energy
7. Avoid prolong exposure to moist heat(25)
10.JOINT
PROTECTION PRINCIPLES:
1.
Respect
For Pain
2.
Balance
Activity And Rest
3.
Avoid Activities Which Cannot Be Stopped
4.
Use Larger, Stronger Joints For Activities,
When Possible, Distributing The Weight
Over Non-involved Or Stronger Joints.
5.
Avoid
Staying In One Position For Extended Periods Of Time.
6.
Maintain
Or Use Your Joints In Good Alignment.(26)
11.SELF HELP, ENVIRONMENT AND
HOME: (ADAPTATION AND MODIFICATION )
INFECTION CONTROL:
1. Handwashing
2. Covering your cough
3. Appropriate
gloving
4. Cleaning, sanitizing, and disinfection
5. Food safety
6. Exclusion
guidelines Avoid sharing personal items
7. Promote
self-care
HOME AND ENVIRONMENT (ADAPTATION AND MODIFICATION)
1. Consider the safety of family
2. Follow the label instructions for mixing, using, and
storing solutions.
3. Store these
products safely out of reach of family
4. Clean soiled surfaces and items before using
sanitizers or disinfectants.Use warm/hot water with any household soap or
detergent
5. Change water when it looks or feels dirty, after
cleaning bathrooms and diaper changing area, and after cleaning the kitchen
6. Always clean the least dirty items and surfaces first
(for example, countertops before floors, sinks before toilets)
7. Always clean high surfaces first, then low surfaces
8. Disposable towels are preferred for cleaning. If using
reusable cloths/rags, launder between cleaning uses. DO NOT use sponges since
they are hard to clean
9. Clean
completely on a regular schedule and spot clean as needed
10. Items washed /sanitizers/air dired immediately after
each uses
REFERENCES:
1.
WHO (2003), Weekly Epidemiological
Record No. 12, 21March2003.
2.
WHO (2003), World Health Report
2003, Shaping the future.
3.
WHO (2003), Weekly Epidemiological
Record No. 43, 24th Oct. 2003.
4.
WHO (2009), Weekly Epidemiological
Record No. 7, 13th Feb. 2009.
5.
Stephen J. Mcphee et al, (2010),
Current Medical Diagnosis and Treatment, 49th Ed. A Lange Medical Publication.
7.
.https://www.ersnet.org/the-society/news/novel-coronavirus-outbreak--update-and-information-for-healthcare-professionals
8.
Green E, Walters ED, Green AM, et al: Feedback
technique fordeep relaxation, Psychophysiology 6(3):371–377, 1969.
9.
Breslin EH: The pattern of respiratory muscle
recruitment during pursed-lip breathing, Chest 101(1):75–78, 1992.
10. Migliore A: Management of
dyspnea guidelines for practice for adults with chronic obstructive pulmonary
disease, Occupational Therapy Health Care 18(3), 2004.
11. Green E: Biofeedback techniques for deep
relaxation, Psychophysiology 6(3):371, 1969.
12. Hodgkin
JE, Celli BR, Connors GL: Pulmonary rehabilitation guidelines to success, ed 3,
Philadelphia, Pa, 2000, Lippincott Williams & Wilkins.
13. Maloney
FP, Moss K: Energy requirements for selected activities, Denver, Colo, 1974,
Department of Physical Medicine, National Jewish Hospital
14. Occupational Therapy Practice Of Frame Work
:Domain & Process 3rd Edition
15. WHO
(1981). Techn.Rep.Ser., No.668.
16.
WHO (1969). Techn.Rep.Ser., No.419.
20. occupational
therapy review guide rev 2.11.2018
21. Hillegass, S, Sadowsky, H: Essentials of
Cardiopulmonary Physical Therapy, ed 2. WB Saunders, Philadelphia, 2001
22. Irwin, S,
Teckline, JS: Cardiopulmonary Physical Therapy, ed 4. CV Mosby, St. Louis,
2004.
26. Cordery, Joy Cumberland, M.A.O.T., OTR, “Joint
Protection - A Responsibility for the
Occupational Therapist,” American Journal of Occupational Therapy, XIX,
%, 1965.
27. Prevention and Control of Communicable DiseasesEditors:
Barbara Wolkoff Autumn Grim Harvey L. Marx, Jr.
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