Physiotherapy Month with Andrew Lockwood

By Bridget Burling

Why is this month important?

May is Physiotherapy Month, where we recognize our rehab assistants and physiotherapists. This month is significant for our physiotherapy team to spread awareness and to recognize the various roles, groups, and departments that we support at the Hospital. We work with inpatients and outpatients, and like many other disciplines, our roles have been impacted greatly during COVID-19.

What are the roles of the physiotherapy group?

We have physiotherapists staffed on all medical and surgical floors for our inpatient services who support optimizing patient’s mobility and safety. Our physiotherapists also play an important role in discharge recommendations and support in coordinating mobility and safety needs for our patients following their acute hospital stay.

We have physiotherapists and rehab assistants staff working to treat patients who received their elective orthopedic surgery at Humber River Hospital and oversee their physiotherapy progression for our outpatient services. Our Advanced Practice Physiotherapists (APP) are physiotherapists with extended training in Orthopedics and Rheumatology who support Humber River Hospital surgeons in screening patients who may be candidates for specific elective surgeries. APP’s are also able to recommend and help coordinate community resources to allow patients to reach their goals in lieu of surgery.

We also have a Falls Prevention Clinic where our physiotherapists and rehab assistants help support patients from our community to help improve their functional mobility as safely and independently as possible. We have physiotherapists who work in the Emergency Department (ED). Their role is to assess admission need through a mobility and safety lens and often coordinate support for patients returning home from the ED to facilitate a safe and supportive transition to their living environment. This often helps reduce unnecessary hospital admissions rates while supporting more appropriate care options in the home and community.

How have you adjusted your role to handle COVID-19?

The most significant impact on the physiotherapy group has been the shift in practice to inpatient focus. An example of this shift would be the elective surgery ramp down with an influx of medicine patients filling our surgical wards. These patients have different needs and challenges that are not typical of what some physiotherapists and rehab assistants are used to treating. Many of us have had to become flexible in adapting to our expanded role while continuing to meet our patient’s needs through consistent service.

With admitted COIVD-19 patient cases, we have had to adapt to its presentation and pathology in our patients. Patients with the virus usually present with impaired endurance in the ICU. Oxygen levels can often drop quickly with any activity. Working with more acute patients while minimizing functional and strength loss has been challenging. We try to mobilize these patients early and frequently within their tolerance. Even though these patients are often acute, we try to work within their capabilities to minimize the impact that COVID-19 will have on them in regards to strength and functional independence.

We helped in developing and supporting the implementation of the proning protocol. Many patients with COVID-19 are being proned as a part of their treatment plan. This means a patient who is a candidate for this type of intervention is positioned by lying on their stomach for a specified amount of time. We have found this often improves lung function and accelerates recovery. This intervention started in the ICU with sedated and intubated patients. We are now supporting proning on medical wards with patients who are awake and able to participate in achieving the prone position independently. We also do chest physiotherapy for patients who are a candidate for specific manual interventions. COVID-19 alone is not always an indication for chest physiotherapy, but in some cases, we need to do manual techniques to help minimize the virus’s impact on breathing.

Do you have any success stories?

Working on the front lines as a physiotherapist has been rewarding. For me, seeing patients who have been able to progress their condition to wean from ventilators and transition from ICU to a medical floor where more aggressive physiotherapists can take place has been great to see. Unfortunately, many people spend an extended time requiring ventilation or other breathing supports and subsequently are very weak once they are able to breathe and mobilize on their own. This is where our roles as physiotherapists and rehab assistants become very important as we build a patient’s strength and functional capacity back to their previous level of independence prior to admission or as close as possible. In this third wave, we are seeing many younger people, often in their 30s-50s, and even though they were in need of ventilators and breathing support initially, they have responded well with increased tolerance to physiotherapy intervention.