Physiotherapy and the long road to recovery from COVID-19
Hamilton resident Habiba Ibrahim spent nearly three months in a medically induced coma owing to COVID-19. She credits the team in St. Joe’s intensive care unit, including the physiotherapists who helped her regain her physical strength, for saving her life.
When Habiba Ibrahim awoke from a medically induced coma after contracting COVID-19, the mother of five children didn’t know why she was in hospital, how she got there, or the long road to recovery she would face.
“I was delusional and everything looked different. I was in a different world altogether,” she says. “I was so confused, I didn’t even recognize my own children. I asked my daughter who she was, and she cried.”
A transplant recipient with compromised immunity, Ibrahim, 61, believes she got COVID-19 from a friend who, unlike her, did not survive the virus.
In September 2020, Ibrahim was so sick her family called an ambulance. She was admitted to St. Joe’s where a tube was placed in her throat to allow air to flow from a ventilator to her lungs. She would later need a tracheostomy, a long-term option for patients needing ventilators.
Ibrahim remained in a coma in the intensive care unit (ICU) until November before being deemed medically stable to wake up.
She credits the team in the ICU for saving her life, and is grateful to the unit’s physiotherapists for helping her recover physical strength to get out of the hospital, and home to her family.
“They pushed me to get moving, and I needed that push. They were a huge part of my recovery so I could be here for my kids,” Ibrahim says.
“They can’t squeeze your hand or wiggle their toes”
Patients in the ICU who recover from COVID-19 experience severe muscle weakness and fatigue, among other challenges.
“The majority of patients in the ICU require a lot of assistance from the ventilator, and sedation or paralytics to relax their muscles and keep them ventilating properly,” says Kristy Obrovac, a physiotherapist in St. Joe’s ICU.
“When they do finally wake up, they are quite delirious. They aren’t able to process what’s happened. They were independent before, and now they can’t squeeze your hand or wiggle their toes,” adds Daana Ajami, a physiotherapist who also works in the ICU.
For these reasons, it’s important physiotherapists get involved with the recovery process as soon as patients are medically stable to participate in therapy.
“It’s honestly like starting from scratch – they’re not able to move anything,” says Ajami. “On top of building up their strength, some patients are weaning off of oxygen, so there are a number of demands to balance.”
To restore their mobility, physiotherapists gradually introduce a series of exercises, such as arm and leg movements, to eventually get patients sitting up and walking again.
“They explained to me where I was, how I got there, and what I needed to do to get my senses back,” Ibrahim says of the physiotherapists who provided her treatment.
“They helped me walk with a wheelchair behind me in case I got tired. They took care of me like their own family. They are angels.”
St. Joe’s physiotherapists play a vital role in helping patients regain their strength, mobility, and function.
"They’ve been in a fog and it’s scary for them”
Many patients have no recollection of the care they received while under sedation, which can add another layer of complexity to their recovery.
“They become anxious because they don’t know what’s happened to them, and why they can’t move,” says Laura Camposilvan, a physiotherapy assistant in the ICU.
“They’ve been in a fog and it’s scary for them. We try to encourage them that small gains are good, but everyone wants to go from zero to 60, and it takes time.”
Ibrahim, too, doesn’t remember anything of her time in a coma, including being transferred to another hospital for potential treatment to support the function of her heart and lungs.
“For three months, I didn’t know I was alive,” Ibrahim says. “When I woke up, I had to learn how to walk again and how to write. My vision was off, and I was coughing like crazy.”
Owing to the mental state of their patients, a physiotherapist’s role also involves comforting them as they progress through recovery.
“There’s a lot of navigating through their anxiety to try to get them moving,” Camposilvan adds.
“It’s about finding that fine line where they don’t get so anxious they can’t participate, while encouraging them to do a little bit more to get stronger each day.”
“No rhyme or reason to recovery”
Much like the varying impact of COVID-19 on a person’s health, the trajectory of a patient’s recovery can also be unpredictable.
“There’s no rhyme or reason to recovery,” says Ajami. “For one patient, one day it will all click and they’ll go the rehab route before transitioning home. For another in a similar condition, they recover at a slower pace and may require complex care.”
As a result, it can take some patients months before gaining the strength to start standing or walking. Even so, many will not regain the same level of function as before, and most will have long-standing limitations.
“People hear the majority of patients recover from COVID-19, but what does that mean?,” says Obrovac.
“They go home, but their lives are significantly different from before they had COVID-19. It has such a lasting impact on them.”
This holds true for Ibrahim. More than six months after being discharged from hospital, only now is she starting to enjoy some semblance of her life before the virus.
“I have to carry an oxygen tank but my life is getting back to normal,” she says. “I can go for walks, go shopping, and I’m driving now. But trust me, recovering from COVID-19 is not like getting over the flu.”