Research report: Rehabilitation of COVID-19 patients, a feasibility study
A recent feasibility study shows that the Motek HERO Solution can help to significantly decrease fatigue and dyspnea in COVID-19 patients, in just 12 weeks of a rehabilitation program.
The HERO Solution system combines Motek and Monitored Rehab Systems devices to offer dual-tasking using virtual reality. This incorporates motor and cognitive tasks which allows complete functional movement rehabilitation. The system consists of four devices: The C-Mill HERO with VR; the “MR Functional Squat”; the “MR Cable Column”; and the “MR Cube”.
All devices are connected through FysioRoadmap software to support treatment planning and data collection.
Many patients with COVID-19 infection experience periods of immobilization after Intensive Care Unit (ICU) admission. These patients have a severely reduced aerobic capacity and in general immobilisation at the ICU has been shown to cause what has been coined ICU Acquired Weakness, with associated muscle weakness, and cognitive and motor impairments stay. More surprisingly, it has recently become apparent that, also in mildly diseased and non-hospitalized patients, COVID-19 infection can cause long-lasting impairments of cardiorespiratory, neuromuscular and cognitive functioning. Common symptoms include dyspnea, muscle weakness, fatigue, and cognitive and attentional problems.
Most patients recover well from a mild COVID-19 infection, but some patients report lasting problems such as fatigue, ‘ brain fog’, difficulty to breathe, also described as ‘Long-Covid’, or post-acute sequelae of COVID19 syndrome (PACS). Estimates of patients with lasting complaints vary from approximately 30%, to 20% after 3 weeks and 10% after 3 months. In contrast to expectations, patients who have been admitted to the hospital seem to recover more rapidly than patients who suffered from a mild infection at home.
Given the poor health status and lasting symptoms after COVID-19 infection, rehabilitation should target cardiorespiratory function and muscle strength and endurance, but likely also motor control and cognition. Theory on training and (re-)learning of motor tasks suggests that training should start as early as possible, involve many repetitions, should be task-specific, have an adequate and incremental intensity and should make use of feedback.
Motek have developed a training program, for patients recovering from COVID-19 infection, based on published guidelines and these training principles. The training program is incorporated in their HERO Solution, which combines a treadmill and three Medical Training Therapy devices all using Virtual Reality applications. All devices are connected with the FysioRoadmap software which supports treatment planning and facilitates data collection. The program is performed under the supervision of a physiotherapist.
It uses treadmill walking as a task-specific training stimulus for mobility and to challenge the cardiovascular and respiratory systems. This is combined with virtual reality (VR) and gaming to provide an additional cognitive challenge. In addition, fitness devices are used to train upper and lower extremity muscle strength, motor control and proprioception. VR and gaming are again employed to provide feedback and to provide additional motor control and cognitive challenges, such as imposed changes in movement speed changes and movement excursions. Exercises are prescribed with incremental intensity, based on current performance, as supported by a protocol integrated in the software. This protocol prescribes standardised assessments, using the same equipment, to assess progress. In addition, continuous monitoring of oxygen saturation is supported, to adjust the intensity of exercise if needed.
The project reported here aimed to evaluate feasibility and usability of this targeted rehabilitation program for patients after COVID-19 infection. The program was implemented in a single physiotherapy practice and consecutive patients who consulted the practice for COVID-19 rehabilitation were invited to participate.