Therapy in the World of COVID-19: What Physical, Occupational & Speech Therapy CliniciansNeed to Know

April 17

Today’s Presenters

James Avery, MD, CMD, FAAHPM, FCCP, FACPMedical Advisor, Aegis Therapies

Martha Schram, PTPresident & CEO, Aegis Therapies

Hilary G. Forman, PT, RAC-CTChief Clinical Strategies Officer HealthPRO® Heritage

Mark Besch, PTChief Clinical Officer, Aegis Therapies

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Understand the clinical presentation of COVID-19

Understand how to protect yourself

Perform a comprehensive assessment for COVID-19 patients

Monitor vital signs to provide safe interventions

Understand clinical best practice interventions

Identify signs of worsened medical condition

Identify & access COVID-19 resources

Learn self-care strategies

Objectives

COVID-19 Background

Coronaviruses: • A large family of viruses• Common in humans & animals

(e.g.: camels, cattle, cats, mice, bats)

Most known coronaviruses cause mild conditions, as with common cold & conjunctivitis

WHO classified the COVID-19 outbreak as a pandemic on March 11

RE: The pandemic designation:• Does not refer to the severity or deadliness of the disease. • Is not necessarily more / less of a killer than a disease that has not• Is more about how widespread a disease has become.

COVID-19 Background

About the Disease / Spread by Air Droplets

• As a respiratory virus, the coronavirus spreads in air droplets when someone coughs or sneezes.

• That means people within 6 feet of an infected person would be the most likely to get sick—when those viral particles land on a mucous membrane, like your eye, nose or mouth.

• Such viruses can also spread when people touch a surface contaminated with infectious droplets, then touch their own nose, mouth, or eyes

COVID-19 Background

COVID-19 Background

About the Disease / Spread by Touch

• Lab research suggests: COVID-19 remains airborne for 2–3 hours & can remain viable on surfaces• Plastic and Stainless Steel: 72 hours• Cardboard: 24 hours • Copper: 4 hours

• At 72 hours on plastic & steel and 24 hours on cardboard: • Less than 0.1% of the starting virus material remains• That is 1of 1,000 virus particles

• NOTE: It is important to separate Lab research from Clinical

• Infection is theoretically possible but extremely unlikely at the levels remaining after a few days. The same numbers hold for other surfaces.

COVID-19 Background

Prolonged Close Contact / Definition

• Living in same household as a sick person with COVID-19

• Caring for a person with COVID-19 unprotected

• Being within 6 feet of a infected person for more than a few minutes (10 – 15 minutes)

• Being in direct contact with secretions from an infected person (being coughed or sneezed on, kissing, sharing utensils)

COVID-19 Background

About the Disease / Incubation Period & Infectivity

• Incubation period = time from exposure to first symptoms• COVID-19 median incubation period = 3.96 days (2 - 14 days)• Influenza median incubation period = 2 days (1-4 days)

Why is this important?• People can be contagious during incubation period, even those who

are asymptomatic. Current thinking: people may be contagious 24-48 hours prior to symptom onset

• CDC is still recommending a 14-day self-quarantine for those exposed to the virus

• This explains the challenge in keeping virus out of our facilities + limitations with temperature screenings

COVID-19 Background

About the Disease /Symptoms

COVID-19 typically causes fever, cough, dyspnea & chest pressure

• Vast majority of cases are VERY mild • Some cases turn into viral pneumonia• Very small portion of cases are severe

The most detailed breakdown of symptoms from a recent WHO analysis of 55,000+ confirmed cases in China. Most common symptoms + percentage of people who had them:

• Fever: 88%• Dry cough: 68%• Fatigue: 38%• Coughing up sputum: 33%• Shortness of breath: 19%

COVID-19 Background

About the Disease / Symptoms

These COVID-19 symptoms cause primarily a lower respiratory tract infection; most symptoms are felt in chest & lungs.

This is different from colds & seasonal allergies that mainly affect upper respiratory tract infection: • Runny nose• Sinus congestion • Sore throat

COVID-19 Background

About the Disease / Severity

• 81-90% (4 out of 5) of patients infected with COVID-19, experience mild-to-moderate symptoms & these folks will completely recover without ever seeing a physician

• 14% (1 in 7) have moderate to severe Sx

• 5% (1 in 20) are critical

COVID-19 Background

Here is the Challenge:

• This is a widespread contagious disease

• People who are infected & contagious may feel okay or only a bit ill (2° long incubation period & predominance of mild disease)

• Elderly, frail, and end-of-life patients are very, very vulnerable

COVID-19 Essential Workers

But They Must:• Pre-Screen: Temp check & symptom screen daily• Self-monitor for fever & symptoms• Wear facemask x 14 days after exposure• Social distance• Disinfect & clean work spaces• Stop working if symptoms develop – even mild ones

– consistent with COVID-19

YOU ARE ESSENTIAL!Rehabilitation is often necessary after the acute

stage

Revised Guidance from the CDC (As of April 8) Critical infrastructure workers (incl healthcare) may continue to work following potential exposure to COVID-19, provided they remain asymptomatic & additional precautions are implemented to protect them & the community.

COVID-19 Infection Control

• Created during coughing, sneezing & talkingTransmitted via respiratory droplets

• Used to prevent transmission of COVID-19 for known & suspected casesDroplet Precautions

• Limits exposure & reduces PPE needDedicated COVID therapy team

• Keep 6 feet away when possible• Read Social Distancing Guidelines at WorkSocial Distancing

• Follow updates based on CDC recommendationsUse PPE appropriately

• Option 1: Keep equipment in room with patients• Option 2: Clean all equipment

Contain or Clean Equipment

PPE TipsFollow the most up-to-date

Aegis/HealthPRO Heritage guidance + facility P&P based on

current CDC recommendations

• Follow facility & organization policies• Perform Hand Hygiene before &

after PPE • PPE is donned outside of room

or home• Consider tips for preserving masks

Use 2-ply masks (surgical mask with a “handmade” cloth mask or face shield)

• Remember eye protection when needed

• Wear scrubs & change clothes/shoes before leaving work

Policies & Procedures to Protect You!

Facility

Attend facility COVID-19 education

Know & follow facility P&P’s• Infection control• Respiratory and cough etiquette• Hand Hygiene & PPE• Transmission based precautions• Emergency preparedness• Equipment cleaning

Know where to get supplies

Know what to do if the facility runs out of PPE

Aegis & HealthPRO Heritage

Keep current with updates related to:

• Handwashing• Social distancing• PPE recommendations• Updated P&P

Therapy guidelines• Double Masking – the Patient

and You. If one mask is available, it should be on the Patient

• Eye Protection• Gowns and Gloves – for

procedures likely to cause coughing or droplets

Timeline for COVID-19

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Therapy in the COVID-19 World

The changing therapy treatment environment:• No group or concurrent therapy

• Many therapy gyms closed or reorganized

• Social distancing for patients & coworkers

• Plans of care & goal development are impacted

• Virtual supervisory visits for assistants

This is now a new opportunity for us to do what we do best:

Innovate & Re-Invent !

Therapy in the COVID-19 World

As a result of social distancing & stay-at-home orders: Patients may experience a deterioration of conditions unrelated to COVID-19.

Unable to leave their rooms or homes for several weeks/months, patients may become more sedentary, lose mobility & function and/or require physical therapy services when restrictions are lifted.

Consider the current situation: • Walking to meals is less common; dining areas are closed• Group activities are restricted or eliminated • Visitor restrictions result in increased isolation

COVID-19 Patient Identification

To identify proper PPE &

treatment approaches,

we must identify:

•Patients with positive & suspected COVID-19 cases•Both require the same PPE

•Patients with active COVID symptoms: fever, desaturation, dyspnea at rest •Require medical hold; need MD order to hold•Require MD clearance to resume

•Patients recovered from COVID•Ready for therapy!•This training will help you understand how to

safely & effectively manage these patients

How do you ID suspected COVID-19?

•Common symptoms are present: fever, dry cough, difficulty breathing, chest pressure & loss of smell/taste; Diarrhea & nausea may also be present.

•Known direct exposure to someone with + COVID. 21

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Assessment of COVID-19 Patients

Best Practices

• Ensure MD has cleared for services

• Check EMR to determine patient status:• On Hold • Specific therapy orders

Prior to Initiating Services

• Check EMR to determine patient status:• On Hold• New orders or

therapy orders

• Check with RN before each session

Prior to Each Session

Covid-19 restrictions & precautions• Isolation Precautions• Universal Precautions• Room Quarantine

Supplemental Oxygen Parameters: can we wean?Breathing treatments and equipment

• Incentive spirometer• C-PAP• Nebulizer

Diet and Fluid restrictions

Daily weights

Medication review/common side effects & what to monitor

Familiarize Yourself with Patient Orders

Know the code status

of your patients!

You never know when an

emergency will arise

Prior to initiating theassessment you must know:

Vital Signs

Vital Signs MUST be at the center of

assessment & treatments

•Assessment of vital signs begins at the evaluation

•Assess: Before, During, and After activity

Key Vital Signs•Heart rate •Blood pressure•Lung assessment: listen to

lung sounds and RR•SPO2•Borg Scale of Perceived

Exertion

Reassess Often•Changes can occur often•You must assess vital signs

throughout each session•Assess: Before, During,

and After activity

Physical Therapy Occupational Therapy Speech-Language PathologyBreathing Exercises Medication Management Cognition

Functional exercise & balance sit-to-stand, mini-squats

step-ups /downs

ADLs daily: showering/bathing, BADLs, laundry, making the bed,

meal/snack prep

Communication-voice problems from vent/ trach

Safety strategies & training Activity tolerance/stamina Swallowing

Cardiopulmonary endurance Energy conservation & work simplification Medication management

Functional mobility Adaptive techniques & devices Safety strategies

Fall Recovery strategies Applied cognition/addressing psychosocial needs

Health Literacy education Safety training

Oxygen management & titration Health literacy education Oxygen management

Functional Treatment Overview

26Assess & Re-assess vitals signs throughout tx!

Addressing Pulmonary Symptoms

thin ALL assessment and treatment

COVID-19 can cause a range of breathing

problems, from mild to critical.

Addressing impact of COVID-19 pulmonary symptoms MUST be

incorporated within ALL assessment and

treatments provided

Understanding Pulmonary Impact of COVID-19

• 80% of cases are mild & have a dry cough or sore throat • Some have pneumonia, causing the alveoli to become

inflamed • Seen on CXR or CT scan

Mild/Mod

•14% of cases are severe; more swelling, lungs fill with fluid/debris•Pneumonia is more severe- alveoli fill with mucus/fluid/other cells •Difficulty with O2 exchange; causing dyspnea SOB, or rapid

breathing•CT scan will show opaque spots in the lungs, may be numerous

Severe

•5% of cases, causes damage to alveoli due to inflammation•Result: difficulty exchanging oxygen & carbon dioxide

•Severe pneumonia•Acute respiratory distress syndrome possible, may require

ventilation•Symptoms include rapid breathing, dizziness, rapid heart rate

Critical

Post Intensive Care Syndrome (PICS)

Physical impairment

Can Include

Weakness

Cognitive Impairment

Can Include

Memory, Attention &

Mental Processing

deficits

Psychosocial Impairment

Can include

Depression & Anxiety

Must assess these key areas both when assessing & treating a resident

PICS is a phenomenon called associated with long

ICU stays

It covers a range of symptoms that falls

under 3 broad categories:

Goals & Treatment Overview

Improve respiratory capacity

Stabilize vitals including HR, RR & SPO2Increase cardiopulmonary function

Improve safety

Improve Independence & Functional capacity

Improve patients understanding of disease process & risks

TreatmentIncrease lung capacity

Oxygen assessment

Pain management

Functional task training

Assess for signs of exacerbation

Deep breathing & capacity training

Caregiver training & education

Goals

Breathing Exercises

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Incentive Spirometer training & use as a HEP

Respiratory muscle manual resistive exercises• Can use Thera band for self resistive exercises

Equal ratio breathing: patient takes the same amount of time to inhale & exhale

• Should feel comfortable & not stressful• Example: inhale for 4 counts, exhale for 4 counts

Prolonged inhale: patient performs very long inhale & short exhale• Should feel conformable & invigorating• Example: inhale for 6 counts, exhale for 3 counts

Prolonged exhale: patient performed short inhale & a very long exhale

• Should feel easy & cooling• Example: inhale for 3 counts, exhale for 8 counts

Variations for pursed lip or

diaphragmatic breathing

Chest Physiotherapy

Other airway clearance localized techniques:

ONLY for those physical therapists who

have the skill & have been trained, or if RT is available

Techniques :chest percussions

& postural drainage

Monitor for Cardiorespiratory Capacity

Look

For breathing patterns, diaphragmatic breathing edema, weight gain, or

jugular distention

Swollen legs after therapy could be sign of activity

intolerance

Listen

For breath sounds: crackles/ rales to lungs

before and after treatment or

communicate with RN

Feel

For increase in peripheral edema 2-3 hours after treatment,

sign of activity intolerance if present

Strictly monitor HR, BP, SOB, peripheral edema

ADL &IADL’s

Medication Management

Compensatory Strategies

Health Literacy

Must complete comprehensive ADL assessment,

including: feeding, bathing, dressing, hygiene,

toileting

Ensure understanding of both new/old meds

common side effects

Assess overall activity tolerance:

sitting & standing;provide work

simplification techs

Assess overall understanding of

disease management & needed health

literacy

Car transfers, simple meal prep &

homemaking tasks

Must include how to manage O2, &

other breathing devices (e.g. CPAP)

Early identification of AE

Understanding precautions & self monitoring of vitals

Standardized Tests : Modified Barthel Index, Barthel Index & Modified Physical Performance Test

ADL/IADL

Swallowing/Communication

Communication Issues

Phonation issues

Ability to express

needs/wants

OT completes screen of

swallowing needs

Management of foods & secretions

Breath –Swallow

Coordination

ST completes in-depth

swallow eval

Impact Lung Inflammation

has on swallowing

Residual effects of being on

vent/trach

High Risk SLP Treatments

Dysphagia care/ treatments may include, but not limited to:Non-instrumental swallowing assessment:

• Structural & functional assessment of oral mechanism,

• Testing oral reflexes (e.g., gag & cough reflexes)

• Clinical (bedside) administration of different diet & liquid consistencies

Instrumental assessment of swallowing:• Fiberoptic endoscopic evaluation of

swallowing (FEES)—with or without sensory testing

• Video fluoroscopic swallowing study (VFSS), among others

Dysphagia treatment:

• Rehabilitative & compensatory approaches 36

High risk ST treatments may include, but not limited to:• Instrumental assessment of voice via

endoscopy; with or without stroboscopy

• Assessment & management of laryngectomy, including voice restoration using voice prosthesis & stoma care

• Assessment treatment of tracheostomies, with or without mechanical ventilation, including suctioning

• Non-invasive ventilation such as high-flow nasal oxygen (HFNO) & nasal cannulae

https://www.asha.org/Practice-Portal/Clinical-Topics/Head-and-Neck-Cancer/https://www.asha.org/Practice-Portal/Professional-Issues/Tracheostomy-and-Ventilator-Dependence/

High Risk SLP Treatments

Our Recommendations:If -- in your clinical judgement -- a treatment will be high risk & potentially cause coughing or other AGP:• Use PPE for droplet precautions:

• Mask• Face shield/eye wear• Gown• Gloves

• Do not sit directly in front of the patient

• Choose/modify treatment environment for the safety of patient, you, others that may be in the room even at a social distance

Improving Function

Balance & Fall Risk:Berg Balance

TinettiTUG

Strength:Focus on assessing

accessory muscles for breathing

Respiratory Capacity:Deep Breathing Techs

Respiratory MuscleRetraining

Activity Tolerance:BORG scale of

Perceived ExertionPhysical Performance Test

2/6 Minute Walk Test

Gait Quality:Dynamic Gait Index

Gait Speed

Pain:VAS

Wong BakerFACES

Pain-AD

Additional Impairments:Skin Integrity

SensationVisual spatial

Therapy in the COVID-19 World

Impact of isolation on cognition & behaviors:

• Isolation, quarantine or social distancing place residents at higher risk for decline

• Indicators• Worsening or new physical symptoms• New onset or worsening of nightmares, irrational

thoughts, irritability• New on set or changes in weight, appetite• Sleep disturbances• Increase or new behaviors in those with dementia or

mental health issues• Less interest in self care, grooming

Stop Treatment

Reassessment is Crucial During Treatment

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• Chest pain• Severe SOB• BP drops > 20 mmHg• Pulse >140 bpm• BP > 200/110• O2 sats 28 or

Communicate the following: • Dyspnea -difficulty breathing• Abnormal lung sounds• Rapid or irregular heart rate• Increased fatigue, weakness• Swelling in the legs and/or abdomen• Rapid weight gain• Cyanosis- bluish color of lips and skin• Reduced exercise/ activity tolerance• Syncope or c/o dizziness• Lack of appetite, nausea• Chest pain

Signs of Worsening

Clinical Skills Needed for Treatment

• Plan treatment & equipment needs in advance of arriving in patient’s room

• Ability to accurately take & interpret vitals

• Ability to assess lung sounds

• Ability to monitor signs & symptoms of exacerbation

• Utilize Borg Scale of Perceived Exertion

• Select appropriate Standardized Test & interpret data

• Ability to teach Health Literacy

Limit number of therapists on

COVID unit:

Identify dedicated

COVID Team of therapists

Identify the discipline that has the most

critical need & initiate

treatment by the

appropriate discipline

When multiple disciplines are

needed, spread

frequency over 7 days;

may not be every discipline

each day

Treat COVID patients at beginning or

end of shift

Intensity at the level that will result in the

most effective & efficient

clinical outcome

Patient Scheduling

Health Literacy Considerations

Disease Management

Infection Prevention

Pneumonia

Handwashing Hygiene

Energy Conservation

Vital Signs

Skin care

Training for Transitioning Home

Limit Contact at Home

Only 1 person should provide

care

Do not share personal items

(toiletries, towels, linens, utensils)

Use separate bathrooms if possible

Protect Yourself

If you are “high risk”:

find someone else to provide care

if possible

Wash hands frequently:

at least 20 sec.

Use PPE appropriately

when available

Clean Environment

Disinfect all surfaces often

Wash all laundry in hot water

Clean “high touched surfaces”

(electronics, surfaces,

doorknobs, etc.)with hand sanitizer

≥70% alcohol

PPE

Change gloves after each task

Masks can be reused but should

be discarded if soiled / damaged

Homemade masks are

acceptable;launder & sanitize

if soiled

Caregiver Education: Key Issues to Support Transition Home

Follow health literacy & disease management

Recognize possibility of decreased lung capacity for weeks or months (up to 20-30%)• Take measures to avoid complications such as PNA• Avoid lying in bed/ maintaining an upright position for

extended periods of time to keep airways clear Monitor vital signs daily & report any changes to your MD

Perform breathing exercises multiple times/day

Have patient participate in daily ADLs to maintain & improve functional status

Monitor vital signs daily & report changes to MD

Caregiver Education: Key Issues to Support Transition Home

Utilize technology such as video chat to ensure caregiver stays connected

• Perform virtual home assessment to ensure safe discharge to next level of care

• Get Up and Get Connected

Involve caregiver in education & treatment sessions to ensure carryover

• Can be done virtually (documentation needs to reflect method)

• Must assess caregiver’s capacity and competency during comprehensive evaluation

Remember to focus on function and education• Use teach-back method to ensure competency• Document all education provided

The Future for Students

Clinical education will always remain important!

Overall, at this time, volume of personnel entering facilities is limited – more so in some institutions than others

• Does not reflect a change in commitment

We will achieve a new normal; just as in many aspects of healthcare & life, in general

Creative thinking will be important• e.g.: Perhaps incorporate telecommunications

48

Therapy is essential to the well-being, care & recovery of our patients.

Therapy is not an optional service.

There often is a window of opportunity for improvement –especially for seniors.

If that window is missed (e.g.: muscle strength, function, flexibility), it may be difficult to regain/maintain improvements

Therapy is Essential

I. You reduce or eliminate pain

II. You help people avoid surgery

III. You help people do better if they need surgery

IV. You improve mobility

V. You help people recover from strokes and heart attacks

VI. You help people eat effectively and safely

VII. You help people recover from injuries

VIII. You help people prevent injuries

IX. You improve balance and prevent falls

X. You help people age better

XI. You help people manage heart and lung diseases

XII. You keep people out of the hospital

Therapy is Essential

51Langeh, Monika [@drmonika_langeh]. (2020, March 29).What You Choose? [Twitter moment]. Retrieved from https://twitter.com/drmonika_langeh/status/1244472906685353989

https://nam03.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2Fdrmonika_langeh%2Fstatus%2F1244472906685353989&data=02%7C01%7Ckathryn.abrahamson%40aegistherapies.com%7C54c16e6ac05540bd284408d7e22d8577%7C9e3f9d04719d4c68ab2a5c080ff5ccf2%7C0%7C0%7C637226559120688266&sdata=RudDnIlXvp5BVrnEypB0nw2JyY5QLGTg6lVbaXQtfUg%3D&reserved=0

Be your own advocate

Stay informed – but not

compulsively

Check-in & stay

connected with others

Maintain routines as best as you

can

Practice self care &

calming techniques

Exercise & keep active

Get outdoors – Fresh air

helps

Focus on the things you

CAN control

Meditate for the

health of It –time to unwind

Employee Stress

Management Resources

Self-Care is Critical!

From Cleveland Clinic:https://www.bravowell.com/clevelandclinic/covid-19?utm_source=hs_email&utm_medium=email&utm_content=85180895&_hsenc=p2ANqtz-9DBNgexAJHx0Eh-Qr4v4BR6FKdAYjtiNdyIrHADgxKHjlck1nLmWAe5SQjV8jc6Jyxp5yYqSfOBaXi5ghctYPXIs_1Xtz5hSs9a17L4ReZCtk5OiU&_hsmi=85180895

https://aegistherapies.com/blog/wellness-wednesday-guided-imagery/

https://aegistherapies.com/blog/wellness-wednesday-hump-day-stretches/

Resources & Caring for Yourself

https://www.bravowell.com/clevelandclinic/covid-19?utm_source=hs_email&utm_medium=email&utm_content=85180895&_hsenc=p2ANqtz-9DBNgexAJHx0Eh-Qr4v4BR6FKdAYjtiNdyIrHADgxKHjlck1nLmWAe5SQjV8jc6Jyxp5yYqSfOBaXi5ghctYPXIs_1Xtz5hSs9a17L4ReZCtk5OiU&_hsmi=85180895https://aegistherapies.com/blog/wellness-wednesday-guided-imagery/https://aegistherapies.com/blog/wellness-wednesday-hump-day-stretches/

https://www.cdc.gov/coronavirus

https://aegistherapies.com/categories/covid-19/

http://www.healthpro-heritage.com/covid-19

http://www.apta.org/Coronavirus/

https://www.aota.org/Practice/Health-Wellness/COVID19.aspx

https://www.asha.org/About/Coronavirus-Updates/

https://www.ahcancal.org/facility_operations/disaster_planning/Documents/Therapy-Personnel-Guidance-COVID19.pdf

https://www.sralab.org/sites/default/files/2018-04/Rating_of_perceived_exertion_-_Borg_scale.pdf

Resources & Information

https://www.cdc.gov/coronavirushttps://aegistherapies.com/categories/covid-19/http://www.healthpro-heritage.com/covid-19http://www.apta.org/Coronavirus/https://www.aota.org/Practice/Health-Wellness/COVID19.aspxhttps://www.asha.org/About/Coronavirus-Updates/https://www.ahcancal.org/facility_operations/disaster_planning/Documents/Therapy-Personnel-Guidance-COVID19.pdfhttps://www.sralab.org/sites/default/files/2018-04/Rating_of_perceived_exertion_-_Borg_scale.pdf

Frequently Asked

Questions

55

Let’s Review

Thank You for Attending!

56

For over 20 years, Aegis Therapies has been anationally recognized leader in rehabilitationand wellness services. Aegis offers a fullcontinuum of services, in skilled nursingfacilities, assisted living facilities, independentliving facilities and continuing care retirementcommunities across 36 states. Aegis alsooffers additional products and services withinthe hospital, hospice, home health, outpatientand medically oriented gym sectors.Regardless of setting, professionals at Aegisstrive to fulfill the mission of the company:Health and Wellness Solutions for Life andsupport individuals and families in theirhealthcare goals.

https://aegistherapies.com/categories/covid-19 http://www.healthpro-heritage.com/covid-19

HealthPRO® Heritage is a national providerof Consulting & Therapy Managementservices. Currently operating in 43+ states,Deep experience in care redesign, clinicalreimbursement and cross-continuumprogramming enables HPH to supportclients with critical marketplace intelligence,innovative clinical solutions and outcomesthat drive value and inform strategicdecisions. Three separate service sectors --Clinical Strategies Division, Senior LivingDivision, and Home Health Division --compliment the core Therapy ManagementServices, and effectively address marketopportunities & shape care on multiplelevels.

https://aegistherapies.com/categories/covid-19/http://www.healthpro-heritage.com/covid-19

Aegis Therapies welcomes all persons in need of its services and does not discriminate on the basis of age, disability, race, color, national origin, ancestry, religion, gender identity, sexual orientation or source of payment. Aegis Therapies and HealthPro Heritage are separate companies.

Therapy in the World of COVID-19: What Physical, Occupational �& Speech Therapy Clinicians�Need to Know��April 17Today’s PresentersObjectivesCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 BackgroundCOVID-19 Essential WorkersCOVID-19 Infection ControlPPE TipsPolicies & Procedures to Protect You!Timeline for COVID-19Therapy in the COVID-19 World Therapy in the COVID-19 World COVID-19 Patient IdentificationSlide Number 22Best PracticesFamiliarize Yourself with Patient OrdersVital SignsFunctional Treatment OverviewAddressing Pulmonary Symptoms Understanding Pulmonary Impact of COVID-19Post Intensive Care Syndrome (PICS)Goals & Treatment OverviewBreathing ExercisesChest Physiotherapy Monitor for Cardiorespiratory CapacityADL/IADLSwallowing/CommunicationHigh Risk SLP TreatmentsHigh Risk SLP TreatmentsImproving FunctionTherapy in the COVID-19 World Reassessment is Crucial During TreatmentSigns of WorseningClinical Skills Needed for TreatmentPatient SchedulingHealth Literacy Considerations Training for Transitioning HomeCaregiver Education: Key Issues to Support Transition HomeCaregiver Education: Key Issues to Support Transition HomeThe Future for StudentsTherapy is EssentialTherapy is EssentialSlide Number 51Self-Care is Critical!Resources & Caring for YourselfResources & InformationSlide Number 55Thank You for Attending!Slide Number 57