MANAJEMEN REHABILITASI

MEDIK PADA
PASIEN COVID & LONG COVID-19

Dr. Siti Chandra Widjanantie, SpKFR (K)

PENDAHULUAN
• Pandemi COVID-19 “belum usai”
• Berdampak pada Aktivitas sehari-
hari (sedentary)
• Berdampak secara utama pada
sistem pernapasan (respirasi)
PENDAHULUAN
• Batuk (kering  berdahak)
• Sesak  hipoksia, napas berat
• Lekas lelah ( fatigue )
• Fibrotic Lung  Post COVID-19
DAMPAK COVID-19 PADA RESPIRASI

• inflamasi saluran
pernapasan
• Inflamasi sistemik
 badai sitokin
COVID-19 TIMELINE
MEKANIKA
PERNAPASAN
 KALIBRASI POSTUR

• Gerak dinding dada saat bernapas

• Inspirasi (Tarik napas)
• Ekspirasi (Buang napas)
• Korelasi antar bagian tubuh
(thoracoabdominal)
• Efek dari postur tubuh

Thomas Meyer. Anatomi Train. Disitasi dari https://www.anatomytrains.com/

 https://www.who.int/news-room/fact-sheets/detail/rehabilitation

What is rehabilitation?
• Rehabilitation is defined as “a set of interventions designed to
optimize functioning and reduce disability in individuals with
health conditions in interaction with their environment”.  

What is “rehabilitation problems”?

• Rehabilitation problem = understanding “dysfunction, less
functioning”
• Regarding the function of multiorgan system
 REHABILITASI PARU (RESPIRASI)
PADA COVID-19
Chin J Tuberc Respir Dis, 2020:43

Bertujuan :  “promotive – preventive – kuratif – rehabilitative”

• Mempertahankan, meningkatkan kemampuan fungsional pasien
COVID-19, baik pada sistem respirasi maupun kebugaran pada
umumnya
• Mencegah seoptimal mungkin disfungsi respirasi (pernapasan) pasca
infeksi.
• Secara promotif rehabilitatif, menghimbau untuk menjaga fungsional
pernapasan sebelum terpapar sakit
 REHABILITASI MEDIK COVID-19
• Disfungsi Kardiorespirasi :
• Lelah • Teknik Konservasi Energi , Relaksasi,
• Batuk Latihan Kebugaran bertahap sesuai
kondisi
• Sesak • Latihan batuk efektif
• Dahak • Latihan mobilitas dinding dada

• Disfungsi Musculoskeletal:
• Nyeri sendi • Modalitas Rehabilitasi Medik
• Exercise untuk stretching keluhan terkait
• Nyeri otot • Koreksi postur

• Post ICU Syndrome

• = Disfungsi kardiorespirasi
• CIPNM (kelemahan neuromuscular)
• PTSD
MONITORING RESPIRASI

• Menilai kemampuan respirasi

• Secara:
• Mandiri
• Supervisi oleh tenaga medis
 tele-monitoring
 MONITORING SAAT REHABILITASI RESPIRASI

CHEST EXPANCY
(PENGEMBANGAN DADA) SINGLE BREATH COUNT TEST
 BREATH
COUNT TEST
(HITUNG
NAPAS)
 PRONE
(LUNG RECRUITMENT)
 PENGARUH POSISI PRONE TERHADAP FUNGSI PARU

Compliance paru

Rekruitmen paru

Bersihan jalan napas

Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med. 2018;6(19):384–384.
PENGARUH POSISI PRONE TERHADAP FUNGSI PARU
AWAKE PRONING (SADAR)
Proning in RSDCWAK
EDUKASI LATIHAN PERNAPASAN
SIMPLE BREATHING EXERCISE
SIMPLE BREATHING EXERCISE
 EFEK LONG COVID-19
Lopez-leon S, 2021, More Than 50 Long-term Effects Of COVID-19: A Systematic Scientific Reports 2021 11:1 (2021) 11(1) 1-12
Review And Meta-analysis. https://doi.org/10.1101/2021.01.27.21250617

• Dyspnoea
• Fatigue
• ADL limitation
• Persistent Cough
• Brain fog
• Athralgia
RESPIRATORY REHAB:
• Edukasi (materi video)
• Exercise (Aerobik, bertahap) 3-5x /minggu,
20-30menit/x, hindari kelelahan krn
overtraining
• Latihan penguatan strength bertahap
• Latihan keseimbangan
• Latihan Pernapasan : control breathing,
thoracal mobility, Latihan batuk efektif
• Latihan ADL
HOME PROGRAM (TELE-REHABILITASI)
TERDIRI:
• Latihan Kalibrasi Postur / Koreksi Postur
• Latihan Pernapasan (Tarik Napas, Pengembangan Dada)
• Latihan endurance (Latihan berjalan dan Latihan sepeda)
• Energi Konservasi dan Adaptasi untuk Aktivitas Sehari-hari

• MONITORING:
• Hitung Napas (Breath Count Test)
• Saturasi Oksigen
• Skala Sesak
Physical Meedicine & Rehabilitation Case Report in RSDCWAK
• Awasi skala sesak, hitung napas,
saturasi turun < 94%

• Perhatikan tanda vital (monitoring)

saat manuver prone!

• Perhatikan semua line yang ada

pada pasien

• Konfirmasi pada tim DPJP apakah

ada risiko perdarahan, dll
 Sci Rep. 2021 Dec 1;11(1):14042

• Dysautonomia is marked by the failure or

the increased of the sympathetic or
parasympathetic components activities in
the ANS.

• Dysautonomia shows numerous clinical

symptoms, such as fatigue, labile blood
pressure, orthostatic hypotension,
dysfunction in heart rate variability (HRV),
apparition of impotence, dysfunction of
bladder, and damages in bowel functions.

• Dysautonomia could be acute or chronic,

progressive but also reversible
 “post-COVID-19 condition, could become a significant global health burden”

Pathophysiological mechanisms still lacking.

no plausible hypotheses regarding the

underlying immunological and physiological
mechanisms of post-COVID condition
Post COVID-19 Condition and comorbidities
Hannah et al identified:
• 205 symptoms
• in 10 organ systems
• among patients with long
covid and comorbidities.
• 3762 respondents from 56
countries
• Most patients (91.6%) had
not been admitted to hospital
(self isolation)
• The most frequent symptoms
reported after 6 months were
fatigue, post-exertional
21% of patients were still experiencing severe symptoms after
malaise, and cognitive
six months
dysfunction
Two thirds required a reduced work schedule or were no longer
working owing to their illness
Journal of International Medical
Research 2020: 48(8) 1–10

it is necessary to formulate
rehabilitation program:
• to help them restore physical
and respiratory function
• to reduce anxiety and
depression
• particularly patients with
comorbidities
• and those who live alone or in
rural settings
• to restore a good quality of life.
TIPS UNTUK MELAKUKAN LATIHAN PERNAPASAN SECARA
RUTIN
REKOMENDASI ATS/ERS:
• 30-45 menit
• 2-3x seminggu
• Atau dosis kecil, setiap hari
• Reguler
• Habitual = engram = kebiasaan melakukan latihan
• “Compliance” pasien dalam menjalankan program rehabilitasi respirasi
Rehabilitation Approach After COVID
J Med Virol. 2022;94:2060–2066

• Diabetes Mellitus • Physiatrist (rehab doctor) assess

• Chronic Heart Disease
• History Heart Attack
• High Blood Pressure
• High Cholesterol
• History Stroke
• Autoimmune disease
• Asthma/reactive airway
• Chronic Lung dis
• Chronic kidney dis
• Cancer
• Depression
• Anxiety
• Pregnant
• Overweight/obese
the remain functional respiratory
capacity
• Tailoring rehabilitation program
• CPET
• Respiratory power meter
• Diaphragmatic Exercise
• Incentive Spirometry Training
• Air Stack or Breath Stacking Exercise
• Task Oriented Exercise for ADL
• Endurance & Strength Training
 KESIMPULAN
• Rehabilitasi Medik pada pasien COVID-19 dan Long COVID-19
disesuaikan dengan kemampuan fungsional yang dimiliki.

• Rencana program disusun secara individual diterapkan bertahap yang

berfokus pada :
• Pemulihan fungsi seoptimal mungkin
• Meminimalisir disabilitas
• Kembali aktif (return to activity in society)
• Meningkatkan kualitas hidup pasien pasca COVID-19

Polastri M, Nava S, Clini E, et al. COVID-19 and pulmonary rehabilitation: preparing for phase three.
Eur Respir J 2020; 55: 2001822 [https://doi.org/10.1183/13993003.01822-2020].
TERIMA KASIH