Covid rehabilitation: Occupational Therapy
Watch this video for advice on how to pace yourself and manage any mental effects of COVID-19.
As you recover from COVID you might be experiencing symptoms such as fatigue and breathlessness or changes in your mood and thinking. These symptoms are common after a serious illness, especially if you have received hospital treatment. You might find that these symptoms affect your ability to complete everyday activities, such as getting washed and dressed, and doing tasks around the home. Activities that are usually simple might seem like hard work, and you may feel that you have less energy than usual.
There are lots of simple things you can do to help yourself. Getting enough sleep and making sure you eat well will both help. It is important to conserve your energy when you are completing your everyday tasks to help make sure that you have enough energy throughout the day. Try following the 3 P’s Principle – Pace, Plan and Prioritise – to conserve your energy when going about your daily activities.
- Spread activities out over the day by prioritising what needs to be done.
- Take frequent breaks to avoid an over activity/under activity cycle.
- Try not to talk and move at the same time.
- Give yourself time to recover your breath and conserve your energy for the task.
The impact of COVID on cognition
Many patients recovering from COVID are also experiencing cognitive problems. These symptoms are estimated to be present in up to a third of patients who have been hospitalised; but may also affect those that haven’t been hospitalised.
The brain is endlessly:
It is always active, yet, we don’t notice most of our brain’s activity as we move throughout our daily routine. Put simply, cognition is THINKING. Our brain acquires processes and uses information from our senses, knowledge and experiences. Cognitive impairment is one of the three most common persisting symptoms six months post COVID so it is important to be aware!
One aspect of being very unwell, particularly with an infection, can be the occurrence of delirium. If you have experienced delirium you may have:
- Been unsure about where you were or what you were doing there
- Had vivid dreams, which are often frightening and may carry on when you wake up
- Heard noises or voices when there was nothing or no one to cause them
- Seen people or things which were not there
- Been worried that other people are trying to harm you
- Feel very unsure about what was real and what was not.
- Had moods that change quickly. You can be frightened, anxious, depressed, or irritable
- Been more confused at some times than others
How to help
- Multisensory stimulation to promote alertness – touch, sound, smell, taste, visual stimuli to prevent sensory deprivation and maintain connection to the environment and others.
- Mobilise/keep active as early as safe to do so (with support/equipment if necessary). Moving in bed, sitting out, using your arms/hands, transfers, walking.
- Orientate to time, place and person use clocks/watches, calendar, newspapers. Photographs of family and familiar objects/environments, time with familiar people – family and friends.
- Take a person centered approach. Engage the person in everyday routines and activities that they usually do or enjoy to do (it may be just a small part of their usual routine) to promote functional independence.
- Listen to music, engage in art/writing/brain games & puzzles as able.
- Environmental modifications to promote better orientation – good lighting, labelling currently used places.
- Support a good sleep routine.
Commonly thought of as concentration. This can make it hard to focus and ignore distractions. So focusing on a task or conversation may be difficult. It may be hard to divide or alternate your attention between doing two or more things.
How to help
- Actively reduce distractions. Find a time and place that is quiet and ask others around you not to disturb you.
- Take regular breaks.
- Smaller tasks/break tasks down.
- Add in interesting tasks/tasks you want to do & enjoy.
- Engage in tasks/activities that challenge you to attend and focus and grade the time and complexity doing these tasks.
If your short term memory is affected, you may find it difficult to hold information in your mind in order to use it to make decisions based on that information. You may struggle to recall something that has happened, or forget to take medication on time.
How to help
- Use external aids to extend your memory. Note book/diary/phone/Apps. To keep a log or automatically remind you when you have to perform a task.
- Use phone camera to capture visual information to help you remember.
Executive functions are the mental processes that allow us to solve problems, make decisions, plan ahead, and see tasks through to completion.
People with executive functioning problems often seem disorganised, impulsive, and not thinking things through. They may find it difficult to get going on tasks, or start a task but not see it through.
How to help
- Plan for a task/the day/the week. (3 P’s; Pacing, Planning and prioritising).
- Grade and break tasks down, use a check list.
- Incorporate “stop and think” – to get yourself to self-monitor …are you on track?
- Be aware of the impairments you have and how they impact you and your daily life.
- Share the difficulties you are having with others and ask for /accept support
- Keep active and continue as far as possible with your usual daily activities/routines/roles (adapted to suit you).
- Use remedial activities to stimulate and challenge your cognition: cards, board games, brain training, word searches, cross words, Sudoku.
BE AWARE OF OTHER IMPACTS ON YOUR COGNITION… Fatigue, fear, stress, anxiety, low in mood and altered sleep patterns all take their toll on our ability to think clearly.
IF YOU ARE STILL HAVING ONGOING DIFFICULTIES WITH YOUR COGNITION CONTACT YOUR GP AND REQUEST A REFERRAL TO OCCUPATIONAL THERAPY OR PSYCHOLOGY.
What is fatigue?
We are all familiar with the feeling of fatigue after exercise or a long period of concentration. Sometimes, however, fatigue can be felt in a way that does not seem normal. Despite resting, and a good night’s sleep, fatigue occurs after minimal effort, is prolonged and limits your usual activity. It can leave people feeling dull and finding it difficult to concentrate and recall memories.
Fatigue is very common after viral infections, such as COVID and normally it settles after 2 or 3 weeks. However, in some people it can linger for weeks or months.
What causes post COVID fatigue?
There are many reasons why people feel fatigued after a COVID infection. These are:
- A continuing response to the COVID virus even though the infection has got better.
- The effect of a serious illness. Fatigue caused by pneumonia can take up to 6 months to resolve.
What makes post COVID fatigue last a long time?
In some people, different things contribute to the fatigue and make it last a long time. Low levels of physical activity, a disturbed daily routine, poor sleep patterns, demanding work, caring responsibilities, low mood, anxiety and stress can all make fatigue worse.
What can I do about fatigue?
Explain to your family, friends, and colleagues at work the impact the fatigue is having. Because fatigue is invisible, sometimes it is not properly understood. Until it is experienced it can be hard to understand the impact of fatigue and how debilitating it can be.
Fatigue feels much worse if your sleep pattern is also disturbed so try and get a good night’s sleep.
Relaxation techniques can help with fatigue as they promote a good sleep pattern, and can help reduce stress. Consider trying techniques such as mindful meditation, aromatherapy, yoga, tai chi, and other activities you find relaxing, such as reading or having a long shower or bath.
Plan each day in advance so that you can do what you need, and consider what can be delegated to other people. Build a regular routine, and try to avoid ‘boom and bust’ behaviour, where you are very active on ‘good’ days and then feel exhausted the following day. An activity diary can help with this.
You can also decide which activities that you are doing are most important to you. If this is a task which is very important, prioritise and do it when you have the most energy. If they are not important, but ‘have to be done’ can you delegate them?
Think about areas where you can save energy and delegate tasks, for example, online shopping rather than a trip to the supermarket, or cooking at the weekend for the week ahead when you are busy. Finally, make sure you are doing some things which are enjoyable, such activities can be energising.
For one or two weeks, keep a record of what you have done during the day and how you feel after each activity. Also note if you had a good day. Activities can be physical, social, cognitive (thinking), or emotional, and some can be more tiring than others. Diaries can help you spot unhelpful activity patterns, such as irregular sleep patterns and ‘boom and bust’ behaviours.
Energy levels are also helped by staying active. Being unfit makes you more tired. Once the amount of activity you are doing is stable, try to increase the amount you do slowly and gently.
A healthy diet can help.
When should I talk to my doctor?
Talk to your GP so they can rule out any other condition that could be causing your tiredness if;
- Your fatigue is getting worse rather than better.
- After 3 months your fatigue is unchanged.
- You are worried or have other new symptoms.
Emotional and Psychological Impact
Many people who have been seriously unwell (including their families or loved ones) can often experience symptoms of anxiety or depression. These symptoms may include:
- feeling restless or on edge, being irritable, feeling anxious or worried.
- flashbacks, nightmares, repetitive and distressing images or sensations.
- irritability, angry outbursts, feeling intolerant of others.
- continuous low mood or sadness, feeling tearful, feeling hopeless and helpless.
- having low self-esteem, feeling guilt-ridden.
- having no motivation or interest in things, not getting any enjoyment out of life.
- having suicidal thoughts or thoughts of harming yourself, feeling like you are not connected to your body, a feeling of dread or a fear of dying.
Feeling anxious or depressed also include physical symptoms (it is often difficult or impossible to decide if these symptoms have a physical or an emotional cause or a bit of both). Symptoms may include:
- a racing heartbeat, feeling faint, sweating, nausea, chest pain, dizziness, numbness or pins and needles.
- shortness of breath, a choking sensation, dry mouth.
- trembling, hot flushes, chills, shaky limbs, having tense muscles.
- a need to go to the toilet, a churning stomach.
- ringing in your ears, a tingling in your fingers.
- having difficulty getting to sleep or staying asleep.
- difficulty concentrating, finding it difficult to make decisions.
In many ways feeling anxious or low is a normal part of recovery from an illness but if you find the symptoms do not reduce, or if they cause you distress, or interfere with your ability to recover and get back to life, help is available.
Anxiety is something everyone will experience and feeling anxious is a very normal reaction to the illness you are overcoming. Sometimes feelings of anxiety can be overwhelming and can affect your daily life.
Anxiety can make you feel sweaty, shaky, short of breath and increase your heart rate. It can cause changes in our behaviour such as becoming overly careful or avoiding things that trigger feelings of anxiety.
Top tips to cope with anxiety:
- Understand your anxiety - try keeping a diary
- Make time for worries - set aside specific 'worry time'
- Face the things you want to avoid
- Challenge your anxious thoughts
- Shift your focus - try meditation
- Get to grips with the problems - use problem solving to help manage your worries
While regular exercise is important, you should also take some time to relax both your mind and body.
Stress and anxiety is not uncommon after illness, it can:
- increase both your heart rate and blood pressure
- interrupt your sleep
- cause low mood which may affect your ability to resume your normal day to day routines.
Guided imagery is a technique which involves mentally visualizing a place in your life that represents safety, comfort or happiness.
Places may include a garden, a beach or a house. You can practice some deep breathing exercise during this.
Your body has been through a lot so it is important you make time for yourself regularly. It does not take very much time and regular practice can dramatically reduce your stress levels. Some good examples of mindfulness can be found on ‘Every Mind Matters’ on YouTube, Headspace from the app store or Be Mindful is an online course.
Doing things that you enjoy is a great way to relax. This may include:
- Listening to music
- Reading a good book
- Sitting in the garden
- Drawing or doing something creative