COVID-19 Long Haulers Symposium: Solutions for Rehab Professionals

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Karen Pryor, PhD, PT, DPT, CH, CFPS Related seminars and products

Health Sphere Wellness Center

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Karen Pryor, PhD, PT, DPT, CH, CFPS, has a doctorate in physical therapy and has practiced for 40 years in the field. Dr. Pryor is the owner of Health Sphere Wellness Center, an integrative therapy clinic in Nashville, Tennessee. Involved with early intervention in the birth-three population for over 30 years, she has developed neuroplasticity techniques that are used in a wide variety of settings, including homes, childcare centers, and school systems, to advanced pediatric therapy programs.

Dr. Pryor serves on several boards, including the Leadership Interagency Council for Early Intervention (2014-2019), a position to which she was appointed by Tennessee Governor Bill Haslam. In 2010, she received the President's Volunteer Service Award for her contributions to the advanced treatment of children from President Barack Obama. In addition to her work with children, Dr. Pryor has served as an adjunct professor at the Tennessee State University Occupational Therapy Assistant program. She is a clinical instructor for several universities and colleges. With her years of experience and passion for complete wellness, Dr. Pryor advances a more expansive view of how to integrate therapy throughout the lifespan by using neuroplasticity techniques.

 

Speaker Disclosures:
Financial: Karen Pryor is the owner of Health Sphere Wellness Center, LLC and is a field examiner for PDMS-3. She has employment relationships with Tennessee State University, the University of Tennessee at Chattanooga Physical Therapy School, the Daymar Physical Therapy Assistant School and the Volunteer State Community College. She is a paid consultant for Evergreen Certifications. Karen Pryor receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Karen Pryor is a reviewer with Tennessee Physical Therapy Association and American Physical Therapy Association. She is an Ambassador for National Down Syndrome Society. She serves on the editorial board for APTA Journal.

Shelly Denes, PT, C/NDT, CFPS, CGCP Related seminars and products

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Shelly Denes, PT, C/NDT, CFPS, CGCP, is an expert in fall prevention and neuro-rehab with more than 30 years of experience treating patients with hemiplegia, neurological diseases, neuromuscular disorders, TBI, and SCI. She has a special interest in Long COVID, autoimmunity and the impact of chronic inflammation and sleep deprivation in rehab. She has been involved extensively with neuroprosthetic devices, lower extremity orthotics, and exoskeleton devices at the Rehab Institute of Michigan. Mrs. Denes travels nationally to present seminars on fall prevention, Long COVID and geriatric rehabilitation. Additionally, her expertise has been presented through expert witness work and consulting both nationally and locally. She also sits on the State of Michigan Fall Prevention Coalition committee. Shelly Denes is a graduate of University of Michigan’s PT program, and she earned her certification in Neurodevelopmental Treatment for Adult Hemiplegia (NDT) at the Rehab Institute of Chicago. She helped create the certifications for ‘Fall Prevention Specialist’ and ‘Geriatric Care Professional’ with Evergreen Certifications, holds these two certifications and sits on their advisory board.

 

Speaker Disclosures:
Financial: Michel Janet (Shelly) Denes is the owner of Denes Physical Therapy Consulting LLC. She is a consultant with Experts in Therapy LLC and previously with NewGait™. She receives a speaking honorarium from Motivations, Inc. Michel Janet (Shelly) Denes receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Michel Janet (Shelly) Denes is an advisory board member for Evergreen Certifications. She serves on the Fall Prevention Coalition Committee at Michigan Department of Health and Human Services.

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Objectives

1. Differentiate the clinical features of viruses, specifically SARS-CoV-2. 
2. Investigate the latest available treatments for the management of COVID-19, including the vaccines to prevent COVID-19 for the outpatient setting and individuals at home. 
3. Develop an understanding of what constitutes a COVID-19 ‘Long Hauler’. 
4. Construct an evidence-based toolkit for neurological, musculoskeletal and organ system challenges for outpatient symptom management. 
5. Justify the importance of sleep/rest in rehabilitation post SARS-CoV-2 infection. 
6. Assess for symptoms of the immune response in COVID-19 ‘Long Haulers’ and how to address these changes. 
7. Investigate the significance of the inflammatory response in COVID-19 and how to address these changes in patients.  
8. Differentiate cytokine storms and how it relates to multi-organ failure and coagulation. 
9. Investigate post-viral autonomic dysregulation and how to rewire with neuroplasticity techniques. 
10. Appraise, accommodate, and treat rehabilitation challenges such as brain fog with poor memory of home program, tachycardia, POTS, and immune system challenges. 
11. Analyze symptoms of autonomic system dysfunction including night sweats, temperature dysregulation, gastroparesis, and peripheral vasoconstriction. 
12. Appraise anxiety levels and discuss changes in the emotional environment of the COVID-19 patient.

Outline

1. SAR-Co-V2 and COVID-19
   1. SAR-CoV-2 VIRUS DEFINITION and DETAILS 
   2. COVID-19 DISEASE and ‘LONG HAULERS’ 
   3. The huge impact on the body’s: 
      1. AUTONOMIC NERVOUS SYSTEM 
      2. SYMPATHETIC NERVOUS SYSTEM 
      3. THE IMMUNE SYSTEM 
          
2. The COVID ‘Long Hauer’ 
   1. Pre-existing diseases and their impact on COVID-19  
      1. Hyperglycemia 
   2. History of Covid Symptoms 
   3. Exposure 
   4. Nutrition? High sugar, salt, things that feed virus 
       
3. Pathology of illness and course in hospital  
   1. ICU 
   2. Respirator 
   3. Feeding – IV, Feeding tube 
       
4. Comprehensive Evaluation with emphasis on the Neuro Screen 
   1. Neuro 
      1. Damage to CNS 
      2. Damage and Symptoms of ANS 
      3. Homeostasis? 
   2. CNS 
      1. Blood Brain Barrier 
      2. Stroke 
      3. Headaches 
      4. Tremors 
   3. Cranial nerves 
      1. Visual tracking 
      2. Hearing 
      3. Swallowing 
      4. Chewing 
      5. Vagus nerve 
      6. Tremors 
      7. Balance 
      8. Dizziness – Vertigo 
   4. Peripheral nerves 
      1. Numbness – peripheral neuropathy 
      2. Tingling 
      3. Weakness 
   5. Strength 
      1. Functional movements 
      2. Balance – sitting, standing, walking 
      3. Gait disturbances 
      4. Post exertional malaise 
      5. Reaction to heat 
      6. Myalgias 
   6. Pain 
      1. Location 
      2. Central 
      3. Peripheral 
   7. Brain fog 
      1. Extreme fatigue 
      2. Poor focus 
      3. Difficulty reading 
      4. Sleep disturbances 
          
5. Related Organ Systems 
   1. Psychology Related 
      1. Depression 
      2. Anxiety & Reducing Stressors 
      3. PTSD 
   2. Respiratory 
      1. Dyspnea 
      2. SOBOE 
      3. Chest pain 
      4. Cough 
      5. ‘Happy Hypoxia’ 
      6. Use of a Pulse Ox 
      7. Proning 
      8. Breath Control / Nasal Breathing 
   3. Cardiac 
      1. Chest Pain 
      2. Myocarditis 
      3. Palpitations 
      4. Evaluating HR (Apple Watch / EKG Monitor) 
   4. Vascular 
      1. The Inflammation Response 
      2. Coagulopathy 
   5. G-I Tract 
      1. Bowel and Bladder Issues 
      2. Sore Throat 
      3. Nausea 
      4. Non-inflammatory Foods 
   6. Liver, Kidney, Spleen, Pancreas 
       
6. Persistent Symptoms after the active Covid phase and what can we as health care providers do about it?  
   1. SOBOE 
   2. Nerve Pain 
   3. Myalgias 
   4. Nerve Pain 
   5. Anxiety 
   6. Extreme Fatigue and Post-Exertional Fatigue 
      1. AVOID EXHAUSTION AT ALL COSTS 
      2. ‘Energy Envelope’ 
   7. Brain Fog 
   8. Sleeping Disorders 
      1. Foundation on the importance of sleep 
      2. Healthy Circadian Rhythms  
      3. Recommendations with COVID-19 ‘Long Haulers’ 
          
7. POTS & Dysautonomia in Long Haulers 
   1. What it is  
   2. “Hitting the Wall” 
   3. How to deal with it 
   4. Scenarios for this continuum 
       
8.   Bouncing Back from COVID-19 as a ‘Long Hauler’ 
   1. Beginning Phase 
   2. Building Phase 
   3. Being Phase 
   4. Exercise Prescription 
   5. Recovery is slow and variable 
       
9. Ramifications of the New Variants 
   1. Delta 
   2. Omicron 
   3. The Future? 
       
10. Case Scenarios  
     
11. Key Takeaways 
    1. Proning 
    2. Enough Sleep and REST 
    3. Correcting Sleep-Wake Cycles 
    4. Hydration 
    5. Anti-inflammatory Diet 
    6. Lower Anxiety Levels / Mindfulness 
    7. Breath Control / Nasal Breathing / Multi-Dimensional Breathing 
    8. Compression Socks 
    9. Stay on the cool side 
    10. Avoid Fatigue

Target Audience

• Physical Therapists
• Physical Therapy Assistants
• Occupational Therapists
• Occupational Therapy Assistants
• Other Rehab Professionals