Exploring the Ability to Perform Activities of Daily Living and Cognitive Status after Hospitalization with COVID-19: A Multiple Case Study
Table 2
Case descriptions.
Case
Sex age
Civil status
Habitual illness
Habitual functional level
Adm diag
ICU DoA
Referral to OT Initial OT observations
Initial OT treatment goals
OT treatment plan and notes during admission
Days to discharge test
Iso
Focus of rehabilitation plans (OT and/or PT)
1
M 62
Cohabitating Early retirement
Cardiovascular disease
Mobilizing with a wheeled walker. General weakness, loss of appetite, weight loss. Assistance for medicine administration daily and with bathing every three days. Shower bench and raised toilet seat.
Intra cerebral hemorrhage
19 days
Yes. Swallowing assessment. Moderate dysphagia. Nasogastric tube. Able to hold a glass, but needs physical assistance getting it to the mouth for sips. Cognitive dysfunctions.
To be able to swallow mouth water safely. To be able to keep oral cavity clean from residue independently. To be able to eat texture modified foods and drink thickened liquids.
Reassessment of swallowing. ADL assessment. After 4 days, able to drink moderately thick liquids and eat pureed foods with physical assistance + supplementary nasogastric tube. Facilitation of participation in P-ADL (toothbrushing, washing the face, and lifting a glass to the mouth). Mobilized in a wheelchair and unable to walk. Rehabilitation plan
36
No
Inpatient rehabilitation unit in hospital. Hospital readmission. Initially discharge to own home, but then transferred to a nursing home.
Multidisciplinary neurorehabilitation
2
M 40
Cohabitating Employed full time
None
Independent in all ADL, including work.
COVID-19
43 days
Yes. Swallowing assessment. Able to drink thin liquids and eat pureed foods. Physical assistance in getting food and drink to the mouth, due to lack of strength and coordination of both arms. Difficulty following verbal commands.
To be able to eat minced and moist foods independently.
ADL assessment. Able to brush teeth and dress upper body independently but exhausted by completion. Mobilized in a wheelchair and unable to walk. Rehabilitation plan.
56
No
Inpatient rehabilitation unit in community. Home with outpatient rehabilitation.
Independence in P-ADL and I-ADL. Return to work. Endurance, strength, and manipulation. Swallowing assessment.
3
M 76
Cohabitating Retired
Obesity Cardiovascular lung disease Arthritis
Mobilizing independently in wheelchair. Able to walk short distances with walking frame. Independent in transfers. Independent in some P-ADL, e.g., upper body dressing. Help for I-ADL. Dyspnoea during activity performance. Assistance for medicine dispensing.
Reposition of total knee arthroplasty (TKA)
24 days
Yes. Swallowing assessment. Able to drink small amounts of mildly thick liquids, needing help lifting the cup to the mouth and intermittent verbal prompting to initiate swallow.
To be able to eat pureed foods within seven days. To be able to drink thin liquids within fourteen days.
Reassessments of swallowing. After 6 days, able to drink thin liquids and eat pureed foods, but still being very tired and needing breaks to catch his breath during meals.
77
Yes
Inpatient rehabilitation unit in hospital. Inpatient rehabilitation unit in community.
ADL Transfer methods. Trunk stability. Lower limb exercise after TKA. Upper limb exercise.
4
F 44
Cohabitating Unemployed
Autoimmune disorders Endometriosis
Independent in all ADL, including recent work.
COVID-19
80 days
Yes. Swallowing assessment. Able to drink thin liquids and eat small amounts of minced foods, nasogastric tube. Assistance for positioning in bed. Able to get glass and spoon to her mouth, unable to dress and especially button. Fatigue.
To be able to button clothes. To be able to press down asthma inhaler.
ICU: Reassessment of swallowing. A week after, risk of aspiration, nasogastric tube. Assistance lifting glass and spoon to the mouth. Post-ICU: Re-assessment of swallowing. ADL assessment. Strengthening exercises for the hands. Encourage participation in P-ADL, combining rest with activity to avoid exhaustion. Rehabilitation plan.
95
Yes
Inpatient rehabilitation unit in hospital. Inpatient rehabilitation unit in community. Home with outpatient rehabilitation.
Independence and efficiency during ADL. Return to work. Walking, balance, energy conservation, endurance, strength, and dyspnoea. Pulmonary rehabilitation, including Coping at exhaustion.
5
M 60
Cohabitating Employed full time
Ulcerative colitis
Independent in all ADL, including work.
COVID-19
26 days
No
To be able to shower independently seated within three weeks. To be able to prepare a small meal within two months To be able to walk the dog within four months To be able to mow the lawn within six months To be able to vacuum the house with few breaks within eight months
Project tests. Rehabilitation plan.
39
No
Home with outpatient rehabilitation.
Return to work and complex ADL focusing on endurance, memory and concentration. Pulmonary rehabilitation focusing on endurance, dyspnoea and strength. Mental health and cognition. Energy conservation.
6
F 68
Cohabitating Retired
Hypertension
Independent in all ADL.
COVID-19
Nil
No
To be able to structure everyday life in order to go for walks and regain habitual activities.
Project tests. Rehabilitation plan.
7
Yes
Home with outpatient rehabilitation.
Principles of energy conservation in order to carry out ADL. Strength, pulmonary rehabilitation.
7
M 84
Coliving Retired
Cardiovascular and hematological diseases ataxia
Mobilizing with a wheeled walker. Assistance with showering once a week and support stockings daily. Assistance for I-ADL. Shower bench and raised toilet seat.
COVID-19
Nil
Yes. ADL assessment. Able to brush his teeth when assisted to sitting and with remedies within reach, needing help for most other ADL.
To be able to walk 5-10 meters with a wheeled walker and support of 1 person. To be able to put on a shirt independently within 10 days.
Project tests. Rehabilitation plan.
17
Yes
Inpatient rehabilitation unit in community.
Independence in P-ADL and mobilizing with wheeled walker. Endurance.
8
F 57
Cohabitating Employed full time
Hypertension Obesity
Independent in all ADL, including work.
COVID-19
10 days
Yes. Swallowing assessment. Able to drink thin liquids and eat minced foods, nasogastric tube.
To be able to eat normal foods. To be able to eat and drink sufficiently, not needing supplementary feeding. To be able to shower sitting, remedies within reach in 5 days.
Reassessment of swallowing. ADL assessment. After 6 days, able to eat and drink sufficiently and eat normal foods. Rehabilitation plan.
15
Yes
Home with outpatient rehabilitation. Hospital readmission.
Efficient and independent complex ADL focusing on motor ability skills and upper extremity. Walking. Strength, endurance, and dyspnoea.
9
M 87
Cohabitating Retired
Malignant melanoma
Mobilizing with a wheeled walker. Independent in P-ADL. Assistance with I-ADL.
COVID-19
Nil
Yes. Swallowing assessment. Weakness, dysphagia, low energy for chewing. Able to eat minced foods and drink mildly thick liquids. Assistance to complete all P-ADL.
To be able to drink thin liquids To be able to eat soft foods To be able to wash his face with a face cloth independently, within 7 days.
Reassessment of swallowing. ADL assessment. Facilitation of participation in P-ADL (eating, drinking, toothbrushing, and washing the face). Rehabilitation plan.
19
No
Local hospital. Inpatient rehabilitation unit in community. Death
Independence in P-ADL focusing on strength in upper extremity. Energy conservation and pulmonary rehabilitation. Sit–stand, coordination swallow, and breath.
10
F 79
Living alone Retired
None
Independent in all ADL, except heavy shopping.
COVID-19
10 days
Yes. Swallowing assessment. Aspiration of thin liquids and pain during swallowing. Pureed foods and moderately thick liquids + nasogastric tube.
To be able to drink mildly thickened liquids and soft foods within 7 days.
Reassessment of swallowing. After 4 days, able to drink thin liquids and eat soft foods. Rehabilitation plan.
20
Yes
Home with outpatient rehabilitation.
Complex ADL, like leisure activities, focusing on endurance, and process ability skills.
Mobilizing with a wheeled walker. Assistance for support stockings daily. Independent in all other P-ADL. Participate in some I-ADL like shopping.
COVID-19
Nil
No
To be able to shower independently as prehospitalization.
Project tests. Rehabilitation plan.
19
Yes
Home with outpatient rehabilitation.
ADL focusing on strength, manipulation, coordination of the upper extremity, energy conservation, and dyspnoea. Cognition focusing on visuospatial/executive domains and memory. Strength, endurance, balance, and walking. Sit-stand.
Adm diag: admission diagnosis; ICU: intensive care unit; DoA: days of admission; OT: occupational therapist. Days from admission to discharge test at Rigshospitalet. Iso: isolation at discharge test; PT: physiotherapist; rehabilitation plan: referral for further community rehabilitation; M: male; F: female; P-ADL: personal activities of daily living (e.g., washing, eating, and dressing); I-ADL: instrumental activities of daily living (e.g., work, cooking, and shopping).
