Issue link: https://www.massageandbodyworkdigital.com/i/1276187
C h e c k o u t A B M P 's P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 51 To make things even more complicated, hypoxia and inflammation can affect various parts of the brain to cause neuropsychiatric symptoms, including agitation, memory loss, altered mental state, loss of cognition, and other problems. These issues do not appear to be permanent, although many patients report ongoing struggles with concentration and the ability to focus long after the acute phase of the infection subsides. Implications for Massage Therapy Consult with clients' health-care providers (if they give permission) to establish what their risks are for stroke, encephalitis, or other CNS complications. Clients who have cerebral hypertension need to delay any impactful massage until this situation is resolved, although they may appreciate gentle, educated touch. If a client is in recovery from a stroke, we may be able to coordinate our work with their physical or occupational therapists for an enhanced recovery process. Any impairments in sensation and any other ongoing symptoms might require other accommodations. It isn't possible to anticipate every circumstance here, but this is where we can rely on pathology education to offer some suggestions and guidance. MENTAL AND MOOD CHALLENGES The stress of living under the long-term threat of pandemic has led to heightened levels of anxiety and depression in many people, and these conditions take a serious toll on quality of life. However, COVID-19 survivors—especially those who have had very severe infections that required hospitalization and ventilation— are vulnerable to mental and emotional challenges that don't affect others. Post-intensive care syndrome (PICS) is a frequent consequence of time spent in an intensive care unit for any reason. This condition involves physical, psychological, and cognitive effects of being in a high-stress environment, often while constrained and heavily sedated. Delirium, nightmares, and paranoia are common consequences, and these effects can persist for weeks or months after a patient is released from the ICU. People recovering from COVID-19 have some added vulnerability for PICS because the anxiety related to breathing problems can trigger a whole-body sympathetic reaction. Added to this are the stress of isolation, touch deprivation, separation from loved ones, fear of getting other people sick, and the many unknowns about what recovery looks like and what long-term consequences might be. Anxiety, depression, and posttraumatic stress disorder (PTSD) are also predictable issues for people who have been through COVID-19, as well as those who care for them. Implications for Massage Therapy Mood disorders in general tend to respond well to educated, welcomed, non-task- oriented touch. Special focus on breathing and promoting a sense of inner strength will be particularly helpful for COVID survivors who struggle with PICS and other emotional challenges. As with other situations, it is important to work for incremental changes and to check back frequently for any unexpected responses. OTHER POST-COVID ISSUES The list I've provided here focuses on the COVID complications that have been discussed in the medical literature, and that are likely to have the biggest impact on clinical decision making for massage therapists. However, other complications have been noted, both by the medical community and by the many hundreds of thousands of people who are in recovery. Some of these are also likely to influence massage therapy choices, which is why it is important to ask about any and all post-COVID health changes. These conditions might include: • Relapsing episodes of acute symptoms • Benign paroxysmal positional vertigo: a situation where the displacement of otoliths in the inner ear causes episodes of sudden-onset and potentially debilitating vertigo • Shingles: a resurgence of varicella zoster that is often seen at times of great stress and immune system overwhelm • Chronic fatigue syndrome/fibromyalgia syndrome: these may be flares of preexisting problems, or the beginning of a new pattern of pain, fatigue, and a host of other quality-of-life limiting symptoms (that fortunately often respond well to massage) • Autoimmune disease flares: people with rheumatoid arthritis, autoimmune vasculitis, and other autoimmune diseases report flares • Problems with blood glucose control and a risk of new-onset diabetes • Guillain-Barré syndrome, a peripheral nerve demyelinating disease that is usually temporary but can be very serious • Severe muscle wasting that goes beyond simple deconditioning • … and many more WHAT CAN WE DO? We have no history or tradition to pull from for our work with COVID-19 survivors. Massage therapists will have to return to basic principles of identifying potential risks, hoped-for benefits, and appropriate accommodations that will minimize risks To see more of Ruth Werner's COVID-19 materials, go to www.abmp.com/updates/blog-posts/helpful-covid- 19-and-pathology-resources-abmp-and-ruth-werner.