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 Table of Contents  
TECHNICAL NOTE
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 53-68

Patient and caregiver guide to managing COVID-19 patients at home


1 Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, NY, USA
2 Medical Student, Albert Einstein College of Medicine, Bronx, NY, USA
3 Department of Neurology; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

Date of Submission30-Mar-2020
Date of Acceptance30-Mar-2020
Date of Web Publication15-Apr-2020

Correspondence Address:
Dr. Anne Felicia Ambrose
Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, NY 10467
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisprm.jisprm_4_20

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  Abstract 


Since the beginning of 2020, COVID-19 infections have increased exponentially, overwhelming health-care services globally. Survivors of this infection have significant disabilities due to the debilitating weakness and compromised lung function. Unfortunately, rehabilitation services are scarce due to diversion of rehabilitation clinicians to emergency medical care. This manual aims to bridge this gap by providing a self-directed home care and graduated exercise program which does not require any special equipment. The exercises were carefully selected based on research by the authors on self-directed home exercises in frail, elderly patients.

Keywords: COVID-19, home exercises, self-directed exercises


How to cite this article:
Ambrose AF, Bartels MN, Verghese TC, Verghese J. Patient and caregiver guide to managing COVID-19 patients at home. J Int Soc Phys Rehabil Med 2020;3:53-68

How to cite this URL:
Ambrose AF, Bartels MN, Verghese TC, Verghese J. Patient and caregiver guide to managing COVID-19 patients at home. J Int Soc Phys Rehabil Med [serial online] 2020 [cited 2020 Jul 9];3:53-68. Available from: http://www.jisprm.org/text.asp?2020/3/2/53/282570




  What Is Covid-19? Top


SARS-CoV-2, the virus that causes COVID-19, is a new virus that is causing serious illness in many countries of the world. Most patients have fever, dry cough, muscle pain, and extreme weakness. In the majority of patients, symptoms last for 2–3 weeks and often resolve spontaneously. In some patients, COVID-19 can be a more serious illness causing pneumonia or affecting other organs and requiring hospitalization. Doctors and scientists are learning about this disease and the information given below is based on current knowledge.


  Symptoms of a Covid-19 Infection (Cdc.gov) Top


These symptoms may appear 2–14 days after exposure.

  • Fever
  • Cough
  • Shortness of breath
  • Loss of smell or taste.


If you develop emergency warning signs for COVID-19, get medical attention immediately.

Emergency warning signs[1],[2]

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face.


More information is available at: www.cdc.gov/coronavirus/2019.


  Caring for a Covid-19 patient at Home Top


These precautions should last until medical authorities clear the patient.

Monitoring the patient

  1. Check the patient's temperature twice a day
  2. Monitor for new symptoms such as chest pain, difficulty breathing, blue fingers or face, palpitations, changes in mental status, confusion, or swelling of legs. Contact your medical provider if any of these symptoms occur.


Isolation directions

  1. Isolate the affected person. They should be in a separate room. It is important to have good air circulation in the room. For example, air conditioning or keeping a window open
  2. The patient should avoid all contact with older people, pregnant women, or anyone with compromised immunity
  3. The patient should always wear a mask (see instructions below) and keep at least six feet away if the caregiver has to come into the room. Keep these interactions as brief as possible
  4. If possible, the patient should have a separate bathroom. If this is not possible, all other unaffected family members should use caution when using shared facilities. Use diluted bleach to wipe down the door handles, toilet seat and handles, sinks, etc., each time the patient uses the bathroom. The patient should have their own toilet roll and towels, which should be kept separately
  5. The affected person should eat in their room, and if possible, use disposable plates, knives, and forks. If not, use gloves when washing their plates, spoons, knives, and forks. Use diluted bleach and rinse well.


Hygiene and cleaning

  1. Patients and caregivers should wash hands with soap and water for at least 20 seconds, regularly
  2. Encourage the patient to have a daily bath
  3. The affected person's clothes should be washed separately and with a bleach containing detergent using a hot wash (90°C) for at least 30 minutes
  4. Use disposable gloves and a mask when entering the affected person's room
  5. Dispose of the patient's trash carefully. Use gloves and avoid handling it with your bare hands
  6. SARS-CoV-2 can live on cardboard, plastic, and food surfaces for several days. Discard all packaging or disinfect surfaces by wiping them down with a disinfectant solution. Wash all fruit and vegetables for at least 20 seconds using soap and water. Heat appears to kill the virus. However, frozen foods may harbor the virus, so make sure all food is heated well. Microwaving until steam rises also appears to kill coronavirus.


Emotional and mental health

  1. Try to keep the patient's spirits up. Communicate regularly with them via phone, video calls, or social media
  2. Confirmed COVID-19 patients often have symptoms such as regret and resentment, loneliness, helplessness, depression, anxiety and phobia, irritation and sleep deprivation, and even panic attacks.


  1. Try slow breathing, relaxation, meditation, and mindfulness
  2. If these symptoms are persistent or recurring, please seek professional help.



  Instructions in Case of Accidental Exposure to Patient's Body Fluids (Saliva, Tears, Sputum, Etc.) Top


  1. If it falls on your intact skin, remove the contaminant with a tissue or gauze and apply 0.5% iodophor or 75% alcohol to the skin. Let the solution sit for at least 3 minutes for disinfection, and then thoroughly flush with running water
  2. If it falls on broken skin or on mucous membrane such as the eyes, nose, or mouth, flush with plenty of normal saline (salt water) or 0.05% iodophor for disinfection. Isolate yourself for 14 days and observe for symptoms
  3. If you have a sharp object injury, squeeze blood out from the top of the wound to the bottom end, and flush the wound with running water. Then, disinfect with 75% alcohol or 0.5% iodophor. Isolate yourself for 14 days and observe for symptoms
  4. If you are coughed or sneezed on directly, immediately go to another room. Gargle with plenty of normal saline or 0.05% iodophor. Dip a cotton swab into 75% alcohol, and wipe your nasal cavity gently in a circular motion. Isolate yourself for 14 days and observe for symptoms.



  How to Wear a Mask (From the Who International Website) Top


  1. Before putting on a mask, clean your hands with an alcohol-based hand rub or soap and water
  2. Cover mouth and nose with mask and make sure there are no gaps between your face and the mask
  3. If you are using a surgical mask, the colored part should face the outside
  4. Avoid touching the mask when using it; if you do, clean your hands with an alcohol-based hand rub or soap and water
  5. Replace the mask with a new one as soon as it is damp and do not reuse single-use masks
  6. To remove the mask: remove it from behind (do not touch the front of mask), discard immediately in a closed bin, and then immediately clean your hands with an alcohol-based hand rub or soap and water.


Getting Started

See [Table 1] for sequence of exercise.
Table 1: Overview of exercise program

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Level 1

The Level 1 exercises are designed for patients who are very weak and lying down most of the time. See [Table 2] for a summary of the exercises, recommended frequency of the exercises and the targeted body part.
Table 2: Level 1 exercise

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  Diet Top


  1. The Covid-19 patient needs a nutritious high-calorie diet to recover. Foods that boost immunity include citrus fruits, watermelon, berries, spinach, wheat germ, yoghurt, garlic, ginger, and chicken soup
  2. However, they may get exhausted easily and struggle to finish the meal. They may be able to eat soups or soft foods
  3. Make sure they drink plenty of water. They will need at least 8–10 glasses of water every day. However, if they have heart or kidney disease or low sodium, please consult the physician on the correct amount of fluids to drink daily. One way to make sure is to ask them to check their urine. They should have a clear or pale-yellow urine and be urinating 3–4 times a day. If not, they need to drink more water.



  Exercise Top


This illness is highly debilitating. We do not yet know how long most patients will take to recover, but we think it will take several months to recover fully.

  • Please check with your physician before starting any exercises
  • These exercises are designed to be done alone by the patient in their room. The caregiver should not be in the same room
  • The caregiver can provide remote instructions and supervision by telephone from another room.
  • Equipment required:
  • Incentive spirometer: If this is not available, a packet of balloons and a disposable straw can be used as a substitute
  • Light weights: If this is not available, a water bottle can be used as a substitute
  • 12-inch exercise ball: If this is not available, a cushion or small pillow can be used as a substitute.


Precautions

  1. You can start gentle exercises if:


    1. You have not had fever for at least 7 days
    2. You have no shortness of breath, palpitations, or chest pain when walking around in your house
    3. You have experienced no swelling of the legs.


  2. STOP immediately if you develop any of the following. Get help immediately


  1. Shortness of breath
  2. Chest pain
  3. Palpitations
  4. Exhaustion
  5. Dizziness or Lightheadedness.


Deep breathing exercises

  1. Lie on your back in bed with a pillow under your head and knees
  2. Place one hand on your belly. Place the other hand on your chest
  3. Slowly breathe in through your nose. Let your belly fill with air, feeling your belly rise
  4. Breathe out through your nose. As you breathe out, feel your belly sink
  5. The hand on your belly should move more than the one that is on your chest
  6. Repeat for 2 min, several times a day.


Pursed lip breathing exercises[Figure 1]
Figure 1: Pursed lip breathing exercise

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  1. Relax your neck and shoulder muscles
  2. Breathe in for 2 Seconds through your nose, keeping your mouth closed as if you are smelling a rose
  3. Breathe out for 4 Seconds through pursed lips as if you are blowing out birthday candles. If this is too long for you, simply breathe out twice as long as you breathe in
  4. Repeat for 2 Minutes.


Blowing exercises [Figure 2]
Figure 2: Incentive spirometer

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  1. If you were given an incentive spirometer, use it


    1. Sit straight on a chair or the edge of your bed
    2. Breathe out completely to clear all the air from your lungs
    3. Close your lips firmly around the mouthpiece. You will have to breathe in only through your mouth. Plug your nose if you need to
    4. Breathe in slowly, and make the piston/ball rise as high as you can. Then, hold your breath up to 5 Seconds
    5. Repeat 10 times.


  2. If you do not have an incentive spirometer, you could


    1. Get a packet of balloons, practice blowing them up
    2. Get a straw and imagine sucking up a thick milkshake and hold your breath up to 5 Seconds
    3. Repeat 10 times.


Ankle pumps [Figure 3] and [Figure 4]
Figure 3: Ankle pumps (toes up)

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Figure 4: Ankle pumps (toes down)

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  1. Lie down on the bed. Point your toes up to the ceiling [Figure 3], then point it straight down, so that your toes are parallel to the bed [Figure 4]
  2. Repeat 2–3 times
  3. Increase gradually to 8 times.


Hip and Knee bends in bed [Figure 5]
Figure 5: Hip and Knee Bends in Bed

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  1. Slide your feet up the bed so your heels are almost touching your buttocks
  2. lReturn to the original position
  3. Repeat 2–3 times
  4. Increase gradually to 8 times.


Crossing your legs in bed [Figure 6]
Figure 6: Crossing your legs in bed

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  1. Bend both knees
  2. Place your right ankle on your left knee (as shown). Hold for 10 Seconds
  3. Repeat on the other side.


Overhead arm stretch [Figure 7] and [Figure 8]
Figure 7: Overhead arm stretch (pointing to the head of the bed)

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Figure 8: Overhead arm stretch (pointing to the side)

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  1. When lying in bed, bring your right arm straight up to point to the head of the bed [Figure 7]
  2. Keeping your elbows straight, bring your arm to your side as shown [Figure 8] return to the starting position [Figure 7]
  3. Repeat 2–3 times. Change sides and repeat
  4. Increase gradually to 8 times.


Touch the back of your neck [Figure 9]
Figure 9: Clasping back of neck

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  1. Bring both palms up and place them on the back of your neck
  2. Bring your arms back to your sides and repeat 2–3 times
  3. Increase gradually to 8 times.


Touch your mid-back [Figure 10]
Figure 10: Touching mid-back

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  1. Bring both arms up to touch your back (as if you are trying to hook a bra)
  2. Repeat 2–3 times. Increase gradually to 8 times.


Dangling legs [Figure 11]
Figure 11: Dangling legs

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  1. Sit at the side of the bed
  2. Dangle your legs off the bed
  3. Sit for as long as you can tolerate it.


Supported sit to stand [Figure 12] and [Figure 13]
Figure 12: Supported sit to stand

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Figure 13: Supported sit to stand

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  1. Sit at the edge of the bed. Place the back of a sturdy chair in front of you [Figure 12]
  2. Stand up when leaning on to a support [e.g. back of chair or a table [Figure 13]
  3. Repeat 2–3 times. Increase gradually to 8 times.


Relaxation [Figure 14]
Figure 14: Relaxation

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  1. Lie on the bed with a pillow under your head and your knees
  2. Imagine a peaceful setting
  3. Keeping this image in your mind, focus on controlled, relaxing breathing, slowing your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one
  4. Your mind may wander during this exercise – if you notice your thoughts wandering, bring your attention back to your breath.
  5. Continue for 10 Minutes before getting up slowly from the bed.


Level 2 exercises

The Level 2 exercises are designed for patients who can sit up most of the time. See [Table 3] for a summary of the exercises, recommended frequency of the exercises and the targeted body part.
Table 3: Level 3 exercises

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Chin up and down [Figure 15] and [Figure 16]
Figure 15: Chin up

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Figure 16: Chin down

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  1. Sit up
  2. Slowly drop chin to chest [Figure 15], and then look up to the ceiling. [Figure 16]
  3. Start with 1–2 times, increase gradually to 8 times.


Head turns [Figure 17] and [Figure 18]
Figure 17: Head turns (left)

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Figure 18: Head turns (right)

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  1. Look left over your left shoulder [Figure 17]
  2. Look right over your right shoulder [Figure 18]
  3. oStart with 1–2 times, increase gradually to 8 times.
  4. Repeat 8 times.


Shoulder rolls [Figure 19] and [Figure 20]
Figure 19: Shoulder rolls (forward)

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Figure 20: Shoulder rolls (backwards)

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  1. Roll shoulders forward 8 times [Figure 19]
  2. Roll shoulders backward 8 times [Figure 20].


Finger stretch [Figure 21]
Figure 21: Finger stretch

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  1. Stretch both your arms out in front of you
  2. Keep your elbows straight
  3. With the right hand, stretch the fingers of your left hand backward
  4. Count to 8, repeat on the other side.


Calf stretches in bed [Figure 22]
Figure 22: Calf stretches in bed

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  1. Sit up in bed
  2. Place a towel on the sole of your foot
  3. Grab both ends of the towel and pull. You should feel the stretch in your calf
  4. Count to 8. Repeat on the other side.


Wrist curls with light weights [Figure 23] and [Figure 24]
Figure 23: Wrist curls with light weights (down)

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Figure 24: Wrist curls with light weights (up)

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  1. Place your forearm on a chair's armrest with your hand hanging over the edge [Figure 23]
  2. Hold a light weight (2–5lb) slowly bend your wrist up and down [Figure 24], then repeat 2–3 times and increase gradually to 8 Repetitions
  3. Repeat on the other side.


Biceps curls [Figure 25] and [Figure 26]
Figure 25: Biceps curls (down)

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Figure 26: Biceps curls (up)

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  1. Place your forearm on a chair's armrest [Figure 25]
  2. Hold a light weight (2–5lb)
  3. Keep your elbow on the armrest


    1. Bring the weight up to your chin, slowly lower your arm to return to the starting point [Figure 26]
    2. Repeat 2–3 times and increase gradually to 8 Repetitions.


    3. Repeat on the other side.


Seated overhead weights [Figure 27] and [Figure 28]
Figure 27: Seated overhead weights (start)

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Figure 28: Seated overhead weights

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  1. Sit on the chair and hold the ball or a cushion at chest level [Figure 27]
  2. Move ball up overhead [Figure 28] and return to start position [Figure 27]
  3. Repeat 8 times.


Tummy twists [Figure 29] and [Figure 30]
Figure 29: Tummy twists (start)

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Figure 30: Tummy twists (finish)

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  1. Begin in the seated position, holding the ball/cushion in both hands [Figure 29]
  2. Slowly twist to the right, return to the center [Figure 30], and then twist to left
  3. Repeat 8 times on each side.


Shoulder abductions [Figure 31] and [Figure 32]
Figure 31: Shoulder abductions (start)

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Figure 32: Shoulder abductions (finish)

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  1. Sit with elbow at the side [Figure 31], when holding light weights
  2. Slowly raise both arms when keeping the elbows bent at 90° [Figure 32]
  3. Slowly lower both arms to return to starting price.


Seated knee lift [Figure 33]
Figure 33: Seated knee lift

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  1. Sit on the chair
  2. Lift the right leg and hold it up for count of 8
  3. Change legs
  4. Repeat each leg 3 times.


Knee extensions [Figure 34]
Figure 34: Knee extension

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  1. Begin seated in a chair with your back straight and knees bent
  2. Slowly extend your right leg forward and hold for a few seconds before lowering back to starting position
  3. Repeat with your left leg. Do 8 Repetitions per leg.


Relaxation [Figure 35]
Figure 35: Relaxation

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  1. Lie on the bed with a pillow under your head and your knees
  2. Imagine a peaceful setting
  3. Keeping this image in your mind, focus on controlled, relaxing breathing, slowing your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one
  4. Your mind may wander during this exercise – if you notice your thoughts wandering, bring your attention back to your breath
  5. Continue for 10 Minutes before getting up slowly from the bed.


Level 3 exercises

The Level 3 exercises are designed for patients who can stand up without difficulty. See [Table 4] for a summary of the exercises, recommended frequency of the exercises and the targeted body part.
Table 4: Level 3 exercises

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Overhead stretch [Figure 36]
Figure 36: Overhead stretch

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  1. Start off by standing up straight with your hands at your sides and feet shoulder width apart
  2. Lace your fingers together and raise your hands up toward the ceiling with your palms facing up
  3. Fully stretch your torso and hold for a count of 8, then return back to the starting position.


Side stretch [Figure 37]
Figure 37: Side stretch

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  1. Stand with your back straight and your feet shoulder-width apart. You can do this stretch sitting down if you are not steady on your feet
  2. Hold your arms above your head, and hold one hand with the other
  3. Pull upward when leaning straight over toward your right side. Keep your lower body straight. You should feel the stretch along your left side
  4. Hold 15–30 seconds, and then switch sides
  5. Repeat 2–4 times for each side 1.


Triceps stretch [Figure 38]
Figure 38: Triceps stretch

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  1. Stand with your back straight and your feet shoulder-width apart
  2. Bring your left elbow straight up when bending your arm
  3. Grab your left elbow with your right hand, and pull your left elbow toward your head with light pressure
  4. Hold 15 to 30 seconds, and then switch elbows
  5. Repeat 2–4 times for each arm.


Quadriceps stretch [Figure 39]
Figure 39: Quadriceps stretch

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  1. Lie on your side with one hand supporting your head
  2. Bend your upper leg back and grab your ankle with your other hand
  3. Stretch your leg back by pulling your foot toward your buttocks. You will feel the stretch in the front of your thigh. If this causes stress on your knees, do not do this stretch
  4. Hold the stretch 15–30 seconds
  5. Repeat 2–4 times for each leg.


Groin stretch [Figure 40]
Figure 40: Groin stretch

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  1. Sit on the floor and put the soles of your feet together. Do not slump your back
  2. Grab your ankles and gently pull your legs toward you
  3. Press your knees toward the floor. You will feel the stretch in your inner thighs
  4. Hold 15–30 seconds
  5. Repeat 2–4 times.


Calf stretch [Figure 41]
Figure 41: Calf stretch

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  1. Place your hands on a wall for balance
  2. Step back with your left leg, keeping the knee straight and pressing the heel into the floor
  3. Press your hips forward, bending your right leg slightly. You will feel the stretch in your left calf
  4. Hold the stretch 15–30 seconds
  5. Repeat 2–4 times for each leg.


Standing shoulder flexion [Figure 42]
Figure 42: Standing shoulder flexion

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  1. Stand when holding light weights in both hands
  2. Lift arms slowly up, when keeping elbows straight as shown
  3. Slowly bring arms down to return to starting position
  4. Start 2–3 times and increase to 8 times.


Standing arm abduction [Figure 43] and [Figure 44]
Figure 43: Standing arm abduction

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Figure 44: Standing arm abduction

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  1. Stand when holding light weights in both hands [Figure 43]
  2. Lift arms slowly up, when keeping elbows bent as shown [Figure 44]
  3. Slowly bring arms down to return to starting position
  4. \
  5. Start with 2–3 repetitions and increase to 8 times.


Upright front row [Figure 45]
Figure 45: Upright front row

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  1. Begin standing with your feet shoulder-width apart, knees slightly bent, and partially leaning forward
  2. Hold one dumbbell in each hand in front of you, with palms facing toward your body
  3. Lift both dumbbells toward your chin when keeping your back straight and shoulders stationary
  4. Return to starting position and repeat 8 times.


Biceps curls [Figure 46] and [Figure 47]
Figure 46: Biceps curls (start)

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Figure 47: Biceps curls (finish)

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  1. Place your forearm on a chair's armrest
  2. Hold a light weight (2–5lb)
  3. Keep your elbow on the armrest and bring the weight up to your chin
  4. Slowly lower your arm to return to the starting point
  5. Repeat 2–3 times and increase gradually to 8 repetitions
  6. Repeat on the other side.


Core exercises [Figure 48], [Figure 49], [Figure 50] [Figure 51]
Figure 48: Core exercises (crossing arms)

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Figure 49: Core exercises (leaning back)

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Figure 50: Core exercises (sitting arms out)

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Figure 51: Core exercises (standing arms out)

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  1. Sit upright near the edge of the chair with elbows crossed [Figure 48]
  2. Keeping the elbow crossed, slowly lean backward [Figure 49]
  3. Come back to the seated upright position
  4. Straighten both arms in front of you and stand up without using your arms [Figure 50]
  5. Sit down again to return to the starting position [Figure 48]
  6. Start with 1–2 reps and slowly increase to 8 repetitions.


Leg abduction [Figure 52]
Figure 52: Leg abduction

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  1. Stand facing the back of the chair
  2. Hold on to the back of the chair
  3. Slowly lift one leg as shown
  4. Hold for a count of 8
  5. Slowly lower the leg to return to the original position
  6. Change legs and repeat
  7. Start with 2-3 times reps and increase to 8 repetitions on each leg.


Hamstring curls [Figure 53]
Figure 53: Hamstring curls

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  1. Stand with feet slightly apart
  2. The knee of your support leg should be slightly bent
  3. Slowly bend the other knee, bringing your heel toward your buttocks
  4. Hold for count of 8 and return to start position
  5. Repeat using other leg
  6. Start with 2–3 times reps and increase to 8 repetitions on each leg.


Supported lateral lunge [Figure 54]
Figure 54: Supported lateral lunge

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  1. Stand facing the back of the chair
  2. Hold on to the back of the chair
  3. Slowly lift one leg as shown
  4. Hold for count of 8
  5. Slowly lower the leg to return to the original position
  6. Change legs and repeat
  7. Start with 2–3 times reps and increase to 8 repetitions on each leg.


Supported squats [Figure 55]
Figure 55: Supported squats

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  1. Stand facing the back of the chair
  2. Hold on to the back of the chair
  3. Slowly bend both knees to do half-squat
  4. Hold for a count of 8
  5. ASlowly return to the original position
  6. Start with 2–3 times reps and increase to 8 repetitions on each leg.


Wall push-ups [Figure 56] and [Figure 57]
Figure 56: Wall push-ups

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Figure 57: Wall push-ups

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  1. Stand facing the wall and place both hands on the wall [Figure 56]
  2. Lean forward, keeping both knees straight [Figure 57]
  3. Hold for a count of 8
  4. Slowly return to the original position [Figure 56]
  5. Start with 2–3 times reps and increase to 8 repetitions.


Walking

  1. Walk for 10 minutes at a comfortable pace
  2. Gradually increase to 3 times a day.


Relaxation [Figure 35]

  1. Lie on the bed with a pillow under your head and your knees
  2. Imagine a peaceful setting
  3. Keeping this image in your mind, focus on controlled, relaxing breathing, slowing your heart rate, or feeling different physical sensations, such as relaxing each arm or leg one by one
  4. Your mind may wander during this exercise – if you notice your thoughts wandering, bring your attention back to your breath
  5. Continue for 10 min before getting up slowly from the bed.


Acknowledgments

  • These unsupervised exercises described above were developed based on research conducted at the Division of Cognitive and Motor Aging (Neurology) laboratory under Dr. Verghese's leadership
  • Thank you to Tanya Verghese and David Verghese for their input, editing, and willingness to pose multiple times for the illustrations
  • Dr. Joe Verghese for his support, invaluable assistance, editing, and formatting of the manual
  • Drs. Matthew Bartels, Sayeed Wahezi, Andrew Gitkin, and Jeffrey Nissinhoff from the Department of Rehabilitation Medicine for their feedback and recommendations
  • My dear friends, Dr. Sara Cuccurullo, Dr. Carmen Terzic, and Dr. Maya Therattil, for their willingness to review the manual during this chaotic period.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
2.
Zhang, Y. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an outbreak of 2019 novel coronavirus diseases (COVID19) China CDC weekly, online date: February 17th,2020, Vol 2/Number 8. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20], [Figure 21], [Figure 22], [Figure 23], [Figure 24], [Figure 25], [Figure 26], [Figure 27], [Figure 28], [Figure 29], [Figure 30], [Figure 31], [Figure 32], [Figure 33], [Figure 34], [Figure 35], [Figure 36], [Figure 37], [Figure 38], [Figure 39], [Figure 40], [Figure 41], [Figure 42], [Figure 43], [Figure 44], [Figure 45], [Figure 46], [Figure 47], [Figure 48], [Figure 49], [Figure 50], [Figure 51], [Figure 52], [Figure 53], [Figure 54], [Figure 55], [Figure 56], [Figure 57]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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What Is Covid-19?
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