June 05, 2020
People with physical disabilities such as spinal cord injury/dysfunction (SCI/D), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), cerebral palsy and stroke may be at greater risk of severe illness and pneumonia if they develop COVID-19.
For example, people with MS may be taking medications that can cause immunosuppression. People with SCI/D and ALS may have underlying respiratory disease or limitations due to weakened diaphragm and chest and abdominal muscles impairing their ability to remove lung secretions by coughing. Also, temperature dysregulation (poikilothermia) can prevent a febrile response.
Atypical presentation may occur in this population, with hypoxia and dyspnea as the key symptoms of COVID-19 due to a person's difficulties in mounting a febrile response and difficulty coughing. Therefore, early testing for COVID-19 is suggested to avoid delay of diagnosis and treatment.
Lisa A. Beck, APRN, CNS, M.S., and Kristin L. Garlanger, D.O., both with Physical Medicine and Rehabilitation at Mayo Clinic suggest that people with physical disabilities should be proactive to prevent illness. Here are some ways to do that:
- Stay hydrated to keep lung secretions thin.
- Eat a healthy, well-balanced diet to boost the immune system.
- Perform deep breathing and "coughing exercises," which are controlled coughing maneuvers that help clear lungs.
- Change position frequently, using gravity to help clear lungs.
Additional considerations for wheelchair use, caregiver plans and respiratory devices should be considered for people with physical disabilities.
Wheelchair users
People who use wheelchairs face increased risk of exposure to COVID-19. Their heads are lower than those of people who are standing, so they may be more vulnerable to respiratory droplets produced when an infected person coughs, sneezes or talks because the droplets drop.
Wheelchair users should consider these tips:
- Keep at least 6 feet from others, when possible.
- Wash your face, in addition to your hands, after being in public and after having in-person conversations.
- Use an antibacterial solution to clean high-touch surfaces, such as wheels, brakes and push rims, of a manual wheelchair throughout the day. For a power wheelchair, use an antibacterial solution to clean the joystick and any other controls, armrests, tray or any parts your hands touch.
- If you use other assistive devices, such as walkers or canes, be sure to regularly wipe those with antibacterial products too.
People with caregivers
People with caregivers should consider these tips:
- Ask caregivers to wear masks when they enter and work with you in your home.
- Have caregivers wash their hands when they arrive and each time before touching you.
- Ask caregivers to be vigilant about not touching their faces or yours.
- Have caregivers check their temperatures before arrival.
- Ask caregivers not to come to your house if they are not well, including if they have symptoms such as a cough or temperature of 100.4 F (38 C) or higher, or if they have a known exposure to someone who is sick.
- Plan ahead to find someone who can help you or your pets if your caregiver gets sick or isn't able to assist you.
If your usual caregiver is unavailable:
- Plan on backup caregivers and prepare anyone you may need to rely on in an emergency.
- Ensure you can get assistance if a caregiver does not show up.
- Identify people to assist with groceries or have meals delivered to your home.
- Identify a way to get medications and other supplies in a timely manner.
- Remember pet needs, too. Ensure plenty of food is on hand and arrange a backup caregiver for your service animal or pet.
Users of ventilators or other respiratory assistive devices
Some people with disabilities rely on ventilators every day. Making sure caregivers follow strict guidelines to clean and use these machines will help protect those who are vulnerable to respiratory illnesses.
Users of ventilators or other respiratory assistive devices should consider these tips:
- Clean and disinfect medical equipment according to the manufacturer's instruction.
- Change filters, as suggested by the manufacturer's instructions.
- Wash hands before and after working with the ventilator or the person.
- Make sure caregivers wear masks or eye shields if they are suctioning secretions.
When seeking medical care
If a person becomes sick and needs medical attention, the person or the caregivers should mention to medical providers or emergency responders that the person has a disability and share how the disability affects the person's respiratory system.