7th March 2022 (Monday) 0800-1700 CPD Category A1 (8 points) Organized By: Rehabilitation Medicine Department & Post Graduate Society Hospital Sungai Buloh
CONTENTS Organizing Committee 3-4 Topic Highlight 5 Forewords 6-8 Programme Schedule 9-13 SpeakersF’ BOiogRraEphyWORDS14-25 Abstracts 26–39 Symposium Bibliography 40 Throwback 2015 - 2021 41-44 Past Symposiums & Trainings 45 Key Awards & Achievement 46-48 Acknowledgement 49 Advertisement 50-54 2
ORGANIZING COMMITTEES Advisors: Dr Kuldip Kaur Prem Singh Dr Yusniza Mohd Yusof Chairperson: Dr Akmal Hafizah Zamli Members: Dr Kavitha Andiappan Dr Hajar Zainon Dr Shafiq Eiman Abdul Razak Dr Izuan Effendi Abdul Wahab Dr Siti Nadiah Md Sabri Dr Ho Wan Yi Dr Amitha Na Sherng Lhung Dr Reginald Valentino Rapieng Dr Fatnin Faqiha Azmi Mahmud Dr Noor Aqeela Othman Talib Dr Nur Izianty Zool Kafli Dr Tan Bee Cher Dr Dayang Nur Atheerah Dr Mohd Zarif Asyraaf Dr Fatin Nabilah Hanis Dr Norfaezah Kamaluddin Madam Juliana Ibrahim Madam Ruhini Md Isa Miss Nur Hazrina Iderus 3
A VERY WARM WELCOME FROM ALL OF US! Front row from left: Dr Shafiq Eiman Abdul Razak, Dr Izuan Effendi Abdul Wahab, Dr Reginald Valentino Rapieng, Dr Amitha Na Sherng Lhung; Centre Puan Juliana Ibrahim, Dr Kavitha Andiappan, Dr Akmal Hafizah Zamli, Cik Nur Hazrina Iderus, Dr Siti Nadiah Md Sabri; Back: Dr Nur Izianty Zool Kafli, Dr Tan Bee Cher, Dr Ho Wan Yi, Dr Aqeela Othman Talib, Dr Fatnin Faqiha Azmi Mahmud. 4
Topic Highlight By January 2022, more than 2.7 million Malaysian populations had recovered from COVID-19, but to some their journey may have just started. Symptoms such as persistent fatigue, breathlessness, brain fog, and depression could debilitate many of them. Widely termed as Long COVID, the World Health Organization in October 2021 defined “Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months, that cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others which generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.” With absence of scientifically proven treatments, its effect on society, from the increased health-care burden and economic and productivity losses, is substantial. Post COVID-19 condition (Long COVID) is indeed today’s medical challenge of first order. With us today are distinguished speakers from the various discipline experts for guidance on delivering comprehensive and effective care to our patients. Sit Back, Relax and Enjoy! “My Lord, increase me in knowledge” 5 - Al-Quranul Karim Taha, 20:114
Foreword Director of Hospital Sungai Buloh Dr Kuldip Kaur Prem Singh Firstly, my heartiest congratulations to the Department of Rehabilitation Medicine for successfully organizing the national virtual symposium titled ‘Post Covid-19 Condition Focused Rehabilitation Medicine: Fronting the Challenges Together’. It takes a great effort and commitment as showcased by this department to be able to keep their track record in delivering yearly national event without fail. As we all know, COVID-19 can cause persistent ill-health. Around a quarter of people who have had the virus experience symptoms that continue for at least a month but one in 10 are still unwell after 12 weeks. This has been described by patient groups as “Long COVID\". In Malaysia itself, almost 20 000 patients are reported to suffer from post covid syndrome. According to WHO, rehabilitation measures are part of an essential solution to tackle this complex problem. Long COVID has a serious impact on people’s ability to go back to work or have a social life. It affects their mental health and may have significant economic consequences for them, their families and for society. This being said, I believe that this timely event will provide the opportunity for the healthcare providers to update their knowledge, competency and skills towards rendering a more holistic management of Long Covid patients. This symposium also consists of experience sharing session that could potentially be an eye opener besides being an inspirational tool for the patients themselves. As Malaysia enters into a possible ‘living with the virus’ phase, Long Covid becomes inevitable. As such, patients displaying post covid syndrome must be accessible to good rehabilitation care and services to improve their physical and mental wellbeing which is proven as of now to be an effective way to curb Long Covid which is growing to be a huge public health concern. “The struggle you're in today is developing the strength you need for 6 tomorrow”
Foreword Head of Rehabilitation Medicine Services, Ministry of Health Malaysia Dr Yusniza Mohd Yusof “Long COVID” is a term being used to describe illness in people who have either recovered from COVID-19 but still report lasting effects of the infection or have had the usual symptoms for far longer than would be expected. Long COVID is still evolving but the condition can be very debilitating. It is associated with a range of overlapping symptoms including but not limited to generalized chest and muscle pain, fatigue, shortness of breath, and cognitive dysfunction. As the call for multidisciplinary, multi-specialty approaches to assess and manage Long COVID rises worldwide, I am very proud to say that the Rehabilitation Medicine Department of Hospital Sungai Buloh has not only initiated the post- Covid rehabilitation care in Malaysia but also has paved and lead the way in developing these services nationwide. Additionally, this department has played a vital role in involving patients both to foster self-care and self-help and in shaping awareness of Long COVID. They have also implemented a well- functioning patient register; creating cohorts of patients; and following up those affected as a means to support the research which is so critical to understanding and treating Long COVID. As such, I believe that the Rehabilitation Medicine team of Hospital Sungai Buloh is the most relevant and appropriate organizer for the first ever national level long COVID symposium titled ‘Post COVID-19 Condition Focused Rehabilitation Medicine: Fronting the Challenges Together’. Furthermore, it would be a great privilege to be able to gain first-hand knowledge and experience in managing COVID survivors from the pioneers themselves. Finally, congratulations to the organizing committee for their efforts in organizing this event. To all participants, wishing you a successful and an enjoyable symposium! “ Tough times never last, but tough people do. Together we stand strong!” 7
Foreword Head of Rehabilitation Medicine Department, Hospital Sungai Buloh Dr Akmal Hafizah Zamli On behalf of the organizing committee, we would like to extend our greatest pleasure in welcoming all highly respected participants to the National Symposium Post COVID-19 Condition - Focused Rehabilitation Medicine “Fronting the Challenges Together” 2022. Due to the on-going pandemic, this years’ event shall be conducted fully virtual. Barely beyond 2 years, by now more than 2.5 million Malaysians had recovered from COVID-19. However, for some their journey may have just started. Symptoms such as persistent fatigue, breathlessness, brain fog, and depression could debilitate many of them. We thanked all distinguished speakers of the diverse medical specialties for their commitments in providing us guidance in delivering comprehensive and effective care to our patients. The multi-disciplinary lecture series and cased-based inter-disciplinary rehabilitation workshop series topics are specifically selected with aim for creating awareness; and sharing of knowledge, skills and experiences in key practices relevant to PCC rehabilitation. Our most sincere gratitude to all participants for the inspiring interest and support for this event. The passion that we have to improve our service for those in need has brought us together today and we sincerely hope that all of us shall gain maximally and achieved the expectation for this event. We also hoped that the compilation of educational posters, video series and handbook shall add value to our current practices in providing better services for the COVID-19 survivors. Wishing all of you an enlightening & enriching experience! “The best among you are those who bring greatest benefits to many 8 others” - Prophet Muhammad pbuh
Programme Schedule Highlight Series 0800-0845 Registration 0845-0900 Video Message from The Global Webinar 06-10-21 0900-0915 0915-0945 WHO INTRODUCTION TO REHABILITATION POST 0945-1000 COVID-19 CONDITION Dr De Groote Wouter Head of Rehabilitation Programme, WHO Geneva, Switzerland Post COVID-19 Condition - Rehabilitation Medicine Strategies for The Nation A PLAN AHEAD Dr Yusniza Mohd Yusof Head of Rehabilitation Medicine Services Ministry of Health Malaysia Sneak Peek Into The Post COVID-19 Condition Database COVID-19 REHABILITATION OUTPATIENT SPECIALIZED SERVICES (CROSS) Dr Akmal Hafizah Zamli Head of Rehabilitation Medicine Department Hospital Sungai Buloh Tea Break 9
Programme Schedule Multi-disciplinary Perspectives Lecture Series 1000 -1030 Issues & Challenges in Post COVID-19 Condition EMBRACING THE PANDEMIC STORM 1030 -1100 Dr Nor Arisah Misnan Consultant Infectious Disease Physician Hosp Sg Buloh Addressing the Psychological Impacts TACKLING THE SIREN CALL 1100 -1130 Dr Lee Chung Wah Consultant Psychiatrist & Senior Lecturer Taylor's University School of Medicine Management of Long Term Pulmonary Consequences FIXING THE PULMONARY WRECKS 1130 - 1200 Dr Arvindran Alaga Kedah State Head of Respiratory Services Head of Respiratory Unit Hosp Sultanah Bahiyah Rehabilitation Medicine Approach to Recovery for Post COVID-19 Condition GETTING BACK ON DECK Dr Sa'ari Mohamad Yatim Selangor State Head of Rehabilitation Medicine Services Head of Rehabilitation Medicine Dept Hosp Serdang 10
Programme Schedule Survivors Perspectives, Officiating & Launching 1200-1230 Post COVID-19 Condition... The Survivor Perspective 1230-1300 THEIR TRUE STORIES 1300-1400 Dr Kavitha Andiappan Rehabilitation Medicine Physician Hosp Sg Buloh Officiating and Launching POST COVID-19 CONDITION EDUCATIONAL LEAFLETS & VIDEO SERIES Dr Yusniza Mohd Yusof Head of Rehabilitation Medicine Services Ministry of Health Malaysia EDUCATIONAL BOOKLET “OPTIMUM: PANDUAN, SOKONGAN SERTA INSPIRASI BAGI PENGURUSAN KENDIRI REHABILITASI PASCA JANGKITAN COVID-19” Dr Kuldip Kaur Prem Singh Director Hospital Sungai Buloh Lunch & Zohor Prayer TAKE A BREAK Occupational Therapy Unit Team Hospital Sungai Buloh 11
Programme Schedule Inter-disciplinary Rehabilitation Perspectives, Case Based Discussion Series 1400-1425 Home Oxygen therapy 1425-1450 1450-1515 BREATHING IS BEGINNING 1515-1540 Dr Akmal Hafizah Zamli Head of Rehabilitation Medicine Department Hospital Sungai Buloh Rehabilitation Nursing Perspectives PRIORITIES & INTERVENTIONS Madam Ruhini Md Isa Head of Rehabilitation Nursing Unit, Rehabilitation Medicine Department, Hospital Sungai Buloh Physiotherapy Management of Respiratory & Musculoskeletal Impacts THE SHORT & LONG OF IT! Miss Nur Hazrina Iderus Head of Physiotherapy Unit, Rehabilitation Medicine Department, Hospital Sungai Buloh Occupational Therapy Management for Fatigue, Brain Fog, Insomnia & Psychological Distress TACKLING THE WAX & WANE Madam Juliana Ibrahim Head of Occupational Therapy Unit, Rehabilitation Medicine Department, Hospital Sungai Buloh 12
Programme Schedule Inter-disciplinary Rehabilitation Perspectives, Case Based Discussion Series 1540-1615 POST COVID 19 Stroke & Spasticity – Our Experience 1615-1640 IS THERE ROLE OF BOTULINUM NEUROTOXIN? Dr Kavitha Andiappan Rehabilitation Medicine Physician, Rehabilitation Medicine Department, Hospital Sungai Buloh Return to Work Programme for Post COVID-19 Condition THE ULTIMATE TARGET Dr Fazita Abdul Talib Head of Rehabilitation Medicine Department Social Security Organization (SOCSO) Rehabilitation Centre Tun Abdul Razak 1640-1700 Discussions and Closing QUESTIONS & ANSWERS...ANYONE? All Inter-disciplinary Case Based Speakers Rehabilitation Medicine Department, Hospital Sungai Buloh 13
BIOGRAPHY DR WOUTER DE GROOTE Dr De Groote works for the Rehabilitation Programme in the Department of Non-communicable Diseases at the WHO Headquarters in Geneva, Switzerland, where he is dedicated to COVID-19 related activities and strengthening rehabilitation in health information systems. He has a specialty in Physical and Rehabilitation Medicine, and has been Head of the Inpatient Rehabilitation Department at AZ Rivierenland (Belgium) for 10 years. He has a postgraduate in ‘International Development Cooperation’ and ‘Rehabilitation Management in the Global South’. He has been working as a consultant for the development of rehabilitation guidelines at the Ministry of Health in Vietnam, and for the International Federation for Spina Bifida and Hydrocephalus. He is the founder of CBR International and has joined the CBR task force at the International Disability and Development Consortium. He has been chairing the ISPRM ‘Capacity building in low resource countries’ Working Group for several years. He has experience in the strategic planning and monitoring of rehabilitation service implementation, and has been involved in numerous trainings for rehabilitation professionals around the globe. “ The greatest wealth is to live content with little” 14
BIOGRAPHY DR YUSNIZA MOHD YUSOF Dr Yusniza Mohd Yusof graduated with MBBS from University of Malaya, Kuala Lumpur and obtained her Master Degree in Rehabilitation Medicine from University of Malaya, Kuala Lumpur. She then pursued her area of interest study in Spinal Cord Injury Rehabilitation at University of Chang Mai,Thailand. Dr Yusniza sits on many professional bodies’ committee locally and internationally. She is currently the Head of Rehabilitation Medicine services in the Ministry of Health Malaysia, Head of Clinical Services, Hospital Rehabilitasi Cheras Kuala Lumpur. She is also actively presented at various national and international conferences notably Malaysia’s representation at various World Health Organization organized meeting and conferences. These included Global Webinar Rehabilitation 2030: A Call for Action; Second Global 2030 Rehabilitation 2030 meeting and World Health Organization Western Pacific Region Access to Quality Rehabilitation Services conference. “Alone we can do so little, together we can achieve so much…” - Helen Keller 15
BIOGRAPHY DR SA’ARI MOHAMAD YATIM Dr Sa'ari Mohamad Yatim graduated with MD from University of Sciences, Malaysia and obtained his Master Degree in Rehabilitation Medicine from University of Malaya, Kuala Lumpur. He is also a Certified Medical Impairment Assessor (CMIA) under NIOSH Malaysia. He then pursued his area of interest in Cardiopulmonary Rehabilitation in Tung Wah Hospital, Hong Kong and following that special training in pulmonary rehabilitation in Chonbuk National University, Korea. Dr Sa’ari sits on several committees locally and internationally. He is currently the Deputy Head of Rehabilitation Medicine services in the Ministry of Health Malaysia. Apart from that, Dr Sa’ari also serves as the Head of Selangor State Rehabilitation Medicine Services. He currently practiced as Consultant Rehabilitation Physician and the Head of Rehabilitation Medicine Department, Hospital Serdang, Selangor. At the international level, Dr Sa’ari also sits as executive board member of Asia-Oceanian Society of Physical and Rehabilitation Medicine and AsiaPRevent. “There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” 16 - Albert Einstein
BIOGRAPHY DR ARVINDRAN ALAGA Dr Arvin graduated with MBBS from the Melaka Manipal Medical College, Malaysia and obtained his MRCP (United Kingdom). He subsequently pursued FRCP (Edinburgh) and completed Interventional Pulmonology Fellowship in Nagoya Japan. He then completed Fellowship in Respiratory Medicine Malaysia and Fellowship of Asia Pacific Society of Respirology. He further obtained European Diploma in Adult Respiratory Medicine (HERMES) in 2021. Dr Arvin actively presented at various national and international training and conferences in various topics including COVID-19 and Post COVID-19 conditions. He is an avid researcher and educator, having published many articles and has been heavily involved in undergraduate and postgraduate medical trainings and examinations. He also sits at various national and international committees and including as the current National Deputy Secretary of the Malaysian Medical Association. “ Once you stop learning, you start dying” 17
BIOGRAPHY DR AKMAL HAFIZAH ZAMLI Dr Akmal Hafizah Zamli graduated with MBBS from University of Malaya, Kuala Lumpur and obtained her Master Degree in Rehabilitation Medicine from University of Malaya, Kuala Lumpur. She then pursued her area of interest training in Spinal Cord Injury and Brain Injury Rehabilitation at Hampstead Rehabilitation Centre, South Australia. She subsequently pursued further training at the Spinal Cord Medicine & Rehabilitation at Burwood Spinal Unit, Christchurch New Zealand. Since the unprecented global pandemic, Hospital Sungai Buloh being one of the primary centre for COVID-19 has led to her active involvement in post COVID-19 rehabilitation. She had contributed as development group member of the National Guideline Post COVID-19 Guideline Rehabilitation Chapter; initiated the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) framework. She has since presented at various national webinars and including at the World Health Organization Global Webinar Post COVID-19 Condition 2021. “Determination today leads to success tomorrow.” 18
BIOGRAPHY DR NOR ARISAH MISNAN Dr Nor Arisah Misnan graduated with MBBS from University of Nottingham, United Kingdom and obtained her Master Degree in Internal Medicine from University of Malaya, Kuala Lumpur. She is currently the Consultant Infectious Disease Physician at Hospital Sungai Buloh. She actively presented at various national and international conferences and participated in clinical audits, research activities and trainings in various infectious disease topics including COVID-19 and Post COVID-19 conditions. She has contributed as trainer, advisor and development group members of the diverse COVID-19 related National Guidelines, Ministry of Health Malaysia. She has co-initiated the establishment of COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) framework. She also sits at various national committees and including as the executive board committee of the Malaysia Society of Infection Control and Infectious Disease (MyICID). “Who question much, shall learn much and retain much” 19
BIOGRAPHY DR LEE CHUNG WAH Dr Lee Chung Wah graduated with MBBS from Kasturba Medical College Manipal and obtained his Master Degree in Medicine (Psychiatry) from University Science Malaysia. During the COVID-19 pandemic he served as Consultant Psychiatrist at Hospital Sungai Buloh and had contributed to the establishment of Psychological First Aid (PFA) service for those affected by COVID-19. He has also provided psychiatry consultation for referrals of patients with psychological impacts at COVID-19 Rehabilitation Outpatient Specialized Services (CROSS). His enthusiasm and passion for academic teachings has led him to the career pathway as academician and senior lecturer at Taylor’s University School of Medicine. “Tell me and i will forget, show me and I may remember, involve me 20 and I will understand”
BIOGRAPHY DR KAVITHA ANDIAPPAN Dr Kavitha Andiappan graduated with MBBS from the Crimea State Medical University, Ukraine and obtained Masters in Rehabilitation Medicine from the University of Malaya. She is interested in a wide variety of rehabilitation medicine specialities including Spinal Cord Injury, Amputee, Musculoskeletal, Paediatrics and Cardiac Rehabilitation, with a focus on the field of neurorehabilitation. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement in post COVID-19 rehabilitation. She has significantly contributed to the establishment of the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS). “Life is not a problem to be solved but a reality to be experienced” 21
BIOGRAPHY DR FAZITA ABDUL TALIB Dr Fazita Abdul Talib graduated with Medical Degree in University Kebangsaan Malaysia. She then obtained Masters of Occupational Safety and Health Management System at University Utara Malaysia. She achieved various certification including Certified Disability Management Professional National Institute of Disability Management & Research (NIDMAR Canada); Certification in Training the Trainer Course (HRDF Malaysia); Certification in Occupational Health Doctor (NIOSH Malaysia); Certified Independent Medical Examiners (CIME USA) and Certified Medical Impairment Assessor (CMIA NIOSH Malaysia). She sits in many committees and task force most notable including as trainer for Certified Disability Management Professional (CDMP Canada). Apart from Pusat Rehabilitasi PERKESO Tun Abdul Razak, she also manages its satellites in Ara Damansara Medical Centre, Quill City Mall and Kuala Terengganu medical affairs. She is also part of Task Force for COVID-19 and had contributed significantly to the Return to Work Program for survivors with Post COVID-19 condition; referral by COVID-19 Rehabilitation Outpatient Specialized Services (CROSS) Hospital Sungai Buloh as well as in other centers. “Success is the capacity to learn, to persist, to persevere..” 22
BIOGRAPHY MADAM JULIANA IBRAHIM Madam Juliana Ibrahim graduated from College of Kuala Lumpur with a Diploma in Occupational Therapy. She then pursued her Bachelor of Occupational Therapy with Honors from the National University of Malaysia. She obtained certificates in Hand Rehabilitation from the Christine M.Kleinert Institute Kentucky USA. She is currently is the Head of Occupational Therapy Unit of Hospital Sungai Buloh. She had completed her Masters in Children Disability and Development from University Technology MARA in 2019 and had interest in various fields including Early Intervention Program, Pre-School program, Special School & Education for Disabilities and Children Development. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement in post COVID-19 rehabilitation. Since its establishment, she has served the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS). “Knowledge comes from learning. Wisdom comes from living” 23
BIOGRAPHY MISS NUR HAZRINA IDERUS Miss Nur Hazrina Iderus graduated from University Technology MARA with a Degree in Physiotherapy. She currently is the Physiotherapy Unit of Hospital Sungai Buloh. She has various interest in Physiotherapy interventions including musculoskeletal, neurological, and general physiotherapy. She aspires to pursue further studies in the near future. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement in post COVID-19 rehabilitation. Since its establishment, she has served the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and COVID-19 Rehabilitation Outpatient Specialized Services (CROSS). She has also contributed to the development of National Post COVID-19 Guideline, Ministry of Health in 2021. “Just like your body needs exercise, so does your brain! You're 24 never too old to grow and learn something new”
BIOGRAPHY MADAM RUHINI MD ISA Madam Ruhini graduated from Nursing College Kuala Lumpur and subsequently obtained her post basic midwifery from Nursing College Kuala Lumpur. She later pursued further studies and obtained post basic rehabilitation nursing from the Seremban Nursing College. She completed Bachelor of Science (Hons) nursing post registration from the University of MAHSA in 2021. Madam Ruhini had served in rehabilitation nursing practice for more than 16 years for various services including amputee, spinal cord injury, neuromedical and neurosurgical rehabilitation services. Hospital Sungai Buloh being one of the primary centre for COVID-19 has also led to her active involvement throughout the acute, subacute and post acute COVID-19. Since its establishment, she has served the COVID-19 Rehabilitation Inpatient Specialized Services (CRISS) and facilitated the COVID-19 Rehabilitation Outpatient Specialized Services (CROSS). “We can be knowledgeable with other men's knowledge, 25 but we cannot be wise with other men's wisdom”
ABSTRACT Highlight Series: Introduction to Rehabilitation for Post COVID-19 Condition DR WOUTER DE GROOTE According to current data, approximately 10–20% of people experience persistent or new onset symptoms after 3 months following SARS-CoV-2 infection, which occurs irrespective of initial disease severity. In people with persistent symptoms; limitations in functioning are common and rehabilitation needs are high; people experience limitations in self-care, mobility, and return to work, among other. People recovering from COVID-19 may require close monitoring of rehabilitation needs and adequate referral. Rehabilitation services should be developed as an integral part of the model of care for people with post COVID-19 condition, and aim at reducing the physical, cognitive and mental health impacts of COVID-19. During this session, we are extremely honored to be granted the approval by Dr Wouter De Groote to highlight his video presentation at the 6 October 2021, the World Health Organization (WHO) Expanding our understanding of Post COVID-19 Condition webinar series: Rehabilitation Care entitled “Introduction to Rehabilitation for Post COVID-19 Condition”. 26
ABSTRACT Highlight Series: Post COVID-19 Condition - Rehabilitation Medicine Strategies for The Nation. A PLAN AHEAD DR YUSNIZA MOHD YUSOF Covid 19 has posed a great challenge and created a significant impact to the health care system of all levels. However, every cloud has a silver lining. Covid-19 has taught us to emerge stronger than ever by working together, pooling resources and developing new innovations enabling the nation to combat the pandemic in par with the rest of the world. Due to the nature of the disease and its multisystem involvement, rehabilitation services play an integral role in managing Covid-19 patients of various stages be it in the acute, sub-acute or chronic phase. The term ‘Long Covid’ that has been coined for post Covid-19 symptoms and signs have been reported in all severity category of Covid-19 and the condition can be very debilitating. Rehabilitation medicine is proven to be one of the mainstays in battling ‘Long Covid’. Planning against an ever-evolving foe, demands multiple solutions pending on the availability of resources. Hence, working together on multiple fronts is essential in providing care to our patients, the Covid Survivors. 27
ABSTRACT Highlight Series: Sneak Peek Into The Post COVID-19 Condition Database COVID-19 REHABILITATION OUTPATIENT SPECIALIZED SERVICES (CROSS) DR AKMAL HAFIZAH ZAMLI On 6th November 2020, the need to formalize a specialized, structured and comprehensive Rehabilitation Medicine services to cater for the intermediate and long-term effects of COVID-19 in the moderately severe Stage 4 & 5 survivors was agreed upon between the multi-disciplinary team involved in COVID-19 management. The key goals are to identify and manage any residual impairments expected primarily in the pulmonary, musculoskeletal, cardiovascular and cognitive domains to optimize the COVID-19 survivors’ return to their best functional level or in severe cases to adapt to living with residual disabilities. Known as COVID-19 Rehabilitation Outpatient Specialized Services (CROSS), the ultimate aim of this initiative is for full re-integration of the survivors back into society. This lecture shall highlight the preliminary key analyses of the CROSS database (November 2020 – December 2021) related to PCC incidence, prevalence, multi-system spectrum of symptoms and most importantly the impact it has holistic and comprehensive rehabilitation medicine services provision for its management. 28
ABSTRACT Multi-disciplinary Perspectives Lecture Series Rehabilitation Medicine Approach to Recovery for Post COVID-19 Condition EMBRACING THE PANDEMIC STORM DR NOR ARISAH MISNAN The past 2 years have been difficult for all health care providers as we faced multiple challenges during the COVID pandemic. Over 3 million people in Malaysia were infected with SARS COV-2 and more than 32, 000 lives lost due to this virus. As the number of recovered cases accumulate, clinicians are now facing issues with significant numbers of patients with post covid and long covid syndrome amongst the survivors. This is defined as collections of symptoms that developed during or following a confirmed or suspected case pf COVID-19, and which may continue for more than 28 days. This disorder has impacted their life, work and affected their return to the baseline health status. How do we navigate during and after the storm? We are all perhaps in different ships embracing the storm and learning to deal with the new sense of normality. Since the challenges in managing post covid are best tackled with the involvement of multidisciplinary team for a holistic approach, this lecture is meant to highlight the issues that clinicians need to identify in the care process and learn how to manage post COVID condition. 29
ABSTRACT Multi-disciplinary Perspectives Lecture Series Rehabilitation Medicine Approach to Recovery for Post COVID-19 Condition TACKLING THE SIREN CALL DR LEE CHUNG WAH We have been living with the Covid19 pandemic for 2 years now and much have been understood in terms of its impact towards our patient’s physical health compare to when it first began. On the verge of getting our patients better, many of us often overlooked the importance of mental health. And, from the perspective of mental health, a prolonged pandemic as Covid19 does not only affect our patients alone but the whole of our society nationwide. This lecture provides us an overview of how the pandemic has affected mental health at different levels, the principle of management the nation has adopted in tackling them and how you, as a health care provider, can apply these principles in your practise to offer your patients a more holistic treatment plan. 30
ABSTRACT Multi-disciplinary Perspectives Lecture Series Rehabilitation Medicine Approach to Recovery for Post COVID-19 Condition FIXING THE PULMONARY WRECKS DR ARVINDRAN ALAGA Since the identification of the novel coronavirus SARS-CoV-2 in December 2019, the pandemic has become a leading cause of morbidity and mortality worldwide including Malaysia. As effective vaccines and treatments begin to emerge, the burden shifts to identify and proactively manage the long-term respiratory complications of severe disease. The patterns of imaging abnormalities coupled with data from prior coronavirus outbreaks suggest that patients with severe COVID-19 pneumonia are likely at an increased risk of lung function abnormalities. In this talk, we briefly review the pathophysiology of Covid 19 and Long COVID with mechanisms of lung injury in COVID-19 infection. Finally, we address pulmonologist perspective of fixing the pulmonary wrecks in these patients and local guidelines in managing pulmonary complications and sequelae. 31
ABSTRACT Multi-disciplinary Perspectives Lecture Series Rehabilitation Medicine Approach to Recovery for Post COVID-19 Condition GETTING BACK ON DECK DR SA’ARI MOHAMAD YATIM COVID-19 patients presented many clinical problems, including respiratory failure, excessive immunological response and clotting disorders, renal failure and myocarditis. Many patients will experience a variety of problems with normal functioning and will require rehabilitation services to overcome these problems. The principle of and evidence-based rehabilitation will allow an effective response. These include a simple screening process; use of a multidisciplinary expert team; four evidence-based classes of intervention (exercise, practice, psychosocial support, and education particularly about self-management; and a range of tailored interventions for other problems. Applying the principles of rehabilitation to COVID-19 based on an evidence-based description of effective rehabilitation based on the framework of Donabedian include patients and places, the structure, the goal (outcome) and the process obviously much to learn about rehabilitation after COVID-19. Holistic approach of rehabilitation management should be implemented with guidance of biopsychosocial model of ICF. 32
ABSTRACT Multi-disciplinary Perspectives Lecture Series Rehabilitation Medicine Approach to Recovery for Post COVID-19 Condition GETTING BACK ON DECK DR SA’ARI MOHAMAD YATIM Multicomponent of therapeutic exercise intervention in early phase has been showed favourable result in the improvement of COVID-19 patient’s physical performance. A local protocol in COVID-19 Rehabilitation should be implemented include during acute phase, convalescence phase and post discharge period in order to reduce the risk of post COVID condition (long COVID). Patients who recover from COVID-19 after a prolonged ICU stay should undergo pulmonary rehabilitation, initially in an individualized, gradual manner during hospitalization, and continuing after hospital discharge in order to mitigate/reverse the consequences of the disease. The efficacy of home-based rehabilitation has been demonstrated in various studies. In an attempt to mitigate difficulties in the process of rehabilitating COVID-19 survivors and to reduce risks, greater attention has been given to telerehabilitation. Telerehabilitation uses telecommunication resources to offer rehabilitation remotely, in real time or not, the benefits of which are similar to those of face-to-face supervised rehabilitation, thus minimizing barriers of distance, time, costs, and risks. 33
ABSTRACT Inter-disciplinary Perspectives Case Based Series Home Oxygen Therapy BREATHING IS BEGINNING DR AKMAL HAFIZAH ZAMLI As the current COVID-19 inpatient strategy depends heavily on managing oxygenation, selected patients could be discharged home if oxygen administration could be addressed in a safe manner. Home oxygen therapy can be defined as oxygen delivered in a home, also known as domiciliary oxygen. It includes not only long-term oxygen but also short-term, nocturnal, palliative, ambulatory, and short-burst oxygen. It excludes oxygen use in healthcare and emergency settings. This lecture shall discuss rehabilitation medicine assessment and prescription involving 3 post COVID-19 condition case scenarios. These include ambulatory oxygen defined as oxygen delivered during exercise or activities of daily living; short term oxygen therapy (STOT) defined as oxygen provided temporarily during a period of severe hypoxemia; and long-term oxygen therapy (LTOT) defined as oxygen that is delivered to patients with chronic hypoxemia, in most cases for the remainder of the patient’s life indicated if therapy is prescribed for at least 15 h/d. 34
ABSTRACT Inter-disciplinary Perspectives Case Based Series Rehabilitation Nursing Perspectives PRIORITIES & INTERVENTIONS MADAM RUHINI MD ISA COVID-19 is a novel disease currently ravaging the world as a pandemic. More emphasis has been focused on the acute disease, with less attention on the detection and management of long-term sequelae which develop in some patients, variously termed “Long COVID”. There are also various reports in the literatures on the duration of viral shedding, with the longest known recorded being about 75 days, and whether this duration has an effect on prognosis or patients remain infectious which is still unknown. The case of a 59-year-old, chinese lady with multiple comorbids including diabetis mellitus with retinopathy, hypertension and dyslipidemia has admission for 11 weeks from symptoms onset with ICU admission and finally discharge from Rehabilitation Covid Ward on 13.1.2022. 35
ABSTRACT Inter-disciplinary Perspectives Case Based Series Physiotherapy Management of Respiratory & Musculoskeletal Impacts THE SHORT & LONG OF IT! MISS NUR HAZRINA IDERUS As the title name implies this presentation is about to bring you to the short and long journey of rehabilitation process for post Covid-19 patient. In which will emphasize on physiotherapy management. Considering the several impairment such persistent pulmonary function impairment, muscle weakness, pain and fatigue often associated with severe COVID-19, thus the roles of physiotherapy are anticipated. This session shall highlight physiotherapy assessment and intervention involve in managing post Covid-19 patient pertaining to these case scenario. The discussion will include the outcome measure used and several interventions such as but not limited to breathing exercise and limb exercise. 36
ABSTRACT Inter-disciplinary Perspectives Case Based Series Occupational Therapy Management for Fatigue , Brain Fog, Insomnia & Psychological Distress TACKLING THE WAX & WANE MADAM JULIANA IBRAHIM Limitation in doing simple routine activities is such a burden to people who survive from covid19. It is as simple as waking up in the early morning and going to the bathroom to shower. Tired and frustrated when it takes an hour to complete and most of the time still need help from family members. Everything is new to them and for medical frontiers to face and battle. Do the symptoms of fatigue or psychological distress cause insomnia or brain fog? No one knows, and everyone is unique. They have their own way to combat the battle and survive. Occupational Therapy practices and trains a theory in energy conservation techniques, cognitive therapy, and behavior therapy to modify and adjust the individual needs in achieving independent living with optimum ability. Step by step and trying hard as well as minimizes mistake is the key to help post covid19 survivors to succeed. Learn a new skill such as relaxation techniques and master on that becomes familiar and useful for almost post covid19 heroes. Every day they explore simple ways to adapt and complete routine activities. They scarify to relearn skills for the easy tasks until they mastered and are satisfied better than premorbid skills. 37
ABSTRACT Inter-disciplinary Perspectives Case Based Series Post COVID-19 Stroke & Spasticity IS THERE ROLE OF BOTULINUM NEUROTOXIN? DR KAVITHA ANDIAPPAN Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke. Although respiratory symptoms are most commonly reported, neurological symptoms are increasingly recognized. However, the data on the characteristics of stroke presentation in Covid-19 is still sparse. More so when it comes to the incidence and features of spasticity in stroke associated with Covid-19. We take this opportunity to discuss our experience and findings in managing patients with post stroke spasticity in the background of Covid-19. 38
ABSTRACT Inter-disciplinary Perspectives Case Based Series Return To Work Program THE ULTIMATE TARGET DR FAZITA ABDUL TALIB Pertubuhan Keselamatan Pekerja (PERKESO) collaborated with Rehabilitation Medicine Services fraternity both within the Ministry of Health, Ministry of Education and private entities to provide support for eligible insured worker affected by Post COVID-19 condition. This session shall highlight and elaborate on the PERKESO’s role in PCC management. These include but not limited to empowerments of the survivors with impairments with the required skills under the Return to Work (RTW) Program; provision of intensive and holistic care based on the survivors unique requirements; supporting those clinically indicated with appropriate rehabilitation aids and devices; financial benefits to those eligible and enrollment of suitable insured individuals for intensive program provided at the main PERKESO Rehabilitation Centre Tun Abdul Razak in Melaka and its satellite branches. 39
BIBLIOGRAPHY Update on Clinical Long-Term Effects of COVID-19. World Health Organization, 2021. https://www.who.int/docs/default-source/coronaviruse/risk-comms- updates/update54_clinical_long_term_effects.pdf World Health Organization Global Webinar on Expanding our Understanding of Post COVID- 19 Condition (PCC) – Rehabilitation Care 6 October 2021. https://www.who.int/news-room/events/detail/2021/10/06/default calendar/expanding-our-understanding-of-post-covid-19-condition-web-series- rehabilitation-care COVID-19 Statistics Ministry of Health Malaysia https://covidnow.moh.gov.my/ COVID-19 Rehabilitation Out-patient Specialized Services (CROSS) Pandemic Calamity Response. Malaysian Medical Association Newsletter Feb 2021; Volume 51; No 2: 28-29. Support for Rehabilitation: Self-Management after COVID-19 Related Illness Second Edition. World Health Organization 2021. Boleh didapati di laman sesawang: Sokongan untuk Pemulihan: Pengurusan Kendiri bagi Gejala Berkaitan COVID-19. Pertubuhan Kesihatan Sedunia usahasama penterjemahan oleh Jabatan Perubatan Pemulihan Pusat Perubatan Universiti Malaya 2021. https://apps.who.int/iris/handle/10665/344472 Post COVID-19 Management Protocol Ministry of Health Malaysia. 2021. https://COVID-19.moh.gov.my/garis-panduan/garis-panduan-kkm Rehabilitation & Allied Health Practice Considerations Post COVID-19. Alberta Health Services June 2021. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-COVID-19-rehab- allied-health-practice-considerations-post-covid Patient Information leaflet. Stop Cough Technique. NHS West Suffolk. NHS Trust Foundation 2021. Inamoto Y., Pongpipatpaiboon K., Shibata S., Aoyagai Y., Kagaya H., Matsuo K. (2018) Swallowing Exercises. In: Saitoh E., Pongpipatpaiboon K., Inamoto Y., Kagaya H. (eds) Dysphagia Evaluation and Treatment. Return to Work (RTW) Programme, Social Security Organization (SOCSO); https://www.perkeso.gov.my/uncategorised/70-program-return-to-work-rtw.html 40
REHABILITATION MEDICINE DEPARTMENT THROWBACK 2015 - 2021 REHABILITATION MEDICINE DEPARTMENT 2021 REHABILITATION MEDICINE DEPARTMENT 2020 41
REHABILITATION MEDICINE DEPARTMENT THROWBACK 2015 - 2021 REHABILITATION MEDICINE DEPARTMENT 2018 ESSENTIAL SCI REHABILITATION IN CONJUNCTION WITH WORLD SCI DAY 2019 REHABILITATION MEDICINE DEPARTMENT 2016 42
REHABILITATION MEDICINE DEPARTMENT THROWBACK 2015 - 2021 REHABILITATION MEDICINE DEPARTMENT 2017 ESSENTIAL SCI REHABILITATION IN CONJUNCTION WITH WORLD SCI DAY 2019 REHABILITATION MEDICINE DEPARTMENT 2016 43
REHABILITATION MEDICINE DEPARTMENT THROWBACK 2015 - 2021 REHABILITATION MEDICINE DEPARTMENT 2015 ESSENTIAL SCI REHABILITATION IN CONJUNCTION WITH WORLD SCI DAY 2019 REHABILITATION MEDICINE DEPARTMENT 2016 44
SYMPOSIUM & TRAININGS THROWBACK 2015 - 2021 45
KEY AWARDS & ACHIEVEMENTS 46
KEY AWARDS & ACHIEVEMENTS 47
BOOKS PUBLICATION 48
ACKNOWLEDGEMENT The Honorable Minister of Health Malaysia , Mr Khairy Jamaluddin Abu Bakar Director General of Health Malaysia, Tan Sri Dato’ Sri Dr Noor Hisham Abdullah Dato’ Dr Asmayani Khalib, Deputy Director General of Health Malaysia (Medical) Dr Mohd Fikri Ujang, Director of Medical Development Division, Ministry of Health Malaysia Dr Yusniza Md Yusof, Head of Rehabilitation Medicine Services, Ministry of Health Malaysia Dato’ Indera Sha’ari Ngadiman, Director of Selangor State Health Department Dr Kuldip Kaur Prem Singh, Director Hospital Sungai Buloh Dato’ Dr Suresh Kumar Chidambaran, Head of Medical Department/Head of Infectious Disease Unit, Hospital Sungai Buloh Deputy Directors, Head of Departments and Units, Hospital Sungai Buloh All dedicated members of Medical, Rehabilitation Medicine and other Departments of Hospital Sungai Buloh President and all members of Malaysian Association of Rehabilitation Physician. Social Security Organization (SOCSO) Care & Share Circle All of our patients and their caregivers Vendors and sponsors All those whom had contributed directly or indirectly to the successful organization of this conference 49
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