Principles of Pre- and Postoperative Physiotherapy PDF

Principles of Pre- and Postoperative Physiotherapy During preoperative physiotherapy assessment the therapist should specifically look for the following: Respiratory issues such as impaired air entry, inability to cough and clear secretions from the airway effectively. Lifestyle issues such as...

Principles of Pre- and Postoperative Physiotherapy During preoperative physiotherapy assessment the therapist should specifically look for the following: Respiratory issues such as impaired air entry, inability to cough and clear secretions from the airway effectively. Lifestyle issues such as sedentary habits, obesity, smoking and alcohol abuse. Cardiovascular issues such as reduced exercise tolerance due to deconditioning, chest pain, varicosity, risk for developing deep vein thrombosis and persistent edemas of the feet or hands. Musculoskeletal issues such as arthritis, contractures, tightness and deformity and muscular weakness or incompetence, specifically related to the site of the operation and the extremities affected directly after the operation.  Respiratory Issues Needing Specific Attention of the Therapist  the deterioration of respiratory muscle function after spinal, brain, thoracic and abdominal surgeries contribute significantly to poor pulmonary function and this leads to the incidence of postoperative respiratory complications, increasing rate of morbidity and mortality in all types of surgical cases.  Inhibition of chest expansion due to stretch pain of the surgical wound and reduced respiratory muscular activity contribute significantly to development of common postoperative pulmonary complications such as reductions in pulmonary flows and volumes, leading to atelectasis, reduced cough efficiency, increased work of breathing.  Active smokers have an increased risk of postoperative pulmonary complications.  Physiotherapy in Abdominal Surgeries  Postoperative Rehabilitation Program, The program is broken down into stages and must be completed step by step. The patient should not progress to the next stage until he has mastered the exercises of the previous stage. The stages are:  Stage 1: Learn to contract the deep muscles which stabilize the spine. At first this takes quite a bit of concentration. Each individual will master this at their own pace. There is no set time, but perseverance is the key.  Stage 2: Increase the endurance capacity of the deep stabilizing muscles of the spine, by practicing to contract them in different situations for as long as one can. This will become easier with practice.  Stage 3: Begin arm and leg movements whilst contracting the deep stabilizing muscles of the spine.  Stage 4: Progress to the core strengthening exercises, while contracting the deep stabilizing muscles (out-patient \ on clinic).  Instruments Needed for Core Strengthening Exercises  The exercises of the core strengthening program are a progression from the previously described core stabilization exercises. It is very important to ensure that a controlled contraction of the core stabilizing muscles is maintained during all of these exercises.  Essential kits for core strengthening exercises are:  Gym ball  6’ × 3’ exercise mat  Medicine ball.  Day 1  The patient should be able to sit up on bed independently into an upright position, in order to promote scarring in functional position.  Start with isometric abdominal exercises: Lie supine with knees bent.  Slide hands up thighs, then hold for four seconds at half way position (6 repetitions).  Then do knee rolls: Lying supine, roll both knees to the left, then to the right (6 repetitions).  Then flex one knee up to chest and straighten other knee out and keep it raised 10 cm off the bed. Repeat other side (6 repetitions). Days 2–5  Carry out daily exercises as for day one (8 repetitions), three times each day.  Initiate gentle cardiovascular work in straight lines using bike, stepper, cross trainer, etc. From Day 6  Continue exercises as for days 2–5 (10 repetitions), three times each day. Continue cardiovascular work in straight lines with bike, stepper, cross trainer, etc.  Initiate core strength exercises—2 sets of each exercise.  Core Strength Exercises  1. Side/holds with leg lift: Lay on side, with the trunk straight, resting on the elbow. Raise the upper leg and hold for four seconds, then relax. Repeat 10 times.  2. Trunk twists (med ball between knees): Balance on the trunk on a gym ball, with a medicine ball held between the knees. Hold another medicine ball in outstretched arms and twist slowly from left to right, then back again.  3. Lunges: Lunge forward. Progress to lunging forward with a medicine ball in outstretched arms and then twist in alternate directions, right then left.  4. Ball rolls: shoulder, trunk and adductor exercise: Place hands on the floor and feet balancing on the gym ball. Roll the gym ball first to the left then to the right. Repeat 10 times on either side.  5. Adductor strengthening: Lie on one side on an exercise mat. Bend the top leg as shown. Lift the underside leg off the floor and hold for a count of five. Repeat 5 times.  6. Hamstring exercises: Lie on the back on the mat with heels on top of the gym ball. Dig the heels into the ball and lift the pelvis up. Hold for 4 seconds.  7. Hamstring and gluteal exercise: With the knees bent at 90° and ankles 15 cm apart, balance on the gym ball lying on the back. Tighten the bottom and push the pelvis up. Raise alternate legs to horizontal and hold for 4 seconds.  8. Trunk exercise: Sit on the gym ball and balance with the feet off the ground. Note how long can one balance before touching the ground.  9. Back extensor exercise: Lying prone, slowly lift the head and shoulders up off the floor. Hold for 6 seconds.  10. Back extensor and gluteal exercise: Lying supine, keep knee straight and slowly lift one leg up. Hold for 6 seconds then relax. Repeat with opposite leg.  11. Back extensor and gluteal exercise: Lying supine, slowly lift opposite arm and leg. Hold for 6 seconds. Repeat on other side Side/holds with leg lift in side lying on arm support Trunk twists back resting on gym ball Lunges—starting position Hamstring exercises—rolling a gym ball forward and back with feet Adductor strengthening exercises in side lying Ball rolling exercises in arm support prone lying with legs resting on gym ball Hamstring and gluteal exercises—trunk resting on a gym ball Trunk exercises—sitting on a gym ball with feet off the ground Back extensor exercises—prone lying on a mat Back extensor and gluteal exercise—prone lying on a mat, raising head and alternate legs simultaneously Back extensor and gluteal exercise—prone lying on a mat, opposite arm and legs raised simultaneously From Day 7  Discontinue mat exercises.  Progress core strength exercises to 2 sets × 8 repetitions.  Start bike, stepper, cross trainer progression.  Once the wound is closed and stitches removed initiate hydrotherapy rehabilitation—aqua jogging in straight lines wearing buoyancy belt. From Day 9  Progress core strength exercises to 2 sets × 10 repetitions.  Continue bike, stepper, cross trainer progression.  Continue hydrotherapy progression. From Day 12  Progress core strength exercises to 3 sets × 8 repetitions.  Continue bike, stepper, cross trainer progression.  Continue hydrotherapy progression. From Day 15  Progress core strength exercises to 3 sets × 10 repetitions.  Continue bike, stepper, cross trainer progression.  Initiate straight line jogging (treadmill) at slow speed.  Continue hydrotherapy progression. From Day 18  Progress core strength exercises to 3 sets × 12 repetitions.  Continue bike, stepper, cross trainer progression.  Progress speed of straight line running (treadmill).  Continue hydrotherapy progression.  Initiate single plane power exercises—squats, calf raises, clean and jerk. From Day 21  Progress core strength exercises to 4 sets × 10 repetitions.  Continue bike, stepper, cross trainer progression.  Progress speed of straight line running to three-fourth pace (treadmill).  Continue hydrotherapy progression.  Continue progression of single plane power exercises—squats, calf raises, clean and jerk. From Day 24  Progress core strength exercises to 4 sets × 10 repetitions.  Continue bike, stepper, cross trainer progression.  Progress speed straight line running to sprints. Introduce ball work to 75 percent straight runs.  Continue core strength exercises to 4 sets × 12 repetitions as a preventive strategy.  Continue bike, stepper, cross trainer progression.  Continue straight line running sprints/ball work to 100 percent straight runs.  Progress to full functional training.