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Physiotherapy post surgery in the hospital and at Home
Physiotherapy after surgery is an integral part of treatment for patients who are or have been hospitalized as prolonged immobilization puts patients at risk for complications such as deconditioning, muscle weakness, myopathy and neuropathy, respiratory infections, and contractures. It is important for such patients to consider physiotherapy at home as an integral part of the recovery process.
The main aim of a physiotherapist is to assist your return to normal activities of daily living after hospitalisation. Physiotherapists typically help with many aspects of your treatment while in the intensive care unit (ICU) and will continue working with you when you transfer to a general ward until you leave hospital to go home. Even at home, in many cases a physiotherapy home care program can significantly aid the recovery of patient. ReLiva Physiotherapy's home care program is designed and our physiotherapists understand the requirements for post surgical/ post ICU patients
Our home visit physiotherapist will assess and treat :
cardiorespiratory complications of the patients and help them in recovery.
The physiotherapist is involved in specific patient positioning, suctioning, mobilization, ambulation, strengthening and balance exercises, passive range of motion exercises and airway clearance techniques.
As per Dr Farhad Kapadia, Consultant Physician, M.D, M.R.C.P, D.A (U.K.), E.D.I.C, FRCP: "Physiotherapy may be our best tool in getting the patient rapidly functional after a critical illness, and it needs to become an integral aspect of intensive care"
Benefits of physiotherapy in hospital:
Enables the patients to recover from the episodes of hospital as early as possible
Prevent post op complications
Teach the patient how to manage their own recovery post discharge
Facilitate safe and early discharge by reducing the length of stay in the hospital
Improves the quality of life
Physiotherapy helps in:
Improve the cardiovascular endurance
Improved performance of daily tasks
Improves the strength and endurance of the muscles
Improves the lung capacity
Makes the patient mobile and independent
Improves the airway clearance
Early mobilization of ventilated patients by a physiotherapist reduces mortality, and results in improved physical function and mobility
Physiotherapy post surgery:
The main aim is to return to the normal activities as early as possible.
Routine post operative physiotherapy intervention comprises of breathing exercises, circulatory exercises and early mobilisation to prevent complications and education in home management cardiovascular fitness, limiting restrictions due to medical procedure and
Positioning: To prevent complications like bedsores, congestion in the lungs, change of positions after regular intervals become important.
Breathing exercises are important for the patient to reduce the chest infections and improve the air entry in the lungs. It also helps complete expansion of the thorax in order to have an effective breathing. Breathing exercises includes deep breathing exercises, segmental breathing exercises, thoracic expansion exercises, pursed lip breathing exercises and active cycle of breathing techniques.
Coughing huffing techniques where the patient is taught how to do forceful expiration by supporting the wound to get rid of the accumulated sputum actively
Airway clearance: physiotherapists help to clear the excess sputum by different techniques like positioning the patient, postural drainage, suctioning and use of different expiratory devices
It is important to maintain blood circulation following surgery to reduce the risk of deep vein thrombosis due to immobility. Hence mobility exercises are important.
Also, it helps to improve and maintain the joint mobility and muscle strength which eventually gets deconditioned due to illness
Early mobilisation is a key factor in reducing post operative complications, enabling a quick recovery and timely discharge from hospital. Patient is assisted to get out of bed by physiotherapist on the day of your operation or the following day depending upon the type of the surgery. The final goal is to increase patients mobility making them independent and training stair climbing if required.
The above mentioned treatment principles were the general ones. But the treatments differs in different surgeries viz; orthopedic surgeries, abdominal surgeries, cardiothoracic surgeries, vascular surgeries, neuro surgeries.
To determine the treatment needs,the physiotherapist assesses the patients physical function including:
Pain, swelling, joint range of motion, muscle strength, muscle coordination, mobility status, balance, respiratory status and cardiovascular fitness in ortho surgeries
Pain, discrepancies in balance, coordination, muscle weakness and fatigue, work of breathing, and loss of range of movement, loss of cardiovascular fitness and mobility status in abdominal and cardiovascular surgeries
Pain, muscle tone, consciousness, orientation, work of breathing, balance and coordination, sitting and standing ability, synergy patterns, gait in neuro surgeries.
If you or your loved ones, have been recently discharged from the hospital after a long stay, the patient needs to continue supervised physiotherapy treatment to ensure complete recovery in the long term basis. Please feel free to give us a call at 9920991584 and speak to our physiotherapists should you require any assistance.
Let’s take this chance to give someone what most breathless patients miss! We don’t know and most of the time THEY also don’t know that it is possible to better manage and even reduce the Asthma Attacks / COPD episodes and AVOID related Hospitalisation. Share this story with someone you know…
“Your Victory is right around the corner. Never Give up”
I think this quote very appropriately fits one of my patients – Mr Anand Rai (Name changed for patient privacy).
Mr. Rai (Or Rai uncle, as he prefers me to call him) is 71 yrs old retired Engineer who was diagnosed with Chronic Obstructive Pulmonary Disorder (COPD) about thirty year back! When I first saw him for consultation, I was looking at a very tired, breathless and weak looking old man. Despite his many difficulties, he seemed to own an amazing ‘spirit’, a great ‘will’ to get better and a beautiful ‘smile’ on his face.
I was told that Mr Rai had an episode of severe breathlessness, excessive sweating and total black-out one month back, when he was shopping for vegetables. He was immediately taken to the hospital, and admitted there for a week. He had been home bound, since then. After month-long restrictions, due to severe breathlessness and lack of endurance, he was now even scared to go out! Imagine the mental condition of a person, who loves outdoors, travelling, socializing, but because of his condition, is restricted to his house. I still remember his first words to me, “Dr. Kashmira, please make me better, so that I can go out and enjoy the rains when it comes and take a walk in the garden independently.” Another significant factor in his history was that he was a chain smoker for over 30 years, and still smoked 4 cigarettes a day.
Further assessment and observation revealed that he had very-less to no air-entry in the lower zones of his chest. The whole chest was filled with congestion. His overall endurance was very poor, the sputum was greenish yellow in colour, which meant presence of infection in the lungs. All these factors together contributed to severe breathlessness, which could happen even when he was JUST SITTING, without doing any activity! After further (simple) tests and viewing his reports, I discussed his treatment protocol with him.
I have always felt that a patient should be an active participant of his treatment protocol, he should know what his condition is, what protocol we are following for him and how will he benefit from that. His whole and sole goal was to go out for a walk. Even though this seems quite simple to us, imagine how difficult it would be for a person, who cannot walk even a few steps without halting to catch a breath. But what is life without a few challenges in it?! We started working towards our goal together.
When we started with the protocol, my first and foremost goal was to remove or reduce the
main culprit for his severe breathlessness – accumulation of secretions in his chest. So, I started with a combination of steam, Chest Physiotherapy, positioning for the patient and various other techniques. In the next few days, secretion had come down a bit, but the process was painfully slow. But as the saying goes, ‘Slow and steady wins the race’, we continued. And soon his secretions were under control, he was able to move with minimal breathlessness within the house.
Our next challenge was to improve his endurance so that he would feel less tired. So we started with endurance training and secretion removal on alternate days. There were many ups and downs during the therapy. One such incident was when, his friend visited him at his place, and they were chatting continuously for hours together. And when I met him the next day, I was shocked to see him again severely breathless; I felt I will have to start all over again from ground zero. But luckily his condition improved the next day, when he sincerely followed my instruction of not talking the whole day, unless absolutely necessary. He still laughs till date, remembering the stern expression on my face.
Finally after 20 sessions of therapy the day arrived when, it was time for him to step out for a walk, I still remember the joy and also the anxiousness on his face. Before we went downstairs together, I gave him a few important tips, and simply asked him to believe in himself. And we did it! He was able to walk with minimal breathlessness inside the building compound and he was able to climb the stairs as well!
I continued the therapy for 10 more sessions, because we still needed to improve his endurance during walking and stair climbing. On 30th session, I discharged him, I still remember the words he said to me that day, “Dr. Kashmira, I don’t feel like calling you a doctor.” A bit confused I asked him why.
He answered, “I feel like calling you ‘beta’, because now you’re like a daughter to me.” And I didn’t know how to reply to that, so I just smiled.
Contributed by Dr. Kashmira Khedgaonkar (PT). She is an ever smiling Physiotherapist with ReLiva Physiotherapy & Rehab ( www.reliva.in ) who has a special trait of gaining confidence of the toughest of people. She deserves it rightly so, with her skills to put her learning to practice to enable their recovery.
DISCLAIMER: Picture of Pulmonary Physiotherapy session does not represent the patient in the story and used for representational purpose only.
Most people have no idea that THIS is what patients of Asthma and COPD have to face during acute episodes of breathlessness. Read on to discover how he got back to his everyday life ! If you know a fellow Asthma/ COPD fighter, please SHARE this story.