Therapeutic Exercise for Postoperative management Flashcards
week 5
When might surgical intervention be warranted?
- when conservative managment is unsuccessful
- severity of condition or injury is not for appropriate conservative management
- incapacitating pain
- gross instability of a joint or bone due to a fracture
- deformations (congenital, or injury/trauma)
- functional loss leading to disability
pre operative management
patient eduction should include
- overview of POC
- pain management
- wound care
- postoperative recaustions
- post overative expectations
- bed mobility and transfers
- preoperative exercises
- intial postoperative exercises
- gait training
factors influencing postoperative rehab
- tissue related factors
- procedure related factors
when assessing tissue related factors what are you considering?
- extent of tissue pathology or damage
- tissue type and characteristics (healing potential, stage oftissue healing, integrity of structures adjacent to involed tissues)
when assessing procedure related factors what are you considering
- type and unique characteristics of the surgical procedure
- philosophy of the surgeon
what are some pt related factors
- age
- extent of preoperative impairements and functional limitatiosn
- health history
- lifestyle history
- needs, goals, expectations and social support
- level of motivation and ability to adhere to an HEP
these look similar to tissue tolerance for exercise
what are some typical postovertive impairments?
- pain
- swelling
- potential circulator/pulmonary complications
- jont stiffness or limitation
- muscle disuse atrophy bc of immobilization
- loss of strength
- limitation of weight bearing
- loss of strenght mobility of nonoperated joints
pulmonary dysfunction including
including pneumonia or atelectasis
infection including
- local
- systemic
some muscle function deficits could be seen postoperatively
- ischemia
- nerve compression
these could occur from the tourniquet during surgery
what are some other potential postoperative complications
- boney union
- rupture of incompletely healed soft tissue
- subluxation or dislocation
- nerve
- contractures
- failure, or dispalcement of internal fixation devices or joint implants
post operative check for signs of:
- redness
- tissue necrosis
- tenderness
- edema
- heat
- dranage (noting color and amount on dressing)
- assess incision integrity crossing a joint during/after exercise
- incision heals, check the mobility of the scar
gerenal postoperative phases
maximum protection
- manage pain & swelling
- prevent post op complications
- resume a safe lvl of protected functional mobility
timesframes vary based on procedure
general postoperative phases
moderate protection
- tissues can handle stress that is gradually introduced
- gradually restore ROM, neuromuscualr control, stability, balance, muscular performance, cardiopulmonary endurance
general postoperative phases
minimum protection
- continue to restore increase and optimize function and performance
plan of care: maximum protection
9 steps
1) pt edu
- safe positioning and limb movements
- postoperative precautions and/or contraindications
2) decrease postoperative pain, muscle guarding or spasm:
- relaxation exercises
- modalities (cold, heat, TENS)
3) prevent wound infection:
- monitor close
- instruct ina dn review proper wound care w/pt
4) minimize swelling
- elevation of operated extremity
- active muscle pumping exercises at distal joints
- compression garment
- gentle distal to proximal massage (MLD)
5) prevent complications, such as DVT, PE, pneumonia
- active exercies to distal muscles
- deep breathing & coughing exercises
6) prevent or minimize contractures
- CPM or PROM or AAROM
7) minimize muscle atrophy across immobilized joints
- muscle setting exercises
8) maintain ROM and strenth above and below operative site:
- ative and resistive ROM exercises to non-operated areas
9) maintain protected functional mobility:
- adaptive equipment and assistve devices
plan of care: moderate protection
4 steps
1) pt edu
- monitor effects of exercise program
- appropriate adjustments if swelling or pain increases
2) gradually restore soft tissue and joint mobility
- AAROM AROM
- joint mobilization procedures
3) establish a mobile scar
- gentle massage across and around the maturing scar
4) strengthen involved muscle and improve joint stability:
- agasint increasing resistance
- isometrics and rhythmic stabilization
- dynamic exercise against light resistance in open and closed chain positions
- light functional activities w/ operated limb
plan of care: minimum protection
6 steps
1) pt edu
- incorporate gradual yet progressive muscle perforamnce, mobility and balance into functional activities
2) prevent reinjyry or postoperative complications
- reinforce self monitoring and review the signs and symptoms of excessive use
- identify unsafe activites
3) restor full joint and soft tissue mobility:
- jont mobs and self stretching techniques
4) maximizez muscle perforamcne, dynamic stability and neuromuscular control:
- progressive strengthening exercises
- simulate functiona activiteis w exercises
5) restor balance coordination
6)acquire or relearn specific motor skills
- apply priniciples of motor learning
- feedback during task specific training
the goals across all the phase of rehab look very similar and can be boiled down to:
- manage pain and swelling and resume safe level of protected functional mobility
- gradually restore ROM, neuromuscular control, stability, balance, muscular performance and cardiopulmonary endurance
- further restor increased with increaing focus on function and performance
signs of DVT or PE postoperatively
- color change (Red/purple)
- can have pitting edema
- swelling
- increase pain (esp if it has been reducing and then goes back up)
- superficial collateral veins (bulging)
