Physiotherapy in Pre and Post Operative Spine Surgeries

Physiotherapy
in
Pre and Post
operative
• The incidence of pulmonary and circular complications
is higher after abdominal surgery
• Physical therapy has a valuable role to play in prevention

of respiratory and circulatory complications as well as
their treatment
Key Concepts
• Principles /Aims of physiotherapy

• Preoperative assessment
• Preoperative training
• Postoperative assessment
• Post operative training
Principles /Aims of physiotherapy
To prevent chest complications

To prevent circulatory complications
To maintain muscle power and joint ROM

To prevent pressure sore
To maintain good posture
To improve & enhance bed mobility

To gain cooperation & confidence
To educate the patient
Steps of physiotherapy in SPINE SURGERIES
Preoperative
Preoperative assessment
physiotherapy Preoperative
training
Postoperative
Postoperative assessment
Postoperative
physiotherapy training
Preoperative physiotherapy
Ideally patient should be admitted to the hospital 24 hours

or more before the operation
This allowed the patient to settle in and to meet those who are
responsible for the surgery
Preoperative assessment
a) Read the notes
b) Assess the respiratory functions
c) Check for circulatory problems
d) Detailed history of the patient
It include both subjective and objective

assessment
Benefits
• To gain good rapport

• To know the functional status
• To understand patients goals
a) Clinical notes reading
• Causes for surgery
• Comorbid conditions – like asthma, obesity, diabetes etc.
• Any other notes by the surgeon/ physician
b) Respiratory assessment
• Chest deformities – Kyphosis, Kyphoscoliosis,
pectusexcavatum and pectuscarninatum
• Breathing pattern – Normal rate
Inspiration and Expiration ratio
• Abnormal breathing pattern – Pursed lip breathing
Apnoea, Hypopnea
Cheyne stokes respiration
Ataxic breathing
Apneustic breathing
• Chest movements – Symmetry of chest movements
Depth of respiration
Accessory muscle involvement
• Chest expansion – Both observational and palpation
• Dyspnoea/ Breathlessness – “The New York Heart Association
Scale Of Dyspnoea”
• Orthopnoea – Breathless when lying flat
“The New York Heart Association Scale Of Dyspnoea”
I - No symptoms with ordinary activity /Breathlessness with exertion
II – Symptoms with ordinary activity
III – Symptoms with mild exertion
IV- Symptoms at rest

d) Circulatory assessment
• Homan’s test
• oedema- qualitative and quantitative
both
e) History taking
• Medical history
• Subjective history
Preoperative training
Teach the patient any exercise that will be started during the very
early postoperative period
These often include..
• Breathing exercise
• Cough reflex
• Arm and leg exercise
• Posture correction
Benefits
• To educate and train the patient about the post operative
exercise program and physiotherapy importance
a) Patient education
• Explain the general plan of care
• Pre operative instructions
b) Breathing exercises
• Diaphragmatic and local expansion exercises
c) Cough
• Teach huffing and coughing technique
d) Arm exercises
• Short lever exercises
• Long lever exercises
e) Leg exercises
• Ankle& toe movements
• Static Q’ceps & glutei
f) Posture correction
• Advices
• Ergonomic advantages
Post-operative physiotherapy
Aim
• To avoid respiratory and circulatory complication
• To prevent pressure sore
• To prevent muscle wasting and joint stiffness
• To prevent wound infection
• Scar management
• Postural awareness
• Complete rehabilitation in ADL
Post operative assessment
(SOAP assessment format should be followed)
• Surgery notes reading

• Vital signs checking
• Understating the attachments
• Objective assessment
• Inspection of the surgical incision
Benefit –
• To know the post operative problems of the patient

a) Surgery notes reading
• Type of incision
• Type of anaesthesia
• Duration of surgery
• Immediate
complications/unwanted
events/management
b) •Vital signs
Pulse checking
oximetry • CVP
• PR • TPR chart
• ECG • Ventilator support
• Lungs volume
• Heart sounds
• ABG analysis
• Systemic arterial blood pressure
c) Understanding the
attachments
• IV lines
• Nasogastric tube
• Catheter
• PCA- patient control anaesthesia
• Drains
d) Orientation assessment
• Communication ability
• Alertness
• Perceptual ability to follow instructions
e) Objective assessment
i. Respiratory
ii. Circulatory
iii. ROM/MUSCLE POWER
iv. Mobility/functional
i) Respiratory assessment
• Painful Breathing
• Difficulty In Coughing
• Impaired Respiration
• Accumulation Of Secretions
• Palpation
• Auscultation
ii) Circulatory assessment
• Homan’s sign
• Oedema
iii) Posture & mobility

• Kypho scoliosis
• Bed mobility
iv) Pain assessment

• VAS
• MPQ
• NPRS
Post operative training
Benefits
• Early recovery and less hospital stay
a) To prevent chest complication

• Breathing exercise (emphasis on lower segments)
• Coughing/cough support
• Inhalation, humidification & PD
• Breath control exercises with arm movements
b) To prevent circulatory complication
• Trendelenburg tilt (15 degree bed end elevation)

• Leg exercises
• Early ambulation
• Bed mobility
• Trunk &abs exercises
• Prevention by medical means
e) Prevention of bad posture

• Firm back support
• Chair with arms
• Over correction
f) To prevent muscle wasting and joint stiffness
• Strengthening exe to weak muscle

• Endurance training
• Encourage walking and increase distance gradually
• Stair climbing
• Ask the Patient to be as independent as possible.
• Immediately after surgery, encourage patient to move his
limbs freely in full ROM.
• Relaxed passive movements.
• Active assisted exe. in full ROM then active movments.
g) Scar management
• Friction massage
• Modality like us.
h) Complete rehabilitation in ADL

Transitioning Supine to/from Sitting
SITTING
BALANCE
SELECTING A
WHEELCHAIR
• Pt with high cervical lesions (C1-C4) require electric
wheelchair with tilt-in space seating or reclining seat back;
microswitch or puff and sip control, portable respirator may
be attached
• Pt with cervical lesions, shoulder function, elbow flexion
(C5): can use a manual chair with propulsion aids
independent for short distances on smooth flat surfaces;
may choose electric wheelchair for distances and energy
conservation
• C6: manual wheelchair with friction surface
hand rims; independent
• C7: same for C6, but with increased
propulsion
• Patients with hand function C8-T1 and
below: manual wheelchair, standard hand
rims
• Significant changes in lighter, more
durable, sports-oriented chairs
APPROPRIATE ORTHOTIC
PRESCRIPTION/ AMBULATION
TRAINING
• Pt’s with midthoracic lesions (T6-9): supervised
ambulation for short distances (physiological,
limited household ambulatory); requires
bilateral knee-ankle-foot orthoses and crutches,
swing-to gait pattern; requires assistance; may
prefer standing devices/ standing wheelchairs
for physiological standing
• Pt’s with high lumbar lesions (T12-L3); can be
independent in ambulation all surfaces and
stairs; using a swing-through or four-point gait
pattern and bilateral KAFOs and gait orthoses
with walker with or without FES system.
Typically independent house hold ambulators;
wheelchair use for community ambulation
• Patients with low lumbar lesions (L4-5); can
crutches or canes. Typically independent
community ambulators; may still use
wheelchair for activities with high-endurance
requirements.
• High rate of rejection of orthoses/ambulation
in favor of wheelchair mobility and energy
conservation

Physiotherapy in Pre and Post Operative Spine Surgeries

Uploaded by

Copyright:

Available Formats

Physiotherapy in Pre and Post Operative Spine Surgeries

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Physiotherapy in Pre and Post Operative Spine Surgeries

Uploaded by

Copyright:

Available Formats

Physiotherapy

• Physical therapy has a valuable role to play in prevention

• Principles /Aims of physiotherapy

To prevent chest complications

To maintain muscle power and joint ROM

To maintain good posture

To improve & enhance bed mobility

Ideally patient should be admitted to the hospital 24 hours

It include both subjective and objective

• To gain good rapport

“The New York Heart Association Scale Of Dyspnoea”

I - No symptoms with ordinary activity /Breathlessness with exertion

II – Symptoms with ordinary activity

III – Symptoms with mild exertion

IV- Symptoms at rest

(SOAP assessment format should be followed)

• Surgery notes reading

• To know the post operative problems of the patient

iii) Posture & mobility

iv) Pain assessment

a) To prevent chest complication

• Trendelenburg tilt (15 degree bed end elevation)

e) Prevention of bad posture

• Strengthening exe to weak muscle

h) Complete rehabilitation in ADL

You might also like