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Therapeutic Exercise I Chapter 12

Therapeutic Exercise I Chapter 12. Surgical Interventions and Postoperative Management. Non-operative options. Rest Protection/Splinting Use of assisted device Medication. Non-operative options. Therapeutic Exercises Manual Therapy Functional Training

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Therapeutic Exercise I Chapter 12

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  1. Therapeutic Exercise IChapter 12 Surgical Interventions and Postoperative Management

  2. Non-operative options • Rest • Protection/Splinting • Use of assisted device • Medication

  3. Non-operative options • Therapeutic Exercises • Manual Therapy • Functional Training • Use of Physical Agents/Electrotherapy

  4. Guidelines for Pre-Operative and Post-Operative Management • Ideally rehabilitation starts pre-surgery, through the recovery of surgery and after…with a well devised self-management program (HEP) • Although surgery can correct or reduce adverse effects/impairments, a well designed post-operative program is essential to achieve optimal functional outcomes

  5. Pre-Operative Examination and Evaluation • Should contain the following information for realistic goals and relevant functional activities to be accomplished following surgery and with the implementation of Physical Rehabilitation….which are the same components following the evaluation after surgery and throughout the rehabilitation process

  6. Pre-Operative Examination and Evaluation Continued: --Pain-use of pain scale (visual analog scale or a scale specific on functional activities) --ROM and Joint Integrity --Integrity of the skin --Muscle Performance --Posture --Gait Analysis --Functional Status

  7. Components of Preoperative Patient Education • Overview of the POC • Post-operative precautions • Bed mobility/transfers • Initial post-operative exercises • Gait training • Wound care

  8. Post-Operative Examination and Evaluation • A well devised POC should be constructed by the supervising PT composed of: therapeutic exercises, functional modalities, functional training, and ongoing patient education • Ongoing exam/evaluation will help design an individuals program/HEP

  9. Phases of Post-Operative Rehabilitation: • Maximal protection phase • Moderate protection phase • Minimal Protection/return to function phase Note: Time-Based and Criterion-Based Progression…each time frame will vary pending tissues involved and type of procedure, along with the patients response

  10. Putting Post-Operative Rehabilitation into Perspective • Due to limited therapy sessions by the insurance companies or patient’s ability for payment/attend PT sessions…all phases will not necessarily be under the care of the therapist, therefore it is imperative to educate the patient to ensure safe and effective self-management of their program, and is important to periodically monitor and modify the program as needed

  11. Potential Post-Operative Complications • Pulmonary • Deep Vein Thrombosis (DVT) • Subluxation or dislocation after joint surgery • Restricted motion from adhesions and scar tissue formation • Failure, displacement, or loosening of internal fixation

  12. Surgical Approaches • Open • Arthroscopic • Arthroscopically Assisted Procedure

  13. Use of Tissue Grafts • Autograft-(autogenous or autologus graft) is when the patient uses their own harvested tissue • Allograft- is when a fresh or cryopreserved tissue is used by a source other than the patient ie: cadaver • Synthetic grafts- is when materials such as Gore-Tex and Dacron is offered as an alternative to human tissue (however, not a successful rate)

  14. Types of Tissue Grafts: • http://www.bing.com/images/search?q=pictures+of+hamstring+grafts&view=detail&id=0BE71E4EE74A48E86D203DB566B42B38B9905217&first=31&FORM=IDFRIR Hamstring Auto Graft Allograft Synthetic Gore-Tex Synthetic Dacron

  15. Types of Repairs, Reattachments, Reconstruction, Stabilization or Transfers of Soft Tissue • Muscle repair • Tendon repair • Ligament repair • Capsule stabilization and reconstruction • Tendon transfer or re-alignment • Release, lengthening, or decompression

  16. Joint Procedures • Synovectomy • Articular Cartilage Procedures • Arthroplasty (Minimally invasive versus traditional arthroplasty) • Arthrodesis • Extra-Articular Bony Procedures

  17. Examples of Traditional Arthroplasty: Shoulder

  18. Alternative Arthroplasty:

  19. Remember!!!!! • Always communicate with your supervising PT • Be aware of abnormal signs and repot them to your supervising PT • As a PTA you are to assist the entire process, including preparations for discharge • Always educate the patient and ensure safe performance of any activity asked of them-supply with HEP only if the patient fully understands what is being asked of them

  20. Remember!!!! • Communication is both verbal and non-verbal • It is your responsibility to communicate with all health care personnel that are involved in the patients care • Be timely, accurate, and concise with your documentation • Always use good body mechanics for your and your patient and ensure a safe environment to work in

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