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 Use of Physical Agents/Electrotherapy

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

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

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

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

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

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

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

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

Surgical Approaches Open Arthroscopic Arthroscopically Assisted Procedure

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)

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

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

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

Examples of Traditional Arthroplasty: Shoulder

Alternative Arthroplasty:

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

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