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Textbook of Physiotherapy in Surgical Conditions
Pushpal K Mitra
CHAPTER 1:
Role and Scope of Physical Rehabilitation after Surgery
ROLE OF NURSING CARE
ROLE OF PHYSICAL THERAPY
ROLE OF OCCUPATIONAL THERAPY
ROLE OF PROSTHETICS AND ORTHOTICS
ROLE OF FOLLOW-UP MEDICAL CARE
ROLE OF DIETETICS AND NUTRITION
ROLE OF CLINICAL PSYCHOLOGY, VOCATIONAL AND SOCIAL SERVICES
How can Physiotherapy Help after Surgery?
ROLE OF CORRECTIVE POSITIONING AND EXERCISES
ROLE OF CHEST PHYSIOTHERAPY
ROLE OF ELECTROTHERAPY
Electrotherapy in Pain Management
Interferential Therapy
Microcurrent Therapy
Transcutaneous Electrical Nerve Stimulation (TENS)
Electrotherapy in Muscle Rehabilitation
Neuromuscular Stimulation
High or Low Voltage Pulsed Direct Current Therapy
Electrotherapy in Fluid Movement
Interferential Therapy
High or low voltage Pulsed Direct Current Therapy
Neuromuscullar Stimulation
ROLE OF MANUAL THERAPY, MASSAGE STRAPPING AND ACUPUNCTURE
CHAPTER 2:
Principles of Pre- and Postoperative Physiotherapy
CONCLUSION
REFERENCES
ANNEXURE 2.1
CHAPTER 3:
Physiotherapy in Abdominal Surgeries
OPEN ABDOMINAL INCISIONS
Physiotherapy in Abdominal Surgeries
PLANNING OF AN ABDOMINAL INCISION
CLASSIFICATION OF INCISIONS
Vertical Incisions
Midline Incision (Fig. 3.5)
Advantages
Disadvantages
Paramedian Incision (Fig. 3.6)
Disadvantages
Transverse Incisions (Fig. 3.7)
Kocher Subcostal Incision (Fig. 3.8)
Transverse Muscle-dividing Incision
McBurney Grid Iron or Muscle-split Incision (Fig. 3.10)
Pfannenstiel and Maylard Transverse Muscle Cutting Incision
Thoracoabdominal Incision (Figs 3.11 and 3.12)
Why does a Physiotherapist Need to Know about Surgical Incisions?
Points to Ponder
LAPAROSCOPY—ABDOMINAL SURGERY THROUGH KEYHOLE INCISION
Definition
Indications for Laparoscopy
Preoperative Protocol
Anesthesia
Description of the Procedure
After Procedure
Pain After Laparoscopy
Possible Complications
Average Hospital Stay
Postoperative Care
Outcome
Preparing for Surgery
What the Patient Needs to Know about Medications?
Instructions to the Patient before Surgery
Planning Recovery
COMMON ABDOMINAL SURGERIES AND THEIR POSTOPERATIVE PHYSIOTHERAPY MANAGEMENT
Operation of the Gallbladder
Drainage Tubes
Postoperative Care
After Open Cholecystectomy
After Laparoscopic Cholecystectomy
Repair of Inguinal Hernia
Common Signs and Symptoms of Inguinal Hernia
Pathomechanics of Inguinal Hernia
Diagnosis of Inguinal Hernia
How Pressure Biofeedback Device Works?
Compression Shorts
Surgical Repair of Inguinal Hernia
Prevention of Inguinal Hernia
Partial and Total Gastrectomy—Surgeries for Stomach Cancer
Causes of Stomach Cancer
Symptoms of Stomach Cancer
Diagnosis of Stomach Cancers
Staging of Stomach Cancers
Treatment of Stomach Cancers
The Operation
Bypass Surgery
Drips and Drains
Drinking and Eating
Pain
Postoperative Complications
Going Home
PRINCIPLES OF POSTOPERATIVE EXERCISES AFTER ABDOMINAL SURGERIES
Role of Core Muscles in Trunk Stability
What is the Core Strengthening Program?
How will it Help During Postoperative Rehabilitation?
Postoperative Rehabilitation Program
Points to Ponder
Instruments Needed for Core Strengthening Exercises
Day 1
Days 2–5
From Day 6
Core Strength Exercises
From Day 7
From Day 9
From Day 12
From Day 15
From Day 18
From Day 21
From Day 24
REFERENCES
CHAPTER 4:
Physiotherapy in Cardiothoracic Surgeries
INTRODUCTION
What is Cardiothoracic Suregry?
The Cardiothoracic Team
Indications for Cardiothoracic Surgery
Brief Outline of the Anatomy and Physiology of the Lungs
THORACOTOMY
Definition
Types and Description
Common Indications for Thoracotomy
Preoperative Preparation
Preoperative Physiotherapy
Procedure
Aftercare
Risks
New Alternatives
Common Surgeries of the Lungs
Common Causes for Lung Surgeries
Potential Complications of the Procedure
Postoperative Care after Lung Surgeries
Pain Management
Care of Drainage Tubes and Catheters after Surgery
Points to Ponder
How to do Self-care of the Lungs?
How to Restore Normal Activity?
How to Care at Home?
Points to Ponder
Points to Ponder
Common Surgeries of the Heart
CORONARY ARTERY BYPASS GRAFT SURGERY (CABG) (OTHER TERM: OPEN HEART BYPASS SURGERY)
Introduction to Arteries of the Heart
What is Coronary Artery Bypass Graft Surgery?
Description of the Procedure
Recent Advance in CABG
Preoperative Investigations
Indications for CABG
Risks of the Procedure
Preoperative Preparations
During the Procedure
CABG-on-Pump Procedure
CABG-off-Pump Procedure
Procedure Completion, Both Methods
Recovery after the CABG
Role of the Physiotherapist
Cardiac Rehabilitation after Heart Surgeries—an Overview
PHYSICAL THERAPY AFTER CARDIOTHORACIC SURGERIES
Introduction
Principles of Physical Reconditioning
Principles of PT in Physical Reconditioning
Dysfunction of the Respiratory Pump
Relaxation Exercises
Pursed Lips Breathing
Breathe Reeducation to Improve Respiratory Muscle Efficiency
Contraction of the Abdominal Muscles during Expiration
Body Position
Abdominal Belt
Respiratory Muscle Training
BREATHING RETRAINING TO OPTIMIZE THORACOABDOMINAL MOVEMENTS
Diaphragmatic Breathing
Slow and Deep Breathing
IMPAIRED AIRWAY CLEARANCE AND LUNG INFLATION
Forced Expiration Techniques
Exercise
Postural Drainage and Body Position
Percussion and Vibration
POSITIVE EXPIRATORY PRESSURE MASKS BREATHING (BI-PAP) AND FLUTTER BREATHING
Chest Expansion and Lung Inflation
CONCLUSION
Points to Ponder
REFERENCES
CHAPTER 5:
Physiotherapy after Breast Surgeries
INTRODUCTION
RISK FACTORS
Family Connection
Age
Fertility
Late Pregnancy
Breastfeeding
Removal of the Ovaries
Other Probable Risk Factors
WARNING SIGNS TO WATCH FOR
Biopsy
Fine Needle Aspiration
Mammography
Ultrasonogram
MRI Screening of the Breast
STAGING THE SPREAD OF BREAST CANCER
TREATMENT: ASSESSING THE OPTIONS
SURGERY OF THE BREAST
TYPES OF BREAST SURGERIES
Lumpectomy
Indication
Contraindications to Lumpectomy
Preoperative Preparation
Description of the Procedure
Postoperative Care
RISKS OF COMPLICATIONS
Simple Mastectomy
Indication
Description
Modified Radical Mastectomy
Description
Breast Reconstruction
Radical Mastectomy
Diagnosis/Preparation
IMMEDIATE POSTOPERATIVE CARE
RISKS ASSOCIATED WITH MASTECTOMIES
Prognosis
Alternative Surgeries
Radiation's Role
Follow-up Treatment
Chemotherapy
Hormonal Therapy
The Need for Follow-up Care
POSTOPERATIVE CARE AFTER BREAST SURGERIES
How can Physical Therapy Help Following Breast Cancer Surgery?
Wound Management and Prevention of Contractures following Mastectomies
EXERCISE PLAN FOR THE FIRST POSTOPERATIVE WEEK
GENERAL GUIDELINES FOR POSTOPERATIVE EXERCISES
Exercises in Lying Position
Exercises in Sitting Position
Exercises in Standing Position
Points to Ponder
MANAGEMENT OF LYMPHEDEMA FOLLOWING RADICAL MASTECTOMY
Manual Lymph Drainage (MLD)
Combined Decongestive Therapy5
Initial Phase
Maintenance Phase
REFERENCES
CHAPTER 6:
Physiotherapy in Burn and Plastic Surgeries
INTRODUCTION TO BURN INJURY
PHASE 1
Acute Care of Burn
First Aid: COOL, COVER and CALL
For Thermal Burns
For Chemical Burns
Emergency Treatment of Burns: Points to Ponder
Stabilization, Wound Care and Transport: Points to Ponder
Primary Care in the Hospital ER
Initial Assessment
Assessing Airway Damage
Assessing Breathing
Assessing Circulation
Assessing Associated Injuries
Checklist for ER
Respiratory
Circulatory
LOC (Level of Consciousness)
Physical examination
Assessment of the Burn Injury
Classification Based on Agents of Burn
Structure of Human Skin
Nature of Burn Injury
PART—I
JACKSON'S BURN MODEL
Classification Based on Depth of Burn
First Degree Burn
Second Degree Burn
Third Degree (Full Thickness) Burns
Fourth Degree Burns
Calculating Percentage of Total Body Surface Area (TBSA) Affected by Burn
Pathophysiology of Burn
Inflammation and Edema
Altered Hemodynamics
Immunosuppression
Hypermetabolism
Renal System
Gastrointestinal System
Infection and Septicemia
Principles Medical Management of Burns
Hospital Treatment of Burn Injury
Criteria for Hospitalization: Points to Ponder
Resuscitation: Points to Ponder
Fluid Replacement Therapy
Escharotomy1
Smoke Inhalation Injury
Management of Inhalation Injury: Points to Ponder
Inhalation Treatments
Novel Ventilator Therapies
PHASE 2
Acute Care of Burn Wound1
Points to Ponder
Choice of Dressing
Antibiotic Creams or Gels
Alternative Treatment
Synthetic Coverings: Points to Ponder1
Biologic Coverings1
Steps for Minimizing Complications of Burn: Points to Ponder
Nutrition in Burn Injury
Nutritional Support
Calorie Requirement
Dietary Composition
Psychosocial Aspects of Burn Injury
Special Burn Injuries
Electrical Injuries
Chemical Burns
Hydrocarbons
PHASE 3
Surgical Management of Burn1
Rationale Behind Skin Graft
What is a Skin Graft?
Types of Skin Grafts
Techniques and Procedures of Skin Grafting
Preparation of the Recipient Site
Procedure for Harvesting
Categories of Skin Graft
Care of the Grafted Skin
Risks
Usual Outcome
Alternative Methods of Wound Coverage
How does Artificial Skin Work?
Reconstructive Surgery
Modes of Reconstruction
Pedicle Grafts
Postoperative Rehabilitation of Burn
Plan of Postoperative Rehabilitation
Early Problems in the Postoperative Convalescent Phase
PHASE 4
Rehabilitation of the Burn Patient
Rehabilitation Goals and Planning3
Points to Ponder
Principles of Physiotherapy in Care of Burn Patients
Positioning
Points to Ponder
General Guideline to Optimum Positioning for Different Body Segments3
Basic Principles of Splinting in Burn (Also See Annexure 6.1)
Splinting Definitions
Points to Ponder
Mechanical Principles of Splinting
Role of Physiotherapy in Pain and Wound Management in Burn Injury
Hydrotherapy in Burn—A Viable Treatment Option
Introduction
Material
Procedure
Role of the Physiotherapist in the Critically-ill Burn Patient
Points to Ponder
Role of the Physiotherapist in the Recovering Burn Patient
Points to Ponder
Areas of Concerns for Burns of the Upper and Lower Extremities
Upper Extremity
Lower Extremity
Management of Scar
Points to Ponder
Extreme Pruritus or Itching is a Frequent Part of Burn Wound Healing
REFERENCES
ANNEXURE 6.1: SPLINTING GUIDE FOR BURN THE WHOLE BODY
Face
Neck
Axilla/Shoulder
Elbow
Wrist
Dynamic Splints
Hand
Types of Hand Splints
Hip
Knee
Ankle/Foot
Serial Plastering
ANNEXURE 6.2: TYPES OF GRAFT
CHAPTER 7:
Physiotherapy in Women's Health—Obstetrics and Gynecology
INTRODUCTION
PELVIC INFLAMMATORY DISEASES (PID)
Causes
Symptoms of Pelvic Inflammatory Disease
Exams and Tests
IMAGING
EXPLORATORY LAPAROSCOPIC SURGERY
MEDICAL TREATMENT OF PELVIC INFLAMMATORY DISEASE
Surgery
Physiotherapy in PID
Prevention
PELVIC ADHESION RELATED DISORDERS (PARD)
Management of Pelvic Adhesions
Physiotherapy in PARD
Vibration
VISCERAL MANIPULATION
Principles of Visceral Manipulation
Fascial Continuity
Core
Abdomen
Thorax
PELVIC FLOOR DISORDERS
How do the Pelvic Floor Muscles Work?
Urinary Incontinence
Pelvic Anatomy
Normal Bladder Control
Types of Urinary Incontinence
Stress Incontinence
Urge Incontinence
Overflow Incontinence
Functional Incontinence
Diagnosis
Treatment
Noninvasive Treatment Methods
Medical Therapy
Anticholinergic Drugs
Tricyclic Antidepressants
Alpha-Adrenergic Drugs
Surgery
TVT (Tension-Free Vaginal Tape)
Injection Therapy
Artificial Sphincter
Sacral Nerve Stimulation
Prevention of Incontinence—Tips for the Patients
Pelvic Floor Myalgia
Points to Ponder: Tips to Patients on Using Vaginal Dilators
Future
HYSTERECTOMY
Cesarean Delivery—An Overview
Reasons for the Procedure
Risks of the Procedure
The Procedure
Postoperative Care
In the Hospital
At Home
Day 1
Deep Breathing Exercises
Huffing
Coughing
Circulatory Exercises
Ankles
Knees
Day 2 Onwards
Abdominal Exercise
Pelvic Tilting
Knee Rolling
Knee Bends
To Get Out of Bed
Posture and Back Care
Advice on Discharge
Do's and Don'ts of Household Activities
Do's
Don'ts
Exercise during Pregnancy
Posture
Standing
Sitting
Points to Ponder
Kneeling
Bending
Lifting
Lying Down
Exercises during and after Pregnancy
Appropriate Exercise
Dedicated Antenatal Exercises—Group/Individual
Warming-up Exercises
Stretching Exercises
Ankle and Foot Exercises
Arm and Shoulder Exercises
Abdominal Exercises
Back Exercises
Pelvic Exercises
Pelvic Tilt
Pelvic Floor
Reasons for Toning the Pelvic Floor Muscles
The Golden Rules of Exercise during Pregnancy
Relaxation
Are you Tense?—A Short Self-assessment
Preparation
Muscle Relaxation
Mind Control
Postnatal Exercise
REFERENCES
Visceral Manipulation
Pelvic Floor Disorders
INDEX
TOC
Index
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