Principles of Physiotherapy

1. Principles of physiotherapy in
abdominal surgery
A.THANGAMANI RAMALINGAM
PT, MSc (PSY),MIAP

2. Principles of physiotherapy in
abdominal surgery
 To prevent chest complication
 To prevent circulatory complication
 To maintain muscle power &joint ROM
 To prevent pressure sores
 To maintain good posture
 To improve &enhance bed mobility
 To gain cooperation &confidence

3. Pre operative assessment
 Read the notes
 Assess the respiratory function
 Check for circulatory problems
 Detailed history of the patient

4. Clinical notes reading
 Co morbid conditions
 Cause for surgery
 Any other note by the
surgeon/physician

5. Respiratory assessment
 Symmetry
 Rate
 Depth
 Chest expansion
 Dysnoea
 Accessory muscle involvement
 measurement

6. Circulatory assessment
 Homan’s test
 oedema

7. History taking
 Medical history
 Subjective history

8. Pre operative training

9. Breathing exercises
 Diaphragmatic and local expansion
exercises

10. cough
 Teach real cough

11. Arm exercises
 Short lever exs
 Long lever exs

12. Leg exercises
 Ankle& toe movements
 Static Q’ceps& glutei

13. Posture correction
 Advices
 Ergonomic advantages

14. Post operative assessment

15. Surgery notes reading
 Type of incision
 Type of anesthesia
 Duration of surgery
 Immediate complications/unwanted
events/management

16. Vital signs checking
 Tidal volume-2ml/kg body weight
 Minute volume-100ml/kg body weight
 FVC-70ml/kg
 FEV1-70-90%of FVC
 paO2-not less than 70mm/hg
 Paco2-not more than 50mm/hg
 RR-12-16/min
 ABG analysis

17.  Pulse oxymetry
 PR
 ECG
 Heart sounds
 Systemic arterial blood pressure
 CVP
 TPR chart
 Ventilator support

18. Understanding the attachments
 Iv lines
 Nasogastric tube
 Catheter
 PCA
 drains

19. Orientation assessment
 Communication ability
 Alertness
 Perceptual ability to follow
instructions

20. Objective assessment
 respiratory
 Circulatory
 ROM/MUSCLE POWER
 Mobility/functional
 Etc

21. Respiratory assessment
 Painful breathing
 Difficulty in coughing
 Impaired respiration
 Accumulation of secretions
 Palpation
 auscultation

22. Circulatory assessment
 Homan’s sign
 oedema

23. Posture& mobility
 Kypho scoliosis
 Bed mobility

24. Pain assessment
 VAS
 MPQ

25. Post operative
treatment

26. To prevent chest complication
 Breathing exercise
 Coughing/cough support
 Inhalation,humidification&PD
 Breath control exs with arm movts

28. To prevent circulatory complication
 Trendelenberg tilt(15 degree bed end
elevation)
 Leg exs
 Early ambulation
 Bed mobility
 Trunk &abs exs
 Prevention by medical means

29. Prevention of bad posture
 Firm back support
 Chair with arms
 Over correction

30. LEARNING POINTS
* The incidence of pulmonary complications
is higher after upper abdominal or chest
surgery than operations on other parts of
the body due to a severe and prolonged
alteration in pulmonary mechanics.
• The sitting position increases FRC
significantly and early mobilization is to be
actively encouraged. Sufficiently effective
analgesia must be maintained so that these
activities are not impeded by pain.

31. * It is critically important that the
analgesic method chosen is one that
can best improve pain and pulmonary
function. Effective analgesia will
improve the detrimental effects of
surgery on pulmonary mechanics and
prevent pulmonary complication

32. * Physical therapy has a valuable role to
play in the prevention of respiratory
complications as well as their
treatment, although the relative
values and indications for different
therapies have still to be conclusively
determined.