Mgr. Alena Sedláková

Involves a surgical operation on organs
inside the abdomen (stomach, gallbladder,
small intestine, large intestine, liver,
pancreas, spleen, oesophagus, appendix,
abdominal aorta)
 Main reasons include infection, obstruction,
tumors, infflamatory bowel disease
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Mini-invasive operations – laparoscopy
 Open abdominal surgery
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Prevention of post-operative pulmonary
complications such as pneumonia
Prevention of decubitus
Prevention of cardiovascular complications
such as tromboembolism
Prevention of ileus
Prevention of muscle contractions,
weakness and joint stiffness
Prevention of hernia - training safety
coughing, getting out of bed

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Preconditioning is important and involves
increasing endurance fitness and
minimizing functional deficits of the
movement system prior to surgery
Having already increased the patinnet‘s
fitness during the pre-operative phase is an
important benefit during the post-operative
rocovery period
Any strenghtening prior to surgery
increases and accelerates the period of
post-surgical recovery

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The practice of pulmonary physical therapy
practical skills prior to surgery gives
patients the needed peace and certainty
during the post-surgical stay in Intensive
Care Unit

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Includes the explanation of physical therapy
before and after surgery
Training of pulmonary physical therapy
practical skills
Breathing techniques emphasizing respiratory
thoracic and abdominal excursion
Expectoration with holding an abdominal
incision
Corrective work of the postural system
Lower extermity movements and movements of
the arms
Training of getting out of and in bed

We continue with the pre-surgical physical
therapy
 As soon as possible and following a
consultation with the doctor, we initiate the
intensive exercises that should be repeated
2-4 times per day
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Cardiovascular exercises – ankle pumping
exercices to prevent deep vein thrombosis
 Respiratory physical therapy
 Lower and upper extermities movements
 Splinting abdominal incisions during
coughing or sneezing
 Bed mobility – movement toward either side
of the bed or up and down in the bed
 Rolling to the side – toward the operated or
healthy side
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Training of verticalization procces (sitting,
standing, walking) – strict log-rolling for
getting in and out of bed
 Scare care (incision mobilization) after
stiches extraction
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Bed mobility – movement toward either side
of the bed or up and down in the bed
 Rolling to the side – toward the operated or
healthy side
 Sitting at the edge of the bed, legs in
contact with the floor
 Balance training in sitting
 Training of getting out of bed over the
operated side
 Training walking and stair training
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Orthostatic disorders
 Such as pale in face, sweat, bad balance,
nauzea, feeling dizzy
 Hart rate, blood presure when the patients
are monitoring in the Intensive care unit
 Post-operative patients may have inserted
multiple lines, tubes and drains (such as
peripheral line, central line, chest tube,
wound drains, urinary catheter etc.).
Before mobilization, ask the nurses about
discconnection of lines
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1st.day – respiratory physical therapy,
cardiovascular gymnastics, conditioning
training in laying position, bed mobility,
training verticalization – sitting?, standing?,
walking around the bed?
 2nd.day - respiratory physical therapy,
cardiovascular gymnastics, conditioning
training in laying position, in sitting position,
walking around the bed, walking in the
room…
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3rd.day - respiratory physical therapy,
cardiovascular gymnastics, conditioning
training in laying position, in sitting position,
walking around the bed, walking in the
room, in the corridor, with our assistance or
without
 Approximately after 2 or 3 days the patients
are moved from Intensive care unit to
standard wards in hospital and we continue
with higher level of physical therapy
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Of course the patients continue with
rehabilitation at home following
physiotherapist instructions

Avoid lifting more than 15-20 pounds for 6
weeks
 Avoid strong abdominal work (sit-ups,
resisted hip flexion)
 Strict log-rolling for getting in and out of
bed
 Avoid activities that encourage Valsava
manoeuvre (heavy lifting, forceful coughing,
straining on the toilet)
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