Top 10 Exercises for Pediatric Patients after Cardiac Surgery

Physiotherapy plays an important part in the recovery process of pediatric patients after cardiac surgery. After cardiac surgery, the child needs to start the exercises as soon as possible. Before cardiac surgery, pediatric patients are given some exercises by the physiotherapist to prepare them for the surgery. These exercises are required to be done after surgery to help them recover and to keep their lungs clear, well-expanded, and free of mucus. Physiotherapy treatment focuses on general mobility and chest care. It is essential to consult a physiotherapist before cardiac surgery. As he guides and teaches exercises that should be practiced before and after the surgery. This blog is designed to mention a few exercises that will help pediatric patients to recover after cardiac surgery.

 

Exercise strategy

A physiotherapist is a health professional who is trained to prevent, identify, and correct movement problems. Pediatric patients should start doing the exercises as soon as possible while in the hospital. The posture is frequently checked during the day to make sure the child sits or stands straight and does not lean forward or to the side.

• Sit in a chair with feet on the floor.
• Sit or stand up straight, with the shoulders pulled back and down.
• Shoulders should be stacked above the hips and should not be arching the back.

The breastbone takes approximately three months to heal. Therefore, to prevent stress on the breastbone the child should avoid pushing through his/her arms. He/she is advised to put his/her hands on the knees and shuffle the bottom when getting out of bed or a chair for the next three months.

 

Chest care

Chest physiotherapy begins on the first day after the surgery. Discomfort or pain from the chest wound can stop the child from taking a deep breath in and coughing. For the first few days, the child may not be as mobile as he/she would normally be and so he/she can't breathe deeply. If the child is taught deep breathing exercises before the surgery, then it is easier to remember these exercises afterward.

 

Breathing exercise:

The physiotherapist will teach the child how to practice deep breathing.

• The child is made to sit upright with hands placed over the sides of the chest.
• Then, asked to slowly take a deep breath through the nose.
• Hold this breath in for one to two seconds and then breathe the air out slowly through the mouth.
• Repeat 5 times.
• Then huff 5 times.

To do a huff take a breath (medium-sized) then force the air out quickly through an open mouth.

Coughing:

• Take a deep breath in and have a good strong cough, supporting the chest wound with a small pillow.
• Take normal relaxed breaths after coughing.
• Young children can practice deep breathing by blowing bubbles.
• Older children can practice deep breathing using a device called an incentive spirometer.

After surgery, once the child is awake and breathing on their own, it is important to start doing the exercises.

 

Chin tucks:

Prevent forward chin posture, to encourage good posture, as forward chin posture can cause neck discomfort.

• Sit in a good posture.
• Sit up tall, drawing the shoulder blades towards the center of the spine.
• While holding this posture, focus on bringing the chin back so the neck is long.
• Hold this position for 5-10 seconds to feel the stretch and repeat 5-10 times.

Initially, some gentle arm and leg exercises should be done to prevent stiffness, help circulation, and then progress to walking

 

Shoulder shrugs:

From the first day after the surgery, exercising should be encouraged.

• The patient is sitting in a chair or standing.
• Gently bring both shoulders up and down.
• Repeat five to ten times.

 

Shoulder rolls:

Improve shoulder movement while maintaining neck posture.

• Sit in a good posture.
• Slowly and gently roll the shoulders in circles forward and backward.
• Relax and repeat 5-10 times.

 

Arm raise:

The exercise goes like this:

• Sit in a good posture.
• Sit up tall, and draw the shoulder blades towards the center of the spine.
• Lift one arm so that the elbow is beside the ear and then lower the arm.
• Repeat 5-10 times. Repeat with the other arm.
• Raise both arms straight forward over the head.
• Then bring both arms back and down.
• Repeat five to ten times.

 

Trunk side flexion:

Reduce stiffness that can happen with a side incision.

• Sit in a good posture.
• Lift the arm straight up on the incision.
• Bend away from the incision so that it feels a stretch.
• Breathe, in, then breathe out.
• Return to the starting position and repeat 5-10 times.

 

Gentle heel slides:

These exercises are taught to help keep the muscles strong and promote circulation.

• The patient lies on the bed with the legs well supported.
• Bend both knees and straighten the legs alternatively.
• Repeat 10 times.

 

Ankle movements:

The exercise goes like this:

• The patient lies on the bed or sits in a chair.
• Draw a circle shape with the feet from ankles, in one direction.
• Repeat in the other direction.
• Repeat 10 times in each direction.
• Bring the ankles up towards the body.
• Then bring them down toward the floor.
• Repeat 10 times with each ankle.

Quadriceps sets:

The exercise goes like this:

• The patient lies on the bed with legs straight.
• Tighten the thigh muscles on the front of the legs.
• Press the back of the knee into the bed and pull the toes towards the body. 

Quadriceps arc:

The exercise goes like this:

• The patient lies on the bed with legs straight.
• Tighten the thigh muscles.
• Lift the leg from the bed to a small height.
• Hold for 2 seconds, then slowly bring it down
• Repeat ten times with each leg. 

From day two onwards following the surgery, begin to progress the mobility under the guidance of an experienced physiotherapist. After heart surgery, the child may have been unable to exercise for some time, so the increase in an activity needs to be done gradually, to build up his/her fitness slowly. Your physiotherapist may also recommend an exercise bike or pedals, to improve the patient's fitness by increasing the length of time on the bike rather than the resistance. At three months after the surgery, the child should be able to do everything that he/she did before the surgery.

 

Pre and Post Physiotherapy for Pediatric undergoing Cardiac Surgery

Cardiac Surgery is successfully performed on numerous Pediatric patients suffering from many different congenital heart defects. The frequency of heart surgery in children with congenital heart disease is very high, and the occurrence of pulmonary complications in post-operative heart surgery is equally common. Children also have postoperative pulmonary risks similar to adults. Since the complications like atelectasis and pneumonia are highlighted among them, it is important to make use of effective means to prevent, reduce or treat such complications. These complications are minimized by drugs, and by Physiotherapy. Positive results have been found after providing physiotherapy services in preoperative and postoperative pediatric cardiac surgery patients. This blog summarizes the efficacy of Pediatric Physiotherapy treatment through different techniques emphasizing the importance of early mobilization and ambulation and also promotes the application of physiotherapy pre and post-operative pediatric cardiac surgery.

 

PHYSIOTHERAPY

Physiotherapy in the pre-and postoperative period in pediatric cardiac surgery is used to reduce the risk of pulmonary complications like atelectasis, retention of secretions, and pneumonia. Physiotherapy interventions contribute to the appropriate ventilation and successful extubation.

 

Pre-operative Physiotherapy:

Physiotherapy techniques used are clearance, re-expansion, abdominal support, and guidance on the importance and objectives of physiotherapy intervention for parents.

 

Post-operative Physiotherapy:

Postoperative physiotherapy includes vibration in the chest wall, percussion, compression, manual hyperinflation, re-expansion maneuver, positioning, postural drainage, cough stimulation, aspiration, breathing exercises, mobilization, and acceleration of expiratory flow.

• After heart surgery, the child must be repositioned (approximately every two hours) throughout the day to ensure that the lungs stay well-expanded and free of mucous. This will also help the child to recover the movement. Whether the child is still on the breathing machine or is breathing by himself, the physiotherapist will check whether the lungs are clear of secretions. The physiotherapist will use techniques to help increase the air going to the lungs and to clear the secretions from the lungs. These techniques may include positioning, deep breathing exercise, chest percussion, and coughing.
• The child should start moving soon after the operation and the physiotherapist will help the child with sitting out of bed if the child is old enough, start walking in the first couple of days after surgery.
• Good positions post-operation includes turning the child onto the side, onto the back, holding him in the arms, and placing them into an infant seat. This will help the child recover sooner so that he can go home.
• Aspiration with the techniques of respiratory physiotherapy such as manual vibration, positioning, percussion, compression, manual hyperinflation, and postural drainage are found to be beneficial. Physiotherapy tends to produce improvement in pulmonary compliance, expiratory tidal volume, and pulmonary resistance.
• The treatment for atelectasis consists of physiotherapy, deep breathing, incentive spirometry, etc. However, sometimes, atelectasis is difficult to reverse and it is necessary to associate it with another method, respiratory physiotherapy, and inhalation of hypertonic saline solution with NaCl at 6% is recommended.
• Chest radiographs and four physiotherapy sessions lasting 20 minutes were performed daily, using maneuvers of bronchial hygiene, pulmonary re-expansion, postural drainage, and tracheal aspiration shows significant results. Immediately before and after physiotherapy inhalation of hypertonic saline solution with NaCl at 6% can be given.
• Breathing exercises are recommended in cases of atelectasis due to thoracic or upper abdominal surgery, because they improve respiratory efficiency, increase the diameter of the airways, which helps to dislodge secretions, prevent alveolar collapse, and facilitate the expansion of the lung and peripheral airways clearance.
• Significant increase in oxygen saturation and reduction in cardiac and respiratory rate after intervention with the increased expiratory flow in children with pneumonia has been proven and the physiotherapeutic technique for bronchial hygiene is found to be effective in improving lung function.
• When the presence of pulmonary complications is associated with other complications regarding the time of hospital stays, such as sepsis, pneumothorax, pleural effusion, and others, if the patient is treated by physiotherapy before and after surgery it shows a lower risk of developing such complications.

Post Surgery:

• Avoid activities that disturb the wound.
• Avoid lying on the tummy.
• Take care of the chest muscles and bones during any movement.
• Avoid lifting the toddlers under the arms. Lift the baby under the head/neck and bottom.
  
  

Physiotherapy is included in the multidisciplinary team that contributes significantly to the better prognosis of Pediatric patients undergoing heart surgery, as it prevents and treats pulmonary complications using various techniques. The effectiveness of physiotherapy in reducing the risk and/or treating pulmonary complications caused by surgical procedures in children with congenital heart disease has been proven.