physiotherapy for vascular patient

PHYSIOTHERAPY FOR PHYSIOTHERAPY FOR VASCULAR PATIENTVASCULAR PATIENTVASCULAR PATIENTVASCULAR PATIENT

BY:BY:ZALILA KASIMZALILA KASIM

SENIOR PHYSIOTHERAPIST,SENIOR PHYSIOTHERAPIST,PHYSIOTHERAPY DEPARTMENT,PHYSIOTHERAPY DEPARTMENT,

HOSPITAL KUALA LUMPUR.HOSPITAL KUALA LUMPUR.

INTRODUCTIONINTRODUCTION

�� Peripheral vascular disease is a narrowing Peripheral vascular disease is a narrowing of blood vessels that restricts blood flow. of blood vessels that restricts blood flow. It most occurs in the legs, but is It most occurs in the legs, but is sometimes seen in the arms.sometimes seen in the arms.sometimes seen in the arms.sometimes seen in the arms.

�� Both veins and arteries may be affectedBoth veins and arteries may be affected

�� Peripheral vascular disease is a Peripheral vascular disease is a progressive disease that can lead to progressive disease that can lead to gangrene of the affected areagangrene of the affected area

EXERCISE THERAPYEXERCISE THERAPY

�� In patient suffering from intermittent In patient suffering from intermittent claudication it has long been thought that claudication it has long been thought that increasing exercise can result in improved increasing exercise can result in improved performanceperformanceperformanceperformance

�� This has to led the traditional advice to This has to led the traditional advice to patients on diagnosis to “ stop smoking patients on diagnosis to “ stop smoking and keep walking”and keep walking”

EXERCISE THERAPYEXERCISE THERAPY

�� A Cochrane review :A Cochrane review :

Supervised exercise therapy in patient Supervised exercise therapy in patient with intermittent with intermittent claudicationclaudication showed in showed in improvement of maximal treadmill walking improvement of maximal treadmill walking improvement of maximal treadmill walking improvement of maximal treadmill walking distance.distance.

EXERCISE THERAPYEXERCISE THERAPY

�� Walking distance 150 meters increase inWalking distance 150 meters increase in

3 months of supervised exercise 3 months of supervised exercise

Increase in quality of life with precaution Increase in quality of life with precaution �� Increase in quality of life with precaution Increase in quality of life with precaution

during exerciseduring exercise

SCOPE OF SERVICESSCOPE OF SERVICES

�� In patient In patient

ward 12 , ward 13 and ward 14ward 12 , ward 13 and ward 14

�� Out patientOut patient

-- at Surgical Out Patient Department at Surgical Out Patient Department -- at Surgical Out Patient Department at Surgical Out Patient Department

( SOPD ) on Friday from 8.00 am until ( SOPD ) on Friday from 8.00 am until

12.00 pm12.00 pm

-- at Physiotherapy Department every at Physiotherapy Department every

Tuesday 2.00pm until 5.00 pmTuesday 2.00pm until 5.00 pm

PHYSIOTHERAPY INTERVENTIONPHYSIOTHERAPY INTERVENTION

�� Before patient undergone physiotherapy Before patient undergone physiotherapy treatment, all the patient must be asses treatment, all the patient must be asses using using CardiorespiratoryCardiorespiratory Physiotherapy Physiotherapy Assessment form and followed by Assessment form and followed by Assessment form and followed by Assessment form and followed by progression note subjective, objective, progression note subjective, objective, analysis and plananalysis and plan

AIMS OF PHYSIOTHERAPY AIMS OF PHYSIOTHERAPY TREATMENTTREATMENT

PRE OPERATIVE PHYSIOTHERAPYPRE OPERATIVE PHYSIOTHERAPY

�� To maintain airway clearanceTo maintain airway clearance

�� To improve circulatoryTo improve circulatory

�� To maintain thoracic and shoulder mobilityTo maintain thoracic and shoulder mobility�� To maintain thoracic and shoulder mobilityTo maintain thoracic and shoulder mobility

�� To maintain range of movement for upper To maintain range of movement for upper limb and lower limblimb and lower limb

�� To maintain muscle strengthTo maintain muscle strength

�� To educate the confident of the patientTo educate the confident of the patient

AIMS OF PHYSIOTHERAPY AIMS OF PHYSIOTHERAPY TREATMENTTREATMENT

POST OPERATIVE PROCEDUREPOST OPERATIVE PROCEDURE

�� To improve airway clearanceTo improve airway clearance

�� To improve circulatoryTo improve circulatory

To reduce swellingTo reduce swelling�� To reduce swellingTo reduce swelling

�� To improve range of movement for upper To improve range of movement for upper limb and lower limblimb and lower limb

�� To improve in bed mobility from bed until To improve in bed mobility from bed until patient ambulationpatient ambulation

PHYSIOTHERAPY TREATMENTPHYSIOTHERAPY TREATMENTPHYSIOTHERAPY TREATMENTPHYSIOTHERAPY TREATMENT

PRE OPERATIVE PHYSIOTHERAPYPRE OPERATIVE PHYSIOTHERAPY

�� CHEST PHYSIOTHERAPYCHEST PHYSIOTHERAPY

-- diaphragmatic breathingdiaphragmatic breathing

-- effective coughingeffective coughing-- effective coughingeffective coughing

-- manual technique if relevantmanual technique if relevant

PRE OPERATIVE PHYSIOTHERAPYPRE OPERATIVE PHYSIOTHERAPY

�� CIRCULATORY EXERCISECIRCULATORY EXERCISE

-- dorsi flexion / plantar flexion, dorsi flexion / plantar flexion,

circumduction of ankle joint circumduction of ankle joint circumduction of ankle joint circumduction of ankle joint

-- static quadriceps contractionstatic quadriceps contraction

-- high sitting, knee extension and flexionhigh sitting, knee extension and flexion

ANKLE MOVEMENTANKLE MOVEMENT

INVERSION AND EVERSION OF ANKLE JOINT

DORSIFLEXION AND PLANTERFLEXION OF ANKLE JOINT

PRE OPERATIVE PHYSIOTHERAPYPRE OPERATIVE PHYSIOTHERAPY

�� THORACIC AND SHOULDER MOBILITY THORACIC AND SHOULDER MOBILITY EXERCISEEXERCISE

-- lift up both upper limb above the headlift up both upper limb above the head-- lift up both upper limb above the headlift up both upper limb above the head

-- lift both arm side wayslift both arm side ways

POST OPERATIVE PHYSIOTHERAPYPOST OPERATIVE PHYSIOTHERAPY

�� CHEST PHYSIOTHERAPYCHEST PHYSIOTHERAPY

-- Active Breathing Cycle Technique it Active Breathing Cycle Technique it consist of :consist of :consist of :consist of :

Breathing controlBreathing control

Thoracic Expansion ExerciseThoracic Expansion Exercise

Forced Expiratory TechniqueForced Expiratory Technique

POST OPERATIVE PHYSIOTHERAPY POST OPERATIVE PHYSIOTHERAPY

�� THORACIC AND SHOULDER MOBILITY THORACIC AND SHOULDER MOBILITY EXERCISEEXERCISE

-- lift up both hand above the headlift up both hand above the head-- lift up both hand above the headlift up both hand above the head

-- lift arm side wayslift arm side ways

-- finger on the shoulder joint, rotated finger on the shoulder joint, rotated

shoulder joint ( anti clock wise/ clock shoulder joint ( anti clock wise/ clock

wise )wise )

SHOULDER EXERCISESHOULDER EXERCISE

POST OPERATIVE PHYSIOTHERAPY POST OPERATIVE PHYSIOTHERAPY

�� CIRCULATORY EXERCISECIRCULATORY EXERCISE

-- dorfsiflexion/ planterflexion /dorfsiflexion/ planterflexion /

circumduction of the ankle jointcircumduction of the ankle jointcircumduction of the ankle jointcircumduction of the ankle joint

-- static quadriceps contractionstatic quadriceps contraction

( will do this exercise with elevation )( will do this exercise with elevation )

-- hip and knee flexionhip and knee flexion

POST OPERATIVE PHYSIOTHERAPY POST OPERATIVE PHYSIOTHERAPY

�� Physiotherapy AdjunctPhysiotherapy Adjunct

-- triflometertriflometer

-- voldynevoldyne

POST OPERATIVE PHYSIOTHERAPY POST OPERATIVE PHYSIOTHERAPY

�� AmbulationAmbulation

-- patient must wear TED sockpatient must wear TED sock

-- ambulate patient in wardambulate patient in ward

-- gradually increasing the distance day bygradually increasing the distance day by-- gradually increasing the distance day bygradually increasing the distance day by

dayday

( using walking aids if patient not stable( using walking aids if patient not stable

like tripod, walking frame ) like tripod, walking frame )

POST OPERATIVE PHYSIOTHERAPY POST OPERATIVE PHYSIOTHERAPY

�� Strengthening exercise : Strengthening exercise :

“using weight”“using weight”

-- sand bagsand bag

-- therabendtherabend-- therabendtherabend

-- static bicycle static bicycle

-- quadricep benchquadricep bench

-- gyro bench gyro bench

STRENGTHENING EXERCISESTRENGTHENING EXERCISE

Upper limb exercise using therabend

Cycling Strengthening exercise for quardiceps muscle using sand bag

PHYSIOTHERAPY ROLE IN VASCULAR CLINIC, HOSPITAL KUALA LUMPUR

ROLE PHYSIOTHERAPY IN CLINIC ROLE PHYSIOTHERAPY IN CLINIC VASCULARVASCULAR

�� To be review early physiotherapy To be review early physiotherapy intervention and effective treatment for intervention and effective treatment for patient with peripheral vascular disease patient with peripheral vascular disease

�� To an improvement in quality of lifeTo an improvement in quality of life�� To an improvement in quality of lifeTo an improvement in quality of life

�� To prevent a delay in disease progressionTo prevent a delay in disease progression

�� To an improvement of the vascular risk To an improvement of the vascular risk profileprofile

Patient Education :- information about important of exercise

Circulatory exercise : - dorsiflexion, and plantarflexion of ankle joint exercise

Static Quadriceps exercise

Circumduction of the ankle joint exercise

Skin care and lower limb elevation of lower limb after doing activities

PHYSIOTHERAPY TREATMENT AS OUT PATIENT IN PHYSIOTHERAPY DEPARTMENT, PHYSIOTHERAPY DEPARTMENT, HKL

Monitoring pulse rate before patient exercise and after exercise

Walking exercise

Cycling exercise for strengthening of lower limb muscle and endurance

Strengthening exercise for calf and foot muscle using therabend

Strengthening exercise for lower limb muscle using therabend

Strengthening exercise for upper limb using dumbell

Step exercise to improve endurance

Strengthening exercise for quadriceps and calf muscle using Gyro Bench

Strengthening exercise for quadriceps muscle using quadricep bench

COMPLICATION COMPLICATION

�� AMPUTATIONAMPUTATION

-- Physiotherapy intervention is important Physiotherapy intervention is important

for preparation ambulation with for preparation ambulation with

prosthesis by strengthening :prosthesis by strengthening :--prosthesis by strengthening :prosthesis by strengthening :--

* upper limb muscle* upper limb muscle

* unaffected lower limb muscle* unaffected lower limb muscle

* affected limb muscle* affected limb muscle

AMBULATION WITH WAKLING FRAME AMBULATION WITH WAKLING FRAME

GAIT TRAINING AT PARALLEL BARGAIT TRAINING AT PARALLEL BAR

PATIENT WALKING WITH PROTHESISPATIENT WALKING WITH PROTHESIS

THANK YOU