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Physiotherapy in patients after cardiac interventions
VÝBORNÁ, Markéta
In my thesis I tried to focus on the issue of physiotherapy and curative rehabilitation by the patients after cardio-surgical interventions during their stay in a hospital facility. In the opening part I am presenting a brief overview of used cardio-surgery techniques and accesses with their short evaluation. I dealt in brief with the issue of wound healing and the scar formation, including a summary of the most important post-operation complications and accesses, which enable to avoid these complications. One of partial tasks solved in my thesis was the search of physiotherapeutic techniques after the heart operations. Here I focused especially on modern and recently used strategies. I adduce their short definition and explanation of possible benefits resulting from their use. In the second part of my work I am directly evaluating the progress of physiotherapy of two patients with the identical diagnosis who were operated on by two different techniques. Both the patients were taken to the planned performance ? the exchange of the aortic valve as a consequence of their stenosis and present insufficiency at the cardio-surgical department of the hospital in České Budějovice. In one case the classical medial sternotomy was performed, in the other case it was decided to perform a mini-invasive intervention ? the right-side mini-thoracotomy. With both the observed patients the same exercise was practiced just from the first day of the physiotherapy. During the whole period the values of vital functions were carefully checked and registered. The physical and mental state of patients was also followed including the painfulness of the wound. I collected the data for my thesis by means of interviews with the physiotherapist and the patients participated in the observation. I also elaborated a detailed casuistic and analysis of patients? personal data. I cooperated actively with the present staff. The exercises were done twice a day, in the morning and in the afternoon. The whole rehabilitation unit lasted approximately 15 minutes each time. The exercise was started in the bed where simple mobilization exercises were done, some elements of the breath and vascular gymnastics and elements of Vojta?s reflexive locomotion. Gradual verticalization of the patient enabled us to use even more complicated exercises. The exercise was finished with a walk in the corridor and on the stairs. Some respiration aids were used, described in the following part. From the rehabilitation process, which was in progress on both the patients immediately from the first rehabilitation day, results clearly that the patient with medial sternotomy (a woman) showed a considerably greater painfulness every day, which was very limiting for her. Even her mental condition was worse. This patient was not able to perform with a delay of several days those exercises, practiced by the patient with the mini-invasive entry already without any troubles. Considerable differences were also found in the walking, both in the distance and in posture while walking.
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