PHYSIOTHERAPY FOR VASCULAR PATIENT

BY: ZALILA KASIM SENIOR PHYSIOTHERAPIST, PHYSIOTHERAPY DEPARTMENT, HOSPITAL KUALA LUMPUR.

INTRODUCTION
Peripheral vascular disease is a narrowing of blood vessels that restricts blood flow. It most occurs in the legs, but is sometimes seen in the arms. Both veins and arteries may be affected Peripheral vascular disease is a progressive disease that can lead to gangrene of the affected area

EXERCISE THERAPY
In patient suffering from intermittent claudication it has long been thought that increasing exercise can result in improved performance This has to led the traditional advice to patients on diagnosis to stop smoking and keep walking

EXERCISE THERAPY
A Cochrane review : Supervised exercise therapy in patient with intermittent claudication showed in improvement of maximal treadmill walking distance.

EXERCISE THERAPY
Walking distance 150 meters increase in 3 months of supervised exercise Increase in quality of life with precaution during exercise

SCOPE OF SERVICES
In patient ward 12 , ward 13 and ward 14 Out patient - at Surgical Out Patient Department ( SOPD ) on Friday from 8.00 am until 12.00 pm - at Physiotherapy Department every Tuesday 2.00pm until 5.00 pm

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

AIMS OF PHYSIOTHERAPY TREATMENT

PRE OPERATIVE PHYSIOTHERAPY To maintain airway clearance To improve circulatory To maintain thoracic and shoulder mobility To maintain range of movement for upper limb and lower limb To maintain muscle strength To educate the confident of the patient

AIMS OF PHYSIOTHERAPY TREATMENT

POST OPERATIVE PROCEDURE To improve airway clearance To improve circulatory To reduce swelling To improve range of movement for upper limb and lower limb To improve in bed mobility from bed until patient ambulation

PHYSIOTHERAPY TREATMENT

PRE OPERATIVE PHYSIOTHERAPY

CHEST PHYSIOTHERAPY - diaphragmatic breathing - effective coughing - manual technique if relevant

PRE OPERATIVE PHYSIOTHERAPY

CIRCULATORY EXERCISE - dorsi flexion / plantar flexion, circumduction of ankle joint - static quadriceps contraction - high sitting, knee extension and flexion

ANKLE MOVEMENT

INVERSION AND EVERSION OF ANKLE JOINT

DORSIFLEXION AND PLANTERFLEXION OF ANKLE JOINT

PRE OPERATIVE PHYSIOTHERAPY

THORACIC AND SHOULDER MOBILITY EXERCISE - lift up both upper limb above the head - lift both arm side ways

POST OPERATIVE PHYSIOTHERAPY

CHEST PHYSIOTHERAPY - Active Breathing Cycle Technique it consist of : Breathing control Thoracic Expansion Exercise Forced Expiratory Technique

POST OPERATIVE PHYSIOTHERAPY

THORACIC AND SHOULDER MOBILITY EXERCISE - lift up both hand above the head - lift arm side ways - finger on the shoulder joint, rotated shoulder joint ( anti clock wise/ clock wise )

SHOULDER EXERCISE

POST OPERATIVE PHYSIOTHERAPY

CIRCULATORY EXERCISE - dorfsiflexion/ planterflexion / circumduction of the ankle joint - static quadriceps contraction ( will do this exercise with elevation ) - hip and knee flexion

POST OPERATIVE PHYSIOTHERAPY

Physiotherapy Adjunct - triflometer - voldyne

POST OPERATIVE PHYSIOTHERAPY

Ambulation - patient must wear TED sock - ambulate patient in ward - gradually increasing the distance day by day ( using walking aids if patient not stable like tripod, walking frame )

POST OPERATIVE PHYSIOTHERAPY

Strengthening exercise : using weight - sand bag - therabend - static bicycle - quadricep bench - gyro bench

STRENGTHENING 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 VASCULAR

To be review early physiotherapy intervention and effective treatment for patient with peripheral vascular disease To an improvement in quality of life To prevent a delay in disease progression To an improvement of the vascular risk profile

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, 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
AMPUTATION - Physiotherapy intervention is important for preparation ambulation with prosthesis by strengthening ::* upper limb muscle * unaffected lower limb muscle * affected limb muscle

AMBULATION WITH WAKLING FRAME

GAIT TRAINING AT PARALLEL BAR

PATIENT WALKING WITH PROTHESIS

THANK YOU