How much Pt is allowed to use his arms for weigh bearing- STS after AV replacement?

[inty]

Does someone Know what is the guidelines for using arms in weight bearing for sit-to -stand after Aortic Valve Replacement?

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[Dr Damien]

I am not a cardiac physiotherapist, however i dont see that there should be a problem with using your arms to sit to stand after an aortic valve surgery. The little I know about about cardiac rehab, overhead activities especially resisted is the concern. Sit to stand is a natural functional process, for as long as it is done correctly with no valsava maneovres i honestly dont see a problem.

I would let the physios who are more knowledgeable in cardiac rehab give you something more evidence based...Im curious to know what they have to say

cheers

[inty]

Thanks for your reply.
thats true what you are saying, but when the patient is elderly and with decresed muscles strenght of the legs, they usaly are puting a loths of effort to push with their arms and in the early after post cardiac surgery this could be contraindication. I know that Pt post cardiac ops should avoid lifting weight, but isn't it the body weight be quite a lot for some of the Pts?
I thought there have guidelines in week 1 for example what the Pts can or can not do, week 2, 3...etc.

[Dr Damien]

Dear Inty

I have very little clue about acute management of immediate post surgical cardiac rehab. But my little experience with the elderly suggests to me that some form of cardiac funstion test would be done prior to any rehab, e.g ejection fraction, heart rate, blood pressure, SPO2 etc...
Any patient who is having to push through his arms fully cardiac patient or not is not sitting to stand properly... in this case I would suspect that some assistance will be needed...or sit to stand training from a high surface might be needed...they probably will be walking with some walking aid and supervision or assistance of one or two...the rehab of this client will depend on previous comorbidities e.g age, motivation, history of COPD, diabetes, chronic fatigue syndrom, hypertension, previous strokes, arthritis, O2 use during hospitalization , previous surgeries etc will all determine what the functional recovery will look like... some patients with little or no comorbidities will recover faster than those with a lot of issues.

...rehab can start on the first day with just sitting out of bed, or even bed exercises...I suspect that cardiac function tests will guide what is expected, In this case, I would work closely with a nurse (preferrably someone with cardiac specialty interests).

I my be wrong but guidelines may not be appropriate for all patients. I have a friend who works in as an ICU specialist physiotherapist in Canada and when we discuss cases, he always emphasizes early mobilization. The only way the heart can pick up its function is for it to experience the stress it needs to work the whole body...I would focus on mobilizing early but I would let the results of the cardiac function test guide me...

Like I said, I am not a cardiorespiratory specialist...but this is how I would manage these patients...I wouldnt think that trying to get them to sit to stand will be a contraindcation, the question will be how they are doing it and how much assistance is required...

Lets hear from the cardiorespiratory specialists, they might have better reasoning

cheers

[thabiso]

Dear Inty

I have very little clue about acute management of immediate post surgical cardiac rehab. But my little experience with the elderly suggests to me that some form of cardiac funstion test would be done prior to any rehab, e.g ejection fraction, heart rate, blood pressure, SPO2 etc...
Any patient who is having to push through his arms fully cardiac patient or not is not sitting to stand properly... in this case I would suspect that some assistance will be needed...or sit to stand training from a high surface might be needed...they probably will be walking with some walking aid and supervision or assistance of one or two...the rehab of this client will depend on previous comorbidities e.g age, motivation, history of COPD, diabetes, chronic fatigue syndrom, hypertension, previous strokes, arthritis, O2 use during hospitalization , previous surgeries etc will all determine what the functional recovery will look like... some patients with little or no comorbidities will recover faster than those with a lot of issues.

...rehab can start on the first day with just sitting out of bed, or even bed exercises...I suspect that cardiac function tests will guide what is expected, In this case, I would work closely with a nurse (preferrably someone with cardiac specialty interests).

I my be wrong but guidelines may not be appropriate for all patients. I have a friend who works in as an ICU specialist physiotherapist in Canada and when we discuss cases, he always emphasizes early mobilization. The only way the heart can pick up its function is for it to experience the stress it needs to work the whole body...I would focus on mobilizing early but I would let the results of the cardiac function test guide me...

Like I said, I am not a cardiorespiratory specialist...but this is how I would manage these patients...I wouldnt think that trying to get them to sit to stand will be a contraindcation, the question will be how they are doing it and how much assistance is required...

Lets hear from the cardiorespiratory specialists, they might have better reasoning

cheers

Hi,

Thanks for the input. I am not a specialist in this area too but I definitely agree. Without set guidelines my personal approach would be to initially reduce/minimise anything that is likey produce a Valsava manouvre or overly strain the patient therefore that means high seats initially for sit-to-stand, sit to stand with assitance etc (all of this is totally dependent on the patient's INDIVIDUAL capacity). Post surgery it is essential to get the patient up and about as early as is possible. The first step is really sitting up in bed, the usual bed exercises to sitting out in a chair and so on.Guidelines are good but are just that, guidelines.

Cheers

[Brosnan]

AVR and CABG come under same protocol as far as mobilisation is concerned. POD1 sit out POD2 mobility within room-to toilet POD3- gentle ambulation around ward POD-5 stair climbing training within the PT department(only if home condition demands stair climbing). Usually these open heart pts are adviced not to lift weight and not to push or pull heavily so that they dont hurt the sternum and the sternal wires untill 4-6 weeks which is a normal healing period for the soft bone sternum. Standing with the walker or sit to stand from chair with PT or family help gets easier from the 3rd POD provided the pt is off from sedatives, urine catheter, wound drain and pacing wires.

Does someone Know what is the guidelines for using arms in weight bearing for sit-to -stand after Aortic Valve Replacement?