Post Thoracotomy Rehab Protocol

Developed by Terri Brewer, MS, PT
For Dr. Neri Cohen’s patients

Sunrise Health Center will provide Physical Therapy and/or Respiratory Therapy following thoracic surgery, providing individualized comprehensive personal care for these patients. The goals of this program are:

• To strengthen the shoulder girdle and prevent any negative effects of disuse, i.e. frozen shoulder.
• General reconditioning to increase endurance and overall health.
• To allow patients to come off their oxygen sooner.
• To provide education to effectively manage their condition and maximize their physical and emotional independence.
• To minimize loss of function and morbidity associated with thoracic surgery.
• To maximize pulmonary function and clearance of secretions.
• To wean patients off pain medication more rapidly as their function is restored.

This program should begin up to a month prior to surgery if feasible and will continue post-op.  If it is not feasible to begin the program prior to surgery, a pre-op meeting will be scheduled with the PT to familiarize patients with the post-op program.

I.  Diaphragmatic breathing exercise – Begin and end each session with diaphragmatic breathing.

II.  Shoulder ROM exercises:

A.  Pendulum exercises

B.  Codman’s exercises

C.  Wand exercises in supine

D.  Pulleys

E.  Active exercises

III.  Shoulder strengthening exercises – Once pt is able to do 30 reps of each active exercise, 1 lb weight will be added each week if there are no adverse reactions.

A. Shoulder flexion

B. Shoulder abduction

C. Shoulder extension

D. Shoulder internal rotation

E. Shoulder External rotation

F. Shoulder horizontal abd/adduction

G. Shoulder shrugs

H. Serratus anterior strengthening in supine

IV.  Pulmonary Rehab Program

A.  Individualized progressive program consisting of various exercises, including the treadmill, rowing machine, arm ergometer, and stationary bike.

 B.  Assessment performed throughout session, including vital signs, oxygen saturation, and subjective measures using the Modified Borg Scale and the Rate of Perceived Exertion.

 V.     Education- Including but not limited to the following:

A. Disease process and Management

B. Breathing Retraining

C. Understanding medications and how to take them properly

D. Nutrition

E. Advanced Directive

F. Stress management

G. Energy conservation

H. Exercise

I. Self assessment techniques

J. Bronchial hygiene

K. Smoking cessation