Physiotherapy following Transplant Surgery

Introduction

The aim of this booklet is to give you advice on exercises that will aid and enhance your recovery following your transplant.

The lungs following surgery

After your operation the lungs can be affected by the anaesthetic, pain and immobility. Many people find they have a cough after the anaesthetic and it is important that you start to clear any sputum (phlegm) immediately after your operation. Any sputum that remains in the lungs produces the ideal environment for infections to develop.

It is important that your pain is sufficiently controlled to take deep breaths, to cough and to move around. You might have a PCA (patient controlled analgesia), which delivers pain relief when a button is pressed by the patient. If you do not have one or still have pain, it is important you speak to your doctor, nurse or physiotherapist.

Deep-breathing exercises

You should start deep-breathing exercises straight after the operation. While doing the breathing exercises, try to sit as upright as possible and ensure your pain is well controlled.

1. Take a slow, deep breath in through your nose, if possible.
2. Hold the breath for the count of three.
3. Gently breathe out through your mouth.
4. Repeat this three times (do not do too many at once as this may make you lightheaded).

Aim to do one to two sets of three deep breaths every waking hour.

‘Huff’ and cough

It is not harmful to your wound to ‘huff’ or cough after the operation. To make your ‘huff’ and cough stronger and more comfortable, you can hold a pillow or towel as a support over your wound. To loosen the sputum, you may wish to do a huff before a cough; this is a breath in followed by a forced breath out through your open mouth (as if steaming up a mirror).

It is vitally important that you cough as frequently as is required to clear the sputum from your chest.

Bed mobility

We encourage patients like you to sit in a chair and move as soon as possible after your operation. This may be as early as the same day or the day after your operation. The ward physiotherapists or nurses will help you with this.

The most comfortable way of getting out of bed is to bend up your knees with your feet flat on the bed, then roll on to your side. Then put your legs over the edge of the bed and push up through your arms.

Circulation exercises

It is important to start circulation exercises immediately after the operation to help reduce swelling and to prevent blood clots.

Pull your toes up towards you then briskly point your toes 10-20 times every 30 minutes. In addition, try circling your feet and squeezing your buttocks together to increase your circulation.

Neck and shoulder exercises

Gently start to move your neck from side to side, and up and down (do not roll or circle your neck). Repeat five times. Lift your shoulders up towards your ears and relax back down. Again, repeat five times every 30 minutes.

The image above shows:

• Exercise 1: Lift your arm forwards letting the thumb lead the way
• Repeat ten times

The image above shows:

Sit to stand:

• Start sitting down
• Stand up (with or without use of arms) and sit back down
• Repeat five times
• Progress by increasing the number of times

Marching on the spot

• Hold on to a bar if you need to
• March on the spot
• Start with ten steps and build up as able

The image above shows:

Knee bends:

• Slowly bend your knees keeping your back straight and heels on the floor
• Repeat ten times

Heel Raises:

• Push up on your toes
• Repeat ten times

The image above shows:

• Sitting out in the chair, bend and straighten your ankles, alternating between lifting your toes and heels off the floor. Repeat this ten times.
• Rotate you ankles then change direction. Repeat this ten times.
• Pull your toes up towards you, tighten your thigh muscle and straighten your knee. Hold it there for five seconds then slowly relax your leg. Repeat five times on each leg.

Getting mobile

Walking is an excellent form of exercise after your operation.

The benefits of walking are to promote independence, reduce the risk of developing chest infections and blood clots. Try to gradually increase your walking daily.

You will be assisted out into the chair the day after your surgery and assisted to mobilise if appropriate. All drips and drains are portable and will run on battery power where appropriate. The distance you mobilise should be increased daily. You will initially require assistance to mobilise, due to your attachments.

Exercises

In addition to the above exercises, included in this booklet are a few exercises that will help to develop your cardiovascular system, strength, balance and confidence following your operation.

Some of these can be performed at the bedside, or you will find exercise stations around the ward with equipment and information.

Inside this leaflet is an exercise diary where you can record your activity throughout your stay in hospital and beyond!

Going home and beyond

Once you are able to mobilise independently, you should aim to have a short walk every two hours on the ward. The physiotherapist will do a stairs assessment with you prior to discharge if required.

When you go home it is important you continue with walking and exercise, gradually building up the frequency and distance.

Rest is important as well as exercise in the initial stages after your operation. It is common to feel tired for some time after the operation, and you may wish to have a rest in the afternoon. Let your family/ friends help with daily activities where required and try to pace your activities evenly throughout the day.

Below is a general guide to returning to other common activities. Please note this is a general guide and if you have any questions or concerns please discuss with your consultant.

Whom do I contact for further advice or questions?

Surgical Physiotherapy Team: 01223 245151 (Switchboard)