Rehabilitation following arthroscopic meniscectomy can be divided into four phases: protection, moderate protection, early functional and late functional.The word guideline is used instead of the protocol as it allows for individualization.
The immediate postoperative phase is characterized by soft tissue bleeding and effusion, pain and quadriceps inhibition. Prior to discharge from the hospital, the patient’s involved extremity is placed in a jobs cryo temp in an elevated position for 20 minutes. By utilizing the intermittent compression device, RICE (rest, ice, compression, and elevation) is quickly applied.
The patient is then instructed in a series of home therapeutic exercises, which include quadriceps setting, straight leg raises (SLR) in multiple planes and an active- assisted range of motion exercise. The patient is fitted with crutches and instructed in ambulation training weight bearing as tolerated on all surfaces.
The patient is encouraged to follow the RICE principle and to curtail any excessive walking throughout this first phase, which usually lasts 5 to 7 days postoperatively. Non-steroidal anti-inflammatory drugs are prescribed, as they have been shown to decrease pain and effusion throughout the postoperative period following arthroscopic meniscectomy.
MODERATE PROTECTION PHASE
The moderate protection phase is characterized by decreased pain, mild effusion, the range of motion greater than or equal to 90 degrees, and weakness.At the beginning of this phase, approximately 1 week postoperatively, the patient begins rehabilitation. History, measurements, and tests consistent with an initial evaluation are taken.
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems. Rehab programs include exercise training, education on the heart and healthy living, and counselling to reduce stress and help you return to an active life.
What is the duration of this program?
As per the requirement of the patient, the program duration can vary from 6 to 8 weeks to lifelong.
What can one achieve through this program?
The goal of this program is to prevent and limit the physiological and psychological effects of cardiac illness and to improve the overall cardiovascular fitness and health of the patient. This is accomplished by developing individualised program which cover exercise, education and lifestyle modification, tailored to the individual needs and abilities of the patients.
Who requires Cardiac Rehabilitation?
People with the following cardiac diseases require cardiac rehabilitation:
·Coronary Artery Bypass Surgery
·Stable Angina Pectoris
·Two Or More Documented Classical Risk Factors For Coronary Heart Disease
·Stable Chronic Heart Failure
·Peripheral Vascular Disease
·Diabetes Mellitus (Type II)
·Valvular Heart Disease
What are the facilities for Cardiac Rehabilitation at SAANS?
SAANS Foundation has a dedicated cardiac rehab facility, complete with exercise equipment, i.e., treadmills, ergocycles, steppers and cross trainers; a gymnasium for pre-class warm-up and resistance training classes; Human Performance Labs for fitness testing; and a dedicated area for patient education.
The cardiac rehabilitation team
Phase I (Initial Phase)
This is an inpatient program. It begins with pre-procedure counselling and continues immediately after coronary artery grafting or stenting and post-angina or myocardial infarction. Its aim is to initiate early mobilisation (out of the bed) to reduce the effects of de-conditioning, along with patient education about heart disease. This is continued with a walking and exercise program at home or till the patient returns back to the hospital for Phase II.
Phase II (Conditioning Phase)
This consists of a comprehensive program to modify the risk factors for heart disease and consists of exercise, stress management, smoking cessation, behaviour modification, nutritional advice and patient education about the risk factors of heart disease. The aerobic exercise program can begin as early as 2 weeks after an uncomplicated infarction, angina and stenting or 4 weeks after a complicated infarction or bypass grafting. This is conducted in the form of group sessions or classes consisting of the three steps of initial stretching exercises, conditioning phase of aerobic training on the treadmill, ergo cycle, stepper or cross trainer (along with strengthening exercises) followed by the cool down phase. One session usually lasts for 60 to 90 minutes. It takes a frequency of 3 to 5 times a week to complete 20 sessions. Initial sessions are conducted with electrocardiographic monitoring. The behaviour management and nutritional component runs along with the exercise program. All sessions are physician monitored and are conducted by trained staff.
Phase III (Maintenance Phase)
This aims at continuing the benefits gained by patients during the second phase. It consists of the continuation of the aerobic exercise program but at a lesser frequency of about 2 to 3 times a week at home/in a gymnasium/at a hospital.
What Is Rehabilitation?
A comprehensive intervention for patients with chronic diseases who are symptomatic and often have decreased daily activities.
It is designed to
Optimize functional status
Reduces health care costs
Stabilises or reversing systemic manifestations of the disease
Address morbidities and their consequences through education and exercise
Why Rehabilitation is the Need of Hour
Chronic Disease Era
Associated Mental Health Concerns with Chronic Diseases.
Continuity in Healthcare delivery system
Who Can Benefit?
Chronic respiratory disease symptomatic with optimum drug therapy
Chronic cardiovascular diseases with breathlessness despite optimum intervention and drug therapy
Chronic neurological diseases
Chronic orthopedic diseases, pre & post operative conditions
Pre Natal and Post Natal Conditions
Chronic and Acute pain conditions
Alcohol Deaddiction & Smoking Cessation
What are Consequences of advanced chronic disease?
Peripheral Muscle dysfunction
Respiratory muscle dysfunction
What are the components of Rehabilitation program?
Proper education of Disease process
Breathing and Relaxation techniques
Medications, devices & specific therapy
What are the Possible Benefits?
Improved Exercise Capacity
Reduced perceived intensity of dyspnoea and stress
Improve health-related QOL
Reduced anxiety and depression
Improved limb function and ADL’s
Benefits extend well beyond immediate period of training
For a successful rehabilitation program, it requires an efficient coordination and teamwork of medical professionals, which includes:
Nursing Attendants and health care workers
Wellness Coach and Psychologists
What is Pulmonary Rehabilitation?
Pulmonary Rehabilitation (Rehab) is a medically supervised program that helps to improve the health and well being of people who have pulmonary problems.
Rehab programs include endurance training, chest therapy, education on lung hygiene and healthy living, counseling to reduce stress & trigger factors and smoking cessation thus helping you return to an active and healthy lifestyle.
Who requires Pulmonary Rehabilitation?
People with following diseases require Pulmonary Rehabilitation:
Chronic Obstructive Pulmonary Disease (COPD)
Interstitial lung diseases
Obesity and Breathing Disorders
Combined cardio-pulmonary diseases
SAANS Foundation has a dedicated Pulmonary Rehab facility with separate areas for postural drainage, oxygen therapy and Non Invasive Ventilation, nebulisation and telemetric ECG monitored exercise systems i.e. ergo cycles, stepper and cross trainer; a gymnasium for pre-class warm-up and resistance training classes; Lung function testing labs; and a dedicated area for patient education.
A multi-disciplinary team consisting of
Physiatrists (rehab physician)
Physical and Occupational Therapists
Psychologists and Wellness Coach
As per patient requirement, the program duration can vary from 4-6 weeks to lifelong.
The goal of this program is to prevent and limit the physiological and psychological effects of pulmonary illness and to improve overall cardio-pulmonary status and health. This is accomplished by developing individualized programs of exercise, education and lifestyle modification that are tailored to individual needs and abilities.
Phase I (Initial)
This is an inpatient program which starts at the time of hospitalization. It aims to initiate early mobilization to reduce the effects of de-conditioning. It consists of oxygen therapy, chest wall manipulation, nebulization, postural drainage, breathing exercises and incentive spirometry to improve oxygenation. This is continued with a walking and exercise program at home or till patient return back to the hospital for Phase II.
Phase II (Conditioning Phase)
This consists of a comprehensive program to modify the aggravating factors for lung disease along with endurance training. This consists of chest care, aerobic exercise, stress management, smoking cessation, behavior modification, nutritional advice and patient and family education. The Phase II can begin after stabilization of the early symptoms. This is conducted in the form of group sessions or classes, one session usually last for 60-90 minutes. Frequency is 3-5 times a week to complete a total of about 20 sessions. Initial sessions of aerobic training are conducted with electrocardiographic monitoring. All sessions are physician monitored conducted by trained staff.
Phase III (Maintenance Phase)
This aims to continue the benefits gained by patients during Phase II. It consists of continuation of the aerobic exercise program but at a lesser frequency of 3 times a week at home/in a gymnasium/at a hospital.
What is Musculoskeletal Rehabilitation?
Musculoskeletal Rehabilitation involves maximising your function and potential so that you can return back to the community as soon as possible after any injury.
Who requires Musculoskeletal Rehabilitation?
People with following problems require Musculoskeletal Rehabilitation:
·Acute or chronic musculoskeletal pain
·Post fracture stiffness and reduced function
·Loss of a part of limb
·Repetitive strain injury
·Prolonged bed rest with generalised weakness (deconditioning syndrome)
Complex MSK Management
The Complex MSK Management specialises in treating patients who have significant functional mobility and movement impairments related to the musculoskeletal system such as, arthritis, osteoporosis, de-conditioning syndrome, post-operative complications and diabetes mellitus with associated neurological and cardiac conditions. Patients receive physical and occupational therapy, balance & gait training and education to improve their level of independence in daily living.
Multiple Trauma Management
Multiple Trauma Management provides rehab to people who have sustained multiple fractures and other injuries e.g. in a motor vehicle accident. The admission criteria are two or more active orthopedic medical conditions, multiple injuries / fractures as a result of trauma, physically ready to participate in the entire rehab process with cognitive ability to learn new activities and follow direction. These patients will be managed by a multi-disciplinary team taking care of post trauma stress disorder, pain management, mobility and activities of daily living.
The Sports Rehab provides comprehensive care to people with shoulder joint and rotator cuff injuries, tennis and golfers elbow, hand injuries, anterior cruciate ligament tears, hamstring and ankle sprains who are engaged in outdoor sports like cricket, football, basketball, volleyball, etc. leading to significant pain, strength, movement & mobility impairments. The latest technology available at the centre - multi-joint dynamometer and gait and motion analysis gives significant input in managing these conditions allowing early return to the sporting activities.
Repetitive Strain Injury (RSI) Management
The RSI Management aims to manage patients who present with chief complaints of neck or back pain or any other cumulative trauma disorders due to overuse. Patients will be evaluated by an inter-disciplinary team and comprehensive rehabilitation activities will be provided with pharmacotherapy, electrotherapy, exercise programmes, ergonomic advice, behaviour and relaxation techniques, trigger point injection procedures and education.
Amputation Management caters to the need of upper and lower limb amputation due to traumatic, ischemic, diabetic or other conditions. It offers comprehensive programme beginning with pre-amputation counselling, immediate post-operative pain reduction & temporary prosthesis, permanent prosthesis fitting & training and management of late early & late complications. The programme aims to reintegrate the person back into the society.
As per patient requirement, the programme duration can vary from 2-12 weeks.
Seeing someone who used to do all their activities on their own turn to someone who needs help even with small things like going to the bathroom can be very difficult.
The lungs are vital organs in that they are essential to supply oxygen to the entire body. If the various organs do not receive adequate oxygen, their function can be impaired. Therefore, lung function needs to be maintained. Lung function can be impaired by chronic conditions like COPD and bronchiectasis. In both these, the overall ability of the lungs to take in adequate oxygen is reduced. Therefore, the lungs need to be rehabilitated so that they can improve their ability to function better. These exercises are aimed at the following:
It has been proven beyond doubt that in addition to medications, physiotherapy plays a vital role in improving lung function over a period of time. Depending on the actual condition of the patient, a physiotherapy program is drawn up. Initially, the therapist will guide the patient and/or the caretaker with the various exercises. Over a period of time, the caretaker and the patient can do these on their own. The intent of these common exercises is to improve breathing efficiency, clear mucus, and improve overall lung function.
It has been proven beyond doubt that with no side effects (unlike medications), physiotherapy improves the overall quality of life in people with COPD.
The lungs are responsible for taking in and filtering out oxygen which is then supplied to the body via circulation. They are also responsible for removing the carbon dioxide from the body. This happens through breathing, and though no effort is required, when the function is impaired, the entire body system takes a toll.
Lung function can be impaired by a multitude of issues including infections like pneumonia, chronic diseases like COPD and pulmonary hypertension, heart conditions like a congestive failure, etc. While the acute cases would go off once the infection is treated, the long-term conditions are helped by physiotherapy in addition to medications.
The lungs are made up of elastic tubules and have the ability to hold secretions. Therefore training the lungs to improve their function via exercise can help improve overall lung function. Some of the routine exercises are simple ones as below.
Multiple studies have shown that physiotherapy plays a vital role in lung rehabilitation. As noted above, while the benefit may be not very evident in short-term lung impairment, it makes a significant difference in long-term and chronic conditions like COPD, pulmonary hypertension, and even congestive heart failure. Lung rehab has shown to produce the following changes: