DEPARTMENT OF PHYSIOTHERAPY,  IJN.

Introduction

• The objective of the Physiotherapy Department is directed towardspatient achieving an optimal level of physical and socialindependence and improving quality of life.
• Our team of physiotherapists work together to provide a complete continuum of quality physiotherapeutic care to IJN’s patients – preventive, rehabilitative and maintenance.

Our Services

1. Cardiothoracic and Cardiopulmonary care
2. Cardiac Rehabilitation Program
3. Pain Management services
4. Special test / Diagnostic Test
5. Cardio fitness Program
6. Patient education on physical activities

We are located at:

Ground floor, Block B,

National Heart Institute,

145, JalanTunRazak,

Kuala Lumpur

Tel: 03- 2617 8339

Cardiothoracic and Cardiopulmonary Care

INTRODUCTION

Cardiorespiratory endurance refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. Early mobilization and physical activity improves the respiratory system by increasing the amount of oxygen that is inhaled and distributed to body tissue.

ACTIVE/PASSIVE EXERCISE

Active/passive exercise are done through the whole range of motion of the joint to preserve flexibility and mobility of the joints on which they are performed. These exercises maintain existing joint and soft-tissue mobility, minimize effects of the formation of contractures & improves sensory feedback from the contracting muscles.

AMBULATION

The ability to walk from one place to another independently with or without assistive device is the ultimate goal of the patient. To be able to move (especially walking), prevents cardio-pulmonary and musculoskeletal complications such as reduced cardiovascular endurance, muscular dystrophy, loss of coordination and stability as well as reverse anxiety and disease related stress.

BREATHING/AIRWAY CLEARANCE

• Definition:To mobilize and clear excess bronchial secretions from the lungs. Frequently executed with a combination of manual therapy such as postural drainage (percussion & vibration), special breathing techniques and effective coughing and warm humidified steam therapy to enhance airway clearance.

• Incentive Spirometry allows patients to perform sustained maximal inspiration (SMI) without added resistance while presenting a visual feedback of the inspiratory effort. It increases transpulmonary pressure and inspiratory volumes, improves inspiratory muscle performance, and simulate the normal pattern of  pulmonary hyperinflation.

Cardiac Rehabilitation program

Introduction

Cardiac rehabilitation is a continuous process of care which begins in the hospital. This program designed specifically for your needs, includes exercise, lifestyle changes, education, and emotional support from a multidisciplinary team. It can help improve your health and enable you to live a more active and quality life. Cardiac rehab can also help you return to work safely and in a timely manner.

Cardiac Rehabilitation can be divided into 3 phases.

Phase 1

This is the period of time when patients are admitted in hospital for a cardiac event. With supervision from the physiotherapist, patients begin with non-strenuous activities, such as sitting up in bed, breathing exercise, range-of-motion exercises and self-care, such as shaving. The program then progresses to walking and low intensity exercises either in the wards or gymnasium.

Phase 2

This is done in an outpatient setting upon discharge from the hospital. The Cardiac Rehab Phase II program is a structured, medically supervised, outpatient program for patients with heart disease that incorporates regular exercise ( group and circuit training ) along with other services such as nutritional education, stress management, and smoking cessation. In IJN, our Cardiac Rehabilitation Program Phase II may start as early as 2-3 weeks post-surgery or cardiac event.

Phase 3

This phase is a long term maintenance program. At this point, you probably would have developed your own exercise routine at home or at a local gym. The challenge now is to maintain a regular exercise program for the rest of your life.

PAIN MANAGEMENT SERVICES

• The use of electrotherapeutic modalities to relieve or reduce pain. These include TENS, Hot pack, Laser therapy, Ultrasound, Cryotherapy.

1) Transcutaneous Electrical Nerve Stimulation (TENS)

Induces pain relief for headaches, acute post-operative pain, arthritis, Phantom limb and low backache.

Contraindication:-

1. Patients with a cardiac pacemaker
2. Heart failure
3. Epileptic patients
4. Pregnant ladies in the 1^st trimester
5. Open wound

2) Hot pack

Suitable for soft tissue Injuries, muscles spasm, acute &superficial inflammatory conditions or for those contraindicated for electrical modalities.

Contra-indication

• Psychological
• Skin insensitivity
• Peripheral nerve injuries e.g. numbness, impaired sensation.
• Vasospastic diseases
• Peripheral vascular disease (decreased circulation)
• Cold insensitivity.

3) Cryotherapy (Ice Pack)

For relieving or reduce pain, reduce spasticity, reduce muscle spasm, reduce swelling, promote repair and provide excitatory stimulus when muscles are inhibited

Contra-indication

• Psychological treat
• Peripheral nerve injuries with impaired sensation.
• Vasospastic diseases
• Peripheral vascular disease
• Cold sensitivity.

4) Light amplification by stimulated emission of radiation (LASER)

LASER is used as a pain relief modality in conditions such as painful shoulder, hip arthrosis, epicondylitis, carpel tunnel syndrome etc. LASER heals the tissue while providing a powerful and non-addictive form of pain management by blocking pain pathways in the nervous systems and brings immediate pain relief.

Contra-indication

• Pacemaker
• Pregnancy
• Epileptic seizures
• Thyroid gland
• Active cancer/malignancy

5) Ultra Sound Therapy

Ultrasound is a therapeutic modality used for the treatment of acute & chronic condition affecting ligaments, tendons and muscle tissue. It is also used to achieve muscle relaxation and pain reduction by improving blood perfusion and recovery of injured tissue.

Contra-indication

• Vascular condition
• Pregnancy
• Acute infections
• Severe ischemic areas
• Radiotherapy
• The nervous system
• Tumors
• Metal implant

SPECIAL TEST/ DIAGNOSTIC SERVICES

Introduction

• A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease, injury or any other medical condition
• It may be used to confirm that a person is free from a disease, or to fully diagnose a disease, including sub-classifying it according to the severity and susceptibility to treatment.
• A Special test is important to obtaining an accurate diagnosis, and in turn maximizing treatment outcomes.

Six Minute Walk Test ( 6MWT )

• The test is used as a performance-based measure of functional exercise capacity.
• The test is used as a measure of the response to medical interventions in patients with moderate to severe heart or lung disease.

Lung Function Test

• Lung function tests provides a guide to the state and function of the respiratory system.
• Monitors the progress of the disease or response to treatment.
• To assess- and define the degree or severity of the disease or disability.

Breath CO test

• The test is used to measure the amount of Carbon Monoxide (CO2) in your lungs and blood.
• This is an indirect, non-invasive measure of blood carboxyhemogblobin (%COHb), which is the level of CO in your blood

Body Composition Analysis / Body Impedance Analysis

• This method measures body composition by sending a low, safe electrical current through the body.
• The current passes freely through the fluids contained in muscle tissue, but encounters difficulty/resistance when it passes through fat tissue. This resistance of the fat tissue to the current is termed ‘bioelectrical impedance’.
• When set against a person’s height, gender and weight, the scales can then compute their body fat percentage, lean muscle mass, total percentage of water and minerals.

Cardio Fitness Program

Introduction

This is progression of the Cardiac Rehabilitation Program in the later stages following a cardiac event. It is also applicable to those with one or more risks factors of cardiovascular disease to improve cardiovascular fitness and take change of self- management strategies of life long behavioral changes.

A series of tests and medical screening will be carried out prior to a prescribed exercise program in a safe environment with top medical facilities.

The client will go through a strict risk stratification which will be reviewed by a doctor to determine suitability for the program.

Suitable for:

1. All physically fit individual
2. Sedentary people
3. Those who want to change lifestyle
4. Those who wants to improve cardiovascular fitness
5. Those with one or more coronary risk factors for heart disease

Benefits of CFP

1 Stimulates production of red blood cells

2 Improves resistance to infection

3 Develops alertness, awareness & lessens reaction time

Between brain and body.

4 Decrease hazard of diabetes

5 Improve blood circulation in the legs.

6 Strengthens heart muscle – reduces high blood pressure and heart rate

7 Improves cardiovascular endurance and exercise tolerance.

Contraindication

1 Unstable or unresolved angina.

2 Fever and acute systemic illness.

3 Patient in severe pain.

4 Resting blood pressure: SBP> 180mmHg, DBP> 100mmHg

5 Significantly unexplained drop in blood pressure.

6 Tachycardia > 100bpm.

7 New or recurrent symptoms of breathlessness, palpitation, dizziness.

8 Significant lethargy.

For more information, please contact:

Tel: +603- 2617 8339

Fax: +603- 2600 6545

Email: cfp@ijn.com.my

Website: www.ijn.com.my 

Patient education on Physical Activities Post Cardiac Event

 Introduction

Education on physical activities throughout the recovery process is essential to prevent and eliminate adverse lifestyles and behaviors and specific interventions such as smoking cessation, dietary modification and exercise are recommended to prevent recurrences and slow the progression of disabling complication.

Objective:

1. Provide health information on the (coronary) disease process and therapeutic interventions aimed at slowing, halting or reversing the progression.

2. Allows the patient the freedom to discuss any queries or concerns regarding social and home activities.

3. Prepare patients for a return to work and resumption of activities of daily living at home and in the community.

4. Equip patients with the knowledge on how to progress with their exercise training program safely and appropriately within the constraints of their medical condition.

Benefit of exercise:

1. Regular activity strengthens your heart muscle
2. Lowers blood pressure
3. Increases high- density lipoproteins or HDLs.
4. Lowers low-density lipoproteins or LDLs.
5. Enhances blood flow.
6. Helps your heart function more efficiently.
7. Gives you more energy
8. Improves your mood.
9. Helps you manage your weight.
10. Promotes better sleep.