Physiotherapy plays an important part in the recovery process of pediatric patients after cardiac surgery. After cardiac surgery, the child needs to start the exercises as soon as possible. Before cardiac surgery, pediatric patients are given some exercises by the physiotherapist to prepare them for the surgery. These exercises are required to be done after surgery to help them recover and to keep their lungs clear, well-expanded, and free of mucus. Physiotherapy treatment focuses on general mobility and chest care. It is essential to consult a physiotherapist before cardiac surgery. As he guides and teaches exercises that should be practiced before and after the surgery. This blog is designed to mention a few exercises that will help pediatric patients to recover after cardiac surgery.


Exercise Strategy

A physiotherapist is a health professional who is trained to prevent, identify, and correct movement problems. Pediatric patients should start doing the exercises as soon as possible while in the hospital. The posture is frequently checked during the day to make sure the child sits or stands straight and does not lean forward or to the side.

Sit in a chair with feet on the floor.
Sit or stand up straight, with the shoulders pulled back and down.
Shoulders should be stacked above the hips and should not be arching the back.
The breastbone takes approximately three months to heal. Therefore, to prevent stress on the breastbone the child should avoid pushing through his/her arms. He/she is advised to put his/her hands on the knees and shuffle the bottom when getting out of bed or a chair for the next three months.


Chest Care

Chest physiotherapy begins on the first day after the surgery. Discomfort or pain from the chest wound can stop the child from taking a deep breath in and coughing. For the first few days, the child may not be as mobile as he/she would normally be and so he/she can't breathe deeply. If the child is taught deep breathing exercises before the surgery, then it is easier to remember these exercises afterward.


Breathing Exercise:

The physiotherapist will teach the child how to practice deep breathing.

The child is made to sit upright with hands placed over the sides of the chest.
Then, asked to slowly take a deep breath through the nose.
Hold this breath in for one to two seconds and then breathe the air out slowly through the mouth.
Repeat 5 times.
Then huff 5 times.
To do a huff take a breath (medium-sized) then force the air out quickly through an open mouth.


Take a deep breath in and have a good strong cough, supporting the chest wound with a small pillow.
Take normal relaxed breaths after coughing.
Young children can practice deep breathing by blowing bubbles.
Older children can practice deep breathing using a device called an incentive spirometer.

After surgery, once the child is awake and breathing on their own, it is important to start doing the exercises.


Chin tucks:

Prevent forward chin posture, to encourage good posture, as forward chin posture can cause neck discomfort.

Sit in a good posture.
Sit up tall, drawing the shoulder blades towards the center of the spine.
While holding this posture, focus on bringing the chin back so the neck is long.
Hold this position for 5-10 seconds to feel the stretch and repeat 5-10 times.

 Initially, some gentle arm and leg exercises should be done to prevent stiffness, help circulation, and then progress to walking


Shoulder shrugs:

From the first day after the surgery, exercising should be encouraged.

The patient is sitting in a chair or standing.
Gently bring both shoulders up and down.
Repeat five to ten times.

Shoulder rolls:

Improve shoulder movement while maintaining neck posture.

Sit in a good posture.
Slowly and gently roll the shoulders in circles forward and backward.
Relax and repeat 5-10 times.

Arm raise:

The exercise goes like this:

Sit in a good posture.
Sit up tall, and draw the shoulder blades towards the center of the spine.
Lift one arm so that the elbow is beside the ear and then lower the arm.
Repeat 5-10 times. Repeat with the other arm.
Raise both arms straight forward over the head.
Then bring both arms back and down.
Repeat five to ten times.

Trunk side flexion:

Reduce stiffness that can happen with a side incision.

Sit in a good posture.
Lift the arm straight up on the incision.
Bend away from the incision so that it feels a stretch.
Breathe, in, then breathe out.
Return to the starting position and repeat 5-10 times.

Gentle heel slides:

These exercises are taught to help keep the muscles strong and promote circulation.

The patient lies on the bed with the legs well supported.
Bend both knees and straighten the legs alternatively.
Repeat 10 times.

Ankle movements:

The exercise goes like this:

The patient lies on the bed or sits in a chair.
Draw a circle shape with the feet from ankles, in one direction.
Repeat in the other direction.
Repeat 10 times in each direction.
Bring the ankles up towards the body.
Then bring them down toward the floor.
Repeat 10 times with each ankle.

Quadriceps sets:

The exercise goes like this:

The patient lies on the bed with legs straight.
Tighten the thigh muscles on the front of the legs.
Press the back of the knee into the bed and pull the toes towards the body. 

Quadriceps arc:

The exercise goes like this:

The patient lies on the bed with legs straight.
Tighten the thigh muscles.
Lift the leg from the bed to a small height.
Hold for 2 seconds, then slowly bring it down
Repeat ten times with each leg. 

From day two onwards following the surgery, begin to progress the mobility under the guidance of an experienced physiotherapist. After heart surgery, the child may have been unable to exercise for some time, so the increase in an activity needs to be done gradually, to build up his/her fitness slowly. Your physiotherapist may also recommend an exercise bike or pedals, to improve the patient's fitness by increasing the length of time on the bike rather than the resistance. At three months after the surgery, the child should be able to do everything that he/she did before the surgery.