Thoracic Organ Transplantation

Question 1

Physiotherapy Assessment: Subjective

Answer 1

> Clinical course
> Symptoms experienced
> Main limitations to activities
> Ability to perform ADLs
> Current/previous exercise and rehabilitation
> Recreational pursuits, employment
> Social supports
> Patient goals and expectations of transplant

Question 2

Physiotherapy Assessment: MSK

Answer 2

> Posture
> Joint ROM
> Muscle length
> Muscle strength
> Muscle bulk

Question 3

Physiotherapy Assessment: Exercise capacity

Answer 3

> 6MWT: in adults <300-400 m = appropriate for heart and/or lung transplantation.
Max exercise testing: VO2 peak ≤14 ml x kg x min is an indication for listing for cardiac transplant.

Question 4

Physiotherapy Assessment: Respiratory

Answer 4

> Breathing pattern: extent and use of accessory muscles, WOB
Auscultation
Effectiveness of cough and huff
Ventilatory support: O2 therapy, non-invasive ventilation
Airway clearance: sputum quantity and quality, evaluation of current techniques, preferences of techniques, adherence.

Question 5

Pre-transplant exercise guidelines

Answer 5

> Exercise 3-5 times/week
Supervision when possible
Combination of endurance and strength training
Intensity: for lung pt RPE 4; for cardiac pt RPE 9-12
30’ total time endurance training
Interval training useful with symptomatic pt
Stretch/maintain muscle length (particularly LL)
Maintain ROM of shoulders and chest wall
Include fx exercises

Question 6

Post-operative PT treatment

Answer 6

> Optimize ventilation
> Clear retained lung secretions
> Promote independent function
> Improve fitness/activity tolerance
> Facilitate self-management