Briefly the main aims are to:

1-Gain the patient confidence
2-Clear the lungs fields
3-Teach respiratory control and inspiratory holdings
4-Teach postural awareness
5-Teach arm, trunk and leg exercises
6-Teach mobility about the bed.
7-Exercise Tolerance testing

Patientís confidence : An explanation of the aim of physiotherapy helps the patientís understanding. Teaching the exercises to be undertaked postoperatively and answering the patientís questions helps to allay some of the fears of operations.

Clearing lung Fields:

The patient must be discourged from smoking. Shaking, clapping and vibrations with postural drainage if necessary must be used to clear the secretions from the sound lung. Huffing is taught as this is used in preference to coughing postoperatively. The patient is instructed on how to support the wound during coughing and huffing. The arm of unaffected side is placed across the front of the thorax and around the affected side just below the incision side giving firm pressure with the forearm and hand. The upper arm of the affected side reinforces the pressure and the hand fixes the opposite elbow.

Teaching the respiratory control:

Inspiratory exercises are taught for the sound lung together with the inspiratory holding. This means that the patient is asked to take a deep breath in, hold, then breathe in a little further, hold, then breathe out.

Breathing control has to be practiced after secretions have been cleared.

Incentive spirometry may be helpful to improve the patientís inspiratory capacity.

This a technique used to encourage the patient to take a deep breath in when there is hypoventilation after thoracic or high abdominal surgery due to pain or secretions retention. The breathes in through a tube which is attached to a device that illustrate the volume of the inspired air. For example, at low lung volume, a plastic ball rises to the top of the column, at mid lung volume a second ball rises and at high lung volume a third ball rises. So long as the patient holds a deep breath, the balls remain at the top of the columns. Some devices operate by a light coming on when the volume of breath reaches a pre set level. Some devices work on the expiratory phase rather than the inspiratory phase.

Teaching the postural Awareness:

There is a tendency to protect the scar leads to a scoliosis (concave on the scar side) and forward flexion. This should be prevented.

Teaching Arm Trunk And leg Exercises:

The following exercises shoudl be taught to the patient.

Foot and ankle exercises.

The arm on the affected side must be moved.

1- Into full elevation
2- Hand behind head

3- Hand behind back
4- Hand touch opposite shoulder

Trunk Exercises

1- Sitting on the edge of the bed
(a) Trunk turning
(b) Trunk bending side to side
(c) Trunk stretching backwards

Teach mobility Around the Bed:

A rope ladder should be provided so that patient can pull on it to move around in bed and sit up.

Exercise Tolerance Testing:

An exercise tolerance test should be a part of the preoperative assessment if the lung to be excised is functional and also for the other normal lung.