__Progressive_Exercise_Therapy_in_Rehabilitation_and_Physical_Education

190 PROGRESSIVE EXERCISE THERAPY EXERCISE THERAPY The lists of progressive exercises given here are intended to be a guide to the after-treatment of partial and total gastrectomy. FIRST 2 POSTOPERATIVE DAYS Usually, intravenous therapy is used on the lst day, and one of the patient's arms or legs is immobilized for this purpose. A Ryle's tube may be in position for intermittent aspiration of the stomach remnant. To help prevent pulmonary complications the patient should spend a considerable amount of his time lying flat on his back and on the left and right sides; he stays in each position for about 1-2 hours at a time (p. 185). Should a collapse of a particular area of the lung develop in spite of all precautions, postural drainage will be instituted as outlined on p. 185. Sitting out of Bed Provided that there are no respiratory complications, sitting out in a chair for about 10-20 minutes is generally allowed on the 1st postoperative day. Supervised walking round the bed is usually allowed on the 2nd day. Remedial Aims To prevent postoperative respiratory and circulatory complications. Exercise Period 15-20 minutes, two or three times daily. In addition to these treatment sessions the patient will practise some of the exercises on 'little and often' lines. Primary Exercises Breathing, Ankle/Foot and Leg Exercises (see previous section, pp. 186-188) It should be noted that diaphragmatic breathing is extremely shallow on the 1st postoperative day and may be almost impossible to obtain (p. 184). 3rd and 4th POSTOPERATIVE DAYS The patient rests in bed between intervals of sitting out in a chair; provided there are no respiratory complications he takes up an ordinary half-lying position. Short periods of walking in the ward are encouraged.