從振興醫院經驗淺談 心臟復健data.tptas.org.tw/doc/cardiac...
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從振興醫院經驗淺談心臟復健
振興醫院心臟醫學中心物理治療長黃心怡
100/04/24
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What is cardiac rehabilitation?
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A supervised program of progressive exercise, psychological support, and education or training to enable a patient who has had a myocardial infarction to resume the activities of daily living on an independent basis. Special training may be needed to adapt the patient to a new occupation and lifestyle.
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Target Populations
Post‐myocardium infarction(MI)coronary artery bypass graft(CABG)PercutaneousTransluminal Coronary Angioplasty (PTCA)Stable angina
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Target Populations
Compensated heart failureControlled dysrhythmiasAICD/pacemakerPost‐valve replacementCardiomyopathyMyocardial aneurysm resectionPre‐ and post‐heart transplantCongenital heart defects
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Target Populations
StrokePeripheral vascular disease Hypertension(HTN)Diabetes(DM) and etc.
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Team Members
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45
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Physician Physical Therapist
Nutritionist
Pharmacist Psychologist
Others Cardiac Rehabilitation
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Physical therapy
Musculoskeletal system managementMuscle spam, Back pain, Spinal dysfunction, and etc.
Functional training Occupation therapy, recreational training, and etc.
Education and consultationExercise behavior change, exercise injury prevention, and etc.
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Nutritionist
Nutritional supplement 營養食品, 配方等
Individual diet planDietary diary, 飲食份量等
Education and consultationDASH 飲食
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Psychological component
Stress managementRelaxation
Psychotherapy
Education and consultation
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Education classes
• Smoking Cessation• Medication Usage • Risk Factors Modification
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Phases of cardiac rehabilitation
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Phase I cardiac rehabilitation
• Pre‐operation preparation• CCU stage• Step down stage• Discharge preparation
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Phase I cardiac rehabilitation
• Pre‐operation preparation– History – Risk factor– Heart function – Lung function– Musculoskeletal system – Neurological system– Occupation/ADL– Other disease
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Phase I cardiac rehabilitation
• CCU stage– lung injury after GA and ventilator
– prevent deconditioning– prevent complication– early upright – early mobilization
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Phase I cardiac rehabilitation
• Step down stage– Maximize ADL function – Early ambulation– Wound care– Correct posture– Musculoskeletal dysfunction– Neurological dysfunction
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Phase I cardiac rehabilitation
• Discharge preparation– Energy consumption– Advanced ADL function– Early aerobic training– Self monitor and self record
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Phase II cardiac rehabilitation
• Chart review• Individualized evaluation• Functional capacity assessment
– Exercise pulmonary function test– 6‐min walking test
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Phase II cardiac rehabilitation
• Aerobic vs. Anaerobic training
• Risk factor reduction• Musculoskeletal system dysfunction
• Functional activity training / energy consumption
• Return to work preparation
• Education
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Phase II cardiac rehabilitation
• Nutritional consult– Coumadin– 健康食品、配方奶粉
• Psychological support – Emotional control – Relaxation technique
• Pharmacy consult• Smoking quick cession
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Phase III cardiac rehabilitation
• Continued aerobic training
• Advanced weight training
• Combined with other leisure activity
• Occupational consultant
• Social support• Psychological support
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Phase III cardiac rehabilitation
99.04 得舒飲食餐會
99.08 病友運動會
99.05 打開心裡那扇窗
99.06 戶外休閒活動守則
從振興醫院經驗淺談心臟復健What is cardiac rehabilitation? Target PopulationsTarget PopulationsTarget PopulationsTeam MembersPhysical therapyNutritionistPsychological component Education classesPhases of cardiac rehabilitationPhase I cardiac rehabilitationPhase I cardiac rehabilitationPhase I cardiac rehabilitationPhase I cardiac rehabilitationPhase II cardiac rehabilitationPhase II cardiac rehabilitationPhase II cardiac rehabilitationPhase III cardiac rehabilitationPhase III cardiac rehabilitation
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