Lucy Coughlan

Highly Specialised Physiotherapist

St George’s Hospital, London

Rehabilitation following pelvis reconstruction

Content

• Short / medium / long term physiotherapy intervention possibilities

• Rehab options

• Physiotherapy considerations specific to pelvic trauma

Pre - Op Early Middle Late

• Background history

• Other injuries

• Education

• Peripheral nerve assessment

• Maintenance exercises

• Early discharge considerations

Pre - Op Early Middle Late

• Cardiovascular stability • Pain relief • Education • Muscle length and strength • Review nerve function • Early mobility • Involvement of family/carers • Psychological support • Goals and expectations • Discharge options

Mobility - Bed mobility - Forwards / backwards - Sitting on the edge of

the bed - Slide board transfers - Pivot transfers - Seating considerations - Wheelchair skills - ?walking

Pre - Op Early Middle Late

Pre - Op Early Middle Late

Exercises • Maintenance for NWB

limbs • Pelvic floor • Core stability • Flexibility • Balance • Strengthening for upper

limbs • Desensitising (PNI) • Passive ROM • Proprioception

Progression

Problem solving techniques

Maximise independence

Pre - Op

Early Middle Late

Onward rehab • Goal setting • Bed based ICT • Home based ICT • Community therapy • Outpatient physiotherapy • Hydrotherapy • PNI unit • Women’s / men’s health (pelvic floor rehab) • Orthotics • Vocational rehabilitation

Other considerations • Psychosocial impact • High trauma, major

injury • Child bearing age ? • Financial • Uro/sexual function • Home adaptations • Reliance on other

people • Long term complications

Summary

• Major injury with potentially severe / long term consequences

• Huge impact on many aspects of life

• Holistic and MDT approach to rehab in short/medium/long term

Resources and references

• www.aftertrauma.org • www.dayone.uk.com • Baessler K, Bircher MD, Stanton SL: Pelvic floor dysfunction in

women after pelvic trauma. Br J Obstet Gynaecol 2004;111:499–502 • Wright JL, Nathens, AB, Rivara FP, MacKenzie EJ, Wessells H: Specific

fracture configurations predict sexual and excretory dysfunction in men and women 1 year after pelvic fracture. J Urology 2006;176:1540–1545.

• Brenneman FD, Katyal D, Boulanger BR, et al. Long-term outcomes in open pelvic fractures. J Trauma. 1997;42:773–777

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