Children who require a heart transplant have very complicated medical issues. Therefore, in order to prepare for, and recover from, heart transplant surgery, you and your child will work with a comprehensive care team that includes a variety of health care professionals. This includes a physiotherapist.
What is a physiotherapist?
A physiotherapist (PT) is a medical professional who will assess your child’s lungs and muscles and how they move and exercise.
How do physiotherapists help children having heart transplants?
Before heart transplant
The PT will assess your child’s level of function. This includes evaluating your child’s developmental skills, strength, range of movement, flexibility and ability to perform activities.
Many children waiting for heart transplants have limited activity level, but all children are encouraged to participate to the best of their abilities.
Being in the best shape possible before surgery will help to speed up the recovery time. Depending on your child’s medical status, their PT may set up a low-level exercise activity program for them to do at home, or they may have your child come to the hospital. The exercises usually involve aerobic and resistance (strength) training, as well as stretching and balance exercises. Activities might include light weights, a treadmill, and/or a bicycle. For younger children, the program is more focused on fun and developmental activities, such as climbing, throwing and kicking balls.
Their PT may also refer your child to another physiotherapist in the community, rather than having them come to the hospital - especially if your child is under the age of two.
After heart transplant
Once your child is stable, their PT will work with them right from the Cardiac Critical Care Unit (CCCU) until after you go home, to help them recover from surgery. They will help your child get back to the activities that they enjoyed before their transplant, and may help with finding new ones.
Goals for your child while in the CCCU
Keeping the lungs healthy
As soon as your child’s breathing tube is removed, they will be encouraged to do deep breathing and coughing exercises to help their lungs stay healthy. At this point, their physiotherapist may provide you with bubbles or breathing exercises to practice with your child throughout the day. This will help encourage bigger breaths with movement of the diaphragm, and help open the air sacs in the lungs to reduce the risks of breathing problems.
Getting your child moving
To prevent stiffness, and help with keeping their lungs healthy, your child will be encouraged to sit up (first in bed and then getting into a chair) as soon as possible. Their physiotherapist and/or bedside nurses will help you with this. You can get your child ready to do this by encouraging them to move their arms and legs gently in bed.
It can be quite scary to think about doing exercise in critical care, but the more your child does here, the sooner they can regain their activity and leave the hospital.
Goals for your child while on the ward and working to discharge from the hospital
Walking
Your child’s nurses and physiotherapists will encourage them to be up out of bed and going for walks. This will start with short distances (i.e. to the bathroom) and progress as possible. Your child should try to be up and out of bed a minimum of three times a day. This will help their overall recovery.
Going to the gym
Once your child is well enough, they will begin going to the gym. Here your child’s health-care team will work on getting them ready to go home, return to school, and work on all the activity goals they have for the future.
Precautions while your child’s incision is healing
Instructions for babies
| Time period | Activity recommendations |
|---|---|
| Up to two weeks after surgery, or until the chest wound is fully healed |
|
| Up to six weeks after surgery |
|
Instructions for toddlers, children, and teens
| Time period | Activity recommendations |
|---|---|
| Up to two weeks after surgery, or until the chest wound is fully healed |
|
| Up to six weeks after surgery |
|
| Up to 12 weeks after surgery |
|
At home and at school
The goal of physiotherapy is to help your child achieve an active, healthy lifestyle. Common problems after transplant surgery are general deconditioning and weakness. For younger children this may result in reduced performance of some of their gross motor skills such as sitting, crawling and walking. Physiotherapy will help to alleviate these problems.
Right after your child is released from the hospital, their PT will follow up with them as an outpatient. Children over the age of 6 may attend physiotherapy at the hospital for a progressive exercise program to maximize their recovery. They will also be given some exercises to do at home.
Younger children may attend outpatient physiotherapy or, if it is appropriate, home visits from a PT will be arranged. Once your child is ready to go back to school, their PT may give you information on new exercises that should be done regularly. They may also prepare a letter for your child to take to school, outlining any physical activity restrictions that need to be observed in gym class. Many children may not have been active before their transplant because of their heart condition. The PT can help set safe activity goals and start your child on a path to lifelong health and fitness.
Long-term exercise after transplant
Most children return to school and participate fully in gym class without any concerns. However, it must be noted that after a heart transplant it is important to include a warm-up and cool-down with exercise. This is because the new heart is not attached to the brain, so the brain cannot automatically tell the heart to speed up in response to exercise. Your child’s PT can tell you what activities they should participate in, for how long, and at what intensity.