Post-Surgical Rehabilitation Program

Treatment Guide

This interdisciplinary guideline is designed to bridge the gap between clinical hands-on care and the client's home environment. By integrating Clinic-Based Physical Therapy (PT) with Virtual Occupational Therapy (OT), we ensure a seamless transition from "recovering" to "living."

1. Program Philosophy & Interdisciplinary Structure

The core of this program is the "Dual-Site Continuity" model. While PT focuses on the physiological and mechanical aspects of recovery in a controlled clinical setting, OT uses tele-health to translate those physical gains into the client's specific living and working environment.

PT (Clinic-Based): Focuses on manual techniques, high-level balance equipment, and supervised progressive loading.

OT (Virtual): Focuses on "In-Situ" recovery, modifying the home environment, ADL/IADL instruction in real-time, and ergonomic workplace assessments.

ST (Virtual - As Indicated): Addresses post-surgical cognitive "fog," swallowing dysfunction (if applicable), or communication barriers impacting recovery.

2. Clinical Treatment Guidelines

A. Tissue Integrity & Edema Management

Post-surgical healing begins with managing the environment of the surgical site.

Scar Management: PT initiates soft tissue mobilization (STM) once the incision is fully closed. OT provides virtual education on self-massage techniques and silicone sheeting application.

Edema/Lymphedema:

PT: Manual Lymphatic Drainage (MLD) and measurement for compression garments.

OT: Virtual monitoring of limb girth and education on elevation positioning during daily tasks.

B. Pain Management & Wellness

Moving away from a purely pharmacological approach to a multi-modal recovery.

Desensitization: For clients with nerve sensitivity, OT guides the client through sensory re-education using home items (textures, temperatures).

Healing Literacy: Both disciplines educate on "hurt vs. harm" to reduce fear-avoidance behaviors.

Wellness: Integration of sleep hygiene, hydration, and anti-inflammatory lifestyle habits.

C. Mobility, Balance, and Fall Risk

Clinic PT: Focused on gait training, strength, and reactive balance. Transitioning from assistive devices (walker/cane) to independent ambulation.

Virtual OT: Conducts a Virtual Home Safety Assessment. This involves the client moving their camera through their home to identify trip hazards, lighting issues, and the need for grab bars in the bathroom.

Community/Work Re-entry: PT simulates community distances; OT assesses the ergonomics of the client's actual workstation via video call.

D. ADLs, IADLs, and Precautions

This is the primary domain of the Virtual OT, ensuring the client adheres to surgical precautions (e.g., weight-bearing limits, hip precautions) while performing real-life tasks.

ADLs: Toileting, dressing, and bathing using adaptive equipment.

IADLs: Meal preparation, laundry, and light housework. The OT oversees the client performing these tasks in their own kitchen and provides real-time ergonomic corrections.

3. Virtual Speech Therapy (ST) Integration

ST is added if the client exhibits "Post-Operative Cognitive Dysfunction" (POCD); has been in the hospital for a long period of time, or if the surgery involves the neck/throat area. Speech Language pathologists may also work with individuals on respiration needs and managing vocalizations.

Cognitive Rehab: Managing "brain fog," memory strategies for medication management, and executive function for returning to work.

Dysphagia: Virtual swallow assessments and diet texture modification for clients post-intubation or cervical surgery.

Respiration, vocalizations and social communication: Educating clients on managing respiration and endurance to improve vocalizations. Helping clients respond socially during the recovery period.

4. Collaborative Communication Protocol

To ensure the "Interdisciplinary" nature of the program, the following touchpoints are required:

Frequency	Action	Participants
As often as needed	Collaboration regarding precaution progression.	All Therapists
As often as needed	Joint goal review (Update ADL vs. Physical metrics).	All Therapists
Monthly	Progress Report to Surgeon/Primary Physician.	All Therapists

5. Discharge Criteria

The client is ready for discharge when:

• Safety: They demonstrate a 0% fall rate in the home and community.
• Independence: They can perform all essential I/ADLs within the confines of their permanent restrictions.
• Self-Management: The client is independent in their home exercise program (HEP) and scar management.
• Functional Capacity: Mobility levels meet the requirements for their specific vocational or avocational goals and home living environment.
• Self Management: Demonstrates the ability to use strategies, manage recovery and responsibilities independently.