Introduction
Heart surgery is only the beginning of recovery. For many patients, the real challenge starts after discharge rebuilding strength, regaining mobility, and learning to perform everyday activities again. This case study highlights the inspiring rehabilitation journey of a 57-year-old patient who progressed from complete dependence and severe generalized weakness to independent walking through structured physiotherapy rehabilitation after Coronary Artery Bypass Grafting (CABG).
Recovery after cardiac surgery can become highly complicated when prolonged bed rest, respiratory weakness, and generalized muscle weakness limit movement and independence. Physiotherapy rehabilitation plays a vital role in helping patients regain strength, improve breathing capacity, prevent complications, and restore functional independence.
This case demonstrates how a carefully planned and phase-wise rehabilitation program helped a post-CABG patient recover physically and functionally over a period of 24 weeks.
Understanding the Case
Initial Condition
A 57-year-old male had a significant medical history of Diabetes Mellitus and Hypertension, both of which are major risk factors for cardiovascular disease and can negatively affect recovery after cardiac surgery. Due to underlying coronary artery disease, the patient underwent Coronary Artery Bypass Grafting (CABG). Following surgery, he developed severe generalized weakness that resulted in complete dependency and a bedridden condition. Prolonged immobility further contributed to reduced muscle strength, poor endurance, swelling in both feet (bilateral pedal edema), respiratory compromise, and difficulty clearing secretions. The combination of multiple comorbidities, post-surgical deconditioning, and respiratory weakness made the rehabilitation process highly challenging and required a comprehensive, long-term physiotherapy rehabilitation approach.
Major Challenges at Admission
- Inability to move upper and lower limbs
- Severe muscle weakness
- Dependency for all daily activities
- Reduced sitting tolerance
- Respiratory compromise and secretion retention
- Bilateral pedal edema (swelling in both feet)
Clinical Assessment Findings
Motor Function
Muscle strength was extremely poor, with only trace contractions present in both upper and lower limbs.
Sensory Examination
- Sensations were intact
- No dermatomal loss observed
Functional Status
Initial outcome measures showed severe disability and complete dependence:
- Functional Independence Measure (FIM): 0
- Barthel Index (BI): 0
- Berg Balance Scale (BBS): Not Applicable
These scores reflected the patient's inability to perform even basic functional tasks independently.
Rehabilitation Approach
A structured, phase-wise physiotherapy rehabilitation plan was implemented over 24 weeks. The program focused on gradual progression while ensuring patient safety and respiratory stability.
Phase 1: Early Recovery and Respiratory Care (Weeks 1–2)
During the initial phase, the priority was preventing complications associated with prolonged bed rest and improving respiratory function.
Interventions Included
- Passive Range of Motion (PROM) exercises
- Positioning for optimal lung expansion
- Chest physiotherapy
- Percussion and vibration techniques
- Suction assistance for secretion retention
- Deep breathing exercises
- Thoracic expansion exercises
- Pressure sore prevention strategies
- Circulation improvement exercises
This phase helped maintain joint mobility, improve circulation, and support pulmonary recovery.
Phase 2: Assisted Mobility and Breathing Improvement (Weeks 2–4)
As the patient's condition stabilized, assisted movement and upright positioning were introduced.
Key Interventions
- Active Assisted Range of Motion (AAROM) exercises
- Calf and hamstring stretching
- Supported sitting
- Incentive spirometry
- Segmental breathing exercises
- Assisted coughing techniques
- Upright positioning for improved ventilation
Gradual sitting helped improve respiratory endurance and participation in therapy sessions.
Intermediate Rehabilitation and Respiratory Weaning (Weeks 5–10)
This phase focused on improving functional mobility while gradually reducing respiratory dependency.
Rehabilitation Progression
- Sitting with and without support
- Bed mobility training
- Active Range of Motion (AROM) exercises
- Standing with two-person support
- Stretching and strengthening exercises
- Leg raises in sitting position
Respiratory Weaning Interventions
- Monitoring oxygen saturation and respiratory rate
- Progressive reduction of respiratory support
- Functional mobility training with respiratory monitoring
- Endurance training through sitting and standing activities
- Continued airway clearance techniques
During this period, the patient demonstrated:
- Improved secretion clearance
- Better spontaneous coughing ability
- Increased sitting tolerance
- Improved respiratory endurance
Advanced Functional Rehabilitation (Weeks 11–18)
Once standing tolerance improved, the focus shifted toward strengthening, balance, and functional independence.
Interventions Included
- Standing frame training
- Sit-to-stand exercises
- Shoulder pulley exercises
- Motorized cycling
- Theraband and dumbbell strengthening
- Walker-assisted standing and transfers
- Continued breathing exercises
The patient gradually progressed from supported standing to standing independently.
Gait Training and Functional Independence (Weeks 19–24)
The final stages of rehabilitation emphasized gait training, coordination, and independent functional activities.
Final Rehabilitation Activities
- Walking with walker
- Independent standing
- Strengthening exercises
- Half squats
- Coordination training
- Independent sit-to-stand practice
- Walking without support
By the end of 24 weeks, the patient was able to walk independently for up to 50 yards without support.
Functional Improvements Achieved
The patient showed remarkable improvements throughout rehabilitation.
Physical Improvements
- Improved muscle strength
- Better sitting and standing balance
- Enhanced endurance
- Improved mobility and coordination
Respiratory Improvements
- Improved oxygenation
- Better chest expansion
- Reduced secretion dependency
- Improved respiratory endurance
- Reduced risk of pulmonary complications
Functional Improvements
- Improved participation in rehabilitation
- Increased independence in daily activities
- Ability to perform sit-to-stand independently
- Independent walking achieved
Final Outcome Measures
At the completion of cardiac rehabilitation, significant improvements were observed:
- Berg Balance Scale (BBS): 25
- Functional Independence Measure (FIM): 68
- Barthel Index (BI): 80
- Morse Fall Scale: 30
These scores reflect major functional recovery and partial independence.
Rehabilitation Goals
The rehabilitation program focused on both physical recovery and respiratory rehabilitation. Cardiac rehab is important for faster and smoother recovery.
Primary Goals
- Improve muscle strength and mobility
- Prevent bed sores and joint contractures
- Improve lung expansion and oxygenation
- Reduce risk of pneumonia and atelectasis
- Improve chest expansion and respiratory endurance
- Enhance sitting and standing balance
- Restore independence in activities of daily living (ADLs)
- Progress toward independent walking
Short-Term Rehabilitation Goals
- Prevent bed sores, joint stiffness, and muscle contractures
- Improve circulation and reduce bilateral pedal edema
- Enhance lung expansion and improve oxygenation
- Facilitate secretion clearance and improve breathing efficiency
- Improve sitting tolerance and postural control
- Initiate gradual upper and lower limb mobility exercises
- Improve respiratory endurance and reduce pulmonary complications
- Increase participation in physiotherapy sessions
- Begin supported bed mobility and functional movements
Long-Term Rehabilitation Goals
- Improve overall muscle strength and endurance
- Achieve independent sitting and standing balance
- Restore functional mobility and gait training
- Progress from supported walking to independent ambulation
- Improve coordination and functional activities
- Achieve independence in basic activities of daily living (ADLs)
- Enhance cardiovascular and respiratory endurance
- Reduce dependency on caregivers for mobility and transfers
- Improve overall functional independence and quality of life
- Facilitate safe return to daily routine activities
Conclusion
This case highlights the importance of after cardiac surgery, especially in patients with severe generalized weakness and prolonged immobility. Through early mobilization, respiratory rehabilitation, progressive strengthening, and functional training, the patient successfully progressed from a completely bedridden condition to independent walking.
The case demonstrates how consistent rehabilitation can significantly improve mobility, respiratory health, functional independence, and overall quality of life after major cardiac surgery.
