Thursday, 24 September 2026

EFFECT OF EARLY PHYSIOTHERAPY ON PULMONARY FUNCTION AND FUNCTIONAL RECOVERY FOLLOWING SURGICAL REPAIR OF ATRIAL SEPTAL DEFECT AND VENTRICULAR SEPTAL DEFECT

A BACHELOR OF PHYSIOTHERAPY THESIS

Submitted in partial fulfilment of the requirements for the degree of Bachelor of Physiotherapy

ABSTRACT

Background

Atrial septal defect (ASD) and ventricular septal defect (VSD) are common congenital heart defects that may require surgical correction depending on the size of the defect, haemodynamic significance, symptoms, associated complications and individual clinical characteristics. Although surgical repair corrects the structural cardiac abnormality, children may experience temporary postoperative respiratory dysfunction, reduced physical activity, muscle weakness, pain, fatigue and decreased functional capacity.

Physiotherapy has an important role in the perioperative management of children undergoing congenital cardiac surgery. Interventions may include preoperative education, respiratory assessment, breathing exercises, airway-clearance strategies when clinically indicated, positioning, early mobilisation, therapeutic exercise and functional retraining. A 2024 scoping review found that physiotherapy-delivered rehabilitation following paediatric congenital heart surgery may have beneficial effects on functional/developmental outcomes and muscle strength, although published studies remain heterogeneous and often have small sample sizes. (PubMed)

Aim

To investigate the effect of an early physiotherapy intervention programme on pulmonary function and functional recovery in children following surgical repair of ASD and VSD.

Objectives

To assess pulmonary function before and after surgical repair of ASD/VSD.
To assess functional mobility following surgery.
To determine the effect of early physiotherapy on postoperative recovery.
To compare outcomes between children receiving structured physiotherapy and children receiving routine postoperative care.
To examine the relationship between physiotherapy intervention and hospital length of stay.

Methodology

A prospective controlled study or randomised controlled trial may be conducted among children undergoing surgical repair of ASD or VSD. Eligible participants would be allocated to an intervention group receiving a structured physiotherapy programme or a control group receiving routine postoperative care according to institutional practice.

Outcome measures may include age-appropriate pulmonary-function measures, oxygen saturation, respiratory rate, functional mobility, walking capacity, pain, duration of hospital stay and postoperative pulmonary complications.

Expected Outcome

It is hypothesised that a structured early physiotherapy programme will contribute to improved functional recovery, progressive mobilisation and respiratory recovery following surgical ASD/VSD repair.

Conclusion

Early physiotherapy represents an important component of multidisciplinary rehabilitation following paediatric congenital cardiac surgery. However, intervention protocols should be individualised according to age, surgical procedure, haemodynamic status, respiratory status and the treating cardiac team's precautions.

Keywords: ASD, VSD, congenital heart disease, paediatric cardiac surgery, physiotherapy, early mobilisation, pulmonary function, functional recovery, cardiac rehabilitation.

CHAPTER 1 INTRODUCTION

1.1 Background

Congenital heart disease (CHD) refers to structural abnormalities of the heart or great vessels that are present at birth. CHD represents an important cause of morbidity in children and may range from relatively simple lesions to complex conditions requiring multiple surgical interventions.

Atrial septal defect and ventricular septal defect are among the important congenital cardiac lesions encountered in paediatric cardiac practice.

An ASD is an abnormal communication between the atria that permits blood flow between the right and left atria. Depending on the size and physiological significance of the defect, the condition may produce right-sided volume overload and other cardiovascular consequences.

A VSD is an abnormal opening between the right and left ventricles. The physiological consequences depend on the size of the defect and pulmonary vascular resistance. Larger defects may produce significant left-to-right shunting and symptoms related to pulmonary overcirculation and cardiac workload.

Surgical repair can correct the anatomical defect, but the postoperative period may involve considerable physiological stress. Anaesthesia, mechanical ventilation, thoracic surgery, pain, altered breathing mechanics and temporary reduction in physical activity may contribute to postoperative functional limitations.

Physiotherapy therefore forms an important part of multidisciplinary postoperative management.

A systematic review of perioperative chest physiotherapy in paediatric cardiac patients found that active approaches such as mobilisation and deep-breathing strategies were more useful than some passive techniques, while the evidence for routine prophylactic chest physiotherapy remained heterogeneous. (PubMed)

This supports an important principle for modern physiotherapy practice: treatment should be clinically indicated and appropriately dosed, rather than automatically applying the same respiratory treatment to every postoperative child.

1.2 Atrial Septal Defect

An atrial septal defect is a congenital communication between the atria.

Major anatomical types include:

ostium secundum ASD;
ostium primum ASD;
sinus venosus ASD;
coronary sinus defect.

The clinical significance varies according to defect size and associated cardiovascular abnormalities.

Children with significant ASD may have increased pulmonary blood flow and right-sided cardiac volume loading.

Some children remain asymptomatic during early childhood, while others may present with:

recurrent respiratory symptoms;
exercise intolerance;
poor growth;
fatigue;
recurrent infections;
cardiac enlargement.

Treatment depends on the anatomical and physiological characteristics of the defect.

1.3 Ventricular Septal Defect

Ventricular septal defect is an opening between the right and left ventricles.

VSDs may vary in:

location;
size;
haemodynamic significance;
associated cardiac abnormalities.

A significant VSD can result in left-to-right shunting and increased pulmonary blood flow.

Clinical presentation may include:

tachypnoea;
feeding difficulty;
failure to thrive;
recurrent respiratory infections;
sweating during feeding;
fatigue;
exercise intolerance in older children.

Surgical closure may be indicated in selected patients.

1.4 Surgical Repair

Surgical ASD/VSD repair is performed to close the abnormal communication and restore appropriate cardiovascular physiology.

The exact surgical approach varies according to the defect, age, anatomy and institutional practice.

From a physiotherapy perspective, the important consequences are not limited to the heart itself. The patient may experience:

postoperative pain;
reduced chest expansion;
altered breathing pattern;
secretion retention;
reduced mobility;
muscle weakness;
fatigue;
reduced exercise tolerance.

Therefore, rehabilitation should address both respiratory and functional recovery.

1.5 Physiotherapy After Paediatric Cardiac Surgery

Physiotherapy can begin with preoperative assessment and education and continue throughout the postoperative period.

Potential components include:

respiratory assessment;
positioning;
breathing exercises;
airway clearance when indicated;
supported coughing;
limb exercises;
bed mobility;
sitting and standing;
early walking;
progressive functional activity;
caregiver education;
discharge planning.

A scoping review published in Physiotherapy in 2024 identified published evidence for physiotherapy-delivered rehabilitation in children following congenital cardiac surgery and reported potential positive effects on functional/developmental outcomes and muscle strength, while emphasising limitations in study quality and intervention standardisation. (PubMed)

1.6 Rationale of the Study

Despite advances in paediatric cardiac surgery, postoperative rehabilitation remains an area requiring further investigation.

A major evidence gap is the lack of standardised physiotherapy protocols specifically targeting children after ASD/VSD repair.

Existing research includes different:

age groups;
congenital diagnoses;
surgical procedures;
intervention programmes;
outcome measures;
follow-up periods.

Therefore, studying a defined population undergoing ASD/VSD repair may help provide more clinically focused evidence.

Exercise research in postoperative congenital heart disease populations has suggested potential benefits for exercise capacity, although findings across studies are not completely consistent. A systematic review and meta-analysis of children and adolescents after CHD surgery reported an improvement in peak oxygen uptake with exercise training, while effects on FEV1 and FVC were not statistically significant. (PubMed)

This provides a rationale for examining both functional and respiratory outcomes, rather than relying on a single outcome measure.

1.7 Problem Statement

Children undergoing surgical repair of ASD and VSD may experience postoperative respiratory and functional limitations. There is a need to determine whether an appropriately structured physiotherapy programme can facilitate early recovery following surgery.

1.8 Aim

To determine the effect of an early physiotherapy intervention programme on pulmonary function and functional recovery following surgical repair of ASD and VSD in children.

1.9 Objectives

Primary objective

To determine the effect of early physiotherapy on functional recovery following surgical ASD/VSD repair.

Secondary objectives

To evaluate changes in respiratory parameters.
To evaluate changes in oxygen saturation.
To assess postoperative mobility.
To assess exercise tolerance.
To assess postoperative pain.
To document postoperative pulmonary complications.
To compare hospital length of stay between groups.

1.10 Research Question

Does an early structured physiotherapy programme improve pulmonary function and functional recovery following surgical repair of ASD/VSD in children?

1.11 Hypothesis

Null hypothesis (H0)

There will be no significant difference in pulmonary or functional outcomes between children receiving structured early physiotherapy and those receiving routine postoperative care following ASD/VSD repair.

Alternative hypothesis (H1)

Children receiving structured early physiotherapy will demonstrate significantly better pulmonary and functional recovery than children receiving routine postoperative care following ASD/VSD repair.

CHAPTER 2 REVIEW OF LITERATURE

2.1 Congenital Heart Disease and Functional Capacity

Children with CHD may have reduced physical activity and exercise capacity due to their underlying cardiovascular condition, previous interventions and activity restrictions.

After surgical correction, recovery does not necessarily mean immediate restoration of normal physical capacity.

Deconditioning can occur because of:

preoperative inactivity;
hospitalisation;
postoperative bed rest;
pain;
fear of movement;
muscle weakness;
reduced participation in normal play.

Consequently, physiotherapy should incorporate functional activity appropriate to the child's developmental stage.

2.2 Respiratory Consequences of Cardiac Surgery

Postoperative respiratory dysfunction can occur because of:

anaesthesia;
mechanical ventilation;
pain;
reduced inspiratory effort;
altered thoracic mechanics;
secretion retention;
reduced mobility.

Potential complications include:

atelectatic changes;
secretion retention;
impaired ventilation;
hypoxaemia;
pneumonia.

Physiotherapy assessment should therefore be directed toward identifying children who actually require respiratory intervention.

2.3 Chest Physiotherapy

Chest physiotherapy has historically included:

breathing exercises;
percussion;
vibration;
postural drainage;
suction;
incentive spirometry;
mobilisation.

However, evidence does not support indiscriminate use of every technique.

A systematic review and meta-analysis of paediatric cardiac surgery found no convincing evidence that routine chest physiotherapy prevented pneumonia or atelectasis, while active interventions such as mobilisation and deep breathing appeared more useful than some passive approaches. (PubMed)

This is clinically important because paediatric patients should not be exposed unnecessarily to uncomfortable or potentially poorly tolerated interventions.

2.4 Early Mobilisation

Early mobilisation is a key component of contemporary postoperative rehabilitation.

Progression may include:

Bed activity → sitting → standing → assisted walking → independent walking → functional play/activity.

The exact timing should depend on:

haemodynamic stability;
oxygen requirement;
lines and drains;
surgical precautions;
pain;
alertness;
medical clearance.

The AATS congenital cardiac surgery consensus document specifically addresses enhanced recovery following paediatric cardiac surgery and supports a comprehensive perioperative approach. (PubMed)

2.5 Exercise Training

Exercise training after congenital heart surgery may help improve physical capacity.

A systematic review and meta-analysis found evidence suggesting improvement in peak VO₂ after exercise training in children and adolescents following CHD surgery, although effects on conventional spirometric outcomes were less clear. (PubMed)

Another meta-analysis of postoperative CHD exercise interventions found improvements in some quality-of-life outcomes but did not demonstrate consistent improvement across exercise capacity and other physiological outcomes. (PubMed)

These findings suggest that exercise rehabilitation is promising but requires appropriately designed, diagnosis-specific research.

2.6 Physiotherapy and Motor Development

Children recovering from congenital cardiac surgery may be at risk of impaired motor development or reduced physical activity.

A systematic review and meta-analysis has reported motor-development concerns following surgery for critical congenital heart disease. (PubMed)

Physiotherapy should therefore consider developmental stage rather than treating a child as a small adult.

Interventions may include:

age-appropriate play;
gross motor activities;
balance activities;
transfers;
walking;
functional reaching;
caregiver-guided activity.

2.7 Preoperative Respiratory Muscle Training

Where clinically appropriate and feasible, preoperative respiratory muscle training may be considered.

A systematic review of cardiac-surgery populations reported reduced postoperative pulmonary complications and pneumonia and shorter hospital stay with preoperative respiratory muscle training. However, these data are from broader cardiac-surgery populations and should not automatically be extrapolated to every paediatric ASD/VSD patient. (PubMed)

This distinction is important when interpreting evidence.

2.8 Research Gap

The literature demonstrates several limitations:

Small sample sizes.
Heterogeneous congenital diagnoses.
Different surgical procedures.
Different physiotherapy interventions.
Lack of standardised protocols.
Different outcome measures.
Limited long-term follow-up.
Limited ASD/VSD-specific research.

The 2024 scoping review specifically highlighted the heterogeneity and limited evidence base surrounding physiotherapy rehabilitation following paediatric congenital heart surgery. (PubMed)

The proposed study therefore focuses specifically on ASD/VSD surgical repair.

CHAPTER 3 METHODOLOGY

3.1 Study Design

A prospective randomised controlled trial is proposed.

If randomisation is not feasible at the clinical site, the study may instead be conducted as a prospective comparative study.

3.2 Study Setting

The study may be conducted in:

Department of Physiotherapy and Department of Paediatric Cardiothoracic Surgery/Paediatric Cardiology at [Name of Hospital].

3.3 Study Population

Children undergoing surgical repair of ASD or VSD.

3.4 Sample Size

The final sample size should be calculated using:

the primary outcome;
expected effect size;
alpha level;
statistical power;
anticipated dropout.

For a BPT dissertation, the sample-size calculation should be performed with the assistance of the university statistician or supervisor rather than selecting an arbitrary number.

3.5 Inclusion Criteria

Potential inclusion criteria:

Children undergoing surgical repair of ASD or VSD.
Age within the predetermined study range.
Medically stable following surgery.
Parent/guardian provides informed consent.
Child is able to participate in age-appropriate physiotherapy.

3.6 Exclusion Criteria

Potential exclusion criteria:

Complex congenital heart disease requiring additional major procedures.
Significant pre-existing neuromuscular disorder.
Severe developmental impairment preventing assessment.
Significant postoperative haemodynamic instability.
Prolonged mechanical ventilation requiring individualised ICU physiotherapy.
Major postoperative complications preventing participation.
Any medical contraindication to mobilisation.

3.7 Ethical Considerations

Before recruitment:

approval should be obtained from the Institutional Ethics Committee;
informed consent should be obtained from parents/guardians;
assent should be obtained from children where developmentally appropriate;
confidentiality must be maintained;
participation must be voluntary;
participants must be allowed to withdraw;
adverse events must be documented;
treatment must be supervised by appropriately qualified healthcare professionals.

Because the participants are children, ethical safeguards are particularly important.

3.8 Outcome Measures

The following outcomes may be considered.

Primary outcome

Functional mobility/recovery

An age-appropriate functional mobility measure should be selected based on the study population.

Secondary outcomes

oxygen saturation;
respiratory rate;
heart rate;
respiratory symptoms;
pain;
walking capacity;
pulmonary function where age and cooperation permit;
duration of ICU stay;
total hospital length of stay;
postoperative pulmonary complications.

Important methodological point

Do not force spirometry on very young children who cannot perform reliable manoeuvres. The selected pulmonary-function measure must be age appropriate and validated for the population.

CHAPTER 4 PHYSIOTHERAPY INTERVENTION PROTOCOL

4.1 Preoperative Phase

Where time and clinical condition permit:

Patient/caregiver education

Explain:

postoperative physiotherapy;
importance of movement;
breathing exercises;
coughing;
mobilisation;
pain reporting;
expected recovery.

Baseline assessment

Record:

heart rate;
respiratory rate;
SpO₂;
respiratory pattern;
functional mobility;
pain;
baseline activity level.

4.2 Immediate Postoperative Phase

Treatment begins only after appropriate medical clearance.

Goals

Maintain adequate ventilation.
Assist secretion clearance when required.
Prevent unnecessary immobility.
Maintain joint mobility.
Reduce deconditioning.
Begin safe functional recovery.

4.3 Positioning

Appropriate positioning may include:

head and trunk elevation;
comfortable supported sitting;
regular position changes;
mobilisation out of bed when appropriate.

Positioning should consider all lines, drains, monitoring equipment and surgical precautions.

4.4 Breathing Exercises

Depending on age and cooperation:

diaphragmatic breathing;
thoracic expansion;
relaxed breathing;
age-appropriate breathing games;
blowing activities where clinically appropriate.

The intervention should never be forced in a distressed child.

4.5 Airway Clearance

Airway-clearance treatment should be indication based.

Possible interventions may include:

supported cough;
active cycle breathing techniques in appropriately cooperative older children;
suction where clinically indicated and within professional scope;
positioning;
mobilisation.

Routine percussion should not be automatically prescribed to every child because evidence has not demonstrated universal benefit and some studies have reported adverse physiological responses. (PubMed)

4.6 Limb Exercises

Gentle active movements may include:

ankle pumps;
knee flexion/extension;
hip movements;
hand opening/closing;
elbow flexion/extension;
shoulder movements within surgical precautions.

Exercises should be performed according to the child's tolerance and the surgical team's restrictions.

4.7 Early Mobilisation

A proposed progression:

Phase 1

Bed mobility and active limb movement.

Phase 2

Sitting in bed or at the edge of the bed.

Phase 3

Supported standing.

Phase 4

Short-distance assisted walking.

Phase 5

Progressive corridor walking.

Phase 6

Age-appropriate functional activity and play.

The child's response should determine progression.

4.8 Functional and Play-Based Rehabilitation

For children, rehabilitation should be developmentally appropriate.

Examples include:

reaching for toys;
sitting games;
standing games;
walking toward a parent;
ball activities;
age-appropriate play;
supervised stair practice where appropriate.

This can make physiotherapy more engaging while promoting functional movement.

4.9 Discharge Physiotherapy

Before discharge, assess:

functional mobility;
walking ability;
tolerance to activity;
caregiver understanding;
home activity plan;
surgical precautions;
warning symptoms.

Parents/caregivers should receive clear instructions regarding progressive activity and when to seek medical attention.

CHAPTER 5 DATA COLLECTION PROCEDURE

Day 0 – Preoperative

Record:

demographic information;
diagnosis;
surgical plan;
baseline physiological measures;
baseline functional status.

Postoperative assessment

Assess according to clinical stability and institutional protocol.

Record:

SpO₂;
respiratory rate;
heart rate;
pain;
functional mobility;
walking/activity tolerance.

Daily assessment

Document:

physiotherapy interventions;
duration;
mobility level;
symptoms;
physiological response;
complications.

At discharge

Repeat the selected outcome measures.

Record:

functional status;
length of stay;
ICU duration;
pulmonary complications;
physiotherapy tolerance.

CHAPTER 6 STATISTICAL ANALYSIS

Data should be entered into appropriate statistical software.

Descriptive statistics

For continuous variables:

mean;
standard deviation;
median;
interquartile range.

For categorical variables:

frequency;
percentage.

Inferential statistics

The appropriate statistical test depends on the final study design and distribution of the data.

Possible analyses include:

independent-samples t-test;
paired t-test;
Mann–Whitney U test;
Wilcoxon signed-rank test;
chi-square test/Fisher's exact test;
repeated-measures analysis.

If baseline differences or confounders are present, multivariable analysis may be considered.

A p-value <0.05 may be selected as the conventional threshold for statistical significance, provided this is specified prospectively in the protocol.

Effect sizes and confidence intervals should also be reported rather than relying only on p-values.

CHAPTER 7 EXPECTED RESULTS

The intervention group is expected to demonstrate:

progressive improvement in functional mobility;
earlier achievement of independent ambulation;
improvement in activity tolerance;
appropriate respiratory recovery;
potentially reduced duration of functional limitation;
potentially shorter hospitalisation.

However, these are hypotheses, not findings. The actual results must be determined from collected study data.

CHAPTER 8 DISCUSSION

The proposed study is based on the concept that surgical correction of the cardiac defect is only one component of recovery.

Children may require additional time to regain:

normal activity;
walking tolerance;
confidence with movement;
respiratory function;
muscle strength.

Physiotherapy can address these domains through a structured progression from respiratory assessment and positioning to functional mobility and age-appropriate activity.

The evidence base supports physiotherapy as a component of paediatric cardiac rehabilitation, but current literature also demonstrates important uncertainty. The 2024 scoping review identified only seven relevant peer-reviewed studies meeting its criteria and noted heterogeneity in participants, procedures and rehabilitation programmes. (PubMed)

Similarly, evidence regarding chest physiotherapy is mixed. The systematic review of paediatric cardiac patients did not establish that routine chest physiotherapy prevents pneumonia or atelectasis, reinforcing the need for clinically targeted rather than indiscriminate treatment. (PubMed)

Exercise-based rehabilitation has somewhat more encouraging evidence for selected outcomes. A meta-analysis reported improvement in peak VO₂ after exercise training in children and adolescents following CHD surgery, although pulmonary-function outcomes were not consistently improved. (PubMed)

Therefore, a comprehensive physiotherapy programme should not focus exclusively on respiratory treatment.

Instead, it should integrate:

Respiratory care + early mobilisation + functional activity + exercise progression + caregiver education.

CHAPTER 9 CLINICAL IMPLICATIONS

The findings of this research could potentially help physiotherapists:

develop structured postoperative pathways;
identify children requiring respiratory intervention;
standardise mobility progression;
improve documentation;
encourage age-appropriate activity;
improve caregiver education;
facilitate communication between physiotherapy and cardiac teams.

The research may also provide a foundation for future larger studies.

CHAPTER 10 LIMITATIONS

Potential limitations include:

Small sample size.
Single-centre design.
Variation in age.
Differences between ASD and VSD patients.
Differences in surgical complexity.
Difficulty performing reliable pulmonary-function testing in younger children.
Variation in postoperative medical management.
Short follow-up period.
Difficulty blinding physiotherapy interventions.
Potential influence of parental involvement and usual activity.

CHAPTER 11 CONCLUSION

ASD and VSD are important congenital cardiac conditions that may require surgical correction. Although surgical repair addresses the structural cardiac defect, children may experience postoperative respiratory and functional limitations.

Physiotherapy has an important role in supporting recovery through appropriate respiratory assessment, positioning, clinically indicated airway clearance, early mobilisation, therapeutic exercise, functional training and caregiver education.

Current literature suggests that physiotherapy rehabilitation following paediatric congenital cardiac surgery may have beneficial effects on functional and developmental outcomes, but the available evidence remains heterogeneous and further high-quality research is required. (PubMed)

The proposed study therefore aims to evaluate a structured early physiotherapy programme specifically in children undergoing surgical ASD/VSD repair.

A patient-centred, developmentally appropriate and safety-focused approach should remain central to paediatric cardiac physiotherapy.

REFERENCES

Clarke SL, Milburn NC, Menzies JC, Drury NE. The provision and impact of rehabilitation provided by physiotherapists in children and young people with congenital heart disease following cardiac surgery: a scoping review. Physiotherapy. 2024;122:47–56. (PubMed)
Fuller S, Ram Kumar S, Roy N, et al. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2021;162(3):931–954. (PubMed)
Beningfield A, Jones A. Peri-operative chest physiotherapy for paediatric cardiac patients: a systematic review and meta-analysis. Physiotherapy. 2018;104(3):251–263. (PubMed)
Gomes-Neto M, Saquetto BB, Silva e Silva CM, Conceição CS, Carvalho VO. Impact of exercise training in aerobic capacity and pulmonary function in children and adolescents after congenital heart disease surgery: a systematic review with meta-analysis. Pediatric Cardiology. 2016;37(2):217–224. (PubMed)
Xu C, Su X, Ma S, et al. Effects of exercise training in postoperative patients with congenital heart disease: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2020;9(5):e013516. (PubMed)
Yoshihara R, Kanejima Y, Kitamura M, Ishihara K, Izawa KP. Optimal exercise training for children with congenital heart disease: a systematic review. American Heart Journal Plus. 2022;13:100119. (PubMed)
Sprong MCA, Broeders W, van der Net J, Breur JMPJ, de Vries LS, Slieker M, van Brussel M. Motor developmental delay after cardiac surgery in children with a critical congenital heart defect: a systematic literature review and meta-analysis. Pediatric Physical Therapy. 2021;33(4):186–197. (PubMed)
Preoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review. Physiotherapy. 2023. (PubMed)

APPENDIX I

PROPOSED PHYSIOTHERAPY ASSESSMENT FORM

Patient information

Patient ID:
Age:
Sex:
Diagnosis: ASD / VSD
Date of surgery:
Type of repair:
Weight:
Height:
Relevant medical history:

Baseline assessment

Parameter	Preoperative	Postoperative	Discharge
HR
RR
SpO₂
Pain
Functional mobility
Walking/activity tolerance
Oxygen requirement

APPENDIX II

PHYSIOTHERAPY DAILY RECORD

Date:
Postoperative day:

Respiratory

Breathing pattern:
Secretions:
Cough:
SpO₂:
Oxygen:
Respiratory intervention:

Mobility

Bed mobility:
Sitting:
Standing:
Walking distance:
Assistance required:

Exercise

Limb exercises:
Breathing exercises:
Functional activity:
Play-based activity:

Response

HR before:
HR after:
SpO₂ before:
SpO₂ after:
Pain:
Fatigue:
Adverse symptoms:

Physiotherapist's signature:

APPENDIX III

PROPOSED FLOW OF INTERVENTION

Preoperative assessment

↓

Patient/caregiver education

↓

Postoperative medical clearance

↓

Respiratory assessment

↓

Positioning + breathing exercises where indicated

↓

Active limb movement

↓

Sitting

↓

Standing

↓

Assisted walking

↓

Progressive walking

↓

Age-appropriate functional/play activity

↓

Discharge education

↓

Follow-up / cardiac rehabilitation

KEY MESSAGE FOR CLINICAL PRACTICE

The goal of physiotherapy after ASD/VSD repair is not simply to “clear the chest.”

The broader objective is:

“To restore safe breathing, movement, functional independence and age-appropriate physical activity as early as clinically appropriate.”