Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy.

Ansel Lapier,Kimberly Cleary,Francesca Cordella

doi:10.1155/2021/8889502

Ansel Lapier, Kimberly Cleary + Show 1 more

Open Access

https://doi.org/10.1155/2021/8889502

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Abstract

Patients often need to use their arms to assist with functional activities, but after open heart surgery, pushing with the arms is limited to <10 lb (4.5 kg) to help minimize force across the healing sternum. The main purposes of this study were to determine if older patients (>60 years old) (1) accurately estimated upper extremity (UE) weight bearing force of 10 lb or less and (2) if feedback training improved their ability to limit UE force and pectoralis major muscle contraction during functional activities. An instrumented walker was used to measure UE weight bearing force, and electromyography was used to measure pectoralis major muscle activity simultaneously during 4 functional mobility tasks. After baseline testing, healthy older subjects (n = 30) completed a brief session of visual and auditory concurrent feedback training. Results showed that the self-selected UE force was >10 lb for all tasks (20.0-39.7 lb [9.1-18.0 kg]), but after feedback training, it was significantly reduced (10.6-21.3 lb [4.8-9.7 kg]). During most trials (92%), study participants used >12 lb (5.5 kg) of arm weight bearing force. Pectoralis major muscle peak electromyography activity was <23% of maximal voluntary isometric contraction and was reduced (9.8-14.9%) after feedback training. Older patients may not be able to accurately estimate UE arm force used during weight bearing activities, and visual and auditory feedback improves accuracy and also modulation of pectoralis major muscle activation. Results suggest that an instrumented walker and feedback training could be clinically useful for older patients recovering from open heart surgery.

Highlights

To access the heart, median sternotomy is performed during a variety of different surgeries such as coronary artery bypass, heart valve replacement, heart transplantation, and thoracic trauma repairs
This study revealed that during all of the functional tasks performed before feedback training, on average, the force put through the upper extremity (UE) by the study participants exceeded that generally recommended with sternal precautions 10 lb (4.5 kg) or less [5, 8, 9]
Po-Chen and Cherng [39] found that healthy older adults on average put 22-28 lb (10.0-12.7 kg) of UE force through a standard walker when given no instructions to limit weight which is similar to the mean value during ambulation with a standard walker in our study of 30.6 lb (13.9 kg)

Summary

Introduction

Median sternotomy is performed during a variety of different surgeries such as coronary artery bypass, heart valve replacement, heart transplantation, and thoracic trauma repairs. A variety of wiring techniques are used to reunite the sternal halves after surgery completion [1]. Because it allows for optimal visualization and access to the heart and mediastinum, median sternotomy is frequently used during cardiac surgery despite the development of less invasive techniques [2]. Previous research has identified many of these risk factors including obesity, female gender, diabetes, history of smoking, disability, intraoperative blood loss, redo sternotomy, bilateral internal mammary artery grafting, prolonged mechanical ventilation, cardiopulmonary bypass, and surgical time [6, 7]. In order to avoid many of the complications associated with median sternotomy, upper extremity (UE) activity limitations are prescribed to minimize postsurgical stress across the healing sternal halves [5, 7,8,9]

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