This study will be conducted to investigate the effect of neuromuscular electrical stimulation on phrenic regeneration post cardiac surgery

Phrenic nerve injury post cardiac surgery is a serious problem closely related to frequent respiratory complications. It has been associated with diaphragm dysfunction, pneumonia and difficulty weaning from mechanical ventilation in critical ill patients.

Neuromuscular electrical stimulation (NMES) is commonly used in physical therapy to increase muscle strength and promote muscle hypertrophy.

There is increased flow of patients after heart surgery in kasr Aini hospital who suffers from respiratory complication due to phrenic nerve injury so the hospitalization period of them increased which make economic burden in health insurance services with decreased level of quality of life that is the most concern as to improve patient status and relief this burden. So this study aims to decrease respiratory complication and improve phrenic nerve regeneration by using neuromuscular electrical stimulation as a safe, noninvasive , inexpensive and virtually risk free method.

Inclusion Criteria:

• Patients post cardiac surgery (coronary artery bypass graft, valve repair or replacement ).
• Patients referred by physician.
• Medically stable patients.
• Both genders
• Ages from 25 to 45
• BMI 25-29.9 kg/m2
• Able to understand the requirements of the study.
• Conscious patient and respond to verbal commands.

Exclusion Criteria:

Participants will be excluded if they meet one of the following criteria:

• Patients with rib fracture.
• Patients developing lung cancer.
• Patients have dementia.
• Patients on mechanical ventilator after 24 hours
• Metabolically unstable chronic illness