Comparison of Supra-abdominal ex Versus Infra-abdominal With Laser on Median Sternotomy

Effect of Supra-abdominal Versus Infra-abdominal Muscles Training Combined With LASER on Sternal Instability After Open Heart Surgery

the aim of this study is to find out the differences between the effect of supra- abdomen exercises and the effect of infra-abdomen exercise combined with LASER And the effect of LOW LEVEL LASER only on sternal instability. Methods: 120 patients of both sexes who had acute sternal instability post-open heart surgery will be recruited in this study at Assiout University Hospitals; their ages will be > 18 years. They will be randomly assigned into 4 equal groups:

1. Study group (A): patients will receive supra-abdominal resisted exercises combined with LLL and the traditional cardiac rehabilitation program of phase one.
2. Study group (B): patients will do infra-abdominal resisted exercises combined with LLL and the traditional cardiac rehabilitation program of phase one.
3. Study group (c): patients will receive a traditional cardiac rehabilitation pro-gram of phase one with LLL
4. Control group: patients will receive the traditional cardiac rehabilitation pro-gram of phase one only

Type of study: Randomized controlled trial This study is a prospective interventional study one that will be conducted on 120 patients of both sexes who had acute sternal instability post-open heart surgery; their ages will be < 18 years. They will be recruited from Assiut University Hospitals and will randomly be divided into 4 equal groups

1. Study group (A): patients will receive supra-abdomen resisted exercises combined with LLL and the traditional cardiac rehabilitation program of phase one.
2. Study group (B): patients will do infra-abdomen resisted exercises combined with LLL and the traditional cardiac rehabilitation program of phase one.
3. Study group (c): patients will receive a traditional cardiac rehabilitation pro-gram of phase one with LLL
4. Control group: patients will receive Traditional cardiac rehabilitation pro-gram of phase one only

IInclusion criteria :

All included patients will be:

• Their age 18<.
• Both sexes.
• Hemodynamic stable.
• Acute sternal instability.
• Able to provide informed consent.

Exclusion criteria:

Patient will be excluded if:

• Emergency or urgent operation.
• Revision sternotomy.
• Manifesting hypoxemia.
• Partial oxygen pressure in arterial blood < 60 mmHg.
• Renal insufficiency with serum creatinine ≥ 1. 8 mg/dl after surgery.
• Low cardiac output syndrome with ST segment elevation in multiple electrocardiogram leads.
• Cardiac arrhythmias or hypotension.
• Other medical conditions, such as diabetes, uncontrolled hypertension and obesity.
• Previous medical history including conditions that may have influenced the provision of physiotherapy interventions, such as severe asthma, chronic airflow limitation, bronchiectasis, ankylosing spondylitis or lumbar disc prolapse.
• Impaired cognition.