Breast cancer rehabilitation

BREAST CANCER REHABILITATION
Dr.Nidhi Ahya (Asst Professor)
Cardiovascular & Respiratory PT
DVVPF College of Physiotherapy,
Ahmednagar 414111
1
Dr.Nidhi( MPT-Cardio-Vascular &
Respiratory PT)

Objectives
Post operative assessment
Physiotherapy intervention in surgical cases
Physiotherapy interventions during
chemotherapy
radiotherapy
Respiratory PT)
2

Physiotherapy Intervention In Surgical
Cases:
 Pre- Operative Assessment
• Detailed History (Obsteritic & Gynecological h/o)
• Chest assessment
• Lung function tests (PFT)
• Stage of cancer, extent of the disease
• Surgical plan should be documented -length & duration of
surgery, type of incision & details of the flap used for
reconstruction
• Assess the involvement of lymph nodes, posture, mobility
• Checking of the Exercise capacity considering the patient’s
tolerance
3
Respiratory PT)

Post- operative Assessment
• Chest Assessment
• Examination of Surgical site
• Severity of Pain(NPRS)
• Evaluation Of Posture and mobility
• Lymphoedema Evaluation- Skin changes
Girth measurement Levels- Volumetric Measurement-
9” above elbow Water displacement
compared B/L
6” above elbow ( > 200ml taken as cut-off)
3” above elbow
6” below elbow
3” below elbow ( British Journal Of Surgery ,2000)
4
Respiratory PT)

Problem List:
• Post- operative Pain
• Pulmonary Complications
• Lymphoedema
• Decreased Shoulder Mobility
• Weakness and Impaired Functional Control
Of involved upper extremity
• Posture Malallignment
• Fatigue and decreased Endurance
• Psychological Considerations 5
Respiratory PT)

Pain
• Surgical pain
• Neuropathic pain
 Management Options:
• Drug therapy is the mainstay of pain
management
• Therapeutic applications of cold packs
• High Frequency TENS has been proved to be
effective (Duration-15 to 20 mins,twice a day
uptill POD7)
• Positioning and posture correction to avoid
pain due to muscle spasm
6
Respiratory PT)

Pulmonary Complications
• Breathing Pattern
• Effective Airway clearance
• Symmetrical Lung Expansion
7
Respiratory PT)

Lymphoedema
• Excessive and persistent accumulation of
extravascular and extracellular fluid and protien
collection in tissue spaces
• International Society Of Lymphology
Classification for Lymphoedema
Grade I : Swelling pits on pressure, reduces on
elevation
Grade II : Firmer, non-pitting skin, hair loss, skin
texture changes
Grade III : Elephantiasis- very thickened skin
with loose folds
8
Respiratory PT)

Grade I Grade II Grade
III
9
Respiratory PT)

Pathophysiology:
Dissection of axillary lymph nodes
causing interrupted lymphatic drainage
Inability to clear protein concentration
from interstitial spaces
Disturbance of fluid- protein concentration across
capillary membrane
Increased fluid into interstitial spaces
Excess load on lymphatic vessels exceeding capacity
Lymphoedema
10
Respiratory PT)

Management Strategies:
 Skin Care
 Manual Lymphatic Drainage
 Compression Bandaging
 Decongestive Exercises
• These strategies are incorporated
together and termed as –
Complex Decongestive Physical
Therapy
11
Respiratory PT)

Manual Lymphatic drainage:
• Manual Lymphatic Drainage was pioneered by Dr.
Emil Vodder in the 1930s
• It is a gentle manual technique which improves the
activity of the lymph vessels by mild mechanical
stretches on walls of lymph collectors
Step 1:stimulate lymph node in non affected side of
the trunk.
Step 2 :edema fluid is pushed from congested
quadrant of chest to quadrant free of edema
Step3: trunk followed by proximal and then distal
parts
12
Respiratory PT)

• A very light pressure of <9 ounces per sq inch and
rhythmic circular movements are given
• In fibrotic tissue , greater pressure is applied , but
not too much to cause redness
• Sliding of the skin is not done , instead the skin is
pushed and stretched
• Following this there is a resting phase , where
pressure is not applied but contact with the skin is
sustained
• This change in pressure creates a pumping effect
13
Respiratory PT)

• Starting at the trunk bordering at
the edematous area , slowly
moving distally and ending with
the hand
• It is given for 45 mins twice daily
• Various techniques-
Pump Technique; Rotary
Technique, Stationary circular
strokes, scoop strokes
14
Respiratory PT)

Compression Bandaging
• This provides mechanical assistance to prevent re-
accumulation of fluid post lymphatic drainage
- Low stretch compression bandage
- Pneumatic compression Device
15
Respiratory PT)

Decongestion Exercises
• Active, non-resistant, repititive, ROM
exercises
• Role of exercises is based upon the fact that
flow along the valved lymphatic vessels is
stimulated by contraction of adjacent
striated muscles
• Excessive exercise may increase blood
flow into the limb , possibly exacerbating
the problem
• Dynamic exercises prefered over static
exercise
16
Respiratory PT)

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Respiratory PT)

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Respiratory PT)

19
Respiratory PT)

Physiotherapy Intervention during
Chemotherapy:
• Patients undergoing chemotherapy present
with-
 Reduced exercise time
 Reduced VO2 Max
 Abnormal Heart rate response
 ST and T wave changes
 Exercise induced hypotension
• Subacute sensory neuropathy has also been
observed in patients undergoing
chemotherapy
20
Respiratory PT)

• Exercise in Chemotherapy:
Aerobic exercise in the form of supervised
daily supine bicycle ergometry to HR of 50%
of calculated HRmax, for 5-15-minute
intervals over a period of 30 mins-
Benefits-
 Less pain
 Reduced decrement in treadmill
performnce
 Reduced fatigue levels
 shorter hospitalization
 Better recovery
21
Respiratory PT)

Physiotherapy Intervention during
Radiation therapy
• Prevent chest wall adhesions
• Specific shoulder girdle exercises
• Relaxation techniques
• Aerobic conditioning
22
Respiratory PT)

ACSM Guidelines
• Intensity – 55-85% of max HR or 40-75% of
max heart reserve or 40-75% of max oxygen
uptake
• Duration – 20-60mins (minimum of 10mins,
continuous bouts throughout the day)
• Frequency – atleast 2days per week
• Total exercise period - 6 week
23
Respiratory PT)

Summary
Post operative assessment
Physiotherapy intervention in surgical cases
chemotherapy
radiotherapy
Respiratory PT)
24

25
Respiratory PT)

Breast cancer rehabilitation

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