oncolgy & pallative-1.pptx rehabilitation principles for tumor patients, post and pre operative rehabilitation

1. Supervised by : Dr . MOSTAFA AHMED
LECTURER AT FACULTY OF PHYSICAL
THERAPY

2. DEFINITION
multidisciplinary and holistic
assessment and management of
physical, psychosocial and spiritual
symptoms, with the goal of
alleviating suffering.

3. Palliative care has transformed over the
years from being indicated when aggressive
treatment no longer was deemed appropriate,
to today where palliative care “is given
throughout the cancer experience, whenever
the person is having symptoms that need to
be controlled.

4. ROLE OF PHYSICAL THERAPIST
 “Provide services to individuals and populations to
develop, maintain and restore maximum movement and
functional ability throughout the life-span...
Physical Therapists are concerned with identifying and
maximizing quality of life and movement potential within
the spheres of promotion, prevention,
treatment/intervention, habilitation and rehabilitation.

5. CLINICAL PRACTICE
GUIDELINES FOR QUALITY
PALLIATIVE CARE .

6. PALLIATIVE CARE MODELS
 The patient and family are at the center of care, and addressing
their desires is reflected in palliative physical therapy models. These
models consider the extreme variations of the end-of-life course
which may include periods of improvement, stabilization, and
decline; also included within the models is the limited
reimbursement structure of managed care.
 These models include:

7. TRADITIONAL REHAB
This model is most commonly utilized as Physical Therapy
treatment in settings of Acute, sub-acute, outpatient, and
home health rehab. Treatments are scheduled daily to two
or three times a week with the goal of improving patient
function and limiting impairments.

8. This model is utilized early in treating patients with
palliative care needs when rehab potential is good despite
having a poor long term prognosis. An example of this
model would be for a patient undergoing surgical
lobectomy of lung parenchyma to remove lung cancer and
prevent metastasis.
It would be beneficial for the patient to receive acute care
level rehab to restore functional impairments followed by
subacute or home health rehab

9. REHAB LIGHT
When symptoms have been managed and the person is
feeling trail though somewhat better, they may express a
desire to regain strength and mobility, even with the
awareness that their condition is life-limiting.
A gentle rehabilitation program with weekly or biweekly
visits can be applied, with instruction in limited but
effectively targeted home exercise programs and measured
sitting or walking for endurance.

10. This slower approach to treatment would be beneficial for
patients experiencing secondary symptoms and
impairments of fatigue, weakness, and atrophy from
radiation therapy or chemotherapy in cancer patients. The
frequency of treatment is commonly prescribed as once a
week for four weeks or once every other week for eight
weeks

11. CASE MANAGEMENT
 In the instance that a patient has a complex condition with multiple
comorbidities, is home-bound, and does not have any medical needs or
impairments that are out of the ability for the family or caregiver to safely provide
for the patient, a case management model would fit well to monitor the patient
and save costs.
 In this model, intermittent treatment sessions appointed monthly, bimonthly, or
“as needed” are set-up to reassess the functional status of the patient, continuing
to educate the caregiver on proper transfers and exercise form, and updating any
therapeutic exercise prescribed.
 These re-assessments are indicated and important knowing that care needs will
arise because of the progressive nature of the illness.

12. REHABILITATION IN REVERSE
 As impairments of strength and motor control change, it may threaten the
patients ability to remain safely at home in the care of those they love. At various
thresholds of decline, more support or assistance will be required to successfully
navigate the environment and may require the use of a properly fitted cane,
walker, or other assistive device.
 Physical assistance by caregivers is also likely to be required at some point as
well, whether with ambulation, transfers or even moving in bed. Skilled physical
therapy intervention and training can be provided throughout the course of
decline, as it reflects the broad knowledge and teaching provided by therapists in
more traditional settings, but in reverse order.
 This care can meet the patient’s desire to maintain maximal independence and
mobility, and the family’s desire to successfully care for their loved one at home.

13. SKILLED MAINTENANCE
 Skilled maintenance is similar to the case management model in which it occurs
when patients have medical conditions that will make very little if no progress in
health progression. However, in some complex situations it may occur that these
patients will require skilled care performed by a Physical Therapist that would
create an unsafe situation for the patient if administered by a caregiver.
 Situations with issues such as balance, tone, coordination or medical conditions
such as cardiopulmonary and orthopedic conditions would require the services and
expertise of a Physical Therapist or other health care professional

14. SUPPORTIVE CARE
Steps are taken to enhance patient comfort and improve
quality of life and are essential to effective end-of-life care.
Demonstration and teaching of appropriate techniques by
the therapist to caregivers such as:

15.  Massage-provides temporary relief, long term management of edema, somato-
sensory stimulus, and reduces muscle tension.
 Active, assistive, or passive range of motion-eases discomfort of inactivity and
prevents contractures.
 Guided imagery-provides a common pleasant experience when combined with
range of motion activities
 Vestibular stimulation-a gentle rocking motion and provide comfort.
 Conversation-provides sharing of information, meaning, and understanding which
can support the end-of-life process.

16. INTERVENTIONS
Physical therapists should seek to maintain
strength, make environmental modifications,
furnish necessary assistive equipment, teach
energy management techniques, provide family
education; achieve safety, independence, meaning,
and quality of life, despite the physical and mental
decline which is expected.

18. PHYSICAL THERAPY PAIN
MANAGEMENT
The five categorized mechanisms and their descriptions
are defined below in addition to the recommended
intervention strategies to be employed by a physical
therapist.

19. 1. CENTRAL SENSITIZATION
Defined as increased sensitivity of a higher order neuron
within the central nervous system, that causes constant
pain in the absence of a peripheral nociceptive stimulus.

20. RECOMMENDED INTERVENTIONS
Patient Education
 Reduction of pain/ pain-related barriers due to improved understanding of disease
process
 Transcutaneous electrical stimulation (low frequency) - evidence still being
investigated.
 Relaxation
 Deep Cutaneous Pressure
 Biofeedback
 Guided, Mental, Motor Imagery
 Mirror Therapy
 Virtual Reality
 Manual Therapy

21. 2. PERIPHERAL
SENSITIZATION/
NEUROPATHIC
Defined as neuropathies to the brachial plexus and
cranium, as well as chemotherapy-induced, post-herpetic
and surgical neuropathy in addition to post-radiation
plexopathies.

22. RECOMMENDED
INTERVENTIONS[
Neurodynamic Mobilization
Nerve Sliders and Tensioners
Nerve Massage
Peripheral Nerve Electrical Stimulation

23. 3. NOCICEPTIVE MECHANISM
Defined as pain secondary to non-use, deconditioning
and/or improper posture and movements resulting from
symptoms of cancer pain.

24. RECOMMENDED INTERVENTIONS
•Positional Changes
•Relaxation
•Energy Conservation
•Therapeutic Modalities
•Cryotherapy
•Ultrasound
•Transcutaneous Electrical Stimulation
•Interferential Electrical Stimulation
•Therapeutic exercise/increased physical activity
•Stretching and Flexibility
•Manual Therapy
•Soft-tissue Manipulations
•Joint Manipulations
•Myofascial Release

25. 4. SYMPATHETIC-MAINTAINED/ -
DEPENDENT PAIN MECHANISM


26. RECOMMENDED
INTERVENTIONS
Modalities
 Thermal Therapy
 Cryotherapy
 Transcutaneous Electrical Stimulation
Sympathetic Slump Mobilization
Therapeutic Exercises
 Passive Range of Motion
 Isometric Strengthening

27. 5. COGNITIVE-AFFECTIVE
MECHANISM
Patient Education
Relaxation
Cognitive behavioral therapy provided by physical
therapists

28. Motivation Encouraged Relief & Well Being
Security Hope Independence
Feelings Experienced by Patients in
PT within Palliative Care