Dharamshila Narayana Superspeciality Hospital

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Rehabilitation Clinic

Cervical contracture

Progressive fibrosis of the anterior and lateral cervical soft tissue may be highly problematic for Head and Neck Carcinoma patients, particularly those who receive radiation therapy. Complications of the radiation therapy, includes fibrosis, scarring, and atrophy. Complications from radiation therapy can occur months to years after treatment.

Proactive ROM in all planes of neck motion should be initiated as soon as safely possible and can be continued throughout radiation therapy in the absence of significant skin breakdown. Isometric strengthening of the cervical extensors, and postural modifications are beneficial.

Compression garments are a convenient means of applying compression, if required.

Pain

Most of the patients at all stages of the disease experience significant pain. Most of this pain can be adequately relieved by oral analgesics. Treatment of pain disorders often involves a multimodality approach that may include physical therapy, medications, and interventional procedures. Physiotherapy can include therapeutic exercises, active or passive mobilization techniques, graded and purposeful activity, relaxation, distraction, postural re-education, positioning, mobility, TENS, heat or cold therapy et. Exercises commonly increase the subject′s awareness of posture, motion patterns and breathing and are designed to heighten the patient′s perception of the areas where pain originates and are a basis for active processing of pain by the patient.

Shoulder disability

Shoulder disability refers both to impaired mobility in the shoulder joint and to pain in the shoulder region after neck dissection. This is a well-known and common problem. This leads to problems in daily activities and a reduced Quality Of Life. Early physiotherapy has very important role in this.

Trismus/temporomandibular joint dysfunction

The temporomandibular joint (TMJ) dysfunction includes fibrosis due to radiotherapy, scarring, weakness and atrophy of the muscles producing the movements after surgery, and intra-articular damage due to radiotherapy and surgery, which leads to the stiffness of the joint. So the patients may feel difficult in the mouth opening, mastication, and speech.Other problems include headaches, usually at the temples and side of head, vague tooth soreness or toothaches, which often move around the mouth, pain and fatigue when eating hard or chewy foods, clicks, pops, or grinding sound in jaw joint, and cervical neck tension and pain.

The rehabilitation for preventing reduced mouth opening mainly concentrates on programs using different jaw-stretchers or mouth-opening exercises. Physical therapy can help relax the muscles, increase joint flexibility, and the other oro-motor exercises.

Moist heat is very helpful for the sore muscles of TMD. Jaw and neck exercises, which will help the muscles stretch. Passive joint mobilization, re-education of the jaw movement, scar mobilisation, and strengthening exercises to the jaw muscles play vital part after the surgery or chemo and radiotherapy.

Some therapies may be preventative and may begin prior to and continue throughout treatment. For example, the patient who receives radiotherapy and chemotherapy needs oral ROM exercises to maintain movement of the lips, tongue, and jaw.

Fatigue

Fatigue is the most common symptom experienced by the cancer patients. Fatigue reduces the energy, mental capacity, functional status, and psychologic resilience of cancer patients. Anemia has received the greatest attention as a source of fatigue.

Rehabilitation exercises including physical therapy may be of help along with mild exercises or walking to overcome fatigue. Mild to moderate exercise to help promote energy are a boost for Quality Of Life even though they may feel tired

An important thing is to avoid too much rest and overexercise, which may cause fatigue by using important energy stores, lack of exercise can also cause fatigue through physical deconditioning and deterioration

Chemotherapy-induced neuropathy

Patients receiving specific types of neurotoxic chemotherapeutic agents may develop peripheral neuropathy that can result in sensory, motor, and/or autonomic deficits. While some patients’ deficits will resolve quickly after cessation of chemotherapy, others have a persistent peripheral polyneuropathy that may impact strength, balance, and function.

Currently, numerous drug therapies are being tested to prevent and treat chemotherapy-induced peripheral neuropathy. Exercise and physiotherapy modalities can restore function in extremities, and help in reducing neuropathy symptoms but most effective if done in the early treatment phase. Exercise can also enhance balance, strength, and safety, and braces can be used to support weak muscles.

Swallowing difficulty

Dysphagia due to the trauma to the upper digestive tract during treatment of Head and Neck Carcinoma is associated with aspiration with an increased risk of pneumonia and a reduced Quality of life. The main reasons for swallowing problems in Head and Neck Carcinoma patients after radiotherapy are thought to be reduced tongue strength, reduced laryngeal elevation, reduced tongue base retraction during swallowing, and fibrosis of the muscles involved in swallowing.

Most rehabilitation programs concentrate on maintaining tongue strength, tongue mobility, and the mobility of the larynx. In the rehabilitation program, the exercises consisted of tongue mobility and stretching.

Exercise and cancer

Physical activity seems to be useful in the rehabilitation process for cancer patients. Impaired physical capacity can be explained by several factors, such as tumor toxicity and the treatment of cancer, including surgery, chemotherapy, and radiotherapy, which may induce cardiorespiratory and musculoskeletal deconditioning.. These effects can be reduced by physiotherapy.

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