Dharamshila Narayana Superspeciality Hospital

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Rehabilitation of Musculoskeletal Impairments in Cancer

The primary goals of rehabilitation includes relief of pain, improved mobility and function, bone protection, and safety awareness.

Therapist evaluates the patient′s upper-extremity function and coexisting upper-extremity metastases before weight bearing through the upper extremities. Special consideration is given to further bony protection in the presence of multiple metastasis, to the care of plastic reconstructions and/or closures, to donor sites for flaps and/or skin grafts, and to modification of bracing as appropriate to protect the flaps or grafts.

A major emphasis of rehabilitation before and after surgery is placed on instructions in fall prevention, including optimal body mechanics and exercises to maintain strength and balance. The patient′s specific environment and activities are considered, and any necessary equipment or strategies are used.

Exercise recommendations for patients with bone metastases both before and after surgery focus on increasing their muscle strength and endurance while maintaining bone-protection strategies.  After surgery, Range Of Motion activities are included for the joints above and below the affected area.

The number of cases of metastatic bone disease is relatively high. Patients with this type of disease can appreciate a dramatic positive change in their Quality Of Life with Physiotherapy, which can occur both before and after surgical intervention for pain relief and/or bone stabilization. Although these 2 interventions seem to go together, most patients with metastatic bone disease do not undergo surgery but do receive chemotherapy, radiation therapy, immunotherapy, or hormonal therapy. Patients in these categories may also gain substantial benefits from physiotherapeutic interventions. Supportive spinal orthosis are given to patients to provide the support to the vertebrae and rib cage and help in reducing pain due to postural imbalance and weakening of the bone due to metastasis. Few walking aids like walker, crutches, tripod and stick are also provided to patients to make them ambulatory. This possibility illustrates the need for a true multidisciplinary approach to the care and treatment of patients with bony metastatic disease.

The role of the physiotherapist, as an essential member of the multi-disciplinary team is key to the successful rehabilitation and management of patients with cancer and palliative care needs. The absence of physiotherapy intervention would be detrimental to patient care and the ability of the patient/family to cope with the effects of the disease or its treatment on their functional capacity and quality of life

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