● Dystonia. ● Gait dysfunction. ● Headache. ● History of fall.
● Sexual dysfunction. ● Shoulder pain. ● Speech impairment. ● Swallowing impairment. ● Urinary dysfunction. ● Visuospatial and/or proprioception dysfunction. Functional Limitations: ● Inability to return to work. ● Difficulty caring for children/grandchildren. ● Limited mobility due to safety concerns (walking, driving, etc.). ● Inability to travel and take vacations. ● Difficulty with activities of daily living, or ADLs (e.g., dressing, bathing). ● Difficulty with instrumental activities of daily living, or IADLs (e.g., chores, shopping). 2. Restorative phase : Interventions that attempt to return patients to previous levels of physical, psychological, social, and vocational functioning. The restorative phase strives for the maximal recovery of function in patients with remaining function and ability. It attempts to achieve maximal functional recovery in patients who have impairments of function and decreased abilities. 3. Supportive phase : Interventions designed to teach patients to accommodate their disabilities and to minimize debilitating changes from ongoing disease. The supportive phase increases the patient’s ability for self- care and improves mobility. It uses methods that are effective for patients whose cancer has been growing and whose impairments of function and declining abilities have been progressing. Examples of these interventions include training with assistive devices, self-care, and more skillful ways of performing ADLs. It also focuses on preventing disuse impairments, such as contractures, muscle atrophy, loss of muscle strength and decubitus. 4. Palliative phase : Interventions focused on minimizing or eliminating complications and providing comfort and support. The palliative phase enables patients in the terminal stage to lead a high quality of life physically, psychologically, and socially, while respecting their wishes. It is designed to relieve symptoms such as pain, dyspnea, and edema. These interventions also help prevent contractures and decubitus using heat, low-frequency therapy, positioning, breathing assistance, relaxation, or the use of assistive devices. 3. Recurrence (supportive phase): ○ Educating the patient about the impact of recurrence and its effect on function. ○ Educating the patient about monitoring in the context of the new clinical status. ○ Supervising the patient in an appropriate program to restore function or prevent its decline. 4. End of life (palliative phase) : ○ Educating patient/family regarding mobility training, good body mechanics, and assistive devices. ○ Pain management (non-pharmacologic treatment) and symptom control. ○ Maintaining independence and quality of life.
● Jaw excursion, limited. ● Joint pain, localized. ● Joint range of motion limitations. ● Lymphedema. ● Muscular asymmetry. ● Neck pain. ● Osteopenia/osteoporosis. ● Paralysis. ● Radiation fibrosis syndrome. ● Radiculopathy. ● Scapular winging.
● Scar adhesions. ● Sensory deficits.
THE FOUR PHASES OF ONCOLOGY REHABILITATION
J. Herbert Dietz, MD authored one of the first groundbreaking cancer rehabilitation textbooks, Rehabilitation Oncology , while he was an attending surgeon at Memorial-Sloan Kettering Cancer Center (Dietz, 1981). In his book, he described cancer rehabilitation according to four distinct phases. His classification system pioneered the idea of integrating rehabilitation interventions into the palliative phase of the disease. Since that time, research has supported this concept. Dr. Julie Silver and a team of researchers (2015) determined that cancer rehabilitation is medical care that should be integrated throughout the continuum of oncology care to diagnose physical, psychological, and cognitive impairments. Dietz described the use of rehabilitation in the early stages of cancer to prevent impairments and disabilities. Today, this is called pre-habilitation and it has become a growing area of interest and research. Dr. Silver and colleagues have defined pre-habilitation as: A process on the continuum of care that occurs between the time of diagnosis and the beginning of acute treatment and includes physical and psychological assessments that establish a baseline functional level, identify impairments, and provide targeted interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments (Silver et al., 2015). The four phases of oncology rehabilitation, as described by Dietz (1981) are: 1. Preventative phase : Interventions that will lessen the effect of expected disabilities. The preventative phase starts soon after cancer has been diagnosed. It is performed before or immediately after radiation therapy, surgery, or chemotherapy. No impairments of function present yet. The purpose of rehabilitation interventions is preventing impairments. Contributions of rehabilitation in each phase of cancer 1. Treatment (preventative phase) : ○ Evaluating the effects of rehabilitation treatments on function. ○ Preserving and restoring function through exercise, increased activity, and edema management. ○ Controlling pain using thermal modalities (heat or cold) and transcutaneous electrical nerve stimulation. 2. Post-treatment (restorative phase) : ○ Developing and supporting a program to help restore daily routines and promote a healthy lifestyle. ○ Educating the patient about self-monitoring. ○ Supervising a maintenance program of exercise, mobility management, edema management, and mobility.
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