lexi harlow, pt, dpt, clt seattle cancer care alliance · references egan my, mcewen s, sikoral,...
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Lexi Harlow, PT, DPT, CLT Seattle Cancer Care Alliance
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Importance of Rehabilitation In Oncology Care
Patient and family centered care Individualized treatment and management of side
effects from cancer modalities Reduce symptom burden Maintain or restore function Enhance quality of life
education.healthcaresource.com
© Lexi Harlow, 2017
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Importance of Rehabilitation in Oncology Care
Education for providers and patients Screening for impairments Rehabilitation referrals Cost containment (Shih, 2009)
Evidence based
oncologypt.org © Lexi Harlow, 2017
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What services do we uniquely provide to the cancer setting? Enhanced care of unique needs of cancer patients Rehabilitation perspective through “oncology” lenses Support oncologists in managing side effects Provide prestige, leadership, and marketing
opportunities
eyesightcorner.com © Lexi Harlow, 2017
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What services do we uniquely provide to the cancer setting?
Education outreach to providers, patients, community Research opportunities Program development
© Lexi Harlow, 2017
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Melanoma Treatment: What have you experienced? Fatigue Joint pain Joint restrictions Deconditioning/weakness Balance challenges Peripheral neuropathy Cognitive impairments Depression Anxiety
Gait difficulties Lymphedema Osteopenia/osteoporosis Scar adhesions Difficulty with daily
activities (dressing, bathing)
Difficulty with chores, shopping, driving
Need for assistive device
© Lexi Harlow, 2017
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Rehabilitation Professionals: Who can help me? Rehabilitation Medicine Physician (Physiatrist) Physical Therapists Occupational Therapists Speech/Language Pathologists Rehabilitation Psychologist
© Lexi Harlow, 2017
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Rehabilitation Physicians (Physiatrists) Nerve, muscle, and bone experts who treat
injuries or illnesses that affect how you move Treat any disability resulting from disease or injury Pinpoint the source of an ailment and design
appropriate rehabilitation treatment plan
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What might a physiatrist do? New and Follow-up
Patient Visits Injections
Botulinum Fluoroscopic Ultrasound guided Joint Trigger point
EMG Testing Medical guidance on
physical activity/exercise programs
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Physical Therapists Examine, diagnosis, and develop an individualized
plan of care Work with patients to achieve the following:
Reduce pain Improve or restore mobility Prevent or manage condition Minimize disability
© Lexi Harlow, 2017
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Typical Physical Therapy Needs
Deconditioning/muscle mass loss Scar tissue restrictions and/or fibrosis Cording (Axillary Web Syndrome) Joint contracture Fatigue Pain
vanderbilthealth.com
© Lexi Harlow, 2017
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Typical Physical Therapy Needs Osteopenia/osteoporosis Peripheral neuropathy Mobility challenges Decreased balance/fall risk Peripheral edema/lymphedema management
livingwith peripheralneuropathy.com © Lexi Harlow, 2017
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Physical Therapy Treatment
Patient education Cardiovascular conditioning Strength training Flexibility and balance training Edema/lymphedema management Maximize and facilitate independence Pain and fatigue management
www.actx.edu
© Lexi Harlow, 2017
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Occupational Therapists Individualized evaluation with customized
intervention Health promotion Prevent or enhance quality of life with injury, illness,
or disability
© Lexi Harlow, 2017
ecmc.edu
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Typical Occupational Therapy Needs Fatigue Peripheral neuropathy (upper extremity) Cognitive impairments Lymphedema Difficulty with ADLs (dressing, bathing) Difficulty with chores, shopping, etc. Need for assistive device or adaptive equipment Home safety evaluation Return to work assessment/workplace evaluation Driving evaluation
© Lexi Harlow, 2017
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Occupational Therapy Treatment Patient education Self-care task instruction and/or modifications Task simplification Energy conservation Edema/lymphedema management Hand therapy Maximize and facilitate independence Compensatory strategies for cognitive deficits
© Lexi Harlow, 2017
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Evidence Based Practice Musculoskeletal concerns Deconditioning/endurance deficits Fatigue management Balance/falls UE function after breast cancer treatment Pain Sexual functioning Lymphedema
Silver 2011; Egan 2013
usf.edu
© Lexi Harlow, 2017
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Other Rehabilitation Professionals Rehabilitation Psychologist
Assess and treat cognitive and emotional disability due to injury or illness
Speech Language Pathologist
Prevent, assess, diagnose, and treat speech, language, social communication, cognitive communication, and swallowing disorders in children and adults
© Lexi Harlow, 2017
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Current State of Our Program Physical therapy services
only Staffing:
Physical Therapists (7) Department Coordinator Physical Therapy Manager
Staff skill set includes the following expertise: lymphedema, orthopedics, neurologic, myofascial techniques, pelvic floor/incontinence
© Lexi Harlow, 2017
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Future Treatments and Programs Activities of Daily Living Training Hand Therapy Vestibular Rehabilitation Speech and Swallowing Rehabilitation Return to Work Program Cognitive Rehabilitation Group Exercise/Therapy Survivorship (long-term needs) Integrative Care (massage, acupuncture, etc.)
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Dr. Julie Silver “After Cancer Treatment: Heal Faster, Better, Stronger”
© Lexi Harlow, 2017
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References Egan MY, McEwen S, Sikora L, Chasen M, Fitch M, Eldred S. Rehabilitation
following cancer treatment. Disabil Rehabil. 2013 Mar 15. Fitzpatrick, TW (2009). Principles of physical and occupational therapy in cancer.
In MD Stubblefield, MW O’Dell (Ed.), Cancer Rehabiliation: Principles and Practice (pp. 785-796). New York: Springer Publishing.
Shih YT, Xu Y, Cormier JN, Giordano S, Ridner SH, Buchholz TA, Perkins GH, and Elting LS. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. Journal of Clin Onc. 2009 27:12, 2007-2014
Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin 2013;63:295-317
Silver JK, Gilchrist LS. Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions. Am J Phys Med Rehabil 2011;90(suppl):S5-S15.
Stout NL, Silver JK, Raj VS, Rowland J, Gerber LH, Cheville AL, Ness KK, Radomski M, Nitkin R, Stubblefield MD, Morris GS, Acevedo A, Brandon Z, Braveman B, Cunningham S, Gilchrist L, Jones L, Campbell G, Hendricks J, Perkin K, Chan L. Toward a national initiative in cancer rehabilitation: recommendations from a subject matter expert group. Arch Phys Med and Rehab. 2016;97:2006-15