Read i bc27f85be50b71b1 Online
Authors: Unknown
358
AClfffi CARE HANDBOOK FOR I'HYSICAL lHERAPISTS
• The physical therapist should assess the need for positioning and splinting devices.
• The physical therapist should determine the location of
the lesion and the need for range-of-motion exercises to prevent contractures. If the lesion involves an area that will be stressed (e.g., joints), the physical therapist should check the
physician's orders for precautions limjting motion.
General Physical Therapy Guidelines
for Patients with Cancer
The following are general goals and guidelines for the physical therapist working with the patient who has cancer. These guidelines should be adapted to a patient'S specific needs.
The primary goals of physical therapy in this patient population
are similar to those of other patients in the acute care setting; however, because of the systemic nature of cancer, the time frames for achieving goals will most likely be longer. These goals are to (I) optimize functional mobility, (2) maximize activity tolerance and endurance, (3) prevent joint contracture and skin breakdown, (4) prevent or reduce limb edema, and (5) prevent postoperative pulmonary
complications.
General guidelines include, but are not limited to, the following:
•
Knowing the stage and grade of cancer can help the physical
therapist modify a patient's treatment parameters and establish
realistic goals and intervention.
• Patients may be placed on bed rest while receiving cancer treatment or postOperatively and will be at risk for developing pulmonary complications, deconditioning, and skin breakdown. Deepbreathing exercises, frequent position changes, and an exercise program that can be performed in bed are beneficial in counteracting these complications.
• Patients who have metastatic processes, especially ro bone, are
at high risk for pathologic fracture. Pulmonary hygiene is indicated
for most patients who undergo surgical procedures. Care should be
taken with patients who have metastatic processes during the per-
ONCOLOGY
359
formance of manual chest physical therapy techniques. Metastatic
processes should al 0 be considered when prescribing resistive
exercises ro patients, as the muscle action on the frail bone may be
enough to cause fracture.
• Patient and family education regarding safety management,
energy conservation, postural awareness, and body mechanics during activities of daily living should be provided. An assessment of the appropriate assisrive devices, prosthetics, and required orthotics should also be performed. Decreased sensation requires special attention when prescribing and fining adaptive devices.
•
If a patient is placed on isolation precautions, exercise equipment, such as stationary bicycles or upper-extremity ergomerers (after being thoroughly cleaned with sterile solutions), should
be placed in his or her room. Assessment is necessary for the
appropriateness of this equipment, along with the safety of
independent use.
•
\'Vhen performing mobility or exercise treatments, care should
be taken to avoid bruising or bleeding into joint spaces when
patients have low platelet counts.
•
Emotional support for both the patient and family is at times
the most appreciated and effective method in helping to accomplish the physical therapy goals.
• Timely communication with the entire health care team is
essential for safe and effective care. Communication should
minimally include patient's current functional status, progress
toward patient'S goals, and any factors that are interfering with
the patient'S progress.
• Laboratory values, especially hemoglobin/hematocrit, white
blood cell count, platelet COli nt, and prothrombin time/international normalized ratio (PTIINR) should be monitored daily.
References
I. Cotran RS, Kumar V, Robbins S, Schoes FJ (eds). Robbins Pathologic
Basis of Disease. Philadelphia: Saunders, 1994.
2. Goodman ee, Boissonnault WG (eds). Pathology: Implications for the
Physical Therapist. Philadelphia: Saunders, 1998.