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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-

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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.