Rehabilitation-After-Breast-Cancer-Surgery.ppt

Rehabilitation-After-Breast-Cancer-Surgery.ppt

• 1.
  Rehabilitation After Breast CancerSurgery Presented by: Lauren Suggs, S.P.T. UNC-Chapel Hill
• 2.
  Types of Surgery Mastectomy  Removal of entire breast with possible removal of the fascia covering the pectoral muscles  Breast Conserving Surgery  Lumpectomy—excision of the cancerous mass as well as a margin of healthy breast tissue  Segmental Mastectomy—excision of the affected quadrant of the breast  Lymphadenectomy  One of the above procedures with axillary lymph node dissection Kisner, C, Colby, LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. Philadelphia: F.A. Davis Company; 2007.
• 3.
  Impairments & ComplicationsRelated to Breast Cancer Surgery  Incisional pain  Posterior cervical and shoulder girdle pain  Postoperative vascular and pulmonary complications  Lymphedema  Chest wall adhesions  Decreased shoulder mobility  Weakness of the involved upper extremity  Postural malalignment  Fatigue and decreased endurance  Psychological considerations Kisner, C, Colby, LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. Philadelphia: F.A. Davis Company; 2007.
• 4.
  Guidelines for ManagementAfter Breast Cancer Surgery Patient Education Exercise Community Resources Kisner, C, Colby, LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. Philadelphia: F.A. Davis Company; 2007. http://utpulmonary.com/patient_ed.asp
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  Patient Education—Lymphedema  Symptoms Prevention  Deep Breathing Exercises  Flexibility Exercises  Strengthening and Muscular Endurance Exercises  Cardiovascular Conditioning Exercises  Lymphatic Drainage Exercises Kisner, C, Colby, LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. Philadelphia: F.A. Davis Company; 2007. http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/Patient/page1
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  Management of Lymphedema… Make sure that all injections are given and blood tests are drawn in the unaffected arm.  Avoid wearing clothing with elastic cuffs.  Carry your handbag or heavy packages in the unaffected arm.  Avoid sunburns and other burns to the affected arm.  Make sure that all blood pressure tests are performed on the unaffected arm.  Clean the skin of the affected arm daily and apply lotion. When drying the arm, be gentle, but thorough.  Keep the arm elevated when possible.  Do exercises regularly to improve drainage, but first consult with your physician or physical therapist.  Eat a well-balanced, low-sodium diet.  Avoid extreme hot or cold temperatures on the affected arm, such as heating pads or ice packs.  Take proper care of the fingernails and avoid cutting cuticles.  Clean all cuts with soap and water, and then apply anti-bacterial ointment and a sterile dressing.  Avoid vigorous, repetitive movements against resistance (such as scrubbing, pulling, or pushing) with the affected arm.  Notify your physician immediately of any signs of infection, such as redness, pain, heat, increased swelling, or fever. Lymphedema Following a Mastectomy. Robert Wood Johnson University Hospital. 2011. Available at: http://www.rwjuh.edu/health_information/adult_breast_lymph.html. Accessed July 27, 2011.
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  Exercise  General Do’sand Don'ts of exercise after surgery  Inpatient Postoperative Rehabilitation  Outpatient Postoperative Rehabilitation http://curvesbuford.com/lower-your-breast-cancer-risk-through-exercise http://websterscommunitypharmacy.wordpress.com/2011/ 02/16/walk-away-from-breast-cancer/
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  Do’s of Exercise… Before exercising actively, be certain that post-surgery swelling subsides and that surgical wounds are healing.  Try to start moving as soon as possible after surgery.  Keep arm elevated after surgery to prevent swelling. Use two pillows to support arm when lying down or sitting.  Stretch both sides of upper body a few times per day. 3-5 slow repetitions of each stretch.  Know the difference between discomfort and unusual pain. If pain or fatigue persists, stop and rest.  After surgery, try to walk around (indoors) for a few minutes 2 - 3 times daily to regain stamina.  Avoid lifting anything over 2-3 pounds, particularly with the involved arm.  Enlist anyone you can to accompany you and encourage you to walk frequently. Toglia, A. Staying Abreast: Rehabilitation Exercises for Breast Cancer Surgery. 2011. Available at: http://www.stayingabreast.com/site/index.htm. Accessed July 28, 2011.
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  Don'ts of Exercise… Let mastectomy arm hang down, especially when holding or carrying objects.  Move arm quickly, or with jerking, pulling motions. Learn to move slowly and smoothly, especially when changing positions, lifting bags, opening doors, etc.  Carry anything over two pounds after surgery until you receive approval from your physician. Limit carrying anything over 5 pounds indefinitely with involved arm to prevent swelling.  Wear shoulder bags on involved arm. The pressure of the strap on the shoulder can cause lymphedema. Avoid use of shoulder bags indefinitely.  Continue an exercise upon unusual discomfort or persistent pain.  Continue an exercise upon unusual fatigue. Rest for a moment, breathe, relax, and then continue slowly and carefully. If fatigue persists, stop exercising. Toglia, A. Staying Abreast: Rehabilitation Exercises for Breast Cancer Surgery. 2011. Available at: http://www.stayingabreast.com/site/index.htm. Accessed July 28, 2011.
• 10.
  Inpatient Postoperative Rehabilitation ImmediatelyPost Surgery  Initially…  Deep Breathing  Relaxation  Simple Postural Exercises—chin tucks, posterior shoulder rolls  Next…  Active/Active Assistive shoulder mobility exercises  Self-ROM  Cane stretches  Wall-walking  Pulleys  Pendulums—occasionally  Shoulder ER at zero degrees abduction  Frequency and Intensity  Initially 5 repetitions 3-4 times per day  Progress by increasing the number of sets performed McAnaw M, Harris K. The Role of Physical Therapy in the Rehabilitation of Patients with Mastectomy and Breast Reconstruction. Breast Disease [serial online]. December 2002;16(1):163-174. Available from: Academic Search Premier, Ipswich, MA. Accessed July 25, 2011.
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  Outpatient Postoperative Rehabilitation Weeks1-3  Simple walking exercise program as a warm up to stretching  Once drains are removed, progress exercises by including longer stretches and greater range  Bilateral and unilateral cane stretches  ER/horizontal abduction  “Praying child”  Wall-walking  Pulleys  Posture Education  Arm Measurements McAnaw M, Harris K. The Role of Physical Therapy in the Rehabilitation of Patients with Mastectomy and Breast Reconstruction. Breast Disease [serial online]. December 2002;16(1):163-174. Available from: Academic Search Premier, Ipswich, MA. Accessed July 25, 2011.
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  Outpatient Postoperative Rehabilitation Weeks3-6  Adjuvant chemotherapy or radiotherapy  Aerobic exercise at moderate intensity  Progressively increase the intensity of current stretching exercise  ROM—full ROM is usually achieved by 4-6 weeks postoperatively  4-6 weeks postoperatively—strengthening exercises using progressive Therabands or light weights  Skin stretching and scar massage McAnaw M, Harris K. The Role of Physical Therapy in the Rehabilitation of Patients with Mastectomy and Breast Reconstruction. Breast Disease [serial online]. December 2002;16(1):163-174. Available from: Academic Search Premier, Ipswich, MA. Accessed July 25, 2011.
• 13.
  Exercises… Overhead cane stretcheswith deep breathing and relaxation are encouraged as soon as the drains are removed. Patient is encouraged to relax her elbows towards the bed to achieve a progressive pectoralis major stretch. In the “praying child” stretch, the patient starts in the quadriped position, plants hands, and gradually sits back on feet. This allows the patient to control this indirect shoulder stretch. Bilateral wall walking stretch encourages postural symmetry. McAnaw M, Harris K. The Role of Physical Therapy in the Rehabilitation of Patients with Mastectomy and Breast Reconstruction. Breast Disease [serial online]. December 2002;16(1):163-174. Available from: Academic Search Premier, Ipswich, MA. Accessed July 25, 2011. Patient can use the traditional pulley or simply a bathrobe belt over an open door edge to passively stretch the operative shoulder.
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  References 1. Kisner, C,Colby, LA. Therapeutic Exercise: Foundations and Techniques, 5th ed. Philadelphia: F.A. Davis Company; 2007. 2. Lymphedema Following a Mastectomy. Robert Wood Johnson University Hospital. 2011. Available at: http://www.rwjuh.edu/health_information/adult_breast_lymph. html. Accessed July 27, 2011. 3. Toglia, A. Staying Abreast: Rehabilitation Exercises for Breast Cancer Surgery. 2011. Available at: http://www.stayingabreast.com/site/index.htm. Accessed July 28, 2011. 4. McAnaw M, Harris K. The Role of Physical Therapy in the Rehabilitation of Patients with Mastectomy and Breast Reconstruction. Breast Disease [serial online]. December 2002;16(1):163-174. Available from: Academic Search Premier, Ipswich, MA. Accessed July 25, 2011.