Physiotherapy management of malignant spinal cord compression
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Physiotherapy Management of Malignant Spinal Cord Compression. Suzanne Hodson Senior Physiotherapist at WPH October 2013. Aims. National Cancer Rehab Care pathway for MSCC recommends referrals to Physiotherapy within 24 hours of patient’s admission

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Physiotherapy Management of Malignant Spinal Cord Compression

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Physiotherapy management of malignant spinal cord compression

Physiotherapy Management of Malignant Spinal Cord Compression

Suzanne Hodson

Senior Physiotherapist at WPH

October 2013


Physiotherapy management of malignant spinal cord compression

Aims

  • National Cancer Rehab Care pathway for MSCC recommends referrals to Physiotherapy within 24 hours of patient’s admission

  • Aim to maintain patients at their optimum level of functional independence to enable maximum quality of life


Bed rest or mobilisation

Bed Rest or Mobilisation

  • Previous practice during radiotherapy for MSCC was flat bed rest

  • Now once diagnosis has been made and spinal stability assessed

    • Patients able to sit up gradually to 60 degrees over period of 3-4 hours

    • Monitoring symptoms

  • If they walked in safely they are able to continue mobilising


If the spine is unstable

If the spine is unstable

  • Refer to physiotherapy for bed rest exercises

  • Refer to orthotics for a spinal brace/collar

  • Brace/collar to be fitted by orthotics prior to commencing mobilisation

  • Sit up slowly in bed to 60 over 4 hrs

  • If tolerated without any deterioration in pain or neurology

  • Progress with rehabilitation & mobilisation as able


If the spine is stable

If the spine is stable

  • Refer to the physiotherapists

  • Slowly sit the patient up to 60 over 4 hrs

  • If tolerated & no deterioration in pain or neurology

  • Patient can start to mobilise, if able

  • If unable to mobilise await physiotherapy assessment for rehabilitation


Physio assessment

Physio - Assessment

  • Muscle strength

  • Neurological deficits

  • Respiratory assessment

  • Co-morbidities e.g. COPD, arthritis

  • Clarification of pt’s understanding of diagnosis

  • Setting realistic expectations


Setting realistic expectations

Setting Realistic Expectations

  • Level of therapy in-put at WPH & afterwards

  • Functional Ability

  • Improvements in Ability

  • Functional Outcome

  • Prognosis


Rehabilitation of mscc patients

Rehabilitation of MSCC Patients

  • Physiotherapy rehabilitation starts as soon as MSCC is diagnosed

    • Bed rest exercises or mobilisation

  • Patients sit up or starting rehabilitation & mobilisation while they are in hospital for radiotherapy

  • To clarify what patients are able to do the Consultants at WPH have agreed a system where all patients are suitable for rehabilitation unless documented otherwise


Summary

Summary

  • Early referral to physiotherapists

  • Rehabilitation can start even if unable to get out of bed

  • Monitor symptoms as patients start to sit up

  • Patients can do as much as their symptoms allow them to

  • Realistic expectations


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