Oncology Rehabilitation

Cancer and cancer treatment may impact your physical abilities and lifestyle. It may interfere with your normal daily routine. Your goals may be as simple as having enough energy to do the things you have been missing, like fishing, playing with your children, or interacting with friends in your community. Rehabilitation can help.

Rehabilitation can be your foundation for functioning before, during and after cancer treatment. It may help you in the following ways:

• Build strength and endurance
• Decrease fatigue
• Reduce pain and discomfort
• Maintain functional independence
• Improve physical well-being

At Cancer Treatment Centers of America (CTCA) at Southwestern Regional Medical Center, we understand that your ability to function independently plays an important role in your overall quality of life. The Oncology Rehabilitation Program aims to help you regain your strength, energy and independence.

“Our goal for our patients is to help them reach their personal goals of function and safety while partnering with our staff and their loved ones to improve their life quality,” says Karen Gilbert, Director of Rehabilitation Services at Southwestern.

Oncology Rehabilitation at Southwestern

Southwestern’s Oncology Rehabilitation Department is dedicated to helping you achieve your highest level of physical and cognitive functioning. The department is staffed with an integrated team of caring and experienced physical therapists (PTs), occupational therapists (OTs), speech and language pathologists and massage therapists.

Upon your arrival at Southwestern, and prior to your cancer treatment, you will meet with a rehabilitation therapist for a thorough physical evaluation. Part of this initial evaluation consists of a functional assessment, in which your therapist measures your ability to perform activities of daily living (ADLs). Then, you and your therapist will work together to identify your physical and functional status.

Based on this evaluation, your therapist will develop a rehabilitation plan tailored to your needs. This plan will be goal-oriented, with well-defined outcomes to help improve your safety, independence and satisfaction with your life activities. “Rehabilitation is a process that requires effort and careful planning and thus a sense of accomplishment when personal goals are set and met,” says Gilbert.

Your rehabilitation plan may include therapeutic exercises and neuromuscular training, as well as cardiovascular, flexibility and strength training designed to meet your individual needs. The goal of the therapies is to help minimize cancer-related fatigue and optimize your physical function and safety. Our rehabilitation team also provides education on the benefits of physical restoration to help prepare you and your family for continuing the program at home.

Throughout your cancer treatment, our rehabilitation team will work closely with you, your family and other members of your cancer care team to complement your traditional cancer treatments with rehabilitation therapies. The Oncology Rehabilitation Department receives the clinical support of Southwestern physicians, nurses, care managers, social services, naturopaths, dietitians, mind-body specialists, patient relations and information management. This team approach provides you with comprehensive cancer care.

“Keeping fit and functional while receiving cancer treatment is a multi-faceted task that realizes the best outcomes by focusing on the entire physiological, psychosocial and spiritual systems of our patients,” Gilbert says.

Oncology Rehabilitation Programs & Therapies

Motion for Life

Southwestern’s oncology rehabilitation team leads a Motion for Life Program. This program is central to fitness and function and can help reduce stress, prevent fatigue and improve your quality of life. It consists of a patient-specific physical regimen that incorporates therapeutic activities to help you maintain the energy you need to participate in activities that are important to you, and to find fulfillment in your level of independence.

"Motion for Life is a program that includes the occupational therapy component and an exercise program with energy conservation techniques to preserve function and physical performance status, in order for patients to continue their cancer treatment while keeping active and in optimum health,” says Gilbert.

Sometimes your goals might be as simple as bathing, dressing yourself, or having enough energy to do something you have been missing, like playing with your children. “Patients desire to continue those activities that they feel give their lives meaning and that give them a since of autonomy and health. They want to be self-sufficient and continue making informed decisions concerning their health care,” adds Gilbert.

As part of the Motion for Life Program, your rehabilitation therapist will try to treat cancer-related fatigue by helping you continue activity at the right level, and at the right time, so you still have energy to do the things you enjoy. They will monitor your level of fatigue using a scale of 0 to 10, with 0 representing ‘full of energy’ and 10 being ‘totally exhausted.’ Patients often find that after doing their exercises, their fatigue level improves dramatically.

Physical Therapy

Southwestern’s physical therapists aim to reduce your cancer pain, improve your mobility and restore your physical function in everyday activities. They team up with our occupational therapists to deliver individualized exercise programs that combine range-of-motion training with other light activities, like resistance training. The goal is to improve your energy level, help you regain mobility, and boost your body’s tolerance to cancer treatments, such as radiation therapy and chemotherapy.

Borg Rating of Perceived Exertion (RPE)

The Borg Rating of Perceived Exertion helps you identify the intensity of activity that will improve your fitness and, at the same time, give you a boost in energy. By using either words or numbers on a scale, you rate how hard you are working when doing something physical. Since the condition of each person is unique and varies from day to day, the Borg system is able to keep exercise and activity at the right level.

Flexibility Program

Our physical therapists recommend stretching to relieve joint stiffness and pain, improve posture, prevent injuries, promote physical and mental relaxation and improve your overall mobility and range-of-motion.

Occupational Therapy: Teaching ways to work smarter, not harder

Southwestern’s occupational therapists assist in performing Activities of Daily Living (ADLs), such as grooming, dressing, eating, etc. They will help you identify and rate your performance in your daily activities, and prioritize these activities based on their importance to you. They will study you as you interact with your day-to-day surroundings, assess function, and teach you how to address, and adapt to, any physical limitations resultant from cancer and its treatment. This may include help with showering, dressing, eating and toileting.

“We try to help our patients find ways to work smarter, not harder,” says occupational therapist Terry Herauf. “By conserving energy in other areas and pacing themselves, they are more likely to reach their goal. It’s the difference between existing and living.”

Canadian Occupation Performance Measure (COPM)

This patient-driven, therapist-assisted program gives meaning and purpose to mobility and strength. It is a restorative program based on a patient’s satisfaction with their performance of activities they identified as a priority. “For example, a patient may value playing with their children but would prefer that someone help them conserve energy by driving their children to school,” says Gilbert.

Our therapists strive to help you restore the “fun” in function—and discover self satisfaction in taking your own shower, playing with your kids, and chatting with friends—while you conserve your energy to fight the disease.

Lymphedema Prevention & Treatment

Up to 30 percent of mastectomy patients develop lymphedema after surgery, a condition in which excess fluid collects in tissue and causes swelling. In lymphedema, the removal of lymph nodes from the axilla (underarm) changes the way the lymph fluid flows within that side of the upper body, making it more difficult for fluid in the arm to circulate to other parts of the body. Not all patients are at risk for developing lymphedema, nor do all patients require lymphedema treatment for breast cancer recovery.

Our rehabilitation therapists help our breast cancer patients build an individualized lymphedema management program after surgery. This program combines gentle range-of-motion exercises and massage. We also provide education in techniques you can use in your day-to-day life to stimulate your lymphatic system, and help prevent lymphedema. In addition, Gilbert facilitates a lymphedema support group for breast cancer survivors.

Southwestern’s oncology rehabilitation team may use one of the following techniques to either prevent lymphedema, or reduce the swelling associated with the condition:

Lymph Drainage Therapy (LDT)

This is a specialized massage technique, designed to activate the pumping action of your lymphatic system. This pumping action reduces and, in some cases, prevents fluid build-up following surgery and radiation. “LDT stimulates lymphatic flow, reduces laryngeal edema, minimizes risks of swallowing and decreases the risk of infection in edematous extremities after lymph node dissection in the groin and axilla,” says Gilbert.

Le Duc Manual Lymph Drainage

This combines manual lymph drainage with multi-layer bandaging and a compression pump, to clear excess lymphatic fluids from your body by activating the pumping action of the lymphatic system.

Speech and Language Pathology

Southwestern’s speech and language pathologists provide a dual role in the department. They teach speech therapy to help you communicate your wants and needs with ease and clarity. They also help resolve any swallowing problems that may limit your ability to eat.

Our speech pathologists collaborate with our Nutrition Department to thicken or puree food to a tolerable consistency. They also work with our surgical oncology and radiation departments to support head and neck cancer patients who undergo laryngectomies or receive TomoTherapy Highly Integrated Adaptive Radiotherapy (HI-ART) ®.

Neuromuscular Re-education with Electrical Stimulation

This aims to help restore an efficient safe swallow in patients treated for head and neck cancer. Dysphagia treatment consists of “Talk Tools,” a system that uses graduated exercises with straws, horns and jaw bites to improve oral motor and laryngeal function leading to safe nutrition. “Testing of one’s swallow function using Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is readily used in the treatment process for patient biofeedback,” says Gilbert.

Pain Management

Often times, Southwestern’s Oncology Rehabilitation Department will team up with our Cancer Pain Management Department to help relieve your pain and restore your physical abilities. Our rehabilitation therapists will rate functional status using a scale of 0 to 5 (with 0 meaning cancer has not restricted a patient’s activity).

“As pain issues increase or decrease, the two departments address those concerns immediately,” says Gilbert. “Daily communication flows with the pain staff as patients increase their mobility and require pain medication adjustments,” she adds. All of our efforts and the patient’s energies go into restoration of activities of daily living.

Manual Therapy

Southwestern’s massage therapists perform manual muscle therapy to help reduce pain and help improve your quality of life. One means of manual muscle therapy is massage therapy. If it is indicated, your rehabilitation therapist will refer you to a massage therapist.

The following are some of the manual therapy options available at Southwestern:

• Traditional Massage – A manual technique which aims to promote relaxation, reduce pain, enhance immune response, accelerate wound healing, reduce edema, and provide an overall sense of well being.
• Stone Therapy – A massage technique in which warmed stones are placed on points on the body and used as massage tools to promote deep muscle and tissue relaxation, alleviate stress, release toxins, relieve pain, and improve circulation.
• Myofascial Release – A form of bodywork that uses long stretching strokes to rebalance the body by releasing tension in the fascia/connective tissue. This technique may help to increase range of motion, improve circulation, reduce stiffness, decrease pain and tension, rejuvenate and free muscle tissue, and improve lymphatic flow.
• Soft Tissue Manipulation with Passive Stretching – A technique in which the manual therapist begins on the opposite side and creates a range of motion to discover any restrictions, then moves to the aggravated site and uses soft palpation to relieve the spasm. This may help to increase range of motion, improve circulation, reduce stiffness, and decrease pain and tension.
• Aromatherapy – Uses essential oils, which are inhaled and massaged (in a diluted form) into the skin. This technique aims to treat a variety of disorders, such as stress and anxiety, as well as a wide range of other physical ailments. For instance, aromatherapy may help to reduce hypertension, treat skin conditions (e.g., burns), reduce chronic pain and muscle aches, aid in digestion, and treat respiratory infections.
• Effleurage – A smooth, gliding stroke, generally used in a Swedish massage, which uses both hands to relax soft tissue. This may help to promote relaxation, improve breathing, reduce pain, enhance immune response, accelerate wound healing, reduce edema, and provide a sense of well being.
• Friction – The deepest of Swedish massage strokes, this technique involves deep, circular movements applied to soft tissue, causing the underlying layers of tissue to rub against each other and increase blood flow to the massaged area. This method may help to break down scar tissue, increase circulation, decrease scar tissue, and accelerate the healing of wounds and fractures.
• Trigger Point Therapy – A method that applies concentrated finger pressure to trigger points to break cycles of pain and dysfunction. This technique may help to reduce stiffness, relieve pain, and increase range of motion, flexibility, and circulation.
• Acupressure – This method involves applying pressure to points on the body, such as the face and wrist, to relieve symptoms like stomach discomfort, pain and tingling, nausea, and headaches. For example, the therapist may press directly under the nostrils to relieve hamstring pain, the wrist to alleviate nausea, and hill of the hand to relieve headaches.
• Reflexology – A technique applied to the feet and hands to promote healing and to stimulate the body’s internal organs and muscle systems. This technique may help to release tension and congestion, improve circulation of blood and lymphatic fluids, increase energy, normalize body functions, increase oxygen flow, and improve immune function.
• Reiki – A form of energy healing that is used to reduce stress, improve sleep, decrease depression and fear, and increase energy, peace and feelings of well being.

Auriculotherapy

Originally based on the ancient Chinese practices of acupuncture, auriculotherapy consists of an electrical stimulus which is applied to external ear points that correspond to locations on the body. “This is a simple modality that has few contraindications and has demonstrative results in seconds, relieving issues like nausea, clouded thinking, dry mouth, pain and sluggishness,” says Gilbert.

Through stimulation of the auricle of the external ear, auriculotherapy aims to alleviate health conditions in other parts of the body. For instance, for lung cancer patients, a probe is used to apply a small electrical current to a specific point on the ear that corresponds to a point in the lung. This aims to help reduce shortness of breath and help patients take deep cleansing breaths with less pain.

Auriculotherapy may also help with other conditions, including loss of mobility, balance and coordination, nausea, vomiting, loss of appetite, hiccups, dry mouth, swallow dysfunction, dizziness, hearing loss, and fatigue.

ReBuilder

This method aims to improve peripheral neuropathy, a condition that causes pain, numbness, tingling, or loss of reflexes in different parts of the body. The technique involves an electronic stimulation to the area of peripheral neuropathy, such as the hands or feet, to increase tactile sensory and awareness.

Interactive Metronome

Using headphones and special hand and foot sensors, interactive metronome is a simple series of computer-generated “sounds” and feedback to measure a rhythmic beat and response to the millisecond. The goal is to increase concentration and improve balance, function, and cognition in a few short minutes and a few treatment sessions.