Med Conditions Midterm

Contact Precautions

• May include but not limited to: Presence of stool incontinence, Norovirus, Rotavirus, Clostridium difficile(C-Diff), Draining wounds, Uncontrolled secretions, Bedbugs/head lice

• Hand hygiene with soap and water – sanitizer does not suffice! Disinfect used equipment with a bleach wipe, PPE-

Contact PPE

• Gloves, Gown, Do not wear the same gown and gloves for the care of more than one person

Droplet

• can be generated from the source person during coughing, sneezing, talking and during the performance of certain procedures such as oral suctioning

• may contain microorganisms and generally travel no more than 3 feet from the patient. These can be deposited on the host’s nasal mucosa, conjunctivae or mouth

Droplet Conditions

Conditions include, but are not limited to: Pertussis, Influenza, RSV, Diphtheria, invasive Neisseria meningitidis

Droplet PPE

Gloves, Surgical mask, Do not wear the same PPE for the care of more than one person, Source control: put a mask on the patient if patient agreeable

Airborne

Transmission occurs through the dissemination of either: Airborne droplet nuclei (small-particles containing microorganisms that remain suspended in the air for long periods of time), Dust particles that contain an infectious agent. Applies to patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei

Airborne Conditions

Measles, COVID-19, Severe Acute Respiratory Syndrome (SARS), Varicella (chickenpox), Mycobacterium tuberculosis

Airborne PPE

Patients may be placed in specially-ventilated negative pressure rooms, PPE- Gloves, Fitted N95 or Powered-Air Purifying Respirator (PAPR) hood, Do not wear the same PPE for the care of more than one person, Source control: put a mask on the patient if patient agreeable; patient's door should remain closed

Neutropenia

Condition characterized by a low number of neutrophils in blood causing individual to be an increased risk for acquiring infection

• Compromised immune system, Blood cancers, Chemotherapy and radiation, Hemodialysis, HIV or autoimmune diseases, Neutropenic precautions

Neutropenic precautions

Hand hygiene pre/post session, before and after touching items in the environment without gloves, and when visibly soiled, Surgical mask before entering room and throughout session, No live flowers or plants in the room (They can harbor bacteria and fungal spores that pose an infection risk to individuals with weakened immune systems)

Medication classes typically seen in OT and use

• Analgesics: Pain relief, Acetaminophen (Tylenol), NSAIDs (Ibuprofen, aspirin), Oxycodone, Morphine, Dilaudid

• Neuropathic agents: Gabapentin

• Muscle relaxants: Cyclobenzaprine (Flexeril), Methocarbamol (Robaxin), Baclofen (Botox)

• Anticoagulants (Blood thinners): Warfarin, Heparin, Lovenox

• Antihemorrhagics: Thrombin

• Antihypertensives: Lisinopril, Amlodipine, Metroprolol, Hydrochlorothiazide (*also a diuretic), Metolazone (*also a diuretic)

• Diuretics: Furosemide (Lasix), Bumetanide (Bumex)

Arrhythmias

• Ventricular tachycardia: Characterized by regular rhythm and rate, QRS complexes wide and bizarre, P waves not discernible, can be caused by MI

• Ventricular fibrillation: Ventricular rhythm and rate are rapid and chaotic, can be caused by MI

• Atrial fibrillation: Uncoordinated, irregular contraction, resulting in "quivering" of chamber, characterized by irregular, rapid rhythm

• Asystole: severe form of cardiac arrest where the heart's electrical and mechanical activity stops entirely, showing as a flat line on an electrocardiogram

Labs

• Troponin: Proteins are normally only found in skeletal muscles and heart, but can leak into bloodstream when heart has been damaged. Observe trend of troponin levels; Increasing levels may indicate cardiac insult

• Hemoglobin: Assists in assessing abnormal states of tissue oxygenation, anemia, blood loss. Symptoms-based approach to treatment (12-18 g/dL normal)

  • Low hemoglobin <8 g/dL may result in decreased endurance, activity tolerance, tachycardia. <7 g/dL: Consider deferring out of bed activity

Vitals

• SPO2 norms: between 92% - 100%, SpO2 values below 92% are considered to be abnormal, and caution should be taken at these values

  • Some people with chronic lung disease or sleep apnea can have normal levels around 90%

  • Patients with an SpO2 reading of less than 92% are considered hypoxemic

  • Patients with an SpO2 reading of less than 85% would be severely hypoxemic (These patients would most likely need an external oxygen supply)

Lines/Drains

• NG Tubes: Medical catheter that’s inserted through nose, travels to stomach

  • Single lumen = single-channel tube ("one-way")
    Double lumen = two-channel tube ("two-way")
    Used for temporary periods to deliver substances such as food or medications to your stomach, Can also be used to draw substances out

  • Contraindications
    Maintain aspiration precautions at all times: Client should remain at upright angle (30 degrees or more), defer therapy if tube is dislodged, defer therapy if tube has been recently placed without x-ray to confirm placement

Arterial line

Monitoring of continuous arterial bp, blood sampling, and administration of medicines, vasopressors (increase bp meds), no ROM at area of insertion (when inserted in femoral artery, limit hip flexion)

• Needs to be recalibrated by nursing once patient has mobilized out of bed

• If line is dislodged/pulled, it is a medical emergency; apply pressure and notify nursing immediately

Central line

Often inserted into the jugular, subclavian, or femoral vein and rests in the proximal artery

• Precautions: Limit excessive ROM, If central line becomes dislodged/pulled it is a medical emergency, apply pressure and notify the nurse immediately

PICC line

in a large peripheral vein in the arm, passes through the superior vena cava near the heart, no bp in extremities, can’t get dressing wet, no resistive exercises on that arm, it is a medical emergency if the line gets dislodged

Peripheral IV

inserted into a vein usually through the hand or arm, can become dislodged, apply pressure and tell nurse immediately

DVT (Deep Vein Thrombosis)

Occurs when a blood clot (thrombus) develops in a vein deep in the body, often in the calf, thigh, or pelvis

• May partially or completely block blood flow through the vein, swelling of leg or arm on one side (sometimes, this happens suddenly), diagnosed through Doppler ultrasound, venogram, or d-dimer test, can lead to PE

Contractures

Occurs when scarring (of skin) or fibrosis (of ligaments or muscles) makes soft tissues tighten and stiffen, resulting in permanent reductions to ROM

Usually happens when the tissues try to repair themselves after injury or after wasting away from disuse

Medical Management for Contractures

• Braces, casts and splints, Serial casting: Muscle/tendon is immobilized in lengthened position, Myofascial release, Anti-inflammatory drugs

• Surgery:

  • Tenotomy ("tendon lengthening") Makes small cuts or holes in the tendon to release tension. As the tendon repairs itself, it can grow back longer.

  • Tendon transfer: Removes the contracted tendon and transfers another tendon from a donor or from elsewhere in the body

  • Arthroplasty (for joint capsule contractures): Surgery to replace parts of or the full joint capsule

  • Fasciotomy (for contractures that involve fascia, like Dupuytren’s contracture): Surgeons cut holes in the fascia to release it or remove pieces of scar tissue. Example: "Z-plasty" - Zig-zag cuts are made to encourage the tissue to repair itself without shrinking.

  • Plastic surgery (for scar contractures): Scarred tissue is removed and replaced with a skin graft or skin flap taken from a donor or from elsewhere on the body

OT role in contractures

Orthotics/serial casting

• Preventative: Early mobilization, Positioning, PROM of immobile body parts/joints

Heterotopic ossificans

Occurs when bone tissue develops in the soft tissues, presents as a bony, painful lump that develops underneath the skin, Often, people get HO after an injury or major surgery, Genetic HO is rarer and more severe, If the lump is near a joint, it may restrict ROM

Activity orders on Trauma

§  ROM restrictions

·       Types of ROM allowed

o   Ex. AROM or PROM only?

·       Planes of ROM allowed

o   Ex. Flexion and abduction only?

§  Weight bearing statuses

·       Non–weight bearing (NWB) - 0% weight

·       Touchdown weight bearing (TDWB) - 10%–15% weight

·       Partial weight bearing (PWB) - 30%-50% weight

o   Some surgeon protocols do not specify percentage – Always best to clarify!

·       Weight bearing as-tolerated (WBAT) / Full weight bearing (FWB) - 100% weight as tolerated

§  Braces/orthotics

·       Ordered for the patient

o   Ex. Knee immobilizer, hip abduction brace, CAM boot, etc

§  Additional info:

·       When surgeon’s protocol requires complete rest of injured tendon, bone, or joint, ROM measurements are deferred until movement is permissible.

·       When client is on specific program (e.g., controlled ROM), therapist:

o   Measures joint, adhering to precautionary boundaries

o   Does not allow client to exceed limits of surgeon’s prescription.

·       Assessing strength after fracture or surgery—only be performed when ordered by orthopedist

Intercondylar Fractures

Volkmann’s ischemia

• Compartment syndrome of the forearm

• Signs of ischemia include severe pain with passive stretching of fingers; pale, bluish skin color; absence of forearm radial pulse; pins and needles; and decreased hand sensation and paralysis

• Immediate medical action is important if Volkmann’s ischemia is suspected. The common surgical approach includes decompressive fasciotomy.

Ligament Injuries (Grades 1-3)

Grade 1

• • structural damage only on microscopic level, with slight local tenderness and without joint instability

• • May produce discomfort during activities—requiring rest, thermal modalities, and temporary modifications to work, ADL, and leisure activities.

Grade 2

• • Partial tear (rupture) of the ligament, visible swelling and noticeable tenderness, but without joint instability (or with mild instability)

• • Require longer immobilization until ligament fibers are healed—gentle protected (functional) movement encouraged, within anatomical lines, to maintain joint flexibility but prevent reinjury.

  • oSplinting for immobilization if indicated, gentle ROM within prescribed limits, ROM/strengthening and edema management at unaffected joints, re-conditioning affected joint once cleared by physician

Grade 3

• • Complete rupture of the ligament with significant swelling and with instability of the joint

• • Require surgical intervention to reattach ligament to bone with OT to improve functional use of hand following full healing.

• • Splinting for immobilization, ROM/strengthening and edema management at unaffected joints, re-conditioning affected joint once cleared by physician

Nerve lesions

abnormal growth of nerve tissues after the nerve is injured

Ulnar nerve lesion

•Laceration of ulnar nerve at wrist, a low ulnar lesion, results in loss of most of hand intrinsics. Denervation of abductor digiti minimi, flexor digiti minimi, & opponens digiti minimi results in flattening of hand with loss of distal transverse metacarpal arch.

•Ring and small fingers present a “claw hand” deformity.

Median nerve lesion

•Laceration at wrist results in low median nerve palsy, with denervation of opponens pollicis and abductor pollicis brevis and lumbricals to index and long fingers.

•Motor and sensory input

•Results in “ape hand” deformity

Radial nerve lesion

•High radial nerve injury often occurs with humeral fractures as nerve spirals around humerus. Damage to radial nerve in this area leads to absent wrist, digital extensors, and “wrist drop” deformity.

•Weak finger and wrist extension muscles

Causes of Amputation

• Dysvascular disease (54%) - poor blood flow to limb, causes tissues to die

• Trauma (45%) - lost because of injury or accident

• Cancer (approx. 1%) - cannot be treated while actively preserving the limb

Phantom limb pain vs. phantom limb sensation

Phantom Limb Sensation—nonpainful sensation experienced in missing limb.

• Described as a sense of phantom limb: (a) still present, (b) temperature changes, (c) itching, (d) pressure, and (e) tingling.

Phantom Limb Pain – Painful sensation described as burning, shooting, or cramping sensation in the phantom limb

• Exact cause unknown – thought to be neuropathic in nature due to disruption to central and peripheral nervous systems

Levels/Types of Burns

• Superficial (old 1st degree) - epidermis damage only

• Superficial partial thickness (old 2nd degree) - epidermis and upper-level dermis

• Deep partial thickness (old 2nd degree) - epidermis and severe damage to dermis

• Full thickness (old 3rd degree) - epidermis and dermis destroyed

Skin grafts

When medically stable

Full-thickness burns and for large, deep partial-thickness burns

Type of grafts

• Autografts: Skin harvested from an unburned area of the patient

• Skin substitutes: Can be either

  • Biologic, such as allografts or xenografts (from cadaver and bovine skin, respectively)

  • Synthetic, such as Biobrane comprising nylon and silastic

Ejection Fraction (EF)

Percentage of the amount of blood ejected relative to the amount received by the ventricle

• Tells us how well the heart is pumping

• Normal adult - 60%

  • Low EF

    • Systolic dysfunction or failure

    • Clients present with: low endurance, SOB and LB edema

Congestive Heart Failure

Complex diagnosis resulting from impaired structure and/or function of ventricles affecting heart’s ability to pump.

• Heart muscle becomes stretched beyond its ability to contract resulting in fluid in lungs or extremities

  • Heart pumps forcibly at higher pressure, cardiac walls thicken causing ventricle hypertrophy—making oxygenating heart muscle difficult—may lead to ischemic damage.

• 75% of individuals with CHF have history of HTN leading to diastolic dysfunction

CHF may begin with acute onset or progress becoming chronic, although many cases are initially asymptomatic.

Symptoms classified stages from mild to severe.

In majority of cases, left-sided heart failure will lead to right-sided dysfunction.

Risk and Predisposing factors of CHF

Risk Factors: Hypertension, eating foods high in fat, sodium, and cholesterol, sedentary lifestyle, emotional stress, obesity

Predisposing Factors: History of: CAD, heart valve disorders, diabetes, thyroid disorders, renal disease

Symptoms and Diagnosis of CHF

Symptoms: Shortness of breath (dyspnea), Shortness of breath while lying down (orthopnea), Fatigue, Muscle weakness, Hepatomegaly: enlargement of the liver, May be nauseated, bloated, or have abdominal pain, Rapid weight gain due to fluid build up within the body, Lower extremity edema, Fluid retention

Diagnosis: Blood tests, Cardiac catheterization, Chest X-ray, EKG, Heart MRI (magnetic resonance imaging), Cardiac computed tomography (CT), Multigated Acquisition Scan (MUGA scan), Stress test.

Medical Management of CHF

Managed with medication and lifestyle changes (ACE inhibitors, ARBs, beta-blockers, diuretics), Surgical interventions may also be indicated (Valve replacements)

Impact on Occupation and OT Role in CHF

Impact on Occupation → Dyspnea (at rest and with exertion [DOE]) and orthopnea (SOB while laying down), Fatigue, Weakness, LE edema, Functional mobility and LE ROM, Skin integrity

OT Role

• Monitoring skin integrity (especially with LE edema), Medication management, O2 line management during functional activities, Training in adaptive strategies/equipment for ADLs/IADLs and work/leisure tasks, Energy conservation, Mitigating symptoms associated with adverse effects of medication, Toileting / adaptive strategies to manage urinary incontinence, Reducing fall risk through training on adaptive strategies/equipment to manage dizziness/hypotension

• Sleep hygiene-Positioning to manage orthopnea

• Lifestyle changes-Healthy meal prep, Home exercise program, stress reduction techniques, Smoking cessation

Peripheral Arterial Disease (PAD) / Peripheral Vascular Disease (PVD)

• Chronic and progressive

• Arteries are narrowed due to buildup of fatty deposits (atherosclerosis)

• o The legs or arms – usually the legs – don't get enough blood flow to keep up with demand

o Results in leg pain during ambulation (claudication)

• • If not addressed, may lead to amputation

Risk Factors and Predisposing Factors of PAD/PVD

Risk Factors: High BP, High cholesterol, Obesity, Smoking, Sedentary lifestyle

Predisposing Factors: Genetics, Age, History of diabetes, CAD, HIV

Symptoms and Diagnosis of PAD/PVD

Symptoms: Claudication, Muscle pain or cramping in the arms or legs, Cold extremities, Extremity numbness or weakness., Skin color changes on the extremities, Non-healing ulcers

Diagnosis:

• Blood tests

  • Detects high cholesterol, glucose abnormalities

• Ankle-brachial index (ABI)

  • Blood pressure readings are taken in the ankle and arm before and after exercise to compare blood pressure between extremities with activity

• Ultrasound

  • Radiologic imaging to photograph blood flow through the extremities

  • Doppler ultrasound is a special type of ultrasound used to spot blocked or narrowed arteries

• Angiography

  • Radiologic imaging tests that uses a dye (injected into blood vessel) to check for blockages in the arteries

Medical Management of PAD/PVD

Medication, surgical intervention, lifestyle changes, offloading footwear (for non-healing ulcers on the feet)

Vascular Surgeries: Angioplasty, Bypass grafting, Stent placement, and Atherectomy

Impact on Occupation and OT Role of PAD/PVD

Impact on Occupation:

• Pain, Edema, Sensory changes to extremities

• Decreased activity tolerance

  • Foot ulcers > decreased standing tolerance

  • Claudication > decreased mobility

OT Role:

• Health management

  • Adaptive strategies for safety due to decreased sensation on hands/feet

  • Skin checks, Foot care/hygiene, Donning/doffing offloading footwear

• Pain management

• Functional mobility

• Training in adaptive strategies/equipment for improved participation in ADLs/IADLs and work/leisure tasks

• Lifestyle changes: Home exercise program, Smoking cessation, Stress reduction

Coronary Artery Disease (CAD)

This disease generally arises from atherosclerosis, a buildup of plaque in the coronary arteries

• Plaque buildup in the coronary arteries prevents necessary oxygen-rich blood and nutrients from reaching the heart.

  • This is known as myocardial ischemia

Reduced blood flow to the heart can lead to numerous complications, including: Angina, Myocardial Infarction (Heart attack), Arrhythmias and heart failure

Risk and Predisposing factors of CAD

Risk factors: Smoking, high BP, high cholesterol, obesity, sedentary lifestyle, high stress, use of hormonal birth control

Predisposing Factors

• >45 male or >55 female

• Genetics

• History of:

  • Anemia.

  • Autoimmune diseases, including lupus and rheumatoid arthritis.

  • Chronic kidney disease.

  • Diabetes.

  • HIV/AIDS.

  • Metabolic syndrome.

  • Sleep apnea.

  • Endometriosis.

  • Gestational diabetes, eclampsia or preeclampsia.

Symptoms and Diagnosis of CAD

Symptoms: Chest pain (angina), Nausea & vomiting, Diaphoresis (excessive sweating), Fatigue, Pallor, Coolness of extremities, Shortness of breath (dyspnea)

Diagnosis: Echocardiogram (EKG), Stress test, Cardiac catheterization/angiogram

Medical Management of CAD

Medications

• ACE inhibitors, ARBs, beta-blockers, antithrombotic (anti-clotting) agents (aspirin)

Surgical options

• Coronary artery bypass graft (CABG) surgery to circumvent blocked vessels.

• Or, percutaneous coronary intervention (PCI), (aka: coronary angioplasty) with/without stent placement to open artery.

Impact on Occupation and OT Role of CAD

• Impact on Occupation

• o Symptoms: dyspnea, fatigue

• o Post-operative

  •  Sternal precautions

    • • Don’t reach both arms overhead.

    • • Don’t reach both arms out to the side.

    • • Don’t reach behind your back.

    • • Don’t lift more than 5 to 8 pounds.

• OT Role

• o Health management

  •  Monitoring BP

  •  Medication management

• o Mitigating symptoms associated with adverse effects of medication

  •  Reducing fall risk through training on adaptive strategies/equipment to manage dizziness/hypotension

• o Post-operative

  •  Early mobilization

  •  Training on adaptive strategies/equipment to maintain post-operative sternal precautions

    • • Energy conservation

• o Lifestyle changes

  •  Healthy meal prep

  •  Home exercise program

  •  Stress reduction techniques

  •  Smoking cessation

NSTEMI v. STEMI

NSTEMI – non-ST segment elevation MI

• Characterized by a partial coronary blockage, partial-thickness necrosis

STEMI – ST-segment elevation MI

• Characterized by a complete coronary blockage, full-thickness necrosis

Vascular Surgeries

Bypass grafting: A healthy blood vessel is taken from another part of the body (commonly the leg)

• The new vessel is connected below the blockage, creating a new path for blood flow

Angioplasty: A balloon catheter is inserted into a narrowed artery

• The balloon is inflated to squeeze plaque against the artery wall, improving blood flow

Stent placement: A small metal tube is placed in the artery to keep it open

Atherectomy: A device, laser, or blade is used to scrape away plaque

Asthma

inflamed airways, making the airways swollen and sensitive to certain substances, Narrows airways and reduces airflow, Airways react with irritants, causing muscles to constrict, Narrows airways and reduces airflow, Increase in mucus production, Narrows airways and reduces airflow

• Pediatric: Symptoms are irregular, Higher sensitivity to allergens, Increased likelihood of asthma attack, Symptoms may disappear during puberty

• Adult: Persistent symptoms, Require regular symptom management, Chronic

COPD

Characterized by airflow obstruction impacting gas exchange causing dyspnea and limited reserve lung capacity, Umbrella term for emphysema, chronic bronchitis, and obstructive bronchiolitis, It is Progressive

• Anti-inflammatory response that results in: A lack of elastic recoil in airways and alveoli, The walls between alveoli being destroyed, The walls of airways becoming thick and inflamed, The airways making more mucus than usual and becoming clogged, All cause less air to flow in and out of the airway

• Hypercapnia = buildup of carbon dioxide in your bloodstream, Affects people who have chronic obstructive pulmonary disease (COPD), air cannot leave the lungs during expiration and becomes trapped, leading to dyspnea, exercise intolerance, and reduced ability to engage in physical activities

Dialysis

Process of removing waste from the blood, used when kidneys cannot effectively perform these functions (chronic kidney disease)

• Out of bed activity is contraindicated during dialysis treatment

Hemodialysis: Administered through vascular access port, usually an arm or leg. 2 port types: Arteriovenous (AV) fistula: Created under the skin of the extremity or an AV graft: Graft is created using plastic tubing where a loop connects the artery and vein

• Patient is connected to HD machine - blood passes out of the body into the machine where it is cleansed and returned to the body; can take between 4-5 hours

Peritoneal dialysis: Catheter is surgically inserted into the abdomen, through which a solution (called dialysate) is infused to absorb body wastes; session can take between 4-6 hours, can be performed at home

Continuous renal replacement therapy: Specialized for acute kidney failure, Used with critically ill patients, Administered through central venous catheter (CVC), which is connected to CRRT machine – blood is removed, cleansed, and returned to the body; may be operated 24 hours/day, depending on patient's needs

OT Role in Dialysis Patients

Health management, Medication management, Managing urinary catheters during ADLs, mobility, Mitigating symptoms associated with adverse effects of medication, Toileting / adaptive strategies to manage urinary incontinence, Energy conservation strategies (especially during dialysis days), Reducing fall risk through training on adaptive strategies/equipment to manage dizziness/hypotension, Lifestyle changes, Meal prep with dietary restrictions, Fluid restrictions, Home exercise program

Chronic Liver Disease

Refers to conditions pertaining to liver damage

Symptoms: Yellowing of your skin or the whites of eyes (jaundice), Edema and abdominal ascites, Dark-colored urine, Digestive difficulties, especially with fats, Weakness and muscle loss, Mild brain impairment (hepatic encephalopathy), Associated with buildup of ammonia in the blood, Pruritus (itchy skin, but with no visible rash), Fatigue, Nausea or loss of appetite

Hepatitis → Fibrosis → Cirrhosis → End-stage liver disease

T1D vs. T2D

Type I diabetes—Body doesn’t produce insulin, 10% cases

Type II diabetes—Body doesn’t produce insulin or doesn’t use properly, leading to hyperglycemia— 90% cases

Medical Management of Diabetes

Daily insulin therapy: Continuous blood glucose monitoring + insulin therapy (daily injections via pens/syringes or an insulin pump to provide both basal (background) and prandial (mealtime) coverage), Combination of lifestyle changes and medications (Metformin)

Impact on Occupation and OT Role in Diabetes

Impact on occupation: Fatigue, Possible visual changes (diabetic retinopathy), Sensory changes (neuropathy), Delayed healing of wounds, Especially on the feet, Increased pain during functional mobility, ADLs/IADLs and work/leisure tasks, Risk of infection

OT Role: Medication management, Blood glucose testing and insulin management, Skin checks/foot checks, Hygiene/bathing, Mitigating symptoms associated with uncontrolled diabetes, Visual strategy training, Diabetic retinopathy Adaptive strategies for sensory loss Neuropathy, Lifestyle changes like healthy meal prep, exercise program, stress reduction, and smoking cessation

Cancer

a group of diseases where (a) abnormal cells divide without control, (b) invade nearby tissues, and (c) travel (via blood & lymph) to other body parts. Classified by body location and tissue type at origination

Metastases

named for originating locations— then spread (e.g., breast cancer with metastasis to bones).

Common types of cancer seen in OT → symptoms and impact on occupation

Breast cancer: Weakness, fatigue, body-image issues, pain, lymphedema, limited range of motion, brachial plexus injury, cognitive inefficiencies

Lung cancer: Fatigue, dyspnea, weakness, limited ROM and endurance

Brain cancer: Cognitive problems, impaired vision and balance, decreased sensation, dysphasia, hemiparesis, impaired coordination, personality changes

Head and neck cancer: Limited cervical ROM, shoulder dysfunction, loss of scapular stability, difficulty swallowing, speech problems, stigma associated with disfigurement

Medical Management of Cancer

Chemotherapy: medicines or drugs that can be used to contain or slow tumor growth or kill cancer cells

Radiation: using high energy particles or wavelengths to kill the cancerous cells and shrink tumors

Immunotherapy: substances made from living organisms to treat cancer