PHYSIOTHERAPY MANAGEMENT OF SPINAL TUMOR
"The spinal tumor is an abnormal mass of tissue within the spinal column or spinal cord. "
PHYSIOTHERAPY TREATMENT :-
GOALS :-
1) Patient and family counselling
2)Relieving symptoms
3)Enhancing functional independence
4)Prevent secondary complications
5)Improving quality of life
ROLE OF PHYSIOTHERAPIST :-
1)Patient and family education
2)Prevent secondary complications
3)Skin care
4)pain management
5)Bracing
6)ROM/flexibility exercises
7)strengthening exercises
8)Functional mobility
9)Use of Tilt table
10)Bowel Bladder management
11)Gait training
The Rehabilitation programme for spinal tumor is a multifocal approach .So ,before creating any type of treatment protocol for these patient we should first concerned with physician or surgeon who is envolved in this case.
The physiotherapy protocol varies from patient to patient .So we should first concentrate on physiotherapy assessment of the patient .With the help of PT assessment a therapist is able to know about the available muscles strength, ROM,Functional mobility etc. It becomes easier for therapist to make protocol and follow it on the basis of physiotherapy assessment. So It is essential to a therapist to first take a assessment.
TREATMENT :-
1)Patient and family counselling :-
Patient and family counselling is a main part of physiotherapy protocol.
A therapist must properly council the patient and his family member about the procedure, It's advantages and disadvantagesee ,Preoperative and postoperative care of patient ,Precautions etc.
2)RELIEVING SYMPTOMS :-
-BANK AND NECK pain is the one of the most common and initial symptom of spinal tumor.
-The pain aggravates by performing activities or when patient lying in straight supine position. So in this condition and therapist relieve the pain symptoms by altering position of patient like a pillow can be placed under knee to relief symotors.
-The activities which aggravates the patient 's symptoms can be modified or restricted to relieve the pain.
-The other symptoms includes weakness , Impaired coordonation , paraesthesia , cold sensations of fingers or hands , Bladder Bowel dysfunction, gait disturbance etc.
-The symptoms can be relieve by active assisted or passive range of motion exercises, soft tissues massage, Bladder Bowel training, Functional mobility etc.
3) PREVENT SECONDARY COMPLICATIONS :-
-Due to immobility secondary complications are more common to occur the secondary complications may be pressure sores , pulmonary infections , Deep venous thrombosis , CSF leakage , wound healing issues etc.
These can be prevented by:-
-Regular inspection of surgical site for CSF leakage , infection ,wound healing issues, pressure sores etc.
-Regular chest physiotherapy to prevent pulmonary complications.
-Passive range of motion exercises to prevent deep venous thrombosis ,Prevent contracture and deformity ,maintain joint integrity etc.
-Continues changing patient's position in each two hours to prevent pressure sores.
4)MAINTAIN BRONCHIAL HYGIENE :-
If the patient is on ventilation :-positioning, Nabulization and Regular suctioning is important.
If patient is on bed :-Encourage the patient to perform deep breathing exercises.
5 )SKIN CARE:-
-As the patient becomes bedridden ,so it is most likely to have skin problems like pressure sores due to immobility .
So we have to prevent the pressure sores via:-
-Frequent changing patient's position in every two hours.
-Advice for sponge bath to prevent infection.
-Advice for apply talcum powder for dryness of the area.
-Advice to use waterbed or airbed to equalise pressure on patient's body if affordable .
-Gental massaging the pressure susceptible areas to increase blood circulation around the area,preventing the chances of skin infection.
Due to any cause if pressure sores are developed then ,
-We should focus on regular dressing of wound.
-IR and UVR over the wound can increase the blood circulation so it can be used.
-Cryotherapy may also helpful.
-LASER therapy at appropriate dose may also be used .
6) Bracing:-
The braces can be used to ,
-pain management
-Postural correction
-Strengthening and stretching
-Stability.
The braces are of following types :-
1)Cervical collar
2)Clavicle strap
3)TLSO
4)AFO
5)Additional support by
-Abdominal binder
-Compression stroking.
CLAVICLE STRAP
7) PAIN MANAGEMENT :-
-Proper positioning of patient is comfortable position .
-postural Bracing .
-Modalities :-Cryotherapy ,TENS.
-Mannual therapy :- Soft tissues massage.
-Avoiding pain creating activities.
-Avoiding straight supine lying.
8) ROM/FLEXIBILITY :-
-Continues passive range of motion exercises on limbs as tolerated by patient,
-For prevent muscle contractures.
-For prevent spasticity.
-For maintain joint range of motion.
-For prevent muscle dystrophy.
-For proprioceptive stimulation.
Continues passive range of motion exercises in every two hours is most important.
A therapist should teach the patient 's relatives and nursing staff about handling and movements. The therapist should also guide the caregiver about not to produce unnecessary excessive movement on spine.
9)STRENGTHENING EXERCISES :-
-Progressive Resisted exercises for upper and lower limb.
-Resisted exercises for scapular muscles .
-Strengthening of abdominal ,Paraspinal and pelvic floor muscles are also important.
-Strengthening of upper limb muscles is essential as it help the patient for use of assistive devices like wheel chair, walking aids, crutches etc.
10) Use of Tilt table :-
In initial stages when there is no trunk stability.
-A therapist can use tilt table for weight bearing on lower limbs.
-With the help of Tilt table the patient can passively stands on his lower limb in erect posture.
11)FUNCTIONAL MOBILITY :-
Functional mobility is essential but it should be performed with care.
In initial stage :-
-Positioning :-For skin and joint integrity.
-Bed mobility :-Log rolling
-Lifting
-Turning
In late stage:-
As soon as the patient develops active muscle Contraction .
Then we should start mat exercises like,
-Bridging.
-Prone on elbow.
-Prone on hand.
-Quadrepud position
-Kneeling
-Half kneeling
As muscular strength increases we can progress to standing and walking.
12)Active exercises to reduce spasticity :-
-If spasticity develops in patient then the following measures should use:-
-Gental rhythmic passive movement.
-Prolonged icing over the spastic muscle for15 to 30 min.
Sustained stretching of spastic muscle.
-Proper positioning .
-Reflex movement pattern
-Faradic stimulation to weak antagonist muscle to reduce spasticity of agonist muscle.
13)Transfer activities :-
To make patient functionally independent it is essential to train the patient about use of assistive devices like wheel chair.
-It is essential to train the patient about use of wheel chair and how to transfer from wheel chair to bed and bed to wheel chair.
The patient should also trained for balance in sitting position.
14)GAIT TRAINING :-
-Assistive devices like crutches and callipers can be used.
-The paraplegia patient can be made to ambulation with this devices.
-The gait training can be performed with the help of parallel bar for feedback purpose.
14)Bowel Bladder training :-
-The patient is taught self cleaning techniques and intermittent catheterisation or timed voiding.
-Valsalva maneuver can also be taught in patients with lower motor lesion.
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