Post on 01-Aug-2020
5/14/2013
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Oncology Basics:
Creative Adaptations to Promote Activity for Patients with Cancer
Kelly Guich, MS, OTR/L, CEIM
June 1, 2013
© 2013 Memorial Sloan-Kettering Cancer Center All Rights Reserved.
This presenter has no conflict of interest to report regarding any commercial product/manufacturer that may be referenced during thisthat may be referenced during this presentation.
Objectives
Understand:
Practice framework and relevance of adaptations.
Unique OT needs of patients in the acute oncology and palliative care settings.
Barriers patients with cancer experience requiring creative interventions.
Areas of oncology that frequently require adaptations.
Examples of custom adaptations OT’s can fabricate for patients with cancer during all phases of treatment.
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5/14/2013
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Practice Framework
The Person-Environment-Occupation Model
Add ll 3 f t t t l ti Address all 3 factors to create a solution
Allows for implementation of care at different levels and in any context1
Practice Framework
The Occupational Therapy Intervention Process Model
Implementing adaptive occupations for
Compensation
Remediation2
Occupational Therapy in Oncology
The role of Occupational therapy in oncology is “to facilitate and enable an individual patient to achieve maximum functional pperformance, both physically and psychologically, in everyday living skills regardless of his or her life expectancy”2
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Occupational Therapy Approach in Oncology Care 3,4
Intervention methods to:
Remediate
Compensate
Adapt
Cancer or the treatments involved in one’s care may lead to changes in physical, cognitive, and emotional well-being 3
Research has shown:
Adequate post-operative adaptations will maximize long-
Impact of Cancer Treatment on Performance
term function
Rehabilitation can improve patient’s feelings of stability and activity levels”5,2
Problem-solving interventions might be needed to resolve obstacles to the proper management of cancer pain 6
Orthotic Fabrication 7,8,9
Orthopedic reconstructive surgeries for tumor removal
Plastics reconstruction for tumor removal and tissue transfers
Plastics reconstructive surgeries with free flaps
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Role of Fabricating Orthotics for Reconstructive Surgeries 7
Occupational Therapy is consulted for immobilization of the graft site
Plastic surgery and Orthopedic surgery work Plastic surgery and Orthopedic surgery work together with OT to determine appropriate positioning
Once integrity of the graft is proven, maintaining joint and muscle integrity becomes the priority
Goals of OT for Patients Requiring Custom Orthotics
Immobilization of the joint
Protection of the flap/circulatory system
BADL
Education
Optimal positioning
Forearm Supination Orthosis with Adapted Positioning
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Extensive Forearm Graft
Extensive Forearm Graft Orthosis
Lower Extremity Orthotics
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Adapting Multi-Podus Boots
Scrotal Edema 10,11
A variety of disorders may cause scrotal inflammation
Male patients become significantly uncomfortable, limiting functional activity
Goals of OT for Patients Experiencing Scrotal Edema
Creation of custom supports
Education
BADLBADL
Functional mobility
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General Custom Scrotal Support
Custom scrotal supports assist with decreasing edema gand increasing patient comfort with functional activities.
Unique Case: External Hemipelvectomy 12
Amputation of lower extremity at hip level
Multiple limitations
OT goals: Scrotal edema
management
Increasing OOB, mobility and BADL
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Role of OT in Adapting Durable Medical Equipment 13,14
Modifications for post-surgical patients: Provide optimal positioning and pressure relief
Increase comfort to promote healing and activity
Common modifications: Commodes, cushions, and wheelchairs
Patient and family education is essential for carryover
Orthopedic Surgeries Requiring Seating Adaptations
Hemipelvectomy
Sacrectomy Partial or complete removal
of the sacrum
Att h t t l b Attachments at lumbar
vertebra and ilium
OT goals: ADL modification
Balance
Cushioning needs
Image: Stubblefield MD, O’Dell MW, eds. Cancer Rehabilitation Principles and Practice. New York: Demos Medical; 2009.
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Adapted Cushions
Modified Wheelchair Leg Rest
Modified Wheelchair Leg Rest
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Other Unique Adaptations 15
Helping patients to live their days to the fullest while maintaining a sense of control and dignity are the primary contributions of occupational therapy in the management of cancer-related treatments 18
Uniqueness of the individual and their obstacle preventing activity or independence is priority
Always consider psychosocial needs
Barrier: Preventing Complications While Improving Mobility in Patients with Head
and Neck Cancer
Patients that undergo surgical interventions for tumor excisiontumor excision
Plastic surgery team requirements for the patient to remain in specific positions to promote healing 16
Solution: Head and Neck Support
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5/14/2013
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Barrier: Pediatric Patients with Ongoing Chemotherapy Treatments
Some patients will require MediPort placements for easeplacements for ease with multiple future treatments.
Image: MSKCC 2013
Solution: Protective Chest Plates
Barrier: Incontinence & Self Catheterization
Numerous diagnoses may cause incontinence
May increase family burden and decrease patient independence
Altered self image
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Solution: Self Catheterization Mirror
Barrier: Altered Body Image After Surgerical Procedures
Some surgeries may result in a change in the structure and visual appearance of the body
Psychological affects on body image can influence self esteem, functional activity, independence, and work/social involvement
Solution: Cosmetic Adaptation
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Barrier: Protecting Surgical Sites
Surgeries may require multiple operations over an extended period of time
Healing of the first surgery is essential before the next surgery can take place
OT’s consulted to assist in assuring protection of the surgical site while awaiting the next operation
Solution: Protective Orthotic
Documentation and Billing
Custom Orthoses
L Code Splint/Orthosis
L0100 Cranial helmet
L3906 Custom wrist splint
L3702 Elbow splint
Adaptations without L-codes Orthotic fit and train (i.e. pediatric chest plate)
Self care/BADL (i.e. scrotal support)
Evaluation
L3913 Hand/finger splint
© 2013 Memorial Sloan-Kettering Cancer Center, All Rights Reserved.
5/14/2013
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Conclusion Cancer treatments can significantly affect an individual’s
performance in daily activities or restrict the ways in which they are able to move
Creative custom designs or adaptations to existing resources are required in acute care to improve patient’s participation in occupations
OTs in oncology are challenged to create unique splints and positioning devices to maintain specific precautions set by the surgeons post operatively
OT practitioners provide holistic comprehensive interventions and adaptations that focus on a patient’s goals and ability to successfully participate in their lifestyle choices and improve quality of life during and well beyond their Cancer experience
Thank you
References1. Jones, Stubblefield, M. (2004). The role of knee immobilizers in cancer patients with femoral neuropathy. Archives of Physical
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2. Hughes, CW., Godden, D., Perkins CS. (2003). "Splinting the radial forearm free flap donor site." British Journal of Oral & Maxillofacial Surgery. Jun; 41(3): 193.
3. American Occupational Therapy Association. (2011). The role of occupational therapy in oncology. Retrieved from www.aota.org/Practitioners/PracticeAreas/MentalHealth/Fact-Sheets/OT-Role-
4. Penfold, Sarah, L. (1996). The role of the Occupational Therapist in Oncology. Cancer Treatment Reviews , 22, 75-81.
5. Kielhofner, G. (1998) Model of Human Occupational Therapy and Application. Baltimore: Williams and Wilkins, pp. 232-241.
6. Law, M. (1996). The person-environment-occupation model: A transactive approach to occupational performance. No. 63).
7. Caulfield, RH., Maleki-Tabrizi, A., Birch, J., Ramakrishnan, V.(2008). "A Novel splinting technique to protect free flaps in major limb trauma." The Journal of Trauma. Mar; 64 (3) E:44-6.
8. Saint-Cyr, M. and Langstein, H. N. (2006), Reconstruction of the hand and upper extremity after tumor resection. J. Surg. Oncol., 94: 490–503. doi: 10.1002/jso.20486
9. Selber, JC., Treadway, C., Lopez, A., Lewis, VO., Chang, DW. (2011). "The use of free flap for limb salvage in children with tumors of the extremities " The Journal of Pediatric Surgery April;46(4):736-44tumors of the extremities. The Journal of Pediatric Surgery. April;46(4):736-44.
10. Brooks JD. Anatomy of the lower urinary tract and male genitalia. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell's Urology. 8th edition. Philadelphia: Saunders; 2002: 41-80
11. Conn, H. (1972). Unilateral edema and jaundice after portacaval anastomosis. Annals of Internal medicine, 76, 459-461.
12. Stubblefield MD, O’Dell MW, eds. Cancer Rehabilitation Principles and Practice. New York: Demos Medical; 2009
13. Stewart, A. (1994) Empowerment and enablement: occupational therapy , 2001. BI: Journal of Occupational Therapy. 57 (7): 248-254.
14. Vallerand, A. H., Templin, T., Hasenau, S. M., & Riley-Doucet, C. (2007). Factors that affect functional status in patients withcancer-related pain. Pain, 132(1-2), 82-90. doi: 10.1016/j.pain.2007.01.029
15. Llyod, C. (1989) Maximizing occupational role performance with the terminally ill patients. BE Journal of Occupational Therapy: 52: 227-230.
16. Sardesai, MG., Fung, K., Yoo, JH., Bakker, H. (2008). "Donor-site morbidity following radial forearm free tissue transfer in head and neck surgery." The Journal of Otolaryngology of Head and Neck Surgery. Jun;37(3):411-6.
© 2013 Memorial Sloan-Kettering Cancer Center, All Rights Reserved.