Lymphedema Physical Therapy Evaluation: Fill & Download for Free

There are many different areas of physical therapy/physiotherapy including:* Inpatient acute care: where you work in a hospital to assist people with either returning home or helping them determine the next level of care. When you come in the morning you will make a schedule or see what your schedule looks like for the day and then work to see the people on your list. Each hospital has a different method for determining the schedule but the main goal is to assess what someone can achieve to determine if they would be safe to return to their current living situation and make recommendations for safety. If someone is not safe to return to their prior living arrangement therapy will provide recommendations such as going for rehab at an inpatient facility or recommend family support/assist. Hospitals are meant for short term stay so while we work on strengthening, balance, etc the focus is making sure people are ready and safe to leave. Hospital treatments can include crutch training, teaching how to use a walker or cane or how to safely get out of bed after surgery/injury/illness. Education is a big portion of therapy and frequently includes surgical precautions, education on safety with mobility, education on importance of getting out of bed while in the hospital to prevent muscle weakness and atrophy for some examples.*Rehabilitation: I am speaking from a United States perspective as to what rehab provides but it is typically split into 2 categories of acute rehab, which is considered intensive 3 hours/day short term stay, and sub-acute rehab, for people who can not tolerate 3 hours/day due to medical issues and will require a longer stay. Rehab can include Occupational Therapy, Speech Therapy, Recreational Therapy and as they are staying there you have nurses and nursing assistants. The doctors make rounds and there are team meetings to discuss patient progress. At rehab a therapist will typically carry a caseload of patients that they oversee treatment for and you will spend more time with each person and build more of a relationship than you would in the hospital. It is often stated that therapists spend more one on one time with patients than the nurses as they are in charge of multiple people at one time. Building the relationship becomes important if you consider how trust is needed to ask sensitive questions such as “will I be able to have sex again?” after a spinal cord injury. It is very rewarding to see people make progress and return home but you also recognize that not everyone will. There are multiple factors at work including psychological or cognitive barriers, severity of disease, amount of support available to the person, home set up. This setting is where I first questioned whether I did enough to help them or not but that is where talking with other therapists helps and trying to keep up on the latest research. Therapists will frequently share their experiences and cases with each other to help brainstorm ideas or make changes to plans of care.*Home Care: Therapists make home visits and in the U.S. it is typically 1–3 times a week. There are challenges with home visits that include you are required to drive and bring your equipment with you. You are also limited by the space available in a persons home for what you can do to work toward reaching the patient’s goals. Typically home care is recommended after a hospital discharge or rehab discharge as a way to continue to make improvements. Many of the home therapists I have talked to state that they will end up taking their notes home with them to finish. There is some flexibility to your schedule and most home therapists create their own schedules.*Outpatient: Your schedule in outpatient is typically determined a week or two before as people have to agree to come in at that time. While some may try to schedule a month out the schedule can always change and people might call the day before or day of and if you have an opening due to a cancellation it becomes filled. You will typically have some evaluations every day for initial visits to assess and determine what is wrong and what the plan of care is.*School based pediatric: Some therapists work in a school setting with children and will see the children either one on one or in a classroom or group setting depending on the goals.There is also Long-term acute care setting which is a step down from the hospital for people who require increased medical care that can not be provided at a rehab but there is not a reason to remain at the hospital they are currently at. Therapy is typically provided at these settings but is similar to a rehab setting in how therapy is set up. Skilled nursing facilities are similar to sub-acute settings as far as how it is run on the therapy side and will frequently have long-term setting with a sub-acute section.Part of therapy no matter what setting you are in involves paperwork. It is the part I dislike the most (probably because it involves sitting still) but also the most important. My teachers in school used to state that if you don’t write it down it did not happen. The documentation is very important as you need to be able to state why you are needed, what you are doing and show whether there is progress. In some settings you are required to send paperwork to the doctors for signatures or send for insurance authorizations. You also have to complete billing as it is important if you want a paycheck and the clinic needs money to be able to stay open. To see a patient you typically have a script from a physician/nurse practitioner/physician assistant however some states in the U.S. now have direct access. With direct access patients are allowed to come to an outpatient clinic without a script to be evaluated. Each state has their own rules as to whether therapists have direct access and to what extent.Therapists are typically good advocates for patients and will voice to doctors, social workers, insurance companies, etc what they feel they need. We make phone calls or send emails to physicians/nurse practitioners/physician assistants regarding change in status or regarding needs of the patient. We contact insurance companies to fight a denial. A challenging aspect for allowing a person to be as independent as possible is money… People may not be able to afford a wheelchair or walker or hospital bed, etc but insurance is not willing to pay for it or they do not have insurance. Sometimes there are resources available to refer them for help and sometimes not. Therapists have also been known to be creative to help the patient save money by coming up with another solution rather than something they are unable to afford. I met a therapist that would make a bed rail for $10 so patients wouldn’t have to go and buy one that costs $30 or more. Patients have also been known to come up with amazing ideas as well. I have had patients tell me that they liked doing the stepper and made themselves one to work on it at home. Another barrier we face is how many visits we are allowed. Insurance is looking for ways to remain cost effective and there are plans that require a $90 (US dollars) copay or only allowed 10 visits in a year. If a patient has a new head injury and has not recovered enough to return to work how do they cope? Often they cannot afford to pay out of pocket for therapy. Some people will put therapy on hold when it is the last few months of the year to wait for their benefits to start over. Money is a big barrier we face when providing care.People are all different in their beliefs, personalities and lifestyles which allows us to have amazing personalities to work with on a daily basis. Are some people challenging to us? Yes! But sometimes it is because we are having a bad day or the person is having difficulty coping with what is going on. You need an open mind. I have had many times where I have walked into a room to have someone yell at me that they do not want to get out of bed and that they hate therapy. Taking the time to talk with them and be open makes a huge difference. I had one patient tell me “I’m sorry” later in the session and explain that they had a bad morning due to pain at night and not sleeping. There is a learning curve to figuring out if you are wasting your time and the patient’s time by staying and trying to encourage them to participate. Not everyone will change their mind. It is a lot of fun when you get to joke with people. I have frequently told patients who are nervous (and can take a joke) that I won’t let them fall because there is too much paperwork involved if that happens. You learn what motivation is and how some people do not give up while others think their life is over. You can see 2 people with the same issue have different outcomes due to how much effort they apply.Continuing education is a requirement in the United States and some therapists pay for all of it while some receive money from their employer to cover some or all of the courses. Courses can range in cost from free to $20 or $100–$600 with some I’ve seen being over $1000 US dollars and courses can be a weekend, a week, a day or a couple of hours either self study or classroom setting. Some companies will even provide courses for their employees.It is difficult to get into what an evaluation or treatment would involve as it is different for each patient depending on setting, diagnosis and prognosis. You might be working with a patient with orthopedic issues, sports related issues, neurological issues, lymphedema management, pediatric, etc. There are also many different theories and methods for completing treatments and therapists even have the opportunity to specialize in an area if they are interested in doing so. You can become a therapist specialized in neurological disorders and can sub-specialize by focusing on Traumatic Brain Injuries or Vestibular or Spinal Cord Injuries for example. There are therapists who are sports specific and work in an outpatient clinic or with sports teams for schools, etc.The work can be challenging but the rewards of being able to help people reach their goals and return to their lives makes it worth it. I had an opportunity to watch an 82 year old man who had a stroke return to walking and eventually golfing. The excitement of having someone tell your their success stories when you see them such as “I was able to go to the bathroom by myself today” or “I walked 4 blocks today with my cane” can make your day change from bad to good as you celebrate with them. There are multiple factors involved in the success of a patient’s rehab from medical limitations, motivation, money or questioning whether you did enough but if I didn’t work as a physical therapist/physiotherapist I would not have had the opportunity to help make a difference in peoples lives and meet amazing people.

Exercise based recuperation helps individuals of any age who have ailments, ailments or wounds that point of confinement their ordinary capacity to move and capacity.A modified non-intrusive treatment program can assist people with coming back to their earlier degree of working, and support exercises and way of life changes that can help counteract further damage and improve by and large wellbeing and prosperity. Essential care specialists frequently allude patients to exercise based recuperation whenever there's any hint of an issue, since it is viewed as a traditionalist way to deal with overseeing issues. Thinking about what makes exercise based recuperation so significant? To pay tribute to Physical Therapy month in October, here are 10 different ways it might profit you:Diminish or dispose of agony. Restorative activities and manual treatment strategies, for example, joint and delicate tissue preparation or medicines, for example, ultrasound, taping or electrical incitement can help diminish torment and reestablish muscle and joint capacity to lessen torment. Such treatments can likewise keep torment from returning.Keep away from medical procedure. In the event that exercise based recuperation encourages you wipe out torment or mend from damage, medical procedure may not be required. What's more, regardless of whether medical procedure is required, you may profit by pre-medical procedure exercise based recuperation. On the off chance that you are going into a medical procedure more grounded and fit as a fiddle, you will recoup quicker a short time later as a rule. Likewise, by evading medical procedure, medicinal services costs are diminished.Improve versatility. In case you're experiencing difficulty standing, strolling or moving—regardless of your age—exercise based recuperation can help. Extending and fortifying activities help reestablish your capacity to move. Physical specialists can appropriately fit people with a stick, supports or some other assistive gadget, or evaluate for orthotic remedy. By tweaking an individual consideration plan, whatever action that is critical to a person's life can be polished and adjusted to guarantee maximal execution and wellbeing.Recuperate from a stroke. It's entirely expected to lose some level of capacity and development after stroke. Active recuperation fortifies debilitated portions of the body and improve stride and equalization. Physical specialists can likewise improve stroke patients' capacity to move and move around in bed with the goal that they can be increasingly autonomous around the home, and decrease their weight of care for toileting, washing, dressing and different exercises of every day living.Recoup from or avert games damage. Physical specialists see how various games can build your hazard for explicit sorts of wounds, (for example, stress breaks for separation sprinters). They can configuration proper recuperation or counteractive action practice programs for you to guarantee a protected come back to your game.Improve your equalization and avoid falls . At the point when you start exercise based recuperation, you will get screened for fall chance. In case you're at high hazard for falls, specialists will give practices that securely and cautiously challenge your parity as an approach to emulate genuine circumstances. Advisors likewise help you with activities to improve coordination and assistive gadgets to help with more secure strolling. At the point when the equalization issue is brought about by an issue in one's vestibular framework, Physical advisors can perform explicit moves that can rapidly reestablish legitimate vestibular working, and diminish and wipe out side effects of discombobulation or vertigo.Oversee diabetes and vascular conditions. As a major aspect of a general diabetes the executives plan, exercise can help viably control glucose. Furthermore, individuals with diabetes may have issues with sensation in their feet and legs. Physical specialists can help give and teach these patients on legitimate foot care to avoid further issues not far off.Oversee age-related issues . As people age, they may create joint pain or osteoporosis or need a joint substitution. Physical specialists are specialists in helping patients recoup from joint substitution, and oversee ligament or osteoporotic conditions moderately.Oversee heart and lung illness. While patients may finish cardiovascular restoration after a coronary episode or methodology, you likewise may get non-intrusive treatment if your day by day working is influenced. For aspiratory issues, non-intrusive treatment can improve personal satisfaction through reinforcing, molding and breathing activities, and assist patients with clearing liquid in the lungs.Deal with Women's Health and different conditions. Ladies have explicit wellbeing concerns, for example, with pregnancy and baby blues care. Physical advisors can offer particular the board of issues identified with ladies' wellbeing. Furthermore, PT can give specific treatment to: Bowel incontinence, bosom malignant growth, obstruction, fibromyalgia, lymphedema, male pelvic wellbeing, pelvic torment, and urinary incontinence.

There is a fairly consistent, albeit non-universal body of research documenting cognitive declines after cancer and its treatments. While few of these studies have included those 65 and older, it is logical to expect that older patients are at risk of cognitive decline.Cognitive functioning during treatmentVirtually all patients with gliomas and metastatic brain tumours cannot be cured from their disease. Therefore, palliation of symptoms and sustained or improved quality of life are considered as equally important treatment goals as prolonged survival and postponed tumour progression. Evaluation of treatment outcome in brain tumour patients should therefore focus beyond survival endpoints, and should also aim at avoiding adverse treatment effects on the normal brain to ensure optimal social and professional functioning. Research in this area during recent years has provided several important insights. As stated, numerous studies have demonstrated that the tumour itself can have a profound adverse impact on cognition. Resecting the tumour in a symptomatic patient may result in both deterioration and improvement of cognitive functioning.Learning and memory problemsMany cancer survivors have problems with learning and memory during and immediately after treatment. If you’ve received high doses of chemotherapy or radiation therapy to the brain, you have an increased risk for problems with memory and concentration. This includes survivors treated for cancers such as breast cancer, lung cancer, brain tumours, lymphoma or melanoma.When chemotherapy affects the way the brain functions this is sometimes called “chemo-brain.” High doses of radiation to the brain (cranial radiation) are more likely to result in long-term changes in mental or emotional functioning. High doses of radiation are needed to treat many brain tumours. Radiation to the brain given along with intrathecal chemotherapy can also increase the chance of cognitive changes.Nervous system changesSometimes cancer treatment (such as surgery or certain chemotherapy drugs) can cause nervous system damage or neuropathy. Symptoms of nervous system damage include:tingling, burning or numbness in your hands or feetsudden sharp painloss of balance, difficulty walking or clumsinessbeing more or less sensitive to heat and coldLymphedemaLymphedema is swelling that occurs usually in the arm, leg, face or neck from buildup of lymph fluid. Lymphedema is usually caused by either removal or damage of lymph nodes due to surgery or radiation therapy. You may be at risk of lymphedema if you have had surgery or radiation therapy for melanoma of the arms or legs, prostate cancer, cancer of the female or male reproductive organs or other cancers that have spread to the lower abdominal area.OsteoporosisCancer survivors are at risk for bone and joint problems, especially survivors of breast and prostate cancers. Osteoporosis is a common late effect of cancer treatment. Osteoporosis weakens the bones, causes them to become very fragile and break (fracture) more easily. Osteoporosis can exist for years without symptoms. Chemotherapy, steroids and hormone therapy can increase your risk of developing osteoporosis.Mouth and teeth problemsMany cancer survivors develop problems with their mouth or teeth. These problems, which may have begun during treatment, may last a long time before they eventually go away. In some cases, they are permanent. Sometimes, problems develop months or years after treatment has ended. Surgery or radiation therapy to the head or neck for head and neck cancers and certain types of chemotherapy can increase the risk of having mouth or teeth problems. Problems may include dry mouth, tooth decay, taste changes, sore mouth, difficulty swallowing or changes to the jaw bone (osteoradionecrosis or trismus).Vision changesVision changes can occur when radiation therapy to the head or neck damages the blood vessels of the eye or optic nerve. Vision changes most often occur long after radiation therapy is finished and are more likely to happen when high doses of radiation are given. Vision problems caused by radiation therapy include dry eyes, vision loss or cataracts. Steroid therapy can increase the risk of eye problems, such as cataracts.Changes in weightSome survivors may have problems with weight gain or weight loss. Certain types of chemotherapy, such as those used in breast cancer treatment, can cause weight gain and can increase the percentage of fat tissue while also causing a decrease in muscle mass. Some cancer survivors may lose weight and muscle tone because of a loss of appetite.Menopausal symptomsMenopause occurs naturally as women age, usually when a woman reaches her early 50s. Women treated for some types of cancer may experience early menopause as a side effect of certain cancer treatments such as chemotherapy, radiation therapy to the pelvis or surgery to remove the ovaries. This is known as treatment-induced menopause.Fertility problemsSome cancer treatments lead to fertility problems. Infertility (the inability to conceive a child) is only temporary for some survivors, but in other cases it can be permanent. Your age and whether or not you already have children can play a part in how you deal with the news of infertility. While all side effects are upsetting, this one can be devastating. You may feel a great sense of loss or grief, or be very angry, sad or anxious that cancer and its treatment caused these changes to your body.Digestive problemsChemotherapy, radiation therapy or surgery can cause problems with the digestive system. Digestive problems, such as constipation, diarrhea or nausea and vomiting can occur during treatment, but they can also be a long-term effect for cancer survivors. Some chronic digestive problems, such as constipation, can occur as a result of physical damage or can be a side effect of certain pain medicines used after treatment. Digestive problems can result in the body not being able to absorb nutrients as well.Bladder problemsBladder problems can happen after treatment for bladder, prostate, colorectal, ovarian or other cancers. This can include loss of bladder control or urinary incontinence. Bladder damage can occur from surgery, certain types of chemotherapy or radiation therapy to the pelvis.Bowel problemsBowel problems can happen after treatment for bladder, prostate, colorectal, ovarian or other cancers. Bowel damage can occur from surgery or radiation therapy to the pelvis.Heart (cardiac) problemsHeart problems can occur after treatment for cancer. Some common problems include inflammation of the heart muscle, congestive heart failure or heart disease. The main causes of heart problems in adult cancer survivors include radiation therapy to the chest or chemotherapy using anthracycline drugs like doxorubicin (Adriamycin), daunorubicin (Cerubidine) or cyclophosphamide (Cytoxan). People who received high-dose chemotherapy, both radiation therapy to the chest and chemotherapy or those aged 65 or older are at increased risk for heart problems after treatment.Lung problemsChemotherapy or radiation therapy to the chest may cause lung problems. Cancer survivors who received both chemotherapy and radiation therapy to the chest are at increased risk. Some chemotherapy drugs that increase the risk of lung problems include bleomycin (Blenoxane), carmustine, prednisone, dexamethason and methotrexate. Late effects include changes in lung function, thickening of the lining of the lungs, inflammation of the lungs or difficulty breathing.Second cancersUnfortunately, cancer survivors are at an increased risk of developing a second cancer. People at highest risk are those who have received both chemotherapy and radiation therapy.Second cancers may develop anytime after chemotherapy, sometimes 15 years or more after treatment has finished. The most common types of second cancers after chemotherapy are acute leukemia (the most common), non-Hodgkin lymphoma, bladder cancer and sarcoma.The most common second cancers that develop after radiation therapy are sarcomas of the bone and tissue, acute myelogenous leukemia, and some tumours like breast or bladder cancer. While a second cancer may develop several years after radiation treatment, most don’t occur until 10 to 20 years (or more) after exposure to radiation.