Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings such as hospice and palliative care centers where as part of a multidisciplinary team of care, they address the physical and functional dimensions of the patients’ suffering. Physiotherapy treatment methods like therapeutic exercise, electrical modalities, thermal modalities, actinotherapy, mechanical modalities, manual physical therapy and assistive devices are useful for a range of life-threatening and life-limiting conditions like cancer and cancer-associated conditions; HIV; neurodegenerative disorders like amyotrophic lateral sclerosis, multiple sclerosis; respiratory disorders like idiopathic pulmonary fibrosis; and altered mental states. The professional armamentarium is still expanding with inclusion of other miscellaneous techniques which were also proven to be effective in improving quality of life in these patients. Considering the scope of physiotherapy in India, and in palliative care, professionals in a multidisciplinary palliative care team need to understand and mutually involve toward policy changes to successfully implement physical therapeutic palliative care delivery.

Conditions We Treat:-

  • Cancer Pain Management
  •  Lymphedema Management
  •  Fitness Training

World Confederation for Physical Therapy (WCPT) defines Physical Therapy as; “… providing services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the life-span. Physiotherapy includes the provision of services in circumstances where movement and function are threatened by the process of ageing or that of injury or disease. Full and functional movement are at the heart of what it means to be healthy. Physiotherapy is concerned with identifying and maximizing movement potential, within the spheres of promotion, prevention, treatment and rehabilitation. Physiotherapy involves the interaction between physiotherapist, patients or clients, families and care givers, in a process of assessing movement potential and in establishing agreed upon goals and objectives using knowledge and skills unique to physiotherapists”

Physical therapists practice in a broad range of inpatient, outpatient, and community-based settings, including the following:

  • Hospitals (eg, critical care, intensive care, acute care, and subacute care settings)

  • Outpatient clinics or offices

  • Rehabilitation facilities

  • Skilled nursing, extended care, or subacute facilities

  • Homes

  • Education or research centers

  • Schools and playgrounds (preschool, primary, and secondary)

  • Hospices or palliative care centers

  • Corporate or industrial health centers

  • Industrial, workplace, or other occupational environments

  • Athletic facilities (collegiate, amateur, and professional)

  • Fitness centers and sports training facilities.

PHYSICAL THERAPY TECHNIQUES

Therapeutic exercise

It comprises passive movement, assisted active movement, active movement, assisted-resisted active movement, and resisted movement techniques. The techniques can be applied in anatomical planes or as functional movement direction. The techniques can be performed on land or in water. The latter is termed as “hydrotherapy”. Best examples of therapeutic exercise techniques are relaxation, massage, suspension therapy, muscle- re-education, progressive resisted exercise, floor aerobics, active mobility exercises, mobilization and stabilization exercise, proprioceptive neuromuscular facilitation (facilitation and inhibition techniques); breathing exercise; postural training; work simulation, work conditioning and work hardening; graded activity program and cognitive-behavioral training. Exercises are useful for reconditioning and physical fitness.

Electrical modalities

Low-frequency modalities like neuromuscular electrical stimulation (both galvanic and faradic) and functional electrical stimulation, iontophoresis, high-voltage pulsed galvanic current, transcutaneous electrical nerve stimulation (TENS) and diadynamic currents; medium frequency modalities like Russian currents and Interferential therapy. High frequency modalities are usually grouped under deep-heating modalities under thermal modalities. Electrical modalities are very useful adjuncts in pain management.

Thermal modalities

Cryotherapy (ice massage, cold pack, cold bath, vapocoolant spray); superficial heating agents (fluidotherapy, hot pack, infrared radiation, paraffin wax; and contrast baths. Deep heating agents (diathermy- shortwave and microwave, ultrasound and phonophoresis); hydrotherapy (whirlpool and contrast bath). Thermal modalities are effective adjuncts to exercise and/or electrical modalities.

Mechanical modalities

Traction therapy, compression therapy, therapeutic taping and continuous passive motion. Compression therapy can be very useful in managing lymphedema.

EVIDENCE FOR PHYSICAL THERAPY IN PALLIATIVE CARE

Need for physical therapy in palliative care

Physiotherapy aims to: maintain optimum respiratory function; maintain optimum circulatory function; prevent muscle atrophy; prevent muscle shortening; prevent joint contractures; influence pain control; optimize independence and function; and, education and participation of the carer.

Palliative physical therapy in patients with cancer

Physical therapists have a very important role to play in holistic care of patients diagnosed with cancer as stated by Flomenhoft and Rashleigh. Rashleigh listed the therapeutic strategies employed by physical therapists in palliative oncology as ambulation and musculoskeletal therapy; neurological therapy; respiratory therapy; electrophysical agents; mechanical therapy; decongestive physiotherapy; and, education. Santiago-Palma and Payne listed treatments used by physical therapists on cancer patients are therapeutic massage, therapeutic heat, therapeutic Cold, patient education- advice on activity modification, range of motion and strengthening exercise, training ambulation using assistive devices, environmental modification, energy conservation and work simplification techniques. Twycross mentioned that physical treatment methods like massage, heat pads and TENS are useful for pain management in cancer patients.

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