Dear Emily- you shall enjoy treating this patient!! The biggest issues are ,
of course, to obtain a complete medical history esp. of his CA treatment! The
types of impairments that can be seen in this population are many:
1. C-spine limitations due to pain and myofascial restrictions from
scarring AND radiation
2. TMJ issues (see above!)
3. Postural issues
4. Spinal Accessory Nerve Palsy (SANP) if neck dissection surgery
5. Lymphedema
6. Swallowing and Speech issues
7. Cancer Related Fatigue
Be careful of recently irradiated skin- it should be treated with great
respect- as non-intact skin if redness still apparent and gently thereafter.
Patients have been known to develop tissue adherence to the jugular and carotid
when irradiated and can be at risk for ‘blow out’ so using multiplanar
flexibility exs rather than deep tissue work has always been my preference.
I truly believe that a key to working in this population is teaching that
radiation is a ‘gift that keeps on giving’- radiation fibrosis can actually
progress for multiple YEARS post treatment and a regular, pared down, FOCUSED
self care plan is my primary goal in this population. When the redness fades
post radiation, the fibrosis is only beginning.
Re: trismus exs: Pauli, N et al Exercise intervention for the treatment of
trismus in head and neck cancer Acta Oncologica, 2014; 53: 502–509.
Hope this helps. We see A LOT of Head and Neck Cancer patients at Penn. Reach
out to me directly for additional questions if you have any!
Cheers, Joy C Cohn PT, CLT
From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> On
Behalf Of Emily Vierow
Sent: Thursday, July 14, 2022 5:01 PM
To: APTAOncology@xxxxxxxxxxxxx
Subject: [External] [aptaoncology] Head and Neck Cancer Eval
Good Afternoon,
I have an evaluation tomorrow for a 51 yo make with tonsil cancer who’s
referral is for neck tightness and trisimus. I have never done an evaluation
for this and would love some feedback or things to consider for this! Let me
know, thanks!
Emily Vierow PT, DPT
