Claudia, I think your strategy is justified. I would suggest that it's our
responsibility to promote tissue healing while optimizing function... This
feels like one of those oncology rehab-specific clinical decision making
moments where we understand that things are going to get worse before they
get better due to treatment effects. While a patient is actively undergoing
XRT, I usually limit manual interventions within the radiation field (as
you describe) and transition to AROM (to patient's tolerance) and think
about what I can do in adjacent regions (deep breathing to facilitate rib
cage expansion, pec lengthening if skin is less/not irritated there, scap
stabilization strengthening)... I may set a goal with the patient about
maintaining a certain ROM rather than pushing to get more during this phase.
I think it's also a great opportunity to educate the patient about what
they can expect including signs/symptoms of worsening skin irritation that
they can look for (so when they're stretching at home and inevitably
pushing themselves further than you might, they know when they're going too
far)... Educating them about how taking a step back in our therapy
intensity may be necessary to prevent 2 steps back if we cause worse skin
breakdown with aggressive STM/movement... we may be the first provider to
educate them on what's to come - not an easy conversation but important!
To Cheryl's question - I do tend to have a heavy hand but I would say my
rule of thumb is still to think about promoting tissue healing even in the
chronic stage. So if things get "hot" and stay hot after STM... maybe that
was too much. If you're getting results (greater soft tissue mobility, ROM,
less pain) without s/s of increased inflammation... maybe that's the sweet
spot! Different for each patient.
Steve
On Thu, Mar 3, 2022 at 2:08 PM Perry Ashley <dmarc-noreply@xxxxxxxxxxxxx>
wrote:
That's a good question. I have done a lot of research to try and find the
answer to this. I even sat down with a Rad Onc to have a discussion of
tissue properties, combed through his text books to see how the cellular
matrix is effected but didn't find a lot of concrete advice. I would be
interested to hear if anyone has a clear answer.
That being said, what I did find is the cellular matrix is essentially
dried out with high levels of cytokines for at least 3 months. I asked the
Physicist how long these elevated cytokine levels last and his exact words
" no one really knows. "
I usually err on the side of caution as to not cause more inflammation
furthering scar tissue in the long run, but it does kill me not to be able
to get in aggressively right away.
-----Original Message-----
From: aptaoncology-bounce@xxxxxxxxxxxxx [mailto:
aptaoncology-bounce@xxxxxxxxxxxxx] On Behalf Of Canaday, Cheryl A
Sent: Thursday, March 03, 2022 1:10 PM
To: APTAOncology@xxxxxxxxxxxxx
Subject: [aptaoncology] Re: Radiation and STM
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To add to that question, I would also like to know what is the best
practice for STM over radiated field after many years where there is
significant radiation fibrosis
Cheryl Canaday, PT, DPT, CLT-LANA
Physical Therapist, Certified Lymphedema Therapist
Baptist Health South Campus ǀ Rehabilitation Services
Phone: 904-271-6575 ǀ Fax: 904-271-6678 ǀ Cheryl.canaday@xxxxxxxxxx
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-----Original Message-----
From: aptaoncology-bounce@xxxxxxxxxxxxx [mailto:
aptaoncology-bounce@xxxxxxxxxxxxx] On Behalf Of claudia wiser
Sent: Thursday, March 3, 2022 1:04 PM
To: APTAOncology@xxxxxxxxxxxxx
Subject: [aptaoncology] Radiation and STM
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I received a call from a physiatrist yesterday who specializes in onc
rehab and he advised me that I should be doing more aggressive STM in a
patient’s axilla where he is currently receiving radiation. I typically go
hands off when skin starts to get pink, sooner if there are other factors
that concern me.
What is the current best practice for STM in the radiated field?
Thank you!
Claudia Wiser
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