The Role of the Physiotherapist
The Physiotherapist on the Head and Neck Unit works closely with the Nurses, Doctors and other members of the multi-disciplinary team (MDT) to provide holistic care for the patient.
The role of the Physiotherapist is to assess each individual to identify their problems and to establish aims of treatment, thus devising an individual treatment plan.
Pre-Operative Assessment
The majority of patients undergoing surgery for oral cancer will be assessed by the Physiotherapist prior to their operation in the MDT Pre-treatment clinic. This is in order to establish a good relationship with the patient and also to discuss post-operative treatment plans. During this assessment the Physiotherapist will normally examine your chest, your neck and shoulder movements, and also your general mobility levels. This is also a time for the patient to ask the Physiotherapist any questions you may have about your post-operative recovery.
Post-Operative Assessment
All patients will be assessed the day after their operation, whether that is on the Critical Care Unit or on the ward, and will be treated daily until the patient is either discharged or no longer needs Physiotherapy input. The treatment given will comprise of chest clearance exercises, neck and shoulder exercises, donor flap site exercises and general mobility rehabilitation.
1. Chest Clearance Exercises
Many patients undergoing surgery for oral cancer will require a temporary breathing tube (tracheostomy) to help with their breathing. Whilst this tube is in place, and also when removed, patients will be taught breathing exercises in order to clear any excess secretions off their chest. The Physiotherapist will work closely with the doctors to ensure the tracheostomy is removed at the most appropriate time. Patients will also be taught techniques on how to effectively cough and clear secretions through their tracheostomy tube, and advice on how to use additional suction to clear secretions.
Maintaining a clear chest is very important in the first few days following surgery so patients will be expected to continue with their breathing exercises on a regular basis during the day.
2. Neck and Shoulder Exercises
As a long neck incision is often made during surgery patients will need advice on exercises to ensure a maximum recovery of their neck and shoulder movements. All patients' neck and shoulder movements will be assessed to establish any weaknesses that may be present and therefore to plan what specific exercises should be carried out. In some cases weaknesses may persist until the day of discharge from hospital therefore further out-patient Physiotherapy may be arranged at your local hospital. Exercise and advice sheets will be given to all patients so they are able to follow the specific exercises taught.
3. Donor Flap Site Exercises
In the majority of patients an area of tissue or bone may be used to reconstruct the inside of your mouth where the cancer was removed. Common flap sites include the back of the forearm (radial forearm free flap), the shoulder blade (scapula), the rim of your pelvis (DCIA), and the fibula bone in the lower leg. Whatever flap site is used this will need to be exercised, again to restore all the movements you had prior to surgery. Specific exercise sheets will be given to each patient depending on what flap site is used, so that the patient can continue with their exercises when the Physiotherapist is not present.
4. Mobility Rehabilitation
Most patients will want to get back onto their feet as soon as possible, and as Physiotherapists we agree with that too. After your operation you will be encouraged to sit out in a chair, often on the second day after your operation. From here the Physiotherapist will be able to progress your mobility daily, which may initially require the use of zimmer frames or walking sticks, until you reach a stage were you are able to walk safely by yourself. Prior to discharge you may also require a 'stair assessment' to ensure that you are both safe and confident mobilising up and down stairs when you return home.
Finally...
During your hospital stay your Physiotherapist will be working closely with all team members on the ward to ensure that we are all working towards the same goals for you, the patient.
Physiotherapist Details:
Ruth Price Specialist Head and Neck Oncology Physiotherapist