Physiotherapy Management of Malignant Spinal Cord CompressionSuzanne Hodson

Senior Physiotherapist at WPH

October 2013

Aims

National Cancer Rehab Care pathway for MSCC recommends referrals to Physiotherapy within 24 hours of patient’s admission

Aim to maintain patients at their optimum level of functional independence to enable maximum quality of life

Bed Rest or Mobilisation

Previous practice during radiotherapy for MSCC was flat bed rest

Now once diagnosis has been made and spinal stability assessedPatients able to sit up gradually to 60

degrees over period of 3-4 hoursMonitoring symptoms

If they walked in safely they are able to continue mobilising

If the spine is unstable

Refer to physiotherapy for bed rest exercises

Refer to orthotics for a spinal brace/collar Brace/collar to be fitted by orthotics prior to

commencing mobilisation Sit up slowly in bed to 60 over 4 hrs If tolerated without any deterioration in pain

or neurology Progress with rehabilitation & mobilisation

as able

If the spine is stable

Refer to the physiotherapists Slowly sit the patient up to 60 over 4 hrs If tolerated & no deterioration in pain or

neurology Patient can start to mobilise, if able If unable to mobilise await physiotherapy

assessment for rehabilitation

Physio - Assessment

Muscle strength Neurological deficits Respiratory assessment Co-morbidities e.g. COPD, arthritis Clarification of pt’s understanding of

diagnosis Setting realistic expectations

Setting Realistic Expectations

Level of therapy in-put at WPH & afterwards

Functional Ability Improvements in Ability Functional Outcome Prognosis

Rehabilitation of MSCC Patients Physiotherapy rehabilitation starts as soon

as MSCC is diagnosed Bed rest exercises or mobilisation

Patients sit up or starting rehabilitation & mobilisation while they are in hospital for radiotherapy

To clarify what patients are able to do the Consultants at WPH have agreed a system where all patients are suitable for rehabilitation unless documented otherwise

Summary

Early referral to physiotherapists Rehabilitation can start even if unable to get

out of bed Monitor symptoms as patients start to sit up Patients can do as much as their symptoms

allow them to Realistic expectations