Comprehensive physical therapy management of chemotherapy-induced peripheral neuropathy PDF Download

Author: Michael C. Sanders
Publisher:
ISBN:
Category :
Languages : en
Pages : 29

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Book Description
BACKGROUND AND PURPOSE: As survival rates increase among individuals diagnosed with cancer, secondary issues arise post-treatment such as cancer-related fatigue, lymphedema, genitourinary dysfunction, pain and peripheral neuropathies, mainly chemotherapy-induced peripheral neuropathy (CIPN). CIPN typically presents with primarily sensory-related deficits including numbness, tingling, and pain. Studies have shown that the negative consequences of CIPN can be quite significant and result in a marked decrease in quality of life, functional abilities, ambulation and an increase in fall risk. The purpose of this case report is to describe the comprehensive physical therapy management of a patient diagnosed with CIPN following bilateral mastectomy with left axillary lymph node resection and chemotherapy with taxane agents, completed six months prior to physical therapy evaluation. CASE DESCRIPTION: The patient was a 52 year old Caucasian female who was referred to physical therapy for management of CIPN associated pain, balance and functional deficits. The patient reported numbness, tingling, and pain in bilateral feet, rating pain at a 4/10 at rest and 7/10 with increased activity. Patient reported occasional dizziness when fatigued and a decline in balance during ADL-related task and positional changes especially notable in low light situations. Sensory organization testing (SOT) on the NeuroCom system revealed deficits in conditions #5 and #6 with a composite score of 68; 3% below age norms. Patient reported difficulty with stairs, floor transfers and relied on upper extremities for balance with sit to stand transfers. She was unable to complete her custodial job due to deficits. Interventions included a trial of TENS and a referral for Calmare pain therapy or ?scrambler therapy?, manual lymph drainage and compression garments for lymphedema management, and dynamic balance activities including the use of unstable surfaces, narrow base of support conditions, eyes open/eyes closed conditions, and incorporation of head turns with functional activities. OUTCOMES: The patient requested to be discharged on her 9th physical therapy session stating that she felt she had made significant progress in both her balance, restoration of functional abilities and reduction of bilateral foot pain which she rated 3-4/10 with activity. Patient reported being pain free for 24-36 hours after ?Scrambler Therapy?. Furthermore, the patient cited no dizziness or perception of instability in low light settings or during positional changes. The patient also demonstrated improvements from 37-71 on the vestibular component. She was also able to return to work. DISCUSSION: This patient progressed well throughout physical therapy and presented with findings that warrant further research. Specifically, this report agrees with a study by Wampler et al reporting that postural instability in breast cancer survivors was likely due to the patients’ inability to appropriately use their vestibular input. Although no studies report vestibular toxicity following taxane use there has been research suggesting a vestibular component to those patients post-chemo treatment who presented with postural instability. Finally, the few studies published regarding the efficacy of ?Scrambler? therapy in patients with CIPN have shown promising results. The patient in this case report benefitted from the use of this pain modality.