Physiotherapy Management of Malignant Spinal Cord Compression

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Physiotherapy
Management of
Malignant Spinal Cord
Compression
Suzanne 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 assessed

Patients able to sit up gradually to 60
degrees over period of 3-4 hours
 Monitoring 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
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