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23 Cards in this Set

  • Front
  • Back
COMMON CHILDHOOD CANCERS

•___ 30%
•Brain tumors 22%
•Neuroblastoma 7%
•Wilms tumor 6%
•Bone cancers: osteosarcoma/ewings sarcoma 3%
•Hodgkins and non-hodgkins lymphoma
•Rhabdomyosarcoma
•Retinoblastoma
Leukemia
MEDICAL INTERVENTION

Chemotherapy
Radiation Therapy
Surgery
Transplant
-Stem Cell
-Bone ___
Marrow
COMMON CHEMOTHERAPEUTIC DRUGS

V___
C___
M___
D___
P___
D___

Can it be? Can it be ___
will E cayote went ___
Dexa, Doxo
Vincristine
Cisplatin
Methotrexate
Dexamethasone
Prednisone
Doxorubicin
CHEMOTHERAPY EFFECTS

Early Effects:

•Hair loss
•Pain
•Fatigue
•___ pain
•Paresthesias
•Peripheral ___
Bone

neuropathy
CHEMOTHERAPY EFFECTS

Late Effects:

•Bone pain
•Peripheral neuropathy
•___ loss
•Ataxia
•___ DTRs
•Myopathy
•Osteonecrosis
•Osteoporosis
Hearing

Decreased
RADIATION THERAPY EFFECTS

Early Effects:

•Skin redness
•Blistering
•Hair loss
•___
•Fatigue
•Cognitive Deficits
Fibrosis
RADIATION THERAPY EFFECTS

Late Effects

•Fibrosis
•Pathologic ___
•Bone Growth Abnormalities
•Osteonecrosis, osteoporosis
•___ necrosis
•Cardiac problems
•Htn
Fracture

Avascular
PHYSICAL THERAPY SYSTEMS REVIEW

Integumentary
•Bruising; skin temp/color/texture

Cardiovascular/ Pulmonary
•Respiratory rate; heart rate, exertion, fatigue

Neuromuscular
•Pain
•Sensation
•Antalgic gait
•Guarding
•Muscle tone –increased or decreased
•Paralysis
•Cognitive deficit
ok
SYSTEMS REVIEW

MUSCULOSKELETAL

Range of Motion
•Joint contracture or foot drop
•Goniometry
•Functional ROM

Strength
•MMT
•Dynamometer
•Functional ability
--PEDI

Postural alignment

QOL
•Pediatric Quality of Life Scale

Developmental Skills
•Standardized tests

Locomotion/ Gait
•Walking tests
•TUG
•Timed Up and Down Stairs

Balance
•Pediatric Balance Test
ok
PHYSICAL THERAPY ASSESSMENT

•Impairments
•Activity Limitation
•Participation
•Environmental/ Personal Factors
•QOL
ok
EXERCISE GUIDELINES

Monitor
•Vital signs
•Patient pallor
•Fatigue level
•Bruising
•Petechiae
•Patient report

Be aware of
•Medical Interventions –Lumbar puncture; bone marrow testing; chemo infusion
ok
EXERCISE GUIDELINES

NO EXERCISE IF:
•Platelet count < ___
•Hemoglobin < 8
•WBC < ___
< 20,000

< 5,000
EXERCISE GUIDELINES

LIGHT EXERCISE IF:
•Platelet count ___
•Hemoglobin ___
•WBC >5000
20,000-50,000

8-10
EXERCISE GUIDELINES

RESISTIVE EXERCISE IF:
•Platelet count > ___
•Hemoglobin >___
•WBC > 5000
> 50,000

>10
EXERCISE GUIDELINES

NORMAL VALUES:

•Platelets ___/ul

•Hemoglobin ___ G/100 ml

•WBC ___/mm
•Platelets 150,000-350,000/ul

•Hemoglobin 10-13 G/100 ml

•WBC 4500-11,000/mm
PATIENT
•3 y/o
•Presenting symptoms = excessive bruising; antalgic gait
•Diagnosed with ALL
•Chemotherapy protocol:
•Prednisone, Dexamethasone
•Vincristine
•Doxorubicin
•Methotrexate
•3 years
PHYSICAL PERFORMANCE
•Parents report patient c/o of pain when walking; previously age appropriate motor skills
•FACES scale: no pain at rest; 5 (>) with standing or assisted walking
•Asks parent for assist with all transfers; content to sit in play; does not try to keep up with siblings
•Note increased exertion with assisted transitions; note increased RR and paucity to perform
KNOWN RISKS OF RECENT CHEMOTHERAPY TREATMENT

Vincristine

•___ pain
•Weakness
•Parasthesias
•Peripheral neuropathy
•___ dysfunction
Leg

Motor
KNOWN RISKS OF RECENT CHEMOTHERAPY TREATMENT

Steroids

•Osteonecrosis
•Osteoporosis
•___ muscle weakness
•Growth ___
Proximal

suppression
KNOWN RISKS OF RECENT CHEMOTHERAPY TREATMENT

Doxorubicin

•Bone marrow ___
•___ toxicity
•Myocarditis
suppression

Cardio
KNOWN RISKS OF RECENT CHEMOTHERAPY TREATMENT

Methotrexate

•___
•Osteopenia
•Osteoporosis
•Bone fracture
•___ deficits
•Coordination impairments
Arthralgia

Visual spatial
IMPAIRMENTS
•Weakness
•Deconditioning
•Pain

Monitor for:
•Peripheral neuropathy, osteonecrosis, fx, visual perceptual deficits, coordination
impairment, SOB
ok
ACTIVITY AND PARTICIPATION LIMITATIONS
•Unable to move comfortably without assistance from parent/ caregiver
•Unable to play with siblings/ peers
•Unable to locomote independently
ok
PHYSICAL THERAPY PLAN OF CARE
•Goal –Patient will stand at table in play for 3 minutes without c/o of pain 2 out of 5 trials.
•Activity –supported standing at chest height table
•Motivation –stickers and paper; toys on table for play
•Feedback –hands on with verbal feedback
•Increase Challenge -?
•Decrease Challenge -?
ok