Guidelines for rehabilitation exercise after radiation therapy for head and neck cancer

This is an automatically translated article.

Physiotherapy plays an important role in rehabilitation for patients receiving radiation therapy for head and neck cancer. Physical therapy is very beneficial in helping to restore tissue, tissue flexibility, range of motion, strength, and postural control to restore function to all affected areas. of body.

1. Why is rehabilitation after radiation therapy necessary?

During radiation therapy, there is often tissue injury, as well as inflammation of the tissues. Local inflammation eventually leads to the formation of scar tissue, which can cause tissue damage and loss of skin mobility and flexibility in the irradiation field.
In the head and neck area, this can make it difficult to move the neck, face, and jaw. In the oral cavity, fibrosis interferes with opening, speaking, and swallowing. In the legs and lower body, this can lead to a variety of mobility difficulties, as well as functional difficulties with walking, running, balance, etc.

2. When is the best time to start physical therapy treatment?

The best time to start physical therapy is during the early stages of radiation therapy. This will help reduce local inflammation, and the more inflammation is reduced with physical therapy, the less scar tissue fibrosis will occur.
Physicians, physiotherapists should learn and interact with the radiation therapist's radiation program and arrange appropriate physical therapy so that the patient can meet both appointments in the most efficient and timely manner.

3. What is the goal of recovery during/after radiation therapy?

Has multiple purposes, including the following:
Promotes healing of skin and subcutaneous tissues Reduces scar tissue formation Minimizes pain, swelling, and inflammation Improves range of motion Maximizes limb mobility Maximize Function Rehabilitate Exercise, Hobbies, and Professional/Social Life

4. What is Physiotherapy?

Physiotherapy can be said to be a therapeutic activity that the patient actively participates in. It works best when the patient works alongside a physical therapist to help the patient recover. They will guide the patient with advice and information on what the patient can do to help themselves.

5. The role of the physiotherapist

The physical therapist's role is to assess the patient's needs, identify any problems that could be helped by physical therapy, and develop an individualized treatment plan for the patient.
Patients will usually be evaluated the day after radiation therapy, and will be reviewed as required until the patient leaves the hospital, or until physical therapy is no longer needed.

6. Physical therapy may include:

Breathing techniques Postural advice General mobility rehabilitation (moving around) Exercise, shoulders and jaw

7. Physiotherapy guidelines for head and neck radiotherapy patients

The following is an exercise guide for head and neck radiation therapy patients
Breathing technique Everyone's lungs produce phlegm as part of the body's natural compensatory system. After radiation therapy to the apex of the lung, this compensatory system slows down and sputum may accumulate. Long-term activities can also reduce the amount of air that can get into your lungs. Both of these can cause problems.
The patient's physical therapist will work with the patient to help reverse these changes. This may include a number of breathing exercises. The patient's physiotherapist will show the patient how to do these effectively.
Posture Help the patient be aware of their posture. Try not to 'drop' or sag. Try to sit and stand upright, with the patient's head, shoulders and upper back straight. When sitting, you can rest your arms on the pillow.

Exercises and shoulder exercises During radiation therapy, try to stay as active as the patient can, for example go for regular walks. This can help maintain a moderate level of exercise for the patient to pass the time of radiation therapy. If the patient feels tired, try to do a little and more often than many times at a time

8. After radiation therapy is complete, what exercises should I do?

Turn the head Turn the patient's head to look over one shoulder until the patient feels a muscle tension begin. Return to the middle position. Then he turned his head to the other shoulder. Repeat 5-10 times on each side, keeping the patient's shoulder from rotating.

Tilt the head Tilt the head to one side until the patient feels a stretch begin. Return to the center then lean to the other side. Repeat five to ten times on each side, keeping the patient's chin forward and the patient's shoulders still.

Looking up/looking down Gently bend the patient's head forward, lowering the chin to the chest. Return to the center and then gently lift your chin, tilting your head back. Stretch only as far as the patient feels comfortable - the patient only needs to feel the stretch begin to be satisfactory. Repeat 5 to 10 times.

Shrug and roll Shrink, try to move them with the same speed and time. Repeat 5 to 10 times. Then roll them forward/backward 5-10 times.

Shoulder Squeeze Squeeze the patient's shoulder pins together and hold for about five to ten seconds.

During the next three exercises (six, seven and eight), try to sit or stand up. If they feel uncomfortable, try having them lie down.
Take the arm out to the side Keeping the patient's elbow close to the waist, bring the hand out to the side, back, and repeat five times.

Forearm Raise Raise your arm forward, then continue up and overhead. Use the other hand to support the patient's arm if this is difficult, or the patient can slide your hand up the wall, using the wall to support your arm's weight. Lower and repeat 5 to 10 times.

Raise the Lead arm with your thumb, reaching your arm out to the side and along your head. If difficult, slide your hand up the wall or place your hand on the patient's shoulder and raise the patient's elbow to the side. Lower and repeat five to ten times.

Jaw opening exercise Jaw opening may be limited after head and neck radiotherapy (jaw constriction). This can lead to the problem of not opening the mouth enough to eat, speak, clean the mouth, or get an exam.
It's first important to know how much the patient's mouth can open - a good test of this is to see how many fingers the patient can hold between the front teeth or gums. Practice this every day until the patient's treatment is complete.
Then the patient can practice opening the mouth by sucking on a lemon (or any fruit) with increasing size.
In addition, some specialized mouthpieces can be used.

9. Additional things patients can try

Good nutrition: Good nutrition (eating healthy) is essential for a patient's wound to heal. This will help the patient return to his or her normal activities. Please follow the advice of a dietitian and any advice from speech therapists.
Avoid smoking: This will help the wound heal and can help avoid other problems, such as the cancer coming back. Ask the patient's healthcare provider if the patient would like assistance with smoking cessation.
During radiation therapy, nerves in the area may become stretched or inflamed. If this happens, the nerve also cannot send messages to the muscles. This can reduce movement, particularly in the face and shoulders, and can mean it takes longer to recover.

10. Management of neck lymphedema after radiation therapy

Lymphedema is a common chronic complication following head and neck radiation. The neck lymphedema management program should consider the following:
Reduce the risk of lymphedema Treat the lymphatic system in the early stages of recovery Manage lymphedema at the time of diagnosis Education on follow-up Lymphedema for Patients The lymphedema therapy program aims to initiate at the subclinical level of lymph node management, providing an opportunity for the lymphatic system and/or lymphedema status and Its symptoms will be greatly reduced if treatment is done at an early stage of onset.

11. What are the rehabilitation goals for patients with lymphedema?

Reduced risk - early transition to lymphedema Treat stage 0 and stage 1 of lymphedema when we can facilitate healing of injured systems to reduce risk of developing edema irreversible lymphatic vessels. Patient education, including the most important aspects of lymphatic management. Oncology Center - Vinmec Central Park International General Hospital gathers good experts in radiation therapy, chemotherapy and surgery, equipped with modern facilities. The center is modernly built according to international standards, using a multi-specialist approach in diagnosis and selection of appropriate treatment regimens for each patient, contributing to comprehensive patient care.
Vinmec Central Park Hospital can treat cancer with multimodal cancer treatment protocols suitable for each case, bringing high treatment efficiency, helping patients not have to go abroad for treatment.

In April & May 2021, when there is a need for examination and treatment of Head and Neck Cancer at Vinmec Central Park International General Hospital, customers will enjoy double incentives:
- Free specialist examination and 50% discount on many cancer screening packages
- 50% discount on costs for customers who have indicated treatment after examination. The program is limited to the corresponding technique of each hospital and to customers who perform this treatment technique for the first time at Vinmec.

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

References
Physiotherapy for patients recovering from head and neck surgery-Guy and St Thomas Hospital-London-England. Oncologyrehab.net.