Rehabilitation in Palliative Care. Sandy Ayre, OT Alyssa Sherwin, PT

Transcription

1 Rehabilitation in Palliative Care Sandy Ayre, OT Alyssa Sherwin, PT

2 Occupational Therapy Physical Therapy

3 Objectives To enhance the awareness of the benefits of rehabilitation in the palliative population To illustrate the delicate balance of the duality faced by palliative patients who are concurrently living and dying Through the use of a case study, explore the practical implementation of potential rehabilitation interventions.

4 Meet Frank

5

6 Movement is a symbol of life and maybe it is the most important time to move when one is no longer able to, to feel that one is still alive and get confirmation that one still belongs to life.

7 The TPCU

8 The Palliative Course

9 k

10 Back to Frank

11 Complex symptoms Pain Edema Decreasing function Pathological fractures Drowsiness Confusion Depression Decreased appetite ESAS MMSE ECS-CP PPS

12 E S A S

13 M M S e

14 E C S - C p

15 P P s

16 P D q

17 Opioid Toxicity Myoclonus Confusion Apnea Disorganized thinking Drowsiness Hallucinations Vivid dreams

18

19

20 Affirm Life Prepare for Death

21 Goals are centered around Quality of Life within the context of the patients environment and social situation.

22 Mobility

23 Seating

24 Comfort

25 Edema

26 Functional Independence

27 Other factors to consider: anorexia cachexia sarcopenia

28 Swallowing

29 Transition of Focus Supporting the Decline

30 Reassessment of Goals relevant meaningful Clientcentered GOALS

31 New plan

32 Changing the Focus

33

34 What staff are saying: Doing transfers with PT provides me with increased confidence to move the patient in the future I like care plans for movement and exercise sheets to give to patients who are seeking independence as this gives them hope I love the philosophy that mobilization adds to quality of life even for dying patients. It helps increase control and autonomy OT and PT provide interventions that help patients foster connection with themselves and others and what they value OT has skills in deep breathing and relaxation that have assisted patients with coping with pain, anxiety and grief (when they identify these practices as meaningful) Making small gains gives patients something to celebrate and the whole team celebrates with them. Gives patients a sense of accomplishment as we all recognize their achievement or even the effort they have exerted towards their goal

35 What patients are saying: I had very good experiences with the OT and PT. they were very willing to help me to live as independently as I can without being pushy. They were very observant as to my wants and needs. They were very good at giving me hope for the future. The OT and PT have been so helpful to me. They realized my potential and started me at the proper level. I am very impressed with my progress. They are also very flexible with their time. I want to thank you so very much for helping my mom make those beautiful legacy bracelets for my sister and I. I know that meant just as much to my mom as it did to us. I will truly treasure it the bracelet and the words. I feel at a loss as to how to thank all of the staff on this ward for the truly compassionate care we received.

36 References Initial perceptions of palliative care: an exploratory qualitative study of patients with advanced cancer and their family caregivers. Palliative Medicine Mar 01. (epub ahead of print) Anna Collins, Sue-Anne McLachlan, Jennifer Philip World Health Organization. (2016). Cancer: WHO Definition of palliative care. Retrieved from Bye, Rosalind. (1998). When Clients are Dying: Occupational Therapists Perspectives. The Occupational Therapy Journal of Research; Winter 1998; 18(1). Frymark U, Hallgren L, Reisberg A. (2009). Physiotherapy in Palliative Care A Clinical Handbook. Page 32. American Occupational Therapy Association. (2016). The role of occupational therapy in end-oflife care. American Journal of Occupational Therapy, 70(Suppl.2), Other resources: Canadian Virtual Hospice, mygrief.ca, LEAP, Practice Wise Occupational Therapy and Palliative Oncology: