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Curtin School of Occupational Therapy and Social Work
OT 242/ OT 542
Physical Rehabilitation:
Pallative Care and OT
John Harmsen with thanks to Sharon Keesing
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COMMONWEALTH OF AUSTRALIA

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Curtin University is a trademark of Curtin University of Technology
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Lecture Unit Outcome
Unit Outcome 1 (from your unit outline)


Assess the impact of known conditions on
occupational performance, CLO1, T4.

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Dr Seuss for today from Did I ever tell you
how lucky you are

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Common condition for OTs working in
pallative care
Cancer
Disordered and uncontrolled growth of cells within an
organ or tissue.

Left untreated, they grow steadily and result in a mass,
tumour

Benign or malignant
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What is cancer?
Malignant cells proliferate and sometimes spread to other
sites in the body (metastases)

May be treated and cured or progress to palliation
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Types
Classified according to the tissues and cells where they
originate


Haematological cancers


Oncological cancers

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Haematological cancers
Leukaemia

Lymphoma

Myeloma

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Oncological cancers
Lung
Breast
Gastrointestinal
- bowel
- stomach
- liver
Prostate

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Oncological cancers
Skin
- basal cell carcinoma
- squamous cell carcinoma
- melanoma
Gynaecological
Urinary
Brain
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Oncological cancers
Testicular

Head and neck

Soft tissue, bone

Cancers from an unknown primary
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Signs and symptoms
Many and varied


Silent
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10 most commonly diagnosed cancers

Australian Institute of Health and Welfare, 2011
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Treatment and side effects
Surgery
Radiotherapy
Chemotherapy
Hormone therapy
Steroids
Bone marrow transplant
Stem cell transplant
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Treatment and side effects
Allied health

Alternative therapies

Complementary therapies

Supportive care
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OT role
Enable the person to participate in
meaningful occupation and chosen
roles regardless of prognosis.


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Rehabilitation Stages (Dietz,1981)

Preventative anticipation of potential disability to
lessen severity
Restorative return to pre-morbid status without
significant handicap
Supportive support through decline of progressive
but stabilised disease to remain as functional as
possible & retaining an element of choice & control
Palliative assist in symptom control & in advanced
stages preventing complications through positioning,
pressure care & prevention of contractures.
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Not restoration to a former condition & status but a
recomposition of life using the OT process to help to
build the clients life to a manageable level
(Unknown Author and Source)
30.07.2010 Footer text - slideshow title
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Assessment
Consider the context
COPM
MBI, FIM
Specialised sensory/motor screening
Cognitive screening
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Interventions




Person Environment Occupation
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Occupation

How can I assist the person to carry out their chosen
activities within the limits of their illness?

How might this change over time/progression of
illness/treatment?
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Functional Issues
Self maintenance impaired independence in ADLs
Productivity loss of role/ personal satisfaction
Leisure Participation
Sensory skills pressure problems, pain, shortness of
breath, balance, co-ordination & safety
Cognitive memory, concentration, problem solving,
coping
Inter-personal - communication / relationships
Intra-personal Anxiety, depression, denial
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Fatigue
A persistent, subjective sense
of tiredness related to cancer
that or cancer treatment that interferes with usual
functioning
(Mock, et al 2004)
One of the most prevalent symptoms reported by people
with cancer

One of the most common side effects of chemotherapy


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Management strategies
Medical review
Self monitoring
Energy conservation
Distraction
Stress management
Exercise
Nutrition
Sleep
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Management strategies
Budgeting energy
(deposits V withdrawals)
Activity records
Prioritise
Plan
Positioning
Pacing
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Lymphoedema
www.jacksonvillelymphcl
inic.com
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Management strategies
pain and swelling, infection

ROM

strain and muscles and joints

function

Education

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Management strategies
Compression garments

Self management strategies

Complex lymphatic bandaging
-massage
bandaging


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Stress and Anxiety
Normal sensation and response

Only a problem when it interferes with our
ability to function on a day to day basis

For people with cancer,
anxiety is a real threat (terminal illness)


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Management strategies
Many and varied

Relaxation techniques

Problem solving strategies

Distraction (occupation?)

Cognitive approaches


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Pressure care and comfort
Pain and other symptoms will impact person

Positioning, transfers, mobility, ADL/IADL, leisure,
productive roles

Provision of equipment and environmental modifications
Occupation
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Palliative care
Prognosis and illness trajectories

Access and referral

A good death

Carers
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Role of carers
Impact on lives of carers, may experience their own
occupational disruption

Value of contributions largely unrecognised

Significant part of rehab process





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Support and Resources
Cancer Council (Australia)
- Breast Cancer support
- Prostate Cancer support

Health Department
- WA Cancer and palliative care network

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Taking care of yourself
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Acknowledgements
Kellie Blyth, Senior Occupational Therapist
SCGH
Hilary Palladino, Senior Occupational Therapist, SCGH
Sharon Keesing, Curtin University School of OT and SW
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Resources
http://www.dyingmatters.org/

http://www.cancer.org.au/home.htm

http://www.palliativecare.org.au/


Curtin University is a trademark of Curtin University of Technology
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References
Australian Institute of Health and Welfare (2011) . The 10 most commonly
diagnosed cancers in Australia, 2007; The 10 most common causes of death
from cancer in Australia, 2007 Retrieved from: http://www.aihw.gov.au/cancer/
Dietz, J. H. (1981). Rehabilitation Oncology. New York: John Wiley
Mock, V (2003). Cancer related fatigue. In Evidence based cancer care and
prevention. Given, C, Given, B, champion, V, Kozachik, S & DeVoss, D. (Eds).
New York, Springer.