Physiotherapy in palliative careâ - Stockholms sjukhem

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functioning. She also has pain in her neck and in the left shoulder. She is used to exercising andfeels that she has a hard time exercising as usual as her body does not obey her and shebecomes breathless very quickly. She has a wish to exercise but needs to get her exerciseprogram adapted to her new physical condition.Suggest the physiotherapeutic goal for the patient. What kind of exercises could be useful? Howcan she be helped with her lymph edema? What could be the reason for her pain? Is there aneed for more investigation of her pain? What kind of treatment for her pain would be useful totry?FinallyPhysiotherapeutic palliative care is by necessity focused on the body. For a person in the mostproblematic time of life, just before leaving life, it is painfully clear how important the body is.Movement is a symbol of life and maybe it is the most important time to move when one is nolonger able to, to feel that one is still alive and get confirmation that one still belongs to life.Today it is essential to have a rehabilitative approach as people live longer, but often withfunctions reduced due to treatment. Physiotherapists have - with their specific competence - atask to prevent, examine and treat functional barriers that limit or threaten to limit the humanmovement. By facilitating the patient to keep or improve functions or through technical aids theindependence and the quality of life of the patient can improve, in all stages of life.Please note that the physiotherapist’s symptom relief and activating treatments have very fewside effects!The exercises and physical activities that the physiotherapist offers resemble life when thepatient was still healthy. This gives the patients some breathing-space, pausing from thoughts ofillness and death - an important rest for the patient and a possibility to recuperate.Physiotherapists must always strive to base treatments on best available knowledge. Theexisting evidence for different physiotherapeutic treatment methods are in some areas notsufficient and in palliative care few studies have been carried out. This does not mean that thetreatment is useless but that there is a need for more research in this area.Physiotherapy in palliative care – a clinical handbook Ulla Frymark, Lilian Hallgren, Ann‐Charlotte Reisberg 32
Through increased knowledge about physiotherapy treatment methods for patients in the laststages of life we hope that this group of patients will receive a better quality of life.Last but not least we would like to thank our colleagues for valuable input during the time ofwriting this handbook. Ylva Dahlin, Ingrid Gulde, Pia Gunnarsson, Elisabeth Wahlberg, HelgaHirschfeld and Carina Persson.References(1) Vård i livets slutskede - Socialstyrelsens bedömning av utvecklingen i landsting ochkommuner, Socialstyrelsen artikelnr: 2006-103-8. sid 8(2) National cancer control programs: policies and managerial guidelines, 2nd ed Geneva.World Health Organisation 2002. Svensk översättning: Kenne-Sarenmalm E, Fürst CJ, StrangP, Ternestedt BM.(3) Strang P. Utveckling inom den svenska palliativa vården. Nordisk geriatrik nr 6, 2008.(4) Sand L. Existentiell challengers and coping in palliative cancer care. Experiences ofpatients and family members. Karolinska Institutet 2008.(5) Doyle D, Hanks G, Cherny N, Calman K. Oxford textbook of palliative medicine. Thirdedition 2004.(6) Bruera E, Higginson I, Ripamonti C, von Gunten C. Textbook of palliative medicine,Oxford university press inc USA 2006.(7) Kaasa S (red). Palliativ behandling och vård. Studentlitteratur 2001.Physiotherapy in palliative care – a clinical handbook Ulla Frymark, Lilian Hallgren, Ann‐Charlotte Reisberg 33
Page 4: ForewordPalliative care is good car
Page 9: Palliative rehabilitationPatients l
Page 12 and 13: Strong scientific evidenceModerate
Page 14 and 15: Depression can be hard to diagnose
Page 16 and 17: Compression of the vertebrae affect
Page 18 and 19: Physical weaknessDecreased muscle s
Page 20 and 21: PainPain is a common symptom with p
Page 22 and 23: Massage and relaxing techniquesMass
Page 24 and 25: There is not enough evidence to sug
Page 26 and 27: compression, manual lymphatic drain
Page 31: 3.A 64-year old woman living alone
Page 35 and 36: (20) Cramp F, Daniel J. Exercise fo
Page 37: (42) Billhult A, Bergbom I, Stener-

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Physiotherapy in palliative careâ - Stockholms sjukhem