It is not unusual for an orthopedic physician to order “Pre rehab” prior to a surgical procedure. Given its success, there is now consideration for “pre rehab” for patients facing other medical treatments.
Unlike rehabilitation, which typically follows a surgical or medical procedure, pre-habilitation happens beforehand. For cancer patients facing chemotherapy, radiation, or surgery, pre-habilitation may dramatically improve the speed and effectiveness post intervention.
A number of cancer patients have physical restrictions because they haven’t felt or haven’t moved their body very much; therapy can help loosen them up and prepare them for treatment. Jamie Baker, INTEGRIS Baptist Regional Health Center Director of Rehabilitation and Physical Therapy, says “Physical therapy or occupational therapy, where we work the joints and the muscles, can stretch the muscles, the tissues, the tendons and prepare them for cancer type treatment.
Specialists at the Stephenson Cancer Center in Oklahoma City are strong believers in the difference pre-habilitation can make. Sam De La Rosa, 65, was referred there with multiple myeloma, a cancer that affects the plasma in the blood which weakens the bones. At the start of pre-habilitation, Mr. De Rosa reported that “I had problems with my muscles in my calves and I couldn’t really stand up and walk a distance, I walked a little bit, but I had to hold on to the counter, whatever I could hold on to, to be able to walk.” Part of the issue was neuropathy in De La Rosa’s feet which were both diabetic and chemotherapy-induced. De La Rosa was also weak, so weak that he was not considered a good candidate for stem cell transplantation, his best chance at beating his cancer. “When Sam first came in, he was in a wheelchair, he was walking some with a walker and he was pretty down,” said Vicky Davidson, a physical therapist at Stephenson.
Jamie Baker said that individuals who are diagnosed with cancer may feel like giving up and lay in bed, which is the worst thing that can be done to the body. “Non-activity is one of the worst things they can do with their body,” she said. “Getting up, doing functional stretching and activities is more of a holistic type medicine for the body. It does wonders.” So the first thing that was done to lift De La Rosa’s spirits was to get him to set goals. De La Rosa had two goals for his pre-habilitation. He wanted to get strong enough to have his stem cell transplant and also to take a family vacation at the beach. “Anything we asked of him, he was willing to try,” Davidson said. “He just kept getting stronger and stronger. It’s the kind of improvement that really helps patients in their fight against cancer.”
It was only a matter of weeks for De La Rosa to show dramatic improvement. The wheelchair or walker was no longer needed. De La Rosa was able to walk on his own with just a cane for reassurance. He even took that family vacation he wished for. Upon his return, he got back to work in pre-habilitation to gain more strength in preparation for his stem cell transplant. “You need to have someone support you and be behind you,” De La Rosa said with a smile.” If you don’t have those people to help you get stronger, you’re just going to give up, and I’m not a quitter.”
Other programs are recognizing the importance of preparing patients for surgery with intensive PT or OT sessions. “The idea is that you are going to go into a surgery or a chemotherapy treatment and you are going to get hit a little bit functionally,” said Elizabeth Hile, director of the Cancer Rehabilitation Science Program and assistant professor at the OU College of Allied Health. “So we work to help build you up beforehand. If you go in as strong as possible, you are likely to have a better outcome. It’s about building your functional reserve or having your glass as full as it can be going in. The healthier we can keep people, the stronger we can keep people, the more mobile we can keep people,” Hile said. “It just improves their quality of life and it also can improve their cancer outcomes, ultimately.”
De La Rosa is now so much stronger and mobile that he is now ready for a stem cell transplant. “The body thrives on movement, which brings blood flow and that helps nourish the body, so that’s the key to physical therapy,” Baker said. Physical therapy works so hard on improving your motion and strength that it can make you a much strong candidate for intensive surgery and improve post-surgical recovery as well.
Therapists at the Stephenson Cancer Center plan to conduct research soon to determine if as little as three weeks of pre-habilitation prior to surgery or chemotherapy can make a difference in outcomes for cancer patients. If you work if in a research-oriented cancer program, discussing the benefits of pre-habilitation with your PT and OT colleagues and superiors may help your patients that like Mr. De La Rosa. Cancer surgeries and treatments are often so debilitating that pre-habilitation can dramatically improve their recovery.
Robert Hoyt, Ph.D.
Allied Health Professionals LLC