APTA Oncology Section Offers Course on Breast Cancer

The APTA Oncology Section will host “Breast Cancer Rehabilitation,” presented by Barbara E. Nicholson, PT, MSPT, CLT-LANA, October 1-2, 2011 at Kadlec Medical Center, Richland, Wash. The course is open to PTs, PTAs, OTs and OTAs who are interested in working with patients who have breast cancer or are already working with this population because of shoulder dysfunction.

Attendees will receive 1.6 CEUs, 16 contact hours, for attendance. Registration closes Sept. 9, 2011 and costs $475 for section members, $525 for other APTA members and $600 for nonmembers.

Here are some thoughts from Nicholson on how PTs can help improve the lives of breast cancer survivors.

Physical Therapists Help Improve the Lives of Breast Cancer Survivors

Barbara E. Nicholson, PT, MSPT, CLT-LANA

There are 2.6 million breast cancer survivors in the United States.[1] These courageous women are mothers, friends, sisters, wives, partners, daughters and grandmothers.  They will see surgeons, oncologists, radiation oncologists, nurses, social workers, integrative medicine physicians and physical therapists. The side effects of breast cancer treatment can create functional and physical impairments that can keep these women from doing activities that bring joy to their lives. It can be the mother who does not have the strength to lift her child, the athlete who wants to return to her sport or the woman who needs her arm strength to return to work. As PTs we can assist in decreasing the side effects of cancer treatment that can lead to frozen shoulder, pain, upper extremity weakness and lymphedema.

Axillary web syndrome can occur one to eight weeks after the surgical removal of axillary lymph nodes for breast cancer staging.[2] This disorder is characterized by fibrous bands or cords that originate in the axilla and may extend to the wrist or palm. Cording is palpable when the shoulder is in 90 degrees of abduction. 2 These cords have been found to consist of sclerosed lymphatic vessels and veins. Women with axillary web syndrome will complain of pain or they may have difficulty lifting their hand above their head. Shoulder range of motion will be most limited in abduction. In physical therapy treatment we can educate them on the benign nature of this process, teach gentle shoulder and trunk exercise and perform myofascial release techniques to decrease cording. This treatment can help decrease painful guarding that may lead to frozen shoulder.

Six to twelve months after breast cancer surgery 50 percent of women report shoulder range of motion restrictions.[3] Breast reconstruction can also contribute to limited shoulder range of motion. Expanders or implants placed under the pectoralis muscle can cause an anterior pull of the scapula, changing the scapulo-humeral rhythm and creating impingement.

Radiation treatment can cause fibrosis in the pectoral muscles increasing tension over the expander or implant. These physical changes can be reduced with rotator cuff and postural muscle strengthening, stretching, joint mobilization and myofascial release techniques.

Breast cancer related lymphedema may occur after the removal of axillary lymph nodes. The reported incidence of this lymphedema ranges from 7 to 47 percent.[4]   Risk factors depend on the number of axillary lymph nodes removed, radiation treatment, infection and body mass index. Lymphedema may affect the upper extremity, trunk and breast. It can cause achiness, decreased shoulder motion, weakness, difficulty wearing clothes and self-esteem issues. Recent research is beginning to show that early treatment of lymphedema can decrease the progression of this chronic condition and allow the patient improved function and mobility.4

Working with women with breast cancer is an extremely rewarding experience for both the practitioner and the patient. Physical therapy plays an important role in improving the quality of lives of women who are healing from breast cancer. Our techniques greatly improve shoulder range of motion, strength, tissue mobility and decrease lymphedema, allowing patients to gain trust in their ability to heal and strengthen their bodies again. If you are interested in learning more about working with breast cancer survivors, the Oncology Section of the American Physical Therapy Association is offering a course in Richland, Wash. October 1-2, 2011. For more information and to register please visit www.oncologypt.org.

[1] SEER Cancer Statistics Review Bethesda , MD: Nation Cancer Institue,  http://seer.cancer.gov/statfacts/html/breast.html#survival

[2] Moskovitz A, Anderson B, Yeung R, Byrd D, Lawton  T, Moe R.: Axillary web syndrome after axillary dissection. Amer J Surg 2001; 181: 434-439

3 Thomas- MacLean RL, Hack T, Kwan W, Towers A, Miedema B, Tilley A.: Arm Morbidity and Disability After Breast Cancer:  New Directions for Care.  Journal Club.  Oncology Nursing Forum 2008; VOL 35, No 1:65-71

4 Stout-Gergich N, Pfalzer L, McGarvey C, Springer B, Gerber L, Soballe  P: Preoperative Assesment Enables the Early Diagnosis and Successful Treatment of Lymphedema.  Cancer 2008; VOL 112, No 12.


Mark Your Calendar: Free L&I Billing Workshops Coming Up

At these free L&I billing workshops, attendees will:

Learn to bill L&I correctly

Get new tools for doing business with L&I

Meet Provider Account Representatives

Two workshops are available:

January 14, 2011, 9 a.m. to 1 p.m.
Tukwila Labor & Industries Building
12806 Gateway Dr S
Tukwila, WA

February 25, 2011, 9 a.m. to 1 p.m.
Labor & Industries Auditorium
7273 Linderson Way SW
Tumwater, WA

To sign up, email the following information:

  • Name
  • Clinic/Office Name
  • L&I Provider Number
  • Email address

PTAs: Improve Your Understanding of Assessment Measures at PTWA Fall Conference

Your 9 a.m. patient has arrived. You check the chart and see that she is a 61-year-old female sent to therapy because of generalized deconditioning, loss of functional mobility and balance problems. Under her medical history you find she has dilated cardiomyopathy, COPD and a left TKR. The plan of care states that the patient will receive therapy for aerobic and resistance training to improve functional tolerance to activities, breathing exercises, gait and balance training and patient education. Where do you start?

Whether you are a physical therapist or a physical therapist assistant, this question can be difficult to answer and can change day to day depending on the patient’s condition. This is why understanding assessment measures like heart rate, lung sounds and blood pressure are important skills. Have a Heart: a PTA Cardiopulmonary Course at PTWA Fall Conference will cover important key indicators to determine appropriate interventions for patients with heart and/or lung disease. We will also cover current literature supporting endurance and resistance training in these patients. Remember that sometimes cardiopulmonary disease is a secondary diagnosis that can greatly affect therapeutic outcomes for standard musculoskeletal conditions. Safely establishing or modifying a patient’s exercise prescription with cardiopulmonary conditions is the foundation of this class. We hope to see there.

David Kennedy, PT, MS, CCS

Kennedy, along with Diane Madras, PT, PhD, will teach Have a Heart, Keep Your Exercise Prescriptions Safe and Affective: a PTA Cardiopulmonary Course October 30 at PTWA Fall Conference held at the Greater Tacoma Convention & Trade Center. Click here for details and to register!

Three or more APTA members who register as a group receive a 20 percent group discount.

ASIG Seminar to Cover Social Media and Computer Gaming in Balance Intervention

PTWA’s Administrative Special Interest Group presents “Merging Clinical Practice and Contemporary Management in Rehabilitation Services,” June 24 at Swedish Medical Center.

Scheduled sessions:

“Social Networking: What’s All the Buzz?” with Jeremy Chevalier, Multimedia Manager

“Use of Computer Gaming to Enhance Physical Therapy Interventions for Balance Difficulties” with Marsha Melnick, PT, PhD

“Efficiency in the Therapy Service: What is it?  Where, Why, and How Does It Fit In Contemporary Practice?” with Richard W. Hillyer, DPT, MBA, MSM

Click here for details and a registration form.

The Role of PT in Diabetes Treatment at PTWA Spring Conference

I met Mary Sinnott last year at the House of Delegates. She has incredible experience, speaks well, is very informative and has a good sense of humor to boot! The other reason I decided to take her class, “Management of Diabetes Mellitus Across the Continuum: The Role of Physical Therapy,” at PTWA Spring Conference: more than 20 percent of the population of Americans over age 60 have diabetes. Almost 11 percent of Americans over 20 have diabetes. I feel this disease has a great impact on a large population that we treat and I want to understand more about diabetes mellitus, the disease continuum and what we can do in physical therapy to best meet the needs, including education of patients.

Keiley Giboney, PTA
PTWA PTA SIG Treasurer

Sign up for Mary’s class at www.ptwa.org/conference by April 2 to receive the Early Bird Discount!

Pharmaco-Therapeutics at PTWA Spring Conference

I like drugs. And my dad sold drugs for almost 50 years until retiring this year. However, rather than selling them, I wanted to teach people how to use them…and that’s what I’ve been doing for the last 10 plus years.

As a pharmacist teaching at Idaho State University I have had the privilege of working with countless students, health care professionals and patients all the while trying to improve outcomes. Over the last six years I have worked with the DPT program at ISU teaching various topics to students in their therapeutic class and I must say that I initially thought, “Why does a PT or an OT need to know about drugs?”  However, after working with them, I clearly understand how deep your understanding is of physiology, biochemistry and disease pathology…and more importantly that medications can play a significant role in either helping you reach your outcomes in patients, or prevent you because of side effects, sub therapeutic effects or other reasons.

And that’s why I’m excited to come to Tacoma and present on the basics of drug therapy to students, PTs and any one else willing to come and learn about medications. After reviewing some basic pharmacology for an hour or so, we’ll talk about legal issues and then get right into some meds for a variety of disease states like depression, anxiety, MS, HIV and others. Now, when I looked at the schedule and realized that I had six hours I knew that I had to do something to keep the audience engaged for this time…so I plan on bringing an audience response system for some question and answer time as well as cases where you can work with others during this session to discuss how you would handle a certain situation. Because if I had to listen to myself for six hours, I’d go crazy! See you in April!!

David M. Hachey, PharmD, BCPS
Clinical Associate Professor
Idaho State University

Dr. Hachey will present April 16 at PTWA Spring Conference. To register for his class, visit www.ptwa.org/conference.

Look for some familiar faces at CSM this week

Washington’s physical therapy schools will be representing PTWA at CSM this week! Stop by the following presentations and see what students and faculty at the Washington schools are up to.
Thursday Feb. 18

Platform presentation

12:30-2:30 p.m.
Cahalin L, LaPier TK, Shaw DK. Sternal Precautions – What Do They Mean?  (EWU)

Friday Feb. 19

Platform presentations

Cleary KK, LaPier TK, Jamison A, Beadle C. A novel approach to a typical cardiac rehabilitation program: For Your Heart, an exercise DVD. (EWU)

4 p.m.
Mike Walker, Bob Boyles, Brian Young, Joe Strunce, Gail Deyle, JulieWhitman, Matt Garber M, Rob Wainner RS. The efficacy of manual therapy versus placebo ultrasound for mechanical neck disorders, a randomized clinical trial. (UPS)


11 a.m.-12:30 p.m.
Yvette Griffiths, Christina Hamilton, Hillary Robins, Jennifer Hastings. The differences in self-efficacy, function, and participation between adults with C6 or C7 motor tetraplegia who use power or manual wheelchairs. (UPS)

11 a.m.-12:30 p.m.
Roger Allen, Nick Siewert, Lars Kellow, Matt Kirchoff, James Evans. Effects on episodic vertigo intensity of plantar somatosensory input via direct pressure vs. TENS in patients with benign paroxysmal positional vertigo. (UPS)

11 a.m.-12:30 p.m.
Carol Ann Davidson, Cheryl Fong, Jeremiah Griffith, Jeff Holdener, Melissa Newcombe. A qualitative analysis of patient approach to post-stroke physical therapy intervention. (UPS)

Saturday, Feb. 20


Kranenburg M, Cleary KK. Gait and balance deficits in a patient hospitalized with bipolar schizoaffective disorder: a case report.  (EWU)

LaPier TK, Cleary KK, Gefroh J, Graham R, Hedgecock K.  Physical function, age and mental status are related to physical activity and exercise self-efficacy 3, 6 and 12 months following coronary artery bypass surgery. (EWU)

11 a.m.-12:30 p.m.
Laura Murahashi, Tanya Sena T, Bobby Yarnall, Bob Boyles, Cindy Benson-McGregor. Immediate effects of thoracic transverse mobilization in patients with the primary complaint of mechanical neck pain:  A pilot study. (UPS)

Platform presentations

8:45 – 9 a.m.
Roger Allen, Amy Moe, Casey Pyle, Chelsea Athing,  Elizabeth Luppino, Mauri Terao, Jeffrey Kline. Temporal relationship between stress and episodic pain flares in patients with fibromyalgia syndrome. (UPS)

9 – 9:15 a.m.
Roger Allen, Kelsey Wallin, Anna K. Smith, Caryn Bittenbender. Quantitative pain topography assessment: Reliability and functional correlations for patients with fibromyalgia syndrome. (UPS)

Goldrick SB, Anton D, Mizner R, Hess J, Kincl L.
“Analysis of Two Ergonomic Interventions for Lifting Concrete Blocks Over Rebar Wall Supports in the Masonry Trade” (EWU)

Plus check the conference schedule to see platform presentations from Eastern’s Drs. Kimberly Cleary and Tanya LaPier on their research labs at Eastern.

Have a great time in San Diego — your chapter staff is jealous.