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Therapist prehab

Prehab assessment:

  • Baseline posture assessment
  • Function (i.e. quick dash, LLIS, PSFS)
    • Level of activity
  • Limb Volume
    • Especially upper arm/trunk circumference under axillary fold (note, with mastectomy, we are expecting a reduction in circumference under axillary fold but post surgical swelling is expected)
  • Strength
    • Arm curl test
    • Dynamometer
    • Shoulder manual muscle test (not to be retested until 6 weeks post op)
  • Range of motion:
    • Shoulder: flexion, scaption, horizontal abduction, external/internal rotation, hands behind back/hands over back
    • Scapular mobility
    • Trunk: flexion, extension, lateral flexion, rotation

Sample documentation of assessment and plan for prehab visit

  • Patient presents to OT for planned double incision chest masculinization surgery on [date of surgery]. They are not currently experiencing symptoms [OR] They are experiencing symptoms (i.e. from binding, etc.) such as [XYZ]. Due to upcoming surgery, they are at increased risk for swelling, infection, scar formation, and decreased ROM/strength/endurance due to upcoming surgery. They will require ongoing monitoring to reduce risk of functional impairments, return to current level of function and to educate patient in risk reduction practices and post surgical rehab protocols. Comprehensive evaluation and assessment performed w/circumferential measurements, active range of motion and strength of BUE was performed and personal risk factors were assessed. Reviewed prehab recommendations including preparation for surgery, pain control, post surgical movement precautions and exercise protocol, diaphragmatic breathing and basic MLD principals, postural education/positioning (for sitting and sleeping), and risk reduction practices. At post op visit [in X weeks], patient to be re-evaluated for possible post surgical sequelae such as range of motion, decline in function, scar adhesions, edema, scapular winging, pain and/or postural issues. At that time, a future plan of care and goals may be established and skilled care continued if indicated.

Sample goals for prehab

  • Patient will implement a daily conservative home program of diaphragmatic breathing, observing AROM surgical restrictions, self-MLD, skin care to reduce risk of infection and daily compression-wear.
  • Patient’s post surgical swelling in the involved quadrant will decrease and/or stabilize within 8 weeks as evidenced by circumferential measurements, clinical observation and patient report as compared to measurements pre-op.
  • Patient will return to previous level of strength as measured by [arm curl test, dynamometer, etc] within 10 weeks of surgical date.
  • Patient will return to previous level of active range of motion for the BUE’s within 8 weeks of surgical date.
  • Patient demonstrates awareness of post operative movement restrictions and HEP to facilitate tissue healing, reduce risk of seroma formation, and ensure shoulder and trunk mobility within 2 weeks of the surgical date.

ICD Codes

Binding can result in the following:

  • R29.3 Abnormal Posture
  • R07.89 Pain in chest
  • M62.81 Muscle Weakness (abdominal)
  • Z72.3 Lack of physical exercise (due to decreased activity tolerance/diffiuclty with respiration from binding)
  • Other symptoms resulting from binding may include back pain, skin breakdown, difficulty with respiration, digestive issues, musculoskeletal changes, numbness, headache, etc.