1. Physiotherapy Management of Malignant Spinal Cord Compression Suzanne Hodson Senior Physiotherapist at WPH October 2013

2. Aims National Cancer Rehab Care pathway for MSCC recommends referrals to Physiotherapy within 24 hours of patient’s admission Aim to maintain patients at their optimum level of functional independence to enable maximum quality of life

3. Bed Rest or Mobilisation Previous practice during radiotherapy for MSCC was flat bed rest Now once diagnosis has been made and spinal stability assessed Patients able to sit up gradually to 60 degrees over period of 3-4 hours Monitoring symptoms If they walked in safely they are able to continue mobilising

4. If the spine is unstable Refer to physiotherapy for bed rest exercises Refer to orthotics for a spinal brace/collar Brace/collar to be fitted by orthotics prior to commencing mobilisation Sit up slowly in bed to 60  over 4 hrs If tolerated without any deterioration in pain or neurology Progress with rehabilitation & mobilisation as able

5. If the spine is stable Refer to the physiotherapists Slowly sit the patient up to 60  over 4 hrs If tolerated & no deterioration in pain or neurology Patient can start to mobilise, if able If unable to mobilise await physiotherapy assessment for rehabilitation

6. Physio - Assessment Muscle strength Neurological deficits Respiratory assessment Co-morbidities e.g. COPD, arthritis Clarification of pt’s understanding of diagnosis Setting realistic expectations

7. Setting Realistic Expectations Level of therapy in-put at WPH & afterwards Functional Ability Improvements in Ability Functional Outcome Prognosis

8. Rehabilitation of MSCC Patients Physiotherapy rehabilitation starts as soon as MSCC is diagnosed Bed rest exercises or mobilisation Patients sit up or starting rehabilitation & mobilisation while they are in hospital for radiotherapy To clarify what patients are able to do the Consultants at WPH have agreed a system where all patients are suitable for rehabilitation unless documented otherwise

9. Summary Early referral to physiotherapists Rehabilitation can start even if unable to get out of bed Monitor symptoms as patients start to sit up Patients can do as much as their symptoms allow them to Realistic expectations