Rehabilitation Post-Transplant

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Significant proportion of the transplant patients show signs of cGVHD.

PT’s are best placed to help in early detection of MSK related cGVHD specially for those patients where the impact is on muscle power, fascia, advanced sclerotic skin changes,  functional capacity and quality of life. With the pre-transplant functional capacity evaluation already available to the PT’s,  it can be a useful tool to help correlate any deterioration in patient’s functional capacity, thus helping in early detection, flagging and intervention.  


However, to achieve this, it is important that patients are offered full body functional evaluation post-transplant at 4 weeks, 8 weeks, 12 weeks, 15weeks, 18weeks and 21 weeks. This repeated assessments is useful in  monitoring subtle changes in the myofascial level and the patient reported symptoms. PT’s should make themselves familiar with the myofascial movement pattern so that the measurements of the movement reflects myofascial chain and not just the joint range of motion.


PT’s who are trained in using diagnostic ultrasound can also utilize this technology to help monitor the changes in the skin / fascia on selective sites like hand, forearm, calf, hamstrings and spinal area during each assessment to monitor changes [1, 2].


The rehab should follow SMART (specific, measurable, attainable, realistic and time bound) goals which should be reflected via individualized exercise prescription plan. Some patients might also need functional restoration program to help them return to work or sports activities which again will need a careful planning and execution on behalf of the PT along with the multidisciplinary team. Please note that the return to work recommendations must only be made by PT’s or healthcare professionals who are experienced in occupational health field and qualified to do so. 

References:

 

  1. Pracoń G, Płaza M, Walentowska-Janowicz M, Sudoł-Szopińska I. The value of ultrasound in the diagnosis of limited scleroderma–a case report. Journal of ultrasonography. 2015 Sep;15(62):326. 
  2. Hesselstrand, Roger et al. “High frequency ultrasound of skin involvement in systemic sclerosis - a follow-up study” Arthritis research & therapy vol. 17 329. 19 Nov. 2015, doi:10.1186/s13075-015-0853-5.