Was wir noch tun können: Rehabilitation am Lebensende Potential and Possibility: Rehabilitation at end of life

"Potential and Possibility: Rehabilitation at end of life.
Physiotherapy in Palliative care"

Eds: Taylor, Simader, Nieland

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Jacob van den Broek


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Table of Contents

1Approaching the specialty of physiotherapy in palliative care
1.1Definition of palliative care and end of life care
1.2Who is the palliative care physiotherapist?
1.2.1Professional profile: The value of the physiotherapist in palliative care
1.2.2Clinical skills and knowledge
1.2.3Education opportunities for physiotherapists in palliative care
1.3From symptom control to rehabilitation: Physiotherapy approaches to end of life care
1.3.1Physiotherapy then and now
1.3.2Current context and aim of intervention
1.3.3Patient goals and outcomes
1.3.4Understanding the patient in depth
1.3.6The collaborative physiotherapy model
1.3.7Physiotherapy at end of life
1.3.8Alternative contexts for physiotherapy intervention
1.3.9The educational role of the physiotherapist
1.4The right time for physiotherapy: Is there a 'too late' or a 'too early'?
1.4.1Early referral to physiotherapist
1.4.2Late physiotherapeutic interventions
1.4.3The patient journey
1.4.4Determining the right time for physiotherapy
1.5Physiotherapy at end of life: Patient's perspectives
1.5.1Patients' needs and priorities
1.5.2Patients' thoughts on physiotherapy in palliative care
1.5.3How can we learn from our patients?
1.5.4The goldfish bowl
1.5.5What have we learnt from our patients this far?
1.5.6Three personal testimonies
1.6Physiotherapy Students in Palliative Care
2Physiotherapy and medical aspects
2.1Clinical reasoning
2.1.1Clinical reasoning in physiotherapy
2.1.2Clinical reasoning in physiotherapy in palliative care
2.2.1Case study
2.2.3Spinal cord compression
2.2.5Reflective questions
2.3Respiratory symptoms: dyspnoea/breathlessness from airway obstruction and impaired oxygen capacity
2.3.1Case study
2.3.2Airway obstruction in the palliative care setting
2.3.3Impaired oxygen capacity in the palliative care setting
2.3.4Medication for breathlessness and associated symptoms
2.3.6Reflective questions
2.4Breathlessness and fear
2.4.1Case study
2.4.2Context of breathlessness at end of life
2.4.3Effective physiotherapy strategies for managing breathlessness
2.4.4Context of anxiety and panic in the breathless patient
2.4.5A physiotherapy approach to managing anxiety and panic in the context of breathlessness
2.4.7Reflective questions
2.5.1Case study
2.5.2Lymphatic system and potential disorders
2.5.3Physiotherapy for lymphoedema in the palliative care setting
2.5.4Reflective questions
2.6Fatigue and weakness
2.6.1What is fatigue?
2.6.2Case study
2.6.3Physiotherapy and fatigue
2.6.5Reflective questions
2.6.6Group work in palliative care
2.7Anxiety in the context of palliative physiotherapy
2.7.1Case study
2.7.2Anxiety in palliative care patients
2.7.3Specific and practical assessment methods related to anxiety
2.7.4Physiotherapeutic interventions related to anxiety
2.7.6Reflective questions
2.8.1Development and types of dementia
2.8.2Diagnosing dementia
2.8.3Dementia and the body
2.8.4Principles of supportive physiotherapy in dementia
2.8.5Patient cases and physiotherapeutic interventions
2.8.7Reflective questions
2.9Physiotherapy in paediatric palliative care
2.9.1Features of paediatric palliative care
2.9.2Principles of physiotherapy with children and adolescents in the palliative care setting
2.9.3Special features of therapy in different situations
2.9.4Case study
2.9.6Reflective questions
2.10Physiotherapy in the terminal phase
2.10.1Physiotherapy at end of life – yes or no?
2.10.2Physiotherapeutic interventions in the terminal phase
2.10.4Reflective questions
3Psycho-social aspects
3.1Communication in palliative care: an introduction
3.2'Of sad lions that roar' and handling strong emotions
4Ethical, spiritual and cultural aspects
4.1Ethics and ethical reasoning in palliative physiotherapy
4.2The interface between function and meaning
4.2.1What does society tell us about our bodies?
4.2.2To what is the healthy body an antidote?
4.2.3Function and meaning
4.2.4The use of narrative: A key approach for the physiotherapist
4.2.6Reflective questions
4.3With respect and openness: intercultural competence in palliative physiotherapy
5"Self care" for Physiotherapists
5.1"How am I really feeling?" – questions and suggestions for (self-)supervision
5.2Closeness and distance, to touch and be touched; the physiotherapeutic dynamic