Physiotherapy Rehabilitation in a Patient with Carcinoma of Cervix and Leprosy - A Case Report

Physiotherapy Rehabilitation in a Patient with Carcinoma of Cervix and Leprosy - A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Physiotherapy Rehabilitation in a Patient with Carcinoma of Cervix and Leprosy - A Case Report Gunjan Ambalkar, Mansi Subhedar, Amisha Zade This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5885280/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Cervical cancer is significant health issue, particularly in women from low resource areas, and when combined with leprosy, a chronic infectious disease that affects the skin and peripheral nerves, the challenges of treatment and rehabilitation intensify. This case report discusses a 70-year-old female patient with both cervical cancers, treated through radical hysterectomy, chemotherapy, and radiation therapy, and a history of leprosy, which had already caused peripheral neuropathy and deformities. The concomitant issues, such as nerve damage, muscle weakness, and lymphedema, significantly reduced her quality of life and functional capacity. physiotherapy played a key role in her recovery, focusing on specific regimen that sought to strengthen certain muscles, offer gait training along with manual lymphatic drainage for pain relief. It was possible to manage pain, restore mobility and improve functional independence within a span of six weeks. It is emphasized how rehabilitation plans are to be used for such complex patients. Cervical cancer leprosy physiotherapy rehabilitation multidisciplinary approach lymphedema management. Introduction Cervical carcinoma or Cancer Cervix refers to the malignant growth of tissues of the cervix, which is the lower part of the uterus that opens into the vagina. Carcinoma of cervix is the fourth most common neoplasm in women [ 1 ]. It is generally caused by changes in the cervical epithelial cells. This is mainly caused by the continued spread of high-risk strains of human papillomavirus (HPV). Although other factors such as smoking, immune suppression and a history of sexually transmitted infections can also help [ 2 ]. Precancerous lesions, sometimes called dysplasia, often precede cervical cancer and can be identified early. with standard screening techniques These include Pap smears and HPV tests. Disease recurrence affects one in three cervical cancer patients. It mostly occurs within the first two years after treatment ends and will Factors predicting disease recurrence [ 3 ]. Early stages of cervical cancer may not cause symptoms. But as the disease progresses, symptoms can include abnormal vaginal bleeding. Pelvic pain and vaginal discharge. The most common type of cervical cancer is squamous cell carcinoma. Early detection and treatment of cervical cancer can help. It has improved greatly in recent years. Due to the widespread use of screening programs [ 5 ]. However, when the diagnosis is at an advanced stage or when treatment involves harsh procedures such as chemotherapy, the patient may experience severe physical abnormalities [ 6 ]. These damages can include fatigue. Pelvic pain, weakness in the arms and legs, and complications related to cancer treatment such as neuropathy and lymphadenopathy [ 7 ]. Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae [ 8 ]. While the frequency of leprosy is declining in most parts of the world, it's still endemic in certain areas, and its long-term sequelae might range from severely disabling to progressive with time. The most important constituent of the disease commonly hits upon skin, peripheral nerves, upper respiratory tract, and eyes. The most important late after-effects of leprosy embrace irreversible disability due to peripheral neuropathy and injuries to the innervated territories, particularly the hands and feet [ 9 ]. Within the clinicopathologic spectrum described by the Ridley-Jopling classification, lepromatous leprosy (LL) and tuberculoid leprosy (TT) lie at opposite poles. Tuberculoid patients show a few localized and well-defined skin lesions, isolated peripheral nerve damage, and a heightened cell-mediated immune reactivity to M. leprae. Plural, borderline lepromatous (BL) and LL are afflicted with immunological mechanisms deficient in humoral and cell-mediated immunity that affect the individual up to the intradermal spread of the intracellular Leprae, M. [ 10 ]. Although treated successfully, other residual disabilities that may persist in patients after they have recovered from the infection include muscle weakness, sensory loss, and joint deformities, which materially contribute to the impairment of their quality of life [ 9 ]. A patient diagnosed with both cervical cancer and leprosy poses unique clinical dilemmas. Patients suffering from both conditions sustain a great deal of physical and functional impairments, and such an association might impede rehabilitation. For example, chemotherapy-induced neuropathy in a patient with an already present leprosy-induced neuropathy aggravates sensory loss and limits mobility further. Fatigue and weakness emanating from cancer and its treatment may indicate a compounding effect on the muscle weakness and atrophy otherwise induced from leprosy [ 11 ]. This case report seeks to address the general clinical findings, rehabilitation strategies, and the associated outcome of this patient to highlight the multidisciplinary approaches needed in the management of a complex case involving cancer and chronic infectious diseases like leprosy [ 12 ]. By dealing with both conditions simultaneously, the intended goal is to improve quality of life, functional ability, and independence of the patient struggling with considerable challenges due to these coexisting conditions [ 13 ]. The treatment mainly addresses pain relief, mobility enhancement, strengthening of muscles, and functional independence while considering the specific limitations imposed by both conditions [ 14 ]. Chemo-associated fatigue and pelvic pains, due to which there is muscle weakness and sensory loss, needed a carefully constructed individualized rehabilitation plan. The specific physiotherapy types sought here contributed greatly toward an improvement of the patient's quality of life, mobility, and restoring her confidence in performance of daily activities [ 15 ]. Case presentation A 70-year-old female patient visited AVBRH with a 34-year history of leprosy and 4 years history of cervical cancer; she had come in for physiotherapy rehabilitation following chemotherapy treatment for her cancer. The chemotherapy was completed, but she still suffered from persistent fatigue, pelvic pain, and weakness in the lower limbs. Her long-standing leprosy has left the patient with chronic complications such as peripheral neuropathy, muscle weakness, joint deformities, and residual skin lesions. these complications contributed to significant functional limitations, such as impaired mobility, balance difficulties, and increased risk of falls. The patient reported challenges in performing daily activities independently and required assistance with walking and other routine tasks. Clinical finding She was conscious, cooperative, well-oriented, and aware during the examination. On physical examination, the vital signs were temperature − 97.7 degrees Celsius, heart rate − 82 beats per min, blood pressure 128/78 mmHg, and respiratory rate − 20 beats per min. All sensations were normal. On motor examination, weakness of both upper (UL) and lower limbs (LL) was prominent (UL- 3/5 and LL – 3/5), as shown in Table 1 . Post-chemotherapy effects are prominent, with significant fatigue, pelvic pain, and lower limb weakness affecting her daily functioning. A long-standing complication of her leprosy, manifests as numbness, tingling, and loss of sensation in the extremities, contributing to balance issues and an increased risk of falls. Muscle weakness and atrophy are present, particularly in the lower limbs and hands, along with joint deformities in the hands and feet due to chronic nerve damage from leprosy. The patient also has residual skin changes such as hypo-pigmented patches and thickened areas, though these are not currently active. Mobility is notably impaired, with the patient demonstrating gait abnormalities and difficulty performing daily activities independently, often requiring assistance or the use of mobility aids. The overall clinical picture reflects a complex interplay of cancer-related and leprosy-related complications, necessitating a comprehensive and multidisciplinary approach to her physiotherapy and rehabilitation. Table 1 mentioned manual muscle testing mentioned. Table 1 Manual Muscle Testing Muscle groups Right side Left side Shoulder Flexors and Extensor 3/5 3/5 Shoulder Adductors and Abductors 3/5 3/5 Elbow Flexors and Extensors 3/5 3/5 Hip Flexors and Extensors 3/5 3/5 Hip Extensors 3/5 3/5 Hip Abductors and Adductors 3/5 3/5 Knee Flexors and Extensors 3/5 3/5 Ankle Planter flexion and Dorsi flexion 3/5 3/5 Physiotherapy rehabilitation The physiotherapy intervention was structures across three phases: acute, subacute and chronic. In the acute phase, the focus was on pain management, reducing inflammation and gentle mobility exercises. The subacute phase emphasized progressive strengthening, range of motion improvement, and functional retraining. In the chronic phase, the intervention targeted advanced strengthening, endurance training and strategies to enhancing long term functional independence and prevent recurrence mention in Table 2 . Table 2 Physiotherapy Intervention Phase Goal Treatment Progression Acute Phase Reduce post-surgical pain and inflammation - Cryotherapy : Apply cold packs to reduce swelling and manage pain. - TENS (Transcutaneous Electrical Nerve Stimulation) : Use for pain relief. - Gentle ROM Exercises : Perform gentle, pain-free range of motion exercises to prevent joint stiffness - Cryotherapy : 15–20 minutes every 2–3 hours during the first 48 hours. - TENS : 15–30 minutes, 2–3 times daily. - Gentle ROM Exercises : 2–3 sets of 10 repetitions, 2–3 times daily. Prevent complications - Deep Breathing Exercises : Encourage diaphragmatic breathing and incentive spirometry to prevent respiratory complications. - Manual Lymphatic Drainage : Initiate gentle techniques to reduce lymphedema and improve lymphatic circulation. - Deep Breathing Exercises : 10 deep breaths every hour while awake. - Manual Lymphatic Drainage : 15–30 minutes, 2–3 times daily. Maintain mobility - Bed Mobility and Early Ambulation : Assist with bed mobility and promote early ambulation to prevent deconditioning and deep vein thrombosis (DVT). - Early Ambulation : Begin within 24–48 hours post-surgery; progress walking distance daily. Subacute Phase Improve mobility and strength - Progressive ROM Exercises : Gradually increase range of motion exercises for the lower limbs and trunk to restore flexibility and joint mobility. - Strengthening Exercises : Start with isometric exercises, progressing to isotonic exercises targeting weakened muscle groups due to surgery or immobility. - ROM Exercises : Increase repetitions and range weekly. - Strengthening Exercises : Start with 10–15 reps, progress to 3 sets of 10–15 reps. Manage lymphedema - Manual Lymphatic Drainage : Continue and intensify lymphatic drainage techniques to reduce swelling and maintain lymphatic circulation. - Manual Lymphatic Drainage : 20–30 minutes, 2–3 times daily. Prevent deformities -Splinting/Bracing : Apply orthotic devices to prevent or correct deformities related to leprosy-induced nerve damage. - Gait Training : Implement gait training with or without assistive devices (e.g., walker, cane) to improve walking ability, balance, and coordination. Focus on correcting abnormal gait patterns and ensuring safe ambulation. - Splinting/Bracing : Adjust every 2 weeks based on progress. - Gait Training : 20–30 minutes, 2–3 times daily, progress as tolerated. Improve abdominal strength - Abdominal Exercises: Start with isometric abdominal contractions, progressing to dynamic exercises such as leg raises, pelvic tilts, and bridges. − 2–3 sets, 10–15 reps, 3–4 times/week. Chronic phase Enhance functional independence - Advanced Strengthening Exercises : Incorporate resistance training and weight-bearing exercises to improve overall strength and endurance, focusing on affected areas. - Balance and Coordination Training : Engage in exercises using balance boards, stability exercises, and proprioceptive training to improve coordination, stability, and prevent falls. - Strengthening Exercises : Increase resistance/weight every 2–3 weeks. - Balance Training : 20–30 minutes, 3–4 times weekly. Manage chronic pain - Chronic Pain Management : Continue using TENS, massage therapy, and heat therapy for persistent pain relief. Implement desensitization techniques for neuropathic pain, with gradual reintroduction of sensory stimuli. - TENS/Heat Therapy : 15–30 minutes, 2–3 times daily. - Desensitization Techniques : Gradual increase in exposure to stimuli. Improve quality of life - Functional Training : Focus on activities of daily living (ADL) training to enhance independence in self-care, household tasks, and community participation. Address practical skills needed for daily routines. - Home Exercise Program : Develop a personalized home exercise plan that includes strength, flexibility, lymphedema management, and functional activities to maintain physical gains and prevent regression. Encourage long-term adherence to ensure sustained improvement. - Functional Training : 30–45 minutes daily, progress to independent tasks. - Home Exercise Program : Perform 4–5 times per week, adjust exercises based on progress. Follow up and outcome The Table 3 below presents the Manual Muscle Testing (MMT) scores recorded pre and post intervention, highlighting changes in muscle strength and functional outcomes following the implemented therapeutic approach. Table 3 Manual muscle testing pre and post rehabilitation. Muscle groups Pre-Rehabilitation Post rehabilitation Right limb Left limb Right limb Left limb Shoulder Flexors and Extensors 3/5 3/5 4/5 4/5 Shoulder Adductors and Abductors 3/5 3/5 4/5 4/5 Elbow Flexors and Extensors 3/5 3/5 4/5 4/5 Hip Flexors and Extensors 3/5 3/5 4/5 4/5 Hip Abductors and Adductors 3/5 3/5 4/5 4/5 Knee Flexors and Extensors 3/5 3/5 4/5 4/5 Ankle Planter flexion and Dorsi flexion 3/5 3/5 4/5 4/5 Outcome measures Outcome measures for pre and post rehabilitation mentioned in Table 4 . Table 4 Pre and post rehabilitation outcomes Outcome measure Pre rehabilitation Post rehabilitation Numerical pain rating scale (NPRS) On rest- 3/10 On activity- 7/10 On rest- 2/10 On activity- 5/10 Upper Extremity strength (MMT) 3/5 4/5 Lower Extremity strength (MMT) 3/5 4/5 WHO- QOL 58/100 80/100 Discussion In this case report, we present the rehabilitation of a patient with cervix cancer complicated by leprosy. The primary physiotherapy goal centred on pain management. Particularly in preoperative and post operative phases. Pain levels were assessed during Numerical Pain Rating Scale (NPRS), providing a qualifiable measure of the patient’s discomfort. our 6-week rehabilitation protocol led to significant reduction in pain, highlighting the effectiveness of targeted interventions during this critical period [ 16 ]. Postoperatively, the patient’s abdominal strength became focal point of rehabilitation process. Due to postoperative pain, pelvic floor muscle strengthening exercises were initially contraindicated. Strengthening the abdominal muscles not only improved the patients core stability but also indirectly enhanced pelvic floor muscle strength. This connection between pelvic floor muscle function and is well documented and proved to be effective approach to circumvent the limitations imposed by postoperative pain [ 17 ]. The comprehensive physiotherapy intervention, as outlined in treatment table, facilitated marked improvement in patient’s functional mobility. Functional mobility is cornerstone of rehabilitation, particularly in cancer patients, as it directly influences independence and overall quality of life. By alleviating pain and enhancing muscular strength, the patient was able to regain mobility, which in turn contributed to better postoperative recovery experience [ 18 ]. By addressing pain and strength deficits, the patient was able to progress through rehabilitation with improved outcomes in mobility and daily functioning [ 19 ]. This rehabilitation plan was customized uniquely to meet the patient's needs and could be changed since the exercises were contraindicated in some instances. This flexibility was critical in ensuring the patient progressed even during troublesome events such as postoperative pain. Pain control combined with muscle strengthening and functional mobility meant the patient benefited a great deal from the physical and overall improvement of life quality [ 20 ]. Conclusion The case report concludes that treating a cervical cancer patient along with the leprosy represents a diverse area where management would entail considerations for a dual diagnosis arising from physical rehabilitation strategies. The cases highlight the need for a comprehensive, individualized approach that addresses the unique challenges posed by leprosy-related impairments and the functional consequences of cervical cancer and its treatments. Successful rehabilitation in such cases depends on a multidisciplinary team effort, tailored interventions, and a focus on improving quality of life. This case of great benefit would also serve as a fundamental stepping stone towards the fine-tuning of rehabilitation practices and strategical development for dealing with similar cases in the future. Declarations Ethics Approval and consent to participant: Ethical approval was obtained from patients, and written informed consent was obtained from the patient for participation in this study Consent for publication: Written informed consent was obtained from the patient for the publication of this case report Competing Interests: The authors declare that they have no competing interests . Authors' Contributions: G.A. and M.S. wrote the main manuscript text. A.Z. conducted the literature review and provided critical revisions to the manuscript. All authors reviewed and approved the final manuscript. Acknowledgments: Not applicable. Funding Declaration Statement No funding was received for the preparation of this case report. Availability of data and materials: Not applicable. References Brenner DE: Case Report Carcinoma of the Cervix — A Review. 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Gynecol Oncol. 2007, 107:S98–100. 10.1016/j.ygyno.2007.07.038 van Nagell Jr. JR, Donaldson ES, Wood EG, Maruyama Y, Utley J: Small cell cancer of the uterine cervix. Cancer. 1977, 40:2243–9. 10.1002/1097-0142(197711)40:53.0.CO;2-H Britton WJ, Lockwood DNJ: Leprosy. Lancet Lond Engl. 2004, 363:1209–19. 10.1016/S0140-6736(04)15952-7 Bajpai J, Shetty N, Gupta A, Samar A, Kelkar R: A case report of osteogenic sarcoma with leprosy. J Cancer Res Ther. 2013, 9:311. 10.4103/0973-1482.113403 Ridley DS, Jopling WH: Classification of leprosy according to immunity. A five-group system. Int J Lepr Mycobact Dis Off Organ Int Lepr Assoc. 1966, 34:255–73. Purtilo DT, Pangi C: Incidence of cancer in patients with leprosy. Cancer. 1975, 35:1259–61. 10.1002/1097-0142(197504)35:43.0.CO;2-M A Cochrane Systematic Review of Transcutaneous Electrical Nerve Stimulation for Cancer Pain - ScienceDirect. Accessed: August 27, 2024. https://www.sciencedirect.com/science/article/pii/S0885392408004569. 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Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: A randomized controlled trial - ScienceDirect. Accessed: August 27, 2024. https://www.sciencedirect.com/science/article/abs/pii/S0090825812002399. Women’s Cancer Rehabilitation: a Review of Functional Impairments and Interventions Among Breast and Gynecologic Cancer Survivors | Current Physical Medicine and Rehabilitation Reports. Accessed: August 27, 2024. https://link.springer.com/article/10.1007/s40141-020-00261-9. Fialka-Moser V, Crevenna R, Korpan M, Quittan M: Cancer Rehabilitation. Particularly with aspects on physical impairments. J Rehabil Med Off J UEMS Eur Board Phys Rehabil Med. 2003, 35:153–62. 10.1080/16501970310000511 The impact of cervical cancer on quality of life—The components and means for management - ScienceDirect. Accessed: August 27, 2024. https://www.sciencedirect.com/science/article/abs/pii/S0090825807007755. 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Carcinoma of cervix is the fourth most common neoplasm in women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is generally caused by changes in the cervical epithelial cells. This is mainly caused by the continued spread of high-risk strains of human papillomavirus (HPV). Although other factors such as smoking, immune suppression and a history of sexually transmitted infections can also help [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Precancerous lesions, sometimes called dysplasia, often precede cervical cancer and can be identified early. with standard screening techniques These include Pap smears and HPV tests. Disease recurrence affects one in three cervical cancer patients. It mostly occurs within the first two years after treatment ends and will Factors predicting disease recurrence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly stages of cervical cancer may not cause symptoms. But as the disease progresses, symptoms can include abnormal vaginal bleeding. Pelvic pain and vaginal discharge. The most common type of cervical cancer is squamous cell carcinoma. Early detection and treatment of cervical cancer can help. It has improved greatly in recent years. Due to the widespread use of screening programs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, when the diagnosis is at an advanced stage or when treatment involves harsh procedures such as chemotherapy, the patient may experience severe physical abnormalities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These damages can include fatigue. Pelvic pain, weakness in the arms and legs, and complications related to cancer treatment such as neuropathy and lymphadenopathy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLeprosy, also known as Hansen's disease, is a chronic infectious disease caused by \u003cem\u003eMycobacterium leprae\u003c/em\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. While the frequency of leprosy is declining in most parts of the world, it's still endemic in certain areas, and its long-term sequelae might range from severely disabling to progressive with time. The most important constituent of the disease commonly hits upon skin, peripheral nerves, upper respiratory tract, and eyes. The most important late after-effects of leprosy embrace irreversible disability due to peripheral neuropathy and injuries to the innervated territories, particularly the hands and feet [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Within the clinicopathologic spectrum described by the Ridley-Jopling classification, lepromatous leprosy (LL) and tuberculoid leprosy (TT) lie at opposite poles. Tuberculoid patients show a few localized and well-defined skin lesions, isolated peripheral nerve damage, and a heightened cell-mediated immune reactivity to M. leprae. Plural, borderline lepromatous (BL) and LL are afflicted with immunological mechanisms deficient in humoral and cell-mediated immunity that affect the individual up to the intradermal spread of the intracellular Leprae, M. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough treated successfully, other residual disabilities that may persist in patients after they have recovered from the infection include muscle weakness, sensory loss, and joint deformities, which materially contribute to the impairment of their quality of life [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A patient diagnosed with both cervical cancer and leprosy poses unique clinical dilemmas. Patients suffering from both conditions sustain a great deal of physical and functional impairments, and such an association might impede rehabilitation. For example, chemotherapy-induced neuropathy in a patient with an already present leprosy-induced neuropathy aggravates sensory loss and limits mobility further. Fatigue and weakness emanating from cancer and its treatment may indicate a compounding effect on the muscle weakness and atrophy otherwise induced from leprosy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis case report seeks to address the general clinical findings, rehabilitation strategies, and the associated outcome of this patient to highlight the multidisciplinary approaches needed in the management of a complex case involving cancer and chronic infectious diseases like leprosy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. By dealing with both conditions simultaneously, the intended goal is to improve quality of life, functional ability, and independence of the patient struggling with considerable challenges due to these coexisting conditions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The treatment mainly addresses pain relief, mobility enhancement, strengthening of muscles, and functional independence while considering the specific limitations imposed by both conditions [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Chemo-associated fatigue and pelvic pains, due to which there is muscle weakness and sensory loss, needed a carefully constructed individualized rehabilitation plan. The specific physiotherapy types sought here contributed greatly toward an improvement of the patient's quality of life, mobility, and restoring her confidence in performance of daily activities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 70-year-old female patient visited AVBRH with a 34-year history of leprosy and 4 years history of cervical cancer; she had come in for physiotherapy rehabilitation following chemotherapy treatment for her cancer. The chemotherapy was completed, but she still suffered from persistent fatigue, pelvic pain, and weakness in the lower limbs. Her long-standing leprosy has left the patient with chronic complications such as peripheral neuropathy, muscle weakness, joint deformities, and residual skin lesions. these complications contributed to significant functional limitations, such as impaired mobility, balance difficulties, and increased risk of falls. The patient reported challenges in performing daily activities independently and required assistance with walking and other routine tasks.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eClinical finding\u003c/h2\u003e \u003cp\u003eShe was conscious, cooperative, well-oriented, and aware during the examination. On physical examination, the vital signs were temperature \u0026minus;\u0026thinsp;97.7 degrees Celsius, heart rate \u0026minus;\u0026thinsp;82 beats per min, blood pressure 128/78 mmHg, and respiratory rate \u0026minus;\u0026thinsp;20 beats per min. All sensations were normal. On motor examination, weakness of both upper (UL) and lower limbs (LL) was prominent (UL- 3/5 and LL \u0026ndash; 3/5), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Post-chemotherapy effects are prominent, with significant fatigue, pelvic pain, and lower limb weakness affecting her daily functioning. A long-standing complication of her leprosy, manifests as numbness, tingling, and loss of sensation in the extremities, contributing to balance issues and an increased risk of falls. Muscle weakness and atrophy are present, particularly in the lower limbs and hands, along with joint deformities in the hands and feet due to chronic nerve damage from leprosy. The patient also has residual skin changes such as hypo-pigmented patches and thickened areas, though these are not currently active. Mobility is notably impaired, with the patient demonstrating gait abnormalities and difficulty performing daily activities independently, often requiring assistance or the use of mobility aids. The overall clinical picture reflects a complex interplay of cancer-related and leprosy-related complications, necessitating a comprehensive and multidisciplinary approach to her physiotherapy and rehabilitation. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e mentioned manual muscle testing mentioned.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eManual Muscle Testing\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight side\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeft side\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder Flexors and Extensor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder Adductors and Abductors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow Flexors and Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Flexors and Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Abductors and Adductors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnee Flexors and Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkle Planter flexion and Dorsi flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePhysiotherapy rehabilitation\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe physiotherapy intervention was structures across three phases: acute, subacute and chronic. In the acute phase, the focus was on pain management, reducing inflammation and gentle mobility exercises. The subacute phase emphasized progressive strengthening, range of motion improvement, and functional retraining. In the chronic phase, the intervention targeted advanced strengthening, endurance training and strategies to enhancing long term functional independence and prevent recurrence mention in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePhysiotherapy Intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePhase\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGoal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProgression\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAcute Phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReduce post-surgical pain and inflammation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eCryotherapy\u003c/strong\u003e: Apply cold packs to reduce swelling and manage pain.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eTENS (Transcutaneous Electrical Nerve Stimulation)\u003c/strong\u003e: Use for pain relief.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eGentle ROM Exercises\u003c/strong\u003e: Perform gentle, pain-free range of motion exercises to prevent joint stiffness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eCryotherapy\u003c/strong\u003e: 15\u0026ndash;20 minutes every 2\u0026ndash;3 hours during the first 48 hours.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eTENS\u003c/strong\u003e: 15\u0026ndash;30 minutes, 2\u0026ndash;3 times daily.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eGentle ROM Exercises\u003c/strong\u003e: 2\u0026ndash;3 sets of 10 repetitions, 2\u0026ndash;3 times daily.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevent complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eDeep Breathing Exercises\u003c/strong\u003e: Encourage diaphragmatic breathing and incentive spirometry to prevent respiratory complications.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eManual Lymphatic Drainage\u003c/strong\u003e: Initiate gentle techniques to reduce lymphedema and improve lymphatic circulation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eDeep Breathing Exercises\u003c/strong\u003e: 10 deep breaths every hour while awake.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eManual Lymphatic Drainage\u003c/strong\u003e: 15\u0026ndash;30 minutes, 2\u0026ndash;3 times daily.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaintain mobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eBed Mobility and Early Ambulation\u003c/strong\u003e: Assist with bed mobility and promote early ambulation to prevent deconditioning and deep vein thrombosis (DVT).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eEarly Ambulation\u003c/strong\u003e: Begin within 24\u0026ndash;48 hours post-surgery; progress walking distance daily.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eSubacute Phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove mobility and strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eProgressive ROM Exercises\u003c/strong\u003e: Gradually increase range of motion exercises for the lower limbs and trunk to restore flexibility and joint mobility.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eStrengthening Exercises\u003c/strong\u003e: Start with isometric exercises, progressing to isotonic exercises targeting weakened muscle groups due to surgery or immobility.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eROM Exercises\u003c/strong\u003e: Increase repetitions and range weekly.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eStrengthening Exercises\u003c/strong\u003e: Start with 10\u0026ndash;15 reps, progress to 3 sets of 10\u0026ndash;15 reps.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManage lymphedema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eManual Lymphatic Drainage\u003c/strong\u003e: Continue and intensify lymphatic drainage techniques to reduce swelling and maintain lymphatic circulation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eManual Lymphatic Drainage\u003c/strong\u003e: 20\u0026ndash;30 minutes, 2\u0026ndash;3 times daily.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevent deformities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-Splinting/Bracing\u003c/strong\u003e: Apply orthotic devices to prevent or correct deformities related to leprosy-induced nerve damage.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eGait Training\u003c/strong\u003e: Implement gait training with or without assistive devices (e.g., walker, cane) to improve walking ability, balance, and coordination. Focus on correcting abnormal gait patterns and ensuring safe ambulation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eSplinting/Bracing\u003c/strong\u003e: Adjust every 2 weeks based on progress.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eGait Training\u003c/strong\u003e: 20\u0026ndash;30 minutes, 2\u0026ndash;3 times daily, progress as tolerated.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove abdominal strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Abdominal Exercises: Start with isometric abdominal contractions, progressing to dynamic exercises such as leg raises, pelvic tilts, and bridges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;2\u0026ndash;3 sets, 10\u0026ndash;15 reps, 3\u0026ndash;4 times/week.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eChronic phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnhance functional independence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eAdvanced Strengthening Exercises\u003c/strong\u003e: Incorporate resistance training and weight-bearing exercises to improve overall strength and endurance, focusing on affected areas.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eBalance and Coordination Training\u003c/strong\u003e: Engage in exercises using balance boards, stability exercises, and proprioceptive training to improve coordination, stability, and prevent falls.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eStrengthening Exercises\u003c/strong\u003e: Increase resistance/weight every 2\u0026ndash;3 weeks.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eBalance Training\u003c/strong\u003e: 20\u0026ndash;30 minutes, 3\u0026ndash;4 times weekly.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManage chronic pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eChronic Pain Management\u003c/strong\u003e: Continue using TENS, massage therapy, and heat therapy for persistent pain relief. Implement desensitization techniques for neuropathic pain, with gradual reintroduction of sensory stimuli.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eTENS/Heat Therapy\u003c/strong\u003e: 15\u0026ndash;30 minutes, 2\u0026ndash;3 times daily.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eDesensitization Techniques\u003c/strong\u003e: Gradual increase in exposure to stimuli.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImprove quality of life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eFunctional Training\u003c/strong\u003e: Focus on activities of daily living (ADL) training to enhance independence in self-care, household tasks, and community participation. Address practical skills needed for daily routines.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eHome Exercise Program\u003c/strong\u003e: Develop a personalized home exercise plan that includes strength, flexibility, lymphedema management, and functional activities to maintain physical gains and prevent regression. Encourage long-term adherence to ensure sustained improvement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- \u003cstrong\u003eFunctional Training\u003c/strong\u003e: 30\u0026ndash;45 minutes daily, progress to independent tasks.\u003c/p\u003e\n \u003cp\u003e- \u003cstrong\u003eHome Exercise Program\u003c/strong\u003e: Perform 4\u0026ndash;5 times per week, adjust exercises based on progress.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003eFollow up and outcome\u003c/h3\u003e\n\u003cp\u003eThe Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e below presents the Manual Muscle Testing (MMT) scores recorded pre and post intervention, highlighting changes in muscle strength and functional outcomes following the implemented therapeutic approach.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eManual muscle testing pre and post rehabilitation.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePre-Rehabilitation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePost rehabilitation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeft limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRight limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLeft limb\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder Flexors and Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShoulder Adductors and Abductors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElbow Flexors and Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Flexors and Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Abductors and Adductors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnee Flexors and Extensors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnkle Planter flexion and Dorsi flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eOutcome measures for pre and post rehabilitation mentioned in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and post rehabilitation outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre rehabilitation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost rehabilitation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumerical pain rating scale (NPRS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOn rest- 3/10\u003c/p\u003e \u003cp\u003eOn activity- 7/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOn rest- 2/10\u003c/p\u003e \u003cp\u003eOn activity- 5/10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Extremity strength (MMT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Extremity strength (MMT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHO- QOL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58/100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80/100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this case report, we present the rehabilitation of a patient with cervix cancer complicated by leprosy. The primary physiotherapy goal centred on pain management. Particularly in preoperative and post operative phases. Pain levels were assessed during Numerical Pain Rating Scale (NPRS), providing a qualifiable measure of the patient\u0026rsquo;s discomfort. our 6-week rehabilitation protocol led to significant reduction in pain, highlighting the effectiveness of targeted interventions during this critical period [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePostoperatively, the patient\u0026rsquo;s abdominal strength became focal point of rehabilitation process. Due to postoperative pain, pelvic floor muscle strengthening exercises were initially contraindicated. Strengthening the abdominal muscles not only improved the patients core stability but also indirectly enhanced pelvic floor muscle strength. This connection between pelvic floor muscle function and is well documented and proved to be effective approach to circumvent the limitations imposed by postoperative pain [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe comprehensive physiotherapy intervention, as outlined in treatment table, facilitated marked improvement in patient\u0026rsquo;s functional mobility. Functional mobility is cornerstone of rehabilitation, particularly in cancer patients, as it directly influences independence and overall quality of life. By alleviating pain and enhancing muscular strength, the patient was able to regain mobility, which in turn contributed to better postoperative recovery experience [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. By addressing pain and strength deficits, the patient was able to progress through rehabilitation with improved outcomes in mobility and daily functioning [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis rehabilitation plan was customized uniquely to meet the patient's needs and could be changed since the exercises were contraindicated in some instances. This flexibility was critical in ensuring the patient progressed even during troublesome events such as postoperative pain. Pain control combined with muscle strengthening and functional mobility meant the patient benefited a great deal from the physical and overall improvement of life quality [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe case report concludes that treating a cervical cancer patient along with the leprosy represents a diverse area where management would entail considerations for a dual diagnosis arising from physical rehabilitation strategies. The cases highlight the need for a comprehensive, individualized approach that addresses the unique challenges posed by leprosy-related impairments and the functional consequences of cervical cancer and its treatments. Successful rehabilitation in such cases depends on a multidisciplinary team effort, tailored interventions, and a focus on improving quality of life. This case of great benefit would also serve as a fundamental stepping stone towards the fine-tuning of rehabilitation practices and strategical development for dealing with similar cases in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and consent to participant:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from patients, and written informed consent was obtained from the patient for participation in this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for the publication of this case report\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003cstrong\u003e\u003cem\u003e.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; Contributions:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eG.A. and M.S. wrote the main manuscript text.\u003c/li\u003e\n \u003cli\u003eA.Z. conducted the literature review and provided critical revisions to the manuscript.\u003c/li\u003e\n \u003cli\u003eAll authors reviewed and approved the final manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments:\u003cbr\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding Declaration Statement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for the preparation of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrenner DE: \u003cem\u003eCase Report\u003c/em\u003e Carcinoma of the Cervix \u0026mdash; A Review. 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Accessed: August 27, 2024. https://journals.lww.com/jwphpt/abstract/2013/09000/pain_and_psychological_outcomes_after.2.aspx. \u003c/li\u003e\n\u003cli\u003eEffect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: A randomized controlled trial - ScienceDirect. Accessed: August 27, 2024. https://www.sciencedirect.com/science/article/abs/pii/S0090825812002399. \u003c/li\u003e\n\u003cli\u003eWomen\u0026rsquo;s Cancer Rehabilitation: a Review of Functional Impairments and Interventions Among Breast and Gynecologic Cancer Survivors | Current Physical Medicine and Rehabilitation Reports. Accessed: August 27, 2024. https://link.springer.com/article/10.1007/s40141-020-00261-9. \u003c/li\u003e\n\u003cli\u003eFialka-Moser V, Crevenna R, Korpan M, Quittan M: Cancer Rehabilitation. Particularly with aspects on physical impairments. J Rehabil Med Off J UEMS Eur Board Phys Rehabil Med. 2003, 35:153\u0026ndash;62. 10.1080/16501970310000511\u003c/li\u003e\n\u003cli\u003eThe impact of cervical cancer on quality of life\u0026mdash;The components and means for management - ScienceDirect. Accessed: August 27, 2024. https://www.sciencedirect.com/science/article/abs/pii/S0090825807007755. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cervical cancer, leprosy, physiotherapy rehabilitation, multidisciplinary approach, lymphedema management.","lastPublishedDoi":"10.21203/rs.3.rs-5885280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5885280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCervical cancer is significant health issue, particularly in women from low resource areas, and when combined with leprosy, a chronic infectious disease that affects the skin and peripheral nerves, the challenges of treatment and rehabilitation intensify. This case report discusses a 70-year-old female patient with both cervical cancers, treated through radical hysterectomy, chemotherapy, and radiation therapy, and a history of leprosy, which had already caused peripheral neuropathy and deformities. The concomitant issues, such as nerve damage, muscle weakness, and lymphedema, significantly reduced her quality of life and functional capacity. physiotherapy played a key role in her recovery, focusing on specific regimen that sought to strengthen certain muscles, offer gait training along with manual lymphatic drainage for pain relief. It was possible to manage pain, restore mobility and improve functional independence within a span of six weeks. It is emphasized how rehabilitation plans are to be used for such complex patients.\u003c/p\u003e","manuscriptTitle":"Physiotherapy Rehabilitation in a Patient with Carcinoma of Cervix and Leprosy - A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-06 06:04:45","doi":"10.21203/rs.3.rs-5885280/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ad65bd0c-0427-40d2-bd4a-4c1d2661fd33","owner":[],"postedDate":"February 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-12T14:53:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-06 06:04:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5885280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5885280","identity":"rs-5885280","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}