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You have been asked by a head and neck surgeon to evaluate a right-hand dominant 46-year-old self-employed carpenter. The patient has been complaining of increasing pain in the right shoulder region following a right-sided neck dissection performed 3 months ago. Six months ago, the patient was diagnosed with squamous cell carcinoma of the mucosal lining of the head and neck and he has been undergoing intervention for this condition since. Surgical clearance of Levels I to IV of the posterior triangle of the neck was performed and the patient completed 5 weeks of daily radiotherapy to this region. The patient's previous medical history is otherwise unremarkable. Amongst a variety of issues, the patient has been complaining of an inability to fully elevate his right upper limb since the surgery. The increasing pain has also caused his sleep to become disturbed. He is aware that he "lacks strength" in his right upper limb in a variety of activities of daily living (ADLs). He reports that his social encounters with other individuals who have undergone head and neck surgery have made him fearful that his physical function will continue to deteriorate and he has concerns for his future quality of life (QOL).

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What are the examination priorities?

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Based on his health condition, what do you anticipate may be the contributors to activity limitations?

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What are possible complications that may limit the effectiveness of physical therapy?

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What is his rehabilitation prognosis?

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Describe a physical therapy plan of care based on each stage of the health condition.

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How might the patient's emotional condition affect rehabilitation?

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ACTIVITIES OF DAILY LIVING (ADLs): Typical functional pursuits of the individual based upon his work, hobbies, and general lifestyle both prior to and after surgery

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HEAD AND NECK CANCER: Typically relates to cancer of the mucosal lining of the head and neck and most commonly involves the lymph nodes of the neck

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NECK DISSECTION: Surgical clearance of all cancerous cells and relevant lymph nodes of the region; commonly called "Levels I to IV clearance" based on the anatomical division of lymph nodes of the neck into distinct groups

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QUALITY OF LIFE (QOL): Relates not only to the ability of an individual to perform ADLs, but also to the individual's social interactions with others; commonly takes into consideration both physical and mental health and emotional well-being

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SHOULDER: Includes both the glenohumeral and scapulothoracic complex and associated musculature that control position and range of motion (ROM) of the upper limb

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  1. Outline the anticipated physical presentation of the individual at 3 months postsurgical neck dissection and identify the adaptive processes that have likely occurred.

  2. Understand the interaction of different neuromusculoskeletal structures causing ...

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