Case Study #7: Leukemia

Jaclyn Cook, Madeline Barnauskas, Theo St. John, Larson

Karns, & Madison Martin
History Review
● Clinical/community case - OP PT - prehab
● 56 year old female
● Diagnosis:
○ Pt went to PCP with c/o severe fatigue, swollen lymph nodes, frequent infection, bruising
easily, and unexplained weight loss
○ PCP ordered blood test and bone marrow biopsy for diagnosis and staging
○ Diagnosed with chronic lymphocytic leukemia
■ Stage III
■ 3 weeks ago
● Pt will start chemotherapy soon
History Review
● Family:
○ 2 children, 13 and 16 y.o.
○ Married, husband works as a highschool teacher
○ No other family support in the area
● Occupation:
○ Hairstylist - for 30 years
○ Has concerns about insurance and the cost of treatment
● PMH:
○ HTN, prediabetes, hx of smoking, anxiety, depression, repetitive strain injury R wrist and shoulder
● Current medications:
○ Lisinopril, zoloft, iron supplement
● Physical activity:
○ Walks regularly with neighbor friends
○ No other exercise
○ Decreased aerobic capacity
Referrals
● Social Worker
○ Assist with coping of disease, family, and everyday life
● Psychiatrist
○ Treat potential mental disorders
● Occupational Therapist
○ Loss of fine motor skills and dexterity
● Dietitian
○ GI complications from chemotherapy, weight loss and maintain prediabetes
● Lymphedema Specialist
○ History of swollen lymph nodes
Evaluation & Assessment
● Depression Screen
○ PHQ-9: 9 item questionnaire to assess
depression
● Fatigue
○ Fatigue Severity Scale
● Sensation Testing
○ Monofilament Testing → Baseline for CIPN
and diabetes
● Gross UE and LE strength and ROM screen
● Mobility Testing
○ 6 Minute Walk Test → Endurance, Gait
Speed and Gait Assessment
○ 5TSTS
● Balance Testing
○ Single Leg Stance
○ Romberg
Clinic/Community/Pre-Rehabilitation
● Adding endurance and strength exercises to maintain or increase physical wellness
before treatment
● Make sure her family is aware of possible adverse effects from chemotherapy and
other treatments
● Address her home lay out and make sure that it is suitable for her when she receives
her chemotherapy and other treatments
● Address lab results to make sure that she is not anemic and is safe to participate in
exercise
● Patient education
Education

● Educate the importance of having family, friends and support groups

● Having appropriate shoes during exercise, due to peripheral neuropathy
● The importance of regular foot examination to prevent ulcers
● Advocate exercise during chemotherapy and other treatments
Education Continue
● Aware of possible decline in fine motor skills and muscle
weakness
● During chemotherapy to be aware of energy conservation and
possible fatigue
● Advise use of pulse oximeter and taking blood pressure daily to
ensure she is aware of her vitals
● Aware of potential edema due to her surgeries and
chemotherapy
Home Exercise Program
Start with a walking program and progress into strength exercises. Some
exercises could include:
● Abdominal Bracing
● Deep Breathing
● Wall angels
● Wall push ups
● Squats
● Lunges
● Marches
● Stretches
Exercise

Yoga/Tai Chi Flow

Positions challenge balance, flexibility, strength, and proprioception

Hold positions for 30 seconds each direction

Tai chi emphasizes mindfulness in each position - *stresses of dx

Promote functional balance as hairstylist and mother

References

Physical therapy guide to childhood leukemia. American Physical Therapy

Association.https://www.choosept.com/symptomsconditionsdetail/physical-ther
apy-guide-to-childhood-leukemia.Published January 8, 2021. Accessed July 4,
2021