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Overview of Bone Tumors

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Bony tumors are classified and named based on the type of tissue from which they originate: osteogenic, chondrogenic, fibrogenic, angiogenic, or myelogenic. The incidence for some bony tumors is associated with their location within a bone, the age of the client, and with certain types that are more prevalent in adolescents, who are undergoing rapid changes in their skeletal structures. Treatment of bone tumor is based on the location, size, and staging. Radiation and chemotherapies have been successfully used to treat many benign and metastatic tumors, whereas other tumors are best treated with surgical excision and limb salvage procedures.

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Comorbidities to Consider

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  • Clients become deconditioned due to the disease process and treatment programs that produce persistent fatigue and decreased tolerance to physical activities.

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Client Examination

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Keys to Examination of Clients

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  • Determine the clients' physiologic status and preparedness for engaging in the physical activities by assessing the results of blood tests for platelet levels, hemoglobin, and white blood cell levels.

  • As a general guideline, clients undergoing chemotherapy should not participate in aerobic activities when hemoglobin levels are <10 g/dL and platelet counts are <50,000/mm3, but this may vary among medical centers. Clients need ongoing assessment for any abnormal responses to exercise.

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Recommended Baseline Testing of Fitness Levels

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  • Use walking tests or a cycle ergometer to assess clients' tolerance for exercise.

  • Clients' mobility and flexibility should be assessed before they begin exercise activities.1 Clients who have undergone surgical procedures should be assessed for wound healing and potential for return to activities.

  • Clients who have undergone amputation need to be assessed in preparation for prosthetic fitting or for wheelchair fitting. The Toronto Extremity Salvage Score or the Musculoskeletal Tumor Society Rating Scale can be used to provide a baseline for physical function, along with measures for pain and fatigue levels.2,3,4

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Exercise Prescription

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Type: Walking, cycle ergometry

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Intensity: Low intensities, 40%–65% of maximum heart rate5

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Duration: Start at 10–20 minutes, with short bouts

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Frequency: Five times per week

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Getting Started

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Intensity should be assessed by heart rate and perceived exertion levels as fatigue may be a limiting factor. Emphasize full movements of the extremities during resistive exercises, using low resistance and high repetitions as these will be important for regaining range of motion and functional mobility.5 Sitting and standing balance activities are important components for clients with amputated limbs in preparation for prosthetic or wheelchair fitting. Encourage clients to choose a variety of exercise and recreational activities to increase their levels of function and maintain a healthy lifestyle.

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References

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Carty  CP, Dickinson  IC, Watts  MC,  et al. Impairment and disability following ...

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