Rehabilitation after treatment for soft tissue sarcoma

Rehabilitation is an important part of returning to the activities of daily living after soft tissue sarcoma treatment. You may need to restore how your body works or find new ways of doing things that you did before. Recovery is different for each person, depending on where the cancer was in your body, the stage of the cancer, the organs or tissues removed during surgery, the type of treatment and many other factors. A person with soft tissue sarcoma may be concerned about:

• muscle weakness
• problems using and moving parts of your body, such as an arm or a leg
• problems doing activities of daily living
• fatigue

Several different healthcare professionals may be on your rehabilitation team. These may include the following.

Physiotherapists, or physical therapists, help you improve your body’s strength, flexibility (range of motion) and movement. This may include helping you with walking (called gait training) and doing other activities of daily living.

Occupational therapists help make sure you are able to complete your daily activities. They may suggest using assistive aids or making changes at your home, work or school so you can do things on your own.

Prosthetists are specially trained to design, make and fit people with artificial limbs called prostheses.

If you’ve had treatment for soft tissue sarcoma, you may have the following concerns about rehabilitation.

Members of the rehabilitation team can help you recover from soft tissue sarcoma treatment. They often meet with you after surgery and help you recover successfully.

Rehabilitation is needed after either limb-sparing surgery or amputation. Limb-sparing surgery is more complex than an amputation, and physical rehabilitation after limb-sparing surgery will be different than rehabilitation after an amputation.

• After limb-sparing surgery involving the leg, it can take up to a year to return to walking on your own without a cane, crutches or a walker. Some people may always need a walking aid after their recovery.
• After an amputation involving the leg has healed, you may be fitted with a prosthesis. You will learn how to use this during your treatment. With proper physiotherapy, most people are walking again in 3 to 6 months. But this can vary depending on each person’s recovery.

The rehabilitation health professional will teach you exercises to help keep muscles strong and the joints mobile to help your recovery. Physical therapy exercises that help maintain range of motion and strengthen the arms and legs are very important for people who have had surgery on a limb. There may be some restrictions after surgery until the area has healed. For example, you may not be allowed to lift heavy things, have too much pressure on a limb or move a limb in a certain way.

Some people may need a brace or splint to help support lower limbs and help make sure you are following any restrictions. Most people will need a cane, crutches or a walker at different times throughout their recovery to help them walk after leg surgery. In some cases, the use of a wheelchair may be needed. Sometimes a sling, splint or brace is needed after upper limb surgery.

People treated with radiation therapy for soft tissue sarcoma in a limb may have joint stiffness and decreased joint motion and muscle strength. It is important to keep using the joint as normally as possible during and after treatment. Physical therapy helps prevent and minimize disabilities after radiation therapy to a limb. An exercise program is often started early during treatment to help you keep strong and moving properly.

An artificial limb is also called a prosthesis. It may be used after an amputation of an arm or leg. Sometimes a prosthesis can’t be used. Members of the rehabilitation team can help you recover from limb amputation. They help you learn how to use and take care of the artificial limb, how to care for the stump and how to adapt the way you complete your daily activities.

A prosthetist makes each artificial limb specific for each person. The prosthetist may show you various prosthesis options. You may be measured for an artificial limb before or after surgery. The measurements make sure the prosthesis fits properly. Some people may have a temporary prosthesis until the wound has healed enough to allow a permanent prosthesis to be fitted. This may take up to 3 months. The prosthesis may need to be adjusted or refitted if you lose or gain weight or the stump changes in size.

Caring for a prosthesis and stump involves learning how to:

• keep the stump clean and dry and the skin in good condition
• check the stump daily for any signs of skin breakdown
• bandage the stump after surgery to help reduce swelling and to shape the stump, which helps prepare for wearing the prosthesis
• do exercises that strengthen the limb and maintain joint range of motion
• use an elastic wrap or stump sock before putting on the prosthesis and to make sure it is cleaned frequently
• put on the prosthesis and gradually increase the wearing time
• use the new prosthesis

A prosthesis allows you to walk, run, take part in sports and use the limb to perform activities of daily living. Artificial limbs can be very advanced and some are specially designed for sports or swimming. It can take many months to learn how to use an artificial limb. Some people need to use mobility aids like a cane, crutches, a walker or a wheelchair until they learn to walk with a lower limb prosthesis. Many people with artificial limbs can return to their previous level of activity.