Background and Purpose:
Individuals referred to physical therapy
with a medical diagnosis of spinal accessory nerve palsy following medical intervention for head and neck cancer
(HNC) are often managed by focusing on upper-quadrant impairments. Consequently, the presence of multisystem dysfunction may be overlooked. The International Classification of Functioning, Disability, and Health (ICF) model provides a useful framework to assess the patient with HNC and cues the physical therapist to formulate a comprehensive patient-centered treatment plan. This case study sought to assess the effectiveness of using the ICF model
as a conceptual basis to develop a plan of care and assist a patient with HNC to realize his or her primary goal of returning to the workforce.
The patient was seen as an outpatient in the University of Southern California faculty practice as part of a DPT student integrated project. His chief complaints included inability to work as a carpenter due to right shoulder pain, weakness, and generalized fatigue. During the initial examination, the physical therapist identified activity and participation restrictions and contextual barriers that limited the individual's ability to perform his work-related tasks. Guided by the ICF model
theoretical construct, physical therapy
interventions targeted the barriers that prevented him from fulfilling his role as a carpenter.
Utilization of the ICF model
for evaluation and treatment of an individual with HNC proved to be effective in guiding the physical therapy
plan of care and in assisting the patient to achieve his primary goal of returning to work.