Unit Plan for Recovering Mastectomy Patients, by Caitlin Aydt

Introduction:
This group had had surgery to remove the breast as well as tissue, lymph nodes, and muscle around it. This is called a Mastectomy and is a common procedure for women and men who have been diagnosed with breast cancer. Many patients experience shoulder stiffness after removal of the lymph nodes and muscle in the armpit and surrounding areas. These patients look to get the area where muscle and tissue have been removed working like it used to preoperational. This stiffness can be corrected with time, but more importantly with exercise and physical therapy.

This group is small, about 10-15 members at time, who are mostly women between the ages of 45-85, with a few younger and older exceptions, with the ability to function by themselves and who can handle physical activity. Due to what feels like a weightless conditions the patients will have what seems to be an easier recovery as that of therapy on "dry" land. Because of the shallow water for the aquatic therapy, these women, and possibly men, can have no previous aquatic skills in order to participate in this extremely effective plan for recovery.

Facilities:
The only facility requirement is any pool, preferably inside, with a large shallow end at about 4-4.5 feet deep. This is because women tend to be short and the group needs to be able to stand to do many of the exercises required, as well as mostly covered by water. It would also be convenient if the water temperature was held at about 75 degrees Fahrenheit to have it be comfortable, but not too hot for exercise.

Equipment:
The equipment needs are what look like dumbbells, but are in actuality PVC pipe with cut “noodles” on the ends to add resistance to the arms while under the water.

Goals:
The goal of this plan is to have the patients recover 100% from removal of lymph nodes, tissue, and muscle from mastectomy. They will also hopefully have the desire to keep up aquatic therapy for everyday exercise and recovery needs.

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Objectives, Activities, and Daily Plans:

Day 1:

* First 5 minutes ~ warm up by walking wall to wall in the shallow end of the pool to increase heart rate before stretching
* 5 minutes ~ Stretch the body out of the water. First the legs, both sides, then down the middle, calves, and hamstrings . Next the arms, carefully because that is the focus area of the therapy, but done to examine and increase flexibility. To finish rotate the neck to reduce get those muscles moving to reduce stress on them.
* 10 minutes ~ Get in the water and first start a small bounce, then add the movement of arms from the middle to the side, them the side to the middle. Then do the arms up and down. Finally, still bouncing begin to rotate arms in circles out to the side, depending upon flexibility. The objective is to strengthen the muscles using the water as a resistance. The instructor must make it clear for the patients to not stress the muscles if intense pain is felt.
* 5 minutes ~ Holding on to the side of the pool and kicking the legs to increase heart rate and to use arm strength to hold on to the wall.
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness.

Day 2:

* First 5 minutes ~ warm up by walking wall to wall in the shallow end of the pool to increase heart rate before stretching
* 5 minutes ~ Stretch the body out of the water. First the legs, both sides, then down the middle, calves, and hamstrings . Next the arms, carefully because that is the focus area of the therapy, but done to examine and increase flexibility. To finish rotate the neck to reduce get those muscles moving to reduce stress on them.
* 10 minutes ~ Get in the water and first start a small bounce, then add the movement of arms from the middle to the side, them the side to the middle. Then do the arms up and down. Finally, still bouncing begin to rotate arms in circles out to the side, depending upon flexibility. The objective is to strengthen the muscles using the water as a resistance. The instructor must make it clear for the patients to not stress the muscles if intense pain is felt.
* 5 minutes ~ Holding on to the side of the pool and kicking the legs to increase heart rate and to use arm strength to hold on to the wall. The difference from the first class, depending upon the increased strength, tell the group to push away from the wall a little to stretch the arm muscles out and slowly increase the shoulder muscles.
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness.

Day 3:

* 10 minutes ~ Same a previous sessions (see days one and two)
* 10 minutes ~ Begin using the equipment required for the class (PVC pipe dumbbells) for added resistance in the water; use the same movements as previous days
* 5 minutes ~ Stretch the arms out farther from the wall while doing the kicks from previous days.
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness.

Day 4:

* 10 minutes ~ Same a previous sessions (see days one and two)
* 10 minutes ~ Begin using the equipment required for the class (PVC pipe dumbbells) for added resistance in the water; use the same movements as previous days
* 5 minutes ~ Stretch the arms out farther from the wall while doing the kicks from previous days.
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness.

Day 5:

* 10 minutes ~ Same a previous sessions (see days one and two). A strong warm-up is more important than the workout itself.
* 15 minutes ~ Teaching and applying the freestyle and back strokes to increase the arm rotation. The strength of the arm muscles should be improved enough to try and even accomplish the stroke effectively. The instructor cannot expect a 100% recovery yet so the strokes will be a little difficult for the group to master.
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness. Just as important as the warm-up.

Day 6:

* 10 minutes ~ Same a previous sessions (see days one and two). A strong warm-up is more important than the workout itself.
* 15 minutes ~ Applying the freestyle and back strokes to increase the arm rotation. The strength of the arm muscles should be improved enough to accomplish the stroke effectively. The instructor still cannot expect full mastery yet, but the continuous attempts and movement should be good for muscle recovery and use.
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness. Just as important as the warm-up.

Day 7:

* 10 minutes ~ Same a previous sessions (see days one and two)
* 5 minutes ~ Use the equipment required for the class (PVC pipe dumbbells) for added resistance in the water; use the same movements as days 3 and 4.
* 10 minutes ~ Free style and backstroke laps
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness.

Day 8:

* 10 minutes ~ Same a previous sessions (see days one and two)
* 20 minutes ~ Free swim using any stroke or arm movement. Muscle recovery should be at about 85% or higher due to the time elapse and the aquatic therapy. CONGRATS!
* 5 minutes ~ Walking around the shallow end and cooling down. At the end stretch the arms and legs again to reduce soreness.

To conclude, the group should be recovered almost fully. The instructor should advise more aquatic therapy if they feel they aren't recovered, or just in general because it works the body without much pressure and unnecessary muscle strain. They have completed therapy sessions and should feel they can move freely and without much pain if any at all!

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