Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol
ABSTRACT Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.
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- "This suggests that several patterns of altered scapulothoracic motion may exist in this population, which is consistent with findings in the general population of individuals with symptomatic rotator cuff disease . In light of this, numerous factors are likely to be responsible for altered scapulothoracic motion including pain, impaired scapulothoracic muscle performance, imbalances in anterior and posterior chest wall soft tissue flexibility, impaired resting shoulder girdle alignment, and altered motor control   . We believe that women who are undergoing breast cancer treatment will likely develop one or more of these factors, which, in turn, place them at risk for developing, altered scapulothoracic motion. "
ABSTRACT: Over 2.6 million breast cancer survivors currently reside in the United States. While improvements in the medical management of women diagnosed with breast cancer have resulted in a 5-year survival rate of 89%, curative treatments are associated with a high prevalence of shoulder and arm morbidity, which, in turn, can negatively impact a woman's quality of life. Breast cancer survivors frequently experience shoulder and arm pain, decreased range of motion, muscle weakness, and lymphedema. These symptoms can lead to difficulties with daily activities ranging from overhead reaching and carrying objects to caring for family and returning to work. Despite health care professionals awareness of these problems, a significant number of breast cancer survivors are confronted with long-term, restricted use of their affected shoulder and upper extremity. This problem may partially be explained by: (1) an incomplete understanding of relevant impairments and diagnoses associated with shoulder/arm pain and limited upper extremity use, and (2) the limited effectiveness of current rehabilitation interventions for managing shoulder pain and decreased upper extremity function in breast cancer survivors. Because breast cancer treatment directly involves the neuromusculoskeletal tissues of the shoulder girdle, it is understandable why breast cancer survivors are likely to develop shoulder girdle muscle weakness and fatigue, decreased shoulder motion, altered shoulder girdle alignment, and lymphedema. These impairments can be associated with diagnoses such as post-mastectomy syndrome, adhesive capsulitis, myofascial dysfunction, and brachial plexopathy, all of which have been reported among breast cancer survivors. It is our belief that these impairments also put women at risk for developing symptomatic rotator cuff disease. In this paper we set forth the rationale for our belief that breast cancer treatments and subsequent impairments of shoulder girdle neuromusculoskeletal tissues place breast cancer survivors at risk for developing symptomatic rotator cuff disease. Additionally, we identify knowledge gaps related to the current understanding of relevant shoulder girdle impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Ultimately, information from studies designed to meet these gaps will provide a scientific basis for the development of new, or refinement of existing, examination, intervention, and prevention techniques, which should lead to improved clinical outcomes in this population.Medical Hypotheses 07/2011; 77(4):481-7. DOI:10.1016/j.mehy.2011.06.015 · 1.07 Impact Factor
Conference Paper: A 580 × 500-element CCD imager with a shallow flat P well[Show abstract] [Hide abstract]
ABSTRACT: This paper will discuss an interline-transfer CCD imager employing a shallow flat P-well that incorporates CCD shift registers, as well as photodiodes. Aperture ratio is 32% and a smear level of -70db has been obtained. In the unit cell, an N type substrate acts as an overflow drain for blooming suppression, while a single flat P-well is employed in the imaging area.Solid-State Circuits Conference. Digest of Technical Papers. 1985 IEEE International; 03/1985
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ABSTRACT: Prognostics and Health Management (PHM) technologies for potential application on aircraft engines have been maturing rapidly in recent years due in part to initiatives supported by the Joint Strike Fighter program. Incorporation of new technologies such as PHM on product applications must be justifiable on the basis of cost versus benefit, i.e. affordability. This paper describes the development of a cost benefit analysis methodology to assess the effectiveness of PHM technologies on aircraft engines with respect to both financial and operational metrics to assist in making the appropriate case for product implementation. The methodology utilizes traditional reliability and logistics source information. This data is combined with fleet-wide operational metrics such as aircraft delivery schedules, projected usage, etc., and basic parts cost information to generate specific life cycle costs and operational impacts for specific PHM system capabilities.Aerospace Conference Proceedings, 2002. IEEE; 02/2002