Tereza Hořčicová
Faculty of Health Studies
Bc. Tereza Hořčicová is a graduate from the study program of Physiotherapy at the Faculty of Health Studies at UJEP. In her bachelor's thesis, "Physiotherapy after Breast Ablation" she monitored a selected patient from the pre-operative period, through the acute post-operative phase, and then during the period of her subsequent recovery. Through the use of modern investigative methods at the Laboratory for the Study of Motion (FZS UJEP) there has been established in Ústí nad Labem the comprehensive concept of physiotherapeutic care for patients after breast ablation. At the end of 2015, Tereza received the Scholarship of the Director of Health Insurance from the Ministry of the Interior of the Czech Republic for the branch in Ústí nad Labem and Hradec Králové for the best bachelor's thesis.

Can you explain to readers what you do as a physiotherapist?

I care for pacients who have problems with their musculoskeletal systems. Currently I am working at an orthopedic clinic. My work consists of therapy for patients after surgery of the spine, knees, hip and shoulder joints, and others. The main task of a physiotherapist in the post-operative phase is to ensure a complete return to normal physical activities and fitness. During rehabilitation I use modern physiotherapeutic methods according to the specifics of the surgical results.

“Cooperation with women after breast ablation, and discovering how
often there are post-operative complications, motivated me to focus
on this problem.”

To what extent is timely physiotherapeutic care able to reduce complications connected with surgical procedures?

The timely intervention of the physiotherapist enables the patient to prepare not only physically but also psychologically. By means of an understanding of the procedure itself and familiarizing the patient with the possibilities for preventative physiotherapeutic techniques which can be implemented almost immediately after surgery, we can prevent complications which lead to a marked impairment in movement. With a well-instructed patient it is then possible to prevent a long-lasting reduction of the range of motion in a shoulder joint and the pain associated with this, but also the often unpleasant complications in the form of lymphedema, which is a swelling of the upper limbs associated with the disruption of the lymphatic system during the removal of lymph nodes from the armpit.

What are the actual causes of breast ablation (removal) and why did you choose this topic?

The most common cause of breast ablation is the presence of cancer in the breast which threatens the physical condition of the patient. During my studies I led group lessons for members of the association ARCUS which cares for cancer patients. The lessons were for patients after breast ablation as a prevention of the reduction in the range of motion in the shoulder joint. Cooperation with these women and discovering how often there are post-operative complications motivated me to focus on this problem.

What methods did you use during the examination for breast ablation?

For the examination I used, other than the common examination techniques such as goniometry or anthropometry, also an instrumental evaluation of motion (3D analysis) and stabilometry. The 3D cinematic analysis of motion and stabilometric examination were conducted at the Laboratory for the Study of Motion at FZS UJEP, using the Qualisis camera system for evaluating motion in indicated parts of the body and the stabilometric Kistler plates for monitoring changes in balance.

How long did you monitor the patient and what do the results show?

I monitored the patient in the period before the surgery, in the three weeks after the surgery, and then at intervals of 3, 6, and 12 months after the surgery. The results reflect the influence of the surgery on the condition of the patient’s musculoskeletal system. In the post-operative phase, that is, roughly during those three weeks, a significant reduction in range of motion was visible in the shoulder joint on the side of the ablation, a swelling of the limbs and, among other things, also a significant change in the stability of her stance when compared with the examination before the surgery. The patient gradually improved during the therapy, which is visible in the course of monitoring and in the final evaluation. After a year of therapy the results were comparable to her condition at the beginning, before she underwent the surgery.

What are you currently working on?

Currently I am completely dedicated to the patients at the orthopedic clinic. More particularly, I am focusing on the problem of acquired defects of the foot and the possibilities of influencing the quality and functionality of feet in patients undergoing correctional surgery for bunions or stiff toe, hammertoe, or transverse arches. The prerequisite is a pre-operative intervention and cooperation with the patient for the greater effectiveness of recovery after the surgery.

Have you offered your experience and the knowledge you have gained to any health facilities?

A result of this topic was the publication of an informational brochure for patients with breast cancer which is freely available at the oncological ward and the department for thoracic surgery of Masaryk Hospital in Ústí nad Labem. Currently, in cooperation with the Internal Hematological and Oncological Clinic, it has also been provided to patients at the Brno Faculty Hospital in Bohunice.

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