occupational therapy after spinal fusion

The occupational or physical therapist also helps arrange medical equipment for later use in the persons home, if needed. Similarly, individuals who have limited wrist control may benefit from using a plate guard, which creates a barrier around the plate to prevent spilling. On average, survivors complete hundreds of repetitions per half hour session. Spinal cord injury patients should use extra caution when showering by remaining seated, applying non-slip mats to the floor, and using a handheld showerhead to minimize the need to move around. In such cases, an occupational therapist must get creative and employcompensatory strategies: new ways to accomplish everyday tasks. Physical therapy after neck fusion surgery is a crucial part of the recovery process. Always follow the instructions and advice from your doctor. However after trying FitMi, I could feel that slowly and steadily I am improving. Here is an example of the types of exercises your physical therapist may recommend for rehab after cervical fusion. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Reachers can also assist some individuals with getting their feet through their pant legs when getting dressed. All rights reserved. You can learn more about how we ensure our content is accurate and current by reading our. Individuals with paralysis often find it easier to dress themselves in their beds instead of their wheelchairs. \_zwpc\ This is where your OT can help you out. Based on your health condition, your healthcare provider may have other instructions for you. Spinal fusion is a procedure that permanently joins two vertebrae into one solid bone. If spinal anesthesia is used, you will have no feeling from your waist down. Once you have mastered this, practice doing the exercise with a light weight in each hand. 382 0 obj <>stream With your palms down, lift your arms up into the air, holding them for 1 to 2 seconds. If the home is more than an hours drive, it is advisable to stop and get out to walk for a brief time. Huntington Beach, CA 92649 Occupational therapists work with patients on the activities that occupy their time and help them to participate in these activities as fully as possible. Tell your healthcare provider of all prescribed and over-the-counter medicines and herbal supplements that you are taking. Get Veritas Health Newsletters delivered to your inbox. Following promising phase 1 testing, Mayo Clinic is launching phase 2 of a randomized clinical trial of stem cell treatment for patients with severe spinal cord injury. Most surgeons will encourage patients to get out of bed and walk the first day after surgery, and recommend walking frequently throughout the initial recovery period, increasing the amount and length of the walks as tolerated. 18 0 obj Two other complications to watch out for include infections and blood clots. 6>b2_vX2iL+[3ms7ZRV;6Snw{u7I;hG*T;|wtt]99]8rWL6,`n0zE V+KB}\k 5$F,Bv8)EN}'?-wO~;{ZKE|XIqc endobj This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. This lack of movement means the levels above and below the fusion are now at a higher risk of also wearing out and wearing out faster because you had surgery. Repeat this 5 times on each side. Pacific St., Seattle, WA 98195 | 206-598-4830 . stream Loss of bowel or bladder control from pressure in the cervical or lumbar spine also usually needs surgery. Is Minimally Invasive Spine Surgery Right for You? Occupational therapy after spinal cord injury focuses on easing the transition back to everyday life. An occupational therapist may recommend using a universal cuff to spinal cord injury patients that struggle with gripping. endobj Work and school make up a significant portion of an individuals lifestyle, and occupational therapists can help patients understand what to expect as they return. SD(E2r$4CObGCO/ #: Your physical therapist will develop an individualized exercise program based on their assessment of your specific condition. To do shoulder shrugs, follow these instructions: Shoulder shrugs strengthen your trapezius muscles, helping to stabilize your neck and upper back and reduce the strain on your neck and shoulder muscles. Post cervical fusion exercises are a critical component to your full recovery. "I could not stand up, " she recalled. In some cases, spinal fusion may be done at the same time. "We will also use biomarker studies to learn about the characteristics of responders' cells. In some cases, the physical therapist may advise the patient to use a walker for stability. See How to Prep Your Home for Spine Surgery Recovery Video, Next Page: It may be four to six weeks before you can comfortably go back to work. The most severe pain will be in the days immediately following surgery. Your doctor will discuss this with you in advance. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. "We are hopeful about the potential of stem cell therapy to become part of treatment algorithms that improve physical function for patients with these devastating injuries.". This involves learning what day-to-day activities are most important to patients and finding a way to increase their engagement in these activities. The numbness or weakness will be felt in the body part where the nerve is involved, often the arms or legs. <> v>"A Happy Travelers start here. Restrictions similar to those for other spinal stenosis surgery procedures should be followed, along with any . A disk may be displaced or damaged because of injury or wear and tear. Another goal of physical therapy after neck fusion surgery is to work on postural flexibility and strength. 2020;95:406. SCI patients can maximize their independence by practicing everyday activities and using adaptive equipment. Your physical therapist will most likely instruct you in how to maintain proper posture when you . "Our patient also reported a strong improvement with his grip and pinch strength, as well as range of motion for shoulder flexion and abduction," Dr. Bydon says. Back support belts are used to reduce the risk of back injury and relieve pain in the short term. <> All rights reserved. Back or neck pain that interferes with normal daily activities may need surgery for treatment. We are vaccinating all eligible patients. A vital part of the recovery process is education combined with post-operative care, as suggested by your doctor, as well as physical and occupational therapy. After undergoing urgent posterior cervical decompression and fusion, as well as physical and occupational therapy, the patient demonstrated improvement in motor and sensory function. You may get a sedative before the surgery to help you relax. Manual therapy: o Grade 1-2 joint mobilization for neuro-modulation of pain (primarily thoracic region) 7 0 obj While its important for SCI patients to participate in both PT and OT, these compensatory activities have direct, real-world application, making them very important. Arrange for someone to help you for a few days with the household activities and driving. Laminectomy usually requires that you stay in the hospital one or more days. Many people find it helpful to bring sturdy slip-on shoes with them to the hospital, since surgeons and hospital staff encourage patients to get up and walk around as quickly as possible after the surgery. It is particularly important to stretch the hamstrings and quadriceps, as well as the middle back where the nerve root is located to prevent the formation of adhesions or scarring of the nerve. I feel more at ease in flexing.. The physical therapist will work with you to extend your ability to look from side to side, up, and down. Employers and educational institutions must make reasonable accommodations to help individuals with disabilities succeed. endobj Laminectomies can be performed in the cervical, thoracic or lumbar regions of the spine and may also be performed concurrently with a spinal fusion, which permanently joins two or more vertebrae together. <> Check out our bestselling tool by clicking the button below: Medications for Spinal Cord Injury That Help Minimize Complications, C7 Spinal Cord Injury: What to Expect in the Aftermath & Recovery Process, Activities for Spinal Cord Injury Patients That Promote Recovery. Youll also receive our popular recovery emails with SCI survivor stories and other useful tips you can opt out anytime. As pain gradually alleviates and the energy level rises, it is good to gradually increase activity levels. et al. Obtain Long Term Pain Relief. For example, a patient might practice how to get out of bed or brush their teeth. Stairs can be a major obstacle for individuals with lower body motor impairments. Revision surgeries usually necessitate bone graft implementation as an adjunct to hardware revision. A seated hamstring stretch can be performed while sitting on the edge of chair. The anesthesiologist will continuously watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Activities of Daily Living After . stream Mayo surgeons can perform spinal fusion from the back, front or side of the spine and have access to the newest varieties of bone-fusing materials. For example, some adaptive utensils can wrap around the forearm for those who cannot grip and others can have a bent handle for those who cannot twist or bend their wrists. While there's no guaranteed way to prevent acute central cord syndrome, you can help protect your spine from injury when you: Therefore, the next best option is to find alternative ways to promote a fulfilling lifestyle. If family members or friends cannot assist with major household responsibilities, a home health aide may be arranged. endobj Read on to discover more about why you want to have physical therapy after neck fusion surgery and what it might entail. To do prone extensions, follow these instructions: To do arm and shoulder retractions, follow these instructions: Arm and shoulder retractions focus on improving the strength of your shoulder blades, thus improving your posture. The surgeon removes the bony arch of the posterior part of the vertebra (lamina) to ease the pressure on the nerves in the area. What they tell you might be slightly different than what is presented in this general guide. You may have blood tests or other diagnostic tests. The goal at this stage of your recovery is to allow your spine to heal, your vertebrae to fuse, and your back muscles to grow stronger. The graft is inserted between the vertebrae and then rods and screws are placed. All of this comes together for a motivating home therapy program. Essentially, rehabilitation (physical therapy, exercise) can help patients recover from spine surgery as quickly and completely as possible. Stem cells were injected nearly a year after his injury and several months after his improvement had plateaued. Spinal injections Physical rehabilitation, physical therapy, or both Occupational therapy Weight loss (if overweight) Smoking cessation Assistive devices, such as mechanical back supports Laminectomy is usually done for back or neck pain that continues after medical treatment. During this time, its important to keep moving and to follow instructions from your physical therapist and your surgeon. c\jmZ/m1&(MT[zbg It will fade as you continue to recover. The Road To Recovery after Spine Surgery 6 A fusion stabilizes the vertebrae of the spine creating less chance for slippage of the discs. Youll build light daily tasks, such as driving and simple daily chores. We're proud of who we are and where we're going! Certain activities may be limited after your surgery. Rated as the number one physical therapy clinic in the United States on Yelp!, were committed to helping our patients: Give In Motion O.C. Spinal fusions, achieved by means of Steffee plates, can be followed by the patient being encased in a hip spica jacket for 3-6 months. You can read more about these broad milestones and when theyll occur below. <> Rehabilitation and exercise are an essential part of recovery from a lumbar spine fusion. 8\Oxw8URPPPfHB 1999-2023 Veritas Health, LLC. endobj Like physical therapy, occupational therapy may use task-specific, highly repetitive exercise to regain mobility. <> Update it with a new topper for just-right comfort. Sometimes a patient has recovered enough to leave the hospital but not enough to be at home. This site complies with the HONcode standard for trustworthy health information: verify here. Any nerve damage to your spine will take up to 2 years to completely heal. This can involve learning how to use adaptive tools and practicing new techniques to compensate for lost functions. (cross street is Ward), Digital Marketing by Incredible Marketing. Learn the symptoms and your options for treatment. You will still be taking medications to help manage your pain. % endobj Youll be asked to avoid: Physical therapy sessions are very important during this stage of the healing process. A Beginners Guide, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Central Cord Syndrome: Causes and How to Treat It, Decompression Therapy: What You Should Know About This Technique, What Minimally Invasive Spine Surgery Is and How It Works, Klippel-Feil Syndrome (KFS): Causes, Symptoms, and Treatment, lifting anything heavier than about 8 pounds, pain and redness in your lower legs that might extend above your knee, redness and swelling and the incision site, drainage or pus coming from the incision site. 14 0 obj At Fusion, it's our mission to improve the lives of everyone we touch by sticking to our core values; Humble, Driven, & Positive Attitude. Anterior lumbar fusion - uses an anterior (front, through the abdominal region) approach to fuse (mend) the lumbar spine bones together . Full recovery from spinal fusion surgery can take between six months to a year to resume normal activities. Its important not to get discouraged or hold yourself to standards and goals that arent a good fit for your circumstances. See Lower Back Stabilization Exercises for Back Pain, Next Page: See Prepare for Blood Loss after Spinal Fusion Surgery. Individuals with poor trunk stability may find it difficult to sit upright and remain balanced, especially when reaching for items. However, spinal fusion can greatly improve the quality of life for people who have it. Physical therapists typically propose adjustments to the work environment to help . Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. hb```f``2d` aB &$Z,S5arp@;O*qQ- They should be completed by moving arms and legs while avoiding any rocking or arching of the lower trunk. Or it is done when the pain is accompanied by symptoms of nerve damage, such as numbness or weakness in the arms or legs. Healthline Media does not provide medical advice, diagnosis, or treatment. Take 1 full breath between each repetition. A leg-lifter allows patients to move their feet and legs to increase ease of transfers and repositioning following spinal cord injury. 12 0 obj Mb6^WRINI| \,>oT3R}'rpgYqls&4mc5MCQ*;t.-S;sQnat4:o@,G0#BfLGawb1{@,jYO e`,zd8k There may be other reasons for your healthcare provider to recommend a laminectomy. For example: Hospital recovery after a fusion surgery focuses on managing pain and learning how to move safely while the lumbar spinal fusion solidifies. Redness, swelling, bleeding, or other drainage from the incision site, Trouble urinating or loss of control of your bladder or bowel, The reason you are having the test or procedure, What results to expect and what they mean, The risks and benefits of the test or procedure, What the possible side effects or complications are, When and where you are to have the test or procedure, Who will do the test or procedure and what that person's qualifications are, What would happen if you did not have the test or procedure, Any alternative tests or procedures to think about, Who to call after the test or procedure if you have questions or problems, How much will you have to pay for the test or procedure. 5 0 obj About 6 weeks to 3 months after surgery, an outpatient physical therapy program may be started. CELLTOP clinical trial: First report from a phase I trial of autologous adipose tissue-derived mesenchymal stem cells in the treatment of paralysis due to traumatic spinal cord injury. ]g~Mjm56t9SAS1b3cM Do you notice how tight the muscles in the back of your neck always feel? Follow any directions you are given for not eating or drinking before the surgery. Do not bend forward at the waist more than 90 or raise knees higher than hips. Masks are required inside all of our care facilities. 1 0 obj During this time period of about 1 to 3 months after the surgery, the lumbar fusion bone mass is becoming established. Home Neurological Recovery Blog Spinal Cord Injury Occupational Therapy for Spinal Cord Injury Patients: How Everyday Activities Can Increase Independence. The healthcare staff will clean the skin over the surgical site with an antiseptic solution. Your physical therapy team will help teach you recovery exercises. Your healthcare provider will explain the surgery to you and offer you the chance to ask any questions that you might have about the procedure. 360 0 obj <> endobj 17 0 obj In addition to a complete health history, your healthcare provider may do a physical exam to make sure that you are in good health before undergoing the procedure. The worst pain is generally over by 4 weeks after surgery. The surgeon's technique and the patient's individual diagnosis will influence what rehabilitation should be done. However, there are a few simple exercises you can take on at home that are part of nearly all spinal fusion recovery programs. I believe this device will help me concentrate on making the repetitive actions needed to obtain further movement range in my wrist and hand and arm and therefore rating it with five stars. ,xxP[j!5 )wi!Z]4bQ&siL#pE )f{0|-\i\m~bfwqcxo{N>&wl<<8jUqa=~_\2}-7}1@{v Your spine is fusing and growing together by this time. A laminectomy is considered only after other medical treatments have not worked. %%EOF Please refer to your doctors instructions and follow them closely. The incision is checked every day to ensure it remains dry and clean. a call today to schedule your consultation. Last medically reviewed on March 23, 2022. While the program will be different for each patient, here is a general guideline for post-operative spine fusion rehabilitation that should be customized for each patient. Patients will not be able to drive themselves home. Whether you are preparing for neck fusion surgery or have already gone through surgery and are looking for physical therapy after neck fusion surgery, In Motion O.C.s experienced physical therapists are here to help. &iiB)0N|IWY `XMdET>ykc(9{"k a\&'^G n9 <> To minimize the risk of falling, an occupational therapist may recommend using a reacher as an extension of the arm. The occupational therapist is a therapist who, through advanced study, specializes in rehabilitating patients with conditions affecting the hands and upper extremities. 's new Physical Therapy Director in Fountain Valley, Physical Therapy for Arthritis: Slowing Progression and Relieving Symptoms. Sometimes a patient-controlled analgesia (PCA) pump is used, in which the patient controls when an attached device administers the pain medication. <> Your doctor will prescribe pain medication to help manage the pain in the first week or two. Using your arms, press up and out of the chair until your elbows are straight. The surgery is done to help stabilize your spine, reduce pain, or address spine issues, such as scoliosis.. A raised toilet seat may reduce the height difference between a patients wheelchair and the toilet seat, making the seat easier to get on and off from, and can minimize pressure on the joints. If you liked this post, youll LOVE our emails and ebook. . <> Form a bridge with trunk raised by raising hips from floor and keeping a straight line from shoulders to hips. cF"_Pi_~%>65Hg/'fKDe{+9Hl3AYP=xQ>R{x0s2fOI2iOBY^UHs-M6p[\gmv0v6j2me>+qu=L 8|BB[>4w}%9 x 5v=X Its important to seek immediate medical treatment if you have symptoms of either complication. Most people will feel that they are fully recovered by about 1 year following their spinal fusion. #2: Strengthen Postural Flexibility Another goal of physical therapy after neck fusion surgery is to work on postural flexibility and strength. as well as perform any hobbies or recreational activities. Compensatory strategies typically involve the use ofadaptive toolsto help make up for lost function. (1 Keeping the spine aligned correctly is important after surgery in order to minimize its workload and reduce the risk of disrupting the healing process. Your doctor will have specific guidelines for you. Occupational Therapy helps develop, recover or maintain daily living and work skills. Fountain Valley, CA 92708 A sterile bandage or dressing will be applied. To do the pectoral doorway stretch, follow these instructions: The pectoral doorway stretch improves your posture and increases the range of motion in your thoracic spine and shoulders. Anterior cervical discectomy and fusion is one of the most common surgical procedures performed in the United States. hbbd``b`@ $X\W+Y@BEHx4?C7 * Some medical treatments for pain may include: Laminectomy is usually done for back or neck pain that continues after medical treatment. See Getting Adequate Pain Control After Back Surgery. Having physical therapy after cervical spine surgery can help to maintain range of motion and prevent or postpone the need for additional surgeries. <> Iliac crest bone graft is the gold standard but availability can be limited and usage often leads to persistent postoperative pain at the donor site. The patient must move frequently beginning the first day after surgery. You may be told to stop these medicines before the procedure. 15 0 obj An orthopedic specialist will check on your spinal fusion after 6 months. Get Veritas Health Newsletters delivered to your inbox. Treatment Spinal Fusion 3 Weeks to 3 Months After ACDF Surgery 3 Weeks to 3 Months After ACDF Surgery By: David DeWitt, MD Peer-Reviewed Watch: ACDF Video By 3 weeks, patients usually are cleared to do some light work around the home. Spinal Fusion Surgery Recovery: 3 Months and After, Learn how bone growth stimulation therapy can help your healing process. Aspirin or certain other pain medicines may increase the chance of bleeding. Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthesia medicines (local and general). This helps ease pressure on the spinal cord or the nerve roots that may be caused by injury, herniated disk, narrowing of the canal (spinal stenosis), or tumors. Because of the large surface area of the mattress, individuals can move around without worrying about losing their balance or falling over. Also while lying on the stomach, extend hip muscles by raising one leg at a time holding the knee straight. Various compensatory strategies need to be taught to these patients to make swallowing safer and to prevent aspiration. Rehab after cervical fusion may include the following 3 phases of exercise: Having physical therapy after cervical spine surgery will help you to recover more quickly and prevent re-injury by: Following neck fusion surgery, you will lose some range of motion in your neck. Everyones recovery timeline can look slightly different depending on factors such as their overall health, ability to exercise, ability to heal, weight, and more. Repetition is critical because it helps sparkneuroplasticity; the mechanism the central nervous system uses to rewire itself and regain function after injury. Support groups and forums are great places to build community during your recovery. %PDF-1.4 Laminectomy is a type of surgery in which a surgeon removes part or all of the vertebral bone (lamina). 3. Wearing a snug-fitting t-shirt or tank top under the brace helps make it more comfortable against the skin, and prevents skin irritation such as rashes or blisters. Occupational therapy will help prepare SCI patients to return to their everyday lives through restorative and compensatory strategies. You will most likely start getting out of bed and walking the evening of your surgery. Showers are typically not allowed the first few days after spinal fusion surgery. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Patients may progress from Techniques for Effective Exercise Walkingto more demanding exercises, such as swimming. endobj Spinal fusion surgery connects two or more vertebrae of your spine together. This medication may be given in the vein or by injection into the muscle of the arm or leg. But first, lets discuss the reason why occupational therapy is critical for all spinal cord injury patients. Get back to enjoying their day-to-day activities pain-free, In Motion O.C. Be sure to discuss any concerns with your healthcare provider before the surgery. 1. Advanced techniques. Using a transfer benchcan make it easier and safer for individuals to get in or out of the bathtub. Youll still need to avoid bending, lifting heavy objects, and twisting motions. Stretching of muscles should be done slowly with 30-second holds, three repetitions, two sets per day. gi;;93HAAOC?Yd0vua"v?JtthfWGAAAA!bB-.Q]]&b?oz#zc:'Vtu3)'?.BXL>MOVRjfWOAAAA! tt~t3JTPPPPCtz@G:'h*2wuA4]_G:t/*UPPPPGX:{:{}IF8KU]]\l[fPezcv@!oxuu2?3G~hC+wv -_oh!rw+(((\:w#?DdGWW@AAAF2vDJh?6~%r6TPPP9$j~ET:pMbt=W}=$6>GcTeGq%/ V However, there are some general milestones you can expect to hit as you recover. Other doctors told him he might never walk again. <> Tell your healthcare provider about any of the following: Don't drive until your healthcare provider tells you it's OK. Don't bend over to pick up objects or arch your back. The transition from the hospital will be smoother if the home has been adapted in advance to accommodate recovery. Most people are not able to resume all their usual activities for at least 6 months, and it may be 1 year or more before some activities can be attempted. Occupational therapy after spinal cord injury focuses on easing the transition back to everyday life. Lifting items that weigh up to 10 pounds is now allowed. Youll begin with walking and other small activities. Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015, Spinal Fusion Surgery Recovery: 1 to 3 Months After, Guide to Physical Therapy After Spinal Fusion, Back Surgery Video: How Spinal Fusion Stops Back Pain, Getting Adequate Pain Control After Back Surgery, Practical Advice for Recovering from Back Surgery, Postoperative Care for Spinal Fusion Surgery, Hospital Care After Spinal Fusion Surgery (2 to 4 Days), Spinal Fusion Surgery Recovery: After Discharge (First Few Days), Spinal Fusion Surgery Recovery: 1 to 4 Weeks After, Spinal Fusion Surgery Recovery: 3 Months and After, How to Prep Your Home for Spine Surgery Recovery Video, Physical Therapy after Spinal Fusion: Weeks 6 to 9, Techniques for Effective Exercise Walking, Physical Therapy after Spinal Fusion: Weeks 9 to 12, What Causes Buttock Muscle Pain and How to Relieve it, Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency, Massage to Reduce Buttock Muscle Pain from Piriformis Syndrome, Suffering from Lumbar Spinal Stenosis? Patients may progress from Techniques for Effective Exercise Walking to more demanding exercises, such as swimming. We will never sell your email address, and we never spam. Following these guidelines will protect your spine and help you recover. Extend the upper body by lying on the stomach and squeezing shoulder blades together while slowly raising head and shoulders only one inch off floor. Youll talk with an orthopedic specialist at around the 6-month mark. By simply placing the foot inside the loop and pulling on the strap, patients who have good upper body strength can easily maneuver their legs. When the disk presses on the spinal nerves, this causes pain, and sometimes numbness or weakness. Bring your shoulder blades down and back. See Guide to Physical Therapy After Spinal Fusion. The quadriceps flexion stretch is done while lying on the stomach, and bringing heel toward buttocks as far as possible. Theres no one set path for recovery from spinal fusion surgery. Unlike physical therapy, however, occupational therapy takes a more holistic approach by using practical, activity-based techniques and exercises to improve ones ability to engage in daily life. <> Youll also meet with physical and occupational therapists to begin your recovery. You might need to stay longer if youre at risk of an infection or other complications. "Not every patient who receives stem cell treatment is going to be a superresponder. However, there might be permanent restrictions in certain circumstances. Want 15 pages of SCI recovery exercises in PDF form? Depending on your job, you might be allowed to return to work during this stage. An ALIF is just one kind of lumbar spine fusion. With education from an occupational therapist, many patients with spinal cord injuries are able to complete self-catheterization, greatly increasing their independence with toileting. Much of the education component will focus on teaching the patient how to be aware of their posture throughout the day in order to get back to a healthy postural state. Manual Therapy Grade 1 or Grade 2 joint mobilizations for neuromodulation of pain Scar mobilization: educate patients in scar mobilization

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