Return to Work After Head and Neck Cancer Surgery
A 55-year-old man underwent total laryngectomy and neck dissection for laryngeal cancer 6 weeks ago. He has a tracheostomy and is learning esophageal speech. He works as a customer service representative, requiring frequent verbal communication. He has shoulder weakness (3/5) and limited cervical rotation (30 degrees) due to surgery. He is eager to return to work but is concerned about voice and shoulder function. His employer is willing to provide accommodations.
1. What are the physical and functional impairments that may affect his return to work, and how would you assess them?
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Impairments: shoulder weakness (3/5) and limited cervical rotation (30 degrees) affecting reaching, lifting, and computer use; voice impairment affecting communication; potential lymphedema. Assess shoulder strength (MMT, dynamometry), ROM (goniometry), and functional tasks (e.g., reaching overhead, typing). Assess voice with speech-language pathologist. Evaluate work ergonomics and job demands. Use Patient-Specific Functional Scale to identify challenging tasks.
2. What interventions and workplace accommodations would you recommend to facilitate his return to work?
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Interventions: Strengthening exercises for shoulder and scapular muscles (3 times/week), ROM exercises for cervical rotation, and postural training. Voice therapy with SLP for esophageal speech. Ergonomic modifications: adjustable desk, headset for phone, voice amplification device, and written communication options. Workplace accommodations: allow breaks for voice rest, provide speech-to-text software, and modify phone duties. Gradual return to work (e.g., part-time initially). Educate employer on laryngectomy and communication strategies. Coordinate with vocational rehabilitation.