ABOUT SIOBHAN

Siobhan O’ Reilly Bracken MISCP MPA MSc-Sports CLT has over 30 years of experience in physical rehabilitation. She founded The O’ Reilly Centre for Lymphedema, Cancer Rehab and Sports in 2006. She graduated from University College Dublin in 1982 with a Diploma in Physiotherapy, in 1998 from New York University’s Wagner School of Public Administration and in 2011 from University College Dublin with a MSc in Sports Physiotherapy. Siobhan is a Certified Pink Ribbon Program Instructor and A Certified Lymphedema Therapist.

LinkedIn: https://www.linkedin.com/in/siobhan-bracken-5a312119/

Career highlights

Siobhan started her career in 1983 with The North Western Health Board working in an Irish speaking community in County Donegal. She then accepted a position in a private practice in Toronto Canada and volunteered as team Physio with the Balmy Beach Rugby Club. She got married in 1986 in New York City, where she worked for three years at The Rusk Institute of Rehabilitation and volunteered with Dick Traum in the early days of the Achilles Track Club. At age 29 Siobhan co-founded and co-directed Duffy & Bracken PT, the first private physiotherapy practice based in a New York City hospital.

Breast cancer

In 1996 at age 36 Siobhan had treatment for right sided breast cancer which included a total lymph node dissection and TRAM Flap reconstruction, and so began her personal and professional  interest in cancer rehab, lymphedema and return to sports. Cancer rehab services were scare at that time and like everybody else she had to figure it out by herself by trial and error.

Work with Refugees

Inspired by earlier voluntary work in war-torn Bosnia, she decided to put her MPA in program evaluation to use and joined IRC.org, an international emergency relief agency as their first DM&E Officer (Program Design Monitoring and Evaluation) and did some consulting at the UN with UNIFEM. This work involved training front line personnel how to use a framework to improve program analysis and effectiveness. Over 4 years she rolled out the new framework with IRC staff in Bosnia, Afghanistan, Pakistan, Thailand, Azerbaijan, Georgia, Sudan, Guinea, Senegal, Sierra Leone and Kenya.

Founding The O’ Reilly Centre

In 2005 Siobhan returned to Ireland and founded The O’ Reilly Centre, A Physiotherapy Centre dedicated to training physiotherapists in cancer rehab and to rehabilitating people after cancer treatment and with lymphatic disorders. To gain expertise in this area she studied and worked with cancer US experts including Steve Norton, Dr Andrea Cheville, Jodi Winicour PT, Nancy Roberge PT, Doreen Puglisi MS then Dr M Stubblefield, Jeannette Zucker PT and Marina Guarnieri PTA at Memorial Sloan Kettering Cancer Center and with researcher Jill Brinkley PT in Atlanta. Siobhan is now certified in Cancer Rehab with New Zealand’s Lou James, is a Certified Lymphedema Therapist and a registered Pink Ribbon Instructor.

Cancer Rehab Physiotherapists as part of the Cancer Team

The cancer rehab physio is a member of the oncology (cancer) team. The team members are aware of what each member is doing with their patient and they communicate with each other as needed.

A patient’s oncology team may include the imaging radiologist, the pathologist, the onco-genetic counsellor, the cancer and plastic surgeons, the oncologist, the radiation oncologist, the clinical nurse specialist, the GP, the speech therapist, the occupational therapist, the dietician, the pain specialist, the psychologist, the psychiatrist and the counsellor. If the patient develops lymphoedema their team may also include the vascular consultant, a MLD therapist and/or a can rehab physiotherapist who is also a certified lymphoedema therapist. Cancer patients often need specialist aftercare services including fittings for prostheses, bras, wigs, scarfs and swimsuits. For community-based support, for example a driver to bring them to radiation therapy sessions, patients may have access to a cancer support group which is turn is supported by the national cancer society.

Working with Lymphoedema Ireland

Siobhan volunteers as a writer and blogger with Lymphoedema Ireland www.lymphoedemaireland.ie/ a national patient advocacy group and has posted the following educational articles for their website and newsletters:

• 10 Tips to Manage Cancer Related Fatigue

• Nordic Walking versus Brisk Walking and Jogging

• What is “The Gold Standard Treatment for Lymphoedema?

• Air Travel and Vacation Tips

• Water Based Exercises for Leg Lymphoedema.

Referrals for Cancer Rehab

It is never too late for a doctor to refer their patient for cancer rehab, for example, a patient may have mild lymphoedema for many years and can make an appointment to be assessed and if necessary be fitted with a compression garment and a course of Manual Lymph Drainage (MLD) and advise on how to prepare when planning a holiday and a long haul flight.

The oncologist, surgeon or GP may refer the patient who is complaining of stiffness many years after cancer treatment. Patients can call in and make an appointment for a course of hands-on manual therapy and stretching to soften and loosen tight restricted and sometimes fibrosed muscles and joints.

GPs may refer patients complaining of shoulder pain and stiffness, which is common in breast cancer survivors who play golf and tennis. A course of physio may relieve the pain and soften and stretch out the shoulder soft tissues for a smoother swing.

Early rehab however is the key and according to the research a course of early cancer rehab yields many benefits. A doctor’s referral for early cancer rehab may include:

• Manual therapy to recover full and pain-free range of motion when there is axillary cording, adherent scars and/or radiation fibrosis

• A strength program to recover functional movement.

• Assessment and treatment for secondary lymphoedema.

• Recording baseline limb circumferential measures for long-term surveillance.

• Measuring and fitting compression garments.

• Manual Lymph Drainage (MLD massage) to improve lymph flow.

• Education in self-care and lymphoedema risk reduction practices, including meticulous skin-care, self-MLD, multi-layer bandaging and cellulitis.

• Instruction in a 16 week progressive walking program to meet Physical Activity (PA) guidelines for cancer survivors.

Research shows that patients who are referred to cancer rehab early recover well and reduce their risks of developing the common impairments in the first place.

Physiotherapists trained in cancer rehab

Physiotherapists trained in cancer rehab are aware that besides the direct effects of cancer, patients are also dealing with the indirect effects of cancer treatment such as surgery, chemotherapy and radiotherapy. These Physios will observe the relevant precautions and contraindications when using manual techniques, exercise therapies and other physiotherapeutic modalities.

For example, cancer treatments may result in an area with a compromised vascular and lymphatic system that require the skin and cellulitis precautions. In another example, cancer treatments may result in local and systemic changes in bone density that require bony precautions.

Besides considering the direct and indirect effects of cancer and its treatment, Physiotherapists trained in cancer rehab, will also take-into-account, degenerative disorders associated with aging and other pre-existing conditions when planning their rehab approach. For example, patients may have cancer treatment bone density issues and bone density issues related their age, to menopause or to long-term steroid use for another chronic condition.

What we treat

• Breast cancer rehabilitation including manual therapy to mobilise cording (also known as axillary web syndrome), adherent surgical scars and radiation fibrosis. Lymphatic and compression therapy. Strength training. Lymphedema management and surveillance for early identification. Patient education in self-care.

• Rehabilitation after treatment for skin cancer, head and neck cancer, gynaecological cancers, sarcomas in lower extremities, metastatic bone cancer and lung cancer.

• Lymphoedema risk reduction practices

• Lymphoedema assessment and management.

• Lipidema management.

• Measuring and ordering compression garments

• MLD for sinusitis.

• Pink Ribbon Pilates Program after breast cancer.

• Yoga Therapy for lymphoedema

• Sports specific strength training after cancer treatment.

• 16 week walking program to helps survivors meet Physical Activity guidelines

Courses and training offered by The O’ Reilly Centre

High quality cancer rehab and lymphoedema services will soon be available in most hospital physio departments and private physio practices. Physiotherapy Schools now offer courses in the cancer rehabilitation. Since 2006 Siobhan has giving training and offering courses to her rehab colleagues and has been a guest lecturer, teaching physiotherapy undergraduates at University College Dublin. Her lectures and courses include:

• Introduction to Breast Cancer Rehab for Physiotherapists.

• Advanced Breast Cancer Rehab for Physiotherapists.

• The Strong Pink Women Program.

• Manual Therapy Techniques for Cancer Rehab.

• Radiation Fibrosis Syndrome and Physiotherapy.

• The healing lymphatic system; implications for cancer rehab.

• Developing a Breast Cancer Rehab Service in your Private Practice.

Course dates are posted on www.theoreillycentre.com,  Facebook and Twitter