<> d]'^qnuN"t7fD&PJIA)8_m"-d'# Ujvs The therapist also can teach basic and simple neural mobilization for the nerves involving the lumbosacral plexus. Get Veritas Health Newsletters delivered to your inbox. 4. <> endobj Please click on the following links for your rehab protocols. 617-732-5500, Rehabilitation Services - Physical and Occupational Therapy, Arthroscopic Anterior Shoulder Stabilization Protocol, Latissimus Dorsi Tendon Transfer Protocol, Open Anterior Shoulder Stabilization Protocol, Posterior and Posterior Inferior Capsular Shift of the Shoulder Protocol, Proximal Humeral Fracture Open Reduction Internal Fixation (ORIF), Reverse (Inverse) Total Shoulder Arthroplasty Protocol, Rotator Cuff Repair Small to Medium Tear, Rotator Cuff Repair Large to Massive Tear, Ulnar Collatoral Ligament of the Elbow Reconstruction Protocol, Autologous Chondrocyte Implantation Protocol, Medial Patellofemoral Ligament (MPFL) Reconstruction, Post-operative Rehabilitation Protocol following Arthroscopic Hip Surgery for Femoroacetabular Impingement, Ankle Fracture with Open Reduction and Internal Fixation (ORIF), Brostrom Gould Repair for Ankle Instability, Functional Activity Progression Protocol following Lower Extremity Stress Injury, Return to Sport Following Knee Injury/Surgery, Running Injury Prevention Tips & Return to Running Program, Running Injury Prevention Tips & Strength Training Program, Reverse (Inverse) Total Shoulder Arthroplasty, Anterior Cruciate Ligament (ACL) Non-surgical Management, Non-Operative Management of Labral Tear of the Hip, Pelvic Floor Considerations in the Transgender and Gender Nonconforming Patient, Breast Reconstruction following Mastectomy, Physical Therapy Treatment of Blocked Milk Ducts, Inpatient-Specific Physical Therapy Standards of Care, Inpatient PT and OT Services: Main Campus, Anesthesiology, Perioperative and Pain Medicine. It is caused by impairment of a certain pathway in the sympathetic nervous system. discretion and will be fit and set up by representative (EBI/TERA). endstream ?LlAZlE0`x/*Xr``Gd0@Z|Kr)}$$WL6N:\K[XH angle from your sides, then take a small step forward until you feel a stretch in the front of your. endstream endobj startxref continue to advance/progress exercise program. Confirmatory diagnostic testing often includes MRI scanning and discography for equivocal cases. Push belly forward to move into stretch while keeping chest high. Your therapist should monitor and assess your progress frequently to ensure you're hitting the milestones before moving on to the next phase of the protocol. H\n0. Anterolisthesis, or a forward slippage of one vertebra on the next, is the hallmark radiographic finding in spondylolisthesis. Spine surgery patients who start physical therapy early tend to resume functional activities sooner than those who don't. Kd."qpXJ@n,M54:,m[vcga8yV9 An inpatient orthopedic rehab program conducted under professional supervision at a reputable facility is one of the best ways to help accelerate your healing process so you can resume normal activities safely post-op. A well-designed PT protocol will help you strengthen and stabilize your neck and back and improve your posture to prevent re-injuries as your resume normal activities and become independent. endobj While safe recovery from back surgery cant be rushed, there is a right and a wrong way to do it. ,xxP[j!5 )wi!Z]4bQ&siL#pE )f{0|-\i\m~bfwqcxo{N>&wl<<8jUqa=~_\2}-7}1@{v 0000010336 00000 n Examples of other exercises (performed while bracing) initiated in the later stages of phase II include the following: Lateral pulls (light resistance with approval of surgeon), Scapular depression (avoid resisting more than 40% of body weight), Push-ups standing and leaning into the wall. <> Fact: With the advancement of medical technology, the recovery time after spine surgeries have reduced in comparison to previous times. Multiple incidents of spinal surgery [29] . With the personal attention that comes from our being part of a smaller community. A physical therapist must respect the guidelines from the operating surgeon since they know the ins and outs of the surgery performed. Incisional pain can be expected to decrease gradually over 6 to 8 weeks. Understand self-management and concept of pacing concept and considering posture to 9 0 obj Physical therapy management during this phase consists of teaching patients the proper way to get in and out of bed, dress and perform other self-care activities, and walk (perhaps with a walker for the first 1 or 2 days). If any of the following occur, contact Dr. Poulter and hold off on physical therapy: Any signs of infection A seated hamstring stretch can be performed while sitting on the edge of chair. Rehab Selects post-surgical inpatient rehab is provided by a team of highly skilled professionals who will tailor a recovery plan to meet your specific needs. 16 0 obj <> Proximal Humeral Fracture Open Reduction Internal Fixation (ORIF) Reverse Shoulder Arthroplasty. endobj endobj 0 They should have a good grasp of not only the exercises and physical activity required to reach their goals but also ways to modify those activities. 0000002620 00000 n <> This position is the basis for keeping the lumbar spine stable. 13 0 obj Rehabilitation Protocol: Post-Operative Lumbar Spinal Fusion Department of Neurosurgery Lahey Hospital & Medical Center, Burlington 781-744-7580 . <> Patients should follow their surgical team's recommendations. See Lower Back Stabilization Exercises for Back Pain, Next Page: Meeting with a physical therapist before and/or a few days after surgery is important so specific direction can be given on when to begin various types of exercise. V1lJts)`(V$J dB~#-&4sKn"_^ oet!i2*J&tcTZ=AT]$XW,|t&*u3gRED|MtK,5R0Be5Jt.rFD2XNf*t+YxE"Ej#@ ju/p*2uhEzbm7@jLehl35`W=7'Jonm6;Ndt_Od}C{Ly]n`qvV@2UwB AvyM"+4cg&#*~V~%c%#[V+]Nt#O$L(R D r`b,`WhyczvY-|;''6W 'aR-tOj JQl-__Q#^mKu]*vs@'YPC,e &;+L'p)8u,\7 @Mj"vwF'9c{u3*z,txN. While supporting the raised leg with hands behind the knee, pump the ankle while holding the knee still. 10 0 obj Stronger muscles take the load off your joints, reducing the risk of overuse and pain. endobj endstream ]3d{ [.]wq,U('q; conducted under professional supervision at a reputable facility is one of the best ways to help accelerate your healing process so you can resume normal activities safely post-op. A sprain affects the ligaments between two bones, otherwise known as a joint. Patients should be progressing to full restoration of their pre-injury level of function and be independent with conducting their previous home and gym program. as soon as they can after spinal surgery to counteract the adverse physiological effects associated with prolonged bed rest. Through soft tissue mobilisation techniques. 0000010876 00000 n Spine fusion surgery can be done in the neck, mid back, and low back regions of the spine, and your physical therapy schedule will vary based on this and other factors, so it's good to involve your PT early. 6>b2_vX2iL+[3ms7ZRV;6Snw{u7I;hG*T;|wtt]99]8rWL6,`n0zE V+KB}\k 5$F,Bv8)EN}'?-wO~;{ZKE|XIqc Here's what to look for in a spinal surgery physical therapy protocol: A Multi-disciplinary Approach to Back Surgery Rehabilitation. endobj 0000004902 00000 n Orthopedic rehab aims to restore mobility and motor function, build strength, and support recovery from injuries affecting the muscles, bones, and jointsincluding injuries to the spinal column and spinal cord. Follow-up x-rays may be taken at 1 week and 6 weeks to demonstrate the beginning of bone healing at fusion site. s\A0W+ Spinal Rehab. Brace removed at approximately 8 weeks, if indicated will begin physical therapy. It also provides technologically advanced care techniques, such as state-of-the-art electric nerve stimulation devices to improve nerve responsivity in the spinal cord. Choose from one of the five Alabama locations of Rehab Select as the place to ensure a safe and successful return to your workplace, family, and social life. General strength and conditioning exercises should also be initiated during this phase of rehabilitation after it is cleared by the physician and the patient demonstrates appropriate stabilization. The team of compassionate, highly renowned orthopedic surgeons and specialists at Hamilton Orthopedics, Spine & Sports Medicine are dedicated to providing patients with the most advanced orthopedic care in sports medicine, reconstructive surgery, total joint replacements and revisions, treatment of spinal cord injuries and diseases, on-site x-ray and casting, on-site physical therapy and rehabilitation, and arthroscopic rotator cuff repair. % Clavicle Protocol Non-Surgical. It also provides technologically advanced care techniques, such as state-of-the-art electric nerve stimulation devices to improve nerve responsivity in the spinal cord. <> 0000060336 00000 n Co-contraction of the TA, multifidus, and pelvic floor muscles with and without using pressure biofeedback (BFB). PT should be part of this patient-centered, evidence-based, multi-disciplinary approach that reduces a patient's surgical stress response and accelerate recovery. Rehabilitation for the postsurgical orthopedic patient. Our doctors also perform surgeries at APEX Surgical Center. %PDF-1.7 Schedule a tour to see how we can be part of your healing journey. modulation as part of the physical therapy treatment plan. <> 7 0 obj 0000051766 00000 n The information contained in these standards of care or protocols is not intended in any way to be used as primary medical advice or to replace medical advice offered by physical, occupational, speech therapists or other health care professionals. Hip flexors stretching should only start after the permission of the surgeon. <> Therapist must have a complete picture about the procedure, surgical approach and fused levels. (2015). endobj Gradual return to ADL's at home ! 12 0 obj lumbar fusion physical therapy post op protocol n psif/alif/llif/tlif typical psif can be done alone, or in combination with anterior, lateral lumbar, or transforaminal lumbar interbody fusion placement of one or multiple interbody devices into disc space through posterior, anterior, lateral or transforaminal approach. 14 0 obj ]=:Xf 8d~@/Z~s Igkv6RQo1(Y2tz;M=q]pFO^z:K}#3jRR ['W"y-T{< . Osteophytes and segmental disc space narrowing in patients with degenerative spondylosis. Continue to take prescribed pain medication and use ice as needed for pain control. **If patient cannot complete these correctly, they should not be performed independently. 3. This stretch may cause increased symptoms during the stretch, which should resolve immediately on relaxing. 7 0 obj 2013-2023 Rehab Select. Spine surgery patients who start physical therapy early tend to resume functional activities sooner than those who don't. With your elbows bent, place your forearms on the sides of the doorway at roughly a 60 degree. Frozen Shoulder. Post-Operative Protocols The following protocols may be prescribed to you after surgery. 0000004423 00000 n D-Lateral Interbody Fusion: nerve stretch injury reported, with L4 nerve root injury most common. stream 6. 1 to 5 days after surgery (inpatient) and up to 6 Weeks. It also involves learning proper lifting techniques to help you minimize the chances of re-injury. But you can't just move around and hope for the best! If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. endobj Shoulder Shoulder Arthroscopy Small-Medium Rotator Cuff Tears Spinal manipulative therapy; SPPB: Short Physical Performance Battery; SRE: Supervised . After spinal surgery, you'd want to heal as quickly as possible and resume normal activities. The incidence of spine surgery has increased more than 200% in the last decade.1 Before bracing is initiated, it is best to make sure the patient can isometrically contract the TA, multifidi, and pelvic floor muscles. Avoid any rocking of the pelvis. Our doctors also perform some procedures at UHS Chenango Memorial Hospital as well. Here is a general guide for physical therapy after spine fusion surgery: First week after surgery. 2 0 obj Choose from one of the five Alabama locations of Rehab Select as the place to ensure a safe and successful return to your workplace, family, and social life. <> Patients and their family should leave the hospital with an understanding of the home care required until they begin their outpatient physical therapy. Lumbar Microdiscectomy PostOperative Physiotherapy and Rehabilitation Phase I (0 to 2 Weeks): Protective Phase Precautions Avoid twisting back , lifting and carrying objects of greater than 10kg Sitting needs to be no longer than 30 mins and broken up with standing breaks. Rehabilitation after neck or back surgery For Patients Rehab Protocols Dr. Poulter may prescribe physical therapy for non-operative treatment or rehabilitation exercises for after surgery. <> <> 12 0 obj Shoulder Arthroplasty. <> endobj <>/Metadata 245 0 R/ViewerPreferences 246 0 R>> endobj The next step is in your recovery is choosing a physical therapy practice and physical therapist that that has significant experience treating lumbar fusion procedures. Stay Informed. : A midline posterior incision, with a laminectomy if necessary. Random therapy and not following the surgical protocol can . 0000003930 00000 n 13 0 obj ]g~Mjm56t9SAS1b3cM SD(E2r$4CObGCO/ #: 0000012367 00000 n s\A0W+/0w%pW] w%pW]ycWnn>>,]]]]]]]]]]lp6:glp6:glp^aNp[b,&nu'4,78._W endstream endobj 285 0 obj <> endobj 286 0 obj <>stream 0000016960 00000 n <> A herniated disc, on the other hand, happens to the discs between the vertebrae . This is the proper timing for assessing functional outcomes and psychological support. Several reports describe a persistently painful disc under a solid posterior fusion.[4]. 5pOGF=vu#?3'?f>{:)$}7t/?c?/]]1k j1EE{Xhyj~C!|EMiTwj3|0)5*=+}MPmzjgiiZ}VEiugi SSy%tu(0)I}h`.hv>DG7$^>@^%&e|0!UUPPP Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. stream 0000004311 00000 n cant be rushed, there is a right and a wrong way to do it. % xY[o6~7AjZJM6k*9XaDtDd;W~m\t+7Om~l6\7\M'0F3IF2aDIj5ddo I?w;?%sUH@(@V*O?l\/IRS q"3`)j,eE8Sd&b8yQQ((2c**{V7tV$u*t&KW[W34L&kr6dO2m`8tBC"2M3E1pj?P8uwX)|B_0 transcutaneous electrical nerve stimulation. is developed based on your unique condition and requirements. Patient needs to be taught to sit in correct posture. 0000003472 00000 n Board Certified Spine Surgeon Keith Meister, MD Sports Medicine / Arthroscopy Head Team Physician Lumbar Laminectomy REHABILITATION PROTOCOL Phase I: Protection Phase/Immediate Motion (0 - 6 Weeks post-op) 0-3 Weeks post-op: ! <>/Metadata 165 0 R/ViewerPreferences 166 0 R>> Clin Orthop 384:153-161,2001. 0000001746 00000 n trailer <]/Prev 117090/XRefStm 1565>> startxref 0 %%EOF 325 0 obj <>stream f{X q^?UvAS 6EN&t98Gu"zLHUrYgO* 2c\p2:N7K0M_{slNP0~d IWh&c9 61aX>8FOH=t':EI 1=]2@-@3JL ng&8)zH`}\5b j6f'OGpaX}v8!tEFM.GO,Y)r'ju+S.EkANkxt 7OZG!^K;Gx(=TJLPRc%5 Post-op physical therapy (PT) is critical in this recovery process to help you minimize complications, shorten recovery time, and optimize treatment outcomes. See Spinal Fusion Surgery Recovery: 1 to 4 Weeks After. Hamilton Orthopaedic | All Rights Reserved | Design by. cyqSix &'J s8v"kr7 I,(K E@l- =z~CZ[; =Y" {C099iTVTG _twUUUG UUU~5%5a; fj&_ AYer|2,n R)##s/yX Y]^ %z?9b g FKcm#jd @$55;oNni]X E9T9rY+22u A"_8 Protect the surgical site from infection and mechanical stress, nerve root mobility at the involved levels, Begin a stabilization and reconditioning program, Improve scar and surrounding soft tissue mobility, Treat restrictions of thoracic, UEs, and LEs that can lead to more strain on the lumbar spine. The main difference between a herniated disc and a lumbar sprain is the part of the body that's hurt. 0000076710 00000 n 0000003210 00000 n Keep looking down at the floor throughout the exercise. 0000005875 00000 n 4 0 obj In routine cases of posterolateral fusions the disc is not radically resected. collected, please refer to our Privacy Policy. <> <> <> Lahey Danvers Rehabilitation, Danvers 978-739-7400 Lahey Outpatient Center, Lexington 781-372-7060 . They should be completed by moving arms and legs while avoiding any rocking or arching of the lower trunk. Not all patients will respond positively to physical therapy interventions. <> 0000052425 00000 n Physical Therapy Protocols Dr. Buckley PT Protocols Lumbar Discectomy (Partial Disc Removal) Protocol Acute Phase: 1 day - 1 week post-op Hospital stay 0-1 night. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Posted by Note: During a posterior fusion, the multifidi are retracted from the spine. MD Physical Therapy Section Kenneth Kirby, PT, DPT William Beaumont Army Medical Center . 15 0 obj Your physical therapist should help you control pain, which will allow you to better follow the protocol and perform the appropriate exercises to regain your strength. Return to prior level of function and work related activities (pending M.D. Working with an experienced physical therapist in an. Evaluation was conducted on consecutive patients with knee OA attending a physical therapy department. kyphoplasty physical therapy post op protocol bracing: jewett brace usually no brace unless > 2 levels and/or patient osteoporotic criteria for progression to next phase: -pain managed (meds/activity modification) -ale to perform adl's for self are and hygiene -tolerance of 15-30 min. x}xTjBQjHB{3f(#$!6[I>c'-wW Mobbs, R. J., Phan, K., Malham, G., Seex, K., & Rao, P. J. Obtain Long Term Pain Relief. This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. 8 0 obj A joint is held together with fibrous, tough tissue that can become damaged or torn. 14 0 obj endobj Your care team will incorporate spinal surgery physical therapy protocols and other modalities, such as occupational therapy, to help you adapt to your new physical abilities. 5w';hG]LanjE&]XzD;V(W HB v(2u\ MF9B4R)Ew'9FOk|N$4bj9c[-UX+9DlL)L+&X8jIk+G93iz?eW,TN2Rlv~G$opr;;z0E $ O?l0O&9>Tf`g9igW.g+r@'-qX'5wf7!dP:sj0Xrtt NhpCJ+B|x+>p-a@oUy?"Qor<>S <>/Metadata 209 0 R/ViewerPreferences 210 0 R>> Physical Therapy Protocols We have developed injury and surgery-specific therapy protocols designed to focus your recovery. endobj endobj It may also involve using a corset or brace to support healing, especially in the early stages. endobj 2. K#|9;(|VaP(iE(4R&pS* <> Physical Therapy after Spinal Fusion: Weeks 9 to 12 advertisement Weeks 1-9: Include Static Stabilization Exercises These movements are described as "static" because they are done without moving the trunk. Most patients are referred for physical therapy anywhere between 4 to 7 weeks after their discharge from the hospital. At this stage the expectation is that pain continues to decrease and be at a minimal level. then a bone graft is placed on the decorticated surfaces. Post-op physical therapy (PT) is critical in this recovery process to help you minimize complications, shorten, encourage patients to perform goal-directed early mobilization. Click here to schedule a meeting or tour today to see how we can help you on your journey of recovery. 0000002361 00000 n Physical Therapy Protocols Shoulder Elbow Hip/Knee Ankle Return to Sports Guidelines Physical Therapy Standards of Care Ankle Spine Shoulder Hip/Knee Lower Extremity Pelvic Health endobj Physical Therapy after Spinal Fusion: Weeks 6 to 9. The previous trunk stabilization activities should be progressed within the patient tolerance with modifications according to the patient's condition. Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015. Mobilise independently and safely. endobj Transverse process, pars interarticularis, and if needed, the sacral alae are decorticated (posterior fusion). Physical Therapy for Spinal Stenosis The goals of physical therapy for someone with spinal stenosis include: Improving range of motion of the lumbar spine Reducing tightness in the surrounding muscles Decreasing pain and joint stiffness Relieving nerve compression Strengthening the core muscles Improving postural alignment of the lumbar spine 0000076640 00000 n 8 0 obj stream It is not advised to do complex weight lifting tasks, but to focus on light free weight activity and machine based exercises that allow the patient to perform them with proper posture, technique, and bracing. 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 Looking for physical therapy after back surgery in Alabama? Lumbar ROM is allowed to tolerance all planes after brace removal beginning in mid-range with progression to full available within pain limits. %PDF-1.5 % Ultrasound shouldn't be applied over a healing bony fusion. is your best bet for a smooth recovery. (1 They should be completed by moving arms and legs while avoiding any rocking or arching of the lower trunk. All rights reserved. Restrictions: No pushing, pulling, bending, or lifting, no driving, no sitting more than 20 minutes at a time. xGzwpI}r)nRHQERpbl8?@1,@a8 kw IYwoTUw?> hb```l@(" Oy|^p&10vwfV;ZNeu`h``` RQ@Z"!|,_|>jn1eSl*z 8_?jkaU qc.H30. Spinal surgery physical therapy protocols aim to minimize the development of scar tissue, reduce pain and inflammation, relieve joint stiffness and muscle tightness, and identify potential issues early in the healing process so the medical team can mitigate them before they turn into serious problems. Bobby Stephenson. ? Sponge bathing (to keep incision dry) is to be performed until removal of staples (2 weeks post-op). 0000009594 00000 n <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 0000007813 00000 n Rehab Select offers post-surgical orthopedic rehab that incorporates a multi-disciplinary approach into a broad-based, integrated, and customized treatment plan to help shorten back surgery recovery time while improving your treatment outcomes. <> 11 0 obj Movement. Lumbar Laminectomy Physical Therapy Prescription The intent of this protocol is to provide guidelines for rehab. Every injury and surgery is different, and the timelines provided are a suggestion. Exercises: Train Neutral lumbar position: Create independent movement of the pelvis and then find and maintain a neutral position of the lumbar spine. Improve posture. 4 0 obj General Information: The evaluation shouldn't include Lumbar ROM or hip flexor mobility especially at first stages of rehabilitation. Patients should extend the knee while lying supine with the spine in a neutral position and the hip flexed to a 90 angle. Stretching of muscles should be done slowly with 30-second holds, three repetitions, two sets per day. 0000005331 00000 n The "rehabilitation must match the surgery" for optimal gains. Your personalized treatment plan must prioritize your safety to avoid re-injury. All of our locations are handicapped accessible. E] H\0}\z^Xvmh/|/]XAI_ }S7UK6g.XD7~[OC.Me& |]k{to"^ X|3Z6LTEpW|"vH2/Kx%cMk)5kd1hd Lumbar Spine Fusion is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity[1]. . Patients with severe pain problems can try using a home. 0000011977 00000 n 16 0 obj A nerve stretch is achieved by lying on the back with legs on the ground, and slowly lifting one leg until a stretch is felt in the back of the thigh and through the hip. They often return to work with modified duties or on a part-time schedule. Functional dynamic lumbar stability Normal gait Exercises: (Stabilization) Supine: Heel slides SLR Marching Dead bugs stabilized Curl ups with spine in protected position Diagonal curl ups with spine in protected position Bridging: Two legs Mini marching Single leg Prone: Single leg & arm lifts Simultaneous opposite leg & arm lifts The intent of posting these standards of care and protocols is to provide clinicians and patients an understanding of our current standards of care and protocols at BWH. endobj 0000011013 00000 n 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. endobj 19 0 obj What You Need to Know About Spinal Surgery Physical Therapy Protocol, , you'd want to heal as quickly as possible and resume normal activities. A typical protocol uses therapeutic exercises and functional activities to help you build endurance for various movements (e.g., walking) while regaining strength gradually. An experienced rehab therapist will combine proven methods with their assessment of your health condition to develop a personalized plan for your healing journey.
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