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Critical Reviews™ in Physical and Rehabilitation Medicine
Rehabilitation for Patients With Brain Tumors
Department of Rehabilitation Medicine, Boston University
As the prevalence of brain tumors (BTs) increases with better neurosurgical techniques, radiation therapy, and chemotherapy, the role of rehabilitation will broaden. Neurological deficits in this population, in descending order of frequency, include impaired cognition, weakness, visual-perceptual deficits, sensory loss, bowel and bladder dysfunction, dysphagia, and aphasia. In a group of inpatients, about 75% had 3 or more concurrent neurological deficits, and 39% had 5 or more deficits. The majority of primary tumors are gliomas (40%–60%), and cerebral metastasis accounts for 25% to 50% of all intracranial neoplasms. An inpatient rehabilitation study found that patients with metastatic BTs had outcomes similar to those with primary tumors. Side effects from surgery, radiotherapy, and chemotherapy are not uncommon and need close monitoring. The prevention and treatment of medical complications share similarities with other rehabilitation diagnoses and are discussed. Potentially reversible factors include depression, metabolic disorders (e.g., hypercalcemia), dehydration, and infections. An overview of therapeutic strategies includes positioning, cardiovascular exercise, and therapeutic exercise for activities of daily living, as well as rehabilitation strategies for sensory and balance and coordination impairments. This article focuses on cognitive rehabilitation (CR). All areas of cognitive functioning can be affected, particularly memory, language, and executive skills. CR approaches typically involve 1 or a combination of 3 strategies: restorative, compensatory, and holistic. A CR program should assess a patient’s cognitive status and its effect on everyday functions and emotions. The retraining of attention, language, and self-regulation (impulsivity or apathy) can respond well to CR. Methylphenidate has been shown to improve motivation, initiation, stamina, and gait in patients with BTs. Psychological adjustment has important ramifications for quality of life (QOL) and overall health status; one study revealed a prevalence rate of 30% for depression and 16% for anxiety. Supportive counseling for patients and families, psychiatric consultation for antidepressants or anxiolytics, and a trial of methylphenidate may be indicated. The case report of a patient with a BT exemplifies the complexity of rehabilitation for this population. Patients with BTs markedly improved in function and QOL following an interdisciplinary rehabilitation program, and about 67% were discharged home. These results justify rehabilitation services for patients with brain tumor.
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