Physiotherapy management of brain tumors and neurocutaneous disorders

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Physiotherapy management of brain tumors and neurocutaneous disorders

  1. 1. Sandesh Rayamajhi MPT-II year
  2. 2. Brain tumors  Definition  Causes  Types  Clinical features  Neurocutaneous disorders  Causes  Types  Clinical features  Assessment  PT management 
  3. 3.  Definition: word – “ swelling”  A tumor is commonly used as a synonym for a neoplasm that appears enlarged in size.  It is an abnormal mass of tissue which may be solid or fluid- filled.  Latin
  4. 4.  Genetic factorsTransformation of normal cells to malignant growth probably results from a variety of different processesa)Alteration in the expression of protooncogenes b)Inactivation of expression of tumour suppressor genes
  5. 5. b) Over expression of genes controlling growth factor  Cranial irradiation  Immunosuppression
  6. 6. WHO (2000)  based on the tissue of origin. Neuroepithelial Astrocytes- Astrocytoma  Oligodendrocytes- Oligodendroglioma  Ependymal cells and choroid plexusEpendymoma Choroid plexus papilloma 
  7. 7.  Neurons- Neurocytoma or ganglioglioma or gangliocytoma  Pineal cells- Pineocytoma or pineoblastoma  Poorly differentiated and embryonal cellsMedulloblastoma
  8. 8. ASTROCYTOMA OLIGODENDROGLIOMA
  9. 9. EPENDYMOMA CHOROID PLEXUS PAPILLOMA
  10. 10. NEUROCYTOMA PINEOCYTOMA
  11. 11. MENINGIOMA MENINGEAL SARCOMA
  12. 12. Meningeal melanoma
  13. 13. SCHWANNOMA NEUROFIBROMA
  14. 14. Blood vessels
  15. 15. GERMINOMA TERATOMA
  16. 16. CRANIOPHARYNGIOMA PITUITARY ADENOMA
  17. 17. EPIDERMOID OR DERMOID CYSTS COLLOID CYSTS
  18. 18. CHORDOMA GLOMUS JUGULARE TUMOUR
  19. 19. CHONDROMA CHONDROSARCOMA
  20. 20.  Symptoms tend to develop insidiously, gradually progressing over a few weeks or years, depending on the degree of malignancy.  Intracranial tumours are considered in relation to these common clinical manifestation:
  21. 21.  Changes in mental function  Headaches  Vomiting  Seizures- 30%
  22. 22.  Periodic bifrontal and bioccipital headaches  Projectile vomiting  Mental torpor  Unsteady gait  Sphincteric incontinence  Papilledema
  23. 23.  Symptoms and signs of general cerebral impairment and increased pressure occur late or not at all.
  24. 24.  Hereditary disorders, characterized by multiorgan malformations and tumours.  Phakomatoses or Neurocutaneous Syndromes  Disorders of central nervous system that additionally result in lesions on the skin and the eye.
  25. 25.  Neurofibromatosis  Tuberous  Sturge Von sclerosis Weber syndrome Hippel- Lindau disease  Ataxia Telangiectasia
  26. 26.  Tuberous sclerosis an autosomal dominant condition.  Many children born with TS are the first cases in a family.  Majority of TS is caused by a new gene change (mutation).  Gene localized to chromosome 9 and 16.
  27. 27.  NF1 is an autosomal dominant condition  Gene on chromosome 17.  NF2- autosomal dominant conditon  Gene on chromosome 22.
  28. 28.  NF may also be the result of a new gene change. Half of NF cases are caused by a new mutation.  Males and females are equally affected. Schwannomatosis- a recently recognized form of NF that is genetically distinct from NF1 and NF2.  It occurs rarely.
  29. 29.  The cause of Sturge-Weber disease is unknown and is considered to be sporadic.  Ataxia telangiectasia is autosomal recessive disorder.  Mutation in the ATM gene- chromosome 11.
  30. 30.  Neurofibromatosis (NF):  There are three distinct types of NF, classified as NF I, NF II, and Schwannomatosis. NF1 It is characterized by café au lait spots and neurofibromas.  Von Recklinghausen’s disease.  Subcutaneous neurofibromata
  31. 31.  Mollusca fibrosa  Plexiform neuroma Skeletal manifestations Scoliosis ( 50%)  Subperiosteal neurofibromas  Sphenoid wing dysplasia  Occular manifestations- Lisch nodules
  32. 32. Neurological manifestations Mental retardation and Epilepsy- 15%  Neoplasia NF2 It is autosomal dominant disorder characterized by tumours of the 8th cranial nerve ( vestibular division).  Café au lait spots – rare
  33. 33.  Schwannomatosis- The primary feature is the growth of multiple schwannomas throughout the body except the vestibular nerve is not involved.  Extremely intense pain- main symptom.  Numbness  Tingling or weakness in the fingers and toes.
  34. 34.  Autosomal dominant disorder with high sporadic mutation rate.  Characterized by cutaneous, neurologic, renal, skeletal, cardiac and pulmonary abnormalities.  Adenoma sebaceum  Shagreen patch.  Pitted teeth
  35. 35.  Facial angioma associated with a leptomeningeal venous angioma.  Capillary naevus – “Port wine stain”  Eye disorders  Atrophic hemisphere  Epilepsy (75% cases)  Hemiparesis, homonymous hemianopia (30%)  Behavioral disorder and mental retardation
  36. 36.  Haemangioblastomas in the cerebellum, spinal canal and retina and are associated with a number of visceral pathologies:  Renal angioma and Renal cell carcinoma  Phaeochromocytoma  Pancreatic adenoma  Cysts and haemangiomas in liver and epididymis
  37. 37.  Louis- Bar syndrome  Multisystem disorder is characterized by Cerebellar ataxia  Occular and cutaneous telangiectasia  Immunodeficiency
  38. 38.  Evaluation Comprehensive examination and assessment of all systems. A thorough review- medical history and an understanding of the medical diagnosis.
  39. 39.  Important psychosocial factorsoccupation, support system, personal goals and role in the family.  Examination of all the systems through functional tasks
  40. 40.  Functional Assessment The Functional Independence Measure (FIM)-functional assessment tool used to measure degree of disability, regardless of underlying pathology and burden of care to demonstrate functional outcomes of rehabilitation and assist clinicians with discharge planning.
  41. 41.  Goal setting The functional deficits and objective neurological findings- valuable information to assess prognosis, establish goals, and determine a treatment plan.  Maximize the potential for function, introduce effective, task-oriented movement strategies, and offer multiple movement options.
  42. 42.  Comprehensive caregiver training to independent mobility with transition back to a work environment.
  43. 43.  Side effects and Considerations Mindful of the side effects when developing a plan of intervention.  Fatigue, low blood count, and gastrointestinal complaints- limit a patient’s ability to fully participate in the planned therapy session.
  44. 44.  The clinician must be flexible to determine the optimal time for intervention.  Changes in cognition or personality as a result of the tumour’s location.
  45. 45.  Intervention-  The ultimate goal- to achieve maximum restoration of function, within the limits imposed by the disease, in the client’s preferred environment.  Begins in the intensive care unit and continues in the inpatient, outpatient, and home health settings.
  46. 46.  Communication with nursing staffregarding present medical status and an understanding of ICP, hemodynamic values, and monitoring devices is crucial to determining tolerance for therapy intervention. .
  47. 47.  Medically stable patient- upgrade mobility and prepare for the next stage of rehabilitation.  Inpatient rehabilitation setting- Treatment focuses on optimizing functional capabilities to prepare for discharge.
  48. 48.  Integrating personal goals and interests into therapeutic intervention invests the client and family in the rehabilitation process.  Prepare the client and caregivers for an efficient transition.
  49. 49.  Utilizing motor learning principles to teach functional mobility will best produce transfer of learning from a constant environment to an unpredictable home environment.
  50. 50.  Repeated practice of specific parts of a skill in fixed surroundings, with physical and verbal guidance throughout the movement, and frequent feedback during and following the completion of the task, are beneficial in teaching acquisition of a specific movement or activity.
  51. 51.  Practicing the whole activity in a variable context, with irregular feedback and decreased physical and verbal guidance.  Learning results in the ability to execute a task in any setting.
  52. 52.  Community outings and home passes naturally provide an environment that facilitates learning.  Measure retention and transfer of learning by the client’s performance in the community or at home.
  53. 53.  This information- used to adjust the treatment plan and make recommendations for environmental modifications that minimize physical and cognitive demands on the client.
  54. 54.  Kenneth W. Lindsay, Ian Bone, Neurology and Neurosurgery illustrated, 4th Ed.  Maurice Victor and Raymond D. Adams, Principles of Neurology, 6th Ed.  Darcy A. Umphred, Neurological Rehabilitation, 5th Ed.  Delisa, Physical Medicine and Rehabilitation, 4th Ed.
  55. 55.  http://www.hopkinsmedicine.org/healthlibra ry/conditions/nervous_system_disorders/n eurocutaneous_syndromes_85,P00794

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