A 62-year-old right-hand dominant male went to the hospital with complaints of persistent headaches that were getting progressively worse, increasing left-sided weakness, and gait instability. Magnetic resonance imaging revealed a large enhancing mass within the right parietal lobe with extensive surrounding vasogenic edema. Differential diagnoses include a solitary metastasis or a primary central nervous system (CNS) neoplasm. The patient was admitted to the hospital and the tumor was grossly resected the next day. Relevant inpatient medications include dexamethasone, insulin, ondansetron, oxycodone, acetaminophen, bisacodyl, and senna-docusate. Physical therapy evaluation was ordered on the third postoperative day (POD 3). The patient is expected to be discharged home tomorrow. He is a retired schoolteacher and lives in a single-story house with his wife, who will be available as a full-time caregiver.
Based on his health condition, what do you anticipate will be the contributors to activity limitations?
What are the examination priorities?
What are the most appropriate physical therapy interventions?
What precautions should be taken during physical therapy examination and interventions?
What are possible complications interfering with physical therapy?
How would this individual's contextual factors influence or change your patient/client management?
- CRANIOTOMY: Most common surgical procedure to resect (remove) a brain tumor; part of the skull is removed to gain access to the brain; after brain tumor is biopsied and/or removed, bone flap is secured back in position
- METASTASIS: Spread of cancer cells to one or more areas elsewhere in the body, usually by the lymph or vascular system
- NEOPLASM (TUMOR): Abnormal mass of tissue resulting from neoplasia; tumors can be cancerous (malignant) or noncancerous (benign)
Describe the medical treatment plan for benign and malignant brain tumors.
Understand the indications for the drugs prescribed to a patient post-craniotomy.
Identify potential adverse drug reactions (ADRs) that may affect physical therapy examination or interventions and describe possible therapy solutions.
Recognize signs and symptoms of rising intracranial pressure (ICP).
List the anticipated deficits resulting from parietal lobe damage or dysfunction.
List typical craniotomy precautions and discuss their rationale.
Design an appropriate plan of care for the patient status/post brain tumor resection, in the absence of knowing the prognosis.
PT considerations during management of the individual status/post craniotomy due to brain tumor:
- General physical therapy plan of care/goals: Prevent or minimize loss of range of motion, strength, and aerobic functional capacity; maximize functional independence and safety while minimizing secondary impairments; improve quality of life
- Physical therapy interventions: Patient and caregiver education regarding craniotomy precautions, decreasing risk of deep vein thromboses, and decreasing the risk of falls; gait training; caregiver training for safe guarding during ambulation; prescription of a home exercise program; and, if indicated, referral to home health or outpatient physical therapy...
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