Rehabilitation Services Provide Significant Benefits to Patients with Brain Tumors

When neurosurgeons at Sylvester Comprehensive Cancer Center or University of Miami Hospital refer patients with a primary brain tumor to him, David S. Kushner, M.D., Medical Director for the UM rehabilitation program at HealthSouth Rehab Hospital, finds that rehabilitation can play a key role in helping them recover their functions and enjoy a higher quality of life. His work, and the findings he has derived from it, are the focus of two recently published papers in the journal Neuro-Oncology Practice.

“Referral for rehabilitation services should be considered an integral part of care, even for patients with malignant primary brain tumors,” said Kushner, a clinical associate professor in the Department of Physical Medicine and Rehabilitation, and at the School of Nursing and Health Studies. “Increasing patient survival rates highlights the importance of interventions to regain motor skills, address cognitive impairments, assist in seizure control and reduce other medical complications.”

Kushner was the co-author of the two articles — “Rehabilitation of motor dysfunction in primary brain tumor patients” and “Clinical implications of motor deficits related to brain tumors” — with Christina Amidei, a professor in the Department of Neurology and Rehabilitation at the University of Illinois. The pair developed the articles following a presentation at the Society for Neuro-Oncology’s 2014 scientific meeting in Miami.

An estimated 688 000 Americans were living with a primary brain tumor in 2010. The five-year survival rate was 96 percent for nonmalignant tumors and 34 percent for malignant tumors in all ages, according to the authors’ study.

Survival rates have steadily improved significantly since the 1970s for most types of tumors including certain malignant ones such as gliomas. Many patients with malignant gliomas and certain other brain tumors develop motor dysfunction, said Kushner.

“Motor dysfunctions, such as difficulty in walking, balancing or getting up from a chair may occur in all types of brain tumor patients,” he said. “That can lead to a loss of functional independence, anxiety or depression, and an overall reduction in quality of life.”

Rehabilitation can also reduce complications of immobility, such as the risk of a serious fall, the development of skin ulcerations, or a blood clot in the leg that leads to an embolism, Kushner said. Most patients are referred to rehabilitation following neurosurgery, whether initial or subsequent to recurrence, for motor and/or cognitive impairments.

“A multidisciplinary medical team that includes a rehabilitation specialist is important for patient care before and after neurosurgery,” he said.

Kushner added that a careful clinical analysis is needed to determine the root cause of a patient’s motor problems, which may be related to many interacting factors such as muscle weakness, spasticity, incoordination, imbalance, impaired cognition, fatigue, side effects of medications, infection, poor nutrition, metabolic factors, impaired perceptions and anemia, among many other possible causes. For example, steroid medications can reduce swelling in the brain, but also lead to weakness in the shoulder or hip muscles.

“Some causes may respond quickly to rehabilitation, while others may require long-term therapy,” he said, “Exercise is a complementary treatment that deserves further study for its role in improving quality of life and prolonging survival.”

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