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Chieffo, D.P.R.;  Lino, F.;  Arcangeli, V.;  Moriconi, F.;  Frassanito, P.;  Massimi, L.;  Tamburrini, G. Posterior Fossa Tumor Rehabilitation. Encyclopedia. Available online: https://encyclopedia.pub/entry/24955 (accessed on 06 July 2024).
Chieffo DPR,  Lino F,  Arcangeli V,  Moriconi F,  Frassanito P,  Massimi L, et al. Posterior Fossa Tumor Rehabilitation. Encyclopedia. Available at: https://encyclopedia.pub/entry/24955. Accessed July 06, 2024.
Chieffo, Daniela Pia Rosaria, Federica Lino, Valentina Arcangeli, Federica Moriconi, Paolo Frassanito, Luca Massimi, Gianpiero Tamburrini. "Posterior Fossa Tumor Rehabilitation" Encyclopedia, https://encyclopedia.pub/entry/24955 (accessed July 06, 2024).
Chieffo, D.P.R.,  Lino, F.,  Arcangeli, V.,  Moriconi, F.,  Frassanito, P.,  Massimi, L., & Tamburrini, G. (2022, July 08). Posterior Fossa Tumor Rehabilitation. In Encyclopedia. https://encyclopedia.pub/entry/24955
Chieffo, Daniela Pia Rosaria, et al. "Posterior Fossa Tumor Rehabilitation." Encyclopedia. Web. 08 July, 2022.
Posterior Fossa Tumor Rehabilitation
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This entry is adapted from the peer-reviewed paper 10.3390/children9060904
Pediatric brain tumors are the leading cause of solid tumor mortality in childhood. Tumors of the skull base, such as posterior fossa tumors, were, in the past, associated with a poor prognosis. The evolution of surgical techniques, together with the greater knowledge of the anatomy and phisiology of these diseases and the progress made in diagnostic techniques, now allow treatments that are also curative.
tech mediated rehabilitation posterior fossa tumor brain tumor

1. Pediatric Brain Tumor

 According to Fountain and Burke [1], central nervous system tumors are the most common pediatric cancers after hematological malignancies, and the most common pediatric solid organ tumor.
Cognitive deficits are described by Mukand [2] as one out of the three most common complications in rehabilitation for brain tumors. In such a framework, cognitive complications are present in 80% of patients in acute rehabilitation after brain surgery. The other most common complications are represented by focal deficits (78%) and perceptual deficits (53%).
In the last decade, some reviews have been completed on rehabilitation techniques across specific domains for children with acquired brain injury [3][4]. Some other reviews investigated, more specifically, the functional outcome of different rehabilitation models [5][6].

2. Posterior Fossa Tumor Rehabilitation

In the last decades, as survival rates in brain tumors have risen [7][8], it has become imperative to investigate which kind of interventions are the ones that fit best with children needs. Cognitive remediation/rehabilitation therapy is based on the principles of neural plasticity of the brain. It is a type of rehabilitation asking the patient to train with cognitive exercises to booster several cognitive functions. Historically, greater efforts have been directed to cognitive rehabilitation in adulthood and in particular, in patients with other types of acquired brain injuries (i.e., stroke and traumatic brain injury). Cognitive rehabilitation interventions can be helpful for patients with tumors too. Rehabilitation exploits the principles of plasticity and functional compensation, possible after a stroke, as well as after brain surgery. Cognitive intervention to implement a remodeling of functional networks, combined with pharmacological treatment, can improve the residual functional capacity [9].
Despite the growing interest in rehabilitation after pediatric brain tumor surgery, the literature of proven effective interventions is still poor.
In 2015, Fountain and Burke [1] investigated the evidence base for multidisciplinary rehabilitation in the children and adolescent population with brain tumors. In their review, they found that no study considered a specific tumor type, and all the studies they identified were single-center-based studies. They concluded that a multi-centre study with a cost-effective strategy, standardized procedures, and long-term analysis is needed.
A dissertation across methods used insingle cognitive domains rehabilitation will follow.

3. Visuo Spatial Skills

Pediatric posterior fossa tumors have been associated with neuropsychological sequelae in terms of visuospatial organization [10]. Children with cerebellar damage may display deficits in complex visuospatial processes such as mental rotation, visuospatial organization, and planning [11]. Starowicz and colleagues specifically explored the link between the side of cerebellar lesions and the level of visuospatial impairments. Visuospatial deficits have been observed in several previously published studies considering adults with cerebellar lesions, whereas others have been centered on the pediatric population. Depending on the side of cerebellar lesion, a specific cognitive-damage profile can be depicted. [12][13][14]. However, there is a lack of randomized controlled studies specifically dedicated to visuospatial function rehabilitation in children treated for a brain tumors, and no studies are present for specific tumor locations.
The performance in visual-spatial working-memory improved more after the training than after the waiting-list period, showing efficacy and near-transfer effects. The abovementioned study proposed five games, focusing on different cognitive domains, and relied on visual-spatial competence. Games focused on: detecting the orientation of a stimulus in space (Disillusion, Lost in Migration), matching together (Disillusion) or recognizing figures different in shape and colours (Tidal Treasure, Speed Match), solving arithmetic operations presented in drops that moved vertically on the computer screen (Raindrops), maintaing in working memory the shapes and colors of visual stimuli (Tidal Treasure, Speed Match). The primary outcome in this study was the Corsi block-tapping test. In the Section 10, the authors suggest that “the best cognitive benefts in pediatric acquired brain injury are achieved by the intensive stimulation of the same cognitive function”.

4. Ataxia and Motor Problems

It is sometimes possible to observe motor difficulties, hypotonia, walking difficulties, postural deficits, or ataxia in children with pCMS [15].
Ataxia is present, according to Wilne and colleagues [16], in 60% of children with pCMS. Specific tumor locations are predictors of a long-term ataxia [17].
Motor therapy is often included in a multidisciplinary rehabilitation approach in pediatric patients. Though there is no scientific evidence for the efficacy of this approach, there is an indication in the literature for conventional physical therapy for children with ataxia in the general context of acquired brain injury. Sabel and colleagues [18] investigated the efficacy of a home-based video game training for balance training in children after brain tumors. The training was based on an active video game training using an “off the shelf” tool: the Nintendo Wii. On the other side, the literature suggests that children with balance problems recovering from brain tumors could benefit from treadmill training [19].
Extensive literature documents the use of technologies such as VR tools in motor rehabilitation following acquired brain injury in adult patients. Some studies also highlight the role played by the combination of the use of robotics and VR tools in the effectiveness of rehabilitation treatments. More studies are needed to confirm the results in children [20]. Barbarulo and colleagues have recently observed in their study on multiple sclerosis that the combination of cognitive and motor rehabilitation has “mutual improvement effect on motor outcome compared to their independent administration” [21]. This could be linked, according to Manuli and colleagues, to an improved adaptive neuroplasticity that would find justification in the involvement of shared neural circuits (cortical-subcortical), most of which would refer to the mirror neuron system. The abovementioned network is not only involved in motor movement, but also in movement planning. Movement planning needs the attention of more primarily executive functions that confirm the grip relationship between movement and cognition. Considering this framework, VR could bring better cognitive–motor–behavioral outcomes because it can combine physical exercise with cognitive excercise, and both sensorymotor function and cognitive inputs would be given in the virtual environment. More research in this field is needed to identify evidence-based protocols to be applied for children’s rehabilitation.

5. Behavioral and Emotional Disturbances

Behavioral symptoms may occur in the pre- and post-surgical period following resection of a tumor in the posterior cranial fossa.
A change in behavior as a reduction of feeding and increased fuzziness have been reported, for example, to mask, particularly in smaller children, signs of increased intracranial pressure, delaying the diagnosis [22].
Due to their common persistence after surgery, it is necessary to treat behavioral symptoms that can be very disabling in order to make the child an active part of the rehabilitation. In 2017, Lanier and colleagues [23] summarized in a review the near- and long-term psychosocial and psychiatric implications of emotional and behavioral symptoms. They also depicted a useful and comprehensive overview for clinicians, providing clinical examples of the presentation, management, and lasting implications of posterior fossa syndrome.
Emotional and behavioral symptoms may accompany the mutism phase when posterior fossa syndrome is present. From a behavioral perspective, marked apathy and lack of interest for the environment with decreased responsiveness to surrounding stimuli may occur. Physical agitation, restlessness, poverty of spontaneous movements, and withdrawal may also be present. The emotional symptoms most commonly described in the literature are irritability, dysphoria, lability, tearfulness, and inconsolability. These manifestations cannot uniquely be linked to the frustration experienced by the child because of speech deficits. Very often, in fact, emotional symptoms persist even when speech deficits are improved.
Children after posterior fossa tumor surgery may show emotional or behavioral symptoms even years after surgery [24][25][26][27][28].
The manifestation of behavioral problems is directly related to: exact location of the tumor, treatments such as radiotherapy, onset of complications, or other medical conditions [29][30].
The most damaged functions in this type of patients seem to be those related to more frontal neuroanatomic areas, with consequent behavioral outcomes (predominantly dorsolateral frontal expression).
Di Rocco and colleagues [31] studied the correlation between pre-operative and post-operative disorders. They investigated the presence of speech disturbances and preoperative behavioral disturbances (sleep disturbances, hyperactivity, and somatic disturbances). What was found was that all children who developed postoperative cerebellar mutism (i.e., 20.6%) had preoperative disturbances.
The recovery, as it can be easily inferred, requires targeted behavioral therapy, physical therapy, occupational therapy, and speech therapy.
Given that a persistent motor speech disorder is often present [32], it would be useful, as Hocking highlighted in his study [33], to consider a component of social reintegration as part of the rehabilitation programs for supporting social skills for these children.

References

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  2. Mukand, J.A.; Blackinton, D.D.; Crincoli, M.G.; Lee, J.J.; Santos, B.B. Incidence of Neurologic Deficits and Rehabilitation of Patients with Brain Tumors. Am. J. Phys. Med. Rehabil. 2001, 80, 346–350.
  3. Limond, J.; Leeke, R. Practitioner Review: Cognitive rehabilitation for children with acquired brain injury. J. Child Psychol. Psychiatry 2005, 46, 339–352.
  4. Slomine, B.; Locascio, G. Cognitive rehabilitation for children with acquired brain injury. Dev. Disabil. Res. Rev. 2009, 15, 133–143.
  5. Tal, G.; Tirosh, E. Rehabilitation of Children with Traumatic Brain Injury: A Critical Review. Pediatr. Neurol. 2013, 48, 424–431.
  6. Gordon, A.L.; di Maggio, A. Rehabilitation for children after acquired brain injury: Current and emerging approaches. Pediatric Neurol. 2012, 46, 339–344.
  7. Jemal, A.; Siegel, R.; Ward, E.; Hao, Y.; Xu, J.; Murray, T.; Thun, M.J. Cancer statistics, 2008. CA Cancer J. Clin. 2008, 58, 71–96.
  8. Pui, C.-H.; Campana, D.; Pei, D.; Bowman, W.P.; Sandlund, J.T.; Kaste, S.C.; Ribeiro, R.C.; Rubnitz, J.E.; Raimondi, S.C.; Onciu, M.; et al. Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation. N. Engl. J. Med. 2009, 360, 2730–2741.
  9. Gehring, K.; Sitskoorn, M.M.; Aaronson, N.K.; Taphoorn, M.J. Interventions for cognitive deficits in adults with brain tumours. Lancet Neurol. 2008, 7, 548–560.
  10. Levisohn, L.; Cronin-Golomb, A.; Schmahmann, J.D. Neuropsychological consequences of cerebellar tumour resection in children: Cerebellar cognitive affective syndrome in a paediatric population. Brain 2000, 123 Pt 5, 1041–1050.
  11. Starowicz-Filip, A.; Chrobak, A.; Milczarek, O.; Kwiatkowski, S. The visuospatial functions in children after cerebellar low-grade astrocytoma surgery: A contribution to the pediatric neuropsychology of the cerebellum. J. Neuropsychol. 2015, 11, 201–221.
  12. Botez, M.I.; Botez, T.; Elie, R.; Attig, E. Role of the cerebellum in complex human behavior. Neurol. Sci. 1989, 10, 291–300.
  13. Molinari, M.; Petrosini, L.; Misciagna, S.; Leggio, M.G. Visuospatial abilities in cerebellar disorders. J. Neurol. Neurosurg. Psychiatry 2004, 75, 235–240.
  14. Tedesco, A.M.; Chiricozzi, F.R.; Clausi, S.; Lupo, M.; Molinari, M.; Leggio, M. The cerebellar cognitive profile. Brain 2011, 134, 3672–3686.
  15. Piscione, P.J.; Bouffet, E.; Mabbott, D.J.; Shams, I.; Kulkarni, A.V. Physical functioning in pediatric survivors of childhood posterior fossa brain tumors. Neuro-Oncology 2013, 16, 147–155.
  16. Wilne, S.; Collier, J.; Kennedy, C.; Koller, K.; Grundy, R.; Walker, D. Presentation of childhood CNS tumours: A systematic review and meta-analysis. Lancet Oncol. 2007, 8, 685–695.
  17. Küper, M.; Döring, K.; Spangenberg, C.; Konczak, J.; Gizewski, E.R.; Schoch, B.; Timmann, D. Location and restoration of function after cerebellar tumor removal—A longitudinal study of children and adolescents. Cerebellum 2013, 12, 48–58.
  18. Sabel, M.; Sjölund, A.; Broeren, J.; Arvidsson, D.; Saury, J.M.; Blomgren, K.; Lannering, B.; Emanuelson, I. Active vi-deo gaming improves coordination in survivors of childhood brain tumours. Disabil. Rehabil. 2016, 38, 2073–2084.
  19. Rasooli, A.H.; Birgani, P.M.; Azizi, S.; Shahrokhi, A.; Mirbagheri, M.M. Therapeutic effects of an anti-gravity lo-comotor training (Alter G) on postural balance and cerebellar structure in children with cerebral palsy. In Proceedings of the 2017 International Conference on Rehabilitation Robotics, London, UK, 17–20 July 2017; pp. 101–105.
  20. Manuli, A.; Maggio, M.G.; Latella, D.; Cannavò, A.; Balletta, T.; De Luca, R.; Naro, A.; Calabrò, R.S. Can robotic gait rehabi-litation plus Virtual Reality affect cognitive and behavioural outcomes in patients with chronic stroke? A rando-mized controlled trial involving three different protocols. J. Stroke Cerebrovasc. Dis. 2020, 29, 104994.
  21. Barbarulo, A.M.; Lus, G.; Signoriello, E.; Trojano, L.; Grossi, D.; Esposito, M.; Costabile, T.; Lanzillo, R.; Saccà, F.; Morra, V.B.; et al. Integrated Cognitive and Neuromotor Rehabilitation in Multiple Sclerosis: A Pragmatic Study. Front. Behav. Neurosci. 2018, 12, 196.
  22. Sacks, P.; Lucke-Wold, B.; Rivera-Zengotita, M.; Blatt, J. Suboccipital Craniotomy and C1 Laminectomy for Atypical Choroid Plexus Papilloma. J. Clin. Neurol. Neurosci. 2021, 2, JCNN-21-12.
  23. Lanier, J.C.; Abrams, A.N. Posterior fossa syndrome: Review of the behavioral and emotional aspects in pediatric cancer patients. Cancer 2016, 123, 551–559.
  24. Wells, E.M.; Khademian, Z.P.; Walsh, K.S.; Vezina, G.; Sposto, R.; Keating, R.F.; Packer, R.J. Postoperative cerebellar mutism syndrome following treatment of medulloblastoma: Neuroradiographic features and origin. J. Neurosurg. Pediatr. 2010, 5, 329–334.
  25. Varela, M.; Liakopoulou, M.; Alexiou, G.A.; Pitsouni, D.; Alevizopoulos, G.A. Presurgical neuropsychological and beha-vioral evaluation of children with posterior fossa tumors. J. Neurosurg. Pediatr. 2011, 8, 548–553.
  26. Lassaletta, A.; Bouffet, E.; Mabbott, N.; Kulkarni, A.V. Functional and neuropsychological late outcomes in posterior fossa tumors in children. Child’s Nerv. Syst. 2015, 31, 1877–1890.
  27. Reimers, T.S.; Mortensen, E.L.; Schmiegelow, K. Memory deficits in long-term survivors of childhood brain tumors may primarily reflect general cognitive dysfunctions. Pediatr. Blood Cancer 2007, 48, 205–212.
  28. Keng, A.; Stewart, D.E.; Sheehan, K.A. Neuropsychiatric symptoms following brain tumor resection in children and adolescents: A scoping review. J. Acad. Consult Liaison Psychiatry 2021, 63, 110–118.
  29. Mulhern, R.K.; Palmer, S.L.; Merchant, T.E.; Wallace, D.; Kocak, M.; Brouwers, P.; Krull, I.K.; Chintagumpala, M.; Stargatt, R.; Ashley, D.M.; et al. Neurocognitive consequences of risk-adapted therapy for chil-dhood medulloblastoma. J. Clin. Oncol. 2005, 20, 5511–5519.
  30. Due-Tonnessen, B.; Helseth, E. Management of hydrocephalus in children with posterior fossa tumors: Role of tumor surgery. Pediatr. Neurosurg. 2007, 43, 92–96.
  31. Di Rocco, C.; Chieffo, D.; Frassanito, P.; Caldarelli, M.; Massimi, L.; Tamburrini, G. Heralding cerebellar mu-tism: Evidence for pre-surgical language impairment as primary risk factor in posterior fossa surgery. Cerebellum 2011, 10, 551–562.
  32. De Smet, H.J.; Baillieux, H.; Catsman-Berrevoets, C.; De Deyn, P.P.; Mariën, P.; Paquier, P.F. Postoperative motor speech production in children with the syndrome of ‘cerebellar’ mutism and subsequent dysarthria: A critical review of the literature. Eur. J. Paediatr. Neurol. 2007, 11, 193–207.
  33. Hocking, M.C.; McCurdy, M.; Turner, E.; Kazak, A.E.; Noll, R.B.; Phillips, P.; Barakat, L.P. Social competence in pediatric brain tumor survivors: Application of a model from social neuroscience and developmental psychology. Pediatr. Blood Cancer 2014, 62, 375–384.
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Subjects: Pediatrics; Rehabilitation
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Daniela Pia Rosaria Chieffo
,
Federica Lino
,
Valentina Arcangeli
,
Federica Moriconi
,
Paolo Frassanito
,
Luca Massimi
,
Gianpiero Tamburrini
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Update Date: 12 Jul 2022
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