Brain tumor

BRAIN
TUMOR
Presentation by : Vyom Jain

Content
1. Brain & Brain Tumor
2. Types and Grades of Tumors
3. Risk Factors
4. Signs and Symptoms
5. Diagnosis
6. Treatment
7. Supportive Care
8. Rehabilitation

Brain Tumor
A Brain Tumor is a collection, or mass, of abnormal cells in Brain.
Skull, which encloses the brain, is very rigid, any growth
inside this restricted place can cause problems.
when these tumors grow inside the brain it increases intra cranial
pressure, which can cause bran damage and may be even life
threatening.
When most normal cells grow old or get damaged,
they die, and new cells take there place. Sometime,
this process goes wrong. New cells form whn body
doesn't need them, and old or damaged don't die as
they should. the buildup of extra cells often forms a
mass of tissue called a growth or Tumor.

Incidence & Prevelance
• In 2010, 62,930 new cases were reorded in United states for adult brain
tumors, while for children 4,030 new cases for were recorded for the same
period, of which 2,880 children were under 15 year of age.
• White american > Black Americans
• In US, brain tumor typically occur in 2 distinct categories
• Children aged 0-15years
• Adults in there 5th
to 7th
decade
• Meningioma, a benign primary tumor - 33.8% of primary brain tumor
• Glioblastoma Multiforme, a malignant tumor - 17.1% of adult primary tumor
• The largest percentage of childhood tumor i.e. 17% located
in frontal, parietal and occipital lobe followed by
cerebellum (16%) and Brain Stem (11%)

Figure : Distribution of all primary brain and CNS tumors by histology (From CBTRUS, 2010)

Overview...
The World Health Organization (WHO) first published a universal
classification system for CNS tumors in 1979.
This system classifies tumors according to there
microscopic characteristics and has been accepted as the universal
method of classification of brain tumor.
Tumors were classified into 2 categories :
1. Primary Brain Tumors
2. Secondary Brain Tumors

Primary Brain Tumors :
• These tumors can be Benign or Malignant.
• Primary tumors originates in the CNS
• Benign brain tumors do not contain cancer cells :
‒ Usually, benign tumors can be removed and the rarely
grow back.
‒ Benign brain tumors have an obvious border or edge.
‒ They dont spread to other parts of the body
‒ They don't invade tissues around them
‒ However, benign tumors can press on sensitive area of
brain and can cause serious health problems.
‒ Unlike benign tumor of other parts of the body, benign
tumor of the brain are sometimes life threatening.
‒ with time benign brain tumors can become malignant.

• Malignant brain tumors (Also called Brain Cancer) contain cancer
cells :
– More serious and often are threat to life
– Rapid Growth
– Invade or crowd nearby healthy brain tissue
– Cancer cell may spread to other parts of the brain or to
the spinal cord
– rarely spread to other parts of the body.

Tumor Grade
Doctors group brain tumor by grade. the grade of a tumor
refers to the way cells look under a microscope:

Types of Primary Brain Tumors
1. Gliomas (A)
2. Astrocytomas (A)
3. Glioblastoma Multiforme
4. Oligodendrogliomas (A)
5. Ependymomas & Ependymoblastomas (C)
6. Medulloblastomas (C)
7. Meningiomas (A)
8. Pituitary adenomas
9. Schwannomas
10. Primary CNS lymphoma
There are many type of primary brain tumors. they are named
according to the type of cells or the part of the brain in which they
begin. for example : most primary brain tumors begins in glial cell
and are called Glioma.

Figure : Karnofsky Performance Status Scale

Secondary Brain Tumor :
Secondary brain tumors also called as Metastatic Brain Tumor
originates from malignancies outside of the CNS and spread to the
brain, typically through arterial circulation.
•Approx. 25% of individual with systemic cancer develop metastatic
brain tumor approx. 80% in cerebral hemisphere and 20% in the
posterior fossa.
•1/3rd
of bin metastases orginate in lungs and followed in manner
below in order of frequency :
Lungs→Breast→Skin→GI tract→Kidney
•Frontal lobe is the most common site
•Average survival with the treatment is approx. 6
months but varies widely by the extent of other
systemic metastases.

• A risk factor is something that may increase the chance of getting a
disease.
• Studies have found the following risk factors for brain tumors:
1. Ionizing Radiations : especially from high dose x-rays
and other sources can cause cell damage that leads to a
tumor. most common types are meningioma or glioma.
2. Family History : It is rare for brain tumors to run in a
family. only a very few number of families have several
member with brain tumors
** Studies have not shown consistent links between
these possible risk factors and brain tumors, but
additional research is needed.

• The symptoms of a brain tumor depend on tumor size, type and
location.
• Symptoms may be causedwhen a tumor presses on the nerve or
harms the part of the brain
• Most common symptoms of brain tumors are :
• Headaches (usually worse in the morning)
• Nausea and vomiting
• Changes in speech, vision, or hearing
• Problems balancing or walking
• Changes in mood, personality, or ability to
concentrate
• Problems with memory
• Muscle jerking or twitching (seizures or
convulsions)
• Numbness or tingling in the arms or legs

General Signs & Symptoms
• Headache is the presenting symptom in 30 % of the cases &
devlops during the vourse of the disease in 70% of the cases
• It is important to identify the specific nature of the headaches,
because certain features often indicate the presence of a brain
tumor. these feature include :
1. The headache that interrupts sleep or is worse on
waking and improves throughout the day
2. The headache that is elicited by postural changes,
coughing, or exercise
3. The headache of recent onset that is more severe
or of a different type than usual
4. The new onset of headache in a previously
asymptomatic person
5. The headache associated with nausea and
vomiting, papilledema, or focal neurological signs

• Seizure activity is the presenting symptom in 1/3rd
of cases and is
present in 50%-70% of cases at some stage of the disease.
• Approx 10%-20% adults with new onset seizure activity have brain
tumors.
• Seizures produce by glioma in
• Frontal Lobe (59%)
• Parietal Lobe (42%)
• Temporal Lobe (35%)
• Occipital Lobe (33%)
• Altered Mental Status is the initial symptom in 15% to
20% of individuals.
• Slight changes in concentration, memory, affect,
personality, initiative, & abstract reasoning to severe
cognitive problems & confusion

• Papilledema (Swelling of optic nerve) is less frequent now-a-
days because brain tumors are being diagnosed earlier with the
use of sensitive imaging techniques.
• It is more common in children with slow growing tumors and
posterior fossa tumors.
**Other less common symptoms are vomiting and
frank positional vertigo, usually accompanying
tumorsfound in the posterior fossa

Specific Signs & Symptoms
Few Clinical features are related to functional areas of the brain thus
have a specific localizing value in medically diagnosing a brain tumor.
FRONTAL LOBE
Functions : Motor functioning, initiation of action, and
interpretention of emotion,including motor speech.
motor praxis, attention, cognition,emotions,
intellegence, judgement, motivation and memory.
Disorders : Hemiparesis, Seizures, Aphasia & Gait
Difficulties. with gowth of tumor there may
be personality changes like Disinhibition,
Irritability, Impaired Judgement, & Lack of
Initiation

PARITAL LOBE
Functions : It processes complex sensory & perceptual
infomation related to somesthetic sensation, spatial relations,
booody schema, & praxis.
General Condition : Contralateral Sensory loss &
hemiparesis, Homonymous visual deficits or neglect, agnosias,
apraxias & visual-spatial disorders.
If Dominant Parital Lobe is involved, Aphasia &
Seizures may be present.
If Non-Dominant Parietal Lobe is Involved,
Contralateral neglect & decresed awareness of
impairements can commonly be found.

OCCIPITAL LOBE
Functions : It is primary processing area of
visual information.
General Condition : Dysfunction of the eye
movement & Homonymous hemianopsia. If parieto-
occipital junction is involved, visual agnosia &
agraphia are often present.
Bilateral tumor may cause Cortical
Blindness.

TEMPORAL LOBE
Functions : Auditory and limbic processing.
Condition :
Ant. lesion - clinically silent until they become
very large and causing seizes.
Lateral Side - Auditory and perceptual changes
Medial Side - Changes in cognitive integration,
long-term memory, learning, and emotions may be seen.
Dominant Temporal lobe - Aphasia
Left Temporal lobe lesion - Anomia, agraphia,
acalculia, Wernicke aphasia (Fluent, nonsensical
speech)
Bitemporal involvement - It is rare and causes
memory deficits & possible dementia.

CEREBELLUM
Function : Coordination & Equilibrium.
Common Symptoms : In adults, headache, nausea and
vomiting present in 40% of condition & ataxia in 25% of Cases.
Lesion of midline - Truncal & Gait Ataxia
Lesion of Hemispheres - Uni. Appendicular ataxia
mostly in UE
Lesion of either Hemisphere - Ipsilateral dysmetria,
dysdiadochokinesia, and intention tremor.
Lesion in cerebellopontine angle - hearing loss,
headache, ataxia, dizziness, tinnitus and facial palsy may occur.
If tumor invades meninges the at foramen magnum causes
cerebellar tonsil herniation, nuchal rigidity and head tilt away from
lesion may be seen.
** As cerebellum is located in an extremely confined space, even
minimal increases in pressure can cause death from cerebellar tonsil
herniation.

BRAIN STEM
Function : It communicates information to and from the
cerebral cortex via fiber tracts, control basic life function. Reticular
formation specifically controls consciousness and attention.
Symptoms : Tumor have an insidious onset and may
include gait disturbances, diplopia, focal weakness,
headache, vomiting, facial numbness and weakness,
and perrsonality changes.
Dorsal Midbrain - Parinaud Syndrome(Loss of upward
gaze, pupillary areflexia to light, and loss of
convergence)
Reticular System of Pons & Medulla - Apnea,
hypo- or hyperventilation, orthostic hypotension or
syncope

PITUITARY GLAND
Functions : It secretes hormones that regulate many bodily
process
Condition : Tumors are typically large and affect pitutary
function by compressing its structure or
hypersecreting hormones.
•Enlarging tumor decreases the hormone production resulting in
Pituitary disorders are specific to type of hormones involved e.g.
Cushings disease, hypothyroidism, addisodisease, diabetes etc.
•As tumor enlarge it compresses nearby area :
• Lateral Extension -
• 3rd
& 4th
cranial nerve - Diplopia
• 5th
Nerve - Ipsilateral Facial Numbeness
• Internal Carotid artery occlusion - Cerebral
Infarction
• Upward Extension - Compresses Optic Chiasma &
Hypothalamus
• Downward Extension - Compresses Sphenoid Sinus

Figure : Correlation between clinical symptom & anatomical location
of tumor

Clinical Diagnosis
• A clinical diagnosis consist of information the physician gathers
during a comprehensive examination.
• Medical History including the specific nature of S&S
• Neurological Examination - Testing of reflexes & assess visual,
cognitive, sensory, and motor function.
• Doctor also examines your eyes to look for swelling caused by a
tumor pressing on the nerve that connects the eye and brain.
• After clinical diagnosis suspects the tumor the next
diagnostic step is Tumor Imaging

Radiological Diagnosis
• The modern era of CNS imaging began with the introduction of
CT in 1973 & with MRI in 1979.
• The availability of sensitive imaging allows for earlier tumor
detection and has revolutionised the diagnosis and management of
brain tumors.
• Tumor Imaging are classified into 3 categories :
• Static Imaging
• Dynamic Imaging
• Computer Integration Imaging

Static Imaging....
• Static neurological imaging includes CT and MRI, which are
noninvasive techniques that provide accurate anatomical and
functional analysis of intracranial structures.
CT Scan :
• CT uses ionizing radiation, thin bands of x-rays, to produce images
of slices of brain tissue.
• It was the first brain imaging technique to allow
determination of tumor size.
• Contrast enhancement helps to identify isodense
tumor from surrounding parenchyma, hypodense
lesions in edematous areas, and optimal sites for
tumor biopsy.

• After surgical intervention, CT can be used to confirm the proper
tissue biopsy site and determine the success of tumor resection.
• Although MRI has become the preferred method, CT scanning
offers lower cost, a shorter scanning time, and a more sensitive
method to detect calcification and bony involvement.

Magnetic Resonance Imaging :
•MRI is the imaging procedure of choice
•MRI uses magnetic fields
•MRI is superior to CTin detecting & localizing tumor as well
as evaluating edema, hydrocephalus or hemorrhage.
•MRI is more sensitive imaging modality
•Contrast enhancement with gadolinium sharpens the definition
of lesion
• MRI enhanced with gadolinium can distinguish
between edema and tumor
• Not all high grade astrocytoma enhance with
gadolinium , and MRI may imitate abnormalities
seen in low grade astrocytomas
• MRI also cannot accurately predict tumor typeor
grade of malignancy, for which biopsy is

Dynamic Imaging....
It includes :
• Positron emission tomography (PET)
• Single photon emission CT (SPECT)
• Magnetic Resonance Spectroscopy (MRS)
• Functional MRI
PET Scan :
• It is non-invasive and uses cyclotron and specific isotopes to
obtain info about metabolism and physiology of the tumor and
surrounding tissue.
• It uses radioactive markers to measure glucose
metabolism which is useful to determine the grade of
primary brain tumor. It also helps in study of
metabolic effect of chemotherrapy, Radiation therapy
and steroids on the tumor.
• It is expensive & less reliable in patient with heavy
dose of chemo therapy

SPECT Scan :
•It is functional imaging technique evolved from PET scan & uses
isotopes w/o cyclotron to assess cerebral blood flow and determining
tumor location.
•It is used to identify high- & low- grade tumor to differentiate
between tumor recurrence and radiation necrosis.
•It is used pre-op with static imaging to localize highest metabolic
area of tumor for biopsy.
• SPECT is less sensitive method to obtain
physiological information on tumors.
• It is more readily available and less expensive.

Magnetic Resonance Spectroscopy :
•It is a non-invasive technique used in conjunction with static MRI to
measure the metabolism of brain tumors.
•It has been proved to differentiate successfully normal brain from
malignant tumor and recurrent tumor from radiation necrosis.
•It also has been used to document early treatment response and
provide information regarding histological grade of astrocytomas.
• Magnetic resonance angiography (MRA) generates
images of blood vessels without dye or ionizing
radiation to evaluate the blood flow and position of
vessels leading to the brain tumor.

Functional Magnetic Resonance Imaging :
•It uses a conventional MRI scanner fitted with echo planar
technology to map cerebral blood flow at the capillary level.
•Its intended purpose is to provide information regarding the diffusion
of contrast into tumor, resulting in better resolution of tumor and
edema.
• It can also be used to identify the motor, sensory, and
language areas of the brain or the functional eloquent
cortex.

Computed Integration Imaging...
• Modern computer technology allows for the two- and three-
dimensional reconstruction of identical planes in cranial space by
combining tumor images from different modalities, including CT,
MRI, PET, and SPECT.
• Computed integration imaging involves the simultaneous display
of images from different techniques in a single imaging system
that is transposed to a reference stereotactic frame.
• This development has resulted in significant
advances in stereotactic biopsy, interstitial
radiotherapy, and laser-guided stereotactic
resection.
• It provides a safer, more accurate method of tissue
acquisition and biopsy.
• A correct tissue diagnosis can be made in 95% of

Biopsy
• Surgical biopsy is performed to obtain tumor tissue as part of
tumor resection or as a separate diagnostic procedure.
• Stereotactic biopsy is a computer-directed needle biopsy. When
guided by advanced imaging tools, stereotactic biopsy yields the
lowest surgical morbidity and highest degree of diagnostic
information.
• This technique is frequently used with deep-seated
tumors in functionally important or inaccessible areas
of the brain in order to preserve function.

Laboratory Diagnosis
• Laboratory testing is often used to further assess focal deficits
during the diagnosis and management of brain tumors.
• Perimetry is the measurement of visual fields used when evaluating
tumors near the optic chiasm.
• Electroencephalography (EEG) is used to monitor brain activity and
detect seizures but has limited value during screening because EEG
findings are often normal in clients with brain tumors.
• Lumbar puncture is used to analyze CSF, which is useful
in the diagnosis and detection of dissemination of certain
brain tumors.
• Audiometry and vestibular testing are useful for
diagnosing tumors in the cerebellopontine angle.
• Endocrine testing is used to examine endocrine
abnormalities with tumors in the pituitary gland and
hypothalamus.

Medical & Surgical Management
• The ultimate goal of tumor management are to improve quality of
life and extend survival, by improving body function & structures.
• Treatment techniques are determined by histological type,
location, grade, and size of tumor; age of onset; and medical
history of the patient.
Four Type of Treatment are discussed :
1. Traditional Surgery
2. Chemotherapy
3. Radiation Therapy
4. Stereotactic Radiosurgery

TRADITIONAL SURGERY :
Primary Goal : Maximal tumor resection with the least amount of
damage to neural or supporting structures.
The purposes of surgery in the management of brain tumors include the
following :
1. Biopsy to establish a diagnosis
2. Partial resection to decrease the tumor mass to be
treated by other methods
3. Complete resection of the tumor
4. Provision of access for adjuvant treatment techniques.

Biopsies are performed through open, needle, and stereotactic needle
techniques.
‒Open biopsies involve exposure of the tumor followed by removal of
a sample through surgical excision.
‒Needle biopsies involve insertion a needle into the tumor through a
hole in the skull and the excision of the tissue sample drawn through
the needle.
‒Stereotactic needle biopsies use computers and MRI or CT scanning
equipment to assisst in directing the needle into the tumor.
Partial & Complete Resections are accomplished through
craniotomy.
–Craniotomy involves removal of a portion of the skull
and seperation of the dura mater to expose the tumor.
–Stereotactic craniotomy uses technologyto guide
neurosurgeon duing the procedure.
–Awake craniotomy allows for intra-op brain mapping.

Preoperative Management : Before surgery, clients are evaluated for
general surgical risks and the possibility of tumors in additional
locations.
Unless medically contraindicated, steroids & anticonvulsant
medications are administered before surgery
Intraoperative Management : During surgery, precautions are taken to
prevent an increase in edema or ICP.
Mannitol(vasodiuretic) &Hyperventilation is used to
decrease ICP,
Steroid use is continued and
Antibiotics are administered to prevent infection.

Postoperative Management : Patients are observed in an intensive care
unit for at least 24 hours for possible intracranial bleeding or seizures.
Blood pressure is monitored continuously.
Post-op these patients are more prone to DVT but due to the
risk of intracranial bleeding, acoagulants cannot be given so
Compression stockings are used prophylactically.
Steroids are tapered in 5-10 days post-op.
The Primary Limitations of traditional surgery include :
1. Medical Complication such as Hematoma,
Hydrocephalus, infection infarction from procedure.
2. Complications resulting from GA
3. Increased cost of hospital stay and surgical
procedure.

CHEMOTHERAPY :
It can be used independently or as an adjuvant to surgery or radiation.
Chemotherapy can be administered in a number of different ways.
•Most agents are given intravenously through a peripheral intravenous
line or through a catheter such as a peripherally inserted central
catheter (PICC).
•Chemotherapy drugs impede cellular replication of the tumor cells,
interfering with their ability to copy deoxyribonucleic acid (DNA)
and reproduce.
• Methotrexate (Highly neuro-toxic) is admnistered
with Leucovorin (Antidote)
• Temozolomide is orally available chemotherapeutic
agent for the Rx of Gliomas.

• The antiangiogenesis monoclonal antibody Avastin
(bevacizumab) improved the progression- free survival and
the tumor images on MRIs of patients with glioblastoma. The
drug targets vascular endothelial growth factor (VEGF) and
is administered intravenously.

RADIATION THERAPY :
• It can be used alone or in conjunction with surgery or chemotherapy
to treat malignant brain tumors.
• It is typically chosen as a treatment option for tumors that are too
large or inaccessible for surgical resection and to eradicate residual
neoplastic cells after a surgical debulking.
• Radiotherapy consists of the delivery of high-powered
photons, with energies in a much greater range than that
of standard x-rays, as an external beam directly at the
tumor site.

• Hyperfractionated radiation therapy is believed to increase the
efficacy and decrease the long-term side effects of radiation.
• Conformal radiation delivery is the Peacock system. This method
attempts to deliver a uniform amount of radiation to the tumor and
minimize irradiation of healthy brain tissue.
• Radiosurgery involves relatively high-dose
hypofractionated radiation beams directed at small
tumor areas through the use of computer imaging.
This type of treatment includes the Gamma Knife,
linear accelerators, and the cyberknife.

STEREOTACTIC RADIOSURGERY :
• Stereotactic radiosurgery is defined as delivery of a high dose of
ionizing radiation, in a single fraction, to a small, precisely defined
volume of tissue.
• The high-energy accelerators involved with stereotactic
radiosurgery improve the physical effect of radiation by allowing
energy to travel more precisely in a straight line and penetrate
deeper before dissipating.
• The goal of stereotactic radiosurgery is to arrest tumor
growth.
• Advantages of stereotactic radiosurgery are as follows:
1. Is a noninvasive procedure using local anesthesia and
sedation to place the stereotactic frame
2. Avoids risks of general anesthesia and immediate
postoperative risks such as bleeding, CSF leak, and
infection
3. Lowers treatment cost and shortens hospital stays.

• Stereotactic radiosurgery is used to treat benign and malignant
tumors, vascular malformations, and functional disorders. The
primary modes of administration for stereotactic radiosurgery
include the Gamma Knife, linear accelerators, and the cyberknife.
• The Gamma Knife was first introduced in Sweden in 1968 and is
now used worldwide at 65 sites. The Gamma Knife is typically used
for deeply embedded small tumors that require precise delivery of
radiation.
• Linear accelerators used for conventional radiation
can be modified for stereotactic radiosurgery. The
brain lesion to be targeted is stereotactically placed
in the center of the arc of rotation of the machine. A
single, highly focused beam of radiation is delivered
over multiple sweeps around the brain lesion. Linear
accelerators can be used to treat larger tumors with
precise shape while maintaining uniform dose.

The Cyberknife uses a compact linear accelerator mounted on a
robotic arm, with the robotic arm moving around the linear accelerator
to multiple precalculated positions. At each position the accelerator
fires a beam of radiation at the tumor or lesion. A high cumulative
dose of radiation is achieved at the tumor or lesion because of the
convergence of the beams. This dose is typically strong enough to
destroy the abnormal cells while minimizing the damaging effects of
radiation to healthy surrounding tissue.

• A brain tumor and its treatment can lead to other health problems.
You may receive supportive care to prevent or control these
problems.
• You can have supportive care before, during, and after cancer
treatment.
• It can improve your comfort and quality of life during treatment.
• Health care team help you with following problems :
• Swelling of the Brain
• Seizures
• Fluid buildup in the skull
• Sadness and other feeling
** Many people with brain tumors receive supportive
care along with treatments intended to slow the
progress of the disease. Some decide not to have
antitumor treatment and receive only supportive care

• Rehabilitation can be a very important part of the treatment plan. The
goals of rehabilitation depend on your needs and how the tumor has
affected your ability to carry out daily activities.
• Some people may never regain all the abilities they had before the
brain tumor and its treatment. But your health care team makes every
effort to help you return to normal activities as soon as possible.
Several types of therapists can help :
• Physical Therapists
• Speech Therapists
• Occupational Therapists
• Physical Medicine Specialist
**Children with brain tumors sometimes have tutors in the
hospital or at home. Children who have problems learning or
remembering what they learn may need tutors or special
classes when they return to school.

• Rehabilitation is a key component n the management of the client
with a brain tumor.
• With advances in technology and treatment intervention, survival
rates of people with cancer have improved.
• Ultimate goal for rehab is by preventing complications,
maximizing function, and providing support, rehabilitation
specialists ultimately improve the client's quality of life.
• The most effective rehabilitation plan is flexible, to
allow for increasing impairment, and sensitive, to
accommodate the highly emotional impact that
accompanies the diagnosis of a primary brain tumor.
• To establish an appropriate plan of care, the clinician
must understand the nature of the specific tumor, the
client's fluctuating neurological status & Prepare the
likelihood of progressive decline.

Evaluation...
• The evaluation process must include a comprehensive examination
and assessment of all systems in order to establish an appropriate
impairment diagnosis, problem list, prognosis, and plan of care.
• The client's occupation, support system, personal goals, and role in
the family are important psychosocial factors that should be
identified in the evaluation.
These factors+Functional exam.+Neurological Examination
↓
Diagnostic process
↓
Identification of clinical problem
↓
Establishment of realistic & appropriate Goals
↓
Selection of most effective intervention
& Discharge planning

Goal Setting...
• To set realistic & client oriented goals, it is important for the
therapist to envision where the patient will be at discharge based on
present level of function, prognosis , and disease course, while
considering client and caregiver personal goals.
• Appropriate goals range from comprehensive caregiver training to
independent mobility with transition back to a work environment.
• Goals need to challange the client to attain an optimal level of
function.
• Patient who have the potential to return to work may
require neuropsychology, vocational rehabilitation, or
a multidisciplinary day program, dependingupon the
nature of the job
• If the patient has a poor prognosis, the rehabilitation
team can train family members and give them weekly
goals.

Functional Assessment...
• The functional assessment is a critical component in the development
of the treatment intervention.
• It provides a method of analyzing deficits, compiling a problem list,
developing a treatplan, and measuring functional outcomes.
• The Functional Independence Measure (FIM) is a 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.
• Physicians use Specific Functional evaluation scales
to measure success of treatment such as Karnofsky
Performance Scale, which rate patient's functional
performance.

Intervention...
• The ultimate goal of rehabilitation is to achieve maximum
restoration of function, within the limits imposed by the disease, in
the client’s preferred environment.
• The clinician must recognize that the physical, cognitive, and
emotional status of these individuals is inconsistent and changing as
a result of the disease process or medical intervention.
• Treatment plans must be flexible to effectively manage fluctuations
in the client’s presentation.
• In the intensive care unit, communication with
nursing staff regarding the client’s present medical
status and an understanding of ICP, hemodynamic
values, and monitoring devices are crucial to
determining tolerance for therapy intervention.

• For a ventriculostomy, a catheter is placed in the third ventricle to
drain CSF and to monitor ICP. Mobilizing a patient with a
ventriculostomy is possible, but nursing staff must close the drain
before any positional change and should inform the clinician of
appropriate treatment measures.
• As the client becomes more medically stable, the clinician upgrades
mobility and prepares the client for the next stage of rehabilitation.
• Clinicians spend many hours with clients during their
rehabilitation stay. This daily interaction gives the
clinician the opportunity to connect with the client on a
personal level and observe her or him in many settings.
• In the inpatient rehabilitation setting, treatment focuses
on optimizing functional capabilities to prepare the
client and family for discharge.

FIGURE : A patientafter parietal tumor resection seen in neuro ICU

Discharge Planning
• Discharge planning is initiated early, continues throughout the
rehabilitation process, and must allow for changes in the client’s
functional status.
• On discharge from the rehabilitation setting, the client will make the
transition to one of the following settings: home, skilled nursing
facility, or hospice.
• The transition to home is typically preferred by the client, caregiver,
and interdisciplinary rehabilitation team.
• If the client cannot be physically or medically
managed at home, then placement in a skilled nursing
facility may be necessary.
• The client may choose hospice care when medical
treatment is no longer providing control of the tumor
and the physical demands of the client are not
manageable by the caregivers.

FIGURE : Brain
Tumor Teaching Goals
Sheat

Psychosocial Care...
Hope is a key psychosocial need of the individual with cancer. It is an
important coping strategy that can help clients with brain tumors face
an uncertain and often fearful future. Hope gives the client something
to look forward to each day. Clinicians can create a hopeful
environment by encouraging clients to share their expectations,
identify realistic shortterm goals, and acknowledge hopes, even if
they are unrealistic. It is important to recognize that hope must be
balanced with reality and honest disclosure regarding
diagnosis and prognosis

Brain tumor

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