Multidisciplinary Rehabilitation in Children with Brain Tumors: Bambino Gesù Children's Hospital Experience

Chair

Susanna Staccioli

Presenters:

Emanuela Tavernese
Simone Gazzellini
Letizia Morgia
 

Description:

CNS tumors are the most common pediatric cancers after haematological malignancies and the most common pediatric solid organic tumor. While it remains the most common cause of cancer-related death in pediatric patients, improvements in surveillance and treatment have resulted in larger population of cancer survival. In the management of brain tumors, neurological problems can be observed as sequelae of the pathology itself, neurosurgical intervention and medical complication (e.g. epilepsy and hydrocephalus), adjuvant oncological treatment or a combination of these, despite the use of hyperfractionated radiotherapy and the advent of proton therapy. Patients can develop a combination of multiple sequelae, including neurological problems, cognitive deficits, emotional and physical discomfort, swallowing and feeding difficulties, endocrine disorders. In particular long-term neuropsychological follow up studies in children with BT demonstrated a range of cognitive deficits, concerning memory, attention, executive function, speed of processing, neurovisual defects, academic problems, behavioral and emotional/affective disturbances. The localization of the damage seems to have only a limited impact on neuropsychological outcome. Disturbing connectivity in a developing system could have considerable impact on the developing of cognitive abilities. In the literature regarding children and adolescent and in clinical practice too, there is a growing consensus on the importance of a multidisciplinary approach to rehabilitation. Even if benefit of multidisciplinary rehabilitation for children with brain tumor of several types is difficult to establish due to heterogeneity of patients, in our opinion it is important to stress the need of individual rehabilitation strategies, across specific domains. In this view seven years ago we created in our Hospital a medicine teamwork for inpatient and outpatient children affected of CNS tumors, including: oncologist, neurosurgeon, pediatric neurologist, physiatrist, neuropsychologist, psychologist, physical therapist, speech therapist. We have followed more than 200 children. Requests increased over the course of year, showing that pediatricians and families became more and more aware of the benefits offer by this type of intervention. We observed that improvements is notable independent of the prognosis. This approach includes a strong collaboration with the family and a creation of network with territory structures. This strong coordination and collaboration improves quality of care and quality of life of our little patients. This symposium will propose:1) to demonstrate the importance of an early rehabilitative treatment in acute phase and through admission in a unit for intensive treatment in all area involved by the damage; 2) to evidence the need of a quickly management of psychological distress of both the child and his family in all the disease steps ; 3) regular multidisciplinary follow up after acute phase. 

 

Learning Objectives:

  1. Identify neuropsychological deficits in children with brain tumor (supratentorial and posterior fossa tumor).
  2. Explain the reasons according to which it is necessary to create a teamwork in children with brain tumors. 
  3. Describe appropriate assessment and choose rehabilitative tools in children with brain tumor.