Cerebellar Mutism: The rehabilitation challenge in pediatric neuro-oncology: Case studies

Abstract

Cerebellar Mutism Syndrome (CMS), also known as posterior fossa syndrome (CMS/PFS), refers to a transient loss of speech followed by dysarthria and is a common complication in the pediatric population following resection of a cerebellar tumor. Recognition and rehabilitation of CMS is critical in the post-operative phases of recovery. Two case studies, including neuropsychological assessments, along with the family and patient's perspectives are reviewed.

Post-operative cerebellar mutism syndrome: rehabilitation issues

“…At present, the complex array of post-operative challenges for children with pCMS requires an integrated approach to rehabilitation. Early intervention is required with a long-term plan for the management and surveillance of speech and language, as children remain at risk throughout development [15,64,65]. As a group, children receiving surgery and other treatments for brain tumors often experience poor long-term quality of life outcomes due to disorders of speech and language, which include academic failure and loss of friendships that lead to devastating negative impacts upon healthy development and socialization [2,19,33,43,51].…”

“…The profound, persistent, and widespread impact of pCMS highlights the importance of ongoing rehabilitation and effective and early intervention [42,52,67]. The complexities of pCMS stress the importance of multidisciplinary management [64]. In the case of pCMS, restoration of motor functions and communication relies heavily upon physiotherapy and occupational, speech, and language therapy [64].…”

“…The complexities of pCMS stress the importance of multidisciplinary management [64]. In the case of pCMS, restoration of motor functions and communication relies heavily upon physiotherapy and occupational, speech, and language therapy [64]. Rehabilitation in the acute phase of pCMS is often severely hampered by the behavioral deficits that prevent the child from fully participating in therapy at a level necessary for effective rehabilitation.…”

“…An integrated approach to rehabilitation that also includes in the team physiatrists, neuropsychologists, child psychiatrists, and social workers-in close cooperation with the family-will serve to improve the quality of life for children with pCMS, as well as their families and wider communities. Walker and colleagues described families and the school community as "powerful agents of change," where family-delivered rehabilitation is considered much more effective than clinician-directed management [64].…”

“…Cognitive rehabilitation after pCMS should be tailored to the individual needs of the child, and evaluations are important in developing such individualized rehabilitation or interventions. Where children are left with significant residual impairment, the incorporation of compensatory technology to aid communication is recommended [64]. Interventions, particularly those focused on the cognitive consequences of pCMS, should consider the use of telemedicine or alternative intervention delivery (e.g., home-based computer intervention programs) to maximize access and feasibility to these interventions.…”