Medulloblastoma

Please use this wiki to compile resources, links, and files related to your final project case study. You may use and organize this wiki however you wish, but please note that the following items are required:
 * Information about the child's diagnosis
 * Evidence-summary table and links to articles, websites, abstracts, etc (from the Nov 16 EBP lab) on a clinical question of your choice (related to the child's diagnosis, condition, limitations, and/or restrictions)
 * Educational material of your choice (such as a brochure, home exercise program, inservice presentation) related to the child's diagnosis, condition, restrictions/limitations

Remember, you MAY NOT include any identifying information on this page. Do not include the child's name or birth date, any personal information about the child, photographs or video of the child, or the WHO-ICF model completed about the child.

=**Pediatric Medulloblastoma: What is it?**= Medulloblastoma is the most common malignant brain tumor diagnosed in pediatrics. The tumor originates in the cerebellum but has a high probability of spreading throughout the CNS if not caught in its early stages. The most utilized course of treatment includes aggressive surgery to excise the tumor, followed by chemotherapy and radiation regimens.

Early symptoms are mainly due to increased intracranial pressure, and school-aged children oftentimes complain of sporadic dull headaches and fatigue. Early signs of increasing intracranial pressure may include deterioration in school performance and altered personality. Other common signs associated with the clinical presentation of medulloblastomas include decreased trunk and extremity coordination and gait deficits secondary to cerebellar dysfunction and gaze palsy, facial weakness, and hearing loss secondary to brainstem dysfunction, specifically in regards to the cranial nerves. Fiorillo et al. found ataxic gait in all 16 of their subjects with posterior fossa tumors of which about 40% are medulloblastomas.

Here's a video of ataxic gait due to medulloblastoma (pre-surgery): media type="youtube" key="JKMnJh-dzTw" height="315" width="420" And another video of a child post medulloblastoma removal walking with a reverse walker: media type="youtube" key="SGUJluPzQYc" height="315" width="420" __**Sources**__: MacDonald, Tobey. “Pediatric Medulloblastoma.” 2009. Retrieved from [] Fiorillo A, Rinaldi M , Foggia L. "Gait analysis in children treated by surgery followed by adjuvant therapy for posterior fossa tumors." [Abstract] 2010. Retrieved from [] =Physical Therapy and Medulloblastoma= This multidisciplinary case study concerns an adolescent undergoing treatment for medulloblastoma. The introduction and first discussion of the case are written by physical therapists. This quote is a sort of summary of the message of the article: "Intensive rehabilitative therapy and early identification of functional deficits that are potentiallly reversible are as important as the treatment given to control the tumor. For this reason, children should be treated in centers having both excellent therapeutic options and agressive and experienced rehabilitation. Their caregivers should be experienced in avoiding unrealistic expectations" (Page 142).

=**Focusing on Tumors: Medulloblastoma**=

=
This is a very informative online booklet compiled by the American Brain Tumor Association outlining the specifics of medulloblastomas. Towards the end of the publication, there is a section titled "Resources" that provides contact information for treatment option inquiries as well as for support groups and pen-pal programs.======

[[file:Focusing on Tumors Medulloblastoma.pdf]]
=Organizations for Pediatric Brain Tumors= American Childhood Cancer Organization: [] Brain Tumor Foundation for Children, Inc.: [] Children's Brain Tumor Foundation: [] Pediatric Brain Tumor Foundation: [] American Society of Clinical Oncology: [|http://www.cancer.net/] St. Jude's Children's Research Hospital: []

=**Is Aquatic Therapy an Effective Therapeutic Intervention for Individuals with Gross Motor Skill Impairments?**= (3 days/week for 1 hour) aquatic therapy programme on physical fitness (strength, endurance, body composition, flexibility) || Aquatic therapy programs for people with TBIs can lead to increased ROM, muscular endurance, strength, and functional capacity. Improvements in physical fitness components can translate into more functional gains (ie increased success in completing ADLs). || =Aquatic Physical Therapy: A Case Study and Interventions= The web link below contains two videos that are commentated by Cindy Jarosch, a physical therapist at Children's Hospital, who speaks about the aquatic therapy rehabilitation program of a child with a medulloblastoma.The first video outlines the child's history and provides a brief verbal description of the types of exercises utilized in aquatic therapy sessions. The second video is of an actual aquatic therapy session, with the PT and child demonstrating the exercises commonly performed. [|Aquatic PT for a Child with a Medulloblastoma Tumor]
 * **AUTHOR** || **SOURCE** || **DATE** || **TITLE** || **SAMPLE** || **METHODOLOGY/MAIN IDEA** || **RESULTS** ||
 * Driver, O’Connor, Lox, Rees || Brain Injury, 18(9): 847-859 || 2004 || Evaluation of an aquatics programme on fitness parameters of individuals with a brain injury || 16 adults (8 men, 8 women) suffering a brain injury >1 year ago, ranging in ages from 33-45 years with a classification of 6 or greater on the Ranchos Los Amigos Scale of Cognitive Functioning || Pre-test-post-test randomized-groups design examining the effects of an 8 week
 * Fragala-Pinkham, Haley, and O’Neil || Developmental Medicine and Child Neurology 50(11): 822-827 || 2008 || Group aquatic aerobic exercise for children with disabilities. || 16 children with a mean age of 9 years 7 months with disabilities resulting in decreased fitness per parent report and able to ambulate. Example diagnoses included myelomeningocele, CP, PDD-NOS, Down syndrome, autism, and developmental delay. || Non-randomized, A-B group design. Two measures taken during baseline period compared with measures after 14 weeks of twice weekly aquatic exercise sessions. Variables measured included lower extremity and abdominal strength, floor to stand (FTS) test, half mile walk/run, and the Multidimensional PEDI. || Cardiopulmonary endurance as measured by the half mile walk/run was significantly improved. No other changes were significant though moderate effects were also seen in the M-PEDI and abdominal strength. Aquatic therapy may be a safe and fun alternative to land based therapy for increasing cardiopulmonary endurance in children with disabilities. ||
 * Getz, Hutzler, and Vermeer || Clinical Rehabilitation 20: 927-936 || 2006 || Effects of aquatic interventions in children with neuromotor impairments: a systematic review of the literature || 173 participants diagnosed with CP (63%) with mean age of 19 years, MD (33%) with mean age of 7 years, high risk infants (2%) with mean age of 4 months || Systematic review using 11 articles to evaluate the effectiveness of aquatic interventions in children with neuromuscular impairments with regard to the ICF dimensions || Hydrotherapy might improve respiratory function in children with CP. 10 articles reported positive effects of aquatic interventions on activity outcomes. Varied outcome measures and limited information of intervention intensity, dosage, and duration requires further research be implemented to obtain the additional effects of aquatic interventions. ||
 * Hillier, McIntyre, Plummer || Physical & Occupational Therapy in Pediatrics 30(2): 111-124 || 2010 || Aquatic physical therapy for children with Developmental Coordination Disorder (DCD): a pilot randomized controlled trial || 12 children diagnosed with DCD (10 males, 2 females) with mean age of 7 years 1 month completed the study || Pilot randomized controlled trial examining the feasibility of aquatic therapy for children with DCD and its initial effectiveness in improving motor function, self-perception, and level of participation. Intervention group received aquatic physical therapy (six, 30-min sessions over a pre-set 6-8 week period*). Wait-list control group received no intervention and was advised to continue “life as usual” for 6-8 weeks until reassessment
 * = actually took 15 weeks from time of initial assessment to time of reassessment || Aquatic therapy is a feasible intervention if pool and therapist availability hours are taken into account during planning and sessions are individualized. The participants in the intervention group demonstrated a trend towards greater improvement in motor abilities and in self-perceived physical competence compared to the control group. Participation levels increased in both the intervention and control groups, with the control group scoring better with social activities. ||

=Home Exercise Program= Here's an example HEP, without any names. It's envisioned as an email sent to a parent with hypertext links to additional resources such as youtube videos explaining how to play hopscotch.