Case 3: Cerebral Hemispherectomy (exam 3) Flashcards
sometimes referred to as “aseptic” meningitis: may occur postsurgically and is associated with fever, stiff neck, and malaise
chemical meningitis
*acute inflammation of meninges covering brain/SC
Congenital malformation of the cortex; a cause of seizures
cortical dysplasia
Also known as “water on the brain”; swelling of the brain due to excessive accumulation of cerebrospinal fluid (CSF) that can occur when the normal flow or absorption of CSF around the brain is obstructed
hydrocephalus
Pressure measured inside the skull, and thus, the pressure exerted on the brain tissue and CSF
ICP: intracranial pressure
Visual field defect involving the right halves of the visual field of both eyes
right homonymous hemianopsia
Plastic tube used in neurosurgery to drain fluid from the ventricles of the brain and thus keep them decompressed; used to monitor and relieve elevated ICP and hydrocephalus
ventricular catheter
Device used to treat hydrocephalus that allows fluid to move from a ventricle of the brain to the peritoneal cavity
VENTRICULOPERITONEAL (VP) shunt
What is a cerebral hemispherectomy
complete surgical resection and/or disconnection of one hemisphere.
It is a dramatic procedure typically performed to stop the detrimental effects of chronic and persistent drug- resistant seizures on a child’s development.
Functional outcomes for children status/post cerebral hemispherectomy may be related to _ _ at time of surgery
etiology and/or age
*acquired etiology and younger age = better outcomes
The _ is a valid, reliable tool to identify gross motor, fine motor, and cognitive delays in children (ages 1 month to 42 months) and may be appropriate in assessing children with cerebral hemispherectomy.
Bayley Scale of Infant and Toddler Development 3rd edition
_ improves motor function and increase use of the hemiparetic extremity in children with cerebral hemispherectomy.
CIMT (Constraint-induced movement therapy)
The most common indication for a cerebral hemispherectomy is:
A. cortical tumor
B. medically intractable seizures
C. infarcts leading to hemiplegic CP
D. seizures arising from several areas of the brain in both hemispheres
B. most commonly used for intractable seizures resistant to medications
Typical clinical presentation of children status/post hemispherectomy includes:
A. Increased spasticity with more involvement in the involved lower extremity as compared to the involved upper extremity
B. Visual field cut without sensory deficits in the upper extremity
C. Global delays in all areas with more involvement in the involved distal upper extremity
D. Increased difficulty in walking recovery for children who walked previous to surgery
C. typically has spasticity with motor involved in lower extremity, however **MOST involvement is distal upper extremity **due to decreased subcortical innervation and/or etiology
Physical therapy interventions for children status/post hemispherectomy:
A. should be novel, task-specific, intense, and repetitive.
B. are unlikely to change deficits due to complete disconnection of the involved cerebral hemisphere.
C. are only necessary in the acute phase of recovery.
D. have been shown to be ineffective when presented in massed blocked sessions.
A.
Although more research is required regarding the effectiveness and dosage of physical therapy in clients status/post hemispherectomy, strategies implementing motor learning techniques (novel, massed practice) are feasible options for this population and positive changes may occur. Due to the younger ages of certain etiologies such as cortical dysplasia, children status/post cerebral hemispherectomy are aging with a chronic disability and would likely benefit from physical therapy throughout their lifespan.
PT precautions for post cerebral hemispherectomy
- Delayed hydrocephalus that can develop at any time postsurgery
- any gradual change, including a change in school performance, may indicate a need for a VP shunt or shunt revision
- seizures may reoccur due to delayed hydrocephalus
- seizures may indicate a need for additional surgery and/or change in medication management
complications interfering with PT for cerebral hemispherectomy
- **Global delays **in cognition, language, fine motor, gross motor, social, emotional, and adaptive development may interfere with physical therapy participation
- functional skills may be impacted by** visual and/or perceptual neglect**
** persistent hemiparesis **with more distal extremity involvement
* spasticity
** sensory impairments **with possible pain and sensory integration dysfunction
