ABSTRACT

Posterior Fossa Syndrome or cerebellar Mutism Syndrome is typically a result after a tumor is surgically removed in the posterior fossa of the skull. The therapeutic outlook for these patients are variable leading to long term sequelae or a full recovery. Some examples of symptoms include dysarthria, ataxia, reduced IQ and persistent psycho-social problems. However, across the board, these patients' speech is the last to return to their previous level. This study involves a 10 year old female who had a juvenile pilocytic astrocytoma at the cerebellum/brain stem resulting in posterior fossa syndrome. This patient performed virtual reality exercises within the Neurological Recovery Center and at home as a part of a home exercise program during her normal physical therapy during an 8 month period of time. During this time through the use of virtual reality within her treatments the patient began to show functional improvements in balance and gait.

INTRODUCTION

The patient is a 10 year old patient diagnosed with Posterior Fossa Syndrome secondary to a Juvenile Pilocytic Astrocytoma at the Cerebellum/Brain Stem. She began physical therapy at the Neurological Recovery Center from 02/2019. Due to her low function and complicated case her family had struggled to find a solution for physical therapy before coming to the Neurological Recovery Center. Her family reported she was dependent for activities of daily living, she frequently fell and that the burden of care was great. In order to alleviate the burden and improve the quality of life, as well as provide greater motivation towards therapy Virtual Reality functional exercises were utilized as a part of her normal therapy routine.

CLIENT CHARACTERISTICS

The patient presented with poor balance, frequent falls, vision defecits, poor endurance, silent aspiration, ataxia, unsteady gait, dependence in ADLs, W/C bound. The patient had goals of returning back to school/ambulating independently, returning to swimming, soccer, running, and jumping on a trampoline.

EXAMINATION FINDINGS

The patient exhibits poor balance and frequent loss of balance and uncontrolled falls. The patient's endurance was lacking and with fatigue would demonstrate nausea/vomiting. This patient was also impulsive however always in good spirits and wanting to play. Her 6 minutes walk test is > 1000 feet with assistive device.

INTERVENTIONS

Virtual Reality exercises were administered utilizing Neuro Rehab VRs XR therapy system. The activities included functional multiplanar reaching outside of BOS, squatting, floor to stand transfers, cognitive challenges and standing balance. These activities were performed 3x a week for 20 minutes and towards the end of the trial period the patient began to perform the same activities as a part of her HEP intermittently throughout the week.

OUTCOME

As of 10/13/19 the patient is participating in all day schooling 3x a week/half days 2x/week, Independent without AD for ambulation in classroom, modified independent with assistive device in hallways, competes in swimming, climbing, jumping on trampoline, rides rollercoasters, and is mostly a community ambulator. Her 6 minute walk test is 1293 feet without an assistive device.

DISCUSSION/CLOSING

These results show that Virtual Reality exercises can be used as a viable alternative modality to be used along with normal therapeutic intervention. The patient transitioned from being dependent to independent with ambulation, activities of daily living, and is able to participate in activities she used to do before her injury over the course of 8 months.