Date of Award

2019

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Kristin Johnson Thomanschefsky

Keywords

Acoustic Stimulation; Ataxia -- rehabilitation; Music Therapy; Physical Therapy Modalities; Postural Balance; Radiotherapy -- adverse effects; Case Reports

Abstract

Background and Purpose: Medulloblastomas are a form of cancer most commonly found in children. They are normally treated through surgery, radiation therapy, and chemotherapy. Radiation necrosis is a possible side effect of radiation therapy which can have devastating effects on a patient's function. Research on the effects of physical therapy interventions in treating the functional impairments which can result from medulloblastomas and radiation necrosis is limited. The purpose of this case study is to examine the effects of collaborative treatment between two student physical therapists and a student music therapist on a· patient with functional limitations due to a medulloblastoma and radiation necrosis.

Case Description: The patient is a 35-year-old female who presented to therapy with an ataxic gait pattern, balance deficits, strength deficits, and impaired coordination of upper and lower extremities. Various balance, quality of life, and functional assessments were used. These measures included the Short Form 36 (SF 36), Berg Balance Test, Activity Specific Balance Confidence Scale (ABC Scale), Four Square Step Test (FSST), and the Five Times Sit to Stand test (FTSTS). She was rated as having an increased fall risk, decreased mobility, and decreased quality of life.

Intervention: The interventions performed with this patient focused on improving balance, coordination, gait, strength, and function. Interventions included stairs with unilateral upper extremity support, tandem-stepping exercises, boxing, and waltzing among others. Rhythmic auditory stimulation (RAS) was implemented into appropriate interventions in order to improve patient performance.

Outcomes: Improvement was seen with the Berg Balance Test, FSST, FTSTS. The Berg Balance improvement was significant and moved her into the low fall risk category. She remained below the cut-off scores for the FSST and FTSTS. Decline was seen with the ABC Scale and the SF-36.

Discussion: This case study demonstrated the efficacy of the implementation of RAS into physical therapy interventions in treating patients with cerebellar radiation necrosis secondary to a medulloblastoma as improvements were seen in balance, strength, retro-ambulation, and coordination. Further research is needed to assess vvhether results are replicable in similar patients.

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