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Functional Gains in Children Receiving Inpatient Rehabilitation After Brain Tumor Resection
Alyssa M Day1, Beth S Slomine2, Christina Salama3
1Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD.
Insights
Children with brain tumors benefit from inpatient rehabilitation, showing significant functional gains. Admission factors like age and time since surgery best predict outcomes for pediatric brain tumor patients undergoing rehabilitation.
Area of Science:
- Pediatric Neuro-oncology
- Rehabilitation Medicine
- Clinical Outcomes Research
Background:
- Brain tumors are a significant cause of acquired disability in children.
- Post-surgical rehabilitation is crucial for optimizing functional recovery in pediatric patients.
- Predictors of functional outcomes in this population require further investigation.
Purpose of the Study:
- To determine if children with brain tumors benefit from inpatient rehabilitation post-resection.
- To identify factors at admission that predict better functional outcomes.
Main Methods:
- Retrospective cohort study of 40 pediatric patients (ages 3-21) undergoing brain tumor resection.
- Multidisciplinary rehabilitation including occupational, physical, and speech-language therapy.
- Functional outcomes assessed using the FIM for Children (WeeFIM) at admission, discharge, and 3-month follow-up.
Main Results:
- Patients demonstrated significant functional gains (WeeFIM DFQ scores) during rehabilitation and at 3-month follow-up.
- Admission WeeFIM DFQ, time from surgery to admission, and age at admission were strong predictors of outcomes.
- The Neurological Predictor Scale (NPS) did not add predictive value beyond patient characteristics.
Conclusions:
- Inpatient rehabilitation leads to significant functional improvements for children post-brain tumor resection.
- Patient age and timing of admission are key predictors of rehabilitation success.
- Current predictive models do not require the NPS for assessing outcomes in this cohort.
Objective:
To examine whether children with brain tumors treated with resection benefit from inpatient rehabilitation and to explore what factors present at admission may predict better functional outcomes.
Design:
Retrospective cohort design.
Setting:
Pediatric inpatient rehabilitation unit.
Participants:
Forty patients (N=40; ages 3-21y; 42.5% female) admitted to the rehabilitation unit between 2003 and 2015 after brain tumor resection.
Interventions:
Patients received multidisciplinary rehabilitation therapies as part of their admission to inpatient rehabilitation, including occupational, physical, and speech-language therapy.
Main Outcome Measures:
Functional outcomes included the FIM for Children (WeeFIM) at discharge and 3-month follow-up as well as WeeFIM efficiency.
Results:
A repeated-measures analysis of variance using patient WeeFIM Developmental Functional Quotients (DFQs) at admission, discharge, and 3-month follow-up showed significant gains in total WeeFIM DFQ scores across time. Admission WeeFIM DFQ, time from surgery to admission, and age at admission provided the strongest model for predicting discharge and 3-month follow-up WeeFIM DFQ scores. Admission WeeFIM DFQ and time from surgery to admission provided the strongest model for predicting WeeFIM efficiency. Total Neurological Predictor Scale (NPS) at admission did not add predictive power to any of the 3 models over and above patient characteristics (admission WeeFIM DFQ, age at admission, time from surgery to admission).
Conclusions:
Patients admitted to inpatient rehabilitation after brain tumor resection made significant functional gains (as measured by the WeeFIM) during inpatient rehabilitation and continued to make significant gains 3 months after discharge. Age and timing of admission provided the strongest models for predicting patient outcomes. The NPS did not predict functional outcomes after rehabilitation when controlling for other variables known to influence rehabilitation outcomes.
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