REhabilitation Approaches in CHildren with cerebellar mutism syndrome (REACH): An international cross-disciplinary survey study

Abstract

Objective: Pediatric cerebellar mutism syndrome (pCMS) can occur following resection of a posterior fossa tumor and, although some symptoms are transient, many result in long-lasting neurological deficits. A multi-disciplinary rehabilitation approach is often used in cases of pCMS; however, there have been no clinical trials to determine gold standards in rehabilitation practice in this population, which remains a research priority. The purpose of this study was to identify and compare intervention practices used in pCMS throughout the disciplines of occupational and physical therapy, speech-language pathology, and neuropsychology across geographic regions.

Methods: A 55-question e-survey was created by an international multidisciplinary research group made up of members of the Posterior Fossa Society and sent to rehabilitation professionals in pediatric neuro-oncology centers in the US, Canada, and Europe.

Results: Although some differences in the type of intervention used in pCMS were identified within each discipline, many of the targeted interventions including dose, frequency, and intensity were similar within disciplines across geographic regions. In addition, there were common themes identified across disciplines regarding challenges in the rehabilitation of this population.

Conclusion: These results provide a foundation of current practices on which to build future intervention-based clinical trials.

Keywords: Cerebellar mutism syndrome (CMS); neuropsychology; occupational therapy; physical therapy; speech-language pathology.

Fig. 1

Types of interventions used with children with CMS reported by A) neuropsychologists B) occupational therapists C) physical therapists/physiotherapists and D) speech-language pathologist across geographic regions. X axis represents the number of respondents; the y axis represents the types of interventions reported. In the occupational therapy data, there was also one response for each: yoga, virtual training and biofeedback. Education (Edu); Activities of Daily Living (ADLs); Neurodevelopmental Training (NDT); Range of Motion (ROM); Augmentative and Alternative Communication (AAC).

Fig. 2

Interventions used “most often” with children with CMS reported by occupational theraposts (top), physical therapists (middle) and speech-language pathologists (bottom) in the UK (n = 9), US (n = 10), Spain (n = 3), Belgium (n = 1), Ireland (n = 1) and Italy (n = 2). Range of Motion (ROM).

Fig. 3

Frequency of intervention visits across disciplines in an A) inpatient setting and B) outpatient setting. Neuropsychology (NP); Occuapational Therapy (OT); Physical Therapy (PT); Speech-Langauge Pathology (SLP).

Fig. 4

Thematic interpretation of responses identifying challenges to providing rehabilitation to children with Cerebellar Mutism syndrome.