BRAIN TUMORS

By / Muhannad Al‫ـ‬Gubishy
 01 02 03
DEFINE EXPLAIN DISCUSS
Brain tumors, classification, Risk factors, Tumorigenesis Locations, Symptoms
Types

04 05
DESCRIBE Case Study
Diagnosis, Treatment,
Rehabilitation
01
q A Brain tumor is a cranial cavity mass result from abnormal growth and division of cells
( Uncontrolled ) .

q Neuroglial cells, fibroblast ( meninges ), endothelial cells

q Happens in : cerebrum, cerebellum, brain stem, meninges

q Benign or malignant

q Other terms :
I. Neoplasm
II. Lesion
 BRAIN TUMORS

PRIMARY SECONDARY

1- GLIAL (GLIOMAS) BRAIN METASTATIC

2- NON-GLIAL
 Most common
Meningioma Medulloblastoma
also known as meningeal tumor, is a
primary brain tumor that forms from 01 02 a malignant pediatric brain
tumor that arises in the
the meninges cerebellum

Ependymoma
Astrocytoma
Brain tumor arises in glial cell Commonly arise in the lining of
(Astrocytes) 03 04 ventricular system
(ependymal cells)
 Less common
Glioblastoma Brainstem Glioma

Pituitary adenoma Neurofibroma

Chordoma Schwannoma
02
the cause of a brain tumor is unknown, but the following factors may
raise a person’s risk of developing a brain tumor :

Radiation Exposure Genetic Environmental toxicity

Ionizing radiations 5% of Brain tumors Heavy metals
Eg : x-ray, gamma ray linked to hereditary Eg : chromium, nickel,
conditions mercury
Eg: other tumors,
neurofibromatosis

Age Lifestyle
Gender
older adults Drugs abuse, Alcohol,
by average : 55 years Male than Female Smoking, Bad diet
Except Meningioma
 TUMORIGENESIS
● also called oncogenesis, is the formation of a tumor where the
normal cells are transformed into cancer cells.

● Normally cell will division and growth controllably, it’s done by specific Genes :

o Proto-oncogene : start cell division when activate

o Anti-oncogene : stops cell division when activate

o DNA repair gene : control the balance between those two genes by orders

Ø The risk factors will mutate those genes and distribute this process
 SUMMARY

01 02 03 04
Normal cell 1st Mutation 2nd Mutation Cancerous cell
Growth and divides Proto‫ـ‬oncogene Inactivate Result in
Normally Anti‫ـ‬oncogene Benign or Malignant
Oncogene Tumor
03 SYMPTOMS
Common symptoms :
§ Headache
§ Seizures
§ Nausea
§ Vomiting
§ Personality changes
§ Hearing, vision problems
§ Dementia
§ Aphasia
§ Dysarthria
§ One side weakness
§ Numbness
§ Loss of proprioception
§ Loss of balance, coordination
§ Loss of dexterity
§ Ataxia
04 Ø DIAGNOSIS, TREATMENT
o Radiology : to classify and locate the tumor, size

o Biopsy : to identify the type and cell

o Surgery

o Chemotherapy

o Radiotherapy

o Medication
 Ø REHABILITATION
● The rehabilitation after brain tumor resection is important to regain, restore the
functional level for daily activities

● Consist of : PT , OT , Speech Therapy, Psychotherapy

● As PT we will focus on neuroplasticity process, depend on patient currently

functional level we will facilitate this process by our program

● To increase patient independence and functional ability we must :

o Improve balance
o Increase strength
o Promote ADL
o Prevent muscle wasting
o Prevent joint stiffness
 CASE
STUDY
Ø History
57 y/o male diagnosed with G-l meningioma at
posterior fossa, referred to ARC after meningioma
resection, complaining of inability to sit&stand
independently and inability to walk.
• Medically free
• Craniotomy
• One case of ductal carcinoma
Ø Assessment
• MMT : 3/5 for U&L limbs
o Deltoid, Biceps, Triceps, Wrist F&E
o Hip flexors & Extensor, Hamstring,
quadriceps, calf, tibialis.Ant
o Rectus Abdominis
• PROM : full for U&L limbs
o Shoulder, elbow, hip, knee, ankle
• Normal sensory examination
• Berg balance scale : 3/56

Ø Observation
• Pt in wheelchair Ø Problems list
• Mesomorph o Poor Bed mobility
• Skull surgical scar o Poor balance
o Poor coordination
o Unable to sit, stand, walk
o Dependant for transfer
Ø Short term goals

• Improve muscle strength

• Maintain ROM
• Improve bed mobility
• Achieve static sitting
• Achieve dynamic sitting

Ø Long term goals

• Achieve static/dynamic standing

• Achieve walking
• Increase independence
• Restore ADL
 3 sessions per week
Ø 1st. Week
• Strengthening :
o U&L , Core muscles
• Bed mobility :
o Supine to sitting, rolling
• Frenkel Exercise

Ø 2nd. Week
• Same program
• Static sitting for 1min
o Progress : eyes closed
• Transfer education
Ø 3rd. Week

• Same program
• Dynamic sitting
o Forward&Side reach

Ø 4th. Week
• Same program
• Dynamic sitting
o Reach and organize the cones
o Forward&side reaching for 1kg ball
• Sit to stand
o Max assistance : 2persons
Ø 5th. Week
• Same program
• Sit to stand
o 1 person
• Standing
o Min assistance : 1 person

Ø 6th. Week

• Same program
• Progress standing
o Min assistance for 2 min
• Dynamic standing
o Forward & side reaching
 Outcomes

1st. Assessment Currently

Berg balance scale Berg balance scale
3/56 10/56
ü Static sitting
ü Dynamic sitting
ü Min assistance transfer
Patient still receive Physical Therapy
 REFERENCES
● https://siteman.wustl.edu/treatment/cancer-types/brain-tumor-center/diagnosis-and-
grading/#:~:text=Brain%20and%20spine%20tumors%20are,always%20a%20grade%20IV%20
tumor.

● https://www.health.harvard.edu/a_to_z/brain-tumor-overview-a-to-z

● https://journals.lww.com/ajpmr/Abstract/2006/07000/Rehabilitation_Outcomes_in_Patients_
with_Brain.3.aspx

● https://pubmed.ncbi.nlm.nih.gov/9838898/
THANK
YOU