Brain Tumor RehabilitationBy Anjum Sayyad, MD, MBA, FAAPMR and Mary Voegeli, FNP-BC, APNP, CRRN, CBIS
Growing Need for Brain Tumor Rehabilitation
The need for rehabilitation is growing intensely for patients diagnosed with brain tumors. The most common brain tumors are metastatic in nature (15-20%), with approximately 200,000 new cases per year in the US. In general, there is an increase in these types of tumors since 1970s, likely due to improved ability to diagnose and/ or increased environmental carcinogen exposure but with reduced mortality. This is a direct result of concurrent advances in medical and surgical treatment, which can include resection, chemotherapy, and radiation therapy. Therefore, patients are surviving longer from brain tumors, but with increasing disability. Impairments from brain tumors are often non-specific but could include the following:
- Aphasia and/or dysarthria
- Pain from headaches
- Paresis and/or sensory loss
- Ataxia
- Vertigo
- Visual field cut
- Hearing loss
- Neurocognitive and neurobehavioral deficits (such as confusion, memory loss, personality changes)
Secondary (metastatic) brain tumor include lung, breast, and melanoma.
Unique Features of Brain Tumor Rehabilitation Programming at Froedtert & the Medical College of Wisconsin Neurotumor Board
Our brain injury team is a member of Neurotumor board, which also includes neuro-oncology, radiation oncology, pathology, and neurosurgery. Neurotumor board meets every Wednesday at 7:00 am. Cases are reviewed in the context of pathology, radiological findings, molecular markers, prognosis, past and planned treatments (medical and/or surgical), etc. As physiatrists, we provide input to the team regarding patients current and expected functional status (if in IPR) as well as the impact of social support for future treatment. Consults
Consults performed in this patient population can often be challenging and dynamic. Prognosis and expected course can vary greatly as compared to assessing patients with diagnosis of TBI. Patients with brain tumors are seen in consult often without an official diagnosis, as molecular markers are pending. As a result, planning for possible admission to acute inpatient rehabilitation can occur while treatment decisions are still being made. When performing consults in this patient population, we are considering the following: baseline functional status, expected functional status in context of treatment, prognosis, location and number of tumors, and chemo/radiation therapy plan. Acute Inpatient Rehabilitation
Current evidence shows that patients with primary brain tumors have significant functional improvement after rehabilitation 1. Patients with initial tumor diagnosis have greater functional gain than those with recurrent tumors after rehabilitation 2 . It has been demonstrated that functional gain in brain tumor patients undergoing acute inpatient rehabilitation is comparable to those with stroke and traumatic brain injury 3, 4. Discharge to community is greater than 80%, often with significantly shorter lengths of stay. However, complications are seen in greater rates as compared to patients with TBI, with high rates of emergent discharge at about 31%. References - Marciniak CM, Sliwa JA, Spill G et al. Functional outcome following rehabilitation of the cancer patient. Arch Phys Med Rehabil 77:54-57.
- Marciniak CM, Sliwa JA, Heinmann et al. Functional outcomes of persons with brain tumors after inpatient rehabilitation. Arch Phys Med Rehabil 82:457-63.
- Huang ME, Cifu DX, Keyser-Marcus L. Functional outcome after brain tumor and acute stroke: a comparative analysis. Arch Phys Med Rehabil. 1998;79:1386-1390.
- Bartolo M, Zucchella C, Pace A, et al. Early rehabilitation after surgery improves functional outcome in inpatients with brain tumors. J Neuro-Oncol. 2012;107(3):537-44.
- Congratulations Dr. Pete Connelly for achieving certification in Neuromuscular Ultrasound of Added Qualification (CAQ) through the American Board of Electrodiagnostic Medicine (ABEM).
- Congratulations Dr. David deDianous for celebrating 20-years of service to MCW. Way to go!
- Congratulations Dr. Kim Zvara and Dr. Sara Wineman for their presentation at the MCW Kaleidoscope Series on "The Opportunity of Adversity" on October 28, 2021.
- Congratulations to Dr. Colton Sauer, PGY2 Resident, for being accepted into the Rehabilitation
Medicine Scientist Training Program. The RMSTP is an NIH-funded program organized by the Association of Academic Physiatrists (AAP). In the first phase of the program Dr. Sauer will participate in the Research Career Development Workshop yearly at the Annual Meeting of the AAP. This 3-day workshop will provide Dr. Sauer a valuable opportunity to receive intensive education and networking at each of the four phases of RMSTP through a series of lectures, small group interactions, and individual meetings. The workshop process provides individualized support to candidates to define their research domain, select appropriate mentors, and plan for maximal productivity in their research training and funding proposals.
Meet the rest of our PGY2 Residents
Abdihakim (Hakim) Mohamoud, MD
Where are you from? Where have you trained so far?
I was born in Somalia and emigrated to the US as a refugee. I practically grew up in Rochester, Minnesota and have stayed in the Midwest since then. I completed medical school at Loyola University Chicago Stritch School of Medicine, and intern year at MCW. What are your hobbies?
Hiking/camping, astrophotography, painting, reading, running/weightlifting, cooking. What drew you to Milwaukee?
Milwaukee felt like a smaller Chicago. That and the proximity to friends and family really made this a great choice for me. Milwaukee’s relatively lower cost of living and the large number of summer festivals/attractions really make this city hard to top. What drew you to our PM&R program?
A welcoming community of physicians. The program’s commitment to help meet your needs/interests when it comes to research, community involvement, and clinical experiences. Professional interests: interested in the space industry and the potential role physiatrists can play.
Where are you from? Where have you trained so far?
I’m from Golden, CO. I went to medical school at University of Colorado, pediatric prelim year at Geisinger in Danville, PA, and now in MKE for residency. What are your hobbies?
Riding my road bike, cooking, and building computers. What drew you to Milwaukee?
The culture seemed pretty similar to the Denver area with sports teams and many local breweries, but without as many people and all the horrible traffic. And apparently it’s right next to a lake, but the lake is so big it’s basically like you’re living next to an ocean. What drew you to our PM&R program?
The faculty! My first impression was at the interview dinner where they introduced themselves in the first half hour of the night and got to know us as a person, not just as more applicants they needed to interview. The more time I’ve spent with them I’ve realized that they truly want you to not only be successful in residency, but also make sure that you are succeeding in personal life outside of work as well. Professional interests: pediatric PM&R!
Where are you from? Where have you trained so far?
I’m originally from the thriving metropolis that is Sheboygan, WI. I completed my undergraduate education at Rice University in Houston, TX before returning to Wisconsin for medical school here at MCW. I then did my intern year at Ascension St. Joseph Hospital in Milwaukee. What are your hobbies?
I enjoy playing and watching sports, camping and hiking (I’m working on visiting every National Park), and pretty much any outdoor activity. I love trying out new restaurants and breweries, and will do unspeakable things for some good BBQ. What drew you to Milwaukee?
Milwaukee has everything you could want in a city: Lake Michigan, great beer, killer cheese curds, Summerfest (and other great festivals), and plenty to do no matter what interests you may have. What drew you to our PM&R program?
The people! From the first day on my PM&R rotation as a student at MCW, everyone from the residents to the attending physicians was exceedingly kind, helpful, and genuinely cared about my personal interests, wellbeing, and career aspirations. There is a great sense of community and family here at MCW. Professional interests: Sports medicine, adaptive sports, musculoskeletal medicine, pain medicine, and spasticity.
Congratulations Dr. Kosasih for her son's Wedding!Andrew and Claire Kosasih got married on a beautiful Fall day - October 10, 2021. Being a mother of all boys, she finally got not just one, but two daughters in her family.
MCW Community Giving Campaign October 4 through October 15, 2021PM&R has raised $6,707 with 13 online participants. MCW faculty and staff can still make online/ payroll deduction donations until mid December, 2021. Any amount big or small contributes to the great programs United Way supports. Please consider pledging. It is for a great cause.
Dr. Meghan Caballero and Millie
Mama and Baby Cow
Melissa Carroll, NP and children
Connor, Harper and Carson
Dr. Tysson's kids - Emerson and Paxton
Police-girl and little lawbreaker
Dr. Zvara's kids
Koa, Jovie and Xavia
Have news to share with your PM&R colleagues? We would love to hear from you for our next issue, so please email any recent publications, awards, presentations, shout-outs, pictures, etc. to Beatriz Envila at benvila@mcw.edu.
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