Postural Control and Balance Training in a Pediatric Patient Status-Post Medulloblastoma Removal

Background & Purpose: Medulloblastomas are cerebellar brain tumors that are the second most common brain tumor to occur in children in the United States today.1 Postural control and balance deficits are impairments frequently present after brain tumor surgical removal. The systems theory of neural control of posture and balance suggests the musculoskeletal and neural systems work together to help maintain normal postural control through interactions of the individual with the task and the environment. 5The purpose of this case study is to describe physical therapy interventions and outcomes specifically focused on improving postural control in a patient that is status-post medulloblastoma removal. Case Description: The subject of this case study was a 12-year-old male, 19 months post-surgery with a diagnosis of medulloblastoma and posterior fossa syndrome. This report provides a description of the physical therapy evaluation and interventions associated with this subject's postural control and balance deficits. Interventions used included static and dynamic balance activities, such as tandem stance on an airex mat with a throwing activity and traversal of a 6-inch balance beam, to increase the use of ankle and hip strategies. Outcomes were assessed at weeks 1, 4, and 8 with the Pediatric Balance Scale and the Bruininks-Oseretsky Test of Motor Proficiency. Outcomes: On the Pediatric Balance Scale, the score increased from 50/56 initially to 54/56 at final evaluation. “Meaningful improvements” on the Bruininks-Oseretsky Test of Motor Proficiency were noted: Subtest 2: Balance, initial score of 5 with final score equal to 9 (SEM = 3.7) and Subtest 4: Strength, initial score of 4 and final score of 8 (SEM = 2.0). Discussion: Little research has been conducted on the outcomes of children receiving physical therapy following medulloblastoma removal. This case study demonstrated that outpatient physical therapy interventions have the potential to positively influence balance in the pediatric cerebellar tumor population.