Posterior Fossa Syndrome

Outpatient I

Physical Therapy Evaluation

Subjective History

Chief complaint: decreased muscle tone, balance, and control of movement; irritable.

Precipitating injury: hydrocephalus secondary to a posterior fossa tumor, status post removal of tumor and placement of an extraventricular drain.

PMH: patient had surgery for the removal of the desmoplastic medulloblastoma. Had a port for chemotherapy access. Past therapies: WNL in all areas prior to illness.

Functional limitations: overall decline in ADLs: unable to dress, toilet, self feed and bathe. Patient required assistance with all functional mobility and assistive devices. Patient was impulsive and unsafe.

Patient/family expectations:
Strengths: family support, able to eat without NG tube.
Needs: therapy was coordinated with radiation treatment.
Goals: to function as independently as possible.

Objective Data

Patient has a manual wheelchair with a reclinable high back.
Patient was alert, attentive, interactive, and responsive to questions.

Systems review

System	Assessment
Neuromuscular:	Ataxic Decreased tone in trunk and legs Static sit with stand by assistance/contact guard assistance Dynamic sit with moderate assistance Static stand with moderate assistance Dynamic standing with maximum assistance Postural control decreased in legs, and trunk/pelvis Sit to stand with moderate assistance Supine to sit with maximum assistance Gait for 20 feet with maximum assistance x 2, high stepping and foot drop
Musculoskeletal:	ROM WNL B LE and trunk Strength grossly 3+/5 B LE, 2-5 ankles, symm. Uncontrolled movement
Cardiopulmonary:	WNL
Integumentary:	WNL except for radiated areas

Goals

Patient will be able to:

Short Term (within one month):

Static sitting balance (90/90) with moderate assistance x 1 minute.
Transition supine to sit with moderate assistance.
Stand pivot transfer with moderate assistance.
Gait 25 feet with maximum assistance.

Long Term (within three months):

Static sitting 90/90 for 5 minutes with contact guard assistance.
Supine to sit with contact guard assistance.
Transfers with contact guard assistance.
Gait 50 feet with minimum assistance.

Occupational Therapy

Goals

The patient will:

Short Term (within one month):

Engage in 15 minutes of activity.
Follow 2 step commands.
Tolerate 30 minutes of bilateral arm exercises.
Require moderate assistance with self feeding skills.
Reach to midline 1 out of 4 x.
Engage in 30 minutes of activity.

Treatment will include functional training, patient/family education, ADL training, therapeutic exercise and will address equipment needs.

---

How will chemotherapy affect Katie and her ability to progress in therapy?

---