Acute Rehabilitation After Brain Tumor
Jean Von Berg’s Story
On June 15, 2010, a 61-year-old woman named Jean Von Berg presented to the emergency department with a history of several months of progressive headache, dizziness, and unsteady gait. Her physical examination was remarkable for lateral gaze nystagmus and mild ataxia of gait. Magnetic resonance imaging of the brain with contrast showed an enhancing mass in the left cerebellum, with surrounding edema and obstructive hydrocephalus (Figure 1). Upon admission to the hospital, she was treated with intravenous dexamethasone, followed by catheter angiography, partial embolization of the tumor, and microsurgical resection. Postoperative imaging showed complete excision of the mass (Figure 2).Subsequently, the cerebellar edema and secondary hydrocephalus resolved.
Within a week, Ms. Von Berg had learned of a brain tumor, found a doctor, had the tumor successfully removed, and began a diffICUlt recovery process. It was indeed a frightening and revelatory turn of events. "I had never experienced anything like it," she recalled. "I’ve always been relatively healthy and I was experiencing a completely new world."
After several days in the ICU, her physicians Drs. Brian Andrews and Jeffrey Thomas recommended that she spend some time in California Pacific Regional Rehabilitation Center (CPRRC). When Ms. Von Berg was presented with the idea of additional hospitalization in the acute rehabilitation unit, she was reluctant. She wanted to go home. But she trusted her physicians and agreed to the transfer. To her surprise, she realized she was not ready to go home: "I found the acute rehabilitation facility to be a critical bridge between my surgery and going home. My time there was invaluable to my recovery process."
Dr. Thomas commented, "Among the most important—and most difficult—tasks for the neurological patient and her physicians is to take a realistic account of the timeline for recovery of the nervous system." He noted, "Such a complex and highly developed system can be expected to require six to twelve months for initial recovery, and full recovery may require several years. Rehabilitation therapy plays a critical role in guiding and accelerating this process, which is why it is the single most important intervention following neurological injury."
CPRRC therapists were able to track Ms. Von Berg’s functional recovery using standardized tests and assessments of both her physical abilities and her cognitive performance. "I was slow in some areas, but I didn’t even realize this until I was assessed," she recalled. As with all patients admitted to acute rehabilitation, the entire team of physicians, nurses, therapists, case managers, and neuropsychologists evaluated and discussed her progress in a weekly team conference. Smaller groups of the team met daily to refine Ms. Von Berg’s treatment plan and goals as she progressed. This teamwork enabled her to get the best possible care. She was especially impressed with the physical and occupational therapists. "Everyone there was devoted to their jobs and my recovery. They really tried pushing me—but did so in a safe environment—which was so important."
Ms. Von Berg still faces challenges in her recovery. Nonetheless she is optimistic about the process. "My brain is not yet functioning normally," she noted. "However, because of the care I received at CPMC—especially in the acute rehabilitation center—I have a better understanding of the challenges ahead, but I also have confidence that I will eventually get there with time."