P18.14 Usefulness of providing assistive techniques for QOL of malignant CNS tumor clients in convalescent hospital rehabilitation: 2 case reports

摘要

>Introduction: The desired goal of the neurological rehabilitation is the restoration of neurological deficit. Some compensatory means including assistive devices and orthoses improve client’s activities of daily living (ADLs) and instrumental ADLs (IADLs). In the rehabilitation for malignant central nervous system (CNS) tumor clients, providing their caregivers with assistive techniques sometimes seems effective in order to bring good quality of life (QOL). Authors report the experiences of the rehabilitation for malignant CNS tumor clients. CASE 1: Female; 62Y.O. She had undergone the surgery and radiotherapy 16 years before in a cancer center hospital owing to the right breast cancer. Hormone therapy was being continued. Magnetic resonance (MR) image showed a tumor in the right parietal area. This was assessed as the metastatic tumor. She underwent the cerebral tumor resection since she had fallen a lot of times. Her ADLs became worse owing to the left hemiparesis. Even after the hemiparesis improved by the rehabilitation in our hospital, she fell a few times due to stereoagnosis. An assistive device improved her ADLs and IADLs in home. Her participation in social activities was achieved with her husband’s assistive techniques. CASE 2: Male; 64Y.O. He had undergone several times of surgery, radiotherapy, and chemotherapy because of anaplastic astrocytoma in the left parietal area during 12 years at a university hospital. Right hemiparesis and memory disturbance deteriorated his ADLs after the last surgery. Histological examination showed glioblastoma. The rehabilitation in our hospital enabled him to walk with an ankle foot orthosis in 2 weeks. His wife’s assistive techniques were also helpful in the return to his domestic situation. Meningeal dissemination was found in MR image 6 weeks after the beginning of the rehabilitation. He underwent chemotherapy at the former hospital and died several weeks after the transition to home. DISCUSSION AND >conclusions: The rehabilitation for malignant CNS tumor patients may have had little importance in the treatment owing to the rapid exacerbation of their diseases. While many patients survive by the developed treatment of malignant CNS tumors, the neurological deficits require the rehabilitation. The rehabilitation needs to aim not only to recover ADLs and IADLs, but also to aid the preparation for the client’s good QOL. Every rehabilitation staff needs to consider how the client will act in home and participate in the community. This view of consideration possibly benefits the client’s QOL. Assistive techniques can be useful for the client’s QOL even when the independent ADLs or IADLs are not expected during the inpatient rehabilitation.