Artikel
Structured evaluation of patients with low-grade glioma by an occupational therapist – is our clinical examination enough?
Suche in Medline nach
Autoren
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Christian F. Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: For optimal treatment of patients with diffuse low-grade gliomas (dLGG), preservation of neurological function is mandatory when offering a surgical resection, given that the predominantely young patients have to be able to return to work. To determine whether a structured evaluation by an occupational therapist can reveal deficits that might be overseen in routine clinical examination of patients with a surgically treated dLGG.
Method: Fifteen patients with radiographic suspected low-grade gliomas have been examined objectively by an occupational therapist at three stages: pre-, postoperatively and after three months. Evaluation consisted of simple forcemeter-testing and mirroring-tasks, followed by stereognostic evaluation and a 9-hole PEG-test. Finally patients underwent an ARA-test (Action research arm test). Descriptive analysis of the results was performed.
Results: Thirteen patients (86,6%) showed no postoperative motor deficit, one suffered akinesia due to SMA involvement and one demonstrated a transient hemiparesis with manifestation on the first postoperative day. Patients with eloquent dLGGs, involving speech (n=8, 53,3%), exhibited different transient speech disturbances according to the localization of the lesion. Structured testing revealed a postoperative worsening of movement mirroring (upper extremity) and finger discrimination (sensory) in 10 of 15 patients (66%). Stereognostic discrimination of objects and forcemeter evaluation of the upper extremity was decreased in all patients for the affected hemisphere even though motor deficits were absent in most patients. The deficits recovered within the first 3 months. The ARA test also showed deterioration in all patients postoperatively, with a complete restitution at 3 months postoperatively.
Conclusions: Routine clinical examination and neuropsychological evaluation fail to detect mild deficits in sensory function, reactivity and apraxia. Nonetheless, there is a lack of robust data and ongoing research should elaborate the role of a structured evaluation by an occupational therapist.
