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Acute Care Physical Therapist Evaluation and Intervention for an Adult After Right Hemispherectomy

AL Bates, PT, MS, GCS, is Inpatient Clinical Specialist, Massachusetts General Hospital, Boston, Mass. She was Physical Therapist I, Beth Israel Deaconess Medical Center, Boston, Mass, when this patient was treated. Address all correspondence to Ms Bates at Massachusetts General Hospital, Physical Therapy Services, WACC 128, 15 Parkman St, Boston, MA 02114 (USA) (abates{at}partners.org)
CC Zadai, PT, DPT, MS, CCS, FAPTA, is Assistant Professor, MGH Institute of Health Professions, Boston, Mass. She was Chief of the Rehabilitation Services, Beth Israel Deaconess Medical Center, when this patient was treated

Background and Purpose. Hemispherectomy is performed to help control intractable seizures, yet little research quantifies and projects the clinical course of the impairments, functional limitations, and disabilities of patients who have undergone the procedure. This case report describes the physical therapist preoperative and postoperative examination, evaluation, and intervention during the acute hospitalization of an adult who underwent a right hemispherectomy. Case Description. The patient was a 27-year-old man who had intractable seizures despite having tried multiple drug regimens and undergoing several surgical interventions after a brain injury at age 5 years. He underwent a right functional hemispherectomy and then had 9 postoperative physical therapy sessions during his acute hospitalization. Outcomes. The patient made rapid gains, surpassing all initial goals. At discharge, the patient had distal left-sided sensorimotor impairments, but he was able to ambulate 121.9 m (400 ft) with assistance to maintain his balance. Discussion. The patient's posthemispherectomy recovery was rapid. His brain injury at a young age may have triggered preoperative transfer of function to the unaffected left hemisphere. The prognosis for this patient's improvements of impairments and functional limitations was better than initially expected, perhaps because of the redundant features and plasticity of the central nervous system.

Key Words: Hemispherectomy • Physical therapy • Rehabilitation