第四腦室室管膜瘤個案報告－使用「國際功能、失能和健康分類模式」分析及介入

Case Report: Application of ICF Model for a Case of Fourth Ventricle Ependymoma

張逸平(Yi-Ping Chang) ； 嚴筱晴(Hsiao-Ching Yen)

《物理治療》 37卷3期 (2012/09) Pp. 264-270

摘要

室管膜瘤是一種少見的神經膠質瘤，起源於室管膜細胞，好發位置可分為顱內與脊髓。其中，顱內室管膜瘤又可依小腦天幕分為天幕上和天幕下室管膜瘤兩種，而天幕下室管膜瘤常發生在第四腦室。本篇個案是一位復發性第四腦室室管膜瘤的46歲女性，於2011年8月被發現意識喪失並被送到醫院急診室，腦部電腦斷層顯示第四腦室腫瘤合併急性水腦，而後進行手術切除，個案2011年11月出院。並且開始接受門診物理治療。本篇使用「國際功能、失能和健康分類模式」分析，發現個案的肌力、肌張力和感覺皆為正常，但軀幹的自主控制以及與平衡相關的協調能力明顯不足，導致站立時軀幹容易搖晃且造成運動失調之行走型態，影響個案活動功能。因此，本篇針對此個案評估分析結果，同時應用「以挑戰為導向訓練」的概念設計其運動介入計畫。於四週實行後，結果顯示以此原則下之運動訓練能有效改善個案的平衡、動作協調問題及行走功能。

關鍵字

室管膜瘤 ； 軀幹控制失調 ； 以挑戰為導向 ； 治療

並列摘要

Ependymoma is a rear glioma, which arises from ependymal cells. It's commonly located in intracranial and spinal cord regions. Intracranial ependymoma could be further classified as supratentorial ependymoma and infratentorial ependymoma, depending on its location relative to tentorium cerebelli. An infratentorial ependymoma is more commonly seen in the fourth ventricle. The case of the study is a 46-year-old woman who had the history of recurrent fourth ventricular ependymoma for two times. She was found unconscious in 2011/8, and later sent to the emergency room of a hospital. Brain CT showed a fourth ventricle tumor combined with acute hydrocephalus. The follow-up MRI showed tumor progression, so the case received tumor excision three days later. After follow-up management, the case was discharged in 2011/11, and then started to receive out -patient physical therapy. With the analysis of International Classification of Functioning, Disability and Health model, we found that the evaluation of muscle strength, muscle tone, and sensation of the patient were all within normal limit while the ability of trunk control and equilibrium coordination were obviously insufficient. These impairments contributed to increasing body sway during standing and ambulation, and restricted the functional mobility. Therefore, we designed exercise training programs for our case based on the results of assessment and the concept of ”challenge-oriented training”. After 4 weeks of training, the results supported the exercise program based on the design concept was effect on improvement of balance, coordination and walking ability.

並列關鍵字

Ventricule ependymoma ； Truncal ataxia ； Challenge-oriented ； Intervention