Some children with brain tumours may experience long-term physical and sensory changes after treatment for a brain tumour.
Physical challenges are common in children with brain tumours. Many children report a change in physical function.
Some treatments can cause problems with hearing. Depending on the treatment, these effects may start to develop during treatment, or else they may appear years later.
Vision problems are also common among children with brain tumours and are sometimes caused by the tumour itself. Depending on the type and location of the tumour, these problems may include squinting, double vision, blurred vision, or the loss of ability to see distances.
Physical ability
Physical changes are common in children with brain tumours. Physical challenges can include:
- poor balance
- tremors
- poor coordination
- being weak or unable to move the arms or legs
- weakness on one side of the body
What causes physical changes?
In some cases, the tumour itself may cause these symptoms, depending on the location of the tumour in the brain. These symptoms may have led to your child’s diagnosis. In some cases, the physical challenges may occur as a result of surgery, radiation, chemotherapy or a combination of these factors.
What can be done?
Some physical challenges can get better with time. Physiotherapy and occupational therapy can help improve your child's physical strength and abilities. Physiotherapists and occupational therapists can help your child restore function or they can suggest new ways of doing things if changes are thought to be permanent.
For tumours in the back of the brain (posterior fossa), some physical symptoms can get worse many years after surgery and radiation. Rehabilitation may need to continue for months or years.
How will physical changes affect your child’s future?
Some of these challenges do affect a child’s physical stamina, ability to get around, and participate in certain sports. If this is the case, it will be important to explore activities that can be modified to meet your child’s level of ability or try new activities so your child can remain involved with peers. As an adult, the ability to do manual work or drive may be affected. This depends on a person’s particular situation.
Hearing
Some therapies used to treat brain tumours can cause your child’s hearing to deteriorate. Depending on the treatment, these effects may start to develop during treatment, or may appear years later.
What causes hearing loss?
Certain chemotherapy drugs, such as cisplatin and carboplatin, can cause damage to the inner ear hair cells and may result in sensorineural hearing loss. Infants treated with chemotherapy drugs risk losing their ability to hear high-pitched sounds. Examples of high-pitched sounds include birds singing, leaves rustling, people whispering, and the speech sounds "s" and "f." If children have problems hearing these sounds, they may also have problems learning to say them properly. Additionally, children may not be able to effectively filter out background noise, which will make paying attention and listening to teachers more difficult and ultimately affect children’s ability to learn.
Radiation therapy can cause the build-up of ear wax. The build-up of dry, crusty ear wax can affect a child’s ability to hear.
For children receiving radiation therapy for certain types of tumours, such as medulloblastomas and ependymomas in the back of the brain (posterior fossa), there is a possibility for significant hearing loss to occur 25 to 30 years after treatment. Some antibiotics can make hearing damage worse.
Hearing loss will be more severe when:
- children are younger at time of treatment
- the area being treated is larger
- the radiation dose is higher
How will hearing changes be screened?
Before and during chemotherapy treatment with cisplatin or carboplatin, an audiologist will monitor your child’s hearing. If the hearing test shows that your child’s hearing is decreasing, the doses of the chemotherapy drugs may be reduced to try and prevent further hearing loss. Your child’s ears will also be monitored for any ear wax build up at this time.
What can be done?
For children who suffer from sensorineural hearing loss due to chemotherapy, an audiologist may prescribe hearing aids for your child. Hearing aids will help your child regain access to speech sounds. As a result, they will be able to better focus in the classroom, distinguish between the various speech and environmental sounds. It should help to increase their ability to learn at the same rate as their peers. If any speech or language difficulties occur due to effects of prolonged hearing loss, therapy with a speech-language pathologist would be recommended.
To help with classroom noise, special devices called frequency modulation (FM) systems as well as classroom acoustic modifications may be available to your child. Your child’s school’s speech-language pathologist, along with your child’s teacher and audiologist, will help to determine what your child needs and how to implement these supports in the school.
Mineral oil used periodically in the ears will help manage ear wax build-up. Make sure to check with your child’s doctor first to find out if the use of mineral oil is appropriate for your child.
Adults who develop hearing loss caused by radiation received during childhood may also need to use hearing aids. Radiation oncologists (doctors who use radiation in treatment), are always trying new techniques to lower the radiation dose to the inner ear, which may reduce the occurrence and/or degree of hearing loss.
Vision
Vision changes are not uncommon among children with brain tumours. Some problems are caused by the tumour itself, depending on the tumour location. These problems may include squinting, double vision, blurred vision, or the loss of ability to see distances. In rare cases, blindness may develop. Cataracts may also develop after certain treatments. Cataracts are a clouding of the lens of the eye.
What causes vision changes?
There are different causes for the changes that may occur.
Certain tumours can lead to vision changes such as loss of vision. A tumour in the optic pathway can lead to a narrower visual field, or blindness in one or both eyes.
Hydrocephalus causes damaging pressure in the optic nerve, it can lead to a decrease in vision, and in rare cases to blindness.
Radiation or the long-term use of steroids can cause cataracts. They can cause blurred or cloudy vision or make children sensitive to bright lights.
What can be done?
Children whose sight is affected will need regular checkups with an ophthalmologist, a doctor who specializes in eye care. In many cases, these vision problems cannot be corrected with glasses.
If your child has vision problems, some changes may need to be made in the classroom. For example, they may have problems reading the blackboard and may need to sit at the front of the class. Large print books and handouts may be necessary as well.
Children who develop blindness will need extra support. This support can come from a community organization that provides help to blind people, such as the Canadian National Institute for the Blind, The National Federation of the Blind in the U.S., or the Royal National Institute for the Blind in the U.K. Learning Braille, a touch-based alphabet for people who are visually impaired, may be an option.
If a child has cataracts, there may not be any changes in vision if the cataract is small. If the cataract is larger or grows over time and this creates problems with daily activities, it may need to be removed with surgery.
How will vision changes affect your child’s future?
Vision problems may affect a person’s ability to do certain jobs or drive a car. This depends on how much the child's vision is affected.
