Multidisciplinary Rehabilitation for a Patient with Pituitary Adenoma and Stroke

Case Report

Austin J Clin Ophthalmol. 2014;1(6): 1029.

Multidisciplinary Rehabilitation for a Patient with Pituitary Adenoma and Stroke

Kar Ho Siong1, George C Woo1, Dora Yuk Lin Chan2, Hobby Cheung3, Claudia Kam Yuk Lai4 and Allen Ming Yan Cheong1*

1School of Optometry, Hong Kong Polytechnic University, China

2Department of Occupational Therapy, Kowloon Hospital, China

3Department of Rehabilitation, Kowloon Hospital, China

4School of Nursing, Hong Kong Polytechnic University, China

*Corresponding author: Allen Ming Yan Cheong, School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, china

Received: July 10, 2014; Accepted: Aug 05, 2014; Published: Aug 06, 2014


Purpose: To demonstrate the clinical benefits of a multidisciplinary rehabilitation program provided by Optometric rehabilitation and occupational therapy.

Case Report: A 54-year-old male patient with multiple disabilities due to primary pituitary adenoma and secondary stroke was referred for rehabilitation by occupational therapists and optometrists, where improvements were shown in physical, cognitive, and functional performances (eye-hand coordination and mobility). Improvement in the physical performance was also shown in the field expansion by wearing Fresnel prism during orientation and mobility. Enhancements in self-perceived functional performance and fewer mobility difficulties were also reported.

Conclusion: Early recognition and intervention (e.g. vision rehabilitation) of visual problems is essential for multidisciplinary management on patients with acquired brain injury for improving their quality of life.

Keywords: Stroke; Rehabilitation; Vision; Multidisciplinary Communication; Tumor


Pituitary adenoma is noncancerous benign tumor of the pituitary gland. It is a slow-growing tumor, affecting about 16.7 % of people in the general population [1]. Patients may report various clinical symptoms such as headaches; blur vision, and changes in mood and behavior [2]. A pituitary adenoma may compress the optic chiasm and retinal nerve fibers (RNF), leading to a corresponding bitemporal visual field (VF) defect and functional disability. Prescription of prism can increase the peripheral awareness to improve independence and confidence during mobility [3]. Although the tumor can be managed by radiotherapy and surgical removal, the effect on the VF defect may not be recoverable [4]. Furthermore, the surgical management increases the potential risk of vascular complications, patient’s body coordination, physical and cognitive functions [5]. To manage patients with multiple disabilities in both visual and physical caring, rehabilitation should cover two aspects: muscle and cognition training by occupational therapists and vision rehabilitation by optometrists. In this case report, a multidisciplinary rehabilitation program was provided for a patient with multiple deficits due to pituitary adenoma and secondary stroke. The study followed the tenets of Declaration of Helsinki and informed consent was obtained from the patient.

Case Presentation

Medical history

Patient CTS (54 year-old Hong Kong Chinese male) complained of blurry vision, speech disturbance and limb weakness on the left side since December 2009. He was then referred to a neurologist for Magnetic Resonance Imaging (MRI) examination. A 3 cm X 2.8 cm X 2.5 cm macro-adenoma was diagnosed at his pituitary gland. Surgical removal of the tumor was successful. Unfortunately, secondary stroke (infarction in left lacunars region) occurred after surgery. Patient reported poor vision and he was diagnosed with temporal VF defect on right and left eye respectively after the surgery. However, no vision rehabilitation was arranged at this stage. Right hemi paresis, multiple cognitive and physical impairments were also identified and this might delay the referral to optometric rehabilitation.

Occupational rehabilitation

The patient received occupational rehabilitation from January 2010 for 6 months (two times per week), with training targeted on upper limb strength, gait performance and cognitive function. Training on trunk rotation [6], visual scanning [7], individualized activities of daily living (ADL) and instrumental activities of daily living (IADL) were also given. To evaluate the effectiveness of training, physical and cognitive functions, and functional measures on daily tasks were examined at 3 time-points: baseline (before the intervention) and post-intervention (2-month and 6-month, Table 1).