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Special interest group

Rehabilitation

Lead: Vânia de Aguiar, PhD

The Rehabilitation group develops and evaluates diagnostic tools and therapy strategies for children with posterior fossa syndrome (PFS). Their needs span speech, language, swallowing, movement, cognition, and emotion. Work from this group also actively identifies less known impairments in children with PFS, and characterizes how recovery happens over time.

Domains affected

Speech and language

Speech-language pathology

Mutism resolves within days to months.1 Following, both speech (i.e., dysarthria) and language impairments are observed with varying degrees of severity, and these may persist several years after surgery.2, 3

Motor coordination

Physical therapyOccupational therapy

Ataxia, affecting balance, gait, and hand coordination, recovers more slowly than speech4 and can influence physical performance many years later.5

Swallowing

Speech-language pathology

Oropharyngeal dysfunction and dysphagia are common features in the early phase, and swallowing assessment guides safe feeding.3, 6

Cognition

NeuropsychologyOccupational therapy

Processing speed, attention, working memory, and executive function are the areas most often affected over the long term.5, 7, 8

Emotion and behavior

Psychology and psychiatryNeuropsychology

Emotional lability is a core early feature. Survivors of childhood brain tumors are at risk for social and emotional difficulties,9, 10 and posterior fossa syndrome can add unique and lasting challenges.11, 12

Daily life and participation

Occupational therapyNeuropsychology

Practical and overall adaptive skills can be affected,13 and some survivors need help with daily activities into adulthood.5 Support at school and at home makes a difference to independence.

Specialties most often involved

  • Speech-language pathology
  • Physical therapy
  • Occupational therapy
  • Neuropsychology
  • Psychology and psychiatry

Every child's team is different; a rehabilitation physician or care coordinator often brings these specialties together.

Recovery across the lifespan

Posterior fossa syndrome is not only an acute condition. Systematic reviews of long-term outcomes show that while every child improves, many continue to have neurological, cognitive, and behavioral needs that affect daily life and deserve ongoing support.7, 11 Children with more severe symptoms at onset are more likely to need long-term help.6

Weeks to months

Early recovery

In a prospective study, speech returned at a median of 2.3 months in children with complete mutism and 0.7 months in those with reduced speech. Apraxia resolved at a median of 1.6 and 1.1 months, and irritability and emotional lability at 1.4 and 1.1 months, respectively.1 Walking independently can take longer, especially after complete mutism: about two thirds of these children walked on their own by a median of 2.1 months, but nearly half of those followed for a year still needed support to walk. Children with reduced speech walked independently at a median of 1.5 months.1

The school years

Learning and development

Differences in processing speed, attention, and working memory are evident by twelve months14 and persist over the following years. Some skills, such as attention and working memory, may fall further behind peers over time, which is why regular neuropsychological follow-up matters.8 A 2025 systematic review confirms that cognitive difficulties remain after recovery from mutism, most notably in processing speed, psychomotor function, and executive function.7 Across pediatric brain tumor survivors more broadly, cognitive abilities are affected whatever the treatment, with better neurocognitive and academic outcomes after proton than photon radiotherapy.10

Adolescence and adulthood

Long-term needs

More than a decade after diagnosis, survivors who had the syndrome are more likely to need support with attention, processing speed, executive function, physical performance, and daily activities.5 Early identification of these needs allows support to be planned into adulthood.

Current rehabilitation practice and evidence

  • Therapy strategies. An international cross-disciplinary survey (REACH) found that clinicians commonly use school interventions, upper-limb training, gait training, and swallowing therapy, but that no clinical guidelines exist.15
  • Speech, language, and swallowing. Systematic reviews summarize language outcomes after posterior fossa tumor surgery2 and communication and swallowing outcomes after childhood brain tumors and leukemia,3 as well as the gaps in how these outcomes are measured.
  • Medications. Evidence for pharmacological treatment comes from small series, and prospective studies are needed.6, 16
  • Emerging approaches. Transcranial direct current stimulation, transcranial magnetic stimulation, and virtual reality are being explored as ways to improve rehabilitation outcomes.17

Selected references

  1. Khan RB, Patay Z, Klimo P, et al. Clinical features, neurologic recovery, and risk factors of postoperative posterior fossa syndrome and delayed recovery: a prospective study. Neuro Oncol. 2021;23(9):1586–1596. Link
  2. Svaldi C, Ntemou E, Jonkers R, et al. Language outcomes in children who underwent surgery for the removal of a posterior fossa tumor: a systematic review. Eur J Paediatr Neurol. 2024;48:129–141. Link
  3. Hodges R, Campbell L, Chami S, Knijnik SR, Docking K. Communication and swallowing outcomes of children diagnosed with childhood brain tumor or leukemia: a systematic review. Pediatr Blood Cancer. 2021;68(2):e28809. Link
  4. Hansen M, Bendel A, Blabolil JA, Hooke MC. Cerebellar mutism syndrome in children after surgery for a posterior fossa tumor: patient characteristics and recovery. J Pediatr Hematol Oncol Nurs. 2022. Link
  5. Sarvode S, Dhaduk R, Chen Y, et al. Long-term outcomes associated with posterior fossa syndrome in survivors of childhood medulloblastoma. JAMA Netw Open. 2026;9(2):e2559376. Link
  6. Toescu SM, Pizer B, Gump W, et al. Toward reducing the risk of cerebellar mutism syndrome: consensus statement from the Posterior Fossa Society. J Neurosurg Pediatr. 2025;36(6):789–797. Link
  7. Horne BM, Attanayake AA, Aquilina K, Murphy T, Malcolm CP. Neurocognitive outcomes following postoperative paediatric cerebellar mutism syndrome: a systematic review. Dev Med Child Neurol. 2025;67(12). Link
  8. Schreiber JE, Palmer SL, Conklin HM, et al. Posterior fossa syndrome and long-term neuropsychological outcomes among children treated for medulloblastoma on a multi-institutional, prospective study. Neuro Oncol. 2017;19(12):1673–1682. Link
  9. Willard VW, et al. Social skills interventions for survivors of pediatric brain tumors: a review and reformulation. Pediatr Blood Cancer. 2018. Link
  10. Patel T, Johar P, Kanisetti V, et al. Long-term neurocognitive and behavioral outcomes in survivors of pediatric brain tumors: a systematic review. Front Neurosci. 2025;19:1587059. Link
  11. Hughes MH, Paturzo JGR, Fernandez CM, et al. Neurological, neuropsychological, and social outcomes in pediatric patients diagnosed with cerebellar mutism syndrome: a systematic review. Pediatr Blood Cancer. 2025;72(12):e32072. Link
  12. Wibroe M, Ingersgaard MV, Larsen HB, et al. Living with the cerebellar mutism syndrome: long-term challenges of the diagnosis. Acta Neurochir (Wien). 2021;163(5):1291–1298. Link
  13. Adaptive, behavioral, and emotional outcomes following postoperative pediatric cerebellar mutism syndrome in survivors treated for medulloblastoma. J Neurosurg Pediatr. 2024;33(6). Link
  14. Palmer SL, Hassall T, Evankovich K, et al. Neurocognitive outcome 12 months following cerebellar mutism syndrome in pediatric patients with medulloblastoma. Neuro Oncol. 2010;12(12):1311–1317. Link
  15. Samargia-Grivette S, Hartley H, Walsh K, et al. REhabilitation Approaches in CHildren with cerebellar mutism syndrome (REACH): an international cross-disciplinary survey study. J Pediatr Rehabil Med. 2024;17(2):185–197. Link
  16. Turkistani AN, Alsharif TH, Aldhafeeri WF, et al. Medical management for cerebellar mutism syndrome following posterior fossa surgery: a systematic review. Clin Neurol Neurosurg. 2024;242:108352. Link
  17. Walsh KS, Pizer B, Samargia-Grivette S, et al. Proceedings of the first global meeting of the Posterior Fossa Society: state of the art in cerebellar mutism syndrome. Childs Nerv Syst. 2024;40(7):2177–2191. Link

Get involved

Society members can join this group by contacting its lead or writing to info@posteriorfossasociety.org. Not yet a member? Membership is open to clinicians and researchers working on posterior fossa syndrome.

Membership