The purpose of rehabilitation for cancer patients is similar to that for patients with other diseases; emphasis is placed on restoring or maximizing independence with activities of daily liv-ing (ADL), mobility, cognition, and communication. Rehabilitation interventions can be applied in all stages of the disease, although rehabilitation goals change as the stage of illness advances. Preventive re-habilitation maintains maximum functional indepen-dence in patients who undergo treatment and who have potential loss of function. When tumor progres-sion causes a decline in functional skills, or the dis-ease causes fluctuating abilities, rehabilitation as-sumes a supportive role, with goals adjusted to accommodate persistent anatomic and physiologic limitations. During terminal stages of illness, pallia-tive rehabilitation can improve and maintain comfort and quality of life until the end of life. An optimal rehabilitation team consists of a physiatrist, primary physician, nurse, physical therapist, occupational therapist, speech-language therapist, recreational therapist, social worker, case manager, dietitian, and chaplain (Gar-den and Gillis, 1996). Benefits of rehabilitation are noted. It is important to understand that even a small low-grade malignant tumor may cause significant resid-ual functional deficits if it resides in a critical loca-tion. Lesions located near the brain stem can be particularly damaging to motor functions, sensory functions, coordination, and cranial nerves. Primary malignant tumors in adults are mostly gliomas, which account for more than 90% of lesions (Bondy and Wrensch, 1993). Of these, glioblastoma multiforme has the worst prognosis and low-grade astrocytoma, the best (Black, 1991). The location of these tumors may or may not permit resection. Pituitary tumors may result in headaches, bilateral visual loss (due to their central location), and hormonal abnormalities (Black, 1991). With acoustic neuromas, hearing loss and/or vertigo may occur due to their proximity to the cranial nerve. Other symptoms associated with these tumors include facial palsy and numbness, dys-phagia, and hydrocephalus. Visual loss and sexual dysfunction can be present with craniopharyngiomas in adults, and growth failure may occur in children with these tumors. Changes in behavior, appetite, memory, and endocrine function may be seen fol-lowing radiation treatment (Black, 1991). The lung and breast are the most frequent primary sources of metastatic CNS tumors. Other common primary sources are carcinomas from the colon/rectum, kidney, and pancreas, as well as malignant melanomas. These tumors tend to be highly invasive and destructive. Edema is often present and may extend for some distance beyond the tumor. Leptomeningeal metastases with multiple cranial nerve and spinal root involvement may also occur. It is essential to consider the fluctuant nature of dis-ease progression for many of these patients and that the overall prognosis may not be very good when these tumors are present. Rehabilitation interventions should be guided by the evidence regarding the nature and be-havior (aggressive or indolent) of each patient’s tumor, the ongoing clinical course, and the patient’s neuro-logic status. If the prognosis is very limited, or severe cognitive injury impedes patient learning and retention of new information, caregiver education and adapta-tion of the patient’s environment become dominant components of the rehabilitation plan. In cases of ex-pected survival of less than 2 months, primary goals usually shift to injury prevention, safety for patient and caregivers, and ease in performing tasks of hygiene and transfers into and out of bed. Common complications influencing the rehabilitation program for these patients are listed ..With temporal lobe tumors, dysnomia, disturbance of comprehension, and defective hearing and memory may occur (Nelson et al., 1993). Loss of vision, spatial disorientation, memory loss, dressing apraxia, and proprioceptive agnosia may occur with parietal lobe tumors. Behavioral abnormalities can occur with frontal lobe tumors, and these may include person-ality or libido changes, with impulsive behavior, la-bile emotions, and excessive jocularity. Hypona-tremia, as seen in the syndrome of inappropriate diuretic hormone (SIADH), may lead to mental sta-tus changes (Nelson et al., 1993). Fatigue may be-come an issue with radiation treatment. Steroid psy-chosis occasionally complicates the rehabilitation course. With prolonged immobility in bed, supportive care is important. Measures should be taken to prevent pressure ulcers and deep venous thrombosis. Range of motion of all joints should be maintained with daily exercises or passive stretch if paralysis or altered mental status is present. Sensory stimulation should be provided, along with socialization. Corticosteroids, which are commonly used to com-bat peritumoral edema, tend to improve diffuse neu-rologic dysfunction rather than focal deficits. Myopa-thy with proximal muscle weakness often ensues and is very difficult to reverse until steroid doses have been tapered or discontinued. Unfortunately, immo-bility and myopathy frequently create cumulative deficits in strength and endurance. Patients should receive strengthening therapies and exercise pro-grams when steroid therapy is initiated. Patients may have uninhibited bladder due to lack of cortical influence and may require frequent prompting. Behavioral training may be helpful in pa-tients with unimpaired cognition. This involves pro-gressively increasing the time between voiding, often by 10 to 15 minutes every 2 to 5 days until a rea-sonable interval between voiding is obtained. Drugs to inhibit bladder evacuations, such as anticholiner-gic and antispasmodic agents, should be judiciously used. External (condom) catheters may be an option for some male patients. If a diaper is used, it should be changed within 2 to 4 hours to avoid skin break-down. Immobile or sedentary patients become con-stipated easily and may require a bowel program with higher fluid intake, stool softeners, and digital stim-ulation, along with suppositories, laxatives, and enemas.Orthotic devices that support a limb or joint and assistive devices such as walkers and canes may be issued. Use of a wheelchair may be necessary for those with significant weakness and balance impair-ment. Occupational and physical therapists should be consulted early for evaluation and teaching of ADL, ambulation, and strengthening and stretching exer-cises. Speech therapists can assist with the assessment of cognition, linguistic, and communication deficits. They can also determine the presence of swallowing difficulties and recommend therapeutic exercises, compensatory maneuvers, and modified-consistency diets. Seizures and hydrocephalus are complications of brain tumors that often negatively impact the course of rehabilitation through declining functional perfor-mance. Todd’s paralysis and subclinical seizures may mimic other etiologies for declining neurologic sta-tus and prevent participation in a rehabilitation pro-gram. Hydrocephalus may also have a presentation suggestive of other diagnoses, may be acute or chronic in nature, and usually leads to a decline in functional status. It is classically described as a triad of subcortical dementia, incontinence, and gait dis-order.