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Título

DIFFUSION TENSOR TRACTOGRAPHY, MOTOR, COGNITIVE AND BEHAVIOR SCALES IN A REHABILITATION OUTCOME FOLLOWING A PEDIATRIC TRAUMATIC BRAIN INJURY: A CASE REPORT.​

Apresentação do caso

A 7-year old boy who has been severely brain-injured in a car accident in February 2016. Initially, Glasgow coma scale was 7. He needed decompressive craniectomy and a ventriculoperitoneal shunt.
At first, he was tetraplegic, without hability for locomotion.
His initial MRI including DW, CSD tractography and spectroscopy showed frontal and parietal hemorrhage, parenchymal contusions, areas of reduced levels of Naa and less fibres of right corticospinal tract and of the corpus callous.
We used Gross Motor Function Scales (GMFM; Functional skills: mobility, self-care and social function (Paediatric Evaluation of Disability Inventory- PEDI); Manual function - PEGBOARD); Cognitive (Wechsler Inteligence Scale Cognitive IV); Vineland Adaptative Behaviour Scales-Second Edition (VINELAND-II), which evaluates communication, daily living skills, socialization and motor skils.
We decided for an internal and intensive 8-week rehabilitation program with an experienced
transdisciplinary team, followed by an external program, 3 times a week.

Discussão

Radiological Images collected three months after the initial (Pictures 3,4, 5) showed that there
was almost no more parenchymal hemorrhage; there was reduction on the ventriculomegaly
and partial increasing of the number of fibres of the corpus callous.
GMFM scale shows that now he has the abilities of rolling, sitting, crawling
and uses a walker for limited distance locomotion.
PEDI scale shows that he has gained important progresses at daily life activities, being
partially dependent:
Manual Function- PEGBOARD: Initially, he was unable to execute the test; now, he is able to
perform it, still slow, because of movements incoordination, mainly using his left hand, but
now he is already able to do bimanual activities.
Cognitive and behavioural evolution: the results for total Scores, in both moments,
have compatible classifications, although his performance was better at the second. Mild
differences at the results show global improvement, specially at the processing speed; worsen
at perceptual organization, which may be related to changes at his behaviour.
VINELAND II shows that after the rehabilitation period the patient had gains
considering socialization and adaptative behaviour.

Comentários finais

Comparative evaluation showed a positive correlation between motor, cognitive and
behavioural improvement, compared to a resolution of an intracranial hemorrhage, on MRI,
and an increase at the fibres of corpus callous on tractography.

Referências (se houver)

1- McKinlay A, Linden M, DePompel R, Johnsson CA, Anderson V, Braga L, Castelli E, Koning P,
Hawley CA, Hermans E, Kristiansen I, Madden A, Rumney P, Savage R, & Wicks B. Service
provision for children and young people with acquired brain injury: Practice recommendations.
Brain Injury 2016; 30(13-14): 1656-1664.
2- Haley SM, Coster WJ, Ludlow LH, Haltiwanger JT, Andrellos PJ. Paediatric Evaluation of
Disability Inventory - PEDI; Inventario de Avaliaçao Pediatrica de Incapacidade; Versão 1.0
Brasileira.
3- Sparrow SS, Cicchetti DV, Balla DA; Vineland Adaptative Behavior Scales, Second Edition.

Fonte de Fomento (se houver)

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