Neurorehabilitation and acquired brain injury: Case

This girl is in the subacute phase of recovery from a moderate to severe traumatic brain injury, four months out and still within the high-plasticity window in which the intensive goal-directed therapy pays the greatest dividend. The left spastic hemiparesis with the equinus gait and the disuse of the hand, the cognitive deficits of the slowed processing speed and the poor working memory, the disorganisation and the impulsivity, and the disabling afternoon fatigue are the typical mixture of the motor, the cognitive, and the participation deficits that the multidisciplinary rehabilitation must address together. ^[8]

Clinical findings and assessment

The key findings are the left spastic hemiparesis, the disuse of the hand, the equinus gait, and the cognitive and the fatigue deficits. The modified Ashworth grade of 2 in the left gastrocnemius and the left biceps is a focal spasticity that limits the function, and the equinus gait and the foot drop are the consequence. The disuse of the left hand is the activity limitation that the upper limb therapy addresses, and the slowed processing speed, the poor working memory, the disorganisation, and the impulsivity are the cognitive and the behavioural deficits that the neuropsychological testing will define. ^[8]

The assessment is multidisciplinary and structured around the International Classification of Functioning. The motor assessment uses the Gross Motor Function Measure, the Melbourne Assessment of Unilateral Upper Limb Function, and the Assisting Hand Assessment for the activity level, and the modified Ashworth scale and the goniometry for the impairment level. The neuropsychological testing measures the attention, the processing speed, the working memory, and the executive function, and it is repeated at the school transitions because the executive deficit emerges late. The vision and the hearing are screened, and the fatigue and the sleep are assessed with the validated questionnaires. ^[2]