Biomedical Engineering Reference
In-Depth Information
matching process, the psychotechnologist will lead the team by monitoring critical issues,
strengths, and possible problems.
9.3.1 Medical Case
At the age of 35 years and four months, apparently without any relevant symptoms, Mr. S.A.
was struck by a bulb-pons intraparenchymal cerebral hemorrhage with a consequent coma-
tose state. The computed tomography (CT) scan, conducted on the same day, emphasized
the presence of a “voluminous intraparenchymal hematoma next to the bulb-pons with
tetra-ventricular hemorrhage.” The following day the patient underwent a neurosurgical
operation. The coma lasted for approximately three months, during which a trachea-sto-
machic cannula (removed at the age of 37 years) and percutaneous endoscopic gastrostomy
(PEG) tube (still present) was positioned.
The patient currently presents with marked dysarthria, serious dysphagia (he can only
be nourished through PEG), sialorrhoea, and open bite. Eye motility is possible only in
bilateral lagophthalmos vertical look. A noticeable lowering of the hearing standard is
present in the left ear.
9.3.1.1 Motor Evaluation
The subject presents hypotonic tetraparesis with serious control deficit of the pelvis, trunk,
and head. He cannot autonomously maintain a sitting position because of marked kyphosis
of the trunk, retroverted pelvis, head noticeably placed before the scapular cingulum, and
lower limbs positioned in extra rotation. The right upper limb presents a residual mobility
at the proximal level, but no functional activity is possible because of serious movement
hindrance. The left upper limb presents both residual proximal mobility and sufficient
movement capability. The patient is able to index, but there is serious dysmetria: With this
limb the patient can reach his face to clean the mouth; he can beat, grasp, pull, and press;
and the left hand is used to produce an alphabetic gestural code by using the thumb and
the index and middle fingers.
The lower limbs are used to cooperate during the transfers (e.g., from wheelchair to bed)
by using the right leg as a pivot. On request, the patient is able to move the head in any
direction but through very laborious and extremely difficult movements. The transfers can
be realized either through a hand-pushed wheelchair or an electric wheelchair, which can
be driven by a joystick handled by the left hand. S.A. is enlisted in an physiokinesitherapy
rehabilitation program, which aims to improve control of the trunk, head, and pelvis
by reducing as much as possible the kyphosis and the dysmetria. The patient is also
undergoing phoniatric and respiratory therapy.
9.3.1.2 Neuropsychological Test
The neuropsychological test was performed one year and nine months after the lesion.
Because of the marked motor and communicative limitations, a standardized evaluation
and most verbal and nonverbal tests could not be done. A rough evaluation of verbal
memory capabilities was made through a codified alphabetic code. Notwithstanding
the unfavorable conditions, in a prose memory test S.A. showed good capabilities of
storing the material in the short term, and he was able to recall it without substantial loss
information. Logical-deductive reasoning capabilities, which were evaluated by means of
nonverbal material, are perfectly preserved. Finally, an overview of the analyses made
