Biomedical Engineering Reference
In-Depth Information
12.6.2 Case 2—John (Traumatic Brain Injury)
12.6.2.1 Case History
John*, currently 15 years old, sustained a TBI (Glasgow 8) in a serious car accident when
he was 12. He was treated at a trauma center and remained in the ICU for 58 days. When
he was admitted to the ICU, he underwent a computed tomography (CT) scan of the brain,
which revealed various cranial fractures and mild to moderate brain swelling. He was tra-
cheostomized for 19 days and experienced seizures, which did not reoccur after discharge
from the hospital.
At the time of the accident, he was attending sixth grade at a regular school, played
soccer, took swimming and karate lessons, and was independent in activities of daily
living. He is an only child, lives with his mother, who is a high-school graduate; his father
attended college for two years.
John was admitted to the SARAH Network by an interprofessional team 6 months after
the accident. He presented with spastic tetraplegia and left-sided facial paralysis; he kept
his mouth open most of the time. He was not attending school and was being seen at a
public clinical rehabilitation facility, where treatment included daily sessions of physical
therapy, occupational therapy, speech therapy, and water therapy in the pool. His family
complained of fragmented assistance, lack of guidance, and failure to adequately attend to
John's rehabilitation needs and social reinsertion.
A magnetic resonance imaging (MRI) scan showed an anterior lesion to the temporal
lobe bilaterally, with impairment of the amygdala and hippocampus on the left; thalamic,
parietal, and frontal lesions on the right; and parietal and frontal lesions on the left; and
supretentorial ventricular dilation, ex-vacuum without the need of a ventriculo-peritoneal
derivation valve.
12.6.2.2 Motor Evaluation
Upon admission to the rehabilitation program at SARAH, John presented with increased
tonus in the four limbs, more pronounced on the right side. Babinski was present on
the left. There was an extensor pattern of the lower limbs (feet in equinus and in right
inversion) and flexor pattern of the upper limbs (elbow and wrists). When asked, John
could flex and extend his right elbow and flex and extend his right knee, with no active
movement of the lower left limb.
He had regular neck balance and no trunk control, gait, or voluntary grasping. He was
totally dependent for activities of daily living and did not have a wheelchair. At home,
John usually lay in bed or on a recliner-type seat, on which he was also fed and bathed.
For longer distances, he was taken in the family car, and while at home he was carried
around.
12.6.2.3 Neuropsychological Evaluation
During the period of admission, John underwent a qualitative assessment of his cognitive
state. He responded to simple, contextual requests by smiling and directing his gaze.
After a consistent pattern of responses was established through conventionalization of
signs, he was also submitted to Raven's Special Scale of the Colored Progressive Matrices.
The data revealed a cognitive performance “definitively below average,” with errors
*
Not the patient's real name.
