Early neurorehabilitation in a patient with severe traumatic brain injury to the frontal lobes.
BACKGROUND
It seems to be generally believed that early neurostimulation after severe TBI is useless or even harmful, and neuropsychological intervention should not be initiated until the patient is medically stable. On the other hand, the unstimulated brain can incur irreversible damage. The purpose of the present study is to assess the impact of early neuropsychological rehabilitation on a patient with an extremely severe TBI.


METHODS
The patient, a 32-year old male, suffered a massive cranio-facial injury with significant loss of tissue in the right frontal lobes after being struck by a tram. Beginning two weeks after injury, after pharmacological coma, he was attended on a daily basis by a neuropsychologist and a neurolinguist, with the active assistance of his family, when he was still in critical condition and essentially without logical contact. By the time he returned to Scotland 4 weeks later, he was sitting up, writing complete, sensible and grammatical sentences, and making rapid progress every day despite the development of hydrocephalus. Over the course of neurorehabilitation, most of MF's cognitive dysfunctions resolved. Six months later, however, hydrocephalus was increasing and the patient was showing severe frontal syndrome. A personalized version of Community Based Rehabilitation was applied. After two weeks of intensive treatment considerable improvement was achieved and frontal syndrome was reduced.


CONCLUSIONS
The present case suggests that the prevailing views regarding the inadvisability of early neurorehabilitation in the acute phase after TBI should be reconsidered.
Institute of Psychology, University of Gdansk, Gdansk, Poland.
Maria
M
Pachalska
Marek
M
Moskała
Bruce Duncan
BD
MacQueen
Jarosław
J
Polak
Magdalena
M
Wilk-Frańczuk
D000161:Acoustic Stimulation; D000210:Acute-Phase Reaction / Q000209:etiology / Q000534:rehabilitation*; D000328:Adult; D019341:Aromatherapy; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology / Q000534:rehabilitation*; D006259:Craniocerebral Trauma / Q000150:complications / Q000473:pathology / Q000534:rehabilitation*; D003695:Delivery of Health Care / Q000379:methods; D056344:Executive Function / Q000502:physiology*; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology*; D020557:Neurolinguistic Programming; D009483:Neuropsychological Tests; D010775:Photic Stimulation; D010812:Physical Stimulation; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome