Neurological rehabilitation in children and adolescents

Abstract

We report about 38 patients aged between 1 and 19 years (36.8% female, 63.2% male; mean age 7.8 years) admitted as inpatients for further neurorehabilitation mostly 4 weeks after severe acquired brain injury (ABI) of different aetiology. Of the patients, 73.7% were in a state of minimal responsiveness (vigilance score < 7 WVS) on admission. We evaluate the course of rehabilitation and the outcome 6 months after the end of the inpatient-period. The average stay of 15.5 weeks is strikingly low. The average intensity of therapy comes to about 16 units per week including strategies of rehabilitative education. The incidence of good rehabilitation was 21%, whereas almost 45% of patients displayed severe impairment. Although further improvements were found in almost 40% of patients 6 months later, these only slightly changed the overall picture of the GOS values. More than 3/4 returned to their families after rehabilitation, often despite great functional impairment. A return to the former environment outside the family (kindergarten, school) was, however, possible in 2/3 of the subjects. The proportion of minimally responsive patients fell from 73.7% to 18.4% during the stationary rehabilitation phase. After a further 6 months (follow up), 36.4% of the originally minimally responsive patients achieved a GOS value of > 5.

Diagnostic tools should be used for the diagnosis of chemotherapy induced peripheral neuropathy in breast cancer patients receiving taxanes

“…Sensory CIPN symptoms in patients treated with taxanes often emerge in a stocking and glove pattern. 20 , 21 To assess sensory changes, cold sensibility was measured delivering stimuli with an ice cold Tip‐Therm and pinprick sensibility was measured delivering stimuli with a BD™ 18 G Blunt Fill Needle. Stimuli were given every 3 cm from the cubital fossa to the top of the third digit and from the patella to the top of the first (big) toe on the left and right side.…”

“…Sensory CIPN symptoms in patients treated with taxanes often emerge in a stocking and glove pattern 20,21 . To assess sensory changes, cold sensibility was measured delivering stimuli with an ice cold Tip‐Therm and pinprick sensibility was measured delivering stimuli with a BD™ 18 G Blunt Fill Needle.…”

Early Detection of Neurologic Injury and Issues of Rehabilitation after Pediatric Cardiac Extracorporeal Membrane Oxygenation

“…Very often, prognostic statements are difficult to make because commonly used neurological and psychological test batteries are not feasible in pediatric patients after acquired hypoxic brain injury. To assess the progress of rehabilitation, Berger developed a vigilance score evaluated once a week by the whole rehabilitation team (20). He also found that improvements of the vigilance score were observed predominantly during the first 12 weeks after the insult, stressing the importance of early effective rehabilitation.…”