Neurorehabilitation With Padovan Method in a Newborn With Treacher Collins Syndrome: A Case Report

Abstract

Treacher Collins Syndrome (TCS) is an autosomal dominant disorder that leads to congenital craniofacial malformation, and may then be assisted by the Padovan Method® for neurological rehabilitation. That being said, the aim of this article is to report the functional improvements obtained by a patient with TCS who underwent the Padovan Method®. The child was born on november 26th of 2014, cesarean delivery, 37 weeks, Apgar 9/10, weighted 3625g, PC = 35cm, C = 49CM, presenting mild respiratory discomfort, absence of suction and the presence of syndromic facies, which is characteristic of TCS with retrognathism, oblique palpebral cleft downward divergent strabismus on left, pointed ears with cleft lobes, narrow auditory canal, malar hypoplasia and narrow palate. Padovan therapy was initiated at the 6th day of life, from orofacial, vestibular, ocular and motor exercises that seek to recapitulate the neuroevolutionary phases of human development with the purpose of propitiating a motor and neurological maturation of the central nervous system (CNS) and the correction of its possible failures. The child presented suction on the second day of therapy and on the fifth day was discharged from the hospital with good suction to the breast. The patient was followed up on an outpatient office and was given physiotherapy and speech therapy. The patient no longer received the Padovan Method® because at that time it was not available outside the hospital. Upon returning to childcare at age of 3, a good motor coordination performance was noticed, also speaking few loose words, but with good interaction and understanding. Therefore, due to the lack of standard behavior in neonatal neurological rehabilitation, considering the concepts of neuroplasticity andknowing the importance of early intervention, the Padovan Method® is shown as an alternative in the CNS reorganization in patients with TCS.

Recommendation of Neurorehabilitation according to the Padovan-Method Neurofunctional Reorganisation® for treating neurodevelopmental disorders: a systematic review

“…See Table B2 (Appendix B) for a reference list of excluded items. Finally, four studies (no RCT, one pseudo-RCT [49], one non-RCT/CCT [55], one CBA [44] and one retrospective self-compared cohort study [48]) and n = 14 case documentations (10 CR [46,47,(50)(51)(52)(53)72,(164)(165)(166) and 4 CS [22,36,54,167]) remained for inclusion. Divergent from the protocol, no further exclusion was made in the case of CS or CR with unclear documentation of the therapists quali cation (therapy under supervision [52,53,72] or NI [50,51,54,[164][165][166]).…”

“…None of the included CS and CR completely ful lled the CARE [106] recommendations. Critical limitations were present in all items regarding at least one of the following domains: 'Diagnostic assessment' [22,47,[50][51][52][53]164], 'Follow-up and outcomes' (all items) [22, 36, 46, 47, 50-54, 72, 164-167] and 'Discussion' [47, 50-53, 72, 164, 166]. Limitations of CS and CR where therefore considered to be moderate [36,46,54,72,[165][166][167] or high [22,47,[50][51][52][53]164].…”

“…The age of the participants ranged between ve days [22] to 28 years [46]. Indicating diagnosis were microcephalia (with total n = 14 in six case reports [50][51][52][53][54]72]), neonatal hypoxic-ischemic encephalopathy (n = 10 [22]), myo-functional disorder (n = 8 [36]), foetal alcohol syndrome (n = 2 [167]), neurological alteration by kernicterus (n = 1 [22]), speech development disorder (n = 1 [166]), audiogenic dyslalia (n = 1 [165]), treacher collins syndrome (n = 1 [47]), tetra paresis and open bite (n = 1 [164]) and brain injury (n = 1 [46]). Study drop-outs (n = 5) were reported in one case series due to lack of time to adhere to the therapy protocol [36].…”

“…Within all reports, patients received therapy sessions according to the Padovan-Method®. The duration of each session was 45-60 minutes [36,46,51,52,72,166] or not speci ed [22,47,50,53,54,164,165,167], with application frequencies of 1 or 2 times per week (1-2/w) [36,46,54,72,165], 5-6/w, [47,53] and 7/w [50][51][52] (NI: [22,164,166,167]). The intervention periods were between ve days [47] and two years [165] (NI: [46]).…”

“…Statistically signi cant outcomes are listed separately (see Table 2). To extract the early response from acute phase treatment, response the length of intervention was used (cut-of duration of treatment process ≤ 1 month [22,47,48,55,167] and ≤ 3 months for acute phase treatment [22,[49][50][51][52][53]167], > 3 months for longterm response [36,46,47,54,72,164,165]). As some of the included trails or reports extended over a long period, by derogation from the protocol [96], the section 'follow-up response between four and six months' was extended to 'long-term and follow-up response between four and six months and more'.…”