Improvement in persistent vegetative state of a 4-year-old, 2 years after near-drowning.
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1
Carrick Institute, Clinical Neuroscience, United States
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2
Plasticity Brain Centers, Neurorehabilitation, United States
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3
NeuroSynergy Associates, PA, Neurorehabilitation, United States
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4
Harvard Medical School and Harvard-Macy MGH Institute of Health Professions, United States
Presentation
A 4-year-old male who had a near-fatal drowning accident, was presented in a vegetative state from an anoxic brain injury that occurred 2 years prior.
Examination
The patient was in a persistent vegetative state (Pediatric Glasgow 7: E4/V1/M2). His eyes were open and blinked randomly, to an air stimulus, and not to a visual stimulus. He was unable to respond or follow any verbal commands. During intake physical examination he demonstrated a low frequency (1.5 Hz), high amplitude upbeat nystagmus. He had decorticate spasticity in extremities, with greater spasticity on his right upper and lower extremities. At times he would assume a decerebrate posturing, with extension of his head, both legs, and arms by his sides. His pupils were equal and responded to light with fatigue demonstrated at 4 seconds. His optokinetic responses were diminished, but intact in the horizontal and vertical planes. Doll’s Eye response was appropriately present. Upon ophthalmic examination, he had a 1:1 VA ratio on the right and 3:2 VA ratio on the left. A right-sided rooting response was observed. Spinal galant reflex was absent. His right hand is spastic with his thumb enclosed inside of his hands. Toes were bilaterally down-going without a withdrawal response on plantar stimulation. Capillary refill on slower on the right leg and hand when compared to the left. At the time his grandmother reports that he has been anorexic for the past 48 hours. She was concerned and was considering taking him to the ED if he had not eaten that evening.
Intervention
An intensive treatment plan consisting of nerve stimulation, photic therapy, optokinetic therapy, vestibular rehabilitation, and single-axis rotational therapy was implemented, three times per day, for 5 days.
Outcome
After 14 sessions of treatment, his Pediatric Glasgow Score was a 9 (E4/V1/M4). His upbeat nystagmus has reduced to very infrequent. He now demonstrates a withdrawal response upon plantar stimulation. He no longer was assuming a decerebrate posture and decreased spasticity was observed in his right upper extremity, with his fingers having more mobility and his right thumb coming out of its usually fully-flexed posture. His grandmother observed that he attempted to clear his through which is not a typical behavior for him. He also ate baby food for the first time since his injury. He was also able to sit up, unsupported for 10 minutes.
Conclusion
This report presents an improvement in human function of a patient in a vegetative state following a 5-day intensive multi-modal rehabilitation program. The authors recommend further investigation into the effectiveness of 5-day, intensive multi-modal rehabilitation programs, for individuals in persistent vegetative states.
Keywords:
vegetative state,
Glasgow,
anoxic brain injury,
Vestibular Rehabilitation,
non-invasive nerve stimulation
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Antonucci
MM,
Barton
DA,
Link
PE and
Carrick
FR
(2016). Improvement in persistent vegetative state of a 4-year-old, 2 years after near-drowning..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00064
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Received:
31 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Matthew M Antonucci, Carrick Institute, Clinical Neuroscience, Cape Canaveral, United States, drnucci@gmail.com