Late cognitive and behavioural improvement following treatment of disabling orthopaedic complications of a severe closed head injury
作者:
DENYSP.,
AZOUVIP.,
DENORMANDIEP.,
SAMUELC.,
PATELA.,
BUSSELB.,
期刊:
Brain Injury
(Taylor Available online 1996)
卷期:
Volume 10,
issue 2
页码: 149-154
ISSN:0269-9052
年代: 1996
DOI:10.1080/026990596124656
出版商: Taylor&Francis
数据来源: Taylor
摘要:
Interactions of physical, emotional, cognitive and behavioural impairments after severe closed head injury (CHI) remain poorly understood. A 47-year-old man was referred to our department 13 months after a severe CHI. He demonstrated severe left hemiplegia and disabling orthopaedic complications (left hip infectious arthritis, after surgical treatment for heterotopic ossification). His hip was blocked and extremely painful. He was totally dependent for daily-life activities (Functional Independence Measure (FIM) score = 18). Moreover he exhibited severe cognitive and behavioural troubles, which had been stable for many months beforehand, e.g. complete disorientation for time and place, major memory disorders, agitation, anxiety, depression, irritability, disinhibition, aggressiveness and lack of initiative. Pain disappeared within a few weeks after treatment. Progressively, functional improvement occurred (sitting position, transfers, walking between parallel bars). The FIM score increased to 63. Aggressiveness, irritability and agitation disappeared. Surprisingly, neuropsychological assessment demonstrated parallel improvement of cognitive functions, especially in regard to orientation, and to a lesser degree attention and memory. Such an observation should encourage use of active treatment of physical disabilities, even in patients presenting with an apparently poor cognitive prognosis at a late stage of severe CHI.
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