Traumatic Brain Injury Study 1

Name: R
Age: 11
Gender: Male

HISTORY

R was operated on for a Medulloblastoma (tumor) on June of 1998. The surgical report indicates that there must have been a high degree of vascularization of this tumor, as it did bleed extensively during the operation. Following the operation and recovery from anesthesia, he is noted to have been obeying commands and being able to move all four extremities, and pupils were equal and reaction to light. He was transported to intensive care to further stabilize his condition.

The next day it was observed that he had developed Hydrocephalous and that there was also bleeding in the general area of the operation (Occipital area). As a result, he was operated on a second time to remove the blood clot and to maintain homeostasis.

Subsequent problems in maintaining pressure was corrected by placement of a VP shunt a month after the original surgery. Since the time of the second operation it was noted that there was severe neurological impairment, including a note from Neurology indicating that he was, at that time, in a “locked-in” syndrome. He is reported to have significant ataxia.

He was in ICU for three months, and was in the hospital from June until November of 1988. R’s mother reports that following the second surgery he was in a “semi coma” for 5 weeks. His eyes were open but he was unable to communicate. After 5 weeks he was able to nod, but his responses were very inconsistent.

R has had a series of chemo, physical, occupational and speech therapies. He presently is only receiving physical therapy, 2 X’s out-patient, and 2X’s weekly in the school that he attends.

When I first met R, he had great difficulty walking without lumbering from side to side. He need assistance walking from my wait area to the treatment room (about 12 feet). His entire left side was noticeably weaker than the right. His right eye was much more exposed than his left, as he was unable to close his left eye. It appeared that he was having difficulty focusing when looking at me. His eyes seemed unable to coordinate very well. I had difficulty understanding his speech as he slurred his words considerably. His processing time seemed a little slow as he was unable to respond to questions without some delay in his responses. He was quite fatigued by the end of the session.

R’s parents report that previously to the surgeries he was a normal, active and highly intelligent 10 year old. He engaged in many physical activities and enjoyed sports tremendously.

TESTING

TOVA
He was given the visual version of the TOVA. He told me that he had no difficulty in seeing the objects on the screen.

INITIAL TOVA: All four quarters were invalid due to excessive anticipatory responses
2ND TOVA: there were no invalid quarters

COGNOMETER
Comparison of test 1 to test 2. Test 2 was administered after 15 NF treatments.

Immediate and Delayed Memory: Both within 1 SD (standard deviation) below the norm.

Attention: First test more than 2 SD below the norm, second test slightly less than than 1 SD below the norm.

Speed: First test more than 2 SD below the norm, second test slightly less than than 2 SD below the norm.

Motor Reflexes: First test more than 2 SD below the norm, second test slightly less than 1 SD below the norm.

Perceptual Threshold: First test more than 2 SD below the norm, second test slightly more than 1 SD below the norm

OBSERVATIONS/CHANGES
Most of the observations came from R’s physical therapists as well as observations from myself and others working in my office.

After 1st session: physical therapist reports R is more focused. Parents report that he was not tired following session.

After 2nd session, Dad reports he was much more talkative on the return home. R seemed more able to focus during session, he noticed the change in color on the monitor when switching from left to right side.

After 3rd session: Mom reports that R’s physical therapist said he had an excellent session. Ryan was able to walk 12 feet to seat in office without assistance. R appears more focused during training.

After 5 sessions: R reports that work at school seems easier to him, he is noticing that walking seems easier. No report from physical therapist today.

After 7 sessions: Physical therapist reports than R’s stamina and distance has improved significantly while walking. They have stopped counting steps as he is able to walk well over 1,000 without assistance.

After 9 sessions: Mom says that R has always been a good speller, she was reviewing his spelling words with him and thought they were very difficult for his age. R got the highest grade on the test, others mostly failed.

After 12 sessions: Physical therapist reports that R’s balance is improving greatly. He is able to walk within a 12″ space without losing his balance. He is able to stand within a 4″ area, one foot in front of the other keeping his balance. Both Ryan and Dad report he is doing very well in school.

After 14 sessions: Physical therapist reports that R is able to step up on a platform without falling off. Never been able to do this before. Physical therapist very excited about changes/improvements in the past month.

After 15 sessions: Insurance is very impressed with reports from this office and physical therapy. Will renew additional sessions.

R is able to walk significantly better as reported by parents, physical therapists and our own observations. He is engaging with us considerably more, even joking with us. His eyes appear to coordinate better when looking at something. His energy level has increased. He is having an easier time at school. There seems to be a softening in his face. His balance is improving significantly.

When I showed Mom the results from his second round of tests (Dec. 24th), she told me that this was the best Christmas present that she had received.

PROTOCOLS

Session 1: C3, 2-7 inhibit, 15-18 reward band for 6 min.
C4, 2-7 inhibit, 12-15 reward band for 6 min.
Session 2: same as above except increased both sides by 3 min.
Session 3&4: T3, 2-7 inhibit, 15-18 reward for 9 min
T4, 2-7 inhibit, 12-15 reward for 9 min
Session 4-5 : T3, 2-7 inhibit, 15-18 for 9 min
T4-P4, 2-7 inhibit, 12-15 for 9 min
Session 6-8: T3, 2-7 15-18 for 12 min.
T4-P4, 2-7 12-15 for 12 min.
Session 9-12: T3-FP1, 2-7 15-18 for 3 min
T3, 2-7 15-18 for 9 min
T4-P4, 2-7 12-15 for 12 min
Session 13- T3-FP1, 2-7 15-18 for 3 min
T3-F7, 2-7 15-18 for 3 min
T3-A1, 2-7 15-18 for 6 min
T4-P4, 2-7 12-15 for 12 min

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