Diffusion tensor tractography, motor, cognitive and behavior scales in a rehabilitation outcome following a pediatric traumatic brain injury: a case report

Case presentation: A 7-year-old boy who has been severely brain-injured in a car accident in February 2016. Initially, Glasgow coma scale was 7. He needed decompressive craniectomy and a ventriculoperitoneal shunt. At first, he was tetraplegic, without ability for locomotion. His initial MRI including DW, CSD tractography and spectroscopy showed frontal and parietal hemorrhage, parenchymal contusions, areas of reduced levels of Naa and less fibers of right corticospinal tract and of the corpus callous. We used Gross Motor Function Scales (GMFM; Functional skills: mobility, self-care and social function (Pediatric Evaluation of Disability Inventory- PEDI); Manual function - PEGBOARD); Cognitive (Wechsler Intelligence Scale Cognitive IV); Vineland Adaptative Behavior Scales-Second Edition (VINELAND-II), which evaluates communication, daily living skills, socialization and motor skills. We decided for an internal and intensive 8-week rehabilitation program with an experienced transdisciplinary team, followed by an external program, 3 times a week.

Discussion: Radiological Images collected three months after the initial (Pictures 3,4, 5) showed that there was almost no more parenchymal hemorrhage; there was reduction on the ventriculomegaly and partial increasing of the number of fibers of the corpus callous. GMFM scale shows that now he has the abilities of rolling, sitting, crawling and uses a walker for limited distance locomotion. PEDI scale shows that he has gained important progresses at daily life activities, being partially dependent: Manual Function- PEGBOARD: Initially, he was unable to execute the test; now, he is able to perform it, still slow, because of movements incoordination, mainly using his left hand, but now he is already able to do bimanual activities. Cognitive and behavioral evolution: the results for total Scores, in both moments, have compatible classifications, although his performance was better at the second. Mild differences at the results show global improvement, specially at the processing speed; worsen at perceptual organization, which may be related to changes at his behavior. VINELAND II shows that after the rehabilitation period the patient had gains considering socialization and adaptative behavior.

Final comments: Comparative evaluation showed a positive correlation between motor, cognitive and behavioral improvement, compared with a resolution of an intracranial hemorrhage, on MRI, and an increase at the fibers of corpus callous on tractography.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023