Late cognitive and behavioural improvement following treatment of disabling orthopaedic complications of a severe closed head injury
Late cognitive and behavioural improvement following treatment of disabling orthopaedic complications of a severe closed head injury
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DOI：
10.1080/026990596124656
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发表时间：
1996-02-01
期刊：
影响因子：
1.9
通讯作者：
Bussel, B
中科院分区：
文献类型：
--
作者：
Denys, P;Azouvi, P;Bussel, B
严重闭合性脑损伤（CHI）后身体、情感、认知和行为障碍的相互作用仍然知之甚少。一名47岁的男子被转介到我们的部门13个月后，严重的CHI。他表现出严重的左侧偏瘫和致残骨科并发症（左髋感染性关节炎，手术治疗异位骨化后）。他的臀部被堵住了，非常痛苦。他完全依赖于日常生活活动（功能独立性测量（Functional Independence Measure）评分= 18）。此外，他表现出严重的认知和行为问题，这些问题在之前已经稳定了许多个月，例如，对时间和地点完全失去方向感、严重的记忆障碍、激动、焦虑、抑郁、易怒、去抑制、攻击性和缺乏主动性。疼痛在治疗后几周内消失。功能逐渐改善（坐姿、转移、在双杠之间行走）。最后的分数上升到63。攻击性、易怒和躁动消失。令人惊讶的是，神经心理学评估表明，认知功能，特别是在定向方面，以及在较小程度上的注意力和记忆力的平行改善。这样的观察应该鼓励使用积极的治疗身体残疾，即使在患者表现出明显的认知预后不良的晚期严重CHI。
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.