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EDITORIAL EDITOR: Claire Rush McMillan Claire.Rush@newmedia.co.za NEWS WRITER: Nicky Belseck Nicky.Belseck@newmedia.co.za SUB-EDITOR: Gill Abrahams EDITORIAL CONTRIBUTORS Dr Ilhaam Mohamed, Prof James Ker, Dr Justus Apffelstaedt, Prof Morgan Chetty LAYOUT & DESIGN: Naresh Budraj ADVERTISING ADVERTISING EXECUTIVES Anel du Plooy - Tel: 082 786 9517 Anel.duPlooy@newmedia.co.za Cindy Riederer - Tel: 082 492 0229 Cindy.Riederer@newmedia.co.za
Beat the odds in severe brain injury
Early intervention in paediatric brain complications is key to improved development in later years.
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LITTLE GIRL WHO astonished healthcare professionals with her remarkable progress following a severe brain injury has, one year later, become a shining example of just what a difference rehabilitation can make to the developing brain. Three-year-old Nhlelo Chauke was travelling home from a family visit in Limpopo in January last year when her mother’s vehicle was involved in a terrible car accident that left Nhlelo totally unresponsive, with paramedics having to resuscitate her at the scene. After three weeks spent fighting for her life at Netcare Montana Hospital, Nhlelo was transferred to Netcare Rehabilitation Hospital in Johannesburg. According to Prof Andre Mochan, neurologist practising at the paediatric unit of the rehabilitation facility, it was clear that Nhlelo had a long way to go in regaining brain functionality. “She had suffered a diffuse brain injury, where due to the impact of the accident the nerves and cells had been badly shaken, resulting in bleeding in multiple parts of the brain. On arrival, she was completely non-communicative, had difficulty responding to visual stimuli and her movements were totally uncoordinated. She was not able to sit up or hold up her head.” Prof Mochan, along with the other members of the dedicated multi-disciplinary paediatric team in the unit, spent the first three days
assessing Nhlelo using internationally recognised scoring systems. “Nhlelo’s scores were very low but there were some hopeful signs, such as her ability to move her limbs and open her eyes,” says Prof Mochan. Charne Cox, Nhlelo’s physiotherapist at the rehabilitation hospital, explains that although she was three years old, Nhlelo’s brain injury was so severe that the team needed to go right back to the basics of baby movements – doing tummy time, learning to roll, learning to sit and so on. “As therapists, we almost always work together through all treatments, so that our patients have the benefit of not only therapies by a multi-disciplinary team but also interdisciplinary involvement.” Cox explains that many different types of therapy were involved in Nhlelo’s treatment, such as the use of a tilt table to familiarise her with the sensation of standing once more. Neural optometrists from Eyetek, who assist in all cases involving visual concerns, did visual stimulation exercises in the darkroom to strengthen her eye muscles. “Our speech therapist worked on imitating gestures to encourage Nhlelo to communicate, such as waving, reaching, smiling and so on. Within the first week, we began to see improvements in her scores and as she progressed she became increasingly engaged and enthusiastic. “Nhlelo really enjoyed the hydrotherapy in the heated pool where
we have floating toys. This is always a joyful experience for children as the weightlessness in the water gives them a great sense of freedom. She also loved the visits to the hospital by TOP Dogs – these are clean, highly trained therapy dogs. Patients can brush, feed and, if possible, walk them. Nhlelo also enjoyed the baking groups which provide a sense of community fun and cognitive stimulation. While Nhlelo’s progress was far beyond our expectations, we find that all children have amazing mental strength and can adapt more quickly and easily than an adult, provided they have the appropriate support,” notes Cox. Nhlelo was discharged in April 2021 and now, one year later, her father says he sees her recovery as a miracle. “She attends creche every day and while she still has some difficulties with her balance due to an ongoing issue with her ear, she is improving all the time. She’s very smart and loves counting, reciting the days of the week and the months of the year, and is fascinated by colour. Prof Mochan further points out that when it comes to children’s brains the rehabilitation process is particularly complex compared to that of the adult brain, which is already fully developed. In a child, injury disturbs normal development, which needs to be addressed in addition to the recovery from the injury itself. MEDICAL CHRONICLE | May 2022 39
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