LATE COGNITIVE AND BEHAVIORAL IMPROVEMENT FOLLOWING TREATMENT OF DISABLING ORTHOPEDIC COMPLICATIONS OF A SEVERE CLOSED-HEAD INJURY

Interactions of physical, emotional, cognitive and behavioural impairm ents after severe closed head injury (CHI) remain poorly understood. A 47-year-old man was referred to our department 13 months after a seve re CHI. He demonstrated severe left hemiplegia and disabling orthopaed ic complications (left hip infectious arthritis, after surgical treatm ent for heterotopic ossification). His hip was blocked and extremely p ainful. 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 mon ths beforehand, e.g. complete disorientation for time and place, major memory disorders, agitation, anxiety, depression, irritability, disin hibition, aggressiveness and lack of initiative. Pain disappeared with in 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 agita tion disappeared. Surprisingly, neuropsychological assessment demonstr ated 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 disab ilities, even in patients presenting with an apparently poor cognitive prognosis at a late stage of severe CHI.