INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Shubert Complex (Posters 1-60) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #59 Culturally Sensitive Practice and the Course of Cognitive Recover After Severe Brain Injury Due to Hemolytic Uremic Syndrome Eman Rettig, University of Texas at Austin Dell Medical School & Dell Children's Medical Center, Austin, United States Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child) Keyword 1: bilingualism/multilingualism Keyword 2: brain injury Keyword 3: pediatric neuropsychology Objective: To describe the course of neurologic and neuropsychologic recovery in a pediatric patient who sustained a severe acquired toxic metabolic brain injury due to hemolytic uremic syndrome (HUS) resulting from Shiga-toxin producing Escherichia coli (STEC) while considering culturally sensitive care. Notably, this case report provides novel and detailed neurologic and neuropsychologic contributions to the scientific literature on a rare condition. The patient presented with worsening neurologic status including fever, hypoxic respiratory failure, seizures, and worsening kidney functioning. She was diagnosed with urinary tract infection, STEC, and HUS (rare kidney disease). Neuroimaging showed cerebral edema, hypoxic-ischemia, and microhemorrhages in the bilateral putamen, thalami, the genu of the corpus callosum, columns of the fornix, midbrain, pons, and medulla. Participants and Methods: The patient was a 4-year-old Hispanic female who primarily spoke/understood Spanish and understood a few English words. She had an expressive communication disorder at baseline. The Coma Recovery Scale, Revised (CRS-R) was administered multiple times over the course of her inpatient rehabilitation stay by the inpatient pediatric neuropsychologist in conjunction with either physical, occupational, and/or speech-language therapists. Once clinically appropriate, the Mullen Scales of Early Learning and Receptive One-Word Picture Vocabulary Test, Spanish-Bilingual Edition were administered by an English-Spanish bilingual psychometrist. An in-person English-Spanish bilingual interpreter supported communication with the patient and parent. Results: The patient transferred to the inpatient rehabilitation unit 8 weeks post admission. Results from the first CRS-R showed she was in a minimally conscious state plus and then showed she emerged 4 weeks later. Neuropsychological testing was conducted about 6 weeks after emergence. Scores were low average for Spanish receptive vocabulary and verbal reasoning. Scores were exceptionally low for brief attention, visual reasoning, expressive vocabulary, and fine and gross motor skills. Conclusions: This 4-year-old Spanish-speaking Hispanic female sustained a severe acquired toxic metabolic brain injury due to SPEC, HUS, and multi-systemic complications. Despite the odds, she made remarkable transitions from being in a disorder of consciousness, to emerging, and then to showing enough cognitive recovery to participate in inpatient neuropsychological testing. She continued showing progress, albeit sometimes minimal, to extend her inpatient rehabilitation stay to support continued recovery. Collectively, she received intensive medical care for about 8 weeks and intensive inpatient rehabilitation services for about 12 weeks. The inpatient rehabilitation team approached the patient and family through a culturally sensitive clinical framework. This included ensuring that all team members used an in-person/virtual interpreter during each interaction no matter how brief, prioritizing assignment of an English-Spanish bilingual nurse, providing appropriate religious support, understanding the family’s culture and background to support their health literacy, and providing resources in Spanish among others. These culturally sensitive interventions resulted in strong therapeutic relationships and supported the medical team in achieving impressive clinical outcomes. Overall, this case report provides a novel contribution to the scientific literature on a rare medical/neurological presentation, neuropsychological monitoring, and culturally sensitive clinical care on an inpatient rehabilitation unit.

Poster

Poster Session 03 Program Schedule

02/15/2024
09:30 am - 10:40 am
Room: Shubert Complex (Posters 1-60)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #59

Culturally Sensitive Practice and the Course of Cognitive Recover After Severe Brain Injury Due to Hemolytic Uremic Syndrome

Eman Rettig, University of Texas at Austin Dell Medical School & Dell Children's Medical Center, Austin, United States

Category: Acquired Brain Injury (TBI/Cerebrovascular Injury and Disease - Child)

Keyword 1: bilingualism/multilingualism
Keyword 2: brain injury
Keyword 3: pediatric neuropsychology

Objective:

To describe the course of neurologic and neuropsychologic recovery in a pediatric patient who sustained a severe acquired toxic metabolic brain injury due to hemolytic uremic syndrome (HUS) resulting from Shiga-toxin producing Escherichia coli (STEC) while considering culturally sensitive care. Notably, this case report provides novel and detailed neurologic and neuropsychologic contributions to the scientific literature on a rare condition. The patient presented with worsening neurologic status including fever, hypoxic respiratory failure, seizures, and worsening kidney functioning. She was diagnosed with urinary tract infection, STEC, and HUS (rare kidney disease). Neuroimaging showed cerebral edema, hypoxic-ischemia, and microhemorrhages in the bilateral putamen, thalami, the genu of the corpus callosum, columns of the fornix, midbrain, pons, and medulla.

Participants and Methods:

The patient was a 4-year-old Hispanic female who primarily spoke/understood Spanish and understood a few English words. She had an expressive communication disorder at baseline. The Coma Recovery Scale, Revised (CRS-R) was administered multiple times over the course of her inpatient rehabilitation stay by the inpatient pediatric neuropsychologist in conjunction with either physical, occupational, and/or speech-language therapists. Once clinically appropriate, the Mullen Scales of Early Learning and Receptive One-Word Picture Vocabulary Test, Spanish-Bilingual Edition were administered by an English-Spanish bilingual psychometrist. An in-person English-Spanish bilingual interpreter supported communication with the patient and parent.

Results:

The patient transferred to the inpatient rehabilitation unit 8 weeks post admission. Results from the first CRS-R showed she was in a minimally conscious state plus and then showed she emerged 4 weeks later. Neuropsychological testing was conducted about 6 weeks after emergence. Scores were low average for Spanish receptive vocabulary and verbal reasoning. Scores were exceptionally low for brief attention, visual reasoning, expressive vocabulary, and fine and gross motor skills.

Conclusions:

This 4-year-old Spanish-speaking Hispanic female sustained a severe acquired toxic metabolic brain injury due to SPEC, HUS, and multi-systemic complications. Despite the odds, she made remarkable transitions from being in a disorder of consciousness, to emerging, and then to showing enough cognitive recovery to participate in inpatient neuropsychological testing. She continued showing progress, albeit sometimes minimal, to extend her inpatient rehabilitation stay to support continued recovery. Collectively, she received intensive medical care for about 8 weeks and intensive inpatient rehabilitation services for about 12 weeks. The inpatient rehabilitation team approached the patient and family through a culturally sensitive clinical framework. This included ensuring that all team members used an in-person/virtual interpreter during each interaction no matter how brief, prioritizing assignment of an English-Spanish bilingual nurse, providing appropriate religious support, understanding the family’s culture and background to support their health literacy, and providing resources in Spanish among others. These culturally sensitive interventions resulted in strong therapeutic relationships and supported the medical team in achieving impressive clinical outcomes. Overall, this case report provides a novel contribution to the scientific literature on a rare medical/neurological presentation, neuropsychological monitoring, and culturally sensitive clinical care on an inpatient rehabilitation unit.