Neuropsychological Approach to Traumatic Brain Injury Pires-Barata S, Vieira I, Palma Gois L*, Teixeira da Silva MH Physical Medicine and Rehabilitation and Psychiatric* Departments Hospital do Espírito Santo Évora, Portugal Traumatic brain injury (TBI) is one of the leading causes to total or partial physical and/or psychosocial disability. TBI can have impact in several areas of the brain, which may affect different aspects such as memory, attention, motor, behaviour and personality. A multidisciplinary approach becomes a relevant need since the acute stage. The case report to 3 years of neuropsychological approach in a 19 year old male, who suffered a severe TBI. The polimodal stimulation and the cognitive rehabilitation process were described in this paper. CASE REPORT Male; 19 years old; Motor vehicle accident August 2001; 6 grade; Building construction worker; Good social support. Admitted in Neurosurgery, with a Glasgow Coma Scale of 6; 19 days in Intensive Care Unit; 10 days with assistant ventilation; pulmonary pathology. CT scan showed multiple temporal bilateral concussions; MRI showed lesions in the first frontal lobe circumvolution, bilateral lesions in the basal ganglia and right side of corpus callosum. January 2002 Diagnosis: severe TBI, decerebration, spastic tetraparesis, paralysis III right nerve. Barthel Index: 0/100; Functional Independence Measure: 18 MULTIDISCIPLINARY APPROACH Multidisciplinary team: neurologist, internist, physiatrist, neuropsychologist/psychologist, occupational therapist, physiotherapist, speech therapist. Knowledge of the patient premorbid condition. Knowledge of the family. POLIMODAL STIMULATION Neuropsychologist, physiotherapist, occupational therapist, speech therapist. January 2002 Induced pain – escape reaction; no facial expression Smell of different odours – significant reaction: negative to coco (which the patient did not like) and positive to his frequent body lotion Taste – extreme reaction to positive and negative stimulus (whether the patient previously like it or not); 1st facial expression – lemon vs chocolate Visual – photographs, elements football team, TV Auditive – TV, favourite CDs and radio station Neurosensorial stimulation; Motor stimulation; Deglutition training. The team main purpose was to give as much stimulation as possible, without repeating the stimulus and working with the patient for short periods of time. He was discharged in March Barthel Index: 90/100 Functional Independence Measure: 120 OUTPATIENT CLINIC May 2002 Neuropsychological evaluation: Frontal lobe syndrome – impairment in: memory, executive functions, attention and behaviour and personality change. REHABILITATION CLINIC June – December 2002 NEUROPSYCHOLOGICAL APPROACH February 2003 Attentional and memory impairment. Less disinhibition, less impulsive, humour stabilized, development of compensatory strategies. March – May 2003 Planning compensatory strategies; psychotherapy; family guidelines. COGNITIVE REHABILITATION (paper/pencil work) June 2003 – January 2004 Function: attention (3x10 sessions) at the beginning the patient was evaluated DI=173%WP=-30 at the end of the training was revaluated DI=60% WP=20 Although, pathological values observed the patients did a recovery of most of his attentional deficits. Function: memory (2x10 sessions) working memory visual memory The sessions were interrupted due to a manifestation of a psychiatric disorder. The patient had Fregoli’ Syndrome – a delusional misidentification syndrome, most often seen in psychiatric disorders, but also reported in brain diseases, usually associated with diffuse lesions although right temporal lobe has also been referred as implicated. After 4 months of psychiatric medication, the training was initiated and vocational counselling was performed. The patient is presently in a landscaping course.