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Harlen Forya - Chronic encephalopathy

Author Admin Views Posted at 2014/07/18

Name:Harlen Forya

Sex: Female

Country: Argentina

Age: 9 years

Diagnoses: 1. Chronic encephalopathy 2. Epilepsy 3. Microcytic hypochromic anemia

Admission Date: 2013-06-21

Days Admitted to the Hospital: 28

Before treatment:

Harlen Forya is a 9 year old girl. She had had a developmental delay in her brainy and dyskinesia for more than 8 years. She was diagnosed with Chronic encephalopathy.

Admission PE:

Bp: 117/60mmHg; Br: 22/min, Hr: 98/min. Skin and mucous membrane were intact, with no breakage or petechia. The thorax was symmetrical. The respiration in both lungs was clear; there were no dry or moist rales. The heart rate was faster than normal, the rhythm of her heartbeat was normal, with no obvious murmur in any valve area. The abdomen was flat and soft, with no masses found by touch. The liver and spleen were not touched under the ribs.

Nervous System Examination:

Harlen Forya was alert. Her intelligence development was clearly delayed. She had no response when others called her name. She could cry. She had laloplegia, and only could say "A". She had a semi-liquid diet and mealtime was about 15-20 minutes. There was no obvious cough when she had her meal, and she salivated occasionally. Both pupils were equal in size and round, the diameter was about 4.0mms. Both pupils were slow in response to light reflex. There was no obvious nystagmus. Her eyes could not follow the movement of the object. She was unable to perform the vision or visual field examinations. She had no obvious response when others called her name. She could not complete instructions. She had little control of her head. She could not maintain a seated position by herself. She could voluntarily turn over on her own. She could not stand or walk by herself. Even with some assistance, her heel still could not touch the floor. All four of her limbs were able to move. Both hands could not grasp an object. She could not perform the examination testing the strength of all four limbs' muscle. The muscle tone of bilateral waist and ankle joints were almost normal. The muscle tone of other limbs was almost normal. The patellar tendon reflex of right side was agitated. The tendon reflex of other limbs was normal. The sucking reflex was negative. Bilateral palm jaw reflex was negative. Bilateral Babinski sign was negative. She could not perform the rapid rotation test, the finger-to-nose test, the heel-knee-shin test or Romberg's sign.

Treatment:

Harlen Forya received a complete examination and she was diagnosed with 1. Chronic encephalopathy 2. Epilepsy 3. Microcytic hypochromic anemia. The patient maintained antiepileptic drug level prior to admission. She received treatment to nourish the neurons, improve the blood circulation and treat anemia. She also received treat for nerve regeneration.This was accompanied with rehabilitation training.

Post-treatment:

The patient's condition has improved gradually. She has better response to the peripheral environment. She can raise her head when others call her name. Both pupils have a more sensitive reflex to light stimuli. She occasionally will respond when she hears a voice. The muscle strength of the waist and back is stronger. Sometimes she can maintain a seated position for 3-5 seconds. The muscle strength of both lower limbs is improved. With wearing a short limb and some assistance, the patient can stand 2-3 seconds on one leg. The flexion of both knee-joints is reduced when standing in bed with the weight of the sandbag. The patient's condition is stable.

Dear Dr :

We send the progress made ​​Forya to 3 months of treatment, which saw their therapists and us as parents.

Occupational Therapist and Physiotherapist :

In upper limbs : increased tolerance to contact and mobilization

In Lower Member : greater elongation. Presence of discomfort in his right ankle.

In trunk and neck : posterior muscles shortening with fixation of the head to the right ( lower range of motion )

Communication: greater connection , look communicative .

Psychomotor Therapist :

Lateral decubitus position : beginning of collaboration sitting trunk passage .

Prone position : greater tolerance to support arms and head elevation fluctuating in pitch.

Seating Systems : with full support , improves tone straightening and bottom of spine. When bending greater tolerance appears to support and head righting reaction .

Decreased tone hands slowly . There is still increased in wrists.

Phonoaudiological Therapist:

Since different areas phonoaudiological work swallowing function , muscle tone, language and hearing. It has been shown more tolerance to proprioceptive stimuli (tactile , vibratory and thermal ) at orofacial and responsive to new directions and faster to auditory stimuli (music and vocals)

Special and mainstream school :

Forya behaviors observed in these last 2 months :

One sees more attentive to the activities , stimuli , people and environment .

Rejects less contact with their hands , and can manipulate deferens items with teacher assistance .

Smile a lot in certain activities and resources when working in the Classroom Sensory, especially when you combine music and visual effects of light , always interacting very closely.

Decreased their discomfort that manifested when he starts to scratch his nose .

Generally manages to stay all the time working in her chair when we are participating in the special school hours together. Previously it was necessary to take it out and hold it in her arms.

Parents:

You sleep alone and sleep through the night with only one section .

Sleeping more hours.

Poop every 2 days ago .

Improved communication with the look.

TheraTogs increased tolerance and splints .

Increased tolerance for therapies and equipment.

Increased tolerance and holding objects hands with assistance .

Improved digestion and tolerance to certain foods.

Eat more .

Gained weight and grew.

 

It is quieter .

Decreased hypersensitivity.

Improved trunk and head control and sitting posture .

Best Regards

Forya's parents email to us:

Date: 2014-02-26

Dear Dr, Thank you for your response and will continue for one month and then get back to report.

The problem that Forya is very sleepy in the morning, is prior to this dose of clonazepam.

We also want to inform you that Forya is fine, as the latter crisis was not affected. Maybe it holds the head and trunk, is more connected, is your best look, holding objects in their hands for a few minutes and works best with the therapists, they also noted their improvement.

Keep in touch, best regards to you, Dr Wu and all the team, always remember them fondly.

Date: 2014-04-28

Dear Dr: we want to tell that you are climbing Harlen Forya red blood cells and hemoglobin.

Also say that we are happy with the progress you are doing: holding either her head, improved posture, at times is sitting alone, unaided, are more connected are the environment, fixed over the look and follow objects, tolerates many hours the Thera Togs and also the standing and walking with long boots, among other things.

We want to ask for help because she started waking up 2 or 3 times a night, not sleeping well, it makes the next day we are all very tired, she is sleepy in the morning and we are not right to work. The question is whether we can indicate that Eli medicine for a good night's sleep and improve their status during the day.

From already thank you very much, will always be grateful for what they did, they do and will do for our daughter. Regards.

Date: 2014-05-31

Dear Dr: I send the latest Harlen blood test.

We also tell you that Harlen started to go to school and walking therapies with long boots (long brace), accepts very well and she looks happy with the stop position.

Looking forward to your reply, thank you very much, best regards.

 Date: 2014-11-21


Dear Dr: thank you very much for your support and interest in Elisa continues to improve, that is our goal, see it better every day and with your help we are succeeding.
 
I send you the latest analysis we did to Elisa for evaluation by Dr. Wu. Elisa is not taking iron since August and we see that the red blood cells have improved.
 
We hope to see you soon. Hugs Daniela.


 

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