Using the finger-to-thumb opposition sequence (FOS) learning task, we characterized motor skill learning in sub-acute patients hospitalized for rehabilitation following traumatic brain injury (TBI). Ten patients (Trained TBI) and 11 healthy participants (Trained Healthy) were trained using a multi-session protocol: a single session was afforded in the first week of the study, and four daily sessions were afforded during the second week. Intensity of practice was adapted to patients. Performance speed and accuracy were tested before and after each session. Retention was tested 1 month later. Ten patients (Control TBI) had no FOS training and were tested only at the beginning and the end of the 6 week period. Although baseline performance on the FOS was very slow, all three phases of skill learning found in healthy adults (acquisition, between-session consolidation gains, and long-term retention) could be identified in patients with TBI. However, their time-course of learning was atypical. The Trained TBI group improved in speed about double the spontaneous improvements observed in the Control TBI group, with no speed-accuracy tradeoff. Normalized to their initial performance on the FOS, the gains accrued by the Trained TBI group after a first training were comparable to those accrued by healthy adults. Only during the second week with daily training, the rate of improvement of the Trained TBI group lagged behind that of the Trained Healthy group, due to increasing within-sessions losses in performance speed; no such losses were found in healthy participants. The Functional Independence Measure scores at the start of the study correlated with the total gains attained at the end of the study; no correlations were found with severity of injury or explicit memory impairments. Despite within-sessions losses in performance, which we propose reflect cognitive fatigue, training resulted in robust overall learning and long-term retention in patients with moderate-severe TBI. Given that the gains in performance evolved mainly between sessions, as delayed, offline, gains, our results suggest that memory consolidation processes can be effectively engaged in patients with TBI. However, practice protocols and schedules may need to be optimized to better engage the potential for long-term plasticity in these patients.

Background: A long-term follow-up study comparing children after anoxic brain injury (AnBI) with those after traumatic brain injury (TBI) was conducted, and prognostic factors were mapped. Methods: A prospective historical study following long-term functional outcome after childhood brain injury was conducted in two phases. The first phase included patients suffering from moderate-severe TBI. The second phase assessed children after AnBI, and the results were compared. Functional outcome was recorded and factors influencing prognosis were outlined. Results: On admission vegetative state (VS) was twice as prevalent in the AnBI subgroup. Approximately 90% of children with TBI and 60% of patients with AnBI gained independency in activities of daily living (ADL) and mobility. Long-term positive outcome, i.e., return to school and open-market employment, were higher in patients with TBI when compared with AnBI (61% and 48.1%, respectively). Significant outcome-predicting factors were VS at admission to rehabilitation, length of loss of consciousness (LOC) up to 11 days and functional independence measure (FIM) score at admission and discharge. Aetiology was not found to be a predicting factor. Conclusions: Duration of unconsciousness is the main long-term negative prognostic outcome factor. Anoxic brain damage, associated with longer periods of unconsciousness also heralds a less favourable outcome.

Ischemic myelopathy is uncommon in the pediatric population, with fibrocartilaginous embolism (FCE) being one of its rarest causes. We present the case of an otherwise healthy 17-year-old student who experienced sudden onset of severe low-back pain amidst intensive physical training, which rapidly deteriorated to complete sensory-motor paralysis of his lower limbs. He was treated with IV Methylprednisolone and anticoagulation after the initial work-up suggested spinal cord infarction. After eight days, sufficient clinical-radiological correlation was achieved to support FCE diagnosis as the most likely cause of infarction. He subsequently received inpatient rehabilitation treatment for four months, after which he was followed as an outpatient for a total period of 16 months. While significant neurological and functional gains were achieved during this period, he also experienced some worsening. This case highlights the importance both of performing a thorough assessment and being familiar with FCE as a possible differential diagnosis of spinal cord infarction in children, to facilitate its timely identification and proper acute and long-term management. This case report was prepared following CARE guidelines after obtaining the patient’s written informed consent.

Objectives: Dysphagia is a major complication of acquired brain injury (ABI) in children; however, its trajectory and prognostic indicators remain insufficiently characterized. This study aimed to identify predictors of dysphagia and its recovery following pediatric ABI. Methods: This retrospective study included all children admitted with ABI to tertiary pediatric rehabilitation center between 2014 and 2017. Data were collected from electronic medical records. Results: One hundred children aged 2:00–17:11 years were included; 61% had dysphagia at admission. Participants with dysphagia received speech–language pathology (SLP) treatment, with a recovery rate of 78.68%. Treatment duration was significantly shorter among children who recovered (36 days) compared with those who did not (136 days; p < 0.001). Dysphagia at admission was associated with mechanical ventilation, duration of unconsciousness, duration of acute hospitalization, CNS tumor etiology, cranial nerve impairment (V, IX, X, XII), voice and speech impairments, and cognitive and behavioral impairments. Logistic regression showed that reduced consciousness, cranial nerve impairment, voice disorders, and CNS tumors explained 70.6% of dysphagia likelihood. Non-recovery was associated with unconsciousness, enteral feeding, hypoglossal injury, and dysphagia severity at admission. Level of consciousness at admission explained 33.7% of recovery likelihood. Conclusions: Dysphagia was highly prevalent among children with ABI. Recovery rates following SLP treatment were high and were associated with level of consciousness at admission to rehabilitation.

Background/Objectives: Patients with prolonged disorder of consciousness (PDOC) who regained consciousness in intensive care for consciousness rehabilitation (ICCR) were referred to further brain rehabilitation (FBR). The current retrospective cohort study evaluated the functional and cognitive outcomes of FBR. Methods: We assessed outcomes in 258 PDOC patients during FBR and used multivariate regression analyses to examine the influence of demographic and clinical characteristics on outcomes. Results: During FBR, Functional Independence Measure (FIM) motor, cognitive, and total scores improved from 21 ± 11, 11 ± 10, and 32 ± 15 to 43 ± 26, 18 ± 7, and 61 ± 32, respectively (p < 0.001). Dynamic Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA) total scores increased from 57 ± 29 to 82 ± 36, and the average 6-min-walk (6MW) distances improved from 295 to 374 m (p < 0.001). Higher discharge FIM and DLOTCA scores were associated with younger age, traumatic etiology of the brain injury, shorter time to regaining consciousness, and higher FIM and DLOTCA scores at admission to FBR (p < 0.05). Conclusions: We observed functional and cognitive improvement in the examined patients. The improvement was associated with factors that may mainly reflect the severity of brain damage. The findings support continuing rehabilitation before and after emerging from PDOC.