Possibilities and limitations of rehabilitation after traumatic apallic syndrome in children and adolescents.

Report on long-term follow-up studies in 23 children and 2 adolescents who survived severe brain injury and a resulting apallic syndrome. Neurological examinations and psychiatric observations were performed in all patients, and psychological tests were administered whenever possible. EEGs were recorded in all cases, and 11 patients had CT scans. 6 patients died after surviving the acute phase. 2 survived in state of stabilized unconsiousness. Recovery from the apallic syndrome was observed in 17 patients, but complete recovery did not occur in a single case. 7 patients (group A) retained severe handicaps, and the other 10 (group B) demonstrated les serious residual deficits. With a few exceptions, neurological deficit correlated with permanent psychological damage. The patients of group A presented a fairly uniform set of neurological deficits characterized by severe quadiparesis, dysarthria and other signs of permanent cerebellar dysfunction. psychological disorders included permanent aphasia (3 patients) and a major reduction on intelligence (4 patients). These patients retained a capacity for emotional response but were never able to attend school, and they remained dependent on their families or on institutions. The patients in group B demonstrated less severe permanent neurological deficits but a similar pattern of central paralysis combined with cerebellar dysfunction. These patients were able to finish their scholastic education in either a normal or special school and to work in a sheltered workshop in most cases. Only 3 patients were able to hold a job performing rather simple tasks. Duration of the initial syndrome - coma and fully developed apallic syndrome - proved to be the most significant single criterion for estimating prognosis. Rate of recovery also provided some indication of prognosis. The CT scan has proved its value in documenting localized and diffuse brain damage in later stages. We believe that CT will play an increasingly important role in establishing diagnosis as well as prognosis in the early phase.