Investigating the use of neurorehabilitation scales in paediatric neurosurgical patients at a tertiary academic hospital in Gauteng

Abstract

Introduction: Children with central nervous system disorders frequently display altered synaptic processes, discordant brain activity, delayed development, and reduced neuroplasticity. A major hallmark of neuroplasticity is the ability of the brain to reorganize and heal after injury, and may be enhanced through neurorehabilitation. Early rehabilitation, particularly for conditions such as traumatic brain injury, brain tumours, spina bifida, and hydrocephalus, can dramatically improve patients’ functional outcomes. This study sought to examine the criteria used for identifying paediatric neurosurgery patients’ eligibility for neurorehabilitation, evaluate the clinical outcomes assessed by particular neurorehabilitation scales, and examine the time between surgery and rehabilitation, as well as the length of the overall inpatient stay. Materials and Methods: This retrospective study was conducted at Steve Biko Academic Hospital (SBAH) and Tshwane Rehabilitation Hospital (TRH), using patient records. The study evaluated the length of hospital stay, neurorehabilitation eligibility criteria, and the specific scales used in neurorehabilitation. Results and Discussion: A total of 51 patients were included in the study. The study revealed that, despite the absence of defined criteria, clinical judgment based on physical, cognitive, developmental, and social factors was the primary determinant for transferring patients to the rehabilitation facility. Interestingly, 21.5% of the study population demonstrated cognitive and physical improvement based on the documented Glasgow Outcome Scale, Glasgow Coma Scale, and Waterlow Scales. The data revealed that patients with brain tumours spent the longest time at the tertiary academic hospital (approximately 47 days), and had the longest overall length of stay (119 days) with the least number of transit-affecting factors. Patients with hydrocephalus had the longest hospitalisation stay at the neurorehabilitation facility (approximately 70 days). The study highlighted disparities in hospitalisation periods based on neurological conditions, with notable impacts on hydrocephalus patients. Neurorehabilitation scale usage exhibited inconsistencies, and a fraction of patients demonstrated improvement in functional outcomes. Furthermore, other reasons for requiring transfer to a rehabilitation facility such as nutritional and psychosocial support were also considered. Rehabilitation interventions, including occupational therapy, physiotherapy, and speech therapy, were tailored to specific needs. Conclusion: The study's results highlight the complex nature of neurorehabilitation in children, marked by extended hospitalisation and resource-intensive care demands, underscoring the vital necessity for tailored support. Furthermore, these findings emphasize the ongoing imperative of enhancing rehabilitation strategies, particularly for patients with limited cognitive and physical progress, stressing the continued dedication to advancing rehabilitative approaches to benefit a broader range of patients and enhance their overall well-being. Therefore, the inclusion of the Bayley Scales of Infant and Toddler Development may serve to improve the comprehensiveness of the assessment, particularly for younger patients, highlighting a potential area for improvement in the rehabilitation protocol.