Usefulness of RemiPro for pediatric neurorehabilitation in severe head injury: A case report

Introduction: RemiPro is a standardized and valid instrument for assessing activities and participation during the course of remission in children and adolescents (3–16 years old) with severe acquired brain injuries. Individual abilities are monitored and categorized in six levels, each comprising 20–25 activities, in which the child participates passively, which are performed with the child, or which the child performs actively.

Here, we demonstrate the usefulness of RemiPro for documentation and goal-finding during early-phase neurorehabilitation in a case example.

Case report: At 6 years of age, J. was hit by a car while riding a bike and suffered a severe head injury. She lost consciousness immediately (GCS 3), was intubated and ventilated for 14 days. Neuroimaging showed multiple skull fractures, multiple parenchymal hemorrhages and shearing injuries. On admission to rehabilitation, she was comatous, tetraspastic and tube-fed.

RemiPro for documentation of the course of remission:

After 4w: relaxes, appears more alert when spoken to → „sleep-wake-level“

After 6w: directs attention towards activities → „perception level“

After 8 w: presses button, self-initiated → „communication level“

RemiPro for goal-finding:

1 year after the accident, the patient is still „only“ on communication level. The documentation of single items, however, reveals ongoing progress in cognitive abilities contrasted by stagnating motor abilities. Therefore, further therapy must focus on finding cognitively challenging activities with only minor motor involvement.

Conclusion: Even in severe cases, RemiPro can identify small but relevant changes especially in early phases of remission. It allows finding adequate and individualized goals for therapy focussing on activity and participation. Therefore, RemiPro is a useful instrument for pediatric neurorehabilitation.