A-1 How Far We’ve Come: Promoting Resilience Following Significant Early Life Neurological Insult

Abstract

Abstract Objective: Despite empirical data indicating continued and increased negative neurocognitive effects of neurological insult due to early life exposure to brain resections, refractory seizures, and chemoradiotherapy, it is possible for patients to rewrite their narratives and demonstrate resilience and terrific response to rehabilitation. A longitudinal, single case study demonstrating the positive impact of therapeutic intervention is presented here. Method: Patient is a 14-year-old Hispanic female diagnosed with atypical Teratoid Rhabdoid Tumor (ATRT) at age 2 was treated as per Dana Farber ATRT protocol, including brain resection and chemoradiation treatment. Neurological and cognitive complications due to treatment and late effects were observed. Patient also underwent a right temporal lobectomy (age 11) which controlled her refractory seizures and cognitive regression. Patient subsequently received intensive neurorehabilitation and serial neuropsychological assessments (age 4, 7, 10, 14). Results: Early assessments (ages 4 and 7) indicated a decline in neurocognitive performance (exceptionally low range across domains). More recent assessments (ages 10 and 14), however, demonstrated a change in trajectory (ranging from low average to exceptionally low). The greatest growth was observed in verbal and quantitative reasoning, as well as executive functioning abilities. Conclusions: Even for children who have had multiple, chronic, insidious early life neurocognitive insults, intensive and directive therapies can alter their trajectory and allow steady gains to be made. These findings highlight the importance of taking a biopsychosocial approach for informing therapy led by a strong treatment team. It is critical to integrate the strengths of the individual, family, treatment team, and environment in supporting the patient-family’s treatment goals.