Individualized goal directed dance rehabilitation in chronic state of severe traumatic brain injury: A case study

Abstract

Few long-term studies report late outcomes after severe traumatic brain injury. New rehabilitation techniques are needed for this heterogenous patient group. We present a dance intervention six and half years after an extreme severe TBI including excessive diffuse axonal injury, which disconnects the brain networks. Given the fact, that efficient brain function depends on the integrated operation of large-scale brain networks like default mode network (DMN), we created an intervention with multisensory and multimodal approach and goal-directed behavior. The intervention lasted four months including weekly one-hour dance lessons with the help of a physiotherapist and dance teacher. The measures included functional independence measure (FIM), repeated electroencephalogram (EEG) analysis of three subnets of DMN and clinical evaluations and observations. The results showed clear improvement after the intervention, and FIM stayed in elevated level during several years after the intervention. We present suggestion for further studies using larger patient groups.

Keywords: Neurology; Rehabilitation.

Fig. 1

A schematic representation of the intervention.

Fig. 2

Functional Independence Measure (FIM) years and months after accident.

Fig. 3

Synchrony strength dynamics within three sub-nets of the brain self-referential network in the rehabilitee during three last years of observation. The Y-axis presents z-values of strength of operational synchrony for every subnet that is responsible for different aspect of complex selfhood: ‘Self’, ‘Me’ and ‘I’, as well as z-scores for FIM scales. The X-axis represents three last years after the accident. Abbreviations: FIM: Functional Independence Measure; y: year; m: month. Modified from Fingelkurts & Fingelkurts, 2017b © Clinical EEG & Neuroscience.