A little girl who astonished healthcare professionals with her remarkable progress following a severe brain injury has, one year later, become a shining example of just what a difference rehabilitation can make to the developing brain.
Three year old Nhlelo Chauke was travelling home from a family visit in Limpopo in January last year when her mother’s vehicle was involved in a terrible car accident that left Nhlelo totally unresponsive, with paramedics having to resuscitate her at the scene. After three weeks spent fighting for her life at Netcare Montana Hospital, Nhlelo was transferred to Netcare Rehabilitation Hospital in Johannesburg.
According to Prof Andre Mochan, a neurologist practising at the paediatric unit of the rehabilitation facility, it was clear that Nhlelo had a long way to go in regaining brain functionality. “She had suffered a diffuse brain injury, where due to the impact of the accident the nerves and cells had been badly shaken, resulting in bleeding in multiple parts of the brain. On arrival, she was completely non-communicative, had difficulty responding to visual stimuli and her movements were totally uncoordinated. She was not able to sit up or hold up her head.”
Prof Mochan, along with the other members of the dedicated multi-disciplinary paediatric team in the unit, spent the first three days assessing Nhlelo using internationally recognised scoring systems. “Nhlelo’s scores were very low but there were some hopeful signs, such as her ability to move her limbs and open her eyes,” says Prof Mochan.
Charne Cox, Nhlelo’s physiotherapist at the rehabilitation hospital, explains that although she was three years old, Nhlelo’s brain injury was so severe that the team needed to go right back to the basics of baby movements – doing tummy time, learning to roll, learning to sit and so on.
|Pic: Three-year-old Nhlelo Chauke made rapid strides in recovery at Netcare Rehabilitation Hospital following a car accident in which she sustained a severe brain injury.
Pic: Little Nhlelo enjoying the Valentine’s Day celebrations at her creche just over one year since she was involved in a terrible car accident.
Nhlelo’s father, Mzamani Steven Chauke, recalls the relief that he and his family felt as Nhlelo began to improve. “At the time of the accident, I was still in Limpopo, as I was going to drive back home a couple of days after my wife who needed to return to work. I am a paramedic and when I received the call I did not even know if my little girl would make it through resuscitation.
“Upon arriving at Netcare Montana Hospital’s emergency department, I was informed that Nhlelo had a very slim chance of survival. There was nothing we could do but pray, and our prayers were truly answered. Nhlelo survived and by her second week at Netcare Rehabilitation Hospital she started to recognise me again. That’s when I knew something positive was happening.”
Chauke says that the team at the hospital included him and his wife throughout Nhlelo’s rehabilitation, providing encouragement and sharing information as to how she was improving at regular family meetings with the entire treatment team.
“We know that children coming to our facility have already been through a lot and that being hospitalised is difficult for a child and their family under any circumstances,” says Cox. “Our brightly coloured paediatric unit at Netcare Rehabilitation Hospital is specially geared towards making the children who stay with us feel comfortable and we use elements of play in almost all therapies,” she says.
“Our small multi-disciplinary team includes an occupational therapist, speech therapist, social worker, psychologist as well as skilled nurses and together we develop the best possible treatment plan for each one of our patients, whilst engaging the family every step of the way. Successful treatment of children depends heavily on the involvement of their parents who really do become a part of the treating team, as they get to know us all and receive ongoing emotional support from the social worker and psychologist.
“As therapists, we almost always work together through all treatments, so that our patients have the benefit of not only therapies by a multi-disciplinary team but also interdisciplinary involvement. For example, when the speech therapist was working on feeding strategies to build oral strength for Nhlelo, I as the physiotherapist would also be present to ensure that she was correctly positioned for swallowing her food and ensuring that the lungs are clear once the feeding has finished. Ultimately, all team members have the same goals of development, and it is most effective if we work together in achieving these.”
Cox explains that many different types of therapy were involved in Nhlelo’s treatment, such as the use of a tilt table to familiarise her with the sensation of standing once more. Neural optometrists from Eyetek, who assist in all cases involving visual concerns, did visual stimulation exercises in the darkroom to strengthen her eye muscles.
“Our speech therapist worked on imitating gestures to encourage Nhlelo to communicate, such as waving, reaching, smiling and so on. Within the first week, we began to see improvements in her scores and as she progressed she became increasingly engaged and enthusiastic.
“Nhlelo really enjoyed the hydrotherapy in the heated pool where we have floating toys. This is always a joyful experience for children as the weightlessness in the water gives them a great sense of freedom. She also loved the visits to the hospital by TOP Dogs – these are clean, highly trained therapy dogs. Patients can brush, feed and, if possible, walk them. Nhlelo also enjoyed the baking groups which provide a sense of community fun and cognitive stimulation.
Originally Nhlelo had been booked into Netcare Rehabilitation Hospital for 12 weeks, but her progress was so exceptional that she was able to go home after just eight weeks. “By the end of her stay, when I would walk into the ward in the morning, she would smile and run to hug me. It was truly heart-warming to see her recover so well.
While Nhlelo’s progress was far beyond our expectations, we find that all children have amazing mental strength and can adapt more quickly and easily than an adult, provided they have the appropriate support,” notes Cox.
Looking back, Chauke recalls that before the accident he had not realised the significance of Nhlelo’s second name, Confidence. “At the time it was just a name that I chose but it came to have great meaning as our little Nhlelo has all the confidence she needs to take on and overcome life’s challenges,” he says.
Nhlelo was discharged in April 2021 and now, one year later, her father says he sees her recovery as a miracle. “She attends creche every day and while she still has some difficulties with her balance due to an ongoing issue with her ear, she is improving all the time. She’s very smart and loves counting, reciting the days of the week and the months of the year, and is fascinated by colour.
“Nhlelo has become very attached to the photographs we have of her at Netcare Rehabilitation Hospital. She keeps them on the dressing table and gets quite upset if anyone moves them. The people at the hospital really do things with all their hearts. The way they support the family and look after the kids goes above and beyond the call of duty,” says Chauke.
Prof Mochan explains that each brain injury patient is different, and it is almost impossible to predict what the outcome may be in the rehabilitation process. “We cannot force the brain to do things that it is not capable of doing but it shows us what it can do during the treatment process. As that is revealed we can adjust our strategy and work with the brain. It is from this that we can start to see a trajectory of improvement.
“When a human brain has been damaged by injury or a tumour for example, the rehabilitation process is a bit like rebooting a computer after crashing, opening program after program with the team closely observing to assess where problems may lie. This is a delicate process and you do not want to overstimulate the brain as that will risk ‘crashing the computer’ again. This is important for both healthcare professionals and family members to understand. We have to go step by step, at the pace at which the brain is able to recover.”
Prof Mochan further points out that when it comes to children’s brains the rehabilitation process is particularly complex compared to that of the adult brain, which is already fully developed. In a child, injury disturbs normal development, which needs to be addressed in addition to the recovery from the injury itself.
“Sometimes a child may seem to recover quickly following a brain trauma and it is understandable that the parents want to take their little one home as soon as possible, however skipping the rehabilitation process would be doing the child a great disservice. This is because it is hard to know what damage has been done to longer term development processes. It is therefore imperative that kids with brain complications, no matter how small, are referred to a rehabilitation facility so that an in-depth evaluation can be conducted, and a rehabilitation plan can be developed accordingly,” concludes Prof Mochan.
Notes to editor
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