P3B061: Trauma-informed Approach in Transdisciplinary Care of the Neurologically Impaired Child: A Case Report

Introduction:

Introduction: Trauma-informed care does not have a standardized definition, but rather reflects the transdisciplinary approach and interventions that develop around it. The Buffalo Center for Social Research considers it as care that “understands and considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize.” Triggers and manifestations of trauma vary by the individual, and are further influenced by gender, age, underlying illness, and environment. While there is compelling literature connecting trauma to gender, mental health, and the military, there is less that highlights major trauma resulting in, or occurring to those with significant neurological impairment in the pediatric population. We present a case of a child survivor of a near-drowning incident, his initial responses to showering, and resultant response post-interventions.

Case Description:

Case Presentation: At the time of the event, the child was a 16-year-old, typically developing boy, who suffered a near-drowning event. As per family, his floating device tipped over while in a pool, and he was unable to free himself. Family members responded, but estimate that he was under water for approximately five minutes. Upon arrival, EMS noted that he was in full arrest, and initiated CPR with intubation and compressions. ROSC was achieved after approximately 18 to 20 minutes, but the anoxic damage left him with significant cognitive and motor impairment.
Following this event, showering became difficult for him, with episodes of coughing, vomiting, elevated heartrate, and powerful upper body movements, that at times, lifted his torso off the bath gurney.
These behaviors were identified as manifestations of trauma, in relation to water-based activity. Following discussion with the transdisciplinary team, a plan was implemented to mitigate these behaviors. Interventions included verbal counseling prior to shower, the addition of soft background music, changing direction and placement of the water cascade, and the use of a shower mask to avoid direct contact with water to the face.
A positive response to the interventions was quickly noted. While intermittent cough did occur at times during showers, vomiting and ballistic-type movements ceased, heartrate stabilized, and he appeared calmer.

Discussion:

Discussion: As this child experienced severe physical and emotional trauma during his near-drowning incident, it seems reasonable to connect the event and the outcome. However, trauma and its manifestations are often missed in those with severe neurological impairment, due to their inability to articulate clearly and specifically

Conclusion:

Conclusion: Awareness and identification of how trauma can manifest in this population is the first step to treatment. Interventions are individualized, but often can be easily inserted into regularly scheduled care, with the overall goal being comfort and avoidance of re-traumatization.