Persistence of Cognitive Deficits Following Paediatric Head Injury Without Professional Rehabilitation in Rural East Coast Malaysia

Objective To use data from a prospective, longitudinal study to determine whether psychomotor functions improve spontaneously during the first year following paediatric traumatic brain injury without modern rehabilitation facilities in a rural area of Malaysia. Methods Thirty-six paediatric patients who were referred for neurosurgical management for mild to severe head injuries were studied over a period of 2 years. No patients had orthopaedic or surgical trauma. Assessment of patients occurred at 3, 6 and 12 months, and patients were subjected to the Bender Gestalt Test, Weschler Intelligence Scale for Children-Revised and subtests from the Weschler Preschool and Primary Scale of Intelligence. None of the patients received professional rehabilitation due to a lack of facilities; only traditional treatment was given during this period. Results There were no significant changes in any of the parameters, except for integration error, after a period of 1 year. Cognitive function improved in 30% of patients after 1 year of follow-up. Despite an increased relationship of the caregiver to the patient in the first year of trauma, there was no general improvement when compared to the Western literature. Conclusion A lack of modern resources in the community, a low general practitioner to patient ratio, and no inpatient or outpatient rehabilitation services do not lead to spontaneous improvement in the psychomotor condition of our patients despite good interfamily support. These are important findings for the future restructuring of the psychological service in Malaysia.