Aisha Salim Al Ghailani, hailing from Oman was brought to the Physical Medicine and Rehabilitation (PMR) Department of the Aster Medcity on the 24th of January 2020. She was drowsy, disorientated and had a tracheostomy tube to help her breathe. She was bed bound and was tube fed ever since she was admitted in Oman in December of 2019. When she was admitted there, she was diagnosed with Hypoxic Ischaemic Encephelopathy (HIE), a condition caused by poor blood supply to the brain for a time as a result of her cardiac arrest. Her cardiac arrest was caused by Pulmonay embolism (a dislodged clot from her legs getting stuck in her lung arteries). In addition to the HIE, she had a serious complication called myoclonic jerks, in all four limbs. This meant that she was unable to keep her limbs still and they would fling out in an uncontrolled fashion, every time she tried to move her limbs. These jerks were quite severe preventing any meaningful movement of her hands and legs. This rare combination of HIE with the severe myoclonic jerk made us diagnose a rare condition called Lance Adam syndrome, a condition reported in fewer than 150 cases world-wide till date.
Her care in the PMR department was a testament of teamwork. We discussed in detail with the family about the diagnosis and the plan we put in place for her rehabilitation. We aimed at getting her on to a PEG feeding tube instead of a naso-gastric tube and it was carried out with the help of our Gastroenterology department. A process of weaning and de-cannulation of her tracheostomy tube started and completed successfully. This was done concomitant with swallowing training by our departmental Speech Therapist. Well before her discharge, Aisha had completely switched over to oral feeding. The PEG tube was removed eventually.
Our Neurologist Dr Mathew Abraham helped with the management of her myoclonic jerks and it got controlled so well that our Physical Therapists were eventually able to get her to stand and walk with minimal support. Regular Occupational Therapy input helped her to achieve her activities of daily living (ADL) with dressing and feeding and helping with her toileting. All the physical improvement was possible because of the improvement in her higher mental functions which was helped with regular Occupational Therapy input.
By the time of her discharge, her feeding tube and tracheostomy tubes were removed and she became independent in feeding and dressing herself. In addition, with minimal support, she was able to walk and do transfers. She also had very significant improvement in her higher mental functions to the extent that she started demanding that she wanted to go back to Oman to her own home! Unfortunately, her discharge was delayed purely on account of the Covid pandemic preventing travel.
Finally, the time has come for her to leave us and go home. Her near normal recovery would not have been possible without the team work and support of our PMR family and her family (especially her sister Sheikha) as well as Aisha’s cooperation. She is a living proof of what her name means- Aisha - She who lives.