Case Report: Ventilator weaning, tracheostomy decannulation and noninvasive ventilation in an adolescent with autism spectrum disorder and new onset spinal cord injury

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0248-y · Published: November 29, 2019

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This case report discusses a teenage boy with autism who experienced a spinal cord injury and needed help breathing. He was dependent on a ventilator and had a tracheostomy. The patient was successfully transitioned to noninvasive ventilation (NIV) through behavioral desensitization using a team approach. The interdisciplinary team used behavioral techniques to help him get used to breathing without the ventilator, remove his tracheostomy tube, and switch to noninvasive ventilation.

Study Duration

Not specified

Participants

One adolescent with autism spectrum disorder and spinal cord injury

Evidence Level

Case Report

Key Findings

1
A medically complex adolescent with autism spectrum disorder and a new spinal cord injury was successfully weaned off mechanical ventilation and transitioned to noninvasive ventilation.
2
Behavioral desensitization techniques, including gradual exposure and positive reinforcement, were effective in overcoming the patient's behavioral barriers to noninvasive ventilation.
3
The patient tolerated BiPAP following a desensitization protocol and demonstrated a normal and significantly improved AHI (Apnea-Hypopnea Index).

Research Summary

This case report presents the successful weaning of a ventilator-dependent adolescent with autism spectrum disorder and a new spinal cord injury using behavioral desensitization techniques. The interdisciplinary team approach, incorporating in vivo desensitization and strategic behavioral reinforcement, enabled the patient to transition to noninvasive ventilation (NIV) and undergo tracheostomy decannulation. The study highlights the importance of addressing behavioral barriers to medical interventions in patients with pre-existing conditions like autism, and it demonstrates that significant improvements in respiratory management can be achieved through a tailored behavioral protocol.

Practical Implications

Interdisciplinary Approach

Emphasizes the need for collaborative care involving pediatric psychology, respiratory therapy, nursing, and medical staff in managing complex patients.

Behavioral Desensitization

Highlights the effectiveness of gradual exposure and positive reinforcement in overcoming behavioral barriers to medical interventions, especially in patients with autism spectrum disorder.

Improved Quality of Life

Demonstrates that successful ventilator weaning and transition to noninvasive ventilation can significantly improve the quality of life for patients and their families.

Study Limitations

1
Single case study limits generalizability.
2
Specific behavioral interventions may not be universally applicable.
3
Long-term outcomes beyond the inpatient rehabilitation period are not reported.

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