Breaking boundaries: Resilient three-year-old Nhlelo defeats brain injury effects after year-long rehabilitation

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, pictured, was travelling home from a family visit in Limpopo in January last year when her mother’s vehicle was involved in an accident.

It 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.”

Mochan, along with the other members of the dedicated multidisciplinary 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 Mochan.

Charne Cox, Nhlelo’s physiotherapist, 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 and learning to sit.

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 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.

“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, she started to recognise me again. That’s when I knew something positive was happening.”

Chauke says the team at the hospital included him and his wife throughout Nhlelo’s rehabilitation, providing encouragement and sharing information as to her improvement at regular meetings with the treatment team.

“We know 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.

“As therapists, we almost always work together through all treatments. For example, when the speech therapist was working on feeding strategies to build oral strength I, as the physiotherapist, would also be present to ensure she was correctly positioned for swallowing and ensuring the lungs were clear once the feeding had finished.”

Cox explains that many different types of therapy were involved in Nhlelo’s treatment, such as the use of a tilt table to refamiliarise her with the sensation of standing. Neural optometrists from Eyetek, who assist in all cases involving visual concerns, did visual stimulation exercises 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.”

Originally Nhlelo had been booked into the 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 … 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 all children have amazing mental strength and can adapt more quickly and easily than an adult, provided they have the appropriate support,” says Cox.

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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 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 last year. Her father 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. The people at the hospital really do things with all their hearts,” says Chauke.