A 30-year-old married woman, a homemaker, educated up to class XII, with upper socio economic background, was brought with complaints of forgetfulness, anger outbursts, irritability, stiffness and loss of sensation in left hand since 3 years. Onset was abrupt, and it was continuous in course. The precipitating factor was cardiac and respiratory arrest during the delivery of the third child.
The patient was functioning normally till the delivery of the third child. Cardiac and respiratory arrest occurred during labor; she was on ventilators for 24 hours, was unconscious for 5 days and hospitalized for 15 days. After discharge from the hospital, she was able to recognize friends and relatives; however, she did not remember the reason for hospitalization. She had stiffness and partial loss of sensation in the left hand. She would forget day-to-day events, phone numbers, etc. This caused distress to family members. Biological functions were normal. Sexual functioning was devoid : it was a conscious decision made by the husband fearing that the patient might become pregnant. Her husband wanted to remarry due to her above-mentioned condition. She was brought to NIMHANS in February 2004. Diagnosis of hypoxic encephalopathy was made. She was referred from adult psychiatry unit to family psychiatry Unit and Neuropsychology Unit for family therapy and neuropsychological assessment and rehabilitation.
After obtaining written informed consent from the patient, neuropsychological assessment and retraining were carried out.
Neuropsychological assessment showed deficits in attention, fluency, working memory, planning, verbal and visual learning and memory. The neuropsychological profile was indicative of dorso-lateral pre-frontal cortex and bilateral temporal lobe involvement.
Cognitive retraining was carried out for a period of 7 months over 138 sessions : everyday for 1 hour. Principles of saturation cueing were followed. The tasks were given in an order of increasing difficulty. The tasks were designed in such a way that the design had provisions for scoring error and time [Table 1].