The patient was discharged after a 7-month period of hospitalization, which required maximal assistance in mobility, self-care, and cognition domains as measured with the Functional Independence Measure for Children. For her outpatient rehabilitation, we arranged fixed physical, occupational, and speech therapists with whom she was familiar, and we placed her in an isolated setting to avoid distracting stimuli that might deteriorate her attention span, emotional status, and behavioral outbursts. At 12 months after the onset of symptoms, she had merely achieved the developmental age of 6-8 months in terms of gross-motor and fine-motor milestones and 9-12 months in terms of cognition. She could obey some simple verbal orders but was mute most of the time, with cognitive deficits considered to be the main cause. Over the next 6 months, sequential programs such as toy-based training for postural control, imitation learning, matching training, and treadmill ambulation with partial body-weight support produced significant improvement. Her gross-motor skills progressed to the developmental milestone of 24-27 months, her fine-motor movements improved to 20-23 months, and her cognition advanced to 24-29 months. She could deal with simple self-care tasks, but occasional incontinence was still noted. She could speak more than five words and expressed herself correspondingly. The physical therapy with tricycle riding and balance-beam exercise continued according to the patient's tolerance.
In order to improve her cognitive deficits, psychological evaluation and training such as cognitive-behavioral therapy for attention, memory, and emotion regulation were added to her programs. The initial assessment for her intelligence quotient (IQ), measured by Wechsler Preschool and Primary Scale of Intelligence, was reported as mild mental retardation (full IQ =62), with performance IQ out of proportion to her scale in verbal IQ (scores were 58 and 71, respectively).