@article{ref1,
title="Clinical observation of self-injurious behavior correlated with changes in scalp morphology in a child with congenital hydrocephalus",
journal="Journal of child neurology",
year="2008",
author="Hartman, Ellie C. and Gilles, Elizabeth and McComas, Jennifer J. and Danov, Stacy E. and Symons, Frank J.",
volume="23",
number="9",
pages="1062-1065",
abstract="We report the case of a 12-year-old girl born with cerebral dysgenesis and congenital hydrocephalus first shunted shortly after birth. She had severe tissue-damaging self-injurious behavior, profound mental retardation, quadriparesis, as well as multiple cranial anomalies including turricephaly. After stage 1 cranial remodeling, a bone window was left pending second stage remodeling. Episodic changes in fluctuation of the scalp overlying the bone window were easily observed. During the course of a behavioral assessment for her self-injury, it was observed that the overall frequency of occurrence of self-injury increased significantly (P < .01) when the scalp was protruding and bulging compared with when the scalp was flush with the skull table. Periods of increased scalp protrusion were also associated with higher scores on a pain scale developed for children with communicative impairments associated with severe neurological impairment. After shunt replacement, there was remarkable improvement in functional status and decreased episodic self-injury.<p /> <p>Language: en</p>",
language="en",
issn="0883-0738",
doi="10.1177/0883073808314155",
url="http://dx.doi.org/10.1177/0883073808314155"
}