bacterial menigitis

im currently on a rural placement in far north WA. a 15 year old aboriginal boy form halls creek was transfered to darwin by air med (NT version of RFDS) with an acute case of bacterial meningitis. He was extreemly unwell and not expected to live.

He pulled through and has now been transfered back to our dept to continue neuro rehab following the infection. He is currently walking independantly and his major problems are cognitive, fine motor and sensory defecits. So far Rx has included working with the OT to improve fine motor skills and work on improving proprioception (UL affected greater than lower limb).

The department is working together to improve his function so he is able to return home to halls creek ASAP. This patient shows severe developmental delays (ie. he cant write his name and doesnt know if he is left or right handed). We are currently trying to determine whether these problems were pre or post infection. On consulting with his teachers, It appears that there may have been a degree of developmental delay and substance abuse prior to the infection.

For physiotherapy, this patient is very challenging.He has a very short attention span and rarely engages with the staff. He will walk out a treatment session mid Rx once he is bored. We have tried to make activities more functional and interesting with short sessions as often as possible (yet up here resources are very stretched!!). He is very motivated but fails to succeed and he is getting very frustrated (as are we!!!)

On the weekend he was allowed to return to halls creek for the weekend (with the physio) and return via bus on Monday. It is now tuesday and we have seen no site of him. As they live rurally with no phone, we have to get the aboriginal social workers to go bush and track them down.

SO not only are we dealing with an extreemly rare condition in a young boy who doent want to be in hospital and has decided to go walk about. How do we get maximal results and keep this kid interested so he can improve?????