Role of SLT Flashcards
What % children with CP have dysarthria?
33-63%
What are the most common cause of cancer deaths in children?
CNS tumours
Primary brain tumours involve:
a growth that starts in the brain, rather than spreading to the brain from another part of
the body.
* may be low grade (less aggressive) or high grade (very aggressive).
Cause of brain tumours?
Unknown but thought to be germ line mutations or genetic
Most common site of brain tumours?
posterior fossa (60%)
How many children are diagnosed with a brain tumour each year in Ireland?
60
What is CP?
a broad term for heterogenous group of one of the
most common neurodisability.
* Life-long physical disabilities which causes activity limitations due to an injury to the immature brain in utero, during or shortly after birth
Born with normal musculoskeletal system at birth but develop problems with posture over time.
CP rates
1.4 per 1000 live
births in high income countries
Causes of CP
White matter damage, BG or deep grey matter damage, congenital malformation, focal infarcts, neonatal encephalopathy
What is a chiara malformation?
Lower part of the brain pushes
down into the spinal canal.
Pressure on the brainstem,
spinal cord, and obstructs the
flow of fluid.
Associated with bulbar presentation – saliva control issues, swallowing problems due to CN compression
Types of chiara malformation
Chiara I: Often no symptoms
Chiara II: associated with neural tube defects, particularly myelomeningocele, in around
100% of cases.
Chiara III: Most severe
II and III Associated with hydrocephalus
Global DMD birth prevalence
19.8 per 100,000 live male births
SMA prevalence
one in every 6,000 to
10,000 babies worldwide is born with
SMA
Language mechanisms are influenced by:
brain growth, plasticity, language dominance
Brain growth in language development
- Rapid period of brain
growth in the first 2 years
of life - Differential brain growth
- Age and structure dependent- E.g. cerebellum develops rapidly from before birth to
1 year - Brainstem divisions grow rapidly prenatally and
decelerate postnatally. - Growth of the cerebral
cortex essential for speech
and language function - Most Neural structures for
communication integrated in the
cortex - Supported by synaptic
connections and myelination
Myelination for Language
Significant indices of brain maturation
Supports rapid transmission of neural information along neural
fibers between hemispheres, lobes, cortical and subcortical
structures
WADA test in language dominance
Shows function of each side of the brain with
respect to language and memory but unable to
refine exact
areas of function.
* Can be useful in assisting surgical approaches
* During test – alternate sides of the brain are
temporarily put to sleep (injecting drug into the
carotid artery) and patient undergoes tests of
speech, memory and motor function.– Invasive, not readily repeatable– Risk of stroke 0.6%-1
fMRI in language dominance
- Non-invasive brain mapping procedure, est. about 30 years- Indirect measure of neuronal activity, relying on the blood
oxygen level-dependent (BOLD) signal- Defines and refines hemispheric language dominance, the
optimal surgical route for resection, plan for intraoperative
language mapping- Patient performs selected specific linguistic tasks
overt vs covert tasks in fMRI
- Motor cortex can be stimulated if patient moves so mixture of covert and
overt tasks important to try isolate more eloquent language areas - OVERT –spoken verb generations
- i.e. ‘tell
me a verb associated with flower’ ‘smell’ (spoken so jaw
MOVEMENT associated) - COVERT –non-verbal verb generations
- i.e. ‘think
of a verb associated with with flower - Listening / receptive task – capture cortical activation while listening to a
story and silent reading (age / literacy-dependent factors) of real and non
real words
motor systems involved in neuromuscular control for speech
pyramidal system, extrapyramidal system and cerebellar systems
pyramidal system in speech
major pathway for all movement ; voluntary
movement of the muscles of speech; corticobulbar tract is part of this system and it controls the cranial nerves, many of which directly innervate the muscles of speech
extrapyramidal system in speech
plays a significant role in speech and its
disorders; complex pathways connecting clusters of subcortical motor
nuclei, the basal ganglia
cerebellar systems for speech
provides coordination and precise motor control
for speech
SLT case history
- pregnancy and birth hx
- developmental hx
- time onset of signs and symtpoms: near instant, gradual, episodic
- age of onset of signs and symptoms
- neurological examinations
- medications
SLT ax
- speech
- oromotor ax
- language
- pre-verbal skills
- narrative skills
- social and pragmatic skills
- voice
- fluency
- AAC
- hearing
- vision
UMN vs LMN lesions in facial palsy
UMN: upper face spared because unaffected hemisphere can compensate
LMN: entire face affected on one side
Formal language ax options
- Infant/toddler: PLS, REEL, Symbolic Play test, Ages and Stages questionnaire, Bayley Scales of Infant development
- Preschool/school: PLS/CELF, British Picture Vocab test, Test of Word findings, Edmonton Narrative Norms Instrument, RAPT
- Adolescent: CELF, BPVS, TWF, EVT
formal FEDS ax
PEDI-EAT 10, pFOIS, SOFFI
* SOMA/ JAYS/ Wolf & Glass / Evan Morris & Dunn
Klein / McCurtin / NOMAS.
* Dysphagia Disorders Survey – Paediatric
* STEP-CHILD
