SLT role in peds neurology Flashcards
prevalence of dysarthria in CP (%)
33% - 63%
most common solid tumor
CNS tumors (brain and spine)
most common cause of cancer deaths
CNS tumors (brain and spine)
brain tumors occur when ?
- genetic alteration in brain cells
- causes changes that result in a growing mass of abnormal cells
primary brain tumors involve ?
- a growth that starts in the brain
- low grade (less aggressive) or high grade (very aggressive)
cause of brain tumors
- unknown
- ? genetic
every year in Ireland ? children are diagnosed with a brain tumor
60 children
most common site of brain tumor (and %)
- posterior fossa
- 60%
other tumors
- medullablastoma
- diffuse midline glioma (DMG)
- atypical teratoud rhabdoid tumors (ATRT)
- pleomorphic xantoastrocytoma (PXA)
? risk is higher with brain tumors
- hydrocephalus
- buildup of fluid in the ventricles
- increases the size of the ventricles and puts pressure on the brain
cerebral palsy (CP) definition and cause
- life-long physical disability that causes activity limitations
- due to an injury to the immature brain (in utero or shortly after birth)
- born with normal muscluoskeletal system at birth, develop posture problems over time
CP prevalence in high income countries (? in 1,000)
1.4 per 1,000
(CP) white matter damage % and considerations
- 45%
- more common in preterm injury
- any functional level or motor subtype
- more common in spastic than dyskinetic CP
- predict feeding difficulties
(CP) basal ganglia or deep grey matter % and considerations
- 13%
- dyskinetic CP > other subtypes
(CP) congenital malformation
- 10%
- more common in term injury than preterm
- any functional level or motor subtype
- associated with higher levels of functional impairment than other causes
(CP) focal infarcts %
7%
(CP) neonatal encephalopathy considerations
- long-term functional impairment is realted to the severity of the initial encephalopathy
- dyskinetic motor subtype > other
chiara malformation
- lower part of the brain pushes down into the spinal canal
- pressure obstructs CSF flow
- associated with bulbar presentation (saliva control, swallowing issues due to CN compression)
types of chiara malformation
- chiara I
- chiara II
- chiara III
chiara I symptoms
often none
chiara II
- associaed with neural tube defects (usually myelomeningocele)
- associated with hydrocephalus
chiara III
- most severe
- associated with hydrocephalus
duchenne muscular dystrophy (DMD)
- progressive degeneration of skeletal muscules
- symptoms around 3 years
- loss of ambulation by 13 years
- followed by cardiac complications and respiratory disorders (includes chronic respiratory failure)
DMD prevalence (? in 100,000)
19.8 in 100,000
spinal muscular atrophy (SMA)
- autosomal recessive condition
- weakness and wasting in the voluntary muscles
- weakness, fatigue, FEDS and GI issues, scoliosis/bone issues
- little protein to cervical motor neurons, they waste away
SMA Type 1, ? presentation
bulbar
SMA prevalence (? in 6,000 - 10,000)
1 in 6,000 - 10,000
types of encephalitis
- infective encephalitis
- autoimmune ecephalitis
which type of encephalitis is more common
infective (viral)
infective encephalitis types and causes
viral
- after infectious diseases/viruses
arbovirus encephalitis
- from flea, tick, or mosquito bites
bacterial or fungal encephalitis
- least common
autoimmune encephalities
- immune system attacks the brain
- inflammation affects how the brain works
- usually unknown cause
- associated with a longer stay in the PICU (with intubation), prolonged NG, delirium, apraxia
infectious encephalitis symptoms
- develop quickly
- fatigue
- headache
- high fever
- mild-mod neck stiffness
autoimmune encephalitis symptoms
- develop slowly
- causes neurological symptoms
- confusion
- drowsiness
- loss of consciousness
- memory issues
- nausea and vomiting
- personality changes
- seizure
- speech changes
- weakness, loss of movement
language mechanisms influenced by ?
- brain growth
- plasticity
- language dominance
growth of ? is essential for speech and language function
- cerebral cortex
- supported by synaptic connections and myelination
sensory neurons
- from sensory receptors to the brain or spinal cord
- paresthesias
motor neurons
- from brain or spinal cord to muscles/glands
- paralysis
myelination for language
- important for brain maturation
- supports rapid transmission of neural information along neural fibers between hemispheres/structures
plasticity
- process involving adaptive structural and functional changes to the brain
- assumes non-damaged areas can take over functions
- damage to left hemisphere may lead to language reorganization (to the right)
types of brain plasticity
- type 1: structural plasticity
- type 2: functional plasticity
language dominance assessments
- WADA
- functional MRI (fMRI)
WADA
- assess language dominance
- shows function of each side of the brain, but can’t refine the exact areas of function
- during test: alternate sides of the brain are put to sleep with an injection, patient is tested on speech, memory, and motor function
is WADA or fMRI used more (and why)
- fMRI
- WADA: risk of stroke, invasive, not readily repeatable
- fMRI easier and refined
fMRI
- assess language dominance
- non-invasive brain mapping
- indirect measure of neuronal activity, relies on blood oxygen level-dependent (BOLD) signal
- defines and refines hemispheric language dominance
- finds optimal surgical route for resection
- patient performs specific linguistic tasks
- mixture of covert (non-verbal, think about) and overt (spoken verb, tell) tasks
3 classic motor systems for neuromuscular speech control
- pyramidal system
- extrapyramidal system
- cerebellar system
pyramidal system
- major pathway for all movement
- voluntary movements of the speech muscles
- corticobulbar tract controls CNs
extrapyramidal system
- play a significant role in speech and disorders
- complex pathways connect clusters of subcortical motor nuclei, basal ganglia
cerebellar systems
coordination and precise motor control for speech
acquired motor speech disorders
- changes to voice and speech
- associated with damage to the CNS and PNS
prognosis of acquired motor speech disorders
- improvement
- plateau
- inevitably deteriorating
case history questions
- pregnancy and birth history
- developmental history
- time course (onset of signs and symptoms)
different time courses (of onset of signs and symptoms)
near instant onset
- in minutes
- suggests vascular event
gradual development
- in days (suggests inflammation)
- over weeks/months (suggests a space occupying lesion)
episodic symptoms
- intervals of complete normality
- e.g. epilepsy
UMN lesion
- central
- face area of primary motor cortex or descending corticobulbar fibers
- central facial palsy or corticobulbar palsy
LMN lesion
- peripheral
- involve motor facial nucleus or facial nerve
- peripheral/LMN facial palsy
< 3 years assessments
- PLS
- REEL
- symbolic play test
- ages and stages questionnaire
- PEDI
- derbyshire
3-5 years assessment
- PLS/CELF-P2
- BPVS
- TWF
- RAPT
- PEDI
5-12 years assessment
- CELF-5
- BPVS
- TWF
- RAPT
- PEDI (until 8)
12-16 years assessment
- CELF-5
- BPVS
- TWF
dysarthria assessment components
- type of respiration at rest and in speech (diaphragmatic, abdominal, clavicular)
- MPT
- S/Z ratio
NB: dysarthria
- don’t categorize as flaccid, spastic, etc.
- more important to note characteristics
most important FEDS assessment
- informally assess (hard to formally assess children)
- watch the oral phase, oropharyngeal phase
- assess airway protection
what to look out for in airway protection
- cough
- change in vocal quality
- increased respiratory rate
- color change
- eye tearing
- drop in O2 saturation
tools to support feeding assessment
- VFSS
- clinical swallow assessment
- FEES
- reports from home, school, etc.
VFSS purpose
- NOT to detect aspiration
- to explore why something is happening
- to confirm effectiveness of a selected treatment
- SLT role: determine if it is necessary and will change management
which aspects of management are the most important?
- time sensitive
- targeted
feeding management options
- oral
- part oral, part tube fed
- non-oral
- combination
- palliative
communication management options and goal
- language
- speech
- AAC
- functional participation
6 F words for childhood disability
- fitness (body structure and function)
- functioning (activity)
- friends (participation)
- family (environmental factors)
- fun (personal factors
- future
