Emma's Story. A New Prognosis for Agenesis of the Corpus Callosum


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Emma's Story. A New Prognosis for Agenesis of the Corpus Callosum

  1. 1. The Use of IM in Infancy By: Lucy Barlow, CCC-SLP Emma’s Study
  2. 2. Emma <ul><li>Born 6.22.05 </li></ul><ul><li>Agenesis of the Corpus Callosum </li></ul><ul><li>Failure to Thrive </li></ul><ul><li>Seizure Disorder </li></ul><ul><li>Global Developmental Delays </li></ul><ul><li>Probable Cerebral </li></ul><ul><li>Palsy </li></ul>
  3. 3. The Corpus Callosum <ul><li>is a band of over 200 million nerve fibers connecting the two sides (hemispheres) of the brain </li></ul><ul><li>provides the main route for the transfer and integration of information between the two hemispheres of the brain </li></ul><ul><li>Agenesis of the corpus callosum (ACC) is a birth defect in which the structure that connects the two hemispheres of the brain (the corpus callosum) is partially or completely absent </li></ul>
  4. 4. www.TheFetus.net A transverse section of a normal brain. The corpus callosum is observed as a bundle of fibers crossing the midline (represented in gray). The coronal section of a normal brain. The corpus callosum is observed as a bundle of fibers crossing the midline (represented in gray). The sagittal section of a normal brain. The corpus callosum is represented in gray.
  5. 5. Corpus Callosum <ul><li>living brain as seen </li></ul><ul><li>via MRI scan </li></ul><ul><li>Normal </li></ul><ul><li>Corpus Callosum </li></ul>
  6. 6. Parts of the Human Corpus Callosum <ul><li>In Emma’s case this entire structure is absent </li></ul>
  7. 7. Functional Deficits Physical Deficits-Initial Evaluation <ul><li>No core/trunk tone, unable to sit unsupported </li></ul><ul><li>No prone positioning </li></ul><ul><li>No step reflex </li></ul><ul><li>No protective balance reflex </li></ul><ul><li>Unable to weight bear on upper extremities </li></ul><ul><li>Limited reach/grasp behaviors/No pincher grasp </li></ul><ul><li>No crossing of midline </li></ul><ul><li>Presents in the 5th percentile on growth chart </li></ul>
  8. 8. Functional Deficits Sensory Deficits- Initial Evaluation <ul><li>Hypersensitive/Defensive to touch on face, hands or feet </li></ul><ul><li>Severe gag reflex, with non-tolerance to a sippy cup or textured food </li></ul><ul><li>Frequent rocking and head banging </li></ul><ul><li>Limited Visual Tracking/No eye contact </li></ul><ul><li>Visual fixation on geometric shapes </li></ul><ul><li>Severe startle reflex-easily upset/over stimulated in crowds </li></ul>
  9. 9. Functional Deficits Cognitive/Language Deficits- initial evaluation <ul><li>Excessive sleeping (18-20 hours per day) with limited arousal time </li></ul><ul><li>Limited use of pragmatics </li></ul><ul><li>Limited oral movements for sound production </li></ul><ul><li>Limited localizations to her name </li></ul><ul><li>Limited cause-effect behaviors </li></ul><ul><li>Limited & infrequent sound productions with low volume (whispers) </li></ul>
  10. 10. The Beginning <ul><li>Results of REEL-2 indicate an age equivalency of 4 months in receptive language and 2 months in expressive language </li></ul><ul><li>Traditional pre-linguistic therapy yielded minimal improvement (6 month gain after 18 months of therapy) </li></ul>
  11. 11. Why IM? <ul><li>This provider’s prior observations of the success of IM with cross-hemisphere difficulties </li></ul><ul><li>Neuro rehabilitative aspects of IM </li></ul><ul><li>Prospect of stimulating hemispheric communications </li></ul><ul><li>Motivation to achieve best possible outcome for patient </li></ul>
  12. 12. Taking IM out of the box <ul><li>Develop Emma specific IM goals </li></ul><ul><li>How to adapt IM exercises for a 22 month old developmentally delayed child? </li></ul><ul><li>“ stakeholder” discussion with parents </li></ul>
  13. 14. The Results-Physical <ul><li>Sitting unsupported </li></ul><ul><li>Moderate righting/balance reflex </li></ul><ul><li>Weight bearing of Upper extremities </li></ul><ul><li>Getting on knees & crawling </li></ul><ul><li>Grasping objects, banging objects together </li></ul><ul><li>Using pincher grasp </li></ul><ul><li>Crossing midline, reaching across midline </li></ul>
  14. 15. The Results-Cognitive/Language <ul><li>After 3 sessions Mother reported marked increase in babbling and volume </li></ul><ul><li>Consistent localization to name </li></ul><ul><li>Identifying familiar people by localizing head </li></ul><ul><li>Direct imitation of speech sounds </li></ul><ul><li>Rapid increase in babbling & jargoning sound variety </li></ul><ul><li>Mouthing “Momma” and “bye-bye” </li></ul><ul><li>More affective behavior noted-laughing, smiling, obviously understanding tone of speaker’s emotion </li></ul>
  15. 16. The Results-Sensory <ul><li>Frequently makes & maintains eye contact </li></ul><ul><li>Less visually defensive when objects approach face/ startle reflex greatly reduced </li></ul><ul><li>Consistently eats textured foods without gagging. Using pincher grasp to feed herself </li></ul><ul><li>Allows/enjoys use of Z-Vibe for oral stimulation </li></ul><ul><li>Non-defensive when touching feet, hands or face </li></ul>
  16. 17. “How to” guide? <ul><li>No 2 patients, regardless of age are going to be alike </li></ul><ul><li>Think “out-of-the-box” and find what works </li></ul><ul><li>IM can lead to amazing improvements, even if the treatment requires total “hand-over-hand” assistance </li></ul>
  17. 18. The Results…
  18. 19. Questions