This document discusses acquired childhood aphasia, specifically examining its diagnosis. It begins by acknowledging the support of the author's advisor and the speech pathology faculty. It then provides background on childhood strokes, defining types of strokes and discussing causes such as sickle cell disease and maternal/perinatal risk factors. It discusses aphasia symptoms depending on brain location of damage. The document examines causes of childhood strokes such as arterial problems, cardiac disorders, and structural malformations for hemorrhagic strokes. It notes seizures can both result from and indicate strokes. The author aims to examine diagnosis and treatment of childhood aphasia.
This document provides an overview of dementia and the role of speech language pathologists. It discusses that dementia is an acquired brain disease that affects cognition. SLPs play an important role on interdisciplinary teams by screening, assessing, treating cognitive and communication impairments, and educating other professionals. SLPs can help identify when further evaluation is needed and discuss changes with physicians. The document also reviews risk factors for dementia and evidence-based interventions that can help prevent or delay cognitive decline.
Abstract: Fetal alcohol spectrum disorder (FASD) is a significant public health issue in Australia that is poorly diagnosed, chronic and costly.
FASD is a diffuse acquired brain injury secondary to prenatal alcohol exposure. The prevalence rate of FASD among the general population in Australia is currently unknown; however, an Australian study in a selected high-risk population reported some of the highest rates of FASD in the world. A common misconception among clinicians is that a child must have ‘the face’ of FASD to have the disorder. This is incorrect. The three
sentinel facial features only occur in the minority of individuals with FASD. FASD should be considered as a ‘whole body’ disorder as increased susceptibility to chronic health problems suggests suboptimal in utero environments places the individual at risk of later disease. Clinicians are reluctant to consider FASD as a possible diagnosis because of the concern of inducing stigma; however, this concern is neither supported by the
evidence nor patient stories. The Australian Guide to the Diagnosis of FASD is now available to assist health professionals in providing timely and accurate diagnoses, which can lead to improved outcomes via evidence-based intervention and is an important first step in future prevention.
The document reviews literature on the evolution of headaches from childhood to adulthood. Some key findings include:
1) Headaches are very common in childhood, affecting up to 75% of children by age 15, with migraine being the most frequent recurrent headache.
2) Studies have found that 30-45% of children experiencing migraines or tension-type headaches become headache-free by adulthood, while 20-25% transition to the other type of headache.
3) Younger age of headache onset, more severe headaches, and the presence of psychiatric disorders or early somatic disorders are associated with a less favorable prognosis and higher likelihood of continued headaches in adulthood.
Prevalence and Services in Countries outside of Europe and North AmericaBronwyn Orsatti
This document discusses autism prevalence and services outside of Europe and North America. It begins by explaining why studying worldwide prevalence is important given the imbalance in knowledge from wealthier countries. It then discusses challenges in international prevalence studies, such as differences in cultures and diagnostic criteria. The document reviews prevalence findings from studies conducted in Africa, the Middle East, Latin America, Southeast Asia, and other regions. It shifts to discussing service provision for autism in developing countries and provides an example of a personal experience assessing services in Cambodia.
Best neurosurgeons in bannerghatta road bangalore | Know more about Dementiaanishmehta03
Abnormal brain changes cause Dementia.
This change leads to a decline in thinking skills, also called cognitive abilities.
This disease hampers daily life and independent function.
They can also affect feelings, behavior and relationships.
With advancing medical science, doctors are treating the disease.
Group Draft Multiple Disabilities Presentationkw1213
The document discusses terminology, definitions, prevalence, causes, identification and assessment, characteristics, and educational considerations for students with severe disabilities including severe intellectual disabilities, multiple disabilities, deaf-blindness, physical disabilities such as orthopedic impairments and other health impairments, and traumatic brain injury. It provides definitions from IDEA and discusses the complex nature of identifying and assessing students with multiple, co-occurring disabilities that affect cognitive, physical, sensory, and behavioral functioning.
The document discusses multiple-severe disabilities, defined as concomitant impairments that cause severe educational needs that cannot be accommodated in special education programs for a single impairment. It notes that around 0.23% of students ages 6-21 nationally have multiple-severe disabilities. Some key characteristics of these students include problems transferring learning, limited communication skills, difficulties with memory, and needing services from multiple therapists. The document then outlines various teaching methods, challenges, and technologies that can help support students with multiple-severe disabilities.
This document provides an overview of dementia and the role of speech language pathologists. It discusses that dementia is an acquired brain disease that affects cognition. SLPs play an important role on interdisciplinary teams by screening, assessing, treating cognitive and communication impairments, and educating other professionals. SLPs can help identify when further evaluation is needed and discuss changes with physicians. The document also reviews risk factors for dementia and evidence-based interventions that can help prevent or delay cognitive decline.
Abstract: Fetal alcohol spectrum disorder (FASD) is a significant public health issue in Australia that is poorly diagnosed, chronic and costly.
FASD is a diffuse acquired brain injury secondary to prenatal alcohol exposure. The prevalence rate of FASD among the general population in Australia is currently unknown; however, an Australian study in a selected high-risk population reported some of the highest rates of FASD in the world. A common misconception among clinicians is that a child must have ‘the face’ of FASD to have the disorder. This is incorrect. The three
sentinel facial features only occur in the minority of individuals with FASD. FASD should be considered as a ‘whole body’ disorder as increased susceptibility to chronic health problems suggests suboptimal in utero environments places the individual at risk of later disease. Clinicians are reluctant to consider FASD as a possible diagnosis because of the concern of inducing stigma; however, this concern is neither supported by the
evidence nor patient stories. The Australian Guide to the Diagnosis of FASD is now available to assist health professionals in providing timely and accurate diagnoses, which can lead to improved outcomes via evidence-based intervention and is an important first step in future prevention.
The document reviews literature on the evolution of headaches from childhood to adulthood. Some key findings include:
1) Headaches are very common in childhood, affecting up to 75% of children by age 15, with migraine being the most frequent recurrent headache.
2) Studies have found that 30-45% of children experiencing migraines or tension-type headaches become headache-free by adulthood, while 20-25% transition to the other type of headache.
3) Younger age of headache onset, more severe headaches, and the presence of psychiatric disorders or early somatic disorders are associated with a less favorable prognosis and higher likelihood of continued headaches in adulthood.
Prevalence and Services in Countries outside of Europe and North AmericaBronwyn Orsatti
This document discusses autism prevalence and services outside of Europe and North America. It begins by explaining why studying worldwide prevalence is important given the imbalance in knowledge from wealthier countries. It then discusses challenges in international prevalence studies, such as differences in cultures and diagnostic criteria. The document reviews prevalence findings from studies conducted in Africa, the Middle East, Latin America, Southeast Asia, and other regions. It shifts to discussing service provision for autism in developing countries and provides an example of a personal experience assessing services in Cambodia.
Best neurosurgeons in bannerghatta road bangalore | Know more about Dementiaanishmehta03
Abnormal brain changes cause Dementia.
This change leads to a decline in thinking skills, also called cognitive abilities.
This disease hampers daily life and independent function.
They can also affect feelings, behavior and relationships.
With advancing medical science, doctors are treating the disease.
Group Draft Multiple Disabilities Presentationkw1213
The document discusses terminology, definitions, prevalence, causes, identification and assessment, characteristics, and educational considerations for students with severe disabilities including severe intellectual disabilities, multiple disabilities, deaf-blindness, physical disabilities such as orthopedic impairments and other health impairments, and traumatic brain injury. It provides definitions from IDEA and discusses the complex nature of identifying and assessing students with multiple, co-occurring disabilities that affect cognitive, physical, sensory, and behavioral functioning.
The document discusses multiple-severe disabilities, defined as concomitant impairments that cause severe educational needs that cannot be accommodated in special education programs for a single impairment. It notes that around 0.23% of students ages 6-21 nationally have multiple-severe disabilities. Some key characteristics of these students include problems transferring learning, limited communication skills, difficulties with memory, and needing services from multiple therapists. The document then outlines various teaching methods, challenges, and technologies that can help support students with multiple-severe disabilities.
President of MSSA Prof. Dr. Vladimir Trajkovski prsented the his topic: "Association between cerebral palsy and autism spectrum disorders" at 8th interdisciplinary congress: "Cerebral palsy and other movement disorders" on 1-2 of November 2018 in Moscow, Russia.
Running head ALZHEIMER’S DISEASE RESEARCH FINAL1ALZHEIMER’S DI.docxhealdkathaleen
Running head: ALZHEIMER’S DISEASE RESEARCH FINAL 1
ALZHEIMER’S DISEASE RESEARCH FINAL 22
Alzheimer’s Disease Research Final
Dalia Catalan
Florida National University
Alzheimer’s Disease Research Final
Phase one
Introduction
Alzheimer's disease tends to be a progressive, irreversible ailment that impacts the normal functioning of the brain slowly destroying the thinking and memory-related skills and as it progresses it limits the patient the ability to conduct simple tasks ("What Is Alzheimer's Disease?," 2020). Researchers suggest that approximately 6 million American citizens older than 65 years of age have dementia which is caused by Alzheimer's disease. In most patients, the symptoms of this condition begin to be identified when they are in their mid- the 60s. This condition is often ranked as one of the top ten causes of death in the United States, but following a recent investigation, the condition has climbed the ladder and it is currently ranked as the top five leading cause of death in the United States. Often the disease is categorized with cancer and heart disease as the main cause of death among the older population. This paper will focus on planning research that is focused on understanding Alzheimer's disease, its causes symptoms and its impact on the older population.
Problem identification
Alzheimer's disease tends to be the most common cause of dementia among the older population around the world. The condition impacts the normal functioning of the brain hence causing the loss of cognitive functioning such as reasoning, remembering and thinking. Also, it impacts behavioral abilities to the extent of the victim not being able to conduct various daily essential activities ("What Is Alzheimer's Disease?," 2020). The severity of the brain damage from the mildest stage where the normal function of a person is impact and it progresses to a most severe stage and the victim must be dependent on the people around him or her for basic activities related to daily living. The condition is most popular among the older population and its estimated that the condition has impacted about 6 million senior American citizens' normal function and also it is a leading cause of death among this population ("Alzheimer's Disease Fact Sheet," 2020).
Significance of the Problem to Nursing
With a significant population estimated to be victims of Alzheimer's disease in the United States, it is most likely that individuals in the nursing practice will encounter patients suffering from this condition either in their personal lives on in their careers. Thus, it is essential for the nurses to be able to understand and recognize the Alzheimer's Disease symptoms, treatment approaches, and options as well as learn how to effectively interact with this vulnerable population ("Update on Alzheimer’s: What Nurses Should Know," 2020).
To be able to provide quality health care services the nurse practitioner needs to underst ...
Running head ALZHEIMER’S DISEASE RESEARCH FINAL1ALZHEIMER’S DI.docxtoddr4
Running head: ALZHEIMER’S DISEASE RESEARCH FINAL 1
ALZHEIMER’S DISEASE RESEARCH FINAL 22
Alzheimer’s Disease Research Final
Dalia Catalan
Florida National University
Alzheimer’s Disease Research Final
Phase one
Introduction
Alzheimer's disease tends to be a progressive, irreversible ailment that impacts the normal functioning of the brain slowly destroying the thinking and memory-related skills and as it progresses it limits the patient the ability to conduct simple tasks ("What Is Alzheimer's Disease?," 2020). Researchers suggest that approximately 6 million American citizens older than 65 years of age have dementia which is caused by Alzheimer's disease. In most patients, the symptoms of this condition begin to be identified when they are in their mid- the 60s. This condition is often ranked as one of the top ten causes of death in the United States, but following a recent investigation, the condition has climbed the ladder and it is currently ranked as the top five leading cause of death in the United States. Often the disease is categorized with cancer and heart disease as the main cause of death among the older population. This paper will focus on planning research that is focused on understanding Alzheimer's disease, its causes symptoms and its impact on the older population.
Problem identification
Alzheimer's disease tends to be the most common cause of dementia among the older population around the world. The condition impacts the normal functioning of the brain hence causing the loss of cognitive functioning such as reasoning, remembering and thinking. Also, it impacts behavioral abilities to the extent of the victim not being able to conduct various daily essential activities ("What Is Alzheimer's Disease?," 2020). The severity of the brain damage from the mildest stage where the normal function of a person is impact and it progresses to a most severe stage and the victim must be dependent on the people around him or her for basic activities related to daily living. The condition is most popular among the older population and its estimated that the condition has impacted about 6 million senior American citizens' normal function and also it is a leading cause of death among this population ("Alzheimer's Disease Fact Sheet," 2020).
Significance of the Problem to Nursing
With a significant population estimated to be victims of Alzheimer's disease in the United States, it is most likely that individuals in the nursing practice will encounter patients suffering from this condition either in their personal lives on in their careers. Thus, it is essential for the nurses to be able to understand and recognize the Alzheimer's Disease symptoms, treatment approaches, and options as well as learn how to effectively interact with this vulnerable population ("Update on Alzheimer’s: What Nurses Should Know," 2020).
To be able to provide quality health care services the nurse practitioner needs to underst.
- Alzheimer disease (AD) is the most common cause of dementia, affecting over 5 million Americans. This number is expected to triple by 2050 due to an aging population.
- Late-onset AD typically presents as progressive memory impairment, though this clinical presentation is non-specific and can occur in other neurodegenerative diseases. Emerging biomarkers are helping to characterize patients based on underlying neuropathology.
- Genetic and environmental factors influence risk for late-onset AD. The APOE ε4 allele is the primary genetic risk factor, while vascular risk factors, sleep disturbances, and head injuries increase risk. Greater education and cognitive/physical activity decrease risk.
The document summarizes research showing links between hearing loss and chronic diseases like diabetes, heart disease, kidney disease, and Alzheimer's. Studies found these diseases are associated with increased risk of hearing loss. Untreated hearing loss can also worsen the effects of chronic illnesses and reduce quality of life. However, hearing aids are effective at improving hearing and quality of life for people with chronic diseases and hearing loss. The document encourages people to get their hearing checked regularly.
AHA guideline on stroke in neonates and children stroke 2019Carmenlahiffjenkins
This document provides an overview and update on perinatal and childhood stroke. It discusses the purpose, methods, results, and conclusions of the scientific statement from the American Heart Association/American Stroke Association on the management of stroke in neonates and children. Key points include:
- Stroke is an important cause of acquired brain injury in children, occurring most commonly in neonates and throughout childhood.
- Annual pediatric stroke incidence ranges from 3 to 25 per 100,000 children in developed countries, with newborns having the highest risk.
- Stroke in children can be ischemic or hemorrhagic and classification includes differences by age (perinatal vs. childhood) and subtype.
- Risk factors,
The document discusses Stella Maris, LLC and mitochondrial damage diseases (MDDs) like ME/CFS, autism and Alzheimer's disease. It states that these diseases share mitochondrial dysfunction, oxidative stress, genetic factors and irregularities in metabolic processes like methylation. Common symptoms and deficiencies are also listed. Stella Maris aims to address nutritional needs of people with MDDs. Cellular respiration, methylation pathways and possible environmental causes of increased MDD prevalence are described.
This document discusses research on childhood anxiety disorders and their effects over the lifespan. It describes a longitudinal study called the Great Smoky Mountains Study that explored anxiety symptoms from childhood to adolescence. The study found that over 16% of participants met criteria for an anxiety disorder. Specific phobias and oppositional defiant disorder tended to remain stable over time, while rates of social anxiety disorder and ADHD decreased from childhood to adolescence. Girls had higher rates of anxiety disorders and depression compared to boys. The study provided insight into the progression and prevalence of various childhood anxiety disorders.
1) The document discusses the importance of health literacy and patient-centered care in audiology. Many patients have low health literacy due to hearing loss and other factors.
2) A study found that counseling dialogs between audiologists and patients had a reading level below a 4th grade level, significantly lower than the language used by audiologists. Patient materials like hearing aid instructions were also too advanced.
3) Low health literacy is common and associated with poorer health outcomes. Audiologists must find ways to improve communication through simpler language and formats responsive to patient needs and abilities.
Autism is a neurodevelopmental disorder that affects communication and social interaction. It is one of the fastest growing developmental disabilities, with 1 in 68 children in the US being diagnosed with autism spectrum disorder. Autism encompasses a wide spectrum, so symptoms and severity vary greatly between individuals. While autism was first discussed in the 1940s, little was understood about the disorder until recent decades of increased research.
This document presents a case study of a 71-year-old female patient who experienced a stroke. It includes sections on the patient's history, including her past medical history of a previous stroke in 2005. Physical assessments were performed and vital signs such as temperature and cardiac rate were monitored daily. The document discusses the pathophysiology of stroke, medical management including medications and diagnostic tests, nursing care, and a discharge plan. The overall goal is to provide a clinical guide for a safe and quality nursing care approach for patients who experience stroke.
This document provides an overview of apraxia, including its causes, types, symptoms, diagnosis, treatment and prognosis. Apraxia is caused by damage to areas of the brain that control movement planning and execution. It can result from conditions like stroke, head injury, brain tumor or Alzheimer's disease. There are several types of apraxia that affect different functions. Diagnosis involves neurological and speech evaluations. Treatment focuses on rehabilitation therapies to help retrain movements and communication. The prognosis depends on the underlying cause, with some cases seeing significant improvement with therapy and others requiring long-term care.
This document summarizes current research on autism spectrum disorder (ASD) to help clinicians provide guidance to families. It discusses that ASD is characterized by difficulties with social communication and repetitive behaviors. While ASD is lifelong, outcomes have improved in recent decades due to things like increased community support services. However, most individuals still require lifelong support. The document reviews signs and symptoms of ASD based on diagnostic criteria, issues around screening and diagnosis at different ages, risk factors and causes, available treatments and their effectiveness, transitions individuals face, and recommendations for clinicians in assisting families.
This summary provides an overview of an epidemiology paper on respiratory syncytial virus (RSV) infections in children. The paper discusses the epidemiological triangle as it relates to RSV, describing the agent (RSV virus), host (infants and young children), and environment (fall, winter, early spring seasons). It also covers the types of epidemiology (descriptive and analytic) and levels of prevention (primary, secondary, tertiary) for RSV infections.
Autism Spectrum Disorder A case study of Mikey.pdfKathryn Patel
This case study describes an 8-year-old boy, Mikey, who was diagnosed with Autism Spectrum Disorder at age 4. Mikey is having behavioral issues during his morning routine that disrupt his entire day. An occupational therapy evaluation found that Mikey has sensory processing difficulties, engages in repetitive behaviors, and plays at the social developmental level of a 12-month old. The evaluation suggests occupational therapy to address Mikey's sensory needs and develop his social skills morning routine.
- The document reviews literature on the evolution of headache from childhood to adulthood. It summarizes several studies that found that around 30-45% of children experiencing headaches like migraine or tension-type headache see improvement or remission of symptoms over time, while around 20-25% experience a change in diagnosis from one headache type to another. Early onset of headaches before age 6 may be associated with a less favorable prognosis.
President of MSSA Prof. Dr. Vladimir Trajkovski prsented the his topic: "Association between cerebral palsy and autism spectrum disorders" at 8th interdisciplinary congress: "Cerebral palsy and other movement disorders" on 1-2 of November 2018 in Moscow, Russia.
Running head ALZHEIMER’S DISEASE RESEARCH FINAL1ALZHEIMER’S DI.docxhealdkathaleen
Running head: ALZHEIMER’S DISEASE RESEARCH FINAL 1
ALZHEIMER’S DISEASE RESEARCH FINAL 22
Alzheimer’s Disease Research Final
Dalia Catalan
Florida National University
Alzheimer’s Disease Research Final
Phase one
Introduction
Alzheimer's disease tends to be a progressive, irreversible ailment that impacts the normal functioning of the brain slowly destroying the thinking and memory-related skills and as it progresses it limits the patient the ability to conduct simple tasks ("What Is Alzheimer's Disease?," 2020). Researchers suggest that approximately 6 million American citizens older than 65 years of age have dementia which is caused by Alzheimer's disease. In most patients, the symptoms of this condition begin to be identified when they are in their mid- the 60s. This condition is often ranked as one of the top ten causes of death in the United States, but following a recent investigation, the condition has climbed the ladder and it is currently ranked as the top five leading cause of death in the United States. Often the disease is categorized with cancer and heart disease as the main cause of death among the older population. This paper will focus on planning research that is focused on understanding Alzheimer's disease, its causes symptoms and its impact on the older population.
Problem identification
Alzheimer's disease tends to be the most common cause of dementia among the older population around the world. The condition impacts the normal functioning of the brain hence causing the loss of cognitive functioning such as reasoning, remembering and thinking. Also, it impacts behavioral abilities to the extent of the victim not being able to conduct various daily essential activities ("What Is Alzheimer's Disease?," 2020). The severity of the brain damage from the mildest stage where the normal function of a person is impact and it progresses to a most severe stage and the victim must be dependent on the people around him or her for basic activities related to daily living. The condition is most popular among the older population and its estimated that the condition has impacted about 6 million senior American citizens' normal function and also it is a leading cause of death among this population ("Alzheimer's Disease Fact Sheet," 2020).
Significance of the Problem to Nursing
With a significant population estimated to be victims of Alzheimer's disease in the United States, it is most likely that individuals in the nursing practice will encounter patients suffering from this condition either in their personal lives on in their careers. Thus, it is essential for the nurses to be able to understand and recognize the Alzheimer's Disease symptoms, treatment approaches, and options as well as learn how to effectively interact with this vulnerable population ("Update on Alzheimer’s: What Nurses Should Know," 2020).
To be able to provide quality health care services the nurse practitioner needs to underst ...
Running head ALZHEIMER’S DISEASE RESEARCH FINAL1ALZHEIMER’S DI.docxtoddr4
Running head: ALZHEIMER’S DISEASE RESEARCH FINAL 1
ALZHEIMER’S DISEASE RESEARCH FINAL 22
Alzheimer’s Disease Research Final
Dalia Catalan
Florida National University
Alzheimer’s Disease Research Final
Phase one
Introduction
Alzheimer's disease tends to be a progressive, irreversible ailment that impacts the normal functioning of the brain slowly destroying the thinking and memory-related skills and as it progresses it limits the patient the ability to conduct simple tasks ("What Is Alzheimer's Disease?," 2020). Researchers suggest that approximately 6 million American citizens older than 65 years of age have dementia which is caused by Alzheimer's disease. In most patients, the symptoms of this condition begin to be identified when they are in their mid- the 60s. This condition is often ranked as one of the top ten causes of death in the United States, but following a recent investigation, the condition has climbed the ladder and it is currently ranked as the top five leading cause of death in the United States. Often the disease is categorized with cancer and heart disease as the main cause of death among the older population. This paper will focus on planning research that is focused on understanding Alzheimer's disease, its causes symptoms and its impact on the older population.
Problem identification
Alzheimer's disease tends to be the most common cause of dementia among the older population around the world. The condition impacts the normal functioning of the brain hence causing the loss of cognitive functioning such as reasoning, remembering and thinking. Also, it impacts behavioral abilities to the extent of the victim not being able to conduct various daily essential activities ("What Is Alzheimer's Disease?," 2020). The severity of the brain damage from the mildest stage where the normal function of a person is impact and it progresses to a most severe stage and the victim must be dependent on the people around him or her for basic activities related to daily living. The condition is most popular among the older population and its estimated that the condition has impacted about 6 million senior American citizens' normal function and also it is a leading cause of death among this population ("Alzheimer's Disease Fact Sheet," 2020).
Significance of the Problem to Nursing
With a significant population estimated to be victims of Alzheimer's disease in the United States, it is most likely that individuals in the nursing practice will encounter patients suffering from this condition either in their personal lives on in their careers. Thus, it is essential for the nurses to be able to understand and recognize the Alzheimer's Disease symptoms, treatment approaches, and options as well as learn how to effectively interact with this vulnerable population ("Update on Alzheimer’s: What Nurses Should Know," 2020).
To be able to provide quality health care services the nurse practitioner needs to underst.
- Alzheimer disease (AD) is the most common cause of dementia, affecting over 5 million Americans. This number is expected to triple by 2050 due to an aging population.
- Late-onset AD typically presents as progressive memory impairment, though this clinical presentation is non-specific and can occur in other neurodegenerative diseases. Emerging biomarkers are helping to characterize patients based on underlying neuropathology.
- Genetic and environmental factors influence risk for late-onset AD. The APOE ε4 allele is the primary genetic risk factor, while vascular risk factors, sleep disturbances, and head injuries increase risk. Greater education and cognitive/physical activity decrease risk.
The document summarizes research showing links between hearing loss and chronic diseases like diabetes, heart disease, kidney disease, and Alzheimer's. Studies found these diseases are associated with increased risk of hearing loss. Untreated hearing loss can also worsen the effects of chronic illnesses and reduce quality of life. However, hearing aids are effective at improving hearing and quality of life for people with chronic diseases and hearing loss. The document encourages people to get their hearing checked regularly.
AHA guideline on stroke in neonates and children stroke 2019Carmenlahiffjenkins
This document provides an overview and update on perinatal and childhood stroke. It discusses the purpose, methods, results, and conclusions of the scientific statement from the American Heart Association/American Stroke Association on the management of stroke in neonates and children. Key points include:
- Stroke is an important cause of acquired brain injury in children, occurring most commonly in neonates and throughout childhood.
- Annual pediatric stroke incidence ranges from 3 to 25 per 100,000 children in developed countries, with newborns having the highest risk.
- Stroke in children can be ischemic or hemorrhagic and classification includes differences by age (perinatal vs. childhood) and subtype.
- Risk factors,
The document discusses Stella Maris, LLC and mitochondrial damage diseases (MDDs) like ME/CFS, autism and Alzheimer's disease. It states that these diseases share mitochondrial dysfunction, oxidative stress, genetic factors and irregularities in metabolic processes like methylation. Common symptoms and deficiencies are also listed. Stella Maris aims to address nutritional needs of people with MDDs. Cellular respiration, methylation pathways and possible environmental causes of increased MDD prevalence are described.
This document discusses research on childhood anxiety disorders and their effects over the lifespan. It describes a longitudinal study called the Great Smoky Mountains Study that explored anxiety symptoms from childhood to adolescence. The study found that over 16% of participants met criteria for an anxiety disorder. Specific phobias and oppositional defiant disorder tended to remain stable over time, while rates of social anxiety disorder and ADHD decreased from childhood to adolescence. Girls had higher rates of anxiety disorders and depression compared to boys. The study provided insight into the progression and prevalence of various childhood anxiety disorders.
1) The document discusses the importance of health literacy and patient-centered care in audiology. Many patients have low health literacy due to hearing loss and other factors.
2) A study found that counseling dialogs between audiologists and patients had a reading level below a 4th grade level, significantly lower than the language used by audiologists. Patient materials like hearing aid instructions were also too advanced.
3) Low health literacy is common and associated with poorer health outcomes. Audiologists must find ways to improve communication through simpler language and formats responsive to patient needs and abilities.
Autism is a neurodevelopmental disorder that affects communication and social interaction. It is one of the fastest growing developmental disabilities, with 1 in 68 children in the US being diagnosed with autism spectrum disorder. Autism encompasses a wide spectrum, so symptoms and severity vary greatly between individuals. While autism was first discussed in the 1940s, little was understood about the disorder until recent decades of increased research.
This document presents a case study of a 71-year-old female patient who experienced a stroke. It includes sections on the patient's history, including her past medical history of a previous stroke in 2005. Physical assessments were performed and vital signs such as temperature and cardiac rate were monitored daily. The document discusses the pathophysiology of stroke, medical management including medications and diagnostic tests, nursing care, and a discharge plan. The overall goal is to provide a clinical guide for a safe and quality nursing care approach for patients who experience stroke.
This document provides an overview of apraxia, including its causes, types, symptoms, diagnosis, treatment and prognosis. Apraxia is caused by damage to areas of the brain that control movement planning and execution. It can result from conditions like stroke, head injury, brain tumor or Alzheimer's disease. There are several types of apraxia that affect different functions. Diagnosis involves neurological and speech evaluations. Treatment focuses on rehabilitation therapies to help retrain movements and communication. The prognosis depends on the underlying cause, with some cases seeing significant improvement with therapy and others requiring long-term care.
This document summarizes current research on autism spectrum disorder (ASD) to help clinicians provide guidance to families. It discusses that ASD is characterized by difficulties with social communication and repetitive behaviors. While ASD is lifelong, outcomes have improved in recent decades due to things like increased community support services. However, most individuals still require lifelong support. The document reviews signs and symptoms of ASD based on diagnostic criteria, issues around screening and diagnosis at different ages, risk factors and causes, available treatments and their effectiveness, transitions individuals face, and recommendations for clinicians in assisting families.
This summary provides an overview of an epidemiology paper on respiratory syncytial virus (RSV) infections in children. The paper discusses the epidemiological triangle as it relates to RSV, describing the agent (RSV virus), host (infants and young children), and environment (fall, winter, early spring seasons). It also covers the types of epidemiology (descriptive and analytic) and levels of prevention (primary, secondary, tertiary) for RSV infections.
Autism Spectrum Disorder A case study of Mikey.pdfKathryn Patel
This case study describes an 8-year-old boy, Mikey, who was diagnosed with Autism Spectrum Disorder at age 4. Mikey is having behavioral issues during his morning routine that disrupt his entire day. An occupational therapy evaluation found that Mikey has sensory processing difficulties, engages in repetitive behaviors, and plays at the social developmental level of a 12-month old. The evaluation suggests occupational therapy to address Mikey's sensory needs and develop his social skills morning routine.
- The document reviews literature on the evolution of headache from childhood to adulthood. It summarizes several studies that found that around 30-45% of children experiencing headaches like migraine or tension-type headache see improvement or remission of symptoms over time, while around 20-25% experience a change in diagnosis from one headache type to another. Early onset of headaches before age 6 may be associated with a less favorable prognosis.
1. Running Head: ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS
Acquired Childhood Aphasia: An Examination of Diagnosis
Annie Martines
Senior Inquiry, Winter Term 2016
Lynn Drazinski, Research Advisor
Augustana College, Rock Island, IL
2. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 2
Acknowledgements
Ms. Martines acknowledges the unconditional support of her advisor Lynn Drazinski.
Her guidance and reassurance were essential to the development of this investigation.
Additionally, Ms. Martines is grateful for the outstanding faculty and staff at Augustana
College’s Center of Speech-Language and Hearing for their encouragement and support of Ms.
Martines’ endeavors as a student a professional.
3. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 3
Stroke and Aphasia
Within recent decades medicine has made substantial progress in order to ensure the
livelihood of children who have suffered from stroke. For example, between the years 1979 and
1998 the childhood mortality rate due to a stroke decreased by 58% as a result of advances in
medicine (American Stroke Association, 2015). Even though more children are surviving these
difficulties, many of them still suffer from the effects of stroke such as cognitive impairments,
physical disabilities, and language difficulties. Since more children are living due to these
medical milestones, recent research has been able to focus on the risk factors, possible etiologies,
and outcomes associated with children who suffered from stroke. The most recent research in
these topics will be discussed throughout this investigation.
A cerebrovascular accident (CVA), commonly referred to as a stroke, is a life threatening
condition in which the blood supply of the brain is either interrupted or severely reduced
(National Institute of Neurological Disorders and Stroke, 2015). According to the American
Stroke Association (ASA), anyone can be affected by a stroke, no matter his or her race, gender,
or age. In fact, strokes are the leading cause of adult disability, as well as the fifth most common
cause of death within the United States. The ASA differentiates two overarching types of stroke,
ischemic and hemorrhagic. For an ischemic stroke, the blood supply is either severely reduced or
blocked, and in a hemorrhagic stroke blood vessels erupt and cause bleeding in the brain. In
either type, the brain is deprived of oxygen and nutrients, which results in brain cell damage, or
even death.
Causes of Stroke
Although every stroke is unique, there are a wide variety of factors that influence the risk
of having a stroke. ASA classified the risk factors for stroke into two categories: risk factors that
4. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 4
can be modified, and risk factors that cannot be modified. The adult population can be affected
by both risk factor categories, such as unhealthy lifestyle choices or increase in age. Children
who have strokes, on the other hand, only suffer from the unchangeable risk factors of a stroke,
which will later be discussed.
Aphasia
While the impact or severity of the stroke varies greatly throughout the affected
population, the location of the damaged cells influences the symptoms and severity of each
stroke (American Speech-Language-Hearing Association, 2015). An individual who suffered
from a stroke may experience gross and fine motor difficulties, paralysis, or even communication
deficits. A specific communication disorder is aphasia, an acquired deficit that impairs the
expressive or receptive element of speech and language, including the ability to read or write
(National Aphasia Association, 2015). Aphasia occurs when there is neurological damage, which
results from traumatic brain injuries and tumors (Fogle, 2013); however, strokes are the most
common cause of aphasia (ASHA, 2014).
Aphasia Symptoms
The location of damaged neurons within the language-dominant hemisphere determines
the symptoms of the specific type of aphasia (NAA, 2015). ASHA describes these types of
aphasia along with the respective symptoms as occurring in a variety of categories. For example,
if the damage is located posterior to the central sulcus, also known as Wernicke’s area, it will
result in receptive or fluent aphasia. A person with receptive aphasia will exhibit impairments of
auditory comprehension and integration of information. If the lesion is located anterior to the
central sulcus, specifically Broca’s area, it will result in expressive or nonfluent aphasia. A
person with expressive aphasia will exhibit impairments in producing complete sentences,
5. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 5
correct syntax; and naming objects. When a person exhibits both receptive and expressive
deficits, it is generally considered to be the most severe form of aphasia called global aphasia.
This type of aphasia is associated with larger lesions, which affect both the posterior and anterior
portion of the brain in relation to the central sulcus.
Incidence and Prevalence
Currently, there are one million people in the United States who are diagnosed with
aphasia (NINDS, 2015). Each year, about 180,000 people in the United States acquire aphasia
(NAA, 2015). While strokes and aphasia are most commonly associated with adults, they can
affect children as well.
The ASA conducted the most current research on the incidence and prevalence of stroke
in children (2015). The organization found that strokes occur in 1 out of every 4,000 live births.
Also, the incidence of stroke from birth to 18 years old is 11 per 10,000 children. Strokes are one
of the top 10 causes of death for children, but out of the children who do survive, 50-80% will
suffer permanent neurological deficits.
The risk factors for stroke within the adult population consist of both modifiable and non-
modifiable aspects of an individual’s life. An adult can increase their chances of stroke through
modifiable aspects such as unhealthy life choices, and through non-modifiable aspects such as
age. Children on the contrary, are not pre-disposed to these modifiable factors. They are only at
risk through the non-modifiable, unpreventable aspects. With this in mind, there is need for an
examination of these factors in order for health professionals, especially speech-language
pathologists (SLP), working with this population to better understand the medical events
associated with the individual’s outcomes.
6. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 6
In addition, there are well-established protocols in assessing and treating adults with
aphasia within the speech-language pathology realm. In fact, the majority of the body of
literature about strokes and aphasia focuses on the adult population. For this population, speech
and language development have already been established for many years. However, what occurs
when there is an interruption in language function before or during speech and language
development? How would this impact assessment and intervention of a child for a speech-
language pathologist? Examination is needed to differentiate the treatment protocols of aphasia
between adults and children.
This research essay will address the following questions, specifically:
What are the causes of stroke and aphasia in children?
What are the known treatment options for children with aphasia?
Causes of Stroke and Aphasia in Children
There is a variety of definitions presented throughout the medical and rehabilitation
literature that describes the specific gestational and chronicle age of an infant. The literature
involving the risk factors or etiologies of stroke divides the terms into two categories, perinatal
and pediatric. The perinatal stage begins at 20 weeks gestation and continues until 28 days after
birth. From there the infant is considered to be within the pediatric stage until reaching 18 years
of age. Technically, the term neonatal is used to describe the lifespan from one month to one
year of age, however; many studies combine the neonatal stage with the pediatric stage
(Darmency-Stamboul, 2012). The causes of stroke within each stage of infancy and childhood
are differential from one another. Furthermore, the causes are further separated between ischemic
and hemorrhagic strokes for these age groups.
7. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 7
Sickle Cell Disease
Sickle Cell Disease (SCD) is the most common cause of childhood stroke (NINDS,
2015). The Internet Stroke Center (2015) is an online resource that focused on how SCD
influences stroke in children, and defined SCD as a group of inherited blood disorders that have
a diminished ability to carry oxygen throughout the body. The sickle-shaped blood cells clump
together throughout the arterial system and eventually block the blood flow, causing an arterial
ischemic stroke. SCD is inherited throughout an autosomal recessive gene, which means the
gene is received from both parents. In regards to treatment of SCD, the STOP 2 clinical trial
(2000) concluded that receiving red blood cell transfusions every month will reduce the
likelihood of stroke by 90%. With this clinical significance in mind, many researchers have
modified their personal research within childhood stroke to specifically exclude participants with
SCD, in order to find the underlying causes of stroke for the population without SCD. Therefore,
the research presented throughout this essay will only consist of participants without SCD.
Maternal Risk Factors of Stroke
The child’s risk of stroke can begin with the mother. Many studies have shown that there
are preventable environmental factors, such as smoking and other teratogens, that will increase
the likelihood of the child having a stroke (Darmency-Stamboul et al., 2012). However, more
recent studies have focused on the unpreventable genetic factors that influence the risk of
childhood stroke. In 2005, Lee et al. conducted a case-controlled study focusing on maternal risk
factors that are associated with perinatal ischemic stroke. The study discovered independent risk
factors that can be categorized by problems within a specific body system. For example, mothers
who had problems within the reproductive system, such as a history of infertility or structural
abnormalities in the placenta, were more prevalent in the perinatal arterial stroke population in
8. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 8
comparison to a control group. Also, specific maternal diseases within the gestational system,
such as gestational diabetes, may also increase the chance of the child having a stroke. Finally,
problems with the hematologic system, such as coagulation, hyperhomocysteinemia, and Factor
V Leiden can put the child at risk for ischemic stroke as well. Other circumstantial factors, such
as being pregnant for the first time, were also significantly associated with the child having a
stroke.
Perinatal Risk Factors of Stroke
When prepartum complications occur before the perinatal stage of fetal or embryonic
development, it usually results in fatality. Therefore, researchers only include participants of the
perinatal stage of the 20-week gestational mark, and not earlier in development, within the
studies. Also, the body of literature addressing perinatal stroke is relatively recent, so the
researchers have only discovered risk factors, as opposed to etiologies, within the population. In
continuation of the study, Lee et al. (2005) determined infant characteristics associated with
perinatal stroke. The study found that decreased fetal movement or oligohydramnios is a
predictor of perinatal arterial stroke. In addition, the study concluded that a stable fetal
environment is essential during the perinatal stage. A stressed fetus can experience heart-rate
abnormalities and meconium-stained amniotic fluids, which are both risk factors associated with
stroke. In addition, chorioamnionitis, or inflammation of the fetal membranes due to infection,
can put the infant at risk for having a stroke.
When compared to a control group, intrapartum complications were more common
within the infant population who has suffered from a perinatal stroke (Darmency-Stamboul,
2012). However, the specificity of the types of complications throughout the delivery process
was not significant enough to determine it as an independent risk factor for perinatal strokes (Lee
9. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 9
et al., 2005). The more risk factors associated with the infant, the higher chance of a stroke
occurring. These risk factors discussed are only linked with perinatal ischemic strokes, and do
not influence strokes in later infancy.
Pediatric Etiologies of Stroke
In comparison to perinatal strokes, there is a greater abundance of literature involving the
causes of pediatric strokes. While the literature for perinatal stroke only has examined risk
factors, the literature involving pediatric stroke has revealed specific etiologies, or definitive
causes of strokes. The latest research focusing on strokes in children is a systematic review by
Gumer, Del Veccio, and Aronoff (2014). The researchers examined 12 studies involving
pediatric strokes and divided the etiologies of ischemic stroke into 10 categories. Almost half of
the etiologies involved arterial damage or malfunction, such as steno-occlusive arteriopathies,
moyamoya syndrome, and arterial dissection. However, the single most common category of
ischemic stroke in children was undetermined, involving 26% of the population. Overall, the
study concluded that the etiology of pediatric stroke is diverse but also still undetermined, unlike
the adult population.
Another study conducted by Mackay et al. (2011) focused on risk factors and etiologies
of pediatric stroke across the world. The study contained a population of 676 children of any age
between one month and 18 years in order to determine differential risk factors between age
groups. The researchers divided the population into four age groups in order to determine the
prevalence of risk factors associated by age. One of the significant differences found was a
higher prevalence in acute systemic conditions, or problems associated with a specific body
system, within children one month to five years old. Chronic head and neck disorders were
significantly more prevalent among children who suffered from stroke who were 10 years or
10. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 10
older. Other than those significant differences, the risk factors associated with pediatric strokes
were similar among all ages within the population. The study found results similar to the Gumer
et al. systematic review with arterial problems, specifically arteriopathies, being the most
common risk factor associated with pediatric strokes across the globe. The second most common
etiology in both studies, however, was cardiac disorders, which includes congenital heart disease,
cardiac catheterization, cardiac surgery, and cardio embolism. This finding influenced other
international pediatric studies to continue research focusing on cardiac disorders.
Dowling et al. conducted the most recent study involving this topic in 2013. The
researchers focused on 667 children within various pediatric stages in order to differentiate
characteristics and clinical presentations between children who had strokes in addition to cardiac
disorders and children who had strokes without cardiac disorders. The study found that usually
children who have cardiac disorders are younger, and that congenital heart disease is the most
common type of cardiac disorder among the entire population. The study also included children
with bilateral and hemorrhagic strokes, and discovered a higher prevalence in children with
cardiac disorders involving those types of strokes.
As a general overview, the etiologies and risk factors of ischemic strokes are associated
with arterial problems as well as specific cardiac diseases. However, it is important to
differentiate these findings in regards to hemorrhagic strokes (Gunner et al., 2014).
Hemorrhagic Strokes
The incidence of hemorrhagic stroke, 2.9 out of 100,000 children, is much less than the
incidence of arterial ischemic strokes, which occur in 7.8 out of 100,000 children (Tran &
Heaton, 2015). Therefore, the research does not categorize the population between perinatal and
pediatric; it combines all children under 18 years old. While ischemic strokes are associated with
11. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 11
disease and specific symptoms, hemorrhagic strokes are caused by structural malformations or
severe head trauma (Tran & Heaton, 2015). Specifically, vascular malformations such as
arteriovenous malformations, venous malformations, and cavernous hemangioma make up the
majority of the structural malformations that cause a pediatric hemorrhagic stroke (Tran &
Heaton, 2015). Gumer et al. expanded these etiologies by also including aneurysms, brain
tumors, and trauma (2014). Similar to arterial ischemic strokes, there are undetermined etiologies
associated with hemorrhagic strokes.
Seizures as Related to Stroke
The adverse outcomes of childhood stroke have been well researched and examined
throughout the general body of literature. Persistent neurological deficits, stroke recurrence,
psychosocial implications, and others can result from any kind of stroke at any age of
development (Tran & Heaton, 2015). Rather than being classified as an etiology or risk factor
associated with stroke, seizures are associated with stroke in unique ways. Not only can seizures
be a result of a stroke in some cases, but also can be a manner of presentation of a stroke in some
cases. In other words, seizures can both be a result and a symptom in relation to childhood
stroke.
In regards to outcomes, nearly one third of child stroke survivors develop epilepsy
sometime throughout his or her lifetime (Tran & Heaton, 2015). Some researchers theorize that
the effects of cumulative seizures may interfere with the child’s continuous learning, and cause
secondary functional damage (Murias, K., Brooks, B., Kirton, A., & Iairia, G., 2014). In a
longitudinal study of children with perinatal ischemic stroke researchers did not find an overall
decrease in IQ in comparison to the control group. However, when the stroke-effected group was
12. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 12
divided between children with seizures and children without seizures, there was a significant
interaction between children with seizures and a depressed IQ (Ballantyne et al., 2008).
In relation to seizures being a result of childhood strokes, 31% of strokes are presented
through seizures (Mackey et al., 2011). A recent case report focused on a five-year-old female
with an existing seizure disorder who complained of a severe headache along with consistent
vomiting. Although the patient had consistent seizures in the past, the family indicated that the
most recent seizure was different and admitted her to the emergency room. After a computed
tomography (CT) scan of her head, the physician diagnosed her with a right-sided stroke due to
the loss of grey white matter differentiation with the CT scan (Ahmadzedeh, K., Bhardwaj, V., &
Johnson, S.A., 2014). The authors summarize that this case is significant for all emergency
physicians in order to recognize that a seizure may be the initial symptom of a pediatric stroke,
regardless of case history. Overall, seizures are 18 times more likely associated with children
than adults (Chadehumbe, M.A., Khatri, P., & Khoury, J.C., 2009). It is necessary to be aware of
the aftermath of seizures in relation to stroke causes, as well as the outcomes of strokes in
relation to reoccurring seizures.
Summary
Overall, both hemorrhagic and ischemic pediatric stroke have a low incidence of 2 to 8
per 100,00 children (Gumer, 2014). Substantial progress has been made in discovering risk
factors and etiologies, such as arteriopothies and vascular malformations, in childhood strokes.
However, there is still a wide range of unknown risk factors and etiologies for children, unlike
the adult population. In addition, the effects of childhood stroke are dangerous, especially the
language and cognitive deficits seen in acquired childhood aphasia. Speech-language
13. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 13
pathologists would benefit from knowledge of the known treatments for speech and language
development in association with acquired childhood aphasia.
Known Treatment Options for Children with Aphasia
Aphasia is an acquired language disorder caused by brain damage that results in partial or
complete impairment of language comprehension, formulation, and use for communication
(Anderson N.B., & Shames, G.H., 2006). When adults are diagnosed with aphasia, speech and
language has already been developed and well established for many years. Children, however,
are currently in the process, or have not begun the process of developing these communication
skills. Therefore when a stroke impacts the neurological system, especially in regards to speech
and language, adults and children will present language deficits in different ways.
Diagnosis of aphasia is relatively common among the adult population; however, based
on the differences of language deficits it is difficult to determine aphasia among the pediatric
population. Unfortunately, medical doctors and researchers have consistently misdiagnosed all
types of acquired language disorders in children as aphasia. It is necessary to differentiate how
language is affected after stroke between the adult and child populations, including a
consideration of how plasticity within a developing brain contributes to language function after
stroke. The differences of presentation of language deficits between adults and children inform
the speech-language pathologist (SLP) in how to assess and provide intervention for this younger
population.
How Language Is Affected After Stroke: Differences Between Adults and Children
Although both populations experience language deficits after a neurological trauma, there
is a significant difference between adults and children. Murias and peers (2014) conducted a
systematic review involving 27 studies focusing on the cognitive outcomes of children who
14. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 14
experienced perinatal stroke. This study analyzed the site of lesion of children’s strokes in
association to their speech and language deficits, and discovered significant differences
compared to the adult population. This is the most recent and comprehensive study regarding the
language outcomes of perinatal stroke, and will be cited throughout the research essay, unless
otherwise stated.
Adults present speech and language deficits immediately following a stroke, while
children with stroke will most likely exhibit deficits later on in life. Babies who have
experienced perinatal strokes, in particular, are typically born without presenting concerns, but
may present language deficits later in infancy. Speech and language deficits in adults who suffer
from stroke are associated with specific symptoms of receptive or expressive aphasia, while
children who suffer from stroke present overall language deficits, such as experience late
language development, or an overall delay in verbal skills.
In addition to overall presentation of deficits, the specific location of stroke will impact
the speech and language abilities differently between adults and children. Children do not usually
display hemispheric or location specific deficits, which significantly differs from the adult
symptoms of aphasia. For example, when the stroke occurred in the left hemisphere, there was a
decrease in only vocabulary expression in children, as opposed to multiple aspects of expressive
language in adults. In regards to the right hemisphere there was a decrease in vocabulary
comprehension as well as inappropriate gesture use. These language aspects in adults are
typically associated within the left hemisphere of the brain.
Improvement in aphasia for adults is a slow process, and unfortunately adults who still
experience aphasic symptoms for more than 3 months after stroke will probably not fully recover
(NAA, 2015). Children are different. Children who experience language deficits such as, but not
15. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 15
limited to, a decrease in vocabulary expression due to a perinatal stroke, will not display these
deficits by the time they are five to seven years old. Also, when children following perinatal
stroke exhibit initial language delays, they reach normal language ability and achievement by
preschool age.
Confirming these findings is a longitudinal study by Lauterbah, Gilde Costa, Leah,
Willmes, & Martins (2010), who focused on three young adults who all experienced a left frontal
subcortical ischemic stroke during infancy. Twenty years after the stroke, magnetic resonance
imaging (MRI) and functional magnetic resonance imaging (fMRI) were conducted in order to
analyze how each patient’s brain had developed. Each imaging technique focused on specific
Brodmann’s areas, regions within the cerebral cortex specifically associated with a function,
while patients were asked to complete a variety of linguistic tasks. The study discovered a full
and functional recovery of speech and language skills for each participant. There were deficits
within some subcomponents of language, such as semantic, phonological, or fluency difficulties;
however, none of these were adequately significant to determine the early stroke as their cause.
Although full recovery from stroke in children is the outcome of some research, there are
some conflicting studies. Murias and peers (2014) theorize that these conflicting studies of
language outcomes are due to various populations, as well as intervention options. Since each
stroke is highly individualized based on type, onset, or severity, it is difficult to analyze the
outcome of each situation with clinical significance. None of the studies in the review discussed
or defined intervention options and measures. This, which will later be discussed, can be an
impacting factor for language recovery.
Overall, children have a better chance of fully recovering from speech and language
deficits due to stroke than adults, which may be attributed to neuroplasticity (Chilosi, 2007).
16. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 16
Plasticity
Plasticity is defined as a general property of the brain and refers to the compensatory
mechanisms underlying lesion-induced neurofunctional reorganization (Chilosi, 2007). Children
who suffer from stroke are able to retain the ability to develop both verbal and non-verbal
functions of speech and language through the mechanisms of neuroplasticity (Murias et al.,
2014).
Imaging has played a crucial role in analyzing the neuroplasticity within a child’s
affected brain. Especially within the last decade, there have been multiple studies comparing
fMRI results between children who have had a stroke and a control group. Murias’ and peers’
(2014) review of these studies discovered an overall reorganization of cortical representation
within the brains of children affected from stroke. When children were asked to perform
cognitive-based tasks, the fMRI showed neural activity occurring in atypical locations. For
example in some language specific tasks, the control group showed neural activity in Broca’s
area, while children with strokes demonstrated a bilateral increase in neural activity.
There are a few studies that have focused on plasticity specifically within the left
hemisphere of children. Raja Beharelle and cohorts (2010) used imaging to study 25 children
with pediatric or perinatal stroke within the left hemisphere and compared the findings to a
control group that consisted of each participant’s siblings. The study assessed each participant in
measures such as cognitive and language abilities, including the Clinical Evaluation of Language
Fundamentals (CELF), along with an fMRI in order to develop a global language score. Overall,
the siblings had significantly higher global language scores in comparison to the stroke group;
however, the affected stroke group still regained functional language abilities, despite the deficit.
From there the researchers focused on specific language areas within the brain, and compared the
17. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 17
neural activity between the two groups. When asked to execute receptive language tasks, the
frontal lobe within both hemispheres showed activation in both groups. However, when asked to
perform other language tasks, language areas within the posterior and temporal language regions
of the brain were different between the sibling control group and the children who were affected
by strokes. Left hemisphere activation in these areas was typical, while children affected by
stroke showed a bilateral neural pattern during these tasks.
In addition, Lauterbah and cohorts (2010) found a relationship between hemispheric
activation and the size of lesion. For bigger lesions, lateralization occurred in both hemispheres,
while smaller lesions resulted in changes within the left hemisphere. From this, the researchers
concluded that the affected brain would try to maintain language functions within the left
hemisphere as much as possible, or until a sufficiently large lesion compromises it. In this case,
plasticity will enable right hemisphere function for language tasks that are typically considered
left hemisphere functions.
However, not all stroke cases produce the same recovery results. The onset of stroke is
very important in regards to plasticity. As the child gets older the brain becomes less plastic.
Plasticity can only play a significant role until puberty, until which time hemispheric
specialization for language is presumed to be incomplete until then (Chilosi 2007). For example,
children who experienced stroke later in childhood exhibited greater difficulties in narrative
retelling when they reached puberty as compared to the narrative abilities of a child with a
perinatal stroke (Murias et al., 2014). Age of onset of the stroke is essential in regards to
recovery, due to the amount of plasticity within the brain.
Murias and his counterparts (2014) discussed another theory associated with the
inconsistencies of plasticity, in regards to children’s recovery abilities. They theorize that
18. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 18
plasticity can only accommodate the functions within early development, and cannot handle the
complexity of new skills in later years. This may be the reason why some children may begin to
exhibit cognitive deficits at later ages, as opposed to presenting deficits immediately after stroke.
In conclusion, plasticity is the primary reason for cognitive-linguistic recovery for
children who suffer from strokes. The earlier the onset of stroke the more plastic the brain is, and
the greater likelihood of attaining typical speech and language development.
Summary
This evidence makes clear the significant differences in language outcomes between
adults and children who have strokes. Given the definition of aphasia, it is not appropriate to
provide intervention based on what we know about aphasia; however, based on the specific
language deficit that each child presents. There are well-established protocols in the speech-
language pathology realm regarding these deficits, and the children should be treated
accordingly.
Discussion
The current research of the causes of stroke, as well as speech and language outcomes
following a stroke, shows a significant difference between the adult and child populations.
However, children who have suffered any speech or language deficits due to a stroke were
possibly misdiagnosed with aphasia among the health professional field. There has been
substantial progress regarding these misdiagnoses; however, it is still a critical problem today.
A study involving aphasia in children by A.W.G. Ewing (1930) wrongfully used 10 child
participants with cases of “aphasia.” The diagnosis was based on “binaural lack of hearing”
deficiency that was associated with each participant’s speech and language development (p.
253). Ewing hypothesized that the speech and language deficits of the participants was due to his
19. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 19
or her hearing, which enables them to hear the high frequency speech sounds. Aphasia is not an
aural disorder like Ewing concluded, but an auditory processing disorder can be a symptom. This
is only one example of the common misdiagnoses in children within the medical field. Although
this article is relatively outdated, these incorrect findings are still discussed today.
The most recent study focusing on Landau Kleffner Syndrome (LKS), an epileptic
disorder associated with aphasia in children, by Gaworowski (2015) wrongfully describes
aphasic symptoms in children. While describing LKS the author defines aphasia as “a severe
disorder in auditory comprehension leading to complete muteness as the child can no longer hear
his/her own words.” Muteness is not associated with aphasia, nor does the child not being able to
hear ever cause muteness or aphasia. Differential diagnosis needs to occur in the body of
literature in relation to children with aphasia. Medical researchers must know the exact
symptoms that aphasia presents, especially when associating the disorder within the pediatric
population.
Unfortunately, these misconceptions diffuse into the speech-language pathology field. A
meta-analytic review regarding motor impairments in children in association with speech and
language development used the diagnoses of “developmental language disorder” and
“developmental aphasia” interchangeably (Rechetnikov & Maitra, 2000, p. 255). This is
inaccurate because aphasia is not developed, but acquired. In addition, a language disorder can
encompass aphasia; however, aphasia cannot encompass all language disorders as the study
implied.
Also, the body of literature lacks in measurement or assessment of the children’s exact
language deficits when defining participants referred to as having aphasia. For example, Martins
and Ferro gathered 11 cases of “acquired childhood aphasia” based on lesions shown by medical
20. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 20
scans (1993, p. 489). There was no further assessment or examination measures by a speech-
language pathologist in order to confirm the diagnosis of aphasia. Even recently, Lauterbach and
cohorts determined aphasia in a case study solely based on the location of the lesion in the left
frontal cerebral area in the individual (2010). Both cases are illogical assumptions of an aphasia
diagnosis, with the knowledge of the literature examining the differences between adults and
children regarding the location of language functions in the brain. Differentiation between the
disorders of aphasia and language impairments need to be distinguished, and assessment and
measurement should be conducted in order to determine true aphasia in children.
Bates and colleagues noticed this trend in literature, and conducted a study focusing on
the differences between adults and children in regards to how unilateral lesions affect language
production (2001). An adult with a lesion in the left temporal lobe would typically present with
Wernicke’s, or receptive aphasia; however, children show significantly greater delays in
expressive vocabulary and grammar when there is a lesion involving the same area. Bates and
colleagues concluded that these children did not manifest true aphasic symptoms because the
effects of the lesion sites are vastly different in comparison to adults (2001). Therefore, it is
wrong to diagnose a child with aphasia solely based on the location of the lesion.
The research in this investigation illustrates that children are still developing speech and
language. The brain, being plastic, is often able to adjust to the changes imposed by a lesion,
unlike an adult. The location of the lesion does not determine specific symptoms in regards to
language deficits, as it does in adults. Due to these drastic differences, health professionals
should not be diagnosing children with aphasia.
The majority of the studies reviewed in this investigation suggested speech and language
intervention; however, no studies stated current protocols or provided recommendations in how
21. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 21
to proceed with intervention. Speech-language pathologists need to be aware of the language
differences between adults and children following stroke, as well as determine the most
appropriate intervention for the child. This profession plays an important role in developing
future research regarding speech and language assessment and intervention for this population of
children who have suffered a stroke.
22. ACQUIRED CHILDHOOD APHASIA: AN EXAMINATION OF DIAGNOSIS 22
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