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Rehabilitation of Language Disorders in Adults and Children
Published in Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten, Tamara Ownsworth, Neuropsychological Rehabilitation, 2017
Anastasia Raymer, Lyn Turkstra
The paediatric aphasia rehabilitation literature is sparse. A search of the Speech Pathology Database for Best Interventions and Treatment Efficacy (SpeechBITE) revealed only one single case description of treatment of aphasia in a child (Lee Oelschlaeger and Scarborough, 1976), and a search of PubMed, PsychInfo and Google Scholar yielded only medical treatments. The absence of treatment studies is most likely because aphasia is rare in children, which in turn is because common aetiologies of aphasia, such as stroke, are rare in children; the incidence of stroke in children is 1 in 100,000 vs. 1 in 2300–5000 for perinatal stroke and 1 in 500 for stroke in adults (Tsze and Valente, 2011; Lynch, 2009; CDC.gov, 2016), although numbers may be higher in countries where stroke aetiologies such as sickle cell disease are common (e.g. Toure et al., 2008). While low incidence may be the major reason for the lack of paediatric aphasia treatment literature, other factors might include: (1) the erroneous belief that children have better language outcomes than adults, and thus will recover spontaneously (see critique by Dennis, 2010); (2) methodological challenges of differentiating treatment effects vs. spontaneous recovery vs. developmental changes; and (3) the multifactorial nature of childhood rehabilitation, which includes parents, school, peers, hospital therapists and school-based therapists, making it challenging to identify active and essential treatment ingredients. In the absence of formal treatment guidelines, readers are referred to general rehabilitation principles for acquired communication disorders in children, described in sources such as Allison, Byom and Turkstra (2017) and Ylvisaker and Feeney (1998).
Lessons learned from proteome analysis of perinatal neurovascular pathologies
Published in Expert Review of Proteomics, 2020
Paloma Menéndez-Valladares, Noelia Sola-Idígora, Alejandro Fuerte-Hortigón, Irene Alonso-Pérez, Cristina Duque-Sánchez, Ana M. Domínguez-Mayoral, Patricia Ybot-González, Joan Montaner
Perinatal stroke refers to the presence of ischemic or hemorrhagic brain injury between 20 weeks of fetal life and postnatal day 28 [24]. There are many risk factors associated with perinatal ischemic stroke, such as prothrombotic states, acute systemic disease, infection, heart disease, maternal and obstetric factors, and placental pathology [25,26]. The under-diagnosis of ischemic perinatal stroke is influenced by the fact that only half of patients become symptomatic during the neonatal period, so that in many cases they are detected by subsequent neurodevelopmental abnormalities. Perinatal hemorrhagic stroke causes greater morbi-mortality, and despite diagnostic efforts, most cases are idiopathic [27]. According to the American Heart Association/American Stroke Association, there is no evidence of hyperacute stroke therapies (thrombolytic agents or embolectomy) due to the frailty of the blood vessels [28].
Predictors of Cognitive and Academic Outcome following Childhood Subcortical Stroke
Published in Developmental Neuropsychology, 2018
Robyn Westmacott, Kyla P. McDonald, Samantha D. Roberts, Gabrielle deVeber, Daune MacGregor, Mahendranath Moharir, Nomazulu Dlamini, Tricia S. Williams
Childhood stroke often involves subcortical regions, including the basal ganglia and thalamus. Motor impairments have been documented consistently, but cognitive and academic outcomes have not been well characterized in this population. The majority of the neuropsychological research on pediatric stroke has focused on perinatal stroke, likely due to its relative frequency. Perinatal ischemic stroke occurs between 20 weeks gestation and 28 days after birth, whereas childhood arterial ischemic stroke occurs between one month and 18 years of age. Incidence of perinatal stroke is estimated to be as high as 1 in 2,500 (Cárdenas, Rho, & Kirton, 2011), but childhood stroke is much less common, with 0.6–13 cases per 100,000 children (Kirton, Westmacott, & deVeber, 2007). As a result, childhood stroke is much more difficult to study and little is known about the predictors of neuropsychological outcome in this group. Given the importance of the basal ganglia and thalamus in a variety of cognitive and affective processes, including attention, working memory, emotion regulation, encoding, retrieval, and executive function (Ardila, 2011; Frodl et al., 2017; Koziol, Barker, Joyce, & Hrin, 2014; Koziol & Budding, 2009), examination of neuropsychological outcome following childhood subcortical stroke is essential.
The significance of thrombophilia in paediatric thromboembolism
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2018
Sofie Sommer Hedegaard, Anna Christina Klein, Anne-Mette Hvas
During the first 28 days of life, the symptoms of an ischaemic stroke might be very difficult to recognise and the event will only be recognised later depending on the clinical picture. We registered a neonatal thrombosis, if the radiologist described signs of perinatal stroke on the MRI. Among the 14 children with neonatal thrombosis, eight children had an exogenous factor as explanation for the thrombosis as severe asphyxia, immaturity or infections, while five had thrombophilia. Only four of the 52 neonates with arterial thrombosis had an exogenous factor as possible explanation for the thrombosis, while four of the neonates with arterial thrombosis had factor V Leiden mutation.