Dudas sobre la ponencia de neurodesarrollo en daño cerebral pediátrico

Ana Belén Vintimilla answers questions about her presentation on neurodevelopment in pediatric brain damage


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Neuropsychologist Ana Belén Vintimilla responds to pending questions about her presentation on neurodevelopment in pediatric brain damage last March in #YoMeQuedoEnCasa learning with #NeuronUPAcademy at NeuronUP.

If you want to see the presentation in deferred it is available exclusively in NeuronUP

Doubts about the paper on neurodevelopment in pediatric brain damage

 

1. Noemí Puig González: Hello, Ana Belén. I would like to know how often you treat patients in cognitive rehabilitation on a weekly basis, in the clinical cases presented.

Hello, Noemí, the cases I have presented are usually worked in an interdisciplinary way, generally most patients have 2 sessions of 45 min (physiotherapy and TO), 2 sessions of 45 min of speech therapy and 2 sessions of 30 min of neuropsychology. The weekly cadence of the sessions and the schedules are usually organized according to the needs of each case, but the ideal is that they attend between 2-3 days a week and do 2 sessions a day. We must also take into account the therapies they receive in another center, for example, early care, school, hospitals, etc.

For example, neuropsychology sessions are designed to be shorter in duration with the objective of greater repetition throughout the week in conjunction with physiotherapy/TO or speech therapy sessions.

2. Lydia Amate Amaro: Hi, I’m Lydia, a psychologist and student of Clinical Neuropsychology. I am currently doing my internship in a center specialized in infantile cerebral palsy, ASD, among others. Talking to my tutor, who also does early care, she told me that she doesn’t know if it is casual or studied, but most, if not all, children with hemiparesis that she has treated are often cognitively inflexible. Therefore, my question would go to whether she knows of studies on this or has found it in her clinical practice.

Hello Lydia, cognitive rigidity is a very common symptom in pathology related to white matter damage, precisely because of the difficulty of handling information simultaneously and much more in the face of novelty, so neurocognitive profiles of cognitive rigidity is very common to observe in patients with pediatric brain damage, even in milder cases, is one of the symptoms and signs also more associated with behavioral difficulties. I wouldn’t say only in cases with hemiparesis but associated in general with brain damage.  For example, of the cases that I present, 1, 2 and 3 that have evolved very favorably cognitive rigidity continues to be one of the main objectives that we work with them and the etiology of each case is very different from the other.

3.Loli González Espejo: Good morning, my name is Loli González and I am a teacher at a C.E.E. in Madrid. I would like to thank Ana Belén for the talk which has been very interesting, practical and very respectful of the children and their families, a thousand thanks indeed. I would like to know if you have online training to complete this talk where I can access, enjoy and learn more about it.

Hello Loli, thank you for your words and I’m glad to have teachers in the audience, I really don’t do training, beyond some talks to which I am invited or some kind of specific masters, as for teaching I am one of those who prefer to teach on the battlefield and teach from experience and daily clinical practice.

4. andra Blay Villalba: I wanted to ask if in your opinion, there are tests or scales that can be reliably used to observe in a quantitative way the evolution of treatment in children with Cerebral Damage. Thank you very much!

Hello Sandra, in pediatric age we only have developmental scales, which in my opinion provide very little to monitor real evolution in a quantitative way, it can serve as a support, but all types of tests have the great disadvantage of having to interact with a very broad motor and verbal component, not being able to adapt to the motor skills of the patient and the compensations used to communicate voluntarily, so in the end it brings you very little, I recommend making observations and developments within the same work sessions and create the profile of each patient, in some cases in particular you can add certain tests or scales, but it will always depend on the case and your goal. For example, the Batelle if it has adaptations for children with motor damage. I usually use this type of tool in cases where it is necessary to set a pre-study and a post as it is usually in neurosurgical patients.

4. María Paredes: Good afternoon, my name is María Paradés, I’m from Jerez, but I’m currently working in Valencia. I found the talk very interesting, I share with you many ideas (teamwork, always work, even if it seems that no progress is made, etc). I have been working in the Valencian epilepsy association in collaboration with the Hospital de La Fe for three years, but I am currently working in another centre. I spoke to David de Civet when the centre in Jerez was about to open, but as it was something new it was a bit complicated for me to leave my job in Valencia to move there without something guaranteed.

With regard to the subject of alternative communication systems, I would like to know if you know of any resources, courses, books, etc, that could be used to train me in this subject. In the centres where I have worked, it is usually done by speech therapists and they give us some guidelines, but I think it is very interesting to also have knowledge in this subject. Thank you very much and greetings.

Hello Maria, training in alternative communication systems is quite scarce and basic, it is more oriented to the use of technological tools and they are usually organized by the companies that sell the equipment and programs, but at the level of neuropsychology I would not really know who does it, we in our team given the demand are training professionals from each area in this regard and planning a program focused on these patients (we have it as a project), the way we work now is coordinating between the areas and professionals, First, it is very important to adjust the orthopedic and physical therapy to properly position the patient. Once this objective has been achieved, the neuropsychology area works on the pre-requisites focused mainly on access, analyzing how to obtain voluntary and controlled responses from the patient, working on attention systems, visual monitoring of eye-hand coordination, cause-effect and concept acquisition (not only from the vocabulary), the communication objectives are carried out in coordination with the speech therapy area; We try to adjust to each case and coordinate with the objectives.

It is important to understand that we have two main objectives. 1. Access: where we have to analyze the variables that will allow the patient to manage one of these systems: (if it is going to be by communicators, optical mouse, iPad, etc) and 2. Content: where we work on the acquisition of communication, language, learning. This work if we do it from a single professional is very short, the success is in teamwork.

5. Eva Mª Cubero: First of all I would like to congratulate you for Ana’s presentation, it was wonderful! What book do you recommend about brain neurodevelopment? I know you mentioned one, but I didn’t get the title. Also, if you know/exist some book of clinical cases. Thank you again

Thank you, Eva. The book that I recommended to know more about general neurodevelopment is by María José Más (La aventura de tu cerebro), it is a very didactic book with a clear language to understand such complex processes that occur during neurodevelopment and above all it highlights a lot that importance of the interaction with the environment.

6. Sara Rivas Campoamor: In case 2, which was a hemiplegia, did you use restrictive therapy on the healthy side in the treatment?

Hi Sara, the professionals at the early care center just did that therapy a few months ago with this patient. We at our center, despite working a lot within the sessions with MSD, have not used that particular method, and during the period in which that intervention was performed, we changed objectives so as not to condition their goals.

7. Nuria Pecino Macias: I would like you to recommend any bibliography you consider interesting to know more about neurodevelopment, as well as pediatric brain damage. It was a very interesting talk.

Thanks Nuria, as a general book on neurodevelopment I recommend the one I talked about in the talk (the adventure of your brain, by María José Más, also her blog) and at a more specific level of brain damage I do not have one that I really like or that I consider to contribute, I think it is a very little studied population and therefore published, the things I find are very basic, always repeating the same thing, I think it takes a lot of real clinical experience of professionals to focus on books or articles,

8. Miriam Cabrera:

Good afternoon, I’m Miriam Cabrera, a speech therapist at an Early Care Center.

I saw this morning the lecture on neurodevelopment in Brain Injury by Ana Belén Vintimilla and I wanted to ask you a question. I have some children, who have no diagnosis beyond “maturity delay” and there is nothing in their medical history that makes us think that there is a problem at the neurological level (in the neurologist’s reviews they have not done any tests). However, we observe certain behaviors from all disciplines that make us think there has to be some alteration.

I put the case of a 5 and a half year old boy who:

  • It shows great difficulty in repeating a two-syllable sequence. (without difficulty in auditory discrimination tasks).
  • Has difficulty planning an activity such as imitating a cube construction or simply performing a two-step activity.
  • Activities must be broken down into small steps so that she understands what to do.
  • She can make mistakes over and over again in a task without knowing how to correct them, even when you tell her where the mistake is.

Do you know if it is possible to perform neurological tests that make us see what is failing when performing certain activities? I think what I mean is a functional MRI, but it’s not a test they normally do…

The child is making remarkable progress, but we are very intrigued by what we observe and doubt what may be causing it.

I don’t know if you could tell me if there’s any way to find out what might be altering it. I hope I’ve explained myself well. A greeting and thank you in advance!

Hello Miriam, I think that your observations are important to be taken into account by your referring doctors, since you are the one who is day to day with the child and can better relate those symptoms to something that is not going well, beyond immaturity; those cases are very common in early care centers, we get many cases without clear studies or diagnoses and when we evaluate them we know that there is something else that can explain those difficulties and the evolution of them.

If in your clinical history there are no risk factors for perinatal brain damage (hypoxia, stroke, immaturity or malnutrition) that information is usually in the reports of discharge at birth, the main thing would be to rule out more genetic pathologies, there are many genetic syndromes that are usually associated with the alteration of proper development of the frontal lobe and usually give symptoms as you say, despite the evolution always observed a significant difficulty in learning processes, understanding, verbal structure, fluency, etc..

It is usually advisable to make a report detailing the clinic you observe for your doctors of reference and that they can better guide the complementary tests and diagnoses.

A functional resonance in children is very rare, and neither would it have such an objective to do it, a complete neuropsychological study plus the contributions of all the professionals in your early care centre is the best complementary test in neurodevelopment 😉, the important thing is that your reference doctors read their reports and can make the best medical decisions that allow them to guide the etiological diagnosis.

9. Jessica Melgar Cabezas: I would like to know which objectives are a priority, or the order of the objectives when a child comes to us, which is more important? Where do we start? Thank you

Hello Jessica, it is a very global question to achieve a contribution of information that is more useful, since each case is unique and the objectives we consider in relation to the specific case, but as I said in my talk if they are children under 3 years, focus much on sensory objectives, we must work hard on the perception and objectives of parietal integration which is the basis for the acquisition after more complex concepts, besides contributing significantly to the evolution of motor disorders… remember that at the beginning of development it is fundamental to process sensory information from all the pathways (visual, auditory, somatosensory), the first thing to develop is the occipital and parietal areas, and in older children the main thing is to assess how the development of these areas is and if we observe disorders we start from there.

We must avoid learning only by repetition.

I give an example:

When we work with animals, if we do it only from vocabulary using the same cards, the only thing we will achieve is that he recognizes that drawing with that concept, but he won’t be able to transfer that learning. For a concept to be acquired in its totality, the whole concept must be worked on.

Cow: form, colors, sound, what it does, so that it serves, recognize it in group or by parts, in real photos, in drawings, to black and white, to colors, in its natural environment, etc etc, (parietal zones of association) and then introduce the concept in more complex tasks.

If you want to see the paper in deferred it is available exclusively at NeuronUP

If you liked this entry about neurodevelopmental issues in pediatric brain injury, you may be interested in more presentations from #YoMeQuedoEnCasa learning with #NeuronUPAcademy. You can find them in this link:

 

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