AAC Intervention for Stroke Survivors - An Anomic Aphasic Case Study

Aphasia is an impairment of language that is a consequence of a cerebral insult or damage affecting the speech production and/or comprehension, as well as the ability to read or write. Etiology of Aphasia is multifactorial, most commonly in the form of a stroke (Cerebrovascular Accident), especially in older individuals. The type of aphasia is determined based on multiple factors such as the site of lesion, signs and symptoms and also through patient’s clinical presentation. Rehabilitation for stroke survivors plays a major role in communication effectiveness. Computerized Intervention method provides a prognostic factor in the treatment for adults with aphasia. AAC devices (high-tech) are used to enhance communicative effectiveness of aphasic individuals who are less likely to use strategies/techniques that the caregiver can use to foster interactions between themselves and the aphasic individual outside the treatment setting. Other factors that determine the success of the intervention are the intensiveness and the duration of intervention. This study focuses on one such intervention of an adult Anomic Aphasia patient using a high tech AAC computerized application known as Avaz. The results showed that the client was able to perform much better in terms of the word retrieving abilities and is now able to communicate well. Key words: Augmentative and Alternative Communications; Anomic Aphasia; Language intervention; Avaz; High tech.

Dyke-Davidoff-Masson Syndrome with crossed cerebellar atrophy

Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurological condition characterised clinically by recurrent seizures, facial asymmetry, hemiplegia and mental retardation likely due to foetal or early childhood cerebral insult. We describe the MRI findings of DDMS in a 10-year-old male child. MRI brain revealed right cerebral atrophy, ipsilateral thickening of calvarium, right lateral ventricular dilatation, hyper-pneumatisation of frontal sinus, and contralateral cerebellar atrophy which are consistent with DDMS.

Propofol–Bispectral Index (BIS) Electroencephalography (EEG) Pharmacokinetic-Pharmacodynamic Model in Patients With Post–Cerebral Hemorrhage Hydrocephalus

Background. Titrating hypnotic agents for patients who suffer from a cerebral insult is a challenging task. To date there is no real gold standard to precisely quantify electroencephalography (EEG) response in a fashion that could be utilized for patients with post–cerebral hemorrhage hydrocephaly. While we must administer “as per usual” analgesics for noxious stimuli, we have to administer the hypnotic agents more “sparingly” due to lack of objective monitoring. Methods. We compared 15 adult post–cerebral hemorrhage hydrocephalus patients undergoing ventriculo-peritoneal shunt placement with 15 controls matched for gender and approximate age. We set propofol target controlled infusion estimated plasma concentrations (Cp) to gradually reach 4 µg/mL over 4 minutes. To precisely quantify post–cerebral hemorrhage mental dysfunction, we used electronically retrieved bispectral index (BIS) and propofol Cp data points to create individual inhibitory monophasic mathematical model for each patient that incorporates an independent hysteresis “lag” function. Results. In post–cerebral hemorrhage patients Cp-BIS curve, C50 (propofol concentration associated with inhibitory 50% BIS response) cutoff point was significantly shifted to the left by 39%. Whereas before infusion and at stable propofol 4 µg/mL aneurismal surgical sides ipsilateral (75 ± 13, 25 ± 9) and contralateral (73 ± 15, 27 ± 9) mean ± SD BIS values were significantly lower than ipsilateral (95 ± 3, 46 ± 12) and contralateral (94 ± 3, 46 ± 12) matched controls. Conclusions. Using BIS as surrogate marker of propofol hypnotic effect, BIS monitoring in patients with post–cerebral hemorrhage hydrocephaly showed a pattern of change and trend that was similar albeit 39% significantly lower than subjects without.

Integrative monitoring of systemic hemodynamics and the oxygen-transport status and the choice of the intensive therapy tactics in patients, suffering an ischemic cerebral insult

Objective. To elaborate the intensive therapy tactic in patients, suffering ischemic cerebral insult (ICI) depending on changes in the systemic hemodynamics indices and the oxygen-transportation status.Маterials and methods. In 42 patients, suffering the ICI of middle severity, ageing 45 - 88 years old, the integrative monitoring of the neurological state severity, systemic hemodynamics indices and the oxygen-transportation status on background of targeted intensive therapy was conducted. Results. In the patients, suffering initial hypoxemia, a hypokinetic heart index (HI) - (2,0±0,1) l×min-1×m-2 and the lowered systemic delivery of oxygen (DO2) - (356±21) ml×min-1×m-2were revealed. Prophylactic oxygenation is needed if the value of the oxygen content in arterial blood (SаO2) exceeds 95% and DO2 is lesser than 520 ml×min-1×m-2. Aiming the achievement of eukinetic values of the HI, correction of vascular spasm and antihypertensive therapy was conducted, using alpha-adrenoblocking agent (urapydil) up to stabilization of the DO2 indices on the level of 520-600 ml×min-1×m-2. In hyperoxidal state a hyperkinetic HI - (3.6±0.1) l×min-1×m-2 and a raised DO2 - (699±14) ml×min-1×m-2 were revealed. Prophylactic oxygenation is not indicated if the value of the SаO2 index exceeds 95% and DO2 exceeds 600 ml×min-1×m-2. Aiming to achieve eukinetic values of HI it is mandatory to conduct antihypertensive therapy, using therapy with аlpha-beta-аdrenoblocking agent (labetalol). Conclusion. Targeted intensive therapy, oriented towards balance with general oxygenation of the organism tissues, normalizes the oxygen-transport homeostasis in shortest terms, what impacts the results of treatment in patients, suffering ICI, immediately.

Cerebral palsy: not always what it seems

Cerebral palsy (CP) is not a disease, but a neurological syndrome, a combination of signs and symptoms, some of which may occur in neurodegenerative or metabolic disorders, particularly those with an onset in the first 2 years of life. There are many different causes of the syndrome. All children with CP should undergo brain MRI, even with an identified antenatal or perinatal insult. Children with CP should be referred to a paediatric neurologist or a clinical geneticist, or both, if appropriate and particularly in the absence of a known perinatal cerebral insult, with brain MRI that is reported to be normal, a progression in, or new, signs or where there is a reported ‘family history of CP’. Finally, a few of the CP syndromes may be readily treatable and potentially prevent irreversible neurological and cognitive impairment.

Comparative Assessment of Severity of Dyselectrolytaemia (Sodium and Potassium) in Cerebral Infarction and Cerebral Hemorrhage

<strong>Aim:</strong> 1) To compare serum electrolyte levels (sodium and potassium levels) in cerebral Infarction and cerebral hemorrhage. 2) To compare serum electrolytes in thalamic and other intracranial hemorrhages. <strong>Material and Methods:</strong> In this retrospective type of study, we compared serum electrolyte levels of 70 patients, 45 diagnosed as cerebral infarction with the 25 patients, diagnosed as cerebral hemorrhage. The sample for electrolyte analysis was collected within first 24 hrs of onset of the event. <strong>Result:</strong> Statistical analysis was done by Z test and independent t test using SPSS 16 which showed statistically no significant difference in serum electrolyte levels in both groups there was also no statistical difference in serum electrolyte levels in thalamic hemorrhages compared to other intracranial hemorrhages. <strong>Conclusion:</strong> Electrolyte imbalance is common in cerebrovascular accidents and needs to be intervene as early as possible irrespective of the type of cerebral insult. Correction of electrolytes imbalance can help in better prognosis of the patient and may avoid complications.