Neurological Disorders in Pediatric Population Related to Dysphagia

Microcephaly

Head circumference more than 2 standard deviations below the mean for age and gender

Hydrocephalus

Abnormal accumulation of CSF in ventricles - puts pressure on the brain and often see decreased balance, confusion, and incontinence

Intraventricular hemorrhage

Bleeding into fluid-filled areas of the brain

Periventricular leukomalacia

Brain injury characterized by death of white matter

Birth asphyxia

Umbilical cord wrapped around the neck or lack of oxygen

Hypoxic ischemic encephalopathy

Hypoxia or ischemia to cerebral circulation and results in variable inflammation, injury or death of neural tissue

Cerebral Palsy

General term for group of nonprogressive movement disorders

Spastic CP

Spasticity is predominant impairment where hypertonic muscles due to UMN lesion

Choreoathetoid or dyskinetic CP

Mixed muscle tone that has involuntary movements and results from damage to basal ganglia or extrapyramidal tract (occurs in 10% of individuals with CP)

Ataxic CP

Least common type of CP as there is damage to the cerebellum and a lack of control in muscle movement and coordination which results in decreased fine motor control and muscle weakness

Mixed CP

Unpredictable in symptoms and development over lifespan and has symptoms of spastic, athetoid, and ataxic CP

Gross Motor Function Classification System (GMFCS)

Describes gross motor function of people with CP

• Decreased speed, balance, coordination

• Can walk indoors / outdoors, climb stairs without using railing

• Can run / jump

Level 1 of GMFCS

• Able to walk indoors, climb stairs with railing

• Difficulty with uneven surfaces, inclines, and crowds

• Minimal ability to run / jump

Level 2 of GMFCS

• Walks with assistive devices indoors / outdoors on level surfaces

• May be able to climb stairs with railing

• May be able to propel manual wheelchair short distances on level surfaces

Level 3 of GMFCS

• Walking ability severely limited even with assistive devices

• Generally, wheelchair users

• May propel own power wheelchair

• Standing transfers with assistance

Level 4 of GMFCS

• Physical impairments that restrict voluntary movement

• Impaired in all areas of motor function

• Cannot sit or stand independently, even with adaptive equipment

• Cannot walk independently but may use powered mobility

• Restricted ability to maintain head / neck position against gravity

Level 5 of GMFCS

• Assault

• Fall

• Motor vehicle crash

• Struck by or against object

Types of TBI

• Infection

• Stroke

• Tumor

• Substance exposure

• Poisoning

• Encephalopathy

• Hypoxia

Types of non-traumatic brain injury

Glasgow Coma Scale

Tool used to assess consciousness and track severity of brain trauma, particularly following head injuries

Seizures

Brief episodes of abnormal or excessive neuronal activity in the brain

Focal seizures

Start in one area of the brain and may spread to other regions

Generalized seizures

Abnormal activity in both hemispheres of the brain simultaneously and involve a loss of consciousness

• Focal

• Generalized

What are the 2 types of seizures?

Focal dyscognitive seizures

Awareness altered where person may appear confused or dazed

Focal seizures

Jerking movements that may begin in one limb or muscle group and spread to surrounding muscle groups

Tonic seizures

Sustained contraction of muscles of limbs followed by extension and arching of back where person often stops breathing

Clonic seizures

Involve shaking of limbs

Tonic-clonic seizures

Involve a tonic component followed by a clonic component

Myoclonic seizures

Spasms of muscle groups (e.g., just a leg)

Atonic seizures

Loss of muscle activity

Absence seizures

Subtle minor activity such as eye blinking or a turn of the neck

• Dysphagia due to neurological impairments or medication effects

• Altered consciousness

• Lethargy due to injury or medications

• Feed refusal due to irritability or behavioral issues

• Physical impairments and altered movements

• Fasting for medical procedures

People with neurologic disorders have reduced energy intake due to…

Reflux

Altered tone may increase the frequency of what?