emma's story. a new prognosis for agenesis of the corpus callosum
TRANSCRIPT
The Use of IM in Infancy
By: Lucy Barlow, CCC-SLP
Emma’s Study
Emma
• Born 6.22.05• Agenesis of the
Corpus Callosum• Failure to Thrive• Seizure Disorder • Global Developmental
Delays• Probable Cerebral Palsy
The Corpus Callosum
• is a band of over 200 million nerve fibers connecting the two sides (hemispheres) of the brain
• provides the main route for the transfer and integration of information between the two hemispheres of the brain
• Agenesis of the corpus callosum (ACC) is a birth defect in which the structure that connects the two hemispheres of the brain (the corpus callosum) is partially or completely absent
www.TheFetus.net
The sagittal section of a normal brain. The corpus callosum is represented in gray.
The coronal section of a normal brain. The corpus callosum is observed as a bundle of fibers crossing the midline (represented in gray).
A transverse section of a normal brain. The corpus callosum is observed as a bundle of fibers crossing the midline (represented in gray).
Corpus Callosum
living brain as seen
via MRI scan
Normal
Corpus Callosum
Parts of the Human Corpus Callosum
• In Emma’s case this entire structure is absent
Functional DeficitsPhysical Deficits-Initial Evaluation
• No core/trunk tone, unable to sit unsupported• No prone positioning• No step reflex• No protective balance reflex• Unable to weight bear on upper extremities• Limited reach/grasp behaviors/No pincher grasp• No crossing of midline• Presents in the 5th percentile on growth chart
Functional DeficitsSensory Deficits- Initial Evaluation
• Hypersensitive/Defensive to touch on face, hands or feet
• Severe gag reflex, with non-tolerance to a sippy cup or textured food
• Frequent rocking and head banging• Limited Visual Tracking/No eye contact • Visual fixation on geometric shapes• Severe startle reflex-easily upset/over stimulated in
crowds
Functional DeficitsCognitive/Language Deficits- initial
evaluation
• Excessive sleeping (18-20 hours per day) with limited arousal time
• Limited use of pragmatics• Limited oral movements for sound
production• Limited localizations to her name• Limited cause-effect behaviors• Limited & infrequent sound productions with
low volume (whispers)
The Beginning
• Results of REEL-2 indicate an age equivalency of 4 months in receptive language and 2 months in expressive language
• Traditional pre-linguistic therapy yielded minimal improvement (6 month gain after 18 months of therapy)
Why IM?
• This provider’s prior observations of the success of IM with cross-hemisphere difficulties
• Neuro rehabilitative aspects of IM• Prospect of stimulating hemispheric
communications• Motivation to achieve best possible outcome
for patient
Taking IM out of the box
• Develop Emma specific IM goals
• How to adapt IM exercises for a 22 month old developmentally delayed child?
• “stakeholder” discussion with parents
The Results-Physical
• Sitting unsupported• Moderate righting/balance reflex• Weight bearing of Upper extremities• Getting on knees & crawling• Grasping objects, banging objects together• Using pincher grasp• Crossing midline, reaching across midline
The Results-Cognitive/Language• After 3 sessions Mother reported marked increase in
babbling and volume• Consistent localization to name• Identifying familiar people by localizing head• Direct imitation of speech sounds• Rapid increase in babbling & jargoning sound
variety• Mouthing “Momma” and “bye-bye”• More affective behavior noted-laughing, smiling,
obviously understanding tone of speaker’s emotion
The Results-Sensory
• Frequently makes & maintains eye contact• Less visually defensive when objects
approach face/ startle reflex greatly reduced• Consistently eats textured foods without
gagging. Using pincher grasp to feed herself• Allows/enjoys use of Z-Vibe for oral
stimulation• Non-defensive when touching feet, hands or
face
“How to” guide?
• No 2 patients, regardless of age are going to be alike
• Think “out-of-the-box” and find what works• IM can lead to amazing improvements, even
if the treatment requires total “hand-over-hand” assistance
The Results…
Questions