ColoradoPediatric Stroke Parent

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Stroke Today

Expert Corner

March 2012

Family SpotlightWhat is a clinical neuropsychologist and why are they seeing my child?By Richard Boada PhD

Most families have not heard of a clinical neuropsychologist, and are therefore

surprised when they are asked to have their child evaluated by one as part of

the Children’s Hospital Colorado Stroke Clinic. I write this column in order to

shed light on our profession, and the integral role that neuropsychologists have

on the stroke team.

A clinical neuropsychologist is first a clinical psychologist (without the “neuro”

part), with an appropriate doctorate degree (e.g., Ph.D. or Psy.D.) and a license

to practice clinical psychology. The “neuro” part comes afterwards, once we

have obtained additional post-doctoral training in our subspecialty. Clinical

neuropsychology studies the relationship between brain and function. The

latter is a broad term that covers a variety of skills and behaviors, including

thinking and reasoning, language, memory, attention, motor skills, visual-spatial

skills, academic s (e.g., math, reading), and higher level abilities such as

planning, organizing and multi-tasking. Function also includes social, emotional

and behavioral regulation. These skills and abilities are controlled, like

everything else we do, by our brain. Although the brain works as a whole,

different parts contribute differently to these functions. Sometimes, an injury

can be specific enough that only certain functions are affected and not others.

When a child has suffered a stroke, a pediatric clinical neuropsychologist will

perform an evaluation to determine how, and to what extent, the brain injury

has affected these functions, and what can be done to improve them. The

evaluation is a complex process, and can have multiple parts, depending on the

age of the child. For most children, the neuropsychologist will interview the

family and child, obtain information from school teachers or tutors, performs a

variety of tests, and integrate information about the nature of the stroke (e.g.,

location, size, type of stroke). Depending on the pattern of results, the

neuropsychologist will provide a diagnosis and also a set of treatment recom-

mendations. He or she will often also consult with other medical professionals,

including neurologists, psychiatrists, and rehabilitation professionals.

Young children (e.g., below age 5) are also evaluated by the neuropsychologist,

but the focus is more on the skills and abilities that children exhibit at those

young ages. Tests are selected so that they are appropriate for the child’s

developmental level and linguistic background. It is also important to point out

that the types of tests that neuropsychologists use do not hurt; they are quite

similar to what a child might do in school.

Having a thorough understanding of how a child functions after a stroke helps

the stroke team implement specific interventions and treatments to improve

outcome. It also helps the team track the child’s progress over time, to make

sure that things are improving as they should. If things are not going well, it is

important to know that too, so that further evaluations can be requested and so

that changes to treatments can be made. Finally, our goal is to have the child

return to what they need to be doing as children – learning and playing. To

that end, the results of a neuropsychological evaluation are also used by

teachers and other school personnel to facilitate a successful transition back to

the classroom, with appropriate supports and accommodations, as needed.

Children and adolescents who have suffered a stroke will be seen by the various

members of the stroke team on various occasions, to make sure that the child

is getting better. One of these follow-up visits will be with the clinical neuropsy-

chologist, so that progress in the various functions discussed above can also be

monitored. As is hopefully clear from this brief description, a neuropsychologi-

cal evaluation is a critical component of a child’s treatment when they have

suffered a stroke. We are very fortunate to have the opportunity to work

together with the rest of the stroke team professionals, with the overarching

goal of making children feel and do better.

Jaden,

Being the parent of a special needs child is very challenging and has proven to be the most emotional experience in my life so far. Some days are good while others are harder, making me ask a question I will never know the answer to- why did this happen to my child? It is important to take into consideration the effect that having a child who is a stroke survivor has not only on my son Jaden, but also on our family, friends and everyone we meet. People tell me I am the strongest person they have ever met, and while this is an amazing compliment, I can’t help but think that it is Jaden who is strong, not me.

The hope I see in Jaden and the inspiration he gives others has led me to raise awareness about infant/childhood stroke. The impact of Jaden’s stroke has been life-changing for our family and other like us who have had a child diagnosed with stroke. However, through it all we have found strength and remain thankful in knowing that Jaden and others like him will achieve success and believing in him even when he may not believe in himself. Jaden has shown us to cherish the small things -- sitting up, tying our shoes, clapping our hands and what it means to have a life free of occupa-tional therapy, physical therapy and speech therapy.

My son has changed people’s idea of what it means to have the diagnosis stroke. He has inspired me to encour-age people to speak openly about medical conditions and meet with members of the community to share our story, spread information and help patients and their families cope with this life changing diagnosis, the diagnosis of childhood stroke.

Please visit our blog website or e-mail me directly if you have questions or would like to connect. www.jadenstory.blogspot.com

Christina BrownE-mail:christinaandroy@yahoo.com

The Colorado Pediatric Stroke Parent Support Group (CPSPSG) newsletter is a new addition to the CPSPSG and we are excited to announce this as our first issue. In the future, the Stroke Spotlight will contain information on research and breaking news about stroke in infants, children, and young adults. In coming months we hope to tailor this section based on feedback and questions we receive from our CPSPSG families, however, for our first issue, we hope to provide a little history on how the CPSPSG came to be.

The CPSPSG was started in 2010 as an extension of the services offered by the Children’s Hospital of Colorado Pediatric Stroke team in an effort to provide support and education to families impacted by pediatric stroke. Additionally, the CPSPSG hopes to build community awareness for pediatric stroke and serve as advocates for our families. In December of 2010 the CPSPG was awarded a grant from the Professionals Miracles foundation that has facilitated the development of our newsletters and will also continue to provide funding for CPSPSG meetings like our first meeting held in April of 2011. The CPSPSG is directed by Dr. Tim Bernard and Whitney Hoover. Also, Jessica Jack has recently joined the leadership team for the CPSPSG and brings another great facet to our group. Dr. Bernard has been a prominent childhood stroke specialist in Colorado since 2007 and is the director of the Children’s Hospital Colorado Pediatric Stroke program. Whitney has worked in pediatric stroke research for the past two years and is currently a medical student at the University of Colorado along with Jessica. As our newest CPSPSG co-Director Jessica has become involved with pediatric stroke through research and her involvement in the pediatrics interest group within the School of Medicine. On behalf of our CPSPSG leadership team and the many other providers who work with us, thank you for becoming involved with the CPSPSG and please let us know if you have any suggestions.

Please take this

SURVEY

Editors: Whitney Hoover and Jessica Jackstrokesupport@childrenscolorado.org.

Jaden, 19 months and Micah, 5 years