1/2. dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour.The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
2/2. On the problems of speech compensation and fluctuating intellectual performance.Some of the factors involved in compensation of speech deficits following local brain lesions are enumerated. An illustrative case is presented of a right-handed patient who failed to become aphasic despite massive resections for glioma from the left hemisphere. The surprising degree of speech intactness is discussed according to theories of interhemispheric transfer of speech function and the possibility that the right hemisphere had originally been the dominant hemisphere for speech, a so-called "ectopic speech center." It has been known for many years that an aphasic patient with a left hemisphere lesion has a better prognosis if a family history of left handedness is present. A sister of the patient reported here, although right-handed, is shown by dichotic listening studies to be right hemisphere dominant for speech. Thus, it is suggested that this finding on dichotic listening tests in a close relative may prove to be a favorable prognostic sign for compensation of the speech function. The patient also showed fluctuating intellectual performance and a curious "warming up" phase for the individual neuropsychological tasks. Data is presented from simultaneous neuropsychological testing and an integrated EEG frequency analysis which demonstrates an electrophysiological and behavioral correlation. The question arises as to whether the fluctuations frequently seen in brain-damaged patients might have a similar electrophysiological association.- - - - - - - - - - ranking = 5.5keywords = speech (Clic here for more details about this article) |