Aphasia in children and
adolescents
8.11.201
Brno/Brünn
Masaryk University
Dipl.-Log. Markus Heinzl Mania
FACULTY OF HUMAN SCIENCES - INSTITUTE FOR SPECIAL EDUCATION - III – ACADEMIC SPEECHTHERAPY/LOGOPEDICS
Traumatic brain injury and childhood aphasia
80 % accidental traumatic brain
injury
road accidents
crashes during play and
sports
physical violence
Abb.: fotocommunity.com
Dysphasia vs. Aphasia
central language disorder before
or during childbirth
normal language
development from the
beginning
aphasia
dysphasia
Abb.: https://study.com/academy/lesson/what-is-dysphasia-definition-causes-symptoms.html
Arterial ischemic stroke: Incidence rate
 acute focal arterial circulatory
disorder => Arterial ischemic
stroke => lasting damage
 incidence of about 3-5: 100.000
children / year
 Boys 2: 1
Abb.: https://www.chronobiology.com/de/
Atiology Pediatric stroke
 at any age
 accumulation in preschool age => parainfectious / infectious risk
factors
 adolescent age => systemic diseases and oncological conditions
 significant event for the victim and his family
 70% remaining damage
 problems of further social integration
 major cost burden for the welfare system
Incidence rate acquired childhood aphasia
• 3.000 children and adolescents/year => aphasia
• much higher number of affected persons => child's aphasia is an
unrecognized or neglected phenomenon.
Time is brain
Pediatric emergency situation
• Despite of a primary
manifestation of hemiparesis in
> 40% of cases
=> 2/3 of children are diagnosed
too late for interventional medical
therapy
Abb.: Fotolia/freshidea
Diagnosis Children with a stroke
• stroke is only diagnosed in 1/3 of the affected children within the 6 h
limit (Steinlin M., Pfister I.; Pavlovic J. et al (2005)
• 53% of the cases: delay in the diagnosis is due to inadequate
assessment of the situation by the parents or the physicians primarily
consulted
=> 42% of children with stroke: diagnosis was not primarily
suspected
=> 11% misjudged
(Brown KP, Chaplain LJ, Kirkham FJ, Veber G de, 2006)
Imaging diagnostics: CT and MRI
• Computed tomography (CT) is
organizationally feasible in most
hospitals
• The gold standard today is
magnetic resonance imaging
(MRI)
Abb.: Getty Images/Choul Jib Lee, TongRo Images
Causes and risk factors ischemic stroke
Pediatric stroke is a "multiple risk" problem
• > 50 % of the children 2 and more risk factors (Ganesan V., Prengler M., McShane
MA et al., 2003), (Steinlin M., Pfister I., Pavlovic J. et al., 2005)
• Recognizing them is helpful in estimating the likelihood of a stroke in
the acute situation
• the knowledge of the risk factors: prognostic statements,risk of
recurrence.
Causes and risk factors ischemic stroke
Infections
 most common risk factor for childhood arterial ischemic stroke
 31% of children with stroke (control group 9%) suffered from a
varicella infection in the previous year.
 other infections: Borrelia, mycoplasma, enteroviruses and
parvoviruses
 34% of the children (control group 9%) had a viral infection the month
before the stroke.
Riikonen R., Santavuori P. (1994)
Causes and risk factors ischemic stroke
Vasculopathy
 42-79% of children had abnormalities in their vessels during imaging
(Fullerton HJ, Qu YW, Sidney S et al.,2007)
Cardiac causes
 Second most common underlying risk factor.
Hereditary coagulopathies
 are usually not the main cause of a childhood stroke.
Metabolic diseases
 Rarely, however, important for pediatrics are metabolic strokes.
Repetitive risk
 15-20% The recurrence risk of a childhood stroke
 5-20% with TIA
(Fullerton HJ, Qu YW, Sidney S et al., 2007)
Mortality
• 16% on average
• increases to 40% in children with pre-existing severe illnesses
• decreases to 3% in previously healthy children
(Amlie-Lefond C., Sebire G., Fullerton HJ. , 2008)
Effects of a stroke
• Hemiplegia
• Aphasia
• Epilepsy
• Swallowing disorder (Dysphagia)
• Cognitive development:
(low) normal IQ score (85-95)
• Pronounced mood swings
long-term problems and impaired quality of life for adolescents
causes depression, agressivity and mood swings
Accompanying symptoms Frontal brain damage
Performance disorders
• Visuospatial functions
• Concentration
• Attention
• Memory disorders
• Behavioral abnormalities
• Agression
• Hyperactivity
Normal language aquisition
• 8. year: language development is
completed
• reading and writing are still
relatively fresh and are often not
well controlled
• additional language skills, such
as Idioms etc.: up to the age of
12-14 years
Abb.: http://logopaediewiki.de/wiki/Sprachbaum
Abb.: http://logopaediewiki.de/wiki/Sprachbaum
Aphasia: Loss of language ability
• loss of an already acquired language ability
• The term is also applied to children who have not yet completed
speech development
• in this context that aphasia must be a reduction or loss of existing
language functions
• shows a significant difference to language developmental disorders
• infantile aphasias occur after or during an initially normal language
acquisition and are the result of a clearly circumscribed event
Impairment of language
• in the least case means a temporal impairment of language
development
• in the worst case:, language skills and abilities are spilled
• Language can only be learned with difficulty and not in the quality of
the native language
• remains permanently impaired in its development
• in particular, the field of written language is often and persistently
affected
• Often, the ability to write and read is much more impaired than the
spoken language.
Input/Output linguistic impairments
• Word finding
• Speech understanding
• Writing
• Reading
There is no mental retardation!
Mutism and hypospontaneity of speech
• Mutism: is one of the main
symptoms of childhood aphasia
• "hypospontaneity of speech„: a
reduction of the spontaneous
language, follows the mutistic
phase.
• the lack of initiation of speech
Abb. chromorange/Reinhold Tscherwitschke / CHROMO
Psychosocial effects
• the aphasia has great effects for the child and the relatives
• friends withdraw, the child becomes aggressive or depressed
• parents and relatives are helpless
Schooling
• Schooling: obstacles for aphasic
children and adolescents
• Aphasia in children and
adolescents has not been
anchored in any school concept.
Abb.: https://commons.wikimedia.org/wiki/File:Grundschule_Haus_St_Marien_Neumarkt_-
_Klassenzimmer_13.JPG
Prognosis
• > 50 % of the surviving children recover completely or show minimal
neurological deficits
• Prognostically unfavorable factors are young age in stroke, male sex,
bilateral or large-volume infarctions (Boardman JP, Ganesan V, Rutherford MA et
al.,2005); Steinlin M, Pfister I, Pavlovic J et al., 2005)
• 42% of children show severe to moderate residual hemiplegia (Askalan R,
Laughlin S, Mayank S et al., 2001)
Prognosis
• Regarding the recovery and linguistic abilities of aphasia in children,
the prognosis and course vary widely in individual cases
• The main factors that are most commonly referred to in the context
of recovery are
 age of the child at the onset of the impairment
 type of injury
 long-term development of childhood aphasia is rather unclear.
Prognosis
• traditional view: better than adult aphasia
• Today: no longer as good as adult aphasia
• Factors such as age and gender are not as important as the type of
causation
• even in long-standing or chronic aphasia especially in children
recovery successes are still possible
Logopedic diagnostics
• complete a picture as possible of the linguistic abilities
• Aim: to build on it therapeutically
• This includes: detection of the linguistic level before the brain
damage.
• differentiate between language development disorder and child
aphasia
Logopedic diagnostic
• the aphasic impairment of children and adolescents is probably the
most striking phenomenon
• But: it is not the only one
• the entire child's personality experiences impairments
• Aim: capture the child in all its personality.
• affected children: not only have impaired abilities and achievements
Logopedic diagnostic
Szenario-Kids
• A Participation-based Test for 8to
15-year-old Children with
Aphasia
L. Plum, R. Nobis-Bosch, F. Krzok,
M. van de Sandt-Koenderman, K.
Willmes, S. Abel (2015)
Abb.: christianchan / fotolia.com
Logopedic therapy
Essential therapy tasks are
• the restoration of those language abilities that the child had before
the damage
• learning of new (linguistic) skills, e.g. literacy skills
• The special feature of the rehabilitation of aphasic children is
therefore the linking of working methods that serve the restoration
and acquisition of language skills under individually complicated
learning.
Logopedic therapy
Child's language acquisition
capacity is not affected by the
child's aphasia
• Therefore, it is not enough if
once existing skills are re-
learned
• the stimulation of the ability to
re-learn is at the center of
rehabilitation
Abb.: TOM Jochen Enterprises, Berlin
Neurological rehabilitation
• neurological rehabilitation facilities offer specialized therapy
programs specifically for aphasia in childhood and adolescence
• the therapy units can be carried out either in individual or in group
sessions
• usually performed stationary over several weeks.
Outpatient Therapy
• If the inpatient rehabilitation is completed and the outpatient therapy
is carried out by speech therapists
• speech therapy are carried out at the place of residence
• therapists should have at least experience in both the treatment of
childhood language developmental disorders and adult aphasia
therapy
Elemtary schools and special education
• there is no aphasia-specialized
schools and the normal school is
usually overwhelmed
• special education areas: aphasia
can only be classified
insufficiently
• Aphasia is neither physical
disability, learning disability nor
behavioral problems
Abb.: https://www.gettingsmart.com/2016/07/bridging-the-knowledge-gap-of-special-
education-students/
Děkujeme vám za pozornost!
Thank you very much for your
attention!
Vielen Dank für Ihre
Aufmerksamkeit!
Dipl.-Log. Markus Heinzl Mania
FACULTY OF HUMAN SCIENCES - INSTITUTE FOR SPECIAL
EDUCATION - III – ACADEMIC SPEECHTHERAPY/LOGOPEDICS
Abb.:
https://de.depositphotos.com/62067009/stock-
photo-person-with-megaphone-in-hand.html
Literature
1. Amlie-Lefond C, Sebire G, Fullerton HJ (2008) Recent development in
childhood arterial ischemic stroke. Lancet Neurol 7: 425-435
2. Askalan R, Laughlin S, Mayank S et al (2001) Chickenpox and stroke in
childhood: a study of frequency and causation. Stroke 32: 1257-1262
4. Boardman JP, Ganesan V, Rutherford MA et al (2005) Magnetic image
correlates of hemiparesis after neonatal and childhood middle cerebral
artery stroke. Pediatrics 115: 321-326
5. Brown KP, Chaplain LJ, Kirkham FJ, Veber G de (2006) Diagnostic
pitfalls in pediatric ischemic stroke. Dev Med Child Neurol 48: 985-990
Literature
7. Everts R, Pavlovic J, Kaufmann F et al (2008) Cognitive functioning,
behavior and quality of life after stroke in childhood. Child Neuropsychol 14:
323-338
8. Forum CNS: aids for children with aphasia. CNS - Hannelore Kohl
Foundation. Forum CNS, issue 2/2007, p.1f.
9. Fullerton HJ, Qu YW, Sidney S et al (2007) Risk of recurrent childhood
arterial ischemic stroke in a population-based cohort: the importance of
cerebrovascular imaging. Pediatrics 119: 495-501
10. Ganesan V, Prengler M, McShane MA et al (2003) Investigation of risk
factors in children with arterial ischemic stroke. Ann Neurol 53: 167-173
Literature
11. Kubandt M. (2009) Aphasie bei Kindern und Jugendlichen.
Pediatrics 115: 321-326
12. Loew, M./Böhringer, K .: Childhood aphasia. Contributions to the
neurological rehabilitation of children, adolescents and young adults.
Series of publications Jugendwerk. Gailingen 2002
13. Mhplusdu. The info magazine of your health insurance: Speechless.
Helps for children with aphasia. 4/2007, p.16-18
14. Neuronal- the journal for the neurological patient: Model project
"Education of aphasic children". Issue 3/2007, p.24-25
Literature
15. Rother, A .: Childish aphasia. In: LOGOS Interdisciplinary 2/2005, p.
90-92
16. Riikonen R, Santavuori P (1994) Hereditary and acquired risk factors
for childhood stroke. Neuropediatrics 25: 227-233
17. Spencer, P.G .: Childhood Aphasia - Backgrounds and Practice. NOT
3/2006, p.24-26
18. Steinlin M, Pfister I, Pavlovic J et al (2005) The first three years of
the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based
study of incidence, symptoms and risk factors. Neuropediatrics 36: 90-
97
Literature
19. Steinlin M. (2008)Kindlicher Schlaganfall:Wann daran denken? Was
unternehmen? Monatsschrift Kinderheilkunde 1223: 1232