Guest guest Posted March 8, 2009 Report Share Posted March 8, 2009 I know this is an apraxia group, but I was hoping for insight on other language issues. I have yet to find a good support group for the language issues my son has. My questions is what kind of MRI would be warranted for a child with a history of a skull fracture (R temporal lobe) and aphasia-like speech. Specifically he has issues with syntax and semantics in addition to resolved apraxia (clearly not misdiagnosed, VMPAC scores to show that and I have had to whip them out to show people who doubt he has apraxia!) I remember reading long ago that sometimes MRIs were done awake with the patient giving verbal responses, naming pictures, reading passages, etc. He's 7 now and while he would probably be scared I feel he could cooperate and he reads at about a third grade level (he's in 1st.) His SLP mentioned that it would be interesting to see if there was some damage or lesions in his brain as a result of his injury. His speech and language improved drastically in the fall of '07 to the point where his apraxia could be considered " resolved " but he hasn't improved much in the last 12 months. Initially when he learned to read last April his speech started improving. He read and used final s's, his pronoun usage became more consistent and accurate as did his use of articles. We were hoping that SEEING proper language use might help him use it. Well now that he is a very fluent reader he is dropping plurals and articles in his reading too! He's reading out loud and writing in the same way he speaks and the improvement in his spoken language has stalled. He can get his point across, but his syntax is so confusing it is difficult for an untrained listener (or reader.) What proves the most difficult for him is the inability to answer an open ended question. He didn't ask a why question until about two weeks before his 7th birthday. He infrequently asks why now. He does great with choices. For example I reword all reading comp questions into multiple choice and he always gets the same answer and he can retell stories after reading them. He clearly understands reading better than spoken language. In addition to reading he has wonderful problem solving skills and has developed some very sophisticated coping techniques. Rarely does anyone (other than his SLP and I) believe that his language issues are as severe as they are. Most people don't even realize he has any issues. He's just a very sweet, well behaved and " shy " boy in the eyes of casual acquaintances. He's had cognitive testing (high normal IQ with superior ability in some subtests), chromosome tests were all normal, he doesn't have LKS and his two EEGs (sleep deprived and sleep induced/drugged) were normal although that doesn't fully rule out some form of epileptic aphasia. He has aphasic-like language. Sometimes he will expressively or receptively forget common words such as table, sink, refrigerator. Then the next day he is clearly using the word again. His pediatrician has not recommended testing, but his SLP feels it might shine a light on things. I just want to make sure I ask for the correct kind of referrals when he has his annual physical on Tuesday. Thanks! Miche Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2009 Report Share Posted March 9, 2009 You have to ask yourself if you do determine any new information what can you do with it? For example my 5yr 9mos ds is already in therapy. I'm not sure learning something new about his brain would lead to different therapies. That being said I generally feel that non-invasive tests should be considered. Bet wishes on whatever you decide, Sincerely, Debra > > I know this is an apraxia group, but I was hoping for insight on other > language issues. I have yet to find a good support group for the > language issues my son has. > > My questions is what kind of MRI would be warranted for a child with a > history of a skull fracture (R temporal lobe) and aphasia-like speech. > Specifically he has issues with syntax and semantics in addition to > resolved apraxia (clearly not misdiagnosed, VMPAC scores to show that > and I have had to whip them out to show people who doubt he has > apraxia!) > > I remember reading long ago that sometimes MRIs were done awake with > the patient giving verbal responses, naming pictures, reading > passages, etc. He's 7 now and while he would probably be scared I > feel he could cooperate and he reads at about a third grade level > (he's in 1st.) His SLP mentioned that it would be interesting to see > if there was some damage or lesions in his brain as a result of his > injury. His speech and language improved drastically in the fall of > '07 to the point where his apraxia could be considered " resolved " but > he hasn't improved much in the last 12 months. Initially when he > learned to read last April his speech started improving. He read and > used final s's, his pronoun usage became more consistent and accurate > as did his use of articles. We were hoping that SEEING proper > language use might help him use it. Well now that he is a very fluent > reader he is dropping plurals and articles in his reading too! He's > reading out loud and writing in the same way he speaks and the > improvement in his spoken language has stalled. He can get his point > across, but his syntax is so confusing it is difficult for an > untrained listener (or reader.) > > What proves the most difficult for him is the inability to answer an > open ended question. He didn't ask a why question until about two > weeks before his 7th birthday. He infrequently asks why now. He does > great with choices. For example I reword all reading comp questions > into multiple choice and he always gets the same answer and he can > retell stories after reading them. He clearly understands reading > better than spoken language. In addition to reading he has wonderful > problem solving skills and has developed some very sophisticated > coping techniques. Rarely does anyone (other than his SLP and I) > believe that his language issues are as severe as they are. Most > people don't even realize he has any issues. He's just a very sweet, > well behaved and " shy " boy in the eyes of casual acquaintances. > > He's had cognitive testing (high normal IQ with superior ability in > some subtests), chromosome tests were all normal, he doesn't have LKS > and his two EEGs (sleep deprived and sleep induced/drugged) were > normal although that doesn't fully rule out some form of epileptic > aphasia. He has aphasic-like language. Sometimes he will > expressively or receptively forget common words such as table, sink, > refrigerator. Then the next day he is clearly using the word again. > > His pediatrician has not recommended testing, but his SLP feels it > might shine a light on things. I just want to make sure I ask for the > correct kind of referrals when he has his annual physical on Tuesday. > > Thanks! > Miche > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2009 Report Share Posted March 9, 2009 Go see a Pediatric Neurologist who would be able to order an MRI and maybe answer some of your questions. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2009 Report Share Posted March 10, 2009 I have a 3 1/2 year old daughter, who you almost described perfectly in describing your son (except for the reading part). We are actually starting to teach her to read, specifically to address grammar/syntax. And like your son, she has some word retrieval problems and people outside the family and very close friends think she is very shy, which is not at all true. I am very interested in learning whatever you find out about the MRI. I feel like where at a critical point for her and nobody seems to know what to do next. You are lucky you have a good SLP, now that that she has essentially finished her PROMPT therapy, we can't seem to find an SLP to take her to the next step! We're doing most of the work ourselves. Please post any info. you find and If I learn anything, I'll post it as well. Good luck! -Deborah > language use might help him use it. Well now that he is a very fluent > reader he is dropping plurals and articles in his reading too! He's > reading out loud and writing in the same way he speaks and the > improvement in his spoken language has stalled. He can get his point > across, but his syntax is so confusing it is difficult for an > untrained listener (or reader.) > > What proves the most difficult for him is the inability to answer an > open ended question. He didn't ask a why question until about two > weeks before his 7th birthday. He infrequently asks why now. He does > great with choices. For example I reword all reading comp questions > into multiple choice and he always gets the same answer and he can > retell stories after reading them. He clearly understands reading > better than spoken language. In addition to reading he has wonderful > problem solving skills and has developed some very sophisticated > coping techniques. Rarely does anyone (other than his SLP and I) > believe that his language issues are as severe as they are. Most > people don't even realize he has any issues. He's just a very sweet, > well behaved and " shy " boy in the eyes of casual acquaintances. > > He's had cognitive testing (high normal IQ with superior ability in > some subtests), chromosome tests were all normal, he doesn't have LKS > and his two EEGs (sleep deprived and sleep induced/drugged) were > normal although that doesn't fully rule out some form of epileptic > aphasia. He has aphasic-like language. Sometimes he will > expressively or receptively forget common words such as table, sink, > refrigerator. Then the next day he is clearly using the word again. > > His pediatrician has not recommended testing, but his SLP feels it > might shine a light on things. I just want to make sure I ask for the > correct kind of referrals when he has his annual physical on Tuesday. > > Thanks! > Miche > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2009 Report Share Posted March 10, 2009 Thanks! I received some informative replies off list as well. It seems the MRI studies I read about are possibly what is called a function MRI which is a research tool and not yet used diagnostically. My son's SLP is great. We used to go to the Prompt Inst in Santa Fe and he saw Deborah Hayden there as well as an SLP working directly under Deb. When we moved Deb referred us to one of her trainers. We make the long trip to see her because she is just a top notch therapist all around. She almost never uses Prompt on him because he's beyond needing that, but she has come up with some great creative things to try to work with him language, but sometimes she is just stumped with him. I brought up the MRI because it was on the list of things to do from the neurologist he saw at ages 2.5, 3 and 5. We chose against it in the past initially because I didn't want him sedated and then later because he was making progress in therapy. When his apraxia started resolving and his language issues became much more apparent we did the EEG studies. Now I'm thinking we should look into the MRI. At the very least if there is a lesion it will give an answer and also give a medical reason to get more therapy covered by insurance. His fracture was small and on the right side with a clear CT scan (no swelling internal to the skull) but I always wonder if the impact on the opposite side of his brain did something int he language areas of the left side. It's my hunch and intuition (and I've usually been right about my kid!) that the apraxia and the language issues are two completely separate things that just happen to be in the same kid. On Tue, Mar 10, 2009 at 8:33 AM, djuner <djuner@...> wrote: > I have a 3 1/2 year old daughter, who you almost described perfectly in > describing your son (except for the reading part). We are actually starting > to teach her to read, specifically to address grammar/syntax. And like your > son, she has some word retrieval problems and people outside the family and > very close friends think she is very shy, which is not at all true. I am > very interested in learning whatever you find out about the MRI. I feel like > where at a critical point for her and nobody seems to know what to do next. > You are lucky you have a good SLP, now that that she has essentially > finished her PROMPT therapy, we can't seem to find an SLP to take her to the > next step! We're doing most of the work ourselves. Please post any info. you > find and If I learn anything, I'll post it as well. Good luck! -Deborah Quote Link to comment Share on other sites More sharing options...
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