Faculty Bibliography

Pediatric specialists are faced with many challenges when confronted with young patients diagnosed with acquired or congenital disabilities. In addition to the myriad of presenting medical issues, team members also need to acknowledge and address contributing psychological, social and environmental factors when working with medically involved children. Specifically, the understanding of developmental, cognitive, familial, and emotional considerations is essential for tailoring more successful individual treatment plans. The purpose of this article is to address the multidimensional aspects associated with the treatment of children presenting with physical or neurological impairments. Specifically, psychological and neuropsychological perspectives will be discussed and case examples will be presented in an effort to propose a comprehensive approach for the promotion of better outcomes in pediatric patient care

Five children (three males, two females; four right-, one left-handed; age range 6 to 14 years) who developed aphasia after gross-total excision of left predominantly thalamic tumors are reported. Three patients had Broca aphasia, one had mixed transcortical aphasia, and one patient had conduction aphasia. In the months after surgery, three children improved while receiving radiation and/or chemotherapy, although none recovered completely. Two patients with malignant tumors developed worsening aphasia when the tumor recurred, and later died. Two of three patients tested had visuospatial difficulties in addition to language deficits. Attention and executive functioning were affected in three of three patients tested. Memory, verbal and/or visual functioning, were affected in four of four patients tested. Both patients who were tested showed transient right hemineglect. Two of two patients tested were probably apraxic. The wide range of deficits in these children highlights the importance of the thalamus and other subcortical structures in developing cognition.