Steenkristensen9632

Numerous technologies have been introduced for the diagnosis, treatment, and management of patients with neurologic disorders, offering the promise of early diagnosis, tailored and individualized interventions, improvement in quality of life, and restoration of neurologic function. Many of these technologies have become available commercially without having been evaluated by rigorous clinical trials and regulatory reviews, or at the least by peer review of results submitted for publication. A subset is intended to assess, assist, and monitor cognitive functions, motor skills, and autonomic functions and as such may be applicable to persons with developmental disabilities. Barriers that have previously limited the use of technologies by persons with neurodevelopmental disabilities are disappearing as new technologies that have the potential to substantially augment diagnosis and interventions to enhance the daily lives of persons with these disorders are emerging. While recent and future advances in technology have the potential to transform their lives, cautious and thoughtful evaluation is needed to ensure the technologies provide maximal value. As such, further work is needed to demonstrate feasibility, efficacy, and cost-effectiveness, and technologies should be designed to be optimized for individual use.The paramount importance of research design and research methodologies within the shared space of neurology, clinical neurophysiology, and cognitive neuroscience serves as the theme around which a range of topics is presented. After a tour of historical figures of human electrophysiology and electroencephalography (EEG), the discussion turns to event-related potential (ERP). Emphasizing the lengthy history of these manifestations of cognition, the chapter outlines the extensive research literature that has demonstrated the sensitivity of ERPs to a range cognitive functions, including attention, language processing, and memory. There follows a series of examples of ERP applications in the clinical domain, including disorders of consciousness, stroke, autism, coma, and concussion. These examples not merely demonstrate the general utility of these electrophysiological responses but stress that their independence from behavioral responses provides a much needed clinical method to assess individuals who are literally or virtually impossible to assess using traditional behaviorally based clinical tools. The chapter concludes with the suggestion that is time that the incontrovertible utility of ERPs be employed more fully within clinical contexts to assist the clinical community in providing objective assessments of a range of neurologic conditions.Among the range of methods available to assess neurodevelopmental disorders, functional MRI (fMRI) has been a preferred tool of choice. Indeed, fMRI can reveal functional alterations in brain networks, irrespective of their structural integrity. Yet, whether fMRI studies have provided unique added value and influenced the clinical care and assessments in children with these conditions remains controversial. This chapter aims to give an overview of the clinical use of task-based as well as resting-state fMRI in children with neurodevelopmental disorders, such as dyslexia, DLD, and epilepsy. We introduce analysis methods that appear promising (namely PPI and machine learning) and describe strengths and limitations of fMRI in the field of pediatrics. Altogether, we suggest that fMRI has provided us with a unique understanding of some developmental conditions. Indeed, findings from group studies have both informed neuroanatomical models and revealed compensation mechanisms. In addition, improvements have made fMRI an increasingly child-friendly method. Nevertheless, clinicians should be aware of limitations, including (1) lack of replication of results, (2) the limited specificity as a diagnostic tool, and (3) difficulties with interpretation of findings. The use of fMRI in the clinic currently remains restricted, with the exception of epilepsy surgery planning, where it is used routinely.Characterizing the neuroanatomical correlates of brain development is essential in understanding brain-behavior relationships and neurodevelopmental disorders. Advances in brain MRI acquisition protocols and image processing techniques have made it possible to detect and track with great precision anatomical brain development and pediatric neurologic disorders. In this chapter, we provide a brief overview of the modern neuroimaging techniques for pediatric brain development and review key normal brain development studies. Characteristic disorders affecting neurodevelopment in childhood, such as prematurity, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), epilepsy, and brain cancer, and key neuroanatomical findings are described and then reviewed. Large datasets of typically developing children and children with various neurodevelopmental conditions are now being acquired to help provide the biomarkers of such impairments. While there are still several challenges in imaging brain structures specific to the pediatric populations, such as subject cooperation and tissues contrast variability, considerable imaging research is now being devoted to solving these problems and improving pediatric data analysis.The purpose of a pediatric neuropsychologic assessment is to evaluate cognitive, behavioral, sensory-motor, perceptual, and socioaffective functioning. learn more A standardized, validated set of tools, questionnaires, and qualitative methods is applied to this end. The neuropsychologist integrates the results of the formal assessment, the case history, and third-party observations to interpret the individual findings across disciplines and draw conclusions about brain-behavior relationships. Various indications for neuropsychologic assessment include the identification of neurodevelopmental difficulties and the characterization of the impact of medical conditions or a pharmaceutical treatment. Prior to the evaluation, as much information as possible must be gathered about the child for efficient and accurate planning. In the context of pediatric neuropsychologic assessments, special challenges requiring more flexibility as regards the duration of the assessment, the use of different age-specific tools, or particular sensitivity when interacting with the child may arise.