Walking in the shoes of Neurological Disorders and Stroke - kelly
According to the National Institute of Health, Neurofibromatoses are genetic disorders of the nervous system that primarily affect the development and growth of neural (nerve) cell tissues. These disorders cause tumors to grow on nerves and produce other abnormalities such as skin changes and bone deformities. This condition is characterized by bilateral tumors (occurring on both sides of the body) on the eighth cranial nerve. The tumors cause pressure damage to neighboring nerves. Affected individuals may notice hearing loss as early as the teen years. Other early symptoms may include tinnitus (ringing noise in the ear) and poor balance. Headache, facial pain, or facial numbness, caused by pressure from the tumors, may also occur.
Kelly was the result of an uncomplicated pregnancy that ended in an induced delivery after 39 weeks gestation. She weighed 9lbs - 7 oz. at birth. She was diagnosed with failure to thrive and reflux at birth. By two months, she was successfully feeding from a bottle. She walked at 16 months and said her first words at 17 months, being slightly developmentally delayed. She was toilet trained at 31/2 years old. According to a parental report, she had mild articulation problems and received speech therapy for one and one-half years. Parent report also indicated mild coordination and visual perceptual problems, such as she had difficulty riding a bike because she did not like to have her feet off the ground. She did not receive services for motor difficulties.
At age 9 years, 2 months, Kelly was referred for a neuropsychological evaluation to assess her neurocognitive functioning as a result of parental concerns about academic difficulties in the areas of reading comprehension and math comprehension that began at the end of second grade. Testing indicated difficulty on free and cued story recall, measuring a weakness. In addition, on the NEPSY Memory for Names subtest, she was not able to build on rote memory for names, even after three learning trials. Her memory skills were on the WISC-IV were consistent with her performance on the NEPSY. She scored in the low average range on the Digit span, which is another task requiring her to attend to and manipulate verbally presented material; abstract relationships between concrete and abstract relationships between complex verbal materials. On a task requiring her to replicate designs using blocks, she struggled with correctly replicating the designs, responded quickly, and was unable to identify incorrect responses, indicating a weakness in the area of visual motor integration and may be related to problems with attention and concentration. Regarding sensory motor, Kelly appeared to have more difficulty with non-preferred left hand on sensorimotor tasks, which is consistent with her difficulties on block design subtest of the WISC-IV and supports issues with visual construction. When information is presented orally to Kelly, she appears to have difficulty with attention and concentration. Her oral expression abilities appear to be negatively impacted by executive functioning problems with concentration and organization.
By the end of grade five, Kelly’s confidence levels in the academic areas appeared to be decreasing. She demonstrated an ability to memorize for the day of the test, but could not recall the information she had learned unless “coaxed” for the appropriate answers. She did not appear capable of making application of the information she had previously learned. Without many hours of tutoring by her mother, she would likely fail any and all tests. As the workload quantity increased, Mrs. Hammett was most concerned that she would not be capable of “picking up the pace.”