Consequences:
The consequences of an anoxic event can range
from mild to severe depending upon the duration of the anoxic event, core body
temperature, and blood pressure (Lundren, 1986).
Disturbances in cognition, executive functions and/or physical
functioning can occur. Damage to the basal ganglia can produce physical
impairment in the form of general motor slowing, spastic and ataxic diplegia, dystonia or hemiplegia
Attention and Memory
Children who sustain an anoxic event
often display deficits in two primary domains: memory and attention. The most
common form of memory problem is the reduced ability to remember new
information. This is due, primarily, to the sensitive nature of the hippocampus
to decreased oxygen. For example, Shannon, a 13 year old 7th grader, sustained
an anoxic event following cardiac surgery. She had problems recalling academic
information presented in class, homework which was assigned, and scheduled
appointments without the use of compensatory memory
techniques.
Anoxic brain injuries can have an impact on different
aspects of attention. For example, problems in divided or alternating attention
may affect a child's ability to do multiple tasks simultaneously (e.g. listen to
a lecture and take notes at the same time or to demonstrate adequate cognitive
flexibility (e.g. think about one thing, then another and then return to the
original tasks. Slowness in processing information can give rise to attentional
problems and a child who may feel "overloaded" with too much information.
Travis, sustained an anoxic event from a near suffocation following "horseplay"
and is unable to simultaneously listen and take notes in class while his teacher
gives a lecture. When with friends he finds that he has difficulty following the
conversation when friends are talking in a group. Click here for more
information on attention.
Visuoperceptual
Changes in visuoperceptual abilities are also
observed following anoxia. The type of visuoperceptual impairment is dependent
upon the site of damage in the brain and the developmental age of the child.
Complex perceptual deficits result in being able abstract and organize and
interpret information derived from the sensory system. For example a child may
be able to "hear" (i.e. primary auditory input is normal) but not be able to
understand what he hears (e.g. being able to understand another child's verbal
communication such as humor, anger sarcasm, etc). Visuospatial deficits involve
problems in perceiving spatial relationships judging distance between objects or
self and 2 or more objects (e.g being able to play soccer because the child
doesn't know where she should be relative to where her teammates on the field).
Language
Basic expressive and receptive language abilities
following anoxic brain injury are generally preserved; however, in severe cases,
expressive deficits are reported. In these cases reduction in overall
spontaneous speech output, poor naming, perseverations and word-finding difficulties can be seen.
In some cases the expressive problems are so severe so as to warrant training in
augmentative communication.
Behavior and Personality
Children who sustain anoxic brain
injuries may manifest a variety of short term or long term changes in behavioral
and/or personality. During the acute hospitalization phase children may show a
whole range of behavioral changes including low tolerance for frustration,
irritability, verbal/physical aggression (i.e. "too much behavioral") to
problems in initiation, drive, lack of motivation (i.e. "too little" behavior).
Sometimes often these behavioral/personality changes are mistaken for symptoms
of depression or other forms of psychiatric disturbance (see Case Illustration
section). The following are examples of the type of short or long tern problems
that can occur after anoxic injury:
- reduced judgment
- loss of insight
- apathy or indifference
- impulsivity
- childlike, silly
- reduced emotional expression
- lack of concern for others
- reduced initiation or drive
- reduced planning, initiation, sequencing, execution of task
- behavioral or affective disinhibition
- concrete thinking
During the months following the event these
changes may continue or decrease. In the early changes of recovery it is
impossible to known whether there will be any permanent change in a child's
behavioral and personality. However, significant neurological illness/injury may
alter or distort the normal course of psychological or personality development.
For more information on this subject,
click here. These
changes can be temporary or permanent, and require proper conceptualization for
intervention at home and school.
Physical Functioning
The physical problems often
seen after an anoxic event can be transient or permanent. The type of physical
problem seen reflects the site of damage to the brain with problems in the basal
ganglia, cerebellum and/or motor cortex often being most affected. Common
problems include: