INHOUDSOPGAVE
DEEL 1: neuropsychologische symptomatologie (volwassenen en ouderen).......................................... 11
H1 visuele waarneming ................................................................................................................... 11
1.1 visuele waarneming ............................................................................................................... 11
1.2 stoornissen in de visuele waarneming .................................................................................... 12
1.2.1 lagere orde visuele stoornissen ........................................................................................ 12
visuele velddefecten ............................................................................................................ 12
andere lagere orde visuele stoornissen ................................................................................. 13
visuele hallucinaties en illusies ............................................................................................. 13
1.2.2 midden orde visuele stoornissen ...................................................................................... 14
cerebrale (hemi-)achromatopsie .......................................................................................... 14
cerebrale akinetopsie ........................................................................................................... 14
visuele agnosie .................................................................................................................... 14
1.2.3 hogere orde visuele stoornissen ....................................................................................... 15
visuele agnosie .................................................................................................................... 15
prosopagnosie ..................................................................................................................... 16
H2 ruimtelijke cognitie .................................................................................................................... 17
2.1 perceptie .............................................................................................................................. 17
2.1.1 stoornis in de lijnoriëntatie............................................................................................... 17
2.2 aandacht .............................................................................................................................. 17
2.2.1 simultaanagnosie............................................................................................................ 17
hiërarchische stimuli............................................................................................................ 17
illusoire conjuncties ............................................................................................................. 18
2.2.2 hemispatiaal neglect ....................................................................................................... 18
heterogeniteit van hemispatiaal neglect ................................................................................ 18
test ..................................................................................................................................... 18
neglect dyslexie ................................................................................................................... 19
neglect dysgrafie .................................................................................................................. 19
neglect versus extinctie ........................................................................................................ 19
2.3 geheugen .............................................................................................................................. 20
2.3.1 stoornissen in het leren van een route .............................................................................. 20
topografische desoriëntatie .................................................................................................. 20
topografische agnosie of landmark-agnosie .......................................................................... 20
topografische amnesie ......................................................................................................... 20
relatie deficits en bepaalde letsels ........................................................................................ 21
links-rechtts verwarring ........................................................................................................ 21
, 2.4 praxis.................................................................................................................................... 21
2.4.1 visuoconstructie praxis ................................................................................................... 21
2.4.2 optische ataxie ............................................................................................................... 22
optische ataxie versus apperceptieve agnosie ....................................................................... 22
H3 geheugen .................................................................................................................................. 23
3.1 geheugenklachten ................................................................................................................. 23
3.2 stoornissen in het kortetermijngeheugen en werkgeheugen ..................................................... 23
3.3 het amnestisch syndroom ...................................................................................................... 23
3.4 andere geheugenstoornissen ................................................................................................. 24
3.4.1 transient global amnesia (TGA) ........................................................................................ 24
3.4.2 posttraumatische amnesie (PTA) ..................................................................................... 24
3.4.3 psychogene amnesie of fugue .......................................................................................... 25
3.4.4 andere selectieve geheugenstoornissen ........................................................................... 25
H4 taal ........................................................................................................................................... 25
4.1 afasie ................................................................................................................................... 25
4.1.1 woordvindingsstoornissen ............................................................................................... 25
4.1.2 stoornissen in de vloeiendheid ......................................................................................... 26
4.1.3 problemen in de zinsbouw ............................................................................................... 26
4.1.4 stoornissen in het taalbegrip ............................................................................................ 27
4.1.5 stoornissen in het naspreken ........................................................................................... 27
4.1.6 stoornissen in het lezen en schrijven ................................................................................ 27
4.1.7 taxonomie van afasiesyndromen ...................................................................................... 28
broca, motorische of expressieve afasie ................................................................................ 28
wernicke of ‘sensorische’ afasie ........................................................................................... 29
conductie of ‘centrale’ afasie ............................................................................................... 29
globale of totale afasie ......................................................................................................... 29
transcorticale afasie ............................................................................................................ 30
amnestische of anomische afasie ......................................................................................... 30
4.2 verbale dyspraxie en dysartrie ................................................................................................ 30
H5 aandacht en executieve functies ................................................................................................ 31
5.1 stoornissen in de aandacht .................................................................................................... 31
5.1.1 vertraagde informatieverwerking ...................................................................................... 31
5.1.2 stoornissen in de selectiviteit van aandacht ...................................................................... 32
stoornis in de gerichte aandacht ........................................................................................... 32
stoornis in de verdeelde aandacht ........................................................................................ 32
5.1.3 stoornissen in de intensiteit van aandacht ........................................................................ 32
stoornis in de volgehouden aandacht .................................................................................... 32
, stoornis in de arousal ........................................................................................................... 32
5.2 stoornis in de executieve functies ........................................................................................... 34
5.2.1 dysexecutief syndroom.................................................................................................... 34
kenmerken .......................................................................................................................... 34
Letsel: ................................................................................................................................. 34
diagnose ............................................................................................................................. 35
5.1.2 apatisch of amotivationeel syndroom ............................................................................... 35
5.1.3 pseudopsychopatisch syndroom ..................................................................................... 35
H6 emotie en sociale cognitie ......................................................................................................... 36
6.1 stoornissen in emotie en sociale cognitie ................................................................................ 36
6.1.1 verschillende niveau’s ..................................................................................................... 36
6.1.2 illlustratie ....................................................................................................................... 36
H7 actie en motoriek ...................................................................................................................... 36
7.1 belang van actie en motoriek binnen de neuropsychologie ....................................................... 36
7.2 hemiplegie en hemiparese ..................................................................................................... 37
7.3 apraxie .................................................................................................................................. 37
7.3.1 imiteren van handbewegingen ......................................................................................... 37
7.3.2 gebruik van voorwerpen ................................................................................................... 37
7.3.3 uitbeelden van het gebruik van voorwerpen (pantomime) .................................................. 38
7.3.4 pantomime versus het uitbeelden van betekenisvolle gebaren .......................................... 38
7.3.5 classificaties .................................................................................................................. 38
classificatie op basis van lichaamsdeel ................................................................................. 38
classificatie op basis van sensorische modaliteit ................................................................... 39
classificatie op basis van type beweging ................................................................................ 39
7.4 optische ataxie ...................................................................................................................... 40
7.5 Alien hand syndroom (AHS) .................................................................................................... 40
H8 overview ................................................................................................................................... 40
8.1 clusters van neuropsychologische symptomen ....................................................................... 41
8.1.1 redenen .......................................................................................................................... 41
8.1.2 implicaties ...................................................................................................................... 41
DEEL 2: werkcollege (volwassenen en ouderen) ................................................................................... 42
H1 neuropsychologische diagnostiek .............................................................................................. 42
1.1 belang van neuropyschologische diagnostiek.......................................................................... 42
1.2 scientist-practioner model als basis ....................................................................................... 42
1.2.1 vraagstelling en hypotheses ............................................................................................. 43
aanvraag voor neuropsychologisch onderzoek ....................................................................... 43
anamnese en heteroanamnese ............................................................................................ 44
, 1.2.2 neuropsychologisch onderzoek ....................................................................................... 45
belang van gedragsobservaties in de neuropsychologische diagnostiek .................................. 45
selectie van neuropsychologische testen .............................................................................. 45
interpretatie, rapportage en advies ........................................................................................... 49
interpretatie van neuropsychologische testscores ................................................................. 49
1.3 opdracht werkcollege ............................................................................................................ 50
1.4 les werkcollege 1 ................................................................................................................... 52
verschillende testen ................................................................................................................ 53
H2 niet- aangeboren hersenletsel .................................................................................................... 57
2.1 cerebrovasculair accident of beroerte .................................................................................... 57
2.1.1 klinisch beeld.................................................................................................................. 57
2.1.2 ischemisch herseninfarct ................................................................................................ 58
2.1.3 hersenbloeding ............................................................................................................... 58
2.1.4 neuropsychologische gevolgen ........................................................................................ 59
beroerte in de voorste hersenslagader: arteria cerebri anterior (ACA) ...................................... 59
Beroerte in de linker middelste hersenslagader: arteria cerebri media (MCA) ........................... 60
Beroerte in de rechter middelste hersenslagader: arteria cerebri media (MCA) ........................ 60
Unilaterale beroerte in de achterste hersenslagader: arteria cerebri posterior (PCA) ................ 60
Bilaterale beroerte in de achterste hersenslagader: arteria cerebri posterior (PCA) .................. 61
andere syndromen ............................................................................................................... 61
andere gevolgen van een beroerte ......................................................................................... 61
2.1.5 neuropsychologische diagnostiek: enkele overwegingen ................................................... 62
2.2 traumatisch hersenletsel .................................................................................................. 62
2.2.1 klinisch beeld.................................................................................................................. 63
2.2.2 primaire schade na een traumatisch hersenletsel ............................................................. 64
diffuus axonaal letsel ........................................................................................................... 64
coup-contrecoupletsel......................................................................................................... 64
2.2.3 secundaire schade na een TBI .......................................................................................... 65
2.2.4 neuropsychologische gevolgen ........................................................................................ 65
middelzwaar tot ernstig hersenletsel ..................................................................................... 66
licht traumatisch hersenletsel .............................................................................................. 66
whiplash-gerelateerde stoornissen ....................................................................................... 67
2.2.5 neuropsychologisch onderzoek: enkele overwegingen ...................................................... 67
2.3 opdracht werkcollege ............................................................................................................ 67
2.4 les werkcollege 2 ................................................................................................................... 68
Belang van observaties ............................................................................................................ 69
verslaggeving .......................................................................................................................... 70
, H3 neurodegeneratieve aandoeningen ............................................................................................ 71
3.1 neurocognitieve stoornis........................................................................................................ 71
3.1.1 classificatie volgens DSM-5 ............................................................................................. 71
normale cognitieve achteruitgang? ....................................................................................... 71
delirium, dementie, depressie .............................................................................................. 72
beperkte of uitgebreide NCS ................................................................................................. 72
etiologie .............................................................................................................................. 73
3.2 neuropsychologische diagnostiek: enkele overwegingen ......................................................... 80
3.3 tekst: differential diagnosis of depression and dementia .......................................................... 81
3.3.1 DEPRESSION-RELATED COGNITIVE IMPAIREMENT OR “PSEUDODEMENTIA”..................... 81
3.3.2 depression as a symptom of dementia ............................................................................. 81
clinical assessment ............................................................................................................. 82
3.3.3 assesment of geriatric depression .................................................................................... 82
3.3.4 considerations for differential diagnosis ........................................................................... 83
3.3.5 differences between depression and dementia ................................................................. 84
3.3.6 neuropsychological profiles of depression and dementia .................................................. 85
3.3.7 conclusion ...................................................................................................................... 86
3.4 opdracht werkcollege ............................................................................................................ 86
3.5 les werkcollege 3 ................................................................................................................... 87
DEEL 3: kinderen en jongeren ............................................................................................................. 90
H1 preterms ................................................................................................................................... 90
1.1 introductie ............................................................................................................................ 90
1.1.1 definitie .................................................................................................................... 90
1.1.2 incidentie ....................................................................................................................... 91
1.2 medical problems ................................................................................................................. 91
1.2.1 hyaline membrane disease – bronchopulmonary dysplasia ............................................... 91
1.2.2 retinopathy of prematurity ............................................................................................... 92
1.2.3 infecties ......................................................................................................................... 93
1.2.4 periventricular white matter disease / periventricular leucomalacia ................................... 93
1.2.5 intraventriculaire hemorrhage ................................................................................... 93
1.3 follow up of childeren born preterm ........................................................................................ 94
1.4 developmental problems ....................................................................................................... 94
1.4.1 algmeen ......................................................................................................................... 94
complications short-term ..................................................................................................... 96
complications long-term ...................................................................................................... 96
1.4.2 predictive factors ............................................................................................................ 96
hoofdomtrek ........................................................................................................................ 96
, neuroimaging....................................................................................................................... 96
Prognostic factors cerebral palsy and motor impairment........................................................ 97
1.4.3 motor development ......................................................................................................... 97
cerebral palsy ...................................................................................................................... 97
Developmental coordination disorder ................................................................................... 98
1.4.4 visuele problemen........................................................................................................... 99
retinopathy of the preterm .................................................................................................... 99
cerebral visuel impairement ................................................................................................. 99
1.4.5 cognitive development .................................................................................................... 99
executive dysfunction .......................................................................................................... 99
feeding problems ............................................................................................................... 100
language problems ............................................................................................................ 100
why difference in development ........................................................................................... 100
1.4.5 behavioral problems ..................................................................................................... 101
autism ............................................................................................................................... 101
ADHD ................................................................................................................................ 101
1.5 late preterms ...................................................................................................................... 102
1.6 does early intervention make a difference? ........................................................................... 102
H2 epilepsie ................................................................................................................................. 103
2.1 Definitie .............................................................................................................................. 103
2.2 korte herhaling werking hersenen ......................................................................................... 103
2.3 epidemiologie ..................................................................................................................... 103
2.4 pasgeborene en infanten ..................................................................................................... 103
2.5 diagnose van epilepsie ......................................................................................................... 104
2.5.1 aanvalsBeschrijving ...................................................................................................... 104
2.5.2 Type aanval ................................................................................................................... 104
2.5.3 epileptie Syndroom ....................................................................................................... 105
2.5.4 Etiologie ....................................................................................................................... 107
2.5.5 Diagnose ...................................................................................................................... 108
EEG ................................................................................................................................... 108
other investigations ............................................................................................................ 108
2.6 differentiaaldiagnoses ......................................................................................................... 108
2.7 behandeling ........................................................................................................................ 109
2.7.1 side effects ................................................................................................................... 109
2.7.2 epilepsie chirurgie ......................................................................................................... 110
2.7.3 andere behandeling ...................................................................................................... 110
2.8 comorbiditeiten................................................................................................................... 110
, 2.8.1 factoren geassocieerd met cognitieve comorbiditeiten ................................................... 110
2.8.2 factoren geassocieerd met slechtere outcomes.............................................................. 111
2.8.3 intelectual disability ...................................................................................................... 111
2.8.4 ASD .............................................................................................................................. 111
2.8.5 ADHD ........................................................................................................................... 111
2.8.6 impact van cognitieve comorbiditeit ............................................................................... 111
2.8.7 neuropsychologie: cognitieve domeinen ......................................................................... 112
2.8.8 feiten en grafieken ......................................................................................................... 112
2.8.9 factoren die invloed hebben op cognitieve functioneren in epilepsie ................................ 113
seizure-related variables .................................................................................................... 113
treatment-related variables ................................................................................................ 113
non-seizure-related variables ............................................................................................. 114
2.10 practical guidelines ........................................................................................................... 114
2.10.1 information ................................................................................................................. 114
2.10.2 adjustments in classroom ........................................................................................... 114
2.10.3 sports ......................................................................................................................... 115
2.10.4 camps/trips ................................................................................................................ 115
H3 cerebrale parese ..................................................................................................................... 116
3.1 definitie .............................................................................................................................. 116
3.2 incidentie en prevalentie ...................................................................................................... 116
3.3 classificatie ........................................................................................................................ 117
3.3.1 naar topografie.............................................................................................................. 117
welke delen van de hersenen aangetast?............................................................................. 118
voorbeeldfimpjes ............................................................................................................... 118
kenmerken van subtypes .................................................................................................... 118
3.3.2 classificatie naar ernst .................................................................................................. 120
GMFCS E&R ....................................................................................................................... 120
MACS ................................................................................................................................ 121
communication function classification system .................................................................... 122
Viking speech scale............................................................................................................ 122
eating and drinking ability classification sysytem ................................................................. 122
visual function classification scale ..................................................................................... 123
3.3.3 timing van het letsel ...................................................................................................... 123
3.4 oorzaken ............................................................................................................................. 124
3.4.1 prenatale oorzaken ....................................................................................................... 124
3.4.2 pre/perinatale oorzaken ................................................................................................ 124
3.4.3 postnataal .................................................................................................................... 125
, 3.5 comorbiditeit ...................................................................................................................... 125
H4 ASS ........................................................................................................................................ 129
4.1 definitie .............................................................................................................................. 129
4.2 epidemilogy ........................................................................................................................ 129
4.3 neurobiology ....................................................................................................................... 129
4.4 medical problems ............................................................................................................... 130
4.4.1 clinical history and general pediatric exam ..................................................................... 130
4.4.2 physical examination .................................................................................................... 130
4.4.3 genetics........................................................................................................................ 130
overervingspatronen .......................................................................................................... 130
syndromic autism .............................................................................................................. 131
4.4.4 epilepsie ....................................................................................................................... 132
4.4.5 sleep problems ............................................................................................................. 133
Characteristics of sleep problems in Children with ASD and Autism ..................................... 133
measures of sleepproblems ............................................................................................... 133
causes of insomnia ............................................................................................................ 133
comprehensive sleep history .............................................................................................. 134
initial treatment of insomnia ............................................................................................... 134
4.4.6 feeding problems in ASD ................................................................................................ 135
Als eetprobleem een sensorisch probleem is ....................................................................... 135
probleem met betekenisverlening ....................................................................................... 136
probleem van sociale communicatie .................................................................................. 136
4.4.7 gastro-intestinal problems ............................................................................................. 136
4.4.8 voiding problems........................................................................................................... 137
4.4.9 dental problems ............................................................................................................ 137
4.4.10 motor evaluation ......................................................................................................... 137
H5 neuromuscular disorders in children: cognition and psychosocial aspects ................................. 138
5.1 neuromuscular disorders ..................................................................................................... 138
5.1.1 overzicht stoornissen .................................................................................................... 138
5.1.2 anterior horn cell (motor neuron).................................................................................... 139
spinal muscular atrophy (SMA) ........................................................................................... 139
5.1.3 peripheral nerver ........................................................................................................... 140
charcot-Marie-Thooth (CMT) ............................................................................................... 140
Guillain-Barré syndrome (GBS) ........................................................................................... 140
5.1.4 neuromusculaire junctie ................................................................................................ 140
5.1.5 muscle ......................................................................................................................... 141
duchenne musculaire dystrofie (DMD) ................................................................................ 141
, myotonic dystrophy type 1 (Steinert’s disease) .................................................................... 143
5.1.6 cognitieve en psychosociale aspecten ........................................................................... 144
5.1.7 behandeling .................................................................................................................. 145
5.1.8 take home messages..................................................................................................... 145
5.2 neuropsychologie bij neuromusculaire aandoeningen ........................................................... 145
5.2.1 pediatrische neuropsychologie in de praktijk .................................................................. 145
5.2.2 intrinsiek potentieel....................................................................................................... 146
duchenne musculaire dystrofie........................................................................................... 146
eerste uitdaging ................................................................................................................. 147
tweede uitdaging................................................................................................................ 148
in de praktijk ...................................................................................................................... 149
derde uitdaging .................................................................................................................. 149
5.2.3 psychosocial development ............................................................................................ 149
illness identity ................................................................................................................... 150
coping mechanisms and emotion regulation strategies ........................................................ 151
quality of life ...................................................................................................................... 151
5.2.4 context ......................................................................................................................... 152
Sociale gevolgen van MNDs ................................................................................................ 152
5.2.5 gedrag .......................................................................................................................... 152
H6 visual impairement .................................................................................................................. 154
6.1 het oog ............................................................................................................................... 154
6.2 breking (refractie) van het licht ............................................................................................. 154
6.2.1 Bijziend ........................................................................................................................ 154
6.2.2 Verziend ....................................................................................................................... 154
6.2.3 Astigmatisme ................................................................................................................ 154
6.3 Gezichtsscherpte ................................................................................................................ 155
6.4 Gezichtsveld ....................................................................................................................... 155
6.5 Contrastgevoeligheid ........................................................................................................... 155
6.6 Kleur ................................................................................................................................... 156
6.7 Oogmotoriek ....................................................................................................................... 156
6.8 Dieptezicht ......................................................................................................................... 157
6.9 CVI ..................................................................................................................................... 157
6.9.1 wat? ............................................................................................................................. 157
6.9.2 Herkennen .................................................................................................................... 157
6.10 CVI online les .................................................................................................................... 158
6.10.1 definition .................................................................................................................... 158
6.10.2 visual pathways, lesions causing visual field defects & impairment ................................ 158
, visual fiel impairments ....................................................................................................... 159
6.10.3 visual acuity, contrast sensitivity .................................................................................. 159
diminshed/decreased visual acuity ..................................................................................... 159
reduced contrast sensitivity ................................................................................................ 159
6.10.4 ventral en dorsal stream .............................................................................................. 160
visual limitations caused by cognitive visual dysfunction...................................................... 160
streams interact ................................................................................................................ 161
6.10.5 case studies – films ..................................................................................................... 161
6.10.6 causes of CVI .............................................................................................................. 161
spectrum of CVI ................................................................................................................. 162
6.10.7 diagnostic procedure, visuoperceptual tests, questionnaires ........................................ 162
diagnosing CVI ................................................................................................................... 162
6.10.8 what to keep in mind when working with a child with CVI ............................................... 166
testing ............................................................................................................................... 166
Clarity of vision .................................................................................................................. 166
Educational material/aid reading ........................................................................................ 166
Colour and contrast ........................................................................................................... 166
Visual memory ................................................................................................................... 167
Crowding & complexity ....................................................................................................... 167
Visual fatigue ..................................................................................................................... 167
Recognition ....................................................................................................................... 167
Locating objects ................................................................................................................ 167
social problems ................................................................................................................. 167
6.10.9 developmental milestones........................................................................................... 167
tummy time ....................................................................................................................... 167
from lying to sitting ............................................................................................................. 168
crawling ............................................................................................................................ 168
bicycle .............................................................................................................................. 168
walking .............................................................................................................................. 168
how to adapt the environment of the child ........................................................................... 168
6.10.10 rehabilitation examples ............................................................................................. 170
DEEL 1: neuropsychologische symptomatologie (volwassenen en ouderen).......................................... 11
H1 visuele waarneming ................................................................................................................... 11
1.1 visuele waarneming ............................................................................................................... 11
1.2 stoornissen in de visuele waarneming .................................................................................... 12
1.2.1 lagere orde visuele stoornissen ........................................................................................ 12
visuele velddefecten ............................................................................................................ 12
andere lagere orde visuele stoornissen ................................................................................. 13
visuele hallucinaties en illusies ............................................................................................. 13
1.2.2 midden orde visuele stoornissen ...................................................................................... 14
cerebrale (hemi-)achromatopsie .......................................................................................... 14
cerebrale akinetopsie ........................................................................................................... 14
visuele agnosie .................................................................................................................... 14
1.2.3 hogere orde visuele stoornissen ....................................................................................... 15
visuele agnosie .................................................................................................................... 15
prosopagnosie ..................................................................................................................... 16
H2 ruimtelijke cognitie .................................................................................................................... 17
2.1 perceptie .............................................................................................................................. 17
2.1.1 stoornis in de lijnoriëntatie............................................................................................... 17
2.2 aandacht .............................................................................................................................. 17
2.2.1 simultaanagnosie............................................................................................................ 17
hiërarchische stimuli............................................................................................................ 17
illusoire conjuncties ............................................................................................................. 18
2.2.2 hemispatiaal neglect ....................................................................................................... 18
heterogeniteit van hemispatiaal neglect ................................................................................ 18
test ..................................................................................................................................... 18
neglect dyslexie ................................................................................................................... 19
neglect dysgrafie .................................................................................................................. 19
neglect versus extinctie ........................................................................................................ 19
2.3 geheugen .............................................................................................................................. 20
2.3.1 stoornissen in het leren van een route .............................................................................. 20
topografische desoriëntatie .................................................................................................. 20
topografische agnosie of landmark-agnosie .......................................................................... 20
topografische amnesie ......................................................................................................... 20
relatie deficits en bepaalde letsels ........................................................................................ 21
links-rechtts verwarring ........................................................................................................ 21
, 2.4 praxis.................................................................................................................................... 21
2.4.1 visuoconstructie praxis ................................................................................................... 21
2.4.2 optische ataxie ............................................................................................................... 22
optische ataxie versus apperceptieve agnosie ....................................................................... 22
H3 geheugen .................................................................................................................................. 23
3.1 geheugenklachten ................................................................................................................. 23
3.2 stoornissen in het kortetermijngeheugen en werkgeheugen ..................................................... 23
3.3 het amnestisch syndroom ...................................................................................................... 23
3.4 andere geheugenstoornissen ................................................................................................. 24
3.4.1 transient global amnesia (TGA) ........................................................................................ 24
3.4.2 posttraumatische amnesie (PTA) ..................................................................................... 24
3.4.3 psychogene amnesie of fugue .......................................................................................... 25
3.4.4 andere selectieve geheugenstoornissen ........................................................................... 25
H4 taal ........................................................................................................................................... 25
4.1 afasie ................................................................................................................................... 25
4.1.1 woordvindingsstoornissen ............................................................................................... 25
4.1.2 stoornissen in de vloeiendheid ......................................................................................... 26
4.1.3 problemen in de zinsbouw ............................................................................................... 26
4.1.4 stoornissen in het taalbegrip ............................................................................................ 27
4.1.5 stoornissen in het naspreken ........................................................................................... 27
4.1.6 stoornissen in het lezen en schrijven ................................................................................ 27
4.1.7 taxonomie van afasiesyndromen ...................................................................................... 28
broca, motorische of expressieve afasie ................................................................................ 28
wernicke of ‘sensorische’ afasie ........................................................................................... 29
conductie of ‘centrale’ afasie ............................................................................................... 29
globale of totale afasie ......................................................................................................... 29
transcorticale afasie ............................................................................................................ 30
amnestische of anomische afasie ......................................................................................... 30
4.2 verbale dyspraxie en dysartrie ................................................................................................ 30
H5 aandacht en executieve functies ................................................................................................ 31
5.1 stoornissen in de aandacht .................................................................................................... 31
5.1.1 vertraagde informatieverwerking ...................................................................................... 31
5.1.2 stoornissen in de selectiviteit van aandacht ...................................................................... 32
stoornis in de gerichte aandacht ........................................................................................... 32
stoornis in de verdeelde aandacht ........................................................................................ 32
5.1.3 stoornissen in de intensiteit van aandacht ........................................................................ 32
stoornis in de volgehouden aandacht .................................................................................... 32
, stoornis in de arousal ........................................................................................................... 32
5.2 stoornis in de executieve functies ........................................................................................... 34
5.2.1 dysexecutief syndroom.................................................................................................... 34
kenmerken .......................................................................................................................... 34
Letsel: ................................................................................................................................. 34
diagnose ............................................................................................................................. 35
5.1.2 apatisch of amotivationeel syndroom ............................................................................... 35
5.1.3 pseudopsychopatisch syndroom ..................................................................................... 35
H6 emotie en sociale cognitie ......................................................................................................... 36
6.1 stoornissen in emotie en sociale cognitie ................................................................................ 36
6.1.1 verschillende niveau’s ..................................................................................................... 36
6.1.2 illlustratie ....................................................................................................................... 36
H7 actie en motoriek ...................................................................................................................... 36
7.1 belang van actie en motoriek binnen de neuropsychologie ....................................................... 36
7.2 hemiplegie en hemiparese ..................................................................................................... 37
7.3 apraxie .................................................................................................................................. 37
7.3.1 imiteren van handbewegingen ......................................................................................... 37
7.3.2 gebruik van voorwerpen ................................................................................................... 37
7.3.3 uitbeelden van het gebruik van voorwerpen (pantomime) .................................................. 38
7.3.4 pantomime versus het uitbeelden van betekenisvolle gebaren .......................................... 38
7.3.5 classificaties .................................................................................................................. 38
classificatie op basis van lichaamsdeel ................................................................................. 38
classificatie op basis van sensorische modaliteit ................................................................... 39
classificatie op basis van type beweging ................................................................................ 39
7.4 optische ataxie ...................................................................................................................... 40
7.5 Alien hand syndroom (AHS) .................................................................................................... 40
H8 overview ................................................................................................................................... 40
8.1 clusters van neuropsychologische symptomen ....................................................................... 41
8.1.1 redenen .......................................................................................................................... 41
8.1.2 implicaties ...................................................................................................................... 41
DEEL 2: werkcollege (volwassenen en ouderen) ................................................................................... 42
H1 neuropsychologische diagnostiek .............................................................................................. 42
1.1 belang van neuropyschologische diagnostiek.......................................................................... 42
1.2 scientist-practioner model als basis ....................................................................................... 42
1.2.1 vraagstelling en hypotheses ............................................................................................. 43
aanvraag voor neuropsychologisch onderzoek ....................................................................... 43
anamnese en heteroanamnese ............................................................................................ 44
, 1.2.2 neuropsychologisch onderzoek ....................................................................................... 45
belang van gedragsobservaties in de neuropsychologische diagnostiek .................................. 45
selectie van neuropsychologische testen .............................................................................. 45
interpretatie, rapportage en advies ........................................................................................... 49
interpretatie van neuropsychologische testscores ................................................................. 49
1.3 opdracht werkcollege ............................................................................................................ 50
1.4 les werkcollege 1 ................................................................................................................... 52
verschillende testen ................................................................................................................ 53
H2 niet- aangeboren hersenletsel .................................................................................................... 57
2.1 cerebrovasculair accident of beroerte .................................................................................... 57
2.1.1 klinisch beeld.................................................................................................................. 57
2.1.2 ischemisch herseninfarct ................................................................................................ 58
2.1.3 hersenbloeding ............................................................................................................... 58
2.1.4 neuropsychologische gevolgen ........................................................................................ 59
beroerte in de voorste hersenslagader: arteria cerebri anterior (ACA) ...................................... 59
Beroerte in de linker middelste hersenslagader: arteria cerebri media (MCA) ........................... 60
Beroerte in de rechter middelste hersenslagader: arteria cerebri media (MCA) ........................ 60
Unilaterale beroerte in de achterste hersenslagader: arteria cerebri posterior (PCA) ................ 60
Bilaterale beroerte in de achterste hersenslagader: arteria cerebri posterior (PCA) .................. 61
andere syndromen ............................................................................................................... 61
andere gevolgen van een beroerte ......................................................................................... 61
2.1.5 neuropsychologische diagnostiek: enkele overwegingen ................................................... 62
2.2 traumatisch hersenletsel .................................................................................................. 62
2.2.1 klinisch beeld.................................................................................................................. 63
2.2.2 primaire schade na een traumatisch hersenletsel ............................................................. 64
diffuus axonaal letsel ........................................................................................................... 64
coup-contrecoupletsel......................................................................................................... 64
2.2.3 secundaire schade na een TBI .......................................................................................... 65
2.2.4 neuropsychologische gevolgen ........................................................................................ 65
middelzwaar tot ernstig hersenletsel ..................................................................................... 66
licht traumatisch hersenletsel .............................................................................................. 66
whiplash-gerelateerde stoornissen ....................................................................................... 67
2.2.5 neuropsychologisch onderzoek: enkele overwegingen ...................................................... 67
2.3 opdracht werkcollege ............................................................................................................ 67
2.4 les werkcollege 2 ................................................................................................................... 68
Belang van observaties ............................................................................................................ 69
verslaggeving .......................................................................................................................... 70
, H3 neurodegeneratieve aandoeningen ............................................................................................ 71
3.1 neurocognitieve stoornis........................................................................................................ 71
3.1.1 classificatie volgens DSM-5 ............................................................................................. 71
normale cognitieve achteruitgang? ....................................................................................... 71
delirium, dementie, depressie .............................................................................................. 72
beperkte of uitgebreide NCS ................................................................................................. 72
etiologie .............................................................................................................................. 73
3.2 neuropsychologische diagnostiek: enkele overwegingen ......................................................... 80
3.3 tekst: differential diagnosis of depression and dementia .......................................................... 81
3.3.1 DEPRESSION-RELATED COGNITIVE IMPAIREMENT OR “PSEUDODEMENTIA”..................... 81
3.3.2 depression as a symptom of dementia ............................................................................. 81
clinical assessment ............................................................................................................. 82
3.3.3 assesment of geriatric depression .................................................................................... 82
3.3.4 considerations for differential diagnosis ........................................................................... 83
3.3.5 differences between depression and dementia ................................................................. 84
3.3.6 neuropsychological profiles of depression and dementia .................................................. 85
3.3.7 conclusion ...................................................................................................................... 86
3.4 opdracht werkcollege ............................................................................................................ 86
3.5 les werkcollege 3 ................................................................................................................... 87
DEEL 3: kinderen en jongeren ............................................................................................................. 90
H1 preterms ................................................................................................................................... 90
1.1 introductie ............................................................................................................................ 90
1.1.1 definitie .................................................................................................................... 90
1.1.2 incidentie ....................................................................................................................... 91
1.2 medical problems ................................................................................................................. 91
1.2.1 hyaline membrane disease – bronchopulmonary dysplasia ............................................... 91
1.2.2 retinopathy of prematurity ............................................................................................... 92
1.2.3 infecties ......................................................................................................................... 93
1.2.4 periventricular white matter disease / periventricular leucomalacia ................................... 93
1.2.5 intraventriculaire hemorrhage ................................................................................... 93
1.3 follow up of childeren born preterm ........................................................................................ 94
1.4 developmental problems ....................................................................................................... 94
1.4.1 algmeen ......................................................................................................................... 94
complications short-term ..................................................................................................... 96
complications long-term ...................................................................................................... 96
1.4.2 predictive factors ............................................................................................................ 96
hoofdomtrek ........................................................................................................................ 96
, neuroimaging....................................................................................................................... 96
Prognostic factors cerebral palsy and motor impairment........................................................ 97
1.4.3 motor development ......................................................................................................... 97
cerebral palsy ...................................................................................................................... 97
Developmental coordination disorder ................................................................................... 98
1.4.4 visuele problemen........................................................................................................... 99
retinopathy of the preterm .................................................................................................... 99
cerebral visuel impairement ................................................................................................. 99
1.4.5 cognitive development .................................................................................................... 99
executive dysfunction .......................................................................................................... 99
feeding problems ............................................................................................................... 100
language problems ............................................................................................................ 100
why difference in development ........................................................................................... 100
1.4.5 behavioral problems ..................................................................................................... 101
autism ............................................................................................................................... 101
ADHD ................................................................................................................................ 101
1.5 late preterms ...................................................................................................................... 102
1.6 does early intervention make a difference? ........................................................................... 102
H2 epilepsie ................................................................................................................................. 103
2.1 Definitie .............................................................................................................................. 103
2.2 korte herhaling werking hersenen ......................................................................................... 103
2.3 epidemiologie ..................................................................................................................... 103
2.4 pasgeborene en infanten ..................................................................................................... 103
2.5 diagnose van epilepsie ......................................................................................................... 104
2.5.1 aanvalsBeschrijving ...................................................................................................... 104
2.5.2 Type aanval ................................................................................................................... 104
2.5.3 epileptie Syndroom ....................................................................................................... 105
2.5.4 Etiologie ....................................................................................................................... 107
2.5.5 Diagnose ...................................................................................................................... 108
EEG ................................................................................................................................... 108
other investigations ............................................................................................................ 108
2.6 differentiaaldiagnoses ......................................................................................................... 108
2.7 behandeling ........................................................................................................................ 109
2.7.1 side effects ................................................................................................................... 109
2.7.2 epilepsie chirurgie ......................................................................................................... 110
2.7.3 andere behandeling ...................................................................................................... 110
2.8 comorbiditeiten................................................................................................................... 110
, 2.8.1 factoren geassocieerd met cognitieve comorbiditeiten ................................................... 110
2.8.2 factoren geassocieerd met slechtere outcomes.............................................................. 111
2.8.3 intelectual disability ...................................................................................................... 111
2.8.4 ASD .............................................................................................................................. 111
2.8.5 ADHD ........................................................................................................................... 111
2.8.6 impact van cognitieve comorbiditeit ............................................................................... 111
2.8.7 neuropsychologie: cognitieve domeinen ......................................................................... 112
2.8.8 feiten en grafieken ......................................................................................................... 112
2.8.9 factoren die invloed hebben op cognitieve functioneren in epilepsie ................................ 113
seizure-related variables .................................................................................................... 113
treatment-related variables ................................................................................................ 113
non-seizure-related variables ............................................................................................. 114
2.10 practical guidelines ........................................................................................................... 114
2.10.1 information ................................................................................................................. 114
2.10.2 adjustments in classroom ........................................................................................... 114
2.10.3 sports ......................................................................................................................... 115
2.10.4 camps/trips ................................................................................................................ 115
H3 cerebrale parese ..................................................................................................................... 116
3.1 definitie .............................................................................................................................. 116
3.2 incidentie en prevalentie ...................................................................................................... 116
3.3 classificatie ........................................................................................................................ 117
3.3.1 naar topografie.............................................................................................................. 117
welke delen van de hersenen aangetast?............................................................................. 118
voorbeeldfimpjes ............................................................................................................... 118
kenmerken van subtypes .................................................................................................... 118
3.3.2 classificatie naar ernst .................................................................................................. 120
GMFCS E&R ....................................................................................................................... 120
MACS ................................................................................................................................ 121
communication function classification system .................................................................... 122
Viking speech scale............................................................................................................ 122
eating and drinking ability classification sysytem ................................................................. 122
visual function classification scale ..................................................................................... 123
3.3.3 timing van het letsel ...................................................................................................... 123
3.4 oorzaken ............................................................................................................................. 124
3.4.1 prenatale oorzaken ....................................................................................................... 124
3.4.2 pre/perinatale oorzaken ................................................................................................ 124
3.4.3 postnataal .................................................................................................................... 125
, 3.5 comorbiditeit ...................................................................................................................... 125
H4 ASS ........................................................................................................................................ 129
4.1 definitie .............................................................................................................................. 129
4.2 epidemilogy ........................................................................................................................ 129
4.3 neurobiology ....................................................................................................................... 129
4.4 medical problems ............................................................................................................... 130
4.4.1 clinical history and general pediatric exam ..................................................................... 130
4.4.2 physical examination .................................................................................................... 130
4.4.3 genetics........................................................................................................................ 130
overervingspatronen .......................................................................................................... 130
syndromic autism .............................................................................................................. 131
4.4.4 epilepsie ....................................................................................................................... 132
4.4.5 sleep problems ............................................................................................................. 133
Characteristics of sleep problems in Children with ASD and Autism ..................................... 133
measures of sleepproblems ............................................................................................... 133
causes of insomnia ............................................................................................................ 133
comprehensive sleep history .............................................................................................. 134
initial treatment of insomnia ............................................................................................... 134
4.4.6 feeding problems in ASD ................................................................................................ 135
Als eetprobleem een sensorisch probleem is ....................................................................... 135
probleem met betekenisverlening ....................................................................................... 136
probleem van sociale communicatie .................................................................................. 136
4.4.7 gastro-intestinal problems ............................................................................................. 136
4.4.8 voiding problems........................................................................................................... 137
4.4.9 dental problems ............................................................................................................ 137
4.4.10 motor evaluation ......................................................................................................... 137
H5 neuromuscular disorders in children: cognition and psychosocial aspects ................................. 138
5.1 neuromuscular disorders ..................................................................................................... 138
5.1.1 overzicht stoornissen .................................................................................................... 138
5.1.2 anterior horn cell (motor neuron).................................................................................... 139
spinal muscular atrophy (SMA) ........................................................................................... 139
5.1.3 peripheral nerver ........................................................................................................... 140
charcot-Marie-Thooth (CMT) ............................................................................................... 140
Guillain-Barré syndrome (GBS) ........................................................................................... 140
5.1.4 neuromusculaire junctie ................................................................................................ 140
5.1.5 muscle ......................................................................................................................... 141
duchenne musculaire dystrofie (DMD) ................................................................................ 141
, myotonic dystrophy type 1 (Steinert’s disease) .................................................................... 143
5.1.6 cognitieve en psychosociale aspecten ........................................................................... 144
5.1.7 behandeling .................................................................................................................. 145
5.1.8 take home messages..................................................................................................... 145
5.2 neuropsychologie bij neuromusculaire aandoeningen ........................................................... 145
5.2.1 pediatrische neuropsychologie in de praktijk .................................................................. 145
5.2.2 intrinsiek potentieel....................................................................................................... 146
duchenne musculaire dystrofie........................................................................................... 146
eerste uitdaging ................................................................................................................. 147
tweede uitdaging................................................................................................................ 148
in de praktijk ...................................................................................................................... 149
derde uitdaging .................................................................................................................. 149
5.2.3 psychosocial development ............................................................................................ 149
illness identity ................................................................................................................... 150
coping mechanisms and emotion regulation strategies ........................................................ 151
quality of life ...................................................................................................................... 151
5.2.4 context ......................................................................................................................... 152
Sociale gevolgen van MNDs ................................................................................................ 152
5.2.5 gedrag .......................................................................................................................... 152
H6 visual impairement .................................................................................................................. 154
6.1 het oog ............................................................................................................................... 154
6.2 breking (refractie) van het licht ............................................................................................. 154
6.2.1 Bijziend ........................................................................................................................ 154
6.2.2 Verziend ....................................................................................................................... 154
6.2.3 Astigmatisme ................................................................................................................ 154
6.3 Gezichtsscherpte ................................................................................................................ 155
6.4 Gezichtsveld ....................................................................................................................... 155
6.5 Contrastgevoeligheid ........................................................................................................... 155
6.6 Kleur ................................................................................................................................... 156
6.7 Oogmotoriek ....................................................................................................................... 156
6.8 Dieptezicht ......................................................................................................................... 157
6.9 CVI ..................................................................................................................................... 157
6.9.1 wat? ............................................................................................................................. 157
6.9.2 Herkennen .................................................................................................................... 157
6.10 CVI online les .................................................................................................................... 158
6.10.1 definition .................................................................................................................... 158
6.10.2 visual pathways, lesions causing visual field defects & impairment ................................ 158
, visual fiel impairments ....................................................................................................... 159
6.10.3 visual acuity, contrast sensitivity .................................................................................. 159
diminshed/decreased visual acuity ..................................................................................... 159
reduced contrast sensitivity ................................................................................................ 159
6.10.4 ventral en dorsal stream .............................................................................................. 160
visual limitations caused by cognitive visual dysfunction...................................................... 160
streams interact ................................................................................................................ 161
6.10.5 case studies – films ..................................................................................................... 161
6.10.6 causes of CVI .............................................................................................................. 161
spectrum of CVI ................................................................................................................. 162
6.10.7 diagnostic procedure, visuoperceptual tests, questionnaires ........................................ 162
diagnosing CVI ................................................................................................................... 162
6.10.8 what to keep in mind when working with a child with CVI ............................................... 166
testing ............................................................................................................................... 166
Clarity of vision .................................................................................................................. 166
Educational material/aid reading ........................................................................................ 166
Colour and contrast ........................................................................................................... 166
Visual memory ................................................................................................................... 167
Crowding & complexity ....................................................................................................... 167
Visual fatigue ..................................................................................................................... 167
Recognition ....................................................................................................................... 167
Locating objects ................................................................................................................ 167
social problems ................................................................................................................. 167
6.10.9 developmental milestones........................................................................................... 167
tummy time ....................................................................................................................... 167
from lying to sitting ............................................................................................................. 168
crawling ............................................................................................................................ 168
bicycle .............................................................................................................................. 168
walking .............................................................................................................................. 168
how to adapt the environment of the child ........................................................................... 168
6.10.10 rehabilitation examples ............................................................................................. 170
