Neurodegeneratieve stoornissen
en cerebrale parese
Inhoud
HOOFDSTUK 1: parate kennis
1. Neuromotorische handicap..............................................................................................................5
2. Neuromusculaire aandoeningen – NMA...........................................................................................5
2.1 Algemene kenmerken..................................................................................................................5
2.2 Symptomen..................................................................................................................................5
2.3 Soorten NMA...............................................................................................................................5
3. Cerebrale parese – CP.......................................................................................................................5
3.1 Vormen van hersenschade..........................................................................................................6
3.2 Indeling volgens topografie..........................................................................................................6
3.3 indeling volgens klinisch beeld – classificatie...............................................................................6
3.4 klinisch beeld gelinkt aan hersenschade......................................................................................6
3.5 test jezelf !...................................................................................................................................7
1. Motorische/ orthopedische problemen.............................................................................................8
2. Mentale retardatie (33%)..................................................................................................................9
3. Stoornis in aandacht en geheugen.....................................................................................................9
4. Gedragstoornissen.............................................................................................................................9
5. Stoornissen in auditieve functies:......................................................................................................9
6. Stoornissen in visuele functies.........................................................................................................10
7. Epilepsie...........................................................................................................................................10
8. Stoornissen in waarnemen/verwerken van prikkels........................................................................11
9. Sensorische modulatieproblemen...................................................................................................11
10. Communicatie................................................................................................................................11
11. Voeding..........................................................................................................................................11
12. gastro-oesofageale reflux.............................................................................................................13
13. Problemen met mondhygiëne.......................................................................................................13
14. Drooling.........................................................................................................................................13
1. Spasticiteit.......................................................................................................................................14
1.1 tonustabel..................................................................................................................................14
1.1 geassocieerde reacties...............................................................................................................14
1.2 logopedische problemen bij hypertonie....................................................................................15
1.2.1 fonatie.................................................................................................................................15
1.2.2 mondmotoriek....................................................................................................................15
1
,Neurodegeneratieve stoornissen en CP 2024-2025
1.2.3 adem-stemcoordinatie........................................................................................................15
1.2.4 Spraak.................................................................................................................................15
1.2.5 taal......................................................................................................................................15
1.2.6 voeding...............................................................................................................................16
1.2.7 Tanden poetsen..................................................................................................................16
2. Dyskinesie.......................................................................................................................................16
2.1 Kenmerken.................................................................................................................................16
2.2 klinisch beeld.............................................................................................................................17
2.3 Tonustabel.................................................................................................................................17
2.4 Logopedische problemen bij dyskinesie....................................................................................18
2.4.1 Fonatie................................................................................................................................18
2.4.2 Mondmotoriek....................................................................................................................18
2.4.3 stemgeving..........................................................................................................................18
2.4.4 spraak.................................................................................................................................19
2.4.5 comorbiditeit......................................................................................................................19
3. Ataxie...............................................................................................................................................19
3.1 Kenmerken.................................................................................................................................19
3.2 Logopedische problemen bij ataxie...........................................................................................19
3.2.1 ademhaling.........................................................................................................................20
3.2.2 stemgeving – spraak...........................................................................................................20
3.2.3 taal......................................................................................................................................20
3.2.4 voeding...............................................................................................................................20
4. hypotonie (+ prematuriteit).............................................................................................................20
4.1 logopedische problemen bij hypotonie.....................................................................................21
4.1.1 houding/motoriek...............................................................................................................21
4.1.2 Ademhaling en stemgeving.................................................................................................21
4.1.3 Spraak.....................................................................................................................................21
4.1.4 taal......................................................................................................................................21
4.1.5 voedingsproblemen............................................................................................................21
5. hoe klinken de stemmen?................................................................................................................22
1. Preventie en vroegdiagnose............................................................................................................22
1.1 prevalentie.................................................................................................................................22
1.2 Belang van vroegdiagnose.........................................................................................................22
1.3 stellen van vroegtijdige diagnose...............................................................................................22
1.4 Teamwork in COS.......................................................................................................................23
1.5 Referentiecentra........................................................................................................................23
1.6 Belang van vroegtijdige interventie...........................................................................................24
2. Onderzoek bij CP..............................................................................................................................24
2
,Neurodegeneratieve stoornissen en CP 2024-2025
2.1 Logopedisch onderzoek bij CP...................................................................................................24
2.1.1 Anamnese...........................................................................................................................24
2.1.2 Preklinisch onderzoek.........................................................................................................25
2.1.3 Orofaciaal onderzoek..........................................................................................................25
2.1.4 Onderzoek slikact en speekselcontrole...............................................................................25
2.1.5 Dysartrie onderzoek............................................................................................................26
2.1.6 Onderzoeken.......................................................................................................................26
2.1.7 Samenvatting......................................................................................................................27
2.8.1 Conclusie logopedisch onderzoek.......................................................................................27
2.2 Therapie.....................................................................................................................................27
2.2.1 Algemeen............................................................................................................................27
2.3 Logopedisch handelingsplan......................................................................................................28
1. Houding en motoriek.......................................................................................................................29
1.1 Spasticiteit.................................................................................................................................29
1.2 Dyskinesie..................................................................................................................................29
1.3 Ataxie.........................................................................................................................................29
1.4 Hypotonie..................................................................................................................................29
2. Eet- en drinktherapie.......................................................................................................................29
2.1 totale controle...........................................................................................................................29
2.2 Locale controle of mondcontrole...............................................................................................30
2.3 Wanneer doen we aan mondcontrole?.....................................................................................30
2.4 Waarom doen we aan mondcontrole?......................................................................................30
2.5 Lepelvoeding..............................................................................................................................30
2.6 Kauwen......................................................................................................................................30
2.7 Drinken......................................................................................................................................30
2.8 Bij welke mensen vraagt voeding extra aandacht?....................................................................31
2.8.1 Onderscheid tussen CP en NMA.........................................................................................31
2.8.2 Tips bij het slikken...............................................................................................................31
2.8.3 Als het fout gaat..................................................................................................................32
2.8.4 richtlijnen voor een veilige eet-en drinksituatie.................................................................32
3. Tandverzorging en mondhygiëne....................................................................................................33
4. Drooling...........................................................................................................................................33
5. Ademhaling......................................................................................................................................34
6. Fonatie.............................................................................................................................................34
6.1 waarom adem-stemtherapie?...................................................................................................35
6.2 wanneer doen we aan adem-stemtherapie?.............................................................................35
7. Resonantie.......................................................................................................................................35
8. Spraak, taal, communicatie..............................................................................................................35
3
, Neurodegeneratieve stoornissen en CP 2024-2025
9. Non-verbale en ondersteunde communicatie.................................................................................36
1. Kenmerken.......................................................................................................................................36
2. Logopedische therapie bij NMA.......................................................................................................36
2.1 Ademhaling en stemgeving........................................................................................................37
2.1.1 Ademhaling.........................................................................................................................37
2.1.2 Stemproblemen..................................................................................................................37
2.1.3 Logo-kiné............................................................................................................................37
2.1.4 Toestellen...........................................................................................................................38
2.2 Mondmotoriek...........................................................................................................................38
2.3 Eet- en drinktherapie.................................................................................................................39
2.4 Taalontwikkeling........................................................................................................................39
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