Understanding your Child’s Sensory Development

I was recently asked  the question “Should I concerned about my child’s sensory development?”  The answer is YES!  Children are oriented toward sensory experiences.  Children experience the world by tasting, touching, smelling, seeing and hearing. Stimulating the senses sends signals to a child’s brain that helps to strengthen the neural pathways. 

What is sensory development?

Screen Shot 2016-04-28 at 5.21.06 PMIt is the journey that your baby will take in exploring the world through their senses. Most babies are born with their senses fully developed. As a child approaches 3 years of age subtle changes occur. Understanding typical development is important as any problems with one system could affect your child’s development. Your baby is unique and may acquire certain skills at a slower or more rapid pace. Routine checkups by your child’s doctor or pediatrician is recommend for further evaluation of sensory development.

TASTE/SMELL

Screen Shot 2016-04-28 at 5.25.43 PMInfants have more taste buds for sweets than adults. A babies’ flavor progression starts with sweet, followed by salty, sour, and acquires bitter last. They will have full sensitivity to their taste between 12 to 19 months. Toddlers will enjoy smashing, licking, and playing with new foods. Separate tastes and textures in the beginning of feeding. Use visual appeal and let your babies explore their new foods! Your baby will have use of smell from birth. They enjoy pleasant odors and may turn head away from unpleasant smells.

HEARING/LISTENING

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While babies begin to hear at 16 weeks gestational hearing is not fully developed and the middle ear is filled with fluid at birth. Babies respond best to high pitched sounds or voices at birth. Because they learn to hear in the womb they are able to distinguish their mothers voice at birth. While your baby will be able to localize sounds at birth it is not until three months of age however, your baby will turn his or her head towards the sound location. When your baby is between four to six months of age an infant will recognize familiar voices and will respond in vocal play with others. They will respond to background music or music from toys. By seven months to one year of age your baby will listen, demonstrating an understanding of simple words often responding to requests by facial gestures or babbling. As speech continues to develop through listening, between one to two years of age your child should respond to stories and directions using words, eye contact and gestures. By age three to four years old your child should show response to auditory stimuli from a different room and will be able to answer who, what, when where questions.

 

TOUCH

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Babies are very sensitive to touch. At birth, they are most sensitive in their hands and mouth. Make sure your baby gets lots of touching throughout the day! Touch can be either alerting or calming to them. Use soft, smooth, and furry textures to sooth your baby in a swaddle. At birth, they will can distinguish temperatures and feel plan.

 

 

BALANCE/EQUILIBRIUM

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Newborns are completely dependent on you for their external support. During feeding, babies are mostly held in a reclining position with support to their head and upper body at 45­degrees. Head and neck control will improve around 3 months leading to a more upright position for feeding. By 9 months, children will begin to crawl, roll, and sit upright with little external support while feeding. Your 12­month old will begin finding their independence in mobility and feeding; including, crawling on household items, taking their first steps, grasping food, and reaching for feeding utensils. By 19 months, toddlers are running, walking, and no longer need external support in a high chair. Their balance is now developed enough for them to sit independently at the table with the family using a booster seat or child’s tall chair.

VISION

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Infants will develop their visual skills over a period of time. A newborn’s vision is primarily near sighted and they can only focus on objects around 8­10 inches from their face. This enables them to detect the face of their parents. During this time period, and infants eyes are sensitive to light. As they eyes are not fully coordinated during the first two months, they may appear to wander or be crossed. This is typically normal unless the eye appears to do this in a consistent fashion. If this occurs an evaluation is warranted. between five to eight months the baby is begins to see in color, and develops depth perception. It is at this time the world becomes three dimensional. Between 9 months to a year the baby will be able to grasp with precision, and can judge distances fairly well. They are able recognize their own images in the mirror and familiar objects. Keep in mind vision development is not always typical and should be checked by a doctor or pediatrician assesses vision further.

SIGNS OF SENSORY DEFICIT/DELAY

Birth – ­3 months­ the inability to control or maintain posture especially when laying on stomach. Arms and legs may have limited mobility or may appear stiff.                                   6­-12 months­ the child may appear stronger on one side of the body. They may have difficulty crawling or putting food to the mouth.                                                                                By 18­- 24 months signs of deficit may include irritability, inadequate walking pattern (walks on toes). They may be hypersensitive to sounds, textures or movement.
3­6 months­ a baby may have difficulty rolling over and back. Their limbs & trunk may be excessively loose and the baby is unable to sit without support.

Additional Resources

References

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Understanding Your Child’s Reflexes

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REFLEXES

A reflex is a voluntary action in which the body responds without thinking about it. Often when we think of reflexes we think of the doctor hitting your knee with a hammer. Reflexes are used to assess and determine the health and development of a baby’s nervous system.

Many infant reflexes will diminish over time, and are considered abnormal if they persist past a certain age. Your pediatrician will perform a physical exam to determine if the reflexes are typical of normal development.

Asymmetrical Tonic Neck Reflex (ATNR) “aka” The Fencer Reflex”: This reflex is can be elicited with the baby lying on his back. Adjust the head to one side and the reflex will cause the arm and leg on the same side to straighten, while the opposite arm and leg will flex. This is a transitional reflex that prepares the infant to roll over. It attributes to the development of  hand-eye coordination along with activities that require crossing the mid-line of the body. This reflex typically is integrated by 4-6 months.

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Functional significance: Social/learning problems can be associated with this un-integrated reflex such as poor hand eye coordination due to difficulty with ocular tracking that require crossing the mid-line. This affects handwriting and written expression.

Babinski Reflex “aka” The Big Toe Sign: This occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out. This is due to the lack of maturity of the infants neurological system. This is a normal reflex and may disappear as early as 6 months and as late as 2 years.  

Screen Shot 2016-04-18 at 1.33.07 PMFunctional significance: A Babinski reflex in an older child or adult is atypical and is a sign of a problem in the brain or spinal cord. A Babinsiki reflex  can present on one side but not the other is also atypical, and can indicate which  side of the brain is involved.   

Corneal/Eye Blink Reflex: This reflex is involuntary blinking of the eyes caused by a tactile stimulation or bright light to the cornea. This protection mechanism helps keep the eye from drying out when irritated by dust, smoke, allergens or other foreign object.

Functional significance: Excessive eye blinking may be caused by conditions such as blepharospasm (involuntary tight closure of the eyelids), a rapid, involuntary muscle contraction.

Gag Reflex: This is triggered with touch to the posterior tongue, soft palate, or tonsillar area. With infants, this can be triggered when a baby attempts to swallow too much milk. Occasionally a baby will gag on excess mucous in the back of their throats, particularly in the first few days after birth. This can make them momentarily look distressed and turn blue.

Supporting the baby in an upright position or placing them over your shoulder will help relieve the distress. This reflex will diminish around 6-7 months in babies allowing the baby to swallow chunky or swallowed foods. In children and adults this reflex is usually triggered only by the presence of an large object in the back of the throat.

Functional significance: While the gag reflex has no relationship to swallowing in adults, it is important in infancy to prevent choking as the infant transitions from liquid to solid foods. The gag reflex does not disappear and persists throughout your child’s life. For those with a Hypersensitive gag reflex (HGR), the reflex continues to be activated by substances in the mouth. Typically food that are sticky such as bananas and mashed potatoes, get stuck. In extreme cases this can lead to a picky eater or malnourishment.

Landau Reflex “aka” The Superman Response: The onset of this reflex is typically about 3-4 months. When the child is placed in the prone position and supported in the air, the head will extend and the back and hips will expend in sequence. This reflex will typically be integrated about 12-24 months.

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Functional significance: This reflex breaks up the total flexion pattern seen at birth. If the landau reflex fails to diminish, children may experience short-term memory problems, poor motor development and low muscle tone.

Moro Reflex “aka” The Startle Reflex or Embrace Reflex: Occurs in response to any sudden movement or loud noise. The baby will respond by flinging their arms out, fanning their fingers with extension of legs and then quickly pull their arms back in towards their body in an ’embrace’ position. The reflex can elicit a negative emotional response causing the baby to cry. This reflex is typically is integrated by 4-6 months.

Screen Shot 2016-04-18 at 1.17.23 PMFunctional significance:  The presence of asymmetry during the response of this reflex could indicate peripheral nerve problems to the upper extremities. The child may become over sensitive and over reactive to sensory stimulus. This results in poor impulse control, sensory overload and anxiety. Children will be over emotional and will lack social maturity. Some additional signs of a retained Moro reflex are motion sickness, poor balance, poor coordination, easily distracted, unable to adapt well to change, and mood swings.

Palmar Reflex “aka” The Grasp Reflex: This reflex is demonstrated by placing your finger or an object into your baby’s open palm, causing the baby to reflexively grasp or grip. If you try to pull away, the grip will get even stronger. This is typically integrated by 4-6 months of age.

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Functional significance: Many children who fail to integrate this reflex have difficulty with independent finger movements. This may be indicative of poor handwriting skills and a poor ability to process ideas and then write them down such as; copying words is often easy, however the task of spelling words is difficult and messy.

Phasic Bite Reflex: This reflex is initiated with pressure is place on the baby’s gums. The response is a rhythmic closing/opening of the jaw with no lateral movement of the jaw. This reflex typically diminishes between 9-12 months when a controlled, sustained bite. It should be noted that the child may pull their head backward in slight extension initially to help with the bit until stable typically around 18 months.

Functional significance: This behavior is when disassociation of lips, tongue and jaw begins with true sucking. It is responsible for early munching/vertical chewing patterns.

Plantar Grasp “aka” The readiness Tester: This reflex is demonstrated by applying firm pressure to the plantar surface of the child’s foot, causing the child to reflexively flex all of their toes. This is typically integrated by 9 months.

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Functional significance: This reflex is important at it integrates at the same time that independent gait/steps first become possible.

 

Pupillary Light Reflex: The diameter of the pupil constricts or dilates in response to entering light. A bright light will cause constriction while darkness causes pupil dilation to allow for more light to enter the eye.

Functional significance: Pupils that do not constrict in response to light or are       unequal in size can be a sign of a serious medical emergency including stroke,       bleeding or tumor. Seek immediate medical care if your child’s pupils do not       constrict or are unequal in size.

Rooting Reflex: This reflex occurs when a baby’s lips to the cheek is stroked by a finger. The baby turns his head towards the stimulus and opens his mouth wide in anticipation to eat. This occurs regardless of hunger state and may not be present if the infant is not hungry. This can interfere with eating if a caregiver strokes the baby’s cheek while they are feeding as it can make the baby stop drinking and turn their head towards the stimulus. This reflex is strong during the first 4 months and can last until the child’s first birthday.

Screen Shot 2016-04-18 at 1.49.12 PMFunctional significance: Persistence of this reflex can interfere with the infants sucking pattern while absence of this reflex is often seen in infants with neurological impairments.

                                                              

Tonic bite reflex: This is an abnormal reflex in which an oral stimulation causes the child to bite down with tension that is difficult to release.

Functional significance: A tonic bite can be frustrating and scary for the child and can be misinterpreted by the feeder as a signal that the child does not want to cooperate with mealtime.

Tonic Labyrinthine Reflex (TLR): The gentle tilting back of the baby’s head while laying down causes the back to stiffen and arch backwards. The baby’s legs will straighten stiffly and push together. The toes point and the arms will bend at the elbows and wrists, causing the hands to become fisted and the fingers to curl. This reflex prepares the baby for movements of rolling over and crawling. This reflex typically is integrated by around 3-4 years of age.

Functional significance: Persistence of this reflex can lead to poor muscle tone. It can impede activities, which require graded co-activation of flexor and extensor muscles and children will have a tendency to walk on toes. Other signs may be motion sickness and poor balance.

Step Reflex “aka” The Dance Reflex: This reflex is present at birth despite that an infant cannot support his own weight. When the baby is held in the upright position and the feet are placed on a firm surface, the baby will place one foot in front of the other. Typically this will disappear between 6-8 weeks and then will reappear no longer as a reflex but as a voluntary movement around 8 months – 1 year.

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Functional significance: Premature infants will tend to walk in a toe-heel pattern while more mature infants will walk in a heel-toe pattern.

Spinal Galant Reflex: This reflex occurs with an infant placed on their tummy or lightly supported under the abdomen with a hand under them. With a finger, one side of the baby’s spinal column is stroked from the head to the buttocks. The response occurs with the baby’s trunk curving toward the stimulated side. This reflex is typically is integrated by 3-9 months.

Functional significance: Social/learning problems can be associated with this             un-integrated reflex such as the inability to sit still, poor concentration, poor posture and hip rotation on one side, which is attributed to scoliosis. Chronic digestive issues and bed-wetting may occur beyond age of 5 years.

Suck-Swallow Reflex: Sucking a thumb and swallowing amniotic fluid can first be seen at about 12 to 13 weeks gestation and mature about 36 weeks. The ability to coordinate the reflexes to produce rhythmical sucking simultaneously to drink, swallow and breathe is known as the ‘sucking – swallowing – breathing’ sequence. This reflex should disappear between 2-5 months.

Functional significance: Persistence of this reflex could inhibit voluntary sucking.

Symmetrical Tonic Neck Reflex (STNR) aka” The Crawling Reflex: A typical response in infants is to assume the crawl position by extending the arms and bending the knees when the head and neck are extended. This reflex typically is integrated by 11 months.

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Functional significance: Necessary to achieve quadruped crawling. Developmental delays related to poor muscle tone, tendency to slump while sitting, and inability to sit still and concentrate can result if the STNR fails to diminish.

 

 

 

Questions or Concerns?

This is a brief overview of reflexes seen in typically developing children. If you are concerned that your child’s reflexes are not normal, consult with your pediatrician.

AnneMarie Finn MS CF-SLP

Additional Resources on Reflexes

 

Understanding Sensory Defensiveness: Mealtime Strategies

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What is sensory defensiveness?

Sensory defensiveness is a type of hypersensitivity that often includes anger or fear towards certain stimuli, and is highly emotional. The stimuli can be tactile, auditory, smell, or taste. When children experience this with food texture or taste, they can get very defensive and refuse food altogether, become fearful of food, and begin to thoroughly examine the food they are about to eat. Children can also experience emotional responses to the food such as screaming, hitting, gagging, vomiting and throwing the food (Morris, 2000).

                  Interaction Patterns between the feeder and the child is a very important one; it creates a bond and helps develop the importance of mealtime experiences. If the child has sensory defensiveness, they can give the feeder confusing messages while feeding. Since the reaction to specific sensory information can be an emotional one, the feeder can interpret their messages as unwanted behavior or as the child not wanting to eat altogether. This creates stress for the child and the feeder and can cause nutritional deficiencies. A child with sensory defensiveness may not react the same way to every bite of food. One bit may not stimulate a defensive reaction while the next bite will make the child react negatively. Things such as the way the utensil is entering the mouth can trigger the emotional reaction.

More than the food that is presented can also cause sensory defensiveness at mealtimes. Noises and lights can have an impact on mealtime for a child with sensory defensiveness. Mealtime interactions are a very important part of development for the child, so when the sensory defensiveness begins to interfere negatively with the mealtime interaction, modifications need to be made.

Understanding the Interaction Patterns

Hyper-sensitivity

Oral Tactile: The child will react negatively to being messy around their mouth and may have adverse reactions to specific textures and/or feeding tools.                                                   * Use a firm touch with wiping the face. (see activities)

Olfactory/Gustatory: The child will prefer bland foods. Certain smells may cause gagging or vomiting. They will often be a very picky eater and often refuse different types of food.

Hypo-sensitivity

Oral tactile and Proprioceptive:  The child may have atypical chewing patterns such as lengthy chewing or even swallowing food whole. They might pocket food in their cheeks. They are typically messy eaters. Choking or vomiting is not uncommon.

* To prevent choking modify food texture to chopped and present food in   small pieces.
* Pocketing food or extensive chewing – increase sensory properties of food and pace the bites. Be aware of the child’s visual and verbal cues.

Olfactory/Gustatory. The child might be disinterested in eating without enhancement of smell. They often prefer crunch and highly flavored food.                                                                * Gradually introduce new smells, labeling smells as possible flavors.

With any refusals to accept modifications remember that gradual subtle changes are best.

Force-feeding is not the answer!

Modifications for success during mealtimes

Preparation: Preparing the environment, food, and sensory experiences contributes to success.

Environment: reducing noise or lights in the dining room. The addition of music can have a calming effect for some children. Music can also help the child organize the sensory information.

Food: listen to the child; they will let you know what they don’t like. This can often be frustrating for parent but keep in mind preferences may change daily. It is important to pay attention to how your child is responding. Allow the child to help you choose the foods that work for them, and be sure to be able to adapt those sensations to get a favorable response from the child.

Introduction of new foods: utensils or favorite toys can be dipped in food to introduce new flavors. Remember, gradual changes are best. (Morris, 2000)

The body: Slowing down the vestibular system helps to slow down your child’s integration of sensory information.

Rocking with the child.
* Carrying the child up & down the stairs.
* Swinging the child.
* Use a big ball to roll or bounce on a ball.

Massage: touch that is firm but caring/gentle Light touch can over stimulate children.
Begin with firm pressure in less sensitive areas of the body and gradually work towards more sensitive areas.

Routine activities/Before feeding activities

Providing deep input to the joint and muscles helps your child to integrate sensory information such as; clapping, bouncing, marching, jumping, or pushing larger toys.

Toothbrush activities help with oral defensiveness. Always let your child know what you are doing and why

Have an adult soft toothbrush and take turns showing them on your mouth.                 Products such as a NUK trainer set are great tools to help the child explore their mouth.   

With your child’s permission, on their face, begin with firm even strokes on the cheeks then move towards the chin.

With your child’s permission, gently brush his lips, gums and sides of tongue and surface of teeth with a NUK  brush or finger toothbrush. Gradually introduce new textures such as a soft washcloth or sponge. With any of these activities, your child will let you know the appropriate amount of stimulation.

Watch for cues. These activities can be incorporated into a before mealtime routine to help the child become better organized to enjoy and participate in mealtime.

 “UNDERSTANDING THAT THE BEHAVIOR OF THESE INDIVIDUALS, IS THE RESULT OF A CONSTELLATION OF NEUROBIOLOGICAL IMPAIRMENTS RATHER THAN WILLFUL ACTS OF   NONCOMPLIANCE.” Twachtmean-Reilly, ET AL, 2009

Direct intervention and training in the use of these intervention techniques can be discussed with your speech language pathologist.

AnneMarie Finn MS CF-SLP

Additional Resources

References

  • Greis, S.M.,Hunt, S.M. Textures Progression: The Effects of Oral Sensory Defensiveness on Oral Motor Function in ASD. The Childrens Hospital of Philadelphia Pediatric Feeding & Swallowing center. http://www.chop.edu/export/download/pdfs/articles/pediatric-feeding-and-swallowing/textureprogression.pdf.
  • Morris, S.E., & Klein, M.D. (2000). Pre-feeding Skills; A Comprehensive Resource for Mealtime Development (2nd ed.). United States; TSB/Harcourt.
  • Twachtman-Reilly, J., Amaral, S., and Zebrowski, P. (2009). Addressing Feeding Disorders in Children on the Autism Spectrum in School Based Settings: Physiological and Behavioral Issues. Language, Speech and Hearing Services in Schools. Vol. 39. 261-272.

 

Apraxia & Dysarthria Motor Speech Disorders

After reading last month’s excellent blog post about Apraxia of Speech, I began to reflect on memories back in graduate school, when I was first taking Neurogenic Speech Disorders and Neurogenic Language Disorders. I thought about the initial excitement I felt about preparing to learn about the myriad of neurogenic disorders including diagnosis and treatment. I remembered how overwhelmed I felt about having to learn all the medical terminology especially when it came to motor speech disorders.

These disorders affect a patient’s ability communication at home, socially and at work. When I began to work with wonderful patients and their families, the complexity of these disorders became quite clear. I began to witness first hand, the challenges and frustrations that patients and family members have during this very difficult time.

Communication during medial interactions is so important and can be daunting for patients with a diagnosis of apraxia or dysarthria. While medical staff makes every attempt to educate patients and their families, sometimes this can be difficult as there is only  limited time for most medical appointments. When patients and their family member(s) come to our clinic, we encourage questions and take the time to answer them.

The following is a resource to help understand these complex motor speech disorders.

 

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A Guide to Apraxia & Dysarthria Motor Speech Disorders

Apraxia and Dysarthria Etiologies (causes) can be acquired due to a trauma to the head, tumor, stroke or degenerative diseases of the brain.

Apraxia Types

Apraxia of Speech (AOS) (sometimes referred to as verbal apraxia or dyspraxia). Apraxia is a cortical (cortex) problem that results from a central nervous system lesion following damage to the brains left frontal lobe. Specifically; the third gyrus (ridge/fold of the surface of the brain), which is known as Broca’s Area, or Brodmann’s area 44.

Apraxia is a motor speech disorder that involves difficulty initiating and executing the movement patterns needed for speech production. With apraxia there is no paralysis, weakness, or in-coordination of the muscles, it is thought to be an impairment in the motor planning (the ability to conceive, plan and carry out the motor act) needed for speech. Apraxia effects both articulation (structures & movements to produce speech sounds) and prosody (rhythm) and may be associated with aphasia (affects ability to understand and comprehend language) and dysarthria’s (Hedge, 2010).

Types of errors with apraxia are variable. There will be a difference between a patients’ spontaneous speech production (will contain fewer errors) vs. repetition. Rote or over-learned material such as; the days of the week or months of the year are often spoken clear and fluently.

Patients will have difficulty when attempting to put their thoughts into words, due to the inability to coordinate the muscles for speech. Patients will exhibit false starts, effortful and audible groping for the right sounds and word. Numerous attempts to self-correct will be made, as patients understand that they are making errors. Substitutions are common and approximations of targeted phonemes (distinct units of sound) are made. Other errors include; transpositions, omissions, additions, repetitions or even prolongation of words. Distorted vowels and consonants are produced, while vowels tend to be easier to produce than consonants and single consonants are easier than blends. As in stuttering, final consonants are easier than those in the initial position of words.  This may occur because initial consonants are affected by anticipatory errors. Also, perhaps once an apraxic gets speech started with the production of a vowel, production continues in a more automatic fashion. Fricative [/f/, /v/, (/ð/ as in thy and /θ/ in thigh) /s/, /z/, “sh”, /z/, /ʒ-as in measure/ and /h/) and affricates (/tʃ/ = “ch”) and /dʒ/ in germ], are the most difficult phonemes for apraxics to produce. These sounds require very complex articulatory movements (McCaffrey, 2013). Their rate and rhythm will be irregular when speaking and often intervals between syllable segregation and errors in stress.

Oral apraxia will be demonstrated when non-speech volitional (a choice or a decision) movements are attempts such as attempting to being asked to pucker your lips, or puffing out your cheeks.

Childhood Apraxia of Speech (CAS) (sometimes referred to as developmental apraxia), can be congenital (present from birth-hereditary) or it can be acquired during speech development. Both congenital and acquired onsets can be idiopathic (disease or condition that arises spontaneously or the cause is unknown) or can occur in the context of complex neurodevelopmental disorders (impairments of the growth and development of the brain or central nervous system) or in association with a neurological event (Shriberg, 2010). Meaning that there isn’t a known cause for the apraxia, but it is evident that it is in planning and/or programming speech movements. (ASHA, 2007). In contrast with adults who have already developed these processes.

While acquired apraxia and childhood apraxia of speech have similar speech characteristics, the fundamental difference is with CAS is the age in which it presents. Speech typically develop as an infant progressing from cooing, babbling, words, phrases to finally sentences between 3-4 years of age. This developmental process is interactive involving not only sensory and motor control but perception and psycholinguistic (psychological and neurobiological factors on how we acquire, use, comprehend and produce language) processes. For children with CAS this process is somehow interrupted.

Dysarthria

Dysarthria is a term used to describe neurological speech disorder of movement and/or muscular control. This is due to damage of either the central nervous system (consists of brain and spinal cord) or the peripheral nervous system (consists of nerves outside the brain and spinal cord). The neural pathway that sends signals between the brain and muscles for motor movements of speech is interrupted. Types of are classified by injury site within the nervous system and by speech characteristics.

The types of errors in dysarthria is different from those of patients with apraxia. There is no time when speech errors are not present. Errors in dysarthria are consistent and predictable. Speech sound errors will occur under all speaking tasks and will not change. They will include distorted errors and omissions of sounds.

Dysarthria Types

Flaccid dysarthria: characterized by muscular weakness with recovery after rest. Typically weakness progresses along with low muscle tone, possible twitching of muscles. Symptoms do vary by type of injury.  Respiration, speech and swallowing can be impacted.

Spastic dysarthria: characterized by weakness, reduced range and slowness of movement. Symptoms include slow effortful speech, fatigue, hypernasality, drooling, dysphagia (trouble swallowing), and difficulty controlling emotional expression.

Ataxic dysarthria: characterized by difficulties with body position and walking, tremor, reduced muscle tone and range of movement. “Drunken-like” effortful speech , with difficulty coordinating respiration difficulty with the oral phase of swallowing and  fatigue are common.

Hypokinetic dysarthria: characterized by resting tremor, rigidity, slow and reduced range of movement, and posture abnormalities. Symptoms of weak voice, fast rate of speech, fatigue, drooling and swallowing difficulties.

Unilateral upper motor neuron: characterized by Babinski reflex (the big toe remains extended or extends itself when the sole of the foot is stimulated, abnormal except in young infants) on the affected side. Weakness, low tone appear first but transition into spasms strong reflexes and increased tone. Symptoms of fatigue, unintelligible, slow rate of speech, drooling, with chewing and swallowing difficulties.

Mixed: damage to different areas of the nervous system or from multiple lesions, caused by various diseases such as multiple sclerosis, multiple strokes, and ALS. Characteristics depend on the combination of dysarthria.

Treatment Considerations

Apraxia and Dysarthria treatments will vary dependent upon the individual patient’s needs. Factors such as severity, etiology, coexisting problems including patients’ ability and motivation are considered.

Dysarthria therapy is strictly compensatory (learning techniques to help increase clear speech), due to the severed motor pathways, which cannot be repaired.

Apraxia therapy works on retraining to create neuronal connections to improve the planning, sequencing, and coordination of musle movements for speech production.

Childhood Apraxia of Speech works on creating neuronal connections typically involving movement patterns vs. sound patterns.

A Speech Language Pathologist will evaluate, discuss treatment options and goals specific to each unique individual’s needs.

Communication Tips

As frustrating as it may be for you, remember your loved one is struggling as well. Patience is the key. Remember to look at the person when they talk, reducing background noise and distractions. Allow plenty of time for a response, eliminating stress and anxiety that can further impede communication. Avoid correcting errors or finishing sentences unless you have discussed this and the patient prefers your help. Otherwise it can cause resentment. Honesty is best.  If you do not understand on the first try, paraphrase what you did understand and ask for clarification. Saying you did understand when you did not causes frustration.

AnneMarie Finn MS CF-SLP

Resources and Support

References:

  • Childhood Apraxia of Speech (2007) Retrieved June 27, 2014, from http://www.asha.org/
  • Duffy, J.R. (2003) Motor speech disorders: substrates, differential diagnosis, and management (3rd ed.). St. Louis, Mo.: Elsevier Mosby.
  • Hedge, M.N., & Davis, D. (2010) Clinical methods and practicum in speech-language pathology (5th ed.).  Clifton Park, NY: Delmar Cengage Learning.
  • McCarthy, P. (2013) Neuropathologies of Swallowing and Speech. Retrieved April, 7 2016 from  http://www.csuchico.edu/~pmccaffrey//syllabi/SPPA342/342unit15.html.
  • Yorkston, K.M. (2010) Management of motor speech disorders in children and adults, (3rd ed.). Austin,  Tex.: Pro-Ed.