Cerebral Vascular Accidents

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            Blood supplies brain cells with essential nutrition, such as glucose and oxygen. Oxygen supply by the bloodstream is vital to normal brain function. A cerebral vascular accident (CVA) occurs when there is an interruption in the supply of oxygenated and bloodPrintto the brain. This can be caused by an artery that has ruptured or an obstruction of an artery (Isaksen et. al,. 2008). CVA’s are classified as either hemorrhagic or ischemic. Hemorrhagic type strokes are the result of a blood vessel rupturing, such as an aneurysm. An aneurysm is a ballooning area of an artery. The ballooning causes the walls of the aneurysm to become stretched and thinned. An aneurysm ruptures when wall tension exceeds the strength of the wall tissue (Isaksen et. al,. 2008). The rupturing of an aneurysm results in spilling of blood into the subarachnoid space, thus resulting in a hemorrhagic stroke (Cebral et. al., 2005).

            An ischemic type of stroke is the result of a blood clot or sclerotic material obstructing blood flow to the brain. An ischemic stroke can be the result of a thrombosis or an embolism. A thrombosis is a clot that forms inside of the brain. An embolism is a clot that forms elsewhere in the body and travels through the bloodstream towards the brain. An embolus blood clot is often caused by atrial fibrillation (Jespersen & Ostergaard 2012).

            Obstruction of oxygen and glucose supply to the brain can result in impairments in speech and in voice (Jespersen & Ostergaard 2012). For example, a CVA may result in vocal fold paresis or paralysis, dysarthria, aphasia, or apraxia. The changes in speech and voice are dependent on the location and the extent of the cerebral event.Circle_of_Willis_en.svg

            Although CVA’s may result in speech impairments, initial severity of symptoms often become less severe. This is due to a reduction in swelling in the areas of the brain that were impacted. Additionally, when one area of the brain is impacted by a CVA blood supply is often still supplied by way of the circle of Willis. The circle of Willis is the ultimate form of collateral circulation and plays an important role preserving blood supply to brain tissue following an obstruction (Romero et. al. 2009).

            The circle of Willis works to secure blood supply to each side of the brain. Therefore, if a person experiences a CVA in one area of the brain, blood supply to that portion may still
be delivered. The presence of collateral circulation is a favorable prognostic factor in cases of CVA (Romero et. al. 2009).

Rose Costanzo MA CF-SLP, TSSLD

 

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APRAXIA OF SPEECH

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Developmental apraxia of speech is characterized by the inability to plan and execute motor-speech tasks. More specifically, it is the inability to coordinate oral movements that are necessary to form syllables and words in the absence of oral paresis or paralysis. The speech of children with developmental apraxia of speech is filled with inconsistent articulation errors. The errors in this population increase with word length. These children exhibit more errors in consonants than in vowels, especially in the initial consonants of words and in consonant clusters (Wertz, LaPointe, and Rosenbek, 1991).

Children who are able to produce many sounds in isolation, yet exhibit difficulty maintaining sound combinations, reduce the number of syllables in simple words, or inconsistently substitute sounds are appropriate candidates for a speech-language evaluation. A speech-language evaluation should also be complemented with a detailed case history, as certain answers may assist in the diagnosis of developmental apraxia.

The American Speech-Language-Hearing Association (2007) identified the features consistent with the developmental apraxia diagnosis. These features include inconsistent errors on consonants and vowels in repeated syllables or words, lengthened and disrupted co-articulatory transitions between sounds and syllables, and inappropriate prosody (ASHA, 2007).

 

Rose Costanzo MA CF-SLP, TSSLD

The Benefits of Breastfeeding

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What are the benefits of breastfeeding as compared to bottle-feeding?

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Studies are mixed on whether breastfeeding can give your baby a true advantage (when compared with bottle-feeding) in developing speech and language skills, but breastfeeding does naturally strengthen the tongue, lips, and jaw in a way that promotes speech and language readiness. An increased duration of breastfeeding is associated with a decreased risk of: abnormal tongue posture, nonnutritive sucking, orthodontic treatment, and malocclusion (misaligned teeth). Bottle-feeding requires a different tongue movement than breastfeeding does, and overtime may affect the development and growth of oral and facial tissue.

A newborn baby suckles, but as the baby continues to grow he/she must develop stronger muscles to have more efficient feeds. As the tongue works to retrieve milk from the breast, it is also spreading out, getting stronger, and anchoring itself at the back of the mouth. This anchor is essential for speech because some sounds later on are developed in the back of the mouth. The anchor also allows the tongue, jaw, and lips to move independently from one another (another precursor for mature speech). Bilabial sounds such as /m/,/b/,/p/ come from the lips and /k/, /g/, and /ng/ all require independent movement – by the tongue.

Bottle-feeding gives your baby less control over his/her milk intake. Milk flows easily from a bottle nipple even if the baby is not sucking. The baby must push his/her tongue forward to stop the milk from flowing outward in excess. In addition, a faster flow can promote a baby to continue feeding after he/she is full. During breastfeeding, a baby is more easily able to control the milk flow without the forward motion of the tongue.  Research has also suggested that yet another benefit to breastfeeding is that infants who are breastfed are better able to determine fullness as children and are therefore less likely to overeat as well and become prone to obesity (Isslemann 2011).

Sources:

Are There Differences Between Breastfeeding Directly and Bottle-feeding Expressed Milk? – Native Mothering™. (2012, April 30). Retrieved February 2, 2015, from http://nativemothering.com/2012/04/are-there-differences-between-breastfeeding-directly-and-bottle-feeding-expressed-milk/

Breast-Feeding & Speech Development: What You Need to Know – mom.me. (n.d.). Retrieved February 2, 2015, from http://mom.me/baby/10084-breastfeeding-speech-development-what-you-need-know/