cerebral palsy

Speech-language pathologist role in Cerebral palsy

Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Signs and symptoms vary among people and over time. Often, symptoms include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, swallowing, and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, which each occur in about one third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.

Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Most often, the problems occur during pregnancy; however, they may also occur during childbirth or shortly after birth. Often, the cause is unknown. Risk factors include preterm birth, being a twin, certain infections during pregnancy such as toxoplasmosis or rubella, exposure to methylmercury during pregnancy, a difficult delivery, and head trauma during the first few years of life, among others. About 2% of cases are believed to be due to an inherited genetic cause. A number of sub-types are classified based on the specific problems present.^[1] For example, those with stiff muscles have spastic cerebral palsy, those with poor coordination have ataxic cerebral palsy and those with writhing movements have athetoid cerebral palsy. Diagnosis is based on the child's development over time.^[1] Blood tests and medical imaging may be used to rule out other possible causes.^[1]

If a child with cerebral palsy has issues with communication and/or swallowing and breathing issues, speech therapy is generally recommended. Children’s speech and language development typically follows a pattern.  Those with cerebral palsy may not progress as predictably – calling for speech therapy intervention. 

Speech therapy has widespread benefits for cerebral palsy patients.  Not only does the process improve communication interactions, but speech therapy can also be used to strengthen and improve facial and oral muscle control.

Dysphagia and oral feeding difficulties affect cerebral palsy patients in several ways.  The condition can include problems chewing, swallowing, gagging, coughing and drinking.  Maintaining healthy body weight and nutrition may present challenges for children with CP, including hydration concerns and questions about long-term physical development.

Feeding and swallowing therapy, conducted by trained speech and language pathologists, ensures physical challenges do not interfere with a child’s nutritional intake.

Speech therapy supports development in these areas:

• Producing sounds, words and syllables
• Pitch
• Regulating voice volume
• Listening/perception
• Articulation and pronunciation
• Vocabulary
• Understanding and comprehension
• Voice quality
• Chewing and swallowing

cleft lip and palate

Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of speech and language problems, as well as feeding and swallowing problems, associated with cleft lip and palate. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research (ASHA, 2016b).

A team approach to service delivery is essential throughout the individual's care, and SLPs typically provide services as part of, or in collaboration with, a team.

Appropriate roles for SLPs include, but are not limited to,

• counseling persons with cleft lip and palate and their families regarding communication- and feeding/swallowing-related issues and providing education aimed at preventing further complications relating to these conditions;
• educating other professionals about the needs of persons with cleft lip and palate and the role of SLPs in diagnosis and management;
• screening individuals who present with cleft lip and palate; determining the need for further assessment and/or referral for other services;
• conducting a comprehensive, culturally and linguistically appropriate assessment of speech, language, resonance, voice, or feeding problem associated with cleft lip and palate;
• diagnosing speech, language, resonance, voice, or feeding disorders associated with cleft lip and palate;
• referring to other professionals to rule out co-occurring conditions, determine etiology, and facilitate access to comprehensive services;
• making decisions about the management of speech, language, resonance, voice, and feeding/swallowing problems related to cleft lip and palate;
• developing treatment plans, providing treatment, documenting progress, and determining appropriate dismissal criteria;
• consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate;
• remaining informed of research in the area of cleft lip and palate and helping advance the knowledge base related to the nature and treatment of these conditions;
• advocating for individuals with cleft lip and palate and their families at the local, state, and national levels;
• serving as an integral member of an interdisciplinary team working with individuals who have cleft lip and palate and their families/caregivers; and
• providing quality control and risk management.

As indicated in the Code of Ethics (ASHA, 2016a), SLPs who serve this population should be specifically educated and appropriately trained to do so. This is of paramount importance for those serving on a cleft palate-craniofacial team, where decisions regarding surgical intervention require significant SLP input.

autism

AUTISM

Autism is a developmental language disability that usually involves impaired verbal and nonverbal communication, social interaction and cognitive skills. persons with autism commonly experience different speech, language and communication problems. These children may

• Not talk at all
• experience Trouble understanding the meaning of words outside the context where they were learned,
• Use echolalia (repeating what another person says), robotic-like speech or foreign-sounding "words",
• Use the right phrases and sentences, but with an unexpressive tone of voice
• Be unable to communicate non-verbally (including use of gestures, eye contact, …).
• Rely on language with the lack of creativity.

Because of these communication challenges, a child with autism needs early interventional programs and specifically, speech therapy.

Speech therapists are a key part of the autism diagnosis and treatment team. They play role in early detection of people at risk and making essential referrals to other specialists. when autism is diagnosed, speech therapists assess the best ways to improve communication and enhance a person's quality of life. They learn children to comprehend verbal and nonverbal communication and respond to it both verbally and nonverbally. Throughout therapy, the speech-language pathologist also works closely with the family, school, and other professionals. The overall goal is to help the person communicate in more useful and functional ways. If someone with autism is nonverbal or has major trouble with speech, the speech therapist may introduce alternatives to speech, such as AAC.

developmental language disorder

Developmental Language Disorder (DLD)

Developmental language disorder (DLD), a new term which has been replaced the term specific language impairment (SLI) is diagnosed when a child has problems with language development that continue beyond 5 years old and there are no known biomedical causes, such as mental retardation, hearing loss or autism for language learning difficulties that are experienced by affected children.

Expressive language is characterized by non-specific words, short simple sentences to express meanings and many grammatical errors.  Different aspects of language including Phonology (speech sounds), Semantics (vocabulary) Syntax and morphology (grammar), Discourse (narrative, conversation) may be variably impaired at both expressive and receptive modalities, though most obvious problems could be seen in morpho-syntax. Other than language, most children with DLD experience cognitive problems specially in phonological working memory.

Language deficits emerge in early childhood, have a significant impact on everyday social interactions or educational progress, and persist throughout the school years and into adulthood. However, natural variability in language acquisition can make it challenging to assess early delays and to distinguish late talkers from language impaired children with persistent symptoms. 

Assessment, differential diagnosis and treatment of children with DLD is mainly carried out by speech and language pathologists. SLPs use a wide range of techniques to stimulate language learning. These interventions can significantly enhance children’s ability to communicate and can increase their competence in specific areas of language, though as yet, there is no cure for DLD.

intellectual deficit

Intellectual Deficit (ID)

Intellectual disability (ID) is a neurodevelopmental disorder characterized by 3 features including: 1) deficits in cognition, 2) deficits in adaptive function, and 3) onset during the developmental period

genetic abnormalities as well as prenatal, perinatal, and postnatal environmental factors could be the causes of ID. Suspicion of ID can arise during infancy regarding developmental delays, although ID can be determined with greater certainty by age 5 years, when cognitive abilities become more stable.

speech and language deficits are so prevalent (around 55%) in children with intellectual disabilities, and children with different etiologies of intellectual disabilities show different symptoms.  

speech language pathologists have the primary responsibility for the assessment and treatment of speech, language, and swallowing impairments in children with ID, though providing an effective assessment and Intervention program for these children requires interdisciplinary collaboration among SLPs, audiologists, behavioral consultants, caregivers, educators, nurses, occupational therapists, physicians, physiotherapists, psychologists and social workers.

Treatment programs may include any areas of oral or written communication; social interaction; and, eating and swallowing function and usually incorporate building on the client’s strengths and remediating areas of weakness. Also, the person’s environment should be considered as an important part of any intervention for successful communication. Generalization of new skills can be a particular challenge for individuals with ID and should be a focus of any treatment program. Education and consultation for the individual, family and other care providers is also a crucial component of treatment. in the case of nonverbal children with major trouble with speech, SLPs may introduce AAC as an alternative to speech.

fluency disorder

Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of fluency disorders in children. The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), advocacy, education, administration, and research.

Appropriate roles for SLPs working with children with fluency disorders include:

• providing prevention information to individuals and groups known to be at risk for fluency disorders and to individuals working with those at risk;
• educating other professionals about the needs of children with fluency disorders and the role of SLPs in screening, assessing, diagnosing, and managing fluency disorders;
• screening of communication when a fluency disorder is suspected and as part of a comprehensive speech-language evaluation;
• understanding that awareness and concern about stuttering may vary across individuals and cultures and conducting a culturally and linguistically relevant comprehensive assessment of fluency and language;
• diagnosing fluency disorders;
• referring the patient/client to other professionals to rule out other conditions, determine etiology, and facilitate access to comprehensive services;
• developing culturally and linguistically relevant treatment and intervention plans focused on helping the child achieve fluent speech, providing treatment, documenting progress, and determining appropriate dismissal criteria;
• recommending related services when necessary for daily classroom management and treatment;
• counseling individuals with fluency disorders and their families and providing education aimed at preventing further complications related to fluency disorders;
• consulting and collaborating with families, individuals with fluency disorders, other professionals, support personnel, peers, and other invested parties to identify priorities and build consensus on an intervention plan focused on functional outcomes;
• remaining informed of research in the area of fluency disorders and advancing the knowledge base of the nature of the disability, screening, diagnosis, prognostic indicators, assessment, treatment, and service delivery for individuals with fluency disorders;
• advocating for individuals with fluency disorders and their families at the local, state, and national levels.

As indicated in the Code of Ethics (ASHA, 2010), SLPs who serve this population should be specifically educated and appropriately trained to do so. The American Board of Fluency and Fluency Disorders, under the auspices of ASHA's specialty certification program, offers clinical specialty certification in fluency and fluency disorders. Board Certified Specialists in Fluency are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with fluency disorders.