Speech Therapy
Cerebral Palsy (CP) refers to a group of permanent disorders that affect the development of movement and posture that cause activity limitation. This condition attribute to non progressive disturbances that occurred in the developing fetal or infant brain. Some children with cerebral palsy often show characteristics in disturbances of sensation, perception, cognition, communication, and/or behaviour. For this condition, at present there is no cure to treat the problem, except for medical intervention that is limited to the treatment and prevention of complications arising from CP’s effects. Various forms of therapy can help a person with CP to function and live more effectively. In general, the earlier treatment begins the better chance for the children to overcome the developmental disabilities and learn new ways to accomplish the tasks that challenge them.
Babies born with severe CP often have an irregular posture; their bodies may be either very floppy or very stiff. In some cases, babies born with CP may have other defects during birth such as spinal curvature, a small jawbone, or a small head. The symptoms of irregular posture may appear or change as the child gets older. Some babies born with CP even do not show any obvious signs right away. Classically, CP becomes evident when the baby reaches the developmental stage at six and a half to 9 months. Any sign of asymmetry or gross motor developmental delay would be identified at this stage.
In general, the primary condition of CP is characterized by abnormal muscle tone (i.e. slouching over while sitting), reflexes, or motor development and coordination. There can be joints and bone deformities and contractures that involve with permanently fixed, tight muscles and joints. The typical symptoms are spasticity, spasms, other involuntary movements (e.g. facial gestures or hands movement), unsteady gait, problems with balance, and/or soft tissue findings consisting largely of decreased muscle mass. Toe walking and scissor walking are common features among people with CP who are able to walk, but no one individual would be the same to another individual.
Secondary conditions of CP could involve with other related problem as such seizures, epilepsy, apraxia, dysarthria or other communication disorders, eating problems, sensory impairments, mental retardation, learning disabilities, and/or behavioral disorders.
How does CP influence in speech and language area?
Speech and language disorders are common in people with Cerebral Palsy. The incidence of dysarthria is estimated to range from 31% to 88%. Speech problems are associated with poor respiratory control, laryngeal and velopharyngeal dysfunction as well as oral articulation disorders that are due to restricted movement in the oral-facial muscles. There are three major types of dysarthria in cerebral palsy: spastic, dyskinetic (athetosis) and ataxic.
Spastic dysarthria involves four major speech abnormalities of voluntary movement: spasticity, weakness, limited range of motion and slowness of movement.
Athetoid dysarthria is caused by disruption of the internal sensory-motor feedback system for appropriate motor commands, which leads to the generation of faulty movements that are perceived by others as involuntary. Speech mechanism impairment in athetosis involves a disorder in the regulation of breathing patterns, laryngeal dysfunction (monopitch, low, weak and breathy voice quality). It is also associated with articulatory dysfunction (large range of jaw movements), inappropriate positioning of the tongue and instability of velar elevation.
Ataxic dysarthria is uncommon in cerebral palsy. The speech characteristics are: imprecise consonants, irregular articulatory breakdown, distorted vowels, excess and equal stress, prolonged phonemes, slow rate, monopitch, monoloudness and harsh voice.
In general, language delay is associated with problems related to mental retardation, hearing impairment and learned helplessness. Children with cerebral palsy are at risk of learned helplessness and becoming passive communicators to initiate communication with others. Therefore, early intervention is very important to help children with CP to target situations in which they have to communicate with others. Besides this, it would help the children to learn that they can control people and objects in their environment through this communication, including making choices, decisions and doing mistakes.
How does CP influence in feeding and swallowing?
Children with CP often have oral sensory disturbances; meaning that they have too little or too much sensitivity around and in the area of mouth. An infant with CP may not be able to suckle or suck the nipple; or he may have problem to swallow the milk. The infant may struggle during feeding; or he may only drink the milk in shorter time because he easily gets tired; or he struggle to swallow and breathe at the same time. These entire scenarios directly would give negative impacts such as stress and self-blame to the whole family especially the mother or feeder. Therefore, as early detection of any problem during feeding need to be addressed as soon as possible.
Children with CP, normally they need to coordinate between chewing and swallowing and at the same time, they need to control their breathing. This complex mechanism required them to take longer period to finish their food. It is quite tricky on how to stimulate awareness and give the idea of importance controlling the food during eating and prepared their mind when they initiate to swallow the food. This safe eating is very important as inability to eat properly would lead the food goes into the wrong tract (i.e. trachea and lungs) and that would result in complex medical problem.
Due to physical limitation, the children with CP may have problem to feed themselves as they need to control fine motor especially finger dexterity; which is the most prevalent motor impairment among this children. Finger dexterity is essential for manipulating cutlery or bringing food to the mouth. Fine finger dexterity, like picking up a spoon, is more frequently impaired than gross manual dexterity, like spooning food onto a plate. Grip strength impairments are less common. Overall, children with CP may have difficulty chewing and swallowing food, holding utensils, and preparing food due to sensory and motor impairments.
How does CP influence in speech and language?
Communication is a very important tool for human as we need some method to share or convey our thought and emotion to others. Children with CP may have communication problems related to speaking, because of their difficultness in controlling the muscles needed for speech. Therefore, they may need to learn other method as such sign language or using a communication aid in delivering their message. It is important for these children to express themselves and via certain communication methods would be a relief to them as they know they have the opportunity to relate their thoughts, needs and concerns to their surround.
Cerebral palsy can affect the motor skills and muscle coordination throughout the entire body, meaning all muscles in the body are susceptible. Besides the extremities, such as arms and legs, muscles that control eating, speaking, and breathing can be affected as well. Usually, trouble communicating is an issue for the child with cerebral palsy; with help from the speech-language pathologist, the issue can be resolved and aided in establishing a communication method that best suited for the individual.
Sign language or special boards with pictures, words, or letters can help for those who have trouble in speaking. Computers can be used for several different aspects for example; using computers to amplify a faint voice and teach special programs that are used to practice and enhance speech. Certain computers have programs that use objects or symbols as a way to communicate. These programs give someone that doesn’t speak at all the ability to communicate.
Cerebral palsy and speech therapy are a necessary combination in building a line of communication between the child and caregiver. Speech therapy will help relieve the frustration of mixed communication between both sides. A child that knows he or she is understood will have a generally better outlook when trying to accomplish other tasks. A speech pathologist can decide which types of speech therapy will benefit your child the most.
The Speech-Language Pathologist’s roles in managing children with CP
Speech-language pathologists have a central role in providing services and supports for families and their infants or toddlers with disabilities as members of the early intervention team. Speech-language pathologist helps children with cerebral palsy to improve the communication skills. Communication skills may refer to verbal mode (talking), using sign language or using a communication aid. For those children who are able to talk, the main concern would be to make the speech clearer and easier to understand by family members and strangers. For those who have problems in communication, the focus of therapy would be based on individual needs to reach the highest level of independence. By accomplish this level of independence; it will relieve stress for both sides; the patient and the caregivers. The needs and capacity of the children would be differing from oneto another. Therefore, the individual therapy is based on the patient needs and problems. For example; the speech-language pathologist , the child and family members are working closely to build up the child’s language skills in learning new words, practicing lengthened words in sentences, and improving the auditory comprehension skills.
Speech therapy helps the patient correct speech disorders, restore speech, use communication aids, learn sign language, and improve listening skills. The duration of a particular speech therapy program varies depending on the degree of cerebral palsy being treated, and the patient’s response to speech therapy. Speech therapy is performed by a speech pathologist, and involves regular meetings with the therapist in a one-on-one or group setting, as well as home exercises.
The level of therapy is determined by the patient’s ability to communicate, and whether they’re able to speak or not. Some people with cerebral palsy have problems moving their mouths to form words correctly because of muscle control. Hearing loss can be evident as well in a person with cerebral palsy, and speech therapy can help them to speak more clearly. Speech therapists can also help them build their language skills by learning new words, learning to speak in sentences, or improving their listening skills.
To strengthen muscles used in speaking, the patient might be asked to say words, smile, close his mouth, or stick out his tongue. Picture cards may be used to help the patient remember everyday objects and increase his or her vocabulary. The patient might use picture boards of everyday activities or objects to communicate with others. Workbooks might be used to help the patient recall the names of objects, practice reading, writing, and listening. Computer programs are also available to help sharpen speech, reading, recall, and listening skills.
There are so many problems with cerebral palsy and communication related to some patient’s ability such as vision limitation or blindness and hearing impairment. Therefore, assistive technology devices could be use in order to aid the communication needs. These devices are tools, equipment, or services that are designed to increase the performance of some physical or mental ability in cerebral palsy children.
Augmentative communication devices are methods that help individuals with cerebral palsy communicate more easily and effectively. These devices can be a simple board with pictures representing a patient’s daily needs or electronic speech synthesizers. This technology can help a child with cerebral palsy communicate, feel more independent, and take part in activities with other children.
Physiotherapy
The main aims of physiotherapy are to:-
1. Maintain the child’s body in its best mechanical order to prevent joints and muscles from tightening and shortening from lack of use or abnormal and/or incorrect posture.
2. Facilitate normal movement developmental patterns.
3. Facilitate and improve function to achieve maximum independence possible.
Physiotherapy is not confined only to the department or gym but extends to the swimming pool (hydrotherapy) and riding grounds (hippotherapy). The latter two provide a moral boost to CP children as they are on par with able-bodied children as far as activity is concerned.
Occupational Therapy
What is Occupational Therapy?
Occupational therapy is the use of purposeful activity to help disabled individuals develop skills necessary to live a life as normal and independent as possible. All individuals have a need to participate in work, leisure and self-care activities as part of living. Disabled individuals may have difficulty doing this because of physical, physiological, and/or cognitive limitations. Occupational therapy aims to teach and train disabled individuals how to overcome or compensate for their disability to improve their functioning.
Occupational Therapy and children with Cerebral Palsy:-
Defined simply, cerebral palsy is a movement disorder. The ability to move one’s arm, leg, head or trunk in a controlled and normal manner is hampered by abnormal muscle tone. Associated issues like cognitive and behavioral problems or leaning disabilities which may be present further limit an individual’s ability to carry out a task or activity. Children with cerebral palsy present with varying degrees of disability, ranging from severe to mild. They therefore require the services of a physiotherapist, speech therapist and/or occupational therapist for effective rehabilitation.
The aim of Occupational Therapy:-
Through the specific use of selected and purposeful activity, the aim of occupational therapy is to maximize one’s ability to perform everyday tasks independently. This is achieved by enhancing physical and cognitive function and by preventing secondary disabilities.