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| DYSARTHRIA |
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Dysarthria is a neurogenic speech disorder caused by dysfunctional or damaged innervation to the speech musculature (tongue, lips, soft palate, facial muscles, larynx). Generally, in flaccid dysarthria oral musculature is weak (paresis), or there is significant low muscle tone. In some cases there can even be paralysis. Dysarthria is usually characterized by difficulty in vegetative functioning. Children with dysarthria usually have early sucking, chewing and swallowing challenges. They may also “drool” for a lengthy period of time. They stick with very soft foods to digest. They also may gag or choke often.
Apraxia/dyspraxia of speech can coexist with dysarthria.
Speech characteristics of dysarthria:
1. Marked difficulties with strength, speech and accuracy of articulatory movement.
2. Imprecise or weakly targeted consonants.
3. Imprecise or weakly targeted vowels, especially those which involve spreading intrinsic tongue muscles, such as /i/, /ai/, /ei/, oi/.
4. Weak vocal quality (lack of respiratory support).
5. Hypo or hypernasality.
6. Weak articulatory contacts.
7. Rapid or slow speaking rate.
8. Speech clarity disintegrates with lengthy utterances
*may be due to lack of breath support or muscle fatigue
*may resemble apraxia of speech
9. Weak targets, especially for / r, s, l / and vowels.
10. Generally weak, mushy, garbled, imprecise speech.
*Many children with apraxia of speech have an accompanying oral-motor weakness (mild dysarthria). Usually, working on the apraxia inadvertently helps to strengthen weak muscles.
*Oral-motor stretch, tone and strength activities are indicated. Severe dysarthria can be such a significant obstacle to motor-speech skill development in that the average listener may not be able to decode speech. Children with severe dysarthria will require an augmentative communication system
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FEEDING DISORDERS |
What are feeding and swallowing disorders? |
Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding disorder.
Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:
- Oral phase–sucking, chewing, and moving food or liquid into the throat
- Pharyngeal phase–starting the swallow, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
- Esophageal phase–relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach
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What are some signs or symptoms of feeding and swallowing disorders in children? |
Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child.
The following are signs and symptoms of feeding and swallowing problems in very young children:
- arching or stiffening of the body during feeding
- irritability or lack of alertness during feeding
- refusing food or liquid
- failure to accept different textures of food (e.g., only pureed foods or crunchy cereals)
- long feeding times (e.g., more than 30 minutes)
- difficulty chewing
- difficulty breast feeding
- coughing or gagging during meals
- excessive drooling or food/liquid coming out of the mouth or nose
- difficulty coordinating breathing with eating and drinking
- increased stuffiness during meals
- gurgly, hoarse, or breathy voice quality
- frequent spitting up or vomiting
- recurring pneumonia or respiratory infections
- less than normal weight gain or growth
As a result, children may be at risk for:
- dehydration or poor nutrition
- aspiration (food or liquid entering the airway) or penetration
- pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
- embarrassment or isolation in social situations involving eating
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How are feeding and swallowing disorders diagnosed? |
If you suspect that your child is having difficulty eating, contact your pediatrician right away. Your pediatrician will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. A speech-language pathologist (SLP) who specializes in treating children with feeding and swallowing disorders can evaluate your child and will:
- ask questions about your child's medical history, development, and symptoms
- look at the strength and movement of the muscles involved in swallowing
- observe feeding to see your child' s posture, behavior, and oral movements during eating and drinking
- perform special tests, if necessary, to evaluate swallowing, such as:
- modified barium swallow–child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
- endoscopic assessment–a lighted scope is inserted through the nose, and the child's swallow can be observed on a screen.
The SLP may work as part of a feeding team. Other team members may include:
- an occupational therapist
- a physical therapist
- a physician or nurse
- a dietitian or nutritionist
- a developmental specialist
Your child's posture, self-feeding abilities, medical status, and nutritional intake will be examined by the team. The team will then make recommendations on how to improve your child's feeding and swallowing.
To contact a speech-language pathologist, visit ASHA's Find a Professional. |
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What treatments are available for children with feeding and swallowing disorders? |
Treatment varies greatly depending on the cause and symptoms of the swallowing problem.
Based on the results of the feeding and swallowing evaluation, the SLP or feeding team may recommend any of the following:
- medical intervention (e.g., medicine for reflux)
- direct feeding therapy designed to meet individual needs
- nutritional changes (e.g., different foods, adding calories to food)
- increasing acceptance of new foods or textures
- food temperature and texture changes
- postural or positioning changes (e.g., different seating)
- behavior management techniques
- referral to other professionals, such as a psychologist or dentist
If feeding therapy with an SLP is recommended, the focus on intervention may include the following:
- making the muscles of the mouth stronger
- increasing tongue movement
- improving chewing
- increasing acceptance of different foods and liquids
- improving sucking and/or drinking ability
- coordinating the suck-swallow-breath pattern (for infants)
- altering food textures and liquid thickness to ensure safe swallowing
After the evaluation, family members or caregivers can
- ask questions to understand problems in feeding and swallowing
- make sure they understand the treatment plan
- go to treatment plans
- follow recommended techniques at home and school
- talk with everyone who works with the child about the feeding and swallowing issues and treatment plan
- provide feedback to the SLP or feeding team about what is or is not working at home
To contact a speech-language pathologist, visit ASHA's Find a Professional. |
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What other organizations have information about feeding and swallowing disorders? |
This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.
- Mayo Clinic
- http://www.asha.org/public/speech/swallowing/FeedSwallowChildren.htm
- WebMD
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Fine Motor Delays |
Young children develop, function, and learn by interacting with their environment through “hands on” experiences. Developmentally delayed children have difficulty in learning from their experiences because of their specific delay.
Motor delayed children will experience difficulties with control of coordinated body movements. Fine motor delays may affect the face and/or hands.
(http://www.mde.k12.ms.us/special_education/docs/Dev_Delayed.doc) |
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CAUSES and DIAGNOSIS of a developmental delay |
* Currently, researchers are investigating areas such as neurological damage and biochemical imbalance in the brain.
This disorder is not caused by psychological factors.
Bayley Scales of Infant Development - Second Edition (BSID-II)
These scales were designed to identify children who have a cognitive or
motor delay, and help lead to needed intervention. The test is for infants
from 1 month to 42 months. BSID-II yields a mental scale, motor scale, and
a behavior rating scale.
(http://www.coe.unt.edu/pemberton/EDSP5800math/developmental%20delay.doc)
* If your baby experienced difficulties at birth that increase his or her chances for developmental difficulties, you may have been invited to participate in a high-risk follow-up program. Follow-up programs exist to track the progress of children who have an increased likelihood of developmental problems that tend to appear gradually over the first several years of life. These developmental problems include major handicapping conditions, such as cerebral palsy, mental retardation, blindness and deafness, but also include more common issues like developmental delays, growth problems, and various types of sensory impairment (vision and hearing problems). Early identification of developmental difficulties is believed to be critical to the success of treatments for these conditions.
All children should have some developmental screening periodically throughout childhood. Most commonly, children are screened during routine visits to their pediatrician prior to school age and also through schools at preschool and/or kindergarten entry. General pediatricians can provide satisfactory screening using a mass screening tool (for example, Abbreviated Denver Developmental Screening Test, Revised Parent Developmental Questionnaire, etc.) designed to identify delays across major areas of development.
http://www.prematurity.org/followup.html
The American Academy of Pediatrics has a policy statement on "Developmental Surveillance and Screening of Infants and Young Children." This article can be read at
http://www.aap.org/policy/re0062.html
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RED FLAGS for a fine motor delay |
Lack of :
-Midline orientation by 4 months
-Reaching by 5 months
-Transferring by 6 months
-Raking grasp by 8 months
-Mature pincer by 12 months
-Index finger isolation by 12 months
( http://www.unmc.edu/Pediatrics/undergraduateeducation/images/Growth_Devel.pdf) |
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Here are some developmental milestones for hand and finger skills: |
By the end of 2 years:
-Scribbles spontaneously
-Turns over container to pour out contents
-Builds tower of four blocks or more
-Might use one hand more frequently than the other
By the end of 3 years:
-Makes vertical, horizontal and circular strokes with pencil or crayon
-Turns book pages one at a time
-Builds a tower of more than six blocks
-Holds a pencil in writing position
-Screws and unscrews jar lids, nuts and bolts
-Turns rotating handles
By the end of 4 years:
-Copies square shapes
-Draws a person with two to four body parts
-Uses scissors
-Draws circles and squares
-Begins to copy some capital letters
If your child hasn't met these milestones he/she may possibly have a fine motor delay.
(http://www.medem.com/search)
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WEB SITES for parents |
http://www.coe.iup.edu/worldofkindergarten/FM.html
This site offers excellent activities to do with children to help develop their fine motor skills. Some of the activities include:
-Roll out play dough with a rolling pin
-Screw nuts into matching bolts
-Play with "pick up" sticks
-Use a Lite Brite or pegboard
-Wind up musical toys
-Manipulate clothes pins.
http://www.parents.com/articles/ages_and_stages/3037.jsp
This will link you to the Parents Magazine article "Encouraging Fine Motor Skill Development"
By Cammie McGovern
This article breaks motor development down into stages and describes what skills should be mastered at each stage. It also offers activities to do at each stage to enhance motor development. Once in this site you can also do searches for any child development topic.
http://www.ldonline.org/
On this site you can search for articles and information on motor development. You can also submit your questions about motor development and other developmental topics, shop on the online store and view a state by state resource guide that offers names and addresses of helpful American state agencies, local organizations, and other resources available in your state. |
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TIPS for parents on activities and toys
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- You can help develop your child's motor skills by involving him/her with food experiences. Children develop their arm, hand and finger muscles by scrubbing vegetables, peeling hardboiled eggs, shucking corn and grinding nuts. For more information and food activities click on the address below: http://www.ext.vt.edu/pubs/preschoolnutr/348-011/348-011.html
- "Handmade Dining" by Ellen Booth Church discusses how cooking a family meal is a fun and delightful way to help your child develop fine motor skills. Just think of all the small muscles and eye-hand coordination a child uses by ripping, cutting, rolling and stirring the ingredients in a family meal.
Highlight fine motor skills by:
-washing your hands
-having the child do little things like opening the refrigerator door, unwrapping packages of meat, and unscrewing caps
-Point out how strong his/her hands are and how careful he/she is being. This will help the child to focus on his/her hands.
-Sing a song as your child works. This will encourage him/her to stay with it longer.
(E. B. Church)
- Offering your child a variety of open-ended materials to play with is a great way to develop fine motor skills. TRY:
-Basic materials like paint and crayons, which offer endless opportunities for developing small finger muscles.
-Magnetic or snap blocks that allow your child to build and rebuild as he/she problem-solves.
-Scissors to help your child take things apart, and tape, glue, yarn and string so he/she can put them together again.
-Miniature animals and other tiny toys to help your child strengthen his/her pincer grasp.
(S. Miller)
Special Kids Resource is a web site that provides educational materials, resources and information for children with autism and other developmental delays. Some of the materials available for fine motor development include: stacker pegs, peg boards, puzzles, lace and trace activities and beads.
http://www.specialkidsresource.com/site/promotion.asp |
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