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SPEECH AND LANGUAGE PATHOLOGY IN PREMATURITY
Ramin Mohseni
Speech and Language pathologist
ra_mohseni@yahoo.com
December 2014
INTRODUCTION
Speech & Language Pathology is the science of assessment, therapy and consultant of speech, language & swallowing disorders.
It related with: _ Neurology _ ENT _ Pediatric _ Psychology _ NICU/ICU
IMPORTANT FACTORS IN SPEECH:
Brain
Hearing
Breathing
Phonation
Resonation
Articulation
INTRODUCTION
Prematurity:
• Defined by some according to birth weight under approximately 5.5 pounds or age being born before 37 weeks of gestation
• A premature infant’s organs are not fully developed.
• Infants usually cannot coordinate sucking and swallowing before 34 weeks gestation.
• Prematurity can have long – term effects.
INTRODUCTION
They have medical, developmental, or behavioral problems
A premature baby may have feeding tube.
In United States %8.2
In Iran %9.6-%11.8
PREMATURE INFANTS ARE AT RISK OF:
Feeding & Swallowing Disorders
Congenital Disorders
Neurological Disorders
Developmental Disorders
Long- Term Psychological and Social problems
Dysfunction at school
SWALLOWING Swallowing involves coordination of the sequence of
activation and inhibition for more than 25 pairs of muscles in the mouth, pharynx, larynx, and esophagus.
SWALLOWING Normal swallowing :
1. Oral Preparatory Phase
2. Oral Phase
3. Pharyngeal Phase
4. Esophageal Phase
SWALLOWING Oral reflexes: ( is essential information for clinicians
working with newborns and infants in their first year of life who swallowing problems)
Rooting reflex (0 - 6m) Sucking ref. (0 - 12m) Bite ref. (0 – 12m) Tongue ref. (0 – 18m) Swallowing ref. (0 up to end of life ) Gag ref. (0 up to end of life )
The presence or absence of specific primitive reflexes can indicate a infant’s neurological stability and potential for swallowing disorders.
FEEDING DEVELOPMENTS:
1. Suckling
2. Sucking
3. Transitional Feeding Period
4. Munching
5. Chewing
SWALLOWING
Problems feeding :
Trouble sucking
Premature spillage
Coordinating swallowing and breathing (Problem in Oral-Motor Movement )
o The premature infant’s underdeveloped lungs and airway can add life-threatening complications.
o Newborns with respiratory problems have greater risk for swallowing problems, and newborns with swallowing problems have greater risk for respiratory problems.
SWALLOWING
Problems feeding : Poor Intake
Fatigue with Feeding
Delayed Feeding Skills
Lower of oral motor skills
Hyper Sensitivity
CONGENITAL DISORDERS
Clefts of the lip and palate
(Cause of swallowing problems)
NEUROLOGICAL DISORDERS
Central Nervous System is not fully prepared to function because of:
Smaller hippocampus
Lower gray-to-white-matter ratio
Smaller cerebellum
NEUROLOGICAL DISORDERS
Cerebral palsy(Spastic diplegia) Brain Damage Intraventricular Hemorrhage (IVH) Mental retardation Hearing Loss Visual Impairment Hydrocephalus
DEVELOPMENTAL DISORDERS:
Perceptual & Cognitive Development
Language Development
Motor Development
PERCEPTUAL DEVELOPMENT
Maturation of the brain determine infants’ abilities to perceive and produce sound
Speech perception refers to infants’ attention to phonemes, rhythm, prosody, and lexical features
The first step of perceptual development is mothers’ sound distinguish than other sounds
COGNITIVE DEVELOPMENT
Abstract reasoning
Judgment
Problem solving
LANGUAGE DEVELOPMENT IN NORMAL CHILDREN:
Communication Skills: Auditory System Visual System Verbal Symbolic System
Speech Production:
Academic Learning Social Communication
PREVERBAL STAGES OF DEVELOPMENTS :
Basic biological noises (0-2 month)
Cooing & Laughing (1-4 month)
Vocal Play (3-8 month)
Babbling (5-10 month)
Melodic Utterance (9-18 month)
LANGUAGE DEVELOPMENT
Assess receptive language skills
Assess expressive language skills
Assess articulation skills
SPEECH & LANGUAGE DIFFICULTIES:
Impaired verbal comprehension skills Absence of words by age 18 mounts Absence of meaningful two word phrases by
age 2 years Echolalia Poor speech intelligibility Word – finding Short – term memory skills Delayed development of play skills Developmental apraxia of speech Tendency toward development of LD
MOTOR DEVELOPMENTS:
Delay in areas of gross to fine motor
SCHOOL FUNCTION(LD):
Problem in Reading
Problem in Mathematics
Deficit in Spelling
Lower Academic Achievement
Poorer Functional Performance
LANGUAGE DISORDER INTERVENTION:
o Early intervention program.
o Provide language development activities.
o Work with parents, caregivers, and teachers to provide language development activities.
CONCLUSION:
Referring time
Role of speech and language pathologist
Family and Caregivers
Teamwork
Tomorrow’s Success Begins Today
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