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