Speech Therapy: Vital To Opening a Child’s World

By Lee Vander LoopCP Family Network Editor

Years ago, before the invention of augmentive communication devices, children who displayed an inability to communicate were assumed to suffer from severe developmental disabilities and treated as such.

Imagine the heartache and frustration of a child with sound cognitive abilities or mild to moderate learning disabilities trapped in their body as a result of their inability to communicate. Augmentive communication devices have opened doors and given new lives to many individuals, providing a means of speech communication for those who would otherwise have no means of expressing themselves and their needs. Thankfully, speech therapists and augmentive devices are common today and can help most any child communicate in some way with the world around him or her.

The Basics of Speech Therapy

Speech therapy is the treatment of communication disorders, regardless of the origin. Therapists that work in the field of communication disorders are known as speech therapists and speech-language pathologists. Therapy can consist of a series of exercises and drills to strengthen the muscles involved in speech, and improve oral motor skills needed for speech as well as swallowing. Speech therapy may also include sign language and the use of picture symbols or augmented and alternative communication devices.

Many children with cerebral palsy experience some level of challenge with speech. Their challenges could be due to cognitive delays as in the case of mental retardation and learning disorders, or may be the result of damage to the area of the brain that facilitates speech. The speech center of the brain is referred to as the Broca’s area and is located in the left side of the brain for right-handed and most left-handed people. Nerves from the Broca’s area lead to the neck and face and control movements of the tongue, lips, and jaw.

Children learn speech from parroting what they hear in their environment. Children with hearing disabilities also experience challenges with speech because they cannot clearly hear sounds they and those around them are making. Children with cerebral palsy and speech challenges also commonly suffer from feeding disorders. Therapy to strengthen speech muscles also greatly benefits eating and swallowing.

Issues Involving Specific Types of Diagnosis

With children diagnosed with spastic cerebral palsy, muscle tightness (hypertonia) may cause the tongue to constantly push up against the roof of the mouth, or palate, making speech all but impossible. Children diagnosed with hypotonia (low muscle tone) likewise would experience challenges with speech, since the muscles of the mouth and tongue work together to form sounds.

The tongue is the primary organ involved in speech. It is also the primary organ of taste, chewing and swallowing. In chewing, the tongue holds the food against the teeth; in swallowing, it moves the food back into the pharynx, and then into the esophagus when the pressure of the tongue closes the opening of the trachea, or windpipe. It also acts, together with the lips, teeth, and hard palate, to form word sounds. Early intervention in this area is vital to a child’s development.

What to Expect From Your Child’s Therapy/Therapist

Communication-Your child’s physical or speech therapist should be communicating openly with you as to what they are doing, what muscles they are working with and why they are taking the approach they have chosen. In the case of oral motor and swallowing skills, your child’s therapist should take every precaution to minimize the risk of choking and aspirating.

You should also expect the therapist to communicate with your child. Most young children are anxious and fearful with strangers. The therapist should be working and communicating with your child to win your child’s trust and confidence. Regardless of whether your child is capable of comprehension or capable of communication, the therapist should be treating your child with respect, patience and compassion. If you meet a therapist that treats your child like an OBJECT and not a human being, FIND ANOTHER THERAPIST!

Teaching-Your child’s therapist is not only working with your child, but should also be teaching you so that you can be consistent in your child’s care and contribute to help your child achieve and maintain goals.

Questions to Ask:

• Communication works both ways. You should be communicating any concerns and questions you have to the therapist. If necessary, keep a journal and note problems and challenges you see your child may be experiencing between therapy sessions.

• Ask the therapist what you can do between therapy sessions to help your child maintain their progress.

• Ask how often you should work with your child and the duration of each session.

• If your child has been prescribed adaptive or augmentive equipment, inquire as to how often you should use the equipment and the duration of each session.

Compassion and Patience-You have the right to expect compassion and patience from your child’s therapist. If you feel a therapist is being overly aggressive and seems to be traumatizing your child… STOP THEM. Effective therapy should not be traumatizing. This is contradictive and will result in your child relating therapy to pain.

Accountability-Your child’s therapist should have written goals. You should be provided with the results of the first assessment and goals the therapist hopes to achieve in addressing issues and challenges your child may be experiencing. The therapist should do periodic assessments and provide you with goals for improvement and notify you of progress or regression on a regular basis.

Coordination-You have the right to expect your child’s therapist to work with your child’s educators in developing your child’s Individual Education Program (IEP) and to be an active member of your child’s IEP team. In the case of a private physical therapist not associated with your child’s school, he or she should be communicating with your child’s teachers and involved in the IEP process to make sure everyone is working toward the same goals.

The therapist should also be coordinating and communicating with your primary care doctor about any needed adaptive equipment or communication devices, and should keep the doctor informed of your child’s progress or problems. If the therapist feels your child would benefit from a specific communication device or piece of adaptive equipment, it is their responsibility to communicate the need to the physician and to follow-up in obtaining the device.

Continuity of Care-You have the right to demand continuity of care for your child. This means that the same therapist works with and follows your child throughout the therapy process. Of course, this isn’t always possible, but it should be the goal of any agency you work for. If your therapist belongs to a group or agency and they are sending a different therapist with each session, find another agency. This is not acceptable.

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References

Scienceclarified.com

National Speech/Language Therapy Center

Health Science

Electrical Muscle Stimulation Treatments for 
Cerebral Palsy

By John Lehman

View similar stories.

Electrical Muscle Stimulation (EMS) refers to a group of treatments that make use of electrical current to stimulate nerve endings, with the aim of reverting damage to the patient’s nervous system. Children suffering from cerebral palsy often have issues with movement and muscle spasticity, and EMS has proven to be effective at treating these issues, improving their overall quality of life. Combined with physical therapy, research has shown that EMS can increase walking speed, reduce muscle spasticity and improve overall motor function.

Types of Electrical Muscle Stimulation

EMS can be broken down into two main categories:

• Neuromuscular Electrical Stimulation (NMES) – Also known as Therapeutic Electrical Stimulation (TES) or Functional Electrical Stimulation (FES). This form of the treatment is usually provided by a medical practitioner. Unlike Threshold Electrical Stimulation, NMES uses a higher voltage in shorter increments, with the aim of stimulating muscles to contract.
• Threshold Electrical Stimulation – This treatment differentiates itself from NMES, as it does not induce muscle contractions. Instead, a lower voltage is used over a long period of time. Patients can purchase devices for this treatment without a prescription and use it at home, typically while sleeping.

How EMS Works

Whether treating cerebral palsy or other motor dysfunctions, EMS follows the same procedure. First, electrodes are placed on the skin near muscles that have atrophy or are weaker than their counterparts. These electrodes are attached to a small electric generator, operated by patient (or in this case, the parent), or by a medical practitioner.

As mentioned before, Threshold Electrical Stimulation is usually performed at home, with the parent sending minor amounts of electric current through the electrodes over the course of several hours. With NMES, the patient is subjected to a slightly higher level of current, which coerces the muscle to contract. In either case, the electric current is mild and should not cause any pain or discomfort for your child.

How Effective is EMS?

Although doctors can usually agree on the benefits of EMS, many find that the therapy is unnecessary or unreliable since it does not produce permanent results. EMS typically needs to be conducted over a long period of time, as a single session of EMS will only temporarily improve motor function in the patient. Marked improvement is usually seen after the patient has undergone treatment between one to three months, with 2-hour sessions every day. Any prolonged breaks from the treatment may result in your child’s spasticity returning to an abnormal state. Because of this, many patients undergo the treatment throughout their life.

Although research is promising regarding the use of EMS for cerebral palsy patients, most research suggests that it is supplementary to standard treatments. Typically, EMS is combined with exercise or some other form of physical activity, depending on the child’s muscle condition. Some studies suggest that EMS alone can be used to treat smaller muscle groups, such as forearms or wrists. For larger muscle groups, such as leg muscles, EMS would be combined with another form of physical therapy.

Nevertheless, research is ongoing as to whether EMS can stand alone as an effective treatment for cerebral palsy and issues with motor skills. Ask your child’s doctor about EMS and whether it could help your child’s spasticity.

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Therapy Options for Children with Tactile Sensitivity

By Lee Vander Loop
CP Family Network Editor

Many children with cerebral palsy experience some type of sensory impairment. A study by a Spanish university concluded that children with CP showed reduced sensitivity to non-painful stimuli but enhanced sensitivity to painful stimuli compared to healthy individuals. What’s behind these sensitivities and what can parents and caregivers do to help?

The Anatomy of Our Senses

The portion of the brain that responds to touch and other environmental stimulation is called the somatosensory cortex.  This system is responsible for multiple sensations including light touch, pain, pressure, and temperature. The somatosensory cortex also assesses the size, shape, and texture of objects based on their feel and helps judge body position using sensory input from the joints, muscle and skin.
Many times, cerebral palsy results in damage to this region of the brain, so it’s not surprising that many children with cerebral palsy experience sensory challenges and difficulties. Data suggest that altered somatosensory brain processing in people with cerebral palsy may cause overstimulation of the portion of the brain.  This can result in inappropriate responses to everyday experiences, such as physical affection, play, bathing and other activities.

Does Your Child Have Tactile Sensitivity?

Every child is sensitive from time to time, but frequent negative reactions to touch may indicate a problem. According to the Family Education Network, signs of tactile sensitivity in children include but are not limited to:

• Becoming upset about being dirty
• Difficulty feeling comfortable in clothing
• Anxiety about walking barefoot
• Avoiding touch
• Unusual sensitivity to pain
• Strong dislike of grooming activities such as nail clipping and hair washing

Children with sensitivities are often irritable and don’t adjust well to changes or new situations. They spend so much energy dealing with the many unpleasant perceptions and sensations they face on a daily basis, they don’t have much left to deal with anything else.

Helping Your Child Cope

If you suspect your child may be experiencing sensory processing difficulties, ask your pediatrician or therapist for an evaluation. If left untreated, tactile sensitivity can seriously interfere with a child’s quality of life.
Children suffering from environmental and tactile sensitivity often benefit from occupational therapy. An occupational therapist will work with a child in a sensory-rich environment to help them learn coping strategies that will allow them to behave in a functional manner in daily life.  Occupational therapy for children is designed to be fun but challenging, with the end goal that the child can eat, play with friends, attend school, and participate in other activities that were difficult before therapy.

At Home Activities

There are many activities you can do with your child at home to help them become more comfortable with “unpleasant” sensations. Your child’s occupational therapist will recommend activities appropriate for your child’s unique situation. A few of the most common at-home therapeutic activities are mentioned here.

The Wilbarger Brushing Protocol

This popular therapy relies on the application of firm and rapid pressure to the arms, hands, back, legs and feet with a specific plastic surgical scrub brush. This is followed by gentle joint compressions to the shoulders, elbows, wrists, hips, ankles and sometimes, fingers and feet. A knowledgeable therapist should tell you if this is an appropriate therapy for your child and show you how to conduct it properly.

Deep Pressure/Weighted Products

There are many wearable weighted products on the market designed to provide deep pressure to children suffering from tactile sensitivity. The deep pressure provides important sensory information to the joints and muscles that helps calm sensitive children. Weighted products should be used under the supervision of a pediatrician or therapist.

Messy Play

Many children with tactile sensitivity have an aversion to touching things of a certain texture or “messy” things. Therapists often encourage children to explore these items through play. Messy play can involve play dough, glue, finger paint, sand or other hands-on materials. Ease into messy play slowly. If your child is fearful of the materials, encourage play in a less threatening way. For example, therapists recommend you allow your child to use your hands to start touching the material. Allow him to put objects in and out of the messy materials. As your child becomes more comfortable with the material, slowly encourage him to explore it more. As with any therapy, you should consult your child’s doctor or therapist before beginning messy play at home.

Conclusion

Tactile sensitivity in children with cerebral palsy can have a huge impact on their quality of life. Supervised therapy should be started at an early age to help a child learn to overcome and cope with his negative reactions to daily activities. For more information about tactile sensitivity, talk to your child’s doctor and check out the additional resources listed below.

Additional Resources

Tactile Sensitivity in Children
Tactile Defensiveness… So THAT’S Why He Acts That Way!

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Tips for Writing Letters of Medical Necessity

Letters of medical necessity are critical to getting reimbursed for any equipment or service. These are letters from your doctor or therapist. Such a letter must include certain, specific information or it will automatically be denied.

Many doctors and therapists are familiar with what needs to be in a letter of medical necessity. But if they don’t send the right information, it just means a longer delay and headache for you. Don’t take that chance.

You can help by writing down the answers to as many of the questions below as you can and giving it to your doctor or therapist. This will save them time and hopefully speed the process along.

1. Patient name, diagnosis, and the date the doctor prescribed the service or equipment needed.

2.  Patient’s diagnosis and how it relates to the service or equipment needed.

3.  Why the patient needs the service or equipment.

4. Patient’s overall therapeutic goals and how the service or equipment will help him meet those goals.

5.  A description of the product or service in as much detail as possible. This can come from the therapist or from the company that supplies a product. (You may be able to get this online).

6. The doctor or therapist’s phone number and email address, in case the insurance company has any questions.

Make a note of the date the letter was mailed. If you haven’t heard anything after 2-3 weeks, call the insurance company or funding agency and ask about the status of the claim. Make sure you write down the name of the person you talk to and get their permission to call them with any follow-up questions. Ask when a decision might be expected on payment.

If that date comes and goes, call again. Let them know you are tracking the request with dates and people’s names. But stay as pleasant as possible. You want their cooperation. If the agency or insurance company is unresponsive, get the doctor or therapist to help.

This good example of a letter of medical necessity is from Dr. Freeman Miller’s book Cerebral Palsy: A Complete Guide to Caregiving.

You can find more information about cerebral palsy and resources for parents and children with cerebral palsy at www.cpfamilynetwork.org.