Speech, Language and Oral Motor Development Flashcards
What are the muscles of respiration?
Diaphragm
Intercostals
Abdominals
Accessory Muscles
What type of shape does the rib cage resemble during infancy?
Triangle!
Only occupies the upper 3rd of the thoracic cavity
What force/activities all the rib cage too descend?
Gravity!
More upright postures allow the intercostal spaces to expand and the rib cage becomes more rectangle in shape
What is the diaphragms origins and insertions?
Origin: Upper 2 3 lumbar vertebrae, Inner surface of the xiphoid process (sternum), Inner surfaces of the lower 6 ribs and costal
cartilages
Insertion: Central tendon
What does the diaphragm do during inspiration?
Descends/flattens during inspiration
Assist moving contents from the stomach into the bowels (motility via lower esophageal sphincter)
Also to provides the pressure right at that juncture so that food and liquid may not come up into the esophagus
How does a bell shaped rib cage impact the diaphragm?
Much more flattened diaphragm. In that way, it may not be as effective in approximating the lower esophageal sphincter and also in helping to move food and liquids through the stomach into the bowels
What makes up the oral cavity?
Lips
Jaw
Palate
Tongue
Cheeks
What is oral phase of the “anatomy of the swallow” and what anatomy is involved?
The lips, the tongue, and the jaw are all involved in the oral phase of the anatomy of the swallow
They collect the bolus or the food or liquid that is in the mouth, they process it, they help chew, the cheeks keep tension, and the lips close, and you are able to then gather the bolus into one lump where you can transport it back and initiate a swallow
What is pharyngeal phase of the “anatomy of the swallow”?
The initiation of the swallow, where the food and the liquid go into the nasal pharynx and the pharyngeal cavity
That pharyngeal phase is not volitional instead it is all inertia based on the tongue pushing the bolus down into the pharyngeal area and then pressures that are present there between the swallow and the initial opening of the upper esophageal sphincter
What can go wrong during the pharyngeal phase?
Food may go up to the nose through the nasal pharynx if there is an inadequate palatal rise of the soft palate to close off that part of the anatomy or the bolus may also flow into the airway from there if the individual swallowing doesn’t have adequate propulsion or good collection of the bolus or coordinated swallowing
What is the airway protection phase of the “anatomy of the swallow” and what anatomy is involved?
The larynx is involved in airway protection as is the epiglottis
The airway is adjacent to the esophagus therefore, the airway is right in front of the esophagus
The epiglottis tips over the esophagus over the larynx in order to protect the airway
What is the esophageal phase of the “anatomy of the swallow” and what anatomy is involved?
Once you get through the pharynx, there is a constriction of the muscles that help move the bolus through the esophagus past the lower esophageal sphincter and into the stomach
This is called peristalsis - it’s a wave that moves from the top to the bottom
How can peristalsis go wrong?
When the esophagus gets overstretched, the airway closes, peristalsis stops, and you have a moment of apnea
Also a cause of reflux
What is the last phase of the “anatomy of the swallow” and what anatomy is involved?
GI
includes the stomach and the bowels
What are the four parts of the “anatomy of vocalization”?
Larynx
Voice production
Resonance
Pronunciation
What anatomy is included in the larynx phase of the “anatomy of vocalization”?
3 Single cartilages:
Cricoid (base of larynx and forms a ring)
Thyroid (largest and forms Adam’s apple)
Epiglottis (folds down over the laryngeal opening during swallowing to protect it from penetration)
3 Paired cartilages:
Arytenoids (allow the vocal folds to close and open)
Corniculate & Cuneiform (provide structural support to the mucous membranes of the larynx and assist with airway protection)
Vocal folds: Open/close/alter tension
How does a child’s anatomy impact their ability to swallow?
The tongue is much larger and takes up a larger part of the oral cavity further, the structures are much more close together
As we age the structures spread out more and the need for control increases
What does the glottis do?
helps close the airway down to create increased pressure in the lungs that provides stiffness and stability to the rib cage
When the glottis closes and allows you to build up that pressure, it allows you to build up enough pressure for when it opens a forceful exhalation of air, which is essential to a cough
What are the typical developments in utero?
Finger Buds/Hands to Mouth 12-14 weeks gestation (self soothing and increases innervation at mouth)
Pharyngeal swallow comes in at 10-14 weeks gestation (non volitional part)
Suckling at 18-24 weeks gestation
Tongue Cupping 28 weeks gestation
Ability to orally feed adequately for growth 34-37 weeks gestation (requirement for feed tube is born before)
What are some normal respiration & vocalization presentations at birth?
Ribcage shape is rounded
Triangular and elevated
Ribs are horizontaland close together
Diaphragm pulls on ribcage - retraction and paradoxical, abdominal breathing pattern
Obligatory nose breather - Normal RR=30-60 BPM with decreased tidal volume
Crying open vowel, short
Vocalizations are tied to mvmt and nasal in quality
Vegetative sounds clicks/friction
What are some normal oral motor & feeding presentations at birth?
Strong rooting response (looking for food)
Phasic Bite response (“munching pattern”)
Gag present
Suck/Suckle pattern
Cheek fat pads = stability
Tongue fills oral cavity
No tongue-jaw dissociation
Tongue Cupping
2-6 ounces every 3-4 hours
Spillage common but drooling is minimal
What are some normal cognition & communication presentations at birth?
Quiets when picked up
Visually does best in dim light
Orients to auditory & visual stimuli
Attracted to lights, patterns and high contrast
Seeks out oral stimuli (hand to mouth, face on surface)
Hand to hand & hand to mouth in side lying
What are some normal respiration & vocalization presentations during 1-2 months?
Ribcage shape is beginning to flatten and flaring at lower ribs
Increased rhythmic respiration pattern for increased periods
Increased variety in cry (pitch, loudness,
duration)
Begins to coo
What are some normal oral motor & feeding presentations during 1-2 months?
Drooling may increase with variety of positions and increased jaw mvmt
What are some normal cognition & communication presentations during 1-2 months?
Visually much more aware
Increased visual convergence
Interest in faces
Orients to auditory & visual stimuli
Cry is becoming differentiated in relationship needs
Emerging object permanence
What are some normal respiration & vocalization presentations during 3-5 months?
Anterior ribcage opens up significantly and becomes more rectangular in shape
Abdominal pattern still dominant
Increased tidal volume with increased accessory muscle recruitment
Greater head control
Supported sit for extended periods
Weight shifting in prone
Vocalizes more; cries less
Less nasal vocalizations
Begins to babble (bilabials/lingua dental)
What are some normal oral motor & feeding presentations during 3-5 months?
Rooting diminishing
Phasic Bite diminishing
Gag diminishing except with new textures
Increased control medial lips
Liquid loss from corners
May begin spoon feeding purees
Hands to bottle
Drooling may increase teething and in new positions
Experiences new oral motor movements in association trunk and head mvmts
Anticipatory mouth opening for bottle, breast or spoon
Emerging munch
More upright feeding
What are some normal cognition & communication presentations during 3-5 months?
Visually crossing midline and can track objects smoothly
Strong hand to mouth pattern
More purposeful extremity mvmt & reaching
Mouthing to explore environment
Localizes to auditory stimuli
Begins to search for partially hidden objects
Shakes objects
Emerging cause and effect
What are some normal respiration & vocalization presentations at 6 months?
More weight shifting through trunk
Prone on arms = increased shoulder girdle stability
More upright against gravity ribcage elongates providing efficient respiration
Vocalization still may be asynchronous with
excitement
Combination abdominal pattern with upper chest
More sounds emerge (lingua dental, labio dental, increased lingual sounds, front and back sounds)
Sound production with mvmt
Respiration more coordinated with mvmt
What are some normal oral motor & feeding presentations at 6 months?
Suck = predominant
Emerging cup drinking
Bite on cup for stability
Upper lip mvmt emerging with spoon
Lower lip protrusion present with spoon and cup = stability
Very little liquid loss at bottle/breast
Gags on new textures
Food loss
Long chains of coordinated sucking with only occasional problems with SSB
Emerging lateral tongue mvmt with jaw shift
Swallows whole or spits out pieces
Open mouth posture with new positions
What are some normal cognition & communication presentations at 6 months?
Eyes move independent of head
Searches for dropped objects
Increased manual manipulation of objects
Begins to search for partially hidden objects
Attachment objects and people
Facial expressions - likes and dislikes
Multi sensory exploration of objects
Stranger awareness
Babbling associated more with feeding, oral exploration and not as much social
Reduplicated babbling with increased variation
What are some normal respiration & vocalization presentations during 7-9 months?
Less ribcage flaring and ribcage collapse/retractions
Increased ease of respiration in transitional movements
Produces sounds separate from body mvmt
Increased independence with mvmt and postural control
Moves upper body over
BOS in sitting
What are some normal oral motor & feeding presentations during 7-9 months?
Finger feeding
Respiration and feeding/swallowing coordination continues to improve
Emerging lip closure for swallow
Bite to break off pieces when held
Tongue lateralization and dissociation from jaw
Lips more active in feeding
Tongue protrusion increases
Emerging consecutive swallows from cup
Vertical jaw mvmt with chew
What are some normal cognition & communication presentations during 7-9 months?
Longer chains of reduplicated babbling with greater variety
Consonant vowel combinations may be
perceived as a word
Differentiates nasalized and denasal consonants made in the same location (d/n, b/m)
Improved self calming
Pushes away objects (dislike)
Reaches for objects (want)
Repeats sounds and actions
Attempts to imitate actions and sounds
Tests controls and independence
Object function
What are some normal respiration & vocalization presentations during 10-12 months?
Refining abdominal thoracic pattern
Rotational movement helps increase
abdominal strength
Increase in descent and contour of the ribcage
Lung volume has increased 4 fold since birth
Increased holding of intercostals against negative pressure and control for forceful exhalation
Increased intercostal spacing with downward rotation of ribs
What are some normal oral motor & feeding presentations during 10-12 months?
Increase in coordination of tongue/lip/and jaw
Improved cup drinking and consecutive swallowing
A-P jaw movement as well as wide excursions up and down with cup
Cheeks more active and corners of mouth in controlling bolus
Cleans off lower lip with upper teeth
Lingual lateralization improves
Eats lumpy or mashed foods
Sustained bite on solids
Drooling very rare
Moves toward spoon
Chew is mixture of up/down and diagonal
What are some normal cognition & communication presentations during 10-12 months?
Non-reduplicated babbling
Produces fricatives and vowel variations
Begins to use jargon
Produces first real words
Points to body parts
Helps with dressing
Uses an object as a tool
Actively explores object use
Builds towers/ Turns pages
Greater independence and control
Approximates new words and gestures
Vocalizes anger rather than crying
Looks for people and objects that are mentioned and not present
Uses consistent approximations or words for objects
What is average vocabulary for 18, 24 and 36 months?
18 months: 5-20 words
24 months: 150- 300 words
36 months: 900-1000 words
What are the stages of development for language?
Perlocutionary (involuntary and reflexive responses are interpreted by listener)
Illocutionary (intentional use of gestures and non verbal communication to direct requests)
Locutionary (uses words to request and modify environment and express needs)
What are some abnormal respiration/ribcage issues?
Secretion management & pulmonary hygiene
Coordination for feeding & swallowing
Support for mobility
Support for vocalization
What are some treatment strategies for respiration issues?
Positioning
Facilitating Mobility & Stability (Therapeutic Facilitation, Taping, Body Jackets, Binders)
Assisted Cough Techniques
Mechanical Treatment Options
Clincal symptoms that there is an issue with swallowing/feeding?
Insufficient weight gain & growth
Volume Limitations
Frequent Emesis
Food selectivity
Coughing and choking surrounding meals
Wet vocal quality
Dehydration
Chronic low grade fevers
Frequent waking at night
Failure to advance texture
Constipation
Sweating during meals
Stooling out
Wheezing or airway compromise
Nasal Regurgitation
Complaints of something being stuck in throat
What are the impacts of abnormal swallowing?
Dysphagia:
Phases
Penetration & Aspiration
Postural Stability:
Tone
Seating/Alignment
GI Issues:
GERD
Constipation and
Motility
UES opening
Transient LES
What are some treatment options for abnormal swallowing?
Medical Intervention
Texture Modification
Temperature Manipulation
Taste
Vocalizations and Cough Strategies
Head and Neck Positioning
Building Stability
Alter Delivery Method
NMES
How does PPT posture impact patients?
Chest constriction:
Inadequate inflation of lungs
Decreased Diaphragm Descension
Increase in Shallow Breathing = Quicker Breaths
Expend more energy = fatigue
Abdominal constriction:
More pressure on the GI tract
Risk of constipation & bowel
Issues, Increased GER issues
Excessive forward flexion:
Limits Visual Field
Poor Awareness & Communication
Eye Gaze Downward
Fighting Gravity
How does APT posture impact patients?
Lumbar Curvature
Increased pressure particularly to the bladder & stomach = Pressure on the digestive tract
Abdominal constriction:
More pressure on the GI tract
Risk of constipation & bowel
Issues, Increased GER issues
Excessive Hyperextension:
Choking & Aspiration Risk
Decrease Lip Closure
Limits Visual Field
Poor Awareness & Communication, Eye Gaze Upward
What is included tithing the pediatric feeding care cycle?
Assessment -> diagnosis and goal settings -> Intervention -> monitoring and evaluation -> repeat
What are some examples of abnormal communication?
Voice: Vocal abuse, Aphonic
Motor Control and Output: Apraxia/Dysarthria, Tone issues, Access
Cognitive Impairment
Hearing Impairment: Auditory Processing
Visual Impairment
What are some treatment strategies for impaired communication?
Identify pathways that are intact and available to process information
Identify impaired pathways and begin to hypothesize about adaptations that may be made to achieve optimal processing of information
Clue into the student s non verbal/less obvious methods of communication (posture, body language, eye contact, etc)
What are some vision related adaptations?
High contrast materials
Lighting
Decreasing clutter in the environment
Size of materials
Decreasing glare
Orientation of materials (Including spacing, arrangement and introduction of materials)
Adding tactile cues
What are some tactile related adaptations?
Switch selection degree of contact and strength required
Tactile feedback
Boundaries / key guards
Manipulatives
What are some auditory related adaptations?
Volume, intonation, rate, pitch of material being presented
Repetition
Auditory feedback from materials
What are some modes of communication that cane be useful?
Vocalization
Gestures
Mobility/movement
Language/communication boards
Devices (varying technologies)
