Speech, Language and Oral Motor Development

Question 1

What are the muscles of respiration?

Answer 1

Diaphragm
Intercostals
Abdominals
Accessory Muscles

Question 2

What type of shape does the rib cage resemble during infancy?

Answer 2

Triangle!
Only occupies the upper 3rd of the thoracic cavity

Question 3

What force/activities all the rib cage too descend?

Answer 3

Gravity!
More upright postures allow the intercostal spaces to expand and the rib cage becomes more rectangle in shape

Question 4

What is the diaphragms origins and insertions?

Answer 4

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

Question 5

What does the diaphragm do during inspiration?

Answer 5

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

Question 6

How does a bell shaped rib cage impact the diaphragm?

Answer 6

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

Question 7

What makes up the oral cavity?

Answer 7

Lips
Jaw
Palate
Tongue
Cheeks

Question 8

What is oral phase of the “anatomy of the swallow” and what anatomy is involved?

Answer 8

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

Question 9

What is pharyngeal phase of the “anatomy of the swallow”?

Answer 9

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

Question 10

What can go wrong during the pharyngeal phase?

Answer 10

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

Question 11

What is the airway protection phase of the “anatomy of the swallow” and what anatomy is involved?

Answer 11

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

Question 12

What is the esophageal phase of the “anatomy of the swallow” and what anatomy is involved?

Answer 12

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

Question 13

How can peristalsis go wrong?

Answer 13

When the esophagus gets overstretched, the airway closes, peristalsis stops, and you have a moment of apnea
Also a cause of reflux

Question 14

What is the last phase of the “anatomy of the swallow” and what anatomy is involved?

Answer 14

GI
includes the stomach and the bowels

Question 15

What are the four parts of the “anatomy of vocalization”?

Answer 15

Larynx
Voice production
Resonance
Pronunciation

Question 16

What anatomy is included in the larynx phase of the “anatomy of vocalization”?

Answer 16

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

Question 17

How does a child’s anatomy impact their ability to swallow?

Answer 17

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

Question 18

What does the glottis do?

Answer 18

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

Question 19

What are the typical developments in utero?

Answer 19

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)

Question 20

What are some normal respiration & vocalization presentations at birth?

Answer 20

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

Question 21

What are some normal oral motor & feeding presentations at birth?

Answer 21

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

Question 22

What are some normal cognition & communication presentations at birth?

Answer 22

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

Question 23

What are some normal respiration & vocalization presentations during 1-2 months?

Answer 23

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

Question 24

What are some normal oral motor & feeding presentations during 1-2 months?

Answer 24

Drooling may increase with variety of positions and increased jaw mvmt

Question 25

What are some normal cognition & communication presentations during 1-2 months?

Answer 25

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

Question 26

What are some normal respiration & vocalization presentations during 3-5 months?

Answer 26

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)

Question 27

What are some normal oral motor & feeding presentations during 3-5 months?

Answer 27

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

Question 28

What are some normal cognition & communication presentations during 3-5 months?

Answer 28

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

Question 29

What are some normal respiration & vocalization presentations at 6 months?

Answer 29

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

Question 30

What are some normal oral motor & feeding presentations at 6 months?

Answer 30

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

Question 31

What are some normal cognition & communication presentations at 6 months?

Answer 31

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

Question 32

What are some normal respiration & vocalization presentations during 7-9 months?

Answer 32

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

Question 33

What are some normal oral motor & feeding presentations during 7-9 months?

Answer 33

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

Question 34

What are some normal cognition & communication presentations during 7-9 months?

Answer 34

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

Question 35

What are some normal respiration & vocalization presentations during 10-12 months?

Answer 35

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

Question 36

What are some normal oral motor & feeding presentations during 10-12 months?

Answer 36

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

Question 37

What are some normal cognition & communication presentations during 10-12 months?

Answer 37

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

Question 38

What is average vocabulary for 18, 24 and 36 months?

Answer 38

18 months: 5-20 words 24 months: 150- 300 words 36 months: 900-1000 words

Question 39

What are the stages of development for language?

Answer 39

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)

Question 40

What are some abnormal respiration/ribcage issues?

Answer 40

Secretion management & pulmonary hygiene Coordination for feeding & swallowing Support for mobility Support for vocalization

Question 41

What are some treatment strategies for respiration issues?

Answer 41

Positioning Facilitating Mobility & Stability (Therapeutic Facilitation, Taping, Body Jackets, Binders) Assisted Cough Techniques Mechanical Treatment Options

Question 42

Clincal symptoms that there is an issue with swallowing/feeding?

Answer 42

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

Question 43

What are the impacts of abnormal swallowing?

Answer 43

Dysphagia: Phases Penetration & Aspiration Postural Stability: Tone Seating/Alignment GI Issues: GERD Constipation and Motility UES opening Transient LES

Question 44

What are some treatment options for abnormal swallowing?

Answer 44

Medical Intervention Texture Modification Temperature Manipulation Taste Vocalizations and Cough Strategies Head and Neck Positioning Building Stability Alter Delivery Method NMES

Question 45

How does PPT posture impact patients?

Answer 45

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

Question 46

How does APT posture impact patients?

Answer 46

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

Question 47

What is included tithing the pediatric feeding care cycle?

Answer 47

Assessment -> diagnosis and goal settings -> Intervention -> monitoring and evaluation -> repeat

Question 48

What are some examples of abnormal communication?

Answer 48

Voice: Vocal abuse, Aphonic Motor Control and Output: Apraxia/Dysarthria, Tone issues, Access Cognitive Impairment Hearing Impairment: Auditory Processing Visual Impairment

Question 49

What are some treatment strategies for impaired communication?

Answer 49

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)

Question 50

What are some vision related adaptations?

Answer 50

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

Question 51

What are some tactile related adaptations?

Answer 51

Switch selection degree of contact and strength required Tactile feedback Boundaries / key guards Manipulatives

Question 52

What are some auditory related adaptations?

Answer 52

Volume, intonation, rate, pitch of material being presented Repetition Auditory feedback from materials

Question 53

What are some modes of communication that cane be useful?

Answer 53

Vocalization Gestures Mobility/movement Language/communication boards Devices (varying technologies)