Thas 201 Cerebral Palsy

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Cerebral Palsy

Back 1

• Non-progressive disorder of motor control caused by damage to the developing brain during birth, before, or very shortly after birth.
  
• 
  
• Wide variety of motor disabilities
  

Front 2

Cerebral Palsy continued

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• Lack of voluntary speech-motor control
  
• More complex than disordered articulation
  
• Treatment typically accounts for more than speech sound production difficulties
  

Front 3

Other things to consider besides articulation

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• Cognitive delays
  
• Language delays (receptive &expressive)
  
• Feeding
  
• All possible areas SLP-A may have treatment goals for
  

Front 4

More things to consider besides articulation

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• Perception difficulties
  
• Sensory Issues
  
• Hearing not within typical range
  
• Emotional -Behavioural issues
  
• Seizure Control Movement Problems
• Coordination Problems
  

Front 5

Team Approach

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• Occupational Therapist
  
• Psychologist
  
• Social Worker
  
• Speech-Language Pathologist
  
• Specializing Physician/Pediatrician
  
• Physical Therapist
  
• SLPA, PTA, OTA (treatment)
  

Front 6

Can affect ALL motor speech processes:

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• breathing
  
• voicing (larynx)
  
• articulation
  
• resonance
  
• prosody or rhythm of speech
  

• may have to start with trunk or neck support

Front 7

Different types:

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1. Spastic
   
2. Ataxia
   
3. Athetosis
   

• all affect motor movement
• Treatment completely different from one child toanother because of the variety of types of CP

Front 8

Spastic

(most common for us to work with)

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1. Hemiplegia
   
2. Paraplegia
   
3. Diapledia
   
4. Quadriplegia
   

• Stiff and jerky muscle tone
  
• muscles become stiff and tight

Front 9

Ataxia

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• lack of coordination of movement
  
• inability to maintain balance and posture
  

Front 10

Athetosis

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• abnormal muscle contractions that movement
  
• cause involuntary riding movement (twisty turning, twitchy movements)
  

Front 11

Respiration:

• We need to take their cognition and structural issues into consideration when writing their goals - structure must be intact for us to work on it
  

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- sustaining speech (not enough breath support)

Difficulty with:

• multi-syllabic utterances
  
• longer utterances (sustaining speech)
  
• change in loudness (sustaining vowels)
  
• difficulty with conversation
  

* give cues for deep breathing—do in hierarchy e.g.Short utterance to build up breath support

Front 12

Phonation

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• Vocal quality - hoarse, breathy, harsh
  

- with CP - typically harsh voice - really strained and tight

• Pitch
  
• Loudness (intensity of voice)
  

• Pitch and loudness variation - you might work on maintaining them
  

Front 13

Resonation

nasality

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• Hypernasality
  
• Alternating nasality
  

• make sure structure is intact before working on it
  
• mirror under nose to see how much air is escaping

Front 14

Articulation

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• Imprecise articulation - difficulty with hitting articulatory targets - sounds sloppy
  
• sound distortions - vowel distortions and nothing is going to be consistent
  
• Disorganized Phonological Systems - Not enough breath support and muscle strength
  - motor control issues - fronting, backing, gliding

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General considerations

for treatment:

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• Depends on cause and severity of the CP, and age of child
  
• Mild – goal may be to reestablish speech patterns that closely approximate normal production
  
• Severe – may be working on establishing functional communication through the use of AAC
  

Front 16

General considerations continued

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• Interdisciplinary team is necessary
  
• Begin with appropriate postural support & respiratory support (PT support)
  
• May begin with oral exercises to improve awareness, sensation of the oral mechanism and minimize impacts of abnormal tone
  
• Specific sounds targeted on the basis of ease of production, and paired with syllable structure
  

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Treatment framework includes:

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• Facilitation techniques – make them better than what they can already accomplish
• Compensatory techniques – help with residual function - make things more functional
  

Front 18

Treatment: Oral Motor

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• Normalize oral sensitivity
  
• Increase jaw control to provide a stable base for finely graded movements of lips and tongue
  
• Strengthen lip movement increase muscle tone
• Improve tongue control for elevation and lateralization
• Move into practice of coordinated movements for speech sounds, beginning with sounds the child is able to produce
• Functional vocabulary, accepting approximations for intelligibilty
  

Front 19

May treat single sounds (follow atraditional articulation hierarchy of cueing)

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• Stimulable sounds
  
• Visible sounds (e.g., /b/, /m/, /p/)
  
• Produced in some context
  
• Early or late developing sound
  

May not be working to a“perfect” sound (may be an acceptable production)

Front 20

General Treatment approaches

important info

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• Use a combination of facilitation techniques and compensatory techniques, recognizing the contribution of all speech subsystems to intelligibility
  
• Goal is to improve functional speech production within the physiological limitations of their entire speech-producing systems.
  

Front 21

General Treatment approaches continued

important info

Back 21

• Work on speech. Use what you know about developmental progression, syllable structure, and phonetic environment
  
• Build in functional word practice
  
• Introduce AAC early in the process