Pediatric Speech Therapy

What is Pediatric Speech Therapy?
Speech Language Pathologists (SLP) address communication and swallowing disorders in patients.  If a child has trouble comprehending or expressing spoken or written language, a speech-language pathologist can help.  SLPs help a child understand and use vocabulary, grammar, and the social aspects of language and metalinguistic skills.  Some children respond to traditional therapy interventions while others may benefit from use of an alternative or augmentative communication system.  SLPs also assist children with articulation, voice and fluency disorders.  All children develop the sounds that make up words at different rates.  However, when a child’s development in this area falls below developmental norms or affects his or her ability to be understood, an articulation disorder may be suspected.  Finally, if an individual has difficulty with any aspect of swallowing, a SLP can assist in the development or rehabilitation of the oral and pharyngeal stages of swallowing.

Our Pediatric Speech-Language Pathologists (SLP) specialize in speech and communication disorders as well as swallowing disorders.  SLPs work with patients on components of speech production and language as well as oral motor and feeding.

Components of speech production include: phonation, the process of sound production; resonance, opening and closing of the vocal folds; intonation, the variation of pitch; and voice, including aeromechanical components of respiration.

Components of language include phonology, the manipulation of sound according to the rules of the language; morphology, the understanding and use of the minimal units of meaning; syntax, the grammar or principles and rules for constructing sentences in language; semantics, the interpretation of meaning from the signs or symbols of communication; and pragmatics, the social aspects of communication.

Speech Therapy Treatments

Oral-motor patterns must be directly observed.  The individual presents many different patterns at once with varying degrees of severity and skill, making identification of baseline oral motor skills challenging for the therapist.  Different patterns may be observed with different food types and in response to different types of stimuli.
Due to medical complications, many of our patients do not develop oral skills required to coordinate sucking and oral exploration during early development.  A lack of oral skills development often leads to difficulties in oral feeding.  We work with feeding on all levels from enteral to oral feeds.  Some children are not born with feeding issues, but develop feeding problems as a result of NICU hospitalizations, sensory impairments, sensory-motor impairments or failure to thrive.  These children may have oral aversion, limited food choices, poor appetite, poor intake or weight gain.  After an extensive evaluation, the best-individualized treatment approach is chosen and implemented.
Treatment involves correcting inappropriate productions of standard speech sounds due to incorrect placement of the lips, tongue, teeth, velum and pharynx during speech.  Correct speech becomes easier as a child’s tongue and motor skills mature and gain experience.  Sometimes a child holds onto these “baby” or an “immature” pattern of speech simply because they are not aware that they are saying sounds wrong.  If a child continues to use these phonological processes, the result is a developmental phonological disorder.

Articulation (phonetic mastery) refers to the correct production of individual speech sounds.  Assessment involves the use of standardized tests to identify errors in the production of individual speech sounds (phonemes) in initial, medial and final positions in single words.  The child may have an articulation disorder if errors continue past the expected age.   Phonological development looks at the development of speech sound patterns observed in the production of syllables, words or longer units of spoken language.  Assessment involves the use of standardized testing to evaluate patterns of errors such as “final sound deletion” (/ha/ for “hop”). “velar fronting” (/ti/ for “key”) and “initial voicing” (/bat/ for “pat”).)

An augmentative and alternative communication (AAC) device is a form of communication (other than oral speech) that is used to express thoughts, needs, wants and ideas.  It includes things such as facial expressions, gestures, symbols, pictures or writing.  It may be a low-tech or high-tech device that provides nonverbal means of communication.  These range from picture cards to electronic devices that emit spoken words and sentences.  AAC is used by those with a wide range of speech and language impairments, including congenital impairments such as cerebral palsy, intellectual impairments and autism, and acquired conditions such as amyotrophic lateral sclerosis and Parkinson’s disease.

You may feel as though providing your child with an AAC device is the equivalent of giving up on speech therapy, but in actuality, studies have shown that children who use AAC devices are encouraged to increase their nonverbal and verbal communication.  These children are also less likely to be socially isolated or to become frustrated because they cannot express themselves.  AAC devices are intended to complement speech therapy, not replace it.  Consider AAC devices to be another tool in your arsenal of speech therapy treatments, much like using Speech Buddies to encourage correct pronunciation.

Children with speech/language impairments may also have cognitive deficits. Cognitive impairments may present areas of weakness in memory, perception, reasoning/judgment, attention, visio-spatial skills, executive function, social interaction and problem solving.  Speech-language pathologists work with children to improve their overall “thinking” skills.
Play is a vital part of a child’s learning.  If milestones are not met, it can signal to medical professionals and parents a more serious problem, or the need for further investigation to identify the underlying cause of the delay.  Often times, the first signals of motor skill, sensory or cognitive delays present themselves as delayed milestones.  It is important to address these delays as soon as they are identified to prevent secondary impairments or compensatory movements that may lead to further motor, sensory, behavioral or cognitive delays.
Language development is one of the most remarkable pieces of your child’s development.  In some children, typical development does not occur in the way that it should.  Researchers have found that language development begins before a child is even born.  Children may have difficulties comprehending and/or using spoken and written communication.  Deficits may be identified in the form, content and function of language.  A functional language approach focuses on improving the child’s ability to communicate basic wants and needs.  Improving the overall use of spontaneous communication, social skills, vocabulary, syntax and grammar are also commonly treated in speech therapy.
Stuttering affects the fluency of speech.  Stuttered speech often includes repetitions of words or parts of words, as well as prolongations of speech sounds.  These disfluencies occur more often in persons who stutter than they do in the general population.

During an evaluation, an SLP will note the number and types of speech disfluencies a person produces in various situations.  The SLP will also assess the ways in which the person reacts to and copes with disfluencies.  The SLP may also gather information about factors such as teasing that may make the problem worse.   A variety of other assessments (e.g., speech rate, language skills) may be completed as well, depending upon the person’s age and history.  For younger children (ages 1-5), it is important to predict whether the stuttering is likely to continue.  Factors that are noted by many specialists include a family history of stuttering, stuttering that has continued for 6 months or longer, presence of other speech or language disorders, and/or strong fears or concerns about stuttering on the part of the child or family.  It is typical for children between the ages of 1 and 5 to have some speech disfluencies or stuttering.  Pediatric clients who are determined to be appropriate for therapy based on the assessment criteria listed above are taught to use fluency enhancing techniques to reduce or eliminate the occurrences of stuttering during spontaneous speech.

For older children and adults, the question of whether stuttering is likely to continue is somewhat less important, because the stuttering has continued at least long enough for it to become a problem in the person’s daily life.  For these individuals, an evaluation consists of tests, observations and interviews that are designed to assess the overall severity of the disorder.  In addition, the impact the disorder has on the person’s ability to communicate and participate appropriately in daily activities is evaluated.  Information from the evaluation is then used to develop a specific treatment program, one that is designed to help the individual speak more fluently, communicate more effectively and participate in more fully in life activities.

NDT is the primary treatment technique for individuals with central nervous system impairment such as children with cerebral palsy or traumatic brain injury.  NDT trained therapists believe that due to the central nervous system impairment, atypical posture and movement patterns are used by the child for function.  Unfortunately, it is the use of these patterns that lead to secondary impairments and dysfunction.  NDT trained therapists use clinical thinking to evaluate a person’s movement in order to determine the focus of each physical, occupational or speech therapy session.  Therapeutic handling is used to assist in the facilitation of typical movement to gain function.
Children may use picture cards to express their wants and needs.  Each card has an image that depicts a word.  For example, a child might hold up a picture of a sandwich to indicate that he is hungry.  He might hold up a picture of a bed to indicate that he is sleepy.  Picture cards are a simplistic type of AAC device that children with a limited vocabulary can understand and easily use.  However, the drawback is that it can be cumbersome to carry around lots of picture cards.  Some picture card AAC devices are available in flipbooks.  Your child’s speech therapist may also introduce him to a board that displays numerous images.  The child can point to the appropriate image.
Voice therapy encompasses a variety of techniques and may involve correcting abnormal pitch, loudness, resonance and/or quality of voice that interferes with communication.  These techniques may seek to eliminate potentially harmful vocal behaviors, alter the manner of voice production, and/or enhance vocal fold tissue healing following injury.  Emerging data suggests that voice therapy is an effective and appropriate method of therapy either in itself or as a compliment to other treatment modalities (e.g., surgery, medications).

The PPHC Approach

The commitment of PPHC is to provide high quality, outcome-oriented healthcare to patients requiring specialized pediatric rehabilitation services in the home. This commitment is shared by every employee of PPHC as we strive daily for clinical excellence, high standards of patient care, partnerships with our families and communities, and ongoing therapy education.

By providing Physical, Occupational and Speech Therapy we are able to provide a valuable multidisciplinary approach that serves all the child’s therapy needs. In addition, consistent collaboration with doctors and community healthcare providers widen our ability to care for the children further. Frequent communication and cooperation with a child’s school is also taken into consideration as we provide the most thorough care possible to meet each child’s goals.

Our hope is to set goals with the patient and family and do everything we can to help a child reach their personal best. The family is a key component in optimizing therapy outcomes. We want all of our families to feel that they are involved and knowledgeable about the therapy and care their children are receiving, because help and follow through at home can make a world of difference in the effectiveness of therapy.

With caregiver collaboration and family centered treatment, we provide a level of excellence in therapy that we are proud to share with you.