Speech-language pathologists (speech or oral-motor therapists) assess the speech, language, cognitive communication, and swallowing skills of children; determine what types of communication problems exist; and identify the best way to treat these challenges. Speech-language pathologists skilled at working with infants and young children are also vital in training parents and infants in other oral-motor skills, such as how to feed an infant born with a cleft lip and palate.
Speech-language therapy involves having a speech-language specialist work with a child on a one-on-one basis, in a small group, or directly in a classroom to overcome a specific disorder using a variety of therapeutic strategies. Language intervention activities involve having a speech-language specialist interact with a child by playing and talking to him or her, using pictures, books, objects, or ongoing events to stimulate language development. Articulation therapy involves having the therapist model correct sounds and syllables for a child, often during play activities.
Children enrolled in therapy early (<3 years of age) tend to have better outcomes than children who begin therapy later. Older children can make progress in therapy, but progress may occur more slowly because these children often have learned patterns that need to be modified or changed. Parental involvement is crucial to the success of a child’s progress in speech-language therapy.
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Limp In-Toeing, Out-Toeing, and Toe-Walking Bowlegs and Knock-Knees Hypotonia and Weakness
Cerebral palsy (CP) refers to a group of nonprogressive, but often changing, motor impairment syndromes secondary to anomalies or lesions of the brain arising before or after birth. The prevalence of CP at age 8 in the United States is 3.6 per 1000; prevalence is much higher in premature and twin births. Prematurity and low birth weight infants (leading to perinatal asphyxia), congenital malformations, and kernicterus are causes of CP noted at birth. Ten percent of children with CP have acquired CP, developing at later ages. Meningitis and head injury (accidental and nonaccidental) are the most common causes of acquired CP (Table 10-10). Nearly 50% of children with CP have no identifiable risk factors. As genomic medicine advances, many of these causes of idiopathic CP may be identified.
Most children with CP, except in its mildest forms, are diagnosed in the first 18 months of life when they fail to attain motor milestones or show abnormalities such as asymmetric
Low socioeconomic status Prematurity Low birth weight/fetal growth retardation (<1500 g at birth) Maternal seizures/seizure disorder Treatment with thyroid hormone, estrogen, or progesterone Pregnancy complications
Hemiparesis (hemiplegia)—predominantly unilateral impairment of the arm and leg on the same (e.g., right or left) side
Diplegia—motor impairment primarily of the legs (often with some limited involvement of the arms; some authors challenge this specific type as not being different from quadriplegia)
Quadriplegia—all four limbs (whole body) are functionally compromised.
gross motor function, hypertonia, or hypotonia. CP can be characterized further by the affected parts of the body (Table 10-11) and descriptions of the predominant type of motor disorder (Table 10-12). Comorbidities in these children often include epilepsy, learning difficulties, behavioral challenges, and sensory impairments. Many of these children have an isolated motor defect. Some affected children may be intellectually gifted.
Treatment depends on the pattern of dysfunction. Physical and occupational therapy can facilitate optimal positioning and movement patterns, increasing function of the affected parts. Spasticity management also may include oral medications (dantrolene, benzodiazepines, and baclofen), botulinum toxin injections, and implantation of intrathecal baclofen pumps. Management of seizures, spasticity, orthopedic impairments, and sensory impairments may help improve