When is It Too Late for Changes in Speech?

How much change can you expect in a day or two? If you access the child’s neuroplasticity with a novel challenge, the change can be amazing. Listen to Oscar reading an excerpt about Star Wars characters. I had captions added to the second paragraph to help you understand what he was reading.

At first, I could not understand anything he was trying to say. Adding the captions helped me understand, but this is not really a practical solution. Those in his close social and school circles understand him but the broader community struggle to understand his speech. The dominant belief for many children like Oscar is that his brain was permanently damaged and after a period of early speech therapy, he was discharged with no expectation of further improvement. In most North American centers, augmentative communication would be the next step.

Does speech at age 4 – 5 years predict later function?
The short answer is no! The brain continues to grow and mature; developing new abilities, if only we learn how to use them. I asked Oscar to sing for the camera. Listen to this!

What a change! Oscar was faced with a novel challenge that he could only accomplish by using the singing parts of his brain. These singing parts are in very different areas of the brain than the parts we use to speak.

His usual speech is an early-learned habit.
What do we now know about this boy’s speech problem? First, his hearing, his processing of speech and his ability to read are well within normal for age. His problem is dysarthria, a condition caused by poor motor control of respiration and the muscles that are used to produce speech. This is one of the most common type of speech difficulties in children with cerebral palsy.

Having him sing was a novel, challenging task. We know that novelty is a stimulus to neuroplasticity, but in this case, we were also using substitution neuroplasticity, purposely having him use a different part of the brain to accomplish a function. More on this in my upcoming book, The Boy Who Could Run But Not Walk, to be released on September 20, 2016 ( The Boy Who Could Run, But Not Walk). Using his singing brain, he could manage the control of his breath and oral muscles. So improved speech requires a new way of thinking about his speech difficulty. We have to rewire a set of different brain and muscle pathways for speech. (Rewire Your Brain with a New Habit)

What does he do now?
I asked his parents to get him singing, learning songs and sports team cheers as a family routine. They need to make it as fun an activity as possible. He needs to develop the pathways with use.

In the intensive he attended, the SLP therapist taught him a whole series of breath training techniques that he is now old enough to both understand and use. Just because he couldn’t do them at 5 years does not mean he cannot learn to do it at an older age. He has been back in weekly SLT for three years but after his intensive experience, focus will now be on the control of breathing combined with music therapy.

He was also introduced to water exercise with a wet vest, both to improve his ataxic gait and to improve his overall cardiovascular fitness and respiratory function. Most children and adults can improve speech production this way. Christine, an adult with choreoathetosis comments on her changes at the end of this post. (Deep Water Jogging for Gait Training)

She was one of the many patients who taught me that sometimes simple exercises can have a widespread effect. She was over 30 years old when her speech dramatically improved. Later on, she sang Bette Midler’s song The Rose to a packed audience of Acting Without Boundaries. (www.actingwithoutboundaries.org)

Oscar returned home with an active program to build on what he accomplished in 10 short days. Not every child will have such a dramatic change, but parents have to remember, the brain grows and matures and can learn new skills throughout life. The catch is that doing more of the same harder does not work.

See more of Oscar’s change at www.cpkids.co.nz

As ever, I look forward to your comments and questions.

 


7 Responses to “When is It Too Late for Changes in Speech?”
  1. Melanie says:

    My daughter is 3.5, not yet formally diagnosed with CP but suspected mild hemiplegia. She has slight low tone but walks (and of course, runs), stairs with a hand rail currently, but is challenged with overall motor coordination issues. Her biggest delay has been with speech. She’s been in PROMPT therapy now for a few months and we have seen a burst of language through that and in conjunction with an ACC device TouchChat. She’s gone from 10 words to 50 words. As we work through the apraxia, are there other therapies you recommend for this age group for better progress in the journey?

    • Karen Pape says:

      Hi Melanie, you certainly have a good program set up for your daughter. Well done.First point is to recognize that there is a lot of brain growth still to come.Remember to give her time to respond verbally and reward her attempts with your enthusiasm. Additional things would be water exercise with a Wet Vest that would help her with overall strengthening and respiratory function. http://www.karenpapemd.com/water-exercise-for-children-with-cerebral-palsy/ Also singing together. Songs like Happy Birthday are good because they have a limited number of words. Thanks for your comment.

      • Melanie says:

        Hi Karen:
        Thanks so much for your reply. I’ll check out this weight vest! We have done simple songs and nursery rhymes since she was an infant and have never stopped. No surprise that a lot of her first words came from them. 🙂 I have such hope for her and can’t wait to see how much more she will accomplish and it’s my life goal to support her in every way I can as long as I can. Thanks do much for all your knowledge. Hope to make it to the Hope For HIE event and meet you!

  2. Penny Watts says:

    My adopted son who I have had since he was 9 days old has Kernicterus. He is now 10 years.
    His speech is very difficult to understand so I shall try your suggestion of singing. He also has Ataxic CP and cannot hold a cup, do buttons, zips, laces and finds writing very very difficult.
    He is still not able to read and can dress himself as long as his cloths are not inside out or the wrong way round. He had a lot of involuntary movement and his balance is poor.
    Apart from this he is a bright and happy boy and the light of my life!!
    Any suggestions how I can help him further?

    • Karen Pape says:

      Dear Penny, Thank you for your email. I have two suggestions. With his diagnosis an incomplete hearing loss is common. Now that he is older, I would have it checked by an expert.Look at this post.
      http://www.karenpapemd.com/quick-fixes-take-your-therapists-hands-home-with-you/
      It shows a boy with a severe movement disorder helped greatly by a TheraTogs to give him central support. It may well help your son as well. You might also try the water exercise program with a Wet Vest. There is a downloadable program on my website. For many children with difficulties moving against gravity, this form of movement allows to experience more movement and that may translate to land as well.

  3. Penny Watts says:

    Ah yes, another problem. When Michael is hungry he gets terrible pains in his stomach.
    Is this part of the condition?
    He also cannot stand bright sunlight. Our GP says he has ‘cornial sensitivity’ and suggests he wears sunglasses outside.
    He tells me his eyes go out of focus when he looks intently at something but the optician says he cannot help as this is due to his CP.

    • Karen Pape says:

      I have no good ideas on the stomach pains other than more frequent feedings.I would look for a developmental optometrist to check out his eyes. They are especially trained to work with children with CP.