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.