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Feeding aversion/Failure to thrive
Many children are described as “picky eaters” and have a limited variety of select foods that they willingly eat. When weight, nutrition, behavior, social functioning or extreme parental frustration during mealtime becomes a problem, this issue may require a diagnosis and intervention from a professional. Various medical diagnoses such as craniofacial anomalies or genetic disorders may also cause feeding and swallowing to be problematic. Adults may also have feeding difficulty following a stroke, other neurological issues, dementia or post surgery. Therapy typically involves various oral motor exercises, creating an environment most likely to encourage eating, playing with different textures and making feeding fun. Feeding aversion becomes a failure to thrive when weight and nutrition are negatively affected and the ability to maintain life functions is compromised. Children with feeding aversion or failure to thrive typically do not improve significantly without direct intervention.
Simply put, articulation describes a person’s ability to produce speech. Specifically, it is the use of articulators (lips, tongue, etc.) to produce speech sounds. Certain speech sounds are acquired at different ages. When children do not acquire these sounds at the correct age, or when they are difficult to understand overall, intervention may be recommended.
This is the ability to understand language. Receptive abilities involve the understanding of verbal expression as well as other forms of language (sign language, writing, etc.), the understanding of age appropriate concepts, and how language is organized in the brain. There are a number of different causes for deficits in receptive language in both children and adults. Treatment differs depending on the type and severity of receptive deficits.
Expressive language is the ability to express oneself. It involves language expression through speech and gestures, and how information and thoughts are put into words and sentences. This includes vocabulary, sentence structure and grammar, semantics (meaning in language) and formulation. Again, there are many different disorders associated with expressive language impairments and treatment differs accordingly.
Memory and Cognition
Difficulty in this area may occur in children with developmental disorders or after trauma in adults due to aging, neurological deficits, dementia or stroke. There are different types of memory and each is an integral skill needed for overall language functioning.
Apraxia of Speech may occur in children or adults. Apraxia is a neurologically based motor planning disorder that is characterized by difficulty producing purposeful movements. Muscle weakness is not typically associated with this disorder. This is a complicated disorder to treat and requires a speech pathologist with additional training in this area.
Oral motor refers to the tone, range of motion and function of numerous muscles involved in the production of speech and feeding/swallowing. For different reasons, these muscles may be hypotonic (weak) or hypertonic (excessively tense) or a combination of both. Oral motor deficits may cause decreased intelligibility while speaking and difficulties with chewing or manipulating food while eating. Adequate oral motor function is necessary for successful speech production and eating.
Voice refers to the quality of sound that the vocal chords produce. Your voice is an important aspect of your identity. There are numerous specific voice disorders that have various causes and treatments. Overall, when the voice quality is atypical, there is usually an underlying medical or functional cause that needs to be addressed. Voice is measured in terms of pitch, quality, loudness, nasal resonance and oral resonance. Therapy involves education on the optimal way to use and take care of your voice as well as exercises, breathing and phonation training.
Cleft palates/lips occur prenatally and are typically not detected until birth. Speech may be negatively affected and require intervention. Infants with clefts often exhibit difficulties feeding due to decreased intraoral pressure as well.
Aphasia is the loss of language abilities and function as a result of brain damage. Receptive aphasia may involve loss of concepts, organization, personal information, and the ability to process information. Expressive aphasia may involve the inability to speak fluently, difficulty finding the correct word, difficulty speaking coherently, and deficits in reading and writing. There are numerous types of aphasia depending on the areas damaged in the brain. Therapy is typically most beneficial up to two years post stroke or trauma, but ability may continue to improve with intervention after two years.
Autism is a social language disorder that is characterized by significant deficits in speech and language development as well as nonverbal communication. Persons with autism often exhibit poor communicative intent and inappropriate social behaviors. There is a wide range of severity with autism and it is described as the “autism spectrum”. Therapy is typically ongoing and addresses all aspects of receptive, expressive and social language development.
Developmental Coordination Discorder (DCD)
Research shows that DCD is currently present in a t least 6-8% of children. DD affects the way children are able to adapt, plan, and control their movements. Children with DCD have a harder time learning new skills to problem solve and engage in tasks such as writing, dressing, and playing. Social skills and learning ability may also be negatively affected. Children with DCD’s confidence and participation often deteriorate over time, contributing to academic and developmental difficulties. If you feel your child may be having difficulty with coordination, occupational therapy can often help.
Sensory processing is the way that the brain interprets and integrates sensations throughout the body. These senses are regulated and transmitted in behavioral and motor responses subconsciously every minute of every day. Sensory processing deficits have been linked to decreased mood, and ability to cope with certain activities. The body requires proper processing of sensory input to produce functional motor output. Therefore, sensory processing difficulty may cause difficulty in motor skills in certain children. Treatment for sensory processing is called sensory integration, and involves a specialized plan to aid the brain in processing and integrating sensory input. Many people only know about the five senses, and do not realize that there are actually seven! The seven senses are taste, smell, touch, hearing, sight, vestibular, and proprioceptive. Some researchers also express that there may be eight senses. The 8 th sense is called interception, which is the body’s internal feeling (hunger, thirst, drives, pain, etc.).
Vestibular processing is essential for children, as it supports and is linked to other sensory systems. The vestibular system is responsible for balance, and helps your brain determine where your body is in space. It is also closely related to the auditory and visual sensory systems as the vestibular headquarters is located in the inner ear. Balancing the regulation of the vestibular system has been associated with improved attention and calming in many children. A child may be under-regulated or over-regulated in regard to vestibular functioning. Common signs of vestibular dysregulation are fatigue, constant rocking or spinning, head banging or overheard shaking, and side-looking. It is important that every child receive the “just right” amount of vestibular input as they develop. An occupational therapist is trained to help your child target the vestibular processing that is needed to regulate their sensory system.
Proprioception is the way that your sensory system processes information from the joints and muscles about the body’s position, stretch, weight, movement, and change in position. Our proprioceptive system aids us in grading movements to accomplish everyday tasks. The following are a few of the signs that children are not processing proprioceptive input functionally: clumsiness, difficulty walking down steps, liking to crash into things, missing the chair to sit, hand flapping, hitting, etc.
Visual Motor Integration (VMI)
VMI is the way that your eyes coordinate with your hands to complete tasks. The eyes are guiding the activity while the hands are controlling the activity. Therefore, even small tasks require a joint effort from multiple systems at once. VMI is essential for drawing, copying, and writing. VMI is required to copy basic shapes which is a prerequisite to writing letters. If a child’s handwriting is disjointed or does not flow they may be struggling with VMI.
Handwriting is a complex skill that sometimes requires special attention from an occupational therapist. It has been proven that certain children benefit from cursive writing rather than print, even at a young age. There may be other compensatory methods or adjustments to the environment that may help with writing as well. If your child is struggling with illegible writing, an occupational therapist can determine if there are underlying skills that may need to be addressed such as visual motor integration. Progress requires taking things one step at a time.
Fine Motor Skills (FM)
All children need to be provided daily opportunities and coaching to develop these intricate and detailed skills of the hand which we refer to as fine motor skills. FM skills consist of strength and coordination of the small muscles of the hand. They also include reaching, grasping, and manipulation of objects. Engaging a child in motivating activities that build fine motor skills can prepare children for many important “daily occupations” such as the ability to hold a pencil, or placing body parts into a Mr. Potato Head, etc.
Poor core strength can cause postural instability and gross motor delays. Core strength also indirectly affects the development of fine motor ability as well, as core strength is the foundation to all other muscle coordination and strength. A child’s core begins to strengthen as a baby during “tummy time”, when a baby learns to lift their head and torso, pushing off the floor with the upper body. Children further develop core strength by everyday activities like playing outdoors, running, jumping, climbing, crawling, and playing. Poor core strength presents as slouching shoulders, poor endurance, poor balance, W-sitting, etc. Research has shown that children with better core strength also have better fine motor skills and writing ability. Overall, children that develop good core strength have increased self-assurance, and endure tasks longer.
Self-regulation is the ability to maintain a level of alertness appropriate to a given activity. Self- regulation is a process that develops naturally as a child matures. Yet, some children need help developing self-regulation. Self-regulation is heavily dependent on attention, sleep cycles, emotional control, and transition between routines. Much of the body’s ability to self-regulate is driven by a child’s arousal level. Arousal has to do with the level of alertness, how the child is feeling inside, and how a child’s sensory system is processing information presented.
Proper vision is more than passing a basic vision screening. A child with 20/20 vision may still have difficulty with visual processing. Visual processing is how the brain receives and interprets the information that is seen. A child with VP difficulties may have trouble with age appropriate mazes, hidden pictures or puzzles, sight words, writing, finding information, noticing small differences, etc. Deficits in VP may underlie motor and academic issues, and occupational therapy is often imperative to a child’s success.