Thursday, April 19, 2012

Brain Development

The first three years of life are a period of incredible growth in all areas of a baby's development. But by age 3, his brain has grown dramatically by producing billions of cells and hundreds of trillions of connections, or synapses, between these cells.

While we know that the development of a young child's brain takes years to complete, we also know there are many things parents and caregivers can do to help children get off to a good start and establish healthy patterns for life-long learning.

Brain development is "activity-dependent," meaning that the electrical activity in every circuit: SENSORY, MOTOR, EMOTIONAL, COGNITIVE - shapes the way that circuit gets put together. Like computer circuits, neural circuits process information through the flow of electricity. Unlike computer circuits, however, the circuits in our brains are not fixed structures. Every experience,whether it is seeing one's first rainbow, riding a bicycle, reading a book, sharing a joke - excites certain neural circuits and leaves others inactive. Those that are routinely turned on over time will be strengthened, while those that are rarely excited may be dropped away. The elimination of unused neural circuits, also referred to as "pruning," may sound harsh, but it is generally a good thing. It streamlines children's neural processing, making the remaining circuits work more quickly and efficiently. 

Infants prefer human stimuli (your face, voice, touch, and even smell) over everything else.  Activities for stimulating infant brain development are simple at this stage. The best ways to nurture infant development simply require your time and interaction. Here are some activities that have been suggested by leading experts to get you started:
  • Look into your newborn baby's eyes. Infants begin to recognize faces very early! Each time he stares at you, he's developing his memory.
  • Have your baby look at himself in a non-breakable mirror. At first, he may wonder who that other baby is, but eventually, he will recognize that he can make that baby move!
  • Encourage communication. Whenever your baby babbles or coos, repeat the sound he makes and then pause to give him the chance to respond. This shows him that what he's saying is important to you and encourages communication.
  • Stroke your baby's knuckles to encourage him to open his fingers. Then gently place a rattle or toy in his palm. In the beginning, he won't be able to hold it for long, but the experience will let him practice for later play.
  • Talk to your baby, but leave short pauses where your baby would speak. Soon he'll catch on to the idea of conversation and start cooing in response.
  • Sing songs. Play music. Say nursery rhymes. It is thought that if your child is exposed to these things early in life, it lays many foundations for academics.
  • Tickle his toes -- and everything else. Laughter is the first step in developing a sense of humor. Playing games like "Patty Cake", or "I'm Gonna Get You!" teaches your child to anticipate events.
  • Go ahead and let loose with the baby talk (also known as "motherese"). Your cooing and high-pitched baby talk really grabs your baby's attention. This type of special talk is linked to increased language development.
  • Change your baby's positions frequently. When an infant learns to play in a new position (such as on his side), his motor skills are challenged in different ways and develop more thoroughly.
  • Use your baby's name when talking to him. Studies show that babies can recognize their own name by 4 1/2 months if it is used often.
  • Make the most of diaper time. Use these moments to teach body parts or pieces of clothing, and to sing nursery rhymes. Narrate to help your baby learn to anticipate routines.
  • Use feeding time (breastfeeding or bottle feeding) as a learning time. It is a great time to bond with your infant by singing, talking, or simply stroking that wonderful baby hair.
  • Turn off the TV and other constant background noises. Your baby's brain needs one-on-one interaction without distraction.
  • Explore new places. Take your baby on walks in a front carrier, sling, or stroller, and talk about what you see:  "That's a big truck!" or "Look at the pretty flower!" or "Did you hear that ambulance?."  This will encourage vocabulary development.
  • Surprise him. Do the unexpected every now and then by gently blowing on his face, arms, or tummy. Make a pattern with your breaths and watch him react and anticipate.
  • Stimulate his senses. Walk around the house with your baby in your arms and...touch his hand to the cool window, stop to smell supper cooking, listen to the birds, look at everything, and talk about everything as you go.
  • Incorporate infant massage into your routine. A gentle massage while telling him what you are doing stimulates infant brain development.
  • Read books! Read books! Read books! Scientists have found that babies as young as 8 months can learn to recognize the sequence of words in a story when it's read 2 or 3 times in a row. This is believed to help them learn language.
  • When you reach the end of a it again! Each time you re-read something, his memory skills are sharpened and he learns to predict what's next.
  • Teach your baby sign language. Baby signing is linked with earlier development of non-verbal and verbal communication. This is a terrific way to give a boost to infant brain development.
  • Give your baby time alone. He needs some down-time to learn to amuse himself and process all of the new information.
Remember, both nature and nurture will influence your baby's future. Optimal infant brain development will occur when a newborn's loved ones provide loving interaction.

Until Next Time,
Salima Dhamani M.S., CCC-SLP

Wednesday, January 25, 2012

Dysphagia, Anyone?

Swallowing requires a complex chain of events; most of which are "automated," meaning that no thought is required for swallowing once swallowing is initiated.  The swallowing center of the brain is connected to the pharynx (part of the throat situated directly behind the mouth and nasal cavity) and esophagus (a flap of elastic cartilage attached to the back end of the tongue) via a superhighway of nerves.  These connections enable reflexes that enable proper swallowing.

To get a sense of all that is required for the "simple" skill of swallowing, here is a look at the mechanisms that are involved in making it work:
  1. Food is masticated (chewed) in the mouth and mixed with saliva; forming a bolus (lump of masticated food).  This is the first and only step of swallowing that is not automated.
  2. The bolus is then propelled towards the pharynx.
  3. The soft palate, or the back end of the roof of your moth, is elevated to keep food from entering the nasal passage.
  4. The upper pharynx contracts, pushing the bolus towards the lower pharynx.  At the same time, the larynx (voice box) is pulled forward by muscles in the neck, allowing the epiglottis to bend downwards...this dual action keeps food from traveling into your trachea (windpipe) and larynx.
  5. Contractions of the muscular pharynx propel the bolus further.
  6. The upper esophageal sphincter (muscle at the upper end of the esophagus) relaxes, allowing the bolus to enter the esophageal tube.
  7. A wave of contractions allow the bolus pass through the entire length of the esophagus.
  8. The lower esophageal sphincter, relaxes so that when it arrives the bolus can pass on into the stomach.
The medical term for any difficulty or discomfort when swallowing is dysphagia.  If you find it difficult to swallow, the problem can occur at any one or more of these stages.  Premature babies, the elderly, stroke and Alzheimer's sufferers, traumatic brain injury patients along with individuals with throat and neck cancer can all suffer with swallowing disorders. 

So, whats the big deal if you have a swallowing disorder?!  One of the most eminent concerns of dysphagia is aspiration where food/liquid travel into the trachea and lungs.  If you aspirate a particularly large piece of food, you face the life-threatening danger of airway obstruction.  While the aspiration of smaller particles of food or liquid pose less of a threat to the airways, they can lead to infection.  Some lesser threatening consequences include: weight loss, dehydration, malnutrition, failure to thrive and social withdrawal.  All of which can have a detrimental impact on your quality of life.  Reach out to your speech pathologist for assessment, diagnosis and treatment for dysphagia

Until next time,
Salima Dhamani M.S., CCC-SLP

Tuesday, January 17, 2012

Early Speech & Language Development and When to Seek Help

Research shows that the emergence of communication begins in infancy, before your baby speaks her first words. However, its important to know that at 16 weeks of pregnancy, tiny bones are already in place in the fetus's ears, making it likely that your baby can hear your voice when you are speaking; arguably, this is when early speech and language first begin to be impacted!  

While pregnant, speak and sing to your baby.  Studies have shown that newborn babies respond to the voices and sound patterns they were exposed to while in the womb.  

After your baby arrives into the world, there are many things that you as parents can do to stimulate speech and language development; here are some things you can do at home:
  • during infancy, talk, sing and encourage imitation of sounds and gestures
  • as early as 6 months of age, begin reading to your baby
  • be the "sports announcer" during daily tasks so that your toddler can be exposed to a variety words and expressions
    • explain what you are doing while you cook a meal, clean a room, point out objects (and their use) around the house, as you drive point out the sounds you hear 
  • engage in simple dialog with your 2 and 3 year old by asking questions and acknowledging her responses 

Seek the advice of your pediatrician and/or speech therapist if:
  • By the age of 1 your child is not tuning into and understanding a variety of environmental noises, not making a variety of sounds through babbling or vocal play, not beginning to anticipate and imitate your simple actions.
  • By the age of 3 your child is not producing words and phrases spontaneously, does not use oral language beyond the communication of her immediate needs, cannot follow simple directions, does not have ineligible speech a majority of the time (caregiver should be able to understand more than half of the child's speech by 3 years of age).  
  • Your instinct tells you that that something is not right.  Parental instinct can kick in early on and should not be dismissed as an overreaction.  

Until next time,
Salima Dhamani M.S., CCC-SLP


Thursday, January 12, 2012

Cerebral Palsy and the Speech and Language Pathologist

Cerebral palsy (CP) is a chronic condition affecting body movements and muscle coordination.  It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development or infancy.  It also can occur before, during or shortly following birth.

"Cerebral" refers to the brain and "Palsy" to a disorder of movement or posture.  If someone has CP it means that because of an injury to their brain they are not able to use some of the muscles in their body in the normal way.  Most children with CP are likely to have speech and hearing impairments accompanied by involuntary body or facial movements (that look like a tick), disturbed gait (walking pattern), and or seizures. 

As a parent/caregiver/sibling it is important to be aware of effective means by which to communicate with someone with CP and even more important to educate unfamiliar communication partners on CP in general and best communication practices in specific.  The follwing are some helpful tips:
  • look directly at them when speaking
  • have moderate to slow rate of speech
  • if they have a hearing impairment, be sure to be in close proximity when speaking to them
  • move your lips when talking to them so they can speech read (do not speak under your breath)
  • allow for a longer response time and expect that they may have slow, labored, halting speech output
In cases of cerebral palsy where speech is severely impacted, a speech therapist can introduce alternative augmentative communication (AAC) devices.  These devices can range from high tech voice output devices with eye tracking abilities to low tech boards with photos and letter or words.  Other methodologies to enhance communication can include sign and body language training, and respiratory strength training.  

Remember, that just as every non-CP individual is different and unique in their own way, so is each and every individual with CP; one script does not fit all.  Engage with your child's speech therapist and seek out her advice on the best course of action for your child.  She will be able to ascertain the best course of therapy given your family's needs, his particular motor, visual, auditory, cognitive, language and communication strengths and weaknesses.   

Until next time, 
Salima Dhamani M.S., CCC-SLP