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

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

    

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