Hot Topic Blog - Oral/Pharyngeal Sensory-Motor, Orofacial Myofunctional, & Airway Information
A CASE STUDY - EFFECT OF ORAL SENSORY-MOTOR TREATMENT ON EXPRESSIVE LANGUAGE: PART 1By Krupa Venkatraman, Speech-Language Pathologist in India
This descriptive study is about the use of oral sensory-motor treatment including neurodevelopmental treatment (NDT) and oral placement therapy (OPT) for a three-year-old male client diagnosed with Alternating Hemiplegia of Childhood (AHC), a rare neurological condition. The client exhibited severe generalized hypotonia, overall oral hypo-sensitivity, imprecise lingual movements, jaw weakness, and in-coordination of breathing.
Prior to this treatment, the child had received traditional language therapy with a few Non-Speech Oral Motor Exercises (NSOMEs) for 8 months. However, no changes were noted in expressive language but non-verbal comprehension seemed to improve with the prior treatment.
Oral sensory-motor treatment incorporating thermal stimulation, flavoring, jaw, lip, and tongue exercise in addition to OPT was carried out for 1 year. Re-evaluation was done every three months. These evaluations revealed consistent improvements in expressive language levels. The improvements were attributed to the oral sensory-motor program which included both NDT and OPT treatment methods. These methods along with traditional language stimulation techniques aided better speech outcomes in this child exhibiting significant oral sensory-motor problems.
Alternating Hemiplegia of Childhood
Alternating Hemiplegia of Childhood (AHC) is a rare neurological disorder in which repeated, transient attacks of hemiplegia (paralysis of a portion of the body, including the face) occurs unilaterally or bilaterally (Mikati, Kramer, Zupanc, & Shanahan, 2000). The estimated incidence of AHC is roughly 1 in 1,000,000 births (Pysden, 2010).
The characteristics of AHC include oculomotor deficits and involuntary movements such as facial dyskinesia, dystonia, and athetosis associated with hemiplegia or occurring independently (Gergont & Kacinski, 2014). The speech and language characteristics of children with AHC range from dysphasia/aphasia to dysarthria (Kalra & Rathi, 1996).
The causes of the disorder are inconclusive. There are numerous genes reportedly associated with AHC such as, ATP1A2, SCN1A, CACNA1A, and SCN1A (Ju, Hirose, Shi, Ishii, Hu, & Zou, 2016). However, there are no specific gene patterns observed to cause AHC. Gergont and Kacinski (2014) inferred the cause of AHC from several single-subject studies as channelopathy (i.e., possible mutations in the calcium channel gene and the sodium potassium channel gene).
The disorder is varied in symptomatic expressions, along with individual variability. Neville and Ninan (2007) examined thirteen children diagnosed with AHC using Electro-Encephalography (EEG), cranial Magnetic Resonance Imaging (MRI), serum amino acid analysis, urinary organic acids, measurement of plasma lactate, and pyruvate levels. The results revealed no abnormal patterns in any of the tests. However, video-EEG in three children with AHC revealed epileptiform patterns. EEG is considered to be an effective tool in the diagnosis of AHC as part of an eclectic approach. The treatment for AHC is as complicated as the disorder being expressed. There are a range of treatments like flunarizine, anti convulsants, beta blockers, calcium channel blockers, methyl-sergide, amantadine, aripiprazole, and haloperidol (Gergont & Kacinski, 2014).
Due to rare presentation and frequent misdiagnosis, the understanding and medical treatment of the disorder is still in an early stage. Research regarding speech and language delays associated with the disorder and effective treatment strategies are yet to be explored and discovered. In reviewing the general characteristics of the disorder, it presents as a type of movement disorder (Aylward, 1996) associated with muscle weakness and flaccidity. Hence, a therapy approach that facilitates movement and sensory awareness in the muscles is hypothesized to attain better speech and language outcomes.
Aylward, R. (1996). Alternating hemiplegia of childhood. .Journal of Neurology, Neurosurgery, & Psychiatry, 60, 466.
Gergont, A., & Kacinski, M. (2014). Alternating hemiplegia of childhood: New diagnostic options. Neurologia I Neurochirurgia Polska, 48(2), 130-135.
Ju, J., Hirose, S., Shi, X. Y., Ishii, A., Hu, L. Y., & Zou, L. P. (2016). Treatment with Oral ATP decreases alternating hemiplegia of child with de novo ATP1A3 Mutation. Orphanet Journal of Rare Diseases, 11(1), 1.
Kalra, V., & Rathi, S. (1996). Alternating hemiplegia of child. Indian Pediatrics, 33, 233-235.
Mikati, M. A., Kramer, U., Zupanc, M. L., & Shanahan, R. J. (2000). Alternating hemiplegia of childhood: Clinical manifestations and long-term outcomes. Pediatric Neurology, 23(2), 134-141.
Neville, B. G. R., & Ninan, M. (2007). The treatment and management of alternating hemiplegia of childhood. Developmental Medicine & Client Neurology, 49(10), 777-780.
Pysden, K. (2010). Alternating hemiplegia of childhood. Journal of Pediatric Neurology, 8(1), 35.
About the Author
Krupa’s Mission: I am a very ambitious individual with multi-tasking capabilities, prepared to take up challenges in handling a variety of pathological conditions. I have a personality determined to work to bring positive changes in my clients by imparting a structured treatment approach. My positives include exceptional understanding of different speech and language disorders, effective client communication, and team playing to name a few. I understand the need for professional communication and emphasis on team work which is of paramount importance in the rehabilitation process. Having been equipped with my education and experience, I am looking for opportunities to make significant contribution that can bring about positive changes in my patients.
Krupa’s Career: I started my career in 2011 and worked at a few child developmental centers and special schools. However, I was determined to start my private practice where I am free to employ my way of looking at a disorder or a condition. I happened to work with the pediatric population, predominantly children with Autism Spectrum Disorder, Cerebral palsy, ADHD etc. I do on-call visits to hospitals for bedside evaluations of adults with neurogenic communication disorders, addressing feeding, oral sensory-motor issues, and communication.
I received my undergraduate and post-graduate education at Sri Ramachandra University, Porur, Chennai, India. I was awarded a gold medal for academic and clinical performance. I like to work with a variety of disorders; however, oral sensory-motor programs are my prime area of interest. You may contact me via email: Krupa V email@example.com
This is Part 1 of a case study. Part 2 will be posted in October 2017.