what is speech therapy?

Speech-Language Therapy
The purpose of speech-language therapy is to enhance intentional communication via expression of ideas, obtaining desires, sharing information and interpersonal interaction.

Language is the means by which communication is achieved.Components of language include but are not limited to

• suntax...... sentence construction also called grammar (content)


• semantics...... i.e. meaning includes proverbs, humour etc.


• pragmatics i.e. use of language in social contexts alos enhanced by body orientation, facial expressions and gestures.

Therefore, speech therapy focuses around teaching the child what he or she
needs and also making use of language for communication.For the child who is not currently using words, language is still possible through other means. A child may be taught to use various ways of utilizing their language skills to convey meaning. These may consist of gestures, eye contact, facial expression, vocalizations or manual tools such as communication pictures/boards/books. These however are subject to discreetion of the therapist.
Oral-motor deficits are also addressed in speech-language tharapy. Since proper structure and function of the oral areas is necessary for speech and sound production, intervention to improve coordination, strength, movement of the lips, tongue, jaw and cheeks (both internally and externally) is required.

What causes speech and language problems?
Speech and language disorder is a common reason for speech/language problems in kids. This involves the following areas:
• Spoken language—delays and disorders in listening and speaking
• Written language—problems with reading, writing and spelling
• Arithmetic—trouble doing arithmetic or understanding basic concepts
• Reasoning—problems organizing and putting together thoughts
• Memory—problems remembering facts and instructions.

These kids may have trouble producing speech sounds, using spoken language to communicate, or understanding what other people say. Speech and language problems are often the earliest sign of other disorders.
• Hearing loss is often overlooked, and easily identified. If your child is speech/language delayed, their hearing should be tested.
• Mental retardation is described as below-average general intellectual function with associated deficits in adaptive behavior that can be seen in early years, common cause of speech and language delay.
• Autism, : diagnostic category of pervasive developmental disorders (PDD) refers to a group of disorders characterized by delays in the development of socialization and communication skills. Parents may note symptoms as early as infancy, although the typical age of onset is before 3 years of age. Symptoms may include problems with using and understanding language; difficulty relating to people, objects, and events; unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and repetitive body movements or behavior patterns. Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident. Unusual responses to sensory information, such as loud noises and lights, are also common.

• Extreme environmental deprivation can cause speech delay. this also includes Children out of intercaste marriages under pressure to pick up both the langauges simultaneously!

• Premature births can lead to developmental delays, including speech/language problems.

• Neurological problems like cerebral palsy, muscular dystrophy, and traumatic brain injury can affect the muscles needed for speaking.

• Structural problems like cleft lip or cleft palate can also interfere with normal speech

.• Apraxia of speech is a specific speech disorder in which the child has difficulty in sequencing and executing speech movements.

• Selective mutism is also called funtional disorder at times when a child does not talk at all in certain situations.

If your child does not follow regular speech/language development milestones, you should talk to your pediatrician. or rehabilitation professional

"NOISE"........... beware!

TOO LOUD????Our ears evolved over the millennia in the backdrop ofsilence. In ancient times, our life was marked by thesound of wind, of water, temple bells, of the cries ofwild animals and, most importantly, laughter.Come 20th Century, all this changed. Industry,automobiles, aircraft, jackhammers arrived. Also,engineering equipment began tearing up the ground tobuild tall buildings and skyscrapers — there was bignoise all around.Today, we are marooned with a medley of noise that ourears were never designed for.Honking, music systems, personal stereos, and iPods…the list is endless. They have only added to blazingcacophony.Too much noise is damaging to us. The irony is — wedon't notice until it's too late to do anything aboutit.

ORIGIN OF SOUND AS LANGAUGE OS SPEECH: the infant hears his first sounds outside the womb, the moment it is born. A normal hearing infant is exposed to all kinds of sounds, i.e. Speech-language of his environment, sounds of toys, birds chirping…. The list is endless. This according to the Chomskian theory of Language development helps him to develop adequate speech and Language skills.
Following are the typical milestones regarding the child’s’ speech and hearing development:

Birth – 2 months → startling response to loud sounds
2months – 6months → eye movements to sounds
6months – 12 months → head turning response to sounds, human voice
> 12 months → child babbles mama…baba… etc.
1½ years → single meaningful words
2½ years → 2- word phrases (“mama give”; “give ball”)
3 years and above → meaningful simple sentences (“mama give ball”)

It is known and seen that any disruption in the sensory status of the Ear (any degree or type of deafness) causes marked speech-language delay.


POWER VIS-A-VIS SOUND:
Sound may be described in terms of physical as well as psychological phenomena. I.e. a series of disturbances of molecules within an elastic medium and an auditory experience- hearing something, respectively.
Sound is generated by vibration and is carried through the air around us in form of pressure waves. Only when these waves strike the ear that hearing takes place.
Human reactions to sound are psychological and reflect such subjective experiences as pitch, loudness, sound quality and ability to tell the direction of the sound source. The range of human ear is very great and so the unit called “ decibel (dB)” is used for intensity.

Airborne sounds are measured by devices called Sound Level Meters as concern over noise pollution grows SLMs are useful in the study of acoustics in industry and environment.
All sounds that normal hearing persons may hear without discomfort can be found in the range form: threshold of audibility to threshold of discomfort.



The approximations can be determined with the help of the following table
0dB: just audible sound
10dB: soft rustle of leaves
20dB: whisper at 4ft
30dB: gurgling of a stream
40dB: night noises in the city (threshold or outskirts of city)
50dB: quiet automobile 10ft away
60-70dB: normal conversation at 3ft
80dB: heavy traffic/ loud telephone rings
90dB: pneumatic drill 10ft away
100-110dB: oil tanker explosion few ft away
120dB: A blaring stereo close by (1ft)./ aeroplane flying (near airports)





Noise Induced hearing loss (NIHL)
The industrial Revolution’s introduction of high noise levels brought a greater threat to the human auditory system than evolution had prepared for. In some cases hearing losses may result from brief exposure to high-level sounds, with subsequent partial or complete recovery (temporary hearing threshold shift). In other cases repeated exposure to high-level sounds result in permanent hearing impairment (permanent hearing threshold shift). According to studies hearing loss may be due to biological changes in the sensory cells (of the inner ear), physical dislodging of hair cells during hyper acoustic stimulation, changes in the cochlear blood supply, loss of outer hair cells, rupture of Reissner’s membrane, or detachment of the organ of corti from the basilar membrane.
Acoustic trauma indicates NIHL from impulsive sounds such as explosions.
Exposure to jet engines, drop forges, pneumatic hammers, subways, rock music, and even computers has been documented to be causing hearing loss.



Hearing conservation program (HCP):
1 identifies people who are at risk for NIHL
2 abates dangerous noise levels as economically as possible
3 protects employees who are at-risk for NIHL. (use of protective hearing devices such as ear muffs or ear plugs)

4 periodic hearing examinations a must.
5 setting regulations for the society (deadlines for loudspeakers)

importance of the awareness: many persons effected usally are unaware of the hearing losses caused due to noise exposure. By the time they do, severe communicative difficulties also set in, thus effecting the person overall.


Bottom line: Take care of your ears before it is too late. Hearing aids of even the best technological advantage cannot replicate the human ear.
PREVENTION IS ALWAYS BETTER THAN CURE.


hearing conservation program



what should you do?

many a times i hear from my clients who tell me "had we known earlier we could have done better for our child...". Unfortunately by the time ppl realise their child has a problem (in this topic- HEARING IMPAIRMENT {HI}) its usually too late. This is because, every child has a 'critical period' for speech-language development. In a gist following are the typical milestones:

(for parents and child health practitioners.)
Early response to be looked for:
Birth – 2 months → startling response to loud sounds
2months – 6months → eye movements to sounds
6months – 12 months → head turning response to sounds, human voice
> 12 months → child babbles mama…baba… etc.
1½ years → single meaningful words
2½ years → 2- word phrases (“mama give”; “give ball”)
3 years and above → meaningful simple sentences (“mama give ball”)



Very often in todays times it is seen that both parents pursue careers and at such times the child is left in the care of day care centres (usually household ones). By the time the mother returns she gets busy with the housework and this routine continues. Ther child may occasionally respond to lod door banging or high volumes, loud name call or rock music. In such cases the parents may not suspect anything amiss in the child. Its usually when the child is about 3 yrs old and admitted to a school that teachers usually point out the facts to parents.



Then follows a series of doctor shopping and different reactions from parents... Denial, Anger, guilt etc. By the time parents accept the fact that their child is hearing impaired and needs to wear a hearing -Aid throughout his life its almost another yr which passes along.



The main goal of writing this article is to make the parents aware as to what they can do once hearing loss is suspected.

• Visit the nearest ENT &/ Audiologist. The tests usually performed are : Pure Tone Audiometry (for children above 3yrs), Behavioral Observation Audiometry (BOA), VIsual response Audiometry(VRA). If these tests cant get to a conclusion then a BERA is recommended to arrive at a final conclusion.


• Based on the type and severity of the hearing loss
  (pls ask the audiologist to give u the details of the problem), different options are recommended to the parents.


• the options include, fitting of hearing aid/s, or the recent Cochlear Implantation. The latter is very expensive and one needs to consult the concerned profesional regarding the details (Hinduja Hospital in Mumbai).


• if Hearing Aid/s need to be fitted then the moulds have to be made first. These are very important for adequate benefits of the aid and to prevent the loss of amplified sounds.


• this should be followed by trials of different aids (based on power and company). Avoid buying aids without a trial.


• once the fitting is done auditory training begins along with speech-language therapy. As far as possible visit a qualified speech therapist near ur area. Their information is usually available with the ENT or local hospitals.


• Schooling type (regular or special school) depends on a lot of factors and should be decided along with the speech therapist and the Special Educator for the Hearing Impaired.

A very Important point here is to remember: In rehabilitation the child rides a bicycle. The front wheel is the rehab team member and the back wheel with a hub is the parent. Unless the back wheel moves the front will not move!

i await readers comments and suggestions.

{look ahead for further information and links on hearing aids}

reply to comments

i'll definitely answer ur concerns in the privious post. As for adopting a child u need to contact the Registered agencies. THey have different criteria and norms which u ve to fullfill irrespective of whom u want to adopt. As for using the word "special" , it stands for "the specially abled" U seem to have suffered too so u must understand the term better.U are correct about the society. It doesnt accept the specially abled infact creates trouble for them...... be it at pre-school, school or vocational level. Once in my clinic i had organised a grooup schedule for a homogenous group of my clentele. U'll be surprised to know that parents who had another "normal" child refused to get them to participate with the selected group. Charity begins at home isnt it? Such changes which we expect from the society ahoud begin in the homes of the effected individuals.