IMPROVING CHILDREN’S HEARING AND SPEECH
The speech/language pathology programs at Riley Hospital for Children at Indiana University Health include a variety of services to help children with communication and feeding difficulties:
- Speech/language evaluation and treatment
- Voice and resonance evaluation and treatment
- Outpatient feeding evaluation and treatment
- Videofluoroscopic swallow studies
- Augmentative and alternative communication program
- Inpatient services
Speech/language evaluation and treatment at Riley Hospital for Children at IU Health helps children who have difficulty with a variety of aspects of communication. For example, a child with an articulation disorder may have difficulty saying their speech sounds correctly. A child with a language disorder may have trouble understanding others or have difficulty communicating their thoughts and ideas.
A speech/language evaluation begins with an interview of the child’s family to determine specific concerns and goals. A play-based assessment often follows. We also perform standardized testing, which involves having the child engage in various activities, such as looking at books. These tests allow us to compare the child’s skills with those of other children their age. We then share our findings and recommendations with the family. We also share recommendations with primary care physicians and community therapists, as needed.
Children who come to the program for assessment include those with a wide spectrum of possible causes for delays in speech and language acquisition. These causes include:
- Cerebral palsy
- Down’s syndrome
- Hearing loss
- Childhood apraxia (in which signals from the brain to the mouth are disrupted)
- Developmental delays
- Fluency disorders (for example, stuttering)
- Receptive and expressive language disorders (difficulty understanding and/or responding to others)
- Articulation disorders (inability to form certain sounds correctly; for example, lisping or substituting sounds)
Treatment is usually given in once-a-week sessions, ideally with parents present. This way parents can observe the speech pathologist’s techniques and apply them at home as appropriate.
Our speech pathologists are extensively trained and experienced with even rare speech and language problems. Families from all parts of Indiana bring their children to us for assessment and treatment. For children who don’t live in the Indianapolis area, speech pathologists work with local doctors, therapists and teachers to help children overcome their speech and language problems.
Voice evaluations and treatment at Riley at IU Health help children who have voice issues, such as hoarseness. Often, these issues occur because a child misuses their voice (for example yelling or talking in silly voices). Treatment involves re-teaching the child how to breathe and talk in a way that is easier on their voice. We often perform voice evaluations after the child has seen an ear, nose and throat doctor to rule out any medical issues.
Another disorder we frequently treat is called “vocal cord dysfunction.” This problem occurs when the vocal folds move in the wrong direction while breathing and can cause the child to feel it is difficult to get air in. Treatment involves working with the child to identify new breathing patterns to keep the airway open.
Resonance evaluation and treatment at Riley at IU Health helps children who have difficulty balancing the flow of air between the nose and mouth during speech. Sometimes, a child will have too much airflow from the nose, which can make it difficult for people to understand their speech. The most common causes for such a problem are a cleft palate or another cranialfacial anomaly.
Treatment for resonance disorders involves working as part of a team with other medical professionals. Speech therapy can teach the child how to correctly make sounds but cannot fix any structural issues. At times, we need to perform instrumental assessments to see the muscles of the throat and palate in order to help coordinate treatment with the child’s doctor.
We treat a large number and variety of patients. Our team’s extensive experience gives us the ability to treat even rare disorders effectively.
The goal of outpatient feeding evaluation and treatment at Riley at IU Health is to help children become better eaters. Using a wide range of techniques, the team develops personalized treatment plans with a schedule of therapy sessions that may range from once or twice a week to once a month.
Children come to us with a variety of problems:
- Oral motor delays - lack of skills for biting, chewing and managing food and drink
- Food refusal - refusal to eat certain foods or to eat at all
- Texture aversion - dislike of or refusal to eat foods with certain textures
- Dysphagia - a disorder that causes difficulty swallowing or inability to swallow
- Reduced or limited intake - eating an inadequate amount of food
We also provide meal structuring, which helps families provide the right foods on an appropriate schedule.
Often children referred to our program have been on a feeding tube for long periods of time. Having been accustomed to acquiring nutrition without eating, these children need to learn to manage food. They may lack eating skills or have aversions to eating.
Children who can benefit from this therapy range from birth to the teenage years. In all cases, educating parents is a substantial part of therapy. Parents attend all therapy sessions and learn the techniques used to help their children acquire appropriate eating skills.
Our outpatient feeding evaluation and treatment program is a major resource for children throughout Indiana who have feeding disorders. Because the team evaluates and treats children from all over the state, we often see and treat even the most difficult cases.
Children with difficulty swallowing may need an X-ray to help diagnose their swallowing problems. A child with this problem is referred for a videofluoroscopic swallow study at Riley at IU Health. This study uses an X-ray to observe directly the act of swallowing within the patient. With this information, the speech pathologist can determine:
- How the muscles of the mouth and throat work while swallowing
- If the food or liquid is going into the airway instead of the stomach
- What foods or liquids might be the safest to swallow
When children have difficulty talking, augmentative and alternative communication at Riley at IU Health can provide a means for them to communicate without speech. Children who are likely candidates for this communication assistance can be those with:
- Cerebral palsy
- Hearing impairment
- Down’s syndrome
- Cognitive impairments
- Various other congenital syndromes
- Traumatic brain injury
Ages for children who can benefit from augmentative and alternative communication range from birth to 18 years. To accommodate this wide range of ages, we can use a variety of communication tools, including:
- Binders and arrays of symbols or pictures (even very young children can point to the objects and actions they want to communicate)
- Sign language
- Communication boards (these display arrays of symbols and are customized to each child’s needs)
- Voice generation
For children using communication boards, pointing is often the means by which they use the board. Some children, however, cannot point. For these children it is possible to use eye-gaze technology that recognizes which symbol the child is selecting. Another technology used with children who cannot point is a button system, in which the child presses one button to scan the symbols and a second button to select a symbol.
Augmentative and alternative communication methods can become permanent adaptations or be used to augment communication while children work to improve their language and speech skills. Research has shown that augmentative communication does not inhibit language and speech acquisition, and can actually help children develop better communication skills.
Children are often referred from throughout Indiana to our program to be assessed for possible therapy in augmentative and alternative communication. Because we have a variety of communication devices to aid in evaluation, this helps narrow down particular needs and provide appropriate therapy methods.
Children admitted to the hospital may have difficulty with their speech or swallowing due to a variety of medical diagnoses, including:
- Premature birth
- Acute respiratory problems
- Refusal to eat or aversion to eating or drinking
- Heart defects that cause difficulty coordinating breathing, language and swallowing
- Developmental delays caused by such conditions as cerebral palsy and Down’s syndrome
- Difficulty gaining weight
Sometimes children are in the hospital for only a short time. In these cases, our assessment is followed by instructions to parents, primary care physicians and local therapists to enable them to continue helping the child to learn normal swallowing and speech.
Our extensive experience with inpatient services is unique in Indiana. Children are referred here from all over the state, often with disorders that other hospitals see infrequently.