1. SPEECH AND LANGUAGE PATHOLOGY IN PREMATURITY Ramin Mohseni Speech and Language pathologist ra_mohseni@yahoo.com December 2014

2. I NTRODUCTION  Speech & Language Pathology is the science of assessment, therapy and consultant of speech, language & swallowing disorders.  It related with: _ Neurology _ ENT _ Pediatric _ Psychology _ NICU/ICU

3. I MPORTANT FACTORS IN SPEECH :  Brain  Hearing  Breathing  Phonation  Resonation  Articulation

4. I NTRODUCTION Prematurity : Defined by some according to birth weight under approximately 5.5 pounds or age being born before 37 weeks of gestation A premature infant’s organs are not fully developed. Infants usually cannot coordinate sucking and swallowing before 34 weeks gestation. Prematurity can have long – term effects.

5. I NTRODUCTION They have medical, developmental, or behavioral problems A premature baby may have feeding tube. In United States %8.2 In Iran %9.6-%11.8

6. P REMATURE INFANTS ARE AT RISK OF : Feeding & Swallowing Disorders Congenital Disorders Neurological Disorders Developmental Disorders Long- Term Psychological and Social problems Dysfunction at school

7. S WALLOWING Swallowing involves coordination of the sequence of activation and inhibition for more than 25 pairs of muscles in the mouth, pharynx, larynx, and esophagus.

8. S WALLOWING Normal swallowing : 1. Oral Preparatory Phase 2. Oral Phase 3. Pharyngeal Phase 4. Esophageal Phase

9. S WALLOWING Oral reflexes: ( is essential information for clinicians working with newborns and infants in their first year of life who swallowing problems)  Rooting reflex (0 - 6m)  Sucking ref. (0 - 12m)  Bite ref. (0 – 12m)  Tongue ref. (0 – 18m)  Swallowing ref. (0 up to end of life )  Gag ref. (0 up to end of life ) The presence or absence of specific primitive reflexes can indicate a infant’s neurological stability and potential for swallowing disorders.

10. F EEDING DEVELOPMENTS : 1. Suckling 2. Sucking 3. Transitional Feeding Period 4. Munching 5. Chewing

11. S WALLOWING Problems feeding : Trouble sucking Premature spillage Coordinating swallowing and breathing (Problem in Oral-Motor Movement ) o The premature infant’s underdeveloped lungs and airway can add life-threatening complications. o Newborns with respiratory problems have greater risk for swallowing problems, and newborns with swallowing problems have greater risk for respiratory problems.

12. S WALLOWING Problems feeding : Poor Intake Fatigue with Feeding Delayed Feeding Skills Lower of oral motor skills Hyper Sensitivity

13. C ONGENITAL D ISORDERS Clefts of the lip and palate (Cause of swallowing problems)

14. N EUROLOGICAL D ISORDERS Central Nervous System is not fully prepared to function because of:  Smaller hippocampus  Lower gray-to-white-matter ratio  Smaller cerebellum

15. N EUROLOGICAL D ISORDERS  Cerebral palsy(Spastic diplegia)  Brain Damage  Intraventricular Hemorrhage (IVH)  Mental retardation  Hearing Loss  Visual Impairment  Hydrocephalus

16. D EVELOPMENTAL D ISORDERS :  Perceptual & Cognitive Development  Language Development  Motor Development

17. P ERCEPTUAL D EVELOPMENT Maturation of the brain determine infants’ abilities to perceive and produce sound Speech perception refers to infants’ attention to phonemes, rhythm, prosody, and lexical features The first step of perceptual development is mothers’ sound distinguish than other sounds

18. C OGNITIVE D EVELOPMENT Abstract reasoning Judgment Problem solving

19. L ANGUAGE D EVELOPMENT IN NORMAL CHILDREN : Communication Skills: Auditory System Visual System Verbal Symbolic System Speech Production: Academic Learning Social Communication

20. P REVERBAL STAGES OF DEVELOPMENTS : Basic biological noises (0-2 month) Cooing & Laughing (1-4 month) Vocal Play (3-8 month) Babbling (5-10 month) Melodic Utterance (9-18 month)

21. L ANGUAGE D EVELOPMENT Assess receptive language skills Assess expressive language skills Assess articulation skills

22. S PEECH & L ANGUAGE D IFFICULTIES :  Impaired verbal comprehension skills  Absence of words by age 18 mounts  Absence of meaningful two word phrases by age 2 years  Echolalia  Poor speech intelligibility  Word – finding  Short – term memory skills  Delayed development of play skills  Developmental apraxia of speech  Tendency toward development of LD

23. M OTOR D EVELOPMENTS : Delay in areas of gross to fine motor

24. S CHOOL F UNCTION (LD): Problem in Reading Problem in Mathematics Deficit in Spelling Lower Academic Achievement Poorer Functional Performance

25. LANGUAGE DISORDER I NTERVENTION : o Early intervention program. o Provide language development activities. o Work with parents, caregivers, and teachers to provide language development activities.

26. C ONCLUSION :  Referring time  Role of speech and language pathologist  Family and Caregivers  Teamwork