IFCP had published articles on squint and immature retina written by Dr BV Rao and Dr Subhadra Jalia respectively in previous issues. These articles created tremendous awareness regarding prevention or worsening of visual problems. In the series of such articles, herewith IFCP is publishing an article on another associated problems seen often in children with cerebral palsy. this article would educate the readers about normal speech generation and how it becomes abnormal following damage to immature brain i.e. in children with cerebral palsy. The important reason to publish this article is o help parents to understand speech therapy which IFCP would publish in coming issues. Kindly refer IFCP Vol.5, No.1 for an article on normal development of speech.

Children with cerebral palsy manifest a high incidence of speech and communication disorders. The difficulties the children with cerebral palsy have in generating an intelligible speech is described currently by the term DEVELOPMENTAL DYSARTHRIA.

Developmental Dysarthria has been described as a disability in producing the speech due to some dysfunction of the neuromotor or neuro muscular systems or both. The severity of the developmental dysarthria depends on the severity of the involvement of the speech producing musculature.

Speech is a complex physiological process. It involves integration of various systems. The entire process involves the five principle systems :

The respiratory system consisting of the lungs, ribcage, diaphragm and the windpipe

The phonatory/laryngeal system - consisting of the larynx or the voice box and the thin vibrating membrance or the vocal folds

The articulatory system - consisting of the oral cavity and the lips, tongue, jaw, palate etc

The air pushed from the lungs to the vocal tract during exhalation causes the vibration of the vocal folds in the larynx/voice box and generates the voice.

The voice, thus generated is further modified into different speech sounds by the configuration of the articulators

The velopharynx either joints or separates the oral and nasal cavities so that the air passes through the oral or nasal cavities, and adds the resonance quality to the speech sounds.

This entire process is controlled by the nervous system. Impairment in any of these systems may result in an inability to produce adequate speech.

As a result of the abnormal breathing patterns, the children may speak at the end of exhalation portion of a breathing cycle, result in in short, choppy speech.

Or, they may have long pauses at inappropriate times while talking. These problems, in turn, affect the rate and prosody of speech.

Additionally, these children may have difficulties in coordinating breathing with phonation.

Difficulty in initiating phonation due to spasm that holds the vocal folds together

The children with cerebral palsy frequently have a delayed or deviant articulatory patterns which interfere significantly with speech intelligibility. This happens because articulation requires rapid, coordinated movements of the tongue and lips, in conjunction with normal breathing and phonatory processes. Although the specific articulation problems are directly related to the type of cerebral palsy and more precisely to the site of neurological damage, the severity of the motor dysfunction influences the severity of the articulatory impairment.

Thus, there is no one pattern of speech disability in children with cerebral palsy should begin as early as possible in order to capitalize on the developmental period when the speech and language learning is naturally quite rapid. Readers to Note : IFCP invites questions and comments on this article

IFCP will publish articles on simple methods to improve speech dysfunctions in the next issues.