Brain injury due to hypoxic-ischemic encephalopathy (HIE) is rarely confined to a simple area of the brain, though it is certainly possible in certain mild cases. Because oxygen deprivation affects the connections in the brain on a global level, it is often possible that children with HIE will have multiple interrelated delays in development.
Children with HIE can sometimes have delays in developing speech and language. These delays can sometimes be mitigated, while in other, more severe circumstances, children may remain non-verbal and require the use of alternative or augmentative communication (AAC) technologies to assist them in communicating their thoughts, needs, and desires. Developing a method for communicating helps these children interact with others, develop relationships, learn, work and socialize.
Speech and language are clearly highly inter-related, but they are not interchangeable. Speech refers to the physical act of expressing words and sounds, while language refers to communicating in a systematic and meaningful way. Because language is related to intelligence, disorders in language acquisition and expression are generally considered more serious than speech disorders. There are two broad categories of language disorders:
- Expressive language disorder: Relates to the ability to communicate meaning to others
- Receptive language disorder: Relates to the ability to understand someone else’s message
Language disorders can be expressive, receptive, or mixed receptive-expressive. The signs and symptoms of these disorders can vary depending on the type of disorder a child has:
Symptoms of Expressive Language Disorders
- Difficulty constructing grammatically correct or complex sentences
- Difficulty using standard grammar conventions
- Difficulty finding words
- Overuse of placeholder holders like ‘um’ or ‘uh’
- Smaller vocabulary than is age-appropriate
- Repetition of certain phrases
- Echoing of questions in responses
Symptoms of Receptive Language Disorders
- Difficulty understanding speech
- Difficulty following spoken direction
- Difficulty organizing thoughts
Speech Delays and Language Disorders Associated with HIE
There are several conditions that are common in certain children with HIE. These conditions can be improved via intensive speech-language pathology treatment, and can include:
- Aphasia (A disorder in understanding written or spoken language)
- Dyspraxia (Difficulty in physically pronouncing words) and Articulation disorders
- Dysprosody (Disorders in speech timing/cadence)
- Dysarthria (Abnormal facial muscle tone)
- Fluency Disorders (Stuttering)
- Dysphagia (Trouble swallowing or breathing, resulting in increased choking risk)
- Resonance Disorders (Abnormalities in the vocal tract)
When Should a Child Get Speech-Language Therapy?
If a child is not acquiring speech or language at the usual expected rate, it is recommended that parents work with the child’s pediatrician to have the child evaluated as soon as possible (during infancy or very early childhood). Sometimes, children may require some extra assistance or therapy to help them acquire language, or may need extra intervention in the case of concurrent developmental issues.
It is critical to make these diagnoses early so the child may be enrolled in an Early Intervention (Zero to Three, Head Start, Early On) program to mitigate some of the difficulties that may be associated with poor communication. These can include future academic struggles, emotional or behavioral problems associated with poor social interaction, and difficulties in occupational or psychological development. These programs are most effective when a child is very young, as beginning these programs at an older age will mean that the child must also take the extra step of unlearning old frameworks and developing new ones.
It is also worth noting that sometimes speech and/or language delays can result from hearing-related deficits, as hearing problems may make it appear that a child has a language or speech issue when they only require a hearing aid or medical intervention to get their speech and/or language development on track.
What Causes Speech Delays and Language Disorders?
Delays in speech and/or language can be due to several root causes. In some children, HIE-related speech/language disorders are due to damage to the part of the brain responsible for processing language, which can require a different approach from speech/language disorders arising from damage to parts of the brain that control the muscles of the throat, mouth and jaw (a common feature of cerebral palsy stemming from HIE).
A licensed speech-language therapist will be able to determine the best way to assist a child with a speech/language disorder, working with the child’s caregiver team of physicians, physical therapists, psychologists and social workers to help the child overcome cognitive or developmental difficulties that can make communication difficult.
Therapy for Speech Delays and Language Disorders
Usually, when a child is evaluated and found to have a speech or language disorder, they can be referred to a speech and language pathologist – an American Speech–Language–Hearing Association (ASHA)-certified professional (with a minimum of a Master’s degree in speech and language pathology) that helps individuals with difficulty communicating adapt and compensate to maximize their communication abilities. These professionals have training in pathology, audiology, anatomy and physiology, linguistics and phonetics, human development, and American Sign Language (ASL), among other courses, which allows them to effectively assist children with specialized developmental needs.
Parents seeking a speech-language pathologist for their children can request assistance at a variety of locations, as speech-language pathologists are often available at clinics, community health centers, hospitals, rehabilitation centers, public schools, nursing homes and state health departments. The location a child will receive care will depend on several factors, including:
- The child’s age
- The child’s medical history
- Availability of services in their community
- Whether insurance will cover care
Under ideal circumstances, children receive one-on-one services with additional exercises that they practice at home with parents outside of therapy sessions. In other circumstances, speech-language pathology services are provided in a small group setting as well. Sometimes, these services can be provided in a home setting without having to travel.
What Happens During Speech Language Therapy?
First and foremost, it is important to remember that each child is different, so the exercises that a speech-language pathologist may recommend may differ very substantially child-to-child. For children who are verbal, speech-language therapy can help children:
- Pronounce words more clearly
- Listen to and understand conversation
- Use words properly
- Understand grammar
- Have a bigger vocabulary
- Comprehend conversation
- Speak in complex sentences
- Speak conversationally
- Improve memory and recall
- Understand the differences and similarities between written text and spoken words
A speech-language pathologist will not only help the child physically form words needed for communication but will also develop a training regimen designed to help the child’s brain interpret and understand words, sounds, numbers and gestures.
Some children with HIE may be non-verbal. When working with children who are nonverbal, speech-language pathologists work with the child to create alternate communication strategies. These can include strategies such as sign language or the use of cue cards or picture boards, or they can be more technological in nature. Technological aids such as Alternate and Augmentative Communication (AAC) systems are often used; speech-language pathologists can help evaluate which systems would be most suited to a particular child’s abilities, preferences and cognitive abilities.
Additional Benefits of Speech-Language Therapy
Speech-language therapy revolves around the use of the muscles involved in the functioning of the throat, mouth and jaw. While communication is the primary goal of speech-language therapy, it often has the added benefit of helping children drink, eat, breathe and chew more effectively as well. Often, children with HIE who have cerebral palsy will have a degree of impairment in eating and drinking (dysphagia); speech-language pathologists can assist these children in improving complex muscle coordination. This decreases the risk that a child will aspirate their food (which can lead to choking and/or pneumonia), have abnormal breathing, increased coughing, dehydration or malnutrition.
Why is Speech-Language Therapy Important?
Communication is the underpinning of social interaction, which makes early intervention critical. Developing a communication system helps to ensure that the child will have frameworks in place for inclusion and socialization, allowing them to more fully engage with their surroundings, participate in activities in school or at home, learn new skills, and develop new hobbies or interests.
This therapy also increases the likelihood that other interventions will be effective. Because other types of therapies are dependent on the child’s ability to comprehend and follow instruction, speech-language therapy is a crucial part of a child’s multidisciplinary therapy regimen. Speech-language therapy supports learning, education, literacy, and community integration.
There are no risks to speech-language therapy. Indeed, delaying speech-language pathology can increase the risk of isolation or depression, and can mean that other areas of development (social, educational, psychological, etc.) may also slow without continued communication-related support.
Additional Speech and Language-Related Resources
- University of Michigan: Speech and Language Delay and Disorder Quick Reference
- What Does Normal Speech Acquisition Look Like?
- Speech Therapy: How it Works, What to Expect
- How Long Does it Take For Speech Therapy to Work?
- Apraxia of Speech: Understanding Apraxia
- Encyclopedia of Children’s Health: Language Delays
- A Parent’s Guide to Speech and Language Disorders
- What to Expect from Speech-Language Therapy
- Communication Development: A Parent’s Guide