As a pediatric OT, many of my clients have speech and feeding problems that are attributed to low muscle tone. Very often, that is where assessment ends. Perhaps it shouldn’t. Joint hypermobility can also create issues such as dysarthria, disfluency and poor voice/breath control. It isn’t only about oral muscles and muscle coordination for feeding. Being able to identify all the causes of speech delays and difficulties means better treatment and better results.
I have had the privilege in my career to know a handful of master speech pathologists, whose manual evaluation skills are amazing. These clinicians are capable of identifying joint laxity and poor tissue integrity (which contribute to injury, weakness and instability) as well as identifying low muscle tone, sensory processing issues and dyspraxia. They can assess whole-body stability and control, instead of ending their assessment at the neck. Many of them have received a certificate in Neurodevelopmental Treatment, and use the letters C/NDT or others to indicate their training. I recommend that hypermobile adults and the parents of hypermobile children look on the NDT website to find a provider with this training. Because it is so comprehensive, it can be more helpful than PROMPT training to someone with generalized hypermobility. Sorry, PROMPT fans!!
It is sometimes difficult to clearly differentiate the origin of speech issues as coming from essential low muscle tone or from primarily hypermobile joints. Assessing the youngest clients means that they cannot be formally interviewed and do not follow instructions carefully (or at all!) in an assessment makes evaluation a challenge.
Many times we are forced to rely on observation and history as much as we use responses from direct interaction with a child. In truth, laxity and low tone often co-exist. Lax joints create overstretched or poorly aligned muscles that don’t contract effectively. You can have muscle dysfunction with normal muscle tone. Low muscle tone doesn’t support joints effectively to achieve and maintain stability, creating a risk for overstretching ligaments and injuring both tendons and joint capsules. Kids who start out able to speak intelligibly can fatigue by the end of a sentence. A vicious cycle ensues, creating more weakness, instability and more difficulties with motor control.
Some of the children that are diagnosed with flaccid dysarthria, poor suck/swallow/breathe synchrony, phonological issues and poor respiratory control may be diagnosed later in life (sometimes decades later) as having Ehlers-Danlos syndrome (EDS) or generalized benign joint hypermobility syndrome. What is that? Read Is Benign Joint Hypermobility Syndrome (BJHS) All That Benign?. They often drop the final sounds in a word, or their voice fades away at the end of a sentence. These kids might avoid reading or speaking front of the class or with friends. This isn’t from social anxiety or an oppositional attitude problem. They are struggling to achieve and maintain the carefully graded control needed for these speech skills.
Finally, issues with instability of the cervical vertebrae and instability/ligament laxity in the region of the lower brainstem as it sits on top of the spinal cord can cause issues with oral motor control and speech. Dysarthria and dysphagia can be related to AAI and CCI. They can cause a syndrome known as POTS. If your child complains of visual symptoms and headaches in addition to speech or swallowing problems, please consult a neurologist to be sure that they do not have these rare but important co-morbidities of EDS.
You may notice a breathy-ness to their voice that makes them sound more like their grandparents than their peers. Children that avoid running in sports like soccer or hockey may be unable to continue because they are globally fatigued or in pain. Being unable to stabilize their trunk results in inefficient muscular recruitment and limited grading of breath. Ask any runner or singer and they will tell you what that means: nothing they do has the right results. This is where finding skilled therapy is essential.
If your child is struggling with these issues and isn’t receiving speech therapy, now may be the time to explore it. A PROMPT-certified speech therapist may be especially helpful, as this specialized speech therapy treatment approach uses tactile and proprioceptive cues to learn the oral control needed for speech. Your PT or OT can help address the breath control strategies, but learning to use them in speech often requires coordinating this with the training of a speech language pathologist. You and your child may be relieved to learn that there is effective therapy out there!
Looking for more information on hypermobility I wrote 2 books for you!
The JointSmart Child: Living and Thriving With Hypermobility Volume One: The Early Years is finally available on Amazon.com as a read-only download OR a paperback, and on Your Therapy Source as a printable and click-able download.
Volume One is a practical guide that emphasizes building safety and independence in infants, toddlers, and preschoolers right from the start! Parents learn how to select the right equipment, offer support and assistance that teaches safe movement, and builds a child’s confidence every step of the way. There are even chapters to improve a parent’s communication effectiveness with babysitters, family members, teachers and doctors. Read Parents of Young Hypermobile Children (and Their Therapists) Finally Get Their Empowerment Manual! to learn more today!
The JointSmart Child: Living and Thriving With Hypermobility Volume Two: The School Years is even more comprehensive, addressing school, sports, and even playing a musical instrument while dealing with hypermobility. There are chapters on picking the right chair, desk, bike, and the right pencils to make life easier and safer for kids 6-12. The appendix includes forms that parents can bring to IEP meetings, give to baby-sitters and forms to organize their thoughts before medical appointments. Therapists can use the same materials for their home programs or for professional trainings in their facility or their school. Read more about this new book here: Parents and Therapists of Hypermobile School-Age Kids Finally Have a Practical Guidebook!
Both books are available now on Amazon as and on Your Therapy Source .
Don’t have a kindle?
Not a problem; it is easy to download it from Amazon onto your phone or iPad!
Is your child struggling with toilet training? I wrote another book just for YOU!
The Practical Guide to Toilet Training Your Child With Low Tone is available on Amazon and Your Therapy Source. I looked far and wide for resources to help the families I work with as an OT. There wasn’t anything out there that explained why kids and parents find this skill so hard to achieve, so I had to do something to help the situation. When parents understand the underlying sensory and behavioral complications of low tone, they can make real progress with potty training!