Parents understandably want their child not only to be able to understand them, but to be able to communicate with them too. Interaction is fundamental to humanity, - in a way I think it defines who and what we are. We are the only species which uses the symbolism of language and when a human being cannot, it causes immense distress. So why does the language and communication development of children with cerebral palsy so often fail? Let's examine some of the major reasons.
(1). Many difficulties with the development of language and communication begin very early on, when the parents bring the child home from hospital after birth. The parents being so weighed down by the worry and the crippling stress of having to cope with their child's unexpected problems and reeling from the shock of being informed that their child has this problem known as 'cerebral palsy,' do not then interact with their child as they would have done had he been an uninjured baby. They may miss the communicative signals given out by the child and may not supply baby with input appropriate to the development of language. This is no fault of the parents, who are invariably doing a heroic job in caring for their baby's needs and helping him to survive despite sometimes overwhelming difficulties; - it is merely a set of circumstances produced by the extremely stressful situation in which the parents find themselves.
So, having missed the early communicative opportunities provided by normal parent – child interactions, baby's language and communicative skills fail to develop. Instead, baby sometimes completely fails to develop a communicative understanding with Mum and Dad, with the consequence that an understanding of language fails to develop. In the absence of an understanding of language, the child also fails to produce language. In other cases, where some appropriate but incomplete interaction has taken place between parents and baby, a partial understanding of language develops, with little or no production of language.
Another reason for the failure of language to develop is because the child is experiencing sensory distortions. The brain injury which produces what we understand as cerebral palsy can adversely affect the functioning of several structures within the brain, which are responsible for the processing of incoming sensory information from the environment. Obviously we all know that successful language development is dependent upon successful auditory development, quite simply if the child's ability to process sound is poor, then his language development will be poor. - If his ability to process sounds is non – existent, his language development is likely to be non existent. It is quite simply a matter of successful sensory reception leading to successful motor output (language is an output skill after all). - In other words it is a sensory – motor loop, the successful development of the motor part of the loop being dependent upon the successful development of the sensory part of the loop. So if we have a child who hears nothing, we are likely to face NINO situation (Nothing in – nothing out), or if we have a child who is experiencing sensory distrotions, whose hearing is hypersensitive, or hyposensitive, or who is experiencing difficulties in regulating his auditory attention, we could well be facing a CICO situation, (Chaos in, - chaos out).
The third factor which will affect language development is direct injury to the left hemisphere of the cortex, around the regions known as Wernicke's area (responsible for our ability to understand language) and Broca's area, (responsible for our ability to produce language). The connotations for injury in these areas is obvious and does not need to be discussed in depth here.
When a child suffers a brain injury, invariably the ability of his brain to process information is slowed down. As a consequence he may simply not be able to process the content of meaning of of interaction quickly enough and if he does, he might be unable to respond quickly enough. This can be very frustrating for a child who is desperately attempting to interact as he quite simply keeps missing his turn and as a consequence, in frustration he may simply stop trying.
The question is, what can we do to assist the language development of the child with cerebral palsy, or other types of brain dysfunction, such as autism, dyspraxia, learning difficulties and specific language impairment?
What we do is to treat these four major factors sequentially.
First of all, we take parents and their child back to the patterns of initial interaction, which they have possibly missed. We teach parents to look for communicative signals given by their child and we teach them how to respond to those signals in order to give encouragement to their child to repeat them and to further expand them. Very often, these simple procedures can 'kick start' language development and we can then guide the child through the next stages.
Secondly we address any sensory distortions the child might be experiencing. This might mean the construction of an 'adapted developmental environment' as a temporary measure in order that we might train the parts of the brain which are responsible for sensory processing to 're-tune' their activity to a more normal level. Again this can often provide a boost to language development.
The third problem, which involves direct injury to the areas of the brain involved with language comprehension and production can be more problematic, but is certainly not hopeless. The reason these areas of the brain are not functioning correctly is the fact that out of the millions of neural networks involved with these functions have lost cells due to injury. Therefore individual networks are operating without their full complement of brain cells. The effect of this is that they operate less efficiently and language comprehension and production is constrained. We can however use stimulatory techniques to train these networks to operate more efficiently and can utilise the concept of sprouting (dendrites forming new connections, thereby enhancing neural network funtion), and the concept of neurogenesis (the production of new brain cells), in order to encourage neural networks to recruit new cells.
The final problem, the one of slower speed of processing is perhaps the most easily addressed. Quite simply, children must be given more time to process information, more time to plan a response and more time to respond. In this way they will not miss their turn in an interaction and will not withdraw into themselves in frustration at their failure.
If your child has issues with language and communication, or indeed if you are an adult who has suffered a brain injury and you are interested in Snowdrop's approach to treating language and communication difficulties, go to our website at http://www.snowdropcerebralpalsyandautism where you will find our contact details.
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