Speech, language and swallowing difficulties in a child with aids

Figures & data

Table 1. Findings of oral mechanism examination.

Oral structure	Structure	Function
Lips	Normal symmetry	Restricted lip movements during puckering and retraction; reduced range and speed of movement; seal was affected
Tongue	Normal	Restricted protrusion, elevation and lateral movements; reduced range and speed of movement
Teeth	Most of the teeth were decayed except for one canine tooth on the upper jaw (right side)	Inadequate biting and chewing abilities; attempts to use intact canine tooth for biting
Velum	Normal	Reduced movement (on phonation)
Hard palate	Normal
Jaw	Normal symmetry	Reduced strength, range and speed of movement

Table 2. Assessment of different subsystems involved in speech production.

Sub-systems	Findings
Respiratory system	The child exhibited shallow breathing pattern with poor respiratory control for speech production. Mouth breathing was observed at times
Phonatory system	Perceptually the child had deviant habitual pitch; he could sustain phonation to a maximum of 1–2 s
Resonatory system	The child had severe hypernasality as perceived
Articulatory system	The child could attempt near accurate place of articulation, but manner of articulation was severely affected; speech intelligibility and acceptability were observed to be poor
Prosody	The child’s prosody was found to be disrupted due to monotony with restricted pitch and loudness variations; restricted stress and intonation patterns in his expressive speech was noted

Table 3. Description of language skills.

Language component	Reception	Expression
Semantics	The child’s lexicon consisted of basic lexical categories consisting of commonly used nouns and verbs	His expression was limited to simple gestures denoting his lexicon
Syntax	The child comprehended simple to complex sentences comprising of grammatical structures of varied complexity	He expressed his needs through pointing, dragging the person towards the object of interest, crying and bisyllabic words (poor intelligibility)
Phonology	Phonological awareness of most of the sounds was achieved. Phoneme discrimination (auditory) was achieved	The child’s phonetic repertoire consisted of all vowels and few consonants (bilabials and labiodentals) accompanied with severe hypernasality

Pragmatics: child had good eye contact and contextually appropriate social smile; his turn taking and topic initiation skills were poor and he was distracted easily.