I wasn't saying we are permanently reinforcing incorrect motor patterns
by not treating early, but perhaps we are restricting the amount of
motor cortex devoted to the tongue if its' mobility is restricted past
the point of neuronal pruning... I have seen people of all ages benefit
from speech therapy, so truly believe plasticity continues, but at a
lower level than the huge plasticity of the newborn. Young children with
Rasmussen's encephalopathy can have a hemispherectomy (removal of half
the brain) with surprisingly few consequences. Just a few years later,
the associated deficits can be much more severe.
So far there are two studies that show tt adults use different tongue
movements to achieve the same sounds, one in an Indian journal, the
other in a Polish one. I wonder if these are more effortful, like the
compensatory sucking movements we see in bf infants with tt.
Compensation is not a bad thing unless it provides a poor basis for
future skills or increases effort and decreases effectiveness. We see
sucking compensations CAN do both.
I agree, Laura, we need lots more research to untangle all this.
Catherine Watson Genna BS, IBCLC NYC cwgenna.com
On 4/29/2011 2:52 AM, Laura Wasielewski wrote:
>
> One more random story I want to throw out there, in response to Cathy Genna's commentary on neurological hard wiring and the thought that perhaps we are permanently reinforcing incorrect motor patterns by *not* clipping early (which theoretically makes perfect sense and does seem to correlate to many LCs experiences of a baby having a hard time figuring out how to "use" his tongue after getting it clipped): My first year as a licensed SLP I worked in an elementary school. One of my students was a 9 year old with Down Syndrome and a pretty significant type 1 tt. Lingual elevation was very restricted and he had the classic "w" for "l", etc. About one month into the school year his mother asked me if I thought she should get his tongue clipped. We talked about the potential costs and benefits. I expressed my reservations that he was already 9 years old and had cognitive deficits and his motor speech programs were probably pretty ingrained at this point so even if his tongue were "freed" he might continue to have difficulty with correct tongue placement for speech sounds. This mom felt like she didn't have anything to lose per se and decided to go ahead with the surgery. Well, I about fell out of my chair when one week post surgery this kid starts saying the /l/ sound in the initial position of short words. He couldn't even repeat an /l/ by itself before the surgery. He did progress more slowly than some of the other kiddos people have described on lactnet but he definitely made huge strides that I am sure he wouldn't have if his tongue wasn't clipped. SO even at that age and with less than ideal cognition there was still enough plasticity somewhere in the system to allow him to make those sounds appropriately once he was able. Human beings are pretty amazing creatures, huh?
>
> This SLP, for one, does NOT know it all and is really grateful for this amazing community to hash out these problems with and compare notes on various experiences!
>
> Laura Wasielewski MS, CCC-SLP, IBCLC
> Los Angeles, CA
>
>
> ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet welcome
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
