The National Association of Neonatal Therapists (NANT) is an organization created specifically for neonatal occupational therapists, physical therapists, and speech-language pathologists. NANT provides multiple ways for neonatal therapists to connect, learn, mentor and inspire while advancing this focused field of therapy on a national level.
By Laura Madlinger-Lewis January 27, 2015
Neonatal brachial plexus palsy (NBPP) is a condition that warrants early evaluation and treatment by a neonatal therapist. Infants with NBPP are often seen by a therapist in the NICU, and then referred to therapy as outpatients, and possibly to a specialized brachial plexus clinic. In addition to motor and sensory deficits in the affected upper extremity, other conditions associated with NBPP include phrenic nerve palsy, facial nerve palsy, developmental disability, torticollis, and skeletal fractures.
Researchers at the University of Michigan also anecdotally observed a higher prevalence of language delay in children ages 24-36 months with NBPP than in the general population. However, this observation was not previously reported in the literature. Therefore, the researchers conducted a cross-sectional pilot study to investigate the prevalence of language delay in this population. The Preschool Language Scale 4th Edition was administered to 20 toddlers with NBPP. Children with biological or physical risk factors for language delay were excluded from recruitment. To control for additional factors that could potentially affect language development, parents of children participating in the study completed a questionnaire regarding demographics and socioeconomic status. Researchers found that 30% of the study participants had language delay, compared to 5-15% in the general population.
While this study does not aim to discover a causal relationship between NBPP and early language delay, researchers did offer possible explanations that could be explored further. Altered limb preference due to NBPP could potentially affect language lateralization. Additionally, hand gesturing is important for language development, and children with NBPP may have difficulty using their affected hand to communicate.
Although this study had a small sample size, the results raise questions with regard to appropriate follow up for children with NBPP. Study authors cited routine language screening for toddlers with NBPP at 12, 24, and 36 months as a potential mechanism for early identification of language delay.
As neonatal therapists, we can consider advocating for NBPP to be diagnostic criterion for being monitored in NICU follow up clinic, as well as educate families and other health professionals on these study findings.
Below is a link to the abstract for the study, as well as information for accessing the full text article.
Chang, KW, Yang, LJ, Driver, L., & Nelson, V. (2014). High prevalence of early language delay exists among toddlers with neonatal brachial plexus palsy. Pediatric Neurology, 51, 384-389.
By Sue Ludwig January 20, 2015