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 create issues such as dysarthria, disfluency and poor voice control. It isn’t only about muscles and muscle coordination. Being able to identify all the causes of speech delays and difficulties means better treatment and better results.
I have had the privilege 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.
It is more difficult to clearly differentiate low muscle tone from hypermobile joints in young children. Assessing the youngest clients that cannot be interviewed and do not follow instructions carefully (or at all!) is 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. 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. A vicious cycle ensues, creating more weakness, instability and more difficulties with motor control.
Some 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 or generalized benign joint hypermobility syndrome. They often drop the final sounds in a word, or their voice fades away at the end of a sentence when they are younger. These kids might avoid reading or speaking front of the class when older. This isn’t social anxiety or an attitude problem. They are struggling to achieve and maintain the carefully graded control needed for these speech skills.
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 aren’t always 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: game over.
If your child is struggling with these issues and isn’t receiving speech therapy, now may be the time to explore it. You and your child may be relieved to learn that there is effective therapy out there!