CASE

Case

Case

Case scenario 3:

Clair is a term infant born to a mother aged 38 years. Clair was noted to have very poor muscle tone at delivery and was investigated. The diagnosis of Trisonomy 21 was made. The infant has no other abnormality relating to this condition other than slow to feed and poor muscle tone. You have noted the mother is detached from the infant. Discuss the management options you may be able to instigate to help Clair and her mother. In your discussion you will need to consider which other health professionals may be able to help in this situation in the short and long term.

Multi disciplinary team approach for this case

We also know that many children with Down Syndrome have poor muscle tone which results in a distinctive posture characterized by a curved back a slouched shoulders. This poor muscle tone also gives some children an expressionless facial mimicry and a tendency to keep their mouths open with their apparently oversized tongues protruding. Speech production, in particular articulation, is adversely affected.

The rate and precision of the adaptation of the “auditory radar” is critical in verbal expression. Close observation of the neuro-muscular links between the middle ear and the phonatory apparatus sheds light on these audio-vocal connections. The trigeminal nerve (5th cranial pair) and facial nerve (7th cranial nerve) are both involved in the production of voice and speech. The trigeminal innerves the temporal and masseter muscles instrumental in the closing of the mouth. The facial nerve innerves the digastric muscle involved in the opening of the mouth as well as the muscles of the lips, which are so important in the articulation of speech. Tomatis stresses that the same trigeminal nerve also innerves the hammer muscle (tensor tympani) and the facial nerve innerves the stirrup muscle. These ...