Speech Language Pathologist (SLP) Interview with Michelle Pentz MS, CCC-SLP- Augmentative and Alternative Communication and Apraxia/Pediatric Stroke

Introduction

Pediatric strokes are caused by blocked blood vessels or bleeding in the brain. They are more common than many realize, particularly around birth. Often, parents may not know their child has experienced a stroke until milestones like crawling or talking appear atypical. Early recognition and treatment are critical, and speech-language pathologists (SLPs)—therapists who help with communication and feeding—play a vital role in recovery.

Understanding Pediatric Stroke

Pediatric stroke happens in a child’s brain with many known/unknown causes. Children can often “rewire” brain pathways due to the brain’s ability to adapt over time. Their brains have a greater ability to change and relearn after an event like a stroke, as opposed to the adult brain. Signs of pediatric stroke can be hard to notice. These signs include persistent automatic newborn movements, weakness of mouth muscles used for eating and speaking, facial asymmetry, and difficulty moving the tongue side-to-side. From a speech standpoint, clinicians frequently observe difficulty making specific sounds and using muscles for speech or eating.

Communication and Swallowing Challenges

Children post-stroke may present with:

• Difficulty making specific sounds and trouble planning and coordinating mouth movements needed for speech.
• Difficulty communicating (speech therapy is often beneficial if needed) There are a variety of speech/language needs a child may require after a stroke, such as help making certain sounds or help with functional communication (getting basic wants and needs met, basic communicative intent). This can be worked on in speech therapy through various ways, such as the use of AAC (see next line).
• Difficulty moving the hands or eyes across the midline of the body, affecting use of/ability to navigate AAC to communicate if needed (Augmentative and Alternative Communication—tools including picture boards or electronic speech devices).
• Risk of choking or food entering the airway instead of the stomach in cases where children have multiple health needs, due to the swallowing difficulties that can result as a result of a stroke. While swallowing issues are less common in comparison to adults who suffer from stroke, they remain a concern for children who have had a more severe stroke.

Role of the SLP

SLPs are essential in both hospital care and long-term rehabilitation. Speech Language Pathologists are communication professionals who evaluate, diagnose, and treat communication and swallowing disorders in people of all ages. SLPs can address communication/swallowing needs such as speech clarity/ articulation, voice, stuttering, social communication, and difficulty with swallowing. SLPs can work in schools, private practices, hospitals, nursing homes, etc.

Evidence-based interventions include:

• PROMPT therapy: When the SLP touches the child’s face to guide speech movements, and touch-based reminders for speech sound production.

How It Works

• The clinician provides structured tactile input to specific muscles involved in
• These prompts help the child feel the correct movement patterns for producing sounds and syllables.
• Therapy integrates motor planning, proprioception (the ability to sense the body’s position and movement), and timing, all of which are often impaired in children with a motor planning disorder (General Apraxia or Childhood Apraxia of Speech or CAS).

Goals

• Develop accurate and consistent speech
• Improve speech subsystems: jaw control, lip rounding, tongue elevation, and movement sequencing.
• Support functional communication by gradually reducing tactile support as motor patterns become automatic.

Benefits

• Addresses the root motor-planning issue rather than merely sound imitation.
• Can be combined with visual and auditory cues for multimodal learning.

For example, when a child has Childhood Apraxia of Speech, meaning the child knows what they want to say but struggles to coordinate the movements needed for speech, the SLP uses touch cues applied to the child’s face and under the chin to guide jaw, lip, and tongue movements during speech.

How Augmentative and Alternative Communication (AAC) Helps Children with Pediatric Stroke

Children who experience pediatric stroke often present with motor speech disorders, aphasia, or severe expressive/receptive language delays. AAC (communication boards, electronic communication devices/Ipads, as well as various other forms) can be critical because:

1. Provides Immediate Communication Access: Stroke can severely impair speech; AAC ensures the child can express needs, feelings, and participate socially while speech
2. Reduces Frustration and Maladaptive Behaviors: When children cannot communicate verbally, frustration often leads to behavioral challenges. AAC offers an alternative outlet.
3. Supports Language Development: Research shows AAC does not hinder speech recovery—it often accelerates it by providing consistent language models and reducing communication pressure.
4. Promotes Social Interaction and Cognitive Growth: Early AAC use helps maintain engagement with caregivers and peers, which is essential for cognitive and emotional
5. Flexible Across Severity Levels: AAC ranges from low-tech (picture boards) to high-tech (speech-generating devices), allowing customization based on motor and cognitive ability

Lastly, family education and collaboration is critical—SLPs often provide videos, home exercise plans, and counseling to ensure skills continue to be practiced outside of therapy sessions. There are many other interventions that can be successful, but these are two that are evidence based and proven to work with pediatric stroke patients. Research can determine new/updated approaches as we learn more.

Collaboration and Outcomes

Successful recovery focuses on ability to communicate ideas and needs in daily life and feeding skills rather than perfection. Many specialists such as neurologists, PT, OT, and psychologists, work together to ensure children receive help with all skills that need work. It is important to note that progress changes from day to day, and that one day can look very different from the next. It is important to look at progress as individual to the child, and to help them achieve their individual goals. Clinicians are encouraged to manage parent expectations and celebrate small improvements.

Family Perspectives

Pediatric stroke can be difficult for families to navigate alone. There are many online and in person support groups for children and their families. They can also be beneficial for adults who suffered a stroke as a child and want to come back and share their experience, as well as provide hope to families and raise concerns of unmet needs. These groups have been deemed successful by many as this is an experience that can be very isolating, and that families may not have a lot of information on.

Future Directions

Pediatric stroke rehabilitation, particularly in AAC access and long-term language skills, still needs to be studied. Emerging technologies and more frequent or longer session therapy models may help children improve faster.

Conclusion

Pediatric stroke presents unique challenges and opportunities for SLPs. With adaptability, collaboration, and evidence-based strategies, clinicians can help children achieve meaningful communication that allows important needs, choices, and feelings to be expressed which allow for more enriched participation and an improved quality of life.

References

1. Arroyo, C. G., Goldfarb, R., Cahill, D., & Schoepflin, J. (2010). AAC interventions: Case study of in-utero stroke. The Journal of Speech and Language Pathology – Applied Behavior Analysis, 5(1), 32–47. https://doi.org/10.1037/h0100260

2. American Stroke Association. (2024). Perinatal stroke infographic. Stroke.org. https://www.stroke.org/en/about-stroke/stroke-in-children/perinatal-stroke-infogra phic [stroke.org]

3. Children’s Hospital of Orange County. (2022, May 3). How to recognize stroke symptoms in children. Health.choc.org.

4. Dale, P. S., & Hayden, D. A. (2013). Treating speech subsystems in childhood apraxia of speech with tactual input: The PROMPT approach. American Journal of Speech-Language Pathology, 22(4), 644–661. https://doi.org/10.1044/1058-0360(2013/12-0055)

5. Kopyta, I. (2023, May 19). Pediatric stroke management [Infographic]. International Pediatric Stroke Organization. Retrieved December 28, 2025, from https://community.internationalpediatricstroke.org/pediatric-stroke-around-the-world/

6. Lingraphica. (2025, November 25). Does AAC prevent speech? The truth about communication devices. Lingraphica. https://lingraphica.com/resources/does-aac-prevent-speech/ [lingraphica.com]

7. Wright, W. J. A., Howdle, C., Coulson, N. S., & De Simoni, A. (2024). Exploring the types of social support exchanged by survivors of pediatric stroke and their families in an online peer support community: Qualitative thematic analysis. Journal of Medical Internet Research, 26, e49440. https://doi.org/10.2196/49440

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