[Understand the neurodevelopment of language: a necessity to prevent learning disabilities in children]. / Comprendre le neurodéveloppement du langage, une nécessité pour prévenir les troubles des apprentissages de l'enfant ?

Clinical and radiological knowledge of language development in the former premature infant compared to the newborn allows us to argue for exploration of the sensorimotor co-factors required for proper language development. There are early representations of the maternal language in the infant's visual, auditory, and sensorimotor areas, activated or stabilized by orofacial and articulatory movements. The functional architecture of language is different for vulnerable children such as premature infants. We have already mentioned the impact of early dysfunction of the facial praxis fine motor skills in this population presenting comprehension disorders. A recent meta-analysis confirms the increasing difficulty of understanding between 3 and 12 years, questioning the quality of the initial linguistic processes. A precise analysis of language, referenced from 3 years of age, should be completed by sensorimotor tests to assess possible constraints in automating neurolinguistic foundations. The usual assessment at this age can exclude sensory disturbances and communication and offers guidance and socialization. However, a recent study shows the ineffectiveness of "language-reinforced immersion" at 2 and 3 years in a population of vulnerable children. The LAMOPRESCO study of language and motor skills in the premature infant (National PHRC 2010) has assessed language and sensorimotor skills of preterm-born (<33 weeks) 3.5-year-old children without cerebral palsy. Fragile children were randomized into 2 groups, 1 stimulated by a specific individual protocol, the other given guidance. The primary endpoint was phonology, assuming that it is composed of very early good-quality sensorimotor integration stabilized by the child's oral facial motor skills before 5 years of age. This developmental integrative dynamic validates the "motor theory of speech perception." Early and accurate assessment of language and the patient's constraints should differentiate and specify management strategies for all children, whatever their background and pathologies.

[Evaluation of language at 6 years in children born prematurely without cerebral palsy: prospective study of 55 children]. / Évaluation à 6 ans du langage de l'enfant né grand prématuré sans paralysie cérébrale : étude prospective de 55 enfants.

OBJECTIVES: Very premature birth carries a high risk of neurocognitive disabilities and learning disorders. Acquiring sufficient speech skills is crucial to good school performance. METHODS: A prospective study was conducted in 2006 to evaluate speech development in 55 children born very prematurely in 2000 at the Rouen Teaching Hospital (Rouen, France), free of cerebral palsy, compared to 6-year-old born at full term. A computerized speech assessment tool was used (Bilan Informatisé du Langage Oral, BILO II). RESULTS: In the premature-birth group, 49 % of 6-year-old had at least 1 score below the 25th percentile on 1 of the 8 BILO II tests. Significant speech impairments were noted for 2 components of speech, namely, comprehension and phonology. Oral comprehension scores no higher than the 10th percentile were obtained by 23 % of prematurely born children (P<0.02 vs controls). On word repetition tasks used to test phonology, 21 % of prematurely born children obtained scores no higher than the 10th percentile (P<0.01 vs controls). An evaluation of sensorimotor language prerequisites (constraints) in 30 of the 55 prematurely born children showed significant differences with the controls for word memory, visual attention, and buccofacial praxis. CONCLUSION: The speech development impairments found in 6-year-old born very prematurely suggest a distinctive pattern of neurodevelopmental dysfunction that is consistent with the motor theory of speech perception.