What are Neurological Soft Signs?

Although the term “Neurological Soft Signs (NSS)” sounds like it may be referring to  signs of a stroke or other impairment, it actually refers to something much more subtle. The reason we say “sift” signs is because NSS refers to a series of testable reflexes, movements, and sensory experiences that may suggest that there is a neurological abnormality this is not related to a specific area of the brain or a specific disorder. Many of these signs are developmental and can be just a delay that is “grown out of.” However, they are also precursory signs that another more serious impairment may be the underlying cause of these abnormalities.

Neurological soft signs are typically broken into three subcategories:

1.       Sensory integration which may include

a.       Low muscle tone (hypotonia): signs of this would include toe-walking, difficulty feeding, a lax tongue, a floppy head as a baby, delayed physical milestones, any muscle floppiness (ex: eyelids, arms, etc.)

b.       Audio-visual integration: problems with audio integration would mean that a child has problems with taking in auditory information and using it to explore his world. Problems with visual integration would be issues taking in visual information to explore his world. This can look like clumsiness because of visio-spatial awareness; this could be a child not responding to noises or language despite having normal hearing. An eye specialist, an audiologist, a physical therapist, or a general practitioner may help to diagnose these problems.

c.       Tactile recognition: doctors often test this with typical reflex testing or with other tactile integration tests including if the patient can identify shapes or letters drawn on their skin without looking.

2.       Motor coordination involves general coordination, balance and gait.

a.       General Coordination: I look to see if your child is “clumsy”; a lot of times, I see kids fall out of their seat with no known reason

b.       Balance: A lot of times, OTs and PTs notice this first as they are looking for balance much more often, like if your child can stand on one leg

c.       Gait: this is another word for “walking”; does your child have a “drunk walk”? All children have that uneasy walk when they are first learning to walk, but if it extends into toddlerhood, you may want to look further into this

3.       Complex motor sequencing involves complex motor tasks.

a.       This includes diadochokinetics, which are repetitive alternating movements. This can include fine motor movements such as touching each of your fingers to your thumb in rapid succession. In speech, we look to see if you can make smooth, rapid, and alternating speech movements. Often, we ask a young child to say a word over and over that has them making movements in the front of their mouth, in the middle (or on the palate), then in the back of the throat, such as “Pattycake” or “Buttercup”. Older children, we can ask to say “Puh, Tuh, Kuh” as it’s the same vowel sound with different initial consonants to see how they are planning motor sequences.

You may be asking yourself why on earth I look for all of these issues in children if they aren’t that big of a deal. As an SLP, I am trying to make a diagnosis of the speech problem that my clients present with. Many times, it is just a language delay or a single articulation issue. However, many times, the etiology, or the root of the problem, is much more complex. These subtle signs allow me to see that there may be a neurological aspect at play in the diagnosis of your child. If your child presents with several NSS, I will ask you to bring them up with your pediatrician or refer you to other specialists.

As an SLP, my job is to help you help your child. I wrote this blog post to help you understand what professionals may be looking for when they evaluate or treat your child. Noticing NSS helps me personally diagnose Childhood Apraxia of Speech, as you often see several NSS co-occuring with this diagnosis. In addition, I am able to refer children for Occupational Therapy, Physical Therapy, or Developmental Evaluations that can help children receive the correct services for their needs. I am often the first-lineman when it comes to therapy needs and I do my best with seeing the whole child.

If you have any follow-up questions, please leave a comment below or contact us here at Rehabilitation Specialists at 412-761-6062 or rehab.specialists@verizon.net. Until next time!

-Kathleen