Maybe your child has cerebral palsy or low tone, and you've noticed that one side of their face doesn't move quite like the other. Maybe their tongue drifts to one side when they stick it out. Maybe they've been working hard in speech therapy for a long time, and the progress has been real but slow.
If no one has ever talked to you about cranial nerves, there may be a piece of the picture you haven't seen yet.
The Missing Piece
Cranial nerves come straight out of the brainstem. They control the muscles of the face, jaw, lips, tongue, throat, and neck, which are the same muscles your child needs to talk, eat, and hold their head up.
When a child has had a brain injury or has cerebral palsy, the connection between those muscles and the brain can get disrupted. The brain loses its sense of where the muscle is and how to use it. Speech is a motor skill. If the brain can barely feel a muscle, it's much harder to learn to control it, no matter how hard your child is working.
How We Measure It
In the office, we use a device called a StimPod. It's a peripheral nerve stimulator, a small tool that sends a gentle electrical signal to a specific nerve. We put a small pad on the body, add some gel to the skin, and use a pen-like tip to reach individual nerves. It's comfortable and doesn't hurt.
What we're watching for is how much signal it takes to get a muscle to respond. When I tested it on my own face, the left side moved at a level of three. The right side needed a six. That told me the right side of my face was weaker.
In kids with cerebral palsy, especially when it affects one side of the body, we commonly see one side of the face respond at a low setting while the other side needs a lot more. That gap tells us where the brain isn't getting good feedback.
Building Tone, One Nerve at a Time
Once we know where the weakness is, we can stimulate those nerves and muscles directly. Activating a muscle over and over is how it builds tone. It's similar to how your child's early reflexes activated their muscles automatically when they were a baby. We're giving the brain that information again so it can start to perceive those muscles and use them.
We work through several nerves, including the ones that move the jaw and lips, lift the throat during speech, support the soft palate and digestion, control the tongue, and keep the head upright. Good head position matters more than most people realize, because an open airway is part of being able to move air and speak.
Here's something you can notice at home: when your child sticks out their tongue, it should come straight out. If it drifts to one side, that can be a sign of weakness on that side.
Why This Matters for Your Family
Speech therapy, OT, and the other work your child is doing are valuable. What we often see is that when we build better tone and symmetry in these muscles first, those therapies start to go more efficiently. Your child is no longer trying to learn a skill with a muscle their brain can barely feel.
There's also research suggesting that stimulating certain cranial nerves may help calm neuroinflammation, which is common in kids who have had a brain injury.
Final Thoughts
The brainstem is the foundation of the brain. When things aren't balanced there, the rest of the brain has to work overtime to make up for it. Sometimes your child doesn't need to try harder. They need their brain to be able to feel the muscles they're being asked to use.