Dysarthria in children - causes, treatment with medicines, breathing exercises and massage. What is dysarthria in children and how is it treated? Characteristics of the speech of a child with dysarthria

10.08.2023

- a disorder of the pronunciation organization of speech associated with a lesion of the central part of the speech-motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. The structure of the defect in dysarthria includes a violation of speech motility, sound pronunciation, speech breathing, voice and the prosodic side of speech; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics is performed (EEG, EMG, ENG, MRI of the brain, etc.), speech therapy examination of oral and written speech. Corrective work for dysarthria includes therapeutic effects (drug courses, exercise therapy, massage, physical therapy), speech therapy classes, articulatory gymnastics, speech therapy massage.

General information

Causes of dysarthria

Most often (in 65-85% of cases) dysarthria accompanies cerebral palsy and has the same causes. In this case, an organic lesion of the central nervous system occurs in the prenatal, birth or early period of a child's development (usually up to 2 years). The most common perinatal factors of dysarthria are toxicosis of pregnancy, fetal hypoxia, Rhesus conflict, chronic somatic diseases of the mother, pathological course of childbirth, birth trauma, asphyxia at birth, nuclear jaundice of newborns, prematurity, etc. The severity of dysarthria is closely related to the severity of motor disorders during ICP: so, with double hemiplegia, dysarthria or anartria is detected in almost all children.

In early childhood, CNS damage and dysarthria in a child can develop after neuroinfections (meningitis, encephalitis), purulent otitis media, hydrocephalus, traumatic brain injury, severe intoxication.

The occurrence of dysarthria in adults is usually associated with a stroke, head trauma, neurosurgical operations, brain tumors. Also, dysarthria can occur in patients with multiple sclerosis, amyotrophic lateral sclerosis (ALS), syringobulbia, Parkinson's disease, myotonia, myasthenia gravis, cerebral atherosclerosis, neurosyphilis, mental retardation.

Classification of dysarthria

The neurological classification of dysarthria is based on the principle of localization and syndromological approach. Taking into account the localization of the lesion of the speech-motor apparatus, there are:

bulbar dysarthriaassociated with damage to the nuclei of the cranial nerves /glossopharyngeal, hypoglossal, vagus, sometimes facial, trigeminal/ in the medulla oblongata
pseudobulbar dysarthria associated with damage to the cortical-nuclear pathways
extrapyramidal (subcortical) dysarthria associated with damage to the subcortical nuclei of the brain
cerebellar dysarthria associated with damage to the cerebellum and its pathways
cortical dysarthria associated with focal lesions of the cerebral cortex.

Depending on the leading clinical syndrome in cerebral palsy, spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, atactico-hyperkinetic dysarthria can occur.

Speech therapy classification is based on the principle of intelligibility of speech for others and includes 4 degrees of severity of dysarthria:

1 degree(erased dysarthria) - defects in sound pronunciation can only be detected by a speech therapist during a special examination.
2 degree- defects in sound pronunciation are noticeable to others, but in general, speech remains understandable.
3 degree- understanding of the speech of a patient with dysarthria is available only to close circle and partially to strangers.
4 degree- speech is absent or incomprehensible even to the closest people (anartria).

Symptoms of dysarthria

The speech of patients with dysarthria is slurred, fuzzy, incomprehensible (“porridge in the mouth”), which is due to insufficient innervation of the muscles of the lips, tongue, soft palate, vocal folds, larynx, and respiratory muscles. Therefore, with dysarthria, a whole complex of speech and non-speech disorders develops, which make up the essence of the defect.

Dysfunction of articulatory motility in patients with dysarthria may manifest itself in spasticity, hypotension, or dystonia of the articulatory muscles. Muscular spasticity is accompanied by a constant increased tone and tension of the muscles of the lips, tongue, face, neck; tight closing of the lips, limitation of articulatory movements. With muscular hypotension, the tongue is flaccid, lies motionless at the bottom of the oral cavity; lips do not close, the mouth is half open, hypersalivation (salivation) is pronounced; due to paresis of the soft palate, a nasal tone of voice appears (nasalization). In the case of dysarthria occurring with muscular dystonia, when trying to speak, muscle tone changes from low to increased.

Violations of sound pronunciation in dysarthria can be expressed to varying degrees, depending on the location and severity of damage to the nervous system. With erased dysarthria, individual phonetic defects (distortions of sounds), "blurring" of speech are observed. With more pronounced degrees of dysarthria, there are distortions, omissions, and replacements of sounds; speech becomes slow, inexpressive, slurred. General speech activity is markedly reduced. In the most severe cases, with complete paralysis of the speech-motor muscles, the motor realization of speech becomes impossible.

Specific features of impaired sound pronunciation in dysarthria are the persistence of defects and the difficulty of overcoming them, as well as the need for a longer period of automation of sounds. With dysarthria, the articulation of almost all speech sounds, including vowels, is disturbed. Dysarthria is characterized by interdental and lateral pronunciation of hissing and whistling sounds; voicing defects, palatalization (softening) of hard consonants.

Due to insufficient innervation of the speech muscles in dysarthria, speech breathing is disturbed: exhalation is shortened, breathing at the moment of speech becomes rapid and intermittent. Voice disorders in dysarthria are characterized by its insufficient strength (a quiet, weak, fading voice), a change in timbre (deafness, nasalization), melodic intonation disorders (monotonity, absence or inexpressiveness of voice modulations).

Due to the inarticulateness of speech in children with dysarthria, auditory differentiation of sounds and phonemic analysis and synthesis suffer for the second time. Difficulty and insufficiency of verbal communication can lead to unformed vocabulary and grammatical structure of speech. Therefore, in children with dysarthria, phonetic-phonemic (FFN) or general underdevelopment of speech (OHP) and related types of dysgraphia associated with them may be noted.

Characteristics of clinical forms of dysarthria

For bulbar dysarthria characteristic areflexia, amimia, disorders of sucking, swallowing solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is indistinct and extremely simplified. All the variety of consonants is reduced to a single slotted sound; sounds are not differentiated from each other. Typical nasalization of the voice timbre, dysphonia or aphonia.

At pseudobulbar dysarthria the nature of the disorders is determined by spastic paralysis and muscle hypertonicity. Most clearly, pseudobulbar paralysis is manifested in a violation of the movements of the tongue: attempts to raise the tip of the tongue up, take it to the sides, and hold it in a certain position cause great difficulties. With pseudobulbar dysarthria, it is difficult to switch from one articulatory position to another. Typically selective violation of voluntary movements, synkinesis (friendly movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is slurred, slurred, has a nasal connotation; the normative reproduction of sonors, whistling and hissing, is grossly violated.

For subcortical dysarthria the presence of hyperkinesis is characteristic - involuntary violent muscle movements, including facial and articulatory ones. Hyperkinesias can occur at rest, but are usually exacerbated by attempts to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic side of speech; sometimes at patients involuntary guttural cries break out.

With subcortical dysarthria, the rate of speech may be disturbed by the type of bradilalia, takhilalia, or speech dysarthmia (organic stuttering). Subcortical dysarthria is often combined with pseudobulbar, bulbar and cerebellar forms.

Typical manifestation cerebellar dysarthria is a violation of the coordination of the speech process, resulting in a tremor of the tongue, jerky, chanted speech, individual cries. Speech is slow and slurred; the pronunciation of front-lingual and labial sounds is most disturbed. With cerebellar dysarthria, ataxia is noted (unsteadiness of gait, imbalance, awkwardness of movements).

Cortical dysarthria in its speech manifestations, it resembles motor aphasia and is characterized by a violation of arbitrary articulatory motility. Disorders of speech breathing, voice, prosody in cortical dysarthria are absent. Taking into account the localization of lesions, kinesthetic post-central cortical dysarthria (afferent cortical dysarthria) and kinetic premotor cortical dysarthria (efferent cortical dysarthria) are distinguished. However, with cortical dysarthria, there is only articulatory apraxia, while with motor aphasia, not only the articulation of sounds suffers, but also reading, writing, speech understanding, and the use of language tools.

Diagnosis of dysarthria

Examination and subsequent management of patients with dysarthria is carried out by a neurologist (pediatric neurologist) and a speech therapist. The scope of the neurological examination depends on the proposed clinical diagnosis. The most important diagnostic value is the data of electrophysiological studies (electroencephalography, electromyography, electroneurography), transcranial magnetic stimulation, MRI of the brain, etc.

Forecast and prevention of dysarthria

Only early, systematic speech therapy work on the correction of dysarthria can give positive results. An important role in the success of the correctional and pedagogical influence is played by the therapy of the underlying disease, the diligence of the dysarthria patient himself and his close circle.

Under these conditions, almost complete normalization of the speech function can be expected in the case of erased dysarthria. Having mastered the skills of correct speech, such children can successfully study in a general education school, and receive the necessary speech therapy assistance in clinics or at school speech centers.

In severe forms of dysarthria, only an improvement in the state of speech function is possible. Important for the socialization and education of children with dysarthria is the continuity of various types of speech therapy institutions: kindergartens and schools for children with severe speech disorders, speech departments of neuropsychiatric hospitals; friendly work of a speech therapist, neurologist, psychoneurologist, masseur, specialist in physiotherapy exercises.

Medical and pedagogical work to prevent dysarthria in children with perinatal brain damage should begin from the first months of life. Prevention of dysarthria in early childhood and adulthood is to prevent neuroinfections, brain injuries, and toxic effects.

dysarthria- this is a speech disorder, which is expressed in the difficult pronunciation of certain words, individual sounds, syllables or in their distorted pronunciation. Dysarthria occurs as a result of a brain lesion or disorder of the innervation of the vocal cords, facial, respiratory muscles and muscles of the soft palate, with diseases such as the cleft palate, cleft lip and due to the absence of teeth.

A secondary consequence of dysarthria may be a violation of written speech, which occurs due to the inability to clearly pronounce the sounds of the word. In more severe manifestations of dysarthria, speech becomes completely inaccessible to the understanding of others, which leads to limited communication and secondary signs of developmental deviations.

Dysarthria causes

The main cause of this speech disorder is considered to be insufficient innervation of the speech apparatus, which appears as a result of damage to certain parts of the brain. In such patients, there is a limitation in the mobility of the organs involved in speech reproduction - tongue, palate and lips, thereby complicating articulation.

In adults, the disease can manifest itself without an accompanying breakdown of the speech system. Those. is not accompanied by a speech perception disorder through hearing or a violation of written speech. Whereas in children, dysarthria is often the cause of disorders leading to reading and writing disorders. At the same time, speech itself is characterized by a lack of smoothness, a disturbed rhythm of breathing, a change in the pace of speech in the direction of slowing down, then accelerating. Depending on the degree of dysarthria and the variety of forms of manifestation, there is a classification of dysarthria. The classification of dysarthria includes an erased form of dysarthria, severe and anarthria.

The symptomatology of the erased form of the disease has an erased appearance, as a result of which dysarthria is confused with a disorder such as dyslalia. Dysarthria differs from dyslalia by the presence of a focal form of neurological symptoms.

With a pronounced form of dysarthria, speech is characterized as inarticulate and almost incomprehensible, sound pronunciation is impaired, disorders also appear in the expressiveness of intonations, voice, and breathing.

Anartria is accompanied by a complete lack of opportunities for speech production.

The causes of the disease include: incompatibility by the Rh factor, toxicosis of pregnant women, various pathologies of the formation of the placenta, viral infections of the mother during pregnancy, prolonged or, conversely, rapid births that can cause hemorrhages in the brain, infectious diseases of the brain and its membranes in newborns.

There are severe and mild degrees of dysarthria. A severe degree of dysarthria is inextricably linked with cerebral palsy. A mild degree of dysarthria is manifested by a violation of fine motor skills, pronunciation of sounds and movements of the organs of the articulatory apparatus. With this degree, speech will be understandable, but fuzzy.

The causes of dysarthria in adults can be: stroke, vascular insufficiency, inflammation or brain tumor, degenerative, progressive and genetic diseases of the nervous system (, Huntington), asthenic bulbar palsy and multiple sclerosis.

Other causes of the disease, much less common, are head injuries, carbon monoxide poisoning, drug overdose, intoxication due to excessive consumption of alcoholic beverages and drugs.

Dysarthria in children

With this disease, children show difficulties with the articulation of speech as a whole, and not with the pronunciation of individual sounds. They also have other disorders associated with a disorder of fine and gross motor skills, difficulties with swallowing and chewing. It is quite difficult for children with dysarthria, and under an hour it is completely impossible, to jump on one leg, cut out paper with scissors, fasten buttons, it is quite difficult for them to master written language. Often they miss sounds or distort them, while distorting words. Sick children, for the most part, make mistakes when using prepositions, use incorrect syntactic connectives of words in a sentence. Children with such disorders should be educated in specialized institutions.

The main manifestations of dysarthria in children lie in the violation of the articulation of sounds, the disorder of voice formation, changes in rhythm, intonation and tempo of speech.

The listed violations in babies differ in severity and various combinations. It depends on the location of the focal lesion in the nervous system, on the time of occurrence of such a lesion and the severity of the violation.

Disorders of phonation and articulation partially impede or sometimes completely prevent articulate sound speech, which is the so-called primary defect, leading to the appearance of secondary signs that complicate its structure.

Conducted studies and studies of children with this disease show that this category of children is rather heterogeneous in terms of speech, motor and mental disorders.

The classification of dysarthria and its clinical forms is based on the identification of various foci of localization of brain damage. Babies suffering from various forms of the disease differ from each other in certain defects in sound pronunciation, voice, articulation, their disorders of varying degrees can be corrected. That is why for professional correction it is necessary to use various methods and methods of speech therapy.

Forms of dysarthria

There are such forms of speech dysarthria in children: bulbar, subcortical, cerebellar, cortical, erased or light, pseudobulbar.

Bulbar dysarthria of speech is manifested by atrophy or paralysis of the muscles of the pharynx and tongue, a decrease in muscle tone. With this form, speech becomes fuzzy, slow, slurred. People with bulbar form of dysarthria are characterized by weak mimic activity. It appears with tumors or inflammatory processes in the medulla oblongata. As a result of such processes, the nuclei of the motor nerves located there are destroyed: vagus, glossopharyngeal, trigeminal, facial and hypoglossal.

The subcortical form of dysarthria is a violation of muscle tone and involuntary movements (hyperkinesis), which the baby is not able to control. Occurs with focal lesions of the subcortical nodes of the brain. Sometimes a child cannot pronounce certain words, sounds or phrases correctly. This becomes especially relevant if the child is in a state of calm in the circle of relatives whom he trusts. However, the situation can change radically in a matter of seconds and the baby becomes unable to reproduce a single syllable. With this form of the disease, the pace, rhythm and intonation of speech suffer. Such a baby can very quickly or, conversely, very slowly pronounce entire phrases, while making significant pauses between words. As a result of articulation disorders in conjunction with the irregularity of voice formation and speech breathing disorders, characteristic defects in the sound-producing side of speech appear. They can manifest themselves depending on the state of the baby and are reflected mainly in communicative speech functions. Rarely, with this form of the disease, violations of the human hearing apparatus, which are a complication of a speech defect, can also be observed.

Cerebellar speech dysarthria in its pure form is quite rare. Children affected by this form of the disease pronounce words, chant them, and sometimes just shout out individual sounds.

It is difficult for a child with cortical dysarthria to play sounds together when speech flows in one stream. However, at the same time, the pronunciation of individual words is not difficult. And the intense pace of speech leads to a modification of sounds, creates pauses between syllables and words. The fast pace of speech is similar to the production of words when stuttering.

The erased form of the disease is characterized by mild manifestations. With her, speech disorders are not detected immediately, only after a comprehensive specialized examination. Its causes are often various infectious diseases during pregnancy, fetal hypoxia, toxicosis of pregnant women, birth injuries, and infectious diseases of infants.

The pseudobulbar form of dysarthria is most common in children. The reason for its development may be a brain lesion suffered in infancy, due to birth trauma, encephalitis, intoxication, etc. With mild pseudobulbar dysarthria, speech is characterized by slowness and difficulty in pronouncing individual sounds due to impaired movements of the tongue (movements are not accurate enough), lips. Medium-degree pseudobulbar dysarthria is characterized by the absence of facial muscle movements, limited mobility of the tongue, a nasal tone of voice, and profuse salivation. The severe degree of the pseudobulbar form of the disease is expressed in the complete immobility of the speech apparatus, open mouth, limited movement of the lips, and amimicity.

Erased dysarthria

The erased form is quite common in medicine. The main symptoms of this form of the disease are slurred and inexpressive speech, poor diction, distortion of sounds, and the replacement of sounds in complex words.

For the first time the term "erased" form of dysarthria was introduced by O. Tokareva. She describes the symptoms of this form as mild manifestations of the pseudobulbar form, which are rather difficult to overcome. Tokareva believes that sick children with this form of the disease can pronounce many isolated sounds as needed, but in speech they do not sufficiently differentiate sounds and poorly automate them. Disadvantages of pronunciation can be of a completely different nature. However, they are united by several common features, such as blurring, blurring and fuzzy articulation, which manifest themselves especially sharply in the speech stream.

The erased form of dysarthria is a pathology of speech, which is manifested by a disorder of the prosodic and phonetic components of the system, resulting from microfocal brain damage.

Today, diagnostics and methods of corrective action are worked out rather poorly. This form of the disease is often diagnosed only after the child reaches the age of five years. All children with a suspected erased form of dysarthria are referred to a neurologist to confirm or not confirm the diagnosis. Therapy for an erased form of dysarthria should be comprehensive, combining drug treatment, psychological and pedagogical assistance and speech therapy assistance.

Symptoms of erased dysarthria: motor awkwardness, a limited number of active movements, rapid muscle fatigue during functional loads. Sick children are not very stable on one leg and cannot jump on one leg. Such children are much later than others and have difficulty learning self-care skills, such as buttoning up buttons, untying a scarf. They are characterized by poor facial expressions, the inability to keep the mouth closed, since the lower jaw cannot be fixed in an elevated state. On palpation, the facial muscles are flaccid. Due to the fact that the lips are also sluggish, the necessary labialization of sounds does not occur, therefore, the prosodic side of speech worsens. Sound pronunciation is characterized by mixing, distortion of sounds, their replacement or complete absence.

The speech of such children is quite difficult to understand, it does not have expressiveness and intelligibility. Basically, there is a defect in the reproduction of hissing and whistling sounds. Children can mix not only complex sounds that are close in the way of formation, but also opposite in sound. A nasal tone may appear in speech, the pace is often accelerated. The voice of children is quiet, they cannot change the pitch of their voice, imitating some animals. Speech is characterized by monotony.

Pseudobulbar dysarthria

Pseudobulbar dysarthria is the most common form of the disease. It is a consequence of organic brain damage suffered in early childhood. As a result of encephalitis, intoxication, tumor processes, birth injuries, pseudobulbar paresis or paralysis occurs in children, which is caused by damage to the conductive neurons that go from the cerebral cortex to the glossopharyngeal, vagus and hypoglossal nerves. In terms of clinical symptoms in the field of facial expressions and articulation, this form of the disease is similar to the bulbar form, but the probability of full assimilation of sound pronunciation in the pseudobulbar form is much higher.

Due to pseudobulbar paresis in children, a disorder of general and speech motility occurs, the sucking reflex and swallowing are disturbed. The muscles of the face are sluggish, salivation is observed from the mouth.

There are three degrees of severity of this form of dysarthria.

A mild degree of dysarthria is manifested by the difficulty of articulation, which consists in not very accurate and slow movements of the lips and tongue. At this degree, mild, unexpressed violations of swallowing and chewing also occur. Due to not very clear articulation, pronunciation is disturbed. Speech is characterized by slowness, blurred pronunciation of sounds. Such children, most often, experience difficulties with the pronunciation of such letters as: p, h, j, c, w, and voiced sounds are reproduced without proper participation of the voice.

Also difficult for children are soft sounds that require raising the tongue to the hard palate. As a result of incorrect pronunciation, phonemic development also suffers, and written speech is disturbed. But violations of the structure of the word, vocabulary, grammatical structure with this form are practically not observed. With a mild degree of manifestations of this form of the disease, the main symptom is a violation of the phonetics of speech.

The average degree of the pseudobulbar form is characterized by amimicity, the absence of facial muscle movements. Children cannot puff out their cheeks or pout their lips. The movements of the tongue are also limited. Children cannot lift the tip of the tongue up, turn it to the left or right and hold it in that position. It is very difficult to switch from one movement to another. The soft palate is also inactive, and the voice has a nasal tone.

Also characteristic signs are: profuse salivation, difficulty chewing and swallowing. As a result of violations of articulation functions, rather severe defects in pronunciation appear. Speech is characterized by indistinctness, blurring, quietness. This degree of severity of the disease is manifested by the fuzziness of the articulation of vowel sounds. The sounds s, and are often mixed, and the sounds y and a are characterized by insufficient clarity. Of the consonants, t, m, p, n, x, k are more often correctly pronounced. Sounds such as: h, l, p, c are reproduced approximately. Voiced consonants are more often replaced by voiceless ones. As a result of these disorders, speech in children becomes completely illegible, so such children prefer to remain silent, which leads to loss of experience in verbal communication.

The severe degree of this form of dysarthria is called anarthria and is manifested by deep muscle damage and complete immobilization of the speech apparatus. The face of sick children is mask-like, the mouth is constantly open, and the lower jaw droops. A severe degree is characterized by difficulty in chewing and swallowing, a complete lack of speech, sometimes there is an inarticulate pronunciation of sounds.

Diagnosis of dysarthria

When diagnosing, the greatest difficulty is the distinction between dyslalia and pseudobulbar or cortical forms of dysarthria.

The erased form of dysarthria is a borderline pathology, which is located on the borderline between dyslalia and dysarthria. All forms of dysarthria are always based on focal lesions of the brain with neurological microsymptomatics. As a result, a special neurological examination is necessary to make a correct diagnosis.

It is also necessary to distinguish between dysarthria and aphasia. With dysarthria, the technique of speech is impaired, and not praxic functions. Those. with dysarthria, a sick child understands what is written and heard, can logically express his thoughts, despite defects.

The differential diagnosis is made on the basis of a general systematic examination developed by domestic speech therapists, taking into account the specifics of the listed non-speech and speech disorders, age, psychoneurological state of the child. The younger the child and the lower his level of speech development, the more significant the analysis of non-speech disorders in the diagnosis. Therefore, today, based on the assessment of non-speech disorders, methods have been developed for the early detection of dysarthria.

The presence of pseudobulbar symptoms is the most common manifestation of dysarthria. Its first signs can be detected even in a newborn. Such symptoms are characterized by a weak cry or its absence altogether, a violation of the sucking reflex, swallowing, or their complete absence. The cry in sick children remains quiet for a long time, often with a nasal tone, poorly modulated.

When suckling, children may choke, turn blue, and sometimes milk may flow from the nose. In more severe cases, the baby may not breastfeed at all at first. These babies are fed through a tube. Breathing can be shallow, often irregular and rapid. Such violations are combined with leakage of milk from the mouth, with facial asymmetry, sagging of the lower lip. As a result of these disorders, the baby cannot latch onto the nipple or nipple of the breast.

As the child grows older, the lack of intonational expressiveness of the cry and voice reactions becomes more and more manifest. All the sounds made by the child are monotonous and appear later than the norm. A child suffering from dysarthria cannot bite, chew, or choke on solid food for a long time.

As the child grows older, the diagnosis is made on the basis of the following speech symptoms: persistent defects in pronunciation, insufficiency of arbitrary articulation, voice reactions, incorrect position of the tongue in the oral cavity, disorders of voice formation, speech breathing, and delayed speech development.

The main signs by which differential diagnosis is carried out include:

- the presence of weak articulation (insufficient bending of the tip of the tongue upwards, tremor of the tongue, etc.);

- the presence of prosodic disorders;

- the presence of synkinesis (for example, movements of the fingers that occur when moving the tongue);

- slowness of the tempo of articulations;

- difficulty maintaining articulation;

- difficulty in switching articulations;

- the stability of violations of the pronunciation of sounds and the difficulty of automating the delivered sounds.

Also, the correct diagnosis helps to establish functional tests. For example, a speech therapist asks the child to open his mouth and stick out his tongue, which should be held still in the middle. At the same time, the child is shown an object moving laterally, which he needs to follow. The presence of dysarthria in this test is indicated by the movement of the tongue in the direction in which the eyes move.

When examining a child for the presence of dysarthria, special attention should be paid to the state of articulation at rest, with movements of facial expressions and general movements, mainly articulatory. It is necessary to pay attention to the range of movements, their pace and smoothness of switching, proportionality and accuracy, the presence of oral synkinesis, etc.

Dysarthria treatment

The main focus of the treatment of dysarthria is the development of normal speech in the child, which will be understandable to others, will not interfere with communication and further learning of elementary writing and reading skills.

Correction and therapy for dysarthria should be comprehensive. In addition to constant speech therapy work, medication prescribed by a neuropathologist and exercise therapy are also required. Therapeutic work should be aimed at treating three main syndromes: articulation and speech breathing disorders, voice disorders.

Drug therapy for dysarthria implies the appointment of nootropics (for example, Glycine, Encephabol). Their positive effect is based on the fact that they specifically affect the higher functions of the brain, stimulate mental activity, improve learning processes, intellectual activity and memory of children.

Therapeutic physical training consists in conducting regular special gymnastics, the action of which is aimed at strengthening the muscles of the face.

Well proven massage for dysarthria, which must be done regularly and daily. In principle, massage is the first thing the treatment of dysarthria begins with. It consists in stroking and lightly pinching the muscles of the cheeks, lips and lower jaw, bringing the lips closer together in the horizontal and vertical direction, massaging the soft palate with the pads of the index and middle fingers, no more than two minutes, while the movements should be back and forth. Massage for dysarthria is needed to normalize the tone of the muscles that take part in articulation, reduce the manifestation of paresis and hyperkinesis, activate poorly functioning muscles, and stimulate the formation of brain areas responsible for speech. The first massage should take no more than two minutes, then gradually increase the massage time until it reaches 15 minutes.

Also, for the treatment of dysarthria, it is necessary to train the respiratory system of the child. For this purpose, exercises developed by A. Strelnikova are often used. They consist in sharp breaths when bending and exhalations when straightening.

A good effect is observed with self-study. They consist in the fact that the child stands in front of a mirror and trains to reproduce such movements of the tongue and lips as he saw when talking with others. Gymnastics techniques to improve speech: open and close your mouth, stretch your lips like a “proboscis”, keep your mouth open, then half-open. You need to ask the child to hold a gauze bandage in his teeth and try to pull this bandage out of his mouth. You can also use a lollipop on the shelf, which the child must hold in his mouth, and the adult needs to get it. The smaller the lollipop, the harder it will be for the child to hold it.

The work of a speech therapist with dysarthria consists in automating and staging the pronunciation of sounds. You need to start with simple sounds, gradually moving on to sounds that are difficult to articulate.

Also important in the treatment and correction work of dysarthria is the development of fine and gross motor skills of the hands, closely related to the functions of speech. For this purpose, they usually use finger gymnastics, picking up various puzzles and constructors, sorting small objects and sorting them out.

The outcome of dysarthria is always ambiguous due to the fact that the disease is caused by irreversible disorders in the functioning of the central nervous system and brain.

Correction of dysarthria

Corrective work to overcome dysarthria should be carried out regularly along with medication and rehabilitation therapy (for example, therapeutic and prophylactic exercises, therapeutic baths, hirudotherapy, acupuncture, etc.), which is prescribed by a neuropathologist. Non-traditional methods of correction have proven themselves well, such as: dolphin therapy, isotherapy, sensory therapy, sand therapy, etc.

Corrective classes conducted by a speech therapist mean by themselves: the development of motor skills of the speech apparatus and fine motor skills, voices, the formation of speech and physiological breathing, the correction of incorrect sound pronunciation and the consolidation of delivered sounds, work on the formation of speech communication and expressiveness of speech.

Allocate the main stages of corrective work. The first stage of the lesson is a massage, with the help of which the muscle tone of the speech apparatus develops. The next step is to conduct an exercise to form the correct articulation, with the aim of the subsequent correct pronunciation of sounds by the child, for the production of sounds. Then work is carried out on automation during sound pronunciation. The last step is to learn the correct pronunciation of words using already delivered sounds.

Important for a positive outcome of dysarthria is the psychological support of the child by loved ones. It is very important for parents to learn to praise their children for any, even the smallest achievements. The child needs to form a positive incentive for self-study and confidence that he can do everything. If the child does not have any achievements at all, then you should choose a few things that he does best and praise him for them. The child must feel that he is always loved, regardless of his victories or losses, with all his shortcomings.

Cortical dysarthria is a group of motor speech disorders of different pathogenesis associated with focal lesions of the cerebral cortex.

The first variant of cortical dysarthria is caused by a unilateral or more often bilateral lesion of the lower part of the anterior central gyrus. In these cases, selective central paresis of the muscles of the articulatory apparatus (most often the tongue) occurs. Selective cortical paresis of individual muscles of the tongue leads to a limitation of the volume of the most subtle isolated movements: the upward movement of the tip of the tongue. With this option, the pronunciation of front-lingual sounds is disturbed.

For the diagnosis of cortical dysarthria, a subtle neurolinguistic analysis is needed to determine which of the anterior lingual sounds are affected in each particular case and what is the mechanism of their disturbance.

In the first variant of cortical dysarthria, among the anterior lingual sounds, the pronunciation of the so-called cacuminal consonants, which are formed with the tip of the tongue raised and slightly bent upwards, is primarily disturbed. (w, w, p). In severe forms of dysarthria, they are absent; in milder forms, they are replaced by other anterior lingual consonants, most often dorsal, during the pronunciation of which the front part of the back of the tongue rises with a hump to the palate. (s, s, s, s, t, d, To).

Difficult to pronounce with cortical dysarthria are also apical consonants, which are formed when the tip of the tongue approaches or closes with the upper teeth or alveoli (l).

With cortical dysarthria, the pronunciation of consonants can also be disturbed according to the way they are formed: stop, slot, and trembling. Most often - slotted (l, l).

A selective increase in muscle tone is characteristic, mainly in the muscles of the tip of the tongue, which further limits its fine differentiated movements.

In milder cases, the tempo and smoothness of these movements are disturbed, which manifests itself in the slow pronunciation of front-lingual sounds and syllables with these sounds.

The second variant of cortical dysarthria is associated with insufficiency of kinesthetic praxis, which is observed with unilateral lesions of the cortex of the dominant (usually left) hemisphere of the brain in the lower post-central sections of the cortex.

In these cases, the pronunciation of consonants suffers, especially hissing and affricates. Articulation disorders are inconsistent and ambiguous. The search for the desired articulation mode at the moment of speech slows down its pace and breaks the smoothness.

Difficulty in feeling and reproducing certain articulation modes is noted. There is a lack of facial gnosis: the child finds it difficult to clearly localize a point touch to certain areas of the face, especially in the area of the articulatory apparatus.

The third variant of cortical dysarthria is associated with insufficiency of dynamic kinetic praxis; this is observed with unilateral lesions of the cortex of the dominant hemisphere in the lower sections of the premotor areas of the cortex. In case of violations of kinetic praxis, it is difficult to pronounce complex affricates, which can break up into component parts, there are replacements of fricative sounds with stops (h- e) omissions in consonant clusters, sometimes with selective stunning of voiced stop consonants. Speech is tense and slow.

Difficulties are noted when reproducing a series of successive movements on a task (by showing or by verbal instructions).

In the second and third variants of cortical dysarthria, the automation of sounds is especially difficult.

Pseudobulbar dysarthria occurs with bilateral damage to the motor cortical-nuclear pathways that go from the cerebral cortex to the nuclei of the cranial nerves of the trunk.

Pseudobulbar dysarthria is characterized by an increase in muscle tone in the articulatory muscles according to the type of spasticity - a spastic form of pseudobulbar dysarthria. Less commonly, against the background of limiting the volume of voluntary movements, there is a slight increase in muscle tone in individual muscle groups or a decrease in muscle tone - a paretic form of pseudobulbar dysarthria. In both forms, there is a limitation of active movements of the muscles of the articulatory apparatus, in severe cases - their almost complete absence.

In the absence or insufficiency of voluntary movements, the preservation of reflex automatic movements, the strengthening of the pharyngeal, palatine reflexes, and also, in some cases, the preservation of reflexes of oral automatism are noted. There are synkinesis. The tongue with pseudobulbar dysarthria is tense, drawn back, its back is rounded and closes the entrance to the pharynx, the tip of the tongue is not pronounced. Voluntary movements of the tongue are limited, the child can usually stick out the tongue from the oral cavity, however, the amplitude of this movement is limited, he hardly keeps the protruding tongue in the midline; the tongue deviates to the side or falls on the lower lip, bending towards the chin.

The lateral movements of the protruding tongue are characterized by small amplitude, slow pace, diffuse movement of its entire mass, the tip remains passive and usually tense during all its movements.

Particularly difficult in pseudobulbar dysarthria is the movement of the protruding tongue up with the bending of its tip towards the nose. When performing the movement, an increase in muscle tone, passivity of the tip of the tongue, as well as exhaustion of the movement are visible.

In all cases, with pseudobulbar dysarthria, the most complex and differentiated arbitrary articulatory movements are violated in the first place. Involuntary, reflex movements are usually preserved. So, for example, with limited voluntary movements of the tongue, the child licks his lips while eating; having difficulty in pronouncing sonorous sounds, the child makes them in crying, he coughs loudly, sneezes, laughs.

Dissociation in the performance of voluntary and involuntary movements in pseudobulbar dysarthria determines the characteristic violations of sound pronunciation - selective difficulties in pronouncing the most complex and differentiated by articulation patterns of sounds (r, l, w, w, c, h). Sound R loses its vibrating character, sonority, is often replaced by a slotted sound. For sound l characterized by the absence of a specific focus of education, active deflection of the back of the tongue down, insufficient elevation of the edges of the tongue and the absence or weakness of the closure of the tip with the hard palate. All of this defines the sound. l like flat-slit sound.

Thus, with pseudobulbar dysarthria, as well as with cortical, the pronunciation of the most difficult to articulate anterior lingual sounds is disturbed, but unlike the latter, the violation is more common, combined with a distortion of pronunciation and other groups of sounds, disturbances in breathing, voice, intonation- melodic side of speech, often - salivation.

Features of sound pronunciation in pseudobulbar dysarthria, in contrast to cortical dysarthria, are also largely determined by the mixing of a spastically tense tongue in the posterior part of the oral cavity, which distorts the sound of vowels, especially front ones. (And, e).

With diffuse spasticity of the muscles of the speech apparatus, voicing of deaf consonants is noted (mainly with spastic pseudobulbar dysarthria). In the same variant, the spastic state of the muscles of the speech apparatus and neck violates the resonant properties of the pharynx with a change in the size of the pharyngeal-oral and pharyngeal-nasal openings, which, along with excessive tension of the pharyngeal muscles and muscles that raise the soft palate, contributes to the appearance of a nasal shade when pronouncing vowels, especially back row (oh y), and solid sonorants (p, l), solid noisy (h, w, w) and affricates c.

With paretic pseudobulbar dysarthria, the pronunciation of stop labial sounds suffers, requiring sufficient muscle effort, especially bilabial (P,b, m)lingual-alveolar, and also often vowel sounds, especially those that require lifting the back of the tongue up (And,s, y). There is a nasal connotation vote. The soft palate sags, its mobility during the pronunciation of sounds is limited.

Speech in the paretic form of pseudobulbar dysarthria is slow, aphonic, fading, poorly modulated, salivation, hypomia and amimia of the face are pronounced. Often there is a combination of spastic and paretic forms, i.e., the presence of spastic-paretic syndrome.

Bulbar dysarthria is a symptom complex of motor speech disorders that develop as a result of damage to the nuclei, roots or peripheral sections of the VII, IX, X and XII cranial nerves. With bulbar dysarthria, there is a peripheral paresis of the speech muscles. In pediatric practice, unilateral selective lesions of the facial nerve in viral diseases or inflammation of the middle ear are of the greatest importance. In these cases, flaccid paralysis of the muscles of the lips, one cheek develops, which leads to disturbances and blurred articulation of labial sounds. With bilateral lesions, violations of sound pronunciation are most pronounced. The pronunciation of all labial sounds is grossly distorted by the type of their approximation to a single deaf fricative labial-labial sound. All occlusive consonants also approach the fricative, and the anterior lingual consonants - to a single deaf flat-slit sound, voiced consonants are deafened. These pronunciation disorders are accompanied by nasalization.

The distinction between bulbar dysarthria and paretic pseudobulbar is carried out mainly according to the following criteria:

The nature of paresis or paralysis of the speech muscles (with bulbar - peripheral, with pseudobulbar - central);

The nature of the violation of speech motility (with bulbar, voluntary and involuntary movements are violated, with pseudobulbar - mainly arbitrary);

The nature of the lesion of articulatory motility (with bulbar dysarthria - diffuse, with pseudobulbar - selective with a violation of fine differentiated articulatory movements);

The specifics of sound pronunciation disorders (with bulbar dysarthria, the articulation of vowels approaches a neutral sound, with pseudobulbar dysarthria it is pushed back; with bulbar dysarthria, vowels and voiced consonants are stunned, with pseudobulbar dysarthria, along with the stunning of consonants, their voicing is observed);

With pseudobulbar dysarthria, even with the predominance of the paretic variant, elements of spasticity are noted in individual muscle groups.

Extrapyramidal dysarthria. The extrapyramidal system automatically creates the background of pre-readiness, on which it is possible to carry out fast, precise and differentiated movements. It is important in the regulation of muscle tone, sequence, strength and motor contractions, provides automated, emotionally expressive performance of motor acts.

Violations of sound pronunciation in extrapyramidal dysarthria are determined by:

Changes in muscle tone in the speech muscles;

The presence of violent movements (hyperkinesis);

Disorders of propceptive afferentation from the speech muscles;

Violations of the emotional-motor innervation. The range of motion in the muscles of the articulatory apparatus with extrapyramidal dysarthria, in contrast to pseudobulbar, may be sufficient. The child experiences particular difficulties in maintaining and feeling the articulatory posture, which is associated with constantly changing muscle tone and violent movements. Therefore, with extrapyramidal dysarthria, kinesthetic dyspraxia is often observed. In a calm state, slight fluctuations in muscle tone (dystonia) or some decrease in it (hypotension) can be noted in the speech muscles; when trying to speak in a state of excitement, emotional stress, sharp increases in muscle tone and violent movements are observed. The tongue gathers in a lump, pulls up to the root, sharply strains. An increase in tone in the muscles of the vocal apparatus and in the respiratory muscles eliminates the arbitrary connection of the voice, and the child cannot utter a single sound.

With less pronounced violations of muscle tone, speech is blurry, slurred, voice with a nasal tint, the prosodic side of speech, its intonational-melodic structure, tempo are sharply disturbed. Emotional nuances in speech are not expressed, speech is monotonous, monotonous, unmodulated. There is an attenuation of the voice, turning into an indistinct muttering.

A feature of extrapyramidal dysarthria is the absence of stable and uniform disturbances in sound pronunciation, as well as great difficulty in automating sounds.

Extrapyramidal dysarthria is often combined with hearing impairments of the type of sensorineural hearing loss, while hearing in high tones primarily suffers.

Cerebellar dysarthria. With this form of dysarthria, the cerebellum and its connections with other parts of the central nervous system, as well as the fronto-cerebellar pathways, take place.

Speech in cerebellar dysarthria is slow, jerky, chanted, with impaired modulation of stress, attenuation of the voice towards the end of the phrase. There is a decreased tone in the muscles of the tongue and lips, the tongue is thin, flattened in the oral cavity, its mobility is limited, the pace of movements is slowed down, it is difficult to maintain articulation patterns and weakness of their sensations, the soft palate sags, chewing is weakened, facial expressions are sluggish. The movements of the tongue are inaccurate, with manifestations of hyper- or hypometry (redundancy or insufficiency of the volume of movement). With more subtle purposeful movements, a slight trembling of the tongue is noted. Nasalization of most sounds is pronounced.

Differential diagnosis of dysarthria is carried out in two directions: the delimitation of dysarthria from dyslalia and from alalia.

Delimitation from dyslalia carried out on the basis of three leading syndromes(syndromes of articulatory, respiratory and vocal disorders), the presence of not only impaired sound pronunciation, but also disorders of the prosodic side of speech, specific disorders of sound pronunciation with the difficulty of automating most sounds, as well as taking into account the data of a neurological examination (the presence of signs of an organic lesion of the central nervous system) and anamnesis features ( indications of the presence of perinatal pathology, features of pre-speech development, screaming, vocal reactions, sucking, swallowing, chewing, etc.

Delimitation from alalia is carried out on the basis of the absence of primary violations of language operations, which is manifested in the features of the development of the lexical and grammatical side of speech.

Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998. - 680 p.

Psychological and pedagogical characteristics of children with dysarthria

Dysarthria (from the Greek words: dys - denial and arthroo - articulate) is a violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus. It occurs due to the fact that the tongue, lips, palate, vocal cords, diaphragm cannot move in full. The cause of immobility is paresis (Greek paresis - a decrease in the strength or amplitude of movements due to a violation of innervation) of the muscles of the articulatory apparatus. Thus, dysarthria is a symptom of an organic lesion of the central nervous system of the brain, those of its departments that make up the motor speech zone. This is a severe disorder of all speech activity. First of all, speech motor skills, all components of the speech motor act, suffer. With dysarthria, not only sound pronunciation is disturbed (almost all groups of sounds), but the entire prosodic organization of the speech act, the so-called speech prosodic, including voice, intonation, tempo, rhythm, also the intonational-rhythmic side and emotional coloring of speech, suffers. In the manual Pravdina O.V. describes various types of speech disorders. Common manifestations of disorders in dysarthria are:

Bulbar dysarthria (d. buulbaris from gr. - a bulb, the shape of which resembles the medulla oblongata.) due to peripheral paresis or paralysis of the muscles involved in articulation, due to damage to the glossopharyngeal, vagus and hypoglossal nerves and their nuclei. Often associated with swallowing disorders.

Cortical dysarthria (d. corticalis) - caused by damage to the parts of the cerebral cortex associated with the function of the muscles involved in articulation; differs in the disorder of pronunciation of syllables while maintaining the correct structure of the word.

Cerebellar dysarthria (d. cerebellaris) - D., caused by damage to the cerebellum or its pathways; characterized by stretched, scrambled speech with broken modulation and fluctuating volume.

Dysarthria extrapyramidal (hyperkinetic, subcortical) (d. extrapyramidalis) - D., arising from the defeat of the subcortical nodes and their nerve connections of the striapallidar system.

Dysarthria erased form - a violation of the pronunciation of whistling and hissing sounds according to the type of lateral sigmatism, was first identified by the Czech doctor M. Zeeman; is often the only symptom indicating that a child has undiagnosed dysarthria.

Pseudobulbar dysarthria (from the Greek pseudes - false) is a form of dysarthria that occurs with bilateral damage to the motor cortical-nuclear pathways running from the cerebral cortex to the nuclei of the cranial nerves of the trunk. It entails central paralysis of the muscles innervated by the glossopharyngeal, vagus and hypoglossal nerves. There are three forms of pseudobulbar dysarthria:

Spastic (i.e. spasmodic);

Paretic (paretic - muscle immobility);

Mixed (spastic-paretic).

Children with dysarthria also have difficulty in visual activity. They cannot properly hold a pencil, use scissors, regulate the force of pressure on a pencil and a brush. These children are also characterized by difficulties in performing physical exercises and dancing. It is not easy for them to learn to correlate their movements with the beginning and end of a musical phrase, to change the nature of movements according to the percussion beat. They say about such children that they are clumsy, because they cannot clearly and accurately perform various motor exercises. It is difficult for them to maintain balance while standing on one leg, often they cannot jump on their left or right foot.

Violation of sound pronunciation and the prosodic side of speech (tempo, rhythm, modulation, intonation) caused by organic insufficiency of the muscles of the speech apparatus (organic brain damage).

Speech symptoms:

Sound impairment. Depending on the degree of damage, the pronunciation of all or several consonants may suffer. The pronunciation of vowels may also be disturbed (they are pronounced indistinctly, distorted, often with a nasal tone).

Violation of prosodic - tempo, rhythm, modulation, intonation.

Violation of the perception of phonemes (sounds) and their distinction. It arises as a result of fuzzy, blurry speech, which does not allow the correct auditory image of sound to form.

Violation of the grammatical structure of speech.

Nonverbal symptoms:

Violations of the locomotor apparatus (usual tests, you look at the accuracy, smoothness, switchability and correctness of the articulation exercises, you need to look both at rest and during motor load); be sure to palpate the muscles of the tongue, which makes it possible to more accurately determine the nature of the violation of muscle tone (the tongue, lips, soft palate, mimic muscles, chewing look; additional symptoms are salivation (at rest or during exercise and during speech);

Violation of the emotional-volitional sphere.

Violation of a number of mental functions (attention, memory, thinking).

Violation of cognitive activity.

A unique form of personality.

Pronunciation, grammar.

Features of speech development of children with pseudobulbar dysarthria.

With dysarthria, unlike dyslalia, the pronunciation of both consonants and vowels can be disturbed. Vowel disorders are classified according to rows and elevations, consonant disorders - according to their four main features: the presence and absence of vibration of the vocal folds, the method and place of articulation, the presence or absence of an additional rise of the back of the tongue to the hard palate.

Depending on the type of impairment, all defects in sound pronunciation in dysarthria are divided into: a) anthropophonic (sound distortion) and b) phonological (lack of sound, replacement, undifferentiated pronunciation, mixing). With phonological defects, there is an insufficiency of oppositions of sounds according to their acoustic and articulatory characteristics. Therefore, the most common violations of written speech.

For all forms of dysarthria, articulatory motility disorders are characteristic, which manifest themselves in a number of ways. Violations of muscle tone, the nature of which depends primarily on the localization of brain damage. The following forms are distinguished in the articulatory muscles: spasticity of the articulatory muscles - a constant increase in tone in the muscles of the tongue, lips, in the facial and cervical muscles. An increase in muscle tone may be more localized and extend only to individual muscles of the tongue.

With a pronounced increase in muscle tone, the tongue is tense, pulled back, its back is curved, raised up, the tip of the tongue is not expressed. The tense back of the tongue, raised to the hard palate, helps soften consonant sounds. Therefore, a feature of articulation with spasticity of the muscles of the tongue is palatalization, which can contribute to phonemic underdevelopment. So, pronouncing the same words ardor And dust, they say And moth, the child may find it difficult to differentiate their meanings.

An increase in muscle tone in the circular muscle of the mouth leads to spastic tension of the lips, tight closure of the mouth. Active movements are limited. The impossibility or limitation of the forward movement of the tongue may be due to spasticity of the geniolingual, maxillohyoid, and digastric muscles, as well as the muscles attached to the hyoid bone.

All muscles of the tongue are innervated by the hypoglossal nerves, with the exception of the lingual-palatine muscles, which are innervated by the glossopharyngeal nerves. An increase in muscle tone in the muscles of the face and neck further limits voluntary movements in the articulatory apparatus.

With paretic pseudobulbar dysarthria, the pronunciation of occlusive labial sounds suffers, requiring sufficient muscle effort, especially bilabial (p, b, m) lingo-alveolar, as well as often a number of vowel sounds, especially those that require lifting the back of the tongue up (and, s, y). There is a nasal tone of voice. The soft palate sags, its mobility during the pronunciation of sounds is limited.

Dysarthria is often combined with underdevelopment of other components of the speech system (phonemic hearing, lexical and grammatical side of speech). Depending on the severity of these manifestations, it is extremely important for speech therapy practice to distinguish several groups of children with dysarthria: with phonetic disorders; phonetic-phonemic underdevelopment; general underdevelopment of speech (the level of speech development is indicated). With purely phonetic (anthropophonic) disorders, the main task is to correct the sound pronunciation. When dysarthria is combined with speech underdevelopment, a complex system of speech therapy is carried out, including phonetic work, the development of phonemic hearing, work on a dictionary, grammatical structure, as well as special measures aimed at preventing or correcting violations of written speech.

General underdevelopment of speech - various complex speech disorders in which children have impaired formation of all components of the speech system related to its sound and semantic side, with normal hearing and intelligence. For the first time, a theoretical justification for the general underdevelopment of speech was formulated as a result of multidimensional studies of various forms of speech pathology in children of preschool and school age, conducted by R.E. Levina and a team of researchers from the Research Institute of Defectology (N.A. Nikashina, G.A. Kashe, L. F. Spirova, G.I. Zharenkov and others) in the 50-60s. 20th century Deviations in the formation of speech began to be considered as developmental disorders proceeding according to the laws of the hierarchical structure of higher mental functions. From the standpoint of a systematic approach, the issue of the structure of various forms of speech pathology depending on the state of the components of the speech system was resolved. A correct understanding of the structure of OHP, the reasons underlying it, the various ratios of primary and secondary disorders is necessary for the selection of children in special institutions, for the selection of the most effective methods and correction, and for the prevention of possible complications in school education. General underdevelopment of speech can be observed in the most complex forms of children's speech pathology: alalia, aphasia, as well as rhinolalia, dysarthria - in those cases when the vocabulary of the grammatical structure and gaps in phonetic and phonemic development are simultaneously detected.

Characteristics of the general underdevelopment of speech in children.

General underdevelopment of speech - various complex speech disorders in which the formation of all components of the speech system related to the sound and semantic side is impaired. For the general underdevelopment of speech, the characteristic features are: its late appearance (often only by 7-8 years), a meager vocabulary, agrammatism, pronunciation and phoneme formation defects. Underdevelopment of speech has a different origin and, accordingly, a different structure of its abnormal manifestations. In some children, speech in its generally accepted forms is completely absent, in others it is in its infancy. For some, speech turns out to be more formed if, however, there are signs of a significant lag behind the norm. All the variety of degrees of speech underdevelopment is conditionally divided into three levels: the absence of commonly used speech, extended speech with elements of phonetic and lexical and grammatical underdevelopment. The degrees of speech underdevelopment do not represent frozen formations. In each of them we find elements of the previous and subsequent levels. New elements are first interspersed and then displace previous forms. We rarely deal with pure expression, of any particular level. More often you can find transitional states in which the features of a new level are combined along with the still unexpired manifestation of earlier formations.

As common features, the following are noted: late onset of speech development, poor vocabulary, agrammatism, defects in phoneme formation. This underdevelopment can be expressed in varying degrees: from the absence of speech or its babble state to expanded, but with elements of phonetic and lexical and grammatical underdevelopment. Depending on the degree of formation of speech means in a child, general underdevelopment is divided into three levels.

Levels of general underdevelopment of speech.

Based on correctional tasks, R.E. Levina made an attempt to reduce the diversity of speech underdevelopment to three levels. Each level is characterized by a certain ratio of the primary defect and secondary manifestations that delay the formation of speech components. The transition from one level to another is characterized by the emergence of new speech possibilities.

I level - complete or partial absence of commonly used speech. Children communicate with others using “babbling” words, incomplete, “babbling” sentences, reinforcing statements with gestures and facial expressions. The limited vocabulary is combined with an insufficient level of understanding of speech; it is difficult for children to complete tasks related to understanding the category of number, tense, gender, and case. Analyzing the independent speech of such children, the following patterns can be distinguished:

The use of the same "babble" words to refer to several objects and phenomena (bibi - car, bicycle, plane, etc.)

Replacing the names of objects with the names of actions - and vice versa: tidi (sit) - chair, stool, armchair; set (sews) - needle.

The child reproduces commonly used words in the form of separate syllables and combinations: ko - cat; baka - dog, etc. Tatik cha - the boy has a ball.

Level II of speech development is characterized by the fact that the child already has simple common sentences of 2-3-4 words in independent statements. The use of the most frequent grammatical constructions is noted, the vocabulary is expanding, mainly due to the subject and verbal everyday vocabulary. The possibilities of reproducing not only two-, but also three-four-syllables are expanding. For example: Sek a uliti. (Snow on the street.) An analysis of such children's statements allows us to identify the main problems in the formation of all language components that give the right to talk about severe underdevelopment of speech in this category of children, including:

1) limited passive vocabulary, ignorance of the names of many professions and their attributes, not only shades, but also some primary colors (yellow, brown, green, etc.), verbs with different shades of meanings (arrived, moved, left), subject and verbal vocabulary related to the animal and plant world, etc.;

2) the presence of agrammatism (incorrect use of grammatical constructions), the omission of prepositions (pat kovati - sleep on the bed), the lack of agreement between adjectives and nouns (et pati - five fingers); mixing of case forms (isu kadas - I draw with a pencil);

3) a gross violation of the syllabic structure and sound-filling of words (gayu - I play, leka - Christmas tree);

4) the insufficiency of the phonetic side of speech is confirmed by the presence of a large number of unformed sounds (there are 6 types of sound pronunciation disorders: voicing defects, mitigation, sigmatism, rotacism, lambdacism, iotacism and palatal sounds defects).

Characteristics of children with III level of speech development.

This level of development of children's speech is characterized by the presence of extended phrasal speech with pronounced elements of underdevelopment of vocabulary, grammar and phonetics. Typical is the use of simple common, as well as some types of complex sentences. The structure of sentences can be broken by skipping or rearranging major and minor members, for example: "Byika is muddy and does not recognize" - the squirrel looks and does not recognize (the hare); "from the smoke of the toyby, potamumta khuidna" - Smoke is pouring out of the chimney because it's cold. In the statements of children appear words consisting of three to five syllables ("akvbiyum" - aquarium, "tatallimst" - tractor driver, "wadapavud" - water pipes, "zadigbyka" - lighter).

Special tasks allow you to identify significant difficulties in the use of some simple and most complex prepositions, in agreeing nouns with adjectives and numerals in oblique cases (“I took it from the yamsik” - took from the box "aphids led" - three buckets, "koyobka climb under the stool" - the box is under the chair, "no amount of pblk" - no brown stick, "pimsit lambstel, kbsit lumchcom" - writes with a felt-tip pen, paints with a pen, "pulls from thuja" - took from the table, etc.). Thus, the formation of the grammatical structure of the language in children at this level is incomplete and is still characterized by the presence of pronounced violations of coordination and control.

An important feature of the child's speech is the insufficient formation of word-formation activity. In their own speech, children use simple diminutive forms of nouns, individual possessive and relative adjectives, the names of some professions, prefixed verbs, etc., corresponding to the most productive and frequent word-building models (“tail - tail, nose - nose, teaches - teacher , plays hockey - hockey player, chicken soup - chicken, etc."). At the same time, they do not yet have sufficient cognitive and speech capabilities to adequately explain the meanings of these words (“switch” - "blinking light""vineyard" - "he'll get lost""stove" - "Pichka" and so on.). Persistent and gross violations are observed when trying to form words that go beyond the scope of everyday speech practice. So, children often replace the operation of word formation with inflection (instead of "hand" - "hands", instead of "sparrow" - "sparrows" etc.) or generally refuse to transform the word, replacing it with a situational statement (instead of "cyclist" - "who rides a bicycle" instead of "sage" - "who is smart, he thinks everything"). In cases where children still resort to word-formation operations, their statements . are replete with specific speech errors, such as: violations in the choice of a generating basis (“builds houses - dumnik", ski poles - pblnye), omissions and replacements of derivational affixes ("tractoriml - tractor driver, chimtik - reader, apricusnyn - apricot", etc.), a gross distortion of the sound-syllabic structure of the derived word ("lead - whistle, whistle"), the desire for a mechanical connection within the word root and affix ("pea - pea","fur - mykhniy" and so on.). A typical manifestation of the general underdevelopment of speech at this level is the difficulty in transferring word-formation skills to new speech material.

These children are characterized by an inaccurate understanding and use of generalizing concepts, words with an abstract and figurative meaning (instead of "clothing" - "fingered", "kufnichki" - blouses, "furniture" - "different chairs""dishes" - "mimsky"), ignorance of the names of words that go beyond everyday everyday communication: parts of the human body (elbow, bridge of the nose, nostrils, eyelids), animals (hooves, udders, mane, tusks), names of professions (engine driver, ballerina, carpenter, carpenter) and actions related with them (leads, performs, saws, cuts, planes), the inaccuracy of the use of words to refer to animals, birds, fish, insects (rhinoceros - "cow", giraffe - "big horse", woodpecker, nightingale - "bird", pike, catfish - "fish", spider - "fly", caterpillar - "worm"), etc. There is a tendency to multiple lexical substitutions for various types: confusions based on external similarity, substitutions according to the meaning of the functional load, species-generic confusions, substitutions within the same associative field, etc. (“dishes” - "Bowl","nora" - "hole","pot" - "Bowl","dived" - "bathed").

Along with lexical errors in children with the III level of speech development, a specific originality of coherent speech is also noted. Its insufficient formation is often manifested both in children's dialogues and in monologues. This is confirmed by the difficulties of programming the content of extended statements and their language design. The characteristic features of coherent speech are a violation of the coherence and sequence of the story, semantic omissions of essential elements of the storyline, a noticeable fragmentation of the presentation, a violation of temporal and causal relationships in the text. These specific features are due to the low degree of independent speech activity of the child, with the inability to single out the main and secondary elements of his intention and the connections between them, with the impossibility of clearly constructing a holistic composition of the text. Along with these errors, poverty and uniformity of the language means used are noted. So, when talking about favorite toys or events from their own lives, children mostly use short, uninformative phrases. When constructing sentences, they omit or rearrange individual members of the sentence, replace complex prepositions with simple ones. Often there is an incorrect design of word links within a phrase and a violation of interphrase links between sentences.

In independent speech, difficulties in reproducing words of different syllabic structure and sound filling are typical: perseveration ( "nevinimk" - snowman, "hihiimst" - hockey player), anticipations ( "astubus" - bus), adding unnecessary sounds ( "mendvid" - bear), syllable truncation ( "misanile" - policeman, "vapravut" - plumbing), permutation of syllables ( "Vukrik" - rug, "vosuliki" - hairs), adding syllables or a syllabic vowel ( "korbbyl" - ship, "tyravb" - grass). The sound side of speech is characterized by the inaccuracy of the articulation of some sounds, the fuzziness of their differentiation by ear. The insufficiency of phonemic perception is manifested in the fact that children have difficulty distinguishing the first and last consonant, vowel sound in the middle and end of a word. They do not select pictures that have a given sound in the name, they cannot always correctly determine the presence and place of a sound in a word, etc. Tasks for independently inventing words for a given sound are not performed.

Organization of correctional and developmental work with children (III level of speech development)

The main objectives of the correctional and developmental education of this speech level of children is to continue the work on the development of:

1) understanding of speech and lexical and grammatical means of the language;

2) the pronunciation side of speech;

3) independent extended phrasal speech;

4) preparation for mastering the elementary skills of writing and reading.

In the first year of study, five-year-old children with general underdevelopment of speech cannot fully master the educational material in frontal classes with the whole group. Not only the lag in the development of speech is affected, but also difficulties in concentrating attention, memory, rapid exhaustion and fatigue. Therefore, it is advisable to divide the group into two subgroups for conducting frontal speech therapy, as well as partially educational classes, taking into account the level of speech development.

The following types of training sessions are envisaged:

* connected speech;

* vocabulary, grammatical structure;

* pronunciation.

The number of classes that implement correctional and developmental tasks varies.

Conclusion: In the literature, a lot of attention is paid to the gradual development of speech during its normal development. In the monograph by A.N. Gvozdev, in the works of G.L. Rosengard-Pupko, D.B. Elkonina, A.A. Leontieva, N.Kh. Shvachkina, V.I. Beltyukova et al. describe in detail the formation of speech in children from early childhood.

Dysarthria is a symptom of an organic lesion of the central nervous system of the brain, those parts of it that make up the motor speech zone. This is a severe disorder of all speech activity. First of all, speech motor skills, all components of the speech motor act, suffer. Based on correctional tasks, R.E. Levina made an attempt to reduce the diversity of speech underdevelopment to three levels. Each level is characterized by a certain ratio of the primary defect and secondary manifestations that delay the formation of speech components. The transition from one level to another is characterized by the emergence of new speech possibilities.

Conclusions on the first chapter:

1) An analysis of the literature on this topic showed a difference in the development and formation of oral speech in children with normal development and in children with dysarthria. Children with dysarthria lag behind in their speech development from children whose speech development occurs in accordance with age norms.

2) Pseudobulbar dysarthria is a common speech defect among preschool children. The birth rate of children with this clinical diagnosis tends to increase.

3) Analysis of literary sources shows the existence of the main signs in children with dysarthria, which are:

1. increase or decrease in tone in articulatory motility;

2. the difficulty of finding certain positions of the lips, tongue, soft palate, necessary for the pronunciation of sounds;

3. salivation;

4. violation of the phonetic side of speech:

a) a violation of sound pronunciation, which manifests itself in distortions, mixtures, substitutions, omissions of sounds. Characteristic is the simplification of articulation, when complex sounds are replaced by simpler ones in terms of their articulatory-acoustic features: slotted - explosive, voiced - deaf, hissing - whistling, hard - soft, affricates are split into their constituent sound elements;

b) violation of the prosodic side of speech: blurry, incomprehensible, monotonous, unmodulated and intonationally inexpressive speech.

5) underdevelopment of phonemic hearing and perception;

6) violation of the lexical and grammatical structure of speech (delay in the development of the semantic structure of the word, difficulties in distinguishing the grammatical forms of the word).

7) reduced level of stability and shifting of attention; small amount of memory; weakening of mental activity;

8) features of the emotional-volitional sphere: slight excitability, unstable mood, restlessness, tendency to irritability.

9) As the studies of many authors show, the leading defect in the structure of dysarthria is a persistent violation of the phonetic side of speech, which affects the formation of its other sides. Most often, these violations lead to a general underdevelopment of speech.

Children with erased dysarthria are a heterogeneous group. Depending on the level of development of language means, children are sent to specialized groups:

with phonetic disorders;

with phonetic-phonemic underdevelopment;

with general underdevelopment of speech.

According to E. F. Arkhipova, the first words are elementarily simple in phonetic terms. They consist of one or two open syllables. In two-syllable words, the syllables are predominantly the same ba-ba, ma-ma, bi-bi, etc., which resembles the repetition of syllables in babbling. Gradually, the child singles out the stressed syllable from the word, which is characterized by dynamic tension and in most cases occupies the initial position.

Thus, the pre-speech period is preparatory in relation to the actual speech activity. The child practices the articulation of individual sounds, syllables and syllabic combinations, coordination of auditory and speech-motor images takes place, intonation structures of the native language are worked out, prerequisites are formed for the development of phonemic hearing, without which it is impossible to pronounce the simplest word. The development of the phonemic side of speech is closely connected with the development of the motor sphere, with the improvement of the work of the peripheral speech apparatus.

The number of spoken sounds gradually increases. The mastery of speech sounds occurs in a certain ontogenetic sequence: labials appear earlier than lingual ones, and explosive sounds earlier than fricative ones. This is explained by the fact that it is much easier to pronounce a sound at the moment of opening the speech organs than to keep them close to each other for some time to form an affricate gap necessary for the passage of air jets; then affricates and sonorants are mastered.

Conventionally, the sequence of formation of the articulation base in ontogenesis can be represented as follows:

- by the first year - the bows of the organs of articulation appear;
- by one and a half years - it becomes possible to alternate positions (bow - gap);
- after three years - it becomes possible to lift the tip of the tongue up and tension the back of the tongue;
- by the age of five - there is a possibility of vibration of the tip of the tongue.

According to E. F. Arkhipova, violations of the sound-producing side of speech in children with an erased form of dysarthria are expressed in distortion, confusion, replacement, in omissions of sounds, which brings it closer to dyslalia. But with erased dysarthria, disturbances in sound pronunciation and prosodic components of speech are due to organic insufficiency of innervation of the muscles of the speech apparatus (respiratory, vocal and articulatory sections of the peripheral speech apparatus). With dyslalia, there are no violations of the innervation of the muscles of the speech apparatus.

To eliminate erased dysarthria, a complex effect is needed, including medical, psychological, pedagogical and speech therapy areas. The medical impact, determined by the neurologist, should include drug therapy, exercise therapy, reflexology, massage, physiotherapy, etc. The psychological and pedagogical impact carried out by speech pathologists, psychologists, educators, parents is aimed at:

development of sensory functions;

refinement of spatial representations;

formation of constructive praxis;

development of higher cortical functions;

- formation of fine differentiated hand movements;
-- formation of cognitive activity;
- psychological preparation of the child for schooling.

Speech therapy work with erased dysarthria provides for the mandatory inclusion of parents in correctional speech therapy work. Logopedic work includes several stages. At the initial stages, work is planned to normalize the muscle tone of the articulatory apparatus. To this end, a speech therapist conducts a differentiated massage. Exercises are planned to normalize the motor skills of the articulatory apparatus, exercises to strengthen the voice and breathing. Special exercises are introduced to improve millet speech. An obligatory element of speech therapy classes is the development of fine motor skills of the hands.

Children with erased dysarthria are characterized by:

phonetic disorders.

phonemic disorders.

Violation of prosodic.

4. Violation of the lexical and grammatical component of the language.

Disorder of general motor skills.

Fine motor skills disorder of the fingers.

Disorder of articulatory motility.

Many specialists dealt with the correction of dysarthria: O.V. Pravdina, E.M. Mastyukova, K.A. Semenova, L.V. Lopatina, N.V. Serebryakova, E.F. Arkhipova. All authors note the need for specific targeted work on the development of general motor skills, articulatory motor skills, fine motor skills of the fingers, as well as finger gymnastics, breathing and voice exercises.

Speech therapy work to eliminate erased dysarthria can include five stages.

Stage 1 - preparatory.

The purpose of this stage is to prepare the articulation apparatus for the formation of articulation structures. It includes six areas:

1) normalization of muscle tone,

normalization of motor skills of the articulation apparatus,

normalization of speech exhalation, development of a smooth, long exhalation,

prosodic normalization,

normalization of fine motor skills of the hands.

The 2nd stage is the development of new pronunciation skills and abilities. Directions:

development of basic articulation modes,

determining the sequence of work on sounds,

development of phonemic awareness,

sound setting,

automation,

6) differentiation (differentiation by ear; differentiation of articulation of isolated sounds; pronunciation differentiation at the level of syllables, words).
3rd stage -- development of communicative skills and abilities.

Directions:

developing self-control

training correct speech skills in various speech situations.

Stage 4 -- overcoming or preventing secondary violations.
Stage 5 - preparation for schooling. Directions:

formation of graphomotor skills,

development of connected speech,

3) the development of cognitive activity and the expansion of the child's horizons.

The sequence of practicing sounds is determined by the preparatoryness of the articulatory base. Particular attention is paid to the selection of lexical material in the automation and differentiation of sounds. One of the important points in speech therapy work is the development of self-control in the child over the implementation of pronunciation skills. Correction of erased dysarthria in preschool children prevents dysgraphia in schoolchildren.

Violation of the pronunciation of speech, due to insufficient innervation of the muscles of the speech apparatus, also refers to dysarthria (E.M. Mastyukova, M.V. Ippolitova). Leading in the structure of a speech defect in dysarthria is a violation of the sound-producing and prosodic side of speech. Mild brain disorders can lead to the appearance of blurred dysarthria, which should be considered as the degree of manifestation of dysarthria.

Speech is a complex set of nervous processes carried out with the joint activity of various stem-subcortical and cortical regions of the brain.

For the formation of speech function, biological prerequisites are necessary: the safety of auditory, visual, kinesthetic analyzers and a certain level of maturity of the nervous system, the timely flow of information from external objects and from the receptors of one's own body in the form of impulses going to the central nervous system along ascending afferent pathways. The afferentation system plays an important role in the development of speech, motor, emotional and volitional functions of the child.

The perception of speech is based on the analysis and synthesis of the elements of the sound stream and is carried out by the joint work of the auditory and kinesthetic analyzers. The process of pronunciation of speech sounds is a complex system of coordinated articulatory movements formed in previous individual experience and based on the work of kinesthetic and auditory analyzers.

Complex cortical systems process and store incoming information and develop a response program. The speech functional system implements the transmission of speech messages. For this, the motor efferent systems of the brain are used. With the defeat of these systems, dysarthria occurs, that is, a disorder of the direct motor mechanism of speech.

As studies by physiologists have shown, the formation of speech motor skills and, in particular, articulation is based on the development of a dynamic stereotype - a relatively stable system of conditioned reflexes that are formed as a result of repeated exposure to conditioned signals that repeat in time and follow in a certain order.

In children with erased dysarthria, the development of a dynamic stereotype presents a certain difficulty, which manifests itself in the difficulties of automating the correct pronunciation of sounds in spontaneous speech.

Sound speech is carried out due to the influence of three physiological functions: respiration, voice formation, articulation. These functions occur in certain organs of our body: the lungs, the diaphragm, the larynx with the vocal folds, and the articulatory apparatus, which includes the oral and nasal cavities. Active organs of articulation take part in the formation of sounds: lips, tongue, lower jaw, soft palate; vocal apparatus: larynx with vocal folds and pharynx; fixed organs of articulation: hard palate, teeth, upper jaw.

The energy or respiratory department includes the lungs, airways, intercostal muscles, abdominal septum (diaphragm). The regulation of the energy system is provided by a powerful component in the form of afferent and centrifugal impulses. Speech breathing is formed on the basis of normal physiological breathing. The nature of speech breathing varies depending on the volume, intonation and rhythmic structure of speech.

The voice-producing department is represented by the larynx with the vocal folds located in it. Sound vibrations arising in the larynx as a result of innervation and under the influence of a respiratory air stream are perceived by the auditory organ as the sound of a voice, which has three qualities:

- height (depends on the frequency of vibration of the vocal folds);
- force (depends on the amplitude of oscillations);
- timbre (depends on the shape of the resonator cavities and the structural features of the larynx).

In the formation of speech sounds, resonators are of great importance - the supraglottic cavities (oral, nasal, pharyngeal cavity). The presence of two resonance links provides a set of constant elements (formant) in the sound spectrum - "speech statics", and at the same time - "speech dynamics, syllabic quantization". The dynamic unit in the process of articulation is the syllable. Therefore, impulses to contract the muscles of the vocal folds are sent by the central nervous system simultaneously with impulses to contract the muscles of the articulatory apparatus. The qualities of the oral cavity as a resonator are determined by the shape of the hard palate and the nature of the bite, the size and shape of the mouth opening, the position of the tongue and the palatine curtain, the state of muscle tone of the soft palate and the back wall of the larynx. In addition to the main resonators, the cavities of the trachea, bronchi, and chest as a whole take part in the amplification and modulation of the voice.

The activity of active organs in the oral cavity is called articulation and provides the formation of speech sounds. The position that the organs of articulation take when pronouncing a particular sound is called the articulation mode. Each individual sound is characterized only by its inherent combination of various articulatory and acoustic features.

A common feature for all vowel sounds is the absence of obstacles in the path of exhaled air. When consonants are formed, various kinds of obstacles arise in the path of the exhaled air stream in the extension tube. Overcoming them, the air jet produces noises that are specific to each phonetic group of consonants. Just as the place of formation of the barrier is different, the method of its formation may also be different. In accordance with this, stop consonants are distinguished ([b], [b "], [n], [n "], [d], [d "] [t], [t "], [k], [k" ], [g], [g"]); slotted ([f], [f "], [c], [c"], [s], [s "], [h], [h "], [w], [g], [u], [x], [x "], [th]); lock-slit ([c], [h]) and lock-through ([m], [m "], [n], [n"], [ l], [l "], [p], [p "]).

A characteristic feature of consonants is the distinction between hard and soft sounds in them. Sound softening is achieved by its palatalization, that is, additional contraction of the muscles of the tongue with raising its back up and moving the entire articulation forward.

In a speech stream, speech sounds are almost never pronounced in isolation. They are pronounced as part of more or less automated sound sequences - syllables, words (groups of syllables united by a single stress), syntagmas (solid intonation-semantic measures), phrases. In such sound sequences, the sound of individual sounds acquires various positional features. From a physiological point of view, these features of articulation are the result of a delay in the previous sound setting: (“progressive assimilation”) and an earlier inclusion of articulatory movements characteristic of neighboring sounds (“regressive assimilation”). As a result, there is a mutual adaptation of articulatory structures that facilitate pronunciation. The manifestation of positional features of pronunciation contributes to the accelerated rhythm of speech.

Thus, the human speech apparatus is complex. The final cumulative effect of his activity is the sounds of speech. This apparatus is controlled by the nervous system, which innervates the muscles of the peripheral speech apparatus.

The main role in the innervation of the muscles of the peripheral speech apparatus is played by the facial, trigeminal, glossopharyngeal, vagus, and hypoglossal nerves. With lesions of these nerves, articulation and phonation disorders can be observed, leading to the appearance dysarthria.

So, with the defeat of the V-th pair - the trigeminal nerve - the movements of the lower jaw are disturbed. On the side of the lesion, the cheek hangs down, the nasolabial fold is smoothed, the corner of the mouth is lowered.

With the defeat of the VIIth pair - the facial nerve - the articulation of sounds is disturbed: [b], [p], [c], [f] due to the inability to fold the lips into a tube. In children with erased dysarthria, movements are not performed in full, inaccurately, with reduced muscle tone, in the presence of synkinesis. In all cases, there is difficulty in maintaining the articulatory posture. Violation of the function of the facial nerve is manifested in the impossibility or difficulty of performing facial movements.

With the defeat of the IXth pair - the glossopharyngeal nerve - in severe cases, paralysis of the muscles of the pharynx, tongue, soft palate occurs, phonation and articulation are disturbed, and with erased dysarthria, an insufficient elevation of the soft palate is characteristic, in some cases with a deviation of the small tongue to the side. Tasks associated with switching movements are performed with difficulty, with prolonged searches for articulation, in an incomplete volume, at a slow pace, with the appearance of concomitant movements in the mimic muscles, with a violation of lightness, smoothness, with the occurrence of perseverations and rearrangements. The possibility of simultaneous execution of movements is violated. There are erratic movements of the tongue.

With the defeat of the XII pair - the hypoglossal nerve - in severe cases, paralysis of the corresponding half of the tongue occurs. There is atrophy of the muscles of the tongue (thinning of the paralyzed half), hypotension (the tongue is thin, elongated), and the tongue deviates when it protrudes towards paralysis. Movement of the tongue to the affected side is limited or impossible. Limitation of the mobility of the tongue up, forward. Even minor lesions of this nerve disrupt the pronunciation [s], [s], [t], [d], [n], [h, c, u], [p, l].

Thus, the foregoing shows the complexity of the functional system of speech, which is controlled by the central nervous system. To control the motor mechanism of speech, the full functioning of various brain structures that are affected in children with erased dysarthria is necessary.

Dysarthria in children - causes, treatment with medicines, breathing exercises and massage. What is dysarthria in children and how is it treated? Characteristics of the speech of a child with dysarthria

General information

Causes of dysarthria

Classification of dysarthria

Symptoms of dysarthria

Characteristics of clinical forms of dysarthria

Diagnosis of dysarthria

Forecast and prevention of dysarthria

Dysarthria causes

Dysarthria in children

Forms of dysarthria

Erased dysarthria

Pseudobulbar dysarthria

Diagnosis of dysarthria

Dysarthria treatment

Correction of dysarthria

Psychological and pedagogical characteristics of children with dysarthria

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