Dysarthria is a speech disorder caused by changes in nervous regulation speech apparatus in which pronunciation suffers. Considering that in recent years the proportion of pathological pregnancies has been increasing, decreasing general level health of mothers and their children, the problem of speech disorders is becoming increasingly urgent.

Causes

The causes of dysarthria are:

• intrauterine infections;
• severe toxicosis during pregnancy in the mother;
• birth injury;
• past infections of the central nervous system(meningitis, encephalitis);
• malformations of the nervous system;
• severe hereditary diseases.

Classification

Speech therapists determine the types of dysarthria based on the severity of symptoms:

• severe (anarthria) - patients do not speak at all and there is complete immobility of the speech muscles.
• moderate severity, when the mobility of some muscle groups and the articulation of individual sounds are preserved.
• erased dysarthria(mild degree). In this case, there is blurred speech, children speak through their noses, and unclear sound pronunciation.

Neurologists classify dysarthria according to the location of the lesion in the brain. There are 5 forms:

• Cortical - the development of writing and reading is disrupted, the development of vocabulary is difficult. Individual sounds are pronounced well, but difficulties arise in the speech flow - replacing some sounds with others. When the rate of speech accelerates, hesitations begin, reminiscent of stuttering.
• Pseudobulbar form - voluntary movements change, for example, it is difficult to raise the tip of the tongue upward, but involuntary movements remain - stretching the lips with a tube, smacking, sticking out the tongue, licking, loud crying and laughter. Children cannot open their mouths or utter a sound upon request, while yawning, sneezing, crying, and coughing persist. The pronunciation of sounds is voiceless, but in some cases deaf people can be voiced. A sagging palate results in a nasal tone in speech. Fine motor skills of the hands suffer - it is impossible to tie shoelaces or fasten buttons independently. Children do not know how to sculpt and draw. As a rule, a child hears his defects and tries to fight them, which can lead to even greater manifestations of disorders due to increased muscle tone due to anxiety.
• Bulbar - leads to paresis or paralysis of the muscles of the tongue, palate, chewing and swallowing are impaired. The voice of such children is weak, pronunciation is nasal. Speech is slurred, unclear, unintelligible. On examination, you can see atrophy of the muscles of the tongue and pharynx, atony, and the face is amicable.

• Subcortical dysarthria is manifested by a violation of intonation and speech rate. More often it becomes noticeable with excitement and emotions. Features of this form are hyperkinesis both in the speech muscles and in the muscles of the body. The patient can correctly speak words and phrases with loved ones and in a state of emotional comfort, and a moment later - not utter a sound. The voice is interrupted, there may be spontaneous cries, guttural sounds. Characteristic is a violation of tempo, rhythm, and intonation. Manifestations vary depending on the patient’s condition and this affects the ability to communicate and maintain a conversation. Sometimes hearing loss may be concomitant, which complicates speech defects.

Symptoms

With dysarthria, the pronunciation of both consonants and vowels suffers. Violations can manifest themselves in the form of absence of sounds, replacement of them with others, distortion and mixing of them. The motility of the muscles responsible for the formation of speech changes - their tone is disrupted, which manifests itself both in increased spasticity of the muscles of the tongue, face, lips, neck, and hypotension (decreased tone).

Dystonia is manifested by the fact that at rest the muscle tone is reduced, but when trying to talk (speech, pronouncing words) it increases sharply. There may be restrictions on muscle mobility due to changes in tone and hyperkinesis (involuntary movements), tremor (shaking).

Speech breathing disorders are manifested by changes in the tone of the respiratory muscles, movement disturbances, changes in the voice, melody, and intonation. The strength of the voice may suffer, becoming weak and quiet, as if strength is running out. The timbre is dull, dull, and difficulties arise in changing the tone.

Dysarthria is often accompanied by symptoms not related to speech - these may be disturbances in chewing, swallowing, sucking, changes in the emotional-volitional sphere, lack of interest in the outside world and acquiring new knowledge.

Erased dysarthria

This is the most common type. Children speak through their noses and their intonation may be disrupted. When speaking, articulation is not expressed, lip movements are minimal. The problem is to form a tube from the lips. Patients have poor diction, unclear, slurred and slurred speech, replacement or distortion of sounds in polysyllabic words. The poems are told monotonously, the voice gradually fades away. When asked to imitate animal sounds, attempts are unsuccessful.

In general development, one can note awkwardness in movements; such children grasp and hold objects later than healthy ones, walk and run awkwardly, and it is difficult for them to jump on one or two legs. The child has a hard time learning to skate, ski, and ride a bike. Due to violation fine motor skills He is not good at sculpting his fingers, drawing, putting together mosaics, doesn’t like small toys and doesn’t play with construction sets. In children with erased form dysarthria, writing and reading is difficult, poor handwriting.

Dysarthria can be diagnosed based on several symptoms or syndromes. This may be a change in the tone of the muscles responsible for pronunciation and speech formation - facial expression, lethargy or spasticity of the tongue, trembling in the tongue, the inability to perform movements such as curling the lips into a tube, raising the tongue up and down. There is a nasal tone of speech and drooling.

Characteristic is difficulty in pronouncing not one, but several sounds, fading and slowing of speech towards the end of the phrase, pronunciation becomes unintelligible. The intonation changes and becomes unnatural. Children speak monotonously and slowly.

It is important to assess the medical history - the presence of previous intrauterine pathology or complications during childbirth, neurological and electrophysiological examination (electroneurography, electroencephalography).

Correction

Treatment by a neurologist is mandatory - medicinal and restorative, which is prescribed after establishing an accurate diagnosis and type of disease. In addition to medications, reflexology, massage, physiotherapeutic methods, and psychotherapy are used. Non-traditional forms of influence are widely used - dolphin therapy, play therapy.

Working with a speech therapist

Children with dysarthria need constant work with a speech therapist.

The specialist divides classes with children into specific blocks. First it is carried out speech therapy massage, which is designed to normalize the tone of the speech muscles. Next, articulatory gymnastics classes, breathing and intonation training. Children are taught to self-control their pronunciation. The exercises become more difficult as you master them.

Activities aimed at developing fine motor skills of the hands are mandatory, since the muscles responsible for precise small movements are associated with the articulatory apparatus.

In severe cases, training in special schools for speech correction is indicated.

Prevention

Children with an increased risk of developing dysarthria (pathology of intrauterine development, trauma during childbirth, previous neuroinfections) need constant attention with an emphasis on psychophysiological development. It is necessary to monitor the regime and prevent the influence of unfavorable physical and psychological factors.

These children need constant communication, conversation, it is necessary to support babbling at an early age, and stimulate babbling. Attention is paid to the development of grasping movements, encouraging the exploration of toys of various shapes and surfaces.

Forecast

With the earliest possible start of correction and rehabilitation in the case of an erased form of dysarthria, the prognosis is favorable. Success depends on the diligence of the patient himself, a favorable psychosocial background, and the support of parents and loved ones.

When severe forms with timely treatment, active work with a speech therapist, and placement of children in special schools, a significant improvement in speech can be achieved.

In the video, the speech therapist teacher talks about games and techniques that parents can use to develop their children’s speech:

When asked what could cause this type of disease, doctors list a whole range of physiological reasons, including:

• Incorrect innervation of the speech apparatus. It entails insufficiency of articulatory muscles, for example, the tongue, palate, lips. In addition, the disorder is accompanied by imprecise movements and rapid exhaustion due to damage to the central nervous system.
• Disorders motor function. The child cannot quickly determine and find the correct position of the articulatory muscles, which allows him to correctly pronounce a sound or word.
• Oral apraxia and minimal brain dysfunction that does not change as the disease progresses.

Unlike other forms, erased can occur in children without impaired body mobility. It can be caused by mild asphyxia or trauma received during childbirth.

Symptoms

It is the erased form of the disease that most often manifests itself in children aged 1 year and older. The prevalence of this type of dysarthria is very high. Pathology can be recognized by paying attention to characteristic first signs that are expressed as follows:

• the child says “on the nose”
• serious violations of intonation are obvious,
• articulatory muscles are inactive,
• when pronouncing sounds, the child’s lips remain motionless,
• folding your lips into a “tube” or stretching them into a wide smile is a difficult task for children,
• speech is slurred and unclear.

Manifestations of the disease begin with the child uttering his first words much later than his peers. At an earlier age, the baby does not “boom”; the babbling characteristic of babies is practically or completely absent. Signs of dysarthria in children of primary and secondary school age include the inability to read poems or prose texts with expression. During the process of monologue or reading, the child’s voice gradually fades away, becoming barely audible and very quiet. In addition to speech dysfunction, the minor patient has problems with fine motor skills, simple movements, and writing.

When it comes to speech symptoms, there are substitutions, distortions and exclusions of “problematic” sounds from speech. The child strives to simplify articulation as much as possible, as a result of which he chooses monosyllabic words without hissing or whistling sounds. In some cases, the erased form of the disease is accompanied by damage to the nerves responsible for eye mobility.

Diagnosis of erased dysarthria in a child

Typically, the person responsible for making the diagnosis is children's speech therapist. Diagnosis of the disease in minor patients begins with a conversation with parents and study of data clinical picture. Next, in order to determine an accurate diagnosis, the specialist examines:

• Motor skills - both general and fine. The doctor may ask the patient to stand or jump on one leg, which the child, as a rule, cannot cope with. To test fine motor skills, the doctor suggests working with pencils.
• Mobility of facial and articulatory muscles. The speech therapist’s task is to assess the degree of deviation of tone indicators from normal.
• Breathing. The doctor may ask the child to puff out his cheeks, fill the space under his lip with air, or move it from side to side.

Laboratory tests for dysarthria are not prescribed.

Complications

The question of why erased dysarthria is dangerous is relevant for all parents. To the list of possible negative consequences includes:

• Psychological trauma, tendency to depression.
• Problems with external communications.
• Social problems in relationships with loved ones.

Treatment

What can you do

In the case of an erased form of dysarthria, a noticeable normalization of speech is possible, up to clear and free pronunciation of all sounds. The child acquires the necessary skills, which allows him to attend educational institutions with extra classes at the clinic or at school. The disease can be cured using conservative treatment methods and speech therapy sessions.

It will take quite a long time to treat dysarthria, and the child may already feel different from other children at an early age. The task of parents is to prevent the development of complexes and psychological trauma. It is necessary to provide maximum support and take an active part in the treatment process. Home speech therapy sessions are required. You can find out what to do at home directly from a speech therapist or neurologist.

What does a doctor do

First aid for a child with an erased form of dysarthria consists of effective treatment of the underlying disease. In addition, additional stimulation of the central nervous system may be required. To do this, the doctor prescribes appropriate nootropic drugs that improve brain activity, intelligence, and memory. Drug treatment and physical therapy are selected taking into account the patient’s condition and age.

Prevention

It is almost impossible to prevent the disease. The only ways Minimizing risks means avoiding birth and traumatic brain injuries. Constant monitoring throughout the entire period of pregnancy is important, refusal bad habits. Warning recommended infectious diseases or their careful treatment.

Also watching

Arm yourself with knowledge and read a useful informative article about the disease erased dysarthria in children. After all, being parents means studying everything that will help maintain the degree of health in the family at around “36.6”.

Find out what can cause the disease and how to recognize it in a timely manner. Find information about the signs that can help you identify illness. And what tests will help identify the disease and make a correct diagnosis.

In the article you will read everything about methods of treating a disease such as erased dysarthria in children. Find out what effective first aid should be. How to treat: choose medications or traditional methods?

You will also learn how untimely treatment of erased dysarthria in children can be dangerous, and why it is so important to avoid the consequences. All about how to prevent erased dysarthria in children and prevent complications.

And caring parents will find on the pages of the service full information about the symptoms of the disease erased dysarthria in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat the disease erased dysarthria in children?

Take care of the health of your loved ones and stay in good shape!

The erased form of dysarthria or pseudobulbar is a violation of speech activity due to articulation disorders with lesions of the nervous system. Deviations in this form of dysarthria are difficult to identify without the help of a specialist. A characteristic manifestation is clarity in the pronunciation of isolated sounds, but poor differentiation and automation of pronunciation during speech flow. Obvious symptoms erased is:

• slurred speech;
• difficulties with diction;
• distorted pronunciation of sounds;
• automatic replacement of syllables based on pronunciation adjacency.

What is erased dysarthria?

Modern speech therapy cannot give an unambiguous definition of the term “erased dysarthria.” It is believed that this is a pathological disease, which manifests itself in the distortion of phonetic prosodic components of speech activity, due to the presence of microorganic effects on the brain.

This concept appeared in the scientific literature relatively recently, and it was introduced by O. Tokareva, who designated erased dysarthria as a form of the disease that has mild symptoms. The presence of erased dysarthria can be detected only after reaching 5 years of age. The disease requires long-term complex treatment in combination with individual speech therapy. Universal techniques correctional work does not yet exist, but the presence of the disease can be diagnosed at early stage development. The complex of therapy methods includes:

• drug treatment;
• psychological and pedagogical correctional work;
• speech therapy classes.

The most common causes of the disease in children are:

• intrauterine development disorders;
• infectious diseases brain;
• injuries received during childbirth.

Symptoms of manifestation

Modern speech therapy identifies symptoms of the disease in children at three levels: general motor skills, fine motor skills of the hands and articulatory apparatus.

Modern speech therapy considers characteristic signs of the development of the disease in children to be unclear pronunciation, involuntary changes in movements and weakness of articulatory muscles in the process of speech activity and exercises.

Pronunciation of sounds

The symptoms of the disease are similar, as is dyslalia (difficulty with sound pronunciation). During the initial examination of children, distortion, replacement and mixing of sounds are observed, but prosodic disturbances occur only in the erased form.

The main difference between the disease is the correct pronunciation of isolated sounds. An obvious sign of the disease is difficulty pronouncing whistling and hissing sounds. The articulatory apparatus is not capable of distinguishing sounds according to an adjacent method of formation, therefore overtones of acoustically opposed sounds are observed. The sound content of speech is simplified and assimilation of sound structures occurs.

General development of the speech apparatus

Conventionally, children with erased dysarthria can be divided into 3 groups:

1. Patients with difficulties in differentiating sounds and prosody. The level of development of the speech apparatus in such children is at a high level, and the disease manifests itself in difficulties in using prepositions. A disorder in the pronunciation of complex syllable structures is accompanied by a lack of spatial orientation.
2. There is a developmental disorder phonemic hearing against the background of prosody and difficulties with the pronunciation of sounds. The speech contains lexical and grammatical errors. There is no sound differentiation skill.
3. Polymorphic deviations in sound differentiation and underdevelopment phonemic awareness characteristic of the third group. Lexicon and lack of knowledge of grammar are combined with difficulties in constructing syllable structures.

Patients are unable to clearly express their thoughts. Against the background of difficulties with articulation, a perception disorder develops, which subsequently leads to the development of mental disorders.

Impaired sound pronunciation always causes discomfort and fear in a person. What does it mean when we hear a diagnosis of dysarthria?

Dysarthria is a speech disorder caused by damage to the functions of the speech apparatus, during which the connection of cells and tissues with nerve endings is disrupted, which causes restriction of the movement of the speech organs, thereby complicating articulation.

Dysarthric speech is characterized by unintelligibility and crumpledness. Children may experience general developmental delays due to the disease's effect on speech and writing. In adults, impairments in writing and auditory perception of speech are not detected. Despite this, the disease causes the same discomfort at any age.

Neurological classification of deviation is based on the area of ​​damage to the speech-motor system. Based on the principle of localization of the focus of disease development, the following forms of dysarthria are distinguished.

Bulbarnaya

With this form of the disease, a decrease in muscle tone or atrophy of the muscles of the speech apparatus occurs. The deviation occurs due to the development of tumor or inflammatory processes in the medulla oblongata, which destroys the nuclei of the motor nerves. The speech of this form of dysarthria is characterized by slowness, incomprehensibility and nasal sound.

Pseudobulbar

Most often, pseudobulbar dysarthria is diagnosed in children as a result of brain damage suffered before the age of one year. Speech is slow, slurred, with impaired reproduction of whistling, hissing and sonorant sounds. Pseudobulbar dysarthria in children is characterized by limited movement of the lips and tongue. Patients are prone to profuse salivation and increased pharyngeal reflex.

Subcortical

Develops due to damage to the subcortical nodes of the brain. Symptoms include slow, slurred speech and frequent involuntary movements of the facial or articulatory muscles, causing spasms facial muscles and uncontrollable guttural screams. There may be a change in the tempo and timbre of speech and a violation of intonation.

Cerebellar

This diagnosis is made quite rarely. Speech is characterized by fluctuations in volume, chanting of words and shouting of individual sounds. There is also unsteadiness of gait, awkwardness, and imbalance.

Cortical

Characterized by impaired articulation. When pronouncing words correctly, it may be difficult to reproduce syllables. There are no reading or writing impairments.

According to the classification of speech therapists, based on the degree of speech intelligibility, there are 4 forms of dysarthria.

1. At the first stage, speech disorders are invisible to others and can only be identified by a specialist. This stage of the disease also has two other names: erased dysarthria and dysarthric component.
2. The deviation becomes noticeable to others. Speech intelligibility is maintained.
3. Speech defects are clearly expressed. The patient's speech is understandable only to those close to him.
4. Speech is completely incomprehensible or absent altogether.

Regardless of the principles by which the types of dysarthria are distinguished, first of all, it is important to identify the cause of dysarthria.

Causes

Dysarthria in adults in most cases is a consequence of injury or disease of the brain. Thus, the following factors can be the reasons for the development of dysarthria in an adult:

• head injuries;
• stroke;
• tumor formations in areas of the brain;
• neurosurgical operations;
• neurosyphilis;
• oligophrenia;
• Parkinson's disease;
• multiple sclerosis;
• myatonia;
• myasthenia gravis, etc.

Often this disease is diagnosed in children under 5 years of age. Typically, dysarthria in a child develops in parallel with childhood cerebral palsy, being its consequence. This is due to damage to the central nervous system, which can occur both in utero and after birth for about 2 years.

The following factors may affect the unborn fetus:

• toxicosis during pregnancy;
• Rhesus conflict;
• birth injuries;
• asphyxia during childbirth;
• development of pathologies during pregnancy;
• prolonged or rapid labor;
• premature birth, etc.

Development of dysarthria in postpartum period usually associated with infectious diseases of the brain, otitis media, severe poisoning, traumatic brain injury and other reasons.

Symptoms

With dysarthria at any age, speech activity is impaired, caused by a weakening of the connection between the cells and tissues of the speech apparatus and the nerve endings. This, in turn, changes the breathing rhythm at the time of speech, making it intermittent and rapid.

The speech of a dysarthric person is unclear and incomprehensible. Depending on the stage of dysarthria, speech impairments of varying severity are observed. Thus, erased dysarthria in preschool children and adults is characterized by subtle disturbances in the pronunciation of certain sounds. Further stages of the development of the disease are characterized by more obvious speech defects (missing sounds, slow speech). The most severe stage of dysarthria is characterized by paralysis of the muscles of the speech apparatus and, as a consequence, the patient’s inability to speak.

Articulation disorders manifest themselves, as a rule, in an increase or decrease in the tone of the muscles of the speech apparatus. With increased tone, tension in the muscles of the face, neck, lips and tongue is observed. If the disease occurs with decreased muscle tone, lethargy appears in the muscles of the tongue and lips. Lips and mouth slightly open, characteristic copious discharge saliva.

If dysarthria is diagnosed in a child, as a result there is a distortion of auditory perception of speech and other disorders, which causes the development of associated speech abnormalities related nature and deviations in the general development of the child.

Typically, dysarthria in a child is detected no earlier than 5 years of age. As a rule, erased dysarthria is characterized by speech impairments that are little noticeable and can be easily corrected, so that children can study in regular educational institutions. If dysarthria in a child is severe, it is necessary to enroll the child in specialized educational institutions.

For dysarthria in up to school age treatment should begin immediately. It can be difficult to identify the disease yourself at home, since at this age children are just developing their speech characteristics, and making mistakes is quite natural. Parents should pay attention to some other factors. Thus, in children who may have a dysarthric component, fine motor skills of the hands are impaired, which causes difficulties with tying shoelaces, fastening buttons or zippers, modeling plasticine, etc.

Moreover, even an erased form of dysarthria in children causes weakening of the facial muscles and muscles of the speech apparatus, as a result of which the child’s face may look sluggish, the mouth is usually slightly open, and insufficient tone of the tongue muscles creates obstacles in sound pronunciation.

Diagnostics

Diagnosis of the disease takes place in two stages: a neurological examination performed using clinical tests, and speech therapy examination.

The tests and procedures that a patient must go through during a neurological examination include the following:

• magnetic resonance imaging of the brain;
• electroneurography;
• electroencephalography;
• electromyography;
• transcranial magnetic stimulation and other procedures.

An examination by a speech therapist is aimed at identifying certain speech and articulation defects in the patient. The activity of the articulatory apparatus and the condition of the muscles of the speech apparatus and facial muscles are assessed, as well as who, like the patient, breathes.

Diagnosis of dysarthria includes

Correction

Treatment of dysarthria is considered successful, as a result of which the patient restores his ability to express himself clearly to others. In order to achieve this goal, an integrated approach is needed to how to treat the disease, which is based on the correct diagnosis of dysarthria, competent drug treatment, speech therapy correction of dysarthria and physiotherapeutic measures.

Drug treatment is prescribed by a specialist after a complete examination of the patient. However, the problem cannot be solved with medication alone, so physiotherapeutic measures are included in the patient’s course of treatment.

The patient is prescribed medicinal baths, special physical exercise, acupuncture, various types of massages, as well as such non-traditional, but, nevertheless, effective methods corrections such as swimming and communication with dolphins, creative therapy, creative and educational games with sand and much more.

Speech therapy measures to correct dysarthria are aimed at restoring the articulatory apparatus. During classes, the speech therapist works with the patient on pronouncing sounds, establishing proper breathing and voice, performs special gymnastics to develop the articulatory apparatus, and also massages the tongue.

Treatment of dysarthria in a child should be based on speech therapy sessions, as well as treatment at home.

Exercises for children at home

Classes with a speech therapist are pointless if dysarthria is not corrected at home. A child under 6 years old with dysarthria urgently needs the constant attention of his parents, who, in turn, must devote a lot of time to special classes aimed at restoring the child’s speech functions.

First, you need to massage the facial muscles, during which you need to alternately pinch and stroke the child’s lips, cheeks and lower jaw. It is also important to teach your child to massage himself, standing in front of a mirror, which will help him study his face and the work of the muscles of the tongue and lips.

To restore the correct functioning of the speech apparatus, it is important to hone the movements of the jaw to open and close the mouth, fix a certain position of the jaw, depict an animal grin and make pipes with the lips.

Your child will love playing with lollipops. So, the child must hold the lollipop in his mouth, and mom and dad try to pull it out. As the size of the candy decreases, it will become more difficult to hold it. You can also apply the candy first to the right and then to the left corner of the mouth so that the child tries to reach it with his tongue in this position.

You can develop hand motor skills at home with the help of small objects, such as peas or beads, which the child must sort through. The baby will enjoy the process if the parents try to make it look like a game for the baby.

Prognosis and prevention

Many patients and their loved ones are concerned about the question of whether it is possible to completely recover from dysarthria. There are no exact forecasts in this regard, since in relation to the correction of dysarthria it is important to diagnose the disease in a timely manner and begin treatment. In addition, absolute restoration of the functions of the speech apparatus is possible only in the case of a mild disease, that is, with erased dysarthria.

Erased dysarthria in preschool children is corrected as the child grows and develops. In subsequent stages there is a chance for some improvement in speech, but the severe degree cannot be completely cured.

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Erased dysarthria in children

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Erased dysarthria in children

The textbook is devoted to the study of erased dysarthria, examination methods and planning of correctional and speech therapy work.

The first chapter presents an analysis of literary data of a theoretical and methodological nature.

The second chapter provides a detailed clinical and pedagogical description of children with erased dysarthria. Data from recent years are presented.

The fourth chapter describes the physiological basis of the formation of speech function. An analysis of information about the state of the phonetic aspect of speech in children with erased dysarthria is given in comparison with the state of the phonetic system at different stages of ontogenesis. Modified methods for examining sound pronunciation in this category of children are proposed, taking into account the phonetic context. Using the example of an examination of whistling sounds, the interdependence of the quality of sound pronunciation and the increasingly complex phonetic and lexical context is demonstrated. The graphic diagram reflects the most difficult positions of sounds in spontaneous speech for children with erased dysarthria. Taking this data into account, it is possible to plan the correction of sound pronunciation in more detail.

The second section of the fourth chapter is devoted to the study of phonemic hearing both in ontogenesis and in cases with erased dysarthria. For the examination of phonemic hearing, a scheme for a systematic examination of phonemic hearing is also proposed.

In the fifth chapter, the state of sound-syllable | structures in children with erased dysarthria in comparison with the ontogenetic development of the sound-syllable structure, and a detailed system for examining the syllabic structure of a word is proposed.

The sixth chapter includes the study of the lexical and grammatical structure of speech. As in previous chapters, a detailed survey design has been developed using scoring criteria.

The seventh chapter is devoted to the least studied section - the state of the prosodic side of speech in children with erased dysarthria.

Material is presented on the development of intonation-expressive means in ontogenesis and some information about specific prosody disorders in children with erased dysarthria. A detailed prosody examination scheme has been developed.

CHAPTER I
The problem of studying erased dysarthria
in specialized literature

Erased dysarthria occurs very often in speech therapy practice. The main complaints with erased dysarthria: slurred, inexpressive speech, poor diction, distortion and replacement of sounds in words with complex syllable structure, etc.

Erased dysarthria is a speech pathology manifested in disorders of the phonetic and prosodic components of speech functional system and arising as a result of unexpressed microorganic damage to the brain (L.V. Lopatina).

Studies of children in mass kindergartens have shown that in senior and preparatory school groups from 40 to 60% of children have deviations in speech development. Among the most common disorders: dyslalia, rhinophonia, phonetic-phonemic underdevelopment, erased dysarthria.

In groups for children with general speech underdevelopment, up to 50% of children, and in groups with phonetic-phonemic underdevelopment - up to 35% of children have mild dysarthria. Children with severe dysarthria need long-term, systematic individual speech therapy assistance. Speech therapists of specialized groups plan speech therapy work as follows: in frontal, subgroup classes with all children they study program material aimed at eliminating general speech underdevelopment, and in individual classes they correct the pronunciation side of speech and prosody, i.e. elimination of symptoms of erased dysarthria.

Diagnosis of erased dysarthria and methods of correction work have not yet been sufficiently developed. In the works of G.G. Gutzman, O.V. Pravdina, L.V. Melekhova, O.A. Tokareva, I.I. Danchenko, R.I. Martynova discusses the symptoms of dysarthric speech disorders, in which there is a “washed out”, “erased” articulation. The authors note that erased dysarthria is very similar in its manifestations to complex dyslalia. In the works of L.V. Lopatina, N.V. Serebryakova, E.Ya. Sizova, E.K. Makarova and E.F. Sobotovich raises issues of diagnosis, differentiation of training and speech therapy work in groups of preschool children with erased dysarthria. The problems of differential diagnosis of erased dysarthria and the organization of speech therapy assistance for these children remain relevant, given the prevalence of this defect.

The erased form of dysarthria is most often diagnosed after five years. All children whose symptoms correspond to erased dysarthria are sent for consultation to a neurologist to clarify or confirm the diagnosis and to prescribe adequate treatment, because for erased dysarthria, the method of correction work should be comprehensive and include:

Medical exposure;

Psychological and pedagogical assistance;

Speech therapy work.

For early detection erased dysarthria and the correct organization of complex effects, it is necessary to know the symptoms that characterize these disorders. The examination of the child begins with a conversation with the mother and study of the child’s outpatient development chart. Analysis of anamnestic information shows that there are: deviations in intrauterine development (toxicosis, hypertension, nephropathy, etc.); asphyxia of newborns; rapid or prolonged labor. According to the mother, “the child did not cry right away; the child was brought in to be fed later than everyone else.” In the first year of life, many were observed by a neurologist and prescribed medication and massage. The diagnosis for up to a year was NEP (perinatal encephalopathy). The development of a child after one year, as a rule, is successful for everyone, the neurologist no longer observes these children, and the child is considered healthy.

When examined in a clinic by a speech therapist, children aged 5-6 years with erased dysarthria reveal the following symptoms:

GENERAL MOTOR SKILLS. Children with erased dysarthria are motorically awkward, the range of active movements is limited, the muscles quickly tire during functional loads. They stand unsteadily on one leg, cannot jump on one leg, walk along a “bridge,” etc. They imitate movements poorly: how a soldier walks, how a bird flies, how bread is cut, etc. Motor incompetence is especially noticeable in physical education and music classes, where children lag behind in tempo, rhythm of movements, as well as in switching movements.

FINE MOTOR SKILLS OF HAND. Children with erased dysarthria late and have difficulty mastering self-care skills: they cannot button a button, untie a scarf, etc. During drawing classes, they don’t hold a pencil well and their hands are tense. Many people don't like to draw. Motor clumsiness of the hands is especially noticeable during applique classes and with plasticine. In works on appliqué, difficulties in the spatial arrangement of elements can also be traced. Violation of fine differentiated movements of the hands is manifested when performing sample tests of finger gymnastics. Children find it difficult or simply cannot perform an imitation movement without outside help, for example, “lock” - put their hands together, intertwining their fingers; “rings” - alternately connect with thumb index, middle, ring and little fingers and other finger gymnastics exercises.

During origami classes they experience great difficulties and cannot perform the simplest movements, because... both spatial orientation and subtle differentiated hand movements are required. According to mothers, many children under 5-6 years old are not interested in playing with construction sets, do not know how to play with small toys, and do not assemble puzzles.

School-age children in the first grade experience difficulties in mastering graphic skills (some experience “mirror writing”; substitution of letters “d”-“b”; vowels, word endings; poor handwriting; slow pace of writing, etc.).

FEATURES OF THE ARTICULATING APPARATUS. In children with erased dysarthria, pathological features in the articulatory apparatus are revealed.

Pareticity muscles of the organs of articulation are manifested in the following: the face is hypomimic, the facial muscles are flaccid upon palpation; Many children do not maintain the closed mouth pose, because the lower jaw is not fixed in an elevated state due to laxity of the masticatory muscles; lips are flaccid, their corners are drooping; During speech, the lips remain flaccid and the necessary labialization of sounds is not produced, which worsens the prosodic side of speech. The tongue with paretic symptoms is thin, located at the bottom of the mouth, flaccid, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.

Spasticity muscles of the organs of articulation is manifested in the following: the face is amicable, the facial muscles upon palpation are hard and tense. Such a child’s lips are constantly in a half-smile: upper lip presses against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the “tube” articulation exercise, i.e. pull the lips forward, etc. With a spastic symptom, the tongue is often changed in shape: thick, without a pronounced tip, inactive.

Hyperkinesis with erased dysarthria, they manifest themselves in the form of trembling, tremor of the tongue and vocal cords. Tremor of the tongue appears during functional tests and loads. For example, when asked to support a wide tongue on the lower lip with a count of 5-10, the tongue cannot maintain a state of rest, tremors and slight cyanosis appear (i.e., blue discoloration of the tip of the tongue), and in some cases the tongue is extremely restless (waves roll through the tongue in longitudinal or transverse direction). In this case, the child cannot keep his tongue out of the mouth. Hyperkinesis of the tongue is often combined with increased muscle tone of the articulatory apparatus.

Apraxia with erased dysarthria, it is simultaneously revealed in the inability to perform any voluntary movements with the hands and organs of articulation. In the articulatory apparatus, apraxia manifests itself in the inability to perform certain movements or when switching from one movement to another. Kinetic apraxia can be observed when the child cannot smoothly transition from one movement to another. Other children experience kinesthetic apraxia, when the child makes chaotic movements, “groping” for the desired articulatory position.

Deviation, those. deviation of the tongue from the midline, also manifests itself during articulation tests and during functional loads. Deviation of the tongue is combined with asymmetry of the lips when smiling with a smoothness of the nasolabial fold.

Hypersalivation(increased salivation) is determined only during speech. Children cannot cope with salivation, do not swallow saliva, and the pronunciation side of speech and prosody suffer.

When examining the motor function of the articulation apparatus in children with erased dysarthria, the ability to perform all articulation tests is noted, i.e. Children, according to instructions, perform all articulatory movements - for example, puff out their cheeks, click their tongue, smile, stretch out their lips, etc. When analyzing the quality of performing these movements, one can note: blurriness, unclear articulation, weakness of muscle tension, arrhythmia, decreased range of movements, short duration of holding a certain pose, decreased range of movements, rapid muscle fatigue, etc. Thus, under functional loads, the quality of articulatory movements sharply falls. During speech, this leads to distortion of sounds, their mixing and deterioration in the overall prosodic aspect of speech.

SOUND PRONUNCIATION. When first meeting a child, his sound pronunciation is assessed as complex dyslalia or simple dyslalia. When examining sound pronunciation, the following are revealed: confusion, distortion of sounds, replacement and absence of sounds, i.e. the same options as for dyslalia. But, unlike dyslalia, speech with erased dysarthria also has disturbances on the prosodic side. Impaired pronunciation and prosody affect speech intelligibility, intelligibility, and expressiveness. Some children go to the clinic after classes with a speech therapist. Parents ask why the sounds that the speech therapist provided are not used in the child’s speech. The examination reveals that many children who distort, omit, mix or replace sounds can pronounce these same sounds correctly in isolation. Thus, sounds in erased dysarthria are produced in the same ways as in dyslalia, but for a long time they are not automated and are not introduced into speech. The most common violation is a defect in the pronunciation of whistling and hissing sounds. Children with erased dysarthria distort and mix not only articulatory complex sounds that are close in place and method of formation, but also acoustically opposed ones.

Quite often, interdental pronunciation and lateral overtones are noted. Children have difficulty pronouncing words with a complex syllabic structure; they simplify the sound content by omitting some sounds when consonants are combined.

PROSODICA. The intonation-expressive coloring of the speech of children with erased dysarthria is sharply reduced. The voice, vocal modulations in pitch and strength suffer, speech exhalation is weakened. The timbre of speech is disrupted and sometimes a nasal tone appears. The pace of speech is often accelerated. When reciting a poem, the child’s speech is monotonous, gradually becomes less intelligible, and the voice fades away. The children's voice during speech is quiet, modulation in pitch and voice strength is not possible (the child cannot change the pitch of the voice by imitation, imitating the voices of animals: cows, dogs, etc.).

In some children, speech exhalation is shortened, and they speak while inhaling. In this case, speech becomes choked. Quite often, children are identified (with good self-control) in whom, during a speech examination, deviations in sound pronunciation do not appear, because They pronounce the words in a chant, i.e. by syllables, and only violation of prosody comes first.

GENERAL SPEECH DEVELOPMENT. Children with erased dysarthria can be divided into three groups.

First group. Children who have impaired sound pronunciation and prosody. This group is very similar to children with dyslalia. Often speech therapists treat them as dysleptics and only in the process of speech therapy work, when there is no positive dynamics when automating sounds, a suspicion arises that this is erased dysarthria. Most often, this is confirmed during a thorough examination and after consultation with a neurologist. These children have good level speech development, but many of them experience difficulties in mastering, distinguishing and reproducing prepositions. Children confuse complex prepositions and have problems distinguishing and using prefixed verbs. At the same time, they speak coherently and have a rich vocabulary, but may have difficulty pronouncing words with a complex syllabic structure (for example, frying pan, tablecloth, button, snowman and so on.). In addition, many children experience difficulties with spatial orientation (body diagram, concepts of “below and above,” etc.).

Second group. These are children in whom a violation of sound pronunciation and the prosodic side of speech is combined with the incomplete process of forming phonemic hearing. In this case, children encounter isolated lexical and grammatical errors in their speech. Children make mistakes in special tasks when listening and repeating syllables and words with oppositional sounds - for example, when asked to show the desired picture ( mouse-bear, fishing rod-duck, scythe-goat etc.) .

Thus, in children, the auditory and pronunciation differentiation of sounds is unformed. Children's vocabulary lags behind the age norm. Many people experience difficulties in word formation, make mistakes in agreeing a noun with a numeral, etc. Sound pronunciation defects are persistent and are regarded as complex, polymorphic disorders. This group of children with phonetic-phonemic underdevelopment (FFN) and erased dysarthria should be referred by the speech therapist of the clinic to the MPC (medical-pedagogical commission), to a specialized kindergarten (to the FFN group).

Third group. These are children who have a persistent polymorphic disorder of sound pronunciation and a lack of prosodic aspect of speech combined with underdevelopment of phonemic hearing. As a result, the examination reveals a poor vocabulary, pronounced errors in grammatical structure, the impossibility of a coherent statement, and significant difficulties in mastering words of different syllabic structures.

All children in this group demonstrate immature auditory and pronunciation differentiation. Ignoring prepositions in speech is indicative. These children with erased dysarthria and general speech underdevelopment (GSD) should be referred to MPC (to specialized groups kindergarten) into OHP groups.

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

With phonetic disorders;

With phonetic-phonemic underdevelopment;

With general speech underdevelopment.

To eliminate erased dysarthria, a complex intervention is necessary, including medical, psychological, pedagogical and speech therapy areas. Medical intervention determined by a neurologist should include drug therapy, exercise therapy, reflexology, massage, physiotherapy, etc. Psychological and pedagogical intervention carried out by defectologists, psychologists, educators, and parents is aimed at:

Development of sensory functions;

Clarification of spatial representations;

Formation of constructive praxis;

Development of higher cortical functions;

Formation of subtle differentiated hand movements;

Formation cognitive activity;

Psychological preparation of the child for school.

Speech therapy work for erased dysarthria requires the mandatory inclusion of parents in correctional speech therapy work. Speech therapy work includes several stages. At the initial stages, work is envisaged to normalize the muscle tone of the articulatory apparatus. For this purpose, the speech therapist conducts 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 speech prosody. Required element speech therapy session is the development of fine motor skills of the hands.

The sequence of practicing sounds is determined by the preparedness of the articulatory base. Special attention is paid to the selection of lexical material for 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 aspect of speech, caused by insufficient innervation of the muscles of the speech apparatus, also refers to dysarthria (E.M. Mastyukova, M.V. Ippolitova). The leading structure of a speech defect in dysarthria is a violation of the sound pronunciation and prosodic aspects of speech. Mildly expressed brain disorders can lead to the appearance of erased dysarthria, which should be considered as the degree of manifestation of dysarthria.

Faint, erased disorders of the cranial nerves can be identified during long-term, dynamic observation, when performing increasingly complex motor tasks. M.B. Eidinova, E.N. Pravdina-Vinarskaya describes cases of mild residual innervation disorders encountered during an in-depth examination, which underlie violations of full articulation, which leads to inaccurate pronunciation.

Erased dysarthria can be observed in children without obvious movement disorders, who have suffered mild asphyxia or birth trauma, who have a history of PEDs and other mildly expressed adverse effects during fetal development or during childbirth, as well as after birth. In these cases, mild (erased) dysarthria is combined with other signs of minimal brain dysfunction(E.M. Mastyukova). The brain of a young child has significant plasticity and high compensatory reserves. A child with early cerebral damage by the age of 4-5 years loses most of the symptoms, but a persistent violation of sound pronunciation and prosody may remain. In children with erased dysarthria, due to damage to the central nervous system and impaired innervation of the muscles of the speech apparatus, the necessary kinesthesia is not formed, as a result of which the pronunciation side of speech does not spontaneously improve.

Existing methods correction of erased dysarthria in preschool children does not solve the problem in full, and further development of methodological aspects of eliminating dysarthria is relevant. A study of preschool children with erased dysarthria showed that, along with disturbances in the function and tone of the articulatory apparatus, a deviation in the state of gross and fine manual motor skills is characteristic of this group of children, which is consistent with the literature data of recent years.

Many works emphasize that with erased dysarthria, the development of fine motor skills of the hands is necessary. The proximity of the cortical zones of innervation of the articulatory apparatus with the zones of innervation of the muscles of the fingers, as well as neurophysiological data on the importance of manipulative activity of the hands for stimulating speech development, determine this approach to correctional work.

Children with erased dysarthria are characterized by:

1. Phonetic disorders.

2. Phonemic disorders.

3. Violation of prosody.

4. Violation of the lexico-grammatical component of the language.

5. Gross motor disorder.

6. Fine motor skills disorder of the fingers.

7. Articulatory motor disorder.

Many specialists dealt with the issues of dysarthria correction: 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 purposeful work on the development of general motor skills, articulatory motor skills, fine motor skills of the fingers, as well as finger exercises, breathing and voice exercises.

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

Stage 1 - preparatory.

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

1) normalization of muscle tone,

2) normalization of motor skills of the articulatory apparatus,

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

5) normalization of prosody,

6) normalization of fine motor skills of the hands.

Stage 2 - development of new pronunciation skills. Directions:

1) development of basic articulation patterns,

2) determining the sequence of work on sounds,

3) development of phonemic hearing,

4) sound production,

5) automation,

6) differentiation (differentiation by ear; differentiation of articulation of isolated sounds; pronunciation differentiation at the level of syllables, words).

Stage 3 - development of communication skills.

Directions:

1) development of self-control,

2) training correct speech skills in various speech situations.

Stage 4 - overcoming or preventing secondary disorders.

Stage 5 - preparation for school.

Directions:

1) formation of graphomotor skills,

2) development of coherent speech,

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

The problem of identifying and correcting erased dysarthria continues to be relevant to this day. There are numerous indications in the literature that in speech therapy practice, children experience pronunciation deficiencies, which in symptoms resemble dyslalia, but have a longer and more complex dynamics of elimination. The study of erased dysarthria is the subject of research in medical, pedagogical and linguistic disciplines.

For the first time, the question of atypical pronunciation disorders, the correction of which requires long-term lessons, was raised in the second half of the 19th century by G. Gutsman, who noted general signs such disorders, manifested in “washiness, erasure of articulation.” In 1879, A. Kussmaul described in detail a number of forms of speech disorders, among which he studied a special type of sound pronunciation disorders in children and called them “dysarthria.” They identified various manifestations of dysarthria: articulation disorder And diction disorder. The first one was called dysarthria, and the second - dysphasia. Subsequently, various domestic and foreign authors noted that there is a group of children with disorders of the formation of the sound side of speech, the symptoms and nature of which do not correspond to either dyslalia or dysarthria.

The term “erased” dysarthria was first proposed by O.A. Tokareva, who characterizes the manifestations of “erased dysarthria” as mild (erased) manifestations of “pseudobulbar dysarthria”, which are particularly difficult to overcome. In her opinion, usually these children can pronounce most isolated sounds correctly, but in the speech stream they weakly automate them and do not differentiate them enough. It was noted that articulatory movements in these children may be impaired in a unique way: when the movements of the tongue and lips are limited, inaccuracy of movements and insufficient strength are observed. Lethargy and approximate movements are characteristic of some cases, while in others, inaccuracy of movements is explained by hyperkinesis of the tongue.

Later M.P. Davydova proposed a slightly modified definition of erased dysarthria: “violations of sound pronunciation caused by selective inferiority of certain motor functions of the speech-motor apparatus, as well as weakness and lethargy of the articulatory muscles, can be attributed to mild erased pseudobulbar dysarthria.” She notes that in the practice of school speech therapy centers, mild, so-called erased dysarthria predominates. Disadvantages of pronunciation are the most different character, and yet the main symptom of this disorder is blurredness, fuzziness, and unclear articulation, which are especially pronounced in the stream of speech.

To diagnose this disorder, it is necessary to pay attention to the presence of neurological symptoms and carry out dynamic observation in the process of correctional work: if, during an outpatient examination, a neuropsychiatrist immediately detects organic neurological symptoms, then such forms can rightfully be classified as dysarthria. There are often children who do not show any symptoms after a single examination.

A different definition of such a speech disorder was proposed by A.N. Kornev. He defines this disorder as selective, mild, but rather persistent disturbances in sound pronunciation, which are accompanied by mild, peculiar disturbances of the innervation insufficiency of the articulatory organs. With them there are no total polymorphic disturbances of sound pronunciation (as with dysarthria in children with cerebral palsy), there are no pronounced disturbances in the tone and contractility of the articulatory muscles. Kornev believes that this category of disorders of the pronunciation aspect of speech occupies an intermediate position between dyslalia and dysarthria, and that the terminological designation of this speech disorder does not reflect the clinical and nosological independence of this group. For this type of speech disorder, Kornev proposed the term "verbal dyspraxia".

IN foreign literature(Mondelaers B.Zh.) for such violations the concept is used "speech or articulatory developmental dyspraxia"(Developmental apraxia of speech - DAS) . DAS is defined as a disorder of speech movement control. Mondelaers uses the following definition of the speech disorder being studied: "Dyspraxia- “This is a speech disorder of neurogenic origin, but unlike dysarthria, this disorder is associated not only with motor disorders.”

In Russian speech therapy, the term “articulatory developmental dyspraxia” is used little; it is usually used to define the mechanisms of some forms of speech underdevelopment, including erased dysarthria. Various terms are proposed to describe these violations and their designation: articulatory dyspraxia, central organic or complicated dyslalia, apraxic dysarthria. I.B. Karelina introduced new terminology, where erased dysarthria is interpreted as minimal dysarthric disorders - MDD.

Among the reasons causing erased dysarthria, various authors have identified the following:

1. Violation of the innervation of the articulatory apparatus, in which there is a deficiency of individual muscle groups (lips, tongue, soft palate); inaccuracy of movements, their rapid exhaustion due to damage to certain parts of the nervous system.

2. Motor disorders: difficulty finding a certain position of the lips and tongue necessary to pronounce sounds.

3. Oral apraxia.

4. Minimal brain dysfunction.

Mild forms of dysarthria can be observed in children without obvious movement disorders, who have suffered mild asphyxia or birth trauma, and also have a history of other mild adverse effects during fetal development or childbirth. In these cases, mild, “erased” forms of dysarthria are combined with other signs of minimal brain dysfunction, i.e. are considered one of the symptoms of MMD.

For the first time, an attempt to classify the forms of erased dysarthria was made by E.N. Vinarskaya and A.M. Pulatov based on the classification of dysarthria proposed by O.A. Tokareva. The authors identified mild pseudobulbar dysarthria and noted that pyramidal spastic paralysis in most children is combined with a variety of hyperkinesis, aggravated during speech. To the ear, such speech sounds slurred, monotonous and inexpressive; it is often characterized by increased volume, slowness and tension. In this classification, only the degree of disturbance comes to the fore, but mechanisms and nosology are not taken into account.

In the studies of E.F. Sobotovich and A.F. Chernopolskaya was the first to note that deficiencies in the sound aspect of speech in children with “erased dysarthria” appear not only against the background of neurological symptoms, but also against the background of a violation of the motor side of the process of sound pronunciation. A typology of disorders has been determined depending not only on neurological symptoms, motor disorders, but also phonemic and general development for various forms of mild dysarthria. Depending on the manifestations of violations of the motor side of the pronunciation process and taking into account the localization of paretic phenomena in organs; articulatory apparatus, the authors identified four groups of children and identified the following types erased dysarthria:

Sound pronunciation disorders caused by selective inferiority of certain motor functions of the speech-motor apparatus (I group);

Weakness, lethargy of articulatory muscles (II group).

These two groups belong to the erased form of pseudobulbar dysarthria.

Clinical features sound pronunciation disorders associated with difficulty in performing voluntary motor acts (III group), the authors refer to cortical dysarthria;

Defects in the sound aspect of speech in children with various forms of motor impairment (IV group), classified as mixed forms of dysarthria.

An attempt to classify erased dysarthria from the perspective of neurolinguistic and neuropsychological approaches was made by Kornev. As theoretical basis For this classification, the theory of N.A. was used. Bernstein about the level organization of movements and their development in ontogenesis.

Bernstein developed a theory of movement organization, including subcortical and cortical levels, and attributed speech to highest level organization of movements - at the cortical speech motor level. They were shown that since a person makes movements that differ in the degree of voluntariness, in participation in the motor act of speech, then the degree of control of these movements is different. Bernstein identified the following stages of performing a voluntary movement. 1. On initial first stage, the perception and assessment of the situation is carried out by the individual himself, included in this situation. 2. At the second stage, a motor task or an image of what should be is outlined. Understanding the future movement serves as the basis for formulating the task and programming its solution in motor terms. 3. At the third stage, the solution to the defined problem is programmed. 4. At the fourth stage, the actual execution of the movement is carried out: the person overcomes all excess degrees of movement, turns it into a controlled system and performs the desired purposeful movement. This is possible if the individual has mastered the coordination of movements, because it is she who is the central link of the movement. Violation of one of the components of coordination leads to movement disturbances, for example, disproportionality of movement causes dysmetria, disturbance of smooth movement - ataxia.

Coordination of movements develops gradually on the basis of experience and exercise, since it is a complex sensorimotor act, starting with an afferent flow and ending with an adequate central response.

Kornev thus highlights:

Dysphonetic dyspraxia caused by dysfunction of the first level of praxis organization;

Dysphonological dyspraxia caused by level II maturation deficiency;

Verbal dyspraxia, caused by inferiority of the highest, III level of speech praxis organization.

In the proposed study guide, these issues are examined in more depth from the perspective modern ideas And scientific achievements in this area of ​​speech therapy.

conclusions

1. Erased dysarthria is one of the most common speech disorders encountered in speech therapy practice.

2. Issues of diagnostics and content of correctional work with children with erased dysarthria remain insufficiently developed both in theoretical and practical terms.

3. The complex structure of speech impairment with erased dysarthria requires an integrated approach in organizing and carrying out corrective measures.

4. The study of erased dysarthria is the subject of research in medical, pedagogical and linguistic disciplines. At the same time, the question of the terminology of this violation in different directions research is interpreted differently.

5. Thus, in the specialized literature, the choice of term defining erased dysarthria remains controversial.

Study questions and assignments

2. What reasons can lead to erased dysarthria?

3. What parameters are considered in the differential diagnosis of erased dysarthria and dyslalia?

4. What pathological symptoms are revealed during examination of the articulatory apparatus?

5. What is included in the structure of speech impairment in erased dysarthria?

6. How can you characterize the general speech development of children with erased dysarthria?

7. How do groups of children with erased dysarthria compare with the levels of speech development according to the psychological and pedagogical classification of R.E. Levina?

8. What directions does it consist of? complex method eliminating erased dysarthria?

9. What terms exist for erased dysarthria?

10. What classifications of erased dysarthria currently exist?

11. Take notes on the article by L.V. Lopatina. “Techniques for examining preschoolers with an erased form of dysarthria and differentiation of their education,” g. “Defectology”, 1986, No. 2, p. 54-70.

CHAPTER II
Clinical and pedagogical characteristics of children
with erased dysarthria in the specialized literature

Dysarthria is a disorder of sound pronunciation, voice formation and prosody, caused by insufficient innervation of the muscles of the speech apparatus: respiratory, vocal, articulatory. With dysarthria it is disturbed propulsion mechanism speech due to organic damage to the central nervous system. The structure of the defect in dysarthria is a violation of the entire pronunciation aspect of speech and extra-speech processes: general and fine motor skills, spatial representations, etc. The structure of the defect has been sufficiently studied in the specialized literature.

Treatment issues for this group of children are also widely represented in the medical literature. The most severe degrees of dysarthria occur in children with cerebral palsy. Less pronounced degrees of dysarthria are observed in children with mental retardation and mental retardation. Mild degrees of dysarthria (MDD - minimal dysarthric disorders) are very common in children with ODD (50-80%); in children with FFN (30-40%); In some children with an initial diagnosis of “complex dyslalia,” a thorough examination reveals erased dysarthria (10%).

At school age, erased dysarthria manifests itself not only in form (indistinct, unclear), but also in writing. Typical dysgraphic errors in writing are omissions and replacement of vowels, omissions of consonants when several consonants are present in a word, and underwriting of endings. These errors are due to insufficiently clear articulation of vowels, which in oral speech pronounced in a reduced manner. In addition to these errors, there are also graphical errors, which are based on the inferiority of optical-spatial representations.

Erased dysarthria (mild degree of dysarthria, MDR - minimal dysarthric disorders) in speech therapy practice is one of the most common and difficult to correct disorders of the pronunciation side of speech. G. Gutsman is the first to identify among children with polymorphic sound pronunciation disorders a category of children in whom articulation is blurred and for whom the process of correcting sound pronunciation is extremely difficult. In the future, Pravdina-Vinarskaya and Eidinova analyze cases of motor impairment. The abbreviation “MDR” was introduced by G.V. Chirkina and I.B. Karelina to indicate a low (erased) degree of dysarthria. Mild “erased” dysarthria was identified by Pravdina and Melekhova when examining children with complex dyslalia. They identified functional, mechanical dyslalia, as well as organic cerebral dyslalia, which later began to be classified as mild dysarthria and began to be called erased dysarthria. The authors note that with organic cerebral disorders of sound pronunciation (erased dysarthria), there is insufficient mobility of individual muscle groups of the speech apparatus (lips, soft palate, tongue), and general weakness of the entire peripheral speech apparatus due to damage to certain parts of the nervous system. Studying the anamnesis of children with erased dysarthria, Mastyukova, Lopatina, Arkhipov, Karelin and others identify the following factors: unfavorable course of pregnancy; asphyxia, low Apgar score at birth, the presence of a diagnosis of PEP - perinatal encephalopathy - in the vast majority of children in the first year of life.

In the infant period from 0 to 1 year, pathological pre-speech symptoms are not detected in psychomotor development, because Screening examination of psychomotor functions of children has not yet been introduced into practice. And, as a result, there is no psychological, pedagogical and correctional speech therapy support for infants with PEP.

It came out tutorial on speech therapy work with young children, where screening methods for examining infants are offered. A study of the anamnestic data of young children indicates a delay in locomotor functions (motor clumsiness when walking, increased exhaustion when performing individual movements, inability to jump, step up stairs, grasp and hold a ball).

There is a late appearance of finger grasping of small objects, and a long-term persistence of the tendency to grasp small objects with the entire hand. The medical history notes difficulties in mastering self-care skills, dislike of drawing; Many children do not know how to hold a pencil correctly for a long time. In the future, they continue to have persistent difficulties in the formation of graphomotor skills. Interesting data are presented in Lopatina’s study on the psychomotor skills of children with MDD (minimal dysarthric disorders). When studying the psychomotor skills of children with erased dysarthria, tests proposed by N.I. were used. Ozeretsky, E.Ya. Bondarevsky, M.V. Serebrovskaya.

1. A test for static coordination of movements shows that violation of statics is manifested in significant difficulty (and sometimes impossibility) in maintaining balance, in limb tremor. When holding a pose, children often sway, trying to maintain balance, lower their raised leg, touching it to the floor, and rise on their toes. They maintain their balance better when standing on their right foot. Having difficulty maintaining balance (mainly standing on the left leg), they try to hold on to the back of a nearby chair with their hands.

2. Test for dynamic coordination of movements. The dynamic test shows that in more than a third of cases, children throw the ball at the target not “from the turned shoulder”, without a swing, but from below. At the same time, at the moment of throwing with one hand, the other is tense and brought towards the body. The number of times the ball hits the target is significantly greater when performing movements with the right hand. In most cases, successful execution of the test for right hand is carried out on the first attempt, while for the left - on the second and third.

Most children with severe dysarthria are able to jump over a tight rope without running. At the same time, the task is not always completed on the first try. When the test is performed on the second or third attempt, the rope is noted to touch the rope when jumping with the feet and landing on the heels. In isolated cases, falling or touching the floor with hands after a jump and not jumping, but stepping over a rope were recorded.

Performing test tasks to study dynamic coordination of movements is characterized by insufficiently coordinated activity of various muscle groups, “jerking”, and clumsiness of the movements performed.

3. Test to study the speed of movements. Completing a task to study the speed of movement shows that more than half of the children find it difficult to sit on the floor and stand up without using their hands. Basically, the task is performed at a slow pace. Children are able to sit on the floor without using their hands, but cannot get up without this help. They rest on either one or both hands. In less than half of the cases, children are able to quickly and correctly complete this task on the first try without using their hands. The inability to perform this test was noted in isolated cases. The nature of the children's performance of the task confirms the insufficient development of dynamic coordination of movements and motor maneuverability, discovered when performing other tests.

4. Motor memory tests. A motor memory test, in which the experimenter's movements program the sequence of their execution and at the same time have a confusing effect, causes significant difficulties for most children. When reproducing movements, their tempo slows down or, conversely, accelerates. Disruptions in the motor program began already from the third or even from the second movement, and difficulties were noted in the transition from one motor element to another. The error-free execution of this test on the first attempt was recorded only in isolated cases.

5. Test for simultaneous movements. The greatest difficulty to perform is the test for simultaneous movements. Simultaneous performance of movements for both limbs is observed in a small number of children. More often, there are either pronounced difficulties in performing these movements (mainly for the left hand), or their execution at different times. During the time allotted for completing the task, most children change the pace of winding the thread more than three times, while the pace of this movement does not correspond to the pace of walking.

6. Test to identify synkinesis (i.e. friendly, unnecessary movements). The motion clarity test is performed more successfully. The overwhelming majority of children perform it at a sufficient pace (for both limbs) without the occurrence of synkinesis. At the same time, cases were recorded of performing movements at a slow pace, with a violation of the amplitude (mainly for the left hand), with tension in the fingers when holding a pencil, with numerous synkinesis: movements of the lips, protruding the tongue, tilting the head forward, etc.

These tests are aimed at identifying the maturity of the level organization of movements according to M.A. Bernstein. Lopatina's research confirms that children with erased dysarthria at almost all levels (according to Bernstein) show deviations from the norms in psychomotor skills. Violations of the function of static balance (level A), dynamic coordination (level B) are revealed; violations of tempo and dexterity of movements (level B and C); decreased motor memory (level D). These studies not only reveal the mechanism of the disorder and the structure of the defect in erased dysarthria, but also define new directions in the psychological, pedagogical, medical and speech therapy aspects of influence, aimed at correcting the psychomotor skills of children.

A study of the neurological status of children with erased dysarthria reveals certain abnormalities in the nervous system, manifested in the form of a mild, predominantly unilateral, hemisyndrome. Paretic symptoms are observed in articulatory and general muscles, which is associated with impaired innervation of the facial, glossopharyngeal or hypoglossal nerves. (G.V. Gurovets, S. Mayevskaya)

In cases of dysfunction of the hypoglossal nerve, deviation of the tip of the tongue towards paresis is noted, and mobility in the middle part of the tongue is limited. When the tip of the tongue and the middle part of the tongue are raised, the middle part quickly falls to the side of the paresis, causing the appearance of a lateral air stream. In some children, dysfunction of the glossopharyngeal nerve predominates. In these cases, the leading symptoms of disorders are phonation disorders, the appearance of nasalization, distortion or absence of back-lingual sounds. A violation of muscle tone is often detected. The voice suffers significantly with dysarthria. It becomes hoarse, tense or, conversely, very quiet and weak. Thus, unintelligible speech in dysarthria is caused not only by a disorder of articulation itself, but also by a violation of the coloring of speech, its melodic-intonation side, i.e. violation of prosody. Dysarthria is characterized by inexpressiveness of speech, monotony of intonation, and a nasal tone of pronunciation. At the same time, erased dysarthria can be complicated by phonetic-phonemic underdevelopment, general speech underdevelopment, stuttering and other speech disorders.

Studies by Lopatina et al. revealed in children with erased dysarthria; disturbances in the innervation of facial muscles: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulty raising the eyebrows, closing the eyes. Along with the characteristic symptoms for children with erased dysarthria are: difficulties switching from one movement to another, reduced range of movements of the lips and tongue; Lip movements are not performed in full, they are approximate, and there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, imprecision of movements, difficulties in spreading the tongue, lifting and holding the tongue at the top, tremor of the tip of the tongue are noted; In some children, the pace of movements slows down when performing a task repeatedly.

Many children experience rapid fatigue, increased salivation, and the presence of hyperkinesis of the facial and lingual muscles. In some cases, a deviation of the tongue (deviation) is detected.

Features of facial muscles and articulatory motor skills in children with erased dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These disorders are most often not detected primarily by a neurologist and can only be identified during a thorough speech therapy examination and dynamic observation during correctional speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal and hypoglossal nerves, which determines the features and variety of phonetic disorders in children. Thus, in cases of predominant damage to the facial and hypoglossal nerves, disorders of the articulation of sounds are observed, caused by inadequate activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.

Phonetic and prosodic disturbances in erased dysarthria are caused by pareticity or spasticity of certain muscle groups of the articulatory, vocal and respiratory parts of the speech apparatus. The variability and mosaic nature of these violations determines the variety of phonetic and prosodic violations:

Interdental pronunciation of front-lingual in combination with throat [r];

Lateral pronunciation of sibilants, sibilants and affricates;

Softening defect: explained by spasticity of the tip of the tongue and its tendency to articulate more anteriorly;

Whistling sigmatisms: are formed when sibilants due to pareticity of the tip of the tongue are formed in the lower position of the tongue;

Hissing sigmatisms: can be explained by spasticity of the tongue, where the tongue is thickened and tense;

Vocalization defects: These should be considered partial voice disorders, phonation disorders and other phonetic disorders.

All of the listed sound pronunciation disorders are combined with a variety of phonation, prosodic and respiratory disorders.

In this category of children, mild neurological symptoms are noted in the form of erased paresis, hyperkinesis, and disturbances in the muscle tone of articulatory and facial muscles. With functional dyslalia, there are no deviations from the central nervous system. Autonomic nervous system disorders in to a greater extent are observed with dysarthria, and to a lesser extent with dyslalia. Violation of neuropsychic functions (attention, memory, thinking), delay in tempo mental development most typical for erased dysarthria.

Currently the problem is erased dysarthria childhood is being intensively developed in clinical, neurolinguistic, psychological-pedagogical and correctional-speech therapy aspects. To distinguish erased dysarthria from complex dyslalia, a comprehensive medical and pedagogical study is necessary: ​​analysis of medical and pedagogical documentation, study of anamnestic data. By comparing the symptoms of speech and non-speech signs in children with dyslalia and dysarthria, diagnostic significant differences can be determined.

Thus, in children with erased dysarthria, in addition to impaired sound pronunciation, there is a violation of the voice and its modulations, weakness of speech breathing, and pronounced prosodic disturbances. At the same time, general motor skills and fine differentiated hand movements are impaired to varying degrees. The identified motor clumsiness and lack of coordination of movements cause a delay in the formation of self-care skills, and the immaturity of fine differentiated movements of the fingers causes difficulties in the formation of graphomotor skills.

In studies devoted to the problem of speech disorders in erased dysarthria, it is noted that disturbances in sound pronunciation and prosody are persistent and in many cases cannot be corrected. This negatively affects the development of the child, the processes of his neuropsychic development in preschool age, and later can lead to school maladjustment. These disorders have a negative impact on the formation and development of other aspects of speech, complicate the process of schooling for children, and reduce its effectiveness. A relationship has been established between the pronunciation disorder itself and the formation of phonemic and grammatical generalizations, the formation of vocabulary, and coherent speech.

In the work of O.Yu. Fedosova compares dyslalia and erased dysarthria. For complex functional dyslalia:

¨ articulation of only consonant sounds suffers;

¨ a clear violation of the articulation of certain sounds in different conditions their implementation;

¨ fixing the formed sounds does not cause difficulties;

¨ there are no violations of the tempo-rhythmic organization of speech;

¨ breathing changes are not typical;

¨ phonation disorders are not observed;

For mild pseudobulbar dysarthria:

¨ possible blurred, unclear pronunciation of vowel sounds with a slight nasal tint;

¨ sounds can be preserved in isolation, but in the speech stream they are pronounced distortedly and unclearly;

¨ the automation process is difficult: the supplied sound may not be used in speech;

¨ characterized by an accelerated or slow pace of speech;

¨ breathing is shallow, speech is noted during inhalation, phonation exhalation is shortened;

¨ coordination of these processes suffers.

To understand and explain the nature and mechanism of the disorder in erased dysarthria, it is necessary to turn to the provisions of the teaching on the mechanisms of speech by A.R. Luria, P.K. Anokhin and others.

The mechanisms of speech are associated with a holistic, hierarchical organization of brain activity, including several links, each of which makes its own specific contribution to the nature of speech activity.

The first link of the speech functional system is the receptors of hearing, vision, and sensitivity that perceive initial information. The systems of the initial receptive level also include kinesthetic sensations, which signal the position of the organs of articulation and the whole body. If speech kinesthesia is insufficient, speech development is disrupted.

The second link is complex cortical systems that process and store incoming information, develop a response program and translate the original semantic thought into a schema of a detailed speech utterance.

The third link of the speech functional system implements the transmission of voice messages. This link has a complex sensorimotor organization. When the third link of the speech functional system is damaged, the innervation of the speech muscles is disrupted, i.e. The motor mechanism of speech is directly disrupted.

E.F. Sobotovich and A.F. Chernopolskaya distinguishes four groups of children with erased dysarthria.

Group

These are children with insufficiency of some motor functions of the articulatory apparatus: selective weakness, pareticity of some muscles of the tongue. Asymmetric innervation of the tongue, weakness of movements of one half of the tongue cause such violations of sound pronunciation as lateral pronunciation of soft whistling sounds [s] and [z], affricates [ts], soft anterior lingual [t] and [d], posterior lingual [g], [k ], [x], lateral pronunciation of vowels [e], [i], [s].

Asymmetrical innervation of the anterior edges of the tongue causes lateral pronunciation of the entire group of whistling, hissing sounds [r], [d], [t], [n]; in other cases, this leads to interdental and lateral pronunciation of the same sounds. The causes of these disorders, according to Sobotovich, are unilateral paresis of the hypoglossal (XII) and facial (VII) nerves, which are of an erased, unexpressed nature. A small proportion of children in this group have phonemic underdevelopment associated with distorted pronunciation of sounds, in particular, underdevelopment of phonemic analysis skills and phonemic representations. In most cases, children have an age-appropriate level of development of the lexical and grammatical structure of speech.

Group

Children in this group were not found to have pathological features general and articulatory movements. During speech, sluggish articulation, unclear diction, and general blurred speech are noted. The main difficulty for this group of children is pronouncing sounds that require muscle tension (sonorants, affricates, consonants, especially plosives). Thus, children often skip the sounds [r], [l], replace them with fricatives, or distort them (labial lambdacism, in which the stop is replaced by a labiolabial fricative); single-beat rhoticism resulting from difficulty vibrating the tip of the tongue. There is a splitting of affricates, which are most often replaced by fricative sounds. Violation of articulatory motility is mainly observed in dynamic speech-motor processes. The general speech development of children is often age appropriate. Neurological symptoms manifests itself in the smoothness of the nasolabial fold, the presence of pathological reflexes (proboscis reflex), deviation of the tongue, asymmetry of movements and increased muscle tone.

According to Sobotovich and Chernopolskaya, children of groups 1 and 2 have erased pseudobulbar dysarthria.

Group

Children have all the necessary articulatory movements of the lips and tongue, but there are difficulties in finding the positions of the lips and especially the tongue according to instructions, imitation, based on passive displacements, i.e. when performing voluntary movements and in mastering subtle differentiated movements. A peculiarity of pronunciation in children of this group is the replacement of sounds not only in place, but also in the method of formation, which is inconsistent. In this group of children, phonemic underdevelopment is observed varying degrees expressiveness. The level of development of the lexico-grammatical structure of speech ranges from normal to pronounced ONR. Neurological symptoms manifest themselves in increased tendon reflexes on one side, increased or decreased tone on one or both sides. The nature of articulatory movement disorders is considered by the authors as manifestations of articulatory dyspraxia. Children in this group, according to the authors, have erased cortical dysarthria.

Group

This group consists of children with severe general motor impairment, the manifestations of which are varied. Children exhibit inactivity, stiffness, slowness of movement, and limited range of motion. In other cases, there are manifestations of hyperactivity, anxiety, a large number of unnecessary movements. These features also manifest themselves in the movements of the articulatory organs: lethargy, stiffness of movements, hyperkinesis, a large number of synkinesis when performing movements lower jaw, in the facial muscles, inability to maintain a given position. Violations of sound pronunciation are manifested in replacement, omissions, and distortion of sounds. A neurological examination of children in this group revealed symptoms of organic damage to the central nervous system (deviation of the tongue, smoothness of the nasolabial folds, decreased pharyngeal reflex, etc.). The level of development of phonemic analysis, phonemic representations, as well as the lexico-grammatical structure of speech varies from normal to significant OHP. This form of disorder is defined as erased mixed dysarthria.

Lopatina's (1986) studies presented three groups of children with erased dysarthria.

The criteria for differentiation of groups are the qualities of the pronunciation side of speech: the state of the sound pronunciation, prosodic side of speech, as well as the level of formation of linguistic means: vocabulary, grammatical structure, phonemic hearing. General and articulatory motor skills are assessed. Common to all groups of children is a persistent violation of sound pronunciation: distortion, replacement, confusion, difficulties in automating the given sounds. All children in these groups are characterized by a violation of prosody: weakness of the voice and speech exhalation, poor intonation, monotony of speech: some violations of general and fine motor skills.

First group. Violations of sound pronunciation are expressed in multiple distortions and absence of sounds.

Phonemic hearing is fully formed: children correctly perform tasks on auditory and pronunciation differentiation of sounds. The syllabic structure of words of varying complexity is not disrupted. The quality and volume of active and passive vocabulary correspond to the age norm, children successfully master the skills of inflection and word formation. Coherent monologue speech of children of the first group is formed in accordance with age standards. There are no structural or morphemic agrammatisms in the speech of children in this group.

If we consider the first group of children with erased dysarthria within the framework of the psychological and pedagogical classification (R.E. Levina), then we can classify them as a group with phonetic underdevelopment (PH).

Second group. Expressive speech is rated satisfactorily. Violation of sound pronunciation is in the nature of multiple substitutions and distortions. Phonemic hearing is impaired to a greater or lesser extent.

Children have insufficiently developed auditory and pronunciation differentiation of sounds. Difficulties arise when teaching them sound analysis. When reproducing the syllabic structure of complex words, rearrangements and other errors occur. Active and passive vocabulary lags behind the age norm. There are errors in the grammatical formatting of speech (morphemic agrammatisms).

Particular difficulties arise when coordinating neuter nouns with numerals and using prepositions in word formation. Coherent monologue speech is characterized by the use of two-word, uncommon sentences.

According to the psychological and pedagogical classification of R.E. Levina, these children with erased dysarthria belong to the group with phonetic-phonemic underdevelopment (FFN).

Third group. The expressive speech of children in this group with erased dysarthria is unsatisfactorily formed. Impressive agrammatisms are noted, i.e. difficulties in understanding complex logical and grammatical sentence structures. Violation of sound pronunciation is polymorphic in nature, i.e. sounds of different phonetic groups suffer. Cancel

There may be multiple substitutions, distortion, and lack of sounds. Pronounced violation phonemic hearing: auditory and pronunciation differentiation of sounds is not sufficiently formed, which does not allow mastering sound analysis. The violation of the syllabic structure of words is more pronounced. Active and passive vocabulary lags significantly behind age standards, and lexical and grammatical errors are numerous and persistent.

This group of children with erased dysarthria does not master coherent speech. According to the classification of R.E. Levina, this group of children correlates with general speech underdevelopment (GSD).

The identification of three groups of children with erased dysarthria in Lopatina’s studies allows us to correlate