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

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

To diagnose cortical dysarthria, a subtle neurolinguistic analysis is required to determine which of the anterior lingual sounds are affected in each specific case and what is the mechanism of their impairment.

In the first variant of cortical dysarthria, among the anterior lingual sounds, the pronunciation of the so-called kakuminal consonants, which are formed when the tip of the tongue is raised and slightly bent upward, is primarily disrupted (w, f, r). At severe forms dysarthria, they are absent, with milder ones they are replaced by other anterior lingual consonants, most often dorsal, when pronounced, the front part of the back of the tongue rises with a hump to the palate (s, s, s, s, t, d, To).

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

With cortical dysarthria, the pronunciation of consonants according to the method of their formation may also be impaired: stops, fricatives and tremors. Most often - slotted (l, l).

Characterized by a selective increase in muscle tone, mainly in the muscles of the tip of the tongue, which further limits its subtle differentiated movements.

In milder cases, the pace and smoothness of these movements is disrupted, which manifests itself in the slow pronunciation of front-lingual sounds and syllables with these sounds.

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

In these cases, the pronunciation of consonant sounds, especially sibilants and affricates, suffers. Articulation disorders are variable and ambiguous. Finding the right articulatory pattern at the moment of speech slows down its pace and disrupts its smoothness.

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

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

Difficulties are noted when reproducing a series of sequential movements according to a task (by demonstration or by verbal instructions).

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

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

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

In the absence or insufficiency of voluntary movements, preservation of reflex automatic movements, strengthening of the pharyngeal and palatal reflexes, and also, in some cases, preservation of reflexes of oral automatism are noted. There are synkinesis. In pseudobulbar dysarthria, the tongue is tense, pulled back, its back is rounded and covers the entrance to the pharynx, the tip of the tongue is not pronounced. Voluntary movements of the tongue are limited, the child can usually stick his tongue out of the mouth, but the amplitude of this movement is limited, he has difficulty keeping his tongue stuck out in the midline; the tongue deviates to the side or falls on the lower lip, curving towards the chin.

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

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

In all cases, with pseudobulbar dysarthria, the most complex and differentiated voluntary articulatory movements are disrupted first. Involuntary, reflex movements are usually preserved. For example, when voluntary movements of the tongue are limited, the child licks his lips while eating; Having difficulty pronouncing ringing sounds, the child makes them while crying, he coughs loudly, sneezes, laughs.

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

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

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

With diffuse spasticity of the muscles of the speech apparatus, voicing of voiceless consonants is observed (mainly with spastic pseudobulbar dysarthria). With this same option, the spastic state of the muscles of the vocal apparatus and neck disrupts the resonator properties of the pharynx with a change in the size of the pharyngo-oral and pharyngo-nasal openings, which, along with excessive tension in the pharyngeal muscles and muscles that lift the soft palate, contributes to the appearance of a nasal tint when pronouncing vowels, especially back row (oh, y), and solid sonorants (r, l), hard noisy (h, w, g) and affricates c.

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

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

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

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

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

The nature of the speech motor disorder (with bulbar, voluntary and involuntary movements are impaired, with pseudobulbar - predominantly voluntary);

The nature of the damage to articulatory motor skills (with bulbar dysarthria - diffuse, with pseudobulbar - selective with a violation of fine differentiated articulatory movements);

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

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

Extrapyramidal dysarthria. The extrapyramidal system automatically creates that background of pre-readiness, against which fast, accurate and differentiated movements are possible. It is important in the regulation of muscle tone, sequence, strength and motority of muscle contractions, and ensures automated, emotionally expressive performance of motor acts.

Violations of sound pronunciation with extrapyramidal dysarthria are determined by:

Changes in muscle tone in the speech muscles;

The presence of violent movements (hyperkinesis);

Violations of propriceptive afferentation from speech muscles;

Disturbances of emotional-motor innervation. The range of movements in the muscles of the articulation apparatus with extrapyramidal dysarthria, in contrast to pseudobulbar dysarthria, may be sufficient. The child experiences particular difficulties in maintaining and feeling articulatory posture, which is associated with constantly changing muscle tone and violent movements. Therefore, with extrapyramidal dysarthria, kinesthetic dyspraxia is often observed. IN calm state in the speech muscles, slight fluctuations in muscle tone (dystonia) or some decrease in muscle tone (hypotonia) may be observed; when attempting to speak in a state of excitement, emotional stress, sharp increases in muscle tone and violent movements are observed. The tongue gathers into a ball, is pulled towards the root, and sharply tenses. An increase in tone in the muscles of the vocal apparatus and in the respiratory muscles eliminates the voluntary activation of the voice, and the child cannot utter a single sound.

With less pronounced violations of muscle tone, speech is blurred, slurred, the voice has a nasal tint, the prosodic side of speech, its intonation-melodic structure, and tempo are sharply impaired. Emotional nuances in speech are not expressed, speech is monotonous, monotonous, unmodulated. There is a fading of the voice, turning into an unclear muttering.

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

Extrapyramidal dysarthria is often combined with hearing impairment such as sensorineural hearing loss, with hearing for high tones primarily affected.

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

Speech with cerebellar dysarthria is slow, jerky, scanned, with impaired modulation of stress, and attenuation of the voice towards the end of the phrase. There is a decreased tone in the muscles of the tongue and lips, the tongue is thin, spread out in the oral cavity, its mobility is limited, the pace of movements is slow, there is difficulty in maintaining articulatory patterns and weakness of their sensations, the soft palate sags, chewing is weakened, and facial expressions are sluggish. The movements of the tongue are inaccurate, with manifestations of hyper- or hypometria (excessive or insufficient range of motion). With more subtle, targeted movements, a slight tremor of the tongue is noted. Nasalization of most sounds is pronounced.

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

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

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

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

Table 17 (end)

6.2. Differential diagnosis of dysarthria according to the degree of damage

The most common form of dysarthria is pseudobulbar(96%). The pseudobulbar form of dysarthria is differentiated by the degree of damage (Table 18).

Table 18

Differentiation of pseudobulbar dysarthria

Table 18 (end)

Knowledge of the neurological foundations of speech therapy will help the speech therapist to meaningfully qualify the defect, understand its structure, etiology, mechanisms, pathogenesis, which in turn will allow choosing the most optimal, adequate correctional methodology, taking into account the reserve, compensatory capabilities of each child individually, which will ensure a person-oriented correction approach speech disorders.

6.3. Main indicators for diagnosing dysarthria

The main indicators for diagnosing dysarthria according to the degree of damage are facial expressions, breathing, voice production, reflex movements of the tongue, its shape, retention of articulatory posture; voluntary movements of the tongue and lips; soft palate, hyperkinesis, oral synkinesis, sound pronunciation (Table 19).

Table 19

Indicators for diagnosing dysarthria

Table 19 (end)

6.4. Differential diagnosis. Distinctive signs of erased forms of dysarthria from dyslalia

A broad analysis of practice has shown that erased forms of pseudobulbar dysarthria are quite often confused with dyslalia (Table 20). However, correcting sound pronunciation with dysarthria causes certain difficulties. G. Gutsman was the first to draw attention to this. He noted that these disorders are characterized by blurred, erased articulation.

Table 20

Differential diagnosis of dyslalia and dysarthria

Having summarized the analysis of literary data, M. B. Eidinova and E. N. Pravdina-Vinarskaya explain disorders of the articulatory apparatus by its insufficient innervation and consider these cases as dysarthric. Despite the fact that in both dysarthria and complex dyslalia, hissing, whistling and sonorant groups of sounds are more likely to suffer, for dysarthria the correct isolated pronunciation of sounds is possible, but in spontaneous speech there is blurriness, palatalization, nasalization, and a violation of the prosodic side of speech. Children often say the end of a sentence while inhaling, the voice is hoarse, weak, quiet, and fading.
A child with dysarthria is given a “diagnosis on the face”, visible visually, without special examination. First of all, this is an inexpressive facial expression, the face is amicable, the nasolabial folds are smooth, the mouth is often slightly open due to paresis of the orbicularis muscle. Asymmetry of the face, skull, mouth, and palpebral fissures is possible.
Discoordination of gross motor skills, manual and oral praxis is observed, resulting in blurred pronunciation, difficulties in drawing, writing, and mastering cultural and hygienic skills: such children take a long time to eat, are unkempt, have difficulty fastening buttons, and tying shoes. Characterized by rapid fatigue, exhaustion of the nervous system, low performance, impaired attention and memory.
The nature of speech disorders is closely dependent on the state of the neuromuscular apparatus of the organs of articulation. We examined 673 children. Analysis of the data obtained on the speech and psychoneurological state of children showed that their phonetic disorders are caused by paretic phenomena in certain muscle groups of the articulatory apparatus.
As a result, children have a predominance of interdental, lateral pronunciation of whistling and hissing sounds in combination with guttural pronunciation of sounds. R. Spastic tension of the middle back of the tongue makes all the child’s speech softened. For spasticity vocal cords a defect in voicing is observed, and if they are paretic, a defect in deafening is observed. Hissing sounds with dysarthric symptoms are formed in a simpler lower variant of pronunciation. Not only phonetic, but also respiratory and prosodic speech disturbances can be observed. The child speaks while inhaling.
Quite often observed mixing bulbar form of dysarthria with pseudobulbar (Table 21).

Table 21

Differential diagnosis of similar speech pathologies of the bulbar form of dysarthria from pseudobulbar

The bulbar form of dysarthria is rare. Pseudobulbar is the most common (96% of children).
According to its manifestations, cortical dysarthria is sometimes confused with motor alalia, since the focus of localization is the cerebral cortex (Table 22).

Table 22

Comparative characteristics of pronunciation in children with alalia and dysarthria

Thus, alalik children are characterized by a ringing voice and fairly preserved sound pronunciation. Pronunciation disorders are dominated by inconsistent sound substitutions. Children with alalia distort mainly sounds that are complex in articulation. Interchanges of sounds are relatively frequent. The facial expressions and speech of Alaliks are lively and expressive, and their speech activity is increased.
Children with cortical dysarthria resemble children with motor alalia, since the syllabic structure of complex words is primarily disrupted.
The difference is that the child’s face is amicable, his voice is monotonous and fading; breathing is shallow, clavicular; there are no violations in the development of lexico-grammatical structure.
The pronunciation is blurred, the same type of violations predominate, where distortions dominate (interdental, lateral, nasal sigmatism, etc.). Omissions of articulatory complex sounds are possible. The entire prosodic side of speech suffers (tempo, timbre, etc.).

7. Interaction of specialists

There is safety in numbers.

The diagnostic results determined the choice of tactics and strategy. Target consisted of creating and testing a model of interaction between teachers, parents and doctors in the process of correctional and developmental educational activities, removing contradictions, changing parental attitudes, unfounded ambitions, increasing the professional competence of teachers and training parents in new forms of communication and pedagogical support for the child, organizing subject correctional and developmental environment that stimulates the child’s speech and personal development.
The content and structure of pedagogical support and rehabilitation largely depended on the diagnosis, structure of the defect, etiology, compensatory capabilities of the child, “the zone of his current and immediate development,” and a person-oriented approach.
To achieve the goals, we set tasks:
1) creation of a comprehensive integrated model of correctional and developmental activities of specialists as a condition for the child’s speech development;
2) modeling, design and construction of the organizational, content and methodological aspects of preventive, correctional and developmental activities of specialists;
3) development of personality-oriented forms of interaction between subjects (children, parents, specialists) of the institution, which determine an increase in the level of professional competence of specialists and mastery of integrated methods of developing a child’s personality and correcting speech disorders.
Leading ideas for the rehabilitation of children with speech disorders:
1) person-oriented interaction of specialists on an integrative basis;
2) individualization of correctional and developmental activities;
3) taking into account the compensatory and potential capabilities of the child;
4) integration of methods of correctional and developmental education, efforts and capabilities of parents, teachers and doctors.
The model of correctional and developmental activities is a holistic system. Its goal is to organize the educational activities of a medical or educational institution as a system that includes diagnostic, preventive and correctional and developmental aspects that ensure a high, reliable level of speech, intellectual and mental development of the child.
The content of correctional and developmental activities is built taking into account the leading lines of speech development - phonetics, vocabulary, grammar, coherent speech - and ensures the integration of the child’s speech, cognitive, environmental, artistic and aesthetic development.
The implementation of this installation is ensured by the flexible use of traditional and non-traditional means of development: puppet and fairy tale therapy, kinesitherapy (movement therapy), brain kinesiology, psycho-gymnastics, articulation, finger and breathing exercises, acupressure and segmental massage, relaxation, physio-, phyto-, aromatherapy. , chromotherapy, music therapy, speech therapy rhythm, kinesiotherapy and hydrotherapy, etc.
The system of correctional and developmental activities provides for individual, subgroup and frontal classes, as well as the child’s independent activity in a specially organized spatial-speech environment.
Graphically, the model of interaction between specialists in the correction of speech disorders is presented in Fig. 10.
When creating a model, all specialists work under the guidance speech therapist, who is the organizer and coordinator of all correctional and developmental work, conducts medical and pedagogical consultations, draws up, together with colleagues, a block integrated calendar and thematic plan, organizes diaphragmatic-speech breathing, corrects defective sounds, their automation, differentiation, introducing them into independent speech, promotes speech therapy for routine moments and activities, children’s practical mastery of word formation and inflection skills, which helps the child’s personal growth, the formation of confident behavior, a sense of dignity, adaptation in the society of peers and adults, and, ultimately, successful learning at school.
Educators consolidate acquired knowledge, practice skills before automating skills, integrating speech therapy goals, content, technology into the daily life of children (in play, work and educational activities), into the content of other activities (mathematics, visual arts, speech development and familiarization with the environment through observation of natural phenomena and social life), in sensitive moments.
Psychologist conducts training on confident behavior, relaxation, psycho-gymnastics, which teaches children to manage their mood, facial expressions, maintain a positive emotional tone, conflict-free behavior, a favorable microclimate in the institution and at home; kinesiology of the brain, which helps to overcome interhemispheric asymmetry of the brain, correct impaired functions, enable compensatory functions and develop the child’s potential, etc.

Rice. 10. Model of interaction between specialists in the correction of speech disorders

Musical director carries out the selection and implementation of music therapy works into the child’s daily life, listening to which helps normalize falling asleep and waking up; creates a musical background during play, work and educational activities, which minimizes behavioral and organizational problems, significantly increases the performance of children, stimulates their attention, memory, and thought processes.
Logorhythmic classes improve general and fine motor skills (coordination of movements, manual praxis, articulatory muscles), expressiveness of facial expressions, plasticity of movements, work on staging diaphragmatic-speech breathing, voice, prosodic side of speech (tempo, timbre, expressiveness, voice strength).
The highest priority forms of interaction between specialists are: teacher councils, consultations, trainings, workshops, medical-psychological-pedagogical consultations, business games, round tables, surveys, viewing and analysis of classes, etc.
Teacher training takes place according to a long-term plan of work at seminars, practical and lecture classes, consultations, teacher councils, through self-education without leaving the main place of work and, of course, in advanced training courses.
Increasing professional competence equips employees with theoretical and practical knowledge in the field correctional pedagogy and speech therapy, forms the necessary skills, activates the exchange of information, practical experience, develops the need for continuous self-education and self-improvement.
Taking into account the fact that not all teachers have a developed desire for this, it is better to select teachers for speech therapy groups on a competitive basis, taking into account their speech characteristics, knowledge, skills, personal potential (kindness, love for the profession, children, ability to work with parent contingent).
This encourages teachers to improve their professionalism and their qualification category.
Organization of correctional and developmental educational environment includes creating a comfortable environment that stimulates the child’s speech development. Speech zones with mirrors for facial and articulatory gymnastics are equipped, visual and illustrative material on lexical topics and main phonetic groups is selected; story pictures for working on phrases, toys for improving diaphragmatic-speech breathing, various manual praxis aids, developing visual memory and improving phonemic hearing.
Based on the teacher’s recommendations, parents also organize corners at home that stimulate children’s speech development, fine motor skills etc. In the speech therapy room in the group for children, corners for puppet and fairy tale therapy are arranged, an area for relaxation and psycho-gymnastics is organized.
Speech therapy groups, speech therapists’ offices, and a health and compensation center should preferably be concentrated in one wing, which will facilitate organizational issues and increase work efficiency.
Regrouping of children for the purpose of personalized, differentiated learning is carried out taking into account the structure of speech impairment, the degree of damage, and the compensatory capabilities of each child.
Relationship between specialists, especially a speech therapist with teachers, consists in speech therapy of routine moments
and classes. In everyday life, teachers systematically develop fine motor skills of the hand and articulatory apparatus in children. This work is carried out in the form of “Tales of the Merry Tongue”, finger gymnastics, folk games, shadow theater. To normalize facial expressions, facial gymnastics and “mood screens” are used, on which children reflect their mood using pictograms. It awakens kind, caring and Attentive attitude to the people around you.
For the development of verbal memory, visual supports in the form of letter diagrams are effective, which are compiled by isolating the first sound from a generalizing word, then – specific concepts. Converting phonemes into graphemes tells children “encrypted” words, significantly expands the volume of verbal memory, instills self-confidence, increases self-esteem, promotes the formation of phonemic awareness, mastery of sound-letter analysis, and literacy.
Serious work is being done to automate the assigned phonemes and practical mastery of word formation and inflection skills.
The approach to determining the sequence of sound pronunciation correction may differ from the traditional one. Comparison of experimental data with results traditional methods shows its advantages: reducing the time of correctional work, reducing energy costs on the part of the child and the teacher.
With the aim of prevention of writing disorders Special work is systematically carried out in a playful way, as a result of which preschoolers master the rules of the Russian language.
For an unstressed vowel:“If a vowel is in doubt, you should rather stress it.” Children select test words: houses - house, fields - field, water - water; river - rivers, wall - walls, forests - forest, etc.;
To deafen consonants at the end and middle of a word: tooth - teeth, flag - flags, garden - gardens, grass snakes; mug - mug, booth - booth, etc.
Communication speech therapy with mathematics were widely implemented by teachers not only in the classroom, but also in everyday life. So, for example, in the process of becoming familiar with mathematics, you can practice lexical and grammatical categories(agreement in gender, number, case), magnitude concepts(tall - short, long - short, thick - thin, narrow - wide, etc.), which, as practice shows, are very often quite poorly differentiated by children and are often designated unambiguously (big - small). The weak link are and temporary concepts(fast - slow), children also mix concepts such as today - yesterday - tomorrow, days of the week, months, seasons).
Orientation in space is often disrupted (above - below, in front - behind, under - above, right - left, between, because of, from under, etc.), which makes it difficult to master prepositional case constructions.
Counting, counting operations, and problem solving help children master the agreement of numerals with nouns in gender (one cat, one fish, one towel, etc.), number (one chair, three chairs, five chairs; one window, two windows, five windows; one bun, two buns, five buns).
Development of coherent speech, its prosodic side (expressiveness, timbre, tempo, voice strength) can be successfully implemented through the regional component, for example, when introducing preschoolers to the life and history of the Don Cossacks (work experience of L.V. Gavrilchenko, A.R. Krasikova, G.G. Chebanyan). For example, in the child development center No. 49 “Olenenok” in Rostov-on-Don there is an area designed in the spirit of a Cossack upper room. The interior and Cossack household items help to convey to children who the Cossacks are and how they appeared on the banks of the Don. In everyday work, it is possible to expand children’s understanding of the historical past of the Cossacks, its traditions, and the way of life of the people of the Don. Children will learn about the wide expanses of the Don steppe, that it stretches from the Kalach Upland in the north to the expansive Kuban steppes in the south, from the ancient Lukomorye in the west to the semi-deserts of Kalmykia in the east.
The Don region has a bright and rich history. Our region knew the invasion of the Huns, experienced the blows of the Batu and Tamerlane hordes. On the Don land, Svyatoslav’s warriors crushed the Khazars, Igor’s brave Russians blocked the field with red shields, covering the Russian land from the Polovtsians. More than once the Don steppe burned with the flames of Cossack and peasant uprisings led by S. Razin, K. Bulavin, E. Pugachev.
Speech material is selected taking into account the pronunciation capabilities of children, who not only feel the flavor of the speech of the Don Cossacks, but also use it in their speech. Riddles, proverbs, sayings, songs, dances, chants, chants - these are the pearls of folk wisdom that are easily perceived by a child, develop his verbal memory, and promote speech development. They reflect humor, sadness, love for the Fatherland.
They provide great assistance at work puppet therapy And fairytale therapy, which contribute to the development of coherent expressive speech, overcoming existing speech disorders, logophobias, provide children with the opportunity to feel self-confident, liberate, and fall in love theatrical activities(G.V. Bedenko, T.N. Golubtsova, A.R. Krasikova, G.G. Chebanyan, G.V. Gorshkova, L.A. Rudova).
Puppet therapy – This is a section of art therapy, which is used as the main method of psychocorrective influence on a doll as an intermediate object of interaction between an adult and a child. The goal of puppet therapy is to eliminate painful experiences, strengthen mental health, improve social adaptation, develop self-awareness, resolve conflicts in a collective creative activity.
Teachers share their experience of using real life toys that help relieve aggression, promote creative self-expression, and weaken negative emotions; consider methods such as psychodrama technique, non-game type “Grandfather Shchukar” technique, indirect suggestion technique, use didactic doll in speech therapy work.
Puppet therapy allows you to solve such important correctional problems as overcoming uncertainty and shyness, expands the child’s repertoire of self-expression, allows you to achieve emotional stability and self-regulation, and corrects relationships in the “parent-child” system.
The psychologist, together with a speech therapist and educators, carries out diagnostics, identifies compensatory possibilities, difficulties in the personal development and intellectual-cognitive activity of the child, conducts training for confident behavior, introduces teachers and parents to technologies for providing assistance to problem children experiencing difficulties in social adaptation (interpersonal relationships, speech communication, etc.). Elements of educational kinesiology of the brain successfully activate the potential and compensatory capabilities of the child, help overcome interhemispheric asymmetry of the brain, correct and prevent speech disorders, including disorders of written speech (motor dysgraphia).
Peculiarities visual arts children with dysarthria against the background of general speech underdevelopment (GSD) help us in the differential diagnosis of speech pathologies. Children's technical skills, especially shading, the ability to regulate direction, pressure, and range of motion are an indicator of the muscle tone of the leading hand. All visual arts activities (modeling, appliqué, design, drawing) are correctional in orientation, as they contribute to the development of not only fine motor skills of the hand, planning speech functions, but also orientation in space, the development of thinking, and creativity.
Integrative connections between speech therapy and swimming and physical education classes described by teacher-instructor A. M. Mashits. These activities improve your health children's body, contribute to the establishment of diaphragmatic-speech breathing, improvement of coordination of basic types of movements, fine motor skills of the hand, articulatory motor skills, overcoming interhemispheric asymmetry of the brain, enrichment of vocabulary, formation of positive personal qualities in the child’s behavior: sociability, ability to calculate one’s strengths, education of self-control, courage, determination, perseverance, modesty, self-criticism, responsiveness, sense of camaraderie, etc.
The creation of a single cohesive team and coordination of actions is helped by monthly medical-psychological-pedagogical consultations, where current issues prevention, speech correction, continuity between specialists is ensured, which stimulates the speech therapy of routine moments and the content of other classes, the penetration of speech therapy into everyday life.
Thanks to this approach, it is possible to establish continuity, achieve the necessary interaction of all persons interested in correctional and developmental education, which has a positive effect on the quality of work (96% of development center graduates go to school with clear speech), reduces the time of correctional work by one third, and practically reduces minimize possible relapses.
Of no small importance for the successful correction of speech disorders, especially in preschool children with an erased form of dysarthria, is competent selection of linguistic material.
When selecting it, the following requirements must be observed: first of all, it must be significant for the student, in demand, accessible in content and, most importantly, correspond to his pronunciation capabilities.
In the course of the work, the selection and sequence of presentation of linguistic material in the process of automation of sounds is substantiated according to the structure of the defect; the methods of mastering word formation skills are clarified, the features of children’s understanding of the relationships that exist between various elements of the lexical system and manifest themselves in language in such categories as polysemy, synonymy And antonymy; the pattern and frequency of use of these lexical-semantic groupings of words in speech are analyzed.
When studying the patterns of mastering the semantics of a word, experts rely on the provisions of modern linguistics: the meaning of each lexical unit is determined by its correlation with other units of the same level. When selecting linguistic material for speech correction, the principles of correctional pedagogy are taken into account.

– a disorder of the pronunciation organization of speech associated with damage to the central part of the speech motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. The structure of the defect in dysarthria includes violations of speech motor skills, sound pronunciation, speech breathing, voice and prosodic aspects of speech; at severe lesions anarthria occurs. If dysarthria is suspected, neurological diagnostics (EEG, EMG, ENG, MRI of the brain, etc.) and speech therapy examination of oral and written speech are performed. Corrective work for dysarthria includes therapeutic interventions (medication courses, exercise therapy, massage, physical therapy), speech therapy classes, articulation gymnastics, speech therapy massage.

Causes of dysarthria

Most often (in 65-85% of cases) dysarthria accompanies cerebral palsy and has the same causes. In this case, organic damage to the central nervous system occurs in the prenatal, birth or early periods of child development (usually up to 2 years). The most common perinatal factors of dysarthria are toxicosis of pregnancy, fetal hypoxia, Rh conflict, chronic somatic diseases of the mother, pathological course childbirth, birth trauma, asphyxia at birth, kernicterus of newborns, prematurity, etc. The severity of dysarthria is closely related to the severity motor disorders with cerebral palsy: for example, with double hemiplegia, dysarthria or anarthria is detected in almost all children.

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

The occurrence of dysarthria in adults is usually associated with a stroke, head injury, neurosurgery, and brain tumors. Dysarthria can also occur in patients with multiple sclerosis, amyotrophic lateral sclerosis, syringobulbia, Parkinson's disease, myotonia, myasthenia, cerebral atherosclerosis, neurosyphilis, oligophrenia.

Classification of dysarthria

The neurological classification of dysarthria is based on the principle of localization and a syndromic approach. Taking into account the localization of damage to the speech-motor apparatus, the following are distinguished:

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

Depending on the presenter clinical syndrome With cerebral palsy, spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, ataxic-hyperkinetic dysarthria can occur.

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

Characteristics of clinical forms of dysarthria

For bulbar dysarthria characterized by areflexia, amymia, disorder of sucking, swallowing solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is slurred and extremely simplified. All the variety of consonants is reduced into a single fricative sound; sounds are not differentiated from each other. Nasalization of voice timbre, dysphonia or aphonia is typical.

At pseudobulbar dysarthria the nature of the disorders is determined by spastic paralysis and muscle hypertonicity. Pseudobulbar palsy manifests itself most clearly in impaired tongue movements: great difficulty is caused by attempts to raise the tip of the tongue upward, move it to the sides, or hold it in a certain position. With pseudobulbar dysarthria, switching from one articulatory posture to another is difficult. Typically selective impairment of voluntary movements, synkinesis (conjugal movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is blurred, slurred, and has a nasal tint; the normative reproduction of sonors, whistling and hissing, is grossly violated.

For subcortical dysarthria characterized by the presence of hyperkinesis - involuntary violent muscle movements, including facial and articulatory ones. Hyperkinesis can occur at rest, but usually intensifies when attempting to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic aspect of speech; Sometimes patients emit involuntary guttural screams.

With subcortical dysarthria, the tempo of speech may be disrupted, such as bradylalia, tachylalia, or speech dysrhythmia (organic stuttering). Subcortical dysarthria is often combined with pseudobulbar, bulbar and cerebellar forms.

Typical manifestation cerebellar dysarthria is a violation of the coordination of the speech process, which results in tremor of the tongue, jerky, scanned speech, and occasional cries. Speech is slow and slurred; The pronunciation of front-lingual and labial sounds is most affected. With cerebellar dysarthria, ataxia is observed (unsteadiness of gait, imbalance, clumsiness of movements).

Cortical dysarthria in its speech manifestations it resembles motor aphasia and is characterized by a violation of voluntary articulatory motor skills. There are no disorders of speech breathing, voice, or prosody in cortical dysarthria. Taking into account the localization of lesions, kinesthetic postcentral cortical dysarthria (afferent cortical dysarthria) and kinetic premotor cortical dysarthria (efferent cortical dysarthria) are distinguished. However, with cortical dysarthria there is only articulatory apraxia, while with motor aphasia not only the articulation of sounds suffers, but also reading, writing, understanding speech, and using language.

Diagnosis of dysarthria

The examination and subsequent management of patients with dysarthria is carried out by a neurologist (children's neurologist) and speech therapist. The extent of the neurological examination depends on the expected clinical diagnosis. The most important diagnostic value is given by electrophysiological studies (electroencephalography, electromyography, electroneurography), transcranial magnetic stimulation, MRI of the brain, etc.

Forecast and prevention of dysarthria

Only early, systematic speech therapy work to correct dysarthria can give positive results. A major role in the success of correctional pedagogical intervention is played by the therapy of the underlying disease, the diligence of the dysarthric patient himself and his close circle.

Under these conditions, one can count on almost complete normalization of speech function in the case of erased dysarthria. Having mastered the skills of correct speech, such children can successfully study in a comprehensive school, and receive the necessary speech therapy help in clinics or at school speech centers.

In severe forms of dysarthria, only improvement in speech function is possible. The continuity of various types of speech therapy institutions is important for the socialization and education of children with dysarthria: kindergartens and schools for children with severe speech disorders, speech departments of psychoneurological hospitals; friendly work of a speech therapist, neurologist, psychoneurologist, massage therapist, and physical therapy specialist.

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

Bulbar form

Etiology: damage to the nuclei of the cranial nerves: glossopharyngeal IX, vagus X and hypoglossal XII.
Pathogenesis: disorders of the peripheral type flaccid paralysis. Hypotonia or atony is observed.
Symptoms: speech is slurred, slurred.
1) Paresis of the vocal folds. Paresis of the muscles of the soft palate does not allow the use of an oral resonator.
Unvoiced or semi-voiced variants predominate; sonors are replaced by unvoiced ones (for example, rama - tata). The speech is extremely illegible and incomprehensible. Vowels take on a noisy connotation (with an “X” sound). All oral sounds are nasalized (for example, daughter-hoh). The opposition on the basis of “oral - nasal” is erased.
2) Paresis of articulation muscles.
The tongue lies at the bottom of the oral cavity and is almost not involved in articulation. Some individual words are replaced by pharyngeal exhalation (cat-hoh). The phenomenon of assimilation of speech sounds to the system of phonemes of another language is observed. Symptom of loss of articulation (for example, baba-papa-fafa-haha).
3) Paresis of the respiratory muscles.
Reduces subglottic pressure on the vocal folds
There is no clear coordination of inhalation and exhalation at the time of speech. The inhalation is shallow, superficial, sluggish, equal to the exhalation; a long-lasting air stream is not formed. The voice fades towards the end of the phrase. The phenomenon of hypotonia is observed: the voice sounds weak, quiet, and inexpressively intonation.

Correction: speech therapy is carried out against the background of treatment of bulbar syndrome using existing medications and non-drug methods impact. Pay attention to the development of the accuracy of articulatory movements, proprioceptive sensations in the speech muscles through passive-active gymnastics of the articulatory muscles. Resistance exercises are used to develop sufficient muscle strength.

Pseudobulbar form

Etiology: damage to the corticonuclear pathway at any site.
Pathogenesis: central spastic paralysis. Disinhibition of the segmental apparatus of the medulla oblongata and spinal cord.
Symptoms: Spasticity, increased muscle tone (hypertonicity), in which the tone of the flexors in the arms increases, and the tone of the extensors in the legs. Hyperreflexia. There are pathological reflexes of early development (sucking, plantar, proboscis). There is a violation of fine differentiated movements of the fingers. The tongue is pulled towards the throat, upward movements are grossly disrupted. Various synkinesis are present. Increased salivation. The articulation of all complex anterior lingual sounds is impaired (frictional, whistling - fricative labial "V", "F"), hard - soft, plosive - fricative. The volume and functioning of the vocal folds decreases: the voice is rough, hoarse, harsh with a hint of rhinophony. In general motor skills there are no voluntary movements, involuntary ones are preserved.

Correction: speech therapy should begin from the first months of life: education of swallowing, sucking, chewing skills, development of proprioceptive sensations in the speech muscles through passive-active gymnastics of articulatory muscles, development of respiratory function, education of vocal activity.
Subsequently, speech kinesthesia is educated, the kinesthetic trace image is developed in the speech muscles and in the muscles of the fingers.
All speech therapy is carried out against the background of drug treatment.
Preliminary reduction of muscle tone in speech and skeletal muscles through the selection of special poses and positions for speech therapy work.

Cerebellar form

Etiology: damage to the cerebellum and its connections.
Pathogenesis: hypotonia and pareticity of articulatory muscles, ataxia with symptoms of hypermetry.
Symptoms: Difficulties in reproducing and maintaining certain articulatory patterns. Severe asynchrony (the process of coordination of breathing, phonation, articulation is disrupted). Speech is slow, chanting. Great exhaustion of speech occurs; modulation, sound duration, and intonation expressiveness are impaired. The lips and tongue are hypotonic, their mobility is limited, soft. the palate passively sags, chewing is weakened, facial expressions are sluggish. The pronunciation of front-lingual, labial and plosive sounds suffers. Overt nasality may occur.

Correction: it is important to develop the accuracy of articulatory movements and their sensations, to develop the intonation-rhythmic and melodic aspects of speech, to work on synchronizing the processes of articulation, breathing and voice formation.

Subcortical (extrapyramidal) form

Etiology: damage to the extrapyramidal system.

1. Pathogenesis: disturbance of muscle tone such as dystonia. When the pallidal system is damaged, parkinsonism is observed: motor acts are disrupted according to the type of hypofunctions. Violations manifest themselves in all motor skills, including articulation.
Symptoms: Respiratory rhythm and coordination between breathing, phonation and articulation are impaired.
The movements are slow, poor, inexpressive, freezing in an awkward position. "Old man's pose" - a shuffling gait, arms bent at the elbows, head and chest. Facial expressions are poor, fine motor skills are not developed. articulation is weakened.

2. Pathogenesis: with disorders of the striatal system, motility is impaired according to the type of hyperkinesis
Symptoms: 1) choreic hyperkinesis: movements are uncoordinated, involuntary, twitching, dancing in nature;
2) athetoid hyperkinesis: violent, slow, worm-like movements in the hands and toes; 3) choreoathetoid hyperkinesis: torsion spasm, spastic torticollis, hemiballismus, facial hemispasm, tremor, tics.
Speech is intermittent; some syllables are stretched out, while others are swallowed; tempo, modulation, and expressiveness are impaired.

Correction: All speech classes are carried out against the background of pathogenetic and symptomatic drug therapy. Using reflex - prohibiting positions. Development of voluntary movements in articulatory, phonation, respiratory and skeletal muscles. Fostering the ability to move in a certain rhythm and tempo, to voluntarily stop movements and switch from one movement to another. Rhythmic, voluntary breathing develops. Certain rhythmic stimuli are used: auditory - music, metronome beats, counting, visual - rhythmic waves of the hands of the speech therapist and then the child himself. Important role belongs to singing and logorhythmics. They use special breathing exercises, blowing soap bubbles, blowing out candles, and playing lip games. music instruments (pipes, accordions, pipes). Development of articulation and phonation. Development of static-dynamic sensations, clear articulatory kinesthesia. Collective speech play therapy is carried out. Separate elements of autogenic training are used.

Cortical form

With efferent form
Etiology: the lesion is localized in the anterior central gyrus.
Pathogenesis: the innervation of the articulatory muscles suffers.

In the afferent form
Etiology: the presence of lesions in the retrocentral areas of the cerebral cortex.
Pathogenesis: kinesthetic apraxia in the speech muscles and fingers.

Symptoms: sounds suffer, pronunciation cat. associated with the most subtle isolated movements of individual muscle groups. language (r, l, etc.) No drooling, no voice or breathing disorders.

Correction: against the background of drug therapy, fine differentiated articulatory movements, kinesthetic sensations, oral and manual praxis develop.

See a speech therapist for advice

Oksana Makerova
Dysarthria

Dysarthria- violation of the sound pronunciation side of speech, caused by organic insufficiency of innervation of the speech apparatus.

The term "dysarthria" is derived from the Greek words arthson - articulation and dys - particle meaning disorder. This is a neurological term because... Dysarthria occurs when the function of the cranial nerves of the lower part of the brainstem, responsible for articulation, is impaired.

The cranial nerves of the lower part of the trunk (medulla oblongata) are adjacent to the cervical spinal cord, have a similar anatomical structure and are supplied with blood from the same vertebrobasilar area.

Very often there are contradictions between neurologists and speech therapists regarding dysarthria. If a neurologist does not see obvious disturbances in the function of the cranial nerves, he cannot call the speech disorder dysarthria. This question is almost a stumbling block between neurologists and speech therapists. This is due to the fact that a neurologist, after making a diagnosis of dysarthria, is obliged to carry out serious therapy for the treatment of brainstem disorders, although such disorders (excluding dysarthria) do not seem to be noticeable.

The medulla oblongata of the brainstem, as well as cervical region spinal cord, often experiences hypoxia during labor. This leads to a sharp decrease in motor units in the nerve nuclei responsible for articulation. During a neurological examination, the child adequately performs all tests, but cannot cope properly with articulation, because it is necessary to perform complex and fast movements that are beyond the strength of weakened muscles.

Main manifestations of dysarthria consist of a disorder of articulation of sounds, disturbances in voice formation, as well as changes in the rate of speech, rhythm and intonation.

These disorders manifest themselves to varying degrees and in various combinations depending on the location of the lesion in the central or peripheral nervous system, the severity of the disorder, and the time of occurrence of the defect. Articulation and phonation disorders, which make it difficult and sometimes completely prevent articulate sonorous speech, constitute the so-called primary defect, which can lead to secondary manifestations that complicate its structure. Clinical, psychological and speech therapy studies of children with dysarthria show that this category of children is very heterogeneous in terms of motor, mental and speech disorders

Causes of dysarthria
1. Organic damage to the central nervous system as a result of the influence of various unfavorable factors on the developing brain of a child in the prenatal and early periods of development. Most often these are intrauterine lesions resulting from acute, chronic infections, oxygen deficiency (hypoxia), intoxication, toxicosis of pregnancy and a number of other factors that create conditions for the occurrence of birth trauma. In a significant number of such cases, asphyxia occurs during childbirth and the child is born premature.

2. The cause of dysarthria may be Rh factor incompatibility.

3. Dysarthria occurs somewhat less frequently under the influence of infectious diseases of the nervous system in the first years of a child’s life. Dysarthria is often observed in children suffering from childhood cerebral palsy(cerebral palsy). According to E.M. Mastyukova, dysarthria with cerebral palsy manifests itself in 65-85% of cases.

Classification of clinical forms of dysarthria
The classification of clinical forms of dysarthria is based on the identification various localizations brain damage. Children with various forms of dysarthria differ from each other in specific defects in sound pronunciation, voice, and articulatory motor skills, require different speech therapy techniques and can be corrected to varying degrees.

Forms of dysarthria
Bulbar dysarthria (from the Latin bulbus - a bulb, the shape of which is the medulla oblongata) manifests itself with a disease (inflammation) or tumor of the medulla oblongata. In this case, the nuclei of the motor cranial nerves located there (glossopharyngeal, vagus and sublingual, sometimes trigeminal and facial) are destroyed.
Characteristic is paralysis or paresis of the muscles of the pharynx, larynx, tongue, soft palate. A child with a similar defect has difficulty swallowing solid and liquid food and has difficulty chewing. Insufficient mobility of the vocal folds and soft palate leads to specific voice disorders: it becomes weak and nasal. Voiced sounds are not realized in speech. Paresis of the muscles of the soft palate leads to the free passage of exhaled air through the nose, and all sounds acquire a pronounced nasal (nasal) tone.
In children with the described form of dysarthria, atrophy of the muscles of the tongue and pharynx is observed, and muscle tone also decreases (atonia). The paretic state of the tongue muscles causes numerous distortions in sound pronunciation. Speech is slurred, extremely unclear, slow. The face of a child with tabloid dysarthria is amicable.

Subcortical dysarthria occurs when the subcortical nodes of the brain are damaged. A characteristic manifestation subcortical dysarthria is a violation of muscle tone and the presence of hyperkinesis. Hyperkinesis is violent involuntary movements (in this case in the area of ​​articulatory and facial muscles) that are not controlled by the child. These movements can be observed at rest, but usually intensify during speech.
The changing nature of muscle tone (from normal to increased) and the presence of hyperkinesis cause peculiar disturbances in phonation and articulation. A child can correctly pronounce individual sounds, words, short phrases (especially in a game, in a conversation with loved ones or in a state of emotional comfort) and after a moment he is unable to utter a single sound. An articulatory spasm occurs, the tongue becomes tense, and the voice is interrupted. Sometimes involuntary screams are observed, and guttural (pharyngeal) sounds “break through.” Children may pronounce words and phrases excessively quickly or, conversely, monotonously, with long pauses between words. Speech intelligibility suffers due to unsmooth switching of articulatory movements when pronouncing sounds, as well as due to disturbances in the timbre and strength of the voice.
A characteristic sign of subcortical dysarthria is a violation of the prosodic aspect of speech - tempo, rhythm and intonation. The combination of impaired articulatory motor skills with disorders of voice formation and speech breathing leads to specific defects in the sound aspect of speech, which manifest themselves variably depending on the child’s condition, and are reflected mainly in the communicative function of speech.
Sometimes with subcortical dysarthria in children, hearing loss is observed, complicating a speech defect.

Cerebellar dysarthria characterized by chanted “chopped” speech, sometimes accompanied by shouts of individual sounds. In its pure form, this form is rarely observed in children.

Cortical dysarthria presents great difficulties for isolation and recognition. With this form, voluntary motor skills of the articulatory apparatus are impaired. In its manifestations in the sphere of sound pronunciation, cortical dysarthria resembles motor alalia, since, first of all, the pronunciation of words with a complex sound-syllable structure is impaired. In children, the dynamics of switching from one sound to another, from one articulatory posture to another, is difficult. Children are able to clearly pronounce isolated sounds, but in the speech stream the sounds are distorted and substitutions occur. Combinations of consonant sounds are especially difficult. At an accelerated pace, hesitations appear, reminiscent of stuttering.
However, unlike children with motor alalia, children with this form of dysarthria do not experience disturbances in the development of the lexico-grammatical aspect of speech. Cortical dysarthria should also be distinguished from dyslalia. Children have difficulty reproducing articulatory posture, and it is difficult for them to move from one sound to another. During correction, attention is drawn to the fact that defective sounds are quickly corrected in isolated utterances, but are difficult to automate in speech.

Erased form
I especially want to highlight the erased (mild) form of dysarthria, since in Lately In the process of speech therapy practice, we are increasingly encountering children whose speech disorders are similar to the manifestations of complex forms of dyslalia, but with longer and more complex dynamics of learning and speech correction. A thorough speech therapy examination and observation reveals a number of specific disorders in them (disorders of the motor sphere, spatial gnosis, phonetic aspects of speech (in particular, prosodic characteristics of speech), phonation, breathing, and others), which allows us to conclude that there are organic lesions of the central nervous system.

Practical and research work shows that it is very often difficult to diagnose mild forms of dysarthria, differentiate it from other speech disorders, in particular dyslalia, in determining the ways of correction and the amount of necessary speech therapy assistance for children with an erased form of dysarthria. Considering the prevalence of this speech disorder among preschool children, we can conclude that at present there is a very urgent need for current problem- the problem of providing qualified speech therapy assistance to children with an erased form of dysarthria.

Mild (erased) forms of dysarthria can be observed in children without obvious movement disorders who have been exposed to various unfavorable factors during the prenatal, natal and early postnatal periods of development. Among these unfavorable factors are:
- toxicosis of pregnancy;
- chronic fetal hypoxia;
- acute and chronic diseases of the mother during pregnancy;
- minimal damage to the nervous system in Rh-conflict situations between mother and fetus;
- mild asphyxia;
- birth injuries;
- acute infectious diseases of children in infancy etc.

The impact of these unfavorable factors leads to the emergence of a number of specific features in the development of children. IN early period development in children with an erased form of dysarthria, motor restlessness, sleep disturbances, and frequent, causeless crying are noted. Feeding such children has a number of peculiarities: there is difficulty in holding the nipple, rapid fatigue when sucking, babies refuse the breast early, and burp frequently and profusely. In the future, they become poorly accustomed to complementary feeding and are reluctant to try new foods. At lunch, such a child sits for a long time with his mouth full, chews poorly and reluctantly swallows food, hence frequent choking while eating. Parents of children with light forms dysarthric disorders note that in preschool age children prefer cereals, broths, and purees to solid foods, so feeding such a child becomes a real problem.

A number of features can also be noted in early psychomotor development: the formation of static-dynamic functions may be somewhat delayed or remain within the age norm. Children, as a rule, are somatically weakened and often suffer from colds.

The anamnesis of children with an erased form of dysarthria is burdened. Most children under 1-2 years of age were observed by a neurologist, but later this diagnosis was removed.

Early speech development in a significant proportion of children with mild symptoms dysarthria was slightly slowed down. The first words appear by 1 year, phrasal speech is formed by 2-3 years. At the same time, for quite a long time, children’s speech remains illegible, unclear, understandable only to parents. Thus, by the age of 3-4 years, the phonetic aspect of speech in preschoolers with an erased form of dysarthria remains unformed.

In speech therapy practice, we often encounter children with sound pronunciation disorders who, in the conclusion of a neurologist, have evidence of the absence of focal microsymptoms in their neurological status. However, correction of speech disorders in such children using conventional methods and techniques does not bring effective results. Consequently, the question arises of further examination and a more detailed study of the causes and mechanisms of occurrence of these violations.

A thorough neurological examination of children with similar speech disorders using functional loads reveals mild microsymptoms of organic damage to the nervous system. These symptoms manifest themselves in the form of motor disorders and extrapyramidal insufficiency and are reflected in the state of general, fine and articulatory motor skills, as well as facial muscles.

The general motor sphere of children with an erased form of dysarthria is characterized by awkward, constrained, undifferentiated movements. There may be a slight limitation in the range of movements of the upper and lower extremities; with functional load, conjugate movements (syncenesis) and disturbances in muscle tone are possible. Often, with pronounced general mobility, the movements of a child with an erased form of dysarthria remain awkward and unproductive.

Insufficiency of general motor skills is most clearly manifested in preschoolers with this disorder when performing complex movements that require precise control of movements, precise work of various muscle groups, and correct spatial organization of movements. For example, a child with an erased form of dysarthria, somewhat later than his peers, begins to grasp and hold objects, sit, walk, jump on one or two legs, runs awkwardly, and climbs on a wall bars. In middle and senior preschool age, it takes a long time for a child to learn to ride a bicycle, ski and skate.

In children with an erased form of dysarthria, disturbances in fine motor skills of the fingers are also observed, which are manifested in impaired accuracy of movements, a decrease in the speed of execution and switching from one pose to another, slow initiation of movement, and insufficient coordination. Finger tests are performed imperfectly, and significant difficulties are observed. These features are manifested in the child’s play and learning activities. A preschooler with mild manifestations of dysarthria is reluctant to draw, sculpt, or play ineptly with mosaics.

Features of the state of general and fine motor skills are also manifested in articulation, since there is a direct relationship between the level of formation of fine and articulatory motor skills. Disturbances in speech motor skills in preschool children with this type of speech pathology are caused by the organic nature of the damage to the nervous system and depend on the nature and degree of dysfunction of the motor nerves that ensure the process of articulation. It is the mosaic nature of the damage to the motor conducting cortical-nuclear pathways that determines the greater combinability of speech disorders in the erased form of dysarthria, the correction of which requires the speech therapist to carefully and detailed develop an individual plan for speech therapy work with such a child. And of course, such work seems impossible without the support and close cooperation with parents interested in correcting their child’s speech disorders.

Pseudobulbar dysarthria - the most common form of childhood dysarthria. Pseudobulbar dysarthria is a consequence of organic brain damage suffered in early childhood, during childbirth or in the prenatal period as a result of encephalitis, birth injuries, tumors, intoxication, etc. The child experiences pseudobulbar paralysis or paresis caused by damage to the pathways coming from the cerebral cortex to the nuclei of the glossopharyngeal, vagus and hypoglossal nerves. According to the clinical manifestations of disorders in the area of ​​facial and articulatory muscles, it is close to bulbar. However, the possibilities of correction and full mastery of the sound-pronunciation side of speech with pseudobulbar dysarthria are much higher.
As a result of pseudobulbar palsy, the child's general and speech motor skills are impaired. The baby sucks poorly, chokes, chokes, and swallows poorly. Saliva flows from the mouth, facial muscles are disturbed.

The degree of impairment of speech or articulatory motor skills may vary. Conventionally, there are three degrees of pseudobulbar dysarthria: mild, moderate, severe.

1. A mild degree of pseudobulbar dysarthria is characterized by the absence of gross disturbances in the motor skills of the articulatory apparatus. Difficulties in articulation lie in slow, insufficiently precise movements of the tongue and lips. Chewing and swallowing disorders are revealed faintly, with rare choking. Pronunciation in such children is impaired due to insufficiently clear articulatory motor skills, speech is somewhat slow, and blurred pronunciation of sounds is characteristic. The pronunciation of complex sounds is more likely to suffer. according to the articulation of sounds: zh, sh, r, ts, ch. Voiced sounds are pronounced with insufficient participation of the voice. Soft sounds are difficult to pronounce, requiring the addition of raising the middle part of the back of the tongue to the hard palate to the main articulation.
Pronunciation deficiencies have an adverse effect on phonemic development. Most children with mild dysarthria experience some difficulty in auditory processing. When writing, they encounter specific errors in replacing sounds (t-d, t-ts, etc.). There is almost no violation of the structure of the word: the same applies to grammatical structure and vocabulary. Some uniqueness can only be revealed through a very careful examination of children, and it is not typical. So, the main defect in children suffering from pseudobulbar dysarthria is mild degree, is a violation of the phonetic side of speech.
Children with a similar disorder, who have normal hearing and good mental development, attend speech therapy classes at the regional children's clinic, and at school age - a speech therapy center at a comprehensive school. Parents can play a significant role in eliminating this defect.

2. Children with average degree dysarthrias constitute the largest group. They are characterized by amicity: lack of movement of the facial muscles. The child cannot puff out his cheeks, stretch out his lips, or close them tightly. Tongue movements are limited. The child cannot lift the tip of his tongue up, turn it to the right, left, or hold it in this position. Switching from one movement to another is a significant difficulty. The soft palate is often inactive, and the voice has a nasal tone. Characterized by profuse salivation. The acts of chewing and swallowing are difficult. The consequence of dysfunction of the articulatory apparatus is a severe pronunciation defect. The speech of such children is usually very slurred, slurred, and quiet. The articulation of vowels, usually pronounced with a strong nasal exhalation, is characteristic due to the inactivity of the lips and tongue. The sounds "a" and "u" are not clear enough, the sounds "i" and "s" are usually mixed. Of the consonants, p, t, m, n, k, x are most often preserved. The sounds ch and ts, r and l are pronounced approximately, like a nasal exhalation with an unpleasant “squelching” sound. The exhaled mouth stream is felt very weakly. More often, voiced consonants are replaced by voiceless ones. Often sounds at the end of words and in combinations of consonants are omitted. As a result, the speech of children suffering from pseudobulbar dysarthria is so incomprehensible that they prefer to remain silent. Along with the usually late development of speech (at the age of 5-6 years), this circumstance sharply limits the child’s experience of verbal communication.
Children with such a disorder cannot study successfully in a comprehensive school. The most favorable conditions for their education and upbringing are created in special schools for children with severe speech impairments, where these students receive an individual approach.

3. A severe degree of pseudobulbar dysarthria - anarthria - is characterized by deep muscle damage and complete inactivity of the speech apparatus. The face of a child suffering from anarthria is mask-like, lower jaw droops, the mouth is constantly open. The tongue lies motionless on the floor of the oral cavity, lip movements are sharply limited. The acts of chewing and swallowing are difficult. Speech is completely absent, sometimes there are individual inarticulate sounds. Children with anarthria with good mental development They can also study in special schools for children with severe speech impairments, where, thanks to special speech therapy methods, they successfully master writing skills and a curriculum in general education subjects.

A characteristic feature of all children with pseudobulbar dysarthria is that with distorted pronunciation of the sounds that make up a word, they usually retain the rhythmic contour of the word, i.e., the number of syllables and stress. As a rule, they know the pronunciation of two- and three-syllable words; four-syllable words are often reproduced reflectively. It is difficult for a child to pronounce consonant clusters: in this case, one consonant is dropped (squirrel - “beka”) or both (snake - “iya”). Due to the motor difficulty of switching from one syllable to another, there are cases of likening syllables (dishes - “posyusya”, scissors - “noses”).

Impaired motor skills of the articulatory apparatus leads to improper development of the perception of speech sounds. Deviations in auditory perception Caused by insufficient articulatory experience, the lack of a clear kinesthetic image of sound leads to noticeable difficulties in mastering sound analysis. Depending on the degree of speech motor impairment, variously expressed difficulties in sound analysis are observed.

Most special tests that reveal the level of sound analysis are not available to dysarthric children. They cannot correctly select pictures whose names begin with a given sound, come up with a word containing a certain sound, or analyze the sound composition of a word. For example, a twelve-year-old child who has studied for three years at mass school, answering the question what sounds are in the words of the regiment, the cat calls p, a, k, a; k, a, t, a. When completing the task of selecting pictures whose names contain the sound b, the boy puts aside a jar, a drum, a pillow, a scarf, a saw, and a squirrel.
Children with better preserved pronunciation make fewer mistakes; for example, they select the following pictures based on the sound “s”: bag, wasp, plane, ball.
For children suffering from anarthria, such forms of sound analysis are not available.

Literacy acquisition for dysarthria
The level of proficiency in sound analysis in the vast majority of dysarthric children is insufficient for mastering literacy. Children who enter public schools are completely unable to master the 1st grade curriculum.

Letter
Deviations in sound analysis are especially pronounced during auditory dictation.

I will give a sample letter from a boy who studied for three years in a public school: house - “ladies”, fly - “muaho”, nose - “ouch”, chair - “oo”, eyes - “naka”, etc.

Another boy, after a year at a public school, writes instead of “Dima goes for a walk” - “Dima dapet gul ts”; “There are wasps in the forest” - “Lusu wasps”; “The boy feeds the cat milk” - “Malkin lali kashko maloko.”

The largest number of errors in the writing of children suffering from dysarthria occur in letter substitutions. There are often vowel replacements: children - “detu”, teeth - “zubi”, bots - “buti”, bridge - “muta”, etc. Inaccurate, nasal pronunciation of vowel sounds leads to the fact that they hardly differ in sound.

Consonant substitutions are numerous and varied:
l-r: squirrel - "berka"; h-ch: fur - “sword”; b-t: duck - “duck”; g-d: gudok - “dudok”; s-ch: geese - “guchi”; b-p: watermelon - "arpus".

Typical cases are cases of violation of the syllabic structure of a word due to the rearrangement of letters (book - “kinga”), omission of letters (cap - “shapa”), reduction of the syllable structure due to underwriting of syllables (dog - “soba”, scissors - “knives” and etc.).

There are frequent cases of complete distortion of words: bed - “damla”, pyramid - “makte”, iron - “neaki”, etc. Such errors are most typical for children with profound articulation disorders, in whom the lack of differentiation of the sound composition of speech is associated with distorted sound pronunciation.

In addition, in the writing of dysarthric children, errors such as incorrect use of prepositions, incorrect syntactic connections of words in a sentence (coordination, control), etc. are common. These non-phonetic errors are closely related to the learning characteristics of dysarthric children orally, grammatical structure, vocabulary.

Children's independent writing is characterized by a poor composition of sentences, their incorrect construction, omission of sentence parts and function words. For some children, even small-scale presentations are completely inaccessible.

Reading
Reading for dysarthric children is usually extremely difficult due to the inactivity of the articulatory apparatus and difficulties in switching from one sound to another. For the most part it is syllable-by-syllable, not colored by intonation. Understanding readable text insufficient. For example, a boy, having read the word chair, points to the table; after reading the word cauldron, he shows a picture depicting a goat (cauldron-goat).

Lexico-grammatical structure of speech of dysarthric children
As noted above, the immediate result of damage to the articulatory apparatus is difficulties in pronunciation, which lead to insufficiently clear perception of speech by ear. The general speech development of children with severe articulation disorders proceeds in a unique way. Late onset of speech, limited speech experience, and gross pronunciation defects lead to insufficient accumulation of vocabulary and deviations in the development of the grammatical structure of speech. Most children with articulation disorders have deviations in their vocabulary, do not know everyday words, and often mix words based on similarity in sound composition, situation, etc.

Many words are used inaccurately; instead of the desired name, the child uses one that denotes a similar object (loop - hole, vase - jug, acorn - nut, hammock - net) or is situationally related to this word (rails - sleepers, thimble - finger).

Characteristic features of dysarthric children are a fairly good orientation in the environment and a stock of everyday information and ideas. For example, children know and can find objects in the picture such as a swing, a well, a buffet, a carriage; determine the profession (pilot, teacher, driver, etc.); understand the actions of the persons depicted in the picture; show objects painted in one color or another. However, the absence of speech or limited use of it leads to a discrepancy between active and passive vocabulary.

The level of vocabulary acquisition depends not only on the degree of impairment of the sound-pronunciation side of speech, but also on the intellectual capabilities of the child, social experience, and the environment in which he is raised. Dysarthric children, as well as children in general with general speech underdevelopment, are characterized by insufficient command of the grammatical means of the language.

Main directions of correctional work
These features of the speech development of children with dysarthria show that they need systematic special training aimed at overcoming defects in the sound side of speech, development vocabulary and grammatical structure of speech, correction of writing and reading disorders. Such correctional tasks are solved in a special school for children with speech disorders, where the child receives an education equivalent to a nine-year general education school.

Preschool children with dysarthria need targeted speech therapy sessions to develop the phonetic and lexical-grammatical structure of speech. Such classes are conducted in special preschool institutions for children with speech disorders.

Speech therapy work with dysarthric children is based on knowledge of the structure of speech defects in various forms of dysarthria, mechanisms of violation of general and speech motor skills, and taking into account the personal characteristics of children. Particular attention is paid to the state of children's speech development in the field of vocabulary and grammatical structure, as well as the peculiarities of the communicative function of speech. For school-age children, the state of written speech is taken into account.

Positive results of speech therapy work are achieved subject to the following principles:
gradual interconnected formation of all components of speech;
systematic approach to the analysis of speech defects;
regulation mental activity children through the development of communicative and generalizing functions of speech.

In the process of systematic and, in most cases, long-term training, a gradual normalization of the motor skills of the articulatory apparatus, the development of articulatory movements, the formation of the ability to voluntarily switch the movable organs of articulation from one movement to another at a given pace, overcoming monotony and disturbances in the tempo of speech are achieved; full development of phonemic perception. This prepares the basis for the development and correction of the sound side of speech and creates the prerequisites for mastering the skills of oral and written speech.

Speech therapy work must begin in early preschool age, thereby creating conditions for the full development of more complex aspects of speech activity and optimal social adaptation. The combination of speech therapy with therapeutic measures and overcoming deviations in general motor skills is also of great importance.

Preschool children with dysarthria, who do not have gross deviations in the development of the musculoskeletal system, have self-care skills and have normal hearing and full intelligence, are educated in special kindergartens for children with speech impairments. At school age, children with severe dysarthria are educated in special schools for children with severe speech impairments, where they receive education equivalent to a nine-year school with simultaneous correction of speech defects. For children with dysarthria who have pronounced violations musculoskeletal system, the country has specialized kindergartens and schools, where much attention is paid to therapeutic and physiotherapeutic measures.

When correcting dysarthria in practice, as a rule, regulation of speech breathing is used as one of the leading methods for establishing fluency of speech.

Breathing exercises by A. N. Strelnikova
In speech therapy work on speech breathing of children, adolescents and adults, paradoxical breathing exercises by A. N. Strelnikova are widely used. Strelnikovskaya breathing gymnastics is the brainchild of our country; it was created at the turn of the 30-40s of the 20th century as a way to restore the singing voice, because A. N. Strelnikova was a singer and lost it.

This gymnastics is the only one in the world in which a short and sharp breath is taken through the nose using movements that compress the chest.

Exercises actively involve all parts of the body (arms, legs, head, hip girdle, abdominals, shoulder girdle, etc.) and cause a general physiological reaction of the whole body, an increased need for oxygen. All exercises are performed simultaneously with a short and sharp inhalation through the nose (with absolutely passive exhalation), which enhances internal tissue respiration and increases the absorption of oxygen by tissues, and also irritates that extensive area of ​​receptors on the nasal mucosa, which provides reflex communication between the nasal cavity and almost all organs.

That's why this breathing exercise has such wide range effects and helps with a lot of different diseases of organs and systems. It is useful for everyone and at any age.

In gymnastics, the focus is on inhalation. The inhalation is very short, instantaneous, emotional and active. The main thing, according to A. N. Strelnikova, is to be able to hold, “hide” your breath. Don't think about exhaling at all. The exhalation goes away spontaneously.

When teaching gymnastics, A. N. Strelnikova advises following four basic rules.

Rule 1. "It smells like burning! Alarm!" And sharply, noisily, throughout the entire apartment, sniff the air like a dog trail. The more natural the better. The biggest mistake is to pull the air to get more air. The inhalation is short, like an injection, active and the more natural the better. Just think about inhaling. The feeling of anxiety organizes active inhalation better than reasoning about it. Therefore, without hesitation, sniff the air furiously, to the point of rudeness.

Rule 2. Exhalation is the result of inhalation. Do not prevent the exhalation from leaving after each inhalation as much as you like - but better through your mouth than through your nose. Don't help him. Just think: “It smells like burning! Alarm!” And just make sure that the inhalation occurs simultaneously with the movement. The exhalation will go away spontaneously. During gymnastics, the mouth should be slightly open. Get carried away with inhalation and movement, do not be boring and indifferent. Play savage like children play, and everything will work out. The movements create sufficient volume and depth for short inhalations without much effort.

Rule 3. Repeat the inhalations as if you were inflating a tire at the tempo of a song and dance. And, training movements and breaths, count by 2, 4 and 8. Tempo: 60-72 breaths per minute. Inhalations are louder than exhalations. Lesson norm: 1000-1200 breaths, more is possible - 2000 breaths. Pauses between doses of breaths are 1-3 seconds.

Rule 4. Take as many breaths in a row as you can easily take at the moment. The whole complex consists of 8 exercises. First - warm-up. Stand up straight. Hands at your sides. Feet shoulder width apart. Take short, injection-like breaths, sniffing loudly through your nose. Do not be shy. Force the wings of the nose to connect as you inhale, rather than widening them. Train 2 or 4 breaths in a row at a walking pace of “a hundred” breaths. You can do more to feel that the nostrils are moving and listening to you. Inhale, like an injection, instantaneous. Think: “It smells like burning! Where does it come from?” To understand gymnastics, take a step in place and simultaneously inhale with each step. Right-left, right-left, inhale-inhale, inhale-inhale. And not inhale and exhale, as in regular gymnastics.
Take 96 (hundred) steps-breaths at a walking pace. You can stand still, you can while walking around the room, you can shift from foot to foot: back and forth, back and forth, the weight of the body is either on the leg standing in front, or on the leg standing behind. It is impossible to take long breaths at the pace of your steps. Think: “My legs are pumping air into me.” It helps. With every step - a breath, short, like an injection, and noisy.
Having mastered the movement, lifting your right leg, squat a little on your left, lifting your left - on your right. The result is a rock and roll dance. Make sure that the movements and breaths go at the same time. Do not interfere or help the exhalations to come out after each inhalation. Repeat the breaths rhythmically and often. Do as many of them as you can easily do.

Head movements.
- Turns. Turn your head left and right, sharply, at the pace of your steps. And at the same time with each turn, inhale through your nose. Short, like an injection, noisy. 96 breaths. Think: “It smells like burning! Where does it come from? On the left? On the right?” Sniff the air...
- "Ears". Shake your head as if you were saying to someone: “Ay-ay-ay, what a shame!” Make sure your body doesn't turn. The right ear goes to the right shoulder, the left ear goes to the left. Shoulders are motionless. Simultaneously with each rocking, inhale.
- "Small pendulum". Nod your head back and forth, inhale and inhale. Think: “Where does the burning smell come from? From below? From above?”

Main movements.
- "Cat". Feet shoulder width apart. Remember the cat that sneaks up on the sparrow. Repeat her movements - squat a little, turn first to the right, then to the left. Shift the weight of your body either to your right leg or to your left. To the direction you turned. And noisily sniff the air to the right, to the left, at the pace of your steps.
- "Pump". Hold a rolled-up newspaper or stick in your hands like a pump handle and think that you are inflating a car tire. Inhale - at the extreme point of the inclination. When the tilt ends, the breath ends. Do not pull it while unbending, and do not unbend all the way. You need to quickly inflate the tire and move on. Repeat the inhalations and bending movements frequently, rhythmically and easily. Don't raise your head. Look down at an imaginary pump. Inhale, like an injection, instantaneous. Of all our inhalation movements, this is the most effective.
- “Hug your shoulders.” Raise your arms to shoulder level. Bend your elbows. Turn your palms towards you and place them in front of your chest, just below your neck. Throw your hands towards each other so that the left one hugs the right shoulder, and the right one hugs the left armpit, that is, so that the arms go parallel to each other. Step pace. Simultaneously with each throw, when your hands are closest to each other, repeat short, noisy breaths. Think: "Shoulders help the air." Do not move your hands far from your body. They are close. Don't straighten your elbows.
- "Big Pendulum". This movement is continuous, similar to a pendulum: “pump” - “hug your shoulders”, “pump” - “hug your shoulders”. Step pace. Bend forward, hands reaching towards the ground - inhale, bend back, hands hug your shoulders - also inhale. Forward - back, inhale, inhale, tick-tock, tick-tock, like a pendulum.
- "Half squats." One leg is in front, the other is behind. The weight of the body is on the leg standing in front, the leg behind just touches the floor, as before the start. Perform a light, barely noticeable squat, as if dancing in place, and at the same time with each squat, repeat a short, light breath. Having mastered the movement, add simultaneous counter movements of the arms.

This is followed by a special training of “latent” breathing: a short inhalation with a tilt, the breath is held as much as possible without straightening, you need to count out loud to eight, gradually the number of “eights” pronounced on one exhalation increases. With one tightly held breath, you need to collect as many “eights” as possible. From the third or fourth training, the utterance of “eights” by stutterers is combined not only with bending, but also with “half squats” exercises. The main thing, according to A. N. Strelnikova, is to feel the breath “caught in a fist” and show restraint, repeating out loud the maximum number of eights while holding your breath tightly. Of course, the “eights” in each workout are preceded by the entire complex of exercises listed above.

Exercises for developing speech breathing
The following exercises are recommended in speech therapy practice.

Select comfortable position(lying, sitting, standing), place one hand on your stomach, the other on the side of your lower chest. Take a deep breath through your nose (this pushes your stomach forward and expands your lower chest, which is controlled by both hands). After inhaling, immediately exhale freely and smoothly (the abdomen and lower chest return to their previous position).

Take a short, calm breath through your nose, hold the air in your lungs for 2-3 seconds, then exhale long, smoothly through your mouth.

Take a short breath when open mouth and on a smooth, drawn-out exhalation, pronounce one of the vowel sounds (a, o, u, i, e, s).

Smoothly pronounce several sounds on one exhalation: aaaaa aaaaaooooooo aaaaauuuuuu.

Count on one exhalation up to 3-5 (one, two, three...), trying to gradually increase the count to 10-15. Make sure you exhale smoothly. Count down (ten, nine, eight...).

Ask your child to repeat after you proverbs, sayings, and tongue twisters in one breath. Be sure to follow the instructions given in the first exercise.

The drop and the stone are chiseling.
They build with their right hand and break with their left.
Whoever lied yesterday will not be believed tomorrow.
Toma cried all day on a bench near the house.
Don't spit in the well - you'll need to drink the water.
There is grass in the yard, there is firewood on the grass: one firewood, two firewood - do not cut wood on the grass of the yard.
Like thirty-three Egorkas lived on a hillock: one Egorka, two Egorkas, three Egorkas...

- Read the Russian folk tale "Turnip" with the correct reproduction of inhalation during pauses.

Turnip.
Grandfather planted a turnip. The turnip grew very, very big.
Grandfather went to pick turnips. He pulls and pulls, but he can’t pull it out.
Grandfather called grandma. Grandma for grandpa, grandpa for the turnip, they pull and pull, but they can’t pull it out!
The grandmother called her granddaughter. Granddaughter for grandma, grandma for grandfather, grandfather for turnip, they pull and pull, they can’t pull it out!
The granddaughter called Zhuchka. The bug for the granddaughter, the granddaughter for the grandmother, the grandmother for the grandfather, the grandfather for the turnip, they pull and pull, they can’t pull it out!
Bug called the cat. Cat for Bug, Bug for granddaughter, granddaughter for grandmother, grandmother for grandfather, grandfather for turnip, they pull and pull, they can’t pull it out!
The cat called the mouse. Mouse for the cat, cat for the Bug, Bug for the granddaughter, granddaughter for the grandmother, grandmother for the grandfather, grandfather for the turnip, pull and pull - they pulled out the turnip!

Practiced skills can and should be consolidated and fully applied in practice.

* "Whose steamer sounds better?"
Take a glass vial approximately 7 cm high, neck diameter 1-1.5 cm, or any other suitable object. Bring it to your lips and blow. “Listen to how the bubble hums. Like a real steamboat. Will you make a steamboat? I wonder whose steamer will hum louder, yours or mine? And whose will take longer?” It should be remembered: for the bubble to buzz, the lower lip must lightly touch the edge of its neck. The air stream should be strong and come out in the middle. Just don’t blow for too long (more than 2-3 seconds), otherwise you’ll get dizzy.

* "Captains".
Place paper boats in a bowl of water and invite your child to ride on a boat from one city to another. In order for the boat to move, you need to blow on it slowly, pursing your lips like a tube. But then a gusty wind blows in - the lips fold as if to make the sound p.

Whistles, toy pipes, harmonicas, inflating balloons and rubber toys also contribute to the development of speech breathing.

The tasks become more complex gradually: first, long speech exhalation training is carried out on individual sounds, then on words, then on a short phrase, when reading poetry, etc.

In each exercise, the child’s attention is directed to a calm, relaxed exhalation, to the duration and volume of the pronounced sounds.

Treatment
The full course of correction and treatment of dysarthria takes several months. As a rule, children with dysarthria are in a day hospital for 2-4 weeks, then continue the course of treatment on an outpatient basis. In conditions day hospital undergo restorative physiotherapy, massage, exercise therapy, and breathing exercises. This allows you to reduce the time to achieve maximum effect and makes it more sustainable.

Treatment of dysarthria using hirudotherapy
Back in the 16th-17th centuries, hirudotherapy (hereinafter HT) was used for diseases of the liver, lungs, gastrointestinal tract, tuberculosis, migraine, epilepsy, hysteria, gonorrhea, skin and eye diseases, and disorders menstrual cycle, cerebrovascular accidents, fever, hemorrhoids, as well as to stop bleeding and other diseases.

Why did interest in the leech begin to increase? The reasons for this are the insufficient therapeutic effectiveness of pharmaceuticals. funds, an increase in the number of drug-allergic people, a huge number (40-60%) of counterfeit pharmaceuticals in the pharmacy chain.

To understand the mechanisms therapeutic effect medical leech (MP), it is necessary to study the biologically active substances (BAS) of the secretion of the salivary glands (SSG). The secretion of the leech salivary glands contains a set of compounds of protein (peptide), lipid and carbohydrate nature. Reports by I. I. Artamonova, L. L. Zavalova and I. P. Baskova indicate the presence of more than 20 components in the low molecular weight fraction of leech SSG (molecular weight less than 500 D) and more than 80 in the fraction with a molecular weight of more than 500 D.

The most studied components of SSF: hirudin, a histamine-like substance, prostacyclins, prostaglandins, hyaluronidase, lipase, apyrase, collogenase, viburnum and saratin - platelet adhesion inhibitors, platelet activating factor inhibitor, destabilase, destabilase-lysozyme (destobilase - L), bdellins-trypsin inhibitors and plasmin, eglins - inhibitors of chymotryptosin, subtilisin, elastase and cathepsin G, neurotrophic factors, blood plasma kallikrein inhibitor. The intestinal canal of the leech contains the symbiont bacterium Aeromonas hidrophilia, which provides a bacteriostatic effect and is a source of some components of the SSF. One of the elements of MP contained in saliva is hyaluronidase. It is believed that with the help of this substance, toxic (endo- or exogenous origin) products that have not undergone metabolic transformations are removed from the matrix space (Pischinger’s space), which allows them to be removed from the body by the MP using excretory organs. They can cause vomiting or death in MPs.

Neurotrophic factors (NTFs) MP. This aspect associated with the effects of SSF on nerve endings and neurons. This problem was first raised in our research. The idea arose as a result of the results of treatment of children with cerebral palsy and myopathy. Patients showed significant positive changes in the treatment of spastic tension skeletal muscles. A child who, before treatment, could only move on all fours, could move on his own legs several months after MP treatment.

Neurotrophic factors are low molecular weight proteins that are secreted by target tissues and are involved in differentiation nerve cells and are responsible for the growth of their processes. NTFs play an important role not only in the processes of embryonic development of the nervous system, but also in the adult body. They are necessary to maintain the viability of neurons.

To assess the neurite-stimulating effect, a morphometric method is used, which makes it possible to measure the area of ​​the ganglion along with the growth zone, consisting of neurites and glial elements, after adding drugs to the nutrient medium that stimulate neurite growth in comparison with control explants.

The results obtained on the treatment of alalia and dysarthria in children using the method of herudotherapy, as well as the results of superposition brain scanning, made it possible to record the accelerated maturation of neurons in the speech motor cortex of the brain in such children.

Data on the high neurite-stimulating activity of the components of the salivary glands (secretion of the salivary glands) explain the specific effectiveness of gerudotherapy in neurological patients. Moreover, the ability of leech proteinase inhibitors to modulate neurotrophic effects enriches the arsenal of proteolytic enzyme inhibitors that are currently considered promising therapeutic drugs for a wide range of neurodegenerative diseases

So, the biologically active substances produced by MP provide the currently known biological effects:
1. thrombolytic effect,
2. hypotensive effect,
3. reparative effect on the damaged wall of the blood vessel,
4. antiatherogenic effect of biologically active substances actively influence the processes of lipid metabolism, leading to normal conditions functioning; lower cholesterol levels,
5. antihypoxic effect - increasing the percentage of survival of laboratory animals under conditions of low oxygen content,
6. immunomodulating effect - activation of the body’s protective functions at the level of the macrophage link, the compliment system and other levels immune system humans and animals,
7. neurotrophic effect.

To specific technical means include: Derazhne corrector, "Echo" (AIR) apparatus, sound amplification apparatus, tape recorder.

The Derazhne device (like the Barany ratchet) is built on the sound damping effect. Various strengths noise (in a corrective recorder it is adjusted using a special screw) is fed through rubber tubes ending in olives directly into ear canal, drowning out his own speech. But the sound dampening method may not be applicable in all cases. The Echo device, designed by B. Adamczyk, consists of two tape recorders with an attachment. The recorded sound is played back after a split second, creating an echo effect. Domestic designers have created a portable device "Echo" (AIR) for individual use.

A unique apparatus was proposed by V. A. Razdolsky. The principle of its operation is based on sound amplification of speech through loudspeakers or air telephones to the Crystal hearing aid. Perceiving their speech as sound-amplified, dysarthric people strain their speech muscles less and more often begin to use a soft attack of sounds, which has a beneficial effect on their speech. Another positive fact is that when using sound amplification, patients hear their correct speech from the very first lessons, and this accelerates the development of positive reflexes and free, relaxed speech. A number of researchers use in practice various variants of delayed speech ("white noise", sound deadening, etc.).

During speech therapy sessions, sound recording equipment can be used for psychotherapeutic purposes. During a tape lesson followed by a conversation with a speech therapist, dysarthric people’s mood improves, a desire to achieve success in speech classes appears, confidence in the positive outcome of the classes is developed, and trust in the speech therapist grows. During the first tape lessons, material for the performance is selected and carefully rehearsed.

Tape training sessions help develop correct speech skills. The purpose of these classes is to draw the patient’s attention to the pace and smoothness of his speech, sonority, expressiveness, and grammatical correctness of the phrase. After preliminary conversations about the qualities of correct speech, listening to appropriate speech samples, and after repeated rehearsals, the dysarthric person speaks in front of the microphone with his text, depending on the stage of the lesson. The task is to monitor and manage your behavior, pace, smoothness, sonority of speech, and to avoid grammatical errors in it. The manager records in his notebook the state of speech and behavior of the patient at the time of speaking in front of the microphone. Having finished the speech, the dysarthric person evaluates his speech himself (speaking quietly - loudly, quickly - slowly, expressively - monotonously, etc.). Then, after listening to the speech recorded on tape, the patient evaluates it again. After this, the speech therapist analyzes the speech of the stutterer, his ability to give a correct assessment of his speech, highlights the positive in his speech, in his behavior in class, and sums up the overall result.

An option for teaching tape lessons is to imitate the performances of artists and masters of artistic expression. In this case, an artistic performance is listened to, the text is learned, reproduction is practiced, recorded on tape, and then compared with the original, similarities and differences are noted. Comparative tape sessions are useful, in which the dysarthric person is given the opportunity to compare his real speech with the one he had before. At the beginning of the course of speech classes, with the microphone turned on, he is asked questions on everyday topics, plot pictures are offered to describe their content and compose a story, etc. A tape recorder records cases of convulsions in speech: their place in a phrase, frequency, duration. Subsequently, this first recording of the speech of a dysarthric person serves as a measure of the success of the ongoing speech classes: the state of speech in the future is compared with it.

Advice from a speech pathologist
When corrective work with dysarthrics is important, the formation of spatial thinking is important.

Formation of spatial representations
Knowledge about space and spatial orientation develop in the context of various types of children’s activities: in games, observations, labor processes, in drawing and design.

By the end of preschool age, children with dysarthria develop such knowledge about space as: shape (rectangle, square, circle, oval, triangle, oblong, rounded, curved, pointed, curved), size (large, small, more, less, the same , equal, large, small, half, in half), length (long, short, wide, narrow, high, left, right, horizontal, straight, oblique), position in space and spatial relationship (in the middle, above the middle, below the middle, right, left, side, closer, further, in front, behind, behind, in front).

Mastering this knowledge about space presupposes: the ability to identify and distinguish spatial features, name them correctly and include adequate verbal designations in expressive speech, orientate in spatial relationships when performing various operations associated with active actions.

The completeness of mastering knowledge about space, the ability to spatial orientation is ensured by the interaction of the motor-kinesthetic, visual and auditory analyzers in the course of performing various types activities of the child aimed at active knowledge of the surrounding reality.

The development of spatial orientation and the idea of ​​space occurs in close connection with the formation of a sense of the diagram of one’s body, with the expansion of children’s practical experience, with a change in the structure of object-game action associated with the further improvement of motor skills. The emerging spatial concepts are reflected and further development in the subject-game, visual, constructive and everyday activities of children.

Qualitative changes during formation spatial perception are associated with the development of speech in children, with their understanding and active use of verbal designations of spatial relationships, expressed by prepositions and adverbs. Mastering knowledge about space presupposes the ability to identify and distinguish spatial features and relationships, the ability to correctly denote them verbally, and navigate spatial relationships when performing various labor operations based on spatial representations. A major role in the development of spatial perception is played by design and modeling, and the inclusion of verbal symbols adequate to children’s actions in expressive speech.

Methods for studying spatial thinking in junior schoolchildren with dysarthria
TASK No. 1

Goal: to identify an understanding of spatial relationships in a group of real objects and in a group of objects depicted in the picture + object-game action to differentiate spatial relationships.

Mastering left-right orientations.

Poem by V. Berestov.

There was a man standing at a fork in the road.
Where is right, where is left - he could not understand.
But suddenly the student scratched his head
With the same hand with which I wrote,
And he threw the ball and flipped through the pages,
And he held a spoon and swept the floor,
"Victory!" - there was a jubilant cry:
Where is right and where is left the student recognized.

Movement according to given instructions (mastering the left and right parts of the body, left and right sides).

We are marching bravely in the ranks.
We learn science.
We know left, we know right.
And, of course, all around.
This is the right hand.
Oh, science is not easy!

"The Steadfast Tin Soldier"

Stand on one leg
It's like you're a steadfast soldier.
Left leg to the chest,
Yes, be careful not to fall.
Now stand on the left,
If you are a brave soldier.

Clarification of spatial relationships:
* standing in a line, name the one standing on the right, on the left;
* according to the instructions, place objects to the left and right of the given one;
* determine the place of your neighbor in relation to yourself;
* determine your place in relation to your neighbor, focusing on the neighbor’s corresponding hand (“I stand to the right of Zhenya, and Zhenya is to my left.”);
* standing in pairs facing each other, determine first your own, then your friend’s, left hand, right hand, etc.

Game "Body Parts".
One of the players touches some part of his neighbor’s body, for example, his left arm. He says: "This is mine left hand"The one who started the game agrees or denies the neighbor's answer. The game continues in a circle.

"Locate it by the trail."
On a piece of paper in different directions hand and foot prints are drawn. It is necessary to determine which hand or foot (left or right) this print is from.

Determine by plot picture, in which hand the characters in the picture are holding the called object.

Mastering the concepts " Left-hand side leaf - Right side leaf.

Coloring or drawing according to instructions, for example: “Find the small triangle drawn on the left side of the sheet, color it red. Find the largest triangle among those drawn on the right side of the sheet. Color it with a green pencil. Connect the triangles with a yellow line.”

Determine left or right sleeve of a blouse, shirt, pocket of jeans. The products are in different positions in relation to the child.

Mastering the directions “up-down”, “top-bottom”.

Orientation in space:
What's above, what's below? (analysis of towers built from geometric bodies).

Orientation on a sheet of paper:
- Draw a circle at the top of the sheet and a square at the bottom.
- Put an orange triangle, put a yellow rectangle on top, and a red one below the orange one.

Exercises in the use of prepositions: for, because of, about, from, before, in, from.
Introduction: Once upon a time, the resourceful, smart, dexterous, cunning Puss in Boots was a little playful kitten who loved to play hide and seek.
An adult shows cards with a picture of where the kitten is hiding, and helps the children with questions like:
-Where did the kitten hide?
-Where did he jump from? etc.

TASK No. 2

Goal: verbally indicate the location of objects in the pictures.

Game "Shop"(the child, acting as a seller, placed toys on several shelves and said where and what was located).

Show the actions mentioned in the poem.
I will help my mother
I will clean everywhere:
And under the closet
and behind the closet,
and in the closet
and on the closet.
I don't like dust! Ugh!

Orientation on a piece of paper.

1. Simulation of fairy tales

"Forest School" (L. S. Gorbacheva)

Equipment: each child has a sheet of paper and a house cut out of cardboard.
“Guys, this house is not simple, it is fabulous. Forest animals will study in it. Each of you has the same house. I will tell you a fairy tale. Listen carefully and place the house in the place mentioned in the fairy tale.
Animals live in a dense forest. They have their own children. And the animals decided to build a forest school for them. They gathered at the edge of the forest and began to think about where to put it. Lev suggested building in the lower left corner. The wolf wanted the school to be in the upper right corner. The fox insisted on building a school in the upper left corner, next to her hole. A squirrel intervened in the conversation. She said: “The school should be built in the clearing.” The animals listened to the squirrel’s advice and decided to build a school in a forest clearing in the middle of the forest.”

Equipment: each child has a sheet of paper, a house, a Christmas tree, a clearing (blue oval), an anthill (gray triangle).

"Winter lived in a hut at the edge of the forest. Her hut stood in the upper right corner. One day Winter woke up early, washed her face white, dressed warmly and went to look at her forest. She walked along the right side. When she reached the lower right corner, I saw a small Christmas tree. Winter waved her right sleeve and covered the Christmas tree with snow.
Winter turned to the middle of the forest. There was a large clearing here.
Winter waved her hands and covered the entire clearing with snow.
Winter turned to the lower left corner and saw an anthill.
Winter waved her left sleeve and covered the anthill with snow.
Winter went up: it turned to the right and went home to rest."

"The Bird and the Cat"

Equipment: each child has a piece of paper, a tree, a bird, a cat.

"There was a tree growing in the yard. A bird was sitting near the tree. Then the bird flew and sat on the tree above. A cat came. The cat wanted to catch the bird and climbed up the tree. The bird flew down and sat under the tree. The cat remained on the tree."

2. Graphic reproduction of directions (I. N. Sadovnikova).

Given four points, put a “+” sign from the first point from below, from the second - from above, from the third - to the left, from the fourth - to the right.

Four points are given. From each point, draw an arrow in the direction: 1 - down, 2 - right, 3 - up, 4 - left.

Given four points that can be grouped into a square:
a) Mentally group the points into a square, highlight the upper left point with a pencil, then the lower left point, and then connect them with an arrow in the direction from top to bottom. Similarly, select the upper right point and connect it with an arrow to the upper right point in the direction from bottom to top.
b) In the square, select the upper left point, then the upper right point and connect them with an arrow in the direction from left to right. Similarly, connect the lower points in the direction from right to left.
c) In the square, select the upper left point and the lower right point, connect them with an arrow directed simultaneously from left to right, top to bottom.
d) In the square, select the lower left point and the upper right one, connect them with an arrow directed simultaneously from left to right and from bottom to top.

Mastering prepositions with spatial meaning.

1. Perform various actions according to the instructions. Answer the questions.
- Put the pencil on the book. Where is the pencil?
- Take a pencil. Where did you get the pencil from?
- Put the pencil in the book. Where is he now?
- Take it. Where did you get the pencil from?
- Hide the pencil under the book. Where is he?
- Take out the pencil. Where was it taken from?

2. Line up following the directions: Sveta behind Lena, Sasha in front of Lena, Petya between Sveta and Lena, etc. Answer the questions: “Who are you behind?” (in front of whom, next to whom, ahead, behind, etc.).

3. Arrangement of geometric shapes according to these instructions: “Put a red circle on a large blue square. Place a green circle above the red circle. An orange triangle in front of the green circle, etc.”

4. "What word is missing?"
The river has reached its banks. Children run class. The path led to the field. Green onions in the garden. We reached the city. The ladder was leaned against the wall.

5. "What's mixed up?"
Grandfather in the stove, wood on the stove.
There are boots on the table, flat cakes under the table.
Sheep in the river, crucian carp by the river.
There is a portrait under the table, a stool above the table.

6. “On the contrary” (name the opposite preposition).
The adult says: “Above the window,” the child: “Under the window.”
To door - …
In the box -...
Before school - …
To the city -…
In front of the car -...
- Select pairs of pictures that correspond to opposite prepositions.

7. "Signalers".
a) For the picture, select a card diagram of the corresponding preposition.
b) An adult reads sentences and texts. Children show cards with the necessary prepositions.
c) An adult reads sentences and texts, omitting prepositions. Children show cards with diagrams of missing prepositions.
b) The child is asked to compare groups of geometric shapes of the same color and shape, but different sizes. Compare groups of geometric shapes of the same color and size, but different shapes.
c) “Which figure is extra.” Comparison is carried out according to external characteristics: size, color, shape, changes in details.
d) “Find two identical figures.” The child is offered 4-6 items that differ in one or two characteristics. He must find two identical objects. The child can find same numbers, letters written in the same font, identical geometric shapes, and so on.
e) “Choose a suitable box for the toy.” The child must match the size of the toy and the box.
f) “Which site will the rocket land on?” The child matches the shape of the rocket base and the landing pad.

TASK No. 3

Goal: to identify spatial orientation associated with drawing and design.

1. Place geometric shapes on a sheet of paper in the indicated manner, either by drawing them or using ready-made ones.

2. Draw shapes using reference points, while having a sample drawing made using points.

3. Without reference points, reproduce the direction of the drawing using the sample. In case of difficulty - additional exercises in which you need:
A) distinguish the sides of the sheet;
B) draw straight lines from the middle of the sheet in different directions;
B) trace the outline of the drawing;
D) reproduce a drawing of greater complexity than the one proposed in the main task.

4. Tracing templates, stencils, tracing contours along a thin line, shading, dots, painting and shading along various lines.

Kern-Jirasek technique.
When using the Kern-Jirasek method (includes two tasks - copying written letters and drawing a group of dots, i.e. working according to a model), the child is given sheets of paper with presented examples of completing tasks. The tasks are aimed at developing spatial relationships and concepts, developing fine motor skills of the hand and coordination of vision and hand movements. The test also allows you to identify (in general outline) intelligence of child development. Tasks on drawing written letters and drawing a group of dots reveal the children’s ability to reproduce a pattern. It also helps determine whether the child can work with concentration for a period of time without distractions.

“House” technique (N.I. Gutkina).
The technique is a task of drawing a picture depicting a house, the individual details of which are made up of capital letters. The task allows you to identify the child’s ability to focus his work on a model, the ability to accurately copy it, and reveals developmental features voluntary attention, spatial perception, sensorimotor coordination and fine motor skills of the hand.
Instructions to the subject: “In front of you lies a sheet of paper and a pencil. On this sheet I ask you to draw exactly the same picture that you see in this drawing (a piece of paper with “House” is placed in front of the subject). Take your time, be careful, try as hard as you can The drawing was exactly the same as this one on the sample. If you draw something wrong, then you can’t erase anything with an eraser or your finger, but you need to draw it correctly on top of it or next to it. Do you understand the task? Then get to work.”

When performing the tasks of the "House" Method, the subjects made the following mistakes:
a) some details of the drawing were missing;
b) in some drawings, proportionality was not observed: an increase in individual details of the drawing while maintaining a relatively arbitrary size of the entire drawing;
c) incorrect representation of the elements of the picture;
e) deviation of lines from a given direction;
f) gaps between lines at junctions;
g) lines climbing one on top of another.

“Complete the tails for the mice” and “Draw handles for the umbrellas” by A. L. Wenger.
Both mouse tails and handles also represent letter elements.

Graphic dictation and “Sample and Rule” by D. B. Elkonin - A. L. Wenger.
When completing the first task, the child draws an ornament on a sheet of paper in a box from the pre-set dots, following the instructions of the presenter. The presenter dictates to the group of children in which direction and how many cells the lines should be drawn, and then offers to complete the “pattern” resulting from dictation to the end of the page. Graphic dictation allows you to determine how accurately a child can fulfill the requirements of an adult given orally, as well as the ability to independently perform tasks on a visually perceived model.
The more complex “Pattern and Rule” technique involves simultaneously following in your work a model (the task is given to draw exactly the same picture point by point as a given geometric figure) and a rule (a condition is stipulated: you cannot draw a line between identical points, i.e. connect a circle with a circle, a cross with a cross and a triangle with a triangle). A child, trying to complete a task, can draw a figure similar to the given one, neglecting the rule, and, conversely, focus only on the rule, connecting different points and without checking the sample. Thus, the technique reveals the child’s level of orientation towards complex system requirements.

“The car is driving along the road” (A. L. Wenger).
A road is drawn on a piece of paper, which can be straight, winding, zigzag, or with turns. There is a car drawn at one end of the road, and a house at the other. The car must drive along the path to the house. The child, without lifting the pencil from the paper and trying not to go beyond the path, connects the car with the house with a line.

You can come up with many similar games. Can be used for training and passing simple labyrinths

“Hit the circles with a pencil” (A. E. Simanovsky).
The sheet shows rows of circles with a diameter of about 3 mm. The circles are arranged in five rows of five circles in a row. The distance between the circles in all directions is 1 cm. The child must, without lifting his forearm from the table, place dots in all the circles as quickly and accurately as possible.
The movement is strictly defined.
I-option: in the first line the direction of movement is from left to right, in the second line - from right to left.
Option II: in the first column the direction of movement is from top to bottom, in the second column - from bottom to top, etc.

TASK No. 4

Target:
1. Fold the stick figures according to the pattern given in the figure.
2. Fold four parts into geometric shapes - a circle and a square. If you have difficulty, perform this task step by step:
A) Make a figure from two then three and four parts;
B) Fold a circle and a square according to the pattern of the drawing with the component parts dotted on it;
C) Fold figures by superimposing parts on a dotted drawing, followed by construction without a sample.

“Make a picture” (like E. Seguin’s board).
The child matches the tabs to the slots according to shape and size and puts together the shapes cut out on the board.

“Find the shape in the object and fold the object.”
In front of the baby are contour images of objects made up of geometric shapes. The child has an envelope with geometric shapes. Need to be folded this item from geometric shapes.

"The picture is broken."
The child must put together the pictures cut into pieces.

"Find what the artist hid."
The card contains images of objects with intersecting contours. You need to find and name all the drawn objects.

"The letter is broken."
The child must recognize the entire letter from any part.

“Fold the square” (B.P. Nikitin).
Equipment: 24 multi-colored squares of paper measuring 80x80 mm, cut into pieces, 24 samples.
You can start the game with simple tasks: “Make a square from these parts. Look carefully at the sample. Think about how to arrange the parts of the square. Try to put them on the sample.” Then the children independently select the parts by color and assemble the squares.

Montessori frames and inserts.
The game is a set of square frames, plates with cut-out holes, which are closed with an insert lid of the same shape and size, but of a different color. Insert covers and slots have the shape of a circle, square, equilateral triangle, ellipse, rectangle, rhombus, trapezoid, quadrangle, parallelogram, isosceles triangle, regular hexagon, five-pointed star, right isosceles triangle, regular pentagon, irregular hexagon, scalene triangle.
The child matches the inserts to the frames, traces the inserts or slots, and inserts the inserts into the frames by touch.

"Mailbox".
A mailbox is a box with slots of different shapes. The child places three-dimensional geometric bodies into the box, focusing on the shape of their base.

“What color is the object?”, “What shape is the object?”.
Option I: children have object pictures. The presenter takes chips of a certain color (shape) from the bag. Children cover the corresponding pictures with chips. The one who closes his pictures the fastest wins. The game is played according to the “Loto” type.
Option II: children have colored flags (flags with images of geometric shapes). The presenter shows the object, and the children show the corresponding flags.

"Assemble according to form."
The child has a card of a certain shape. He selects suitable items for it, shown in the pictures.

Games "Which form is gone?" and “What has changed?”
Geometric figures of different shapes are placed in a row. The child must remember all the figures or their sequence. Then he closes his eyes. One or two figures are removed (switched places). The child must name which figures are missing or say what has changed.

Exercises to develop ideas about size:
- Arrange the mugs from smallest to largest.
- Build the nesting dolls by height: from tallest to shortest.
- Place the narrowest strip on the left, next to the right place a slightly wider strip, etc.
- Color the tall tree with a yellow pencil, and the low tree with red.
- Circle the fat mouse, and circle the thin one.
And so on.

"Wonderful bag."
The bag contains three-dimensional and flat figures, small toys, objects, vegetables, fruits, etc. The child must determine by touch what it is. You can put plastic, cardboard letters and numbers in the bag.

"Drawing on the back."
Draw letters, numbers, geometric shapes, and simple objects on each other’s backs with your child. You need to guess what your partner drew.