Examination
Modern ideas about erased dysarthria in preschool children. Modern scientific ideas about dysarthria 1 modern ideas about mild dysarthria

Modern ideas about erased dysarthria in preschool children. Modern scientific ideas about dysarthria 1 modern ideas about mild dysarthria

Speech therapy massage for the correction of dysarthric speech disorders in children of early and preschool age.

St. Petersburg: KARO, 2008.

Differentiated speech therapy massage is part of a comprehensive medical, psychological and pedagogical work aimed at correcting various speech disorders. Massage is used in speech therapy work with children with dysarthria, rhinolalia, stuttering and voice disorders. With these forms of speech pathology (especially with dysarthria), massage is a necessary condition effectiveness of speech therapy intervention.

Speech therapy massage is one of the speech therapy technologies, active method mechanical impact. Massage is used in cases where there are disturbances in the tone of the articulatory muscles. By changing the state of the muscles of the peripheral speech apparatus, massage ultimately indirectly helps to improve the pronunciation side of speech.

Massage can be carried out at all stages of correctional speech therapy, but its use is especially important at initial stages work when the child does not yet have the ability to perform certain articulatory movements.

Differentiated speech therapy massage can be performed by a speech therapist, defectologist, or exercise therapy instructor who has undergone special training.

Chapter I Perinatal pathology of the central nervous system in children................... 4

Chapter II Dysarthric speech disorders in infants and children

preschool age................................................... ........................................................ ........... 12

2.1. Main disorders (structure of the defect) in dysarthria.................................................. 12

2.2. Degrees of severity of dysarthria.................................................... ........................... 17

2.3. Early diagnosis of speech motor disorders.................................................... 21

2.4. Modern approaches to the classification of dysarthria.................................................. 23

Chapter III Speech therapy examination of children with

dysarthric disorders................................................................ ........................................ 32

Chapter IV Specifics of correctional speech therapy work for dysarthria.............. 50

4.1. Principles, tasks and methods of speech therapy work for dysarthria.................................. 50

4.2. Differentiated speech therapy massage.................................................... ..... 53

4.2.1. Objectives, indications, contraindications and conditions for speech therapy massage 54

4.2.2. Relaxing massage of articulatory muscles.................................... 58

4.2.3. Stimulating massage of articulatory muscles.................................... 60

4.2.4. Massage of the lingual muscles.................................................... ........................... 61

4.3. Passive and active articulatory gymnastics.................................................... 63

4.4. Artificial local contrastothermy................................................................. ............. 67

4.5. Development of breathing and correction of its disorders (breathing exercises)...... 68

4.7. Development of prosody and correction of its violations.................................................... .......... 75

4.8. Correction of sound pronunciation disorders................................................................. ............. 77

4.9. Development of hand functionality and fingers,

correction of fine (fine) motor skills.................................................. ............. 81

Chapter I
Perinatal pathology
central nervous system in children

The problem of correctional and speech therapy assistance to children with neurological pathology is currently extremely relevant. The need for measures to diagnose and correct disorders in the development of children is associated with the presence of an alarming demographic situation in the country, characterized not only by a general decrease in the birth rate, but also by an increase in the proportion of births of unhealthy, physiologically immature children. According to special studies, the proportion of healthy newborns during recent years decreased from 48.3% to 26.5%-36.5%. Today, up to 80% of newborns are physiologically immature, over 86% have perinatal pathology of the central nervous system, the lack of timely correction of which leads to the development of persistent disorders in the future. Pathology suffered by a child in the perinatal period has a negative impact on the state of many body systems, primarily the nervous system (G.V. Yatsyk).

Perinatal lesions of the central nervous system combine various pathological conditions caused by exposure of the fetus to harmful factors in the prenatal period, during childbirth and in the early stages after birth. The leading place in perinatal pathology of the central nervous system is occupied by asphyxia and intracranial birth trauma, which most often affect the nervous system of an abnormally developing fetus. IN clinical practice The terms “perinatal central nervous system damage” and “perinatal encephalopathy (PEP)” are generally accepted.

Early brain damage in most cases later manifests itself as impaired development to one degree or another. Due to the fact that the immature brain suffers, further rates of its maturation slow down. The order of inclusion of brain structures as they mature into functional systems is disrupted. PEP is a risk factor for the development of deviations in the development of various functional systems in a child. In this case, various “lines of development” - motor, cognitive and speech - may be disrupted.

Despite the equal probability of damage to all parts of the nervous system, when pathogenic factors act on the developing brain, the motor analyzer is the first and most affected. In children with perinatal cerebral pathology, gradually, as the brain matures, signs of damage or disturbances in the development of various parts of the motor analyzer, mental and speech development are revealed. With age, in the absence of adequate therapeutic and pedagogical assistance, developmental disorders gradually become stronger and a more complex pathology can form.

Disturbances in the motor, mental and speech development of children are a consequence of damage to the central nervous system of various origins. The same harmful factors affecting the brain during the period of its intensive development, in some cases cause only a slight delay in the formation of age-related functions, and in others lead to pronounced developmental disorders (E.M. Mastyukova, L.T. Zhurba).

Studying the psychomotor development of children in the first years of life, L.T. Zhurba and E.M. Mastyukov identified different degrees of severity of neurological pathology: mild, moderate and severe.

Light degree:

hypertension syndrome, hydrocephalic syndrome, minimal brain dysfunction, hyperexcitability and hypoexcitability syndromes, mild neurological symptoms in the form of muscle tone disorders, tremor.

Average degree:

movement disorder syndromes, episyndrome (convulsive syndrome), cerebrasthenic syndrome.

Severe degree:

cerebral palsy, organic damage to the central nervous system.

1 . Hypertensive-hydrocephalic syndrome.

Hypertension syndrome (increased intracranial pressure) in children is often combined with hydrocephalus, which is characterized by dilation of the ventricles in the subarachnoid space as a result of the accumulation of excess cerebrospinal fluid. Increased intracranial pressure in infants can be transient or permanent, hydrocephalus can be compensated or subcompensated, which causes a wide range of clinical manifestations.

Neurological symptoms in hypertensive-hydrocephalic syndrome depend both on the severity of the syndrome and its progression, and on the brain changes that caused it. With hypertension syndrome, the behavior of children first changes. They become easily excitable, irritable, the cry becomes sharp, piercing; sleep is superficial, children often wake up. With hydrocephalic syndrome, on the contrary, children are lethargic and drowsy. Decreased appetite, regurgitation, and sometimes even vomiting can lead to weight loss.

The child’s neuropsychic development may not suffer, but in some cases it is delayed. The depth and nature of psychomotor development delay in hypertensive and hydrocephalic syndromes vary widely depending on the primary changes in the nervous system. With timely and effective correction of the primary process, both hypertensive and hydrocephalic syndromes, and mild developmental delay are compensated.

2. Hyperexcitability syndrome.

The main manifestations of hyperexcitability syndrome are motor restlessness, emotional lability, sleep disturbance, increased reflex excitability, and a tendency to a reduced threshold of convulsive readiness. These children may not have a pronounced lag in psychomotor development, but with a thorough examination it is usually possible to note some mild deviations. Disorders of psychomotor development in hyperexcitability syndrome are characterized by a lag in the formation of voluntary attention, differentiated motor and mental reactions, which gives psychomotor development a peculiar unevenness.

All motor, sensory and emotional reactions to external stimuli in a hyperexcitable child arise quickly after a short latent period and fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for and grab objects; quickly switch to objects. At the same time, manipulative-research activity is not expressed enough.

3. Hypoexcitability syndrome.

The main manifestations of the syndrome: low motor and mental activity of the child, which is always below his motor and intellectual capabilities; high threshold and long latent period for the occurrence of all reflex and voluntary reactions. The syndrome is often combined with muscle hypotonia, slow switching of nervous processes, emotional lethargy, low motivation and weakness of volitional efforts. Hypoexcitability can be expressed to varying degrees and manifest itself either episodically or persistently.

With hypoexcitability syndrome, the formation of positive emotional reactions is noted at a later date. This manifests itself both when communicating with an adult and in the spontaneous behavior of a child. While awake, the child remains lethargic and passive; indicative reactions occur mainly to strong stimuli. The reaction to novelty is sluggish and insufficient.

With hypodynamic syndrome, there may be a delay in psychomotor development. It is characterized by developmental disproportion, which manifests itself in all forms of sensory-motor behavior. At all age stages there may be insufficient communication activity.

4. Minimal brain dysfunction syndrome (MMD).

The main manifestations of MMD syndrome are the so-called “minor neurological signs”, which manifest themselves differently depending on age. The most frequently observed disorders are muscle tone, which, although they do not interfere with active movements, are persistent; tremor, cranial innervation disorders, Graefe's symptom, general anxiety, reflex asymmetry.

5. Cerebrasthenic syndrome.

The main content of the syndrome is increased neuropsychic exhaustion, which manifests itself in weakness of the function of active attention, emotional lability, disturbance of manipulative, objective and play activity; in the predominance of either hyperdynamic or hypodynamic processes. Often there is also a secondary lack of perception due to increased mental exhaustion. Characterized by dynamism and uneven severity of clinical manifestations in the same child at different times. Clinical manifestations often intensify towards the end of the day due to unfavorable meteorological conditions. Features of delayed psychomotor development in this syndrome depend on the predominance of hypo- or hyperexcitability processes.

6. Convulsive syndrome (episyndrome).

Seizures may appear against the background of existing neurological disorders and delayed psychomotor development or occur as the first symptom indicating brain damage. The effect of convulsive syndrome on developmental delay depends on the age of the child, the level of psychomotor development before the onset of seizures, the presence of other neurological disorders, the nature of convulsive paroxysms, their frequency and duration. The younger the child is at the onset of seizures, the more pronounced the delay in psychomotor development will be. If seizures occurred in a healthy child, were episodic and short-term, then they themselves may not have a significant impact on age-related development. In all other cases, paroxysms, especially if they were prolonged and repeated, in turn can cause irreversible changes in the central nervous system.

Convulsions that appear against the background of delayed psychomotor development and/or other neurological disorders complicate the course of the underlying disease, exacerbating the developmental delay. The child may lose acquired motor, mental and speech skills.

7. Movement disorder syndromes.

Children with movement disorder syndromes experience delayed development of basic motor skills. The main characteristics in the diagnosis of movement disorders in the first year of life are muscle tone and reflex activity. Changes in muscle tone manifest as muscle hypertension (spasticity), hypotonia and dystonia.

Syndrome muscle hypertension(increased muscle tone) is characterized by an increase in resistance to passive movements, limitation of spontaneous and voluntary motor activity. The severity of muscle hypertension syndrome can vary from a slight increase in resistance to passive movements to complete stiffness, when any movements are practically impossible. If the syndrome is not pronounced and is not combined with pathological tonic reflexes and other neurological disorders, its influence on the development of static and locomotor functions may manifest itself in their slight delay at various stages of the first years of life. Depending on which muscle groups have more increased tone, differentiation and final consolidation of certain motor skills will be delayed. Thus, with an increase in muscle tone in the hands, a delay in directing the hands to an object, grasping a toy, manipulating objects, etc. is noted. With an increase in muscle tone in the legs, the formation of the support reaction of the legs and independent standing is delayed. Children are reluctant to stand on their feet, prefer to crawl, and stand on their toes when supported.

Syndrome muscle hypotonia(decreased muscle tone) is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity is limited. If the syndrome of muscle hypotonia is not clearly expressed and is not combined with other neurological disorders, it either does not affect the child’s age-related development or causes a delay in motor development, more often in the second half of life. The lag is uneven; more complex motor functions are delayed, requiring coordinated activity of many muscle groups for their implementation. So, if you sit down a 9-month-old child, he sits, but cannot sit up on his own. Such children begin to walk later, and the period of walking with support is delayed for a long time.

Movement disorder syndrome may be accompanied by muscular dystonia changing character of muscle tone). At rest, these children show general muscle hypotonia during passive movements. When trying to actively perform any movement, with positive or negative emotional reactions, muscle tone increases sharply.

8. Cerebral palsy.

Cerebral palsy (CP) is a serious disease of the nervous system, which often leads to disability of the child. Cerebral palsy manifests itself in various motor, mental and speech disorders. The leading ones in the clinical picture of cerebral palsy are movement disorders, which are often combined with mental and speech disorders, dysfunctions of other analytical systems (vision, hearing, deep sensitivity), and convulsive seizures (K.A. Semenova, E.M. Mastyukova). Cerebral palsy is not a progressive disease. With age and treatment, the child's condition usually improves.

The severity of movement disorders varies over a wide range, where at one pole there are severe movement disorders, at the other - minimal ones. Mental and speech disorders, as well as motor disorders, have different degrees of severity, so a whole range of different combinations can be observed. For example, with severe motor disorders, mental disorders may be minimal, and vice versa, with mild motor disorders, severe mental and/or speech disorders are observed.

9. Early organic damage to the central nervous system(“congenital or early acquired dementia syndrome” - L.T. Zhurba, E.M. Mastyukova).

The main manifestation of the syndrome of early organic damage to the central nervous system is underdevelopment cognitive activity , which is most often combined with speech development disorders. Delays in motor development can be expressed in varying degrees- from mild forms to severe disorders. However, in all cases, the lag in motor development is not due to a primary lesion of the motor system, but to a decrease in motivation. Already in the first year of life, children have weakly expressed reactions to the environment, differentiated visual and auditory orienting reactions; the development of manipulative and objective activities and the initial understanding of addressed speech are impaired.

Chapter II
Dysarthric speech disorders
in children of early and preschool age

Dysarthria(speech motor disorder) - a violation of the pronunciation side of speech, caused by insufficient innervation of the speech muscles. Dysarthria is a consequence of organic damage to the central nervous system, in which the motor mechanism of speech is disrupted. In dysarthria there is no impairment programming speech utterance, and motor realization of speech.

The leading defects in dysarthria are disturbances in the sound-pronunciation aspect of speech and prosody, as well as disturbances speech breathing, voice and articulatory motor skills. Speech intelligibility in dysarthria is impaired, speech is blurred and unclear.

2.1. Main violations (defect structure)
for dysarthria

Impaired tone of articulatory muscles(facial muscles, tongue, lips, soft palate) by type of spasticity, hypotension or dystonia.

1. Spasticity- increased tone in the muscles of the tongue, lips, face and neck. With spasticity, the muscles are tense. The tongue is pulled back “lumpy”, its back is spastically curved, raised upward, the tip of the tongue is not pronounced. The tense back of the tongue raised towards the hard palate helps soften consonant sounds (palatalization). Sometimes the spastic tongue is pulled forward with a “sting.” An increase in muscle tone in the orbicularis oris muscle leads to spastic tension of the lips, tightly closing the mouth (voluntarily opening the mouth is difficult). In some cases, with a spastic condition of the upper lip, the mouth may, on the contrary, be slightly open. In this case, increased salivation (hypersalivation) is usually observed. Active movements with spasticity of the articulatory muscles are limited. (Muscle spasticity is observed in spastic-paretic dysarthria.)

2. Hypotension- decreased muscle tone. With hypotonia, the tongue is thin, spread out in the oral cavity; lips are flaccid and cannot close tightly. Because of this, the mouth is usually half-open, and hypersalivation may be expressed. Hypotonia of the muscles of the soft palate prevents the velum from moving sufficiently upward and pressing it against the back wall of the pharynx; a stream of air exits through the nose. In this case, the voice acquires a nasal tint (nasalization). (Hypotonia of articulatory muscles occurs with spastic-paretic and ataxic dysarthria.)

3. Dystonia - changing character of muscle tone. At rest, low muscle tone may be noted; when attempting to speak and at the moment of speech, the tone increases sharply. Dystonia significantly distorts articulation. A characteristic feature of sound pronunciation in dystonia is impermanence distortions, substitutions and omissions of sounds. (Dystonia is noted with hyperkinetic dysarthria.)

In children with neurological pathology, a mixed and variable nature of tone disturbances in the articulatory muscles (as well as in the skeletal muscles) is often noted, i.e. in individual articulatory muscles, tone can change differently. For example, spasticity may be observed in the lingual muscles, and hypotonia in the facial and labial muscles. In all cases, there is a certain correspondence between tone disturbances in the articulatory and skeletal muscles.

Impaired mobility of articulatory muscles. Limited mobility of the muscles of the articulatory apparatus is the main manifestation of paresis of these muscles. Insufficient mobility of the articulatory muscles of the tongue and lips causes disturbances in sound pronunciation. When the lip muscles are damaged, the pronunciation of both vowels and consonants suffers. Articulation in general is impaired. Sound pronunciation is especially severely impaired when the mobility of the tongue muscles is sharply limited.

The degree of impairment of the mobility of articulatory muscles can be different - from complete impossibility to a slight decrease in the volume and amplitude of articulatory movements of the tongue and lips. In this case, the most subtle and differentiated movements are disrupted first (primarily raising the tongue upward).

Specific sound pronunciation disorders:

- persistent character violations of sound pronunciation, the particular difficulty of overcoming them;

Specific difficulties in automating sounds (the automation process requires more time than with dyslalia). If speech therapy classes are not completed on time, acquired speech skills often disintegrate;

The pronunciation of not only consonants, but also vowels is impaired (average or reduced vowels);

The predominance of interdental and lateral pronunciation of sibilants [ With], [h], [ts]and hissing [ w], [and], [h], [sch]sounds;

Stunning of voiced consonants (voiced sounds are pronounced with insufficient participation of the voice;

Softening of hard consonants (palatalization);

Violations of sound pronunciation are especially pronounced in the speech stream. With increasing speech load, general slurring of speech is observed and sometimes increases.

Depending on the type of violation, all sound pronunciation defects in dysarthria are divided into two categories: anthropophonic (sound distortions) and phonological (substitutions, confusions). In dysarthric disorder, the most typical violation of the sound structure of speech is distortion sound.

Speech breathing disorders.

Breathing disorders in children with dysarthria are caused by insufficient central regulation of breathing. Insufficient depth of breathing. The rhythm of breathing is disturbed: at the moment of speech it becomes more frequent. There is a violation of the coordination of inhalation and exhalation (shallow inhalation and shortened weak exhalation). Exhalation often occurs through the nose, despite the half-open mouth. Respiratory disorders are especially pronounced in the hyperkinetic form of dysarthria.

Voice disorders are caused by changes in muscle tone and limited mobility of the muscles of the larynx, soft palate, vocal folds, tongue and lips. The most common symptoms are insufficient voice strength (quiet, weak, fading) and deviations in voice timbre (dull, nasal, constricted, hoarse, intermittent, tense, guttural).

In various forms of dysarthria, voice disturbances are of a specific nature.

Prosody disorders(melodic-intonation and tempo-rhythmic characteristics of speech).

Melody-intonation disorders are often considered one of the most persistent signs of dysarthria. They greatly influence the intelligibility and emotional expressiveness of speech. There is a weak expression or absence of vocal modulations (the child cannot voluntarily change the pitch). The voice becomes monotonous, poorly or unmodulated.

Violations of the tempo of speech are manifested in its slowdown, less often - in its acceleration. Sometimes there are disturbances in the rhythm of speech (for example, chant - “chopped” speech, when there is an additional number of stresses in words).

Lack of kinesthetic sensations in the articulatory apparatus.

In children with dysarthria, there is not only a limitation in the range of articulatory movements, but also a weakness in the kinesthetic sensations of articulatory postures and movements.

Autonomic disorders.

One of the most common autonomic disorders in dysarthria is hypersalivation. Increased salivation is associated with limited movements of the tongue muscles, impaired voluntary swallowing, and paresis of the labial muscles. It is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva) and decreased self-control.

Hypersalivation can be expressed to varying degrees. It can be constant or intensify with certain conditions. Even mild hypersalivation (moistening of the corners of the lips during speech, slight leakage of saliva) indicates the presence of neurological symptoms in the child.

Less common are vegetative disorders such as redness or pallor of the skin, increased sweating during speech.

Violation of the act of receiving food.

Children with dysarthria often have difficulty, and in severe cases, no chewing of solid food or biting off a piece. Choking and choking when swallowing are often observed. Difficulty drinking from a cup. Sometimes coordination between breathing and swallowing is impaired.

The presence of synkinesis.

Synkinesias are involuntary accompanying movements when performing voluntary articulatory movements (for example, additional upward movement of the lower jaw and lower lip when trying to raise the tip of the tongue).

Oral synkinesis - opening of the mouth during any voluntary movement or when attempting to perform it.

Increased pharyngeal (gag) reflex.

Loss of coordination of movements (ataxia).

Ataxia manifests itself in dysmetric, asynergic disorders and in the scantiness of the rhythm of speech. Dysmetria is a disproportion, inaccuracy of voluntary articulatory movements. It is most often expressed in the form of hypermetry, when the desired movement is realized in a more sweeping, exaggerated, slower movement than necessary (excessive increase in motor amplitude). Sometimes there is a lack of coordination between breathing, voice production and articulation (asynergia). Ataxia is noted with ataxic dysarthria.

The presence of violent movements (hyperkinesis and tremor) in the articulatory muscles.

Hyperkinesis - involuntary, irregular, violent; There may be pretentious movements of the muscles of the tongue and face (hyperkinetic dysarthria).

Tremor - trembling of the tip of the tongue (most pronounced during targeted movements). Tremor of the tongue is observed in ataxic dysarthria.

Degrees of severity of dysarthria

The severity of dysarthric speech impairment depends on the severity and nature of the damage to the central nervous system. Conventionally, there are 3 degrees of dysarthria severity: mild, moderate and severe.

Mild degree The severity of dysarthria is characterized by minor disturbances (speech and non-speech symptoms) in the structure of the defect. Often, manifestations of mild dysarthria are called “mildly expressed” or “erased” dysarthria, meaning mild (“erased”) paresis of the muscles of the articulatory apparatus that disrupt the pronunciation process. Sometimes practicing speech therapists use the terms “minimal dysarthric disorders” and “dysarthric component,” while some of them incorrectly consider these manifestations to be only elements of dysarthria or an intermediate disorder between dyslalia and dysarthria.

With a mild degree of dysarthria, overall speech intelligibility may not be impaired, but sound pronunciation is somewhat blurred and unclear. Distortions are most often observed when pronouncing whistling, hissing and/or sonorant sounds. When pronouncing vowels, the greatest difficulties are caused by the sounds [ And]And [ at]. Voiced consonant sounds are often deafened. Sometimes, in isolation, a child can pronounce all sounds correctly (especially if a speech therapist works with him), but with an increase in speech load, a general blurriness of sound pronunciation is noted.

There are also deficiencies in speech breathing (rapid, shallow), voice (quiet, muffled) and prosody (low modulation).

With a mild degree of dysarthria in children, there are mildly expressed disturbances in the tone of the muscles of the tongue, sometimes the lips, and a slight decrease in the volume and amplitude of their articulatory movements. In this case, the most subtle and differentiated movements of the tongue are disrupted (primarily upward movement). Non-speech symptoms can also manifest themselves in the form of mild salivation, difficulty chewing solid food, rare choking when swallowing, and an increased pharyngeal reflex.

At average(moderately expressed) degree of dysarthria The general intelligibility of speech is impaired, it becomes slurred, sometimes even incomprehensible to others. In some cases, a child's speech is difficult to understand without knowing the context. Children have a general blurred sound pronunciation (numerous pronounced distortions in many phonetic groups). Often sounds at the end of words and in consonant clusters are omitted. Disturbances in the depth and rhythm of breathing are usually combined with disorders of strength (quiet, weak, fading) and timbre of the voice (dull, nasalized, tense, compressed, intermittent, hoarse). The lack of voice modulation makes the voice unmodulated and children's speech monotonous.

Children have pronounced disturbances in the tone of the lingual, labial and facial muscles. The face is hypomimic, articulatory movements of the tongue and lips are slow, strictly limited, inaccurate (not only the upper elevation of the tongue, but also its lateral abductions). Significant difficulties arise from holding the tongue in a certain position and switching from one movement to another. Children with moderate dysarthria are characterized by hypersalivation, disturbances in the act of eating (difficulty or absence of chewing, mastication and choking when swallowing), synkinesia, and an increased gag reflex.

Severe dysarthria- anarthria - This is a complete or almost complete absence of sound pronunciation as a result of paralysis of the speech motor muscles. Anarthria occurs when the central nervous system is severely damaged, when motor speech becomes impossible. Most children with anarthria mainly exhibit disorders of the control of speech articulations (articulatory, phonatory, respiratory departments), and not just performance. In addition to the pathology of the central executive systems of speech activity, the formation of dynamic articulatory praxis is impaired. There is a disorder of voluntary control of the speech apparatus. Impaired pronunciation abilities in anarthria are caused by pronounced central speech-motor syndromes: very severe spastic paresis, tonic disorders of the control of articulatory movements, hyperkinesis, ataxia and apraxia. Apraxia covers all parts of the speech apparatus: respiratory, phonatory, labio-palato-lingual. Apraxic disorders are manifested by the child’s inability to arbitrarily form vowel and consonant sounds, to pronounce a syllable from existing sounds or a word from existing syllables.

Anarthria is characterized by deep damage to the articulatory muscles and complete inactivity of the speech apparatus. The face is amicable, mask-like; the tongue is motionless, lip movements are sharply limited. Chewing of solid food is practically absent; choking when swallowing and hypersalivation are pronounced.

The severity of manifestations of anarthria can be different (I.I. Panchenko):

a) complete absence of speech (sound pronunciation) and voice;

c) the presence of sound-syllable activity.

Depending on the combination of speech motor disorder with disorders of various components of speech functional system Several groups of children with dysarthria can be distinguished.

1. Children with purely phonetic violations. Their sound pronunciation, speech breathing, voice, prosody and articulatory motor skills. In this case, there are no violations of phonemic perception and lexico-grammatical structure of speech.

2. Children with phonetic-phonemic underdevelopment. Not only the pronunciation side of their speech is impaired (sound pronunciation, speech breathing, voice, prosody), but also phonemic processes(difficulties sound analysis and synthesis). At the same time, no lexico-grammatical speech defects are observed.

3. Children with general underdevelopment speech. In children of this group, all components of speech are impaired - both the pronunciation side of speech and the lexical, grammatical and phonemic development. Limitations noted vocabulary: children use everyday words, often use words in an inaccurate meaning, replacing them with adjacent ones by similarity, by situation, by sound composition. Dysarthric children are often characterized by insufficient mastery of the grammatical forms of language. In their speech, prepositions are often omitted, endings are left out or used incorrectly, case endings and number categories are not learned; there are difficulties in coordination and management.

The degree of severity (severity) of dysarthria does not depend on the number of impaired components of the speech functional system. For example, when erased (mild) dysarthria all components of speech (phonetic, phonemic and lexico-grammatical structure) may be impaired, and if moderate to severe dysarthria Only the phonetic structure of speech can be disrupted.

is 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; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics are performed (EEG, EMG, ENG, MRI of the brain, etc.), speech therapy examination oral and writing. Corrective work for dysarthria, includes therapeutic effects (medication courses, exercise therapy, massage, physical therapy), speech therapy classes, articulation gymnastics, speech therapy massage.

ICD-10

R47.1 Dysarthria and anarthria

General information

Classification

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 leading clinical syndrome, cerebral palsy may include spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, ataxic-hyperkinetic dysarthria.

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

1st degree(erased dysarthria) – defects in sound pronunciation can only be identified by a speech therapist during a special examination.
2nd degree– defects in sound pronunciation are noticeable to others, but overall speech remains understandable.
3rd degree- understanding the speech of a patient with dysarthria is only possible close circle and partly to strangers.
4th degree– speech is absent or incomprehensible even to the closest people (anarthria).

Symptoms of dysarthria

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

Impaired articulatory motor skills in patients with dysarthria may manifest as spasticity, hypotonia, or dystonia of the articulatory muscles. Muscle spasticity is accompanied by constant increased tone and tension in the muscles of the lips, tongue, face, and neck; tightly closed lips, limiting articulatory movements. With muscular hypotonia, the tongue is flaccid and lies motionless on the floor of the mouth; the lips do not close, the mouth is half open, hypersalivation (salivation) is pronounced; Due to paresis of the soft palate, a nasal tone of voice appears (nasalization). In the case of dysarthria occurring with muscular dystonia, when attempting to speak, muscle tone changes from low to increased.

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

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

Due to insufficient innervation of the speech muscles during dysarthria, speech breathing is disrupted: exhalation is shortened, breathing at the time of speech becomes rapid and intermittent. Voice disturbances in dysarthria are characterized by insufficient strength (quiet, weak, fading voice), changes in timbre (deafness, nasalization), melodic-intonation disorders (monotony, absence or inexpressibility of voice modulations).

Bulbar dysarthria

Bulbar dysarthria is 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.

Pseudobulbar dysarthria

With pseudobulbar dysarthria, the nature of the disorder is determined by spastic paralysis and muscle hypertonicity. Pseudobulbar paralysis 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.

Subcortical dysarthria

Subcortical dysarthria is characterized by the presence of hyperkinesis - involuntary violent muscle movements, including facial and articulatory movements. 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.

Cerebellar dysarthria

A typical manifestation of 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

Cortical dysarthria in its speech manifestations 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.

Complications

Due to slurred speech in children with dysarthria, auditory differentiation of sounds and phonemic analysis and synthesis suffer secondarily. Difficulty and insufficiency verbal communication can lead to an unformed vocabulary and grammatical structure of speech. Therefore, children with dysarthria may experience phonetic-phonemic (FFN) or general speech underdevelopment (GSD) and associated corresponding types of dysgraphia.

Diagnostics

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 the data from electrophysiological studies (electroencephalography, electroneuromyography), transcranial magnetic stimulation, MRI of the brain, etc.
Speech therapy examination for dysarthria includes assessment of speech and non-speech disorders. Assessment of non-speech symptoms involves studying the structure of the articulatory apparatus, the volume of articulatory movements, the state of facial and speech muscles, and the nature of breathing. The speech therapist pays special attention to the history of speech development. As part of the diagnosis of oral speech in dysarthria, a study of the pronunciation aspect of speech (sound pronunciation, tempo, rhythm, prosody, speech intelligibility) is carried out; synchronicity of articulation, breathing and voice production; phonemic perception, level of development of the lexico-grammatical structure of speech. In the process of diagnosing written speech, tasks are given for copying text and writing from dictation, reading passages and comprehending what is read.

Based on the examination results, it is necessary to distinguish between dysarthria and motor alalia, motor aphasia, dyslalia.

Correction of dysarthria

Speech therapy work to overcome dysarthria should be carried out systematically, against the background of drug therapy and rehabilitation (segmental reflex and acupressure, acupressure, exercise therapy, medicinal baths, physiotherapy, mechanotherapy, acupuncture, hirudotherapy), prescribed by a neurologist. A good background for correctional and pedagogical classes is achieved by using non-traditional forms of restorative treatment: dolphin therapy, touch therapy, isotherapy, sand therapy, etc.

On speech therapy classes To correct dysarthria, the following is developed:

fine motor skills(finger gymnastics),
motor skills of the speech apparatus (speech therapy massage, articulatory gymnastics);
physiological and speech breathing (breathing exercises),
voices (orthophonic exercises);
correction of impaired and consolidation of correct sound pronunciation; work on the expressiveness of speech and the development of verbal communication.

The order of production and automation of sounds is determined by the greatest accessibility of articulatory patterns on this moment. Automation of sounds in dysarthria is sometimes carried out until complete purity is achieved. isolated pronunciation, and the process itself requires more time and persistence than with dyslalia.

The methods and content of speech therapy work vary depending on the type and severity of dysarthria, as well as the level of speech development. If phonemic processes and the lexico-grammatical structure of speech are violated, work is carried out on their development, prevention or correction of dysgraphia and dyslexia.

Prognosis and prevention

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 correct speech, such children can successfully study in secondary school, and the necessary speech therapy assistance is received in clinics or 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.

Mild degree The severity of dysarthria is characterized by minor disturbances (speech and non-speech symptoms) in the structure of the defect. Often, manifestations of mild dysarthria are called “mildly expressed” or “erased” dysarthria, meaning mild (“erased”) paresis of the muscles of the articulatory apparatus that disrupt the pronunciation process. Sometimes practicing speech therapists use the terms: “minimal dysarthric disorders” or “dysarthric component”, while some of them incorrectly consider these manifestations to be only elements of dysarthria, or an intermediate disorder between dyslalia and dysarthria.

With a mild degree of dysarthria, overall speech intelligibility may not be impaired, but sound pronunciation is somewhat blurred and unclear. Distortions are most often observed in the group of whistling, hissing and/or sonorant sounds. When pronouncing vowels, the sounds “i” and “u” cause the greatest difficulties. Voiced consonant sounds are often deafened. Sometimes, in isolation, a child can pronounce all sounds correctly (especially if a speech therapist works with him), but with an increase in speech load, a general blurriness of sound pronunciation is noted.

There are also deficiencies in speech breathing (rapid, shallow); voices (quiet, muffled) and prosody (low modulation).

At average(moderately expressed) degree of dysarthria The general intelligibility of speech is impaired, it becomes slurred, sometimes even incomprehensible to others. In some cases, a child's speech is difficult to understand without knowing the context. Children have a general blurred sound pronunciation (numerous pronounced distortions in many phonetic groups). Often sounds at the end of words and consonant clusters are omitted. Disturbances in the depth and rhythm of breathing are usually combined with disorders of strength (quiet, weak, fading) and timbre of the voice (dull, nasalized, tense, compressed, intermittent, hoarse). The lack of voice modulation makes the voice unmodulated and children's speech monotonous.

Children have pronounced disturbances in the tone of the lingual, labial and facial muscles. The face is hypomimic, articulatory movements of the tongue and lips are slow, strictly limited, imprecise (not only the upper elevation of the tongue, but also its lateral abductions). Significant difficulties arise from holding the tongue in a certain position and switching from one movement to another. Children with moderate dysarthria are characterized by hypersalivation, disturbances in the act of eating (difficulty or absence of chewing, mastication and choking when swallowing), synkinesia, and an increased gag reflex.

Severe degree of dysarthria - anarthria- this is a complete or almost complete absence of sound pronunciation as a result of paralysis of the speech motor muscles. Anarthria occurs when the central nervous system is severely damaged, when motor speech becomes impossible. Most children with anarthria mainly exhibit disorders of the control of speech articulations (articulatory, phonatory, respiratory departments), and not just performance. In addition to the pathology of the central executive systems of speech activity, the formation of dynamic articulatory praxis is impaired. There is a disorder of voluntary control of the speech apparatus. Impaired pronunciation abilities in anarthria are caused by pronounced central speech-motor syndromes: very severe spastic paresis, tonic disorders of the control of articulatory movements, hyperkinesis, ataxia and apraxia. Apraxia covers all parts of the speech apparatus: respiratory, phonatory, labio-palato-lingual. Apraxic disorders are manifested by the child’s inability to arbitrarily form vowel and consonant sounds, to pronounce a syllable from existing sounds or a word from existing syllables.

The severity of manifestations of anarthria can be different (I.I. Panchenko):

a) Complete absence of speech (sound pronunciation) and voice;

c) The presence of sound-syllable activity.

Depending on the combination of speech motor disorder with disorders of various components of the speech functional system, several groups of children with dysarthria :

1. Children with " purely" phonetic violations. Their sound pronunciation, speech breathing, voice, prosody and articulatory motor skills suffer. In this case, there are no violations of phonemic perception and lexico-grammatical structure of speech.

2. Children with phonetic-phonemic underdevelopment. Not only the pronunciation aspect of speech is impaired in them (sound pronunciation, speech breathing, voice, prosody), but also phonemic processes (difficulties in sound analysis and synthesis). At the same time, no lexico-grammatical speech defects are observed.

3. Children with general speech underdevelopment. In children of this group, all components of speech are impaired: both the pronunciation aspect of speech and lexical, grammatical and phonemic development. Vocabulary limitations are noted: children use everyday words, often use words with inaccurate meanings, substituting adjacent words based on similarity, situation, and sound composition. Dysarthric children are often characterized by insufficient mastery of the grammatical forms of language. In their speech, prepositions are often omitted, endings are left out or used incorrectly, case endings and number categories are not learned; there are difficulties in coordination and management.

The degree of severity (severity) of dysarthria does not depend on the number of impaired components of the speech functional system. For example, when erased (mild) dysarthria all components of speech may be impaired (phonetic, phonemic and lexico-grammatical structure); and when moderate to severe dysarthria Only the phonetic structure of speech can be disrupted.

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2.2. Degrees of severity of dysarthria

With a mild degree of dysarthria, overall speech intelligibility may not be impaired, but sound pronunciation is somewhat blurred and unclear. Distortions are most often observed when pronouncing whistling, hissing and/or sonorant sounds. When pronouncing vowels, the greatest difficulties are caused by the sounds [ And] And [ at]. Voiced consonant sounds are often deafened. Sometimes, in isolation, a child can pronounce all sounds correctly (especially if a speech therapist works with him), but with an increase in speech load, a general blurriness of sound pronunciation is noted.

There are also deficiencies in speech breathing (rapid, shallow), voice (quiet, muffled) and prosody (low modulation).

The severity of manifestations of anarthria can be different (I.I. Panchenko):

a) complete absence of speech (sound pronunciation) and voice;

c) the presence of sound-syllable activity.

Depending on the combination of speech motor disorder with disorders of various components of the speech functional system, several groups of children with dysarthria can be distinguished.

1. Children with purely phonetic violations. Their sound pronunciation, speech breathing, voice, prosody and articulatory motor skills suffer. In this case, there are no violations of phonemic perception and lexico-grammatical structure of speech.

2. Children with phonetic-phonemic underdevelopment. Not only the pronunciation aspect of speech is impaired in them (sound pronunciation, speech breathing, voice, prosody), but also phonemic processes (difficulties in sound analysis and synthesis). At the same time, no lexico-grammatical speech defects are observed.

3. Children with general speech underdevelopment. In children of this group, all components of speech are impaired - both the pronunciation aspect of speech and lexical, grammatical and phonemic development. Vocabulary limitations are noted: children use everyday words, often use words in an inaccurate meaning, replacing them with adjacent ones based on similarity, situation, and sound composition. Dysarthric children are often characterized by insufficient mastery of the grammatical forms of language. In their speech, prepositions are often omitted, endings are left out or used incorrectly, case endings and number categories are not learned; there are difficulties in coordination and management.

2.3. Early diagnosis of speech motor disorders

The structure of the defect in dysarthria includes both speech and non-speech disorders (manifestation of neurological symptoms in the muscles and motor skills of the articulatory apparatus). In the first year of life, and sometimes later, only non-speech disorders can be identified and assessed.

Early diagnosis of dysarthric disorders is based on the assessment of non-speech disorders. How younger child and the lower the level of his speech development, the greater the importance of the analysis of non-speech disorders. Most often, the first manifestation of dysarthric disorders is the presence of pseudobulbar (spastic-paretic) syndrome, the first signs of which can be detected already in a newborn. First of all, this is the absence of a cry (aphonia) or its weakness, monotony, short duration. The cry can be strangled or piercing, sometimes there are isolated sobs or instead of a cry there is a grimace on the face. Almost all children with perinatal pathology of the central nervous system have an early manifestation of neurological symptoms in the muscles and motor skills of the speech apparatus. The most typical violations are the following.

1. Pathological changes in the structure and functioning of the articulatory apparatus; violation of the tone and mobility of articulatory muscles:

a) in the facial muscles: the presence of asymmetry, smoothness of the nasolabial folds, drooping of one of the corners of the mouth, skewing of the mouth to the side when smiling and crying; hypomimia; violation of the tone of the facial muscles such as spasticity, hypotension or dystonia; facial hyperkinesis;

b) in the labial muscles: impaired muscle tone, severe or slight limitation of lip mobility; insufficient lip closure, difficulty keeping the mouth closed, drooping lower lip, preventing a firm grip on the pacifier or teat and causing milk to leak from the mouth;

c) in the lingual muscles: impaired muscle tone; pathology of the structure of the tongue (with spasticity - the tongue is massive, pulled “lumpy” back or pulled forward with a “sting”; with hypotonia - thin, flaccid, spread out in the oral cavity; bifurcation of the tongue, lack of expression of the tip of the tongue, shortening of the frenulum); pathology of tongue position (deviation to the side, tongue protruding from the mouth); hyperkinesis, tremor, fibrillary twitching of the tongue; restriction of mobility of the lingual muscles (from complete impossibility to a decrease in the range of articulatory movements); increased or decreased pharyngeal (gag) reflex;

d) soft palate: sagging of the palatal curtain (with hypotension); deviation of uvula from midline.

2. Breathing disorders: infantile breathing patterns (predominance of abdominal breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.

3. Violation of voice formation: insufficient voice strength (quiet, weak, fading), deviations in timbre (nasalized, deaf, hoarse, constricted, tense, intermittent, trembling); violation of voice modulations, intonation expressiveness of the voice. Sometimes there is asynchrony of breathing, voice production and articulation.

4. Violation of the act of eating: disturbance of sucking (weakness, lethargy, inactivity, irregular sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup .

5. Hypersalivation (constant or worsening under certain conditions).

6. Oral synkinesis (the child opens his mouth wide during passive and active hand movements and even when trying to perform them).

7. Absence or weakening of reflexes of oral automatism (up to 3 months), the presence of pathological reflexes of oral automatism (after 3-4 months).

With age, a child with neurological pathology increasingly shows insufficiency of vocal reactions - screaming, humming, babbling. Long time the cry remains quiet, poorly modulated, monotonous, without intonation expressiveness (does not change depending on the child’s condition). Often the cry has a nasal tone. The sounds of humming and babbling are characterized by monotony, poor sound composition, low activity, and fragmentation.

At later stages of development, speech symptoms begin to become increasingly important in the diagnosis of dysarthric disorders: qualitative insufficiency of vocal reactions, persistent disturbances in sound pronunciation, speech breathing, voice formation, and prosody.

2.4. Modern approaches
to the classification of dysarthria

There are different approaches to the classification of dysarthria. They are based on the principle of localization of brain damage, the degree of intelligibility of speech for others, and a syndromic approach.

When classifying dysarthria based on the principle of localization of brain damage There are pseudobulbar, bulbar, extrapyramidal (subcortical), cerebellar, cortical forms of dysarthria (O.V. Pravdina and others).

Classification of dysarthria according to the degree of speech intelligibility for others was proposed by the French neurologist Tardieu. They identified 4 degrees of severity of speech motor disorders (in children with cerebral palsy):

1) violations of sound pronunciation are detected only by a specialist during the examination of the child;

2) pronunciation disorders are noticeable to everyone, but speech is understandable to others;

3) speech is understandable only to those close to the child;

4) speech is absent or incomprehensible even to the child’s loved ones (the fourth degree of sound pronunciation impairment is essentially anarthria). This classification is very convenient for use not only by speech therapists, but also by teachers, educators, and psychologists.

For speech therapy work, including differentiated massage, articulation and breathing exercises, it is convenient classification of dysarthria based on a syndromic approach, in which spastic-paretic, spastic-rigid, hyperkinetic, atactic and mixed forms of dysarthria are distinguished (I.I. Panchenko). In children with cerebral palsy, it is difficult to isolate the symptoms of speech motor disorders due to the complexity of damage to speech motor skills, unless they are correlated with general motor disorders. In cerebral palsy, general motor disorders (main syndromic disorders) are spastic paresis, tonic control disorders such as rigidity, hyperkinesis, ataxia, and apraxia.

Sound pronunciation and articulation disorders

for various forms of dysarthria (classification of dysarthria

according to the principle of localization of brain damage)

Violations

articulation

Violations

sound pronunciations

Bulbar dysarthria

Selective, predominantly right- or left-sided paralysis of the muscles of the speech apparatus

Amyotrophy

Muscle atony

Any voluntary or involuntary movements are impaired

All consonants approach (converge) to fricative sounds

Vowels converge to a sound like unstressed [ A] or [ s] with the erasure of opposition by row, rise and roundness

Nasal shade

Reduction of specific speech noises that occur during the articulation of oral sounds

Pseudobulbar

dysarthria

Bilateral spastic paralysis of the muscles of the speech apparatus

Muscle tone is increased according to the type of spastic hypertension (tongue is tense, pushed back)

The mobility of articulatory muscles is sharply limited

Selective disorders of voluntary movements

The most complex and differentiated sounds are selectively affected [ R], [l], [sch], [X], [ts], [h]

Softening sounds

Violations

articulation

Violations

sound pronunciations

Subcortical

(extrapyramidal) dysarthria

Sudden change in tone

Disturbance of emotional-motor innervation

Hyperkinesis

There are no stable problems with sound pronunciation

Cerebellar

dysarthria

Marked asynchrony of breathing, phonation and articulation

The tone in the articulatory muscles is reduced

Difficulties in maintaining articulatory patterns

Tongue movements are imprecise

With subtle targeted movements, tongue tremor is possible

The pace of movements is slow

The pronunciation of front-lingual, labial, and plosives is impaired.

Nasalization of most sounds

Violations

articulation

Violations

sound pronunciations

TO orc dysarthria

I. Kinesthetic postcentral

Lack of kinesthetic praxis

Incorrect and unclear articulation of sounds

Active search for the right ways

The noise characteristics of consonant sounds are replaced:

Places of education (especially linguistic ones);

Method of formation (especially sibilant affricates);

Hardness and softness. Substitutions are labile and ambiguous

II. Kinetic

premotor

Insufficiency of dynamic kinetic praxis

The sequence of articulatory movements is disrupted

Articulation of consonant sounds is impaired:

Initial and final consonants are often elongated or jerky;

Replacing slotted ones with occlusive ones;

Omissions of sounds in consonant clusters;

Simplification of affricates;

Selective deafening of voiced stops

(according to E.M. Mastyukova)

Isolated damage to individual muscles of the articulatory apparatus

Selective spastic paresis of speech muscles

The most subtle isolated movements suffer (elevation of the tongue)

The pronunciation of front-lingual sounds is impaired [ w], [and], [R]: they are absent or replaced by other consonants

Consonants formed when the tip of the tongue approaches the upper teeth or alveoli are difficult [ l]

Similar defects are observed in speech motor skills. The type of dysarthric speech disorder is determined by the nature of the clinical syndrome. This classification of dysarthria orients the speech therapist on the quality of articulatory motor impairment, which allows for a more targeted determination of the means of therapeutic and speech therapy work to normalize muscle tone and motor activity of the articulatory apparatus. This classification can only be used by a speech therapist together with a neurologist who determines the leading neurological syndrome.

When various syndromes are included in the structure of a speech defect, dysarthria is characterized as mixed.

Spastic-paretic dysarthria (leading syndrome - spastic paresis).

Spastic-rigid dysarthria (leading syndromes are spastic paresis and tonic control disorders speech activity type of rigidity).

Hyperkinetic dysarthria (leading syndrome - hyperkinesis).

Atactic dysarthria (leading syndrome is ataxia).

Spastic-atactic dysarthria (leading syndromes are spastic paresis and ataxia).

Spastic-hyperkinetic dysarthria (leading syndromes are spastic paresis and hyperkinesis).

Spastic-atactico-hyperkinetic dysarthria (leading syndromes are spastic paresis, ataxia, hyperkinesis).

Atactico-hyperkinetic dysarthria (leading syndromes are ataxia and hyperkinesis).

Document

4. Zavaleskiy Yu.I. The library is an important structural unit, an information center for the background education of the school library. – 2004.

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

The causes of erased dysarthria can be:

Deviations in intrauterine development (toxicosis, hypertension (high blood pressure), nephropathy during pregnancy, etc.);

Infectious diseases (ARVI, Influenza, etc.) suffered during pregnancy

Asphyxia of newborns;

Rapid or prolonged labor;

Long waterless period;

Mechanical obstetrics (forceps, vacuum).

When examining children 5-6 years old with erased dysarthria, the following symptoms are revealed:

General motor skills: children are clumsy, the range of active movements is limited, and they quickly tire under load. They stand unsteadily on one leg. They imitate movements poorly: how a soldier walks, how a bird flies, how bread is cut, etc. Motor incompetence is noticeable in physical education and music classes, where children lag behind in tempo, rhythm of movements, as well as in switching movements. General motor (motor) clumsiness and lack of coordination of movements cause a delay in the formation of self-care skills. Children with “erased” dysarthria develop a delayed hand readiness for writing.

Fine hand motor skills: children with erased dysarthria late and have difficulty mastering self-care skills: they cannot button a button, untie a scarf, etc. During drawing classes, they don’t hold a pencil well and their hands are tense. Motor clumsiness of the hands is especially noticeable during applique classes and with plasticine. In works on appliqué, difficulties in the spatial arrangement of elements can be traced. Children find it difficult or simply cannot, without outside help, perform an imitation movement, for example, “lock” - put their hands together, intertwining their fingers; “rings” - alternately connect the index, middle, ring, little fingers and other finger gymnastics exercises with the thumb. According to mothers, many children under 5-6 years old are not interested in playing with construction sets, do not know how to play with small toys, and do not assemble puzzles. School-age children in the first grade experience difficulties in mastering graphic skills, poor handwriting, slow pace of writing, “mirror” writing, and letter substitutions.

Features of the articulatory apparatus: characterized by weakness and lethargy of the articulatory muscles. The pace of articulatory movements is noticeably reduced. Children poorly feel the position of the tongue and lips, and have difficulty finding the direction of their movements necessary to pronounce sounds. In children with an erased form of dysarthria, the following features of the articulatory apparatus are observed.

Pareticity of the muscles of the organs of articulation is manifested in the following: flaccid lips, the corners of the mouth are drooping, and during speech the lips remain flaccid. The paretic tongue is thin, located at the bottom of the mouth, flaccid, the tip of the tongue is little active. With exercise (speech therapy gymnastics), muscle weakness increases.

Muscle spasticity is manifested in the following: the face is amicable, the facial muscles feel hard and tense to the touch. Lips in a half smile: the upper lip is pressed to the gums. Many children cannot make a straw out of their lips. The tongue with a spastic symptom is often changed in shape: thick, without a pronounced tip, inactive.

Hyperkinesis with erased dysarthria manifests itself in the form of trembling of the tongue and vocal cords. Trembling occurs under load. For example, when holding a wide tongue on the lower lip for a count of 5-10, the tongue cannot maintain a state of rest, trembling and slight blueness of the tip of the tongue appears, and in some cases waves roll across the tongue in the longitudinal or transverse direction. In this case, the child cannot keep his tongue out of the mouth. Hyperkinesis is often combined with increased muscle tone of the articulatory apparatus.

Apraxia manifests itself in the inability to perform certain movements of the articulatory apparatus or switch from one movement to another. Some children experience kinesthetic apraxia, when the child makes chaotic movements, “groping” for the desired articulatory position.

Deviation, i.e. deviation of the tongue from the midline, manifests itself during speech therapy gymnastics (when holding a pose, switching from one exercise to another).

Hypersalivation (increased salivation) is detected only during speech. Children cannot cope with salivation and do not swallow saliva.

Children with erased dysarthria perform all the movements from speech therapy gymnastics as instructed, but the quality of these movements suffers. Movements become blurred, unclear movements, weak muscle tension, arrhythmia, decreased amplitude of movements, rapid muscle fatigue, etc. During speech, this leads to distortion of sounds, mixing them and deterioration in the overall prosodic aspect of speech.

Sound pronunciation with erased dysarthria is characterized by: confusion, distortion, replacement and absence of sounds, i.e. the same options as for dyslalia. Sounds with erased dysarthria are produced in the same ways as with dyslalia, but for a long time they are not automated and speech is not introduced. The most common defects in sound pronunciation are violations of whistling and hissing sounds. Quite often, interdental pronunciation and lateral overtones are noted. Children have difficulty pronouncing words with a complex syllable structure; they simplify the sound content by omitting some sounds when consonants are combined (mitione instead of militiaman).

Children with erased dysarthria can pronounce most isolated sounds correctly, but in the speech stream they weakly automate them (the given sound may not be used in speech). Articulatory movements can be disrupted in a unique way: when the movements of the tongue and lips are limited, there is inaccuracy and disproportion in the performance of voluntary movements and insufficient strength.

Prosody. In the speech of children with “erased” dysarthria, in addition to disturbances in sound pronunciation and phonemic hearing, prosody disturbances are observed. The main complaints with “erased” dysarthria: unclear, blurred sound pronunciation; speech is monotonous and unexpressive; diction disorders; distortion and replacement of sounds in words with complex syllabic structure; failure to say elements of speech (for example, prepositions), etc.

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

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

A number of vocabulary features are noted, manifested in inaccurate use of words and limited vocabulary. Various phonetic means of formalizing an utterance (tempo, rhythm, stress, intonation) closely interact, determining both the semantic content and the speaker’s attitude to the content.

Less pronounced forms of dysarthria can be observed in children without obvious movement disorders, who have suffered short-term asphyxia (suffocation) or birth trauma, or who have a history (the totality of information about the illness and development of the child) of the influence of other not clearly expressed adverse effects during intrauterine development (viral infections, toxicosis, hypertension, nephropathy, pathology of the placenta, etc.) or during childbirth (prematurity; prolonged or rapid labor causing hemorrhage in the baby’s brain) and at an early age (infectious diseases of the brain and meninges: meningitis, meningoencephalitis, etc.).

As a result of various causes, mild brain disorders occur. Faint, “erased” disorders of the cranial nerves underlie mild innervation disorders, i.e. dysfunction of the motor nerves that ensure the process of normal speech. This leads to inaccurate pronunciation and other unexpressed speech disorders.

A study of the neurological status of children with an “erased” form of dysarthria reveals certain abnormalities in the nervous system, manifested in the form of a mild hemisyndrome. At the same time, children experience mild neurological symptoms in the form of “erased” paresis (limited mobility) of speech motor muscles, hyperkinesis, and disturbances in the muscle tone of articulatory and facial muscles.

Mild (“erased”) dysarthria is most often diagnosed after 5 years. Early speech development in a significant proportion of children with mild manifestations of dysarthria is slightly delayed. A child with early cerebral (brain) damage by the age of 4-5 years loses most of the symptoms, but a persistent violation of sound pronunciation and prosody may remain.

E.F. Sobotovich and A.F. Chernopolskaya distinguishes 4 groups of children with erased dysarthria:

Group 1 - children with insufficiency of some motor functions of the articulatory apparatus: selective weakness, pareticity of some muscles of the tongue. Asymmetric innervation of the tongue, weakness of movements of one half of the tongue cause such violations of sound pronunciation as lateral pronunciation of soft whistling sounds [s,] and [z,], affricates [ts], soft anterior lingual [t,] and [d,], posterior lingual [g ], [k], [x], lateral pronunciation of vowels [e], [i], [s].

Asymmetrical innervation of the anterior edges of the tongue causes lateral pronunciation of the entire group of whistling, hissing sounds [r], [d], [t], [n]; in other cases, this leads to interdental and lateral pronunciation of the same sounds.

The causes of these disorders are unilateral paresis of the hypoglossal (XII) and facial (VII) nerves, which are of an erased, unexpressed nature. A small proportion of children in this group have phonemic underdevelopment associated with distorted pronunciation of sounds, in particular, underdevelopment of phonemic analysis skills and phonemic representations. In most cases, children have an age-appropriate level of development of the lexical and grammatical structure of speech.

Group 2: children in this group did not show pathological features of general and articulatory movements. During speech, sluggish articulation, unclear diction, and general blurred speech are noted. The main difficulty for this group of children is pronouncing sounds that require muscle tension (sonorants, affricates, consonants, especially plosives). Thus, children often skip the sounds [r], [l], replace them with fricatives, or distort them (labial lambdacism, in which the stop is replaced by a labiolabial fricative); single-beat rhoticism resulting from difficulty vibrating the tip of the tongue. There is a splitting of affricates, which are most often replaced by fricative sounds. Violation of articulatory motility is mainly observed in dynamic speech-motor processes. The general speech development of children is often age appropriate. Neurological symptoms manifest themselves in the smoothness of the nasolabial fold, the presence of pathological reflexes (proboscis reflex), deviation of the tongue, asymmetry of movements and increased muscle tone. According to E.F. Sobotovich and A.F. Chernopolskaya, children of groups 1 and 2 have erased pseudobulbar dysarthria.

Group 3: children have all the necessary articulatory movements of the lips and tongue, but there are difficulties in finding the positions of the lips and especially the tongue according to instructions, imitation, based on passive displacements, i.e. when performing voluntary movements and in mastering subtle differentiated movements. A feature of pronunciation in children of this group is the replacement of sounds not only in place, but also in the method of formation, which is inconsistent. In this group of children, phonemic underdevelopment of varying degrees of severity is noted. The level of development of the lexico-grammatical structure of speech ranges from normal to pronounced OHP. Neurological symptoms manifest themselves in increased tendon reflexes on one side, increased or decreased tone on one or both sides. The nature of articulatory movement disorders is considered by the authors as manifestations of articulatory dyspraxia. Children in this group, according to the authors, have erased cortical dysarthria.

Group 4 are children with severe general motor impairment, the manifestations of which are varied. Children exhibit inactivity, stiffness, slowness of movement, and a limited range of movements. In other cases, there are manifestations of hyperactivity, anxiety, and a large number of unnecessary movements. These features are also manifested in the movements of the articulatory organs: lethargy, stiffness of movements, hyperkinesis, a large number of synkinesis when performing movements of the lower jaw, in the facial muscles, the inability to maintain a given position. Violations of sound pronunciation are manifested in replacement, omissions, and distortion of sounds.

A neurological examination of children in this group revealed symptoms of organic damage to the central nervous system (deviation of the tongue, smoothness of the nasolabial folds, decreased pharyngeal reflex, etc.). The level of development of phonemic analysis, phonemic representations, as well as the lexico-grammatical structure of speech varies from normal to significant OHP. This form of disorder is defined as erased mixed dysarthria.

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