Speech therapy massage for the correction of dysarthria 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 for the effectiveness of speech therapy.

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

Massage can be carried out at all stages of corrective speech therapy, but it is especially important to use it on early stages work, when the child does not yet have the opportunity to perform certain articulatory movements.

Differentiated speech therapy massage can be performed by a speech therapist, defectologist, 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 children of early and

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

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

2.2. The severity of dysarthria ............................................................... ............................... 17

2.3. Early diagnosis of speech and movement disorders .............................................................. 21

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

Chapter III Logopedic examination of children with

dysarthria .................................................................................. ......................................... 32

Chapter IV Specifics of correctional and speech therapy work in dysarthria .............. 50

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

4.2. Differentiated logopedic massage .............................................................. ..... 53

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

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

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

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

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

4.4. Artificial local contrastothermia ............................................................... ............. 67

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

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

4.8. Correction of violations of sound pronunciation .................................................... ............. 77

4.9. Development of the functionality of the hands and fingers,

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

Chapter I
Perinatal pathology
central nervous system in children

The problem of corrective speech therapy assistance to children with neurological pathology is currently extremely relevant. The need for measures to diagnose and correct violations in the development of children is associated with the presence of an alarming demographic situation in the country, characterized not only by a general decline 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 has decreased in recent years 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. The 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 unite various pathological conditions caused by the impact on the fetus of harmful factors in the prenatal period, during childbirth and in the early stages after birth. The leading place in the perinatal pathology of the CNS 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 CNS damage" and "perinatal encephalopathy (PEP)" are generally accepted.

Early brain damage in most cases later manifests itself in varying degrees of impaired development. Due to the fact that the immature brain suffers, the further pace of its maturation slows down. The order of inclusion of brain structures is violated as they mature into functional systems. PEP is a risk factor for the occurrence of deviations in the development of various functional systems in a child. In this case, various "lines of development" - motor, cognitive and speech - can be violated.

Despite the equal probability of damage to all parts of the nervous system, under the action of pathogenic factors on the developing brain, the motor analyzer suffers first and most of all. In children with perinatal cerebral pathology, gradually, as the brain matures, signs of damage or impaired development of various parts of the motor analyzer, mental and speech development. With age, in the absence of adequate medical and pedagogical assistance, developmental disorders gradually become fixed and a more complex pathology can form.

Violation of the motor, mental and speech development of children is 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 some delay in the formation of age-related functions, while in others they 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:

syndromes of movement disorders, episindrome (convulsive syndrome), cerebrosthenic syndrome.

Severe degree:

cerebral palsy, organic lesion of the central nervous system.

1 . Hypertension-hydrocephalic syndrome.

Hypertensive syndrome (increased intracranial pressure) in children is often combined with hydrocephalic, which is characterized by the expansion of the ventricles in the subarachnoid space as a result of the accumulation of excess amounts of cerebrospinal fluid. An increase in intracranial pressure in infants can be transient and permanent, hydrocephalus - 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 those changes in the brain that caused it. With hypertension, the behavior of children changes first of all. They become easily excitable, irritable, cry - sharp, piercing; sleep - superficial, children often wake up. With hydrocephalic syndrome, on the contrary, children are lethargic, drowsy. Loss of appetite, regurgitation, sometimes even vomiting can lead to weight loss.

The neuropsychic development of the child may not suffer, but in some cases it is delayed. The depth and nature of the delay in psychomotor development 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. Syndrome of hyperexcitability.

The main manifestations of the hyperexcitability syndrome are restlessness, emotional lability, sleep disturbance, increased reflex excitability, and a tendency to a reduced threshold of convulsive readiness. There may not be a pronounced lag in psychomotor development in these children, but with a thorough examination, it is usually possible to note some minor deviations. For violation of psychomotor development in hyperexcitability syndrome, a lag in the formation of voluntary attention, differentiated motor and mental reactions is characteristic, which gives psychomotor development a kind of 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 any objects, capture them; quickly switch to objects. At the same time, manipulative research activity is not sufficiently expressed.

3. Syndrome of hypoexcitability.

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

With the syndrome of hypoexcitability, the formation of positive emotional reactions is noted at a later date. This is manifested both when communicating with an adult, and in the spontaneous behavior of the child. In the state of wakefulness, the child remains lethargic, passive, orienting reactions occur mainly to strong stimuli. The reaction to novelty is sluggish, insufficient.

With hypodynamic syndrome, there may be a delay in psychomotor development. It is characterized by a disproportion in development, which manifests itself in all forms of sensory-motor behavior. For everyone age stages There may be a lack of communication.

4. Syndrome of minimal cerebral dysfunction (MMD).

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

5. Cerebrosthenic syndrome.

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

6. Convulsive syndrome (episindrome).

Seizures may appear against the background of already existing neurological disorders and psychomotor retardation or occur as the first symptom indicating brain damage. The impact 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's age at the onset of seizures, the more pronounced will be the delay in psychomotor development. If convulsions 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 long and repeated, in turn can cause irreversible changes in the central nervous system.

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

7. Syndromes of movement disorders.

Children with syndromes of movement disorders have a later formation 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 are manifested in the form of muscle hypertension (spasticity), hypotension 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 the syndrome of muscular hypertension can vary from a slight increase in resistance to passive movements to complete stiffness, when any movement is almost impossible. If the syndrome is not pronounced, is not combined with pathological tonic reflexes and other neurological disorders, its effect 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 are more toned, differentiation and final consolidation of certain motor skills will be delayed. So, with an increase in muscle tone in the hands, a delay in directing the hands to the object, grasping the 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 up, prefer to crawl, stand on their toes on a support.

Syndrome muscle hypotension(decrease in muscle tone) is characterized by a decrease in resistance to passive movements and an increase in their volume. Limited spontaneous and voluntary motor activity. If the syndrome of muscular hypotension is not pronounced and is not combined with other neurological disorders, it either does not affect the age development of the child, 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 the coordinated activity of many muscle groups for their implementation. So, if you plant a child of 9 months, he sits, but he cannot sit down on his own. Such children later begin to walk, 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 with passive movements expressed general muscular hypotension. When trying to actively perform any movement, with positive or negative emotional reactions muscle tone increases dramatically.

8. Cerebral palsy.

Cerebral palsy (ICP) is a severe disease of the nervous system, which often leads to a child's disability. Cerebral palsy manifests itself in the form of various motor, mental and speech disorders. Leading in the clinical picture of cerebral palsy are motor disorders, which are often combined with mental and speech disorders, dysfunctions of other analyzer systems (vision, hearing, deep sensitivity), convulsive seizures (K.A. Semenova, E.M. Mastyukova). Cerebral palsy is not a progressive disease. As a rule, the condition of the child improves with age and under the influence of treatment.

The degree of severity of movement disorders varies in a wide range, where the grossest movement disorders are at one extreme, and minimal at the other. Mental and speech disorders, as well as motor disorders, have different degrees of severity, so a whole gamut of different combinations can be observed. For example, with gross motor disorders, mental disorders can be minimal, and vice versa, with mild motor disorders, severe mental and/or speech disorders are observed.

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

The main manifestation of the syndrome of early organic lesions of the central nervous system is underdevelopment cognitive activity , which is most often combined with a violation of speech development. The lag 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 due not to the 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 activity, the initial understanding of addressed speech are disturbed.

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

dysarthria(motor speech disorder) - a violation of the pronunciation side of speech, due to insufficient innervation of the speech muscles. Dysarthria is a consequence of an organic lesion of the central nervous system, in which the motor mechanism of speech is upset. With dysarthria, not programming speech utterance, and motor realization of speech.

The leading defects in dysarthria are a violation of the sound-producing side of speech and prosodic, as well as violations of speech breathing, voice and articulatory motility. Speech intelligibility in dysarthria is impaired, speech is slurred, fuzzy.

2.1. Basic violations (defect structure)
with dysarthria

Violation of the tone of the articulatory muscles(muscles of the face, tongue, lips, soft palate) according to the 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 in a “lump”, its back is spastically curved, raised up, the tip of the tongue is not expressed. The tense back of the tongue raised to the hard palate helps to soften consonant sounds (palatalization). Sometimes the spastic tongue is pulled forward with a "sting". An increase in muscle tone in the circular muscle of the mouth leads to spastic tension of the lips, tight closing of the mouth (voluntary opening of the mouth is difficult). In some cases, with a spastic condition of the upper lip, the mouth may, on the contrary, be ajar. This is usually accompanied by increased salivation (hypersalivation). Active movements with spasticity of the articulatory muscles are limited. (Spasticity of the muscles is noted in spastic-paretic dysarthria.)

2. Hypotension- decreased muscle tone. With hypotension, the tongue is thin, flattened in the oral cavity; lips flaccid, unable to close tightly. Because of this, the mouth is usually half open, hypersalivation can be expressed. Hypotonia of the muscles of the soft palate prevents sufficient progress of the palatine curtain upwards and its pressing against the back wall of the pharynx; a stream of air exits through the nose. In this case, the voice acquires a nasal tone (nasalization). (Hypotonia of the articulatory muscles occurs in spastic-paretic and atactic dysarthria.)

3. Dystonia - changing character of muscle tone. At rest, low muscle tone may be noted, while trying to speak and at the time 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 in hyperkinetic dysarthria.)

In children with neurological pathology, a mixed and variable nature of tone disorders in the articulatory muscles (as well as in the skeletal muscles) is often noted; in individual articulatory muscles, the tone can change in different ways. For example, spasticity may be noted in the lingual muscles, and hypotension in the facial and labial muscles. In all cases, there is a certain correspondence between violations of tone in the articulatory and skeletal muscles.

Impaired mobility of the 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. With damage to the muscles of the lips, the pronunciation of both vowels and consonants suffers. Articulation as a whole is disturbed. Sound pronunciation is especially grossly impaired with a sharp restriction of the mobility of the muscles of the tongue.

The degree of impaired mobility of the 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 violated first of all (primarily raising the tongue up).

Specific disorders of sound pronunciation:

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

Specific difficulties in automating sounds (the automation process takes more time than with dyslalia). With the untimely completion of speech therapy classes, the acquired speech skills often disintegrate;

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

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

Stunning 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 an increase in speech load, general blurring of speech is observed, and sometimes increases.

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

Speech breathing disorders.

Respiratory disorders in children with dysarthria are due to a lack of central regulation of respiration. Insufficient depth of breathing. The rhythm of breathing is disturbed: at the time of speech, it quickens. There is a violation of the coordination of inhalation and exhalation (a superficial inhalation and a 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 limitation of mobility of the muscles of the larynx, soft palate, vocal folds, tongue and lips. Most often, there is insufficient voice power (quiet, weak, fading) and deviations in the timbre of the voice (deaf, nasalized, choked, hoarse, intermittent, tense, guttural).

In various forms of dysarthria, voice disorders are specific.

Prosody violations(melodic-intonational and tempo-rhythmic characteristics of speech).

Melodic intonation disorders are often referred to as one of the most persistent signs of dysarthria. They largely affect the intelligibility, emotional expressiveness of speech. There is a weak expression or absence of voice modulations (the child cannot arbitrarily change the pitch). The voice becomes monotonous, little or unmodulated.

Violations of the pace of speech are manifested in its slowdown, less often in acceleration. Sometimes there are violations of the rhythm of speech (for example, chanting - "chopped" speech, when an additional number of stresses in words is noted).

Insufficiency of kinesthetic sensations in the articulatory apparatus.

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

Vegetative disorders.

One of the most common autonomic disorders in dysarthria is hypersalivation. Increased salivation is associated with limited movements of the muscles of the tongue, 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 a decrease in self-control.

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

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

Violation of the act of receiving write.

In children with dysarthria, it is often difficult, and in severe cases, there is no chewing of solid food, biting off a piece. Choking and choking are often noted when swallowing. Difficulty drinking from a cup. Sometimes the coordination between breathing and swallowing is disturbed.

The presence of synkinesis.

Synkinesis - involuntary accompanying movements when performing arbitrary articulatory movements (for example, additional movement of the lower jaw and lower lip upwards when trying to raise the tip of the tongue).

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

Increased pharyngeal (vomit) reflex.

Loss of coordination of movements (ataxia).

Ataxia is manifested in dysmetric, asynergic disorders and in the chanting of the rhythm of speech. Dysmetria is disproportion, inaccuracy of arbitrary articulatory movements. It is most often expressed in the form of hypermetry, when the desired movement is realized by a more sweeping, exaggerated, slower movement than necessary (excessive increase in motor amplitude). Sometimes there is a violation of coordination between breathing, voice formation and articulation (asynergy). Ataxia is noted in atactic dysarthria.

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

Hyperkinesis - involuntary, non-rhythmic, violent; there may be fanciful movements of the muscles of the tongue, face (hyperkinetic dysarthria).

Tremor - trembling of the tip of the tongue (most pronounced with purposeful movements). Tremor of the tongue is noted in atactic dysarthria.

The severity of dysarthria

The severity of dysarthria speech disorders depends on the severity and nature of the lesion of the central nervous system. Conventionally, 3 degrees of severity of dysarthria are distinguished: mild, moderate and severe.

Light degree the severity of dysarthria is characterized by minor disturbances (speech and non-speech symptoms) in the structure of the defect. Often, manifestations of a mild degree of dysarthria are called “unsharply pronounced” or “erased” dysarthria, meaning non-rough (“erased”) paresis of the muscles of the articulatory apparatus that disrupt the pronunciation process. Sometimes speech therapists use the terms "minimal dysarthria disorders" and "dysarthria 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, the general intelligibility of speech may not be impaired, but the sound pronunciation is somewhat blurred, fuzzy. Distortions are observed most often when pronouncing whistling, hissing and / or sonorous sounds. When pronouncing vowels, the greatest difficulties are caused by sounds [ and]and [ at]. Voiced consonants are often deafened. Sometimes, in isolation, a child can pronounce all sounds correctly (especially if a speech therapist deals with him), but with an increase in speech load, a general blurring of sound pronunciation is noted.

There are also shortcomings in speech breathing (rapid, shallow), voice (quiet, deaf) and prosodic (low modulation).

With a mild degree of dysarthria in children, mildly pronounced violations of the tone of the muscles of the tongue, sometimes lips and a slight decrease in the volume and amplitude of their articulatory movements are noted. At the same time, the most subtle and differentiated movements of the tongue are disturbed (first of all, lifting up). Non-verbal symptoms can also manifest as mild salivation, difficulty chewing solid foods, occasional choking when swallowing, and an increase in the pharyngeal reflex.

At middle(moderate) degree of dysarthria the general intelligibility of speech is impaired, it becomes slurred, sometimes even incomprehensible to others. In some cases, the child's speech is difficult to understand when the context is not known. In children, there is a general blurring of sound pronunciation (numerous pronounced distortions in many phonetic groups). Often, sounds at the end of a word and in a confluence of consonants are omitted. Violations of the depth and rhythm of breathing are usually combined with disorders of strength (quiet, weak, fading) and voice timbre (deaf, nasalized, tense, choked, intermittent, hoarse). The absence of voice modulations makes the voice unmodulated, and the speech of children is monotonous.

In children, violations of the tone of the lingual, labial and facial muscles are expressed. The face is hypomimic, articulatory movements of the tongue and lips are slow, strictly limited, inaccurate (not only the upper tongue lift, but also its lateral abductions). Significant difficulties are represented by keeping the tongue in a certain position and switching from one movement to another. For children with an average degree of dysarthria, hypersalivation, disturbances in the act of eating (difficulty or lack of chewing, chewing and choking when swallowing), synkinesis, and an increase in the gag reflex are characteristic.

Severe dysarthria- anartria - 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 the motor realization of speech becomes impossible. Most children with anarthria show mainly control disorders. speech articulations(articulatory, phonatory, respiratory department), 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. Pronunciation disorders in anarthria are caused by pronounced central motor speech syndromes: spastic paresis in a very severe degree, tonic disorders in the control of articulatory movements, hyperkinesis, ataxia and apraxia. Apraxia covers all parts of the speech apparatus: respiratory, phonatory, labio-palatine-lingual. Apraxic disorders are manifested by the child's inability to arbitrarily form vowels and consonants, to pronounce a syllable from the available sounds or a word from the available syllables.

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

According to the severity of the manifestations of anartria, it can be different (I.I. Panchenko):

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

c) the presence of sound-syllabic activity.

Depending on the combination of speech motor disorder with disorders of various components of speech functional system There are several groups of children with dysarthria.

1. Children with purely phonetic. They suffer from sound pronunciation, speech breathing, voice, prosodic and articulatory motor skills. At the same time, there are no violations of phonemic perception and the lexical and grammatical structure of speech.

2. Children with phonetic-phonemic underdevelopment. They violate not only the pronunciation side of speech (sound pronunciation, speech breathing, voice, prosodic), but also phonemic processes (difficulties in sound analysis and synthesis). At the same time, there are no lexical and grammatical shortcomings of speech.

3. Children with general underdevelopment of speech. All components of speech are impaired in children of this group - both the pronunciation side 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 related ones in terms of similarity, situation, and sound composition. Dysarthric children are often characterized by insufficient mastery of the grammatical forms of the language. Prepositions are often omitted in their speech, endings are not agreed upon or used incorrectly, case endings, categories of number are not assimilated; there are difficulties in coordination, management.

The 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) can be violated, and when moderate to severe dysarthria only the phonetic structure of speech can be violated.

Modern ideas about erased dysarthria

in preschool children

As a special type of speech disorder, erased dysarthria began to stand out in speech therapy relatively recently - in the 50-60s of the twentieth century.

E.F. Sobotovich, who identified shortcomings in sound pronunciation, which manifested themselves against the background of neurological symptoms and had an organic basis, but were of an erased, unexpressed character. E.F. Sobotovich qualified them as disorders of the dysarthria series, noting that the symptoms of these disorders differ from the manifestations of those classical forms of dysarthria that occur with cerebral palsy. Later in the studies of E.F. Sobotovich, R.I. Martynova, L.V. Lopatina and others, these disorders began to be designated as erased dysarthria.

At present, in the domestic literature, erased dysarthria is considered as a consequence of minimal brain dysfunction, in which, along with violations of the sound-producing side of speech, there are not pronounced disturbances in attention, memory, intellectual activity, emotional-volitional sphere, mild motor disorders and delayed formation of a number of higher cortical functions.

The literature emphasizes that the erased degree of dysarthria in its manifestations is characterized by smoothing of symptoms, their heterogeneity, variability, a different ratio of speech and non-speech symptoms, disorders of the sign (linguistic) and non-sign (sensory-motor) levels. Therefore, it presents a significant difficulty for differential diagnosis.

The etiology of erased dysarthria is associated by domestic authors with organic causes acting on brain structures in the prenatal, natal and early postnatal periods. In many cases, there is a chain of hazards in the anamnesis of all three periods of the child's development.

The leading symptom in erased dysarthria is phonetic. Such children are characterized by a polymorphic violation of sound pronunciation, which manifests itself in distortions and the absence of mainly three groups of sounds: whistling, hissing, sonors. Speech is characterized by low expressiveness, monotony, "blurred" intonation pattern. Secondary lexical and grammatical disorders in dysarthria are characterized by a delay in formation.

In studies devoted to the study of the problem of erased dysarthria, notes c I, that in children with this speech pathology, violations of phonemic perception are common. It is difficult for them to distinguish by ear hard-soft, voiced-deaf sounds, affricates and their constituent elements. They are characterized by distortions in the sound-syllabic structure of the word, difficulties in mastering sound-syllabic analysis, synthesis, and the formation of phonemic representations. Also E.F. Sobotovich, L.V. Lopatin distinguish children with erased dysarthria with underdevelopment of the grammatical structure of speech: from a slight delay in the formation of the morphological and syntactic systems of the language to pronounced agrammatisms in expressive speech.

Along with speech symptoms, there are also non-speech ones. R.I. Martynova revealed the features of the formation of a number of higher mental functions and processes in children with erased dysarthria: a decrease in the functions of attention, memory, difficulties in generalizing, classifying, determining the logical sequence of events in plot series, a violation in establishing cause-and-effect relationships.

And also in children with this defect, there are violations of the motor sphere, manifested both in general and in fine and articulatory motor skills. Researchers note slowness, awkwardness, insufficiency of movements with the relative safety of their volume. L.V. Lopatina, describing violations of manual motor skills in these children, draws attention to the inaccuracy, lack of coordination, insufficient dynamic organization of movements. Studies of articulatory motility have shown that children have a dysfunction of the muscles innervated by the lower branch of the trigeminal nerve, facial, hypoglossal and glossopharyngeal nerves.

Thus, the literature describes the presence of the following symptoms of erased dysarthria in children: neurological symptoms, insufficiency of visual gnosis, spatial representations, memory, motor disorders, prosodic side of speech, low level of development of sound pronunciation, phonemic perception, violation of the grammatical structure of speech.

Article prepared

Speech therapist Gavrilova E.G.

Used Books:

1. Lopatina L.V. Speech therapy work with preschool children with minimal dysarthria. - St. Petersburg: "Soyuz", 2005.- 192 p.

2. Lopatina L.V. An integrated approach to the diagnosis of erased dysarthria in preschoolers // journal: Speech therapist in kindergarten. 2005. No. 4. - S. 50-52.

3. Martynova R.I. Comparative characteristics of children suffering from mild forms of dysarthria and functional dyslalia // Speech disorders and methods for their elimination. Sat. articles / Ed. S.S. Lyapidevsky. S. N. Shakhovskoy. - M. 1975. - S.79-91.

4. Fedosova O.Yu. Differential approach to the diagnosis of mild dysarthria // Speech therapist in kindergarten. 2004. No. 3. - P. 53.

5. Sobotovich E.F., Chernopolskaya A.F. The manifestation of erased dysarthria and methods for their diagnosis // journal: Defectology. 1974. No. 4 - S. 19-26.

6. Kiseleva V.A. Diagnosis and correction of the erased form of dysarthria. Manual for speech therapists. - M .: "School Press", 2007.- 48 p.

7. Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. 1996. No. 5 - S.! 0-15.

8. Gurovets G.V., Maevskaya S.I. On the issue of diagnosing erased forms of pseudo-bulbar dysarthria // Questions of speech therapy. M.: 1982. - P.75.

dysarthria- violation of pronunciation, due to insufficient innervation of the speech apparatus in case of lesions of the posterior frontal and subcortical regions of the brain. The speech is usually understood as unclear, slurred, deaf, often with a nasal tint, "as if porridge in the mouth." Causes The formation of such a speech pathology as dysarthria is served by various hazards of the prenatal, natal, postnatal periods: maternal illness during pregnancy, weak labor activity of the mother, impaired early psychomotor development and severe illnesses of the child, especially in the first year of life. Main manifestations dysarthria: a disorder of articulation of sounds, a violation of voice formation, a change in the pace and rhythm of speech, a change in intonation.

Classification according to the degree of severity. It is based on the degree of brain damage. And depending on the degree of damage, anartria, dysarthria, erased dysarthria are distinguished: anartria- complete impossibility of the pronunciation side of speech; dysarthria(expressed) - the child uses oral speech, but it is inarticulate, incomprehensible, sound pronunciation is grossly disturbed, as well as breathing, voice, intonation expressiveness; erased dysarthria- all symptoms (neurological, psychological, speech) are expressed in an erased form. Erased dysarthria can be confused with dyslalia. The difference is that children with erased dysarthria have focal neurological microsymptoms.

Classification according to the degree of intelligibility of speech for others. It is based on the consideration of purely external manifestations. The author highlighted four degrees of severity of speech disorders: first- the mildest degree - a violation of sound pronunciation is detected only by a specialist in the process of examining a child; second- violations of pronunciation are noticeable to everyone, but speech is understandable to others; third- speech is understandable only to the relatives of the child and partially to others; fourth, the most severe - the lack of speech or speech is almost incomprehensible even to the relatives of the child (anarthria). - The classification in domestic neuropathology and speech therapy was created taking into account the mechanism of the violation, according to the localization of the lesion. Bulbar dysarthria. Characteristic is paralysis or paresis of the muscles of the pharynx, larynx, tongue, soft palate. In a child with a similar defect, swallowing of solid and liquid food is disturbed, chewing is difficult. Insufficient mobility of the vocal folds, soft palate leads to specific voice disorders: it becomes weak, nasalized. 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. Speech is slurred, extremely indistinct, slow. The face of a child with boulevard dysarthria is amimic. Cortical dysarthria. With this form, arbitrary motility of the articulation apparatus is disturbed. According to its manifestations in the field of sound pronunciation, cortical dysarthria resembles motor alalia, since, first of all, the pronunciation of words that are complex in sound-syllabic structure is disturbed. In children, the dynamics of switching from one sound to another, from one articulatory position to another, is difficult. Children are able to clearly pronounce isolated sounds, but sounds are distorted in the speech stream, substitutions occur. Consonant combinations are especially difficult. At an accelerated pace, hesitation appears, reminiscent of stuttering. Pseudobulbar dysarthria. The child develops pseudobulbar paralysis or paresis, caused by damage to the pathways that run 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 ​​mimic and articulatory muscles, it is close to bulbar. The degree of violation of speech or articulatory motility may be different. Conventionally, there are three degrees of pseudobulbar dysarthria: mild, moderate, severe: main defect in light degree, is a violation of the phonetic side of speech. 2. average- amimicity: lack of movements of the facial muscles. The child cannot puff out his cheeks, stretch out his lips, close them tightly. severe pronunciation defect. Speech is very slurred, slurred, quiet. 3. heavy- anarthria - characterized by deep muscle damage and complete inactivity of the speech apparatus. Erased form of dysarthria. Mild (erased) forms of dysarthria can be observed in children without obvious movement disorders. Early speech development is slightly slowed down. by the age of 3-4, the phonetic side of speech in preschoolers with an erased form of dysarthria remains unformed. Cerebellar dysarthria- dysarthria caused by damage to the cerebellum or its pathways; characterized by stretched, scrambled speech with broken modulation and fluctuating volume.

Handbook of a speech therapist Author unknown - Medicine

CLASSIFICATION OF DYSARTRIA BY SEVERITY

According to the severity of dysarthria, the following types are distinguished.

Anartria- complete impossibility of sound pronunciation, speech is absent, separate inarticulate sounds are possible.

Severe dysarthria - the child is able to use oral speech, but it is inarticulate, incomprehensible to others, there are gross violations of sound pronunciation, breathing, voice and intonational expressiveness are also significantly impaired.

Erased dysarthria- with a given degree of severity of dysarthria, all the main signs, both neurological and speech, and psychological, are expressed in a minimal, erased form.

However, a thorough examination reveals neurological microsymptoms, and violations of the performance of special tests are noted.

The most common speech therapist in children's practice is pseudobulbar dysarthria. According to the severity of violations of speech and articulatory motility, it is customary to distinguish three degrees of severity of pseudobulbar dysarthria: mild, moderate and severe.

Mild pseudobulbar dysarthria

With a mild degree (III degree) of pseudobulbar dysarthria, there are no gross violations of the motility of the articulatory apparatus. The cause of these disorders is most often unilateral lesions of the lower parts of the anterior central gyrus, or rather the neurons of the motor cortico-bulbar pathways. A neurological examination describes a picture of selective damage to the muscles of the articulation apparatus, with the muscles of the tongue being most often affected.

With a mild degree of dysarthria, there is a restriction and violation of the implementation of the most subtle and differentiated movements carried out by the tongue, in particular, the upward movement of its tip is difficult. Also, in children suffering from a mild form of pseudobulbar dysarthria, there is, as a rule, a selective increase in the muscle tone of the muscles of the tongue. The main violations are violations of the tempo and smoothness of sound pronunciation. Difficulties in pronunciation are associated with slow and often insufficiently precise movements of the tongue and lips. Swallowing and chewing disorders are not pronounced and are manifested mainly by rare choking.

Speech slows down, and blurring appears when pronouncing sounds. Violations of sound pronunciation relate primarily to sounds that are complex in articulation: [g], [w], [p], [c], [h]. When pronouncing voiced sounds, insufficient participation of the voice is noted. The pronunciation of soft sounds is also difficult, for which it is necessary to add to the main articulation the rise of the back of the tongue to the hard palate. So the pronunciation of the sounds "l", "l" is difficult.

Cacuminal consonants [g], [w], [p] are absent in speech, or in some cases they are replaced by dorsal sounds [s], [h], [sv], [sv], [t], [d] , [n].

In general, these changes in sound pronunciation negatively affect phonemic development. The vast majority of children suffering from mild pseudobulbar dysarthria have described difficulties in sound analysis. In the subsequent teaching of writing, such children, according to a number of authors, have specific errors in the replacement of sounds ([t] - [d], [h] - [c]). Violations of vocabulary and grammatical structure are extremely rare. It is generally accepted that the essence of a mild form of dysarthria lies in the presence of violations of the phonetic side of speech.

The average degree of pseudobulbar dysarthria Most children with dysarthria have an average degree (grade II) of the severity of disorders. It occurs as a result of more extensive unilateral lesions localized in the lower post-central regions of the cerebral cortex. As a result of damage to the central nervous system, insufficiency of kinetic praxis is observed. Also, in children with an average degree of dysarthria, there is a lack of facial gnosis, which is especially pronounced in the region of the articulatory apparatus. At the same time, the ability to accurately determine the place of exposure to the stimulus is impaired. That is, when touching the face, there are difficulties in indicating the exact place of touch. Violations of gnosis are closely related to disturbances in the sensation and reproduction of articulation patterns, the transition from one articulation pattern to another. It is difficult to find the desired articulation mode, which leads to a significant slowdown in speech, loss of its smoothness.

When examining a child suffering from moderate dysarthria, a violation of facial expressions attracts attention. The face of such a child, as a rule, is amimic, movements of the facial muscles are almost completely absent.

When performing simple movements - puffing out the cheeks, tightly closing the lips, stretching the lips - significant difficulties arise. There are significant restrictions on the movements of the tongue. Often it is impossible to raise the tip of the tongue up, turn it to the sides, and most importantly, it becomes difficult or impossible to hold the tongue in such a position. Transitions from one movement to another are also significantly more difficult. There are paresis of the soft palate with a pronounced limitation of its mobility. The voice takes on a pronounced nasal tone. These children have increased salivation. Violations of the processes of chewing and swallowing are revealed.

The function of the articulatory apparatus is significantly impaired, as a result of which pronounced disturbances in sound pronunciation develop. The pace of speech is slow. Speech is usually slurred, slurred, and quiet. Due to impaired lip mobility, the articulation of vowel sounds is upset, it becomes fuzzy, sounds are pronounced with increased nasal exhalation. In most cases, there is a mixture of sounds [and] and [s]. The clarity of the pronunciation of sounds [a], [y] is disturbed. Of the consonants, the most frequent violations are described for hissing sounds [g], [w], [u], affricates [h], [c] are also violated. The latter, as well as the sounds [p] and [l], are pronounced approximately, in the form of a nasal exhalation with an overtone of a “squishing” character. At the same time, the exhaled oral jet is significantly weakened and is felt with difficulty. Voiced consonants in many cases are replaced by deaf ones. More often than others, the sounds [n], [t], [m], [n], [k], [x] are preserved. Often, terminal consonants, as well as consonants in confluences of sounds, are omitted. The speech of children with moderate dysarthria is significantly impaired, often so little understood by others that such children prefer not to engage in conversations, keep aloof and remain silent. At the same time, the development of speech is significantly delayed and occurs at the age of only 5–6 years. Children with moderate dysarthria can, with proper corrective work, study in ordinary general education schools However, the most favorable conditions for the education of such children require the creation of an individual approach, which is feasible in special schools.

Severe pseudobulbar dysarthria Severe degree of pseudobulbar dysarthria (I degree) is characterized by gross speech disorders up to anarthria. With a given degree of severity of speech disorders, gross violations of the reproduction of a series of movements following one after another are observed. In such children, a pronounced insufficiency of kinetic dynamic praxis is revealed, as a result of which there are violations of the automation of the set phonemes, which is especially pronounced in words with a confluence of consonants. Speech in such cases is almost inarticulate, tense. The affricates break up into constituent parts [c] - [ts], [h] - [tsh]. There are replacements of slotted sounds with occlusive ones [s] - [t], [h] - [e]. When the consonants converge, the sounds are lowered. Voiced consonants are selectively stunned.

The extreme severity of dysarthria - anarthria - occurs with deep violations of the functions of muscle groups, and also, according to some researchers, "complete inactivity of the speech apparatus." The face of a child suffering from anarthria is amimic and reminiscent of a mask; as a rule, the lower jaw is not kept in a normal position and sags, as a result of which the mouth is constantly half open. The tongue turns out to be almost completely immobile and is constantly located at the bottom of the oral cavity, the movements of the lips are sharply limited in their volume. The acts of swallowing and chewing are significantly impaired. The complete absence of speech is characteristic, sometimes there are separate inarticulate sounds.

It is believed that pseudobulbar dysarthria is characterized by the preservation of the rhythmic contour of the word, regardless of the distortion of the pronunciation of sounds in its composition. Children suffering from pseudobulbar dysarthria are in most cases able to pronounce two-syllable and three-syllable words, while four-syllable words are usually pronounced in reflection. Disorders of articulatory motility have a great influence on the development of the perception of speech sounds, causing the formation of its violations. Secondary auditory perception disorders associated with insufficient articulatory experience, as well as the lack of a clear kinesthetic image of sound, result in impaired development of sound analysis. Children suffering from pseudobulbar dysarthria are not able to correctly perform most of the existing tests to assess the level of sound analysis. So, during the examination, dysarthric children cannot correctly choose from the mass of the proposed pictures, the names of objects on which begin with the given sounds. They also cannot think of a word that begins or contains the required sound. At the same time, violations of sound analysis depend on the severity of violations of sound pronunciation, therefore, children with less pronounced defects in sound pronunciation make fewer errors in samples for sound analysis. In the case of anartria, however, such forms of sound analysis are inaccessible. Violations and underdevelopment of sound analysis in children with dysarthria cause significant difficulty up to the impossibility of learning to read and write. At the same time, the main number of errors in the writing of such children is the substitution of letters. At the same time, the replacement of vowel sounds children - “detu”, “teeth” - “teeth”, etc. are very frequent. This is due to the inaccuracy of the nasal pronunciation of vowels in the child, in which they are practically indistinguishable in sound. Consonant substitutions in writing are also numerous and varied.

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To build the correct treatment regimen and correction, the team of doctors needs not only to make a diagnosis, but also to classify the form, degree and severity of the disease.

• Degree detection methods

Classification of the degrees of the disease

The classification according to which the degree of dysarthria is established is based on an analysis of the severity of the symptoms, their severity and the general picture of the disorder.

There are the following degrees of severity of dysarthria:

1. light;
2. average;
3. heavy.

Mild dysarthria

Most often, in this case, a latent form of a speech defect is implied, since it differs in a not so obvious picture of the disease and the generality of symptoms. Speech and motor disorders are mild, and complications are minor.

When determining, it is important to take into account both the symptoms of speech disorders and the general ones. So, the following speech symptoms are determined:

• Fuzzy or blurred sounds.
• Substitution of sounds in difficult words for the child.
• Problems in pronunciation agree with sounds like "sh", "x".
• Voiced consonants have a voiceless sound.
• Difficulties in pronunciation of vowels: "and", "y".
• The voice is weak, unexpressed.

Nonverbal symptoms include:

1. Breathing is frequent, shallow.
2. Weakness of articulation.
3. Difficulties in the implementation of the arbitrariness of language control.
4. Light salivation.
5. Motor awkwardness.
6. Slight tension when chewing and swallowing.
7. Weak changes in the expression of emotions through facial expressions.

Average degree of dysarthria

This is the so-called moderate severity. It is characterized by more pronounced and severe symptoms ().

Speech symptoms include:

• Unintelligible vague speech.
• Blurred speech.
• "Swallowing" endings.
• Silent, muffled voice.
• Voice color disorder (deafness, hoarseness, nasalization).
• Monotony in speech.

Nonverbal symptoms are characterized by:

1. Disorder of muscle tone of the face, speech apparatus.
2. Weak facial expressions.
3. Slow articulation.
4. Difficulty in the arbitrariness of language control.
5. Increased salivation.
6. Difficulty chewing, swallowing movements.
7. Increased gag reflex.
8. Involuntary movements.
9. Changes in breathing, its rhythm and depth.

First of all, this serious illness is characterized by anarthria, that is, a complete (sometimes insignificant elements of speech remain) deficiency of sound production. This violation occurs due to paralysis of the speech muscles, disorders of the nervous system.

In children, the severity of articulation is observed in all its branches (articulatory, phonatory, respiratory). There are pronounced spastic paresis, hypertonicity or hypotonicity of muscles, hyperkinesis, ataxia and apraxia. Sometimes the defect is so significant that it is impossible to pronounce a syllable of several sounds together.

The face of such children is completely amimic, has the appearance of a mask. The movements of the tongue are not subject to them, and the lips are limited in their functionality, salivation is profuse. The processes of capturing food, chewing and swallowing are almost not controlled by children, as a result of which they are completely dependent on others.

At the same time, anarthria is also divided into degrees of severity:

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• Speech and voice are completely absent.
• Voice reactions are present.
• There is a sound-syllabic component of speech.

Features accompanying types of dysarthria

It must be taken into account, during the study of the disease, that the division of dysarthria according to severity, where there are 3 degrees, is not the only classification. The main one is the localization of the affected area.

Thus, bulbar, cortical, pseudobulbar, subcortical are distinguished. Each has its own characteristics. So, with cerebellar, in addition to changes in the form of jerky speech, there are cerebellar symptoms - gait instability, tremor, etc. With subcortical - hyperkinesis is expressed. And all types of dysarthria have 3 degrees of severity.

According to statistics, the most common form is. Consider, using her example, the features of the disease in accordance with the degree.

For light, gross changes are not inherent. Accurate, precise movements are difficult. They are slow and little differentiated. The child occasionally chokes when swallowing, violations of chewing acts are not very pronounced. The main feature of this degree of dysarthria will be the lack of smoothness, the pace of speech, blurred sounds during pronunciation. The greatest difficulty for them is caused by “g”, “c”, “h”, soft sounds. Children with this disorder can make substitutions for some sounds.

Moderate dysarthria is diagnosed in most people with this diagnosis. It can manifest itself in a violation of the arbitrariness of movements, including the regulation of the speech apparatus, in such patients articulation is reduced. It is difficult for them to perform actions such as puffing out their cheeks, squeezing or even completely covering their mouth, and limiting the mobility of the tongue. In addition, a weakening of sensitivity is diagnosed - the patient does not determine the place touched by the doctor.

Speech is also slowed down due to a decrease in articulation, it is blurred and incomprehensible (this is especially noticeable when pronouncing similar vowels - “a” - “y”, “i” - “s” - and hissing sounds). The voice is quiet and has a nasal tone. The face is severely limited in facial expressions, it is almost absent, the face takes on the form of a mask. Functions of capture, chewing and swallowing are disturbed, there is a strong salivation.

With a severe degree of pseudobulbar dysarthria, symptoms will be very pronounced, gross violations can reach a complete loss of the ability to produce sound. If there is speech, then it will be slurred, slurred, tense. When pronouncing, children change sounds, divide them into components (“c” is heard like “tc”).

The most serious variant with this degree of severity is anarthria with complete facial expression. In this case, the face takes on a strange expression, since the lowered lower jaw contributes to a constantly open mouth, while the tongue is motionless, but is in the mouth. Salivation is profuse, the process of chewing and swallowing is severely impaired.

A feature of the manifestation of dysarthria is also that at any degree (and type) of the disease in a child, negative symptoms are possible in different components of speech. That is, the manifestations may not depend on the severity. So, with a mild degree of severity, the doctor can note changes in both the phonetic and grammatical structure of speech. And in severe cases, all violations can be limited only to grammatical.

Degree detection methods

In speech disorders, it is important to establish not only the form, but also the severity of the disease. So, a common diagnostic practice is when a child, after an outpatient examination, with a systemic speech disorder, is sent for a medical and social examination, where he will be confirmed to have a mild, moderate or severe degree of dysathria.

Various neurological and speech therapy tests and tests play an important role in the examination. The main among them are methods for detecting facial expression disorders, breathing features, voice, motor and articulatory characteristics, the state of muscles and the speech apparatus as a whole.

The work plan includes:

1. Questioning (parents, first of all) and inspection. They specify the duration of the disease, the main complaints, when viewed, they look at the general physical development, the condition of the tongue, soft palate, the presence or absence of paresis and hyperkinesia.
2. functional tests. 2 tests are used: the first is to stick out a wide tongue from the mouth and hold it in one position, the second is to move the tongue to the sides, up and down, while the doctor holds his hand on the child's neck.
3. Tests for facial motor skills: ask the child to squint, raise and lower his eyebrows, smile, pout his lips.
4. Study of articulation: repetition of poses according to the model, according to verbal instructions (raise your hands, touch your nose with your finger).
5. The study of written language.
6. The study of oral speech: the pronunciation of words, sounds, sentences.
7. Methods for studying the coordination of movements: walk in a straight line, stand on one leg.

After that, based on the results of tests, examination and in accordance with the criteria, the commission establishes the diagnosis and severity.