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 blurry 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

At 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 it will be confirmed that he has a mild, moderate or severe degree of dysarthria.

Various neurological and speech therapy tests and tests play an important role in the examination. The main among them are methods for identifying 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. Clarify 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.

Modern ideas about erased dysarthria

in children preschool age

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, while 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, violations 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, the 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.