Modern scientific understanding of dysarthria and its correction. Modern ideas about erased dysarthria in preschool children Analysis of modern ideas about dysarthria

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 necessary condition 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 at the initial stages of 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 functionality 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 in the country of an alarming demographic situation, characterized not only overall decline birth rate, but also an increase in the proportion of the birth 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. 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 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. At all age stages, there may be insufficient communication activity.

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, violation of 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 effect on age 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 motor 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 physical 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, in these children with passive movements, general muscle hypotonia is expressed. 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 the minimum 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 closure of the mouth (arbitrary 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 disturbances 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 of automating sounds (the automation process requires 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 [ sh], [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.

Synkinesia - 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, unsharply pronounced violations of the muscle tone 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 food, 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. In most children with anarthria, speech articulation control disorders (articulatory, phonatory, respiratory department) are mainly manifested, 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.

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

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 sound analysis and synthesis). At the same time, there are no lexical and grammatical shortcomings of speech.

3. Children with general underdevelopment of speech. In children of this group, all components of speech are impaired - both the pronunciation side of speech, and lexical, grammatical and phonemic development. Restrictions noted vocabulary: children use everyday words, often use words in an inaccurate meaning, replacing them with related ones in similarity, in situation, in 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 left out or misused, not digested. case endings, number categories; 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.

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 intonation 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) 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 ringing sounds there is a lack of voice participation. 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 with mild degree pseudobulbar dysarthria, difficulties in sound analysis are described. 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. This impairs the ability to exact definition stimulus sites. 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 lift 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 correctional 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 that 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, sound analysis disorders depend on the severity of sound pronunciation disorders, so children with less pronounced sound pronunciation defects make fewer errors in sound analysis tests. 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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Cortical dysarthria

Classification of dysarthria according to 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.

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.

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 motor cortico-bulbar tracts. 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.

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. During 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, there is an insufficiency of kinesthetic praxis. 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.

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 that 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. Affricates break up into components [c] - [ts], [h] - [tsh]. There are replacements of slotted sounds with occlusive ones [s] - [t], [h] - [d]. When the consonants converge, the sounds are lowered. Voiced consonants are selectively stunned.

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Cortical dysarthriaBasic principles for examining children with dysarthria (basic indicators for diagnosing dysarthria)

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.

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 corticobulbar tracts. 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.

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, there is an insufficiency of kinesthetic praxis. 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.

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 that 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.

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, children with dysarthria 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, sound analysis disorders depend on the severity of sound pronunciation disorders, so children with less pronounced sound pronunciation defects make fewer errors in sound analysis tests. 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.

- this 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 a violation of speech motility, sound pronunciation, speech breathing, voice and the prosodic side of speech; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics is performed (EEG, EMG, ENG, MRI of the brain, etc.), speech therapy examination of oral and written speech. Corrective work for dysarthria includes therapeutic effects (drug courses, exercise therapy, massage, physical therapy), speech therapy classes, articulatory gymnastics, speech therapy massage.

ICD-10

R47.1 Dysarthria and anartria

General information

Classification

The neurological classification of dysarthria is based on the principle of localization and syndromological approach. Taking into account the localization of the lesion of the speech-motor apparatus, there are:

bulbar dysarthriaassociated with damage to the nuclei of the cranial nerves /glossopharyngeal, hypoglossal, vagus, sometimes facial, trigeminal/ in the medulla oblongata
pseudobulbar dysarthria associated with damage to the cortical-nuclear 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 in cerebral palsy, spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, atactico-hyperkinetic dysarthria can occur.

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

1 degree(erased dysarthria) - defects in sound pronunciation can only be detected by a speech therapist during a special examination.
2 degree- defects in sound pronunciation are noticeable to others, but in general, speech remains understandable.
3 degree- understanding of the speech of a patient with dysarthria is available only to close circle and partially to strangers.
4 degree- speech is absent or incomprehensible even to the closest people (anartria).

Symptoms of dysarthria

The speech of patients with dysarthria is slurred, fuzzy, 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 make up the essence of the defect.

Dysfunction of articulatory motility in patients with dysarthria may manifest itself in spasticity, hypotension, or dystonia of the articulatory muscles. Muscular spasticity is accompanied by a constant increased tone and tension of the muscles of the lips, tongue, face, neck; tight closing of the lips, limitation of articulatory movements. With muscular hypotension, the tongue is flaccid, lies motionless at the bottom of the oral cavity; 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 trying to speak, muscle tone changes from low to increased.

Violations of sound pronunciation 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 (distortions of sounds), "blurring" of speech are observed. With more pronounced degrees of dysarthria, there are distortions, omissions, and replacements of sounds; speech becomes slow, inexpressive, slurred. General speech activity is markedly reduced. In the most severe cases, with complete paralysis of the speech-motor muscles, the motor realization of 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 disturbed. 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 in dysarthria, speech breathing is disturbed: exhalation is shortened, breathing at the moment of speech becomes rapid and intermittent. Voice disorders in dysarthria are characterized by its insufficient strength (a quiet, weak, fading voice), a change in timbre (deafness, nasalization), melodic intonation disorders (monotonity, absence or inexpressiveness of voice modulations).

Bulbar dysarthria

Bulbar dysarthria is characterized by areflexia, amimia, disorders of sucking, swallowing solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is indistinct and extremely simplified. All the variety of consonants is reduced to a single slotted sound; sounds are not differentiated from each other. Typical nasalization of the voice timbre, dysphonia or aphonia.

Pseudobulbar dysarthria

With pseudobulbar dysarthria, the nature of the disorders is determined by spastic paralysis and muscle hypertonicity. Most clearly, pseudobulbar paralysis is manifested in a violation of the movements of the tongue: attempts to raise the tip of the tongue up, take it to the sides, and hold it in a certain position cause great difficulties. With pseudobulbar dysarthria, it is difficult to switch from one articulatory position to another. Typically selective violation of voluntary movements, synkinesis (friendly movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is slurred, slurred, has a nasal connotation; 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 mimic and articulation. Hyperkinesias can occur at rest, but are usually exacerbated by attempts to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic side of speech; sometimes at patients involuntary guttural cries break out.

With subcortical dysarthria, the rate of speech may be disturbed by the type of bradilalia, takhilalia, or speech dysarthmia (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, resulting in a tremor of the tongue, jerky, chanted speech, and individual cries. Speech is slow and slurred; the pronunciation of front-lingual and labial sounds is most disturbed. With cerebellar dysarthria, ataxia is noted (unsteadiness of gait, imbalance, awkwardness of movements).

Cortical dysarthria

Cortical dysarthria in its speech manifestations resembles motor aphasia and is characterized by impaired voluntary articulatory motility. Disorders of speech breathing, voice, prosody in cortical dysarthria are absent. Taking into account the localization of lesions, kinesthetic post-central 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, speech understanding, and the use of language tools.

Complications

Due to the inarticulateness of speech in children with dysarthria, auditory differentiation of sounds and phonemic analysis and synthesis suffer for the second time. Difficulty and insufficiency of verbal communication can lead to unformed vocabulary and grammatical structure of speech. Therefore, in children with dysarthria, phonetic-phonemic (FFN) or general underdevelopment of speech (OHP) and related types of dysgraphia associated with them may be noted.

Diagnostics

Examination and subsequent management of patients with dysarthria is carried out by a neurologist (pediatric neurologist) and a speech therapist.

The scope of the neurological examination depends on the proposed clinical diagnosis. The most important diagnostic value is the data of electrophysiological studies (electroencephalography, electroneuromyography), transcranial magnetic stimulation, MRI of the brain, etc.
Logopedic examination for dysarthria includes an assessment of speech and non-speech disorders. Assessment of non-speech symptoms involves the study of the structure of the articulatory apparatus, the volume of articulatory movements, the state of mimic and speech muscles, and the nature of breathing. The speech therapist pays special attention to the anamnesis of speech development. As part of the diagnosis of oral speech in dysarthria, a study is made of the pronunciation side of speech (sound pronunciation, tempo, rhythm, prosodic, speech intelligibility); synchrony of articulation, breathing and voice formation; phonemic perception, the level of development of the lexical and grammatical structure of speech. In the process of diagnosing written speech, tasks are given for writing off the text and writing from dictation, reading passages and understanding what has been read.

Based on the results of the examination, 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, therapeutic 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 rehabilitation treatment: dolphin therapy, sensory therapy, isotherapy, sand therapy, etc.

On the speech therapy classes for the correction of dysarthria, the development is carried out:

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

The order of staging and automation of sounds is determined by the greatest availability of articulation patterns on this moment. The automation of sounds in dysarthria sometimes proceeds until the complete purity of their isolated pronunciation is achieved, and the process itself requires more time and perseverance 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. In case of violation of phonemic processes and the lexical and grammatical structure of speech, work is carried out on their development, prevention or correction of dysgraphia and dyslexia.

Forecast and prevention

Only early, systematic speech therapy work on the correction of dysarthria can give positive results. An important role in the success of the correctional and pedagogical influence is played by the therapy of the underlying disease, the diligence of the dysarthria patient himself and his close circle.

Under these conditions, almost complete normalization of the speech function can be expected in the case of erased dysarthria. Having mastered the skills of correct speech, such children can successfully learn in general education school, and the necessary speech therapy assistance is received in polyclinics or at school speech centers.

In severe forms of dysarthria, only an improvement in the state of speech function is possible. Important for the socialization and education of children with dysarthria is the continuity of various types of speech therapy institutions: kindergartens and schools for children with severe speech disorders, speech departments of neuropsychiatric hospitals; friendly work of a speech therapist, neurologist, psychoneurologist, masseur, specialist in physiotherapy exercises.

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 is to prevent neuroinfections, brain injuries, and toxic effects.