Modern scientific ideas about dysarthria. Modern ideas about erased dysarthria in preschool children 1 modern ideas about mild dysarthria
Speech therapy massage in the correction of dysarthria speech disorders in children of early and before school 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 of an alarming demographic situation in the country, characterized not only by a general decline in the birth rate, but also by an increase in the proportion of births of unhealthy, physiologically immature children. According to special studies, the proportion of healthy newborns has decreased in recent years from 48.3% to 26.5%-36.5%. Today, up to 80% of newborns are physiologically immature, over 86% have perinatal pathology of the central nervous system, the lack of timely correction of which leads to the development of persistent disorders in the future. 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 exposure to the fetus of harmful factors in the prenatal period, during childbirth and in the early stages after birth. The leading place in the perinatal pathology of the CNS is occupied by asphyxia and intracranial birth trauma, which most often affect the nervous system of an abnormally developing fetus. In clinical practice, the terms "perinatal CNS damage" and "perinatal encephalopathy (PEP)" are generally accepted.
Early brain damage in most cases later manifests itself in varying degrees of impaired development. Due to the fact that the immature brain suffers, the further pace of its maturation slows down. The order of inclusion of brain structures is violated as they mature into functional systems. PEP is a risk factor for the occurrence of deviations in the development of various functional systems in a child. In this case, various "lines of development" - motor, cognitive and speech - can be violated.
Despite the equal probability of damage to all parts of the nervous system, under the action of pathogenic factors on the developing brain, the motor analyzer suffers first and most of all. In children with perinatal cerebral pathology, gradually, as the brain matures, signs of damage or impaired development of various parts of the motor analyzer, mental and speech development. With age, in the absence of adequate medical and pedagogical assistance, developmental disorders gradually become fixed and a more complex pathology can form.
Violation of the motor, mental and speech development of children is a consequence of damage to the central nervous system of various origins. The same harmful factors affecting the brain during the period of its intensive development, in some cases cause only some delay in the formation of age-related functions, while in others they lead to pronounced developmental disorders (E.M. Mastyukova, L.T. Zhurba).
Studying the psychomotor development of children in the first years of life, L.T. Zhurba and E.M. Mastyukov identified different degrees of severity of neurological pathology: mild, moderate and severe.
Light degree:
hypertension syndrome, hydrocephalic syndrome, minimal brain dysfunction, hyperexcitability and hypoexcitability syndromes, mild neurological symptoms in the form of muscle tone disorders, tremor.
Average degree:
syndromes of movement disorders, episindrome (convulsive syndrome), cerebrosthenic syndrome.
Severe degree:
cerebral palsy, organic lesion of the central nervous system.
1 . Hypertension-hydrocephalic syndrome.
Hypertensive syndrome (increased intracranial pressure) in children is often combined with hydrocephalic, which is characterized by the expansion of the ventricles in the subarachnoid space as a result of the accumulation of excess amounts of cerebrospinal fluid. An increase in intracranial pressure in infants can be transient and permanent, hydrocephalus - compensated or subcompensated, which causes a wide range of clinical manifestations.
Neurological symptoms in hypertensive-hydrocephalic syndrome depend both on the severity of the syndrome and its progression, and on those changes in the brain that caused it. With hypertension, the behavior of children changes first of all. They become easily excitable, irritable, cry - sharp, piercing; sleep - superficial, children often wake up. With hydrocephalic syndrome, on the contrary, children are lethargic, drowsy. Loss of appetite, regurgitation, sometimes even vomiting can lead to weight loss.
The neuropsychic development of the child may not suffer, but in some cases it is delayed. The depth and nature of the delay in psychomotor development in hypertensive and hydrocephalic syndromes vary widely depending on the primary changes in the nervous system. With timely and effective correction of the primary process, both hypertensive and hydrocephalic syndromes, and mild developmental delay are compensated.
2. Syndrome of hyperexcitability.
The main manifestations of the hyperexcitability syndrome are restlessness, emotional lability, sleep disturbance, increased reflex excitability, and a tendency to a reduced threshold of convulsive readiness. There may not be a pronounced lag in psychomotor development in these children, but with a thorough examination, it is usually possible to note some minor deviations. For violation of psychomotor development in hyperexcitability syndrome, a lag in the formation of voluntary attention, differentiated motor and mental reactions is characteristic, which gives psychomotor development a kind of unevenness.
All motor, sensory and emotional reactions to external stimuli in a hyperexcitable child arise quickly after a short latent period and fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for any objects, capture them; quickly switch to objects. At the same time, manipulative research activity is not sufficiently expressed.
3. Syndrome of hypoexcitability.
The main manifestations of the syndrome are: low motor and mental activity of the child, which is always below his motor and intellectual capabilities; a high threshold and a long latent period for the occurrence of all reflex and voluntary reactions. The syndrome is often combined with muscle hypotension, delayed switching of nervous processes, emotional lethargy, low motivation, and weakness of willpower. Hypoexcitability can be expressed in varying degrees and manifest itself either episodically or persistently.
With the syndrome of hypoexcitability, the formation of positive emotional reactions is noted at a later date. This is manifested both when communicating with an adult, and in the spontaneous behavior of the child. In the state of wakefulness, the child remains lethargic, passive, orienting reactions occur mainly to strong stimuli. The reaction to novelty is sluggish, insufficient.
With hypodynamic syndrome, there may be a delay in psychomotor development. It is characterized by a disproportion in development, which manifests itself in all forms of sensory-motor behavior. 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, impaired manipulative, objective and gaming activities; in the predominance of either hyperdynamic or hypodynamic processes. Often there is also a secondary insufficiency of perception due to increased mental exhaustion. Characterized by dynamism, unevenness of the severity of clinical manifestations in the same child at different times. Clinical manifestations are often intensified by the end of the day due to adverse meteorological conditions. Features of delayed psychomotor development in this syndrome depend on the predominance of hypo- or hyperexcitability processes.
6. Convulsive syndrome (episindrome).
Seizures may appear against the background of already existing neurological disorders and psychomotor retardation or occur as the first symptom indicating brain damage. The impact of convulsive syndrome on developmental delay depends on the age of the child, the level of psychomotor development before the onset of seizures, the presence of other neurological disorders, the nature of convulsive paroxysms, their frequency and duration. The younger the child's age at the onset of seizures, the more pronounced will be the delay in psychomotor development. If convulsions occurred in a healthy child, were episodic and short-term, then they themselves may not have a significant 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 motor activity. If the syndrome of muscular hypotension is not pronounced and is not combined with other neurological disorders, it either does not affect the age development of the child, or causes a delay in motor development, more often in the second half of life. The lag is uneven, more complex motor functions are delayed, requiring the coordinated activity of many muscle groups for their implementation. So, if you plant a child of 9 months, he sits, but he cannot sit down on his own. Such children later begin to walk, and the period of walking with support is delayed for a long time.
Movement disorder syndrome may be accompanied by muscular dystonia changing character of muscle tone). At rest, 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 disorders in the articulatory muscles (as well as in the skeletal muscles) is often noted; in individual articulatory muscles, the tone can change in different ways. For example, spasticity may be noted in the lingual muscles, and hypotension in the facial and labial muscles. In all cases, there is a certain correspondence between violations of tone in the articulatory and skeletal muscles.
Impaired mobility of the articulatory muscles. Limited mobility of the muscles of the articulatory apparatus is the main manifestation of paresis of these muscles. Insufficient mobility of the articulatory muscles of the tongue and lips causes disturbances in sound pronunciation. With damage to the muscles of the lips, the pronunciation of both vowels and consonants suffers. Articulation as a whole is disturbed. Sound pronunciation is especially grossly impaired with a sharp restriction of the mobility of the muscles of the tongue.
The degree of impaired mobility of the articulatory muscles can be different - from complete impossibility to a slight decrease in the volume and amplitude of articulatory movements of the tongue and lips. In this case, the most subtle and differentiated movements are violated first of all (primarily raising the tongue up).
Specific disorders of sound pronunciation:
- persistent character violations of sound pronunciation, the particular difficulty of overcoming them;
Specific difficulties in automating sounds (the automation process takes more time than with dyslalia). With the untimely completion of speech therapy classes, the acquired speech skills often disintegrate;
The pronunciation of not only consonants, but also vowels is impaired (average or reduction of vowels);
The predominance of interdental and lateral pronunciation of whistling [ from], [h], [c]and hissing [ w], [well], [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 lexical grammatical structure 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, case endings, categories of numbers are not assimilated; there are difficulties in coordination, management.
The severity (severity) of dysarthria does not depend on the number of impaired components of the speech functional system. For example, when erased (mild) dysarthria all components of speech (phonetic, phonemic and lexico-grammatical structure) can be violated, and when moderate to severe dysarthria only the phonetic structure of speech can be violated.
- 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.
In 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 study in a general education school, and receive the necessary speech therapy assistance in clinics 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.
When analyzing the function of the motor sphere, special attention is paid to those that make it difficult learning activities on the stability of the child in upright movement, the possibilities of walking in the state of movement of the hand. The greatest attention should be paid to the freedom or stiffness of movements, the number of lethargy, or vice versa - convulsive hand movements with big amount synkinesis of accompanying movements. Reproduce the position of the hand in space. For this, the task is given to reproduce the proposed posture of the hand, posture of the fingers ...
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INTRODUCTION .................................................. ................................................. ...........3
1 MODERN SCIENTIFIC VIEW OF DYSARTRIA AND ITS CORRECTION .................................................................. ................................................. ................6
1.1 Determination of the cause, form and structure of the defect ..............................................................6
1.2 Types of correctional work in dysarthria .............................................................. ...19
conclusion................................................. ................................................. ..thirty
LIST OF USED LITERATURE.................................................................32
APPENDIX................................................. ................................................. ..34
Introduction
The relevance of research. From year to year there is an increase in the number of children with various speech disorders. Speech is not an innate ability, but develops in the process of ontogenesis (individual development of the organism from the moment of its inception to the end of life) in parallel with the physical and mental development of the child and serves as an indicator of its overall development. A full-fledged harmonious development of a child is impossible without educating him in correct speech. Such speech should be not only correctly designed in terms of word selection (dictionary), grammar (word formation, inflection), but clear and flawless in terms of sound pronunciation and sound-syllabic content of words.
The formation of speech is one of the main characteristics of the overall development of the child. Normally developing children have good abilities to master their native language. Speech becomes an important means of communication between the child and the outside world, the most perfect form of communication that is unique to man.
Since speech is a special higher mental function that is provided by the brain, any deviations in its development should be noticed in time. For the normal formation of speech, it is necessary that the cerebral cortex reaches a certain maturity, the articulatory apparatus is formed, and hearing is preserved. Another indispensable condition is a full-fledged language environment from the first days of a child's life.
A fairly common severe speech disorder among preschool children is dysarthria. It is often combined with other complex speech disorders (stuttering, phonetic-phonemic speech disorder (FFNR), general speech underdevelopment (OHP) and others). This speech pathology manifests itself in defects in the phonemic and prosodic components of the speech functional system of the native language and occurs as a result of a microorganic lesion of the brain, which leads to a violation of the innervation of the articulatory apparatus, a violation of the muscle tone of the speech and facial muscles.
"Dysarthria" - a Latin term, translated means "violation of articulate speech - pronunciation. Violation of sound pronunciation in dysarthria manifests itself to varying degrees and depends on the nature and severity of the damage to the central nervous system. In mild cases, there are individual distortions in the pronunciation of sounds, "blurred speech" , in heavier ones there are distortions, and replacements, and omissions of sounds.The tempo, expressiveness, modulation suffer, in general, the pronunciation becomes incomprehensible.
In children, the frequency of dysarthria is primarily associated with the frequency of perinatal pathology (damage to the nervous system of the fetus and newborn). More often, dysarthria is observed in cerebral palsy, according to various authors, from 6.5 to 85 percent.
There is a relationship between the severity and nature of the lesion of the motor sphere, the frequency and severity of dysarthria. In the most severe forms of cerebral palsy, when there is damage to the upper and lower extremities and the child remains practically motionless (double hemiplegia), dysarthria (anarthria are observed in almost all children). A relationship was noted between the severity of the upper limb lesion and the lesion of the speech muscles.
On the present stage the problem of childhood dysarthria is being intensively developed in clinical, neurolinguistic, psychological and pedagogical directions.
The object of the study is the development of speech in children with dysarthria.
The subject of the study is the system of speech therapy work on the correction of dysarthria.
The aim of the study is to study and characterize the methods of speech therapy for the correction of dysarthria.
Research objectives:
1. Determine the causes, forms and structure of the defect.
2. Describe the types of correctional work in dysarthria.
Methodological and theoretical basis studies were the provisions:
General and special psychology about unity general patterns development of normal and abnormal children (Vygotsky L.S., Luria A.R.),
On a systematic approach to the analysis of speech disorders (Levina R.E. Lubovsky V.I)
Works by Filicheva T.B., Chirkina G.V., N.A. Cheveleva, Tkachenko T.A., dedicated to the upbringing and education of children with FFNR.
During the work, we used the following research methods: analysis of psychological, pedagogical and methodological literature on the research problem; study of medical and pedagogical documentation; qualitative analysis of the obtained data.
Work structure. The work consists of an introduction, one section divided into two subsections, a conclusion, a list of references, which includes 22 sources, applications. The main text of the work is presented on 30 pages.
1 MODERN SCIENTIFIC VIEW OF DYSARTRIA AND ITS CORRECTION
1.1 Determination of the cause, form and structure of the defect
Dysarthria is a violation of pronunciation due to insufficient innervation of the speech apparatus with lesions of the posterior frontal and subcortical regions of the brain. The leading defect in dysarthria is a violation of sound pronunciation and the prosodic side of speech, associated with an organic lesion of the central and peripheral nervous system. 1 .
The classification of dysarthria is based on the principles of localization, the syndromological approach, the degree of speech understanding for others 2 .
Based on the syndromic approach, the following forms of dysarthria are distinguished: spastic-paretic; spastic-regid; spastic-hyperkinetic; spastic-atactic; atactico-hyperkinetic 3 . This approach is partly due to the more common brain damage in children with cerebral palsy and, in connection with this, the predominance of its complicated forms.
The classification of dysarthria according to the degree of intelligibility of speech for others was proposed by the French neuropathologist G. Tardieu in accordance with children with cerebral palsy. The author identified four degrees of severity of speech disorders in such children.:
1. The first is a mild degree, when sound pronunciation disorders are detected only by a specialist during the examination.
2. The second - a violation of sound pronunciation is noticeable to everyone, but speech is understandable to others.
3. Third - speech is understandable only to close people and partially to others.
4. The fourth is severe, lack of speech or speech is almost incomprehensible even to the relatives of the child (anarthria) 4 .
Anarthria refers to the complete or partial inability to pronounce sound due to paralysis of speech motor muscles. 5 .
The main signs (symptoms) of dysarthria are defects in sound pronunciation and voice, combined with a violation of speech, primarily articulation, motor skills and speech breathing. With dysarthria, in comparison with dyslalia, a violation of the pronunciation of both consonants and vowels is possible 6 .
Depending on the type of violations, all defects in sound pronunciation in dysarthria are divided into:
Anthropophonic (sound distortion);
Phonological (lack of sound, replacement, undifferentiated pronunciation, mixing) 7 .
For all forms of dysarthria, articulatory motility disorders are characteristic, which manifest themselves in a number of ways.
The following forms of violation of muscle tone in the articulatory muscles are distinguished: elasticity of the articulatory muscles - a constant increase in tone in the muscles of the tongue, lips, in the muscles of the face and neck.
With a pronounced increase in muscle tone, the tongue is tense, pulled back, its back is curved, raised up, the tip of the tongue is not expressed. The tense back of the tongue is raised to the hard palate, which helps to soften consonant sounds. Therefore, a feature of articulation with the elasticity of the muscles of the tongue is palatalization, which can contribute to phonemic underdevelopment 8 .
An increase in muscle tone of the circular muscle of the mouth leads to spastic tension of the lips, tight closing of the mouth.
The next type of muscle tone disorder is hypotension. At the same time, the tongue is thin, flattened in the oral cavity, the lips are flaccid, there is no possibility for them to close tightly. Because of this, the mouth is usually half open, hypersalivation is pronounced.
A feature of articulation in hypotension is nasalization, when the hypotension of the muscles of the soft palate prevents sufficient movement of the palatine curtain up and pressing it against the back wall of the pharynx. The airflow exits through the nose, and the airflow that exits through the mouth is extremely weak. The presence of violent movements and oral synkenesis in the articulatory muscles is a common sign of dysarthria. 9 .
Violation of articulatory motility in combination with each other constitutes the first important syndrome of dysarthria - the syndrome of articulatory disorders.
With dysarthria, speech breathing is disturbed due to a violation of the innervation of the respiratory muscles. The rhythm of breathing is not regulated by the content of speech, at the moment of speech it is usually fast, after the pronunciation of individual syllables or words, the child takes superficial convulsive breaths, the active exhalation is reduced and passes more often through the nose, despite the constantly half-open oral cavity 10 .
The second syndrome of dysarthria is a syndrome of impaired speech breathing. The next characteristic feature of dysarthria is a violation of the voice and melodic intonation disorders.
Thus, the main symptoms of dysarthria - a violation of sound pronunciation and the prosodic side of speech - are determined by the nature and severity of manifestations of articulatory, respiratory and voice disorders. There are also non-speech disorders. These are manifestations of the bulbar and pseudobulbar syndrome in the form of disorders of sucking, swallowing, chewing physiological breathing in combination with a violation of general motor skills and especially fine, differentiated motor skills of the fingers. 11 .
The diagnosis of "dysarthria" is made on the basis of the specifics of linguistic and non-linguistic disorders.
Let us characterize in more detail the various forms of dysarthria.
Cortical dysarthria is a group of motor speech disorders of various pathogenesis associated with local damage to the cerebral cortex.
The first variant of cortical dysarthria is due to a unilateral or, more often, bilateral lesion of the lower anterior central gyrus. In these cases, selective central paresis of the muscles of the articulatory apparatus (usually the tongue) occurs. At the same time, the pronunciation of consonants is violated, which are formed with the tip of the tongue raised and slightly bent upwards ("Sh", "Zh", "R"); difficulties in pronouncing consonants, which are formed when the tip of the tongue approaches or connects with the upper teeth or alveoli ("L") 12 .
The second option is associated with insufficiency of kinesthetic praxis, which is observed with unilateral lesions of the cortex of the dominant hemisphere (left) in the lower post-central cortex. In these cases, the pronunciation of consonants suffers, especially hissing and Africans. The search for the desired articulation mode during speech slows down its pace and breaks the smoothness 13 .
The third option is associated with the insufficiency of dynamic kinesthetic praxis, this is observed with unilateral lesions of the cortex of the dominant hemisphere, in the lower parts of the premotor areas of the cortex. At the same time, the pronunciation of complex Afrikats becomes difficult, which can break up into its constituent parts, there are replacements of slotted sounds with closing ones ("З" - "Д"). Omissions of sounds at the junction of consonants, sometimes with selective muffled voiced, closing consonants. Speech is slow, tense 14 .
Pseudobulbar dysarthria occurs with bilateral damage to the motor cortical-nuclear pathways from the cerebral cortex to the nuclei of the cranial nerves of the trunk. Pseudobulbar dysarthria is characterized by an increase in muscle tone in the articulatory muscles according to the type of elasticity - a spastic form of dysarthria 15 .
Less commonly, against the background of limiting the volume of voluntary movements, there is a slight increase in muscle tone in individual muscle groups or a decrease in muscle tone - a paretic form of pseudobulbar dysarthria. In both forms, there is a limitation of the active actions of the muscles of the articulatory apparatus, and in severe cases, their almost complete absence. The tongue with the corresponding form of dysarthria is tense, pulled back, the back is rounded and closes the entrance to the pharynx, the tip of the tongue is unexpressed. Especially difficult is the movement of the extended tongue up, bending its tip to the nose 16 .
In all cases, with pseudobulbar dysarthria, the most complex and differentiated arbitrary articulatory movements are violated in the first place. Reflex movements are usually preserved. So, for example, with limited voluntary movements of the tongue, the child licks his lips while eating, finding it difficult to pronounce voiced ones, the child pronounces them when he cries, coughs loudly, and laughs.
With this form of dysarthria, characteristic disturbances in sound pronunciation, selective difficulties in pronouncing the most complex and differentiated articulatory sounds ("P", "L", "Sh", "Zh", "Ch", "Sh") are manifested. The sound "P" loses its vibrational character, sonority, is often replaced by a slotted sound 17 .
Thus, in pseudobulbar dysarthria, as in cortical dysarthria, the pronunciation of the most complex anterior lingual sounds is disturbed. But, unlike the latter, the violation is more common, combined with a distortion of pronunciation and other groups of sounds, disorders of breathing, voice, intonation-melodic side of speech, often salivation.
With paretic pseudobulbar dysarthria, the pronunciation of closure, labial sounds that require sufficient muscle tension, especially bilabial ("P", "B", "M") linguistic-alveolar, as well as a number of vowel sounds ("I", "And", " IN "). There is a nasal tone of voice.
Bulbar dysarthria is a symptomatic complex of motor speech disorders that develop as a result of damage to the nuclei or peripheral parts (7th, 9th, 10th, 12th pairs of cranial nerves). With bilateral lesions, the violation of sound pronunciation is most pronounced. The pronunciation of all labial sounds is grossly distorted by the type of their approach to a single deaf fricative labial sound. All closure consonants also approach fricative consonants, and the anterior lingual consonants approach a single deaf flat-slit sound, voiced consonants are muffled. These speech disorders are accompanied by nasalization 18 .
Distinguishing bulbar dysarthria from paretic pseudobulbar is carried out according to the following criteria:
The nature of paresis or paralysis of the speech muscles (with bulbar - peripheral, with pseudobulbar - central);
The nature of the violation of speech motility (in case of bulbar, voluntary and involuntary movements are violated, in case of pseudobulbar - mainly arbitrary);
The nature of the lesion of articulatory motility (with bulbar - diffuse, with pseudobulbar - selective with a violation of fine differentiated articulatory movements);
The specifics of sound pronunciation disorders (with bulbar dysarthria - the articulation of vowels approaches a neutral sound, with pseudobulbar dysarthria it is removed back, with bulbar - vowels and calls are muffled, with pseudobulbar - along with muffled sounds, their voicing is observed)
With pseudobulbar dysarthria, even with the predominance of the paretic variant, elements of elasticity are noted in individual muscle groups. 19 .
The extrapyramidal system is important in the regulation of muscle tone, gradualness, strength and real estate of muscle contractions, provides automated, emotionally expressive execution of motor acts. Violation of sound pronunciation in extrapyramidal dysarthria is determined by:
Changes in muscle tone in the articulatory muscles;
The presence of obsessive movements-hyperkinesis;
Violation of propreceptive apherenation from the tongue muscles;
Violations of the emotional-motor innervation 20 .
A feature of extrapyramidal dysarthria is the absence of stable and uniform disturbances in sound pronunciation, as well as great difficulty in automating sounds. Extrapyramidal dysarthria is often combined with hearing loss of the type of sensorineural hearing loss.
With cerebellar dysarthria, the cerebellum and its connections with other parts of the central nervous system, as well as the fronto-cerebellar pathway, are affected. At the same time, the speech is slow, jerky, chanted, with a violation of the modulation of stress, attenuation of the voice towards the end of the phrase 21 .
Differentiated diagnosis of dysarthria is carried out in two directions:
Separation of dysarthria from dyslalia;
Separation of dysarthria from alalia.
Dissociation from dyslalia is carried out on the basis of the identification of three leading symptoms (syndromes of articulation, respiratory, voice disorders), taking into account the data of a neurological examination and the characteristics of the anamnesis.
Dissociation from alalia is carried out on the basis of the absence of primary violations of language operations, which is manifested in the features of the development of the lexical and grammatical side of the language 22 .
Examination of children with dysarthria disorders has a dual purpose:
1. This examination should distinguish between dysarthria and other disorders - stuttering, rhinolalia.
2. Help to more accurately determine the form of dysarthria with which it is necessary to work. The examination ends when the speech therapist can predict the results. The leading defect in dysarthria is movement disorders, therefore, a significant place in the examination program is given to the study of the motor and cultural-motor spheres. 23 .
To study the motor sphere, a speech therapist studies the child's performance of such tasks: running, walking, jumping on each leg alternately, throwing, in which the child stretches one leg and arm in one direction, in different (arm in one, leg in the other). These tasks make it possible to draw a conclusion about the structure of running, jumping, throwing, as well as the state of movements for switching 24 .
When analyzing the function of the motor sphere, special attention is paid to those that impede learning activity, to the stability of the child in standing upright, moving, walking, in the state of movement of the hand.
An analysis of the nature and speed of hand movement can reveal muscle paresis or a different increase in tone. The greatest attention should be paid to freedom or stiffness of movements, strength, lethargy, or vice versa - convulsive movement of the hand with a large number of synkinesis (accompanying movements).
We can observe especially rough movements of the compression (grasping) function:
The fingers are tense and half bent;
The fingers are bent into a fist;
Holding the ball only with the thumb and forefinger, the rest are bent;
The child takes and holds a pencil, a pen with the tips of all fingers or two 25 .
Analysis of motor-visual coordination allows to identify such violations:
Eye movements at random;
Eye movements in the opposite direction;
Eye movement at the speech therapist, a gaze typical of children who are unsure of themselves, helpless in independent activities 26 .
This indicates a violation of the motor act.
To study the state of the speech-motor sphere, 8 special tests are used (speech-motility, facial nerve, speech-lips-pharynx, etc.).
Gnosis and praxis constitute the non-speech sphere. The study of the non-verbal (non-speech) sphere includes an examination of the state of praxic and gnostic processes.
To study praxis, we use three tests:
1. Reproduce the position of the hand in space. If the right hand is in a state of at least slight paresis, the child is asked to reproduce postures in which the hand (hand) is either vertically, or horizontally, or at an angle. If there are no paresis, then he must perform these tasks with both hands at the same time.
2. Examination of the praxis of the posture. To do this, the task is given to reproduce the proposed posture of the hand (poses of fingers, hands, postures of Daktel) on both hands. When performing these tasks, attention is drawn to how long the child is looking for a position, conducts a number of additional tests before finding the right one.
3. When examining object-symbolic praxis, we study whether the child is able to find a whole range of movements to perform a meaningful action. This assignment comes in two versions:
Complete the proposed task in a real subject situation (fasten buttons, lace up shoes, cut out a picture);
Complete the task in an imaginary situation (pour tea, embroider a flower, play the piano). The child must obey the imaginary situation 27 .
To examine oral (speech) praxis, we use the following tasks:
Tests for maintaining a deep sense of the tongue (tongue with a napkin);
Tests for the reproduction of a number of movements demonstrated to the child (any of the exercises for the development of motor skills);
Perform the same movements, but only according to verbal instructions;
Recreate a number of meaningful symbolic acts (whistle, knock, etc.);
Samples for performing rhythms, which the speech therapist taps with a finger or pencil;
Tests for switching movements (fist-rib-palm), Ozer test - squeezing one hand and straightening the other 28 .
Examination of gnostic processes includes tests for the study of:
Optical (visual) gnosis;
Spatial syntheses;
Successive syntheses (successive series of determining which subject);
Simultaneous synthesis (simultaneously, embrace at once, generalize) 29 .
Three tasks are used to study optical (visual) gnosis:
Presentation of single geometric figures quickly in 4-6 geometric figures. The child must name them;
Presentation of images of objects that the child must find among a group of drawings (find 5 objects among 30 others, depicted in dotted lines, superimposed on each other, on the same background, etc.);
Presentation of plot drawings, united into one whole (by meaning). Start with the simplest situations (for example, children are sledding).
Spatial gnosis includes such tests:
Observation of the orientation of the child in space;
Copying a series of geometric shapes, the elements of which have the appropriate spatial orientation (with prepositions: a cross over a circle, under a circle, a circle between crosses, etc.;
Head's test (the child in front of the speech therapist repeats the movements that the speech therapist performs; reproduces mirror movements);
Image of schemes of spatial relations (from the classroom, to the dining room);
Distinguishing symbolically designated spatial relationships (left and right sides of your body, sitting opposite the speech therapist);
Distinguishing named fingers (little finger, index finger, etc.) 30 .
To examine successive syntheses, a test is given for the reproduction and retention of rhythms:
They give a series of rhythmic beats (2 or 3), for example, 1 short, 2 long. The child must say that there was 1 short, two long;
In addition to assessing the nature of the impacts, it is proposed to evaluate the number of impacts (this is a preparation for sound analysis);
The child is invited to practically reproduce the given rhythm.
The study of praxis and gnosis allows the speech therapist to get an idea of the existing violations in the child even before examining the state of speech. The results of the fulfillment of these tasks form the basis for the study and correction of speech activity.
The examination of speech is aimed at studying disorders of sound pronunciation. These disorders are studied from different perspectives:
1. From the position of structural phonetics:
Acoustic data are studied (characteristics of the voice, its height, strength, mobility, ability to modulate);
The prosodic organization of the sound stream (rhythm, tempo, melody) is being studied;
intonation possibilities;
Articulatory data of the process of sound pronunciation (characteristics of articulatory movements, their strength, accuracy, smoothness, speed, synchronism, switching symmetry);
Determination of the nature of the pronunciation of a defective sound (pass, replacement, shift).
2. From the standpoint of structural linguistics, the features of writing and reading are studied.
3. From the position of psycholinguistics:
The features of understanding the semantic meaning of the sound stream are studied (as I read - sad, cheerful, surprised, not in content);
We study the features of phonemic perception of speech and differentiation of sounds;
Features of the child's own readiness for improvement and correction of inclinations;
Features of the child's unconscious and conscious control of language 31 .
In dysarthria, the study of speech development of the processes of sound pronunciation (pronunciation, breathing, voice, articulation) is the main one, and these violations are leading.
1.2 Types of correctional work for dysarthria
In speech therapy correctional work with dysarthria, special attention is paid to the state of speech development of children in the field of vocabulary and grammar, as well as to the features of the communicative function of speech. In school-age children, the state of written speech is taken into account.
Positive results of speech therapy work are achieved subject to the following principles:
Phased interconnected formation of all components of speech;
A systematic approach to the analysis of a speech defect;
Regulation of the mental activity of children through the development of the communicative and generalizing functions of speech 32 .
In the process of systematic and in most cases long-term exercises, the gradual normalization of the motor skills of the articulation apparatus, the development of articulation movements, the formation of the ability to consciously switch the moving organs of articulation from one movement to another at a given pace, overcoming monotony and violations of the tempo of speech, the full development of phonemic perception are carried out.
This prepares the basis for the development and correction of the sound side of speech and forms the prerequisites for mastering the skills of oral and written speech.
Speech therapy work must be started at a younger preschool age, thereby creating conditions for the full development of more complex aspects of speech activity and optimal social adaptation. 33 .
Great importance It also has a combination of speech therapy and therapeutic measures.
Treatment of children with dysarthric speech disorders is carried out taking into account the natural ontogenesis of motor skills, which consists of two phases.
1. First phase. Morphological maturation of the central nervous elements: myelination of the conducting pathways takes place, which ends mainly before two or three years, and in children with cerebral palsy it is years late. Therefore, the neuropathologist begins the treatment of the child as early as possible. During this period, the child is given medications that promote myelination, improve metabolism - nerabol, vitamin Wb, ATP and others. Restorative, desensitizing, sedative, dehydration therapy, sanitation of the nasopharynx, etc. are necessary preparatory measures for the following speech therapy classes.
2. Second phase. Ontogenesis - functional maturation and adjustment of the work of coordination levels. In this phase, the development of speech motor skills is not always progressive - in some periods, temporary stops and even regressions may occur. In this phase, the combination of medication and speech therapy is especially important. Until now, there are no means that would restore a completely and completely dead cell, its axon, would normalize the tone and conduction in the neuromuscular apparatus for a long time. However, there is a large arsenal of drugs that affect acetylcholine metabolism in any of its links, on the biochemical and physiological processes of the central nervous system. All this creates positive conditions for the recovery, compensatory process in dysarthria disorders. 34 .
Physiotherapy plays an important role in the treatment of dysarthria disorders. Acting on unconditioned stimuli, physical factors cause changes in the functional state of various parts of the nervous system, contribute to the restoration of disturbed physiological balance, improve blood circulation conditions, and tissue metabolism processes.
Only complex medical and pedagogical measures can provide children with dysarthria with a real opportunity for verbal communication.
The main directions of work with children suffering from dysarthria:
1. Learning the correct sound pronunciation, i.e. development of articulatory motility, speech breathing, staging and fixing sounds in speech.
3. Normalization of the prosodic side of speech, that is, overcoming disorders of rhythm, melody and intonational side of speech.
4. Correction of manifestations of general underdevelopment of speech. Overcoming OHP in children with dysarthria is carried out in the process of training and education in a special kindergarten 35 .
The primary task of correcting the sound pronunciation of dysarthric children is to achieve differentiated pronunciation. Since the main reason for the shortcomings of sound pronunciation is the complete or partial immobility of the organs of the speech apparatus, the main attention of the speech therapist should be directed to the development of the mobility of the organs of the articulatory apparatus.
To improve the innervation of the facial muscles, overcome the mimicry of the face and the immobility of the articulatory apparatus, a massage of the entire facial muscles is performed: a light pat on the cheeks with the palm of your hand, light pinching movements with your fingers along the edge of the lower jaw from the outside, along the hyoid and pharyngeal-palatine muscles. Facial stroking is also used. In addition, systematic lip massage, stroking movements on the lips, slight pinching of closed lips, mechanical convergence of the lips in the horizontal and vertical directions, circular stroking movements in the corners of the mouth are used. The soft palate is massaged with the inside of the thumb or index finger from front to back. Massage duration - no more than two minutes 36 .
The child's voluntary movements must be reinforced by systematic repetition. The child observes the movements of the organs of articulation in himself (in the mirror) and in the speech therapist, listens to the sound of a groan (for the sound "M"), the sound of a cough (for the sound "K"). The movements are performed first together with a speech therapist, later after the demonstration - according to the model. This ensures a gradual transition to independent execution. The passive gymnastics method is most effective for children with subcortical and pseudobulbar dysarthria. With the help of an adult or with mechanical help, the child reproduces the necessary position of the organs of articulation and thereby more clearly feels the movements of the tongue, lips, etc. Gradually, an opportunity is created to perform active independent movements.
Mechanical assistance is used (a speech therapist's hand, special probes and spatulas) with passive gymnastics of the articulation organs. It is possible to carry out exercises with the help of a child's hand (with control in front of a mirror). Movements should be performed slowly, smoothly, rhythmically, with a gradual increase in amplitude. For example, a child opens his mouth wider: for this, the thumb of the right hand, thoroughly washed, is placed on the lower teeth, and four fingers under the chin. The tongue protrudes as far as possible: for this, the tip of the tongue is covered with a napkin and the child sticks it forward 37 .
As passive movements become less difficult, it is possible to reduce mechanical assistance and move on to holding the achieved position.
During this period, the elimination of salivation begins. The child is asked to chew with the head slightly tilted back.
The next stage is active gymnastics of the articulatory apparatus. Approximate types of exercises 38 :
1. For the lower jaw - opening and closing the mouth (with snapping teeth); keeping the mouth open (under the account).
In the process of performing these exercises, it is necessary to ensure that the mouth is closed according to middle line. You can use mechanical assistance - light pressure on the crown of the head and under the jaw.
It is also used to pull out a gauze napkin bitten with teeth by hand. In addition to control with a mirror, the child should feel the movement of the head of the lower jaw in the joint with his hands.
2. To develop lip movements:
Bared teeth, protruding lips with a proboscis. To stretch the lips with a proboscis, smacking is used. A finger or lollipop is inserted and later pulled out. If there is enough tight coverage of the lips and suction movements of the cheeks, a clicking sound is produced. Reducing the size of the lollipop creates more tension in the muscles of the lips. These exercises are repeated many times;
After these exercises, you can move on to holding tubes or straws for cocktails of various diameters or probes with your lips (the speech therapist tries to pull out the tube, and the child holds it). To practice this exercise, use your fingers to press the corners of the lips;
Pulling closed lips, returning to the starting position;
Lip stretching - stretching in a smile with open jaws;
Pulling the upper lip along with the tongue (the tongue pushes the upper lip);
Retraction of the lips inside the mouth with tight pressing to the teeth;
Biting the lower lip with the upper teeth;
Retraction of the lower lip under the upper;
Circular movements of the lips extended by the proboscis.
3. Exercises aimed at developing the mobility of the tongue, in difficult cases, begin with an unconditional reflex level.
In order to cause the tongue to move towards the lips, a lollipop is introduced into the child's mouth or the lower lip is smeared with jam or a piece of sticky paper is attached to it. To cause a contraction of the tongue, you need to put a piece of sweet on the tip of the tongue or touch it with a spatula.
To develop tongue movements to the sides, a piece of sugar is placed between the cheek and teeth or smeared with a sweet corner of the mouth. To raise the tip of the tongue, it is useful to touch the caramel to the upper lip.
These exercises gradually prepare the active movements of the tongue:
Movement back and forth. If the tongue is tense, it is recommended to lightly pat it with a spatula, invite the child to blow on it. The last technique is used only when a correctly directed air stream is produced;
Light biting of the protruding tongue, while it is necessary to ensure that it extends along the midline;
Movement to the right and left, the tip of the tongue should reach the corners of the mouth. With unilateral paresis, the paretic side of the tongue is adjusted more. This movement is difficult, so it is advisable to use mechanical assistance;
Elevation of the tongue behind the upper teeth. This movement is done gradually. The smacking of the lips is combined with the protrusion of the tongue, so that a click of the tongue can be obtained if it is absent. Then the tongue is pushed between the lips (interlabial position), the child snaps it.
With the help of the speech therapist's hand, the lips are moved away (interdental position of the tongue), it turns out that the back of the tongue clicks on the edges of the upper teeth. When the named movement is received, the speech therapist, placing the spatula horizontally, on the edge under the tongue, pushes the raised tip of the tongue deep into the mouth. This is how the snapping of the tongue is developed at the alveoli of the upper teeth. Mastering this skill takes time and patience. To enhance the tactile sensation during articulatory gymnastics, exercises with resistance are used.
4. Simultaneously with these exercises, the development of speech breathing and voice is carried out.
The purpose of breathing exercises is to increase the vital capacity of the lungs, improve chest mobility, and teach the child to rationally use exhalation during speech.
The speech therapist should show on himself the correct, short and deep breath and a long gradual exhalation. To control diaphragmatic inspiration, place a hand on the abdomen in the area of the diaphragm. To develop an extended exhalation, exercises such as blowing out candles, inflating rubber toys, etc. are used, which are usually used in working with dysarthric children. 39 .
When the correct oral exhalation is formed, proceed to voice exercises. At first, they are carried out on vowel sounds, later, with the appearance of consonant sounds in speech, complex exercises are also introduced. They work out an elongated and short sound, raising and lowering the voice. A large role in the development of voice and speech breathing belongs to music lessons.
The first group of sounds that need to be put and fixed in the language, the lightest in articulation, are far from each other acoustically. These are the sounds: a, p, c, m, k, i, n, x, c, c, t, s, l. These sounds, as the most simple, can be worked out to the norm. At the same time, work is being done on these phonemes to develop phonemic perception and sound analysis skills (singling out a sound from a number of others, from syllables, in simple words, etc.) 40 .
In severe cases of articulation disorders, the production of these sounds requires special assistance. Using vision, tactile-vibrational sensations, a speech therapist explains and helps the child perform the movements necessary to pronounce a particular sound and feel them kinesthetically. For example, with anarthria, a speech therapist to create the articulation of the sound "B" brings the child's lips together with his hand.
Significant help is given by the pronunciation of this sound by a speech therapist at the time the child articulates this sound, since in this case, insufficiently clear kinesthetic impressions from personal inferior pronunciation are supplemented by the child due to the perception of someone else's speech 41 .
Working on the production of sounds, a speech therapist must achieve at least an approximate pronunciation of them. At first, even a child's possession of an analogue of sound is extremely important for their distinction, since in this way a relationship is formed between articulatory and auditory images of sound. The quality of the analog and the degree of its proximity to normal sound are determined by the degree of damage to the articulatory apparatus 42 .
Depending on the individual characteristics of the child, the analogue includes a different number of articulation elements. Practicing each new sound, it is necessary to study its articulation features, highlight the main characteristic feature of articulation that distinguishes it from other sounds, compare it with other articulations.
Through systematic exercises, the transition from analogue to full-fledged sound is carried out. The speech therapist gradually increases the requirements for the clarity and correctness of the articulation of the sound being studied.
In addition to work on articulatory motor skills and the production of sounds, systematic work is underway to develop phonemic perception. Children are taught to distinguish vowels from a number of other vowels, to analyze the sound range of two or three consonants. As they study sounds, children learn to repeat various combinations of two or three syllables, name the sounds that make up a syllable, word, and identify their sequence. 43 .
After some time, children who pronounce a sound studied with varying degrees of closeness to the normal one, equally freely recognize it by ear, both in combinations and in words.
In the classes on sound pronunciation, frontal work is carried out, aimed at the development of the articulatory apparatus. The exercises used in this should be available to the entire group. In addition, breathing exercises are mandatory. Part of each sound pronunciation lesson is the repetition by children of already learned vowels and consonants, isolated in sound combinations. To check the assimilation of what has been passed, the speech therapist invites the children to describe (or show) the position of the articulation organs characteristic of a particular sound, and later pronounce it in isolation and in words. Sound exercises are carried out under the control of visual and tactile perception. As a speech exercise, children pronounce in chorus and individually accessible words, which consist of the necessary sounds, as well as sentences with these words. 44 .
During the initial period, children are significantly aligned in phonemic development, auditory perception improves and is significantly ahead of progress in articulation.
At this stage, exercises are also carried out to differentiate sounds, which are increasingly sharply opposed to each other by articulatory features:
Differentiation of oral and nasal sounds ("P" - "M");
Intragroup differentiation of nasal sounds ("M" - "H");
In the group of posterior lingual sounds, differentiation is "K" - "X";
Differentiation of vowels "A", "U", "I";
Differentiation of breakthrough and fricative sounds ("T" - "C") 45 .
In the process of these exercises, a base is created for the assimilation of all other sounds.
The next group of sounds to be studied are phonemes composed by articulation. These are voiced, hissing consonants, Africans and the sound "R". A sufficiently developed phonemic perception and some skills of sound analysis play a significant leading role in this period. Secondary deviations in auditory perception are overcome more successfully than pronunciation deficiencies.
In the second period, i.e. when studying other sounds, exercises for distinguishing sounds have less articulatory resistance. The pronunciation of such sounds as "R", "Sh", "Zh", Afrikat in most children is very inaccurate, but their distinction is much less difficult. Despite this, additional time is specially allotted for exercises in distinguishing and differentiating sounds. Thus, sound representations are formed in children based on a differentiated pronunciation of sounds, which reflects a certain period of their assimilation. Work is underway to differentiate the sounds "S" - "S", "Sh" - "Zh", "Ts" - "M", "M" - "H" and to differentiate in the group of iotized.
After the speech therapist makes sure that all children accurately distinguish the sound, can determine its place in a syllable, word, etc., he presents them with the corresponding letter (in the preparatory group for school).
From this point on, pronunciation correction has its purpose of refining the analog of the sound to normal. This problem is solved with the help of exercises for a clear pronunciation of sounds, carried out in group and individual classes.
Features of articulation, the quality of the analogue, its proximity to the correctly pronounced sound are recorded in individual plans, based on which the speech therapist plans the content of individual lessons. It is necessary to repeatedly return to the same sounds in order to clarify them as much as possible. 46 .
As a result of the combination of intensive work on the development of correct sound pronunciation with work on the education of phonemic perception of sounds based on approximate sound pronunciation, phonemic readiness for the full assimilation of writing is created in children with dysarthria.
Early and properly organized speech therapy assistance in combination with appropriate educational measures (overcoming speech negativism, activating the compensatory capabilities of the child's body, his cognitive interests, etc.) makes it possible for a significant part of children with dysarthria to learn the general education school program.
CONCLUSION
From year to year there is an increase in the number of children with various speech disorders. Speech is not an innate ability, but develops in the process of ontogenesis (individual development of the organism from the moment of its inception to the end of life) in parallel with the physical and mental development of the child and serves as an indicator of its overall development. A full-fledged harmonious development of a child is impossible without educating him in correct speech. Such speech should be not only correctly designed in terms of word selection (dictionary), grammar (word formation, inflection), but clear and flawless in terms of sound pronunciation and sound-syllabic content of words.
Dysarthria is a speech disorder that occurs as a result of damage to the muscles of the speech apparatus: soft palate, larynx, lips. Acute dysarthria can develop as a result of a violation of the innervation of the articulation apparatus. With dysarthria, speech becomes unclear, undivided into semantic segments, with a nasal tone.
Speech therapy work with children with dysarthria is based on knowledge of the structure of a speech defect in various forms of dysarthria, the mechanisms of violations of general and speech motor skills, and taking into account the personal characteristics of children.
In working with children suffering from dysarthria, the following areas are used:
1. Learning the correct sound pronunciation, i.e. development of articulatory motility, speech breathing, staging and fixing sounds in speech.
2. Development of phonemic perception, formation of sound analysis skills.
3. Normalization of the prosodic side of speech, i.e. overcoming disorders of rhythm, melody and intonation of speech.
4. Correction of manifestations of general underdevelopment of speech. Overcoming OHP in children with dysarthria is carried out in the process of education and upbringing in a special kindergarten.
The task of a speech therapist is to convince the child together with the parents that speech can be corrected, that you can help the baby become like everyone else. It is important to interest the child so that he himself wants to participate in the process of speech correction. And for this, classes should not be boring lessons, but an interesting game.
LIST OF USED LITERATURE
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- Belobrykina O.A. Speech and communication. A guide for parents and teachers. - Yaroslavl: Academy of Development, 2008. - 240 p.
- Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- 144 p.
- Volkova G.A. Methods of psychological and logopedic examination of children with speech disorders. Issues of differential diagnosis. - St. Petersburg: Peter, 2010. - 548 p.
- Vygotsky L.S. Thinking and speech. – M.: Labyrinth, 2010. – 569 p.
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- Games in speech therapy work with children: Book for speech therapists. / Ed. Comp. IN AND. Selivestrov. - M.: Enlightenment, 2007. - 142 p.
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- Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. - M .: Humanit. ed. Center VLADOS, 2008. - 680 p.
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APPENDIX
A set of exercises for the correction of dysarthria
Breathing exercises.
"Cat". Legs shoulder width apart. Remember the cat that sneaks up on the sparrow. Repeat her movements - crouching a little, turn to the right, then to the left. Transfer the weight of the body to the right leg, then to the left. The direction in which you turned. And sniff the air noisily on the right, on the left, at the pace of steps.
"Pump". Hold a rolled-up newspaper or a stick in your hands like a pump handle and think you are inflating a car tire. Inhale - at the extreme point of the slope. The slope is over - the breath is over. Do not pull it, unbending, and do not unbend to the end. The tire must be quickly pumped up and go further. Repeat the breaths at the same time as the bends often, rhythmically and easily. Don't raise your head. Look down at an imaginary pump. Inhale, like an injection, instantaneous. Of all our breath movements, this is the most effective.
"Hug your shoulders." Raise your arms to shoulder level. Bend them at the elbows. Turn your palms towards you and place them in front of your chest, just below your neck. Throw your hands towards each other so that the left hugs the right shoulder, and the right hugs the left armpit, that is, so that the arms run parallel to each other. pace of steps. Simultaneously with each throw, when the hands are closest together, repeat short noisy breaths. Think: "The shoulders help the air." Keep your hands away from your body. They are nearby. Do not bend your elbows.
"Big Pendulum". This movement is continuous, similar to a pendulum: "pump" - "hug your shoulders", "pump" - "hug your shoulders". pace of steps. Tilt forward, arms reaching for the ground - inhale, lean back, arms hugging shoulders - also inhale. Forward - back, inhale, inhale, tick-tock, tick-tock, like a pendulum.
"Half squats". One leg in front, the other behind. Body weight on the front leg, back leg slightly touching the floor, as before the start. Perform a light, slightly noticeable squat, as if dancing in place, and at the same time with each squat, repeat the breath - short, light. Having mastered the movement, add simultaneous counter movements of the hands.
Exercises for the development of speech breathing:
Choose a comfortable position (lying, sitting, standing), put one hand on your stomach, the other on the side of the lower chest. Take a deep breath in through your nose (this pushes your belly forward and expands your lower chest, which is controlled by both hands). After inhalation, immediately make a free, smooth exhalation (the abdomen and lower chest take their previous position).
Take a short, calm breath through the nose, hold the air in the lungs for 2-3 seconds, then make a long, smooth exhalation through the mouth.
Take a short breath with your mouth open and on a smooth, long exhalation, say one of the vowels (a, o, u, and, uh, s).
Say several sounds smoothly on one exhalation: aaaaa - aaaaaooooooo - aaaaauuuuuu.
Count on one exhalation to 3-5 (one, two, three...), trying to gradually increase the count to 10-15. Watch for smooth exhalation.
Count down (ten, nine, eight...).
Ask the child to repeat proverbs, sayings, tongue twisters after you on one exhale. Be sure to follow the setup given in the first exercise.
A drop and a stone hollow.
Building with the right hand, breaking with the left.
Whoever lied yesterday will not be believed tomorrow.
On the bench outside the house, Toma sobbed all day.
Do not spit in the well - you will need water to drink.
There is grass in the yard, firewood on the grass: one firewood, two firewood - do not cut firewood on the grass of the yard.
Thirty-three Egorkas lived on a hillock near a hill: one Egorka, two Egorkas, three Egorkas...
Read Russian folk tale"Turnip" with the correct reproduction of inspiration during pauses.
Turnip.
Grandfather planted a turnip. A large turnip has grown.
Grandfather went to pick a turnip. Pulls - pulls, can not pull.
Grandpa called grandma. Grandmother for grandfather, grandfather for turnip, they pull - they pull, they cannot pull it out!
The grandmother called her granddaughter. Granddaughter for grandmother, grandmother for grandfather, grandfather for turnip, they pull - they pull, they cannot pull it out!
Granddaughter called Zhuchka. A bug for a granddaughter, a granddaughter for a grandmother, a grandmother for a grandfather, a grandfather for a turnip, they pull - they pull, they cannot pull it out!
Bug called the cat. A cat for a bug, a bug for a granddaughter, a granddaughter for a grandmother, a grandmother for a grandfather, a grandfather for a turnip, they pull - they pull, they cannot pull it out!
The cat called the mouse. A mouse for a cat, a cat for a bug, a bug for a granddaughter, a granddaughter for a grandmother, a grandmother for a grandfather, a grandfather for a turnip, they pull - they pull - they pulled a turnip!
The acquired skills can and should be consolidated and comprehensively applied in practice.
"Whose steamboat hums better?"
Take a glass vial about 7 cm high, with a neck diameter of 1-1.5 cm, or any other suitable object. Bring it to your lips and blow. "Listen to how the bubble hums. Like a real steamboat. Can you make a steamboat? I wonder whose steamboat will hum louder, yours or mine? And whose longer?" It should be remembered: for the bubble to buzz, the lower lip should lightly touch the edge of its neck. The air jet should be strong and come out in the middle. Just do not blow too long (more than 2-3 seconds), otherwise you will feel dizzy.
"Captains".
Dip paper boats into a basin of water and invite your child to take a boat ride from one city to another. In order for the boat to move, you need to blow on it slowly, folding your lips with a tube. But then a gusty wind comes up - the lips fold, as for the sound p.
Whistles, toy pipes, harmonicas, blowing up balloons and rubber toys also contribute to the development of speech breathing.
The tasks become more difficult gradually: first, training of a long speech exhalation is carried out on individual sounds, then on words, then on a short phrase, when reading poetry, etc.
In each exercise, the child's attention is directed to a calm, relaxed exhalation, to the duration and volume of the sounds being uttered.
Exercises to develop the kinesthetic basis of hand movements:
Stretch your arm forward and down; squeeze all fingers except the thumb; thumb up.
Lower your right hand down. Squeeze all fingers except the thumb, stretch the thumb to the left.
Lower the left hand down. Squeeze all fingers except the thumb, stretch the thumb to the right.
Squeeze the hands of both hands into fists, while stretching the thumbs up.
Clench the right (left) hand into a fist, put the palm of the left (right) hand on top of it.
Clench the right (left) hand into a fist, lean the palm of the left (right) hand vertically against it.
Loosely squeeze the fingers of the right (left) hand into a fist, leaving a small hole between the fingers and the palm.
Connect obliquely (“house”) the fingers of the right and left hands, while the thumbs are pressed to the hands.
The hands are in the same position as in the previous exercise, only the thumbs of the right and left hands are removed from the hands and are located horizontally.
Extend the index finger and little finger of the right (left) hand, squeeze the rest of the fingers.
Extend at the same time (both on the right and on the left hand) the index finger and little finger, squeeze the rest of the fingers.
Extend the thumb and little finger of the right (left) hand, squeeze the rest of the fingers.
Extend at the same time (both on the right and on the left hand) the thumb and little finger, squeeze the rest of the fingers.
Extend the index and middle fingers of the right (left) hand, squeeze the rest of the fingers.
Extend simultaneously (both on the right and on the left hand) the index and middle fingers, squeeze the rest of the fingers.
Form the fingers of the right (left) hand into a ring. (This exercise is variant: the ring can be obtained by connecting the thumb to any other, while the remaining fingers are extended.)
Put your right (left) hand on the table in front of you with fingers apart, place your index finger on the middle one (or vice versa).
Put your right (left) hand clenched into a fist in front of you on the table, raise your index and middle fingers, spreading them.
. "Horse". Turn your hand with your palm facing you, thumb up. Place four bent fingers of the other hand (mane) on the edge of the palm from above. Raise two thumbs up (ears). The horse can shake its mane, move its ears, open and close its mouth (lower the little finger and press it to the hand).
. "Frog". Bend the index finger and little finger, pull back (eyes). Bend the ring and middle fingers, press to the middle of the palm (mouth). Place the thumb horizontally on the nails of the middle and ring fingers.
. "Crocodile". Bend the index finger and little finger, pull back (eyes). Extend the middle and ring fingers forward. Press a straight thumb against them from below, forming the mouth of a crocodile.
. "Hen". Connect the ends of the thumb and forefinger (beak). The rest of the fingers (scallop) are superimposed on the beak fan-shaped.
. "Cock". Connect the ends of the thumb and forefinger (beak). The remaining fingers are half-bent, do not touch each other (scallop). The comb can move with the movements of the cockerel.
. "The bird is drinking water." Clench the left hand loosely into a fist, leaving a small hole between the fingers and the palm (a barrel of water). Connect the thumb and forefinger of the right hand in the form of a beak, clench the remaining fingers into a fist (bird). Connected together, the thumb and forefinger of the right hand are inserted from above into the hole of the left.
. "Bridge". Place the middle and ring fingers of the right and left hands horizontally so that they touch each other with the fingertips. Raise the index fingers and little fingers of both hands up. Press the thumbs to the brushes.
. "Elephant". The index and ring fingers are the front legs of an elephant. The thumb and little finger are the hind legs. The middle finger extended forward is the trunk.
. "Owl". Take the thumb and little finger to the sides (owl wings), they can move during the "flight". Bend the remaining three fingers, pressing the pads to the base of the fingers (head).
. "Greetings". Position the right (left) hand vertically. Form a semicircle with index and thumb.
. "Glasses". The hands of both hands are placed vertically. The index and thumb fingers form rings, touching each other with the tips.
. "Gates". Press the tips of the fingers together to each other; arms
turn your palms towards you, raise your thumbs up.
. "Roof". Connect the fingertips of both hands in an inclined position of the palms.
. "Counter". Connect the fingertips of both hands in an inclined position of the palms. Index fingers should be placed horizontally, thumbs should be pressed against them.
. "House". Half-bent fingers spread downwards rest on the table.
. "The house is closed." Clench the right (left) hand into a fist, while pressing the thumb with the other four fingers.
. "Flower". Connect both palms, fingers slightly bent and spread apart.
. "Plant Root" Having connected the hands with the back side, freely lower the fingers down.
. "The plant has sprouted." Clench the fingers of both hands into fists, press tightly against each other. Raise your thumbs up. Then slowly raise all other fingers up, as if forming a flower bud.
. "Horse". All fingers of the right hand, except for the index, are half-bent and rest on the table. The index finger is extended horizontally.
. "Rider on horseback". The right hand is in the same position as in the previous task. The index and middle fingers of the left hand are widely separated and "planted" on the index finger of the right hand.
. "Cat". Press the middle and ring fingers with a bent thumb to the palm, the little finger and index finger - stretch up.
. "The Man in the House" Raise the thumb of the right (left) hand up and tightly grasp the fingers of the other hand.
. "Ship". Place your hands horizontally, press your palms tightly against each other, fingers slightly apart.
. "Sun rays". Raise the hands of both hands up, cross, fingers apart.
. "Christmas tree". Turn the palms of both hands towards you, interlace your fingers.
. "Passengers on the Bus" Clasp your fingers. Back sides of the hands
turn outward, raise your thumbs up.
. "Snail". Clench your right (left) hand into a fist, put it on the table. Raise your index and middle fingers apart. Put the left (right) hand on top (snail shell).
Play the graphic scheme proposed by the speech therapist with closed eyes.
Exercises to develop the kinetic basis of hand movements:
Development of dynamic hand coordination in the process of performing sequentially organized movements
Alternately touch the thumb of the right hand to the second, third, fourth and fifth fingers at the usual and maximum pace.
Perform a similar task with the fingers of the left hand.
Perform a similar task simultaneously with the fingers of both hands at a normal and maximum pace.
With the fingers of the right (left) hand, “say hello” in turn with the fingers of the left (right) hand (patting the fingertips, starting with the thumb).
. "Fingers say hello." Connect fingers. To carry out alternately, starting with the thumb, touching movements of all fingers. 6. "Who will defeat whom." Connect the hands in front of you. Alternately make hand presses to the right, to the left.
Spread the fingers of the right (left) hand wide, bring them together, spread them again, hold for 2-3 seconds.
. "Sun". Put the palm of the right (left) hand with spread fingers-rays on the table. Make alternate tapping with your fingers on the table.
. "Swamp". The thumb of the right (left) hand is set on the "bump". The remaining fingers alternately "jump from bump to bump." (Similar movements are carried out starting with the little finger.)
Alternately bend the fingers of the right (left) hand, starting with the thumb.
A squirrel sits on a cart.
She sells nuts
Chanterelle-sister
Sparrow, titmouse,
Bear fat-fifth,
Mustachioed hare.
Alternately bend the fingers of the right (left) hand, starting with the little finger.
This finger wants to sleep
This finger - jump into bed,
This finger curled up
This finger suddenly yawned,
Well, this one is already asleep.
Squeeze the fingers of the right (left) hand into a fist; straighten them one by one, starting with the thumb.
Come on, brothers, to work,
Show your passion:
Bolshak - to chop wood,
Stoke everything for you,
And you carry water
And you cook dinner
And you feed the children.
Squeeze the fingers of the right (left) hand into a fist; straighten them one by one, starting with the little finger.
Little finger decided to go for a walk,
But the nameless did not allow
And the middle one heard about it -
Almost out of patience.
And the forefinger said sadly:
"The big one will definitely be upset."
got the little finger
From everyone to the hotel.
Put the right (left) hand in front of you (as when playing the piano), perform sequential movements with the first and second, first and fifth fingers, etc.
Continuously draw a line along the drawn labyrinth with a pencil taken in the right (left) hand, without changing the position of the sheet of paper on which the labyrinth is drawn.
Crumple a sheet of tissue paper into a compact ball with the fingers of the right (left) hand, without helping with the other hand.
Beads of different sizes, but of the same color (or of the same size, but of different colors, or of different sizes and different colors) are laid out on the table. It is proposed to independently string beads on the thread, selecting them by color or size, and tie the ends of the thread with a bow.
A card is offered in which, in a certain sequence,
holes are made. It is necessary: to stretch the woolen thread sequentially through all the holes; stretch the woolen thread, skipping one hole; perform normal lacing.
. "Friendship".
Girls and boys are friends in our group (fingers are connected into a “lock”).
We will make friends with little fingers (rhythmic touch of the fingers of the same name).
One, two, three, four, five (alternately touching the fingers of the same name, starting with the little fingers),
One, two, three, four, five (alternately touching the fingers of the same name, starting with the thumbs),
. "Fists".
Lean your elbows on the table. Clench into a fist, first the fingers of the right, then the left hand; unclench, relaxing the brush first of one, then the other hand.
. "Clean Mouse".
The mouse washed its paw with soap (with one hand “wash” the other),
Each finger in order (with the index finger touch each finger of the other hand).
Here she lathered Big (with all fingers, first with the right, then with the left hand, “soap” the thumb),
Rinse it with water.
I did not forget the Pointer,
Wash away dirt and paint
(similar movements with index fingers).
Average lathered diligently,
The dirtiest was probably (similar movements with middle fingers).
The nameless rubbed with paste,
The skin immediately turned red (similar movements with the ring fingers).
And Littlefinger quickly washed:
He was very afraid of soap (soap his little fingers with quick movements).
. "Running Man"
Alternately touching the surface of the table with the tips of the index and middle fingers of the right (left) hand, depict a running man.
. "Angles".
We can show angles
Let's fold our hands like this.
Here is a straight line at the crossroads (connect the ends of the fingers of both hands under right angle),
The tip of the arrow is an acute angle (fingertips and elbows are connected, wrists are separated),
Raised Boom Crane -
It turns out blunt (the elbow of the other is attached to the fingertips of one hand).
. "Scissors". Spread the index and middle fingers of the right (left) hand to the sides 7-10 times.
. "Football". Drive the ball into the goal with one and two fingers of the right (left) hand.
. "Gourmet". Clench the left hand loosely into a fist, forming a small hole (pot) between the fingers and the palm. With the index and middle fingers of the right hand, depict a crouching cat.
Standing at the kitchen table
Pot with fresh milk.
The cat sneaked into the kitchen
Taste a little milk (the index and middle fingers of the right hand slowly move towards the left hand).
Leaning down, drinking a vershok,
Sticking his head into the pot (the index and middle fingers of the right hand are inserted into the loosely clenched fist of the left).
And then - oh-oh-oh! Ah ah ah!
Do not take out the head (the fist of the left hand, squeezing the fingers of the right hand, does not allow them to rise up).
The cat runs into the yard
Hit the fence
Boom! Bang! Here! Here! Current!
That pot broke (hands spread apart).
The cat ran into the house
Again for delicious milk.
. "I'll iron diapers for sister Alenka." A sheet of paper (diaper) is placed in front of the child. It is necessary: using all the fingers of both hands, smooth it so that it does not bulge, and the edges do not remain bent; do the same using one hand; do the same using the thumbs, index and middle fingers of both hands; do the same with two little fingers; smooth the sheet with the fists of both hands, thumb and forefinger of one hand, index and middle fingers of one hand, middle and ring fingers of one hand, ring and little fingers; repeat all movements with closed eyes.
. "Builders". From logs (counting sticks) you need to build a house.
A) Move the logs to the construction site: using any fingers of both hands; using any fingers of the right (left) hand; using only two fingers - thumb and little finger - of the right (left) hand; using only the index and middle fingers of the right (left) hand; using only the middle and ring fingers of the right (left) hand; using only the ring and little fingers of the right (left) hand.
B) With the index and middle fingers of the right (left) hand, build a quadrangle (walls).
C) With the middle and little fingers of the right (left) hand, build a triangle (roof).
Development of dynamic hand coordination in the process of performing simultaneously organized movements:
Put the matches in the box with both hands at the same time: with the thumb and forefinger of both hands, simultaneously take the matches lying on the table and at the same time put them in the matchbox.
Take a pencil in your right and left hands and at the same time tap them on the paper, placing dots in random order.
At the same time, change the position of the hands: clench one into a fist, unclench the other, straightening the fingers.
At the same time, throw the hands forward, while clenching the fingers of one hand into a fist, and connecting the fingers of the other into a ring.
With the index fingers of outstretched hands, describe identical circles of any size in the air. With the finger of the right hand, describe circles in the clockwise direction, with the finger of the left hand - in the opposite direction.
. "Merry painters". Synchronous movements of the hands of both hands up - down with the simultaneous connection of the wrist swing, then: left - right.
. "Fists".
Lean your elbows on the table, clench the fingers of both hands into fists.
At the same time, open your fingers, relax your hands.
."Sewing machine".
With the right hand, make circular movements in the hand and elbow (imitating the rotation of the wheel). With your left hand, perform small movements characteristic of the operation of the sewing machine needle. Change the conditions for completing the task: make circular movements with the left hand, and imitate the movements of the needle with the right hand.
."Bud".
By nightfall, the bud has collected the petals (the fingers of the right and left hands are gathered into a “handful”).
The sun sends out its rays.
In the morning under the sun
Flowers open (simultaneously slowly spread the fingers of both hands).
The sun has set, and dusk has deepened,
And until the morning my flower closed (at the same time the fingers of the right and left hands are connected).
To beat at a convenient pace one beat with the right (left) hand, at the same time hit the table with the index finger of the left (right) hand at the same time.
To beat at a convenient pace with the right (left) hand one measure at a time, at the same time as the index finger of the left (right) hand stretched forward, describe a small circle in the air.
. "Jump rope".
Clench the fingers of both hands into fists. Raise your thumbs up and describe with them rhythmic, with a large amplitude, circular movements, first in one direction, then in the other.
I'm jumping, I'm spinning
new jump rope,
If I want to, I'll outrun Galya and Natalka.
Well, one, well, two
In the middle of the track
Yes, running, with the breeze,
Yes, on the right leg.
I'm jumping, I'm spinning
New jump rope.
I ride, I teach Galya and Natalka.
Well, one, well, two
Sisters are learning.
Behind the back day by day
Jumping pigtails.
. "Cats and mice".
Cat mouse scratch-scratch (fingers of both hands clenched into fists),
I held it, I held it, I let it go (the fists open at the same time),
The mouse ran, ran (at the same time the fingers of both hands move along the plane of the table),
She wagged her tail, wagged (the index fingers of both hands move from side to side).
Goodbye, mouse, goodbye (simultaneous tilts of the hands forward and down).
1 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Enlightenment, 2009. - S. 74.
2 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. - M.: VLADOS, 2009. T. II - S. 190.
4 Balobanova V.P., Bogdanova L.G., Venediktova L.V. Diagnosis of speech disorders in children and the organization of logopedic work in a preschool educational institution. - St. Petersburg: Detstvo-press, 2011. - P. 237.
5 Ibid. - S. 238.
6 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. – M.: VLADOS, 2009. T. II – P.193.
7 Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. - 2006. - No. 5. - S. 12.
8 Arkhipova E.F. Erased dysarthria in children. - St. Petersburg: AST, 2010.- P. 75.
9 Ibid. - S. 76.
10 Volkova G.A. Methods of psychological and logopedic examination of children with speech disorders. Issues of differential diagnosis. - St. Petersburg: Peter, 2010. - S. 43.
11 Volkova G.A. Methods of psychological and logopedic examination of children with speech disorders. Issues of differential diagnosis. - St. Petersburg: Peter, 2010. - S. 45.
12 Ibid. - S. 46.
13 Volkova G.A. Methods of psychological and logopedic examination of children with speech disorders. Issues of differential diagnosis. - SPb.: Piter, 2010.– P. 47.
14 Ibid. - S. 48.
15 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 38.
16 Ibid. – S. 39.
17 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 40.
18 Filicheva T. B. and others. Fundamentals of speech therapy: Proc. allowance for students ped. in-t on spec. "Pedagogy and psychology (preschool)" / T. B. Filicheva, N. A. Cheveleva, G. V. Chirkina. - M .: Education, 2009. - P. 132.
19 Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. - 2006. - No. 5. - S. 12.
20 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 43.
21 Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. - M .: Humanit. ed. center VLADOS, 2008. - S. 211.
22 Pravdina O. V. Speech therapy. Proc. manual for students defectologist. facts ped. in-comrade. Ed. 2nd, add. and reworked. - M., "Enlightenment", 2010. - P. 117.
23 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. - M.: VLADOS, 2009. T. II - S. 197.
24 Ibid. – S. 198.
25 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Enlightenment, 2009. - S. 252.
26 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Education, 2009. - S. 253.
27 Tsvetkova L.S. Semenovich A.V. Actual problems of childhood neuropsychology: Textbook. - M.: Moscow Psychological and Social Institute; Voronezh: Publishing house NPO "MODEK", 2011. - P. 243.
28 Ibid. - S. 245.
30 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. - M.: VLADOS, 2009. T. II - S. 198.
31 Pravdina O. V. Speech therapy. Proc. manual for students defectologist. facts ped. in-comrade. Ed. 2nd, add. and reworked. - M., "Enlightenment", 2010. - P. 119.
32 Lopukhina I.S. Speech therapy: 550 entertaining exercises for the development of speech: a guide for speech therapists and parents. - M.: Aquarium, 2011. - S. 42.
33 Arkhipova E.F. Erased dysarthria in children. - St. Petersburg: AST, 2010.- P. 36.
34 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 74.
35 Garkusha Yu.F. The system of correctional classes of a kindergarten teacher for children with speech disorders. - M.: EKSMO, 2010. - S. 152.
36 Lopatina L.V., Overcoming speech disorders in preschoolers: [textbook] / Lopatina L.V., Serebryakova N.V. - St. Petersburg. Ed. RGPU them. A.I. Herzen Publishing House "Soyuz", 2011. - S. 80.
37 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Education, 2009. - S. 257.
38 Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. - M .: Humanit. ed. Center VLADOS, 2008. - S. 404-406.
39 Games in speech therapy work with children: Book for speech therapists. / Ed. Comp. IN AND. Selivestrov. - M .: Education, 2007. - S. 68.
40 Balobanova V.P., Bogdanova L.G., Venediktova L.V. Diagnosis of speech disorders in children and the organization of logopedic work in a preschool educational institution. - St. Petersburg: Detstvo-press, 2011. - P. 269.
41 Ibid. – S. 270.
42 Garkusha Yu.F. The system of correctional classes of a kindergarten teacher for children with speech disorders. - M.: EKSMO, 2010. - S. 161.
43 Lopukhina I.S. Speech therapy: 550 entertaining exercises for the development of speech: a guide for speech therapists and parents. - M.: Aquarium, 2011. - S. 245.
44 Filicheva T. B. and others. Fundamentals of speech therapy: Proc. allowance for students ped. in-t on spec. "Pedagogy and psychology (preschool)" / T. B. Filicheva, N. A. Cheveleva, G. V. Chirkina. - M .: Education, 2009. - P. 153.
45 Shvaiko G.S. Games and game exercises for the development of speech. - M.: Pedagogy, 2007. - S. 227.
46 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Education, 2009. - S. 306.
Page 41
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Anartria- complete impossibility of sound pronunciation, speech is absent, separate inarticulate sounds are possible.
Severe dysarthria - the child is able to use oral speech, but it is inarticulate, incomprehensible to others, there are gross violations of sound pronunciation, breathing, voice and intonational expressiveness are also significantly impaired.
Erased dysarthria- with a given degree of severity of dysarthria, all the main signs, both neurological and speech, and psychological, are expressed in a minimal, erased form.
However, a thorough examination reveals neurological microsymptoms, and violations of the performance of special tests are noted.
The most common speech therapist in children's practice is pseudobulbar dysarthria.
According to the severity of violations of speech and articulatory motility, it is customary to distinguish three degrees of severity of pseudobulbar dysarthria: mild, moderate and severe.
Mild pseudobulbar dysarthria
With a mild degree (III degree) of pseudobulbar dysarthria, there are no gross violations of the motility of the articulatory apparatus. The cause of these disorders is most often unilateral lesions of the lower parts of the anterior central gyrus, or rather the neurons of the motor 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.
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 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.
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 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] - [d]. 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, 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, violations of sound analysis depend on the severity of violations of sound pronunciation, therefore, children with less pronounced defects in sound pronunciation make fewer errors in samples for sound analysis. In the case of anartria, however, such forms of sound analysis are inaccessible. Violations and underdevelopment of sound analysis in children with dysarthria cause significant difficulty up to the impossibility of learning to read and write. At the same time, the main number of errors in the writing of such children is the substitution of letters. At the same time, the replacement of vowel sounds children - “detu”, “teeth” - “teeth”, etc. are very frequent. This is due to the inaccuracy of the nasal pronunciation of vowels in the child, in which they are practically indistinguishable in sound. Consonant substitutions in writing are also numerous and varied.
FEDERAL AGENCY FOR EDUCATION
SMOLENSKY STATE
UNIVERSITY
Department of Special Pedagogy
Organization and content of speech therapy work with children suffering from dysarthria.
Course work
4th year students
Faculty of Primary and
special education
full-time department Goravneva
Yulia Alexandrovna
Scientific adviser:
cand. ped. Sciences, Associate Professor
Kostikova Veronika Vladimirovna
Smolensk
Introduction…………………………………………………………………………...3
Chapter I. Modern ideas about dysarthria……………………………..7
1.1. Understanding dysarthria as a complex speech disorder, classification of forms of dysarthria…………………………………………………7
1.2. Clinical and psychological characteristics of children suffering from dysarthria……………………………………………………………………..20
Conclusions…………………………………………………………………………...27
Chapter II. Experimental study of the organization and content of speech therapy work with children suffering from dysarthria………………..29
2.1. Organization of the ascertaining experiment. Exploring the state
problems in the practice of the work of a speech therapist………………………...29
2.2 Results of the ascertaining experiment. Terms
the effectiveness of the organization and content of speech therapy work with
children suffering from dysarthria………………………………………..37
Conclusions…………………………………………………………………………...39
Conclusion………………………………………………………………………….40
List of studied literature…………………………………………………….44
Appendix…………………………………………………………………………46
Introduction
The urgency of the problem. Mastering the native language, speech development is one of the most important acquisitions of a child in childhood and is considered in modern education as a general basis for the development and education of children.
Speech is one of the most powerful factors and stimuli for the development of a child. Thanks to speech, people communicate thoughts, desires, convey their life experience, coordinate actions. It serves as the main means of communication between people. In children suffering from dysarthria, this basic remedy is disturbed, so it is very difficult for them to communicate with other people. Currently, this speech pathology is considered as a complex syndrome of central organic origin, manifested in neurological, psychological and speech symptoms.
Dysarthria is a complex speech disorder characterized by a combination of multiple disturbances in the process of motor implementation of speech activity.
The clinical picture of dysarthria was first described in 1885 by Oppenheim in adults as part of the pseudobulbar syndrome.
Later, in 1911, H. Gutzmann defined dysarthria as a violation of articulation and identified two of its forms: central and peripheral. The works of M.S. had a great influence on the modern understanding of dysarthria. Margulis (1926), who for the first time clearly distinguished dysarthria from motor aphasia and divided it into bulbar and cerebral forms.
E.N. Vinarskaya, 1973 and L.B. Litvak, 1959. For the first time, E.N. Vinarskaya conducted a comprehensive neurolinguistic study of dysarthria in focal brain lesions in adult patients.
Currently, dysarthria is described in most detail in children with cerebral palsy (M.B. Eidinova, E.N. Pravdina-Vinarskaya, 1959; K.A. Semyonova, 1968; E.M. Mastyukova, 1969, 1971, 1979, 1983 ; I. I. Panchenko, 1979; etc.). In foreign literature, it is represented by the works of G. Bohme, 1966; M. Clement, T.E. Twitchell, 1959; R.D. Neilson, N. O'. Dwer, 1984.
Speech therapy, clinical psychological and speech therapy study of children with dysarthria shows that this category of children is very heterogeneous in terms of motor, mental and speech disorders. Violation of sound pronunciation in dysarthria manifests itself to varying degrees and depends on the nature and severity of the damage to the nervous system. In mild cases, there are separate distortions of sounds, "blurred speech", in more severe cases, distortions, substitutions, omissions of sounds are observed, the tempo, expressiveness, modulation suffer, in general, pronunciations become slurred. The leading symptom in the structure of a speech defect in erased dysarthria is phonetic disorders, which are often accompanied by underdevelopment of the lexical and grammatical structure of speech. Violations of the phonetic side of speech are difficult to correct, negatively affect the formation of the phonemic, lexical and grammatical components of the speech functional system, causing secondary deviations in their development.
These disorders make it difficult for children to go to school. Timely correction of speech development disorders is a necessary condition for the psychological readiness of children to master schoolwork. In this regard, knowledge of modern ideas about the symptoms, mechanisms of dysarthria, and methods of its correction is extremely important for the training of speech therapists.
The urgency of the problem, its practical significance and insufficient development determined the choice of the object, subject and hypothesis of the study.
Object of study is the organization and content of speech therapy work with older preschool children suffering from dysarthria.
Subject of study are the conditions for successful correctional and psychological and pedagogical work with children of older preschool age suffering from dysarthria in a speech therapy group of a kindergarten.
An analysis of the state of the issue in theory and practice made it possible to formulate research hypothesis. Corrective work for dysarthria will be effective if the following conditions are met:
comprehensive and systems approach to the analysis of speech defect;
step-by-step interconnected formation of all components of speech;
3) taking into account the individual characteristics of the child in the correction of dysarthria.
4) the use of game methods and techniques in speech therapy work.
Purpose of the study- to identify the conditions for effective correctional and pedagogical work.
In accordance with the hypothesis and the purpose of the study, we determined main tasks:
1) to study the state of the problem in the theory and practice of the modern speech therapy process;
2) determine the conditions for the effectiveness of speech therapy work with children suffering from dysarthria;
3) to identify the features of the content and organization of speech therapy work with children suffering from dysarthria.
The most important sources of research:
1. literature on the theory and practice of overcoming dysarthria;
speech cards of children suffering from dysarthria.
To test the proposed hypothesis, a research program was developed, which included the following research methods:
studying the state of the problem in the practice of speech therapists;
analysis, generalization of data on the research problem and development of a hypothesis;
planning and conducting the experiment;
analysis of the results obtained during the pilot study;
evaluation of the results of the experiment and their comparison with the hypothesis.
Practical significance of the study: theoretical conclusions and practical results can be used in the practice of working with children suffering from dysarthria.
Implementation in practice: The identified conditions can be taken into account by students when organizing speech therapy work with children in a preschool institution during their work experience.
Work structure. The course work consists of an introduction, two chapters, a conclusion, a list of literature studied (21 sources), an application.
Workload 46 pages of printed text.
Chapter I. Modern ideas about dysarthria
1.1. Understanding dysarthria as a complex speech disorder, classification of forms of dysarthria
Despite the fact that the clinical picture of dysarthria within the pseudobulbar syndrome was described about 100 years ago, there is no single definition of this form of speech disorder. Some authors (K.A. Semenova, M.Ya. Smuglin) refer to dysarthria only those forms of speech pathology in which the violation of the sound-producing side of speech is caused by paresis and paralysis of the articulatory muscles.
Others (E.M. Mastyukova, M.V. Ippolitova) interpret the concept of "dysarthria" more broadly and include all disorders of articulation, phonation and speech breathing resulting from damage to various levels of the central nervous system. Depending on the localization of the lesion, the clinical manifestations of dysarthria will vary.
Dysarthria is a Latin term, and in translation it means a disorder of articulate speech - pronunciation ("dis" - a violation of a sign or function, "artron" - articulation). When defining dysarthria, most authors do not proceed from the exact meaning of this term, but interpret it more broadly, referring to dysarthria disorders of articulation, voice formation, tempo, rhythm and intonation of speech.
Dysarthria is a violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus.
The leading defect in dysarthria is a violation of the sound-producing and prosodic side of speech, associated with an organic lesion of the central and peripheral nervous systems.
The pathogenesis of dysarthria is determined by an organic lesion of the central and peripheral nervous system under the influence of various unfavorable external (exogenous) factors affecting the prenatal period of development, at the time of childbirth and after birth. Among the causes, important are asphyxia and birth trauma, damage to the nervous system in hemolytic disease, infectious diseases of the nervous system, craniocerebral trauma, less often - cerebrovascular accident, brain tumors, malformations of the nervous system, for example, congenital aplasia of the nuclei of the cranial nerves. (Mobius syndrome), as well as hereditary diseases of the nervous and neuromuscular systems.
With severe lesions of the central nervous system, speech becomes impossible due to complete paralysis of the speech motor muscles. Such disorders are called anartria (a - the absence of a given sign or function, artron - articulation).
Dysarthric speech disorders are observed in various organic lesions of the brain, which in adults have a more pronounced focal character. In children, the frequency of dysarthria is primarily associated with the frequency of perinatal pathology (damage to the nervous system of the fetus and newborn). Most often, dysarthria is observed in children with cerebral palsy, according to various authors, from 65 to 85% (M.B. Eidinova and E.N. Pravdina-Vinarskaya, 1959; E.M. Mastyukova, 1969, 1971).
Less pronounced forms of dysarthria are observed in children without obvious movement disorders, who have undergone mild asphyxia or birth trauma, or who have a history of the influence of other not pronounced adverse effects during intrauterine development or during childbirth. In these cases, mild (erased) forms of dysarthria are combined with other signs of minimal cerebral dysfunction (L.T. Zhurba and E.M. Mastyukova, 1980).
Often, dysarthria is also observed in the clinic of complicated oligophrenia, but data on its frequency are extremely contradictory.
Dysarthria is characterized by: violations of articular motility in the form of a change in the tone of the articulatory muscles, limitation of the volume of their productive movements, coordinating disorders, various kinds of synkinesis, tremor, hyperkinesis of the tongue, lips; respiratory failure; voice disorders.
Speech with dysarthria is slurred, fuzzy. The pace of speech is often disturbed, which can be accelerated (tachyllalia) or (more often) slow (bradilalia). Sometimes there are alternations of accelerated and slow tempo of speech. The phrase is formulated indistinctly, does not speak, semantic stresses are randomly placed, the arrangement of pauses is disturbed, omissions of sounds, words, mumbling towards the end of the phrase are characteristic. Voice disorders are also observed: the voice is usually quiet, often uneven - sometimes quiet, sometimes loud, monotonous, sometimes nasal, often hoarse. With dysarthria, violations of the lexical and grammatical side of speech are leading. However, damage to the motor mechanisms of speech in the pre-speech period, combined with sensory disorders, can lead to complex disintegration and pathology of all parts of the speech development of a child with cerebral palsy.
A feature of dysarthria in children is often its mixed nature with a combination of various clinical syndromes. This is due to the fact that when a harmful factor affects the developing brain, damage is often more widespread, and the fact that damage to some brain structures necessary to control the motor mechanism of speech can delay maturation and disrupt the functioning of others. This factor determines the frequent combination of dysarthria in children with other speech disorders (delayed speech development, general underdevelopment of speech, motor alalia, stuttering).
With dysarthria, the clarity of kinesthetic sensations is impaired, and the child does not perceive the state of tension or, conversely, the relaxation of the muscles of the speech apparatus, violent involuntary movements, or incorrect articulation patterns.
It follows that dysarthria is one of the most complex and severe speech disorders. The problem of studying dysarthria was dealt with by many domestic (E.M. Mastyukova, M.V. Ippolitova, G.E. Sukhareva, M.S. Pevzner, O.V. Pravdina, L.V. Lopatina, L.V. Serebryakova, E. .N. Vinarskaya and others) and foreign (Brain, Froeschels, Peocher, Grewel) authors.
The main clinical signs of dysarthria are:
Violation of muscle tone in the speech muscles;
Limited possibility of arbitrary articulatory movements due to paralysis and paresis of the muscles of the articulatory apparatus;
Important problems of the modern study of dysarthria are:
neurolinguistic study of various forms of dysarthria, taking into account the localization of brain damage.
improving the methods of speech therapy work in the pre-speech period and in the first years of life with children with perinatal brain damage, and with children at risk.
development of methods for early neurological and speech therapy diagnosis of manifestations of dysarthria in children.
improving the methods of speech therapy work, taking into account the forms of dysarthria.
strengthening the relationship between the work of a neuropathologist and a speech therapist.
Classification of forms of dysarthria
The classification of dysarthria according to the degree of intelligibility of speech for others was proposed by the French neurologist G. Tardier (1968) in relation to children with cerebral palsy. The author identifies 4 degrees of speech disorders in children.
The first, easiest degree, when sound pronunciation disorders are distinguished only by a specialist in the process of examining a child.
The second - violations of pronunciation are noticeable to everyone, but speech is understandable to others.
The third - the speech is understandable only to the relatives of the child and partially to others.
The fourth, the most difficult, is the lack of speech or speech is almost incomprehensible even to the relatives of the child (anarthria).
Anarthria refers to the complete or partial inability to pronounce sound as a result of paralysis of the speech-motor muscles. According to the severity of the manifestations of anartria, it can be different: severe - the complete absence of speech and voice; moderate - the presence of only voice reactions; light - the presence of sound-syllabic activity. (I.I. Panchenko, 1979)
I.I. Panchenko and L.A. Shcherbakov, on the basis of a clinical and phonetic analysis of pronunciation speech disorders, eight main constantly occurring forms of dysarthric speech disorders are distinguished:
1. spastic-paretic (leading syndrome - spastic paresis);
2. spastic-rigid (leading syndromes - spastic paresis and tonic disorders of control such as rigidity);
3. hyperkinetic (the leading syndrome is hyperkinesis: choreic, athetoid, myoclonus);
4. atactic (the leading syndrome is ataxia);
5. spastic-atactic (the leading syndrome is spastic paresis and ataxia;
6. spastic-hyperkinetic (the leading syndrome is spastic paresis and hyperkinesis);
7. spastic-atactico-hyperkinetic (the leading syndrome is spastic paresis, ataxia, hyperkinesis);
8. atactico-hyperkinetic (the leading syndrome is ataxia, hyperkinesis).
The basis of the modern classification of dysarthria is the principle of localization, the syndromological approach, the degree of constancy of speech for others. The most complete differentiation of forms of dysarthria belongs to E.N. Vinarskaya, who in her work "Dysarthria" systematized them in the form of a table.
The most common classification in Russian speech therapy was created taking into account the neurological approach based on the level of localization of the lesion of the motor apparatus of speech (O.V. Pravdina and others).
The following forms of dysarthria are distinguished: bulbar, pseudobulbar, extrapyramidal (subcortical), cerebellar, cortical.
Currently, minimal dysarthria disorders (MDD) are common - a speech disorder of central origin, characterized by combinatorial disorders of speech activity: articulation, breathing, voice, facial expressions and the prosodic side of speech.
Minimal dysarthria disorders occupy an intermediate position between dyslalia and dysarthria, therefore, in the special literature, the term “erased dysarthria”, proposed by O.A. Tokareva (1969). In foreign literature, the term "speech or articular developmental dyspraxia" is used for such disorders.
The choice of the term remains debatable, since the existing terminological designation of this speech disorder does not reflect the clinical and nosological independence of this group of speech disorders.
All the symptoms of MDD are manifested in a not pronounced form.
The main symptom of MDD is a persistent violation of pronunciation, which is difficult to correct and negatively affects the formation of other aspects of speech.
All children with MDD are characterized by polymorphic impairment of sound pronunciation. The prevalence of impaired pronunciation of various groups of sounds in this category of children is characterized by certain features that are due to the interaction of speech-auditory and speech-motor analyzers and the acoustic proximity of sounds.
Along with pronounced disorders of sound pronunciation in children of this group, there is a violation in the formation of the intonation structure of the sentence.
In children with MDD, there is an underdevelopment of phonemic perception, manifested in a violation of phonemic analysis.
Children in this category represent a heterogeneous group, both in terms of the manifestation of neurological symptoms and the level of speech development. Depending on the manifestation of neurological symptoms and the state of the neuromuscular apparatus of the organs of articulation, 3 groups of children with MDD can be distinguished, which are observed in children with cerebral palsy:
I - with right-sided hemiparesis;
II - with left-sided hemiparesis;
III - with slight bilateral paresis.
According to the level of development of the lexico-grammatical system and the coherence of speech, children can be divided into 2 groups:
I - MDD, combined with phonetic-phonemic underdevelopment.
II - MDR, combined with a general underdevelopment of speech.
Symptoms of dysarthria
Violation of muscle tone in the articulatory muscles
The following forms are distinguished: spasticity of the articulatory muscles - a constant increase in tone in the muscles of the tongue, lips, in the facial and cervical muscles. An increase in muscle tone may be more localized and extend only to individual muscles of the tongue. An increase in muscle tone in the circular muscle of the mouth leads to spastic tension of the lips, tight closure of the mouth. Active movements are limited. An increase in muscle tone in the muscles of the face and neck further limits voluntary movements in the articulatory apparatus. Spasticity of the articulatory muscles occurs in the spastic form of pseudobulbar dysarthria. Along with spasticity of the speech muscles in children, spasticity is also noted in skeletal muscles.
The next type of violation of muscle tone is hypotension. With hypotension, the tongue is thin, flattened in the oral cavity, the lips are flaccid, there is no possibility of their complete closure. In this regard, the mouth is usually half-open, hypersalivation is pronounced, and nasalization is noted. According to M.Ya. Smuglin, K.A. Semyonova, hypotension in the articulatory muscles is most often observed in the cerebellar form of dysarthria.
Also, a violation of muscle tone in dysarthria can manifest itself in the form of dystonia. At rest, there is a low muscle tone, while trying to speak, the tone increases sharply.
Discoordination disorders are a characteristic sign of articulatory motility disorders in dysarthria. They manifest themselves in violation of the accuracy and proportionality of articulatory movements.
Violation of sound pronunciation
There is an impaired pronunciation of sounds that require the tongue to move upwards, as well as sounds that require the combined action of the indicated muscles of the tongue for their reproduction ([l], [r], [g], [w], [h], [e], [t] and some others). Sometimes there is an insufficiency of the downward movement of the tongue.
With paresis of the muscles of the tongue, a change in their tone, it is often impossible to change the configuration of the tongue: lengthening, extension, shortening, pulling back and raising its individual parts, curvature, various lateral movements. All this leads to a violation of the sound pronunciation of the so-called lingual sounds, the pronunciation of which is associated with a change in the bending of the back of the tongue ([a], [e], [i]), palatal-lingual ([x], [h], [g], [ l], [s], [w], [k], [t], [g], [d], [p], [n]).
Thus, when the muscles of the tongue are affected, the sound pronunciation of most sounds is upset. Along with the limited mobility of the tongue, there is usually little mobility of the lips, it becomes impossible or limited to stretch the lips with a tube, stretch the corners of the mouth, as well as other movements that change the size and shape of the vestibule of the mouth, thereby affecting the resonance of the entire oral cavity. With damage to the muscles of the lips, the pronunciation of labial sounds suffers mainly ([b], [p], [m], [c], [f]). The limited mobility of the soft palate is also noted as a result of damage to the palatine muscles, the sound pronunciation is even more disturbed.
Violation of voice formation
K.A. Semenova, E.M. Mastyukova, M.Ya. Smuglin in his work “Clinic and Rehabilitation Therapy of Infantile Cerebral Palsy” notes that a characteristic feature of dysarthria is voice disturbance, which largely depends on the pathological condition of the muscles of the larynx, especially the cricoid-thyroid, stretching the true vocal cords. With the defeat of these muscles, the voice becomes weak, non-melodious.
Carrying out articulatory gymnastics when setting up the voice, especially great attention is paid to the development of movements of the soft palate. With the help of these movements, sufficient resonator chambers are formed, which are necessary for the sounding of voice and sound in children with dysarthria and are carried out in the general complex of speech therapy for these children.
Respiratory failure
Respiratory disorders are common in dysarthria, especially in hyperkinetic and cerebellar forms.
These respiratory disorders have a complex pathogenesis. First of all, pareticity of the respiratory muscles, changes in their tone, violation of their reciprocal innervation may be of importance.
Thus, the main symptoms of dysarthria - violations of sound pronunciation and the prosodic side of speech - are determined by the nature and severity of manifestations of articulatory, respiratory and voice disorders. With dysarthria, the lower phonological level of the language is disturbed.
When working with children suffering from dysarthria, it is necessary, along with the development of sound pronunciation, to pay great attention to the development of the auditory functional system, the education of phonemic hearing, to work on the development of speech understanding, to develop the inner speech and intelligence of these children.
1.2. Clinical and psychological characteristics of children with dysarthria
Children suffering from dysarthria, according to their clinical and psychological characteristics, represent an extremely heterogeneous group. At the same time, there is no relationship between the severity of the defect and the severity of psychopathological abnormalities.
Children with dysarthria according to clinical and psychological characteristics can be conditionally divided into several groups depending on their general psychophysical development:
Dysarthria in children with normal psychophysical development.
Dysarthria in children with cerebral palsy (the clinical and psychological characteristics of these children are described in terms of cerebral palsy by many authors: E.M. Mastyukova 1973; M.V. Ippolitova and E.M. Mastyukova, 1975; N.V. Simonova, 1967 , and etc.).
Dysarthria in children with oligophrenia (clinical and psychological characteristics correspond to children with oligophrenia: G.E. Sukhareva, 1965; M.S. Pevzner, 1966).
Dysarthria in children with hydrocephalus (clinical and psychological characteristics correspond to children with hydrocephalus: M.S. Pevzner, 1973; M.S. Pevzner, L.I. Rostyagailova, E.M. Mastyukova, 1983).
Dysarthria in children with mental retardation (MS Pevzner, 1972, etc.).
Dysarthria in children with minimal brain dysfunction. This form of dysarthria is most common among children of special preschool and school institutions. Along with the insufficiency of the sound-producing side of speech, they usually have not pronounced disturbances in attention, memory, intellectual activity, emotional-volitional sphere, mild motor disorders and delayed formation of a number of higher cortical functions.
Emotional-volitional disorders are manifested in the form of increased emotional excitability and exhaustion of the nervous system. In the first year of life, such children are restless, cry a lot, require constant attention. They have sleep disturbances, appetite, predisposition to regurgitation and vomiting, diathesis, gastrointestinal disorders. They do not adapt well to changing weather conditions.
Most children with dysarthria are characterized by extreme excitability, which is associated with various neurological symptoms, and therefore games that are not controlled by the teacher sometimes take on very unorganized forms. Often, children of this category cannot occupy themselves with a certain task at all, which indicates that they have insufficiently developed joint activities.
Others are timid, inhibited in a new environment, avoid difficulties, and do not adapt well to a change in the situation. They are characterized by passivity, sensitivity, dependence on others, a tendency to spontaneous behavior.
A significant part of first-graders (40%) have the property of concentricity, which indicates their focus on their problems, the tendency to keep all experiences in themselves, isolation.
Despite the fact that children do not have pronounced paralysis and paresis, their motor skills are characterized by general awkwardness, lack of coordination, they are awkward in self-service skills, they lag behind their peers in dexterity and accuracy of movements, they have a delay in developing hand readiness for writing, therefore, for a long time there is no interest in drawing and other types of manual activities, poor handwriting is noted at school age. Disorders of intellectual activity are expressed in the form of low mental performance, memory and attention disorders.
Many children are characterized by a slow formation of spatio-temporal representations, optical-spatial gnosis, phonemic analysis, and constructive praxis.
Very important for the formation of the child's personality is the problem of awareness of one's defect. IN AND. Seliverstov (1989) distinguishes the following degrees of fixation of children on their defect.
Zero. Children do not experience frustration from the consciousness of the inferiority of their speech or even do not notice its shortcomings at all. They willingly come into contact with peers and adults, acquaintances and strangers.
Moderate. Children experience unpleasant experiences in connection with the defect, hide it, compensating for the manner of verbal communication with the help of tricks. Nevertheless, these children's awareness of their lack does not result in a constant, painful feeling of their inferiority.
Expressed. Children are constantly fixed on their speech deficiency, deeply experience it, put all their activities in dependence on their speech failures. They are characterized by withdrawal into illness, self-abasement, morbid suspiciousness, pronounced fear of speech.
Disorders in the emotional-volitional and personal spheres not only worsen and reduce the performance of children with dysarthria, but can also lead to behavioral disorders and social maladjustment, in connection with which differentiated psychoprophylaxis and psychocorrection of the features of emotional and personal development acquire special significance.
Many authors dealt with the problem of complex correction of disorders in children with dysarthria. Some researchers (M.B. Eidinova, E.N. Pravdina-Vinarskaya, K.A. Semyonova, E.M. Mastyukova, I.I. Panchenko, L.A. Shcherbakova and others) considered this problem in the aspect of overcoming deviations in cerebral palsy. L.V. Lopatina, N.V. Serebryakova, R.I. Lalaeva, I.B. Karelina and other authors have been developing methods for overcoming disorders in children with an erased form of dysarthria. Below are the methodological recommendations for overcoming dysarthria disorders in the clinic for the rehabilitation of cerebral palsy and the content of speech therapy effects in case of erased dysarthria.
I.I. Panchenko and L.A. Shcherbakov, who proposed a system of work on the correction of dysarthria in children with cerebral palsy, believe that the correction should be carried out in a complex manner, taking into account the need for medical and physiotherapeutic treatment and proper speech therapy measures of a corrective nature.
The speech therapy aspect of recovery provides for:
The system of exercises of therapeutic speech therapy physical education;
The system of psychological influence;
A system of exercises on the phonemic analysis of words and the formation of the reproduction of phonemes;
Normalization of prosodic speech;
Fight against salivation.
I.B. Karelina offers the following content of the stages of speech therapy intervention in MDD.
Propaedeutic.
Examination, massage of the organs of the articulatory apparatus, correction of general and fine motor skills.
II. Correction of the phonetic side of speech.
The development of phonemic perception, the consolidation of correct voice leading and breathing.
Sound correction.
III. Correction of the lexical and grammatical side of speech.
Activation and expansion of the dictionary.
Correction of grammatical disorders.
A technique for overcoming phonetic disorders in children with an erased form of dysarthria (L.V. Lopatina, N.V. Serebryakova).
The main attention in the method of overcoming phonetic disorders in children with an erased form of dysarthria L.V. Lopatina, N.V. Serebryakova pays attention to the formation of the kinesthetic basis of hand movements and articulatory movements. The system of exercises for the development of motor function provides for a simultaneous impact on the kinetic basis of movement, on static and dynamic coordination of movements and their gradual complication. When developing this technique, some exercises described in the works of A.R. Luria, N.I. Ozeretsky, O.S. Bot, E.F. Sobotovich, R.I. Lalayeva.
The methodology includes the following exercises for the correction of phonetic disorders: for the development of the kinesthetic basis of hand movements; on the development of dynamic coordination of hands in the process of performing sequentially organized movements; on the development of dynamic correction of the hands in the process of performing simultaneously organized movements; on the formation of the kinesthetic basis of articulatory movements; by definition of the tip of the tongue (raised or lowered); to distinguish between a narrow and wide tip of the tongue; on the development of statics of articulatory movements; on the development of dynamic coordination of articulatory movements in the process of performing sequentially organized movements; on the development of dynamic coordination of articulatory movements in the process of performing simultaneously organized movements.
Since the phonetic side of speech is a close interaction of its main components (sound pronunciation and prosodic), and since children with an erased form of dysarthria have a violation of a number of prosodic elements of speech, the methodology indicates techniques for the formation of intonational expressiveness of speech, taking into account modern linguistic ideas about intonation, as well as features of the intonation structure of sentences in the speech of the category of children under study.
Work on the formation of intonational expressiveness of speech is preceded by rhythmic exercises. They prepare for the perception of intonation expressiveness, contribute to its development, create the prerequisites for the assimilation of logical stress, the correct reading of phrases.
The methodology includes sets of exercises for the development of rhythm perception; on the formation of ideas about intonation expressiveness in impressive speech (the formation of general ideas about intonational expressiveness of speech; acquaintance with narrative intonation, means of its expression and ways of designation; acquaintance with interrogative and exclamatory intonation, means of their expression and ways of designation; differentiation of the intonation structure of sentences in an impressive speech); on the formation of intonational expressiveness in expressive speech (development of voice power, height, intonational expressiveness, narrative, exclamatory and interrogative sentences).
Speech therapy work to overcome phonemic disorders in children with an erased form of dysarthria is carried out taking into account modern ideas about the multilevel structure of the speech perception process (N.I. Zhinkin, I.A. Zimnyaya, V.I. Galunov, L.A. Chistovich, E. N. Vinarskaya). Taking into account the ratio of elementary and higher mental functions in the process of child development and scientific data on the stages of development of phonemic functions in ontogenesis.
When developing this methodology, some techniques and methods described in the works of V.K. Orfinskaya, D.B. Elkonina, E.F. Sobotovich, R.I. Lalayeva.
The methodology includes the following sections on the correction of phonemic disorders: the formation of the perception of oral speech at the phonetic level; formation of the perception of oral speech at the phonological level.
The first stage includes: the formation of the perception of oral speech in the process of imitation of syllables; formation of perception of oral speech in the process of distinguishing between correctly and distortedly pronounced sound
The second stage includes: clarification of the articulation of sound based on visual, auditory, tactile perception, kinesthetic sensations; highlighting a sound against the background of a syllable; highlighting the sound against the background of the word.
Thus, the methodology developed sets of exercises, taking into account the disturbed components of speech in dysarthria and disturbed mental processes characteristic of children with an erased form of dysarthria.
conclusions
Based on the studied literature, the following conclusions can be drawn.
1. Speech is the result of the coordinated actions of many brain mechanisms, namely the mechanisms that perceive speech and ensure its understanding. With dysarthria, which is a complex speech pathology, focal lesions of the brain are noted, limited mobility of the organs of the articulatory apparatus is diagnosed: soft palate, tongue, lips. This is a consequence of insufficient innervation of the muscles of the speech apparatus.
2. Characteristic manifestations of dysarthria are: violations of articulatory motility in the form of changes in the tone of the articulatory muscles, limitation of the volume of their voluntary movements, coordination disorders, various kinds of synkinesis, tremor, hyperkinesis of the tongue, lips; respiratory disorders; voice disorders.
3. The leading defect, which is associated with an organic lesion of the central and peripheral nervous systems, is a violation of the sound-producing and prosodic aspects of speech, which are determined by the nature and severity of manifestations of articulatory, respiratory and voice disorders.
4. There are various classifications of dysarthria, which are based on different approaches to this speech disorder.
The most common classification in Russian speech therapy was created taking into account the neurological approach based on the level of localization of the lesion of the motor apparatus of speech, developed by O.V. Pravdina and others.
Based on this classification, the following forms of dysarthria are distinguished:
bulbar
pseudobulbar
extrapyramidal (or subcortical)
cerebellar
cortical
The basis for the allocation of these forms of dysarthria is the different localization of brain damage.
There are also minimal dysarthria disorders, which occupy an intermediate position between dysarthria and dyslalia.
5. Speech therapy work with dysarthria is complex: correction of sound pronunciation, the prosodic side of speech is combined with the formation of sound analysis and synthesis, the development of the lexical and grammatical side of speech and a related statement. A feature of working with children with dysarthria is a combination with differentiated articulatory massage and gymnastics, speech therapy rhythm, and sometimes with general physiotherapy, physiotherapy, as well as drug treatment. Very important in speech therapy work with children is the individualization of the correctional process, depending on the form of dysarthria, the selection of differentiated methods of correction.
Correctional and pedagogical work includes the following sections:
Development of manual motor skills and motor skills of the articulatory apparatus.
Formation of the correct articulation of sounds and their automation in various forms of speech.
Formation of intonational expressiveness of speech.
Formation of oral speech perception.
ChapterII. Experimental study of the organization and content of speech therapy work with children suffering from dysarthria
2.1. Organization of the ascertaining experiment. Studying the state of the problem in the practice of the work of a speech therapist
The experiment was carried out in May 2007 in the preschool institutions of Smolensk "Jubilee", "Sun", "Little Red Riding Hood".
Purpose: to identify the effectiveness of the organization and content of speech therapy work with children suffering from dysarthria.
In connection with the goal, speech therapists of preschool institutions, who were asked to fill out questionnaires, took part in the experiment. The questionnaire consists of three blocks:
1 block - general information about the speech therapist teacher;
2 block - theoretical knowledge of a speech therapist teacher about dysarthria;
Block 3 - the practical activities of a speech therapist teacher to overcome dysarthria.
Below is the application form.
1 block. General information about the teacher-speech therapist.
1. Full name _______________________________________________________________
2. Education____________________________________________________________________
3. Work experience as a teacher-speech therapist ___________________________________________________________
4. Place of work __________________________________________________________
2 block. Theoretical knowledge on the problem of dysarthria.
1. List the main causes of dysarthria __________________________________________________________
__________________________________________________________________
2. What are the most common disorders in dysarthria?_________________________________________________________________________________________________________________
3. What aspects of speech suffer from dysarthria? _________________________________________________________________________________________________________________________________________________________________________________________________
4. What characterizes speech in dysarthria? _________________________________________________________________________________________________________________________________________________________________________________________________
5. Specify the forms of dysarthria disorders ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
6. Who proposed the most common classification of forms of dysarthria?
7. Specify the main clinical manifestations of dysarthria in children ________________________________________________________________________________________________________________________________________________________________________________________________________________
8. What is the most common form of dysarthria?
9. What are the main neurological symptoms in dysarthria?_______________________________________________________________________________________________________________________________________________________________________________________________
10. What is the peculiarity of working with dysarthric children? _________________________________________________________________________________________________________________________________________________________________________________
3 block. Practical work teacher-speech therapist to overcome dysarthria.
1. Has the number of children with dysarthria changed during your tenure as a speech pathologist? If yes, how?________________________________________________________________________________________________________________________________________________________________________________________________
2. What is the trend in the prevalence of dysarthria?_________________________________________________________________________________________________________________________________________________________________________________________________
3. What are the main areas of work with dysarthric children in your work can you highlight?_________________________________________________________________________________________________________________
__________________________________________________________________
4. Indicate the severity of dysarthria disorders in children of your group _______________________________________________________________________________________________________________________________
5. What difficulties do you experience in correcting dysarthria:
a) in the diagnosis of dysarthria and similar conditions ________________________________________________________________________________________________________________________________________________________________________________________________
b) when organizing speech therapy work with children with dysarthria _______________________________________________________________________________________________________________________________________________________________________________________________
c) when selecting language material _________________________________________________________________________________________________________________________________________________________________________________________________
d) when selecting exercises, tasks and didactic games ________________________________________________________________________________________________________________________________________________________________________________________________________________
e) when correcting the respiratory function
6. What is the leading direction, in your opinion, when working with dysarthria?
7. State what you think are the prerequisites for a successful
overcoming dysarthria?________________________________________________________________________________________________________________________________________________________________________________________________
7. Do you exercise psychological influence during the correction of dysarthria? How?________________________________________
__________________________________________________________________
In order to study in more detail the organization and content of speech therapy work with children suffering from dysarthria, Marina Alexandrovna Isaeva was introduced to the experience of the teacher-speech therapist of the MDOU CRR d / s No. 38 "Jubilee". 11 years of experience as a speech pathologist. In addition to this educational institution, Marina Alexandrovna works at the secondary school No. 19, at the Yagodka preschool.
During her work as a teacher-speech therapist, Marina Aleksandrovna notes an increase in the number of children suffering from dysarthria. The speech therapist considers erased dysarthria the most common form. Marina Alexandrovna distinguishes the following disorders characteristic of children with dysarthria: hypersalivation, various types of sigmatism (especially interdental and lateral), low muscle tone in the articulatory apparatus. The speech therapist refers to the clinical manifestations of dysarthria: tremor of the tongue, limitation of movements and switching of articulatory movements, difficulties in maintaining the articulatory posture, impaired sound pronunciation, difficulties in automating sounds, deviations in the prosodic characteristics of speech. The specialist considers the combination of articulatory gymnastics with articulatory massage to be a feature of the work to overcome dysarthria. An individual approach to the correction of dysarthria is needed: taking into account the age, personality characteristics of the child, the level of his intellectual development, which determines a certain choice of exercises, tasks and didactic games. According to the plan, the speech therapist conducts 3 individual sessions per week, although he does not consider this amount of time to be sufficient.
Marina Alexandrovna considers sound production and automation to be the main stages in the correction of dysarthria. Moreover, automation is the most difficult aspect and, as the speech therapist notes, it is especially difficult in syllables and words. But even sound production sometimes causes difficulties, especially when correcting the interdental shape, which, as Marina Aleksandrovna notes, is also a cosmetic defect and cannot always be corrected. For example, the lateral form is overcome much easier and faster.
A very interesting aspect of work during sound production, which Marina Alexandrovna uses, is the production of sounds based on the palm of a child. The speech therapist shows the language structure and asks the child to repeat after him, using his fingers. For example, when setting [w], the child's hand rises up along with the tongue, which gives an additional tactile sensation, visual support. This technique contributes to the accelerated automation of sound.
Correction of the respiratory function and prosodic characteristics of speech Marina Alexandrovna begins to carry out only when speech therapy work is already carried out on the material of coherent speech.
During his work, the speech therapist states a decrease in the intellectual abilities of children, which, of course, complicates the process of overcoming dysarthria. Delay is especially common mental development(ZPR). If this violation takes place, Marina Alexandrovna notes that in this case the sounds are set quite quickly, just as with the norm of intellectual development, but it is much longer and more difficult to automate. Normally, this process occurs much faster, since the intellectual abilities of the child are included in the work.
Marina Alexandrovna cannot single out characteristic psychological and pedagogical features and neurological symptoms, since at present a very large number of children who have not been diagnosed with dysarthria have developmental deviations.
The teacher-speech therapist conducts all speech therapy work using gaming methods and techniques. For example, the child's phonemic reactions to hearing (jump, clap, etc.); laying out pictures in two rows according to the principle of the presence of the desired sound in them; the use of geometric shapes - put them as many as you hear a given sound, etc.
Unfortunately, as Marina Alexandrovna notes, the conditions for successful speech therapy work are minimal, since this is a rather complex and polymorphic disorder that requires long-term and high-quality work by a specialist.
2.2. The results of the ascertaining experiment. Conditions for the effectiveness of the organization and content of speech therapy work with children suffering from dysarthria
Based on the analysis of the questionnaires, the following conclusions can be drawn:
An increase in the number of children suffering from dysarthria;
The peculiarity of working with children with dysarthria is the need for massage, gymnastics for the tongue.
Speech therapy work with dysarthria should be built in stages;
The most common form of dysarthria is pseudobulbar;
The main aspects of speech therapy work, which are given more time in the correction of dysarthria, are sound production, automation, work on articulatory motor skills;
In order for speech therapy work with dysarthria to be effective, it is necessary to ensure the full functioning of the muscular apparatus.
Based on the experiment, the following conditions for the effectiveness of the organization and content of speech therapy work with children suffering from dysarthria can be distinguished:
a sufficient amount of theoretical knowledge and practical experience of a speech therapist teacher is required;
it is necessary to use gaming methods and techniques in the correction of dysarthria;
when correcting dysarthria, it is necessary to cover all components of the speech system;
when working with dysarthria, work should begin with the normalization of the muscle base;
in order to successfully overcome dysarthria in the organization of speech therapy classes, it is necessary to take into account the individual capabilities of each child;
the success of speech therapy classes largely depends on their early start and systematic implementation;
communication of a speech therapist teacher with teachers, doctors and family is necessary;
work on sound pronunciation is built taking into account the form of dysarthria, the level of speech development and the age of the child. They begin with those sounds, the articulation of which the child has is more preserved. Sometimes the sounds are chosen according to the principle of simpler motor coordinations, but always taking into account the structure of the articulation defect as a whole, first of all, they work on the sounds of early ontogenesis. In severe disorders, when speech is completely incomprehensible to others, work begins with isolated sounds and syllables. If the child's speech is relatively understandable and in some words he can pronounce defective sounds correctly, work begins with these words. In all cases, it is necessary to automate these sounds in all contexts and various speech situations.
conclusions
Methods and techniques of correctional work are differentiated depending on the level of speech development.
Early and systematic speech therapy help is important.
To effectively overcome dysarthria, it is necessary to use game methods and visual aids.
When organizing speech therapy classes, it is necessary to take into account the individual characteristics of each child.
Since dysarthria is a complex speech disorder, correction of all aspects of speech is necessary.
In the process of working on all aspects of speech, the prosodic characteristics of speech, respiratory function are corrected, and the muscle base is normalized.
Polymorphic violation of sound pronunciation determines the choice of a specific system for working on sounds.
The greatest attention should be paid to the automation of sounds in connected speech.
It is necessary to form communicative pronunciation skills and abilities. That is, the knowledge acquired speech therapy session, should be actively used in everyday communication.
At each stage of speech therapy work, work is needed to develop articulatory movements and praxis, since the lack of control over the position of the mouth in children with dysarthria greatly complicates the development of voluntary articulatory movements.
The interrelated work of the teacher-speech therapist and parents is necessary.
Conclusion
Speech is one of the most important mental functions of a person.
In the process of speech development, the highest forms of cognitive activity, the ability to conceptual thinking are formed. In the process of the mental development of the child, a complex, qualitatively new unity arises - speech thinking, speech-thinking activity.
Speech is complex function, and its development depends on many factors. The influence of others plays a big role here - the child learns to speak on the example of the speech of parents, teachers, friends. Surrounding should help the child in the formation of correct, clear speech. It is very important that a child from an early age hear correct, distinctly sounding speech, on the example of which his own speech is formed. Violation of speech, limited speech communication can negatively affect the formation of the child's personality, cause mental layers, specific features of the emotional-volitional sphere.
If a child has speech defects, he is often subjected to peer ridicule, offensive remarks, and does not participate in concerts and children's parties. The child is offended, he does not feel equal among other children. Gradually, such a child separates from the team, withdraws into himself. He tries to remain silent or answer in monosyllables, not to take part in speech games.
The task of a speech therapist, together with parents, is to convince the child that speech can be corrected, you can help him become like everyone else. It is important to interest the child so that he himself wants to participate in the process of speech correction. And for this, classes should not be boring lessons, but an interesting game.
Currently, dysarthria is a consequence of an organic disorder of the central nature, leading to movement disorders.
Dysarthria is a violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus.
With dysarthria, there is a lack of formation of all links of the complex mechanism of phonation formulation of an utterance, which results in anarthria, which manifests itself in the impossibility of realizing the sound realization of speech. In mild cases of dysarthria, when the defect manifests itself mainly in articulatory-phonetic disorders, they speak of its erased form. Such cases should be distinguished from dyslalia.
The classification is based on the principle of localization, syndromological approach, the degree of intelligibility of speech for others. The most common classification in Russian speech therapy is related to the neurological approach based on the level of localization of the lesion of the motor apparatus of speech (O.V. Pravdina et al.)
There are the following forms of dysarthria: bulbar, pseudobulbar, extrapyramidal (or subcortical), cerebellar, cortical.
There is a classification of dysarthria according to the severity of speech disorders (dysarthria of the 3rd degree, dysarthria of the 2nd degree and dysarthria of the 1st degree - anartria).
The main signs of dysarthria are defects in sound pronunciation and voice, combined with speech disorders, primarily articulatory motility and speech breathing. With dysarthria, unlike dyslalia, the pronunciation of both consonants and vowels can be disturbed. Vowel disorders are classified according to rows and elevations, consonant disorders - according to their four main features: the presence and absence of vibration of the vocal folds, the method and place of articulation, the presence or absence of an additional rise of the back of the tongue to the hard palate.
For all forms of dysarthria, articulatory motility disorders are characteristic, which manifest themselves in a number of ways. Violations of muscle tone, the nature of which depends primarily on the location of the brain lesion. The following forms are distinguished in the articulatory muscles: spasticity of the articulatory muscles - a constant increase in tone in the muscles of the tongue, lips, in the facial and cervical muscles. An increase in muscle tone may be more localized and extend only to individual muscles of the tongue.
The main symptoms of dysarthria are violations of sound pronunciation and the prosodic side of speech, which are determined by the nature and severity of manifestations of articulatory, respiratory and voice disorders. With dysarthria, the lower phonological level of the language is disturbed.
With dysarthria, along with speech disorders, non-speech disorders are also distinguished. These are manifestations of bulbar and pseudobulbar syndromes in the form of disorders of sucking, swallowing, chewing, physiological breathing in combination with disorders of general motor skills and especially fine differentiated motor skills of the fingers. The diagnosis of dysarthria is made on the basis of the specifics of speech and non-speech disorders.
In the course of work, to test the hypothesis, the goal of the study was set - to determine the conditions for effective correctional and pedagogical work with children suffering from dysarthria. In accordance with the hypothesis and the goal, the following tasks were solved:
1) the state of the problem in the theory and practice of the modern speech therapy process has been studied;
2) the conditions for the effectiveness of the organization and conduct of speech therapy work with preschoolers suffering from dysarthria are determined;
So, the organization of speech therapy work with children suffering from dysarthria largely depends on the form of this disorder, its severity. The content of speech therapy classes can also vary depending on many factors. For example, the personality traits of the child. A necessary aspect in overcoming dysarthria is the relationship of a speech therapist with other specialists, as well as the help of parents. And, finally, no less important is the early diagnosis and correction of dysarthria, as well as the phasing and sequence of speech therapy classes.
List of studied literature
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Vinarskaya E.N. Dysarthria. - M.: Astrel, 2005 - p. 140
3. Vlasova T.E., Lebedinskaya K.S. Actual problems of clinical
study of mental retardation / Defectology. - 1975. -№
6. - p. 20-27.
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ped. un-t im. A.I. Herzen. - St. Petersburg: Book publishing house "Saima", 1993.
5. Karelina I.B. New directions in the correction of minimum
dysarthric disorders // Defectology. - 2000. - No. 1.
6. Kopytova S.V. Correctional work with children with dysarthria
speech disorders // Education and education of children with disabilities
development. - 2006. - No. 3. - p. 64-69.
7. Speech therapy: Proc. for students defectol. fak. Pedagogical Universities / Ed.
L.S. Volkova, S.A. Shakhovskaya. – M.: VLADOS, 1999.- p. 156-196
8. Speech therapy: Methodological heritage: a guide for speech therapists and students
defectol. fak. ped. universities: in 5 books. / ed. L.S. Volkova. – M.: Vlados,
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Publishing house of the Russian State Pedagogical University im. A.I. Herzen, Soyuz, 2001
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speech correction. - Rostov - on - Don: RGPU, 1997.
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Experimental study of the state of motor functions in children with dysarthria
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Thesis >> PsychologyEducational Job from children with delayed speech development Job Content Introduction... patients, suffering dysarthria varying degrees ... speech disorders in children and organization speech therapy work in a preschool setting...
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Coursework >> PsychologyEarly age suffering cerebral palsy... dysarthria. pseudobulbar dysarthria... shows that content, methods and... Logopedic Job from children with cerebral palsy Planning speech therapy work... is an organization early...
