Mild (erased) form of dysarthria. The concept of "erased dysarthria" in Russian speech therapy

Today we will try to understand the essence of the phenomenon called "dysarthria". What it is? What causes pathology? This is especially important, since in children with normal mental development, this disease is up to 6% of cases, and there is an upward trend in this indicator.

Dysarthria is a violation of the pronunciation of sounds caused by damage to areas of the brain and, accordingly, a disorder of the innervation of the muscles involved in speech.

Severe dysarthria - what is it?

There is dysarthria in mild and severe form. The latter is considered as one of the manifestations. Such children receive both speech therapy and medical care in the complex. It is provided by specialized children's institutions (kindergartens and schools for children with speech problems or disorders of the musculoskeletal system).

Erased dysarthria - what is it?

Children with a mild degree of dysarthria (in other words, it is called "erased") are trained, as a rule, in general children's institutions.

It manifests itself in a slight violation of the functions of the organs of articulation, and the speech of such children is fuzzy, but understandable to others, since the basis of the disease is only pinpoint lesions of the cerebral cortex. This results in paresis of only some of the muscles used for articulation, such as only one side of the tongue or its tip.

When compared with dyslalia (impaired pronunciation of sounds with normal innervation of the articulatory apparatus), the violations in question have a completely different cause and

Symptoms of dysarthria

Diagnosis of dysarthria, despite the fact that children affected by it, most often do not stand out among their peers, occurs according to some common features:

In addition to these problems, children, even with a mild degree of dysarthria, suffer from increased excitability and exhaustion. nervous system. Already from the first year of life, this is manifested by tearfulness and a constant demand for attention from loved ones, sleep disturbances, a predisposition to frequent vomiting, and gastric disorders. The condition of such children often depends on meteorological changes.

Treatment of dysarthria

Dysarthria is treated comprehensively, with the participation of both a psychoneurologist and a speech therapist. But a significant role in this is given to parents, so it is extremely important for them to know: the diagnosis of "dysarthria" - what it is, for which certain procedures and exercises are carried out, and also to clearly imagine the possible results.

In the course of treatment, they are used as therapeutic procedures ( medications, physiotherapy and acupuncture to normalize muscle tone, as well as speech therapy (articulatory gymnastics, voice correction and pronunciation correction, etc.).

Dysarthria is a speech disorder caused by a change in the nervous regulation of the speech apparatus, in which pronunciation suffers. Considering that in last years the proportion of pathological pregnancies is increasing, the general level of health of mothers and their children is decreasing, the problem of speech disorders is becoming more and more urgent.

The reasons

The causes of dysarthria are:

intrauterine infections;
severe toxicosis during pregnancy in the mother;
birth injury;
past infections of the central nervous system (meningitis, encephalitis);
malformations of the nervous system;
severe hereditary diseases.

Classification

Speech therapists determine the types of dysarthria according to the severity of symptoms:

severe degree (anarthria) - patients do not speak at all, and at the same time, complete immobility of the speech muscles is observed.
moderate severity, when the mobility of some muscle groups and the articulation of individual sounds are preserved.
erased dysarthria (mild degree). In this case, blurred speech is observed, children speak through the nose, fuzzy sound pronunciation.

Neurologists classify dysarthria according to the location of the lesion in the brain. There are 5 forms:

Cortical - the development of writing and reading is disturbed, the development of vocabulary is difficult. Individual sounds are well pronounced, but difficulties arise in the speech flow - replacing one sound with another. With the acceleration of the pace of speech, hesitation begins, resembling stuttering.
Pseudobulbar form - voluntary movements change, for example, raising the tip of the tongue up is difficult, and involuntary ones remain - stretching the lips with a tube, smacking, sticking out the tongue, licking, loud crying and laughter. Children cannot, at the request, open their mouths, make a sound, while yawning, sneezing, crying, coughing persist. The pronunciation of sounds is deaf, but in some cases the deaf can be voiced. The sagging of the palate leads to a nasal tone of speech. Fine motor skills of the hands suffer - it is not possible to tie shoelaces on your own, fasten buttons. Children do not know how to sculpt and draw. As a rule, the child hears his defects and tries to fight them, which can lead to even greater manifestation of disorders due to increased muscle tone due to unrest.
Bulbar - leads to paresis or paralysis of the muscles of the tongue, palate, chewing and swallowing are disturbed. The voice of such children is weak, pronunciation in the nose. Speech is slurred, slurred, unintelligible. On examination, one can see atrophy of the muscles of the tongue and pharynx, atony, and the face is amimic.

Subcortical dysarthria is manifested by a violation of intonation and tempo of speech. More often it becomes noticeable with excitement and emotions. The features of this form are hyperkinesis both in the speech muscles and in the muscles of the body. The patient can correctly speak words and phrases with loved ones and in a state of emotional comfort, and after a moment - not utter a single sound. The voice is interrupted, there may be spontaneous cries, guttural sounds. Characteristic is the violation of tempo, rhythm, intonation. Manifestations are variable depending on the condition of the patient and this is reflected in the ability to communicate and maintain a conversation. Sometimes hearing loss can be associated, which complicates speech defects.

Symptoms

With dysarthria, the pronunciation of both consonants and vowels suffers. Violations can manifest themselves in the form of the absence of sounds, replacing them with others, distorting and mixing them. The motility of the muscles responsible for the formation of speech changes - their tone is disturbed, which manifests itself both in increased spasticity of the muscles of the tongue, face, lips, neck, and hypotension (decreased tone).

Dystonia is manifested by the fact that at rest the muscle tone is reduced, when you try to talk (speech, pronounce words) it rises sharply. There may be restrictions on muscle mobility due to changes in tone and hyperkinesis (involuntary movements), tremors (trembling).

Speech breathing disorders are manifested by a change in the tone of the respiratory muscles, movement disorders, voice, melody, intonation changes. The strength of the voice may suffer, which becomes weak, quiet, as if strength is running out. The timbre is deaf, dull, there are difficulties in changing the tone.

Dysarthria is often accompanied by symptoms that are not related to speech - these can be chewing, swallowing, sucking disorders, changes in the emotional-volitional sphere, lack of interest in the outside world and the acquisition of new knowledge.

Erased dysarthria

This is the most common type. Children speak through their noses, intonation may be disturbed. When talking, articulation is not expressed, lip movements are minimal. The problem is to fold the tube from the lips. Patients have poor diction, fuzzy, slurred and slurred speech, replacement or distortion of sounds in polysyllabic words. Poems are told in a monotone, the voice gradually fades away. At the request to depict the sounds of animals, attempts are unsuccessful.

In general development, awkwardness in movements can be noted, such children grab and hold objects later than healthy ones, walk awkwardly, run, jumping on one or two legs is difficult for them. The child learns hard to skate and ski, ride a bike. Due to the violation of fine motor skills of the fingers, he poorly sculpts, draws, puts together a mosaic, does not like small toys and does not play constructors. In children with an erased form of dysarthria, writing and reading is difficult, poor handwriting.

The diagnosis of dysarthria can be established by several symptoms or syndromes. This may be a change in the tone of the muscles responsible for pronunciation and the formation of speech - facial expression, lethargy or spasticity of the tongue, trembling in the tongue, inability to perform movements such as curling the lips with a tube, raising the tongue up and down. There is a nasal tone of speech, salivation.

Characteristic is the difficulty in pronouncing not one, but several sounds, the fading and slowing down of speech by the end of the phrase, the pronunciation becomes illegible. The intonation changes and becomes unnatural. Children speak monotonously and slowly.

It is important to assess the anamnesis - the presence of intrauterine pathology or complications in childbirth, neurological and electrophysiological examination (electroneurography, electroencephalography).

Correction

Treatment by a neurologist is obligatory - medical and restorative, which is prescribed after establishing an accurate diagnosis and type of disease. In addition to medicines, reflexology, massage, physiotherapy methods, and psychotherapy are used. Non-traditional forms of influence are widely used - dolphin therapy, game therapy.

Working with a speech therapist

Children with dysarthria need constant work with a speech therapist.

The specialist divides classes with children into original blocks. First, a speech therapy massage is performed, which is designed to normalize the tone of the speech muscles. Further classes in articulatory gymnastics, training of breathing, intonations. Children are taught self-control of their pronunciation. The exercises get more difficult as you get better.

Mandatory classes are aimed at developing fine motor skills of the hands, since the muscles responsible for precise small movements are associated with the articulatory apparatus.

In severe cases, training in special schools for speech correction is shown.

Prevention

Children with an increased risk of developing dysarthria (pathology of intrauterine development, trauma during childbirth, neuroinfections) need constant attention with an emphasis on psychophysiological development. It is necessary to monitor the regime, to prevent the influence of adverse physical and psychological factors.

These children need constant communication, conversation, you need to keep buzzing in early age, stimulate babble. Attention is paid to the development of grasping movements, the promotion of the study of toys in a variety of ways. different shapes and surfaces.

Forecast

With the earliest possible start of correction and rehabilitation in case of erased form dysarthria, the prognosis is favorable. Success depends on the diligence of the patient himself, a favorable psychosocial background, the support of parents and relatives.

When severe forms at timely treatment, active work with a speech therapist, placement of children in special schools, you can achieve a significant improvement in speech.

In the video, a speech therapist talks about games and techniques that parents can use to develop their children's speech:

The erased form of dysarthria is one of the most common and difficult-to-correct disorders of the pronunciation side of speech in children of preschool and primary school age. With minimal dysarthria disorders, there is insufficient mobility of individual muscle groups of the speech apparatus (lips, soft palate, tongue), general weakness of the entire peripheral speech apparatus due to damage to certain parts of the nervous system. Today it can be considered proven that, in addition to specific disorders of oral speech, there are deviations in the development of a number of higher mental functions and processes responsible for the development of written speech, as well as a weakening of general and fine motor skills.

Studying the anamnesis of children with erased dysarthria, factors of an unfavorable course of pregnancy and childbirth, asphyxia, a low Apgar score at birth, the presence of a diagnosis of PEP - perinatal encephalopathy in the vast majority of children in the first year of life are revealed.

When getting acquainted with the early development of the child, a delay in locomotor functions is noted. These children often refuse breastfeeding, disproportionality of development is noted: they start standing earlier than sitting, walking ahead of crawling, crawling backwards or sideways, experiencing motor awkwardness when walking, quickly getting tired when performing certain movements, they cannot jump, step over stairs, grab and hold the ball. There is a late appearance of the finger grip of small objects, a long-term preservation of the tendency to capture small objects with the whole brush.

Children with erased dysarthria have some characteristic features. In early childhood, they speak slurredly and eat poorly. Usually they do not like meat, carrots, hard apple, as it is difficult for them to chew. After chewing a little, the child can hold the food behind his cheek until adults reprimand him. It is more difficult for such children to develop cultural and hygienic skills that require precise movements of various muscle groups. The child cannot rinse his mouth on his own, because. he has poorly developed muscles of the tongue and cheeks. Children with dysarthria do not like and do not want to fasten their own buttons, lace up their shoes, roll up their sleeves. They also experience difficulties in visual activity: they cannot properly hold a pencil, use scissors, regulate the force of pressure on a pencil and a brush. These children are also characterized by difficulties in performing physical exercises and in dancing. It is not easy for them to learn to correlate their movements with the beginning and end of a musical phrase, to change the nature of movements according to the percussion beat. They say about such children that they are clumsy, because they cannot clearly and accurately perform various tasks. movement exercises. It is difficult for them to maintain balance while standing on one leg, often they cannot jump on their left or right foot.

Studies of the neurological status of children with erased dysarthria reveal a mosaic of disorders of the innervation of the facial, glossopharyngeal or hypoglossal nerves. The fibers of the hypoglossal nerve innervate the muscles of the tongue. These nerve fibers fan up and forward, attaching to the mucous membrane of the back of the tongue, which gives the tongue mobility and flexibility, as well as the ability to upset the tongue downwards.

In cases of dysfunction of the hypoglossal nerve, deviation of the tip of the tongue towards paresis (deviation) is noted, mobility in the middle part of the tongue is limited. When the tip of the tongue is raised, the middle part of the tongue quickly descends to the side of the paresis, causing the appearance of a lateral air stream. With lesions of the hypoglossal nerve, the movements of the lower jaw are difficult, there is increased salivation, and violations of the function of swallowing.

The glossopharyngeal nerve innervates the tongue, pharynx, middle ear, and parotid gland. In children with a predominance of dysfunction of the glossopharyngeal nerve, the leading symptoms are changes in the muscle tone of the root of the tongue and soft palate, which leads to phonation disorders, the appearance of nasalization, distortion or absence of posterior lingual sounds [K] [G] [X]. The voice suffers significantly, it becomes hoarse, tense, or, conversely, very quiet, weak. Thus, unintelligible speech in dysarthria is caused not only by a disorder of articulation itself, but also by a violation of the coloring of speech, its melodic-intonation side, inexpressiveness of speech, monotony, i.e. violation of prosodic.

Research Lopatina L.V. and other authors revealed in children with erased dysarthria violations of the innervation of the mimic muscles: the presence of smoothing of the nasolabial folds, violations of the muscle tone of the lips and their asymmetry, a reduced range of lip movements, there are difficulties in stretching the lips, raising the eyebrows, closing the eyes.

Along with this, symptoms characteristic of children with erased dysarthria are distinguished: difficulties in switching from one movement to another. When performing exercises for the tongue, selective weakness of some muscles of the tongue, inaccuracy of movements, difficulties in spreading the tongue, lifting and holding the tongue up, tremor of the tip of the tongue are noted; in some children - a slowdown in the pace of movements when the task is repeated, cyanosis of part of the tongue with an increase in load. Many children have: rapid fatigue, the presence of hyperkinesia of the muscles of the face and lingual muscles.

Features of mimic muscles and articulatory motility in children with erased dysarthria indicate neurological microsymptoms. These violations are most often not detected initially by a neurologist and can only be established in the process of a thorough speech therapy examination and dynamic monitoring in the course of corrective speech therapy work. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.

Many authors: Levina R.E., Kiseleva V.A., Lopatina L.V. - the relationship between the violation of the pronunciation side itself and the formation of phonemic and grammatical generalizations has been established. As R.E. Levina points out, the violation of speech kinesthesia in morphological and motor lesions of the speech organs affects the auditory perception of the entire sound system of the language. The slurred, slurred speech of these children does not provide an opportunity for the formation of a clear auditory perception and self-control. This leads to the fact that children with erased dysarthria have an underdevelopment of phonemic perception, which further aggravates the violation of sound pronunciation. In such children, the inability to distinguish their own incorrect pronunciation slows down the process of “adjusting” articulation in order to achieve a certain acoustic effect. In turn, a violation of phonemic perception leads to a secondary underdevelopment of the grammatical structure of speech, which manifests itself as minor delays in the formation of the morphological and syntactic systems of the language, as well as pronounced agrammatisms. The main mechanism of the unformed grammatical structure of speech in children with an erased form of dysarthria is a violation of the differentiation of phonemes. This disorder makes it difficult for children to distinguish the grammatical forms of words due to the fuzziness of the auditory and kinesthetic image of the word and especially the endings.

Lopatina L.V. identifies three groups of children with erased dysarthria, familiarization with which will allow us to more accurately diagnose speech therapy disorders. In the first group of children, the main violation is the distortion or absence of sounds. Violations of sound pronunciation are expressed in multiple distortions and the absence of sounds. Phonemic hearing is fully developed. The syllable structure is not broken. Children successfully master the skills of inflection and word formation. Coherent monologue speech is formed in accordance with age norms. If we consider children with erased dysarthria within the framework of the psychological and pedagogical classification of R.E. Levina, then they can be attributed to the group with phonetic underdevelopment. (FN). According to Arkhipova E.F. the number of children with an erased degree of dysarthria with the initial conclusion "complex dyslalia" is 10%.

In the second group of children, the violation of sound pronunciation is in the nature of multiple substitutions, distortions. To a greater or lesser extent, phonemic hearing is impaired. Difficulties arise in teaching them sound analysis. When reproducing words of a complex syllabic structure - permutations and other errors. Active and passive vocabulary lags behind the norm. There are grammatical errors in speech. Coherent monologue speech is characterized by the use of disyllabic, uncommon sentences. According to Levina's classification, these are children with phonetic and phonemic underdevelopment. (FFN), according to Arkhipova E.F., they make up approximately 30–40% of the entire group with FFN.

In the third group of children, expressive speech is formed unsatisfactorily. Difficulties in understanding complex logical and grammatical structures of sentences are noted. Violations of sound pronunciation are polymorphic in nature. Severe violation of phonemic hearing: the auditory and pronunciation differentiation of sounds is not sufficiently formed, which does not allow mastering sound analysis. The violation of the syllabic structure of words is more pronounced. Active and passive vocabulary lags far behind age standards, and lexical and grammatical errors are multiple and persistent. This group of children with erased dysarthria does not acquire coherent speech.

According to R.E. Levina, the third group of children correlates with general underdevelopment of speech. (ONR). In this group, the erased degree of dysarthria can be in 50 to 80% of children.

With erased dysarthria, pronunciation disorders are caused by violations of phonetic operations, therefore, the development of articulatory motility becomes the most important area of correctional and speech therapy work. This work is carried out in two directions:

the formation of the kinesthetic basis of movement: a sense of the position of the organs of articulation;
the formation of the kinetic basis of movement: the movements of the tongue and articulatory organs themselves.

The determining moment in the production of sound is the formation of static-dynamic sensations, clear articulatory kinesthesias and a kinesthetic image of the movements of the articulatory muscles. The work must be carried out with the maximum connection of all analyzers. Shakhovskaya S.N. recommended the use of all analyzers in speech therapy classes. One and the same thing should be spoken, portrayed, looked at, i.e. pass through the "gates" of all the senses. The success of work on sound is determined by the possibility of forming conscious kinesthetic supports in children. It is important that the child can feel the position and movement of the articulatory organs at the moment of articulation (for example, the rise of the back of the tongue when pronouncing [k], [g]). It is necessary to take into account a variety of tactile sensations (primarily tactile-vibrational and temperature ones), for example, a hand feeling of vibration in the region of the larynx or crown when pronouncing voiced consonants, the duration and smoothness of the exhaled jet when pronouncing slotted sounds [F], [B], [X], brevity of articulation, sensation of a push of air when pronouncing stop consonants [P], [B], [T], [D], [G], [K], sensation of a narrow stream of air [C], [Z], [F], wide [T], [K], temperature [C] - cold jet, [W] - warm.

When staging sounds, it is important that children know the articulation pattern of sound, be able to tell and show the position of the lips, teeth, tongue, whether the vocal folds vibrate or not, what is the strength and direction of the exhaled air, the nature of the exhaled jet. It is useful to compare speech sounds with non-speech sounds. Such a conscious mastery of the correct articulation is of great importance for the formation of the correct articulatory image of the sound of its pronunciation and, what is no less important, its distinction from other sounds.

When forming the kinetic basis of articulatory movements, the main attention should be paid to exercises aimed at developing the necessary quality of movements: volume, mobility of the organs of the articulatory apparatus, strength, accuracy of movements, and the development of the ability to hold the articulatory organs in a given position. Traditional articulation exercises are widely used to develop dynamic coordination of movements, however, special sets of exercises, taking into account the specifics of the disorder, also give a good positive result.

For children with mild dysarthria with increased muscle tone in the articulatory muscles, exercises are offered to relax the tense muscles of the tongue and lips.

To relax the tongue:

stick out the tip of the tongue. Wrinkle it with your lips, pronouncing the syllables pa-pa-pa-pa - then leave your mouth ajar, fixing a wide tongue and holding it in this position counting from 1 to 5-7;
stick out the tip of the tongue between the teeth, bite it with your teeth, pronouncing the syllables ta-ta-ta-ta, leaving the mouth ajar on the last syllable, fixing the wide tongue and holding it in this position counting from 1 to 5-7 and return to its original position;
open your mouth, put the tip of your tongue on your lower lip, fix this position, holding it counting from 1 to 5–7, return to its original state;
silently pronounce the sound AND, while pressing the lateral teeth on the lateral edges of the tongue (this exercise is also a kind of massage technique for the paretic state of the muscles of the lateral edges of the tongue)

To lower the tense root of the tongue, exercises related to protruding the tongue are proposed.

Relaxation of tense lips is achieved by lightly patting the upper lip against the lower lip.

When decreased muscle tone preschoolers with a mild degree of dysarthria are offered tasks for activation, strengthening of paretic muscles:
- scratching with the tip of the tongue on the upper incisors;
- counting the teeth, resting the tip on each;
- stroking the cheek with the tip of the tongue, pressing hard on it inside;
- holding a round candy near the alveoli with the tongue.

not tight-fitting, flaccid lips train using the following tasks:
- stretch the lips into a smile, while exposing the upper and lower incisors, holding the count from 1 to 5–7, return to its original position;
- stretch in a smile only the right, left corner of the lip, while exposing the upper and lower incisors, hold the count from 1 to 5-7, return to its original position;
- hold with your lips pieces of crackers, tubes of different diameters, strips of paper;
- tight closing of the lips.

In the process of correcting sound pronunciation in children with a mild degree of dysarthria, it is proposed to begin fixing the majority of newly formed sounds with the structure of syllables of the SG type, and then move on to the “vowel-consonant” structure. When forming [C], [P], it is allowed to introduce a sound first into the GS syllable. Since the fricative [P] (and at the end of words it is a fricative) is often absorbed better than the trembling one. From the fricative [Р] they successfully pass to the pronunciation of their main trembling variants. The same sequence is followed when working with the sounds [C], since the pronunciation of this consonant at the end of words contributes to the formation in children of the kinesthetic supports they realize.

However, if the child works only with specially selected material, then he will not learn to use sound in independent speech, the effect of “armchair speech” appears. The organizing factor of speech therapy work should be communicative training, the creation of a model of the communication process, which is a series of successive situations. For this, plot games, dramatization games are used that encourage the child to verbal utterance. Project activity can be widely included in the process of fixing a particular sound, its introduction into free speech. Project activity in speech therapy practice can become an important form of work on automating sound pronunciation, as it belongs to the communicative type of learning and creates a model of the communication process, brings children closer to a living situational environment. Such an organization by a speech therapist of the stage of sound automation will also attract additional attention of parents to corrective work.

Thus, in order to carry out successful correctional work with children with an erased degree of dysarthria, it is necessary to highlight the main aspects:

To identify an accurate speech therapy conclusion, a thorough psychological, medical and pedagogical examination is necessary with the study of the child's medical record, familiarization with the anamnestic data, and the doctor's conclusion. A close relationship should be maintained with parents, not only to obtain information about early development child, but in order to clarify the features of this violation.

Implementation of a differentiated approach in overcoming dysarthria, with increased or decreased muscle tone.

An important factor in working with children with an erased degree of dysarthria is the formation of clear static-dynamic sensations of the articulatory muscles.

Consistency in the work on the formation of phonemic operations, the development of the melodic-intonation side of speech, the processes of breathing, voice formation, articulation.

The communicative orientation of training is the use of plot, didactic games, project activities in the process of automating sound pronunciation.

Literature:

Arkhipova E.F. Correctional and speech therapy work to overcome erased dysarthria. - M., 2008.
Kiseleva V.A. Diagnosis and correction of the erased form of dysarthria. - M., 2007.
Lopatina L.V., Serebryakova N.V. Overcoming speech disorders in preschoolers. - St. Petersburg, 2001.
Fedosova O.Yu. Conditions for creating a strong sound pronunciation skill in children with a mild degree of dysarthria. - Speech therapist in kindergarten № 2, 2005.

Seek advice from a speech pathologist

Oksana Makerova
dysarthria

dysarthria- violation of the sound-producing side of speech, due to organic insufficiency of the innervation of the speech apparatus.

The term "dysarthria" is derived from the Greek words arthson, articulation, and dys, a particle meaning disorder. This is a neurological term, because dysarthria occurs when the function of the cranial nerves of the lower part of the trunk, responsible for articulation, is impaired.

cranial nerves of the lower brainstem ( medulla oblongata) adjacent to the cervical region spinal cord, have a similar anatomical structure and are supplied with blood from the same vertebrobasilar basin.

Very often there are contradictions between neurologists and speech therapists about dysarthria. If the neurologist does not see obvious disturbances in the function of the cranial nerves, he cannot call the speech disorder dysarthria. This question is almost a stumbling block between neurologists and speech therapists. This is due to the fact that after the diagnosis of "dysarthria" is made, the neurologist is obliged to carry out serious therapy for the treatment of stem disorders, although such disorders (excluding dysarthria) do not seem to be noticeable.

The medulla oblongata, like the cervical spinal cord, often experiences hypoxia during childbirth. This leads to a sharp decrease in motor units in the nuclei of the nerves responsible for articulation. During a neurological examination, the child adequately performs all tests, but cannot properly cope with articulation, because here it is necessary to perform complex and fast movements that are beyond the power of weakened muscles.

The main manifestations of dysarthria consist in a disorder of articulation of sounds, violations of voice formation, as well as in changes in the tempo of speech, rhythm and intonation.

These disorders manifest themselves to varying degrees and in various combinations, depending on the location of the lesion in the central or peripheral nervous system, on the severity of the disorder, and on the time the defect occurred. Disorders of articulation and phonation, which impede and sometimes completely prevent articulate sonorous speech, constitute the so-called primary defect, which can lead to secondary manifestations that complicate its structure. 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.

Causes of dysarthria
1. Organic lesions of the central nervous system as a result of the impact of various adverse factors on the developing brain of a child in the prenatal and early periods of development. Most often, these are intrauterine lesions resulting from acute, chronic infections, oxygen deficiency (hypoxia), intoxication, toxicosis of pregnancy and a number of other factors that create conditions for the occurrence of birth trauma. In a significant number of such cases, during childbirth, asphyxia occurs in the child, the child is born prematurely.

2. The cause of dysarthria may be the incompatibility of the Rh factor.

3. Somewhat less often, dysarthria occurs under the influence of infectious diseases of the nervous system in the first years of a child's life. Dysarthria is often observed in children suffering from childhood cerebral palsy(ICP). According to E. M. Mastyukova, dysarthria in cerebral palsy manifests itself in 65-85% of cases.

Classification clinical forms dysarthria
Classification of clinical forms of dysarthria is based on the allocation of different localization of brain damage. Children with various forms dysarthria differ from each other by specific defects in sound pronunciation, voice, articulatory motility, they need different methods of speech therapy and can be corrected to varying degrees.

Forms of dysarthria
Bulbar dysarthria (from lat. bulbus - a bulb, the shape of which has a medulla oblongata) manifests itself with a disease (inflammation) or a tumor of the medulla oblongata. At the same time, the nuclei of the motor cranial nerves located there (glossopharyngeal, vagus and hypoglossal, sometimes trigeminal and facial) are destroyed.
Characteristic is paralysis or paresis of the muscles of the pharynx, larynx, tongue, soft palate. In a child with a similar defect, swallowing of solid and liquid food is disturbed, chewing is difficult. Insufficient mobility vocal folds, soft palate leads to specific voice disorders: it becomes weak, nasalized. Voiced sounds are not realized in speech. Paresis of the muscles of the soft palate leads to the free passage of exhaled air through the nose, and all sounds acquire a pronounced nasal (nasal) tone.
In children with the described form of dysarthria, atrophy of the muscles of the tongue and pharynx is observed, and muscle tone (atony) also decreases. The paretic state of the muscles of the tongue is the cause of numerous distortions of sound pronunciation. Speech is slurred, extremely indistinct, slow. The face of a child with boulevard dysarthria is amimic.

Subcortical dysarthria occurs when the subcortical nodes of the brain are damaged. A characteristic manifestation of subcortical dysarthria is a violation of muscle tone and the presence of hyperkinesis. Hyperkinesis - violent involuntary movements (in this case in the area of articulatory and facial muscles) that are not controlled by the child. These movements can be observed at rest, but usually increase during a speech act.
The changing nature of muscle tone (from normal to increased) and the presence of hyperkinesis cause peculiar disturbances in phonation and articulation. A child can correctly pronounce individual sounds, words, short phrases (especially in a game, in a conversation with loved ones or in a state of emotional comfort), and after a moment he is unable to utter a single sound. There is an articulatory spasm, the tongue becomes tense, the voice is interrupted. Sometimes involuntary cries are observed, guttural (pharyngeal) sounds "break through". Children can pronounce words and phrases too quickly or, conversely, monotonously, with long pauses between words. The intelligibility of speech suffers due to the uneven switching of articulatory movements when pronouncing sounds, as well as due to a violation of the timbre and strength of the voice.
A characteristic sign of subcortical dysarthria is a violation of the prosodic side of speech - tempo, rhythm and intonation. The combination of impaired articulatory motility with impaired voice formation, speech breathing leads to specific defects in the sound side of speech, which manifest itself variably depending on the state of the child, and is mainly reflected in the communicative function of speech.
Sometimes, with subcortical dysarthria, children experience hearing loss, complicating a speech defect.

Cerebellar dysarthria characterized by scanned "chopped" speech, sometimes accompanied by cries of individual sounds. In its pure form, this form is rarely observed in children.

Cortical dysarthria presents great difficulties for isolation and recognition. With this form, arbitrary motility of the articulation apparatus is disturbed. According to its manifestations in the field of sound pronunciation, cortical dysarthria resembles motor alalia, since, first of all, the pronunciation of words that are complex in sound-syllabic structure is disturbed. In children, the dynamics of switching from one sound to another, from one articulatory position to another, is difficult. Children are able to clearly pronounce isolated sounds, but sounds are distorted in the speech stream, substitutions occur. Consonant combinations are especially difficult. At an accelerated pace, hesitation appears, reminiscent of stuttering.
However, unlike children with motor alalia, in children with this form of dysarthria there are no disturbances in the development of the lexico-grammatical side of speech. Cortical dysarthria should also be distinguished from dyslalia. Children have difficulty reproducing the articulatory position, making it difficult for them to move from one sound to another. During correction, attention is drawn to the fact that defective sounds are quickly corrected in isolated utterances, but are hardly automated in speech.

Erased form
I especially want to highlight the erased (mild) form of dysarthria, since recently in the process of speech therapy practice there are more and more children whose speech disorders are similar to the manifestations of complex forms of dyslalia, but with a longer and more complex dynamics of learning and speech correction. A thorough speech therapy examination and observation reveals a number of specific disorders in them (disturbances in the motor sphere, spatial gnosis, the phonetic side of speech (in particular, the prosodic characteristics of speech), phonation, breathing, and others), which allows us to conclude that there are organic lesions of the central nervous system.

The experience of practical and research work shows that it is very often difficult to diagnose mild forms of dysarthria, its differentiation from other speech disorders, in particular, dyslalia, in determining the ways of correction and the amount of necessary speech therapy assistance to children with an erased form of dysarthria. Considering the prevalence of this speech disorder among preschool children, we can conclude that a very urgent problem has now arisen - the problem of providing qualified speech therapy assistance to children with an erased form of dysarthria.

Mild (erased) forms of dysarthria can be observed in children without obvious motor disorders who have undergone the impact of various adverse factors during the prenatal, natal and early postnatal periods of development. Among these adverse factors are:
- toxicosis of pregnancy;
- chronic hypoxia fetus;
- sharp and chronic diseases mothers during pregnancy;
- minimal damage to the nervous system in Rh-conflict situations of the mother and fetus;
- mild asphyxia;
- birth trauma;
- sharp infectious diseases children in infancy, etc.

The impact of these unfavorable factors leads to the emergence of a number of specific features in the development of children. AT early period development in children with an erased form of dysarthria, motor restlessness, sleep disturbances, frequent, causeless crying are noted. Feeding such children has a number of features: there is difficulty in holding the nipple, fatigue when sucking, the babies refuse the breast early, often and spit up abundantly. In the future, they are poorly accustomed to complementary foods, they are reluctant to try new food. At dinner, such a child sits for a long time with a full mouth, chews poorly and swallows food reluctantly, hence frequent choking during meals. Parents of children with mild forms of dysarthria note that at preschool age, children prefer cereals, broths, mashed potatoes to solid foods, so feeding such a child becomes a real problem.

In early psychomotor development, a number of features can also be noted: the formation of statodynamic functions may be somewhat delayed or remain within the age norm. Children, as a rule, are somatically weakened, often suffer from colds.

The anamnesis of children with an erased form of dysarthria is aggravated. Most of the children under 1-2 years of age were observed by a neurologist, later this diagnosis was removed.

Early speech development in a significant proportion of children with mild manifestations of dysarthria is slightly slowed down. The first words appear by the age of 1, phrasal speech is formed by 2-3 years. At the same time, for quite a long time, the speech of children remains illegible, unclear, understandable only to parents. Thus, by the age of 3-4, the phonetic side of speech in preschoolers with an erased form of dysarthria remains unformed.

In speech therapy practice, there are often children with impaired sound pronunciation, who, in the conclusion of a neurologist, have data on the absence of neurological status focal microsymptoms. However, the correction of speech disorders in such children by conventional methods and techniques does not bring effective results. Therefore, the question arises of additional examination and a more detailed study of the causes and mechanisms of these violations.

A thorough neurological examination of children with similar speech disorders using functional loads reveals mild microsymptoms. organic damage nervous system. These symptoms manifest themselves as a disorder of the motor sphere and extrapyramidal insufficiency and are reflected in the state of general, fine and articulatory motor skills, as well as facial muscles.

The general motor sphere of children with an erased form of dysarthria is characterized by awkward, constrained, undifferentiated movements. There may be a slight limitation in the range of motion of the upper and lower extremities, with a functional load, friendly movements (syncenesia), violations of muscle tone are possible. Often, with a pronounced general mobility, the movements of a child with an erased form of dysarthria remain awkward and unproductive.

Most clearly, the lack of general motor skills is manifested in preschoolers with this disorder when performing complex movements that require precise control of movements, precise work of various muscle groups, and correct spatial organization of movements. For example, a child with an erased form of dysarthria, somewhat later than his peers, begins to grab and hold objects, sit, walk, jump on one or two legs, clumsily runs, climbs on the Swedish wall. At middle and senior preschool age, a child cannot learn to ride a bicycle, ski and skate for a long time.

In children with an erased form of dysarthria, there are also violations of fine motor skills of the fingers, which manifest themselves in a violation of the accuracy of movements, a decrease in the speed of execution and switching from one position to another, slow inclusion in movement, and insufficient coordination. Finger tests are performed incompletely, significant difficulties are observed. These features are manifested in the play and learning activities of the child. A preschooler with mild manifestations of dysarthria is reluctant to draw, sculpt, or clumsily play with mosaics.

Features of the state of general and fine motor skills are also manifested in articulation, since there is a direct relationship between the level of formation of fine and articulatory motor skills. Speech motility disorders in preschoolers with this type of speech pathology are due to the organic nature of the damage to the nervous system and depend on the nature and degree of impaired functioning of the motor nerves that provide the process of articulation. It is the mosaic nature of the lesions of the motor conducting cortical-nuclear pathways that determines the great combination of speech disorders in the erased form of dysarthria, the correction of which requires the speech therapist to carefully and detailed develop an individual plan for speech therapy work with such a child. And of course, such work seems impossible without the support and close cooperation with parents interested in correcting their child's speech disorders.

Pseudobulbar dysarthria is the most common form of childhood dysarthria. Pseudobulbar dysarthria is the result of early childhood, during childbirth or in the prenatal period of organic damage to the brain as a result of encephalitis, birth trauma, tumors, intoxication, etc. The child develops pseudobulbar paralysis or paresis due to damage to the pathways that go from the cerebral cortex to the nuclei of the glossopharyngeal, vagus and hypoglossal nerves . By clinical manifestations violations in the field of mimic and articulatory muscles, it is close to bulbar. However, the possibilities of correction and full mastery of the sound-producing side of speech with pseudobulbar dysarthria are much higher.
As a result of pseudobulbar paralysis, the child's general and speech motility is disturbed. The baby sucks badly, chokes, chokes, swallows badly. Saliva flows from the mouth, the muscles of the face are disturbed.

The degree of violation of speech or articulatory motility may be different. Conventionally, there are three degrees of pseudobulbar dysarthria: mild, moderate, severe.

1. A mild degree of pseudobulbar dysarthria is characterized by the absence of gross violations of the motility of the articulatory apparatus. Difficulties in articulation consist in slow, insufficiently precise "movements of the tongue, lips. Chewing and swallowing disorders are not detected brightly, in rare choking. Pronunciation in such children is impaired due to insufficiently clear articulatory motility, speech is somewhat slow, blurring is characteristic when pronouncing sounds. Pronunciation of complex sounds is more likely to suffer according to the articulation of sounds: w, w, p, c, h. Voiced sounds are pronounced with insufficient participation of the voice. Soft sounds are difficult to pronounce, requiring the addition of the rise of the middle part of the back of the tongue to the hard palate to the main articulation.
Pronunciation deficiencies have adverse effects on phonemic development. Most children with mild dysarthria experience some difficulty in sound analysis. When writing, they encounter specific errors in the replacement of sounds (t-d, ch-ts, etc.). Violation of the structure of the word is almost not observed: the same applies to the grammatical structure and vocabulary. Some peculiarity can be revealed only with a very careful examination of children, and it is not characteristic. So, the main defect in children suffering from mild pseudobulbar dysarthria is a violation of the phonetic side of speech.
Children with such a disorder, who have normal hearing and good mental development, attend speech therapy classes in the district children's clinic, and at school age - a speech therapy center at a comprehensive school. Parents can play a significant role in eliminating this defect.

2. Children with medium degree dysarthria constitute the largest group. They are characterized by amimicity: the absence of movements of the facial muscles. The child cannot puff out his cheeks, stretch out his lips, close them tightly. Language movements are limited. The child cannot lift the tip of the tongue up, turn it to the right, to the left, and keep it in this position. Switching from one movement to another is a significant difficulty. The soft palate is often inactive, the voice has a nasal tone. Profuse salivation is characteristic. Difficulty in chewing and swallowing. The consequence of dysfunction of the articulatory apparatus is a severe defect in pronunciation. The speech of such children is usually very slurred, blurry, quiet. Fuzzy articulation of vowels, usually pronounced with a strong nasal exhalation, is characteristic due to the immobility of the lips and tongue. The sounds "a" and "y" are not clear enough, the sounds "and" and "y" are usually mixed. Of the consonants, n, t, m, n, k, x are more often saved. The sounds h and c, r and l are pronounced approximately, like a nasal exhalation with an unpleasant "squishy" overtone. The exhaled oral jet is felt very weakly. More often, voiced consonants are replaced by voiceless ones. Often, sounds at the end of a word and in consonant combinations are omitted. As a result, the speech of children suffering from pseudobulbar dysarthria is so incomprehensible that they prefer to remain silent. Along with the usually late development of speech (at the age of 5-6 years), this circumstance sharply limits the child's experience of verbal communication.
Children with such a disorder cannot successfully study in a comprehensive school. Most favorable conditions for their education and upbringing are created in special schools for children with severe speech disorders, where these students are treated individually.

3. A severe degree of pseudobulbar dysarthria - anarthria - is characterized by deep muscle damage and complete inactivity of the speech apparatus. The face of an anarthritic child is mask-like, lower jaw hangs down, the mouth is constantly open. The tongue lies motionless at the bottom oral cavity, lip movements are sharply limited. Difficulty in chewing and swallowing. Speech is completely absent, sometimes there are separate inarticulate sounds. Children with anarthria with good mental development can also study in special schools for children with severe speech disorders, where, thanks to special speech therapy methods, they successfully master writing skills and a program in general subjects.

A characteristic of all children with pseudobulbar dysarthria is that, with distorted pronunciation of the sounds that make up the word, they usually retain the rhythmic contour of the word, i.e., the number of syllables and stress. As a rule, they know the pronunciation of two-syllable, three-syllable words; four-syllable words are often reproduced in reflection. It is difficult for a child to pronounce consonant clusters: in this case, one consonant falls out (squirrel - "beka") or both (snake - "iya"). Due to the motor difficulty of switching from one syllable to another, there are cases of likening syllables (dishes - "posyusya", scissors - "nose").

Violation of the motor skills of the articulatory apparatus leads to improper development of the perception of speech sounds. Deviations in auditory perception caused by insufficient articulatory experience, the absence of a clear kinesthetic image of sound lead to noticeable difficulties in mastering sound analysis. Depending on the degree of motor speech impairment, variously expressed difficulties in sound analysis are observed.

Most of the special tests that reveal the level of sound analysis are not available to dysarthric children. They cannot correctly select pictures whose names begin with a given sound, come up with a word containing a certain sound, and analyze the sound composition of a word. For example, a twelve-year-old child who studied for three years in a public school, answering the question, what sounds in the words of the regiment, cat, calls p, a, k, a; k, a, t, a. When completing the task, select pictures whose names contain the sound b, the boy puts a jar, a drum, a pillow, a scarf, a saw, a squirrel.
Children with more preserved pronunciation make fewer mistakes, for example, they select the following pictures for the sound "s": a bag, a wasp, an airplane, a ball.
Children suffering from anarthria do not have access to such forms of sound analysis.

Literacy in dysarthria
The level of proficiency in sound analysis in the vast majority of dysarthric children is insufficient for literacy. Children enrolled in mass schools are completely unable to master the program of the 1st grade.

Letter
Deviations in sound analysis are especially pronounced during auditory dictation.

I will give a sample letter from a boy who studied for three years in a public school: the house is "ladies", the fly is "muaho", the nose is "oush", the chair is "woo", the eyes are "naka", etc.

Another boy, after a year in a public school, writes instead of "Dima goes for a walk" - "Dima dapet gul ts"; "In the forest wasps" - "Lusu wasps"; "The boy feeds the cat with milk" - "Malkin lali kashko little".

The greatest number of errors in the writing of children suffering from dysarthria are in the substitution of letters. Often there are substitutions of vowels: children - "detu", teeth - "teeth", bots - "buts", bridge - "muta", etc. Inaccurate, nasal pronunciation of vowels leads to the fact that they almost do not differ in sound.

Consonant substitutions are numerous and varied:
l-r: squirrel - "berk"; x-h: fur - "sword"; b-t: duck - "ubka"; gd: beep - "pipe"; s-h: geese - "guchi"; b-p: watermelon - "arpus".

Characteristic are cases of violation of the syllabic structure of the word due to rearrangement of letters (book - "kinga"), omission of letters (hat - "shapa"), reduction of the syllabic structure due to underwriting of syllables (dog - "soba", scissors - "knives" and etc.).

There are frequent cases of complete distortion of words: a bed - "damla", a pyramid - "makte", an iron one - "neaki", etc. Such errors are most typical for children with deep articulation disorders, in whom the inarticulateness of the sound composition of speech is associated with distorted sound pronunciation.

In addition, in the writing of dysarthric children, such errors as the incorrect use of prepositions, incorrect syntactic connections of words in a sentence (agreement, control), etc. are common. These non-phonetic errors are closely related to the peculiarities of mastering oral speech, grammatical structure, vocabulary reserve.

Children's independent writing is distinguished by a poor composition of sentences, their incorrect construction, omissions of sentence members and function words. Some children are completely inaccessible to even small presentations.

Reading
Reading dysarthric children is usually extremely difficult due to the immobility of the articulatory apparatus, difficulties in switching from one sound to another. For the most part, it is syllable-by-syllable, not intonation-colored. Understanding of the text being read is not enough. For example, a boy, after reading the word chair, points to the table, after reading the word cauldron, shows a picture depicting a goat (a cauldron-goat).

Lexico-grammatical structure of speech of dysarthric children
As noted above, the direct result of the defeat of the articulatory apparatus are pronunciation difficulties, which lead to insufficiently clear perception of speech by ear. The general speech development of children with gross articulation disorders proceeds in a peculiar way. Late onset of speech, limited speech experience, gross pronunciation defects lead to insufficient vocabulary accumulation and deviations in the development of the grammatical structure of speech. Most children with articulation disorders have deviations in vocabulary, do not know everyday words, often mix words, focusing on similarities in sound composition, situation, etc.

Many words are used inaccurately, instead of the desired name, the child uses one that denotes a similar object (a loop - a hole, a vase - a jug, an acorn - a nut, a hammock - a net) or is situationally related to the given word (rails - sleepers, thimble - finger).

Characteristic for dysarthric children are a fairly good orientation in the environment, a stock of everyday information and ideas. For example, children know and can find in the picture such objects as a swing, a well, a sideboard, a wagon; determine the profession (pilot, teacher, driver, etc.); understand the actions of the persons depicted in the picture; show objects painted in one color or another. However, the absence of speech or limited use of it leads to a discrepancy between the active and passive vocabulary.

The level of mastering vocabulary depends not only on the degree of violation of the sound-producing side of speech, but also on the intellectual capabilities of the child, social experience, and the environment in which he is brought up. For dysarthric children, as well as for children with general underdevelopment of speech in general, insufficient knowledge of the grammatical means of the language is characteristic.

The main directions of corrective work
These features of the speech development of children with dysarthria show that they need systematic special education aimed at overcoming defects in the sound side of speech, developing vocabulary and grammatical structure of speech, correcting writing and reading disorders. Such correctional tasks are solved in a special school for children with speech disorders, where the child receives education in the amount of a nine-year general education school.

Preschool children with dysarthria need targeted speech therapy classes to form the phonetic and lexical-grammatical structure of speech. Such classes are held in special preschool institutions for children with speech disorders.

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 impaired general and speech motor skills, and taking into account the personal characteristics of children. Particular attention is paid to the state of speech development of children in the field of vocabulary and grammatical structure, as well as 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 communicative and generalizing functions of speech.

In the process of systematic and in most cases long-term exercises, gradual normalization of the motor skills of the articulation apparatus, the development of articulation movements, the formation of the ability to arbitrarily switch the movable organs of articulation from one movement to another at a given pace, overcoming monotony and violations of the tempo of speech are carried out; full development of phonemic perception. 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. Great importance also has a combination of speech therapy and therapeutic measures, overcoming deviations in general motor skills.

Children of preschool age with dysarthria, who do not have gross deviations in the development of the musculoskeletal system, possess self-care skills and have normal hearing and full intelligence, study in special kindergartens for children with speech disorders. At school age, children with severe dysarthria study in special schools for children with severe speech disorders, where they receive education in the amount of a nine-year school with simultaneous correction of a speech defect. For children with dysarthria, who have severe disorders of the musculoskeletal system, there are specialized kindergartens and schools in the country, where much attention is paid to therapeutic and physiotherapeutic measures.

When correcting dysarthria in practice, as a rule, regulation of speech breathing is used as one of the leading methods for establishing speech fluency.

Breathing exercises by A. N. Strelnikova
In speech therapy work on the speech breathing of children, adolescents and adults, paradoxical breathing exercises by A. N. Strelnikova are widely used. Strelnikovskaya breathing gymnastics is the brainchild of our country, it was created at the turn of the 30-40s of the XX century as a way to restore the singing voice, because A.N. Strelnikova was a singer and lost it.

This gymnastics is the only one in the world in which a short and sharp inhalation through the nose is done on movements that compress the chest.

Exercises actively involve all parts of the body (arms, legs, head, hip girdle, abdominals, shoulder girdle, etc.) and cause a general physiological reaction of the whole organism, an increased need for oxygen. All exercises are performed simultaneously with a short and sharp inhalation through the nose (with an absolutely passive exhalation), which enhances internal tissue respiration and increases the absorption of oxygen by tissues, and also irritates that vast receptor zone on the nasal mucosa, which provides a reflex connection of the nasal cavity with almost all bodies.

That is why this breathing exercise has such a wide range of effects and helps with a host of various diseases of organs and systems. It is useful for everyone and at any age.

In gymnastics, the focus is on inhalation. The breath is made very briefly, instantly, emotionally and actively. The main thing, according to A. N. Strelnikova, is to be able to hold, "hide" your breath. Don't think about breathing at all. Exhalation goes away spontaneously.

When teaching gymnastics, A. N. Strelnikova advises to follow four basic rules.

Rule 1 "Smell of burning! Alert!" And abruptly, noisily, throughout the apartment, sniff the air like a dog's footprint. The more natural the better. The worst mistake is to pull air in order to take in more air. The breath is short, like an injection, active and the more natural, the better. Think only about the breath. The feeling of anxiety organizes an active breath better than reasoning about it. Therefore, do not be shy, furiously, to the point of rudeness, sniff the air.

Rule 2 Exhalation is the result of inhalation. Do not prevent the exhalation from leaving after each breath as you like, as much as you like - but it is better with your mouth than with your nose. Don't help him. Think only: "It smells of burning! Anxiety!" And just make sure that the breath goes simultaneously with the movement. Exhalation will go away spontaneously. During gymnastics, the mouth should be slightly open. Get carried away with inhalation and movement, do not be boring and indifferent. Play savage like children play and you'll be fine. Movements create sufficient volume and depth for a short breath without much effort.

Rule 3 Repeat the breaths as if you were inflating a tire in song and dance tempo. And as you train your movements and breaths, count to 2, 4, and 8. Rate: 60-72 breaths per minute. Inhale louder than exhale. Norm of the lesson: 1000-1200 breaths, and more - 2000 breaths. Pauses between doses of breaths - 1-3 seconds.

Rule 4 Take as many breaths in a row as you can easily do at the moment. The whole complex consists of 8 exercises. First, a warm-up. Stand up straight. Hands at the seams. Legs shoulder width apart. Take short, like an injection, breaths, sniffing loudly. Do not be shy. Force the wings of the nose to connect at the moment of inhalation, and do not expand them. Train for 2, 4 breaths in a row at a walking pace of "hundred" breaths. You can do more to feel that the nostrils move and obey you. Inhale, like an injection, instantaneous. Think: "It smells of burning! Where does it come from?" To understand the gymnastics, take a step in place and simultaneously with each step - inhale. Right-left, right-left, inhale-inhale, inhale-inhale. And not inhale-exhale, as in ordinary gymnastics.
Take 96 (one hundred) steps-breaths at a walking pace. You can stand still, you can walk around the room, you can shift from foot to foot: back and forth, back and forth, the weight of the body is either on the leg standing in front, then on the leg standing behind. It is impossible to take long breaths at the pace of steps. Think, "My legs are pumping air into me." It helps. With each step - a breath, short as a shot, and noisy.
Having mastered the movement, lifting right leg, slightly squat on the left, raising the left - on the right. Get a rock and roll dance. Make sure that the movements and breaths go at the same time. Do not interfere with or help the exhalations come out after each inhalation. Repeat the breaths rhythmically and often. Make as many as you can easily.

Head movements.
- Turns. Turn your head left and right, sharply, at the pace of steps. And at the same time with each turn - inhale through the nose. Short as a prick, noisy. 96 breaths. Think: "It smells of burning! Where? Left? Right?". Smell the air...
- "Ears". Shake your head as if you are saying to someone: "Ai-yay-yay, shame on you!" Make sure that the body does not turn. Right ear goes to the right shoulder, left - to the left. Shoulders are motionless. Simultaneously with each swing - a breath.
- "Small pendulum". Nod your head back and forth, inhale, inhale. Think: "Where does the smell of burning come from? From below? From above?"

Major movements.
- "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 go 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 close. 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.

This is followed by a special training of "concealed" breathing: a short inhalation with an inclination, the breath is held as much as possible, without unbending, it is necessary to count aloud to eight, gradually the number of "eights" uttered on one exhalation increases. On one tightly held breath, you need to dial as many "eights" as possible. From the third or fourth workout, stuttering "eights" is combined not only with inclinations, but also with "half squats" exercises. The main thing, according to A. N. Strelnikova, is to feel the breath "caught in a fist" and show restraint, repeating aloud the maximum number of eights on a tightly held breath. Of course, the "eights" in each workout is preceded by the entire complex of the exercises listed above.

Exercises for the development of speech breathing
In speech therapy practice, the following exercises are recommended.

Choose a comfortable position (lying, sitting, standing), put one hand on your stomach, the other on the side of the lower part 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.

- Read the Russian folk tale "Turnip" with the correct reproduction of inhalation during pauses.

The acquired skills can and should be consolidated and comprehensively applied in practice.

* "Whose ship 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.

Treatment
The full course of correction and treatment of dysarthria is several months. As a rule, children with dysarthria are in the day hospital for 2-4 weeks, then continue the course of treatment on an outpatient basis. In a day hospital, there are general strengthening physiotherapy, massage, exercise therapy, breathing exercises. This reduces the time to reach the maximum effect and makes it more stable.

Treatment of dysarthria with hirudotherapy
Back in the 16th-17th centuries, hirudotherapy (hereinafter referred to as HT) was used for diseases of the liver, lungs, gastrointestinal tract, tuberculosis, migraine, epilepsy, hysteria, gonorrhea, skin and eye diseases, and disorders menstrual cycle, violations cerebral circulation, with fever, hemorrhoids, as well as to stop bleeding and other diseases.

Why did interest in the leech begin to increase? The reasons for this are the lack of therapeutic efficacy of pharmaceuticals. funds, an increase in the number of drug-allergic people, a huge number (40-60%) of counterfeit pharmaceuticals in the pharmacy network.

To understand the mechanisms therapeutic effect medicinal leech(MP) need to study biologically active substances(BAS) salivary gland secretion (SSG). The secret of the salivary glands of a leech contains a set of compounds of protein (peptide), lipid and carbohydrate nature. Reports by I. I. Artamonova, L. L. Zavalova, and I. P. Baskova indicate the presence of more than 20 components in the low molecular weight fraction of leeches FSF (molecular weight less than 500 D) and more than 80 in the fraction with a molecular weight of more than 500 D.

The most studied components of SSZh: hirudin, a histamine-like substance, prostacyclins, prostaglandins, hyaluronidase, lipase, apyrase, collogenase, calin and saratin - platelet adhesion inhibitors, platelet activating factor inhibitor, destabilase, destabilase-lysozyme (detobilase - L), bdellin-trypsin inhibitors and plasmin, eglins - inhibitors of chymotryptosin, subtilisin, elastase and cathepsin G, neurotrophic factors, blood plasma kallikrein inhibitor. The intestinal canal of the leech contains the symbiont bacterium Aeromonas hidrophilia, which provides a bacteriostatic effect and is the source of some components of the SF. One of the elements contained in saliva MP is hyaluronidase. It is believed that with the help of this substance, toxic (endo - or exogenous origin) products are removed from the matrix space (Pishinger's space), which have not undergone metabolic transformations, which allow them to be removed from the MP body with the help of excretory organs. They can cause MPs to vomit or die.

Neurotrophic factors (NTF) MP. This aspect is associated with the effect of SSF on nerve endings and neurons. For the first time this problem was raised in our research. The idea arose as a result of the results of the treatment of children with cerebral palsy, and with myopathy. Patients showed significant positive changes in the treatment of spastic skeletal muscle tension. A child who before treatment could only walk on all fours could walk on his own legs a few months after MP treatment.

Neurotrophic factors - low molecular weight proteins that are secreted by target tissues are involved in differentiation nerve cells and are responsible for the growth of their processes. NTPs play an important role not only in the processes of embryonic development of the nervous system, but also in the adult organism. They are necessary to maintain the viability of neurons.

To assess the neurite-stimulating effect, a morphometric method is used, which makes it possible to measure the area of the ganglion together with the growth zone, consisting of neurites and glial elements, after the addition of drugs that stimulate the growth of neurites to the nutrient medium compared to control explants.

The results obtained in the treatment of alalia and dysarthria in children by the method of gerudotherapy, as well as the results of superposition brain scanning, made it possible to fix accelerated maturation neurons of the speech-motor cortex in such children.

Data on the high neuritis-stimulating activity of the components of the SSF (the secretion of the salivary glands) explain the specific effectiveness of herudotherapy in neurological patients. Moreover, the ability of leech proteinase inhibitors to modulate neurotrophic effects enriches the arsenal of proteolytic enzyme inhibitors, which are currently considered as promising therapeutic drugs for a wide range of neurodegenerative diseases.

So, BAS produced by MP provide biological effects known to date:
1. thrombolytic action,
2. hypotensive action,
3. reparative effect on the damaged wall of the blood vessel,
4. anti-atherogenic action of biologically active substances actively influence the processes of lipid metabolism, bringing it to normal functioning conditions; reduce cholesterol levels,
5. antihypoxic effect - increasing the percentage of survival of laboratory animals in conditions of low oxygen content,
6. immunomodulating action - activation of the protective functions of the body at the level of the macrophage link, the compliment system and other levels immune system man and animals,
7. neurotrophic action.

To specific technical means include: Derazhnya proofreader, apparatus "Echo" (AIR), sound amplification apparatus, tape recorder.

The Derazhnya apparatus (as well as Barany's ratchet) is built on the effect of sound deadening. Noise of varying strength (in the corrector it is regulated with a special screw) is fed through rubber tubes ending in olives, directly into ear canal drowning out his own speech. But not in all cases, the sound damping method can be applied. The apparatus "Echo", designed by B. Adamchik, consists of two tape recorders with a prefix. The recorded sound plays back after a fraction of a second, creating an echo effect. Domestic designers have created a portable apparatus "Echo" (AIR) for individual use.

A peculiar apparatus was proposed by V. A. Razdolsky. The principle of its operation is based on the sound amplification of speech through loudspeakers or air telephones to the hearing aid "Crystal". Perceiving their speech sound-reinforced, dysarthria tense their speech muscles less, more often they begin to use a soft attack of sounds, which has a beneficial effect on their speech. It is also positive that when using sound amplification, patients hear their correct speech from the very first lessons, and this accelerates the development of positive reflexes and free, relaxed speech. A number of researchers use in practice various variants of delayed speech ("white noise", sound dampening, etc.).

In the process speech therapy classes for psychotherapeutic purposes, you can use sound recording equipment. With a tape lesson followed by a conversation with a speech therapist, the mood of dysarthria improves, there is a desire to achieve success in speech classes, confidence in the positive outcome of classes is developed, trust in the speech therapist grows. At the first tape lessons, the material for the performance is selected and carefully rehearsed.

Learning tape lessons contribute to the development of correct speech skills. The purpose of these classes is to draw the patient's attention to the pace and fluency of his speech, sonority, expressiveness, grammatical correctness of the phrase. After preliminary conversations about the qualities of correct speech, listening to the appropriate speech samples, after repeated rehearsals, the dysarthria performs in front of a microphone with his text, depending on the stage of the lesson. The task is to monitor and control one's behavior, pace, fluency, sonority of speech, and avoid grammatical errors in it. The leader records in his notebook the state of speech and the behavior of the patient at the moment of speaking in front of the microphone. Having finished the speech, the dysarthria himself evaluates his speech (he spoke softly - loudly, quickly - slowly, expressively - monotonously, etc.). Then, after listening to the speech recorded on the tape, the patient evaluates it again. After that, the speech therapist analyzes the stutterer's speech, his ability to give a correct assessment of his speech, highlights the positive in his speech, in his behavior in the classroom, and sums up.

A variant of teaching tape lessons is to imitate the performances of artists, masters of the artistic word. In this case, an artistic performance is listened to, the text is learned, reproduction is practiced, recorded on tape, and then compared with the original, similarities and differences are stated. Comparative tape sessions are useful, in which the dysarthria is given the opportunity to compare his real speech with the one he had before. At the beginning of the course of speech classes, with the microphone turned on, he is asked questions on everyday topics, plot pictures are offered to describe their content and compose a story, etc. The tape records cases of convulsions in speech: their place in the phrase, frequency, duration. Subsequently, this first recording of the speech of a dysarthria serves as a measure of the success of the ongoing speech classes: the state of speech in the future is compared with it.

Defectologist's advice
In corrective work with dysarthria, it is important to form spatial thinking.

Formation of spatial representations
Knowledge about space, spatial orientation develop in conditions various types activities of children: in games, observations, labor processes, in drawing and designing.

By the end of preschool age, children with dysarthria develop such knowledge about space as: shape (rectangle, square, circle, oval, triangle, oblong, rounded, curved, pointed, curved), size (large, small, more, less, the same , equal, large, small, half, in half), length (long, short, wide, narrow, high, left, right, horizontal, straight, oblique), position in space and spatial connection (in the middle, above the middle, below the middle, right, left, side, closer, farther, front, back, behind, in front).

Mastering the indicated knowledge about space implies: the ability to identify and distinguish spatial features, correctly name them and include adequate verbal designations in expressive speech, navigate in spatial relationships when performing various operations associated with active actions.

The usefulness of mastering knowledge about space, the ability to spatial orientation is provided by the interaction of motor-kinesthetic, visual and auditory analyzers in the course of performing various kinds activities of the child aimed at active knowledge of the surrounding reality.

The development of spatial orientation and the idea of space occurs in close connection with the formation of a sense of the scheme of one's body, with the expansion of children's practical experience, with a change in the structure of object-game action associated with the further improvement of motor skills. The emerging spatial representations are reflected and further developed in the subject-playing, visual, constructive and everyday activities of children.

Qualitative changes in the formation of spatial perception are associated with the development of speech in children, with their understanding and active use of verbal designations of spatial relations, expressed by prepositions, adverbs. Mastering knowledge about space involves the ability to identify and distinguish spatial features and relationships, the ability to correctly designate them verbally, to navigate in spatial relationships when performing various labor operations based on spatial representations. An important role in the development of spatial perception is played by design and modeling, the inclusion of verbal designations adequate to the actions of children in expressive speech.

Methods for the study of spatial thinking in younger schoolchildren with dysarthria
TASK #1

Purpose: to reveal the understanding of spatial relations in a group of real objects and in a group of objects depicted in the picture + object-play action on the differentiation of spatial relations.

Assimilation of orientations from left to right.

Poem by V. Berestov.

A man was standing at a fork in the road.
Where is the right, where is the left - he could not understand.
But suddenly the student scratched his head
With the same hand that he wrote
And he threw the ball, and flipped through the pages,
And he held a spoon, and swept the floor,
"Victory!" - there was a jubilant cry:
Where is the right, where the left was recognized by the student.

Movement according to a given instruction (assimilation of the left and right parts of the body, left and right sides).

We march bravely in the ranks.
We know science.
We know the left, we know the right.
And, of course, around.
This is the right hand.
Oh, science is not easy!

"The Steadfast Tin Soldier"

Stay on one leg
Like you're a solid soldier.
Left leg - to the chest,
Look, don't fall.
Now stay on the left
If you are a brave soldier.

Refinement of spatial relationships:
* standing in a line, name the one standing on the right, on the left;
* according to the instructions, place objects to the left and right of this one;
* determine the place of a neighbor in relation to himself;
* determine your place in relation to a neighbor, focusing on the corresponding hand of a neighbor ("I am standing to the right of Zhenya, and Zhenya is to my left.");
* standing in pairs facing each other, first determine for yourself, then for a friend, the left hand, right hand etc.

Game "Parts of the body".
One of the players touches any part of the body of his neighbor, for example, the left hand. He says: "This is my left hand." The one who started the game agrees or refutes the neighbor's answer. The game continues in a circle.

"Trace it."
Prints of hands and feet are drawn on the sheet in different directions. It is necessary to determine which hand, foot (left or right) this print is from.

Determine by storyline, in which hand the characters in the picture have the called object.

Assimilation of the concepts "Left side of the sheet - right side of the sheet.

Coloring or drawing according to the instructions, for example: "Find the small triangle drawn on the left side of the sheet, color it in red. Find the largest triangle among those drawn on the right side of the sheet. Color it with a green pencil. Connect the triangles with a yellow line."

Determine left or right a sleeve at a blouse, a shirt, a pocket at jeans. Products are in a different position in relation to the child.

Assimilation of the directions "up-down", "top-bottom".

Orientation in space:
What's up, what's down? (analysis of towers built from geometric bodies).

Orientation on a sheet of paper:
- Draw a circle at the top of the sheet, a square at the bottom.
- Put an orange triangle, put a yellow rectangle on top, and a red one below the orange one.

Exercises in the use of prepositions: for, because of, about, from, in front of, in, from.
Introduction: Once resourceful, smart, agile, cunning, Puss in Boots was a playful little kitten who loved to play hide-and-seek.
An adult shows cards where it is drawn, where the kitten is hiding, and helps the children with questions like:
Where is the kitten hiding?
- Where did he jump from? etc.

TASK #2

Purpose: to verbally indicate the location of objects in the pictures.

Game "Shop"(the child, acting as a seller, arranged toys on several shelves and said where and what was).

Show the actions that are described in the poem.
I will help my mother
I will clean everywhere
And under the closet
and behind the closet
and in the closet
and on the closet.
I don't like dust! Ugh!

Orientation on a sheet of paper.

1. Simulation of fairy tales

"Forest School" (L. S. Gorbacheva)

Equipment: each child has a sheet of paper and a house cut out of cardboard.
"Guys, this house is not simple, it is fabulous. Forest animals will study in it. Each of you has the same house. I will tell you a fairy tale. Listen carefully and put the house in the place that is mentioned in the fairy tale.
Animals live in the dense forest. They have their own kids. And the animals decided to build a forest school for them. They gathered at the edge of the forest and began to think where to put it. Leo suggested building in the lower left corner. The wolf wanted the school to be in the upper right corner. The fox insisted on building a school in the upper left corner, next to her hole. A squirrel intervened in the conversation. She said: "The school should be built in the clearing." The animals listened to the advice of the squirrel and decided to build a school in a forest clearing in the middle of the forest.

Equipment: each child has a sheet of paper, a house, a Christmas tree, a clearing (blue oval), an anthill (gray triangle).

“Winter lived in a hut at the edge of the forest. Her hut stood in the upper right corner. One day Winter woke up early, washed her face white, dressed warmer and went to look at her forest. She walked along the right side. When she reached the lower right corner, I saw a small Christmas tree, Winter waved her right sleeve and covered the Christmas tree with snow.
Winter turned to the middle of the forest. There was a big field here.
Winter waved her hands and covered the entire clearing with snow.
Winter turned to the lower left corner and saw an anthill.
Winter waved her left sleeve and covered the anthill with snow.
Winter went up: she turned to the right and went home to rest.

"Bird and Cat"

Equipment: each child has a sheet of paper, a tree, a bird, a cat.

"A tree grew in the yard. A bird was sitting near the tree. Then the bird flew and sat on the tree, upstairs. A cat came. The cat wanted to catch the bird and climbed the tree. The bird flew down and sat under the tree. The cat remained on the tree."

2. Graphic reproduction of directions (IN Sadovnikova).

Four points are given, put a "+" sign from the first point from the bottom, from the second - from above, from the third - to the left, from the fourth - to the right.

Four points are given. From each point, draw an arrow in the direction: 1 - down, 2 - right, 3 - up, 4 - left.

Given four points that can be grouped into a square:
a) Mentally group the points into a square, select the upper left point with a pencil, then the lower left point, and then connect them with an arrow from top to bottom. Similarly, select the upper right point and connect it with an arrow to the upper right point in the direction from bottom to top.
b) In the square, select the upper left point, then the upper right point and connect them with an arrow in the direction from left to right. Similarly, connect the lower points in the direction from right to left.
c) In the square, select the upper left point and the lower right point, connect them with an arrow pointing simultaneously from left-to-right-top-down.
d) In the square, select the lower left point and the upper right point, connect them with an arrow pointing simultaneously from left to right and from bottom to top.

Assimilation of prepositions that have spatial significance.

1. Perform various actions according to the instructions. Answer the questions.
- Put the pencil on the book. Where is the pencil?
- Take a pencil. Where did you get the pencil from?
- Put the pencil in the book. Where is he now?
- Take it. Where did you get the pencil from?
- Hide the pencil under the book. Where is he?
- Take out the pencil. Where was it taken from?

2. Line up, following the instructions: Sveta behind Lena, Sasha in front of Lena, Petya between Sveta and Lena, etc. Answer the questions: "Who are you behind?" (in front of whom, next to whom, ahead, behind, etc.).

3. Arrangement of geometric shapes according to this instruction: "Put a red circle on a large blue square. Put a green circle above the red circle. An orange triangle in front of the green circle, etc."

4. "What word is missing?"
The river overflowed its banks. Children run class. The path went across the field. Green onions in the garden. We got to the city. The ladder was leaned against the wall.

5. "What's mixed up?"
Grandfather in the oven, firewood on the stove.
Boots on the table, cakes under the table.
Sheep in the river, carp by the river.
Under the table is a portrait, above the table is a stool.

6. "On the contrary" (name the opposite pretext).
The adult says: "Above the window", the child: "Under the window."
To door - …
In a box...
Before school - …
To the city…
In front of the car...
- Pick up pairs of pictures that match the opposite prepositions.

7. "Signals".
a) To the picture, select a card-scheme of the corresponding preposition.
b) An adult reads sentences, texts. Children show cards-schemes with the necessary prepositions.
c) An adult reads sentences, texts, skipping prepositions. Children show flashcards of the missing prepositions.
b) The child is invited to compare groups of geometric shapes of the same color and shape, but of different sizes. Compare groups of geometric shapes of the same color and size, but different shapes.
c) "Which figure is superfluous." The comparison is based on outward signs: size, color, shape, changes in details.
d) "Find two identical figures." The child is offered 4-6 items that differ in one or two features. He must find two identical objects. The child can find the same numbers, letters written in the same font, the same geometric shapes, and so on.
e) "Choose a suitable toy box." The child must match the size of the toy and the box.
e) "On which site the rocket will land." The child correlates the shape of the base of the rocket and the landing pad.

TASK #3

Purpose: to reveal the spatial orientation associated with drawing and construction.

1. In the indicated way, place geometric shapes on a sheet of paper by drawing them or using ready-made ones.

2. Draw figures by reference points, while having a sample drawing made by points.

3. Without reference points, reproduce the direction of the drawing, using the sample. In case of difficulty - additional exercises in which it is necessary:
A) distinguish the sides of the sheet;
B) draw straight lines from the middle of the sheet in different directions;
B) outline the outline of the drawing;
D) reproduce a drawing of greater complexity than the one proposed in the main task.

4. Tracing templates, stencils, tracing contours along a thin line, hatching, dots, shading and hatching along various lines.

Kern-Jirasek technique.
When using the Kern-Jirasek technique (includes two tasks - drawing written letters and drawing a group of dots, i.e. work according to a model), the child is given sheets of paper with presented examples of tasks. Tasks are aimed at the development of spatial relationships and representations, the development of fine motor skills of the hand and the coordination of vision and hand movements. Also, the test allows you to identify (in general terms) the intelligence of the development of the child. Tasks for drawing written letters and drawing a group of dots reveal the ability of the children to reproduce the pattern. It also allows you to determine whether the child can work for some time with concentration, without distractions.

Method "House" (N. I. Gutkina).
The technique is a task for drawing a picture depicting a house, the individual details of which are made up of capital letters. The task allows you to identify the child's ability to focus on a sample in his work, the ability to accurately copy it, reveals the features of the development of voluntary attention, spatial perception, sensorimotor coordination and fine motor skills of the hand.
Instruction to the subject: "There is a sheet of paper and a pencil in front of you. On this sheet, I ask you to draw exactly the same picture that you see in this picture (the sheet with the "House" is placed in front of the subject). Take your time, be careful, try to the drawing was exactly the same as this one on the sample. If you draw something wrong, then you can’t erase anything with an elastic band or your finger, but you need to draw it right on top of the wrong one or next to it. Do you understand the task? Then get to work. "

When performing the tasks of the "House" Methodology, the subjects made the following mistakes:
a) some details of the drawing were missing;
b) in some drawings, proportionality was not respected: an increase in individual details of the drawing while maintaining a relatively arbitrary size of the entire drawing;
c) incorrect depiction of drawing elements;
e) deviation of lines from a given direction;
f) gaps between lines at junctions;
g) climbing lines one on top of the other.

"Draw mouse tails" and "Draw umbrella handles" by A. L. Wenger.
Both mouse tails and pens are also letter elements.

Graphic dictation and "Sample and Rule" by D. B. Elkonin - A. L. Wenger.
Performing the first task, the child draws an ornament on a piece of paper in a box from the pre-set points, following the instructions of the leader. The facilitator dictates to a group of children in which direction and how many cells the lines need to be drawn, and then offers to draw the “pattern” obtained from dictation to the end of the page. Graphic dictation allows you to determine how accurately a child can fulfill the requirements of an adult given orally, as well as the ability to independently perform tasks of a visually perceived pattern.
A more complex technique "Pattern and rule" involves the simultaneous following in your work to the pattern (the task is given to draw exactly the same pattern as the given geometric figure point by point) and the rule (the condition is stipulated: you cannot draw a line between the same points, i.e. connect a circle with a circle, a cross with a cross and a triangle with a triangle). The child, trying to complete the task, can draw a figure similar to the given one, neglecting the rule, and, conversely, focus only on the rule, connecting different points and not referring to the model. Thus, the methodology reveals the level of orientation of the child to a complex system of requirements.

"The car is driving along the road" (A. L. Wenger).
A road is drawn on a sheet of paper, which can be straight, winding, zigzag, with turns. A car is drawn at one end of the road, and a house at the other. The car should drive along the path to the house. The child, without lifting the pencil from the paper and trying not to go beyond the path, connects the car with the house with a line.

You can come up with many similar games. Can be used for training and passing the simplest labyrinths

"Hit the circles with a pencil" (A. E. Simanovsky).
The sheet shows rows of circles with a diameter of about 3 mm. Circles are arranged in five rows of five circles in a row. The distance between the circles from all directions is 1 cm. The child must, without lifting his forearm from the table, put dots in all circles as quickly and accurately as possible.
The movement is strictly defined.
I-option: in the first line the direction of movement is from left to right, in the second line - from right to left.
II-option: in the first column the direction of movement is from top to bottom, in the second column - from bottom to top, etc.

TASK №4

Target:
1. Fold the figures from the sticks according to the pattern given in the figure.
2. Add geometric shapes from four parts - a circle and a square. In case of difficulty, perform this task in stages:
A) Make a figure of two then three and four parts;
B) Fold a circle and a square according to the pattern of the drawing with the constituent parts dotted on it;
C) Fold the figures by superimposing on the dotted drawing of the part, followed by design without a sample.

"Make a picture" (like E. Seguin's board).
The child selects the tabs to the slots in shape and size and folds the figures cut out on the board.

"Find a shape in an object and put the object together."
In front of the baby, contour images of objects made up of geometric shapes. The child has an envelope with geometric shapes. It is necessary to add this object from geometric shapes.

"The picture is broken."
The child must fold the pictures cut into pieces.

"Find what the artist has hidden."
The card contains images of objects with intersecting contours. You need to find and name all the drawn objects.

"The letter is broken."
The child must recognize the entire letter from any part.

"Fold a square" (B. P. Nikitin).
Equipment: 24 multi-colored paper squares 80x80 mm in size, cut into pieces, 24 samples.
The game can be started with simple tasks: "Make a square out of these parts. Look carefully at the sample. Think about how to arrange the parts of the square. Try to put them on the sample." Then the children independently select the parts by color and assemble the squares.

Montessori frames and inserts.
The game is a set of square frames, plates with cut out holes, which are closed with an insert lid of the same shape and size, but of a different color. The lids and slits are round, square, equilateral triangle, ellipse, rectangle, rhombus, trapezoid, quadrilateral, parallelogram, isosceles triangle, regular hexagon, five pointed star, right isosceles triangle, regular pentagon, irregular hexagon, scalene triangle.
The child picks up the liners to the frames, circles the liners or slots, inserts the liners into the frames by touch.

"Mailbox".
Mailbox - a box with slots of various shapes. The child lowers volumetric geometric bodies into the box, focusing on the shape of their base.

"What color is the object?", "What shape is the object?".
Option I: children have subject pictures. The leader takes out chips of a certain color (shape) from the bag. Children cover the corresponding pictures with chips. The winner is the one who closed his pictures the fastest. The game is played like "Lotto".
Option II: children have colored flags (flags depicting geometric shapes). The host shows the item, and the children show the corresponding flags.

"Collect according to the form."
The child has a card of a certain form. He selects the appropriate items shown in the pictures for her.

Games "What form is gone?" and "What has changed?".
Geometric figures of different shapes are put in a row. The child must memorize all the figures or their sequence. Then he closes his eyes. One or two figures are removed (swapped). The child must name which figures are gone, or say what has changed.

Exercises for the formation of ideas about the value:
- Arrange the circles from smallest to largest.
- Build nesting dolls by height: from the tallest to the shortest.
- Put the narrowest strip on the left, next to the right put a strip a little wider, etc.
- Color the tall tree with a yellow pencil and the low one with red.
- Circle the fat mouse, and circle the thin mouse.
And so on.

"Great bag"
The bag contains voluminous and flat figures, small toys, objects, vegetables, fruits, etc. The child must feel to determine what it is. You can put plastic, cardboard letters and numbers in the bag.

"Painting on the back".
Draw letters, numbers, geometric shapes, simple objects on each other's backs with your child. You need to guess what the partner drew.

Speech developmental disorders are a fairly common problem among children. Such pathological conditions are not always manifested by severe symptoms, and in this case, parents do not pay close attention to them. And completely in vain, because in the absence of adequate correction, such violations can bring a lot of trouble in later life. The most common speech therapy disorders include dysarthria in preschool children in an erased form, the topic of our conversation today will be the symptoms of erased dysarthria and its treatment.

Erased dysarthria is a fairly common pathology that is difficult to correct. Such a violation concerns the pronunciation side of speech, and is usually observed in children of preschool, as well as primary school age.

Symptoms of erased dysarthria

With an erased form of dysarthria in young patients, insufficient mobility of a number of muscle groups in the speech apparatus is fixed, which can be represented by lips, soft palate or tongue. In some cases, there is a general weakness in the entire peripheral speech apparatus due to damage to certain parts of the nervous system.

With erased dysarthria, babies can pronounce most of the isolated sounds correctly, however, in the general speech stream, they poorly automate these sounds and at the same time do not sufficiently differentiate them. Disadvantages of pronunciation can be very different. Most often, with erased dysarthria, blurring and blurring, as well as some fuzziness of articulation, are observed. Such symptoms are especially noticeable in the flow of speech.

With an erased form of dysarthria, children do not have pronounced polymorphic disturbances in sound pronunciation, they also do not have violations of tone and problems in the contractility of the articulatory muscles.

Many pathological features of the articulatory apparatus become classic symptoms of dysarthria. In young patients, paresis of the muscles of the articulatory organs can be observed, which is expressed in the lethargy of the muscles of the face and lips, the drooping of the corners of the lips, and the inability to hold the position of the closed mouth. There is lethargy of the tongue, its tip is not active enough. Exercise leads to increased muscle weakness.

Erased dysarthria in preschool children is sometimes accompanied by muscle spasticity, which manifests itself in facial muscle tension, a constant half-smile of the lips, upper lip while pressing against the gums. When speaking, the lips do not participate in articulation in any way, so children with spasticity of the muscles of the face simply cannot pull their lips forward. The tongue becomes thick, it does not have a pronounced tip, and this organ also becomes inactive.

Also, an erased form of dysarthria in children can be manifested by hyperkinesis (trembling of the tongue and vocal cords), apraxia, deviation of the tongue from the midline and hypersalivation ().

How is erased dysarthria corrected, what is the effective treatment of the disease?

The elimination of erased dysarthria implies a complex impact, which includes medical, psychological and pedagogical, as well as speech therapy direction.

Successful treatment of this pathological condition depends on the full cooperation of specialists and parents. An important role is played by the correct development of articulatory motor skills.
And an excellent effect is given by the correct exercises, selected taking into account the specifics of the identified violation. Complexes of exercises can be selected, both for relaxation and for increasing the tone of problem areas. The speech therapist teaches the correct implementation of the exercises, and parents should practice them.

Correction of erased dysarthria may involve breathing exercises. So the implementation of the complex gives an excellent effect, it effectively develops speech breathing and helps to establish fluency of speech.

With some varieties of dysarthria, the child's mouth may be constantly ajar. At the same time, parents need to teach the baby to control the position of the mouth.

Successful correction of the erased form of dysarthria also includes the adoption of measures for the development of motor skills. Young patients need to perform exercises to overcome motor awkwardness and develop finger motor skills. An excellent effect is given by gymnastics, special exercises for coordination, as well as for balance. Children are encouraged to collect puzzles, mosaics and lacing, as well as perform other similar tasks.

The erased form of dysarthria requires correction of sound pronunciation. A speech therapist helps a preschooler to master the correct pronunciation of sounds, both vowels and consonants. In addition, therapy includes the development of speech from all sides. At the same time, the phonemic and lexico-grammatical side of speech is corrected: phonemic hearing develops, sound analysis skills develop, vocabulary expands, and training is also provided for the competent construction of statements.

An excellent effect with erased dysarthria is given by a speech therapy massage. It is performed by a certified speech pathologist. This method of correction involves massage of the lips, tongue and cheeks to optimize muscle tone, as well as to stimulate the muscles of the speech apparatus.

In some cases, the correction of erased dysarthria should include classes with a psychologist, for example, if it is necessary to correct the emotional disorders present in a preschooler.