Erased form of dysarthria as a stable symptom complex. Erased form of dysarthria in children

Very often in modern children there is a pathology in the pronunciation of certain words. The problem of this lies in violations of the nervous support of the speech apparatus. With incomplete (limited) movement of the lips, tongue and soft palate, difficulty in speech develops.

This phenomenon is called dysarthria. The causes of dysarthria in children can be very different, and the pathology itself, of course, is better amenable to correction at its first manifestations.

Dysarthria has several forms that differ from each other in the localization of the lesion:

• Cerebellar. The child has a change in the volume of speech, he can draw words. The reason is damage to the cerebellum or brain.
• Bulbarnaya. There is a speech disorder and problems with swallowing. The cause may be damage to the muscles that are responsible for articulation. Possible paralysis of the glossopharyngeal, hypoglossal, facial, trigeminal, or vagus nerve.
• pseudobulbar. Speech without emotional coloring, the reason is the incorrect operation of the cortical-nuclear pathways.
• Cold. Speech problems only occur when the air temperature rises or falls. It provokes a neuromuscular syndrome.
• Cortical. The child does not change the structure of words, however, the syllables are pronounced incorrectly. Possible cause is a violation of the functionality of the cerebral cortex, which leads to problems in the work of the muscles involved in the pronunciation of words.
• Extrapyramidal (subcortical). Speech is slurred, most sounds are pronounced nasally. The problem is in the subcortical nodes.
• parkinsonian. Slow, incomprehensible speech. observed in patients with parkinsonism.
• Erased. The child cannot make hissing and whistling sounds.

This is a neurological classification of pathology. By severity, dysarthria also has a classification, it is called speech therapy:

• 1 degree- Defects are detected only with a specialized study. The erased form of dysarthria belongs to this degree.
• 2 degree- speech can be understood, however, everyone hears its defects.
• 3 degree- only parents and close friends can understand what the child is saying, everyone else understands the child's speech partially.
• 4 degree- speech can not be understood by anyone, or it is absent altogether.

Causes of erased dysarthria

Erased dysarthria in children is a barrier moment in the development of a specific pathology of a neurological nature. As a rule, it is positioned as the easiest form of pseudobulbar. If the pathology is diagnosed and treated in the early stages, then there is a guarantee of a complete cure for this disease.

The reasons that can cause this pathology appear in a child in utero or at birth, they are as follows:

• fetal hypoxia;
• serious gestosis and toxicosis in the mother;
• renal lesions or neuropathy;
• mother got sick viral disease at the beginning of pregnancy;
• excessive activity or, conversely, weakness of labor activity;
• birth injury;
• various neuroinfections.

It is very important to start treating the pathology before the age of 5, since only before this age it can be completely eliminated and the child can be provided with a normal pronunciation of all words. Treatment after 5 years will be complicated not only by the formed perception of the child, but also by mental disorders. In adulthood, the treatment of pathology is complicated by the fact that the body has already been formed and the active stage of growth has already ended.

Clinical picture

Symptoms of erased dysarthria develop at three levels - articulatory, fine motor skills and general motor skills. It can be recognized by the following features:

1. The child gets tired quickly, activity is usually reduced, movements are limited. The kid cannot balance on one leg, poorly imitates movements, is practically unable to repeat elementary physical exercises.
2. There may be problems with learning self-care skills, the child has difficulty in drawing, as well as in working with small objects. In some cases, it may be difficult to determine the spatial arrangement of objects.
3. Speech is sluggish, while the tongue and lips are inactive, muscle paresis may be observed. Articulation exercises are also given to the child with great difficulty. In addition, the pathology is accompanied by a change in the tongue and its trembling - by this sign it can be determined that the dysarthria is erased. Dysarthria may be accompanied by trembling of the voice, such a phenomenon is observed provided that the muscles of the face are tense. Apraxia is often manifested - difficulties in the movement of the articulatory apparatus, while performing speech therapy exercises, the lips may be bent. If the child has increased salivation, then this indicates a weak muscle tone and problems with their management.

These symptoms may be similar to another pathology - dyslalia - problems with the pronunciation of sounds. But the main difference between these pathologies is the correct pronunciation of individual sounds. With erased dysarthria, whistling and hissing are either not pronounced at all, or are pronounced incorrectly.

Doctors conditionally divide children who have erased dysarthria into three groups:

1. Children with hearing problems. The speech apparatus in this case is well developed, and the pathology manifests itself in the fact that it is difficult for the child to pronounce prepositions.
2. Against the background of pathology, a disorder of phonemic hearing develops, while the child's speech contains both grammatical and lexical errors.
3. Underdevelopment of phonemic perception, syllabic structures are built with difficulty.

Due to the fact that with erased dysarthria it is difficult for children to express their thoughts, they may develop a perception disorder, which can lead to various mental disorders.

Problem Diagnosis

Examination of patients with erased dysarthria is carried out not only by a speech therapist, but also by a neurologist. Neurological examination directly depends on what clinical diagnosis the patient has. A very important and informative examination is an electrophysiological study - electroneurography, electroencephalography and others. An MRI of the brain was also shown.

Speech disorders are assessed during a speech therapy examination. In addition, the specialist studies the structure of the articulatory apparatus and other indicators.

If the study is carried out at an already mature age, then a study of written speech is carried out - rewriting the text, reading, writing texts from dictation, and others.

When diagnosing, it is very important to differentiate the pathology from dyslalia, motor alalia, and from motor aphasia. A lot of information about the differentiation and diagnosis of pathology is available in the book of Arkhipov E. F. "Erased dysarthria in children."

Correction of pathology

Since dysarthria is not a separate disease and is often observed in pathologies nervous system, all therapeutic measures should have a clear scheme. It should include both the treatment of the underlying pathology and speech therapy correction of dysarthria. In this case, the condition of the patient and his age must be taken into account.

Treatment methods for the disease are complex, as a rule, they consist of the following items:

• speech therapy correction;
• medications;
• massage;
• gymnastics for the respiratory centers.

All medications are prescribed by a neuropsychiatrist, however, there are no specialized drugs for the treatment of dysarthria, so the specialist prescribes drugs that can only eliminate the symptoms and alleviate the patient's condition. Most often written:

• Magne B6;
• drugs that relieve vascular spasms - Pantogam.

In especially severe cases are assigned:

• preparations for vessels - Cinnarizine, Instenon, Cavinton and others;
• nootropics - Encephabol, Pantocalcin;
• means for metabolism - Actovegin, Cerebrolysin;
• sedatives - Tenoten, Persen.

A good effect is given by Cerebrcurin, Piracetam.

As for speech therapy correction, it is based on the comprehensive development of speech - this is phonemic hearing, vocabulary, and grammatical construction.

In order to better develop listening comprehension, improve memory and attention, and also have a beneficial effect on breathing, general motor skills and articulation, special gymnastics is used. It is very important, as children diagnosed with dysarthria usually have great difficulty in mastering writing skills. We are talking about Strelnikova's breathing exercises, which perfectly regulate speech breathing and help make speech smoother.

Breathing exercises are selected for each patient differently, depending on the degree and type of dysarthria, but the essence of the gymnast is to breathe sharply through the nose, this is what the patient's attention will be focused on. Nasal breaths are taken naturally and without a certain rhythm, so gymnastics covers all parts of the body and provokes an increased need for oxygen in the body.

Treatment of dysarthria begins in the hospital, and then the patient can be treated on an outpatient basis. The goal of treatment is to eliminate the root cause that caused the pathology, the course of treatment is usually about six months.

Therapeutic exercise has great importance, since all types of exercises in this case are aimed at general motor skills. Massage is shown, which should be carried out carefully so as not to provoke additional muscle spasm.

Consequences, forecasts, prevention

Dysarthria does not have any bright and serious consequences and complications. With the progression of the pathology, anarthria may develop, as a result of which the patient will not be able to pronounce sounds at all. In addition, the pathology is accompanied by strong psychological discomfort, which can adversely affect psychological state patient.

As for prognosis, taking into account the polymorphism of the disease, it is the erased form of the disease that is best served for speech therapy correction. If we talk about the forms that provoke brain disorders, then, as a rule, such pathologies are practically not amenable to treatment and remain for life. The prognosis depends entirely on the form of the disease, the degree of its development, the age of the patient, patience and compliance with all medical recommendations.

Of course, there are no preventive measures for dysarthria. However, if, while carrying a child, the mother has been ill with infectious diseases, there were birth injuries or other problems that can provoke dysarthria, it is necessary to more closely monitor the psychophysiological development of the child. In addition, it is desirable to avoid the pathological influence of psychological or physical factors.

With children who are at high risk of developing dysarthria, it is necessary to talk more, respond to their cooing, stimulate babbling. Very important in early age develop grasping movements, give children toys different shapes- in general, try to develop fine motor skills.

Man is distinguished from animals by organized and structured speech, which has many functions. Every person is taught speech from birth. If there are various forms deviations and the causes of speech deformation, which are symptoms of diseases, then the child is sent for correction or treatment. Dysarthria is one of these disorders that must be addressed with the help of specialists.

Already at an early age, it can be noted that the child's speech is impaired. At the stage of formation of the articulatory apparatus, this fact is difficult to establish, since it is difficult for all children to correctly pronounce words and phrases. However, over time it becomes clear. First of all, you can contact a speech therapist to diagnose the child's speech and establish a diagnosis.

What is dysarthria?

What is dysarthria? This is a speech disorder in which the child incorrectly (distorted or difficult) pronounces sounds, words, phrases, syllables. Scientists call the cause of this disorder brain damage or various disorders in the articulatory apparatus:

• Innervation of the vocal cords, muscles of the soft palate or facial muscles as a result of various diseases, such as cleft palate or cleft lip.
• Absence of teeth.

As a result of speech dysarthria, writing develops when a child cannot learn the correct letter due to the incorrect pronunciation of sounds and syllables. AT severe forms dysarthria takes the form of speech incomprehensible to others. As a result, the child becomes closed and isolated, and the tendency to develop written skills is also disturbed.

Causes of dysarthria

The main cause of dysarthria, doctors call brain damage, resulting in innervation of the articulatory apparatus - the organs that are involved in the creation of speech are not very mobile. These include lips, tongue, palate, vocal cords, etc.

If dysarthria manifests itself in adults, then they do not have a violation of writing and reading. These functions are saved. However, the appearance of dysarthria in children leads to a disorder in writing and reading. The child already initially becomes incapable of any form of speech. At the same time, oral speech is devoid of smoothness, accompanied by a change in tempo (sometimes it accelerates, sometimes it slows down), a downbeat rhythm of breathing.

There is the following classification of dysarthria:

1. Hidden. It has erased symptoms, so it is confused with dyslalia, from which dysarthria differs by a focus of neurological symptoms.
2. Expressed. Its main symptoms are incomprehensibility, inarticulateness, inexpressiveness of intonation, breathing, voice, as well as impaired sound pronunciation.
3. Anartria is the complete absence of sound reproduction.

Other causes of dysarthria in children may include:

• Toxicosis during pregnancy.
• Improper development of the placenta.
• Rh factor incompatibility.
• Viral diseases during pregnancy.
• Rapid or prolonged labor.
• Infectious diseases of the brain in the newborn.

Other causes of dysarthria in adults are:

• vascular insufficiency.
• Postponed stroke.
• Genetic, progressive or degenerative diseases of the nervous system (Huntington's disease,).
• Tumor or inflammation of the brain.
• Multiple sclerosis.
• Asthenic bulbar paralysis.

Dysarthria is divided into degrees of severity:

1. Mild - violation of fine motor skills, movements of articulatory organs, pronunciation of sounds. Speech is slurred but understandable.
2. Severe - associated with cerebral palsy.

Less common causes of dysarthria are:

• Medicine overdose.
• Carbon monoxide poisoning.
• Head injury.
• Intoxication due to drug or alcohol abuse.

Dysarthria in children

Often dysarthria manifests itself in children, which has peculiar forms of manifestation. It can be recognized by:

1. Difficulties in pronouncing all sounds. Children distort them, distort them.
2. Difficulties with chewing and swallowing.
3. Underdevelopment of fine and gross motor skills: it is difficult to jump on one leg, fasten buttons, cut out paper.
4. Difficulties in learning to write.
5. Difficulties in using prepositions and in making sentences.
6. Disorder of voice formation, changes in intonation, rhythm and tempo of speech.

The combination of all disorders that are observed in a child with dysarthria differs depending on the severity of the disease, the degree, the focus of the lesion of the nervous system and the time of development. Speech, motor and mental disorders differ in this category of children.

Such children should be taught in specialized schools, where diagnosis and clarification of the type and degree of the disease are first carried out, after which individual approach to the education of the child.

Forms of dysarthria

There are various forms of dysarthria:

1. Bulbar - manifested in a decrease in muscle tone, atrophy or paralysis of the muscles of the tongue and pharynx. Speech becomes slurred, slow, fuzzy. Occurs due to tumors or inflammation in medulla oblongata. People with this form of dysarthria have low mimic activity.
2. Subcortical - manifests itself in a violation of tone and involuntary muscle movements (hyperkinesis). In a calm state and in a circle of friends and relatives, the child incorrectly pronounces words, sounds, phrases. The situation is aggravated if the child finds himself in a stressful environment - he cannot utter a single syllable. Changes in intonation, tempo and rhythm. Speech becomes either fast or slow, with a large gap between words. Defects in sound production and communication skills develop. Hearing loss may also develop.
3. Cerebellar - manifested in chanting or shouting out sounds. Occurs rarely.
4. Cortical - manifested in the pronunciation of whole phrases and sentences. There are pauses between words, as if stuttering. If speech is intensive, then various modifications of sounds arise. At the same time, the child pronounces individual words without difficulty.
5. Erased (light).
6. Pseudobulbar - manifests itself most often due to various injuries during childbirth or intoxication. Light form it is expressed by slow and difficult speech, which is explained by the low mobility of the lips or tongue. The severe form is expressed by complete immobilization of the speech apparatus, amimicity, limited lip movements, in the open mouth.

Erased dysarthria

Quite often there is erased dysarthria, in which the main characteristic features are:

• Bad diction.
• Indistinctness and inexpressiveness of speech.
• Replacement and distortion of sounds.

For the first time, this form of dysarthria was described by O. Tokareva, who pointed out that the separate pronunciation of sounds in children does not cause difficulty, but their pronunciation in complex words and phrases already leads to distortion. Speech becomes blurred, fuzzy, blurry.

Damage to the brain leads to the development of erased dysarthria. Usually it is detected at the age of 5. If dysarthria is suspected, the child should be taken to a neurologist who diagnoses the disease and then prescribes treatment. Corrective therapy is poorly developed, but it includes a complex of medicines, psychological and pedagogical work and speech therapy.

In addition to replacing or total absence sounds, the child has an inability to learn self-care skills, impaired gross motor skills, and an inability to keep the mouth closed due to flaccidity of the jaw muscles.

Pseudobulbar dysarthria

Transferred at an early age infectious diseases or head injuries lead to the appearance of pseudobulbar dysarthria, which is characterized by a violation of speech motility, sucking reflex, swallowing. The muscles of the face are sluggish, salivation is observed from the mouth.

According to the severity, the following forms of pseudobulbar dysarthria are distinguished:

• The mild form is manifested in inaccurate, slow, unexpressed speech. There are also violations in swallowing and chewing. Sounds are difficult to pronounce and devoid of voice.
• The middle form is characterized by amimicity and lethargy of the facial muscles. It is difficult for children to pull their lips forward or puff out their cheeks. Also, the tongue becomes almost immobile. The soft palate also practically does not participate in sound production.
• The severe form (anarthria) is manifested by complete paralysis of the muscles. The face is mask-like, the jaw hangs down, the mouth is open. Speech is practically absent, it is inarticulate.

Diagnosis of dysarthria

Dysarthria should not only be diagnosed, but also differentiated from other diseases such as dyslalia and aphasia. The doctor bases his findings on those skills that should already be observed in the child being tested. If the baby is not yet talking, then pay attention to his cry. In those suffering from dysarthria, the cry is quiet and nasal. There may be sagging of the lower lip, asymmetry of the facial muscles. The child may not take breasts in his mouth, choke on milk, turn blue.

Over time, the inability of the child to pronounce sounds manifests itself. He also has trouble swallowing and chewing. The older the child becomes, the more various deviations are noted:

1. Slow speech.
2. Weak articulation.
3. The presence of synkinesis.
4. prosodic disorder.
5. Difficulties in holding and switching articulation.
6. Violation in the pronunciation of sounds and their automaticity.

Treatment of dysarthria

The main direction in the treatment of dysarthria is the restoration of the functions of correct articulation so that the child can further communicate and learn calmly. Everything happens in three ways: medication, exercise therapy and speech therapy. It eliminates the violation of the voice, the disorder of speech breathing and articulation.

Among the medicines, nootropics are prescribed: Encephabol, Glycine, etc. Physiotherapy includes exercises that develop facial muscles. The main method of treatment is massage, where all the muscles of the articulatory apparatus are worked out. A. Strelnikova's breathing exercises are actively used.

The child should train to pronounce sounds, words and sentences. This can be done both independently and with a speech therapist. In addition, the emphasis is on the development of motor skills and the elimination of other dysfunctions.

Correction of dysarthria

It will not work to cure dysarthria on your own. In addition to therapeutic measures, you can resort to dolphin therapy, sensory therapy, isotherapy, sand therapy, etc. Correction of dysarthria depends on the severity of the disease. Basically, a speech therapist works with the patient, who develops his articulatory apparatus, breathing, facial muscles, etc.

Corrective work is divided into the following stages:

1. Massage when the muscles of the face are being developed.
2. Articulation exercises.
3. Automation in sound pronunciation.
4. Correct pronunciation of sounds.

Forecast

Dysarthria is cured depending on the measures taken in the treatment. The prognosis remains varied, depending on the causes and the ability of doctors to eliminate the factors of the disease.

Much falls on the shoulders of parents, who must also follow the recommendations of doctors and support their child. One should give him love and understanding, as well as praise for any slightest achievements.

Erased dysarthria is very common in speech therapy practice.

The main complaints with erased dysarthria:

1) slurred inexpressive speech,

2) poor diction

3) distortion of sounds

4) replacement of sounds in words that are complex in syllabic structure, etc.

In the specialized literature, the choice of a term that defines erased dysarthria remains debatable.

The term "erased" dysarthria was first proposed by O.A. Tokareva, who characterizes the manifestations of "erased dysarthria" as mild (erased) manifestations of "", which are particularly difficult to overcome. In her opinion, usually these children can pronounce most of the isolated sounds correctly, but in the speech stream they poorly automate them and do not sufficiently differentiate.

Pronunciation flaws are of a very different nature, and yet the main symptom of this violation is blurring, blurring, fuzzy articulation, which are especially sharply detected in the flow of speech.

Erased dysarthria

-speech pathology, manifested in disorders of the phonetic and prosodic components of the speech functional system and resulting from an unexpressed micro organic damage brain.

Studies of children in mass kindergartens have shown that in the older and preparatory groups for school, from 40 to 60% of children have deviations in speech development.

Among the most common disorders: dyslalia, rhinophonia, phonetic-phonemic underdevelopment, erased dysarthria.

In groups for children with general underdevelopment of speech, up to 50% of children, and in groups with phonetic-phonemic underdevelopment - up to 35% of children have erased dysarthria.

Children with erased dysarthria need long-term, systematic individual speech therapy assistance.

Speech therapists of specialized groups plan speech therapy work as follows: in frontal, subgroup classes with all children, they study program material aimed at eliminating the general underdevelopment of speech, and in individual classes they correct the pronunciation side of speech and prosodic, i.e. elimination of symptoms of erased dysarthria.

Diagnosis of erased dysarthria and methods corrective work not yet developed enough.

The problems of organizing speech therapy assistance to these children remain relevant, given the prevalence of this defect.

The erased form of dysarthria is most often diagnosed after five years.

All children whose symptoms correspond to erased dysarthria are referred for a consultation with a neurologist to clarify or confirm the diagnosis and to prescribe adequate treatment, because. with erased dysarthria, the method of corrective work should be comprehensive and include:

medical impact;
- psychological and pedagogical assistance;
- logopedic work.

For early detection erased dysarthria and the correct organization of complex effects, it is necessary to know the symptoms that characterize these disorders.

The examination of the child begins with a conversation with the mother and a study of the outpatient map of the child's development.

Analysis of anamnestic information shows that there are:

• deviations in intrauterine development (toxicosis, hypertension, nephropathy, etc.);
• asphyxia of newborns;
• rapid or prolonged labor.

According to the mother, "the child did not cry right away, the child was brought to feed later than everyone else." In the first year of life, many were observed by a neurologist, drug treatment and massage. The diagnosis was NEP (perinatal encephalopathy) for up to a year. The development of a child after one year, as a rule, is successful for everyone, the neuropathologist no longer observes these children, and the child is considered healthy.

When examined in a polyclinic by a speech therapist in children aged 5-6 years with erased dysarthria, the following symptoms are revealed:

Thus, children with erased dysarthria are a heterogeneous group.

Depending on the level of development language tools children are sent to specialized groups:

• with phonetic disorders;

• with phonetic-phonemic underdevelopment;

• with general underdevelopment of speech.

At school age Erased dysarthria manifests itself not only in speech (indistinct, fuzzy), but also in written speech.

Characteristic dysgraphic errors in writing are omissions and replacement of vowels, omissions of consonants when several consonants converge in a word, and underwriting of endings.

These errors are due to insufficiently clear articulation of vowels, which are also pronounced in oral speech in a reduced way.

In addition to these errors, there are also graphic errors, which are based on the inferiority of optical-spatial representations.

(23 liked, average score: 4,78 out of 5)

ERASED FORM OF DYSARTRIA AS A STABLE SYMPTOM COMPLEX

MODERN VIEW ON THE PROBLEM

How special kind speech disorder, an erased form of dysarthria began to stand out in speech therapy relatively recently - in the 50-60s of the XX century.

In her classification of disorders of the sound-producing side of speech, based on the pathogenetic principle, R.A. Belova-David distinguished two main types: dyslalia, associated with the functional nature of the disorder, and dysarthria, due to organic damage to the central nerve - noah system.

Systematizing violations of sound pronunciation in preschoolers, taking into account the pathogenesis of sound pronunciation disorders, E.F. Sobotovich identified shortcomings in sound pronunciation, which manifested themselves against the background of neurological symptoms and had an organic basis, but were of an erased, unexpressed character. She qualified them as disorders of the dysarthria series, while noting that the symptomatology of these disorders differs from the manifestations of those classical forms of dysarthria that occur with cerebral palsy.

Other domestic and foreign researchers also pointed out that there is a group of children with impaired formation of the sound side of speech, whose symptoms and nature do not correspond to either dyslalia or dysarthria.

For a long time, the nature of these disorders remained unclear, which was also manifested in the variability of terminology (apractical dysarthria, articulatory dysarthria, organic, central or complicated - "protracted" - dyslalia, functional dysarthria, minor dysarthria, minimal dysarthria disorders, etc.) . Later, in the studies of E.F. Sobotovich, R.I. Martynova, E.Ya. Sizova, E.K. Makarova, L.Vlopatina and others, these disorders began to be designated as erased dysarthria or as an erased form of dysarthria.

The very term “erased form of dysarthria” was first used by Tokareva O.A., according to which children suffering from this pathology can pronounce most sounds correctly, but in spontaneous speech they are poorly automated and differentiated.

It is obvious that initially the researchers attributed the erased form of dysarthria to the actual sound-producing disorders, but subsequently these disorders were interpreted by many authors as a symptom complex that includes speech and non-speech symptoms. Currently, in the domestic literature, an erased form of dysarthria is considered as a consequence of minimal brain dysfunction, in which, along with impaired sound pronunciation,
On the negative side of speech, mild disturbances of attention, memory, intellectual activity, emotional-volitional sphere, mild motor disorders and delayed formation of a number of higher cortical functions are observed. The literature emphasizes that the erased form of dysarthria in its manifestations is characterized by smoothing of symptoms, their heterogeneity, variability, a different ratio of speech and non-speech symptoms, violations of the sign (linguistic) and non-sign (sensory-motor) levels. Therefore, it presents a significant difficulty for differential diagnosis.

The etiology of the erased form of dysarthria is associated by domestic authors with organic causes acting on brain structures in the prenatal, natal and early postnatal periods. In many cases, there is a chain of hazards in the anamnesis of all three periods of the child's development. The researchers note that when exposed to a harmful factor on developing brain damage is widespread and can contribute to delayed maturation and impaired functioning of structures

Brain.

In foreign literature, for such disorders, the concept of “speech, or articulatory, developmental dyspraxia” (Development apraxia of speech-DAS) is used. Among the causes of DAS are usually called a violation of the innervation of the articulatory apparatus, movement disorders, oral apraxia as a violation of the central program for the temporal coordination of voluntary muscular movements of the articulatory apparatus, minimal

brain dysfunction.

Domestic and foreign researchers note the presence of diverse neurological symptoms in children with an erased form of dysarthria,

Symptoms of an organic lesion of the central nervous system are found in the form of erased cuts, changes muscle tone, hyperkinesis (excessive involuntary movements), manifested mainly in the mimic and articulatory muscles, in the presence of pathological reflexes, disruption of the autonomic nervous system.

G.V. Gurovets, S.I. Maevskaya, B.A. Arkhipov indicate a violation of the function oculomotor nerves in children with an erased form of dysarthria, manifested in unilateral ptosis, strabismus, limited volume -

Ema eyeball movements.

In the motor sphere in this category of children, the same development of the functions of both hands and pseudo-left-handedness are observed. Researchers note slowness, awkwardness, insufficiency of movements during

relative preservation of their volume, emphasizing that the limitation of the range of motion of the upper and lower extremities is detected mainly on one side.

It should be noted that the general motor skills of children with an erased form of dysarthria have not been sufficiently studied, in contrast to fine motor skills, the violation of which, along with articulation, is defined by the authors as one of the leading symptoms in an erased form of dysarthria. L.V. Lopatina, N.V. Serebryakova, describing the violations of manual motor skills in these children, note inaccuracy, lack of coordination, insufficient dynamic organization of movements. A.V. Semenovich points to gross violations of reciprocal and synergistic sensorimotor coordination, an abundance of synkinesis.

Studies of articulatory motility have shown that children with an erased form of dysarthria have a dysfunction of the muscles innervated by the lower branch trigeminal nerve, facial, hypoglossal, and glossopharyngeal nerves. Violations of the functions of the trinitarian nerve (V pair) are manifested in a narrowing of the range of motion of the lower jaw. At the same time, inaccuracy, limited movements, synkinesis of the lips and tongue are noted. Function disorders facial nerve(VII pair) in children with an erased form of dysarthria are manifested in smoothness, asymmetry of the nasolabial folds, insufficient volume of facial movements, lip movements during baring. Violations of the innervation of the hypoglossal nerve (XII pair) are manifested in the impossibility of maintaining a static posture, tremor of the tip of the tongue, difficulty in lifting the tongue up, hyper or hypotonicity of the muscles. Dysfunction of the glossopharyngeal nerve (IX pair) is manifested in insufficient elevation of the soft palate (Uvula), nasalized tone of speech, salivation, limited range of motion of the middle part and root of the tongue.

The authors also point out the difficulties of switching movements, reproducing simultaneous movements of the articulatory organs, perseveration (compulsively repetitive movements), rearrangements when reproducing a series of movements.

The listed motor disorders of the articulatory apparatus determine a variety of phonetic deficiencies, which, according to most researchers, are dominant in the structure of the defect in the erased form of dysarthria. OA Tokareva points out that this category of children has more severe manifestations of sound pronunciation disorders than with dyslalia, requiring long-term speech therapy to eliminate them. Features of sound pronunciation are determined by the nature of innervation disorders, the state of the neuromuscular apparatus of the articulatory organs. According to G.V. Gurovets and S.I. Maevskaya, the most common distortions are lateral, interdental, softened pronunciation of sounds. Children with an erased form of dysarthria often replace complex sounds with articulatory simpler ones, split affricates into components

their components, slotted ones are replaced by occlusive ones, hard ones are replaced by soft ones.

Most researchers note that children with this defect are characterized by a polymorphic impairment of sound pronunciation, which manifests itself in distortions and the absence of mainly three groups of sounds: whistling, hissing, and sonors.

Less pronounced, according to the authors, in this category of children are prosodic (voice) disorders. Deviations in the tempo and dynamic organization of speech are indicated. There are features of the voice timbre (high, loud, noisy, breaking into falsetto or, conversely, quiet, low, weak), insufficient differentiation of various types of intonation. Speech is characterized by low expressiveness, monotony, "blurred" intonation pattern.

In many studies devoted to the study of the problem of an erased form of dysarthria (G.V. Gurovets, S.I. Maevskaya, E.F. Sobotovich, L.V. Lopatina, etc.), it is noted that phonemic perception disorders are common in children of this category . It is difficult for them to distinguish by ear hard-soft, voiced-deaf sounds, affricates and their constituent elements. They are characterized by distortions in the sound-syllabic structure of words, difficulties in mastering sound-syllabic analysis and synthesis, and the formation of phonemic representations.

The question of the mechanisms of phonemic underdevelopment in the structure of a speech defect in an erased form of dysarthria is debatable. According to research by L.V. Lopatina, in preschoolers with an erased form of dysarthria, the existence of fuzzy articulatory images leads to the fact that the boundaries between auditory differential features of sounds are erased, and the lack of clear auditory perception and control contributes to the preservation of sound-producing defects in speech. As R.E. Levina noted, such a phenomenon is observed in violation of speech kinesthesia that occurs with morphological and motor lesions of the speech organs. Thus, in modern defectological literature, phonemic underdevelopment in the structure of a defect in an erased form of dysarthria is considered as a secondary violation.

Neuropsychological researchers (A.V. Semenovich, L.I. Serova and others) adhere to a different point of view. They also believe that the violation of phonemic perception, along with the insufficiency of the phonetic side of speech, is one of the dominant symptoms in the erased form of dysarthria, however, it is not due to sound-producing disorders, but to a systemic delay and distortion of the cerebrogenesis of the brain systems.

E.F. Sobotovich, L.V. Lopatina note in children with an erased form of dysarthria the underdevelopment of the grammatical structure of speech: from a slight delay in the formation of the morphological and syntactic systems of the language to pronounced agrammatisms in the expressive

speech. One of the reasons for the insufficient formation of the grammatical structure of speech in this category of children, in their opinion, is a violation of the differentiation of phonemes. A similar point of view is shared by N.V. Serebryakova, who points to the presence of lexicogrammatic underdevelopment of speech and violations of coherent speech in preschoolers with an erased form of dysarthria. However, other researchers do not agree with this point of view (R.I. Martynova, G.V. Gurovets, etc.) and argue that these violations are not mandatory, they can manifest themselves in the presence of certain adverse factors.

Researchers-neuropsychologists find in children with an erased form of dysarthria a violation of the correlation of the word-name and the image of the object. In some children, there is a lack of formation and poverty of independent speech production, a delay in the formation of the generalizing and regulating function of the word.

A number of authors (R.I. Martynova, E.F. Sobotovich, L.V. Lopatina and others) reveal the features of the formation of a number of higher mental functions and processes in children with an erased form of dysarthria: weakening of mental activity by the type of asthenia with a pronounced decrease in the functions of attention and memory, difficulties in generalizing, classifying, determining the logical sequence of events in plot series, violations in establishing causal relationships.

Some researchers (O.A. Krasovskoy, A.V. Semenovich and others) singled out defects in the selectivity of visual memory, perception, spatial representations as typical symptoms of an erased form of dysarthria. So, OA Krasovskaya points to violations of visual recognition of objects: fragmentary perception of object images, violations of simultaneous gnosis and insufficiency of visual control. She notes that in the study of the drawings in these children, the violations revealed are of a different nature: from the complete collapse of visual-constructive activity, the inability to perform the drawing either according to the instructions or according to the model, to the distortion of individual details, sizes, and its incorrect location in space. (rotate 90 degrees). A.V. Semenovich speaks about the tendency to inversion of the visual perception vector; m (from right to left, from bottom to top) and left-sided ignoring.

Researchers involved in the study of this problem, conducted observations mainly on children of preschool age. Nevertheless, some of them (R.I. Martynova, M.P. Davydova and others) indicate the possible difficulties of teaching children with an erased form of dysarthria at school. L.V. Lopatina and N.V. Serebryakova write that children with an erased form of dysarthria, even by the age of 7, are not sufficiently prepared for mastering the school curriculum in the Russian language. According to R.I. Martynova, dysgraphic errors are observed in writing in children with an erased form of dysarthria.

G.V. Chirkina also points to writing disorders in children with this defect: “Many children who entered public schools could not master the first grade program at all,”

Thus, the literature notes the presence of the following symptoms of an erased form of dysarthria in children: neurological symptoms, insufficiency of visual gnosis, spatial representations, memory, motor disorders, prosodic side of speech, low level the development of sound pronunciation, phonemic perception, the lexical and grammatical side of speech, coherent speech. The mental development of these children proceeds according to a specific type and is characterized by a systemic dynamic delay and distortion in the formation of a number of higher mental functions and processes.

In order to organize effective corrective work, it is necessary to determine the dominant symptoms that are mandatory for the symptom complex with an erased form of dysarthria, and the secondary ones that manifest themselves under certain conditions, as well as a good understanding of the influence of the mental developmental characteristics of this category of children on the formation of reading and writing,

Violation of sound pronunciation in a person always causes discomfort and fear. What does it mean when we hear the diagnosis - dysarthria?

Dysarthria is a speech disorder caused by damage to the functions of the speech apparatus, during which the connection of cells and tissues with nerve endings is disrupted, which causes restriction of the movement of the speech organs, thereby complicating articulation.

Dysarthric speech is illegible and crumpled. Children may experience a general developmental delay due to the impact of the disease on speech and writing. In adults, violations of writing and auditory perception of speech are not detected. Despite this, the disease delivers the same discomfort at any age.

The neurological classification of the deviation is based on the area of ​​damage to the speech and motor apparatus. Based on the principle of localization of the focus of the development of the disease, the following forms of dysarthria are distinguished.

Bulbarnaya

With this form of the disease, there is a decrease in muscle tone or atrophy of the muscles of the speech apparatus. The deviation occurs due to the development of tumor or inflammatory processes in the medulla oblongata, which destroys the nuclei of the motor nerves. The speech of this form of dysarthria is characterized by slowness, incomprehensibility and nasal sound.

pseudobulbar

Most often, pseudobulbar dysarthria is diagnosed in children as a result of a lesion. brain activity under the age of one year. Speech is slow, slurred with impaired reproduction of whistling, hissing and sonorous sounds. Pseudobulbar dysarthria in children is characterized by limited movement of the lips and tongue. Patients are prone to profuse salivation and increased pharyngeal reflex.

subcortical

It develops due to damage to the subcortical nodes of the brain. Symptoms include slow, slurred speech and frequent involuntary movements of the facial or articulatory muscles, causing spasms of the facial muscles and uncontrollable guttural screams. There may be a change in the tempo and timbre of speech and a violation of intonation.

Cerebellar

This diagnosis is rarely made. Speech is distinguished by fluctuations in volume, chanting of words and shouting out individual sounds. Also observed instability of gait, awkwardness, imbalance.

Cortical

It is characterized by a violation of articulation. With the correct pronunciation of words, difficult reproduction of syllables can be observed. There are no reading or writing impairments.

According to the classification of speech therapists, based on the degree of intelligibility of speech, there are 4 forms of dysarthria.

1. At the first stage, speech disorders are invisible to others and can only be detected by a specialist. This stage of the course of the disease also has two other names: erased dysarthria and dysarthria component.
2. The deviation becomes noticeable to others. The intelligibility of speech is maintained.
3. Speech defects are clearly expressed. The speech of the patient is understandable only to those close to him.
4. Speech is completely incomprehensible or absent altogether.

Regardless of the principles by which the types of dysarthria are distinguished, in the first place, it is important to identify the cause of dysarthria.

The reasons

Dysarthria in adults in most cases is the result of an injury or disease of the brain. So, the following factors can be the reasons for the development of dysarthria in an adult:

• head injury;
• stroke;
• tumor formations in areas of the brain;
• neurosurgical operations;
• neurosyphilis;
• oligophrenia;
• Parkinson's disease;
• multiple sclerosis;
• myatonia;
• myasthenia, etc.

Often this disease is diagnosed in children under 5 years of age. Usually, dysarthria in a child develops in parallel with childhood cerebral palsy, being its consequence. This is due to damage to the central nervous system, which can occur both during fetal development and after birth for about 2 years.

The following factors can affect the unborn fetus:

• toxicosis during pregnancy;
• Rhesus conflict;
• birth trauma;
• asphyxia during childbirth;
• development of pathologies during pregnancy;
• prolonged or rapid childbirth;
• premature birth, etc.

The development of dysarthria in the postpartum period is usually associated with the transfer infectious diseases brain, otitis media, severe poisoning, traumatic brain injury and other causes.

Symptoms

With dysarthria at any age, there is a violation of speech activity caused by a weakening of the connection between cells and tissues of the speech apparatus with nerve endings. This, in turn, changes the rhythm of breathing at the time of speech, making it intermittent and rapid.

Dysarthria's speech is slurred and incomprehensible. Depending on the stage of dysarthria, speech disorders of varying severity are observed. So, erased dysarthria in preschool children and adults is characterized by subtle disturbances in the pronunciation of certain sounds. Further stages of the development of the disease are distinguished by more obvious speech defects (omissions of sounds, slowness of speech). The most severe stage of dysarthria is characterized by paralysis of the muscles of the speech apparatus and, as a result, the patient's inability to speak.

Articulation disorders are manifested, as a rule, in an increase or decrease in the tone of the muscles of the speech apparatus. With increased tone, there is tension in the muscles of the face, neck, lips and tongue. If the disease proceeds at low muscle tone, manifested sluggishness in the muscles of the tongue and lips. Lips and mouth parted, characterized by profuse salivation.

If dysarthria is diagnosed in a child, as a result, there is a distortion of auditory perception of speech and other disorders, which causes the development of concomitant speech deviations of an adjacent nature and deviations in the overall development of the child.

Usually, dysarthria in a child is detected not earlier than 5 years of age. As a rule, erased dysarthria is characterized by speech disorders that are not very noticeable and can be easily corrected, so that children can study in ordinary educational institutions. If the child's dysarthria is severe, it is necessary to identify the baby in specialized educational institutions.

For dysarthria in preschool age, treatment should begin immediately. It can be difficult to identify the disease on your own at home, since at this age children are only forming their speech characteristics, and making mistakes is quite natural. Parents should pay attention to some other factors. So, in children with a possible dysarthria component, fine motor skills of the hands are impaired, which causes difficulties with tying shoelaces, fastening buttons or zippers, modeling from plasticine, etc.

Moreover, even the erased form of dysarthria in children causes a weakening of the facial muscles and muscles of the speech apparatus, as a result of which the child's face may look sluggish, the mouth is usually ajar, and insufficient muscle tone of the tongue creates obstacles in sound pronunciation.

Diagnostics

Diagnosis of the disease takes place in two stages: a neurological examination performed using clinical analyzes and speech therapy examination.

Tests and procedures that the patient must undergo during a neurological examination include the following:

• magnetic resonance imaging of the brain;
• electroneurography;
• electroencephalography;
• electromyography;
• transcranial magnetic stimulation and other procedures.

An examination by a speech therapist is aimed at identifying certain defects in speech and articulation in a patient. The activity of the articulatory apparatus and the condition of the muscles of the speech apparatus and facial muscles are assessed, as well as who, as a patient, breathes.

Diagnosis of dysarthria includes

Correction

Treatment of dysarthria is considered successful, as a result of which the patient restores his ability to express himself clearly to others. In order to achieve this goal, an integrated approach is needed on how to treat the disease, which is based on the correct diagnosis of dysarthria, competent drug treatment, speech therapy correction of dysarthria and physiotherapy measures.

Drug treatment is prescribed by a specialist after complete examination patient. However, it will not be possible to solve the problem only with medication, therefore, physiotherapeutic measures are included in the course of treatment of the patient.

The patient is prescribed therapeutic baths, special physical exercises, acupuncture, various kinds of massages, as well as such non-traditional, but, nevertheless, effective methods corrections, such as swimming and communication with dolphins, creative treatment, creative and educational games with sand and much more.

Speech therapy measures for the correction of dysarthria are aimed at restoring the articulatory apparatus. During the classes, the speech therapist works with the patient on the pronunciation of sounds, setting the correct breathing and voice, performs special gymnastics to develop the articulatory apparatus, and also massages the tongue.

Treatment of dysarthria in a child should be based on speech therapy classes and home treatment.

Exercises for kids at home

Classes with a speech therapist are meaningless if dysarthria is not corrected at home. A child under 6 years old with dysarthria is in dire need of the constant attention of his parents, who, in turn, must devote a lot of time to special classes aimed at restoring the functions of the baby's speech.

First you need to massage the muscles of the face, during which you need to alternately pinch and stroke the lips, cheeks and lower jaw child. It is also important to teach your child to massage himself, standing in front of a mirror, which will help him to study his face and the work of the muscles of the tongue and lips.

To restore the correct functioning of the speech apparatus, it is important to hone the movements of the jaw for opening and closing the mouth, fixing a certain position of the jaw, the image of an animal grin and a tube with lips.

The child will love playing with candy on a stick. So, the child should hold the lollipop in his mouth, and mom and dad should try to pull it out. As the size of the candy decreases, it will become more difficult to hold it. You can also apply the candy first to the right and then to the left corner of the mouth so that the child tries to get it with his tongue in this position.

You can develop hand motor skills at home with the help of small objects, such as peas or beads, which the child must touch. The baby will enjoy the process if the parents try to make it look like a game for the baby.

Forecast and prevention

Many patients and their loved ones are concerned about the question of whether it is possible to completely recover from dysarthria. There are no exact predictions in this regard, since with regard to the correction of dysarthria, it is important to diagnose the disease in a timely manner and begin treatment. In addition, the absolute restoration of the functions of the speech apparatus is possible only in the case of a mild course of the disease, that is, with erased dysarthria. Erased dysarthria in preschool children is corrected as the child grows and develops. In subsequent stages, there is a chance for some improvement in speech, but a completely severe degree is not treated.

Patients with dysarthria at any age need constant attention from loved ones, which will help some (with mild forms of the disease) to fight dysarthria, and others (with severe forms) will not feel deprived and isolated. Dysarthria and its consequences greatly affect the socialization of a person, which is why such patients need care and attention.