What to do if a child is diagnosed with dysarthria: advice from a speech therapist

Dysarthria is a speech disorder. It occurs due to damage to the parts of the brain that are responsible for connections with the articulatory apparatus. One of the most common and simplest forms is erased dysarthria. It is diagnosed when the child reaches 5 years of age. The baby's speech is slurred, he distorts or replaces sounds, he has poor diction - these are the signs of this disease.

In the article we will talk about correctional work for dysarthria, features of sound production, complex treatment and prevention of the disease.

Principles of speech correction for dysarthria

Speech therapists use several principles when working with children. Here they are:

1. Individual approach. The specialist evaluates the compensatory capabilities of the little patient - what articulatory movements have been preserved, what sounds and syllables the baby pronounces correctly;
2. From simple to complex. Correction always begins with those sounds that the child pronounces best. This sequence of sound production for dysarthria allows you to achieve better results.
3. Long practice of each sound. Speech correction in children with dysarthria requires much more time than other speech therapy problems.

Corrective work includes the following stages: production, automation and differentiation of sounds. But the very first task of a speech therapist is to teach the child to distinguish them by ear.

What to do if a child is diagnosed with dysarthria: advice from a speech therapist

Some parents are faced with the fact that their child - natural or adopted - has speech problems and, hearing the word “dysarthria”, feel confused. What is dysarthria, why does it occur and how to correct it, says Resource specialist, speech therapist of the highest category, member of the Russian Dyslexia Association Galina Orlova.

− Dysarthria is a disorder of the pronunciation side of speech, which is associated with damage to the central part of the speech motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. Simply put, the child cannot fully perform the movements necessary for speech. Sound pronunciation suffers from this, explains Galina. - In milder cases, this is a distortion of certain sounds. In severe cases of the diagnosis, omissions and replacement of sounds may be noticed. The pace and expressiveness of speech are impaired.

Dysarthria can also be characterized by the presence of paralysis and paresis of the organs of articulation. In this case, incomprehensible speech is a consequence of the diagnosis, up to the absence of speech due to complete paralysis of the speech motor muscles - anarthria.

The causes of dysarthria can be different - deviations from the norm during intrauterine development due to toxicosis, hypertension, nephropathy in the mother, infectious diseases suffered by a woman during pregnancy, as well as asphyxia of newborns, rapid or prolonged labor, mechanical obstetrics, a long anhydrous period in childbirth

From the very first days of life, such children are observed by a neurologist. They are often prescribed medication, massage and other rehabilitation procedures.

− How to recognize dysarthria?

− An attentive parent may suspect it by the child’s unusual facial expressions, profuse salivation, the shape and position of the tongue, the ability to fix an articulatory position, and sound pronunciation.

− When should you start working with dysarthrics?

− It is advisable to begin speech therapy work with any speech disorder in early preschool age. The earlier the disease is diagnosed, treatment and corrective classes are started, the greater the chances of success.

− What should parents do if their child is diagnosed with dysarthria?

— The first step, of course, is an examination by a neurologist. There are no special medications to combat dysarthria. The doctor only corrects some neurological symptoms with the help of medications. It is also important to consult a speech therapist who knows the technique of speech therapy massage, who, after a full examination, will give a conclusion and recommendations.

In addition, experts advise developing fine motor skills. You can assemble puzzles and Lego sets, sculpt from plasticine - there are many games that develop little fingers. You can use non-traditional methods of influence, such as su-jok therapy. The simplest method of su-jok therapy is training with special massage balls.

Logorhythmics classes are recommended for children two to three years old, for example, according to Zheleznova’s method. To correct dysarthria in children five years old, a speech pathologist is involved in the classes.

− What is the focus of the speech therapist’s work in the classroom?

— The specialist is engaged in the development of the prosodic side of speech - rhythm, strength, timbre, melody, tempo, logical stress, diction, as well as articulation and sound pronunciation, auditory attention, phonemic hearing, correction of speech breathing. The speech therapist will also pay attention to the normalization of muscle tone in the articulatory muscles and the development of voluntary facial movements.

If you do not have the opportunity to visit a speech therapist, then you can work with your child at home on your own, having previously completed a course with a specialist.

I will give examples of some elements of speech therapy massage and self-massage: take turns puffing out our cheeks, retracting our cheeks; close and open your mouth, click your teeth; suck on a small piece of sugar or candy; imitate the resorption of a lollipop; lick your lips; We hold a piece of bandage or gauze with our teeth for a long time; the adult’s task is to try to carefully remove the fabric.

It is also important to perform a complex of articulatory gymnastics - these are the “Proboscis” exercises (pull your lips forward, teeth and lips are closed, hold for five seconds), “Fence” (lips in a smile are tense with the mouth slightly open, teeth are clenched, the lower jaw is in a calm state, hold for five seconds) and their alternation, “Window” (with each count we open and close our mouth), “Spatula” (when smiling with an open mouth on a relaxed lower lip, place the tongue flat, hold for five seconds), “Needle” (smile with an open with our mouth, we put our tongue forward, trying not to bend it upward), “Needle shovel” (alternating exercises), “Clock” (we smile with our mouth open, stick out our tongue and make movements to the right and left, while touching the corners of our mouth with our tongue), “ “Swing” (smile with an open mouth, the tip of the tongue resting either on the upper or lower teeth), “Horse” (we click the tip of the tongue, imitating the clatter of hooves).

Over the years of work, I have often met children diagnosed with dysarthria of varying severity. This type of speech disorder has become a global problem in recent years, so it is extremely important to identify disorders in time and consult a specialist. But parents should know that correctional work with dysarthric children should not be limited to classes with a speech therapist. For the best results, this work should be continued at home, on a walk and in any joint activities.

Press service of the Department of Labor and Social Protection of the Population of Moscow

Stages of correction of sound pronunciation disorders

The speech therapist adheres to a strict sequence of sound production for dysarthria. Corrective work consists of 6 stages.

First: the specialist prepares the articulatory base for the production and pronunciation of palatal, sonorant, hissing and whistling sounds. When the baby masters some of them, the speech therapist moves on to working on them. It involves kinesthetic, auditory and visual control. Here is an example of a speech therapist’s instructions to a small patient: “Look in the mirror and repeat after me,” “Look in the mirror and do the exercise,” “Look at yourself in the mirror, stretch out your lips.” This feature of sound production gives good results.

This approach is necessary to reduce the apraxic disorders that accompany dysarthria. In general, the first stage is the foundation for the further development of sound pronunciation skills.

Second: the speech therapist determines the sequence of correction. He assesses which articulatory structure the patient has “mature”. Many children with motor and speech disorders are better at producing more complex sounds, such as hissing sounds. But the patient can master lighter whistling sounds, with which it is recommended to begin correction, later.

Third: the specialist stimulates or plays a certain sound. When staging, he uses classical techniques - staging by imitation, mechanical or mixed method.

Fourth: consolidation, or automation. This is the most difficult stage in all correctional work. It takes the most time. Often children master a sound and pronounce it in isolation, but make mistakes in speech. Therefore, after the production stage, the speech therapist focuses on working on isolated sound pronunciation, and then connects words with different syllable structures. Thus, the child pronounces the sound at the beginning, middle or end of words. Then the speech therapist connects sentences in which the sound being studied is concentrated.

The speech therapist selects lexical material individually. It must be appropriate for the baby’s age and capabilities, and also not include sounds that he cannot yet pronounce or distort.

Fifth: separation of delivered and oppositional sounds. First, the speech therapist suggests 2 syllables, then increases to 3. for example, sa - sha, sta - shta, etc. After this, he works on pairs of words with different syllable structures.

Sixth: developing communication skills. Another difficult stage. Often children communicate in a speech therapist’s office, but in front of other people and outside the office, the acquired speech skills are lost, and the child begins to speak “the old fashioned way.” In order to develop communication skills, the painstaking work of a speech therapist is necessary, but without the desire of the child himself, success cannot be achieved either.

The development of communication skills in dysarthria is facilitated by techniques such as memorizing rhymes, retelling or writing stories.

Dysarthria

Iya Valerievna Bolgova

Dysarthria

Task 1. Describe the symptoms of bulbar dysarthria and draw up a plan for correctional and speech therapy work to restore speech.

of bulbar dysarthria :

Disorder of the muscles responsible for the swallowing function, which is expressed in difficulty swallowing, and sometimes even in aphagia (impossibility of swallowing)

. Under such conditions, there is a risk that food will enter the trachea and directly into the lungs, which can lead to suffocation and death.

Speech disorder. At the same time, it becomes inaccessible to perception. The voice and the very ability to speak may disappear. The patient gets tired of the tension that the muscles of the speech apparatus experience when speaking.

Weakening of the respiratory and cardiovascular systems, which is due to the proximity of their location to the damaged areas of the nerves;

Deviation of the tongue to the side not affected by paralysis.

Drooping soft palate. Absence of pharyngeal and palatal reflexes.

Uncontrollable crying or laughing when holding an object over the surface of the teeth.

Features of work with bulbar dysarthria .

For flaccid paralysis and paresis, the goal of speech therapy work is to improve tissue nutrition, conductivity of nerve tissue, muscle excitability and reactivity, and induce reflexes.

This can be achieved through tonic massage and gymnastics. Gymnastics is initially passive, then passive - active.

Respiratory muscle training is a must. With flaccid paralysis of the muscles of the soft palate and pharynx, it is necessary to select exercises to train these muscles.

To activate the vocal cords, it is useful to let a speech therapist feel the sound of your voice. The child puts his hand to the speech therapist’s larynx and feels the tension of the sounding voice and the vibration that occurs. At the same time, the child is taught to distinguish between turning the voice on and off by ear.

Then the child himself is taught to produce his voice while exhaling. At first, it is recommended to start voice exercises with the sound M, since this sound is simple in articulation, but requires the active supply of an air stream into the nasal cavity and the inclusion of the voice.

Voice exercises also begin with practicing vowel sounds, using elements of singing and music

Speech therapy work for dysarthria is carried out in stages .

The first stage, preparatory, includes its main goals: preparation of the articulatory apparatus for the formation of articulatory structures; in a young child, education of the need for verbal communication, development and clarification of passive vocabulary, correction of breathing and voice.

An important task at this stage is the development of sensory functions, especially auditory perception and sound analysis, as well as the perception and reproduction of rhythm.

Methods and techniques of work are differentiated depending on the level of speech development.

The second stage is the formation of primary communicative pronunciation skills. Its main goal is the development of speech communication and sound analysis.

Work is underway to correct articulation disorders.

Work on relaxing the muscles of the articulatory apparatus begins with general muscle relaxation, relaxation of the neck, chest muscles, and arm muscles.

Then they begin to relax the lip muscles.

After relaxation, and in case of low tone, after a firming massage of the lips, they are trained in passive-active movements.

After general muscle relaxation and the exercises described above, begin training the muscles of the tongue.

The first stage of work is exercises for the lips, helping to relax them and enhance tactile sensations in combination with passive closing of the child’s mouth. Attention is fixed on the sensation of a closed mouth, the child sees this position in the mirror.

At the second stage, the mouth is closed in a passive-active way. At first, it is easier for a child to close his mouth when his head is tilted, and easier to open when his head is slightly tilted back. At the initial stages of work, these lightweight techniques are used. The transition from passive mouth opening movements to active ones becomes possible through reflex yawning.

At the third stage, active opening and closing of the mouth is trained according to verbal instructions: “Open your mouth wide”

,
“Pull your lips forward”
,
“Gather your lips into a tube and return them to their original position
.

Various tasks are offered to imitate the position of the mouth presented in the pictures. Gradually, the exercises become somewhat more complicated: the child is asked to blow through relaxed lips and make vibration movements.

Task 2. Describe the symptoms of cerebellar dysarthria and select exercises to restore the pronunciation aspect of speech.

Features of work with cerebellar dysarthria .

Occurs when the cerebellum and its connections with other brain structures are damaged.

Pathogenesis and clinical symptoms. There is marked asynchrony between breathing, phonation and articulation. As a result, speech is slow in tempo, jerky, with impaired stress modulation, with the voice fading towards the end of the phrase, that is, chanted speech. Due to hypotonia, movements of the articulatory organs are reproduced and maintained with difficulty. As a result, sounds that require sufficiently clear, differentiated movements and sufficient strength of muscle contractions are phonetically impaired: complex anterior lingual sounds, affricates, stop sounds. A symptom of open nasality develops. Prosodic disturbances are more pronounced.

In this form of dysarthria, violations of general and articulatory motor skills are determined by low muscle tone, lack of precision and proportionality of movements, disturbance of synchrony and rhythm. There is a gross violation of the intonation of speech; its monotony. Speech is slurred and fragmentary.

The cerebellum and its functions can develop during training, and the higher voluntary level of movement regulation carried out by the cerebral cortex should be used as much as possible. Thus, when teaching a child any movements, consciousness is included and they are taught to control their movements with the help of vision.

Before starting complex classes on dysarthria , it is necessary to carry out thorough preparation, which consists of four stages of work. Long-term plan and work to develop speech muscles and carry out the necessary correction:

Working on proper breathing to develop speech. The sequence of inhalation and exhalation when speaking, holding the breath on individual syllables and sounds. Development of articulatory motor skills.

Auditory memory training, work to increase attention and perception.

Exercises for fine and gross motor skills.

The work is based on two methods - passive and active articulatory gymnastics.

Passive gymnastic movements

The passive method for eliminating speech defects promotes the development of the functions of a certain muscle group that was not previously involved in work. In addition, automation of the muscle group that took an active part in the conversation is being further developed. All these factors form various voluntary muscle movements for staging the development of speech. Thanks to passive exercises, an image of articulation is created in which new tactics for pronouncing sounds are implemented and new patterns of movement of the speech organs are determined. Inert articulatory gymnastics and exercises are carried out after a massage session. On the part of the baby, it is performed without his actual participation: all movements of the tongue and lips are made without his help. Articulatory speech exercises are repeated serially from three to five times. Passive articulatory gymnastics is performed for the tongue and lips. It has its own methods that allow the child to acquire correct speech.

Gymnastics and tongue exercises:

the tongue is removed from the oral cavity and then returned to it (input-output)

;
raising the tongue and moving it back (setting and correcting the sound “l”
);

the tongue reaches to the chin;

the tongue reaches towards the nose;

stretching the tongue and abducting it from side to side;

lowering the tongue to the bottom of the mouth;

the tip of the tongue stretches and reaches the palate (setting and correcting the sound “r”

);
relaxing the tongue muscle with small swings to the right and left. Articulation gymnastics and exercises for passive exercises (lips)
:

light squeezing of the upper lip - carried out with fingertips, which are fixed in the corner of the mouth;

light squeezing of the lower lip - carried out in a similar way;

proboscis movement

- gathering the upper and lower lips into a tube (making the sound
“u”
);

fixing the fingers in the corners of the mouth, the line is stretched (making the sound “and”

);

raising the upper lip towards the nose;

drooping of the lower lip to the sides of the chin;

full compression and closure of the mouth (producing the sounds “m”

,
"P"
);

placement of the corners of the mouth to produce vowel sounds: “o”

,
“u”
,
“i”
,
“yu”
, “s”,
“a”
.

When performing passive gymnastics exercises, the relationship between the instructor and the student is very important. Thus, the following actions must be present: visual control - the child sees a reflection in the mirror, thus it becomes clear to him which muscles can actively develop speech to activate the pronunciation of sounds; auditory perception - inform your child about your actions. For example: “Now your tongue is touching the roof of your mouth.”

,
“your upper lip reaches your nose
.
After passive gymnastics, active exercises of speech muscles are performed (automation of speech)
. However, it should be borne in mind that the structure of the work transition should be smooth, that is, it is advisable to devote some time to passive-active exercises.

Active gymnastic movements

They are carried out in front of a mirror. The child looks at speech therapy instructions and repeats facial movements.

Here are some popular methods: "surprise"

. With this grimace, you need to roll your eyes out and raise your brow ridge upward. If the child does not do this well, then help him by slightly raising his forehead with your fingers;

rapid blinking of the eyes;

inflating first one cheek, then the second, and after that two at once!

Do the same sequence with the lips: first blow air under the upper lip, and then under the lower lip (making the sound “f”

).
After this warm-up, you can proceed directly to working on the muscles of the oral cavity. Again, in front of the mirror, we help the child complete the following speech therapy tasks: stretch the tongue forward and make it soft and spread out; make the elongated tongue a “tube”
, that is, try to bring its edges together;
With the tip of your tongue, lick the upper border of the lip, and then the lower; reach your tongue to your nose and then to your chin; reproduce the running of a horse, that is, click your tongue (set the sound to)
.

An excellent exercise for working the lower frenulum and palate; smile so that as many teeth as possible are exposed (set the sound and)

;
gather your lips into a “pipe”
; alternating the two previous exercises; jaw work: moving it forward and backward, left and right.

Task 3. List the main symptoms of anarthria.

Make a plan for correctional and speech therapy work to restore speech in anarthria and select exercises.

Symptoms of anarthria

• Lack of ability to pronounce words, letters, and sometimes even sounds.

•Severe slurring of speech: words are pronounced with great difficulty, stuttering, as if through the nose (nasally)

. The patient critically evaluates his speech defect and prefers to remain silent or communicate using gestures and writing.

• Choking when eating (does not directly relate to the term “anarthria”, but is often encountered with it).

Speech therapy work for dysarthric disorders should begin with weakening the manifestation of disorders of the innervation of the muscles of the speech apparatus. By expanding the possibilities of movement of speech muscles, one can count on their better spontaneous inclusion in the articulatory process.

When carrying out correctional and speech therapy work with children with dysarthria , it is advisable to use the following methods of speech therapy:

• differentiated speech therapy massage (relaxing or stimulating)

;

• probe, acupressure, manual, brush massage;

• passive and active articulatory gymnastics;

• breathing and voice exercises;

• artificial local contrastothermia (combination of hypo- and hyperthermia)

.

Speech therapy work with dysarthric children is based on :

• knowledge of the structure of speech defects in various forms of dysarthria ,

• knowledge of the mechanisms of disorders of general and speech motor skills,

• taking into account the personal characteristics of children.

Particular attention is paid to the state of children's speech development in the field of vocabulary and grammatical structure, as well as the peculiarities of the communicative function of speech. For school-age children, the state of written speech is taken into account.

Classes with a speech therapist: correction of an existing defect with the help of special exercises (physical therapy to normalize muscle tone and increase the range of movements of the articulation organs (tongue, cheeks, lips)

.

An approximate complex of passive gymnastics:

• The lips close passively and are held in this position. The child's attention is fixed on closed lips, then he is asked to blow through his lips, breaking their contact;

• Using the index finger of the left hand, lift the child’s upper lip, exposing the upper teeth; with the index finger of the right hand, raise the lower lip to the level of the upper incisors and ask the child to blow;

• The tongue is placed and held. between teeth;

• The tip of the tongue is pressed and held against the alveolar process, the child is asked to blow, breaking the contact;

An approximate set of static articulation exercises for dysarthrics . L. V. Lopatina, N. V. Serebryakova

1. Open your mouth, hold it open while counting from 1 to 5-7, and close it.

2. Open your mouth slightly, push your lower jaw forward, hold it in this position for 5-7 seconds, return to its original position.

3. Pull the lower lip down, hold it while counting from 1 to 5-7, return to its original state;

- raise your upper lip, hold it while counting from 1 to 5-7, return to its original state.

4. - stretch the lips into a smile, exposing the upper and lower incisors, hold the count from 1 to 5-7, return to their original state;

- stretch only the right (left)

The corner would be held, exposing the upper and lower incisors, counting from 1 to 5-7, and returned to its original position.

5. - lift first the right one, then the left one: the corner of the lip, lips closed, hold at a count from 1 to 5-7, return to its original state.

6. — stick out the tip of your tongue, mash it with your lips, pronouncing the syllables pa-pa-pa-pa. After pronouncing the last syllable, he will leave his mouth slightly open, fixing his wide tongue and holding it in this position, counting from 1 to 5-7;

- stick the tip of your tongue between your teeth, bite it with your teeth, pronouncing the syllables ta-ta-ta-ta. After pronouncing the last syllable, leave the mouth slightly open, fixing the wide tongue and holding it in this position, counting from 1 to 5-7, return to its original position.

7. - place the tip of the tongue on the upper lip, fix this position and hold it counting from 1 to 5-7, return to its original state;

- place the tip of the tongue under the upper lip, fix it in this position, hold it while counting from 1 to 5-7, return it to its original state;

- press the tip of the tongue to the upper incisors, hold the given position counting from 1 to 5-7, return to its original state;

- "licking"

with the tip of the tongue from the upper lip into the oral cavity behind the upper incisors.

8. – give the tip of the tongue a “bridge”

(
“slides”
): press the tip of the tongue to the lower incisors, raise the middle part of the back of the tongue, press the lateral edges to the upper lateral teeth, hold the given position of the tongue counting from 1 to 5-7, lower the tongue.

An approximate set of dynamic articulation exercises for dysarthrics . L. V. Lopatina, N. V. Serebryakova

1. Stretch your lips into a smile, exposing the upper and lower incisors; stretch your lips forward in a “tube”

.

2. Stretch your lips into a smile with your incisors bared, and then stick out your tongue.

3. Stretch your lips into a smile with your incisors bared, stick out your tongue, and press it with your teeth.

4. Raise the tip of the tongue on the upper lip, lower it on the lower lip (repeat this movement several times)

.

5. Place the tip of your tongue under the upper lip, then under the lower lip (repeat this movement several times)

6. Press the tip of the tongue behind the upper, then lower incisors (repeat this movement several times)

.

7. Alternately make the tongue wide, then narrow.

8. Lift your tongue up, place it between your teeth, and pull it back.

9. Build a “bridge”

(the tip of the tongue is pressed against the lower incisors, the front part of the back of the tongue is lowered, the front is raised, forming a gap with the hard palate, the back is let down, the lateral edges of the tongue are raised and pressed against the upper lateral teeth, break it, then build it again and break it again, etc. .

10. Alternately touch the protruding tip of your tongue to the right, then to the left corner of your lips.

11. Raise the tip of the tongue on the upper lip, lower it on the lower lip, alternately touch the protruding tip of the tongue to the right, then to the left corner of the lips (repeat this movement several times)

.

Gymnastics for making sounds

Finger games must be included in the correction program for dysarthria. They can be done at home with your parents. For example, these:

1. Reading book “Finger Boy, Where Have You Been?” The child opens his palm and, for each line of the rhyme, touches each finger with his thumb - index, middle, ring and little fingers.
2. "We depict animals." This is an analogue of the “Shadow Theatre”. The kid opens his palm, sticks his thumb up - imitates a dog. Raises and lowers the little finger - the dog barks. And if you press your ring and little fingers with your thumb to your palm, and raise your middle and index fingers up, you will get a bunny that moves its ears.
3. Hand massage. The technique depends on the tone of the hands.

If you have spasticity, you need to relax: stroke your arms: from your fingertips up to your palms and to your shoulders. Then repeat the movement from top to bottom.

When hypotonicity occurs, muscles need to be strengthened. To do this, parents actively knead and rub their fingers and palms. Stimulating movements.

Article:

The close relationship between the development of speech, sensory functions, motor skills and intelligence determines the need for correction of speech disorders in dysarthria in children in combination with stimulation of the development of all its aspects, sensory and mental functions, thereby realizing the formation of speech as an integral mental activity.
The system of speech therapy treatment for dysarthria is complex: correction of sound pronunciation is combined with the formation of sound analysis and synthesis, development of the lexical and grammatical aspect of speech and coherent utterance. The specificity of the work is the combination with differentiated articulation massage and gymnastics, speech therapy rhythms, and in some cases with general physical therapy, physiotherapy and drug treatment.

The success of speech therapy classes largely depends on their early start and systematic implementation.

Work on sound pronunciation is based on the following provisions:

Dependence on the form of dysarthria, the level of speech development and the age of the child.

Development of speech communication. The formation of sound pronunciation should be aimed at the development of communication, school and social adaptation of the child.

Development of motivation, desire to overcome existing disorders, development of self-awareness, self-affirmation, self-regulation and control, self-esteem and self-confidence.

Development of differentiated auditory perception and sound analysis.

Strengthening the perception of articulatory patterns and movements through the development of visual-kinesthetic sensations.

Step by step. They start with those sounds whose articulation is more intact in the child. Sometimes sounds are chosen on the basis of simpler motor coordination, but always taking into account the structure of the articulatory defect as a whole; first of all, they work on the sounds of early ontogenesis.

In case of severe disorders, when speech is completely incomprehensible to others, work begins with isolated sounds and syllables. If the child’s speech is relatively clear and he can pronounce defective sounds correctly in individual words, work begins with these “key” words. In all cases, automation of sounds is necessary in all contexts and in various speech situations.

In children with damage to the central nervous system, it is important to prevent severe disorders of sound pronunciation through systematic speech therapy work in the pre-speech period.

Speech therapy work for dysarthria is carried out in stages.

The first stage, preparatory, includes its main steps: preparing the articulatory apparatus for the formation of articulatory patterns; in a young child, nurturing the need for verbal communication, developing and clarifying passive vocabulary, correcting breathing and voice.

An important task at this stage is the development of sensory functions, especially auditory perception and sound analysis, as well as the perception and reproduction of rhythm.

Methods and techniques of work are differentiated depending on the level of speech development. In the absence of verbal means of communication, initial vocal reactions are stimulated in the child and induce onomatopoeia, which is given a character of communicative significance.

Speech therapy work is carried out against the background of medication, physiotherapy, physical therapy and massage.

The second stage is the formation of primary communicative pronunciation skills. Its main goal: the development of speech communication and sound analysis. Work is being carried out to correct articulation disorders: in case of spasticity - relaxation of the muscles of the articulatory apparatus, development of control over the position of the mouth, development of articulatory movements, development of the voice; correction of speech breathing; development of sensations of articulatory movements and articulatory praxis.

Work on relaxing the muscles of the articulatory apparatus begins with general muscle relaxation, relaxation of the neck, chest muscles, and arm muscles. Then a relaxing facial muscle massage is performed. Movements begin from the middle of the forehead towards the temples. They are performed with light stroking, uniform movements with the fingertips at a slow pace.

A relaxing massage is carried out in doses, applying only to those areas of the face where there is increased

muscle tone, while in flabby and weakened muscle groups, a tonic, strengthening massage is used.

The second direction of a relaxing facial massage is the movement from the eyebrows to the scalp. Movements are carried out evenly with both hands on both sides.

The third direction of movement is downward from the forehead line, through the cheeks to the muscles of the neck and shoulder.

Then they begin to relax the lip muscles. The speech therapist places his index fingers on a point located between the middle of the upper lip and the corner of the mouth on both sides. The movements go towards the midline, so that the upper lip is gathered into a vertical fold. The same movement is done with the lower lip, then with both lips together.

In the following exercise, the speech therapist's index fingers are placed in the same position, but the movements go up the upper lip, exposing the upper gums, and down the lower lip, exposing the lower gums.

Then the speech therapist's index fingers are placed at the corners of the mouth and the lips are stretched (as if smiling). With a reverse movement, the lips return to their original position with the formation of wrinkles.

These exercises are performed in different positions of the mouth: the mouth is closed, slightly open, half-open, wide open.

After relaxation, and in case of low tone, after a firming massage of the lips, they are trained in passive-active movements. The child is taught to grasp and hold lollipops and sticks of various diameters with his lips, and is taught to drink through a straw.

After general muscle relaxation and the exercises described above, begin training the muscles of the tongue. When relaxing them, it is important to consider that they are closely connected to the muscles of the lower jaw. Therefore, the downward movement of the spastically raised tongue in the oral cavity is most easily achieved with a simultaneous downward movement of the lower jaw (mouth opening). For school-age children, similar exercises are offered in the form of auto-training: “I am calm, completely relaxed, my tongue lies calmly in my mouth. I slowly lower it down when my lower jaw drops.”

If these techniques are not enough, then it is useful to place a piece of sterile gauze or a sterile stopper on the tip of the tongue. The resulting tactile sensation helps the child understand that something is interfering with the free movements of the tongue, i.e., to feel a state of spasticity. After this, the speech therapist uses a spatula or tongue depressor to apply light horizontal pressure.

The next technique is light, smooth swaying movements of the tongue to the sides. The speech therapist carefully grabs the tongue with a piece of gauze and smoothly rhythmically moves it to the sides. Gradually, the passive assistance of the speech therapist decreases, and the child begins to perform these exercises himself. The massage is performed by a specialist (physical therapy), but its elements are used by a speech therapist and parents under the mandatory supervision of a doctor, in compliance with the necessary hygienic rules.

Developing control over mouth position. Lack of control over mouth position in children with dysarthria significantly complicates the development of voluntary articulatory movements. Usually the child’s mouth is slightly open and drooling is pronounced.

The first stage of work is exercises for the lips, helping to relax them and enhance tactile sensations in combination with passive closing of the child’s mouth. Attention is fixed on the sensation of a closed mouth, the child sees this position in the mirror.

At the second stage, the mouth is closed in a passive-active way. At first, it is easier for a child to close his mouth when his head is tilted, and easier to open when his head is slightly tilted back. At the initial stages of work, these lightweight techniques are used. The transition from passive mouth opening movements to active ones becomes possible through reflex yawning.

At the third stage, active opening and closing of the mouth is trained according to verbal instructions: “Open your mouth wide,” “Pull your lips forward,” “Gather your lips into a tube and return them to the starting position.”

Various tasks are offered to imitate the position of the mouth presented in the pictures. Gradually, the exercises become somewhat more complicated: the child is asked to blow through relaxed lips and make vibration movements.

Articulation gymnastics. During its implementation, tactile-proprioceptive stimulation, the development of static-dynamic sensations, and clear articulatory kinesthesia are of great importance.

At the initial stages, work is carried out with the maximum connection of other, more secure analyzers (visual, auditory, tactile). Many exercises are performed with eyes closed, drawing the child's attention to proprioceptive sensations. Articulatory gymnastics is differentiated depending on the form of dysarthria and the severity of damage to the articulatory apparatus.

Before work on developing the mobility of speech muscles, exercises are performed for facial muscles. Already from preschool age, the child develops arbitrariness and differentiation of facial movements and control over his facial expressions. The child is taught according to instructions to close and open his eyes, frown, puff out his cheeks, swallow saliva, close and open his mouth.

To develop sufficient strength in the muscles of the face and lips, special exercises with resistance are used, sterile napkins and tubes are used. The child wraps his lips around the tube and tries to hold it, despite the adult’s attempts to pull it out of his mouth.

Articulatory gymnastics of the tongue begins with the development of active contact with the end of the tongue to the edge of the lower teeth. Then they develop general, less differentiated movements of the tongue, first in the passive plane, then to passive-active and, finally, active movements.

Stimulation of the muscles of the tongue root begins with their reflex contractions by irritating the root of the tongue with a spatula. Consolidation is carried out by voluntary coughing.

An important section of articulatory gymnastics is the development of more subtle and differentiated movements of the tongue, activation of its tip, delimitation of movements of the tongue and lower jaw. Exercises to stimulate movements of the tip of the tongue with an open mouth and a stationary jaw are useful. The development of articulatory motor skills is carried out systematically, over a long period of time, using a general complex and specific exercises. The work is facilitated by the use of games that are selected depending on the nature and severity of damage to articulatory motor skills, as well as taking into account the age of the child. Games published in the literature can be used with some adaptation.

Voice development. For the development and correction of voice in children with dysarthria, various orthophonic exercises are used, aimed at developing the coordinated activity of breathing, phonation and articulation.

Work on the voice begins after articulatory gymnastics and massage, relaxation of the neck muscles, special exercises to perform movements in all directions with the head (neck muscles are relaxed) while simultaneously pronouncing chains of vowel sounds: i-e-o-u-a-y.

Of great importance for voice correction is the activation of movements of the soft palate: swallowing drops of water, coughing, yawning, pronouncing the vowel a on a hard attack. Exercises are carried out in front of a mirror, counting. The following techniques are used: stimulation of the back of the tongue and palate with light patting movements using a tongue depressor; training in voluntary swallowing: a speech therapist drops drops of water from a pipette against the back wall of the pharynx, the child’s head is slightly tilted back. Cough-like movements, yawning, palatal and pharyngeal reflexes are stimulated.

Jaw movements are of great importance for voice production: opening and closing the mouth, imitation of chewing. The jaw tremor reflex is used: light tapping rhythmic movements on the chin cause the lower jaw to move upward.

Special exercises to lower the lower jaw are also used. Initially, against the background of muscle relaxation, the speech therapist helps in performing this movement, achieving lowering of the lower jaw by about 1-1.5 cm (the child closes the mouth independently).

They develop voluntary control over the volume and pace of movement, using various visual techniques (a drawing depicting lowering a bucket into a well, a ball tied to a rope, facial pictures, etc.).

Then these exercises are performed according to verbal instructions with the simultaneous pronunciation of various sound combinations: don-don, kar-kar, aw-aw, etc.

To strengthen the muscles of the palatine curtain, exercises are used alternating its relaxation and tension. The child is asked to abruptly pronounce the sound a before the end of the yawning movement, and with his mouth wide open, move from pronouncing the sound a to the sound p, holding the air in the mouth under pressure. The child's attention is drawn to the sensation of the state of the velum palatine. They use exercises to develop the strength, timbre and pitch of the voice: counting directly in tens with a gradual strengthening of the voice and counting backwards with its gradual weakening. For the development of the pitch of timbre and intonation of the voice, various games, reading fairy tales based on roles, dramatizations, etc. are of great importance.

Correction of speech breathing. Breathing exercises begin with general breathing exercises, the purpose of which is to increase the volume of breathing and normalize its rhythm.

The child is taught to breathe with his mouth closed, alternately pinching one or the other nostril; to increase the depth of inhalation, a “fan of air” is created in front of the child’s nostrils.

Exercises are carried out to train nasal exhalation. The child is given instructions not to open his mouth: “Inhale deeply and exhale for a long time through the nose.”

The next exercise is aimed at developing predominantly oral inhalation. The speech therapist closes the child's nostrils and asks him to inhale through his mouth until he asks him to pronounce individual vowel sounds or syllables.

Resistance exercises are used. The child inhales through the mouth. The speech therapist places his hands on the child’s chest, as if preventing him from inhaling for 1-2 seconds. This promotes deeper and faster inhalation and longer exhalation.

The child is asked to hold his breath, achieving a quick and deep breath and a slow, long exhalation.

Exercises are carried out daily for 5-10 minutes. During these exercises, at the moment of exhalation, the speech therapist pronounces various chains of vowel sounds, stimulating the child to imitate, while varying the volume and tone of the voice. Then the child is encouraged to pronounce fricative consonants in isolation and in combination with vowels and other sounds, dynamic and static breathing exercises are distinguished.

When doing breathing exercises, they try not to overtire the child, make sure that he does not strain his shoulders, neck, or take vicious poses; all breathing movements should be carried out smoothly, to the count or to music.

Breathing exercises are carried out before meals, in a well-ventilated area.

Development of sensations of articulatory movements and articulatory praxis. To develop motor-kinesthetic feedback, the following exercises must be performed. Shaking the upper and lower lips; straightening the cheeks (raising them from the dental arch). Lowering and raising the lower jaw.

Placement of the tongue over the lower and upper incisors. First, the speech therapist conducts them in front of a mirror, then without it, the child’s eyes are closed, the speech therapist makes this or that movement, and the child names it.

It is necessary to train the following articulatory-sensory circuits:

bilabial: the lips close passively and are held in this position. The child's attention is fixed on closed lips, then he is asked to blow through his lips, breaking their contact;

labiodental: with the index finger of the left hand, the speech therapist lifts the child’s upper lip, exposing the upper teeth, with the index finger of the right hand, raises the lower lip to the level of the upper incisors and asks the child to blow;

lingual-dental: the tongue is placed and held between the teeth;

lingual-alveolar: the tip of the tongue is pressed and held by the alveolar process, the child is asked to blow, breaking the contact;

lingual-palatal: the child’s head is thrown back somewhat, the back of the tongue is raised towards the hard palate, the child is asked to make coughing movements, fixing his attention on the sensations of the tongue and palate.

For the development of articulatory praxis, early speech therapy work, expansion and enrichment of the child’s speech experience, as well as the predominance of special syllabic exercises over purely articulatory ones are of great importance. A series of syllables are selected that require a sequential change of various articulatory movements.

Correction of sound pronunciation. The principle of an individual approach is used. The method of sound production and correction is selected individually. If the pronunciation of several sounds is impaired, consistency in work is important. First of all, those phonemes that can be pronounced correctly in certain contexts, as well as those whose motor coordination is the simplest, are selected for correction. Or the sound that is most easily corrected is selected, for example, a sound that is reflected correctly pronounced.

Before calling and staging sounds, it is important to distinguish them by ear. By modeling this or that articulatory structure for the child, the speech therapist stimulates the evocation of an isolated sound, then automates it in syllables, words and in contextual speech. Training of auditory perception is necessary; the child must learn to listen to himself, to catch the difference between his pronunciation and the normalized sound.

There are several techniques for producing sounds for dysarthria. The most common method is the so-called phonetic localization, when the speech therapist passively gives the child’s tongue and lips the necessary position for a particular sound. Probes, flat tongue plates and a number of other devices are used. The child's attention is drawn to the sensation of positions. He then performs the movements independently, with or without some help from a speech therapist.

When working on sound pronunciation, they rely on knowledge of the articulatory structures of the native language, analysis of the structure of sound pronunciation disorders in each child (kinetic analysis) and on specific techniques for producing individual sounds.

The main methods of work are: motor-kinesthetic and auditory-visual-kinesthetic. In the process of speech therapy work, inter-analyzer connections are established between the movement of articulatory muscles and their sensation, between the perception of a sound by ear, the visual image of the articulatory structure of a given sound and the motor sensation when pronouncing it. All methods of correctional work are based on the patterns of development of the phonetic-phonemic system of language in normal conditions.

When developing sound pronunciation skills in various situations of speech communication, preventing and overcoming secondary speech disorders, the speech therapist works to automate and differentiate sounds, and develop pronunciation skills in various communication situations. Sounds are fixed in words and sentences.

For automation, the technique of simultaneous pronunciation of a sound and the image of its symbol is used - writing and speaking. These exercises help to enhance the sound and enrich it with motor action.

For children who cannot write, the sound is made at the same time as finger tapping or foot tapping.

The new sound is then fixed in various syllables. Gradually move from simple exercises to more complex ones, speeding up the pace of exercises.

When working on sound pronunciation, it is important to identify the child’s intact compensatory abilities (intact sounds, articulatory movements, special sound combinations and words in which defective sounds are pronounced correctly). The work is based on these safe links.

Correction of the sound pronunciation aspect of speech is combined with work on its expressiveness. The work is carried out by imitation. The child is taught to speed up and slow down the rate of speech depending on the content of the statement, evenly alternate stressed and unstressed syllables, and highlight individual words or groups of words with pauses or a raised voice.

The content and methods of work vary depending on the nature and severity of dysarthria, and the general level of retardation development. When dysarthria is combined with speech underdevelopment, a comprehensive program of speech therapy classes is carried out, including phonetic work, the development of phonemic hearing, work on vocabulary, grammatical structure, as well as special measures aimed at preventing or correcting disorders of written speech.

In other cases, work is carried out on sound pronunciation and clarification of phonemic hearing.

In all cases, the main task of speech therapy work for Yari dysarthria is the development and facilitation of speech communication, and not just the formation of the correct pronunciation of sounds. Play therapy techniques are used in combination with individual work on articulation, breathing, phonation and sound pronunciation correction, as well as on the child’s personality as a whole. The most common is pseudobulbar dysarthria, in which the use of differentiated massage (relaxing and strengthening) taking into account the state of muscle tone in individual muscles of the articulatory apparatus, as well as articulatory gymnastics, is important. Speech therapy work includes the development of speech breathing, intonation and methodological aspects of speech, and phonemic perception.

Work with persons suffering from dysarthria is carried out in various types of speech therapy institutions: kindergartens and schools for children with severe speech impairments, in schools for children with musculoskeletal disorders (consequences of polio and cerebral palsy), in speech departments of psychoneurological hospitals. For milder (erased) forms of dysarthria, work is carried out in clinics and speech therapy centers in secondary schools.

Dysarthria requires early, long-term and systematic speech therapy work. Its success largely depends on the relationship in the work of a speech therapist and a neurologist or neuropsychiatrist, a speech therapist and parents, and in case of obvious motor disorders - a speech therapist and a massage therapist, a specialist in physical therapy.

Early diagnosis of pathology and speech therapy work with these children in the first years of life are important. Our country has developed a system of comprehensive measures to prevent dysarthria in children with perinatal brain damage. This system includes comprehensive medical and pedagogical work with children starting from the first months of their life. The work is carried out in special neurological hospitals for children with perinatal pathology.

To prevent dysarthria, preventive examinations of children in the first years of life with perinatal pathology are important, as well as children at risk, i.e. children who do not have signs of brain damage, but who had pathology of the nervous system in the first months of life or who were born with asphyxia , from a pathological pregnancy, etc. The doctor and speech therapist give reasonable recommendations to parents on treatment, education, raising children, and on the development of articulatory motor skills.

Conclusions and problems

The structure of the defect in dysarthria includes a violation of the sound pronunciation and prosodic aspects of speech, caused by organic damage to the speech motor mechanisms of the central nervous system. Sound pronunciation disorders in dysarthria depend on the severity and nature of the lesion. The main clinical signs of dysarthria are:

disturbances of muscle tone in the speech muscles;

limited possibility of voluntary articulatory movements due to paralysis and paresis of the muscles of the articulatory apparatus;

voice and breathing disorders. The main signs of pseudobulbar dysarthria are: increased tone in the articulatory muscles, limited movements of the lips, tongue, soft palate, increased salivation, breathing and voice disorders. Children chew, swallow poorly, and choke when eating. Speech is blurred, incomprehensible, intonation-inexpressive, monotonous, the voice is dull, with a nasal tint. Dysarthria is often combined with underdevelopment of other components of the speech system (phonemic hearing, lexico-grammatical aspects of speech). Depending on the severity of these manifestations, it is extremely important for speech therapy practice to identify several groups of children with dysarthria: with phonetic disorders; phonetic-phonemic underdevelopment; general underdevelopment of speech (the level of speech development is indicated). For purely phonetic (anthropophonic) disorders, the main task is to correct sound pronunciation. When dysarthria is combined with speech underdevelopment, a comprehensive system of speech therapy is carried out, including phonetic work, the development of phonemic hearing, work on vocabulary, grammatical structure, as well as special measures aimed at preventing or correcting disorders of written speech.

Important problems in the modern study of dysarthria are:

neurolinguistic study of various forms of dysarthria, taking into account the location of brain damage;

development of methods for early neurological and speech therapy diagnosis of minimal manifestations of dysarthria in children;

improving methods of speech therapy work in the pre-speech period and in the first years of life with children with perinatal brain damage and with children at risk;

improving methods of speech therapy work taking into account the form of dysarthria;

strengthening the relationship in the work of a neurologist and speech therapist.

A set of articulation exercises

The exercise includes 5 exercises and can also be done at home.

“Horse” - clicking the tongue. This is a very useful and effective exercise. Not all children get it right away.

“Pancakes” - the baby opens his mouth slightly, spreads his tongue into a flat pancake.

“Snake” - the child imitates the sting of a snake - the tongue is just as sharp. Then he sticks it back and forth.

“Tube” - the baby tries to roll his tongue into a tube.

Another exercise is to try to reach the tip of your tongue to your nose and then to your chin.

Corrective work for erased dysarthria

Erased form of dysarthria

– one of the most common and difficult to correct disorders of pronunciation of speech in children of preschool and primary school age. The number of children with an erased form of dysarthria has especially increased in recent years, which was noted during my work in the Zaslavsky school and Minsk.

With minimal dysarthric 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.

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

With erased dysarthria, sound pronunciation disorders are caused by violations of phonetic operations, therefore the development of articulatory motor skills becomes the most important area of ​​correctional speech therapy work. In my work, I carry out a differentiated approach to each child, and also adhere to two directions of correctional work: 1. formation of the kinesthetic basis of movement:

feeling the position of the organs of articulation;
2. formation of the kinetic basis of movement:
the movements of the tongue and articulatory organs themselves.

The defining moment in sound production is the formation of static-dynamic sensations, clear articulatory kinesthesia and a kinesthetic image of the movements of articulatory muscles. The work must be carried out with maximum connection of all analyzers. Shakhovskaya S.N. recommended using all analyzers in speech therapy classes. The same thing should be said, depicted, looked at, i.e. pass through the “gate” of all senses. The success of working on sound is determined by the ability to form conscious kinesthetic supports in children. It is important that the child can feel the position and movements 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 various tactile sensations (primarily tactile vibration and temperature), for example, the feeling of vibration in the hand in the area of ​​the larynx or crown when pronouncing voiced consonants, the duration and smoothness of the exhaled stream when pronouncing fricative sounds [F], [V], [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 [S], [Z], [F], wide [T], [K], temperature [C] – cold jet, [W] – warm.

When producing sounds, it is important that children know the articulatory structure of sound, be able to tell and show in what position the lips, teeth, tongue are, whether the vocal folds vibrate or not, what is the strength and direction of the exhaled air, the nature of the exhaled stream. It is useful to compare speech sounds with non-speech sounds. Such conscious mastery of correct articulation is of great importance for the formation of the correct articulatory image of the sound of its pronunciation and, most importantly, its differentiation 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 developing the ability to hold the articulatory organs in a given position. Traditional articulation exercises are widely used to develop dynamic coordination of movements, but special sets of exercises that take into account the specifics of the disorder also give good positive results.

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

To relax the tongue

:

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

To lower a tense tongue root

Exercises involving tongue protrusion are suggested.

Relaxing tense lips

achieved by lightly patting the upper lip on the lower lip.

In case of decreased muscle tone

preschoolers with mild dysarthria are offered tasks to activate and strengthen paretic muscles:

– scratching with the tip of the tongue on the upper incisors;

– counting the teeth, resting the tip on each one;

– stroking the cheek with the tip of the tongue, pressing forcefully on its inner side;

– holding a round piece of candy at the alveoli with the tongue.

Lips that do not close tightly, flaccidly are trained using the following tasks:

– stretch your lips into a smile, exposing the upper and lower incisors, holding the count from 1 to 5–7, return to their original position;

– stretch only the right and left corners of the lip in a smile, exposing the upper and lower incisors, hold the count from 1 to 5–7, return to the original position;

– hold pieces of crackers, tubes of different diameters, strips of paper with your lips;

- tightly closed lips.

And for the little ones (from three years old)

You can use the following types of exercises, which can be done in a playful way.

Exercises will help develop the mobility of articulatory muscles and promote the development of clear diction. You can start practicing with these articulation exercises if you have erased dysarthria. To make it interesting for children to do the exercises, their names are presented in a playful way.

"Fence"

- Teeth closed, smile broadly and show upper and lower teeth. Maintain the position for 10 seconds, repeat 3-4 times.

"Tube"

- teeth are closed, lips are pulled forward so that they resemble an “elephant’s trunk”, while the lower jaw remains motionless. Hold the position for 10 seconds, repeat 3-4 times.

"Pancake"

- open your mouth, place your wide and spread tongue on your lower lip. Maintain the position for 10 seconds, repeat 3-4 times.

"Needle"

- open your mouth and stick your sharp tongue out of your mouth as far as possible. Hold the position for 5 seconds, repeat 3-4 times.

"Pancake - a needle"

- alternate the 2 previous exercises, while ensuring that the lower jaw remains motionless. Perform the exercise at a slow pace, repeat each movement 4 times.

"Pendulum"

- open your mouth, alternately touch your sharp tongue to the right and then to the left corner of your mouth. Make sure that the lower jaw remains motionless. Perform the exercise at a slow pace, repeat each movement 4 times.

"Swing"

- open your mouth, alternately touch your sharp tongue to the upper lip, then to the lower. Make sure that the lower jaw remains motionless. Perform the exercise at a slow pace, repeat each movement 4 times.

"Let's lick our lips"

- open your mouth, lick in a circle first the upper, then the lower lip. Make sure that the lower jaw remains motionless. Repeat the exercises in a circle 4-5 times.

"Vanka-Vstanka"

- open your mouth, bend the tip of your tongue as far as possible to the base of the upper incisors, then bend the tongue to the base of the lower incisors. Perform the exercises at a slow pace, repeat the movements in each direction 4 times.

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 anamnestic data, and a doctor’s conclusion. It is necessary to maintain a close relationship with parents, not only in order to obtain information about the early development of the child, but in order to explain the characteristics of this disorder.

Implementation of a differentiated approach to 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 articulatory muscles. Systematicity in the work on the formation of phonemic operations, the development of the melodic-intonation side of speech, breathing processes, voice formation, articulation. The communicative focus of training is the use of story-based, didactic games, and project activities in the process of automating sound pronunciation.

Literature:

1. Arkhipova E.F. Correctional and speech therapy work to overcome erased dysarthria. – M., 2008.

2. Kiseleva V.A. Diagnosis and correction of the erased form of dysarthria. – M., 2007.

3. Lopatina L.V., Serebryakova N.V. Overcoming speech disorders in preschool children. – St. Petersburg, 2001.

4. Fedosova O.Yu. Conditions for creating a strong sound pronunciation skill in children with mild dysarthria. – Speech therapist in kindergarten No. 2, 2005.

5. www.logoped-therapy.com (Rusina Yu.V. Articulation gymnastics for clear pronunciation)

6. www.festival.1september.ru (Komarova A.A. Erased form of dysarthria in preschool children)

A set of breathing exercises

Includes 2 exercises. Parents can easily do them with their baby at home.

"Racing" . Place two cotton balls on the table. The parent blows on one balloon, the child on the other. The one who moves his ball the greatest distance wins.

"Magic Breath" . Insert pieces of cotton wool into the baby's nostrils. The main thing is not deep! Ask him to exhale and at the same time hold the cotton wool - it should not fall out.

Another version of breathing exercises is according to A.N. Strelnikova. The essence of gymnastics is to take a sharp breath through your nose every second and do the exercises at the same time. The inhalation is noisy and strong, and the exhalation is natural, imperceptible.

There are several rules: with each inhalation, lower your shoulders and close your nostrils tightly, as if someone is pressing on them.

Gymnastics should be a joy, so you need to do it until the first signs of fatigue. There is no need to force your child if he does not want to study.

Gymnastics is designed for adults, so the duration of the lesson and the number of approaches is best agreed upon with a speech therapist.

We train to navigate in space

1. “Whose traces?” . Pictures with traces of hands and feet are needed. The baby must determine which arm or leg is right and which is left.
2. "Supermarket" . The parent asks the child to arrange the goods: “on the shelf”, “near the cash register”, “to the right of the cookies”, “under the counter”.
3. Counting sticks. Can be replaced with matches. The parent makes some figure out of them, and the baby makes a similar one according to the image.

This complex can also be performed at home.

Methods for diagnosing dysarthria

Dysarthria is usually preceded by a primary neurological disease, such as cerebral palsy. Therefore, before starting classes with a speech therapist, you need to consult a neurologist. Only he can diagnose the disease.

Diagnosis includes electroencephalography, MRI of the brain, electroneurography or other examinations. After this, the neurologist refers the patient to a speech therapist. In turn, the specialist, based on speech therapy tests, will determine the form and degree of the speech disorder.

Where to start treatment

Treatment of any disease must begin with a correct diagnosis. A young patient is first referred to a neurologist for consultation. After the examination, the specialist, if necessary, prescribes examinations :

• EEG;
• electromyography;
• MRI;
• electroneurography;
• transchannel magnetic stimulation.

After the diagnosis is established, the child is sent to a speech therapist who conducts special speech therapy tests. They allow you to determine the degree of the disease and its form. Subsequently, a neuropsychiatrist and a defectologist are involved in the process.

There are four degrees of the disease :

• 1st degree – the diagnosis is established only through special tests by a competent specialist;
• 2nd degree – speech is understandable, but has minor defects;
• 3rd degree – only close relatives understand the speech;
• 4th degree – speech is incomprehensible or absent.

Depending on the degree of the disorder, the specialist prescribes treatment and carries out corrective measures.

Complex treatment of the disease

Only an integrated approach gives good results. Here are the activities included in treatment:

• Speech therapy classes: development of fine motor skills of the hands, breathing, motor skills of the speech apparatus, voice (timbre, intonation, strength), training in correct sound pronunciation;
• Physiotherapeutic procedures: physical therapy, massage, acupressure, etc.;
• Drug treatment. Nootropic drugs are prescribed;
• Psychotherapy. This group includes sand therapy, play therapy, and isotherapy.

If parents notice speech impairments in time and seek help from doctors, the baby has every chance of getting rid of the disease. But provided that there are no pronounced lesions of the nervous system.

How to help a child with erased dysarthria in kindergarten

Dysarthria is a disorder of sound pronunciation, voice formation and prosody, caused by insufficient innervation of the muscles of the speech apparatus: the respiratory, vocal and articulatory departments.

Erased dysarthria (mild degree of dysarthria, MDD - minimal dysarthric disorders) in speech therapy practice is one of the most common and difficult to correct disorders of pronunciation of speech.

Erased dysarthria occurs very often in preschoolers and schoolchildren. The main complaints with erased dysarthria are the following: slurred, inexpressive speech, poor diction, distortion and replacement of sounds in words with a complex syllable structure, and others. Children with severe dysarthria need long-term, systematic individual speech therapy assistance.

Erased dysarthria is most often diagnosed after five years. All children whose symptoms correspond to erased dysarthria are referred for consultation to a neurologist to clarify or confirm the diagnosis and to prescribe adequate treatment, because in case of erased dysarthria, the method of correctional work should be comprehensive and include: medical intervention; psychological and pedagogical assistance; speech therapy work.

For early detection of erased dysarthria and proper organization of complex effects, it is necessary to know the symptoms that characterize this disorder. When examining a child aged 5-6 years with erased dysarthria, the following features and negative symptoms are revealed:

GENERAL MOTOR SKILLS. Children with severe dysarthria are characterized by motor clumsiness. Some people have a limited range of active movements. Muscles quickly tire during functional loads. They stand unsteadily on one leg, cannot jump on one leg, walk along a “bridge”, etc. They imitate movements poorly: how a soldier walks, how a bird flies, how bread is cut, etc. Motor incompetence is especially noticeable in physical education and music classes, where children lag behind in tempo, rhythm of movements, as well as in switching movements.

FINE MOTOR SKILLS OF THE HAND. Children with erased dysarthria late and have difficulty mastering self-care skills: they cannot button a button, untie a scarf, etc. During drawing classes, they don’t hold a pencil well and their hands are tense. Many people don't like to draw. Motor clumsiness of the hands is especially noticeable during applique classes and with plasticine. In works on appliqué, difficulties in the spatial arrangement of elements can also be traced. Violation of fine differentiated movements of the hands is manifested when performing sample tests of finger gymnastics. Children find it difficult or simply cannot perform an imitation movement without outside help, for example, “lock” - put their hands together, intertwining their fingers; “rings” - alternately connect the index, middle, ring and little fingers with the thumb and other finger gymnastics exercises and others

During origami classes they experience great difficulties and cannot perform the simplest movements, because... both spatial orientation and subtle differentiated hand movements are required. Many children under 5-6 years old are not interested in playing with construction sets, do not know how to play with small toys, and do not assemble puzzles.

Children with severe dysarthria may experience difficulties in mastering graphic skills already in the first grade. Some children exhibit “mirror writing.” For example, there may be a replacement of the letters “d” with “b”. It is possible to replace vowels and word endings when writing. Poor handwriting and slow writing speed are often noted.

Erased dysarthria, which in preschool age mainly manifests itself in unintelligible speech, is complicated by difficulties in mastering written speech at school age. This is a large number of errors in writing and difficulties in mastering reading. All this hinders the successful development of the school curriculum. At the same time, speech therapists, kindergarten teachers and parents can, even in the preschool period, help a child with erased dysarthria and eliminate violations that interfere with clear and intelligible speech, as well as remove the preconditions for violations in children’s written speech.

FEATURES OF THE ARTICULATING APPARATUS. In children with erased dysarthria, pathological features in the articulatory apparatus are revealed. Some children experience muscle flaccidity (pareticity, hypotension).

Muscular hypotonia of the organs of articulation is manifested in the following: the face is hypomimic (weak facial expressions), the facial muscles are flaccid. There is lethargy of the masticatory muscles; children chew poorly. The mouth is often open, the lips are flaccid, their corners are drooping. During speech, the lips remain flaccid, which worsens the intonation-expressive side of speech. The child's tongue is at the bottom of the mouth, flaccid, the tip of the tongue is inactive.

There are other symptoms when muscle tone is increased (spasticity). At the same time, the face is amicable (there are no facial reactions), the facial muscles are tense. The lips of such a child are constantly in a half-smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the “tube” articulation exercise, that is, stretch their lips forward and others. With increased tone, the tongue is often thick, without a pronounced tip, and inactive.

SOUND PRONUNCIATION. When examining sound pronunciation, the following are revealed: confusion, distortion of sounds, replacement and absence of sounds. But, unlike dyslalia (a simple violation of sound pronunciation), speech with erased dysarthria has, in addition to disturbances in sound pronunciation, disadvantages in the prosodic side of speech, that is, disturbances in the intonation-expressive coloring of speech.

Impaired pronunciation and prosody affect speech intelligibility, intelligibility, and expressiveness. The examination reveals that many children who distort, omit, mix or replace sounds can pronounce these same sounds correctly in isolation. The most common disorder is a defect in the pronunciation of whistling and hissing sounds.

Quite often, such defects in sound pronunciation as interdental pronunciation and lateral overtones are noted. Children have difficulty pronouncing words with a complex syllabic structure; they simplify the sound content of words by omitting some sounds when consonants are combined.

PROSODICA. The intonation-expressive coloring of the speech of children with erased dysarthria is sharply reduced. The voice, vocal modulations in pitch and strength suffer, speech exhalation is weakened. The timbre of speech is disrupted and sometimes a nasal tone of speech appears. The pace of speech is often accelerated. When reciting a poem, the child’s speech is monotonous, gradually becomes less intelligible, and the voice fades away. The children's voice during speech is quiet, modulation in pitch and voice strength is not possible (the child cannot change the pitch of the voice by imitation, imitating the voices of animals: cows, dogs, etc.).

In some children, speech exhalation is shortened, and they speak while inhaling. In this case, speech becomes choked.

Quite often, children with good self-control are identified who, during a speech examination, do not show deviations in sound pronunciation, because They pronounce the words in a chant, that is, syllable by syllable. At the same time, prosody disturbances are expressed, which affects the communicative function of speech, and the child’s ability to communicate verbally with other children and with adults deteriorates.

GROUPS OF CHILDREN WITH ERASED DYSARTHRIA. Children with mild dysarthria are a heterogeneous group. Depending on the level of development of linguistic means, children belong to different groups.

So, if sounds and prosody are disturbed, and the vocabulary of speech is rich and grammatically correct, then such a child will be included in the group with phonetic disorders (FN).

If, in addition to disturbances in sounds and prosody, a child’s phonemic hearing is also impaired, then such a child with erased dysarthria will already be classified in the group with phonetic-phonemic underdevelopment (FFN).

Phonemic awareness is the ability to identify and distinguish phonemes of the native language at the word level. The ability to distinguish sounds is normally formed in a child from 6 months of age to 1 year 7 months.

In the same case, when a child’s speech is poorly developed and there is a poor vocabulary, pronounced disturbances in the formation of the syllabic structure of words and the grammatical structure of speech, and in addition there is also a gross violation of sound pronunciation and prosody, then in this case the child will be assigned to a group with a general speech underdevelopment (OND).

COMPLEX IMPACT. To eliminate erased dysarthria, a complex intervention is required, including medical, psychological, pedagogical and speech therapy.

Medical impact is determined by a neurologist. Treatment should include drug therapy, exercise therapy, reflexology, massage, physiotherapy and others.

Psychological and pedagogical influence is carried out by psychologists, educators, parents and speech therapists in group classes. Psychological and pedagogical influence should be aimed at the development of sensory functions; clarification of spatial representations; formation of constructive praxis; stereognosis, development of higher cortical functions; formation of subtle differentiated hand movements; formation of cognitive activity; psychological preparation of the child for school.

The speech therapy direction is implemented by a speech therapist teacher in special individual speech therapy classes that take into account the specific characteristics of a child with erased dysarthria.

Literature

1. Arkhipova E.F. Erased dysarthria in children (textbook) M.: AST-Astrel, 2006.
2. Arkhipova E.F. Correctional and speech therapy work to overcome erased dysarthria (textbook) M.: Astrel, (series “Speech therapist’s library”) 2008.
3. Arkhipova E.F. Speech therapy massage for dysarthria (textbook). M.: Astrel (series “Library of Speech Therapist”), 2008.

Arkhipova E.F. Doctor of Pedagogical Sciences, Professor at Moscow State Pedagogical University, Moscow.

Methods for preventing the disease

Due to the biological factors in the development of the disease, it is worth thinking about its prevention during pregnancy and childbirth. Difficult pregnancy, intrauterine infections, asphyxia, complicated childbirth, injuries in the first months of a newborn’s life - all this can cause speech disorders in the future.

We list the main methods of preventing the disease after the birth of the baby.

First, develop your reflexes. These include gaze fixation and object tracking, auditory concentration, motor activity, and the oral automatism reflex - all of them are very important in the development of the newborn.

Secondly, communicate with the baby. Tactile, visual, auditory sensations - all this is extremely important for its development. Smile at him, talk to him, carry him in your arms, stroke him.

Third, be always there. This is especially true for mom. After all, a newborn needs her closeness, the opportunity to touch her, see her, feel her, and receive a return hug.

Fourth, stimulate the sucking reflex. The more actively and longer the baby suckles at the breast, the better its muscles develop - they become stronger and more flexible.

Fifth, encourage the baby's attempts to communicate. Humming and babbling - this needs to be stimulated.

Sixth, develop fine motor skills. Speech is directly related to fine motor skills and the more dexterous the baby’s hands are, the better. Introduce him to different textures.

Seventh, speak to your baby in your native language. Speak clearly and competently. And encourage him to communicate. Even if he doesn't talk, still try to make him make sounds. If he wants something and shows it with gestures, provoke him to ask for it verbally.

Understand the problem

Nowadays, dysarthria is diagnosed in approximately 6% of children. This is a fairly high indicator to classify the disorder as common.

Despite the fact that the disease is quite common, many parents are confused when hearing the diagnosis of “dysarthria” in their child. Due to ignorance, treatment of a child’s pathology may be started late or follow the wrong plan. For children, it is important to do everything on time, including correcting pronunciation, otherwise the incorrect pronunciation model can be firmly fixed and remain forever.

With dysarthria, organic damage occurs to the facial muscles involved in the formation of speech: the muscles of the cheeks, tongue, and the area around the mouth. Nerve fibers innervating muscles and skin are also affected. As a result, facial expressions become impoverished. Dysarthric is deprived of the opportunity to fully work the facial muscles in order to pronounce the desired sound. The baby's speech becomes unintelligible, quiet, and monotonous.

Among the causes of the disorder are:

• severe toxicosis of pregnant women;
• Rhesus conflict;
• intrauterine infection;
• prematurity;
• premature birth;
• intrauterine fetal hypoxia;
• asphyxia of newborns;
• birth injuries;
• hereditary diseases;
• traumatic brain injury;
• hydrocephalus;
• infectious brain damage;
• intoxication of various origins;
• purulent otitis.

Dysarthria often accompanies cerebral palsy and mental retardation.

recognize their child’s illness at the beginning of their journey by the following signs:

• weakness of the facial muscles, accompanied by prolapse of the tongue, half-open mouth;
• spasm of the facial muscles - the child closes his lips tightly;
• late appearance of speech;
• problems with eating food – constant choking, difficulty swallowing, holding food in the cheek for a long time;
• increased salivation recorded after 6 months;
• the baby talks “in his nose” for no reason;
• speech without emotional coloring, too fast or slow. In case of increased tone of the vocal cords, the voice is squeaky;
• distortion, omission of individual sounds;
• impaired fine motor skills - difficulty fastening buttons or tying shoelaces. Cannot sculpt from plasticine, cannot draw due to weakness of holding a pencil;
• poor ear for music;
• speech breathing is impaired. Children, pronouncing a phrase, gasp, pause in pronunciation;
• complete muteness is possible due to paralysis of the facial muscles.

At 5 years old, the articulation of all sounds should be formed. If this does not happen, then the existing tongue-tiedness cannot be attributed to age. Specialist intervention is required. The sooner children go to a speech therapist, the better for them and their parents.

Often the problem is diagnosed as a rib at the age of about 7 years, before entering school. This age is considered late for the start of correction; the work will be more difficult and more effort will be required.

conclusions

Dysarthria is not just a failure to pronounce certain sounds. And you certainly shouldn’t expect a child with such a diagnosis to “talk” like the neighbors’ daughter. This speech disorder is much deeper and more complex, but it is not always a death sentence. The main thing is not to waste time.

This is why turning a blind eye to the problem is a huge mistake as parents. Of course, it is difficult to accept the fact that your child has some kind of impairment. But this must be done precisely for the benefit of the future of your baby. An untreated disease will bring many problems to an adult in social life - from communication to work.

If the disease is detected at an early stage of development, it can be cured. An integrated approach to therapy gives good results. Of course, if there are no gross disorders of the nervous system.

It is even better if it was possible to diagnose the disease when it has not yet made itself felt, that is, before the baby’s first attempts to speak. Such early corrective work will become effective prevention.