home Biology Modern ideas about dysarthria. Modern scientific understanding of dysarthria and its correction. Average degree of dysarthria

Modern ideas about dysarthria. Modern scientific understanding of dysarthria and its correction. Average degree of dysarthria

dysarthria- violation of pronunciation, due to insufficient innervation of the speech apparatus in case of lesions of the posterior frontal and subcortical regions of the brain. The speech is usually understood as unclear, slurred, deaf, often with a nasal tint, "as if porridge in the mouth." Causes The formation of such a speech pathology as dysarthria is caused by various hazards of the prenatal, natal, postnatal periods: maternal diseases during pregnancy, weak labor activity of the mother, impaired early psychomotor development and severe illnesses of the child, especially in the first year of life. Main manifestations dysarthria: a disorder of articulation of sounds, a violation of voice formation, a change in the pace and rhythm of speech, a change in intonation.

Classification according to the degree of severity. It is based on the degree of brain damage. And depending on the degree of damage, anartria, dysarthria, erased dysarthria are distinguished: anartria- complete impossibility of the pronunciation side of speech; dysarthria(expressed) - the child uses oral speech, but it is inarticulate, incomprehensible, sound pronunciation is grossly disturbed, as well as breathing, voice, intonation expressiveness; erased dysarthria- all symptoms (neurological, psychological, speech) are expressed in an erased form. Erased dysarthria can be confused with dyslalia. The difference is that children with erased dysarthria have focal neurological microsymptoms.

Classification according to the degree of intelligibility of speech for others. It is based on the consideration of purely external manifestations. The author highlighted four degrees of severity speech disorders : first- the mildest degree - a violation of sound pronunciation is detected only by a specialist in the process of examining a child; second- violations of pronunciation are noticeable to everyone, but speech is understandable to others; third- speech is understandable only to the relatives of the child and partially to others; fourth, the most severe - the lack of speech or speech is almost incomprehensible even to the relatives of the child (anarthria). - Classification in domestic neuropathology and speech therapy was created taking into account the mechanism of the violation, according to the localization of the lesion. Bulbar dysarthria. Characteristic is paralysis or paresis of the muscles of the pharynx, larynx, tongue, soft palate. In a child with a similar defect, swallowing of solid and liquid food is disturbed, chewing is difficult. Insufficient mobility of the vocal folds, the soft palate leads to specific voice disorders: it becomes weak, nasalized. Voiced sounds are not realized in speech. Paresis of the muscles of the soft palate leads to the free passage of exhaled air through the nose, and all sounds acquire a pronounced nasal (nasal) tone. Speech is slurred, extremely indistinct, slow. The face of a child with boulevard dysarthria is amimic. Cortical dysarthria. With this form, arbitrary motility of the articulation apparatus is disturbed. In its manifestations in the field of sound pronunciation, cortical dysarthria resembles motor alalia, since, first of all, the pronunciation of words that are complex in sound-syllabic structure is disturbed. In children, the dynamics of switching from one sound to another, from one articulatory position to another, is difficult. Children are able to clearly pronounce isolated sounds, but sounds are distorted in the speech stream, substitutions occur. Consonant combinations are especially difficult. At an accelerated pace, hesitation appears, reminiscent of stuttering. Pseudobulbar dysarthria. The child develops pseudobulbar paralysis or paresis, caused by damage to the pathways that run from the cerebral cortex to the nuclei of the glossopharyngeal, vagus, and hypoglossal nerves. According to the clinical manifestations of disorders in the area of mimic and articulatory muscles, it is close to bulbar. The degree of violation of speech or articulatory motility may be different. Conventionally, there are three degrees of pseudobulbar dysarthria: mild, moderate, severe: main defect in light degree, is a violation of the phonetic side of speech. 2. average- amimicity: lack of movements of the facial muscles. The child cannot puff out his cheeks, stretch out his lips, close them tightly. severe pronunciation defect. Speech is very slurred, slurred, quiet. 3. heavy- anarthria - characterized by deep muscle damage and complete inactivity of the speech apparatus. Erased form of dysarthria. Mild (erased) forms of dysarthria can be observed in children without obvious movement disorders. Early speech development is slightly slowed down. by the age of 3-4, the phonetic side of speech in preschoolers with an erased form of dysarthria remains unformed. Cerebellar dysarthria- dysarthria caused by damage to the cerebellum or its pathways; characterized by stretched, scrambled speech with broken modulation and fluctuating volume.

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2.2. The severity of dysarthria

The severity of dysarthria speech disorder depends on the severity and nature of the lesion of the central nervous system. Conventionally, 3 degrees of severity of dysarthria are distinguished: mild, moderate and severe.

Light degree the severity of dysarthria is characterized by minor disturbances (speech and non-speech symptoms) in the structure of the defect. Often, manifestations of a mild degree of dysarthria are called “unsharply pronounced” or “erased” dysarthria, meaning non-rough (“erased”) paresis of the muscles of the articulatory apparatus that disrupt the pronunciation process. Sometimes speech therapists use the terms "minimal dysarthria disorders" and "dysarthria component", while some of them incorrectly consider these manifestations to be only elements of dysarthria or an intermediate disorder between dyslalia and dysarthria.

With a mild degree of dysarthria, the general intelligibility of speech may not be impaired, but the sound pronunciation is somewhat blurred, fuzzy. Distortions are observed most often when pronouncing whistling, hissing and / or sonorous sounds. When pronouncing vowels, the greatest difficulties are caused by sounds [ and] and [ at]. Voiced consonants are often deafened. Sometimes, in isolation, a child can pronounce all sounds correctly (especially if a speech therapist deals with him), but with an increase in speech load, a general blurring of sound pronunciation is noted.

There are also shortcomings in speech breathing (rapid, shallow), voice (quiet, deaf) and prosodic (low modulation).

With a mild degree of dysarthria in children, unsharply pronounced violations of the muscle tone of the tongue, sometimes lips, and a slight decrease in the volume and amplitude of their articulatory movements are noted. At the same time, the most subtle and differentiated movements of the tongue are disturbed (first of all, lifting up). Non-verbal symptoms can also manifest as mild salivation, difficulty chewing solid foods, occasional choking when swallowing, and an increase in the pharyngeal reflex.

At middle(moderate) degree of dysarthria the general intelligibility of speech is impaired, it becomes slurred, sometimes even incomprehensible to others. In some cases, the child's speech is difficult to understand when the context is not known. In children, there is a general blurring of sound pronunciation (numerous pronounced distortions in many phonetic groups). Often, sounds at the end of a word and in a confluence of consonants are omitted. Violations of the depth and rhythm of breathing are usually combined with disorders of strength (quiet, weak, fading) and voice timbre (deaf, nasalized, tense, choked, intermittent, hoarse). The absence of voice modulations makes the voice unmodulated, and the speech of children is monotonous.

In children, violations of the tone of the lingual, labial and facial muscles are expressed. The face is hypomimic, articulatory movements of the tongue and lips are slow, strictly limited, inaccurate (not only the upper tongue lift, but also its lateral abductions). Significant difficulties are represented by keeping the tongue in a certain position and switching from one movement to another. For children with an average degree of dysarthria, hypersalivation, disturbances in the act of eating (difficulty or lack of chewing, chewing and choking when swallowing), synkinesis, and an increase in the gag reflex are characteristic.

Severe dysarthria- anartria - is it complete or almost complete absence sound pronunciation as a result of paralysis of speech motor muscles. Anarthria occurs when the central nervous system is severely damaged, when the motor realization of speech becomes impossible. In most children with anarthria, speech articulation control disorders (articulatory, phonatory, respiratory department) are mainly manifested, and not just performance. In addition to the pathology of the central executive systems of speech activity, the formation of dynamic articulatory praxis is impaired. There is a disorder of voluntary control of the speech apparatus. Pronunciation disorders in anarthria are caused by pronounced central motor speech syndromes: spastic paresis in a very severe degree, tonic disorders in the control of articulatory movements, hyperkinesis, ataxia and apraxia. Apraxia covers all parts of the speech apparatus: respiratory, phonatory, labio-palatine-lingual. Apraxic disorders are manifested by the child's inability to arbitrarily form vowels and consonants, to pronounce a syllable from the available sounds or a word from the available syllables.

Anarthria is characterized by deep damage to the articulatory muscles and complete inactivity of the speech apparatus. The face is amimic, mask-like; the tongue is motionless, the movements of the lips are sharply limited. Chewing of solid food is practically absent; pronounced choking when swallowing, hypersalivation.

According to the severity of the manifestations of anartria, it can be different (I.I. Panchenko):

a) the complete absence of speech (sound pronunciation) and voice;

c) the presence of sound-syllabic activity.

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

1. Children with purely phonetic. They suffer from sound pronunciation, speech breathing, voice, prosody and articulatory motility. At the same time, there are no violations of phonemic perception and lexical grammatical structure speech.

2. Children with phonetic-phonemic underdevelopment. They violate not only the pronunciation side of speech (sound pronunciation, speech breathing, voice, prosody), but also phonemic processes(difficulties of sound analysis and synthesis). At the same time, there are no lexical and grammatical shortcomings of speech.

3. Children with general underdevelopment speech. In children of this group, all components of speech are impaired - both the pronunciation side of speech, and lexical, grammatical and phonemic development. Restrictions noted vocabulary: children use everyday words, often use words in an inaccurate meaning, replacing them with related ones in similarity, in situation, in sound composition. Dysarthric children are often characterized by insufficient mastery of the grammatical forms of the language. Prepositions are often omitted in their speech, endings are left out or misused, not digested. case endings, number categories; there are difficulties in coordination, management.

The severity (severity) of dysarthria does not depend on the number of impaired components of the speech functional system. For example, when erased (mild) dysarthria all components of speech (phonetic, phonemic and lexico-grammatical structure) can be violated, and when moderate to severe dysarthria only the phonetic structure of speech can be violated.

2.3. Early diagnosis of speech and movement disorders

The structure of the defect in dysarthria includes both speech and non-speech disorders (manifestation of neurological symptoms in the muscles and motility of the articulatory apparatus). In the first year of life, and sometimes later, only non-speech disorders can be identified and assessed.

Early diagnosis of dysarthria disorders is based on the assessment of non-speech disorders. The younger the child and the lower the level of his speech development, topics greater value has an analysis of non-speech disorders. Most often, the first manifestation of dysarthria is the presence of a pseudobulbar (spastic-paretic) syndrome, the first signs of which can already be detected in a newborn. First of all, this is the absence of a cry (aphonia) or its weakness, monotony, short duration. The scream may be strangled or shrill, sometimes there are separate sobs or a grimace on the face instead of a scream. Almost all children with perinatal pathology of the central nervous system have an early manifestation of neurological symptoms in the muscles and motor skills of the speech apparatus. The most typical are the following violations.

1. Pathological changes in the structure and functioning of the articulatory apparatus; violation of the tone and mobility of the articulatory muscles:

a) in the facial muscles: the presence of asymmetry, smoothness of the nasolabial folds, the omission of one of the corners of the mouth, the skew of the mouth to the side when smiling and crying; hypomia; violation of the tone of the facial muscles by the type of spasticity, hypotension or dystonia; face hyperkinesis;

b) in the labial muscles: a violation of muscle tone, a sharp or slight limitation of the mobility of the lips; insufficiency of lip closure, difficulty in keeping the mouth closed, sagging of the lower lip, preventing a tight grip on the nipple or nipple and causing leakage of milk from the mouth;

c) in the lingual muscles: violation of muscle tone; pathology of the structure of the tongue (with spasticity - the tongue is massive, pulled back with a "lump" or stretched out with a "sting" forward; with hypotension - thin, flaccid, flattened in the oral cavity; bifurcation of the tongue, unexpressed tip of the tongue, shortening of the frenulum); pathology of the position of the tongue (deviation to the side, protrusion of the tongue from the mouth); hyperkinesis, tremor, fibrillar twitching of the tongue; restriction of mobility of the lingual muscles (from complete impossibility to a decrease in the volume of articulatory movements); increase or decrease in the pharyngeal (vomit) reflex;

d) soft palate: sagging of the palatine curtain (with hypotension); deviation of the uvula from the midline.

2. Respiratory disorders: infantile breathing patterns (the predominance of the abdominal type of breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.

3. Violation of voice formation: insufficient voice power (quiet, weak, fading), timbre deviations (nasalized, deaf, hoarse, strangled, tense, intermittent, trembling); violation of voice modulations, intonational expressiveness of the voice. Sometimes there is asynchrony of breathing, voice formation and articulation.

4. Violation of the act of eating: violation of sucking (weakness, lethargy, inactivity, irregularity of sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup .

5. Hypersalivation (permanent or intensifying under certain conditions).

6. Oral synkinesis (the child opens his mouth wide with passive and active hand movements and even when trying to perform them).

7. Absence or weakening of reflexes of oral automatism (up to 3 months), the presence of pathological reflexes of oral automatism (after 3-4 months).

With age, in a child with neurological pathology, the insufficiency of vocal reactions - screaming, cooing, babble - is increasingly revealed. For a long time, the cry remains quiet, slightly modulated, monotonous, without intonational expressiveness (does not change depending on the child's condition). Often the cry has a nasal connotation. The sounds of humming and babble are distinguished by their monotony, poor sound composition, low activity, and fragmentation.

At later stages of development, in the diagnosis of dysarthria, speech symptoms begin to become increasingly important: qualitative insufficiency of voice reactions, persistent disturbances in sound pronunciation, speech breathing, voice formation, and prosody.

2.4. Modern approaches
to the classification of dysarthria

There are various approaches to the classification of dysarthria. They are based on the principle of localization of brain damage, the degree of intelligibility of speech for others, the syndromological approach.

When classifying dysarthria based on the principle of localization of brain damage distinguish between pseudobulbar, bulbar, extrapyramidal (subcortical), cerebellar, cortical forms of dysarthria (O.V. Pravdina and others).

Classification of dysarthria according to the degree of speech intelligibility for others was proposed by the French neurologist Tardieu. They were allocated 4 degrees of severity of motor speech disorders (in children with cerebral palsy):

1) violations of sound pronunciation are detected only by a specialist in the process of examining a child;

2) violations of pronunciation are noticeable to everyone, but speech is understandable to others;

3) speech is understandable only to relatives of the child;

4) speech is absent or incomprehensible even to the relatives of the child (the fourth degree of impaired sound pronunciation, in essence, is an anarthria). This classification is very convenient for use not only by speech therapists, but also by teachers, educators, and psychologists.

For speech therapy work, including differentiated massage, articulation and breathing exercises, it is convenient classification of dysarthria based on the syndromological approach, in which spastic-paretic, spastic-rigid, hyperkinetic, atactic and mixed forms of dysarthria are distinguished (I.I. Panchenko). In children with cerebral palsy, it is difficult to isolate the symptoms of motor speech disorders due to the complexity of the damage to speech motor skills, if not correlated with general motor disorders. In cerebral palsy, common motor disorders (main syndromic disorders) are spastic paresis, tonic control disorders such as rigidity, hyperkinesis, ataxia, and apraxia.

Disorders of sound pronunciation and articulation

with various forms of dysarthria (classification of dysarthria

according to the principle of localization of brain damage)

Violations

articulation

Violations

sound pronunciation

Bulbar dysarthria

Selective, predominantly right- or left-sided paralysis of the muscles of the speech apparatus

Amyotrophy

Muscle atony

Any voluntary and involuntary movements are impaired

All consonants approach (converge) fricative sounds

Vowels converge to a sound like an unstressed [ a] or [ s] with the erasure of opposition along the row, rise and roundness

nasal tint

Weakening of specific speech noises arising from the articulation of oral sounds

pseudobulbar

dysarthria

Bilateral spastic paralysis of the muscles of the speech apparatus

Muscle tone is increased according to the type of spastic hypertension (tongue is tense, pushed back)

The mobility of the articulatory muscles is severely limited

Selective disorders of voluntary movements

The most complex and differentiated sounds are selectively affected [ R], [l], [sch], [X], [c], [h]

Softening sounds

Violations

articulation

Violations

sound pronunciation

subcortical

(extrapyramidal) dysarthria

Sudden change in tone

Violation of the emotional-motor innervation

Hyperkinesis

Stable violations of sound pronunciation are absent

Cerebellar

dysarthria

Pronounced asynchrony of breathing, phonation and articulation

Decreased tone in articulatory muscles

Difficulties in maintaining articulation patterns

Tongue movements are inaccurate

With subtle purposeful movements, a tremor of the tongue is possible

Movement pace slowed down

Impaired pronunciation of front-lingual, labial, explosive

Nasalization of most sounds

Violations

articulation

Violations

sound pronunciation

To orc dysarthria

I. Kinesthetic postcentral

Lack of kinesthetic praxis

Incorrect and fuzzy articulation of sounds

Active search for the right ways

Noise signs of consonants are replaced:

Places of education (especially lingual ones);

Method of formation (especially sibilant affricates);

Hardness and softness. Substitutions are labile and ambiguous

II. Kinetic

premotor

Lack of dynamic kinetic praxis

The sequence of articulatory movements is disturbed

Impaired articulation of consonants:

Initial and final consonants are often lengthened or jerky;

Replacement of slotted ones with occlusive ones;

Missing sounds in consonant clusters;

Simplifying the affricate;

Selective stunning of voiced stops

(according to E.M. Mastyukova)

Isolated lesion of individual muscles of the articulatory apparatus

Selective spastic paresis of speech muscles

The most subtle isolated movements suffer (lifting the tongue)

The pronunciation of front-lingual sounds is disturbed [ w], [and], [R]: they are missing or replaced by other consonants

Difficult consonants formed when the tip of the tongue approaches the upper teeth or alveoli [ l]

In speech motor skills, similar defects are noted. The type of dysarthria speech disorder is determined by the nature of the clinical syndrome. This classification of dysarthria focuses the speech therapist on the quality of articulatory motility disorders, which makes it possible to more purposefully determine the choice of means of medical and speech therapy work to normalize muscle tone and motility of the articulatory apparatus. This classification can only be used by a speech therapist in conjunction with a neuropathologist who determines the leading neurological syndrome.

When various syndromes are included in the structure of the speech defect, dysarthria is characterized as mixed.

Spastic-paretic dysarthria (the leading syndrome is spastic paresis).

Spastic-rigid dysarthria (leading syndromes are spastic paresis and tonic disturbances in the control of speech activity such as rigidity).

Hyperkinetic dysarthria (the leading syndrome is hyperkinesis).

Atactic dysarthria (the leading syndrome is ataxia).

Spastic-atactic dysarthria (leading syndromes are spastic paresis and ataxia).

Spastic-hyperkinetic dysarthria (leading syndromes are spastic paresis and hyperkinesis).

Spastic-atactico-hyperkinetic dysarthria (leading syndromes - spastic paresis, ataxia, hyperkinesis).

Atactico-hyperkinetic dysarthria (leading syndromes are ataxia and hyperkinesis).

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4. Zavalsky Yu.I. The library is an important structural support, the information center of the primary lighting foundation of the Shkilna Library. – 2004.

Particular attention in the analysis of the function of the motor sphere is paid attention to those that impede educational activity on the stability of the child in upright movement, the possibilities of walking in the state of movement of the hand. The greatest attention should be paid to freedom or stiffness of movements, lethargy, or vice versa - convulsive hand movements with a large number of synkinesis of accompanying movements. Reproduce the position of the hand in space. For this, the task is given to reproduce the proposed posture of the hand, posture of the fingers ...

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INTRODUCTION .................................................. ................................................. ...........3

1 MODERN SCIENTIFIC VIEW OF DYSARTRIA AND ITS CORRECTION .................................................................. ................................................. ................6

1.1 Determination of the cause, form and structure of the defect ..............................................................6

1.2 Types of correctional work in dysarthria .............................................................. ...19

conclusion................................................. ................................................. ..thirty

LIST OF USED LITERATURE.................................................................32

APPENDIX................................................. ................................................. ..34

Introduction

The relevance of research. From year to year there is an increase in the number of children with various speech disorders. Speech is not an innate ability, but develops in the process of ontogenesis (individual development of the organism from the moment of its inception to the end of life) in parallel with the physical and mental development child and serves as an indicator of his overall development. A full-fledged harmonious development of a child is impossible without educating him in correct speech. Such speech should be not only correctly designed in terms of word selection (dictionary), grammar (word formation, inflection), but clear and flawless in terms of sound pronunciation and sound-syllabic content of words.

The formation of speech is one of the main characteristics of the overall development of the child. Normally developing children have good abilities to master their native language. Speech becomes an important means of communication between the child and the outside world, the most perfect form of communication that is unique to man.

Since speech is a special higher mental function, which is provided by the brain, any deviations in its development should be noticed in time. For the normal formation of speech, it is necessary that the cerebral cortex reaches a certain maturity, the articulatory apparatus is formed, and hearing is preserved. Another indispensable condition is a full-fledged language environment from the first days of a child's life.

A fairly common severe speech disorder among children preschool age is dysarthria. It is often combined with other complex speech disorders (stuttering, phonetic-phonemic speech disorder (FFNR), general speech underdevelopment (OHP) and others). This speech pathology manifests itself in defects in the phonemic and prosodic components of the speech functional system. mother tongue and occurs as a result of a microorganic lesion of the brain, which leads to a violation of the innervation of the articulatory apparatus, a violation of the muscle tone of the speech and facial muscles.

"Dysarthria" - a Latin term, translated means "violation of articulate speech - pronunciation. Violation of sound pronunciation in dysarthria manifests itself to varying degrees and depends on the nature and severity of the damage to the central nervous system. In mild cases, there are individual distortions in the pronunciation of sounds, "blurred speech" , in heavier ones there are distortions, and replacements, and omissions of sounds.The tempo, expressiveness, modulation suffer, in general, the pronunciation becomes incomprehensible.

In children, the frequency of dysarthria is primarily associated with the frequency of perinatal pathology (damage to the nervous system of the fetus and newborn). More often, dysarthria is observed in cerebral palsy, according to various authors, from 6.5 to 85 percent.

There is a relationship between the severity and nature of the lesion of the motor sphere, the frequency and severity of dysarthria. With the most severe forms of cerebral palsy when there is a lesion of the upper and lower extremities and the child remains practically motionless (double hemiplegia), dysarthria (anarthria are observed in almost all children). A relationship was noted between the severity of the upper limb lesion and the lesion of the speech muscles.

At the present stage, the problem of childhood dysarthria is being intensively developed in clinical, neurolinguistic, psychological and pedagogical directions.

The object of the study is the development of speech in children with dysarthria.

The subject of the study is the system of speech therapy work on the correction of dysarthria.

The aim of the study is to study and characterize the methods of speech therapy for the correction of dysarthria.

Research objectives:

1. Determine the causes, forms and structure of the defect.

2. Describe the types of correctional work in dysarthria.

The methodological and theoretical basis of the study was the following:

General and special psychology about the unity of the general patterns of development of normal and abnormal children (Vygotsky L.S., Luria A.R.),

On a systematic approach to the analysis of speech disorders (Levina R.E. Lubovsky V.I)

Works by Filicheva T.B., Chirkina G.V., N.A. Cheveleva, Tkachenko T.A., dedicated to the upbringing and education of children with FFNR.

During the work, we used the following research methods: analysis of the psychological and pedagogical and methodical literature on the research problem; study of medical and pedagogical documentation; qualitative analysis of the obtained data.

Work structure. The work consists of an introduction, one section divided into two subsections, a conclusion, a list of references, which includes 22 sources, applications. The main text of the work is presented on 30 pages.

1 MODERN SCIENTIFIC VIEW OF DYSARTRIA AND ITS CORRECTION

1.1 Determination of the cause, form and structure of the defect

Dysarthria is a violation of pronunciation due to insufficient innervation of the speech apparatus with lesions of the posterior frontal and subcortical regions of the brain. The leading defect in dysarthria is a violation of sound pronunciation and the prosodic side of speech, associated with an organic lesion of the central and peripheral nervous system. 1 .

The classification of dysarthria is based on the principles of localization, the syndromological approach, the degree of speech understanding for others 2 .

Based on the syndromic approach, the following forms of dysarthria are distinguished: spastic-paretic; spastic-regid; spastic-hyperkinetic; spastic-atactic; atactico-hyperkinetic 3 . This approach is partly due to the more common brain damage in children with cerebral palsy and, in connection with this, the predominance of its complicated forms.

The classification of dysarthria according to the degree of intelligibility of speech for others was proposed by the French neuropathologist G. Tardieu in accordance with children with cerebral palsy. The author identified four degrees of severity of speech disorders in such children.:

1. The first is a mild degree, when violations of sound pronunciation are detected only by a specialist during the examination.

2. The second - a violation of sound pronunciation is noticeable to everyone, but speech is understandable to others.

3. Third - speech is understandable only to close people and partially to others.

4. The fourth is severe, lack of speech or speech is almost incomprehensible even to the relatives of the child (anarthria) 4 .

Anarthria refers to the complete or partial inability to pronounce sound due to paralysis of speech motor muscles. 5 .

The main signs (symptoms) of dysarthria are defects in sound pronunciation and voice, combined with a violation of speech, primarily articulation, motor skills and speech breathing. With dysarthria, in comparison with dyslalia, a violation of the pronunciation of both consonants and vowels is possible 6 .

Depending on the type of violations, all defects in sound pronunciation in dysarthria are divided into:

Anthropophonic (sound distortion);

Phonological (lack of sound, replacement, undifferentiated pronunciation, mixing) 7 .

For all forms of dysarthria, articulatory motility disorders are characteristic, which manifest themselves in a number of ways.

The following forms of violation of muscle tone in the articulatory muscles are distinguished: elasticity of the articulatory muscles - a constant increase in tone in the muscles of the tongue, lips, in the muscles of the face and neck.

With a pronounced increase in muscle tone, the tongue is tense, pulled back, its back is curved, raised up, the tip of the tongue is not expressed. The tense back of the tongue is raised to the hard palate, which helps to soften consonant sounds. Therefore, a feature of articulation with the elasticity of the muscles of the tongue is palatalization, which can contribute to phonemic underdevelopment 8 .

An increase in muscle tone of the circular muscle of the mouth leads to spastic tension of the lips, tight closing of the mouth.

next view muscle tone disorder is hypotension. At the same time, the tongue is thin, flattened in the oral cavity, the lips are flaccid, there is no possibility for them to close tightly. Because of this, the mouth is usually half open, hypersalivation is pronounced.

A feature of articulation in hypotension is nasalization, when the hypotension of the muscles of the soft palate prevents sufficient movement of the palatine curtain up and pressing it against the back wall of the pharynx. The airflow exits through the nose, and the airflow that exits through the mouth is extremely weak. The presence of violent movements and oral synkenesis in the articulatory muscles is a common sign of dysarthria. 9 .

Violation of articulatory motility in combination with each other constitutes the first important syndrome of dysarthria - the syndrome of articulatory disorders.

With dysarthria, speech breathing is disturbed due to a violation of the innervation of the respiratory muscles. The rhythm of breathing is not regulated by the content of speech, at the moment of speech it is usually fast, after the pronunciation of individual syllables or words, the child takes superficial convulsive breaths, the active exhalation is reduced and passes more often through the nose, despite the constantly half-open oral cavity 10 .

The second syndrome of dysarthria is a syndrome of impaired speech breathing. The next characteristic feature of dysarthria is a violation of the voice and melodic intonation disorders.

Thus, the main symptoms of dysarthria - a violation of sound pronunciation and the prosodic side of speech - are determined by the nature and severity of manifestations of articulatory, respiratory and voice disorders. There are also non-speech disorders. These are manifestations of the bulbar and pseudobulbar syndrome in the form of disorders of sucking, swallowing, chewing physiological breathing in combination with a violation of general motor skills and especially fine, differentiated motor skills. fingers 11 .

The diagnosis of "dysarthria" is made on the basis of the specifics of linguistic and non-linguistic disorders.

Let us characterize in more detail the various forms of dysarthria.

Cortical dysarthria is a group of motor speech disorders of various pathogenesis associated with local damage to the cerebral cortex.

The first variant of cortical dysarthria is due to a unilateral or, more often, bilateral lesion of the lower anterior central gyrus. In these cases, selective central paresis of the muscles of the articulatory apparatus (usually the tongue) occurs. At the same time, the pronunciation of consonants is violated, which are formed with the tip of the tongue raised and slightly bent upwards ("Sh", "Zh", "R"); difficulties in pronouncing consonants, which are formed when the tip of the tongue approaches or connects with the upper teeth or alveoli ("L") 12 .

The second option is associated with insufficiency of kinesthetic praxis, which is observed with unilateral lesions of the cortex of the dominant hemisphere (left) in the lower post-central cortex. In these cases, the pronunciation of consonants suffers, especially hissing and Africans. The search for the desired articulation mode during speech slows down its pace and breaks the smoothness 13 .

The third option is associated with the insufficiency of dynamic kinesthetic praxis, this is observed with unilateral lesions of the cortex of the dominant hemisphere, in the lower parts of the premotor areas of the cortex. At the same time, the pronunciation of complex Afrikats becomes difficult, which can break up into its constituent parts, there are replacements of slotted sounds with closing ones ("З" - "Д"). Omissions of sounds at the junction of consonants, sometimes with selective muffled voiced, closing consonants. Speech is slow, tense 14 .

Pseudobulbar dysarthria occurs with bilateral damage to the motor cortical-nuclear pathways from the cerebral cortex to the nuclei of the cranial nerves of the trunk. Pseudobulbar dysarthria is characterized by an increase in muscle tone in the articulatory muscles according to the type of elasticity - a spastic form of dysarthria 15 .

Less commonly, against the background of limiting the volume of voluntary movements, there is a slight increase in muscle tone in individual muscle groups or a decrease in muscle tone - a paretic form of pseudobulbar dysarthria. In both forms, there is a limitation of the active actions of the muscles of the articulatory apparatus, and in severe cases, their almost complete absence. The tongue with the corresponding form of dysarthria is tense, pulled back, the back is rounded and closes the entrance to the pharynx, the tip of the tongue is unexpressed. Especially difficult is the movement of the extended tongue up, bending its tip to the nose 16 .

In all cases, with pseudobulbar dysarthria, the most complex and differentiated arbitrary articulatory movements are violated in the first place. Reflex movements are usually preserved. So, for example, with limited voluntary movements of the tongue, the child licks his lips while eating, finding it difficult to pronounce voiced ones, the child pronounces them when he cries, coughs loudly, and laughs.

With this form of dysarthria, characteristic disturbances in sound pronunciation, selective difficulties in pronouncing the most complex and differentiated articulatory sounds ("P", "L", "Sh", "Zh", "Ch", "Sh") are manifested. The sound "P" loses its vibrational character, sonority, is often replaced by a slotted sound 17 .

Thus, in pseudobulbar dysarthria, as in cortical dysarthria, the pronunciation of the most complex anterior lingual sounds is disturbed. But, unlike the latter, the violation is more common, combined with a distortion of pronunciation and other groups of sounds, disorders of breathing, voice, intonation-melodic side of speech, often salivation.

With paretic pseudobulbar dysarthria, the pronunciation of closure, labial sounds that require sufficient muscle tension, especially bilabial ("P", "B", "M") linguistic-alveolar, as well as a number of vowel sounds ("I", "And", " AT "). There is a nasal tone of voice.

Bulbar dysarthria is a symptomatic complex of motor speech disorders that develop as a result of damage to the nuclei or peripheral parts (7th, 9th, 10th, 12th pairs of cranial nerves). With bilateral lesions, the violation of sound pronunciation is most pronounced. The pronunciation of all labial sounds is grossly distorted by the type of their approach to a single deaf fricative labial sound. All closure consonants also approach fricative consonants, and the anterior lingual consonants approach a single deaf flat-slit sound, voiced consonants are muffled. These speech disorders are accompanied by nasalization 18 .

Distinguishing bulbar dysarthria from paretic pseudobulbar is carried out according to the following criteria:

The nature of paresis or paralysis of the speech muscles (with bulbar - peripheral, with pseudobulbar - central);

The nature of the violation of speech motility (with bulbar, voluntary and involuntary movements are violated, with pseudobulbar - mainly arbitrary);

The nature of the lesion of articulatory motility (with bulbar - diffuse, with pseudobulbar - selective with a violation of fine differentiated articulatory movements);

The specifics of sound pronunciation disorders (with bulbar dysarthria - the articulation of vowels approaches a neutral sound, with pseudobulbar dysarthria it is removed back, with bulbar - vowels and calls are muffled, with pseudobulbar - along with muffled sounds, their voicing is observed)

With pseudobulbar dysarthria, even with the predominance of the paretic variant, elements of elasticity are noted in individual muscle groups. 19 .

The extrapyramidal system is important in the regulation of muscle tone, gradualness, strength and real estate of muscle contractions, provides automated, emotionally expressive execution of motor acts. Violation of sound pronunciation in extrapyramidal dysarthria is determined by:

Changes in muscle tone in the articulatory muscles;

The presence of obsessive movements-hyperkinesis;

Violation of propreceptive apherenation from the tongue muscles;

Violations of the emotional-motor innervation 20 .

A feature of extrapyramidal dysarthria is the absence of stable and uniform disturbances in sound pronunciation, as well as great difficulty in automating sounds. Extrapyramidal dysarthria is often combined with hearing loss of the type of sensorineural hearing loss.

With cerebellar dysarthria, the cerebellum and its connections with other parts of the central nervous system, as well as the fronto-cerebellar pathway, are affected. At the same time, the speech is slow, jerky, chanted, with a violation of the modulation of stress, attenuation of the voice towards the end of the phrase 21 .

Differentiated diagnosis of dysarthria is carried out in two directions:

Separation of dysarthria from dyslalia;

Separation of dysarthria from alalia.

Dissociation from dyslalia is carried out on the basis of the identification of three leading symptoms (syndromes of articulation, respiratory, voice disorders), taking into account the data of a neurological examination and the characteristics of the anamnesis.

Dissociation from alalia is carried out on the basis of the absence of primary violations of language operations, which is manifested in the features of the development of the lexical and grammatical side of the language 22 .

Examination of children with dysarthria disorders has a dual purpose:

1. This examination should distinguish between dysarthria and other disorders - stuttering, rhinolalia.

2. Help to more accurately determine the form of dysarthria with which it is necessary to work. The examination ends when the speech therapist can predict the results. The leading defect in dysarthria is movement disorders, therefore, a significant place in the examination program is given to the study of the motor and cultural-motor spheres. 23 .

To study the motor sphere, a speech therapist studies the child's performance of such tasks: running, walking, jumping on each leg alternately, throwing, in which the child stretches one leg and arm in one direction, in different (arm in one, leg in the other). These tasks make it possible to draw a conclusion about the structure of running, jumping, throwing, as well as the state of movements for switching 24 .

When analyzing the function of the motor sphere, special attention is paid to those that impede learning activity, to the stability of the child in standing upright, moving, walking, in the state of movement of the hand.

An analysis of the nature and speed of hand movement can reveal muscle paresis or a different increase in tone. The greatest attention should be paid to freedom or stiffness of movements, strength, lethargy, or vice versa - convulsive movement of the hand with a large number of synkinesis (accompanying movements).

We can observe especially rough movements of the compression (grasping) function:

The fingers are tense and half bent;

The fingers are bent into a fist;

Holding the ball only with the thumb and forefinger, the rest are bent;

The child takes and holds a pencil, a pen with the tips of all fingers or two 25 .

Analysis of motor-visual coordination allows to identify such violations:

Eye movements at random;

Eye movements in the opposite direction;

Eye movement at the speech therapist, a gaze typical of children who are unsure of themselves, helpless in independent activities 26 .

This indicates a violation of the motor act.

To study the state of the speech-motor sphere, 8 special tests are used (speech-motility, facial nerve, speech-lips-pharynx, etc.).

Gnosis and praxis constitute the non-speech sphere. The study of the non-verbal (non-speech) sphere includes an examination of the state of praxic and gnostic processes.

To study praxis, we use three tests:

1. Reproduce the position of the hand in space. If the right hand is in a state of at least slight paresis, the child is asked to reproduce postures in which the hand (hand) is either vertically, or horizontally, or at an angle. If there are no paresis, then he must perform these tasks with both hands at the same time.

2. Examination of the praxis of the posture. To do this, the task is given to reproduce the proposed posture of the hand (poses of fingers, hands, postures of Daktel) on both hands. When performing these tasks, attention is drawn to how long the child is looking for a position, conducts a number of additional tests before finding the right one.

3. When examining object-symbolic praxis, we study whether the child is able to find a whole range of movements to perform a meaningful action. This assignment comes in two versions:

Complete the proposed task in a real subject situation (fasten buttons, lace up shoes, cut out a picture);

Complete the task in an imaginary situation (pour tea, embroider a flower, play the piano). The child must obey the imaginary situation 27 .

To examine oral (speech) praxis, we use the following tasks:

Tests for maintaining a deep sense of the tongue (tongue with a napkin);

Tests for the reproduction of a number of movements demonstrated to the child (any of the exercises for the development of motor skills);

Perform the same movements, but only according to verbal instructions;

Recreate a number of meaningful symbolic acts (whistle, knock, etc.);

Samples for performing rhythms, which the speech therapist taps with a finger or pencil;

Tests for switching movements (fist-rib-palm), Ozer test - squeezing one hand and straightening the other 28 .

Examination of gnostic processes includes tests for the study of:

Optical (visual) gnosis;

Spatial syntheses;

Successive syntheses (successive series of determining which subject);

Simultaneous synthesis (simultaneously, embrace at once, generalize) 29 .

Three tasks are used to study optical (visual) gnosis:

Presentation of single geometric shapes quickly 4-6 geometric shapes. The child must name them;

Presentation of images of objects that the child must find among a group of drawings (find 5 objects among 30 others, depicted in dotted lines, superimposed on each other, on the same background, etc.);

Presentation of plot drawings, united into one whole (by meaning). Start with the simplest situations (for example, children are sledding).

Spatial gnosis includes such tests:

Observation of the orientation of the child in space;

Copying a series of geometric shapes, the elements of which have the appropriate spatial orientation (with prepositions: a cross over a circle, under a circle, a circle between crosses, etc.;

Head's test (the child in front of the speech therapist repeats the movements that the speech therapist performs; reproduces mirror movements);

Image of schemes of spatial relations (from the classroom, to the dining room);

Distinguishing symbolically designated spatial relationships (left and right sides of your body, sitting opposite the speech therapist);

Distinguishing named fingers (little finger, index finger, etc.) 30 .

To examine successive syntheses, a test is given for the reproduction and retention of rhythms:

They give a series of rhythmic beats (2 or 3), for example, 1 short, 2 long. The child must say that there was 1 short, two long;

In addition to assessing the nature of the impacts, it is proposed to evaluate the number of impacts (this is a preparation for sound analysis);

The child is invited to practically reproduce the given rhythm.

The study of praxis and gnosis allows the speech therapist to get an idea of the existing violations in the child even before examining the state of speech. The results of the fulfillment of these tasks form the basis for the study and correction of speech activity.

The examination of speech is aimed at studying disorders of sound pronunciation. These disorders are studied from different perspectives:

1. From the position of structural phonetics:

Acoustic data are studied (characteristics of the voice, its height, strength, mobility, ability to modulate);

The prosodic organization of the sound stream (rhythm, tempo, melody) is being studied;

intonation possibilities;

Articulatory data of the process of sound pronunciation (characteristics of articulatory movements, their strength, accuracy, smoothness, speed, synchronism, switching symmetry);

Determination of the nature of the pronunciation of a defective sound (pass, replacement, shift).

2. From the standpoint of structural linguistics, the features of writing and reading are studied.

3. From the position of psycholinguistics:

The features of understanding the semantic meaning of the sound stream are studied (as I read - sad, cheerful, surprised, not in content);

We study the features of phonemic perception of speech and differentiation of sounds;

Features of the child's own readiness for improvement and correction of inclinations;

Features of the child's unconscious and conscious control of language 31 .

In dysarthria, the study of speech development of the processes of sound pronunciation (pronunciation, breathing, voice, articulation) is the main one, and these violations are leading.

1.2 Types of correctional work for dysarthria

In speech therapy correctional work with dysarthria, special attention is paid to the state of speech development of children in the field of vocabulary and grammar, as well as to the features of the communicative function of speech. In school-age children, the state of written speech is taken into account.

Positive results of speech therapy work are achieved subject to the following principles:

Phased interconnected formation of all components of speech;

A systematic approach to the analysis of a speech defect;

Regulation of the mental activity of children through the development of the communicative and generalizing functions of speech 32 .

In the process of systematic and in most cases long-term exercises, the gradual normalization of the motor skills of the articulation apparatus, the development of articulation movements, the formation of the ability to consciously switch the moving organs of articulation from one movement to another at a given pace, overcoming monotony and violations of the tempo of speech, the full development of phonemic perception are carried out.

This prepares the basis for the development and correction of the sound side of speech and forms the prerequisites for mastering the skills of oral and written speech.

Speech therapy work must be started at a younger preschool age, thereby creating conditions for the full development of more complex aspects of speech activity and optimal social adaptation. 33 .

Great importance It also has a combination of speech therapy and therapeutic measures.

Treatment of children with dysarthric speech disorders is carried out taking into account the natural ontogenesis of motor skills, which consists of two phases.

1. First phase. Morphological maturation of the central nervous elements: myelination of the pathways takes place, which ends mainly before two or three years, and in children with cerebral palsy years late. Therefore, the neuropathologist begins the treatment of the child as early as possible. During this period, the child is given medications that promote myelination, improve metabolism - nerabol, vitamin Wb, ATP and others. Restorative, desensitizing, sedative, dehydration therapy, sanitation of the nasopharynx, etc. are necessary preparatory measures for the following speech therapy classes.

2. Second phase. Ontogenesis - functional maturation and adjustment of the work of coordination levels. In this phase, the development of speech motor skills is not always progressive - in some periods, temporary stops and even regressions may occur. In this phase, the combination of medication and speech therapy is especially important. Until now, there are no means that would restore a completely and completely dead cell, its axon, would normalize the tone and conduction in the neuromuscular apparatus for a long time. However, there is a large arsenal of drugs that affect acetylcholine metabolism in any of its links, on the biochemical and physiological processes of the central nervous system. All this creates positive conditions for the recovery, compensatory process in dysarthria disorders. 34 .

Physiotherapy plays an important role in the treatment of dysarthria disorders. Acting on unconditioned stimuli, physical factors cause changes in the functional state of various parts of the nervous system, contribute to the restoration of disturbed physiological balance, improve blood circulation conditions, and tissue metabolism processes.

Only complex medical and pedagogical measures can provide children with dysarthria with a real opportunity for verbal communication.

The main directions of work with children suffering from dysarthria:

1. Learning the correct sound pronunciation, i.e. development of articulatory motility, speech breathing, staging and fixing sounds in speech.

3. Normalization of the prosodic side of speech, that is, overcoming disorders of rhythm, melody and intonational side of speech.

4. Correction of manifestations of general underdevelopment of speech. Overcoming OHP in children with dysarthria is carried out in the process of education and upbringing in a special kindergarten 35 .

The primary task of correcting the sound pronunciation of dysarthric children is to achieve differentiated pronunciation. Since the main reason for the shortcomings of sound pronunciation is the complete or partial immobility of the organs of the speech apparatus, the main attention of the speech therapist should be directed to the development of the mobility of the organs of the articulatory apparatus.

To improve the innervation of the facial muscles, overcome the mimicry of the face and the immobility of the articulatory apparatus, a massage of the entire facial muscles is performed: a light pat on the cheeks with the palm of your hand, light pinching movements with your fingers along the edge of the lower jaw from the outside, along the hyoid and pharyngeal-palatine muscles. Facial stroking is also used. In addition, they systematically use lip massage, stroking movements on the lips, slight pinching of closed lips, mechanical convergence of the lips in the horizontal and vertical directions, circular stroking movements in the corners of the mouth. The soft palate is massaged with the inside of the thumb or index finger from front to back. Massage duration - no more than two minutes 36 .

The child's voluntary movements must be reinforced by systematic repetition. The child observes the movements of the organs of articulation in himself (in the mirror) and in the speech therapist, listens to the sound of a groan (for the sound "M"), the sound of a cough (for the sound "K"). The movements are performed first together with a speech therapist, later after the demonstration - according to the model. This ensures a gradual transition to independent execution. The passive gymnastics method is most effective for children with subcortical and pseudobulbar dysarthria. With the help of an adult or with mechanical help, the child reproduces the necessary position of the organs of articulation and thereby more clearly feels the movements of the tongue, lips, etc. Gradually, an opportunity is created to perform active independent movements.

Mechanical assistance is used (a speech therapist's hand, special probes and spatulas) with passive gymnastics of the articulation organs. It is possible to carry out exercises with the help of a child's hand (with control in front of a mirror). Movements should be performed slowly, smoothly, rhythmically, with a gradual increase in amplitude. For example, a child opens his mouth wider: for this, the thumb right hand, thoroughly washed, is placed on the lower teeth, and four fingers under the chin. The tongue protrudes as far as possible: for this, the tip of the tongue is covered with a napkin and the child sticks it forward 37 .

As passive movements become less difficult, it is possible to reduce mechanical assistance and move on to holding the achieved position.

During this period, the elimination of salivation begins. The child is asked to chew with the head slightly tilted back.

The next stage is active gymnastics of the articulatory apparatus. Approximate types of exercises 38 :

1. For the lower jaw - opening and closing the mouth (with snapping teeth); keeping the mouth open (under the account).

In the process of performing these exercises, it is necessary to ensure that the closing of the mouth occurs along the midline. You can use mechanical assistance - light pressure on the crown of the head and under the jaw.

It is also used to pull out a gauze napkin bitten with teeth by hand. In addition to control with a mirror, the child should feel the movement of the head of the lower jaw in the joint with his hands.

2. To develop lip movements:

Bared teeth, protruding lips with a proboscis. To stretch the lips with a proboscis, smacking is used. A finger or lollipop is inserted and later pulled out. If there is enough tight coverage of the lips and suction movements of the cheeks, a clicking sound is produced. Reducing the size of the lollipop creates more tension in the muscles of the lips. These exercises are repeated many times;

After these exercises, you can move on to holding tubes or straws for cocktails of various diameters or probes with your lips (the speech therapist tries to pull out the tube, and the child holds it). To practice this exercise, use your fingers to press the corners of the lips;

Pulling closed lips, returning to the starting position;

Lip stretching - stretching in a smile with open jaws;

Pulling upper lip together with the tongue (tongue pushes the upper lip);

Retraction of the lips inside the mouth with tight pressing to the teeth;

Biting the lower lip with the upper teeth;

Retraction of the lower lip under the upper;

Circular movements of the lips extended by the proboscis.

3. Exercises aimed at developing the mobility of the tongue, in difficult cases, begin with an unconditional reflex level.

In order to cause the tongue to move towards the lips, a lollipop is introduced into the child's mouth or the lower lip is smeared with jam or a piece of sticky paper is attached to it. To cause a contraction of the tongue, you need to put a piece of sweet on the tip of the tongue or touch it with a spatula.

To develop tongue movements to the sides, a piece of sugar is placed between the cheek and teeth or smeared with a sweet corner of the mouth. To raise the tip of the tongue, it is useful to touch the caramel to the upper lip.

These exercises gradually prepare the active movements of the tongue:

Movement back and forth. If the tongue is tense, it is recommended to lightly pat it with a spatula, invite the child to blow on it. The last technique is used only when a correctly directed air stream is produced;

Light biting of the protruding tongue, while it is necessary to ensure that it extends along the midline;

Movement to the right and left, the tip of the tongue should reach the corners of the mouth. With unilateral paresis, the paretic side of the tongue is adjusted more. This movement is difficult, so it is advisable to use mechanical assistance;

Elevation of the tongue behind the upper teeth. This movement is done gradually. The smacking of the lips is combined with the protrusion of the tongue, so that a click of the tongue can be obtained if it is absent. Then the tongue is pushed between the lips (interlabial position), the child snaps it.

With the help of the speech therapist's hand, the lips are moved away (interdental position of the tongue), it turns out that the back of the tongue clicks on the edges of the upper teeth. When the named movement is received, the speech therapist, placing the spatula horizontally, on the edge under the tongue, pushes the raised tip of the tongue deep into the mouth. This is how the snapping of the tongue is developed at the alveoli of the upper teeth. Mastering this skill takes time and patience. To enhance the tactile sensation during articulatory gymnastics, exercises with resistance are used.

4. Simultaneously with these exercises, the development of speech breathing and voice is carried out.

The purpose of breathing exercises is to increase the vital capacity of the lungs, improve mobility chest, teaching the child to rationally use exhalation during speech.

The speech therapist should show on himself the correct, short and deep breath and a long gradual exhalation. To control diaphragmatic inspiration, place a hand on the abdomen in the area of the diaphragm. To develop an elongated exhalation, exercises such as blowing out candles, inflating rubber toys, etc. are used, which are usually used in working with dysarthric children. 39 .

When the correct oral exhalation is formed, proceed to voice exercises. At first, they are carried out on vowel sounds, later, with the appearance of consonant sounds in speech, complex exercises are also introduced. They work out an elongated and short sound, raising and lowering the voice. A large role in the development of voice and speech breathing belongs to music lessons.

The first group of sounds that need to be put and fixed in the language, the lightest in articulation, are far from each other acoustically. These are the sounds: a, p, c, m, k, i, n, x, c, c, t, s, l. These sounds, as the most simple, can be worked out to the norm. At the same time, on these phonemes, work is being done to develop phonemic perception and sound analysis skills (singling out a sound from a number of others, from syllables, into simple words etc.) 40 .

AT expressed cases articulatory disorders staging these sounds requires special assistance. Using vision, tactile-vibrational sensations, a speech therapist explains and helps the child perform the movements necessary to pronounce a particular sound and feel them kinesthetically. For example, with anarthria, a speech therapist to create the articulation of the sound "B" brings the child's lips together with his hand.

Significant help is given by the pronunciation of this sound by a speech therapist at the time the child articulates this sound, since in this case, insufficiently clear kinesthetic impressions from personal inferior pronunciation are supplemented by the child due to the perception of someone else's speech 41 .

Working on the production of sounds, a speech therapist must achieve at least an approximate pronunciation of them. At first, even a child's possession of an analogue of sound is extremely important for their distinction, since in this way a relationship is formed between articulatory and auditory images of sound. The quality of the analog and the degree of its proximity to normal sound are determined by the degree of damage to the articulatory apparatus 42 .

Depending on the individual characteristics child, the analogue includes a different number of elements of articulation. Practicing each new sound, it is necessary to study its articulation features, highlight the main characteristic feature of articulation that distinguishes it from other sounds, compare it with other articulations.

Through systematic exercises, the transition from analogue to full-fledged sound is carried out. The speech therapist gradually increases the requirements for the clarity and correctness of the articulation of the sound being studied.

In addition to work on articulatory motor skills and the production of sounds, systematic work is underway to develop phonemic perception. Children are taught to distinguish vowels from a number of other vowels, to analyze the sound range of two or three consonants. As they study sounds, children learn to repeat various combinations of two or three syllables, name the sounds that make up a syllable, word, and identify their sequence. 43 .

After some time, children who pronounce a sound studied with varying degrees of closeness to the normal one, equally freely recognize it by ear, both in combinations and in words.

In the classes on sound pronunciation, frontal work is carried out, aimed at the development of the articulatory apparatus. The exercises used in this should be available to the entire group. In addition, breathing exercises are mandatory. Part of each sound pronunciation lesson is the repetition by children of already learned vowels and consonants, isolated in sound combinations. To check the assimilation of what has been passed, the speech therapist invites the children to describe (or show) the position of the articulation organs characteristic of a particular sound, and later pronounce it in isolation and in words. Sound exercises are carried out under the control of visual and tactile perception. As a speech exercise, children pronounce in chorus and individually accessible words, which consist of the necessary sounds, as well as sentences with these words. 44 .

During the initial period, children are significantly aligned in phonemic development, auditory perception improves and is significantly ahead of progress in articulation.

At this stage, exercises are also carried out to differentiate sounds, which are increasingly sharply opposed to each other by articulatory features:

Differentiation of oral and nasal sounds ("P" - "M");

Intragroup differentiation of nasal sounds ("M" - "H");

In the group of posterior lingual sounds, differentiation is "K" - "X";

Differentiation of vowels "A", "U", "I";

Differentiation of breakthrough and fricative sounds ("T" - "C") 45 .

In the process of these exercises, a base is created for the assimilation of all other sounds.

The next group of sounds to be studied are phonemes composed by articulation. These are voiced, hissing consonants, Africans and the sound "R". A sufficiently developed phonemic perception and some skills of sound analysis play a significant leading role in this period. Secondary deviations in auditory perception are overcome more successfully than pronunciation deficiencies.

In the second period, i.e. when studying other sounds, exercises for distinguishing sounds have less articulatory resistance. The pronunciation of such sounds as "R", "Sh", "Zh", Afrikat in most children is very inaccurate, but their distinction is much less difficult. Despite this, additional time is specially allotted for exercises in distinguishing and differentiating sounds. Thus, sound representations are formed in children based on a differentiated pronunciation of sounds, which reflects a certain period of their assimilation. Work is underway to differentiate the sounds "S" - "S", "Sh" - "Zh", "Ts" - "M", "M" - "H" and to differentiate in the group of iotized.

After the speech therapist makes sure that all children accurately distinguish the sound, can determine its place in a syllable, word, etc., he presents them with the corresponding letter (in the preparatory group for school).

From this point on, pronunciation correction has its purpose of refining the analog of the sound to normal. This problem is solved with the help of exercises for a clear pronunciation of sounds, carried out in group and individual classes.

Features of articulation, the quality of the analogue, its proximity to the correctly pronounced sound are recorded in individual plans, based on which the speech therapist plans the content of individual lessons. It is necessary to repeatedly return to the same sounds in order to clarify them as much as possible. 46 .

As a result of the combination of intensive work on the development of correct sound pronunciation with work on the education of phonemic perception of sounds based on approximate sound pronunciation, phonemic readiness for the full assimilation of writing is created in children with dysarthria.

Early and properly organized speech therapy assistance in combination with appropriate educational measures (overcoming speech negativism, activating the compensatory capabilities of the child's body, his cognitive interests, etc.) makes it possible for a significant part of children with dysarthria to learn the general education school program.

CONCLUSION

From year to year there is an increase in the number of children with various speech disorders. Speech is not an innate ability, but develops in the process of ontogenesis (individual development of the organism from the moment of its inception to the end of life) in parallel with the physical and mental development of the child and serves as an indicator of its overall development. A full-fledged harmonious development of a child is impossible without educating him in correct speech. Such speech should be not only correctly designed in terms of word selection (dictionary), grammar (word formation, inflection), but clear and flawless in terms of sound pronunciation and sound-syllabic content of words.

Dysarthria is a speech disorder that occurs as a result of damage to the muscles of the speech apparatus: soft palate, larynx, lips. Acute dysarthria can develop as a result of a violation of the innervation of the articulation apparatus. With dysarthria, speech becomes unclear, undivided into semantic segments, with a nasal tone.

Speech therapy work with children with dysarthria is based on knowledge of the structure of a speech defect in various forms of dysarthria, the mechanisms of violations of general and speech motor skills, and taking into account the personal characteristics of children.

In working with children suffering from dysarthria, the following areas are used:

1. Learning the correct sound pronunciation, i.e. development of articulatory motility, speech breathing, staging and fixing sounds in speech.

2. Development of phonemic perception, formation of sound analysis skills.

3. Normalization of the prosodic side of speech, i.e. overcoming disorders of rhythm, melody and intonation of speech.

4. Correction of manifestations of general underdevelopment of speech. Overcoming OHP in children with dysarthria is carried out in the process of education and upbringing in a special kindergarten.

The task of a speech therapist is to convince the child together with the parents that speech can be corrected, that you can help the baby become like everyone else. It is important to interest the child so that he himself wants to participate in the process of speech correction. And for this, classes should not be boring lessons, but an interesting game.

LIST OF USED LITERATURE

APPENDIX

A set of exercises for the correction of dysarthria

Breathing exercises.

"Cat". Legs shoulder width apart. Remember the cat that sneaks up on the sparrow. Repeat her movements - crouching a little, turn to the right, then to the left. Transfer the weight of the body to the right leg, then to the left. The direction in which you turned. And sniff the air noisily on the right, on the left, at the pace of steps.

"Pump". Hold a rolled-up newspaper or a stick in your hands like a pump handle and think you are inflating a car tire. Inhale - at the extreme point of the slope. The slope is over - the breath is over. Do not pull it, unbending, and do not unbend to the end. The tire must be quickly pumped up and go further. Repeat the breaths at the same time as the bends often, rhythmically and easily. Don't raise your head. Look down at an imaginary pump. Inhale, like an injection, instantaneous. Of all our breath movements, this is the most effective.

"Hug your shoulders." Raise your arms to shoulder level. Bend them at the elbows. Turn your palms towards you and place them in front of your chest, just below your neck. Throw your hands towards each other so that the left hugs the right shoulder, and the right hugs the left armpit, that is, so that the arms run parallel to each other. pace of steps. Simultaneously with each throw, when the hands are closest together, repeat short noisy breaths. Think: "The shoulders help the air." Keep your hands away from your body. They are close. Do not bend your elbows.

"Big Pendulum". This movement is continuous, similar to a pendulum: "pump" - "hug your shoulders", "pump" - "hug your shoulders". pace of steps. Tilt forward, arms reaching for the ground - inhale, lean back, arms hugging shoulders - also inhale. Forward - back, inhale, inhale, tick-tock, tick-tock, like a pendulum.

"Half squats". One leg in front, the other behind. Body weight on the front leg, back leg slightly touching the floor, as before the start. Perform a light, slightly noticeable squat, as if dancing in place, and at the same time with each squat, repeat the breath - short, light. Having mastered the movement, add simultaneous counter movements of the hands.

Exercises for the development of speech breathing:

Choose a comfortable position (lying, sitting, standing), put one hand on your stomach, the other on the side of the lower chest. Take a deep breath in through your nose (this pushes your belly forward and expands your lower chest, which is controlled by both hands). After inhalation, immediately make a free, smooth exhalation (the abdomen and lower chest take their previous position).

Take a short, calm breath through the nose, hold the air in the lungs for 2-3 seconds, then make a long, smooth exhalation through the mouth.

Take a short breath with your mouth open and on a smooth, long exhalation, say one of the vowels (a, o, u, and, uh, s).

Say several sounds smoothly on one exhalation: aaaaa - aaaaaooooooo - aaaaauuuuuu.

Count on one exhalation to 3-5 (one, two, three...), trying to gradually increase the count to 10-15. Watch for smooth exhalation.

Count down (ten, nine, eight...).

Ask the child to repeat proverbs, sayings, tongue twisters after you on one exhale. Be sure to follow the setup given in the first exercise.

A drop and a stone hollow.

Building with the right hand, breaking with the left.

Whoever lied yesterday will not be believed tomorrow.

On the bench outside the house, Toma sobbed all day.

Do not spit in the well - you will need water to drink.

There is grass in the yard, firewood on the grass: one firewood, two firewood - do not cut firewood on the grass of the yard.

Thirty-three Egorkas lived on a hillock near a hill: one Egorka, two Egorkas, three Egorkas...

Read the Russian folk tale "Turnip" with the correct reproduction of the breath on the pauses.

Turnip.

Grandfather planted a turnip. A large turnip has grown.

Grandfather went to pick a turnip. Pulls - pulls, can not pull.

Grandpa called grandma. Grandmother for grandfather, grandfather for turnip, they pull - they pull, they cannot pull it out!

The grandmother called her granddaughter. Granddaughter for grandmother, grandmother for grandfather, grandfather for turnip, they pull - they pull, they cannot pull it out!

Granddaughter called Zhuchka. A bug for a granddaughter, a granddaughter for a grandmother, a grandmother for a grandfather, a grandfather for a turnip, they pull - they pull, they cannot pull it out!

Bug called the cat. A cat for a bug, a bug for a granddaughter, a granddaughter for a grandmother, a grandmother for a grandfather, a grandfather for a turnip, they pull - they pull, they cannot pull it out!

The cat called the mouse. A mouse for a cat, a cat for a bug, a bug for a granddaughter, a granddaughter for a grandmother, a grandmother for a grandfather, a grandfather for a turnip, they pull - they pull - they pulled a turnip!

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

"Whose steamboat hums better?"

Take a glass vial about 7 cm high, with a neck diameter of 1-1.5 cm, or any other suitable object. Bring it to your lips and blow. "Listen to how the bubble hums. Like a real steamboat. Can you make a steamboat? I wonder whose steamboat will hum louder, yours or mine? And whose longer?" It should be remembered: for the bubble to buzz, the lower lip should lightly touch the edge of its neck. The air jet should be strong and come out in the middle. Just do not blow too long (more than 2-3 seconds), otherwise you will feel dizzy.

"Captains".

Dip paper boats into a basin of water and invite your child to take a boat ride from one city to another. In order for the boat to move, you need to blow on it slowly, folding your lips with a tube. But then a gusty wind comes up - the lips fold, as for the sound p.

Whistles, toy pipes, harmonicas, blowing up balloons and rubber toys also contribute to the development of speech breathing.

The tasks become more difficult gradually: first, the training of a long speech exhalation is carried out on individual sounds, then on words, then on short phrase, when reading poetry, etc.

In each exercise, the child's attention is directed to a calm, relaxed exhalation, to the duration and volume of the sounds being uttered.

Exercises to develop the kinesthetic basis of hand movements:

Stretch your arm forward and down; squeeze all fingers except the thumb; thumb up.

Lower your right hand down. Squeeze all fingers except the thumb, stretch the thumb to the left.

Lower the left hand down. Squeeze all fingers except the thumb, stretch the thumb to the right.

Squeeze the hands of both hands into fists, while stretching the thumbs up.

Clench the right (left) hand into a fist, put the palm of the left (right) hand on top of it.

Clench the right (left) hand into a fist, lean the palm of the left (right) hand vertically against it.

Loosely squeeze the fingers of the right (left) hand into a fist, leaving a small hole between the fingers and the palm.

Connect obliquely (“house”) the fingers of the right and left hands, while the thumbs are pressed to the hands.

The hands are in the same position as in the previous exercise, only the thumbs of the right and left hands are removed from the hands and are located horizontally.

Extend the index finger and little finger of the right (left) hand, squeeze the rest of the fingers.

Extend at the same time (both on the right and on the left hand) the index finger and little finger, squeeze the rest of the fingers.

Extend the thumb and little finger of the right (left) hand, squeeze the rest of the fingers.

Extend at the same time (both on the right and on the left hand) the thumb and little finger, squeeze the rest of the fingers.

Extend the index and middle fingers of the right (left) hand, squeeze the rest of the fingers.

Extend simultaneously (both on the right and on the left hand) the index and middle fingers, squeeze the rest of the fingers.

Form the fingers of the right (left) hand into a ring. (This exercise is variant: the ring can be obtained by connecting the thumb to any other, while the remaining fingers are extended.)

Put your right (left) hand on the table in front of you with fingers apart, place your index finger on the middle one (or vice versa).

Put your right (left) hand clenched into a fist in front of you on the table, raise your index and middle fingers, spreading them.

. "Horse". Turn your hand with your palm facing you, thumb up. Place four bent fingers of the other hand (mane) on the edge of the palm from above. Raise two thumbs up (ears). The horse can shake its mane, move its ears, open and close its mouth (lower the little finger and press it to the hand).

. "Frog". Bend the index finger and little finger, pull back (eyes). Bend the ring and middle fingers, press to the middle of the palm (mouth). Place the thumb horizontally on the nails of the middle and ring fingers.

. "Crocodile". Bend the index finger and little finger, pull back (eyes). Extend the middle and ring fingers forward. Press a straight thumb against them from below, forming the mouth of a crocodile.

. "Hen". Connect the ends of the thumb and forefinger (beak). The rest of the fingers (scallop) are superimposed on the beak fan-shaped.

. "Cock". Connect the ends of the thumb and forefinger (beak). The remaining fingers are half-bent, do not touch each other (scallop). The comb can move with the movements of the cockerel.

. "The bird is drinking water." Clench the left hand loosely into a fist, leaving a small hole between the fingers and the palm (a barrel of water). Connect the thumb and forefinger of the right hand in the form of a beak, clench the remaining fingers into a fist (bird). Connected together, the thumb and forefinger of the right hand are inserted from above into the hole of the left.

. "Bridge". Place the middle and ring fingers of the right and left hands horizontally so that they touch each other with the fingertips. Raise the index fingers and little fingers of both hands up. Press the thumbs to the brushes.

. "Elephant". The index and ring fingers are the front legs of an elephant. The thumb and little finger are the hind legs. The middle finger extended forward is the trunk.

. "Owl". Take the thumb and little finger to the sides (owl wings), they can move during the "flight". Bend the remaining three fingers, pressing the pads to the base of the fingers (head).

. "Greetings". Position the right (left) hand vertically. Form a semicircle with index and thumb.

. "Glasses". The hands of both hands are placed vertically. The index and thumb fingers form rings, touching each other with the tips.

. "Gates". Press the tips of the fingers together to each other; arms

turn your palms towards you, raise your thumbs up.

. "Roof". Connect the fingertips of both hands in an inclined position of the palms.

. "Counter". Connect the fingertips of both hands in an inclined position of the palms. Index fingers should be placed horizontally, thumbs should be pressed against them.

. "House". Half-bent fingers spread downwards rest on the table.

. "The house is closed." Clench the right (left) hand into a fist, while pressing the thumb with the other four fingers.

. "Flower". Connect both palms, fingers slightly bent and spread apart.

. "Plant Root" Having connected the hands with the back side, freely lower the fingers down.

. "The plant has sprouted." Clench the fingers of both hands into fists, press tightly against each other. Raise your thumbs up. Then slowly raise all other fingers up, as if forming a flower bud.

. "Horse". All fingers of the right hand, except for the index, are half-bent and rest on the table. The index finger is extended horizontally.

. "Rider on horseback". The right hand is in the same position as in the previous task. The index and middle fingers of the left hand are widely separated and "planted" on the index finger of the right hand.

. "Cat". Press the middle and ring fingers with a bent thumb to the palm, the little finger and index finger - stretch up.

. "The Man in the House" Raise the thumb of the right (left) hand up and tightly grasp the fingers of the other hand.

. "Ship". Place your hands horizontally, press your palms tightly against each other, fingers slightly apart.

. "Sun rays". Raise the hands of both hands up, cross, fingers apart.

. "Christmas tree". Turn the palms of both hands towards you, interlace your fingers.

. "Passengers on the Bus" Clasp your fingers. Back sides of the hands

turn outward, raise your thumbs up.

. "Snail". Clench your right (left) hand into a fist, put it on the table. Raise your index and middle fingers apart. Put the left (right) hand on top (snail shell).

Play the graphic scheme proposed by the speech therapist with closed eyes.

Exercises to develop the kinetic basis of hand movements:

Development of dynamic hand coordination in the process of performing sequentially organized movements

Alternately touch the thumb of the right hand to the second, third, fourth and fifth fingers at the usual and maximum pace.

Perform a similar task with the fingers of the left hand.

Perform a similar task simultaneously with the fingers of both hands at a normal and maximum pace.

With the fingers of the right (left) hand, “say hello” in turn with the fingers of the left (right) hand (patting the fingertips, starting with the thumb).

. "Fingers say hello." Connect fingers. To carry out alternately, starting with the thumb, touching movements of all fingers. 6. "Who will defeat whom." Connect the hands in front of you. Alternately make hand presses to the right, to the left.

Spread the fingers of the right (left) hand wide, bring them together, spread them again, hold for 2-3 seconds.

. "Sun". Put the palm of the right (left) hand with spread fingers-rays on the table. Make alternate tapping with your fingers on the table.

. "Swamp". The thumb of the right (left) hand is set on the "bump". The remaining fingers alternately "jump from bump to bump." (Similar movements are carried out starting with the little finger.)

Alternately bend the fingers of the right (left) hand, starting with the thumb.

A squirrel sits on a cart.

She sells nuts

Chanterelle-sister

Sparrow, titmouse,

Bear fat-fifth,

Mustachioed hare.

Alternately bend the fingers of the right (left) hand, starting with the little finger.

This finger wants to sleep

This finger - jump into bed,

This finger curled up

This finger suddenly yawned,

Well, this one is already asleep.

Squeeze the fingers of the right (left) hand into a fist; straighten them one by one, starting with the thumb.

Come on, brothers, to work,

Show your passion:

Bolshak - to chop wood,

Stoke everything for you,

And you carry water

And you cook dinner

And you feed the children.

Squeeze the fingers of the right (left) hand into a fist; straighten them one by one, starting with the little finger.

Little finger decided to go for a walk,

But the nameless did not allow

And the middle one heard about it -

Almost out of patience.

And the forefinger said sadly:

"The big one will definitely be upset."

got the little finger

From everyone to the hotel.

Put the right (left) hand in front of you (as when playing the piano), perform sequential movements with the first and second, first and fifth fingers, etc.

Continuously draw a line along the drawn labyrinth with a pencil taken in the right (left) hand, without changing the position of the sheet of paper on which the labyrinth is drawn.

Crumple a sheet of tissue paper into a compact ball with the fingers of the right (left) hand, without helping with the other hand.

Beads of different sizes, but of the same color (or of the same size, but of different colors, or of different sizes and different colors) are laid out on the table. It is proposed to independently string beads on the thread, selecting them by color or size, and tie the ends of the thread with a bow.

A card is offered in which, in a certain sequence,

holes are made. It is necessary: to stretch the woolen thread sequentially through all the holes; stretch the woolen thread, skipping one hole; perform normal lacing.

. "Friendship".

Girls and boys are friends in our group (fingers are connected into a “lock”).

We will make friends with little fingers (rhythmic touch of the fingers of the same name).

One, two, three, four, five (alternately touching the fingers of the same name, starting with the little fingers),

One, two, three, four, five (alternately touching the fingers of the same name, starting with the thumbs),

. "Fists".

Lean your elbows on the table. Clench into a fist, first the fingers of the right, then the left hand; unclench, relaxing the brush first of one, then the other hand.

. "Clean Mouse".

The mouse washed its paw with soap (with one hand “wash” the other),

Each finger in order (with the index finger touch each finger of the other hand).

Here she lathered Big (with all fingers, first with the right, then with the left hand, “soap” the thumb),

Rinse it with water.

I did not forget the Pointer,

Wash away dirt and paint

(similar movements with index fingers).

Average lathered diligently,

The dirtiest was probably (similar movements with middle fingers).

The nameless rubbed with paste,

The skin immediately turned red (similar movements with the ring fingers).

And Littlefinger quickly washed:

He was very afraid of soap (soap his little fingers with quick movements).

. "Running Man"

Alternately touching the surface of the table with the tips of the index and middle fingers of the right (left) hand, depict a running man.

. "Angles".

We can show angles

Let's fold our hands like this.

Here is a straight line at the crossroads (connect the ends of the fingers of both hands under right angle),

The tip of the arrow is an acute angle (fingertips and elbows are connected, wrists are separated),

Raised Boom Crane -

It turns out blunt (the elbow of the other is attached to the fingertips of one hand).

. "Scissors". Spread the index and middle fingers of the right (left) hand to the sides 7-10 times.

. "Football". Drive the ball into the goal with one and two fingers of the right (left) hand.

. "Gourmet". Clench the left hand loosely into a fist, forming a small hole (pot) between the fingers and the palm. With the index and middle fingers of the right hand, depict a crouching cat.

Standing at the kitchen table

Pot with fresh milk.

The cat sneaked into the kitchen

Taste a little milk (the index and middle fingers of the right hand slowly move towards the left hand).

Leaning down, drinking a vershok,

Sticking his head into the pot (the index and middle fingers of the right hand are inserted into the loosely clenched fist of the left).

And then - oh-oh-oh! Ah ah ah!

Do not take out the head (the fist of the left hand, squeezing the fingers of the right hand, does not allow them to rise up).

The cat runs into the yard

Hit the fence

Boom! Bang! Here! Here! Current!

That pot broke (hands spread apart).

The cat ran into the house

Again for delicious milk.

. "I'll iron diapers for sister Alenka." A sheet of paper (diaper) is placed in front of the child. It is necessary: using all the fingers of both hands, smooth it so that it does not bulge, and the edges do not remain bent; do the same using one hand; do the same using the thumbs, index and middle fingers of both hands; do the same with two little fingers; smooth the sheet with the fists of both hands, thumb and forefinger of one hand, index and middle fingers of one hand, middle and ring fingers of one hand, ring and little fingers; repeat all movements with closed eyes.

. "Builders". From logs (counting sticks) you need to build a house.

A) Move the logs to the construction site: using any fingers of both hands; using any fingers of the right (left) hand; using only two fingers - thumb and little finger - of the right (left) hand; using only the index and middle fingers of the right (left) hand; using only the middle and ring fingers of the right (left) hand; using only the ring and little fingers of the right (left) hand.

B) With the index and middle fingers of the right (left) hand, build a quadrangle (walls).

C) With the middle and little fingers of the right (left) hand, build a triangle (roof).

Development of dynamic hand coordination in the process of performing simultaneously organized movements:

Put the matches in the box with both hands at the same time: with the thumb and forefinger of both hands, simultaneously take the matches lying on the table and at the same time put them in the matchbox.

Take a pencil in your right and left hands and at the same time tap them on the paper, placing dots in random order.

At the same time, change the position of the hands: clench one into a fist, unclench the other, straightening the fingers.

At the same time, throw the hands forward, while clenching the fingers of one hand into a fist, and connecting the fingers of the other into a ring.

With the index fingers of outstretched hands, describe identical circles of any size in the air. With the finger of the right hand, describe circles in the clockwise direction, with the finger of the left hand - in the opposite direction.

. "Merry painters". Synchronous movements of the hands of both hands up - down with the simultaneous connection of the wrist swing, then: left - right.

. "Fists".

Lean your elbows on the table, clench the fingers of both hands into fists.

At the same time, open your fingers, relax your hands.

."Sewing machine".

With the right hand, make circular movements in the hand and elbow (imitating the rotation of the wheel). With your left hand, perform small movements characteristic of the operation of the sewing machine needle. Change the conditions for completing the task: make circular movements with the left hand, and imitate the movements of the needle with the right hand.

."Bud".

By nightfall, the bud has collected the petals (the fingers of the right and left hands are gathered into a “handful”).

The sun sends out its rays.

In the morning under the sun

Flowers open (simultaneously slowly spread the fingers of both hands).

The sun has set, and dusk has deepened,

And until the morning my flower closed (at the same time the fingers of the right and left hands are connected).

To beat at a convenient pace one beat with the right (left) hand, at the same time hit the table with the index finger of the left (right) hand at the same time.

To beat at a convenient pace with the right (left) hand one measure at a time, at the same time as the index finger of the left (right) hand stretched forward, describe a small circle in the air.

. "Jump rope".

Clench the fingers of both hands into fists. Raise your thumbs up and describe them with rhythmic, large-amplitude circular movements, first in one direction, then in the other.

I'm jumping, I'm spinning

new jump rope,

If I want to, I'll outrun Galya and Natalka.

Well, one, well, two

In the middle of the track

Yes, running, with the breeze,

Yes, on the right leg.

I'm jumping, I'm spinning

New jump rope.

I ride, I teach Galya and Natalka.

Well, one, well, two

Sisters are learning.

Behind the back day by day

Jumping pigtails.

. "Cats and mice".

Cat mouse scratch-scratch (fingers of both hands clenched into fists),

I held it, I held it, I let it go (the fists open at the same time),

The mouse ran, ran (at the same time the fingers of both hands move along the plane of the table),

She wagged her tail, wagged (the index fingers of both hands move from side to side).

Goodbye, mouse, goodbye (simultaneous tilts of the hands forward and down).

1 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Enlightenment, 2009. - S. 74.

2 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. - M.: VLADOS, 2009. T. II - S. 190.

4 Balobanova V.P., Bogdanova L.G., Venediktova L.V. Diagnosis of speech disorders in children and the organization of logopedic work in a preschool educational institution. - St. Petersburg: Detstvo-press, 2011. - P. 237.

5 Ibid. - S. 238.

6 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. – M.: VLADOS, 2009. T. II – P.193.

7 Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. - 2006. - No. 5. - S. 12.

8 Arkhipova E.F. Erased dysarthria in children. - St. Petersburg: AST, 2010.- P. 75.

9 Ibid. - S. 76.

10 Volkova G.A. Methods of psychological and logopedic examination of children with speech disorders. Issues of differential diagnosis. - St. Petersburg: Peter, 2010. - S. 43.

11 Volkova G.A. Methods of psychological and logopedic examination of children with speech disorders. Issues of differential diagnosis. - St. Petersburg: Peter, 2010. - S. 45.

12 Ibid. - S. 46.

13 Volkova G.A. Methods of psychological and logopedic examination of children with speech disorders. Issues of differential diagnosis. - SPb.: Piter, 2010.– P. 47.

14 Ibid. - S. 48.

15 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 38.

16 Ibid. – S. 39.

17 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 40.

18 Filicheva T. B. and others. Fundamentals of speech therapy: Proc. allowance for students ped. in-t on spec. "Pedagogy and psychology (preschool)" / T. B. Filicheva, N. A. Cheveleva, G. V. Chirkina. - M .: Education, 2009. - P. 132.

19 Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. - 2006. - No. 5. - S. 12.

20 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 43.

21 Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. - M .: Humanit. ed. center VLADOS, 2008. - S. 211.

22 Pravdina O. V. Speech therapy. Proc. manual for students defectologist. facts ped. in-comrade. Ed. 2nd, add. and reworked. - M., "Enlightenment", 2010. - P. 117.

23 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. - M.: VLADOS, 2009. T. II - S. 197.

24 Ibid. – S. 198.

25 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Enlightenment, 2009. - S. 252.

26 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Education, 2009. - S. 253.

27 Tsvetkova L.S. Semenovich A.V. Actual problems of childhood neuropsychology: Textbook. - M.: Moscow Psychological and Social Institute; Voronezh: Publishing house NPO "MODEK", 2011. - P. 243.

28 Ibid. - S. 245.

30 Reader on speech therapy (extracts and texts): [textbook for students of higher and secondary special. ped. educational institutions: in 2 vols.] / Ed. L.S. Volkova and V.I. Seliverstov. - M.: VLADOS, 2009. T. II - S. 198.

31 Pravdina O. V. Speech therapy. Proc. manual for students defectologist. facts ped. in-comrade. Ed. 2nd, add. and reworked. - M., "Enlightenment", 2010. - P. 119.

32 Lopukhina I.S. Speech therapy: 550 entertaining exercises for the development of speech: a guide for speech therapists and parents. - M.: Aquarium, 2011. - S. 42.

33 Arkhipova E.F. Erased dysarthria in children. - St. Petersburg: AST, 2010.- P. 36.

34 Vinarskaya E.N. Dysarthria. - St. Petersburg: Transitbook, 2011.- P. 74.

35 Garkusha Yu.F. The system of correctional classes of a kindergarten teacher for children with speech disorders. - M.: EKSMO, 2010. - S. 152.

36 Lopatina L.V., Overcoming speech disorders in preschoolers: [textbook] / Lopatina L.V., Serebryakova N.V. - St. Petersburg. Ed. RGPU them. A.I. Herzen Publishing House "Soyuz", 2011. - S. 80.

37 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Education, 2009. - S. 257.

38 Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. - M .: Humanit. ed. Center VLADOS, 2008. - S. 404-406.

39 Games in speech therapy work with children: Book for speech therapists. / Ed. Comp. IN AND. Selivestrov. - M .: Education, 2007. - S. 68.

40 Balobanova V.P., Bogdanova L.G., Venediktova L.V. Diagnosis of speech disorders in children and the organization of logopedic work in a preschool educational institution. - St. Petersburg: Detstvo-press, 2011. - P. 269.

41 Ibid. – S. 270.

42 Garkusha Yu.F. The system of correctional classes of a kindergarten teacher for children with speech disorders. - M.: EKSMO, 2010. - S. 161.

43 Lopukhina I.S. Speech therapy: 550 entertaining exercises for the development of speech: a guide for speech therapists and parents. - M.: Aquarium, 2011. - S. 245.

44 Filicheva T. B. and others. Fundamentals of speech therapy: Proc. allowance for students ped. in-t on spec. "Pedagogy and psychology (preschool)" / T. B. Filicheva, N. A. Cheveleva, G. V. Chirkina. - M .: Education, 2009. - P. 153.

45 Shvaiko G.S. Games and game exercises for the development of speech. - M.: Pedagogy, 2007. - S. 227.

46 Fundamentals of the theory and practice of speech therapy. Ed. R. E. Levina. - M.: Education, 2009. - S. 306.

Page 41

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Speech therapy massage in the correction of dysarthria speech disorders in children of early and preschool age.

St. Petersburg: KARO, 2008.

Differentiated speech therapy massage is part of a comprehensive medical, psychological and pedagogical work aimed at correcting various speech disorders. Massage is used in speech therapy work with children with dysarthria, rhinolalia, stuttering and voice disorders. With these forms of speech pathology (especially with dysarthria), massage is a necessary condition for the effectiveness of speech therapy.

Speech therapy massage is one of the speech therapy technologies, an active method of mechanical action. Massage is used in cases where there are violations of the tone of the articulatory muscles. By changing the state of the muscles of the peripheral speech apparatus, massage ultimately indirectly improves the pronunciation of speech.

Massage can be carried out at all stages of corrective speech therapy, but it is especially important to use it on early stages work, when the child does not yet have the opportunity to perform certain articulatory movements.

Differentiated speech therapy massage can be performed by a speech therapist, defectologist, exercise therapy instructor who has undergone special training.

Chapter I Perinatal pathology of the central nervous system in children .............................. 4

Chapter II Dysarthric speech disorders in children of early and

preschool age ................................................................ ................................................. ........... 12

2.1. Main disorders (defect structure) in dysarthria .............................................. 12

2.2. The severity of dysarthria ............................................................... ............................... 17

2.3. Early diagnosis of speech and movement disorders .............................................................. 21

2.4. Modern approaches to the classification of dysarthria .............................................. 23

Chapter III Logopedic examination children with

dysarthria .................................................................................. ......................................... 32

Chapter IV Specifics of correctional and speech therapy work in dysarthria .............. 50

4.1. Principles, tasks and methods of speech therapy work with dysarthria ............... 50

4.2. Differentiated logopedic massage .............................................................. ..... 53

4.2.1. Tasks, indications, contraindications and conditions speech therapy massage 54

4.2.2. Relaxing massage of the articulatory muscles............................................... 58

4.2.3. Stimulating massage of the articulatory muscles .............................. 60

4.2.4. Massage of the lingual muscles ....................................................... .............................. 61

4.3. Passive and active articulation gymnastics............................................. 63

4.4. Artificial local contrastothermia ............................................................... ............. 67

4.5. Development of breathing and correction of its disorders ( breathing exercises)..... 68

4.7. Development of prosody and correction of its disorders .............................................. ........ 75

4.8. Correction of violations of sound pronunciation .................................................... ............. 77

4.9. Development of the functionality of the hands and fingers,

correction of violations of fine (fine) motor skills .............................................. .............. 81

Chapter I
Perinatal pathology
central nervous system in children

The problem of corrective speech therapy assistance to children with neurological pathology is currently extremely relevant. The need for measures to diagnose and correct violations in the development of children is associated with the presence in the country of an alarming demographic situation characterized not only by a general decrease in the birth rate, but also by an increase in the proportion of the birth of unhealthy, physiologically immature children. According to special studies, the proportion of healthy newborns has decreased in recent years from 48.3% to 26.5%-36.5%. Today, up to 80% of newborns are physiologically immature, over 86% have perinatal pathology of the central nervous system, the lack of timely correction of which leads to the development of persistent disorders in the future. The pathology suffered by the child in the perinatal period has Negative influence on the state of many body systems, primarily the nervous system (G.V. Yatsyk).

Perinatal lesions of the central nervous system unite various pathological conditions caused by exposure to the fetus of harmful factors in the prenatal period, during childbirth and in the early stages after birth. The leading place in the perinatal pathology of the CNS is occupied by asphyxia and intracranial birth trauma, which most often affect the nervous system of an abnormally developing fetus. In clinical practice, the terms "perinatal CNS damage" and "perinatal encephalopathy (PEP)" are generally accepted.

Early brain damage in most cases later manifests itself in varying degrees of impaired development. Due to the fact that the immature brain suffers, the further pace of its maturation slows down. The order of inclusion of brain structures is violated as they mature into functional systems. PEP is a risk factor for the occurrence of deviations in the development of various functional systems in a child. In this case, various "lines of development" - motor, cognitive and speech - can be violated.

Despite the equal probability of damage to all parts of the nervous system, under the action of pathogenic factors on the developing brain, the motor analyzer suffers first and most of all. In children with perinatal cerebral pathology, gradually, as the brain matures, signs of damage or impaired development of various parts of the motor analyzer, mental and speech development are revealed. With age, in the absence of adequate medical and pedagogical assistance, developmental disorders gradually become fixed and a more complex pathology can form.

Violation of the motor, mental and speech development of children is a consequence of damage to the central nervous system of various origins. The same harmful factors affecting the brain during the period of its intensive development, in some cases cause only some delay in the formation of age-related functions, while in others they lead to pronounced developmental disorders (E.M. Mastyukova, L.T. Zhurba).

Studying the psychomotor development of children in the first years of life, L.T. Zhurba and E.M. Mastyukov identified different degrees of severity of neurological pathology: mild, moderate and severe.

Light degree:

hypertension syndrome, hydrocephalic syndrome, minimal brain dysfunction, hyperexcitability and hypoexcitability syndromes, mild neurological symptoms in the form of muscle tone disorders, tremor.

Average degree:

syndromes of movement disorders, episindrome (convulsive syndrome), cerebrosthenic syndrome.

Severe degree:

cerebral palsy, organic lesion of the central nervous system.

1 . Hypertension-hydrocephalic syndrome.

Hypertensive syndrome (increased intracranial pressure) in children is often combined with hydrocephalic, which is characterized by the expansion of the ventricles in the subarachnoid space as a result of the accumulation of excess amounts of cerebrospinal fluid. An increase in intracranial pressure in infants can be transient and permanent, hydrocephalus - compensated or subcompensated, which causes a wide range of clinical manifestations.

Neurological symptoms in hypertensive-hydrocephalic syndrome depend both on the severity of the syndrome and its progression, and on those changes in the brain that caused it. With hypertension, the behavior of children changes first of all. They become easily excitable, irritable, cry - sharp, piercing; sleep - superficial, children often wake up. With hydrocephalic syndrome, on the contrary, children are lethargic, drowsy. Loss of appetite, regurgitation, sometimes even vomiting can lead to weight loss.

The neuropsychic development of the child may not suffer, but in some cases it is delayed. The depth and nature of the delay in psychomotor development in hypertensive and hydrocephalic syndromes vary widely depending on the primary changes in the nervous system. With timely and effective correction of the primary process, both hypertensive and hydrocephalic syndromes, and mild developmental delay are compensated.

2. Syndrome of hyperexcitability.

The main manifestations of the hyperexcitability syndrome are restlessness, emotional lability, sleep disturbance, increased reflex excitability, and a tendency to a reduced threshold of convulsive readiness. There may not be a pronounced lag in psychomotor development in these children, but with a thorough examination, it is usually possible to note some minor deviations. For violation of psychomotor development in hyperexcitability syndrome, a lag in the formation of voluntary attention, differentiated motor and mental reactions is characteristic, which gives psychomotor development a kind of unevenness.

All motor, sensory and emotional reactions to external stimuli in a hyperexcitable child arise quickly after a short latent period and fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for any objects, capture them; quickly switch to objects. At the same time, manipulative research activity is not sufficiently expressed.

3. Syndrome of hypoexcitability.

The main manifestations of the syndrome are: low motor and mental activity of the child, which is always below his motor and intellectual capabilities; a high threshold and a long latent period for the occurrence of all reflex and voluntary reactions. The syndrome is often combined with muscle hypotension, delayed switching nervous processes, emotional lethargy, low motivation and weakness of willpower. Hypoexcitability can be expressed in varying degrees and manifest itself either episodically or persistently.

With the syndrome of hypoexcitability, the formation of positive emotional reactions is noted at a later date. This is manifested both when communicating with an adult, and in the spontaneous behavior of the child. In the waking state, the child remains lethargic, passive, orienting reactions occur mainly in response to strong stimuli. The reaction to novelty is sluggish, insufficient.

With hypodynamic syndrome, there may be a delay in psychomotor development. It is characterized by a disproportion in development, which manifests itself in all forms of sensory-motor behavior. At all age stages, there may be insufficient communication activity.

4. Syndrome of minimal cerebral dysfunction (MMD).

The main manifestations of the MMD syndrome are the so-called "minor neurological signs", which manifest themselves differently depending on age. The most frequently observed violations of muscle tone, which, although they do not interfere with active movements, are persistent; tremor, disorders of craniocerebral innervation, Graefe's symptom, general anxiety, reflex asymmetry.

5. Cerebrosthenic syndrome.

The main content of the syndrome is increased neuropsychic exhaustion, which manifests itself in the weakness of the function of active attention, emotional lability, impaired manipulative, objective and gaming activity; in the predominance of either hyperdynamic or hypodynamic processes. Often there is also a secondary insufficiency of perception due to increased mental exhaustion. Characterized by dynamism, unevenness of the severity of clinical manifestations in the same child at different times. Clinical manifestations are often intensified by the end of the day due to adverse meteorological conditions. Features of delayed psychomotor development in this syndrome depend on the predominance of hypo- or hyperexcitability processes.

6. Convulsive syndrome (episindrome).

Seizures may appear against the background of already existing neurological disorders and psychomotor retardation or occur as the first symptom indicating brain damage. The impact of convulsive syndrome on developmental delay depends on the age of the child, the level of psychomotor development before the onset of seizures, the presence of other neurological disorders, the nature of convulsive paroxysms, their frequency and duration. The younger the child's age at the onset of seizures, the more pronounced will be the delay in psychomotor development. If convulsions occurred in a healthy child, were episodic and short-term, then they themselves may not have a significant effect on age development. In all other cases, paroxysms, especially if they were long and repeated, in turn can cause irreversible changes in the central nervous system.

Seizures that appeared against the background of psychomotor developmental delay and / or other neurological disorders complicate the course of the underlying disease, exacerbating developmental delay. The child may lose acquired motor, mental and speech skills.

7. Syndromes of movement disorders.

Children with syndromes of motor disorders have a later formation of basic motor skills. The main characteristics in the diagnosis of movement disorders in the first year of life are muscle tone and reflex activity. Changes in muscle tone are manifested in the form of muscle hypertension (spasticity), hypotension and dystonia.

Syndrome muscle hypertension(increased muscle tone) is characterized by an increase in resistance to passive movements, limitation of spontaneous and voluntary motor activity. The severity of the syndrome of muscular hypertension can vary from a slight increase in resistance to passive movements to complete stiffness, when any movement is almost impossible. If the syndrome is not pronounced, is not combined with pathological tonic reflexes and other neurological disorders, its effect on the development of static and locomotor functions may manifest itself in their slight delay at various stages of the first years of life. Depending on which muscle groups are more toned, differentiation and final consolidation of certain motor skills will be delayed. So, with an increase in muscle tone in the hands, a delay in directing the hands to the object, grasping the toy, manipulating objects, etc. is noted. With an increase in muscle tone in the legs, the formation of the support reaction of the legs and independent standing is delayed. Children are reluctant to stand up, prefer to crawl, stand on their toes on a support.

Syndrome muscle hypotension(decrease in muscle tone) is characterized by a decrease in resistance to passive movements and an increase in their volume. Limited spontaneous and voluntary physical activity. If the syndrome of muscular hypotension is not pronounced and is not combined with other neurological disorders, it either does not affect the age development of the child, or causes a delay in motor development, more often in the second half of life. The lag is uneven, more complex motor functions are delayed, requiring the coordinated activity of many muscle groups for their implementation. So, if you plant a child of 9 months, he sits, but he cannot sit down on his own. Such children later begin to walk, and the period of walking with support is delayed for a long time.

Movement disorder syndrome may be accompanied by muscular dystonia changing character of muscle tone). At rest, in these children with passive movements, general muscle hypotonia is expressed. When you try to actively perform any movement, with positive or negative emotional reactions, muscle tone increases dramatically.

8. Cerebral palsy.

Cerebral palsy (ICP) is a severe disease of the nervous system, which often leads to a child's disability. Cerebral palsy manifests itself in the form of various motor, mental and speech disorders. Leading in the clinical picture of cerebral palsy are motor disorders, which are often combined with mental and speech disorders, dysfunctions of other analyzer systems (vision, hearing, deep sensitivity), convulsive seizures (K.A. Semenova, E.M. Mastyukova). Cerebral palsy is not a progressive disease. As a rule, the condition of the child improves with age and under the influence of treatment.

The degree of severity of movement disorders varies in a wide range, where the grossest movement disorders are at one extreme, and the minimum at the other. Mental and speech disorders, as well as motor disorders, have different degrees of severity, so a whole gamut of different combinations can be observed. For example, with gross motor disorders, mental disorders can be minimal, and vice versa, with mild motor disorders, severe mental and/or speech disorders are observed.

9. Early organic lesion of the central nervous system(“syndrome of congenital or early acquired dementia” - L.T. Zhurba, E.M. Mastyukova).

The main manifestation of the syndrome of early organic lesions of the central nervous system is underdevelopment of cognitive activity, which is most often combined with a violation of speech development. The lag in motor development can be expressed in varying degrees - from mild forms to severe disorders. However, in all cases, the lag in motor development is due not to the primary lesion of the motor system, but to a decrease in motivation. Already in the first year of life, children have weakly expressed reactions to the environment, differentiated visual and auditory orienting reactions; the development of manipulative and objective activity, the initial understanding of addressed speech are disturbed.

Chapter II
Dysarthric speech disorders
in children of early and preschool age

dysarthria(motor speech disorder) - a violation of the pronunciation side of speech, due to insufficient innervation of the speech muscles. Dysarthria is a consequence of an organic lesion of the central nervous system, in which the motor mechanism of speech is upset. With dysarthria, not programming speech utterance, and motor realization of speech.

The leading defects in dysarthria are a violation of the sound-producing side of speech and prosodic, as well as violations of speech breathing, voice and articulatory motility. Speech intelligibility in dysarthria is impaired, speech is slurred, fuzzy.

2.1. Basic violations (defect structure)
with dysarthria

Violation of the tone of the articulatory muscles(muscles of the face, tongue, lips, soft palate) according to the type of spasticity, hypotension or dystonia.

1. Spasticity- increased tone in the muscles of the tongue, lips, face and neck. With spasticity, the muscles are tense. The tongue is pulled back in a “lump”, its back is spastically curved, raised up, the tip of the tongue is not expressed. The tense back of the tongue raised to the hard palate helps to soften consonant sounds (palatalization). Sometimes the spastic tongue is pulled forward with a "sting". An increase in muscle tone in the circular muscle of the mouth leads to spastic tension of the lips, tight closure of the mouth (arbitrary opening of the mouth is difficult). In some cases, with a spastic condition of the upper lip, the mouth may, on the contrary, be ajar. This is usually accompanied by increased salivation (hypersalivation). Active movements with spasticity of the articulatory muscles are limited. (Spasticity of the muscles is noted in spastic-paretic dysarthria.)

2. Hypotension- decreased muscle tone. With hypotension, the tongue is thin, flattened in the oral cavity; lips flaccid, unable to close tightly. Because of this, the mouth is usually half open, hypersalivation can be expressed. Hypotonia of the muscles of the soft palate prevents sufficient progress of the palatine curtain upwards and its pressing against the back wall of the pharynx; a stream of air exits through the nose. In this case, the voice acquires a nasal tone (nasalization). (Hypotonia of the articulatory muscles occurs in spastic-paretic and atactic dysarthria.)

3. Dystonia - changing character of muscle tone. At rest, low muscle tone may be noted, while trying to speak and at the time of speech, the tone increases sharply. Dystonia significantly distorts articulation. Feature sound pronunciation with dystonia - impermanence distortions, substitutions and omissions of sounds. (Dystonia is noted in hyperkinetic dysarthria.)

In children with neurological pathology, a mixed and variable nature of tone disturbances in the articulatory muscles (as well as in the skeletal muscles) is often noted. in individual articulatory muscles, the tone can change in different ways. For example, spasticity may be noted in the lingual muscles, and hypotension in the facial and labial muscles. In all cases, there is a certain correspondence between violations of tone in the articulatory and skeletal muscles.

Impaired mobility of the articulatory muscles. Limited mobility of the muscles of the articulatory apparatus is the main manifestation of paresis of these muscles. Insufficient mobility of the articulatory muscles of the tongue and lips causes disturbances in sound pronunciation. With damage to the muscles of the lips, the pronunciation of both vowels and consonants suffers. Articulation as a whole is disturbed. Sound pronunciation is especially grossly impaired with a sharp restriction of the mobility of the muscles of the tongue.

The degree of impaired mobility of the articulatory muscles can be different - from complete impossibility to a slight decrease in the volume and amplitude of articulatory movements of the tongue and lips. In this case, the most subtle and differentiated movements are violated first of all (primarily raising the tongue up).

Specific disorders of sound pronunciation:

- persistent character violations of sound pronunciation, the particular difficulty of overcoming them;

Specific difficulties of automating sounds (the automation process requires more time than with dyslalia). With the untimely completion of speech therapy classes, the acquired speech skills often disintegrate;

The pronunciation of not only consonants, but also vowels is impaired (average or reduction of vowels);

The predominance of interdental and lateral pronunciation of whistling [ With], [h], [c]and hissing [ w], [and], [h], [sch]sounds;

Stunning voiced consonants (voiced sounds are pronounced with insufficient participation of the voice;

Softening of hard consonants (palatalization);

Violations of sound pronunciation are especially pronounced in the speech stream. With an increase in speech load, general blurring of speech is observed, and sometimes increases.

Depending on the type of disturbance, all defects in sound pronunciation in dysarthria are divided into two categories: anthropophonic (distortions of sounds) and phonological (substitutions, mixing). In dysarthria, the most typical violation of the sound structure of speech is distortion sound.

Speech breathing disorders.

Respiratory disorders in children with dysarthria are due to a lack of central regulation of respiration. Insufficient depth of breathing. The rhythm of breathing is disturbed: at the time of speech, it quickens. There is a violation of the coordination of inhalation and exhalation (a superficial inhalation and a shortened weak exhalation). Exhalation often occurs through the nose, despite the half-open mouth. Respiratory disorders are especially pronounced in the hyperkinetic form of dysarthria.

Voice disorders are caused by changes in muscle tone and limitation of mobility of the muscles of the larynx, soft palate, vocal folds, tongue and lips. Most often, there is insufficient voice power (quiet, weak, fading) and deviations in the timbre of the voice (deaf, nasalized, choked, hoarse, intermittent, tense, guttural).

In various forms of dysarthria, voice disorders are specific.

Prosody violations(melodic-intonational and tempo-rhythmic characteristics of speech).

Melodic intonation disorders are often referred to as one of the most persistent signs of dysarthria. They largely affect the intelligibility, emotional expressiveness of speech. There is a weak expression or absence of voice modulations (the child cannot arbitrarily change the pitch). The voice becomes monotonous, little or unmodulated.

Violations of the pace of speech are manifested in its slowdown, less often in acceleration. Sometimes there are violations of the rhythm of speech (for example, chanting - "chopped" speech, when an additional number of stresses in words is noted).

Insufficiency of kinesthetic sensations in the articulatory apparatus.

In children with dysarthria, there is not only a limitation in the volume of articulatory movements, but also a weakness in the kinesthetic sensations of articulatory postures and movements.

Vegetative disorders.

One of the most common autonomic disorders in dysarthria is hypersalivation. Increased salivation is associated with limited movements of the muscles of the tongue, impaired voluntary swallowing, and paresis of the labial muscles. It is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva) and a decrease in self-control.

Hypersalivation can be expressed in varying degrees. It can be constant or intensify under certain conditions. Even slight hypersalivation (moistening of the corners of the lips during speech, slight saliva leakage) indicates that the child has neurological symptoms.

Less common are autonomic disorders such as redness or pallor of the skin, increased sweating during speech.

Violation of the act of receiving write.

In children with dysarthria, it is often difficult, and in severe cases, there is no chewing of solid food, biting off a piece. Choking and choking are often noted when swallowing. Difficulty drinking from a cup. Sometimes the coordination between breathing and swallowing is disturbed.

The presence of synkinesis.

Synkinesis - involuntary accompanying movements when performing arbitrary articulatory movements (for example, additional movement of the lower jaw and lower lip upwards when trying to raise the tip of the tongue).

Oral synkinesis - opening the mouth during any voluntary movement or when trying to perform it.

Increased pharyngeal (vomit) reflex.

Loss of coordination of movements (ataxia).

Ataxia is manifested in dysmetric, asynergic disorders and in the chanting of the rhythm of speech. Dysmetria is disproportion, inaccuracy of arbitrary articulatory movements. It is most often expressed in the form of hypermetry, when the desired movement is realized by a more sweeping, exaggerated, slower movement than necessary (excessive increase in motor amplitude). Sometimes there is a violation of coordination between breathing, voice formation and articulation (asynergy). Ataxia is noted in atactic dysarthria.

The presence of violent movements (hyperkinesis and tremor) in the articulatory muscles.

Hyperkinesis - involuntary, non-rhythmic, violent; there may be fanciful movements of the muscles of the tongue, face (hyperkinetic dysarthria).

Tremor - trembling of the tip of the tongue (most pronounced with purposeful movements). Tremor of the tongue is noted in atactic dysarthria.

The severity of dysarthria

The severity of dysarthria speech disorders depends on the severity and nature of the lesion of the central nervous system. Conventionally, 3 degrees of severity of dysarthria are distinguished: mild, moderate and severe.

With a mild degree of dysarthria, the general intelligibility of speech may not be impaired, but the sound pronunciation is somewhat blurred, fuzzy. Distortions are observed most often when pronouncing whistling, hissing and / or sonorous sounds. When pronouncing vowels, the greatest difficulties are caused by sounds [ and]and [ at]. Voiced consonants are often deafened. Sometimes, in isolation, a child can pronounce all sounds correctly (especially if a speech therapist deals with him), but with an increase in speech load, a general blurring of sound pronunciation is noted.

There are also shortcomings in speech breathing (rapid, shallow), voice (quiet, deaf) and prosodic (low modulation).

Severe dysarthria- anartria - this is a complete or almost complete absence of sound pronunciation as a result of paralysis of the speech motor muscles. Anarthria occurs when the central nervous system is severely damaged, when the motor realization of speech becomes impossible. In most children with anarthria, speech articulation control disorders (articulatory, phonatory, respiratory department) are mainly manifested, and not just performance. In addition to the pathology of the central executive systems of speech activity, the formation of dynamic articulatory praxis is impaired. There is a disorder of voluntary control of the speech apparatus. Pronunciation disorders in anarthria are caused by pronounced central motor speech syndromes: spastic paresis in a very severe degree, tonic disorders in the control of articulatory movements, hyperkinesis, ataxia and apraxia. Apraxia covers all parts of the speech apparatus: respiratory, phonatory, labio-palatine-lingual. Apraxic disorders are manifested by the child's inability to arbitrarily form vowels and consonants, to pronounce a syllable from the available sounds or a word from the available syllables.

According to the severity of the manifestations of anartria, it can be different (I.I. Panchenko):

a) the complete absence of speech (sound pronunciation) and voice;

c) the presence of sound-syllabic activity.

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

1. Children with purely phonetic. They suffer from sound pronunciation, speech breathing, voice, prosodic and articulatory motor skills. At the same time, there are no violations of phonemic perception and the lexical and grammatical structure of speech.

2. Children with phonetic-phonemic underdevelopment. They violate not only the pronunciation side of speech (sound pronunciation, speech breathing, voice, prosodic), but also phonemic processes (difficulties in sound analysis and synthesis). At the same time, there are no lexical and grammatical shortcomings of speech.

3. Children with general underdevelopment of speech. In children of this group, all components of speech are impaired - both the pronunciation side of speech, and lexical, grammatical and phonemic development. Vocabulary limitations are noted: children use everyday words, often use words in an inaccurate meaning, replacing them with related ones in terms of similarity, situation, and sound composition. Dysarthric children are often characterized by insufficient mastery of the grammatical forms of the language. Prepositions are often omitted in their speech, endings are left out or misused, case endings, categories of numbers are not assimilated; there are difficulties in coordination, management.

Dysarthria is a speech disorder that is expressed in difficulty pronouncing some words, individual sounds, syllables or in their distorted pronunciation. Dysarthria occurs as a result of a brain lesion or innervation disorder vocal cords, facial, respiratory muscles and muscles of the soft palate, with diseases such as the cleft palate, cleft lip and due to the absence of teeth.

A secondary consequence of dysarthria may be a violation of written speech, which occurs due to the inability to clearly pronounce the sounds of the word. In more severe manifestations of dysarthria, speech becomes completely inaccessible to the understanding of others, which leads to limited communication and secondary signs of developmental deviations.

Dysarthria causes

The main cause of this speech disorder is considered to be insufficient innervation of the speech apparatus, which appears as a result of damage to certain parts of the brain. In such patients, there is a limitation in the mobility of the organs involved in speech reproduction - tongue, palate and lips, thereby complicating articulation.

In adults, the disease can manifest itself without an accompanying breakdown of the speech system. Those. is not accompanied by a speech perception disorder through hearing or a violation of written speech. Whereas in children, dysarthria is often the cause of disorders leading to reading and writing disorders. At the same time, speech itself is characterized by a lack of smoothness, a disturbed rhythm of breathing, a change in the pace of speech in the direction of slowing down, then accelerating. Depending on the degree of dysarthria and the variety of forms of manifestation, there is a classification of dysarthria. The classification of dysarthria includes an erased form of dysarthria, severe and anarthria.

The symptomatology of the erased form of the disease has an erased appearance, as a result of which dysarthria is confused with a disorder such as dyslalia. Dysarthria differs from dyslalia by the presence of a focal form of neurological symptoms.

With a pronounced form of dysarthria, speech is characterized as slurred and almost incomprehensible, sound pronunciation is disturbed, disorders also appear in the expressiveness of intonations, voice, and breathing.

Anartria is accompanied by a complete lack of opportunities for speech production.

The causes of the disease include: incompatibility by the Rh factor, toxicosis of pregnant women, various pathologies of the formation of the placenta, viral infections of the mother during pregnancy, prolonged or, conversely, rapid births that can cause hemorrhages in the brain, infectious diseases of the brain and its membranes in newborns.

There are severe and mild degrees of dysarthria. A severe degree of dysarthria is inextricably linked with cerebral palsy. A mild degree of dysarthria is manifested by a violation fine motor skills, pronunciation of sounds and movements of the organs of the articulatory apparatus. With this degree, speech will be understandable, but fuzzy.

The causes of dysarthria in adults can be: stroke, vascular insufficiency, inflammation or brain tumor, degenerative, progressive and genetic diseases of the nervous system (, Huntington), asthenic bulbar palsy and multiple sclerosis.

Other causes of the disease, much less common, are head injuries, poisoning carbon monoxide, drug overdose, intoxication due to excessive consumption of alcoholic beverages and drugs.

Dysarthria in children

With this disease, children show difficulties with the articulation of speech as a whole, and not with the pronunciation of individual sounds. They also have other disorders associated with a disorder of fine and gross motor skills, difficulties with swallowing and chewing. It is quite difficult for children with dysarthria, and under an hour it is completely impossible, to jump on one leg, cut out paper with scissors, fasten buttons, it is quite difficult for them to master written language. Often they miss sounds or distort them, while distorting words. Sick children, for the most part, make mistakes when using prepositions, use incorrect syntactic connectives of words in a sentence. Children with such disorders should be educated in specialized institutions.

The main manifestations of dysarthria in children lie in the violation of the articulation of sounds, the disorder of voice formation, changes in rhythm, intonation and tempo of speech.

The listed violations in babies differ in severity and various combinations. It depends on the location of the focal lesion in the nervous system, on the time of occurrence of such a lesion and the severity of the violation.

Disorders of phonation and articulation partially impede or sometimes completely prevent articulate sound speech, which is the so-called primary defect, leading to the appearance of secondary signs that complicate its structure.

Conducted studies and studies of children with this disease show that this category of children is rather heterogeneous in terms of speech, motor and mental disorders.

The classification of dysarthria and its clinical forms is based on the identification of various foci of localization of brain damage. Babies suffering from various forms of the disease differ from each other in certain defects in sound pronunciation, voice, articulation, their disorders of varying degrees can be corrected. That is why for professional correction it is necessary to use various methods and methods of speech therapy.

Forms of dysarthria

There are such forms of speech dysarthria in children: bulbar, subcortical, cerebellar, cortical, erased or light, pseudobulbar.

Bulbar dysarthria of speech is manifested by atrophy or paralysis of the muscles of the pharynx and tongue, a decrease in muscle tone. With this form, speech becomes fuzzy, slow, slurred. People with bulbar form of dysarthria are characterized by weak mimic activity. It appears with tumors or inflammatory processes in the medulla oblongata. As a result of such processes, the nuclei of the motor nerves located there are destroyed: vagus, glossopharyngeal, trigeminal, facial and hypoglossal.

The subcortical form of dysarthria is a violation of muscle tone and involuntary movements (hyperkinesis), which the baby is not able to control. Occurs with focal lesions of the subcortical nodes of the brain. Sometimes a child cannot pronounce certain words, sounds or phrases correctly. This becomes especially relevant if the child is in a state of calm in the circle of relatives whom he trusts. However, the situation can change radically in a matter of seconds and the baby becomes unable to reproduce a single syllable. With this form of the disease, the pace, rhythm and intonation of speech suffer. Such a baby can very quickly or, conversely, very slowly pronounce entire phrases, while making significant pauses between words. As a result of articulation disorders in conjunction with the irregularity of voice formation and speech breathing disorders, characteristic defects in the sound-producing side of speech appear. They can manifest themselves depending on the state of the baby and are reflected mainly in communicative speech functions. Rarely, with this form of the disease, violations of the human hearing apparatus, which are a complication of a speech defect, can also be observed.

Cerebellar speech dysarthria in its pure form is quite rare. Children affected by this form of the disease pronounce words, chant them, and sometimes just shout out individual sounds.

It is difficult for a child with cortical dysarthria to play sounds together when speech flows in one stream. However, at the same time, the pronunciation of individual words is not difficult. And the intense pace of speech leads to a modification of sounds, creates pauses between syllables and words. The fast pace of speech is similar to the production of words when stuttering.

The erased form of the disease is characterized by mild manifestations. With her, speech disorders are not detected immediately, only after a comprehensive specialized examination. Its causes are often various infectious diseases during pregnancy, fetal hypoxia, toxicosis of pregnant women, birth injuries, and infectious diseases of infants.

The pseudobulbar form of dysarthria is most common in children. The reason for its development may be a brain lesion suffered in infancy, due to birth trauma, encephalitis, intoxication, etc. With pseudobulbar mild dysarthria the degree of speech is characterized by slowness and difficulty in pronouncing individual sounds due to violations of the movements of the tongue (movements are not accurate enough), lips. Medium-degree pseudobulbar dysarthria is characterized by the absence of facial muscle movements, limited mobility of the tongue, a nasal tone of voice, and profuse salivation. The severe degree of the pseudobulbar form of the disease is expressed in the complete immobility of the speech apparatus, open mouth, limited movement of the lips, and amimicity.

Erased dysarthria

The erased form is quite common in medicine. The main symptoms of this form of the disease are slurred and inexpressive speech, poor diction, distortion of sounds, and the replacement of sounds in complex words.

For the first time the term "erased" form of dysarthria was introduced by O. Tokareva. She describes the symptoms of this form as mild manifestations of the pseudobulbar form, which are rather difficult to overcome. Tokareva believes that sick children with this form of the disease can pronounce many isolated sounds as needed, but in speech they do not sufficiently differentiate sounds and poorly automate them. Disadvantages of pronunciation can be of a completely different nature. However, they are united by several common features, such as blurring, blurring and fuzzy articulation, which manifest themselves especially sharply in the speech stream.

The erased form of dysarthria is a pathology of speech, which is manifested by a disorder of the prosodic and phonetic components of the system, resulting from microfocal brain damage.

Today, diagnostics and methods of corrective action are worked out rather poorly. This form of the disease is often diagnosed only after the child reaches the age of five years. All children with a suspected erased form of dysarthria are referred to a neurologist to confirm or not confirm the diagnosis. Therapy for an erased form of dysarthria should be comprehensive, combining drug treatment, psychological and pedagogical assistance and speech therapy assistance.

Symptoms of erased dysarthria: motor awkwardness, a limited number of active movements, rapid muscle fatigue during functional loads. Sick children are not very stable on one leg and cannot jump on one leg. Such children are much later than others and have difficulty learning self-care skills, such as buttoning up buttons, untying a scarf. They are characterized by poor facial expressions, the inability to keep the mouth closed, since the lower jaw cannot be fixed in an elevated state. On palpation, the facial muscles are flaccid. Due to the fact that the lips are also sluggish, the necessary labialization of sounds does not occur, therefore, the prosodic side of speech worsens. Sound pronunciation is characterized by mixing, distortion of sounds, their replacement or complete absence.

The speech of such children is quite difficult to understand, it does not have expressiveness and intelligibility. Basically, there is a defect in the reproduction of hissing and whistling sounds. Children can mix not only similar and complex sounds, but also opposite in sound. A nasal tone may appear in speech, the pace is often accelerated. The voice of children is quiet, they cannot change the pitch of their voice, imitating some animals. Speech is characterized by monotony.

Pseudobulbar dysarthria

Pseudobulbar dysarthria is the most common form of the disease. It is a consequence of organic brain damage suffered in early childhood. As a result of encephalitis, intoxication, tumor processes, birth injuries, children develop pseudobulbar paresis or paralysis, which is caused by damage to the conductive neurons that go from the cerebral cortex to the glossopharyngeal, vagus and hypoglossal nerves. In terms of clinical symptoms in the area of facial expressions and articulation, this form of the disease is similar to the bulbar form, but the probability of full assimilation of sound pronunciation in the pseudobulbar form is significantly higher.

Due to pseudobulbar paresis in children, a disorder of general and speech motility occurs, the sucking reflex and swallowing are disturbed. The muscles of the face are sluggish, salivation is observed from the mouth.

There are three degrees of severity of this form of dysarthria.

A mild degree of dysarthria is manifested by the difficulty of articulation, which consists in not very accurate and slow movements of the lips and tongue. At this degree, mild, unexpressed violations of swallowing and chewing also occur. Due to not very clear articulation, pronunciation is disturbed. Speech is characterized by slowness, blurred pronunciation of sounds. Such children, most often, experience difficulties with the pronunciation of such letters as: p, h, j, c, w, and voiced sounds are reproduced without proper participation of the voice.

Also difficult for children and soft sounds which require raising the tongue to the hard palate. Due to incorrect pronunciation, phonemic development also suffers, written speech. But violations of the structure of the word, vocabulary, grammatical structure with this form are practically not observed. With a mild degree of manifestations of this form of the disease, the main symptom is a violation of the phonetics of speech.

The average degree of the pseudobulbar form is characterized by amimicity, the absence of facial muscle movements. Children cannot puff out their cheeks or pout their lips. The movements of the tongue are also limited. Children cannot lift the tip of the tongue up, turn it to the left or right and hold it in that position. It is very difficult to switch from one movement to another. The soft palate is also inactive, and the voice has a nasal tone.

Also characteristic signs are: profuse salivation, difficulty chewing and swallowing. As a result of violations of articulation functions, rather severe defects in pronunciation appear. Speech is characterized by indistinctness, blurring, quietness. This degree of severity of the disease is manifested by the fuzziness of the articulation of vowel sounds. The sounds s, and are often mixed, and the sounds y and a are characterized by insufficient clarity. Of the consonants, t, m, p, n, x, k are more often correctly pronounced. Sounds such as: h, l, p, c are reproduced approximately. Voiced consonants are more often replaced by voiceless ones. As a result of these violations, speech in children becomes completely illegible, therefore, such children prefer to remain silent, which leads to loss of experience in verbal communication.

The severe degree of this form of dysarthria is called anarthria and is manifested by deep muscle damage and complete immobilization of the speech apparatus. The face of sick children is mask-like, the mouth is constantly open, and the lower jaw droops. A severe degree is characterized by difficulty in chewing and swallowing, a complete lack of speech, sometimes there is an inarticulate pronunciation of sounds.

Diagnosis of dysarthria

When diagnosing, the greatest difficulty is the distinction between dyslalia and pseudobulbar or cortical forms of dysarthria.

The erased form of dysarthria is a borderline pathology, which is located on the borderline between dyslalia and dysarthria. All forms of dysarthria are always based on focal lesions of the brain with neurological microsymptomatics. As a result, a special neurological examination is necessary to make a correct diagnosis.

It is also necessary to distinguish between dysarthria and aphasia. With dysarthria, the technique of speech is impaired, and not praxic functions. Those. with dysarthria, a sick child understands what is written and heard, can logically express his thoughts, despite defects.

staging differential diagnosis occurs on the basis of a general systematic examination developed by domestic speech therapists, taking into account the specifics of the listed non-speech and speech disorders, age, neuropsychiatric condition of the child. The younger the child and the lower his level of speech development, the more significant the analysis of non-speech disorders in the diagnosis. Therefore, today, based on the assessment of non-speech disorders, methods have been developed for the early detection of dysarthria.

The presence of pseudobulbar symptoms is the most common manifestation of dysarthria. Its first signs can be detected even in a newborn. Such symptoms are characterized by a weak cry or its absence altogether, a violation of the sucking reflex, swallowing, or their complete absence. The cry in sick children remains quiet for a long time, often with a nasal tone, poorly modulated.

When suckling, children may choke, turn blue, and sometimes milk may flow from the nose. In more severe cases, the baby may not breastfeed at all at first. These babies are fed through a tube. Breathing can be shallow, often irregular and rapid. Such violations are combined with leakage of milk from the mouth, with facial asymmetry, sagging of the lower lip. As a result of these disorders, the baby cannot latch onto the nipple or nipple of the breast.

As the child grows older, the lack of intonational expressiveness of the cry and voice reactions becomes more and more manifest. All the sounds made by the child are monotonous and appear later than the norm. A child suffering from dysarthria cannot bite, chew, or choke on solid food for a long time.

As the child grows older, the diagnosis is made on the basis of the following speech symptoms: persistent defects in pronunciation, insufficiency of arbitrary articulation, vocal reactions, incorrect location of the tongue in the oral cavity, voice disorders, speech breathing, and delayed speech development.

The main signs by which differential diagnosis is carried out include:

- the presence of weak articulation (insufficient bending of the tip of the tongue upwards, tremor of the tongue, etc.);

- the presence of prosodic disorders;

- the presence of synkinesis (for example, movements of the fingers that occur when moving the tongue);

- slowness of the tempo of articulations;

- difficulty maintaining articulation;

- difficulty in switching articulations;

- the stability of violations of the pronunciation of sounds and the difficulty of automating the delivered sounds.

Also, the correct diagnosis helps to establish functional tests. For example, a speech therapist asks the child to open his mouth and stick out his tongue, which should be held still in the middle. At the same time, the child is shown an object moving laterally, which he needs to follow. The presence of dysarthria in this test is indicated by the movement of the tongue in the direction in which the eyes move.

When examining a child for the presence of dysarthria, special attention should be paid to the state of articulation at rest, with movements of facial expressions and general movements, mainly articulatory. It is necessary to pay attention to the range of movements, their pace and smoothness of switching, proportionality and accuracy, the presence of oral synkinesis, etc.

Dysarthria treatment

The main focus of the treatment of dysarthria is the development of normal speech in a child, which will be understandable to others, will not interfere with communication and further learning of elementary writing and reading skills.

Correction and therapy for dysarthria should be comprehensive. In addition to constant speech therapy work, medication prescribed by a neuropathologist and exercise therapy are also required. Therapeutic work should be aimed at treating three main syndromes: articulation and speech breathing disorders, voice disorders.

Drug therapy for dysarthria implies the appointment of nootropics (for example, Glycine, Encephabol). Their positive effect is based on the fact that they specifically affect the higher functions of the brain, stimulate mental activity, improve learning processes, intellectual activity and memory of children.

Therapeutic physical training consists in conducting regular special gymnastics, the action of which is aimed at strengthening the muscles of the face.

Well proven massage for dysarthria, which must be done regularly and daily. In principle, massage is the first thing the treatment of dysarthria begins with. It consists in stroking and lightly pinching the muscles of the cheeks, lips and lower jaw, bringing the lips closer together in the horizontal and vertical direction, massaging the soft palate with the pads of the index and middle fingers, no more than two minutes, while the movements should be back and forth. Massage for dysarthria is needed to normalize the tone of the muscles that take part in articulation, reduce the manifestation of paresis and hyperkinesis, activate poorly functioning muscles, and stimulate the formation of brain areas responsible for speech. The first massage should take no more than two minutes, then gradually increase the massage time until it reaches 15 minutes.

Also, for the treatment of dysarthria, it is necessary to train the respiratory system of the child. For this purpose, exercises developed by A. Strelnikova are often used. They consist in sharp breaths when bending and exhalations when straightening.

A good effect is observed with self-study. They consist in the fact that the child stands in front of a mirror and trains to reproduce such movements of the tongue and lips as he saw when talking with others. Gymnastics techniques to improve speech: open and close your mouth, stretch your lips like a “proboscis”, keep your mouth open, then half-open. You need to ask the child to hold a gauze bandage in his teeth and try to pull this bandage out of his mouth. You can also use a lollipop on the shelf, which the child must hold in his mouth, and the adult needs to get it. The smaller the lollipop, the harder it will be for the child to hold it.

The work of a speech therapist with dysarthria consists in automating and staging the pronunciation of sounds. You need to start with simple sounds, gradually moving on to sounds that are difficult to articulate.

Also important in the treatment and correction work of dysarthria is the development of fine and gross motor skills of the hands, closely related to the functions of speech. For this purpose, they usually use finger gymnastics, picking up various puzzles and constructors, sorting small objects and sorting them out.

The outcome of dysarthria is always ambiguous due to the fact that the disease is caused by irreversible disorders in the central nervous system and brain.

Correction of dysarthria

Corrective work to overcome dysarthria should be carried out regularly along with taking medication and rehabilitation therapy (for example, therapeutic and prophylactic exercises, therapeutic baths, hirudotherapy, acupuncture, etc.), which is prescribed by a neuropathologist. Non-traditional methods of correction have proven themselves well, such as: dolphin therapy, isotherapy, sensory therapy, sand therapy, etc.

Corrective classes conducted by a speech therapist mean by themselves: the development of motor skills of the speech apparatus and fine motor skills, voices, the formation of speech and physiological breathing, the correction of incorrect sound pronunciation and the consolidation of delivered sounds, work on the formation of speech communication and expressiveness of speech.

Allocate the main stages of corrective work. The first stage of the lesson is a massage, with the help of which the muscle tone of the speech apparatus develops. The next step is to conduct an exercise to form the correct articulation, with the aim of the subsequent correct pronunciation of sounds by the child, for setting sounds. Then work is carried out on automation during sound pronunciation. The last step is to learn the correct pronunciation of words using the already delivered sounds.

Important for a positive outcome of dysarthria is the psychological support of the child by loved ones. It is very important for parents to learn to praise their children for any, even the smallest achievements. The child needs to form a positive incentive for self-study and confidence that he can do everything. If the child does not have any achievements at all, then you should choose a few things that he does best and praise him for them. The child must feel that he is always loved, regardless of his victories or losses, with all his shortcomings.