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

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 production - the tongue, palate and lips, thereby complicating articulation.

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

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

In a severe form of dysarthria, speech is characterized as inarticulate and practically incomprehensible, sound pronunciation is impaired, disorders also manifest themselves in the expressiveness of intonation, voice, and breathing.

Anarthria is accompanied by a complete lack of ability to reproduce speech.

The causes of the disease include: incompatibility of 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 labor, which can cause hemorrhages in the brain, infectious diseases of the brain and its membranes in newborns.

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

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, carbon monoxide poisoning, drug overdose, and intoxication due to excessive consumption of alcoholic beverages and drugs.

Dysarthria in children

With this disease, children experience difficulties with the articulation of speech as a whole, and not with the pronunciation of individual sounds. They also experience other disorders associated with fine and gross motor skills, difficulties with swallowing and chewing. For children with dysarthria, it is quite difficult, and sometimes completely impossible, to jump on one leg, cut out of paper with scissors, fasten buttons, and it is quite difficult for them to master written language. They often miss sounds or distort them, distorting words in the process. Sick children mostly make mistakes when using prepositions and use incorrect syntactic connections of words in sentences. Children with such disabilities should be educated in specialized institutions.

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

The listed disorders in children vary in severity and in various combinations. This depends on the location of the focal lesion in the nervous system, the time of occurrence of such a lesion and the severity of the disorder.

Partially complicating or sometimes completely preventing articulate sound speech are disorders of phonation and articulation, which is the so-called primary defect, leading to the appearance of secondary signs that complicate its structure.

Conducted research and studies of children with this disease show that this category of children is quite 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. Children 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 techniques and methods of speech therapy.

Forms of dysarthria

There are the following forms of speech dysarthria in children: bulbar, subcortical, cerebellar, cortical, erased or mild, pseudobulbar.

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

The subcortical form of dysarthria consists of impaired muscle tone and involuntary movements (hyperkinesis), which the baby is not able to control. Occurs with focal damage to 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 tempo, rhythm and intonation of speech suffer. Such a baby can pronounce whole phrases very quickly or, conversely, very slowly, while making significant pauses between words. As a result of a disorder of articulation in combination with irregular voice formation and impaired speech breathing, characteristic defects in the sound-forming side of speech appear. They can manifest themselves depending on the baby’s condition and affect mainly communicative speech functions. Rarely, with this form of the disease, disturbances in the human hearing system can also be observed, which are a complication of a speech defect.

Cerebellar speech dysarthria in its pure form is quite rare. Children susceptible to this form of the disease pronounce words by chanting them, and sometimes simply shout out individual sounds.

A child with cortical dysarthria has difficulty producing sounds together when speech flows in one stream. However, at the same time, pronouncing individual words is not difficult. And the intense pace of speech leads to modifications of sounds, creating pauses between syllables and words. A fast speech rate is similar to reproducing words when you stutter.

The erased form of the disease is characterized by mild manifestations. With it, speech disorders are not identified 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 occurs most often in children. The cause of its development may be brain damage suffered in infancy, due to birth injuries, encephalitis, intoxication, etc. With mild pseudobulbar dysarthria, speech is characterized by slowness and difficulty in pronouncing individual sounds due to disturbances in the movements of the tongue (movements are not precise enough) and lips. Moderate pseudobulbar dysarthria is characterized by a lack of facial muscle movements, limited tongue mobility, a nasal tone of voice, and profuse salivation. The severe degree of the pseudobulbar form of the disease is expressed in complete immobility of the speech apparatus, an open mouth, limited lip movement, and facial expression.

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 replacement of sounds in complex words.

The term “erased” form of dysarthria was first introduced by O. Tokareva. She describes the symptoms of this form as mild manifestations of the pseudobulbar form, which are quite difficult to overcome. Tokareva believes that 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. Pronunciation deficiencies can be of a completely different nature. However, they are united by several common features, such as blurriness, smearing and unclear articulation, which manifest themselves especially sharply in the speech stream.

An erased form of dysarthria is a speech pathology, 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 rather poorly developed. This form of the disease is often diagnosed only after the child reaches the age of five. All children with 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 clumsiness, limited number of active movements, rapid muscle fatigue during functional loads. Sick children do not stand 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 fastening buttons and untying a scarf. They are characterized by poor facial expressions and 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 flaccid, the necessary labialization of sounds does not occur, therefore the prosodic side of speech deteriorates. 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 lacks expressiveness and intelligibility. Basically, there is a defect in the reproduction of hissing and whistling sounds. Children can mix not only sounds that are close in their method of formation and complex, but also sounds that are opposite in sound. A nasal tone may appear in speech, and the tempo is often accelerated. Children have a quiet voice, 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, and birth injuries in children, pseudobulbar paresis or paralysis occurs, 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 likelihood of full mastery of sound pronunciation in the pseudobulbar form is significantly higher.

As a result of pseudobulbar paresis, children experience a disorder of general and speech motor skills, the sucking reflex and swallowing are impaired. The facial muscles are sluggish, and there is drooling from the mouth.

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

A mild degree of dysarthria is manifested by difficulty in articulation, which consists of not very accurate and slow movements of the lips and tongue. At this degree, mild, unexpressed disturbances in swallowing and chewing also occur. Due to not very clear articulation, pronunciation is impaired. Speech is characterized by slowness and blurred pronunciation of sounds. Such children most often have difficulty pronouncing letters such as: r, ch, zh, ts, sh, and voiced sounds are reproduced without proper participation of the voice.

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

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

Also characteristic signs are: excessive drooling, difficulty chewing and swallowing. As a result of violations of articulation functions, rather severe pronunciation defects appear. Speech is characterized by slurredness, slurring, and quietness. This degree of severity of the disease is manifested by unclear articulation of vowel sounds. The sounds ы, и are often mixed, and the sounds у and а are characterized by insufficient clarity. Of the consonant sounds, t, m, p, n, x, k are most often correctly pronounced. Sounds such as: ch, l, r, c are reproduced approximately. Voiced consonants are more often replaced by voiceless ones. As a result of these disorders, children's speech becomes completely unintelligible, so such children prefer to remain silent, which leads to a loss of experience in verbal communication.

A 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 chewing and swallowing, a complete absence of speech, and sometimes inarticulate pronunciation of sounds.

Diagnosis of dysarthria

When diagnosing, the greatest difficulty is distinguishing dyslalia from pseudobulbar or cortical forms of dysarthria.

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

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

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

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 at all, 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 tint, poorly modulated.

When suckling at the breast, children may choke, turn blue, and sometimes milk may leak from the nose. In more severe cases, the child may not take the breast at all at first. Such children are fed through a tube. Breathing may be shallow, often arrhythmic and rapid. Such disorders are combined with leakage of milk from the mouth, facial asymmetry, and sagging lower lip. As a result of these disorders, the baby is unable to latch onto the pacifier or nipple.

As the child grows up, the insufficiency of intonation expressiveness of the cry and vocal reactions becomes more and more apparent. All sounds made by a child are monotonous and appear later than normal. A child suffering from dysarthria cannot bite or chew for a long time, and may choke on solid food.

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

The main signs used for differential diagnosis include:

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

— 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;

- persistence of disturbances in the pronunciation of sounds and difficulty in automating the delivered sounds.

Functional tests also help to establish a correct diagnosis. For example, a speech therapist asks a child to open his mouth and stick out his tongue, which should be held motionless in the middle. At the same time, the child is shown an object moving laterally, which he needs to follow. The presence of dysarthria during 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 must be paid to the state of articulation at rest, during facial movements and general movements, mainly articulatory. It is necessary to pay attention to the volume of movements, their pace and smoothness of switching, proportionality and accuracy, the presence of oral synkinesis, etc.

Dysarthria treatment

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

Correction and therapy for dysarthria must be comprehensive. In addition to constant speech therapy work, medication treatment prescribed by a neurologist 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 involves the prescription 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.

Physiotherapy exercises consist of regular special gymnastics, the effect of which is aimed at strengthening the facial muscles.

Massage has proven itself well for dysarthria, which must be done regularly and daily. In principle, massage is the first step in treating dysarthria. It consists of stroking and lightly pinching the muscles of the cheeks, lips and lower jaw, bringing the lips together with the fingers in a horizontal and vertical direction, massaging the soft palate with the pads of the index and middle fingers for no more than two minutes, and movements should be forward and backward. 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 working muscles, and stimulate the formation of areas of the brain 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, to treat dysarthria, it is necessary to train the child’s respiratory system. For this purpose, exercises developed by A. Strelnikova are often used. They involve sharp inhalations when bending over and exhalations when straightening up.

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 the same movements of the tongue and lips that he saw when talking with others. Gymnastics techniques to improve speech: open and close your mouth, stretch your lips like a “proboscis,” hold your mouth in an open position, then in a half-open position. You need to ask the child to hold a gauze bandage between his teeth and try to pull the bandage out of his mouth. You can also use a lollipop on a shelf that the child must hold in his mouth and the adult must take it out. The smaller the lollipop, the more difficult it will be for the child to hold it.

The work of a speech therapist for dysarthria consists of 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 of dysarthria is the development of fine and gross motor skills of the hands, which are closely related to speech functions. For this purpose, finger gymnastics, assembling various puzzles and construction sets, sorting small objects and sorting them out are usually used.

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

Correction of dysarthria

Corrective work to overcome dysarthria must be carried out regularly along with drug treatment and rehabilitation therapy (for example, treatment and preventive exercises, therapeutic baths, hirudotherapy, acupuncture, etc.), which is prescribed by a neurologist. Non-traditional correction methods have proven themselves well, such as dolphin therapy, isotherapy, touch therapy, sand therapy, etc.

Correctional classes conducted by a speech therapist imply: development of motor skills of the speech apparatus and fine motor skills, voice, formation of speech and physiological breathing, correction of incorrect sound pronunciation and consolidation of assigned sounds, work on the formation of speech communication and expressiveness of speech.

The main stages of correctional work are identified. 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 correct articulation, with the goal of subsequently correctly pronouncing sounds by the child, to produce sounds. Then work is carried out on automation of sound pronunciation. The last stage is learning the correct pronunciation of words using already supplied sounds.

Equally important for a positive outcome of dysarthria is the psychological support of the child from loved ones. It is very important for parents to learn to praise their children for any of their achievements, even the smallest ones. The child must be given a positive incentive for independent study and confidence that he can do anything. If a child has no achievements at all, then you should choose a few things that he does best and praise him for them. A child should feel that he is always loved, regardless of his victories or losses, with all his shortcomings.

Modern ideas about erased dysarthria

in preschool children

As a special type of speech disorder, erased dysarthria began to stand out in speech therapy relatively recently - in the 50-60s of the twentieth century.

The study of erased dysarthria was dealt with by E.F. Sobotovich, who identified deficiencies in sound pronunciation, which manifested themselves against the background of neurological symptoms and had an organic basis, but were of an erased, unexpressed nature. E.F. Sobotovich qualified them as dysarthric disorders, noting that the symptoms of these disorders differ from the manifestations of those classical forms of dysarthria that occur with cerebral palsy. Subsequently, in the studies of E.F. Sobotovich, R.I. Martynova, L.V. Lopatina and others, these disorders began to be designated as erased dysarthria.

Currently, in the domestic literature, erased dysarthria is considered as a consequence of minimal brain dysfunction, in which, along with disturbances in the sound-pronunciation aspect of speech, there are mild impairments of attention, memory, intellectual activity, emotional-volitional sphere, mild motor disorders and delayed formation of a number of higher functions. cortical functions.

The literature emphasizes that the erased degree of dysarthria in its manifestations is characterized by smoothness of symptoms, their heterogeneity, variability, different ratios of speech and non-speech symptoms, disorders of the sign (linguistic) and non-sign (sensorimotor) levels. Therefore, it poses a significant difficulty for differential diagnosis.

Domestic authors associate the etiology of erased dysarthria with organic causes acting on brain structures in the prenatal, natal and early postnatal periods. In many cases, the history contains a chain of harmful events from all three periods of the child’s development.

The leading symptom of erased dysarthria is phonetic. Such children are characterized by a polymorphic disorder of sound pronunciation, which manifests itself in distortions and the absence of mainly three groups of sounds: whistling, hissing, and sonorants. Speech is characterized by low expressiveness, monotony, and a “blurred” intonation pattern. Secondary lexico-grammatical disorders in dysarthria are characterized by a delay in formation.

In studies devoted to the study of the problem of erased dysarthria, notes c I believe that phonemic awareness disorders are common in children with this speech pathology. It is difficult for them to distinguish between hard and soft, voiced and voiceless sounds, affricates and their constituent elements. They are characterized by distortions of the sound-syllable structure of a word, difficulties in mastering sound-syllable analysis, synthesis, and the formation of phonemic representations. Also E.F. Sobotovich, L.V. Lopatin distinguishes children with erased dysarthria with underdevelopment of the grammatical structure of speech: from a slight delay in the formation of the morphological and syntactic systems of the language to pronounced agrammatisms in expressive speech.

Along with speech symptoms, there are also non-speech symptoms. R.I. Martynova identified the peculiarities of the formation of a number of higher mental functions and processes in children with erased dysarthria: decreased functions of attention, memory, difficulties in generalization, classification, determination of the logical sequence of events in story series, impairment in establishing cause-and-effect relationships.

And also in children with this defect, motor impairments are observed, manifested in both general and fine and articulatory motor skills. Researchers note slowness, awkwardness, and insufficient movements with relative preservation of their volume. L.V. Lopatina, describing disturbances in manual motor skills in these children, draws attention to inaccuracy, lack of coordination, and lack of dynamic organization of movements. Studies of articulatory motor skills have shown that children have dysfunction of the muscles innervated by the inferior branch of the trigeminal nerve, facial, hypoglossal and glossopharyngeal nerves.

Thus, the literature describes the presence of the following symptoms of erased dysarthria in children: neurological symptoms, insufficiency of visual gnosis, spatial representations, memory, impaired motor skills, prosodic aspects of speech, low level of development of sound pronunciation, phonemic perception, violation of the grammatical structure of speech.

Prepared the article

Teacher-speech therapist Gavrilova E.G.

Used Books:

1. Lopatina L.V. Speech therapy work with preschool children with minimal dysarthric disorders. – St. Petersburg: “Soyuz”, 2005.- 192 p.

2. Lopatina L.V. An integrated approach to diagnosing erased dysarthria in preschool children // journal: Speech therapist in kindergarten. 2005. No. 4. – P. 50-52.

3. Martynova R.I. Comparative characteristics of children suffering from mild forms of dysarthria and functional dyslalia // Speech disorders and methods for their elimination. Sat. articles / Ed. S.S. Lyapidevsky. S. N. Shakhovskaya. – M. 1975. – P.79-91.

4. Fedosova O.Yu. Differential approach to diagnosing mild dysarthria // Speech therapist in kindergarten. 2004. No. 3. – P. 53.

5. Sobotovich E.F., Chernopolskaya A.F. Manifestation of erased dysarthria and methods of their diagnosis // journal: Defectology. 1974. No. 4 – pp. 19-26.

6. Kiseleva V.A. Diagnosis and correction of the erased form of dysarthria. A manual for speech therapists. – M.: “School Press”, 2007. - 48 p.

7. Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. 1996. No. 5 – P.!0-15.

8. Gurovets G.V., Mayevskaya S.I. On the issue of diagnosing erased forms of pseudobulbar dysarthria // Questions of speech therapy. M.: 1982. – P.75.

graduate work

1.1 Modern ideas about dysarthria

Dysarthria as a complex problem of speech pathology is intensively studied and covered in theoretical and practical aspects in the domestic and world scientific literature. The scientific development of the problem of dysarthria in domestic speech therapy is associated with the names of famous neurologists, psychiatrists, psychologists, teachers, neurophysiologists (E.N. Vinarskaya, E.M. Mastyukova, L.M. Shipitsyn, I.I. Panchenko, L.V. Lopatina , I.Yu. Levchenko, O.G. Prikhodko, etc.). All modern authors are unanimous that the study of the problem of dysarthria should be combined with its neurological and psychological aspects of research.

At the present stage of development, speech therapy is not a narrow pedagogical science, but is an interdisciplinary field of knowledge about man.

At the same time, some views on the problem of dysarthria remain controversial due to the complexity of the problem.

The first scientific descriptions of dysarthria appeared in print more than 150 years ago. These were the observations of the famous German neurologist Little (1853), who, giving a detailed clinical picture of cerebral palsy, noted specific speech disorders against the background of damage to the motor systems of the body. The term “dysarthria” was first used in 1879 by Kussmaul, who under this concept united all articulation disorders.

Since the middle of the 20th century, researchers have begun to believe that speech impairments in dysarthria are complex in nature, which is not only associated with a disorder of the finest coordination of the muscles of the speech apparatus, but also with a pathology of the prosodic characteristics of oral speech.

Dysarthria is a violation of the sound pronunciation side of speech, caused by insufficient innervation of the muscles of the speech apparatus.

Dysarthria (from the Greek dis - a prefix meaning disorder, and arthron - articulation) is an articulation disorder, difficulty in pronouncing speech sounds due to insufficiency of the speech apparatus, caused by various organic lesions of the central nervous system.

Dysarthria is a speech articulation disorder caused by paralysis of the muscles of the speech motor apparatus as a result of damage to the glossopharyngeal, vagus and hypoglossal cranial nerves or their nuclei located in the lower parts of the medulla oblongata.

Dysarthria is a generalized name for a group of speech disorders; it has several forms, each of which is characterized by its own neurological and speech symptoms. Dysarthria is the most common dysfunction of the speech production system.

Regardless of the level of damage to the central nervous system, dysarthria always disrupts the integrity of the functional system of expressive speech production. In this case, the pitch, tone, volume of the voice, the rhythmic and intonation level of the utterance are disrupted, the phonetic coloring of speech sounds is distorted, and in general the phonetic structure of speech is incorrectly realized. This pathology of articulate speech is associated mainly with a violation of the innervation of the muscles of the peripheral speech apparatus, which results in a disorder of the neuromotor regulation of muscle tone as a result of organic or functional damage to the central nervous system.

Neuromotor disorders are the cause of pathology in the functioning of the speech production system. There are two important types of neuromotor speech disorders: dysarthria and apraxia of speech, which cause disorders of the motor side of the speech production mechanism. In neuromotor speech disorders, linguistic processes (the correct use of semantics and syntax) are not affected until they coexist with impairments in speech and cognitive processes.

Disturbances in neuromuscular control of speech can cause damage to breathing, phonation, resonant cavities, articulation and prosody.

Violations of the temporal accuracy and perfection of speech movements are associated with such characteristics of speech as intelligibility, clarity, and, consequently, its intelligibility.

Currently, there are 4 main approaches to the study of dysarthria:

1. Clinical

2. Linguistic

3. Neuropsychological

4. Psychological and pedagogical

From the standpoint of a clinical (neurological) approach, the clinical manifestations of dysarthria are studied, which correlate with the level of organic or functional damage to the nervous system, its peripheral or central parts. The clinical approach also examines the causes of dysarthria, the topic (location) and nature of the focal lesion of the central nervous system, symptoms, which include the nature of changes in muscle tone, movements of various parts of the speech apparatus, etc. The presence of dysarthria is associated with organic or functional damage to the brain, which in turn is caused by a variety of reasons that can affect the body before the birth of the child during intrauterine development (prenatal), during birth (perinatal) and shortly after birth (postnatal).

In adolescents and adults, organic and functional disorders that cause dysarthria can develop as a result of injuries, hemorrhages, inflammatory processes, tumors, vascular and infectious diseases.

Neurological data made it possible to identify the following clinical forms of dysarthria: bulbar, pseudobulbar, subcortical, cerebellar and cortical.

Linguistic studies characterize dysarthria in terms of changes in phonemic signal characteristics of speech sounds, phonological oppositions of sounds in the speech stream, clarity of its semantic content (semantic and emotional meaning), phonemic perception of speech, etc. In the psycholinguistic direction, violations of the acoustic characteristics of the sound pronunciation process, the prosodic organization of the sound flow (characteristics of the voice, its height, strength, duration, ability to modulate, rhythm, tempo, combination of stressed and unstressed syllables, speech melody), as well as articulatory data of the sound pronunciation process ( strength, accuracy, smoothness, synchronicity, switchability, freedom to perform speech movements).

The neuropsychological approach uses specific forms of analysis of mental processes in cases of disorders of various brain structures. With the help of research in this direction, in dysarthria, not only violations of the efferent executive mechanisms, but also violations of kinesthetic analysis and synthesis, expressed in apraxic disturbances of the articulatory sphere, distorting the kinesthetic image of the articulatory action (articulation is considered here as a special case of any other voluntary movement that can be impaired in a person with dysarthria).

In turn, the kinesthetic image of articulatory action leads to special specific ways of organizing speech movements (positive and negative compensation) and the formation of abnormal motor stereotypies.

The psychological and pedagogical direction is of particular importance in the study of dysarthria in children, since speech impairment in them is usually associated with pathology of the early stage of development of the central nervous system. From the perspective of a psychological and pedagogical approach, the process of speech development of children who have dysarthria is characterized. At the same time, the nature of the violation of sound pronunciation and voice, the qualitative and quantitative characteristics of the dictionary, the features of the formation of grammatical structures of speech, related statements and writing are qualified.

In the works of I.M. Sechenov and I.P. Pavlov about the higher nervous activity of a person illuminates the conditioned reflex mechanism of higher brain functions. Such a mechanism is formed on the basis of innate unconditioned reflexes, taking into account the individual characteristics of the functions of speech, gnosis, praxis and thinking. This is of great importance in the diagnostic practice of a neurologist, practical psychologist and teacher-defectologist.

To understand and explain the nature and mechanism of the disorder in dysarthria, it is necessary to turn to the provisions of the teaching on the mechanisms of speech by A.R. Luria, P.K. Anokhina and others.

The mechanisms of speech are connected by a holistic, hierarchical organization of brain activity, including several links, each of which makes its own specific contribution to the nature of speech activity.

The first link of the speech functional system is the receptors of hearing, vision, and sensitivity that perceive initial information. The systems of the initial receptive level also include kinesthetic sensations, which signal the position of the organs of articulation and the whole body. If speech kinesthesia is insufficient, speech development is disrupted.

The second link is complex cortical systems that process, store incoming information, develop a program of response action and the period of initial semantic thought into the scheme of a detailed speech utterance.

The third link of the speech functional system implements the transmission of voice messages. This link has a complex sensorimotor organization. When the third link of the speech functional system is damaged, the innervation of the speech muscles is disrupted, i.e. The motor mechanism of speech is directly disrupted.

Sound pronunciation disorders in dysarthria occur as a result of damage to various brain structures necessary to control the motor mechanism of speech.

Such structures include:

· peripheral motor nerves to the muscles of the speech apparatus (tongue, lips, cheeks, palate, lower jaw, pharynx, larynx, diaphragm, chest);

· the nuclei of these peripheral nerves are located in the trunk and in the subcortical regions of the brain and carry out elementary emotional unconditional reflex speech reactions such as crying, laughter, screaming, individual emotional-expressive exclamations, etc.

The defeat of the listed structures gives a picture of peripheral paralysis (paresis): nerve impulses do not arrive to the speech muscles, metabolic processes in them are disrupted, the muscles become sluggish, flabby, their atrophy and atony are observed, as a result of a break in the spinal reflex arc, reflexes from these muscles disappear, areflexia.

The motor mechanism of speech is also provided by the following brain structures located more highly:

1. Subcortical-cerebellar nuclei and pathways that regulate muscle tone and the sequence of muscle contractions of speech muscles, synchrony (coordination) in the work of the articulatory, respiratory and vocal apparatus, as well as the emotional expressiveness of speech. When these structures are damaged, individual manifestations of central paralysis (paresis) are observed with disturbances in muscle tone, strengthening of individual unconditioned reflexes, as well as a pronounced violation of the prosodic characteristics of speech - its tempo, smoothness, volume, emotional expressiveness and individual timbre;

2. Conducting systems that ensure the conduction of impulses from the cerebral cortex to the structures of the underlying functional levels of the motor apparatus of speech (to the nuclei of the cranial nerves located in the brain stem). Damage to these structures causes central paralysis of the speech muscles with increased muscle tone in the muscles of the speech apparatus, increased unconditioned reflexes and the appearance of reflexes of oral automatism with a more selective nature of articulatory disorders;

3. Cortical parts of the brain, providing both more differentiated innervation of the speech muscles and the formation of speech praxis. When these structures are damaged, various central motor speech disorders occur.

In children, damage to individual parts of the speech functional system during a period of intensive development can lead to complex disintegration of the entire speech development as a whole. In this process, damage not only to the motor part of the speech system itself, but also to disturbances in the kinesthetic perception of articulatory postures and movements is of particular importance.

With dysarthria, the clarity of kinesthetic sensations is often impaired and the child does not perceive the state of tension or, conversely, relaxation of the muscles of the speech apparatus, violent involuntary movements or incorrect articulatory patterns. Reverse kinesthetic afferentation is the most important link in the integral speech functional system, ensuring postnatal maturation of cortical speech zones. Therefore, a violation of reverse kinesthetic afferentation in children with dysarthria can delay and disrupt the formation of cortical brain structures: the premotor-frontal and parieto-temporal areas of the cortex and slow down the process of integration in the work of various functional systems that are directly related to speech function. Such an example may be the insufficient development of the relationship between auditory and kinesthetic perception in children with dysarthria.

A similar lack of integration can be observed in the functioning of the motor-kinesthetic, auditory and visual systems.

The identification of clinical forms of dysarthria in children is largely conditional, since they extremely rarely have local brain lesions, which are associated with clearly defined syndromes of motor disorders. Dysarthria in children is usually observed against the background of residual symptoms of cerebral palsy.

The general clinical signs of dysarthria in children are quite close to what is present in adults, namely:

· violation of muscle tone;

· violation of articulatory motor skills;

· breathing disorder.

Despite the commonality of these phenomena in children and adults, there are phenomena that, within these clinical manifestations, have different severity and a different character. Organic brain damage in children precedes the development of speech. Consequently, the course of ontogenesis of speech activity is distorted and therefore these disorders can be attributed to developmental dysarthria. The absence of motor images of speech elements in children from the very beginning of speech development (impaired kinesthesia as a result of paralysis) makes it difficult to form auditory differential signs of speech sounds, creating secondary disorders in the form of phonemic underdevelopment.

Along with this, the difference between the clinical picture of dysarthria in adults and children also lies in the fact that in adults dysarthria is caused by local damage to the brain, and in children by diffuse disorders of brain activity, sometimes without a clearly defined lesion.

The classification of dysarthria in children is complex and cannot be fully correlated with the clinical picture of paralysis, i.e. level of brain damage.

The classification of dysarthria is based on the principle of localization, syndromological approach, and the degree of intelligibility of speech for others.

Works devoted to dysarthria indicate that the clinical features of speech disorders and the degree of their severity depend not only on the severity of brain damage, but also on local diagnostic signs. The degree of dysarthria can be either mild, erased, or severe. In the literary sources of domestic and foreign authors on this issue there is only fragmentary information. Such scientists as O.V. devoted their works to this problem. Pravdina, I.I. Panchenko, E.N. Vinarskaya, as well as the French neuropathologist G.Tardier. One of the earliest attempts to classify dysarthria in children is presented in the work of E.M. Mastyukova (1966). It systematizes dysarthria in children depending on the clinical background against which speech pathology is detected. Characteristics are given in children of various clinical groups: with minimal brain dysfunction, with mental retardation, with normal psychophysical and cerebral palsy. This systematization gives an idea that children with dysarthria can have a wide range of their mental state: from mental retardation to normal.

For the first time, an attempt to classify the forms of erased dysarthria was made by E.N. Vinarskaya and A.M. Pulatov based on the classification of dysarthria proposed by O.A. Tokareva. The authors identified mild pseudobulbar dysarthria and noted that pyramidal spastic paralysis in most children is combined with a variety of hyperkinesis, aggravated during speech.

In the studies of E.F. Sobotovich and A.F. Chernopolskaya was the first to note that deficiencies in the sound aspect of speech in children with dysarthria manifest themselves not only against the background of neurological symptoms, but also against the background of a violation of the motor side of the process of sound pronunciation.

The classification of speech disorders proper in dysarthria in children is still controversial. On the one hand, speech disorders in dysarthria in children, as a rule, cannot be correlated with the localization of organic brain damage, i.e. diffuse damage to the central nervous system, characteristic of cerebral palsy, determines the children's clinical picture. On the other hand, the developing brain and various types of decompensation and compensatory nervous processes change the clinical manifestations of the initial damage to the central nervous system. Many researchers, however, consider it possible to identify forms of dysarthria in children associated with the localization of organic damage to the central nervous system. Classification according to this principle is characterized by the ability to correlate the symptoms of speech disorders with dysfunction of certain brain structures involved in the speech formation process. This approach allows us to theoretically quite clearly imagine the mechanism of speech impairment (motor skills and mental functions as well), and therefore justify the choice of speech therapy technologies for correctional work. This classification is presented in the works of M.B. Eidinova, E.N. Pravdina-Vinarskaya (1959), K.A. Semenova (1968), K.A. Semenova and E.M. Mastyukova, M.Ya. Smuglin (1972), L.M. Shipitsina, I.I. Mamaichuk (2001) and others. It should be noted that all authors note the uniqueness of the forms of dysarthria in children compared to dysarthria in adults. None of the researchers of childhood dysarthria distinguishes the bulbar form.

Classification based on the principle of localization.

The most common classification in Russian speech therapy was created taking into account the neurological approach based on the level of localization of damage to the motor apparatus of speech (O.V. Pravdina et al.). The following forms of dysarthria are distinguished:

· bulbar;

· pseudobulbar;

extrapyramidal (subcortical);

· cerebellar;

· cortical.

The most complex and controversial in this classification is cortical dysarthria. Its existence is not recognized by all authors. In adult patients, in some cases, cortical dysarthria is sometimes confused with the manifestation of motor aphasia. The controversial issue of cortical dysarthria is largely associated with terminological inaccuracy and the lack of one point of view on the mechanisms of motor alalia and aphasia.

According to the point of view of E.N. Vinarskaya, the concept of cortical dysarthria is collective. The author admits the existence of its various forms, caused by both spastic paresis of articulatory muscles and apraxia. The latter forms are designated as apraxic dysarthria.

Classification based on a syndromic approach.

Based on a clinical and phonetic analysis of pronunciation speech disorders, eight main constantly occurring forms of dysarthria are identified in relation to children with cerebral palsy (I.I. Panchenko):

· spastic-paretic;

· spastic-rigid;

· hyperkinetic;

ataxic

· spastic-atactic;

· spastic-hyperkinetic;

· spastic-atactico-hyperkinetic;

· atactico-hyperkinetic.

This approach is partly due to the more widespread brain damage in children with cerebral palsy and, in connection with this, the predominance of its complicated forms.

Syndromological assessment of the nature of articulatory motor disorders poses a significant challenge for neurological diagnosis, especially when these disorders manifest themselves without clear motor disorders. Since this classification is based on a subtle differentiation of various neurological syndromes, it cannot be carried out by a speech therapist. In addition, a child, in particular a child with cerebral palsy, is characterized by a change in neurological syndromes under the influence of therapy and the evaluative dynamics of development, and therefore the classification of dysarthria according to the syndromological principle also presents certain difficulties.

However, in a number of cases, with a close relationship in the work of a speech therapist and a neurologist, it may be advisable to combine both approaches to identifying various forms of dysarthria. For example, a complicated form of pseudobulbar dysarthria; spastic-hyperkinetic or spastic-atactic syndrome, etc.

Classification of dysarthria according to the degree of intelligibility of speech for others.

This classification was proposed by the French neurologist G. Tardier (1968) in relation to children with cerebral palsy. The author identifies four degrees of severity of speech disorders in such children.

· The first, mildest degree, when sound pronunciation disorders are detected only by specialists during the examination of the child.

· Second, pronunciation violations are noticeable to everyone, but speech is understandable to others.

· Third, speech is understandable only to the child’s loved ones and partially to those around him.

· The fourth, most severe - absence of speech or speech is almost incomprehensible even to the child’s loved ones (anarthria).

The main syndromes characteristic of dysarthria.

Disorders of articulatory motor skills, combined with each other, constitute the first important syndrome of dysarthria - the syndrome of articulatory disorders.

It varies depending on the severity and location of brain damage and has its own specific features for various forms of dysarthria.

Most forms of dysarthria are characterized by changes in the muscle tone of the speech muscles. Typically, these changes in tone have a complex pathogenesis associated both with the localization of the lesion and with the complex disintegration of all reflex, motor and speech development. Therefore, in individual articulatory muscles, tone can change differently.

Hypertonicity (spasticity) of articulatory muscles is a constant increase in tone in the muscles of the tongue, lips, facial and cervical muscles.

With a pronounced increase in muscle tone, the tongue is tense, pulled back, the back is curved, raised upward, the tip of the tongue is not pronounced. The tense back of the tongue is raised towards the hard palate, helping to soften consonant sounds. Therefore, a feature of articulation with muscle spasticity is palatalization, which can contribute to phonemic underdevelopment.

An increase in muscle tone in the orbicularis oris muscle leads to spastic tension of the lips and tight closure of the mouth. Active movements are limited. The impossibility or limitation of the forward movement of the tongue may be associated with spasticity of the genioglossus, mylohyoid and digastric muscles, as well as the muscles attached to the hyoid bone.

An increase in muscle tone in the muscles of the face and neck further limits voluntary movements in the articulatory apparatus.

Spasticity of the articulatory muscles occurs in the spastic form of pseudobulbar dysarthria. Along with spasticity of the speech muscles, children also experience spasticity of the skeletal muscles. This most often occurs with spastic diplegia.

Hypotonicity (hypotonia) - decreased tone of the speech muscles. Hypotonia in the speech muscles is usually combined with hypotonia and weakness of the skeletal, facial and masticatory muscles. The tongue is thin, spread out in the oral cavity, the lips are flaccid, there is no possibility of them closing tightly, due to this the mouth is constantly half-open, hypersalivation (salivation) is pronounced.

A feature of articulation in hypotonia is nasalization, when hypotonia of the muscles of the soft palate prevents the velum from moving sufficiently upward and pressing it against the posterior wall of the pharynx. The stream of air coming out through the nose, and the stream of air coming out through the mouth is extremely weak. The pronunciation of labiolabial stop noisy consonants p, p*; b, b* is impaired. Palatalization is difficult, and therefore the pronunciation of voiceless stop consonants is impaired; in addition, the formation of voiceless stops requires more energetic lip work, which is absent in hypotonia. The pronunciation of the front-lingual stop noisy consonants t, t* is also impaired; d, d * articulation of the anterior lingual fricative consonants sh, zh is distorted.

Various types of sigmatism are often observed, especially interdental and lateral.

It is easier to pronounce the labio-labial occlusion-nasal sonants m, m*, as well as the labio-dental fricative noisy consonants, the articulation of which requires a loose closure of the lower lip with the upper teeth and the formation of a flat gap - f, f*; in, in*.

Hypotonia in the articulatory muscles is most often observed in the cerebellar form of dysarthria. Unlike bulbar disorders, there is no atrophy or fibrillary twitching in the tongue, the pharyngeal reflex is preserved. This form of impaired muscle tone most often occurs in some types of diplegia, complicated by cerebellar insufficiency, especially in the first months of a child’s life, as well as in the astatic-atonic form of cerebral palsy.

Dystonia is a changing character of muscle tone: at rest, low muscle tone in the articulatory apparatus is noted; when attempting to speak, it quickly increases.

A characteristic feature of these disturbances is their dynamism, inconstancy of distortions, substitutions, and omissions of sounds. Changing tone of articulatory muscles usually occurs with hyperkinetic dysarthria. Impaired tone of articulatory muscles in these cases is combined with their hyperkinesia (excessive involuntary movements that occur due to disorders of the nervous system). A similar picture is observed in skeletal muscles. This is most often observed in the hyperkinetic form of cerebral palsy.

Limited mobility of the articulatory muscles depends on altered muscle tone, paralysis, paresis of the articulatory muscles, as well as oral apraxia. Hyperkinesis and ataxia of the speech muscles can also play a certain role in the lack of mobility of the articulatory muscles.

Hyperkinesis is divided into:

· Choric hyperkinesis is a wide sweeping movement with a significant amplitude, which, when occurring in the skeletal muscles, can lead to various injuries at the time of hyperkinesis.

· Athetoid hyperkinesis - these are elaborate worm-like movements, usually at the tip of the tongue and fingers.

Hyperkinesis is also divided into organic and functional.

Organic ones arise at any moment, as a reaction to: a change in the position of the head and body in space; change in relation to the body; severe emotional stress; various sharp stimuli from the external environment; change in the position of the tongue and other organs of articulation that are difficult for the child to reach due to the peculiarities of innervation disturbance in each specific case.

These hyperkinesis are subject to drug therapy, but with an unstable effect.

· Functional hyperkinesis occurs at the moment of speech or when attempting to speak. If appropriate drug therapy is started before 5 years of age, you can count on their complete elimination.

With discoordination disorders, sound pronunciation is no longer upset at the level of pronunciation of isolated sounds, but when pronouncing automated sounds in syllables, words and sentences. This is due to the delay in the activation of some articulatory movements necessary to pronounce individual sounds and syllables. Speech becomes slow and chanted.

An essential link in the structure of articulatory motor disorders in dysarthria is the pathology of reciprocal innervation.

Its role in the implementation of voluntary movements was first experimentally demonstrated by Sherington (1923, 1935) in animals. It was found that in voluntary movement, along with the excitation of nerve centers leading to muscle contraction, an important role is played by inhibition that occurs as a result of induction and reduces the excitability of the centers that control the group of antagonist muscles - muscles that perform the opposite function.

Synkinesis - additional movements that involuntarily join voluntary ones. For example, when the tongue moves upward, the muscles that raise the lower jaw often contract, and sometimes the entire cervical muscles tense and the child performs this movement simultaneously with straightening the head.

Synkinesis can be observed not only in the speech muscles, but also in the skeletal muscles, especially in those parts of it that are anatomically and functionally most closely related to speech function. When the tongue moves in children with dysarthria, accompanying movements of the fingers of the right hand (especially the thumb) often occur.

The presence of violent movements and oral synkinesis in the articulatory muscles distorts sound pronunciation, making speech difficult to understand, and in severe cases, almost impossible. They usually intensify with excitement and emotional stress, so disturbances in sound pronunciation vary depending on the situation of speech communication. In this case, twitching of the tongue and lips are noted, sometimes in combination with facial grimaces, slight trembling (tremor) of the tongue, in severe cases - involuntary opening of the mouth, throwing the tongue forward, a forced smile. Violent movements are observed both at rest and in static articulatory postures (for example, when holding the tongue in the midline), intensifying with voluntary movements or attempts at them. This is how they differ from synkinesis.

A characteristic sign of dysarthria is a violation of proprioceptive afferent impulses from the muscles of the articulatory apparatus. Children poorly sense the position of the tongue, lips, and the direction of their movements; they find it difficult to imitate and preserve the articulatory structure, which delays the development of articulatory praxis. As a result, dyspraxia develops (lack of articulatory praxis).

Depending on the type of violation, all sound pronunciation defects in dysarthria are divided into anthropophonic (sound distortion) and phonological (lack of sound, replacement, undifferentiated pronunciation, confusion). With phonological defects, there is a lack of opposition of sounds according to their acoustic and articulatory characteristics. Therefore, violations of written speech are most often observed.

When the muscles of the lips are damaged, the pronunciation of labialized sounds (o, y) suffers, the pronunciation of labiolabial stop sounds p, p* is impaired; b, b*; mm*. Restricted lip mobility often impairs articulation as a whole, since these movements change the size and shape of the vestibule of the mouth, thereby affecting the resonance of the entire oral cavity.

There may be limited mobility of the tongue muscles and insufficient lifting of the tip of the tongue upward in the oral cavity. This is usually due to impaired innervation of the styloglossus and some other muscles. In these cases, the pronunciation of most sounds suffers.

Limitation of downward movement of the tongue is associated with impaired innervation of the claviohyoid, thyroid-hyoid, genioglossus, mylohyoid and digastric muscles. This can interfere with the pronunciation of hissing and whistling sounds, as well as front vowels (i, uh) and some other sounds.

Limitation of the backward movement of the tongue may depend on disturbances in the innervation of the hypoglossopharyngeal, omohyoid, stylohyoid, digastric (posterior belly) and some other muscles. In this case, the articulation of back-lingual sounds (k, g, x), as well as some vowels of the middle and lower rise (e, o, a) is disrupted.

With paresis of the tongue muscles and impaired tone, it is often impossible to change the configuration of the tongue, lengthen, shorten, extend, or pull back.

Violations of sound pronunciation are aggravated by limited mobility of the muscles of the soft palate (stretching and lifting it: velopharyngeal and palatoglossus muscles). With paresis of these muscles, the lifting of the velum palatine at the time of speech is difficult, air leaks through the nose, the voice acquires a nasal tint, the timbre of speech is distorted, and the noise characteristics of sounds are not sufficiently expressed. The innervation of the muscles of the soft palate is carried out by branches of the ternary, facial and vagus nerves.

With dysarthria, reflexes of oral automatism can be detected in the form of preserved sucking, proboscis, searching, palmocephalic and other reflexes that are normally characteristic of young children. Their presence makes voluntary oral movements difficult.

The second dysarthria syndrome is the syndrome of speech breathing disorders.

Voice disorders are extremely diverse and specific to different forms of dysarthria. Most often they are characterized by insufficient voice strength (the voice is weak, quiet, drying up during speech), disturbances in the timbre of the voice (dull, nasal, hoarse, monotonous, compressed, dull; it can be guttural, forced, tense, intermittent, etc.) , weak expression or absence of voice modulations (the child cannot voluntarily change the pitch). Voice impairment largely depends on the pathological state of the laryngeal muscles, especially the cricothyroid muscles, which stretch the true vocal folds. When these muscles are damaged, the voice becomes weak and tuneless.

The larynx is innervated by two nerves: the superior and inferior laryngeal. The superior laryngeal nerve innervates the cricothyroid muscle, and the inferior laryngeal nerve innervates all other muscles of the larynx.

All movements of the larynx are associated with movements of the tongue, palate and lower jaw, therefore voice disorders and articulation disorders most often appear together. Vibration of the vocal cords is of greater importance for the production of voice. When the muscles of the vocal apparatus are weak and paretic, the vibration of the vocal cords is disrupted, so the strength of the voice becomes minimal. Spastic contraction of the muscles of the vocal apparatus sometimes completely eliminates the possibility of vibration of the vocal cords. The process of formation of voiced consonants (b, c, d, z, g, l, m, n, p) is associated with the possibility of vibration of the vocal cords. Therefore, pathological conditions of the muscles of the vocal apparatus can cause disturbances in the pronunciation of voiced consonants and their replacement with voiceless ones, the articulation of which is carried out with the vocal cords not closed and not vibrating (k, p, t, s, f, etc.).

Breathing disorders with dysarthria occur due to impaired innervation of the respiratory muscles. The rhythm of breathing is not regulated by the semantic content of speech; at the moment of speech it is usually rapid; after pronouncing individual syllables or words, the child takes shallow, convulsive breaths; active inhalation is shortened and usually occurs through the nose, despite the constantly half-open mouth. A mismatch in the work of the muscles that inhale and exhale leads to a tendency to speak while inhaling. This further impairs voluntary control of respiratory movements, as well as coordination between breathing, phonation, and articulation.

For the normal functioning of the vocal apparatus, a certain correspondence between the tension of the muscles that carry out inhalation and form exhalation is necessary. These muscles are antagonists. The former increase the volume of the chest during inhalation, the latter, on the contrary, reduce its size and volume. The muscles that perform inhalation primarily include the serratus anterior muscle, as well as the external intercostal muscles. The fine coordinated work of all respiratory muscles is of particular importance in the production of active speech exhalation. In children with cerebral palsy, a pathology of reciprocal innervation and simultaneous spastic co-contraction of antagonist muscles may play a certain role in respiratory failure. So, for active speech exhalation it is necessary to tense the muscles that carry out inhalation, all with the exception of the diaphragm, which, although it participates in inhalation, at the moment of exhalation relaxes and gradually moves upward, i.e. functions together with the expiratory muscles. Simultaneous tension of the diaphragm along with other muscles that carry out inhalation will sharply interfere with speech exhalation.

Thus, dysarthria manifests itself in two groups of symptoms.

1) Negative, caused by a violation or distortion of certain aspects of speech development - the sound-pronunciation and prosodic aspects of speech, which are determined by the nature and severity of articulatory, respiratory and vocal disorders. Dysarthria is often combined with underdevelopment of other components of the speech system: phonemic hearing, lexical and grammatical aspects of speech; in some children with dysarthria there is a delay in the rate of speech development. For example, violations of the intonation aspect of speech with severe degrees of impairment of phonemic hearing, language analysis and synthesis, etc. (speech disorders).

2) Pseudo-positive symptom, which represents features of motor development preserved over a long period, characteristic of younger children. Infantile patterns of breathing, swallowing, and chewing may also be noted. These symptoms are inhibited in the process of correctional work as they significantly interfere with the formation of the necessary articulatory structures (non-speech disorders).

Analysis of the data obtained on the speech and psychoneurological state of children showed that their phonetic disorders are caused by paretic phenomena in certain muscle groups of the articulatory apparatus. As a result, in most children, interdental, lateral pronunciation of whistling and hissing sounds predominates, combined with a distorted pronunciation of the sound (p). Spastic tension of the middle back of the tongue makes all the child’s speech softened. When the vocal cords are spastic, a defect in voicing is observed, and when they are paretic, a defect in deafening is observed. Hissing sounds with dysarthric symptoms are formed in a simpler lower variant of pronunciation. Not only phonetic, but also respiratory and prosodic speech disturbances can be observed. The child speaks while inhaling.

The diagnosis of dysarthria is made based on the specifics of speech and non-speech disorders.

1.2 Methodology for diagnosing children with dysarthria

The initial theoretical basis for developing the principles of diagnosis and organization of correctional work was the doctrine of patterns, compensatory and reserve capabilities, as well as the driving forces of child development. This was developed in the works of L.S. Vygotsky, S.L. Rubinshteina, A.N. Leontyeva, D.B. Elkonina, A.V. Zaporozhets and other researchers. Principles are understood as the initial theoretical principles that guide the teacher in his diagnostic and correctional activities. Correctly developed principles are the basis for the effectiveness of diagnosis and correction of speech disorders. The principle of systematic study of the child and the system of correctional measures is one of the most important approaches to the methodology of domestic pedagogy. The implementation of this principle ensures the elimination of the causes and sources of violations, and its success is based on the results of a diagnostic examination.

An integrated approach, as one of the main pedagogical principles, means the requirements for a comprehensive, thorough examination and assessment of the child’s developmental characteristics. This approach covers not only speech, intellectual, cognitive activity, but also behavior, emotions, level of mastery of skills, as well as the state of vision, hearing, motor sphere, its neurological, mental and speech status. The idea of ​​an integrated approach in the system of speech therapy assistance to children with speech disorders focuses on the diagnostic aspects of this assistance, which is quite consistent with the actual practice of interaction between a speech therapist and representatives of related disciplines. The main form of cooperation between a speech therapist and doctors and other specialized specialists is obtaining information from them that helps clarify the speech diagnosis. Meaningful exchange of information promotes full-fledged cooperation between specialists. Thus, speech therapy research is an organic part of an integrated approach to a comprehensive examination of the child. This principle allows us to build correctional work not as a simple training of speech skills, but as an integral system that organically fits into the child’s daily activities. Integrated training is needed.

The implementation of the activity principle allows us to determine the tactics of corrective action, the choice of means and ways to achieve the goals. Corrective work is carried out in a playful, labor-based and intellectual-cognitive form, so it is important to consider the integration of speech therapy tasks into the child’s daily activities.

The principle of dynamic study is closely related to the development of the provisions of L.S. Vygotsky about the basic patterns of development of normal and abnormal children. Abnormal children (from the Greek anomalos - incorrect) - children with significant deviations from normal physical and mental development, caused by serious congenital or acquired defects and, as a result, in need of special conditions of education and upbringing. Specific patterns have become the main guidelines in the differentiated diagnosis and correction of speech disorders. The principle of dynamic study involves, first of all, not only the use of diagnostic techniques taking into account the age of the subject, but also the identification of potential opportunities, the “zone of proximal development.” Concept of L.S. Vygotsky’s concept of the child’s “zones of actual and proximal development” is important for speech diagnostics. From the concept follows the formulated by L.S. Vygotsky’s “top-down” principle, which puts “tomorrow’s development” in the center of attention, and considers the creation of a zone of proximal personality development in the child’s activities as the main content of correctional work. Correction "from top to bottom" is anticipatory, anticipatory in nature. Its main goal is the active formation of what should be achieved by the child in the near future. When planning a strategy for the correctional educational process, it is important not to limit yourself to immediate needs and demands. It is necessary to take into account the perspective of the child’s speech and personal development.

The principle of qualitative analysis of data obtained in the process of pedagogical diagnostics and correction of speech disorders is in close connection with the principle of dynamic learning. A qualitative analysis of a child’s speech activity includes methods of action, the nature of his mistakes, the child’s attitude to experiments, as well as to the results of his activities. Qualitative analysis of the results obtained during a speech examination is not opposed to taking into account quantitative data. This principle is put forward as opposed to a purely quantitative approach to assessing the data obtained, characteristic of testing (A.N. Leontyev, A.R. Luria, A.A. Smirnov). From the above it follows that it is necessary to use a whole set of diagnostic techniques when diagnosing, each of which should contain several similar tasks. The inevitable content of quantitative and qualitative approaches to data analysis, and qualitative differences between an abnormal and a normal child can only be established by comparing quantitative indicators. Quantitative and qualitative differences are closely interrelated. These indicators are determined on the basis of the transition from quantity to quality. Qualitative and quantitative diagnostics of the main components of learning ability: receptivity to help, ability to transfer logically, activity in problem solving, allow not only to determine the structure of a speech defect, its etiology, pathogenesis, but also to formulate a diagnosis, choose the optimal correction technique, and give a probabilistic forecast. For the development of the foundations of diagnostics, including speech, two provisions formulated by L.S. were especially important. Vygotsky. One of them is that the basic patterns of development are common to both cases. At the same time, Vygotsky also noted the presence of specific patterns of abnormal development, which made it difficult for the child to interact with others.

The principle of the systems approach was developed quite deeply in the research of L.S. Vygotsky, his students and followers. It is one of the main ones in the methodology. However, its full implementation seems to be a very difficult matter and a systematic approach is not always implemented.

The principles can be divided into psychophysiological, psychological and pedagogical.

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Cortical dysarthria

Classification of dysarthria by severity

Depending on the severity of dysarthria, the following types are distinguished.

Anarthria- complete impossibility of sound pronunciation, speech is absent, individual inarticulate sounds are possible.

Severe dysarthria - the child is able to use oral speech, but it is inarticulate, incomprehensible to others, there are gross violations of sound pronunciation, and breathing, voice and intonation expressiveness are also significantly impaired.

Erased dysarthria- at a given degree of severity of dysarthria, all the main signs, both neurological and speech, and psychological, are expressed in a minimal, erased form.

However, a thorough examination reveals neurological microsymptoms and violations of special tests.

The most common type of speech therapist encountered in pediatric practice is pseudobulbar dysarthria. According to the severity of speech and articulatory motor disorders, it is customary to distinguish three degrees of severity of pseudobulbar dysarthria: mild, moderate and severe.

Mild pseudobulbar dysarthria

With mild degree (III degree) of pseudobulbar dysarthria, there are no gross disturbances in the motor skills of the articulatory apparatus. The cause of these disorders is most often unilateral lesions of the lower parts of the anterior central gyrus, or more precisely the motor corticobulbar tracts. A neurological examination describes a picture of selective damage to the muscles of the articulation apparatus, with the muscles of the tongue most often affected.

With a mild degree of dysarthria, there is a restriction and disruption of the most subtle and differentiated movements carried out by the tongue, in particular, upward movements of its tip are difficult. Also, in children suffering from a mild form of pseudobulbar dysarthria, as a rule, there is a selective increase in muscle tone of the tongue muscles. The main violations are violations of the tempo and smoothness of sound pronunciation. Difficulties in sound pronunciation are associated with slow and often insufficiently precise movements of the tongue and lips. Swallowing and chewing disorders are not pronounced and are manifested mainly by rare choking.

Speech slows down and sounds become blurred. Violations of sound pronunciation relate primarily to sounds that are complex in articulation: [zh], [sh], [r], [ts], [h]. When pronouncing voiced sounds, insufficient participation of the voice is noted. It is also difficult to pronounce soft sounds, which require adding to the main articulation the raising of the back of the tongue to the hard palate. This makes it difficult to pronounce the sounds “l”, “l”.

Kakuminal consonants [zh], [sh], [r] are absent in speech, or in some cases they are replaced by dorsal sounds [s], [z], [sv], [zv], [t], [d] , [n].

In general, these changes in sound pronunciation negatively affect phonemic development. The vast majority of children suffering from mild pseudobulbar dysarthria have difficulties in sound analysis. During subsequent learning to write, such children exhibit, according to a number of authors, specific errors in replacing sounds ([t] - [d], [h] - [ts]). Violations of vocabulary and grammatical structure are detected extremely rarely. It is generally accepted that the essence of a mild form of dysarthria lies in the presence of violations of the phonetic aspect of speech.

Moderate pseudobulbar dysarthria Most children suffering from dysarthria have an average degree (II degree) of severity of the disorder. It occurs as a result of more extensive unilateral lesions localized in the lower postcentral parts of the cerebral cortex. As a result of damage to the central nervous system, insufficiency of kinesthetic praxis is observed. Also, in children with moderate dysarthria, there is a lack of facial gnosis, which is especially pronounced in the area of ​​the articulatory apparatus. In this case, the ability to accurately determine the location of the stimulus is impaired. That is, when touching the face, there is difficulty in indicating the exact location of the touch. Violations of gnosis are closely related to disturbances in the sensation and reproduction of articulatory patterns, the transition from one articulatory pattern to another. It becomes difficult to find the desired articulatory pattern, which leads to a significant slowdown in speech and loss of its smoothness.

When examining a child suffering from moderate dysarthria, attention is drawn to impaired facial expressions. The face of such a child, as a rule, is amicable; movements of the facial muscles are almost completely absent.

When performing simple movements - puffing out the cheeks, tightly closing the lips, stretching the lips - significant difficulties arise. There are significant restrictions on tongue movements. It is often impossible to raise the tip of the tongue upward, turn it to the sides, and most importantly, it becomes very difficult or impossible to hold the tongue in this position. Transitions from one movement to another are also significantly difficult. There are paresis of the soft palate with a pronounced limitation of its mobility. The voice takes on a distinct nasal tone. These children experience increased salivation. Disturbances in the processes of chewing and swallowing are detected.

The function of the articulatory apparatus is significantly impaired, as a result of which pronounced disturbances in sound pronunciation develop. The pace of speech is slow. Speech, as a rule, is slurred, blurred, and quiet. Due to impaired lip mobility, the articulation of vowel sounds is disrupted, it becomes unclear, and sounds are pronounced with increased nasal exhalation. In most cases, the sounds [and] and [s] are mixed. The clarity of pronunciation of sounds [a], [u] is impaired. Of the consonants, the most frequent violations are described for hissing sounds [zh], [sh], [sch], and affricates [ch], [ts] are also violated. The latter, as well as the sounds [r] and [l] are pronounced approximately, in the form of a nasal exhalation with a “squelching” sound. In this case, the exhaled oral stream weakens significantly and is difficult to feel. Voiced consonants are in many cases replaced by voiceless ones. More often than others, the sounds [p], [t], [m], [n], [k], [x] are preserved. Often, final consonants, as well as consonants in combinations of sounds, are omitted. The speech of children with moderate dysarthria turns out to be significantly impaired, often incomprehensible to others, so much so that such children prefer not to engage in conversations, stay away and remain silent. The development of speech is significantly delayed and occurs only at the age of 5-6 years. Children with moderate dysarthria can, with proper correctional work, study in regular general education schools, but the most favorable conditions for teaching such children require the creation of an individual approach, which can be implemented in special schools.

Severe pseudobulbar dysarthria Severe degree of pseudobulbar dysarthria (grade I) is characterized by severe speech impairments up to anarthria. With this degree of severity of speech disorders, gross disturbances in the reproduction of a series of consecutive movements are observed. In such children, a pronounced deficiency of kinetic dynamic praxis is revealed, as a result of which disturbances in the automation of the given phonemes occur, which is especially pronounced in words with a combination of consonants. Speech in such cases is practically inarticulate and tense. Affricates break down into component parts [ts] - [ts], [h] - [tsh]. There are replacements of fricative sounds with stop sounds [s] - [t], [z] - [d]. When consonants overlap, the sounds are lowered. Voiced consonants are selectively deafened.

The extreme severity of dysarthria - anarthria - occurs with profound dysfunction of muscle groups, and also, according to some researchers, with “complete inactivity of the speech apparatus.” The face of a child suffering from anarthria is amicable and resembles a mask; as a rule, the lower jaw is not held in a normal position and droops, as a result of which the mouth is constantly half open. The tongue turns out to be almost completely motionless and is constantly located at the bottom of the oral cavity, lip movements are sharply limited in scope. The acts of swallowing and chewing are significantly impaired. Characterized by a complete absence of speech, sometimes there are individual inarticulate sounds.

It is believed that pseudobulbar dysarthria is characterized by the preservation of the rhythmic contour of the word, regardless of the distortion of the pronunciation of sounds in its composition. Children suffering from pseudobulbar dysarthria are in most cases able to pronounce two- and three-syllable words, while four-syllable words are usually pronounced reflectively. Disorders of articulatory motor skills have a great influence on the development of perception of speech sounds, causing the formation of its disorders. Secondary disorders of auditory perception associated with insufficient articulatory experience, as well as the lack of a clear kinesthetic image of sound, result in disturbances in the development of sound analysis. Children suffering from pseudobulbar dysarthria are not able to correctly perform most of the existing tests to assess the level of sound analysis. Thus, during examination, dysarthric children cannot correctly select from the mass of proposed pictures the names of objects in which begin with given sounds. They also cannot think of a word that starts with or contains the required sound. At the same time, sound analysis disorders depend on the severity of sound pronunciation disorders, therefore children with less pronounced sound pronunciation defects make fewer mistakes in sound analysis tests. In the case of anarthria, such forms of sound analysis are inaccessible. Disturbances and underdevelopment of sound analysis in children with dysarthria cause significant difficulties, including the impossibility of mastering literacy. Moreover, the majority of errors in the writing of such children are letter substitutions. At the same time, very frequent replacements of vowel sounds are children - “detu”, “teeth” - “zubi”, etc. This occurs due to the inaccuracy of the child’s nasal pronunciation of vowels, in which they are practically indistinguishable in sound. Substitutions of consonants in writing are also numerous and varied in nature.

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Cortical dysarthriaBasic principles of examining children with dysarthria (main indicators for diagnosing dysarthria)