Dysarthria - this is a speech disorder, which is expressed in the difficult pronunciation of certain words, individual sounds, syllables or in their distorted pronunciation. Dysarthria occurs as a result of brain damage or disorders 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 the absence of teeth.

A secondary consequence of dysarthria may be a violation of the written language, which occurs due to the impossibility of clearly pronouncing the sounds of the word. In the more severe manifestations of dysarthria, speech becomes completely inaccessible for others to understand, which leads to limited communication and secondary signs of developmental disability.

Dysarthria causes

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

In adults, the disease can occur without the concomitant disintegration of the speech system. Those. not accompanied by hearing impairment through hearing or writing disorder. Whereas in children, dysarthria is often the cause of disorders leading to impaired reading and writing. At the same time, speech itself is characterized by a lack of smoothness, a downward rhythm of breathing, a change in the rate of speech in the direction of either slowing down or accelerating. Depending on the degree of dysarthria and the variety of manifestations, there is a classification of dysarthria. The classification of dysarthria includes the erased form of dysarthria expressed and anarthria.

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

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

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

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

There are heavy and light degrees of dysarthria. Severe dysarthria is inextricably interconnected with cerebral palsy. A mild degree of dysarthria is manifested by a violation of fine motor skills, the pronunciation of sounds and movements of the organs of the articulatory apparatus. With such a degree, the speech will be understandable, but unclear.

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

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

Dysarthria in children

In this disease, children have difficulty articulating the speech as a whole, and not with the pronunciation of individual sounds. They also have other disorders associated with the disorder of small and large motility, difficulty in swallowing and chewing. It is quite difficult for children with dysarthria, and under an hour it is completely impossible to make jumps on one leg, cut out of paper with scissors, button buttons, it is quite difficult for them to master written language. Often they skip sounds or distort them, while distorting words. Sick children are mostly mistaken when they use prepositions, use incorrect syntactic bundles of words in a sentence. Children with such disorders should be trained in specialized institutions.

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

The above disorders in babies differ in their 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.

Partly difficult or sometimes completely impede articulate sound speech is phonation and articulation disorders, which is the so-called primary defect, which leads to the appearance of secondary features that complicate its structure.

Studies and studies of children with this disease show that this category of children is quite heterogeneous from the point of view of speech, motor and mental disorders.

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

Forms of dysarthria

There are such forms of 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, decrease in muscle tone. In this form, speech becomes fuzzy, slow, slurred. People with the bulbar form of dysarthria are characterized by weak facial activities. It appears in tumors or inflammatory processes in the medulla oblongata. As a result of such processes, the nuclei of the motor nerves are located there: vagus, glossopharyngeal, trigeminal, facial and hypoglossal.

Subcortical form of dysarthria is a violation of muscle tone and involuntary movements (hyperkinesis), which the baby is not able to manage. Occurs with focal lesions of the subcortical nodes of the brain. Sometimes a child cannot correctly pronounce individual words, sounds or phrases. This becomes especially relevant if the child is in a state of calm in the circle of relatives he trusts. However, the situation can change radically in a matter of seconds and the baby becomes unable to reproduce a syllable. With this form of the disease, tempo, rhythm and intonation of speech suffer. Such a baby can very quickly or, conversely, very slowly utter whole phrases, while making significant pauses between words. As a result of the articulation disorder, in connection with the abnormal golos formation and speech breathing disorders, characteristic defects of the sound-forming side of speech appear. They can manifest themselves depending on the state of the baby and affect mainly communicative speech functions. Rarely, with this form of the disease, there can be observed disorders in the human hearing aid, which are a complication of the speech defect.

Cerebellar dysarthria of speech in its pure form is quite rare. Children prone to this form of the disease utter words, chanting 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 the modification of sounds, creates pauses between syllables and words. A fast paced speech is like stuttering.

The worn form of the disease is characterized by light 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, pregnant women’s toxemia, birth injuries, and infectious diseases of infants.

Pseudobulbar form of dysarthria is most common in children. Brain damage due to birth injuries, encephalitis, intoxication, etc. can be the cause of its development. With a 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), lips. Pseudobulbar dysarthria of moderate degree is characterized by the absence of movements of the facial muscles, limited mobility of the tongue, nasal shade of the voice, and abundant drooling. The severe degree of the pseudobulbar form of the disease is expressed in the complete immobility of the speech apparatus, open mouth, limited lip movement, amymicity.

Erased dysarthria

Blurred form is quite common in medicine. The main symptoms of this form of the disease are the incoherent and inexpressive speech, poor diction, distorted sounds, 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 quite formidable. Tokarev believes that sick children with this form of the disease can make many isolated sounds as they should, but in speech they do not sufficiently differentiate sounds and weakly automate them. The disadvantages of pronunciation can be completely different. However, they are united by several common features, such as blurring, blurring and fuzziness of articulation, which manifest themselves especially sharply in the speech flow.

The worn out form of dysarthria is a speech pathology that is manifested by a disorder of the prosodic and phonetic components of the system, resulting from micro-focal brain damage.

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

Symptoms of erased dysarthria: motor awkwardness, limited number of active movements, rapid muscle fatigue during functional loads. Sick children are not very stable standing on one leg and can not make jumps on one leg. Such children are much later than others and have difficulty mastering self-service skills, such as buttoning and unscrewing a scarf. They are characterized by scant facial expressions, the inability to keep their mouths closed, since the lower jaw cannot lock in a raised position. Palpation facial muscles are limp. Due to the fact that the lips are also sluggish, 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 does not possess expressiveness and intelligibility. In general, there is a defect in the playback of hissing and whistling sounds. Children can mix not only similar in the way of education and complex sounds, but also opposite in sound. In speech, a nasal tint may appear, the pace is often accelerated. The children's voice is quiet, they can not change the pitch of the voice, imitating any 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 trauma in children, pseudobulbar paresis or paralysis occurs, which is caused by lesions of the conductive neurons that go from the cerebral cortex to the glossopharyngeal, vagus and hypoglossal nerves. According to the clinical symptoms in the field of facial expressions and articulation, this form of the disease is similar to the bulbar form, but the probability of a full-fledged mastering of sound pronunciation with a pseudobulbar form is significantly higher.

Due to pseudobulbar paresis in children, general and speech motility disorder occurs, the sucking reflex and swallowing are disturbed. Musculature of the face is limp, salivation from the mouth.

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

The mild degree of dysarthria is manifested by the difficulty of articulation, which consists in not very precise and slow movements of the lips and tongue. To this extent, light, unexpressed swallowing and chewing disorders also occur. Due to not very clear articulation, pronunciation is broken. Speech is characterized by slowness, blurring in the pronunciation of sounds. Such children, most often, have difficulty with the pronunciation of such letters as: p, h, f, f, w, and the voiced sounds are reproduced without the proper participation of voices.

Soft sounds that require lifting the tongue to the hard sky are also difficult for children. Due to the wrong pronunciation, the phonemic development also suffers, the written language is disturbed. But violations of the structure of words, vocabulary, grammatical structure with this form are practically not observed. With mild manifestations of this form of the disease, the main symptom is a violation of the phonetics of speech.

The average degree of pseudobulbar form is characterized by amimicity, lack of movements of the facial muscles. Children can not puff up or stretch their lips. The movement of the tongue is also limited. Children cannot lift the tip of the tongue up, turn it left or right, and hold it in that position. It presents a great difficulty switching one movement to another. The soft palate is also sedentary, and the voice has a nasal tone.

Also characteristic signs are: excessive salivation, difficulty chewing and swallowing. As a result of violations of the functions of articulation appear quite heavy defects of pronunciation. Speech is characterized by slurred, blurred, quiet. This severity of the disease is manifested by the vagueness of articulation of vowel sounds. Sounds are often mixed, and sounds of y and a are characterized by insufficient clarity. Of consonant sounds, t, m, n, n, x, k are most often pronounced correctly. Such sounds as: h, l, p, c reproduce approximately. Voiced consonants are often replaced by deaf. As a result of the above violations, the speech in children becomes completely unintelligible, therefore such children prefer to remain silent, which leads to a loss of the experience of verbal communication.

The severe degree of this form of dysarthria is called anarthria and manifests itself as a deep muscular lesion and complete immobilization of the speech apparatus. The sickly face of a sick child is mouth-shaped, the mouth is constantly open, and the lower jaw drops. A severe degree is characterized by difficulty chewing and swallowing, a complete lack of speech, sometimes there is an inarticulate pronunciation of sounds.

Diagnosis of dysarthria

In diagnosis, the greatest difficulty is the distinction between dyslalia and the pseudobulbar or cortical form of dysarthria.

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

You should also distinguish dysarthria from aphasia. In dysarthria, the speech technique is disturbed, but not the praxical functions. Those. in dysarthria, a sick child understands what is written and heard, and can logically express his thoughts, despite the defects.

The differential diagnosis is made on the basis of a general systemic examination, developed by Russian speech therapists, taking into account the specifics of the listed non-speech and speech disorders, age, and the psycho-neurological state 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 diagnosis. Therefore, today, based on the assessment of nonverbal disorders, methods have been developed for the early detection of dysarthria.

The presence of pseudobulbar symptoms is the most common manifestation of dysarthria. Его первые признаки можно выявить даже у новорожденного. Такая симптоматика характеризуется слабостью крика или вообще его отсутствием, нарушением сосательного рефлекса, глотания или их полное отсутствие.The cry of sick children during a long time remains quiet, often with a nasal touch, poorly modulated.

Babies sucking at the breast may choke, turn blue, sometimes milk may leak from the nose. In more severe cases, the child at first may not take the breast at all. Feeding such children occurs through a tube. Breathing can be superficial, often arrhythmic and rapid. Such violations are combined with milk leakage from the mouth, with facial asymmetry, sagging of the lower lip. Due to these disorders, the baby cannot capture the nipple or nipple of the breast.

As the child grows up, the intonation expressiveness of the shout and voice reactions are becoming increasingly apparent. All sounds emitted by the child are distinguished by monotony and the appearance of the norm later. A child suffering from dysarthria for a long time can not bite, chew, can choke solid food.

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

The main features for which carry out differential diagnosis, include:

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

- the presence of prosodic disorders;

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

- slow pace of articulations;

- the difficulty of retaining articulation;

- difficulty in switching articulations;

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

Also, the correct diagnosis helps establish functional tests. 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 a side-moving object for which he needs to be followed. 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, during facial movements and general movements, mainly articulation. 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 treatment for dysarthria is the development of normal speech in a child, which will be understandable to others, will not interfere with communication and further training in basic writing and reading skills.

Correction and therapy in dysarthria should be comprehensive. In addition to the constant speech therapy work, a medical treatment prescribed by a neurologist and physical therapy are also required. Therapeutic work should be aimed at treating three main syndromes: articulation and speech breathing disorders, voice disorders.

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

Physical therapy is to conduct regular special gymnastics, the action of which is aimed at strengthening the muscles of the face.

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

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

A good effect is observed with self-study. They consist in the fact that the child is standing in front of a mirror and is trained to reproduce such movements of the tongue and lips as he saw when talking to 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 candy on the shelf, which the child must hold in the mouth, and the adult needs to get it. The smaller the size of the lollipop, the harder it will be for the child to hold it.

Speech therapist with dysarthria is in the automation and formulation of pronunciation of sounds. You need to start with simple sounds, gradually moving to the difficult sounds for articulation.

Also important in the medical and correctional work of dysarthria is the development of fine and large hand motor skills, which are closely related to the functions of speech. For this purpose, finger gymnastics, picking up various puzzles and designers, sorting small objects and sorting them are usually used.

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

Correction of dysarthria

Corrective work to overcome dysarthria should be carried out regularly along with the use of drug treatment and rehabilitation therapy (for example, treatment-and-prophylactic exercises, therapeutic baths, hirudotherapy, acupuncture, etc.), which is appointed by a neurologist. Nonconventional correction methods, such as dolphin therapy, isotherapy, sensory therapy, sand therapy, etc., have proven themselves well.

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

The content and methods of correctional work differ depending on the severity and form of dysarthria, the degree of speech development.

Identify the main stages of remedial work. The first stage of the class is a massage, through which the muscular tone of the speech apparatus is developed. The next step is to conduct exercises for the formation of correct articulation, with the aim of subsequent correct pronunciation of sounds by the child, for setting sounds. Then work is done on automation at sound reading. The final step is learning the correct pronunciation of words using the sounds already delivered.

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