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 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.
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.