Neurological and speech therapy characteristics of children with anarthria. What is dysarthria or anarthria? Dysarthria anarthria general characteristics

Dysarthria is a type of pathology, the development of which is caused by organic damage to the central nervous system. Dysarthria, the symptoms of which differ from other forms relating to pronunciation, manifests itself in the form of a disturbance in the patient’s entire speech, and not a disturbance noted in the pronunciation of certain types of sounds.

general description

This type of disorder occurs due to insufficient innervation of the speech apparatus, which, in turn, is achieved due to damage to the corresponding parts of the brain - subcortical and postfrontal. Patients have limited mobility of the organs of speech production (lips, tongue and soft palate), which makes articulation more difficult (articulation is defined as the work carried out jointly by the speech organs, as a result of which the ability to pronounce sounds in speech is ensured).

Dysarthria in adults manifests itself without concomitant forms of disintegration of the speech system (i.e., impaired auditory perception of speech, impaired writing and reading). Dysarthria in children often becomes the cause of disorders associated with the reproduction of words, which, in turn, leads to reading impairment and writing impairment; in some cases, general speech underdevelopment becomes relevant. When pronouncing sounds, they are noted to be unclear and “blurred”; as for the characteristics of the voice, with this disease it can manifest itself either in an extremely weak form of reproduction, or, conversely, in a very sharp one. Speech lacks its characteristic smoothness, breathing becomes irregular, and the pace of speech also changes, sometimes slowing down, sometimes speeding up.

Depending on the clinical and psychological characteristics, children with dysarthria are assigned to a heterogeneous group, and there is no correlation between the severity of the manifestation of this pathology and the severity of psychopathic forms of deviations. It should be noted that dysarthria, as well as its severe forms, can manifest itself even in children with preserved intelligence, while its mild manifestations can appear in this group of children and in children for whom intellectual development disorders are relevant.

Depending on the characteristics identified in each specific case for the psychophysical development of children with dysarthria, clinical and psychological characteristics are based on the following division of patients into groups:

• dysarthria, manifested in children with a normal level of psychophysical development;
• dysarthria in children with hydrocephalus;
• manifestation of dysarthria in children with mental retardation;
• dysarthria with cerebral palsy;
• manifestation of dysarthria in children with mental retardation (i.e. with mental retardation);
• dysarthria in children with MMD (minimal form of brain dysfunction).

The latter option, associated with a minimal form of dysfunction in dysarthria in children, appears quite often, it is noted in groups among children studying in specialized preschool and school institutions. In this case, in addition to speech deficiency, disturbances in memory, attention, volitional and emotional spheres, intellectual activity, mild forms of movement disorders, and slowness in the formation of certain higher-order cortical functions are also added.

The manifestation of motor disorders is mainly observed in the later stages of the formation of motor functions in patients, especially such as the development of independent ability to sit, crawl, walk, grasp objects with fingers and then manipulate them, etc.

Emotional and volitional disorders consist of the manifestation of an increased degree of emotional excitability, as well as general exhaustion, which characterizes the state of the nervous system. During the first year of life, children are noted to be restless, they require constant attention, and they are also whiny. Appetite and sleep disturbances are relevant, there is a predisposition to diathesis, gastrointestinal disorders, as well as regurgitation and vomiting. Children are often characterized by increased weather dependence.

During preschool age, there is motor restlessness, a tendency to increased irritability and mood swings, fussiness, children are disobedient and rude. Increased motor restlessness occurs in a situation where the child is overtired, up to hysterical reactions.

And although children do not develop pronounced forms of paresis and paralysis, their motor skills are predominantly awkward, and there is also a lack of coordination. In addition, there are current problems with awkwardness in the implementation of skills related to self-care, lagging behind peers in terms of accuracy and dexterity in performing movements. The readiness of the hand for writing also develops with a delay; for this reason, for a long time there is no practical interest in manual activities (modeling, drawing, etc.), they have poor handwriting (school age). Disturbances associated with intellectual activity are pronounced, which manifests itself in decreased mental performance, decreased attention and memory impairment.

Dysarthria: causes

In general, dysarthria is a problem on a global scale, because its distribution, as we noted, falls entirely on the function of speech, and not on individual elements in it. Accordingly, in this case, an organic lesion to which the central nervous system has been subjected is considered, due to which a sharp limitation in muscle movement is relevant for the child.

The most significant option is brain damage, against which dysarthria develops. Often the reason for this is the mother suffering from some infectious disease during pregnancy, as well as a serious form of toxicosis. In addition, during pregnancy, exposure options that lead to dysarthria are considered, such as pathological development of the placenta, rapid or, conversely, protracted labor. During childbirth, such types of injuries as birth with asphyxia, cerebral hemorrhage, traumatic brain injury, etc. are relevant.

In addition, the child’s exposure to infectious diseases affecting the brain and its membranes (meningitis, meningoencephalitis, etc.) is taken into account as a possible factor that provoked the disease.

It should be separately noted that in addition to its connection with other types of pathologies, dysarthria can also act as a symptom of cerebral palsy (CP). In this case, the reasons for the connection have not been sufficiently studied. Relatively recently, they adhered to the theory that cerebral palsy is the result of a birth injury, but within the framework of ongoing research it turned out that in about 80% of cases this pathology is congenital in nature, and accordingly, cerebral palsy develops in utero. This pathology can affect the process of labor; in addition, the actual pathology of labor can provoke a worsening of the root cause.

Classification of dysarthria

Depending on the severity, dysarthria can manifest itself in several types of forms:

• erased dysarthria – symptoms (speech, psychological and neurological manifestations) have, accordingly, an erased appearance, which often gives reason to confuse dysarthria with a disorder such as dyslalia (this disorder manifests itself in the fact that children, having normal hearing and with their speech apparatus intact, have a problem associated with sound pronunciation); the difference between one option and the other is the presence of a focal form of neurological microsymptoms in dysarthria;
• severe dysarthria – in this form the child uses speech, but it is characterized as incomprehensible and inarticulate; sound pronunciation is impaired, disturbances also manifest themselves in intonation expressiveness, voice and breathing;
• anarthria – this form of dysarthria is accompanied by the child’s absolute inability to produce speech.

Depending on the specific area of ​​localization, dysarthria may be accompanied by peripheral or central paralysis. In peripheral paralysis, the peripheral motor neuron in combination with its connections to the muscles is affected. In central paralysis, the central motor neuron is affected, as well as the connections that exist between it and the peripheral neuron. With peripheral paralysis, patients have reduced or completely absent reflexes and muscle tone; in addition, muscle atrophy is relevant. As for central paralysis, it develops, as noted, due to damage to the central motor neuron, and this damage occurs within any part of it (i.e. it can be the spinal cord, brain stem, cerebral cortex (motor zone) ).

Peripheral paralysis mainly affects the performance of involuntary and voluntary movements, while central paralysis mainly affects only voluntary movements. Peripheral paralysis is accompanied by a disorder of a diffuse scale in terms of articulatory motor skills, and central paralysis determines a disorder in fine differentiated movements. Differences also exist in the characteristics of muscle tone: central paralysis is accompanied by a predominance of increased muscle tone (which is defined as spasticity); peripheral paralysis is characterized by a virtual absence of tone.

Regarding sound in peripheral paralysis, the articulation of vowels is reduced to a sound of a neutral nature, and voiced consonants and vowels to a dull sound. In this case, it is considered bulbar dysarthria. The bulbar form of the pathology is often combined with the appearance of swallowing disorders in patients. In addition, bulbar dysarthria is also one of the symptoms of the pathology - bulbar syndrome. As for central paralysis, which defines this form of disorder as pseudobulbar dysarthria, then in his case the articulation of vowels shifts back, the sound of consonants can be either muffled or voiced. The speech of patients becomes monotonous. This form of the disease can also act as a symptom, this time relating to a pathology such as pseudobulbar syndrome.

In addition to the bulbar and pseudobulbar forms of the disease, there is cortical dysarthria, it is due to the fact that the parts of the brain that are directly related to the functions of those muscles that are directly involved in the processes of articulation are subject to damage. The peculiarity of this form of the disease lies in the disorder of pronunciation concerning syllables, in which, meanwhile, the correct structure of the spoken word is preserved.

The next form of the disease is cerebellar dysarthria. It is caused by the fact that the cerebellum is damaged (damage to the conduction pathways is not excluded). Cerebellar dysarthria is characterized by the fact that speech becomes scanned and drawn out, modulation is subject to disruption, and the volume also changes.

Extrapyramidal dysarthria(or subcortical, hyperkinetic dysarthria) manifests itself against the background of a lesion affecting the subcortical nodes in combination with their nerve connections. In this case, blurred and slurred speech is noted, and its nasal tone is also noted. The prosody of speech (i.e., its intonation-expressive coloring) and the tempo of speech are sharply disrupted.

The next type of dysarthria is parkinsonian dysarthria, it is diagnosed with parkinsonism. The main features are inexpressiveness and slowness of speech, as well as a general violation of voice modulation. Treatment in this case implies the need for therapy aimed at the disease, which in this case is the main one.

And finally extrapyramidal dysarthria And cold dysarthria. In the first case, the development of the disease is determined by the relevance of the lesion of the striopallidal system; in the second, the disorder is a symptom that occurs with myasthenic syndrome and, in fact, with myasthenia. Focusing on cold dysarthria, we can highlight its features, which consist in the appearance of difficulties associated with articulation as a result of being in conditions of low temperature, as well as when talking on the street. Treatment of cold dysarthria requires initial treatment of the underlying disease. It is noteworthy that this very disorder is often the only symptom indicating the relevance for the patient of a latent form of the disease in the form of myopathy or its congenital undiagnosed form.

Dysarthria: symptoms

Dysarthria at various levels of its manifestation is characterized by a violation of the transmission of impulses from the cerebral cortex to the nuclei of the cranial nerves. Given this feature, the corresponding nerve impulses do not arrive to the muscles (these are the articulatory, vocal and respiratory muscles), as a result of which the function of the main type of those cranial nerves that are directly related to speech (vagus, hypoglossal, facial, trigeminal) is subject to disruption and glossopharyngeal).

Due to the trigeminal nerve, innervation of the lower part of the face and masticatory muscles is ensured; damage to this nerve determines the urgency of difficulties associated with opening/closing the mouth, as well as with movements carried out by the lower jaws, with swallowing and chewing.

The hypoglossal nerve provides muscle innervation concentrated in the area of ​​the two anterior thirds of the tongue. Accordingly, when the facial nerve is damaged, certain disturbances in the mobility of the tongue arise, in addition to which difficulties arise in holding it in a certain given position.

The innervation of the facial muscles is provided, accordingly, by the facial nerve. Damage to this nerve results in a mask-like and facial expression, as well as difficulty closing the eyes, puffing out the cheeks, or furrowing the eyebrows.

Innervation of the posterior third of the tongue is provided by the glossopharyngeal nerve; in addition, it innervates the soft palate and pharyngeal muscles. If this nerve is damaged, the voice takes on a nasal tone, the pharyngeal reflex decreases, and the small tongue deviates to the side.

As for the vagus nerve, it innervates the muscles of the pharynx, soft palate, larynx, respiratory muscles and vocal folds. When the vagus nerve is damaged, the muscles of the pharynx and larynx begin to work ineffectively, and breathing functions are also affected.

During the early period of manifestation of dysarthria with these disorders in infants the following symptoms are noted: muscle pareticity leads to difficulty in breastfeeding (attachment to the breast is carried out by 3-7 days, that is, late), choking, frequent regurgitation and sluggish sucking are characteristic.

The early stage of development of children may be accompanied in this case by the absence of babbling; the same sounds that appear sound nasal. Children pronounce their first words with a delay (mostly at 2-2.5 years), the subsequent development of their speech is accompanied by incorrect pronunciation of almost all types of sounds.

Dysarthria can also be accompanied by articular apraxia, which means a disturbance in the process of voluntary movements of the articulatory organs. The cause of articulatory apraxia may be a lack of kinesthetic sensations in the articular muscles of children.

Disturbances associated with sound pronunciation and arising against the background of articular apraxia have two main features, they are as follows:

• Sounds that are in close proximity to each other in the area of ​​their articulation are subject to change and distortion;
• the resulting disturbances in sound pronunciation are characterized by their own inconstancy; accordingly, this determines the cases in which a child can pronounce certain sounds both in the correct version and in the incorrect version.

Articulatory apraxia can manifest itself in two ways:

• articular kinesthetic apraxia – is directly related to pathology in the parietal regions of the brain, which, in turn, is accompanied by difficulties in finding a separate variant of articulatory posture;
• articular kinetic apraxia– is caused by the occurrence of pathology in the area of ​​the premotor parts of the brain, this manifests itself in the form of a violation of the dynamic organization in articulatory movements, which makes it difficult to move from one sound to another.

In addition, the symptoms of dysarthria are accompanied by various repetitions of syllables and sounds, their insertions, permutations and omissions. Physically, children are clumsy; they often stumble and fall; difficulties associated with performing physical exercises are relevant (this is particularly noticeable when compared with other children). Due to impaired fine motor skills, children have problems with lacing, fastening buttons, etc.

Erased dysarthria: symptoms

I would like to dwell on this form of the disease separately, if only for the reason that it is not only one of the forms of dysarthria, but is also, so to speak, in a related state when considering dysarthria and dyslalia. The external manifestations of this form allow it to be comparable to dyslalia, however, the presence of its own and specific mechanism that characterizes it as a separate disorder determines some removal from this connection, because it lies in the difficulty of overcoming it.

As we have already noted, erased dysarthria acts as one of the variants of the forms of dysarthria, in which disturbances associated with sound pronunciation and the prosodic side of speech occur. These disorders arise against the background of the relevance of the focal form of neurological microsymptoms.

• Non-speech symptoms of the erased form of dysarthria

The neurological status determines, as we have already identified earlier, the actual neurological microsymptoms, which, in turn, manifests itself in the form of syndromes with concomitant damage to the central nervous system, and this is:

Erased forms of paresis (a form of weakening of voluntary movements);

Mild forms of hyperkinesis (automatic movements of a violent nature resulting from muscle contraction carried out in an involuntary manner), manifested in the facial facial muscles;

Changes in muscle tone;

The appearance of certain forms of pathological reflexes, etc.

The cranial nerves are overwhelmingly affected by the hypoglossal nerve, resulting in a certain limitation in the movements of the tongue (forward, down, sideways and up), inconvenience in occupying a certain position, weakness in half of the tongue, passivity in its tip, increased drooling, etc.

Some cases of the erased form of dysarthria are accompanied by a lesion of a different type. So, in particular, we are talking about a lesion affecting the oculomotor nerves, which, in turn, manifests itself in the form of unilateral ptosis and strabismus. Severe variants of disorders of the glossopharyngeal, vagus and trigeminal nerves are mostly absent in the erased form of dysarthria. Meanwhile, in children one can often observe a smoothing of the nasolabial folds in a unilateral manifestation, which occurs due to the state of asymmetry arising from the facial nerves. In addition, a possible option is considered to be insufficiency of muscle tone in the soft palate area, which, in turn, leads to the appearance of nasality in the voice.

The reflex sphere also exhibits its own symptoms, which may consist in the appearance of pathological types of reflexes in patients. The autonomic nervous system determines the appearance of symptoms such as sweaty feet, sweaty palms, etc.

In speech motor skills, exhaustion and low quality of movements performed are determined, which concerns, in particular, insufficient smoothness, accuracy and incomplete volume. Motor symptoms manifest themselves most clearly as a result of performing a complex type of movements, in which they must be clearly controlled, while ensuring the correctness of their spatio-temporal organization.

There are also specific features in terms of mental status within the erased form of dysarthria. They manifest themselves in the insufficiency of certain mental processes, which concerns in particular memory, attention, visual and auditory forms of perception, and mental operations. Cognitive activity is also subject to reduction in children.

• Speech symptoms of the erased form of dysarthria

In this case, as one might assume, violations are noted in terms of sound pronunciation: sounds are distorted, excluded, replaced. Children strive to simplify articulation as much as possible, thus replacing complex sounds with simple ones (due in part to their inherent articulatory-acoustic features). Most often, whistling and hissing sounds, as well as front-lingual sounds, are subject to distortion.

Prosodic disturbances are also relevant, in which there is lack of expressiveness and monotony of speech, decreased (in most cases) and accelerated/slowed timbre. Children's voices are generally quiet. The completion of this symptomatology is the addition of disorders related to phonemic hearing (this term defines the ability to isolate, distinguish, reproduce speech sounds, that is, this is nothing more than speech hearing). Such violations are mainly secondary in nature, because one’s own speech in its “blurred” version does not determine the possibility of forming adequate auditory perception and appropriate control.

Treatment

Treatment of dysarthria determines the need for an integrated approach to ensuring proper therapeutic and pedagogical influence. Correction of dysarthria is carried out in combination with physical therapy and drug treatment. An important role is given to the comprehensive development of speech (phonemic hearing, grammatical structure, vocabulary), because children with dysarthria have difficulties in mastering written language during school education. Ideally, children with this disease should be educated in special speech therapy groups (kindergarten) and speech schools (respectively, during school years). There is no clearly defined outcome regarding the prognosis of dysarthria in children.

The main goal followed in the treatment of this disease is to implement measures aimed at achieving results in which the child’s speech will be understandable to others. Speech correction for this disease is carried out by a speech therapist.

Speech therapy classification is based on the principle of speech intelligibility for others and includes 4 degrees of severity of dysarthria:

• 1st degree (erased dysarthria) - defects in sound pronunciation can only be detected by a speech therapist during a special examination
• 2nd degree - defects in sound pronunciation are noticeable to others, but overall speech remains understandable
• 3rd degree - understanding of the speech of a patient with dysarthria is available only to close associates and partially to strangers
• 4th degree - speech is absent or incomprehensible even to the closest people (anarthria)

Characteristics of children with bulbar dysarthria

Dysarthria caused by peripheral paresis or paralysis of the muscles involved in articulation due to damage to the glossopharyngeal, vagus and hypoglossal nerves or their nuclei.
With bulbar dysarthria, diffuse peripheral paralysis of the speech muscles is noted. Features of the violation of sound pronunciation in this form are gross distortion of the pronunciation of all labial sounds, the approximation of stop consonants to fricatives, and vowels to a neutral sound; deafening of voiced consonants.

Characteristics of children with pseudobulbar form of dysarthria

Dysarthria caused by central paralysis of the muscles innervated by the glossopharyngeal, vagus and hypoglossal nerves, due to bilateral damage to the motor corticonuclear pathways. This form manifests itself in central paralysis and paresis of articulatory and phonation muscles. Due to altered muscle tone and pareticity, the mobility of articulatory muscles is sharply limited, which leads to impaired pronunciation of both consonants and vowels. All sounds are pronounced with a nasal tone. The exhaled mouth stream is felt weakly. A feature of pseudobulbar dysarthria is the presence of synkinesis. Characteristically, there is an absence of voluntary movements while reflexive and automatic movements are preserved.

Characteristics of children with cortical dysarthria

Dysarthria caused by damage to parts of the cerebral cortex associated with the function of muscles involved in articulation.
With cortical dysarthria, selective central paresis of the muscles of the articulatory apparatus (most often the tongue) is observed, which leads to the limitation of the most subtle isolated upward movements of the tip of the tongue, resulting in impaired pronunciation of anterior lingual sounds.

Characteristics of children with subcortical (extrapyramidal) form of dysarthria

A feature of extrapyramidal dysarthria is the absence of stable and uniform sound pronunciation disorders, which depend on:
1. sudden changes in muscle tone in the speech muscles;
2. the presence of violent movements (hyperkinesis);
3. disturbances of emotional-motor innervation.

Characteristics of children with cerebellar form of dysarthria

Dysarthria caused by damage to the cerebellum or its pathways.
Cerebellar dysarthria is characterized by asynchrony between breathing, phonation and articulation. Speech in this form is slow, jerky, chanting, with impaired modulation and attenuation of the voice towards the end of the phrase. There is difficulty in reproducing and maintaining articulatory patterns. Phonetically, the pronunciation of those sounds that require sufficient clarity and differentiation of articulatory movements (forelingual sounds), as well as sufficient muscle strength (plosive sounds), suffers.

Characteristics of children with an erased form of dysarthria

Mild dysarthria ( erased dysarthria) - a speech disorder that often occurs in childhood, in which the leading ones in the structure of the speech defect are persistent disturbances in sound pronunciation, similar to other articulatory disorders and presenting significant difficulties for differential diagnosis and correctional speech therapy work.

Characteristics of children with dysarthric component

The functioning of the articulatory apparatus is impaired, the muscles of the tongue and lips are weak. With a dysarthric component, the sound side of speech is disrupted; if the syllable structure suffers, this is already dysarthria.

Characteristics of children with anarthria

The ability to form speech sounds is lost. Impure pronunciation of several syllables and several vowel sounds is possible. Nasality and hoarseness may be present in speech activity. Weakness of vocal cords: unable to read or repeat words loudly. Intelligence preserved: ability to write, understanding of written and spoken language.

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 higher brain functions, 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.

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

The leading defect in dysarthria is a violation of the sound pronunciation and prosodic aspects of speech associated with organic damage to the central and peripheral nervous systems.” (“Speech therapy” edited by Volkova L.S.)

D isarthria is manifested by a violation of sound pronunciation, tempo, rhythm of speech, intonation, voice timbre, speech breathing.

As you know, a person speaks not with his tongue (more precisely, not only with his tongue), but with his head (more precisely, with his brain). The brain, as a control center, must be connected to the performers (tongue, lips, cheeks, palate, lower jaw, pharynx, larynx, diaphragm) using “wires” - pathways (nerves). With dysarthria, the work of these pathways is disrupted at different levels: from the cortex itself to the innervated muscles.

Classification of dysarthria.

Depending on the location of the lesion, the following types of dysarthria are distinguished: bulbar, pseudobulbar, extrapyramidal, cerebellar and cortical. Each type has its own characteristics, both in symptoms and in treatment.

Depending on the severity of the manifestation of speech disorders, 4 degrees are distinguished: the mildest is 1st degree, the so-called. “erased form of dysarthria” - disturbances in sound pronunciation look like ordinary dyslalia, and only a speech therapist can distinguish them by conducting special functional tests; at grade 2, others notice the child’s speech disturbances and characterize them as “porridge in the mouth”; at degree 3, strangers can no longer understand the child, only those close to him understand him; Stage 4, the most severe, is called “anarthria”, with virtually no speech.

Dysarthria often accompanies cerebral palsy, because the reasons and mechanism are the same.

But dysarthria does not have a direct relationship with a decrease in intelligence. They can coincide as two independent diseases; a decrease in intelligence can be secondary, with severe degrees of dysarthria, since in this case all aspects of speech suffer (vocabulary, grammar, coherent speech). But initially, with dysarthria, intelligence is preserved.

Causes: exposure to “various unfavorable external factors affecting the prenatal period of development, at the time of childbirth and after birth. Among the causes, asphyxia and birth trauma, damage to the unequal system due to hemolytic disease, infectious diseases of the nervous system, traumatic brain injuries, and less often - cerebrovascular accidents, brain tumor, malformations of the nervous system, for example, congenital aplasia of the cranial nuclei are important. nerves (Mobius syndrome), as well as hereditary diseases of the nervous and neuromuscular systems.” (“Speech therapy” edited by Volkova L.S.)

Treatment and prognosis . Dysarthria requires early, long-term and systematic speech therapy work. The effectiveness of speech therapy work depends on the close relationship between the speech therapist and the neurologist who prescribes medication. In case of serious movement disorders caused by impaired muscle tone, the help of a physiotherapist is necessary: ​​physical therapy, massage, gymnastics.

Speech therapy work must begin as early as possible and be carried out systematically.

Dysarthria must be distinguished from other speech disorders.

The erased form of dysarthria looks like dyslalia, but the treatment has its own characteristics. To distinguish these disorders, in addition to anamnesis and neurological examination data (which does not always reveal signs of organic damage to the central nervous system), is possible by performing functional tests during the examination (if not during the initial examination, then during the dynamic examination).

More severe forms of dysarthria should be distinguished from alalia. The fact is that, despite the similarity of external manifestations (lack of speech), these two speech disorders are radically different from each other in essence, and treatment should be completely different

With motor (expressive) alalia, the work is based on the formation of language patterns in the child (i.e., essentially the verbal manifestation of mental functions), and with dysarthria, the meaning of correctional work is the formation of pronunciation skills.

In addition, a combination of several diagnoses is possible.

Anarthria is a disease associated with severe speech impairment. Unlike another speech disorder - the pathology in question affects only the phonetic system. It is a severe form.

The patient's ability to use grammatically correct expressions is preserved. The development of anarthria is associated with damage to the muscles of the face, tongue, and larynx, after which the affected person is unable to speak fully. This begins the development of fear in the patient.

Reasons for the development of the disorder

Anarthria is a complex disorder caused by damage to certain areas of the brain (cerebellum, brainstem, posterior parts of the frontal lobe).

The causes of the disease are often the following pathological processes in the brain:

Symptoms and complaints

Classic manifestations of anarthria are:

1. Unclear speech, pronounced nasally, with noticeable stuttering. The voice becomes hoarse. Often a person, realizing such a defect in his speech, prefers to communicate using notes or remain silent altogether.
2. The patient cannot pronounce sounds, syllables, words.
3. Patients often complain of problems swallowing food– there is a high probability that the patient may choke on food or drink. This phenomenon is not an independent sign of anarthria, but often accompanies it.
4. The psychological state can be described as closed.

Types and degrees of violation

Anarthria is classified as follows:

• mild degree differs from others in that a person retains the ability to pronounce sounds and syllables;
• in case of illness medium degree heaviness, a person can pronounce only individual sounds;
• V severe case he is completely deprived of the ability to speak, his sound activity is completely lost.

Depending on the location of the damage to the nervous system, the following forms of pathology are distinguished:

Anarthria develops as a consequence of neurological diseases occurring in the body. Therefore, treatment is aimed at eliminating them, and only after that - speech disorders.

Establishing diagnosis

Anarthria is a rather complex disease that requires a full diagnosis and consultation with a number of specialists. A detailed history of the patient must be compiled, heredity is studied, his complaints are analyzed, other past and current diseases are noted.

A neurological examination is then performed. A neurologist examines the features of reflexes and the articulatory apparatus.

The otolaryngologist examines the pharynx, larynx, nose in order to exclude or, conversely, identify any pathological processes, influencing human speech activity.

To evaluate sound pronunciation, the patient should visit a speech therapist.

A neurologist, in order to identify the causes of brain disorders, will refer the patient to studies such as and. Thanks to the results obtained, it will become known what neurological causes influenced the development of the disease.

A neuropsychologist will help the patient cope with stress arising from the disease and the inability to fully communicate. Additionally, the patient may be prescribed consultations with other specialists (genetics, oncologist).

Correction and treatment

Treatment of anarthria occurs in two directions: medication and analytically.

A set of measures involving the use of medications and aimed at eliminating the primary disease includes:

• antibiotic therapy;
• prescribing vitamin complexes to strengthen the immune system;
• stabilization of blood circulation in the brain and blood pressure levels;
• as well as surgical opening of purulent wounds, elimination of hemorrhages;
• and undergoing physiotherapy.

Simultaneously with the listed procedures, the patient attends classes with a speech therapist - this is necessary for phonetic restoration speech.

Often, to treat such a disease, stem cells are used that can restore brain function: they take on the functions of damaged ones and improve the conductivity of the nerve sheath.

In order to correct the patient’s mental state, he is prescribed sedatives, as well as tranquilizers, due to the properties of which stress will be less intense. The listed measures of drug treatment of anarthria do not help eliminate the patient’s fear, but only reduce the degree of its severity.

Analytical treatment is an alternative option for eliminating anarthria. Its advantage is that this type of therapy eliminates the use of medications - they are compensated by long conversations with a psychiatrist who will help the patient conduct psychoanalysis and identify the true cause of his phobias, which are located in the subconscious. The disadvantage of analytical therapy is its duration, sometimes reaching 18 months, and considerable cost.

Anarthria is complicated by a person’s loss of the ability to communicate normally with others, which affects his life, causing irreparable psychological trauma. In the absence of medical care, the disease progresses quickly - until the complete loss of speech activity.

With timely, comprehensive therapy, the prognosis is favorable, and it is even possible to achieve significant success. However, it is almost impossible to completely recover from the disease, especially if a visit to the doctor has been postponed for a long period.

A healthy lifestyle is our choice!

Prevention of the disease consists of maintaining a healthy lifestyle - quitting smoking and drinking alcoholic beverages.

It is necessary to pay sufficient attention to physical training.

It is important to maintain a daily routine that includes adequate sleep (from 8 hours), four balanced meals a day, and long walks in the fresh air.

If diseases associated with disruption of the body systems, blood pressure, or metabolic disorders occur, you must immediately consult a doctor and undergo timely, comprehensive treatment.