Specifics of speech therapy work for erased dysarthria. Methods of correctional speech therapy for subcortical dysarthria

Tropko Evgeniya Sergeevna
Teacher - speech therapist,
Elektrostal. Moscow region

Certificate of Publication: was not issued

Dysarthria is a violation of sound pronunciation and prosody caused by insufficient innervation of the muscles of the speech apparatus. Due to insufficient innervation of the muscles of the articulatory, vocal, and respiratory apparatus, not only sound pronunciation is impaired, but also the voice and speech breathing. With dysarthria, the motor mechanism of speech is disrupted due to organic damage to the central nervous system. The structure of a speech defect is a violation of the entire pronunciation aspect of speech.

An integrated approach to eliminating dysarthria includes three blocks.

First block – medical, which is determined by a neurologist. In addition to medications, exercise therapy, massage, reflexology, physiotherapy and others are prescribed.

Second block - psychological and pedagogical. The main directions of this impact will be: the development of sensory functions. By developing auditory perception, forming auditory gnosis, the basis is thereby prepared for the formation of phonemic hearing. By developing visual perception, differentiation and visual gnosis, we thereby prevent graphic errors in writing. By implementing this direction, stereognosis is also being developed. In addition to the development of sensory functions, the psychological and pedagogical block includes exercises for the development and correction of spatial concepts, constructive praxis, graphic skills, memory, and thinking.

Third block - speech therapy work, which is carried out mainly on an individual basis. Taking into account the structure of the defect in dysarthria, speech therapy work is recommended to be planned according to the following stages:

The first stage of work is preparatory and contains the following areas:

1) Normalization of muscle tone of facial and articulatory muscles. Speech therapy massage is provided.
2) Normalization of motor skills of the articulatory apparatus. For this purpose, we carry out differentiated articulation gymnastics techniques. Passive exercises performed by the speech therapist himself are aimed at inducing kinesthesia. Active articulatory gymnastics gradually becomes more complicated and functional loads are added. This type of articulatory gymnastics is aimed at strengthening kinesthesia and improving the quality of articulatory movements.
3) Voice normalization. For this purpose, voice exercises are carried out, which are aimed at causing a stronger voice and modulating the voice in pitch and strength.
4) Normalization of speech breathing. For this purpose, the speech therapist conducts short-term exercises to develop a longer, smoother, more economical exhalation.
5) Normalization of prosody. This direction is the least developed at the first stage. In the specialized literature, there are descriptions of the prosodic side of speech in children with dysarthria: these are disorders such as a quiet and unmodulated voice, disturbances in the rate of speech and timbre of the voice, poor intonation, poor speech intelligibility, lack of pauses and logical stresses, and other symptoms of prosody.
6) Normalization of fine motor skills of the hands. For this purpose, finger gymnastics is carried out, aimed at developing subtle, differentiated movements in the fingers of both hands.

All exercises of the first stage gradually become more difficult.

The second stage of speech therapy work for dysarthria is the development of new pronunciation skills. The directions of the second stage of speech therapy work are carried out against the background of ongoing exercises listed in the first stage, but more complex. The directions of the second stage are:

1) Development of the main articulatory structures (dorsal, cacuminal, alveolar, palatal). Each of these positions determines, respectively, the articulation of whistling, hissing, sonorant and palatal sounds. Having mastered a number of articulatory movements in the first stage, at the second stage we move on to a series of sequential movements performed clearly, exaggeratedly, based on visual, auditory, and kinesthetic control.
2) Determining the sequence of work to correct sound pronunciation. For dysarthria in children, depending on the presence of pathological symptoms in the articulation area and the degree of its severity, the sequence of work on sounds is individually determined. In some cases, they adhere to the traditional order, which recommends staging with broken whistling sounds.
It is recommended, when working to correct sound pronunciation for dysarthria, to clarify or call up that group of sounds whose articulatory structure has “ripened” first of all. And these can be even more difficult sounds, for example: in the alveolar position - r, r, and whistling sounds will be corrected later, after the dorsal position has “matured” (which is one of the most difficult sounds for children).
3) Development of phonemic hearing. The work is carried out according to the classical scheme. Phonemic awareness refers to the child’s ability to identify and distinguish phonemes of his native language.
4) Evoking a specific sound. This work for dysarthria is carried out in the same way as for any other disorder, including dyslalia. This means that the speech therapist uses classical methods of producing sounds (by imitation, mechanical, mixed methods).
5) Sound automation is the most difficult area of work in the second stage. Often in practice, speech therapists are faced with the fact that children in isolation pronounce all sounds correctly, but in the speech stream the sounds lose their differentiated characteristics and are pronounced distorted.
6) Differentiation of the delivered sound in pronunciation with oppositional phonemes. The sequence of presented lexical material is similar to the sequence when automating a given sound. It is only suggested, for example: 2 syllables (sa - sha, as - ash, sta - shta, tsa - tsha, etc.). Then pairs of words, different in syllable structure, etc.

The third stage of speech therapy work is devoted to the development of communication skills.
1) One of the most difficult areas of work is developing self-control skills in a child. Often, speech therapists are faced with a situation where a child, in an office setting, in contact with a speech therapist, demonstrates acquired skills in speech. But when the situation changes, in the presence of other people, the skill that seemed strong disappears, and the child returns to the previous stereotypical pronunciation. To develop communication skills, the child’s active position and his motivation to improve his speech are necessary. In this area of speech therapy work, the speech therapist must act as a psychologist and, on an individual basis, determine ways to develop self-control skills in the child.
2) A more traditional direction at this stage is the introduction of sound into speech in a learning situation (memorizing poetry, composing sentences, stories, retellings, etc.).
3) The specific direction of the stage is the inclusion of prosodic means in the lexical material: various intonations, modulations of the voice in height and strength, changes in the tempo of speech and timbre of the voice, determination of logical stress, observance of pauses, etc.

The fourth stage of speech therapy work is called preventing or overcoming secondary disorders in dysarthria. Bearing in mind the prevention of secondary disorders, early diagnosis of dysarthria should be ensured, as well as early corrective work should be organized. Technologies for correctional work with children at risk for dysarthria at different age periods have been developed. However, preventive work is carried out with children who have severe organic pathology in a hospital setting. The majority of children at risk for dysarthria (mild degree), who have a history of neuropathologist diagnosis of PEP (perinatal encephalopathy) in the first year of life, are deprived of the opportunity to receive adequate corrective propaedeutic care, since hospital treatment is not indicated for them. By the end of the first year of life, the neurologist removes the diagnosis of PEP. And only during a dispensary examination does a speech therapist at the clinic, with a thorough examination, see the symptoms of MDD (minimal dysarthric disorders). These symptoms entail secondary disturbances in the formation of linguistic means (vocabulary, grammar). A consequence of insufficient prevention of secondary disorders is a large number of children with dysarthria complicated by either ODD or FFD.

The fifth stage of speech therapy work is preparing a child with dysarthria for school. The main directions of speech therapy work are: the formation of graphomotor skills, psychological readiness for learning, and the prevention of dysgraphic errors.

Many specialists dealt with the issues of dysarthria correction: O.V. Pravdina, L.V. Lopatina, N.V. Serebryakova, E.F. Arkhipova, I.I. Panchenko, O.A. Tokareva, L.V. Melekhova, O.Yu. Fedosova and others.

The founders of the doctrine of dysarthria, defining the paths of clinical and pedagogical rehabilitation, recommended an integrated approach to correctional measures, which includes three blocks:

The first block is medical, which is determined by a neurologist. In addition to medications, exercise therapy, massage, reflexology, physiotherapy, etc. are prescribed.

The second block is psychological and pedagogical. The main direction of this impact will be the development of sensory functions. By developing auditory perception, forming auditory gnosis, we thereby prepare the basis for the formation of phonemic hearing. By developing visual perception, differentiation and visual gnosis, we thereby prevent graphic errors in writing. By implementing this direction, stereognosis is also developed. In addition to the development of sensory functions, the psychological and pedagogical block includes exercises for the development and correction of spatial concepts, constructive praxis, graphic skills, memory, and thinking.

The third block is speech therapy work, which is carried out mainly on an individual basis. Taking into account the structure of the defect in dysarthria, speech therapy work is recommended to be planned according to the following stages:

The first stage of speech therapy work, called "preparatory", contains the following directions:

- normalization of muscle tone of facial and articulatory muscles. For this purpose, the speech therapist conducts differentiated speech therapy massage.
- normalization of motor skills of the articulatory apparatus. For this purpose, the speech therapist conducts differentiated articulation gymnastics techniques.
- voice normalization. For this purpose, voice exercises are carried out, which are aimed at causing a stronger voice and modulating the voice in pitch and strength.
- normalization of speech breathing. For this purpose, the speech therapist conducts short-term exercises to develop a longer, smoother, more economical exhalation. Then they consolidate new skills in orthophonic exercises, combining articulation, voice and breathing exercises together.
- normalization of prosody. This direction is the least developed at the first stage. In the specialized literature, there are descriptions of the prosodic aspect of speech in children with dysarthria: these are disorders such as a quiet and unmodulated voice, disturbances in the rate of speech and timbre of the voice, poor intonation, poor speech intelligibility, lack of pauses and logical stresses and other symptoms of prosody.
- normalization of fine motor skills of the hands. For this purpose, a speech therapist performs finger gymnastics aimed at developing fine differentiated movements in the fingers of both hands.

All exercises of the first stage gradually become more difficult.

The second stage of speech therapy work for dysarthria is development of new pronunciation skills.

The directions of the second stage of speech therapy work are carried out against the background of ongoing exercises listed in the first stage, but more complex:

- development of the main articulatory structures (dorsal, cacuminal, alveolar, palatal). Each of these positions determines, respectively, the articulation of whistling, hissing, sonorant and palatal sounds.
- determining the sequence of work to correct sound pronunciation;
- clarification or development of phonemic hearing;
- directly evoking a specific sound. This means that the speech therapist uses classical methods of producing sounds (by imitation, mechanical, mixed methods);
- consolidation of the evoked sound, i.e. its automation;
- differentiation of the delivered sound in pronunciation with oppositional phonemes.

The third stage of speech therapy work is devoted to development of communication skills:

- developing self-control skills in the child;
- introducing sound into speech in a learning situation (memorizing poetry, writing sentences, stories, retellings, etc.);
-inclusion of prosodic means into the lexical material: different intonation, voice modulations in pitch and strength, changes in the tempo of speech and timbre of the voice, determination of logical stress, observance of pauses, etc.

The fourth stage of speech therapy work -- preventing or overcoming secondary disorders in dysarthria. Keeping in mind the prevention of secondary disorders, it is necessary to ensure early diagnosis of dysarthria, determine the risk group for dysarthria, and also organize early corrective work.

The fifth stage of speech therapy work is preparing a child with dysarthria for school. The main areas of speech therapy work are:

- formation of graphomotor skills
-psychological readiness for learning
- prevention of dysgraphic errors.

Speech therapy is based on special principles:

1. Systematic principle. Speech is a complex functional system, the structural components of which are in close interaction. Therefore, the correction process involves influencing all components of the speech functional system.
2. The etiopathogenetic principle involves taking into account the mechanisms of the disorder, identifying leading disorders, and the relationship between speech and non-speech symptoms in the structure of the defect. Violations of sound pronunciation with erased dysarthria occur when various brain structures necessary for controlling the motor mechanism of speech are damaged. Difficulties in pronunciation disrupt the articulatory support of speech perception. Fuzzy perception of sounds may cause a lag in mastering the sound composition of a word, which, in turn, causes difficulties in mastering writing.
3. The principle of relying on the laws of ontogenetic development involves taking into account the sequence of formation of mental functions that takes place in ontogenesis. Thus, the sequence in working on sounds is determined by the sequence of their appearance in ontogenesis.
4. The principle of development (taking into account the “zone of proximal development”) involves a gradual complication of tasks and lexical material in the process of speech therapy work. New tasks are initially given on simple lexical material. After the mental action has been mastered, you can move on to performing it on more complex speech material.
5. The principle of the gradual formation of mental actions (P.Ya. Galperin, D.B. Elkonin). The formation of mental actions is a long process that begins with extensive external operations using auxiliary materialized means of support, and then is gradually reduced, automated, and transferred to the mental plane.
6. The principle of taking into account the leading activity of age. Play activity is an important process of cognition (D.B. Elkonin). In a game, the child focuses not on the educational side of it, but on the entertaining side. Therefore, the development and consolidation of acquired skills and abilities occurs unnoticed and naturally for the child. This principle should be taken into account when organizing speech therapy sessions with children.
7. The principle of a differentiated approach involves taking into account the etiology, mechanisms, symptoms of disorders, age and individual characteristics of each child and is reflected in the organization of individual, subgroup and frontal classes.

Thus, the system of speech therapy treatment for dysarthria is complex. The specificity of the work is the combination with differentiated articulation massage and gymnastics, speech therapy rhythms, and in some cases with general physical therapy, physiotherapy and drug treatment.

A differentiated approach in the process of speech therapy treatment for an erased form of dysarthria should be carried out taking into account a complex of factors: symptoms of disorders of the phonetic side of speech, the nature of specific types of sound pronunciation defects, the level of immaturity of speech and non-speech functions, the zone of proximal development, the presence or absence of disorders of phonemic speech, mechanisms and structure speech defect, as well as the individual characteristics of the child.

Erased form of dysarthria- one of the most common and difficult to correct disorders of pronunciation of speech in children of preschool and primary school age. The number of children with an erased form of dysarthria has especially increased in recent years, which was noted during my work in the Zaslavsky school and Minsk.

With minimal dysarthric disorders, there is insufficient mobility of individual muscle groups of the speech apparatus (lips, soft palate, tongue), general weakness of the entire peripheral speech apparatus due to damage to certain parts of the nervous system. Today it can be considered proven that in addition to specific disorders of oral speech, there are deviations in the development of a number of higher mental functions and processes responsible for the development of written speech, as well as a weakening of general and fine motor skills.

Children with erased dysarthria have some characteristic features. In early childhood, they speak unclearly and eat poorly. They usually do not like meat, carrots, or hard apples as they find it difficult to chew. After chewing a little, the child can hold the food in his cheek until adults reprimand him. It is more difficult for such children to develop cultural and hygienic skills, which require precise movements of various muscle groups. The child cannot rinse his mouth on his own, because... his tongue and cheek muscles are poorly developed. Children with dysarthria do not like and do not want to fasten their own buttons, lace up their shoes, or roll up their sleeves. They also experience difficulties in visual arts: they cannot hold a pencil correctly, use scissors, or regulate the pressure on the pencil and brush. Such children also have difficulty performing physical exercises and dancing. It is not easy for them to learn to correlate their movements with the beginning and end of a musical phrase, and to change the nature of movements according to the beat. They say about such children that they are clumsy because they cannot clearly and accurately perform various motor exercises. It is difficult for them to maintain balance while standing on one leg, and they often do not know how to jump on their left or right leg.

With erased dysarthria, sound pronunciation disorders are caused by violations of phonetic operations, therefore the development of articulatory motor skills becomes the most important area of correctional speech therapy work. In my work, I take a differentiated approach to each child, and also adhere to two areas of correctional work:
1. formation of the kinesthetic basis of movement: feeling the position of the organs of articulation;
2. formation of the kinetic basis of movement: the movements of the tongue and articulatory organs themselves.

The defining moment in sound production is the formation of static-dynamic sensations, clear articulatory kinesthesia and a kinesthetic image of the movements of the articulatory muscles. The work must be carried out with maximum connection of all analyzers. Shakhovskaya S.N. recommended using all analyzers in speech therapy classes. The same thing should be said, depicted, looked at, i.e. pass through the “gate” of all senses. The success of working on sound is determined by the ability to form conscious kinesthetic supports in children. It is important that the child can feel the position and movements of the articulatory organs at the moment of articulation (for example, the rise of the back of the tongue when pronouncing [k], [g]). It is necessary to take into account various tactile sensations (primarily tactile vibration and temperature), for example, the feeling of vibration in the hand in the area of the larynx or crown when pronouncing voiced consonants, the duration and smoothness of the exhaled stream when pronouncing fricative sounds [F], [V], [X], brevity of articulation, sensation of a push of air when pronouncing stop consonants [P], [B], [T], [D], [G], [K], sensation of a narrow stream of air [S], [Z], [F], wide [T], [K], temperature [C] – cold jet, [W] – warm.

When producing sounds, it is important that children know the articulatory structure of sound, be able to tell and show in what position the lips, teeth, tongue are, whether the vocal folds vibrate or not, what is the strength and direction of the exhaled air, the nature of the exhaled stream. It is useful to compare speech sounds with non-speech sounds. Such conscious mastery of correct articulation is of great importance for the formation of the correct articulatory image of the sound of its pronunciation and, most importantly, its differentiation from other sounds.

When forming the kinetic basis of articulatory movements, the main attention should be paid to exercises aimed at developing the necessary quality of movements: volume, mobility of the organs of the articulatory apparatus, strength, accuracy of movements, and developing the ability to hold the articulatory organs in a given position. Traditional articulation exercises are widely used to develop dynamic coordination of movements, but special sets of exercises that take into account the specifics of the disorder also give good positive results.

For children with mild dysarthria and increased muscle tone in the articulatory muscles, exercises are offered to relax tense muscles of the tongue and lips.

To relax the tongue :

stick out the tip of your tongue. Mash it with your lips, pronouncing the syllables pa-pa-pa-pa - then leave your mouth slightly open, fixing your wide tongue and holding it in this position, counting from 1 to 5-7;
stick the tip of your tongue out between your teeth, bite it with your teeth, pronouncing the syllables ta-ta-ta-ta, leaving your mouth slightly open on the last syllable, fixing the wide tongue and holding it in this position, counting from 1 to 5-7 and return to its original position;
open your mouth, place the tip of your tongue on your lower lip, fix this position, holding it while counting from 1 to 5–7, return to its original state;
silently pronounce the sound I, while simultaneously pressing the lateral edges of the tongue with your lateral teeth (this exercise is also a kind of massage technique for paretic condition of the muscles of the lateral edges of the tongue)

To lower a tense tongue root Exercises involving tongue protrusion are suggested.

Relaxing tense lips achieved by lightly patting the upper lip on the lower lip.

In case decreased muscle tone preschoolers with mild dysarthria are offered tasks to activate and strengthen paretic muscles:

– scratching with the tip of the tongue on the upper incisors;

– counting the teeth, resting the tip on each one;

– stroking the cheek with the tip of the tongue, pressing forcefully on its inner side;

– holding a round piece of candy at the alveoli with the tongue.

Lips that do not close tightly, flaccidly are trained using the following tasks:

– stretch your lips into a smile, exposing the upper and lower incisors, holding the count from 1 to 5–7, return to their original position;

– stretch only the right and left corners of the lip in a smile, exposing the upper and lower incisors, hold the count from 1 to 5–7, return to the original position;

– hold pieces of crackers, tubes of different diameters, strips of paper with your lips;

- tightly closed lips.

And for the youngest (from three years old) You can use the following types of exercises, which can be done in a playful way.

Exercises will help develop the mobility of articulatory muscles and promote the development of clear diction. You can start practicing with these articulation exercises if you have erased dysarthria. To make it interesting for children to do the exercises, their names are presented in a playful way.

"Fence"- Teeth closed, smile broadly and show upper and lower teeth. Maintain the position for 10 seconds, repeat 3-4 times.

"Tube"- teeth are closed, lips are pulled forward so that they resemble an “elephant’s trunk”, while the lower jaw remains motionless. Hold the position for 10 seconds, repeat 3-4 times.

"Pancake"- open your mouth, place your wide and spread tongue on your lower lip. Maintain the position for 10 seconds, repeat 3-4 times.

"Needle"- open your mouth and stick your sharp tongue out of your mouth as far as possible. Hold the position for 5 seconds, repeat 3-4 times.

"Pancake - needle"- alternate the previous 2 exercises, while ensuring that the lower jaw remains motionless. Perform the exercise at a slow pace, repeat each movement 4 times.

"Pendulum"- open your mouth, alternately touch your sharp tongue to the right and then to the left corner of your mouth. Make sure that the lower jaw remains motionless. Perform the exercise at a slow pace, repeat each movement 4 times.

"Swing"- open your mouth, alternately touch your sharp tongue to the upper lip, then to the lower. Make sure that the lower jaw remains motionless. Perform the exercise at a slow pace, repeat each movement 4 times.

"Let's lick our lips"- open your mouth, lick in a circle first the upper, then the lower lip. Make sure that the lower jaw remains motionless. Repeat the exercises in a circle 4-5 times.

"Vanka-Vstanka"- open your mouth, bend the tip of the tongue to the base of the upper incisors as far as possible, then bend the tongue to the base of the lower incisors. Perform the exercises at a slow pace, repeat the movements in each direction 4 times.

Thus, to carry out successful correctional work with children with an erased degree of dysarthria, it is necessary to highlight the main aspects:
To identify an accurate speech therapy conclusion, a thorough psychological, medical and pedagogical examination is necessary with a study of the child’s medical record, familiarization with anamnestic data, and a doctor’s conclusion. It is necessary to maintain a close relationship with parents, not only in order to obtain information about the early development of the child, but in order to explain the characteristics of this disorder.

Implementation of a differentiated approach to overcoming dysarthria, with increased or decreased muscle tone.

An important factor in working with children with mild dysarthria is the formation of clear static-dynamic sensations of articulatory muscles.
Systematicity in the work on the formation of phonemic operations, the development of the melodic-intonation side of speech, breathing processes, voice formation, articulation.
The communicative focus of training is the use of story-based, didactic games, and project activities in the process of automating sound pronunciation.

Literature:

1. Arkhipova E.F. Correctional and speech therapy work to overcome erased dysarthria. – M., 2008.

2. Kiseleva V.A. Diagnosis and correction of the erased form of dysarthria. – M., 2007.

3. Lopatina L.V., Serebryakova N.V. Overcoming speech disorders in preschool children. – St. Petersburg, 2001.

4. Fedosova O.Yu. Conditions for creating a strong sound pronunciation skill in children with mild dysarthria. – Speech therapist in kindergarten No. 2, 2005.

5. www.logoped-therapy.com (Rusina Yu.V. Articulation gymnastics for clear pronunciation)

6. www.festival.1september.ru (Komarova A.A. Erased form of dysarthria in preschool children)

Erased form of dysarthria- one of the most common and difficult to correct disorders of pronunciation of speech in children of preschool and primary school age.

1. formation of the kinesthetic basis of movement: feeling the position of the organs of articulation;

2. formation of the kinetic basis of movement: the movements of the tongue and articulatory organs themselves.

For children with mild dysarthria and increased muscle tone in the articulatory muscles, exercises are offered to relax tense muscles of the tongue and lips.

To relax the tongue :

stick out the tip of your tongue. Mash it with your lips, pronouncing the syllables pa-pa-pa-pa - then leave your mouth slightly open, fixing your wide tongue and holding it in this position, counting from 1 to 5-7;

stick the tip of your tongue out between your teeth, bite it with your teeth, pronouncing the syllables ta-ta-ta-ta, leaving your mouth slightly open on the last syllable, fixing the wide tongue and holding it in this position, counting from 1 to 5-7 and return to its original position;

open your mouth, place the tip of your tongue on your lower lip, fix this position, holding it while counting from 1 to 5–7, return to its original state;

silently pronounce the sound I, while simultaneously pressing the lateral edges of the tongue with your lateral teeth (this exercise is also a kind of massage technique for paretic condition of the muscles of the lateral edges of the tongue)

To lower a tense tongue root Exercises involving tongue protrusion are suggested.

Relaxing tense lips achieved by lightly patting the upper lip on the lower lip.

In case decreased muscle tone preschoolers with mild dysarthria are offered tasks to activate and strengthen paretic muscles:

– scratching with the tip of the tongue on the upper incisors;

– counting the teeth, resting the tip on each one;

– stroking the cheek with the tip of the tongue, pressing forcefully on its inner side;

– holding a round piece of candy at the alveoli with the tongue.

Lips that do not close tightly, flaccidly are trained using the following tasks:

– stretch your lips into a smile, exposing the upper and lower incisors, holding the count from 1 to 5–7, return to their original position;

– stretch only the right and left corners of the lip in a smile, exposing the upper and lower incisors, hold the count from 1 to 5–7, return to the original position;

– hold pieces of crackers, tubes of different diameters, strips of paper with your lips;

- tightly closed lips.

Thus, in order to carry out successful correctional work with children with an erased degree of dysarthria, it is necessary to highlight the main aspects: To identify an accurate speech therapy conclusion, a thorough psychological, medical and pedagogical examination is necessary with the study of the child’s medical record, familiarization with anamnestic data, and a doctor’s conclusion. It is necessary to maintain a close relationship with parents, not only in order to obtain information about the early development of the child, but in order to explain the characteristics of this disorder.

Implementation of a differentiated approach to overcoming dysarthria, with increased or decreased muscle tone.

An important factor in working with children with mild dysarthria is the formation of clear static-dynamic sensations of articulatory muscles.

Systematicity in the work on the formation of phonemic operations, the development of the melodic-intonation side of speech, breathing processes, voice formation, articulation. The communicative focus of training is the use of story-based, didactic games, and project activities in the process of automating sound pronunciation.

E. F. Arkhipova (professor, teacher at Sholokhov Moscow State Pedagogical University) in her book on erased dysarthria gives the definition as follows:

Erased dysarthria- speech pathology, manifested in disorders of the phonetic and prosodic components of the speech functional system and arising as a result of unexpressed microorganic damage to the brain. (L.V. Lopatina). This negatively affects the development of the child, the processes of his neuropsychic development in preschool age, and later can lead to school maladjustment. This violation complicates the process of schooling for children and reduces its effectiveness.

Scientific studies conducted by Martynova (1963), G.V. Guravets (1978), L.V. Lopatina, N.V. Serebryakova (1994,1996) established a cause-and-effect relationship between the defect itself of the currently observed speech disorder (for example , defects in the sound side) and its delayed consequences:
defects in the formation of phonemic and grammatical generalizations, violations of the semantic aspect of speech, difficulties in the development of coherent speech.

Thus, in the studies of many authors (R. I. Martynova, 1963; L. V. Melekhova, 1964; R. A. Belova-David, G. V. Guravets, S. I. Mayevskaya, 1978 and others) it is noted that In children with an erased form of dysarthria, along with the leading disorders of the phonetic side of speech, underdevelopment of vocabulary is often observed.

The problem of organizing speech therapy work with children with erased dysarthria is caused by damage to the central nervous system, which occurs in parallel with disorders of mental development (memory, attention, thinking). According to various authors, 40-80% of children have certain deviations: mental retardation (40-60%), mental retardation type underdevelopment (15-20%).

The relevance of the chosen topic is confirmed by the following provisions:

The erased form of dysarthria is the most common speech disorder in preschool children (According to E. Arkhipova);

Aimed at studying the relationship between sound pronunciation, the state of articulatory motor skills, prosody, and at providing assistance to children with an erased form of dysarthria.

The purpose of the stated topic is to identify the features of phonetic and prosodic disorders in the erased form of dysarthria. Based on the identified violations, develop a comprehensive correctional and speech therapy system aimed at overcoming it.

The goal was achieved through sequential problem solving:

1. Study and analyze special medical, psychological, pedagogical literature on the problem.

2. Identify motor disorders of the articulatory apparatus and phonetic features of the speech of children with an erased form of dysarthria.

3. Identify the features of the prosodic side of speech.

4. Note the features of the development of mental functions.

2. Clinical and physiological aspects of the erased form of dysarthria.

The erased form of dysarthria is diagnosed after 5 years. All children whose symptoms corresponded to it are sent for consultation to a neurologist to clarify or confirm the diagnosis and to prescribe adequate treatment, because for erased dysarthria, the method of correction work should be comprehensive and include:

Medical exposure;
- psychological and pedagogical assistance;
- speech therapy work.

When examining children aged 5-6 years, the following are revealed: symptoms:

Gross motor skills. Children with erased dysarthria are motorically awkward, they have a limited range of active movements, and their muscles quickly tire under functional loads.

Fine hand motor skills. Children with an erased form of dysarthria late and have difficulty mastering self-care skills: they cannot fasten buttons, tie a scarf, etc. During drawing classes, they don’t hold a pencil well, their hands are tense. Many children don't like to draw.

Features of the articulatory apparatus. Children with erased dysarthria have the following pathological features in the articulatory apparatus:

Pareticity (flabbiness) of the muscles of the organs of articulation: the face is hippomimic, the muscles are flaccid on palpation; Many children cannot maintain the closed mouth position due to weakness of the masticatory muscles; the lips are flaccid, their corners are drooping, which worsens the prosodic side of speech (definition).

The tongue is thin, located at the bottom of the mouth, the tip of the tongue is flaccid, inactive. With functional loads, muscle weakness increases.

Spasticity (tension) manifests itself in the following. The children's faces are amicable. The muscles are hard and tense on palpation. The lips are in a half-smile: the upper lip is pressed against the gums. Many children cannot perform the “Tube” exercise and stretch their lips forward. The tongue is changed in shape: thick, without a pronounced tip, inactive.

Hyperkinesis manifests itself in the form of tremors, that is, tremor of the tongue or vocal cords. They often appear with increased muscle tone of the articulatory apparatus.

Apraxia with erased dysarthria manifests itself in the inability to perform any voluntary movements with the hands and organs of articulation; it is present at all motor levels. There is an inability to switch from one movement to another.

Deviation, i.e. deviation of the tongue from the midline, also manifests itself during articulation tests and during functional loads; combined with lip asymmetry.

Hypersilivation, i.e. increased salivation during speech. Children cannot cope with salivation, do not swallow saliva, and the pronunciation side of speech and prosody suffers.

When examining the motor function of the articulatory apparatus and analyzing the quality of movements, the following is noted: blurredness, unclear articulation, weak muscle tension, arrhythmia, decreased range of movements, short duration of holding a certain position, decreased range of movements, rapid muscle fatigue, etc.

Thus, under functional loads, the quality of articulatory movements drops sharply. This leads to distortion of sounds, mixing them up and deterioration of the overall prosodic aspect of speech.

Sound pronunciation. When first meeting a child, the disorder in sound pronunciation resembles complex dyslalia. Unlike dyslalia, with erased dysarthria, speech has prosodic disturbances, which affects intelligibility, intelligibility, and expressiveness. The automation process is difficult; the supplied sounds are not fully used. Children distort and mix not only sounds that are articulatory complex and close in place and method of formation, but also acoustically opposed ones. Quite often, interdental and lateral distortion of sounds are observed. Children have difficulty pronouncing words with complex syllable structures.

Prosody state was clarified during the conversation with the child. The following features were noted:

Normal
- quiet, loud
- ability to modulate voice in pitch and strength
- presence and absence of nasality

Expressiveness:

Intonation
- timbre

Fast
- slow
- normal

Correct use of pauses in speech flow

Clear
- fuzzy

Verkhnegorodnoye
- diaphragmatic
- lower costal
- duration of speech exhalation
- rhythmicity
- synchronicity
- voice formation

Children with erased dysarthria can be divided into three groups.

First group. Children who have impaired sound pronunciation and prosody. This group is very similar to the group of children with dyslalia (CD). They are often treated as if they were dysarthric, and only in the process of speech therapy work, when there is no positive dynamics during automation, does it become clear that this is an erased form of dysarthria.

Second group. These are children in whom a violation of sound pronunciation and the prosodic side of speech is combined with an incomplete process of formation of phonemic hearing (PHN).

Third group. These are children who have a persistent polymorphic disorder of sound pronunciation and a lack of prosodic aspect of speech combined with underdevelopment of phonemic hearing. Poor vocabulary, pronounced grammatical errors, inability to make a coherent statement.

3. Systematic approach to erased dysarthria.

To eliminate erased dysarthria, a complex intervention is required, including medical, psychological, pedagogical and speech therapy.

The medical direction is determined by a neurologist and should include drug therapy, exercise therapy, reflexology, massage, physiotherapy, etc.

Psychological - pedagogical aspect, carried out by defectologists, psychologists, educators, parents, is aimed at:

Development of sensory functions;
- clarification of spatial representations;
- formation of constructive praxis;
- development of higher cortical functions - stereognosis;
- formation of subtle differentiated movements in the hands;
- psychological preparation of the child for school.

Many specialists dealt with the issues of dysarthria correction: O.V. Pravdina, E.M. Mastyukova, K.A. Semenova, L.V. Lopatina, N.V. Serebryakova, E.F. Arkhipova and others.

Speech therapy work to eliminate erased dysarthria includes five stages:

Stage 1 - preparatory.

The purpose of this stage is to prepare the articulatory apparatus for the formation of articulatory patterns. It includes six controls:

– normalization of muscle tone,
– normalization of motor skills of the articulatory apparatus,
– normalization of speech exhalation,
– voice normalization,
– normalization of prosody,
– normalization of fine motor skills of the hands.

Stage 2 - development of new pronunciation skills.

Directions:

– development of basic articulation patterns,
– determining the sequence of work on sounds,
– development of phonemic hearing,
– sound production,
– automation,
– differentiation (auditory differentiation; differentiation of isolated articulations; pronunciation differentiation at the level of syllables, words).

Stage 3 - development of communication skills.

Directions:

– development of self-control;
– training of correct speech skills in various speech situations.

Stage 4 - overcoming or preventing secondary violations.

Stage 5 - preparation for school.

Directions:

– formation of graphomotor skills;
– development of coherent speech;
– development of cognitive activity and expansion of the child’s horizons.

4. Selection and testing of the most effective methods and techniques of correctional and speech therapy to eliminate the erased form of dysarthria.

Speech therapy massage

1. Collar area.
2. Facial muscles.
3. Lip.
4. Language.
5. Soft palate.

Massage of the collar area, facial muscles, including lips, is performed according to the same rules as cosmetic massage. The tongue is massaged from root to tip with a special probe. All types of massage movements are used: stroking, kneading, patting, vibration. It is necessary to follow an important rule: if the muscles being massaged are flaccid, relaxed, then the massage is active and intense; if the muscles are tense, then you should start with a relaxing massage, performed with light stroking movements, and only as the muscles relax, try to penetrate deeper.

Making sounds for erased dysarthria

This technique is used in the presence of defective pronunciation of several groups of sounds. It consists in correcting several groups simultaneously, and not one by one.

Stages of correction work:

1. Development of fine motor skills.
2. Development of the articulatory apparatus.
3. Massage.
4. Correction and production of whistling sounds and sound [l].
5. Automation of whistling sounds and sound [l].
6. Differentiation of whistling sounds [c]-[z]; [s] - [s]; [s]-[z]; [c]-[ts] and sound [l]: [l][l].
7. Correction and production of hissing [w], [ch], [zh], [sch] and sounds [r] – [ry].
8. Automation of hissing sounds and sounds [р]-[рь].
9. Differentiation of hissing sounds and sounds [р], [рь]; [l]-[r], [l]-[ry]
10. Automation of all sounds (whistling, hissing, sonorous sounds)
11. Differentiation of all sounds.

Development of fine motor skills

Fine motor skills are inextricably linked with articulatory motor skills, therefore it is necessary to accelerate the preparation of the articulatory apparatus with the development of fine motor skills. A few exercises you can use.

Exercises with the ball.

1. Toss the ball up 10 times:

With two hands;
- right hand;
- with your left hand.

2. Hit the ball against the wall:

With two hands;
- right hand;
- with your left hand.

3. Hit the ball on the floor:

With two hands;
- right hand;
- left hand;

Hand exercises

1. Arms extended forward across the chest, fingers spread. Make fists with force, hold for 2-3 seconds, unclench, relax your hands, shake them 4-6 times.

2. Arms extended forward in front of the chest, fingers of the right hand clenched into a fist. Unclench the fingers of your right hand and at the same time squeeze the fingers of your left hand. Do 20 times, accelerating the pace.

3. Palms together, fingers intertwined. Alternately bend and straighten your fingers.

4. Arms bent, touch each finger in turn with your thumb (do this with both hands).

5. Flex and straighten your hands at the wrist joints. Palms are clenched, fingers intertwined.

6. Arms extended forward in front of the chest. Palms turned outward. Return to starting position.

In cases of severe speech impairment, the development of motor skills is especially necessary.

Working on speech technique

In the process of examining children’s speech, every speech therapist encounters cases of “slurred speech.” In this case, the child pronounces all sounds correctly in isolation. There are several reasons:

Weak speech breathing
unclear articulation
accelerated speech
shallow breathing
inability to master the voice as an instrument, which makes speech poor and inexpressive.

Children with slurred speech need different help than speech pathologists.

This work has three components:

1) work on physiological and speech breathing;
2) work on the voice;
3) work on articulation.

In cases where speech speeds up, it should be paused.

Working on breathing

Breathing is the physiological basis of speech. What should phonation breathing be like? It should be deep and lower costal. You can lower your breath to the diaphragm using the “Ball” exercise, inflating your stomach while taking a deep breath.

The next stage is the development of an even air stream.

Exercise 1.

Inhale through the mouth - exhale through the mouth
inhale through the nose, exhale through the nose
inhale through the mouth - exhale through the nose
inhale through the nose, exhale through the mouth

The last option is the basis of speech breathing.

Exercise 2.

Take a deep breath through your nose and exhale, counting to 10,12,15...

Exercise 3. “Flower”

Work on the strength and duration of exhalation, gradually increasing phrases.
OH!
AH, it smells!
OH, what it smells like!
Oh, how the flower smells!
Exercise “Oh, yes I am!”
Boast, tease, “Well, well.”

A light free exclamation liberates the muscles of the phonation apparatus.

Poetic texts can be used as training.

In the game, with the help of onomatopoeia, using the speech-manual reflex and poetic texts, we train the skill of switching and breathing; phonemic breathing should be deep, high, clean.

Conclusion: working on breathing and training the energy system of voice formation is the first stage in mastering the speaking voice.

Working on articulation

To prepare the speech organs, you need to carry out general articulatory gymnastics.

"Fence"
"Smile-pipe"
"Spatula"
"Swing"
"Cup"
"Horse"
"Fungus"

Conclusion: you can prepare the organs of articulation with the help of special exercises, warming up consonant sounds and their difficult combinations during training.

Clarity of pronunciation is achieved with automatic, reflexive, well-coordinated articulation and breathing, equalizing the strength of sound.

Tongue twisters allow you to solve several creative problems: practicing elements of speech technique, mastering intonation expressiveness, conversational intonation, elements of communication.

The task of this stage is to work on the strength, expressiveness, and surround sound of the voice.

Exercise “Baby” A-a-a, ooh-ooh
Exercise “The steam locomotive is buzzing” Oooh! Ooooh - ooh! Uh-Iiii
Exercise “Laughter” Ha-ha-ha!
Exercise “Ball” My cheerful ringing ball,

Speeches, ditties, and rhymes can serve as good training.

General conclusion: a euphonious voice is always formed on a soft attack of sound, vowels sound clearly. The power of sound and flight are achieved not through overstraining the ligaments, but with the help of voice support, active reflex work of the abdominal muscles and diaphragm.