Quite often, children with such a speech disorder as erased dysarthria, which has recently tended to increase significantly among other speech disorders, end up at school speech therapy stations. Sometimes this speech disorder is observed as part of a general underdevelopment of speech, and sometimes - phonetic-phonemic underdevelopment. Currently, this speech pathology is considered as one of the forms of dysarthria - a complex syndrome of central organic origin, manifested in neurological, psychological and speech problems.
Dysarthria - (according to O.V. Pravdina) is a violation of the pronunciation and prosodic (tempo, rhythm, intonational expressiveness) side of speech due to a violation of the innervation of the speech organs, which occurs when the central nervous system and its peripheral parts are damaged (see table 1).
Innervation of the speech organs
Table 1
Modern speech therapy distinguishes several degrees of severity of dysarthria (see table 2)
The severity of dysarthria
table 2
| I. Light (St. Petersburg) or “erased” (Moscow) | II. Moderate | III. heavy | IV. Anartria |
| Only the pronunciation side of speech is disturbed (whistles do not form for a long time, which should normally form by the age of four). The pace of speech may be slightly accelerated | Gross violations of the pronunciation side of speech and voice | Articulate speech is absent. | |
| If the tongue is in good shape, whistling sounds have a hissing overtone, or a lateral pronunciation | |||
| Looks like functional dyslalia | In general, speech is understandable to others | In general, speech is incomprehensible to others |
Erased dysarthria is a complex speech disorder characterized by a combination of multiple disturbances in the process of motor implementation of speech activity. The leading symptom in the structure of a speech defect in erased dysarthria is phonetic disorders, which are often accompanied by underdevelopment of the lexical and grammatical structure of speech. Violations of the phonetic side of speech are difficult to correct, negatively affect the formation of the phonemic, lexical and grammatical components of the speech functional system, causing secondary deviations in their development.
There are several types of dysarthria: subcortical, extrapyramidal, pseudobulbar, cerebellar (atactic). However, only pseudobulbar dysarthria has a mild (“erased”) form. Combined variants of pseudobulbar dysarthria : spastic-rigid (an extreme manifestation of spastic disorders), spastic-paretic (open mouth, salivation, lethargy, and increased tone in the mouth), spastic (classic version: tone is equivalent in all muscle groups).
Giving a characteristic pseudobulbar (spastic) dysarthria, it is necessary to note the symptomatology of “3G”:
- hypertonicity (in general, fine and speech motor skills);
- hypertrophy;
- hyperreflexia,
due to bilateral damage to the conduction nervous system.
When examining a child with this type of dysarthria, we observe:
Nasal, slurred speech;
Lack of synergies (coordinated, fluid movements in gross motor skills) ;
Tremor (increased tone of both the tongue and edges);
Hypermetry (temporary wave-like movements of the back of the tongue);
Deviations (deviations of the tongue to the side) are a manifestation of a violation of reciprocal coordination;
Synkenesia (accompanying movements of the tongue with the lower jaw);
hypersolivation;
Nosalization (tonus of the posterior pharyngeal wall);
Dysphagia (impaired swallowing during meals);
The severity of the gag reflex;
Gross violation of sound pronunciation (violated "flight" of the vowel, nasality, or blurring of speech sounds);
Pseudo-scanning (diligence of pronunciation);
Slowing the pace of speech (up to bradilalia).
Symptoms mild (erased) form of pseudobulbar dysarthria has a neurological character, which manifests itself in tremor, hypermetry, hypersolivation. But at the same time there are no gross violations of the pronunciation side of speech, prosodic, voice. The pace of speech may be accelerated to tachilalia. Sometimes there is cluttering (poltern, battarism) - inconsistent speech with separate hesitations against the background of an accelerated pace.
Studies of articulatory motility have shown that children with an erased form of dysarthria have a dysfunction of the muscles innervated by the lower branch of the trigeminal nerve, facial, hypoglossal and glossopharyngeal nerves. Violations of the functions of the trigeminal nerve (V pair) are manifested in a narrowing of the range of motion of the lower jaw. At the same time, inaccuracy, limited movements, synkinesis of the lips and tongue are noted. Disturbances in the function of the facial nerve (VII pair) in children with an erased form of dysarthria are manifested in smoothness, asymmetry of the nasolabial folds, insufficient volume of facial movements, and lip movements during baring. Violations of the innervation of the hypoglossal nerve (XII pair) are manifested in the inability to maintain a static posture, tremor of the tip of the tongue, difficulty in raising the tongue up, hyper or hypotonicity of the muscles. Dysfunction of the glossopharyngeal nerve (IX pair) is manifested in insufficient elevation of the soft palate (Uvula), nasalized tone of speech, salivation, limited range of motion of the middle part and root of the tongue. Quite often, in the anamnesis of children with an erased form of dysarthria, there is a so-called hypertensive neonatal syndrome.
Due to untreated increased intracranial pressure, the child subsequently suffers behavior for which the frontal zone of the cerebral cortex is responsible. It is the frontal zone of the cerebral cortex that innervates programs of volitional emotions, a sense of duty, responsibility, a critical attitude to one's activity, including speech. According to E.E. Shevtsova (neuropsychologist, associate professor of the department of speech therapy at the Moscow State Humanitarian University named after M.A. Sholokhov), these problems remain for life. And the current generation of infantile 20-30-year-old young people is a clear evidence of this. In such men (in women, the nervous system is stronger - due to high compensatory mechanisms), volitional processes suffer: disinhibition, laxity in behavior are observed, motivation is reduced, and there are no interests. In adolescence, these children stray into groups, because. subject to someone else's negative influence due to the lack of their clear goals. This can lead to alcoholism and even drug addiction.
The causes of erased forms of dysarthria include:
- damage to the fetus in the early stages of pregnancy: hypoxia (oxygen starvation in the womb), infections during pregnancy. Hypoxia in the prenatal period is caused by hyper(hypo)tension, anemia, oligohydramnios, diseases of the cardiovascular system of the mother, malformations of the cardiovascular system of the fetus (associated with cytomegalovirus), entanglement of the umbilical cord of the fetus, resulting in clamping of nerve fibers in the neck , which regulate the functions of innervation of the muscles of speech motor, facial, glossopharyngeal, etc., as well as the blood supply to the brain also has its own disorders;
- prolonged childbirth, which leads to oxygen starvation of the fetus: first hypoxia, then it leads to asphyxia (suffocation) after childbirth. During this period, a huge number of nerve cells die (in 10-15 hours, out of 6 billion neurons, millions die). Due to this, skills and habits are formed more slowly, higher mental functions mature later: memory, thinking, attention, speech, and many others. others;
- long anhydrous period (from 2 to 4 or more hours);
- the effect of drugs that accelerate labor activity, which are administered to women in labor during prolonged labor: this is an artificial hormone acidocyl, which has recently been insufficiently produced in parturient women due to a decrease in the function of the pituitary gland (the influence of mobile phones, computers, and other high-frequency electromagnetic radiation). Often, labors go from protracted to rapid, so the fetus does not have time to group, and compression of the temporal, parietal and other areas of the head occurs. Also, this artificially administered hormone subsequently causes a violation of lactation in the mother;
- caesarean section, which entails just as many complications due to a large pressure drop (the fetus does not experience obstacles on the way, the ability to overcome difficulties is not recorded in the genetic memory, which subsequently leads to infantilism);
- increased intracranial pressure, hypertension syndrome in newborns.
Although erased dysarthria has a milder degree of dysarthria manifestations in a child, however, this speech disorder deserves the close attention of speech therapists, as well as painstaking work to overcome it, since this disorder complicates the process of schooling. Today it can be considered proven that in children with an erased form of dysarthria, 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.
General indications for dysarthria :
Decreased spasticity (providing a background for work);
Medical therapy (provided by a doctor);
Logopedic massage (before and after class)
Restoration of reciprocal coordination (to cope with the paretic side, if there are deviations - “Horse” - suction of the tongue along the midline), so that the sounds are not lateral;
Setting sounds (whistling in parallel with the sound R)
The program of rehabilitation education for the erased form of dysarthria includes :
1. Formation of the installation for the correction of the pronunciation side of speech.
2. Reducing the degree of manifestation of spastic paresis in the muscles of speech history:
Fight against salivation;
Normalization of muscle tone using massage techniques, passive and active articulatory gymnastics.
3. Development of the mobility of the muscles of the articulatory apparatus:
Clarification of schemes of arbitrary oral, mimic, articulatory movements;
Development of the amplitude of arbitrary oral, facial, articulatory movements;
Development of the speed of switching of arbitrary oral, facial, articulatory movements;
Development of the working capacity of the muscles of the articulatory apparatus.
4. Normalization of speech breathing:
Development of the depth of physiological inhalation, the duration of physiological exhalation, using static exercises, dynamic gymnastics;
Development of the duration of speech inspiration;
Development of the duration of speech exhalation;
The development of the working capacity of the muscles of the respiratory department.
5. Normalization of phonetic coloring of sounds:
Refinement of articulations of distorted sounds;
Consolidation of a clear realization of the sounds of all groups, isolation in the speech stream.
6. Restoration of the melodic-intonation side of speech:
Development of the range of sound-height transitions;
Normalization of the pace, rhythm of speech;
Recognition and reproduction of rhythmic-melodic fragments;
Formation of the intonation pattern of the phrase according to the model, on the instructions, independently;
7. Development of control over the pronunciation side of speech.
An invaluable help in working with children with an erased form of dysarthria is provided by properly selected medication. However, with a high employment of neuropathologists, very often during the examination, due attention is not paid to erased neurological symptoms, which is why the treatment may not be effective enough. In this regard, it will be useful for a speech therapist teacher to arrange for the child to be referred to a neurologist (see below). This direction is a description of neurological symptoms characteristic of speech disorders associated with CNS damage. This direction will be convenient to use in the work of both a speech therapist and a neuropathologist, since specific symptoms in articulatory motility will be examined and described.
Referral to a neurologist
For the purpose of conducting an additional examination and prescribing physiotherapy and drug treatment, in accordance with the order of the Ministry of Health of the Russian Federation No. 311 dated August 6, 1999, on the approval of the clinical guide “Models for the diagnosis and treatment of mental and behavioral disorders”, the child’s full name ________________________ is sent
Age___________________________________________________
In the anamnesis found _____________________________________
Features of the articulation apparatus:
Muscle paresis:
Lips (flaccid) ____________________ Corners of the mouth (drooped) _________________
Tongue (thin, at the bottom of the mouth, flaccid, the tip is inactive, muscle weakness increases with exertion) _____________________________________________________________
Muscle spasticity:
Facial expression (inexpressive) ______________________________________________
Facial muscles (hard to the touch, tense) _____________________
Lips (in a half-smile - the upper lip is pressed against the gums, cannot perform the “tube”) _________________________________________________________
Tongue (thick, without a pronounced tip, inactive) _________________
Tongue (trembling and slight bluing of the tip of the tongue, waves roll, cannot hold out of the mouth during the spatula exercise) _______________________________________
deviations
Deviation of the tongue from the midline ___________________
Hypersalivation (increased salivation)
Saliva not swallowed while speaking
Reduced volume and accuracy
articulatory movements (difficulty in performing, switching from one movement to another, “groping” for the desired articulatory position)
____________________________________________________
Movement quality
Blurring, fuzzy movements, weakness of muscle tension, arrhythmia, decreased range of motion, rapid muscle fatigue ( underline it)
Sound pronunciation
(presence of distortions, mixtures -
Specify which ones) ____________________________________________
Pronunciation of words with a complex syllabic structure __________
Prolonged automation of sounds that are not introduced into speech for a long time_____
Prosody (intonation-expressive coloring of speech)
Exhalation (weakened) _______________________________________________________________
Pace (accelerated) _____________________________________________________________
Inhale (speech on the inhale) _________________________________________________________
Graphic skills (difficulties in mastering: poor handwriting, slow pace, “mirror writing”, letter substitutions) ________________________________________________________________________
Attention (impaired: increased distractibility, cannot concentrate) ______________
Memory (difficulties in remembering material (a whole sentence, a poem), forgetting it quickly) ________________________________________________________________________
Based on the above testimony, the alleged speech conclusion _________________________________________________________________________
Disease code __________________ in accordance with the order of the Ministry of Health of the Russian Federation No. 311 of 08/06/1999
“__”______________20__
Speech therapist teacher (name of the institution, full name, signature, seal of the institution)._____________
Deviation of the tongue is its deviation to the right or left of the midline. If a healthy person is asked to stick out his tongue, he will easily do it, and it will be located exactly in the middle of the oral cavity. If somehow it does not work correctly, then it will be possible to observe the deviation of the organ of speech.
It is violations in the functioning of the nervous system that lead to problems in work and sometimes in the face. Most often, such changes occur due to brain diseases, for example, due to a stroke.
What is a stroke?
A stroke is a violation of the blood circulation of the brain, associated with neurological symptoms that do not go away for several months. This is a very serious disease, in which a quarter of cases are fatal. The same proportion of patients become first-degree disabled. And some people who have had a stroke gradually return to normal life. However, this takes a very long time, because in most cases, patients need to re-learn how to move and speak. Often patients are bedridden and unable to take care of themselves.
Tongue deviation during a stroke is just one of the symptoms that can occur. As a rule, a cerebral hemorrhage greatly affects the neurotic state of the patient, and in addition to deviation of the speech organ, atrophy of the facial muscles, the inability to move the limbs on one side, sometimes complete paralysis of the body or its individual parts, may occur. Language deviation in stroke leads to a serious speech disorder. Is it possible to fully rehabilitate, get rid of the disease and how to do it?
What could be the causes of language deviation?
Why does the tongue deviate to the left? The reasons for this are rooted in neuroscience. Deviation can occur due to improper operation of the hypoglossal nerve. In this case, the muscles of the speech organ on the left side become significantly weaker than on the right. Therefore, when the tongue is pushed out of the oral cavity, it shifts to the weaker side. Similarly, there is a deviation of the tongue to the right.
Also, deviation may appear due to the unevenness of the face, when on the one hand it is much stronger. In such cases, when protruding the tongue, it will also move to one side. In some cases, this happens completely imperceptibly, and sometimes the pathology is visible very well. However, the tongue itself functions normally, and its muscles on both sides have the same strength.
Diagnosis of language deviation
Diagnosing the presence of tongue deviation is not always easy. But in most cases, it is enough for the patient to simply stick it out. Seeing the deviation, the doctor can conclude which side of the muscle is weaker. For example, if there is a deviation of the tongue to the right, the reasons lie in the fact that this area of \u200b\u200bthe face is less strong.
However, deviation is not always associated with brain diseases. Sometimes such deviations can be explained by the insufficient development of the facial muscles of the face on the one hand.
To determine what exactly the doctor is dealing with, the patient is usually asked to make a quick movement of the tongue in both directions. In this case, it will be seen with what force these manipulations are performed.
If such measures do not help, then the patient should be asked to press the tongue on both cheeks from the inside in turn. For example, a specialist diagnoses the right side. He tests the force of pressure with the help of a hand on the outside of the right cheek, trying to counteract the force of the tongue. In this case, the specialist will be able to assess how his muscles work and understand if there is a deviation of the tongue to the right.
Treatment of tongue deviation
It should be noted that deviation is not an independent disease, it is only a symptom that manifests itself as a result of other diseases. Therefore, getting rid of such a manifestation depends entirely on the treatment of the disease that caused it. If the cause is a stroke, which happens most often, it is necessary to eliminate violations of the blood supply to the brain. As soon as this problem is eliminated, the nerves will return to normal, and, therefore, the symptoms associated with neurology will also disappear. If the matter is in the facial muscles of the face, then it is necessary to consult a doctor and, with the help of special exercises, develop muscles that lag behind the other side.
Deviation of the child's tongue
A stroke or a curvature of the muscles of the face is an unprecedented phenomenon for a child, but children also experience language deviation. As a rule, the cause of such a symptom is dysarthria or erased dysarthria.
This disease is caused by a violation of the signal from the brain to the muscles of the articulatory apparatus. In this case, an incorrect nerve signal can be reflected both in the muscles of the child's face and in the tongue.
Not many children experience this. However, cases were still recorded. Most of those suffering from such disorders outwardly look like completely healthy children, and only a doctor is able to determine that the child has dysarthria.
Symptoms of dysarthria in a child
With violations of the transmission of the nerve signal, the child's face becomes inactive and does not express any emotions with the help of facial expressions. The patient's lips are often pursed, the corners are lowered down, such a facial expression is preserved in the child almost constantly.
In severe cases, due to the disease, the child cannot close his mouth and keep his tongue in the mouth. Also, with dysarthria, the patient often has a deviation of the tongue. If you ask the baby to stick out the organ of speech, then it will be possible to notice that it is difficult for the child to keep it on the midline. The tongue trembles slightly and deviates to the side.
The difference between dysarthria and erased dysarthria
As a rule, with dysarthria, there is a pronounced inactivity of the face, which is very easy to notice on the face of a child. Other signs can also be noted, such as impaired coordination in hand movements and disorientation in space. In general, children with dysarthria do not like to do drawing, clay modeling or any other activity that requires the use of fine motor skills of the hands.
However, more and more often there are children who do an excellent job with any kind of activity, like to draw and engage in creativity. At the same time, they have mobile facial expressions, they smile a lot, laugh and are no different from an ordinary healthy child. The only thing that betrays the presence of dysarthria is the deviation of the tongue. As a rule, in children suffering from this disease, the tongue is quite thick. If you ask a child to stick it out of his mouth, you may notice that the tongue shakes and deviates to the side. The manifestation of such symptoms in medicine is called erased dysarthria.
Combines both diseases The child may lisp, swallow some sounds. At the same time, it is quite difficult to understand what the child is saying. Speech is extremely slurred and inarticulate.
How does dysarthria affect the child's psyche?
Basically, all children suffering from erased or severe dysarthria have an unstable psyche. They are characterized by frequent mood swings, throwing from one extreme to another. The child may be, on the one hand, overly vulnerable, constantly crying over trifles, on the other hand, it may become aggressive, be rude to adults, and conflict with peers. Such children are rarely good students, as a rule, they are inattentive and do not delve into the essence of learning.
How to get rid of tongue deviation in a child?
In order to get rid of the deviation of the tongue in a child, complex treatment is necessary. Many parents believe that with erased dysarthria, it will be enough just to go to a speech therapist, who will help the child pronounce the words correctly. However, the diagnosis in this case is made by a neurologist and he must also prescribe treatment. As a rule, the child is prescribed not only classes with a speech therapist and training in the correct pronunciation of sounds, but also a course of massage of the neck, collar zone and chin. Also often used in therapy are facial massage with hands and probe massage of the tongue. In this case, it is simply impossible to achieve a result with the help of any medications; regular exposure to the source of the nerve impulse is necessary.
Treatment of tongue deviation in both an adult and a child primarily consists in treating the disease that caused the tongue to deviate from the midline. It is impossible to get rid of this problem without comprehensive measures. Doctors often recommend a combination of therapy aimed at the disease itself, as well as symptomatic treatment, which mainly includes massages and exercise. These measures will allow the tongue and facial muscles to return to normal as soon as possible. It is necessary to pay special attention to the deviation of the tongue in a child, since it is often possible to determine the presence of a disease only on this basis.
The main thing is timely treatment, because, otherwise, complications may develop. The most common are the development of slurred speech, difficulty in pronouncing words, the inability to pronounce any words (loss of speech).
A very large or very thick tongue in a child is called macroglossia. This pathology is caused by structural disorders on the surface or inside the organ. Most often, this pathology appears in children. The diagnosis of macroglossia is made by the doctor when the child's tongue is completely enlarged or its individual parts swell. This disease can be congenital or acquired.
Why does the disease appear
Congenital macroglossia develops during prenatal development of the fetus. Various factors can influence the development of pathology. It can develop on its own against the background of such diseases:
- Down syndrome;
- malocclusion;
- tuberculosis;
- dysfunction in the hormonal background;
- syphilis;
- infectious processes in the body;
- violation of microcirculation of blood fluid, hemorrhages in the oral cavity;
- organ abscess;
- glossitis;
- bruises, injuries, neoplasms of a different nature;
- lymphadenitis;
- development of a purulent focus;
- abnormal structure of the muscles of the tongue;
- acromegaly (a disease associated with excessive production of growth hormone);
- myxedema ("mucosal edema" due to lack of thyroid hormones);
- acute allergic reaction;
- actinomycosis.
These diseases may be accompanied by such a symptom. Therefore, it is important to consult a doctor in a timely manner to determine the cause of macroglossitis and prescribe adequate therapy.
How to detect pathology
Doctors distinguish false and true macroglossitis. The first is due to the abnormal structure of the jaw apparatus. At the same time, the jaw is narrow and slightly sunken, but this is not evidence of a real disease, it is the result of an abnormal structure of the bone apparatus and tissues.
With the development of the true form of the disease, the tongue is too big, its volume is several times higher than the norm. In addition, additional symptoms are:
- the inability to completely close the mouth, the organ is stuck out;
- increased production of salivary fluid, there is a lot of it in the mouth, it flows out or drips;
- irritation and redness of the skin under the lower lip and on the chin;
- teeth marks are visible on the surface of the organ, it can also be covered with sores or erosions;
- the presence of malocclusion;
- difficulties with eating - chewing and swallowing function is difficult;
- difficulty speaking.
Diagnostic measures
When undergoing a routine ultrasound examination during the third trimester of pregnancy, the doctor may detect congenital macroglossia. It is determined after comparison with the indicators of the norm of each age at a given period of fetal development. To make an accurate diagnosis, a second examination is prescribed.
After the birth of a child, an examination by many specialists is expected - an infectious disease specialist, genetics, an otolaryngologist, an endocrinologist. An instrumental examination is carried out, a biochemical study of the blood fluid is prescribed. Based on the results of all tests and diagnostic methods, a diagnosis is made and therapy is prescribed.
Complications and consequences
It is very important to recognize the disease at the initial stages of development. This will allow you to undergo a course of treatment and prevent the development of dangerous consequences. In general, macroglossia does not greatly impair the patient's life, but often causes various diseases. Children with such a diagnosis become outcasts, they do not have normal socialization. Speech is slurred, there is a defect in appearance, so it is not easy for them to communicate with their peers. Usually children prefer to avoid a child with this pathology. The child grows notorious, defective, withdraws into himself.
A secondary disease that develops against the background of macroglossia is the growth of the connective tissues of the tongue. In the presence of pathology, other diseases are also activated:
- Dysfunctions in the respiratory system. Since a very large tongue makes it difficult to fully breathe through the nose, the child gets used to breathing through the mouth.
- Difficulties with pronunciation of sounds. Words are not easy to pronounce, whistling and hissing sounds are not pronounced at all.
- Curvature of teeth.
- Diseases of the oral cavity.
- Since food is not fully chewed, there are various problems with the digestive system - gastritis, colitis, ulcers.
- The tongue is constantly overdried, painful, erosions or sores often appear on its surface.
Therapeutic impact
Choosing the type of therapy, the doctor takes into account the form of the disease, the cause of its origin. If this pathology is provoked by a secondary disease, the cause should be treated in parallel. The general treatment algorithm involves the use of such drugs:
- antibacterial drugs that are used orally or by injection;
- antiseptic solutions that are used for local treatment of the surface of the muscular organ;
- the use of anti-inflammatory drugs for language processing.
In the treatment of the main disease that caused macroglossia, with an integrated approach, medications have a positive effect on the organ, it gradually becomes smaller in size. The therapy is long, the duration of the course of taking medications is set by the attending doctor. You also need to undergo regular check-ups, as treatment may need to be adjusted as the patient recovers.
Surgical treatment
If drug therapy does not bring the desired result, the tongue does not decrease in size, continuing to go beyond the mouth, surgery will usually be required. The main indications for surgical intervention are:
- difficulty in breathing, discomfort from lack of oxygen;
- great difficulty with chewing or swallowing function;
- distorted appearance;
- severely disturbed bite, in which it is impossible to treat the surface of the organ;
- too much production of salivary fluid;
- great difficulties in the speech apparatus, which cannot be corrected by a specialist.
Surgery involves reducing the tongue to normal size and shape. In most operations, the wedge-shaped portion of the organ is removed, due to this, its size becomes smaller. The procedure is performed under general anesthesia, the function is gradually restored.
In the presence of an open bite, a special prosthesis is installed, which prevents the organ from falling out. With a congenital form of the disease, a child after birth undergoes an operation to ligate the arteries. So you can stop the pathological growth.
If the appeal to a specialist is timely, the likelihood of a successful recovery is maximum. If the pathological size is due to the presence of a neoplasm, the therapy consists in the surgical removal of the tumor, then chemotherapy and radiation therapy are prescribed. With the right approach to treatment, strict implementation of all medical prescriptions, you can stop the development of pathology and completely get rid of it.
In our past issues, we wrote about why the color of the tongue can change in children. Sometimes it does not mean anything serious, and sometimes it can be caused by a number of diseases, including quite serious ones. Let's sum up and once again remember when you need to immediately consult a doctor.
In all children, the normal color of the tongue is pink. The tongue is moderately hydrated: it should not be dry, but it should not be too wet either. The surface of the tongue is uniform and velvety in appearance, which is ensured by the uniform distribution of the papillae. If the child's tongue is lined, suddenly changes color or texture of the surface, parents need to be careful. It doesn't happen without a reason.
White or red tongue in a child
Many parents of infants face this phenomenon. Sometimes a white coating is noticeable from birth. Harmless causes that do not require the intervention of doctors are plaque from breast milk or formula, as well as residues after regurgitation. The plaque in this case is thin, has the appearance of a film. It is washed off with plain water - just give the baby a drink from a bottle. Such plaque is formed because in the first months after birth, little saliva is formed in the baby's mouth and the oral cavity is not irrigated properly.
Another common cause is candidiasis, or thrush. In this case, plaque cannot be removed, and it is not necessary, since it is very easy to injure a child’s delicate tongue. The pediatrician will prescribe a sanitation of the oral cavity with special solutions, for example, Candide, which will remove an unpleasant plaque in just a few days. A gauze swab is moistened with a solution and gently applied to the affected areas.
A bright red tongue, too, certainly cannot be attributed to the norm. If the reddening of the tongue is accompanied by a fever, and the tongue becomes crimson, most likely the baby has caught scarlet fever. It mainly affects children aged 2 to 10 years. Later, a rash on the neck and shoulders will join the temperature. Full recovery occurs in one to three weeks.
If the child's tongue not only turned red, but its surface also acquired a lacquered, glossy texture, this is a sign of iron deficiency and vitamins B9 and B12. The doctor will be able to establish this by a general blood test. It is imperative to increase hemoglobin in a child, so you will have to reconsider his diet, including healthy and iron-rich foods, and, perhaps, for some time the baby will take iron supplements and B vitamins.
The tongue may not blush completely, but in patches. Such spots can occur with allergies, inflammatory processes (for example, stomatitis), malfunctions of the gastrointestinal tract, glossitis, herpes infection. Finally, redness can occur with tongue injuries, hot or spicy foods.
Color varies
Pediatricians say: tongue is an indicator of health. If a child has a yellow tongue, this may be due to poor oral hygiene. However, this phenomenon often accompanies various diseases of the internal organs. A yellow tongue in a child may indicate a number of disorders in the body:
- Diseases of the stomach, in particular, gastritis;
- Colitis and enterocolitis;
- Liver diseases;
- Diseases of the gallbladder;
- Poisoning.
The yellow color of plaque occurs due to the release of bilirubin, which rises in the baby during illness. In severe cases, the skin and sclera of the eyes may also turn yellow. If the child has a change in the color of the tongue, heartburn, vomiting, abdominal pain, intestinal disorders, you should immediately consult a doctor.
Brown tongue in a child is rare, unlike adults. In the vast majority of cases, adults pay with a brown coating due to the abuse of strong tea, coffee, and chocolate. A brown tongue in a child, most likely, will also turn out to be just a plaque after eating or drinking containing coloring pigments. In this case, it can be easily cleaned with a regular toothbrush.
If parents see that the child has a black tongue, this can certainly cause panic at first. However, do not rush to conclusions: the sight, of course, is not pleasant, but usually the tongue darkens after eating any food. Ordinary berries like blueberries can lead to this effect. The plaque disappears after a while by itself.
Taking iron supplements can also cause a child to develop a black tongue. After their cancellation, the tongue will turn pink. Taking antibiotics can cause a change in the color of the tongue, and the shades can be both light and dark. If the baby has dysbacteriosis, the tongue may also darken.
Geographic language in a child
If the color of the tongue is more or less clear, what is the geographical language of a child? Doctors use this definition because the language resembles a geographical map. It alternates areas of thickening and desquamation - peeling and detachment of the epithelium. And such an unpleasant phenomenon occurs due to inflammatory processes in the mucous membrane of the tongue and dystrophic changes in it. In the child's medical record, you can see terms such as desquamative glossitis, benign wandering glossitis, chronic erythema migrans (oral form).
The causes of occurrence are several groups of diseases: deficiency of B vitamins, diseases of the gastrointestinal tract and duodenum, diseases of the liver and biliary tract, pancreas, diabetes mellitus, some autoimmune diseases, as well as severe viral infections. In any case, the geographical language of the child requires a visit to the doctor and a health examination.
Do not forget: the child must learn to monitor his oral cavity and brush not only his teeth, but also his tongue. Then there will be no "accidental" plaque and stale breath. And if the child's tongue is lined, then hurry to the doctor. We wish your kids good health!
Text: Olga Pankratieva
Expert:
Anna Smitienko, physician-therapist of the multidisciplinary clinic "MedicCity", candidate of medical sciences
The tongue is an organ with which you can not only shake the air, confess your love, enjoy the taste of food and drinks, it is also an indicator of the state of your body. Look at your tongue - and you will immediately understand if your body is working smoothly.
1. Your tongue is coated
Diseases of the gastrointestinal tract, liver and gallbladder
Do you have a distinct white, whitish-gray, or yellow-brown coating on your tongue? Are you also bothered by a sour, metallic or bitter taste in your mouth? There may be something wrong with your stomach, intestines, liver or gallbladder. You would do well to see a gastroenterologist.
2. Curd on your tongue
Possible problems in the body: oropharyngeal candidiasis
This disease can occur in people with a weakened immune system, most often after taking antibiotics or severe infections. In this case, the tongue, the inner surface of the cheeks, the palatine arches are covered with a white curdled coating, which is easily removed, the affected areas alternate with normal ones. Did you find similar symptoms? Consult with a therapist.
3. Your tongue is bright crimson
Possible problems in the body: anemia
The color of your tongue is excessively bright, with a raspberry tint? Upon closer examination, the following is noticeable: some papillae have atrophied (simply disappeared), which, together with intact papillae, forms a kind of uneven surface of the tongue - the so-called "geographic tongue"? These are indirect signs of anemia. It is possible that your body lacks the vital vitamin B12 or, for example, folic acid, which improves blood flow in your body and significantly reduces the risk of a heart attack. Consult with a general practitioner or hematologist.
4. Your tongue is asymmetrical
Possible problems in the body: stroke
With a number of acute disorders of cerebral circulation, the protruding tongue deviates in one direction from the midline. As a rule, this is accompanied by slurred speech or other speech disorders, as well as loss or limitation of mobility in the arm and / or leg. It is important to remember that a slight deviation of the tongue from the midline (deviation) occurs in some absolutely healthy people - this is their feature from birth. However, if nothing like this has happened to you or your loved ones before, immediately call an ambulance.
5. Your tongue has grown in size.
Possible problems in the body: amyloidosis
In this rare condition, the tongue becomes so large that it can even make chewing or swallowing difficult. Along the edges of the tongue in this case, the imprints of the teeth are often noticeable. However, the defeat of the tongue in amyloidosis - a disease caused by excessive deposition of abnormal amyloid protein in the organs - is of secondary importance. Much worse is that amyloidosis affects the internal organs - the kidneys, intestines, liver or heart. I noticed something similar - immediately consult with a specialist.
Neurogenic suffering of the tongue
Neurogenic suffering of the tongue are divided into motor and trophic; this also includes sensory disorders.
Motor neuroses of the tongue are predominantly lesions of the hypoglossal nerve (n. hypogloesus). Disease of the central pathways of the hypoglossal nerve causes unilateral paralysis of the muscular musculature, in which the act of swallowing is not disturbed. Nuclear lesions mainly cause bilateral paralysis, leading to a complete violation of the act of swallowing, if the accessory nucleus of the hypoglossal nerve is not preserved.
When diagnosing these lesions, it is necessary to perform a special neurological examination, as well as to determine the involvement of other cranial nerves, pyramidal tracts. Relatively simple diagnosis for traumatic injuries of the hypoglossal nerve.
Bilateral damage to the nuclei of the hypoglossal nerve is often observed with bilateral bulbar palsy. First, there are movement disorders, then atrophy of the tongue and lingual dielalia (speech impairment), followed by a violation of swallowing and lip movement. A similar symptom complex can occur with dorsal tabes.
Similar, but unstable symptoms of motor paresis: of the tongue can occur as a result of encephalitis with symptoms of pseudobulb "bar paralysis. We have observed a case of paralysis of the hypoglossal nerve of gunshot origin.
Unilateral damage to the hypoglossal nerve causes the tongue to deviate in the opposite direction when at rest in the oral cavity. When protruding, the tongue usually deviates to the healthy side.
Convulsions of the tongue can be observed with epilepsy, tetanus, rabies, hemiplegia, motor semi-paralysis.
A professional spasm of the tongue among clarinetists is described, similar to the spasm of the fingers of scribes.
With tabes and with cortical lesions in the center of movement, a significant speech disorder may occur due to ataxia of the tongue.
Trophic neuroses of the tongue sometimes find their expression in angiospastic phenomena, in the phenomena of focal desquamation of the papillae.
Sensitive disorders of the tongue represent the most common neurotic lesions of it; they are usually accompanied by similar lesions elsewhere in the trigeminal nerve. Pain sensitivity of the mucous membrane is not the same in different departments; this must be taken into account in a comparative study of individual areas and take into account the relativity of indicators and the topography of pain sensitivity in the zone of physiological hypalgesia and analgesia. With the exception of the lips and the tip of the tongue, pain points are very poorly distributed in the oral cavity (see table).
Anesthesia can be the result of various diseases. Anesthesia of half of the tongue is more often observed - with lesions of anatomical nature (cerebral and bulbar, lesions of the tympanic plexus, lesions in ear diseases) and functional nature (hysteria). Clinically, this kind of anesthesia does not always proceed clearly enough, since sensitivity in the tongue is partially preserved in areas innervated by other nerves; the main part of the back and tip of the tongue is innervated by the lingual nerve, belonging to the III branch of the trigeminal nerve; in addition, the upper laryngeal nerve (n. Iaryngeus superior) and the lingual branches of the glossopharyngeal nerve (n. glossopnaryngeus) also provide sensitive innervation of the tongue.
Hyperesthesia of the tongue constitute a very important group of language sensitivity disorders in practical terms. This group includes neuralgia and glossodynia.
Neuralgia of the tongue represents a disease caused by damage to the lingual nerve, which is in the nature of manifestations of trigeminal neuralgia, mostly in conjunction with neuralgia of the mandibular nerve. The pains are typical paroxysmal in nature; they arise spontaneously or under the influence of minor external physical stimuli (eating, talking), and sometimes of a mental nature.
Due to the fact that patients with neuralgia of the lingual nerve take care of the tongue, try to use it little, during external examination, the tongue often appears to be coated with a gray or brown coating. The presence of plaque is not, of course, an objective sign of neuralgia, but should be considered as a symptom indicating the presence of causes that reduce the self-cleaning of the tongue. In the case of complaints of pain isolated in the tongue of a neuralgic nature without damage to the mandibular nerve, it is necessary to look for objective signs of damage in the tongue itself or at the location of the lingual nerve.
Therapy- neuralgia - X-ray irradiation, galvanization, diathermy of the cervical nodes, novocaine blockade and injection of alcohol into the lingual nerve or resection of the lingual nerve. The last two operations are not very desirable, as they cause a loss of sensitivity of the back of the tongue, and the injection of alcohol, in addition, is often accompanied by a loss of sensitivity in the area innervated by the inferior alveolar nerve.
For injection into the lingual nerve, 80 "alcohol is sometimes used, which is administered in an amount of 0.5 ml. Large amounts should not be administered for fear of damage to the mandibular nerve. Novocain is injected in a 0.25% solution in an amount of 3-5 ml.
The injection technique is the same as for mandibular anesthesia, with the difference that the needle should not be brought to the mandibular foramen. For this purpose, the tip of the needle is rejected by 0.25-0.5 cm to the midline from the bone. It is more convenient and more accurate to inject behind the lower molars at the point of transition of the mucous membrane from the lateral surface of the tongue to the bottom of the mouth, which corresponds to the place where the nerve enters the tongue. Injection is performed one or more times, depending on the observed effect. In order to introduce alcohol into the lingual nerve, the latter can be previously exposed in order to carry out alcoholization under the control of the eye. Exposure of the nerve gives more accurate results. It is also made for resection or twisting. The technique of exposure of the lingual nerve is as follows. The lingual nerve is exposed from the side of the oral cavity. The nerve enters the tongue between the ascending branch of the lower jaw and the anterior arch of the pharynx and lies under the oral mucosa at the large molars at the point of transition of the mucosa from the lateral surface of the tongue to the bottom of the mouth. At this point, the lingual nerve can be exposed from a mucosal incision.
glossodynia. The disease, which has the character of an increase and change in the sensitivity of the tongue, but in its manifestations is significantly different from the neuralgia of the tongue (neuralgia of the lingual nerve), is called g l os with one, or, in the terminology of some authors, "glossalgia". Glossodynia should include lingual itching (pruritus linguae) and other similar diseases.
The etiology of glossodynia, or glossalgia, is different and is associated with a number of general changes in the state of the body, such as stomach diseases accompanied by impaired secretion, blood diseases (anemia), helminthic invasion, decreased function of the sex glands, menopause, hysteria. Locally existing pain can be activated by irritation of the carotid sinus. Carotid stigmatization (intensification) of pain sensations can be accompanied by a wide repercussion, i.e., the presence of separate pain reflexes caused from different parts of the body. Therapy aimed at eliminating or reducing the manifestations of one of the diseases of the type listed above often gives positive results in relation to glossodynia.
Clinical manifestations of the disease are expressed mainly by subjective disorders. Patients complain of a burning or tingling sensation in the tongue. The localization of this feeling is uncertain, although patients often point to the tip and root of the tongue. Sometimes patients define their sensations as itching or a feeling of awkwardness in the tongue, heaviness, sluggishness, fatigue of the tongue. The appearance of these sensations is independent; sometimes patients associate it with general fatigue, the duration of speech, the intake of meat food or spicy foods. In general, these sensations are rarely sharp, painful. The duration of the unpleasant sensation is different: minutes, hours, days; the longer it lasts, the less pronounced it is. Sometimes these sensations disappear for a long period, do not appear for several months, and then reappear.
Most of these patients suffer from a fear of cancer (carcinophobia). They look for manifestations of cancer, examine their own tongue and, not knowing the anatomy, find signs that supposedly confirm the diagnosis of cancer: a tumor, especially at the root of the tongue. There are also cases of natrogenic diseases, when the doctor mistakenly takes the lymphatic follicles of the tongue for ulceration, which he assures the patient. One way or another, it must be remembered that those suffering from glossodynia often have a traumatized psyche, which requires close attention of the doctor and special care in determining their condition. Visible objective changes in glossodynia, or glossalgia, are usually absent. Sometimes hyperplasia of the lymphoid apparatus of the tongue is found, sometimes the phenomenon of atrophic glossitis. However, in most patients, significant deviations from the normal type of language cannot be detected. The manner of showing the tongue is very characteristic of a number of cases. Some patients so often inspect some side of the tongue, where they assume the presence of a lesion, that they accustom the tongue to turn only in one direction when protruding. This "one-sided display" of the language is very typical for patients with glossalgia and gives an idea of the mental experiences of the patient. In differential diagnosis, arthritis of the maxillotemporal joint should be borne in mind.
The treatment of glossalgia primarily requires intervention of a general nature, depending on the suspected diseases of other systems. In women in the premenopausal period or with symptoms of dysmenorrhea, good results are obtained from the appointment of ovarian preparations (ovarin, folliculin, sinestrol). It is sometimes useful for vagotonics with symptoms of increased acidity of gastric juice to prescribe atropine preparations. On the contrary, with complaints of dry mouth, small doses of oral pilocarpine (1% solution of 4 to 8 drops two to three times a day) have a beneficial symptomatic effect. In some cases, we have been able to achieve improvement in this way. It is useful, according to our observations, the appointment of liver preparations inside, in cases where the effects of anemia are not detected. The psyche of the patient must also become the object of therapeutic intervention. In some cases, according to our observations, diathermy of the cervical nodes gives a good effect.
Local tongue therapy is not required. Only with a psychotherapeutic purpose can neutral interventions be prescribed, which are by no means irritating. Particular attention should be paid to the environment, mainly teeth (natural and artificial). When evaluating the possible effects of teeth and prostheses on the tongue, it should be borne in mind that with glossodynia, the doctor is dealing with an organ whose sensitivity to irritation, in particular, mechanical, is aggravated, and sometimes perverted. Therefore, first of all, it is necessary to eliminate all possible sources of mechanical irritation in the oral cavity. Despite the lack of instructions from the patient, it is necessary to supplement his worn fillings, replace poorly placed ones and restore the missing ones. The surface of the seals should not have the slightest roughness. Not a single rotting root, not a single cavity, not a single sharp protrusion should be left in the oral cavity. The same strict requirements must be made! to prosthetic structures. Old prostheses with porous rubber should be removed immediately. Poorly fitted crowns with edges lagging behind the neck, with rubbed chewing surfaces, the so-called saddle bridges, bridges with "sticks", etc. - all this must be removed in a certain sequence.
Particular attention should be paid to the presence of dissimilar metals in the mouth (a metal filling is a gold crown). Due to the potential difference between dissimilar metals, electrical phenomena may occur that irritate the highly susceptible mucous membrane of the tongue. Metal prostheses that are poorly protected by chromium plating should also be regarded as a source of possible irritation. There is no reason to consider the prognosis for glossodynia unfavorable in the sense that this disease is not complicated by any severe disorders. However, it is sometimes difficult to achieve a cure for this suffering, since those general disorders that cause glossodynia cannot always be eliminated.
taste disorder. Various disorders of taste are among the neuroses of the tongue. Disorders of taste sensations can be of a different nature: ageusia (ageusia) - loss of taste, hypogeusia (hypogeusia) - decrease in taste, parageusia (parageusia) - taste perversion. With neurogenic disorders of taste sensations, one should not confuse those changes in taste that occur as a result of putrefactive processes that occur with stomatitis. In these cases, there is not a taste disorder, but the appearance of sources of an unpleasant taste that masks or distorts the usual taste sensations when eating.
Lesions of the lingual nerve cause a violation of taste sensations in the anterior part of the tongue, damage to the glossopharyngeal nerve - at the base of the tongue. Ageusia occurs with lesions of the trigeminal nerve (Gasserian ganglion, lingual nerve, tympanic string) and with central lesions (tabes, progressive paralysis). A transient disappearance or decrease in taste is observed during an attack of epilepsy: during an aura, after an attack, parageusia - sometimes during hysteria.
The structure of a speech defect is a violation of the sound-producing side of speech. For dysarthria characteristic: violations of articulatory motility in the form of a change in the tone of the articulatory muscles, limitation of the volume of their voluntary movements, coordination disorders, various kinds of synkinesis, tremor, hyperkinesis of the tongue, lips; respiratory disorders; voice disorders. Speech with dysarthria is slurred, fuzzy.
spasticity- increased tone in the muscles of the tongue, lips, face and neck. With spasticity, the muscles are tense. The “lump” tongue is pulled back, its back is spastically curved, raised to the top, the tip of the tongue is not expressed. The tense back of the tongue raised to the hard palate helps to soften consonant sounds.
(palatalization). Sometimes spastic tongue "sting", stretched out in front. An increase in muscle tone in the circular muscle of the mouth leads to spastic tension of the lips, tight closure of the mouth (it is difficult to voluntarily close the mouth). In some cases, with a spastic condition of the upper lip, the mouth may be ajar. In this case, there is an increase in salivation (hypersalivation). Active movements with spasticity of the articulatory muscles are limited.
hypotension- decreased muscle tone.
With hypotension, the tongue is thin, flattened in the oral cavity; lips flaccid, unable to close tightly. The mouth is usually half open, hypersalivation may be expressed. Hypotension of the muscles of the soft palate prevents sufficient advancement of the palatal curtain
up and pressing it against the back wall of the pharynx; a stream of air exits through the nose. The voice takes on a nasal tone (nasalization).
Dystonia- changing nature of muscle tone. At rest, low muscle tone can be observed, while trying to speak and at the time of speech, the tone increases sharply. Dystonia distorts articulation. A feature of sound pronunciation in dystonia is the inconsistency of distortions, substitutions and omissions of sounds.
In children with neurological pathology, a mixed and variable nature of tone disturbances in the articulatory muscles (as well as in the skeletal) is often noted. For example, spasticity may be noted in the lingual muscles, and hypotension in the facial and labial muscles.
Impaired mobility of the articulatory muscles.
Limited mobility of the muscles of the articulatory apparatus is the main manifestation of paresis of these muscles.
Insufficient mobility of the articulatory muscles of the tongue and lips causes a violation of sound pronunciation. With damage to the muscles of the lips, the pronunciation of both vowels and consonants suffers. Articulation as a whole is disturbed. Sound pronunciation is especially grossly impaired with a sharp restriction of the muscles of the tongue.
The degree of impaired mobility of the articulatory muscles can be different - from complete impossibility to a slight decrease in the volume and amplitude of articulatory movements of the tongue and lips. First of all, the most subtle and differentiated movements are violated (raising the tongue up).
Specific disorders of sound pronunciation:
- the persistent nature of violations of sound pronunciation, the particular difficulty of overcoming them;
- specific difficulties of automating sounds (duration of automation time). With the untimely completion of speech therapy classes, the acquired speech skills often disintegrate;
- the pronunciation of not only consonants, but also vowels is impaired (average or reduction of vowels);
- the predominance of interdental and lateral pronunciation of whistling with s, c, and hissing sh w h sch sounds;
- stunning voiced consonants (voiced sounds are pronounced with insufficient participation of the voice;
- softening of hard consonant sounds (palatalization);
- violations of sound pronunciation are especially pronounced in the speech stream. With an increase in speech load, general blurring of speech is observed, and sometimes increases.
Depending on the type of violation, all defects in sound pronunciation in dysarthria are divided into two categories: anthropophonic (distortions of sounds) and phonological (substitutions, mixing). In dysarthria, the most typical violation of the sound structure of speech is sound distortion.
Respiratory disorders are caused by insufficiency of the central regulation of respiration. The rhythm of breathing is disturbed: at the moment it becomes more frequent. There is a violation of the coordination of inhalation and exhalation (a superficial inhalation and a shortened weak exhalation). Exhalation often occurs through the nose, despite the half-open mouth. Respiratory disorders are especially pronounced in the hyperkinetic form of dysarthria.
Voice disorders are caused by changes in muscle tone and limitation of mobility of the muscles of the larynx, soft palate, vocal folds, tongue and lips. Most often, there is insufficient voice power (quiet, weak, fading) and deviations in the timbre of the voice (deaf, nasalized, squeezed, hoarse, intermittent, tense, gotany).
Violations of prosodic (melodic-intonational and tempo-rhythmic characteristics of speech).
Melodic intonation disorders are often among the most persistent signs of dysarthria. They have a greater effect on the intelligibility, emotional expressiveness of speech. There is a weak expression or absence of voice modulations (the child cannot arbitrarily change the pitch). The voice becomes monotonous, little or unmodulated. Violations of the pace of speech are manifested in its slowdown, less often in acceleration. Sometimes there is a violation of the rhythm of speech (scanning - "chopped" speech, when there is an additional number of stresses in words).
Insufficiency of kinesthetic sensations in the articulatory apparatus.
In children with dysarthria, there is a weakness in the kinesthetic sensations of articulatory postures and movements.
With dysarthria, vegetative disorders occur.
Frequent autonomic disorder is hypersalivation. Increased salivation is associated with restriction of the movements of the muscles of the tongue, impaired voluntary swallowing, cuts in the labial muscles. This disorder is aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus and a decrease in self-control. There is a vegetative disorder, such as redness or pallor of the skin, increased sweating during speech.
In children with dysarthria, the act of eating is often difficult, and in severe cases, there is no chewing of solid food, biting off a piece. Choking and choking are often noted when swallowing. Difficulty drinking from a cup. There is a lack of coordination between breathing and swallowing.
Dysarthria disorders may be accompanied by synkinesis.
Synkinesia- involuntary concomitant movements when performing voluntary articulatory movements (additional upward movements of the lower jaw and lower lip when trying to raise the tip of the tongue)
Oral synkinesis - opening the mouth during any voluntary movement or when trying to perform it.
Increased pharyngeal (vomit) reflex.
Loss of coordination of movements (ataxia)
Ataxia manifests itself in dysmetric, asynergic disorders and in scanned speech rhythm.
Dysmetria- this is disproportion, inaccuracy of arbitrary articulatory movements. It is most often expressed in the form of hypermetry, when the desired movement is realized by a more sweeping, exaggerated, slow movement than necessary (an excessive increase in motor amplitude). There is also a violation of coordination between breathing, voice formation and articulation (asynergy).
Ataxia is noted in atactic dysarthria.
The presence of violent movements (hyperkinesis and tremor) in the articulatory muscles.
Hyperkinesis- involuntary, non-rhythmic, violent movements of the muscles of the tongue.
Tremor- trembling of the tip of the tongue (most pronounced with purposeful movements). Seen in atactic dysarthria.
Currently, the problem of childhood dysarthria is being intensively developed in clinical, neurolinguistic, psychological and pedagogical directions. It is described in most detail in children with cerebral palsy (M. B. Eidinova, E. N. Pravdina-Vinarskaya, 1959; K. A. Semenova, 1968; E. M. Mastyukova, 1969,1971,1979,1983; I. I. Panchenko, 1979; L. A. Danilova, 1975, etc.). In foreign literature, it is represented by the works of G. Bohme, 1966; M. Climent, T. E. Twitchell, 1959; R. D. Neilson, N. O. Dwer, 1984.
1.
Badalyan L.O. Pediatric neurology. — M.: Medicine, 1984. — 575p.
2.
Speech therapy / Ed. L.S. Volkova, R.I. Lalaeva, E.M. Mastkova., M .: Education, 1989. - 527p.
3.
Mastyukova E.M., Ippolitova M.V. Speech disorders in children with cerebral palsy. — M.: Enlightenment, 1985. — 192p.
4.
speech therapy. Methodical heritage / Ed. L.S. Volkova: In 5 books. Book.I. Part 2. Rhinolalia. Dysarthria. - M.: Vlados, 2003. - 303 p.
5.
Atlas of the human nervous system structure and violation/ Ed. V.M. Astapova, Yu.V. Mikadze - M.: PER SE, 2011. - 79s.
