- mild disorders of the phonetic and prosodic components of speech, due to a mild violation of the innervation of the articulatory organs. A speech defect is characterized by fuzzy articulation, distortion of the sounds of several phonetic groups, automation difficulties, and inexpressive speech. Dysarthria disorders are diagnosed in the process of clarifying speech therapy and neurological status. Correction is carried out using articulatory, respiratory and finger gymnastics, speech therapy massage. Special efforts require automation of evoked sounds and normalization of prosody. In parallel, treatment is carried out by a neurologist.

Pathogenesis

With a mild degree of dysarthria, damage to the lower branch of the trigeminal (V pair), facial (VII pair), glossopharyngeal (IX pair), and hypoglossal (XII pair) nerves is usually detected. As a result, the function of the muscle groups innervated by these cranial nerves is impaired. With the defeat of the trigeminal nerve, there is a restriction of the mobility of the lower jaw, synkinesis of the lips and tongue is noted. Violation of the function of the facial nerve predetermines the insufficient volume of facial movements, smoothness and asymmetry of the nasolabial folds. Innervation inferiority of the glossopharyngeal nerve explains the nasalization of speech, hypersalivation, limitation of the amplitude of movements of the root and back of the tongue. Functional insufficiency of the hypoglossal nerve causes difficulties in maintaining the articulatory position and raising the tongue to the upper position, tremor of the tongue.

With MDD, the function of the muscles of the tongue, the circumference of the mouth, the palate, mimic and masticatory muscles involved in the control of the motor side of speech is primarily affected. The leading disorder in erased dysarthria is persistent phonetic defects. Inadequate innervation of the articulatory organs negatively affects the intonation-expressive aspect of speech. Phonemic and lexical-grammatical disorders are caused by blurry articulation and therefore are of a secondary nature.

Classification

Speech status with erased dysarthria can be impaired in various aspects: in some cases, phonetic defects prevail, in others - prosodic, in the third - they can be equivalent. Depending on the pathogenetic variant, the following types of MDR are distinguished:

• Erased cortical dysarthria. It is caused by a microfocal lesion of the cortical motor speech center. Only the phonetic (pronunciation) sides of speech are disturbed. The phonemic and prosodic components are preserved.
• Erased extrapyramidal dysarthria. Associated with damage to the subcortical nuclei and ganglia. Prosodic disorders come to the fore; violations of sound reproduction and sound perception are expressed to a lesser extent.
• Erased pseudobulbar dysarthria. It occurs when the pathways leading from the cortex to the nuclei of the cranial nerves are damaged. Violations of all phonetic-phonemic components are equally determined.
• Mixed form of erased dysarthria. Usually includes a pseudobulbar component, so the main defects are noted in the pronunciation and sound-distinctive side of speech.

Symptoms of erased dysarthria

In a child with mild dysarthria, the motor sphere, sound pronunciation, and the prosodic aspect of speech are impaired. However, all these defects are minimally expressed, in an erased form, therefore, they are detected only with a careful neurological and speech therapy examination. Usually erased dysarthria is diagnosed at 5-6 years. Prior to this, speech disorders are regarded as polymorphic dyslalia, and only the extraordinary persistence of sound pronunciation defects makes specialists take a deeper look at the problem.

In the general physical development of children with MDD, there is a slight lag behind the age norm. Patients may be short, underweight, and have a narrow chest. They are clumsy, get tired quickly during physical exertion, and find it difficult to synchronize movements. Along with the general motor sphere, fine motor skills suffer. Due to the fact that the differentiated movements of the fingers are disturbed, children have difficulty mastering self-service skills (buttoning, tying shoelaces), they feel awkward in creative work (drawing, appliqué, modeling), they do not like toys with small details (puzzles, constructor). Schoolchildren suffer from graphomotor skills: illegible handwriting, low writing speed.

The defeat of the mimic and articulatory muscles is indicated by hypomimicry of the face, lethargy of the lips, paretic tongue, asymmetry of the nasolabial folds and corners of the mouth. When performing articulation tests, hyperkinesis, synkinesis, slight cyanosis and deviation of the tongue appear. During speech activity, hypersalivation is noted. Difficulty performing articulation movements, maintaining posture, smooth switching from one articulum to another. In the neuropsychic status of children with erased dysarthria, vegetative disorders (sweating and cyanosis of the extremities, persistent dermographism) are revealed. The child can be easily excitable, fussy or inhibited, lack of initiative. Characterized by reduced performance, poor switchability, instability of attention, reduced memory capacity.

Violation of sound pronunciation is multiple in nature - phonetic defects affect two or more groups of sounds (usually whistling, hissing and sonorous). Abnormal pronunciation in most cases is represented by sound distortions (interdental and lateral sigmatism, throat rotacism), often in combination with the absence and replacement of sounds, defects in voicing / stunning and softening. Even having achieved the normative isolated sound of the phoneme, it is difficult to automate the disturbed sound and introduce it into speech. Along with sound pronunciation, the prosodic aspect is violated: the voice is fading, intermittent, unmodulated, nasalized, the intonational expressiveness of speech is reduced. In general, the child's speech is "blurred", poorly legible.

Complications

Sound and prosodic disorders inevitably cause defects in phonemic perception. At the same time, differentiation suffers not only from acoustically close phonemes, but also from sounds that are quite distant in their acoustic and articulatory properties. The impossibility of clear diction and non-differentiation of auditory control underlie FFN. In turn, this creates prerequisites for difficulties in mastering the syllabic structure of the word, inflection and word formation. Dictionary and grammatical violations are also revealed for the second time: depletion of vocabulary, insufficient assimilation of the semantics of the word, agrammatisms. By the beginning of schooling, children with MDD are not sufficiently prepared to master the Russian language program, which inevitably leads to the appearance of persistent shortcomings in writing - dysgraphia.

Diagnostics

To detect the erased manifestations of dysarthria, a complex of medical and pedagogical studies is carried out: the study of anamnestic data, analysis of the child's medical record, an objective examination and instrumental diagnostics. During the examination, close cooperation between a speech therapist and a pediatric neurologist is necessary. The main diagnostic steps include:

• Logopedic examination. At the initial consultation, the speech therapist examines the child's history in detail, examines the state of general and fine motor skills, articulatory praxis and facial muscles, prosody, and speech breathing. Then proceeds to the assessment of sound pronunciation, phonemic hearing, vocabulary and grammar. If dysarthria is suspected, the specialist refers the child to a neurologist.
• Neurological examination. Allows you to identify the nature and determine the severity of specific disorders (paresis, muscular dystonia, oral apraxia, hyperkinesis). In order to objectify the diagnosis and identify pathology, which can serve as a pathogenetic basis for mild dysarthria, EEG, electroneuromyography, brain MRI are prescribed.

It is necessary to appear for a second appointment with a speech therapist, having the conclusion of a neurologist and the results of the diagnostics in hand. Based on a comparison of medical and psychological and pedagogical data, a speech pathologist-defectologist makes a conclusion about the presence of speech disorders in the child (FFN, OHP) caused by erased dysarthria. In the process of medical and speech therapy examination, MDR is differentiated from polymorphic (complex) dyslalia.

Correction of erased dysarthria

The tactics of corrective work in MDD include medical and speech therapy interventions. Only an integrated approach makes it possible to achieve a stable positive effect and compensation for a speech defect. Parents should tune in to long and painstaking work, stock up on perseverance and patience. General medical and speech therapy activities are carried out in parallel and include the following components:

• Neurological treatment and rehabilitation. As part of the medical approach, the intake of nootropic drugs, B vitamins, designed to activate the nervous system, is shown. It is advisable to supplement drug therapy with general massage, exercise therapy, reflexology, physiotherapy, and swimming. This will normalize muscle tone, improve motor skills.
• Finger and articulation gymnastics. The development of coordinated hand movements is closely related to the development of articulatory praxis, therefore, in the process of speech therapy classes, much attention is paid to finger gymnastics. Articulation exercises help to strengthen the oral muscles, mastering the correct articulation patterns and switching. Special breathing techniques help to develop a strong and smooth air stream, which is necessary for normative phonation.
• Logopedic massage. It is an integral component of the correction of erased dysarthria. It can be included in the structure of speech therapy classes or conducted as a separate course. Allows you to prepare the organs of articulation for sound production. Includes massage of the muscles of the face and oral cavity. Probe massage is most effective for dysarthria.
• Correction of speech disorders. It involves the production of defective sounds, their consolidation (automation) in syllables, words and phrasal speech, the differentiation of mixed phonemes. A feature of the MDR correction is the complexity and duration of the automation of sounds. At the same time, work is underway to overcome phonemic disorders, develop the intonation-melodic side of speech, and master lexical and grammatical categories. The total duration of the speech therapy course can be up to 1 year or more.

Forecast and prevention

By itself, erased dysarthria does not pose a threat to the physical development and health of the child. However, any speech disorders, even minimally expressed, impede full-fledged communication, entail secondary speech and psychological layers. Timely uncorrected dysarthria disorders due to persistent defects in diction can impose certain restrictions on the choice of profession and self-realization of the individual. To avoid the occurrence of dysarthria, future parents will help maintain a healthy lifestyle, prevent negative effects on the fetus, careful delivery, and prevent infections in young children.

Sometimes we meet people, including children, whose speech is difficult to understand, because. it is indistinct, monotonous, without intonations and voice modulations. In addition, other behavioral features also fall into the eyes. This means that we are faced with a case of dysarthria. From Latin, this term is translated as "a disorder of articulate speech." Erased dysarthria, being one of its forms, has not very clear, erased psychological, neurological and speech manifestations.

ICD-10 code

R47.1 Dysarthria and anartria

Epidemiology

The epidemiology of the disease is such that the examination of preschool children by speech therapists reveals speech defects in half of them. Among disorders, dysarthria is one of the most common, and 60-85% of cases of the disease are caused by cerebral palsy.

Causes of erased dysarthria

Erased dysarthria - echoes of damage to certain parts of the brain - the higher part of the central nervous system (CNS), which has a connection with all tissues and organs of the peripheral nervous system. That is why its failures entail violations of other organs. The causes of erased dysarthria include:

• head injury;
• infectious diseases(encephalitis, meningitis, etc.);
• intoxication of the body with nicotine, alcohol, drugs or medications with improper treatment;
• vascular diseases (strokes);
• tumors;
• other diseases (multiple sclerosis, Alzheimer's, Parkinson's disease);
• hereditary diseases;
• birth trauma or received during a dysfunctional pregnancy;
• cerebral palsy.

Risk factors

Based on the causes leading to erased dysarthria, risk factors are cerebral atherosclerosis, head injuries, bad habits, careless behavior with chemicals (arsenic, nitrogenous compounds), chronic liver and kidney diseases that affect the brain. In children, erased dysarthria occurs due to infection inside the womb, birth trauma, severe toxicosis during gestation, a mismatch between the Rh factor of a woman and a child, fetal hypoxia, and asphyxia during childbirth.

Pathogenesis

At the heart of the pathogenesis is the defeat of the central and peripheral nervous system of a person. The speech mechanism is designed in such a way that a signal goes from the central nervous system along the centrifugal nerves to the receptors of the speech organs to start it. If one of the links in the brain-face chain is damaged, signals from the cerebral cortex do not reach the muscles responsible for articulation, breathing, and voice.

Symptoms of erased dysarthria

Symptoms of erased dysarthria are expressed both in speech defects and in behavioral actions. Speech symptoms are manifested in the incorrect pronunciation of front-lingual, hissing and whistling sounds. At the same time, the voice is monotonous, weak and quiet, the timbre is changed. Auditory perception is reduced. Non-verbal symptoms include weakening of voluntary movements, the appearance of pathological reflexes (sweating of the feet, palms), involuntary automatic twitching of the face (hyperkinesis), changes in muscle tone. Increased (spasticity) is given out by tightly closed lips, tense muscles of the neck and face, limited movements of the speech apparatus. With reduced tone (hypotension), the tongue is flaccid and lies at the bottom of the mouth, the lips are half open, saliva flows. The change of one tone to another (dystonia) disrupts breathing during a conversation, at the time of pronunciation of words it is intermittent and rapid. In some cases, memory loss, difficulty concentrating, and mental activity are possible.

The first signs of erased dysarthria are blurring, blurring of spoken words, fuzzy articulation, and distortion of sounds. Often such speech resembles a conversation with a full mouth. With adults, this happens after a stroke, a head injury. In infants, a weak sucking reflex may indicate the first signs of the disease.

The development of the motor sphere in erased dysarthria

The development of the motor sphere with erased dysarthria directly depends on which nerve endings the connection is lost with. So, damage to the trigeminal nerve makes it difficult to open and close the mouth, chewing and swallowing food. Due to damage to the sublingual, there is a difficulty in controlling the tongue, the facial one - the inability to puff out the cheeks or frown the eyebrows, and the glossopharyngeal - a malfunction of the larynx, palate, which causes the voice to change, breathing goes astray, etc. But to erased dysarthria most often leads to a violation of the functions of the hypoglossal nerve.

Erased pseudobulbar dysarthria

Erased pseudobulbar dysarthria is more common than others. The reason for its appearance is brain damage that occurred in childhood. This may be a tumor, trauma during childbirth, encephalitis, etc. As a result, no signal is received from the cerebral cortex to the cranial stem nerves that control the speech apparatus. Because of this, motor skills suffer, facial muscles weaken. In such people, the mouth is ajar, saliva flows, the tip of the tongue rises and moves with difficulty, the words are blurred and incomprehensible, nasality appears in the voice. There are three degrees of erased pseudobulbar dysarthria. Mild degree corresponds to minor speech disorders. Most often, r, c, h, w, w are incorrectly pronounced, while voiced sounds do not have sufficient sound content. The average degree is expressed in the immobility of the muscles of the face, difficulty in chewing or swallowing, profuse salivation. The pronunciation of most sounds is distorted, voiced consonants are pronounced muffled, vowels are not voiced enough. Only k, n, m, t, p, x are obtained. A severe degree is characterized by complete immobility of the facial muscles, the mouth is open, chewing and swallowing movements are difficult, speech is absent.

Erased dysarthria in children

Erased dysarthria in children most often occurs as a result of abnormalities during pregnancy, abnormal birth, fetal asphyxia. While the child is not talking, the symptoms are manifested in a weak sucking instinct, refusal to take the nipple in the mouth. In addition, he is somewhat behind in physical development. Poor capture and holding of objects in hand, does not like to play with small toys, collect details of the designer, draw, sculpt. Such a child has increased salivation, inactive facial expressions, it is impossible to roll the tongue into a tube. But, in general, his condition does not cause much concern.

Erased dysarthria in preschoolers

At preschool age, deviations associated with general motor skills become noticeable. Children walk awkwardly, cannot stand on one leg, quickly get tired of physical exertion, do not imitate movements well, react late to changes in positions, tempo and musical rhythm in music lessons, weakly hold a pen in their hand and do not like to draw. It is difficult for such children to sufficiently serve themselves, fasten or unfasten buttons, tie a scarf. At the age of 5-6, features of the articulatory apparatus appear. With reduced muscle tone, the lower jaw is poorly held in an elevated state, so the mouth does not close, lips and tongue are flaccid. Spasticity of the muscles gives a half-smile of the face, their hardness on palpation. It can be difficult for them to keep the same position for a long time: puffed out cheeks, lips with a tube, protruding tongue, because. after a while he begins to tremble and twitch. Conventionally, pronunciation errors are divided into three groups:

• with violations of the pronunciation of sounds and intonation-expressive coloring of speech (prosodic). Such children pronounce words well, have a large vocabulary, but polysyllabic words cause difficulty. They are characterized by poor spatial orientation;
• unformed phonetic hearing joins the first violations. This is expressed in the inability to coordinate various parts of speech in sentences, pronounce complex words, and a weak vocabulary. This group of children is sent to a special kindergarten;
• with obvious violations of pronunciation, prosodic, underdevelopment of phonetic hearing. For such children, specialized groups are organized in kindergartens.

Erased dysarthria in adults

Unlike children, adults have already formed a speech apparatus and a conversational skill at the time of the onset of dysarthria. They hear and perceive everything. Defects in the speech production apparatus occur as a result of damage to the central nervous system for one of the above reasons. The respiratory and articulatory systems are involved in the creation of sounds. Respiratory is responsible for voice formation, which is possible due to the ingress of air from the larynx to the resonators, reflecting it to the articulatory apparatus. That, in turn, with the help of such instruments as the tongue, larynx, palate, lips, teeth, gives rise to sound. Failure of any of these chains leads to speech disorders.

stages

The degree of speech deviation from the norm and the severity of damage to the nervous system are directly related. Speech therapists distinguish four stages of dysarthria. At the first, the distortion of sounds is heard only by a speech therapist. At the second stage, the speaker's speech is understandable, although errors in pronunciation are obvious even to outsiders. The third stage has more pronounced defects - distortions, omissions or substitution of sounds. The conversation is slow, the words are inexpressive, indistinct, they are understood only by relatives. The fourth stage is the most difficult, it occurs with complete paralysis of the speech motor muscles, when speech becomes impossible or completely incomprehensible even to those close to you.

Forms

The types of erased dysarthria are determined by the localization of the CNS lesion, which is responsible for the function of speech, and its symptoms. The following are distinguished:

• pseudobulbar, in which cortical-nuclear nerve endings are affected. It is characterized by a violation of the pronunciation of sounds, lethargy of the speech muscles;
• corticalcaused by a focal lesion of the cerebral cortex (voluntary movements are difficult);
• mixed.

Complications and consequences

The consequences and complications of erased dysarthria are in the social and psychological plane. Serious speech defects that make it difficult to communicate in the family, team, with friends can lead to social isolation. This, in turn, leaves an imprint on the emotional state of a person, causes depressed mood, depression.

Diagnosis of erased dysarthria

Diagnosis of erased dysarthria is carried out by a neurologist and a speech therapist. It is necessary to assess the degree of damage to the central nervous system, its localization.

The neurologist in his conclusions relies on instrumental studies. The speech therapy conclusion is based on an assessment of speech and non-speech symptoms: the nature of breathing, the state of the facial muscles, the ability to produce articulatory movements. Oral speech is analyzed: pronunciation of words, their intonation, intelligibility, rhythm and tempo.

Written tests are carried out: dictations, writing off texts, reading aloud. In children, erased dysarthria is diagnosed after 5 years.

Blood and urine tests are prescribed to determine the general condition of the body.

Instrumental diagnostics plays an important role in determining the diagnosis, its volume depends on the initial diagnosis made by a neurologist or a pediatric neurologist. The following studies will give the most accurate picture: MRI of the brain, electromyography, electroencephalography, electroneurography.

Differential Diagnosis

The task of differential diagnosis, based on assessments of symptoms, is to separate erased dysarthria from motor allalia, aphasia and dyslalia. All these diagnoses are associated with lesions of the brain foci, so only neurological studies will answer the question.

During the diagnosis of erased dysarthria, it is difficult to distinguish between its mild form and complex dyslalia, because. they have similar symptoms. In the case of dyslalia, speech defects are not associated with CNS damage. Most often, it is caused by the peculiarities of the anatomical structure of the articulatory apparatus. Consider the differential signs of dyslalia and erased dysarthria. The main criteria that guide the definition of erased dysarthria are as follows:

• state of articulation (slowness of pace, difficulty in holding or switching articulation);
• the presence of changes in intonation and clarity of pronunciation of words;
• the appearance of other movements while moving the tongue;
• stable nature of violations of the pronunciation of sounds.

Dyslalia is characterized by a violation of the articulation of only consonants, including in various versions of their pronunciation. The sounds formed by the speech therapist are well absorbed, the rhythm and pace of speech are not disturbed, breathing, articulation, and voice formation are coordinated. In contrast, with erased dysarthria, vowels are often pronounced nasally. Separate isolated sounds may sound correct, but are distorted in the word. Their staging causes difficulty, the pace of pronunciation is not stable, breathing is disturbed, speech is made on inspiration. All functions required for correct pronunciation are not coordinated.

Treatment of erased dysarthria

The treatment of erased dysarthria is complex, including drug treatment, the use of physiotherapeutic and pedagogical methods. The goal of treatment is to achieve such a level of pronunciation of words that speech is understandable to others, and the person can adapt to society. For children with erased dysarthria, there are specialized speech therapy groups that are formed depending on the level of development: with phonetic, phonetic-phonemic and general speech impairment. Drug treatment is prescribed by a neurologist and is aimed at enhancing brain activity. These are vascular, nootropic, sedative and metabolic drugs. With the help of therapeutic exercises, the facial muscles are strengthened, fine and gross motor skills of the hands develop, because. it is directly related to the functions of speech. Respiratory gymnastics is also necessary, in this case Strelnikova's gymnastics is effective, facial massage is mandatory. This complex of therapeutic measures is complemented by the continuous work of a speech therapist in the production of sounds.

Methods of correction for erased dysarthria

Correction methods for erased dysarthria include all of the above procedures with the addition of other non-traditional ones. They depend on the severity of the damage to the speech apparatus. At the first stage, facial muscles are strengthened through massage. Next, special exercises are done to establish the correct articulation. This is followed by work on the autonomous production of sounds, then on the correct pronunciation of them in words. If work is carried out with a child, then psychological support in the form of praise and approval is important. In parallel, acupuncture, hirudotherapy, therapeutic baths are used. The method of treatment with the help of communication with dolphins (dolphin therapy), games with the use of sand (sand therapy), game exercises (sensory therapy) gives good results.

Prospective planning for erased dysarthria

Long-term planning for erased dysarthria was developed for preschool children and consists in the development of speech hearing, visual, auditory attention. For this, games are held: for example, with the help of pictures and toys, they offer to remember their location or presence, and then tell what has changed. This strengthens visual attention. To enhance hearing, noise toys are used, for example, you need to guess who owns the voice or where the sound comes from. The next stage is aimed at developing the mobility of the articulatory apparatus. It consists of various exercises for the development of the jaw, strengthening the mobility of the lips, muscles of the tongue, cheeks, breathing exercises. Special gymnastics is done to develop the skills of staging and pronunciation of individual sounds. For this, a visual demonstration is used, where the tongue should be, how the lips are located. In front of the mirror, the skill is being practiced to pronounce whistling, hissing, sound r, l. Further, with the help of games, work is carried out on the correction of sounds, on their accuracy, purity, tempo, and strength. Then there is work on the sound, for which verses, tongue twisters, sayings are memorized and pronounced. Games for recognizing the sound in syllables develop phonemic perception. The great work done is crowned with exercises on the ability to differentiate sounds in syllables, words, phrases, sentences.

Calendar-thematic planning for erased dysarthria

Calendar-thematic planning for erased dysarthria in children provides for an individual work plan with a phased implementation of corrective measures, indicating specific actions and deadlines. This plan is developed for a specific patient, taking into account the age and depth of damage to the speech apparatus. As a rule, it consists of a preparatory and main stage. The first preparatory stage is aimed at forming the interaction between visual, auditory and motor perception, at improving fine motor skills, articulation, memory, and the ability to analyze. The purpose of the main one is the development of speech, the correction of phonetic errors in sounds, the strengthening of the articulatory apparatus.

Logopedic work with erased dysarthria

Drawing up calendar-thematic plans and their phased implementation - this is the speech therapy work with erased dysarthria. Distinctive features of this diagnosis are that a speech therapist needs to carry out a large and time-consuming preparatory stage to make a correction in the pronunciation of sounds. The effectiveness of speech correction in the future depends entirely on the successful work of a speech therapist at this stage.

Exercises for erased dysarthria

Special exercises have been developed for erased dysarthria to strengthen the articulation apparatus, develop general motor skills, including hands, coordination of movements, normalize voice and breathing during pronunciation of words. Hand exercises include lacing, stringing beads on a string, shading with a pencil, modeling with plasticine. They improve coordination of movements with the help of pantomime: with your hands you need to portray what you heard.

There are other exercises to coordinate movements. Speech breathing and voice are normalized with the help of Strelnikova's gymnastics. Here are a few tricks: take a shallow breath, hold your breath and exhale slowly; inhale, hold the air, pronounce any vowel sound as you exhale; on exhalation, smoothly change one vowel sound to another. Also, playing the pipe, inflating balloons helps a lot. Therapeutic measures for speech correction also include exercises for touching objects, spatial representation. To do this, by touch, by texture and form, they offer to recognize the subject, etc. They give the skills to establish a causal relationship, to generalize.

Staging sounds with erased dysarthria

The production of sounds with erased dysarthria begins with vowels, because. they play a major role in the intelligibility and clarity of pronunciation of words, the emotional coloring of speech. At first, work is being done on the correction of such sounds: e, a, i, s, o, u. After achieving clarity in articulation, they move on to consonants [m "-m], sonorants [n "-n], [j], [l "-l], [r "-r], bow-explosive [n "-p] , [b"-b], [t"-t], [d"-d], [k"-k], [g"-k], slotted [f"-f], [c"-c] and front-lingual [s "-s], [s" -s], [sh-zh], [x"-x], [u], [h], [c]. First comes the preparatory stage, then the production of sounds.

Articulatory gymnastics for erased dysarthria

A special articulatory gymnastics has been developed for erased dysarthria using both dynamic and passive exercises.

There is Ermakova's technique for masticatory muscles. Exercises consist in alternately opening and closing the mouth, inflating and retracting the cheeks, pushing forward and towards the jaw, biting the upper lip with the lower lip. Gymnastics Arkhipova is also aimed at strengthening the muscles of the face. It consists in puffing out the cheeks, stretching the lips with a tube, exposing the upper and lower teeth in turn, retracting the lips into the oral cavity, snorting with a “horse”, imitation of rinsing the teeth.

Passive gymnastics for the tongue according to the method of Pravdina involves movements under the influence of another person. Such exercises are carried out in three stages: entry, maintenance and exit from the position. For example, you need to close your lips, an outsider holds them with a finger and offers to blow into them and try to open them. The pronunciation of each group of sounds corresponds to a certain location of the tongue, lips, muscle tension. It is to strengthen these skills that articulatory gymnastics is aimed.

Massage for erased dysarthria

Massage with erased dysarthria is used to strengthen or relax the facial muscles. With hyperkinesis and hypertonicity, a relaxing massage is done. It consists in a short 1-1.5 minute tapping, stroking the face from the temples to the bridge of the nose, forehead, nose, lips. People with low tone are prescribed a firming massage. In this case, the face is longer (3 minutes) and deeply kneaded and rubbed. All movements are directed horizontally from the center to the periphery of the face.

To improve the motor skills of the hands, massage and self-massage of the fingers and hands are carried out. So, in the form of games, children are offered to imitate the movements of an iron, a saw, kneading dough, and others, accompanied by special quatrains on this topic.

Adapted program for erased dysarthria

The adapted program for erased dysarthria is designed for the development and education of preschool children, taking into account their characteristics. It is a plan for a speech therapist teacher and other participants in the educational process, determines the priorities of training, gives a methodology and its organizational aspects, regulates all types of training and a system for evaluating the results of its assimilation. In addition to a speech therapist, educators are involved in it, who, within the framework of an adapted program, are entrusted with conducting games, conversations, excursions, a music director, a specialist in fine arts, an athlete, parents are also involved. The program has been developed for two years and consists of several stages.

• At the first initial diagnostic stage, by collecting an anamnesis, psychological and speech therapy tests, the degree of speech damage and tasks for correcting defects are determined, and a speech map is filled out.
• At the second organizational and preparatory stage, an individual correction program is developed.
• The third stage - correctional-technological provides for the implementation of all planned activities.
• The fourth one is the final diagnostic one.

Speech therapy studies are carried out to assess the state of the speech apparatus and other functions of the child. Decisions are made to stop classes with a speech therapist in case of positive results, to continue or change the nature of classes.

It is important to know!

Dysarthria is a speech disorder that results in slurred, often difficult to understand pronunciation. This pathology is studied both by neurologists, since the cause of its occurrence is the transformation of the nervous regulation of the speech apparatus, and by speech therapists involved in pronunciation correction.

Dysarthria in children is a condition in which the pronunciation of words is disturbed as a result of damage to the nervous system. With this pathology, the innervation of the speech apparatus (tongue, lips and soft palate) suffers. A distinctive feature of the disease is the violation of all speech as a whole, and not just individual sounds.

Reasons for the development of dysarthria

The disease occurs in 5% of all children. There are several important factors that contribute to the occurrence of dysarthria in a child:

• intrauterine fetal hypoxia;
• Rh-conflict pregnancy;
• severe gestosis;
• prematurity;
• asphyxia;
• birth trauma;
• prolonged jaundice;
• hydrocephalus;
• brain tumors;
• meningitis;
• encephalitis;
• purulent otitis;
• traumatic brain injury.

Quite often, dysarthria in a child occurs in combination with cerebral palsy. The causes of both pathologies are similar and are associated with damage to the nervous system of the baby in utero or during childbirth. Often, traumatic factors exert their influence in the first two years of life, leading to the formation of dysarthria.

Do not forget about regular medical examinations in the first months of a child's life. Don't miss the sickness!

Classification of dysarthria

Dysarthria in children exists in several varieties. Forms of the disease are divided according to the location of the pathological focus.

• Bulbarnaya

This form of the disease is characterized by paralysis of the muscles directly responsible for the formation of speech. With this pathology, many nerve fibers are affected, as a result of which the activity of certain muscle groups is disrupted. Often this form of the disease is accompanied by a violation of swallowing liquid food and other disorders. Articulation in this pathology is extremely slurred, the sounds practically do not differ from each other. Characterized by the absence of facial expressions.

• pseudobulbar

The characteristic of this form of the disease includes paralysis of the speech muscles as a result of damage to brain structures. Often, this pathology is combined with other signs of damage to the nervous system (involuntary crying or laughter, the presence of reflexes of oral automatism in a child older than 6 months). A distinctive feature of this type of dysarthria in a child is monotonous speech.

• Cortical

It is characterized by unilateral damage to the structures of the cerebral cortex, which naturally leads to paresis or paralysis of the speech muscles. Symptoms of the disease include the incorrect pronunciation of individual syllables, although the general structure of speech is preserved.

• Cerebellar

This form of the disease is characterized by damage to the cerebellum - a special structure of the brain. With this variant of the disease, the child's speech becomes stretched, with constantly changing volume and tone.

• subcortical

The characteristic of this variant of dysarthria includes the defeat of the subcortical structures responsible for the formation of speech. The subcortical form is distinguished by slurred and slurred speech. In children, it is often combined with hyperkinesis (pathological movements in various muscle groups).

• mixed

Most often occurs with various injuries in a child under the age of 2 years. This form is characterized by a combination of several causes and factors leading to the formation of dysarthria.

Signs of dysarthria

The characteristic of the pathology is not only to identify the cause and location of the lesion of the speech apparatus, but also to determine the severity of the disease. Specialists distinguish 4 forms of the disease, differing in the severity of speech disorders in a child.

Erased dysarthria (I degree)

With this form of the disease, children do not differ too much from their peers. The disease is usually detected at the age of 4-5 years. Symptoms of the pathology are not very specific and can be disguised as other similar diseases of the nervous system. With an erased version of dysarthria, parents notice a mixture, distortion or replacement of some sounds with others. Very often, babies cannot pronounce whistling and hissing sounds. Many children experience certain difficulties in pronouncing long words, omitting some of the sounds.

The erased form of dysarthria is very similar to dyslalia, and even experienced specialists are not always able to make the correct diagnosis from the first appointment. Dyslalia in children is characterized by the appearance of various speech defects with the complete preservation of the speech apparatus. In contrast, with dysarthria, the innervation of the muscles responsible for the formation of speech in a child is impaired. Dyslalia is more often found in children 6-7 years old and schoolchildren, while erased dysarthria is determined a little earlier.

Did your child have a speech impediment? Consult a doctor!

Erased dysarthria is accompanied by other symptoms. Many children have a decrease in the intonation coloring of speech. Often the voice acquires a characteristic nasal tone. Most children with an erased form of the disease are not able to imitate various sounds (for example, imitate the meow of a cat or the lowing of a cow). The monotony of the voice is characteristic when reciting poems or retelling the text.

The erased form of dysarthria is the easiest variant of the course of the disease.

II degree dysarthria characterized by fairly intelligible speech with pronounced pronunciation defects. You can understand the child, but for this you have to make some efforts. Treatment of dysarthria is most effective in the first and second stages of the disease.

In the III stage of the disease the speech of the baby becomes clear only to his parents and some close people. It can be quite difficult for outsiders to make out the words of a child.

In stage IV, the baby’s speech is incomprehensible even to parents or is completely absent.

Examination of children with dysarthria includes:

• examination by a neurologist;
• consultation with a speech therapist;
• EEG (electroencephalography) and other electrophysiological methods;
• transcranial magnetic stimulation;
• MRI of the brain.

An examination by a speech therapist consists of several stages:

• assessment of existing speech disorders;
• definition of disorders not related to articulation;
• assessment of the work of mimic and facial muscles;
• the study of speech (pronunciation, rhythm, pace and intelligibility);
• assessment of written speech (in children older than 5 years).

The success of the correction of the disease largely depends on the form of dysarthria, the severity and the presence of concomitant pathology. Erased dysarthria is the easiest to treat. With this type of disease, observation by a neurologist is recommended, as well as regular classes with a speech therapist.

Treatment of dysarthria necessarily includes the following steps:

• stimulation of physiological respiration;
• development of speech breathing (breathing exercises);
• activation of the speech apparatus (including gymnastics and massage);
• stimulation of fine motor skills;
• voice development;
• correction of pronunciation of sounds;
• development of tonality and expressiveness of speech;
• stimulation of speech communication.

At the moment, there are many sections and circles for children with speech defects. In some of them, classes are held in the presence of parents. Individual sessions with a speech therapist are also available.

Drug treatment is prescribed when neurological diseases that contribute to the development of speech disorders are detected. At the same time, the symptoms of dysarthria in a child are combined with various motor and sensory disorders. The treatment of the underlying disease is carried out by a neurologist, after which the speech therapist is engaged in the correction of speech disorders.

Nootropic drugs are actively used in the treatment of neurological diseases. Such treatment stimulates mental activity, improves memory and attention, and also increases the ability to learn. Of the most popular drugs, it is worth noting glycine, cerebrolysin, Phenibut, Pantogam and Encephabol. Treatment with nootropic drugs is quite long. The dosage and frequency of taking the drugs are determined by the doctor.

Do not take nootropics without a doctor's prescription!

Treatment for dysatria also includes physical therapy. A good effect is seen from acupressure, exercise therapy and therapeutic baths. Massage for a child must be done by a specialist who understands all the intricacies of therapy. Acupuncture and other methods of influencing reflex zones are also actively used to treat speech disorders in children.

Great importance in the treatment of the disease is given to contact with parents. Effective treatment of dysarthria is not possible in isolation. Parents of a sick child should devote as much time as possible to their baby and encourage his attempts to speak correctly. Many children, embarrassed by their defect, withdraw and prefer to simply remain silent. Parents should gently and carefully lead their child to the fact that speech needs to be developed, and together with the baby master all the exercises recommended by the speech therapist.

The prognosis of the disease depends on the form and severity. Mild dysarthria in children lends itself well to correction with timely access to a doctor. The sooner treatment is started, the more likely it is to develop the child's speech and help him adapt to the world around him. Erased dysarthria has a fairly favorable prognosis - up to a complete speech correction.

Prevention of the disease consists in preventing intrauterine fetal hypoxia, as well as protecting the baby from injuries during childbirth. Such measures can prevent damage to the brain of the newborn, and therefore protect the child from dysarthria and other diseases of the nervous system. At the first signs of a speech disorder, you should consult a doctor.

Dysarthria is a type of pathology, the development of which is due to an organic lesion of the central nervous system. Dysarthria, the symptoms of which differ from other forms related to pronunciation, manifests itself in the form of a violation in the patient of complete speech, and not a violation noted in the pronunciation of certain types of sounds.

general description

This type of disorder occurs due to insufficient innervation of the speech apparatus, which, in turn, is achieved due to damage to the corresponding parts of the brain - subcortical and posterior frontal. Patients have limited mobility of the organs of speech reproduction (lips, tongue and soft palate), as a result of which articulation becomes more complicated (articulation is defined as work carried out jointly by the speech organs, as a result of which it is possible to pronounce sounds in speech).

Dysarthria in adults manifests itself without concomitant forms of disintegration of the speech system (i.e. impaired auditory perception of speech, impaired writing and reading). Dysarthria in children often causes disorders associated with the reproduction of words, which, in turn, leads to impaired reading and impaired writing, in some cases, the general underdevelopment of speech becomes relevant. When pronouncing sounds, their fuzziness and “blurring” are noted, as for the characteristics of the voice, then with this disease it can manifest itself both in an extremely weak form of reproduction, and, conversely, in a very sharp one. In speech, there is no smoothness characteristic of it, breathing is lost in rhythm, and the pace of speech is also subject to changes, which is either slowed down or accelerated.

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

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

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

The latter option, associated with a minimal form of dysfunction in dysarthria in children, manifests itself quite often, it is noted in groups among children studying in specialized preschool and school institutions. In this case, insufficiency of speech is also accompanied by disturbances in memory, attention, volitional and emotional spheres, intellectual activity, mild forms of movement disorders, slow formation of certain cortical functions of a higher order.

The manifestation of motor disorders is mainly noted within the later terms of the formation of motor functions in patients, especially such ones as the development of an independent ability to sit, crawl, walk, grab objects with fingers and then manipulate them, etc.

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

During the period of preschool age, motor restlessness, a tendency to increased irritability and moodiness, fussiness, children are naughty and rude. Increased motor anxiety occurs in a situation where the child is overworked, up to hysteroid reactions.

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

Dysarthria: causes

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

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

In addition, it is taken into account as a possible factor that provoked the disease, the transfer of infectious diseases by the child that affects the brain and its membranes (meningitis, meningoencephalitis, etc.).

It should be noted separately that in addition to being associated with another type of pathology, dysarthria can also act as a symptom of cerebral palsy (ICP). In this case, the reasons for the relationship are not well understood. Relatively recently, they adhered to the theory that cerebral palsy is the result of a birth injury, however, as part of the ongoing research, it turned out that in about 80% of cases this pathology is congenital, respectively, cerebral palsy develops in utero. This pathology can affect the process of labor activity, in addition, the actual pathology of labor activity can provoke an aggravation of the root cause.

Classification of dysarthria

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

• erased dysarthria - symptoms (speech, psychological and neurological manifestations) have, accordingly, an erased appearance, which often gives reason to confuse dysarthria with such a disorder as dyslalia (this disorder manifests itself in the fact that children, having normal hearing and preserving their speech apparatus, have a problem associated with sound pronunciation); the difference between one variant and the other lies in the presence of a focal form of neurological microsymptoms in dysarthria;
• pronounced dysarthria - in this form, the child uses speech, but at the same time it is characterized as incomprehensible and inarticulate; sound pronunciation is impaired, violations are also manifested in intonational expressiveness, in voice and in breathing;
• anartria - this form of severity of dysarthria is accompanied by an absolute lack of the child's ability to speak.

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

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

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

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

The next form of the disease is cerebellar dysarthria. It is caused by the fact that the cerebellum is affected (the defeat of the pathways is not excluded). Cerebellar dysarthria is characterized by the fact that speech with it becomes scanned and stretched, the modulation is subject to violation, and the volume also changes.

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

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

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

Dysarthria: symptoms

Dysarthria at various levels of its manifestation is characterized by impaired transmission of impulses from the cerebral cortex to the nuclei of the cranial nerve region. Given this feature, there is no receipt of the corresponding nerve impulses to the muscles (and these are articulatory, vocal and respiratory muscles), as a result of which the function of the main type of those cranial nerves that are directly related to speech (vagus, hypoglossal, facial, trigeminal) is subject to disruption. and glossopharyngeal).

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

Due to the hypoglossal nerve, the innervation of the muscles is provided, concentrated in the region of the two thirds of the tongue located in front. Accordingly, when the facial nerve is damaged, certain disorders occur in terms of the mobility of the tongue, in addition, there are difficulties in keeping it in a certain predetermined position.

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

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

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

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

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

Dysarthria can also be accompanied by articular apraxia, which means a violation in the process of arbitrarily feasible movements of the articulatory organs. The cause of articulatory apraxia may be insufficiency of kinesthetic sensations in children in the articular muscles.

Disorders associated with sound pronunciation, which arose against the background of articular apraxia, have two main features, they are as follows:

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

Articulatory apraxia can manifest itself in two ways:

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

In addition, the symptoms of dysarthria are accompanied by various repetitions of syllables and sounds, their insertions, permutations and omissions. In physical terms, children are clumsy, often stumble and fall, there are actual difficulties associated with the implementation of physical exercises (this is noticeable, in particular, when compared with other children). Due to the violation of fine motor skills of the hands, children have problems with lacing, fastening buttons, etc.

Erased dysarthria: symptoms

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

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

• Non-speech symptoms of an erased form of dysarthria

The neurological status determines, as we have already identified, the actual neurological microsymptomatology, which, in turn, manifests itself in the form of syndromes with concomitant CNS damage, and these are:

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

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

Changes in muscle tone;

The appearance of certain forms of pathological reflexes, etc.

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

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

From the side of the reflex sphere, its own symptoms also manifest themselves, it may consist in the appearance of pathological types of reflexes in patients. The autonomic nervous system determines the appearance of symptoms such as sweating of the feet, sweating of the palms, etc.

In speech motor skills, exhaustion and low quality of the movements performed are determined, which concerns, in particular, insufficient smoothness, accuracy and its incomplete volume. Most clearly, motor symptoms are manifested as a result of performing a complex type of movements, in which they must be clearly controlled, while ensuring correctness in terms of their spatial and temporal organization.

Own features are also present on the part of the mental status within the erased form of dysarthria. They manifest themselves in the insufficiency of certain mental processes, in particular with regard to memory, attention, visual and auditory forms of perception, mental operations. Cognitive activity is also subject to decrease in children.

• Speech symptoms of an erased form of dysarthria

In this case, as can be assumed, violations are noted in terms of sound pronunciation: sounds are distorted, excluded, replaced. Children strive to simplify articulation to the maximum, thus replacing complex sounds with simple ones (in terms of their articulatory-acoustic features). Most often, whistling and hissing, as well as front-lingual sounds are subject to distortion.

Prosodic disorders are also relevant, in which there is inexpressiveness and monotony of speech, reduced (in most cases) and accelerated / slowed down timbre. The voice is mostly quiet in children. The completion of this symptomatology is the addition of disorders related to phonemic hearing (this term defines the ability to isolate, distinguish, reproduce speech sounds, that is, it is nothing more than speech hearing). Such violations are mainly secondary in nature, because one's own speech in its "blurred" version does not determine the possibility of forming adequate auditory perception and appropriate control.

Treatment

The treatment of dysarthria determines the need for an integrated approach to ensuring proper therapeutic and pedagogical impact. Correction of dysarthria is carried out in combination with physiotherapy exercises and drug treatment. An important role is given to the comprehensive development of speech (phonemic hearing, grammatical structure, vocabulary), because children with dysarthria have difficulties in mastering written speech as part of schooling. Ideally, children with this disease should be trained in special speech therapy groups (kindergarten) and in speech schools (respectively, during school years). Regarding the prognosis for dysarthria in children, there is no well-defined result.

The main goal followed in the treatment of this disease is the implementation of measures aimed at achieving results, in which the speech of the child will be understandable to others. Correction of speech in this disease is carried out by a speech therapist.

Dysarthria, when viewed from a purely medical point of view, is a violation in the functioning of the speech apparatus.

A specific disease is caused by the presence of neurological damage, including the human cerebral cortex.

The basis of this violation is blocking (partial paralysis) of the muscles of the speech apparatus.

Let's figure out what mild dysarthria is, symptoms and methods of treatment of the I degree of the pseudobulbar form of the disorder, which is often referred to as erased.

Terminology - forms and stages of violation

There are several main forms of children's, depending on the location of the focus of the existing violation:

1. . The defeat of a large number of nerve endings, which, in turn, leads to the fettering of certain muscle groups that respond and directly affect articulation. Features - violation of facial expressions.
2. . Damage and dysfunction of some parts of the brain, which leads to paralysis of the speech apparatus. A characteristic feature is the monotony of pronunciation.
3. Cortical. Unilateral damage to the cerebral cortex, with a violation of some structures. The main symptom is a violation of the pronunciation of some syllables, and the general structure of speech is preserved.
4. Cerebellar. Speech disorders due to damage to the cerebellum. It is characterized by instability of the structure of the child's speech - the tone and volume are constantly changing.
5. subcortical. The part of the brain responsible for the normal formation of speech is affected. Feature - slurred and blurred pronunciation.
6. mixed. It is a consequence of various injuries of a child of the age group up to 2 years. As a feature - the addition of several factors affecting the formation of dysarthria.

There are four degrees of dysarthria pathology, which are divided according to severity and severity:

1. Grade I- erased dysarthria. Often detected at 5 years of age. The main symptoms may be similar to those of other diseases of the nervous system. Especially noticeable is the mixing of sounds and the substitution of one for another. Most children omit some of the sounds when pronouncing long words.
2. Grade II. Can be characterized by fairly clear speech, but pronunciation defects are especially pronounced. The perception of the child's words requires some effort.
3. Grade III. The aggravation of speech comes to the point that strangers practically cannot perceive the meaning of the words uttered by the child.
4. Grade IV. The distortion of speech reaches such limits that even close relatives cannot perceive what is said the first time. Among other things, speech may be absent altogether.

Erased dysarthria is a turning point in the development of a specific type of neurological pathologies. Is the easiest form , the timely detection of which guarantees a complete cure and the child's ability to continue to lead a normal lifestyle.

The specific term “erased dysarthria” was first proposed by Dr. Tokareva, who clearly characterized the manifestations of the first degree of dysarthria as “erased, in their own manifestation, symptoms of pseudobulbar dysarthria”.

Differs in particular difficulty in overcoming problems with pronunciation. Children suffering from a particular type of disease pronounce the vast majority of sounds correctly, but the child's speech flow is poorly automated and there is no clear differentiation of sounds.

Causes and detection at an early age

Factors provoking the appearance and progress of the disease arise even at the stage of embryonic development in the womb and at birth. Often they are:

• lack of oxygen in a developing fetus;
• severe toxicosis and gestosis;
• neuropathy or kidney damage;
• viral diseases of the I-II trimester;
• birth trauma;
• weakness or excessive activity of labor activity of the mother;

It is important to notice the manifestations of erased dysarthria in as much as possible early age, since its successful and complete cure is possible only if it is detected up to 5 years.

Treatment when detected at a more mature age is complicated by the already formed perception and some additional disorders in the mental development of the child. Also, difficulties arise due to the fact that the body is partly formed and the most active stage of its growth is completed.

Features of the clinical picture

The causes of a particular form of dysarthria are damage to the hypoglossal nerve, which determines the clarity of pronunciation and, as a result, the further progress of the disease and damage to the cerebral cortex.

With an erased form of dysarthria, disorders can affect the nerves of the oculomotor system, which leads to a secondary symptom in the form of strabismus.

Erased dysarthria in children is manifested by the following main symptoms:

• lethargy of speech activity due to partial blockade of the speech apparatus, the patient's lips and tongue are practically motionless, when performing exercises related to articulation, weakness of expression appears;
• trembling of the voice and tongue is noticeable during hypercrises, which are manifested due to the tension of the facial muscles;
• there is a distortion of the lips, which prevents the correct execution of exercises;
• the tone of the facial muscles is weakened, and the control is underestimated, as a result, there is an excess of saliva.

Manifestations that accompany erased dysarthria include:

• violation of fine motor skills;
• increased causeless fatigue;
• imbalance;
• inability to imitate elementary exercises;
• complexity of orientation in space.

Conditional classification of patients

Conventionally, all children with a confirmed diagnosis of erased dysarthria can be divided into three groups, based on which function is impaired:

• children who are unable to clearly separate sounds and reproduce intonations that are the only true in a given situation. Accompanied by violations of spatial perception;
• patients with impaired perception of sound moments and inability to clearly separate sounds and reproduce the required intonations. Speech may contain grammatical and lexical errors;
• polymorphic disorders with separate pronunciation and perception of sounds, intonations, there are also difficulties in adding words and word forms.

Diagnostic criteria and techniques

Determining the presence of the disease is quite difficult. Most of the success in determining the erased form of the violation depends on the responsibility and observation of the parents, who need to notice any violations in a timely manner and go with the child to an appointment with a speech therapist. The speech pathologist will do some checks.

An examination by a doctor consists of the following steps:

• research and verification of those present;
• detection of pathologies not related to articulation;
• checking the performance of the muscles of the face, in particular - mimic;
• checking the writing abilities of children over 5 years old, based on: calligraphy, spelling, etc.

Having identified some defects related to diseases of a neuralgic nature, the speech therapist sends the parents and the child to an appointment with a pediatric neurologist, who is engaged in making a preliminary diagnosis.

In order to accurately determine the disease and stage, a complex of medical measures is carried out. When diagnosing, the neurologist directs the patient to such auxiliary studies:

• study of the conduction of nerve impulses.

Based on the data obtained and based on the results of additional checks, the neurologist draws up a specific treatment plan and makes the final diagnosis.

Correction and treatment

Treatment is carried out on the basis of the diagnosis, in the case of erased dysarthria, with adequate methods of correction, it usually has place a favorable prognosis, but it is required to determine whether there are any other concomitant neuralgic diseases and disorders.

Mandatory methods for its correction with erased dysarthria:

• teaching physiologically correct breathing;
• breathing exercises aimed at speech development and strengthening of the vocal cords;
• massage of the muscles of the speech apparatus and additional exercises to develop conversational skills;
• assignment of exercises aimed at the development of fine motor skills, children with a similar disease often have problems with calligraphy;
• correction of pronunciation and development of expressive speech;
• increase in conversational activity;
• performance of exercises for the development of memory and attention.

Medical treatment

As additional appointments, some groups of drugs are sometimes used and, the main effect of which is aimed at stimulating brain activity, improving memory and increasing the level of attention.

Drug treatment for mild dysarthria includes the following drugs:

• relieving vascular spasms – ;
• - Encephabol, Pantocalcin, others;
• metabolic- Actovegin, Cerebrolysin, others;
• sedatives- Tenoten, Novo-passit.

Preventive measures

As preventive measures to prevent a specific disease, it is necessary to pay close attention to the period of pregnancy and the process of childbirth.

If fetal hypoxia is prevented in a timely manner and the child is protected from head injuries during birth, as well as in the first years after, then dysarthria is unlikely.

To completely eliminate erased dysarthria, parents need:

• regularly visit a speech therapist with the child, - if at the age of one there is no “cooing”, if at two years old she does not speak at all, if up to 3 years the vocabulary is too poor or there is no pronunciation of simple sounds, if at 3-5 years there is no clarity of pronunciation or speech is very different from speech peers - this is a reason for an urgent visit to a speech therapist;
• talk to a child and instill in him an interest in the conversation;
• together with the child practice speech- learn tongue twisters;
• protect the child from contact and ingestion of toxic substances;
• lead prevention- a hat in the cold period is required, timely treatment of colds and ENT diseases, regular visits and treatment of the dentist.

With the manifestation of the initial symptoms of dysarthria, it is necessary to visit a doctor without postponing a visit to the hospital for later. In the case of timely treatment, all appointments and therapy can be limited to a short course of drug treatment of the root cause, that is, brain disorders, and referral to a special group of children in kindergarten. Usually, in such groups all the necessary training and speech correction is carried out.