Dysarthria

causes of dysarthria, classification of clinical forms of dysarthria, main directions of correctional work, breathing exercises



Dysarthria is a violation of the sound-pronunciation side of speech, caused by organic insufficiency of innervation of the speech apparatus.

The term "dysarthria" is derived from the Greek words arthson - articulation and dys - particle meaning disorder. This is a neurological term because... Dysarthria occurs when the function of the cranial nerves of the lower part of the brainstem, responsible for articulation, is impaired.

Cranial nerves of the lower part of the trunk ( medulla oblongata) are adjacent to the cervical spinal cord, have a similar anatomical structure and are supplied with blood from the same vertebrobasilar basin.

Very often there are contradictions between neurologists and speech therapists regarding dysarthria. If a neurologist does not see obvious disturbances in the function of the cranial nerves, he cannot call the speech disorder dysarthria. This question is almost a stumbling block between neurologists and speech therapists. This is due to the fact that a neurologist, after making a diagnosis of dysarthria, is obliged to carry out serious therapy for the treatment of brainstem disorders, although such disorders (excluding dysarthria) do not seem to be noticeable.

The medulla oblongata, as well as the cervical spinal cord, often experiences hypoxia during childbirth. This leads to a sharp decrease in motor units in the nerve nuclei responsible for articulation. During a neurological examination, the child adequately performs all tests, but cannot cope properly with articulation, because it is necessary to perform complex and fast movements that are beyond the strength of weakened muscles.


Main manifestations of dysarthria consist of a disorder of articulation of sounds, disturbances in voice formation, as well as changes in the rate of speech, rhythm and intonation.

These violations manifest themselves in varying degrees and in various combinations depending on the location of the lesion in the central or peripheral nervous system, the severity of the disorder, and the time of occurrence of the defect. Articulation and phonation disorders, which make it difficult and sometimes completely prevent articulate sonorous speech, constitute the so-called primary defect, which can lead to secondary manifestations that complicate its structure. Clinical, psychological and speech therapy studies of children with dysarthria show that this category of children is very heterogeneous in terms of motor, mental and speech disorders.

Causes of dysarthria

1. Organic damage to the central nervous system as a result of the influence of various unfavorable factors on the developing brain of a child in the prenatal and early periods of development. Most often, these are intrauterine lesions that are the result of acute, chronic infections, oxygen deficiency (hypoxia), intoxication, toxicosis of pregnancy and a number of other factors that create conditions for the occurrence of birth trauma. In a significant number of such cases, asphyxia occurs during childbirth and the child is born premature.

2. The cause of dysarthria may be Rh factor incompatibility.

3. Dysarthria occurs somewhat less frequently under the influence of infectious diseases of the nervous system in the first years of a child’s life. Dysarthria is often observed in children suffering from cerebral palsy (CP). According to E.M. Mastyukova, dysarthria with cerebral palsy manifests itself in 65-85% of cases.

Classification of clinical forms of dysarthria

The classification of clinical forms of dysarthria is based on the identification various localizations brain damage. Children with various forms Dysarthria differs from each other by specific defects in sound pronunciation, voice, and articulatory motor skills; they require different speech therapy techniques and can be corrected to varying degrees.

Forms of dysarthria

Bulbar dysarthria(from the Latin bulbus - a bulb, the shape of which is the medulla oblongata) manifests itself with a disease (inflammation) or tumor of the medulla oblongata. In this case, the nuclei of the motor cranial nerves located there (glossopharyngeal, vagus and sublingual, sometimes trigeminal and facial) are destroyed.
Characteristic is paralysis or paresis of the muscles of the pharynx, larynx, tongue, and soft palate. A child with a similar defect has difficulty swallowing solid and liquid food and has difficulty chewing. Insufficient mobility of the vocal folds and soft palate leads to specific voice disorders: it becomes weak and nasalized. Voiced sounds are not realized in speech. Paresis of the muscles of the soft palate leads to the free passage of exhaled air through the nose, and all sounds acquire a pronounced nasal (nasal) tone.
In children with the described form of dysarthria, atrophy of the muscles of the tongue and pharynx is observed, and muscle tone also decreases (atonia). The paretic state of the tongue muscles causes numerous distortions in sound pronunciation. Speech is slurred, extremely unclear, slow. The face of a child with tabloid dysarthria is amicable.

Subcortical dysarthria occurs when the subcortical nodes of the brain are damaged. A characteristic manifestation of subcortical dysarthria is a violation muscle tone and the presence of hyperkinesis. Hyperkinesis - violent involuntary movements (in in this case in the area of ​​articulatory and facial muscles), not controlled by the child. These movements can be observed at rest, but usually intensify during speech.
The changing nature of muscle tone (from normal to increased) and the presence of hyperkinesis cause peculiar disturbances in phonation and articulation. A child can correctly pronounce individual sounds, words, short phrases (especially in a game, in a conversation with loved ones or in a state of emotional comfort) and after a moment he is unable to utter a single sound. An articulatory spasm occurs, the tongue becomes tense, and the voice is interrupted. Sometimes involuntary screams are observed, and guttural (pharyngeal) sounds “break through.” Children may pronounce words and phrases excessively quickly or, conversely, monotonously, with long pauses between words. Speech intelligibility suffers due to unsmooth switching of articulatory movements when pronouncing sounds, as well as due to disturbances in the timbre and strength of the voice.
A characteristic sign of subcortical dysarthria is a violation of the prosodic aspect of speech - tempo, rhythm and intonation. The combination of impaired articulatory motor skills with disorders of voice formation and speech breathing leads to specific defects in the sound aspect of speech, which manifest themselves variably depending on the child’s condition, and are reflected mainly in the communicative function of speech.
Sometimes with subcortical dysarthria in children, hearing loss is observed, complicating a speech defect.

Cerebellar dysarthria characterized by chanted “chopped” speech, sometimes accompanied by shouts of individual sounds. In its pure form, this form is rarely observed in children.

Cortical dysarthria presents great difficulties for isolation and recognition. With this form, voluntary motor skills of the articulatory apparatus are impaired. In its manifestations in the sphere of sound pronunciation, cortical dysarthria resembles motor alalia, since, first of all, the pronunciation of words with a complex sound-syllable structure is impaired. In children, the dynamics of switching from one sound to another, from one articulatory posture to another, is difficult. Children are able to clearly pronounce isolated sounds, but in the speech stream the sounds are distorted and substitutions occur. Combinations of consonant sounds are especially difficult. At an accelerated pace, hesitations appear, reminiscent of stuttering.
However, unlike children with motor alalia, children with this form of dysarthria do not experience disturbances in the development of the lexico-grammatical aspect of speech. Cortical dysarthria should also be distinguished from dyslalia. Children have difficulty reproducing articulatory posture, and it is difficult for them to move from one sound to another. During correction, attention is drawn to the fact that defective sounds are quickly corrected in isolated utterances, but are difficult to automate in speech.

Erased form. I especially want to highlight the erased (mild) form of dysarthria, since recently in the process of speech therapy practice we are increasingly encountering children whose speech disorders are similar to the manifestations of complex forms of dyslalia, but with longer and more complex dynamics of learning and speech correction. A thorough speech therapy examination and observation reveals a number of specific disorders in them (disorders of the motor sphere, spatial gnosis, phonetic aspects of speech (in particular, prosodic characteristics of speech), phonation, breathing, and others), which allows us to conclude that there are organic lesions of the central nervous system.

The experience of practical and research work shows that it is very often difficult to diagnose mild forms of dysarthria, differentiate it from other speech disorders, in particular dyslalia, in determining the ways of correction and the amount of necessary speech therapy assistance for children with an erased form of dysarthria. Considering the prevalence of this speech disorder among preschool children, we can conclude that at present there is a very urgent need for current problem- the problem of providing qualified speech therapy assistance to children with an erased form of dysarthria.

Mild (erased) forms of dysarthria can be observed in children without obvious movement disorders who have been exposed to various unfavorable factors during the prenatal, natal and early postnatal periods of development. Among these unfavorable factors are:
- toxicosis of pregnancy;
- chronic hypoxia fetus;
- acute and chronic diseases of the mother during pregnancy;
- minimal damage to the nervous system in Rh-conflict situations between mother and fetus;
- mild asphyxia;
- birth injuries;
- spicy infectious diseases children in infancy, etc.

The impact of these unfavorable factors leads to the emergence of a number of specific features in the development of children. In the early period of development, children with an erased form of dysarthria experience motor restlessness, sleep disturbances, and frequent, causeless crying. Feeding such children has a number of peculiarities: there is difficulty in holding the nipple, rapid fatigue when sucking, babies refuse the breast early, and burp frequently and profusely. In the future, they become poorly accustomed to complementary feeding and are reluctant to try new foods. At lunch, such a child sits for a long time with his mouth full, chews poorly and reluctantly swallows food, hence frequent choking while eating. Parents of children with mild forms of dysarthric disorders note that in preschool age children prefer cereals, broths, and purees to solid foods, so feeding such a child becomes a real problem.

A number of features can also be noted in early psychomotor development: the formation of static-dynamic functions may be somewhat delayed or remain within the age norm. Children, as a rule, are somatically weakened and often suffer from colds.

The anamnesis of children with an erased form of dysarthria is burdened. Most children under 1-2 years of age were observed by a neurologist, but later this diagnosis was removed.

Early speech development in a significant proportion of children with mild manifestations of dysarthria is slightly delayed. The first words appear by 1 year, phrasal speech is formed by 2-3 years. At the same time, for quite a long time, children’s speech remains illegible, unclear, understandable only to parents. Thus, by the age of 3-4 years, the phonetic aspect of speech in preschoolers with an erased form of dysarthria remains unformed.

In speech therapy practice, we often encounter children with sound pronunciation disorders who have a neurologist’s conclusion indicating the absence of focal microsymptoms in their neurological status. However, correction of speech disorders in such children using conventional methods and techniques does not bring effective results. Consequently, the question arises of further examination and a more detailed study of the causes and mechanisms of occurrence of these violations.

With a thorough neurological examination of children with such speech disorders with the use of functional loads, mildly expressed microsymptoms of organic damage to the nervous system are revealed. These symptoms manifest themselves in the form of motor disorders and extrapyramidal insufficiency and are reflected in the state of general, fine and articulatory motor skills, as well as facial muscles.

The general motor sphere of children with an erased form of dysarthria is characterized by awkward, constrained, undifferentiated movements. There may be a slight limitation in the range of movements of the upper and lower extremities; with functional load, conjugate movements (syncenesis) and disturbances in muscle tone are possible. Often, with pronounced general mobility, the movements of a child with an erased form of dysarthria remain awkward and unproductive.

Insufficiency of general motor skills is most clearly manifested in preschoolers with this disorder when performing complex movements that require precise control of movements, precise work of various muscle groups, and correct spatial organization of movements. For example, a child with an erased form of dysarthria, somewhat later than his peers, begins to grasp and hold objects, sit, walk, jump on one or two legs, runs awkwardly, and climbs on a wall bars. In middle and senior preschool age, it takes a long time for a child to learn to ride a bicycle, ski and skate.

In children with an erased form of dysarthria, disturbances in fine motor skills of the fingers are also observed, which are manifested in impaired accuracy of movements, a decrease in the speed of execution and switching from one pose to another, slow initiation of movement, and insufficient coordination. Finger tests are performed imperfectly, and significant difficulties are observed. These features are manifested in the child’s play and learning activities. A preschooler with mild manifestations of dysarthria is reluctant to draw, sculpt, or play ineptly with mosaics.

Features of the state of general and fine motor skills are also manifested in articulation, since there is a direct relationship between the level of formation of fine and articulatory motor skills. Disturbances in speech motor skills in preschool children with this type of speech pathology are caused by the organic nature of the damage to the nervous system and depend on the nature and degree of dysfunction of the motor nerves that ensure the process of articulation. It is the mosaic nature of the damage to the motor conducting cortical-nuclear pathways that determines the greater combinability of speech disorders in the erased form of dysarthria, the correction of which requires the speech therapist to carefully and detailed develop an individual plan for speech therapy work with such a child. And of course, such work seems impossible without the support and close cooperation with parents interested in correcting their child’s speech disorders.

Pseudobulbar dysarthria- the most common form of childhood dysarthria. Pseudobulbar dysarthria is a consequence of organic brain damage suffered in early childhood, during childbirth or in the prenatal period as a result of encephalitis, birth injuries, tumors, intoxication, etc. The child experiences pseudobulbar paralysis or paresis caused by damage to the pathways coming from the cerebral cortex to the nuclei of the glossopharyngeal, vagus and hypoglossal nerves. According to the clinical manifestations of disorders in the area of ​​facial and articulatory muscles, it is close to bulbar. However, the possibilities of correction and full mastery of the sound-pronunciation side of speech with pseudobulbar dysarthria are much higher.
As a result of pseudobulbar palsy, the child's general and speech motor skills are impaired. The baby sucks poorly, chokes, chokes, and swallows poorly. Saliva flows from the mouth, facial muscles are disturbed.

The degree of impairment of speech or articulatory motor skills may vary. Conventionally, there are three degrees of pseudobulbar dysarthria: mild, moderate, severe.

1. A mild degree of pseudobulbar dysarthria is characterized by the absence of gross disturbances in the motor skills of the articulatory apparatus. Difficulties in articulation lie in slow, insufficiently precise movements of the tongue and lips. Chewing and swallowing disorders are revealed faintly, with rare choking. Pronunciation in such children is impaired due to insufficiently clear articulatory motor skills, speech is somewhat slow, and blurred pronunciation of sounds is characteristic. The pronunciation of complex sounds is more likely to suffer. according to the articulation of sounds: zh, sh, r, ts, ch. Voiced sounds are pronounced with insufficient participation of the voice. Soft sounds are difficult to pronounce, requiring the addition to the main articulation of raising the middle part of the back of the tongue to the hard palate.
Pronunciation deficiencies have an adverse effect on phonemic development. Most children with mild dysarthria have some difficulty in sound analysis. When writing, they encounter specific errors in replacing sounds (t-d, t-ts, etc.). There is almost no violation of the structure of the word: the same applies to grammatical structure and vocabulary. Some uniqueness can only be revealed through a very careful examination of children, and it is not typical. So, the main defect in children suffering from mild pseudobulbar dysarthria is a violation of the phonetic aspect of speech.
Children with a similar disorder, who have normal hearing and good mental development, attend speech therapy classes at the regional children's clinic, and at school age - a speech therapy center at secondary school. Parents can play a significant role in eliminating this defect.

2. Children with moderate dysarthria make up the largest group. They are characterized by amicity: lack of movement of the facial muscles. The child cannot puff out his cheeks, stretch out his lips, or close them tightly. Tongue movements are limited. The child cannot lift the tip of his tongue up, turn it to the right, left, or hold it in this position. Switching from one movement to another is a significant difficulty. The soft palate is often inactive, and the voice has a nasal tone. Characterized by profuse salivation. The acts of chewing and swallowing are difficult. The consequence of dysfunction of the articulatory apparatus is a severe pronunciation defect. The speech of such children is usually very slurred, slurred, and quiet. The articulation of vowels, usually pronounced with a strong nasal exhalation, is characteristic due to the inactivity of the lips and tongue. The sounds "a" and "u" are not clear enough, the sounds "i" and "s" are usually mixed. Of the consonants, p, t, m, n, k, x are most often preserved. The sounds ch and ts, r and l are pronounced approximately, like a nasal exhalation with an unpleasant “squelching” sound. The exhaled mouth stream is felt very weakly. More often, voiced consonants are replaced by voiceless ones. Often sounds at the end of words and in combinations of consonants are omitted. As a result, the speech of children suffering from pseudobulbar dysarthria is so incomprehensible that they prefer to remain silent. Along with the usually late development of speech (at the age of 5-6 years), this circumstance sharply limits the child’s experience of verbal communication.
Children with such a disorder cannot study successfully in a comprehensive school. The most favorable conditions for their training and education have been created in special schools for children with severe speech impairments, where these students receive an individual approach.

3. A severe degree of pseudobulbar dysarthria - anarthria - is characterized by deep muscle damage and complete inactivity of the speech apparatus. The face of a child suffering from anarthria is mask-like, the lower jaw droops, and the mouth is constantly open. The tongue lies motionless on the floor of the oral cavity, lip movements are sharply limited. The acts of chewing and swallowing are difficult. Speech is completely absent, sometimes there are individual inarticulate sounds. Children with anarthria with good mental development They can also study in special schools for children with severe speech impairments, where, thanks to special speech therapy methods, they successfully master writing skills and a curriculum in general education subjects.

A characteristic feature of all children with pseudobulbar dysarthria is that with distorted pronunciation of the sounds that make up a word, they usually retain the rhythmic contour of the word, i.e., the number of syllables and stress. As a rule, they know the pronunciation of two- and three-syllable words; four-syllable words are often reproduced reflectively. It is difficult for a child to pronounce consonant clusters: in this case, one consonant is dropped (squirrel - “beka”) or both (snake - “iya”). Due to the motor difficulty of switching from one syllable to another, there are cases of likening syllables (dishes - “posyusya”, scissors - “noses”).

Impaired motor skills of the articulatory apparatus leads to improper development of the perception of speech sounds. Deviations in auditory perception caused by insufficient articulatory experience and the lack of a clear kinesthetic image of sound lead to noticeable difficulties in mastering sound analysis. Depending on the degree of speech motor impairment, variously expressed difficulties in sound analysis are observed.

Most special tests that reveal the level of sound analysis are not available to dysarthric children. They cannot correctly select pictures whose names begin with a given sound, come up with a word containing a certain sound, or analyze the sound composition of a word. For example, a twelve-year-old child who has studied for three years in a public school, answering the question what sounds in the words of the regiment, cat, names p, a, k, a; k, a, t, a. When completing the task of selecting pictures whose names contain the sound b, the boy puts aside a jar, a drum, a pillow, a scarf, a saw, and a squirrel.
Children with better preserved pronunciation make fewer mistakes; for example, they select the following pictures based on the sound “s”: bag, wasp, plane, ball.
For children suffering from anarthria, such forms of sound analysis are not available.

Literacy acquisition for dysarthria

The level of proficiency in sound analysis in the vast majority of dysarthric children is insufficient for mastering literacy. Children who enter public schools are completely unable to master the 1st grade curriculum.
Deviations in sound analysis are especially pronounced during auditory dictation.

I will give a sample letter from a boy who studied for three years in a public school: house - “ladies”, fly - “muaho”, nose - “ouch”, chair - “oo”, eyes - “naka”, etc.

Another boy, after a year at a public school, writes instead of “Dima goes for a walk” - “Dima dapet gul ts”; “There are wasps in the forest” - “Lusu wasps”; “The boy feeds the cat milk” - “Malkin lali kashko maloko.”

The largest number of errors in the writing of children suffering from dysarthria occur in letter substitutions. There are often vowel replacements: children - “detu”, teeth - “zubi”, bots - “buti”, bridge - “muta”, etc. Inaccurate, nasal pronunciation of vowel sounds leads to the fact that they hardly differ in sound.

Consonant substitutions are numerous and varied:
l-r: squirrel - "berka"; h-ch: fur - “sword”; b-t: duck - “ubka”; g-d: gudok - “dudok”; s-ch: geese - "guchi"; b-p: watermelon - "arpus".

Typical cases are cases of violation of the syllabic structure of a word due to the rearrangement of letters (book - “kinga”), omission of letters (cap - “shapa”), reduction of the syllable structure due to underwriting of syllables (dog - “soba”, scissors - “knives” and etc.).

There are frequent cases of complete distortion of words: bed - “damla”, pyramid - “makte”, iron - “neaki”, etc. Such errors are most typical for children with deep violations articulations in which the lack of differentiation of the sound composition of speech is associated with distorted sound pronunciation.

In addition, in the writing of dysarthric children, errors such as incorrect use of prepositions, incorrect syntactic connections of words in a sentence (coordination, control), etc. are common. These non-phonetic errors are closely related to the peculiarities of dysarthric children mastering oral speech, grammatical structure, vocabulary in stock.

Children's independent writing is characterized by a poor composition of sentences, their incorrect construction, omission of sentence parts and function words. For some children, even small-scale presentations are completely inaccessible.

Reading for dysarthric children is usually extremely difficult due to the inactivity of the articulatory apparatus and difficulties in switching from one sound to another. For the most part it is syllable-by-syllable, not colored by intonation. Understanding of the text being read is insufficient. For example, a boy, having read the word chair, points to the table; after reading the word cauldron, he shows a picture depicting a goat (cauldron-goat).

Lexico-grammatical structure of speech of dysarthric children

As noted above, the immediate result of damage to the articulatory apparatus is difficulties in pronunciation, which lead to insufficiently clear perception of speech by ear. The general speech development of children with severe articulation disorders proceeds in a unique way. Late onset of speech, limited speech experience, and gross pronunciation defects lead to insufficient accumulation of vocabulary and deviations in the development of the grammatical structure of speech. Most children with articulation disorders have deviations in their vocabulary, do not know everyday words, and often mix words based on similarity in sound composition, situation, etc.

Many words are used inaccurately; instead of the desired name, the child uses one that denotes a similar object (loop - hole, vase - jug, acorn - nut, hammock - net) or is situationally related to this word (rails - sleepers, thimble - finger).

Characteristic features of dysarthric children are a fairly good orientation in the environment and a stock of everyday information and ideas. For example, children know and can find objects in the picture such as a swing, a well, a buffet, a carriage; determine the profession (pilot, teacher, driver, etc.); understand the actions of the persons depicted in the picture; show objects painted in one color or another. However, the absence of speech or limited use of it leads to a discrepancy between active and passive vocabulary.

The level of vocabulary acquisition depends not only on the degree of impairment of the sound-pronunciation side of speech, but also on the intellectual capabilities of the child, social experience, and the environment in which he is raised. Dysarthric children, as well as children in general with general speech underdevelopment, are characterized by insufficient command of the grammatical means of the language.

Main directions of correctional work

These features of the speech development of children with dysarthria show that they need systematic special training aimed at overcoming defects in the sound side of speech, developing vocabulary and grammatical structure of speech, and correcting writing and reading disorders. Such correctional tasks are solved in a special school for children with speech disorders, where the child receives an education equivalent to a nine-year general education school.

Preschool children with dysarthria need targeted speech therapy sessions to develop the phonetic and lexical-grammatical structure of speech. Such classes are conducted in special preschool institutions for children with speech disorders.

Speech therapy work with dysarthric children is based on knowledge of the structure of speech defects in various forms of dysarthria, mechanisms of violation of general and speech motor skills, and taking into account the personal characteristics of children. Particular attention is paid to the state of children's speech development in the field of vocabulary and grammatical structure, as well as the peculiarities of the communicative function of speech. For school-age children, the state of written speech is taken into account.

Positive results of speech therapy work are achieved subject to the following principles:
gradual interconnected formation of all components of speech;
systematic approach to the analysis of speech defects;
regulation of mental activity of children through the development of communicative and generalizing functions of speech.

In the process of systematic and, in most cases, long-term training, a gradual normalization of the motor skills of the articulatory apparatus, the development of articulatory movements, the formation of the ability to voluntarily switch the movable organs of articulation from one movement to another at a given pace, overcoming monotony and disturbances in the tempo of speech are achieved; full development of phonemic perception. This prepares the basis for the development and correction of the sound side of speech and creates the prerequisites for mastering the skills of oral and written speech.

Speech therapy work must begin in early preschool age, thereby creating conditions for the full development of more complex aspects of speech activity and optimal social adaptation. Great importance It also combines speech therapy with therapeutic measures to overcome deviations in general motor skills.

Preschool children with dysarthria, who do not have gross deviations in the development of the musculoskeletal system, have self-care skills and have normal hearing and full intelligence, are educated in special kindergartens for children with speech impairments. At school age, children with severe dysarthria are educated in special schools for children with severe speech impairments, where they receive education equivalent to a nine-year school with simultaneous correction of speech defects. For children with dysarthria and severe musculoskeletal disorders, the country has specialized kindergartens and schools, where much attention is paid to therapeutic and physiotherapeutic measures.

When correcting dysarthria in practice, as a rule, regulation of speech breathing is used as one of the leading methods for establishing fluency of speech.

Breathing exercises by A. N. Strelnikova

In speech therapy work on speech breathing of children, adolescents and adults, paradoxical breathing exercises by A. N. Strelnikova are widely used. Strelnikovskaya breathing gymnastics is the brainchild of our country; it was created at the turn of the 30-40s of the 20th century as a way to restore the singing voice, because A. N. Strelnikova was a singer and lost it.

This gymnastics is the only one in the world in which a short and sharp breath is taken through the nose using movements that compress the chest.

Exercises actively involve all parts of the body (arms, legs, head, hip girdle, abdominals, shoulder girdle, etc.) and cause a general physiological reaction of the whole body, an increased need for oxygen. All exercises are performed simultaneously with a short and sharp inhalation through the nose (with absolutely passive exhalation), which enhances internal tissue respiration and increases the absorption of oxygen by tissues, and also irritates that extensive area of ​​receptors on the nasal mucosa, which provides reflex communication between the nasal cavity and almost all organs.

That's why this breathing exercise has such wide range effects and helps with a lot of different diseases of organs and systems. It is useful for everyone and at any age.

In gymnastics, the focus is on inhalation. The inhalation is very short, instantaneous, emotional and active. The main thing, according to A. N. Strelnikova, is to be able to hold, “hide” your breath. Don't think about exhaling at all. The exhalation goes away spontaneously.

When teaching gymnastics, A. N. Strelnikova advises following four basic rules.

Rule 1. “It smells like burning! Alarm!” And sharply, noisily, throughout the entire apartment, sniff the air like a dog trail. The more natural the better. The biggest mistake is to pull the air to get more air. The inhalation is short, like an injection, active and the more natural the better. Just think about inhaling. The feeling of anxiety organizes active inhalation better than reasoning about it. Therefore, without hesitation, sniff the air furiously, to the point of rudeness.

Rule 2 Exhalation is the result of inhalation. Do not prevent the exhalation from leaving after each inhalation as much as you like - but better through your mouth than through your nose. Don't help him. Just think: “It smells like burning! Alarm!” And just make sure that the inhalation occurs simultaneously with the movement. The exhalation will go away spontaneously. During gymnastics, the mouth should be slightly open. Get carried away with inhalation and movement, do not be boring and indifferent. Play savage like children play, and everything will work out. The movements create sufficient volume and depth for short inhalations without much effort.

Rule 3. Repeat the breaths as if you were inflating a tire at the tempo of a song and dance. And, training movements and breaths, count by 2, 4 and 8. Tempo: 60-72 breaths per minute. Inhalations are louder than exhalations. Lesson norm: 1000-1200 breaths, more is possible - 2000 breaths. Pauses between doses of breaths are 1-3 seconds.

Rule 4. Take as many breaths in a row as you can easily do at the moment. The whole complex consists of 8 exercises. First - warm-up. Stand up straight. Hands at your sides. Feet shoulder width apart. Take short, injection-like breaths, sniffing loudly through your nose. Do not be shy. Force the wings of the nose to connect as you inhale, rather than widening them. Train 2 or 4 breaths in a row at a walking pace of “a hundred” breaths. You can do more to feel that the nostrils are moving and listening to you. Inhale, like an injection, instantaneous. Think: “It smells like burning! Where does it come from?” To understand gymnastics, take a step in place and simultaneously inhale with each step. Right-left, right-left, inhale-inhale, inhale-inhale. And not inhale and exhale, as in regular gymnastics.
Take 96 (hundred) steps-breaths at a walking pace. You can stand still, you can while walking around the room, you can shift from foot to foot: back and forth, back and forth, the weight of the body is either on the leg standing in front, or on the leg standing behind. It is impossible to take long breaths at the pace of your steps. Think: “My legs are pumping air into me.” It helps. With every step - a breath, short, like an injection, and noisy.
Having mastered the movement, lifting right leg, squat a little on the left, lifting the left on the right. The result is a rock and roll dance. Make sure that the movements and breaths go at the same time. Do not interfere or help the exhalations to come out after each inhalation. Repeat the breaths rhythmically and often. Do as many of them as you can easily do.

Head movements.
- Turns. Turn your head left and right, sharply, at the pace of your steps. And at the same time with each turn, inhale through your nose. Short, like an injection, noisy. 96 breaths. Think: “It smells like burning! Where does it come from? On the left? On the right?” Sniff the air...
- "Ears". Shake your head as if you were saying to someone: “Ah-ay-ay, what a shame!” Make sure your body doesn't turn. The right ear goes to the right shoulder, the left ear goes to the left. Shoulders are motionless. Simultaneously with each sway, inhale.
- "Small pendulum". Nod your head back and forth, inhale and inhale. Think: “Where does the burning smell come from? From below? From above?”

Main movements.
- "Cat". Feet shoulder width apart. Remember the cat that sneaks up on the sparrow. Repeat her movements - squat a little, turn first to the right, then to the left. Shift the weight of your body either to your right leg or to your left. To the direction you turned. And noisily sniff the air to the right, to the left, at the pace of your steps.
- "Pump". Hold a rolled-up newspaper or stick in your hands like a pump handle and think that you are inflating a car tire. Inhale - at the extreme point of the inclination. When the tilt ends, the breath ends. Do not pull it while unbending, and do not unbend all the way. You need to quickly inflate the tire and move on. Repeat the inhalations and bending movements frequently, rhythmically and easily. Don't raise your head. Look down at an imaginary pump. Inhale, like an injection, instantaneous. Of all our inhalation movements, this is the most effective.
- “Hug your shoulders.” Raise your arms to shoulder level. Bend your elbows. Turn your palms towards you and place them in front of your chest, just below your neck. Throw your hands towards each other so that the left one hugs right shoulder, and the right one - the left armpit, that is, so that the arms go parallel to each other. Step pace. Simultaneously with each throw, when your hands are closest to each other, repeat short, noisy breaths. Think: "The shoulders help the air." Do not move your hands far from your body. They are close. Don't straighten your elbows.
- "Big Pendulum". This movement is continuous, similar to a pendulum: “pump” - “hug your shoulders”, “pump” - “hug your shoulders”. Step pace. Bend forward, hands reaching towards the ground - inhale, bend back, hands hug your shoulders - also inhale. Forward - back, inhale, inhale, tick-tock, tick-tock, like a pendulum.
- "Half squats." One leg is in front, the other is behind. The weight of the body is on the leg standing in front, the leg behind just touches the floor, as before the start. Perform a light, barely noticeable squat, as if dancing in place, and at the same time with each squat, repeat a short, light breath. Having mastered the movement, add simultaneous counter movements of the arms.

This is followed by a special training of “latent” breathing: a short inhalation with a tilt, the breath is held as much as possible without straightening, you need to count out loud to eight, gradually the number of “eights” pronounced on one exhalation increases. With one tightly held breath, you need to collect as many “eights” as possible. From the third or fourth training, the utterance of “eights” by stutterers is combined not only with bending, but also with “half squats” exercises. The main thing, according to A. N. Strelnikova, is to feel the breath “caught in a fist” and show restraint, repeating out loud the maximum number of eights while holding your breath tightly. Of course, the “eights” in each workout are preceded by the entire complex of exercises listed above.

Exercises for developing speech breathing

The following exercises are recommended in speech therapy practice.

Choose a comfortable position (lying, sitting, standing), place one hand on your stomach, the other on the side of your lower part chest. Take a deep breath through your nose (this pushes your stomach forward and expands your lower chest, which is controlled by both hands). After inhaling, immediately exhale freely and smoothly (the abdomen and lower chest return to their previous position).

Take a short, calm breath through your nose, hold the air in your lungs for 2-3 seconds, then exhale long, smoothly through your mouth.

Take a short breath when open mouth and on a smooth, drawn-out exhalation, pronounce one of the vowel sounds (a, o, u, i, e, s).

Smoothly pronounce several sounds on one exhalation: aaaaa aaaaaooooooo aaaaauuuuuu.

Count on one exhalation up to 3-5 (one, two, three...), trying to gradually increase the count to 10-15. Make sure you exhale smoothly. Count down (ten, nine, eight...).

Ask your child to repeat after you proverbs, sayings, and tongue twisters in one breath. Be sure to follow the instructions given in the first exercise.

The drop and the stone are chiseling.
They build with their right hand and break with their left.
Whoever lied yesterday will not be believed tomorrow.
Toma cried all day on a bench near the house.
Don't spit in the well - you'll need to drink the water.
There is grass in the yard, there is firewood on the grass: one firewood, two firewood - do not cut wood on the grass of the yard.
Like thirty-three Egorkas lived on a hillock: one Egorka, two Egorkas, three Egorkas...

- Read the Russian folk tale "Turnip" with the correct reproduction of inhalation during pauses.

Turnip.
Grandfather planted a turnip. The turnip grew very, very big.
Grandfather went to pick turnips. He pulls and pulls, but he can’t pull it out.
Grandfather called grandma. Grandma for grandpa, grandpa for the turnip, they pull and pull, but they can’t pull it out!
The grandmother called her granddaughter. Granddaughter for grandma, grandma for grandfather, grandfather for turnip, they pull and pull, they can’t pull it out!
The granddaughter called Zhuchka. The bug for the granddaughter, the granddaughter for the grandmother, the grandmother for the grandfather, the grandfather for the turnip, they pull and pull, they can’t pull it out!
Bug called the cat. Cat for Bug, Bug for granddaughter, granddaughter for grandmother, grandmother for grandfather, grandfather for turnip, they pull and pull, they can’t pull it out!
The cat called the mouse. Mouse for the cat, cat for the Bug, Bug for the granddaughter, granddaughter for the grandmother, grandmother for the grandfather, grandfather for the turnip, pull and pull - they pulled out the turnip!

Practiced skills can and should be consolidated and fully applied in practice.

* "Whose steamer sounds better?"
Take a glass vial approximately 7 cm high, neck diameter 1-1.5 cm, or any other suitable object. Bring it to your lips and blow. “Listen to how the bubble hums. Like a real steamboat. Will you make a steamboat? I wonder whose steamer will hum louder, yours or mine? And whose will take longer?” It should be remembered: for the bubble to buzz, the lower lip must lightly touch the edge of its neck. The air stream should be strong and come out in the middle. Just don’t blow for too long (more than 2-3 seconds), otherwise you’ll get dizzy.

* "Captains".
Place paper boats in a bowl of water and invite your child to ride on a boat from one city to another. In order for the boat to move, you need to blow on it slowly, pursing your lips like a tube. But then a gusty wind blows in - the lips fold as if to make the sound p.

Whistles, toy pipes, harmonicas, inflating balloons and rubber toys also contribute to the development of speech breathing.

The tasks become more complex gradually: first, long speech exhalation training is carried out on individual sounds, then on words, then on a short phrase, when reading poetry, etc.

In each exercise, the child’s attention is directed to a calm, relaxed exhalation, to the duration and volume of the pronounced sounds.

The full course of correction and treatment of dysarthria takes several months. As a rule, children with dysarthria are in a day hospital for 2-4 weeks, then continue the course of treatment on an outpatient basis. In a day hospital, patients undergo restorative physiotherapy, massage, exercise therapy, and breathing exercises. This allows you to reduce the time to achieve maximum effect and makes it more sustainable.

Treatment of dysarthria using hirudotherapy

Back in the 16th-17th centuries, hirudotherapy (hereinafter HT) was used for diseases of the liver, lungs, gastrointestinal tract, tuberculosis, migraine, epilepsy, hysteria, gonorrhea, skin and eye diseases, and disorders menstrual cycle, cerebrovascular accidents, fever, hemorrhoids, as well as to stop bleeding and other diseases.

Why did interest in the leech begin to increase? The reasons for this are the insufficient therapeutic effectiveness of pharmaceuticals. funds, an increase in the number of drug-allergic people, a huge number (40-60%) of counterfeit pharmaceuticals in the pharmacy chain.

To understand the mechanisms therapeutic effect medical leech (MP), it is necessary to study the biologically active substances (BAS) of the secretion of the salivary glands (SSG). The secretion of the leech salivary glands contains a set of compounds of protein (peptide), lipid and carbohydrate nature. Reports by I. I. Artamonova, L. L. Zavalova and I. P. Baskova indicate the presence of more than 20 components in the low molecular weight fraction of leech SSG (molecular weight less than 500 D) and more than 80 in the fraction with a molecular weight of more than 500 D.

The most studied components of SSF: hirudin, a histamine-like substance, prostacyclins, prostaglandins, hyaluronidase, lipase, apyrase, collogenase, viburnum and saratin - platelet adhesion inhibitors, platelet activating factor inhibitor, destabilase, destabilase-lysozyme (destobilase - L), bdellins-trypsin inhibitors and plasmin, eglins - inhibitors of chymotryptosin, subtilisin, elastase and cathepsin G, neurotrophic factors, blood plasma kallikrein inhibitor. The intestinal canal of the leech contains the symbiont bacterium Aeromonas hidrophilia, which provides a bacteriostatic effect and is a source of some components of the SSF. One of the elements of MP contained in saliva is hyaluronidase. It is believed that with the help of this substance, toxic (endo- or exogenous origin) products that have not undergone metabolic transformations are removed from the matrix space (Pischinger’s space), which allows them to be removed from the body by the MP using excretory organs. They can cause vomiting or death in MPs.

Neurotrophic factors (NTFs) MP. This aspect is associated with the effect of SSG on nerve endings and neurons. This problem was first raised in our research. The idea arose as a result of the results of treatment of children with cerebral palsy and myopathy. Patients showed significant positive changes in the treatment of spastic tension in skeletal muscles. A child who, before treatment, could only move on all fours, could move on his own legs several months after MP treatment.

Neurotrophic factors are low molecular weight proteins that are secreted by target tissues and are involved in differentiation nerve cells and are responsible for the growth of their processes. NTFs play an important role not only in the processes of embryonic development of the nervous system, but also in the adult body. They are necessary to maintain the viability of neurons.

To assess the neurite-stimulating effect, a morphometric method is used, which makes it possible to measure the area of ​​the ganglion along with the growth zone, consisting of neurites and glial elements, after adding drugs to the nutrient medium that stimulate neurite growth in comparison with control explants.

The results obtained on the treatment of alalia and dysarthria in children using the method of herudotherapy, as well as the results of superposition brain scanning, made it possible to record the accelerated maturation of neurons in the speech motor cortex of the brain in such children.

Data on the high neurite-stimulating activity of the components of the salivary glands (secretion of the salivary glands) explain the specific effectiveness of gerudotherapy in neurological patients. Moreover, the ability of leech proteinase inhibitors to modulate neurotrophic effects enriches the arsenal of proteolytic enzyme inhibitors that are currently considered promising therapeutic drugs for a wide range of neurodegenerative diseases

So, the biologically active substances produced by MP provide the currently known biological effects:
1. thrombolytic effect,
2. hypotensive effect,
3. reparative effect on the damaged wall of the blood vessel,
4. antiatherogenic effect of biologically active substances actively influence the processes of lipid metabolism, leading it to normal functioning conditions; lower cholesterol levels,
5. antihypoxic effect - increasing the percentage of survival of laboratory animals under conditions reduced content oxygen,
6. immunomodulating effect - activation of the body’s protective functions at the level of the macrophage link, the compliment system and other levels of the immune system of humans and animals,
7. neurotrophic effect.

To specific technical means include: Derazhne corrector, "Echo" (AIR) apparatus, sound amplification apparatus, tape recorder.

The Derazhne device (like the Barany ratchet) is built on the sound damping effect. Noise of varying strength (in a corrective recorder it is adjusted using a special screw) is fed through rubber tubes ending in olives directly into the ear canal, drowning out one’s own speech. But the sound dampening method may not be applicable in all cases. The Echo device, designed by B. Adamczyk, consists of two tape recorders with an attachment. The recorded sound is played back after a split second, creating an echo effect. Domestic designers have created a portable device "Echo" (AIR) for individual use.

A unique apparatus was proposed by V. A. Razdolsky. The principle of its operation is based on sound amplification of speech through loudspeakers or air telephones to hearing aid"Crystal". Perceiving their speech as sound-amplified, dysarthrics strain their speech muscles less and more often begin to use a soft attack of sounds, which has a beneficial effect on their speech. Another positive fact is that when using sound amplification, patients hear their correct speech from the very first lessons, and this accelerates the development of positive reflexes and free, relaxed speech. A number of researchers use various variants of delayed speech in practice (“ white noise", sound deadening, etc.).

During speech therapy sessions, sound recording equipment can be used for psychotherapeutic purposes. During a tape lesson followed by a conversation with a speech therapist, dysarthric people’s mood improves, a desire to achieve success in speech classes appears, confidence in the positive outcome of the classes is developed, and trust in the speech therapist grows. During the first tape lessons, material for the performance is selected and carefully rehearsed.

Tape training sessions help develop correct speech skills. The purpose of these classes is to draw the patient’s attention to the pace and smoothness of his speech, sonority, expressiveness, and grammatical correctness of the phrase. After preliminary conversations about the qualities of correct speech, listening to appropriate speech samples, and after repeated rehearsals, the dysarthric person speaks in front of the microphone with his text, depending on the stage of the lesson. The task is to monitor and manage your behavior, pace, smoothness, sonority of speech, and to avoid grammatical errors in it. The manager records in his notebook the state of speech and behavior of the patient at the time of speaking in front of the microphone. Having finished the speech, the dysarthric person evaluates his speech himself (speaking quietly - loudly, quickly - slowly, expressively - monotonously, etc.). Then, after listening to the speech recorded on tape, the patient evaluates it again. After this, the speech therapist analyzes the speech of the stutterer, his ability to give a correct assessment of his speech, highlights the positive in his speech, in his behavior in class, and sums up the overall result.

An option for teaching tape lessons is to imitate the performances of artists and masters of artistic expression. In this case, an artistic performance is listened to, the text is learned, reproduction is practiced, recorded on tape, and then compared with the original, similarities and differences are noted. Comparative tape sessions are useful, in which the dysarthric person is given the opportunity to compare his real speech with the one he had before. At the beginning of the course of speech classes, with the microphone turned on, he is asked questions on everyday topics, plot pictures are offered to describe their content and compose a story, etc. A tape recorder records cases of convulsions in speech: their place in a phrase, frequency, duration. Subsequently, this first recording of the speech of a dysarthric person serves as a measure of the success of the ongoing speech classes: the state of speech in the future is compared with it.

Advice from a speech pathologist

When corrective work with dysarthrics is important, the formation of spatial thinking is important.

Formation of spatial representations

Knowledge about space and spatial orientation develop in the context of various types of children’s activities: in games, observations, labor processes, in drawing and design.

By the end of preschool age, children with dysarthria develop such knowledge about space as: shape (rectangle, square, circle, oval, triangle, oblong, rounded, curved, pointed, curved), size (large, small, more, less, the same , equal, large, small, half, in half), length (long, short, wide, narrow, high, left, right, horizontal, straight, oblique), position in space and spatial relationship (in the middle, above the middle, below the middle, right, left, side, closer, further, in front, behind, behind, in front).

Mastering this knowledge about space presupposes: the ability to identify and distinguish spatial features, name them correctly and include adequate verbal designations in expressive speech, orientate in spatial relationships when performing various operations associated with active actions.

The completeness of mastering knowledge about space and the ability to spatial orientation is ensured by the interaction of the motor-kinesthetic, visual and auditory analyzers during the performance of various types of child activities aimed at active cognition of the surrounding reality.

The development of spatial orientation and the idea of ​​space occurs in close connection with the formation of a sense of the diagram of one’s body, with the expansion of children’s practical experience, with a change in the structure of object-game action associated with the further improvement of motor skills. The emerging spatial concepts are reflected and further development in the subject-game, visual, constructive and everyday activities of children.

Qualitative changes in the formation of spatial perception are associated with the development of speech in children, with their understanding and active use of verbal designations of spatial relationships, expressed by prepositions and adverbs. Mastering knowledge about space presupposes the ability to identify and distinguish spatial features and relationships, the ability to correctly denote them verbally, and navigate spatial relationships when performing various labor operations based on spatial representations. A major role in the development of spatial perception is played by design and modeling, and the inclusion of verbal symbols adequate to children’s actions in expressive speech.

Methods for studying spatial thinking in junior schoolchildren with dysarthria

TASK No. 1

Goal: to identify an understanding of spatial relationships in a group of real objects and in a group of objects depicted in the picture + object-game action to differentiate spatial relationships.

Mastering left-right orientations.

Poem by V. Berestov.

There was a man standing at a fork in the road.
Where is right, where is left - he could not understand.
But suddenly the student scratched his head
With the same hand with which I wrote,
And he threw the ball and flipped through the pages,
And he held a spoon and swept the floor,
"Victory!" - there was a jubilant cry:
Where is right and where is left the student recognized.

Movement according to given instructions (mastering the left and right parts of the body, left and right sides).

We are marching bravely in the ranks.
We learn science.
We know left, we know right.
And, of course, all around.
This is the right hand.
Oh, science is not easy!

"The Steadfast Tin Soldier"

Stand on one leg
It's like you're a steadfast soldier.
Left leg to the chest,
Yes, be careful not to fall.
Now stand on the left,
If you are a brave soldier.

Clarification of spatial relationships:
* standing in a line, name the one standing on the right, on the left;
* according to the instructions, place objects to the left and right of the given one;
* determine the place of your neighbor in relation to yourself;
* determine your place in relation to your neighbor, focusing on the neighbor’s corresponding hand (“I stand to the right of Zhenya, and Zhenya is to my left.”);
* standing in pairs facing each other, determine first your own, then your friend’s, left hand, right hand, etc.

Game "Body Parts".
One of the players touches some part of his neighbor’s body, for example, his left arm. He says: "This is mine left hand"The one who started the game agrees or denies the neighbor's answer. The game continues in a circle.

"Locate it by the trail."
Hand and foot prints are drawn on the piece of paper in different directions. It is necessary to determine which hand or foot (left or right) this print is from.

Determine by plot picture, in which hand the characters in the picture are holding the called object.

Mastering the concepts “Left side of the sheet - right side of the sheet.

Coloring or drawing according to instructions, for example: “Find the small triangle drawn on the left side of the sheet, color it red. Find the largest triangle among those drawn on the right side of the sheet. Color it with a green pencil. Connect the triangles with a yellow line.”

Determine left or right sleeve of a blouse, shirt, pocket of jeans. The products are in different positions in relation to the child.

Mastering the directions “up-down”, “top-bottom”.

Orientation in space:
What's above, what's below? (analysis of towers built from geometric bodies).

Orientation on a sheet of paper:
- Draw a circle at the top of the sheet and a square at the bottom.
- Put an orange triangle, put a yellow rectangle on top, and a red one below the orange one.

Exercises in the use of prepositions: for, because of, about, from, before, in, from.
Introduction: Once upon a time, the resourceful, smart, dexterous, cunning Puss in Boots was a little playful kitten who loved to play hide and seek.
An adult shows cards with a picture of where the kitten is hiding, and helps the children with questions like:
-Where did the kitten hide?
-Where did he jump from? etc.

TASK No. 2

Goal: verbally indicate the location of objects in the pictures.

Game "Shop" (the child, acting as a seller, placed toys on several shelves and said where and what was).

Show the actions mentioned in the poem.
I will help my mother
I will clean everywhere:
And under the closet
and behind the closet,
and in the closet
and on the closet.
I don't like dust! Ugh!

Orientation on a sheet of paper.

1. Simulation of fairy tales

"Forest School" (L. S. Gorbacheva)

Equipment: each child has a sheet of paper and a house cut out of cardboard.
“Guys, this house is not simple, it is fabulous. Forest animals will study in it. Each of you has the same house. I will tell you a fairy tale. Listen carefully and place the house in the place mentioned in the fairy tale.
Animals live in a dense forest. They have their own children. And the animals decided to build a forest school for them. They gathered at the edge of the forest and began to think about where to put it. Lev suggested building in the lower left corner. The wolf wanted the school to be in the upper right corner. The fox insisted on building a school in the upper left corner, next to her hole. A squirrel intervened in the conversation. She said: “The school should be built in the clearing.” The animals listened to the squirrel’s advice and decided to build a school in a forest clearing in the middle of the forest.”

Equipment: each child has a sheet of paper, a house, a Christmas tree, a clearing (blue oval), an anthill (gray triangle).

"Winter lived in a hut at the edge of the forest. Her hut stood in the upper right corner. One day Winter woke up early, washed her face white, dressed warmly and went to look at her forest. She walked along the right side. When she reached the lower right corner, I saw a small Christmas tree, Winter waved her right sleeve and covered the Christmas tree with snow.
Winter turned to the middle of the forest. There was a large clearing here.
Winter waved her hands and covered the entire clearing with snow.
Winter turned to the lower left corner and saw an anthill.
Winter waved her left sleeve and covered the anthill with snow.
Winter went up: it turned to the right and went home to rest."

"The Bird and the Cat"

Equipment: each child has a piece of paper, a tree, a bird, a cat.

"There was a tree growing in the yard. A bird was sitting near the tree. Then the bird flew and sat on the tree above. A cat came. The cat wanted to catch the bird and climbed up the tree. The bird flew down and sat under the tree. The cat remained on the tree."

2. Graphic reproduction of directions (I. N. Sadovnikova).

Given four points, put a “+” sign from the first point from below, from the second - from above, from the third - to the left, from the fourth - to the right.

Four points are given. From each point, draw an arrow in the direction: 1 - down, 2 - right, 3 - up, 4 - left.

Given four points that can be grouped into a square:
a) Mentally group the points into a square, highlight the upper left point with a pencil, then the lower left point, and then connect them with an arrow in the direction from top to bottom. Similarly, select the upper right point and connect it with an arrow to the upper right point in the direction from bottom to top.
b) In the square, select the upper left point, then the upper right point and connect them with an arrow in the direction from left to right. Similarly, connect the lower points in the direction from right to left.
c) In the square, select the upper left point and the lower right point, connect them with an arrow directed simultaneously from left to right, top to bottom.
d) In the square, select the lower left point and the upper right one, connect them with an arrow directed simultaneously from left to right and from bottom to top.

Mastering prepositions with spatial meaning.

1. Perform various actions according to the instructions. Answer the questions.
- Put the pencil on the book. Where is the pencil?
- Take a pencil. Where did you get the pencil from?
- Put the pencil in the book. Where is he now?
- Take it. Where did you get the pencil from?
- Hide the pencil under the book. Where is he?
- Take out the pencil. Where was it taken from?

2. Line up following the directions: Sveta behind Lena, Sasha in front of Lena, Petya between Sveta and Lena, etc. Answer the questions: “Who are you behind?” (in front of whom, next to whom, ahead, behind, etc.).

3. Arrangement of geometric shapes according to these instructions: “Put a red circle on a large blue square. Place a green circle above the red circle. An orange triangle in front of the green circle, etc.”

4. "What word is missing?"
The river has reached its banks. Children run class. The path led to the field. Green onions in the garden. We reached the city. The ladder was leaned against the wall.

5. "What's mixed up?"
Grandfather in the stove, wood on the stove.
There are boots on the table, flat cakes under the table.
Sheep in the river, crucian carp by the river.
There is a portrait under the table, a stool above the table.

6. “On the contrary” (name the opposite preposition).
The adult says: “Above the window,” the child: “Under the window.”
To door - …
In the box -...
Before school - …
To the city -…
In front of the car -...
- Select pairs of pictures that correspond to opposite prepositions.

7. "Signalers".
a) For the picture, select a card diagram of the corresponding preposition.
b) An adult reads sentences and texts. Children show cards with the necessary prepositions.
c) An adult reads sentences and texts, omitting prepositions. Children show cards with diagrams of missing prepositions.
b) The child is asked to compare groups of geometric shapes same color and shapes, but different sizes. Compare groups of geometric shapes of the same color and size, but different shapes.
c) “Which figure is extra.” Comparison is carried out according to external signs: size, color, shape, changes in details.
d) “Find two identical figures.” The child is offered 4-6 items that differ in one or two characteristics. He must find two identical objects. A child can find the same numbers, letters written in the same font, the same geometric shapes, and so on.
e) “Choose a suitable box for the toy.” The child must match the size of the toy and the box.
f) “Which site will the rocket land on?” The child matches the shape of the rocket base and the landing pad.

TASK No. 3

Goal: to identify spatial orientation associated with drawing and design.

1. Place geometric shapes on a sheet of paper in the indicated manner, either by drawing them or using ready-made ones.

2. Draw shapes using reference points, while having a sample drawing made using points.

3. Without reference points, reproduce the direction of the drawing using the sample. In case of difficulty - additional exercises in which you need:
A) distinguish the sides of the sheet;
B) draw straight lines from the middle of the sheet in different directions;
B) trace the outline of the drawing;
D) reproduce a drawing of greater complexity than the one proposed in the main task.

4. Tracing templates, stencils, tracing contours along a thin line, shading, dots, painting and shading along various lines.

Kern-Jirasek technique.
When using the Kern-Jirasek technique (includes two tasks - drawing written letters and drawing a group of points, i.e. work according to the sample), the child is given sheets of paper with presented samples of completing tasks. The tasks are aimed at developing spatial relationships and concepts, developing fine motor skills of the hand and coordination of vision and hand movements. The test also allows you to identify (in general terms) the child’s developmental intelligence. Tasks on drawing written letters and drawing a group of dots reveal the children’s ability to reproduce a pattern. It also helps determine whether the child can work with concentration for a period of time without distractions.

“House” technique (N.I. Gutkina).
The technique is a task of drawing a picture depicting a house, the individual details of which are made up of capital letters. The task allows us to identify the child’s ability to focus his work on a model, the ability to accurately copy it, reveals the features of the development of voluntary attention, spatial perception, sensorimotor coordination and fine motor skills of the hand.
Instructions to the subject: “In front of you lies a sheet of paper and a pencil. On this sheet I ask you to draw exactly the same picture that you see in this drawing (a piece of paper with “House” is placed in front of the subject). Take your time, be careful, try as hard as you can "The drawing was exactly the same as this one on the sample. If you draw something wrong, then you can’t erase anything with an eraser or your finger, but you need to draw it correctly on top of the wrong one or next to it. Do you understand the task? Then get to work."

When performing the tasks of the "House" Method, the subjects made the following mistakes:
a) some details of the drawing were missing;
b) in some drawings, proportionality was not observed: an increase in individual details of the drawing while maintaining a relatively arbitrary size of the entire drawing;
c) incorrect representation of the elements of the picture;
e) deviation of lines from a given direction;
f) gaps between lines at junctions;
g) lines climbing one on top of another.

“Complete the tails for the mice” and “Draw handles for the umbrellas” by A. L. Wenger.
Both mouse tails and handles also represent letter elements.

Graphic dictation and “Sample and Rule” by D. B. Elkonin - A. L. Wenger.
When completing the first task, the child draws an ornament on a sheet of paper in a box from the pre-set dots, following the instructions of the presenter. The presenter dictates to the group of children in which direction and how many cells the lines should be drawn, and then offers to complete the “pattern” resulting from dictation to the end of the page. Graphic dictation allows you to determine how accurately a child can fulfill the requirements of an adult given orally, as well as the ability to independently perform tasks on a visually perceived model.
The more complex “Pattern and Rule” technique involves simultaneously following in your work a model (the task is given to draw exactly the same pattern as a given geometric figure point by point) and a rule (a condition is stipulated: you cannot draw a line between identical points, i.e. connect a circle with a circle, a cross with a cross and a triangle with a triangle). A child, trying to complete a task, can draw a figure similar to the given one, neglecting the rule, and, conversely, focus only on the rule, connecting different points and not checking the model. Thus, the technique reveals the child’s level of orientation to a complex system of requirements.

“The car is driving along the road” (A. L. Wenger).
A road is drawn on a piece of paper, which can be straight, winding, zigzag, or with turns. There is a car drawn at one end of the road, and a house at the other. The car must drive along the path to the house. The child, without lifting the pencil from the paper and trying not to go beyond the path, connects the car with the house with a line.

You can come up with many similar games. Can be used for training and passing simple labyrinths

“Hit the circles with a pencil” (A. E. Simanovsky).
The sheet shows rows of circles with a diameter of about 3 mm. The circles are arranged in five rows of five circles in a row. The distance between the circles in all directions is 1 cm. The child must, without lifting his forearm from the table, place dots in all the circles as quickly and accurately as possible.
The movement is strictly defined.
I-option: in the first line the direction of movement is from left to right, in the second line - from right to left.
Option II: in the first column the direction of movement is from top to bottom, in the second column - from bottom to top, etc.

TASK No. 4

Target:
1. Fold the stick figures according to the pattern given in the figure.
2. Fold four parts into geometric shapes - a circle and a square. If you have difficulty, perform this task step by step:
A) Make a figure from two then three and four parts;
B) Fold a circle and a square according to the pattern of the drawing with the component parts dotted on it;
C) Fold figures by superimposing parts on a dotted drawing, followed by construction without a sample.

“Make a picture” (like E. Seguin’s board).
The child matches the tabs to the slots according to shape and size and puts together the shapes cut out on the board.

“Find the shape in the object and fold the object.”
In front of the baby are contour images of objects made up of geometric shapes. The child has an envelope with geometric shapes. You need to assemble this object from geometric shapes.

"The picture is broken."
The child must put together the pictures cut into pieces.

"Find what the artist hid."
The card contains images of objects with intersecting contours. You need to find and name all the drawn objects.

"The letter is broken."
The child must recognize the entire letter from any part.

“Fold the square” (B.P. Nikitin).
Equipment: 24 multi-colored squares of paper measuring 80x80 mm, cut into pieces, 24 samples.
You can start the game with simple tasks: “Make a square from these parts. Look carefully at the sample. Think about how to arrange the parts of the square. Try to put them on the sample.” Then the children independently select the parts by color and assemble the squares.

Montessori frames and inserts.
The game is a set of square frames, plates with cut-out holes, which are closed with an insert lid of the same shape and size, but of a different color. Insert covers and slots have the shape of a circle, square, equilateral triangle, ellipse, rectangle, rhombus, trapezoid, quadrangle, parallelogram, isosceles triangle, regular hexagon, five-pointed star, right isosceles triangle, regular pentagon, irregular hexagon, scalene triangle.
The child matches the inserts to the frames, traces the inserts or slots, and inserts the inserts into the frames by touch.

"Mailbox".
A mailbox is a box with slots of different shapes. The child places three-dimensional geometric bodies into the box, focusing on the shape of their base.

“What color is the object?”, “What shape is the object?”.
Option I: children have object pictures. The presenter takes chips of a certain color (shape) from the bag. Children cover the corresponding pictures with chips. The one who closes his pictures the fastest wins. The game is played according to the “Loto” type.
Option II: children have colored flags (flags with images of geometric shapes). The presenter shows the object, and the children show the corresponding flags.

"Assemble according to form."
The child has a card of a certain shape. He selects suitable items for it, shown in the pictures.

Games "Which form is gone?" and “What has changed?”
Geometric figures of different shapes are placed in a row. The child must remember all the figures or their sequence. Then he closes his eyes. One or two figures are removed (switched places). The child must name which figures are missing or say what has changed.

Exercises to develop ideas about size:
- Arrange the mugs from smallest to largest.
- Build the nesting dolls by height: from tallest to shortest.
- Place the narrowest strip on the left, next to the right place a slightly wider strip, etc.
- Color it tall tree with a yellow pencil, and the low one with a red pencil.
- Circle the fat mouse, and circle the thin one.
And so on.

"Wonderful bag."
The bag contains three-dimensional and flat figures, small toys, objects, vegetables, fruits, etc. The child must determine by touch what it is. You can put plastic, cardboard letters and numbers in the bag.

"Drawing on the back."
Draw letters, numbers, geometric shapes, and simple objects on each other’s backs with your child. You need to guess what your partner drew.

Difficulties in differentiating spatial relations in object-based play activities, correct reasoning and explanations in the process of drawing with erroneous reproduction of spatial features may probably indicate a lack of generalized understanding of the formulations already developed in children for the verbalization of spatial relations, which is ahead of their practical implementation.

Literature

1. Vinarskaya E. N. and Pulatov A. M. Dysarthria and its topical and diagnostic significance in the clinic of focal brain lesions, Tashkent, 1973.
2. Luria A. R. Main problems of neurolinguistics, p. 104, M., 1975.
3. Mastyukova E. M. and Ippolitova M. V. Speech disorders in children with cerebral palsy, p. 135, M., 1985.

IX, X, XI, XII pairs are the caudal group of nerves, the nuclei of which are located in the medulla oblongata. IX, X, XII pairs form bulbar group and innervate the muscles of the pharynx, larynx, and tongue. Pair XI innervates the muscles of the neck and shoulder girdle

3.4.1. IXPAIR: GLOSPHARYNGEAL NERVE

Mixed nerve contains sensory and motor portions. First motor neuron localized in the lower sections precentral gyrus, the axons pass through the knee of the internal capsule and end in dual core ( n. ambiquus ), common with X pair (2nd neuron) both on its own and on the opposite side in the medulla oblongata. The motor portion innervates one stylopharyngeal muscle ( m. stylopharyngeus).

The glossopharyngeal nerve contains fibers of taste and general sensitivity. First sensory neuron localized in superior and inferior jugular ganglia( g. jugularae superius et inferius ). The dendrites of the cells of these ganglia branch in the posterior third of the tongue, soft palate, pharynx, pharynx, epiglottis, auditory tube And tympanic cavity. Taste fibers from the lower ganglion go to the taste buds of the posterior third of the tongue, and the axons end in the taste kernel ( n. solitarii )(2nd neuron). General sensory fibers come from the superior jugular ganglion and end in nucleus of the gray tuberosity ( n. ala cinerea ). Sensory axons switch in both the contralateral and ipsilateral thalamus (3- neuron). Then, passing through the leg of the internal capsule, they end in the cerebral cortex, parahippocampal gyrus and uncus.

The glossopharyngeal nerve also contains autonomic fibers for innervation of the parotid gland. The bodies of autonomic neurons are localized in n. salivatorius , the axons of which end in the ear ganglion ( g. oticum).

FUNCTION STUDY

Testing of taste on the posterior two-thirds of the tongue. The flavor solution is applied to the back two-thirds of the tongue in symmetrical areas using a pipette.

SYMPTOMS OF DEFEAT

1. Hypogeusia (ageusia) – reduction (loss) of taste.

2. Parageusia– false taste sensations.

3. Taste hallucinations .

4. Slight dry mouth.

5. Difficulty swallowing solid foods.

3.4.2. XPAIR: VAGUS NERVE

The vagus nerve is multifunctional and provides motor, sensory and autonomic innervation.

Central motor neuron located in the lower part of the precentral gyrus. Peripheral motor fibers (2nd neuron) start from cells n. ambiquus (common with the glossopharyngeal nerve). The axons of these cells, as part of the vagus nerve root, exit through the jugular foramen and innervate the striated muscles of the soft palate, pharynx, larynx, epiglottis, upper part of the digestive and respiratory apparatus.

The vagus nerve contains motor fibers that innervate the striated muscles of the internal organs (bronchi, esophagus, gastrointestinal tract, blood vessels). Begins from the cells of the parasympathetic nucleus n. dorsalis n. vagi.

The first sensory neurons located in g. superius And g. inferiusat the level of the jugular foramen . Sensitive fibers of the vagus nerve innervate the skin of the outer surface of the auricle and auditory canal, pharynx, larynx, and dura mater of the posterior cranial fossa. The axons of these nodes end in n. solitarii in the medulla oblongata (2nd neuron). They pass to the opposite side, go through the peduncle of the internal capsule and end in the thalamus (3rd neuron), then in the cortex of the lower part of the postcentral gyrus.

FUNCTION STUDY

It is more convenient to examine the functions of the vagus and glossopharyngeal nerves with the patient in a sitting position. To do this, the doctor asks the patient:

1. Open your mouth and pronounce the sound “a”, while paying attention to the contraction of the soft palate and the location of the uvula (normally, the soft palate is located symmetrically, tenses equally on both sides, the uvula is located in the midline);

2. Say a few phrases out loud, but there should be no nasal tone in your voice;

3. Drink a few sips of water; swallowing should be free, without choking.

4. Assess the pharyngeal (gag) reflex - to do this, carefully touch the back wall of the pharynx on the right and left with a spatula. Touching causes swallowing and sometimes gagging movements.

5. Assess the palatal reflex - to do this, touch the mucous membrane of the soft palate on the right and left with a spatula. Normally, the velum palatine is pulled up.

6. Study of autonomic-visceral functions.

SYMPTOMS OF DEFEAT

Peripheral paralysis and paresis of the muscles of the pharynx and soft palate develop with damage to the peripheral neuron - the motor nucleus and motor fibers of the vagus and, to a lesser extent, glossopharyngeal nerves.

For unilateral nerve damage:

· the soft palate on the affected side hangs down. When pronouncing sounds, the mobility of the soft palate on the affected side is reduced, the uvula is deviated to the healthy side, the palatine and pharyngeal (gag) reflexes are reduced, and swallowing food becomes difficult. (dysphagia, aphagia)

· with a special laryngoscopic examination of the vocal cords, paralysis or paresis of the vocal cord on the affected side is observed, hoarseness is noted (dysphonia, aphonia);

· atrophy is observed in the affected muscles, and when the nucleus is damaged, fibrillary twitching is observed.

· Disturbances of autonomic respiratory functions (laryngospasm), heart rate(tachycardia), etc.

Bilateral lesion IX and X FMN pairs are typical for amyotrophic lateral sclerosis, brainstem encephalitis, and tumors. Bilateral weakness of the muscles of the larynx and vocal cords is characteristic of myasthenia gravis. Psychogenic dysphagia and dysphonia may occur in conversion disorders.

3.4.3. XIIPAIR: HYPOGLOUS NERVE

Hypoglossal nerve nucleus (n. hypoglossus ) lies at the bottom of the diamond-shaped fossa in the area trigonum hypoglossi . The nerve roots emerge from the trunk between the pyramids and olives, then merge into a common trunk, which exits the cranial cavity through canalis hypoglossi . The hypoglossal nerve innervates the muscles of the tongue on its side, with its help the tongue moves forward.

Central neuron XII pairs (like all motor cranial nerves) starts from the lower parts of the anterior central gyrus, goes through coronae radiatae , knee of the internal capsule, at the base of the trunk above the fiber core completely switch to the opposite side.

FUNCTION STUDY

The doctor asks the patient to stick out his tongue. Normally, the tongue should be located in the midline.

SYMPTOMS OF DEFEAT

Peripheral paralysis and tongue paresis develop when a peripheral neuron is damaged - the nucleus or trunk of the hypoglossal nerve.

In case of unilateral nerve damage, the following symptoms occur:

· when protruding, the tongue deviates towards the affected muscle, i.e. towards the lesion;

· there is atrophy of half of the tongue on the affected side, it has a thinned, wrinkled surface;

· a degeneration reaction is detected in the muscles of the affected side of the tongue.

· fibrillary twitching is observed on the affected half of the tongue.

Defeats XII FCN pairs of the peripheral type are observed during focal processes in the trunk (encephalitis, amyotrophic lateral sclerosis, tumors, etc.).

Central paralysis and paresis of half the tongue observed with unilateral damage to the central neuron, i.e. corticonuclear pathway:

· the tongue is deviated towards the affected muscle, i.e. in the direction opposite to the lesion;

· no atrophy;

· there are no fibrillary twitches, reactions of degeneration of the tongue muscles.

Defeats XII pairs of the central type are noted when lesions are localized in the internal capsule, lower parts of the anterior central gyrus and upper parts of the brainstem (cerebral circulatory disorders, tumors, etc.).

With bilateral nerve damage, both central and peripheral, the clinical picture shows limited mobility of the tongue, and with complete damage - complete immobility of the tongue (the patient cannot stick his tongue out of his mouth); speech disorder - speech is unclear, blurred, words are poorly understood, develops dysarthria or anarthria. The patient feels difficulty while eating and drinking - the food bolus has difficulty moving in the mouth.

3. 4 .4. BULBAR PARALYSIS

Bulbar palsy develops in case of damage to the lower motor neuron IX, X, XII pairs of cranial nerves (peripheral paralysis) and is manifested by the following symptoms:

• dysarthria;
• dysphagia;
• dysphonia;
• atrophy of the muscles of the tongue, muscles of the pharynx and soft palate;
• fibrillary twitching in the muscles of the tongue, pharynx and soft palate;
• decrease or disappearance of pharyngeal reflexes and reflexes from the mucous membrane of the soft palate;
• the presence of degeneration reactions in the muscles of the tongue.

The most severe and unfavorable for the patient’s life is complete bilateral damage to the vagus nerve nuclei, which, as a rule, leads to bulbar death. The immediate cause of death in this case is respiratory and cardiac arrest.

The causes of the development of bulbar palsy may be inflammatory processes in the brain stem, the development of neoplasms in it, multiple inflammation of peripheral nerves, impaired trophism and ischemia of the medulla oblongata due to atherothrombosis, etc.

3. 4 .5. PSEUDOBULBAR PARALYSIS

Pseudobulbar palsydevelops as a resultbilaterallesions of the corticonuclear pathways ( central paralysis) and has clinical symptoms similar to bulbar:

• dysarthria;
• dysphagia;
• dysphonia;
• there is no atrophy of the muscles of the tongue, pharynx and soft palate;
• no fibrillary twitching in the muscles of the tongue, pharynx and soft palate;
• increased pharyngeal and cough reflexes, reflexes from the mucous membrane of the soft palate;
• there is no reaction of degeneration in the muscles of the tongue.

Pseudobulbar palsy is accompanied by the appearance of:

• oral automatism reflexes(proboscis reflexWurpa is a protrusion of the lips caused by percussion on the upper lip.Palmomental reflex Marinescu-Radoviciconsists of contracting the muscles of the chin with stroke stimulation of the palm.Oppenheim reflex– with stroke irritation of the lips, a sucking movement is caused.Astvatsaturov's nasolabial reflex– stretching out the lips in the form of a proboscis when tapping the bridge of the nose.Corneomental and corneomandibular reflexes- movement upper jaw and contraction of the chin muscles caused by touching the cornea with a cotton swab.Remote-oral reflexes– bringing an object closer to the face causes contraction of the labial and mental muscles).
• mental disorders in the formviolent laughter and crying.

Pseudobulbar palsy is much easier than bulbar palsy, despite the fact that it is accompanied by bilateral damage. Pseudobulbar palsy is a cause of death in extremely rare cases. The cause of pseudobulbar palsy is cerebrovascular pathology, multiple sclerosis, traumatic brain injury, etc.

3.4.6. XIPAIR: ACCESSORY NERVE

Accessory nerve nucleus ( n. accessorius Wilisii ) lies in the gray matter of the anterior horns of the spinal cord at the level of segments 1-5. The roots of the accessory nerve merge into a common trunk, which enters the cranial cavity via foramen magnum. The nerve then exits the cranial cavity through foramen jugulare and innervates the sternocleidomastoid and trapezius muscles. With the participation of the accessory nerve, the head is bent forward, the head is turned in the opposite direction, the shoulders are shrugged, the shoulder girdle is pulled back, the scapula is brought to the spine, and the shoulder is raised above the horizontal line.

FUNCTION STUDY

It is more convenient to examine the functions of the accessory nerve with the patient standing or sitting. For this, the patient is asked:

a) bend your head forward;

b) turn it to the side;

c) shrug;

d) raise your shoulders above the horizontal;

e) bring the shoulder blades to the spine.

Normally, all these movements are performed without difficulty.

SYMPTOMS OF DEFEAT

Peripheral paralysis and paresis of the sternocleidomastoid and trapezius muscles develop when a peripheral neuron is damaged - the nucleus or trunk of the accessory nerve.

With unilateral nerve damage, the following symptoms are observed:

· it is impossible or difficult to turn the head in the healthy direction;

· it is impossible or difficult to raise the shoulder girdle (shrug);

· the shoulder on the affected side is drooping;

· the lower angle of the scapula on the affected side extends outward and upward;

· Lifting the arm above the horizontal is limited.

In the case of bilateral nerve damage, patients cannot hold their head, turning the head to the side, raising the shoulder girdle, etc. is impossible.

Defeat XI peripheral type couples are observed when tick-borne encephalitis, craniospinal tumors.

Questions for self-control

1. List the symptoms of prolapse when the olfactory nerve and olfactory tract are damaged.

2. Define anosmia.

3. How is anosmia different from olfactory agnosia?

4. The patient has olfactory hallucinations. Where is the lesion located?

5. What types of friendly movements of the eyeballs do you know?

6. How to perform a smooth tracking test.

7. List the symptoms of damage to the oculomotor nerve.

8. At what localization of the lesion does the patient develop Yakubovich-Edinger-Westphal syndrome?

9. How does Eydie syndrome manifest clinically?

10. How does Pourfure du Petit syndrome manifest clinically?

11. Describe Prevost's syndrome.

12. Describe the features of gaze innervation.

13. Name the localization of neurons in the optic tract.

14. List the types of color vision disorders.

15. Define field of view.

16. At what location of the lesion does the patient have bitemporal hemianopsia in the clinical picture?

17. At what location of the lesion does the patient have binasal hemianopsia in the clinical picture?

18. How visual fields change with damage to the temporal lobe.

19. List the symptoms of irritation of the occipital lobe cortex.

20. What portions of the trigeminal nerve do you know?

21. Describe the clinical picture of peripheral trigeminal palsy.

22. Describe the features of the sensory nuclei of the trigeminal nerve.

23. Define Zelder zones.

24. What reflexes are closed at the level of the trigeminal nerve.

25. How is peripheral facial palsy clinically different from central paralysis?

26. What is the peculiarity of the innervation of the motor nucleus of the facial nerve?

27. Describe the course of the facial nerve in the facial nerve canal.

28. Define the terms “prosoparesis”, “lagophthalmos”, “xerophthalmia”.

29. Describe the pathway of taste sensitivity.

30. What reflexes close at level 7 of the CN?

Name the nerves of the bulbar group.

31. List the symptoms of damage to the glossopharyngeal and bulbar nerves.

32. Define the terms “dysphagia”, “nasolalia”, “dysphonia”

33. What is the peculiarity of the innervation of the 12th CN nucleus?

34. Describe central and peripheral paralysis 12 CN.

35. The patient has pseudobulbar palsy. Where is the outbreak located?

36. The patient has bulbar palsy. Where is the outbreak located?

37. List the symptoms of accessory nerve damage.

– a disorder of the pronunciation organization of speech associated with damage to the central part of the speech motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. The structure of the defect in dysarthria includes violations of speech motor skills, sound pronunciation, speech breathing, voice and prosodic aspects of speech; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics (EEG, EMG, ENG, MRI of the brain, etc.) and speech therapy examination of oral and written speech are performed. Corrective work for dysarthria includes therapeutic effects ( medication courses, exercise therapy, massage, physical therapy), speech therapy classes, articulation gymnastics, speech therapy massage.

General information

Causes of dysarthria

Most often (in 65-85% of cases) dysarthria accompanies cerebral palsy and has the same causes. In this case, organic damage to the central nervous system occurs in utero, birth or early period child development (usually up to 2 years). The most common perinatal factors of dysarthria are toxicosis of pregnancy, fetal hypoxia, Rhesus conflict, chronic somatic diseases of the mother, pathological course of labor, birth injuries, birth asphyxia, kernicterus of newborns, prematurity, etc. The severity of dysarthria is closely related to the severity of motor disorders during Cerebral palsy: for example, with double hemiplegia, dysarthria or anarthria is detected in almost all children.

In early childhood, damage to the central nervous system and dysarthria in a child can develop after suffering neuroinfections (meningitis, encephalitis), purulent otitis media, hydrocephalus, traumatic brain injury, severe intoxication.

The occurrence of dysarthria in adults is usually associated with a stroke, head injury, neurosurgery, and brain tumors. Dysarthria can also occur in patients with multiple sclerosis, amyotrophic lateral sclerosis (ALS), syringobulbia, Parkinson's disease, myotonia, myasthenia gravis, cerebral atherosclerosis, neurosyphilis, oligophrenia.

Classification of dysarthria

The neurological classification of dysarthria is based on the principle of localization and a syndromic approach. Taking into account the localization of damage to the speech-motor apparatus, the following are distinguished:

• bulbar dysarthria associated with damage to the nuclei of the cranial nerves (glossopharyngeal, sublingual, vagus, sometimes facial, trigeminal) in the medulla oblongata
• pseudobulbar dysarthria associated with damage to the corticonuclear pathways
• extrapyramidal (subcortical) dysarthria associated with damage to the subcortical nuclei of the brain
• cerebellar dysarthria associated with damage to the cerebellum and its pathways
• cortical dysarthria associated with focal lesions of the cerebral cortex.

Depending on the presenter clinical syndrome With cerebral palsy, spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, ataxic-hyperkinetic dysarthria can occur.

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

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

Symptoms of dysarthria

The speech of patients with dysarthria is slurred, unclear, and incomprehensible (“porridge in the mouth”), which is due to insufficient innervation of the muscles of the lips, tongue, soft palate, vocal folds, larynx, and respiratory muscles. Therefore, with dysarthria, a whole complex of speech and non-speech disorders develops, which constitute the essence of the defect.

Impaired articulatory motor skills in patients with dysarthria may manifest as spasticity, hypotonia, or dystonia of the articulatory muscles. Muscle spasticity is accompanied by constant increased tone and tension in the muscles of the lips, tongue, face, neck; tightly closed lips, limiting articulatory movements. With muscle hypotonia, the tongue is flaccid and lies motionless on the floor of the mouth; the lips do not close, the mouth is half open, hypersalivation (salivation) is pronounced; Due to paresis of the soft palate, a nasal tone of voice appears (nasalization). In the case of dysarthria occurring with muscular dystonia, when attempting to speak, muscle tone changes from low to increased.

Sound pronunciation disturbances in dysarthria can be expressed to varying degrees, depending on the location and severity of damage to the nervous system. With erased dysarthria, individual phonetic defects (sound distortions) and “blurred” speech are observed.” With more pronounced degrees of dysarthria, there are distortions, omissions, and substitutions of sounds; speech becomes slow, inexpressive, slurred. General speech activity is noticeably reduced. In the most severe cases, with complete paralysis of the speech motor muscles, motor speech becomes impossible.

The specific features of impaired sound pronunciation in dysarthria are the persistence of the defects and the difficulty of overcoming them, as well as the need for more long period automation of sounds. With dysarthria, the articulation of almost all speech sounds, including vowels, is impaired. Dysarthria is characterized by interdental and lateral pronunciation of hissing and whistling sounds; voicing defects, palatalization (softening) of hard consonants.

Due to insufficient innervation of the speech muscles during dysarthria, speech breathing is disrupted: exhalation is shortened, breathing at the time of speech becomes rapid and intermittent. Voice disturbances in dysarthria are characterized by insufficient strength (quiet, weak, fading voice), changes in timbre (deafness, nasalization), and melodic-intonation disorders (monotony, absence or inexpressibility of voice modulations).

Due to slurred speech in children with dysarthria, auditory differentiation of sounds and phonemic analysis and synthesis suffer secondarily. Difficulty and insufficiency of verbal communication can lead to unformed vocabulary and grammatical structure of speech. Therefore, children with dysarthria may experience phonetic-phonemic (FFN) or general speech underdevelopment (GSD) and associated corresponding types of dysgraphia.

Characteristics of clinical forms of dysarthria

For bulbar dysarthria characterized by areflexia, amymia, disorder of sucking, swallowing solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is slurred and extremely simplified. All the variety of consonants is reduced into a single fricative sound; sounds are not differentiated from each other. Nasalization of voice timbre, dysphonia or aphonia is typical.

At pseudobulbar dysarthria the nature of the disorders is determined by spastic paralysis and muscle hypertonicity. Pseudobulbar paralysis manifests itself most clearly in impaired tongue movements: great difficulty is caused by attempts to raise the tip of the tongue upward, move it to the sides, or hold it in a certain position. With pseudobulbar dysarthria, switching from one articulatory posture to another is difficult. Typically selective impairment of voluntary movements, synkinesis (conjugal movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is blurred, slurred, and has a nasal tint; the normative reproduction of sonors, whistling and hissing, is grossly violated.

For subcortical dysarthria characterized by the presence of hyperkinesis - involuntary violent muscle movements, including facial and articulatory ones. Hyperkinesis can occur at rest, but usually intensifies when attempting to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic aspect of speech; Sometimes patients emit involuntary guttural screams.

With subcortical dysarthria, the tempo of speech may be disrupted, such as bradylalia, tachylalia, or speech dysrhythmia (organic stuttering). Subcortical dysarthria is often combined with pseudobulbar, bulbar and cerebellar forms.

Typical manifestation cerebellar dysarthria is a violation of the coordination of the speech process, which results in tremor of the tongue, jerky, scanned speech, and occasional cries. Speech is slow and slurred; The pronunciation of front-lingual and labial sounds is most affected. With cerebellar dysarthria, ataxia is observed (unsteadiness of gait, imbalance, clumsiness of movements).

Cortical dysarthria in its speech manifestations it resembles motor aphasia and is characterized by a violation of voluntary articulatory motor skills. There are no disorders of speech breathing, voice, or prosody in cortical dysarthria. Taking into account the localization of lesions, kinesthetic postcentral cortical dysarthria (afferent cortical dysarthria) and kinetic premotor cortical dysarthria (efferent cortical dysarthria) are distinguished. However, with cortical dysarthria there is only articulatory apraxia, while with motor aphasia not only the articulation of sounds suffers, but also reading, writing, understanding speech, and using language.

Diagnosis of dysarthria

The examination and subsequent management of patients with dysarthria is carried out by a neurologist (children's neurologist) and speech therapist. The extent of the neurological examination depends on the expected clinical diagnosis. The most important diagnostic value is given by electrophysiological studies (electroencephalography, electromyography, electroneurography), transcranial magnetic stimulation, MRI of the brain, etc.

Forecast and prevention of dysarthria

Only early, systematic speech therapy work to correct dysarthria can give positive results. A major role in the success of correctional pedagogical intervention is played by the therapy of the underlying disease, the diligence of the dysarthric patient himself and his close circle.

Under these conditions, one can count on almost complete normalization of speech function in the case of erased dysarthria. Having mastered the skills of correct speech, such children can successfully study in a comprehensive school, and receive the necessary speech therapy help in clinics or at school speech centers.

At severe forms dysarthria, it is only possible to improve the state of speech function. The continuity of various types of speech therapy institutions is important for the socialization and education of children with dysarthria: kindergartens and schools for children with severe speech disorders, speech departments of psychoneurological hospitals; friendly work of a speech therapist, neurologist, psychoneurologist, massage therapist, and physical therapy specialist.

Medical and pedagogical work to prevent dysarthria in children with perinatal brain damage should begin from the first months of life. Prevention of dysarthria in early childhood and adulthood involves preventing neuroinfections, brain injuries, and toxic effects.

Dysarthria (from the Greek dys - disorder, arthroo - pronounce articulately) is a disorder of sound pronunciation caused by damage to the innervation of the speech apparatus as a result of any brain damage. The difference from other speech disorders is that it is not the articulation of individual sounds that suffers, but the pronunciation of words as a whole.

Dysarthric speech is usually understood as unclear, slurred, muffled, often nasal-tinged speech. They say about such people that they have a “mouth full of porridge.”

This disease in adults is not accompanied by the collapse of the speech system: there is no impairment of auditory perception of speech, writing and reading. But in childhood, dysarthria often leads to a violation of the pronunciation of words and, accordingly, to writing and reading disorders, as well as to a general underdevelopment of speech. Such deficiencies can be corrected through sessions with a speech therapist.

Causes

Dysarthria occurs as a result of damage to the speech apparatus, and the “locus of damage” is localized in a certain part of the central nervous system.

1. In children, the cause of this speech disorder can be:

• organic damage to subcortical structures ( early stage cerebral palsy).
• inflammatory disease of the brain suffered in early childhood (meningitis and encephalitis);
• injury or oxygen deprivation of the brain during childbirth;
• toxicosis of pregnant women.

2. Reasons typical for adults:

• brain tumors (malignant and benign);
• intoxication (alcohol, drugs, drugs, etc.);

Classification of speech therapists

According to the severity of damage to the brain and nerves responsible for the speech apparatus, they are distinguished:

• anarthria - complete loss of the ability to pronounce articulate sounds;
• severe dysarthria - oral speech is possible, but it is inarticulate and incomprehensible. Gross violations of sound pronunciation, breathing, voice and intonation expressiveness.
• “erased” - all neurological, psychological and speech symptoms are expressed in an implicit form.

Severe dysarthria is often confused with dyslalia. The difference is that with the first option, focal neurological microsymptoms can be observed.

Classification of neurologists

Based on the location of damage to the motor apparatus of speech in the brain, they are distinguished

According to this classification, there are 5 forms of dysarthria:

• bulbar - manifests itself in diseases of the medulla oblongata. Characteristic is paresis or paralysis of the muscles of the larynx, pharynx, tongue and soft palate. Swallowing of any food is impaired, chewing is also difficult. The voice becomes weak, all spoken sounds acquire a pronounced nasal (nasal) tone. Words become slurred, extremely unclear, and are pronounced slowly.
• pseudobulbar - most often found in children, as it is a consequence of birth injuries, intoxication of pregnant women or diseases suffered in early childhood. The degree of impairment of speech and articulatory motor skills may vary. According to the clinical manifestations of disorders, this form is close to the bulbar form of dysarthria, but the possibilities of correction and positive prognosis in the treatment of pseudobulbar dysarthria are much higher.
• extrapyramidal (subcortical) - diagnosed when the subcortical nodes are affected. The pronunciation of such a person is blurred, indistinct, with a nasal tint. The intonation and melody of speech and its tempo are greatly impaired.
• cerebellar occurs due to damage to the cerebellum; This form is characterized by chanted, drawn-out speech with constantly changing volume.
• cortical manifests itself when certain parts of the cerebral cortex responsible for articulation are damaged; while maintaining the correct structure of the word, a disorder in the pronunciation of syllables is observed.

Symptoms

Speech symptoms include disorders:

• sound pronunciations;
• intonation;
• phonemic functions;
• reading and writing;
• lexico-grammatical construction of sentences;

Non-speech symptoms of dysarthria include the following:

Diagnostics

Several specialists are involved in making a diagnosis:

• The speech therapist examines the features of sound pronunciation disorders, characterizes other aspects of speech, and then reflects the patient’s condition in a special speech card.
• a practical psychologist examines general intellectual development, excluding psychosomatics and the influence of psychotrauma.
• after this, a neuropsychiatrist, relying on the opinion of a speech therapist and a practical psychologist, makes a diagnosis.

Correction, treatment methods

The goal of correction and treatment of dysarthria is to achieve speech that is understandable to others. For a good result, a complex effect is required. Speech therapy correction must be carried out in combination with exercise therapy and drug treatment.

A comprehensive treatment method for dysarthria consists of:

• medicines;
• physical therapy, physiotherapy, acupuncture;
• hardening and maintenance treatment;
• speech therapy work on the development and correction of speech;
• treatment of concomitant diseases.

The work of a speech therapist is aimed at developing articulation organs. Such impacts include:

• work on expressiveness of speech;
• correction of speech breathing and voice;
• articulation gymnastics;
• correcting the pronunciation of speech sounds;
• tongue massage.

Speech therapy tongue massage for dysarthria

A significant role in treatment (especially for the erased form of dysarthria) is played by tongue massage. Speech therapy massage of the tongue has a beneficial effect on the entire body, and also causes positive changes in the systems that play a major role in the speech-motor process (in the muscular system and nervous system).

The main impact of speech therapy massage is aimed at:

1. normalization of muscle tone of the articulatory apparatus;
2. activation of groups of those muscles of the peripheral speech apparatus that have insufficient contractility;
3. stimulation of proprioceptive sensations;
4. preparing conditions for the formation of voluntary and coordinated movements of the tongue and other organs of articulation;
5. decreased salivation;
6. strengthening the pharyngeal reflex;
7. afferentation (transfer of excitation from peripheral neurons to central neurons) to the speech areas of the cerebral cortex. This stimulates speech development when speech formation is delayed.

Tongue massage is contraindicated if:

1. infectious diseases (for example, influenza and ARVI);
2. skin diseases;
3. herpes on the lips;
4. stomatitis;
5. conjunctivitis;
6. For people with episyndrome (convulsions), speech therapy massage of the tongue should be prescribed with great caution.

Prevention and prognosis

The prognosis in the treatment of dysarthria is most often uncertain. The earlier the patient’s systematic work with a speech therapist begins, the more likely positive result. The most favorable prognosis in the treatment of the disease is possible in the case of treatment of the underlying disease, the efforts of the dysarthric patient himself and the support of such efforts by his environment.

In the case of erased dysarthria, with a similar approach to therapy, you can count on virtually complete normalization of speech. Having mastered the necessary skills of correct speech, a person can subsequently successfully study and work, periodically receiving the speech therapy help he needs in clinics.

In severe cases, it is only possible to improve the state of speech function. Of particular importance for the socialization of people with dysarthria is the joint work of a speech therapist, psychoneurologist, practical psychologist, neurologist, massage therapist and exercise therapy specialist.

Prevention of dysarthria in children with perinatal brain lesions should be carried out from the first month of life. Further prevention in both children and adults is to prevent brain injuries, neuroinfections and toxic effects on the nervous system.

Video on the topic

The video demonstrates a set of articulatory gymnastics that you can do yourself:

Gradually developing dysfunction of the bulbar group of the caudal cranial nerves, caused by damage to their nuclei and/or roots. A triad of symptoms is characteristic: dysphagia, dysarthria, dysphonia. The diagnosis is made based on examination of the patient. Additional examinations (cerebrospinal fluid analysis, CT, MRI) are carried out to determine the underlying pathology that caused the bulbar palsy. Treatment is prescribed in accordance with the causative disease and existing symptoms. Urgent measures may be required: resuscitation, mechanical ventilation, combating heart failure and vascular disorders.

General information

Bulbar palsy occurs when the nuclei and/or roots of the bulbar group of cranial nerves located in the medulla oblongata are damaged. The bulbar nerves include the glossopharyngeal (IX pair), vagus (X pair) and hypoglossal (XII pair) nerves. The glossopharyngeal nerve innervates the muscles of the pharynx and provides its sensitivity, is responsible for the taste sensations of the posterior 1/3 of the tongue, and provides parasympathetic innervation to the parotid gland. The vagus nerve innervates the muscles of the pharynx, soft palate, larynx, upper digestive tract and respiratory tract; provides parasympathetic innervation of internal organs (bronchi, heart, gastrointestinal tract). The hypoglossal nerve provides innervation to the muscles of the tongue.

The cause of bulbar palsy may be chronic cerebral ischemia, which develops as a result of atherosclerosis or chronic vascular spasm in hypertension. TO rare factors Causing damage to the bulbar group of cranial nerves include craniovertebral anomalies (primarily Chiari malformation) and severe polyneuropathies (Guillain-Barre syndrome).

Symptoms of progressive bulbar palsy

At the core clinical manifestations Bulbar palsy is a peripheral paresis of the muscles of the pharynx, larynx and tongue, which results in disturbances in swallowing and speech. The basic clinical symptom complex is a triad of signs: swallowing disorder (dysphagia), articulation disorder (dysarthria) and speech sonority (dysphonia). Difficulty swallowing food begins with difficulty taking liquids. Due to paresis of the soft palate, fluid from the oral cavity enters the nose. Then, with a decrease in the pharyngeal reflex, swallowing disorders of solid foods develop. Limitation of tongue mobility leads to difficulty chewing food and moving the food bolus in the mouth. Bulbar dysarthria is characterized by slurred speech and a lack of clarity in the pronunciation of sounds, which makes the patient’s speech incomprehensible to others. Dysphonia manifests itself as hoarseness of voice. Nasolalia (nasality) is noted.

The patient's appearance is characteristic: the face is hypomimic, the mouth is open, there is drooling, difficulty chewing and swallowing food, and food falling out of the mouth. Due to damage to the vagus nerve and disruption of the parasympathetic innervation of somatic organs, disorders occur respiratory function, heart rate and vascular tone. These are the most dangerous manifestations of bulbar palsy, since often progressive respiratory or heart failure causes the death of patients.

When examining the oral cavity, atrophic changes in the tongue, its folding and unevenness are noted, and fascicular contractions of the tongue muscles may be observed. The pharyngeal and palatal reflexes are sharply reduced or not evoked. Unilateral progressive bulbar palsy is accompanied by drooping of half of the soft palate and deviation of its uvula to the healthy side, atrophic changes in 1/2 of the tongue, deviation of the tongue towards the affected side when it protrudes. With bilateral bulbar palsy, glossoplegia is observed - complete immobility of the tongue.

Diagnostics

A neurologist can diagnose bulbar palsy by carefully studying the patient’s neurological status. The study of the function of the bulbar nerves includes assessment of the speed and intelligibility of speech, timbre of voice, volume of salivation; examination of the tongue for the presence of atrophies and fasciculations, assessment of its mobility; examination of the soft palate and checking the pharyngeal reflex. It is important to determine the frequency of breathing and heart contractions, and study the pulse to detect arrhythmia. Laryngoscopy allows you to determine the lack of complete closure of the vocal cords.

During diagnosis, progressive bulbar palsy must be distinguished from pseudobulbar palsy. The latter occurs with supranuclear damage to the corticobulbar tracts connecting the nuclei of the medulla oblongata with the cerebral cortex. Pseudobulbar palsy is manifested by central paresis of the muscles of the larynx, pharynx and tongue with hyperreflexia (increased pharyngeal and palatal reflexes) and increased muscle tone characteristic of all central paresis. Clinically it differs from bulbar palsy in the absence of atrophic changes in the tongue and the presence of oral automatism reflexes. Often accompanied by violent laughter resulting from spastic contraction of the facial muscles.

In addition to pseudobulbar palsy, progressive bulbar palsy requires differentiation from psychogenic dysphagia and dysphonia, various diseases with primary muscular damage causing myopathic paresis of the larynx and pharynx (myasthenia gravis, Rossolimo-Steinert-Kurshman myotonia, paroxysmal myoplegia, oculopharyngeal myopathy). It is also necessary to diagnose the underlying disease that led to the development of bulbar syndrome. For this purpose, a study of cerebrospinal fluid, CT and MRI of the brain is carried out. Tomographic studies make it possible to visualize brain tumors, demyelination zones, cerebral cysts, intracerebral hematomas, cerebral edema, displacement of cerebral structures during dislocation syndrome. CT or radiography of the craniovertebral junction can reveal abnormalities or post-traumatic changes in this area.

Treatment of progressive bulbar palsy

Treatment tactics for bulbar palsy are based on the underlying disease and leading symptoms. In case of infectious pathology, etiotropic therapy is carried out; in case of cerebral edema, decongestant diuretics are prescribed; tumor processes Together with a neurosurgeon, the issue of removing the tumor or performing shunt surgery to prevent dislocation syndrome is decided.

Unfortunately, many diseases in which bulbar syndrome occurs are a progressive degenerative process occurring in cerebral tissues and do not have effective specific treatment. In such cases, symptomatic therapy is carried out, designed to support vital important functions body. Thus, in case of severe respiratory disorders, tracheal intubation is performed and the patient is connected to a ventilator; in case of severe dysphagia, tube feeding is provided; vascular disorders are corrected with the help of vasoactive drugs and infusion therapy. To reduce dysphagia, neostigmine, ATP, and vitamins are prescribed. B, glutamic acid; for hypersalivation - atropine.

Forecast

Progressive bulbar palsy has a highly variable prognosis. On the one hand, patients may die from cardiac or respiratory failure. On the other hand, with successful treatment of the underlying disease (for example, encephalitis), in most cases, patients recover with complete restoration of swallowing and speech function. Due to the lack of effective pathogenetic therapy, bulbar palsy associated with progressive degenerative damage to the central nervous system has an unfavorable prognosis (with multiple sclerosis, ALS, etc.).