Underdeveloped muscles of the mouth or weak muscle tone of the face are among the causes of deviations in speech development.
Based on the position of N.A. Bernstein about the level organization of voluntary movements and actions, a number of researchers, specialists in this field (in particular, Sheremetyeva E.V.) suggested that articulation, as the highest symbolic level of voluntary movement, can be formed while maintaining all the underlying levels of voluntary movement. The peripheral part of articulation is built on top of the objective level of oral movements that fulfill life-supporting nutritional needs: sucking, biting, chewing, swallowing. Therefore, they considered it possible to evaluate the potential possibility of articulation by observing the objective level of movements of articulators - lips, tongue, lower jaw - in the process of eating and the state of facial expressions in free activity.
After analyzing the results of the study by E.V. Sheremetyeva, in the oral base of articulation, the precursors of speech underdevelopment (indicators of deviations from the normal course of speech development) at an early age were identified:
Refusal of solid food: the child prefers homogeneous, well-ground masses. Often such children, so that they do not remain hungry, parents bring in Kindergarten yoghurts, curds, etc. Such eating behavior can have different causes: late introduction of solid complementary foods; parents for a long time (up to a year, or even two) crushed the child's food to a homogeneous mass; maintenance of the sucking reflex (breastfeeding) up to two, two and a half years; violation of the innervation of the mandibular muscles;
Difficulties in the process of chewing and, as a result, spitting out, which is associated with a violation of the innervation of the corresponding muscle groups. With such a decrease in physical activity, the muscles that lift and hold the lower jaw and the muscles of the tongue weaken;
General amimia in the process of eating: the child sits for a very long time over a plate or with a piece in his hand, then slowly brings the spoon to his mouth or bites off, starts chewing lazily (lack of pleasure “written” on his face from the process of eating);
Liquid food or liquid is often spilled due to the insufficient formation of the lip grip: the child does not sufficiently capture the edge of the spoon, cup with the lower lip (liquid spills) or captures pieces of food from the spoon directly with the teeth. They say about such people: "Eats not neatly." In reality, the innervation of the labial muscles and, as a result, their strength, dexterity and coordination are disturbed.
An increase in the threshold of receptive sensitivity of the skin around the lips, which also indicates a violation of the innervation of the corresponding muscle groups: the child drinks kefir or jelly, the remnants of which, due to insufficient automation of object movement, remain around the lips. He does not try to reduce the irritation from the remnants of the liquid in any way. They say about such children: "Very untidy."
If the perceptive sensitivity of the circumlabial space is preserved, and the innervation of the lingual muscles is impaired, then under similar conditions the following is observed:
The absence of circular licking movements of the tongue when a thick drink or liquid porridge gets on the lips or around the lips: in such cases, the child wipes the upper lip with improvised means;
pulling the back of the tongue up with an unexpressed tip of the tongue in similar conditions;
Reducing irritation of the skin surface of the lips with the help of the lower lip or other means;
Raising the tip of the tongue to the level of the corner of the lips when trying to lick the upper lip.
In general, in the chewing muscles, there is a limitation of the mobility of the lower jaw; slight or fairly pronounced displacement of the lower jaw to the side at rest, during chewing and during articulation; with pathology of masticatory muscle tone, there is a decrease in the intensity and volume of masticatory movements, discoordination of the movements of the lower jaw during articulation; violation of the process of biting off a piece (which can also be complicated by anomalies of the dentoalveolar system); synkinesias are revealed in the motility of the lower jaw during tongue movements (especially when raising the tongue to the upper lip or pulling it to the chin).
E. G. Chigintseva also noted the peculiarities in the lingual muscles: pathological conditions of muscle tone are observed, which in some cases are accompanied by structural features of the tongue (with spasticity, the tongue is more often massive, drawn in a lump deep into the oral cavity or elongated with a “sting”, this can be combined with shortening of the frenulum, presented in the form of a dense cord; with hypotension, the tongue is in most cases thin, flaccid, flattened at the bottom of the oral cavity, which can be complicated by shortening of the sublingual fold, which looks thin and translucent); there are violations of the position of the tongue (at rest and during movement) in the form of deviation to the side, protrusion of the tongue from the mouth, laying the tongue between the teeth; a slight or rather pronounced limitation of the mobility of the lingual muscles is revealed; hyperkinesis, tremor, fibrillar twitching of the tongue; increase or decrease in the pharyngeal reflex. In the muscles of the soft palate, there is a sagging of the palatine curtain (with hypotension); deviation of the uvula (uvula of the soft palate) from middle line. In the vegetative nervous system there are mainly mosaic disturbances in the form of easily occurring spasms of the face (redness or blanching), cyanosis of the tongue, hypersalivation (intense salivation, which can be constant or intensify under certain conditions).
To those influencing the formation speech function factors G.V. Chirkina also refers to later CNS lesions of traumatic or infectious origin, intoxication, severe somatic infections complicated by traumatic situations (separation from the mother, pain shock), even if they were temporary, not permanent).
In a child with rhinolalia, even with a unilateral, complete or partial cleft, inhalation is carried out more actively through the cleft, i.e. through the mouth, not through the nose. A congenital cleft contributes to a “vicious adaptation”, namely, the incorrect position of the tongue, its root, and only the tip of the tongue remains free, which is pulled into the middle part of the oral cavity (the root of the tongue is excessively raised upwards, covers the cleft, and at the same time the pharyngeal space). The tip of the tongue is located at the bottom of the mouth in the middle part, approximately at the level of the fifth tooth of the lower row.
The entry of food through the cleft into the nose also seems to contribute to the overdevelopment of the root of the tongue, which closes the cleft. So, in a child with a congenital cleft, the most important, most vital functions stabilize the position of the overly raised root of the tongue. As a result, the air stream, when leaving the subglottic space, is directed almost perpendicular to the palate. This makes oral exhalation difficult in the speech act and creates a nasal tone of the voice. In addition, the constant position of the raised root of the tongue inhibits the movement of the entire tongue. As a result, the implementation of the necessary movements of the tongue for articulation speech sounds rhinolalics fail; in addition, a weak expiratory stream, not entering the anterior part of the oral cavity, does not stimulate the formation of various articulatory bonds in the upper part of the speech apparatus. Both of these conditions lead to severe impairment of pronunciation. To improve the pronunciation of a particular sound, rhinolalics direct all the tension to the articulatory apparatus, thereby increasing the tension of the tongue, labial muscles, involving the muscles of the wings of the nose, and sometimes all the facial muscles.
In the process of speech dysontogenesis, adapted (compensatory) changes in the structure of the organs of articulation are formed:
high rise of the root of the tongue and its shift to the posterior zone of the oral cavity; relaxed, inactive tip of the tongue;
Insufficient participation of the lips when pronouncing labialized vowels, labial and labial and dental consonants;
Excessive tension of mimic muscles;
The occurrence of additional articulation (laryngealization) due to the participation of the walls of the pharynx.
L.P. Borsch notes that a short frenulum is a malformation, expressed by the formation of a fold of the mucous membrane, fixing the tongue sharply anteriorly, sometimes almost to the teeth. It is often detected in parents or close relatives of children, which can be considered a family feature; anomalies and occlusion are similar. When studying medical charts of the development of children with pathology of the frenulum of the tongue, the author found that in 94.7% there is a syndrome of motor disorders; in 52.7% - hip dysplasia; in 69.4% - delayed psychomotor development; in 38.4% - trauma of the cervical spine; in 8.8% - cerebral palsy.
Newborns with a short frenulum of the tongue have anxiety when feeding. It is due to difficulty in sucking, swallowing. Toddlers do not suck out the norm. The sleep of such children is superficial, intermittent, restless, they cry a lot.
If the correction is not carried out on time, then this is aggravated with age by the fact that speech is formed with deviations; the child is not understood by peers; adults, seeking the correct pronunciation of sounds, call in response negative emotions. He withdraws into himself, prefers to talk less, play alone, an "inferiority complex" begins to form. This often contributes to the development bad habits. They are characterized by a decrease in the emotional-volitional sphere, mood lability. Such children are unbalanced, hyperexcitable, hardly calm down. They are very touchy, whiny, and sometimes aggressive. These children hardly come into contact, refuse to perform certain movements of the tongue at receptions.
By the beginning of schooling, speech remains fuzzy, the pronunciation of several groups of sounds is impaired. The speech is inexpressive, the intonation coloring of the voice is poor. This makes such children more vulnerable, withdrawn, although their intellectual abilities are quite developed. For the most part, these children are self-critical.
The revealed features of the oral motor basis of articulation made it possible to assume that in the absence of timely corrective assistance, at best, there will be disturbances in sound pronunciation and general blurring in the flow of speech.
Early diagnosis is based on the assessment of non-speech disorders, which include the following:
Violation of the tone of the articulatory muscles (face, lips, tongue) according to the type of spasticity (increased muscle tone), hypotension (decreased tone) or dystonia (changing character of muscle tone);
Limitation of the mobility of the articulatory muscles (from the almost complete impossibility of articulatory movements to minor restrictions on their volume and amplitude);
Violation of the act of eating: violation of the act of sucking (weakness, lethargy, inactivity, irregularity of sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup;
Hypersalivation (increased salivation): increased salivation is associated with restriction of tongue muscle movements, impaired voluntary swallowing, paresis of the labial muscles; it is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva); hypersalivation can be constant or increase under certain conditions;
Oral synkinesis (the child opens his mouth wide with passive and active hand movements and even when trying to perform them);
Respiratory disorders: infantile breathing patterns (predominance of abdominal breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.
During the development of speech, systemically controlled auditory-motor formations are formed, which are real, material signs of the language. For their actualization, the existence of an articulatory base and the ability to form syllables are necessary. Articulatory base - the ability to bring the organs of articulation into positions necessary for the formation, formation of sounds that are normative for a given language.
In the process of mastering pronunciation skills under the control of his hearing and kinesthetic sensations, he gradually finds and retains in memory those articulation modes that provide the necessary acoustic effect that corresponds to the norm. If necessary, these articulatory positions are reproduced and fixed. When finding the correct patterns, the child must learn to distinguish between articulation patterns that are similar in the pronunciation of sounds, and develop a set of speech movements necessary for the formation of sounds.
E.F. Arkhipova, characterizing children with erased dysarthria, reveals the following pathological features in the articulatory apparatus. The paresis of the muscles of the organs of articulation is indicated, which manifest themselves as follows: the face is hypomimic, the muscles of the face are flaccid on palpation; many children do not hold the position of the closed mouth, tk. the lower jaw is not fixed in an elevated state due to the lethargy of the masticatory muscles; lips are flaccid, their corners are lowered; during speech, the lips remain sluggish and the necessary labialization of sounds is not produced, which worsens the prosodic side of speech. The tongue with paretic symptoms is thin, located at the bottom of the oral cavity, sluggish, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.
L. V. Lopatina noted spasticity of the muscles of the organs of articulation, manifested in the following: the face is amimic, the muscles of the face are hard and tense on palpation. The lips of such a child are constantly in a half smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the “tube” articulation exercise, i.e. stretch the lips forward, etc. The tongue with a spastic symptom is often changed in shape: thick, without a pronounced tip, inactive
L. V. Lopatina points to hyperkinesis with erased dysarthria, which manifests itself in the form of trembling, tremor of the tongue and vocal cords. Tremor of the tongue manifests itself during functional tests and loads. For example, when asked to support a wide tongue on the lower lip at a score of 5-10, the tongue cannot maintain a state of rest, trembling and slight cyanosis (i.e. blue tip of the tongue) appear, and in some cases the tongue is extremely restless (waves roll over the tongue in longitudinal or transverse). In this case, the child cannot keep the tongue out of the mouth. Hyperkinesis of the tongue is more often combined with increased muscle tone of the articulatory apparatus. When examining the motor function of the articulatory apparatus in children with erased dysarthria, it is noted that it is possible to perform all articulation tests, i.e. on assignment, children perform all articulatory movements - for example, puff out their cheeks, click their tongues, smile, stretch their lips, etc. When analyzing the quality of the performance of these movements, one can note: blurring, blurred articulation, weakness of muscle tension, arrhythmia, a decrease in the amplitude of movements, a short duration of holding a certain posture, a decrease in the range of movements, rapid muscle fatigue, etc. Thus, under functional loads, the quality of articulation movements sharply falls. This leads during speech to the distortion of sounds, their mixing and deterioration in general of the prosodic side of speech.
E.F. Arkhipova, L.V. Lopatina distinguish the following articulation disorders, which manifest themselves:
1) in the difficulties of switching from one articulation to another;
2) in a decrease and deterioration in the quality of articulatory movement;
3) in reducing the time of fixation of the articulatory form;
4) in reducing the number of correctly performed movements.
Studies by L. V. Lopatina and others revealed in children violations of the innervation of the mimic muscles: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulties in raising the eyebrows, closing the eyes. Along with this, the characteristic symptoms for children with erased dysarthria are: difficulty switching from one movement to another, reduced range of motion of the lips and tongue; lip movements are not performed in full, are approximate, there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, inaccuracy of movements, difficulties in spreading the tongue, lifting and holding the tongue up, tremor of the tip of the tongue are noted; in some children - a slowdown in the pace of movements when the task is repeated.
Many children have: rapid fatigue, increased salivation, the presence of hyperkinesis of the facial muscles and lingual muscles. In some cases, a language deviation (deviation) is detected.
Features of facial muscles and articulatory motility in children with dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These disorders are most often not detected initially by a neurologist and can only be established in the process of a thorough speech therapy examination and dynamic monitoring in the course of corrective speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal, and hypoglossal nerves, which determines the characteristics and diversity of phonetic disorders in children. So, in cases of predominant damage to the facial and hypoglossal nerves, articulation disorders of sounds are observed, due to the inferior activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.
In order for a person's speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words necessary condition the implementation of the phonetic design of speech is a well-developed motor skills of the articulatory apparatus.
When pronouncing various sounds, the speech organs occupy a strictly defined position. But since in speech sounds are not pronounced in isolation, but together, smoothly following one after another, the organs of the articulatory apparatus quickly move from one position to another. A clear pronunciation of sounds, words, phrases is possible only if the organs of the speech apparatus are sufficiently mobile, their ability to quickly rebuild and work clearly, strictly coordinated, and differentiated. Which implies accuracy, smoothness, ease of movement of the articulatory apparatus, pace and stability of movement.
Thus, impaired motor capabilities of the articulatory apparatus is one of the causes of deviations in the speech development of children. early age. An analysis of studies on the state of articulation in young children with speech development deviations allowed us to identify the following features:
There is insufficient mobility of the muscles of the tongue, lips, lower jaw;
Features of articulation are manifested in the difficulties of switching from one articulation posture to another, in the difficulty of maintaining an articulation posture;
It is possible to study the state of articulation of young children by observing the child's eating behavior.
Conclusions on Chapter I
The development of articulation is an important component of normal speech development. Articulation is the work of the organs of speech (articulatory apparatus) when pronouncing syllables, words, phrases; this is the coordination of the action of the speech organs when pronouncing speech sounds, which is carried out by the speech zones of the cortex and subcortical formations of the brain. When pronouncing a certain sound, auditory and kinesthetic, or speech-motor control is realized.
In order for speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words, a necessary condition for the implementation of the phonetic design of speech is a well-developed motor skills of the articulatory apparatus. The articulatory apparatus is an anatomical and physiological system of organs, including the larynx, vocal folds, tongue, soft and hard palate, teeth of the upper and lower jaws, lips, nasopharynx and resonator cavities involved in the generation of speech and voice sounds. Any disorders in the structure of the articulatory apparatus of a congenital or early acquired nature (under the age of 7 years) invariably entail difficulties in the formation and development of speech.
All movements of the organs of articulation are determined by the work of the motor analyzer. Its function is the perception, analysis and synthesis of stimuli that go to the cortex from the movement of the organs of speech. In the motor speech zone, a complex and subtle differentiation of speech movements occurs, the organization of their sequence.
In ontogenesis, the process of development of articulation is formed sequentially: cry, cooing, early babbling; late babble; first words, phrases; further fine differentiation of articulatory structures.
Eating behavior is one of the indicators of the development of articulation. If a child prefers soft food to solid food, the organs of articulation are not sufficiently mobile during meals, then this indicates an underdevelopment of the muscles of the mouth and lips.
Deviations in speech development at an early age is an underdevelopment of the cognitive and linguistic components of speech development, due to a violation of psychophysiological prerequisites and / or inconsistency of microsocial conditions with the child's capabilities. It manifests itself in the difficulties of forming the initial children's vocabulary and phrasal speech. It can be an independent speech pathology or a part in the structure of any form of deviant development.
The study of the state of articulation in young children with deviations in speech development is possible with the organization of observation of the child's eating behavior.
Chapter II. Features of articulation in young children with speech development deviations
A specific developmental disorder in which a child's use of speech sounds is below the level appropriate for his or her mental age, but in which there is a normal level of speech skills.
Diagnostic instructions:
The age at which a child acquires speech sounds and the order in which they develop are subject to considerable individual variation.
Normal development. At the age of 4 years, errors in pronouncing speech sounds are common, but the child can be easily understood by strangers. Most speech sounds are acquired by the age of 6-7 years. Although difficulties may remain in certain sound combinations, they do not lead to communication problems. By the age of 11-12, almost all speech sounds should be acquired.
pathological development. Occurs when a child's acquisition of speech sounds is delayed and/or diverted, resulting in: disarticulation with consequent difficulty for others in understanding his speech; omissions, distortions or replacements of speech sounds; a change in the pronunciation of sounds depending on their combination (that is, in some words the child can pronounce phonemes correctly, but not in others).
The diagnosis can only be made when the severity of the articulation disorder is outside the limits of normal variation corresponding to the mental age of the child; non-verbal intellectual level within the normal range; expressive and receptive speech skills within the normal range; articulation pathology cannot be explained by a sensory, anatomical, or neurotic abnormality; mispronunciation is undoubtedly abnormal, based on the characteristics of the use of speech in the subcultural conditions in which the child is located.
Included:
developmental physiological disorder;
Disorder of development of articulation;
Functional articulation disorder;
Baptism (children's form of speech);
Dyslalia (tongue-tied);
Phonological development disorder.
Excluded:
Aphasia NOS (R47.0);
Dysarthria (R47.1);
Apraxia (R48.2);
Disorders of articulation, combined with developmental disorder of expressive speech (F80.1);
Disturbance of articulation, combined with a developmental disorder of receptive speech (F80.2);
Cleft palate and other anatomical anomalies of oral structures involved in speech functioning (Q35 - Q38);
Disorder of articulation due to hearing loss (H90 - H91);
Disorder of articulation due to mental retardation (F70 - F79).
Other related news:
It is characterized by frequent and repetitive disturbance of speech sounds. The child's use of sounds below the level corresponding to his mental age - that is, the child's acquisition of speech sounds is either delayed or rejected, leading to disarticulation with difficulties in understanding his speech, omissions, substitutions, distortions of speech sounds, changes depending on their combination (then says correctly, then no). Most speech sounds are acquired by 6-7 years of age, by 11 years all sounds should be acquired.
In most cases, non-verbal intellectual level is within the normal range.
Etiology and pathogenesis
The cause of developmental articulation disorders is unknown. Presumably, speech impairment is based on a delay in the development or maturation of neuronal connections and neurological processes, and not organic dysfunction. The high percentage of children with this disorder, who have many relatives with similar disorders, points to a genetic component. With this disorder, there is no fine differentiation of motor kinesthetic postures of the tongue, palate, lips; brain basis - the activity of the post-central sections of the left hemisphere of the brain.
Prevalence
The incidence of articulation disorders has been established in 10% of children under 8 years of age and in 5% of children over 8 years of age. This disorder occurs 2-3 times more often in boys than in girls.
Clinic
An essential feature is a defect in articulation, with a persistent inability to use speech sounds, including omissions, substitutions, and distortion of phonemes, in accordance with the expected level of development. This disorder cannot be caused by structural or neurological pathology and is accompanied by the normal development of the language sphere.
In more severe cases, the disorder is recognized around the age of 3 years. In milder cases, clinical manifestations may not be recognized until 6 years of age. The essential features of a speech articulation disorder are a disturbance in the child's acquisition of speech sounds, leading to disarticulation with difficulty for others to understand his speech. Speech can be assessed as defective when compared with the speech of children of the same age and which cannot be explained by the pathology of intelligence, hearing, or the physiology of speech mechanisms. The pronunciation of speech sounds, which appear most late in ontogenesis, is often disturbed, but the pronunciation of vowel sounds is never disturbed. The most severe type of disturbances are omissions of sounds. Substitutions and distortions are a less severe type of violation. Children with developmental articulation disorder may present with comorbid social, emotional, and behavioral disorders. 1/3 of these children have a mental disorder.
Differential Diagnosis
Includes three stages:
1. Identification of the severity of articulation disorders.
2. Exclusion of physical pathology that could cause impaired pronunciation, dysarthria, hearing impairment or mental retardation.
3. Exclusion of developmental disorder of expressive speech, general developmental disorder.
For articulation disorders due to structural or neurological pathology (dysarthria) characterized by low speech speed, uncoordinated motor behavior, disorders of autonomic functions, such as chewing, sucking. Possible pathology of the lips, tongue, palate, muscle weakness. The disorder affects all phonemes, including vowels.
Therapy
Speech therapy is most successful for most articulation errors.
Drug treatment is indicated in the presence of concomitant problems of an emotional and behavioral nature.
Disorder of expressive speech (F80.1).
Severe language impairment that cannot be explained by mental retardation, inadequate learning, and that is not associated with a pervasive developmental disorder, hearing impairment, or neurological disorder. This specific disorder development, in which the child's ability to use expressive colloquial speech is markedly below the level corresponding to his mental age. Understanding speech within the normal range.
Etiology and pathogenesis
The cause of the developmental disorder of expressive language is unknown. Minimal brain dysfunction or delay in the formation of functional neuronal systems has been put forward as possible causes. The presence of a family history indicates the genetic determinism of this disorder. The neuropsychological mechanism of the disorder may be associated with a kinetic component, with an interest in the process of the premotor parts of the brain or postfrontal structures; with the immaturity of the nominative function of speech or the immaturity of the spatial representation of speech (temporo-parietal regions and the area of the parietal-temporo-occipital chiasm) under the condition of normal left hemispheric localization of speech centers and impaired functioning in the left hemisphere.
Prevalence
The frequency of expressive speech disorders ranges from 3 to 10% in children. school age. It is 2-3 times more common in boys than in girls. It is more common among children with a family history of articulation disorders or other developmental disorders.
Clinic
Severe forms of the disorder usually appear before 3 years of age. The absence of separate word formations - to 2 and simple sentences and phrases by 3 years is a sign of delay. Later violations - limited vocabulary development, use of a small set of formulaic words, difficulty in choosing synonyms, shortened pronunciation, immature sentence structure, syntactical errors, omissions of word endings, prefixes, incorrect use of prepositions, pronouns, conjugations, verb declensions, nouns. Lack of fluency in presentation, lack of consistency in presentation and retelling. Understanding speech is not difficult. Adequate use of non-verbal cues, gestures, desire for communication is characteristic. Articulation is usually immature. There may be compensatory emotional reactions in relationships with peers, behavioral disorders, inattention. Developmental coordination disorder and functional enuresis are often comorbidities.
Diagnostics
Indicators of expressive speech are significantly lower than those obtained by non-verbal intellectual abilities (the non-verbal part of the Wechsler test).
The disorder significantly interferes with school success and Everyday life requiring verbal expression.
Not associated with general developmental disorders, hearing impairment or neurological disorder.
It is recommended to carefully collect complaints and anamnesis of the disease, taking into account a survey of parents. .A comment. The inspection is divided into several stages. These include clarification of complaints, clarification of the history of the present disease, the characteristics of the patient's life.
2.2 Physical examination.
A consultation with a neurologist is recommended.Recommendation strength level A, evidence level I.
A speech therapy examination of the child is recommended.
Recommendation strength level A, evidence level I.
A comment. Speech therapy examination should be comprehensive, holistic and dynamic, and also have its own specific content aimed at analyzing speech disorders. The complexity, integrity and dynamism of the survey are ensured by the fact that all aspects of speech and all its components are examined, moreover, against the background of the entire personality of the subject, taking into account the data of his development - both general and speech - from an early age.
It is recommended to evaluate speech development indicators: speech activity, sound pronunciation, understanding of addressed speech, active vocabulary, phrase development, lexical and grammatical structure of speech. Speech activity refers to the desire to use speech for communication, activity in the use of language tools.
Recommendation strength level A, evidence level I.
A comment. The level of sound pronunciation, its compliance or degree of inconsistency with the age of the child is assessed. To assess the understanding of addressed speech, the child is offered, using only verbal instructions, to show objects in the picture, to perform certain actions, gradually complicating the tasks. If there is an understanding of speech at the everyday level, one should reveal an understanding of the meaning of prepositions, differences in time, number, and case.
The volume of the active dictionary is estimated by the number of nouns, verbs, adjectives used in speech. The wider the active vocabulary, the more signs of one object the child can name, more accurately determine the action, convey semantic shades.
The assessment of the lexical and grammatical structure of speech is carried out on the basis of the correctness of the child's use of gender, number, case, prepositions, tenses of verbs, word-formation skills in speech. At psychological examination first of all, such indicators as the child's communications, emotional background, mental development (mainly non-verbal intelligence) are evaluated.
A pathopsychological (experimental psychological) study is recommended.
A comment. Pathopsychological research includes - a conversation with the patient, an experiment, observation of the patient's behavior during the study, collection and analysis of anamnesis, comparison of experimental data with the life history of the researcher. Experiments in modern psychology mean the use of any diagnostic procedure to model an integral system of cognitive processes, motives, and personality traits.
It is recommended to consult a psychiatrist (if indicated).
Level of persuasiveness of recommendations C, level of evidence III.
Consultation with an audiologist (according to indications) is recommended.
Level of persuasiveness of recommendations B, level of evidence II.
A comment. In case of speech disorders, a comprehensive examination is necessary, including a consultation with an audiologist who evaluates hearing and identifies its problems, if necessary, audiography can be performed.
2.3 Instrumental diagnostics.
An EEG is recommended.Level of persuasiveness of recommendations B, level of evidence II.
A comment. Electroencephalography is used for all neurological, mental and speech disorders.
An MRI of the brain is recommended.
Level of persuasiveness of recommendations B, level of evidence II.
A comment. With the help of MRI, three-dimensional images of the head, skull, brain, and spine can be obtained. Magnetic resonance imaging, performed in the vascular mode, allows you to get an image of the vessels that supply the brain. MRI allows you to capture changes in the brain associated with its physiological activity. So, with the help of MRI, the position of the patient's motor, visual or speech centers of the brain, their relationship to the pathological focus - a tumor, a hematoma (the so-called functional MRI) can be determined.
2.4 Differential diagnosis.
Mental retardation.Children with SRR perform unsatisfactorily non-verbal tests and tasks, their cognitive interest and desire for communication are not sufficiently expressed, they are not active in using gestures and in maintaining games.
Autism.
Autism impairs the need for communication and the ability to social interaction, and they can also cause a violation of speech development. Speech is not used for communicative purposes or is not used enough. There is unevenness and asynchrony in the pace of speech development. Phrasal speech can be formed with a delay, often without a preceding babble period. Echolalia, cliched phrases, use of verbs in an indefinite form or in imperative mood, prolonged absence of the pronoun "I" in speech, expression, gesticulation are absent in speech, there is an inability to dialogue, children do not ask questions. Violated pronunciation of sounds, speech melody, rhythm, tempo.
Underdeveloped muscles of the mouth or weak muscle tone of the face are among the causes of deviations in speech development.
Based on the position of N.A. Bernstein about the level organization of voluntary movements and actions, a number of researchers, specialists in this field (in particular, Sheremetyeva E.V.) suggested that articulation, as the highest symbolic level of voluntary movement, can be formed while maintaining all the underlying levels of voluntary movement. The peripheral part of articulation is built on top of the objective level of oral movements that fulfill life-supporting nutritional needs: sucking, biting, chewing, swallowing. Therefore, they considered it possible to assess the potential possibility of articulation by observing the objective level of movements of articulators - lips, tongue, lower jaw - in the process of eating and the state of facial expressions in free activity.
After analyzing the results of the study by E.V. Sheremetyeva, in the oral base of articulation, the precursors of speech underdevelopment (indicators of deviations from the normal course of speech development) at an early age were identified:
refusal of solid food: the child prefers homogeneous, well-ground masses. Often, for such children, so that they do not remain hungry, parents bring yogurt, curd masses, etc. to kindergarten. Such eating behavior can have different causes: late introduction of solid complementary foods; parents for a long time (up to a year, or even two) crushed the child's food to a homogeneous mass; maintenance of the sucking reflex (breastfeeding) up to two, two and a half years; violation of the innervation of the mandibular muscles;
difficulties in the process of chewing and, as a result, spitting out, which is associated with a violation of the innervation of the corresponding muscle groups. With such a decrease in physical activity, the muscles that lift and hold the lower jaw and the muscles of the tongue weaken;
general amimia in the process of eating: the child sits for a very long time over a plate or with a piece in his hand, then slowly brings the spoon to his mouth or bites off, starts chewing lazily (lack of pleasure “written” on his face from the process of eating);
liquid food or liquid is often spilled due to the insufficient formation of the lip grip: the child does not sufficiently capture the edge of the spoon, cup with the lower lip (liquid spills) or captures pieces of food from the spoon directly with the teeth. They say about such people: "Eats not neatly." In reality, the innervation of the labial muscles and, as a result, their strength, dexterity and coordination are disturbed.
an increase in the threshold of receptive sensitivity of the skin around the lips, which also indicates a violation of the innervation of the corresponding muscle groups: the child drinks kefir or jelly, the remnants of which, due to insufficient automation of object movement, remain around the lips. He does not try to reduce the irritation from the remnants of the liquid in any way. They say about such children: "Very untidy."
If the perceptive sensitivity of the circumlabial space is preserved, and the innervation of the lingual muscles is impaired, then under similar conditions the following is observed:
the absence of circular licking movements of the tongue when a thick drink or liquid porridge gets on the lips or around the lips: in such cases, the child wipes the upper lip with improvised means;
pulling the back of the tongue up with an unexpressed tip of the tongue in similar conditions;
reduction of irritation of the skin surface of the lips with the help of the lower lip or other means;
raising the tip of the tongue to the level of the corner of the lips when trying to lick the upper lip.
In general, in the chewing muscles, there is a limitation of the mobility of the lower jaw; slight or fairly pronounced displacement of the lower jaw to the side at rest, during chewing and during articulation; with pathology of masticatory muscle tone, there is a decrease in the intensity and volume of masticatory movements, discoordination of the movements of the lower jaw during articulation; violation of the process of biting off a piece (which can also be complicated by anomalies of the dentoalveolar system); synkinesis is revealed in the motility of the lower jaw during tongue movements (especially when raising the tongue to the upper lip or pulling it to the chin).
E.G. Chigintseva is also noted for features in the lingual muscles: pathological conditions of muscle tone are observed, which in some cases are accompanied by structural features of the tongue (with spasticity, the tongue is more often massive, drawn in a lump deep into the oral cavity or elongated with a “sting”, this can be combined with a shortening of the frenulum, represented by in the form of a dense cord; with hypotension, the tongue is in most cases thin, flaccid, flattened at the bottom of the oral cavity, which can be complicated by shortening of the sublingual fold, which looks thin and translucent); there are violations of the position of the tongue (at rest and during movement) in the form of deviation to the side, protrusion of the tongue from the mouth, laying the tongue between the teeth; a slight or rather pronounced limitation of the mobility of the lingual muscles is revealed; hyperkinesis, tremor, fibrillar twitching of the tongue; increase or decrease in the pharyngeal reflex. In the muscles of the soft palate, there is a sagging of the palatine curtain (with hypotension); deviation of the uvula (uvula of the soft palate) from the midline. In the autonomic nervous system, there are mainly mosaic disorders in the form of easily occurring spasms of the face (redness or blanching), cyanosis of the tongue, hypersalivation (intense salivation, which can be constant or intensify under certain conditions).
To the factors influencing the formation of speech function G.V. Chirkina also refers to later CNS lesions of traumatic or infectious origin, intoxication, severe somatic infections complicated by psycho-traumatic situations (separation from the mother, pain shock), even if they were temporary, not permanent).
In a child with rhinolalia, even with a unilateral, complete or partial cleft, inhalation is carried out more actively through the cleft, i.e. through the mouth, not through the nose. A congenital cleft contributes to a "vicious adaptation", namely, the incorrect position of the tongue, its root, and only the tip of the tongue remains free, which is pulled into the middle part of the oral cavity (the root of the tongue is excessively raised upwards, covering the cleft, and at the same time the pharyngeal space). The tip of the tongue is located at the bottom of the mouth in the middle part, approximately at the level of the fifth tooth of the lower row.
The entry of food through the cleft into the nose also seems to contribute to the overdevelopment of the root of the tongue, which closes the cleft. So, in a child with a congenital cleft, the most important, most vital functions stabilize the position of the overly raised root of the tongue. As a result, the air stream, when leaving the subglottic space, is directed almost perpendicular to the palate. This makes oral exhalation difficult in the speech act and creates a nasal tone of the voice. In addition, the constant position of the raised root of the tongue inhibits the movement of the entire tongue. As a result, the implementation of the necessary movements of the tongue for the articulation of speech sounds in rhinolalics fails; in addition, a weak expiratory stream, not entering the anterior part of the oral cavity, does not stimulate the formation of various articulatory bonds in the upper part of the speech apparatus. Both of these conditions lead to severe impairment of pronunciation. To improve the pronunciation of a particular sound, rhinolalics direct all the tension to the articulatory apparatus, thereby increasing the tension of the tongue, labial muscles, involving the muscles of the wings of the nose, and sometimes all the facial muscles.
In the process of speech dysontogenesis, adapted (compensatory) changes in the structure of the organs of articulation are formed:
high rise of the root of the tongue and its shift to the posterior zone of the oral cavity; relaxed, inactive tip of the tongue;
Insufficient participation of the lips when pronouncing labialized vowels, labial and labial and dental consonants;
Excessive tension of mimic muscles;
The occurrence of additional articulation (laryngealization) due to the participation of the walls of the pharynx.
L.P. Borsch notes that a short frenulum is a malformation, expressed by the formation of a fold of the mucous membrane, fixing the tongue sharply anteriorly, sometimes almost to the teeth. It is often detected in parents or close relatives of children, which can be considered a family feature; anomalies and occlusion are similar. When studying medical charts of the development of children with pathology of the frenulum of the tongue, the author found that in 94.7% there is a syndrome of motor disorders; in 52.7% - hip dysplasia; in 69.4% - delayed psychomotor development; in 38.4% - trauma of the cervical spine; in 8.8% - cerebral palsy.
Newborns with a short frenulum of the tongue have anxiety when feeding. It is due to difficulty in sucking, swallowing. Toddlers do not suck out the norm. The sleep of such children is superficial, intermittent, restless, they cry a lot.
If the correction is not carried out on time, then this is aggravated with age by the fact that speech is formed with deviations; the child is not understood by peers; adults, seeking the correct pronunciation of sounds, evoke negative emotions in response. He closes in on himself, prefers to talk less, play alone, an "inferiority complex" begins to form. This often leads to the development of bad habits. They are characterized by a decrease in the emotional-volitional sphere, mood lability. Such children are unbalanced, hyperexcitable, hardly calm down. They are very touchy, whiny, and sometimes aggressive. These children hardly come into contact, refuse to perform certain movements of the tongue at receptions.
By the beginning of schooling, speech remains fuzzy, the pronunciation of several groups of sounds is impaired. The speech is inexpressive, the intonation coloring of the voice is poor. This makes such children more vulnerable, withdrawn, although their intellectual abilities are quite developed. For the most part, these children are self-critical.
The revealed features of the oral motor basis of articulation made it possible to assume that in the absence of timely corrective assistance, at best, there will be disturbances in sound pronunciation and general blurring in the flow of speech.
Early diagnosis is based on the assessment of non-speech disorders, which include the following:
violation of the tone of the articulatory muscles (face, lips, tongue) according to the type of spasticity (increased muscle tone), hypotension (decreased tone) or dystonia (changing character of muscle tone);
limitation of mobility of the articulatory muscles (from the almost complete impossibility of articulatory movements to minor restrictions on their volume and amplitude);
violation of the act of eating: violation of the act of sucking (weakness, lethargy, inactivity, irregularity of sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup;
hypersalivation (increased salivation): increased salivation is associated with restriction of tongue muscle movements, impaired voluntary swallowing, paresis of the labial muscles; it is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva); hypersalivation can be constant or increase under certain conditions;
oral synkinesis (the child opens his mouth wide with passive and active hand movements and even when trying to perform them);
respiratory failure: infantile breathing patterns (the predominance of the abdominal type of breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.
During the development of speech, systemically controlled auditory-motor formations are formed, which are real, material signs of the language. For their actualization, the existence of an articulatory base and the ability to form syllables are necessary. Articulatory base - the ability to bring the organs of articulation into positions necessary for the formation, formation of sounds that are normative for a given language.
In the process of mastering pronunciation skills under the control of his hearing and kinesthetic sensations, he gradually finds and retains in memory those articulation modes that provide the necessary acoustic effect that corresponds to the norm. If necessary, these articulatory positions are reproduced and fixed. When finding the correct patterns, the child must learn to distinguish between articulation patterns that are similar in the pronunciation of sounds, and develop a set of speech movements necessary for the formation of sounds.
E.F. Arkhipova, characterizing children with erased dysarthria, reveals the following pathological features in the articulatory apparatus. The paresis of the muscles of the organs of articulation is indicated, which manifest themselves as follows: the face is hypomimic, the muscles of the face are flaccid on palpation; many children do not hold the position of the closed mouth, tk. the lower jaw is not fixed in an elevated state due to the lethargy of the masticatory muscles; lips are flaccid, their corners are lowered; during speech, the lips remain sluggish and the necessary labialization of sounds is not produced, which worsens the prosodic side of speech. The tongue with paretic symptoms is thin, located at the bottom of the oral cavity, sluggish, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.
L.V. Lopatina noted spasticity of the muscles of the organs of articulation, manifested in the following: the face is amimic, the muscles of the face are hard and tense on palpation. The lips of such a child are constantly in a half smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the "tube" articulation exercise, i.e. stretch the lips forward, etc. The tongue with a spastic symptom is often changed in shape: thick, without a pronounced tip, inactive
L.V. Lopatina points to hyperkinesis with erased dysarthria, which manifests itself in the form of tremor, tremor of the tongue and vocal cords. Tremor of the tongue manifests itself during functional tests and loads. For example, when asked to support a wide tongue on the lower lip at a score of 5-10, the tongue cannot maintain a state of rest, trembling and slight cyanosis (i.e. blue tip of the tongue) appear, and in some cases the tongue is extremely restless (waves roll over the tongue in longitudinal or transverse). In this case, the child cannot keep the tongue out of the mouth. Hyperkinesis of the tongue is more often combined with increased muscle tone of the articulatory apparatus. When examining the motor function of the articulatory apparatus in children with erased dysarthria, it is noted that it is possible to perform all articulation tests, i.e. on assignment, children perform all articulatory movements - for example, puff out their cheeks, click their tongues, smile, stretch their lips, etc. When analyzing the quality of the performance of these movements, one can note: blurring, blurred articulation, weakness of muscle tension, arrhythmia, a decrease in the amplitude of movements, a short duration of holding a certain posture, a decrease in the range of movements, rapid muscle fatigue, etc. Thus, under functional loads, the quality of articulation movements sharply falls. This leads during speech to the distortion of sounds, their mixing and deterioration in general of the prosodic side of speech.
E.F. Arkhipova, L.V. Lopatin distinguish the following articulation disorders, which manifest themselves:
in the difficulties of switching from one articulation to another;
in a decrease and deterioration in the quality of articulatory movement;
in reducing the time of fixation of the articulatory form;
in reducing the number of correctly performed movements.
Research by L.V. Lopatina et al. revealed disorders in the innervation of the mimic muscles in children: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulties in raising the eyebrows, closing the eyes. Along with this, the characteristic symptoms for children with erased dysarthria are: difficulty switching from one movement to another, reduced range of motion of the lips and tongue; lip movements are not performed in full, are approximate, there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, inaccuracy of movements, difficulties in spreading the tongue, lifting and holding the tongue up, tremor of the tip of the tongue are noted; in some children - a slowdown in the pace of movements when the task is repeated.
Many children have: rapid fatigue, increased salivation, the presence of hyperkinesis of the facial muscles and lingual muscles. In some cases, a language deviation (deviation) is detected.
Features of facial muscles and articulatory motility in children with dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These disorders are most often not detected initially by a neurologist and can only be established in the process of a thorough speech therapy examination and dynamic monitoring in the course of corrective speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal, and hypoglossal nerves, which determines the characteristics and diversity of phonetic disorders in children. So, in cases of predominant damage to the facial and hypoglossal nerves, articulation disorders of sounds are observed, due to the inferior activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.
In order for a person's speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words, a necessary condition for the implementation of the phonetic design of speech is a well-developed motor skills of the articulatory apparatus.
When pronouncing various sounds, the speech organs occupy a strictly defined position. But since in speech sounds are not pronounced in isolation, but together, smoothly following one after another, the organs of the articulatory apparatus quickly move from one position to another. A clear pronunciation of sounds, words, phrases is possible only if the organs of the speech apparatus are sufficiently mobile, their ability to quickly rebuild and work clearly, strictly coordinated, and differentiated. Which implies accuracy, smoothness, ease of movement of the articulatory apparatus, pace and stability of movement.
Thus, impaired motor capabilities of the articulatory apparatus is one of the causes of deviations in the speech development of young children. An analysis of studies on the state of articulation in young children with speech development deviations allowed us to identify the following features:
There is insufficient mobility of the muscles of the tongue, lips, lower jaw;
Features of articulation are manifested in the difficulties of switching from one articulation posture to another, in the difficulty of maintaining an articulation posture;
It is possible to study the state of articulation of young children by observing the child's eating behavior.
Conclusions on Chapter I
The development of articulation is an important component of normal speech development. Articulation is the work of the speech organs (articulatory apparatus) when pronouncing syllables, words, phrases; this is the coordination of the action of the speech organs when pronouncing speech sounds, which is carried out by the speech zones of the cortex and subcortical formations of the brain. When pronouncing a certain sound, auditory and kinesthetic, or speech-motor control is realized.
In order for speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words, a necessary condition for the implementation of the phonetic design of speech is a well-developed motor skills of the articulatory apparatus. The articulatory apparatus is an anatomical and physiological system of organs, including the larynx, vocal folds, tongue, soft and hard palate, teeth of the upper and lower jaws, lips, nasopharynx and resonator cavities involved in the generation of speech and voice sounds. Any disorders in the structure of the articulatory apparatus of a congenital or early acquired nature (under the age of 7 years) invariably entail difficulties in the formation and development of speech.
All movements of the organs of articulation are determined by the work of the motor analyzer. Its function is the perception, analysis and synthesis of stimuli that go to the cortex from the movement of the organs of speech. In the motor speech zone, a complex and subtle differentiation of speech movements occurs, the organization of their sequence.
In ontogenesis, the process of development of articulation is formed sequentially: cry, cooing, early babbling; late babble; first words, phrases; further fine differentiation of articulatory structures.
Eating behavior is one of the indicators of the development of articulation. If a child prefers soft food to solid food, the organs of articulation are not sufficiently mobile during meals, then this indicates an underdevelopment of the muscles of the mouth and lips.
Deviations in speech development at an early age are an underdevelopment of the cognitive and linguistic components of speech development, due to a violation of psychophysiological prerequisites and / or inconsistency of microsocial conditions with the child's capabilities. It manifests itself in the difficulties of forming the initial children's vocabulary and phrasal speech. It can be an independent speech pathology or a part in the structure of any form of deviant development.
The study of the state of articulation in young children with deviations in speech development is possible with the organization of observation of the child's eating behavior.
- In contact with 0
- Google+ 0
- OK 0
- Facebook 0
