Erased form of dysarthria: characteristic, treatment, prognosis

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

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

The epidemiology of the disease is such that examination of preschool-age children with speech therapies reveals speech defects in half of them. Among violations of dysarthria, one of the most common, and 60-85% of cases are due to infantile cerebral palsy.

[8], [9], [10]

Causes of the erased dysarthria

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

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

Risk factors

Based on the reasons leading to the erased dysarthria, risk factors are atherosclerosis of cerebral vessels, head traumas, bad habits, careless behavior with chemicals (arsenic, nitrogenous compounds), chronic liver and kidney diseases affecting the brain. In children, a staged dysarthria occurs as a result of infection inside the mother's womb, birth trauma, severe toxemia in bearing a fetus, a mismatch between the Rh factor of a woman and a child, hypoxia of the fetus, and asphyxiation during labor.

[11]

Pathogenesis

At the heart of pathogenesis is the defeat of the central and peripheral nervous system of man. Speech mechanism is arranged so that from the central nervous system through the centrifugal nerves there is a signal to the receptors of speech organs to start it. If one of the links in the brain-face chain is damaged, signals from the cerebral cortex do not reach the muscles responsible for articulation, breathing and voice.

[12], [13]

Symptoms of the erased dysarthria

Symptoms of erased dysarthria are expressed both in speech defects and in behavioral actions. Speech symptomatology is manifested in the improper pronunciation of the front-language, hissing and whistling sounds. The voice is monotonous, weak and quiet, the timbre is changed. The auditory perception is reduced. Non-primary symptoms include the weakening of voluntary movements, the appearance of pathological reflexes (sweating of feet, palms), involuntary automatic twitching of the face (hyperkinesis), changes in muscle tone. Increased (spasticity) produce tightly closed lips, strained muscles of the neck and face, limited movements of the speech apparatus. With a lowered tone (hypotension), the tongue is flaccid and lies on the bottom of the mouth, lips are half open, saliva flowing. The change of one tonus to another (dystonia) disturbs breathing during a conversation, at the moment of pronunciation of words it is intermittent and quickened. In some cases, memory loss, difficulty concentrating, thinking activity is possible.

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

The development of the motor sphere with erased dysarthria

The development of the motor sphere with the erased dysarthria directly depends on which nerve endings the link has lost. Thus, damage to the trigeminal nerve makes it difficult to open and close the mouth, chewing and swallowing food. Due to damage to the sublingual, difficulty in controlling the tongue arises, facial difficulty - impossibility to inflate cheeks or frown eyebrows, and glossopharyngeal - a malfunction in the larynx, palate, due to which the voice changes, breath is lost, etc. But to the erased dysarthria most often leads to a violation of the sublingual nerve.

[14], [15]

Wiped pseudobulbar dysarthria

The most common is pseudobulbar dysarthria. The reason for its appearance is brain damage that occurred in childhood. This can be a tumor, trauma during childbirth, encephalitis, etc. As a result, a signal from the cerebral cortex to the cranial stem nerves that controls the speech apparatus is not received. Because of this motor skills suffer, the muscles of the face weaken. At such people the mouth is ajar, saliva flows, the tip of the tongue hardly rises and moves, the words are blurred and incomprehensible, a nasal voice appears in the voice. There are three degrees of erased pseudobulbar dysarthria. Slight violations of speech correspond to an easy degree. Most often mispronounced p, q, h, w, w, sonorous sounds do not have enough sound fullness. The average degree is expressed in the lack of mobility of the muscles of the face, difficulties with chewing or swallowing, abundant salivation. The pronunciation of most sounds is distorted, voiced consonants are pronounced dully, vowels are not sufficiently ringed. Only k, n, m, t, n, x are obtained. A severe degree is characterized by complete immobility of facial muscles, the mouth is open, chewing and swallowing movements are difficult, speech is absent.

Wiped dysarthria in children

The erased dysarthria in children most often occurs as a result of abnormalities during pregnancy, abnormal birth, fetal asphyxia. While the child does not talk, the symptoms are manifested in a weak sucking instinct, a refusal to take the nipple into the mouth. In addition, he is somewhat behind in physical development. It's bad to grab and hold objects in your hand, do not like to play with small toys, collect designer details, draw, sculpt. Such a child has excessive salivation, inactive face mimicry, it is impossible to roll the tongue into a tube. But, in general, his condition does not cause much concern.

Wiped dysarthria in preschool children

In the preschool age, deviations associated with general motor activity become apparent. Children walk awkwardly, can not stand on one leg, quickly get tired of physical activities, mimic movements badly, react with delay to change of positions, tempo and musical rhythm, do not hold a pen in their hand and do not like to draw. Such children are difficult to sufficiently serve themselves, fasten or unfasten buttons, tie a scarf. In 5-6 years there are features of the articulatory apparatus. With lowered muscle tone, the lower jaw is poorly held in a raised state, so the mouth does not close, the lips and tongue are sluggish. Spasticity of the muscles gives a half smile to the face, their hardness when palpating. For them it is difficult to keep the same pose for a long time: inflated cheeks, lips with a tube, sticking out tongue, tk. He after a while starts to tremble and twitch. Conditionally the pronunciation errors are divided into three groups:

• with violations of pronunciation of sounds and intonational expressive color of speech (prosody). Such children are good at pronouncing words, have a large vocabulary, but they are difficult to use complex words. They are characterized by poor spatial orientation;
• to the first disturbances is added the unformed phonetic hearing. This is expressed in the inability to reconcile different parts of speech in sentences, to pronounce complex words, to weak vocabulary. This group of children is sent to a special kindergarten;
• with obvious violations of pronunciation, prosody, underdevelopment of phonetic hearing. For such children, specialized groups are organized in kindergartens.

Wiped dysarthria in adults

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

Stages

The degree of deviation from speech and the severity of the lesion of the nervous system are directly dependent. Speech therapists distinguish four stages of dysarthria. At the first distortion of sounds, only a speech therapist is heard. At the second stage, the speaker's speech is understandable, although the errors in pronunciation are obvious to outsiders. The third stage has more pronounced defects - distortions, omissions or substitutions of sounds. The conversation is slow, words are inexpressive, indistinct, only close ones understand them. The fourth stage is the heaviest, it comes with complete paralysis of the motor-muscles, when speech becomes impossible or completely incomprehensible even to the surrounding environment.

Forms

Types of erased dysarthria are determined by the localization of the CNS lesion responsible for the function of speech and its symptoms. Distinguish the following:

• pseudobulbarnuyu, in which the cortex-nuclear nerve endings are affected. It is characterized by a violation of pronunciation of sounds, lethargy of speech muscles;
• cortical, caused by focal lesions of the cerebral cortex (arbitrary movements are hindered);
• mixed.

Complications and consequences

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

Diagnostics of the erased dysarthria

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

The neurologist in his conclusions relies on instrumental research. Speechpedical conclusion is based on the evaluation of speech and non-verbal symptoms: the nature of breathing, the state of the facial muscles, the ability to produce articulatory movements. The oral speech is analyzed: pronunciation of words, their intonation, intelligibility, rhythm and tempo.

Written tests are conducted: dictations, copying texts, reading aloud. In children, a staged dysarthria is diagnosed after 5 years.

Blood tests, urine appoint to determine the general condition of the body.

Instrumental diagnosis plays an important role in determining the diagnosis, its volume depends on the initial diagnosis, delivered by a neurologist or a children's neurologist. The most accurate picture will be given the following studies: MRI of the brain, electromyography, electroencephalography, electroneurography.

[16]

Differential diagnosis

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

During the diagnosis of the erased dysarthria, the difficulty is the delineation of its light form and complex dyslalia, they have similar symptoms. In the case of dyslalia, speech defects are not associated with CNS damage. Most often, it is caused by the peculiarities of the anatomical structure of the articulatory apparatus. Consider the differential signs of dyslasia and erased dysarthria. The main criteria that guide the definition of an erased dysarthria are:

• state of articulation (slow tempo, difficulty in holding or switching articulation);
• the presence of changes in the intonation and clarity of the pronunciation of words;
• the appearance of other movements with simultaneous movement of the tongue;
• The persistent nature of violations of pronunciation of sounds.

For dyslalia is characterized by a violation of the articulation of only consonants, including, and in different versions of their pronunciation. The speech sounds formed by the speech therapist are well absorbed, the rhythm and pace of speech is not disturbed, breathing, articulation, and voice formation are coordinated. In contrast, with erased dysarthria, vowels are often pronounced in the nose. Separate isolated sounds can sound right, but in the word they are distorted. It is difficult to set them, the rate of pronunciation is not stable, breathing is disturbed, speech is made on inspiration. All functions that are required for correct pronunciation are not coordinated.

Treatment of the erased dysarthria

The treatment of erased dysarthria is complex, including medical treatment, the use of physiotherapeutic and pedagogical methods. The goal of the treatment is to achieve such a level of pronunciation of words so that the speech is understandable to others, and the person was able to adapt in society. For children with erased dysarthria, there are specialized speech therapy groups that are formed depending on the level of development: with phonetic, phonetic-phonemic and general speech disorders. Drug treatment is prescribed by a neurologist and is aimed at strengthening brain activity. These are vascular, nootropic, sedative and metabolic drugs. With the help of medical gymnastics, facial muscles are strengthened, small and large motor motility develops. It is directly related to the functions of speech. Need and breathing exercises, in this case, effective gymnastics Strelnikova, a facial massage is required. This continuous complex of medical measures is complemented by the continuous work of the speech therapist in the production of sounds.

Correction methods for erased dysarthria

The methods of correction for the erased dysarthria include all the above procedures with the addition of other non-traditional ones. They depend on the severity of the defeat of the speech apparatus. At the first stage, facial musculature is strengthened through massage. Further special exercises are made to establish correct articulation. This is followed by work on the autonomous setting of sounds, then on the correct pronunciation of them in words. If the work is carried out with the child, then psychological support in the form of praise and approval is important. At the same time, acupuncture, hirudotherapy, medical baths are used. The method of treatment with the help of dialogue with dolphins (dolphin therapy), games with the use of sand (sand therapy), gaming exercises (sensory therapy) gives good results.

Perspective planning with erased dysarthria

Prospective planning for erased dysarthria has been developed for preschool children and consists in the development of verbal hearing, visual, auditory attention. For this, games are played: for example, with the help of pictures and toys, they are suggested to remember their location or availability, and then tell what has changed. So strengthen visual attention. To amplify the auditory use noise toys, say, you need to guess who owns the voice or where the sound comes from. The next stage is aimed at developing the mobility of the articulatory apparatus. It consists of various exercises for the development of the jaw, strengthening the mobility of the lips, the muscles of the tongue, the cheeks, the training of breathing. Special gymnastics is being done to develop the skills of setting and pronunciation of individual sounds. For this, a visual demonstration is used, where the language should be, and how the lips are arranged. Before the mirror, the skill is made to pronounce whistling, hissing, sound p, l. Then, with the help of games, work is done on correcting sounds, over their accuracy, purity, tempo, and strength. Then there is work on the sound, for which memorized and spoken poems, tongue twisters, sayings. Games to recognize sound in syllables develop a phonemic perception. Crown a large exercise work done on the ability to differentiate sounds in syllables, words, phrases, sentences.

Calendar-themed planning with erased dysarthria

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

[17], [18]

Logopedic work with an erased dysarthria

The preparation of calendar-thematic plans and their phased implementation - this is logopedic work with the erased dysarthria. Distinctive features of this diagnosis is that a speech therapist for making corrections in the pronunciation of sounds, it is necessary to spend a large and time-consuming preparatory stage. The effectiveness of speech correction in the future depends entirely on the successful work of the speech therapist at this stage.

Exercises with erased dysarthria

Special exercises have been developed with erased dysarthria to strengthen the articulatory apparatus, development of general motor skills, including hands, coordination of movements, normalization of voice and breathing during pronunciation of words. Exercises for hands include lacing, stringing beads on a string, hatching with a pencil, modeling plasticine. Improve the coordination of movements with the help of pantomime: hands need to picture what they heard.

There are other exercises for coordinating movements. Speech breathing and voice are normalized with the help of Strelnikova gymnastics. Here are a few tricks: take a shallow breath, hold your breath and exhale slowly; breathe in, hold the air, and say any vowel in the exhalation; on exhalation smoothly change one vowel sound to another. Also good is the game on the pipe, inflating balls. In therapeutic measures for speech correction included and exercises for the touch of objects, spatial representation. To do this, feel it by the texture and form offer to find out the subject, etc. They give the skills to establish a causal relationship, generalize.

[19]

The production of sounds with erased dysarthria

The production of sounds with erased dysarthria begins with vowel sounds, tk. They play a major role in the intelligibility and clarity of the pronunciation of words, the emotional coloring of speech. At first, work is being done to correct such sounds: e, a, u, u, o, y. After achieving clarity in the articulation, go to the consonant [m'-m], sonor [n'-n], [j], [n'-n], [p'-p], bow-blasting [n'-n] , [6'-b], [m'-t], [d'-d], [k'-k], [r'-k], the gap [φ'-φ], [θ'-θ] and front-language [c'-c], [s'-s], [w-h], [x'-x], [w], [h], [n]. First comes the sub-stage, then the production of sounds.

Articulatory gymnastics for an erased dysarthria

A special articulatory gymnastics for the erased dysarthria with the use of both dynamic exercises and passive exercises has been developed.

There is a technique Ermakova for chewing muscles. Exercises consist in alternately opening and closing the mouth, inflating and pulling the cheeks, pushing forward and toward the jaw, biting the lower lip of the upper. Gymnastics Arkhipova also aims to strengthen the muscles of the face. It consists in inflating the cheeks, pulling the lips with a tube, exposing the upper and lower teeth alternately, drawing the lips into the mouth, sniffing "horse", imitating the rinsing of the teeth.

Passive gymnastics for the language by the method of Pravdina suggests movements under the influence of another person. Such exercises are conducted in three stages: entrance, maintenance and exit from the position. For example, you need to close your lips, an outsider with your finger and holds them and offers to blow them and try to open them. To the pronunciation of each group of sounds corresponds to a certain location of the tongue, lips, muscle tension. It is precisely in strengthening these skills that articulatory gymnastics is directed.

[20], [21], [22]

Massage with erased dysarthria

Massage with an erased dysarthria is used to strengthen or relax the facial muscles. With hyperkinesia and hypertension, a relaxing massage is done. He is in a short 1-1.5 minutes of effleurage, stroking the face from the temples to the bridge of the nose, forehead, nose, lips. People with a depressed tone are prescribed a firming massage. In this case, the face is longer (minutes 3) and deeply kneaded and grinded. All movements are directed horizontally from the center to the periphery of the face.

To improve the motor skills of the hands, massage and self-massage of the fingers and hands are performed. So, children in the form of games are offered to simulate the movements of iron, saws, kneading dough and others, accompanied by special quatrains on this topic.

Adapted program for erased dysarthria

The adapted program for an erased dysarthria is designed for the development and education of preschool children, taking into account their characteristics. It is a plan for a speech therapist and other participants in the educational process, determines the priorities of training, gives the methodology and its organizational aspects, regulates all types of training and the system for assessing the results of its assimilation. In it, besides the speech therapist, educators are involved, where games, interviews, excursions, a musical director, a specialist in fine arts, a sportsman are involved in the adapted program, and parents are involved. The program is designed for two years and consists of several stages.

• At the first initial diagnostic stage, through the collection of anamnesis, psychological and speech therapy tests, the degree of speech damage and defect correction task is determined, the speech card is filled.
• At the second stage of the organizational and preparatory work, an individual correction program is being developed.
• The third stage - correctional-technological provides for the implementation of all planned activities.
• The fourth is the outcome-diagnostic.

Logopedic studies are conducted to assess the state of the speech apparatus and other functions of the child. Decisions are made to stop the sessions with a speech therapist in case of positive results, continuing or changing the nature of the class.

[23], [24]

Prevention

Prevention of erased dysarthria in adults is identical to the prevention of strokes, Alzheimer's disease and other ailments leading to loss of functions of the speech device. To anticipate and prevent the birth of children with such a defect medicine is not yet able. Therefore for today as preventive maintenance it is possible to recommend a healthy way of life which will give a greater percent of confidence of occurrence of healthy posterity and prolongation of a life at good state of health.

[25]

Forecast

The prognosis of treatment of erased dysarthria with its mild form and early onset of correction is favorable. In any case, the effort will not be in vain and in one way or another improve speech skills.

[26], [27]