Dysarthria is a disorder of the speech function that leads to an inarticulate, often difficult-to-perceive pronunciation. This pathology is studied as a neurologist, because the cause of its occurrence is the transformation of the nervous regulation of the speech apparatus, and speech therapists engaged in pronunciation correction.
Speech therapists classify dysarthria according to the principle of perception of the pronunciation of sounds by others and distinguish three degrees of severity: from practically intelligible speech (mild degree) to its complete absence (severe degree - anarthria).
Logopedic massage with dysarthria has a beneficial effect on pronunciation and speech breathing, sonority of voice and emotional mood of the patient. It is successfully used in a complex of therapeutic and pedagogical rehabilitation activities, conducted with patients of any age, suffering from a disorder of sound.
Regularly performed speech therapy massage contributes to the gradual normalization of the tonus of the musculature of the tongue, the palate, the lips, facial expressions, the spontaneous formation of the correct pronunciation, as well as the reduction of the time for its correction. Even in cases of severe neurological symptoms in a patient, the use of only this type of speech correction, especially at the beginning of treatment, brings a noticeable positive effect.
Indications for the procedure
Reduced or increased tone of the musculature of the speech apparatus and respiration, anatomical shortcomings (short lingual frenulum), manifested as slurred sound, underdevelopment or lack of speech in childhood, post-amputation in adults.
When performing the procedure, the body of the patient is given a pose that allows to relax articulatory muscles and normalize breathing, and also - optimal for the convenience of the masseur. Lying on the back of the patient put a small cushion under the neck, so that the shoulders were slightly raised, and the head was slightly thrown back. The upper limbs of the patient are located along the body, the lower ones are freely straightened or slightly bent in the knees, under which the roller is also placed. A semi-sitting position is provided by a special chair with a reclining high back. For small children, you can use a child's sitting stroller or chair. From the first session, you should not put the child on a massage table. This can cause rejection on his part and undesirable protests. At the beginning of treatment, while the child is not used to the procedure, he can provide the necessary position on the hands of one of the parents.
Before you start the massage, the threshold of the emetic reflex in the patient is established. The speech therapy massage of the tongue is not performed immediately after a meal, it is necessary to maintain a gap of at least two hours.
With spasms of articulatory muscles that occur much more often with dysarthria, it is recommended to take two or three times in the mouth before a session and keep a warm infusion there, prepared as follows: brew a glass of boiling water through a pinch of nettle, St. John's wort, chamomile and tea.
The procedure is carried out with clean, warm hands, so that the patient is comfortable. The nails of the masseur must be carefully cleaned and short-cut, no jewelry on the fingers and wrists are allowed.
First, to relax the muscles of the neck, the massage therapist turns the patient's head from side to side several times, then a facial massage is performed for dysarthria more often for relaxation, sometimes for toning the facial musculature. Massage movements are repeated five to six times.
The patient lies, the masseur is behind. Stroking is performed in the following directions: from the eyebrows to the side of the hair; from the center of the forehead along the arc to the temples; above the eyes - from the inner corner along the arc to the outer one, under the eyes - from the outer to the inner one. In the area of the cheeks, massage the arcs that connect the wings of the nose, and the bone of the cheekbone, then with circular movements of the cheeks directly. The musculature of the lips is massaged from the center above the upper lip to its corners, then also under the lower lip; from the corner of the mouth to the tragus of the ear. Massage, rubbing, chin; the buccal muscle - from the malar bone downwards (with the bones of compressed fingers). With asymmetry of the face, the affected side is massaged more intensively.
Finger massage of the tongue with dysarthria is performed using a flap of natural tissue, gauze, fingertips (according to the sensitivity of the patient). During the procedure, the masseur is conveniently located to the right of the patient. Preliminary, at a leisurely pace, preparatory exercises are done, relaxing the muscles of the root of the tongue:
the masseur clamps the tongue with his fingers (the big one is at the top, the index and the middle one from the bottom) and rotates it several times in one direction, then in the other direction;
pulls the tongue to himself, "wrapping" it on the index finger, then lets go, spinning.
Massage of the tongue begins with the pit under the chin - deep pressing with the middle finger, without lifting your finger. To relax the muscles - the movements are carried out at a calm pace, to activate the muscles - more intensive massage is used. The circular chewing movements massaged the cheeks, then go directly to the tongue. Do it "grinding" a double-folded wide bandage or a piece of cotton cloth. In this case, the thumb is placed on the upper part of the tongue, the two following - from the bottom. If the ligament musculature is tense, massage from the tip to the root, if relaxed - on the contrary, to relax the muscles - the tongue can be shaken.
Exercise "clock" - it is taken from the tip from side to side, then compressed from two sides and is carried along the sides to the tip.
Exercise "arrow" - compressing the tongue with your fingers (large and index), spend, lightly stretching, the index finger of the other hand from its root to the tip.
The muscles are rubbed:
lips - thumb inside, index outside;
cheek - index in the mouth, large - outside.
Logopedic massage with dysarthria is carried out using auxiliary devices called probes. They are made of metal and plastic, they have the most diverse form: a ball, a fungus, a fork, a mustache, a hammer and others. Probe massage with dysarthria effectively develops the articulatory apparatus, normalizes the muscular activity and mobility of the tongue, the sound production becomes more clear and understandable. As a massage tool, spatulas (metal, wooden), toothbrushes are also used. With their help massage is done from the tip of the tongue to its root and vice versa, for example, by a ball probe, activating or relaxing the longitudinal muscles of the tongue. Movements from the center of the tongue to its edges tone up the activity of the transverse linguistic musculature, in the same direction the pinchings are carried out. Relaxing movements, on the contrary, are soft and stroking. A probe, a brush or a spatula are made by circular and spiral movements.
Puncture the tongue around the perimeter with a crenate probe (about 10 seconds).
Having plucked the tongue, perform rhythmic pats on the tongue with any adaptation, moving deeper from its tip. This normalizes the muscular activity of the vertical linguistic musculature, also - it is massaged, simulating a slight vibration, using a toothbrush or spatula.
Perform strokes on the underside of the tongue in the direction from the depth to its tip by any suitable device, while the ligament frenum is stretched.
You can spread out the tongue of a small folded two-fold douche-syringe (most of it), holding on to the tip.
Such massage is done daily or with a daily interval. This is an exemplary list of exercises, and others are possible. They are selected individually depending on the location of the affected muscles.
Relaxing massage with dysarthria is performed using mainly stroking and vibrating movements, and a relaxing effect on acupuncture points is also practiced. Massage the patient usually begin with the collar area, moving to the shoulder area, followed by a facial massage. The procedure ends with a massage of the tongue. The movements of the masseur must be slow and slippery. They are performed from eight to ten times. In order to relax the enslaved muscles at home, the following technique can be used:
stroke the neck from the line of hair growth towards the shoulders;
the index, middle and ring fingers to stroke the forehead from temples to the center, from the hair to the side of the eyebrows;
with the tips of those same fingers stroking the cheeks;
then perform strokes from the temporal bone towards the wings of the nose (movement is performed along the arc);
rub the buccal muscles in a spiral from the auricles towards the wings of the nose;
from the ears to the side of the chin, lightly pressing, stroking the cheekbones;
they rub their fingers alternately upper, then - the lower lip, then knead them, moving from the corners of the mouth to its center;
simultaneously, with both hands, smooth the area of the face from the wings of the nose to the side of the chin and in the opposite direction;
Tap your fingers with the entire surface of your lips.
After that, massage the tongue. Without logopedic probes, at home, you can stroke your index finger from its tip towards the root.
Reduced activity of the articulatory musculature involves more intense actions - stroking and rubbing, patting and kneading, pinching and vibrating. Each position is repeated eight to ten times. The first movements are light, then their intensity gradually increases. They are performed with pressure, but do not cause discomfort.
Initially, the main muscle groups are being studied, then secondary ones:
the forehead strokes his fingers (index and middle) simultaneously both hands from the center towards the temples, kneaded with the knuckles of these fingers, rubbed in the same direction, the work of this section ends with light tapping and pinching movements;
the musculature of the cheeks is worked by rubbing and kneading movements in the direction from the wings of the nose to the ears with the same two fingers, then they are massaged from left to right and spiraling from the ears to the chin, ending with a messy pinching of the skin on the cheeks;
rubbing with increasing activity in arcuate directions from the chin to the ears and from the corner of the lip to the outer corner of the eyes;
the muscles of the lips are developed from the center to the corners of the mouth (separately each lip), they are first stroked, then they pinch and carefully massage the crease from the nose to the lips.
Massage with a toothbrush with dysarthria is performed by brushes of different size and rigidity. The tongue is massaged with both bristles and brush handle. The movements are similar to those described above.
The development of speech and pronunciation is closely related to the fine motor skills of the hands. Therefore, hand massage will be useful to the child from birth. At the earliest age (up to three months), after consulting with a neurologist and in the office of a "healthy child" in a polyclinic, you can begin to do a light massage of the fingers. It is made warm, clean and lubricated with baby oil. Performing easy kneading, rubbing and stroking movements for each finger.
From the fourth month, you can use a variety of objects and toys with protruding parts (cubes, needles, cones). They roll their children, feel their hands.
Children older than a year are recommended to pinch each finger in turn with the index and middle fingers of an adult and gently twist; the child ties the same fingers on the left and right hand (two large, two index, and so on), and the adult uncouples; it is possible to help the child massage his fingers alternately, pressing on both their sides, independently.
In the speech therapy room, children are kneaded by fingers as preparatory procedures. Begin the movement from the tip of the little finger. Rising to the base of the finger, it is carefully kneaded, not missing a millimeter. Having finished kneading all the fingers, press on the finger bulges and tap on them with the end of the nail. Then, in a spiral, smooth the palm from the edge to the center and knead it in the same direction.
There are different methods of massage of fingers, including - point Tibetan, finger games. For the development of fine motor skills, it is useful to handle the grits, peas, grasping and unclenching fingers. Mix two different cereals and ask the child to arrange them according to the grades in two different plates.
Logopedic massage with spoons in dysarthria is performed with the help of four pure teaspoons without architectural excesses. It can be done at home on your own, however, before starting the classes, be sure to consult a doctor.
Technique for performing massage with spoons
With a convex part of the spoons, in a clockwise direction, stroke the whiskey six to eight times; the eye cavities are stroked over the eyes from the inner corner to the outer corner, then under the eyes - on the contrary; cheeks are stroked in circular motions; whiskey - spiraling; then the same - between the eyebrows.
The side of the spoon is done by massaging the cheeks in the direction from the chin to the eyes.
The end of the spoon is rubbing the nasolabial triangle. Work over the upper lip, lightly pressing, then - bottom.
The convex part of the spoons is massaged with circular movements of the chin and cheekbones.
Each movement is repeated six to eight times.
Speech massage should not bring painful sensations. The duration of the session depends on many factors: age, severity of the damage to the articulatory apparatus, individual sensitivity, and others. In the beginning it lasts from two to six minutes, the number of exercises gradually increases and the procedure is extended to 15-20 minutes. At an early age, the duration of the session is not recommended for more than 10 minutes, younger preschoolers should not do a massage for more than a quarter of an hour, children older than five can prolong the session to 25 minutes, teenagers and adults are given from 45 minutes to an hour.
If the child does not want to do the massage, no violence is allowed, the procedure is carried out in a game form, for the first time you can limit yourself to massage your hands and face. It is recommended to distract the child with songs, poems, fairy tales.
For each patient of any age, an individual approach is developed and a personal treatment plan is drawn up. The standard course consists of eight to ten sessions. It is repeated at intervals of three weeks. After the completion of the second course, a positive effect is already noticeable. For example, if the patient did not talk at all, then he starts talking. Three months after the completion of the second stage of treatment, a third may be appointed, if necessary.
Only speech therapy massage with severe dysarthria can not do, it is used as part of a complex of therapeutic measures.
Contraindications to the procedure
Absolute - oncological diseases, thrombosis of blood vessels, blood diseases. Temporary infectious inflammatory processes (angina, acute respiratory infections, stomatitis, conjunctivitis), lymphadenopathy, marked pulsation of the carotid artery, exacerbations of chronic diseases, in particular, cutaneous - herpetetic and allergic rashes are temporary. Caution should be exercised when prescribing and performing massage for children with convulsive syndrome, epilepsy, tremor of the chin.
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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.
To minimize speech disorders of a neurogenic nature associated with damage to certain structures of the brain or a violation of the innervation of the musculature of the articulatory apparatus, correction of the dysarthria is carried out.
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