Methods and stages of sound reproduction correction in children with dysarthria

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.

Because of the limitation of the mobility of the tongue, lips, soft palate, vocal cords in dysarthria, the phonation (pronunciation of sounds) is disturbed, resulting in articulation (formation of sounds), and speech is defined as indistinct, that is, sounding indistinctly.

Logopedic correction of dysarthria

If the diagnosis of dysarthria is determined by neurologists, correction of speech disorders and the formation of proper sound reproduction is done by speech therapists.

Modern logopedic correction of dysarthria - correction of incorrect and formation of correct articulatory patterns (articulatory motor skills in the pronunciation of sounds) - is carried out in the form of developmental training. The system of classes is directed:

• on the increase of mobility and development of the movements of articulatory muscles (typhoid, sublingual, linguistic, lingopharyngeal, etc.);
• on the formation of ideas about the system of phonemes (sound units of speech);
• on the development of the ability to distinguish between the sounds of speech and their order (phonemic hearing);
• on the formulation of correct speech breathing and phonation;
• on the development of the rhythm of speech and the skills of its intonation.

Correction of dysarthria in children requires mandatory prior logopedic examination, which includes studying the features of the structure and degree of mobility of the muscles of the child's articulatory apparatus, ascertaining the level of his phonemic hearing, and determining the structure of speech defects.

Correction of an erased dysarthria - flaccid or mild form of pseudobulbar dysarthria (with a reduced level of phonation, instability of articulation patterns and stretching of syllables), as well as correction of cerebellar dysarthria is based on the same principles and uses the same methods.

Effective methods for correcting dysarthria

For today in logopedic practice such effective methods of dysarthria correction are used, as:

• articulatory gymnastics with the help of complexes of special isometric exercises (which are selected, proceeding from the peculiarities of articulatory apparatus violations) - promotes the development of articulatory motility.
• logopedic massage (during which the speech therapist massages the muscles of nasolabial folds, lips, tongue, soft palate) - helps to normalize the tone of facial and articulatory muscles and increases their mobility.
• correction of speech breathing with the help of respiratory gymnastics - to increase the volume of breathing and normalize its rhythm.
• the system of exercises for the development of articulatory kinesthesias and the development of an articulatory order (bipolar, labial-dental, lingual-dental, lingual-alveolar and lingual-palatine).
• phonetic localization with the use of special devices to develop the correct position of the tongue and lips and correct pronunciation of sounds.
• orthophonic exercises that promote coordination of breathing, voice and motor skills of articulatory muscles.
• various exercises for the development of fine motor skills and in children with cerebral palsy.

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

Stages of logopedic work on correction of dysarthria

Correction of sound production in dysarthria - erased, cerebellar, cortical, as well as correction of pseudobulbar dysarthria in patients of any age can be carried out both individually and in group form (with the number of patients not exceeding 4-5).

In the first case, the speech therapist composes a work program, in the second (and also in specialized preschool and educational institutions) - scheduling is used to correct the dysarthria. But in both cases it should be a clear plan for conducting classes (two or three sessions per week, the maximum duration is 40-45 minutes), indicating their purpose, content, methods and didactic materials used.

At the same time, correction of dysarthria in preschool children and schoolchildren of the younger age group successfully uses gaming methods, and homework is given to fix the correct articulatory skills - with detailed preliminary instruction of parents who should actively participate in this process and have an idea of its main stages.

The main stages of logopedic work on correcting dysarthria:

• Stage I - development of general and speech motor skills (exercises for a group of muscles of the extremities, shoulder girdle and neck, games for coordination of movements and a sense of rhythm, exercises for the development of fine motor skills of the fingers); development of speech hearing, attention and memory; increasing the mobility of all structures of the articulatory apparatus.
• Stage II - familiarity with the peculiarities of articulation of vowels and consonant sounds (demonstration of correct pronunciation using mirrors, hands, articulatory tables); the correct pronunciation of the pronunciation by special exercises designed for each sound.
• The third stage is the development of the automatism of articulatory motility when reproducing sounds in the process of pronunciation of syllables, words, phrases and whole phrases.
• The fourth stage is the consolidation of the automatism of articulatory ways and the ability to distinguish sounds in one's own speech.

Correction of dysarthria in children with cerebral palsy

Disturbances in the reproduction of speech sounds in the form of cortical dysarthria (with lesions of the speech motor analysor of the premortoric cortex of the frontal gyrus) and pseudobulbar dysarthria are present in most children with cerebral palsy, while the erased form is observed only in a third of cases. And timely correction of dysarthria in children with cerebral palsy is very important for their overall development and enhancement of communication capabilities.

In children's cerebral palsy, the complexity of speech formation in children due to impairment of its motor mechanisms is aggravated by violations of general motility (spastic diplegia, hemiparesis, tonic muscle reflexes, syncopeesis, ataxia) and psycho-functional factors: complete or partial absence of sound and visual orientation reactions, insufficient reflex and sensorimotor development, specificity of communication. And only logopedic correction of dysarthria - correction of the articulatory aspect of speech - will be less effective without the participation of a children's neurologist and defectologist.

In this case, the correction of dysarthria in children begins with exercises to reduce the tone of the main muscles of the articulatory apparatus, which should positively affect breathing, improve phonation, reduce the intensity of reflexes of oral automatism, as well as spasticity, deviation and protrusion of the tongue. Although, as noted by speech therapists, correction of pseudobulbar dysarthria of severe degree (for example, with double hemiplegia or tetraparesis) with complete loss of muscle mobility of the articulatory apparatus may be unsuccessful.

In addition to the development of articulatory skills, the correction of dysarthria in children with cerebral palsy includes work to increase the level of perception of speech by the child, to expand his understanding of the meaning of words, and to replenish the active vocabulary.

[8], [9], [10], [11], [12]