Methods and stages of correction of sound pronunciation in dysarthria in children

To minimize speech disorders of a neurogenic nature associated with damage to certain structures of the brain or disruption of the innervation of the muscles of the articulatory apparatus, dysarthria is corrected.

Due to limited mobility of the tongue, lips, soft palate, and vocal cords, dysarthria disrupts phonation (pronunciation of sounds), as a result of which articulation (sound formation) occurs incorrectly, and speech is defined as slurred, that is, sounding indistinct.

Speech therapy correction of dysarthria

If the diagnosis of dysarthria is determined by neurologists, then the correction of speech disorders and the formation of correct sound reproduction is carried out by speech therapists.

Modern speech therapy correction of dysarthria – correction of incorrect and formation of correct articulatory patterns (articulatory motor skills when pronouncing sounds) – is carried out in the form of developmental training. The system of classes is aimed at:

• to increase mobility and practice movements of the articulatory muscles (styloglossus, hyoid, glossopalatine, glossopharyngeal, etc.);
• to form ideas about the system of phonemes (sound units of speech);
• to develop the ability to distinguish speech sounds and their order (phonemic hearing);
• to establish correct speech breathing and phonation;
• to develop the rhythm of speech and intonation skills.

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

Correction of erased dysarthria – a weak or mild form of pseudobulbar dysarthria (with a reduced level of phonation, instability of articulatory 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 of dysarthria correction

Today, speech therapy practice uses such effective methods of dysarthria correction as:

• articulatory gymnastics with the help of complexes of special isometric exercises (which are selected based on the characteristics of the disorders of the articulatory apparatus) – promotes the development of articulatory motor skills.
• speech therapy massage (during which the speech therapist massages the muscles of the nasolabial folds, lips, tongue, soft palate) – helps to normalize the tone of the facial and articulatory muscles and increases their mobility.
• Correction of speech breathing with the help of breathing exercises – to increase the volume of breathing and normalize its rhythm.
• a system of exercises for the development of articulatory kinesthesia and the development of an articulatory position (bilabial, labial-dental, lingual-dental, lingual-alveolar and lingual-palatal).
• phonetic localization using special devices to develop the correct position of the tongue and lips and correct the pronunciation of sounds.
• Orthophonic exercises that promote coordination of breathing, voice and motor skills of the articulatory muscles.
• various exercises for the development of fine motor skills and in children with cerebral palsy.

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Stages of speech therapy work to correct dysarthria

Correction of sound pronunciation 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 a group form (with a number of patients no more than 4-5).

In the first case, the speech therapist draws up a work program, in the second (as well as in specialized preschool and educational institutions) - calendar planning for the correction of dysarthria is used. But in both cases, this should be a clear plan for conducting classes (two or three classes per week, maximum duration - 40-45 minutes) indicating their purpose, content, methods used and didactic materials.

At the same time, the correction of dysarthria in preschoolers and younger schoolchildren successfully uses game methods, and homework is given to reinforce correct articulation skills - with detailed preliminary instructions to parents, who should actively participate in this process and have an idea of its main stages.

The main stages of speech therapy work to correct dysarthria:

• Stage I – development of general and speech motor skills (exercises for the muscle groups of the limbs, shoulder girdle and neck; games for coordination of movements and sense of rhythm; exercises for 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 – familiarization with the features of articulation of vowels and consonants (demonstration of correct pronunciation using mirrors, hands, articulation tables); setting correct pronunciation using special exercises developed for each sound.
• Stage III – practicing the automatism of articulatory motor skills when reproducing sounds in the process of pronouncing syllables, words, phrases and whole phrases.
• Stage IV – consolidation of the automaticity of articulatory patterns and the ability to distinguish sounds in one’s own speech.

Correction of dysarthria in children with cerebral palsy

Speech sound reproduction disorders in the form of cortical dysarthria (with lesions of the speech motor analyzer of the premotor 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 improvement of communication capabilities.

In children with cerebral palsy, speech development difficulties in children, caused by the disruption of its motor mechanisms, are aggravated by general motor disorders (spastic diplegia, hemiparesis, tonic muscle reflexes, synkinesis, 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 speech therapy correction of dysarthria - correction of the articulatory aspect of speech - will be less effective without the participation of a pediatric neurologist and defectologist.

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

In addition to developing articulation skills, correction of dysarthria in children with cerebral palsy includes work on improving the child’s level of speech perception, expanding his understanding of the meaning of words, and expanding his active vocabulary.

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