Differential characteristics of clinical forms of dysarthria table. Types of speech defects

(classification of dysarthria according to the syndomological approach)

Form of dysarthria			Hyperkinetic dysarthria	Atactic dysarthria
Lead Syndrome	Spastic paresis	Spastic paresis and tonic disturbances in the control of speech activity such as rigidity	Hyperkinesis	Ataxia
Form of cerebral palsy	Spastic diplegia, hemiparesis	double hemiplegia	Hyperkinetic form of cerebral palsy	Atonic-astatic form of cerebral palsy
The nature of the violation of muscle tone	Spasticity, less often hypotension	Muscle spasticity and rigidity (maximum sharp increase in muscle tone in all speech and skeletal muscles, aggravated by external stimuli)	Dystonia, less often hypotension (large). Dependence of tone on external influences, emotional state, voluntary movements	Hypotension
The presence of involuntary violent movements, synkinesis	Synkinesis, oral synkinesis. Possible preservation of reflexes of oral automatism	Frequent presence of brain stem synkinesis and oral automatisms (violent sucking and licking movements)	Hyperkinesis of the tongue, face, neck at rest, aggravated by pronunciation attempts. Synkinesia	Tremor of the tongue (with purposeful movements)
Violations of articulatory motility, articulatory praxis,	Decrease in volume and amplitude articulatory movements tongue, lips varying degrees). May suffer performance and save	The volume of articulatory movements is strictly limited. Inclusion in movement with an extended latent period (up to several minutes). At	The volume of articulatory movements may be sufficient. Particular difficulties in holding and feeling the articulatory posture	Dysmetria (disproportion) of articulation movements; more often - hypermetry (increase in amplitude

Form of dysarthria	Spastic-paretic dysarthria	Spastic-rigid dysarthria	Hyperkinetic dysarthria	Atactic dysarthria
facial expressions	articulation postures; switching from one articulation to another. Hypomimia of the face	inclusion in the movement - a sharp increase in tone in all speech and skeletal muscles. The tongue is tense, inactive, pushed back, it is not always possible to remove it from the oral cavity. Non-differentiation of lip and lingual movements (mixed lip-lingual articulation). Mimicry is extremely poor (the face is frozen, mask-like)	and when switching from one articulation to another, i.e. automation of articulatory movements suffers	there, exaggeration, slowness of movements). Difficulty in performing and maintaining articulation patterns. Facial expressions are sluggish
The state of the act of eating (chewing, swallowing)	The act of eating is slowed down but coordinated	Chewing, biting off, swallowing are grossly disturbed. Chewing is often replaced by sucking. Impaired coordination between breathing, chewing, swallowing	The processes of chewing, swallowing are difficult, dis-coordinated	Chewing weakened
Intelligibility of re-chi. Violations of sound pronunciation	Speech intelligibility is significantly reduced, it is often difficult to understand speech without knowing the context. The sounds of speech are devoid of a clear phonetic design. Consonant indistinctness	Speech intelligibility is significantly reduced, often speech is difficult to understand when the context is not known. The sounds of speech are devoid of a clear phonetic design. Indistinctness of consonants. Vowel mediation. Weakness of differentiation of the labial, dental;	Legibility is reduced (slurred, blurred, sometimes incomprehensible speech). The absence of stable violations of sound pronunciation is characteristic (omissions, substitutions, mixing of sounds are inconsistent). Lot	Speech intelligibility is reduced. Violated anterior-lingual, labial, explosive sounds

Form of dysarthria	Spastic-paretic dysarthria	Spastic-rigid dysarthria	Hyperkinetic dysarthria	Atactic dysarthria
	sounds. The averageness of vowels. Weak differentiation of the labials, teeth; hard-soft, voiced-deaf	hard-soft, voiced-deaf.	distortion of sounds (slotted and sonora)
Respiratory disorders	Violations of speech breathing (speech exhalation is shortened and exhausted, the breath is shallow)	Severe violations breathing	Severe respiratory problems	Asynergy - asynchrony of breathing, voice formation and articulation
Voice disorders	Voice of insufficient strength and sonority (quiet, weak, emaciated, muffled). Maybe nasalization (already mentioned)	The voice is quiet, deaf, strangled, tense	The voice is tense, intermittent, vibrating, changing in pitch, strength, sonority. May be nasalization	The voice is depleted, fading towards the end of the phrase; with a nasal tinge
Prosody violations	The amplitude of voice modulations is reduced, there are no tempo-rhythmic interruptions necessary for live intonation (voice is slightly modulated, monotonous)	Almost no voice modulation. Timbre is poor. The pace is a little faster	The melody-intonation side of speech is disturbed, the emotional connotation is lost. Weak or absent voice modulations (monotonicity)	Almost no voice modulation. Almost no intonation. The rhythm is chanted. The pace is slow
Autonomic disorders	Hypersalivation	Hypersalivation	There is no salivation in "pure" hyperkinetic syndrome	May be hypersalivation

Chapter III
Logopedic examination of children
with dysarthria

Logopedic examination of children with dysarthria (speech-motor) disorders is based on a general systematic approach, which is based on the idea of ​​speech as a complex functional system, the structural components of which are in close interaction. In this regard, the study speech development with dysarthria, it involves the impact on all aspects of speech. It is important to take into account the ratio of speech and non-speech disorders (neurological symptoms) in the structure of the defect and to determine the intact mechanisms of speech.

A comprehensive comprehensive examination and assessment of the features of the development of speech, mental functions, the motor sphere, the activities of various analyzer systems will allow us to give objective assessment existing shortcomings of speech development and outline the best ways to correct them. An important condition complex impact is the consistency of actions of a speech pathologist-defectologist and a neuropathologist during examination and diagnosis.

During speech therapy examination children with speech impairments are used following methods:

Study of medical and biographical documentation (collection and analysis of anamnestic data);

Observation of the child (in a normal and specially organized situation);

Conversation with parents and child;

Visual and tactile control (feeling) at rest and during speech;

Individual experiment;

Usage computer games when examining sound pronunciation, respiratory and voice functions.

Before starting the examination of the child, it is important to comprehensively study the medical documentation (history data) and analyze the results of the examination and the conclusion of the neuropathologist (neurological status), preferably discussing it with the doctor. A feature of speech therapy examination and analysis of the structure of the speech defect in children with dysarthria is the principle of correlating articulatory motor disorders with general motor disorders. With dysarthria, articulatory motility, breathing and voice formation features are evaluated in accordance with the general motor capabilities of the child (even minor motor disorders are noted).

Together with a neurologist, a speech therapist studies the features of the child’s general motor skills (holding the head, turning it freely to the sides, sitting, standing upright, walking independently, gait features) and the functionality of the hands and fingers (support function, palmar and finger grip, manipulations with objects , selection of the leading hand, coordination of the actions of the hands, fine differentiated movements of the fingers).

When determining the leading neurological syndrome and the degree of its manifestation in the articulatory muscles and motor skills (speech-motor syndrome), the speech therapist relies on the conclusion of a neuropathologist. At the same time, it is necessary to note the absence or presence of pathological tonic reflexes and their effect on breathing, voice formation and articulation.

It is important that during a speech therapy examination the child is completely calm, does not cry, is not frightened. If a child cries, screams, breaks out of his hands, this may be reflected in a change (increase) in muscle tone, and the idea of ​​motor and speech capabilities that a speech therapist will receive will be false. During the examination, a thorough analysis of those positions and movements that can facilitate or, conversely, aggravate speech activity. It is advisable to lay a child with severe motor impairments on a comfortable couch or carpet, checking different positions - on the back, on the side, on the stomach. In milder cases, the examination is carried out in the "sitting" or "standing" position.

As with any comprehensive examination, it is important to assess the developmental features cognitive activity(thinking, attention, memory), sensory functions (visual, auditory and kinesthetic perception), manifestations of the emotional-volitional sphere.

Speech therapy examination includes the collection of data on the characteristics of the pre-speech, early speech and mental development of the child before the examination. Based on the data of medical records and conversations with parents, it turns out the time of appearance and the nature of the cry, cooing, babble, and then the first words and simple phrases.

Examination of the articulatory apparatus begins with checking the structure of its organs: lips, tongue, teeth, hard and soft palate, jaws. At the same time, the speech therapist determines how much their structure corresponds to the norm.

It is necessary to assess the state of muscle tone of the articulatory apparatus at rest, when trying to speech activity, in the process of speech, with facial, general and articulatory movements. The state of muscle tone in the organs of articulation (facial, labial and lingual muscles) is assessed during a joint examination by a speech therapist and a neuropathologist. In children with dysarthria, articulatory muscle tone disorders are characterized by spasticity, hypotension, or dystonia. Often there is a mixed character and variability of muscle tone disorders in the articulatory apparatus (for example, hypotension can be expressed in the facial and labial muscles, and spasticity in the lingual muscles). The presence or absence of hypomimia, asymmetry of the face, smoothness of the nasolabial folds, synkinesis, hyperkinesis of the facial and lingual muscles, tremor of the tongue, deviation (deviation) of the tongue to the side, hypersalivation are noted.

The speech therapist evaluates the involuntary movements of the articulatory apparatus during eating (sucking, removing food from a spoon, drinking from a cup, biting, chewing, swallowing). The features of violation of the act of eating in a child are clarified: the absence or difficulty of chewing solid food and biting off a piece; choking and choking on swallowing.

Special attention refers to the state of arbitrary articulatory motility. When checking the mobility of the organs of articulation, the child is offered various imitation tasks. Analyzing the state of mobility of the speech muscles, attention is drawn to the possibility of performing articulatory positions, their retention and switching. At the same time, not only the main characteristics of articulatory movements (volume, amplitude, tempo, smoothness and speed of switching) are noted, but also the accuracy, proportionality of the movements, their exhaustion. The speech therapist evaluates the volume of articulatory movements of the tongue in particular detail (strictly limited, incomplete, complete); there is even a slight decrease in the amplitude of articulatory movements of the tongue. In some children with pronounced motor speech syndromes, it is sometimes not possible even to passively remove the tongue from the oral cavity. The possibility of arbitrary protrusion of the tongue, lateral leads, lip licking, holding wide, flattened, upper lifting, clicking, etc. is checked. The degree and limit of the pharyngeal reflex (increase or decrease) is assessed. The speech therapist analyzes the features of the movements of the lips (inactive or rather mobile) and the lower jaw (opening and closing the mouth, the ability to keep the mouth closed).

Assessment of comprehension of reversed (impressive) speech is milestone speech therapy examination. The speech therapist reveals the level of understanding of addressed speech (distinguishing intonation of an adult's voice, situational understanding of addressed speech, at the everyday level, in full). Passive vocabulary is tested on real objects and toys, subject and plot pictures. At the same time, the understanding of the semantic meaning of a word, action, simple and complex plots, lexical and grammatical constructions, and a sequence of events is determined.

When examining one's own (expressive) speech, the level of the child's speech development is revealed. It is important to note the age formation of the lexical and grammatical aspects of speech, the assimilation various parts speech, features syllabic structure words. In speechless children, the possibility of using various non-verbal means of communication is noted: expressive facial expressions, gestures, intonation.

When studying the pronunciation side of speech, the degree of impaired speech intelligibility is revealed (slurred speech, incomprehensible to others; speech intelligibility is somewhat reduced, speech is fuzzy, blurred).

The phonetic-phonemic structure of speech is checked in detail. When examining sound pronunciation, it is necessary to identify the child's ability to pronounce sounds in isolation, in syllables, in words, in sentences, and especially in speech stream. It should be noted the nature of the shortcomings of sound pronunciation: distortions, substitutions, omissions of sounds. Violations of sound pronunciation are compared with the features of phonemic perception and sound analysis. It is important to note whether the child determines the violation of sound pronunciation in someone else's and his own speech; how he differentiates by ear normal and defective sounds he utters.

The quality of the sound disorder in children with dysarthria can vary. I.I. Panchenko proposed to allocate the following forms sound speech disorder:

1 form - a phonetic disorder, manifested in the distortion of sounds, but with the preservation of all differential phonemic features of sounds;

2 form - phonetic-apraxic disorder, including both phonetic disorders (distortion of sounds) and articulatory apraxia, expressed in the replacement and omission of sounds;

3rd form - phonetic-phonemic disorder with phenomena of articulatory apraxia (in addition to sound distortions, there are multiple substitutions, omissions of sounds, violations of the syllabic structure of words, incorrect grammatical use of phonemes at the end of a word).

Analyzing the data of a speech therapy examination, it is necessary to determine to which group the disorders identified in the child should be attributed: to purely phonetic, to phonetic-phonemic, or to manifestations of general underdevelopment of speech.

So, in the course of a speech therapy examination of children with dysarthria, a speech therapist should identify the structure of a speech defect (the ratio of speech and non-speech disorders), comparing it with the severity of damage to articulatory and general motor skills, as well as the level of mental development of the child.

After analyzing the results of a comprehensive examination, the speech therapist gives a conclusion that allows one to judge the state of the speech defect at the time of the examination. It is desirable that a speech therapy conclusion (diagnosis) be made (given) jointly by a speech therapist and a neuropathologist.

Below is a map of a speech therapy examination of children of early and preschool age with neurological pathology, which was developed and modified by the author for more than 15 years in the course of many years. practical work speech therapist in various medical institutions (in the Children's Psychoneurological Hospital No. 18 in Moscow, in the Republican Association for the Rehabilitation of Disabled Children "Childhood", in the "Medincenter" under the Ministry of Foreign Affairs of the Russian Federation). Variants of this map have been repeatedly published earlier in various manuals, often without reference to the author.

Differential characteristics of clinical forms of dysarthria Subcortical dysarthria (extrapyramidal ). Various lesions of the subcortical nuclei of the brain and their nerve connections.

Extrapyramidal disorders of muscle tone in the form of hypertension, hypotension or dystonia. Violent movements (hyperkinesis) in the muscles of the speech apparatus in the form of trembling (for example, intonational tremor), slow worm-like muscle contractions (for example, with double athetosis), quick sudden contractions of different muscle groups (for example, with chorea), rapid rhythmic contractions of the same the same muscles (for example, with myoclonus).

Pronunciation disorders are extremely diverse, often inconsistent. The voice is tense, harsh, hoarse, fluctuating in timbre and volume. Sometimes the voice in the process of speech fades and turns into a whisper. Sometimes the articulation of vowels is broken more than consonants. Separate words and sounds can be pronounced correctly, but at the moment of hyperkinesis they turn out to be sharply distorted and indistinct. As a rule, the tempo, rhythm and melody of speech are upset. The patient notices his articulation disorders.

Cerebellar dysarthria

Cerebellar dysarthria. With this form of dysarthria, the cerebellum and its connections with other parts of the central nervous system, as well as fronto-cerebellar tracts.

Speech in cerebellar dysarthria is slow, jerky, chanted, with impaired modulation of stress, attenuation of the voice towards the end of the phrase. There is a decreased tone in the muscles of the tongue and lips, the tongue is thin, flattened in the oral cavity, its mobility is limited, the pace of movements is slowed down, it is difficult to maintain articulation patterns and weakness of their sensations, the soft palate sags, chewing is weakened, facial expressions are sluggish. The movements of the tongue are inaccurate, with manifestations of hyper- or hypometry (redundancy or insufficiency of the volume of movement). With more subtle purposeful movements, a slight trembling of the tongue is noted. Nasalization of most sounds is pronounced.

Cortical dysarthria

Cortical dysarthria is a group of motor speech disorders of different pathogenesis associated with focal lesions of the cerebral cortex.

The first variant of cortical dysarthria is caused by a unilateral or more often bilateral lesion of the lower part of the anterior central gyrus. In these cases, selective central paresis of the muscles of the articulatory apparatus (most often the tongue) occurs. Selective cortical paresis of individual muscles of the tongue leads to a limitation of the volume of the most subtle isolated movements: the upward movement of the tip of the tongue. With this option, the pronunciation of front-lingual sounds is disturbed.

The second variant of cortical dysarthria is associated with insufficiency of kinesthetic praxis, which is observed with unilateral lesions of the cortex of the dominant (usually left) hemisphere of the brain in the lower post-central sections of the cortex.

In these cases, the pronunciation of consonants suffers, especially hissing and affricates. Articulation disorders are inconsistent and ambiguous. The search for the desired articulation mode at the moment of speech slows down its pace and breaks the smoothness.

Difficulty in feeling and reproducing certain articulation modes is noted. There is a lack of facial gnosis: the child finds it difficult to clearly localize a point touch to certain areas of the face, especially in the area of ​​the articulatory apparatus.

The third variant of cortical dysarthria is associated with insufficiency of dynamic kinetic praxis, this is observed with unilateral lesions of the cortex. dominant hemisphere in the lower premotor areas of the cortex. In case of violations of kinetic praxis, it is difficult to pronounce complex affricates, which can break up into component parts, there are replacements of fricative sounds with stops (h - e), omissions of sounds in confluences of consonants, sometimes with selective stunning of voiced stop consonants. Speech is tense and slow.

Pseudobulbar dysarthria

Pseudobulbar dysarthria occurs with bilateral damage to the motor cortical-nuclear pathways that go from the cerebral cortex to the nuclei of the cranial nerves of the trunk.

Pseudobulbar dysarthria is characterized by an increase in muscle tone in the articulatory muscles according to the type of spasticity - a spastic form of pseudobulbar dysarthria. Less commonly, against the background of limiting the volume of voluntary movements, there is a slight increase in muscle tone in individual muscle groups or a decrease in muscle tone - a paretic form of pseudobulbar dysarthria. In both forms, there is a limitation of active movements of the muscles of the articulatory apparatus, in severe cases - their almost complete absence.

Differential Diagnosis erased dysarthria and complex dyslalia

Influence of muscle tone on the nature of sound pronunciation.

Task for the next trimester

Practical lesson 3/1.

Topic: Methods of neurological examination of children with speech pathology, interpretation of CNS lesions in combination with speech disorders.

Questions for self-study

Tasks for writing:

1. Tests to assess the functioning of the parieto-occipital cortex of the child's brain.

2. Tests for the examination of arbitrary facial motor skills.

3. Tests for the examination of speech motor skills.

4. Tests for the examination of arbitrary motor skills.

5. Tests for the examination of fine movements of the fingers.

6. Cranial nerves, significance for the innervation of the articulatory-phonation muscles.

7. Sensitive and motor innervation of the face, lips, tongue, soft and hard palate.

8. Neurological examination of the function of the cranial nerves.

9. Neurological examination of the function of the cerebellum.

Literature: Povalyaeva M.A. Handbook of a speech therapist - Rostov-on-Don: "Phoenix", 2002. - 448 p.

Practical session 3/2.

Subject: Aphasia. Etiology and pathogenesis, classification, main manifestations, research methods.

Questions for self-study

1. Define expressive and impressive speech.

2. Etiology and pathogenesis of aphasia. Aphasia classification

3. Characteristics of the forms of motor aphasia, dynamic aphasia, characteristics, main manifestations, localization of the lesion in this form.

4. Efferent motor aphasia, main manifestations, localization of the lesion in this form of aphasia.

5. Afferent motor aphasia, characteristics, main manifestations, localization of the lesion in this form. Violation of writing in motor forms of aphasia. Characteristics of sensory forms of aphasia.

6. Sensory aphasia, characteristics, main manifestations, localization of the lesion in this form of aphasia.

7. Semantic aphasia, characteristics, main manifestations, localization of the lesion in this form.

8. Amnestic aphasia, characteristics, main manifestations, localization of the lesion in this form of aphasia.

9. Acoustic-mnestic aphasia, characteristics, main manifestations, localization of the lesion in this form. Violation of reading and writing in sensory forms of aphasia. Acalculia and amusia in aphasia.

10. Features of the course of aphasia in childhood. Research methods for aphasic disorders. Differential diagnosis with similar diseases. Examination and main directions of correction speech therapy work with aphasics.

1. Tasks for written performance:

Characteristics of aphasia

Practice 4.

Subject: Alalia. Etiology and pathogenesis, classification, main manifestations, research methods, differential diagnosis with other diseases associated with speech and auditory disorders.

Questions for self-study

1. Etiology of alalia. Pathogenesis. Alalia classification.

2. Characteristics and features of the course of each form of alalia.

3. Motor alalia, characteristics, main manifestations, localization of the lesion in this form.

4. The severity of the course of alalia: from severe forms to erased forms.

5. Features of the neuropsychic sphere in children with alalia. Features of speech formation in children with alalia.

6. Features of the formation of reading and writing in children with various forms of alalia. Differential diagnosis of alalia with similar forms of speech pathology.

7. Examination of children with alalia.

ACADEMY OF SOCIAL EDUCATION (KSUE)

FACULTY OF PEDAGOGY AND PSYCHOLOGY

DEPARTMENT OF SPECIAL PSYCHOLOGY

Course work

Fundamentals of speech therapy

Subject: Comparative characteristics various forms of dysarthria

Surname: Kalinina Department: part-time

Name: Antonina Specialty: special psychologist

Middle name: Aleksandrovna Group: 6431

Lecturer-reviewer: Kedrova I.A.

Kazan, 2010

2. Neurological foundations of speech………………………………………….. page 4

3. Impressive and expressive speech. Brain and speech…………………. page 9

4. The concept of "dysarthria"…………………………………………………p.11

5. Causes of dysarthria…………………………………p.11

6. Types of dysarthria. Classification of clinical forms of dysarthria ... p.12

6.1. Features of articulation disorders…………………... p.13

6.2. Bulbar dysarthria………………………………………………page 14

6.3. Subcortical dysarthria………………………………………….page 15

6.4. Cerebellar dysarthria………………………………………….page 16

6.5. Cortical dysarthria………………………………………………p.17

6.6. Erased (mild) forms of dysarthria…………………………….page 17

6.7. Pseudobulbar dysarthria……………………………………page 20

a) Easy degree………………………………………………..page 21

b) Average degree…………………………………………………p.21

c) Severe degree……………………………………………...p.22

6.8. Violation of the rate of speech and stuttering as a variety of motor dysarthria……………………………………………………………………….page 23

7. Literacy in dysarthria…………………………………p.25

8. Lexico-grammatical structure of speech………………………………..p.27

9. Correction of dysarthria…………………………………………………p.28

9.1. Breathing gymnastics A.N. Strelnikova………………….page 29

9.2. Exercises for the development of speech breathing…………………..p.32

10. Treatment of dysarthria……………………………………………………..page 34

11. Defectologist's advice…………………………………………………p.37

The subject of the study is the system of speech therapy work to overcome the violation phonetic side speech in children with dysarthria.

Tasks:

to study the essence of dysarthria;

consider the etiopathogenesis of dysarthria;

to study the mastery of reading and writing in ontogeny;

conduct research.

Research methods: theoretical analysis literary sources; empirical research.
Speech, voice and hearing are functions human body, which are of great importance not only for communication between people, but also for cultural and intellectual development of all mankind. The development of speech is closely connected with higher nervous activity. Speech is a relatively young function of the cerebral cortex, which arose at the stage of human development as an essential addition to the mechanism of the nervous activity of animals.

IP Pavlov wrote: “In the developing animal organism, an extraordinary increase in the mechanisms of nervous activity occurred in the human phase.

For an animal, reality is represented exclusively by stimuli and their traces in the large hemispheres of the brain in special cells of the visual, auditory and other centers. This is what appears to a person as impressions, sensations and ideas from the environment. external environment.

This is the first signaling system of reality that we have in common with animals.

But the word constituted a second, special system of reality, being a signal of the first signals.

It was the word that made us human, but there is no doubt that the basic laws established in the work of the first signal system must also operate in the second, because this is the work of the same nervous tissue ... ".

Activities of the first and second signaling systems inextricably linked, both systems are constantly in interaction. The activity of the first signaling system is a complicated work of the sense organs. The first signal system is the carrier of figurative, objective, concrete and emotional thinking, it works under the influence of direct (non-verbal) influences of the external world and the internal environment of the body. A person has a second signaling system, which has the ability to create conditional connections to the signals of the first system and form the most complex relationships between the body and environment. The main specific and real impulse for the activity of the second signal system is the word. With the word arises new principle nervous activity - abstract.

This provides an unlimited orientation of a person in the surrounding world and forms the most perfect mechanism of a rational being - knowledge in the form of universal human experience. Cortical connections formed with the help of speech are a property of the higher nervous activity of a “reasonable person”, however, it obeys all the basic laws of behavior and is due to the processes of excitation and inhibition in the cerebral cortex. So speech is a conditioned reflex higher order. It develops as a second signal system.

The emergence of speech is due to the process of development of the central nervous system, in which a center is formed in the cerebral cortex for the pronunciation of individual sounds, syllables and words - this is the motor center of speech - Broca's center.

Along with it, the ability to distinguish and perceive conditioned sound signals develops depending on their meaning and order - a gnostic speech function is formed - the sensory center of speech - the center of Wernicke. Both centers are closely related in terms of development and function, they are located in the left hemisphere in right-handed people, in the right hemisphere in left-handed people. These cortical sections do not function in isolation, but are connected with the rest of the cortex, and thus the simultaneous function of the entire cerebral cortex is performed. This is the cumulative work of all analyzers (visual, auditory, etc.), as a result of which the complex internal and external environment is analyzed and then the complex activity of the organism is synthesized. For the emergence of speech in a child (speech is an innate ability of a person), hearing is of primary importance, which during the period of speech development is formed by itself under the influence of sound system language. The relationship between hearing and speech, however, does not exhaust the relationship between the first and second signal systems.

Hearing for articulate speech is only one part speech act. Another part of it is the pronunciation of sounds, or the articulation of speech, which is constantly controlled by hearing. Speech is also a signal for communication with other people and for the speaker himself. During articulation (pronunciation) there are numerous subtle irritations coming from speech mechanism into the bark hemispheres, which become a system of signals for the speaker himself. These signals enter the cortex simultaneously with the sound signals of speech.

Thus, the development of speech is an extremely complex process, due to the influence various factors. Numerous studies have shown that the speech function is formed as follows: the results of the activity of all cortical analyzers involved in the formation of speech are transmitted along the pyramidal pathways to the nuclei of the cranial nerves of the brain stem of their own and in more opposite side.

depart from the nuclei of the cranial nerves neural pathways, heading to the peripheral speech apparatus (nasal cavity, lips, teeth, tongue, etc.), in the muscles of which there are endings of motor nerves.
The motor nerves bring impulses from the central nervous system to the muscles, inducing the muscles to contract, as well as regulating their tone. In turn, motor stimuli from the speech muscles go to the central nervous system along sensory fibers.
As already noted, speech is not an innate human ability. The first vocal manifestation of a newborn is a cry.
This is an innate unconditioned reflex that occurs in the subcortical layer, in the lowest section of higher nervous activity. Cry occurs in response to external or internal irritation. Each newborn child is subjected to cooling - the action of air after birth, the temperature of which is lower than the temperature in the mother's womb, in addition, after the umbilical cord is tied, the flow of maternal blood stops and oxygen starvation occurs. All this contributes to the reflex inhalation as the first manifestation of independent life and the first exhalation, during which the first cry occurs.

In the future, the crying of newborns is caused by internal irritations: hunger, pain, itching, etc. At the 4-6th week of life, the voice manifestations of infants reflect his feelings. An external manifestation of calmness is a soft sound of a voice, with unpleasant sensations - a sharp voice, during this period, various consonant sounds begin to appear in the child's voice - “gurgling”. So the child gradually acquires a motor prototype for further development speech. Each emitted sound is transmitted by a wave of air to the hearing aid and from there to the cortical auditory analyzer. Thus, the natural connection between the motor analyzer and the auditory analyzer develops and becomes fixed. At the age of 5-6 months, the child's stock of sounds is already very rich. The sounds are cooing, smacking, vibrating, etc. The easiest thing for a child to do is the sounds formed by the lips and the front of the tongue (“mother”, “dad”, “woman”, “tata”), since the muscles of these departments are well developed due to sucking.

Between 6–8 months, conditioned reflexes and differentiation of the first signaling system are formed. There is a repetition of one syllable as a primitive speech manifestation. The child hears the formation of phonemes (certain sounds), and the sound stimulus reproduces the articulatory stereotype. Thus, a motor-acoustic and acoustic-motor connection is gradually developed, i.e., the child pronounces those phonemes (sounds) that he hears. Between 8–9 months, a period of reflex repetition and imitation begins. The auditory analyzer takes the leading role. By constant repetition of different syllables, the child develops a closed auditory-motor circle.

During this period, a mechanism for the repetition of complex sounds appears. The mother repeats his babbling after the child, and her voice enters the well-established acoustic-motor circle of the child. This is how the work between audible and one's own speech is established. First, the child repeats syllables or monosyllabic words after the mother. This function of simply repeating audible sounds is called physiological echolalia and is hallmark the first signal system (repeat individual syllables and simple words can also be animals, such as parrots, starlings, monkeys). Approximately at the same time as physiological echolalia (repetition, imitation), an understanding of the meaning of words begins to develop. The child perceives words and short phrases as a verbal image. An important role in understanding the meaning of words is played by the tone of the phrase spoken by the parents. During this period, the visual analyzer begins to play an increasingly important role in the formation of speech. As a result of the interaction of the auditory and visual analyzers, the child gradually develops complex analytical (acoustic-optical) processes.

The mechanisms of both signal systems are strengthened, conditioned reflexes of a higher order arise. For example: a child is brought to a ticking clock and at the same time they say: “tick-tock”. A few days later, the child turns to the clock as soon as they say “tick-tock”.

The motor reaction (turning to the clock) is proof that the acoustic-motor connection has been fixed. Auditory perception elicits a motor response that is related to the previous visual perception. At this stage, the motor analyzer is more developed than the stimulus of speech mechanisms. In the future, the child constantly develops more and more complex general motor reactions to verbal stimuli, but these reactions are gradually inhibited, and a speech response is formed. First independent words the child begins to pronounce, as a rule, at the beginning of the second year of life. As the child develops, external and internal stimuli and conditioned reactions the first signaling system cause speech reactions.

In this period of the child's life, all external and internal stimuli, all newly formed conditioned reflexes, both positive and negative (negative), are reflected by speech, that is, they are associated with the motor analyzer of speech, gradually increasing the vocabulary of children's speech.

Based on the already developed acoustic-articulatory and optical-articulatory connections, the child pronounces a previously heard word without prompting and names visible objects.

In addition, he uses tactile and gustatory connections, and all analyzers are included in the complex speech activity. In this period, a complex system of conditional connections, the child's speech are influenced by direct perception of reality. The development of speech is greatly influenced by emotions, and the word arises under the influence of joy, displeasure, fear, etc. This is due to the activity of the subcortical system of the brain. The first words that the child pronounces independently arise as conditioned reflex reactions, depending on the factors of the external and internal environment. The child names the objects that he sees, expresses his needs in words, for example, hunger, thirst, etc. During this period, each word becomes purposeful speech manifestation, has the meaning of "phrase" and is therefore called a "single-word phrase".
A child expresses his mood with a variety of voice tones. The child speaks in single-word phrases for about six months (up to 1.5-2 years of age), then he begins to form short word chains, for example: “mother, on”, “woman, give”, etc. Nouns are used mainly in nominative case, and verbs - in the imperative, indefinite mood, in the third person.
At the 3rd year of life, the correct linking of words into short speech chains begins, vocabulary the child is already 300-320 words. The more objects and things a child knows and names them correctly, the more connections fixed in the cerebral cortex.

With the help of repeated stimuli from the external environment, the child forms complex reactions, which are the product of the interaction of newly acquired and already established reflex connections in the cortex, the product of a close relationship between the first and second signal systems.

This is how the highest integration ability of speech is gradually formed, the highest stage of generalized cortical chain processes that make up physiological basis the most complex speech functions of the brain. Speech chains are linked into more and more complex complexes, and the foundation is laid human thinking. Of course, the development of speech does not end in childhood, it develops throughout the life of the human individual. Thus, the formation and development of speech is based on the most complex processes occurring in the human central nervous system, in the cerebral cortex, subcortical structures, peripheral nerves, sense organs.

Formation, development and individual characteristics human speech depends on the type of higher nervous activity, the type of nervous system. The type of the nervous system is a complex of basic human qualities that determine his behavior.

These main qualities are excitation and inhibition.
The type of higher nervous activity is the activity of the first signal system in its unity with the second signal system. The types of higher nervous activity are not constant and unchanging, they can change under the influence of various factors, which include education, social environment, nutrition, and various diseases. The type of nervous system, higher nervous activity determines the characteristics of human speech.
I type- normally excitable, strong, balanced - sanguine, characterized by a functionally strong cortex, harmoniously balanced with optimal activity of subcortical structures.
Cortical reactions are intense, and their magnitude corresponds to the strength of irritation. In sanguine people, speech reflexes are developed very quickly and the development of speech corresponds to age norms.

The speech of a sanguine person is loud, fast, expressive, with correct intonation, smooth, coherent, figurative, sometimes accompanied by gestures, facial expressions, healthy emotional arousal.

II type- normally excitable, strong, balanced, slow - phlegmatic, characterized by a normal relationship between the activity of the cortex and subcortex, which ensures perfect control of the cerebral cortex over unconditioned reflexes (instincts) and emotions. Conditioned reflex connections in phlegmatic people are formed somewhat more slowly than in sanguine people.
Conditioned reflexes in phlegmatic people of normal strength, are constant, equal to the strength of conditioned stimuli. Phlegmatic people quickly learn to speak, read and write, their speech is measured, calm, correct, expressive, but without emotional coloring, gestures and facial expressions.
III type- strong, with increased excitability - choleric, characterized by the predominance of subcortical reactions over cortical control.
Conditional connections are fixed more slowly than in sanguine and phlegmatic people, the reason for this is frequent outbreaks of subcortical excitations that cause protective inhibition in the cerebral cortex. Cholerics are unstable, poorly suppress their instincts, affects, emotions. It is customary to distinguish three degrees of violation of the interaction of the cerebral cortex and subcortical structures:
1) at the first degree, the choleric person is balanced, but highly excitable, emotional irritability is strong, often has excellent abilities, speech is correct, accelerated, bright, emotionally colored, accompanied by gestures, causeless outbursts of displeasure, anger, joy, etc. are characteristic;

2) in the second degree, the choleric is unbalanced, unreasonably irritable, often aggressive, speech is fast, with irregular accents, sometimes with cries, not very expressive, often unexpectedly interrupted;

3) in the third degree, choleric people are called bullies, extravagant, speech is simplified, rough, jerky, often vulgar, with an incorrect, inadequate emotional coloring.

IV type - a weak type with reduced excitability, characterized by cortical and subcortical hyporeflexia and reduced activity of the first and second signaling systems. A person with a weak type of nervous system has uneven and unstable conditioned reflex connections and frequent imbalances between the process of excitation and inhibition, with the latter predominating. Conditioned reflexes are formed slowly, often do not meet the strength of irritation and the requirements for the speed of responses; speech is inexpressive, slow, quiet, lethargic, indifferent, without emotion. Children with type IV nervous system begin to speak late, speech develops slowly.

Speech is the ability of a person to pronounce articulate sounds that make up words and phrases (expressive speech), and at the same time comprehend them, linking the heard words with certain concepts (impressive speech). Speech disorders include violations of its formation (violation expressive speech) and perception (violation of impressive speech). Speech disorders can be observed with a defect in any part of the speech apparatus: with pathology of the peripheral speech apparatus (for example, congenital anatomical deformities - splitting of the hard palate, splitting upper lip, micro- or macroglossia, etc.), in violation of the innervation of the muscles of the mouth, nasopharynx, larynx involved in voicing different concepts and images, as well as organic and functional changes in some parts of the central nervous system that provide speech function. Disorders in the formation of speech (expressive speech) are manifested in a violation of the syntactic structure of phrases, in a change in the vocabulary and sound composition, melody, tempo and fluency of speech. With disorders of perception (impressive speech), the processes of recognition of speech elements, grammatical and semantic analysis of perceived messages are disrupted. Violation of the processes of analysis and synthesis of messages and speech memory that occurs when the brain is damaged is called aphasia. Thus, aphasia is a systemic disintegration of already formed speech. If damage to the central nervous system in children contributed to the violation speech function and arose before they mastered speech, then an alalia is formed (“a” - negation, “Yyu” - sound, speech). Both of these disorders have much in common: both aphasia and alalia are characterized by complete or partial violation speech, which makes it to some extent impossible the existence of the main function of speech - communication with others. As secondary phenomena in both cases, there are violations of the processes of thinking and changes in the personality and all human behavior.

Often, impaired speech function is associated with damage to certain areas of the brain.

Of course, speech is an integrative function of the entire human brain, however, numerous studies indicate the existence of certain areas in the cerebral cortex, with the defeat of which speech disorders naturally develop. Speech disorders associated with lesions of the central nervous system occur due to:
1) with underdevelopment of the brain (for example, microencephaly);
2) with infectious diseases(meningoencephalitis of various etiologies: meningococcal, measles, syphilitic, tuberculosis, etc.);
3) with brain injuries (including birth injuries);
4) with the development of a tumor process, leading to compression of brain structures, impaired blood supply and degeneration of brain tissue;
5) with mental illness(schizophrenia, manic-depressive psychosis), in which the structure of brain cells is disrupted;
6) with hemorrhage in the brain tissue.

The articulatory apparatus makes our speech legible and articulate. This apparatus includes organs such as the larynx, vocal cords, natural tongue and lips, hard and soft palate, nasopharynx and jaws. Oh yes, more teeth.

In order for this device to work, it needs to give the appropriate command. Who issues commands? Brain. And who is the messenger carrying the order of the brain? The central nervous system, respectively, along the nerves, which in turn consist of a bundle of nerve fibers. If there is no normal speech, then the problem can be anywhere in this chain.

Dysarthria is an angular, one might even say sinister word. The term "dysarthria" is derived from the Greek words arthson, articulation, and dys, a particle meaning disorder. It turns out dysarthria - a pronunciation disorder. This is a neurological term, because dysarthria occurs when the function of the cranial nerves of the lower part of the trunk, responsible for articulation, is impaired.

dysarthria- violation of the sound-producing side of speech, due to organic insufficiency of the innervation of the speech apparatus.

MATERIAL FROM THE ARCHIVE

bulbar form

Etiology: damage to the nuclei of the cranial nerves: glossopharyngeal IX, vagus X and hypoglossal XII. Pathogenesis: violations of the type of peripheral flaccid paralysis. There is hypotension or atony. Symptoms: slurred, slurred speech.

1) Paresis vocal folds . Paresis of the muscles of the soft palate does not allow the use of the oral resonator. Deaf or semi-voiced variants predominate, sonoras are replaced by deaf ones (for example, rama - tata). Speech is extremely slurred and incomprehensible. Vowels take on a noisy tone (with an "X" overtone). All oral sounds are nasalized (for example, daughter-hoh). The opposition on the basis of "oral - nasal" is erased.

2) Paresis of the muscles of articulation. The tongue lies at the bottom of the oral cavity and hardly participates in articulation. Some individual words are replaced by a pharyngeal exhalation (kot-hoh). There is a phenomenon of assimilation of speech sounds to a system of phonemes of another language. A symptom of loss of articulation (for example, baba-papa-fafa-haha).

3) Paresis of the respiratory muscles. Reduced subglottic pressure on the vocal folds
There is no clear coordination of inhalation and exhalation at the time of speech. Inhalation is shallow, superficial, sluggish, equal to exhalation; a long air jet is not formed. The voice fades towards the end of the sentence. The phenomenon of hypotension is observed: the voice sounds weak, quiet, intonationally inexpressive.

Correction: speech therapy is carried out against the background of the treatment of bulbar syndrome using existing medications and non-drug methods impact. Attention is paid to the development of the accuracy of articulatory movements, proprioceptive sensations in the speech muscles through passive-active gymnastics of the articulatory muscles. To develop sufficient muscle strength, resistance exercises are used.

Pseudobulbar form

Etiology: damage to the corticonuclear pathway at any site. Pathogenesis: central spastic paralysis. Disinhibition of segmental apparatuses of the medulla oblongata and spinal cord. Symptoms: Spasticity, increased muscle tone (hypertonicity), in which the tone of the flexors in the arms increases, and that of the extensors in the legs. Hyperreflexia. There are pathological reflexes of early development (sucking, plantar, proboscis). There is a violation of fine differentiated movements of the fingers. The tongue is pulled up to the pharynx, upward movements are grossly violated. Various synkinesis are present. Increased salivation. The articulation of all complex anterior lingual sounds (slotted, whistling - slotted labials "V", "F"), hard - soft, explosive - slotted are disturbed. The volume and functioning of the vocal folds decreases: the voice is rough, hoarse, sharp with a hint of rhinophony. There are no voluntary movements in general motor skills, involuntary ones are preserved.

Correction: speech therapy should begin from the first months of life: the development of swallowing, sucking, chewing skills; the development of proprioceptive sensations in the speech muscles through passive-active gymnastics of the articulatory muscles; the development of the respiratory function; the education of voice activity. In the future, the education of speech kinesthesia is carried out, the development of a kinesthetic trace image in the speech muscles and in the muscles of the fingers. All speech therapy is carried out against the background drug treatment. Preliminary decrease in muscle tone in the speech and skeletal muscles through the selection of special postures and positions for speech therapy.

Cerebellar form

Etiology: damage to the cerebellum and its connections. Pathogenesis: hypotension and paresis of the articulatory muscles, ataxia with hypermetria. Symptoms: Difficulties in reproducing and holding certain articulation patterns. Pronounced asynchrony (the process of coordination of breathing, phonation, articulation is disturbed). Speech is slow, scanned. There is a great exhaustion of speech; modulation is disturbed, the duration of the sound, intonational expressiveness. Lips and tongue are hypotonic, their mobility is limited, soft. the palate sags passively, chewing is weakened, facial expressions are sluggish. The pronunciation of front-lingual, labial and explosive sounds suffers. There may be open nasality.

Correction: it is important to develop the accuracy of articulatory movements and their sensations, to develop the intonational-rhythmic and melodic aspects of speech, to work on the synchronization of the processes of articulation, breathing and voice formation.

Subcortical (extrapyramidal) form

Etiology: damage to the extrapyramidal system.

1. Pathogenesis: violation of muscle tone by the type of dystonia. When the pallidar system is damaged, parkinsonism is observed: motor acts are disturbed by the type of hypofunctions. Violations are manifested in all motor skills, including articulation. Symptoms: Violated respiratory rhythm, coordination between breathing, phonation and articulation. Movements are slow, poor, inexpressive with fading in an uncomfortable position. "Pose of the old man" - shuffling gait, arms bent at the elbows, head and chest. Mimic is poor fine motor skills not formed. articulation is weak.

2. Pathogenesis: in case of violations of the striatal system, motility is disturbed by the type of hyperkinesis. Symptoms: 1) choreic hyperkinesis: movements are uncoordinated, involuntary, twitching, dancing in nature; 2) athetoid hyperkinesis: violent, slow, worm-like movements in the hands and toes; 3) choreoathetoid hyperkinesis: torsion spasm, spastic torticollis, hemiballismus, facial hemispasm, tremor, tics. Speech is broken; some syllables are stretched while others are swallowed; broken tempo, modulation, expressiveness.

Correction: All speech classes carried out against the background of pathogenetic and symptomatic drug therapy. The use of reflex - forbidding positions. Development of voluntary movements in articulation, phonation, respiratory and skeletal muscles. Education of the possibility of movements in a certain rhythm and pace, arbitrary cessation of movements and switching from one movement to another. Rhythmic, voluntary breathing is developed. Certain rhythmic stimuli are used: auditory - music, metronome beats, counting, visual - rhythmic waving of the hands of a speech therapist and then the child himself. An important role belongs to singing and logorhythmics. They use special breathing games-exercises, inflating soap bubbles, blowing out candles, playing on lip children. music instruments (pipes, harmonicas, pipes). Development of articulation and phonation. Development of static-dynamic sensations, clear articulatory kinesthesias. Collective speech game therapy is carried out. Separate elements of autogenic training are applied.

Cortical form

With efferent form. Etiology: the lesion is localized in the region of the anterior central gyrus. Pathogenesis: the innervation of the articulatory muscles suffers.

With afferent form. Etiology: the presence of a lesion in the retrocentral areas of the cerebral cortex. Pathogenesis: kinesthetic apraxia in the speech muscles and fingers.

Symptoms: sounds suffer, pronunciation cat. associated with the most subtle isolated movements of individual muscle gr. lang. (r, l, etc.) No salivation, no voice and breathing disorders.

Correction: against the background of drug therapy, the development of fine differentiated articulation movements, kinesthetic sensations, oral and manual praxis is performed.

© Laesus De Liro

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