Types of dysarthria table. Features accompanying types of dysarthria

Despite such a wide variety of focal brain lesions, all of them ultimately manifested themselves as speech movement disorders. During a neurological examination, there were flaccid or spastic paralysis of the muscles of the speech apparatus (bulbar and pseudobulbar); phenomena of ataxia (cerebellar dysarthria) or apraxia (cortical dysarthria) and muscle tone disorders (extrapyramidal). Thus, the tribal community different forms dysarthria comes down, firstly, to the fact that these are disorders of various motor backgrounds speech act. Since in patients with different clinical forms of dysarthria, only the motor implementation of full-fledged linguistic means speech (words and phrases, phonemes and morphemes), then, secondly, the generic commonality of the forms of dysarthria is revealed in defects, first of all, in the external pronunciation side of speech (complete and necessarily partial replacements of speech sounds, dysprosody, dyspneumia). These defects distort the normative side of Russian speech, it loses its socially regulated sound and, as a result, sometimes acquires various “foreign accents.” Taken together, all of the above substantiates the generic commonality of various dysarthric disorders and makes it possible to distinguish them from other forms of clinical speech pathology. Now let us turn to what distinguishes individual clinical forms of dysarthria and characterizes their species selectivity and specificity, therefore, to what allows us to carry out a private differential diagnosis forms of dysarthria.

Table 1 Comparative characteristics mechanisms of dysarthria.

Form of dysarthria	Site of brain damage	Pathogenesis
Cerebellar	Damage to the cerebellum and its connections with other brain structures	Static and dynamic ataxia of speech movements
Bulbarnaya	Unilateral or bilateral damage to peripheral motor neurons V, VII, IX, X, XII of the cranial nerve and their nuclei	Selective flaccid paralysis of the organs of articulation. Atrophy and atony, pharyngeal and mandibular reflexes are reduced or absent. Voluntary and involuntary movements are affected
Pseudobulbar	Damage to central motor corticobulbar neurons, pyramidal tract	Spastic paralysis of the muscles of the speech apparatus. A combination of increased and decreased muscle tone. Unconditioned reflexes are strengthened
Extrapyramidal	Damage to the extrapyramidal nuclei and their connections with other brain structures, in particular with the cortex	Muscle tone and tonic postural activity are impaired, congenital automatism disorder, hyperkinesis, tremor, synkinesis
	Unilateral cortical lesion dominant hemisphere brain: premotor, motor areas; postcentral gyrus	Articulatory apraxia: “kinesthetic” and “kinetic”

Table 2 Comparative characteristics clinical manifestations dysarthria

dysarthria	Clinical manifestations (phonetic disorder syndromes)	Principle of direction of correctional work
Cerebellar	Speech prosody disorders	Correction of static and dynamic ataxia
	Elimination of flaccid paralysis
changed according to the closed nasal type. Slow speech rate, not smooth, impaired speech modulation	Elimination of pyramidal spastic paralysis
Extrapyramidal	Speech prosody disorder. Intelligibility and articulateness of speech in general are impaired	Overcoming extrapyramidal dystonia and hyperkinesis, including medication
Cortical (kinetic, kinesthetic)	Disorder of choice of syllables with mixing, noise characteristics of syllabic consonants. Disintegration of rhythmic syllabic structures of words; speech rate is slow, fluency is impaired	Formation of syllabic units oral speech

Conclusions on the second chapter: Thus, the structure of the defect in dysarthria includes a violation of the sound-pronunciation and prosodic aspects of speech, caused by organic damage to the speech motor mechanisms of the central nervous system. Sound pronunciation disorders in dysarthria depend on the severity and nature of the lesion.

The main clinical signs of dysarthria are:

· violations of muscle tone in the speech muscles;

· limited possibility of arbitrary articulatory movements due to paralysis and muscle paresis articulatory apparatus;

So, with almost all types of dysarthria, the pronunciation of whistling and hissing sounds is impaired.

To build the correct treatment and correction regimen, the team of doctors needs not only to make a diagnosis, but also to classify the form, degree and severity of the disease.

Methods for identifying degrees

Classification of degrees of disease

The classification, according to which the degrees of dysarthria are established, is based on an analysis of the severity of symptoms, their severity and the overall picture of the disorder.

The following degrees of severity of dysatria are distinguished:

light;
average;
heavy.

Mild dysarthria

Most often, in this case, a hidden form of speech defect is implied, since it is distinguished by a less obvious picture of the disease and a commonality of symptoms. Speech and motor disorders are not severe, and complications are minor.

When determining, it is important to consider both the symptoms of speech impairment and the general ones. Thus, the following speech symptoms are determined:

Fuzzy or blurry sounds.
Substituting sounds in difficult for a child words.
Problems in pronunciation of consonant sounds like “sh”, “x”.
Voiced consonants have a dull sound.
Difficulty pronouncing vowels: “i”, “u”.
The voice is weak, unexpressed.

Non-speech symptoms include:

Breathing is frequent and shallow.
Weakness of articulation.
Difficulties in exercising voluntary control of the tongue.
Mild drooling.
Motor clumsiness.
Slight tension when chewing and swallowing.
Subtle changes in the expression of emotions through facial expressions.

Moderate dysarthria

This is the so-called moderate severity. It is characterized by more pronounced and severe symptoms ().

Speech symptoms include:

Unintelligible, unclear speech.
Slurred speech.
“Swallowing” endings.
A dull, dull voice.
Voice color disorder (deafness, hoarseness, nasality).
Monotony in speech.

Non-speech symptoms are characterized by:

Disorder of the muscle tone of the face and speech apparatus.
Weak facial expressions.
Slow articulation.
Difficulty in arbitrarily controlling the tongue.
Increased salivation.
Difficulty in chewing and swallowing movements.
Strengthening the gag reflex.
Involuntary movements.
Changes in breathing, its rhythm and depth.

First of all, this serious illness is characterized by anarthria, that is, a complete (sometimes minor elements of speech remain) deficiency of sound production. This disorder occurs due to paralysis of the speech muscles and disorders of the nervous system.

Children experience severe articulation in all its branches (articulatory, phonatory, respiratory). There are pronounced spastic paresis, muscle hypertonicity or hypotonicity, hyperkinesis, ataxia and apraxia. Sometimes the defect is so significant that it is impossible to pronounce a syllable consisting of several sounds together.

The face of such children is completely amic and looks like a mask. The movements of the tongue are beyond their control, and the lips are limited in their functionality, salivation is profuse. The processes of grasping food, chewing and swallowing are almost not controlled by children, as a result of which they are completely dependent on those around them.

In this case, anarthria is also divided into degrees of severity:

There is no speech or voice at all.
Voice reactions are present.
There is a sound-syllable component of speech.

Features accompanying types of dysarthria

It is necessary to take into account when studying the disease that the division of dysarthria according to severity, where there are 3 degrees, is not the only classification. The main one is based on the location of the affected area.

Thus, bulbar, cortical, pseudobulbar, subcortical are distinguished. Each has its own characteristics. So, with cerebellar, in addition to changes in the form of jerky speech, there are cerebellar symptoms - gait instability, tremor, etc. With subcortical - hyperkinesis is expressed. And all types of dysarthria have 3 degrees of severity.

According to statistics, the most common form is . Let us use its example to consider the features of the disease in accordance with the degree.

Mild ones are not characterized by gross changes. Neat movements that require precision are difficult. They are slow and poorly differentiated. The child occasionally chokes when swallowing, and disturbances in the acts of chewing are mild. The main feature of this degree of dysarthria will be a lack of fluency, tempo of speech, and sounds blurred during pronunciation. The greatest difficulty for them is caused by “zh”, “ts”, “ch”, soft sounds. Children with this disorder can substitute some sounds.

Moderate dysarthria is diagnosed in most people with this diagnosis. It can manifest itself in a violation of voluntary movements, including regulation of the speech apparatus; in such patients, articulation is reduced. They find it difficult to perform actions such as puffing out their cheeks, clenching or even closing their mouth completely, and limiting the mobility of their tongue. In addition, a weakening of sensitivity is diagnosed - the patient does not determine the place touched by the doctor.

Speech is also slowed down due to decreased articulation, it is blurred and difficult to understand (this is especially noticeable when pronouncing similar vowels - “a” - “u”, “i” - “y” - and hissing sounds). The voice is quiet and has a nasal tone. The face is very limited in facial expressions, it is almost absent, the face takes on the appearance of a mask. The functions of grasping, chewing and swallowing are impaired, and severe salivation is present.

In severe cases of pseudobulbar dysarthria, the symptoms will be very pronounced; severe violations can reach the complete loss of the ability to produce sound. If speech is present, it will be inarticulate, slurred, and tense. When pronouncing children, they change sounds, divide them into components (“ts” is heard as “tz”).

The most serious variant with this degree of severity is anarthria with complete facial amicability. In this case, the face takes on a strange expression, since the lowered lower jaw contributes to a constantly open mouth, while the tongue is motionless, but is in the mouth. Salivation is profuse, the process of chewing and swallowing is greatly impaired.

A feature of the manifestation of dysarthria is also that, with any degree (and type) of the disease, the child may have negative symptoms in different components of speech. That is, manifestations may not depend on the severity. So, with a mild degree of severity, the doctor can note changes in both the phonetic and grammatical structure of speech. And in severe cases, all violations can be limited only to grammatical ones.

Methods for identifying degrees

At speech disorders It is important to establish not only the form, but also the severity of the disease. Thus, a common diagnostic practice is when a child, after an outpatient examination, systemic disorder speech, are sent for a medical and social examination, where the presence of mild, moderate or severe dysatria will be confirmed.

During the examination, various neurological and speech therapy tests and tests play an important role. The main ones among them are methods for identifying violations of facial expressions, breathing patterns, voices, motor and articulatory characteristics, the condition of the muscles and the speech apparatus as a whole.

The work plan includes:

Interview (of parents, first of all) and examination. The duration of the disease, the main complaints are clarified, and during the examination they look at the general physical development, the condition of the tongue, soft palate, the presence or absence of paresis and hyperkinesia.
Functional tests. Two tests are used: the first involves sticking out a wide tongue from the mouth and holding it in one position, the second involves moving the tongue to the sides, up and down, while the doctor holds his hand on the child’s neck.
Tests for facial motor skills: ask the child to squint, raise and lower his eyebrows, smile, pout his lips.
Study of articulation: repetition of poses according to the model, according to verbal instructions (raise your hands, touch your nose with your finger).
Studying writing.
Studying oral speech: pronunciation of words, sounds, sentences.
Methods for studying coordination of movements: walk in a straight line, stand on one leg.

After this, based on the results of tests, examination and in accordance with the criteria, the commission establishes a diagnosis and severity.

(classification of dysarthria according to the syndomological approach)

Form of dysarthria			Hyperkinetic dysarthria	Atactic dysarthria
Leading syndrome	Spastic paresis	Spastic paresis and tonic disorders of speech control 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, increasing under the influence external stimuli)	Dystonia, less often hypotension (major). Dependence of tone on external influences, emotional state, voluntary movements	Hypotension
The presence of involuntary violent movements, synkinesis	Synkinesis, oral synkinesis. Possible preservation of oral automatism reflexes	Frequent presence of brainstem synkinesis and oral automatisms (forceful sucking and licking movements)	Hyperkinesis of the tongue, face, neck at rest, intensifies during pronunciation attempts. Synkinesis	Tremor of the tongue (with purposeful movements)
Violations of articulatory motor skills, articulatory praxis,	Decreased volume and amplitude of articulatory movements of the tongue and lips (of varying degrees). Performance and retention may suffer	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 articulatory postures	Dysmetry (disproportion) of articulation movements; more often - hypermetry (increased ampli-

Form of dysarthria	Spastic-paretic dysarthria	Spastic-rigid dysarthria	Hyperkinetic dysarthria	Atactic dysarthria
facial expressions	lack of articulatory postures; switching from one articulation to another. Facial hypomimia	inclusion in the movement - a sharp increase in tone in the entire speech and skeletal muscles. The tongue is tense, inactive, pushed back, and it is not always possible to remove it from the oral cavity. Lack of differentiation of labial and lingual movements (mixed labial-lingual articulation). Facial expressions are extremely poor (frozen, mask-like face)	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 articulatory patterns. Facial expressions are sluggish
The state of the act of eating (chewing, swallowing)	The act of eating is slow but coordinated	Chewing, biting, and swallowing are grossly impaired. Chewing is often replaced by sucking. Coordination between breathing, chewing, and swallowing is impaired	The processes of chewing and swallowing are difficult and discoordinated	Chewing is weakened
Speech intelligibility. Sound pronunciation disorders	Speech intelligibility is significantly reduced, and speech is often difficult to understand without knowing the context. Speech sounds lack a clear phonetic design. Consonant slurring	Speech intelligibility is significantly reduced, and speech is often difficult to understand without knowing the context. Speech sounds lack a clear phonetic design. Unintelligibility of consonants. Vowel averaging. Weakness of differentiation of labial, dental;	Intelligibility is reduced (speech is slurred, blurred, and sometimes difficult to understand). Characterized by the absence of stable disturbances in sound pronunciation (omissions, substitutions, and mixing of sounds are not constant). A lot of	Speech intelligibility is reduced. Frontal, labial, and plosive sounds are impaired

Form of dysarthria	Spastic-paretic dysarthria	Spastic-rigid dysarthria	Hyperkinetic dysarthria	Atactic dysarthria
	sounds. Vowel averaging. Weakness of differentiation of labial and dental teeth; hard-soft, voiced-voiceless	hard-soft, voiced-deaf.	distortion of sounds (frictional and sonorous)
Breathing disorders	Violations speech breathing(speech exhalation is shortened and exhausted, the inhalation is shallow)	Severe violations breathing	Severe breathing problems	Asynergy - asynchrony of breathing, voice production and articulation
Voice disorders	Voice of insufficient strength and sonority (quiet, weak, exhausted, dull). There may be nasalization (already mentioned)	The voice is quiet, dull, compressed, tense	The voice is tense, intermittent, vibrating, changing in pitch, strength, and sonority. There may be nasalization	The voice is exhausted, fading towards the end of the phrase; with a nasal tint
Prosody disorders	The amplitude of voice modulations is reduced, there are no tempo-rhythmic interruptions necessary for lively intonation (the voice is poorly modulated, monotonous)	There is almost no voice modulation. The timbre is poor. The pace is a little faster	The melodic and intonation side of speech is disrupted, the emotional connotation is lost. Weak expression or absence of voice modulations (monotonicity)	There is almost no voice modulation. There is practically no intonation. The rhythm is chanting. The pace is slow
Autonomic disorders	Hypersalivation	Hypersalivation	There is no salivation in “pure” hyperkinetic syndrome	There may be hypersalivation

Chapter III
Speech therapy examination of children
with dysarthric disorders

Speech therapy examination of children with dysarthric (speech motor) disorders is based on the general systematic approach, which is based on the idea of speech as a complex functional system, structural components which are in close cooperation. In this regard, the study of speech development in dysarthria involves influencing 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.

Comprehensive comprehensive examination and assessment of the developmental features of speech, mental functions, motor sphere, activity of various analyzer systems will allow us to give objective assessment existing deficiencies in speech development and outline optimal ways to correct them. An important condition The complex impact is the coordination of the actions of the speech therapist-defectologist and the neurologist during the examination and diagnosis.

During the speech therapy examination of children with speech motor disorders, the following methods are used:

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

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

Conversation with parents and child;

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

Individual experiment;

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

Before starting an examination of the child, it is important to comprehensively study the medical documentation (history data) and analyze the examination results and the conclusion of a neurologist (neurological status), preferably discussing it with a doctor. A feature of speech therapy examination and analysis of the structure of speech defects in children with dysarthria is the principle of correlating articulatory motor disorders with general motor disorders. With dysarthria, articulatory motor skills, breathing and voice production characteristics are assessed in accordance with the child’s general motor capabilities (even minor motor disorders are noted).

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

When determining the leading neurological syndrome and the degree of its manifestation in articulatory muscles and motor skills (speech motor syndrome), the speech therapist relies on the conclusion of a neurologist. In this case, 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, and is not frightened. If a child cries, screams, or breaks out of his arms, this may be reflected in a change (increase) in muscle tone, and the idea of motor and speech abilities, which the speech therapist will receive will be false. During the examination, a thorough analysis of those positions and movements that can facilitate or, conversely, complicate speech activity is carried out. It is advisable to place a child with severe motor impairment on a comfortable couch or carpet, testing different positions - on the back, on the side, on the stomach. In milder cases, the examination is carried out in a 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 pre-speech, early speech and mental development child until the examination. Based on data from medical documentation and conversations with parents, the time of appearance and the nature of screaming, humming, babbling, and then the first words and simple phrases are determined.

An 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 attempting to speech activity, during speech, during 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 neurologist. In children with dysarthria, articulatory muscle tone disorders are characterized by spasticity, hypotonia or dystonia. Often there is a mixed nature and variability of muscle tone disorders in the articulatory apparatus (for example, hypotonia may be expressed in the facial and labial muscles, and spasticity in the lingual muscles). The presence or absence of hypomimia, facial asymmetry, smoothness of nasolabial folds, synkinesis, hyperkinesis of the facial and lingual muscles, tongue tremor, deviation (deviation) of the tongue to the side, hypersalivation is noted.

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

Particular attention is paid to the state of voluntary articulatory motor skills. When testing 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 paid to the possibility of performing articulatory positions, holding them and switching them. At the same time, not only the main characteristics of articulatory movements are noted (volume, amplitude, tempo, smoothness and speed of switching), but also the accuracy, proportionality of the movements, and their exhaustibility. The speech therapist assesses in particular detail the volume of articulatory movements of the tongue (strictly limited, incomplete, complete); There is even a slight decrease in the amplitude of articulatory movements of the tongue. In some children with pronounced speech-motor syndromes, it is sometimes impossible to even passively remove the tongue from the oral cavity. The possibility of voluntary protrusion of the tongue, lateral abduction, licking of lips, holding wide, spread out, upper lifting, clicking, etc. is checked. The degree and limit of the pharyngeal reflex (increase or decrease) is assessed. The speech therapist analyzes the characteristics of lip movements (sedentary or quite mobile) and lower jaw(opening and closing the mouth, ability to keep the mouth closed).

Assessing the understanding of directed (impressive) speech is the most important stage speech therapy examination. The speech therapist identifies the level of understanding of addressed speech (distinguishing the 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 subject pictures. This determines the understanding semantic meaning words, actions, simple and complex plots, lexical and grammatical structures, sequence of events.

When examining a child’s own (expressive) speech, the level of speech development of the child is revealed. It is important to note the age-related formation of the lexical and grammatical aspects of speech, assimilation various parts speech, features of the syllabic structure of words. Speechless children have the ability to use various nonverbal means of communication: expressive facial expressions, gestures, intonation.

When studying the pronunciation aspect of speech, the degree of impairment of speech intelligibility is revealed (speech is slurred, difficult to understand for others; speech intelligibility is somewhat reduced, speech is unclear, 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 characteristics of phonemic perception and sound analysis. It is important to note whether the child identifies violations of sound pronunciation in someone else’s and his own speech; how he differentiates by ear between normally and defectively pronounced sounds.

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

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

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

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

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

So, during a speech therapy examination of children with dysarthria, the speech therapist must identify the structure of the 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 the speech therapy conclusion (diagnosis) be made (given) jointly by a speech therapist and a neurologist.

Below is a map of the 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 during many years practical work speech therapist in various medical institutions(in children's psychoneurological hospital No. 18 in Moscow, in the Republican Association for the Rehabilitation of Disabled Children "Childhood", in the "Medical Center" under the Ministry of Foreign Affairs of the Russian Federation). Variants of this map have been published several times previously in various benefits, often without reference to the author.

– a disorder of the pronunciation organization of speech associated with damage to the central part of the speech motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. The structure of the defect in dysarthria includes disturbances in speech motor skills, sound pronunciation, speech breathing, voice and prosodic side speeches; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics(EEG, EMG, ENG, MRI of the brain, etc.), speech therapy examination oral and written speech. Corrective work for dysarthria, includes therapeutic effects (drug courses, exercise therapy, massage, physical therapy), speech therapy classes, articulatory gymnastics, speech therapy massage.

Causes of dysarthria

Most often (in 65-85% of cases) dysarthria accompanies cerebral palsy and has the same causes. In this case organic lesion CNS occurs in utero, birth or early period child development (usually up to 2 years). The most common perinatal factors of dysarthria are toxicosis of pregnancy, fetal hypoxia, Rhesus conflict, chronic somatic diseases of the mother, pathological course of labor, birth injuries, birth asphyxia, kernicterus of newborns, prematurity, etc. The severity of dysarthria is closely related to the severity of motor disorders during Cerebral palsy: for example, with double hemiplegia, dysarthria or anarthria is detected in almost all children.

IN early childhood Central nervous system damage and dysarthria in a child can develop after suffering neuroinfections (meningitis, encephalitis), purulent otitis media, hydrocephalus, traumatic brain injury, severe intoxication.

The occurrence of dysarthria in adults is usually associated with a stroke, head injury, neurosurgery, and brain tumors. Dysarthria can also occur in patients with multiple sclerosis, amyotrophic lateral sclerosis, syringobulbia, Parkinson's disease, myotonia, myasthenia, cerebral atherosclerosis, neurosyphilis, oligophrenia.

Classification of dysarthria

The neurological classification of dysarthria is based on the principle of localization and a syndromic approach. Taking into account the localization of damage to the speech-motor apparatus, the following are distinguished:

bulbar dysarthria associated with damage to the nuclei of the cranial nerves (glossopharyngeal, sublingual, vagus, sometimes facial, trigeminal) in the medulla oblongata
pseudobulbar dysarthria associated with damage to the corticonuclear pathways
extrapyramidal (subcortical) dysarthria associated with damage to the subcortical nuclei of the brain
cerebellar dysarthria associated with damage to the cerebellum and its pathways
cortical dysarthria associated with focal lesions of the cerebral cortex.

Depending on the leading clinical syndrome, cerebral palsy may include spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, ataxic-hyperkinetic dysarthria.

Speech therapy classification is based on the principle of speech intelligibility for others and includes 4 degrees of severity of dysarthria:

Characteristics of clinical forms of dysarthria

For bulbar dysarthria characterized by areflexia, amymia, disorder of sucking, swallowing solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is slurred and extremely simplified. All the variety of consonants is reduced into a single fricative sound; sounds are not differentiated from each other. Nasalization of voice timbre, dysphonia or aphonia is typical.

At pseudobulbar dysarthria the nature of the disorders is determined by spastic paralysis and muscle hypertonicity. Pseudobulbar paralysis manifests itself most clearly in impaired tongue movements: great difficulty is caused by attempts to raise the tip of the tongue upward, move it to the sides, or hold it in a certain position. With pseudobulbar dysarthria, switching from one articulatory posture to another is difficult. Typically selective impairment of voluntary movements, synkinesis (conjugal movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is blurred, slurred, and has a nasal tint; the normative reproduction of sonors, whistling and hissing, is grossly violated.

For subcortical dysarthria characterized by the presence of hyperkinesis - involuntary violent muscle movements, including facial and articulatory ones. Hyperkinesis can occur at rest, but usually intensifies when attempting to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic aspect of speech; Sometimes patients emit involuntary guttural screams.

With subcortical dysarthria, the tempo of speech may be disrupted, such as bradylalia, tachylalia, or speech dysrhythmia (organic stuttering). Subcortical dysarthria is often combined with pseudobulbar, bulbar and cerebellar forms.

Typical manifestation cerebellar dysarthria is a violation of the coordination of the speech process, which results in tremor of the tongue, jerky, scanned speech, and occasional cries. Speech is slow and slurred; The pronunciation of front-lingual and labial sounds is most affected. With cerebellar dysarthria, ataxia is observed (unsteadiness of gait, imbalance, clumsiness of movements).

Cortical dysarthria in their own way speech manifestations resembles motor aphasia and is characterized by a violation of voluntary articulatory motor skills. There are no disorders of speech breathing, voice, or prosody in cortical dysarthria. Taking into account the localization of lesions, kinesthetic postcentral cortical dysarthria (afferent cortical dysarthria) and kinetic premotor cortical dysarthria (efferent cortical dysarthria) are distinguished. However, with cortical dysarthria there is only articulatory apraxia, while with motor aphasia not only the articulation of sounds suffers, but also reading, writing, understanding speech, and using language.

Diagnosis of dysarthria

The examination and subsequent management of patients with dysarthria is carried out by a neurologist (children's neurologist) and speech therapist. The extent of the neurological examination depends on the expected clinical diagnosis. The most important diagnostic value is given by electrophysiological studies (electroencephalography, electromyography, electroneurography), transcranial magnetic stimulation, MRI of the brain, etc.

Forecast and prevention of dysarthria

Only started early, systematic speech therapy work for the correction of dysarthria can give positive results. A major role in the success of correctional pedagogical intervention is played by the therapy of the underlying disease, the diligence of the dysarthric patient himself and his close circle.

Under these conditions, one can count on almost complete normalization of speech function in the case of erased dysarthria. Having mastered the skills correct speech, such children can successfully study in secondary school, and the necessary speech therapy assistance is received in clinics or school speech centers.

In severe forms of dysarthria, only improvement in speech function is possible. Continuity is important for the socialization and education of children with dysarthria various types speech therapy institutions: kindergartens and schools for children with severe speech impairments, speech departments of psychoneurological hospitals; friendly work of a speech therapist, neurologist, psychoneurologist, massage therapist, and physical therapy specialist.

Medical and pedagogical work to prevent dysarthria in children with perinatal brain damage should begin from the first months of life. Prevention of dysarthria in early childhood and adulthood involves preventing neuroinfections, brain injuries, and toxic effects.

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, intonation tremor), slow worm-like muscle contractions (for example, with double athetosis), rapid sudden contractions of different muscle groups (for example, with chorea), rapid rhythmic contractions of the same same muscles (for example, with myoclonus).

Pronunciation disorders are extremely varied and often unstable. The voice can be tense, harsh, hoarse, fluctuating in timbre and volume. Sometimes the voice fades during speech and turns into a whisper. Sometimes the articulation of vowels is more impaired than consonants. Single words and sounds can be pronounced correctly, but at the moment of hyperkinesis they turn out to be sharply distorted and inaudible. 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, damage occurs to the cerebellum and its connections with other parts of the central nervous system, as well as the fronto-cerebellar pathways.

Speech with cerebellar dysarthria is slow, jerky, scanned, with impaired modulation of stress, and 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, spread out in the oral cavity, its mobility is limited, the pace of movements is slow, there is difficulty in maintaining articulatory patterns and weakness of their sensations, the soft palate sags, chewing is weakened, and facial expressions are sluggish. The movements of the tongue are inaccurate, with manifestations of hyper- or hypometria (excessive or insufficient range of motion). With more subtle, targeted movements, a fine tremor 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 damage to the cerebral cortex.

The first variant of cortical dysarthria is caused by unilateral or, more often, bilateral damage to 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 in the volume of the most subtle isolated movements: upward movement of the tip of the tongue. With this option, the pronunciation of front-lingual sounds is impaired.

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 postcentral parts of the cortex.

In these cases, the pronunciation of consonant sounds, especially sibilants and affricates, suffers. Articulation disorders are variable and ambiguous. Finding the right articulatory pattern at the moment of speech slows down its pace and disrupts its smoothness.

The difficulty of feeling and reproducing certain articulatory patterns 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 a lack of dynamic kinetic praxis; this is observed with unilateral lesions of the cortex of the dominant hemisphere in the lower parts of the premotor areas of the cortex. With violations of kinetic praxis, it is difficult to pronounce complex affricates, which can break up into component parts, replacement of fricative sounds with stops (z - d), omissions of sounds in consonant clusters, sometimes with selective deafening of voiced stop consonants are observed. Speech is tense and slow.

Pseudobulbar dysarthria

Pseudobulbar dysarthria occurs with bilateral damage to the motor cortical-nuclear pathways running 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 - the spastic form of pseudobulbar dysarthria. Less commonly, against the background of limited range of voluntary movements, a slight increase in muscle tone in individual muscle groups or a decrease in muscle tone is observed - a paretic form of pseudobulbar dysarthria. In both forms, there is a restriction of active movements of the muscles of the articulatory apparatus, in severe cases - their almost complete absence.