How are dyslalia and dysarthria similar? Comparative analysis of dyslalia and erased dysarthria. Differentiation of pseudobulbar dysarthria

Erased forms of dysarthria are quite often confused with dyslalia. However, upon closer examination, differences occur.

Arkhipova F.E. developed parameters for comparing children with an erased form of dysarthria and dyslalia, thereby making a contribution to the issue of differential diagnosis of dysarthria and dyslalia.

5. Gross motor skills

· dysarthria There is motor clumsiness, they run poorly, they often stumble, and there is a lack of coordination of movements.

· dyslalia no impairment of motor skills. During the examination, a neurologist does not find any neurological symptoms in him.

6. Fine motor skills

A child with dysarthria develops self-education skills late. They hold a pencil poorly and strain their arm muscles too much. And, conversely, due to a decrease in the tone of the arm muscles, the child does not press enough on the pencil, and the lines of the drawing are sluggish. When working with a cut-out picture, the folded picture moves out of place, its parts do not exactly move from one another. It seems that the child is sloppy when doing work, but in fact it is a violation of motor skills. For the first time, a defect in orientation on a sheet of paper appears due to a violation of spatial representations. At school age, this leads to mirror writing and insufficient orientation in the notebook. Children may experience difficulties in drawing lessons at an older age when completing geometric tasks. During the examination, the child does not perform finger exercises. Characteristic is the search for movements that require fine differentiated work of the fingers: “lock”, “goat”.
A child with dyslalia does not have such motor impairments.

7. Articulatory apparatus

A child with erased dysarthria has:

Hypertonicity: the child’s face is mask-like, the muscles are hard on palpation; lips - the position of the upper lip is characteristic - it is stretched and pressed against the upper gum, and during speech it is motionless; the tongue is always thick (or changes the shape of an “autumn cucumber”); the voice is weakened, there is no modulation (can’t imagine how a cow mooes); does not complete the “Echo” task; speech is slightly accelerated; speech exhalation is weakened; Consonants and vowels suffer.

Hypotonicity: the face is hypomimic (insufficient facial expressions); upon palpation, the facial muscles are flabby; mouth slightly open; the child does not maintain a closed mouth position (but ENT pathology must be excluded); shallow speech breathing; the child does not finish the endings of words, as if he makes grammatical errors; consonants usually suffer.

Hypersalivation: (increased salivation) especially with increasing load. In this case, it is necessary to exclude diseases of the gastrointestinal tract (gastritis, hunger).

Tongue deviation (deviation of the tongue from the midline) with functional load on the speech apparatus. For example, when performing the “pendulum” exercise, you need to look in which direction the tongue deviates.

Hyperkinesis: (forceful movements of the tongue) degrees of hyperkinesis are distinguished: severe (the tongue twitches in the anterior-posterior direction), medium (waves run through the tongue, sometimes in the longitudinal, sometimes in the transverse direction, sometimes, this is observed only during functional load), mild ( tremor of the tip of the tongue during functional load, sometimes accompanied by cyanosis (blue discoloration).

Impaired quality of articulatory movements: movements are performed, but their quality suffers; weakened muscle strength (cannot make many clicks of the tongue, rhythm suffers); the time of holding an articulatory pose is reduced.

A child with dyslalia usually does not have these symptoms.

8. Sound pronunciation

· In case of erased dysarthria, the production of sounds is carried out according to the classical scheme, i.e. The methods are the same, the techniques are the same, you can use phonetic rhythms. Moreover, here the sounds are easy to place, but the automation process is lengthy. Sometimes you have to practice every sound position in a word in spontaneous speech.

· In case of dyslalia, sound production is also carried out according to the classical scheme, but the delivered sound is absorbed in the child’s speech for a long time and does not require a long process of automation.

General speech development

Children with erased dysarthria can be divided into three groups:

Children whose sound pronunciation and prosody are impaired, but have good phonemic hearing, a rich vocabulary, and the grammatical structure of the language is not impaired - FN (the impairment is borderline with dyslalia, it is difficult to differentiate them).

Children who have not completed the process of developing phonemic hearing. This is the FFN group + an erased form of dysarthria. There can be up to 50% of such children.

Children whose underdevelopment of phonemic hearing affects the underdevelopment of the syllabic structure of the word; poor vocabulary, aggrammatisms in speech. At 5 years old, such a child can say “on the sled” instead of “on the sled.” This is a group of children who develop OHP + an erased form of dysarthria. There may be 80% of them in the group with OHP.

Prosody

In children with an erased form of dysarthria, slurred, unintelligible speech is noted - “porridge in the mouth.” Poor intonations, quiet voice, sometimes a nasal tone of speech. More often, the pace of speech is fast, accelerated, the child does not finish the endings of words and greatly reduces the pronunciation of vowel sounds (reduces to a minimum). The child’s voice is fading, begins to speak loudly, and subsides as the speech load increases. Intonation coloring deteriorates. Children with dysarthria are characterized by deterioration in speech quality with increasing load.
For those with disabilities, the quality of speech improves with repetition of exercises.

Differential diagnosis of dyslalia from dysarthria . Dislalia: 1. In somatically weakened children. There are no organics 2. There are no neurological symptoms. 3. The motor sphere is without pathology, tendon reflexes are lively and uniform. 4.Only sound pronunciation suffers. The prognosis is favorable. 5. The voice is ringing, loud, richly modulated. 6. Speech activity is increased. 7. The child is critical of his defect. 8. Autonomic disorders manifest themselves in sweating of the extremities and red dermographism of the skin. 9.Hygienic skills are developed quickly and maintained firmly; The child is outwardly neat. 10. Restful sleep without night fears and dreams. 11. Diaphragmatic-speech breathing is normal. 12. The child enters into contact easily and behaves adequately. 13.Memory, attention, performance, thought processes, intelligence - normal, mental retardation is rarely observed. 14. The child is active, mobile, willingly engages, and switches from one type of activity to another without much difficulty. Erased form of dysarthria: 1. Associated with damage to the central nervous system. 2. Asymmetry of the face, tongue, and soft palate is clearly expressed; the mouth is slightly open at rest due to a cut on the lips; smoothness of nasolabial folds. 3. General, fine and articulatory motor skills suffer. 4. Along with sound pronunciation, prosody suffers; delivered sounds are difficult to automate. 5.Voice is dull, weak, compressed, fading, intermittent. 6. Speech activity is reduced. 7. Treats defects with indifference. 8.Vegetative disorders are grossly expressed: bluish, cold, wet extremities. 9.Hygienic skills are difficult to develop due to motor disorders; the child is untidy. 10. Sleep disturbances, night terrors, and dreams are observed. 11. Breathing is superficial, clavicular, diaphragmatic-speech - not formed. 12. Behavior is uneven, mood swings are frequent. 13.Memory is reduced, short-term; attention is unstable; low performance; reduced intelligence (mental retardation, mental retardation) 14. Slow or disinhibited, avoid activities, complain of headaches, have difficulty switching from one type of activity to another.

Children with an erased form of dysarthria resemble those with dysarthria. However, the examination reveals unfavorable factors in the anamnesis, organic microsymptoms in the neurological status, as well as difficulties in carrying out speech therapy activities. If in dyslalia the speech defect is associated with incorrect pronunciation of individual sounds or groups, then in dysarthria not only sound pronunciation suffers, but also the voice, tempo, smoothness, modulation, breathing, etc. Correction of pronunciation in the functional form of dyslalia occurs without much difficulty in a short time period (from several lessons to one month). The new pronunciation is easily learned by the child, and he forgets about his incorrect pronunciation

51. Examination of persons with dysarthria. Scheme of speech therapy examination of a child with dysarthria.

52. Methods of speech therapy work for dysarthria.

53. System of speech therapy work for dysarthria:

54. Methods of working with various forms of dysarthria and with varying degrees of manifestation of disorders of the motor, mental and speech spheres of persons with dysarthria.

55. Correction of violations of the pronunciation side of speech with erased dysarthria.

56. Tasks to demonstrate techniques for identifying and overcoming speech disorders (for example, demonstrate and explain techniques for diagnosing minimal manifestations of dysarthria, techniques for developing auditory perception in preschoolers; a set of passive articulatory gymnastics exercises, techniques for forming vowel and consonant sounds with articles in children with open rhinolalia etc.).

Currently, the problem of erased childhood dysarthria is being intensively developed in clinical, neurolinguistic, psychological, pedagogical and correctional speech therapy aspects. To distinguish erased dysarthria from complex dyslalia, a comprehensive medical and pedagogical study is necessary: analysis of medical and pedagogical documentation, study of amnestic data. By comparing the symptoms of speech and non-speech signs in children with dyslalia and dysarthria, diagnostic significant differences can be determined.

Thus, in children with erased dysarthria, in addition to impaired sound pronunciation, there is a violation of the voice and its modulations, weakness of speech breathing, and pronounced prosodic disturbances. At the same time, general motor skills and fine differentiated hand movements are impaired to varying degrees. The identified motor clumsiness and lack of coordination of movements cause a delay in the formation of self-care skills, and the immaturity of fine differentiated movements of the fingers causes difficulties in the formation of graphomotor skills.

In the work of O.Yu. Fedosova compares dyslalia and erased dysarthria.

For complex functional dyslalia:

· articulation of only consonant sounds suffers;
· a clear violation of the articulation of certain sounds in various conditions of their implementation;
· fixing the formed sounds does not cause difficulties;
· there are no violations of the tempo-rhythmic organization of speech;
· changes in breathing are not typical;
· phonation disorders are not observed;
· there is no discoordination of breathing, voice production and articulation.

For erased dysarthria:

· possibly blurred, unclear pronunciation of vowels with a slight nasal tint;
· sounds can be preserved in isolation, but in the speech stream they are pronounced distortedly and unclearly;
· the automation process is difficult: the supplied sound may not be used in speech;
· characterized by an accelerated or slow pace of speech;
· breathing is shallow, speech is noted during inhalation, phonation exhalation is shortened;
· coordination of these processes suffers.

An analysis of cases of children with dyslalia and mild dysarthria shows that speech pathology (violation of sound pronunciation) limits the child’s abilities and social opportunities, affects his entire personality, and in some cases causes separation from the team. Ashamed of his speech defect, the child becomes withdrawn, unsure of his strengths and capabilities. Speech defects in most cases are the reason for his failure at school.

In addition, the weakening of only individual components of the psyche - the child’s attention and memory - negatively affects his success in eliminating the speech defect. The presence of organic neurological symptoms has a particular impact on speech, and therefore mental functions. Thus, we came to the conclusion that the most fruitful approach to a child is one in which the researcher’s attention is focused not only on isolated symptoms (speech), but also on the disorder of the entire complex system of the whole organism. For this purpose, a comprehensive clinical and pedagogical study of children with functional dyslalia, mild dysarthria and children with normal speech was carried out.

1. Results of physical status examination. Children with a mild form of dysarthria and functional dyslalia are somewhat behind children with normal speech in physical development.
2. Results of the study of neurological status. In children with normal speech and functional dyslalia, there were no symptoms of organic damage to the central nervous system. Changes in the autonomic nervous system in the form of persistent dermographism, cold hands, impaired sweating and moisture in the distal extremities (hands and feet) were observed in the majority of children with dyslalia. Neurological symptoms in children with a mild form of dysarthria were often not detected during a one-time study in an outpatient setting, and therefore such children were classified as dysarthria. With a thorough examination and the use of functional loads (repeated movements, forceful stress), it is possible to identify symptoms of organic damage to the central nervous system in the form of erased paresis, changes in muscle tone, hyperkinesis in the facial and articulatory muscles, and pathological reflexes. The main disorder on the part of the cranial nerves is associated with damage to the hypoglossal nerves (XII pair), which manifests itself in the form of some restriction of tongue movement towards hyperkinesis... Repeated movements of the tongue up, forward and to the sides cause rapid fatigue, expressed in a slower pace of movements , and sometimes slight blueness of the tip of the tongue. All these disorders are caused by pareticity of the tongue muscles. Limitation of the range of movements of the eyeballs (III - IV - VI pairs) in the form of a slight failure to reach the external commissure was observed in some children. When testing for accommodation and convergence, mild convergence paresis was noted. One child had strabismus. There were no severe paresis observed in the trigeminal nerves (V pair) in children. However, with lateral movements of the lower jaw, some children experienced synkenesis in the form of turning the head, tongue, and less often lips in the same direction. Asymmetry of the facial nerves (VII pair) was present in children, mainly due to the smoothness of the right or left nasolabial fold. Severe disorders of the glossopharyngeal and vagus nerves (IX, X pairs) were not observed in the examined children. However, insufficient contraction of the soft palate was noted. The children's voice was quiet, muffled with a slight nasal tint. The listed conditions of the cranial nerves in mild forms of dysarthria in most cases are persistent, since they are caused by organic damage to the central nervous system.

On the motor side, the children had mild paresis with denervatory changes in muscle tone. The children's muscle strength was satisfactory. However, most children did not immediately engage in active resistance. Active movements in all subjects were performed in full, but were slow, awkward, and undifferentiated. In the reflex sphere, children showed revival of tendon and periosteal reflexes. In a number of cases, reflexes of oral automatism were observed, as well as unstable, depleting pathological reflexes of Babinsky and Poussep. In addition to the above-mentioned disorders in the neurological status of children with a mild form of dysarthria, changes in the autonomic nervous system were noted, which manifested themselves mainly in the form of sweating of the palms and feet, and the presence of persistent red demography.

Thus, it was found that the majority of children with a mild form of dysarthria had mild (erased) neurological symptoms, which were revealed upon careful examination and indicated an organic lesion of the central nervous system.

3. Results of the study of psychological and pedagogical status.

Attention in children with functional dyslalia and especially with a mild form of dysarthria is less stable than in children with normal speech. The study of individual attention tasks revealed a reduced level of stability and switchability of attention in children with a mild form of dysarthria and functional dyslalia. Violation of the mechanism of stability and switchability of attention, apparently, depends on insufficient mobility of the main nervous processes in the cerebral cortex.

Memory. The nature of the performance of a visual memory task in children with functional dyslalia and a mild form of dysarthria is similar to the results of their study on switching attention, which is apparently associated with a violation of neuro-dynamic connections in the cerebral cortex. The weakness of the process of memorizing words in children with functional dyslalia and a mild form of dysarthria is associated not only with difficulty in developing conditioned reflexes, weakening of attention, but also, possibly, with a violation of phonemic hearing that occurs as a result of underdevelopment of sound pronunciation.

Thus, the study of memory on tasks showed that children with functional dyslalia had minor, and children with mild dysarthria had significant deviations, which can be explained not only by a violation of their phonemic hearing, but also by a disorder of active attention...

Thinking. Children with normal speech and functional dyslalia gave the same number of correct answers. Children with mild dysarthria gave fewer correct answers, and the quality of their work was lower. When performing tasks, children with a mild form of dysarthria were unsure, passive, quickly exhausted, and showed negativism. However, some weakening of their mental activity did not have the character of mental retardation, but took place according to the type of asthenia with a pronounced decrease in the function of attention and memory.

Speech. All children understood speech addressed to them. Children with normal speech and functional dyslalia had adequate vocabulary, complete sentences, a loud voice, and a normal speech rate. In some cases, children with functional dyslalia had a rapid speech rate. In children with a mild form of dysarthria, the active vocabulary was somewhat limited, the phrase was short, the voice was quiet in some, and the speech was fast and unclear. A characteristic symptom for both children with functional dyslalia and mild dysarthria was a violation of sound pronunciation. Phonetic disorders manifested themselves in the form of replacing some sounds with others, mixing sounds, absence of sounds, and unclear, distorted pronunciation of sounds. In children with mild dysarthria, there was a discrepancy between the ability to pronounce sounds in isolation and in the speech stream. In isolation, sounds were pronounced cleaner, more correctly, in the speech stream - unclear, fuzzy, since they were poorly automated and insufficiently differentiated. In some children with a mild form of dysarthria, in addition to a violation of consonant sounds, vowel sounds were also unclearly pronounced, with a slight nasal tint. Phonemic hearing in children was reduced in most cases.

5. A study of psychological characteristics in children with mild dysarthria and functional dyslalia showed that speech therapist work should not be limited to the production and correction of only defective sounds, but should have a wider range of correction of the child’s personality as a whole.

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State Educational Institution of Higher Professional Education "MSPU"

COURSE WORK

Comparative analysis of dyslalia and erased dysarthria.

Completed:

4th year student

Correspondence department

Faculty of Defectology

404 groups

Lebedeva V.V.

I checked the work:

Assoc. Eades R. E.

Introduction

1.Dyslalia. Historical aspect

2. Clinical and pedagogical characteristics of children with dyslalia

2.1Simple and complex dyslalia

2.2Forms of dyslalia

2.3 Features of phonetic disorders in children with dyslalia

2.4Sensory and motor dyslalia

2.5Levels of pronunciation impairment

3.Method of speech therapy for dyslalia

3.1 Main stages of work

4. Erased dysarthria. Historical aspect

4.1 Clinical and pedagogical characteristics of children with erased dysarthria

4.2 Features of phonetic disorders in children with erased dysarthria

4.3 Features of the formation of phonemic hearing in children with erased dysarthria

4.4Features of motor skills in erased dysarthria

4.5 Features of the formation of vocabulary, violations of the formation of grammatical structure, the morphological system of language and the syntactic structure of sentences in erased dysarthria

4.6Prosody

5.Methodology of speech therapy work with children with erased dysarthria

5.1Methods for correcting speech breathing for dysarthria

5.2 Speech correction for dysarthria

6. Comparative analysis of dyslalia and erased dysarthria

Conclusion

Literature

Introduction

Speech sounds are special complex formations unique to humans. They are produced in a child for several years after birth. This process includes complex brain systems and the periphery (speech apparatus), which are controlled by the central nervous system. Harmfulness that weakens it negatively affects the development of pronunciation.

Children with speech impairments are children who have deviations in speech development with normal hearing and intact intelligence. Speech disorders are diverse; they can manifest themselves in impaired pronunciation, grammatical structure of speech, poor vocabulary, as well as impaired tempo and fluency of speech.

Among the various speech disorders in childhood, functional dyslalia and a mild form of dysarthria present great difficulties for differential diagnosis and speech therapy work.

There are numerous indications in the literature that in the practice of speech therapy there are deficiencies in pronunciation, which in their external manifestation resemble dyslalia, but have a long and complex dynamics of elimination.

Thus, the choice of the topic of the course work is determined by its relevance and insufficient knowledge of the problem, which requires special consideration in scientific and methodological aspects.

The purpose of this work is a comparative analysis of dyslalia and erased dysarthria.

Objectives of the study: to study the psychological and pedagogical literature on these disorders, compare and draw a conclusion.

1. Dislalia. Historical aspect. The term "dyslalia". Causes

Dislalia(from the Greek dis - a prefix meaning partial disorder, and lalio - I say) - a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus.

Among the violations of the pronunciation aspect of speech, the most common are selective violations in its sound (phonemic) design with the normal functioning of all other utterance operations.

These disorders manifest themselves in defects in the reproduction of speech sounds: distorted (non-normative) pronunciation, replacement of some sounds with others, mixing of sounds and - less often - their omission.

The term “dyslalia” was one of the first in Europe to be introduced into scientific circulation by Vilnius University professor doctor I. Frank. In a monograph published in 1827. The study of this problem in domestic speech therapy is reflected in the works of: M. E. Khvatsev, A. M. Smirnova, O. V. Pravdina, S. S. Lyapidevsky, R. E. Levina and other equally famous scientists.

Dyslalia is one of the most common pronunciation defects. Statistical data from domestic and foreign researchers indicate that 25-30% of preschool children (5-6 years old) and 17-20% of school-age children (I-II grades) have pronunciation deficiencies. Among older students, pronunciation deficiencies account for no more than 1%. This indicates that there are temporary disturbances that are overcome during the speech development of children and in the process of schooling.

Causes-- biological and social: general physical weakness of the child due to somatic diseases, especially during the period of active speech formation; mental retardation (minimal brain dysfunction), delayed speech development, selective impairment of phonemic perception; an unfavorable social environment that impedes the development of a child’s communication (limited social contacts, imitation of incorrect speech patterns, as well as shortcomings in upbringing, when parents cultivate imperfect child pronunciation, thereby delaying the development of sound pronunciation).

dyslalia hearing speech therapy dysarthria

2. Clinical and pedagogical characteristics of dyslalia

2.1 Simple and complex dyslalia

Depending on how many sounds are pronounced defectively, dyslalia is divided into simple and complex. Simple (monomorphic) include disorders in which one sound or sounds of homogeneous articulation are pronounced defectively; complex (polymorphic) include disorders in which sounds of different groups (whistles and sonorants) are pronounced defectively.

Along with the so-called “pure” forms, there are combined forms of acoustic-phonemic, articulatory-phonemic and articulatory-phonemic dyslalia. M.E. Khvattsev defined such disorders as diffuse, or general, tongue-tiedness and pointed out its connection with speech underdevelopment. Such combinations of disorders represent a special group that cannot be reduced to dyslalia as a selective speech sound disorder; they are combined with underdevelopment of other aspects of speech and are observed against the background of organic lesions of the central nervous system and mental development.

2.2 Fforms of dyslalia

Highlight two main forms of dyslalia depending on the location of the disorder and the reasons causing the defect in sound pronunciation; functional and mechanical(organic).

In cases where no organic abnormalities are observed(peripherally or centrally determined), they talk about functional dyslalia. With deviations in the structure of the peripheral speech apparatus(teeth, jaws, tongue, palate) talk about mechanical(organic) dyslalia.

Functional dyslalia occurs in childhood during the process of mastering the pronunciation system, and mechanical dyslalia occurs at any age due to damage to the peripheral speech apparatus. With functional dyslalia, the reproduction of one or several sounds may be impaired; with mechanical dyslalia, a group of sounds usually suffers. In some cases, combined functional and mechanical defects occur.

Functional dyslalia. This includes defects in the reproduction of speech sounds (phonemes) in the absence of organic disturbances in the structure of the articulatory apparatus.

With functional dyslalia, there are no organic disorders of the central nervous system that impede movement. The specific speech skills to voluntarily assume the positions of the articulatory organs necessary for pronouncing sounds are unformed. This may be due to the fact that the child has not developed acoustic or articulatory patterns of individual sounds. In these cases, it turns out that they have not learned one of the signs of a given sound. Phonemes do not differ in their sound, which leads to replacing sounds. The articulatory base turns out to be incomplete, since not all auditory motor formations (sounds) necessary for speech have been formed. Depending on which of the signs of sounds - acoustic or articulatory - turned out to be unformed, sound replacements will be different.

In other cases, the child has formed all articulatory positions, but does not have the ability to distinguish between some positions, that is, to correctly select sounds. As a result, phonemes are mixed, the same word takes on a different sound form. This phenomenon is called mixing or interchanges sounds (phonemes).

Cases of abnormal sound reproduction due to incorrectly formed individual articulatory positions are often observed. The sound is pronounced as unusual in the phonetic system of the native language in its acoustic effect. This phenomenon is called distortion of sounds.

Mechanical dyslalia-- impaired sound pronunciation caused by anatomical defects of the peripheral speech apparatus (organs of articulation). She is sometimes called organic. The most common pronunciation defects are caused by:

1) anomalies of the dentofacial system: diastema between the front teeth;

2) absence of incisors or their anomalies;

3) irreparable position of the upper or lower incisors or the relationship between the upper or lower jaw (bite defects). These abnormalities may be due to developmental defects or acquired due to injury, dental disease or age-related changes. In some cases, they are caused by the abnormal structure of the hard palate (high arch).

Among pronunciation disorders in such cases, the most frequently observed defects are whistling and hissing sounds (they acquire excess noise), labial-dental, anterior-lingual, plosive, and, less often, r and r.

Quite often, the pronunciation of vowel sounds is also disrupted, which become inaudible due to excessive noise in consonants and insufficient acoustic opposition of vowels.

However, dental anomalies do not always lead to pronunciation defects: with some deformation of the teeth, it may turn out to be normal.

The second most common group consists of sound pronunciation disorders caused by pathological changes in the tongue: too large or small a tongue, shortened hyoid ligament.

With such anomalies, the pronunciation of sibilants and vibrants suffers, and lateral sigmatism is also observed. In some cases, the intelligibility of pronunciation as a whole suffers.

However, not all cases of language anomalies affect the pronunciation of sounds. This has been noted many times by linguists. (R. O. Yakobson, M. V. Panov) and specialists in the field of speech pathology (G. Gutzman, R. A. Yurova, etc.).

Facts of normal sound pronunciation with anomalies of the tongue and teeth indicate compensatory capabilities that make it possible to form a normal pronunciation even under impaired conditions for the realization of sounds; the same acoustic effect can be achieved in different ways.

Disturbances in sound pronunciation caused by labial anomalies are much less common, since congenital defects (various deformities) are overcome surgically at an early age. Thus, the speech therapist encounters mainly the consequences of deformations of traumatic origin, in which the pronunciation of labial sounds is mainly impaired due to incomplete closure of the lips, as well as labiodental sounds. Sometimes there are defects in the pronunciation of labialized vowels (o, u).

Mechanical dyslalia can be combined with functional phonemic dyslalia.

In all cases of mechanical dyslalia, consultation (and in some cases treatment) of a surgeon and orthodontist is necessary.

2.3 Features of phonetic disorders in children with dyslalia

The listed types of violations: replacement, confusion and distortion of sounds are considered in traditional speech therapy as adjacent. In modern speech therapy research, based on the principles of linguistics, they are divided into two multi-level categories. Substitutions and mixtures of sounds qualify as phonological(F.F. Pay), or (which is the same) phonemic(R. E. Levina) defects, in which the language system is disrupted. Sound distortions are classified as anthropophonic(F.F. Pay), or phonetic defects, in which the pronunciation norm of speech is violated.

2.4 Sensory and motor dyslalia

In domestic and foreign literature, it is common to divide dyslalia into two forms, depending on which psychophysiological mechanisms involved in speech processes are impaired. Highlight sensory and motor dyslalia (K. P. Bekker, M. Sovak, M. E. Khvattsev, O. A. Tokareva, O. V. Pravdina, etc.). This division of dyslalia directs attention to the mechanism, the correction of which must be carried out.

There are three main forms of dyslalia: acoustic-phonemic, articulatory-phonemic, articulatory-phonetic.

Acoustic-phonemic dyslalia . This includes defects in the sound design of speech, caused by the selective immaturity of the operations of processing phonemes according to their acoustic parameters in the sensory link of the speech perception mechanism. Such operations include identification, recognition, comparison of acoustic features of sounds and decision-making about the phoneme.

The basis of the disorder is the insufficient development of phonemic hearing, the purpose of which is to recognize and distinguish the phonemes that make up a word. With this disorder, the child’s system of phonemes is not fully formed (reduced) in composition. The child does not recognize one or another acoustic feature of a complex sound, by which one phoneme is opposed to another. As a result, during speech perception, one phoneme is likened to another based on the commonality of most features. Due to the failure to recognize one or another feature, the sound is recognized incorrectly. This leads to incorrect perception of words (mountain - “bark”, beetle - “pike”, fish - “lyba”). These shortcomings prevent both the speaker and the listener from correctly perceiving speech.

Non-distinction leading to identification and assimilation is observed in dyslalia mainly in relation to phonemes with one-dimensional acoustic differences. For example, in relation to noisy phonemes that differ on the basis of deafness and voicedness, some sonorant phonemes (p - l) and some others. In cases where one or another acoustic feature is differential for a group of sounds, for example, deafness-voicedness, the perception of the entire group turns out to be defective. For example, voiced, noisy, which are perceived and reproduced as paired deaf ones (w - sch, d - t, g - k, z - s, etc.). In a number of cases, opposition in a group of plosive or sonorant consonants is disrupted.

With acoustic-phonemic dyslalia, the child does not have hearing impairment. The defect boils down to the fact that he does not selectively develop the function of auditory discrimination of certain phonemes.

Acoustic-phonemic dyslalia should be distinguished from more severe disorders that extend to the perceptual and semantic levels of speech perception processes and lead to its underdevelopment.

Articulatory-phonemic dyslalia . This form includes defects caused by the immaturity of the operations of selecting phonemes according to their articulatory parameters in the motor part of speech production. There are two main types of violations. In the first case, the articulatory base is not fully formed, reduced. When selecting phonemes, instead of the desired sound (which is absent in the child), a sound that is close to it in terms of a set of articulatory features is selected. The phenomenon of substitution, or replacement of one sound with another, is noted. A sound of simpler articulation acts as a substitute.

In the second variant of the disorder, the articulatory base is fully formed. All articulatory positions necessary for the production of sounds have been mastered, but when selecting sounds, an incorrect decision is made, as a result of which the sound appearance of the word becomes unstable (the child can pronounce words correctly or incorrectly). This leads to confusion of sounds due to their insufficient differentiation, and to their unjustified use.

Substitutions and mixtures in this form of dyslalia are carried out on the basis of the articulatory proximity of sounds. But, as in the previous group of disorders, these phenomena are observed mainly between sounds or classes of sounds that differ in one of the characteristics: whistling and hissing s - w, z - z (rat - “roof”), between explosive noisy front-lingual and back-lingual t - k, d - g (Tolya - “Kolya”, gol - “dol”), between the lingual hard and soft phonemes paired in articulation with - s, l - l, t - t (garden - “sit down”, onion - “hatch”, fat - “bale”), etc. These phenomena can be observed among sounds that are identical in the method of formation, between the affricates c and ch (“kuricha” - chicken, “shout” - scream), sonorators r and l (“lyba” - fish, “rapa” - paw).

With this form of dyslalia, the child’s phonemic perception is most often fully formed. He distinguishes all phonemes, recognizes words, including paronymous words. The child realizes his defect and tries to overcome it. In many cases, such self-correction under the control of auditory control is successful. This is evidenced by some comparative data on the prevalence of mixtures and substitutions of sounds at different age stages of children's development. For example, substitutions r - l at 5 years old account for 42% of all violations of the sound r, at 6 years old - 34%, at 7 years old - 18%, at 8-9 years old - 18%; substitutions l - r at 5 years are 9%, at 6 years - 5%, at 7 years and subsequent years are not observed; replacements w - s, g - z in 5 years make up 50% of all hissing violations, in subsequent years - 23-26% (Data from M. A. Aleksandrovskaya). The tendency to overcome substitutions and mixtures of sounds in children in the process of their development is noted in the works of many researchers (A. N. Gvozdev, V. I. Beltyukova, O. V. Pravdina, etc.). At the same time, the authors note that not all children achieve complete overcoming of their deficiencies. Among secondary school students (grades I-II), deficiencies in pronunciation of the phonemic order are at least 15%. By the end of training at the initial level, they occur only rarely.

Defective pronunciation in this form of dyslalia is caused not by motor impairments themselves, but by a violation of the operations of selecting phonemes based on their articulatory characteristics. The child copes with tasks to imitate complex non-speech sounds, which require certain structures of the speech organs for their implementation; often produces sounds that are more complex in motor terms and replaces with them the missing sounds that are the simplest in articulation.

Articulatory-phonetic dyslalia . This form includes defects in the sound design of speech caused by incorrectly formed articulatory positions.

Sounds are pronounced abnormally, distorted for the phonetic system of a given language, which is formed in a child with this form of dyslalia, but phonemes are realized in unusual variants (allophones). Most often, an incorrect sound is close in its acoustic effect to the correct one. The listener, without much difficulty, associates this variant of pronunciation with a specific phoneme.

Another type of distortion is observed, in which the sound is not recognized. In such cases they speak of omission, emission of sound. The case of skipping sounds with this form of dyslalia is a rare phenomenon (more often occurs with other, more severe defects, for example, with alalia). With dyslalia, an analogue of sound, purely individual in its acoustic effect, performs the same phonemic function in the child’s speech system as the normalized sound.

Not all sounds are affected: for example, with various individual characteristics of pronunciation, the acoustic effect when pronouncing labial (plosive and sonorant) consonants, as well as anterior lingual plosives and sonorant consonants, is within normal limits. There are almost no distortions of labiodental f - f, v - v.

The main group of sounds in which distorted pronunciation is observed are front-lingual non-plosive consonants. Less commonly observed is defective pronunciation of posterior lingual plosives and midlingual consonants.

Front-lingual non-plosive consonants are sounds that are complex in articulation; mastering their correct structure requires subtle differentiated movements. When pronouncing, a child cannot rely on the movements that he had previously formed in connection with biological acts, for example, when mastering labial consonants or plosives in the front of the tongue. These sounds are formed in him later than others, because he must master new sets of movements intended for pronunciation.

In the course of mastering pronunciation skills, the child, under the control of his hearing, gradually gropes for those articulatory positions that correspond to the normal acoustic effect. These positions are recorded in the child’s memory and later reproduced as needed. When finding the correct patterns, the child must learn to distinguish patterns that are similar in the pronunciation of sounds, and develop a set of speech movements necessary to reproduce sounds (F.F. Pay). The process of developing speech movements is fraught with specific difficulties, since adequate and inadequate sounds act as intermediate links, which in the Russian language do not have a meaningful function. In a number of cases, such a substitute sound that is intermediate for the development of pronunciation, close to the desired sound in terms of acoustic effect, begins to acquire a semantic-distinguishing (phonemic) function. It is accepted by the child’s phonetic hearing as normal. His articulation is strengthened. In the future, the sound usually does not lend itself to self-correction due to the inertia of articulatory skills. These defects, unlike the defects of the previous groups, tend to become fixed.

To indicate distorted pronunciation of sounds, international terms are used, derived from the names of the letters of the Greek alphabet using the suffix - Meas.:rotacism-- pronunciation defect r And r, lambdacism -- l And l,sigmatism- whistling and hissing sounds, iotacism - iot(j), kappacism - to And k, gammatism - g And g, hitism-- X And X. In cases where a change in sound is noted, the prefix is added to the name of the defect pair:pararotacism, parasigmatism, etc.

The grouping of pronunciation defects and the terms by which they are designated are not suitable for describing violations of the Russian pronunciation system. For example, to denote the violation of back-lingual consonants, two terms are unnecessary, but they are appropriate for those languages in which the geek turns out to be different in the method of formation. This system is insufficient to characterize a number of consonants: there is no name for the defects of fricative sibilants sh and z, for defects of affricates. Since there were no similar sounds in the phonetic system of the Greek language, there were no corresponding names. In this regard, we conditionally combined into the group of sigmatisms, in addition to defects in the pronunciation of sibilants, and defects of other sounds - fricative sibilants and affricates.

A distorted pronunciation disorder is characterized by the fact that, for the most part, a homogeneous defect is observed in groups of sounds that are similar in articulatory characteristics. For example, in a pair of deaf-voiced sounds, the distortion turns out to be the same: z is violated in the same way as s, zh like w. The same applies to hardness-softness pairs: c is violated as c. The exception is the sounds r and r l and l: hard and soft are violated differently. Hard ones may be broken, but soft ones may not be broken.

2.5 Ulevels of impaired pronunciation

Many authors note that in some cases children correctly use sound in isolation, in syllables, and sometimes in words and in reflected speech, but do not use it in independent speech (M. A. Aleksandrovskaya). Similar phenomena are noted in the works of M. E. Khvattsev, O. V. Pravdina, K. P. Bekker and others. These data indicate that children’s pronunciation skills correlate with the degree of complexity of the type of speech activity.

O. V. Pravdina identifies three levels of impaired pronunciation:

Inability to correctly pronounce a sound or group of sounds;

Incorrect pronunciation of them in speech when correctly pronounced in isolation or in light words;

Insufficient differentiation (mixing) of two sounds that are similar in sound or articulation, with the ability to correctly pronounce both sounds.

The identified levels reflect the stages of sound acquisition in the process of child development, identified by A. N. Gvozdev. These data indicate that a child with impaired pronunciation goes through the same stages of sound acquisition as a normal child, but at some stage he may be delayed or stop.

K. P. Becker and M. Sovak distinguish sound, syllabic and verbal dyslalia. A level division of dyslalia is more justified, rather than a division into different forms, since facts indicate that we should be talking about the degree of formation of skills for the same type.

3. MMethods of speech therapy for dyslalia

The main goal of speech therapy for dyslalia is the formation of skills and abilities to correctly reproduce speech sounds. In order to correctly reproduce speech sounds (phonemes), a child must be able to: recognize speech sounds and not confuse them in perception (i.e., recognize a sound by acoustic characteristics; distinguish a normalized pronunciation of a sound from a non-standardized one; exercise auditory control over one’s own pronunciation and evaluate the quality sounds reproduced in one’s own speech; take the necessary articulatory positions that ensure the normalized acoustic effect of the sound: vary the articulatory patterns of sounds depending on their compatibility with other sounds in the flow of speech; accurately use the desired sound in all types of speech.

The speech therapist must find the most economical and effective way to teach the child pronunciation.

With proper organization of speech therapy work, a positive effect is achieved for all types of dyslalia. With mechanical dyslalia, in some cases, success is achieved as a result of joint speech therapy and medical intervention.

A prerequisite for success with speech therapy is the creation of favorable conditions for overcoming pronunciation deficiencies: emotional contact between the speech therapist and the child; an interesting form of organizing classes, corresponding to the leading activity, stimulating the child’s cognitive activity; combinations of work methods to avoid fatigue.

3.1 Basic etapasspeech therapy workfor dyslalia

In the literature there is no consensus on the question of how many stages the speech therapy intervention for dyslalia is divided into: in the works of F. F. Pay, two are distinguished, in the works of O. V. Pravdina and O. A. Tokareva - three, in the works of M. E. Khvatseva - four.

Since there are no fundamental differences in the understanding of the tasks of speech therapy for dyslalia, the allocation of the number of stages is not of a fundamental nature.

Based on the purpose and objectives of speech therapy intervention, it seems justified to distinguish the following stages of work: preparatory stage; stage of formation of primary pronunciation skills; stage of formation of communication skills.

I. Preparatory stage

Its main goal is to include the child in a targeted speech therapy process.

One of the important general pedagogical tasks is the formation of an attitude towards classes: the speech therapist must establish a trusting relationship with the child, win him over, adapt him to the environment of the speech therapy room, arouse his interest in classes and the desire to get involved in them.

II.Stage of formation of primary pronunciation skills.

The goal of this stage is to develop in the child the initial skills of correctly pronouncing sounds using specially selected speech material. Specific tasks are: production of sounds, development of skills for their correct use in speech (automation of skills), as well as the ability to select sounds without mixing them with each other (differentiate sounds).

The need to solve these problems in the process of speech therapy work follows from the laws of ontogenetic mastery of the pronunciation side of speech.

Sound production is achieved by using technical techniques described in detail in specialized literature. In the works of F. F. Pay, three methods are distinguished: By imitation(imitative), mechanical And mixed.

III. Stageformation of communication skills

Its goal is to develop in the child the skills and abilities to accurately use speech sounds in all communication situations.

In classes, texts are widely used, rather than individual words, various forms and types of speech are used, creative exercises are used, and material rich in certain sounds is selected. This kind of material is more suitable for classes on sound automation. But if at this stage the child works only on specially selected material, then he will not master the selection operation, since the frequency of this sound in special texts exceeds their normal distribution in natural speech. And the child must learn to operate with them.

4. Erased dysarthria. Historical aspect.The term "erased dysarthria"

The term “erased” dysarthria was first proposed by O.A. Tokareva, who characterizes the manifestations of “erased dysarthria” as mild (erased) manifestations of pseudobulbar dysarthria, which are particularly difficult to overcome.

A different definition of such a speech disorder was proposed by A.N. Kornev. He defines this disorder as selective, mild, but rather persistent disturbances of sound pronunciation, which are accompanied by mild, peculiar disturbances of the innervation insufficiency of the articulatory organs.

Erased dysarthria (mild degree of dysarthria, MDD - minimal dysarthric disorders) in speech therapy practice is one of the most common and difficult to correct disorders of the sound-pronunciation side of speech.

A study of the neurological status of children with erased dysarthria reveals certain abnormalities in the nervous system, manifested in the form of a mildly expressed predominant unilateral syndrome. Paretic symptoms are observed in the articulatory and general muscles, which is associated with a violation of the innervation of the facial, glossopharyngeal or hypoglossal nerves (G.V. Gurovets, S.I. Mayevskaya).

Erased dysarthria occurs very often in speech therapy practice. The main complaints with erased dysarthria: slurred, inexpressive speech, poor diction, distortion and replacement of sounds in words with complex syllable structure, etc.

Erased dysarthria is a speech pathology that manifests itself in disorders of the phonetic and prosodic components of the speech functional system and arises as a result of unexpressed microorganic damage to the brain (L.V. Lopatina).

Diagnosis of erased dysarthria and methods of correction work have not yet been sufficiently developed. In the works of G.G. Gutsman, O.V. Pravdina, L.V. Melekhova, O.A. Tokareva, R.I. Martynova discusses the symptoms of dysarthric speech disorders, in which there is a “washed out”, “erased” articulation. The authors note that erased dysarthria is very similar in its manifestations to complex dyslalia. In the works of L.V. Lopatina, N.V. Serebryakova, E.Ya. Sizova, E.K. Makarova and E.F. Sobotovich raises issues of diagnosis, differentiation of training and speech therapy work in groups of preschool children with erased dysarthria.

Among the reasons causing erased dysarthria, various authors have identified the following:

1. Violation of the innervation of the articulatory apparatus, in which there is a deficiency of individual muscle groups (lips, tongue, soft palate); inaccuracy of movements, their rapid exhaustion due to damage to certain parts of the nervous system.

2. Motor disorders: difficulty finding a certain position of the lips and tongue necessary to pronounce sounds.

3. Oral apraxia.

4. Minimal brain dysfunction.

The anamnesis of children with erased dysarthria, Mastyukov, Lopatin, Arkhipov, Karelin and others, reveals the following factors: unfavorable course of pregnancy; asphyxia, low Apgar score at birth, the presence of a diagnosis of PEP - perinatal encephalopathy - in the vast majority of children in the first year of life.

4.1 Clinical and pedagogical characteristics of children with erased dysarthria

Erased dysarthria is a complex speech disorder characterized by variability in disturbances in the components of speech activity: articulation, diction, voice, breathing, facial expressions, and melodic-intonation aspects of speech.

Erased dysarthria is characterized by the presence of symptoms of microorganic damage to the central nervous system: insufficient innervation of the speech organs - the brain, articulatory and respiratory sections; violation of muscle tone of articulatory and facial muscles.

To diagnose this disorder, it is necessary to pay attention to the presence of neurological symptoms and carry out dynamic observation in the process of correctional work: if, during an outpatient examination, a psychoneurologist immediately detects organic neurological symptoms, then such forms can be rightfully classified as dysarthria. There are often children who do not show any symptoms after a single examination.

For the first time, an attempt to classify the forms of erased dysarthria was made by E.N. Vinarskaya and A.M. Pulatov based on the classification of dysarthria proposed by O.A. Tokareva. The authors identified mild pseudobulbar dysarthria and noted that pyramidal spastic paralysis in most children is combined with a variety of hyperkinesis, aggravated during speech.

In the studies of E.F. Sobotovich and A.F. Chernopolskaya was the first to note that deficiencies in the sound aspect of speech in children with “erased dysarthria” appear not only against the background of neurological symptoms, but also against the background of a violation of the motor side of the process of sound pronunciation. Depending on the manifestations of disturbances in the motor side of the pronunciation process and taking into account the localization of paretic phenomena in the organs of the articulatory apparatus, the authors identified four groups of children and identified the following types of erased dysarthria:

Igroup: Sound pronunciation disorders caused by selective inferiority of certain motor functions of the speech-motor apparatus;

IIgroup: Weakness, lethargy of articulatory muscles.

These two groups belong to the erased form of pseudobulbar dysarthria.

IIIgroup: Clinical features of sound pronunciation disorders associated with difficulty in performing voluntary motor acts;

IVgroup: Defects in the sound aspect of speech present in children with various forms of motor impairment.

4.2 Features of phonetic disorders in children with erased dysarthria

When first meeting a child, his sound pronunciation is assessed as complex dyslalia or simple dyslalia. When examining sound pronunciation, the following are revealed: confusion, distortion of sounds, replacement and absence of sounds, i.e. the same options as for dyslalia. But, unlike dyslalia, speech with erased dysarthria also has disturbances on the prosodic side.

Sounds with erased dysarthria are produced in the same ways as with dyslalia, but for a long time they are not automated and are not introduced into speech. The most common violation is a defect in the pronunciation of hissing and whistling sounds. Children with erased dysarthria distort and mix not only articulatory complex sounds that are close in place and method of formation, but also acoustically opposed ones.

Quite often, interdental pronunciation and lateral overtones are noted. Children have difficulty pronouncing words with a complex syllabic structure; they simplify the sound content by omitting some sounds when consonants are combined.

Many researchers note that phonetic disorders are common, leading in the structure of speech defects in children with erased dysarthria.

But with erased dysarthria, the cause and mechanism of the disorders are different than with dyslalia. With erased dysarthria, disturbances in sound pronunciation and prosodic components of speech are caused by organic insufficiency of innervation of the muscles of the speech apparatus. With dyslalia, there are no disturbances in the innervation of the muscles of the speech apparatus.

Most authors believe that all children are characterized by a polymorphic disorder of sound pronunciation. The prevalence of pronunciation disorders of various groups of sounds in children is characterized by certain features that are determined by the complex interaction of speech-auditory and speech-motor analyzers and the acoustic proximity of sounds.

In the studies of L.V. Lopatina provides static data and polymorphic data as follows:

Violation of two phonetic groups of sounds - 16.7%;

Violation of three phonetic groups of sounds - 43.3%;

Violation of four or more phonetic groups of sounds - 40%.

The most preserved are the back linguals and the sound “j”.

The most common problems in schoolchildren with erased dysarthria are violations of the pronunciation of whistling sounds. They are followed by disturbances in the pronunciation of hissing sounds. Less common are violations of the pronunciation of sonorous words “r” and “l”.

The nature of the disturbance in sound pronunciation of sounds in children with erased dysarthria, according to Lopatina, is determined by the ratio of the acoustic and articulatory characteristics of various groups of sounds. Groups of acoustically close sounds are learned worse than groups of sounds that are acoustically more distant, although more complex in articulation. This is confirmed by the presence in children of certain disorders of auditory perception of speech and phonemic hearing, and therefore the acoustic proximity of sounds has a negative impact on the acquisition of correct pronunciation.

Research by O.Yu. Fedosova show that the peculiarities of sound pronunciation in children with erased dysarthria proceed as follows: violations manifest themselves depending on phonetic conditions and are in some cases of an unstable nature. Depending on this, the sound can be pronounced differently: in some cases the sound is pronounced correctly, in others it is distorted or even replaced. The nature of pronunciation depends on the place of the sound in the word, on the length of the word and on the syllabic side of the word, on the expansion of the context.

The most favorable for the correct pronunciation of sounds is the strong (stressed) position of the sound, its location at the beginning of the word and in words of a simple syllabic structure.

4. 3 Features of the formation of phonemic hearing in children with erased dysarthria

Impairments in the formation of phonemic hearing in children with erased dysarthria may be secondary. This kind of disturbance is observed in the pathology of speech kinesthesia, which occurs with motor lesions of the speech organs; a violation of phonemic hearing of a secondary nature appears in children with erased dysarthria, and the degree of its severity depends on the degree of severity of the dysarthria itself. Children poorly perform exercises on distinguishing words that are similar in sound (based on pictures), on selecting pictures for a given sound, on recognizing syllables, etc.

Due to the presence of pathological symptoms in the articulatory apparatus, motor skills are impaired, which has a negative impact on the formation of phonemic hearing.

Impaired clarity of articulation during speech does not allow the formation of clear auditory perception. Often children do not control their sound pronunciation. Violation of kinesthetic control and auditory differentiation is the cause of persistent violations of the phonetic and prosodic aspects of speech.

In most children, when studying rhythmic abilities in the perception and reproduction of rhythmic series, errors are noted both in determining the number of beats and in transmitting the rhythmic pattern of samples. At the same time, pronounced motor awkwardness is expressed.

All children experience pronounced difficulties in differentiating syllables and phonemes. Only after several attempts do children manage to differentiate a vowel from a number of other vowel sounds. When differentiating syllables with oppositional consonants, all children fail.

For some children, the main difficulties are revealed only when reproducing a chain of syllables (based on preserved sounds). Typical violations are expressed in the assimilation of the second syllable to the first, in rearrangements of syllables in a chain of words.

4. 4 Features of motor skills in erased dysarthria

The general motor sphere of children with erased dysarthria is characterized by slow, awkward, constrained, undifferentiated movements.

There may be a limitation in the range of motion of the lower and upper extremities, mainly on one side, synkenesis, muscle tone disorders, and extrapyramidal motor insufficiency may occur. Sometimes mobility is pronounced, movements are unproductive and aimless.

The motor skills of the articulatory apparatus are also impaired. This shows up:

1) difficulties in switching from one articulation to another;

2) in a decrease and deterioration in the quality of articulatory movement;

3) in reducing the time of fixation of the articulatory form;

4) in reducing the number of correctly performed movements.

Children with erased dysarthria late and have difficulty mastering self-care skills: they cannot button a button, untie a scarf, etc. During drawing classes, they don’t hold a pencil well and their hands are tense. Many children don't like to draw. Motor clumsiness of the hands is especially noticeable during applique classes and with plasticine. Many children experience different movements.

The following pathological features of the articulatory apparatus are distinguished:

Pareticity of the muscles of the organs of articulation is manifested in the following: the face is hypomimic, the facial muscles are flaccid upon palpation; Many children do not maintain the closed mouth pose, because... the lower jaw is not fixed in an elevated state due to laxity of the masticatory muscles; lips are flaccid, their corners are drooping; During speech, the lips remain flaccid and the necessary labialization of sounds is not produced, which worsens the prosodic side of speech. The tongue with paretic symptoms is thin, located at the bottom of the mouth, flaccid, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.

Spasticity of the muscles of the organs of articulation is manifested in the following: the face is amicable, the facial muscles are hard and tense on palpation. The lips of such a child are constantly in a half-smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the “tube” articulation exercise, i.e. stretch your lips forward. The tongue with a spastic symptom is changed in shape: thick, without a pronounced tip, inactive.

Hyperkinesis with erased dysarthria manifests itself in the form of trembling, tremor of the tongue, vocal cords. In this case, the child cannot keep his tongue out of the mouth. Hyperkinesis of the tip of the tongue is often combined with increased muscle tone of the articulatory apparatus.

Apraxia in erased forms of dysarthria manifests itself in the inability to simultaneously perform any voluntary movements with the hands and organs of articulation, i.e. apraxia is present at all motor levels. In the articulatory apparatus, apraxia manifests itself in the inability to perform certain movements or when switching from one movement to another. Kinesthetic apraxia is noted when the child makes chaotic movements, “groping” for the desired articulatory position.

Deviation, i.e. deviation of the tongue from the midline also manifests itself during articulation tests and during functional loads. Deviation of the tongue is combined with asymmetry of the lips when smiling, with a smoothness of the nasolabial fold.

Hypersalivation, i.e. increased salivation, detected only during speech. Children cannot cope with salivation, do not swallow saliva, and the pronunciation side of speech and prosody suffer.

4. 5 Features of vocabulary formation, violations of the formation of grammatical structure, the morphological system of language and the syntactic structure of sentences in erased dysarthria

N.V. Serebryakova identified the peculiarities of vocabulary: limited volume of vocabulary, especially predicative; a large number of substitutions on semantic grounds, indicating the immaturity of semantic fields, the insufficiency of identifying differential features of word meanings; ignorance or inaccurate use of many commonly used words denoting visually similar objects, parts of objects, parts of the body; replacing semantically similar words; replacement with word-forming neologisms; replacement with words of the same root and words similar in articulation; a large degree of unmotivated associations.

Lopatina identifies three groups of children differing in the structure of the defect. These groups, identified by the author, differ in the degree of formation of linguistic means and accordingly correlate with the group:

FN - phonetic violation;

FFN - phonetic-phonemic disorder;

GSD - general speech underdevelopment.

Thus, the first group (FN) is characterized by the fact that the quality and volume of the active vocabulary corresponds to the age norm.

The second group with erased dysarthria (FFD) - the vocabulary is poorer than that of the first group of children.

Third (ONR) - the quality and volume of the vocabulary did not correspond to the age norm.

Violation of the grammatical structure in children is characterized by heterogeneity and variability of symptoms: from a slight lack of formation of the morphological and syntactic system of the language to pronounced agrammatisms in expressive speech.

The main mechanism for the unformed grammatical structure of speech in children with erased dysarthria is a violation of the differentiation of phonemes, which causes difficulties in distinguishing the grammatical forms of words due to the unclearness of the auditory and kinesthetic image of the word and especially the endings. In this regard, the morphological system of the language primarily suffers, the formation of which is closely related to the opposition of endings according to their sound composition.

The following irregular forms of word combinations in sentences are identified in children with erased dysarthria (ED):

Incorrect use of gender, number, case endings of nouns, pronouns, adjectives (“many spoons”);

Incorrect use of case endings of cardinal numerals (“there are no two buttons”);

Incorrect agreement of the verb with nouns and pronouns (“children draw”);

Incorrect use of numerical and gender endings of verbs in the past tense (“the tree fell”);

Incorrect use of prepositional case constructions (“under the table”).

At the same time, both general and specific agrammatisms (occasional forms) are identified in children. General occasionalisms are characteristic of both normal and impaired speech development.

There is a process of word change, frequent mixing of morphemes.

Violation of the syntactic structure of a sentence is usually expressed in the omission of sentence members, most often predicates, in an unusual word order, which manifests itself even when repeating sentences. Complex sentences are especially difficult.

As a result of the analysis of data from a survey of the grammatical structure of children with erased dysarthria, the following general conclusions can be drawn:

They allow omissions of words and entire parts of sentences, distort the meaning of sentences, and allow rearrangements of words and substitutions;

Many children do not notice their mistakes at all and accordingly do not correct them;

Inability to use a preposition, inability to choose the correct ending of a noun, inability to form plural nouns;

Tasks on writing sentences cause difficulties, except for the simplest ones, etc.

Thus, the immaturity of the grammatical structure of speech in children with erased dysarthria is characterized by variability in symptoms from a slight delay in the formation of the morphological system of the language to pronounced agrammatism in expressive speech.

Deviations in the development of the grammatical structure of speech turn out to be derivative and have the nature of secondary disorders in children with erased dysarthria.

4. 6 Prosody

Erased dysarthria is characterized by disturbances in sound pronunciation and prosodic aspects of speech, which are caused by the presence of neurological microsymptoms. In children, prosody disorders affect the intelligibility, intelligibility, and emotional pattern of speech.

The perception and independent reproduction of intonation structure, which in this case involves auditory-pronunciation differentiation of narrative and interrogative intonation, causes significant difficulties in children. In this case, the process of auditory differentiation of intonation structures turns out to be more disturbed than the process of their independent implementation. Common to children is a violation of the prosodic aspect of speech, which is a diagnostic criterion for differentiating erased dysarthria and dyslalia.

The intonation-expressive coloring of the speech of children with erased dysarthria is sharply reduced. The voice, vocal modulations in pitch and strength suffer, and speech exhalation is weakened. The timbre of speech is disrupted and sometimes a nasal tone appears. The pace of speech is often accelerated. When speaking, the child’s poetic speech is monotonous, gradually becomes less intelligible, and the voice fades away. The children's voice during speech is quiet, modulation in pitch and strength of the voice is not possible, imitating the voices of animals: cows, dogs, etc. The children's speech is not expressive, the diction is unclear. Difficulty playing rhythm.

The reasons for the violation of prosody in erased dysarthria lie in the pathology of the efferent and afferent links of control of intonation and prosody in general.

5. Methods of speech therapy work with children with erased dysarthria

Many specialists dealt with the issues of dysarthria correction: O.V. Pravdina, E.M. Mastyukova, K.A. Semenova, L.V. Lopatina, N.V. Serebryakova, E.F. Arkhipova. All authors note the need for specific, targeted work on the development of general motor skills, articulatory motor skills, fine motor skills of the fingers, as well as finger gymnastics, breathing and voice exercises.

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Pathology of the respiratory system in children, features of their course and assessment of their place in general childhood morbidity. Basic and additional functions of the respiratory tract. External and internal respiration, periods of lung growth in children. First breath and breathing rate.

presentation, added 10/11/2014

Concept and main factors of speech development delay. Minimal brain dysfunction (MCD), its essence, characteristics and causes. The influence of MMD on communication and activity. Symptoms of MMD in children with speech disorders. Prognosis for children with MMD.

abstract, added 03/10/2012

Features of children with mild central nervous system deficiency. Causes, neurophysiological foundations and clinical and psychological syndromes of mental retardation (mental infantilism, cerebrasthenic, hyperdynamic, psychoorganic).

Table of contents

Introduction

1. Features of differential diagnosis of erased forms of dysarthria, dyslalia

Diagnosis of erased dysarthria

Classifications of forms of erased dysarthria

1.3 Features of differential diagnosis of dyslalia

2. Differential diagnosis of erased forms of dysarthria and dyslalia

Research by domestic speech therapists on the issue of differential diagnosis of erased forms of dysarthria and dyslalia

Conclusion

References

Introduction

Speech is one of the main mental functions of a person; any of its disorders are the object of study of various sciences: pedagogy, psychology, speech therapy, neuropsychology, neurolinguistics and others.

Every year, speech therapy science develops and makes various adjustments to methods, documentation, etc. But, nevertheless, the experience of the authors of past centuries remains unchanged, being the basis for the development of this science as a whole.

The topic of my course work is “Differential diagnosis of the erased form of dysarthria and dyslalia.” The choice of topic is due to its relevance and insufficient knowledge of the problem, which requires special consideration in scientific and methodological aspects.

For example, after an examination, a speech therapist is faced with the task of making a diagnosis, and all further correctional work will depend on how correctly he makes it. But often a speech therapist finds it difficult to do this for the reason that one speech disorder is similar in its etiology to another disorder. And for this, first of all, it is necessary to know what manifestations one disorder has and what another.

Thus, I would like to say that the issue of differential diagnosis of the erased form of dysarthria and dyslalia is under development, and it was interesting for me, as a future speech therapist, to bring a little clarity to the consideration of this problem.

A broad analysis of practice has shown that erased forms of dysarthria are quite often confused with dyslalia. However, upon closer examination, differences occur. G. Gutsman was the first to draw attention to this, proving that, for example, correction of sound pronunciation, unlike dyslalia in dysarthria, causes certain difficulties (12, p. 102).

In my course work, I did not set out to consider the issues of differential diagnosis of each of these speech disorders separately. On the contrary, I tried to show in comparison what manifestations the erased form of dysarthria has, and what dyslalia. For convenience, I grouped the obtained data into tables that clearly reflect the essence of this issue.

So, what is an erased form of dysarthria? The main manifestations of the erased form of dysarthria? What classifications exist? How does the differential diagnosis of the erased form of dysarthria differ from dyslalia, and, conversely, how is it similar? I tried to answer these and many other questions in this course project.

I paid more attention to the issue of the erased form of dysarthria than to dyslalia. Since the study of dyslalia has been carried out since the 30s XIX centuries, during this time a large amount of scientific and methodological material has accumulated. Many authors considered it their duty to contribute to the study of this disorder. However, a review of literature data indicates that erased forms of dysarthria remain insufficiently studied, and a systematic approach to correcting this speech disorder has not been developed.

Thus, to date, methods for differential diagnosis of the erased form of dysarthria and similar conditions (dyslalia) have not been sufficiently systematized.

1. Questions of differential diagnosis of the erased form of dysarthria, dyslalia

1.1 Diagnosis of the erased form of dysarthria

A common speech disorder among preschool children iserased dysarthria , which tends to grow significantly. It is often combined with other speech disorders (stuttering, general speech underdevelopment, etc.). This is a speech pathology, manifested in disorders of the phonetic and prosodic componentsspeech functional systemAndWHOdeclining due to unexpressed microorganic damage to the brain (6).

The term “erased” dysarthria was first proposed by O.A. Tokareva, who characterizes the manifestations of “erased dysarthria” as mild (erased) manifestations of “pseudobulbar dysarthria”, which are particularly difficult to overcome.

Among the reasons causing erased dysarthria, various authors have identified the following:

2. Motor disorders: difficulty finding a certain position of the lips and tongue necessary to pronounce sounds.

3. Oral apraxia.

4. Minimal brain dysfunction.

As I have already said, the diagnosis of the erased form of dysarthria and the methodology for corrective work have not yet been sufficiently developed. In the works of G.G. Gutzman, O.V. Pravdina, L.V. Melekhova, O.A. Tokareva, I.I. Panchenko, R.I. Martynova discusses the symptoms of dysarthric speech disorders, in which there is a “washed out”, “erased” articulation. The authors note that erased dysarthria is very similar in its manifestations to complex dyslalia(1, pp. 8 – 9).

Differential diagnosis of erased dysarthria is extremely difficult. Violations of the phonetic aspect of speech in erased dysarthria, outwardly similar to other sound pronunciation disorders, however, have their own specific mechanism. Severe disturbances in sound pronunciation with erased dysarthria are difficult to correct and negatively affect the formation of phonemic and lexico-grammatical aspects of speech and complicate the process of schooling for children. At the same time, timely correction of speech development disorders is a necessary condition for the psychological readiness of children to study at school and creates the prerequisites for the earliest social adaptation of preschool children with speech disorders (7).

For diagnostics this violationnecessary pay attention to the presence of neurological symptoms and carry out dynamic observation in the process of correctional work: if during an outpatient examination a neuropsychiatrist immediately detects organic neurological symptoms, then such forms can rightfully be classified as dysarthria. There are often children who do not show any symptoms after a single examination.

When diagnosing, distinguishing a mild degree of dysarthria from similar disorders is often very difficult, since a number of symptoms of dysarthria are almost identical in form to the symptoms of other speech disorders. The difficulties are aggravated by the fact that dysarthria often manifests itself in the structure of various neurological and psychopathological syndromes (cerebral palsy, minimal cerebral dysfunction syndrome, psychophysical disinhibition syndrome, mental retardation, mental retardation, etc.) and at the same time coexists with other speech disorders (alalia , rhinolalia, stuttering). However, this is extremely important, since the choice of adequate areas of correctional and speech therapy intervention for a child with mild dysarthria and, accordingly, the effectiveness of this intervention largely depend on making the correct diagnosis.

I would like to compare a mild degree of dysarthria in principle with a similar disorder - a severe degree of dysarthria, based on speech and non-speech signs.

The erased form of dysarthria is most often diagnosed after five years.

For early detection of erased dysarthria and proper organization of complex effects, it is necessary to know the symptoms that characterize these disorders. The examination of the child begins with a conversation with the mother and study of the child’s outpatient development chart. Analysis of anamnestic information shows that there are: deviations in intrauterine development (toxicosis, hypertension, neuropathy, etc.); asphyxia of newborns; rapid or prolonged labor. According to the mother, “the child did not cry right away; the child was brought in to be fed later than everyone else.”

When examined in a clinic by a speech therapist, children aged 5–6 years with erased dysarthria reveal the following symptoms.

In some cases, functional tests help to diagnose minimal manifestations of dysarthria (3, p. 11).

Test 1. The child is asked to open his mouth, stick his tongue forward and hold it motionless along the midline and at the same time follow with his eyes an object moving in lateral directions. The test is positive and indicates dysarthria if, at the time of eye movements, there is a slight deviation of the tongue in the same direction.

Test 2. The child is asked to perform articulatory movements with his tongue while placing his hands on his neck. With the most subtle differentiated movements of the tongue, tension in the neck muscles is felt, and sometimes there is a visible movement with the head thrown back, which indicates dysarthria.

With the help of such a special, in-depth examination, mild paresis of the facial muscles is revealed that prevents the normal formation of articulations. Thus, all cases of violations of sound pronunciation of such pathogenesis should be considered as disorders of the dysarthric series.

1.2 Classifications of forms of erased dysarthria

For the first time, an attempt to classify the forms of erased dysarthria was madeE.N. Vinarskaya AndA.M. Pulatov based on the classification of dysarthria proposed by O.A. Tokareva. In this classification, only the degree of disorder comes to the fore, but mechanisms and nosology are not taken into account.

In researchE.F. Sobotovich and A.F. Chernopolskaya a typology of disorders has been determined depending not only on neurological symptoms, motor disorders, but also phonemic and general development in various forms of mild dysarthria.

Depending on the manifestations of disturbances in the motor side of the pronunciation process and taking into account the localization of paretic phenomena in the organs of the articulatory apparatus, the authors identifiedfour groups of children Andhighlighted the followingtypes of erased dysarthria:

disorders of sound pronunciation caused by selective inferiority of certain motor functions of the speech-motor apparatus( I group);

weakness, lethargy of articulatory muscles( II group).

These two groups belong to the erased form of pseudobulbar dysarthria.

clinical features of sound pronunciation disorders associated with difficulty in performing voluntary motor acts( III group), the authors refer to cortical dysarthria;

defects in the sound aspect of speech present in children with various forms of motor impairment( IV group), classified as mixed forms of dysarthria.

1.3 Features of differential diagnosis of dyslalia

Currently, the term dyslalia has acquired an international character, although its content, as well as the types of disorders defined by it, do not always coincide. These discrepancies are related to the basis that researchers take when describing disorders: anatomical-physiological, psychological or linguistic. In traditional descriptions that use clinical criteria, various pronunciation disorders such as dyslalia are often considered as adjacent. Descriptions based on psychological and linguistic criteria include in the concept of dyslalia either its various forms and types, or phonetic and phonetic-phonemic disorders of sound pronunciation (for example, in the works of R.E. Levina) (11).

A critical analysis of the doctrine of dyslalia from modern scientific positions requires a revision of established ideas in speech therapy. Pronunciation defects often turn out to be different in terms of their neurophysiological and psychological mechanism, the reasons that cause them, their role in the child’s overall speech development and methods of overcoming them (9).

The main goal of speech therapy for dyslalia is the formation of skills and abilities to correctly reproduce speech sounds. To correctly reproduce speech sounds (phonemes), a child must be able to: recognize speech sounds and not confuse them in perception (i.e., distinguish one sound from another by acoustic characteristics); distinguish normalized pronunciation of sounds from non-standardized ones: exercise auditory control over one’s own pronunciation and evaluate the quality of sounds reproduced in one’s own speech.

Often in the picture of a speech disorder there are simultaneously combinations of several symptoms of a different nature, which is reflected in the diagnosis. For example, a fairly common diagnosis - tongue-tied, dyslalia, stuttering with tongue-tied or dyslalia with stuttering - does not reflect the true picture of the speech condition, but is only a symptomatic diagnosis that does not reveal the nature of either tongue-tied or stuttering. Since the clinic of speech disorders, based on data from such sciences as neuropathology, pathophysiology and psychology, has won its right to independent existence, the primitive division of all cases of speechopathy into tongue-tiedness and stuttering gives way to a deeper understanding of each type of these disorders. Now more and more attention is being paid to the causal dependence of the form of speech disorder on its pathogenesis.

In my opinion, it is not essential to consider each of the forms of dyslalia, because the essence of each of them is well studied in the works of many authors M.E. Khvatseva, O.V. Pravdina, S.S. Lyapidevsky, B.M. Grinshpun and many others. I think it would be advisable to group all forms of dyslalia into a table that reflects the principles of dividing this speech disorder (10).

I would like to note that in speech therapy work with mechanical dyslalia, mixed cases are unfavorable when, in addition to the defect, there is also an erased form of dysarthria in the structure of the peripheral speech apparatus. In such cases, speech correction is greatly slowed down, and sometimes it is not possible to form the correct pronunciation of all speech sounds.

As for the group of speech disorders that are sometimes diagnosed as organic, or central, dyslalia, a number of difficulties are noted in the analysis of such forms (20). Of course, in cases where a psychoneurologist, during a brief outpatient examination, reveals pronounced organic neurological symptoms, then these forms are rightfully classified as dysarthria. But this is not always the case. In the practice of speech therapy work, we encounter children with speech therapy in whom a medical (psychoneurological) examination often does not note symptoms of organic damage to the nervous system and they are diagnosed with dyslalia. When a speech therapist begins systematic work with such a child, a number of features are revealed in its dynamics that escaped during the first outpatient study, namely: the different position of the tongue in the oral cavity at rest and the limited, inaccurate and weak movements of the tongue.

Correcting pronunciation in the functional form of dyslalia occurs without much difficulty in a short time (from several lessons to one month). The new pronunciation is easily learned by the child, and he forgets about his incorrect pronunciation (17).

Conclusions:

1. Erased dysarthria is one of the most common speech disorders encountered in speech therapy practice.

2. Issues of diagnostics and content of correctional work with children with erased dysarthria remain insufficiently developed both in theoretical and practical terms.

3. The complex structure of speech impairment with erased dysarthria requires an integrated approach in organizing and carrying out corrective measures.

4. The study of erased dysarthria is the subject of research in medical, pedagogical and linguistic disciplines. At the same time, the issue of terminology for this disorder is interpreted differently in different areas of research.

5. Thus, in the specialized literature, the choice of term defining erased dysarthria remains controversial.

In Russian speech therapy, the concept of dyslalia has developed as a type of sound pronunciation disorder that is not caused by organic disorders of the central order. It is the most common speech defect (9).

It is important to note that it is necessary to eliminate dyslalia in preschool age, because it can entail a number of complications and cause other defects in oral and written speech. In the concept of dyslalia, functionally caused pronunciation disorders and organically caused disorders (with anatomical anomalies of the organs of articulation) are divided into independent forms of dyslalia. For modern speech therapy, the search for methodologically justified ways to develop correct sound pronunciation continues to be relevant.

One way or another, “dyslalia in children depends not so much on the imperfection of the functions of their auditory analyzer, but on the difficulties of developing appropriate articulatory patterns, i.e. from the difficulties of developing complex coordination of movements of the organs of speech articulation.”

2. Differential diagnosis of the erased form of dysarthria and dyslalia

2.1 Research by domestic speech therapists on the issue of differential diagnosis of the erased form of dysarthria and dyslalia

Among the various speech disorders in childhood, functional dyslalia and a mild form of dysarthria present great difficulties for differential diagnosis and speech therapy work.

When choosing an adequate correction technique and to achieve the maximum result of speech therapy work to overcome violations of the phonetic side of speech, the issues of differential diagnosis of articulatory disorders that are externally similar in manifestations are relevant.

A review of literature data shows that erased forms of dysarthria remain insufficiently studied, the issue of differential diagnosis of erased forms of dysarthria and complex dyslalia is not sufficiently covered, and a systematic approach to the correction of this speech disorder has not been developed (3, p. 11).

To distinguish erased forms of dysarthria from complex dyslalia, a comprehensive medical and pedagogical study is necessary: analysis of medical and pedagogical documentation, study of anamnestic data.

The study of the differential diagnosis of erased forms of dysarthria and dyslalia is of interest for neurology and speech therapy, and requires further development of techniques for early neurological and speech therapy diagnostics, improvement of methods of speech therapy work in the pre-speech period and in the first years of life with children with perinatal brain lesions and with children of the group risk, improving methods of correctional work with children 5–6 years old, as well as strengthening the relationship in the work of a neurologist and speech therapist.

To consider the issue of differential diagnosis of these speech disorders, it seemed interesting to me to study the views of domestic speech therapists, such as Povalyaeva M.A., Arkhipova F.E., Martynova R.I. to this problem.

Povalyaeva M.A.

A broad analysis of practice has shown that erased forms of pseudobulbar dysarthria are quite often confused with dyslalia (12, pp. 102–103). However, correcting sound pronunciation with dysarthria causes certain difficulties. An analysis of cases of children with dyslalia and mild dysarthria showed that to understand these speech disorders, studying the characteristics of the speech disorder itself is not enough. Speech pathology (violation of sound pronunciation) limits the child’s abilities and social opportunities, affects his entire personality, and in some cases causes separation from the team. Ashamed of his speech defect, the child becomes withdrawn, unsure of his strengths and capabilities. Speech defects in most cases are the reason for his failure at school

Povalyaeva M.A.examined the issue of the similarity of the two disorders, proving that the erased form of dysarthria can rightfully be identified with complex dyslalia. This was one of the main steps towards studying this problem.

Martynova R.I.Thanks to this speech therapist, a comprehensive clinical and pedagogical study of children with functional dyslalia, mild dysarthria and children with normal speech was carried out. The results of this study are presented in table (9).

At the end of the study, several conclusions can be drawn that:

1. The delay in physical development was detected significantly more in children with a mild form of dysarthria than in children with functional dyslalia... and children with normal speech.

2. In children with normal speech and functional dyslalia, no abnormalities in the central nervous system were detected. In mild forms of dysarthria, neurological symptoms in the speech system were revealed only vaguely: in the form of erased paresis, hyperkinesis and impaired muscle tone in the articulatory and facial muscles. Disorders of the autonomic nervous system were especially noted in children with mild dysarthria, and to a lesser extent in functional dyslalia.

3. A comparative study of mental processes (attention, thinking memory) in the children studied showed that the difference between the studied groups is manifested not only in the violation of one local function - speech impairment, but also in the totality of all mental processes. Impairment of neuropsychic functions was significantly more pronounced in mild forms of dysarthria than in functional dyslalia.

4. A similar study of the nervous system and identification of symptoms of organic damage (with erased forms of dysarthria) showed that in these cases the rate of mental development of the child is delayed, which requires more active medical and pedagogical influence.

5. A study of psychological characteristics in children with mild dysarthria and functional dyslalia showed that the work of a speech therapist should not be limited to the production and correction of only defective sounds, but should have a wider range of correction of the child’s personality as a whole.

Arkhipova F.E.It was Arkhipova F.E. developed parameters for comparing children with an erased form of dysarthria and dyslalia, thereby making a contribution to the issue of differential diagnosis of dysarthria and dyslalia.

Gross motor skills

In children with mild dysarthriamotor clumsiness is noted. They run poorly, step awkwardly up the stairs, and often stumble. There is some lack of coordination of movements. During an examination in the speech therapist's office, the child does not stand well on one leg and cannot jump on one leg.
In a child with dyslaliathere are no motor impairments. During the examination, a neurologist does not find any neurological symptoms in him.

Fine motor skills

In a child with dysarthriaself-education skills are formed late. They hold a pencil poorly and strain their arm muscles too much. And, conversely, due to a decrease in the tone of the arm muscles, the child does not press enough on the pencil, and the lines of the drawing are sluggish. When working with a cut-out picture, the folded picture moves out of place, its parts do not exactly move from one another. It seems that the child is sloppy when doing work, but in fact it is a violation of motor skills. For the first time, a defect in orientation on a sheet of paper appears due to a violation of spatial representations. At school age, this leads to mirror writing and insufficient orientation in the notebook. Children may experience difficulties in drawing lessons at an older age when completing geometric tasks. During the examination, the child does not perform finger exercises. Characteristic is the search for movements that require fine differentiated work of the fingers: “lock”, “goat”.

In a child with dyslaliaThere are no such violations on the part of motor skills.

Articulatory apparatus

A child with erased dysarthria has:

hypertonicity: the child’s face is mask-like, the muscles are hard on palpation; lips - the position of the upper lip is characteristic - it is stretched and pressed against the upper gum, and during speech it is motionless; the tongue is always thick (or changes the shape of an “autumn cucumber”); the voice is weakened, there is no modulation (can’t imagine how a cow mooes); does not complete the “Echo” task; speech is slightly accelerated; speech exhalation is weakened; Consonants and vowels suffer.

hypotonia: the face is hypomimic (insufficient facial expressions); upon palpation, the facial muscles are flabby; mouth slightly open; the child does not maintain a closed mouth position (but ENT pathology must be excluded); shallow speech breathing; the child does not finish the endings of words, as if he makes grammatical errors; consonants usually suffer.

hypersalivation: (increased salivation) especially with increasing load. In this case, it is necessary to exclude diseases of the gastrointestinal tract (gastritis, hunger).

deviation of the tongue (deviation of the tongue from the midline) with functional load on the speech apparatus. For example, when performing the “pendulum” exercise, you need to look in which direction the tongue deviates.

hyperkinesis: (forceful movements of the tongue) degrees of hyperkinesis are distinguished: severe (the tongue twitches in the anterior-posterior direction), medium (waves run through the tongue, sometimes in the longitudinal, sometimes in the transverse direction, sometimes, this is observed only during functional load), light ( tremor of the tip of the tongue during functional load, sometimes accompanied by cyanosis (blue discoloration).

violation of the quality of articulatory movements: movements are performed, but their quality suffers; weakened muscle strength (cannot make many clicks of the tongue, rhythm suffers); the time of holding an articulatory pose is reduced.

In a child with dyslaliaUsually there are no such symptoms.

Sound pronunciation

With erased dysarthriaThe production of sounds is carried out according to the classical scheme, i.e. The methods are the same, the techniques are the same, you can use phonetic rhythms. Moreover, here the sounds are easy to place, but the automation process is lengthy. Sometimes you have to practice every sound position in a word in spontaneous speech.
For dyslaliaThe production of sound is also carried out according to the classical scheme, but the delivered sound is absorbed in the child’s speech for a long time and does not require a long process of automation.

General speech development

Children with erased dysarthriacan be roughly divided into three groups:

children whose sound pronunciation and prosody are impaired, but have good phonemic hearing, a rich vocabulary, and the grammatical structure of the language is not impaired - FN (the impairment is borderline with dyslalia, it is difficult to differentiate them).
children who have not completed the process of developing phonemic hearing. This is the FFN group + an erased form of dysarthria. There can be up to 50% of such children.
children whose underdevelopment of phonemic hearing affects the underdevelopment of the syllabic structure of the word; poor vocabulary, aggrammatisms in speech. At 5 years old, such a child can say “on the sled” instead of “on the sled.” This is a group of children who develop OHP + an erased form of dysarthria. There may be 80% of them in the group with OHP.

Prosody

In children with an erased form of dysarthriaslurred, unintelligible speech is noted - “porridge in the mouth.” Poor intonations, quiet voice, sometimes a nasal tone of speech. More often, the pace of speech is fast, accelerated, the child does not finish the endings of words and greatly reduces the pronunciation of vowel sounds (reduces to a minimum). The child’s voice is fading, begins to speak loudly, and subsides as the speech load increases. Intonation coloring deteriorates. Children with dysarthria are characterized by deterioration in speech quality with increasing load.

Among dislaliksWith repetition of exercises, the quality of speech improves.

Conclusions:

A number of observations have established that children suffering from incomprehensible, incomprehensible, at first glance seem to have identical defects. However, an in-depth study made it possible to identify two groups among these children (dysarthria and dyslalia) having a completely different nature of speech defect.

A more detailed examination is necessary for dysarthria, because This type of sound pronunciation disorder is caused not only by a violation of articulatory motor skills, but also by a violation of other components of speech. And motor disorders of the articulatory apparatus are more severe and severe compared to dyslalia. With dyslalia, there are no gross disturbances of the articulatory apparatus, and in some cases there are no articulatory disturbances at all.

With dysarthria (with the exception of erased forms), neurological symptoms appear. Children with an erased form of dysarthria resemble those with dysarthria. However, the examination reveals unfavorable factors in the anamnesis, organic microsymptoms in the neurological status, as well as difficulties in carrying out speech therapy activities. If in dyslalia the speech defect is associated with incorrect pronunciation of individual sounds or groups, then in dysarthria not only sound pronunciation suffers, but also voice, tempo, smoothness, modulation, breathing, etc.

Having summarized the conclusions of all the authors who studied issues related to dysarthria and dyslalia, we note that erased dysarthria in its manifestations is very close to complex dyslalia. The table illustrates this well.

Conclusion

In my course project, I examined in detail the issue of differential diagnosis of the erased form of dysarthria and dyslalia. The goal of finding similarities and differences in the diagnosis of these disorders, I consider, has been achieved. I also fully covered questions regarding the erased form of dysarthria.

As a result of the work, I found out that erased dysarthria is one of the most common speech disorders encountered in speech therapy practice, and the issues of diagnosis and content of correctional work with children with erased dysarthria remain insufficiently developed both in theoretical and practical terms.

It is also necessary to note that a number of observations have established that children suffering from incomprehensible, incomprehensible, at first glance seem to have identical defects. However, an in-depth study made it possible to identify two groups among these children (dysarthria and dyslalia), which have completely different natures of the speech defect.

A more detailed examination is necessary for dysarthria, since this type of sound pronunciation disorder is caused not only by a violation of articulatory motor skills, but also by a violation of other components of speech. And motor disorders of the articulatory apparatus are more severe and severe compared to dyslalia. With dyslalia, there are no gross disturbances of the articulatory apparatus, and in some cases there are no articulatory disturbances at all.

Cases of sound pronunciation disorder combined with voice and breathing disorders cannot be considered as complex dyslalia or delayed speech development. In these cases, the correct conclusion is: an erased form of dysarthria, in which it is necessary to carry out special complex correctional work, combined with massage, exercise therapy, special articulatory gymnastics aimed at developing and strengthening the articulatory muscles, massage of the articulatory apparatus.

Thus, the issue of differential diagnosis of the erased form of dysarthria and dyslalia remains open and insufficiently studied today. But since speech therapy science is developing every year, it is quite likely that in a few years this issue will not be problematic.

References

Arkhipova E.F. Erased dysarthria. – M., 2006.

Gurovets G.V., Mayevskaya S.I. On the issue of diagnosing erased forms of pseudobulbar dysarthria // Questions of speech therapy, - M., 1982.

Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. – 1996. – No. 5. – pp. 10–14

Speech therapy: Textbook. for students defectol. fak. ped. higher chebn. institutions /Ed. L.S. Volkova, S.N. Shakhovskaya. – 3rd ed., revised. and additional – M.: Humanite. ed. VLADOS center, 2003. – 680 p. – (Correctional pedagogy). From 173 – 177.

Speech therapy. Methodological heritage: A manual for speech therapists and students. defectol. faculties of pedagogy universities / Under. ed. L.S. Volkova: In 5 books. – M.: Humanite. ed. VLADOS center, 2003. – Book. 1: Disorders of the voice and sound-pronunciation side of speech: In 2 hours - Part 2. Rhinolalia. Dysarthria. – 304 p. – (Library of a speech pathologist teacher). From 293 – 298.

Lopatina L.V. Techniques for speech therapy examination of preschoolers with an erased form of dysarthria and differentiation of their training // Defectology. – 1986. – No. 2. – P. 64 – 70.

Lopatina L.V. Differential diagnosis of erased dysarthria and functional disorders of sound pronunciation. Proceedings of the conference “Rehabilitation of patients with speech disorders.” – S. – Petersburg, 2000. – pp. 177–182.

Martynova R.I. Comparative characteristics of children suffering from mild forms of dysarthria and functional dyslalia // Reader on speech therapy: Textbook for students of higher and secondary special pedagogical educational institutions: In 2 vols. T. 1. / Ed. L.S. Volkova and V.I. Seliverstova. – M.: Humanite. Ed. VLADOS Center, 1997. – p. 214–218 (Abridged from publication in the collection: Speech disorders and methods for their elimination. / Edited by S.S. Lyapidevsky, S.N. Shakhovskaya. – M.: 1975. – P. 79–91.

Martynova R.I. About the psychological and pedagogical characteristics of children with dysarthric and dysarthric children. Essays on pathology of speech and voice / Ed. S.S. Lyapidevsky. – M.: 1967 – From 98 – 99; 109–110.

Melekhova L.V. Differentiation of dyslalia. (Analysis of cases based on materials from a medical and pedagogical consultation at the defectology faculty of Moscow State Pedagogical Institute named after V.I. Lenin). // Essays on pathology of speech and voice. / Ed. S.S. Lyapidevsky. Vol. 3. – M.: 1967. From 80 – 85.

Fundamentals of the theory and practice of speech therapy / Ed. R.E. Levina – M., 1968 – P. 271 – 290

Povalyaeva M.A.: Speech therapist’s reference book – Rostov-on-Don: “Phoenix”, 2002.

Pravdina O.V. Speech therapy. – M.: 1969.

Speech disorders in children and adolescents / Ed. S.S. Lyapidevsky. – M.: 1969.

Pay E.F. Education of correct pronunciation in children. – M., Medgiz, 1961.

Sobotovich E.F., Chernopolskaya A.F. Manifestations of erased forms of dysarthria and methods of their diagnosis // Defectology. – M., 1974. – No. 4

Tokareva O.A. Functional dyslalia. // Speech disorders in children and adolescents / Ed. S.S. Lyapidevsky. – M.: 1969. – P. 104 – 107.

Filicheva T.B., N.A. Cheveleva, G.V. Chirkina. Fundamentals of speech therapy - M.: 1989. - 221 p. – From 82 – 85.

Khvattsev M.E. Speech therapy. – M.: 1959.

Shembel A.G. Mechanical dyslalia. Speech disorders in children and adolescents / Ed. S.S. Lyapidevsky. – M.: 1969. – P. 128–134; 140–144.

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1. Comparative characteristics of dyslalia and erased dysarthria

Dyslalia is a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus.

Sound pronunciation disorders: distortion, replacement, confusion and omission.

FORMS OF DISLALIA depending on the location of the disorder and the reasons causing the defect in sound pronunciation

depending on how many sounds are pronounced defectively

Dysarthria is a violation of the pronunciation side of speech, caused by insufficient innervation of the speech apparatus.

CLASSIFICATION OF DYSARTHRIA (based on the principle of localization, syndromological approach, degree of speech intelligibility for others)

Bulbarnaya

Pseudobulbar

Extrapyramidal (subcortical)

Cortical

Cerebellar

FORMS OF DYSARTHRIA

in children with cerebral palsy

Spastic-paretic

Spastic-rigid

Spastic-atactic

Spastic-hyperkinetic

Atactico-hyperkinetic

Differential diagnosis of erased dysarthria and dyslalia

Dislalia	Erased dysarthria
Children with somatic weakness. There are no organics.	Children with damage to the central nervous system.
There are no neurological symptoms.	The asymmetry of the face, tongue, and soft palate is clearly expressed; the mouth is slightly open at rest due to paresis of the lips; smoothness of nasolabial folds.
The motor sphere is without pathology, tendon reflexes are lively and uniform.	General, fine and articulatory motor skills suffer.
Only sound pronunciation suffers. The prognosis is favorable.	Along with sound pronunciation, prosody suffers; delivered sounds are difficult to automate.

Speech activity is increased.	Speech activity is reduced.
The child is critical of his defect.	The defect is treated indifferently.
Autonomic disorders manifest themselves in the form of sweating of the extremities and red dermographism of the skin.	Autonomic disorders are grossly expressed: cyanotic, cold, wet extremities.
Hygienic skills are developed quickly and maintained firmly. Outwardly the child is neat.	Hygienic skills are difficult to develop due to motor disorders, and the child is untidy.
Restful sleep without night fears and dreams.	Sleep disorders, night terrors, and dreams are observed.
Diaphragmatic-speech breathing is normal.	Breathing is shallow, clavicular, diaphragmatic-speech - not formalized.
The child makes contact easily and behaves appropriately.	Behavior is uneven, mood swings are frequent.
Memory, attention, performance, thought processes, intelligence are normal; mental retardation is rarely observed.	Memory is reduced, short-term; attention is unstable, low performance, reduced intelligence (mental retardation, mental retardation).
The child is active, mobile, engages willingly, and switches from one type of activity to another without much difficulty.	They are slow or disinhibited, avoid activities, complain of headaches, and have difficulty switching from one type of activity to another.

2. Comparative characteristics of rhinolalia and dysphonia

FORMS OF RINOLALIA

Open rhinolalia

Closed rhinolalia

Mixed rhinolalia

With the open form of rhinolalia, oral sounds become nasal. The timbre of the vowels “i” and “u” changes most noticeably, during the articulation of which the oral cavity is most narrowed. The vowel “a” has the least nasal connotation, since when it is pronounced the oral cavity is wide open.

The timbre is significantly impaired when pronouncing consonants. When pronouncing sibilants and fricatives, a hoarse sound is added that occurs in the nasal cavity. Explosive “p”, “b”, “d”, “t”, “k” and “g” sound unclear, since the necessary air pressure is not generated in the oral cavity due to incomplete closure of the nasal cavity.

The air flow in the mouth is so weak that it is not sufficient to vibrate the tip of the tongue necessary to produce the sound "r"

Organic open rhinolalia can be acquired or congenital. Acquired open rhinolalia is formed with perforation of the hard and soft palate, with cicatricial changes, paresis and paralysis of the soft palate. The cause may be damage to the glossopharyngeal and vagus nerves, injuries, tumor pressure, etc.

Closed rhinolalia occurs when physiological nasal resonance is reduced during the production of speech sounds. The strongest resonance is for the nasal m, m", n, n". When pronounced normally, the nasopharyngeal valve remains open and air enters directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like oral sounds b, b" d, d". In speech, the opposition of sounds on the basis of nasal - non-nasal disappears, which affects its intelligibility. The sound of vowel sounds also changes due to the deafening of individual tones in the nasopharyngeal and nasal cavities. In this case, vowel sounds acquire an unnatural connotation in speech.

Some authors (M. Zeeman, A. Mitronovich-Modrzejewska) identify mixed rhinolalia - a speech condition characterized by reduced nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The cause is a combination of nasal obstruction and insufficiency of velopharyngeal contact of functional and organic origin. The most typical are combinations of a shortened soft palate, its submucosal cleft and adenoid growths, which in such cases serve as an obstacle to air leakage through the nasal passages during the pronunciation of oral sounds.

FORMS OF DYSPHONIA

1) organic (for inflammatory diseases of the larynx: laryngitis, laryngotracheitis, etc.);

2) functional dysphonia (in the absence of inflammation in the larynx).

The following types of functional dysphonia are distinguished:

* hypotonic - decreased muscle tone of the vocal folds, their incomplete closure (observed during laryngoscopy), which is manifested by rapid fatigue, decreased strength and hoarseness of the voice;

* hypertonicity - increased muscle tone of the vocal folds (during laryngoscopy, complete closure of the vocal cords during phonation is noted), which is manifested by hoarseness, pain in the larynx, pharynx and neck;

* hypo-hypertonicity - a decrease in the tone of the muscles of the vocal folds with a simultaneous increase in the tone of the vestibular folds of the larynx (phonation occurs not due to the vocal folds, but due to the vestibular folds), which is manifested by constriction and dryness of the voice;

* mutational - usually occurs in children, more often in boys during puberty. Manifests itself as an unstable voice tone (transitions from high to low pitch);

* spastic - excessively intense work and incoordination of the external and internal muscles of the larynx, as well as the respiratory muscles, which appears in a tense, unnatural, or silent, airy voice. These manifestations can replace each other every day.

Based on duration, dysphonia is divided into:

* short-term (usually with organic type of dysphonia);

* persistent (more often with functional dysphonia).

Differential diagnosis of rhinolalia and dysphonia

symptoms	With open organic rhinolalia caused by congenital facial clefts, the child’s vital functions of nutrition and breathing suffer from the first days of life. When feeding a baby, milk leaks out through the nose, so the newborn does not gain enough weight and does not receive the necessary nutrients. The inhaled air does not have time to warm up sufficiently in the nasal passages, because it immediately enters the lower respiratory tract through the cleft. Children with palatal clefts and open rhinolalia are predisposed to malnutrition, otitis media, eustachitis, bronchitis, and pneumonia. Congenital cleft palates are often combined with malocclusion. The state of intelligence in children with open rhinolalia can be different - from normal to mental retardation and mental retardation of varying degrees. Neurological signs are often observed in children: nystagmus, ptosis, hyperreflexia. The prelinguistic period in children with rhinolalia proceeds abnormally: attention is drawn to the absence of modulated and varied babbling, quiet or silent articulation of sounds. Speech development with rhinolalia is also delayed: the child often pronounces his first words after 2 years. Speech is slurred, inexpressive and incomprehensible to others. With open organic rhinolalia, the articulation of sounds and sound pronunciation are grossly impaired. The root of the tongue is constantly in a raised position, and the tip of the tongue is in a passive, lowered position, and therefore most of the consonants acquire a “back-lingual” connotation and resemble the sound [x]. With open rhinolalia, all sounds have a strong nasal (nasal) connotation and are practically not differentiated from each other; the voice becomes dull and quiet. In an effort to pronounce sounds more clearly, children strain their facial muscles, muscles of the lips, tongue and wings of the nose, which leads to grimaces and further worsens the overall impression of speech. Inaccurate articulation and distorted sounds are accompanied by a secondary impairment of auditory differentiation and phonemic analysis, leading to disorders of written speech - dysgraphia and dyslexia. Limitation of speech contacts in children with rhinolalia leads to insufficient development of vocabulary and grammatical aspects of speech, i.e. ONR. If a child with open organic rhinolalia realizes and experiences his defect, this causes him to develop secondary mental layers: isolation, irritability, shyness. With open functional rhinolalia, it is mainly the sound pronunciation of vowels that suffers; consonant sounds remain intact due to sufficient velopharyngeal closure. Closed organic rhinolalia is accompanied by a violation of the pronunciation of nasal sounds ([m], [m"], [n], [n"]), replacement of [m] with [b], [n] with [d]. At the same time, the timbre of the voice also suffers; Due to the impossibility of nasal breathing, children are forced to breathe through their mouths. Children with closed organic rhinolalia are prone to colds and the development of asthenic syndrome. With closed functional rhinolalia, the voice acquires a dull, unnatural, dead tone.	The variety of forms of functional voice disorders determines the differences in their clinical manifestations. Common symptoms for dysphonia, aphonia, and phonasthenia are constant or periodic hoarseness and voice fatigue. Each form of the disease has characteristic clinical manifestations. With hypokinetic (paretic) dysphonia, the vocal folds are usually slightly hyperemic, and during phonation a gap of various shapes (oval, triangular) is formed. Hyperkinetic (spastic) dysphonia is characterized by a state of spastic hyperkinesis of the laryngeal muscles with a predominance of tonic spasm. During phonation, there is a convulsive convergence of the vocal folds and the folds of the vestibule. The most severe form of functional voice disorder is spasmodic dysphonia. The onset of spasmodic dysphonia is usually acute and is usually caused by mental trauma, which in some cases is preceded by prolonged vocal strain. The disease of spasmodic dysphonia is persistent and long-lasting and has a negative impact on the mental state of patients. Hypotonic dysphonia, a persistent functional voice disorder, is characterized by incoordination of all parts of the vocal apparatus. With hypotonic dysphonia it is determined: Special psychological examinations by L. E. Goncharuk (1986) established that persistent functional voice disorders are not only a disease of the larynx, but are associated with disorders of the neuropsychic sphere.
	1. lowering the initial consonant (“ak” - “so”, “am” - “there”); 2. neutralization of dental sounds according to the method of formation; 3. replacing plosives with fricatives; 4. whistling background when pronouncing hissing sounds or vice versa (“ssh” or “shs”); 5. absence of vibrant r or replacement with the sound s during strong exhalation; 6. adding additional noise to nasal sounds (hissing, whistling, aspiration, snoring, throatiness, etc.); 7. moving articulation to more posterior zones (the influence of the high position of the root of the tongue and the small participation of the lips in articulation). For example, the sound "s" is replaced by the sound "f" without changing the method of articulation. Characteristic is a decrease in the intelligibility of sounds in a combination of consonants in the final position.	sound pronunciation is not impaired
Violation speeches	With rhinolalia, speech develops late (the first words appear by two years and much later) and has qualitative features. Impressive speech develops relatively normally, while expressive speech undergoes some qualitative changes. First of all, it should be noted that the patients’ speech is extremely slurred. The words and phrases that appear in them are difficult to understand for those around them, since the sounds that are formed are unique in articulation and sound. Due to the defective position of the tongue in the oral cavity, consonant sounds are formed mainly due to changes in the position of the tip of the tongue (with little participation of the tongue root in articulation) with excessive activation of the facial muscles. These changes in the position of the tip of the tongue are relatively constant and correlate with the articulation of certain sounds. Pronunciation of some consonant sounds is particularly difficult for patients. Thus, they cannot implement the necessary barrier at the upper teeth and alveoli to pronounce the sounds of the upper position: l, t, d, ch, sh, shch, zh, r; at the lower incisors to pronounce sounds s, z, c with simultaneous oral exhalation; Therefore, whistling and hissing sounds in rhinolalics acquire a peculiar sound. The sounds k and g are either absent or replaced by a characteristic explosion. Vowel sounds are pronounced with the tongue pulled back and air exhaled through the nose and are characterized by sluggish labial articulation. Thus, vowels and consonants are formed with a strong nasal connotation. Their articulation is often significantly changed, and the sounds are not clearly differentiated from each other. For the patient himself, such articulomes serve as kineme, i.e., a motor characteristic of a certain sound, and in his speech they perform a meaning-distinguishing function, which allows them to be used for speech communication. All sounds pronounced by the patient are perceived by ear as defective. Their common characteristic for the listener is snoring sounds with a nasal tint. In this case, unvoiced sounds are perceived as close to the sound “x”, voiced sounds - to the fricative “g”; Of these, the labial and labiodental are close to the sound “m”, and the anterior lingual are close to the sound “n” with a slight modification of the sound. Sometimes articulomes in the speech of a rhinolalic are very close to normal, and their pronunciation, despite this, is perceived by ear as defective (snoring), since speech breathing is impaired, and, in addition, excessive tension in the facial muscles occurs, which in turn affects articulation and sound effect. Thus, sound pronunciation in rhinolalia is completely affected. Patients usually lack independent awareness of their speech defect or their sensitivity to it is reduced.