Erased form of dysarthria: characteristics, treatment, prognosis. Erased dysarthria in children

Dysarthria in children is a condition in which the pronunciation of words is impaired as a result of damage to the nervous system. With this pathology, the innervation of the speech apparatus (tongue, lips and soft palate) suffers. A distinctive feature of the disease is a violation of all speech as a whole, and not just individual sounds.

Reasons for the development of dysarthria

The disease occurs in 5% of all children. There are several important factors that contribute to the occurrence of dysarthria in a child:

• intrauterine fetal hypoxia;
• Rhesus conflict pregnancy;
• severe gestosis;
• prematurity;
• asphyxia;
• birth injuries;
• prolonged jaundice;
• hydrocephalus;
• brain tumors;
• meningitis;
• encephalitis;
• purulent otitis;
• traumatic brain injury.

Quite often, dysarthria in a child occurs in combination with cerebral palsy. The causes of both pathologies are similar and are associated with damage to the baby’s nervous system in utero or during childbirth. Often, traumatic factors exert their influence in the first two years of life, leading to the formation of dysarthria.

Don't forget about regular medical examinations in the first months of your child's life. Don't miss the disease!

Classification of dysarthria

Dysarthria in children exists in several varieties. The forms of the disease are divided according to the location of the pathological focus.

• Bulbarnaya

This form of the disease is characterized by paralysis of the muscles directly responsible for speech formation. With this pathology, many nerve fibers are affected, as a result of which the activity of certain muscle groups is disrupted. Often this form of the disease is accompanied by difficulty swallowing liquid food and other disorders. Articulation in this pathology is extremely slurred, the sounds are practically indistinguishable from each other. Characterized by the absence of facial expressions.

• Pseudobulbar

Characteristics of this form of the disease include paralysis of the speech muscles as a result of damage to brain structures. Often this pathology is combined with other signs of damage to the nervous system (involuntary crying or laughter, the presence of oral automatism reflexes in a child older than 6 months). A distinctive feature of this type of dysarthria in a child is monotonous speech.

• Cortical

It is characterized by unilateral damage to the structures of the cerebral cortex, which naturally leads to paresis or paralysis of the speech muscles. Symptoms of the disease include incorrect pronunciation of individual syllables, although the overall structure of speech is preserved.

• Cerebellar

This form of the disease is characterized by damage to the cerebellum, a special structure of the brain. With this variant of the disease, the child’s speech becomes protracted, with constantly changing volume and tone.

• Subcortical

The characteristics of this variant of dysarthria include damage to the subcortical structures responsible for speech formation. The subcortical form is characterized by slurred and slurred speech. In children, it is often combined with hyperkinesis (pathological movements in various muscle groups).

• Mixed

Most often occurs with various injuries in a child under 2 years of age. This form is characterized by a combination of several causes and factors leading to the formation of dysarthria.

Signs of dysarthria

The characteristics of the pathology consist not only in identifying the cause and location of damage to the speech apparatus, but also in determining the severity of the disease. Experts identify 4 forms of the disease, differing in the severity of speech impairment in the child.

Erased dysarthria (I degree)

With this form of the disease, children are not too different from their peers. The disease is usually detected at the age of 4-5 years. The symptoms of the pathology are not very specific and can masquerade as other similar diseases of the nervous system. With an erased version of dysarthria, parents notice confusion, distortion, or replacement of some sounds with others. Very often, babies cannot pronounce whistling and hissing sounds. Many children experience certain difficulties in pronouncing long words, omitting some sounds.

The erased form of dysarthria is very similar to dyslalia, and even experienced specialists are not always able to make the correct diagnosis from the first appointment. Dyslalia in children is characterized by the appearance of various speech defects with complete preservation of the speech apparatus. In contrast, with dysarthria, the innervation of the muscles responsible for the formation of speech in a child is disrupted. Dyslalia is more often found in children 6-7 years old and schoolchildren, while erased dysarthria is detected a little earlier.

Have you discovered a speech defect in your child? Consult a doctor!

Erased dysarthria is accompanied by other symptoms. Many children experience a decrease in the intonation coloring of speech. Often the voice takes on a characteristic nasal tone. Most children with an erased form of the disease are not able to imitate various sounds (for example, imitate the meow of a cat or the moo of a cow). The monotony of the voice is characteristic when reciting poetry or retelling text.

The erased form of dysarthria is the mildest variant of the disease.

II degree of dysarthria characterized by fairly understandable speech with pronounced pronunciation defects. It is possible to understand a child, but this requires some effort. Treatment of dysarthria is most effective in the first and second stages of the disease.

In stage III of the disease The baby's speech becomes understandable only to his parents and some close people. It can be quite difficult for outsiders to understand a child’s words.

In stage IV, the baby’s speech is incomprehensible even to parents or is completely absent.

Examination of children with dysarthria includes:

• examination by a neurologist;
• consultation with a speech therapist;
• EEG (electroencephalography) and other electrophysiological methods;
• transcranial magnetic stimulation;
• MRI of the brain.

An examination by a speech therapist consists of several stages:

• assessment of existing speech disorders;
• definition of non-articulation disorders;
• assessment of the work of facial and facial muscles;
• speech research (pronunciation, rhythm, tempo and intelligibility);
• assessment of written language (for children over 5 years old).

The success of disease correction largely depends on the form of dysarthria, severity and the presence of concomitant pathology. Erased dysarthria is the easiest to treat. For this type of disease, observation by a neurologist is recommended, as well as regular sessions with a speech therapist.

Treatment of dysarthria necessarily includes the following steps:

• stimulation of physiological respiration;
• development of speech breathing (breathing exercises);
• activation of the speech apparatus (including gymnastics and massage);
• stimulation of fine motor skills;
• voice development;
• correction of sound pronunciation;
• development of tonality and expressiveness of speech;
• stimulation of speech communication.

Currently, there are many sections and clubs for children with speech defects. In some of them, classes are conducted in the presence of parents. Individual lessons with a speech therapist are also possible.

Drug treatment is prescribed when neurological diseases that contribute to the development of speech disorders are identified. In this case, the symptoms of dysarthria in a child are combined with various motor and sensory disorders. Treatment of the underlying disease is carried out by a neurologist, after which a speech therapist corrects speech disorders.

Nootropic drugs are actively used in the treatment of neurological diseases. This treatment stimulates mental activity, improves memory and attention, and increases learning ability. Of the most popular drugs, it is worth noting glycine, Cerebrolysin, Phenibut, Pantogam and Encephabol. Treatment with nootropic drugs is quite long. The dosage and frequency of taking medications are determined by the doctor.

Do not take nootropics without a doctor's prescription!

Treatment for dysatria also includes physical therapy. A good effect has been seen from acupressure, exercise therapy and medicinal baths. A child’s massage must be performed by a specialist who understands all the intricacies of therapy. Acupuncture and other methods of influencing reflexogenic zones are also actively used to treat speech disorders in children.

Great importance is attached to contact with parents in the treatment of the disease. Effective treatment of dysarthria is impossible in isolation. Parents of a sick child should spend as much time as possible with their child and encourage his attempts to speak correctly. Many children, ashamed of their defect, withdraw and prefer to simply remain silent. Parents should gently and carefully lead their child to the fact that speech needs to be developed, and together with the child, master all the exercises recommended by the speech therapist.

The prognosis of the disease depends on the form and severity. Mild dysarthria in children can be easily corrected with timely consultation with a doctor. The sooner treatment is started, the greater the chance of developing the child’s speech and helping him adapt to the world around him. Erased dysarthria has a fairly favorable prognosis - up to complete speech correction.

Prevention of the disease consists of preventing intrauterine fetal hypoxia, as well as protecting the baby from injury during childbirth. Such measures help prevent damage to the newborn’s brain, and therefore protect the child from dysarthria and other diseases of the nervous system. When the first signs of speech impairment appear, you should consult a doctor.

Anastasia Pelin
The concept of “erased dysarthria” in domestic speech therapy.

Erased dysarthria - speech pathology, manifested in disorders of the phonetic and prosodic components of the speech functional system and arising as a result of unexpressed microorganic damage to the brain.

Erased dysarthria occurs very often in speech therapy practice. Main complaints when erased dysarthria: slurred, inexpressive speech, poor diction, distortion and replacement of sounds in complex words syllabic word structure, etc.

Diagnostics erased dysarthria and methods of correctional work have not yet been sufficiently developed. The works of G.V. Gurovets, R.I. Martynova, O.V. Pravdina, O.A. Tokareva and others discuss issues of symptoms dysarthric speech disorders, at which it is observed "washed away", « weariness» articulation. The authors note that erased dysarthria its manifestations are very similar to complex dyslalia. Diagnosis questions are increasingly being raised, speech therapy work and differentiation of learning in groups of preschoolers with erased dysarthria. Problems of diagnosis and organization speech therapy assistance to children with severe dysarthria remain relevant given this defect.

Causes of occurrence dysarthria are various harmful factors (viral infections, toxicosis, pathology of the placenta, which can affect in utero, at the time of birth (protracted, rapid labor) and at an early age (diseases of the brain and brain shells: meningitis, encephalitis, etc.) With dysarthria the transmission of impulses from the cerebral cortex to the nuclei of the cranial nerves is disrupted at different levels. In this regard, to the muscles (respiratory, vocal, articulatory) nerve impulses do not arrive, the function of the main cranial nerves directly related to speech is disrupted (trigeminal, facial, hypoglossal, glossopharyngeal, vagus nerves). For example, a violation of the ternary nerve leads to difficulties in opening and closing the mouth, chewing, swallowing, and movements of the lower jaw. The facial nerve innervates the facial muscles. In case of defeat, the face is amicable, mask-like, it is difficult to close your eyes, frown your eyebrows, and puff out your cheeks. If the hypoglossal nerve is damaged, the mobility of the tongue is limited, and difficulties arise in holding the tongue in a given position. When the glossopharyngeal nerve is damaged, a nasal tone of voice occurs, a decrease in the pharyngeal reflex is observed, and the small tongue deviates to the side. The vagus nerve innervates the muscles of the soft palate, pharynx, larynx, vocal folds, and respiratory muscles. The lesion leads to inadequate functioning of the muscles of the larynx and pharynx, impaired respiratory function [4.]

According to E.F. Arkhipova, in the early period of a child’s development these disorders manifest themselves as follows: way:

· Infancy: due to pareticity of the muscles of the tongue and lips, breastfeeding is difficult - breastfeeding is applied late (3-7 days, sluggish sucking, frequent regurgitation, choking are noted.

· At an early stage of speech development, children may lack babbling, the sounds that appear have a nasal tint, and the first words appear late (by 2-2.5 years). With the further development of speech, the pronunciation of almost all sounds suffers severely.

E. F. Arkhipova offers the following classification dysarthria. By localization defeats:

When the peripheral motor neuron and its connection to the muscle are damaged, peripheral paralysis occurs. When the central motor neuron is damaged and its connection with the peripheral neuron, central paralysis develops. Peripheral paralysis is characterized by the absence or decrease of reflexes, muscle tone, and muscle atrophy. All this is explained by the interruption of the reflex arc. Central paralysis occurs when the central motor neuron is damaged in any part of it (motor area of ​​the cerebral cortex, brain stem, spinal cord). Interruption of the pyramidal tract removes the influence of the cerebral cortex, which leads to increased excitability of the peripheral segmental apparatus. Central paralysis is characterized by muscle hypertension, hyperreflexia, the presence of pathological reflexes and pathological synkinesis. With peripheral paralysis, voluntary and involuntary movements suffer, with central paralysis, mainly voluntary ones. Peripheral paralysis is characterized by a diffuse impairment of articulatory motor skills, while with central paralysis, fine differentiated movements are impaired. Differences are also observed in muscle tone: Thus, with peripheral paralysis there is no tone, with central paralysis elements of spasticity predominate. For peripheral paralysis (bulbar dysarthria) articulation of vowels is reduced to a neutral sound, vowels and voiced consonants are deafened. For central paralysis (pseudobulbar dysarthria) The articulation of vowels is pushed back, consonants can be both voiced and deafened.

By severity:

anarthria - complete impossibility of the pronunciation side of speech

· dysarthria(pronounced)- the child uses oral speech, but it is inarticulate, obscure, sound pronunciation is grossly impaired, as well as breathing, voice, intonation expressiveness

· erased dysarthria - all symptoms(neurological, psychological, speech) expressed in erased form. Erased dysarthria may be confused with dyslalia. Their difference is that children with erased dysarthria neurological focal microsymptoms appear.

By manifestations (built on the basis of a syndromic approach):

· spastic-paretic dysarthria

spastic-rigid dysarthria

· spastic-hyperkinetic dysarthria

· spastic-atactic dysarthria

ataxico-hyperkinetic dysarthria

This classification takes into account and differentiates neurological symptoms. Define Shape dysarthria Only a neurologist can. The main distinguishing feature dysarthria from other pronunciation disorders is that the entire pronunciation side of speech suffers. And dysarthria can be observed in both severe and mild forms.

O. V. Pravdina’s studies of children in mass kindergartens showed that in senior and preparatory school groups from 40 to 60% of children have deviations in speech development. Among the most common violations: dyslalia, rhinophony, phonetic-phonemic underdevelopment, erased dysarthria.

In children with erased dysarthria Pathological features in the articulatory apparatus are revealed. Pareticity of the muscles of the organs of articulation is manifested in the fact that What: facial muscles are flaccid upon palpation, the face is hypomimetic; Children cannot maintain the closed mouth pose; lips are limp; During speech, the lips remain flaccid and the necessary labialization of sounds is not produced, which worsens the prosodic aspect of speech. The tongue with paretic symptoms is thin, flaccid, the tip of the tongue is inactive, the tongue is at the bottom of the mouth.

The child's lips are constantly in a half-smile. During speech, the lips do not take part in the articulation of sounds. [ 13.]

At erased dysarthria apraxia is revealed simultaneously in the inability to perform voluntary movements with the hands and organs of articulation. In the articulatory apparatus, apraxia manifests itself in the inability to perform certain movements or when switching from one movement to another. Kinetic apraxia can be observed when the child cannot smoothly transition from one movement to another. Other children have kinesthetic apraxia, when the child makes chaotic movements, "groping" the desired articulatory position.

Hyperkinesis with erased dysarthria manifest themselves in the form of trembling, tremor of the tongue and vocal cords. Tremor of the tongue appears during functional tests and loads. For example, when asked to maintain a wide tongue on the lower lip with a count of 5-10, the tongue cannot maintain a state of rest, trembling and slight cyanosis appear (i.e., blue discoloration of the tip of the tongue, and in some cases the tongue is extremely restless (waves roll along the tongue in the longitudinal or transverse direction). In this case, the child cannot keep his tongue out of the mouth. Hyperkinesis of the tongue is often combined with increased muscle tone of the articulatory apparatus.

Hypersalivation (increased salivation) determined only during speech. Children cannot cope with salivation, do not swallow saliva, and the pronunciation side of speech and prosody suffer.

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.

General motor skills. Children with erased dysarthria motor awkwardness, the range of active movements is limited, muscles quickly tire during functional loads. They stand unsteadily on one leg, cannot jump on one leg, or walk along "bridge" etc. Poor imitation movements: how a soldier walks, how a bird flies, how bread is cut, etc. Motor incompetence is especially noticeable in physical education and music classes, where children lag behind in tempo, rhythm of movements, as well as in switching movements.

Fine hand motor skills. Children with erased dysarthria late and have difficulty mastering skills self-service: they cannot fasten a button, untie a scarf, etc. During drawing classes they do not hold a pencil well, their hands are tense. Many people don't like to draw. Motor clumsiness of the hands is especially noticeable during applique classes and with plasticine. In works on appliqué, difficulties in the spatial arrangement of elements can also be traced. Violation of fine differentiated movements of the hands is manifested when performing sample tests of finger gymnastics. Children find it difficult or simply cannot perform an imitation movement without assistance, for example, "lock"- put your hands together, intertwining your fingers; "rings"- alternately connect the index, middle, ring and little fingers with the thumb and other finger gymnastics exercises.

During origami classes they experience enormous difficulties and cannot perform the simplest movements, since both spatial orientation and subtle differentiated hand movements are required. According to mothers, many children under 5-6 years old are not interested in playing with construction sets, do not know how to play with small toys, and do not assemble puzzles. School-age children in the first grade experience difficulties in mastering graphic skills (some experience "mirror letter"; replacing letters "d"-"b"; vowels, word endings; bad handwriting; slow pace of writing, etc.).

When examining the motor function of the articulatory apparatus in children with erased dysarthria the possibility of performing all articulation tests is noted, i.e., children perform all articulatory movements according to instructions - for example, puff out their cheeks, click their tongue, smile, stretch out their lips, etc. When analyzing the quality of performing these movements, it is possible Mark: blurredness, unclear articulation, weak muscle tension, arrhythmia, decreased range of movements, short duration of holding a certain position, decreased range of movements, rapid muscle fatigue, etc. Thus, with functional loads, the quality of articulatory movements drops sharply. During speech, this leads to distortion of sounds, their mixing and deterioration in the overall prosodic aspect of speech.

Prosody. Intonation-expressive coloring of the speech of children with erased dysarthria is sharply reduced. The voice, vocal modulations in pitch and strength suffer, speech exhalation is weakened. The timbre of speech is disrupted and sometimes a nasal tone appears. The pace of speech is often accelerated. When reciting a poem, the child’s speech is monotonous, gradually becomes less intelligible, and the voice fades away. The voice of children during speech is quiet, modulation in pitch and strength of the voice is not possible (the child cannot change the pitch of the voice by imitation, imitating voices animals: cows, dogs, etc.).

In some children, speech exhalation is shortened, and they speak while inhaling. In this case, speech becomes choked. Quite often, children are identified (with good self-control), in whom, during a speech examination, deviations in sound pronunciation do not appear, since they pronounce words in a scanned manner, that is, syllable by syllable, and only a violation of prosody comes first.

General speech development. Children with erased dysarthria can be roughly divided into three groups.

First group. Children who have impaired sound pronunciation and prosody. This group is very similar to children with dyslalia. Often speech therapists they are led as dislaliks and only in the process speech therapy work, when there is no positive dynamics when automating sounds, a suspicion arises that this is erased dysarthria. Most often, this is confirmed during an in-depth examination and after consultation with a neurologist. These children have a good level of speech development, but many of them have difficulties in acquisition, discrimination and reproduction prepositions. Children confuse complex prepositions and have problems distinguishing and using prefixed verbs. At the same time, they speak coherent speech and have a rich vocabulary, but may have difficulty pronouncing complex words. syllable structure(for example, a frying pan, tablecloth, button, snowman, etc.). In addition, many children have difficulties with spatial orientation (body diagram, concepts"below-above" etc.).

Sound pronunciation. When first meeting a child, his sound pronunciation is assessed as complex dyslalia or simple dyslalia. When examining sound pronunciation are revealed: mixing, distortion of sounds, replacement and absence of sounds, i.e. the same options as with dyslalia. But, unlike dyslalia, speech with erased dysarthria has violations on the prosodic side. Impaired pronunciation and prosody affect speech intelligibility, intelligibility, and expressiveness. Some children go to the clinic after classes with speech therapist. Parents ask why the sounds that speech therapist delivered, are not used in the child’s speech. The examination reveals that many children who distort, omit, mix or replace sounds can pronounce these same sounds correctly in isolation. Thus, the sounds erased dysarthria are put 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 whistling and hissing sounds. Children with erased dysarthria distort, mix not only articulatory complex sounds and sounds 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 complex words syllable structure, simplify sound filling by omitting some sounds when consonants are combined.

Thus, children with erased dysarthria preschool age is characterized by certain symptoms.

E. F. Sobotovich and A. F. Chernopolskaya identify four groups of children with erased dysarthria.

These are children with insufficiency of some motor functions of the articulatory apparatus: selective weakness, pareticity of some muscles of the tongue. Asymmetric innervation of the tongue, weakness of movements of one half of the tongue cause such violations of sound pronunciation as lateral pronunciation of soft whistling sounds [s, ] and [z, ], affricates [ts], soft anterior lingual [t, ] and [d, ], posterior lingual [g ], [k], [x], lateral pronunciation of vowels [e], [i], [s].

Asymmetrical innervation of the anterior edges of the tongue causes lateral pronunciation of the entire group of whistling, hissing sounds [r], [d], [t], [n]; in other cases, this leads to interdental and lateral pronunciation of the same sounds. The causes of these disorders, according to Sobotovich, are unilateral paresis of the sublingual (XII) and facial (VII) nerves that carry erased unexpressed character. A small proportion of children in this group have phonemic underdevelopment associated with distorted pronunciation of sounds, in particular, underdevelopment of phonemic analysis skills and phonemic representations. In most cases, children have an age-appropriate level of development of the lexical and grammatical structure of speech.

In children of this group, no pathological features of general and articulatory movements were revealed. During speech, sluggish articulation, unclear diction, and general blurred speech are noted. The main difficulty for this group of children is pronouncing sounds that require muscle tension. (sonorants, affricates, consonants, especially plosives). Thus, children often skip the sounds [r], [l], replace them with fricatives, or distort them (labial lambdacism, in which the stop is replaced by a labiolabial fricative); single-beat rhoticism resulting from difficulty vibrating the tip of the tongue. There is a splitting of affricates, which are most often replaced by fricative sounds. Violation of articulatory motility is mainly observed in dynamic speech-motor processes. The general speech development of children is often age appropriate. Neurological symptoms manifest themselves in the smoothness of the nasolabial fold, the presence of pathological reflexes (proboscis reflex, deviation of the tongue, asymmetry of movements and increased muscle tone. According to E.F. Sobotovich and A.F. Chernopolskaya, in children of groups 1 and 2 there is erased pseudobulbar dysarthria.

Children have all the necessary articulatory movements of the lips and tongue, but there are difficulties in finding the positions of the lips and especially the tongue according to instructions, by imitation, based on passive displacements, i.e., when performing voluntary movements and in mastering subtle differentiated movements. A feature of pronunciation in children of this group is the replacement of sounds not only in place, but also in the method of formation, which is inconsistent. In this group of children, phonemic underdevelopment of varying degrees of severity is noted. The level of development of the lexico-grammatical structure of speech ranges from normal to pronounced OHP. Neurological symptoms manifest themselves in increased tendon reflexes on one side, increased or decreased tone on one or both sides. The nature of articulatory movement disorders is considered by the authors as manifestations of articulatory dyspraxia. In children of this group, according to the authors, there is erased cortical dysarthria.

This group consists of children with severe general motor impairment, the manifestations of which are varied. Children exhibit inactivity, stiffness, slowness of movement, and a limited range of movements. In other cases, there are manifestations of hyperactivity, anxiety, and a large number of unnecessary movements. These features are also manifested in the movements of the articulatory organs: lethargy, stiffness of movements, hyperkinesis, a large number of synkinesis when performing movements of the lower jaw, in the facial muscles, inability to maintain a given position. Violations of sound pronunciation are manifested in replacement, omissions, and distortion of sounds. A neurological examination of children in this group revealed symptoms of organic damage to the central nervous system (deviation of the tongue, smoothness of the nasolabial folds, decreased pharyngeal reflex, etc.). The level of development of phonemic analysis, phonemic representations, as well as the lexico-grammatical structure of speech varies from normal to significant OHP. This form of violation is defined as erased mixed dysarthria.

The criteria for differentiating groups are the quality of pronunciation speeches: the state of sound pronunciation, prosodic aspects of speech, as well as the level of formation of linguistic funds: vocabulary, grammatical structure, phonemic hearing. General and articulatory motor skills are assessed. Common to all groups of children is persistent impairment sound pronunciations: distortion, replacement, mixing, difficulties in automating the delivered sounds. All children in these groups are characterized by a violation prosody: weakness of voice and speech exhalation, poor intonation.

Thus, children with erased dysarthria represent a heterogeneous group.

ERASED FORM OF DYSARTHRIA AS A STABLE SYMPTOMOCOMPLEX

A MODERN VIEW AT THE PROBLEM

As a special type of speech disorder, the erased form of dysarthria began to stand out in speech therapy relatively recently - in the 50-60s of the 20th century.

In her classification of disorders of the sound pronunciation aspect of speech, based on the pathogenetic principle, R.A. Belova-David distinguished two main types: dyslalia, associated with the functional nature of the disorder, and dysarthria, caused by organic damage to the central nerve - no system.

Systematizing sound pronunciation disorders in preschoolers taking into account the pathogenesis of sound pronunciation disorders, E.F. Sobotovich identified sound pronunciation deficiencies that manifested themselves against the background of neurological symptoms and had an organic basis, but were of an erased, unexpressed nature. She qualified them as dysarthric disorders, noting that the symptoms of these disorders differ from the manifestations of those classical forms of dysarthria that occur with cerebral palsy.

Other domestic and foreign researchers also pointed out that there is a group of children with disorders of the formation of the sound side of speech, the symptoms and nature of which do not correspond to either dyslalia or dysarthria.

For a long time, the nature of these disorders remained unclear, which was also manifested in the variability of terminology (apractical dysarthria, articulatory dyspraxia, organic, central or complicated - “protracted” - dyslalia, functional dysarthria, minor dysarthria, minimal dysarthria disorders, etc.) . Subsequently, in the studies of E.F. Sobotovich, R.I. Martynova, E.Ya. Sizova, E.K. Makarova, L.V. Lopatina and others, these disorders began to be designated as erased dysarthria or as an erased form of dysarthria.

The term “erased form of dysarthria” was first used by O.A. Tokareva, according to whom children suffering from this pathology can pronounce most sounds correctly, but in spontaneous speech they are poorly automated and differentiated.

It is obvious that initially researchers attributed the erased form of dysarthria to sound pronunciation disorders proper, but later these disorders were interpreted by many authors as a symptom complex that included speech and non-speech symptoms. Currently, in the domestic literature, the erased form of dysarthria is considered as a consequence of minimal brain dysfunction, in which, along with disturbances in sound pronunciation,
In the main part of speech, mild impairments of attention, memory, intellectual activity, emotional-volitional sphere, mild motor disorders and delayed formation of a number of higher cortical functions are observed. The literature emphasizes that the erased form of dysarthria in its manifestations is characterized by smoothness of symptoms, their heterogeneity, variability, different ratios of speech and non-speech symptoms, disorders of the sign (linguistic) and non-sign (sensorimotor) levels. Therefore, it poses a significant difficulty for differential diagnosis.

Domestic authors associate the etiology of the erased form of dysarthria with organic causes acting on brain structures in the prenatal, natal and early postnatal periods. In many cases, the history contains a chain of harm from all three periods of the child’s development. Researchers note that when a developing brain is exposed to a harmful factor, the damage is widespread and can contribute to delayed maturation and disruption of the functioning of structures.

Brain.

In foreign literature, the concept of “speech, or articulatory, developmental dyspraxia” (Development apraxia of speech-DAS) is used for such disorders. Among the reasons causing DAS are usually a violation of the innervation of the articulatory apparatus, movement disorders, oral apraxia as a violation of the central program for the temporary coordination of voluntary muscular movements of the articulatory apparatus, minimal

Brain dysfunction.

Domestic and foreign researchers note the presence of diverse neurological symptoms in children with an erased form of dysarthria,

Symptoms of organic damage to the central nervous system are found in the form of erased pares, changes in muscle tone, hyperkinesis (excessive involuntary movements), manifested mainly in the facial and articulatory muscles, the presence of pathological reflexes, and disruption of the autonomic nervous system.

G.V. Gurovets, S.I. Mayevskaya, B.A. Arkhipov point to dysfunction of the oculomotor nerves in children with an erased form of dysarthria, manifested in unilateral ptosis, strabismus, limitation of volume -

Ema movements of the eyeballs.

In the motor sphere, this category of children shows identical development of the functions of both hands and pseudo-left-handedness. Researchers note slowness, awkwardness, and lack of movement during

relative preservation of their volume, emphasizing that the limitation of the range of movements of the upper and lower extremities is detected mainly on one side.

Note that the general motor skills of children with an erased form of dysarthria have not been sufficiently studied, in contrast to fine motor skills, the violation of which, along with articulation, is defined by the authors as one of the leading symptoms in the erased form of dysarthria. L.V. Lopatina, N.V. Serebryakova, describing disturbances in manual motor skills in these children, note inaccuracy, lack of coordination, and insufficient dynamic organization of movements. A.V. Semenovich points to gross violations of reciprocal and synergetic sensorimotor coordination, an abundance of synkinesis.

Studies of articulatory motor skills have shown that children with an erased form of dysarthria have dysfunction of the muscles innervated by the lower branch of the trigeminal nerve, facial, hypoglossal and glossopharyngeal nerves. Dysfunction of the trigeminal nerve (V pair) manifests itself in a narrowing of the range of movements of the lower jaw. In this case, inaccuracy, limited movements, synkinesis of the lips and tongue are noted. Dysfunction of the facial nerve (VII pair) in children with an erased form of dysarthria manifests itself in smoothness, asymmetry of the nasolabial folds, insufficient volume of facial movements, and lip movements when grinning. Disturbances in the innervation of the hypoglossal nerve (XII pair) are manifested in the inability to maintain a static posture, tremor of the tip of the tongue, difficulty raising the tongue upward, hyper- or hypotonicity of the muscles. Dysfunction of the glossopharyngeal nerve (IX pair) is manifested in insufficient elevation of the soft palate (Uvula), nasal tone of speech, salivation, limited range of movements of the middle part and root of the tongue.

The authors also point out the difficulties of switching movements, reproducing simultaneous movements of articulatory organs, perseveration (obsessively repeated movements), and rearrangements when reproducing a series of movements.

The listed motor disorders of the articulatory apparatus determine a variety of phonetic deficiencies, which, according to most researchers, are dominant in the structure of the defect in the erased form of dysarthria. O.A. Tokareva points out that this category of children has more severe manifestations of sound pronunciation disorders than with dyslalia, requiring long-term speech therapy to eliminate them. Features of sound pronunciation are determined by the nature of innervation disorders and the state of the neuromuscular apparatus of the articulatory organs. According to G.V. Gurovets and S.I. Mayevskaya, the most common distortions are lateral, interdental, softened pronunciation of sounds. Children with an erased form of dysarthria often replace complex sounds with articulatory simpler ones, affricates are split into components

their components, slotted ones, are replaced by occlusive ones, hard ones - by soft ones.

Most researchers note that children with this defect are characterized by a polymorphic disorder of sound pronunciation, which manifests itself in distortions and the absence of mainly three groups of sounds: whistling, hissing, and sonorants.

According to the authors, prosodic (voice) disorders are less pronounced in this category of children. Deviations in the tempo and dynamic organization of speech are indicated. Peculiarities of voice timbre are noted (high, loud, shouting, breaking into falsetto or, conversely, quiet, low, weak), insufficient differentiation of various types of intonation. Speech is characterized by low expressiveness, monotony, and a “blurred” intonation pattern.

Many studies devoted to the study of the problem of the erased form of dysarthria (G.V. Gurovets, S.I. Mayevskaya, E.F. Sobotovich, L.V. Lopatina, etc.) note that disorders of phonemic perception are common in children of this category . It is difficult for them to distinguish between hard and soft, voiced and voiceless sounds, affricates and their constituent elements. They are characterized by distortions of the sound-syllable structure of words, difficulties in mastering sound-syllable analysis and synthesis, and the formation of phonemic representations.

The question of the mechanisms of phonemic underdevelopment in the structure of a speech defect in the erased form of dysarthria is debatable. According to the research of L.V. Lopatina, in preschool children with an erased form of dysarthria, the existence of unclear articulatory images leads to the fact that the boundaries between the auditory differential features of sounds are erased, and the lack of clear auditory perception and control contributes to the preservation of sound pronunciation defects in speech. As noted by R.E. Levina, this phenomenon is observed in violation of speech kinesthesia, which occurs with morphological and motor lesions of the speech organs. Thus, in modern defectological literature, phonemic underdevelopment in the structure of the defect in the erased form of dysarthria is considered as a secondary disorder.

Neuropsychological researchers (A.V. Semenovich, L.I. Serova, etc.) hold a different point of view. They also believe that a violation of phonemic perception, along with insufficiency of the phonetic side of speech, is one of the dominant symptoms in the erased form of dysarthria, however, it is not caused by sound pronunciation disorders, but by a systemic delay and distortion of cerebrogenesis of the brain systems.

E.F. Sobotovich, L.V. Lopatina note in children with an erased form of dysarthria the underdevelopment of the grammatical structure of speech: from a slight delay in the formation of the morphological and syntactic systems of the language to pronounced agrammatisms in the expressive system

speech. One of the reasons for the insufficient formation of the grammatical structure of speech in this category of children, in their opinion, is a violation of the differentiation of phonemes. A similar point of view is shared by N.V. Serebryakova, who points out the presence of lexicogrammatical underdevelopment of speech and disorders of coherent speech in preschoolers with an erased form of dysarthria. However, other researchers do not agree with this point of view (R.I. Martynova, G.V. Gurovets, etc.) and argue that these violations are not obligatory, they can manifest themselves in the presence of certain unfavorable factors.

Neuropsychological researchers find in children with an erased form of dysarthria a violation of the correlation between the word-name and the image of the object. Some children exhibit unformed and poor independent speech production and a delay in the development of the generalizing and regulating function of words.

A number of authors (R.I. Martynova, E.F. Sobotovich, L.V. Lopatina, etc.) reveal the peculiarities of the formation of a number of higher mental functions and processes in children with an erased form of dysarthria: weakening of mental activity according to the type of asthenia with a pronounced decrease in the functions of attention and memory, difficulties in generalizing, classifying, determining the logical sequence of events in story series, disturbances in establishing cause-and-effect relationships.

Some researchers (O.A. Krasovskaya, A.V. Semenovich, etc.) have identified defects in the selectivity of visual memory, perception, and spatial representations as typical symptoms of an erased form of dysarthria. Thus, O.A. Krasovskaya points to violations of visual recognition of objects: fragmentation of the perception of object images, violations of simultaneous gnosis and insufficient visual control. She notes that when studying the drawings of these children, the violations identified are of a different nature: from the complete collapse of visual-constructive activity, the inability to carry out a drawing either according to instructions or according to a model, to distortion of individual details, sizes, and incorrect location in space. (rotate 90 degrees). A.V. Semenovich speaks about the tendency towards inversion of the vector of visual perception (from right to left, from bottom to top) and left-side ignoring.

Researchers studying this problem conducted observations primarily of preschool children. Nevertheless, some of them (R.I. Martynova, M.P. Davydova, etc.) indicate possible difficulties in teaching children with an erased form of dysarthria at school. L.V. Lopatina and N.V. Serebryakova write that children with an erased form of dysarthria, even by the age of 7, are not sufficiently prepared to master the school curriculum in the Russian language. According to R.I. Martynova, dysgraphic errors are observed in writing in children with an erased form of dysarthria.

G.V. Chirkina also points out impairments in written speech in children with this defect: “Many children who entered public schools were completely unable to master the first grade curriculum,”

Thus, the literature notes the presence of the following symptoms of an erased form of dysarthria in children: neurological symptoms, insufficiency of visual gnosis, spatial representations, memory, impaired motor skills, prosodic aspects of speech, low level of development of sound pronunciation, phonemic perception, lexico-grammatical aspects of speech, connected speech. The mental development of these children proceeds according to a specific type and is characterized by a system-dynamic delay and distortion in the formation of a number of higher mental functions and processes.

To organize effective correctional work, it is necessary to determine the dominant symptoms that are required for the symptom complex in the erased form of dysarthria, and the secondary ones that manifest themselves in the presence of certain conditions, and also to have a good understanding of the influence of the mental development features of this category of children on the development of reading and writing,

Massive studies of speech development in older children in kindergartens revealed disorders in 40-60% of cases. Erased dysarthria is one of the mild ones, and in the practice of speech therapists it occurs quite often. In modern medicine, there are problems with diagnosing this type of dysarthria and its subsequent treatment, since motor activity usually does not suffer in such patients.

What is erased dysarthria

The erased form of dysarthria is a pathology of speech function, the cause of which is a slight damage to the brain, in which the child experiences blurred articulation, poor diction, unclear speech, distortion of hissing and whistling sounds. The shortcomings are especially noticeable when speaking quickly and when the baby is nervous. Most often, this type of disease is found in.

Among children with this form of pathology, three groups are distinguished:

• the first group - the disease manifests itself by swallowing some sounds and distorting them. The child has no problems with syllable structure, he understands the process of word formation well and knows how to use the acquired skills;
• the second group – frequent replacement of sounds with incorrect ones; the child’s phonemic chain of speech is disrupted. In complex words, syllables may be rearranged, the vocabulary lags behind;
• the third group - there is practically no correct intonation in speech, a lack of understanding of how to construct complex sentences. A pronounced impairment of understanding the sound structure of a word. Vocabulary is far behind that of healthy peers.

Children with an erased form of dysarthria are able to perform everything that teachers show them in correctional classes, but the quality of movements and articulation is often blurred, and there is weakness in the facial muscles.

Features of the manifestation of the disease

Erased dysarthria in preschool children leaves its mark on their development. Neurological studies of this disease have revealed developmental disorders of the glossopharyngeal and facial nerves, because of this, many children suffer from mobility of the tongue, lips and articulation.

Characteristic features of the development of children with an erased form of dysarthria:

1. in the first months of life they eat poorly and quickly tire when suckling;
2. then the relationship with food remains tense: in the first years the baby refuses to eat, chews poorly, sometimes holds food in his cheek without swallowing it;
3. due to poorly developed muscles of the face and tongue, problems with hygiene arise; it is difficult for such children to rinse the mouth;
4. fine motor skills also suffer: it is difficult for the child to fasten buttons on clothes, tie shoelaces, cut with scissors clearly along a line, hold a brush straight and draw an even line with it;
5. there are difficulties in moving from one activity to another;
6. when performing speech therapy exercises, due to severe fatigue, part of the tongue may turn blue;
7. It is often difficult for such a child to exercise, dance, or jump on one leg, as it is difficult for him to control his body.

The erased form of dysarthria causes problems with facial expressions in children; usually, when speaking, one can see asymmetry of the nasolabial folds, tension of the lips when trying to smile, and other difficulties with expressing emotions on the face.

Signs and causes of pathology

Diagnosis of erased dysarthria and methods for its correction are not fully developed in modern medicine, despite the frequency of this disease. A mild form of the disease may not manifest itself clearly, unlike.

Symptoms of erased dysarthria in children:

• awkward body movements, failure to follow the rhythm of the music when dancing, rapid physical fatigue;
• Such children, later than their peers, begin to hold objects tightly in their hands, learn to write and hold a pen correctly;
• there is a lack of strength in the voice;
• impaired articulation, slurred speech: swallowing sounds, sometimes even words;
• tongue tremor;
• excessive fussiness and nervousness of the child, which does not correspond to the psychological situation;
• When playing with his peers, he is somewhat inhibited and slow.

Important! The main sign of erased dysarthria, which can be seen with the naked eye, is hypomobility of the facial muscles, the child moves his lips slowly and behind speech, and is passive in conversations and active games.

Possible causes of the disease:

1. disorders in the perinatal period: severe toxicosis, hypertension in the later stages of the expectant mother, incompatibility of the immunities of the fetus and the woman, infectious diseases;
2. pathologies during childbirth: infant asphyxia, intracranial injury;
3. infections in an infant in the first year of life (FLU, meningitis, rubella, etc.).

In general, the cause of dysarthria is a disorder of brain activity that appears in the prenatal period, during childbirth, or in the first year of a baby’s life.

Treatment

The erased form of the disease, just like, requires an integrated approach to treatment. Parents, speech therapists and doctors should join the fight against speech disorders. Most often, treatment is delayed for many months and brings results very slowly. When you identify the first symptoms, you should seek examination from a neurologist.

Complex therapy includes:

• correctional classes with teachers;
• taking medications;
• working with a psychologist.

The development of fine motor skills and articulation is a key point in treatment; systematic repetition of exercises, at home and in correctional groups, can give an excellent effect. The teacher must teach parents how to properly perform a massage to relax the facial muscles or tone them, what exercises and how many times should be performed at home with the child.

Breathing exercises, which are usually included in the therapeutic course for children with this diagnosis, help establish fluency of speech and remove clumsiness in sounds and syllables. Teachers recommend focusing on play activities with the baby at home: putting together a puzzle, lacing, mosaics with small parts, recognizing an object through a bag, etc.

Auxiliary medications: sedatives (Glycine, Phenibut, Tenoten), nootropic drugs, medicinal baths. Medicines, dosage and course duration should be selected strictly by a doctor.

Attention! The success of therapeutic interventions largely depends on the coherence of interaction between teachers and parents.

Emotional disorders: stiffness, constriction, complexes in front of peers - need to be corrected in parallel with speech therapy sessions with a child psychologist. Children who undergo correctional procedures are able to study in general education institutions and catch up with their classmates in development.

The prognosis for the treatment of erased dysarthria in children is always different, if the stage of the disease is mild, then the correction is quick and easy, if it is advanced, then you can fight for many months, achieving small improvements. The effect of therapy depends on the individual mental characteristics of the child, the frequency of training with him and the correct selection of drugs.

The erased form of dysarthria is one of the most common and difficult to correct disorders of pronunciation of speech in children of preschool and primary school age. With minimal dysarthric disorders, there is insufficient mobility of individual muscle groups of the speech apparatus (lips, soft palate, tongue), general weakness of the entire peripheral speech apparatus due to damage to certain parts of the nervous system. Today it can be considered proven that in addition to specific disorders of oral speech, there are deviations in the development of a number of higher mental functions and processes responsible for the development of written speech, as well as a weakening of general and fine motor skills.

Studying the anamnesis of children with erased dysarthria, factors of unfavorable course of pregnancy and childbirth are identified, asphyxia, low Apgar score at birth, and the presence of a diagnosis of PEP - perinatal encephalopathy in the vast majority of children in the first year of life.

When getting acquainted with the early development of a child, a delay in locomotor functions is noted. Such children often refuse breastfeeding, there is a disproportion of development: they begin to stand earlier than sit, walking ahead of crawling, crawling backwards or sideways, experience motor awkwardness when walking, quickly get tired when performing certain movements, do not know how to jump, step on stairs, grab and hold the ball. There is a late appearance of finger grasping of small objects, and a long-term persistence of the tendency to grasp small objects with the entire hand.

Children with erased dysarthria have some characteristic features. In early childhood, they speak unclearly and eat poorly. They usually do not like meat, carrots, or hard apples as they find it difficult to chew. After chewing a little, the child can hold the food in his cheek until adults reprimand him. It is more difficult for such children to develop cultural and hygienic skills, which require precise movements of various muscle groups. The child cannot rinse his mouth on his own, because... his tongue and cheek muscles are poorly developed. Children with dysarthria do not like and do not want to fasten their own buttons, lace up their shoes, or roll up their sleeves. They also experience difficulties in visual arts: they cannot hold a pencil correctly, use scissors, or regulate the pressure on the pencil and brush. Such children also have difficulty performing physical exercises and dancing. It is not easy for them to learn to correlate their movements with the beginning and end of a musical phrase, and to change the nature of movements according to the beat. They say about such children that they are clumsy because they cannot clearly and accurately perform various motor exercises. It is difficult for them to maintain balance while standing on one leg, and they often do not know how to jump on their left or right leg.

Studies of the neurological status of children with erased dysarthria reveal a mosaic pattern of disturbances in the innervation of the facial, glossopharyngeal or hypoglossal nerves. The fibers of the hypoglossal nerve innervate the muscles of the tongue. These nerve fibers run in a fan-like pattern upward and forward, attaching to the mucous membrane of the back of the tongue, which gives the tongue mobility and flexibility, as well as the ability to lower the tongue downwards.

In cases of dysfunction of the hypoglossal nerve, deviation of the tip of the tongue towards paresis (deviation) is noted, and mobility in the middle part of the tongue is limited. When the tip of the tongue is raised tooth-to-tooth, its middle part quickly falls to the side of the paresis, causing the appearance of a lateral air stream. With lesions of the hypoglossal nerve, the movements of the lower jaw are difficult, there is increased salivation, and impaired swallowing function.

The glossopharyngeal nerve innervates the tongue, pharynx, middle ear, and parotid gland. In children with predominant dysfunction of the glossopharyngeal nerve, the leading symptoms are changes in the muscle tone of the root of the tongue and soft palate, which leads to phonation disorders, the appearance of nasalization, distortion or absence of posterior lingual sounds [K] [G] [X]. The voice suffers significantly; it becomes hoarse, tense, or, conversely, very quiet and weak. Thus, unintelligible speech in dysarthria is caused not only by a disorder of articulation itself, but also by a violation of the coloring of speech, its melodic-intonation side, inexpressiveness of speech, monotony, i.e. violation of prosody.

Research by Lopatina L.V. and other authors have identified disturbances in the innervation of the facial muscles in children with erased dysarthria: the presence of smoothness of the nasolabial folds, disturbances in the muscle tone of the lips and their asymmetry, a reduced range of lip movements, difficulties in stretching the lips, raising the eyebrows, and closing the eyes.

Along with this, symptoms characteristic of children with erased dysarthria are identified: difficulties in switching from one movement to another. When performing exercises for the tongue, selective weakness of some muscles of the tongue, imprecision of movements, difficulties in spreading the tongue, lifting and holding the tongue at the top, tremor of the tip of the tongue are noted; In some children, the pace of movements slows down when the task is repeated, and part of the tongue turns blue when the load increases. Many children experience rapid fatigue, hyperkinesis of the facial muscles and lingual muscles.

Features of facial muscles and articulatory motor skills in children with erased dysarthria indicate neurological microsymptoms. These disorders are most often not detected primarily by a neurologist and can only be identified during a thorough speech therapy examination and dynamic observation during correctional speech therapy work. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.

Many authors: Levina R.E., Kiseleva V.A., Lopatina L.V. – a relationship has been established between the pronunciation disorder itself and the formation of phonemic and grammatical generalizations. As R.E. Levina points out, a violation of speech kinesthesia with morphological and motor lesions of the speech organs affects the auditory perception of the entire sound system of the language. The blurred, slurred speech of these children does not provide the opportunity for the formation of clear auditory perception and self-control. This leads to the fact that children with erased dysarthria have underdevelopment of phonemic perception, which further aggravates the violation of sound pronunciation. In such children, failure to distinguish their own incorrect pronunciation inhibits the process of “adjusting” articulation in order to achieve a certain acoustic effect. In turn, a violation of phonemic perception leads to secondary underdevelopment of the grammatical structure of speech, which manifests itself as minor delays in the formation of the morphological and syntactic systems of the language, as well as pronounced agrammatisms. The main mechanism of unformed grammatical structure of speech in children with an erased form of dysarthria is a violation of phoneme differentiation. This disorder causes children difficulty in distinguishing the grammatical forms of words due to the unclearness of the auditory and kinesthetic image of the word and especially the endings.

Lopatina L.V. identifies three groups of children with erased dysarthria, familiarization with which will allow us to more accurately diagnose a speech therapy disorder. In the first group of children, the main disorder is distortion or absence of sounds. Violations of sound pronunciation are expressed in multiple distortions and absence of sounds. Phonemic hearing is fully formed. The syllable structure is not broken. Children successfully master the skills of inflection and word formation. Coherent monologue speech is formed in accordance with age standards. If we consider children with erased dysarthria within the framework of the psychological and pedagogical classification of R.E. Levina, then they can be classified as a group with phonetic underdevelopment. (FN). According to Arkhipova E.F. the number of children with an erased degree of dysarthria with the initial conclusion “complex dyslalia” is 10%.

In the second group of children, the violation of sound pronunciation is in the nature of multiple substitutions and distortions. Phonemic hearing is impaired to a greater or lesser extent. Difficulties arise when teaching them sound analysis. When reproducing words with a complex syllabic structure, there are permutations and other errors. Active and passive vocabulary lags behind the norm. Errors in grammatical formatting of speech are noted. Coherent monologue speech is characterized by the use of two-syllable, uncommon sentences. According to Levina’s classification, these are children with phonetic-phonemic underdevelopment. (FFN), according to E. F. Arkhipova, they make up approximately 30–40% of the entire group with FNF.

In the third group of children, expressive speech is unsatisfactorily formed. Difficulties in understanding complex logical and grammatical constructions of sentences are noted. Sound pronunciation disorders are polymorphic in nature. Severe phonemic hearing impairment: auditory and pronunciation differentiation of sounds is not sufficiently formed, which does not allow mastering sound analysis. The violation of the syllabic structure of words is more pronounced. Active and passive vocabulary lags significantly behind age standards, and lexical and grammatical errors are numerous and persistent. This group of children with erased dysarthria does not master coherent speech.

According to the classification of R.E. Levina, the third group of children correlates with general speech underdevelopment. (ONR). In this group, 50 to 80% of children may have an erased degree of dysarthria.

With erased dysarthria, sound pronunciation disorders are caused by violations of phonetic operations, therefore the development of articulatory motor skills becomes the most important area of ​​correctional speech therapy work. This work is carried out in two directions:

1. formation of the kinesthetic basis of movement: sensation of the position of the organs of articulation;
2. formation of the kinetic basis of movement: the movements of the tongue and articulatory organs themselves.

The defining moment in sound production is the formation of static-dynamic sensations, clear articulatory kinesthesia and a kinesthetic image of the movements of articulatory muscles. The work must be carried out with maximum connection of all analyzers. Shakhovskaya S.N. recommended using all analyzers in speech therapy classes. The same thing should be said, depicted, looked at, i.e. pass through the “gate” of all senses. The success of working on sound is determined by the ability to form conscious kinesthetic supports in children. It is important that the child can feel the position and movements of the articulatory organs at the moment of articulation (for example, the rise of the back of the tongue when pronouncing [k], [g]). It is necessary to take into account various tactile sensations (primarily tactile vibration and temperature), for example, the feeling of vibration in the hand in the area of ​​the larynx or crown when pronouncing voiced consonants, the duration and smoothness of the exhaled stream when pronouncing fricative sounds [F], [V], [X], brevity of articulation, sensation of a push of air when pronouncing stop consonants [P], [B], [T], [D], [G], [K], sensation of a narrow stream of air [S], [Z], [F], wide [T], [K], temperature [C] – cold jet, [W] – warm.

When producing sounds, it is important that children know the articulatory structure of sound, be able to tell and show in what position the lips, teeth, tongue are, whether the vocal folds vibrate or not, what is the strength and direction of the exhaled air, the nature of the exhaled stream. It is useful to compare speech sounds with non-speech sounds. Such conscious mastery of correct articulation is of great importance for the formation of the correct articulatory image of the sound of its pronunciation and, most importantly, its differentiation from other sounds.

When forming the kinetic basis of articulatory movements, the main attention should be paid to exercises aimed at developing the necessary quality of movements: volume, mobility of the organs of the articulatory apparatus, strength, accuracy of movements, and developing the ability to hold the articulatory organs in a given position. Traditional articulation exercises are widely used to develop dynamic coordination of movements, but special sets of exercises that take into account the specifics of the disorder also give good positive results.

For children with mild dysarthria and increased muscle tone in the articulatory muscles, exercises are offered to relax tense muscles of the tongue and lips.

To relax your tongue:

• stick out the tip of your tongue. Mash it with your lips, pronouncing the syllables pa-pa-pa-pa - then leave your mouth slightly open, fixing your wide tongue and holding it in this position, counting from 1 to 5-7;
• stick the tip of your tongue out between your teeth, bite it with your teeth, pronouncing the syllables ta-ta-ta-ta, leaving your mouth slightly open on the last syllable, fixing the wide tongue and holding it in this position, counting from 1 to 5-7 and return to its original position;
• open your mouth, place the tip of your tongue on your lower lip, fix this position, holding it while counting from 1 to 5–7, return to its original state;
• silently pronounce the sound I, while simultaneously pressing the lateral edges of the tongue with your lateral teeth (this exercise is also a kind of massage technique for paretic condition of the muscles of the lateral edges of the tongue)

To lower the tense root of the tongue, exercises involving protruding the tongue are suggested.

Relaxation of tense lips is achieved by lightly patting the upper lip on the lower lip.

When decreased muscle tone preschoolers with mild dysarthria are offered tasks to activate and strengthen paretic muscles:
– scratching with the tip of the tongue on the upper incisors;
– counting the teeth, resting the tip on each one;
– stroking the cheek with the tip of the tongue, pressing forcefully on its inner side;
– holding a round piece of candy at the alveoli with the tongue.

Not tightly closed limp lips train using the following tasks:
– stretch your lips into a smile, exposing the upper and lower incisors, holding the count from 1 to 5–7, return to their original position;
– stretch only the right and left corners of the lip in a smile, exposing the upper and lower incisors, hold the count from 1 to 5–7, return to the original position;
– hold pieces of crackers, tubes of different diameters, strips of paper with your lips;
- tightly closed lips.

In the process of correcting sound pronunciation in children with mild dysarthria, consolidating the majority of newly formed sounds, it is proposed to start with the structure of syllables of the SG type, and then move on to the “vowel-consonant” structure. When forming [S], [P], it is allowed to introduce a sound first into the syllable GS. Since the fricative [P] (and at the end of words it is fricative) is often learned better than the tremulous one. From the fricative [P] they successfully move on to pronouncing their main tremulous variants. The same sequence is followed when working with the sounds [C], since pronouncing this consonant at the end of words contributes to the formation of kinesthetic supports in children that they are aware of.

However, if a child works only with specially selected material, he will not learn to use sound in independent speech, and the effect of “armchair speech” occurs. The organizing factor of speech therapy work should be communicative training, the creation of a model of the communication process, which is a series of situations replacing each other. For this purpose, story games and dramatization games are used to encourage the child to make verbal statements. Project activities can be widely included in the process of consolidating a particular sound and its introduction into free speech. Project activity in speech therapy practice can become an important form of work on automating sound pronunciation, as it relates to the communicative type of learning and creates a model of the communication process, bringing children closer to a live situational environment. Such organization by a speech therapist of the stage of sound automation will also attract additional attention from parents to correctional work.

Thus, to carry out successful correctional work with children with an erased degree of dysarthria, it is necessary to highlight the main aspects:

To identify an accurate speech therapy conclusion, a thorough psychological, medical and pedagogical examination is necessary with a study of the child’s medical record, familiarization with anamnestic data, and a doctor’s conclusion. It is necessary to maintain a close relationship with parents, not only in order to obtain information about the early development of the child, but in order to explain the characteristics of this disorder.

Implementation of a differentiated approach to overcoming dysarthria, with increased or decreased muscle tone.

An important factor in working with children with an erased degree of dysarthria is the formation of clear static-dynamic sensations of articulatory muscles.

Systematicity in the work on the formation of phonemic operations, the development of the melodic-intonation side of speech, breathing processes, voice formation, articulation.

The communicative focus of training is the use of story-based, didactic games, and project activities in the process of automating sound pronunciation.

Literature:

1. Arkhipova E.F. Correctional and speech therapy work to overcome erased dysarthria. – M., 2008.
2. Kiseleva V.A. Diagnosis and correction of the erased form of dysarthria. – M., 2007.
3. Lopatina L.V., Serebryakova N.V. Overcoming speech disorders in preschool children. – St. Petersburg, 2001.
4. Fedosova O.Yu. Conditions for creating a strong sound pronunciation skill in children with mild dysarthria. – Speech therapist in kindergarten No. 2, 2005.