Making sounds for dysarthria

Dysarthria is a speech disorder. It occurs due to damage to the parts of the brain that are responsible for connections with the articulatory apparatus. One of the most common and simplest forms is erased dysarthria. It is diagnosed when the child reaches 5 years of age. The baby's speech is slurred, he distorts or replaces sounds, he has poor diction - these are the signs of this disease.

In the article we will talk about correctional work for dysarthria, features of sound production, complex treatment and prevention of the disease.

Principles of speech correction for dysarthria

Speech therapists use several principles when working with children. Here they are:

Individual approach. The specialist evaluates the compensatory capabilities of the little patient - what articulatory movements have been preserved, what sounds and syllables the baby pronounces correctly;
From simple to complex. Correction always begins with those sounds that the child pronounces best. This sequence of sound production for dysarthria allows you to achieve better results.
Long practice of each sound. Speech correction in children with dysarthria requires much more time than other speech therapy problems.

Corrective work includes the following stages: production, automation and differentiation of sounds. But the very first task of a speech therapist is to teach the child to distinguish them by ear.

What is dysarthria? Causes

The diagnosis of dysarthria is confirmed by a neurologist, taking into account the conclusion of a speech therapist. How is this condition characterized? Signs of the disease are limited mobility of the organs of the speech apparatus, in particular the tongue and lips, which arise as a result of neurological pathologies: cerebral palsy, birth injuries of the skull, cerebrovascular accidents, brain injuries and tumors and other disorders.

Children have impairments in listening to speech and pronunciation of words. And, as a consequence, inability to learn to read and write, general underdevelopment of speech.

First of all, it is necessary to conduct a medical examination and identify the root cause of the pathological condition. Only then can you begin to produce sounds using speech therapy methods. Producing the sound “R” for dysarthria requires regular long-term exercises against the background of the use of exercise therapy methods, taking medications and other indications of a neurologist.

Stages of correction of sound pronunciation disorders

The speech therapist adheres to a strict sequence of sound production for dysarthria. Corrective work consists of 6 stages.

First: the specialist prepares the articulatory base for the production and pronunciation of palatal, sonorant, hissing and whistling sounds. When the baby masters some of them, the speech therapist moves on to working on them. It involves kinesthetic, auditory and visual control. Here is an example of a speech therapist’s instructions to a small patient: “Look in the mirror and repeat after me,” “Look in the mirror and do the exercise,” “Look at yourself in the mirror, stretch out your lips.” This feature of sound production gives good results.

This approach is necessary to reduce the apraxic disorders that accompany dysarthria. In general, the first stage is the foundation for the further development of sound pronunciation skills.

Second: the speech therapist determines the sequence of correction. He assesses which articulatory structure the patient has “mature”. Many children with motor and speech disorders are better at producing more complex sounds, such as hissing sounds. But the patient can master lighter whistling sounds, with which it is recommended to begin correction, later.

Third: the specialist stimulates or plays a certain sound. When staging, he uses classical techniques - staging by imitation, mechanical or mixed method.

Fourth: consolidation, or automation. This is the most difficult stage in all correctional work. It takes the most time. Often children master a sound and pronounce it in isolation, but make mistakes in speech. Therefore, after the production stage, the speech therapist focuses on working on isolated sound pronunciation, and then connects words with different syllable structures. Thus, the child pronounces the sound at the beginning, middle or end of words. Then the speech therapist connects sentences in which the sound being studied is concentrated.

The speech therapist selects lexical material individually. It must be appropriate for the baby’s age and capabilities, and also not include sounds that he cannot yet pronounce or distort.

Fifth: separation of delivered and oppositional sounds. First, the speech therapist suggests 2 syllables, then increases to 3. for example, sa - sha, sta - shta, etc. After this, he works on pairs of words with different syllable structures.

Sixth: developing communication skills. Another difficult stage. Often children communicate in a speech therapist’s office, but in front of other people and outside the office, the acquired speech skills are lost, and the child begins to speak “the old fashioned way.” In order to develop communication skills, the painstaking work of a speech therapist is necessary, but without the desire of the child himself, success cannot be achieved either.

The development of communication skills in dysarthria is facilitated by techniques such as memorizing rhymes, retelling or writing stories.

With dysarthria, the motor mechanism of speech is disrupted due to organic damage to the central nervous system. The structure of a speech defect is a violation of the entire pronunciation aspect of speech.

An integrated approach to eliminating dysarthria includes three blocks.

The first block is medical, which is determined by a neurologist. In addition to medications, exercise therapy, massage, reflexology, physiotherapy and others are prescribed.

The second block is psychological and pedagogical. The main directions of this impact will be: the development of sensory functions. By developing auditory perception and forming auditory gnosis, the basis for the formation of phonemic hearing is thereby prepared. By developing visual perception, differentiation and visual gnosis, we thereby prevent graphic errors in writing. By implementing this direction, stereognosis is also being developed. In addition to the development of sensory functions, the psychological and pedagogical block includes exercises for the development and correction of spatial concepts, constructive praxis, graphic skills, memory, and thinking.

The third block is speech therapy work, which is carried out mainly on an individual basis.

Taking into account the structure of the defect in dysarthria, speech therapy work is recommended to be planned according to the following stages.

The first stage of work is preparatory.

Normalization of muscle tone of facial and articulatory muscles. Speech therapy massage is provided.
Normalization of motor skills of the articulatory apparatus. For this purpose, we carry out differentiated articulation gymnastics techniques. Passive exercises performed by the speech therapist himself are aimed at inducing kinesthesia. Active articulatory gymnastics gradually becomes more complicated and functional loads are added. This type of articulatory gymnastics is aimed at strengthening kinesthesia and improving the quality of articulatory movements.
Voice normalization. For this purpose, voice exercises are carried out, which are aimed at causing a stronger voice and modulating the voice in pitch and strength.
Normalization of speech breathing. For this purpose, the speech therapist conducts short-term exercises to develop a longer, smoother, more economical exhalation.
Normalization of prosody. This direction is the least developed at the first stage. In the specialized literature, there are descriptions of the prosodic aspect of speech in children with dysarthria: these are disorders such as a quiet and unmodulated voice, disturbances in the rate of speech and timbre of the voice, poor intonation, poor speech intelligibility, lack of pauses and logical stresses, and other symptoms of prosody.
Normalization of fine motor skills of the hands. For this purpose, finger gymnastics is carried out, aimed at developing subtle, differentiated movements in the fingers of both hands.

All exercises of the first stage gradually become more difficult.

The second stage of speech therapy work for dysarthria is the development of new pronunciation skills.

The directions of the second stage of speech therapy work are carried out against the background of ongoing exercises listed in the first stage, but more complex.

Development of the main articulatory structures (dorsal, cacuminal, alveolar, palatal). Each of these positions determines, respectively, the articulation of whistling, hissing, sonorant and palatal sounds. Having mastered a number of articulatory movements in the first stage, at the second stage we move on to a series of sequential movements performed clearly, exaggeratedly, based on visual, auditory, and kinesthetic control.
Determining the sequence of work to correct sound pronunciation. For dysarthria in children, depending on the presence of pathological symptoms in the articulatory area and the degree of its severity, the sequence of work on sounds is individually determined. In some cases, they adhere to the traditional procedure, which recommends production with impaired whistling sounds. It is recommended, when working to correct sound pronunciation in dysarthria, to clarify or call up that group of sounds whose articulatory structure has “ripened” first of all. And these can be even more difficult sounds, for example: in the alveolar position - r, r, and whistling ones will be corrected later, after the dorsal position has “matured” (which is one of the difficult ones for children).
Development of phonemic hearing. The work is carried out according to the classical scheme. Phonemic awareness refers to the child’s ability to identify and distinguish phonemes of his native language.
Evoking a specific sound. This work for dysarthria is carried out in the same way as for any other disorder, including dyslalia. This means that the speech therapist uses classical methods of producing sounds (by imitation, mechanical, mixed methods).
Sound automation is the most difficult area of work in the second stage. Often in practice, speech therapists are faced with the fact that children in isolation pronounce all sounds correctly, but in the speech stream the sounds lose their differentiated characteristics and are pronounced distorted.
Differentiation of delivered sound in pronunciation with oppositional phonemes. The sequence of presented lexical material is similar to the sequence when automating a given sound. It is only suggested, for example: 2 syllables (sa - sha, as - ash, sta - shta, tsa - tsha, etc.). Then pairs of words, different in syllable structure, etc.

The third stage of speech therapy work is devoted to the development of communication skills.

One of the most difficult areas of work is developing self-control skills in a child. Often, speech therapists are faced with a situation where a child, in an office setting, in contact with a speech therapist, demonstrates acquired skills in speech. But when the situation changes, in the presence of other people, the skill that seemed strong disappears, and the child returns to the previous stereotypical pronunciation. To develop communication skills, the child’s active position and motivation to improve speech are necessary. In this area of speech therapy work, the speech therapist must act as a psychologist and, on an individual basis, determine ways to develop self-control skills in the child.
A more traditional direction at this stage is the introduction of sound into speech in a learning situation (memorizing poetry, composing sentences, stories, retellings, etc.).
The specific direction of the stage is the inclusion of prosodic means in the lexical material: various intonations, voice modulations in pitch and strength, changes in the tempo of speech and timbre of the voice, determination of logical stress, observance of pauses, etc.

The fourth stage of speech therapy work is called preventing or overcoming secondary disorders in dysarthria.

Bearing in mind the prevention of secondary disorders, early diagnosis of dysarthria should be ensured, as well as early corrective work should be organized. Technologies for correctional work with children at risk for dysarthria at different age periods have been developed.

However, preventive work is carried out with children who have severe organic pathology in a hospital setting. The majority of children at risk for dysarthria (mild degree), who have a neuropathologist’s diagnosis of PEP (perinatal encephalopathy) in the first year of life, are deprived of the opportunity to receive adequate corrective propaedeutic care, since hospital treatment is not indicated for them.

By the end of the first year of life, the neurologist removes the diagnosis of PEP. And only during a dispensary examination does a speech therapist at the clinic, with a thorough examination, see the symptoms of MDD (minimal dysarthric disorders). These symptoms entail secondary disturbances in the formation of linguistic means (vocabulary, grammar). A consequence of insufficient prevention of secondary disorders is a large number of children with dysarthria complicated by either ODD or FFD.

The fifth stage of speech therapy work is preparing a child with dysarthria for school.

The main directions of speech therapy work are: the formation of graphomotor skills, psychological readiness for learning, and the prevention of dysgraphic errors.

Gymnastics for making sounds

Finger games must be included in the correction program for dysarthria. They can be done at home with your parents. For example, these:

Reading book “Finger Boy, Where Have You Been?” The child opens his palm and, for each line of the rhyme, touches each finger with his thumb - index, middle, ring and little fingers.
"We depict animals." This is an analogue of the “Shadow Theatre”. The kid opens his palm, sticks his thumb up - imitates a dog. Raises and lowers the little finger - the dog barks. And if you press your ring and little fingers with your thumb to your palm, and raise your middle and index fingers up, you will get a bunny that moves its ears.
Hand massage. The technique depends on the tone of the hands.

If you have spasticity, you need to relax: stroke your arms: from your fingertips up to your palms and to your shoulders. Then repeat the movement from top to bottom.

When hypotonicity occurs, muscles need to be strengthened. To do this, parents actively knead and rub their fingers and palms. Stimulating movements.

Speech therapy massage

An effective method of preparing for the production of the sound “R” for dysarthria is speech therapy massage. Only a qualified speech therapist can perform this procedure, since massage has different types. Those movements that will be beneficial in some cases are contraindicated in others. The types of massage movements depend on the existing problem with the speech apparatus. When toning muscles with the help of massage exercises, the goal is to relax the muscles, and with weak activity, on the contrary, it is necessary to intensify the work of articulatory muscles.

Manual and instrumental massage of the neck, forehead, cheeks, and lips is performed. A special speech therapy probe in the form of a ball is effectively used to massage the tongue. Speech therapy massage for various types of dysarthria is described in detail in the book by Elena Arkhipova.

A set of articulation exercises

The exercise includes 5 exercises and can also be done at home.

“Horse” - clicking the tongue. This is a very useful and effective exercise. Not all children get it right away.

“Pancakes” - the baby opens his mouth slightly, spreads his tongue into a flat pancake.

“Snake” - the child imitates the sting of a snake - the tongue is just as sharp. Then he sticks it back and forth.

“Tube” - the baby tries to roll his tongue into a tube.

Another exercise is to try to reach the tip of your tongue to your nose and then to your chin.

Correct articulation of the sound “R”

Note that a speech therapist’s work on the sound “R” with a child suffering from dysarthria begins only after mastering other sounds, since this sound is difficult to pronounce correctly, and many methods for developing pronunciation are based on other sound units that are similar in articulation.

In Russian speech, the position of the tongue with the sound “R” is as follows: the wide tip of the tongue is on the upper alveoli, the lips are slightly open, a strong stream of air passes through the middle and causes frequent small vibrations.

When pronouncing the sound “Рь”, the tongue arches, the tip is lower than the middle of the back.

A set of breathing exercises

Includes 2 exercises. Parents can easily do them with their baby at home.

"Racing" . Place two cotton balls on the table. The parent blows on one balloon, the child on the other. The one who moves his ball the greatest distance wins.

"Magic Breath" . Insert pieces of cotton wool into the baby's nostrils. The main thing is not deep! Ask him to exhale and at the same time hold the cotton wool - it should not fall out.

Another version of breathing exercises is according to A.N. Strelnikova. The essence of gymnastics is to take a sharp breath through your nose every second and do the exercises at the same time. The inhalation is noisy and strong, and the exhalation is natural, imperceptible.

There are several rules: with each inhalation, lower your shoulders and close your nostrils tightly, as if someone is pressing on them.

Gymnastics should be a joy, so you need to do it until the first signs of fatigue. There is no need to force your child if he does not want to study.

Gymnastics is designed for adults, so the duration of the lesson and the number of approaches is best agreed upon with a speech therapist.

Preparatory stage of production

The sound “R” is produced in several stages. The preparatory stage is intended to activate articulatory and facial muscles and establish proper breathing. In addition, work on producing such a difficult-to-pronounce sound can only begin when the child has mastered almost all other sound units.

At the preparatory stage, articulation, facial and breathing exercises are carried out; if necessary, massage and therapeutic exercises are used, for example, in case of muscle paralysis.

We train to navigate in space

“Whose traces?” . Pictures with traces of hands and feet are needed. The baby must determine which arm or leg is right and which is left.
"Supermarket" . The parent asks the child to arrange the goods: “on the shelf”, “near the cash register”, “to the right of the cookies”, “under the counter”.
Counting sticks. Can be replaced with matches. The parent makes some figure out of them, and the baby makes a similar one according to the image.

This complex can also be performed at home.

How to use the probe correctly?

Speech therapy probes for producing the sound “P” significantly reduce the duration of classes; in fact, quite often the sound is formed after the first use of the instrument.

How to use the probe correctly? Before using the instrument, make the sound “R” from “F”, but without developing vibration. Then, having worked out the fricative “P”, they move on to using the probe. The child is asked to produce a strong “Zh” sound on the upper alveoli. At this moment, the speech therapist installs a probe from below the tongue in the front part and makes frequent but gentle movements from side to side, thereby causing vibration of the tip of the tongue and making the sound “P”.

Methods for diagnosing dysarthria

Dysarthria is usually preceded by a primary neurological disease, such as cerebral palsy. Therefore, before starting classes with a speech therapist, you need to consult a neurologist. Only he can diagnose the disease.

Diagnosis includes electroencephalography, MRI of the brain, electroneurography or other examinations. After this, the neurologist refers the patient to a speech therapist. In turn, the specialist, based on speech therapy tests, will determine the form and degree of the speech disorder.

Mimic gymnastics

Facial gymnastics is an integral part of a speech therapy session with a patient suffering from dysarthria. Developing facial muscles helps to cope with their tone or, conversely, lethargy, which contributes to the correct development and pronunciation of the sounds being studied, including the sound “R”. It is imperative to pay attention to the most damaged and weakened muscles in each specific case. Carrying out such gymnastics effectively in a playful way. For example, you can use dice, on the sides of which various emotions are depicted - which side falls out, this facial expression should be reproduced. For example:

to be surprised - to raise eyebrows;
get angry - frown;
get scared - open your eyes wide;
smile with your mouth closed and open, and the like.

For the little ones, gymnastics is suitable - imitation of animal movements, for example, you can puff out your cheeks and roll air from one side to the other like a hamster, stick out your tongue like a puppy, wiggle your nose, sniffing like a dog. Making the sound “R” does not involve any special facial exercises.

Complex treatment of the disease

Only an integrated approach gives good results. Here are the activities included in treatment:

Speech therapy classes: development of fine motor skills of the hands, breathing, motor skills of the speech apparatus, voice (timbre, intonation, strength), training in correct sound pronunciation;
Physiotherapeutic procedures: physical therapy, massage, acupressure, etc.;
Drug treatment. Nootropic drugs are prescribed;
Psychotherapy. This group includes sand therapy, play therapy, and isotherapy.

If parents notice speech impairments in time and seek help from doctors, the baby has every chance of getting rid of the disease. But provided that there are no pronounced lesions of the nervous system.

Sound Automation

Automation of the sound “R” involves consolidating acquired skills and practicing the pronunciation of sounds in syllables and words. This is a rather lengthy process, as it requires clear systematization and consolidation of various combinations and positions of the sound being studied. At this stage, attention is also paid to the development of phonetic hearing, isolating sound from the flow of other sounds, syllables and words. The lesson plan can be drawn up as follows:

In the first reinforcement lesson, the sound “R” is practiced by imitation. For example, you can growl like a tiger, purr, pretend to be a tractor, and the like. It is recommended to practice pronouncing the sound with different strengths and durations.
Next, they practice the pronunciation of sound combinations TR, DR.
The next stage is mastering reverse syllables: ATR, OTR, UTR and so on.
Only now can you move on to open syllables, studying pure phrases and inserting missing syllables.
Combinations of several consonants with the sound “R” are difficult to master: “pra”, “bra”, “vra” and their variations with other vowels.
After mastering the previous stage, you can practice reverse syllables with a combination of several consonants: “fra”, “kra”, “gra” and their derivatives.
Then you can start working with words, using various gaming techniques, for example, studying short rhymes, tongue twisters, selecting missing words, and more.

The automation stage does not exclude articulation exercises for producing the sound “R”.

Methods for preventing the disease

Due to the biological factors in the development of the disease, it is worth thinking about its prevention during pregnancy and childbirth. Difficult pregnancy, intrauterine infections, asphyxia, complicated childbirth, injuries in the first months of a newborn’s life - all this can cause speech disorders in the future.

We list the main methods of preventing the disease after the birth of the baby.

First, develop your reflexes. These include gaze fixation and object tracking, auditory concentration, motor activity, and the oral automatism reflex - all of them are very important in the development of the newborn.

Secondly, communicate with the baby. Tactile, visual, auditory sensations - all this is extremely important for its development. Smile at him, talk to him, carry him in your arms, stroke him.

Third, be always there. This is especially true for mom. After all, a newborn needs her closeness, the opportunity to touch her, see her, feel her, and receive a return hug.

Fourth, stimulate the sucking reflex. The more actively and longer the baby suckles at the breast, the better its muscles develop - they become stronger and more flexible.

Fifth, encourage the baby's attempts to communicate. Humming and babbling - this needs to be stimulated.

Sixth, develop fine motor skills. Speech is directly related to fine motor skills and the more dexterous the baby’s hands are, the better. Introduce him to different textures.

Seventh, speak to your baby in your native language. Speak clearly and competently. And encourage him to communicate. Even if he doesn't talk, still try to make him make sounds. If he wants something and shows it with gestures, provoke him to ask for it verbally.

Breathing exercises

It turns out that in order to pronounce sounds correctly, including “R”, you need to learn to breathe correctly. We offer several simple but effective exercises:

light a candle and ask your child to blow it out;
the baby lies on his stomach, place a small soft toy in the diaphragm area; the child needs to “roll” the toy by taking a deep breath and exhaling slowly;
using a cocktail straw and a container of water, we blow a “storm”;
to develop the correct air stream for pronouncing the sound “R”, ask the baby to blow air with his mouth slightly open, achieving vibration of the lips;
You can carry out the “Who’s next?” relay race using cotton wool - “snowflakes”, leaves, pieces of paper crumpled into balls, toy turntables, boats on the water.

To safely carry out such exercises, they should not be used on a full stomach, in loose clothing and for no longer than 5 minutes.

conclusions

Dysarthria is not just a failure to pronounce certain sounds. And you certainly shouldn’t expect a child with such a diagnosis to “talk” like the neighbors’ daughter. This speech disorder is much deeper and more complex, but it is not always a death sentence. The main thing is not to waste time.

This is why turning a blind eye to the problem is a huge mistake as parents. Of course, it is difficult to accept the fact that your child has some kind of impairment. But this must be done precisely for the benefit of the future of your baby. An untreated disease will bring many problems to an adult in social life - from communication to work.

If the disease is detected at an early stage of development, it can be cured. An integrated approach to therapy gives good results. Of course, if there are no gross disorders of the nervous system.

It is even better if it was possible to diagnose the disease when it has not yet made itself felt, that is, before the baby’s first attempts to speak. Such early corrective work will become effective prevention.

Articulation gymnastics

Producing the sound “R” requires certain articulation skills. The preparatory stage of working on this sound unit includes various exercises to develop correct pronunciation. When making the sound “R” we suggest the following exercises:

"Horse". The well-known “clicking” of the tongue along the upper alveoli with an open mouth and a motionless jaw.
"Let's brush our teeth." The tip of the tongue should be drawn along the inside of the gums. The “Painter” exercise is similar in technique, only here the tongue moves back and forth across the upper palate.
"We play the accordion." To perform this exercise, you need to place the tip of your tongue on the upper palate and open your mouth in a smile. Without changing the position of your tongue and lips, you must slowly open and close your mouth. Pauses at each end point should be 5 seconds.
"Puppy". In this exercise, encourage your baby to lick the outer surface of his lips with the tip of his tongue.

Articulatory gymnastics for producing the sound “R” exists in a variety of options - you can use the author’s methods or classical techniques.

Speech development

You can start using speech therapy exercises for speech development from a very young age - such activities will only bring benefits, developing the child’s articulatory apparatus and fine motor skills. There are a large number of manuals and materials on speech development. We offer accessible and entertaining exercises:

Finger massage and rhyming gymnastics are an effective way to develop fine motor skills from birth.
Onomatopoeia is used from 6 months, when the baby can pronounce some sounds. You should not refuse such an exercise because the child cannot yet repeat the sounds after his mother, but he hears and remembers them perfectly - a few months will pass, and the baby will say his first “moo” and “woof”.
Poems with movements are offered to children from one year old.
Articulation, breathing and facial gymnastics are an integral part of the development of coherent speech. You shouldn’t scold your baby for making faces - this is actually very useful.
Pure twisters, rhyming and tongue twisters, and composing stories based on pictures can be offered to children from 3 years of age.
And even more often, inflate balloons and blow soap bubbles - it’s fun and very useful!

By applying such simple techniques in practice, the likelihood of using aggressive and not always safe methods of speech correction, for example, such as producing the sound “R” with mechanical assistance, using physiotherapeutic procedures or taking medications, is significantly reduced.

Many speech disorders can be corrected. But the faster the pathology is detected, the less time and effort will be needed to solve the problem. Be attentive to the child’s development, ensure that your child’s skills are appropriate for his age, and undergo regular scheduled examinations, including visits to a neurologist and speech therapist. A problem identified in time is half the way to overcoming it.