Consultation “Psychological and pedagogical characteristics of children with rhinolalia”

Symptoms of rhinolalia

With open organic rhinolalia, the cause of which is various congenital anomalies, the baby’s vital functions such as breathing and nutrition suffer from the very first hours of his life.
As a rule, the sucking reflex in such children is preserved, but feeding becomes difficult, since the child does not latch on to the breast, and when bottle-fed, the mixture flows out through the nose, as a result of which the newborn does not receive the nutrients it needs and is significantly delayed in development. Since nasal breathing is impaired, such children often suffer from chronic inflammatory diseases of the respiratory system, which causes the development of rhinolalia. Among other things, congenital cleft palates are accompanied by various malocclusions, which only contributes to speech problems. This is often due to the fact that in such children the preservation of intelligence varies from normal to very significant developmental delays.

Speech development—both in the prelinguistic period and during the period of speech development—proceeds abnormally. There is no characteristic babbling. Or it is very quiet, barely noticeable. The child begins to pronounce his first words at the age of more than 2 years; his speech is illegible and slurred, and is difficult for others to understand.

With open organic rhinolalia, all sounds have a pronounced nasal connotation, and the child has impaired articulation and pronunciation of sounds. All consonants are more reminiscent of the sound “x”, they cannot be distinguished from each other. The voice is quiet and dull. Trying to pronounce sounds correctly, the child uses the facial apparatus or strains the muscles of the lips, wings of the nose or tongue, which only aggravates the situation.

Problems with speech also affect auditory perception and the ability to phonetically analyze spoken speech. In addition, due to limited communication with peers, these children have a rather poor vocabulary and have problems with written speech. The combination of such changes can lead to the fact that in a child with open organic rhinolalia, speech therapists are forced to note general speech underdevelopment. At the age when the child begins to realize his defect, changes in the speech apparatus are accompanied by various mental disorders and associated layers: isolation, irritability, shyness, etc.

In patients with open functional rhinolalia, the pronunciation of vowel sounds suffers to a greater extent. Such a child pronounces consonants quite well, which is associated with velopharyngeal closure that is quite sufficient for this. With closed functional rhinolalia, as a rule, only the timbre of the voice suffers, which takes on an unnatural, dull, “dead” hue.

Closed organic rhinolalia is characterized by distortion of consonant sounds. The child often changes the sound “m” to the sound “b”, “n” to “d”, etc. With this form of pathology, nasal breathing is difficult, and therefore the child constantly breathes through the mouth, which leads to the fact that such children are susceptible to various inflammatory diseases of the upper respiratory tract, and also often suffer from chronic forms of bronchitis and pneumonia, which have a recurrent course.

Psychological and pedagogical characteristics of children with rhinolalia

Psychological and pedagogical characteristics of children with rhinolalia.

Speech communication occupies a central place in a person’s life, “as a factor of his mental development, a condition of self-regulation”, as “a means of introducing the individual to social knowledge and assimilation of social experience, as a condition for the development of thinking.”

Currently, in the works of domestic and foreign scientists, there is a widespread objective opinion that rhinolalia is the most complex clinical form of speech pathology, since rhinolalia is a violation of the timbre of the voice and sound pronunciation, which is caused by some anatomical and physiological defects of the speech apparatus. With rhinolalia, a nasal voice timbre occurs, and articulation and phonation differ significantly from normal values.

The theoretical aspects of the occurrence of rhinolalia were studied by such scientists as Ippolitova A.G., Nelyubova Z.G., Solomatina G.N., Vansovskaya L.I. and others.

When performing correctional work, it is necessary to have specific knowledge of speech therapy influence on a child. Ippolitova A.G. suggested starting classes with open rhinolalia even before the surgical period.

The diagnosis of “rhinolalia” for a child means the appearance of both functional disorders that significantly affect the child’s physical condition and his psychological state. That is why, at present, an integrated approach to correctional and pedagogical work with such children is necessary. This requires the coordinated work of a whole staff of specialists.

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RINOLALIA.
Rhinolalia is a violation of the pronunciation aspect of speech or voice timbre, caused by anatomical and physiological damage to the speech apparatus. With rhinolalia, a specific change in voice occurs. This is due to the fact that when all sounds are pronounced, the air stream passes not into the oral cavity, but into the nasal cavity, in which resonance occurs. Speech becomes nasal, all sounds without exception are disrupted. The child’s speech becomes monotonous and slurred.

Rhinolalia, caused by congenital clefts of the lip and palate, represents a serious problem for various branches of medicine and speech therapy.

1.1.CHARACTERISTICS OF VIOLATION

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Rhinolalia is a violation of the sound pronunciation and prosodic aspect of speech, primarily the voice, caused by a violation of the structure of the articulatory apparatus in the form of cleft palate, fusion of the lip, alveolar process, gums, hard and soft palate.

Speech therapy classifies rhinolalia as a defect of the speech apparatus such as congenital cleft palate.

1.2. CLASSIFICATION OF VIOLATION.

Congenital clefts of the upper lip: hidden cleft, incomplete cleft: (without deformation of the skin-cartilaginous part of the nose; with deformation of the skin-cartilaginous part of the nose).

Congenital cleft palate:

— clefts of the soft palate: hidden (submucosal); incomplete; full;

- clefts of the soft and hard palate: hidden; incomplete; full;

- complete cleft of the alveolar process, hard and soft palate: unilateral; two-sided;

- complete cleft of the alveolar process and the anterior part of the hard palate: unilateral; bilateral.

2.TYPES OF RINOLALIA

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2.1.OPEN RHINOLALIA

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Open rhinolalia is observed with defects of the soft and hard palate. When pronouncing sounds, a stream of air passes through the nose, and not through the mouth, speech becomes incomprehensible, with a nasal tint.

Open rhinolalia can be organic and functional. Organic rhinolalia can be congenital or acquired. The most common cause of the congenital form is a splitting of the soft and hard palate. The acquired form appears as a result of injuries to the oral and nasal cavities.

With organic rhinolalia, the timbre of sounds, especially vowels, changes greatly, and the sound pronunciation of many consonants is disrupted. Clefts of the upper jaw and hard jaw further alter the formation of a normal bite. With cleft palate, the respiratory and vocal sections of the peripheral speech apparatus do not have any anatomical disorders. And its upper section (articulatory) is grossly disturbed in its structure: the possibility of isolation between the oral and nasal cavities is disrupted. The exhalation of the rhinolalic during speech, with a sufficiently good and full inhalation, remains short, jerky, differentiated oral and nasal breathing is not formed. In the oral cavity, the high position of the tongue root is especially characteristic, which is an adaptive position for closing the cleft palate. This position of the tongue limits the mobility of the tongue.

With functional rhinolalia, the pronunciation of only vowel sounds is impaired, and after phoniatric exercises, the nasal timbre disappears, and pronunciation disorders are eliminated by ordinary exercises. For consonant sounds, velopharyngeal closure is good and nasalization is not detected.

2.2.CLOSED RHINOLALIA

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Closed rhinolalia can also be organic and functional. Organic closed rhinolalia is due to the fact that for some reason the passage into the nasal cavity is constantly closed. The timbre is significantly impaired when pronouncing consonants. When pronouncing hissing and fricative sounds, a hoarse sound is added that occurs in the nasal cavity. Explosive sounds sound unclear because the necessary air pressure is not generated in the oral cavity due to incomplete closure of the nasal cavity. The air flow in the oral cavity is so weak that it is not sufficient to vibrate the tip of the tongue necessary to produce the sound (p). The disruption of nasal breathing characteristic of organic closed rhinolalia leads, in many cases, to the appearance of a number of non-speech symptoms: insufficient development of the child’s chest and poor gas exchange in the lungs, sleep disturbances, impaired nutritional function, fatigue, irritability, and predisposition to chronic respiratory diseases.

Depending on the location of organic changes (nasal cavity or nasopharynx), organic closed rhinolalia is divided into two types: anterior and posterior.

The causes of anterior closed rhinolalia can be polyps and tumors of the nasal cavity, deviated nasal septum, hypertrophy of the nasal mucosa due to chronic runny nose.

Posterior closed rhinolalia is the result of polyps and tumors in the nasopharynx, as well as the result of adenoid growths or fusion of the soft palate with the posterior wall of the pharynx. In all these cases, nasal obstruction occurs.

Functional closed rhinolalia is most often a consequence of hyperfunction of the soft palate, which is constantly in an elevated position. It occurs more often and occurs when the nasal cavity is well patted.

3. PSYCHOLOGICAL AND PEDAGOGICAL CHARACTERISTICS OF CHILDREN WITH RHINOLALIA.

Open rhinolalia is one of the most complex speech defects, as it affects not only the speech development of the child, but also the formation of his psyche. According to the state of mental development, children with clefts form a heterogeneous group: children with normal mental development; children with mental retardation; children with oligophrenia (of varying degrees).

The nature of speech disorders depends on a combination of structural and functional changes. This can be a number of disorders in the musculoskeletal system of speech: narrowing of the upper jaw, hard palate, deformation of the upper row of teeth. The normal interweaving and tone of the muscles of the palate and their necessary physical tension are also disrupted. The muscles are significantly weakened, the vessels supplying them narrow, which leads to the development of scar tissue. Sluggishness of the articulatory apparatus (lips, lower jaw and tongue) is manifested in weakness of the orbicularis oris muscle, up to the inability to hold the softest objects with the lips. When the lip and palate are not fused, a number of adaptive movements of the lips, nose and soft palate are developed. With their help, children, articulating sounds, try to prevent air from escaping through the nose. Speech is accompanied by movements of the wings of the nose, eyebrows, narrowing of the nostrils, contraction of the frontal muscles and raising of the upper lip. The more extensive the defect, the greater the disturbances the child’s body undergoes during its development.

The presence of clefts makes breastfeeding impossible. The fading of the sucking reflex, loss of lip movements leads to a weakening of the entire facial muscles, and facial expressions are impoverished.

Due to incorrect anatomical conditions, the coordinated and differentiated work of the tongue does not develop - it practically does not participate in the articulatory act. In order to adapt to special anatomical conditions, a position of the tongue develops in which its root rises upward, preventing air from escaping through the mouth and further increasing the nasal tone of speech and reducing its intelligibility. In this case, there is a significant limitation in the mobility of the tongue, a displacement of its anterior part towards the middle of the oral cavity, blurred and sluggish articulation. The muscle relationship during feeding is disrupted: when feeding, children squeeze the pacifier not with their lips, but with the root of the tongue and partially with the vault of the palate. With such sucking, along with the movement of the root part of the tongue, the facial muscles are activated, which later affects the quality of babbling and influences the formation of pronunciation.

In children with open rhinolalia, conditions for physiological breathing worsen, and incorrect mechanisms of speech breathing are developed.

There is a lag in the development of gross and fine motor skills of the dominant hand. The muscles of the fingers and hand are weak, get tired quickly, and movements are not sufficiently coordinated. Speech is often accompanied by tension in the outstretched fingers of both hands. Children later begin to hold their heads, sit and walk. The neuromuscular apparatus of speech adapts early to the unique conditions of swallowing and breathing.

Children with congenital clefts often experience functional disorders of the nervous system, pronounced psychogenic reactions to their defect, and increased excitability. Inferiority of speech with rhinolalia affects the formation of all mental functions, isolation, shyness, and irritability develop.

A characteristic feature of children with rhinolalia is a change in oral sensitivity in the oral cavity. The reason lies in the dysfunction of sensorimotor pathways caused by inadequate feeding conditions in infancy.

Pathological features of the structure and activity of the speech apparatus cause various deviations in the development of not only the sound side of speech. Various structural components of speech are affected to varying degrees. Due to a violation of the speech motor periphery, the child loses

intensive babbling, thereby impoverishing the stage of preparatory tuning of the speech apparatus. There is a late onset of speech, a significant time interval between the appearance of the first syllables, words and phrases already in the early period, which is sensitive for the formation of not only its sound, but also its semantic content, i.e. a distorted path of speech development as a whole begins.

As a result of peripheral insufficiency of the articulatory apparatus, adaptive changes in the structure of the organs of articulation are formed during the production of sounds: high elevation of the root of the tongue and its shift to the posterior zone of the oral cavity, insufficient participation of the lips when pronouncing labialized vowels, labiolabial and labiodental consonants, excessive participation of the root of the tongue and larynx.

The most significant manifestations of defective phonetic design of oral speech are violations of all oral speech sounds due to the connection of the nasal resonator and changes in the aerodynamic conditions of phonation. The sounds become nasal. Combinations of nasalization of speech and distortions in the articulation of individual sounds are very diverse. Much depends on the relationship between the resonating cavities and the variety of individual structural features of the oral and nasal cavities. In general, the child’s speech is difficult to understand. Violation of the phonetic structure of speech leaves some imprint on the formation of the lexico-grammatical structure of speech, but deep qualitative changes usually occur when rhinolalia is combined with other speech disorders.

The pronunciation features of children with rhinolalia lead to distortion and immaturity of the phonemic system of the language. Secondarily determined features of the perception of speech sounds are the main obstacle to mastering correct writing. The connection between writing disorders and defects in the articulatory apparatus has various manifestations. If, by the time of training, a child with rhinolalia has mastered intelligible speech, can clearly pronounce most of the sounds of his native language, and only a slight nasal tone remains in his speech, then the development of sound analysis necessary for learning to read and write is proceeding successfully.

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

The cause of the closed form of rhinolalia is most often organic changes in the nasal space or functional disorders of the velopharyngeal closure. Organic changes are caused by painful phenomena, as a result of which nasal breathing becomes difficult.

Functional closed rhinolalia occurs frequently in children, but is not always correctly recognized. It occurs with good patency of the nasal cavity and undisturbed nasal breathing. However, the timbre of nasal and vowel sounds may be more disturbed than with organic forms. During phonation and when pronouncing nasal sounds, the soft palate rises strongly and blocks access to sound waves to the nasopharynx. This phenomenon is more often observed in neurotic disorders in children.

With rhinolalia, speech develops late (the first words appear by two years or later) and has qualitative features. Impressive speech develops relatively normally, while expressive speech undergoes some qualitative changes. The first thing to note is slurred speech. The words and phrases that appear in their mouths are difficult to understand for those around them, so

how the emerging sounds are unique in articulation and sound. Not only the articulation of sounds suffers, but the development of the prosodic elements of speech. There is a late onset of speech, a significant time interval between the appearance of the first syllables, words and phrases already in the early period, which is sensitive for the formation of not only its sound, but also its semantic content. The specific coloring of some consonant sounds is highlighted due to the connection of a pharyngeal resonator. There are also phenomena of additional articulation in the laryngeal cavity, which gives speech a peculiar “clicking” sound. Many other defects are revealed:

- omission of the initial consonant (“ak, am” - so, there);

— neutralization of dental sounds according to the method of formation;

- replacing plosives with fricatives;

- whistling background when pronouncing hissing sounds or vice versa;

- absence of vibrant “r” or replacement with the sound “s” during strong exhalation;

- the imposition of additional noise on nasal sounds (hissing, whistling, aspiration, snoring, throatiness).

Due to obstruction of the nasal cavity, the child is forced to breathe through the mouth, which leads to frequent viral and colds.

4. MAIN DIRECTIONS OF CORRECTIONAL WORK FOR RHINOLALIA.

Step-by-step rehabilitation of children with congenital cleft lip and palate is based on a combination of therapeutic, speech therapy and psychological-pedagogical measures that are carried out during the child’s growth until the age of 14-15 years. This work is carried out by a dental surgeon, orthodontist, speech therapist, otolaryngologist, therapeutic exercise specialist, psychologist and other specialists.

The main tasks of complex influence on the defect:

— surgical elimination of anatomical disorders;

— orthodontic correction of deformation of the upper jaw and constant monitoring of the prevention of secondary deformations;

— restorative treatment;

— timely otolaryngological sanitation (prevention of hearing impairment in children);

— psychotherapeutic influence on the child and his microsocial environment;

— early speech therapy assistance, the main directions of which are as follows:

- development of normal physiological and speech breathing;

- development of full velopharyngeal closure;

— formation of articulatory patterns and correct articulatory movements;

— correction of sound pronunciation disorders;

- elimination of the nasal tone of the voice;

— automation of developed skills in free speech communication;

— normalization of the prosodic side of speech;

- development of phonemic perception and skills of sound analysis and synthesis in order to prevent the possible subsequent occurrence of a written speech disorder - dysgraphia;

— timely elimination of the formation in the development of phrasal speech, lexical and grammatical structure of speech;

— monitoring the child’s overall speech development;

— preparing children for studying in secondary schools.

Corrective pedagogical influence should be based on a number of theoretical provisions (principles) taking into account the structural features of the defect in children with rhinolalia:

1) the principle of an integrated (medical-psychological-pedagogical) approach to eliminating speech defects;

2) etiopathogenetic principle;

3) the principle of relying on preserved links;

4) ontogenetic principle;

5) operating principle;

6) the principle of an individual approach to each child;

7) the principle of taking into account the characteristics of the child’s microsocial environment.

Along with speech therapy principles, correctional work should be based on general didactic principles: systematic and consistent teaching, clarity and accessibility of the proposed material, consciousness and activity, and the strength of acquired skills.

When carrying out correctional work, a special psychological and pedagogical approach to children is required, as well as the formation of a single correctional and educational space around each child with rhinolalia. The influence of multiple surgical interventions and somatic weakness of the child lead to increased exhaustion, decreased performance, activity and endurance. Only the correct distribution of therapeutic and educational load will allow the child to complete all the tasks facing him without unnecessary stress and fatigue. Therefore, the effectiveness of correctional work largely depends on the clear organization of the joint work of many specialists, doctors and teachers.

CONCLUSION

The study of the speech activity of children with rhinolalia shows that defective anatomical and physiological conditions of speech formation, limited motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systemic disorder of all its components.

Thus, the primary disorders in rhinolalia are: breathing disorders, nutrition, retardation in physical development, asthenic syndrome, physical hearing loss, neurological disorders, disorders in the musculoskeletal system of speech, disorders of the dental-maxillary system, disorders of articulatory motor skills, voice disorders and acoustic-articulatory features of sound pronunciation.

Secondary disorders: impaired phonemic hearing and phonemic perception, delay in speech development, lexico-grammatical disorders, general speech underdevelopment, dysgraphia and dyslexia, decreased level of cognitive activity, mental retardation, communication disorders, personality characteristics.

Early correction of deviations in speech development in children with rhinolalia has an extremely important social, psychological and pedagogical significance for normalizing speech, preventing difficulties in learning and choosing a profession.

Diagnosis of rhinolalia

The examination of children and adults with rhinolalia is multifaceted and is carried out by various specialists:

• otolaryngologist;
• speech pathologist;
• speech therapist;
• neurologist;
• orthodontist;
• phoniatrist;
• pediatrician

An examination by specialized specialists allows us to identify the etiology of the disease, characterize as accurately as possible the nature of pathological changes and the severity of all symptoms. The following instrumental diagnostic methods are important:

• X-ray of the nasopharynx;
• rhinoscopy;
• electromyography;
• pharyngoscopy, etc.

These techniques make it possible to visualize the nature of pathological changes and their severity in each individual patient.

Of course, the most significant is an examination by a speech therapist, who, using a number of progressive techniques, will be able to assess the following parameters:

• structure of the articulatory apparatus;
• his mobility;
• voice disorders;
• parameters of physiological and phonation breathing, etc.

To diagnose open rhinolalia, the Gutzmann technique is used, which is based on the fact that the patient pronounces the sounds “a” and “i” alternately, while the doctor opens and closes the nasal passages. In the presence of pathological changes, the vibration of the wings of the nose is very clearly felt, and when the nasal passages are pinched, the sounds are significantly muffled. Thus, it is possible to diagnose the open form of rhinolalia.

Cause of rhinolalia

Rhinolalia usually occurs in an open form. It occurs when there is a split in the hard and soft palate, the alveolus of the lip, or the upper part of the entire speech apparatus. The causes of the pathology are caused by various highly pathogenic effects on the embryo in the period between the 5th and 8th weeks of development.

Typically, the reasons for such effects are associated with problems of the mother’s body during pregnancy such as:

• Flu;
• Mumps;
• Toxoplasmosis;
• Rubella;
• All kinds of endocrine disruptions;
• Abuse of bad habits (alcohol, smoking, etc.);
• ENT disorders in the fetus.
• The causes of the appearance of a closed form of rhinolalia are usually:
• Deviation of the nasal septum;
• Fibroids;
• Polyps;
• Tumors;
• Critical proliferation of adenoids.

Correction of rhinolalia

Correction of rhinolalia should have a comprehensive approach. As a rule, congenital anomalies of the structure of the facial skull are subject to surgical correction. Congenital defects are corrected using plastic surgery. Such operations are aimed at restoring the anatomical structure of the organs of the nose and pharynx, as well as eliminating cosmetic defects.

In addition, some patients require surgical interventions to remove nasal polyps, adenoids and other pathological formations that interfere with normal nasal breathing. Correction of the bite and deformations of the upper jaw by an orthodontist is also required. Physiotherapy, special speech therapy sessions, and psychotherapy also play a significant role in the treatment process.

Rhinolalia is a complex and very diverse disease, the successful treatment of which requires the participation of specialists from many areas of modern medicine. In particular - speech therapy, dental surgery, otolaryngology, orthodontics, psychology.

Treatment and diagnosis

Doctors such as speech therapist, speech therapist and neuropsychiatrist are involved in the examination and development of treatment strategy for the treatment of childhood speech dysfunction caused by rhinolalia. Since the symptoms of the pathology are quite extensive and are caused by various reasons, in the treatment of rhinolalia there may be a need for the services of an orthodontist, dentist, otolaryngologist, and in some particularly severe cases, a plastic maxillofacial surgeon.

A defectologist and speech therapist are responsible for diagnosing the state of development of the speech and cognitive sphere of a child with rhinolalia, as well as developing developmental teaching methods. A child with rhinolalia is usually prescribed articulation exercises and exercises to develop phonemic hearing, speech therapy massage and breathing exercises.