Speech therapy examination for rhinolalia

Rhinolalia is a distortion of sound pronunciation and voice timbre due to a violation of the velopharyngeal closure.

Open rhinolalia is characterized by the presence of a constant open communication between the nasal and oral cavities, which causes the free passage of an air stream simultaneously through the nose and mouth during speech and the occurrence of nasal resonance during phonation.

Closed rhinolalia is associated with the presence of an obstruction blocking the exit of the air stream through the nose. Depending on the level of location of the anatomical obstacle (nasal cavity or nasopharynx), closed anterior and closed posterior rhinolalia are distinguished, respectively.

How to conduct a speech therapy examination of speech for rhinolalia?

During a speech therapy examination of a child with rhinolalia, Gutsmann's tests can be used to identify a hidden (submucosal) cleft.

1. Gutsmann's tests: First, we ask the child to alternately pronounce the vowels A and I, while we either close or open the nasal passages. With an open form, there is a significant difference in the sound of these vowels: with a pinched nose, sounds, especially I, are muffled and at the same time the speech therapist’s fingers feel a strong vibration on the wings of the nose.

2. Examination using a phonendoscope . The speech therapist inserts one olive into his ear, the other into the child’s nose. When pronouncing vowels, especially [U] and [I], a strong hum is heard - this is an indicator of a hidden submucosal cleft.

Rhinolalia

With open organic rhinolalia caused by congenital facial clefts, the child’s vital functions of nutrition and breathing suffer from the first days of life. When feeding a baby, milk leaks out through the nose, so the newborn does not gain enough weight and does not receive the necessary nutrients. The inhaled air does not have time to warm up sufficiently in the nasal passages, because it immediately enters the lower respiratory tract through the cleft. Children with palatal clefts and open rhinolalia are predisposed to malnutrition, otitis media, eustachitis, bronchitis, and pneumonia. Congenital cleft palates are often combined with malocclusion.

The state of intelligence in children with open rhinolalia can be different - from normal to mental retardation and mental retardation of varying degrees. Neurological signs are often observed in children: nystagmus, ptosis, hyperreflexia.

The prelinguistic period in children with rhinolalia proceeds abnormally: attention is drawn to the absence of modulated and varied babbling, quiet or silent articulation of sounds. Speech development with rhinolalia is also delayed: the child often pronounces his first words after 2 years. Speech is slurred, inexpressive and incomprehensible to others.

With open organic rhinolalia, the articulation of sounds and sound pronunciation are grossly impaired. The root of the tongue is constantly in a raised position, and the tip of the tongue is in a passive, lowered position, and therefore most of the consonants acquire a “back-lingual” connotation and resemble the sound [x]. With open rhinolalia, all sounds have a strong nasal (nasal) connotation and are practically not differentiated from each other; the voice becomes dull and quiet.

In an effort to pronounce sounds more clearly, children strain their facial muscles, muscles of the lips, tongue and wings of the nose, which leads to grimaces and further worsens the overall impression of speech.

Inaccurate articulation and distorted sounds are accompanied by a secondary impairment of auditory differentiation and phonemic analysis, leading to disorders of written speech - dysgraphia and dyslexia. Limitation of speech contacts in children with rhinolalia leads to insufficient development of vocabulary and grammatical aspects of speech, i.e. ONR.

If a child with open organic rhinolalia realizes and experiences his defect, this causes him to develop secondary mental layers: isolation, irritability, shyness.

With open functional rhinolalia, it is mainly the sound pronunciation of vowels that suffers; consonant sounds remain intact due to sufficient velopharyngeal closure.

Closed organic rhinolalia is accompanied by a violation of the pronunciation of nasal sounds ([m], [m'], [n], [n']), replacement of [m] with [b], [n] with [d]. At the same time, the timbre of the voice also suffers; Due to the impossibility of nasal breathing, children are forced to breathe through their mouths. Children with closed organic rhinolalia are prone to colds and the development of asthenic syndrome. With closed functional rhinolalia, the voice acquires a dull, unnatural, dead tone.

I. Inspection of the articulatory apparatus.

A speech therapy examination for rhinolalia begins with an examination of the articulatory apparatus. From documents, conversations, and examination, the type of cleft .

The age and type of operation are revealed, and the condition of the articulation organs is described in detail.

With a cleft of the upper lip, its mobility, the severity of cicatricial changes, and the condition of the frenulum are noted.

The palate before surgery is described:

type of cleft,
defect size,
mobility of segments of the soft palate.

The palate after the operation is described as follows: the shape of the vault, scars, the degree of their severity, the length and mobility of the velum.

The palate is normal - at rest, a small tongue is 1-7 mm from the back wall of the pharynx, hanging from the plane of the chewing surfaces of the upper teeth by about 1 mm.

The mobility of the velum palatine is checked with a smooth, drawn-out pronunciation of [A], with the mouth wide open.

The density of the velopharyngeal closure and the activity of the lateral walls of the pharynx during phonation are noted.

When pronouncing vowels, immobility of the soft palate can be detected.

The speech therapist causes a pharyngeal reflex by touching the back and side walls of the pharynx with a spatula. If the functions of the soft palate are not impaired, then an involuntary upward jerk of the velum should occur.

The pharyngeal reflex is assessed: absent, intact, increased or decreased.

The attenuation of the reaction of the pharyngeal muscles can begin at 5 and end at 7 years. Its evaluation is necessary for children who will wear a functional pharyngeal obturator.

Language examination

The condition of the root and tip of the tongue is examined, a shift in the oral cavity, excessive tension, lethargy, and limited mobility are noted.

The child performs the following exercises:

needle,
snake,
spatula,
horse,
watch,
swing,
delicious brew.

All exercises are carried out by imitation, then according to instructions in front of a mirror and without it.

Dental examination

Condition of bite, dentition.

The presence of an orthodontic apparatus, the purpose of application, the density of fixation, and whether or not it interferes with phonation are recorded.

At the end of the examination, the direction of the upper lip is checked.

Exercises:

focus,
spit
blowing a light object into a target.

Blow with your tongue hanging out, with the wings of your nose closed and open.

Correction of open rhinolalia

The structure of correctional work depends on the form of rhinolalia. There are several original approaches to eliminating open rhinolalia, including the works of famous scientists G. Gutsman and M.Yu. Khvattseva. Correction of open rhinolalia is divided into two stages: preoperative and postoperative. A.G. Ippolitova was one of the first to offer classes with children in the preoperative period. Her method is based on the fact that the child’s attention is directed not to the phoneme, but to the article. Speech therapist N.I. Serebrova and doctor L.V. Dmitriev first developed an effective technique after studying radiography, based on the production of oral and nasal breathing. T.N. Vorontsova suggests development in the postoperative period, which boils down to singing sounds. Modern speech therapy is based on the step-by-step methodology of I.I. Ermakova in the preoperative and postoperative periods.

Preoperative period

The preoperative period begins with the birth of the child.

Stage 1. Prevention of asthenic syndrome.

Rhinolalic children are born weak, so from the first days of life it is important to work on hardening and stimulate physical development (swimming pool, bicycle, skiing). Sick children are delayed in crawling and walking, so it is necessary to stimulate motor activity - moving a toy away, etc. The use of walkers is not recommended, since the crawling stage is very important for speech development.

Stage 2. Correcting and preventing incorrect tongue fixation

. Avoid placing the child on his back so that the root of the tongue does not move posteriorly. It is preferable to lay on your stomach or side. From birth, encourage the baby to do some tongue exercises to imitate an adult: “Delicious jam” (lick the upper lip), “Swing” (raise the tip of the tongue up and down), “Clock” (swing the tongue from side to side), “Snake” (stretch your tongue back and forth), “Turkey” (quickly run your tongue along your upper lip).

Stage 3. Prevention of breathing problems.

From 1.5-2 years old, play exercises are carried out: “steep the tea” (hold your lip at the level of the cup), blow into a straw, “smell a flower” - small cups from Kinder Surprise are filled with flower petals, inhale through the nose. You can play the harmonica, blow fluff from your palm, blow up balloons (without tension), soap bubbles, play with an airball, helping to pinch your nose.

Stage 4

.
Activation of the muscles of the velopharyngeal ring
. Do coughing and yawning exercises, gargle with small portions of water, swallow small portions of milk and jelly.

Stage 5

.
Development of voice strength and pitch.
Meow like a big cat and like a small cat.

Stage 6

.
Prevention of speech and mental development delays.
Read to the child as much as possible, show pictures, develop memory, attention, and thinking.

Stage 7

.
Prevention of secondary deviations
. The child should not feel inferior; he must work with the emotional-volitional sphere, encourage, praise, reward the child, and form a good attitude towards the world.

Stage 8

.
Voice exercises.
The speech therapist prepares the velum for closure after surgery and prevents dystrophy of the pharyngeal muscles by singing vowel sounds. First, “A” is long, then “E” is long, then “A-E” is continuous, “E-A.” The exercise should be done 6-8 times a day.

Stage 9

.
Development of the correct air flow
and inhibition of clavicular breathing. Place one hand of the child on the chest, the other on the stomach, so that the child can feel breathing, first lying down, then half-lying, half-sitting. Do the exercise at least 3 times a day for 3 to 15 cycles. Make sure that the baby does not get sick or dizzy, and do not jump up suddenly. It is also useful to blow on a candle, on cotton wool (at lip level).

Stage 10

.
Strengthening the muscles of the larynx.
You need to do voice exercises, start with pronouncing the sound “M” in isolation, teach not to strain the larynx and control the resonance. Then draw out the sound “M” in closed syllables (mom, ma’am, mum). Before surgery, work with vowel sounds for at least a month. It is important to pronounce in a certain order: start with “E” or “A”, then “O”, “I”, “U”, “Y”. This order is based on the study of the strength of the voice, which is needed to hold the soft palate in a horizontal position. Do not start with “U”, “I”, “Y”, since in the preoperative period a clear sound will not work. Possible options for AEC and EIA. Vocal exercises lift segments of the soft palate, lengthen exhalation and make the back wall of the pharynx mobile.

Stage 11

.
Creating a platform for correct sound pronunciation
, training the mobility of lips, cheeks, and tongue. Do exercises: biting the tip of the tongue, stretching the lips, slapping the tongue with the upper lip (“punish the tongue” without making a sound), licking a plate, licking a large spoon. With the deformation of the upper lip, it is necessary to develop its mobility: bite the lip with a tongue, smooth the seams with her teeth, raise the lip up, turn the lower lip (“Negro”), lay candy between the lip and nose. Be sure to massage your lips. Using the tips of the thumb and index fingers from the corners of the mouth, pressing just above the red border, perform acupressure and pull the lip forward. Knead the scar with your fingertips, place your thumb under the seam, and smooth your upper lip with your index finger. Gymnastics and massage should be carried out 3-4 times a day for up to 5 minutes, avoiding sudden movements, painful sensations in which the child experiences tension in the muscles of the forehead, wings of the nose, jaws and neck, which is transmitted to the larynx, pharynx, and tongue.

Stage 12

.
Development of phonemic hearing.
Until the age of 5, a child is introduced to non-speech sounds and taught to distinguish them: the murmur of water, the rustling of paper, a rattle, a tambourine, a whistle, etc. After 5 years, children are introduced to speech sounds, correlating them with letters.

Stage 13

.
Correction of sound pronunciation.
Articulation may be approximate. Correction comes down to the formation of oral consonants.

Postoperative period

1 step.

It begins with the stage of setting vowel sounds and eliminating excessive nasal resonance. If the child received speech therapy before surgery, this period is short (2-3 weeks). If no assistance was provided, the period is delayed by 3-6 months. During this period, the velum palate can be stretched to its maximum, so it is important not to miss the moment. After surgery, a long period of silence is inevitable, so speech deteriorates. The soft palate is swollen, the child feels pain, avoids correct articulation of sounds, and speaks through the nose. It is necessary to include the operated palate into phonation as quickly as possible, this facilitates the acquisition of the skill of oral vowel resonance. The operated organ for the child receives its intended purpose. Speech therapy work must be started on the second day after obturation or 15-20 days after uranoplasty. In six months, when the scarring process is over, the work will be meaningless.

With special exercises and massage, you can stretch the edge of the soft palate by 1-3 cm. Massage is carried out with a probe, spatula or pacifier. Carefully move the instrument back and forth along the hard palate, without touching the seams, while the muscles of the pharynx and soft palate reflexively contract. When pronouncing the sound “A”, apply light pressure on the soft palate with a probe or finger (activation of the gag reflex). The child does self-massage and strokes the stitches with his tongue. Massage is performed at least 2 times a day for a year, two hours before or after meals. Gymnastics for the palate are also performed: swallowing in small portions, coughing with the tongue hanging out, yawning with the mouth closed and open. Articulatory gymnastics includes stretching the lips (“Smile” - “Tube” in dynamics), additionally – vibration of the lips (coachman’s “tpprrrr”, stop the “horse”), for the cheeks – drawing the cheeks into the oral cavity. Voice exercises in the same order, starting with the vowels “A”, “E”. At the same stage, work on breathing is carried out. Inhale-exhale through the nose, inhale-exhale through the mouth, inhale through the nose, exhale through the mouth.

Step 2

– stage of sound pronunciation correction. We start with vowel sounds. The order of consonants is as follows: first “P”, “F”, then “Py”, “F”, “V-V”, “T-T”, “K-K”, “X-H”, “S-” Sj”, “G-G”, “L-L”, “B-B”, “D-D”, “Z-Z”, “Sh”, “R-R”, the last ones – “Zh”, “ Shch", "Ch", "C". At the same time, they develop the prosodic side of speech.

Step 3

– automation of new skills. Features of the work depend on the age of the child. At the same time, they develop the lexical and grammatical structure of speech. The work with breathing does not stop, they use airballs, blowing on a basin of water, on sand, on a toy. Classes are conducted in a playful way, sounds are reinforced in short rhymes.

III. Identification of sound pronunciation features.

Sound pronunciation is checked in the same way as for dyslalia.

Preschoolers are presented with visual aids; schoolchildren can be offered texts.

The nature of sound pronunciation disorders is noted: additional silent pronunciation, i.e. articulation without phonation, accompanying noises.

Legibility or illegibility, blurriness, and nasal resonances must be noted.

When examining all aspects of speech, phonemic hearing and perception are first checked. The examination proceeds as for dyslalia.

Be sure to select material with paronyms (hatch-bow).

The state of sound-letter analysis is checked for older preschoolers and younger schoolchildren. Words are taken with hard variants of consonant sounds. In contrast to dyslalia, it is determined whether the child differentiates his deficiencies by hearing or knows about them from the words of others.

Where to treat rhinolalia to be sure of the result

The NeuroSpectrum Center for Pediatric Speech Neurology and Rehabilitation is a modern medical center that treats patients with impaired or absent speech, mental development disorders, developmental delays, and so on. Patients diagnosed with Rhinolalia

This is also not uncommon here, and the center knows exactly how to make a correct diagnosis and what treatment will be most effective.

The specialists of our Center have extensive experience working with patients with rhinolalia; they have modern diagnostic and medical equipment at their disposal, so we are ready to solve problems of any level of complexity. However, it must be remembered that at an earlier stage of rhinolalia, treatment will be less expensive and more effective, so you should not delay contacting specialists.

IV. Determination of levels of general speech development.

The state of vocabulary is examined, the level of passive and active vocabulary is checked.

The grammatical structure of speech is examined.

The state of coherent speech is checked using the example of dialogue and monologue.

Schoolchildren are tested in writing and reading.

Letter:

cheating,
dictation letter
independent statement.

Reading:

the reading method is checked (letter by letter, syllabic, verbal),
reading comprehension is examined.