Corrective work with dysarthric children
Marina Larina
Corrective work with dysarthric children
Speech is for communication. However, to convey the meaning of what is being said, speech must be legible. It's not as simple as it seems. To do this, first of all, it is necessary that the muscles of the articulation organs be sufficiently mobile and strong, that is, trained, experienced . If the muscles of the organs of articulation are unprepared for speech, then a speech disorder called dysarthria occurs. This is one of the most severe speech disorders. Most often, dysarthria is part of a complex set of disorders caused by organic damage to the central nervous system.
Dysarthria is a disorder of sound pronunciation, voice formation and prosody, caused by insufficient innervation of the muscles of the speech apparatus: respiratory, vocal, articulatory.
Articulation disorder occurs due to the fact that the tongue, lips, palate, vocal cords, diaphragm, i.e., all human organs involved in the act of speech, cannot move fully. The reason for this immobility is paresis of the muscles of the articulatory apparatus.
, G. Gutsman drew attention to the difficulties in correcting He noted that these disorders are characterized by blurred, erased articulation. Many authors have addressed the problem of speech disorders with erased dysarthria (O. V. Pravdina, L. V. Melikhova, O. A. Tokareva, I. I. Panchenko.
There are several types of dysarthria. The nature of the differences depends on which areas of the child’s brain are affected. A common symptom of all dysarthria is unintelligible speech, that is, unclear pronunciation of sounds, words, and phrases. Limited in movements, first of all, the main organ of articulation is the tongue. It becomes awkward, and when protruding, it deviates to the side, most often to the right. The movements of other parts of the speech apparatus are difficult: the lips do not move forward well, do not stretch sufficiently into a “smile”
, a small tongue in the back of the mouth
(velum palatine)
sags and does not close the passage to the nose during speech.
With this position of the velum, the air that is necessary for speech flows out through the nasal cavity. This entails a nasal tone of speech (nasality)
. In addition, with dysarthria, the voice suffers due to paresis of the vocal cords. It becomes hoarse, tense or, conversely, very quiet and weak.
Thus, unintelligibility of speech in dysarthria is caused not only by a disorder of articulation itself, but also by a violation of the coloring of speech - its melody or prosody, as it is commonly called in speech therapy. As a result, dysarthria is characterized by inexpressiveness of speech and monotony of intonation.
From the first days of life, the development of a child with dysarthria differs significantly from the development of normally developing children. Children with dysarthria begin to hold their heads up, sit , stand, and walk late. Some preschoolers with dysarthria have a lack of muscle strength, which is evidenced by the fact that children do not hold objects well with one or even two hands. Violations of the rhythm of voluntary movements, tempo, movements are inaccurate, poorly coordinated. Violations of verbal regulation of actions manifest themselves in difficulties when a child completes a task according to verbal instructions.
At 1.5 - 2 years of age, delayed independent feeding skills are noted; the child only begins to eat with a spoon and drink from a cup.
From 2.5 years of age, fine motor impairment in a child with dysarthria manifests itself in productive activities - visual arts and manual labor. The child has poor or no control over the force of pressure when applying or working with plasticine ; there is no voluntary control over movements; movements are imprecise and chaotic.
At 2 - 3 years old, a child finds it difficult to fold pyramids of varying complexity and soft construction sets. Basic hygiene skills are developed with great difficulty due to motor impairments. The baby is untidy - he has difficulty fastening buttons and lacing his shoes. Folding pyramids and soft construction sets is also difficult. When manipulating objects, the child does not take into account their properties, and the manipulations themselves alternate with inappropriate actions (the child persistently tries to place a large car in a small garage, etc.).
By the age of 4, during work activities, coordination of movements in performing precise actions is difficult; as a rule, the strength of the hand is little controlled or is insufficient.
By the age of 5-6 years, only the simplest movements are available to the child. The child finds it difficult to perform an imitation movement without outside help ( “lock”
- put your hands together, intertwining your fingers;
“rings”
- alternately connect the index, middle, ring and little fingers to the thumb).
Children also continue to experience lethargy in their fingers, which is especially noticeable when working with a pen or pencil.
M. M. Koltsova in her research about
facial muscles from the side of the brain and can be misleading, creating an external impression of the child’s mental inferiority. However, most often it is wrong, and great care must be taken not to jump to conclusions and not to unfairly label the child.
In preschool children with erased dysarthria, the formation of the grammatical structure of speech occurs with pronounced difficulties. Grammatical figures of inflection and word formation appear in children of this category in the same order as in normal speech development. However, there is a slower rate of acquisition of grammatical categories. According to the judgment of L.V. Lopatina, one of the factors of unsatisfactory formation of the grammatical structure of speech seems to be a violation of the differentiation of phonemes. This gives rise to problems in distinguishing the grammatical forms of words due to the unclearness of the auditory and kinesthetic image of the word, and especially the endings.
Preschool children with erased dysarthria have a primary disorder of the pronunciation aspect of speech, which negatively affects the development of other components of the speech system. Deviations in the formation of the grammatical structure of speech are derivative and have the nature of secondary pathologies.
Dysarthric children, as a rule, have normal intelligence. You need to work with them a lot and patiently. In the future, most of these children can choose any specialty, unless, of course, it is associated with the need to perform complex movements. With proper training, children with dysarthria can learn to read and write normally.
Naturally, treatment of children with dysarthria, which, I emphasize once again, is not an independent disease, but only a part of it, is possible only by using a complex method that combines different types of therapeutic effects. Let us name the most important of them:
- medications that affect brain activity and are aimed at reducing the severity of symptoms of organic damage to the central nervous system;
-physiotherapy, massage, physical therapy, acupuncture to normalize muscle tone and increase the range of motion of the limbs, as well as organs of articulation;
- general supportive and hardening treatment to strengthen the body as a whole;
— treatment of concomitant diseases;
— speech therapy work on the development and correction of speech.
In all types of treatment for a child with dysarthria, parents play an extremely important role. It is difficult to overestimate the contribution they make with their patience, accuracy and accuracy in implementing the recommendations of specialists. First of all, this applies to speech therapy classes. Parents should know why certain speech exercises are given, understand their meaning and imagine the expected results.
Basically, speech therapy for dysarthria is aimed at developing the organs of articulation . This is a massage of the organs of articulation (speech therapy massage)
and articulatory gymnastics.
To interest the child, you should turn the exercises into a form of play. For example, the movement of the tongue towards the corners of the lips can be thought of as playing with a watch; hitting the alveoli with the tongue - like playing a woodpecker who is hammering a tree, or a carpenter hammering nails with a hammer, etc.
To develop correct speech breathing, various types of blowing through the mouth are useful: blowing branches, fluff from the palm, blowing on hot tea, a candle, blowing out birthday candles, etc. Speech therapy work on correcting defects in the pronunciation of sounds in dysarthria and tongue-tiedness, called dyslalia in speech therapy, coincides .
In some cases, functional tests help diagnose minimal manifestations of dysarthria.
Sample No. 1. The child is asked to open his mouth, stick his tongue forward and hold it motionless along the midline and at the same time follow with his eyes an object moving in lateral directions. The test is positive and indicates dysarthria if, at the moment of eye movement, there is a slight deviation of the tongue in the same direction.
Sample No. 2. The child is asked to perform articulatory movements with his tongue while placing his hands on his neck. With the most subtle differentiated movements of the tongue, tension in the neck muscles is felt, and sometimes a visible movement with throwing the head back, which indicates dysarthria.
for correctional and speech therapy work , which involves the following stages, depends on this
Preparatory stage. It includes the following areas:
1. Normalization of muscle tone of facial and articulatory muscles. The speech therapist conducts differentiated speech therapy massage.
2. Preparation of the articulatory apparatus for the formation of articulatory structures. Articulation gymnastics can be carried out in both passive and active forms. Passive gymnastics is carried out by a speech therapist and is aimed at activating the muscles of the tongue and lips.
3. Normalization of speech breathing. For this purpose, breathing exercises are performed (exercises to develop a long, smooth exhalation)
.
4. Normalization of prosody. Children with erased dysarthria have disturbances in prosodic components: disturbances in speech rate and voice timbre; decreased speech intelligibility, poor intonation; absence of pauses and logical stresses.
5. Normalization of fine motor skills. For this purpose, a speech therapist performs finger exercises aimed at developing fine differentiated movements in the fingers of both hands.
The second stage of speech therapy work for dysarthria is the development of new pronunciation skills. It includes the following areas:
• Development of basic articulatory patterns for producing a particular sound based on visual and kinesthetic control.
• Development and improvement of phonemic hearing.
• Sound production. This work for dysarthria is carried out in the same way as for dyslalia. When correcting dysarthria, first of all, the group of sounds for which the articulatory structures have been formed is placed.
• Automation of sounds. This is the most difficult direction in the second stage. To automate sounds with erased dysarthria, more training is required than with dyslalia.
The third stage of speech therapy work is the stage of communication skills. It includes the following areas:
Formation of self-control skills in a child.
Consolidating correct sound pronunciation in various speech situations (memorizing poetry, writing sentences, stories, retellings, etc.).
The fourth stage of speech therapy work is the prevention or overcoming of secondary disorders in dysarthria. Development of the lexical and grammatical side of speech, development of attention, memory, thinking.
The fifth stage is preparation for school. It includes the following areas:
Development of sound analysis and synthesis skills.
Introducing letters.
Improving coherent speech.
Preparing a preschooler's hand for writing (shading, outlining letters, printing letters, constructing letters from individual elements).
It should be noted that the success of correctional work with children with dysarthria depends on the coherence of the joint activities of the speech therapist, educator and parents.
Long-term plan for speech therapy work to correct dysarthria
Individual plan for speech therapy work
Speech therapist teacher Borodacheva I.A.
for the correction of dysarthria
I. Preparatory stage.
1. Fostering the need for correct speech.
2.Development and refinement of the child’s passive vocabulary
(what the child understands):
- carried out using plot and subject pictures, which the speech therapist names and asks the child to repeat.
3.Overcoming sensory impairments
(perception, attention, memory):
- carried out in the form of development of auditory and visual attention and perception, etc.
4. Formation of phonemic perception, differentiation of phonemes, phonemic analysis and synthesis:
- the work is similar to working on dyslalia.
5.Creating conditions on the rhythm of speech, the syllabic structure of the word:
— conditions are created in the process of exercises to develop perception and reproduce various rhythmic structures, both simple and accented.
6. Creation of conditions for the formation of general motor and articulatory skills, conditions for the formation and correction of respiratory and vocal functions:
— these conditions are created in the process of medicinal and physiotherapeutic treatment, physical therapy, massage, passive and active gymnastics.
Work on the development of the articulatory apparatus,
it is preceded by:
— carrying out differentiated massage of the facial and articulatory muscles, depending on the state of muscle tone.
The main massage techniques are stroking, pinching, kneading, and vibration. The nature of the movements will also be determined by the state of muscle tone.
— Simultaneously with the differentiated massage, work is carried out to develop facial muscles.
For this purpose, the child is taught to open and close his eyes, frown his eyebrows, nose, etc. As such tasks are completed, their differentiation and arbitrariness gradually develops.
— carrying out work to combat salivation
.
1. The child is explained the need to swallow saliva.
2. Massage the masticatory muscles, which interfere with the swallowing of saliva.
3. Inducing passive and active chewing movements, ask the child to throw his head back and an involuntary desire to swallow saliva arises; can be supported by request.
4. The child is asked to chew solid food in front of a mirror, this stimulates the movements of the chewing muscles and leads to the need to make swallowing movements, which can be reinforced with a request (i.e. from involuntary movements to voluntary ones).
5. Voluntary closing of the mouth due to passive-active movements of the lower jaws. First, passively, one hand of the speech therapist is under the child’s chin, the other is on his head, by pressing and bringing his hands together, the child’s jaws close - a “flattening” movement. Then this movement is done with the help of the child’s own hands, then actively without the help of hands, using counting and commands.
In the case of severe dysarthria, the development of speech motor skills begins with passive gymnastics, with extensive use of involuntary movements.
Work on developing lip mobility.
1. Make the child laugh (involuntary stretching of the lips).
2. Smear your lips with something sweet (“licking”
) - raising the tip of the tongue up or down).
3. Bring a long lollipop to your mouth (pull the child’s lips forward).
After these involuntary movements, they are fixed in a voluntary plan, in active gymnastics. At first, the movements will not be performed in full, not in the exact volume, then they are reinforced in special exercises for the lips (“smile”, “proboscis”, alternating them).
Work on the development of language mobility.
It begins with general movements, with a gradual transition to more subtle, differentiated movements. In case of severe dysarthria, the following exercises will be performed for articulatory gymnastics.
1. Place the tip of the tongue on the inner surface of the lower incisors.
2. Pulling the tongue forward and retracting it back.
3. Stimulation of the muscles of the root of the tongue. First, voluntarily, through reflex contractions, as a result of irritation of the root of the tongue with a spatula. Then the movements are consolidated in unconditioned reflexes, and then in voluntary “coughing” movements.
4. Performing subtle, differentiated movements of the tongue. For this purpose, movements are purposefully selected to develop the desired articulatory pattern, taking into account the normal articulation of sound and the nature of the defect. Articulatory gymnastics is best carried out in the form of games, which are selected taking into account the age of the child and the nature and degree of organic damage. Work on the formation of articulatory motor skills will be effective when it is combined with the development of general and especially manual motor skills. For this purpose, in case of severe dysarthria, a physical therapy methodologist develops the child’s supporting, grasping activities of the hands, as well as differentiated finger movements. The same work is carried out by a speech therapist during speech therapy classes, where clear finger kinesthesia is formed through special exercises and the hand is prepared for writing. You can also use various teaching aids and types of work such as squeezing and unclenching rubber bulbs, grasping small objects with your fingertips, mosaics, plasticine, drawing, tracing, shading stencils, cutting, lacing, sewing buttons, etc.
II. Stage. — Formation of primary pronunciation skills.
1. Correction of movements of the articulatory apparatus.
2. Development of articulatory praxis.
3. Development of respiratory and vocal functions.
4. Work on pronunciation (pronunciation, differentiation of sounds).
5. Work on the formation of prosodic components of speech.
6. Work on enriching the vocabulary and overcoming agramatisms.
1st 2 directions (correction of movements of the articulatory apparatus and development of articulatory praxis.).
The work begun at the 1st stage in the form of articulatory gymnastics continues, but it becomes more complicated and differentiated. If at the 1st stage the child’s basic movements are formed and consolidated, then at the 2nd stage incorrect and imprecise movements are corrected, their strength and accuracy are trained, and coordination is practiced.
In this regard, in articulatory gymnastics at the 2nd stage, differentiated movements of the articulatory organs predominate, and much attention is paid to performing a series of movements (the ability to voluntarily switch from one movement to another is assumed).
Working on breathing.
In the case of severe dysarthria, work on breathing begins with general breathing exercises. The purpose of these exercises is to increase breathing volume and normalize its rhythm. To achieve this goal, the following exercises are performed:
1. The child lies on his back, the speech therapist bends his legs at the knee joints and, with bent legs, presses on the armpits. These movements are performed in a normal respiratory rhythm and counted. This helps normalize the movements of the diaphragm.
2. The child sits, a fan of air is created in front of his nostrils. Under its influence, the depth of inspiration increases due to the inclusion of the diaphragm muscles in the work.
After active work of the diaphragm muscles, the optimal type of physiological breathing is developed. The formation of this type of breathing is carried out by imitation, in various positions, lying, sitting, standing.
The child places one hand on his diaphragm, the other on the speech therapist’s diaphragm. The speech therapist inhales and exhales, engaging the diaphragm muscles; the child, feeling the movements of his hand, tries to breathe in the same way. Then, the movements of the diaphragm, caused by imitation, are reinforced in various breathing games.
After consolidating diaphragmatic breathing, work is carried out on long, smooth exhalation through the mouth, which is carried out:
— without speech accompaniment;
— with speech accompaniment.
Work without speech support
.
It is carried out in the form of various breathing exercises using a variety of didactic aids, which allow visual control of the duration and force of exhalation through the mouth.
When performing breathing exercises, you must adhere to the following rules:
- breathing exercises should be carried out before meals, in a well-ventilated area;
- when performing breathing exercises, you should not overtire the child (the first sign of fatigue is yawning - a symptom of oxygen deficiency);
- when performing breathing exercises, it is necessary to monitor the child’s posture (straight, shoulders straightened, legs, arms calm);
- when exhaling, the child should not strain his shoulders, neck, raise his shoulders, or puff out his cheeks;
- when performing breathing exercises, the child’s attention should be drawn to the sensations of movement of the diaphragm;
— it is better to perform breathing movements smoothly, to the counting of music;
- didactic material used for breathing exercises should be light - cotton wool, thin colored paper, a balloon, etc.; it must be located at the level of the mouth.
Working with speech accompaniment.
Work is carried out while pronouncing speech material of varying complexity, with a long, smooth exhalation.
Some methodologists recommend pronunciation of vowel sounds, others - from fricative, voiceless consonants.
This work is carried out in the following exercises:
- singing vowels while exhaling - “thread”;
- pronouncing combinations of 2, 3, 4 vowels with a long, smooth exhalation (you need to make sure that there are no pauses between vowels for an additional breath);
- pronunciation of isolated fricative, voiceless consonants (when inhaling - sound);
- pronouncing fricative, voiceless consonants with a combination of vowels (sa-so-su-sy; sa-fa-ha-sha)
- pronouncing words with a smooth exhalation, at first few syllables, then many syllabics, first with emphasis on the 1st syllable, then the emphasis changes;
- constant dissemination of the phrase on a long, smooth exhalation (take a breath - then “birds” - “birds are flying” - “birds are flying in the sky” - “birds are flying in the sky to the
south”
, etc.). The number of words a child pronounces in one exhalation is determined by age:
| 5 years - | 4 – 5 words, no more |
| 6 years - | 5 – 6 words, no more |
| 7 years - | 6 – 7 words, no more |
Working on your voice.
It is carried out in parallel with work on breathing, combined with physiotherapeutic, drug treatment and differentiated massage.
In the case of severe dysarthria, the work begins with teaching the child to open and close his mouth voluntarily, since it is these movements (of the lower jaw), performed in full, that ensure normal voice formation and free vocal delivery.
To develop movements of the lower jaw, a special model is used, which is a brightly colored ball tied to a rope. The child takes the ball with his hand and at the moment of lowering his jaw, he pulls it down, then the same movement is performed with his eyes closed, in order to enhance kinesthetic sensations. Then the same movements are practiced when pronouncing vowel sounds and various sounds - imitations. After free vocal delivery is ensured and vocal constriction is relieved, voice (orthophonic) exercises are used to develop the voice. The purpose of the exercises is to develop coordination of breathing, articulatory phonation and practice the basic acoustic characteristics of the voice (strength, pitch, timbre). For example: direct counting with increasing voice or vice versa (voice strength), or ooooh
and
ooooh
, etc. (such exercises are used to develop voice pitch and modulation).
All this is practiced in special voice exercises. Voice skills are strengthened in reading fairy tales, during role-playing games, and in Russian folk tales.
Working on pronunciation.
Working on pronunciation is the main stage. Features of working with dysarthria are the following:
— Work on correcting sound pronunciation defects in dysarthria should be aimed at improving speech communication and social adaptation.
— Work on individual sounds should be carried out in a certain sequence. Start with those sounds whose articulation is most preserved. And among the defective sounds, start working with the sounds of early ontogenesis.
— When correcting sound pronunciation defects, it is necessary to take into account the influence of pathological reflexes (oral automatism).
— When correcting defects in sound pronunciation, it is also necessary to take into account the nature and distribution of spastic and poretic movements in the speech muscles.
— With severe dysarthria, at first it is not possible to achieve a clear sound, so you can move on to working on other sounds, being content with an incomplete sound frequency.
Work on pronunciation is carried out in parallel with the development of phonemic functions (phonemic perception, differentiation, phonemic analysis and synthesis). The techniques for staging, automating and differentiating sounds are the same as for correcting any sound pronunciation disorders.
Work on the prosodic side of speech.
Much attention is paid to developing the correct tempo and rhythm of speech, by learning to arbitrarily change the tempo of speech, highlight stressed syllables in the structure of a statement and correctly alternate them with unstressed syllables, and observe correct pauses.
Correction of speech tempo disorders is combined with work on the development of general movements in logarithmic classes.
The development of melodic-intonation speech is facilitated by voice exercises aimed at developing the basic tone of the statement. The tempo-rhythmic and intonation skills of speech formed in special exercises are consolidated in emotionally charged speech material (reading fairy tales, dramatizations, etc.). When selecting such material, the age of the children and the program requirements of training must be taken into account. So in preschool age it’s Barto, Marshak, etc., and in school age it’s Krylov, poems by Pushkin, Nekrasov. Older - Mayakovsky, etc.
III. Stage. – Formation of communication skills
.
1. Work continues on automation and differentiation of sounds in speech material that is more complex than at other stages.
2. Formation of pronunciation skills in various communication situations, through careful and constant expansion of the circle of communication, creating problematic situations.
3. Work continues to correct lexical and grammatical violations, and work continues with school-age children to correct reading and writing.
Features of the development of fine motor skills in children with dysarthria.
Zachupeyko Anna Valerievna
Features of the development of fine motor skills in children with dysarthria.
The concept of " fine motor skills "
means movement of hands in literal translation.
The need to develop hand motor skills in children with speech impairments , and especially those whose speech is systemically impaired, is determined by the role of fine motor skills in the formation and work of many mental processes - perception, speech, attention, and its importance in graphic and labor activities.
In the history development , the role of hands is often emphasized . It was the hands that made it possible to develop the language of communication of primitive people with the help of gestures. Research by scientists shows that hand movements arise only as a result of upbringing and training.
In addition, improving manual motor skills helps to activate various areas of the brain. In general, the level of development of motor skills is one of the important indicators of readiness for schooling. The development of fine motor skills of a person’s hand is closely related to the level of development of speech activity, therefore deficiencies in the development of this skill entail deficiencies in speech articulation, which are later reflected in the level of mastery of written speech. As is known from research in the field of speech activity in dysarthria , speech impairments are one of the important signs of this mental disorder. Consequently, motor is also the main type of abnormality in children with dysarthria .
The development of a child with dysarthria from the first days of life differs from the development of normal children . In many children with dysarthria, the development of upright posture is delayed , i.e. they begin to hold their head up, sit, stand, and walk much later. This delay in some children can be quite significant, affecting not only the entire first, but also the second year of life.
All children with dysarthria experience a decrease in interest in their surroundings, indifference, and general pathological inertia (which does not exclude loudness, anxiety, irritability, etc.)
.
They do not have a need for emotional communication with adults; as a rule, they do not have a “revitalization complex
.
normally developing child, in response to an adult’s voice or smile, throws up his arms and legs, smiles, and hums quietly, which indicates that the child has a need to communicate with an adult.
In the future, children with dysarthria have no interest in either toys hanging above the crib or toys in the hands of an adult. There is no timely transition to communication with adults based on joint actions with toys, and a new form of communication—gesture—does not arise. Children in the first year of life do not differentiate between “their own”
and
“alien”
adults, although with normal
development this occurs in them already in the first half of life.
This affects the development of the first actions with objects—grasping—and the development of perception , which is closely associated with grasping during this period. Children with dysarthria developing large and small objects differently, like objects of different shapes, as well as distinguishing the objects themselves from a number of others.
In children with dysarthria of early age, object-based activity is not formed. Some of them show no interest in objects, including toys. They do not pick up toys at all or manipulate them. Not only do they not have an orientation like “What can be done with this?”
, but also simpler orientation like
“What is this?”
.
In other cases, children of the third year of life begin to manipulate objects, sometimes reminiscent of the specific use of an object, but in reality the child, when performing these actions, does not take into account the properties and purposes of objects at all.
In addition, these manipulations are interspersed with inappropriate actions. Inappropriate actions are those actions that contradict the logic of using an object and come into conflict with the role of the object in the objective world. For example, when a child first puts a cap on the stem of a pyramid and then tries to string rings; knocks the doll on the table; trying to fit a large car into a small garage, etc. Such actions add nothing to knowledge.
The presence of inappropriate actions is a characteristic feature of a child with dysarthria .
The actions of children with dysarthria with objects represent manipulations that are similar to those of younger, normally developing children , but are interspersed with inappropriate actions that are not typical for normal children .
At the same time, the development trends of a child with dysarthria are the same as those of a normally developing child . Much in the development of a child—a lag in mastering objective actions, lag and systemic deviations in the development of speech and cognitive processes—is largely of a secondary nature. With proper organization of the life of a child with dysarthria , requiring the earliest possible inclusion of special education, many developmental can be corrected and even prevented.
Development in preschool age is, as is known, a continuation of the development that we observe at an early age. Despite the fact that at 3 years a certain leap occurs, further development is based on the level that was achieved before. At the same time, this age has its own characteristics , its own tasks, many of which arise for the first time.
In early preschool age, children mainly master specific manipulations, which should form the basis for the formation of visual-motor coordination and the identification of properties and relationships of objects. However, the process of mastering specific manipulations without special training is slow, since children do not develop a genuine interest in the objective world around them. interest in objects , in particular toys, turns out to be short-lived, as they are stimulated only by their appearance. Along with nonspecific manipulations, children of the fourth year of life exhibit a large number of inappropriate actions with objects. Their number sharply decreases only in the sixth year, giving way to specific manipulations leading to familiarization with the properties and relationships of objects.
It should also be noted that younger preschoolers with speech disorders have underdevelopment of the motor sphere and, above all, fine motor skills . Children's movements are poorly coordinated, imprecise, many of them do not hold objects well, and often operate with one hand. Some children are not capable of quickly changing motor settings . Some preschool children with dysarthria have a lack of muscle strength, rhythm of voluntary movements, and tempo. A violation of verbal regulation of actions is also detected, which manifests itself in difficulties when performing tasks following verbal instructions.
For children with dysarthria, preschool age is the beginning of the development of perceptual action. Based on the child’s awakened interest in objects and toys, an acquaintance with their properties and relationships arises. The fifth year of life becomes a turning point in the development of perception of a child with dysarthria .
However, the problems that were observed in the development of fine motor skills as the sensory basis of perceptual action continue to occur in a preschooler with dysarthria , but due to the complication of activity they become even more profound. At this age, disturbances in manual motor skills no longer appear at the level of individual actions, but at the level of complex sets of movements, as well as at the level of visual-motor coordination of movements, which means that fine differentiated movements of the hands and fingers are especially difficult in children with dysarthria They have difficulty learning to lace up their shoes, tie shoelaces, and fasten buttons; they often do not measure their efforts when handling objects: they either drop them, or squeeze them too hard, or pull them.
Fine motor skills disorders manifest themselves in productive activities: manual labor and visual arts. Often, a child with dysarthria actively turns the sheet of paper when drawing or coloring. This means that the child replaces the ability to change the direction of a line with fine finger movements by turning the sheet, depriving himself of finger and hand training. It is also quite common in practice to encounter such a feature of the visual and graphic activity of a preschooler with dysarthria , when he draws objects that are too small, which, as a rule, indicates a rigid fixation of the brush when drawing. When modeling, a child often cannot control the force of pressure, his movements are chaotic, imprecise, and there is no voluntary control of movements. During work, the child has difficulty performing subtle and precise actions, coordination of movements, and hand strength is either insufficient or poorly controlled. A serious drawback that causes many problems in the development of fine motor skills in children is the lack of self-control over actions, disturbances in the tempo of actions (hasty or slowness)
etc.
as indicators of pathological disorders in the development of fine motor skills in dysarthria .
Stiff hand movements
If a six-month-old child still holds one or both hands clenched into a fist, this is a warning signal for parents and teachers. Sometimes the hands are squeezed so tightly that an adult can hardly insert a rattle into the child’s palm.
Between the 6th and 12th month, the baby should begin to play with his fingers in such a way that each finger actively moves. Children with developmental have difficulty moving individual fingers.
The baby reaches for the object, but he has difficulty grasping and holding it. It is often difficult for an older child to grasp something in his hands, for example, a talking doll, a squeaking rubber toy, etc.
Unilateral fine motor
To recognize disorders at an early stage, great attention must be paid to unilateral weakness or immobility of the hands and fingers. If an older child, in the process of demonstrating tendencies towards right- or left-handedness, prefers one hand, there is no pathology in this. But if a child, when working with objects, never resorts to the help of his second hand, this is a serious suspicion of a unilateral functional disorder.
Cramps and trembling
Sharp and repeated muscle contractions in the child’s hand will be noticeable. Similar convulsive movements can also occur in the area of the forearms, shoulders, and the back of the head (convulsive jerking of the head)
or faces
(facial convulsions)
.
Convulsive twitching of the whole body is sometimes mistaken for shuddering from fear, but their causes may be a violation of the central nervous system.
Sometimes you can observe not impetuous, but slow and pulling movements of the fingers and hands. They, just like convulsions, do not obey the will. In this case, the fingers sometimes perform twisting, worm-like movements. Similar slow and tense movements can be observed in the facial muscles.
described above appear more often in older children . These also include trembling in the hands and fingers during passive and active movements. As a consequence of this, there is uncertainty when grasping objects. A small child who begins to draw cannot make even strokes.
Smaller or larger tremors may also appear in the muscles of the head and body .
When the tongue moves, children with dysarthria often experience accompanying movements of the fingers of the right hand (
especially the thumb) (syncinesia)
.
The development of fine motor skills is of great importance for the development of speech , so normal finger and hand movements are extremely important for children with speech disorders .
fine motor skills deficiencies occurs through children performing a large number of exercises aimed at developing dexterity , accuracy, simultaneity (synchrony)
finger movements.
So, in general terms, the patterns of mental development coincide for normative children and children with deviations . However, there is something specific in the development of children with speech disorders. The development of a child with dysarthria from the first days of life differs from the development of normal children . The actions of children with dysarthria with objects represent manipulations that are similar to those of younger, normally developing children , but are interspersed with inappropriate actions that are not typical for normal children .
Children's movements are poorly coordinated, imprecise, many of them do not hold objects well, and often operate with one hand. Some children are not capable of quickly changing motor settings . Some preschool children with dysarthria have a lack of muscle strength, rhythm of voluntary movements, and tempo. A violation of verbal regulation of actions is also detected, which manifests itself in difficulties when performing tasks following verbal instructions. Later, disturbances in manual motor skills no longer appear at the level of individual actions, but at the level of complex sets of movements, as well as at the level of visual-motor coordination of movements.
Let's consider the features of fine motor skills in its most common form - erased dysarthria .
According to research by L.V. Lopatina, preschoolers with an erased form of dysarthria have impairments in manual motor skills , manifested mainly in impaired accuracy, speed and coordination of movements. causes significant difficulties in children . In most cases, it turns out to be difficult or impossible to quickly and smoothly reproduce the proposed movements. In this case, additional movements, perseverations, rearrangements, and impaired optical-spatial coordination are noted. Switching movements is often carried out in conjunction, according to verbal instructions and with pronouncing their sequence. The most impaired is the ability to simultaneously perform movements, which indicates a certain dysfunction of the premotor systems , which primarily provide the kinetic organization of movements
Thus, it was found that the majority of children with an erased form of dysarthria had mild (erased)
neurological symptoms, which were revealed upon careful examination and indicated organic damage to the central nervous system.
Children with erased dysarthria are motorically awkward , the range of active movements is limited, and the muscles quickly tire under functional loads. They stand unsteadily on one leg, cannot jump on one leg, or walk along a “bridge”
etc. They imitate movements poorly: 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 the tempo, rhythm of movements, as well as in switchability movements.
Children with erased dysarthria late and have difficulty mastering self-care skills: they cannot button a button, a scarf, etc. d. 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, a “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.
The general motor sphere of children with an erased form of dysarthria is characterized by awkward, constrained, undifferentiated movements. There may be a slight restriction in the range of movements of the upper and lower extremities; with functional load, concomitant movements are possible (syncenesis, disturbances in muscle tone. Often, with pronounced general mobility, the movements of a child with an erased form of dysarthria remain awkward and unproductive.
Insufficiency of general motor skills manifested in preschoolers with this disorder when performing complex movements that require precise control of movements, precise work of various muscle groups, and correct spatial organization of movements. For example, a child with an erased form of dysarthria , somewhat later than his peers, begins to grasp and hold objects, sit, walk, jump on one or two legs, runs awkwardly, and climbs on a wall bars. In middle and senior preschool age, it takes a long time for a child to learn to ride a bicycle, ski and skate.
In children with an erased form of dysarthria disturbances in fine motor skills of the fingers , which are manifested in impaired accuracy of movements, a decrease in the speed of execution and switching from one pose to another, slow initiation of movement, and insufficient coordination. Finger tests are performed imperfectly, and significant difficulties are observed. These features are manifested in the child’s play and learning activities. A preschooler with mild manifestations of dysarthria is reluctant to draw , sculpt, or play ineptly with mosaics.
Features of the state of general and fine motor skills are also manifested in articulation, since there is a direct relationship between the level of development of fine and articulatory motor skills .
age children in the first grade experience difficulties in mastering graphic skills (some experience “mirror writing”
;
replacing the letters “d”
-
“b”
; vowels, word endings; bad handwriting; slow pace of writing, etc.).
With pseudobulbar palsy, different muscles are not affected to the same extent: some more, others less.
Clinically, paralytic, spastic, hyperkinetic, mixed and erased forms of the disease are distinguished. Most often, mixed forms occur, when the child has all the phenomena of motor impairment - paresis , spasticity and hyperkinesis.
Paresis manifests itself in the form of lethargy, decreased strength of movement, its slowness and exhaustion, any movement is made slowly, often not completed, repeated movement is made with even greater difficulty, and sometimes cannot be repeated at all.
Specific development of fine motor skills is also observed in cerebellar dysarthria . Considering cerebellar dysarthria , it can be noted that the function of the cerebellum is known to be:
1) has a significant impact on muscle activity, regulating the correctness and coordination of movements;
2) affects the coordination of movements of the muscles of the vocal apparatus.
The cerebellum controls and regulates muscle tone, and when it is damaged, dissemetry occurs, expressed in improper muscle contraction. In general, there is a lack of coordination of movements. The gait becomes unsteady, and the patient has difficulty maintaining balance. There are a number of neurological tests to identify dysfunctions of the cerebellum.
The next form of dysarthria , in which specific disorders of fine motor skills are observed, is bulbar dysarthria . Bulbar dysarthria is a symptom complex of speech motor function disorders that occurs in various diseases of the medulla oblongata in which damage occurs (both unilateral and bilateral)
the motor nuclei of the cranial nerves located in it
(VII, IX, X, XII pairs)
or their roots and peripheral parts.
With bulbar dysarthria, peripheral paresis is observed, sometimes to the extent of paralysis.
The development of pseudobulbar dysarthria occurs with bilateral damage to the motor corticonuclear pathways running from the cerebral cortex to the nuclei of the cranial nerves of the brain stem. With pseudobulbar dysarthria , voluntary movements are most affected.
Pseudobulbar dysarthria is characterized by the development of increased muscle tone in the muscles, similar to spasticity. dysarthria occurs . Much less often, when there is a limitation on the volume of possible voluntary movements, an unexpressed increase in muscle tone in certain muscle groups is observed or, on the contrary, a decrease in muscle tone - in this case they speak of a paretic form of pseudobulbar dysarthria . It should be noted that in both forms there is a significant restriction of voluntary, active movements of the articulatory muscles, and in severe cases, an almost complete absence of such movements. Dysarthric children are unable to care for themselves. Such a child cannot put on clothes and shoes on his own. He runs and jumps poorly. motor skills and fine coordination of movements are primarily affected here.
Signs of pseudobulbar syndrome can be detected already in a newborn. Such first manifestations of pseudobulbar syndrome are weakness or absence of cry (aphonia, disturbances in the acts of sucking, swallowing, absence or pronounced weakness of a number of innate unconditioned reflexes, which include sucking, searching, proboscis and palmar-orocephalic reflexes.
Let's consider the specifics of the development of fine motor skills in the extrapyramidal form of dysarthria . Subcortical, or extrapyramidal, dysarthria develops as a result of various lesions of the subcortical nuclei of the brain, as well as nerve fibers that connect the subcortical nuclei with other structures of the brain, which include the cerebral cortex. The extrapyramidal system provides the existence of a background for the implementation of precise, fast, differentiated and coordinated movements. The extrapyramidal system, through communication with other parts of the nervous system, plays a significant role in maintaining and regulating muscle tone, the strength of muscle contractions, maintaining the sequence of muscle contractions and movements, and ensures the automated execution of complex movements.
The main manifestations are extrapyramidal disorders of muscle tone such as hypertension, hypotension or dystonia.
With extrapyramidal, or subcortical, dysarthria , violent movements are observed (hyperkinesis, various disorders of the formation and conduction of proprioceptive nerve impulses from the muscles of the speech apparatus to the structures of the central nervous system, emotional-motor innervation also suffers. Extrapyramidal disorders manifest themselves mainly as pathogenetically interrelated disorders of the muscle tone (rigidity or hypotonia)
and movement disorders
(hyperkinesis or hypokinesis)
. In the striatal system there is a somatotopic distribution: the head is represented in the oral sections, the arm in the middle, and the torso and leg in the caudal sections. Therefore, when one or another part of the striatum is damaged, violent movements occur in the corresponding muscle groups.
The clinic distinguishes between diseases caused by damage to the predominantly phylogenetically old or new part of the extrapyramidal system. New part of the extrapyramidal system (neostriatum)
has a mainly inhibitory effect on the old (pallidonigral, therefore, when the function of the neostriatum falls out or decreases, the old part of the extrapyramidal system seems to be disinhibited and the patient begins to have violent movements; with a simultaneous decrease in muscle tone,
a hyperkinetic-hypotonic syndrome develops (with choreic hyperkinesis)
.
When the old part of the extrapyramidal system is damaged, the opposite picture occurs. Patients experience slowness and poverty of movements with a simultaneous increase in muscle tone - hypokinetic-hypertensive (akinetic-rigid) develops
syndrome or parkinsonism syndrome, an important link in the pathogenesis of which is considered to be insufficiency of the dopaminergic systems of the brain, primarily dopamine and increased activity of its biochemical antagonist - acetylcholine, which
promotes the release of histamine and inhibition of cholinesterase.
Stiffness, increased tone of all muscles, bradykinesia, bradyllalia, facial and gestural poverty, and lack of accompanying movements are noted. Against the background of general stiffness and stiffness of the muscles, tremor of the fingers is observed, often affecting the lower jaw and tongue. The following types of hyperkinesis are distinguished.
Chorea is characterized by polymorphic rapid violent movements involving the muscles of the limbs, trunk, neck and face. In this case, hyperkinesis is irregular and inconsistent, with a rapid change in the localization of convulsive twitches, intensifies with excitement and disappears in sleep. Reflexes are not changed.
Characteristic of choreic hyperkinesis is the occurrence of rapid involuntary movements against the background of muscle hypotension (hyperkinetic-hypotonic syndrome)
.
Choreic hyperkinesis is observed during low (night)
chorea, Huntington's disease.
Athetosis, or mobile spasm, is hyperkinesis, which is manifested by violent slow worm-like movements with alternating hyperextension and flexor movements mainly in the distal limbs. With this hyperkinesis, the phase of muscle hypotonia is replaced by a phase of a sharp increase in tone. From time to time, a general tonic spasm of all muscles of the limbs may occur.
A tic is a stereotypically repetitive clonic spasm of a single muscle or group of muscles, usually the muscles of the neck and face. In contrast to neurotic reversible tics, extrapyramidal tics are characterized by consistency and stereotyping.
Myoclonus is a short, lightning-fast clonic twitching of individual muscles or muscle groups so fast that there is no movement of the limbs in space. Myoclonus is most often observed in the muscles of the trunk and less often in the limbs, intensifying with excitement and physical stress.
Hemiballismus - as a rule, unilateral rough, tossing, sweeping movements of the limbs, often the hands, are observed, usually carried out by proximal muscle groups. Hemiballismus occurs when the subthalamic nucleus (corpus Luis)
as a result of tuberculoma, syphilitic gumma, metastatic abscess, encephalitis, most often as a result of vascular disorders
(thrombosis, hemorrhage, embolism)
.
The listed types of hyperkinesis are often combined, for example, choreic movements and torsion spasm or athetosis (choreo-athetosis)
.
Trembling (tremor)
- very fast rhythmic
(4-6 oscillations per 1 s)
, low-amplitude violent movements, characterized by alternating flexion and extension in various joints.
In contrast to intention tremor, when the cerebellum is damaged, extrapyramidal tremor is more pronounced at rest and decreases or even disappears with active movements (static tremor)
.
A characteristic feature of hyperkinesis caused by damage to the estrapyramidal system is that they disappear during sleep, and intensify with excitement and voluntary movements.
Let's consider violations of fine motor skills in the cortical form of dysarthria . Depending on the location of the lesion in the cerebral cortex, two types of cortical dysarthria . The first type is cortical kinesthetic postcentral dysarthria (some authors call this type afferent cortical dysarthria ). It occurs due to damage to the postcentral gyrus of the cerebral cortex. As a rule, brain damage is unilateral, and the dominant, most often the left, hemisphere of the brain is affected.
The basis of cortical kinesthetic dysarthria is apraxia of the kinesthetic type. In addition to kinesthetic dyspraxia of the articulatory apparatus, dyspraxia of the kinesthetic type is noted in both the speech muscles and the muscles of the fingers.
Fine motor skills disorders pronounced in productive activities: manual labor and visual arts.
So, intensive physiological development of the hand as an organ occurs during the first three years of a child’s life, and this development must necessarily be accompanied by a special pedagogical organization; It has been established that the effectiveness of his further education largely depends of development
Dysarthria is a Latin term that means a disorder of articulate speech and pronunciation. In practice, a slightly different understanding of this term has developed - as a disorder of the motor motor side of oral speech .
With dysarthria at different levels, the transmission of impulses from the cerebral cortex to the nuclei of the cranial nerves is disrupted. In this regard, to the muscles (respiratory, vocal, articulatory, as well as muscles of the limbs)
nerve impulses do not arrive, the function of the main cranial nerves directly related to speech is disrupted.
As is known from research in the field of speech activity in dysarthria , speech impairments are one of the important signs of this mental disorder. Consequently, motor is also the main type of abnormality in children with dysarthria .
At the same time, lesions of different areas and zones of the brain lead to a significant variety of fine motor skills disorders in children with dysarthria of various forms - from coordination disorders to paralysis and paresis of the limbs.
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