The book is given with some abbreviations.

Mental hygiene is the science of maintaining and strengthening a person's mental health. Psychohygiene is closely related to psychoprophylaxis - the prevention of neuropsychiatric diseases.
Mental hygiene deals with a wide range of issues. At present, they have emerged as independent branches of knowledge - age-related psychohygiene, psychohygiene of labor, psychohygiene of everyday life, psychohygiene of the family and sexual life. Special psychohygiene (military, aviation, space, etc.) is of great importance.

AGE MENTAL

The goals of protecting and promoting a person's mental health change with age. The most responsible periods in this regard should be recognized as childhood, puberty and the period of involution (reverse development, wilting). At this time, the greatest shifts occur in the human psyche (the formation of personality and character, aging processes), as well as in various parts of the nervous system and the whole organism.
In early childhood, a strict feeding regimen is of great psychohygienic importance. Further, it is necessary to emphasize the huge role of a healthy atmosphere in the family, the correct relationship between father and mother. Children should not be witnesses to conflicts, let alone scandals in the family. Negative factors are the violent jealousy of one of the parents, the father's alcoholism, the opportunity for the child to witness the sex life of adults. Proper upbringing is of great psychohygienic importance.
Violations and shortcomings of upbringing are a negative psycho-hygienic factor. So, for example, immoderate self-indulgence, indulgence in the whims of a child contribute to the formation of effeminacy, imbalance of the personality; suppression of the child's independence, mockery of him often lead to the emergence of shyness, self-doubt, suspiciousness.
Children's nutrition plays an important role. Lack of vitamins in the diet causes a number of diseases that affect the neuropsychic sphere (rickets, pellagra, sprue, scurvy, etc.), lack of calcium delays the development of bones, in particular the skull, affects the activity of the endocrine glands (parathyroid glands), iodine deficiency helps to reduce the function of the thyroid gland (development of cretinism). The number of psychohygienic tasks includes ensuring adequate sleep, proper development of the motor sphere (physical education) and much more.
In a later period, mental hygiene studies issues related to school education. This includes overloading students with school subjects, the relationship between students, as well as between student and teacher, violations of the student's routine at home. In adolescence (puberty), a teenager faces new problems that require a psycho-hygienic approach. These include issues of choosing a future life path, critical reflection and assessment of the surrounding reality, self-assessment, as well as issues related to sexual life. In the same period, smoking and drinking alcohol sometimes begins. Some adolescents experience painful flaws in their appearance, shyness, angularity, as well as some bad habits (for example, masturbation). At this age, protest reactions are possible (in the form of leaving home, leaving school, etc.), which require a correct psychological and pedagogical approach.
Let us also dwell on the psychohygiene of elderly and senile people.
During this period, the processes of adaptation of the psyche to new requirements and circumstances deteriorate, it is more difficult to change habitual life stereotypes, memory and attention decrease. Psychohygiene of persons of this age is inextricably linked with gerontology, that is, a science that studies the whole complex of changes in the body associated with its aging.
Leaving a habitual job, transferring from one job to another, changing working conditions in old age should be carried out only after a preliminary psychohygienic assessment of the appropriateness of such a step. Care should be taken to remove irritants such as loud noise, bright lights, and various distractions. Particular attention should be paid to correct daily routine, especially sleep. Night work is not recommended. Nutrition should be rational (a decrease in fats, fried foods, strong soups, hot and spicy seasonings; an increase in the proportion of vegetables and fruits, dairy products. Drinking alcoholic beverages, smoking, and sexual excesses are especially harmful at this age. Walks are useful, especially in forest or near the sea, tireless physical labor, a special set of physical exercises for the elderly.

PSYCHOGY OF LABOR AND TRAINING

As a rule, from a psychohygienic point of view, work is useful and necessary for a person. A very important factor is a person's emotional attitude to work.
Work should be joyful, exciting, and bring moral satisfaction. That is why the right choice of profession is so important. Young people facing this choice should be provided with not only industrial, but also psychohygienic consultation. At this time, it is extremely important to educate the consciousness of the need for labor, as one of the main factors in the formation of attitudes towards life and society.
There are specialties that place increased demands not only on physical health, but also on the mental capabilities of a person. Special working conditions (for example, in hot shops, work on automatic machines, monotonous and monotonous work on some machines) require special psycho-hygienic recommendations. So, workers engaged in monotonous work should alternate this type of work with work of a different type. Persons servicing automatic devices must, in terms of their psychophysiological qualities, approach this work (quick response to a signal from an automaton). In turn, the designs of automata should be created taking into account the capabilities and characteristics of the psychophysiological reactions of a person.
The role of the scientific organization of labor (STO) is growing every year. Occupational psychohygiene is an important component of NOT. It should be noted the importance of industrial aesthetics as a psycho-hygienic factor in production. Modern forms of machines, coloring of premises, cleanliness, beautiful comfortable furniture, flowers are a significant psycho-hygienic factor that reduces fatigue and improves the emotional state of the worker.
Psychohygiene of mental labor is of great importance. Mental work, if it is not properly organized, can be a factor that disrupts health. This can be especially true in cases where a person has not yet learned how to properly engage in mental work. Everyone knows the phenomenon of overwork and even nervous breakdowns in some students (especially before exams).
Mental work is especially productive and useful with a fresh mind (in the first half of the day). It should not last more than 3-4 hours without interruption, but at the same time, its duration should not be too short, since a certain time is spent on “working in” - achieving an optimal rhythm and getting into work. Frequent distraction of a person doing mental work, noise, phone calls disrupt this work. Mental work should be alternated with movement, physical education, physical labor, walks. Smoking interferes with mental work. Pathogens, stimulants of the nervous system (phenamine, caffeine, Chinese magnolia vine, coffee, strong tea) are also not recommended.
Before starting work, you should draw up a general plan for it, prepare a workplace, all the necessary materials. Everything should be at hand. You need to think about the main points of work first, and then move on to the details. Some authors emphasize the fact that sometimes the solution of complex issues, a creative idea does not arise at the desk, but on a walk, on a tram or at night while sleeping. The question of the use of technical devices that facilitate mental work (typewriter, adding machine, slide rule, microfilms, tape recorder, etc.) is very important.
The psychohygiene of education is currently especially intensively developing issues related to the problem of programmed teaching.

PSYCHOGY OF LIFE

The sphere of issues dealt with by the psychohygiene of everyday life includes the housing problem. As you know, we solve it more and more successfully every year. However, in a number of cases, one still has to deal with overconsolidation in apartments, which interferes with rest and sleep. Another issue is the relationship between people in everyday life. The presence of an alcoholic or psychopath in an apartment can be a source of long-term mental trauma to the rest of the residents. Alcoholics are especially harmful to their family members. An important issue raised by many doctors and public figures is foul language.
The modern family has undergone significant changes. In quantitative terms, it decreased (3-4 people). The functional role and workload of its members (husband, wife, children) have changed. Meanwhile, in some families, due to false "traditions", vestiges and bourgeois views, the husband does not take part either in household chores or in raising children. This creates a significant overload on women, which is a negative point. The correct distribution of responsibilities in the family, the involvement of older children in family concerns greatly contributes to the preservation of the health of all its members.

PSYCHOGY OF THE FAMILY AND SEXUAL LIFE

The main traumatic factors in a family are improperly built relationships between its members. One of the options is the despotism of the father, the “head of the family,” defending the order of “house building,” the other is quarrels over raising children, which each of the spouses understands in his own way, and the third is the so-called “dissimilarity of characters”.
The psychohygiene of the family is all the more necessary because its implementation improves the condition of a person not only in the family, but thereby also at work, in an educational institution and in other places. In the family, the person's personality is the least protected, while the emotional value of family relationships is usually very high. This is why most neuroses have their origin in family conflict.
Of course, children and young people should be educated in advance so that they are prepared for family life. Unfortunately, at present the school and other educational institutions do not systematically carry out such work. As a result, young people who get married, often with difficulty, through trial and error, find the right line of family relationships.
Family relationships should be built on the basis of not only love, but also deep respect of the spouses for each other. People brought up in this spirit will be attentive and sensitive not only to themselves, but also to another family member. Questions that are controversial will not lead to violent emotional reactions. They will be treated favorably and in a relaxed atmosphere.
Sex life, being an important element of human life, should also be an object of psychohygiene. Unfortunately, these days young people getting married are often not well informed. Therefore, there are many conflicts and frustrations that could have been avoided. For example, an elementary inability can be regarded as a severe breakdown, sexual weakness, and in the future will be fixed as a kind of neurosis. Frequency of sexual intercourse, prevention of pregnancy, sexual coldness of a woman, etc., for many young spouses represent a complete unknown.
In this regard, it is advisable to indicate the main directions in which the psychohygiene of marriage and sex life should go.
1. Sexual education and sex education for young people, which, of course, is inseparable from the general ethical education and should orient young people to high ideals in this regard.
2. Psycho-hygienic consultation upon marriage. This consultation concerns the age of marriage, the age match of the spouses, the importance of hereditary burden; more detailed sexological advice can be given with appropriate questions from the consultant.
3. Psycho-hygienic consultation for married persons. In collaboration with a sexologist and a gynecologist, a psychohygienist can give recommendations on the mode of sexual activity, the best way to prevent pregnancy, create an appropriate environment, and the right approach to a woman.
4. Psycho-hygienic consultation of persons who raised the issue of divorce. In this case, the psychohygienist, having studied the circumstances of the case, can recommend the preservation of the family (especially if there are children in the family) and indicate specific ways to eliminate the intra-family conflict.
The role of the psychohygienist is also great in cases of sexual pathology, which are usually within the competence of a sex therapist. Psychohygienic consultation is important in the treatment of male sexual weakness, female frigidity, as well as sexual neurasthenia in both sexes.

SPECIAL MENTAL

Space travel, flights on super-high-speed planes have posed new challenges for mental hygiene. One of the serious psycho-hygienic problems of space flights is the study of the influence of weightlessness on the psyche of astronauts. During long interplanetary flights, the so-called psychological compatibility of the spacecraft crew members is of great importance. In the future, when space flights will last for weeks and months, the problem of "sensory hunger", that is, the lack of external impressions due to the absence of changes in the environment, will become relevant. All these problems are studied by space psychohygiene.
The peculiarities of the influence of war conditions on the psyche of people, preparation and training of human mental functions to control the latest military equipment in combat conditions, adaptation to the requirements of a combat situation are studied and developed by military psychohygiene.
The psychohygiene of sports also belongs to the special types of psychohygiene. Modern large sports competitions, especially international ones, place high demands on the mental state of athletes. There are known cases of unsuccessful performances, the reason for which was the so-called "pre-start excitement", mental discomfort or inadequate adaptation to new psychological conditions. In each sports team, it is desirable, along with a coach, to have a psychologist who would give appropriate psycho-hygienic advice.

Control questions

1. What is psychohygiene and psychoprophylaxis?
2. What are the tasks of psychohygiene?
3. List the main types of psychohygiene.
4. What is the content of age-related psychohygiene?
5. What are the features of psychohygiene of elderly and old people?
6. What is the content of psychohygiene of work and training?
7. What are the psychohygienic conditions for mental work?
8. What is the significance of the scientific organization of labor and production aesthetics?
9. What are the main tasks of the psychohygiene of everyday life?
10. What are the main tasks of family psychohygiene and sexual life?

Dysarthria

causes of dysarthria, classification of clinical forms of dysarthria, main directions of correctional work, breathing exercises

Dysarthria is a violation of the sound-pronunciation side of speech, caused by an organic insufficiency of the innervation of the speech apparatus.

The term "dysarthria" is derived from the Greek words arthson - joint and dys - particle meaning disorder. This is a neurological term because dysarthria occurs when the function of the cranial nerves of the lower part of the trunk, which are responsible for articulation, is impaired.

The cranial nerves of the lower part of the trunk (medulla oblongata) are adjacent to the cervical spinal cord, have a similar anatomical structure and are supplied with blood from the same vertebrobasilar basin.

Very often there are contradictions between neurologists and speech therapists about dysarthria. If a neurologist does not see obvious disturbances in the function of the cranial nerves, he cannot call a speech disorder dysarthria. This issue is almost a stumbling block between neurologists and speech therapists. This is due to the fact that after the diagnosis of dysarthria, a neurologist is obliged to conduct serious therapy for the treatment of stem disorders, although such disorders (excluding dysarthria) seem to be not noticeable.

The medulla oblongata, like the cervical spinal cord, often experiences hypoxia during childbirth. This leads to a dramatic decrease in motor units in the nerve nuclei responsible for articulation. During a neurological examination, the child adequately performs all the tests, but cannot cope properly with articulation, because here it is necessary to perform complex and fast movements that are beyond the strength of weakened muscles.

The main manifestations of dysarthria consist in a disorder of the articulation of sounds, impaired voice formation, as well as changes in the tempo of speech, rhythm and intonation.

These disorders are manifested to varying degrees and in various combinations, depending on the localization of the lesion in the central or peripheral nervous system, on the severity of the disorder, and on the time of occurrence of the defect. Violations of articulation and phonation, which complicate, and sometimes completely prevent articulate sonorous speech, constitute the so-called primary defect, which can lead to the emergence of secondary manifestations that complicate its structure. Clinical, psychological and speech therapy studies of children with dysarthria show that this category of children is very heterogeneous in terms of motor, mental and speech disorders.

The causes of dysarthria

1. Organic lesions of the central nervous system as a result of the influence of various unfavorable factors on the developing brain of the child in the prenatal and early periods of development. Most often these are intrauterine lesions resulting from acute, chronic infections, oxygen deficiency (hypoxia), intoxication, pregnancy toxicosis and a number of other factors that create conditions for the occurrence of birth trauma. In a significant number of such cases, during childbirth, asphyxia occurs in a child, the child is born prematurely.

2. The cause of dysarthria may be Rh incompatibility.

3. Somewhat less often, dysarthria occurs under the influence of infectious diseases of the nervous system in the first years of a child's life. Dysarthria is often observed in children with cerebral palsy (cerebral palsy). According to E.M. Mastyukova, dysarthria with cerebral palsy is manifested in 65-85% of cases.

Classification of clinical forms of dysarthria

The classification of clinical forms of dysarthria is based on the isolation of different localization of brain damage. Children with various forms of dysarthria differ from each other in specific defects in sound pronunciation, voice, articulatory motor skills, need various methods of speech therapy and can be corrected to varying degrees.

Forms of dysarthria

Bulbar dysarthria(from Latin bulbus - a bulb, the shape of which has a medulla oblongata) manifests itself in a disease (inflammation) or tumor of the medulla oblongata. At the same time, the nuclei of the motor cranial nerves located there are destroyed (glossopharyngeal, vagus and hypoglossal, sometimes trigeminal and facial).
Paralysis or paresis of the muscles of the pharynx, larynx, tongue, soft palate is characteristic. In a child with a similar defect, swallowing of solid and liquid food is impaired, and chewing is difficult. Insufficient mobility of the vocal folds, soft palate leads to specific voice disorders: it becomes weak, nasalized. Voiced sounds are not realized in speech. Paresis of the muscles of the soft palate leads to free passage of exhaled air through the nose, and all sounds acquire a pronounced nasal (nasal) tone.
In children with the described form of dysarthria, atrophy of the muscles of the tongue and pharynx is observed, and muscle tone (atony) also decreases. The paretic state of the muscles of the tongue is the cause of numerous distortions of sound pronunciation. Speech is indistinct, extremely indistinct, slowed down. The face of a child with tabloid dysarthria is amimic.

Subcortical dysarthria occurs when the subcortical nodes of the brain are affected. A characteristic manifestation of subcortical dysarthria is a violation of muscle tone and the presence of hyperkinesis. Hyperkinesis - violent involuntary movements (in this case, in the area of articulatory and facial muscles), not controlled by the child. These movements can be observed at rest, but are usually intensified during the speech act.
The changing nature of muscle tone (from normal to increased) and the presence of hyperkinesis cause peculiar disorders of phonation and articulation. A child can correctly pronounce individual sounds, words, short phrases (especially in a game, in a conversation with loved ones or in a state of emotional comfort) and after a moment he is not able to pronounce a sound. Articulatory spasm occurs, the tongue becomes tense, the voice is interrupted. Sometimes involuntary cries are observed, guttural (pharyngeal) sounds "break through". Children can pronounce words and phrases excessively quickly or, conversely, monotonously, with long pauses between words. The intelligibility of speech suffers from an uneven switching of articulatory movements when pronouncing sounds, as well as from a violation of the timbre and strength of the voice.
A characteristic sign of subcortical dysarthria is a violation of the prosodic aspect of speech - tempo, rhythm and intonation. The combination of impaired articulatory motor skills with impaired voice formation, speech breathing leads to specific defects in the sound side of speech, manifested variably depending on the state of the child, and is mainly reflected in the communicative function of speech.
Sometimes, with subcortical dysarthria in children, hearing loss is observed, complicating the speech defect.

Cerebellar dysarthria characterized by a chanted "chopped" speech, sometimes accompanied by shouts of individual sounds. In its pure form, this form is rarely observed in children.

Cortical dysarthria presents great difficulties for selection and recognition. With this form, the voluntary motor skills of the articulatory apparatus are impaired. In its manifestations in the field of sound pronunciation, cortical dysarthria resembles motor alalia, since, first of all, the pronunciation of words that are complex in sound-syllable structure is disturbed. Children have difficulty in the dynamics of switching from one sound to another, from one articulatory posture to another. Children are able to clearly pronounce isolated sounds, but in the speech stream, sounds are distorted, replacements occur. Combinations of consonants are especially difficult. At an accelerated pace, stuttering appears, resembling a stutter.
However, unlike children with motor alalia, children with this form of dysarthria do not have impairments in the development of the lexical and grammatical side of speech. Cortical dysarthria should also be distinguished from dyslalia. Children find it difficult to reproduce an articulatory posture, it is difficult for them to transition from one sound to another. When correcting, attention is drawn to the fact that defective sounds are quickly corrected in isolated utterances, but are hardly automated in speech.

The erased form. I especially want to highlight the erased (light) form of dysarthria, since recently, in the process of speech therapy practice, there are more and more children whose speech disorders are similar to the manifestations of complex forms of dyslalia, but with a longer and more complex dynamics of learning and speech correction. Careful speech therapy examination and observation reveal a number of specific disorders in them (disorders of the motor sphere, spatial gnosis, phonetic side of speech (in particular, prosodic characteristics of speech), phonation, respiration, and others), which allows us to conclude that there are organic lesions of the central nervous system.

The experience of practical and research work shows that it is very often difficult to diagnose mild forms of dysarthria, its differentiation from other speech disorders, in particular - dyslalia, in determining the ways of correction and the amount of necessary speech therapy assistance to children with an erased form of dysarthria. Given the prevalence of this speech disorder among preschool children, it can be concluded that a very urgent problem is currently ripe - the problem of providing qualified speech therapy assistance to children with an erased form of dysarthria.

Light (erased) forms of dysarthria can be observed in children without obvious movement disorders who have undergone exposure to various adverse factors during the prenatal, natal and early postnatal periods of development. Among such unfavorable factors are:
- toxicosis of pregnancy;
- chronic fetal hypoxia;
- acute and chronic diseases of the mother during pregnancy;
- minimal damage to the nervous system in Rh-conflict situations of the mother and the fetus;
- slight asphyxia;
- birth trauma;
- acute infectious diseases of children in infancy, etc.

The impact of these unfavorable factors leads to the emergence of a number of specific features in the development of children. In the early period of development in children with an erased form of dysarthria, motor restlessness, sleep disturbances, and frequent, unreasonable crying are noted. Feeding such children has a number of features: there is difficulty in holding the nipple, fatigue when sucking, babies refuse to breastfeed early, often and profusely regurgitate. In the future, they are poorly accustomed to complementary foods, are reluctant to try new food. At lunch, such a child sits for a long time with a full mouth, chews poorly and is reluctant to swallow food, hence the frequent choking during meals. Parents of children with mild forms of dysarthric disorders note that at preschool age, children prefer cereals, broths, mashed potatoes to solid foods, so feeding such a child becomes a real problem.

In early psychomotor development, a number of features can also be noted: the formation of statodynamic functions may be somewhat delayed or remain within the age norm. Children, as a rule, are somatically weakened, often suffer from colds.

The history of children with an erased form of dysarthria is aggravated. Most children under 1-2 years of age were seen by a neurologist, later this diagnosis was withdrawn.

Early speech development in a significant part of children with mild manifestations of dysarthria is slightly slowed down. The first words appear by 1 year, phrasal speech is formed by 2-3 years. At the same time, for a long time, the speech of children remains illegible, unclear, understandable only to parents. Thus, by the age of 3-4, the phonetic side of speech in preschoolers with an erased form of dysarthria remains unformed.

In speech therapy practice, children with pronunciation disorders are often found, who, in the conclusion of a neuropathologist, have data on the absence of focal microsymptomatics in the neurological status. However, the correction of speech disorders in such children by conventional methods and techniques does not bring effective results. Consequently, the question arises of additional examination and a more detailed study of the causes and mechanisms of these violations.

A thorough neurological examination of children with similar speech disorders using functional loads reveals a mild microsymptomatology of organic lesions of the nervous system. These symptoms manifest themselves in the form of a disorder of the motor sphere and extrapyramidal insufficiency and are reflected in the state of general, fine and articulatory motor skills, as well as facial muscles.

The general motor sphere of children with an erased form of dysarthria is characterized by awkward, constrained, undifferentiated movements. There may be a slight limitation of the range of motion of the upper and lower extremities, with functional load, friendly movements (synkenesia), muscle tone disorders are possible. Often, with a pronounced general mobility, the movements of a child with an erased form of dysarthria remain awkward and unproductive.

The most pronounced lack of general motor skills is manifested in preschoolers with this disorder when performing complex movements that require precise control of movements, accurate work of various muscle groups, and correct spatial organization of movements. For example, a child with an erased form of dysarthria, a little later than his peers, begins to grab and hold objects, sit, walk, jump on one or two legs, run awkwardly, and climb on the Swedish wall. In middle and senior preschool age, a child cannot learn to ride a bicycle, ski or skate for a long time.

In children with an erased form of dysarthria, violations of fine motor skills of the fingers are also observed, which are manifested in a violation of the accuracy of movements, a decrease in the speed of execution and switching from one position to another, delayed engagement in movement, and lack of coordination. Finger tests are performed inadequately, there are significant difficulties. These features are manifested in the play and educational activities of the child. A preschooler with mild manifestations of dysarthria is reluctant to draw, sculpt, ineptly play 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 formation of fine and articulatory motor skills. Violations of speech motility in preschoolers with this type of speech pathology are due to the organic nature of damage to the nervous system and depend on the nature and degree of dysfunction of the motor nerves that provide the process of articulation. It is the mosaicity of the defeat of the motor conducting cortical-nuclear pathways that determines the greater combinativeness of speech disorders in the erased form of dysarthria, the correction of which requires a careful and detailed development of an individual plan of speech therapy work with such a child from a speech therapist. And of course, such work seems impossible without the support and close cooperation with parents who are interested in correcting their child's speech disorders.

Pseudobulbar dysarthria- the most common form of childhood dysarthria. Pseudobulbar dysarthria is a consequence of an organic brain damage suffered in early childhood, during childbirth or in the prenatal period as a result of encephalitis, birth trauma, tumors, intoxication, etc. The child develops pseudobulbar paralysis or paresis due to damage to the pathways leading from the cerebral cortex to the nuclei of the glossopharyngeal, vagus and hypoglossal nerves. In terms of clinical manifestations of disorders in the area of mimic and articulatory muscles, it is close to bulbar. However, the possibilities of correction and full-fledged mastering of the sound-pronunciation side of speech in pseudobulbar dysarthria are much higher.
As a result of pseudobulbar paralysis, the child's general and verbal motor skills are impaired. The kid does not suck well, chokes, chokes, swallows badly. Saliva flows from the mouth, the musculature of the face is disturbed.

The degree of impairment of speech or articulatory motility may vary. Three degrees of pseudobulbar dysarthria are conventionally distinguished: mild, moderate, severe.

1. A mild degree of pseudobulbar dysarthria is characterized by the absence of gross violations of the motility of the articulatory apparatus. Difficulties of articulation consist in slow, insufficiently accurate "movements of the tongue, lips. Disorder of chewing and swallowing is revealed dimly, in rare choking. Pronunciation in such children is impaired due to insufficiently clear articulatory motor skills, speech is somewhat slowed down, blurred when pronouncing sounds is characteristic. by articulation of sounds: f, w, r, c, h Voiced sounds are pronounced with insufficient participation of the voice Soft sounds are difficult to pronounce, requiring the addition to the main articulation of the rise of the middle part of the back of the tongue to the hard palate.
Pronunciation deficiencies have an adverse effect on phonemic development. Most children with mild dysarthria have some difficulty in sound analysis. When writing, they have specific errors in replacing sounds (t-d, ch-c, etc.). Violation of the structure of the word is almost not observed: the same applies to grammatical structure and vocabulary. Some peculiarity can be revealed only with a very careful examination of children, and it is not characteristic. So, the main defect in children suffering from mild pseudobulbar dysarthria is a violation of the phonetic side of speech.
Children with a similar disorder, who have normal hearing and good mental development, attend speech therapy classes in the district children's polyclinic, and at school age - a speech therapy center at a general education school. Parents can play a significant role in eliminating this defect.

2. Children with an average degree of dysarthria constitute the largest group. They are characterized by amimicity: the absence of movements of the facial muscles. The child cannot puff out his cheeks, stretch his lips, close them tightly. Tongue movements are limited. The child cannot lift the tip of the tongue up, turn it to the right, left, hold it in this position. Switching from one movement to another presents a significant difficulty. The soft palate is often inactive, the voice has a nasal tone. Profuse salivation is characteristic. Difficulty chewing and swallowing. The consequence of a violation of the function of the articulatory apparatus is a severe defect in pronunciation. The speech of such children is usually very slurred, blurry, quiet. Characterized by indistinct articulation of vowels due to the immobility of the lips and tongue, usually pronounced with a strong nasal exhalation. Sounds "a" and "y" are not clear enough, sounds "and" and "s" are usually mixed. Of the consonants, n, t, m, n, k, x are often preserved. The sounds h and c, r and l are pronounced approximately, like a nasal exhalation with an unpleasant "squelching" sound. The exhaled mouth stream is felt very weakly. More often voiced consonants are replaced by voiceless ones. Often, sounds at the end of a word and in consonant combinations are omitted. As a result, the speech of children suffering from pseudobulbar dysarthria is so incomprehensible that they prefer to remain silent. Along with the usually late development of speech (at the age of 5-6 years), this circumstance sharply limits the child's experience of verbal communication.
Children with such a disability cannot successfully study in a mainstream school. The most favorable conditions for their education and upbringing have been created in special schools for children with severe speech impairments, where an individual approach is provided to these students.

3. A severe degree of pseudobulbar dysarthria - anarthria - is characterized by deep muscle damage and complete inactivity of the speech apparatus. The face of a child suffering from anarthria is mask-like, the lower jaw hangs down, the mouth is constantly open. The tongue lies motionless at the bottom of the mouth, lip movements are sharply limited. Difficulty chewing and swallowing. Speech is completely absent, sometimes there are separate inarticulate sounds. Children with anarthria with good mental development can also study in special schools for children with severe speech impairments, where, thanks to special speech therapy methods, they successfully master the writing skills and the curriculum in general subjects.

A characteristic feature of all children with pseudobulbar dysarthria is that with a distorted pronunciation of the sounds that make up a word, they usually retain the rhythmic outline of the word, that is, the number of syllables and stress. As a rule, they know how to pronounce two-syllable, three-syllable words; four-syllable words are often reproduced reflected. Pronunciation of consonants is difficult for a child: in this case, one consonant falls out (squirrel - "beka") or both (snake - "ia"). Due to the motor difficulty of switching from one syllable to another, there are cases of assimilation of syllables (dishes - "pisses", scissors - "noses").

Violation of the motor skills of the articulatory apparatus leads to an incorrect development of the perception of speech sounds. Deviations in auditory perception caused by insufficient articulatory experience, the absence of a clear kinesthetic image of sound lead to noticeable difficulties in mastering sound analysis. Depending on the degree of motor speech impairment, differently expressed difficulties in sound analysis are observed.

Most of the special tests that reveal the level of sound analysis are not available to children with dysarthrics. They cannot correctly select pictures whose names begin with a given sound, come up with a word containing a certain sound, analyze the sound composition of a word. For example, a twelve-year-old child who studied in a mass school for three years, answering the question of what sounds in the words of the regiment, the cat, calls p, a, k, a; k, a, t, a. When completing the assignment, select pictures whose names contain the sound b, the boy lays down a can, a drum, a pillow, a scarf, a saw, a squirrel.
Children with better preserved pronunciation make fewer mistakes, for example, they select the following pictures for the sound "c": a bag, a wasp, an airplane, a ball.
For children with anarthria, these forms of sound analysis are not available.

Literacy for dysarthria

The level of proficiency in sound analysis in the vast majority of dysarthric children is insufficient for mastering literacy. Children who enter mass schools are completely unable to master the 1st grade curriculum.
Deviations in sound analysis are especially pronounced during auditory dictation.

I will give a sample of a letter from a boy who studied for three years in a mass school: house - "ladies", fly - "muaho", nose - "ouch", chair - "yo", eyes - "naka", etc.

Another boy, after a year in a mass school, writes instead of "Dima is going for a walk" - "Dima dapet hum ts"; "In the Wasp Forest" - "Wasp Lusu"; "The boy feeds the cat with milk" - "Malkin lali kashko maloko".

The largest number of writing errors in children with dysarthria is due to letter substitutions. Vowel substitutions are quite common: children - "children", teeth - "teeth", bots - "buty", bridge - "muta", etc. Inaccurate, nasal pronunciation of vowel sounds leads to the fact that they almost do not differ in sound.

There are numerous and varied consonant substitutions:
lr: squirrel - "berk"; h-h: fur - "sword"; b-t: duck - "ubka"; dd: beep - "pipe"; s-h: geese - "guchi"; bp: watermelon - "arpus".

Typical are cases of violation of the syllable structure of a word due to rearrangement of letters (book - "kinga"), omission of letters (cap - "shapa"), reduction of the syllable structure due to incomplete description of syllables (dog - "soba", scissors - "knives" and etc.).

There are frequent cases of complete distortion of words: bed - "damla", pyramid - "makte", iron - "neaki", etc. Such errors are most typical for children with deep articulation disorders, in whom the lack of separation of the sound composition of speech is associated with distorted sound pronunciation.

In addition, in the writing of dysarthric children, such errors are widespread as incorrect use of prepositions, incorrect syntactic connections of words in a sentence (coordination, control), etc. reserve.

Independent writing of children is distinguished by a poor composition of sentences, their incorrect construction, omission of members of the sentence and official words. Some children are completely inaccessible to even small-volume presentation.

Reading of dysarthric children is usually extremely difficult due to the inactivity of the articulatory apparatus, difficulties in switching from one sound to another. For the most part, it is post-verbal, not intonationally colored. Understanding of the text being read is insufficient. For example, a boy, after reading the word chair, points to the table, after reading the word cauldron, shows a picture depicting a goat (goat-cauldron).

The lexico-grammatical structure of speech of dysarthric children

As already noted above, the direct result of the defeat of the articulatory apparatus is pronunciation difficulties, which lead to insufficiently clear perception of speech by ear. The general speech development of children with gross articulation disorders proceeds in a peculiar way. Late onset of speech, limited speech experience, gross pronunciation defects lead to insufficient accumulation of vocabulary and deviations in the development of the grammatical structure of speech. Most children with articulation disorders have deviations in vocabulary, do not know everyday words, often mix words, focusing on similarity in sound composition, situation, etc.

Many words are used inaccurately; instead of the desired name, the child uses the one that denotes a similar object (loop - hole, vase - jug, acorn - nut, hammock - net) or situationally associated with this word (rails - sleepers, thimble - finger).

Characteristic of dysarthric children are a fairly good orientation in the environment, a stock of everyday information and ideas. For example, children know and can find in the picture objects such as a swing, a well, a sideboard, a carriage; determine the profession (pilot, teacher, driver, etc.); understand the actions of the persons shown in the picture; show objects painted in one color or another. However, the lack of speech or limited use of it leads to a discrepancy between active and passive vocabulary.

The level of vocabulary development depends not only on the degree of impairment of the sound-pronunciation side of speech, but also on the child's intellectual capabilities, social experience, and the environment in which he is brought up. For children with dysarthrics, as well as for children with general speech underdevelopment in general, insufficient knowledge of the grammatical means of the language is characteristic.

The main directions of correctional work

These features of the speech development of children with dysarthria show that they need systematic special training aimed at overcoming the defects in the sound side of speech, developing the lexical stock and grammatical structure of speech, and correcting writing and reading disorders. Such correctional tasks are solved in a special school for children with speech disorders, where the child receives education in the amount of a nine-year general education school.

Preschool children with dysarthria need targeted speech therapy classes to form the phonetic and lexico-grammatical structure of speech. Such classes are held in special preschool institutions for children with speech impairments.

Speech therapy work with children with dysarthria is based on knowledge of the structure of a speech defect in different forms of dysarthria, mechanisms of impairment of general and speech motor skills, taking into account the personal characteristics of children. Particular attention is paid to the state of speech development of children in the field of vocabulary and grammatical structure, as well as to the peculiarities of the communicative function of speech. In school-age children, the state of written speech is taken into account.

Positive results of speech therapy work are achieved subject to the following principles:
step-by-step interconnected formation of all speech components;
a systematic approach to the analysis of a speech defect;
regulation of children's mental activity through the development of communicative and generalizing functions of speech.

In the process of systematic and, in most cases, long-term exercises, a gradual normalization of the motor skills of the articulatory apparatus is carried out, the development of articulatory movements, the formation of the ability to voluntarily switch the movable organs of articulation from one movement to another at a given pace, overcoming monotony and violations of the tempo of speech; full development of phonemic perception. This prepares the basis for the development and correction of the sound side of speech and forms the prerequisites for mastering the skills of oral and written speech.

Speech therapy work must be started at a younger preschool age, thereby creating conditions for the full development of more complex aspects of speech activity and optimal social adaptation. The combination of speech therapy with therapeutic measures, overcoming deviations in general motor skills is also of great importance.

Preschool children with dysarthria, who do not have gross deviations in the development of the musculoskeletal system, who possess self-care skills and have normal hearing and full intelligence, are trained in special kindergartens for children with speech impairments. At school age, children with a severe degree of dysarthria are trained in special schools for children with severe speech impairments, where they receive education in the amount of a nine-year school with simultaneous correction of a speech defect. For children with dysarthria who have pronounced disorders of the musculoskeletal system, there are specialized kindergartens and schools in the country, where great attention is paid to therapeutic and physiotherapeutic measures.

When correcting dysarthria in practice, as a rule, the regulation of speech breathing is used, as one of the leading methods of establishing the fluency of speech.

Respiratory gymnastics A. N. Strelnikova

In speech therapy work on speech breathing of children, adolescents and adults, paradoxical breathing exercises by A.N. Strelnikova are widely used. Strelnikov breathing gymnastics is the brainchild of our country, it was created at the turn of the 30s-40s of the 20th century as a way to restore the singing voice, because A.N. Strelnikova was a singer and lost it.

This gymnastics is the only one in the world in which a short and sharp breath through the nose is done on movements that compress the chest.

Exercises actively involve all parts of the body (arms, legs, head, thigh girdle, abdominal girdle, shoulder girdle, etc.) in work and cause a general physiological reaction of the whole body, an increased need for oxygen. All exercises are performed simultaneously with a short and sharp breath through the nose (with absolutely passive exhalation), which enhances internal tissue respiration and increases the absorption of oxygen by tissues, as well as irritates that vast area of receptors on the nasal mucosa, which provides a reflex connection of the nasal cavity with almost all bodies.

That is why this breathing exercise has such a wide range of effects and helps with the mass of various diseases of organs and systems. It is useful for everyone and at any age.

In gymnastics, the focus is on inhalation. The inhalation is very short, instant, emotional and active. The main thing, according to A. N. Strelnikova, is to be able to hold, "hide" the breath. Do not think about exhalation at all. The exhalation goes out spontaneously.

When teaching gymnastics, A.N. Strelnikova advises to follow four basic rules.

Rule 1. "It smells like smoke! Alarm!" And abruptly, noisily, throughout the apartment, smell the air like a dog's footprint. The more natural the better. The worst mistake is to pull the air in order to take in more air. The inhalation is short, like a shot, active and the more natural the better. Think only about inhaling. The feeling of anxiety organizes an active breath better than reasoning about it. Therefore, do not hesitate, fiercely, to the point of rudeness, smell the air.

Rule 2 Exhalation is the result of inhalation. Do not interfere with the exhalation to leave after each inhalation as you like, as much as you like - but better with your mouth than with your nose. Don't help him. Just think: "It smells like fumes! Alarm!" And make sure only that the inhalation goes along with the movement. The exhalation will go away spontaneously. During gymnastics, the mouth should be slightly open. Get carried away with inhalation and movement, do not be boring and indifferent. Play the savage as children play and you will succeed. The movements create a short breath of sufficient volume and depth without much effort.

Rule 3. Repeat breaths as if you are inflating a tire in the tempo of songs and dances. And, while practicing movements and breaths, count at 2, 4, and 8. Rate: 60-72 breaths per minute. Inhales are louder than exhalations. Lesson rate: 1000-1200 breaths, and more is possible - 2000 breaths. Pauses between inhalation doses are 1-3 seconds.

Rule 4. Take as many breaths in a row as you can easily take at the moment. The whole complex consists of 8 exercises. Warm up first. Stand up straight. Hands at the seams. Feet shoulder width apart. Take short, prick-like breaths, sniffing loudly. Do not be shy. Make the wings of the nose connect as you inhale, rather than expanding them. Train for 2, 4 breaths in a row at the pace of a walking step "hundred" breaths. You can do more to feel that the nostrils move and obey you. Inhale, like a prick, instant. Think: "It smells like fumes! Where from?" To understand gymnastics, take a step in place and inhale with each step. Right-left, right-left, inhale-inhale, inhale-inhale. And not inhale-exhale, as in ordinary gymnastics.
Take 96 (one hundred) steps-breaths at a walking pace. You can, while standing still, you can when walking around the room, you can, shifting from foot to foot: back and forth, back and forth, the heaviness of the body is on the leg in front, then on the leg standing behind. It is impossible to take long breaths at the pace of steps. Think, "My legs are pumping air into me." It helps. With each step - a breath, short as a prick, and noisy.
Having mastered the movement, lifting the right leg, squat slightly on the left, lifting the left - on the right. It will turn out to be a rock and roll dance. Make sure that movements and breaths go at the same time. Do not interfere with or help out the exhalation after each inhalation. Repeat breaths rhythmically and frequently. Do as many of them as you can easily.

Head movements.
- Turns. Turn your head left and right, sharply, at the pace of your steps. And at the same time with every turn - inhale through the nose. Short as a prick, noisy. 96 breaths. Think: "It smells like fumes! Where from? Left? Right?" Sniff the air ...
- "Ears". Shake your head, as if you are saying to someone: "Ay-yay-yay, shame on you!" Make sure that the body does not turn. The right ear goes to the right shoulder, the left to the left. The shoulders are motionless. Simultaneously with each swing, inhale.
- "Small pendulum". Nod your head back and forth, inhale and inhale. Think: "Where does the smell of smoke come from? Bottom? Top?"

Main movements.
- "Cat". Feet shoulder width apart. Think of a cat sneaking up on a sparrow. Repeat her movements - squatting slightly, turn to the right and then to the left. Transfer the severity of the body to the right leg, then to the left. The one in which you turned. And sniff the air noisily to the right, to the left, at the pace of your steps.
- "Pump". Pick up a rolled newspaper or stick like a pump handle and think that you are inflating a car tire. Inhale - at the extreme point of the slope. The tilt ended - the inhalation ended. Do not stretch it, and do not bend it all the way. The tire must be pumped up quickly and continue on. Repeat breaths at the same time as you bend down, often, rhythmically, and easily. Do not raise your head. Look down at an imaginary pump. Inhale, like a prick, instant. Of all our breathing movements, this is the most effective.
- "Hug your shoulders." Raise your arms to shoulder level. Bend them at the elbows. Turn your palms towards you and place them in front of your chest, just below your neck. Throw your hands towards each other so that the left hugs the right shoulder, and the right one - the left armpit, that is, so that the arms are parallel to each other. The pace of the steps. Simultaneously with each throw, when the hands are closest to each other, repeat short noisy breaths. Think, "Shoulders help the air." Do not take your hands far from the body. They are nearby. Do not straighten your elbows.
- "Big pendulum". This movement is continuous, similar to a pendulum: "pump" - "hug your shoulders", "pump" - "hug your shoulders". The pace of the steps. Bending forward, arms reaching for the ground - inhale, leaning back, arms hugging shoulders - also inhale. Forward - backward, inhale, inhale, tick-tock, tick-tock, like a pendulum.
- "Semi-squats". One leg is in front, the other is behind. Body weight on the leg in front, the leg behind slightly touches the floor, as before the start. Perform a light, slightly noticeable squat, as if dancing in place, and at the same time with each squat repeat the inhalation - short, light. Once you've mastered the movement, add simultaneous counter-arm movements.

This is followed by a special training of "bated" breathing: a short breath with an incline, the breath is delayed as much as possible, without unbending, it is necessary to count aloud to eight, gradually the number of "eights" pronounced on one exhalation increases. On one tightly held breath, you need to dial as many "eights" as possible. From the third or fourth workout, pronouncing "eights" by stuttering ones is combined not only with inclinations, but also with "half-squats" exercises. The main thing, according to A. N. Strelnikova, is to feel the breath "gripped into a fist" and to show restraint, repeating aloud the maximum number of eights on a tightly held breath. Of course, the "eights" at each workout is preceded by the whole complex of the above exercises.

Exercises for the development of speech breathing

In speech therapy practice, the following exercises are recommended.

Find a comfortable position (lying, sitting, standing), place one hand on your stomach, the other on the side of your lower chest. Inhale deeply through your nose (your belly bulges forward and your lower rib cage expands, controlled by both hands). After inhaling, immediately make a free, smooth exhalation (the abdomen and lower chest will return to their previous position).

Take a short, calm breath through your nose, hold the air in your lungs for 2-3 seconds, then make a long, smooth exhalation through your mouth.

Take a short breath with your mouth open and on a smooth, prolonged exhalation, pronounce one of the vowel sounds (a, o, y, and, e, s).

Pronounce several sounds smoothly on one exhalation: aaaaa aaaaaooooooo aaaaauuuuuu.

Count on one exhalation to 3-5 (one, two, three ...), trying to gradually increase the count to 10-15. Monitor the smoothness of your exhalation. Count down (ten, nine, eight ...).

Ask your child to repeat after you proverbs, sayings, tongue twisters on one breath. Be sure to follow the setting given in the first exercise.

- Read the Russian folk tale "Turnip" with the correct reproduction of the inhalation on the pauses.

The skills that have been worked out can and should be consolidated and comprehensively applied in practice.

* "Whose steamer buzzes better?"
Take a glass vial approximately 7 cm high, with a neck diameter of 1-1.5 cm, or any other suitable object. Bring it to your lips and blow. "Listen to how the bubble hums. Like a real steamer. Will you make a steamer? I wonder whose steamer will hum louder, yours or mine? And whose is longer?" It should be remembered: for the bubble to hum, the lower lip should slightly touch the edge of its neck. The air jet should be strong and come out in the middle. Just do not blow for too long (more than 2-3 seconds), otherwise your head will spin.

* "Captains".
Dip paper boats into a basin of water and invite your child to ride a boat from one city to another. In order for the boat to move, you need to blow on it slowly, folding your lips with a tube. But then a gusty wind swoops in - the lips fold, as for the sound of p.

Whistles, toy pipes, harmonicas, inflation of balloons and rubber toys also contribute to the development of speech breathing.

Tasks become more complicated: first, training for a long speech exhalation is carried out on individual sounds, then on words, then on a short phrase, while reading poetry, etc.

In each exercise, the child's attention is directed to a calm, relaxed exhalation, to the duration and volume of the sounds uttered.

The full course of correction and treatment of dysarthria is several months. As a rule, children with dysarthria are in the day hospital for 2-4 weeks, then they continue the course of treatment on an outpatient basis. In a day hospital, restorative physiotherapy, massage, exercise therapy, breathing exercises are carried out. This shortens the time to reach the maximum effect and makes it more sustainable.

Dysarthria treatment with hirudotherapy

Back in the 16th-17th centuries, hirudotherapy (hereinafter referred to as HT) was used for diseases of the liver, lungs, gastrointestinal tract, tuberculosis, migraine, epilepsy, hysteria, gonorrhea, skin and eye diseases, menstrual irregularities, cerebrovascular accidents, fever, hemorrhoids , as well as to stop bleeding and other diseases.

Why did interest in the leech begin to rise? The reasons for this are the insufficient therapeutic efficacy of pharmaceuticals. funds, an increase in the number of drug-allergic people, a huge amount (40-60%) of counterfeit pharmaceuticals in the pharmacy network.

To understand the mechanisms of the therapeutic effect of the medicinal leech (MP), it is necessary to study biologically active substances (BAS) of the secretion of the salivary glands (SSG). The secret of the salivary glands of the leech contains a set of compounds of protein (peptide), lipid and carbohydrate nature. The reports of I.I.Artamonova, L.L. Zavalova and I.P.Baskova indicate the presence of more than 20 components in the low molecular weight fraction of the leech SSF (molecular weight less than 500 D) and more than 80 in the fraction with a molecular weight of more than 500 D.

The most studied components of SSF: hirudin, a histamine-like substance, prostacyclins, prostaglandins, hyaluronidase, lipase, apyrase, collogenase, kalin and saratin - platelet adhesion inhibitors, platelet activating factor inhibitor, destabilase, destabilase-lysozyme inhibitors - Lestobitin inhibitors and plasmin, eglins - inhibitors of chymotryptosin, subtilisin, elastase and cathepsin G, neurotrophic factors, an inhibitor of blood plasma kallikrein. The intestinal canal of the leech contains the symbiont bacterium Aeromonas hidrophilia, which provides a bacteriostatic effect and is the source of some components of the CVS. One of the elements contained in MP saliva is hyaluronidase. It is believed that this substance is used to remove toxic (endo- or exogenous) products from the matrix space (Pischinger's space) that have not undergone metabolic transformations, which allow them to be removed from the MP organism using the excretory organs. They can induce vomiting or death in MPs.

Neurotrophic factors (NTF) MP. This aspect is associated with the effect of CVS on nerve endings and neurons. This problem was first raised in our research. The idea arose as a result of the results of treatment of children with cerebral palsy and myopathy. The patients showed significant positive changes in the treatment of skeletal muscle spastic tension. A child who, prior to treatment, could only walk on all fours, could walk on his own legs a few months after MP treatment.

Neurotrophic factors - low molecular weight proteins that are secreted by target tissues, are involved in the differentiation of nerve cells and are responsible for the growth of their processes. NTFs play an important role not only in the processes of embryonic development of the nervous system, but also in the adult organism. They are required to maintain the vitality of neurons.

To assess the neurite-stimulating effect, a morphometric method is used, which makes it possible to measure the area of the ganglion together with the growth zone, consisting of neurites and glial elements, followed by the addition of drugs that stimulate the growth of neurites to the nutrient medium in comparison with control explants.

The results obtained on the treatment of alalia and dysarthria in children by the method of herudotherapy, as well as the results of superposition brain scanning, made it possible to record the accelerated maturation of neurons in the motor cortex of the brain in these children.

Data on the high neurite-stimulating activity of the components of the SSF (secretion of the salivary glands) explain the specific efficacy of herudotherapy in neurological patients. Moreover, the ability of leech proteinase inhibitors to modulate neurotrophic effects enriches the arsenal of proteolytic enzyme inhibitors, which are currently considered as promising therapeutic agents for a wide range of neurodegenerative diseases.

So, the biologically active substances produced by MPs provide the currently known biological effects:
1.thrombolytic action,
2.hypotensive effect,
3.reparative effect on the damaged blood vessel wall,
4. antiatherogenic action of biologically active substances actively influence the processes of lipid metabolism, leading it to normal conditions of functioning; lower cholesterol levels,
5.antihypoxic effect - increasing the percentage of survival of laboratory animals in conditions of low oxygen content,
6.immunomodulating action - activation of the protective functions of the body at the level of the macrophage link, the compliment system and other levels of the immune system of humans and animals,
7. neurotrophic action.

To specific technical means include: Derazhne's corrector, Echo apparatus (AIR), sound reinforcement apparatus, tape recorder.

The Derazhne apparatus (like the Barani ratchet) is built on the sound damping effect. Noise of varying strength (in the proof-phone it is regulated with the help of a special screw) is fed through rubber tubes, ending in olives, directly into the ear canal, drowning out one's own speech. But not in all cases the sound damping method can be applied. The Echo apparatus, designed by B. Adamchik, consists of two tape recorders with an attachment. The recorded sound is played back after a fraction of a second, creating an echo effect. Domestic designers have created a portable device "Echo" (AIR) for individual use.

A peculiar apparatus was proposed by V.A.Razdolsky. The principle of its operation is based on sound amplification of speech through loudspeakers or air telephones to the "Crystal" hearing aid. Perceiving their speech as sound-reinforced, dysarthrics less strain the speech muscles, more often begin to use a soft attack of sounds, which has a beneficial effect on their speech. It is also positive that when using sound amplification, patients hear their correct speech from the very first lessons, and this accelerates the development of positive reflexes and free, relaxed speech. A number of researchers use in practice various variants of delayed speech ("white noise", sound damping, etc.).

In the process of speech therapy classes for psychotherapeutic purposes, you can use sound recording equipment. With a tape lesson followed by a conversation with a speech therapist, dysarthrics improve their mood, there is a desire to achieve success in speech classes, confidence in the positive outcome of classes is developed, and confidence in the speech therapist grows. In the first tape lessons, the material for the performance is selected and carefully rehearsed.

The development of correct speech skills is facilitated by training tape classes. The purpose of these lessons is to draw the patient's attention to the pace and fluency of his speech, sonority, expressiveness, and grammatical correctness of the phrase. After preliminary conversations about the qualities of correct speech, listening to the appropriate speech samples, after repeated rehearsals, the dysarthric appears in front of the microphone with its own text, depending on the stage of the training. The task is to monitor and manage your behavior, tempo, fluency, sonority of speech, to prevent grammatical errors in it. The leader records in his notebook the state of speech and behavior of the patient at the time of speaking in front of the microphone. After finishing the speech, the dysarthric evaluates his speech (he spoke softly - loudly, quickly - slowly, expressively - monotonously, etc.). Then, after listening to the speech recorded on the tape, the patient re-evaluates it. After that, the speech therapist analyzes the speech of the stutter, his ability to give a correct assessment of his speech, highlights the positive in his speech, in his behavior in the lesson and summarizes.

A variant of teaching tape lessons is imitation of the performances of artists, masters of the artistic word. In this case, an artistic performance is listened to, the text is learned, the reproduction is practiced, recorded on a tape recorder, and then compared with the original, similarities and differences are stated. Comparative tape lessons are useful, in which the dysarthric is given the opportunity to compare his real speech with that which he had before. At the beginning of the course of speech lessons with the microphone on, he is asked questions on everyday topics, plot pictures are offered to describe their content and compose a story, etc. The tape recorder records cases of convulsions in speech: their place in a phrase, frequency, duration. Subsequently, this first recording of dysarthric speech serves as a measure of the success of the speech classes: the state of speech in the subsequent is compared with it.

Defectologist's advice

In corrective work with dysarthrics, the formation of spatial thinking is important.

Formation of spatial representations

Knowledge about space, spatial orientation develops in the conditions of various types of activities of children: in games, observations, labor processes, in drawing and construction.

By the end of preschool age, children with dysarthria develop such knowledge about space as: shape (rectangle, square, circle, oval, triangle, oblong, rounded, curved, pointed, curved), size (large, small, more, less, the same , equal, large, small, half, half), length (long, short, wide, narrow, high, left, right, horizontally, straight, obliquely), position in space and spatial relationship (in the middle, above the middle, below the middle, right, left, side, closer, further, front, back, behind, before).

The mastery of this knowledge about space presupposes: the ability to distinguish and distinguish spatial features, to name them correctly and to include adequate verbal designations in expressive speech, to navigate spatial relations when performing various operations associated with active actions.

The completeness of mastering knowledge about space, the ability to spatial orientation is ensured by the interaction of motor-kinesthetic, visual and auditory analyzers in the course of various types of child's activities aimed at active cognition of the surrounding reality.

The development of spatial orientation and the idea of space occurs in close connection with the formation of the sensation of the scheme of one's body, with the expansion of the practical experience of children, with a change in the structure of the object-play action associated with the further improvement of motor skills. The emerging spatial representations are reflected and further developed in the subject-play, visual, constructive and everyday activities of children.

Qualitative changes in the formation of spatial perception are associated with the development of speech in children, with their understanding and active use of verbal designations of spatial relations, expressed by prepositions, adverbs. The mastery of knowledge about space presupposes the ability to distinguish and distinguish spatial features and relationships, the ability to correctly denote them verbally, to navigate in spatial relations when performing various labor operations based on spatial representations. An important role in the development of spatial perception is played by construction and modeling, the inclusion of verbal designations adequate to the actions of children in expressive speech.

Research methods of spatial thinking in primary schoolchildren with dysarthria

TASK # 1

Purpose: to reveal the understanding of spatial relations in a group of real objects and in a group of objects depicted in the picture + object-game action on the differentiation of spatial relations.

Assimilation of orientations from left to right.

Poem by V. Berestov.

There was a man at the road bore.
Where is the right, where is the left - he could not understand.
But suddenly the student scratched his head
With the very hand with which he wrote,
And threw the ball, and leafed through the pages,
And he held a spoon, and swept the floor,
"Victory!" - there was a jubilant cry:
Where is the right, where is the left, the disciple recognized.

Movement according to a given instruction (mastering the left and right parts of the body, left and right sides).

We are marching bravo in the ranks.
We learn sciences.
We know the left, we know the right.
And, of course, all around.
This is the right hand.
Oh, science is not easy!

"The Steadfast Tin Soldier"

Stand on one leg
As if you are a tough soldier.
Left foot - to the chest,
Don't you fall.
Now stay on your left
If you are a brave soldier.

Clarification of spatial relationships:
* standing in a line, name the one standing on the right, on the left;
* according to the instructions, arrange items to the left and right of this one;
* determine the place of a neighbor in relation to yourself;
* determine your place in relation to your neighbor, focusing on the appropriate hand of the neighbor ("I am standing to the right of Zhenya, and Zhenya is to my left.");
* standing in pairs facing each other, determine first for yourself, then for a friend, left hand, right hand, etc.

Body Parts game.
One of the players touches any part of his neighbor's body, for example, his left hand. He says: "This is my left hand" The player who started the game agrees or refutes the neighbor's answer. The game continues in a circle.

"Identify on the trail."
On the sheet of paper, prints of hands and feet are drawn in different directions. It is necessary to determine from which hand, foot (left or right) this imprint.

Identify by plot picture in which hand the characters in the painting hold the named object.

Assimilation of the concepts "The left side of the sheet - the right side of the sheet.

Coloring or drawing according to instructions, for example: "Find the small triangle drawn on the left side of the sheet, color it in red. Find the largest triangle drawn on the right side of the sheet. Color it in green pencil. Connect the triangles with a yellow line."

Determine left or right a sleeve for a blouse, a shirt, a pocket for jeans. Products are in different positions in relation to the child.

Mastering the directions "up-down", "top-bottom".

Orientation in space:
What's up, what's down? (analysis of towers built from geometric bodies).

Orientation on a sheet of paper:
- Draw a circle at the top of the sheet, a square at the bottom.
- Put an orange triangle, put a yellow rectangle on top, and a red one below the orange one.

Exercises in the use of prepositions: for, because of, about, from, before, in, from.
Intro: Once resourceful, smart, dexterous, cunning Puss in Boots was a playful little kitten who loved to play hide and seek.
An adult shows cards where it is drawn where the kitten is hiding, and helps the children with questions such as:
- Where did the kitten hide?
- Where did he jump out of? etc.

TASK number 2

Purpose: to verbally indicate the location of objects in the pictures.

Game "Shop" (the child, acting as a seller, placed toys on several shelves and said where and what is located).

Show the actions referred to in the poem.
I will help mom
I will clean everywhere:
And under the closet
and behind the closet,
and in the closet,
and on the closet.
I do not like dust! Ugh!

Orientation on a sheet of paper.

1. Simulation of fairy tales

"Forest School" (L. S. Gorbacheva)

Equipment: each child has a sheet of paper and a house, cut out of cardboard.
"Guys, this house is not simple, it is fabulous. Forest animals will learn in it. Each of you has the same house. I will tell you a fairy tale. Listen carefully and put the house in the place that the fairy tale says.
Animals live in a dense forest. They have their own kids. And the animals decided to build a forest school for them. They gathered at the edge of the forest and began to think about where to put it. Leo suggested building in the lower left corner. The wolf wanted the school to be in the upper right corner. Fox insisted that a school be built in the upper left corner, next to her burrow. A squirrel intervened in the conversation. She said, "The school needs to be built in the clearing." The animals listened to the advice of the squirrel and decided to build a school in a forest clearing in the middle of the forest. "

Equipment: each child has a sheet of paper, a house, a Christmas tree, a meadow (blue oval), an anthill (a gray triangle).

"Zima lived in a hut near the forest at the edge of the forest. Her hut stood in the upper right corner. Once Zima woke up early, washed white, dressed warmly and went to look at her forest. She walked along the right side. When she reached the lower right corner, Zima waved her right sleeve and covered the tree with snow.
Winter turned to the middle of the forest. There was a large clearing here.
Winter waved her hands and covered the whole clearing with snow.
Zima turned to the lower left corner and saw an anthill.
Zima waved her left sleeve and covered the anthill with snow.
Winter went up: turned to the right and went home to rest. "

"Bird and cat"

Equipment: each child has a sheet of paper, a tree, a bird, a cat.

"There was a tree in the yard. A bird was sitting near the tree. Then the bird flew and sat on the tree above. The cat came. The cat wanted to catch the bird and climbed the tree. The bird flew down and sat under the tree. The cat remained on the tree."

2. Graphic reproduction of directions (I.N.Sadovnikova).

Given four points, put a "+" sign from the first point from the bottom, from the second - from the top, from the third - to the left, from the fourth - to the right.

Four points are given. From each point, draw an arrow in the direction: 1 - down, 2 - right, 3 - up, 4 - left.

There are four points that can be grouped into a square:
a) Mentally group the points into a square, highlight the upper left point with a pencil, then the lower left point, and then connect them with an arrow pointing from top to bottom. Similarly, select the upper right point and connect it with an arrow to the upper right point in the direction from bottom to top.
b) In the square, select the upper left point, then the upper right point and connect them with an arrow pointing from left to right. Similarly, connect the lower points in the direction from right to left.
c) In the square, select the upper left point and the lower right point, connect them with an arrow directed simultaneously from left-to-right-top-down.
d) In the square, select the lower left point and the upper right, connect them with an arrow pointing simultaneously from left to right and from bottom to top.

Assimilation of prepositions that have spatial significance.

1. Carry out various actions according to the instructions. Answer the questions.
- Put your pencil on the book. Where is the pencil?
- Take a pencil. Where did you get the pencil from?
- Put your pencil in the book. Where is he now?
- Take it. Where did you get the pencil?
- Hide the pencil under the book. Where is he?
- Take out the pencil. Where did you get it from?

2. Line up, following the instructions: Sveta behind Lena, Sasha in front of Lena, Petya between Sveta and Lena, etc. Answer the questions: "Who are you behind?" (in front of whom, next to whom, in front, behind, etc.).

3. Arrangement of geometric shapes according to these instructions: "Place the red circle on the blue large square. Place the green circle above the red circle. In front of the green circle there is an orange triangle, etc."

4. "What word is missing?"
The river overflowed its banks. Children run class. The path went to the field. The onion turns green in the garden. We got to the city. The ladder was propped up against the wall.

5. "What is confused?"
Grandfather in the stove, firewood on the stove.
There are boots on the table, cakes under the table.
Sheep in the river, crucian carp by the river.
There is a portrait under the table, a stool above the table.

6. "On the contrary" (name the opposite preposition).
An adult says: "Above the window", a child: "Under the window".
To door - …
In the box - ...
Before school - …
To the city - ...
In front of the car - ...
- Pick up pairs of pictures that correspond to opposite prepositions.

7. "Signalers".
a) For the picture, select the card-diagram of the corresponding preposition.
b) An adult reads sentences, texts. Children show flashcards with the necessary prepositions.
c) An adult reads sentences, texts, skipping prepositions. Children show flashcards of missed prepositions.
b) The child is asked to compare groups of geometric figures of the same color and shape, but of different sizes. Compare groups of geometric shapes with the same color and size, but different shapes.
c) "Which figure is superfluous." The comparison is based on external features: size, color, shape, changes in details.
d) "Find two identical shapes." The child is offered 4-6 items that differ in one or two characteristics. He must find two identical items. The child can find the same numbers, letters written in the same font, the same geometric shapes, and so on.
e) "Choose the right toy box." The child must correlate the size of the toy and the box.
f) "Which site will the rocket land on." The child correlates the shape of the base of the rocket and the landing pad.

TASK No. 3

Purpose: to identify the spatial orientation associated with drawing and construction.

1. In this way, place geometric shapes on a sheet of paper by drawing them or using ready-made ones.

2. Draw shapes using anchor points, while having a sample drawing made by points.

3. Without reference points, reproduce the direction of the drawing, using the sample. In case of difficulty - additional exercises, in which it is necessary:
A) distinguish between the sides of the sheet;
B) draw straight lines from the middle of the sheet in different directions;
C) circle the outline of the drawing;
D) reproduce a drawing of greater complexity than that proposed in the main task.

4. Tracking templates, stencils, tracing contours along a thin line, by hatching, by points, shading and hatching along various lines.

Kern-Jirasek technique.
When using the Kern-Jirasek technique (includes two tasks - sketching written letters and sketching a group of points, i.e. work according to a model), the child is given sheets of paper with the presented samples of the tasks. The tasks are aimed at the development of spatial relationships and representations, the development of fine motor skills of the hand and the coordination of vision and hand movements. Also, the test allows you to identify (in general terms) the intelligence of a child's development. Tasks for sketching written letters and sketching a group of dots reveal the ability of children to reproduce a pattern. It also allows you to determine if the child can work with concentration for a while without distraction.

Methodology "House" (N. I. Gutkina).
The technique is a task for sketching a picture depicting a house, the individual details of which are made up of capital letters. The task allows you to reveal the child's ability to navigate in his work on a sample, the ability to accurately copy it, reveals the features of the development of voluntary attention, spatial perception, sensorimotor coordination and fine motor skills of the hand.
Instructions to the subject: "Before you is a sheet of paper and a pencil. On this sheet I ask you to draw exactly the picture that you see in this picture (a sheet of paper with the" House "is placed in front of the subject) the drawing was exactly the same as this one on the sample. If you draw something wrong, then you cannot erase anything with an eraser or your finger, but you have to draw it over the wrong one or next to it correctly. Do you understand the task? Then get to work. "

When performing the tasks of the "House" Methodology, the subjects made the following mistakes:
a) some details of the drawing were missing;
b) in some drawings, proportionality was not observed: an increase in individual details of the drawing with a relatively arbitrary preservation of the size of the entire drawing;
c) the wrong image of the elements of the picture;
e) deviation of lines from a given direction;
f) gaps between lines at junction points;
g) climbing lines one on top of the other.

"Draw Tails for Mice" and "Draw Handles for Umbrellas" by AL Venger.
Mouse tails and pens are both letter elements.

Graphic dictation and "Sample and Rule" by D. B. Elkonin - A. L. Venger.
Performing the first task, the child draws an ornament on a piece of paper from the previously set points, following the instructions of the leader. The presenter dictates to a group of children in which direction and how many cells the lines should be drawn, and then suggests drawing the resulting dictation "pattern" to the end of the page. Graphic dictation allows you to determine how accurately a child can fulfill the requirements of an adult given orally, as well as the ability to independently perform tasks of a visual perceived sample.
A more complex technique "Pattern and Rule" involves the simultaneous following in your work a pattern (you are given the task to draw exactly the same pattern as a given geometric figure by points) and a rule (the condition is stipulated: you cannot draw a line between the same points, i.e. connect a circle with a circle, a cross with a cross and a triangle with a triangle). A child, trying to complete the task, can draw a figure similar to the given one, neglecting the rule, and, conversely, focus only on the rule, connecting different points and not checking the sample. Thus, the methodology reveals the level of the child's orientation to a complex system of requirements.

"The car drives along the road" (A. L. Venger).
A road is drawn on a sheet of paper, which can be straight, winding, zigzag, with turns. A car is drawn at one end of the road, a house at the other. The car should drive down the driveway to the house. The child, without lifting the pencil from the paper and trying not to go beyond the path, connects the car with the house with a line.

You can think of many similar games. Can be used for training and passing the simplest labyrinths

"Get into the circles with a pencil" (A.E. Simanovsky).
The sheet shows rows of circles with a diameter of about 3 mm. The circles are arranged in five rows of five circles in a row. The distance between the circles from all directions is 1 cm. The child must, without lifting his forearm from the table, put dots in all circles as quickly and accurately as possible.
The movement is strictly defined.
I-variant: in the first line the direction of movement is from left to right, in the second line - from right to left.
Option II: in the first column the direction of movement is from top to bottom, in the second column - from bottom to top, etc.

TASK No. 4

Target:
1. Fold shapes from sticks according to the pattern given in the picture.
2. Add geometric shapes from four parts - a circle and a square. In case of difficulty, this task should be performed in stages:
A) Make a figure from two then three and four parts;
B) Fold a circle and a square according to the pattern with the component parts indicated on it dotted;
C) Fold the figures by superimposing a part on the dotted drawing, followed by design without a sample.

"Make a picture" (like E. Seguin's board).
The child selects the tabs to the slots in shape and size and folds the figures cut on the board.

"Find the shape in the object and fold the object."
In front of the baby, contour images of objects made up of geometric shapes. The child has an envelope with geometric shapes. You need to fold this object from geometric shapes.

"The picture is broken."
The child must fold the pictures, cut into pieces.

Find what the artist has hidden.
The card contains images of objects with intersecting contours. You need to find and name all the objects drawn.

"The letter is broken."
The child must recognize the whole letter for some part.

"Fold the square" (BP Nikitin).
Equipment: 24 multi-colored squares of paper 80X80 mm, cut into pieces, 24 samples.
You can start the game with simple tasks: "Fold a square out of these parts. Look carefully at the pattern. Think about how to arrange the pieces of the square. Try putting them on the pattern." Then the children independently select the pieces by color and collect the squares.

Frames and inserts Montessori.
The game is a set of square frames, plates with cut holes, which are closed with a liner of the same shape and size, but in a different color. Liner covers and slots have the shape of a circle, square, equilateral triangle, ellipse, rectangle, rhombus, trapezoid, quadrilateral, parallelogram, isosceles triangle, regular hexagon, five-pointed star, right isosceles triangle, regular pentagon, irregular hexagon, versatile triangle.
The child selects the liners to the frames, traces the liners or slots, inserts the liners into the frames by touch.

"Mailbox".
A mailbox is a box with slots of various shapes. The child lowers volumetric geometric bodies into the box, focusing on the shape of their base.

"What color is the object?", "What shape is the object?"
Option I: children have object pictures. The presenter takes chips of a certain color (shape) from the bag. Children cover the corresponding pictures with chips. The winner is the one who closed his pictures the fastest. The game is played according to the "Lotto" type.
Option II: children have colored flags (flags with geometric shapes). The presenter shows the object, and the children show the corresponding flags.

"Assemble in shape."
The child has a card of a certain shape. He selects suitable objects for her, shown in the pictures.

Games "What shape is gone?" and "What has changed?"
Geometric shapes of various shapes are displayed in a row. The child must memorize all the figures or their sequence. Then he closes his eyes. One or two figures are removed (swapped). The child must name which figures are gone, or say what has changed.

Exercises for the formation of ideas about the value:
- Arrange the mugs from smallest to largest.
- Build matryoshka dolls by height: from highest to lowest.
- Put the narrowest strip on the left, next to the right, put the strip a little wider, etc.
- Paint the tall tree with yellow pencil, and the short one with red.
- Circle the fat mouse, and circle the thin one.
Etc.

"Wonderful bag".
The bag contains volumetric and flat figures, small toys, objects, vegetables, fruits, etc. The child must feel what it is. You can put plastic, cardboard letters and numbers in the bag.

"Drawing on the back".
Draw letters, numbers, geometric shapes, simple objects on each other's backs with your child. You have to guess what the partner drew.

Difficulties in differentiating spatial relations in object-playing activity, correct reasoning and explanations in the process of drawing with erroneous reproduction of spatial features may probably indicate a lack of generalized understanding of the formulations already established in children for the verbalization of spatial relations, ahead of their practical implementation.

Literature

1. Vinarskaya EN and Pulatov AM Dysarthria and its topical-diagnostic value in the clinic of focal brain lesions, Tashkent, 1973.
2. Luria AR Basic problems of neurolinguistics, p. 104, M., 1975.
3. Mastyukova EM and Ippolitova MV Speech disorders in children with cerebral palsy, p. 135, M., 1985.

Anartria is presented in the form of a lack of speech, the cause of which is the defeat of the neuromuscular apparatus, which provides the articulatory component. This device corrects spoken sounds by cheeks, teeth, pharynx and tongue.

This pathology does not imply a violation of the understanding of the speech heard. The ability to pronounce words, syllables and letters is completely absent. The result of the violation is central or peripheral paralysis of the muscles responsible for articulation.

It can be damage to the cortical-nuclear tracts of the pyramidal system or XII, X, IX, VII, V pairs of cranial nerves. Dysarthria is a less pronounced degree of the disorder in question.

An accompanying symptom complex may be pseudobulbar or bulbar paralysis, combined with aphonia, dysphagia, glossoplegia.

Causes

Anartria occurs against the background of any disease or pathological process that irritates or disrupts the structure of the brain stem, posterior parts of the frontal lobe, cerebellum, subcortical ganglia or pathways connecting the mentioned areas and other areas of the brain.

It is relevant to consider the following reasons:

botulism;
syringobulbia (the formation of pathological areas in the brain stem that impede the conduction of nerve impulses);
amyotrophic lateral sclerosis;
poisoning with salts of heavy metals or industrial poisons;
Fazio-Londe syndrome (a hereditary disease, accompanied by impaired swallowing, progresses gradually and manifests itself in adolescence);
demyelinating diseases, the result of which is the breakdown of myelin (multiple sclerosis, multiple encephalomyelitis);
brain tumors and trauma;
abscess of the cerebellum or brain;
cerebral hemorrhage;
chronic or acute cerebrovascular accident.

Symptoms

Anartria is manifested by the following symptoms:

problems with eating;
inability to pronounce words, letters, or even sounds;
pronounced inarticulate speech, stammering when pronouncing words;
the patient evaluates his own defect critically, is silent and prefers to communicate in writing or using gestures.

Classification

Since anarthria is a type of dysarthria, it is important to consider the classification of such a pathology.

Hypokinetic is the result of damage to the nerve connections of the subcortical nodes and the nodes themselves.
Hyperkinetic.
Ataxic occurs when the cerebellum and its pathways are damaged.
Upper-neuronal unilateral is provoked by unilateral central paresis or muscle paralysis, which are innervated by the glossopharyngeal, hypoglossal, vagus nerves. Also, the result of the occurrence is the defeat of the anterior central gyrus or unilateral damage to the cortical-nuclear pathways.
Spasmodic manifests itself for similar reasons.
Sluggish is provoked by a violation of neuromuscular transmission, as well as damage to the vagus, hypoglossal, glossopharyngeal nerves or their nuclei.
Mixed form.

Any of the pathologies presented require an immediate visit to a neurologist.

Diagnostics

Diagnosis of the speech pathology under consideration involves the following procedures.

Analysis of patient complaints and anamnesis of pathology (duration of manifestation of symptoms, the presence of similar symptoms in relatives).
A neurological examination consists of examining the pharynx, checking the mandibular and pharyngeal reflexes, identifying possible asymmetry of the face, weakness of the facial muscles, atrophy of the muscles of the tongue.
A visit to an otolaryngologist involves examining the cavity of the larynx, nose, pharynx for the presence of pathological processes disturbed by the pronunciation of words.
A visit to a speech therapist requires an assessment of the violation of the tempo and timbre of speech, difficulties in pronouncing certain sounds.
CT and MRI of the head makes it possible to determine the cause of anarthria by studying the layered structure of the brain. These can be foci of myelin decay, tumors, abscesses, foci of circulatory disorders.

Treatment

The essence of the treatment of anarthria lies in the treatment of the underlying disease, which became the cause of speech pathology. The following methods may be relevant.

Elimination of hemorrhage, if its location allows for surgical intervention.
Surgical removal of the tumor.
Normalizing blood pressure and taking medications that improve metabolism and cerebral blood flow.
Surgical removal of the abscess followed by antibiotic therapy to eliminate the infection as quickly as possible.
Physiotherapy - acupuncture, exposure to ultra-high frequency currents, magnetotherapy.
Regular sessions with a speech therapist to correct the defect through special exercises.
Taking medications that improve metabolism and cerebral circulation (angioprotectors, piracetam, nootropics).
Antibacterial therapy.

Prophylaxis

It is much easier to prevent the disease than to further treat it, so it is important to consider the following preventive measures:

regular follow-up by a family doctor;
quitting addictions - smoking, alcohol, drugs, etc .;
blood pressure control;
observance of a balanced and rational diet: refusal from hot, fried, spicy, converted food, the predominance of greens, vegetables and fruits in the diet;
maintaining a healthy lifestyle: eight hours a night's sleep, adherence to the daily routine, regular sports activities and walks in the fresh air.

Since the key consequence of anarthria is a violation of labor and social adaptation due to a serious violation of a speech defect, therefore, timely prevention and competent treatment are important aspects in the process of combating such a pathology. Be healthy!

“Dysarthria is a violation of the pronunciation side of speech due to insufficient innervation of the speech apparatus.

The leading defect in dysarthria is a violation of the sound-articulating and prosodic aspects of speech, associated with organic damage to the central and peripheral nervous systems. " ("Speech therapy" under the editorship of Volkova L.S.)

D isarthria is manifested by a violation of sound pronunciation, tempo, rhythm of speech, intonation, timbre of voice, speech breathing.

As you know, a person speaks not with his tongue (more precisely, not only with his tongue), but with his head (more precisely, with his brain). The brain, as a control center, must be connected with the performers (tongue, lips, cheeks, palate, lower jaw, pharynx, larynx, diaphragm) using "wires" - pathways (nerves). With dysarthria, the work of these pathways is disrupted at different levels: from the cortex itself to the innervated muscles.

Classification of dysarthria.

Depending on the location of the lesion, the following types of dysarthria are distinguished: bulbar, pseudobulbar, extrapyramidal, cerebellar and cortical. Each type has its own characteristics, both in symptomatology and in treatment.

Depending on the severity of the manifestation of speech disorders, 4 degrees are distinguished: the lightest 1 degree, the so-called. "Erased form of dysarthria" - disturbances in sound pronunciation look like ordinary dyslalia, and only a speech therapist can distinguish them by performing special functional tests; at 2 degrees, others notice the child's speech disorders and characterize them as "porridge in the mouth"; at grade 3, strangers can no longer understand the child, only relatives understand him; Grade 4, the most severe, is called "anarthria", with which speech is practically absent.

Dysarthria often accompanies cerebral palsy, because the reasons and the mechanism are the same.

But dysarthria with a decrease in intelligence does not have a direct relationship. They can coincide as two independent diseases, a decrease in intelligence can be secondary, with severe degrees of dysarthria, since in this case all aspects of speech (vocabulary, grammar, coherent speech) suffer. But initially, with dysarthria, the intellect is preserved.

Causes: the impact of “various unfavorable external factors affecting in the prenatal period of development, at the time of childbirth and after birth. Among the reasons, asphyxia and birth trauma, damage to an unequal system in hemolytic disease, infectious diseases of the nervous system, craniocerebral trauma, less often cerebral circulation disorders, a brain tumor, malformations of the nervous system, for example, congenital aplasia of the cranial nuclei, are important. nerves (Mobius syndrome), as well as hereditary diseases of the nervous and neuromuscular systems. " ("Speech therapy" under the editorship of L.S. Volkova)

Treatment and prognosis ... With dysarthria, early, long-term and systematic speech therapy work is required. The effectiveness of speech therapy work depends on the close relationship between the speech therapist and the neuropathologist, who prescribes drug treatment. In case of serious movement disorders caused by a violation of muscle tone, the help of a physiotherapist is needed: physiotherapy exercises, massage, gymnastics.

Speech therapy work must be started as early as possible and carried out systematically.

Dysarthria must be distinguished from other speech disorders.

The erased form of dysarthria looks like dyslalia, but the treatment has its own characteristics. To distinguish these disorders, in addition to the data of anamnesis and data of a neurological examination (which does not always reveal signs of organic lesions of the central nervous system), it is possible to carry out functional tests during the examination (if not at the initial examination, then during the dynamic examination).

More severe forms of dysarthria should be distinguished from alalia. The fact is that, despite the similarity of external manifestations (lack of speech), these two speech disorders are radically different from each other in their essence, and the treatment should be completely different.

With motor (expressive) alalia, work is based on the formation of language models in the child (i.e., in essence, the verbal manifestation of mental functions), and with dysarthria, the meaning of correctional work consists in the formation of pronunciation skills.

In addition, a combination of several diagnoses is possible.

Anartria in speech therapy. Anartria in children. Erased dysarthria: symptoms

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