What to do if a child is diagnosed with dysarthria: advice from a speech therapist

Dysarthria is a speech disorder that develops as a result of organic damage to the areas of the brain that are the speech-motor analyzer, as well as due to damage to the nerve endings responsible for the innervation of the muscles of the articulatory apparatus. It is difficult for people without appropriate education to understand what dysarthria is, since it is not a single disease with severe symptoms, but a series of disorders. Moreover, each age category of children has its own characteristics of this speech disorder.

A distinctive symptom of dysarthria is that the problem does not arise with the pronunciation of certain sounds, but the entire pronunciation part of speech suffers. In this case, there is a limitation in the mobility of not only speech, but also facial muscles. The child’s speech is not smooth, it is unclear and blurred, its pace can be accelerated or slowed down. The voice also suffers, which can be harsh, or, conversely, quiet, dull and weak.

The severity and severity of this condition largely depends on the nature of the existing damage. Despite the fact that dysarthria, as a speech disorder, has been known since ancient times, even the currently existing treatment methods do not always make it possible to completely correct this disorder. Recovery options depend on many factors.

Successful correction of dysarthria requires an integrated approach consisting of speech therapy sessions, drug treatment, physical therapy and physiotherapy.

Reasons for the development of speech disorders

In approximately 85% of cases, the definition of this pathological condition occurs in young children. In most cases, this disorder accompanies cerebral palsy. Organic damage to brain tissue occurs during the period of intrauterine development or against the background of various unfavorable factors to which a baby was exposed before the age of 2 years.

Most often, cerebral palsy leading to the development of dysarthria in children is caused by pregnancy pathologies such as:

• fetal hypoxia;
• toxicosis;
• Rhesus conflict;
• severe labor;
• kernicterus of newborns;
• asphyxia during birth;
• prematurity;
• somatic diseases.

In most cases, children have a mild form of dysarthria - erased. In children, the severity of this speech disorder is closely related to existing movement disorders. It is known that with double hemiplegia, the most severe form of cerebral palsy, dysarthria is detected in the vast majority of children.

At an early age, this speech disorder can develop against the background of other types of central nervous system damage. Other causes of dysarthria in children who do not suffer from cerebral palsy are damage to brain tissue resulting from neuroinfections, as well as from severe intoxication, purulent otitis media, traumatic brain injury and hydrocephalus.

Prognosis and prevention

Timely initiation of therapy using a comprehensive individual approach and the absence of complex neurological pathology are the main conditions for complete speech restoration. The child overcomes his speech impediment and in the future leads a normal life typical for his age. He can study in a regular school and successfully master the school curriculum.

If cerebral palsy or another neurological disease is present, or there is a space-occupying lesion, the prognosis is difficult. In any case, with a competent approach, it is possible to improve speech and reduce the severity of the defect.

Prevention of the cortical form of dysarthria consists of planning pregnancy, giving up bad habits during pregnancy, timely treatment of emerging problems, and preventing complications of pregnancy and childbirth. It is important to choose a method of delivery in advance to prevent birth injuries.

Classification of types and forms of dysarthria

The human brain is an extremely complex structure, so this speech disorder does not follow the same scenario in different children. Depending on the location of the damaged area, the following types of dysarthria are distinguished:

• bulbar;
• pseudobulbar;
• extrapyramidal;
• cerebellar;
• cortical.

A separate classification includes disorders that occur in children due to cerebral palsy. They develop specific forms of dysarthria depending on the leading clinical syndrome. Thus, in children suffering from cerebral palsy, this disorder may be:

• rigid;
• paretic;
• hyperkinetic;
• atactic;
• atactico-hyperkinetic.

Depending on the existing speech therapy problem, there are 4 main forms, each of which has its own characteristics:

1. As a rule, the first or erased dysarthria in children can be detected only at an appointment with a speech therapist. Often its presence does not cause much discomfort either to the baby or to those around him. Only by using special techniques and tests can a speech therapist determine the symptoms of the erased form. Such violations can be easily corrected by a good specialist.
2. In the second degree, characteristic defects in sound pronunciation are revealed. Some existing impairments are noticeable to others, but speech remains understandable.
3. In the third degree of dysarthria, sound pronunciation is severely impaired. The patient’s speech is understandable only to those closest to him, while it is not always clear to outsiders.
4. The most severe is grade 4 dysarthria. There may be a complete loss of speech ability. Often, even close people cannot say with certainty what exactly the patient is saying. In this case, anarthria is usually diagnosed.

Diagnosis of pseudobulbar dysarthria

The patient should be managed by a speech therapist, neurologist and other specialized medical specialists. For accurate diagnosis, the following research methods are used:

• speech therapy speech study;
• electroencephalography;

• electromyography;
• MRI of the head.

In some cases, a study of cerebrospinal fluid by lumbar puncture may be prescribed. This analysis identifies neuroinfectious causes. A neurologist should participate in the diagnosis. They must undergo an examination, special tests, and a study of the child’s motor skills and facial expressions. These methods make it possible to assess the degree, type, and causes of the disorder, and also, based on the data obtained, formulate an effective treatment program.

Possible symptoms

Symptoms of dysarthria are usually represented by defects in sound pronunciation and voice, combined with disturbances in speech breathing and motor skills. This is a rather complex complex that can be expressed in varying degrees of severity. Suffer from:

• speech intonation;
• sound pronunciation;
• phonemic functions;
• lexical and grammatical construction of sentences;
• reading and writing.

In addition, there are a number of non-speech signs. For example, dysarthria in children with mental retardation (with disorders of muscle tone, speech breathing and articulation disorders) is often combined with disorders of cognitive activity and the uniqueness of personality formation.

The complex of symptoms in children usually fully manifests itself at the age of five, although pronounced deviations can be noticed by parents as early as 2 years, since the child in this case has difficulty learning to speak and pronounces even simple words poorly.

Difference between bulbar dysarthria and pseudobulbar dysarthria table

The main differences between bulbar dysarthria and pseudobulbar dysarthria are as follows:

• They differ in the characteristics of paralysis of the speech muscles. With the bulbar type, peripheral paresis is observed, and with pseudobulbar paresis it is central.
• With bulbar, voluntary and involuntary movements of speech motor skills are disrupted. With pseudobulbar, only voluntary sounds are affected.
• With bulbar dysarthria, diffuse articulatory motor skills are affected, and in the second type, a selective nature of the violation of articulatory movements is observed.

There are also differences in sound pronunciation. The bulbar type makes the pronunciation of vowels neutral.

Features of forms of dysarthria

All studied clinical varieties of this disorder have developmental features and disorders inherent only to them. With the most common bulbar dysarthria, amymia, areflexia, sucking disorder, and disturbances in chewing and swallowing food are observed. The muscles of the oral cavity are atonic.

Typically, children under 5–6 years of age who have severe damage to the central nervous system exhibit mental imbalance and a number of symptoms that may indicate the severity of the damage:

• in speech there are sounds that are easiest to pronounce, most often these are vowels
• complex consonant sounds are greatly simplified, forming a single fricative sound;
• even a mild degree of dysarthria of this form is characterized by strong nasalization of timbre, aphonia or dysphonia.

If the patient has a pseudobulbar form, all disorders are the result of spastic paralysis and muscle hypertonicity. This leads to dysfunction of the tongue's mobility, resulting in significant difficulty in moving it upward and retracting it to the sides. People suffering from the bulbar form have difficulty quickly switching from one articulatory position to another.

Associated disorders include excessive drooling, choking, increased pharyngeal reflex, and dysphagia. Typically, speech in this form is slurred and blurred. It may contain nasal notes. Often there is a gross violation of the reproduction of whistling and hissing sounds, sonors. If mild dysarthria is present, speech is quite understandable to others.

In the subcortical form, hyperkinesis is detected, that is, involuntary muscle movements of articulatory and facial muscles. This disorder contributes to the development of articulatory spasms. There is a violation of the strength and timbre of the voice, a noticeable change in the prosodic aspect of speech (melody, duration, intensity, tempo and timbre of pronunciation). Sometimes patients may experience involuntary guttural cries. This disorder can be combined with other disorders, such as stuttering.

With the cerebellar form, there is a violation of the coordination of the speech process. As a result, tongue tremor, Scandinavian speech syndrome, and isolated cries are noted. Even the erased form of dysarthria of this type is characterized by slurred and very slow speech. Usually there is a violation of the pronunciation of labial and anterior lingual sounds, there are signs of ataxia (violation of the coordination of movements of various muscles). Thus, patients with the cerebellar form may experience awkward movements and impaired balance.

The cortical form is usually characterized by a disorder of voluntary motor skills during articulation. As a rule, there are no disturbances in prosody, voice, or speech breathing. Dysarthria is characterized by severe speech disorders. In addition, there may be problems with reading and writing, and using language.

Symptoms of cortical dysarthria in children

Characteristic symptoms of cortical dysarthria are disturbances in the tempo-rhythmic component of speech: there is a slow pace of expressive speech, lack of fluency and automatism. From the outside it seems that it is difficult for the child to move his tongue and lips.

The most difficult sounds are the anterior lingual sounds. The baby replaces or skips problematic sounds. Because of this, speech is blurred and slurred. But there are no problems with the semantic part, that is, the vocabulary is sufficient, children correctly use words in sentences and correctly express their thoughts.

Cortical-subcortical dysarthria is characterized by violent involuntary movements at rest and during conversation.

Afferent cortical dysarthria

Signs of this variant of cortical dysarthria are the search for the correct articulatory structure when pronouncing sounds, which causes pauses. The voice, due to stress during conversation, is loud with a decrease in voiced consonants. Due to the slowness of speech, intercalary sounds appear.

The baby pronounces affricates (consonants made of two sounds) separately or pronounces only a separate part. For example, “t” or “s” or the prolonged “ts” from instead of the sound “ts”. It also replaces some sounds with others: fricative consonants with stop consonants. The child cannot name the place on the face that the speech therapist touches.

Efferent cortical dysarthria

Cortical kinetic dysarthria is characterized by slowness of speech due to problematic transitions between sounds. Stressed vowels are lengthened, and consonants, if they are at the beginning and end of a word, too. The pronunciation of “l”, “sh”, “r”, “zh” suffers: this requires the participation of the tongue, and the child’s tongue movements are difficult. He can replace them with “d” or “t”.

It is difficult for a child to fix the desired articulatory position, so there are unnecessary insertions and omissions of sounds. Children may wrinkle their forehead, stick out their tongue, close their eyes, and lick their lips when talking.

How is diagnostics carried out?

Most children under 5 years of age with organic brain damage are under the supervision of a pediatric neurologist from birth. Children of all age groups, if necessary, are prescribed classes with a speech therapist, who can identify and correct even minor deviations in the pronunciation of sounds.

Considering that the disorder develops against the background of damage to brain tissue and peripheral nerve endings, the leading place is given to instrumental research methods. Typically, in this case, the diagnosis of dysarthria includes:

• electroencephalography;
• electroneurography;
• electromyography;
• MRI of the brain;
• transcranial magnetic stimulation, etc.

Each examination provides more information about the nature of the existing damage. Next, the neurologist may prescribe a number of laboratory tests, including analysis of the cerebrospinal fluid.

After a comprehensive brain assessment, the patient will be advised to visit a speech therapist to conduct an examination and determine any existing speech and written language impairments.

After a diagnosis of dysarthria is made, the treating neurologist and speech therapist develop the necessary regimen of medication, physiotherapeutic treatment and pedagogical intervention to get rid of this disorder.

Anarthria, Dysarthria. Violation of sound pronunciation. Porridge in the mouth.

Since there is a certain connection between intelligence and speech development, it is important to begin corrective work on disorders as soon as possible and accompany it with stimulation of sensory and mental functions. It is important to form speech as an integral mechanism of mental activity. Rehabilitation is accompanied by work with a speech therapist and drug treatment by a neurologist. In severe stages of the disorder, a physiotherapist is needed who will prescribe physical therapy and massage.

Work with a speech therapist for dysarthria should be comprehensive and systematic. When working with sound pronunciation, a sound analysis is formed and a lexical and grammatical base is developed.

As with most speech disorders, it is important to consult a doctor as soon as possible and begin systematic speech correction classes.

To achieve greater efficiency, work on the diagnosis is based on the following factors:

1. The severity of dysarthria, the level of speech development and the age of the patient;
2. State of speech, sound pronunciation;
3. Strengthening articulatory movements through the development of visual-kinesthetic sensations;
4. Correction should begin with those sounds that are easier for the child to pronounce. Sounds are selected taking into account the articulation defect as a whole. First of all, they work on the sounds of early ontogenesis.
5. If the form of the disorder is severe and the patient’s speech is not understandable to others, correction should begin with individual sounds and light syllables

Provided that the child’s speech is understandable to others, the work begins with words that the child is able to pronounce more or less clearly. In any case, it is necessary to automate sounds and their pronunciation in speech.

1. If the nervous system is very damaged, it is important to work with a speech therapist in the pre-speech period of development. This prevention will help to avoid consequences such as worsening problems with sound pronunciation.

Working with a speech therapist for dysarthria proceeds according to the following stages:

-1- Preparatory – When working with young children, they cultivate the need for communication, breathing correction, as well as the development and expansion of vocabulary. With older children, the work is based on preparation for the correct formation of articulation patterns.

At this stage, sensory perception functions develop - auditory perception, sound analysis and rhythm reproduction.

To choose the right method of work, take into account the level of speech development. If the child does not speak, it is necessary to stimulate vocal reactions. This in turn will cause onomatopoeia.

During each stage of treatment, drug treatment is carried out in parallel with massages and physical therapy.

-2- Stage of formation of primary communicative pronunciation skills. The main task is the development of speech communication and sound analysis. Treatment is aimed at correcting articulation disorders.

If they are plastic, the work begins with developing control over the position of the mouth and articulatory movements, correction of breathing, by relaxing the muscles of the articulatory apparatus.

To relax the muscles of the articulatory apparatus, you need to relax the general muscle tone, especially the thoracic region, neck and arm muscles. After which a facial massage is carried out: movements begin from the middle of the forehead and slowly move towards the temples. The movements should be light, stroking and at a slow pace, using only the fingertips. The massage should be dosed, it should be carried out only in those areas where there is muscle tension, and in areas of weakened muscles, a strengthening massage is performed.

The second direction of the massage is the movement from the eyebrows up to the hair. The movements are carried out using both hands, evenly.

The third movement is from the forehead down, through the cheeks and neck to the shoulders.

After this, they begin to relax the lips. The speech therapist places his index fingers on the corners of the patient's mouth, and then moves to the middle, thereby creating a kind of vertical fold. The same manipulations are repeated with the lower lip, and then with both at once.

Next, the speech therapist's index fingers are placed in the same position and move up along the upper lip, opening the gums, and then down along the lower lip, opening the lower gums.

After the above exercises, the speech therapist again places the index fingers in the corners of the mouth and stretches the lips as if smiling. After which, with reverse movements, he returns the lips to their original position. It is worth carrying out this activity both with the mouth closed and in the open, half-open and wide open position.

After a relaxing massage, and in case of low tone - and after stimulating exercises with the lips, during which they train their passive and active movements. The child is taught to hold caramel candies or sticks and straws of various diameters in his mouth, and is taught to drink through a straw.

After general muscle relaxation and exercises, they begin to train the muscles of the tongue. Before you relax them, it is important to consider that the muscles of the tongue are closely connected to the lower jaw. This means that when the jaw moves down, the raised tongue will also fall.

Then articulatory gymnastics are included. During classes, tactile sensations are stimulated and static-dynamic sensations are developed.

Initially, classes are held using visual, auditory and tactile analysis. Some exercises are performed with the eyes closed to draw the patient's attention to proprioceptive sensations. Gymnastic exercises are adjusted depending on the form and severity of dysarthria.

From an early age, the child is encouraged to make voluntary facial movements and control them. They go through exercises to teach them to independently open and close their eyes and mouth, swallow, puff out their cheeks, and move their eyebrows. After which they begin to work on the mobility of the speech muscles.

To develop the strength of the facial muscles, use resistance exercises using napkins and straws. The essence of the exercise is for the child to wrap his lips around the tube and hold it for as long as possible, and the adult should try to pull the tube out from him.

Tongue articulation is developed through an exercise in which you need to touch the edge of your lower teeth with your tongue. After that, general movements of the tongue are stimulated, then passive and ultimately active movements.

The most important part of articulatory gymnastics is the development of more subtle movements of the tongue, activation of its tip, differentiation of movements of the tongue and jaw.

In order to develop and correct a child’s voice, orthophonic exercises are used in practice to develop coordination of breathing and articulation. To start working on your voice, first, you need to take a course of articulatory gymnastics and massage. To correct the voice, the soft palate is stimulated - swallowing liquid, coughing, yawning and pronouncing vowel sounds on a hard attack. It is recommended to carry out the exercises in front of a mirror and counting.

A useful exercise for voice formation is working with the motor function of the jaws - opening and closing the mouth and simulating chewing. To do this, use the jaw reflex, which is caused by a light tapping movement on the chin, which reflexively raises the lower jaw upward.

The doctor tries to develop in the child voluntary control over the execution of movements. For this purpose, a visual technique in the form of drawings and sketches is usually used.

Then, these exercises are performed with the simultaneous pronunciation of syllables: don-don, kar-kar, aw-aw, etc.

You should also strengthen the muscles of the palate. To do this, the patient is asked to intermittently pronounce the sound a before completing the yawn, and then switch to pronouncing n, while holding air in the mouth. Exercises to develop the strength, timbre and pitch of the voice also help: direct counting of numbers with a gradual strengthening of the voice and backward counting with its gradual weakening.

Features of treatment and correction

The possibilities of recovery against the background of existing organic brain damage largely depend on the severity of the child’s general condition and existing additional disorders.

The stage of neglect of the process plays an important role, since if the baby began to receive help at 1 year, then his chances of recovery are high. If in the second year the child already begins to speak clearly, this is a good sign. However, only in rare cases can doctors give a relatively complete prognosis regarding the possibility of restoring speech functions.

It is worth noting that the earlier targeted treatment for dysarthria in children was started, the higher the chances of success.

In addition, the willingness of parents to follow the recommendations of specialists is of no small importance. Only when erased dysarthria is noted can serious progress and complete normalization of speech skills be achieved. In severe forms of the disorder, you can only improve the condition. In some cases, it is possible to achieve normal speech perception by others, but some speech defects still remain. As a rule, the complex work of a neurologist, speech therapist, physical therapy specialist, massage therapist and neuropsychiatrist can achieve significant results.

If signs of perinatal brain damage are detected, prevention of dysarthria from the first months of life may be required. It is important to avoid traumatic brain injuries in children, since they are often the cause of the development of this disorder.

To treat dysarthria, first of all, the necessary medications are selected to relieve neurological symptoms caused by organic brain damage. This is an extremely important point, because otherwise, the neurological condition of the brain may deteriorate, which will lead to even greater disturbances.

Since dysarthria needs to be corrected comprehensively, rehabilitation may be indicated. The treatment complex may include:

• exercise therapy;
• healing baths;
• acupressure;
• reflexology;
• acupuncture;
• mechanotherapy;
• acupressure;
• physiotherapy, etc.

A speech therapist should work in parallel with medical therapy. The help of this specialist is especially important if dysarthria has been identified in a child under 5–6 years of age, since in this case the chances of full recovery are very high.

Typically, exercises for dysarthria include both articulation training and the development of fine motor skills of the fingers and restoration of general motor skills. There are a lot of games that allow you to solve this problem and at the same time will be interesting to the baby, even if he has a developmental delay.

In addition, young patients require special speech therapy massage. Articulatory gymnastics for dysarthria is required to improve the motor skills of the speech apparatus. Breathing and orthophonic exercises significantly help improve speech skills.

Complications in children

Speech defects affect the development of speech in general, the state of the nervous system and cognitive functions. Children do not develop their vocabulary well, and they have a general underdevelopment of speech. Attention and memory deteriorate. A pronunciation defect causes a deterioration in the perception of phonemes. Such violations are fraught with learning problems: written speech and reading suffer.

At older ages, the likelihood of psychological problems is high. School-age children have a hard time with speech disorders, become withdrawn, and may show aggression and irritability. Depression may develop. The situation becomes more complicated if there is a lack of understanding and help from parents.