Dysarthric speech disorders in children of early and preschool age

Dysarthria is a violation of the pronunciation aspect of speech caused by insufficient innervation of the speech apparatus.

Speech dysarthria can be an independent speech defect, and can also be part of more complex speech disorders.
Violation of sound pronunciation cannot be considered a harmless defect, since it can entail serious negative consequences for the development of the child as a whole. Impaired sound pronunciation makes it difficult for schoolchildren to learn Russian. A child who pronounces sounds incorrectly is often imitated in the children's group, which creates additional psychological problems that can be avoided by teaching him the correct pronunciation in time.

Speech disorders significantly reduce compliance and quality of life. This means that the life of the parents does not improve either.

General information

The localization of the pathological process leading to dysarthria in children can develop at different levels of the nervous system responsible for the formation of sounds and the logical order of the story:

• nuclei of the cranial nerves responsible for the nervous control of the tongue, lips, soft palate, etc.;
• pathways between the cortex and cerebral nuclei;
• subcortical centers;
• the cerebellum and pathways, pathways from and to it;
• cortex.

Diagnosis is carried out simultaneously by a neurologist (determines the level of topical damage to the nervous system and the nature of the pathological process) and a speech therapist (determines the degree of speech disorders in order to make a correction prognosis).
Treatment is aimed at eliminating or stabilizing the background pathology that led to speech disorders, as well as articulatory correction.

Cerebellar dysarthria: structure of the defect

The cerebellum performs a regulatory function. It is responsible for muscle tone, motor functions (balance, synchronization and coordination of movements). Affects articulatory and facial muscles, vocal cords. If the regulatory function of the organ is impaired, the cerebellar form of dysarthria develops.

Neurological symptoms are also added to speech disorders:

• desynchronization and incoordination of movements;
• articulatory muscles work inconsistently - speech becomes chanted, the accuracy of articulatory movements decreases;
• jerky breathing due to ataxia of the respiratory muscles;
• hypotonia of the muscles of the lips and tongue - a small patient cannot pronounce soft consonants;
• hypotonia of the muscles of the vocal cords - the baby pronounces voiced sounds deafly;
• hypotonia of the soft palate leads to nasalization of the voice.

This is a feature of cerebellar dysarthria (the structure of the defect): the disease is rarely diagnosed in isolation.

Classification

There are several options for classifying childhood dysarthria. The most common of them is associated with the localization of a pathological focus that affects the functioning of the speech center. The following forms of the disease are distinguished:

• pseudobulbar (most common);
• bulbar;
• extrapyramidal (subcortical);
• cerebellar;
• cortical.

Depending on the degree of damage and the severity of the main symptoms, the following forms of dysarthria are distinguished:

• erased: characterized by minimal pronunciation disorders;
• moderate: severe articulation defects, slurred speech, quiet voice;
• anarthria: complete absence of speech or isolated sounds.

Symptoms Parents May Notice

Erased dysarthria, as the initial stage of the disease, is manifested by minor pronunciation defects. With more serious disorders, there are omissions of sounds, breathing problems, crumpled and incomprehensible speech, or a complete inability to speak due to paralysis of the articulatory muscles. Listening to speech may be difficult. Articulatory dysarthria can occur with high muscle tone and provoke discoordination disorders and spasms. On the contrary, the features of dysarthria that occurs with hypotension are laxity of the muscles of the face, neck, tongue, the patient’s mouth is slightly open, and salivation occurs.

Symptoms of dysarthria in children

The pathogenetic mechanisms of dysarthria are multifaceted and are associated with inadequate innervation of organs involved in speech formation. These are the respiratory muscles, muscles of the lips, tongue and soft palate, larynx and vocal folds. As a result, speech becomes slurred and unclear. Concomitant signs of dysarthria in children are associated with impaired innervation of the muscles responsible for the pronunciation of sounds. Depending on the type of disorder, symptoms vary slightly:

• Muscle spasm. Tension of the lips, tongue, face and neck. The lips are tightly closed. Limitation of movements when pronouncing sounds.
• Muscle hypotension. The tongue is flaccid and lies almost motionless on the floor of the mouth. The mouth is half open, because lips do not close. There is increased salivation. Due to the immobility of the soft palate, the voice acquires a nasal tint (becomes nasal).

With dysarthria, the pronunciation of almost all sounds is impaired - both consonants and vowels.
The child softens hard consonants. When pronouncing hissing and whistling sounds, the tongue moves not forward, but to the side, and the interdental spaces are involved. Due to a complex disturbance of innervation, the characteristics of the voice also change. He becomes quiet, weak, deaf, acquires a nasal tone, etc. An imbalance in the control of the respiratory act leads to the fact that exhalation is shortened, and when speaking, breathing becomes more frequent and intermittent.

Due to slurred speech, the child cannot clearly differentiate sounds by ear. This leads to an unformed vocabulary and the inability to construct a grammatically correct sentence. Therefore, it is so important not to waste time and begin correcting speech disorders as early as possible.

Working on sound pronunciation with dysarthria

If the sound pronunciation of several sounds is impaired, consistency in work is important. First of all, you need to start with the sounds that are most easy for your child to articulate. Or it could be sounds that he pronounces incorrectly in passive speech, but repeating after you (reflectively) correctly.

Before calling and staging sounds, it is important to distinguish them by ear. Auditory training is required. The child must learn to listen to himself, to catch the difference between his pronunciation and the normalized sound.

There are several techniques for producing sounds for dysarthria. The most common method is when the child’s tongue and lips are given the necessary position for a particular sound. Probes, flat tongue plates and a number of other devices are used. The child's attention is drawn to the sensation of positions. He then performs the movements independently, with or without some assistance from an adult.

To automate sounds, the technique of simultaneous pronunciation and motor action is used. For example, writing and speaking or speaking and clapping hands, tapping feet.

Then the new sound is fixed in syllables, words and sentences. Moving from simple exercises to more difficult ones, increasing the pace of exercises.

Causes of dysarthria

Among the most common causes of dysarthria in children are:

• toxicosis;
• antenatal hypoxia;
• immune conflict according to the ABO system and the Rh factor;
• chronic pathologies in a mother carrying a child;
• complicated course of labor;
• birth injuries;
• birth before 37 weeks;
• asphyxia.

All these factors can lead to organic brain damage, incl.
centers responsible for speech development. At the same time, cerebral palsy often develops, and its severity correlates with the severity of speech disorders. In addition, dysarthria can develop in early childhood in an initially healthy child. In this case, the reasons lie in severe neuroinfections and intoxications, for example, carbon monoxide, alcohol poisoning, etc., as well as tumors and brain injuries.

Diagnosis of dysarthria in children

Dysarthria in children is a disorder that is often accompanied by other neurological symptoms and disorders, so the child must be examined not only by speech therapists, but also by neurologists.
The neurologist conducts an objective examination, assesses the severity of reflexes and prescribes additional diagnostic methods. As a rule, neurosonography is an ultrasound examination of the brain that allows identifying focal lesions. Rheoencephalography and encephalography may also be performed.

Speech therapy testing is aimed at assessing speech and non-speech disorders. Non-speech parameters:

• development of facial and speech muscles;
• range of motion in the temporomandibular joint;
• breathing pattern, etc.

Speech assessment parameters:

• pronunciation;
• synchronicity of the work of organs involved in the formation of speech;
• correct pronunciation of sounds, construction of sentences, etc.

Based on a comprehensive examination, the severity of dysarthria is determined. There are 4 degrees of speech impairment:

• First degree (erased form) - speech disorders are invisible to others and are detected only during a speech therapy examination.
• Second degree – speech is understandable, but there are defects in the pronunciation of sounds.
• Third degree - speech becomes slurred, only people from close circle understand it.
• The fourth degree (anarthria) – speech is completely slurred, even people who are constantly with the child cannot understand it.

Treatment of dysarthria

Treatment of dysarthria in children depends on the severity of symptoms, the cause of the disease and the location of the pathological focus.
Regardless of the form of the disorder, therapy includes two basic areas: therapeutic (neurological) and speech therapy. A neurologist provides therapy for the underlying disease that has led to speech impairment. For this purpose, vascular drugs, nootropics, vitamins and others can be prescribed. If there is a brain tumor compressing the speech center, removal is indicated (at this stage a neurosurgeon is involved).

Speech therapy methods for working with a child suffering from dysarthria include:

• stabilization of the tone of the muscles responsible for articulation: speech therapy massage, taping, speech gymnastics;
• exercises aimed at developing motor skills: rhythm, finger gymnastics, etc.;
• breathing control and voice control training;
• production of sounds;
• development of vocabulary, etc.

It takes a lot of time to correct violations. It is important to remember that both doctors and speech therapists, as well as parents, should treat dysarthria in a child. Regular training and exercises at home also contribute to the speedy restoration of speech functions.

In achieving the desired results, the start of therapy as early as possible, the diligence of the parents and the patient himself are of great importance. SM-Doctor specialists build a program of work with the child in such a way that motivation to achieve the goal does not disappear at any stage, but only increases. This and the high professionalism of speech therapists, neurologists and other doctors involved make it possible to achieve high results and restore speech intelligibility.

Speech therapy program

Dysarthria is a pathology that requires persistent, long-term work by the speech therapist, the patient, his relatives and caregivers. A speech map of a speech therapy examination for dysarthria is drawn up. The speech therapy support program is approved after receiving a speech therapy report for dysarthria and recommendations from a neurologist who treats the disease that has caused speech impairment. Speech therapy classes for dysarthria begin as early as possible.

There are the following main areas of speech therapy work for dysarthria:

• Normalization of motor skills of the articulatory apparatus;
• Development of articulatory movements;
• Formation of the ability to voluntarily switch movable organs of articulation from one movement to another at a given pace;
• Overcoming monotony and speech tempo disturbances;
• Full development of phonemic awareness.

The importance of the early start of speech therapy work for dysarthria cannot be overestimated. Speech therapists at the Yusupov Hospital begin to work on restoring speech in patients who have suffered a stroke or acute traumatic brain injury, immediately after the patient’s consciousness has been restored. For demyelinating diseases of the nervous system, speech therapy work is included in the rehabilitation program.

When carrying out correctional speech therapy work, the following speech therapy methods are used:

• Voice and breathing exercises;
• Active and passive articulatory gymnastics;
• Differentiated speech therapy massage (relaxing or stimulating);
• Acupressure, probe, brush, manual massage;
• Artificial local contrastothermy (combination of exposure to low and high temperatures).

Speech therapy for dysarthria is based on compliance with the following principles:

• Systematic approach to the analysis of speech defects;
• Stage-by-stage interconnected formation of all components of speech;
• Regulation of children's mental activity through the development of generalizing and communicative functions of speech.

In the process of systematic long-term training, a gradual normalization of the motor skills of the articulatory apparatus, the development of articulatory movements, and the formation of the ability to voluntarily switch the movable organs of articulation from one movement to another at a given pace are carried out. Monotony and disturbances in the tempo of speech are overcome, and full-fledged phonemic perception develops. This prepares the basis for the development and correction of the sound side of speech.

Prognosis and prevention

The result of treatment depends on the type of disorder and its degree. Regularity of exercise is important. Only constant training and thorough implementation of the doctor’s recommendations will allow you to completely or partially cope with the problem. If we are talking about severe disability, in which dysarthria arose against the background of other pathologies, the likelihood of successful correction is significantly reduced.

Prevention of the disease includes general measures: reducing the risk of injury, a healthy lifestyle during pregnancy, etc.

As soon as you begin to notice the first signs of dysarthria in a preschooler, do not delay your visit to specialists. Only a comprehensive specialized examination will identify or eliminate the problem. At SM-Doctor you will be met by competent doctors and speech therapists who will help you establish an objective diagnosis and correct the identified disorders. Sign up for a consultation with professionals at a convenient time! We find an approach to every child, even the most difficult.

Stages of speech therapy work

Speech therapy work for dysarthria is carried out in stages. The main goal of the first, preparatory stage is to prepare the articulatory apparatus for the formation of articulatory patterns, correction of breathing and voice. An important task at this stage is the development of sensory functions, especially auditory perception and sound analysis, as well as the perception and reproduction of rhythm. Speech therapy work is carried out against the background of medication and physiotherapeutic treatment, massage and physical therapy.

At the second stage, primary communicative pronunciation skills are formed. Its main goal is the development of speech communication and sound analysis. The speech therapist works to correct articulation disorders. In case of spasticity, they work on relaxing the muscles of the articulatory apparatus. Control over the position of the mouth is developed, articulatory movements develop, speech breathing is corrected, the voice, sensations of articulatory movements and articulatory praxis develop.

The formation of sound pronunciation in dysarthria includes the production and consolidation of sounds in speech. The first group of sounds includes phonemes that are the easiest in terms of articulation and acoustically distant from each other. These are the sounds a, y, p, m, n, k, s, x, v, o, l, t, s. These sounds, being the simplest ones, are worked out to the norm. Along the way, these phonemes are used to develop phonemic perception and sound analysis skills (identifying sounds from a number of others, from syllables, in simple words).

Tongue twisters for dysarthria are a phonetic means of developing the mobility of the articulatory apparatus. When using tongue twisters, adhere to the following recommendations:

• The work begins with simple, short, rhyming phrases (“White sheep beat the drums”);
• The principle of selection of didactic material is observed (the tongue twister should not contain words with sounds that are poorly pronounced by the patient;
• Tongue twisters are best used in games.

An individual approach to the selection of means and methods of speech therapy work at each stage of treatment for dysarthria allows specialists at the Yusupov Hospital to achieve speech restoration in patients who were abandoned in other rehabilitation centers.