Comparative characteristics of various forms of dysarthria. Dysarthria (Comparative characteristics of the forms of dysarthria)

10.10.2019

Cortical dysarthria is a group of motor speech disorders of different pathogenesis associated with focal lesions of the cerebral cortex.

The first variant of cortical dysarthria is caused by a unilateral or more often bilateral lesion of the lower part of the anterior central gyrus. In these cases, selective central paresis of the muscles of the articulatory apparatus (most often the tongue) occurs. Selective cortical paresis of individual muscles of the tongue leads to a limitation of the volume of the most subtle isolated movements: the upward movement of the tip of the tongue. With this option, the pronunciation of front-lingual sounds is disturbed.

For the diagnosis of cortical dysarthria, a subtle neurolinguistic analysis is needed to determine which of the anterior lingual sounds are affected in each specific case and what is the mechanism of their violations.

In the first variant of cortical dysarthria, among the anterior lingual sounds, the pronunciation of the so-called cacuminal consonants, which are formed with the tip of the tongue raised and slightly bent upwards, is primarily disturbed. (w, w, p). At severe forms they are absent in dysarthria, with lighter ones they are replaced by other anterior lingual consonants, most often dorsal, during the pronunciation of which the front part of the back of the tongue rises with a hump to the palate (s, s, s, s, t, d, to).

Difficult to pronounce with cortical dysarthria are also apical consonants, which are formed when the tip of the tongue approaches or closes with the upper teeth or alveoli (l).

With cortical dysarthria, the pronunciation of consonants can also be disturbed according to the way they are formed: stop, slot, and trembling. Most often - slotted (l, l).

A selective increase in muscle tone is characteristic, mainly in the muscles of the tip of the tongue, which further limits its fine differentiated movements.

In milder cases, the tempo and smoothness of these movements are disturbed, which manifests itself in the slow pronunciation of front-lingual sounds and syllables with these sounds.

The second variant of cortical dysarthria is associated with insufficiency of kinesthetic praxis, which is observed with unilateral lesions of the cortex of the dominant (usually left) hemisphere of the brain in the lower post-central sections of the cortex.

In these cases, the pronunciation of consonants suffers, especially hissing and affricates. Articulation disorders are inconsistent and ambiguous. The search for the desired articulation mode at the moment of speech slows down its pace and breaks the smoothness.

Difficulty in feeling and reproducing certain articulation modes is noted. There is a lack of facial gnosis: the child finds it difficult to clearly localize a point touch to certain areas of the face, especially in the area of the articulatory apparatus.

The third variant of cortical dysarthria is associated with insufficiency of dynamic kinetic praxis; this is observed with unilateral lesions of the cortex of the dominant hemisphere in the lower sections of the premotor cortex. In case of violations of kinetic praxis, it is difficult to pronounce complex affricates, which can break up into component parts, there are replacements of fricative sounds with stops (h- e) omissions in consonant clusters, sometimes with selective stunning of voiced stop consonants. Speech is tense and slow.

Difficulties are noted when reproducing a series of successive movements on a task (by showing or by verbal instructions).

In the second and third variants of cortical dysarthria, the automation of sounds is especially difficult.

Pseudobulbar dysarthria occurs with bilateral damage to the motor cortical-nuclear pathways that go from the cerebral cortex to the nuclei of the cranial nerves of the trunk.

Pseudobulbar dysarthria is characterized by an increase in muscle tone in the articulatory muscles according to the type of spasticity - a spastic form of pseudobulbar dysarthria. Less commonly, against the background of limiting the volume of voluntary movements, there is a slight increase in muscle tone in individual muscle groups or a decrease in muscle tone - a paretic form of pseudobulbar dysarthria. In both forms, there is a limitation of active movements of the muscles of the articulatory apparatus, in severe cases - their almost complete absence.

In the absence or insufficiency of voluntary movements, the preservation of reflex automatic movements, the strengthening of the pharyngeal, palatine reflexes, and also, in some cases, the preservation of reflexes of oral automatism are noted. There are synkinesis. The tongue with pseudobulbar dysarthria is tense, drawn back, its back is rounded and closes the entrance to the pharynx, the tip of the tongue is not expressed. Voluntary movements of the tongue are limited, the child can usually stick out the tongue from the oral cavity, however, the amplitude of this movement is limited, he hardly keeps the protruding tongue in the midline; the tongue deviates to the side or falls on the lower lip, bending towards the chin.

The lateral movements of the protruding tongue are characterized by small amplitude, slow pace, diffuse movement of its entire mass, the tip remains passive and usually tense during all its movements.

Particularly difficult in pseudobulbar dysarthria is the movement of the protruding tongue up with the bending of its tip towards the nose. When performing the movement, an increase in muscle tone, passivity of the tip of the tongue, as well as exhaustion of the movement are visible.

In all cases, with pseudobulbar dysarthria, the most complex and differentiated arbitrary articulatory movements are violated in the first place. Involuntary, reflex movements are usually preserved. So, for example, with limited voluntary movements of the tongue, the child licks his lips while eating; finding it difficult to pronounce sonorous sounds, the child makes them in crying, he coughs loudly, sneezes, laughs.

Dissociation in the performance of voluntary and involuntary movements in pseudobulbar dysarthria determines the characteristic violations of sound pronunciation - selective difficulties in pronouncing the most complex and differentiated sounds according to articulation patterns (r, l, w, w, c, h). Sound R loses its vibrating character, sonority, is often replaced by a slotted sound. For sound l characterized by the absence of a specific focus of education, active deflection of the back of the tongue down, insufficient elevation of the edges of the tongue and the absence or weakness of the closure of the tip with the hard palate. All of this defines the sound. l like flat-slit sound.

Thus, with pseudobulbar dysarthria, as well as with cortical, the pronunciation of the most difficult to articulate anterior lingual sounds is disturbed, but unlike the latter, the violation is more common, combined with a distortion of pronunciation and other groups of sounds, disturbances in breathing, voice, intonation- melodic side of speech, often - salivation.

Features of sound pronunciation in pseudobulbar dysarthria, in contrast to cortical dysarthria, are also largely determined by the mixing of a spastically tense tongue in the posterior part of the oral cavity, which distorts the sound of vowels, especially front ones. (and, e).

With diffuse muscle spasticity speech apparatus voicing of deaf consonants is noted (mainly with spastic pseudobulbar dysarthria). In the same variant, the spastic state of the muscles of the speech apparatus and neck violates the resonator properties of the pharynx with a change in the size of the pharyngeal-oral and pharyngeal-nasal openings, which, along with excessive tension of the pharyngeal muscles and muscles that raise the soft palate, contributes to the appearance of a nasal shade when pronouncing vowels, especially back row (oh y), and solid sonorants (p, l), solid noisy (h, w, w) and affricates c.

With paretic pseudobulbar dysarthria, the pronunciation of stop labial sounds suffers, requiring sufficient muscle effort, especially bilabial (P,b, m)lingual-alveolar, and also often vowel sounds, especially those that require lifting the back of the tongue up (and,s, y). There is a nasal connotation vote. The soft palate sags, its mobility during the pronunciation of sounds is limited.

Speech in the paretic form of pseudobulbar dysarthria is slow, aphonic, fading, poorly modulated, salivation, hypomia and amimia of the face are pronounced. Often there is a combination of spastic and paretic forms, i.e., the presence of spastic-paretic syndrome.

Bulbar dysarthria is a symptom complex of speech-motor disorders that develop as a result of damage to the nuclei, roots or peripheral sections of the VII, IX, X and XII cranial nerves. With bulbar dysarthria, there is a peripheral paresis of the speech muscles. In children's practice highest value have unilateral selective lesions of the facial nerve with viral diseases or inflammation of the middle ear. In these cases, flaccid paralysis of the muscles of the lips, one cheek develops, which leads to disturbances and blurred articulation of labial sounds. With bilateral lesions, violations of sound pronunciation are most pronounced. The pronunciation of all labial sounds is grossly distorted by the type of their approximation to a single deaf fricative labial-labial sound. All occlusive consonants also approach fricative consonants, and the anterior lingual consonants approach a single deaf flat-slit sound, voiced consonants are stunned. These pronunciation disorders are accompanied by nasalization.

The distinction between bulbar dysarthria and paretic pseudobulbar is carried out mainly according to the following criteria:

The nature of paresis or paralysis of the speech muscles (with bulbar - peripheral, with pseudobulbar - central);

The nature of the violation of speech motility (with bulbar, voluntary and involuntary movements are violated, with pseudobulbar - mainly arbitrary);

The nature of the lesion of articulatory motility (with bulbar dysarthria - diffuse, with pseudobulbar - selective with a violation of fine differentiated articulatory movements);

The specificity of sound pronunciation disorders (with bulbar dysarthria, the articulation of vowels approaches a neutral sound, with pseudobulbar dysarthria - it is pushed back; with bulbar - vowels and voiced consonants are stunned, with pseudobulbar - along with stunning consonants, their voicing is observed);

With pseudobulbar dysarthria, even with the predominance of the paretic variant, elements of spasticity are noted in individual muscle groups.

Extrapyramidal dysarthria. The extrapyramidal system automatically creates the background of pre-readiness, on which it is possible to carry out fast, precise and differentiated movements. It is essential in the regulation of muscle tone, consistency, strength and motor function. muscle contractions, provides automated, emotionally expressive performance of motor acts.

Violations of sound pronunciation in extrapyramidal dysarthria are determined by:

Changes in muscle tone in the speech muscles;

The presence of violent movements (hyperkinesis);

Disorders of propceptive afferentation from the speech muscles;

Violations of the emotional-motor innervation. The range of motion in the muscles of the articulatory apparatus with extrapyramidal dysarthria, in contrast to pseudobulbar, may be sufficient. The child experiences particular difficulties in maintaining and feeling the articulatory posture, which is associated with constantly changing muscle tone and violent movements. Therefore, with extrapyramidal dysarthria, kinesthetic dyspraxia is often observed. In a calm state, slight fluctuations in muscle tone (dystonia) or some decrease in it (hypotension) can be noted in the speech muscles; when trying to speak in a state of excitement, emotional stress, sharp increases in muscle tone and violent movements are observed. The tongue gathers in a lump, pulls up to the root, sharply strains. An increase in tone in the muscles of the vocal apparatus and in the respiratory muscles eliminates the arbitrary connection of the voice, and the child cannot utter a single sound.

With less pronounced violations of muscle tone, speech is blurry, slurred, voice with a nasal tinge, the prosodic side of speech, its intonational-melodic structure, tempo are sharply disturbed. Emotional nuances in speech are not expressed, speech is monotonous, monotonous, unmodulated. There is an attenuation of the voice, turning into an indistinct muttering.

A feature of extrapyramidal dysarthria is the absence of stable and uniform disturbances in sound pronunciation, as well as great difficulty in automating sounds.

Extrapyramidal dysarthria is often combined with hearing impairments of the type of sensorineural hearing loss, while hearing in high tones primarily suffers.

Cerebellar dysarthria. With this form of dysarthria, the cerebellum and its connections with other parts of the central nervous system, as well as the fronto-cerebellar pathways, are affected.

Speech in cerebellar dysarthria is slow, jerky, chanted, with impaired modulation of stress, attenuation of the voice towards the end of the phrase. There is a decreased tone in the muscles of the tongue and lips, the tongue is thin, flattened in the oral cavity, its mobility is limited, the pace of movements is slowed down, it is difficult to maintain articulation patterns and weakness of their sensations, the soft palate sags, chewing is weakened, facial expressions are sluggish. The movements of the tongue are inaccurate, with manifestations of hyper- or hypometry (redundancy or insufficiency of the volume of movement). With more subtle purposeful movements, a slight trembling of the tongue is noted. Nasalization of most sounds is pronounced.

Differential diagnosis of dysarthria is carried out in two directions: the delimitation of dysarthria from dyslalia and from alalia.

Delimitation from dyslalia carried out on the basis of three leading syndromes(syndromes of articulatory, respiratory and vocal disorders), the presence of not only impaired sound pronunciation, but also disorders of the prosodic side of speech, specific disorders of sound pronunciation with the difficulty of automating most sounds, as well as taking into account the data of a neurological examination (the presence of signs of an organic lesion of the central nervous system) and anamnesis features ( indications of the presence of perinatal pathology, features of pre-speech development, screaming, vocal reactions, sucking, swallowing, chewing, etc.

Delimitation from alalia is carried out on the basis of the absence of primary violations of language operations, which is manifested in the features of the development of the lexical and grammatical side of speech.

Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998. - 680 p.

bulbar form

Etiology: damage to the nuclei of the cranial nerves: glossopharyngeal IX, vagus X and hypoglossal XII.
Pathogenesis: violations of the type of peripheral flaccid paralysis. There is hypotension or atony.
Symptoms: slurred, slurred speech.
1) Paresis of the vocal folds. Paresis of the muscles of the soft palate does not allow the use of the oral resonator.
Deaf or semi-voiced variants predominate, sonoras are replaced by deaf ones (for example, rama - tata). Speech is extremely slurred and incomprehensible. Vowels take on a noisy tone (with an "X" overtone). All oral sounds are nasalized (for example, daughter-hoh). The opposition on the basis of "oral - nasal" is erased.
2) Paresis of the muscles of articulation.
The tongue lies at the bottom of the oral cavity and hardly participates in articulation. Some individual words are replaced by a pharyngeal exhalation (kot-hoh). There is a phenomenon of assimilation of speech sounds to a system of phonemes of another language. A symptom of loss of articulation (for example, baba-papa-fafa-haha).
3) Paresis of the respiratory muscles.
Reduced subglottic pressure on the vocal folds
There is no clear coordination of inhalation and exhalation at the time of speech. Inhalation is shallow, superficial, sluggish, equal to exhalation; a long air jet is not formed. The voice fades towards the end of the sentence. The phenomenon of hypotension is observed: the voice sounds weak, quiet, intonationally inexpressive.

Correction: speech therapy is carried out against the background of the treatment of bulbar syndrome using existing drug and non-drug methods of exposure. Attention is paid to the development of the accuracy of articulatory movements, proprioceptive sensations in the speech muscles through passive-active gymnastics of the articulatory muscles. To develop sufficient muscle strength, resistance exercises are used.

Pseudobulbar form

Etiology: damage to the corticonuclear pathway at any site.
Pathogenesis: central spastic paralysis. Disinhibition of segmental apparatuses of the medulla oblongata and spinal cord.
Symptoms: Spasticity, increased muscle tone (hypertonicity), in which the tone of the flexors in the arms increases, and that of the extensors in the legs. Hyperreflexia. There are pathological reflexes of early development (sucking, plantar, proboscis). There is a violation of fine differentiated movements of the fingers. The tongue is pulled up to the pharynx, upward movements are grossly violated. Various synkinesis are present. Increased salivation. The articulation of all complex anterior lingual sounds (slotted, whistling - slotted labials "V", "F"), hard - soft, explosive - slotted are disturbed. The volume and functioning of the vocal folds decreases: the voice is rough, hoarse, sharp with a hint of rhinophony. There are no voluntary movements in general motor skills, involuntary ones are preserved.

Correction: speech therapy should begin from the first months of life: the development of swallowing, sucking, chewing skills; the development of proprioceptive sensations in the speech muscles through passive-active gymnastics of the articulatory muscles; the development of the respiratory function; the education of voice activity.
In the future, the education of speech kinesthesia is carried out, the development of a kinesthetic trace image in the speech muscles and in the muscles of the fingers.
All speech therapy is carried out against the background of drug treatment.
Preliminary decrease in muscle tone in the speech and skeletal muscles through the selection of special postures and positions for speech therapy work.

Cerebellar form

Etiology: damage to the cerebellum and its connections.
Pathogenesis: hypotension and paresis of the articulatory muscles, ataxia with hypermetria.
Symptoms: Difficulties in reproducing and maintaining certain articulation patterns. Pronounced asynchrony (the process of coordination of breathing, phonation, articulation is disturbed). Speech is slow, scanned. There is a great exhaustion of speech; modulation, duration of sound, intonational expressiveness are broken. Lips and tongue are hypotonic, their mobility is limited, soft. the palate sags passively, chewing is weakened, facial expressions are sluggish. The pronunciation of front-lingual, labial and explosive sounds suffers. There may be open nasality.

Correction: it is important to develop the accuracy of articulatory movements and their sensations, to develop the intonational-rhythmic and melodic aspects of speech, to work on the synchronization of the processes of articulation, breathing and voice formation.

Subcortical (extrapyramidal) form

Etiology: damage to the extrapyramidal system.

1. Pathogenesis: violation of muscle tone by the type of dystonia. When the pallidar system is damaged, parkinsonism is observed: motor acts are disturbed by the type of hypofunctions. Violations are manifested in all motor skills, including articulation.
Symptoms: Violated respiratory rhythm, coordination between breathing, phonation and articulation.
Movements are slow, poor, inexpressive with fading in an uncomfortable position. "Pose of the old man" - shuffling gait, arms bent at the elbows, head and chest. Facial expressions are poor, fine motor skills are not formed. articulation is weak.

2. Pathogenesis: in case of violations of the striatal system, motor skills are disturbed according to the type of hyperkinesis
Symptoms: 1) choreic hyperkinesis: movements are uncoordinated, involuntary, twitching, dancing in nature;
2) athetoid hyperkinesis: violent, slow, worm-like movements in the hands and toes; 3) choreoathetoid hyperkinesis: torsion spasm, spastic torticollis, hemiballismus, facial hemispasm, tremor, tics.
Speech is broken; some syllables are stretched while others are swallowed; broken tempo, modulation, expressiveness.

Correction: All speech classes are carried out against the background of pathogenetic and symptomatic drug therapy. The use of reflex - forbidding positions. Development of voluntary movements in articulation, phonation, respiratory and skeletal muscles. Education of the possibility of movements in a certain rhythm and pace, arbitrary cessation of movements and switching from one movement to another. Rhythmic, voluntary breathing is developed. Certain rhythmic stimuli are used: auditory - music, metronome beats, counting, visual - rhythmic waving of the hands of a speech therapist and then the child himself. An important role belongs to singing and logorhythmics. Use special breathing games-exercises, inflation soap bubbles, blowing out the candles, playing on the lips. music instruments (pipes, harmonicas, pipes). Development of articulation and phonation. Development of static-dynamic sensations, clear articulatory kinesthesias. Collective speech game therapy is carried out. Separate elements of autogenic training are applied.

Cortical form

With efferent form
Etiology: the lesion is localized in the region of the anterior central gyrus.
Pathogenesis: the innervation of the articulatory muscles suffers.

With afferent form
Etiology: the presence of a lesion in the retrocentral areas of the cerebral cortex.
Pathogenesis: kinesthetic apraxia in the speech muscles and fingers.

Symptoms: sounds suffer, pronunciation cat. associated with the most subtle isolated movements of individual muscle gr. lang. (r, l, etc.) No salivation, no voice and breathing disorders.

Correction: against the background of drug therapy, the development of fine differentiated articulation movements, kinesthetic sensations, oral and manual praxis is performed.

Seek advice from a speech pathologist

Oksana Makerova
dysarthria

dysarthria- violation of the sound-producing side of speech, due to organic insufficiency of the innervation of the speech apparatus.

The term "dysarthria" is derived from the Greek words arthson, articulation, and dys, a 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, 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 the neurologist does not see obvious disturbances in the function of the cranial nerves, he cannot call the speech disorder dysarthria. This question is almost a stumbling block between neurologists and speech therapists. This is due to the fact that after the diagnosis of "dysarthria" is made, the neurologist is obliged to carry out serious therapy for the treatment of stem disorders, although such disorders (excluding dysarthria) do not seem to be noticeable.

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

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

These disorders manifest themselves 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 violation, on the time of occurrence of the defect. Disorders of articulation and phonation, which impede and sometimes completely prevent articulate sonorous speech, constitute the so-called primary defect, which can lead to secondary manifestations that complicate its structure. Clinical, psychological and speech therapy study of children with dysarthria shows that this category of children is very heterogeneous in terms of motor, mental and speech disorders.

Causes of dysarthria
1. Organic lesions of the central nervous system as a result of the impact of various adverse factors on the developing brain of a child in the prenatal and early periods of development. Most often, these are intrauterine lesions resulting from acute, chronic infections, oxygen deficiency (hypoxia), intoxication, toxicosis of pregnancy 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 the child, the child is born prematurely.

2. The cause of dysarthria may be the incompatibility of the Rh factor.

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 suffering from cerebral palsy (CP). According to E. M. Mastyukova, dysarthria in cerebral palsy manifests itself in 65-85% of cases.

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

Forms of dysarthria
Bulbar dysarthria (from lat. bulbus - a bulb, the shape of which has a medulla oblongata) manifests itself with a disease (inflammation) or a tumor of the medulla oblongata. At the same time, the nuclei of the motor cranial nerves located there (glossopharyngeal, vagus and hypoglossal, sometimes trigeminal and facial) are destroyed.
Characteristic is paralysis or paresis of the muscles of the pharynx, larynx, tongue, soft palate. In a child with a similar defect, swallowing of solid and liquid food is disturbed, chewing is difficult. Insufficient mobility of the vocal folds, the 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 the 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 slurred, extremely indistinct, slow. The face of a child with boulevard dysarthria is amimic.

Subcortical dysarthria occurs when the subcortical nodes of the brain are damaged. 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) that are not controlled by the child. These movements can be observed at rest, but usually increase during a speech act.
The changing nature of muscle tone (from normal to increased) and the presence of hyperkinesis cause peculiar disturbances in 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 unable to utter a single sound. There is an articulatory spasm, the tongue becomes tense, the voice is interrupted. Sometimes involuntary cries are observed, guttural (pharyngeal) sounds "break through". Children can pronounce words and phrases too quickly or, conversely, monotonously, with long pauses between words. The intelligibility of speech suffers due to the uneven switching of articulatory movements when pronouncing sounds, as well as due to a violation of the timbre and strength of the voice.
A characteristic sign of subcortical dysarthria is a violation of the prosodic side of speech - tempo, rhythm and intonation. The combination of impaired articulatory motility with impaired voice formation, speech breathing leads to specific defects in the sound side of speech, which manifests itself variably depending on the state of the child, and is mainly reflected in the communicative function of speech.
Sometimes, with subcortical dysarthria, children experience hearing loss, complicating a speech defect.

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

Cortical dysarthria presents great difficulties for isolation and recognition. With this form, arbitrary motility of the articulation apparatus is disturbed. According to 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-syllabic structure is disturbed. In children, the dynamics of switching from one sound to another, from one articulatory position to another, is difficult. Children are able to clearly pronounce isolated sounds, but sounds are distorted in the speech stream, substitutions occur. Consonant combinations are especially difficult. At an accelerated pace, hesitation appears, reminiscent of stuttering.
However, unlike children with motor alalia, in children with this form of dysarthria there are no disturbances in the development of the lexico-grammatical side of speech. Cortical dysarthria should also be distinguished from dyslalia. Children have difficulty reproducing the articulatory position, making it difficult for them to move from one sound to another. During correction, attention is drawn to the fact that defective sounds are quickly corrected in isolated utterances, but are hardly automated in speech.

Erased form
I especially want to highlight the erased (mild) 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. A thorough speech therapy examination and observation reveals a number of specific disorders in them (disturbances in the motor sphere, spatial gnosis, the phonetic side of speech (in particular, the prosodic characteristics of speech), phonation, breathing, and others), which allows us to conclude that there are organic lesions of the central nervous system.

Experience in 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. Considering the prevalence of this speech disorder among preschool children, it can be concluded that a very urgent problem is now ripe - the problem of providing qualified speech therapy assistance to children with an erased form of dysarthria.

Mild (erased) forms of dysarthria can be observed in children without obvious motor disorders who have undergone the impact of various adverse factors during the prenatal, natal and early postnatal periods of development. Among these adverse 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 fetus;
- mild 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, frequent, causeless crying are noted. Feeding such children has a number of features: there is difficulty in holding the nipple, fast fatiguability when suckling, babies refuse the breast early, spit up often and profusely. In the future, they are poorly accustomed to complementary foods, they are reluctant to try new food. At dinner, such a child sits for a long time with a full mouth, chews poorly and swallows food reluctantly, hence frequent choking during meals. Parents of children with mild forms of dysarthria 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 anamnesis of children with an erased form of dysarthria is aggravated. Most of the children under 1-2 years of age were observed by a neurologist, later this diagnosis was removed.

Early speech development in a significant proportion of children with mild manifestations of dysarthria is slightly slowed down. The first words appear by the age of 1, phrasal speech is formed by 2-3 years. At the same time, for quite 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, there are often children with impaired sound pronunciation, who, in the conclusion of a neuropathologist, have data on the absence of focal microsymptoms in the neurological status. However, the correction of speech disorders in such children by conventional methods and techniques does not bring effective results. Therefore, 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 with the use of functional loads reveals mild microsymptoms of an organic lesion of the nervous system. These symptoms manifest themselves as 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 in the range of motion of the upper and lower extremities, with a functional load, friendly movements (syncenesia), 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 insufficiency of general motor skills is manifested in preschoolers with this disorder when performing complex movements that require precise control of movements, precise work various muscle groups, the correct spatial organization of movements. For example, a child with an erased form of dysarthria, somewhat later than his peers, begins to grab and hold objects, sit, walk, jump on one or two legs, clumsily runs, climbs on the Swedish wall. At middle and senior preschool age, a child cannot learn to ride a bicycle, ski and skate for a long time.

In children with an erased form of dysarthria, there are also violations of fine motor skills of the fingers, 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, slow inclusion in movement, and insufficient coordination. Finger tests are performed incompletely, significant difficulties are observed. These features are manifested in the play and learning activities of the child. A preschooler with mild manifestations of dysarthria is reluctant to draw, sculpt, or clumsily 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. Speech motility disorders in preschool children with this type of speech pathology are due to the organic nature of the damage to the nervous system and depend on the nature and degree of impaired functioning of the motor nerves that provide the process of articulation. It is the mosaic nature of the lesions of the motor conducting cortical-nuclear pathways that determines the great combination of speech disorders in the erased form of dysarthria, the correction of which requires the speech therapist to carefully and detailed develop an individual plan for speech therapy work with such a child. And of course, such work seems impossible without the support and close cooperation with parents interested in correcting their child's speech disorders.

Pseudobulbar dysarthria is the most common form of childhood dysarthria. Pseudobulbar dysarthria is the result of early childhood, during childbirth or in the prenatal period of organic brain damage as a result of encephalitis, birth trauma, tumors, intoxication, etc. The child develops pseudobulbar paralysis or paresis, caused by damage to the pathways leading from the cerebral cortex to the nuclei of the glossopharyngeal, vagus and hypoglossal nerves. By clinical manifestations violations in the field of mimic and articulatory muscles, it is close to bulbar. However, the possibilities of correction and full mastery of the sound-producing side of speech with pseudobulbar dysarthria are much higher.
As a result of pseudobulbar paralysis, the child's general and speech motility is disturbed. The baby sucks badly, chokes, chokes, swallows badly. Saliva flows from the mouth, the muscles of the face are disturbed.

The degree of violation of speech or articulatory motility may be different. Conventionally, there are three degrees of pseudobulbar dysarthria: 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 in articulation consist in slow, insufficiently precise "movements of the tongue, lips. Chewing and swallowing disorders are detected dimly, in rare choking. Pronunciation in such children is impaired due to insufficiently clear articulatory motor skills, speech is somewhat slow, blurring is characteristic when pronouncing sounds. Pronunciation of complex sounds is more likely to suffer according to the articulation of sounds: w, w, p, c, h. Voiced sounds are pronounced with insufficient participation of the voice. Soft sounds are difficult to pronounce, requiring the addition of the rise of the middle part of the back of the tongue to the hard palate to the main articulation.
Pronunciation deficiencies have adverse effects on phonemic development. Most children with mild dysarthria experience some difficulty in sound analysis. When writing, they encounter specific errors in the replacement of sounds (t-d, ch-ts, etc.). Violation of the structure of the word is almost not observed: the same applies to the 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 such a disorder, who have normal hearing and good mental development, attend speech therapy classes in the district children's clinic, and at school age - a speech therapy center at a comprehensive school. Parents can play a significant role in eliminating this defect.

2. Children with an average degree of dysarthria are the most large group. They are characterized by amimicity: the absence of movements of the facial muscles. The child cannot puff out his cheeks, stretch out his lips, close them tightly. Language movements are limited. The child cannot lift the tip of the tongue up, turn it to the right, to the left, and keep it in this position. Switching from one movement to another is a significant difficulty. The soft palate is often inactive, the voice has a nasal tone. Profuse salivation is characteristic. Difficulty in chewing and swallowing. The consequence of dysfunction of the articulatory apparatus is a severe defect in pronunciation. The speech of such children is usually very slurred, blurry, quiet. Fuzzy articulation of vowels, usually pronounced with a strong nasal exhalation, is characteristic due to the immobility of the lips and tongue. The sounds "a" and "y" are not clear enough, the sounds "and" and "y" are usually mixed. Of the consonants, n, t, m, n, k, x are more often saved. The sounds h and c, r and l are pronounced approximately, like a nasal exhalation with an unpleasant "squishy" overtone. The exhaled oral jet 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 disorder cannot successfully study in a comprehensive 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 taken 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 droops, the mouth is constantly open. The tongue lies motionless at the bottom of the oral cavity, the movements of the lips are sharply limited. Difficulty in 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 disorders, where, thanks to special speech therapy methods, they successfully master writing skills and a program in general subjects.

A characteristic of all children with pseudobulbar dysarthria is that, with distorted pronunciation of the sounds that make up the word, they usually retain the rhythmic contour of the word, i.e., the number of syllables and stress. As a rule, they know the pronunciation of two-syllable, three-syllable words; four-syllable words are often reproduced in reflection. It is difficult for a child to pronounce consonant clusters: in this case, one consonant falls out (squirrel - "beka") or both (snake - "iya"). Due to the motor difficulty of switching from one syllable to another, there are cases of likening syllables (dishes - "posyusya", scissors - "nose").

Violation of the motor skills of the articulatory apparatus leads to improper 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, variously expressed difficulties in sound analysis are observed.

Most of the special tests that reveal the level of sound analysis are not available to dysarthric children. They cannot correctly select pictures whose names begin with a given sound, come up with a word containing a certain sound, and analyze the sound composition of a word. For example, a twelve-year-old child who studied for three years in a public school, answering the question, what sounds in the words of the regiment, cat, calls p, a, k, a; k, a, t, a. When completing the task, select pictures whose names contain the sound b, the boy puts a jar, a drum, a pillow, a scarf, a saw, a squirrel.
Children with more preserved pronunciation make fewer mistakes, for example, they select the following pictures for the sound "s": a bag, a wasp, an airplane, a ball.
Children suffering from anarthria do not have access to such forms of sound analysis.

Literacy in dysarthria
The level of proficiency in sound analysis in the vast majority of dysarthric children is insufficient for literacy. Children enrolled in mass schools are completely unable to master the program of the 1st grade.

Letter
Deviations in sound analysis are especially pronounced during auditory dictation.

I will give a sample letter from a boy who studied for three years in a public school: the house is "ladies", the fly is "muaho", the nose is "oush", the chair is "woo", the eyes are "naka", etc.

Another boy, after a year in a public school, writes instead of "Dima goes for a walk" - "Dima dapet gul ts"; "In the forest wasps" - "Lusu wasps"; "The boy feeds the cat with milk" - "Malkin lali kashko little".

The greatest number of errors in the writing of children suffering from dysarthria are in the substitution of letters. Often there are substitutions of vowels: children - "detu", teeth - "teeth", bots - "buts", bridge - "muta", etc. Inaccurate, nasal pronunciation of vowels leads to the fact that they almost do not differ in sound.

Consonant substitutions are numerous and varied:
l-r: squirrel - "berk"; x-h: fur - "sword"; b-t: duck - "ubka"; gd: beep - "pipe"; s-h: geese - "guchi"; b-p: watermelon - "arpus".

Typical cases are violations syllabic structure words due to rearrangement of letters (book - "kinga"), omission of letters (hat - "shapa"), reduction of the syllabic structure due to underwriting of syllables (dog - "soba", scissors - "knives", etc.).

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

In addition, in the writing of dysarthric children, such errors as the incorrect use of prepositions, incorrect syntactic connections of words in a sentence (agreement, control), etc. are common. These non-phonetic errors are closely related to the peculiarities of mastering oral speech, grammatical structure, vocabulary reserve.

Children's independent writing is distinguished by a poor composition of sentences, their incorrect construction, omissions of sentence members and function words. Some children are completely inaccessible to even small presentations.

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

Lexico-grammatical structure of speech of dysarthric children
As noted above, the direct result of the defeat of the articulatory apparatus are 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 vocabulary accumulation 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 similarities in sound composition, situation, etc.

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

Characteristic for 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 such objects as a swing, a well, a sideboard, a wagon; determine the profession (pilot, teacher, driver, etc.); understand the actions of the persons depicted in the picture; show objects painted in one color or another. However, the absence of speech or limited use of it leads to a discrepancy between the active and passive vocabulary.

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

The main directions of corrective work
These features of the speech development of children with dysarthria show that they need systematic special education aimed at overcoming defects in the sound side of speech, developing vocabulary and grammatical structure of speech, 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 lexical-grammatical structure of speech. Such classes are held in special preschool institutions for children with speech disorders.

Speech therapy work with children with dysarthria is based on knowledge of the structure of a speech defect in various forms of dysarthria, the mechanisms of impaired general and speech motor skills, and 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 the features 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:
phased interconnected formation of all components of speech;
a systematic approach to the analysis of a speech defect;
regulation of mental activity of children through the development of communicative and generalizing functions of speech.

In the process of systematic and in most cases long-term exercises, gradual normalization of the motor skills of the articulatory apparatus, the development of articulation movements, the formation of the ability to arbitrarily switch the movable organs of articulation from one movement to another at a given pace, overcoming monotony and speech tempo disturbances are carried out; 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. speech activity and optimal social adaptation. Great importance also has a combination of speech therapy with therapeutic measures, overcoming deviations in general motor skills.

Preschool children with dysarthria, who do not have gross deviations in the development of the musculoskeletal system, possess self-care skills and have normal hearing and full intelligence, study in special kindergartens for children with speech disorders. At school age, children with severe dysarthria study in special schools for children with severe speech disorders, 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 severe disorders of the musculoskeletal system, there are specialized kindergartens and schools in the country, where much attention is paid to therapeutic and physiotherapeutic measures.

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

Breathing exercises by A. N. Strelnikova
In speech therapy work on the speech breathing of children, adolescents and adults, the paradoxical breathing exercises of A. N. Strelnikova are widely used. Strelnikovskaya breathing gymnastics is the brainchild of our country, it was created at the turn of the 30-40s of the XX 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 inhalation through the nose is done on movements that compress the chest.

Exercises actively include all parts of the body (arms, legs, head, hip girdle, abdominals, shoulder girdle, etc.) and cause a general physiological reaction of the whole organism, an increased need for oxygen. All exercises are performed simultaneously with a short and sharp breath through the nose (with an absolutely passive exhalation), which enhances internal tissue respiration and increases the absorption of oxygen by tissues, and also irritates that vast receptor zone 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 a host of various diseases of organs and systems. It is useful for everyone and at any age.

In gymnastics, the focus is on inhalation. The breath is made very briefly, instantly, emotionally and actively. The main thing, according to A. N. Strelnikova, is to be able to hold, "hide" your breath. Don't think about breathing at all. Exhalation goes away spontaneously.

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

Rule 1 "Smell of burning! Alert!" And abruptly, noisily, throughout the apartment, sniff the air like a dog's footprint. The more natural the better. The worst mistake is to pull air in order to take in more air. The breath is short, like an injection, active and the more natural, the better. Think only about the breath. The feeling of anxiety organizes an active breath better than reasoning about it. Therefore, do not be shy, furiously, to the point of rudeness, sniff the air.

Rule 2 Exhalation is the result of inhalation. Do not prevent the exhalation from leaving after each inhalation as you like, as much as you like - but better by mouth than the nose. Don't help him. Think only: "It smells of burning! Anxiety!" And just make sure that the breath goes simultaneously with the movement. 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 savage like children play and you'll be fine. Movements create sufficient volume and depth for a short breath without much effort.

Rule 3 Repeat the breaths as if you were inflating a tire in song and dance tempo. And as you train your movements and breaths, count to 2, 4, and 8. Rate: 60-72 breaths per minute. Inhale louder than exhale. Norm of the lesson: 1000-1200 breaths, and more - 2000 breaths. Pauses between doses of breaths - 1-3 seconds.

Rule 4 Take as many breaths in a row as you can easily do at the moment. The whole complex consists of 8 exercises. First, a warm-up. Stand up straight. Hands at the seams. Legs shoulder width apart. Take short, like an injection, breaths, sniffing loudly. Do not be shy. Force the wings of the nose to connect at the moment of inhalation, and do not expand them. Train for 2, 4 breaths in a row at a walking pace of "hundred" breaths. You can do more to feel that the nostrils move and obey you. Inhale, like an injection, instantaneous. Think: "It smells of burning! Where does it come from?" To understand the gymnastics, take a step in place and simultaneously with each step - inhale. 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 stand still, you can walk around the room, you can shift from foot to foot: back and forth, back and forth, the weight of the body is either on the leg standing 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 shot, and noisy.
Having mastered the movement, raising the right leg, squat a little on the left, raising the left on the right. Get a rock and roll dance. Make sure that the movements and breaths go at the same time. Do not interfere with or help the exhalations come out after each inhalation. Repeat the breaths rhythmically and often. Make as many as you can easily.

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

Major movements.
- "Cat". Legs shoulder width apart. Remember the cat that sneaks up on the sparrow. Repeat her movements - crouching a little, turn to the right, then to the left. Transfer the weight of the body to the right leg, then to the left. The direction in which you turned. And sniff the air noisily on the right, on the left, at the pace of steps.
- "Pump". Hold a rolled-up newspaper or a stick in your hands like a pump handle and think you are inflating a car tire. Inhale - in extreme point tilt. The slope is over - the breath is over. Do not pull it, unbending, and do not unbend to the end. The tire must be quickly pumped up and go further. Repeat the breaths at the same time as the bends often, rhythmically and easily. Don't raise your head. Look down at an imaginary pump. Inhale, like an injection, instantaneous. Of all our breath 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 hugs the left armpit, that is, so that the arms go parallel to each other. pace of steps. Simultaneously with each throw, when the hands are closest together, repeat short noisy breaths. Think: "The shoulders help the air." Keep your hands away from your body. They are close. Do not bend your elbows.
- Big pendulum. This movement is continuous, similar to a pendulum: "pump" - "hug your shoulders", "pump" - "hug your shoulders". pace of steps. Tilt forward, arms reaching for the ground - inhale, lean back, arms hugging shoulders - also inhale. Forward - back, inhale, inhale, tick-tock, tick-tock, like a pendulum.
- "Half-squats". One leg in front, the other behind. Body weight on the front leg, back leg slightly touching 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 breath - short, light. Having mastered the movement, add simultaneous counter movements of the hands.

This is followed by a special training of "hidden" breathing: a short inhalation with an inclination, the breath is held as much as possible, without unbending, it is necessary to count out loud to eight, gradually the number of "eights" uttered on one exhalation increases. On one tightly held breath, you need to dial as many "eights" as possible. From the third or fourth workout, stuttering "eights" 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 "caught in a fist" and show restraint, repeating aloud the maximum number of eights on a tightly held breath. Of course, the "eights" in each workout is preceded by the entire complex of the exercises listed above.

Exercises for the development of speech breathing
In speech therapy practice, the following exercises are recommended.

Choose a comfortable position (lying, sitting, standing), put one hand on your stomach, the other on the side of the lower part chest. Take a deep breath through your nose (this will push your belly forward and expand Bottom part chest, which is controlled by both hands). After inhalation, immediately make a free, smooth exhalation (the abdomen and lower chest take their previous position).

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

Take a short breath with your mouth open and on a smooth, long exhalation, say one of the vowels (a, o, u, and, uh, s).

Say 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. Watch for smooth exhalation. Count down (ten, nine, eight...).

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

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

The acquired skills can and should be consolidated and comprehensively applied in practice.

* "Whose steamboat hums better?"
Take a glass vial about 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 steamboat. Can you make a steamboat? I wonder whose steamboat will hum louder, yours or mine? And whose longer?" It should be remembered: for the bubble to buzz, underlip should lightly touch the edge of his neck. The air jet should be strong and come out in the middle. Just do not blow too long (more than 2-3 seconds), otherwise you will feel dizzy.

* "Captains".
Dip paper boats into a basin of water and invite your child to take a boat ride 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 comes up - the lips fold, as for the sound p.

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

The tasks become more difficult gradually: first, training of a long speech exhalation is carried out on individual sounds, then on words, then on a short phrase, when 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 being uttered.

Treatment
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 continue the course of treatment on an outpatient basis. General strengthening physiotherapy, massage, exercise therapy, breathing exercises. This reduces the time to reach the maximum effect and makes it more stable.

Treatment of dysarthria 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 increase? The reasons for this are the lack of therapeutic efficacy of pharmaceuticals. funds, an increase in the number of drug-allergic people, a huge number (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 the biologically active substances (BAS) of the secretion salivary glands(SSZh). The secret of the salivary glands of a leech contains a set of compounds of protein (peptide), lipid and carbohydrate nature. Reports by 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 leeches FSF (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 SSZh: hirudin, a histamine-like substance, prostacyclins, prostaglandins, hyaluronidase, lipase, apyrase, collogenase, calin and saratin - platelet adhesion inhibitors, platelet activating factor inhibitor, destabilase, destabilase-lysozyme (detobilase - L), bdellin-trypsin inhibitors and plasmin, eglins - inhibitors of chymotryptosin, subtilisin, elastase and cathepsin G, neurotrophic factors, blood plasma kallikrein inhibitor. 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 SF. One of the elements contained in saliva MP is hyaluronidase. It is believed that with the help of this substance, toxic (endo - or exogenous origin) products are removed from the matrix space (Pishinger's space), which have not undergone metabolic transformations, which allow them to be removed from the MP body with the help of excretory organs. They can cause MPs to vomit or die.

Neurotrophic factors (NTF) MP. This aspect is associated with the effect of SSF on nerve endings and neurons. For the first time this problem was raised in our research. The idea arose as a result of the results of the treatment of children with cerebral palsy, and with myopathy. Patients showed significant positive changes in the treatment of spastic skeletal muscle tension. A child who before treatment could only walk on all fours could move 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 differentiation nerve cells and are responsible for the growth of their processes. NTF play an important role not only in the processes embryonic development nervous system, but also in the adult body. They are necessary to maintain the viability 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, after the addition of drugs that stimulate the growth of neurites to the nutrient medium compared to control explants.

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

Data on the high neuritis-stimulating activity of the components of the SSF (the secretion of the salivary glands) explain the specific effectiveness 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 drugs for a wide range of neurodegenerative diseases.

So, BAS produced by MP provide biological effects known to date:
1. thrombolytic action,
2. hypotensive action,
3. reparative effect on the damaged wall of the blood vessel,
4. anti-atherogenic effect of biologically active substances actively influence the processes of lipid metabolism, leading it to normal conditions functioning; reduce 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 human and animal immune system,
7. neurotrophic action.

To specific technical means include: Derazhnya proofreader, apparatus "Echo" (AIR), sound amplification apparatus, tape recorder.

The Derazhnya apparatus (as well as Barany's ratchet) is built on the effect of sound deadening. Noises of varying strength (in a corrective phone it is adjusted with a special screw) are 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 apparatus "Echo", designed by B. Adamchik, consists of two tape recorders with a prefix. The recorded sound plays back after a fraction of a second, creating an echo effect. Domestic designers have created a portable apparatus "Echo" (AIR) for individual use.

A peculiar apparatus was proposed by V. A. Razdolsky. The principle of its operation is based on the sound amplification of speech through loudspeakers or air telephones to the hearing aid "Crystal". Perceiving their speech sound-reinforced, dysarthria tense their speech muscles less, more often they 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 dampening, 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 trust in a speech therapist grows. At the first tape lessons, the material for the performance is selected and carefully rehearsed.

Learning tape lessons contribute to the development of correct speech skills. The purpose of these classes is to draw the patient's attention to the pace and fluency of his speech, sonority, expressiveness, grammatical correctness of the phrase. After preliminary conversations about the qualities of correct speech, listening to the appropriate speech samples, after repeated rehearsals, the dysarthria performs in front of a microphone with his text, depending on the stage of the lesson. The task is to monitor and control one's behavior, pace, fluency, sonority of speech, and avoid grammatical errors in it. The leader records in his notebook the state of speech and the behavior of the patient at the moment of speaking in front of the microphone. Having finished the speech, the dysarthria himself evaluates his speech (he spoke softly - loudly, quickly - slowly, expressively - monotonously, etc.). Then, after listening to the speech recorded on the tape, the patient evaluates it again. After that, the speech therapist analyzes the speech of the stutterer, his ability to give a correct assessment of his speech, highlights the positive in his speech, in his behavior in the classroom, and sums up.

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

Defectologist's advice
At corrective work with dysarthria, the formation of spatial thinking is important.

Formation of spatial representations
Knowledge about space, spatial orientation develop in a variety of activities of children: in games, observations, labor processes in drawing and design.

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, in half), length (long, short, wide, narrow, high, left, right, horizontal, straight, oblique), position in space and spatial connection (in the middle, above the middle, below the middle, right, left, side, closer, farther, front, back, behind, in front).

Mastering the indicated knowledge about space implies: the ability to identify and distinguish spatial features, correctly name them and include adequate verbal designations in expressive speech, navigate in spatial relationships when performing various operations associated with active actions.

The usefulness of mastering knowledge about space, the ability to spatial orientation is provided by the interaction of motor-kinesthetic, visual and auditory analyzers in the course of performing various kinds activities of the child aimed at active knowledge of the surrounding reality.

The development of spatial orientation and the idea of space occurs in close connection with the formation of a sense of the scheme of one's body, with the expansion of children's practical experience, with a change in the structure of object-game 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. Mastering knowledge about space involves the ability to identify and distinguish spatial features and relationships, the ability to correctly designate them verbally, to navigate in spatial relationships when performing various labor operations based on spatial representations. An important role in the development of spatial perception is played by design and modeling, the inclusion of verbal designations adequate to the actions of children in expressive speech.

Methods for the study of spatial thinking in younger 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-play action on the differentiation of spatial relations.

Assimilation of orientations from left to right.

Poem by V. Berestov.

A man was standing at a fork in the road.
Where is the right, where is the left - he could not understand.
But suddenly the student scratched his head
With the same hand that he wrote
And he threw the ball, and flipped through the pages,
And he held a spoon, and swept the floor,
"Victory!" - there was a jubilant cry:
Where is the right, where the left was recognized by the student.

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

We march bravely in the ranks.
We know science.
We know the left, we know the right.
And, of course, around.
This is the right hand.
Oh, science is not easy!

"The Steadfast Tin Soldier"

Stay on one leg
Like you're a solid soldier.
Left leg - to the chest,
Look, don't fall.
Now stay on the left
If you are a brave soldier.

Refinement of spatial relationships:
* standing in a line, name the one standing on the right, on the left;
* according to the instructions, place objects to the left and right of this one;
* determine the place of a neighbor in relation to himself;
* determine your place in relation to a neighbor, focusing on the corresponding hand of a neighbor ("I am standing to the right of Zhenya, and Zhenya is to my left.");
* standing in pairs facing each other, determine first at oneself, then at a friend, the left hand, the right hand, etc.

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

"Trace it."
Prints of hands and feet are drawn on the sheet in different directions. It is necessary to determine which hand, foot (left or right) this print is from.

Determine by storyline, in which hand the characters in the picture have the called object.

Understanding the concepts Left-hand side sheet - the right side of the sheet.

Coloring or drawing according to the instructions, for example: "Find the small triangle drawn on the left side of the sheet, color it red. Find the most big triangle, among those 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 at a blouse, a shirt, a pocket at jeans. Products are in a different position in relation to the child.

Assimilation of 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, in front of, in, from.
Introduction: Once resourceful, smart, agile, 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 like:
Where is the kitten hiding?
- Where did he jump from? etc.

TASK #2

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

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

Show the actions that are described in the poem.
I will help my mother
I will clean everywhere
And under the closet
and behind the closet
and in the closet
and on the closet.
I don't 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 study 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 is mentioned in the fairy tale.
Animals live in the 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 where to put it. Leo suggested building in the lower left corner. The wolf wanted the school to be in the upper right corner. The fox insisted on building a school in the upper left corner, next to her hole. A squirrel intervened in the conversation. She said: "The school should 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 clearing (blue oval), an anthill (gray triangle).

“Winter lived in a hut at the edge of the forest. Her hut stood in the upper right corner. Once Winter woke up early, washed herself white, dressed warmer and went to look at her forest. She walked along the right side. When she reached the lower right corner, I saw a small Christmas tree, Winter waved her right sleeve and covered the Christmas tree with snow.
Winter turned to the middle of the forest. There was a big field here.
Winter waved her hands and covered the entire clearing with snow.
Winter turned to the lower left corner and saw an anthill.
Winter waved her left sleeve and covered the anthill with snow.
Winter went up: she 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.

"A tree grew in the yard. A bird was sitting near the tree. Then the bird flew and sat on the tree, upstairs. A 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 (IN Sadovnikova).

Four points are given, put a "+" sign from the first point from the bottom, from the second - from above, 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.

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

Assimilation of prepositions that have spatial significance.

1. Perform various actions according to the instructions. Answer the questions.
- Put the pencil on the book. Where is the pencil?
- Take a pencil. Where did you get the pencil from?
- Put the pencil in the book. Where is he now?
- Take it. Where did you get the pencil from?
- Hide the pencil under the book. Where is he?
- Take out the pencil. Where was it taken 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, ahead, behind, etc.).

3. Arrangement of geometric shapes according to this instruction: "Put a red circle on a large blue square. Put a green circle above the red circle. An orange triangle in front of the green circle, etc."

4. "What word is missing?"
The river overflowed its banks. Children run class. The path went across the field. Green onions in the garden. We got to the city. The ladder was leaned against the wall.

5. "What's mixed up?"
Grandfather in the oven, firewood on the stove.
Boots on the table, cakes under the table.
Sheep in the river, carp by the river.
Under the table is a portrait, above the table is a stool.

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

7. "Signals".
a) To the picture, select a card-scheme of the corresponding preposition.
b) An adult reads sentences, texts. Children show cards-schemes with the necessary prepositions.
c) An adult reads sentences, texts, skipping prepositions. Children show flashcards of the missing prepositions.
b) The child is invited to compare groups of geometric shapes of the same color and shape, but different size. Compare groups of geometric shapes of the same color and size, but different shapes.
c) "Which figure is superfluous." Comparison is carried out according to external features: size, color, shape, changes in details.
d) "Find two identical figures." The child is offered 4-6 items that differ in one or two features. He must find two identical objects. The child can find the same numbers, letters written in the same font, the same geometric shapes, and so on.
e) "Choose a suitable toy box." The child must match the size of the toy and the box.
e) "On which site the rocket will land." The child correlates the shape of the base of the rocket and the landing pad.

TASK #3

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

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

2. Draw figures by reference 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 the sides of the sheet;
B) draw straight lines from the middle of the sheet in different directions;
B) outline the outline of the drawing;
D) reproduce a drawing of greater complexity than the one proposed in the main task.

4. Tracing templates, stencils, tracing contours along a thin line, hatching, dots, shading and hatching along various lines.

Kern-Jirasek technique.
When using the Kern-Jirasek technique (includes two tasks - drawing written letters and drawing a group of dots, i.e. work according to a model), the child is given sheets of paper with presented examples of tasks. 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 the development of the child. Tasks for drawing written letters and drawing a group of dots reveal the ability of the children to reproduce the pattern. It also allows you to determine whether the child can work for some time with concentration, without distractions.

Method "House" (N. I. Gutkina).
The technique is a task for drawing a picture depicting a house, the individual details of which are made up of capital letters. The task allows you to identify the child's ability to focus on a sample in his work, 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.
Instruction to the subject: "There is a sheet of paper and a pencil in front of you. On this sheet, I ask you to draw exactly the same picture that you see in this picture (the sheet with the "House" is placed in front of the subject). Take your time, be careful, try to the drawing was exactly the same as this one on the sample. If you draw something wrong, then you can’t erase anything with an elastic band or your finger, but you need to draw it right on top of the wrong one or next to it. 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 respected: an increase in individual details of the drawing while maintaining a relatively arbitrary size of the entire drawing;
c) incorrect depiction of drawing elements;
e) deviation of lines from a given direction;
f) gaps between lines at junctions;
g) climbing lines one on top of the other.

"Draw mouse tails" and "Draw umbrella handles" by A. L. Wenger.
Both mouse tails and pens are also letter elements.

Graphic dictation and "Sample and Rule" by D. B. Elkonin - A. L. Wenger.
Performing the first task, the child draws an ornament on a piece of paper in a box from the pre-set points, following the instructions of the leader. The facilitator dictates to a group of children in which direction and how many cells the lines need to be drawn, and then offers to draw the “pattern” obtained from dictation 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 visually perceived pattern.
A more complex technique "Pattern and rule" involves the simultaneous following in your work to the pattern (the task is given to draw exactly the same pattern as the given geometric figure point by point) and the 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). The 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 referring to the model. Thus, the methodology reveals the level of orientation of the child to a complex system of requirements.

"The car is driving along the road" (A. L. Wenger).
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, and a house at the other. The car should drive along the path 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 come up with many similar games. Can be used for training and passing the simplest labyrinths

"Hit the circles with a pencil" (A. E. Simanovsky).
The sheet shows rows of circles with a diameter of about 3 mm. 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-option: in the first line the direction of movement is from left to right, in the second line - from right to left.
II-option: in the first column the direction of movement is from top to bottom, in the second column - from bottom to top, etc.

TASK №4

Target:
1. Fold the figures from the sticks according to the pattern given in the figure.
2. Add geometric shapes from four parts - a circle and a square. In case of difficulty, perform this task in stages:
A) Make a figure of two then three and four parts;
B) Fold a circle and a square according to the pattern of the drawing with the constituent parts dotted on it;
C) Fold the figures by superimposing on the dotted drawing of the part, 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 out on the board.

"Find a shape in an object and put the object together."
In front of the baby, contour images of objects made up of geometric shapes. The child has an envelope with geometric shapes. It is necessary to add 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 drawn objects.

"The letter is broken."
The child must recognize the entire letter from any part.

"Fold a square" (B. P. Nikitin).
Equipment: 24 multi-colored paper squares 80x80 mm in size, cut into pieces, 24 samples.
You can start the game with simple tasks: "Make a square out of these parts. Look carefully at the sample. Think about how to arrange the parts of the square. Try to put them on the sample." Then the children independently select the parts by color and assemble the squares.

Montessori frames and inserts.
The game is a set of square frames, plates with cut out holes, which are closed with a lid-liner of the same shape and size, but of a different color. The lids and slits are round, square, equilateral triangle, ellipse, rectangle, rhombus, trapezoid, quadrilateral, parallelogram, isosceles triangle, regular hexagon, five pointed star, right isosceles triangle, regular pentagon, irregular hexagon, scalene triangle.
The child picks up the liners to the frames, circles the liners or slots, inserts the liners into the frames by touch.

"Mailbox".
Mailbox - 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 subject pictures. The host takes out 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 like "Lotto".
Option II: children have colored flags (flags depicting geometric shapes). The host shows the item, and the children show the corresponding flags.

"Collect according to the form."
The child has a card of a certain form. He selects the appropriate items shown in the pictures for her.

Games "What form is gone?" and "What has changed?".
Geometric figures of different shapes are put 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 circles from smallest to largest.
- Build nesting dolls by height: from the tallest to the shortest.
- Put the narrowest strip on the left, next to the right put a strip a little wider, etc.
- Color the tall tree with a yellow pencil and the low one with red.
- Circle the fat mouse, and circle the thin mouse.
And so on.

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

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

In recent years, various types of dysarthria are increasingly observed in children of different ages. This diagnosis is very common, however, it frightens many parents. It manifests itself in the form of dysfunctions during sound pronunciation due to insufficient communication between tissues and cells and nerve endings. In addition, insufficient lability of facial expressions and other organs of speech are common symptoms of various types of dysarthria. Such restrictions significantly impede full articulation.

Why is this happening

Causes of delayed speech development can be different factors, therefore, at the first signs of the development of this defect, it is necessary to contact narrow-profile specialists and begin appropriate treatment.

In most cases, dysarthria, as a type of speech development disorder, occurs against the background of cerebral palsy and has the same causes of development. Lesions in the central nervous system occur at different stages of embryonic development, during childbirth or in the early stages of child development.

CNS lesions and development of the speech apparatus in children

The main factors for the development of various types of dysarthria in children are complications during pregnancy: toxicosis, threats of miscarriage, chronic pathologies in the mother, pathologies during pregnancy, fetal hypoxia or birth asphyxia and other undesirable conditions.

The severity of articulation disorders is directly related to the degree of impairment of motor functions in cerebral palsy. So, for example, with hemiplegia, dysarthria or anartria is diagnosed in almost all patients.

The causes of the development of various types of dysarthria in cerebral palsy can be infectious diseases, intoxications and injuries during pregnancy or a conflict between the Rh factors of the mother and fetus, as well as CNS lesions in early childhood that occur after neuroinfections, purulent otitis media, hydrocephalus, craniocerebral injuries and intoxications.

Speech disorders in adults

Various types of dysarthria in adults can appear after the development of a stroke, brain injury, surgery, and neoplasms in the brain. Speech disorders can occur in patients with some forms of sclerosis, myasthenia gravis or syringobulbia. Dysarthria is common in Parkinson's disease, myotonia, neurosyphilis, and mental retardation.

Types of speech defects

Various speech disorders have several varieties and depend on the location of the lesion. There are the following types of dysarthria:

Bulbar. It is characterized by damage to a large number of nerve endings, leading to paralysis of the muscles involved in sound pronunciation and facial expressions. This dysfunction is accompanied by difficulty in swallowing food.
Pseudobulbar. It occurs when damage and dysfunction of some parts of the brain leads to paralysis of the muscles of the speech apparatus. The main difference between this violation is the monotony and inexpressiveness of the speech.
Cerebellar. Brain disorders. In this case, the instability of the structure of speech is characteristic - the stretching of spoken words with constantly changing loudness.
Cortical. Occurs with unilateral damage to the cerebral cortex, with a violation of some structures. In this case, the general structure of sound pronunciation remains, but in the child's conversation there is an incorrect pronunciation of syllables.
Subcortical (sometimes called hyperkinetic and associated with extrapyramidal). Occurs due to damage to the subcortical nodes of the brain. For this type of dysarthria in children, it is characteristic with a nasal tinge.
Extrapyramidal. There is damage to the areas of the brain that are responsible for the activity of the facial muscles.
Parkinsonian. It occurs with the development of Parkinson's disease and manifests itself in the form of monotonous, slow speech.
Erased form. Accompanied by violations in the process of pronunciation of hissing and whistling sounds.
Cold. It is a symptom of myasthenia gravis (neuromuscular pathology). This type of dysarthria is characterized by difficulty in speech due to changes in the ambient temperature of the place where the child is located.

Various methods are used to diagnose speech disorders and difficulties in sound pronunciation. Only after determining the exact diagnosis, an appropriate course of treatment is prescribed, since types of dysarthria differing in localization manifest themselves in different ways and require individual exposure in each case.

The main signs and symptoms of dysarthria

Only a qualified specialist can characterize the present violations of the sound pronunciation of the child, however, parents themselves can identify some manifestations of dysarthria. Usually, in addition to speech disorders, a small patient has inconsistent speech with changes in the tempo and melody of speech. Common characteristics of all types of dysarthria can be such manifestations:

Disturbance of speech breathing is clearly noticeable: by the end of the phrase, speech seems to fade out, and the child begins to choke or breathe more often.
Voice disturbances are heard: usually in children with dysarthria, it is too high or squeaky.
Violations of the melodiousness of speech are noticeable: the child cannot change the pitch, speaks monotonously and inexpressively. The verbal flow sounds too fast or, on the contrary, slowed down, but in both cases it is not clear.
It seems that the child speaks through the nose, however, there are no signs of a runny nose.
There are various types of violations of sound pronunciation in dysarthria: the pronunciation is distorted, skipped or replaced by other sounds. Moreover, this does not apply to any one sound - several sounds or sound combinations may not be pronounced at once.
Severe weakness of the articulatory muscles can manifest itself in different ways. If the mouth is open, then the baby's tongue spontaneously falls out, the lips may be too compressed or, on the contrary, be too sluggish and not closed, and increased salivation may be observed.

Separate signs of violations of sound pronunciation are noticeable even in early childhood. Therefore, most attentive parents turn to specialists in a timely manner, which allows them to successfully prepare their child for school. With effective treatment of some forms of dysarthria, the child can freely study in a regular school. For other cases, there are special correctional training programs, since with severe violations in the development of the speech apparatus, it is impossible to fully develop reading and writing skills.

Dyslalia and rhinolalia: causes and types

Examination of dysarthria often reveals other types of sound pronunciation disorders that are characteristic of children and adults with normal hearing and preserved innervation of the speech apparatus. In this case, functional or mechanical dyslalia can be identified.

Functional speech disorders in the case of dyslalia are associated with a dysfunction in the assimilation of the pronunciation system in childhood. The causes of this disorder may be related to:

general physical weakness of the body due to frequent diseases during the formation of the speech apparatus;
deficiency in the development of phonemic hearing;
pedagogical neglect, unfavorable social and speech conditions in which the child develops;
bilingualism in communication with the child.

Functional dyslalia is divided into motor and sensory. They are caused by the appearance of neurodynamic shifts in the parts of the brain responsible for speech (in the first case) and for the auditory apparatus (in the second case).

Depending on the manifestations of certain signs, there are such types of dyslalia as acoustic-phonemic, articulatory-phonemic and articulatory-phonetic.

Mechanical dyslalia can appear at any age due to damage to the peripheral system of the speech apparatus. The reasons for the appearance of this form of violation of sound pronunciation can be:

Dyslalia correction

Usually dyslalia is successfully eliminated. However, the effectiveness and period of correction depend on the age and individual characteristics of the patient, as well as on the regularity and completeness of classes with a speech therapist and the participation of parents.

It is known that in young children this defect is eliminated much faster and easier than in high school students.

Rhinolalia: causes and classification

Violations of the timbre, tempo and melody of the voice, as well as difficulties in sound pronunciation can be associated with anatomical and physiological defects of the speech apparatus. Rhinolalia occurs with congenital physiological anomalies in the structure of the hard or soft palate and nasal cavity. Such defects change the structure and functions of the speech apparatus, and hence the mechanism for the formation of sound pronunciation.

Speech therapists distinguish open, closed and mixed forms of rhinolalia. In addition, this defect can be mechanical or functional.

Open rhinology is characterized by changes in communication between the nasal and oral cavities. This phenomenon causes the simultaneous free passage of the air flow through the nose into the mouth, which leads to the appearance of resonance during phonation. This defect has a mechanical nature of education (may be congenital or acquired).

Closed rhinolalia is due to the presence of an obstacle that limits the exit of the air stream through the nose. In the mechanical form, sound pronunciation disorders are associated with physiological dysfunctions of the pharynx and nasopharynx, arising from the formation of polyps, adenoids, or curvature of the nasal septum. The functional form of rhinolalia is due to the presence of hyperfunction of the soft palate, which blocks the path of the air stream into the nose.

The mixed form of rhinolalia is characterized by obstruction of the nose and insufficiency of the palatopharyngeal closure. In this case, there is a lack of nasal phonemes and a nasal voice.

Rhinolalia correction

The disorders underlying rhinolalia require the participation in the elimination of this defect of the complex interaction of specialists from different fields: dental surgeons, orthodontists, otolaryngologists, speech therapists and psychologists.

Functional rhinolalia in most cases has a favorable prognosis and is corrected with the help of special phoniatric exercises and speech therapy classes. However, in this case, the positive result of treatment depends on the period of contact with specialists, the completeness of the impact and the interest of the parents. The effect of overcoming the organic form is largely determined by the results of surgical intervention, the timing of the start and the completeness of classes with a speech therapist.

Correction of speech disorders

Dysarthria, as a type of speech development disorder, requires a comprehensive therapeutic and pedagogical impact. In this case, a combination of speech therapy correction, drug treatment and exercise therapy is carried out.

speech therapy classes

During classes with children suffering from various types of dysarthria, specialists pay special attention to the overall development of all aspects of the child's speech: replenishment vocabulary, the development of phonetic hearing and the correct grammatical construction of phrases.

Today, special speech therapy groups are being created for this in kindergartens and speech schools. Here, mainly gaming correctional techniques are used with the use of interactive simulators and special programs that allow you to quickly get rid of the problems found in the present speech.

Additionally, articulatory gymnastics is used, which strengthens the muscles of the speech apparatus.

Treatment with medications

To eliminate almost all types of dysarthria, special drug treatment regimens are used. The main drugs used in the elimination of speech disorders are nootropics. These funds contribute to the improvement of the higher functions of the brain: they stimulate brain activity, facilitate learning processes and improve memory. The most popular among neurologists who observe children with various speech disorders have received such drugs as Pantogam (in other words, hopantenic acid), Phenibut, Magne-B6, Cerebrolysin, Cortexin, Cerepro and many other drugs that improve performance vascular system and the brain.

Therapeutic exercise and massage

In the treatment of various types of dysarthria, special techniques are also used. therapeutic gymnastics. These include exercises aimed at improving general motor skills and stimulating articulatory capabilities, developing auditory perception and improving the functioning of the respiratory system.

Forecast

The effectiveness of the treatment of various types of dysarthria, identified in early childhood, in most cases is uncertain. This is due to possible irreversible damage to the brain and central nervous system. The main task of the ongoing treatment of difficult sound pronunciation is to teach the child to speak so that others understand him. In addition, the complex impact contributes to further improvement of the perception of elementary skills of writing and reading.

(classification of dysarthria according to the syndomological approach)

Form of dysarthria			Hyperkinetic dysarthria	Atactic dysarthria
Lead Syndrome	Spastic paresis	Spastic paresis and tonic disturbances in the control of speech activity such as rigidity	Hyperkinesis	Ataxia
Form of cerebral palsy	Spastic diplegia, hemiparesis	double hemiplegia	Hyperkinetic form of cerebral palsy	Atonic-astatic form of cerebral palsy
The nature of the violation of muscle tone	Spasticity, less often hypotension	Muscle spasticity and rigidity (the maximum sharp increase in muscle tone in all speech and skeletal muscles, which increases under the influence of external stimuli)	Dystonia, less often hypotension (large). Dependence of tone on external influences, emotional state, voluntary movements	Hypotension
The presence of involuntary violent movements, synkinesis	Synkinesis, oral synkinesis. Possible preservation of reflexes of oral automatism	Frequent presence of brain stem synkinesis and oral automatisms (violent sucking and licking movements)	Hyperkinesis of the tongue, face, neck at rest, aggravated by pronunciation attempts. Synkinesia	Tremor of the tongue (with purposeful movements)
Violations of articulatory motility, articulatory praxis,	Decreased volume and amplitude of articulatory movements of the tongue, lips (of varying degrees). May suffer performance and save	The volume of articulatory movements is strictly limited. Inclusion in movement with an extended latent period (up to several minutes). At	The volume of articulatory movements may be sufficient. Particular difficulties in holding and feeling the articulatory posture	Dysmetria (disproportion) of articulation movements; more often - hypermetry (increase in amplitude

Form of dysarthria	Spastic-paretic dysarthria	Spastic-rigid dysarthria	Hyperkinetic dysarthria	Atactic dysarthria
facial expressions	articulation postures; switching from one articulation to another. Hypomimia of the face	inclusion in the movement - a sharp increase in tone in all speech and skeletal muscles. The tongue is tense, inactive, pushed back, it is not always possible to remove it from the oral cavity. Non-differentiation of lip and lingual movements (mixed lip-lingual articulation). Mimicry is extremely poor (the face is frozen, mask-like)	and when switching from one articulation to another, i.e. automation of articulatory movements suffers	there, exaggeration, slowness of movements). Difficulty in performing and maintaining articulation patterns. Facial expressions are sluggish
The state of the act of eating (chewing, swallowing)	The act of eating is slowed down but coordinated	Chewing, biting off, swallowing are grossly disturbed. Chewing is often replaced by sucking. Impaired coordination between breathing, chewing, swallowing	The processes of chewing, swallowing are difficult, dis-coordinated	Chewing weakened
Intelligibility of re-chi. Violations of sound pronunciation	Speech intelligibility is significantly reduced, it is often difficult to understand speech without knowing the context. The sounds of speech are devoid of a clear phonetic design. Consonant indistinctness	Speech intelligibility is significantly reduced, often speech is difficult to understand when the context is not known. The sounds of speech are devoid of a clear phonetic design. Indistinctness of consonants. Vowel mediation. Weakness of differentiation of the labial, dental;	Legibility is reduced (slurred, blurred, sometimes incomprehensible speech). The absence of stable violations of sound pronunciation is characteristic (omissions, substitutions, mixing of sounds are inconsistent). A lot of	Speech intelligibility is reduced. Violated anterior-lingual, labial, explosive sounds

Form of dysarthria	Spastic-paretic dysarthria	Spastic-rigid dysarthria	Hyperkinetic dysarthria	Atactic dysarthria
	sounds. The averageness of vowels. Weak differentiation of the labials, teeth; hard-soft, voiced-deaf	hard-soft, voiced-deaf.	distortion of sounds (slotted and sonora)
Respiratory disorders	Violations of speech breathing (speech exhalation is shortened and exhausted, the breath is shallow)	Severe respiratory problems	Severe respiratory problems	Asynergy - asynchrony of breathing, voice formation and articulation
Voice disorders	Voice of insufficient strength and sonority (quiet, weak, emaciated, muffled). Maybe nasalization (already mentioned)	The voice is quiet, deaf, strangled, tense	The voice is tense, intermittent, vibrating, changing in pitch, strength, sonority. May be nasalization	The voice is depleted, fading towards the end of the phrase; with a nasal tinge
Prosody violations	The amplitude of voice modulations is reduced, there are no tempo-rhythmic interruptions necessary for live intonation (voice is slightly modulated, monotonous)	Almost no voice modulation. Timbre is poor. The pace is a little faster	The melody-intonation side of speech is disturbed, the emotional connotation is lost. Weak or absent voice modulations (monotonicity)	Almost no voice modulation. Almost no intonation. The rhythm is chanted. The pace is slow
Autonomic disorders	hypersalivation	hypersalivation	There is no salivation in "pure" hyperkinetic syndrome	May be hypersalivation

Chapter III
Logopedic examination of children
with dysarthria

Logopedic examination of children with dysarthria (speech-motor) disorders is based on a general systematic approach, which is based on the idea of speech as a complex functional system, structural components which are in close interaction. In this regard, the study of speech development in dysarthria involves the impact on all aspects of speech. It is important to take into account the ratio of speech and non-speech disorders (neurological symptoms) in the structure of the defect and to determine the intact mechanisms of speech.

A comprehensive comprehensive examination and assessment of the features of the development of speech, mental functions, the motor sphere, the activity of various analyzer systems will make it possible to give an objective assessment of the existing shortcomings in speech development and outline the best ways to correct them. An important condition for a complex impact is the consistency of the actions of a speech pathologist-defectologist and a neuropathologist during examination and diagnosis.

During the speech therapy examination of children with motor speech disorders, the following methods are used:

Study of medical and biographical documentation (collection and analysis of anamnestic data);

Observation of the child (in a normal and specially organized situation);

Conversation with parents and child;

Visual and tactile control (feeling) at rest and during speech;

Individual experiment;

The use of computer games in the examination of sound pronunciation, respiratory and voice functions.

Before starting the examination of the child, it is important to comprehensively study the medical documentation (history data) and analyze the results of the examination and the conclusion of the neuropathologist (neurological status), preferably discussing it with the doctor. A feature of speech therapy examination and analysis of the structure of the speech defect in children with dysarthria is the principle of correlating articulatory motor disorders with general motor disorders. With dysarthria, articulatory motility, breathing and voice formation features are evaluated in accordance with the general motor capabilities of the child (even minor motor disorders are noted).

Together with a neurologist, a speech therapist studies the features of the child's general motor skills (holding the head, turning it freely to the sides, sitting, standing upright, walking independently, gait features) and the functionality of the hands and fingers ( support function, palmar and finger grip, manipulations with objects, selection of the leading hand, coordination of hand actions, fine differentiated finger movements).

When determining the leading neurological syndrome and the degree of its manifestation in the articulatory muscles and motor skills (speech-motor syndrome), the speech therapist relies on the conclusion of a neuropathologist. At the same time, it is necessary to note the absence or presence of pathological tonic reflexes and their effect on breathing, voice formation and articulation.

It is important that during a speech therapy examination the child is completely calm, does not cry, is not frightened. If a child cries, screams, breaks out of his hands, this may be reflected in a change (increase) in muscle tone, and the idea of motor and speech capabilities that a speech therapist will receive will be false. During the survey, a thorough analysis of those positions and movements that can facilitate or, conversely, aggravate speech activity is carried out. It is advisable to lay a child with severe motor impairments on a comfortable couch or carpet, checking different positions - on the back, on the side, on the stomach. In milder cases, the examination is carried out in the "sitting" or "standing" position.

As with any comprehensive examination, it is important to assess the features of the development of cognitive activity (thinking, attention, memory), sensory functions (visual, auditory and kinesthetic perception), manifestations of the emotional-volitional sphere.

Speech therapy examination includes the collection of data on the features of pre-speech, early speech and mental development child prior to examination. Based on the data of medical records and conversations with parents, it turns out the time of appearance and the nature of the cry, cooing, babble, and then the first words and simple phrases.

Examination of the articulatory apparatus begins with checking the structure of its organs: lips, tongue, teeth, hard and soft palate, jaws. At the same time, the speech therapist determines how much their structure corresponds to the norm.

It is necessary to assess the state of muscle tone of the articulatory apparatus at rest, when trying to speech activity, in the process of speech, with facial, general and articulatory movements. The state of muscle tone in the organs of articulation (facial, labial and lingual muscles) is assessed during a joint examination by a speech therapist and a neuropathologist. In children with dysarthria, articulatory muscle tone disorders are characterized by spasticity, hypotension, or dystonia. Often there is a mixed character and variability of muscle tone disorders in the articulatory apparatus (for example, hypotension can be expressed in the facial and labial muscles, and spasticity in the lingual muscles). The presence or absence of hypomimia, asymmetry of the face, smoothness of the nasolabial folds, synkinesis, hyperkinesis of the facial and lingual muscles, tremor of the tongue, deviation (deviation) of the tongue to the side, hypersalivation are noted.

The speech therapist evaluates the involuntary movements of the articulatory apparatus during eating (sucking, removing food from a spoon, drinking from a cup, biting, chewing, swallowing). The features of violation of the act of eating in a child are clarified: the absence or difficulty of chewing solid food and biting off a piece; choking and choking on swallowing.

Particular attention is drawn to the state of arbitrary articulatory motility. When checking the mobility of the organs of articulation, the child is offered various imitation tasks. Analyzing the state of mobility of the speech muscles, attention is drawn to the possibility of performing articulatory positions, their retention and switching. At the same time, not only the main characteristics of articulatory movements (volume, amplitude, tempo, smoothness and speed of switching) are noted, but also the accuracy, proportionality of the movements, their exhaustion. The speech therapist evaluates the volume of articulatory movements of the tongue in particular detail (strictly limited, incomplete, complete); there is even a slight decrease in the amplitude of articulatory movements of the tongue. In some children with pronounced motor speech syndromes, it is sometimes not possible even to passively remove the tongue from the oral cavity. The possibility of arbitrary protrusion of the tongue, lateral leads, lip licking, holding wide, flattened, upper lifting, clicking, etc. is checked. The degree and limit of the pharyngeal reflex (increase or decrease) is assessed. The speech therapist analyzes the features of the movements of the lips (inactive or fairly mobile) and the lower jaw (opening and closing the mouth, the ability to keep the mouth closed).

Evaluation of understanding of inverted (impressive) speech is the most important stage of speech therapy examination. The speech therapist reveals the level of understanding of addressed speech (distinguishing intonation of an adult's voice, situational understanding of addressed speech, at the everyday level, in full). Passive vocabulary is checked on real objects and toys, subject and plot pictures. At the same time, the understanding of the semantic meaning of a word, action, simple and complex plots, lexical and grammatical constructions, and a sequence of events is determined.

When examining one's own (expressive) speech, the level of the child's speech development is revealed. It is important to note the age formation of the lexical and grammatical aspects of speech, the assimilation of various parts of speech, and the features of the syllabic structure of words. Speechless children have the possibility of using various non-verbal means of communication: expressive facial expressions, gestures, intonation.

When studying the pronunciation side of speech, the degree of impaired speech intelligibility is revealed (slurred speech, incomprehensible to others; speech intelligibility is somewhat reduced, speech is fuzzy, blurry).

The phonetic-phonemic structure of speech is checked in detail. When examining sound pronunciation, it is necessary to identify the child's ability to pronounce sounds in isolation, in syllables, in words, in sentences, and especially in a speech stream. It should be noted the nature of the shortcomings of sound pronunciation: distortions, substitutions, omissions of sounds. Violations of sound pronunciation are compared with the features of phonemic perception and sound analysis. It is important to note whether the child determines the violation of sound pronunciation in someone else's and his own speech; how he differentiates by ear normal and defective sounds he utters.

The quality of the sound disorder in children with dysarthria may vary. I.I. Panchenko proposed to distinguish the following forms of sound speech disorder:

1 form - a phonetic disorder, manifested in the distortion of sounds, but with the preservation of all differential phonemic features of sounds;

2 form - phonetic-apraxic disorder, including both phonetic disorders (distortion of sounds) and articulatory apraxia, expressed in the replacement and omission of sounds;

3rd form - phonetic-phonemic disorder with phenomena of articulatory apraxia (in addition to sound distortions, there are multiple substitutions, omissions of sounds, violations of the syllabic structure of words, incorrect grammatical use of phonemes at the end of a word).

Analyzing the data of a speech therapy examination, it is necessary to determine to which group the disorders identified in the child should be attributed: to purely phonetic, to phonetic-phonemic, or to manifestations general underdevelopment speech.

So, in the course of a speech therapy examination of children with dysarthria, a speech therapist should identify the structure of the speech defect (the ratio of speech and non-speech disorders), comparing it with the severity of damage to articulatory and general motor skills, as well as the level of mental development of the child.

After analyzing the results of a comprehensive examination, the speech therapist gives a conclusion that allows one to judge the state of the speech defect at the time of the examination. It is desirable that a speech therapy conclusion (diagnosis) be made (given) jointly by a speech therapist and a neuropathologist.

Below is a map of a speech therapy examination of children of early and preschool age with neurological pathology, which was developed and modified by the author for more than 15 years in the course of many years. practical work speech therapist in various medical institutions (in the Children's Psychoneurological Hospital No. 18 in Moscow, in the Republican Association for the Rehabilitation of Disabled Children "Childhood", in the "Medincenter" under the Ministry of Foreign Affairs of the Russian Federation). Variants of this map have been repeatedly published earlier in various manuals, often without reference to the author.