Sterile form of dysarthria: characterization, treatment, prognosis

Sometimes we come across people, including children, whose speech is difficult to understand because it is slurred, monotonous, without intonations and voice modulations. In addition, other behavioral features become noticeable. This means that we have encountered a case of dysarthria. This term is translated from Latin as "disorder of articulate speech." Erased dysarthria, being one of its forms, has not very clear, erased psychological, neurological and speech manifestations.

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Epidemiology

The epidemiology of the disease is such that examination of preschool children by speech therapists reveals speech defects in half of them. Among the disorders, dysarthria is one of the most common, and 60-85% of cases of the disease are caused by cerebral palsy.

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Causes severe dysarthria

Erased dysarthria is an echo of damage to individual parts of the brain - the highest part of the central nervous system (CNS), which is connected to all tissues and organs of the peripheral nervous system. That is why its failures entail disorders of other organs. The causes of erased dysarthria include:

• head injuries;
• infectious diseases (encephalitis, meningitis, etc.);
• intoxication of the body with nicotine, alcohol, drugs or medications due to improper treatment;
• vascular diseases (strokes);
• tumors;
• other diseases (multiple sclerosis, Alzheimer's disease, Parkinson's disease);
• hereditary diseases;
• birth injuries or injuries sustained during an unfavorable pregnancy;
• cerebral palsy.

Risk factors

Based on the causes leading to erased dysarthria, risk factors are atherosclerosis of the cerebral vessels, craniocerebral head injuries, bad habits, careless behavior with chemicals (arsenic, nitrogen compounds), chronic liver and kidney diseases affecting the brain. In children, erased dysarthria occurs as a result of infection in the womb, birth injuries, severe toxicosis during pregnancy, mismatch of the Rh factor of the woman and the child, fetal hypoxia, asphyxia during childbirth.

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Pathogenesis

The pathogenesis is based on damage to the central and peripheral nervous system of a person. The speech mechanism is designed so that a signal from the central nervous system goes through the centrifugal nerves to the receptors of the speech organs to start it. If one of the links in the brain-face chain is damaged, signals from the cerebral cortex do not reach the muscles responsible for articulation, breathing and voice.

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Symptoms severe dysarthria

Symptoms of latent dysarthria are expressed both in speech defects and in behavioral actions. Speech symptoms are manifested in incorrect pronunciation of frontal, hissing and whistling sounds. The voice is monotonous, weak and quiet, the timbre is changed. Auditory perception is reduced. Non-speech symptoms include weakening of voluntary movements, the appearance of pathological reflexes (sweating of the feet, palms), involuntary automatic twitching of the face (hyperkinesis), changes in muscle tone. Increased (spasticity) is indicated by tightly closed lips, tense muscles of the neck and face, limited movements of the speech apparatus. With reduced tone (hypotonia), the tongue is flaccid and lies on the bottom of the mouth, the lips are half-open, saliva flows. The change of one tone to another (dystonia) disrupts breathing during a conversation, at the moment of pronouncing words it is intermittent and rapid. In some cases, memory loss, difficulty concentrating, and mental activity are possible.

The first signs of erased dysarthria are blurring, slurring of spoken words, unclear articulation, distortion of sounds. Often, such speech resembles talking with a full mouth. This happens to adults after a stroke or head injury. In infants, the first signs of the disease may be indicated by a weak sucking reflex.

Development of the motor sphere in erased dysarthria

The development of the motor sphere in erased dysarthria directly depends on which nerve endings have lost connection. Thus, damage to the trigeminal nerve makes it difficult to open and close the mouth, chew and swallow food. Damage to the hypoglossal nerve causes difficulty in controlling the tongue, damage to the facial nerve causes difficulty in puffing out the cheeks or frowning, and damage to the glossopharyngeal nerve causes a malfunction of the larynx and palate, which causes the voice to change, breathing to become out of order, etc. But most often, a dysfunction of the hypoglossal nerve leads to erased dysarthria.

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Erased pseudobulbar dysarthria

The most common type of dysarthria is erased pseudobulbar dysarthria. It is caused by brain damage that occurred in childhood. This may be a tumor, birth injury, encephalitis, etc. As a result, the cerebral cortex does not send a signal to the cranial stem nerves that control the speech apparatus. This affects motor skills and weakens the facial muscles. Such people have an open mouth, drool, the tip of the tongue rises and moves with difficulty, words are slurred and incomprehensible, and the voice becomes nasal. There are three degrees of erased pseudobulbar dysarthria. Mild dysarthria is characterized by minor speech disorders. Most often, r, ts, ch, sh, zh are pronounced incorrectly, and voiced sounds do not have sufficient sound fullness. The average degree is expressed in low mobility of the facial muscles, difficulty chewing or swallowing, and profuse salivation. The pronunciation of most sounds is distorted, voiced consonants are pronounced voicelessly, vowels are not sonorous enough. Only k, n, m, t, p, kh are produced. A severe degree is characterized by complete immobility of the facial muscles, the mouth is open, chewing and swallowing movements are difficult, speech is absent.

Erased dysarthria in children

In children, latent dysarthria most often occurs as a result of abnormalities during pregnancy, abnormal birth, and fetal asphyxia. While the child does not speak, the symptoms manifest themselves in a weak sucking instinct, refusal to take a nipple into the mouth. In addition, he is somewhat behind in physical development. He has difficulty grasping and holding objects in his hand, does not like to play with small toys, assemble construction set parts, draw, or sculpt. Such a child has increased salivation, inactive facial expressions, and cannot roll his tongue into a tube. But, in general, his condition does not cause much concern.

Erased dysarthria in preschool children

In preschool age, deviations associated with general motor skills become noticeable. Children walk awkwardly, cannot stand on one leg, quickly get tired of physical activity, poorly imitate movements, react late to changes in position, tempo and musical rhythm in music lessons, hold a pen weakly and do not like to draw. Such children find it difficult to take care of themselves, button or unbutton buttons, tie a scarf. At 5-6 years, features of the articulatory apparatus appear. With reduced muscle tone, the lower jaw is poorly held in a raised position, so the mouth does not close, the lips and tongue are flaccid. Muscle spasticity gives a half-smile to the face, their hardness upon palpation. It can be difficult for them to hold the same pose for a long time: puffy cheeks, tube-shaped lips, protruding tongue, because after a while it begins to tremble and twitch. Conventionally, pronunciation errors are divided into three groups:

• with disorders of pronunciation of sounds and intonation-expressive coloring of speech (prosody). Such children pronounce words well, have a large vocabulary, but polysyllabic words cause difficulties. They are characterized by poor spatial orientation;
• the first violations are accompanied by the undeveloped phonetic hearing. This is expressed in the inability to coordinate different parts of speech in sentences, pronounce complex words, and a weak vocabulary. This group of children is sent to a special kindergarten;
• with obvious pronunciation and prosody disorders, and underdeveloped phonetic hearing. Specialized groups are organized in kindergartens for such children.

Erased dysarthria in adults

Unlike children, adults have already developed a speech apparatus and conversational skills at the time of dysarthria. They hear and perceive everything. Defects in the speech apparatus occur as a result of damage to the central nervous system due to one of the above-mentioned reasons. The respiratory and articulatory systems are involved in the creation of sounds. The respiratory system is responsible for voice formation, which is possible due to air entering the larynx on the resonators, reflecting it to the articulatory apparatus. The latter, in turn, produces sound with the help of such instruments as the tongue, larynx, palate, lips, and teeth. Failure of any of these chains leads to speech disorders.

Stages

The degree of speech deviation from the norm and the severity of damage to the nervous system are directly related. Speech therapists distinguish four stages of dysarthria. At the first stage, distortions of sounds are heard only by the speech therapist. At the second stage, the speaker's speech is understandable, although pronunciation errors are obvious even to strangers. The third stage has more pronounced defects - distortions, omissions or substitution of sounds. Conversation is slow, words are inexpressive, unclear, they are understood only by close people. The fourth stage is the most severe, it occurs with complete paralysis of the speech motor muscles, when speech becomes impossible or completely incomprehensible even to close people.

Forms

The types of erased dysarthria are determined by the localization of the damage to the central nervous system responsible for speech function and its symptoms. The following are distinguished:

• pseudobulbar, in which the cortico-nuclear nerve endings are affected. It is characterized by a violation of the pronunciation of sounds, weakness of the speech muscles;
• cortical, caused by focal damage to the cerebral cortex (voluntary movements are difficult);
• mixed.

Complications and consequences

The consequences and complications of erased dysarthria are in the social and psychological plane. Serious speech defects that make it difficult to communicate in the family, at work, with friends can lead to social isolation. This, in turn, leaves an imprint on the emotional state of a person, causing low mood, depression.

Diagnostics severe dysarthria

Diagnosis of erased dysarthria is performed by a neurologist and speech therapist. It is necessary to assess the degree of damage to the central nervous system and its localization.

The neurologist bases his/her conclusions on instrumental studies. The speech therapy conclusion is based on the assessment of speech and non-speech symptoms: the nature of breathing, the condition of the facial muscles, the ability to make articulatory movements. Oral speech is analyzed: pronunciation of words, their intonation, intelligibility, rhythm and tempo.

Written tests are conducted: dictations, copying texts, reading aloud. In children, erased dysarthria is diagnosed after 5 years.

Blood and urine tests are prescribed to determine the general condition of the body.

Instrumental diagnostics plays an important role in determining the diagnosis, its scope depends on the initial diagnosis made by a neurologist or pediatric neurologist. The most accurate picture will be given by the following studies: MRI of the brain, electromyography, electroencephalography, electroneurography.

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Differential diagnosis

The task of differential diagnostics, based on the assessment of symptoms, is to separate erased dysarthria from motor allalia, aphasia and dyslalia. All these diagnoses are associated with lesions of the brain foci, therefore only neurological studies will answer the question.

When diagnosing erased dysarthria, it is difficult to differentiate between its mild form and complex dyslalia, since they have similar symptoms. In the case of dyslalia, speech defects are not associated with damage to the central nervous system. Most often, it is caused by the peculiarities of the anatomical structure of the articulatory apparatus. Let us consider the differential signs of dyslalia and erased dysarthria. The main criteria that are used to determine erased dysarthria are the following:

• state of articulation (slow tempo, difficulty in maintaining or switching articulation);
• the presence of changes in intonation and clarity of pronunciation of words;
• the appearance of other movements with simultaneous movement of the tongue;
• persistent nature of pronunciation disorders.

Dyslalia is characterized by a violation of the articulation of consonants only, including in various variants of their pronunciation. The sounds formed by the speech therapist are well absorbed, the rhythm and tempo of speech are not disturbed, breathing, articulation, voice formation are coordinated. In contrast, with erased dysarthria, vowels are often pronounced nasal. Individual isolated sounds may sound correct, but are distorted in a word. Their production causes difficulty, the tempo of pronunciation is unstable, breathing is disturbed, speech is produced on inhalation. All functions required for correct pronunciation are not coordinated.

Treatment severe dysarthria

Treatment of latent dysarthria is comprehensive, including drug therapy, physiotherapy and pedagogical methods. The goal of treatment is to achieve such a level of pronunciation of words that speech is understandable to others, and the person can adapt to society. For children with latent dysarthria, there are specialized speech therapy groups formed depending on the level of development: with phonetic, phonetic-phonemic and general speech disorders. Drug treatment is prescribed by a neurologist and is aimed at enhancing brain activity. These are vascular, nootropic, sedative and metabolic drugs. With the help of therapeutic exercises, facial muscles are strengthened, fine and gross motor skills of the hands are developed, since they are directly related to speech functions. Breathing exercises are also necessary, in this case, Strelnikova's gymnastics is effective, facial massage is mandatory. This complex of therapeutic measures is complemented by the continuous work of a speech therapist on setting sounds.

Correction methods for erased dysarthria

Correction methods for erased dysarthria include all the above procedures with the addition of other non-traditional ones. They depend on the severity of the speech apparatus damage. At the first stage, facial muscles are strengthened by massage. Then special exercises are done to establish correct articulation. This is followed by work on autonomous production of sounds, then on their correct pronunciation in words. If the work is carried out with a child, then psychological support in the form of praise and approval is important. Acupuncture, hirudotherapy, and therapeutic baths are used in parallel. Good results are obtained from the method of treatment using communication with dolphins (dolphin therapy), games using sand (sand therapy), and play exercises (sensory therapy).

Prospective planning in erased dysarthria

Long-term planning for erased dysarthria is designed for preschool children and consists of developing speech hearing, visual, and auditory attention. Games are held for this purpose: for example, using pictures and toys, they are asked to remember their location or presence, and then tell what has changed. This is how visual attention is strengthened. Noise toys are used to strengthen auditory attention, for example, you need to guess who the voice belongs to or where the sound is coming from. The next stage is aimed at developing the mobility of the articulatory apparatus. It consists of various exercises for developing the jaw, strengthening the mobility of the lips, muscles of the tongue, cheeks, and breathing training. Special gymnastics is done to develop the skills of setting and pronouncing individual sounds. For this, a visual demonstration is used of where the tongue should be, how the lips are positioned. In front of a mirror, the skill of pronouncing whistling, hissing, r, l sounds is practiced. Then, with the help of games, work is carried out on correcting sounds, their accuracy, purity, tempo, and strength. Then comes work on sound, for which poems, tongue twisters, and proverbs are learned and recited. Games for recognizing sounds in syllables develop phonemic perception. The great work that has been done is crowned by exercises for the ability to differentiate sounds in syllables, words, phrases, and sentences.

Calendar-thematic planning for erased dysarthria

Calendar-thematic planning for erased dysarthria in children provides for an individual work plan with a step-by-step implementation of corrective measures indicating specific actions and deadlines for implementation. This plan is developed for a specific patient, taking into account the age and depth of the speech apparatus lesion. As a rule, it consists of a preparatory and main stage. The first preparatory stage is aimed at forming interaction between visual, auditory and motor perception, improving fine motor skills, articulation, memory, and the ability to analyze. The goal of the main stage is speech development, correction of phonetic errors of sounds, strengthening the articulatory apparatus.

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Speech therapy work with erased dysarthria

Drawing up calendar-thematic plans and their step-by-step implementation - this is what speech therapy work with erased dysarthria consists of. The distinctive features of this diagnosis are that the speech therapist needs to carry out a large and labor-intensive preparatory stage in order to make corrections to the pronunciation of sounds. The effectiveness of speech correction in the future depends entirely on the successful work of the speech therapist at this stage.

Exercises for erased dysarthria

Special exercises have been developed for erased dysarthria to strengthen the articulatory apparatus, develop general motor skills, including hands, coordination of movements, normalize the voice and breathing during pronunciation of words. Exercises for the hands include lacing, stringing beads on a thread, shading with a pencil, and modeling with plasticine. Coordination of movements is improved with the help of pantomime: it is necessary to depict what is heard with the hands.

There are other exercises for coordinating movements. Speech breathing and voice are normalized with the help of Strelnikova gymnastics. Here are some techniques: take a shallow breath, hold your breath and exhale slowly; inhale, hold your breath, pronounce any vowel sound on the exhale; smoothly change one vowel sound to another on the exhale. Playing the flute and blowing up balloons also help well. Therapeutic measures for speech correction also include exercises for tactile perception of objects and spatial representation. For this, they suggest recognizing an object by touch, texture and shape, etc. They teach the skills to establish a cause-and-effect relationship, generalize.

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Sound production in erased dysarthria

The production of sounds in erased dysarthria begins with vowel sounds, since they play a major role in the intelligibility and clarity of pronunciation of words, the emotional coloring of speech. At first, work is carried out on the correction of such sounds: e, a, i, y, o, u. After achieving clarity in articulation, they move on to consonants [m'-m], sonorants [n'-n], [j], [l'-l], [r'-r], plosives [p'-p], [b'-b], [t'-t], [d'-d], [k'-k], [g'-k], fricatives [f'-f], [v'-v] and anterior lingual [s'-s], [z'-z], [sh-zh], [kh'-kh], [shch], [ch], [ts]. First comes the preparatory stage, then the production of sounds.

Articulation exercises for erased dysarthria

Special articulation exercises have been developed for erased dysarthria using both dynamic and passive exercises.

There is a method by Ermakova for the masticatory muscles. The exercises consist of alternately opening and closing the mouth, inflating and pulling in the cheeks, pushing forward and to the side of the jaw, biting the lower lip with the upper lip. Arkhipova's gymnastics is also aimed at strengthening the facial muscles. It consists of inflating the cheeks, stretching the lips into a tube, exposing the upper and lower teeth alternately, pulling the lips into the oral cavity, snorting "horse", imitating rinsing the teeth.

Passive gymnastics for the tongue according to Pravdina's method involves movements under the influence of another person. Such exercises are carried out in three stages: entry, maintenance and exit from the position. For example, you need to close your lips, a stranger holds them with a finger and suggests blowing into them and trying to open them. The pronunciation of each group of sounds corresponds to a certain position of the tongue, lips, muscle tension. Articulatory gymnastics is aimed at strengthening these skills.

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Massage for erased dysarthria

Massage for erased dysarthria is used to strengthen or relax the facial muscles. In case of hyperkinesis and hypertonus, a relaxing massage is done. It consists of a short 1-1.5 minute tapping, stroking the face from the temples to the bridge of the nose, forehead, nose, lips. People with low tone are prescribed a strengthening massage. In this case, the face is longer (3 minutes) and deeply kneaded and rubbed. All movements are directed horizontally from the center to the periphery of the face.

To improve hand motor skills, massage and self-massage of fingers and hands are performed. Thus, children are offered to imitate the movements of an iron, a saw, kneading dough and others in the form of games, accompanied by special quatrains on this topic.

Adapted program for erased dysarthria

The adapted program for erased dysarthria is designed for the development and education of preschool children, taking into account their characteristics. It is a plan for a speech therapist and other participants in the educational process, defines the priorities of training, provides a methodology and its organizational aspects, regulates all types of training and a system for assessing the results of its assimilation. In addition to a speech therapist, it involves educators who are responsible for conducting games, conversations, excursions within the framework of the adapted program, a music director, a fine arts specialist, a physical education teacher, and parents are also involved. The program is designed for two years and consists of several stages.

• At the first initial diagnostic stage, by collecting anamnesis, psychological and speech therapy tests, the degree of speech damage and tasks for correcting defects are determined, and a speech card is filled out.
• At the second stage, the organizational and preparatory stage, an individual correction program is developed.
• The third stage - correctional and technological - involves the implementation of all planned activities.
• The fourth is the final diagnostic.

Speech therapy studies are conducted to assess the condition of the child's speech apparatus and other functions. Decisions are made to terminate classes with a speech therapist in the event of positive results, to continue or change the nature of the classes.

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Prevention

Prevention of erased dysarthria in adults is identical to the prevention of strokes, Alzheimer's disease and other ailments that lead to the loss of speech apparatus functions. Medicine is not yet able to predict and prevent the birth of children with such a defect. Therefore, today, as a preventive measure, we can recommend a healthy lifestyle, which will give a greater percentage of confidence in the appearance of healthy offspring and prolongation of life with good health.

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Forecast

The prognosis for treating erased dysarthria in its mild form and early onset of correction is favorable. In any case, the efforts will not be wasted and will improve speech skills to one degree or another.

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