Differential diagnosis of erased dysarthria and complex dyslalia
Differential diagnosis of erased dysarthria and complex dyslalia
Bondarenko K.A.,
student of the ZMP-Inkl-2-1 group
scientific supervisor Shevchenko L. E.,
Candidate of Pedagogical Sciences
Among various speech disorders in preschool children, complex functional dyslalia and erased dysarthria pose great difficulties for differential diagnosis and correctional and speech therapy work. In speech therapy practice, it is quite difficult to distinguish between these disorders, since they are similar in their manifestations, but at the same time they have a completely different nature of the speech defect. [3] As noted by E.F. Arkhipova, after a thorough examination, erased dysarthria was identified in 10% of children with an initial diagnosis of “complex dyslalia”[1].
When choosing an effective correction technique and to achieve the best result of speech therapy work to overcome speech disorders, the issues of differential diagnosis of articulatory disorders that are externally similar in manifestations are relevant. The problem is aggravated by the fact that these issues are not sufficiently covered in the speech therapy literature, and a comprehensive approach to the correction of erased dysarthria has not been fully developed.
According to L.V. Lopatina, erased dysarthria is a speech pathology, manifested in disorders of the phonetic and prosodic components of the speech functional system and arising as a result of unexpressed microorganic damage to the brain [2]. Erased dysarthria (mild dysarthria, MDD - minimal dysarthric disorders) is one of the most common and difficult to correct disorders of pronunciation of speech. Research by E.F. Arkhipova showed that up to 35% of children in groups with phonetic-phonemic underdevelopment have erased dysarthria, and in groups for children with general speech underdevelopment - up to 50%.[1]
Corrective speech therapy work for erased dysarthria has its own specifics. An integrated approach is important, which includes not only the help of a speech therapist, but also psychological and pedagogical support and medical influence. Work to eliminate violations of sound pronunciation should be combined with general massage and massage of the articulatory apparatus, physical therapy, and special articulatory gymnastics.
Dyslalia is a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus. There are functional and mechanical dyslalia. Functional dyslalia is based on functional disorders in the functioning of the cerebral cortex. With mechanical dyslalia, abnormal development of the articulatory apparatus (open or closed bite, shortened frenulum of the tongue, etc.) most often occurs. According to M.F. Fomicheva, both functional and mechanical dyslalia, can be simple (monomorphic)—when a child’s one group of sounds is impaired, and complex (polymorphic)—when several groups of sounds are impaired.
F. E. Arkhipova, L. V. Lopatina, I. B. Karelina, M. A. Povalyaeva, R. I. Martynova, R. A. Belova devoted their works to the problem of studying the differential diagnosis of the erased form of dysarthria and complex dyslalia. David et al.
R. A. Belova-David identifies the presence or absence of organic symptoms as the main criterion for differentiating sound pronunciation disorders. In this case, organic symptoms can only be detected by special neurological examination techniques. L.V. Lopatina first of all proposes to find out the etiology of the occurrence of sound pronunciation disorders, to identify unfavorable factors in the prenatal, natal and early postnatal periods of child development [4]. For this, according to I.B. Karelina, a comprehensive medical and pedagogical study is needed: analysis of medical and pedagogical documentation, study of anamnestic data [3].
When studying the anamnesis of children with an erased form of dysarthria, it was revealed that the mother had problems with the course of pregnancy: toxicosis, chronic diseases (diseases of the kidneys, liver, cardiovascular system, etc.), diseases suffered during pregnancy (especially in the first half). ). In the catalytic period, phenomena of asphyxia of newborns of varying degrees of severity, rapid or dry protracted labor, Rh-conflict situation, and weakness of labor were noted [4]. And as a result, children have a low Apgar score.
According to I.B. Karelina, the early development of children with dysarthric disorders proceeded well. They began to hold their heads up, sit, and crawl in time. But more complex locomotor functions were slightly behind in development (children began to walk after a year and were motorically awkward). Humming and babbling appeared in a timely manner, but then the babbling disappeared, and the children were silent for some time[3]. L.V. Lopatina notes excessive motor restlessness, constant inexplicable crying, and persistent sleep disturbance in children with dysarthria. In newborns, breast refusal, difficulty holding the nipple, weak cry, sluggishness of the act of sucking, frequent choking, and excessive regurgitation during feeding were observed. Difficulties in chewing and swallowing may become apparent later[4].
There was no history of abnormalities in children with complex dyslalia during pregnancy and childbirth, as well as in early development.
But studying anamnestic data to identify a violation of sound pronunciation is not enough. To more effectively carry out the differential diagnosis of erased dysarthria and complex dyslalia, E.F. Arkhipova developed parameters with which these disorders can be compared.
Table 1. Parameters for comparison of erased dysarthria and complex dyslalia
| Comparison parameter | Erased dysarthria | Complex dyslalia |
| Gross motor skills | There is general motor clumsiness, lack of coordination of movements, motor insufficiency of various forms (they run poorly, stumble; they stand poorly and jump on one leg, while looking for support). | General motor skills are normal. |
| Fine motor skills | Fine motor skills are not well developed. Self-care skills are developed late (children have difficulty fastening buttons, cannot tie shoelaces, and do not hold a spoon correctly). Children do not like to draw, sculpt, or make appliqué, are not interested in playing with construction sets, and do not assemble puzzles. The arm muscles become very tense when drawing with a pencil, or, conversely, the arm muscle tone is reduced. Performing finger exercises (for example, “Goat”, “Castle”, “Rings”) is difficult. School-age children in the first grade experience difficulties in mastering graphic skills (some experience “mirror writing”; substitution of letters “d”-“b”; vowels, word endings; poor handwriting; slow pace of writing, etc.). | Fine motor skills are normal or there are minor problems. |
| Articulatory apparatus | Revealed: -pareticity and spasticity of the muscles of the organs of articulation, -deviation (deviation of the tongue from the midline), - hypersalivation (increased salivation). - hyperkinesis, manifested in the form of trembling, tremor of the tongue and vocal cords. Hyperkinesis of the tongue is often combined with increased muscle tone of the articulatory apparatus. - apraxia, manifested in the inability to simultaneously perform any voluntary movements with the hands and organs of articulation. Children perform all articulation tests (for example, puff out their cheeks, click their tongue, smile, stretch out their lips), but the quality of the movements suffers: there is blurriness, unclear articulation, weak muscle tension, arrhythmia, decreased range of movements, short duration of holding a certain pose, decreased volume movements, rapid muscle fatigue. | There may be structural features that lead to mechanical dyslalia (bite features, shortened frenulum of the tongue, etc.), but there are no disturbances in the functions of the muscles of the articulatory apparatus. |
| Sound pronunciation | Speech is slurred and inexpressive. There is a replacement and absence of sounds, mixing, distortion of sounds. The sounds introduced by the speech therapist are not automated for a long time and are not introduced into speech. The pronunciation of hissing and whistling sounds is impaired (interdental pronunciation, lateral overtones). Children make mistakes when pronouncing words with a complex syllabic structure and omit some sounds when consonants are combined [3]. | Articulation of only consonant sounds suffers. Sounds are quickly automated and introduced into speech. |
| Prosody | There is slurred, unintelligible speech - “porridge in the mouth.” Poor intonations, quiet voice, sometimes nasal tone of speech. More often, the pace of speech is fast, accelerated, the child does not finish the endings of words and greatly reduces the pronunciation of vowel sounds (reduces to a minimum). The child’s voice is fading, begins to speak loudly, and subsides as the speech load increases. Intonation coloring deteriorates. Children with dysarthria are characterized by deterioration in speech quality with increasing load. | No voice disturbances are observed. There are no violations of the tempo-rhythmic side of speech. |
| General speech development | Children with erased dysarthria can be divided into three groups: First group. Children who have a violation of sound pronunciation and prosody, as with dyslalia. Second group. These are children with phonetic-phonemic underdevelopment. In children, the auditory and pronunciation differentiation of sounds is unformed. Children's vocabulary lags behind the age norm; children have isolated lexical and grammatical errors in their speech. Sound pronunciation defects are persistent and are regarded as complex, polymorphic disorders. Third group. These are children with erased dysarthria and general speech underdevelopment. They have a poor vocabulary and experience difficulties in mastering words of different syllable structures. Their grammatical structure is disrupted, auditory and pronunciation differentiation is not formed; poorly developed coherent speech [1]. | There are disturbances in sound pronunciation and prosody. |
| Breath | Breathing is shallow, phonation exhalation is shortened. Discoordination of breathing, voice production and articulation is observed. | No breathing problems |
Thus, the study of differential diagnosis of the erased form of dysarthria and complex dyslalia is of interest for speech therapy and neurology, and requires further development of complex diagnostic methods.
Literature
1. Arkhipova E.F. Erased dysarthria. - M., 2006.
2. Fomicheva M.F. Education of children's correct sound pronunciation: Workshop on speech therapy" – M.: Education, 1989.
3.Karelina I.B. Differential diagnosis of erased forms of dysarthria and complex dyslalia // Defectology. - 1996. - No. 5. - p. 10-13.
4. Lopatina L. V. Differential diagnosis of erased dysarthria and functional disorders of sound pronunciation. Proceedings of the conference “Rehabilitation of patients with speech disorders.” – S.-Pb., 2000. – p. 177-182.
Dislalia
Dyslalia (dis - disorder, lalia - speech) is a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus.
Dyslalia is divided into mechanical (associated with damage or abnormal development of the organs of articulation as a result of injury or thumb sucking habit) and functional (not associated with such damage).
Disorders of the structure of the articulatory apparatus include abnormal structure of the jaws (bad bite), teeth, palate (too high, too low, cleft), tongue (massive, too small, shortened hyoid ligament).
With timely speech therapy assistance, dyslalia is quickly and irrevocably compensated for in children. In adults, too, the prognosis is good.
PRACTICE EXAMPLES
Nikolay, 26 years old. He applied with a violation of the sound pronunciation of the sound “R, R” and pronounced it correctly. 4 lessons were held. We did not expect such a quick and dramatic result. The control session after 3 months confirmed the complete automation of sound. I studied a lot on my own.
Sergey, 22 years old. I contacted him regarding a violation of the sound pronunciation of “R, R” . The cause of the violation was: malocclusion, shortened hyoid ligament. After the operation to trim the frenulum and correct the bite, a course of speech therapy classes (10 lessons) was conducted, resulting in complete automation of sounds in independent speech.
