Methods of speech therapy work for closed rhinolalia

Correction of rhinolalia necessarily includes sessions with a speech therapist.
Even if the cause of the speech disorder is not a functional lesion, but an organic one. Parents must understand that surgery alone will not help the child speak clearly and correctly. The operation only allows the speech organs to function correctly, but only a speech therapist can create sounds and form beautiful, clear diction.

Speech therapy plan for rhinolalia

The first stage is preoperative

It is advisable to begin classes with a speech therapist even before surgery. At this stage, the specialist will make efforts to create the sounds available in the child’s “arsenal” and will pay attention to general speech development and proper breathing. Since after surgery the main emphasis will be on developing new capabilities of the articulatory apparatus, you first need to eliminate incorrect movements of the facial muscles and prepare the skills of proper breathing and articulation.

The second stage is recovery after surgery

At this stage, classes are aimed at improving the mobility of the soft palate, correcting incorrect articulation, and practicing the pronunciation of vowel sounds.

The third stage is working on the pronunciation of all sounds, proper coordination of breathing and articulation

At this stage, work is carried out to establish the correct pronunciation of sounds and eliminate the habitual nasality of speech in the child. Exercises are carried out to improve phonemic hearing, and a lot of time is devoted to the grammatical structure of speech.

The fourth stage - automation of the delivered sounds

This period also takes a long time, since children with rhinolalia do not easily automate the correct sounds. The participation of the child’s parents is extremely important. Monitoring the completion of tasks and timely feedback from the teacher are a significant guarantee of achieving a good result.

Speech therapy classes are the main “weapon” for correcting rhinolalia caused by functional disorders, and no less important than a surgeon’s scalpel for organic rhinolalia. Regular exercises will help restore your child’s speech and give him every opportunity for successful communication and learning.

Corrective work for rhinolalia

CORRECTIONAL WORK FOR RHINOLALIA

The formation of phonetically correct speech in preschool children with a congenital cleft palate is aimed at solving several interrelated problems:

1) normalization of “oral exhalation”, i.e. production of a long-lasting oral stream when pronouncing all speech sounds except nasal ones;

2) development of correct articulation of all speech sounds;

3) elimination of the nasal tone of the voice;

4) developing the skills of differentiating sounds in order to prevent defects in sound analysis;

5) normalization of the prosodic aspect of speech;

b) automation of acquired skills in free speech communication.

Solving these specific problems is possible by taking into account the patterns of mastering correct pronunciation skills. When correcting the sound aspect of speech, the acquisition of correct sound pronunciation skills goes through several stages.

First stage

– stage of “pre-speech” exercises – includes the following types of work:

1) breathing exercises;

2) articulation gymnastics;

3) articulation of isolated sounds or quasi-articulation;

4) syllabic exercises.

At this stage, motor skills are mainly trained on the basis of initial unconditioned reflex movements.

Second phase

– the stage of differentiation of sounds, i.e., the education of phonemic representations based on motor (kinesthetic) images of speech sounds.

Third stage

– the stage of integration, i.e. learning the positional changes of sounds in a coherent utterance.

Fourth stage

– the stage of automation, i.e. the transformation of correct pronunciation into normative, so familiar that it does not require special control by the child himself and the speech therapist.

All stages of sound system acquisition are ensured by two categories of factors:

1) unconscious (through listening and reproduction);.

2) conscious (through the assimilation of articulatory patterns and phonological characteristics of sounds).

Corrective tasks have a certain difference depending on whether plastic surgery to close the cleft is performed or not, although the main types of exercises are used both in the preoperative and postoperative periods.

Before the operation, the following tasks

:

1) release of facial muscles from compensatory movements;

2) preparation of the correct pronunciation of vowel sounds;

H) preparation of correct articulation of consonant sounds accessible to the child.

tasks after surgery

much more complicated:

1) development of mobility of the soft palate;

2) elimination of incorrect arrangement of articulation organs when pronouncing sounds;

H) preparation of the pronunciation of all speech sounds without nasal connotation (with the exception of nasal sounds).

The following types of work are specific for the postoperative period:

a) massage of the soft palate;

b) gymnastics of the soft palate and the back wall of the pharynx;

c) articulation gymnastics;

d) voice exercises.

primary goal

of these exercises is to:

– increase the strength and duration of the air stream exhaled through the mouth;

– improve the activity of articulatory muscles;

– develop control over the functioning of the velopharyngeal seal.

The main purpose of soft palate massage is to knead scar tissue. Massage should be carried out before meals, in compliance with hygienic requirements. It is carried out as follows. Stroking movements are made along the suture line back and forth to the border of the hard and soft palate, as well as left and right along the border of the hard and soft palate. You can alternate stroking movements with intermittent pressing ones. It is also useful to apply light pressure on the soft palate when pronouncing the sound a

. The mouth should be wide open.

Gymnastics of the soft palate

includes a number of exercises:

1. Swallowing water or simulating swallowing movements. Children are offered to drink from a small glass or bottle. You can drip water from a pipette a few drops at a time. Swallowing water in small portions causes the highest rise of the soft palate.

2. Yawning with the mouth open; imitation of yawning.

3. Gargling with warm water in small portions.

4. Coughing. This is a very useful exercise, since coughing causes a vigorous contraction of the muscles of the back of the throat. When coughing, a complete closure occurs between the nasal and oral cavities. By touching the larynx under the chin with your hand, the child can feel the palate rise.

5. Clear, energetic, exaggerated pronunciation of vowel sounds in a high pitch of voice. At the same time, the resonance in the oral cavity increases and the nasal tint decreases. First, the abrupt pronunciation of the vowel sounds a, e,

then -
oh, oo
with exaggerated articulation.
Then they gradually move on to clearly pronouncing the sound series a, e, u, o
in different alternations. In this case, the articulatory pattern changes, but exaggerated oral exhalation remains. When this skill is strengthened, they move on to smoothly pronouncing sounds.

Working on breathing

is necessary for the education of correct sound speech. To develop the correct oral air stream, special exercises are performed in which inhalation and exhalation through the nose alternate with inhalation and exhalation through the mouth, for example, example: inhale through the nose - exhale through the mouth; inhale - exhale through the nose; inhale - exhale through the mouth.

With the systematic use of these exercises, the child begins to feel the difference in the direction of the air stream and learns to direct it correctly. This also helps to develop the correct kinesthetic sensations of movements of the soft palate.

It is very important to constantly monitor your child while performing these exercises, since at first it may be difficult for him to feel air leaking through the nasal passages. Control techniques are different: a mirror, cotton wool, or strips of thin paper are placed at the nasal passages.

Producing the correct air stream

Blowing exercises also help.

Breathing exercises

should be carried out in the form of a game, introducing elements of competition. Some of the toys are made by children themselves with the help of their parents. These are butterflies, pinwheels, flowers, panicles, made of paper or fabric. You can use strips of paper attached to wooden sticks, cotton balls on strings, light paper figures of acrobatics, etc. Such toys should have a specific purpose and be used only in classes on teaching correct speech.

You can also blow on light plastic toys floating in water. A good exercise is to blow through a straw into a bottle of water. At the beginning of the lesson, the diameter of the tube should be 5–6 mm, at the end 2–3 mm.

You can invite children to blow on balls or pencils lying on a smooth surface so that they roll. You can organize a game of “soap bubbles”. A more difficult exercise is playing wind instruments. It must be taken into account that breathing exercises quickly tire the child (they can cause dizziness), so they must be alternated with others.

At the same time, a series of exercises is carried out with the children ,

the main goal of which is
the normalization of speech motor skills.
Features of articulation of children with rhinolalia:

1) high elevation of the tongue and its displacement deep into the oral cavity;

2) insufficient labial articulation;

3) excessive participation of the root of the tongue and larynx in the pronunciation of sounds.

Elimination of these articulation features is an important link in the correction of the defect.

Exercises developing lips, cheeks, tongue:

1) inflating both cheeks at the same time;

2) puffing out the cheeks alternately;

3) retraction of the cheeks into the oral cavity between the teeth;

4) sucking movements - closed lips are pulled forward with the proboscis, then return to their normal position. The jaws are closed;

5) grin: lips stretch strongly to the sides, up and down, exposing both rows of teeth;

6) “proboscis” followed by a grin with clenched jaws;

7) grin with opening and closing of the mouth, closing of the lips;

stretching out the lips in a wide funnel with the jaws open;

9) stretching the lips with a narrow funnel (imitation of whistling);

10) retraction of the lips into the mouth, pressing tightly against the teeth with the jaws wide open;

11) imitation of rinsing teeth (the air presses heavily on the lips);

12) lip vibration;

13) movement of the lips with the proboscis left and right;

14) rotational movements of the lips with the proboscis;

15) strong puffing of the cheeks (air is retained in the oral cavity by the lips).

Tongue exercises:

1) sticking out the tongue with a shovel;

2) sticking out the tongue with a sting;

3) protruding the flattened and pointed tongue alternately;

4) turning the strongly protruding tongue to the right;

5) raising and lowering the back of the tongue - the tip of the tongue rests on the lower gum, and the root either rises or falls;

6) suction of the back of the tongue to the palate, first with the jaws closed, and then with the jaws open;

7) the protruding wide tongue closes with the upper lip, and then retracts into the mouth, touching the back of the upper teeth and palate and bending the tip upward at the soft palate;

sucking the tongue between the teeth, so that the upper incisors “scrape” the back of the tongue;

9) circular licking of the lips with the tip of the tongue;

10) raising and lowering a wide protruding tongue to the upper and lower lips with the mouth open;

11) alternately bending the tongue with a sting to the nose and chin, to the upper and lower lips, to the upper and lower teeth, to the hard palate and the floor of the oral cavity;

12) touching the upper and lower incisors with the tip of the tongue with the mouth wide open;

13) hold the protruding tongue with a groove or boat;

14) hold the protruding tongue with a cup;

15) biting the lateral edges of the tongue with the teeth;

16) resting the lateral edges of the tongue on the upper lateral incisors while grinning, raise and lower the tip of the tongue, touching the upper and lower gums with it;

17) with the same position of the tongue, repeatedly drum the tip of the tongue on the upper alveoli ( t-t-t-t

);

18) make movements one after another: tongue with a sting, cup, up, etc.

The listed exercises should not be given all in a row. Each small lesson should consist of several elements: breathing exercises, articulatory gymnastics and training in pronouncing sounds.

Working on sounds requires a lot of attention and effort

.
The vowel sounds a, o, u, e
are placed first. Initially, sounds are practiced in abrupt, isolated pronunciation with a gradual increase in the number of repetitions per exhalation.

With each pronouncement, control over the direction of the air stream is necessary. To do this, the child holds a mirror or light cotton wool near the wings of the nose.

Then the child is trained in repeating vowels with pauses, during which he learns to keep the soft palate in a raised position (he needs to be shown the correct position of the soft palate in front of a mirror). Pauses are gradually increased to 2–3 s. Then you can move on to smooth pronunciation.

The production of consonant sounds begins with the sounds f

etc.

Exercises for setting and consolidating sounds should be carried out in large quantities and in a variety of combinations .

A good technique that facilitates the introduction of sounds correctly pronounced in an isolated position into independent speech is singing. During singing, the closing of the soft palate and the back wall of the pharynx occurs reflexively and it is easier for the child to concentrate on articulating sounds.

Children with rhinolalia who attend a special kindergarten, under the guidance of a speech therapist, master the correct pronunciation of sounds. Classes are conducted both in groups and individually.

When drawing up an individual plan, the speech therapist should adhere to the following directions:

normalization of the sound side of speech, elimination of lexical and grammatical underdevelopment. A number of sections are included:

1. Sounds subject to production, correction, clarification or differentiation. Attention is drawn to the violation of the actual articulation of sounds and the degree of nasalization when pronouncing them.

2. Rhythmic-syllable structure. Difficulties in pronouncing sounds in complex positions (such as SSG), as well as in polysyllabic words and at the end of a phrase are identified.

3. Phonemic perception and the state of auditory control over one’s own speech.

In the first period of study

in kindergarten for an individual.
a, e, o, u, s
and consonants
p, p'
is clarified f, f'; in, in'; t, t'; production and initial consolidation of sounds:
k, k';
x, x'; s, s'; g, g'; l, l'; b, b'. In the second period

sounds are voiced: and; d, d'; z, z'; w; R.

In the third period

The sound
zh
,
affricates
, and work continues to clarify the articulation of previously learned sounds. At the same time, work is underway to eliminate the nasal tint.

Much attention is given to the differentiation of oral and nasal sounds: m – p; m' n'; n – d; n – t; m – b; m' – b'.

Exercises to correct rhinolalia

Some types of classes should be carried out exclusively by a specialist. For example, in the postoperative period, in addition to breathing exercises, a special massage is also performed to restore the mobility of the soft palate. Parents should not do it themselves.

But many of the exercises can be repeated at home. Frequent “training” will help the child get used to it faster. However, it is important to follow the basic rules:

1. classes should not overtire the child;
2. his diligence must be supported by his family;
3. all exercises must first be worked out with a speech therapist to eliminate the possibility of incorrect execution.

Examination of children with rhinolalia

If a child has a congenital cleft palate, then a systematic approach is used in the treatment of rhinolalia. In addition to a thorough study of the structure and operation of the articulatory apparatus, respiratory and vocal function, a speech therapy study of the state of sound pronunciation, phonemic perception, and the development of vocabulary and grammar is mandatory.

Stage 1 – instrumental methods

At the 1st stage, the examination is carried out by doctors who use special methods. Radiography

is necessary to establish the anatomical and physiological structure of the child’s speech apparatus, the mobility of the soft palate, the characteristics of the velopharyngeal closure, and the activity of the pharyngeal muscles.
The study of timbre and pitch of the voice reveals spectral analysis. The X-ray tomography
method studies the position of the speech organs, the degree of mouth opening, and the direction of tongue movements.
The spirometry
method provides data on respiratory function and lung capacity.
Using rhinoscopy,
the structure and growth in the nasal cavity are studied.
A phonendoscope
examines the presence of submycotic clefts (Gutsman test). Using syllable tables, speech intelligibility is studied (audit analysis method). Only after a medical examination is a diagnosis made: open, closed or mixed rhinolalia.

Stage 2 – psychological examination

The second stage is a psychological examination. Specialists examine the state of memory, attention, thinking, emotional-volitional sphere, communication skills, features of the child’s mental development, leading activities, level of sensory development, general and fine motor skills.

Schoolchildren are examined in reading and writing.

The speech therapist makes a conclusion: FN (phonetic disorder), FFN (phonetic-phonemic disorder), GSD (general speech underdevelopment).

Up

Breathing exercises

Rhinolalics are characterized by breathing with exhalation both through the mouth and through the nose. Therefore, teaching a child to control inhalation and exhalation is very important. To control, you can use a piece of cotton wool or a napkin applied to your nose. The purpose of the exercises is to teach you to “blow” only through your mouth.

Inhale - exhale

This exercise will help you learn to control your breathing. The child inhales and exhales in a strictly defined manner. For example, inhale and exhale through your nose, the next time you inhale and exhale only through your mouth. We complicate the task - inhale through the nose, exhale through the mouth, the next inhale-exhale through the nose, then only through the mouth. And so on.

Storm in a teacup

Playing with water will help to visually control your mouth breathing. Children enjoy blowing into the water through a straw, creating real storms and storms. To prevent the water from splashing, it is more convenient to take a bottle rather than a wide glass. Just be sure to be transparent so that the seething is clearly visible. When the child learns to blow into a tube, creating a gurgling sound, you need to try to lengthen the exhalation. For the storm to be “real,” the exhalation must be uniform and long.

Games for blowing out candles, kicking soccer balls made from cotton balls, various toy wind instruments and blowing up balloons are also very useful. However, what is important here is the gradual complication of the task and the absence of overload. Breathing exercises should not be long, so that the child does not feel dizzy.

Article:

Speech therapy work with children suffering from rhinolalia begins at 2-3 years of age and is carried out both in the preoperative and postoperative periods.
If we keep in mind only rhinolalia (without taking into account the possible general underdevelopment of speech that accompanies it), then the ultimate goal of speech therapy work is to remove the nasal tone of the voice and develop correct sound pronunciation, which will ultimately ensure the normalization of the child’s speech function. However, neither one nor the other can be achieved without providing the necessary prerequisites. These include the development of mobility of the soft palate, the development of a sufficiently strong and prolonged oral exhalation, and the achievement of a forward position of the tongue. The creation of these prerequisites begins already in the preoperative period. The main goal of preoperative speech therapy and a set of therapeutic measures is to prevent as much as possible those possible deviations in the development of the child, which are, as it were, predetermined, programmed by the very fact of the presence of a cleft, and also to prepare more favorable conditions for the operation. During this period, the main attention should be paid to the following.

1. Prevention of the appearance of asthenic syndrome. Since it is known in advance that children with congenital cleft palates are weakened and predisposed to colds, from a very early age it is necessary to take care of hardening the child and stimulating his physical development. Hardening is carried out from the very first months of life. For this purpose, you can use air baths, water procedures, and walks with the child in the air that gradually increase in duration, provided that their duration is gradually increased and the temperature does not fluctuate too sharply.

Stimulation of physical development is achieved mainly through outdoor games and special physical exercises. At the earliest stages of development, it is best to “follow” the course of normal ontogenesis, somewhat activating those movements that are available to a child of a given age. For example, if in the period from 6 to 10 months the child mainly crawls, then attention is focused on intensifying crawling. To stimulate this motor process, the child is asked to crawl either to his mother, or to his father, or to his grandmother, or for a bright toy. The distance can be gradually increased. At the appropriate age, approximately the same thing is done with walking and running. Hide and seek, ball and other outdoor games are used.

2. Prevention of tongue fixation in the wrong position. For this purpose, from the very first days of his life, they avoid placing the baby on his back, so that this position itself does not provoke the tongue to sink back. In the future, they try in every possible way to stimulate the movements of the tip and the front part of the back of the tongue (for example, you can systematically invite the child to lick jam from the upper lip, “brush teeth” with the tip of the tongue, play “clock”, moving the tongue sticking out of the mouth from one corner of the mouth to another and etc.).

The anterior position of the tongue is very important for educating the child already in the preoperative period of oral exhalation, since the root of the tongue, pulled deep into the oral cavity, prevents air from escaping through the mouth. Correct oral exhalation with the root of the tongue lowered allows you to completely remove the nasal connotation on a particular sound, and subsequently in the entire speech. The anterior position of the tongue and every possible activation of its tip are also necessary for the development of correct articulation of sounds, most of which in the Russian language are anterior lingual.

3. Prevention of respiratory dysfunction. Since with rhinolalia there is a leak of air through the nose and the exhalation itself is very shortened and wasteful, you need to try to prevent the final consolidation of this method of breathing. The main task is to develop a sufficiently long and economical, stable oral exhalation, which could be used to pronounce an entire phrase. For this purpose, special breathing exercises are used to prevent a decrease in the volume of inhaled and exhaled air and thereby prepare the child’s respiratory apparatus for normal speech load. Along with this, the child must be taught to breathe through the nose and not the mouth.

To develop the duration of oral exhalation, starting from the age of 1.5-2 years, you can teach your child to “chill tea”, “warm hands” with the warmth of your breath, blow on a sore spot, etc. Exercises such as “sniffing” contribute to the development of inhalation through the nose flower." In the future, you can use rolling round pencils on the table located at the level of the child’s mouth; playing the harmonica, blowing out a candle with a gradual increase in the distance to it, “blowing” fluff flying in the air, blowing away dandelions, etc. However, due to the great tediousness of breathing exercises, they are carried out for 1.5-2 minutes, but in the process of one classes are repeated several times. Breathing exercises, in addition to solving purely speech therapy problems, also contribute to more complete development of the child’s chest, and consequently, to strengthening his health

4. Activation of the muscles of the velopharyngeal ring. It is very important already in the preoperative period, since it significantly improves the conditions for the operation. Here you can recommend exercises such as coughing lightly, yawning, and swallowing small portions of milk or water. In this case, the soft palate (and before the operation - its fragments) reflexively rises upward. A finger massage of the segments of the hard and soft palate is also carried out, which the child’s mother is taught in the maternity hospital. These exercises are resumed two to three weeks after surgery, but even more attention is paid to activating the soft palate. In many cases, physiotherapy is also used for this purpose. The main goal of this work is to ensure closure of the soft palate with the posterior wall of the pharynx, which is necessary to achieve isolation of the nasal cavity from the oral cavity. Rhinolalia is a nasal tone of voice, accompanied by disturbances in sound pronunciation and caused by defects in the structure and functioning of the speech apparatus (rhinos, in Greek - nose, lalia - speech). Previously, the term “nasality” was used to denote this speech disorder, which has a folk origin and reflects the peculiarity of the external manifestation of the disorder.

Movement of the soft palate: A - the soft palate is raised and pressed tightly against the back wall of the pharynx. The timbre of the voice when pronouncing all speech sounds, except nasal ones, is normal; B - the soft palate is raised and pressed against the thickened posterior wall of the pharynx. Voice timbre is normal; B - the soft palate is not raised enough. There is no contact between the soft palate and the walls of the pharynx. Exhaled air freely penetrates into the nasal cavity. Voice timbre is nasal.

5. Development of mobility of articulatory muscles as a necessary prerequisite for developing the correct pronunciation of sounds. Concern about this should begin from a very early age. First, so-called passive movements are carried out. The mother uses her fingers to gather the child’s lips into a tube, and then stretches them into a smile; lifts the upper lip up, exposing the upper gums, after which the lower lip is lowered down, exposing the lower gums. At a later age, they gradually move on to actively performing these same movements by the child himself. Already in the preoperative period, in children with rhinolalia, it is essentially possible to develop the correct articulation of all speech sounds, although the nasal tone of the voice is preserved. But what is important here is that the child gets used to using articulate speech from the very beginning, and does not remain “speechless”, capable of making only mooing sounds. The correct position of the articulatory organs, brought up before the operation, is quickly restored and is more likely to be strengthened in the postoperative period, which significantly reduces the duration of speech therapy work after the operation.

6. Development of voice strength and flexibility. As already noted, the presence of a cleft palate in a child leads to the fact that his voice sounds quiet and muffled. Knowing this, it is necessary to take at least the simplest preventive and corrective measures as early as possible. You can play with your child in imitating the voices of different animals (for example, the low voice of a bear or the moo of a cow and the much higher voice of a cat meowing). It is also good to use “rocking a doll” with its characteristic alternation of higher and lower sounding sounds A. To involuntarily increase the strength of the voice, it is useful to move some distance away from the speaking child. However, all these exercises should be carried out very carefully, without any overstrain of the child’s weak vocal function.

7. Prevention of delayed speech and mental development of the child. This area of ​​preoperative speech therapy is important because the presence of a cleft palate greatly limits the child’s speech communication capabilities and can secondarily cause a delay not only in speech, but also in mental development. To prevent this, it is necessary to attract the child’s attention to speech from a very early age, talk to him more, giving him the opportunity to see the speaker’s face, which will stimulate the need to imitate audible sounds. Later, you should work on expanding your understanding of the speech of others, enriching your vocabulary, clarifying the syllabic structure of words, paying special attention to the child’s correct pronunciation of their endings (prevention of agrammatisms).

8. Prevention of the appearance of secondary mental layers. This very important area of ​​preoperative speech therapy consists of providing psychotherapeutic influence on the child and his immediate family. From the very first days of a child’s life, such an impact is exerted on his parents and, above all, on his mother. A detailed explanatory conversation is held regarding the structure of the speech apparatus and those measures to normalize the child’s appearance and speech that will need to be taken in the future. It is advisable to show photographs of children with cleft lips and palates before and after surgery, as well as to listen to tape recordings of their impaired and normal speech. The general conclusion from this initial conversation, which is quite consistent with the real state of affairs, should be this: everything will return to normal, but only for this it will be necessary to make the necessary efforts over a more or less long period of time. From the very beginning, parents need to be tuned not to worries, but to greater internal self-discipline and activity. Correct behavior of parents towards the child can minimize the need for psychotherapy with him. Otherwise, psychotherapy is carried out not only with the parents, but also with the child.

In the postoperative period, basically the same areas of speech therapy work are maintained and the previously achieved results are consolidated in the new conditions. To prevent the formation of hard postoperative sutures that limit mobility, it is important to carry out active digital massage of the soft palate along the suture line by intermittent pressure on it in order to knead the scar tissue. Light stroking movements are also made on the velum palatine, and light blows are made on it to stimulate innervation.

Subsequently, the nose and mouth no longer close, but both inhalation and exhalation are carried out only through one of the named resonators. At this stage of work, a wide variety of combinations of differentiated inhalations and exhalations are recommended. For example:

• inhale through the mouth and exhale through the mouth;

• inhale through the nose and exhale through the nose;

• inhale through the mouth, exhale through the nose;

• inhale through the nose, exhale through the mouth.

To achieve better performance results and increase the child’s interest in performing the exercises correctly, visual control is used: a narrow strip of thin paper (such as tissue paper) is placed under the very nasal passages, which should remain completely motionless when exhaling correctly through the mouth. The deviation of this piece of paper will indicate that part of the exhaled air is coming out through the nose, which should not be the case.

In addition to visual control, auditory control is gradually developed - the child is trained in distinguishing between a normal-sounding voice and a voice with a nasal tint. At first, you can use the imitation of one or another method of voice production by the speech therapist himself. At the same time, the child determines each time which of the phrases was pronounced correctly and which was not. Developing this skill is very important for subsequent self-control of speech, since a child with rhinolalia cannot hear the nasal sound of his voice.

In the postoperative period, much attention is also paid to the correction of sound pronunciation, during which previously developed skills of correct articulation of sounds are widely used and finally consolidated. At the same time, in the process of correcting each individual sound, in addition to monitoring the correct position of the articulatory organs, special attention is paid to removing nasalization.

At the final stage of work, much attention is paid to the complete automation of correct speech skills. At this stage, control over the child’s speech outside the speech therapy room plays an extremely important role, in which parents must provide literally indispensable assistance. Equally important is the child’s self-control, in whose upbringing parents should again help by constantly drawing the child’s attention to the nasal tone of his voice that periodically appears in his voice.

The effectiveness of speech therapy work to overcome rhinolalia largely depends on the results of the operation - the extent to which it was possible to restore the anatomical structure of the hard and soft palate and ensure the mobility of the soft palate. In addition, the psychophysical state of the child, the characteristics of his behavior and character, his attitude to classes and the degree of assistance to the speech therapist from the parents are very important for achieving a positive result.

Articulation exercises

To correct articulation disorders caused by rhinolalia, special exercises are needed:

1. “Snake or spade” - you need to learn to stick out your tongue with a pointed tip, and then widely flattened. The next stage is to alternate between “snake” and “shovel”.
2. “Bend the back” - the tip of the tongue rests on the lower gums, and the back of the tongue curves up and down.
3. “Inflate and deflate” - the cheeks need to be inflated and deflated, pulling them between the teeth. As an option, learn to inflate not both cheeks at once, but alternately. An adult can help deflate the puffy cheek by lightly touching it with a finger.
4. “Rinse your teeth” - imitate rinsing your teeth without water (the air should press on your lips).
5. “Elephant exercise” - the child must learn to hold his lips closed and extended forward with his “proboscis”, and then move it left and right and even rotate it.

How to help a child with rhinoplasty

In correctional preschool institutions there are children with cleft palate, or rhinolalic. And the teacher immediately has a question: “Where to start the correction?” But first you need to understand what rhinolalia is.

This is a sound pronunciation disorder that occurs due to excessive or insufficient resonance in the nasal cavity. As a result, the air stream takes a “different path”, and speech takes on a “nasal” tone. Before starting speech therapy work, the child must undergo x-rays. This will determine whether it is possible to restore the functions of the palate using speech therapy techniques.

If it is possible to restore the functions of the palate through speech therapy, I use various exercises.

Exercises to develop voice power

1. Open your mouth wide and yawn deeply.
2. Yawn with your mouth closed. 3. Yawn, while exhaling, pronounce the sound [mm-mm]. 4. Yawn, as you exhale, pronounce the syllables: ah, oh, uh. 5. Silently depict the sounds [a, u, o, i, s, e]. 6. Pronounce the sound in a whisper, in a voice. Exercise "Ladder"

: the child, climbing the stairs, pronounces vowel sounds, first quietly, then louder and louder. Going down, the child pronounces sounds more quietly.

To produce the correct air stream, you can use cotton wool, a paper strip, or paper toys.

The child places the cotton wool on his palm, draws in air through his nose and exhales through his mouth onto the cotton wool, without puffing out his cheeks.

The child takes any paper toys, inhales through his nose, exhales through his mouth, does not puff out his cheeks, his back is straight, the toys are at a distance of 15 cm.

Children enjoy playing the pipe, harmonica, and flute, which also helps in working on proper breathing.

With systematic exercises, the child begins to feel a change in phonation and learns to correctly direct the exhaled air. Working on breathing is necessary for correct sonorous speech.

Gradually, the rhinolalik begins to feel its inhalation and exhalation, and learns to control them.

Correct full inhalation skills

Lie on your back, place the palm of one hand on your chest, and the palm of the other hand on the iliac region of the abdomen between the navel and the lower border of the chest.
After exhaling deeply, inhale smoothly and leisurely through your nose so that the upper front wall of your abdomen protrudes forward, raising your arm. In this case, the chest, controlled by the other hand, should remain at rest. Exhale smoothly, through the mouth and as completely as possible. At the same time, the stomach drops and at the end of the inhalation it retracts. Do 3-5 such smooth rhythmic breathing. Subsequently, you can do this exercise while sitting and standing. Lie on your back, place a bag weighing 1.5–2 kg, measuring 50x20 cm, on your stomach in the area of ​​the right and left hypochondrium. Take a deep breath through your nose and spread your arms to the sides. By moving the front wall of the abdomen, you need to raise the bag of sand as high as possible. As you exhale slowly, lower the bag.

Speech muscle training

When performing exercises to train the muscles of the lower jaw, you should keep your head straight, without lowering or raising it sharply;
lower the jaw without jerking or excessive tension; Perform each exercise rhythmically, fixing it in position on a count of 1–5. 1. Open your mouth and close it. (The mouth should be opened so that three fingers can fit into it, placed on the edge between the upper and lower teeth.) 2. Hold a pencil, plastic tubes, and gauze with your lips. 3. Open your mouth while simultaneously moving your lower jaw forward. 4. Bite your upper lip with your lower teeth, then bite your lower lip with your upper teeth. 5. Open your mouth. Imagine that there is a weight hanging on your chin that needs to be lifted up, while raising your chin and straining the muscles underneath it. 6. Squeeze your jaw with force, tense the muscles of your neck and jaw (remember this feeling), relax them and open your mouth.

To train the muscles of the tongue, I suggest the following exercises:

:

1. Open your mouth, your lips are in a smile, your tongue sticks out like a cup or a ladle. Blow the cotton wool off the tip of your nose, the air comes out through the middle of your tongue, and the cotton wool flies straight up. Make sure that the lower jaw is motionless, and the lower lip does not tuck or pull over the lower teeth. 2. Blow on closed lips, causing them to vibrate. 3. Lips in a smile, a wide tongue between the lips and teeth. Blow on the tongue so that the vibration from the lips is transferred to the tongue. Make sure that your tongue and lips are relaxed and not tense. The cheeks should not puff out. 4. The mouth is open, the lips are in a smile, the lateral edges of the tongue rest against the lateral upper teeth. Repeatedly drum with the tense, wide tip of the tongue on the upper gum: d-d-d, gradually increasing the tempo. Make sure that the lower jaw does not move, the lips remain in a smile, the sound has the character of a clear blow, so that the exhaled stream of air is felt. 5. The mouth is open, the lips are in a smile, lift the wide tip of the tongue over the upper teeth and say “yes-yes” repeatedly - first slowly, then gradually increasing the pace. The lips and lower jaw are motionless, only the tongue works.

I built a system of work based on an individual approach and outlining the main goal: to form correct breathing in the child. This corrective work brings positive results.

Larisa Voronina, teacher-speech therapist,
d/s No. 152, Murmansk

Staging sounds

The vowels begin to be practiced first - first A, and after it E, O, U, I. The child learns to correctly pronounce sounds in isolation, one at a time, gradually connecting them together.

Exercises:

1. Pronounce the sound once while exhaling.
2. After some time, the teacher suggests increasing the number of repetitions per exhalation.
3. Alternating combinations of vowels - the child pronounces already mastered sounds together.
4. In the process of practicing, children pronounce sounds in “different voices” - low (like a wolf or a bear), high (like a bird or a bunny), at a normal level.

After practicing vowel sounds and mastering proper breathing and articulation, the speech therapist moves on to the production of consonants. The first sound in line is F. Then they begin to work on voiceless fricatives and plosives, voiced, occlusive fricatives and sonorants. However, of course, in each specific case the sequence of sound production is determined by the speech therapist depending on the situation.

Exercises for automating sounds must be built from simple to complex and based on already learned phonemes, so that it is not difficult for the child to practice.

A good option for practicing pronunciation is singing. When a child sings, the velum closes on its own, which means it becomes possible to pay more attention to controlling the pronunciation of phonemes.

Development of breathing and correction of its disorders in dysarthria

An important section of speech therapy work for dysarthria is the development of breathing and the correction of its disorders. Correction of breathing disorders begins with general breathing exercises, the purpose of which is to increase the volume, strength and depth of inhaled and exhaled air and normalize the breathing rhythm.

The speech therapist conducts passive breathing exercises . While doing breathing exercises, you can turn on or hum a quiet, smooth melody or calmly and affectionately tell something to your child. Breathing training is carried out in various positions of the child: lying on his back, sitting, standing. With infants and young children, as well as with severe motor disorders, breathing exercises should be carried out in a supine position in “reflex-inhibiting positions.”

It is advisable to use the following breathing exercises . 1. In the supine position, by lightly stroking the body and, above all, the upper shoulder girdle, as well as shaking the child’s limbs, some relaxation of the skeletal muscles is achieved. Having grabbed the child’s hands and lightly shaking them, the speech therapist spreads his arms to the sides, raises them up (inhale), then lowers them forward, pressing his hands to the body and lightly pressing on the chest (exhale). 2. In the supine position, in the rhythm of breathing, gently shaking the child’s legs, they are stretched, unbent (inhalation occurs), and bending them at the knees and bringing them to the stomach strengthens and lengthens the exhalation. To activate the diaphragm, this exercise can be performed with the child’s hands under the head. 3. Simultaneously with turning the child’s head to the side, the speech therapist moves his hand to the appropriate side (inhale). Lightly shaking the hand, return the hand and head to their original position (exhale). This exercise helps develop rhythmic movement and breathing. 4. The child lies on his stomach, his arms under the chest rest on a hard surface, his head is lowered. The speech therapist raises his head and shoulders while leaning on his hands (inhale), then lowers them (exhale). It is necessary to strive to actively involve the child in the exercise through play (“Here is our baby! Peek-a-boo, our baby is hiding”). 5. With the child lying or sitting, the speech therapist puts his hands on the child’s pectoral muscles and listens to the rhythm of breathing. At the moment of exhalation, it presses on the chest, as if preventing inhalation (for several seconds). This exercise promotes deeper and faster inhalation and longer exhalation. 6. The child is lying or sitting. A “fan of air” is created in front of his nostrils, which increases the depth of inspiration. 7. The child is asked to hold his breath as long as possible, thus achieving a faster and deeper inhalation and slow exhalation.

Depending on age and functionality, the length of inhalation and exhalation is set individually. When performing any passive movement, it is advisable to carry out afferent stimulation of various analyzers (auditory, visual, kinesthetic). When activating the child’s activity, it is necessary to focus his attention on performing the exercise. The child should not only feel the movement, but also hear the verbal instructions for it and, if possible, see its implementation (in the mirror).

To work on mastering voluntary breathing, so that the child can voluntarily change the rhythm, hold inhalation and lengthen exhalation, long-term training based on involuntary breathing movements is required. For example, a child involuntarily took a deep breath or yawned, the speech therapist fixes his attention on deep inhalation and exhalation (“Oh, how you can breathe deeply! Well, let’s try to breathe so much more”). The child tries to repeat the involuntary breathing movement that has just occurred. This is how a gradual transition occurs from unconditioned reflex reactions to voluntary active respiratory movements.

Involuntary exhalation can be achieved with the following exercises: 1) the speech therapist presses on the shoulders of a sitting child and invites him to rise. The child, trying to do this, presses his feet hard into the floor, straightens his back, and stops breathing. However, the speech therapist, having eased the pressure, still allows him to rise. At this time, the child involuntarily takes a deep, relieved exhalation. This exercise is repeated at least 5 times until a controlled exhalation is achieved. Unbeknownst to himself, the child already takes a breath much deeper than at the beginning; 2) the speech therapist lightly presses on the sitting child’s back and invites him to fall back into the speech therapist’s arms. The child is forced to strongly tense the abdominal muscles, limbs, intercostal muscles and hold his breath. Allowing the child to lie back, the speech therapist achieves an involuntary deep exhalation. After a number of attempts, the child repeats the deep exhalation consciously. At a certain moment, the child is asked to repeat, after the speech therapist, a voiced exhalation that resembles a groan (audible phonatory effort).

The listed and other exercises deepen breathing, make it more rhythmic, enhance ventilation of the lungs, and promote the functioning of the respiratory center. But all of them are only necessary preparation for further work on the organization and development of speech breathing.

With the development of speech breathing, the speech therapist carries out work aimed at differentiating nasal and oral inhalation and exhalation. It is necessary to make the oral exhalation as voluntary, prolonged, and rhythmic as possible. The speech therapist performs all exercises together with the child: 1) to train inhalation and exhalation through the mouth, the speech therapist closes the child’s nostrils and asks him: “Let’s breathe like a dog”; 2) to train nasal inhalation and exhalation, the speech therapist closes the child’s mouth, holding the closed lips with his fingers. Preschool children are given the instruction: “Don’t open your mouth. Inhale deeply and exhale long through your nose.” After some time, the child begins to monitor the position of his mouth himself. When practicing inhaling through the nose, you can play the game “Let's smell the flower”; 3) mouth closed. The speech therapist closes one nostril, and the child breathes to a certain rhythm (counting or the beat of a metronome); then closes the other nostril, and repeats the same cycle of breathing exercises; 4) to form an extended voluntary exhalation through the nose, learn to blow your nose correctly; 5) to consolidate an extended voluntary exhalation (through the mouth), it is necessary to rely as much as possible on kinesthetic sensations. The child should “see and hear” his exhalation. For this purpose, it is recommended to blow through a tube, straw, or pipette into water. The child blows and watches bubbles appear. Then he blows with his eyes closed (to enhance kinesthetic sensations). The speech therapist gives instructions to the child: “Make big bubbles, look, listen,” “Make one small, one big bubble alternately”; 6) for the formation of arbitrary directed exhalation through the mouth, special games-exercises are of great importance: blowing soap bubbles, blowing out candles, blowing small fluffs and pieces of paper off the table, blowing into a pipe, whistle, harmonica. You can play the games “Whose bird will fly farthest”, “Dandelion”, “Whose steamer hums longer”. Games are selected differentially depending on age and the nature of the breathing disorder; 7) oral exhalation can be supported by the feeling of air on the hand. First, the speech therapist blows on the child’s hand, drawing his attention to the sensation of air: “Can you feel the wind?” Then the child himself blows on his hand; Finally, it is very important to teach the child to voluntarily inhale through the nose and exhale through the mouth.

Later, at the moment of oral exhalation, the speech therapist pronounces various vowel sounds (first in a whisper, then loudly), stimulating the child to imitate him. In order to increase the length of the oral exhalation, the child pronounces gradually lengthening chains of vowels in one exhalation.

When performing breathing exercises, you should not overtire the child. It is necessary to ensure that he does not strain his neck, shoulders, or take an incorrect position. The child's attention should be focused on the sensations of movements of the diaphragm, intercostal muscles, and the duration of voluntary inhalation and exhalation. You need to monitor the smoothness and rhythm of your breathing movements. Breathing exercises should be carried out before meals, in a well-ventilated area.

From the book Prikhodko O. G. “Speech therapy massage for the correction of dysarthric speech disorders in children of early and preschool age.

Exercises to develop phonemic awareness

1. "Who is there?" - the child is asked to close his eyes and recognize musical instruments, sounding toys, and people’s voices by ear. Important: he must know all these sounds well before.
2. “Repeat” - the teacher invites the child to repeat after him a set of identical syllables with the emphasis on the first vowel (mA-ma-ma), then on the second (ma-ma-ma) and on the third.
3. “Find the mistake” - children love to “correct” adults, so this game is usually popular. The teacher reads the text, and the child must “convict” the author of the mistake. For example: Our Mishka has a big chip (bump) on his forehead.

Classes do not include all exercises at the same time. The speech therapist selects the necessary ones depending on the specific situation and the child’s readiness.

Publication date: 05/31/2017. Last modified: 05/09/2018.