Specifics of correctional and speech therapy work on the formation of an active vocabulary with preschool children with cerebral palsy

On time means as early as possible

A child with a birth injury, at risk of developing cerebral palsy, omitting the infrequent cases of late diagnosis, as a rule, from infancy is under the close supervision of neurologists and physical therapists, but rarely on time (and in the case of a child with cerebral palsy, on time - this is as early as possible) to a speech therapist. This is understandable - first you just need to survive. Later, master at least some movements. There is no time for speech anymore - you don’t know what to grab onto.

Meanwhile, early speech therapy work with such children can help both the timely development of speech and correct vital functions - swallowing, sucking, chewing.

In most cases, cerebral palsy causes special speech development. This is due both to damage to certain brain structures, and to a limitation in the amount of knowledge and ideas about the environment, and a lack of objective and play activities as the basis for speech development. Most children with cerebral palsy have a delay in speech development - and a specialist can detect this delay at a very early age, in the so-called pre-speech period - by a monotonous weak cry, poor humming and babbling. Also, at a very early age, problems with sucking and swallowing become noticeable, and later – difficulty chewing.

In the first years of a child’s life, we can often observe a slow pace of speech development - as a rule, at an early age, even in severe cases of the disease, the development of general motor skills is ahead of the development of speech.

Children with cerebral palsy pronounce their first words on average only at 2-3 years of age, but after three years, subject to regular speech therapy sessions, a noticeable leap in speech development often occurs; speech begins to outstrip motor skills and rapidly develop. If the child’s intelligence is preserved, the tone and mobility of the muscles of the articulatory apparatus are changed slightly, then with regular classes with a specialist, speech development at school age occurs within the age norm.

Zhigoreva M.V., Ph.D. ped. Sciences, Associate Professor at Moscow State Pedagogical University named after. M.A. Sholokhova, Moscow One of the components of complex correctional and pedagogical work is speech therapy rhythm. Its system was developed by N.G. Alexandrova, V.A. Griner, N.P. Zbrueva, G.A. Volkova, N.A. Rychkova and others. In the work of G.A. Volkova disclosed the goals, objectives and content of logorhythmics with children with various deviations in speech development, including those caused by cerebral palsy [1]. The experience of working with preschoolers with disorders in the musculoskeletal system, accumulated on the basis of the Moscow combined kindergarten No. 2022, forced us to rethink the approaches to organizing logorhythmic classes with them, as well as to supplement the content of this work. In logorhythmics, correctional work is based on the interaction of movement, music, and speech. For children with cerebral palsy, the problem is that the characteristics of each of these components do not correspond to the norm to a certain extent. Let's consider the first component - movement. In cerebral palsy, the impairment of motor functions is primary and represents a peculiar deviation of motor development, which, without appropriate correction, has an adverse effect on the entire course of formation of neuropsychic functions. Damage to the central nervous system in cerebral palsy disrupts the functioning of muscle patterns of voluntary movements, which determines one of the main difficulties in the development of motor skills, and therefore affects the performance of the most basic exercises. The second component is music. On the one hand, it creates a sense of beauty, raises the emotional mood, and increases the motivation to learn. On the other hand, the most important expressive means of music are rhythm and tempo, the observance of which is extremely difficult for children with cerebral palsy. Various disorders of muscle tone (spasticity, rigidity, hypotonia, dystonia), the presence of hyperkinesis, tremor, synkinesia do not make it possible to perform movements at a given rhythm and tempo. At the same time, trying to withstand them can quickly tire the child. The third component is speech. The works of domestic and foreign researchers indicate that with cerebral palsy, along with disorders of the musculoskeletal system, various speech disorders (dysarthria, anarthria, stuttering) are noted. Children with cerebral palsy are characterized by various forms of speech dysontogenesis, manifested in the form of both reversible disorders (delayed pre-speech and speech development) and more persistent systemic disorders (SSD). Therefore, tasks that include speech material must be individual. These contradictions can be avoided if it is appropriate to use each of the components. The identified violations determine not only the relevance of their study, but also the need to change a number of fundamental requirements for methods of logorhythmic work with such children. The goal of speech therapy rhythms for children with cerebral palsy is to maximize the comprehensive development of the child in accordance with his capabilities and appropriate adaptation to the social environment. To achieve this goal, it is necessary to solve the following tasks: - promote the mastery of certain types of motor activity, strengthening the musculoskeletal system; — correct speech disorders (speech breathing, oral praxis, prosody, phonemic hearing, sound pronunciation); - expand and enrich vocabulary, form coherent speech and its grammatical structure; - develop mental functions (visual, auditory perception, memory, attention); - develop spatial orientation skills; - carry out aesthetic and moral development using teaching methods and organization of the environment (didactic aids, musical accompaniment, etc.); — activate potential creative abilities, encouraging children to take initiative, improvise, etc.; — to form the basis of socialization through exercises that imitate everyday actions, playing out scenes from life, etc. Principles of constructing logorhythmic classes 1. Logorhythmic classes for children with cerebral palsy are based on the general provisions of correctional pedagogical work with preschoolers with developmental disabilities, and the theoretical concept of the structure of the defect (the presence of primary and secondary deviations), which is subject to correctional changes and compensatory restructuring. 2. Logorhythmic activities are an integrated activity that combines the tasks of developing a child’s personality. An interdisciplinary approach to the development of a system of logorhythmic classes allows us to collect for correctional and developmental purposes all the best that exists in the theory and practice of psychology, medicine, pedagogy and private methods. 3. The content and didactic techniques of logorhythmics are selected and implemented differentially, in accordance with the age of the children, the structure and composition of the impaired functions. Depending on the location of the brain disorder, various disorders of the motor system and speech are observed in different forms of cerebral palsy. In spastic diplegia, both the arms and legs are affected, with the latter being more affected. The degree of damage to the hands varies - from severe paresis to minimal impairment in the form of mild motor clumsiness, etc. The main signs of spastic diplegia are: increased muscle tone (spasticity) in the limbs; limitation of strength and range of movements in combination with unreduced tonic reflexes; decreased speech intelligibility, quality of articulatory movements, and voice strength; speech breathing disorder; hypersalivation. In the hemiparetic form of cerebral palsy, the limbs on one side of the body are damaged. When the left hemisphere is damaged, speech disorders such as spastic-paretic dysarthria or motor alalia, dyslexia, and dysgraphia are often observed. Damage to the temporal regions of the left hemisphere may be accompanied by disorders of phonemic perception. The degree of intellectual impairment varies from mild mental retardation to severe intellectual defect. The prognosis for motor development in most cases is favorable with timely and adequate treatment. The hyperkinetic form of cerebral palsy is associated with damage to the subcortical parts of the brain. Movement disorders manifest themselves in the form of involuntary violent movements - hyperkinesis. They arise involuntarily and intensify with movement and excitement, as well as with fatigue and attempts to perform any motor act. Hyperkinesis can affect the muscles of the face, tongue, head, neck, torso, upper and lower extremities. With this form, voluntary motor skills develop with great difficulty, movements are sweeping, uncoordinated, and automation of motor skills, especially writing, is difficult. Speech disorders are observed in almost all children, most often in the form of hyperkinetic dysarthria, speech intelligibility is reduced. Characterized by the absence of stable violations of sound pronunciation (omissions, substitutions, mixing of sounds are not constant), there is a lot of distortion of sounds. In the atonic-astatic form of cerebral palsy, the following are noted: low muscle tone, imbalance of the body at rest and when walking, loss of coordination of movements, tremor, hypermetry. The gait is unsteady, uncertain, the arms are spread to the sides, the body makes many excessive swinging movements to maintain balance. The child often falls, his timing and rhythm are disrupted. Most children have speech disorders in the form of delayed development, ataxic dysarthria, and alalia. Speech intelligibility is reduced, difficulties are observed in performing and maintaining articulatory patterns, and facial expressions are sluggish. The voice becomes exhausted, subsides towards the end of the phrase, asynchronous breathing is noted, and there is practically no intonation. The rhythm of speech is chanted, the pace is slow. In the most severe form of cerebral palsy—double hemiplegia—there is total damage to the brain, primarily to its cerebral hemispheres. Movement disorders are expressed equally in the arms and legs. Clinical manifestations of double hemiplegia are the predominance of muscle rigidity, which increases under the influence of intense tonic reflexes that persist for many years. Voluntary motor skills are absent or severely limited. Severe speech disorders are observed. These motor and speech disorders should be taken into account when selecting motor, sensory and speech exercises. 4. The principle of accessibility presupposes the correct selection of tasks, instructions, alternation of exercises, their repetition, etc. All this is determined by the motor, speech and intellectual capabilities of children. 5. The dosage principle is extremely important in organizing and conducting logorhythmics. It has a direct bearing on the selection of exercises and games. G.A. Volkova notes that games should be included in the lesson carefully, since children playing are emotionally excited and do not feel the onset of fatigue [1]. It is useful for them to offer exercises and games with moderate psychophysical stress and general physiological impact. 6. Logorhythmic classes must have a communicative focus. It is known that speech as the main means of communication is formed through movement and social contact. In children with cerebral palsy, the communication function develops unevenly, in contrast to their healthy peers. Impaired articulation and coordination of movements adversely affect it [3]. Logorhythmics classes should be rich in situations that encourage children to speak and communicate. The content of logorhythmic classes includes appropriate material (words, phrases, poems, songs, dialogues, etc.), which is selected taking into account the level of speech development of children. 7. Logorhythmics is carried out in close connection with training and education, therefore the principle of thematic planning should be adhered to. This creates optimal conditions for the comprehensive development of children and provides the opportunity for more effective learning of educational material. 8. The complex nature of correctional logorhythmic classes provides a unique opportunity for the implementation of psychological tasks: mobilizing the activity of intact analyzers, increasing the acuity of perception of almost all modalities, developing cognitive activity, establishing the proper level of motivation for learning, and the formation of personal qualities. Exercises for the development and activation of various functions General motor skills, coordination of movements, spatial orientation  Game “Sun”. Children stand around the hoop and hold on to it. The exercise is performed with musical accompaniment several times. Children need to raise the hoop up and lower it down under the poems that the speech therapist reads. In the morning the sun rises and illuminates with light. In the evening it sets - Night comes. If children cannot independently maintain balance using a hoop, pedagogical support is provided.  Game “Helpers”. Children stand and hold the hoop with one hand. The exercise is performed with musical accompaniment. Children need to move in a circle to the poems read by the speech therapist. We walk in the sun - We strengthen our legs, To put away the toys - We help Mom. If children cannot move independently, an adult helps them (the type of assistance depends on the severity of the impairment). The exercise becomes more complicated by increasing the number of circles. Auditory perception  Exercise “Bells”. Children sit on chairs, each is given two cards: one shows a large bell, the other a small one. The exercise is performed with musical accompaniment. For a loud sound you need to raise a card with a large bell, for a quiet sound - with a small one. Before performing the exercise, the speech therapist conducts a conversation about the sounds that surround us in life. He draws children's attention to the fact that sounds differ in strength, and demonstrates this on a musical instrument. Hand motor skills, facial expressions  Game “Let’s warm our hands.” Children sit on chairs. The exercise is performed without musical accompaniment. Speech therapist. What time of year is it now? Children. Winter. Speech therapist. In winter, your hands get cold in the cold, let's warm them up. To do this, you need to rub the palm of one hand against the other and clench your fists. Oh, winter-winter! We are not afraid of you. We will clasp our palms together, warm them up and move on. During the exercise, attention is paid to ensuring that each hand participates as actively as possible. Preliminary conversations help to activate children's speech.  Game “Children wash themselves.” Children sit on chairs. The exercise is performed without musical accompaniment. Children should imitate the washing motion. Speech therapist. What do people do in the bathroom in the morning? Children. They wash themselves. Speech therapist. Show your eyes, cheeks, nose. Now let's show how everyone knows how to wash themselves well. (Shows the appropriate movements.) Some water, some water, wash my face, So that my little eyes shine, So that my cheeks glow, So that my mouth laughs, So that my teeth bite. Attention is drawn to how actively children move. Preliminary conversation helps to expand the vocabulary, strengthen knowledge about hygiene, and repeat the names of parts of the face.

• Children sit on chairs. The exercise is performed without musical accompaniment. Children must perform facial movements and pronounce interjections at a certain signal.

Speech therapist. The sun came out and it became warm. Children (smile). Oh! Oh! Oh! Speech therapist. A cloud has appeared, it will rain soon. Children (frown). Wow! Wow! Wow! Speech therapist. When we are sick, we are given injections, it hurts. Children (frown). Oh! Oh! Oh! To perform the exercise more emotionally, special equipment in the form of pictures or objects is used. Attention is drawn to ensuring that children simultaneously perform facial movements and pronounce interjections. Muscular system, motor coordination, auditory attention

• Exercise with a ball.

Children sit on chairs or on the carpet. The exercise is performed to music; the signal to begin the movement is a chord. Children must pass the ball to their neighbor and say his name. If they are at a low level of speech development, then they pronounce on or here. I carry the ball in my hands. Oh, I'm afraid I won't be able to hold it. My neighbor helped me and passed it on to someone else. If children have trouble holding the ball, you can roll it. The speech therapist makes sure that each child pronounces the name or words as best he can.

• Exercise with cubes.

Children sit on chairs, each is given cubes. The exercise is performed several times to musical accompaniment; changing passages and chords serve as a signal for the beginning of various movements. Children should lift the blocks forward, up and swing their arms from side to side above their heads. Similarly, you can perform the exercise with other objects - ribbons, twigs, etc. Movements with speech accompaniment

• Exercise with a handkerchief.

Children sit on chairs. The exercise is performed with musical accompaniment. Children must pass the handkerchief to their neighbor and at the same time sing I give to You. Attention is drawn to ensuring that each child sings the phrase to the best of his ability. You can use a flower, bouquet, etc. as an object. Breathing

• Game "Blow out the candle."

Children sit on chairs. The exercise is performed without musical accompaniment. Children should place their open palms in front of them, blow on each finger and form their palms into fists. The speech therapist makes sure that children bend their finger only after blowing on it.

• Game "Breeze".

Children sit on chairs, each one is given plumes or pinwheels. The exercise is performed several times, without musical accompaniment. Children should blow on objects to the poems that the speech therapist reads. You need to try to blow hard to make the figures move. Wind, wind, you are powerful. You are chasing flocks of clouds. You are disturbing the blue sea. You proudly breathe in the open air. A.S. Pushkin Voice

• Children sit on chairs.

The speech therapist tells them that they can speak loudly and quietly. Then he offers to become actors in the proposed situations. Children should say sounds loudly or quietly. You can use objects and pictures for clarity. Speech therapist. We are rocking the doll. Children. Ahhh... Speech therapist. We got lost in the forest. Children. Aw-ow-ow! Speech therapist. The steamer is humming. Children. Woohoo! Speech therapist. The mouse squeaks. Children. Pee-pee-pee...

• Exercise "Ladder".

Children sit on chairs. The exercise is performed with simultaneous conducting: for each line, children raise their hand and lower it. The speech therapist sings the song, and the children sing the highlighted vowels with a gradual rise and fall of their voice. 5. Sound like an antenna 4. We reached the roof. 3. Let’s all rise higher, 2. Sing a song together. 1. We walk up the stairs, 6. And run back! Speech activation

• Children sit on chairs.

The speech therapist begins the poem, the children must finish it. The bees lead a round dance - Thump, thump. The cat hit the drum - Boom, boom. The mice began to dance - Ta, Ta, Ta. So much so that the whole earth began to tremble. Swedish song Vacuum cleaner, vacuum cleaner Where are you sticking your nose? Zhu-zhu-zhu-zhu-zhu-zhu - I'm putting things in order. A. Maslennikova Activation of speech with simultaneous movements

• Children sit on chairs.

The exercise is performed without musical accompaniment. The speech therapist asks the children to complete the rhyme and at the same time perform the movements. Speech therapist. Rain, rain... Children. Drip, drip. (The arms are bent, the hands are at chest level, the fingers, except the index ones, are clenched into fists. The index fingers are alternately lowered down.) Speech therapist. And in the beds... Children. Thump, thump. (Half-bent hands are alternately lowered down.) Speech therapist. Along the path... Children. Top, top. (They tap their knees with their palms.) Speech therapist. And through the puddles... Children. Slap, slap. (Clap their hands.) Rhythm and tempo

• Playing musical instruments.

Children sit on chairs. The speech therapist gives each person a musical instrument (tambourine, drum, spoons, metallophone, etc.). He talks about how each instrument requires unique movements - you can play the instruments with one or two hands. For example, maracas and rattles require one hand, and spoons require two. When playing a drum or tambourine, one hand holds them, the other performs the movements. When distributing tools, it is necessary to take into account the motor abilities of children. Children must play instruments according to a given rhythm. The exercise is performed in several stages. 1. Children learn rhythm together with a speech therapist. 2. Musical accompaniment is listened to. 3. Children play musical instruments to musical accompaniment. If a child cannot independently master playing an instrument at a given rhythm and tempo, then pedagogical assistance is provided. Music is selected at the discretion of the speech therapist. List of used and recommended literature 1. Volkova G.A. Speech therapy rhythm. M., 2003. 2. Levchenko I.Yu., Prikhodko O.G. Technologies for teaching and raising children with musculoskeletal disorders. M., 2001. 3. Shipitsyna L.M., Mamaychuk I.I. Cerebral palsy. St. Petersburg; M., 2001.

Dysarthria and alalia

Unfortunately, only a delay occurs quite rarely; almost always, a child with cerebral palsy is subsequently given a speech diagnosis - dysarthria. This violation manifests itself only in the pronunciation side of speech - with its understanding intact.

There are several forms of dysarthria depending on the form of cerebral palsy, and several degrees - from the most severe - anarthria, to mild - erased dysarthria. In mild cases, the child’s speech is blurred, slow, and poor in intonation; in severe cases, the movements of the organs of articulation are so limited that they do not make it possible to utter a word. The tongue, lips, cheek muscles are the same muscles as in the rest of the body, and disturbances of tone and mobility, present throughout the body, will also be noted in the organs of articulation.

As a rule, there is always a relationship between the degree of impairment of articulatory motor skills and the state of hand motor skills.

In addition to dysarthria, alalia is quite common in children with cerebral palsy - underdevelopment of speech as a result of damage to the cerebral cortex. In this case, not only pronunciation is impaired - understanding of speech also suffers, problems are observed in the coherent, phrasal aspects of speech, the syllabic structure of the word, that is, problems in the formation of speech as a system.

Sucking and swallowing - for differential diagnosis

It can be very difficult to carry out a differential diagnosis and determine the main obstacle to speech development.

At an early age, it can be difficult to understand what awaits the child next, how his speech will develop, what symptoms we will encounter later - but it is extremely necessary to help the child master vital functions - sucking and swallowing, and at an older age - chewing.

For differential diagnosis at a later age, it is very important to know how the child coped with the organization of these processes in infancy. If there is no speech, but he suckled well at the breast, perhaps the main reason for underdevelopment of speech is not dysarthria, it may accompany it, but the child must be examined for alalia.

Speaking of diagnostics and my self-confident juggling with neurological terminology, I think many people know that a speech therapist does not write a diagnosis, but writes a conclusion. For example: “General speech underdevelopment (GSD), Phonetic-phonemic speech underdevelopment (FFND).” And terms like dysarthria, dyslalia, alalia are not conclusions, but diagnoses, and only a neurologist has the right to make them. However, speech therapists working with children with cerebral palsy are forced to use the clinical classification of speech disorders, since the mentioned pedagogical classification does not carry any information about a specific child with cerebral palsy.

Often it is the speech therapist who is able to determine the leading symptoms and correctly organize correctional work.

Help from a speech therapist for cerebral palsy (CP)

Speech and language therapy can help improve communication, eating, and swallowing. It can also promote confidence, learning and socialization.

How does speech therapy help?

Speech impairments are common among people with cerebral palsy.
In fact, a 2012 study by Swedish researchers found that speech problems affect more than half of all children with cerebral palsy. Some children with cerebral palsy have difficulty controlling the muscles of their face, throat, neck, and head. This can lead to problems with speaking, chewing and swallowing. It can also cause drooling and affect your overall ability to interact and learn. Those who also have hearing problems may find it difficult to understand spoken language.

Speech and language therapy aims to improve a child's speech and communication by strengthening the muscles used for speech, improving oral motor skills, and improving understanding of speech and language. It may also help with swallowing disorders such as dysphagia.

Benefits of speech therapy

Speech therapy can be very helpful for children with cerebral palsy.

As children improve their speech and communication, they are better able to express their needs, share their thoughts, and interact with others.

Children with cerebral palsy who have difficulty eating, chewing, and swallowing may also have trouble growing normally and maintaining a healthy weight. Speech therapy can help with these issues, making it easier for your child to get the proper nutrition and hydration he needs. This can improve their overall quality of life and increase their independence.

Speech therapy can help with the following:

• joint
• Pronunciation
• Fluency/Stuttering
• Sound and word formation
• Innings
• Language and vocabulary development
• Speech volume
• Understanding the word
• Word-object association
• Breathing support and control
• Chewing
• Swallowing
• Coordination and strength of speech muscles

The benefits of speech therapy go beyond improving a child's ability to understand and use language. Communication is very important for other areas of development such as cognitive development and social and emotional development. As a child learns to express himself better, the benefits can be seen in many other aspects of his life and development. Speech therapy is useful because it can help:

• Encourage learning and education
• Improve problem solving ability
• Increase independence
• Improve literacy
• Improve the ability to express thoughts and ideas
• Improve socialization
• Increase self-esteem
• Reduce shyness
• Improve quality of life
• Improve swallowing function and safety

Children with different types of cerebral palsy may experience different communication problems, which may benefit from speech therapy. Various speech problems as they relate to each other type of cerebral palsy include:

• Spastic. Children with spastic cerebral palsy typically struggle with slow, imprecise mouth movements that require a lot of force. Their speech is often slurred and their voice sounds hoarse or hoarse.
• Athetoid - Those with athetoid cerebral palsy often have difficulty controlling the muscles of the face and tongue. They also have difficulty controlling their breathing and vocal cords, and have trouble eating and drooling.
• Ataxia, scanning speech that sounds monotone and hoarse, is common in children with ataxic cerebral palsy. Their speech is often marked by pauses and acceleration, and they also have difficulty swallowing.

Can filing a claim help cover the cost of your child's treatment?

What to Expect in Speech Therapy

Speech therapy is different for each child with cerebral palsy. During the first session, the speech therapist will perform an initial assessment of the child's physical and cognitive functioning. This evaluation may include the child's medical history, oral examination, audiological tests, articulation assessments, language and fluency assessments, and cognitive assessments.

After an initial assessment, the speech therapist can determine the child's diagnosis and create a treatment plan. Treatment usually consists of exercises tailored to the child's specific struggles with communication or swallowing. Assistive communication devices and sign language are often used to help the child express himself. This is especially useful in more severe cases, such as when children are completely non-verbal.

Exercises used in speech therapy

Many different exercises are used in speech therapy. Each child's treatment plan will be different depending on their individual problems and needs.

Some examples of common speech therapy exercises include:

• Articulation therapy - using language maps to focus on specific sounds; encouraging children to make sounds while looking in the mirror to help them understand how their mouth moves.
• Blowing Exercises - Blowing bubbles or blowing a whistle to train the mouth muscles to create specific sounds and strengthen the abdominals to control breathing.
• Breathing exercises - Work on inhalation and exhalation to strengthen the diaphragm.
• Jaw Exercises - Eating foods that require extra chewing, such as celery, apples and carrots, to strengthen your jaw muscles; practicing opening and closing their mouth using only their jaw muscles while someone else holds their chin.
• Author's aids - using cards with different words and sounds written on them; by putting together puzzle pieces with words that go together, such as "sock" and "shoe", "toothbrush" and "toothpaste", "bat" and "ball".
• Lip exercises - squeezing your lips around a lollipop to increase strength; pursing your lips to kiss the lollipop to improve lip expansion.
• Swallowing exercises - performing the “difficult swallow”, which collects saliva in the mouth and swallows it in one gulp; performing the "masako maneuver" where the child sticks out his tongue, gently bites it with his teeth to hold it in place, and then practices swallowing.
• Tongue exercises

Equipment used in speech therapy

Speech therapists use many different tools to help children with cerebral palsy improve or overcome their communication problems. Assistive technology or assistive devices are also used as communication tools, especially for non-verbal children.

Tools

Tools commonly used in speech therapy include:

• Placement tools (proper tongue placement for certain sounds)
• Oral touch chews
• straw
• Tongue depressors
• Picture boards
• books
• Flashcards
• Dry erase boards
• Magnetic whiteboard

Assistive devices

The following assistive devices are commonly used to help those who have communication problems:

• pills
• Computers and keyboards
• Additional and alternative communication devices
• Unguided communication systems - using the child's body to convey a message, such as body language or sign language
• Automated communication systems are tools in addition to the child's body, such as paper and pencils, boards, speech generating devices, etc.
• Specialized software

Speech therapy by age

As a child gets older or improves his abilities, his speech therapy plan should change accordingly. The first three years of a child's life are extremely important for acquiring speech and language skills as their brain develops and matures, allowing them to easily absorb this information. Early intervention gives the child the best opportunity to develop and learn to his full potential.

• Toddlers – Speech therapy for toddlers is based on games and toys, repetition of sounds and words, singing songs and arts and crafts.
• Small children. For school-aged children, social interaction is emphasized, although games and toys are still used. Therapy usually consists of various activities aimed at developing communication, such as storytelling, talking, repeating sounds and words, and working on the child's school work. Therapy also helps the child improve his social skills, such as holding his head up and maintaining eye contact while talking.

Looking for a speech therapist

Speech-language pathologists, also known as speech-language pathologists, are licensed health care professionals who specialize in the assessment and treatment of speech, language, and swallowing disorders.

Speech-language pathologists often work closely with the child's treatment team, which may also include physical and occupational therapists, to develop a comprehensive treatment plan.

When choosing a speech therapist, it is important to find someone with experience working with children with cerebral palsy. If you need help finding a speech therapist, check with your child's pediatrician, physical therapist, or occupational therapist to see if they have any recommendations.

Slippery moments of speech therapy diagnostics

One of the slippery aspects of speech therapy diagnosis of a child with cerebral palsy is the fact that often a specialist, without looking closely, shoots out a diagnosis of dysarthria, famously determines its form and begins to work on muscle function. Cerebral palsy, dysarthria by default. Yes, she is. But if a child involuntarily pronounces a sufficiently large volume of sounds, is involuntarily capable of quite complex articulatory movements, and may even be able to reproduce them by imitation, chews and swallows, then it is unlikely that the reason for his silence is dysarthria, and he is so clearly shown an endless probe massage.

Unfortunately, the specialist does not always have a clear understanding of the most pressing task for a given child. For example, in my practice there was a wonderful, smart six-year-old girl with perfectly developed speech as a result of the efforts of speech therapists and parents, but with residual defects in the pronunciation of L and R. These defects were obvious, and my mother was worried, but at that time I was much more worried about something else - my hands girls.

The hand was absolutely not ready for writing, plus there were spatial orientation problems typical for children with cerebral palsy, which, if not eliminated in time, would be guaranteed to lead to impairments in written speech - dyslexia and dysgraphia. And the sounds - yes, it would be possible to spend time on their production and automation, but I was aware that with dysarthria this work would drag on for months and, possibly, years. And the deadlines are running out - school is approaching, the child’s speech is absolutely intelligible and understandable, with such speech many healthy people live and feel great.

Therefore, hand and letter were on the agenda, there was a lot of work there, and we started it. But my mother continued to worry, and it ended with the fact that they stopped coming to me. But, almost two years later, they returned when the girl’s problems at school became completely obvious, and another speech therapist took the easy path and worked on staging these remaining sounds.

MAGAZINE Preschooler.RF

Individual speech therapy lesson for a preschooler with cerebral palsy on the topic: Automation of the sound [F] in syllables. Goals:1. Correctional and educational: - consolidate the idea of ​​the mechanism of sound formation [F]. — expansion and activation of the dictionary on the lexical topic “Seasons”. 2. Corrective and developmental: - consolidating the skill of correct pronunciation of the sound [F] in isolation, in syllables; — strengthening the skills of the respiratory and vocal apparatus; - formation of skills of precise articulatory movements.

3. Correctional and educational: - development of self-control skills for speech. Progress of the lesson Stages Contents of the stages 1. Organizational moment

2. Preparatory part Exercises for breathing development

3. Articulation gymnastics

4. Automation of the sound [F] in syllables

5. Knowledge of the world around us

6. Summary of the lesson Greeting the child: Hello....! I see that your eyes are sparkling cheerfully, and you are ready to work today.

The speech therapist warms up the child’s fingers and tingles them with a massage ball. — Our little friends are cold and want to hide in the house. Help them! The speech therapist encourages the child to pick up a small toy (no more than 3-4 cm in size) and put it in a small box.

(if the child has severe motor impairment, the box should be several times larger than the toy).

1) On the speech therapist’s hand there are paper snowflakes: It’s winter, and a snowflake has flown towards us, let’s blow on it, and it will flyiiiiii....t!

2) How cold it is in winter! Let’s warm our hands,” the speech therapist brings the child’s hands closer to his mouth and encourages him to exhale into his hands: “XXXX…. - this is how we breathe. Are your hands warm? How hot you can breathe on your hands! Well done.

Now let’s rub our hands - if the child, due to the limitation of voluntary movements, cannot cope, then the speech therapist himself makes rubbing movements with the child’s hands.

A toy Frog is placed on the table: The speech therapist encourages the child to touch it, name its properties: hard, soft, cold, etc.

1) “Frog”: Look, it’s a mouth. And what does he look like? We pull the lips hard - This is the mouth of a frog.

2) We pronounce the sound [U] - How does the wind hum in the chimney in winter? - uh uh uh.

3) “Window”. What a cold wind! We will close the window from the wind and open it again. (The child opens and closes his mouth; if necessary, the speech therapist controls the correct movement of the jaw with his hands).

Today we will repeat the sound [F]. How do we pronounce this sound? We say UUU, form a tube from our lips and press our lower lip to our upper teeth.

The child says FFFFFFFFF. Then we repeat the syllables after the speech therapist: fe-fa fa-fo-fu fm-of-uf-if fo-fa fu-fy fy-fu fu-fy-fa fo-fa-fu fu-fa-f Uf-of-af -uf Yf-of-af-uf Of-uf-if-af

The speech therapist offers the child pictures on the topic “Seasons”: - Show me what the artist drew incorrectly? — What was in the pictures first, what came later? The speech therapist encourages the child to unclench his spastic fist and point to the picture with his palm or finger. - Well done, you practiced very well, repeated the sound [F], worked with your fingers.

Literature 1. Egorova O.V. Sounds В, Въ, Ф, Фь. Speech material and games on automation and differentiation of sounds for children 5-7 years old. M.: Publishing house "Gnome and D", 2005. - 24 p.

2. With a speech therapist every day. Notebook 1/S.V.Volkova, A.A. Nikolashina, L.N. Semenova, E.G. Timoschenko.-M.: V. Sekachev, 2011. 3. Smirnova I.A. Speech therapy diagnostics, correction and prevention of speech disorders in preschool children with cerebral palsy. – St. Petersburg: Childhood – Press, 2010.

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Speech therapy massage can almost always help

At an early age or at the beginning of correctional work at any age, while we can still only guess how this child’s speech development will go, speech therapy massage and passive articulatory gymnastics will be our main assistants.

Even in the most difficult cases, when it comes to tube feeding, it is most often possible to help the child. Classes with a speech therapist can help weaken the pronounced gag reflex and stimulate sucking and swallowing. Later, stimulate chewing.

And at an older age, speech therapy massage and passive, and subsequently active, articulatory gymnastics will be indicated for most children with cerebral palsy - to normalize muscle tone, increase the volume and accuracy of movements of the articulatory apparatus.

If the child is very small or has intellectual problems, the use of edible devices and textures that differ in taste, smell, temperature and tactile properties for massage and gymnastics is successful.

For example, it is easier for a child with impaired swallowing function to feel and swallow something cold in the mouth rather than warm, something sour or distinctly sweet rather than neutral. A child with problems with voluntary organization of movements finds it possible to raise his tongue upward not on command, but by trying to reach for a sweet candy.

Older children also respond with pleasure to such tasty gymnastics, and it is precisely such emotionally brightly colored exercises that allow them to achieve the best results.

Personally, I did not have to work with children with cerebral palsy at an early age, but I was able to successfully develop the chewing muscles in older children, thereby significantly improving the child’s quality of life.

Main directions of speech therapy treatment for cerebral palsy

In the absence of speech in a child with cerebral palsy, speech therapy work is carried out in the following areas:

• motor development;
• restoration of muscle tone;
• stimulation of vocal reactions;
• development of tracking and visual fixation;
• development of auditory attention;
• creating conditions for improving motor and visual coordination.

A special massage is prescribed to stimulate the facial muscles. Such exercises can significantly speed up the appearance of the first improvements.

Speech therapy therapeutic massage

Speech therapy massage is classified into the following types:

• point;
• classical;
• probe;
• reflex.

The doctor prescribes the type of massage depending on the complexity and characteristics of the speech dysfunction. In some cases, it is enough to prescribe several courses of classical massage. For complex deviations from the norm, an integrated approach to speech therapy massage is used. In such situations, rehabilitation takes a lot of time. Features of speech therapy work with cerebral palsy lie in the difficulties that arise when communicating and interacting with the patient. In some cases, massage is the only available method of developing the articulatory apparatus in the first stages of treatment.

Relaxing massage of articulatory muscles for cerebral palsy

A relaxing massage is prescribed for increased muscle tone of the tongue, lips and face. The use of this technique requires choosing the correct position for the child. The doctor determines the position in which tense parts of the body relax as much as possible.

The child can be placed on the couch with a bolster secured under the neck. An excellent position for this massage is the “fetal position.” In one of these positions, dynamic movements are performed to relax tense muscles.

To relax the facial muscles, do the following:

• light stroking in the direction from the center of the forehead to the temporal region;
• from eyebrows to scalp hair;
• around the eyes (from the forehead line);
• from the bridge of the nose to the scalp;
• from the forehead line along the neck, cheeks and chin across the entire face;
• from the bottom of the ear to the wings of the nose and cheeks.

Next, you need to perform light pinching along the entire edge of the lower jaw. After this, make pressing movements in the direction from the roots of the hair to the face.

The next stage of the massage is to relax the muscles of the lips:

• stroking the upper and lower lips in the direction from the corners to the center;
• weak rotational movements (clockwise);
• weak tapping on the surface of the lips.

Each movement should be performed 5 to 8 times.

Stimulating massage for the articulatory apparatus in cerebral palsy

Stimulation is necessary to reduce hypotonia of the facial and tongue muscles. A special massage allows you to strengthen the muscular system and increase the chances that the child will begin to speak in the near future.

As part of this technique, the following characteristic movements are performed:

• stroking;
• kneading;
• rubbing;
• vibration;
• tingling.

First, smooth and soft presses are made, the strength of the movements should increase gradually. Avoid activities that may cause even minor pain

To strengthen the facial muscles, it is necessary to perform the following list of movements:

• stroking the eyebrows, forehead, temples, eyelids and cheeks;
• squeezing the chin with light but rhythmic movements;
• kneading the muscles of the cheeks and cheekbones;
• chafing of the cheek muscles;
• slight tingling of the cheeks.

To strengthen the lip muscles, perform the following exercises:

• stroking the lips, nasal wings and nasolabial folds;
• tingling;
• pinching lips.

Vibration is also a very effective method. Such manipulations can be performed using a special mechanical device. The procedure will improve blood supply to the organs of the articulation apparatus and strengthen the muscular system of the face.

Therapeutic massage of the lingual muscles for cerebral palsy

This type of massage can be more intense or calm depending on the condition of the tongue muscles. If you need to reduce tone, then before the procedure you need to hold a small amount of herbal infusion in your mouth.

When performing a massage, the doctor sets the following goals:

• normalization of muscle tone;
• increasing the amplitude of articulatory movements;
• engaging previously inactive muscles;
• decreased salivation;
• stimulation of speech development.

First, the massage is done in the oral cavity, and then outside the oral cavity. In this case, the tongue is held with gauze.

Articulation gymnastics for speech development

Exercises for articulatory gymnastics are aimed at increasing the activity and development of the following parts of the body:

• lips;
• bridle;
• cheeks;
• language.

Gymnastics is best done in a playful way. This way the child will show increased interest, and therefore a positive result can be achieved as quickly as possible.

Passive articulation gymnastics for cerebral palsy

During the exercises, the speech therapist performs careful manipulations with the organs of the articulatory apparatus. In case of serious pathology, this particular type of gymnastics is recommended, because children with such a diagnosis cannot independently perform the simplest speech therapy tasks. The doctor opens and closes the patient’s mouth, stretches his lips into a smile, collects his lips into a tube, lifts his tongue up using an instrument for examining the oral cavity (medical spatula).

To perform passive gymnastics exercises, you should follow the following sequence of actions:

• bringing the tongue forward;
• tongue retraction;
• bringing to the lower lip;
• approach to the upper lip;
• abduction left and right;
• pressing the organ to the lower part of the oral cavity;
• raising the organ to the sky;
• light swaying movements of the organ in different directions.

Exercises are performed serially from 3 to 5 times, depending on muscle development.

An active type of articulation gymnastics for cerebral palsy

The set of exercises is aimed at stimulating tactile, auditory and visual analyzers. Before prescribing active articulatory gymnastics, the patient undergoes passive exercises and speech therapy massage. When performing exercises, it is important to achieve complete range of movements, optimal speed of switching on and switching attention. Smoothness and symmetry of movements play a vital role.

To develop facial muscles, the patient performs the following exercises:

• closing and opening the eyes;
• cheek tension;
• raising and lowering eyebrows;
• chewing movements;
• sudden swallowing of saliva;
• opening, closing the mouth.

To strengthen and develop the labial muscles, the following actions are performed:

• pulling the lips into a tube and stretching to the side;
• alternating smiling and curling lips;
• closing and opening;
• quick closure followed by breaking (imitation of a kiss);
• performing a slow labial exhalation;
• raising the upper lip with further demonstration of the teeth.

After completing such exercises, you can move on to more complex tasks.

Rehabilitation exercises for the lingual muscles

To stimulate the muscles, the specialist acts on the longitudinal muscles of the tongue. To do this, strokes are made from the middle part to the tip of the organ.

To strengthen the transverse muscles of the tongue, pressure is applied to the area from root to tip with the same rhythm. Intensive manipulations are performed using a special spatula.

To stimulate and strengthen the longitudinal muscles, strokes are performed, directed from one side to the other (in a zigzag).

What is artificial local contrast therapy?

The technique is used to eliminate articulatory apraxia (inability to speak clearly). The essence of the procedure is the effect of high and low temperatures on sensitive areas of the tongue. Use crushed ice, herbal infusions or hot water. The choice of exposure can be alternated to increase the effectiveness of the result. Regardless of the chosen direction, the course of treatment lasts from 15 to 20 days.

Artificial local contrast therapy is performed in the following sequence:

• crushed ice is placed in a gauze bag;
• ice is alternately applied to various muscles of the articulatory apparatus;
• the speech therapist holds the patient's tongue with a gauze pad;
• All parts of the tongue are affected in turn.

One session lasts from 2 to 7 minutes, depending on the level of development of the muscles of the articulatory apparatus.

Development of breathing and correction of its disorders when working with patients

Breathing exercises take into account a whole range of exercises that are aimed at normalizing respiratory function and speech development. Exercises are performed in the following sequence:

1. Position – lying or sitting. Creating a “fan of air” near the child’s nostrils.
2. Position – lying on your stomach, arms under your chest, head down. When inhaling, the specialist raises the child’s shoulders and head. When exhaling, the child’s body returns to its original position.
3. The speech therapist asks the child to hold his breath as much as possible.
4. Position – sitting or lying down. The specialist places his hands on the patient's chest, listening to the breathing rhythm. Press on the chest as you exhale.

Apraxia: actively babbles something, but does not repeat or imitate

If in a child we have identified only a limitation in the mobility of the articulatory apparatus, a violation of muscle tone, the measures described above may be sufficient to initiate speech, but if we see apraxia - a violation of the voluntary organization of movements, then targeted classes are needed to evoke sounds, form the syllabic structure of a word, and subsequently phrasal speech.

How can you define apraxia? It can be indicated by a sufficient variety of involuntary sounds with pronounced difficulties in voluntary reproduction - the child seems to be actively babbling something, but does not repeat, does not imitate, or tries to repeat, but repeats any sound other than the required one, although literally five minutes ago you heard this sound We heard from him by chance.

The same is with articulatory postures - involuntary postures are varied, the tongue is quite mobile, but the child is not able to repeat the movement when requested, or he can repeat it for a short time, but is not able to hold it. However, the last symptom is not very informative - the child may simply not have enough strength to hold the pose, or hyperkinesis may interfere. To understand this, close observation of the dynamics is necessary.

How to work with children with apraxia? It is important to remember that logomassage in this case will not be a panacea; it is necessary to purposefully, relying on intact analyzers, on leading activity, bring out sounds into randomness and consolidate, and later - combine sound complexes into words and phrases. The work is long, painstaking, and often begins too late, although if a specialist has experience, it is possible to determine the leading symptoms already in 2-3 years, or even earlier.

Such children are encountered quite often in speech therapy practice; I personally like to work with them using the play method, and use warehouse reading according to Zaitsev as an additional support.

The earliest possible start of speech therapy correction work with a competent specialist is the key to maximizing the child’s speech potential.