Speech therapy work for rhinolalia

Principles of interaction between a patient and a speech therapist

The methods of speech therapy correction for rhinolalia are similar regardless of what form of the disease we are talking about - it can be an open form, a closed form, or in some cases doctors talk about a mixed form.
At the same time, the methods for treating voice formation and articulation disorders caused by defects in the structure of the speech apparatus differ significantly from correctional methods for other speech disorders. One of the unique features of the work in this case is the division of methods into two stages - preoperative and postoperative. In general, five stages of speech therapy work for rhinolalia can be distinguished. All these stages are important, and you cannot skip any of them. The exception is the first year of a child’s life, in which case there is no need to interact with a speech therapist before surgery.

Compilation of characteristics of a small patient. To do this, the specialist uses the child’s medical record, conducts a conversation with mom and dad, and studies the medical history.
Speech therapy examination for rhinolalia with the preparation of a speech map. Similar examinations are carried out for all types of speech pathologies. The characteristics of the articulatory apparatus, the state of the voice, the characteristics of breathing, speech, and the nuances of pronunciation of sounds are studied.
Preparation of the conclusion. In the prepared conclusion, the speech therapist includes all the data that he received during a speech therapy examination of a child with rhinolalia. Next, he draws up a correction plan and makes recommendations. The speech therapist passes the prepared document to other specialists (defectologists, teachers), who contribute to the correction of the pathology.
Preoperative work of a speech therapist with a patient.
Postoperative correction of speech problems.

Here we are talking about a fairly widespread disease that requires an integrated approach and does not tolerate indifference. Only with the joint interaction of the child himself, his parents and many specialists can one count on a quick and effective result.

Diagnosis of rhinolalia

The examination of children and adults with rhinolalia is multifaceted and is carried out by various specialists:

otolaryngologist;
speech pathologist;
speech therapist;
neurologist;
orthodontist;
phoniatrist;
pediatrician

An examination by specialized specialists allows us to identify the etiology of the disease, characterize as accurately as possible the nature of pathological changes and the severity of all symptoms. The following instrumental diagnostic methods are important:

X-ray of the nasopharynx;
rhinoscopy;
electromyography;
pharyngoscopy, etc.

These techniques make it possible to visualize the nature of pathological changes and their severity in each individual patient.

Of course, the most significant is an examination by a speech therapist, who, using a number of progressive techniques, will be able to assess the following parameters:

structure of the articulatory apparatus;
his mobility;
voice disorders;
parameters of physiological and phonation breathing, etc.

To diagnose open rhinolalia, the Gutzmann technique is used, which is based on the fact that the patient pronounces the sounds “a” and “i” alternately, while the doctor opens and closes the nasal passages. In the presence of pathological changes, the vibration of the wings of the nose is very clearly felt, and when the nasal passages are pinched, the sounds are significantly muffled. Thus, it is possible to diagnose the open form of rhinolalia.

Before and after surgery: what is important to know

Speech therapy methods for rhinolalia, which are carried out before surgery, are aimed at preparing the speech apparatus for new conditions. This stage should not be ignored, as it significantly facilitates postoperative correction:

treatment begins with teaching the patient the basics of physiological breathing;
articulation bases are installed;
the patient is taught sound pronunciation from scratch, and it does not matter which sounds the child pronounces incorrectly;
the natural development of speech determines the order of sound production during correction;
special articulation gymnastics will allow you to establish and develop muscle interaction;
Correct articulation and phonemic hearing are built and consolidated.

Preoperative correctional work by a speech therapist for rhinolalia should be carried out by a doctor in the office, while the parents wait outside. Family members can be involved in the processes no earlier than a month and a half after the first lesson, and the role of adults increases over time, since it is important to regularly carry out gymnastics, massage, and follow other recommendations of the speech therapist.

Correction after surgery is aimed at sound analysis, at developing the little patient’s ability to analyze and synthesize sounds. The specialist adjusts the production of sounds (the same as in the case of preoperative preparation). In this case, materials and correction methods are selected depending on the patient’s condition and the skills that he has mastered to date. The main difference between speech therapy work for open rhinolalia is the simultaneous study of phonemes from different groups, but only when their articulation differs. If we are talking about phonemes from the same group, it is necessary to observe large time intervals between their study. Speech therapy massage for rhinolalia helps enhance the effect.

Methodology of correctional and pedagogical work for rhinolalia

The methodology for speech therapy work for rhinolalia is the same as for correcting sound pronunciation defects. When working with rhinolalic, the speech therapist must creatively use these techniques. (O.V. Pravdina)

In domestic speech therapy, methodological techniques for eliminating rhinolalia were developed by the following figures (E. F. Pay, 1933; Prof. F. A. Pay, 1933; 3. G. Nelyubova, 1938; V. V. Kukol, 1941; A. G. Ippolitova , 1955, 1963; 3. A. Repina, 1970; I. I. Ermakova, 1984; G. V. Chirkina, 1987; Volosovets T. V. 1995).

All of these authors distinguished between two stages of speech therapy work, before surgery and after surgery.

· Prof. F. A. Pay, speaking about preoperative work, pointed only to the possibility of preparing the correct formation of vowels in the rhinolalic, which were previously pronounced more or less the same. In his opinion, one can talk about removing the nasal tint only in the mildest cases of rhinolalia, moreover, with a jerky short and strong exhalation (on a hard attack) when pronouncing sounds. F. A. Pay warned about the difficulty of making sounds before surgery and recommended a very careful approach.

· The formation of phonetically correct speech in preschool children with a congenital cleft palate is aimed at solving several interrelated problems (G.V. Chirkina):

1) normalization of “oral exhalation”, the formation of a long-lasting oral stream when pronouncing all speech sounds, except nasal ones;

2) mastering the articulation of all speech sounds;

3) elimination of the nasal tone of the voice;

4) differentiation of sounds in order to prevent violations of sound analysis;

5) normalization of the rhythmic-intonation side of speech;

6) 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.

In preschool children, imitation plays a significant role, but elements of conscious assimilation must be present. This is due to the fact that the restructuring of a strong pathological skill of nasal pronunciation is impossible without activating all the child’s personal qualities, focusing on correcting the defect, and without consciously acquiring new acoustic and motor stereotypes of speech sounds.

Corrective tasks differ somewhat depending on whether plastic surgery to close the cleft is performed or not, although the main types of exercises can be used both in the preoperative period and after surgery.

(G.V. Chirkina) Speech therapy classes must begin in the preoperative period , because they prevent the occurrence of serious changes in the functioning of the speech organs. At this stage, the activity of the soft palate is prepared, the position of the root of the tongue is normalized, the muscular activity of the lips is enhanced, directed oral exhalation is produced - favorable conditions are created for more effective results of the operation and subsequent correction. 15-20 days after the operation, special exercises are repeated, but the main goal of the exercises is to develop the mobility of the soft palate.

· The system developed by A.G. Ippolitova is of great importance. This system is highly effective in correcting sound pronunciation in children who do not have deviations in phonemic development. A.G. Ippolitova was one of the first to recommend exercises in the preoperative period. Characteristic of her technique is a combination of breathing and articulation exercises, a sequence of sound training determined by articulatory interconnectedness.

The sequence of work on sounds is determined by the preparedness of the articulatory base of the language. The presence of full-fledged sounds of one group is an arbitrary basis for the formation of the following. So-called “reference” sounds are used.

Preparation of the articulatory base of sound is carried out using special articulatory gymnastics, which is combined with the development of the child’s speech breathing. The uniqueness of A.G. Ippolitova’s method is that when evoking a sound, the child’s initial attention is directed only to the articulum.

The content of speech therapy classes according to the method of A. G. Ippolitova includes the following sections:

1. Formation of speech breathing when differentiating inhalation and exhalation.

2. Formation of a long oral exhalation when the articulation produces vowel sounds (without including the voice) and fricative voiceless consonants.

3. Differentiation of short and long oral and nasal exhalation in the formation of sonorant sounds and affricates.

4. Formation of soft sounds.

· I. I. Ermakova (1980) developed a step-by-step method for correcting sound pronunciation and voice. She established age-related features of functional voice formation disorders in children with congenital clefts and modified orthophonic exercises for them. Special attention is paid to the postoperative period and methods for developing mobility of the soft palate are recommended, preventing its shortening after surgical plastic surgery.

Elimination of speech sound disorders is based on a thorough speech therapy examination of children.

The presence and degree of velopharyngeal insufficiency, cicatricial changes in the hard and soft palate, and its length are established; nature of contact with the posterior wall of the pharynx (passive, active, functional); dental anomalies, features of motor skills of the articulatory apparatus; the presence of compensatory facial movements.

The specifics of speech therapy sessions before surgery were most fully developed by A.G. Ippolitova and I.I. Ermakova.

Before surgery, it is advisable to carry out the following work:

1) free from compensatory movements of the facial muscles;

2) prepare the correct pronunciation of vowel sounds;

3) prepare the correct articulation of available consonant sounds.

After surgery, correction tasks become significantly more complicated. Their goal:

1) develop mobility of the soft palate;

2) eliminate the incorrect arrangement of the organs of articulation when pronouncing sounds;

3) prepare the pronunciation of all speech sounds without nasal connotation (except for nasal sounds).

Specific exercises for this are the following:

massage of the soft palate;

gymnastics of the soft palate and posterior pharyngeal wall;

articulation gymnastics;

voice exercises.

Their main goal is the following:

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

improve the activity of articulatory muscles;

develop control over the operation of the velopharyngeal seal.

After the operation (after 15-20 days), many special exercises are repeated. Their main goal in this period is the development of elasticity and mobility of the closure. In a significant number of cases, there is a need to “stretch” the soft palate, since it can decrease in length due to scarring in the postoperative period.

To stretch fresh scars, a technique that simulates swallowing is used. A massage is also carried out at the same time.

In the postoperative period, it is necessary to develop the mobility of the soft palate, eliminate the incorrect structure of the organs of articulation and prepare the pronunciation of all sounds without a nasal connotation.

Massage of the soft palate is carried out by a speech therapist 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. The main purpose of massage is to knead scar tissue. The teacher can help the speech therapist and parents with the following exercises: swallowing water or simulating swallowing movements; yawning with your mouth open; gargling with warm water in small portions; coughing

Clear, energetic, exaggerated pronunciation of vowel sounds in a high tone of voice is systematically trained. At the same time, the resonance in the oral cavity increases and the nasal tint decreases. First, they train the abrupt pronunciation of vowel sounds a, e, then o, u s

with exaggerated articulation and a solid attack.
Then they gradually move on to a clear pronunciation of the sound series a, e, u, o in different alternations.
In this case, the articulatory structure changes, but the enhanced oral output remains. When this skill is strengthened, the transition to smooth pronunciation of sounds is made. For example . Pauses between sounds increase to 3 seconds, but the raised position of the soft palate remains, closing the passage into the nasal cavity. Their systematic implementation in the preoperative period prepares the child for surgery and reduces the time of subsequent correctional work.

Working on proper breathing . To form a correct oral air stream, exercises are used in which inhalation and exhalation alternate: inhale through the nose - exhale through the mouth; exhale through the nose; inhale - exhale through the mouth.

At the same time, a series of exercises is carried out, the main goal of which is to normalize speech motor skills. It is known that children with rhinolalia develop pathological articulation features due to special anatomical and physiological conditions (L.I. Vansovskaya). These articulation features are as follows:

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.

It has been established that only a shift of articulation deeper into the oral cavity enhances the nasal tone of speech. Therefore, eliminating these articulation features is an important link in correcting the defect.

Blowing exercises should alternate with exercises that develop the lips, cheeks, tongue, i.e. with so-called articulatory gymnastics . The most effective of them:

inflating both cheeks at the same time;

puffing out the cheeks alternately;

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

sucking movements - closed lips are pulled forward with a “proboscis”, then return to their normal position. The jaws are closed;

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

“proboscis” followed by a grin with clenched jaws;

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

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

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

with the jaws wide open, pull the lips inside the mouth, pressing tightly against the teeth;

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

lip vibration;

movement of the lips “proboscis” to the sides;

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

Language exercises (first performed under the supervision of a speech therapist):

sticking out the tongue like a shovel;

sticking out the tongue with a “sting”;

alternately protruding a flattened and pointed tongue;

turning the strongly protruding tongue left and right;

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

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

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

suction of the tongue to the upper gum with opening and closing of the mouth;

dragging the tongue between the teeth so that the upper incisors “scrape” the back of the tongue; etc.

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

To eliminate rhinophonia (nasal phonation), a complex orthophonic method is used, which requires the participation of a phoniatrist, speech therapist, and teacher. The main goal is to create or restore a functional connection between breathing, articulation and voice production. The technique was developed by E.S. Almazova, L.I. Vansovskaya and others.

The objectives of speech therapy correction are as follows:

differentiation of nasal and oral breathing;

activation of the muscles of the soft palate and the back wall of the pharynx;

evoking a ringing, loud, modulated voice without a nasal tint;

development of prosodic means of speech;

education of auditory control of speech.

There are two stages of work, as well as individual and frontal types of classes. Great importance is attached to psychotherapy aimed at conscious and active inclusion in the correction process. Breathing exercises in the form of games are widely used. At the main stage, the development of voice pitch (vocal exercises) is carried out; speech pronunciation of vowels and their combinations; development of voice strength (transitions from quiet to loud pronunciation and vice versa); development of voice timbre (range and modulation based on combinations of vowels, consonants such as boom-bom,

imitation of voices, etc.).

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. In individual lessons, special exercises are used aimed at eliminating defects specific to this anomaly.

When drawing up an individual plan, the speech therapist must adhere to the following directions: normalization of the sound side of speech and elimination of lexical and grammatical underdevelopment.

A number of special sections are included:

I. 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.

II. 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.

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

In the first period of study in kindergarten, individual lessons are used to clarify the pronunciation of the vowel sounds a, e, o, u, y

and consonants
p, p;
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 the sounds are voiced: and; d, d; z, z; w; R.

In the third period, the sound w,

affricates and work continues to clarify the articulation of previously learned sounds. At the same time, intensive work is being done to eliminate the nasal tint.

Much attention is given to the differentiation of oral and nasal sounds: m - p; m - p; n - d; n - t; m - b; m - b.

At a school for children with severe speech impairments, specific defects are eliminated in individual speech therapy sessions.

In the process of correctional work on normalizing the phonetic aspect of speech, it is necessary to monitor the effectiveness of speech therapy exercises.

The criteria proposed by L.I. Vansovskaya make it possible to more clearly distinguish complex speech disorders in rhinolalia and evaluate the corrective effect in two aspects - elimination of nasalization and articulation defects.

The following speech assessments have been established:

1. Normal and close to normal, i.e. sound pronunciation is formed and nasalization is eliminated.

2. Significant improvement in speech - sound pronunciation is formed, there is moderate nasalization.

3. Improved speech - articulation of not all sounds is formed, there is moderate nasalization.

4. Without improvement - articulation of sounds is not formed, hypernasalization remains.

The effectiveness of correctional interventions is greatly influenced by the active participation of parents in the education of normal speech in children with clefts.

Among some factors that influence the results of correction (the age at which the operation was performed, its quality; the age at which speech therapy training began; duration of training), the factor of cooperation with the child’s family also stands out. The speech therapist instructs parents about the correction techniques used and recommends a significant part of well-developed exercises for systematic use at home.

SOURCES

_____________________________

Fundamentals of speech therapy work with children: A textbook for speech therapists, kindergarten teachers, primary school teachers, students of pedagogical schools / Ed. ed. Doctor of Pedagogical Sciences, prof. G.V. Chirkina. – 2nd ed., rev. – M.: ARKTI, 2003. – 240 pages.

OBJECTIVES AND CONTENT OF CORRECTIONAL MEASURES FOR CHILDREN SUFFERING WITH RHINOLALIA

The formation of phonetically correct speech in preschool children with a congenital cleft palate is aimed at solving several interrelated problems (G.V. Chirkina):

1) normalization of “oral exhalation”, the formation of a long-lasting oral stream when pronouncing all speech sounds, except nasal ones;

2) mastering the articulation of all speech sounds;

3) elimination of the nasal tone of the voice;

4) differentiation of sounds in order to prevent violations of sound analysis;

5) normalization of the rhythmic-intonation side of speech;

6) 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.

Speech therapy classes must begin in the preoperative period , because they prevent the occurrence of serious changes in the functioning of the speech organs. At this stage, the activity of the soft palate is prepared, the position of the root of the tongue is normalized, the muscular activity of the lips is enhanced, directed oral exhalation is produced - favorable conditions are created for more effective results of the operation and subsequent correction. 15-20 days after the operation, special exercises are repeated, but the main goal of the exercises is to develop the mobility of the soft palate.

The specifics of speech therapy sessions before surgery were most fully developed by A.G. Ippolitova and I.I. Ermakova.

Before surgery, it is advisable to carry out the following work:

1) free from compensatory movements of the facial muscles;

2) prepare the correct pronunciation of vowel sounds;

3) prepare the correct articulation of available consonant sounds.

After surgery, correction tasks become significantly more complicated. Their goal:

1) develop mobility of the soft palate;

2) eliminate the incorrect arrangement of the organs of articulation when pronouncing sounds;

3) prepare the pronunciation of all speech sounds without nasal connotation (except for nasal sounds).

Specific exercises for this are the following:

massage of the soft palate;

gymnastics of the soft palate and posterior pharyngeal wall;

articulation gymnastics;

voice exercises.

Their main goal is the following:

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

improve the activity of articulatory muscles;

develop control over the operation of the velopharyngeal seal.

Massage of the soft palate is carried out by a speech therapist 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. The main purpose of massage is to knead scar tissue. Massage should be performed before meals and in compliance with hygienic requirements. It is also useful to apply light pressure on the soft palate when pronouncing the sound a. The mouth should be wide open. The teacher can help the speech therapist and parents with the following exercises:

swallowing water or imitating swallowing movements. Swallowing a small volume of water causes the highest elevation of the soft palate. With successive swallowing movements, the time of the raised position of the soft palate lengthens. Children are encouraged to drink from a small glass or bottle. You can drop a few drops of water onto your tongue from a pipette;

yawning with your mouth open;

gargling with warm water in small portions;

coughing This is a very useful exercise because... Coughing causes vigorous contraction of the muscles at the back of the throat. When coughing, a complete closure occurs between the nasal and oral cavities. Children can feel the active participation of the movement of the palate and the back wall of the pharynx: the hand touches the larynx under the chin, and the rise of the palate is felt.

Voluntary coughing is trained to a large number on one exhalation. At this time, the closure of the palate with the back wall of the pharynx should be maintained, and the air should be directed through the oral cavity. At first, it is recommended to cough with your tongue hanging out. Then they train coughing with arbitrary pauses, during which the child is required to maintain the closure of the palate with the back wall of the pharynx, which teaches him to actively raise the soft palate and direct the air stream through the mouth.

with exaggerated articulation and a solid attack.
Then they gradually move on to a clear pronunciation of the sound series a, e, u, o in different alternations.
In this case, the articulatory structure changes, but the enhanced oral output remains. When this skill is strengthened, the transition to smooth pronunciation of sounds is made. For example . Pauses between sounds increase to 3 seconds, but the raised position of the soft palate remains, closing the passage into the nasal cavity. The listed exercises give positive results in the preoperative period and after surgery. They should be carried out under the supervision of a speech therapist constantly for a long time. Their systematic implementation in the preoperative period prepares the child for surgery and reduces the time of subsequent correctional work.

Working on correct breathing is necessary for developing correct sonorous speech. To form a correct oral air stream, exercises are used in which inhalation and exhalation alternate: inhale through the nose - exhale through the mouth; exhale through the nose; inhale - exhale through the mouth.

With these exercises being systematic, the child begins to feel the difference in the direction of the air stream and learns to control it. This also helps to develop the correct kinesthetic sensations of movements of the soft palate. However, it is necessary to constantly monitor the child, because At first it is difficult for him to feel the air leaking through the nasal passages. Therefore, various control techniques are used: a mirror is placed on the nasal passages, cotton wool, strips of thin paper, etc.

Blowing exercises also contribute to the formation of a proper air stream. They need to be carried out in the form of a game, introducing elements of competition. Some of the toys are prepared by children together with their parents from paper and fabric (butterflies, pinwheels, flowers, panicles, etc.). You can use strips of paper attached to a wooden stand, cotton balls on strings, light paper figures of acrobatics, etc. Such toys should have a specific purpose for teaching correct speech and should be removed only during classes.

Many parents make the mistake of buying balloons and accordions, inspired by the advice of a speech therapist, and giving them to their child for use. Children are not always able to inflate a balloon without preparatory exercises and often cannot play the harmonica. Without sufficient strength of oral exhalation, they become disappointed in these exercises and refuse to perform them. You need to start with easy, accessible exercises so that the effect is easily achievable. A child with a weak mouth exhalation can blow the cotton wool off his palm. If this fails, you can close his nostrils so that he feels the correct direction of the air stream. Then the nasal passages are gradually released. The following technique is often useful: light lumps of cotton wool (unpressed) are inserted into the nasal passages. If the air is mistakenly directed into the nose, then they pop out, and the child himself is easily convinced of the mistake.

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. The tube at the beginning of classes should be of a large diameter (5-6 mm), then smaller (2-3 mm). As the water blows, it begins to bubble, which captivates small children. You can easily estimate the force of exhalation and its duration by the “storm” in the water. It is necessary to show the child that the exhalation should be smooth and long. It is good to mark the time of “seething” on an hourglass. You can roll balls or pencils over a smooth surface with a strong blow, or play “soap bubbles.”

There are a lot of similar exercises. It must be borne in mind that breathing exercises quickly tire the child: dizziness may occur, so they must be alternated with others. You can inflate balloons and rubber toys after the child has developed sufficient oral exhalation force. In this case, you need to draw the children’s attention to how many times they need to inhale to inflate the balloon. A more difficult blowing exercise is playing lip instruments.

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.

Blowing exercises should alternate with exercises that develop the lips, cheeks, tongue, i.e. with so-called articulatory gymnastics . The most effective of them:

inflating both cheeks at the same time;

puffing out the cheeks alternately;

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

sucking movements - closed lips are pulled forward with a “proboscis”, then return to their normal position. The jaws are closed;

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

“proboscis” followed by a grin with clenched jaws;

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

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

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

with the jaws wide open, pull the lips inside the mouth, pressing tightly against the teeth;

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

lip vibration;

movement of the lips “proboscis” to the sides;

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

Language exercises (first performed under the supervision of a speech therapist):

sticking out the tongue like a shovel;

sticking out the tongue with a “sting”;

alternately protruding a flattened and pointed tongue;

turning the strongly protruding tongue left and right;

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

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

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

suction of the tongue to the upper gum with opening and closing of the mouth;

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

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

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

alternately bending the tongue with a “sting” to the nose and chin, upper and lower lips, to the upper teeth, to the hard palate and the bottom of the mouth;

the tip of the tongue touches the upper and lower incisors with the mouth wide open;

hold the protruding tongue with a “groove” or “boat”;

hold the protruding tongue with a “cup”;

keep the tongue in the shape of a “cup” inside the mouth;

biting the lateral edges of the tongue with teeth;

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

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

make movements one after another - tongue “sting”, “cup”, up, etc.

Working on sounds requires a lot of attention and effort. Usually the production of sounds begins with the sound a.

The tongue is at rest, the mouth is wide open.
When making a sound, the tongue is slightly retracted, the lips are pushed forward; sound u
- the lips are stretched with tension into a tube, and the tongue is pulled back even more.
When making the sound e
, the tongue rises slightly in the middle part, the mouth is half-open, the lips are stretched.

These sounds are easy to pronounce by imitation. The main task when pronouncing them is to eliminate the nasal tone. The training begins with an open, isolated pronunciation, in which the number of repetitions of sounds per exhalation increases, for example:

With each pronunciation, control over the direction of the air stream is necessary. The child holds a mirror or a light cotton ball on a string near the wings of his nose.

Then the repetition of vowels with pauses is practiced, during which the child learns to keep the soft palate in a raised position. The correct position of the soft palate needs to be shown to him in front of a mirror, pauses increased to 2-3 seconds. Then you can move on to smooth pronunciation.

It is recommended to start training the pronunciation of consonant sounds with the sounds f and p .

When pronouncing the sound
f , the tongue lies calmly at the bottom of the mouth. The upper teeth lightly bite the lower lip. A strong oral exhalation breaks this stop and forms a jerky f .
Air leaks are checked using a mirror or cotton wool. A large number of exercises are carried out on the pronunciation of practiced sounds 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.

To more effectively consolidate the results of speech therapy work, it is useful to use some types of work with sound recording:

1) listening to the speaker’s speech (the speaker can be an adult or a school-age child who has a clear, clear pronunciation of all sounds) and repeating the presented samples (in the interval);

2) listening to the speaker’s speech and simultaneous (with the speaker’s voice) reproduction of the sample;

3) listening to the speaker’s speech and recording the child’s own speech for subsequent comparison and analysis of errors;

4) recording answers to the speaker’s questions;

5) reading short dialogues with adults (corrected sounds are included in the speech material) and recording them on a tape recorder.

In correctional classes, syllables with studied ivuks and syllable series of varying complexity are used. For example, to consolidate the skills of clear pronunciation of labiolabial sounds in syllables and words, it is useful to use exercises aimed at differentiating nasal and oral sounds, which is most difficult for children with rhinolalia.

Then move on to more difficult ones:

Further:

After the correct pronunciation of the sounds p and b , the child is trained in syllables like:

Then both sounds ( p and b ) must again be trained in combination with the sound m , because This is the most vulnerable and persistent defect in the speech of children. There should be a lot of such exercises. Approximate types of combinations:

Syllable combinations imitate the different syllabic composition of words in the Russian language and contribute to the automation of learned sounds in independent speech.

In the first months of classes, the child must be required to clearly, exaggerated articulation of sounds. As the skill is automated, their pronunciation will become more natural and familiar.

In the process of long-term and systematic lessons, the child’s optimistic attitude towards overcoming the defect is maintained, and even minor successes in pronunciation are encouraged in every possible way. A gentle, tactful attitude towards the child is necessary.

At the same time, it is very important to establish close contact (cooperation) with the family, because Parents can provide invaluable assistance in strengthening the skills of correct speech in natural communication conditions.

The objectives of speech therapy correction are as follows:

differentiation of nasal and oral breathing;

activation of the muscles of the soft palate and the back wall of the pharynx;

evoking a ringing, loud, modulated voice without a nasal tint;

development of prosodic means of speech;

education of auditory control of speech.

NeuroSpectrum is ready to help

The NeuroSpectrum Center for Pediatric Speech Neurology and Rehabilitation employs experienced speech therapists, speech pathologists and other doctors who will help you quickly identify the problem and determine the safest and most effective way to eliminate it. Our specialists have modern diagnostic and medical equipment at their disposal; they constantly improve their qualifications, improve their skills and abilities, so that they are able to cope with the most complex and advanced cases.

The specialists of our Center use different areas of speech therapy work for rhinolalia - a complex effect allows you to get the desired result much faster. Hundreds of our patients have gotten rid of problems with sound pronunciation and speech and today speak clearly, quickly, and confidently.