Dysarthria is one of the most common speech disorders in children.

Dysarthria is a form of speech dysfunction that occurs as a result of organic damage to the central and peripheral nervous system. This disorder is characterized by a violation of articulation, phonation, intonation coloring and tempo-rhythmic organization of speech.

Initially, during the development of a speech deficit, the state of the articulatory apparatus suffers. With dysarthria, this is due to insufficient innervation of the muscles of the lips, soft palate, tongue, vocal cords and facial muscles. As a result, a whole complex of speech and non-speech disorders is formed, which makes up the structure of the defect.

Common clinical signs of dysarthria are slurred and slurred speech. The patient pronounces words vaguely and inarticulately, as if he has “porridge in his mouth.”

In the field of speech therapy, dysarthria ranks third after alalia (complete absence of speech) and dyslalia (sound pronunciation defects) among the most common oral speech disorders. Most often, this psychoneurotic disorder occurs in childhood, in approximately 10-15%. Among the adult population of the Russian Federation, the prevalence of this type of speech defect is 6-8%.

At the Yusupov Hospital, a team of neurologists together with psychotherapists offers a whole range of different services for the treatment of mild and severe forms of speech dysfunction.

Causes

The causes of dysarthria are directly related to diseases that affect the posterior parts of the frontal zone and other parts of the brain. Speech reproduction is impaired due to difficulty moving the tongue and lips. In childhood, in almost all cases, written speech, perception of sounds and reading abilities change.

In adults, such phenomena are observed much less frequently. Dysarthria often occurs during intrauterine development. The factors that caused the disease are gestosis (late toxicosis), oxygen starvation of the fetus, chronic diseases of the mother, injuries received during childbirth, prematurity, suffocation at birth, cerebral palsy (cerebral palsy).

At an early age, the disease is diagnosed due to previous purulent otitis media, meningitis, severe poisoning, hydrocephalus, increased intracranial pressure, as well as traumatic brain injuries. In adults, dysarthria results from:

• Tumors of the brain or cerebellum;
• Cerebrovascular accidents;
• Demyelinating disease (brain disease);
• Having suffered a stroke;
• Syphilitic lesions of the spinal cord or brain;
• Traumatic brain injuries;
• Abscess (purulent inflammation) of the cerebellum;
• Severe poisoning with poisons;
• Parkinson's disease (shaking palsy);
• Multiple sclerosis;
• Severe infectious pathologies;
• Hemorrhages in the brain;
• Serious disorders of the nervous system;
• Autoimmune neuromuscular disease;
• Cerebrovascular diseases;
• Fazio-Londe syndrome (juvenile paralysis);
• Mental retardation (oligophrenia).

In adults and older people, the disease most often occurs suddenly due to a prolonged period of unconsciousness (coma after a traumatic brain injury or major stroke). Dysarthria is often caused by improperly performed brain surgery and botulism (a disease associated with poisoning).

Pathology can also appear due to excessive consumption of alcoholic beverages, improper use of certain groups of medications, and drug overdose. High-risk groups include children under 2 years of age, adolescents and the elderly. At a young age, pathology is diagnosed, but not so often.

The disease is acquired in nature; as a rule, it does not have a genetic predisposition. Only pathologies of brain development that contribute to the occurrence of dysarthria can be inherited.

Dysarthria with cerebral palsy

Cerebral palsy develops when motor pathways and areas of the brain are affected. The central nervous system ceases to control the motor activity of muscles, and damage to motor function develops. Impairment of motor function may be mild or severe. In severe cases, the child cannot move, but movements are preserved; in mild cases, muscle tone is impaired and dipraxia develops. Children with cerebral palsy experience difficulties at all stages of physical development - they have difficulty holding and raising their heads, they get to their feet late, have difficulty sitting, and develop speech problems.

Dysarthria in children with cerebral palsy is associated with high muscle tone; the child makes great efforts to perform movements - this causes an increase in the tone of the articulatory muscles and muscles of the limbs. The delay in speech development occurs due to the late formation of speech departments in the cerebral cortex. Due to illness, the child communicates less with peers and is constantly in a limited space - this affects his psychological state and overall development. Children with severe cerebral palsy often lack speech completely.

Classification

Neurologists and speech therapists are still actively discussing a generally accepted classification of dysarthria, but consensus has not yet been reached. The classification of dysarthria, which is based on the localization of the pathological focus, includes the following types:

• Bulbar dysarthria - associated with the involvement in the pathological process of the nuclei of the cranial nerves, which are localized in the medulla oblongata;
• Pseudobulbar dysarthria - in which the pathology concerns the pathways connecting the motor centers of the cortex with the nuclei of the bulbar nerves;
• Subcortical dysarthria - in which the subcortical nuclei of the brain are affected;
• Cerebellar dysarthria – pathology of the cerebellum and its pathways;
• Cortical dysarthria is a focal pathology of the cerebral cortex itself.

The classification of dysarthria according to the degree of severity divides it into erased, mild, moderate and severe dysarthria.
The Yusupov Hospital has been successfully treating patients with this type of pathology for many years. Doctors achieve tremendous results not only with erased dysarthria, but also with severe disease. Make an appointment

Symptoms and classification

Dysarthria can manifest itself in both mild and pronounced forms. This depends on the degree of innervation disturbance and on the location of the damaged area of ​​the central or peripheral nervous system. All disorders can occur with an increase or decrease in muscle tone of the speech apparatus. Severe cases are characterized by the following symptoms:

• muscle hypertonicity - constant tension of the tongue, face and neck, tightly closed lips, which limits the mobility of the speech apparatus;
• muscle hypotonicity - in such patients the mouth is constantly slightly open, the tongue is relaxed and cannot perform the movements necessary to pronounce sounds, involuntary salivation may occur;
• dystonia - at rest, the muscles remain completely relaxed, but when trying to reproduce sounds, they experience spastic contraction and a sharp increase in tone.

It is difficult to track pathological changes at home, especially if the disease occurs in an erased form. However, treatment is most effective in the early stages, which is why doctors at the Clinical Institute of the Brain recommend that preschool children undergo preventive examinations with a speech therapist. If speech defects are not detected in time, the condition can gradually progress.

Clinical picture

Dysarthria is characterized by any speech defects. Their severity depends on the form and degree of disruption of the innervation of certain muscle groups. At the initial stages, only a speech therapist can diagnose these changes, and pronounced forms are accompanied by persistent changes in speech and diction. These include:

• impaired pronunciation of individual sounds, slurred and slurred speech;
• replacement of individual sounds or their omission, slow pace of speech;
• characteristic disorders - softening of consonant sounds, inability to correctly pronounce hissing and whistling sounds, incorrect reproduction of deaf and voiced sounds;
• difficulty breathing during speech - inhalations and exhalations become fast, intermittent, superficial;
• insufficient voice strength - patients often speak quietly.

If dysarthria manifests itself in childhood, it can affect the child’s overall development. Difficulties with communication lead to limited vocabulary and the inability to fully develop intellectual abilities. Also, the disease is often accompanied by dysgraphia - insufficient development of mental abilities that are involved in the control of written speech.

Forms of dysarthria

When diagnosing dysarthria, its neurological classification must be taken into account. Its main principles are the localization of the damaged area of ​​the nervous system and a set of symptoms that can be noticed during the initial examination. The diagnosis must be confirmed by examining the function of the brain and peripheral nerves. The Clinical Institute of the Brain has all the conditions for a full diagnosis of speech disorders, including those associated with insufficiency of the nervous system.

Bulbar dysarthria

The bulbar form of dysarthria is associated with a violation of the passage of nerve impulses in the nuclei of the cranial nerves located in the medulla oblongata. These can be the sublingual, glossopharyngeal, vagus nerves, less often - facial or trigeminal, as well as various combinations. This form is manifested by characteristic speech activity disorders:

• articulation disorder;
• change in voice timbre;
• inability to differentiate consonant sounds - they are all produced in a similar way.

Bulbar dysarthria is often diagnosed in early childhood. Such patients exhibit disturbances not only in speech activity, but also in other functions, including sucking and swallowing reflexes. Due to dysfunction of the facial muscle group, difficulty in eating both solid and liquid food may be observed. However, the severity of symptoms varies, and the disease may not affect the ability to self-care and social activity.

Pseudobulbar form

Pseudobulbar dysarthria occurs when the functioning of the cortical-nuclear pathways is disrupted. The clinical picture is due to an increase in muscle tone of the speech apparatus, which is manifested by a complex of typical symptoms:

• difficulties with the movement of the tongue during oral speech, the inability to fix it in a certain position (raise it to the sky or move it to the side);
• slurred speech with a characteristic nasal tint;
• impaired reproduction of consonant sounds, especially hissing and whistling sounds.

The pseudobulbar form may also present with additional symptoms. Due to the increased tone of the facial muscles, swallowing movements may be difficult, and the patient is at risk of choking on solid or liquid food. Involuntary movements of facial muscles are also characteristic.

Subcortical form

Subcortical dysarthria is also called extrapyramidal and develops when the passage of nerve impulses in the region of the subcortical nuclei of the central nervous system is disrupted. The main mechanism of pathological changes is hyperkinesis, uncontrolled movements of muscles or their groups, including facial or facial ones. This syndrome can manifest itself in a calm state, but often worsens when attempting to speak. The timbre of the voice in such patients often changes and may suddenly become too loud or quiet. Speech is fast or slow, but its pace can vary, and stuttering is also characteristic of subcortical dysarthria.

The extrapyramidal form can occur alone or in combination with concomitant disorders. It is often diagnosed in combination with other forms of dysarthria, including bulbar, pseudobulbar or cerebellar.

Cerebellar dysarthria

The cerebellar form is directly associated with a violation of the passage of nerve impulses along the cerebellar pathways. Patients have difficulty controlling speech activity, reproducing words and individual sounds. The overall picture may include the following characteristic manifestations:

• tongue trembling;
• impaired speech clarity - the patient concentrates on accurately reproducing words, but there may be individual increases or decreases in timbre and sound intensity, and shouting;
• Difficulty in producing sounds that require precision in the muscles of the tongue and lips.

Damage to the cerebellum affects not only speech function. Such patients often experience poor coordination of movements, unsteady gait and disorders of motor function of the limbs. With a mild form of the disease, the patient experiences difficulty maintaining balance, especially when moving.

Cortical dysarthria

The cortical form of dysarthria is a consequence of damage to certain areas of the cerebral cortex. The disease can occur both in early childhood and in adulthood. The main developmental mechanism is articulatory apraxia. The syndrome consists of the inability to perform complex sequential processes that are interconnected. The speech of such patients is slurred, but there are no breathing problems or changes in voice timbre. During the examination, it is important to carry out a differential diagnosis from motor aphasia, a disease that is characterized by identical disorders, but also includes impaired understanding of conversations and inability to write.

Degrees of dysarthria

The prognosis for the patient and the possibility of his normal socialization depend on the degree of dysarthria. Diagnosis of the disease must be carried out by a speech therapist who specializes in the correction of speech disorders associated with disorders of the nervous system. In total, there are 4 main stages, the first of which is the safest and does not affect the patient’s quality of life.

1. The first stage of dysarthria is hidden. Defects may be invisible even to close relatives, since speech remains as intelligible and understandable as possible. The disorder can only be diagnosed through examination by a speech therapist.
2. The second degree also does not affect the development of the child. Speech defects are noticeable to strangers, but speech remains understandable. The patient does not have difficulties with communication, which provides the opportunity to fully develop intellectual abilities and attend educational institutions.
3. At the third stage of dysarthria, the patient already experiences difficulties in communicating with strangers. Speech is slurred and can be difficult to understand even for close people. However, with competent rehabilitation, it is possible to voice simple thoughts and provide basic needs. Intellectual development is hampered as a result of the inability to communicate normally.
4. The last stage of dysarthria is anarthria. Speech in such patients is completely absent, which is directly related to impaired intellectual development. Characterized by involuntary reproduction of individual sounds and combinations that do not carry a semantic load, as well as uncontrolled movements of the facial muscles or a significant decrease in its tone.

Doctors at the Clinical Brain Institute strongly recommend undergoing routine examinations with a speech therapist, starting in early childhood. Diction disorders in preschool age are normal, and most cases resolve without the use of specific therapy. However, dysarthria requires long-term treatment, which will avoid complications and progression of the disease, as well as ensure maximum socialization of the patient.

Features of erased dysarthria

Erased dysarthria is a pathology in which mild disturbances of nerve conduction of the organs of articulation are observed.
Patients have mild disturbances in sound production and stress placement defects. Speech with erased dysarthria is not clear and unexpressive. Patients have difficulties with sound reproduction of certain phonetic groups and with their automation. This form is most common among children. Signs of dysarthria are also observed in writing - handwriting with dysarthria is illegible, and children write slowly. Erased dysarthria is diagnosed by determining the neurological and speech therapy status.

Depending on the location of the lesion, clinical manifestations also differ. With erased cortical dysarthria, only phonetics is disturbed, with preservation of phonetics and correct stress, since only a section of the cortical center is affected.

In the case of damage to the nuclei and ganglia, pronounced disturbances in stress are observed, but disturbances in perception and the production of sounds are practically preserved or are slightly impaired.

Pseudobulbar dysarthria leads to a uniform disturbance of all components of speech, since the conduction pathways from the cortex to the bulbar nuclei are affected.

The mixed form often includes a defect in sound pronunciation and differences in sounds.

A mild degree of erased dysarthria is characterized by minimal manifestations of pronunciation and stress defects and quite often goes unnoticed. But with a thorough examination by a specialist, the pathology is established. Correction of mild degrees of erased dysarthria includes breathing exercises, finger and articulation exercises, speech therapy and general massage, speech correction, etc.

Speech therapy: dysarthria and treatment methods

For the treatment of dysarthria, treatment methods have been developed depending on the complexity of the brain damage. The first manifestations of dysarthria appear in early childhood. Limited mobility of the organs of articulation occurs when the posterior frontal and subcortical parts of the brain are damaged. Dysarthria has three degrees of severity:

• Erased dysarthria - children do not differ from their peers; speech disorders are observed when pronouncing hissing and whistling sounds. A child with mild dysarthria gets tired faster during any physical activity.
• Typical dysarthria is a pronounced speech disorder.
• Anarthria is a severe degree of dysarthria. There is no normal speech.

Treatment of dysarthria begins after a complete examination of the child. The examination is carried out by a neurologist and speech therapist. The form of the disease and the degree of development of dysarthria are determined. Detecting the disease at an early age increases the chances of recovery. A speech therapist develops an individual treatment program for the patient. The grammatical structure and phonetic hearing are developed, the doctor helps to develop speaking skills, and uses speech correction methods to eliminate defects in the pronunciation of sounds.

Special articulation gymnastics are carried out, which helps to relieve increased muscle tone of the articulation organs and strengthen the facial muscles. A speech therapist provides speech therapy and acupressure massage, and conducts classes to improve fine motor skills. In addition to speech therapy sessions and physical therapy, the child receives medication treatment. Most often, children with dysarthria are prescribed nootropic drugs that improve brain activity. With the development of irreversible processes in the child’s body, the main focus of treatment will be the formation of speech and the patient’s adaptation to society.

Features of mild dysarthria

With a mild degree of dysarthria, there are no gross violations.
In the first degree of dysarthria, articulatory motor skills are inaccurate and slow. The speech is understandable, but a certain defect is still noticeable. Because of it, communication is disrupted. Patients prefer to speak using short words and sentences. Neurotic disorders often occur due to speech impediments. In children whose speech function is just beginning to develop, a diagnosis of mild dysarthria should be immediately treated to prevent general underdevelopment of speech function in the future. Untreated dysarthria will lead to impairment of written speech in the future. If speech disorders in childhood are not corrected, in the long term this will lead to a delay in the child’s mental development. Children with mild dysarthria receive education in secondary schools.

There are no gross defects in chewing and swallowing, but choking and coughing are sometimes observed. The patient's facial expressions are usually not impaired.

Definition and general information

Dysarthria is a speech therapy disorder. Its frequency is only 3-6% of all children, but there is a tendency for this indicator to increase. The disease is among the three most common speech disorders, along with dyslalia (speech defects not associated with damage to the central nervous system) and alalia (serious disturbances or complete absence of speech in children). Dysarthria occurs due to disruption of the central or peripheral nervous system, which affects the innervation of the muscles of the lips and tongue, larynx, palate, larynx and respiratory muscles.

Features of moderate dysarthria

The average severity of dysarthria is already characterized by gross defects in pronunciation, facial expressions, chewing and swallowing.
Speech with this degree of dysarthria becomes inarticulate, blurred, and incomprehensible. Children with moderate dysarthria are educated in specialized schools. After a certain time, relatives get used to it and begin to understand the patient’s speech. Facial expressions with a moderate degree of dysarthria are poor. In most cases, drooling is observed. Eating is difficult due to defects in chewing and swallowing.

Symptoms of dysarthria

Dysarthria manifests itself in inarticulate speech, when a person pronounces words inarticulately, as if with a “mouth full”, nasal sound may appear, as with sinusitis, pronunciation of words in syllables with periodic swallowing, disturbances in the rhythm of speech.

Dysarthria is accompanied by increased muscle tone of the speech apparatus, which causes rapid fatigue. The opposite can also occur - hypotension, in which the tongue, lips, cheeks become sluggish, and salivation increases.

With dysarthria, the pronunciation of all sounds, including vowels, suffers, and speech breathing disorders also occur, which affect the intonation and volume of speech.

Symptoms

Symptoms are quite extensive, divided into speech and non-speech, and also vary depending on the type of pathological process. Impaired articulation manifests itself in excessive tension, hypotonicity (weakening) or involuntary contraction of muscles.

Spasticity (a feature of the behavior of muscle tissue) of muscles causes increased tension in the articulatory organs (lips, tongue, palate). Also among the main manifestations is hypertonicity of the muscles of the neck and face. Due to partial paralysis of the palate, a change in voice occurs. The consequences of muscle weakening are limited tongue movements, a half-open mouth, and increased salivation. In addition to these manifestations, there are symptoms characteristic of a certain type of dysarthria:

• Bulbarnaya. There is a loss of voice ringing, slurred speech, as well as disturbances in visual functions, nervous system, speech breathing and muscle tone. With bulbar dysarthria, patients find it difficult to close their eyes and move their eyebrows. Voiced sounds, as a rule, are absent, and voiceless sounds predominate. If the lesion is unilateral, asymmetry of the oval of the face may appear. At the initial stage, it is difficult to take in liquid because when swallowing it can enter the nasal cavity. As the pathological process develops, problems with eating arise. Patients often complain of headaches, dizziness, nausea and lethargy.
• Pseudobulbar. The patient's speech becomes sluggish, inarticulate, and abrupt. The pronunciation of the sounds “sh”, “ts”, “ch”, “sch” and “r” is significantly difficult. Due to the excessively high tone of the tongue muscles, hissing sounds are softened, and the letters “i”, “e”, “s” are distorted and become more “hard”. It is almost impossible to compress the lips tightly, so saliva leaks from the corners of the mouth. In infants, sucking reflexes are disrupted and problems with swallowing occur.
• Cortical. Characteristic symptoms are difficulty in pronouncing consonant sounds, words or phrases are drawn out, the voice becomes nasal, as if the person is speaking “through the nose.” Due to damage to the tip of the tongue, it is difficult to pronounce the front-lingual sounds - “t”, “d”, “s”, “z”, “l”. Children have difficulty concentrating, writing and reading. Adults often experience depression due to deterioration in speech abilities.
• Extrapyramidal. Symptoms of extrapyramidal dysarthria include disturbances in the psychoemotional state, slurred phrases, and repetitions of certain sounds. Often the patient pronounces sounds similar to the syllables “gy” and “ky”. Involuntary muscle contraction leads to a forced smile and opening of the mouth. In this case, there is increased salivation and accumulation of saliva in the corners of the lips. Speech tends to change. It either speeds up or, on the contrary, slows down.
• Cerebellar. The disease manifests itself as a disorder in the smoothness and rhythm of pronunciation of words, as well as a lack of stress. When pronouncing long vowels, the patient's voice trembles. Inconsistency in voice strength often occurs. Speech is usually difficult, the person is in a tense state due to the inability to pronounce certain sounds. Hyperhidrosis (excessive sweating) appears. In most cases, coordination of movements is impaired, and chewing solid food is difficult.

Young children suffer more severely from the disorder than adults. This is explained by the inability to speak correctly. Often a sick child loses a sense of confidence and becomes withdrawn.

To avoid the disease progressing to a severe form, when the first symptoms are detected, you must consult a doctor as soon as possible. The inpatient unit at the Yusupov Hospital operates around the clock, so the patient will receive timely medical care even at night.

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Spastic-paretic dysarthria

The disease is diagnosed with pseudobulbar dysarthria; the patient has disturbances in the formation of voluntary motor skills, disturbances in differentiated and complex articulations. Dysarthria can manifest itself in various syndromes: hyperkinetic, paretic, spastic. Spastic syndrome is manifested by high muscle tone, hyperkinetic syndrome is characterized by the presence of violent movements (tremors), high muscle tone, paretic syndrome is manifested by low tone of individual muscles of the speech apparatus in combination with high tone of other muscles.

With the spastic type, the pronunciation of anterior lingual sounds is impaired, which are replaced by fricative sounds. The patient's voice is nasal, speech becomes slurred, monotonous, and slow. The child has arrhythmic shallow breathing that is not synchronized with speech. When a child speaks, the tone of the muscles of the articulatory apparatus, upper and lower extremities sharply increases. The mobility of the tongue is limited, the child has difficulty swallowing saliva, and drooling is observed when speaking. Children with spastic dysarthria have difficulty chewing and biting. There are three degrees of impairment: mild, moderate and severe.

With a mild degree, the child pronounces only some sounds unclearly, but oral speech is quite intelligible. The average degree of impairment is characterized by the child’s inability to pronounce most sounds. A severe degree of the disorder is characterized by the inability to pronounce most sounds, speech is slurred, involuntary friendly movements occur, which are accompanied by active movements of the muscles of the face and limbs. The paretic type of disorder is characterized by a decrease in the tone of individual muscles of the speech apparatus; the muscles of the tongue are tense in the root, tip and lateral parts of the organ. The paretic type is of a mixed nature and is observed with pseudobulbar dysarthria.

The child’s sound pronunciation changes, the soft palate often sags, which leads to the development of speech through the nose. The pronunciation of the sounds “l”, “u”, “i”, “s” is impaired. As a result of disorders of the speech apparatus (flaccid paralysis of the lips), the pronunciation of the sounds “m”, “p”, “b” is impaired. The child has facial hypomimia and constant drooling. The most common hyperkinetic variant of the disorder. In children, tempo-rhythmic organizational movements and automation of sounds are disrupted, and loss of speech may occur. Most often, spastic-paretic dysarthria is observed in children with cerebral palsy.

Spastic paresis in such children is associated with weakened innervation of the cranial nerves (CN). Dysarthria of this form can be accompanied by general or selective damage to the central neurons V, VII, IX, X, XI, XII pairs of the cranial nerve. Varying degrees of participation of the muscles of the speech apparatus in spoken speech are formed. The voice of such patients is not clear or loud, speech is slow, and breathing is shallow. The louder the voice, the higher the patient's speech intelligibility. In children after six years of age, gross lexico-grammatical violations are rarely encountered; speech is slightly blurred when pronouncing all sounds; the pronunciation of sonorant and fricative sounds is more impaired.

Diagnostics

A thorough examination and further therapy is carried out by a neurologist and speech therapist. In some cases, consultations with other highly specialized specialists may be required. At the initial stage, the doctor collects complete information - when the first symptoms appeared, whether there are any chronic diseases, whether family members have similar complaints.

After collecting anamnesis, the neurologist conducts a visual examination of the pharynx, checking the mandibular and pharyngeal reflex. The role of the speech therapist at the diagnostic stage is to assess speech abilities (pronunciation of sounds, changes in timbre during a conversation, disturbances in the tempo of speech).

If the patient’s voice is nasal, then to exclude dangerous pathologies in the nasal cavity, an examination by an otolaryngologist is prescribed. After a thorough visual examination, a number of diagnostic measures are prescribed:

• Electromyography (ENMG) is a diagnostic method that tests muscle activity, the functionality of the nerve innervating the damaged muscle, the affected area, and the severity of damage to the nerves and muscles.
• Transcranial magnetic stimulation (TMS) is a technique based on the activation of brain cells. The examination is carried out using a special apparatus with an alternating magnetic wave. The procedure helps determine the excitability of cortical neurons, the functionality of the cortex, and the interaction of certain parts of the brain with each other. Based on the results obtained, the doctor draws conclusions about the functioning of the speech centers, as well as the visual apparatus, cognitive functions (perception of information), and other things.
• Computed tomography (CT) is a study that allows you to examine in detail the internal organs, bone tissue and vascular system in different projections. The procedure takes only 10-15 minutes for each organ examined, after which the doctor receives a layer-by-layer X-ray image, which is used to make a diagnosis.
• Electroencephalography (EEG) is a study of the vital activity of the brain by recording impulses that come from its individual areas. The technique allows us to identify pathological processes occurring in the brain, as well as assess the nature and severity of the disorder.
• Magnetic resonance imaging (MRI) of the brain is a scan of organs using magnetic waves to produce high-quality images. Diagnostics is designed primarily to identify brain abnormalities and a thorough examination of the vascular system. In addition, MRI is used to check intervertebral discs, bile ducts and other human organs.

Diagnostics is the most important stage, allowing you to make a reliable diagnosis and make the right prescription. If the type of pathology and its severity are incorrectly determined, it is impossible to make a correct prescription. This threatens that the prescribed medications will not bring the desired result, and the disease will progress.

To diagnose pathology, you can go to the Yusupov Hospital at any time of the day, where certified specialists will conduct a detailed examination of organs using the latest equipment. Thanks to the latest generation of safe devices, doctors can accurately determine the type of pathological process without harm to the patient’s health. This will allow you to select an individual course of treatment and eliminate the dangerous disease in a short time.

Diagnostic and treatment methods

The Clinical Institute of the Brain specializes in the diagnosis and treatment of speech activity disorders, including those caused by disorders of nervous activity. An important stage is an examination by a speech therapist, during which even hidden forms of dysarthria are identified. The procedure consists of several stages, during which the correctness of breathing and uniformity of speech, reproduction of individual sounds and conscious word combinations are assessed. The patient is also asked to undergo certain tests that reveal the degree of development of written speech. This can be either rewriting fragments of text or writing from dictation, as well as awareness of written speech.

Additional diagnostic stages are aimed at identifying the area of ​​the nervous system in which the lesion is located. This is possible thanks to specific techniques:

• electrophysiological studies, including electroencephalography and assessment of facial muscle activity;
• study of the brain using transcranial magnetic radiation;
• MRI of the brain.

Treatment of dysarthria is a long process that is completely under the control of doctors at the Clinical Brain Institute. The therapy is aimed at strengthening neural connections and stimulating the conduction of nerve impulses, as well as improving speech activity. The main condition for positive dynamics is the work of a competent speech therapist and neurologist, as well as systematic training. A good therapeutic effect is achieved through physiotherapy, physical therapy, and special massage techniques (reflex, acupressure). In addition, spa treatment is recommended, including those aimed at improving the patient’s communication abilities. Spending time with animals is beneficial - most experts recommend hippotherapy. The prognosis depends on the stage of the disease, as well as on the timeliness of its diagnosis and systematic treatment. With mild dysarthria, complete restoration of speech function is possible, with severe dysarthria, its partial improvement.

Treatment

Treatment requires an integrated approach, since monotherapy (taking one medication) will not give anything. The main goals of therapeutic measures are speech correction, normalization of speech breathing and elimination of voice disorders. For these purposes, medications, physical therapy (physical therapy), and speech therapy sessions are prescribed.

Drug therapy

Medicines are selected by the doctor depending on the type of pathology. The following pharmacological groups are most often prescribed:

• Nootropics are drugs designed to increase mental abilities and improve memory. Such drugs include Encephabol, Pantocalcin, Picamilon;
• Sedatives (calming) are medications that relieve nervous tension and have an anti-anxiety effect. The most popular are “Persen” and “Novo-passit”;
• Calcium channel blockers - normalize cerebral circulation, the functioning of the vascular system, and reduce the risk of developing oxygen starvation of brain cells. Cinnarizine, Gliatilin and Instenon are considered effective drugs;
• Metabolics - correction of respiratory functions, improvement of metabolism, normalization of cerebral circulation. They are used for various traumatic brain injuries, hypoxia and other pathological conditions. The most commonly prescribed drugs are Cerebrolysate or Actovegin.

Any prescription is made by a doctor after diagnostics and an accurate diagnosis. Self-medication is unacceptable and leads to aggravating consequences.

Classes with a speech therapist

Speech therapy procedures have a beneficial effect on the muscles of the articulatory organs and develop fine motor skills. Individual techniques are developed by a speech therapist depending on the pathological condition. The set of exercises usually includes:

• Articulation and finger gymnastics;
• Exercises to develop voice (orthophony);
• Breathing exercises;
• Correction of speech expressiveness;
• Treatment and correction of written speech disorders;
• Restoring reading abilities.

Physiotherapy

One of the important techniques for dysarthria of any degree. Exercises are performed at home on an ongoing basis. This can be body turns, forward bends, etc. When performing any complex exercise, it is important to breathe correctly. Take a deep breath through your mouth and exhale slowly through your nose. Gymnastics helps normalize metabolic functions, strengthen the body and improve cerebral circulation.

Massage

Speech therapy massage for dysarthria should be done carefully so as not to cause pain to the patient. An individual set of measures is developed by a speech therapist. To improve articulation abilities, experts recommend several massage exercise techniques:

During the rehabilitation period, physiotherapy, acupuncture, medicinal baths, and hirudotherapy (leech treatment) are prescribed. An important role in the treatment of dysarthria is played by dolphin therapy, art therapy (clay modeling, drawing therapy, etc.), and sensory therapy. The effectiveness of treatment depends on the correctness of the selected individual therapeutic program.

The specialists at the Yusupov Hospital have the highest medical categories, many years of experience in successfully eliminating pathology, and use only modern equipment. Thanks to this, each patient is provided with qualified assistance and the most effective individual method for treating dysarthria is selected.

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How to Diagnose and Treat the Disorder

Diagnosis of the disorder is the prerogative of neurology and speech therapy. Instrumental research methods play a special role in making a diagnosis: EEG, electroneurography, electromyography, MRI, transcranial magnetic stimulation.

The speech therapist, in turn, must examine the condition of the speech-motor organs, facial and facial muscles. The specialist evaluates the nature of speech: how understandable it is for perception, the correct pronunciation of individual sounds, its tempo, rhythm, intonation, volume, synchronicity of the articulatory apparatus, and grammatical aspects.

Written speech is assessed by asking the patient to copy some text or take dictation.

Treatment of the disorder should begin with relief of the underlying disease. But speech disorders cannot be ignored.

It is advisable to begin correction of dysarthria as quickly as possible. Feeling his own conversational peculiarities, the patient will try to limit communication in society. This will lead to worsening of the speech defect. For example, from the first stage it will develop into the second. Isolation can also make it difficult to understand normal speech.

Therefore, in addition to treating the underlying disease, correction of speech defects is carried out. For this purpose, physiotherapy methods are used:

• various types of massage, including Shiatsu - influencing reflexogenic points using the finger method;
• acupuncture;
• physical therapy, including the use of special simulators;
• medicinal baths.

It is permissible for a psychoneurologist to prescribe psychotropic drugs as aids to normalize the psycho-emotional background.

Speech therapy treatment consists of using:

• speech therapy massage – working out the facial muscles. It allows you to improve blood circulation and restore normal muscle tone. Used to improve speech motor skills;
• exercises for voice production - the work of the vocal cords, volume and timbre of the voice are regulated;
• finger gymnastics – development of fine motor skills of the hands, which is interconnected with speech function;
• learning to position the organs of articulation for correct pronunciation;
• prosodic exercises - work on intonation, strength, height, tempo of the voice. Helps eliminate monotony;
• breathing exercises. Her exercises establish the correct breathing rhythm during speech activity.

Among the psychotherapeutic techniques used:

• art therapy;
• laughter therapy;
• clay and wax therapy;
• aromatherapy;
• music therapy;
• chromotherapy or color therapy.

The integrated use of all treatment methods makes it possible to correct speech disorders. In some cases, dysarthria can be completely eradicated, in others, lasting positive changes can be achieved.

It is also important to teach patients how to live in society with their problem. People with dysarthria are taught to establish eye contact with the interlocutor, use nonverbal methods of expression - gestures, pictures, etc., and the ability to recognize that the interlocutor has understood him.

Prevention

Preventive measures involve preventing the development of pathological processes that impair speech abilities. To avoid the occurrence of illness, it is recommended:

1. Treat abscesses, infectious diseases and other pathologies in a timely manner.
2. Avoid traumatic brain and spinal injuries and severe stress that disrupts the functioning of the nervous system.
3. When working with harmful substances, observe safety precautions so that toxic vapors do not enter the body.
4. Strengthen the body with vitamin complexes (in consultation with your doctor). This will help avoid oxygen starvation and cerebral circulation disorders.
5. Regularly monitor blood pressure levels to prevent circulatory and vascular system disorders.

Forecast

The prognosis directly depends on the severity of the disease and how quickly therapeutic measures were started. If you follow all the specialist’s recommendations, complete restoration of speech with erased dysarthria is possible, but treatment requires a serious approach. You should not miss classes with a speech therapist or take prescribed medications.

Severe forms of pathology, unfortunately, in almost all cases leave consequences, but they can be minimal if the right treatment is selected. For children with severe speech disorders there are special kindergartens with speech therapy rooms and consultations with highly specialized specialists (neurologist, psychologist, massage therapist).

If the pathology is congenital, it is necessary to take all measures to prevent the progression of dysarthria - avoid injuries, visit a speech therapist, and avoid contact with aggressive substances that can lead to severe intoxication.

Note. It is easier to prevent a disease than to eliminate its negative consequences later. Therefore, measures to prevent dysarthria have an important role in a person’s life.

Structure of speech defect in dysarthria

The structure of the defect in dysarthria is a violation of sound pronunciation as a result of changes in the tone of the muscles involved in articulation, hyperkinesis of the lips and tongue, breathing problems, and various synkinesis. The patient's speech is slurred and slurred. The technology of voice formation for dysarthria takes place in several stages:

• Preparatory stage.
• Staging precise movements of articulatory organs.
• Formation of an air stream.
• Development of fine motor skills.
• Working with phonemic processes.
• Setting reference sounds.
• The stage of developing speech skills and abilities.
• Formation of communication skills in a child.

The formation of the movement of articulatory organs is carried out with the help of articulatory gymnastics and speech therapy massage. The development of fine motor skills is carried out through hand massage, finger exercises, and the child is taught self-massage of the fingers. The child plays with a construction set, strings beads on a thread, ties shoelaces, and performs other exercises. At the stage of developing skills and the ability to speak correctly, sound production is carried out, articulation is practiced, an air stream is created and the voice is trained to pronounce voiced and sonorant sounds. As well as production of isolated sound, automation and differentiation of sounds. Differentiation of sounds takes place using several techniques:

• Demonstrations of articulation of differentiated sounds.
• Phonemic analysis, synthesis, phonemic representations of sound.
• The connection between letters and sounds.

Sound production occurs in three ways:

• By imitation.
• Mechanically.
• In a mixed way.

Erased dysarthria is the most common form of the disorder and is difficult to correct. The mechanisms of slurred speech in erased dysarthria are associated with a violation of the organization of brain activity and a violation of the innervation of articulatory organs. Erased dysarthria is characterized by unclear articulation of sounds of several phonetic groups at once; the child has difficulty automating sounds, and speech becomes unexpressive. The most difficult thing is to achieve normalization of prosody and automation of sounds. A child with erased dysarthria undergoes simultaneous treatment by a speech therapist and a neurologist. The reason for the development of erased dysarthria is the inferiority of the innervation of the organs of articulation - the tongue, lips, soft palate. Organic damage to the nervous system occurs during fetal development, during childbirth or in the early postnatal period.

The nature of the brain damage is kinesthetic postcentral cortical dysarthria. The causes of postcentral cortical dysarthria are damage to the lower parts of the postcentral fields of the cerebral cortex, in most cases the left hemisphere. With this type of disorder, the voice and timbre of speech are not impaired, the child hears errors in the pronunciation of sounds well, tries to correct them - this affects the fluency of speech and leads to its slowdown. The nature of the brain damage is kinetic premotor cortical dysarthria. It develops as a result of damage to the premotor fields of the cerebral cortex, most often the left hemisphere. The patient's voice timbre is not impaired, the voice is sonorous, the child replaces fricative sounds with stop sounds.

The tension of articulation causes an increase in the volume of the voice, deafening of some stop and rarely fricative consonants. Subcortical dysarthria refers to extrapyramidal dysarthria. Speech disorders are varied: the voice goes from harsh and hoarse to a whisper, fluctuates in volume and timbre. Often the articulation of vowels is more impaired than consonant sounds. The patient hears a violation of articulation and pronounces individual sounds clearly and correctly. When pathological involuntary movements occur, speech becomes slurred and sounds are distorted.

Pseudobulbar dysarthria develops with bilateral damage to the central motor corticobulbar nerves. It is characterized by increased muscle tone, pyramidal spastic paralysis of the articulatory muscles. Voluntary movements and subtle movements of the tongue are impaired. The child replaces stop sounds and the vibrant “r” with fricative sounds, complex fricative sounds with flat fricative sounds, and the articulation of hard consonants is more impaired. The child hears speech disorders well and tries to correct them - this most often leads to an increase in the tone of paralyzed muscle groups and an increase in articulation disorders.

Pseudobulbar dysarthria is caused by spastic paralysis of articulatory muscles and high muscle tone. Paretic and spastic paralysis are characterized as the main pathogenetic mechanism of dysarthria. Cerebellar dysarthria is associated with damage to the cerebellum and other brain structures. Characterized by disturbances in breathing, articulation and phonation. The child's speech is scanned, slow, the patient has difficulty articulating due to muscle hypotonia.

Frontal lingual sounds, stop sounds, and affricates are impaired. Prosodic disturbances are pronounced, and the speech is nasal. Bulbar dysarthria develops with unilateral or bilateral damage to peripheral motor nerves. It is characterized by reduced or completely absent mandibular and pharyngeal reflexes, disorders of voluntary and involuntary movements, flaccid paralysis of the articulatory muscles, atrophy of the muscles of the articulatory apparatus. The patient's speech is slow, dull flat-slit sounds predominate in speech, vowels and voiced consonants sound dull. The timbre of speech is changed, the speech is nasal, the voice is weak.

Treatment in Moscow

For many years, the Yusupov Hospital has specialized in the treatment of dysarthria in children and adults. The high professional level of specialists allows us to accurately determine the type of pathology, which eliminates the possibility of incorrect prescription of therapeutic measures. An individual approach to each patient guarantees a favorable atmosphere throughout the entire course of treatment and rehabilitation. The main directions of the clinic:

1. Treatment of complex neuralgic pathologies - multiple sclerosis, major stroke and other dangerous diseases that cause the death of certain groups of brain cells.
2. Help for patients with cancer - chemotherapy, therapy that eliminates pain syndromes and painful symptoms.
3. Treatment of progressive brain diseases - Alzheimer's disease, vascular dementia, Pick's disease and other rare forms of dementia.
4. Rehabilitation of patients after severe operations, chemotherapy, traumatic brain and spinal injuries, major stroke and radiation therapy.
5. Effective treatment and correction of speech disorders. The range of measures includes constant monitoring by specialists, physiotherapeutic measures, therapeutic exercises and classes with a speech therapist who has extensive experience in the successful treatment of dysarthria.

By contacting the Yusupov Hospital, the patient receives a guarantee of a speedy recovery and the most favorable outcome. You can make an appointment for a consultation with specialists by phone.

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Dysarthria through the eyes of a neuropsychologist

Dysarthria is a neurological disease, the symptoms of dysarthria are neurological symptoms. The etiology of dysarthria is local damage to the central nervous system, damage to the brain. Neurologists created classifications of the disease. Dysarthria was first divided into cerebral and bulbar forms of the disease at the beginning of the 19th century. In the mid-20th century, a systematization of the forms of dysarthria was proposed depending on the location of the brain lesion and the disease that caused the dysarthria. Scientists who have studied dysarthria have found that the development of speech is greatly influenced by motor activity.

At the beginning of the twentieth century, neurologist Bekhterov proved through experiments that facial expressions and well-developed fine motor skills help speech development. The area responsible for speech development is located in the cerebral cortex next to the area responsible for motor muscles. Currently, dysarthria is studied by neurologists (neuropsychologists); the disease is treated by neurologists (neuropsychologists) and speech therapists. A neuropsychologist checks the development of speech, thinking, attention, motor skills and memory in a child, and is the first to detect disturbances in speech development and symptoms of damage to the nervous system.