Classification of speech disorders. Causes of speech disorders.

Normal speech development is one of the important components of the harmonious development of a child’s personality and successful learning. But there is a category of children who have speech disorders. Such disorders include lexico-grammatical speech underdevelopment (LGSD).

This violation belongs to the psychological and pedagogical classification. Children with LGND are distinguished by preserved sound pronunciation and relatively developed phonemic processes (sometimes as a result of speech therapy assistance). But there is a lag in the level of vocabulary from the norm and the presence of agrammatisms in speech. Most often, this disorder is observed with general speech underdevelopment (GSD).

Forms of manifestation of LGNR

Often this disorder accompanies more serious speech disorders and is one of their symptoms:

• Exit from motor alalia. With this form of pathology, the process of language acquisition occurs. This is why LGNR occurs with this type of alalia.
• OHP of any degree.
• Speech development delay (SDD).
• Mental retardation (MDD).
• Dysarthria.

Underdevelopment of the lexico-grammatical aspect of speech is one of the main signs of these disorders. As a rule, its first symptoms appear at 3 years old, when the child begins to communicate in sentences and more actively explore the world around him.

Classification of speech disorders. Causes of speech disorders.

Based on materials from speech therapy literature, it was prepared by speech therapist V.N. Rychkova.

A child, when born, does not have an innate knowledge of the laws of the language he will speak. At a certain period of his development, he learns the norms and rules of the language spoken by the people around him. If for some reason language-speech-mental activity is not formed on time, then in the future this leads to disturbances in the child’s speech to one degree or another.

Classification of speech disorders

Psychological and pedagogical classification of speech disorders:

*Phonetic speech disorder or disorder of the pronunciation of individual sounds (NPOS). In this type, the phonetic side of speech (sound pronunciation, sound-syllabic structure of a word, prosody) as a whole or any individual components of the phonetic structure of speech (for example, only sound pronunciation or sound pronunciation and sound-syllabic structure of a word) are impaired.

*Phonological speech disorder (PSI ). This is the underdevelopment of phonemic processes (sound discrimination): phonemic perception, sound analysis and synthesis with normal sound pronunciation and the absence of agrammatisms.

*Phonetic-phonemic speech disorder (FFSD).

With FFND, along with a violation of the phonetic aspect of speech, there is also an underdevelopment of phonemic processes: phonemic perception (auditory differentiation of sounds), phonemic analysis and synthesis, phonemic representations.

*Lexico-grammatical speech underdevelopment (LGSD). With LGNR, children have normal sound pronunciation, phonemic processes are relatively preserved (most often as a result of speech therapy), but there is a limited vocabulary and a violation of the grammatical structure of speech (agrammatism).

*General speech underdevelopment (GSD I , II and III ). With OHP in children, all components of the language (speech) system are impaired: the phonetic-phonemic side of speech (sound pronunciation and sound discrimination), vocabulary (limited vocabulary), grammatical structure.

Clinical and pedagogical classification —

reveals the mechanisms, forms and types of speech disorders. The following forms of speech disorders are taken into account: dyslalia, dysarthria or an erased form of dysarthria, rhinolalia, voice disorders; motor and sensory alalia; aphasia, delayed speech development (SDD), stuttering and others.

* Dislali I - a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus.

*Dysarthria is a disorder of the pronunciation aspect of speech caused by insufficient innervation of the speech apparatus (damage to the speech motor mechanisms of the central nervous system).

*Alalia (motor and sensory) – absence or underdevelopment of speech due to organic damage to the speech areas of the cerebral cortex in the prenatal or early period of a child’s development.

*Aphasia is a complete or partial loss of speech caused by local brain lesions.

*Speech development delay (SDD) is a slower than normal acquisition of the native language (sound pronunciation, vocabulary, grammatical structure) .

Causes of speech disorders.

Adverse internal factors affecting the brain during the period of its intensive development lead to a delay in the development of the child as a whole. These include: intrauterine pathology (intoxication, infectious diseases of the mother, toxicosis of pregnancy); injuries during childbirth (birth injuries, asphyxia, intracranial hemorrhage); hereditary factors (chromosomal disorders and genetic changes); compatibility of mother and fetus (Rh factor).

They lead to minimal organic brain damage in the infant, which is characterized by lack of attention, weakened memory, lag in motor development, disinhibition and, as a consequence, lag in speech development.

The use of alcohol, nicotine and drugs during pregnancy is especially harmful. This leads to disturbances in the physical and neuropsychic development of the fetus. Women who smoke, drink and use drugs give birth to children with low body weight and lagging behind in physical and mental development.

Unfavorable external factors : lack of an emotionally positive environment; individual characteristics of the mother (suspiciousness, anxiety, emotional coldness), insufficient attention to the child from adults, or, conversely, overprotection; raising a child in two houses, when the child alternately lives with divorced parents.

Etiology

The causes of LGNR can be divided into two large groups - biological and social. The first category includes:

• adverse effects on the fetus during pregnancy (especially on the brain);
• difficult course of pregnancy;
• trauma during childbirth;
• asphyxia;
• severe infectious diseases in the first year of a baby’s life.

Social ones include:

• unfavorable social conditions and speech environment in which the child grows up;
• prolonged stress;
• lack of emotional communication with family;
• overprotection;
• bilingualism.

The genetic predisposition of children to speech disorders causes controversy among experts. Some believe that this feature is passed on genetically. Another group believes that a child can simply imitate an adult who has a speech impediment.

Description of symptoms

LGNR is expressed not in a violation of sound pronunciation, but in underdevelopment of vocabulary and difficulties in mastering grammatical categories. The impressive vocabulary is sharply behind the norm; the child uses words in speech with the wrong meaning. He has difficulty classifying objects; he cannot find generalizing words. Due to delayed vocabulary, children with LGND have difficulties in understanding speech.

His phrases and sentences are ungrammatical. The norms of agreement in gender, number and case are violated. In the speech of children with LGND, nouns predominate rather than adjectives and verbs. A preschooler has difficulty or does not form possessive pronouns and adjectives at all. Numerals, adverbs, and participles are practically not used in speech.

Most often, such children communicate through phrases and uncommon sentences. They do not use prepositions or conjunctions. Their answers to questions are not extensive; they are usually monosyllabic. Also, children with LGNR have difficulties in word formation, especially in the prefix-suffix way.

LGNR also affects the quality of coherent speech. A preschooler cannot independently compose a story or retell a story. Children with such features of speech development do not write descriptive stories because it is difficult for them to select words that are similar in meaning. All this affects the child’s need for communication. If this defect is not corrected in time, it may cause a violation of written speech. Successful exit from LGNR depends on how early correctional work was started.

Classification of general speech underdevelopment in speech therapy

In terms of clinical composition, the category of children with general speech underdevelopment is heterogeneous. Speech therapists distinguish the following forms of pathology:

• uncomplicated forms of general speech underdevelopment in children with minimal disorders of brain function - insufficient regulation of muscle tone, immaturity of the emotional-volitional sphere, motor differentiation);
• complicated forms of OHP in children with psychopathic and neurological syndromes - cerebrasthenic, convulsive, hypertensive-hydrocephalic, hyperdynamic;
• gross underdevelopment of speech in children with organic lesions of the speech parts of the brain (with motor alalia - the absence or underdevelopment of speech in children with normal hearing and initially intact intelligence).

The following classification of speech disorders in speech therapy is currently used:

• the first level of speech development is “speechless children” who lack common speech;
• the second level of speech development - the initial elements of common speech, a poor vocabulary, and the phenomena of agrammatism are determined - speech disorders manifested in difficulties in generating or perceiving sentences;
• the third level of speech development is the appearance of expanded phrasal speech with underdevelopment of its semantic and sound aspects;
• the fourth level of speech development – ​​residual gaps in the development of the lexical-grammatical and phonetic-phonemic aspects of speech.

Diagnostic features

The speech therapist selects visual material depending on the age of the child. When examining the lexical and grammatical aspects of speech, the specialist pays special attention to:

• state of vocabulary (impressive and active);
• mastery of word formation skills;
• the ability to coordinate words in phrases and sentences;
• which parts of speech the child uses more;
• development of coherent speech.

The child is asked to complete a task of generalization and comparison of objects. The speech therapist pays attention to how well the baby understands the speech addressed to him. He is also asked to form possessive adjectives and pronouns; make up new words. To assess coherent speech and mastery of grammatical categories, a speech therapist observes how the child communicates outside of educational activities.

For diagnosis, the child is asked to compose a story based on the picture. During this task, the specialist assesses how often the child uses common sentences; does the words agree? Do you need the help of an adult when compiling them? In addition, the list of tasks includes working with synonyms and antonyms.

Based on the results of the examination, the speech therapist selects special exercises that will most effectively correct this speech disorder.

Principles and visual methods of speech therapy

When to contact a speech therapist? Adults need speech therapy rehabilitation after a stroke, traumatic brain injury, or brain tumors. Children need consultation with a speech therapist in the following cases:

• a child of one and a half to two years old does not pronounce the words “mom”, “dad”, “top-top”;
• the baby is silent until the age of three, although he understands speech addressed to him;
• the child is lagging behind in speech development;
• after traumatic brain injury;
• By the age of five, a child nasals, burrs, lisps, and pronounces sounds incorrectly;
• baby at five, the child doesn’t remember words well.

From the age of three, children are recommended to undergo an annual consultation with a speech therapist, even if their parents think that everything is fine. Intensive development of the cerebral cortex in children continues until the age of 6-7 years. It is better to deal with speech therapy problems before school, and it is worth starting early.

What is the difference between a speech therapist and a speech pathologist? A defectologist has a specialization in “defectology”. He works with children with physical and mental disabilities. A speech therapist works with children without mental retardation or disruption of the central nervous system. He teaches the correct pronunciation of sounds and syllables. The tasks of a speech therapist at school are the correction and prevention of reading and writing disorders.

Speech therapy is based on the following basic principles:

• consistency;
• complexity;
• development principle;
• consideration of speech disorders in relation to other aspects of the child’s mental development;
• the principle of taking into account the causes and mechanisms of speech defects.

Speech therapy methods are conventionally divided into several groups:

• organizational – comparative, longitudinal (study over time), complex;
• empirical – observation, experimental, psychodiagnostic (tests, questionnaires, interviews), biographical (collection and analysis of the patient’s life history);
• quantitative and qualitative analysis of the obtained data, their machine processing using electronic computers and computer programs;
• interpretative – methods of theoretical study of connections between the phenomena being studied.

Technical means that ensure the objectivity of the study are widely used: intonographs, nasometers, spectrographs, video speech, phonographs, spirometers and other modern equipment. X-ray film photography, cinematography, electromyography, glottography make it possible to study the dynamics of holistic speech activity and its individual components. Neurological problems are also studied in speech therapy.

Features of working on improving vocabulary

With LGNR, the main attention is paid to correcting vocabulary, grammatical structure and coherent speech. Work on the lexical component is carried out in the following areas:

• expansion and activation of vocabulary;
• its clarification;
• developing the ability to use generalizing words:
• developing an understanding of complex grammatical structures.

It is best to start working on understanding speech in the context of objective activity. Thus, not only the vocabulary will be enriched, but also its clarification and use in active speech.

By completing tasks using generalizing words, the child learns a specific lexical topic. He learns to classify objects into categories; compare according to various criteria. To consolidate the acquired skills, the speech therapist asks what a certain word means, when it is used in speech, etc.

Work is being carried out not only on updating nouns, but also adjectives, verbs and other parts of speech. It is best to introduce them into active speech in combination with objective activities. For example, adjectives when examining objects, selecting synonyms. Verbs - directly when performing any action; numerals - during counting, etc.

The state of vocabulary affects both the acquisition of grammatical categories and the quality of coherent speech. But the correction of these important components must be carried out in combination for the classes to be effective.

Features of working on grammatical structure and coherent speech

Classes are conducted in the following areas:

• formation of word formation skills;
• mastering the skill of coordinating not only nouns with adjectives, but also with other parts of speech;
• composing complex common sentences;
• compiling a descriptive story based on a plot picture.

The speech therapist works with the child on the use of various grammatical structures. Teaches the use of prepositions and conjunctions in speech. Tasks are offered for the declension of nouns, adjectives, and verbs. In addition to improving grammatical structure, work is being done in parallel to develop coherent speech.

The specialist’s task is not just to teach how to compose a story without the help of an adult, but so that the child can establish logical connections between sentences. At the beginning of the work, the speech therapist helps through leading questions and drawing up a hint plan. Then, gradually, the baby learns to independently give detailed answers and talk about familiar topics.

In addition, work is underway on intonation expressiveness. The child is introduced to the peculiarities of using interrogative and exclamatory intonation. It can be well practiced by staging theatrical performances, expressive reading and memorizing poems.

Correction forecast

The effectiveness of corrective work depends on how early LGNR was identified. The sooner, the better the result will be. With timely speech therapy assistance before entering first grade, it is possible to cope with this disorder. Or you can reduce the gap from the norm as much as possible.

The outcome is also influenced by the characteristics of the speech disorder. The more complex it is, the longer it will take to corrective work to develop the necessary skills. During schooling, LGNR can cause the development of dysgraphia and dyslexia. Therefore, correctional work should be carried out in preschool age.

LGND is usually part of a more complex speech disorder. Therefore, the speech therapist draws up a lesson plan to eliminate the cause of any defect. This disorder becomes more noticeable after 3 years, when the baby begins to interact more actively with the outside world.

To prevent the occurrence of LGNR, adults need to communicate more with the child and be interested in his opinion. While walking, practice some areas for developing lexical and grammatical structure. After all, parents also have an important influence on speech development. Therefore, the speech therapist and parents must interact together so that the child has beautiful and literate speech.

Correction of speech disorders in preschool children using Pantocalcin®

In recent years, both parents and teachers often complain about delays in speech development in children of early and preschool age. Children begin to speak late, speak little and poorly, their speech is poor and primitive. Almost every kindergarten group needs special speech therapy assistance. This picture is observed not only in our country, but throughout the world.

Figure 1. Comparison of indicators of psychospeech development in the study groups after treatment

Figure 2. Dynamics of tasks performed on fine motor skills in the studied groups

Table. Number of tasks performed on fine motor skills in the studied groups

As special studies have shown, 25% of four-year-old children suffer from serious disorders in speech development. In the mid-70s of the XX century. speech deficit was observed in only 4% of children of the same age. Over the past 20 years, the number of speech disorders has increased more than 6 times (1).

The speech therapy conclusion when examining preschoolers with normal intelligence is based on the characteristics of speech disorders according to symptomological (psychological-pedagogical) and clinical-pedagogical classifications that reveal the mechanism, forms and types of speech disorders.

Psychological and pedagogical classification

takes into account the type and severity of disorders of various components of speech. This classification contains the following groups of speech disorders:

phonetic speech disorder (FSD) or disorder of pronunciation of individual sounds (NPOS).

In case of FND, the phonetic aspect of speech (sound pronunciation, sound-syllabic structure of speech, prosody) in a complex or any individual components of the phonetic structure of speech (for example, only sound pronunciation or sound pronunciation and sound-syllabic structure of a word) is impaired;

phonetic-phonemic speech disorder (FFSD).

With FFND, along with a violation of the phonetic aspect of speech, there is also underdevelopment of phonemic processes: phonemic perception (auditory differentiation of sounds), phonemic analysis and synthesis, phonemic representations;

lexico-grammatical speech underdevelopment (LGSD).

With LGNR, children have normal sound pronunciation, phonemic processes are relatively preserved (most often as a result of speech therapy), but there is a limited vocabulary and a violation of the grammatical structure of speech;

general underdevelopment of speech (GSD levels I, II and III), as well as mild general underdevelopment of speech (GOSD).

With OHP in children, all components of the language (speech) system are disrupted: the phonetic-phonemic aspect of speech, the lexical system, and grammatical structure.

Clinical and pedagogical classification

(Volkova L.S. et al., 1999) is more “symptomatic”, i.e. reflects predominantly the clinical picture of a speech disorder. It includes:

oral speech disorders:

violations of the phonation of utterances (the pronunciation side of speech), the most significant clinical manifestations of which are:

• dysphonia
  (
  aphonia
  ) – a disorder (or absence) of phonation due to pathological changes in the vocal apparatus (manifests in the form of disturbances in the strength, pitch and timbre of the voice);
• Bradylalia
  – pathologically slow rate of speech;
• tachylalia
  – pathologically accelerated rate of speech;
• stuttering
  is a violation of the tempo-rhythmic organization of speech caused by convulsive contraction of the muscles of the speech apparatus;
• dyslalia
  - a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus;
• rhinolalia
  - a violation of voice timbre and sound pronunciation, caused by anatomical and physiological defects of the speech apparatus (speech is slurred, monotonous, the pronunciation of all sounds is distorted);
• dysarthria
  is a violation of the sound pronunciation side of speech, caused by organic damage to the central nervous system and disorders of the innervation of the speech apparatus. Common clinical signs of dysarthria are disturbances in muscle tone of the articulatory muscles;

violation of the structural-semantic design of the statement:

• alalia
  – absence or underdevelopment of speech due to damage to the speech zones of the cerebral cortex in the prenatal period or in the early (pre-speech) period of child development (synonyms: dysphasia, early childhood aphasia, developmental dysphasia);
• aphasia
  – complete or partial loss of speech caused by local damage to the speech areas of the cerebral cortex as a result of traumatic brain injury, cerebrovascular accidents, neuroinfection and other diseases of the central nervous system;

writing disorders:

• dyslexia
  – partial specific disorder of the reading process;
• dysgraphia
  is a partial specific writing disorder (2, 4).

Classification

, presented below (Russian State Pedagogical University named after Herzen, 2001), is a variant of the intersection of two classifications: clinical-pedagogical and psychological-pedagogical:

FNR or NPZ:

• dyslalia;
• dysarthria or erased dysarthria;
• voice disorders;
• rhinolalia.

2)
FFNR:

• dyslalia;
• dysarthria or erased dysarthria;
• rhinolalia.

3)
LGNR:

• exit from motor (sensory) alalia;
• by type of speech development delay;
• with mental retardation (MDD);
• unknown origin.

4)
ONR I, II, III levels, NONR:

• motor alalia;
• sensory alalia;
• sensorimotor alalia;
• dysarthria or erased dysarthria;
• by type of speech development delay;
• with ZPR;
• unknown origin.

disturbances in the tempo and rhythm of speech:

• stuttering;
• tachylalia;
• Bradylalia;
• stumbling (poltern).

In the treatment of speech disorders in children, a large role is given to speech therapy classes and psychotherapy. Drug treatment is complex and includes sedatives, vitamins, and a special role is given to nootropic drugs (4).

Among nootropic drugs, the drug of choice for the treatment of speech disorders in children is the domestic drug Pantocalcin® (hopantenic acid) produced by Valenta Pharm OJSC, which, thanks to its composition, effectively improves the psycho-speech development of children, while acting gently and safely.

The pharmacological effect of Pantocalcin® is primarily due to its belonging to the group of nootropic drugs. The spectrum of action of Pantocalcin® is associated with the presence of gamma-aminobutyric acid in its structure. The drug has neurometabolic, neuroprotective and neurotrophic properties. Pantocalcin® increases the brain's resistance to hypoxia and the effects of toxic substances, stimulates anabolic processes in neurons. Pantocalcin® has an anticonvulsant effect, reduces motor excitability while regulating behavior and has an activating effect on performance and mental activity.

The main indications for the use of Pantocalcin® are:

• cognitive impairment in organic brain lesions and neurotic disorders;
• psycho-emotional overload, decreased mental and physical performance, impaired concentration and memory;
• delay in mental, speech, motor development or a combination thereof;
• cerebral palsy;
• stuttering;
• epilepsy (as part of combination therapy);
• consequences of neuroinfections and traumatic brain injuries;
• complex therapy of cerebrovascular insufficiency caused by atherosclerotic changes in cerebral vessels, senile dementia (initial form), residual organic brain lesions in adults and the elderly;
• cerebral organic failure in patients with schizophrenia (in combination with antipsychotics, antidepressants);
• extrapyramidal hyperkinesis.

Pantocalcin® dosage regimen:

average single dose for children

– 0.25-0.5 g;
daily – 0.75-3 g; the average single dose for adults
is 0.5-1 g; daily – 1.5-3 g. The course of therapy with Pantocalcin® ranges from 1 to 4 months, in some cases – up to 6 months. After 3-6 months, the course of treatment can be repeated.

Side effects of the drug are mild and can manifest themselves in the form of allergic reactions, rhinitis, conjunctivitis, and skin rash.

Contraindications are acute severe kidney disease, as well as hypersensitivity to the drug (3).

At the city preschool educational institution No. 5 of the Nevsky district of St. Petersburg, a study was conducted on the use of the drug Pantocalcin® in the treatment of speech disorders in children.

Purpose

This study was an assessment of the effectiveness and safety of using the drug Pantocalcin® for speech disorders in preschool children.

Materials and methods

For all children included in the study, the ICD-10 classification (F 80) was used as the basis for establishing and justifying the diagnosis of “Specific disorders of speech and language development”. 20 children with speech disorders were examined. For the purpose of comparative assessment of the effectiveness of Pantocalcin®, all patients were divided into 2 groups.

The main group (I) consisted of 10 children aged 4 to 6 years with level III OCD who received Pantocalcin® therapy for 1 month. In 5 children, residual encephalopathy and delayed speech development were combined with motor disorders, and in 5 children - with attention deficit disorder.

The comparison group (II) consisted of 10 children (8 children with level III ODD; 2 children with FFNR) aged 4 to 6 years who did not receive Pantocalcin®. In 7 children, residual encephalopathy and delayed speech development were combined with motor disorders, and in 3 children - with attention deficit disorder.

The main etiological factor of specific disorders in the patients included in the study was hypoxic-ischemic damage to the central nervous system during childbirth, confirmed by anamnestic, clinical data and additional research methods (brain ultrasonography and electroencephalography).

A psychological examination of children of groups I and II included a study of the thinking process, auditory-verbal and visual memory, the process of perception, and general erudition.

The neurological examination consisted of an assessment of the neurological status, fine motor skills (assessed by the number of completed tasks out of 22 proposed to the child), the child’s cognitive functions, clarity of pronunciation of sounds, speech, vocabulary, grammatical structure of speech, attention, impulsivity, hyperexcitability (according to generally accepted methods).

The prescription of Pantocalcin® was agreed upon with the children's parents and was carried out under the dynamic supervision of specialists: pediatrician, neurologist, speech therapist, psychologist, educators and parents. During the first 3 days, patients in group I received Pantocalcin® 1 tablet (250 mg) once a day, then 1 tablet (250 mg) 2 times a day after meals for 30 days. Clinical and psychological examination was carried out before and after completion of the course of Pantocalcin® therapy (1 month).

Research results

Psychospeech development.

Improvement in indicators of psychospeech development in the main group during treatment was noted in 70% of children, while in 50% of children with residual encephalopathy, delayed speech development and attention deficit disorder, the dynamics were most pronounced. An improvement in indicators of psycho-speech development was recorded by a neurologist, speech therapist and parents of the children.

In the comparison group, positive dynamics were observed in only 50% of children, mainly in pronunciation (Figure 1).

Fine motor skills.

The number of tasks on fine motor skills performed by children of the main group and the comparison group is reflected in the table and Figure 2.

During treatment in the main group, the number of tasks performed on fine motor skills increased by 18.2%, and in the comparison group - by 9.2%. Improvement was observed mainly in patients with a combination of residual encephalopathy, delayed speech development and motor disorders.

Results of psychological examination.

A repeated psychological examination of the children in the main group revealed a clear positive trend in the following parameters: stability and concentration of attention, visual perception. There was a positive trend in the intellectual sphere: children began to think at a faster pace, and children began to use hints better. The psychologist and teachers noted positive dynamics in the emotional and personal sphere: mood stabilized, anxiety and tearfulness decreased, the level of aggressive reactions decreased, the repertoire and storyline of game actions expanded.

Thus, monitoring the examination of the main group of children during the month of taking Pantocalcin® allowed us to establish:

• improvement in indicators of psycho-speech development in 70% of children (in the comparison group the same figure was 50%);
• improvement in “fine motor skills” in all children of the main group by 18.2% (in the comparison group – by 9.2%);
• improved concentration;
• more successful performance of visual perception tasks in the main group, in contrast to the comparison group.

The drug was well tolerated; all patients in the main group completed the course of therapy with Pantocalcin®.

Conclusion

The data from the study allow us to conclude that Pantocalcin® has a positive effect on the indicators of psycho-speech development of children with general speech underdevelopment (GSD level III). While taking Pantocalcin®, children showed an improvement in concentration and memory, cognitive activity, as well as an improvement in the development of fine motor skills of the fingers.

The effectiveness and safety of Pantocalcin® are the basis for wider use of the drug in pediatric practice for the treatment of speech disorders in children.