The diagnosis of dysarthria is made after a thorough examination by a neurologist and speech therapist. In differential diagnosis, an integrated approach is used, which covers not only speech activity, but also the state of the child’s higher mental functions, behavior, level of mastery of skills, state of vision, hearing, articulation apparatus and motor sphere. No less important is information about the child’s somatic condition and the possible hereditary nature of the disorder. A thorough study will allow not only to make an accurate diagnosis, but also to choose the optimal method for correcting the form of dysarthria.
Distortion of speech due to dysarthria
Speech dysarthria is not considered an isolated disease. This is a symptom that manifests itself in a disorder of all speech characteristics: tempo, intonation, volume, consonance, clarity, etc. As a result, speech becomes slurred.
The cause of the disorder is damage to the parts of the central nervous system responsible for the innervation of the speech-motor apparatus. Dysarthria in adults can develop as a consequence of a stroke, tumor or brain injury. It also accompanies patients with amyotrophic and multiple sclerosis, Parkinson's disease, and occurs in mental retardation, neurosyphilis, and other pathologies affecting the brain.
A whole system of organs is involved in the formation of words. These are lips, tongue, cheeks, larynx, palate, respiratory and facial muscles. With dysarthria, these elements do not work in a coordinated manner. The reason for this is damage to the following nerves:
- sublingual;
- glossopharyngeal;
- facial;
- trigeminal.
In this case, inadequate functioning of the tongue is observed: limited movement of the tongue to the sides, up, down. He is in a tense state, which is why he gets tired quickly, and asymmetry of the lesion may be observed.
The cheek muscles also lack coordinated movements. This reduces the ability to correctly maintain posture when pronouncing sounds. Movement of the lower jaw is difficult. The lips are excessively compressed or, conversely, relaxed, the tongue lies at the bottom of the mouth, and the pliability of the soft palate is also impaired.
Motor stiffness, tension, paresis and paralysis of the facial muscles lead to the fact that the speech of such a patient becomes incomprehensible, unclear and difficult to perceive. It is often characterized as porridge in the mouth.
Speech defects manifest themselves to varying degrees, depending on the area and extent of the lesion. There is an articulation disorder in pronunciation. A person does not pronounce almost all sounds, both vowels and consonants. Often hissing and whistling sounds have interdental or lateral pronunciation, the correct sound of voiced and hard consonants is lost, and defects in the pronunciation of “l” and “r” and sounds with posterior pronunciation appear.
Front-lingual letters (“d”, “t”, “z”, “s”) are pronounced with an interdental whistle. Complex sounds are replaced by simpler ones. Speech either unnaturally slows down, becomes drawn-out, or, conversely, accelerated. Gaps appear between letters and letter substitutions occur.
The voice also undergoes changes. It loses its volume, becoming quieter and weaker. The timbre becomes nasal and dull. Speech is monotonous, without emotional coloring. The intonation of the voice is lost: interrogative, narrative, exclamatory. Speech rhythm is inconsistent, stress placement is disrupted.
Due to problems with innervation, speech breathing also changes. During pronunciation it becomes more frequent, chaotic and intermittent. It’s as if the person doesn’t have enough air to finish the sentence.
Thus, speech impairment in dysarthria is polymorphic in nature, that is, it undergoes changes in all its characteristics. They are quite stable.
The main differences between dysarthria and other speech therapy diagnoses
Dysarthria differs from dyslalia by severe neurological symptoms. In addition, sound pronunciation is grossly impaired; not only the sounds of early ontogenesis are affected, but also vowels. The voice is deaf, weak, fine and general motor skills are impaired, mental processes are reduced: memory, attention, thinking. The child experiences frequent mood swings and hyperactivity. With alalia it is differentiated according to the principle of the absence of primary disturbances in speech production and language operations, which is expressed in the peculiarities of the development of the lexical and grammatical structure of speech.
The main directions of correctional work for dysarthria
When treating dysarthria, an integrated approach is used, and the work of a speech therapist is required. Speech therapy is carried out along with medicinal and non-medicinal means of influence: physiotherapy, medications to relieve muscle spasms, exercise therapy, reflexology, massage. Psychological and pedagogical work is also important, which includes:
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Degrees of disorder
Dysarthric disorder is not limited to speech defects. This includes all disorders that are in one way or another associated with pathological innervation or with inadequate functioning of improperly innervated organs. Thus, due to hypotonia or hypertonicity of the tongue, as well as paresis of the soft palate, difficulties appear in the act of swallowing and chewing. Ptyalism is observed - increased salivation. Facial expressions suffer due to a disorder of the innervation of the facial muscles. The inability to move the eyebrows, smile, puff out the cheeks, the face takes on the appearance of a mask.
However, it cannot be said that one patient has all the pathological characteristics. The disease manifests itself depending on the degree of development of the disorder.
A mild degree of dysarthria is accompanied by a reduction in the activity of the articulatory side of speech due to slow movements of the tongue and lips. The speech of such patients is slowed down and lacks forceful expression. Sounds are blurred during pronunciation. It is difficult to pronounce hissing words, voiced consonants do not sound loud enough. The sound of soft consonants is disrupted, as this requires the active participation of the back of the tongue and the soft palate. Swallowing is practically unimpaired.
With an average degree, a significant modification of speech is already observed. She becomes inarticulate and very quiet. Even defects in the pronunciation of consonants appear. Voiced consonants are replaced by voiceless ones. The endings are swallowed. The voice becomes nasal and there is increased nasal exhalation. Characterized by chewing and swallowing disorders. Facial expressions suffer.
Severe severity is characterized by deep lesions of the speech-motor system. As a result, the tongue and lips of such patients are almost completely immobilized, and the face acquires mask-like features. The mouth is always half open due to drooping of the lower jaw. All this makes speech production very difficult, resulting in anarthria - the inability to speak. A person can only make individual sounds. Chewing and swallowing are inaccessible to him.
Types of dysarthria
The type of disorder, as well as its symptoms, depend on the location of the affected center in the brain:
- The bulbar form develops due to damage to the nuclei of the cranial nerves located in the medulla oblongata. Accompanied by pronounced degradation of speech activity. It becomes extremely indistinct, sounds are difficult to separate from each other. The voice is quiet, the person speaks “in the nose.” The acts of chewing, swallowing, and sucking are impaired, and profuse salivation is observed. There is no facial expression.
- The pseudobulbar form is characterized by damage to the corticobulbar pathways. Along them, the impulse passes from the cortical centers to the articulatory components of the speech-motor apparatus. When this connection is disrupted, the bulbar nerve nuclei become overactive. This causes hypertonicity of the speech muscles. The vocal cords, being in a tense state, cease to vibrate correctly when trying to reproduce sounds, which affects the character of speech. It becomes slow, incomprehensible, and difficulties appear in switching from one speech posture to another. There are difficulties in the act of swallowing, ptyalism.
- Subcortical or hyperkinetic dysarthria manifests itself against the background of damage to the subcortical nuclei of the brain, which is accompanied by hyperkinesis. They are expressed by involuntary contractions of facial and “speaking” muscles. As a result, the patient’s speech is saturated with a sudden change in its usual rhythm. It can slow down, becoming monotonous and incomprehensible, or, conversely, speed up. Then speech becomes super fast, a person can swallow endings, rearrange syllables, and stumble verbally. Often this form is accompanied by stuttering.
- The cortical form develops with focal brain damage. It is accompanied by difficulty in voluntary speech activity.
- The cerebellar form manifests itself in pathologies of the cerebellum. It is characterized by a violation of the organization of the speech flow. It is associated with a break in the fluency of speech. There is a jerky, intermittent tone, chanting, and involuntary shouts.
Prognosis and prevention
The result of treatment depends on the type of disorder and its degree. Regularity of exercise is important. Only constant training and thorough implementation of the doctor’s recommendations will allow you to completely or partially cope with the problem. If we are talking about severe disability, in which dysarthria arose against the background of other pathologies, the likelihood of successful correction is significantly reduced.
Prevention of the disease includes general measures: reducing the risk of injury, a healthy lifestyle during pregnancy, etc.
As soon as you begin to notice the first signs of dysarthria in a preschooler, do not delay your visit to specialists. Only a comprehensive specialized examination will identify or eliminate the problem. At SM-Doctor you will be met by competent doctors and speech therapists who will help you establish an objective diagnosis and correct the identified disorders. Sign up for a consultation with professionals at a convenient time! We find an approach to every child, even the most difficult.
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.
General information
The localization of the pathological process leading to dysarthria in children can develop at different levels of the nervous system responsible for the formation of sounds and the logical order of the story:
- nuclei of the cranial nerves responsible for the nervous control of the tongue, lips, soft palate, etc.;
- pathways between the cortex and cerebral nuclei;
- subcortical centers;
- the cerebellum and pathways, pathways from and to it;
- cortex.
Diagnosis is carried out simultaneously by a neurologist (determines the level of topical damage to the nervous system and the nature of the pathological process) and a speech therapist (determines the degree of speech disorders in order to make a correction prognosis).
Treatment is aimed at eliminating or stabilizing the background pathology that led to speech disorders, as well as articulatory correction.
