Speech therapy examination of children with dysarthric disorders

Speech therapy examination of children with dysarthric disorders

Speech therapy examination of children with dysarthric (speech-motor) disorders is based on a general systems approach, which is based on the idea of ​​speech as a complex functional system, the structural components of which are in close interaction. In this regard, the study of speech development in dysarthria involves influencing all aspects of speech. It is important to take into account the ratio of speech and non-speech disorders (neurological symptoms) in the structure of the defect and to determine the intact mechanisms of speech.
A comprehensive comprehensive examination and assessment of the developmental features of speech, mental functions, the motor sphere, and the activity of various analytical systems will make it possible to give an objective assessment of existing speech development deficiencies and outline optimal ways for their correction. An important condition for a complex impact is the coordination of the actions of the speech therapist-defectologist and the neurologist during the examination and diagnosis.

During the speech therapy examination of children with speech-motor disorders, the following methods are used: - study of medical and biographical documentation (collection and analysis of anamnestic data); - observation of the child (in a regular and specially organized situation); - conversation with parents and child; - visual and tactile control (palpation) at rest and during speech; - individual experiment; — use of computer games when examining sound pronunciation, respiratory and vocal functions.

Before starting an examination of the child, it is important to comprehensively study the medical documentation (history data) and analyze the examination results and the conclusion of a neurologist (neurological status), preferably discussing it with a doctor. A feature of speech therapy examination and analysis of the structure of speech defects in children with dysarthria is the principle of correlating articulatory motor disorders with general motor disorders. With dysarthria, articulatory motor skills, breathing and voice production characteristics are assessed in accordance with the child’s general motor capabilities (even minor motor disorders are noted).

Together with a neurologist, the speech therapist studies the characteristics of the child’s general motor skills (holding the head, freely turning it to the sides, sitting, upright standing, independent walking, gait features) and the functionality of the hands and fingers (support function, palm and finger grip, manipulation of objects , identification of the leading hand, coordination of hand actions, subtle differentiated movements of the fingers). When determining the leading neurological syndrome and the degree of its manifestation in articulatory muscles and motor skills (speech motor syndrome), the speech therapist relies on the conclusion of a neurologist. In this case, it is necessary to note the absence or presence of pathological tonic reflexes and their effect on breathing, voice formation and articulation.

It is important that during a speech therapy examination the child is completely calm, does not cry, and is not frightened. If a child cries, screams, or breaks out of his arms, this may be reflected in a change (increase) in muscle tone, and the idea of ​​motor and speech capabilities that the speech therapist will receive will be false. During the examination, a thorough analysis of those positions and movements that can facilitate or, conversely, complicate speech activity is carried out. It is advisable to place a child with severe motor impairment on a comfortable couch or carpet, testing different positions - on the back, on the side, on the stomach. In milder cases, the examination is carried out in a sitting or standing position.

As with any comprehensive examination, it is important to assess the features of the development of cognitive activity (thinking, attention, memory), sensory functions (visual, auditory and kinesthetic perception), and manifestations of the emotional-volitional sphere. A speech therapy examination includes collecting data on the characteristics of the child’s pre-speech, early speech and mental development before the examination. Based on data from medical documentation and conversations with parents, the time of appearance and the nature of screaming, humming, babbling, and then the first words and simple phrases are determined.

An examination of the articulatory apparatus begins with checking the structure of its organs: lips, tongue, teeth, hard and soft palate, jaws. At the same time, the speech therapist determines how much their structure corresponds to the norm.

It is necessary to assess the state of muscle tone of the articulatory apparatus at rest, during attempts at speech activity, during speech, during facial, general and articulatory movements. The state of muscle tone in the organs of articulation (facial, labial and lingual muscles) is assessed during a joint examination by a speech therapist and a neurologist. In children with dysarthria, articulatory muscle tone disorders are characterized by spasticity, hypotonia or dystonia. Often there is a mixed nature and variability of muscle tone disorders in the articulatory apparatus (for example, hypotonia may be expressed in the facial and labial muscles, and spasticity in the lingual muscles). The presence or absence of hypomimia, facial asymmetry, smoothness of nasolabial folds, synkinesis, hyperkinesis of the facial and lingual muscles, tongue tremor, deviation (deviation) of the tongue to the side, hypersalivation is noted.

The speech therapist evaluates involuntary movements of the articulatory apparatus during eating (sucking, taking food from a spoon, drinking from a cup, biting, chewing, swallowing). The features of disturbances in the act of eating in a child are clarified: absence or difficulty in chewing solid food and biting off a piece; choking and choking when swallowing.

Particular attention is paid to the state of voluntary articulatory motor skills. When testing the mobility of the organs of articulation, the child is offered various imitation tasks. Analyzing the state of mobility of the speech muscles, attention is paid to the possibility of performing articulatory positions, holding them and switching them. At the same time, not only the main characteristics of articulatory movements are noted (volume, amplitude, tempo, smoothness and speed of switching), but also the accuracy, proportionality of the movements, and their exhaustibility. The speech therapist assesses in particular detail the volume of articulatory movements of the tongue (strictly limited, incomplete, complete); There is even a slight decrease in the amplitude of articulatory movements of the tongue. In some children with pronounced speech-motor syndromes, it is sometimes impossible to even passively remove the tongue from the oral cavity. The possibility of voluntary protrusion of the tongue, lateral abduction, licking of lips, holding wide, spread out, upper lifting, clicking, etc. is checked. The degree and limit of the pharyngeal reflex (increase or decrease) is assessed. The speech therapist analyzes the characteristics of the movements of the lips (sedentary or quite mobile) and the lower jaw (opening and closing the mouth, the ability to keep the mouth closed).

Assessing the understanding of directed (impressive) speech is the most important stage of a speech therapy examination. The speech therapist identifies the level of understanding of addressed speech (distinguishing the intonation of an adult’s voice, situational understanding of addressed speech, at the everyday level, in full). Passive vocabulary is tested on real objects and toys, subject and subject pictures. At the same time, an understanding of the semantic meaning of a word, an action, simple and complex plots, lexical and grammatical structures, and the sequence of events is determined.

When examining a child’s own (expressive) speech, the level of speech development of the child is revealed. It is important to note the age-related development of the lexical and grammatical aspects of speech, the assimilation of various parts of speech, and the features of the syllabic structure of words. Speechless children have the ability to use various nonverbal means of communication: expressive facial expressions, gestures, intonation.

When studying the pronunciation aspect of speech, the degree of impairment of speech intelligibility is revealed (speech is slurred, difficult to understand for others; speech intelligibility is somewhat reduced, speech is unclear, blurred).

The phonetic-phonemic structure of speech is checked in detail. When examining sound pronunciation, it is necessary to identify the child’s ability to pronounce sounds in isolation, in syllables, in words, in sentences, and especially in the speech stream. It should be noted the nature of the shortcomings of sound pronunciation: distortions, substitutions, omissions of sounds. Violations of sound pronunciation are compared with the characteristics of phonemic perception and sound analysis. It is important to note whether the child identifies violations of sound pronunciation in someone else’s and his own speech; how he differentiates by ear between normally and defectively pronounced sounds.

The quality of sound disturbance in children with dysarthria may vary. I.I. Panchenko proposed to distinguish the following forms of speech sound disorder: 1 form - phonetic disorder, manifested in the distortion of sounds, but with the preservation of all differential phonemic features of sounds; Form 2 - phonetic-apraxic disorder, including both phonetic disorders (distortions of sounds) and articulatory apraxia, expressed in the replacement and omission of sounds; Form 3 - phonetic-phonemic disorder with phenomena of articulatory apraxia (in addition to distortions of sounds, there are multiple substitutions, omissions of sounds, violations of the syllabic structure of words, incorrect grammatical use of phonemes at the end of words).

Analyzing the data from a speech therapy examination, it is necessary to determine which group the disorders identified in the child should be classified into: purely phonetic, phonetic-phonemic, or manifestations of general speech underdevelopment.

Further, the features of breathing disorders (shallow, rapid, irregular), voice (lack of strength and deviations in voice timbre) and prosodic organization of the speech flow are noted.

So, during a speech therapy examination of children with dysarthria, the speech therapist must identify the structure of the speech defect (the ratio of speech and non-speech disorders), comparing it with the severity of damage to articulatory and general motor skills, as well as the level of mental development of the child.

After analyzing the results of a comprehensive examination, the speech therapist gives a conclusion that allows one to judge the state of the speech defect at the time of the examination. It is desirable that the speech therapy conclusion (diagnosis) be made (given) jointly by a speech therapist and a neurologist.

Text of the book “Handbook for Speech Therapist”

3.8. Examination of the child. Neurological status

Due to the fact that a number of deviations have been identified in the state of motor skills, we considered it necessary to describe the methods and techniques for examining them in preschool children.
The examination is necessary to establish the nature of the violations of voluntary motor skills, as well as to identify the degree of delay or lag in motor development. These data serve as additional material for the differential diagnosis of speech disorders. They help determine the means of differential corrective action during classes and choose methods of individual work. The examination is carried out in three stages and reflects the dynamics of the state of the motor sphere: at the beginning, middle and end of correctional classes. Based on anamnestic data, the speech development of a child from birth to three years, features of the development of motor functions, the nature of manipulative and play activities, and the presence of self-care skills (in relation to age norms) are clarified.

Examination of the state of voluntary motor skills includes the following points:

– examination of voluntary facial motor skills (quality and volume of movements of the muscles of the forehead, eyes, cheeks);

– examination of speech motor skills (strength, accuracy, volume, switchability of movements of the lips, tongue);

– state of individual components of voluntary motor skills: static and dynamic coordination, simultaneity, clarity of movements;

– examination of fine motor skills of the fingers (quality and degree of differentiated movement, ability to act with objects).

3.8.1. Examination of voluntary facial motor skills

To examine children from 4 to 6 years old, L. A. Quint’s tests, modified by G. Gellnitz, are used (the method is adapted to different ages):

1. Raise eyebrows (“Surprise”),

2. Lightly close your eyelids.

3. Squint your eyes (“Bright Sun”),

4. Close your eyelids tightly (“It has become dark”).

5. Purse your lips.

6. Give your lips the position required to play a wind instrument.

7. Extend your lips as if to pronounce the sound “o”.

8. Puff out your cheeks.

9. Bare your teeth (“Fence”).

10. Extend your lips as if you were whistling.

The tasks are repeated 3 times in a row. It is advisable to conduct the examination in a playful way.

The assessment is made using a three-point system. Complete, accurate implementation is scored 1 point; partial, not clear enough – 2 points; failure to complete more than 7 tasks – 3 points.

A general description of facial expressions is given based on observation of the child (lively, sluggish, tense, calm, lack of facial expressions - facial expressions, grimacing, differentiated and undifferentiated facial expressions).

3.8.2. Speech motor examination

1. Opening and closing the mouth.

2. Mouth half open, wide open, close.

3. Imitation of chewing movements.

4. Alternate puffing of the cheeks.

5. Cheek retraction.

6. Pulling back the corners of the mouth: for the sound “and”

then round your lips -
“o”;
pull out as with -
“y”.
7. Sticking out a “wide” and “narrow” tongue, holding a given pose for a count of five.

8. Biting the tip of the tongue.

9. Touching the tip of the tongue alternately to the right and left corners of the mouth, upper and lower lips (“Clock”),

10. Pressing the tip of the tongue into the lower teeth while simultaneously arching the back of the tongue (“The cat is angry”),

11. Sucking the back of the tongue to the palate, clicking (“Let’s click”, “Let’s ride a horse”),

12. Raise the tip of your tongue up, lick your upper lip from top to bottom (“Delicious jam”),

13. Pronouncing vowel sounds on a hard and soft attack. The tasks are presented in a game form, each movement is repeated 3 times.

The strength of speech movements (weak, strong), accuracy (inaccurate, accurate), volume (incomplete, complete) and switchability (slow, fast) are assessed. The presence of synkinesis, deviation of the tongue, the speed of formation of the articulatory structure, and the duration of holding the pose are noted.

Score: 1 point – precise execution of movements; 2 points – minor changes in the volume, strength and accuracy of movements; 3 points – lack of holding poses; pronounced changes in strength, accuracy, volume; difficulty switching speech movements; language deviation.

3.8.3. General voluntary motor examination

For this purpose, tests of the Ozeretsky-Gelnitz motometric scale are used. Both static and dynamic coordination, simultaneity, and clarity of movements are examined.

4 years

1. standing

for 15 seconds with eyes closed; the arms are extended at the seams, the legs are placed in such a way that the toe of the left foot is closely adjacent to the heel of the right foot, the feet are located in a straight line. (Movement and balancing are taken into account as a minus when calculating the score).

2. Finger-nose test.

With your eyes closed, touch the tip of your nose with the index finger of your right and left hands (in turn). (The task is considered failed if the child touches some other place other than the tip of the nose, or first touches another place and then the tip of the nose. The task can be repeated 3 times for each hand. A positive mark is given if the task is completed correctly twice.)

3. Bouncing.

Both legs are lifted off the ground at the same time. Jump height is not taken into account. The task is considered failed if the subject cannot immediately separate both legs from the ground, lands on his heels rather than on his toes, and makes less than 7 jumps within 5 seconds. Repetition is allowed.

fingers of horizontally outstretched arms to describe circles in the air for 10 seconds.

arbitrary, but the same size. With the right hand, circles are described in a clockwise direction, with the left - in the opposite direction. (The task was not completed if the child rotated his hands in the same direction, described circles of irregular shape or unequal size. The task can be repeated no more than 3 times.)

5. Offer your hand and shake it firmly

first with the right, then with the left and finally with both hands. If there are unnecessary movements, the task is considered uncompleted.

5 years

1. standing

for 10 seconds on your toes (“on tiptoes”) with your eyes open. The arms are extended at the seams, the legs are tightly compressed, the heels and toes are closed. (The task is considered failed if the child being examined leaves the original position or touches the floor with his heels. Staggering, balancing and lowering on the toes are taken into account. Repeating up to 3 times is allowed.)

2. Bouncing

with open eyes, alternately on the right and left legs at a distance of 5 m. The child bends his leg at the knee joint at a right angle, hands on his hips. At a signal, he begins to jump and, having jumped to the place indicated to him, lowers his bent leg. Speed ​​is not taken into account. (He failed the task if the subject deviates more than 50 cm from a straight line, touches the floor with his bent leg and swings his arms. The task can be repeated 2 times for each leg.)

3. On the right and left sides of the matchbox (at a distance equal to the length of the match), 10 matches are located closely in a row (vertically) on each side. At the signal, he begins to put matches in the box,

for which he must simultaneously take a match from each side with the thumb and forefinger of both hands and simultaneously put them in the box. The matches closest to the walls of the box are taken first. Within 20 seconds, at least 5 matches must be laid. (The task is considered uncompleted if the child makes movements at different times or places less than 5 matches in 20 seconds. The task may be repeated.)

4. Offer to show your teeth

(smile widely). Make sure there are no unnecessary accompanying movements.

6 years

1. standing

with eyes open for 10 seconds alternately on the right and left leg. One leg is bent at a right angle at the knee joint, arms are extended at the seams. (The task is considered uncompleted if the subject lowers the raised leg, touches the floor with the bent leg, or leaves the seat. Raising the bent leg, balancing, and jumping are also taken into account.)

2. Hitting the ball on target

from a distance of 1 m. The target is a square board 25x25 cm on the wall, at chest level of the subject. The child throws a ball with a diameter of 8 cm from the “expanded shoulder”, first with his right hand, then with his left hand. The task is considered completed if boys hit the target 2 times out of 3 throws with their right hand (girls - 2 times out of 4 throws). The protocol indicates for which hand the task was not completed. The task can be repeated.

3. Jump from a place without a running start over a rope,

stretched at a height of 20 cm from the floor. When jumping, you need to bend both legs and simultaneously separate them from the ground. Out of three tests, the subject must jump over the rope 2 times without touching it. The task is considered uncompleted if the hands touch the floor or fall.

4. The subject marches around the room at any pace. While marching, he must, taking the reel in his left hand,

unwind the thread from it and wrap it around the index finger of your right hand for 15 seconds. After a break of 5-10 seconds, they suggest taking the coil in your right hand.

The task is considered failed if the subject changed the tempo more than 3 times during marching or performed the task at different times (it is noted for which hand the execution failed). Repetition is allowed 2 times.

5. The child is asked to pick up a percussion hammer and hit the table hard with it several times.

Make sure there are no unnecessary movements. Completion of tasks is assessed using a three-point system.

3.8.4. Examination of fine movements of the fingers

Determination of the quality and degree of differentiation of movements:

1. Clench your fingers into a fist.

2. Bend each of the fingers alternately on the right and then on the left hand (“Fingers are hidden”).

3. Connect the fingers of one hand with the fingers of the other (“Fingers say hello”).

3.8.5. Examination of actions with objects

1. Lay out the mosaic pattern.

2. Fasten the buttons yourself.

3. Draw vertical sticks in a lined notebook with a pencil.

4. String beads onto a thread.

5. Place 5 matches (sticks) into the box with your right and left hands, one at a time.

Grade:

1 point – accurate completion of all tasks;

2 – completing no more than 5 tasks from those proposed;

3 – completing one or two tasks from among those proposed; poor coordination, awkward movements.

During the examination and during the observation process, the following are taken into account: the general appearance of the child, posture, attitude to speech instructions, activity, orientation in space, coordination of words with movement, the presence of pathological or accompanying speech movements, state of muscle tone, signs of fatigue, tempo of movements, exercise in motor skills. skills.

3.9. Finger recognition test

It will help assess the functioning of the parieto-occipital regions of the child’s cerebral cortex.

Sit at the table opposite the child, ask him to extend his hand, cover the palm and fingers of this hand with your hand. With your other hand, touch the fingers of his outstretched hand. Ask to stretch out on the other hand the finger that you are touching: 3-year-old child - correctly identifies the thumb; 5-year-old – distinguishes between the thumb and little finger; 6-year-old – can easily distinguish between the thumb, little finger and index finger. Distinguishing between the middle and ring fingers is a big challenge for a six-year-old child. It must be borne in mind that a right-handed child, as a rule, distinguishes the fingers on the right hand somewhat better than those on the left. According to foreign authors, a child’s inability to recognize fingers is a prognostic sign of future difficulties with reading and writing.

Test tasks

The elbows rest on the table, the palms are free in the air, one hand is palm up, and the other is the back. Ask your child to simultaneously turn his palms, one upside down, the other downside down, and do this as quickly as possible.

Place your dominant hand in front of you. The task consists of continuously tapping with the index finger at the fastest possible pace. The task is to tap ri, “one-two-three”

alternately with the index finger of the right hand;
“one-two”
and left
“three”
with a smooth transition from one hand to the other.

The following exercises are very useful for developing manual praxis:

• Using your fingers, twist a pencil, a spool of thread, or a smooth block. The exercise is performed first with all fingers, then with three, then with two, changing them.

• Unscrewing and screwing plugs of different sizes and configurations.

• Drawing and shading with pencils (polycolor, felt-tip pens are not recommended, as they write if the rod is perpendicular to the sheet).

• Work at a certain pace, counting; The child sets the pace and instructions for himself.

• For the development of visual-spatial perception and hand-eye coordination, “fill in the missing details” tasks (first to the drawings, then to the letters) are effective.

3.10. Some indicators of mental and physical development of children

Table 5

Patterns of preverbal and early verbal development

Table 6

Assessment of stages of preverbal and initial verbal development

Table 7

Age-related features of the development of general motor skills

Table 8

Speech Comprehension Assessment

Table 9

Age-related features of the development of visual-motor coordination

Table 10

Age-related features of the development of fine motor skills of the hands

Thus, knowledge of the main indicators of a child’s mental and physical development, taking into account his age characteristics, will help teachers, medical workers and parents timely notice delays (deviations) and organize correctional and developmental activities.

Diagnosis of speech disorders

A study of the literature interpreting the principles of diagnosis and correction of speech disorders has shown that the question of the principles of rehabilitation education is extremely important, since it becomes the direct scientific basis of the correctional educational process, which ensures the development of specific methods and their application in the practice of speech therapy influence scientific, not empirically.

as the initial theoretical principles,

which the teacher is guided in his diagnostic and correctional activities. Correctly developed principles are the basis for the effectiveness of diagnosis and correction of speech disorders, therefore the question of the principles of rehabilitation training is relevant both in the country and abroad.

The initial theoretical basis for developing the principles of diagnosis and organization of correctional work was the doctrine of patterns, compensatory and reserve capabilities, as well as the driving forces of child development. This topic was developed in the works of L.S. Vygotsky, S.L. Rubinshteina, A.N. Leontyeva, D.B. Elkonina, A.V. Zaporozhets and other researchers. The choice of goals, direction of diagnosis, correction, strategy for its implementation are determined by a number of principles. One of the principles is an integrated approach. The principle of systematic study of the child

and systems of correctional measures is one of the most important approaches in the methodology of domestic pedagogy. The implementation of this principle ensures the elimination of the causes and sources of violations, and its success is based on the results of a diagnostic examination.

An integrated approach as one of the main pedagogical principles

means the requirement for a comprehensive, thorough examination and assessment of the child’s developmental characteristics. This approach covers not only speech, intellectual, cognitive activity, but also behavior, emotions, level of mastery of skills, as well as the state of vision, hearing, motor sphere, its neurological, mental and speech status.

Information about the child’s somatic condition, the state of his nervous system, sensory organs, and the possible hereditary nature of disorders is no less important in diagnosing and determining ways of corrective action. The idea of ​​an integrated approach in the system of speech therapy assistance to children with speech disorders focuses on the diagnostic aspects of this assistance, which is quite consistent with the actual practice of interaction between a speech therapist and representatives of related disciplines.

The main form of cooperation between a speech therapist and doctors and other specialized specialists is obtaining information from them that helps clarify the speech diagnosis. Meaningful exchange of information promotes full-fledged cooperation between specialists.

Thus, speech therapy research is an organic part of an integrated approach to a comprehensive examination of the child. This principle allows us to build correctional work not as a simple training of speech skills, but as an integral system that organically fits into the child’s daily activities. Integrated training is needed.

Implementation of the activity principle

allows you to determine the tactics of corrective action, the choice of means and ways to achieve your goals. Corrective work is carried out in a playful, labor-based and intellectual-cognitive form, so it is important to consider the integration of speech therapy tasks into the child’s daily activities.

Dynamic learning principle

is closely related to the development of the provisions of L.S. Vygotsky about the basic patterns of development of normal and abnormal children. Specific patterns have become the main guidelines in the differential diagnosis and correction of speech disorders. The principle of dynamic study involves, first of all, not only the use of diagnostic techniques taking into account the age of the subject, but also the identification of potential opportunities, the “zone of proximal development”. Concept of L.S. Vygotsky’s concept of the child’s “zones of actual and proximal development” is important for speech diagnostics.

From the concept follows the formulated by L.S. Vygotsky's "top-down" principle

which puts in, and considers the creation of a zone of proximal personality development in the child’s activities as the main content of correctional work. The top-down correction is proactive. Its goal is the active formation of what should be achieved by the child in the near future.

When planning a strategy for the correctional educational process, it is important not to limit yourself to immediate needs and demands. It is necessary to take into account the perspective of the child’s speech and personal development.

Principle of qualitative analysis

data obtained in the process of pedagogical diagnostics and correction of speech disorders is in close connection with the principle of dynamic learning. A qualitative analysis of a child’s speech activity includes methods of action, the nature of his mistakes, the child’s attitude to experiments, as well as to the results of his activities. Qualitative analysis of the results obtained during a speech examination is not opposed to taking into account quantitative data.

This principle is put forward as opposed to a purely quantitative approach to assessing the data obtained, characteristic of testing. However, the principle of qualitative analysis needs further development, since its implementation faces the same difficulties as the implementation of the principle of dynamic study.

From the above it follows that when diagnosing it is necessary to use a whole set of diagnostic techniques, each of which must contain several similar tasks. A combination of quantitative and qualitative approaches to data analysis is inevitable, and qualitative differences between an abnormal and a normal child can only be established by comparing quantitative indicators.

Quantitative and qualitative differences are closely interrelated. These indicators are determined on the basis of the transition from quantity to quality. Qualitative and quantitative diagnostics of the main components of learning ability: receptivity to help, ability to transfer logically, activity in solving problems, make it possible to determine the structure of the defect, its etiology, pathogenesis, formulate a diagnosis, choose the optimal correction technique, and give a probabilistic forecast.

For the development of the foundations of diagnostics, including speech, two provisions formulated by L.S. were of particular importance. Vygotsky. One of them is that the basic patterns of development of a normal child remain valid even with abnormal development and are common to both cases.

At the same time, L.S. Vygotsky also noted the presence of specific patterns of abnormal development, which made it difficult for the child to interact with others.

The principle of a systematic approach

received quite deep development in the research of L.S. Vygotsky, his students and followers. It is one of the main ones in the methodology. However, its full implementation seems to be a very difficult matter and a systematic approach is not always implemented.

The principles can be divided into psychophysiological, psychological and pedagogical.

Towards psychophysiological principles

include: the principle of defect qualification; the principle of relying on intact analyzers when training, which is based on the doctrine of functional systems and their plasticity; the principle of relying on intact mental functions interacting with the victim; the principle of relying on different levels of organization of mental functions; the principle of control, since only the flow of feedback signaling ensures timely correction of errors made in speech.

Psychological principles

include: the principle of relying on preserved forms of verbal and nonverbal human activity; the principle of relying on objective activity; the principle of organizing activities based on program training; the principle of taking into account the child’s personality, his individuality, which should form the basis of the entire correctional and educational process.

Towards pedagogical principles

include: the principle from simple to complex; the principle of taking into account the volume and degree of variety of material - verbal and visually illustrative (the volume should be “comfortable”, not overload attention, it is better to work on a small volume and with a small variety of material); the principle of taking into account the complexity of verbal material (phonetic, lexical, accessibility, frequency); the principle of taking into account the emotional side of the material (verbal and non-verbal material should create a favorable background and stimulate positive emotions).

Thus, the basic principles of the system of correctional pedagogical work include a set of methods and require an early start of work, the gradual development of speech disorders, as well as creativity, systematicity, consistency, activity and visibility.

All principles are closely interrelated and interdependent. They are widely used in correctional work, but always taking into account the compensatory capabilities and personal characteristics of children with dysarthria; taking into account the structure of the defect, its etiology, pathogenesis.

The listed principles of pedagogical diagnosis and correction of speech disorders are the scientific basis and contribute to the selection of the most optimal diagnostic correctional and educational paths.

Examination of facial expressions, general and fine motor skills, methodological development in speech therapy on the topic

Examination of gross and fine motor skills

In the child’s speech card, it is necessary to record self-care skills: the ability to tie and untie shoelaces, a scarf, a bow; button and unbutton your coat, dry your hands properly, brush your teeth; note how neat the child is in clothes and food.

During the examination, the child’s ability to stand, jump on the left, on the right leg, on two legs is checked; march to the count, switch from one movement to another (right hand on the belt, left hand on the head, and then vice versa); It is important to identify the capabilities of fine motor skills of the hands (assemble matches, mosaics, etc.).

In the process of performing a series of motor tasks, attention should be paid to the accuracy of reproduction of spatio-temporal parameters, retention of action elements in memory, and the presence of self-control when performing actions.

The examination of the motor skills of the articulatory apparatus is carried out in the following order using the tasks given below.

1. Motor function of the lips:

close your lips; round your lips, as when pronouncing the sound o, hold the pose for a count of 10;

stretch your lips into a tube, as when pronouncing the sound u, hold the pose for a count of 10; stretch out your lips, close them with a “proboscis”, hold the pose for a count of 10; stretch your lips in a smile, hold them in this position for a count of 5; stretch your lips as much as possible in a smile, hold them for a count of 10;

raise the upper lip, the upper teeth are visible; lower the lower lip, the lower teeth are visible;

pronounce labial sounds repeatedly (6-6-6, p-p-p).

2. Motor function of the jaw:

open your mouth wide, as when pronouncing the sound a, and close it; make a movement of the lower jaw to the right, left, forward.

3. Motor functions of the tongue:

place your wide tongue on your lower lip and hold it for a count of 5; place your wide tongue on your upper lip and hold it for a count of 5; move the tip of the tongue from the right corner of the mouth to the left without touching the lips; stick out your tongue (with a spatula, needle);

bring the tip of the tongue one by one to the upper and lower teeth from the inside (mouth slightly open); raise the tip of the tongue to the upper teeth, hold it for a count of 5, lower it to the lower teeth, rest the tongue on the right, then on the left cheek; close your eyes, stretch your arms forward, place the tip of your tongue on your lower lip; move your tongue back and forth with your mouth open.

4. Motor function of the soft palate:

open your mouth wide and clearly pronounce the sound a (on a solid attack); the speech therapist should move a spatula or probe across the soft palate; With your tongue clamped between your teeth, puff out your cheeks and blow hard, as if blowing out a candle flame. Recommendations for analyzing the results of examination of motor functions.

When analyzing the results, you should pay attention to the following points:

— accessibility of the proposed task for the child; — quality of movement execution (preservation of range of movement, possibility of fixing a particular pose, clarity and precision of execution, inertia, exhaustion, stiffness, lethargy, disinhibition, undifferentiated movements); features of switchability: availability of switching from one movement to another, smoothness of switching, its speed, presence of perseverations, getting stuck in one position; features of motor memory, attention, self-control; number of attempts when performing movements, learning opportunities; pace of execution (normal, slow, accelerated); the ability to arbitrarily change the tempo; quality of movements performed at an accelerated pace; errors in spatial orientation: ignorance of the sides of the body; uncertain knowledge;

features of holding a pose (calm or tense, swaying from side to side, balancing with the torso, arms, head, moving from a place or jerking to the sides, etc.); correspondence of the motor reaction to the signal; the presence of accompanying, violent movements; the presence of salivation (in examination of the articulatory apparatus).

V. The examination of the rhythmic sense is carried out using the following task.

The child is asked to tap a rhythmic pattern with a pencil, specified using instructions, a sample, a graphic diagram, with or without emphasis.

Recommendation for analyzing the results of an examination of the sense of rhythm: when a child reproduces a rhythmic pattern, you need to pay attention to his compliance with the given tempo, maintaining the number of elements in a given rhythmic pattern, observing pauses within the rhythmic pattern.

Neuropsychological examination (according to the method of A. V. Semenovich).

The technique includes examination of such motor functions as kinesthetic praxis, kinetic praxis, spatial praxis.

1. Kinesthetic praxis.

A. Praxis of poses according to a visual model.

Instructions: “Do as I do.” The child is sequentially offered various finger poses, which he must reproduce. Both hands are examined in turn. After completing each pose, the child places his hands freely on the table.

B. Praxis of poses according to a kinesthetic model.

Instructions: “Close your eyes. Can you feel how I put my fingers together? Fold them in exactly the same way on the other hand.” Samples of poses and conditions are the same as in point A. The transfer of poses is carried out first from the leading hand (for right-handed people from right to left), and then vice versa (from left to right).

D. Oral praxis.

Instructions: “Do as I do.” The experimenter performs the following actions: stretches the lips into a smile; pulls them into a tube; sticks out his tongue, raises it to his nose, runs it over his lips; puffs out cheeks; frowns, raises eyebrows, etc. Each movement is reproduced by the child.

An option would be to perform this test according to instructions, such as “Frown” or “Reach your tongue to your nose.” But in this case, it should be remembered that errors can be secondary in nature, that is, they may arise in the child due to a lack of understanding of the meaning of words.

2. Kinetic (dynamic) praxis.

A. "Fist - edge - palm." Instructions: “Do as I do.” The test is performed. The experimenter does the task twice with the child slowly and silently. Then he invites him to perform the movements himself and at a faster pace, then - to do the same, but with his eyes closed. Both hands are examined in turn. If necessary, you can offer the child the same movements, but in a modified sequence, for example, “rib - palm - fist”.

B. Reciprocal hand coordination. Instructions: “Put your hands on the table. Do as I do.” Several times the experimenter does the task together with the child, then offers to do it himself. The actions are the same as in point A. B. Oral praxis. Instructions: “Do as I do.” The experimenter, for example, clicks his tongue several times; whistles twice and clicks his tongue; frowns and smiles; touches the tongue to the left, then to the right corner of the mouth, puffs out the cheeks. A variant of this test, as in point 1D, is to perform similar actions according to verbal instructions.

3. Spatial praxis. Head's test. Instructions: “What I will do with my right hand, you will do (touch the child’s hand) with your right hand, what I will do with my left hand, you will do (touch) with your left hand.” They offer to do it first one-handed, then two-handed tests. After completing each test, a free pose is assumed. Examination of the motor sphere of children is necessary to develop principles for constructing and conducting logorhythmic classes. The development of basic motor functions, coordination of movements, their accuracy and speed of reaction serves as a support for improving the movements of the organs of the articulatory apparatus.

Shatskova A.M., teacher-speech therapist of the State Educational Establishment Center for Medical Education and Social Services “Butovo”, Moscow

Recently, speech therapy practice has seen a large number of preschool children with minimal impairments in the pronunciation aspect of speech. Such children at school, as a rule, have difficulties in mastering reading and writing, so in older preschool age they need a thorough examination and clarification of the speech therapy report. Along with well-known and generally accepted methods of speech therapy examination, neuropsychological techniques and various sensitized tests have now been developed aimed at identifying dyspraxic (kinetic and kinesthetic) disorders in children 6-7 years old. To avoid fatigue and overload, the examination should be carried out in the morning with each child. The results of the examination are assessed both qualitatively and in points: for each completed task, the child receives a certain number of points (from 0 to 3) depending on the quality of completion. Examination of speech motor skills State of facial motor skills: - severity of nasolabial folds and their symmetry; - the nature of the closure of the lips (tight, loose, whether the corners of the mouth are lowered); - presence of violent movements (hyperkinesis). During the examination it is suggested: - raise your eyebrows (be surprised); - frown (get angry); - close your eyelids slightly; - close your eyes (bright sun); - calmly open and close your eyes; — successively close the right, then the left eye; - wrinkle your nose; - puff out your cheeks (hamster); - pull in the cheeks (skinny); - inflate the right cheek; - puff out your left cheek. The following is assessed: - presence or absence of movement; - replacing one movement with another; — scope of implementation (full, incomplete); - accuracy (accurate, inaccurate); — activity (normal, lethargy, motor restlessness); — muscle tone (normal, increased, decreased, dystonia); — smoothness of nasolabial folds (right, left, both); — the appearance of accompanying movements (syncinesia); - facial expressions (lively, expressive, adequate, insufficiently expressive, sluggish, amicable). State of articulatory motor skills An examination of the motor function of the articulatory apparatus is carried out with repeated repetition of the required movement to identify subtle disorders. The following tasks are offered: •Examination of movements of the lower jaw: - lower the lower jaw and hold it in this position while counting to 5; - lower and raise the lower jaw; - move the lower jaw from side to side. •Examination of lip movements: - close and open lips; - touch the upper incisors with the lower lip; - stretch the corners of the mouth to the sides and hold while counting to 5; - round and move your lips forward, hold while counting to 5; - alternately move the corners of the mouth to the side; - raise your upper lip and hold it while counting to 5; - lower your lower lip and hold it while counting to 5; — simultaneously raise the upper lip and lower the lower lip and hold it while counting to 5. •Examination of tongue movements: — slightly extend the wide tongue and place it on the lower lip, hold it while counting to 5; - slightly extend the narrowed tongue and hold it while counting to 5; - alternately make the tongue wide and narrow; - lift the tip of the tongue over the upper incisors, then lower it over the lower ones; - use the narrow tip of the tongue to touch the right, then the left corners of the mouth; - stick out your right cheek with your tongue, then your left cheek; - raise the wide front edge of the tongue to the upper lip and lower it onto the lower lip; - lick your lips in a circle with the tip of your tongue; - click (click) your tongue. •Examination of movements of the soft palate: - cough with your mouth open, keep your tongue on your lower lip; - pronounce the sound [a] with your mouth wide open. To identify concomitant movements of the organs of articulation, the following sensitized tests are used: - place the legs in one line so that the right one stands in front and the left one rests on the right heel; Stretch your arms forward, close your eyes, place your tongue on your lower lip and hold it while counting to 10; - put your tongue on your lower lip, cross your outstretched arms in front, place your feet shoulder-width apart and follow with your eyes a pen or pencil that moves from side to side. The following is assessed: - presence or absence of movement; - replacing one movement with another; — scope of implementation (full, incomplete); - accuracy (accurate, inaccurate); - activity (normal, lethargy, motor restlessness), exhaustion of movement; — muscle tone (normal, increased, decreased, dystonia); — pace of execution (normal, fast, slow); — duration of holding organs in a given position; - presence of synkinesis; - ability to switch from one movement to another; - tremor of the tip of the tongue during repeated movements and when holding a pose; - increased hyperkinesis or slower tempo of movements during repeated movements; - deviation of the tip of the tongue when protruding; - salivation; - deviation of the small tongue to the side; - smoothness of nasolabial folds. Examination of the state of general motor skills Examination of static coordination of movements: - stand with eyes closed on the left, then on the right leg for at least 5 s; - jump on the left leg, then on the right leg, on two legs; - stand with your eyes closed, place your feet in one line so that the toe of one foot rests on the heel of the other, arms extended forward; execution time 5 s, 2 times for each leg. Examination of dynamic coordination of movements: - march with alternating steps and clapping of palms (make a clap between steps); — perform three to five squats in a row on your toes, without touching your heels to the floor. The results of the examination of speech (facial and articulatory) motor skills, the state of general motor skills (static and dynamic coordination of movements) are assessed in accordance with the scale. Rating scale Examination of motor memory, switchability of movements and self-control when performing tests: - stretch your arms forward, up, spread to the sides, lower; complicate the task: stand opposite the teacher and repeat the movements after him sequentially, lagging behind by one; the movements of the speech therapist program the task and at the same time act as a disruptive influence; - reproduce all movements with the exception of one predetermined “forbidden” movement; - throw and catch the ball, hit the ball on the floor and catch it; — examine the ability to perform motor programs. Instructions: “I’ll show you my fist, and you show me your finger,” and vice versa. At first, the signals are presented one after the other, then their order is disrupted in order to determine the subject’s ability to overcome stereotypes and subordinate his actions to instructions. Examination of voluntary inhibition of movements: - march and suddenly stop after a certain signal. Rating scale Examination of the spatial organization of movements: - walk from the door to the window, waving your right (left) hand; - according to verbal instructions, complete the following task: take a step forward, two steps to the right, two steps back, one step to the left; stand in the center of the office, walk around the office and return to your original place; turn around in place and jump on two legs around the office. Rating scale Examination of the state of fine motor skills of the fingers Examination of static coordination of movements of the fingers: - perform a task of showing, then following verbal instructions, counting from 1 to 5; - extend the index finger and little finger of the right hand, then the left hand, then both hands; - extend the index and middle fingers of the right hand, then the left hand, then both hands; - place the index fingers on the middle fingers on both hands; — place the middle fingers on the index fingers on both hands; - connect the thumb of the right hand, then the left hand, then both hands with the index finger (middle, ring, little finger) into a ring. Examination of the dynamic coordination of movements of the fingers: - alternately connect all the fingers of the hand with the thumb, first of the right, then of the left hand, then of both hands at the same time (“Fingers of the right and only the left hand are greeted”, “Fingers of the right and left hands are greeted); - perform the “fist-edge-palm” movement with the right, then the left hand, then both hands at the same time; The test must be repeated with the tongue bitten by the teeth. When performing this test, the following is noted: •mastery of the program (from the first presentation, from the second presentation, after joint execution with the experimenter, non-compliance); •the nature of the action (smooth, element-by-element, slow, difficulty switching from one link to another); •errors (perseverations, violation of the sequence of movements); • test for reciprocal coordination: - change hands while simultaneously clenching one hand into a fist and unclenching the fist of the other hand; — “playing the piano” (fingers 1-5, 2-4, 5-1, 4-2, 1-2-3-4-5, 5-4-3-2-1); - coloring, cutting, shading (based on children’s work); - drawing according to the “house – tree – fence” pattern; - examination of the tempo of movements using a written test: draw sticks in a line on paper for 15 s at an arbitrary pace, for the next 15 s draw as quickly as possible, for the next 15 s draw at the original pace; the results of the first and third times are compared and the pace is assessed: slow, normal, accelerated. The results of examining the state of fine motor skills of the fingers (static and dynamic coordination of movements) are assessed as follows. Rating scale Examination of the state of sound pronunciation The examination of sound pronunciation is carried out according to generally accepted methods and begins with a thorough check of isolated pronunciation. Then the sounds in syllables, words and sentences are examined, the nature of the violation of the pronunciation of vowels and consonants is determined in isolation, in open, closed syllables, syllables with a combination of consonants, at the beginning, middle and end of a word, in phrases. The research material can be subject pictures for a given sound. When looking at the pictures, children need to answer the question: What is this? or Who is this? Tasks that require repeated repetition of one sound make it possible to detect difficulties in the innervation of the articulatory apparatus, especially in cases of erased dysarthria. The following is assessed: - the ability to pronounce words with a given sound; - the nature of the violation of sound pronunciation: replacement, distortion, confusion, omission. Rating scale Survey of rhythmic abilities Rhythmic abilities have the following components: - ability to perceive rhythm - sensory part (S); - the ability to reproduce rhythm in movements (M); - ability to retain rhythm - storing it in memory (R); - ability for rhythmic creativity - rhythmic activity (A). When studying the characteristics of children’s perception of rhythms, the following tests are suggested. •Examination of rhythm perception in the acoustic modality: - Listen and tell me how many times I tapped. How many strong blows did you hear? •Examination of rhythm perception in the visual modality: - Look and tell me how many times I knocked. How many weak blows were there? •Inspection of the features of children’s transformation of a visual rhythmic pattern into an acoustic one: - Look carefully and tap as shown here: •Identification of the features of transformation of a verbal rhythmic code into a visual-spatial image: - “Knock 2 times, then 3 times; 2 times weakly and 3 times strongly, repeat again.” Rating scale Examination of the ability to reproduce rhythm in movements: - clap certain rhythms (7 types) or walk in a given rhythm. Rating scale Examination of rhythm retention ability: - tap one rhythm, remember it well; - tap one or two other rhythms, and then remember and tap the first rhythm. Rating scale Examination of the ability for rhythmic creativity: - remember some poem and tap it (or clap it); - place emphasis on different words of the phrase and rap: “I wrote him a letter.” “We will go with you to the theater today.” Rating scale Examination of auditory-verbal memory The examination is carried out using a test (memorizing two groups of three words), which is included as a mandatory part of the neuropsychological research system developed by A.R. Luria (1968). Speech therapist. Children, repeat after me the words: house, forest, cat, night, needle, pie. Children repeat. Repeat more words: night, needle, pie. Children repeat. What words were in the first group? The children answer. What words were in the second group? If children cannot answer, divide the words into groups, ask a simpler question: What words were there anyway? Words are presented up to 4 times if necessary. Then, after some time, after completing other tasks, children are asked to remember and name the words. The following is assessed: - accuracy and consistency of reproduction; — memory capacity for immediate and delayed playback; — number of presentations; — correctness of delayed playback; - signs indicating a decrease in phonemic hearing - literal paraphasia, replacement of words with similar sounds. Rating scale Examination of the syllabic structure of a word The material for studying the syllabic structure of a word is subject pictures. In the process of presenting the pictures, the instruction is given: “Look carefully at the picture and name who or what it is?” 13 series of tasks are offered, which include one-, two- and three-syllable words with closed and open syllables, with clusters of consonants: 1 – two-syllable words of two open syllables (mama, ukha); 2 – three-syllable words made of open syllables (panama, peonies); 3 – monosyllabic words (poppy, lion); 4 – two-syllable words with one closed syllable (skating rink, Alik); 5 – two-syllable words with a cluster of consonants in the middle of the word (pumpkin, duck); 6 – two-syllable words with a closed syllable and a cluster of consonants (kompot, Pavlik); 7 – three-syllable words with a closed syllable (kitten, machine gun); 8 – three-syllable words with a combination of consonants (candy, wicket); 9 – three-syllables with a consonant cluster and a closed syllable (monument, pendulum); 10 – three-syllable words with two sequences (rifle, carrot); 11 – monosyllabic words with a combination of consonants at the beginning and end (whip, glue); 12 – two-syllable words with two sequences (button, cell); 13 – four-syllable words made from open syllables (web, battery). The following are assessed: - features of violations of the syllabic structure of a word; - elision of syllables, deletion of consonants in clusters; - paraphasia, rearrangements while maintaining the outline of words; — iterations, perseverations, adding sounds (syllables); - contamination (part of one word is combined with part of another). Rating scale Examination of the vocabulary and grammatical structure of speech The examination of the vocabulary and grammatical structure of children's speech is carried out using traditional speech therapy methods. The research materials are subject pictures. Vocabulary examination: - name objects from pictures or directly upon presentation: eyelashes, shoulder, trunk, eyebrows, flowerbed, gazebo, elbow, gate, claws, etc.; - name the cubs of a cat, dog, cow, goat, horse, chicken, duck, wolf, fox, bear; - explain the meaning of words: refrigerator, vacuum cleaner; - choose antonyms for words (game: “Words in reverse”): big, wet, light, dull, clean, older, wide, tall, cold, hard; - find out the level of generalizations (vegetables, fruits, furniture, dishes, clothes, shoes, hats, products, toys, domestic and wild animals, insects, birds, transport, tools). Rating scale Survey of the grammatical structure of speech Survey of children’s ability to: - form a plural from the singular of a noun (table - tables, ear - ears, etc.); - form the genitive plural forms of a noun (many toys, books, etc.); - coordinate nouns (tomato, ear, chair, hand) with numerals (one, two, three, four, five); - coordinate adjectives with nouns; - form diminutive forms of nouns (bag - handbag, chair - chair, etc.); - form adjectives from nouns (matryoshka doll made of wood - wooden, mushroom soup - mushroom, etc.); - form possessive adjectives (whose tail? whose head?). Rating scale Examination of the characteristics of coherent speech The examination of the state of coherent speech is carried out according to traditional speech therapy methods. The speech therapist invites children to compose a story based on a picture, a series of plot pictures, a descriptive story, and also retell the story they read (secondary text). Rating scale Criteria for semantic integrity: 0 points – the story corresponds to the situation, has all the semantic links and the correct sequence (a complete coherent description of events); 1 point – the sequence is correct, but there is a slight distortion of the situation, cause-and-effect relationships are not always reproduced correctly (insufficiently complete but coherent description of events); 2 points – loss of semantic links, gross distortion of the meaning of the situation; 3 points - lack of logical sequence, listing objects, actions, refusal to complete the task. Criteria of language design: 0 points - the correctness of the grammatical design of sentences; 1 point - the presence of agramatism (single, rough); 2 points - errors in the preparation of individual sentences; 3 points - non -proliferation of offers. List of used and recommended literature Babina G.V., Safonkina N.Yu. The syllabic structure of the word: examination and formation of children with speech underdevelopment: textbook.-method. allowance. M., 2005. Volkova G.A. Methodology for psychological and speech therapy examination of children with speech disorders. Questions of differential diagnostics: textbook.-method. allowance. SPb., 2004. Inhakova O.B. Album for a speech therapist. M., 2005. Kornev A.N. Articulating and verbal dyspraxia in children // News of otorhinolaringology and logopathology (Appendix No. 1, 1999). Speech disorders. Clinical manifestations and correction methods. SPb., 1999. S. 57-63. Kornev A.N. Fundamentals of childhood logopathology: clinical and psychological aspects. SPb., 2006. Lopatin L.V. Receptions of examination of preschool children with an erased form of dysarthria and the differentiation of their training // Defectology. 1986. No. 2. P. 64-70. Lopatina L.V. The system of differentiated correction of phonetic-phonemic disorders in preschoolers with erased dysarthria / dis. ... Dr. ped. Sciences, St. Petersburg, 2005. Luria A.R. The highest cortical functions of a person and their disorders with local brain damage. M., 1968. Mastyukova E.M. Therapeutic pedagogy. Early and preschool age. M., 1997. Filicheva TB, Tumanova T.V. Children with phonetic-phonemic underdevelopment: education and training. M., 2000.