Speech therapy classes for rhinolalia in children

Correction of rhinolalia necessarily includes sessions with a speech therapist.
Even if the cause of the speech disorder is not a functional lesion, but an organic one. Parents must understand that surgery alone will not help the child speak clearly and correctly. The operation only allows the speech organs to function correctly, but only a speech therapist can create sounds and form beautiful, clear diction.

Speech therapy plan for rhinolalia

The first stage is preoperative

It is advisable to begin classes with a speech therapist even before surgery. At this stage, the specialist will make efforts to create the sounds available in the child’s “arsenal” and will pay attention to general speech development and proper breathing. Since after surgery the main emphasis will be on developing new capabilities of the articulatory apparatus, you first need to eliminate incorrect movements of the facial muscles and prepare the skills of proper breathing and articulation.

The second stage is recovery after surgery

At this stage, classes are aimed at improving the mobility of the soft palate, correcting incorrect articulation, and practicing the pronunciation of vowel sounds.

The third stage is working on the pronunciation of all sounds, proper coordination of breathing and articulation

At this stage, work is carried out to establish the correct pronunciation of sounds and eliminate the habitual nasality of speech in the child. Exercises are carried out to improve phonemic hearing, and a lot of time is devoted to the grammatical structure of speech.

The fourth stage - automation of the delivered sounds

This period also takes a long time, since children with rhinolalia do not easily automate the correct sounds. The participation of the child’s parents is extremely important. Monitoring the completion of tasks and timely feedback from the teacher are a significant guarantee of achieving a good result.

Speech therapy classes are the main “weapon” for correcting rhinolalia caused by functional disorders, and no less important than a surgeon’s scalpel for organic rhinolalia. Regular exercises will help restore your child’s speech and give him every opportunity for successful communication and learning.

Correction of open rhinolalia

The structure of correctional work depends on the form of rhinolalia. There are several original approaches to eliminating open rhinolalia, including the works of famous scientists G. Gutsman and M.Yu. Khvattseva. Correction of open rhinolalia is divided into two stages: preoperative and postoperative. A.G. Ippolitova was one of the first to offer classes with children in the preoperative period. Her method is based on the fact that the child’s attention is directed not to the phoneme, but to the article. Speech therapist N.I. Serebrova and doctor L.V. Dmitriev first developed an effective technique after studying radiography, based on the production of oral and nasal breathing. T.N. Vorontsova suggests development in the postoperative period, which boils down to singing sounds. Modern speech therapy is based on the step-by-step methodology of I.I. Ermakova in the preoperative and postoperative periods.

Preoperative period

The preoperative period begins with the birth of the child.

Stage 1. Prevention of asthenic syndrome.

Rhinolalic children are born weak, so from the first days of life it is important to work on hardening and stimulate physical development (swimming pool, bicycle, skiing). Sick children are delayed in crawling and walking, so it is necessary to stimulate motor activity - moving a toy away, etc. The use of walkers is not recommended, since the crawling stage is very important for speech development.

Stage 2. Correcting and preventing incorrect tongue fixation

. Avoid placing the child on his back so that the root of the tongue does not move posteriorly. It is preferable to lay on your stomach or side. From birth, encourage the baby to do some tongue exercises to imitate an adult: “Delicious jam” (lick the upper lip), “Swing” (raise the tip of the tongue up and down), “Clock” (swing the tongue from side to side), “Snake” (stretch your tongue back and forth), “Turkey” (quickly run your tongue along your upper lip).

Stage 3. Prevention of breathing problems.

From 1.5-2 years old, play exercises are carried out: “steep the tea” (hold your lip at the level of the cup), blow into a straw, “smell a flower” - small cups from Kinder Surprise are filled with flower petals, inhale through the nose. You can play the harmonica, blow fluff from your palm, blow up balloons (without tension), soap bubbles, play with an airball, helping to pinch your nose.

Stage 4

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Activation of the muscles of the velopharyngeal ring
. Do coughing and yawning exercises, gargle with small portions of water, swallow small portions of milk and jelly.

Stage 5

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Development of voice strength and pitch.
Meow like a big cat and like a small cat.

Stage 6

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Prevention of speech and mental development delays.
Read to the child as much as possible, show pictures, develop memory, attention, and thinking.

Stage 7

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Prevention of secondary deviations
. The child should not feel inferior; he must work with the emotional-volitional sphere, encourage, praise, reward the child, and form a good attitude towards the world.

Stage 8

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Voice exercises.
The speech therapist prepares the velum for closure after surgery and prevents dystrophy of the pharyngeal muscles by singing vowel sounds. First, “A” is long, then “E” is long, then “A-E” is continuous, “E-A.” The exercise should be done 6-8 times a day.

Stage 9

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Development of the correct air flow
and inhibition of clavicular breathing. Place one hand of the child on the chest, the other on the stomach, so that the child can feel breathing, first lying down, then half-lying, half-sitting. Do the exercise at least 3 times a day for 3 to 15 cycles. Make sure that the baby does not get sick or dizzy, and do not jump up suddenly. It is also useful to blow on a candle, on cotton wool (at lip level).

Stage 10

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Strengthening the muscles of the larynx.
You need to do voice exercises, start with pronouncing the sound “M” in isolation, teach not to strain the larynx and control the resonance. Then draw out the sound “M” in closed syllables (mom, ma’am, mum). Before surgery, work with vowel sounds for at least a month. It is important to pronounce in a certain order: start with “E” or “A”, then “O”, “I”, “U”, “Y”. This order is based on the study of the strength of the voice, which is needed to hold the soft palate in a horizontal position. Do not start with “U”, “I”, “Y”, since in the preoperative period a clear sound will not work. Possible options for AEC and EIA. Vocal exercises lift segments of the soft palate, lengthen exhalation and make the back wall of the pharynx mobile.

Stage 11

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Creating a platform for correct sound pronunciation
, training the mobility of lips, cheeks, and tongue. Do exercises: biting the tip of the tongue, stretching the lips, slapping the tongue with the upper lip (“punish the tongue” without making a sound), licking a plate, licking a large spoon. With the deformation of the upper lip, it is necessary to develop its mobility: bite the lip with a tongue, smooth the seams with her teeth, raise the lip up, turn the lower lip (“Negro”), lay candy between the lip and nose. Be sure to massage your lips. Using the tips of the thumb and index fingers from the corners of the mouth, pressing just above the red border, perform acupressure and pull the lip forward. Knead the scar with your fingertips, place your thumb under the seam, and smooth your upper lip with your index finger. Gymnastics and massage should be carried out 3-4 times a day for up to 5 minutes, avoiding sudden movements, painful sensations in which the child experiences tension in the muscles of the forehead, wings of the nose, jaws and neck, which is transmitted to the larynx, pharynx, and tongue.

Stage 12

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Development of phonemic hearing.
Until the age of 5, a child is introduced to non-speech sounds and taught to distinguish them: the murmur of water, the rustling of paper, a rattle, a tambourine, a whistle, etc. After 5 years, children are introduced to speech sounds, correlating them with letters.

Stage 13

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Correction of sound pronunciation.
Articulation may be approximate. Correction comes down to the formation of oral consonants.

Postoperative period

1 step.

It begins with the stage of setting vowel sounds and eliminating excessive nasal resonance. If the child received speech therapy before surgery, this period is short (2-3 weeks). If no assistance was provided, the period is delayed by 3-6 months. During this period, the velum palate can be stretched to its maximum, so it is important not to miss the moment. After surgery, a long period of silence is inevitable, so speech deteriorates. The soft palate is swollen, the child feels pain, avoids correct articulation of sounds, and speaks through the nose. It is necessary to include the operated palate into phonation as quickly as possible, this facilitates the acquisition of the skill of oral vowel resonance. The operated organ for the child receives its intended purpose. Speech therapy work must be started on the second day after obturation or 15-20 days after uranoplasty. In six months, when the scarring process is over, the work will be meaningless.

With special exercises and massage, you can stretch the edge of the soft palate by 1-3 cm. Massage is carried out with a probe, spatula or pacifier. Carefully move the instrument back and forth along the hard palate, without touching the seams, while the muscles of the pharynx and soft palate reflexively contract. When pronouncing the sound “A”, apply light pressure on the soft palate with a probe or finger (activation of the gag reflex). The child does self-massage and strokes the stitches with his tongue. Massage is performed at least 2 times a day for a year, two hours before or after meals. Gymnastics for the palate are also performed: swallowing in small portions, coughing with the tongue hanging out, yawning with the mouth closed and open. Articulatory gymnastics includes stretching the lips (“Smile” - “Tube” in dynamics), additionally – vibration of the lips (coachman’s “tpprrrr”, stop the “horse”), for the cheeks – drawing the cheeks into the oral cavity. Voice exercises in the same order, starting with the vowels “A”, “E”. At the same stage, work on breathing is carried out. Inhale-exhale through the nose, inhale-exhale through the mouth, inhale through the nose, exhale through the mouth.

Step 2

– stage of sound pronunciation correction. We start with vowel sounds. The order of consonants is as follows: first “P”, “F”, then “Py”, “F”, “V-V”, “T-T”, “K-K”, “X-H”, “S-” Sj”, “G-G”, “L-L”, “B-B”, “D-D”, “Z-Z”, “Sh”, “R-R”, the last ones – “Zh”, “ Shch", "Ch", "C". At the same time, they develop the prosodic side of speech.

Step 3

– automation of new skills. Features of the work depend on the age of the child. At the same time, they develop the lexical and grammatical structure of speech. The work with breathing does not stop, they use airballs, blowing on a basin of water, on sand, on a toy. Classes are conducted in a playful way, sounds are reinforced in short rhymes.

Exercises to correct rhinolalia

Some types of classes should be carried out exclusively by a specialist. For example, in the postoperative period, in addition to breathing exercises, a special massage is also performed to restore the mobility of the soft palate. Parents should not do it themselves.

But many of the exercises can be repeated at home. Frequent “training” will help the child get used to it faster. However, it is important to follow the basic rules:

classes should not overtire the child;
his diligence must be supported by his family;
all exercises must first be worked out with a speech therapist to eliminate the possibility of incorrect execution.

NeuroSpectrum is ready to help

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

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

Breathing exercises

Rhinolalics are characterized by breathing with exhalation both through the mouth and through the nose. Therefore, teaching a child to control inhalation and exhalation is very important. To control, you can use a piece of cotton wool or a napkin applied to your nose. The purpose of the exercises is to teach you to “blow” only through your mouth.

Inhale - exhale

This exercise will help you learn to control your breathing. The child inhales and exhales in a strictly defined manner. For example, inhale and exhale through your nose, the next time you inhale and exhale only through your mouth. We complicate the task - inhale through the nose, exhale through the mouth, the next inhale-exhale through the nose, then only through the mouth. And so on.

Storm in a teacup

Playing with water will help to visually control your mouth breathing. Children enjoy blowing into the water through a straw, creating real storms and storms. To prevent the water from splashing, it is more convenient to take a bottle rather than a wide glass. Just be sure to be transparent so that the seething is clearly visible. When the child learns to blow into a tube, creating a gurgling sound, you need to try to lengthen the exhalation. For the storm to be “real,” the exhalation must be uniform and long.

Games for blowing out candles, kicking soccer balls made from cotton balls, various toy wind instruments and blowing up balloons are also very useful. However, what is important here is the gradual complication of the task and the absence of overload. Breathing exercises should not be long, so that the child does not feel dizzy.

FORMS OF RINOLALIA

There are three forms of rhinolalia:

Open form

There is no septum between the oral and nasal cavities, so necessary for the proper development of speech. When the baby tries to speak, the air stream does not go through the mouth (as it should be), but through the nose and mouth at the same time, due to which speaking through the nose is formed.

Closed form

There is a barrier in the nasopharynx that makes it difficult for air to escape through the nose. In turn, the closed form is divided into anterior (the barrier is located in the nasal cavity) and posterior (the barrier is located in the nasopharynx).

Mixed form

A mixture of the first two forms: the presence of nasal obstruction and inferiority of the velopharyngeal ring. Characteristic features in this case are nasal sound and absence of nasal sounds.

Articulation exercises

To correct articulation disorders caused by rhinolalia, special exercises are needed:

“Snake or spade” - you need to learn to stick out your tongue with a pointed tip, and then widely flattened. The next stage is to alternate between “snake” and “shovel”.
“Bend the back” - the tip of the tongue rests on the lower gums, and the back of the tongue curves up and down.
“Inflate and deflate” - the cheeks need to be inflated and deflated, pulling them between the teeth. As an option, learn to inflate not both cheeks at once, but alternately. An adult can help deflate the puffy cheek by lightly touching it with a finger.
“Rinse your teeth” - imitate rinsing your teeth without water (the air should press on your lips).
“Elephant exercise” - the child must learn to hold his lips closed and extended forward with his “proboscis”, and then move it left and right and even rotate it.

REASONS FOR THE APPEARANCE

Forms and causes are interconnected. All 3 forms have their own origins.

Open form of rhinolalia	Injuries to the oral and nasal sinuses. Cleft palate. Foreign formations that put pressure on the nervous system, preventing air from circulating properly. Paralysis and paresis (due to diphtheria) of the muscles of the oral cavity. The presence of scars and palate scars. Surgery to remove adenoids. Sluggish activity of the speech apparatus.
Closed form of rhinolalia	Neurological disorders. Polyps and adenoids. The presence of a crooked nasal septum. Enlargement of the nasal mucosa. Formation of a solitary tonsil. Benign and malignant tumors. Copying nasal speech.
Mixed form of rhinolalia	The intersection of some disorders and disorders of closed and open forms.

Staging sounds

The vowels begin to be practiced first - first A, and after it E, O, U, I. The child learns to correctly pronounce sounds in isolation, one at a time, gradually connecting them together.

Exercises:

Pronounce the sound once while exhaling.
After some time, the teacher suggests increasing the number of repetitions per exhalation.
Alternating combinations of vowels - the child pronounces already mastered sounds together.
In the process of practicing, children pronounce sounds in “different voices” - low (like a wolf or a bear), high (like a bird or a bunny), at a normal level.

After practicing vowel sounds and mastering proper breathing and articulation, the speech therapist moves on to the production of consonants. The first sound in line is F. Then they begin to work on voiceless fricatives and plosives, voiced, occlusive fricatives and sonorants. However, of course, in each specific case the sequence of sound production is determined by the speech therapist depending on the situation.

Exercises for automating sounds must be built from simple to complex and based on already learned phonemes, so that it is not difficult for the child to practice.

A good option for practicing pronunciation is singing. When a child sings, the velum closes on its own, which means it becomes possible to pay more attention to controlling the pronunciation of phonemes.

CLASSES WITH A Speech Therapist

This method of correcting rhinolalia is used by all speech therapists. The standard list of exercises includes:

1. Exercise “Sail”. The tip of the tongue is placed on the upper row of teeth, and the back bends forward.

2. Exercise “Cup”. The wide tongue is placed on the lower lip, and the edges begin to curl into a cup shape.

3. Exercise “Hippopotamus”. The baby opens and closes his mouth calmly and without tension.

4. Exercise “Smile”. The child smiles widely, spreading the corners of his lips as far apart as possible, and then returns them to their place.

Such simple exercises will be useful even for children without speech disorders, so I recommend training for prevention purposes.

Exercises to develop phonemic awareness

"Who is there?" - the child is asked to close his eyes and recognize musical instruments, sounding toys, and people’s voices by ear. Important: he must know all these sounds well before.
“Repeat” - the teacher invites the child to repeat after him a set of identical syllables with the emphasis on the first vowel (mA-ma-ma), then on the second (ma-ma-ma) and on the third.
“Find the mistake” - children love to “correct” adults, so this game is usually popular. The teacher reads the text, and the child must “convict” the author of the mistake. For example: Our Mishka has a big chip (bump) on his forehead.

Classes do not include all exercises at the same time. The speech therapist selects the necessary ones depending on the specific situation and the child’s readiness.

Publication date: 05/31/2017. Last modified: 05/09/2018.

COMPREHENSIVE SURVEY

Diagnosis of children with rhinolalia requires an integrated approach and involves examination by several doctors at once.

The general diagnostic system includes step-by-step analysis:

Familiarization with personal file data.
Collection of anamnestic data (information obtained through questioning).
Review of all doctors' reports.
Conducting a conversation with the child and parents.
Development of a correction program.
Formation of a speech map.