Erased dysarthria in preschool children

How does erased dysarthria manifest in children?

A feature of erased dysarthria is the lack of expression of symptoms, which is why the disease is called that. Characterized by unclear articulation due to impaired motor skills, distortion of some sounds. The lack of intonation and inexpressive speech and the complexity of automation are noteworthy. The clinical picture may vary depending on the affected area: in one child the phonetic defect predominates, in another the prosodic defect predominates, in the third both components are present in equal volume.

Sound pronunciation disorder affects two or more groups of sounds. For example, hissing, whistling and sonorous. Speech with erased dysarthria is replete with distortions and replacement of sounds. The baby confuses dull, voiced, and soft sounds and cannot use them correctly. Even if you can overcome these problems, it is difficult to achieve automaticity.

At an early age, such children are usually observed by a neurologist. They are diagnosed with “perinatal damage to the central nervous system” and are given medication, courses of physiotherapy and massage. Over time, the child is removed from the register. Only when speech disorders do not go away do parents and doctors begin to look for the cause. As a rule, erased dysarthria is diagnosed in preschool children - at 5 - 6 years old.

Characteristics of the erased form of dysarthria, which parents themselves can notice, are poor facial expressions, lack of tone of the lips, tongue, asymmetry of the nasolabial folds and corners of the mouth. When performing articulation tests, involuntary movements of the tongue, its trembling and cyanosis occur. Increased salivation. It is difficult to keep the speech organs in one position.

It may be difficult for the baby to chew food, and he refuses to eat if it is in pieces. Infants have difficulty sucking milk and swallowing is impaired.

General development

Neurological status has changed. Noteworthy are persistent dermographism and sweating of the hands and feet. Children are easily excitable, restless, and make a lot of unnecessary movements. Or, on the contrary, they are inhibited and slow. Their memory and attention are impaired.

Physically, children lag behind their peers and are short, thin, and asthenic in build. They get tired quickly during physical activity and are clumsy. The synchronization of movements and fine motor skills suffer. It’s hard for a child to fasten a button, tie shoelaces, or do creative work. In physical education lessons he has difficulty completing assignments. Handwriting is impaired, and in general the child writes slowly.

Causes

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

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

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

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

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

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

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

Causes of erased dysarthria in preschool children

The main reason for the erased form of dysarthria is a violation of the innervation of the muscles of the lips, tongue, and soft palate.

Such disorders are caused by organic brain damage in various periods of child development:

During the prenatal period, the fetus can be negatively affected by infectious diseases of the mother (herpes infection, rubella, toxoplasmosis, viral hepatitis, cytomegalovirus infection). Immunological incompatibility of the fetus and mother, toxicosis, decompensated diabetes mellitus or gestational diabetes play a role. As a result of these conditions, fetoplacental insufficiency develops, the fetus experiences oxygen deficiency, that is, hypoxia;
During childbirth, traumatic injury is possible as a result of rapid or protracted labor or the use of obstetric forceps. A long anhydrous period has a negative effect;
In the postpartum period and in the first year of a child’s life, damage to the central nervous system can occur due to injuries, infectious and other severe diseases, inflammatory diseases of the substance and cerebral cortex.

All of these factors lead to damage to the nerves that innervate the muscles of the articulatory organs: trigeminal, facial, glossopharyngeal, sublingual. Each nerve has its own characteristics. For example, damage to the trigeminal nerve is indicated by limited movements in the lower jaw, lips, tongue, facial nerve - facial muscles, glossopharyngeal nerve - root and back of the tongue, hypoglossal nerve - impaired tongue motility, difficulty raising the tongue to the palate.

Symptoms

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

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

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

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

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

Make an appointment

Diagnosis of erased dysarthria

Erased dysarthria is diagnosed using a number of medical and pedagogical studies. Be sure to study the child’s medical history, as well as the course of pregnancy and childbirth in the mother. An analysis of the outpatient card is carried out: the results of instrumental diagnostic methods may be needed.

The examination is phased and includes:

Speech therapy examination involves assessing the state of motor skills, facial muscles, articulatory apparatus, and speech breathing. After this, the speech therapist studies the quality of sound pronunciation, vocabulary, grammar, and the ability to capture various sounds. If an erased form of dysarthria is suspected, the patient is referred for consultation to a neurologist;
An examination by a neurologist is needed to identify the nature of the disorders - hyperkinesis, paresis, dystonia, atony. The doctor also determines the location of the brain lesion. To clarify the diagnosis, EEG, electroneuromyography, CT, and MRI are prescribed.

After the baby has passed all the examinations, he will be consulted again by a speech therapist/speech pathologist. Having the conclusions in hand, he determines the type of speech disorders and draws up a plan and form of work with the child.

Treatment of erased dysarthria

The therapy is complex, carried out with the participation of a neurologist, psychologist and speech therapist. This tactic allows you to achieve a positive result, consolidate it and compensate for the speech defect.

The medical side of correctional work is to stimulate brain metabolism, which is achieved by prescribing nootropics and vitamins. The effect is strengthened by courses of massage, therapeutic exercises, reflexology, and physiotherapeutic methods. If possible, you can get medicinal baths and visit the pool.

Features of moderate dysarthria

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

Working with a speech therapist

At the initial stage, the speech therapist “sets” defective sounds and corrects other speech disorders. Then comes the consolidation of the normal pronunciation of sounds: the baby learns to use them in syllables, words, phrases. It usually takes a long time to overcome erased dysarthria. Automating sounds is a complex form of work that requires patience and effort.

At the same time, the specialist eliminates phonemic disorders, develops intonation and expressiveness of speech, and teaches grammar.

One of the components of correctional work for latent dysarthria is speech therapy massage. Probe massage is very effective. It allows you to normalize the tone of the muscles involved in articulation, helps the baby to feel them better when speaking, which means to control the position of the speech organs during sound pronunciation. Conducted separately or in parallel with the main course.

Finger and articulation gymnastics are effective:

The coordination of hand movements is associated with the articulatory function, so a lot of time is devoted to finger gymnastics. It can be supplemented with play-based activities. For example, the child is asked to collect beads, puzzles, build construction sets, sculpt, and cut out. Of course, it is important to choose a complex that the patient enjoys and enjoys;
Articulation gymnastics helps strengthen muscles. After them, it is easier for children to give the correct position to the speech organs during sound reproduction and switch to other sounds.

Breathing exercises are also shown - it trains breathing, teaches the child to correctly use a stream of air when speaking, and makes speech more expressive.

Corrective work for erased dysarthria is long-term: up to 1 year or more. The timing depends on the severity of the disease, concomitant speech disorders, and regularity of classes.

Role of parents

With erased dysarthria in preschoolers and primary schoolchildren, the role of parents is invaluable. After all, it is important to strictly follow the doctor’s recommendations and treatment plan. The result depends on this and how soon your child will start talking normally. If your doctor deems it necessary, do the exercises at home: this will speed up your recovery. But don’t overdo it, make sure your baby is in a good mood during homework. Now he is not in the mood for classes, so put them off.

The baby also needs your support. He must know and feel that he is not alone with the problem, that his dad and mom are nearby, who will always understand, support, and take care of him. It is important for a child to know that he is loved, despite his speech impediment. This way he will work harder and it will be easier for you to achieve the effect.

Possible complications

Disorders in the erased form of dysarthria cause defects in the perception of sounds. At the same time, the perception of not only similar-sounding phonemes, but also other sounds is impaired. Over time, the lack of clear speech and the impossibility of normal auditory perception leads to difficulties in understanding the syllable structure.

There are problems with grammar and poor vocabulary. If timely correction is not started, then younger schoolchildren’s writing will suffer.

In children, even with minimal characteristics of an erased form of dysarthria, communication skills suffer. They cannot build a dialogue and generally talk with people. They avoid groups, try to avoid new acquaintances and communication in general. If they attend kindergarten, they play alone. They are also kept apart at school.

This creates the preconditions for psychological problems and secondary speech disorders. For example, children may begin to stutter and develop enuresis.

Article:

Dysarthria is a disorder of sound pronunciation, voice formation and prosody, caused by insufficient innervation of the muscles of the speech apparatus: respiratory, vocal, articulatory.
With dysarthria, the motor mechanism of speech is disrupted due to organic damage to the central nervous system. The structure of the defect in dysarthria is a violation of the entire pronunciation aspect of speech and extra-speech processes: general and fine motor skills, spatial representations, etc. The structure of the defect has been sufficiently studied in the specialized literature. The treatment of this group of children is also widely represented in the medical literature. Mild degrees of dysarthria (MDD - minimal dysarthric disorders) are very common in children with ODD (50-80%); in children with FFN (30-40%); in some children with an initial diagnosis of “complex dyslalia,” a thorough examination reveals erased dysarthria (10%). Erased dysarthria (mild dysarthria, MDD - minimal dysarthric disorders) in speech therapy practice is one of the most common and difficult to correct disorders of pronunciation of speech. G. Gutsman is the first to identify among children with polymorphic sound pronunciation disorders a category of children in whom articulation is blurred and for whom the process of correcting sound pronunciation is extremely difficult. In the future, Pravdina-Vinarskaya and Eidinova analyze cases of motor impairment. The abbreviation “MDR” was introduced by G.V. Chirkina and I.B. Karelina to designate a low (erased) degree of dysarthria. Mild “erased” dysarthria was identified by Pravdina and Melekhova when examining children with complex dyslalia. They identified functional, mechanical dyslalia, as well as organic cerebral dyslalia, which later began to be classified as mild dysarthria and began to be called erased dysarthria. The authors note that with organic cerebral disorders of sound pronunciation (erased dysarthria), there is insufficient mobility of individual muscle groups of the speech apparatus (lips, soft palate, tongue), general weakness of the entire peripheral speech apparatus due to damage to certain parts of the nervous system. Studying the anamnesis of children with erased dysarthria, Mastyukova, Lopatina, Arkhipov, Karelin and others identify the following factors: unfavorable course of pregnancy; asphyxia, low Apgar score at birth, the presence of a diagnosis of PEP - perinatal encephalopathy - in the vast majority of children in the first year of life. In the infant period from 0 to 1 year, pathological pre-speech symptoms are not detected in psychomotor development, because Screening examination of psychomotor functions of children has not yet been introduced into practice. And, as a result, there is no psychological, pedagogical and correctional speech therapy support for infants with PEP. A study of the anamnestic data of young children indicates a delay in locomotor functions (motor clumsiness when walking, increased exhaustion when performing individual movements, inability to jump, step up stairs, grasp and hold a ball). There is a late appearance of finger grasping of small objects, and a long-term persistence of the tendency to grasp small objects with the entire hand. The medical history notes difficulties in mastering self-care skills, dislike of drawing; Many children do not know how to hold a pencil correctly for a long time. In the future, they continue to have persistent difficulties in the formation of graphomotor skills. Interesting data are presented in Lopatina’s study on the psychomotor skills of children with MDD (minimal dysarthric disorders). When studying the psychomotor skills of children with erased dysarthria, tests proposed by N.I. Ozeretsky, E.Ya. Bondarevsky, M.V. Serebrovskaya were used. 1. A test for static coordination of movements shows that violation of statics is manifested in significant difficulty (and sometimes impossibility) in maintaining balance, in limb tremor. When holding a pose, children often sway, trying to maintain balance, lower their raised leg, touching it to the floor, and rise on their toes. They maintain their balance better when standing on their right foot. Having difficulty maintaining balance (mainly standing on the left leg), they try to hold on to the back of a nearby chair with their hands. 2. Test for dynamic coordination of movements. The dynamic test shows that in more than a third of cases, children throw the ball at the target not “from the turned shoulder”, without a swing, but from below. At the same time, at the moment of throwing with one hand, the other is tense and brought towards the body. The number of times the ball hits the target is significantly greater when performing movements with the right hand. In most cases, the test for the right hand is successful on the first attempt, while for the left - on the second and third. Most children with erased dysarthria are able to jump over a tight rope from a standing position, without a running start. At the same time, the task is not always completed on the first try. When the test is performed on the second or third attempt, the rope is noted to touch the rope when jumping with the feet and landing on the heels. In isolated cases, falling or touching the floor with hands after a jump and not jumping, but stepping over a rope were recorded. Performing test tasks to study dynamic coordination of movements is characterized by insufficiently coordinated activity of various muscle groups, “jerking”, and clumsiness of the movements performed. 3. Test to study the speed of movements. Completing a task to study the speed of movement shows that more than half of the children find it difficult to sit on the floor and stand up without using their hands. Basically, the task is performed at a slow pace. Children are able to sit on the floor without using their hands, but cannot get up without this help. They rest on either one or both hands. In less than half of the cases, children are able to quickly and correctly complete this task on the first try without using their hands. The inability to perform this test was noted in isolated cases. The nature of the children's performance of the task confirms the insufficient development of dynamic coordination of movements and motor maneuverability, discovered when performing other tests. 4. Motor memory tests. A motor memory test, in which the experimenter's movements program the sequence of their execution and at the same time have a confusing effect, causes significant difficulties for most children. When reproducing movements, their tempo slows down or, conversely, accelerates. Disruptions in the motor program began already from the third or even from the second movement, and difficulties were noted in the transition from one motor element to another. The error-free execution of this test on the first attempt was recorded only in isolated cases. 5. Test for simultaneous movements. The greatest difficulty to perform is the test for simultaneous movements. Simultaneous performance of movements for both limbs is observed in a small number of children. More often, there are either pronounced difficulties in performing these movements (mainly for the left hand), or their execution at different times. During the time allotted for completing the task, most children change the pace of winding the thread more than three times, while the pace of this movement does not correspond to the pace of walking. 6. Test to identify synkinesis (i.e. friendly, unnecessary movements). The motion clarity test is performed more successfully. The overwhelming majority of children perform it at a sufficient pace (for both limbs) without the occurrence of synkinesis. At the same time, cases were recorded of performing movements at a slow pace, with a violation of the amplitude (mainly for the left hand), with tension in the fingers when holding a pencil, with numerous synkinesis: lip movements, tongue protrusion, head tilts forward, etc. These tests are aimed at identifying maturity of the level organization of movements according to N.A. Bernstein. Lopatina's research confirms that children with erased dysarthria at almost all levels (according to Bernstein) show deviations from the norms in psychomotor skills. Violations of the function of static balance (level A), dynamic coordination (level B), violations of tempo and dexterity of movements (level B and C) are detected; decreased motor memory (level D). These studies not only reveal the mechanism of the disorder and the structure of the defect in erased dysarthria, but also define new directions in the psychological, pedagogical, medical and speech therapy aspects of influence, aimed at correcting the psychomotor skills of children. Children with erased dysarthria do not stand out sharply among their peers, and do not even always immediately attract attention. However, they have some peculiarities. So, these children speak unclearly and eat poorly. They usually do not like meat, bread crusts, carrots, or hard apples as they find it difficult to chew. After chewing a little, the child can hold the food in his cheek until adults reprimand him. Often parents make concessions to the baby - they give soft food so that he can eat. Thus, they, unwittingly, contribute to a delay in the child’s development of movements of the articulatory apparatus. It is necessary to gradually, little by little, teach the child to chew solid food well. It is more difficult for such children to develop cultural and hygienic skills, which require precise movements of various muscle groups. The child cannot rinse his mouth independently, since his cheek and tongue muscles are poorly developed. He either immediately swallows the water or pours it back. Such a child needs to be taught to puff out his cheeks and hold the air, and then pump it from one cheek to the other, retract his cheeks with his mouth open and lips closed. Only after these exercises can you teach your child to rinse his mouth with water. Children with dysarthria do not like and do not want to fasten their own buttons, lace up their shoes, or roll up their sleeves. You can't achieve anything here with orders alone. Fine motor skills should be gradually developed using special exercises. You can teach your child to fasten buttons (first large, then small) on a doll’s clothes or on a removed dress or coat. At the same time, the adult not only shows the movements, but also helps to make them with the hands of the child himself. After such training, children will be able to fasten buttons on clothes they are wearing. To train the ability to lace shoes, various shapes (square, circle, etc.) cut out of thick cardboard are used. Holes are made along the edges of the figure at a distance of 1 cm from each other. The child must sequentially thread a long cord with a metal end through all the holes over the edge, as if stitching the edges. To ensure that your child’s interest in the exercises does not wane, you can stick some picture in the middle of the figure and say that by threading the colored cord correctly, the child will make a toy in this way and will be able to give it to anyone he wants. Then he is asked to lace up his shoes, first taken off his feet, then directly on his feet. Dysarthric children also experience difficulties in visual arts. They cannot hold a pencil correctly, use scissors, or regulate the pressure on the pencil and brush. In order to teach a child how to use scissors faster and better, you need to place his fingers together with your own in the rings of the scissors and perform joint actions, consistently practicing all the necessary movements. Gradually, developing fine motor skills of the hands, the child develops the ability to regulate the strength and accuracy of his movements. Such children also have difficulty performing physical exercises and dancing. It is not easy for them to learn to correlate their movements with the beginning and end of a musical phrase, and to change the nature of movements according to the beat. They say about such children that they are clumsy because they cannot clearly and accurately perform various motor exercises. It is difficult for them to maintain balance while standing on one leg, and they often do not know how to jump on their left or right leg. Usually an adult helps a child jump on one leg, first supporting him at the waist, and then in front with both hands, until he learns to do it independently. A study of the neurological status of children with erased dysarthria reveals certain abnormalities in the nervous system, manifested in the form of a mild, predominantly unilateral, hemisyndrome. Paretic symptoms are observed in articulatory and general muscles, which is associated with impaired innervation of the facial, glossopharyngeal or hypoglossal nerves. (G.V. Gurovets, S.I. Mayevskaya) In cases of dysfunction of the hypoglossal nerve, deviation of the tip of the tongue towards paresis is noted, and mobility in the middle part of the tongue is limited. When the tip of the tongue and the middle part of the tongue are raised tooth-to-tooth, the middle part quickly falls to the side of the paresis, causing the appearance of a lateral air stream. In some children, dysfunction of the glossopharyngeal nerve predominates. In these cases, the leading symptoms of disorders are phonation disorders, the appearance, nasalization, distortion or absence of back-lingual sounds. A violation of muscle tone is often detected. The voice suffers significantly with dysarthria. It becomes hoarse, tense or, conversely, very quiet and weak. Thus, unintelligible speech in dysarthria is caused not only by a disorder of articulation itself, but also by a violation of the coloring of speech, its melodic-intonation side, i.e. violation of prosody. Dysarthria is characterized by inexpressiveness of speech, monotony of intonation, and a nasal tone of pronunciation. At the same time, erased dysarthria can be complicated by phonetic-phonemic underdevelopment, general speech underdevelopment, stuttering and other speech disorders. Studies by Lopatina et al. revealed in children with erased dysarthria disturbances in the linervation of facial muscles: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulties in raising the eyebrows, and closing the eyes. Along with this, characteristic symptoms for children with erased dysarthria are: difficulty switching from one movement to another, reduced range of movements of the lips and tongue; Lip movements are not performed in full, they are approximate, and there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, imprecision of movements, difficulties in spreading the tongue, lifting and holding the tongue at the top, tremor of the tip of the tongue are noted; In some children, the pace of movements slows down when performing a task repeatedly. Many children experience: rapid fatigue, increased salivation, and the presence of hyperkinesis of the facial and lingual muscles. In some cases, a deviation of the tongue (deviation) is detected. Features of facial muscles and articulatory motor skills in children with erased dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These disorders are most often not detected primarily by a neurologist and can only be identified during a thorough speech therapy examination and dynamic observation during correctional speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal and hypoglossal nerves, which determines the features and variety of phonetic disorders in children. Thus, in cases of predominant damage to the facial and hypoglossal nerves, disorders of the articulation of sounds are observed, caused by inadequate activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation. Currently, the problem of erased childhood dysarthria is being intensively developed in clinical, neurolinguistic, psychological, pedagogical and correctional speech therapy aspects. To distinguish erased dysarthria from complex dyslalia, a comprehensive medical and pedagogical study is necessary: analysis of medical and pedagogical documentation, study of anamnestic data. By comparing the symptoms of speech and non-speech signs in children with dyslalia and dysarthria, diagnostic significant differences can be determined. Thus, in children with erased dysarthria, in addition to impaired sound pronunciation, there is a violation of the voice and its modulations, weakness of speech breathing, and pronounced prosodic disturbances. At the same time, general motor skills and fine differentiated hand movements are impaired to varying degrees. The identified motor clumsiness and lack of coordination of movements cause a delay in the formation of self-care skills, and the immaturity of fine differentiated movements of the fingers causes difficulties in the formation of graphomotor skills. In studies devoted to the problem of speech disorders in erased dysarthria, it is noted that disturbances in sound pronunciation and prosody are persistent and in many cases cannot be corrected. This negatively affects the development of the child, the processes of his neuropsychic development in preschool age, and later can lead to school maladjustment. These disorders have a negative impact on the formation and development of other aspects of speech, complicate the process of schooling for children, and reduce its effectiveness. A relationship has been established between the pronunciation disorder itself and the formation of phonemic and grammatical generalizations, the formation of vocabulary, and coherent speech. In the work of O.Yu. Fedosova makes a comparison between dyslalia and erased dysarthria. With complex functional dyslalia: • articulation of only consonant sounds suffers; • a clear violation of the articulation of certain sounds in various conditions of their implementation; • fixing the formed sounds does not cause difficulties; • there are no violations of the tempo-rhythmic organization of speech; • breathing changes are not typical; • phonation disorders are not observed; • there is no discordination of breathing, voice production and articulation. With a mild degree of pseudobulbar dysarthria: • possible blurred, unclear pronunciation of vowel sounds with a slight nasal tint; • sounds can be preserved in isolation, but in the speech stream they are pronounced distortedly and unclearly; • the automation process is difficult: the supplied sound may not be used in speech; • characterized by an accelerated or slow pace of speech; • breathing is shallow, speech is noted during inhalation, phonation exhalation is shortened; • coordination of these processes suffers. To understand and explain the nature and mechanism of the disorder in erased dysarthria, it is necessary to refer to the teachings on the mechanisms of speech by A.R. Luria, P.K. Anokhin, etc. The mechanisms of speech are associated with a holistic, hierarchical organization of brain activity, including several links, each of which makes its specific contribution to the nature of speech activity. The first link of the speech functional system is the receptors of hearing, vision, and sensitivity that perceive initial information. The systems of the initial receptive level also include kinesthetic sensations, which signal the position of the organs of articulation and the whole body. If speech kinesthesia is insufficient, speech development is disrupted. The second link is complex cortical systems that process, store incoming information, develop a response program and translate the original semantic thought into the scheme of a detailed speech utterance. The third link of the speech functional system implements the transmission of voice messages. This link has a complex sensorimotor organization. When the third link of the speech functional system is damaged, the innervation of the speech muscles is disrupted, i.e. The motor mechanism of speech is directly disrupted. E.F. Sobotovich and A.F. Chernopolskaya distinguish four groups of children with erased dysarthria. Group 1 These are children with insufficiency of some motor functions of the articulatory apparatus: selective weakness, pareticity of some muscles of the tongue. Asymmetric innervation of the tongue, weakness of movements of one half of the tongue cause such violations of sound pronunciation as lateral pronunciation of soft whistling sounds [s] and [z], affricates [ts], soft anterior lingual [t] and [d], posterior lingual [g], [k ], [x], lateral pronunciation of vowels [e], [i], [s]. Asymmetrical innervation of the anterior edges of the tongue causes lateral pronunciation of the entire group of whistling, hissing sounds [r], [d], [t], [n]; in other cases, this leads to interdental and lateral pronunciation of the same sounds. The causes of these disorders, according to Sobotovich, are unilateral paresis of the hypoglossal (XII) and facial (VII) nerves, which are of an erased, unexpressed nature. A small proportion of children in this group have phonemic underdevelopment associated with distorted pronunciation of sounds, in particular, underdevelopment of phonemic analysis skills and phonemic representations. In most cases, children have an age-appropriate level of development of the lexical and grammatical structure of speech.

Group 2 In children of this group, no pathological features of general and articulatory movements were revealed. During speech, sluggish articulation, unclear diction, and general blurred speech are noted. The main difficulty for this group of children is pronouncing sounds that require muscle tension (sonorants, affricates, consonants, especially plosives). Thus, children often skip the sounds [r], [l], replace them with fricatives, or distort them (labial lambdacism, in which the stop is replaced by a labiolabial fricative); single-beat rhoticism resulting from difficulty vibrating the tip of the tongue. There is a splitting of affricates, which are most often replaced by fricative sounds. Violation of articulatory motility is mainly observed in dynamic speech-motor processes. The general speech development of children is often age appropriate. Neurological symptoms manifest themselves in the smoothness of the nasolabial fold, the presence of pathological reflexes (proboscis reflex), deviation of the tongue, asymmetry of movements and increased muscle tone. According to Sobotovich and Chernopolskaya, children of groups 1 and 2 have erased pseudobulbar dysarthria. Group 3 In children, the presence of all the necessary articulatory movements of the lips and tongue is noted, however, difficulties are observed in finding the positions of the lips and especially the tongue according to instructions, imitation, based on passive displacements, i.e. when performing voluntary movements and in mastering subtle differentiated movements. A feature of pronunciation in children of this group is the replacement of sounds not only in place, but also in the method of formation, which is inconsistent. In this group of children, phonemic underdevelopment of varying degrees of severity is noted. The level of development of the lexico-grammatical structure of speech ranges from normal to pronounced OHP. Neurological symptoms manifest themselves in increased tendon reflexes on one side, increased or decreased tone on one or both sides. The nature of articulatory movement disorders is considered by the authors as manifestations of articulatory dyspraxia. Children in this group, according to the authors, have erased cortical dysarthria. Group 4 This group consists of children with severe general motor impairment, the manifestations of which are varied. Children exhibit inactivity, stiffness, slowness of movement, and a limited range of movements. In other cases, there are manifestations of hyperactivity, anxiety, and a large number of unnecessary movements. These features are also manifested in the movements of the articulatory organs: lethargy, stiffness of movements, hyperkinesis, a large number of synkinesis when performing movements of the lower jaw, in the facial muscles, the inability to maintain a given position. Violations of sound pronunciation are manifested in replacement, omissions, and distortion of sounds. A neurological examination of children in this group revealed symptoms of organic damage to the central nervous system (deviation of the tongue, smoothness of the nasolabial folds, decreased pharyngeal reflex, etc.). The level of development of phonemic analysis, phonemic representations, as well as the lexico-grammatical structure of speech varies from normal to significant OHP. This form of disorder is defined as erased mixed dysarthria. Lopatina's (1986) studies presented three groups of children with erased dysarthria. The criteria for differentiation of groups are the qualities of the pronunciation side of speech: the state of the sound pronunciation, prosodic side of speech, as well as the level of formation of linguistic means: vocabulary, grammatical structure, phonemic hearing. General and articulatory motor skills are assessed. Common to all groups of children is a persistent violation of sound pronunciation: distortion, replacement, confusion, difficulties in automating the given sounds. All children in these groups are characterized by a violation of prosody: weakness of the voice and speech exhalation, poor intonation, monotony of speech: some violations of general and fine motor skills.

First group. Violations of sound pronunciation are expressed in multiple distortions and absence of sounds. Phonemic hearing is fully formed: children correctly perform tasks on auditory and pronunciation differentiation of sounds. The syllabic structure of words of varying complexity is not disturbed. The quality and volume of active and passive vocabulary correspond to the age norm, children successfully master the skills of inflection and word formation. Coherent monologue speech of children of the first group is formed in accordance with age standards. There are no structural or morphemic agrammatisms in the speech of children in this group. If we consider the first group of children with erased dysarthria within the framework of the psychological and pedagogical classification (R.E. Levina), then we can classify them as a group with phonetic underdevelopment (PH). Second group. Expressive speech is rated satisfactorily. Violation of sound pronunciation is in the nature of multiple substitutions and distortions. Phonemic hearing is impaired to a greater or lesser extent. Children have insufficiently developed auditory and pronunciation differentiation of sounds. When teaching their sound analysis, difficulties arise. When reproducing the syllabic structure of complex words, rearrangements and other errors occur. Active and passive vocabulary lags behind the age norm. There are errors in the grammatical formatting of speech (morphemic agrammatisms). Particular difficulties arise when coordinating neuter nouns with numerals and using prepositions in word formation. Coherent monologue speech is characterized by the use of two-word, uncommon sentences. According to the psychological and pedagogical classification of R.E. Levina, these children with erased dysarthria belong to the group with phonetic-phonemic underdevelopment (FFN). Third group. The expressive speech of children in this group with erased dysarthria is unsatisfactorily formed. Impressive agrammatisms are noted, i.e. difficulties in understanding complex logical and grammatical sentence structures. Violation of sound pronunciation is polymorphic in nature, i.e. sounds of different phonetic groups suffer. Multiple substitutions, distortion, and absence of sounds are noted. Severe phonemic hearing impairment: auditory and pronunciation differentiation of sounds is not sufficiently formed, which does not allow mastering sound analysis. The violation of the syllabic structure of words is more pronounced. Active and passive vocabulary lags significantly behind age standards, and lexical and grammatical errors are numerous and persistent. This group of children with erased dysarthria does not master coherent speech. According to the classification of R.E. Levina, this group of children corresponds to general speech underdevelopment (GSD). The identification of three groups of children with erased dysarthria in Lopatina’s research allows them to be correlated in terms of the level of development of linguistic means with the three groups identified by R.E. Levina: FN - phonetic underdevelopment FFN - phonetic-phonemic underdevelopment OHP - general underdevelopment of speech. V.A. Kiseleva’s research is devoted to the analysis of the reasons for children’s school failure. Studying children with dysgraphia and dyslexia, the author identified mild impairments in sound pronunciation and phonetic hearing in most of them. An examination together with a neurologist and neuropsychologist confirmed the presence of erased dysarthria. Erased dysarthria as an initial defect leads to insufficient phonemic perception, analysis, and synthesis, which causes specific errors in writing and reading. As Levina points out, disruption of speech kinesthesia due to morphological and motor lesions of the speech organs affects the auditory perception of the entire sound system of a given language. This leads to the fact that children with erased dysarthria have underdevelopment of phonemic perception. The blurred, slurred speech of these children does not provide the opportunity for the formation of clear auditory perception and control. This further aggravates violations of sound pronunciation, since failure to distinguish between incorrect pronunciation and the pronunciation of others inhibits the process of “adjusting” one’s own articulation in order to achieve a certain acoustic effect. Kiseleva raises the question of diagnosing and correcting erased dysarthria in preschool age in order to prevent violations of children's written speech and prevent school failure. Conclusions 1. Erased dysarthria is a complex speech disorder characterized by variability in disturbances in the components of speech activity: articulation, diction, voice, breathing, facial expressions, and melodic-intonation aspects of speech. 2. Erased dysarthria is characterized by the presence of symptoms of microorganic damage to the central nervous system: insufficient innervation of the speech organs - the brain, articulatory and respiratory sections; violation of muscle tone of articulatory and facial muscles. 3. With erased dysarthria, as a rule, there are various persistent violations of the phonetic and prosodic aspects of speech, which are leading in the structure of the speech defect, and specific deviations in the development of the lexico-grammatical structure of speech. 4. With erased dysarthria, the state of non-speech functions and mental processes (attention, perception, memory and thinking) has a number of distinctive features. 5. Among the motor functions, the movements of the fingers are of particular importance, since they have a huge impact on the development of the child’s higher nervous activity. The function of hand movement is always closely related to the function of speech, and the development of motor skills will contribute to the development of the pronunciation side of speech. 6. About a third of the entire area of the motor projection of the cerebral cortex is occupied by the projection of the hand, which is located next to the projection of the motor zone; finger movements actually stimulate the maturation of the central nervous system, which, in particular, manifests itself in the acceleration of the child’s speech development. 7. In children with erased dysarthria, both a violation of general motor skills and a lack of fine differentiated movements of the hands and fingers are detected. 8. The complexity of the structure of the defect in dysarthria determines the directions and content of complex corrective action, including medical, psychological, pedagogical and speech therapy aspects.

Prognosis and prevention

Any speech defect, including an erased form of dysarthria in preschool children, entails psychological disorders. If the disorder is not detected in time, diagnosed and therapy is not started, the baby will grow up with this pathology, and others will join it. In such situations, it is difficult for a person to live in society: he is limited in his choice of profession and self-realization. Because of this, he may feel depressed, which can further lead to depression.

Prevention of erased dysarthria begins during pregnancy planning. The expectant mother needs to undergo examination at this stage and prepare for conception: undergo a course of treatment, if there are any problems, eliminate deficiency conditions (anemia, hypovitaminosis).

After pregnancy, you need to be careful about your food choices and daily routine. The expectant mother should have enough rest, walk, avoid physical strain, injury, and stress.

It is important to competently manage labor and avoid injuries and hypoxia. During the newborn period, follow the doctor’s recommendations and undergo examinations on time. If you suspect any developmental abnormality, tell your doctor. Timely diagnosis and therapy are mandatory conditions for the earliest possible recovery and a guarantee that the disorder will not affect the baby’s development in the future.

Features of mild dysarthria

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

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