Exercises to restore the pronunciation side of speech. Overcoming speech pronunciation disorders in patients with efferent motor aphasia. The work of a speech therapist is
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Prepared material
Features of the pronunciation side of speech with dysarthria
Dysarthria is a disorder of sound pronunciation caused by organic insufficiency of innervation of the speech apparatus. In other words, this is a speech disorder in which the connection between the central nervous system and the speech apparatus suffers. As a result, the pronunciation side of speech is disrupted.
The main manifestations of dysarthria are a disorder of the entire pronunciation (these are disturbances in the articulation of sounds, as well as voice, tempo, rhythm and all intonation in general). With dysarthria, the sound pronunciation of both consonants and vowels may be impaired.
Sound pronunciation disturbances in dysarthria manifest themselves to varying degrees and depend on the nature and severity of damage to the nervous system. In mild cases, there are individual distortions of sounds, “blurred”, inexpressive speech, poor diction; in more severe cases, distortions, substitutions and omissions of sounds are observed, tempo, expressiveness, intonation suffer, and in general the pronunciation becomes slurred.
Dysarthria in children is observed with various organic brain lesions. It occurs as a result of some pathology during pregnancy, birth trauma, or may be a consequence of any diseases suffered in early childhood. Dysarthria most often occurs in cerebral palsy (CP).
There are different forms of dysarthria, but all its forms are characterized by certain disturbances that an attentive parent will be able to notice.
Firstly, it is worth paying attention to gross motor skills. The child may move little or poorly, and quickly get tired from exertion. In music classes and during dancing, this can manifest itself in rhythm disturbances.
Also indicative fine motor skills. If a child has difficulty fastening buttons or lacing shoes, does not like to draw, or paints sloppily, you should be wary.
However, the most basic indicators for dysarthria are violations articulatory motor skills, facial muscles. This may manifest itself as follows. The child’s facial muscles are in constant tension, which is why facial movements are absent or weakly expressed. The lips are in a state of frozen half-smile, and the tongue is thick and inactive. This is a sign of muscle spasticity. Also, articulatory muscles may, on the contrary, be sluggish, which is expressed in drooping corners of the lips (which remain like this even when the child speaks). The tongue is thin, sluggish, and little active. This is already a sign of pareticity of the tongue and lips. Also, disorders of articulatory motor skills can manifest themselves in the form of trembling of the tongue, many chaotic movements of the articulatory apparatus when trying to find the appropriate position of the lips and tongue. You should also pay attention to increased salivation during speech.
Among other things, dysarthria is characterized by disorders voice, speech breathing(speech can be inhaled or speech exhalation is shortened and the child seems to “choke” at the moment of speech) and intonation disorders, which are more often found in the form of insufficient voice strength, disturbances in voice timbre and weak expression or complete absence of voice modulations (the child cannot voluntarily change the pitch).
It is very important to understand that dysarthria requires early, long-term and systematic speech therapy work.
Since the formation of the pronunciation side of speech is a complex process during which a child learns to perceive spoken speech addressed to him and control his speech organs to reproduce it, you should not expect results immediately. Correcting pronunciation with dysarthria can take months and even years (depending on the severity and form of dysarthria).
The effectiveness of correctional interventions in eliminating pronunciation defects in children with dysarthria largely depends on the early start of speech therapy classes, the systematicity of their implementation, as well as on the relationship in the work of the speech therapist and parents (mandatory implementation of the recommendations of the speech therapist, neurologist, massage therapist, exercise therapy specialist and other specialists).
As an example, we present some exercises for the development of speech and non-speech breathing and articulatory motor skills (however, we should not forget that speech therapy work for dysarthria is not limited to these exercises!)
Exercises to develop breathing.
Target: produce a smooth, long-lasting, continuous air stream running down the middle of the tongue.
Description: smile, place the wide front edge of the tongue on the lower lip and, as if pronouncing the sound “f” for a long time, blow the cotton wool onto the opposite edge of the table.
Attention!
1. The lower lip should not be pulled over the lower teeth.
2. You can’t puff out your cheeks.
3. Make sure that the child pronounces the sound “f” and not the sound “x”, i.e., that the air stream is narrow and not diffuse.
The breeze is blowing
Target: produce an air stream that exits along the edges of the tongue.
Description: smile, open your mouth slightly, bite the tip of your tongue with your front teeth and blow. Check the presence and direction of the air stream with a cotton swab.
Make sure that the air does not come out in the middle, but from the corners of the mouth.
Focus
Target: develop the upward movement of the tongue, the ability to shape the tongue into a ladle and direct the air stream in the middle of the tongue.
Description: smile, open your mouth slightly, place the wide front edge of the tongue on the upper lip so that its side edges are pressed and there is a groove in the middle of the tongue, and blow off the cotton wool placed on the tip of the nose. The air should go in the middle of the tongue, then the fleece will fly up.
1. Make sure that the lower jaw is motionless.
2. The lateral edges of the tongue should be pressed against the upper lip; a gap is formed in the middle into which an air stream flows. If this doesn't work, you can hold your tongue slightly.
3. The lower lip should not be tucked in or pulled over the lower teeth.
Speech breathing exercises
Football
Roll up a cotton ball and place two cubes as gates. The child must blow on the ball and drive it into the gate.
Windmill
A child blows on the blades of a spinning toy or a windmill from a sand set.
Snowfall
Make snowflakes from cotton wool (loose lumps). Explain to the child what snowfall is and invite the child to blow “snowflakes” from the palm of his hand.
Leaf fall
Cut out various autumn leaves from colored paper and explain to your child what leaf fall is. Invite your child to blow on the leaves so that they fly. Along the way, you can tell which leaves fell from which tree.
Butterfly
Cut out butterflies from paper and hang them on threads. Invite the child to blow on the butterfly so that it flies (while making sure that the child makes a long, smooth exhalation).
Ship
Blow smoothly and for a long time on the paper boat.
Dandelion
Invite your child to blow on a faded dandelion (make sure you exhale correctly).
Storm in a glass
Invite your child to blow through a straw into a glass of water (you need to make sure that your cheeks do not puff out and your lips are motionless).
Exercise technique:
Take in air through the nose
Don't raise your shoulders
The exhalation should be long and smooth
It is necessary to ensure that your cheeks do not puff out (to begin with, you can hold them with your hands); you cannot repeat the exercises many times in a row, as this can lead to dizziness
Articulation gymnastics
“Frog” - “Proboscis” Stretch your lips in a smile and show how wide the frog’s mouth is. Then stretch your lips forward, like a tube - you will get a proboscis, like a baby elephant's |
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"Fence" Open your lips and show closed teeth. Here's a fence! | |
“Spatula” - “Needle” Open your mouth and place a wide, relaxed tongue on your lower lip. Then make the tongue narrow and show a sharp needle. |
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"Swing" Open your mouth and, with the sharp tip of your tongue, reach first to your nose, and then to your chin, then again to your nose, and then again to your chin. This is how the swing swings. | |
"Watch" Open your mouth slightly, stretch your lips in a smile and alternately stretch the tip of your narrow tongue to different corners of your mouth, depicting a clock pendulum. |
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"Slide" Open your mouth, hide the tip of your tongue behind your lower teeth, and lift the back of your tongue up. Show me a steep hill. | |
« Cup» Open your mouth wide, stick out your tongue. Raise the tip and side edges of the tongue to create a cup. |
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"Delicious jam" Open your mouth. Lick your upper lip with your tongue. Performing a top-down movement. | |
"Horse" Open your mouth, raise your tongue to the roof of your mouth and flick it. Show how the horse clicks. | |
"Fungus" Open your mouth. Suck your wide tongue to the roof of your mouth. The dorsum of the tongue is the mushroom cap, and the hyoid ligament is the stalk. |
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"Drum" Open your mouth. Raise your tongue to the “tubercles” behind your upper teeth. While holding this position, say: “D-d-d-d.” | |
"Brushing our teeth" Open your mouth and use the tip of your tongue to “clean” your lower teeth, performing a bottom-up motion. |
Iya Valerievna Bolgova
Dysarthria
Task 1. Describe the symptoms of bulbar dysarthria and draw up a plan for correctional and speech therapy work to restore speech.
For bulbar dysarthria typical symptoms:
Disorder of the muscles responsible for the swallowing function, which is expressed in difficulty swallowing, and sometimes even in aphagia (inability to swallow). Under such conditions, there is a risk that food will enter the trachea and directly into the lungs, which can lead to suffocation and death.
Speech disorder. At the same time, it becomes inaccessible to perception. The voice and the very ability to speak may disappear. The patient gets tired of the tension that the muscles of the speech apparatus experience when speaking.
Weakening of the respiratory and cardiovascular systems, which is due to the proximity of their location to the damaged areas of the nerves;
Deviation of the tongue to the side not affected by paralysis.
Drooping soft palate. Absence of pharyngeal and palatal reflexes.
Uncontrollable crying or laughing when holding an object over the surface of the teeth.
Features of work with bulbar dysarthria.
For flaccid paralysis and paresis, the goal of speech therapy work is to improve tissue nutrition, conductivity of nerve tissue, muscle excitability and reactivity, and induce reflexes.
This can be achieved through tonic massage and gymnastics. Gymnastics is initially passive, then passive - active.
Respiratory muscle training is a must. With flaccid paralysis of the muscles of the soft palate and pharynx, it is necessary to select exercises to train these muscles.
To activate the vocal cords, it is useful to let a speech therapist feel the sound of your voice. The child puts his hand to the speech therapist’s larynx and feels the tension of the sounding voice and the vibration that occurs. At the same time, the child is taught to distinguish between turning the voice on and off by ear.
Speech therapy work with dysarthria is carried out in stages.
The first stage, preparatory - its main goals: preparation of the articulatory apparatus for the formation of articulatory patterns, in a young child - nurturing the need for verbal communication, development and clarification of passive vocabulary, correction of breathing and voice.
An important task at this stage is the development of sensory functions, especially auditory perception and sound analysis, as well as the perception and reproduction of rhythm.
Methods and techniques of work are differentiated depending on the level of speech development.
The second stage is the formation of primary communicative pronunciation skills. Main it target: development of speech communication and sound analysis.
Work is underway to correct articulation disorders.
Work on relaxing the muscles of the articulatory apparatus begins with general muscle relaxation, relaxation of the neck, chest muscles, and arm muscles.
Then they begin to relax the lip muscles.
After relaxation, and in case of low tone - after a firming massage of the lips, they are trained in passive-active movements.
After general muscle relaxation and the exercises described above, begin training the muscles of the tongue.
The first stage of work is exercises for the lips, helping to relax them and enhance tactile sensations in combination with passive closing of the child’s mouth. Attention is fixed on the sensation of a closed mouth, the child sees this position in the mirror.
At the second stage, the mouth is closed in a passive-active way. At first, it is easier for a child to close his mouth when his head is tilted, and easier to open when his head is slightly tilted back. At the initial stages of work, these lightweight techniques are used. The transition from passive mouth opening movements to active ones becomes possible through reflex yawning.
At the third stage, active opening and closing of the mouth is trained according to verbal instructions: "Open your mouth wide", "Pull your lips forward", “Pull your lips into a tube and return them to their original position.”.
Various tasks are offered to imitate the position of the mouth presented in the pictures. Gradually several exercises become more complicated: the child is asked to blow through relaxed lips and make vibration movements.
Task 2. Describe the symptoms of cerebellar dysarthria and select exercises to restore the pronunciation side of speech.
Features of work with cerebellar dysarthria.
Occurs when the cerebellum and its connections with other brain structures are damaged.
Pathogenesis and clinical symptoms. There is marked asynchrony between breathing, phonation and articulation. As a result, speech is slow in tempo, jerky, with impaired stress modulation, with the voice fading towards the end of the phrase, that is, chanted speech. Due to hypotonia, movements of the articulatory organs are reproduced and maintained with difficulty. As a result, sounds that require fairly clear, differentiated movements and sufficient muscle strength are phonetically impaired. abbreviations: complex anterior lingual sounds, affricates, stop sounds. A symptom of open nasality develops. Prosodic disturbances are more pronounced.
With this form dysarthria disorders of general and articulatory motor skills are determined by low muscle tone, lack of accuracy and proportionality of movements, disturbance of synchrony and rhythm. There is a gross violation of the intonation of speech; its monotony. Speech is slurred and fragmentary.
The cerebellum and its functions can develop during training, and the higher voluntary level of movement regulation carried out by the cerebral cortex should be used as much as possible. Thus, when teaching a child any movements, consciousness is included and they are taught to control their movements with the help of vision.
Before starting comprehensive training dysarthria, requires careful preparation, which consists of four stages of work. Long-term plan and work with the aim of developing speech muscles and carrying out the necessary corrections:
Working on proper breathing to develop speech. The sequence of inhalation and exhalation when speaking, holding the breath on individual syllables and sounds. Development of articulatory motor skills.
Auditory memory training, work to increase attention and perception.
Exercises for fine and gross motor skills.
The work is based on two methods - passive and active articulatory gymnastics.
Passive gymnastic movements
The passive method for eliminating speech defects promotes the development of the functions of a certain muscle group that was not previously involved in work. In addition, automation of the muscle group that took an active part in the conversation is being further developed. All these factors form various voluntary muscle movements for staging the development of speech. Thanks to passive exercises, an image of articulation is created in which new tactics for pronouncing sounds are implemented and new patterns of movement of the speech organs are determined. Inert articulatory gymnastics and exercises are carried out after the massage session. On the part of the baby, it is performed without his actual participation: all movements of the tongue and lips are made without its help. Articulatory speech exercises are repeated serially from three to five times. Passive articulatory gymnastics is performed for the tongue and lips. It has its own methods that allow the child to acquire correct speech.
Gymnastics and exercises language:
the tongue is removed from the oral cavity and then returned to it (input Output); raising the tongue and retracting it back (setting and correcting sound "l");
the tongue reaches to the chin;
the tongue reaches towards the nose;
stretching the tongue and abducting it from side to side;
lowering the tongue to the bottom of the mouth;
the tip of the tongue stretches and reaches the palate (sound setting and correction "R"); relaxing the tongue muscle with small swings to the right and left. Articulation gymnastics and exercises for passive exercises (lips):
light squeezing of the upper lip - carried out with fingertips, which are fixed in the corner of the mouth;
light squeezing of the lower lip - carried out in a similar way;
movement "proboscis"- collecting the upper and lower lips into a tube (sound production "y");
fixing the fingers in the corners of the mouth, the line is stretched (sound production "And");
raising the upper lip towards the nose;
drooping of the lower lip to the sides of the chin;
full compression and closing of the mouth (production of sounds "m", "P");
placement of the corners of the mouth to produce vowels sounds: "O", "y", "And", "Yu""s", "A".
When performing passive gymnastics exercises, the relationship between the instructor and the student is very important. Thus, the following must be present: actions: visual control - the child sees a reflection in the mirror, thus it becomes clear to him which muscles can actively develop speech to activate the pronunciation of sounds; auditory perception - inform your child about your actions. For example: “Now your tongue is touching the roof of your mouth.”, “your upper lip reaches your nose”. After passive gymnastics, active exercises of the speech muscles are performed. (speech automation). However, it should be borne in mind that the structure of the work transition should be smooth, that is, it is advisable to devote some time to passive-active exercises.
Active gymnastic movements
They are carried out in front of a mirror. The child looks at speech therapy instructions and repeats facial movements.
Here are some popular ones ways: "astonishment". With this grimace, you need to roll your eyes out and raise your brow ridge upward. If the child does not do this well, then help him by slightly raising his forehead with your fingers;
rapid blinking of the eyes;
inflating first one cheek, then the second, and after that two at once!
Do the same sequence with lips: first blow air under the upper and then under the lower lip (sound production "f"). After this warm-up, you can proceed directly to working on the muscles of the oral cavity. Again, in front of the mirror, we help the child complete the following speech therapy tasks: pull the tongue forward and make it soft and spread out; make an extended tongue "tube", that is, try to bring its edges together; With the tip of your tongue, lick the upper border of the lip, and then the lower; reach your tongue to your nose and then to your chin; reproduce the running of a horse, that is, click your tongue (set sound to).
An excellent exercise for working the lower frenulum and palate; smile so that as many teeth as possible are exposed (sound setting and); gather your lips together "pipe"; alternating the two previous exercises; Job jaws: moving it forward and backward, left and right.
Task 3. List the main symptoms of anarthria.
Make a plan for correctional and speech therapy work to restore speech in anarthria and select exercises.
Symptoms of anarthria
Lack of ability to pronounce words, letters, and sometimes even sounds.
Marked slurring speeches: words are pronounced with great difficulty, stuttering, as if through the nose (nasally). The patient critically evaluates his speech defect and prefers to remain silent or communicate using gestures and writing.
Choking when eating (does not directly relate to the term “anarthria”, but is often encountered with it).
Speech therapy work with dysarthric disorders should begin with weakening the manifestation of disorders of the innervation of the muscles of the speech apparatus. By expanding the possibilities of movement of speech muscles, one can count on their better spontaneous inclusion in the articulatory process.
When carrying out correctional and speech therapy work with children with dysarthria It is advisable to use the following methods of speech therapy impact:
Differentiated speech therapy massage (relaxing or stimulating);
Probe, acupressure, manual, brush massage;
Passive and active articulatory gymnastics;
Artificial local contrast therapy (combination of hypo- and hyperthermia).
Speech therapy work with children - dysarthrics is based on:
Knowledge of the structure of speech defects in different forms dysarthria,
Knowledge of the mechanisms of disorders of general and speech motor skills,
Taking into account the personal characteristics of children.
Particular attention is paid to the state of children's speech development in the field of vocabulary and grammatical structure, as well as the peculiarities of the communicative function of speech. For school-age children, the state of written speech is taken into account.
Classes with a speech therapist: correction of an existing defect with the help of special exercises (physical therapy to normalize muscle tone and increase the range of movements of the articulation organs (tongue, cheeks, lips).
An approximate complex of passive gymnastics:
The lips close passively and are held in this position. The child's attention is fixed on closed lips, then he is asked to blow through his lips, breaking their contact;
Using the index finger of the left hand, lift the child’s upper lip, exposing the upper teeth; with the index finger of the right hand, raise the lower lip to the level of the upper incisors and ask the child to blow;
The tongue is placed and held. between teeth;
The tip of the tongue is pressed and held against the alveolar process, the child is asked to blow, breaking the contact;
An approximate set of static articulation exercises for dysarthrics. L. V. Lopatina, N. V. Serebryakova
1. Open your mouth, hold it open while counting from 1 to 5-7, and close it.
2. Open your mouth slightly, push your lower jaw forward, hold it in this position for 5-7 seconds, return to its original position.
3. Pull the lower lip down, hold it while counting from 1 to 5-7, return to its original state;
Raise your upper lip, hold it while counting from 1 to 5-7, return to its original state.
4. - stretch your lips into a smile, exposing the upper and lower incisors, hold them counting from 1 to 5-7, return to their original state;
Stretch in a smile only the right one (left) hold the corner, exposing the upper and lower incisors, counting from 1 to 5-7, return to its original position.
5. - lift alternately first the right one, then left: corner of the lip, lips closed, hold at a count from 1 to 5-7, return to its original state.
6. - stick out the tip of your tongue, mash it with your lips, pronouncing the syllables pa-pa-pa-pa. After pronouncing the last syllable, he will leave his mouth slightly open, fixing his wide tongue and holding it in this position, counting from 1 to 5-7;
Stick the tip of your tongue between your teeth, bite it with your teeth, pronouncing the syllables ta-ta-ta-ta. After pronouncing the last syllable, leave the mouth slightly open, fixing the wide tongue and holding it in this position, counting from 1 to 5-7, return to its original position.
7. - place the tip of the tongue on the upper lip, fix this position and hold it counting from 1 to 5-7, return to its original state;
Place the tip of the tongue under the upper lip, fix it in this position, hold it while counting from 1 to 5-7, return it to its original state;
Press the tip of the tongue against the upper incisors, hold the given position counting from 1 to 5-7, return to its original state;
Movement "licking" with the tip of the tongue from the upper lip into the oral cavity behind the upper incisors.
8. – give the tip of the tongue a position "bridge" ("slides"): press the tip of the tongue to the lower incisors, raise the middle part of the back of the tongue, press the lateral edges to the upper lateral teeth, hold the specified position of the tongue counting from 1 to 5-7, lower the tongue.
An approximate set of dynamic articulation exercises for dysarthrics. L. V. Lopatina, N. V. Serebryakova
1. Stretch your lips into a smile, exposing the upper and lower incisors; stretch your lips forward "tube".
2. Stretch your lips into a smile with your incisors bared, and then stick out your tongue.
3. Stretch your lips into a smile with your incisors bared, stick out your tongue, and press it with your teeth.
4. Raise the tip of the tongue to the upper lip, lower it to the lower .
5. Place the tip of your tongue under the upper lip, then under the lower lip (repeat this movement several times)
6. Press the tip of the tongue behind the upper, then lower incisors (repeat this movement several times).
7. Alternately make the tongue wide, then narrow.
8. Lift your tongue up, place it between your teeth, and pull it back.
9. Build "bridge"(the tip of the tongue is pressed against the lower incisors, the front part of the back of the tongue is lowered, the front is raised, forming a gap with the hard palate, the back is let down, the lateral edges of the tongue are raised and pressed against the upper lateral teeth, break it, then build it again and break it again, etc. .
10. Alternately touch the protruding tip of your tongue to the right, then to the left corner of your lips.
11. Raise the tip of the tongue to the upper lip, lower it to the lower lip, alternately touch the protruding tip of the tongue to the right, then to the left corner of the lips (repeat this movement several times).
Klepatskaya L.B.
Restoring speech after a stroke. A set of exercises to restore speech. - M.: V. Sekachev, 2011.
A manual for speech therapists working in medical institutions with patients who have suffered a stroke, injury or other brain damage.
Introduction
The proposed manual presents exercises and texts aimed at restoring detailed, grammatically and logically correctly formed, spontaneous speech in patients with moderate and mild forms of aphasia.
Section 1 tasksare aimed at stimulating the ability to adequately comprehend and understand speech both within one sentence, phrase, and an entire text from short simple to more detailed and complex. This included exercises that the patient must carefully read, comprehend, find an error in the construction of the sentence, and rewrite correctly. Another option: make sentences from disparate parts; find the missing part of the sentence in the second part of the text; compose a story from these sentences, etc. These exercises develop verbal thinking in patients, force them to think logically and formulate phrases.
In section 2collected exercises and texts aimed at expanding patients' vocabulary. The richer the patient’s vocabulary, the more complete and developed his phrasal speech becomes. The exercises are designed to replenish the vocabulary with verbal vocabulary, nouns, adjectives, adverbs, to select words, antonyms, synonyms, as well as to use them correctly when composing sentences, stories, and in your own speech.
In section 3material is presented for working on the semantic structure of a word. This- transformations of various kinds of word forms, for example: from verbs to nouns; from nouns- into adjectives, adverbs; adjectives into adverbs; words with a diminutive meaning of the word, etc. Often, a prefix, stress, suffix or a word that sounds similar creates difficulties for the patient in correctly understanding it, as well as in its purpose. For example: craft- fake- different prefixes significantly change the meaning of the entire word. Or words: temporary-modern; atlas-atlas.
Section 4aimed at restoring expanded phrasal speech in patients with aphasia. The tasks are designed in such a way as to develop in patients the ability of speech programming, construction and expansion of a phrase of a simple syntactic model up to (3-5 words) to sentences of a complex and complex type, including from 6 to 12 or more words. Special attention is paid to the use of participial and adverbial phrases, allied words, prepositions...
Exercises to complete unfinished phrases force the patient to logically complete and grammatically correctly formulate a sentence.
In section 5a set of exercises designed to revive the “feeling of the native language” and restore the idea of its norms is presented. This- adding endings, inserting missing prepositions, changing the form of a word by using prefixes, suffixes, placing stress, using the word in the correct case form.
Section 6 tasksare aimed at developing in patients the ability to distinguish consonant sounds by acoustic proximity. Such patients do not differentiate between voiced and unvoiced sounds: b-p; d-t; z-s; g-k; w-sh; ts-ts. Other patients mix sounds that are close to the place of origin- t-n; l-n; district; r-l; k-g-x, etc. A number of exercises pursue the task of eliminating defects in the acoustic differentiation of sound series.
Section 7 Exerciseshelp expand the volume of auditory-verbal memory in patients and strengthen acoustic traces. The speech therapist uses repetition of speech and number series, repetition of word combinations of two or three, reproduction from memory of sentences of 4-8 or more words, retelling of texts from memory, as well as after a certain period of time.
I. Work on understanding speech, sentences, texts.................................................... 5
II. Expanding vocabulary.................................................................... .................... 23
III. Work on the semantic structure of the word.................................................... ..... 55
IV. Working on forming a phrase.................................................... .............. 69
V. Restoration of grammatical forms of the Russian language.................................. 110
VI. Differentiation of sounds................................................... ........................... 142
VII. Expanding the volume of auditory-verbal memory,
strengthening auditory-speech traces................................................................. .................... 146
I. Work on understanding speech, sentences, texts.
Find the mistake in the sentence and rewrite it correctly.
1. Yellow leaves fall from the tree.
2. In winter there is a lot of precipitation.
3. The student was called to the board.
4. The car moved away from the house.
5. The eagle flew over the forest.
6. The boy threw a fishing rod into the river.
7. The birds flew south.
8. The sun illuminates the earth.
9. The forest rises above the plane.
1. The guard is guarded by the garden.
2. The key opens with a lock.
3. The net pulls the fishermen.
4. A flower bed grows on flowers.
5. The sea flows into the river.
6. The key opens the safe.
7. The garden is located in a gazebo.
8. Rocks are broken by waves.
9. There is a sofa hanging above the lamp.
10. The horizon is hiding behind the sun.
11. The sentry is guarded by the border.
2. Find the error in the sentence, rewrite it correctly.
This family consists of three people - father, mother and son, who lives on the fifth floor.
A blue car drove away from the house where my parents live.
The man turned out to be an employee of our institute, whom we met in the park.
What the son said is coming tomorrow.
The more deaf and impenetrable the forest becomes, the further we go.
The stronger and stronger your body becomes, the more often you take walks in the fresh air.
So that I call my friend to clear my doubts.
Although the day is cold, the sun is shining.
Although interesting, the lecture is long.
He often gets sick, so he walks without a hat.
Always leaves me the key, so she often goes on business trips
The weather will be clear if we go out of town.
If I come to see you, there will be free time.
Since I have difficulty understanding him, his speech is unclear.
Since we decided to fly by plane, the symposium began tomorrow.
Complete the sentences by inserting one of the three proposed parts according to their meaning.
1. I'll come see you tomorrow...
If my friend calls
If they give us an apartment
If you have free time
2. I gave my friend a book...
Which is locked with a key
Which is made of crystal
Which I bought last week
3. There will be a city park here...
When do school holidays start?
When will I have a vacation
When will this area be cleared?
4. I approached the village...
Where no man has gone before
Where was the walrus rookery?
Where did I spend my childhood and youth?
5. The sun sparkles in every drop of dew...
Which was sent to me by mail
Which rose above the forest
Which he bought last week
6. Grasses are cut early in the morning...
There's still hope
Until the mushrooms grow
While they haven't dropped the dew yet
Find the missing part of the sentences in the 2nd part of the text
1 .
1. Every year the cranes return...
2. Over the seas and wide steppe, over bright rivers and blue forests...
3. Tall reeds and last year’s dry sedge...
4. In the most inaccessible places...
5. May they live in peace...
6. A wolf will not pass through the swamp, he will not make his way...
7. Cranes fly around in the spring...
8. They will gather in a circle in the swamp and...
9. Throughout the forest they hear...
Cranes fly to their homeland in spring.
A large swamp has become overgrown.
From distant warm countries to the native swamp.
Merry round dances.
Cautious cranes build nests.
Fox, a cautious lynx will not sneak up.
They flap their wings.
In an inaccessible swamp.
Explain the words.
Work carelessly.
Look at everything through your fingers.
Unfold your ears.
Shatter your health.
Sit in a puddle.
Hang your nose.
Walk on your hind legs.
Fly like an arrow.
Prick up your ears.
Gain trust.
Pull the wool over someone's eyes.
Put a spoke in wheel.
Live in perfect harmony.
Dote on your soul.
Out of the blue.
It's like he fell through the ground.
Blow to smithereens.
Taking the bull by the horns.
Neither fish nor fowl.
Like the wind blew it away.
Bright head.
Shot sparrow.
Sore point.
Toughie.
Bonanza.
Skillful fingers.
Long tongue.
Nerves of steel.
Explain the words.
Let it all go to the wind
Sound the alarm
Keep your eyes open
Transfer from a sore head to a healthy one
Lay low
Go into the shadows
To challenge
Muddy the waters
Keep your tongue shut
Keep your mouth shut
How I got water into my mouth
Dumb like a fish
Fights like a fish on ice
Set the heat
Life is a full cup
Not life, but raspberries
Bury your talent
Dot the i
He says it's like a river is babbling
Don't put your finger in your mouth
Turn everything upside down
Make amends
Discover America
Talking into the void
Take someone by surprise
Force an open door
Spin like a top
Give hope
You can't beg for snow in winter
And laughter and tears
Climb right through
Be alert
Exhausted
Bet
Turn your head
Prove with foam at the mouth
Keep a stone in your bosom
Reveal all cards
Arrange "self-inflicted"
Kill time
Go broke to smithereens
Look into the future
Build a castle on the sand
Tighten the nuts
Throw mud at you
Refresh your memory
Establish a connection
Nothing sacred
Hit your pocket
Charm your teeth
To waste money
Wait by the sea for weather
Heartache
Set your teeth on edge
Like peas hitting a wall
Lyko doesn't knit
Not a penny to spare
Doesn't care about the soul
Everything has its time
The horse hasn't rolled yet
Speak behind the scenes
No need for nothing
Case "tobacco"
It's not worth a hatched egg
Business before pleasure
Works like an ox
He speaks as he reads
From empty to empty
And nothing has changed
Explain the proverbs.
Don't sit in your own sleigh.
The hut is not red in its corners, but red in its pies.
Strike while the iron is hot.
Do not count your chickens before they are hatched.
Don't spit in the well, you'll need to drink the water.
Small spool but precious.
The language will take you to Kyiv.
The sun will also peek into our window.
What goes around comes around.
If you love to ride, you also love to carry sleds.
All that glitters is not gold.
If you hurry, you will make people laugh.
Every dog has his day.
If you're afraid of wolves, don't go into the forest.
The forest is being cut down and the chips are flying.
As it comes back, so will it respond.
Well done against the sheep, and against the well done the sheep itself.
Like water off a duck's back.
Measure seven times and cut once.
People are greeted by their clothes, but they are seen off by their intelligence.
Nightingales are not fed fables.
Living life is not a field to cross.
The thief's hat is on fire.
Come out dry from water.
Put everything upside down.
The apple never falls far from the tree.
11. Answer the questions.
The ribbon is wider than the waistband. Which of them is already?
Katya is older than Olya. Who is younger?
Zina is waiting for Seryozha. Who's late?
The maple is lower than the mountain ash. What's higher?
Kolya is taller than Sasha. Who is shorter?
Blueberries are smaller than lingonberries. Which one is larger?
Lena is older than Katya. Who is younger?
The river is smaller than the lake. Which one is deeper?
An orange is larger than an apple. Which one is smaller?
Petya overtakes Vitya. Who's behind?
Anya tells Lena something. Who's listening?
The student asks the teacher. Who is responsible?
The dog runs after the boy. Who runs first?
Before going to the store, I bought a newspaper. What did you do before?
Before going out of town, I visited my parents. What did you do before?
Before eating the sandwich I drank juice. What did you do before?
After the walk, we started cleaning the apartment. What did you do before?
Before going into the forest, we put away all the tools. What did you do before?
I called a friend after I made the report. What did you do before?
We bought the furniture after we renovated it. What did you do before?
Answers
1. Alone. The rest flew away. 2. There were seven, seven left. 3. None. Everyone crashed. 4. No. It will be night. 5. Alone. 6. There were seven, seven left. 7. Three geese. 8. It’s very easy to write one hundred and five units: 111-11 = 100. 9. Two.
Kite
Someone flew a kite. The paper kite rose high into the clouds. From above, he saw a moth in the valley and began to shout to it: “Are you probably jealous of looking at my high flight?”
The moth answered: “No, it’s not envious.” After all, you are on a string, you are tied. And although I fly low, I fly wherever I want, and I don’t rant to please anyone, like you.”
Answer the questions:
1. Who flew in the sky?
2. Why wasn’t the moth jealous of the kite?
3. What did the moth value most in life?
4. Draw a conclusion.
16. Read the story carefully, answer the questions, retell the text.
Gardener and sons
One gardener had sons. The gardener had a large grape garden. The children did not want to work in the garden.
One day the father called his sons and said: “Children, go into the garden and look for what is hidden there.”
The children thought that there was a treasure buried in the garden. They went into the garden and began to dig the ground. They dug up all the ground, but did not find the treasure. But the soil in the garden became loose and good. There were a lot of grapes. The children sold the grapes and became rich.
Answer the questions:
1. What did the gardener want?
2. What did the gardener say to the children?
3. What did the children think?
4. Did the children find the treasure?
5. Why did they become rich?
6. Draw a conclusion.
17. Read the story carefully, answer the questions, retell the text.
Lomonosov
Lomonosov was a famous Russian scientist. One day he was invited to a ball with a rich nobleman. On the way to the ball, the carriage in which Lomonosov was riding fell into a deep rut and got stuck. Lomonosov got out of the carriage and helped the coachman put it on level ground. At that moment his sleeve tore. Lomonosov did not return home to change clothes, and drove on. At the ball, one nobleman approached Lomonosov and, pointing to his sleeve, asked with a grin: “What is it, sir, that you look learned?” Lomonosov replied: “No, sir, it’s stupidity that looks there.”
Answer the questions:
1. Where did Lomonosov once go?
2. What happened on the way?
3. What did one nobleman say to Lomonosov at the ball?
4. Explain Lomonosov’s words.
18. Read the story, answer the questions, draw a conclusion, retell the text.
Stone and road
Once upon a time there lived a big stone. A stream flowed past. The water polished the stone, and it sparkled in the sun. As time passed, the stream dried up. The stone lay alone on a hillock. There were many grasses and bright wildflowers around him. There was a road below. There were stones and cobblestones along the side of the road. The stone was bored lying alone. He looked longingly down at the road, where there was always activity. One day he could not stand it, moved from his place and rolled down. The stone ended up in the bustle of the road. He was trampled, crushed, covered in mud, and roughly thrown to the side. Where did its shine go? More and more often the stone looked up at the hillock with sadness. There he lay peacefully among the green grass and bright wildflowers. But the past cannot be returned. He could only dream about it. So people sometimes leave their native rural places, go to noisy cities, where they find themselves at the mercy of vanity, thirst for money, endless worries and worries.
Leonardo da Vinci
Answer the questions:
1. Where was the stone?
2. What did the stone once want?
3. What happened to the stone on the road?
5. Draw a conclusion.
19. Read the story, answer the questions, draw a conclusion, retell the text.
Vine and peasant
The vine rejoiced, seeing how in the spring the peasant carefully dug up the earth around it, lovingly looked after it, tied it up, and put strong supports so that it would be easy for it to grow.
In gratitude for such care, the vine decided to gift the person with juicy, fragrant bunches. When it was time to harvest the grapes, the vine was completely covered with large tassels. The diligent owner cut them all off and carefully put them in a basket. Then, after thinking, he dug up stakes and supports and used them for firewood. And the poor vine had no choice but to grieve from resentment and freeze all winter on the bare ground. But the next year she was no longer so generous, and the short-sighted peasant paid severely for his greed.
Leonardo da Vinci
Answer the questions:
1. Why was the vine happy?
2. How did the vine thank the peasant?
3. What did the peasant do after harvesting?
4. What happened next year?
5. Draw a conclusion.
20. Read the story, answer the questions, draw a conclusion, retell the text.
Bird cherry and blackbird
Juicy, fragrant fruits have ripened on the bird cherry tree. From morning to evening, annoying blackbirds circled above her. They tore off green leaves and tore off its branches with their beaks and claws.
One day the bird cherry said to the most annoying thrush: “Eat my berries as much as you want, but don’t pick my leaves, they protect me from the scorching sun. Don’t skin my branches, don’t scratch them with your claws.”
This thrush was the first bully in the flock, he said: “Keep quiet, nature itself has it so that you bear fruit for my pleasure. You will go to the firewood in winter.” Hearing this, the bird cherry was greatly saddened.
But one day this same thrush fell into a snare. The man built a cage for the caught bird from twigs and thin bird cherry branches. So the bird cherry again met its offender, who was now sitting in a cage quieter than water, below the grass. But she remained silent, remembering the words that she had heard in her youth: just as warm clothes save you from the cold, so endurance protects you from resentment. Always be calm and no offense will touch you.
Leonardo da Vinci
Answer the questions:
1. From whom did the bird cherry suffer?
2. What did the bird cherry ask for?
3. What did the blackbird say?
4. What happened to the blackbird?
Name the objects.
How is bread cut?
What do you use to cut wood?
What do they sew with?
What do they sweep with?
What are they digging with?
What do you use to cut the grass?
What are trees cut with?
What are the walls painted with?
What are the beds watered from?
How do you cut fabric and paper?
How do you tighten the screws?
How do you light a fire?
What do you wipe your face and hands with?
How do you clean shoes?
How do you erase errors?
What do they write and draw with?
What do they knit with?
How do you hammer nails?
How do you open the lock?
How do you rake the hay?
What are the walls covered with?
How do you finish the bathtub?
What is parquet covered with?
What do they wash with?
What are they ironing with?
What do you vacuum with?
What is the table set with?
What do you use to cover your bed or sofa?
How do you pull out nails?
Name the professions.
Who mines coal? - miner
Who produces oil?
Who writes stories, short stories, novels?
Who composes the music?
Who takes care of the garden?
Who looks after the forest?
Who teaches the children?
Who treats the sick?
Who paints the pictures?
Who sweeps the yard?
Who's driving the car?
Who cuts hair?
Who sews dresses and suits?
Who guards the border?
Who flies the plane?
Who is in charge on the ship?
Who runs the state?
Choose a generalized word.
Ring, earrings, pendant, brooch, necklace... - decorations
Table, sofa, armchair, wardrobe, bed... -
Plate, spoon, fork, cup... -
Coat, jacket, suit, jacket, trousers...-
Linden, maple, birch, pine, spruce...-
Bus, metro, trolleybus, taxi...-
Tomatoes, cucumbers, pumpkin, onions, radishes, cabbage... -
Rose, aster, tulip, chamomile, iris, peon, daffodil... -
Sparrow, magpie, crow, tit, thrush, swallow... -
Ant, fly, beetle, spider, grasshopper, butterfly... -
Wolf, bear, fox, tiger, lion, hare, squirrel... -
Sausage, cheese, bread, fish, ham, butter, cream, juice... -
Silk, drape, cloth, satin, velvet, satin, chintz, suede... -
Violin, piano, guitar, balalaika, trumpet, flute... -
Boots, shoes, slippers, boots, sandals... -
Cap, cap, beret, hat, hood... -
Green, blue, blue, black, white... -
Volga, Lena, Yenisei, Irtysh, Kama, Ob... -
Russia, Canada, America, England, Italy, Poland... -
Tolstoy, Chekhov, Kuprin, Sholokhov, Bulgakov, Gamzatov... -
Pushkin, Lermontov, Blok, Fet, Yesenin, Okudzhava... -
Lomonosov, Tsiolkovsky, Einstein, Kurchatov, Mendeleev... -
Europe, Asia, Arctic, Antarctica, Australia, Africa... -
Moscow, Paris, London, Vienna, Rome, Warsaw, Berlin... -
Choose antonyms.
Straight - crooked, winding...
Difficult - faded
Insert verbs.
Whatever comes back to haunt you...
Live life, not a field...
What goes around comes around...
Language to Kyiv...
Not on your sleigh...
Don't spit in the well, you'll need some water...
Hurry up, people...
Don't be afraid of wolves, don't go into the forest...
Nightingales are not fables...
People meet you by their clothes, but by their intelligence...
The forest is being cut down - chips...
The thief is wearing a hat...
Measure seven times, and once...
He who doesn't work doesn't...
If you love to ride, you also love sleds...
18. Select verbs (2-3 words).
Rosa - sparkles, shines, sparkles.
19. Select verbs (2-3 words).
Skills- acquire, consolidate, develop...
Insert verbs according to their meaning.
Not the wind... over the forest
Not from the mountains... streams
Frost voivode on patrol
Your possessions.
Is it good to have a snowstorm?
Forest paths...
And are there any cracks or crevices?
And is there any bare ground somewhere?
Through the trees...
On frozen water
And the bright sun...
In his shaggy beard
Climbing a large pine tree
Along the branches with a club...
And I’ll delete it to myself
A boastful song...
N. Nekrasov
Insert verbs according to their meaning.
Morning
The stars fade and... The clouds are on fire.
White steam in the meadows...
Along the mirror water, through the curls of willow
Scarlet light from dawn...
Sensitive reeds, silence, solitude around.
The dewy path is barely noticeable.
Bush... shoulder, suddenly on your face
From the leaves... silvery dew.
The breeze blew, the water..., ...
The ducks flew by noisily and...
Far, far away is a bell...
Fishermen in a hut...
Nets from poles, oars to boats...
And the east is still burning...
Birds of the sun..., birds of song...
And the forest costs itself...
Here comes the sun..., because of the arable land...
Over the seas you can spend the night...
To the fields, to the meadows, to the tops of willow trees
Golden streams...
A plowman is riding with a plow... - a song...;
The young man can handle everything heavy
No pain, you soul! ... from worries!
Hello, sunshine and cheerful morning!
I. Nikitin
23. Insert appropriate definitions.
Sample: On wide growing in the clearing tall mighty oak.
The meadow was covered with... ...grass and... dandelions.
Ice floes floated along the... river with noise and crackling.
Stopping at... ...the house, he carefully opened the gate and entered... ...the garden.
A cloud covered the entire sky, thunder roared and it began to... ...rain.
Between... the pine trees and... the field there was... ... a path leading to... the lake.
The table was covered... ...with a tablecloth embroidered with... ...patterns.
It was day...and...and we decided to go...hiking.
Leaves quietly fall from the trees and lie on... ...the ground.
The river reflects..., ..., ... the colors of the evening sky.
On the shore, passengers are offered......raspberries,......strawberries.
The reeds... stretch like a wall along... the river.
In the morning, a chipmunk runs out of its hole. In the rays... of the sun... the stripes on his back shine.
We climbed...... the hill and a... ...valley appeared before us.
Before wintering, the bream lies down on... the bottom, and... ... the perches settle among the stones.
24. Choose definitions for these words (2-4 words).
Case - important, complex, urgent...
25. Insert definitions according to meaning. Use words for reference.
1... ...the wind drove the city... ...clouds.
2. Petersburg lived... ...life.
3. In... the decade... enterprises and projects were created with... rapidity.
4. ...the hall on the second floor is flooded with... ...light... from chandeliers.
5. ...in the evening... a man in... a cloak with... a hood appeared in... an alley.
6. ... poppies, ... daisies and ... buttercups filled the entire valley.
7. The girl looked... ... with her eyes, then, smiling slightly, took... her candy.
Words for reference:red, outstretched, dazzling, sparkling, uncomprehending, dark, amazing, northern, bold, surprised, cold, noisy, ours, last, heavy, bright, restless, autumn, huge, black, tall, white, pulled down, pink.
26. Fill in the missing definitions according to their meaning.
Birch Grove
Nice... ...groves! As soon as the snow melts in the forest, the buds on the birch trees swell. These... days, birch trees treat us... ...with juice. The song of a blackbird is heard far away in the grove. Tits fly from tree to tree. ...spread like a carpet under the birches... ...snowdrops.
It's good in a birch grove and in the summer... time. Under the breath... ...the wind rustles... ...the leaves. It smells......of strawberries.
I want to lie down in... ...the grass and look at the tops of the birches, where... ...clouds float across the... ...sky.
Words for reference:cheerful, vocal, nimble, wonderful, light birch, blue and white, light cool, sultry, juicy young, ripe fragrant, tall thick, blue summer, resinous fragrant, white, spring, life-giving sweet.
27. Instead of dots, insert the missing definitions according to their meaning.
Mountain Lake
After many hours of travel and... transitions... a picture unfolded before the travelers. We saw a mountain lake with... ... shores that were reflected in... the mirror of the waters. The middle of the lake was covered... with ice.
Hidden... by the shores of the mountain lake it seemed... But its color changed with fabulous speed: the water was..., ... and...
Small herds of... deer were grazing in the valley. Fishes swam calmly in... the water and their... backs were visible. On the shore we found many... nests. ... the wall... of rocks did not allow us to move further, and we set off... on our way. ... the birds accompanied us for a long time.
Words for reference:duck, unapproachable, high, reverse, countless, heavy, inaccessible, emerald, blue, pink, golden, amazing, sheer rocky, motionless, bluish, wild, thick, large, transparent.
28. Fill in the missing definitions according to their meaning.
In the ravine
An old wolf is making his way through... the forest, through... ravines with his prey. A wolf's lair is hidden far from... roads and... villages.
The wolves are hungry and homeless in... the cold. At ..., ... at night they wandered through ... fields and roads, caught bunnies, stole dogs. A song was heard over the fields... ...a howl was heard through... the blizzard. The winter is over. In... ...the days the she-wolf gave birth... ...cubs. The wolf cubs are growing, frolicking. Late in the morning... the wolf returns with prey.
The snow crunches under the wolf's paws. The hazel grouse are flying up into the trees. A wolf runs boldly through... ...the forest.
Words for reference:cold, spring warm, blind small, lively, old, caked, timid, familiar, dark, deaf, passing, crowded, winter, frosty blizzard, snowy, wolfish, impenetrable, plaintive.
29. Insert definitions according to meaning (based on I.I. Shishkin’s painting “Rye”).
Noon. A field of... rye spreads out wide in front of us... the ears bend to the ground.
The greenery in the foreground of the picture emphasizes... the tones of rye. We see among... a field... a path that leads to... pine trees.
Pine trees rise majestically against... ...the sky.
We admire... the ebb... ... of the ears of corn, we rejoice at the abundance of bread on... ...the earth.
Words for reference:golden, ripe, native Russian, boundless, sinuous, huge, mighty slender, blue, sultry summer, immense, golden, golden, bright velvety, heavy.
30. Choose definitions (2-5 words).
Day - cold, clear, windy, hot, stuffy, frosty...
Choose words according to their meaning.
Juicy, ripe - watermelon
Match the verbs with words.
Build - house, temple, building...
Explain the words.
Teeth - teeth;
Eclipse - darkening;
Down jacket - down jacket;
Liveliness - liveliness;
Blockhead - blank;
Dish - saucer;
Curtain - curtain;
Sediment - residue;
Abacus - accounts;
Lunch - mass;
Wreath - crown - aureole;
Face - mask - face - personality;
Leaves - leaves;
Chinese - Chinese;
Korean - Korean;
Discuss - condemn;
Replace - change;
Look - look out;
Present - provide;
Dress - put on;
To bow - bows;
Correct - straighten.
Front - advanced;
High - high-rise;
Jealous - zealous;
Temporary - temporary;
Rescue - life-saving;
Practical - practical;
Hard - cruel;
Noticeable - noticeable;
Tsarsky - royal;
Spruce - Christmas tree;
Hostile - hostile;
Thrifty - careful;
Mental - conceivable - mental;
Skillful - artificial;
The top one is the supreme one.
Explain the words.
Offensive - touchy;
Thrifty - spare;
False - false;
Sorrowful - sad;
Forgetful - forgotten;
Decisive - decisive;
Calculating - calculating;
Mourner - mournful;
Intelligible - profitable;
Hasty - efficient;
Intelligent - understandable;
Friendly - welcoming;
Contemptuous - despicable;
Silent - silent;
Fussy - fussy;
Loud - screaming;
Sad - sad;
Trusting - trusted - trusting;
Golden - gilded;
Playful - sparkling;
Classic - classy - classy;
Malicious - malicious;
Land - earthly - earthly;
Single - single - single;
One-time - simultaneous;
Friendly - friendly - friendly;
General - general's;
Main - capital;
Militant - militant;
Guilty - guilty;
Windy - windy - windy;
Upper - supreme - riding.
Insert adverbs according to their meaning.
1. ...walking on thin ice, we... moved to the other side.
3. The teacher asked the student... and... to retell the text.
4. The day was approaching evening, but everything was the same on the street... and...
5. There was... and... in the forest, nothing disturbed the silence.
6. ... and... walk through the flowering meadow.
7. The school evening passed... and...
8. The meeting was... unexpected news.
9. The girl... smiled.
10. The animal... rushed to the side.
Words for reference:easy, fun, clear, hot, careful, attentive, safe, quiet, embarrassed, scared, easy, organized, thoughtful, detailed, fresh, interesting, d
Methods of speech restoration for various forms of dysarthria.
Main directions of rehabilitation for various forms of dysarthria
E.N. Vinarskaya, A.M. Pulatov (1989) recommend for adult patients with dysarthria a neurophonetic analysis of the symptoms of dysarthria, which is usually carried out by a speech therapist - aphasiologist, which allows for a qualitative qualification of dysarthria, highlighting its clinical form. As a rule, adult patients do not have impairments in writing and reading, and the disorders concern only the sound-pronunciation aspect of speech.
The goal of rehabilitation for individuals with dysarthria, broadly speaking, is to return to a previous state or previous ability to function.
Rehabilitation of adults suffering from dysarthria involves a whole range of measures. This means clinical examination and diagnosis, treatment with medications and physiotherapy, special pedagogical work on correcting sound pronunciation, and specialized psychological assistance.
Methods of speech restoration for various forms of dysarthria
Corrective work of a speech therapist for bulbar and pseudobulbar dysarthria includes:
Massage of articulation organs;
Correction of pronunciation of speech sounds;
Work on the expressiveness of speech.
Two types of massage are most often used: activating and relaxing. An energizing massage is performed when the articulatory muscles are sluggish (flaccid paralysis or paresis), i.e. with bulbar dysarthria. A relaxing massage is indicated for muscles with increased tone (spastic paralysis or paresis), i.e. for pseudobulbar dysarthria. Articulatory gymnastics includes exercises similar to ordinary gymnastics exercises, most of which relate to the tongue as the most active organ of “speaking”.
A difficult task to solve is also increasing the dosage of exercises aimed at correcting muscle tone in pseudobulbar dysarthria, which is usually done as part of articulatory gymnastics. The methodological complexity of this work lies in the fact that any exercise to correct a particular articulatory posture leads to an increase in muscle tone in the working organs. Meanwhile, for patients with pseudobulbar dysarthria, hypertonicity of the articulatory muscles is one of the main pathological symptoms, and therefore, its strengthening is contraindicated. A way out of this difficult situation may be to modify the method of presenting exercises, consisting of tasks of repeated repetition of one or another articulatory pose with an emphasis on ease of movement, on a feeling of lightness in the muscles. Pauses between individual poses also lead to a reflex release of muscle tension. Articulatory postures are trained in a similar way, for which syllables and words containing them are usually used.
Corrective work for subcortical dysarthria is of a different nature. The central place in it is not occupied by speech therapy massage and articulatory gymnastics (although they are also used), but by the development of various speech-motor coordination. Since in different forms of subcortical dysarthria, discoordination is of a different nature, correction methods specific to each of them are necessary.
The most common dysmetria-type discoordinations are hyperkinesis and hypokinesis, which are caused primarily by disruptions in the functioning and interaction of striatal and pallidal structures, their connections with the lenticular nucleus, cerebellum and other subcortical nuclei. Hyperkinesis occurs in the clinic of dysarthria much more often than hypokinesis. Since both types of motor dysmetria are violent in nature, their elimination at an arbitrary level is almost impossible. The tasks used in speech therapy practice to keep the facial muscles in a calm state while sitting in front of a mirror (with hyperkinesis), or, on the contrary, to perform them exaggeratedly (with hypokinesis), as shown by long-term observations, are ineffective.
With cerebellar dysarthria, in addition, external supports are used in the form of drawn paths, traces, circles that you need to hit with your foot, etc., restraining the manifestations of ataxia.
Read the continuation of the manual in the article
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Necessary exercises to restore speech after a stroke
Brain infarction is getting younger every year. It affects people of various age categories and social status. A cerebral stroke entails quite severe complications, including speech impairment.
Causes of speech impairment
For a certain time after a stroke, a person experiences significant difficulties with speech – “aphasia”, “dysarthria”, which also causes significant psychological discomfort.
Dysarthria is slow, difficult, or slurred speech. Dysarthria usually occurs due to paralysis of one of the vocal cords, i.e. if the right side is paralyzed, the right vocal cord will not close completely and vice versa. This occurs if a certain area of the brain is damaged, for example, after a stroke of the brainstem and cerebellum.
In such a situation, in addition to basic exercises after a stroke, exercises are necessary - gymnastics for the facial muscles.
Restoring speech after a stroke is a very long process, and a set of special exercises must be performed regularly for several months or even years after the stroke, depending on the location and severity of the lesion.
Indeed, for a full perception of reality events and interaction with relatives and medical specialists, understanding words and the appropriate construction of phrases is a vital need.
Speech restoration is one of the most important areas, along with other rehabilitation exercises after a stroke. Maximum attention is paid to him: there is a psychologist, a speech therapist, and a physiotherapist, in addition to the main supervisor - a neurologist.
The localization of stroke damage in the brain structures, especially the cortical structures responsible for speech activity, is closely related. The more significant the negative focus of the lesion, the slower the process of returning to full communication will progress. The first twelve months are considered temporary periods.
Types of dysarthria during stroke
A person, directly depending on the location of the brain damage, may have sensory or motor aphasia:
- With the motor variant of aphasia, a person is able to perceive speech addressed to him, he fully understands it, but it is difficult for him to pronounce words and formulate his own thoughts. After a stroke, the victim is quite capable of reading or writing, but such actions require significant effort. Therefore, a person tries, as a rule, not to fulfill them.
- With sensory aphasia, a person’s ability to perceive the speech of others is completely lost. At some intervals, incoherent speech may be observed, but it is not controlled. Reading skills are preserved, but the meaning of what was read eludes the person’s consciousness. The ability to write is completely lost.
After a severe stroke, the pronunciation of the patient’s words is characterized by significant confusion,
gesticulation, expressiveness and a variety of intonation. With the help of these techniques, a person tries to express his thought, but due to these points - the inability to clearly pronounce words, construct phrases - the patient becomes aggressive or whiny. The adequacy of the perception of reality events is also lost.
Experts recommend starting rehabilitation measures—replenishment of voice functions—as soon as the condition of the person who has suffered a stroke allows. To make the process happen faster, the victim must first be treated by a speech therapist. But the comprehensive support of loved ones and friends also plays a huge role.
The work of a speech therapist is:
- special cards;
- lotto;
- mastering the ABC book.
It also explains how to compensate for a deficit in verbal activity with gestures and many other useful skills. Every speech therapist knows - care and maximum attention from close relatives,
their everyday speech contacts make a huge contribution to the moment a person returns to normal life.
An excellent effect in pronunciation is observed from:
- Speaking tongue twisters.
- Reading speech therapy texts aloud.
- Humming songs.
- Building logical chains of events.
The degree of difficulty of the classes is determined by a specialist - a speech therapist, depending on the severity of the speech disorders that have arisen; it gradually increases - from simple to complex, so that more and more new brain centers responsible for our speech, memory and logic are included in the rehabilitation.
Also, to improve your voice after a stroke, when brushing your teeth, you can massage your tongue with a toothbrush to relax it (which has a beneficial effect on improving pronunciation), and this will not harm oral hygiene because A large number of bacteria accumulate on the tongue.
To generally strengthen the lungs, you need to blow air through a straw into a glass of water, inflate ordinary balloons, speak more often and generally do breathing exercises.
All speech disorders are difficult to treat; just remember how many people cannot pronounce the letter R their entire lives.
If you have a situation with dysarthria, you know that your speech has become slow, unintelligible and without accent. Without a doubt, such a problem in the dialogue of a person with a voice disorder negatively affects his emotional state.
Important when talking:
- don't strain;
- do not try to pronounce the word syllable by syllable;
- don't shout words;
- in general, oddly enough, when talking, you need to try less and be more relaxed.
When restoring speech after a stroke, Botox and Dysport injections are also given into the vocal cord. I didn’t really delve into the topic, but if it helps, then it’s great, especially since you can get “Dysport” for free by entering it into your IPR.
It is absolutely prohibited to discuss in close proximity to a person who has suffered a stroke, his speech difficulties, as well as other negative consequences of a stroke.
Much better: repeatedly praise even for the slightest successes, encourage and aim for further steps to restore full speech.
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In the article we discuss the restoration of speech after a stroke. We talk about the types of speech disorders and ways to restore them. You will learn how stem cell treatment works, whether classes with a speech therapist are useful, and the necessary exercises.
Speech Impairment
Impaired speech function during stroke is one of the most common consequences of the disease. This condition after an acute cerebrovascular accident is called aphasia.
Aphasia is an acquired local absence or disorder of speech. It develops with organic lesions of the cerebral cortex and occurs with both ischemic and hemorrhagic types of stroke.
With the development of speech disorders, the localization of damage to the parts of the main organ of the central nervous system is of significant importance. Aphasia does not in any way affect the change in the patient’s intelligence; the condition is directly related only to the speech apparatus. It is important for the patient’s relatives to understand this; they should not treat the patient as if they are mentally retarded; such an attitude can provoke depression.
The lack of speech skills greatly hinders the return to the usual rhythm of life and prevents communication with other people. During the rehabilitation period, it is important to encourage the patient and help with exercises.
Types of violations
With a stroke, speech impairment occurs not only in the form of aphasia, but also phenomena such as dyspraxia and dysarthria. In some cases, several types of speech function disorders occur at once.
Aphasia is the most common type of speech disorder. With the development of this dysfunction, the patient loses the ability to understand what is said, reading and writing skills. The condition does not affect the patient's mental function.
There are several types of aphasia, the main ones:
- sensory aphasia – a person who has suffered a stroke has problems understanding what other people say; subtypes include receptive aphasia, as well as Wernicke’s aphasia;
- motor aphasia - the patient understands the speech of other people, but cannot express his thoughts in words; subtypes of the disorder include expressive and Broca's aphasia;
- global or mixed aphasia is a combination of disorders that completely or partially prevent the patient from communicating with other people.
What does a patient feel with sensory aphasia:
- does not understand the speech of other people, it often seems to him that those around him are speaking a foreign language;
- does not understand the meaning of sentences, forgets what his interlocutor is talking about;
- does not understand words and the meaning of sentences in the presence of outside noise or in cases where several people are speaking;
- cannot read, understands short headings, but does not perceive the rest of the text;
- can write, but is unable to read text written independently.
What problems does a patient experience with motor aphasia:
- unable to speak, makes sounds;
- cannot construct simple sentences, misses key words;
- speaks with frequent pauses and is unable to find the right word;
- when denying, he says “yes”, and when agreeing, “no”;
- confuses words, for example, instead of “water” he can say “milk”;
- describes objects, but cannot name them;
- answers questions with a set of several words, often these can be curses;
- repeats one word or sound several times.
With the global type of the disease, patients do not understand speech and cannot form words and sentences. As a result, they experience depression and negative changes in character.
Dyspraxia
Dysraxia is a condition in which there is a violation of the movements and coordination of speech muscles. The speech apparatus does not move in the correct sequence necessary to produce speech.
The difference between dyspraxia and facial paralysis is the absence of paresis. The muscles of the face and speech apparatus can make movements, but they do it incorrectly. A patient with dipraxia does not pronounce words clearly and repeats one word several times, trying to correct the pronunciation.
Dysarthria
Dysarthria is a disorder that occurs when the speech muscles are weak. Pathology does not affect the choice of the right words or understanding the speech of other people. As the disorder develops, the patient's voice changes and he cannot clearly pronounce words and sounds.
With dysarthria, breathing control is impaired; in such a situation, the patient begins to speak in short passages rather than sentences.
You will learn more about restoring speech after a stroke in the following video:
Recovery methods
To quickly restore speech, the patient is prescribed complex treatment. The process requires not only therapeutic measures, but also the active participation of the stroke patient himself. Half the success of restoring speech function depends on the patient’s motivation.
Treatment methods for aphasia and other pathologies:
- taking medications;
- stem cell treatment;
- classes with a speech therapist;
- doing exercises at home;
- working with a psychologist and treating depression.
For the purpose of drug therapy, the patient is prescribed neuroprotectors. Nootropic agents and antioxidants, which form the basis of neuroprotection, protect brain neurons from damage and promote the restoration of oppressed cells. This speeds up the healing processes in the body.
Also, with aphasia and other pathologies of speech function, patients are often prescribed medications against depression.
Stem cell treatment
To restore speech function, doctors use a modern technique - stem cell treatment. Therapy helps to increase the internal strength of the body, against the background of which volitional impulses arise, motivation for recovery and normalization of the ability to speak and understand spoken words. When treatment is carried out in the first days after a stroke, doctors achieve the most positive results.
The stem cell transplantation procedure is carried out on an outpatient basis in two courses, between which there is a break of 2-3 months. Therapy begins with the restoration of blood vessels - eliminating spasms, strengthening vascular walls, dissolving blood clots and removing cholesterol deposits.
Next, the main procedure is carried out, the purpose of which is to restore and renew the affected cells of the main organ of the central nervous system. During treatment, biomaterial from the patient himself is used. Healthy stem cells are grown to the required volume in the laboratory. Stem cells are administered intravenously to the patient in two steps.
Classes with a speech therapist
Immediately after stabilization of the general condition, a person needs the help of a speech therapist. The specialist helps restore the patient’s speech according to a special scheme, guiding him and giving him a load that the patient can cope with.
The speech therapist shows the person who has suffered the pathology special cards and teaches them to read and pronounce syllables. Therapy is often playful in nature - the doctor uses children's lotto, an ABC book, tongue twisters and exercises. But the specialist does not treat the patient like a child, which should be remembered by his relatives, especially if the person does not have an intellectual disability. The speech therapist teaches the patient to compensate for the lack of speech through gestures.
Exercises
In order to restore speech, they perform special exercises at home.
A set of exercises to improve speech function:
- Pull your lips in with a tube, return them to their original position, and perform the exercise for five seconds.
- Grab your lower lip with your upper teeth and then release it in a relaxed manner, perform the exercise for 5 seconds.
- Grab your upper lip with your lower teeth and repeat the exercise for 5 seconds.
- Stick out your tongue and stretch your neck, stay in this position for three seconds, then relax and rest.
- Lick your upper lip first, and then smoothly move your tongue from right to left, left to right. Repeat for the lower lip.
At home, with the help of family and friends, the patient can pronounce tongue twisters, read aloud, and practice live communication. It is important to maintain a leisurely pace of speech, carefully correct the patient, and not laugh or get irritated.
You will learn more about how to restore speech in the following video:
What to remember
- Aphasia is the most common speech disorder after stroke; patients also experience dyspraxia and dysarthria.
- The treatment package includes drug therapy, stem cell treatment, classes with a speech therapist and exercises.
- When restoring the ability to speak, it is important to communicate with the patient on an equal basis, support him and help him take the first steps - learn words, read, listen, pronounce tongue twisters, and so on.
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All information is provided for informational purposes. And it is not an instruction for self-treatment. If you feel unwell, consult a doctor.
Rehabilitation of patients with pseudobulbar dysarthria during the acute period of stroke
The article discusses the problem of pseudobulbar dysarthria in patients with stroke - clinical manifestations, diagnostic criteria, directions in rehabilitation work, specific massage techniques, including acupressure, facial and articulatory gymnastics. Much attention is paid to dysphagia and methods for its elimination (specific exercises), which traditionally raises many questions for speech therapists.
One of the most common and severe consequences of a stroke is a violation of speech function, manifested in the form of aphasia and dysarthria, which are often combined with pathology of other higher mental functions, right/left side hemiparesis and mental disorders. The latter are either directly related to focal or cerebral pathology, or are a reaction to a defect. Upon recovery from the acute condition, the patient begins to evaluate his situation: the impossibility of verbal communication, social and everyday incompetence, limitation of independent movements, disbelief in the possibility of returning to work. All this leads to depression, severe neurotic disorders, including suicidal thoughts, as well as a number of other mental disorders.
One of the most common and severe speech disorders resulting from local brain damage (stroke, trauma, tumors) along with aphasia is dysarthria.
Dysarthria is a speech defect manifested in articulation disorder caused by paralysis or paresis of the speech muscles.
In severe cases, speech turns into a kind of mooing and becomes completely incomprehensible. In addition, speech breathing and voice formation are impaired, that is, speech prosody changes, and swallowing is also often impaired, up to the complete inability to eat per os.
Dysarthric speech disorders are observed in the most diverse focal brain lesions in terms of topic - the cortex of the left and right hemispheres, pathways, subcortical structures, diencephalic region, quadrigeminal region, pons, medulla oblongata.
From a neurological point of view, the following main types of dysarthria are distinguished:
There is much in common between the listed species, but deep differences are also revealed. All this is taken into account in correctional work.
The generic commonality of all these forms of dysarthria in adult patients, i.e. in persons with established speech, is emphasized by the following points:
- Focal lesions of the motor parts of the central or peripheral nervous system;
- Disorder of the pronunciation side of oral speech with a full system of phonemes, a complete dictionary and intact grammatical structure.
- Preservation of understanding the speech of others, reading to oneself, processes of internal speech and thinking.
In the process of rehabilitation treatment of patients after a stroke, three levels of rehabilitation are distinguished.
Level 1 – true restoration of impaired body functions, which are completely restored or approach the original state.
Level 2 – compensation based on the functional transformation of intact brain systems and preventing the development of pathological conditions. At this level, a new organization of function appears.
Level 3 – readaptation – that is, adaptation to the defect. This is necessary in cases of severe brain damage.
The first two levels of rehabilitation treatment are considered within the framework of medical rehabilitation, and the last - within the framework of social rehabilitation.
This work is devoted to the correction of violations. occurring with pseudobulbar dysarthria in patients suffering from acute cerebrovascular accident.
Pseudobulbar dysarthria is caused by central spastic paralysis/paresis of the speech muscles innervated by the corticonuclear pathways. Its main manifestation is muscle hypertonicity.
Pseudobulbar palsies are usually the result of bilateral damage to the corticonuclear pathways. The only exceptions are the muscles of the lower part of the face and tongue. Their innervation is predominantly unilateral.
Spastic paralysis of the speech organs is most clearly manifested in the movements of the tongue, its trophism changes - the tongue is thick, swollen, pulled back, its back is curved. This interferes with normal breathing. The range of motion is significantly reduced. The forward movement of the tongue is impaired, while the tongue falls onto the lower lip, bending its entire mass towards the chin. And the more the patient tries to move the tongue forward, the more it goes down. However, the upper rise of the protruding tongue and the bending of its tip towards the nose are impaired to an even greater extent than the forward movement of the tongue. The patient tries to achieve the desired effect by passively lifting the tongue with the lower lip and lower jaw - synkinesis occurs. Lateral movements of the tongue are also characterized by small amplitude, while it is not the tip that moves, but the entire mass of the tongue. The pharyngeal reflex is increased. The velum does not have time to close the passage to the nose, and an open nasal sound occurs. The properties of the resonators change, exacerbating the nasal tone of the voice. Spastically tense vocal folds make the voice hoarse and tense. Paretic respiratory muscles do not provide adequate breathing - it becomes short, impulsive, noisy.
With pseudobulbar palsy, voluntary movements are selectively impaired, while involuntary movements are carried out much better. This dissociation in the work of muscles expressing emotional states of joy, sadness, surprise leads to manifestations of violent laughter or crying, which further affects the psychological and mental state of the patient.
Thus, clinical manifestations are characterized by hypertrophy, hyperreflexia and hypertension. The acts of chewing and swallowing are also impaired. Hypersalivation is observed. The timbre of speech is nasal, especially for back vowels and hard consonants with a complex articulation pattern p, l, sh, zh, ch, ts. Stop consonants and vibrant r are replaced by fricatives. Frictional consonants turn into flat fricatives. The articulation of hard consonants is more impaired than soft ones. The sound l is characterized by a softening, as the active downward deflection of the back of the tongue disappears.
The patient hears his pronunciation defects and actively tries to overcome them. However, his efforts lead to an increase in hypertonicity in paralyzed muscle groups and, consequently, to an increase in pathological features of articulation. With central paralysis of the vagus, glossopharyngeal and hypoglossal nerves, the resonator properties of the pharynx and oral cavity change. The vocal folds are tense and produce additional friction noises. The voice turns out weak, hoarse and hoarse. And due to excessive tension of the pharyngeal constrictors, palatine arches and soft palate, a nasal, nasal tone of the voice arises.
Corrective work for pseudobulbar dysarthria includes:
- massage of facial muscles
- articulation organs massage
- articulatory gymnastics
- normalization of speech breathing and voice
- correcting the pronunciation of speech sounds
- work on expressiveness of speech
I would like to dwell on the most important issues of establishing contact with the patient, on the psychological side of conducting classes. As experience shows, these moments are sometimes decisive for the entire further course of work.
The task of the first stage is to establish contact with the patient, gain his sympathy and trust. The patient must feel that you treat him with respect, do not consider him a dumb disabled person, but a person who, due to illness, temporarily finds it difficult or impossible to communicate with speech. In addition, the patient’s picture of a speech disorder may change from day to day, since immediately after a stroke a number of disorders occur due to inhibition, and the true picture of a speech disorder is often discovered at later stages.
The speech therapist needs to get acquainted with the medical history in detail, talk with the attending physician and the patient’s relatives. Find out, as the patient said before the stroke, the distinctive features of his character (hot-tempered, calm, stubborn, self-doubting, etc.). Delicately clarify the issue of intra-family relationships, whether there are points that should not be touched upon, names that should not be mentioned in front of him and events that it is better not to mention in front of the patient. Which of the relatives is the patient especially attached to and what does he value? Find out what the patient’s education is, his specialty, intellectual level and interests. Knowledge of all these conditions is extremely important for successful correctional work.
When approaching a patient’s bed for the first time, the speech therapist should smile, looking friendly into the patient’s eyes. You should say hello, looking into the patient’s eyes, calling him by his first name and patronymic. You need to speak in a quiet, calm voice. Post-stroke patients in the acute period can react differently to questions asked: some by nodding their heads, others by opening their eyes, others by turning away and pursing their lips tightly. Some accompany these gestures with vocal production, others with unarticulated mooing, and still others remain silent...
The most difficult thing is when the patient compresses his lips tightly and looks motionlessly at the speaker. The reason for this may be severe speech impairment, general cerebral weakness, or a depressive state. It is always advisable to approach the patient 2-3 times a day in order to catch changes in mood and condition, as well as the moment of impulse to speak.
Significant difficulties also arise when the patient, when asked to say something, stubbornly remains silent and points his finger at his tongue, making it clear that he cannot say anything. This gesture indicates repeated attempts to pronounce something on your own. The patient despaired and believed in the impossibility of verbal communication. In this case, the primary task of the speech therapist is to prove to the patient the illegality of such a decision, using methods of psychotherapeutic influence and speech therapy techniques.
All corrective work begins with speech therapy massage of the face, collar area and articulatory apparatus. If the patient moves independently, the massage takes place in the speech therapy room on a couch. If the patient has severe movement disorders, then in the ward on the bed. In this case, it is most convenient to stand behind the head of the bed.
The massage is carried out with clean, warm hands wearing medical gloves using baby oil or neutral baby powder for better glide. Duration of minutes, cycle of procedures (depending on the time the patient was in the hospital).
Basic massage techniques used:
- Stroking (longitudinal, transverse, zigzag, circular, spiral).
- Trituration.
- Kneading.
- Vibration.
All movements should be light, relaxing, aimed at relieving muscle spasms and relaxation. It is necessary to ensure that the patient lies in a comfortable position; a small pillow or a towel cushion should be placed under the neck and knees. You can sit the patient on a chair or armchair, but, as practice shows, when lying down it is much easier to achieve muscle relaxation, and the effectiveness of the massage increases.
Quiet, calm music and dim lights in the room during the massage have a good sedative effect.
When performing a massage, muscle tone is normalized (in the case of pseudobulbar dysarthria, it decreases); muscle contractile function improves; by improving blood circulation, metabolic processes in the affected muscles are activated; kinesthetic sensations are revived; there is a decrease in pathological motor manifestations – synkinesis; voluntary coordinated movements of the organs of articulation are gradually formed.
The massage should begin with light stroking in the area of the shoulder girdle and neck. Gradually they move to the area of the sublingual muscles, masticatory, articulatory and facial muscles. The procedure ends with a relaxing massage of the tongue and soft palate.
Lines along which segmental reflex speech therapy massage is performed.
Upper shoulder girdle.
The direction of movement is arbitrary from one shoulder joint to another, the shoulder joint itself must be massaged. Movements from the spine to the sides are possible. The massage always ends with movements from top to bottom in accordance with venous and lymphatic outflow.
The front surface from bottom to top to the chin.
Lateral surfaces - from the ears down.
The back surface is from bottom to top to the scalp.
From the middle of the forehead to the temples.
From the middle of the forehead to the ears.
From the lateral ends of the eyebrows to the scalp.
From the medial ends of the eyebrows through the eye sockets to the inner corners of the eyes.
From the back of the nose to the ears.
From the middle of the upper lip to the ears.
From the middle of the upper lip to the chin.
Along the nasolabial folds to the corners of the mouth.
From the middle of the chin to the ears.
The direction of movement is from root to tip and from center to edges. Special probes, wooden spatulas, a toothbrush, and fingers are used. Rolling a finger over the tongue, pinching, stretching and kneading the edges of the tongue are used. Hands of a speech therapist in sterile surgical gloves. The effect on the lower part of the tongue is very effective for hypersalivation.
For swallowing disorders, an excellent effect is observed when massaging the arches and soft palate. Movements from top to bottom, light and neat.
To reduce muscle spasticity and hypersalivation, I use local contrast therapy. This is the effect of low and high temperature agents. Cold water, pieces of ice, and crushed ice act as low-temperature agents. High temperature - hot water, heated spoon, thermal massagers. In clinical practice, this method has shown to be highly effective. The influences alternate.
Cryomassage - pieces of ice or crushed ice in sterile gauze are applied to the orbicularis oris muscle, zygomaticus major muscle, to the root, back and lateral surfaces of the tongue. Single exposure time is 5-15 seconds. If there is a contrast effect, the patient is then asked to rinse his mouth with a warm infusion of herbs (chamomile, calendula, sage, yarrow). Alternate 3-5 times.
When applying cryo treatment to the soft palate, it is convenient to freeze the herbal infusion with a wooden stick, like a popsicle. With cryomassage, after the initial spasm, small vessels dilate, blood flow increases, and the trophism of the affected muscles improves. Patients react very positively to such influences, and relatives willingly take part in rehabilitation - brewing herbs and freezing ice.
One of the most severe manifestations of dysarthria is impaired swallowing - dysphagia. In the acute period of ischemic stroke, dysphagia causes dehydration, nutritional disorders, weight loss, as well as a life-threatening complication - aspiration pneumonia.
In patients with hemispheric unilateral strokes, dysphagia is usually favorable and complete regression of symptoms is often observed. With lesions in the vertebrobasilar region, the manifestations of dysphagia are much more pronounced and less amenable to correction.
Symptoms that alert specialists to a possible swallowing disorder:
- poor oral hygiene
- hypersalivation, inability to swallow saliva
- sluggish, difficult chewing
- food falling out of the mouth while eating
- increasing the duration of meals
- decreased appetite or refusal to eat
- patient avoidance of certain foods
- the appearance of a cough before, during or after a swallow
- anxiety before eating
- labored breathing
In the department, most patients are screened to determine the possibility of oral feeding:
- test for smile asymmetry (weakness of facial muscles)
- tongue muscle strength test (the patient is asked to press his tongue on his cheek, stick out his tongue and move it in different directions)
- test for food falling out of the mouth during chewing or swallowing (insufficient lip closure and incorrect tongue movement)
- test for a positive “hamster” symptom (depositing some of the food between the lower lip and gums, behind the cheeks - weakness of the tongue muscles)
It is necessary to mention that the absence of cough when swallowing is not always favorable. A reflex cough that occurs when swallowing is a protective reaction and protects the airways from aspiration. When the sensitive part of the vagus nerve is damaged, the cough reflex is suppressed when food enters the trachea. In this case, at first glance, it appears that the patient's swallowing function is not impaired, however, in reality, the patient is constantly aspirating food. To identify this condition, it is possible to conduct a test for hidden aspiration - the patient is asked to say “ah”, the sounds of gurgling or wheezing that appear indicate the presence of aspiration. It is clear that in this case oral feeding is stopped.
As my many years of practice have shown, cryomassage and local contrast thermal therapy of the free edge of the soft palate, arches, and tongue are very effective in restoring swallowing. It is advisable to do this even if the patient is receiving nutrition through a nasogastric tube. In parallel with these manipulations, swallowing drops of water and an empty sip are used.
In addition, during classes I always use acupressure. With increased tone, a sedative massage technique is used - place a finger on the projection of the points and rotate clockwise for 5-6 seconds, then fix it for 2 seconds and “unscrew” the finger counterclockwise, reducing the pressure force. Within 1 minute, 4 entries and exits are made.
I use the following points:
- Lao Gong - in the center of the palm between the 3rd and 4th metacarpal bones.
- He-gu - on the back of the hand between the 1st and 2nd metacarpal bones.
- Hou-si - in the depression posterior to the 5th metacarpophalangeal joint on the ulnar side of the hand.
- Le Que - on the radial side of the forearm, just above the styloid process of the radius.
- Tian-tu - approximately 0.5 cm above the middle of the upper edge of the jugular notch Cheng-jiang - in the center of the chin-labial fold.
- Di-he - in the middle of the most protruding part of the chin.
- Shang Lian Quan - on the midline of the neck, one transverse finger above the Lian Quan point with the head thrown back.
- Yin-tang above the bridge of the nose in the depression in the middle of the line connecting the ends of the eyebrows.
All of the above techniques are selected individually for each patient, taking into account the severity of speech disorders, general somatic condition, period of stroke, emotional background and constitutional features.
In the first sessions, no more than 3 points are massaged. The number of acupressure sessions ranges from 7-10, depending on the severity of the speech pathology. I teach all cognitively intact patients and their relatives self-massage of active points. This gives excellent results.
Around the 5th-6th lesson, breathing exercises are added. The goal is to develop diaphragmatic breathing in the patient. The patient lies on the couch, or he lies in the ward on his bed. To control, the palm of the non-paralyzed hand is placed on the stomach. The following instructions are given: “inflate your stomach - inhale, hold your breath, deflate your stomach - exhale.”
To differentiate inhalation/exhalation, the following exercises are done:
- inhale through the nose - pause - exhale through the nose;
- inhale through the nose - pause - exhale through the mouth;
- inhale through the mouth – pause – exhale through the mouth.
A pause after inhaling is mandatory. When exhaling through your mouth, you need to make sure that the stream of exhaled air is cold. You can give the patient instructions to blow on the lips. For control at first, you can exhale onto the back of the hand.
Articulation gymnastics is also a mandatory component of the correction. The difficulty is that any exercise leads to an increase in muscle tone, and for patients with pseudobulbar palsy this is one of the main pathological symptoms. Therefore, a modification of the method of presenting the exercise is used - the articulatory pose is repeated many times with the goal of ease of movement. Pauses between exercises lead to a reflexive release of tension.
It is also necessary to take into account the severity of the general somatic condition of patients, because we are talking about people in the first days after a stroke. For them, articulatory and facial gymnastics is a significant burden. Therefore, the number of exercises is limited.
I use the following articulation exercises:
- puff out your cheeks, hold the air, suck in your cheeks, fix the pose.
- roll the “balloon” from one cheek to the other.
- bare your teeth, silently pronounce I.
- stretch out your lips with a tube, silently pronounce U.
- alternate I and U.
- imitate gagging movements.
- draw out the sounds A E Y (in case of dysphagia, we ask the patient to strain the lower jaw).
- abruptly pronounce the sound A as you exhale.
- cough randomly.
- imitate gargling (without water).
- relax your tongue, bite it, moving it back and forth.
- lift the tongue over the upper teeth, touching the alveoli.
- lower the tongue behind the lower teeth, rest against the alveoli.
- rest your tongue on your cheeks one at a time.
- pull your tongue towards your nose and chin. Alternate.
- lick your lips with your tongue in a circle in different directions. To revive kinesthetic sensations and simply to make it easier to perform this exercise at first, the patient’s lips are smeared with yogurt, jam and similar substances.
- make “faces”, that is, arbitrarily give the face different expressions, emotionally charged.
I will separately dwell on exercises that allow you to develop a long, directed air stream. There are quite a few such exercises, it is advisable to alternate them and select the most suitable ones for a given patient.
- blowing on a cotton ball. You need to make sure that your cheeks do not puff up; you can press them lightly with your palms; the stream of exhaled air should be uniform, that is, blow on the ball in one exhalation.
- blowing onto a napkin or strip of paper - this can be done even if the patient is lying in bed. Hold a napkin in front of your face, which deflects when an air stream hits it.
- blowing through a straw into water in a glass. The task can be set differently - either to blow evenly, or with varying strength. The bubbling of water in a glass clearly shows this. In this exercise, you also need to watch your cheeks so that they do not puff up and keep your lips immobile.
- blowing on the flame of a candle or lighter. We ask the patient to either quickly blow out the candle or to blow smoothly and evenly so that the flame is deflected. As in the case of bubbling water in a glass, this is a very visual exercise, that is, the visual analyzer is also involved.
- blowing on a small piece of paper: the exercise is done with patients who walk independently - the patient approaches the wall, holds a small piece of paper at mouth level with his finger and starts blowing on it. The finger should be released, and the piece of paper should be fixed to the wall with an air stream. The exercise is quite complex, so it is not offered to patients in the first days. Again, watch your cheeks so that the exhalation is intense, but calm, and the air stream is directed.
All exercises are performed slowly. Easy, each 5-7 times. The whole complex 3-4 times a day.
The patient’s relatives (if any) should be trained to perform facial exercises, and the existing problems with swallowing, feeding methods, types of food, and the importance of rehabilitation measures should be clearly explained. I teach caregivers to hygienically treat the patient’s oral cavity - with special cotton swabs, a soft toothbrush or just gauze wrapped on a finger to clean the oral cavity from food debris, to use antiseptic sprays such as Hexoral, Tantum Verde. This is very important for the patient when relatives begin to actively participate in recovery, and not just sit next to them and stuff the unfortunate patient with high-calorie and often simply dangerous food - crackers, chips, cookies, nuts, red caviar, herring, smoked sausage, carbonated water , sweets and so on.
We focus on the need to place food on the healthy side of the patient, sanitation of the oral cavity, and the use of dentures, glasses, and hearing aids.
I make sure to give relatives the following memo. We look through it together, discuss everything that is unclear. By doing this, we benefit the patient and also save ourselves from continuous, same-type questions from relatives.
Eat only while sitting. If it is impossible to sit, use the head end of the bed raised.
After eating, do not lie down for 30 minutes.
Chew food thoroughly, the amount is no more than a teaspoon.
The consistency of the food should be puree. Food should be warm or at room temperature. Porridges, jellies, mousses, meat and fish in the form of steam cutlets or casseroles are allowed. Mashed boiled or stewed vegetables. Omelet, soft-boiled egg. Grated apple. Cottage cheese, kefir, yogurt, low-fat sour cream. Still mineral water, fruit drinks, unsweetened compotes. The amount of liquid for swallowing at once is no more than a teaspoon. The liquid needs to be “chewed”, “rolled” around the mouth and only then attempted to swallow.
When swallowing, the chin should be pressed to the chest. You can tilt your head slightly to the right or left in order to find a position in which swallowing occurs better. It’s good to stroke your throat with your hand from top to bottom while you sip.
Prohibited: bread, pies, cookies, dried goods, crackers, seeds, nuts, meat in pieces, fruits with fiber (citrus fruits), carbonated drinks, intensely sweet and intensely sour dishes, spices, fresh and salted vegetables.
Exercises for the muscles of the pharynx and soft palate.
- imitate gargling with your head thrown back (without water).
- cough randomly.
- puff out your cheeks while pinching your nose.
- yawn with your mouth closed and open.
- swallow small portions of water - 3 drops from a pipette onto the tongue.
- imitate gagging movements.
- spread your tongue with your mouth wide open - the “show your throat to the doctor” position.
- draw out the sounds A E I, while straining the lower jaw.
- abruptly, while exhaling, pronounce the sound A.
- pull out the Y sound, pushing the lower jaw forward.
Exercises should be done at least 3 times a day. Repeat each up to 5 times.
Remember that recovery is a long process, all improvements occur slowly and gradually. We need to be patient.
Good luck and stay healthy!
When training the voice, exercises recommended for overcoming dysphonia are used. All vowels are practiced one by one, starting with A and E. Emphasis is placed on turning on the lower thoraco-dorsal resonator in order to get rid of the nasal tone of the voice. The patient is patted on the back and chest to relax the muscles, we try to make him feel vibration in the chest.
And only now, after at least a few days, purely speech exercises are used to correct sound pronunciation. Moreover, massage, gymnastics, and vocal exercises continue. Thus, elimination of the defect occurs according to the etiopathogenetic principle.
In addition, in any lesson it is good to include various exercises aimed at training attention, memory, logical thinking and other higher mental functions. Patients really like this and create a positive emotional mood.
A few words about the form of classes. A lesson conducted as a conversation in a friendly, relaxed atmosphere relaxes the patient and allows the speech therapist to maneuver various methodological techniques that lead the patient to complete the task. You should speak to the patient without using a simplified vocabulary, as if he were healthy.
The duration of the lesson varies from minutes to minutes. A full-length lesson is possible with relatively somatically intact patients who are sufficiently motivated to correct existing speech defects and who consciously follow all the specialist’s recommendations and tasks. In the case of patients who are not sufficiently critical, as well as patients in serious condition, short, but repeated sessions throughout the day are advisable.
Concluding the presentation of the question about the peculiarities of speech restoration in patients with pseudobulbar dysarthria during the acute period of a stroke, I would like to emphasize the importance of working on positive emotions, respect for the patient’s personality, and creating conditions under which the relationship between the patient and the speech therapist is built on deep trust of the patient and never the weakening desire of the speech therapist to help the patient not only in restoring speech, but also in maintaining his place in the family and in society.
2.2. Exercises for teaching the pronunciation aspect of speech
The formation of stable auditory-pronunciation and rhythmic-intonation skills is a long process, so work on pronunciation should take place at all levels of education.
Exercises aimed at developing auditory and pronunciation skills are usually divided into two large groups:
1. Listening exercises.
2. Exercises in reproduction.
These two groups are closely related to each other, and they are both necessary for the development of both auditory and pronunciation skills.
Listening exercises. The number of types of actual phonetic exercises in listening is relatively small, and all of them are aimed primarily at developing phonetic hearing and establishing differentiated characteristics of studied or repeated phonemes and intonemes.
Listening must be active, therefore it should always be accompanied by a task that concentrates the student’s voluntary attention on a specific characteristic of a phoneme or intoneme.
Exercises can be performed by ear and using a graphic support.
As an example of the first exercises, the following tasks can be given:
Listen to a series of sounds/words, raise your hand when you hear the sound [...]; listen to pairs of sounds and raise your hand when both sounds of the pair are the same; listen to the sentence and say how many times the sound [...] occurs in it.
Playback exercises. The effectiveness of this group of exercises aimed at developing students’ own pronunciation skills increases significantly if the reproduction is preceded by listening to a sample, regardless of whether new material is being trained or previously learned material is being repeated.
The material for these exercises are individual sounds, syllables, words, phrases, and sentences. They can be organized:
Based on the principle of analogy (all examples contain the same feature).
According to the principle of opposition (examples are selected in such a way that they contrast some feature).
Or they are given in any order.
In the first two cases, the exercises perform a training function, and in the last - mainly a control one.
Examples of tasks performed by ear:
Pronounce sounds/syllables/words/phrases/sentences, paying attention to (sign indicated) after the teacher;
remember words containing the sound [...]; repeat the sentence, adding the word suggested by the teacher to it.
In addition to special exercises for substituting, maintaining and improving students’ pronunciation, memorizing tongue twisters, rhymes, poems, dialogues, passages of prose and reading aloud passages of texts studied from a textbook are widely used. These types of work pursue two goals: to achieve, firstly, maximum correctness of pronunciation and, secondly, its fluency.
Accordingly, two stages of work are distinguished.
At the first stage, the text is memorized under the guidance of the teacher, as a result, students receive a grade for correct reading. Only after this does the second stage of work begin, aimed at speeding up the reading of a poem/dialogue/excerpt from a text that has already been learned: the student is required not only to pronounce correctly, but also fluently.
The exercises listed above and similar ones are used at all levels of education, although their purpose is somewhat different: at the initial stage, their goal is to develop auditory and pronunciation skills; at the middle and senior levels they are aimed at preventing mistakes. Therefore, they should be performed when mastering new language material, before appropriate exercises in oral speech and before reading texts.
For the same purposes, at the beginning of each lesson, it is recommended to carry out so-called phonetic exercises, in which the teacher includes the most phonetically difficult material from the upcoming lesson: one or another rhythmic-intonation model, a group of sounds, etc. The exercise can include 1-2 tasks of the above types, which are performed by the student and the choir, and in turn.
Exercises aimed at developing rhythmic and intonation skills in various types of sentences: interrogative, imperative, complex and complex sentences
When assessing the correctness of a student’s speech, one should distinguish between phonetic and phonological errors. The former distort the sound quality, but do not violate the meaning of the statement; the latter distort the content of the statement and thereby make the speech incomprehensible to the interlocutor. In accordance with the accepted approximation, the presence of errors of the first type is allowed in the student’s speech and is not taken into account when assessing the answer, while phonological errors are regarded as a violation of the correctness of speech.
I.L. Beam says that it is possible to distinguish phonetic exercises by levels of material organization; namely:
1. Exercises at the level of individual sounds.
Task: practicing the pronunciation of isolated sounds, for example, in exercises like Hört zu und sprecht nach. Beachtet...(indicates what to pay attention to): a, e, i, o, u - aus bist du!
2. Exercises at the level of sound combinations.
Task: to prevent “palatalization, etc. The task can be formulated in the same way as in 1:
Didi-dada-dede-dudu; didl-dadl-dumm-dumm; li-li, le-le, la-la, lo-lo, lu-lu, etc.
3. Exercises at the word level.
Task: to practice the development of phonemic awareness, for example: Hort zu und sprecht nur die Worter mit nach:
Liegen - legen; Lies - lesen; sehen - sieht; ihr-er, etc.
This includes exercises on stress in simple, derivative and complex words.
4. Exercises at the level of phrases. Task: to practice a hard attack. Task as in 1:
Ich auch; aus bist du; ich heiβe; auch du; das ist, etc. Of particular importance is working on the intonation design of the phrase, for example:
Hört zu und sprecht nach. Macht keine Pausen in der Mitte: In der Schule; in der Classe; auf dem Tisch, etc.
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