home For men Neurological foundations of speech. neurological bases of pathology of speech, hearing and vision

Neurological foundations of speech. neurological bases of pathology of speech, hearing and vision

In children under 10 years of age, after damage to speech centers, speech restoration is possible (after about 1 year) due to the movement of speech centers to the right hemisphere.
In the structure of speech, two processes interact: the pronunciation of words and the perception of speech. Violation of the process of pronouncing words - motor, or expressive, aphasia. Impaired speech perception - impressive aphasia. There are also amnestic A.

Expressive (motor) aphasia

Expressive (motor) aphasia characterized by partial or complete loss of the ability to speak while maintaining understanding of someone else's speech. The degree of motor A. varies: sometimes patients cannot say even one word, cannot repeat words or read aloud, while maintaining the ability to hear and understand someone else’s speech, read to themselves and understand what is written. Sometimes, when trying to speak, patients may repeat the same word, or part of a word, or a short phrase over and over again; such involuntary repetitions are called “speech emboli” or “word emboli”). In other cases, patients can speak with a small number of words, monosyllabic, making mistakes, with frequent perseverations (obsessive repetition of an already spoken phrase or word, often the last syllables). The following variants of motor aphasia are distinguished.

Afferent motor A.- the patient’s inability to find the correct position of the lips and tongue necessary to pronounce the appropriate speech sounds. In this case, articulation and modulation - oral praxis - are disrupted. It manifests itself as sluggishness, slowness of speech, literal or verbal paraphasia (replacement of letters in words or words in phrases). All types of oral speech are impaired: automated, spontaneous, ability to repeat, naming. At the same time, the ability to write and read is preserved. Often combined with oral apraxia.
It is observed with damage to the lower parts of the postcentral gyrus of the left hemisphere in a right-handed person.

Efferent motor A. (Broca's syndrome)- verbal amnesia (forgetting words), distortion of someone else’s speech when repeated, as well as complex phrases, reading and writing. Oral speech is impaired: spontaneous, automated, repeated, naming. A “telegraphic style” of speech is possible: it consists mainly of nouns, few verbs. There are “speech emboli” in speech. The ability to speak freely is lost, but the ability to copy someone else's writing is retained. In this case, the patient pronounces individual sounds well, but cannot pronounce phrases. Speech loses fluency, the patient tends to repeat what has already been said several times (perseveration). The patient finds it difficult to switch from one sound form to another. This circumstance is reflected in the performance of graphics tests.

Repeated speech is not changed as grossly as with afferent motor A.
It is observed when there is damage in the lower parts of the premotor zone (Broca's center, areas 44 and 45 according to Brodmann). The premotor zone is the posterior part of the inferior frontal gyrus.

Dynamic motor A.- the patient pronounces all sounds well, but cannot actively express a thought or ask a question, although he answers the questions asked correctly and articulates all the sounds well. In this case, productive, active speech is impaired. Reproductive speech (the ability to repeat) and automated speech are preserved. Dynamic motor speech is based on a violation of internal speech (programming and structuring of sentences). It is observed with damage to the prefrontal cortex, located anterior to Broca's area.

Impressive aphasia

Impressive speech disorders are manifested by a loss of understanding of the meaning of someone else’s and one’s own speech and are observed in 2 main forms:

sensory aphasia;
semantic aphasia.

Touch A. - loss of the ability to understand someone else's speech. Their own speech is not impaired - patients are verbose, but due to the loss of the ability to understand and control their own speech, it is incoherent, incorrect, incomprehensible, reminiscent of a “word salad” (“verbal okroshka”). Sensory A. occurs when Wernicke's area is damaged (field 22). It is based on phonemic hearing impairment.
Phoneme is a semantically distinctive feature of a language (voiced and deaf, stressed and unstressed, hard and soft sounds). The patient cannot repeat syllables such as “da-ta”, “sa-za”, cannot count the number of sounds in a word, and does not perceive the difference between close phonemes (Gusev E.I., Konovalov A.N., 2001).
The phenomenon of alienation of the meaning of words is possible: the patient is asked to show one object, for example, an eye. Then it is proposed to show two objects, for example, a mouth - an ear. The task cannot be completed, although individual items can be shown correctly.

The writing function is also upset, especially when writing words with alternating voiced and voiceless consonants: errors concern the spelling of “s” instead of “z”, “b” instead of “p” (in the words “constipation”, “fence”, “cathedral”).
Semantic A. develops when the junction of the temporal, parietal and occipital lobes is damaged (Brodmann's areas 39 and 40). In semantic arithmetic, speech formulations that reflect spatiotemporal relationships are not understood. For example, the patient cannot draw a circle above a square, a triangle under a circle, etc.); does not understand the meaning of prepositions and different interpretations(for example, he does not understand the difference between his brother’s father and his father’s brother). Complex logical and grammatical structures are not understood, the task of showing a pen with a pencil and a pencil with a pen is not completed.

Amnestic aphasia

Amnestic A. occurs when the lower and posterior parts of the parietal and temporal regions are affected (fields 37 and 40). In this case, the patient cannot name familiar objects or their images, but he knows and can describe their purpose and use. For example, about a writing pen, the patient will say: “This is what you write with.” The patient's speech contains few nouns and many verbs (to describe the purpose of objects).

Speech disorders in children. Aphasia, alalia, tongue-tied

A. is rare in children. It is possible due to diseases or injuries of the brain after children have already begun to speak. Violation of speech zones in the pre-speech period causes alalia.

Alalia options are distinguished:

motor alalia: with it, the child understands spoken speech, but does not speak.
sensory alalia: with it, the understanding of spoken speech is impaired, but elementary hearing is preserved.

There is also dyslalia - partial underdevelopment of speech.
The most common distortion observed in the pronunciation of various sounds is tongue-tiedness. It means the inability to pronounce or form certain sounds and sound combinations. They are mispronounced, missed, or overlapped. In children under 4 years of age, tongue-tiedness can be physiological. Later this phenomenon is regarded as dyslalia.

Highlight the following types tongue-tied:

isolated: incorrect pronunciation of only individual consonant sounds - more often the sounds “r” (rotacism), “l” (lambdaciism), “g” (gammacism);
plural: incorrect pronunciation of many consonant sounds - lisp: incorrect pronunciation of hissing sounds (sigmatism); nasality: speech impairment due to narrowing of the nasal cavity and nasopharynx (reminiscent of speech with a chronic runny nose. It can be congenital and acquired.
Hottentotism: speech cannot be understood (the most severe form of tongue-tiedness).

Dysarthria, mutism

Among non-aphasic speech disorders, dysarthria and mutism are considered.

Dysarthria (D.)- the result of denervation of the muscles involved in speech movements (respiratory muscles, muscles of the vocal cords, larynx, palate, tongue and lips).
D. is distinguished: bulbar (with damage to the nuclei or roots of the 9th, 10th and 12th cranial nerves); pseudobulbar; extrapyramidal; cerebellar
D. usually manifests itself as unclear, “smeared” speech and may be accompanied by a nasal tone of voice in the case of boulevard or pseudobulbar disorders. The grammatical structure does not suffer. To a certain extent, speech during alcohol intoxication can serve as an idea of D.
D. may occur acutely in the event of a stroke or transient cerebrovascular accident, causing, for example, hypoglossal nerve paresis or cerebellar dysfunction. It is necessary to remember about the possibility of developing rapidly progressing D. in myasthenia gravis with tabloid disorders. With severe damage, speech in D. turns into inarticulate “mooing” or is impossible (anarthria).

Mutism (M.)(muteness) occurs in 2 variants: hysterical M. (conversion disorder) and akinetic M.

Hysterical muteness is, in accordance with ICD-10, a conversion disorder and belongs to dissociative disorders. Having a functional nature, hysterical M. usually develops after or against the background of experiences of a negative nature, after conflicts. stressful situations(“numb with grief”, “numb with fright”, “numb with amazement”, “numb with impudence”, etc.). There are no attempts to pronounce words or they end in attacks of spasm of the vocal muscles.

Akinetic M. observed in cases of severe impairment of brain functions and consists of the absence of motor activity and speech while the consciousness of the patient is preserved, who is motionless, but can fix his gaze and, as it were, “follows with his eyes what is happening.” Often, akinetic M. is a stage of recovery after a coma.

Speech, voice and hearing are functions of the human body that are of great importance not only for human communication, but also for the cultural and intellectual development of all humanity. The development of speech is closely related to higher nervous activity. Speech is a relatively young function of the cerebral cortex, which arose during human development as a significant addition to the mechanism of nervous activity of animals. I.P. Pavlov wrote: “In the developing animal organism during the human phase, an extraordinary increase in the mechanisms of nervous activity occurred.

For an animal, reality is represented exclusively by irritations and their traces in the cerebral hemispheres in special cells of the visual, auditory and other centers. This is what appears to a person as impressions, sensations and ideas from the surrounding external environment.

This is the first signaling system of reality that we have in common with animals.

But the word constituted a second, special system of reality, being a signal of the first signals.

It was the word that made us human, but there is no doubt that the basic laws established in the work of the first signaling system should also operate in the second, because this is the work of the same nervous tissue...”

The activities of the first and second signaling systems are inextricably linked; both systems are constantly in interaction. The activity of the first signaling system is a complicated work of the sense organs. The first signaling system is the carrier of figurative, objective, concrete and emotional thinking, works under the influence of direct (non-verbal) influences from the external world and the internal environment of the body. A person has a second signaling system, which has the ability to create conditioned connections to the signals of the first system and form the most complex relationships between the body and the environment. The main specific and real impulse for the activity of the second signal system is the word. With the word, a new principle of nervous activity arises - abstract.

This ensures unlimited orientation of a person in the world around him and forms the most perfect mechanism of a rational being - knowledge in the form of universal human experience. Cortical connections formed through speech are a property of the higher nervous activity of “homo sapiens,” however, it obeys all the basic laws of behavior and is determined by the processes of excitation and inhibition in the cerebral cortex. So, speech is a conditioned reflex of a higher order. It develops as a second signaling system.

The emergence of speech is due to the process of development of the central nervous system, during which a center for the pronunciation of individual sounds, syllables and words is formed in the cerebral cortex - this is the motor center of speech - Broca's center.

Along with it, the ability to distinguish and perceive conditioned sound signals develops depending on their meaning and order - a gnostic speech function is formed - the sensory center of speech - Wernicke's center. Both centers are closely related in terms of development and function; they are located in the left hemisphere of right-handers and in the right hemisphere of left-handers. These cortical sections do not function in isolation, but are connected with other sections of the cortex, and thus the simultaneous function of the entire cerebral cortex occurs. This is the combined work of all analyzers (visual, auditory, etc.), as a result of which an analysis of the complex internal and external environment occurs and then a synthesis of the complex activities of the body. For the emergence of speech in a child (speech is an innate ability of a person), hearing is of primary importance, which during the period of speech development is formed under the influence of the sound system of the language. The connection between hearing and speech, however, does not exhaust the relationship between the first and second signal systems.

Hearing for articulate speech is only one part of the speech act. Another part of it is the pronunciation of sounds, or articulation of speech, which is constantly controlled by hearing. Speech is also a signal for communication with other people and for the speaker himself. During articulation (pronunciation), numerous subtle irritations arise, coming from the speech mechanism to the cerebral cortex, which become a system of signals for the speaker himself. These signals arrive in the cortex simultaneously with sound signals speech.

Thus, speech development is an extremely complex process determined by the influence of various factors. Numerous studies have shown that the speech function is formed in the following way: the results of the activity of all cortical analyzers involved in the formation of speech are transmitted along the pyramidal tracts to the nuclei of the cranial nerves of the brain stem of their own and, to a greater extent, the opposite side.

Nerve pathways depart from the nuclei of the cranial nerves and go to the peripheral speech apparatus (nasal cavity, lips, teeth, tongue, etc.), in the muscles of which the endings of the motor nerves are located.

As already noted, speech is not an innate human ability. The first vocal manifestation of a newborn is a cry.

This is an innate unconditioned reflex that occurs in the subcortical layer, in the lowest department of higher nervous activity. A cry occurs in response to external or internal irritation. Each newborn child is exposed to cooling - the action of air after birth, the temperature of which is lower than the temperature in the womb; in addition, after ligation of the umbilical cord, the flow of maternal blood stops and oxygen starvation occurs. All this contributes to reflexive inhalation as the first manifestation independent life and the first exhalation, at which the first cry arises.

Subsequently, the crying of newborns is caused by internal irritations: hunger, pain, itching, etc. At the 4-6th week of life, the vocal manifestations of infants reflect his sensations. The outward manifestation of calm is soft sound voices, with unpleasant sensations - the voice is sharp, during this period different consonant sounds begin to appear in the child’s voice - “humming”. This is how the child gradually acquires a motor prototype for further speech development. Each sound produced is transmitted by a wave of air to the hearing aid and from there to the cortical auditory analyzer. In this way, a natural connection between the motor analyzer and the auditory analyzer develops and consolidates. At the age of 5–6 months, the child’s stock of sounds is already very rich. The sounds can be cooing, smacking, vibrating, etc. The easiest sounds for a child to make are those made by the lips and the front part of the tongue (“mom”, “dad”, “baba”, “tata”), since the muscles of these parts are well developed thanks to sucking.

In the period between 6–8 months, conditioned reflexes and differentiation of the first signaling system are formed. There is a repetition of one syllable as a primitive speech manifestation. The child hears the formation of phonemes (certain sounds), and the sound stimulus reproduces the articulatory stereotype. In this way, a motor-acoustic and acoustic-motor connection is gradually developed, i.e., the child pronounces those phonemes (sounds) that he hears. Between 8–9 months, a period of reflexive repetition and imitation begins. The auditory analyzer takes on the leading role. By constant repetition of different syllables, the child develops a closed auditory-motor circle.

During this period, a mechanism for repeating complex sounds arises. The mother repeats the child's babble, and her voice falls into the child's well-established acoustic-motor circle. This is how the work between audible and one’s own speech is established. First, the child repeats syllables or monosyllabic words after the mother. This function simple repetition audible sounds is called physiological echolalia and is characteristic feature the first signal system (animals, such as parrots, starlings, and monkeys, can also repeat individual syllables and simple words). At approximately the same time as physiological echolalia (repetition, imitation), an understanding of the meaning of words begins to develop. The child perceives words and short phrases as a verbal image. The shade of the phrase spoken by parents plays an important role in understanding the meaning of words. During this period, the visual analyzer begins to play an increasingly important role in the formation of speech. As a result of the interaction of the auditory and visual analyzers, the child gradually develops complex analytical (acoustic-optical) processes.

Workshop

Topic: “The child’s speech is incomprehensible to others.” Correction.

Prepared by:

Teacher-speech therapist MBDOU No. 6

Shatskaya M.M.

Teacher-speech therapist MBDOU No. 28

Korsakova N.P.

Ust-Labinsk

2011

Topic: “The child’s speech is incomprehensible to others”

Seminar plan:

I. The connection between speech therapy and other sciences.

II. Neurological foundations of speech.

Symptoms of speech dysfunction.
Various types of speech disorders. Neuropathology.

III. Neuropathological examination of speech.

Brief methodology for clinical and psychological study of cortical speech disorders.
Examination of children whose speech is incomprehensible to others.

The connection between speech therapy and other sciences.

Speech therapy is closely related to many sciences. In order to successfully correct and prevent various speech disorders and to have a comprehensive impact on the individual, it is necessary to know the symptoms of speech disorders, their etiology, mechanisms, the relationship between speech and non-speech symptoms in the structure of speech disorders.

The theory of teaching and raising children with speech disorders is based on knowledge about the structure of the nervous system, its functions and developmental characteristics. The speech therapist must know the neurological basis of speech disorders, be oriented in issues of child psychopathology, have an understanding of the most common forms of mental disorders in children, the so-called borderline states, manifested in behavioral and emotional disorders, mental retardation and delays mental development. This knowledge will help him correctly determine the structure of a speech disorder, choose the most optimal methods of correction, training and education of the child, and prevent the abnormal development of his personality.

Communication with neuropathology, psychopathology, the clinic of mental retardation, pathology of the organs of hearing, speech and vision is necessary for the differential diagnosis of speech disorders. Thus, the diagnosis of speech disorders with hearing loss and sensory alalia requires a thorough examination of the state of auditory function; Diagnosis of speech disorders in mental retardation and alalia is impossible without determining the state of intelligence, characteristics of mental and sensorimotor development.

Data from medical sciences help the speech therapist to correctly approach the understanding of the etiology and mechanisms of speech disorders, and allow them to more correctly resolve issues of diagnosis and differentiated speech therapy in eliminating various forms of speech disorders. The correct placement of children in various types of special institutions depends on an accurate diagnosis.

Speech therapy is closely related to linguistic sciences and psycholinguistics. Speech involves the use of linguistic units of various levels and the rules of their functioning. They may be affected differently in different speech disorders. Knowledge of the laws and the sequence of a child’s assimilation of language norms helps to clarify the speech therapy conclusion and is necessary for the development of a system of speech therapy intervention. When studying and eliminating systemic speech disorders in modern speech therapy, psycholinguistic data are widely used, based on the teachings of L. S. Vygotsky, A. R. Luria, A. A. Leontyev about the complex structure of speech activity, about the operations of perception and generation of speech utterances, F .de Saussure.

^ Neurological foundations of speech.

The speech process is carried out in a complex system of unity of different levels of the nervous system (cortex, subcortical formations, pathways, cranial nerve nuclei) and organs of articulation. Speech develops as an independent functional system on the basis of conditioned reflex activity. For the development of a child’s speech, a certain level of maturation of cortical structures and environmental influences are required, namely optimal visual, auditory and tactile stimulation. It is very important that the stimuli arriving at the cerebral cortex coincide in time. Thanks to combinations of stimuli arriving at the cerebral cortex simultaneously, connections are formed between the lobes of the brain. (Slide 2) Based on these connections, the perception and reproduction of speech will subsequently develop. That is why the speech environment is so important for a small child. All movements of the articulatory organs, upper and lower extremities are recorded in the parietal lobe of the brain and are defined as learned movements - praxis. Internal connections are formed between the auditory and visual parts of the brain, which are the basis for the formation of a passive vocabulary - the verbalization of surrounding objects.

The frontal conus performs the most complex speech and mental functions. It builds on all parts of the cortex, unites them, receiving information from all its areas. The significance of the frontal cone is that, connecting with the speech sections of the cortex, it makes speech meaningful and thinking verbal and abstract. In this area of the cortex

A program of verbal expression (inner speech), a program of volitional activity, and behavior planning is created.

The speech act, like other manifestations of higher nervous activity, is reflexive in nature, in which many levels of the nervous system are involved.

Speech is a conditioned reflex of the highest order. It develops as a second signaling system. The emergence of speech is due to the process of development of the central nervous system, during which a center for the pronunciation of individual sounds, syllables and words is formed in the cerebral cortex - this is the motor center of speech - Broca's center. (slide 3)

Hearing for articulate speech is only one part of the speech act. Another part of it is the pronunciation of sounds, or articulation of speech, which is constantly controlled by hearing. Speech is also a signal for communication with other people and for the speaker himself. During articulation (pronunciation), numerous subtle irritations arise, coming from the speech mechanism to the cerebral cortex, which become a system of signals for the speaker himself. These signals enter the cortex simultaneously with the sound signals of speech.

Thus, the development of speech is an extremely complex process due to the influence of various factors. (slide4) Numerous studies have shown that the speech function is formed as follows: the results of the activity of all cortical analyzers taking part in the formation of speech are transmitted along the pyramidal tracts to the nuclei of the cranial cerebral nerves of the brain stem of its own and, to a greater extent, the opposite side.

Motor nerves carry impulses from the central nervous system to the muscles, causing the muscles to contract and also regulating their tone. In turn, motor irritations from the speech muscles go to the central nervous system through sensory fibers. The parietal lobe of the brain analyzes and records all irritations (kinesthesia) from the articulatory organs (automation of motor acts). The visual area (occipital lobe) provides the perception of visual stimuli. The connections between the visual and motor areas of the cortex are called optomotor, and between the auditory and motor areas - acoustic-motor. The pyramidal tract (the path of voluntary movements) begins from the motor area, located in the anterior central gyrus of the cerebral cortex. The pyramidal tract is conventionally divided into corticobulbar and corticospinal, ending in the nuclei of the cranial nerves and in the spinal cord. From the nuclei of the cranial nerves and the spinal cord, peripheral nerves extend to the muscles of the skeletal and articulatory muscles. The cerebral cortex is closely connected with the subcortical formations into a single functional system.

The impulse to speech comes from the cerebral cortex and is realized in the periphery. The organs of breathing, voice formation and articulation, which are closely related to each other, take part in its implementation.

The first point of application of the impulse, which is a signal to start speaking, is the respiratory system. Exhalation involves the diaphragm and intercostal muscles, which are regulated by an impulse that provides a smooth and prolonged exhalation necessary for pronouncing a word, a phrase, or an entire phrase. This area is called (N.I. Zhinkin) energy, since the force of the exhaled air stream provides voice formation. The second point of application of the nerve impulse is the vocal cords, on which the closure of the glottis, voice modulation, and the formation of subglottic pressure depend, which ensure the formation of the voice. The third point of application of the nerve impulse on the periphery is the oral cavity and the extension tube. In the oral cavity, thanks to the movement of the tongue, lips and soft palate, cracks and closures are formed, speech sounds are differentiated, which is necessary for their clear pronunciation. The resonator system includes the entire extension tube - the oral cavity, pharynx, paranasal sinuses and nasal cavity, which amplify the voice, giving it an individual coloring.

The organs of articulation are also approached by fibers of the extrapyramidal tract, which carry impulses from the subcortical formations, providing tempo, rhythm, smoothness and emotional coloring of speech. Smoothly modulating and changing volume on each speech sound, the extension pipe provides timbre, strength and flight of the voice. Under the influence of two feedback streams - auditory and kinesthetic - a memory is formed in the cerebral cortex for the correct pronunciation of certain syllables of a given language (speech-motor vocabulary).

Symptoms of speech dysfunction.

The speech function is a complex conditioned unconditioned reflex process that arises and develops in human ontogenesis on the basis of the coordinated activity of many subsystems of the brain: analyzers, efferent nerves and intercalary subsystems between them. The latter are included in the mechanisms of regulation of phonation (pronunciation of elementary sounds) and articulation (certain combinations of muscle movements necessary to pronounce exactly one and, more often, several sounds). Phonation is carried out by the vocal cords, innervated by the superior laryngeal nerve (n. laryngeus superior), a branch extending from the vagus nerve, as well as by the respiratory muscles, the control mechanisms of which are located in the spinal cord and medulla oblongata. Conditioned reflex mechanisms of the second signaling system take part in the voluntary control of phonation. From the cortex, impulses travel through interneurons to the motor nuclei of the vagus nerve. Articulation is carried out using the muscles of the mouth, tongue, lower jaw, palate, which are innervated mainly by five motor cranial nerves (V, VII, IX, X and XII) (slide 5). Interneurons approach the nuclei of these cranial nerves and carry impulses from the cerebellum, striatum, globus pallidus, hypothalamic region and motor cortex. It must be emphasized that the muscles that carry out phonation and articulation are not only executive, but also participate in the formation of speech (a special type of code) through feedback (proprioceptive and tactile afferentation): with open or hidden (inner speech) articulation, proprioceptors of the speech muscles, as well as the associated positional muscles of the head, neck, chest, diaphragm, etc. generate streams of impulses entering the cortex along the fibers of the motor analyzer (reinforced by the mechanisms of the reticular formation of the brain stem and thalamus) in a certain area.

These efferent and afferent pathways are the substrate of complex unconditioned sound reflexes (slide 6, Fig. 84), on the basis of which conditioned speech reflexes are developed, which are formed when a person is exposed to various simple and complex conditioned stimuli (for example, to a spoken word, to a combination of conventional signs , sounds). We must not forget that the development of human sound speech is formed under the direct control of hearing.

The cerebral cortex, where conditioned speech reflexes are closed, belongs to the second signaling system, which exists only in humans.

Conditioned speech reflexes have sensory and motor parts of the arcs. The sensory part of the arc can be complex, including fibers of the motor, auditory and visual analyzers. Motor part - interneurons going to the motor nuclei of the cranial nerves. In the left hemisphere of the cortex in an adult there are areas that undoubtedly take part in the formation of conditioned speech reflexes and the defeat of which causes speech impairment of a higher signal nature: in the frontal region (fields 44, 45), in the temporal region (fields 22 and 42), on the junction of the temporal, parietal and occipital regions (fields 37 and 40). These areas are interconnected and are the highest subtle mechanisms of speech function. (slide 7)

^ Various types of speech disorders:

Impaired speech function (complex unconditioned sound reflexes) (slide8) with damage to the motor cranial nerves. Damage to the motor nucleus of the vagus nerve or its branches - the recurrent nerve and branch n. laryngeus superior - on one side it is manifested by a violation of the vibration of the vocal cords, which is caused by unilateral paralysis of the smooth muscles of the larynx and respiratory muscles. The voice becomes hoarse (dysphonia). With bilateral damage to the vagus nerve, loss or soundlessness of the voice (aphonia) is noted.

When the nucleus or branch of the glossopharyngeal nerve is damaged, a nasal voice occurs due to paralysis of the muscles of the velum; nasality is especially pronounced with bilateral damage to the nuclei or branches of the glossopharyngeal nerve.

Damage to the nucleus or branch of the hypoglossal nerve on one side causes paralysis and atrophy of the muscles of the tongue on the same side, and primarily m.

Genioglossus, which cause a violation of the articulation of many letters (dysarthria). The child at first cannot pronounce consonants: 1) lingual-dental - “z”, “ch”; 2) lingual-palatal - “t”, “d”, “l”, “r”. Typically, such dysarthria does not last long, as it is compensated by the muscles of the healthy side. Isolated damage to one hypoglossal nerve is rare, for example with trauma to the occipital bone and upper cervical vertebra. Bilateral damage to the nuclei or branches of the hypoglossal nerve makes it impossible to articulate sounds (anarthria), which is a consequence of not only bilateral paralysis of the tongue muscles, but also paralysis of the orbicularis labii muscle, which is innervated by a branch of the hypoglossal nerve, which is part of the facial nerve. Simultaneous damage to the IX and X nerves (diphtheria polyneuritis) causes unclear articulation of some letters (“b” is pronounced like “m”, “d” - like “n”) and a nasal tone of speech.

Bilateral damage to the motor nuclei or branches of the glossopharyngeal, vagus and hypoglossal nerves manifests itself in a pronounced nasal sound, often disappearing with complete aphonia, and versatile anarthria, in which the articulation of complex sounds and syllables is impossible. This complex of disorders is designated as tabloid speech disorder, which occurs in amyotrophic lateral sclerosis, brainstem infectious encephalitis, gliomatous and vascular lesions of the brainstem.

With unilateral damage to the nucleus or branch of the facial nerve, unstable, mildly expressed dysarthria occurs. Dysarthria with bilateral damage to the facial nerves, which include branches of the hypoglossal nerve to the orbicularis labialis muscles, manifests itself in the unclearness of the labial sounds “b”, “p” and often the lingual-labial “v” and “f”.

^ Impaired speech function (complex unconditioned sound reflexes) with damage to the cerebellopontine subsystems .

This speech disorder is called ataxic dysarthria or scanned speech; difficulty and slowness of speech (bradylalia), combined with explosive, jerky pronunciation of individual words and unusual pauses. Speech is characterized by the rhythmic pronunciation of syllables. In this case, incorrect stresses are observed when pronouncing words without taking into account their semantic meaning.

The occurrence of ataxic dysarthria is caused by damage to the bridge, where the corticomontine tracts end, the crossed pontocerebellar fibers begin and fibers pass from the cerebellum to the motor nuclei of the cranial nerves involved in articulation.

Impulses coming from the cerebellum to the motor cranial nerves are blocked, which leads to disruption of the activity of the corticonuclear and cerebellar-nuclear subsystems. Scanned speech can also be observed with extensive lesions - tumors and cysts of the cerebellum (especially its right hemisphere).

^ Impaired speech function (complex unconditioned sound reflexes) with bilateral damage to corticobulbar interneurons.

With bilateral damage to the corticobulbar interneurons running from the cortex to the nuclei of the IX, X and XII nerves (pseudobulbar palsy), dysarthria with a nasal tint is observed, which can be joined by dysphonia. Unilateral damage to the corticobulbar pathways manifests itself in the same disorders, but to a much lesser extent.

^ Violation of speech function (complex unconditioned sound reflexes) with damage to the extrapyramidal system.

When the pallidal-nigral subsystem is damaged (Parksinsonism syndrome), plastic tone of the speech muscles is observed, causing poor vibration of the voice; due to bradykinesia and hypokinesia of the speech muscles, speech becomes slow (bradylalia) and monotonous. The severe rigidity of the muscles of the face and tongue makes the articulation of sounds almost impossible. Sometimes, with pronounced parkinsonism syndrome, orthostatic anarthria is observed: the inability to articulate letters when standing; in a supine position it improves somewhat. With parkinsonism syndrome expressed to a moderate degree, there may be a pulsational, jerky acceleration of speech (tachylalia) and palilalia - a tendency to repeat phrases and words many times, often at an increasing pace. In the later stages of parkinsonism, in the presence of clonic hyperkinesis of the tongue, speech becomes as if “stuttering” (palihilalia). With chorea, the articulation of individual letters is often disrupted due to hyperkinetic movements of the muscles of the tongue, mouth, face and respiratory muscles. Sometimes athetosis is accompanied by a sudden cessation of breathing with jerky interruptions in phonation, which is caused by irregular contractions of the diaphragm and external respiratory muscles.

^ Speech dysfunction due to damage to the hypothalamic region.

Damage to this area can be detected by myasthenic syndrome - rapid exhaustion of the muscles of the tongue, soft palate, weakness of the vocal cords, causing the almost complete impossibility of pronouncing words.

This type of speech disorder is more often observed when tired, at the end of the day. Injection of proserine reduces speech dysfunction, sometimes restoring it to normal, but for a short time.

^ Speech impairment due to brain pathology.

Speech is a person’s ability to pronounce articulate sounds that make up words and phrases (expressive speech), and at the same time comprehend them, connecting heard words with certain concepts (impressive speech). Speech disorders include disorders of its formation (impaired expressive speech) and perception (impaired impressive speech). Speech disorders can occur with a defect in any part of the speech apparatus: with pathology of the peripheral speech apparatus (for example, congenital anatomical deformities - cleft palate, cleft upper lip, micro- or macroglossia, etc.), with impaired innervation of the muscles of the mouth, nasopharynx, larynx, which takes part in voicing various concepts and images, as well as in organic and functional changes in some parts of the central nervous system that provide speech function. Disorders of speech formation (expressive speech) are manifested in a violation of the syntactic structure of phrases, in changes in the vocabulary and sound composition, melody, tempo and fluency of speech. In perception disorders (impressive speech), the processes of recognition of speech elements, grammatical and semantic analysis of perceived messages are disrupted. A disturbance in the processes of analysis and synthesis of messages and speech memory that occurs when the brain is damaged is called aphasia. Thus, aphasia is a systemic breakdown of already formed speech. If damage to the central nervous system in children contributed to a violation of speech function and arose before they mastered speech, then alalia is formed (“a” - negation, “lalio” - sound, speech). Both of these disorders have much in common: both aphasia and alalia are characterized by complete or partial speech impairment, which makes, to one degree or another, impossible for the existence of the main function of speech - communication with others. As secondary phenomena, in both cases there are disturbances in thinking processes and changes in personality and overall human behavior.

Often, speech dysfunction is associated with damage to certain areas of the brain.

Of course, speech is an integrative function of the entire human brain, but numerous studies indicate the existence of certain areas in the cerebral cortex, when damaged, speech disorders naturally develop. Speech disorders associated with damage to the central nervous system occur due to:

1) with underdevelopment of the brain (for example, microencephaly);

2) with infectious diseases (meningo-encephalitis of various etiologies: meningococcal, measles, syphilitic, tuberculosis, etc.);

3) with brain injuries (including birth injuries);

4) with the development of a tumor process, leading to compression of brain structures, disruption of blood supply and degeneration of brain tissue;

5) with mental illnesses (schizophrenia, manic-depressive psychosis), in which the structure of brain cells is disrupted;

6) with hemorrhage into the brain tissue.

^ Motor aphasia(alalia) is a collective term for a number of conditions with different patterns of manifestations and with different localization of brain damage, common to which is the underdevelopment or absence of expressive speech, i.e. difficulties in mastering the active vocabulary and grammatical structure of the language, as well as sound pronunciation in relatively full development of speech understanding, i.e. impressive speech.

The personality traits of the motor alalik are expressed in some inhibition, which is combined with periods of increased excitability and sensitivity (indecisiveness, touchiness). These features, on the one hand, depend on the underdevelopment of the central nervous system and the type of higher nervous activity, and on the other hand, they are the result of the fact that speech inferiority and general motor awkwardness exclude a person from the team, the immediate environment and, with age, increasingly traumatize his psyche. The formation of expressive speech disorders in motor alalik is caused by a disorder of the speech motor analyzer. These violations are of a different nature:

1) kinesthetic oral apraxia (“a” – denial, “praxia” – action, movement) – difficulty in forming and consolidating articulatory skills, and subsequently motor differentiation of sounds;

2) difficulty switching from one movement to another;

3) the difficulty of mastering the sequence of these movements to reproduce a word (its motor scheme). Regardless of the nature of the disorders, there is a delay in the development of the main leading component of expressive speech - the active vocabulary. The main manifestation of motor aphasia (alalia) is a change, first of all, in oral speech: the language turns out to be poor, meager, distorted, or there is no speech at all. The phonetics and grammatical structure of speech suffer, the writing function is often upset - agraphia arises (“a” - negation, “grapho” - writing). Secondarily, although to a minor extent, impressive speech also suffers.

Studies have shown that motor alalia (aphasia) occurs when the lower parts of the left frontal lobe are affected in right-handed people and the lower parts of the right frontal lobe in left-handed people.

A characteristic sign of motor alalia (aphasia) is speech negativism - a decrease in speech stimulus. The motor alalik is silent, to verbal communication does not strive, communicates with surrounding gestures, with the help of facial expressions, sometimes communication is accompanied by unformed vocal reactions, there is no critical attitude to one’s speech, no understanding of the meaning of grammatical changes in words (singular, plural; masculine, neuter, feminine; case endings, etc. .). If brain damage occurs in the pre-speech period (in children of the first year of life), then the mother already during the period of babbling notes the child’s silence, understanding of speech begins to develop in a timely manner, but expressive speech does not develop for a very long time or is limited to syllables and a few simple words. In the words that appear, unstable word structures, numerous distortions, abbreviations, and rearrangements of syllables are noted. The phrase does not appear for a long time, and when it does appear, it remains grossly agrammatic, there is a delay in the formation and pronunciation of most sounds, and later there is a mixing of sounds across all phonetic groups (whistles and hisses, “p” and “l”, voiced and voiceless, hard and soft, etc.).

Thus, dysarthria is observed - a disorder of articulate speech and pronunciation. Dysarthric speech is usually unclear, slurred, and muffled; the expression “like porridge in the mouth” is used to describe it. In severe cases, speech turns into some kind of mooing and becomes completely incomprehensible, and sometimes any formation of speech sound becomes completely impossible. Such extreme, most severe dysarthrias are called “anarthrias”, i.e. e. complete inability to speak, while maintaining hearing and understanding speech (preserving impressive speech). Dysarthria occurs as a result of damage to the executive apparatus of speech with one or another localization of the lesion in the central nervous system. From a neurological point of view, the following types of dysarthria are distinguished:

1) bulbar;

2) pseudobulbar;

3) subcortical;

4) cerebellar;

5) cortical.

In terms of articulation features, the first two forms - bulbar and pseudobulbar - are very similar to each other; they arise when the bulbar cranial nerves and cranial nuclei are damaged. For clinical practice, the pseudobulbar form of dysarthria is of greatest interest, as it is the most common and is a consequence of pseudobulbar paralysis, which usually develops in early childhood after trauma, infectious diseases (whooping cough, meningitis), etc. Impairment of motor skills of the speech-motor apparatus is widespread. , almost all muscle groups involved in sound formation suffer. In addition, the motor skills of the upper part of the face often suffer, as a result of which the face becomes motionless, mask-like, and amicable; There is general motor awkwardness and clumsiness. Parents pay attention, first of all, to the fact that the child cannot take care of himself - he does not dress himself, does not put on shoes, does not run, does not jump.

Naturally, all functions of a non-speech nature, in which the participation of the tongue, lips and other parts of the speech apparatus are necessary, also turn out to be defective: the child chews food poorly, swallows poorly, does not know how to swallow in time and retain the intensely secreted saliva, so usually more or less severe salivation (salivation).

As a rule, with pseudobulbar palsy, different muscles are not affected to the same extent: some more, others less.

Clinically, paralytic, spastic, hyperkinetic, mixed and erased forms of the disease are distinguished. Most often, mixed forms occur, when the child has all the symptoms of motor impairment - paresis, spasticity and hyperkinesis.

Paresis manifests itself in the form of lethargy, decreased strength of movement, its slowness and exhaustion, any articulatory movement is made slowly, often not completed, the tongue only reaches the teeth, repeated movement is made with even greater difficulty, and sometimes cannot be repeated at all.

Spasticity (constant tension) of all articulatory organs also interferes with the pronunciation of sounds and the formation of speech. In some cases, the leading symptom during pseudobulbar paralysis is violent movements of the entire speech apparatus, so-called hyperkinesis, which occurs with any attempt to move the lips or tongue.

Although the acts of chewing and swallowing are difficult, in the process of eating and other everyday actions the child makes those movements that were impossible for him to perform voluntarily.

For example, neither by verbal instructions nor by demonstration he can bare his teeth, but he can smile in response to affection without difficulty. Thus, in the motor skills of children suffering from pseudobulbar palsy, greater opportunities are noted in their unconditioned reflex and objective activity than in voluntary movements made according to instructions.

Pseudobulbar dysarthria is also observed in adults, especially the elderly, as a result of cerebrovascular accident (after a stroke).

In the acute period, immediately after a stroke, as a rule, there is a complete loss of speech. At the same time, there is drooling and difficulty swallowing and chewing. If you examine speech motor skills during this period, you will find almost complete immobility of the lips, tongue, and soft palate. Speech understanding is maintained.

As cerebral circulation is restored, patients begin to speak, but it is extremely unclear, nasal, and speech can be incomprehensible even to close people. Gradually it becomes clearer, and it turns out that the vocabulary and grammatical structure have suffered somewhat, but writing and reading skills have been preserved (with the exception of handwriting as a result of paralysis).

Despite the gradual improvement, speech remains nasal, monotonous, all sounds are blurred, and the sounds that are most difficult to articulate suffer the most: l, r, hissing, etc.

Speech quickly tires the patient and then becomes even more incomprehensible and illegible. In severe cases, speech is never fully restored.

Subcortical dysarthria occurs much less frequently (in 3–5% of cases), they are caused by damage to the subcortical nodes and are observed against the background of a significant increase in the tone of all muscles and various violent movements. A typical example of subcortical dysarthria is the speech of patients with parkinsonism.

Patients speak quietly, slowly, monotonously, with slurred articulation; by the end of the phrase, the patient’s speech becomes exhausted and turns into vague muttering.

Another type of subcortical dysarthria is observed in patients with chorea (with rheumatic brain damage). Constant violent movements in the speech muscles lead to the fact that the patient’s speech becomes abrupt, individual syllables are pronounced quickly and loudly, as if “pushed out”, while others are not pronounced at all, “swallowed”, the impression is created that the patient “speaks faster than he thinks” ", he is afraid that he will not be allowed to speak out

^ Damage to Broca's area.

Now let's look at the posterior part of the third frontal gyrus, or Broca's area. (slide9) With a lesion localized in this area, a person develops motor aphasia, i.e. the patient loses the ability to speak, but is generally able to perceive someone else’s speech by ear. In such patients, there is no paralysis of the muscles responsible for the movements of the lips and tongue, but praxia of speech movements is lost. Written speech skills are also lost - agraphia occurs, which puts the patient in a more difficult situation than a person suffering from anarthria. With partial motor aphasia, partial preservation of speech is possible (for example, in the remission stage), but the vocabulary is significantly limited, the monologue is difficult to pronounce, and mistakes are made. Agraphia can also be isolated, not associated with motor aphasia. In this case, there is no connection with damage to Broca's area. The cause of this form of agraphia is damage to a small area of the cortex located in the posterior part of the middle frontal gyrus. Such a patient retains all functions associated with understanding oral and written speech; in addition, he can freely pronounce any words and phrases, but does not understand what is written.

^ Damage to the temporal lobe.

The presence of pathological foci in the left temporal lobe (in right-handed people) leads to severe disorders. When a lesion is localized in Wernicke's area, sensory aphasia occurs, for example, which leads to loss of the ability to perceive speech. Sounds, individual words and entire sentences are not attached by the patient to concepts and objects known to him, which makes establishing contact with him almost impossible. At the same time, the speech function of the patient himself is impaired. Patients with lesions localized in Wernicke's area retain the ability to speak; Moreover, they even show excessive talkativeness, but their speech becomes incorrect. This is expressed in the fact that words necessary in meaning are replaced by others; the same applies to syllables and individual letters. In the most severe cases, the patient's speech is completely incomprehensible. The reason for this complex of speech disorders is that control over one’s own speech is lost. A patient suffering from sensory aphasia loses the ability to understand not only other people's speech, but also his own. As a result, paraphasia occurs - the presence of errors and inaccuracies in speech. If patients suffering from motor aphasia are more irritated by their own speech errors, then people with sensory aphasia are offended by those who cannot understand their incoherent speech. In addition, when Wernicke's area is affected, reading and writing skills are impaired.

If we conduct a comparative analysis of speech dysfunctions in pathologies of various parts of the cerebral cortex, then we can confidently say that the least severe lesions are the posterior part of the second frontal gyrus (associated with the inability to write and read); then there is a lesion of the angular gyrus, associated with alexia and agraphia; more severe - damage to Broca's area (motor aphasia); and finally, damage to Wernicke's area has the most serious consequences.

It is worth mentioning a symptom of damage to the posterior part of the temporal and lower part of the parietal lobes - amnestic aphasia, which is characterized by loss of the ability to correctly name objects. During a conversation with a patient suffering from this disorder, it is not immediately possible to notice any deviations in his speech. Only if you pay attention does it become clear that the patient’s speech contains few nouns, especially ones that define objects. He says "sweet that goes into tea" instead of "sugar", claiming that he simply forgot the name of the item.

The rationale for an isolated speech disorder is as follows: a certain field is formed, localized between the cortical centers of hearing and vision (B.K. Sepp), which is the center of the combination of visual and auditory stimulation in the child. When a child begins to understand the meaning of words, they are compared in his mind with a visual image of an object that is simultaneously shown to him. Subsequently, the names of objects are deposited in the above-mentioned associative field when improving speech function. Thus, when this field is damaged, which is, in fact, associative pathways between the fields of visual and auditory gnosis, the connection between the object and its definition is destroyed.

Speech development disorders.

It is not uncommon for a 3-4 year old child to speak so indistinctly that only his mother can understand him. It happens that at this age children do not pronounce certain sounds, replace some sounds with others, or their rhythm and tempo of speech is disturbed - they speak chokingly, very quickly or, conversely, draw out words, etc. Such violations, as a rule, are of little concern parents, and they tend to explain it by saying that “small children are generally difficult to understand!”

Of course, in the early stages of speech development, the articulation of sounds in all children is imperfect: they distort, omit or replace many sounds. However, this can be considered the “norm” for children no older than 2.5-3 years. If articulation defects are observed in older children and persist, measures must be taken to eliminate them. When these defects are very pronounced in young children, it is necessary to pay attention to them - whether they are associated with some kind of disorder. For normal speech activity, the coordinated functioning of the entire brain and other parts of the nervous system is necessary. When various parts of the nervous system are affected, various speech disorders can occur; the nature of these disorders depends on the location and time of the lesion.

In childhood, speech disorders, depending on the causes of their occurrence, can be divided into the following groups.

I. Speech disorders associated with organic damage to the central nervous system. Depending on the level of damage to the speech system, they are divided into:

aphasia- disintegration of all components of speech as a result of damage to the cortical speech zones; (slide 10)
alalia- systemic underdevelopment of speech as a result of damage to cortical speech zones in the pre-speech period; (slide 11)
dysarthria- violation of the sound-pronunciation aspect of speech as a result of disruption of the innervation of the speech muscles. Depending on the location of the lesion, several forms of dysarthria are distinguished. (slide 12)

II. Speech disorders associated with functional changes in the central nervous system:

stuttering- this is a violation of the rhythm, tempo and fluency of speech associated with muscle spasms involved in the speech act; (slide 13)
mutism and surdomutism

III. Violations of the tempo and rhythm of speech. (slide 14)

tachylalia
bradyllalia

IV. Speech disorders associated with defects anatomical structure articulatory apparatus (mechanical dyslalia, rhinolalia).(slide-15)(slide-16)(slide17)

V. Speech disorders not associated with disorders of the innervation of the speech apparatus. (functional dyslalia)

VI. Delayed speech development of various origins (due to prematurity, severe diseases of internal organs, pedagogical neglect, etc.).

VII. Speech disorders associated with hearing impairment.

^ Neuropathological examination of speech.

Incorrect speech can also be caused by damage to the nervous system (slide 18) Carrying out a thorough examination of each cranial nerve,

Using special techniques, the doctor determines the safety of its function. For example, the ability of a child to symmetrically contract the facial muscles - frowning, closing his eyes, baring his teeth - allows us to establish the normal function of the facial nerve. The correct (midline) position of the tongue, its free movements, uniform tension of the soft palate, normal timbre of the voice, the absence of taste disorders and salivary secretion, as well as deviations in heart and breathing rhythms will allow us to state the absence of lesions on the part of the glossopharyngeal, vagus and hypoglossal nerves. In cases where individual cranial nerves are affected, there is an inferiority of one or another function that is associated with a particular nerve.

Along with clinical examination methods, additional methods (laboratory, electrophysiological, etc.) are currently widely used. Laboratory tests include blood and urine tests, which can confirm the presence of abnormalities in the child’s health. Biochemical tests can identify disorders metabolic processes. In a neurological hospital, if necessary, a puncture is performed and cerebrospinal fluid (CSF) is taken for analysis, in which traces of blood in case of injury, water content in case of hydrocephalus, and the presence of pathogenic microflora in inflammatory processes can be detected. Additional examination methods include craniography, which allows you to clarify the size of the skull (reduction or increase), determine bone density (thickening or thinning of the bone wall), flattening of the cranial vault, the condition of the sella turcica (location of the pituitary gland), the presence of digital impressions and calcifications, traces of skull trauma . In the neurosurgical clinic, to clarify the localization of the pathological process, the methods of pneumoencephalography, ventriculography and angiography are used, revealing the structural features of the ventricular and vascular systems, and the subarachnoid space. Brain computed tomography (CT) is used to clarify the nature of the morphological defect. It allows you to identify the presence and localization of hemorrhages, congenital malformations of the brain in newborns, cysts, foci of gliosis, calcifications, objective signs of hydrocephalus, the degree of expansion of the ventricular system, the location of the tumor process in children of other ages. Currently, electroencephalography (EEG) and echography (ECHO) methods are widely used in inpatient and outpatient practice. EEG allows you to assess the state of electrical activity of the brain, identify convulsive readiness, old scar changes, the course of nervous processes (brain biocurrents change in the area of the pathological focus). The state of the ventricular system is determined by echography. Enlargement of the ventricles of the brain or their displacement indicates intraventricular hydrocephalus.

Establishing a medical psychoneurological diagnosis should be based on the totality of all data collected about the child. However, the decisive point in the final diagnosis will be the state of the nervous system and psyche.

For speech pathologists and speech therapists, the conclusion of a neuropathologist or psychoneurologist is especially important, primarily because it confirms or rejects the child’s experience of a brain disease. This circumstance to some extent determines the volume and form of therapeutic and pedagogical activities. Understanding the essence of the disorders occurring in the neuropsychic sphere of the child helps the teacher to build pedagogical work more meaningfully and purposefully.

A close relationship between a neurologist and a speech therapist is the key to successful work in correcting speech disorders.
^

Brief methodology for clinical and psychological study of cortical speech disorders

Before the study, they find out through questioning whether the child is a hidden left-hander.

It is also necessary to establish whether there were left-handers in the child’s family. Tests are then proposed to identify hidden left-handedness.

^ Interlace of fingers test. When this test is performed quickly, a left-handed person has the left thumb on top of the right one. When placing the thumb right hand above the left, the hidden left-hander feels awkward.

^ Napoleon pose test. When crossing the arms on the chest of a hidden left-hander, the left hand is placed on top of the right.

Applause test. A child with erased signs of left-handedness applauds with the active participation of his left hand and a relatively passive position of his right.

Sometimes a sign of hidden left-handedness is a larger nail width of the left little finger than the right one.

^ Study of the state of speech function consists in studying the functional activity of the speech-sensory and speech-motor analyzers.

The study of the speech-sensory analyzer includes studies of: 1) phonemic hearing; 2) understanding words; 3) understanding simple sentences; 4) understanding of logical-grammatical structures.

^ Phonemic hearing research. The study of phonemic hearing or differentiation is carried out using certain techniques. The child is asked to repeat sharply different phonemes (M-R, P-S, B-N), and then similar in sound (B-P, P-B, D-T, T-D, K-G, G-K and etc.). Impairment of phonemic hearing is observed with damage to the posterior superior parts of the temporal lobe of the left hemisphere. (Slide 19)

^ Word Comprehension Research . The child is offered individual words, the meaning of which he verbally defines or points to the object (ear, nose, eyes) that this word denotes. Children suffering from sensory aphasia do not perceive presented words clearly enough, and therefore cannot understand their meaning.

^ Study of simple sentence comprehension . The child is asked a series of simple and complex issues which he must answer. Then he is presented with a series of simple phrases of a certain content, after which he must find a picture corresponding to this phrase. Next, Pierre Marie's test is performed, which consists of performing three consecutive actions formulated in one sentence (for example, “take the book, put it on the window, and give me the plate”). In this case, it is necessary to take into account the age of the child.

If the speech-sensory analyzer is damaged, understanding simple sentences may be difficult.

^ Study of understanding of logical-grammatical structures . One of the options for such a study is proposed. Three objects are placed in front of the child (a pencil, a key and a comb) and the child is given the task of first showing the key with the pencil, and then the comb. Then they repeat the instructions, but in the instrumental case: “Show the key with a pencil, and the pencil with a comb.” After this, the tasks are changed again: “Show the pencil with a comb, and the key with a pencil.” A child with damage to the temporal region of the left hemisphere cannot complete the first task of the instruction. Children suffering from damage to the parieto-occipital regions perform the first task without difficulty, but cannot cope with the second. Children suffering from damage to field 44 can complete the first and second tasks, but have difficulty coping with the third.

^ Study of the speech motor analyzer includes the study of: 1) articulation of speech sounds; 2) reflected speech; 3) the denoting function of speech; 4) narrative speech.

^ Study of the articulation of speech sounds. The child is asked to pronounce individual letters "m, b, l, f, k, g", the syllables "bra, bro, bru, bre" or words, for example, "grove, varnish, bearing, lever, giraffe, curdled milk, shipwreck, intervention " The clarity of sound pronunciation is noted. Impaired articulation may occur with lesions different levels brain.

Study of reflected (repeated) speech. The child must immediately (without a pause) or after 3-10 seconds repeat after the examiner several words (lamp, fire, sun, castle, etc.). This task identifies disturbances characteristic of motor aphasia, especially if an entire phrase is repeated. While easily repeating individual sounds, children cannot repeat words and phrases, which is caused by pathological inertia in the speech motor analyzer.

^ Study of the denoting function of speech. The child is shown objects or their images, which he must name. It is recommended that he name 2-3 items at once. Then the child is asked questions: what is the name of the object that is used to comb hair, what is the name of the object that shows the time, etc. Often you have to suggest the first syllable of the name of the object. Violation of the denoting function of speech is observed in amnestic and sensory aphasia.

^ Narrative speech research . They show a simple picture (slide 20, 21 Fig. 86), the plot of which the child must tell, or read a short story, which he must retell in narrative form. Sometimes they ask him to tell the contents of a familiar work of art (book, painting, etc.). Such a study reveals paraphasias: 1) literal (rearrangement and replacement of letters in a word) and 2) verbal (replacement of words in a sentence). The degree of manifestation of motor aphasia may vary. With pronounced motor aphasia, speech is impossible or limited to familiar words, often interjections. With an average degree of motor aphasia, the child has a small vocabulary of words: “dad,” “mom,” “yes.” With mild motor aphasia, there is a poverty of vocabulary and difficulty in selecting the necessary words.

^ Speech therapy examination of children whose speech is unintelligible.

A child who speaks unintelligibly may have complex speech disorders or simply incorrect pronunciation large number sounds.

Children who speak unintelligibly, indistinctly, unlike non-speaking children, have a vocabulary and know how to use phrases. But their speech is blurred, because it has many shortcomings.

To determine whether a child who speaks slurred has any serious speech disorders, it is necessary to determine:

Lexicon;

Grammatical structure of speech;

Ability to use phrasal speech, the degree of its development;

The syllable structure of the word;

Understanding spoken speech.

2. State of sound pronunciation.

3. Are there any violations of the mobility of the child’s articulation organs?

4. Study of the state of auditory function.

Study of a child's vocabulary.

The initial children's vocabulary is a dictionary, or, in other words, a child's vocabulary. All young children, as a rule, pronounce their first words by the first year of life. These words are similar for all children: mother, woman, na-na, am-am. In their syllabic structure, they resemble babble, and most often they are based on onomatopoeia.

From the first words a child pronounces and understands, the initial children's vocabulary, or in other words, real vocabulary, is formed. This child’s vocabulary usually contains a standard set of concepts that can be divided into several main vocabulary groups, which include:

The names of the people around the child;

Onomatopoeia;

Names of animals and birds, toys, food, actions, definitions, question words.

By the age of two, a child's initial lexicon, or vocabulary, does not exceed 500 words, including both active and passive vocabulary. But children develop differently. Conventionally, the limit of the age norm for a 2-year-old child is the volume of the active vocabulary of about 50 words with a good understanding of spoken speech.

Children's vocabulary increases rapidly and by about 3 years it can reach 850-1000 units. In general, the normal development of a child’s vocabulary looks like this:

1 year – 5-9 words;

1.5 years – from 20 to 40 words;

2 years – from 50 to 200 words;

3 years – from 800 to 1000 words;

3.5 years – 1100 words;

4 years – 1600-1900 words;

5 years – 1900-2200 words.

Object pictures can serve as material for studying a child’s vocabulary. To study the level of vocabulary of a child, depending on age, it is suggested:

Starting from the age of three, name objects from pictures or directly upon presentation: eyelashes, shoulder, trunk, eyebrows, flowerbed, gazebo, elbow, gate, etc.;

Name the cubs of a cat, dog, cow, goat, horse, chicken, duck, wolf, fox, bear;

Starting from the age of four, name the object of a picture with images of objects, actions, qualities and characteristics. Objects and pictures can be selected by topic: toys, dishes, clothes, shoes, furniture and parts of the human body, animals, plants, people’s professions, types of nature, seasons;

Explain the meaning of the words: refrigerator, vacuum cleaner.

When examining vocabulary, the child’s ability to correlate a word with the designated object, action, and correctly use it in speech is revealed.

The main techniques may be the following:

Finding (showing) children objects and actions (Show: who washes and who sweeps, etc.);

Performing the above actions (draw a house - paint the house);

Children’s independent naming of shown objects, actions, phenomena, signs and qualities (Who is drawn in the picture? What is the boy doing? What is he making a ball out of?);

Children naming specific concepts included in any general theme (Tell me which summer clothes you know, winter shoes);

Combining objects into a generalizing group (How can you call a fur coat, coat, dress, skirt in one word?).

The assessment of vocabulary level consists of the following parameters:

1) the volume of vocabulary corresponds to the age norm, is below the age norm, is limited to babbling words, is limited to everyday neologisms;

2) the child’s vocabulary is represented by various morphological categories (nouns, verbs, adjectives, adverbs, pronouns);

3) predominantly uses specific everyday vocabulary, predominantly uses verbal vocabulary, there is a significant amount of adjectives, adverbs, etc.;

4) the ratio of active and passive vocabulary;

5) the child experiences difficulties in activating his vocabulary, i.e. finds words with difficulty, mixes words that are similar in sound composition, replaces them based on situational similarity, according to a different principle (namely: which one?).

^ Examination of the grammatical structure of speech.

By about 3-5 years, the child masters the basic grammatical aspects of speech, i.e. changing words by cases, numbers and persons. It can be simple and complex sentences using conjunctions. The child's speech is enriched.

Since a child's speech is unintelligible, it can be difficult to hear whether he speaks correctly. Therefore, you need to specifically find out whether he uses the necessary endings, prefixes, suffixes, etc. in his speech.

To identify certain violations in the development of the grammatical structure of speech, children’s skills are examined:

Form a plural from the singular of a noun (table - tables, ear - ears, etc.);

Form genitive forms plural noun (many toys, books, etc.);

Coordinate nouns (tomato, ear, chair, hand) with numerals (one, two, three, four, five);

Form diminutive forms of nouns (bag - handbag, chair - chair);

Match adjectives with nouns, for example, black panther, white snow.

^ Examination of phrasal speech.

We invite the child to continue the sentence you started. To do this, use plot pictures. For example, the picture shows a girl who is drawing. You say: “Girl...”. The child must finish: “draws the sun.”

Ask your child to continue your unfinished sentence also based on the plot picture, which, for example, shows boys playing football. You say: "The boys are playing." The child must finish: “The boys are playing football.”

^ Stages of development of phrasal speech:

From the age of 1 year 9 months, phrases consisting of two lexical units appear in the child’s speech: “Lala bah, papa am.”

From the age of 2, sentences appear and develop.

By the age of 3, the child begins to use complex subordinate clauses, questions “why?”, “when?” appear, and they use almost all parts of speech, prepositions and conjunctions. He uses singular and plural.

By the age of 4, a child’s speech should be grammatically correct; as a rule, by this age he uses suffixes and more complex phrases.

The further development of speech is assessed mainly not by the number of words, but by the ability to answer questions, the presence of initiative in a conversation, the construction of logical chains, the ability to compose a story based on a picture, talk about an event, retell a fairy tale.

At the same time, understanding of complex grammatical structures is assessed.

^ Examination of the syllabic structure of a word.

Sometimes children have particular difficulties in pronouncing polysyllabic words and words with consonant clusters. For example, a child says “mitsanei” or “milicilinel” instead of policeman; or “ingulisny” instead of toy, etc. a violation of the syllabic structure of a word most often manifests itself in rearrangement, omission, or addition of sounds or syllables.

Therefore, it is necessary to check how the child pronounces words of different syllabic structures - with a combination of consonants at the beginning, middle and end of the word, multi-syllable words and words consisting of similar sounds. We select subject pictures with such words and listen carefully to what your child will call what is drawn in the pictures. We fix it. This will help in further work.

In the process of presenting the pictures, the instruction is given: “Look carefully at the picture and name: who or what is it?”

9 series of tasks are offered, which include one-, two- and three-syllable words with closed and open syllables, with combinations of consonants:

1 – two-syllable words of two open syllables (mama, ukha);

2 – three-syllable words made of open syllables (panama, peonies);

3 – monosyllabic words (poppy, lion);

4 – two-syllable words with one closed syllable (skating rink, Alik);

5 – two-syllable words with a cluster of consonants in the middle of the word (pumpkin, duck);

6 – two-syllable words with a closed syllable and a cluster of consonants (kompot, Pavlik);

7 – three-syllable words with a closed syllable (kitten, machine gun);

8 - three-syllable words with a combination of consonants (candy, wicket);

9 – three-syllables with a consonant cluster and a closed syllable (monument, pendulum).

Evaluated:

Features of violations of the syllabic structure of a word;

Omission of consonants in conjunctions;

Rearrangements while maintaining the outline of words;

Adding sounds, syllables;

The tendency to connect part of one word with part of another.

If a child has difficulties in reproducing the syllabic structure of a word and its sound content, then it is suggested:

Repeat series of syllables consisting of different vowels and consonants (pa-tu-ko);

Repeat series of syllables with different consonants but the same vowel sounds (pa-ta-ka-ma, etc.);

Repeat series of syllables with different vowels but the same consonant sounds (pa-po-py, tu, ta, then);

Repeat rows of syllables with the same consonant and vowel sounds, but with different stress (pa-pa-pa);

Tap out the rhythmic pattern of the word.

^ Checking sound pronunciation.

Tasks aimed at checking the state of sound pronunciation.

1. Name it correctly.

Equipment: pictures for examining sound pronunciation.

^C: garden, stroller, globe.

Sya: cornflower, taxi.

Z: castle, Dunno.

3: strawberry, monkey.

C: heron, ring, Indian.

Sh: checkers, collar, pencil.

AND: giraffe, beetle, skis.

SCH: pike, puppy, raincoat.

H: teapot, cookies, ball.

L: lamp, wolf, table.

L: lemon, stove, salt.

R: cancer, stamps, fly agaric.

Ry: river, gingerbread, lantern.

Y: watering can, apple, hedgehog, wings.

TO: jacket, violin, wardrobe.

G: row, grapes.

X: bread, weaver, rooster.

2. Repeat the sentences.

Equipment: story pictures.

Zina has an umbrella.

The catfish has a mustache.

A blacksmith forges a chain.

A hat and a fur coat - that’s all Mishutka is.

The hedgehog has a hedgehog.

A woodpecker is hammering a spruce tree.

A mole got into our yard.

Maya and Yura are singing.

^ Examination technique: The child is asked to name the pictures. In these words, the sounds being examined are at the beginning, middle and end of the word. Then, with the same words, they are asked to pronounce a sentence.

Fixed: the child’s ability to pronounce sounds in isolation at the beginning, middle, end of a word and in a phrase.

^ Checking the mobility of the speech organs.

To check, you can use the same exercises as in the previous chapter. You can add the following exercises to them:

Lick your lips with your tongue.

2. Try to reach your nose, chin, left and then right ear with your tongue.

3. raise the tip of your tongue up and hold it in this position for a long time.

4. With the teeth open by about 2 centimeters, the lips in a smile expose the incisors. Move the tip of the tongue either to the left corner of the lips or to the right,

Changing the rhythm of movements.

An exercise to test the mobility of the speech organs.

1. You need to open and close your mouth, “slapping” your lips.

2. Alternately stick your tongue out of your mouth and put it back.

3. Open your mouth slightly, placing your wide, outstretched tongue on your lower teeth, and hold it for about 5-6 seconds in this position in a calm state.

4. The lips should alternately be symmetrically positioned in a narrow smile and stretched into a tube (when performing this task, the child’s teeth should be closed, and movements should be made with the lips alone, without additional movements of the chin).

^ Rules for performing exercises.

Exercises should be performed in front of a mirror: you show the child the movements, he, looking in the mirror, repeats it after you.

The child can repeat each movement many times, since children of this age often find it difficult to complete a new motor task the first time.

^ Examination of a child's hearing.

The simplest and most accessible method is speech hearing testing.

Before the study, you need to explain to the child how he should react to an audible sound (turn around, point to the source of the sound, reproduce the sound or word he heard, raise his hand, clap his hands, etc.).

First, hearing is tested for whispered speech, then for normal conversational speech, and only after that for loud speech.

To do this, you should put the child with his back to you and pronounce familiar words in a whisper. If the child is facing the examiner, then to exclude the possibility of lip reading, you need to use a screen covering the examiner’s face. It could be a piece of cardboard or a sheet of paper. Before pronouncing a word, an adult should take a full breath and in no case exaggerate the whisper.

Practically under normal research conditions, i.e. in an environment of relative silence, hearing is considered normal when perceiving whispered speech at a distance of 6-7 meters. The perception of a whisper at a distance of less than 1 meter is characterized as a very significant hearing loss; a complete lack of perception of whispered speech indicates severe hearing loss, which impedes verbal communication.

When studying auditory perception, material is taken that corresponds to the level of speech development of children. Thus, when studying speech hearing in children just starting to speak, you can use babbling “words”: “am-am” or “av-av” (dog), “meow” (cat), “mu” (cow), “tu-tu” or “bi-bi” (car), etc. To study the hearing of older children, experts (Prof. V.I. Voyachek and others) recommend using two groups of words:

1) With low-frequency sounds: vowels U, O, consonants: M, N, R, V, for example: raven, yard, sea, room, lesson, city, wolf, fish, window, smoke, ear, Vova, soap, thunder , bull, house, etc.

2) With high-frequency sounds: vowels A, I, Z, whistling and hissing sounds, for example: hat, hour, cup, matches, hare, wool, teapot, checkers, Sasha, bird, bunny, grandfather, seagull, etc.

10 words are selected from each specified group. To study hearing in schoolchildren, you can use the selection of individual sounds: s, a, u, o, i, sh, r, m...

To study phonemic hearing in children, i.e. ability to distinguish from each other separate acoustically similar speech sounds (phonemes), it is necessary, where possible, to use specially selected, meaningful pairs of words that would differ from each other phonetically only in the sounds whose differentiation is being studied. For example: heat - ball, cup - checker, point - daughter, kidney - barrel, goat - braid, etc.

This kind of pairs of words can be successfully used to study the ability to differentiate vowel phonemes, for example: stick - shelf, house - smoke, table - chair, bear - mouse, mouse - fly, etc.

If it is impossible to select appropriate pairs of words to study the distinction of consonant sounds, you can use syllables such as ama, anna, ala, avya, etc.

When studying hearing, especially the differentiation of sounds in children of any age, subject pictures are necessarily used. After the speech therapist pronounces a particular word, the child must not only repeat it, but also show the corresponding picture.

If the child cannot repeat the word and show the desired picture, spoken in a whisper at a distance of 6 m, he should come closer by 1 m. If he does not hear the named words at this distance, he comes even closer, each time approaching 1 m. if the child does not distinguish words spoken in a whisper at the auricle, then, therefore, the child does not perceive the whisper. (Recording form - u/r - at the auricle; 1 m or 2 m - the distance of perception of words.)

Next, they move on to testing speech perception at normal conversational volume. To do this, you should place the child at a distance of 5-6 m with his back to you and pronounce well-known words in a normal (not amplified) voice, gradually approaching the child.

To give such speech a more or less constant volume level, the same technique is recommended that is proposed for whispered speech, i.e. use reserve air after a quiet exhalation; in cases where the child’s speech at conversational volume is poorly or not at all distinguishable, speech at amplified volume is used.

A speech hearing test is performed for each ear separately. The ear being tested faces the source of the sound, so the child should be advised to slightly turn his head in the appropriate direction. The opposite ear (when testing with whispered speech) is muffled with a finger (preferably moistened with water) or a damp ball of cotton wool.

When examining hearing with loud speech, the second ear is switched off using an ear ratchet. Plugging the second ear with a finger in these cases does not achieve the goal, since in the presence of normal hearing or with a slight decrease in hearing in this ear, loud speech will be different, despite the complete deafness of the ear being tested.

Table 1

An approximate table of the results of a hearing test for voice and elements of speech

Experts (R.M. Boskis, L.V. Neiman, etc.) note that special difficulties arise when studying auditory perception in children who do not speak and do not show obvious remnants of hearing. Their hearing status is examined only by a teacher of the deaf using sounding toys (drum, tambourine, triangle, accordion, etc.) and voice.

If a preschooler or junior school student If at least a minimal decrease in hearing acuity is detected, the speech therapist will refer him (with his parents) for a more thorough examination to a specialist. An otolaryngologist, using appropriate equipment (tuning forks, an audiometer - a modern electroacoustic device), more skillfully examines the state of hearing.

(slide 22,23, 24,25,26) To improve the pronunciation side of speech in children, mastering the correct pronunciation of words, systematic work is necessary, aimed at developing auditory attention, speech breathing, voices, sound pronunciation. For this purpose, special games and exercises are used. The development of auditory attention is especially important, since under its control the formation of the pronunciation side of speech is carried out. Work to improve pronunciation can be done by imitating sounds, staging sounds different ways and automation of delivered sounds.

^ Children with dysarthria need observation by a neurologist (at least periodically). Since this disorder is always the result of a brain disease, it requires long-term and patient treatment. The same long and patient work should be carried out to correct speech defects - of course, under the guidance of a speech therapist

We carry out correctional work with children who are most often diagnosed with an erased form of dysarthria; it is relatively simple compared to the others, and is more common than all other forms. Everything is corrected as a whole: breathing, voice formation, tempo, rhythm, pronunciation, grammar

Remember that mild forms of dysarthria may not always be accompanied by non-speech disorders!

^ Defects in the structure of the jaws , nasopharynx affects the shape of the face, and children painfully experience their physical disabilities.

Treatment should begin with an attempt to correct the existing physical defect. Currently, most experts recognize the need for early surgical intervention in these cases. Lip plastic surgery can be performed already in the first hours of a child’s life. For cleft palate, a prosthesis is made to cover the defect; The baby will then be able to suck. In the future, such a prosthesis will help the correct development of sound articulation. In the second year you can already do it plastic surgery palate.

To do this, you need to contact a specialist in maxillofacial surgery as soon as possible. Speech therapy classes are of great importance, since it is very important for such children to establish correct breathing and sound of the voice, and to teach them the articulation of sounds. For cleft palates, speech therapy sessions should begin before surgery and continue after it.

(slide 28) In case of violation of the rhythm and tempo of speech treatment consists of the use of tonics, therapeutic exercises and speech therapy rhythm classes. Treatment of children with tachylalia consists primarily of reducing their general excitability (with the help of medications, physical therapy). Imitation plays an important role in the development of speech rate disorders. Therefore, if someone in a child’s family has a violation of the rhythm and tempo of speech (and this is usually the case), then this person must also be treated, otherwise the child will have relapses all the time .

(slide 29) In the treatment of stuttering Along with speech therapy, medical assistance is also necessary. A child who stutters must be under the supervision of a neurologist. Experience shows that the most successful treatment for stuttering is inpatient treatment. Speech classes are built in the form of conversations, viewing didactic materials, filmstrips, and working on crafts. During classes you should use books, toys, and board games. At the same time, parents should monitor their children’s speech, help them express thoughts correctly, without focusing on a speech defect. Speech classes should be conducted regularly and in accordance with the principle from simple to complex, from familiar to unfamiliar. From the simplest situational forms to a detailed statement - this is the way to overcome stuttering. This is a very difficult task, and success here accompanies those parents who are not stopped by the first failures.

At the slightest suspicion of hearing loss in a child, you should consult a doctor. Children from about 5 years of age have the opportunity to very accurately determine the extent of hearing loss using a special device - an audiometer. (slide 30)

^ Used Books.

1. Lyapidevsky S.S.

Neuropathology. Natural science foundations of special pedagogy: Proc. for students higher textbook institutions / Ed. IN AND. Seliverstova. -M.: Humanite. ed. VLADOS center, 2000. - 384 p. - (Correctional pedagogy).

2 .Bibliography: Badalyan L.O. Children's neurology, M., 1984;

3 . Isaev D.N. Mental underdevelopment in children, L., 1982;

4 . Luria A.R. Higher cortical functions of humans and their disturbances in local brain lesions, M., 1969;

Same, Fundamentals of Neuropsychology, M., 1973; aka, Language and Consciousness, M., 1979;

^ 5 .Mastyukova E.M. and Ippolitova M.V. Speech impairment in children with cerebral palsy, M., 1985, bibliogr.;

6 . Ushakov G.K. Child psychiatry, p. 89, M., 1973.

7 . Ananyev B. G. On the problems of modern human knowledge. - M.

1977. Section V. Some issues in the methodology of psychological research. - P. 275-332.

8 . Badalyan L. O. Neuropathology. - M., 1987.

9 . Becker K.P., Sovak M. Speech therapy. - M., 1981. - P. 11-23.

10 . Vygotsky L. S. Thinking and speech // Collection. Op. - M., 1982. -T.

11 . Zhinkin N.I. Speech as a conductor of information. - M., 1982.

12 . Leontyev A. N. Problems of mental development. - M., 1981.

13 . Leontyev A. A. Language, speech, speech activity. - M., 1969.

14 . Luria A. R. Fundamentals of neuropsychology. - M., 1973. - P. 374.

15 . Fundamentals of the theory and practice of speech therapist // Ed., R. E. Levina. -

M., 1968 - P. 7-30.

16. Pravdina O.V. Speech therapy. - M., 1973. - P. 5-8.

17 . Khvattsev M. E. Speech therapy. - M., 1959. - P. 5-14.

For an animal, reality is represented exclusively by irritations and their traces in the cerebral hemispheres in special cells of the visual, auditory and other centers.

This is what appears to a person as impressions, sensations and ideas from the surrounding external environment.

This is the first signaling system of reality that we have in common with animals.

But the word constituted a second, special system of reality, being a signal of the first signals.

This ensures unlimited orientation of a person in the surrounding world and forms the most perfect mechanism of a rational being - knowledge in the form of universal human experience. Cortical connections formed through speech are a property of the higher nervous activity of “homo sapiens,” however, it obeys all the basic laws of behavior and is determined by the processes of excitation and inhibition in the cerebral cortex. So, speech is a conditioned reflex of a higher order. It develops as a second signaling system.

Hearing for articulate speech is only one part of the speech act. Another part of it is the pronunciation of sounds, or articulation of speech, which is constantly controlled by hearing. Speech is also a signal for communication with other people and for the speaker himself. During articulation (pronunciation), numerous subtle irritations arise, coming from the speech mechanism to the cerebral cortex, which become a system of signals for the speaker himself. These signals enter the cortex simultaneously with the sound signals of speech.

As already noted, speech is not an innate human ability. The first vocal manifestation of a newborn is a cry.

This is an innate unconditioned reflex that occurs in the subcortical layer, in the lowest department of higher nervous activity. A cry occurs in response to external or internal irritation. Each newborn child is exposed to cooling - the action of air after birth, the temperature of which is lower than the temperature in the womb; in addition, after ligation of the umbilical cord, the flow of maternal blood stops and oxygen starvation occurs. All this contributes to the reflexive inhalation as the first manifestation of independent life and the first exhalation, during which the first cry occurs.

Subsequently, the crying of newborns is caused by internal irritations: hunger, pain, itching, etc. At 4–6 weeks of life, the vocal manifestations of infants reflect his feelings. An external manifestation of calmness is a soft sound of the voice; in case of unpleasant sensations, the voice is harsh; during this period, different consonant sounds begin to appear in the child’s voice—“humming.” This is how the child gradually acquires a motor prototype for further speech development. Each sound produced is transmitted by a wave of air to the hearing aid and from there to the cortical auditory analyzer. In this way, a natural connection between the motor analyzer and the auditory analyzer develops and consolidates. At the age of 5–6 months, the child’s stock of sounds is already very rich. The sounds can be cooing, smacking, vibrating, etc. The easiest sounds for a child to make are those made by the lips and the front part of the tongue (“mom,” “dad,” “baba,” “tata”), since the muscles of these parts are well developed thanks to sucking.

In the period between 6–8 months, conditioned reflexes and differentiation of the first signaling system are formed. There is a repetition of one syllable as a primitive speech manifestation. The child hears the formation of phonemes (certain sounds), and the sound stimulus reproduces the articulatory stereotype. In this way, a motor-acoustic and acoustic-motor connection is gradually developed, that is, the child pronounces those phonemes (sounds) that he hears. Between 8–9 months, a period of reflexive repetition and imitation begins. The auditory analyzer takes on the leading role. By constant repetition of different syllables, the child develops a closed auditory-motor circle.

During this period, a mechanism for repeating complex sounds arises. The mother repeats the child's babble, and her voice falls into the child's well-established acoustic-motor circle. This is how the work between audible and one’s own speech is established. First, the child repeats syllables or monosyllabic words after the mother. This function of simple repetition of audible sounds is called physiological echolalia and is a characteristic feature of the first signaling system (animals, such as parrots, starlings, and monkeys, can also repeat individual syllables and simple words). At approximately the same time as physiological echolalia (repetition, imitation), an understanding of the meaning of words begins to develop. The child perceives words and short phrases as verbal images. The shade of the phrase spoken by parents plays an important role in understanding the meaning of words. During this period, the visual analyzer begins to play an increasingly important role in the formation of speech. As a result of the interaction of the auditory and visual analyzers, the child gradually develops complex analytical (acoustic-optical) processes.

The mechanisms of both signaling systems are strengthened, and conditioned reflexes of a higher order arise. For example: a child is brought to a ticking clock and at the same time they say: “tick tock.” After a few days, the child turns to the clock as soon as “tick tock” is said.

The motor reaction (turning towards the clock) is evidence that the acoustic-motor connection has been consolidated. Auditory perception causes a motor response, which is related to the previous visual perception. At this stage, the motor analyzer is more developed than the stimulus of speech mechanisms. Subsequently, the child constantly develops more and more complex general motor reactions to verbal stimulation, but these reactions are gradually inhibited, and a speech response is formed. The child begins to pronounce his first independent words, as a rule, at the beginning of the second year of life. As the child develops, external and internal stimuli and conditioned reactions of the first signaling system cause speech reactions.

In this period of the child’s life, all external and internal stimuli, all newly formed conditioned reflexes, both positive and negative (negative), are reflected by speech, that is, they are associated with the motor speech analyzer, gradually increasing the vocabulary of the child’s speech.

Based on the already developed acoustic articulatory and optical articulatory connections, the child pronounces a previously heard word without prompting and names visible objects.

In addition, he uses tactile and gustatory connections, and all analyzers are included in complex speech activity. During this period a complex system conditioned connections, the child’s speech is influenced by direct perception of reality. Emotions have a huge influence on the development of speech, and the word appears under the influence of joy, displeasure, fear, etc. This is due to the activity of the subcortical system of the brain. The first words that a child pronounces independently arise as conditioned reflex reactions, depending on external and internal environmental factors. The child names the objects he sees, expresses his needs in words, for example, hunger, thirst, etc. During this period, each word becomes a targeted speech manifestation, has the meaning of a “phrase” and is therefore called a “one-word phrase.”

The child expresses his mood with a variety of voice tones. The child speaks one-word phrases for about six months (up to 1.5–2 years of age), then he begins to form short verbal chains, for example: “mom, na,” “baba, give,” etc. Nouns are used mainly in the nominative case, and the verbs are in the imperative, indefinite mood, in the third person.

At the 3rd year of life, the correct linking of words into short speech chains begins; the child’s vocabulary is already 300–320 words. The more objects and things a child knows and names them correctly, the more connections are recorded in the cerebral cortex.

With the help of repeated stimuli from the external environment, the child forms complex reactions, which are the product of the interaction of newly acquired and already established reflex connections in the cortex, the product of the close relationship of the first and second signaling systems.

This is how the higher integration ability of speech is gradually formed, the highest level of generalized cortical chain processes that make up physiological basis the most complex speech functions of the brain. Speech chains are connected into increasingly complex complexes, and the foundation of human thinking is laid. Of course, the development of speech does not end in childhood; it develops throughout the life of a human individual. Thus, the formation and development of speech are based on the most complex processes occurring in the human central nervous system, in the cerebral cortex, subcortical structures, peripheral nerves, and sensory organs.

Formation, development and individual characteristics A person’s speech depends on the type of higher nervous activity, the type of nervous system. The type of nervous system is a complex of basic qualities of a person that determine his behavior.

These basic qualities are excitation and inhibition.

The type of higher nervous activity is the activity of the first signaling system in its unity with the second signaling system. The types of higher nervous activity are not constant and unchanging; they can change under the influence of various factors, which include upbringing, social environment, nutrition, and various diseases. The type of nervous system, higher nervous activity determines the characteristics of a person’s speech.

Type I– normally excitable, strong, balanced – sanguine, characterized by a functionally strong cortex, harmoniously balanced with optimal activity of subcortical structures.

Cortical reactions are intense, and their magnitude corresponds to the strength of stimulation. In sanguine people, speech reflexes are developed very quickly and speech development corresponds to age norms.

The speech of a sanguine person is loud, fast, expressive, with correct intonation, smooth, coherent, imaginative, sometimes accompanied by gestures, facial expressions, and healthy emotional arousal.

Type II– normally excitable, strong, balanced, slow – phlegmatic, characterized by a normal relationship between the activities of the cortex and subcortex, which ensures impeccable control of the cerebral cortex over unconditioned reflexes (instincts) and emotions. Conditioned reflex connections in phlegmatic people are formed somewhat more slowly than in sanguine people.

Conditioned reflexes in phlegmatic people are of normal strength, constant, equal to the strength of conditioned stimuli. Phlegmatic people quickly learn to speak, read and write; their speech is measured, calm, correct, expressive, but without emotional overtones, gestures and facial expressions.

III type– strong, with increased excitability – choleric, characterized by a predominance of subcortical reactions over cortical control.

Conditioned connections are consolidated more slowly than in sanguine and phlegmatic people, the reason for this is frequent outbreaks of subcortical excitations, which cause protective inhibition in the cerebral cortex. Cholerics are unstable, poorly suppress their instincts, affects, and emotions. It is customary to distinguish three degrees of disruption of the interaction of the cerebral cortex and subcortical structures:

1) in the first degree, the choleric person is balanced, but highly excitable, has strong emotional irritability, often has excellent abilities, speech is correct, accelerated, bright, emotionally charged, accompanied by gestures, characterized by causeless outbursts of displeasure, anger, joy, etc.;

2) in the second degree, the choleric person is unbalanced, unreasonably irritable, often aggressive, speech is fast, with incorrect accents, sometimes with shouts, not very expressive, often unexpectedly interrupted;

3) in the third degree, choleric people are called bullies, extravagant, their speech is simplified, rude, abrupt, often vulgar, with incorrect, inadequate emotional coloring.

IV type– weak type with reduced excitability, characterized by cortical and subcortical hyporeflexia and reduced activity of the first and second signaling systems. A person with a weak type of nervous system has uneven and unstable conditioned reflex connections and frequent imbalances between the process of excitation and inhibition, with a predominance of the latter. Conditioned reflexes form slowly and often do not meet the strength of stimulation and the requirements for speed of response; speech is inexpressive, slow, quiet, sluggish, indifferent, without emotion. Children with type IV nervous system begin to speak late, speech develops slowly.

Various forms of speech disorders often arise against the background of certain disturbances in the activity of the nervous system, which is the material substrate of thinking, consciousness and speech. Without taking into account the state of the nervous system, a correct understanding of a speech defect is difficult.

Download:

Preview:

Neurological bases of speech pathology: aphasia, alalia, dyslexia, dysgraphia, dysarthria.

APHASIA – speech disorder, a consequence of damage to the areas of the brain responsible for speech. For most people, these areas are located in the left hemisphere of the brain. Aphasia usually occurs suddenly, often as a result of a stroke or head injury, but in some cases - for example, against the background of a brain tumor, infection, dementia (acquired dementia) - it can develop gradually.
Aphasia results in loss of the ability to speak and understand other people's speech, as well as the ability to read and write. Aphasia may be accompanied by other speech disorders - for example, dysarthria (articulation disorder) or apraxia of speech, which themselves are a consequence of brain damage. Aphasia can affect anyone, including children, but the disorder is most often observed in older people, regardless of gender.
Aphasia is the result of damage to one or more areas of the brain responsible for language. Most often, aphasia is a consequence of a stroke - an acute circulatory disorder, as a result of which blood does not flow to the brain, and brain cells, deprived of oxygen and nutrients, die. Aphasia can also be caused by severe head injuries, brain infections, tumors, or other diseases that affect the brain.
Signs and symptoms
Depending on the type of disease, the symptoms of aphasia vary: for example, with expressive aphasia, a person experiences difficulty pronouncing words and sentences, and with sensory aphasia, difficulty understanding speech. With global aphasia, a person is unable to speak or perceive the speech of others.
Depending on the location and size of the damaged area of the brain, the symptoms of aphasia may also vary; loss of speech can be either partial or complete.
Types of aphasia
Sensory aphasia
Damage to the temporal lobe of the brain can cause sensory aphasia, or so-called Wernicke's aphasia. In most cases, this type of aphasia is caused by damage to the left temporal lobe of the brain. People with Wernicke's aphasia may utter long sentences that have no meaning, add unnecessary words to sentences, and construct new words on their own, making their speech very difficult or almost impossible to understand. Wernicke's aphasia causes difficulty understanding other people's speech. At the same time, the person does not have any other visible disorders - since the part of the brain that is located away from the areas of the brain that controls movements is damaged, the person generally behaves and moves completely normally.
Motor aphasia
Efferent motor aphasia, or so-called Broca's aphasia, is a speech disorder caused by damage to the frontal lobe of the brain. People with Broca's aphasia are only able to produce short, simple sentences, often omitting prepositions because pronouncing words is difficult for them. For example, from a person with motor aphasia you might hear “walk the dog” instead of “I’ll go for a walk with the dog.” At the same time, people with Broca's aphasia perceive other people's speech well. Since the frontal lobe of the brain is partially responsible for motor skills, Broca's aphasia is often accompanied by paralysis or weakness of the right limbs - arms and legs.
Another type of aphasia is the so-called total or global aphasia, a consequence of damage to a significant part of the speech centers of the brain. Total aphasia leads to the inability to pronounce words and perceive the speech of others.
In addition, it is customary to distinguish several more types of aphasia, each of which is the result of damage to various speech centers of the brain. In some cases, people with aphasia, although able to speak and understand the meaning of words and sentences, have difficulty repeating individual words or sentences. In other cases, aphasia results in the inability to name an object correctly, even if the person knows what it is and understands how to use it.
Diagnostics
Often, the first signs of aphasia are noticed by the attending physician during the treatment of a head injury or other brain damage - in most cases, a neurologist. The doctor may conduct several tests that require the patient to follow certain commands, answer questions, name objects, and carry on a conversation. If aphasia is suspected, a larger test of the person's language functions is done to confirm the diagnosis.
Treatment .
In some cases, even without treatment, a person’s complete recovery and the disappearance of signs of aphasia are observed - usually after a short-term disruption of blood flow to the brain, the so-called transient ischemic attack, or micro-stroke. In such cases, a person's speech abilities may fully recover within a few hours or days.
In most cases, however, recovery of speech functions is not nearly as quick or complete. Although many people with aphasia experience spontaneous partial recovery of language function within a few weeks or months of brain injury, some signs of aphasia usually persist. In such cases it is often very useful speech therapy techniques. Restoring a person’s speech function usually takes a long time - over two years, and the earlier treatment begins, the more effective the recovery process. The success of speech recovery is influenced by many factors, including the cause of the brain injury, the location of the damaged area of the brain, the severity of the injury, and the person’s age and health.
The participation of family members in the treatment of aphasia in a patient is considered a very important component of therapy, therefore the patient’s relatives are advised to adhere to the following rules:
Simplify speech by building simple, short sentences
Repeat keywords if necessary
Maintain a normal communication style (that is, do not try to talk to the patient as if he were a small child or mentally retarded)
Invite the patient to participate in the conversation
Support all types of communication, be it speech or sign language
Correct a person with aphasia as little as possible
Provide the person with the necessary time to construct and pronounce sentences
Today, there are other approaches to rehabilitation therapy, including the use of computers to improve the speech abilities of a person suffering from aphasia. With the help of computers, therapy helps patients quickly restore certain elements of speech functions. In addition, the computer helps people who have difficulty perceiving individual sounds by providing special exercises for understanding phonemes.
Very often, a child who used to speak suddenly becomes silent as a result of stress or a severe infection. Parents and, often, neurologists attribute this child’s condition to neurosis, or less often to autism (if the speech damage occurred a long time ago). In fact, the state of lack of speech is called in one word - alalia.
ALALIA occurs when the speech areas of the brain are affected. The speech areas of the brain can be affected as a result of otoinfection or severe stress.
Motor alali I is a violation of the motor ability to speak, with full preservation of speech understanding. The child understands speech addressed to him but cannot speak at all. Or the child may speak in separate syllables, without being able to put syllables into words or words into phrases. A striking example of motor alalia is described by Veniamin Kaverin in his book “Two Captains”, when Sanka Grigoriev, the main character of the novel, did not speak until he was 9 years old, when a doctor accidentally appeared in his life and did speech therapy work with him. Subsequently, Sanka spoke perfectly and did not experience any difficulties with speech.
Touch alali I is the lack of understanding of speech in the presence of the opportunity to speak. A child with sensory alalia is immediately visible - sometimes he speaks a lot, but it is not clear. At the same time, he also cannot repeat individual sounds or syllables well after an adult. Or it swaps sounds. For example, instead of "mo", a child may say "om". However, the child has fairly good hearing.
Sensory alalia should be distinguished from Landau-Kleffner syndrome, in which impaired speech understanding is associated with epiactivity of the brain. Landau-Kleffner syndrome itself, in turn, should be distinguished from autism.
Children with alalia are trained using special methods and achieve good results when studying with a speech therapist. The speech therapist performs a special articulatory massage, achieving muscle tone of the articulatory apparatus and its mobility, which is necessary for both children with motor alalia and children with sensory alalia.
The division into sensory and motor alalia is arbitrary, since in practice there are often cases of mixed alalia. However, all forms of alalia are characterized by the presence of dissonance between verbal and non-verbal activities: a child can perfectly perform all tasks that do not require speaking, for example, drawing, putting together puzzles, arranging pictures in strict accordance with the plot, but become completely helpless when it is necessary to compose a story based on the pictures laid out or when an adult asks to explain what a particular character is doing in the picture.
The clinical picture of alalia varies quite widely. There are cases when speech was partially impaired and there are cases of complete absence of speech in a child under 10 or even 15 years old. However, practice has established that working with a speech therapist and neurologist works wonders: the child begins to speak. In addition, music has a huge impact on activating the speech areas of the brain. And as otolaryngologist Alfred Tomatis established, the frequency sound of music passed through the bone of a small patient returns the ability to speak to almost any person. Filtered frequencies are selected individually after special tests.
Practice shows that audiovocal training helps even completely non-speaking children to speak.
DYSLEXIA (from dis - disorder and Greek lexsikos - relating to words, speech) - a complex disorder of reading and writing (written speech) in children with normal intelligence under normal sociocultural conditions of development. There are several classifications of types of D., which are based either on the nature of errors (impairments) in reading and writing, or on the nature of deficits in the development of functions that support these types of activities. Each of the classifications has its own bases and different diagnostic schemes. Correction methods are usually associated with diagnostic methods and an approach to assessing the causes.
There is an idea about the hereditary nature of D. The highest heritability rates were obtained for spelling and the ability to distinguish phonemes (> 70%).
DYGRAPHIA
(from the Greek dys - a prefix meaning disorder, grapho - writing) - a writing disorder in which there are substitutions of letters, omissions and rearrangements of letters and syllables, as well as merging of words. Dysgraphia is caused by a disorder of the speech system as a whole and is a symptom of alalia, various forms of aphasia or speech underdevelopment. Dysgraphia is usually based on inadequate phonemic hearing (hearing for speech sounds) and pronunciation deficiencies that prevent mastery of the phonemic (sound) composition of a word. To correct dysgraphia, classes are conducted to correct deficiencies in oral speech, as well as special exercises in reading and writing.
DYSARTHRIA (from ancient Greek δυσ- - prefix meaning difficulty, disorder +ἀ ρθρόω - “join, connect”) - a pronunciation disorder due to insufficient innervation of the speech apparatus, resulting from lesions of the posterior frontal and subcortical parts of the brain. With dysarthria, unlike aphasia, the mobility of the speech organs (soft palate, tongue, lips) is limited, which makes articulation difficult. In adults, dysarthria is not accompanied by a breakdown of the speech system: disturbances in listening, reading, and writing. In childhood, dysarthria often leads to impaired pronunciation of words and, as a consequence, to impaired reading and writing, and sometimes to general underdevelopment of speech. Speech deficiencies in dysarthria can be corrected with speech therapy sessions.

Diagnostics and diseases. Medicines from A to Z