Articulation disorders as one of the causes of speech development deviation and its condition in young children. Examination of the cranial nerves. XII pair: hypoglossal nerve (n. hypoglossus)

According to the National Research Institute of Public Health of the Russian Academy of Medical Sciences, among the causes of hospitalization of the adult population in the direction of emergency medical care, diseases of the circulatory system are in the first place, in the structure of which cerebrovascular diseases occupy the second place after coronary disease hearts.

Acute cerebrovascular accidents (ACC) are central issue modern neurology. Those patients who, at the first signs of a stroke, seek medical help at the SMP, have a real chance to receive modern treatment in a timely manner.

This provision defines the primary task of the ambulance team - the correct diagnosis of stroke at the prehospital stage.

Taking into account the specifics of the work of mobile teams (time limit, lack of additional methods research) the only accessible way assessment of the state of the brain is a neurological examination.

The purpose of a neurological examination is to get an answer to the only question: is there a lesion of the central nervous system? The foundation for making the correct diagnosis, in addition to the anamnesis data, is a consistent study neurological status, but the only way to substantiate it - registration of all received information in the SMP call card.

The authoritative international journal Stroke proposed a simple test for prehospital rapid diagnosis of stroke - FAST. This abbreviation stands for Face-Arm-Speech-Time, or translated from English "face - hand - speech - time" by the name of the criteria being evaluated. According to the authors, this test is able to detect stroke in 79-83% of cases.

All this dictates the need to develop and introduce into the daily practice of the EMS a clear algorithm for assessing and describing the neurological status in patients not only with acute cerebrovascular pathology, but also with CNS lesions of a different etiology (traumatic brain injury, neuroinfection, toxic brain damage).

For a rapid assessment of the neurological status and a confident judgment about the presence or absence of damage to the central nervous system on DHE, it is necessary and sufficient to conduct a brief neurological examination according to the proposed plan.

Algorithm for assessing neurological status

CVA is diagnosed with the sudden appearance of focal, cerebral and meningeal neurological symptoms.

TO cerebral symptoms include: impaired consciousness, headache, nausea, vomiting, dizziness, convulsions.

The Glasgow Coma Scale is most commonly used to quantify consciousness. To do this, a scoring is carried out according to three criteria (eye opening, spontaneous speech and movements), and the level of impaired consciousness is determined by the sum of the points (15 - clear consciousness, 13-14 - stunning, 9-12 - stupor, 3-8 - coma) .

Headache is most characteristic of hemorrhagic forms of stroke; as a rule, nausea, vomiting, photophobia, and focal neurological symptoms occur simultaneously with it. It is usually followed by depression of consciousness, vomiting, severe neurological disorders.

With subarachnoid hemorrhage, the headache is very intense, unusual in nature, occurs suddenly. Patients characterize it as "a feeling of a strong blow to the head" or "spreading of hot liquid over the head." 3-12 hours after the onset of the disease, most patients develop meningeal signs.

Seizures (tonic, tonic-clonic, generalized or focal) are sometimes observed at the onset of a stroke (primarily hemorrhagic).

Nausea and vomiting are relatively common symptoms of brain damage. In any disease, nausea and vomiting appear, as a rule, not independently, but in combination with other symptoms, which facilitates differential diagnosis. characteristic feature"Brain" vomiting is the lack of connection with food intake, vomiting does not bring relief and may not be accompanied by nausea.

Dizziness can be manifested by the illusion of movement of one's own body or objects in space (true, systemic dizziness) or a feeling of "lightheadedness", lightness in the head (non-systemic dizziness).

Focal neurological symptoms

Focal neurological symptoms are manifested by the occurrence of the following disorders: motor (paresis, paralysis); speech (aphasia, dysarthria); sensitive (hypesthesia); coordinating (ataxia, abasia, astasia); visual (amaurosis, hemianopsia, scotoma); higher mental functions and memory (fixation or transient global amnesia, disorientation in time).

To identify focal neurological symptoms at the prehospital stage, it is necessary, first of all, to use the algorithm FAST test, and if it is impossible to carry it out or if inconclusive results are obtained, it must be supplemented with an assessment of other components of the neurological status.

The FAST test consists of four elements.

• face(face) - ask the patient to smile or show teeth. With a stroke, a noticeable asymmetry of the face occurs - the corner of the mouth is lowered on one side.
• arm(hand) - ask the patient to raise and hold both hands at 90 ° in the sitting position and 45 ° in the supine position. With a stroke, one of the arms drops.
• Speech(speech) - ask the patient to say a simple phrase. With a stroke, it is not possible to clearly pronounce words, or speech is absent.
• Time(time) - the sooner assistance is provided, the greater the chance of recovery.

The foundation for making the correct diagnosis of stroke is a consistent study of the neurological status.

Speech disorders: dysarthria - an articulation disorder in which the patient does not pronounce words clearly. At the same time, a person has a feeling that he has, as it were, "porridge in his mouth."

Aphasia is a disorder in which the ability to use words to communicate with others is lost, while the function of the articulatory apparatus and hearing is preserved. The most common are sensory (lack of understanding of reversed speech), motor (inability to speak while understanding reversed speech) and sensorimotor aphasia (lack of understanding of reversed speech and inability to speak).

From visual disturbances stroke may cause various kinds hemianopsia. Hemianopsia is a partial loss of one half of the visual field. Sometimes (with the defeat of the occipital lobe) hemianopsia may be the only symptom of stroke.

Approximately hemianopsia can be confirmed by a test with the division of the towel. The doctor is located opposite the patient and horizontally pulls a towel (bandage) about 80 cm long with both hands. The patient fixes his gaze at one point and shows where he sees the middle of the towel. The longer end of the towel remains on the side of the hemianopia.

Pupils: pay attention to the width and symmetry of the pupils, their reaction to light. Different sizes of pupils (anisocoria) is a formidable symptom that occurs, as a rule, with damage to the brain stem.

Oculomotor disorders: evaluate the position of the eyeballs and the volume of their movements. The patient is asked to follow with his eyes, without turning his head, an object moving in a horizontal and vertical plane.

With a stroke, the following oculomotor disorders can be observed: gaze paresis - limitation of the volume of movement of the eyeballs in the horizontal or vertical plane; deviation of the eyeballs - a violent turn of the eyeballs to the side; nystagmus - involuntary rhythmic, oscillatory eye movements; diplopia - doubling of visible objects.

Symmetry of the face: pay attention to the symmetry of the frontal folds, palpebral fissures, nasolabial folds, corners of the mouth. They ask the patient to wrinkle his forehead, frown his eyebrows, close his eyes, show his teeth (smile).

There are two options for paresis of facial muscles - central and peripheral. With stroke, central paresis develops on the side opposite to the focus, in which only the lower muscle group is affected. In this case, only the smoothness of the nasolabial fold and the drooping of the corner of the mouth are observed (in patients with impaired consciousness, the cheek “sails”).

In the case of peripheral paresis, the upper and lower muscle groups are affected. At the same time, in addition to the smoothness of the nasolabial fold and the drooping of the corner of the mouth, there are smoothness of the forehead folds, incomplete closure of the eyelids (lagophthalmos), the eyeball moves upward (Bell's phenomenon), and lacrimation is possible.

If the patient has peripheral paresis of facial muscles and no other neurological symptoms (hemiparesis), then the diagnosis of neuropathy of the facial nerve is more likely than a stroke.

Tongue deviation: ask the patient to show the tongue. Pay attention to its deviations from the midline (deviation of the tongue). With strokes, a deviation of the tongue in the direction opposite to the focus may occur.

Swallowing and phonation: with damage to the brain stem, the so-called bulbar syndrome may occur, which includes: swallowing disorder (dysphagia); loss of sonority of the voice (aphonia); nasal tone of voice (nazolalia); impaired articulation of the pronunciation of sounds (dysarthria).

Movement disorders(paresis): tests for latent paresis are carried out when the vision control is turned off. Upper Barre test - ask the patient to stretch their arms forward with palms up and hold them with closed eyes for 10 seconds. The limb on the side of the paresis drops or bends at the joints, and the hand begins to turn palm down (goes into a pronation position).

Lower Barre test - the patient lying on his back is asked to raise both legs 30 degrees and hold them in this state for 5 seconds. The leg on the side of the paresis will begin to drop. It is necessary to distinguish the weakness of one leg from the general weakness and inability to hold the legs in principle.

In patients with impaired consciousness, paresis can be detected as follows: raise your hands above the bed and release at the same time. The paretic hand falls more sharply than the healthy one.

It is necessary to pay attention to the shape of the hips and the position of the feet: on the side of the paresis, the thigh seems to be more spread out, and the foot is rotated outward more than on the healthy side. If you raise your legs by the feet, then the paretic leg bends at the knee joint more than the healthy one.

Pathological reflexes: for the diagnosis of stroke at the prehospital stage, it is enough to check the most common Babinsky reflex. It is manifested by slow extension of the big toe with a fan-shaped divergence of the remaining fingers, sometimes with flexion of the leg at the ankle, knee, and hip joints, in response to dashed irritation of the outer edge of the sole.

Sensitivity disorders: at the prehospital stage, it is enough to assess pain sensitivity. To do this, injections are applied to symmetrical parts of the body on the right and left, finding out whether the patient feels the same or not.

The injections should not be too frequent and strong, you should try to apply them with the same force. With stroke, hemihypesthesia is most common (decrease in sensitivity in one half of the body).

Coordination disorders: a disorder in the coordination of voluntary movements with preserved muscle strength is called ataxia.

Ataxia is examined using coordination tests (for example, finger-to-nose tests), during which it is possible to detect miss-hit and intentional tremor (hand trembling when approaching the target). It is also possible to walk on a wide base (legs wide apart), slow chanted (torn into syllables) speech.

meningeal syndrome

Meningeal syndrome is a symptom complex that occurs when the meninges are irritated. It is characterized by intense headache, often nausea, vomiting, general hyperesthesia, meningeal signs.

Meningeal signs can appear simultaneously with cerebral and focal neurological symptoms, and with subarachnoid hemorrhages, they can act as the only clinical manifestation of the disease.

These include the following symptoms.

Neck stiffness. An attempt to passively bend the head to the chest reveals the tension of the occipital muscles and at the same time it is impossible for the patient's chin to approach the sternum.

Kernig's symptom - the inability to fully straighten the leg at the knee joint, previously bent at a right angle in the hip and knee joints.

The upper symptom of Brudzinsky - when trying to bend the head of a patient lying on his back, his legs involuntarily bend at the hip and knee joints, pulling himself up to the stomach (checked simultaneously with the stiffness of the occipital muscles).

The lower symptom of Brudzinsky - with passive flexion of one leg in the hip joint and extension of it in the knee joint, involuntary flexion of the other leg occurs.

Undoubtedly, this algorithm greatly simplifies the true picture of the disease due to the loss of a number of details, however, it is practical and can be used by ambulance teams in everyday practice, since it allows, while saving time, to conduct an express assessment of all neurological symptoms that may appear in stroke.

Depending on the main complaints of the patient, the most important data on the presence or absence of certain characteristic symptoms should be entered in the EMS call card.

Conducting a rapid assessment of the neurological status according to the proposed algorithm makes it possible to judge with a high degree of certainty the presence or absence of damage to the central nervous system.

M. A. Miloserdov, D. S. Skorotetsky, N. N. Maslova

The hypoglossal nerve innervates the muscles of the tongue (except m. palatoglossus, supplied by the X pair of cranial nerves).

Inspection

The study begins with an examination of the tongue in the oral cavity and when it protrudes. Pay attention to the presence of atrophy and fasciculations. Fasciculations are worm-like, rapid, irregular muscle twitches. Atrophy of the tongue is manifested by a decrease in its volume, the presence of furrows and folds of its mucous membrane. Fascicular twitches in the tongue indicate involvement in the pathological process of the nucleus of the hypoglossal nerve. Unilateral atrophy of the muscles of the tongue is usually observed with a tumor, vascular or traumatic lesion of the hypoglossal nerve trunk at or below the level of the base of the skull; it is rarely associated with an intramedullary process. Bilateral atrophy most often occurs with motor neuron disease [amyotrophic lateral sclerosis (ALS)] and syringobulbia. To assess the function of the muscles of the tongue, the patient is asked to stick out the tongue.

Normally, the patient easily shows the tongue; when protruding, it is located in the midline. Paresis of the muscles of one half of the tongue leads to its deviation to the weak side (i.e. genioglossus healthy side pushes the tongue towards the paretic muscles). The tongue always deviates towards the weaker half, regardless of whether the consequence of any - supranuclear or nuclear - lesion is the weakness of the muscle of the tongue. You should make sure that the language deviation is true and not imaginary.

A false impression of the presence of a deviation of the tongue can occur with asymmetry of the face, due to unilateral weakness of the facial muscles. The patient is asked to perform rapid movements of the tongue from side to side. If the weakness of the tongue is not quite obvious, ask the patient to press the tongue against the inner surface of the cheek and evaluate the strength of the tongue, counteracting this movement. The pressure force of the tongue on the inner surface of the right cheek reflects the force of the left m. genioglossus, and vice versa. The patient is then asked to pronounce syllables with anterior lingual sounds (for example, "la-la-la"). With weakness of the muscles of the tongue, he cannot clearly pronounce them. To detect mild dysarthria, the subject is asked to repeat complex phrases, for example: “administrative experiment”, “episodic assistant”, “large red grapes ripen on Mount Ararat”, etc.

Combined damage to the nuclei, roots or trunks of IX, X, XI, XII pairs of CNs causes the development of bulbar paralysis or paresis. Clinical manifestations of bulbar paralysis are dysphagia (swallowing disorder and choking when eating due to paresis of the muscles of the pharynx and epiglottis); Nazolalia (a nasal tone of voice associated with paresis of the muscles of the palatine curtain); dysphonia (loss of sonority of the voice due to paresis of the muscles involved in the narrowing / expansion of the glottis and tension / relaxation of the vocal cord); dysarthria (paresis of muscles that provide correct articulation); atrophy and fasciculations of the muscles of the tongue; extinction of the palatine, pharyngeal and cough reflexes; respiratory and cardiovascular disorders; sometimes flaccid paresis of the sternocleidomastoid and trapezius muscles.

The IX, X and XI nerves together leave the cranial cavity through the jugular foramen, so unilateral bulbar palsy is usually observed when these cranial nerves are affected by a tumor. Bilateral bulbar palsy can be caused by poliomyelitis and other neuroinfections, ALS, Kennedy's bulbospinal amyotrophy, or toxic polyneuropathy (diphtheria, paraneoplastic, GBS, etc.). The defeat of neuromuscular synapses in myasthenia gravis or muscle pathology in some forms of myopathies are the cause of the same disorders of bulbar motor functions as in bulbar paralysis.

From bulbar palsy, in which the lower motor neuron (the nuclei of the cranial nerves or their fibers) suffers, pseudobulbar palsy should be distinguished, which develops with bilateral damage to the upper motor neuron of the cortical - nuclear pathways. Pseudobulbar palsy is a combined dysfunction of the IX, X, XII pairs of cranial nerves, due to bilateral damage to the cortical-nuclear tracts leading to their nuclei. The clinical picture resembles the manifestations of the bulbar syndrome and includes dysphagia, nasalolia, dysphonia and dysarthria. With pseudobulbar syndrome, in contrast to the bulbar syndrome, the pharyngeal, palatine, and cough reflexes are preserved; reflexes of oral automatism appear, the mandibular reflex increases; observe violent crying or laughter (uncontrolled emotional reactions), hypotrophy and fasciculations of the muscles of the tongue are absent.

Motor skills

GENERAL MOTOR . Children with erased dysarthria are motor awkward, the range of active movements is limited, the muscles quickly get tired during functional loads. Standing unsteadily on any one leg, cannot jump on one leg, walk along the “bridge”, etc. Poor imitate when imitating movements: how a soldier is coming how a bird flies, how bread is cut, etc. Motor failure is especially noticeable in physical education and music classes, where children lag behind in tempo, rhythm of movements, and also in switching movements.

FINE MOTOR HANDS . Children with erased dysarthria learn self-care skills late and with difficulty: they cannot fasten a button, untie a scarf, etc. In drawing classes, they do not hold a pencil well, their hands are tense. A lot of people don't like to draw. Particularly noticeable motor awkwardness of the hands in the classroom for applications and with plasticine. In the works on the application, there are also difficulties in the spatial arrangement of elements. Violation of fine differentiated hand movements is manifested when performing finger gymnastics tests. Children find it difficult or simply cannot, without assistance, perform an imitation movement, for example, “lock” - put the hands together, interlacing fingers; "rings" - alternately connect the index, middle, ring and little fingers with the thumb and other exercises of finger gymnastics.

In children school age in the first grade, there are difficulties in mastering graphic skills (some have “mirror writing”; replacement of letters “d” - “b”; vowels, word endings; poor handwriting; slow pace of writing, etc.).

FEATURES OF THE ARTICULATION DEVICE.
In children with erased dysarthria, pathological features in the articulation apparatus are revealed and the motor skills of the articulation apparatus are impaired. This manifests itself:
1) in the difficulties of switching from one articulation to another;

2) in a decrease and deterioration in the quality of articulatory movement;

3) in reducing the time of fixation of the articulatory form;

4) in reducing the number of correctly performed movements.

Pareticity the muscles of the organs of articulation are manifested as follows: the face is hypomimic, the muscles of the face are flaccid on palpation; posture closed mouth many children do not hold, tk. the lower jaw is not fixed in an elevated state due to the lethargy of the masticatory muscles; lips are flaccid, their corners are lowered; during speech, the lips remain sluggish and the necessary labialization of sounds is not produced, which worsens the prosodic side of speech. The tongue with paretic symptoms is thin, located at the bottom of the oral cavity, sluggish, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.

spasticity muscles of the organs of articulation is manifested in the following: the face is amimic, the muscles of the face are hard and tense on palpation. The lips of such a child are constantly in a half smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the “tube” articulation exercise, i.e. stretch the lips forward, etc. The tongue with a spastic symptom is often changed in shape: thick, without a pronounced tip, inactive.
Hyperkinesis with erased dysarthria, they manifest as trembling, tremor of the tongue and vocal cords. Tremor of the tongue manifests itself during functional tests and loads. For example, when asked to support a wide tongue on the lower lip at a score of 5-10, the tongue cannot maintain a state of rest, trembling and slight cyanosis (i.e. blue tip of the tongue) appear, and in some cases the tongue is extremely restless (waves roll over the tongue in longitudinal or transverse). In this case, the child cannot keep the tongue out of the mouth. Hyperkinesis of the tongue is more often combined with increased muscle tone of the articulatory apparatus.

Apraxia with erased dysarthria, it is simultaneously detected in the impossibility of performing any voluntary movements with the hands and organs of articulation. In the articulatory apparatus, apraxia manifests itself in the inability to perform certain movements or when switching from one movement to another. You can observe kinetic apraxia, when the child cannot smoothly move from one movement to another. Other children have kinesthetic apraxia, when the child makes chaotic movements, “feeling” for the desired articulatory position.

Deviation, those. deviation of the tongue from the midline, also manifests itself with articulation tests, with functional loads. The deviation of the tongue is combined with the asymmetry of the lips when smiling with the smoothness of the nasolabial fold.

Hypersalivation(increased salivation) is determined only during speech. Children do not cope with salivation, do not swallow saliva, while the pronunciation side of speech and prosody suffer.

When examining the motor function of the articulatory apparatus in children with erased dysarthria, it is noted that it is possible to perform all articulation tests, i.e. on assignment, children perform all articulatory movements - for example, puff out their cheeks, click their tongues, smile, stretch their lips, etc. When analyzing the quality of the performance of these movements, one can note: blurring, blurred articulation, weakness of muscle tension, arrhythmia, a decrease in the amplitude of movements, a short duration of holding a certain posture, a decrease in the range of movements, rapid muscle fatigue, etc. Thus, under functional loads, the quality of articulation movements sharply falls. This leads during speech to the distortion of sounds, mixing them and worsening the overall prosodic side of speech.

SOUND PRODUCTION.
At the initial acquaintance with the child, his sound pronunciation is assessed as complex dyslalia or simple dyslalia. When examining sound pronunciation, the following are revealed: mixing, distortion of sounds, replacement and absence of sounds, i.e. the same options as with dyslalia. But, unlike dyslalia, speech with erased dysarthria has violations of the prosodic side. Disorders of sound pronunciation and prosody affect speech intelligibility, intelligibility and expressiveness. Some children go to the clinic after classes with a speech therapist. Parents ask why the sounds that the speech therapist has set are not used in the child's speech. Examination reveals that many children who distort, omit, mix, or replace sounds can pronounce the same sounds correctly in isolation. Thus, sounds with erased dysarthria are put in the same ways as with dyslalia, but for a long time they are not automated and are not introduced into speech. The most common violation is a defect in the pronunciation of whistling and hissing. Children with erased dysarthria distort, mix not only articulatory complex and similar in place and method of formation sounds, but also acoustically opposed ones.

Quite often, interdental pronunciation, lateral overtones are noted. Children experience difficulties in pronouncing words of a complex syllabic structure, simplify the sound filling, omitting some sounds when consonants collide.
PROSODICA.

The intonation-expressive coloring of the speech of children with erased dysarthria is sharply reduced. The voice suffers, voice modulations in height and strength, speech exhalation is weakened. The timbre of speech is disturbed and sometimes a nasal shade appears. The pace of speech is often accelerated. When telling a poem, the child's speech is monotonous, gradually becomes less legible, the voice fades away. The voice of children during speech is quiet, modulation in pitch, in power of voice is not possible (the child cannot change the pitch of the voice by imitation, imitating the voices of animals: cows, dogs, etc.).

In some children, speech expiration is shortened, and they speak on inspiration. In this case, speech becomes choked. Quite often, children (with good self-control) are identified who, when examining speech, do not show deviations in sound pronunciation, tk. they pronounce the words scanned, i.e. by syllables, and only the violation of prosody takes the first place.
GENERAL SPEECH DEVELOPMENT

children with erased dysarthria are a heterogeneous group. Depending on the level of development language tools children are sent to specialized groups:

With phonetic disorders;

With phonetic-phonemic underdevelopment;

With a general underdevelopment of speech.

To eliminate erased dysarthria, a complex effect is needed, including medical, psychological, pedagogical and speech therapy areas. The medical impact, determined by a neurologist, should include drug therapy, exercise therapy, reflexology, massage, physiotherapy, etc.

Glossary.

echopraxia - imitative automatism, automatic repetition of movements and actions of other people.

Synkinesia - (Greek syn- together kinēsis movement; synonym: associated movements, friendly movements) - involuntary muscle contractions and movements accompanying an active motor act.

Kinesthetic oral praxis - The term is used to describe feedback between the sensations and the muscles of the body. Therefore, first of all, we have in mind the sensations associated with movement in space.
Kinetic oral praxis - Simple movements of the lips and tongue: stick out the tongue, puff out the cheeks, place the tongue between the teeth and the lower lip. Complex movements of the lips and tongue: whistle, “blow out” a burning candle, spit, kiss, etc.
Hyperkinesis - involuntary movements caused by contraction of the muscles of the face, trunk, limbs, less often the larynx, soft palate, tongue, external muscles of the eyes.
salivation - salivation, salivation.

Dystonia called a syndrome in which there is a constant or spasmodic muscle contraction, affecting both the agonist muscle and the antagonistic muscle. Muscle spasms are often unpredictable and change the normal position of the body.
hypomimia - Violation of facial expressions, characterized by her poverty, a frozen, mask-like expression. A smile, a grimace of crying with emotions arises belatedly ...
Deviation - deviation of parameters from the norm.

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Diagnosis of disorders of motor development
1. Examination of general voluntary motor skills
Instructions:
a) "Stand on one leg: left, right."

b) "Jump on two legs with advancement."

c) Throw and catch the ball.

D) Stay in one place.

D) Go up and down the stairs.

Criteria for evaluation:

5 points

4 points

3 points - tasks are not performed accurately enough, the child stretches his arms to the sides to maintain balance;

2 points - poor balance, standing on one leg, quickly stumbles, looking for support; throws the ball very low; does not maintain balance when stopped on command;

1 point - the task is not executed.
2. Study of the differentiation of spatial concepts (on a piece of paper)

Instruction: “Show me what is in the center of the picture? What's to the left of the square? What is to the right of the square? What is under the little triangle? What's between a circle and a big square? What are the shapes at the top of the picture? What are the shapes at the bottom of the picture?

Criteria for evaluation:

5 points - tasks are performed correctly;

4 points - tasks are executed with errors, but errors are corrected independently;

3 points - tasks are performed with minimal help from an adult;

2 points - active assistance from an adult is required to complete the task;

1 point - the task is not executed.

The child is offered a piece of paper with a picture geometric shapes

3. Study of the visual-spatial organization of movements
Instruction: “When I raise my right hand, you will also raise your right hand, and when I raise left hand You will also raise your left hand.” "Raise your right hand!" "Take your left ear with your right hand." "Raise your left hand!" "Take your right ear with your left hand."

Criteria for evaluation:

5 points - all tasks are performed correctly;

4 points - all tasks are performed correctly, but in slow motion;

3 points - tasks are performed correctly, errors are noticed and corrected independently;

2 points - echopraxia occurs during the first task and is retained during the subsequent ones, he notices errors on his own;

1 point - persistent echopraxia, he does not notice mistakes on his own.

The experimenter and the child sit opposite each other.

4. Research on the development of the kinesthetic basis of hand movements

Instruction:

1. "Put down the brush right hand down. All fingers except the thumb, squeeze, thumb pull to the left."

2. "Clench the hands of both hands into fists, while stretching the thumbs up."

3. "Clench the right (left) hand into a fist, put the palm of the left (right) hand on it."

4. "Clench the right (left) hand into a fist, lean the palm of the left (right) hand vertically against it."

Criteria for evaluation:

5 points - all tasks are performed correctly;

4 points - all tasks are performed correctly, but in slow motion;

3 points - tasks are performed correctly, synkinesis is observed;

2 points - tasks are performed with the help of an adult;

1 point - Tasks are not executed.

5. Study of visual-motor coordination of movements (graphic tests)

Study of movement accuracy.

A drawing on which "Paths" are drawn, at one end of which there are cars, at the other - a house. The car should "drive" along the path to the house. The width of the tracks is selected so that it is difficult enough, but accessible to the child. The type of tracks becomes more difficult from the first to the last.

Instruction: “Cars and paths to the houses are painted here. You must connect the car with the house with a line without leaving the path.

Criteria for evaluation:

5 points - when performing a task, there are no exits outside the track, the pencil does not come off the paper;

4 points - there are no exits outside the track, the pencil comes off no more than three times;
3 points - there are no exits outside the track, the pencil comes off no more than three times, synkinesis is observed;

2 points - no more than three exits outside the "path", uneven trembling line, very weak, almost invisible, or a line with very strong pressure, synkinesis;

1 point - the impossibility of execution, numerous exits outside the "path", repeated holding in the same place.

"Tracks"
Draw straight lines down the middle of the track without lifting your pencil or moving off the track.

Draw lines in the middle of the track without lifting your pencil and moving off the track.

6. Examination of kinesthetic oral praxis
1. Instruction: “Repeat the sounds after the speech therapist. Tell me, in what position are your lips when pronouncing ... "

BUT - ?

AND - ?

ABOUT - ? U-?

2. Instruction: “Pronounce the sounds [t] and [t] and tell me where the tip of the tongue was when they were pronounced, up or down?

3. Instruction : “Say [si] - [su], [ki] - [ku] and tell me how the position of your lips changed when they were pronounced?

4. Instruction: “Pronounce the sounds [i], [w] in succession in front of the mirror and tell me, when pronouncing which sound, the tip of the tongue is lowered, and when pronouncing which sound is it raised?”

5. Instruction: “Pronounce the sounds [t], [d], [n] and tell me where was the tip of the tongue when they were pronounced - behind the upper or lower teeth?

Criteria for evaluation:

5 points - correct answer;

4 points - self-correction or the correct answer after stimulating assistance;

3 points - search for articulation, response with single errors;

2 points - inaccurate answer, inaccurate performance of the task;

1 point - lack of response.

Examination procedure.

Exercises are performed while sitting in front of a mirror. The child is invited to reflect on the speech therapist to perform this or that exercise. The sequence of performing all exercises: "fence" - "window" - "bridge" - "sail" - "shovel", " delicious jam" etc.

In order to evaluate the performance articulation exercise, the child is asked to hold the organs of articulation in desired position 5-7 seconds.

1. Instruction

Open your mouth wide, lift the tip of the tongue up to the upper teeth - “sail”, fix this position, holding it for 5-7 seconds.

2. Instruction :

Tongue "shovel" - wide, flattened, lying motionless on the lower lip, mouth ajar, fix this position, holding it for 5-7 seconds.

3. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

- “tasty jam” - the mouth is open, a wide tongue wraps around the upper lip and then slowly moves from top to bottom into the oral cavity (hold for 5-7 seconds).

4. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

- "bridge" - the mouth is open, a wide flat tongue lies at the bottom of the mouth. The tip rests on the lower incisors (hold for 5-7 seconds).

5. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

- "window" - the mouth is open, the upper and lower teeth are visible (hold for 5-7 seconds).

Estimated:

The duration of holding the articulatory posture (sufficient, rapid exhaustion);

Symmetry;

Criteria for evaluation:

5 points - correct execution movements with exact correspondence of all characteristics to the presented;

4 points - slow and strenuous performance, rapid exhaustion;

3 points - pose fixation time is limited to 1-3 seconds;

2 points - performance with errors, long search for a pose, deviations in configuration, synkinesis, hyperkinesis, hypersalivation;

1 point l - non-execution of the movement.

8 Examination of dynamic coordination of articulatory movements
Examination procedure.

Exercises are performed while sitting in front of a mirror. The child is invited to perform movements reflected by the speech therapist. The child is asked to perform the exercises 4-5 times.

1. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

- “swing” (raise the tip of the tongue by the upper ones, then lower it by the lower incisors. Repeat this exercise 4-5 times).

2. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

- "Pendulum" (alternately touch the protruding tip of the tongue to the right, then to the left corner of the lips. Repeat this movement 4-5 times).

3. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

Raise the tip of the tongue to the upper lip, lower it to the lower, alternately touch the protruding tip of the tongue to the right, then to the left corner of the lips. Repeat these movements 4-5 times.

4. Instruction: “Look carefully in the mirror and repeat the movements after the speech therapist”: - stick out the tongue forward, while raising its tip up. Repeat these movements 4-5 times.

5. Instruction: “Look carefully in the mirror and repeat the movements after the speech therapist”:

Move at the same time lower jaw and tongue sticking out to the right, then to the left. Repeat these movements 4-5 times.

Estimated:

The sequence of movements;

Ability to switch from one movement to another;

Inertia of movement, perseveration;

The pace of movements;

Range of motion (range of motion sufficient, limited);

Accuracy of performing movements (exact execution, approximate, search for articulation, replacement of one movement by another);

The presence of synkinesis, hyperkinesis, salivation.

Criteria for evaluation:

5 points - relatively accurate execution of movements, all movements are coordinated;

4 points - slow and intense switching from one movement to another;

3 points - the number of correctly performed movements is limited to two or three;

2 points - execution with errors, long search for a pose, replacement of one movement by another, synkinesis, salivation, hyperkinesis;

1 point - non-execution of movements.

9 Examination of mimic muscles
Examination procedure. Exercises are performed in front of a mirror.The child is invited to perform movements reflected by the speech therapist. It is carried out according to the model, then according to verbal instructions.

1. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

Furrow your brows

2. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

Raise your eyebrows

3. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

wrinkle forehead

4. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

Puff cheeks alternately

5. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

Draw in cheeks

Criteria for evaluation:

5 points - accurate performance of tasks, the absence of violations of the muscle tone of the mimic muscles and other pathological symptoms;

4 points - inaccurate execution of some movements, a slight violation of the tone of mimic muscles;

3 points - single movements are broken, single pathological symptoms;

2 points - difficulty in performing movements, moderately pronounced violation of the muscle tone of the mimic muscles (hypertonicity, hypotension, dystonia), smoothness of the nasolabial folds, synkinesis;

1 point - grossly expressed pathology of the muscle tone of the mimic muscles, hypomia.
10 Examination of muscle tone and lip mobility
Examination procedure: the child is invited to repeat the movements reflected by the speech therapist, sitting at the table in front of the mirror.

1. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

- “tube” (pull closed lips forward with a tube, hold for 5-7 seconds).

2. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

Alternating "fence" - "tube" (up to 5 times).

3. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

Raise the upper lip, lower the lower lip, repeat the movements several times.

Criteria for evaluation:

5 points - accurate performance of tasks, tone is normal, lips are mobile;

4 points - inaccurate execution of movements, a slight violation of the tone of the labial muscles (hypertonicity, hypotension, dystonia);

3 points - the upper lip is tense, its mobility is limited;

2 points - Difficulties in performing movements, a pronounced violation of the tone of the labial muscles, the lips are inactive;

1 point - non-fulfillment of tasks, rudely expressed pathology.

11. Examination of the muscle tone of the tongue and the presence of pathological symptoms
Examination procedure:the child is invited to repeat the movements in front of the mirror in reflection behind the speech therapist.

1. Instruction: “Look carefully in the mirror and repeat the movements after the speech therapist”:

- "shovel" - the tongue is wide, flattened, motionless lies on the lower lip.

2. Instruction : "Look carefully in the mirror and repeat the movements after the speech therapist":

- "bridge" - from the "window" position, the tongue rests on the lower incisors, the tongue is wide, flat, calmly lies in the oral cavity.

3. Instruction: “Look carefully in the mirror and repeat the movements after the speech therapist”:

- "Pendulum" - alternately reach the tip of the tongue to the right, then to the left corner of the mouth.

Criteria for evaluation:

5 points - accurate execution of movements, absence of violations of the muscle tone of the tongue, pathological symptoms;

4 points - inaccurate performance of tasks, a slight violation of the tone of the tongue (hypertonicity, hypotension, dystonia);

3 points - difficulties in performing exercises, moderately pronounced violation of the muscle tone of the tongue, salivation, which increases with functional load, deviation of the tongue;

2 points - a roughly pronounced violation of the muscle tone of the tongue, severe pathological symptoms (permanent salivation, hyperkinesis, blue tip of the tongue, deviation);

1 point - does not complete the task.

Diagnosis of motor development disorders in children with erased dysarthria

Profile of the structure of the movement disorder of a child with erased dysarthria

After the completion of the entire examination, a profile of the structure of the movement disorder of a child with erased dysarthria is compiled. The scoring of the function allows us to assess not only the presence of pathological symptoms, but also the degree of its severity.

The graph shows a curve showing the state of motor development (general, manual, articulatory) at the time of the examination. After carrying out corrective measures, the graph reflects the dynamics in the form of a second curve. Thus, the results of the correction work can be seen on the graph.

Examination parameters:
1. Examination of general voluntary motor skills.

2. Study of the differentiation of spatial concepts.

3. Study of visuo-spatial orientation of movement
4. Study of the development of the kinesthetic basis of hand movements.

5. Study of hand-eye coordination (graphic tests).

6. Examination of kinesthetic oral praxis.
7. Examination of kinetic oral praxis.

8. Examination of dynamic coordination of articulatory movements.
9. Examination of mimic muscles.
10. Examination of the labial muscles
11. Examination of the lingual muscles.

conclusions

1. The development of the motor apparatus of children is a factor that stimulates the development of speech.

2. The level of development of children's speech depends on the degree of development of fine movements of the fingers. One third of the entire area of ​​the motor projection of the brain is occupied by the projection of the hand, which is located next to the projection of the speech motor zone.

3. Fine motor skills is a motor activity, which is determined by the coordinated work of the small muscles of the hand and eye.

4. The movements of the fingers are of particular importance, as they influence the development of higher nervous activity child.

5. The motor sphere of children with erased dysarthria is characterized by slow, awkward, constrained, undifferentiated movements.

6. All motor pathological symptoms with erased dysarthria appear in an unsharply pronounced form.

7. Most clearly motor insufficiency manifests itself in the performance of complex motor acts that require precise control of movements.

8. In children with erased dysarthria, the kinesthetic and kinetic basis of movements is not sufficiently developed.

9. In children with erased dysarthria, pathological symptoms are detected in the articulatory, vocal, and respiratory sections of the peripheral speech apparatus.

10. Diagnosis of motor development disorders is necessary to clarify the structure of the defect.

Deviation of the tongue is its deviation to the right or left of the midline. If healthy person ask to stick out the tongue, then he will easily do it, and it will be located exactly in the middle of the oral cavity. If the hypoglossal nerve somehow works incorrectly, then it will be possible to observe the deviation of the organ of speech.

It is violations in the functioning of the nervous system that lead to problems in the muscles of the tongue, and sometimes the face. Most often, such changes occur due to brain diseases, for example, due to a stroke.

What is a stroke?

A stroke is a violation of the blood circulation of the brain, associated with neurological symptoms that do not go away for several months. This is very serious illness, at which in a quarter of cases occurs fatal outcome. The same proportion of patients become first-degree disabled. And some people who have had a stroke gradually return to normal life. However, this takes a very long time, because in most cases, patients need to re-learn how to move and speak. Often patients are bedridden and unable to take care of themselves.

What could be the causes of language deviation?

Why does the tongue deviate to the left? The reasons for this are rooted in neuroscience. Deviation can occur due to improper operation of the hypoglossal nerve. In this case, the muscles of the speech organ on the left side become significantly weaker than on the right. Therefore, when the tongue is pushed out of the oral cavity, it shifts to the weaker side. Similarly, there is a deviation of the tongue to the right.

Also, deviation may appear due to the unevenness of the face, when the facial muscles on the one hand are much stronger. In such cases, when protruding the tongue, it will also move to one side. In some cases, this happens completely imperceptibly, and sometimes the pathology is visible very well. However, the tongue itself functions normally, and its muscles on both sides have the same strength.

Diagnosis of language deviation

Diagnosing the presence of tongue deviation is not always easy. But in most cases, it is enough for the patient to simply stick it out. Seeing the deviation, the doctor can conclude which side of the muscle is weaker. For example, if there is a deviation of the tongue to the right, the reasons lie in the fact that this area of ​​\u200b\u200bthe face is less strong.

However, deviation is not always associated with brain diseases. Sometimes such deviations can be explained by the insufficient development of the facial muscles of the face on the one hand.

To determine what exactly the doctor is dealing with, the patient is usually asked to make a quick movement of the tongue in both directions. In this case, it will be seen with what force these manipulations are performed.

If such measures do not help, then the patient should be asked to press the tongue on both cheeks with inside in turn. For example, a specialist diagnoses the right side. He tests the force of pressure with the help of a hand on the outside of the right cheek, trying to counteract the force of the tongue. In this case, the specialist will be able to assess how his muscles work and understand if there is a deviation of the tongue to the right.

Treatment of tongue deviation

It should be noted that deviation is not an independent disease, it is only a symptom that manifests itself as a result of other diseases. Therefore, getting rid of such a manifestation depends entirely on the treatment of the disease that caused it. If the cause is a stroke, which happens most often, it is necessary to eliminate violations of the blood supply to the brain. As soon as this problem will be eliminated, the nerves will return to normal, and, consequently, the symptoms associated with neurology will also disappear. If the matter is in the facial muscles of the face, then it is necessary to consult a doctor and, with the help of special exercises, develop muscles that lag behind the other side.

Deviation of the child's tongue

A stroke or a curvature of the muscles of the face is an unprecedented phenomenon for a child, but children also experience language deviation. As a rule, the cause of such a symptom is dysarthria or erased dysarthria.

This disease is caused by a violation of the signal from the brain to the muscles of the articulatory apparatus. In this case, an incorrect nerve signal can be reflected both in the muscles of the child's face and in the tongue.

Not many children experience this. However, cases were still recorded. Most of those suffering from such disorders outwardly look like completely healthy children, and only a doctor is able to determine that the child has dysarthria.

Symptoms of dysarthria in a child

With violations of the transmission of the nerve signal, the child's face becomes inactive and does not express any emotions with the help of facial expressions. The patient's lips are often pursed, the corners are lowered down, such a facial expression is preserved in the child almost constantly.

In severe cases, due to the disease, the child cannot close his mouth and keep his tongue in the mouth. Also, with dysarthria, the patient often has a deviation of the tongue. If you ask the baby to stick out the organ of speech, then it will be possible to notice that it is difficult for the child to keep it on the midline. The tongue trembles slightly and deviates to the side.

The difference between dysarthria and erased dysarthria

As a rule, with dysarthria, there is a pronounced inactivity of the face, which is very easy to notice on the face of a child. Other signs can also be noted, such as impaired coordination in hand movements and disorientation in space. In general, children with dysarthria do not like to do drawing, clay modeling or any other activity that requires the use of fine motor skills of the hands.

However, more and more often there are children who do an excellent job with any kind of activity, like to draw and engage in creativity. At the same time, they have mobile facial expressions, they smile a lot, laugh and are no different from the usual healthy child. The only thing that betrays the presence of dysarthria is the deviation of the tongue. As a rule, in children suffering from this disease, the tongue is quite thick. If you ask a child to stick it out of his mouth, you may notice that the tongue shakes and deviates to the side. The manifestation of such symptoms in medicine is called erased dysarthria.

Combines both diseases slurred speech. The child may lisp, swallow some sounds. At the same time, it is quite difficult to understand what the child is saying. Speech is extremely slurred and inarticulate.

How does dysarthria affect the child's psyche?

Basically, all children suffering from erased or severe dysarthria have an unstable psyche. They are characterized by frequent mood swings, throwing from one extreme to another. The child may be, on the one hand, overly vulnerable, constantly crying over trifles, on the other hand, it may become aggressive, be rude to adults, and conflict with peers. Such children are rarely good students, as a rule, they are inattentive and do not delve into the essence of learning.

How to get rid of tongue deviation in a child?

In order to get rid of the deviation of the tongue in a child, complex treatment is necessary. Many parents believe that with erased dysarthria, it will be enough just to go to a speech therapist, who will help the child pronounce the words correctly. However, the diagnosis in this case is made by a neurologist and he must also prescribe treatment. As a rule, the child is prescribed not only classes with a speech therapist and training correct pronunciation sounds, but also a course of massage of the neck, collar area and chin. Also often used in therapy are facial massage with hands and probe massage of the tongue. In this case, it is simply impossible to achieve a result with the help of any medications; regular exposure to the source of the nerve impulse is necessary.

Treatment of tongue deviation in both an adult and a child primarily consists in treating the disease that caused the tongue to deviate from the midline. It is impossible to get rid of this problem without comprehensive measures. Doctors often recommend a combination of therapy aimed at the disease itself, as well as symptomatic treatment, which mainly includes massages and exercise. These measures will allow you to return the tongue and facial muscles as soon as possible. normal condition. Need to be paid Special attention language deviation in a child, since it is often possible to determine the presence of a disease only on this basis.

The main thing is timely treatment, because, otherwise, complications may develop. The most common are the development of slurred speech, difficulty in pronouncing words, the inability to pronounce any words (loss of speech).

Deviation of the tongue is its deviation to the right or left of the midline. If a healthy person is asked to stick out his tongue, he will easily do it, and it will be located exactly in the middle of the oral cavity. If the hypoglossal nerve somehow works incorrectly, then it will be possible to observe the deviation of the organ of speech. It is violations in the functioning of the nervous system that lead to problems in the muscles of the tongue, and sometimes the face. Most often, such changes occur due to brain diseases, for example, due to a stroke.

What is a stroke?

A stroke is a violation of the blood circulation of the brain, associated with neurological symptoms that do not go away for several months. This is a very serious disease, in which a quarter of cases are fatal. The same proportion of patients become first-degree disabled. And some people who have had a stroke are gradually returning to normal life. However, this takes a very long time, because in most cases, patients need to re-learn how to move and speak. Often patients are bedridden and unable to take care of themselves. Tongue deviation during a stroke is just one of the symptoms that can occur. As a rule, a cerebral hemorrhage greatly affects the neurotic state of the patient, and in addition to deviation of the speech organ, atrophy of the facial muscles, the inability to move the limbs on one side, and sometimes complete paralysis of the body or its individual parts may occur. Language deviation in stroke leads to a serious speech disorder. Is it possible to fully rehabilitate, get rid of the disease and how to do it?

What could be the causes of language deviation?

Why does the tongue deviate to the left? The reasons for this are rooted in neuroscience. Deviation can occur due to improper operation of the hypoglossal nerve. In this case, the muscles of the speech organ on the left side become significantly weaker than on the right. Therefore, when the tongue is pushed out of the oral cavity, it shifts to the weaker side. Similarly, there is a deviation of the tongue to the right. Also, deviation may appear due to the unevenness of the face, when the facial muscles on the one hand are much stronger. In such cases, when protruding the tongue, it will also move to one side. In some cases, this happens completely imperceptibly, and sometimes the pathology is visible very well. However, speech itself functions normally, and his muscles on both sides have the same strength.

Diagnosis of language deviation

Diagnosing the presence of tongue deviation is not always easy. But in most cases, it is enough for the patient to simply present it. Seeing deviations, the doctor can conclude which side of the muscle is weaker. For example, if there is a deviation of the tongue to the right, the reasons lie in the fact that this area of ​​\u200b\u200bthe face is less strong. However, deviation is not always associated with brain diseases. Sometimes such deviations can be explained by the insufficient development of the facial muscles of the face on the one hand. To determine what exactly the doctor is dealing with, the patient is usually asked to make a quick movement of the tongue in both directions. In this case, it will be seen with what force these manipulations are performed. If such measures do not help, then the patient should be asked to press the tongue on both cheeks from the inside in turn. For example, a specialist diagnoses the right side. He checks the pressing force with the help of a hand on the outside of the right cheek, trying to counteract the force of the tongue. In this case, the specialist will be able to assess how the muscles work, and understand if there is a deviation of the tongue to the right.

Treatment of tongue deviation

It should be noted that deviation is not an independent disease, it is only a symptom that manifests itself as a result of other diseases. Therefore, getting rid of such a manifestation depends entirely on the treatment of the disease that caused it. If the cause is a stroke, which happens most often, it is necessary to eliminate violations of the blood supply to the brain. As soon as this problem is eliminated, the nerves will return to normal, and, therefore, the symptoms associated with neurology will also disappear. If the matter is in the facial muscles of the face, then it is necessary to consult a doctor and, with the help of special exercises, develop muscles that lag behind the other side.

Deviation of the child's tongue

A stroke or a curvature of the muscles of the face is an unprecedented phenomenon for a child, but children also experience language deviation. As a rule, the cause of such a symptom is dysarthria or erased dysarthria. This disease is caused by a violation of the signal from the brain to the muscles of the articulatory apparatus. In this case, the wrong nerve signal can affect both the muscles of the child's face and the tongue. Not many children experience this. However, cases were still recorded. Most of those suffering from such disorders outwardly look like completely healthy children, and only a doctor is able to determine that the child has dysarthria.

Symptoms of dysarthria in a child

With violations of the transmission of the nerve signal, the child's face becomes inactive and does not express any emotions with the help of facial expressions. The patient's lips are often compressed, the corners down, such a facial expression is preserved in the child almost constantly. In severe cases of the disease, the child cannot close his mouth and keep his tongue in the mouth. Also, with dysarthria, the patient often has a deviation of the tongue. If you ask the baby to put forward the organ of speech, then you can see that it is difficult for the child to keep it in the middle line. The tongue trembles slightly and deviates to the side.

The difference between dysarthria and erased dysarthria

As a rule, with dysarthria, there is a pronounced inactivity of the face, which is very easy to notice on the face of a child. Other signs can also be noted, such as impaired coordination in hand movements and disorientation in space. In general, children with dysarthria do not like to do drawing, clay modeling, or any other activity that requires the use of fine motor skills of the hands. However, more and more often there are children who do an excellent job with any kind of activity, like to draw and engage in creativity. At the same time, they have mobile facial expressions, they smile a lot, laugh and are no different from an ordinary healthy child. The only thing that betrays the presence of dysarthria is the deviation of the tongue. As a rule, in children suffering from this disease, the tongue is quite thick. If you ask the child to stick it out of his mouth, you can notice that the speech trembles and deviates to the side. The manifestation of such symptoms in medicine is called erased dysarthria. Combines both diseases slurred speech. The child may lisp, swallow some sounds. At the same time, it is quite difficult to understand what the child is saying. Speech is extremely slurred and inarticulate.

How does dysarthria affect the child's psyche?

Basically, all children who suffer from erased or severe dysarthria have an unstable psyche. They are characterized by frequent mood swings, throwing from one extreme to another. The child may be, on the one hand, overly vulnerable, constantly crying over trifles, on the other hand, it may become aggressive, be rude to adults, and conflict with peers. Such children are rarely good students, as a rule, they are inattentive and do not delve into the essence of the teaching.

How to get rid of tongue deviation in a child?

In order to get rid of the deviation of the tongue in a child, complex treatment is necessary. Many parents believe that with erased dysarthria, only trips to a speech therapist will be enough to help the child pronounce the words correctly. However, the diagnosis in this case is made by a neurologist and he must also prescribe treatment. As a rule, the child is prescribed not only classes with a speech therapist and training in the correct pronunciation of sounds, but also a course of massage of the neck, collar zone and chin. Also often used in therapy are facial massage with hands and probe massage of the tongue. In this case, it is simply impossible to achieve results with the help of any medications; regular exposure to the source of the nerve impulse is necessary. Treatment of tongue deviation in both an adult and a child primarily consists in treating the disease that caused the tongue to deviate from the midline. It is impossible to get rid of this problem without comprehensive measures. Often, doctors recommend combining therapy aimed at the disease itself, as well as symptomatic treatment, which mainly includes massages and exercise. These measures will allow you to quickly return the tongue and facial muscles to normal. It is necessary to pay special attention to the deviation of the tongue in a child, since it is often possible to determine the presence of a disease only on this basis. The main thing is timely treatment, because, otherwise, complications may develop. The most common are the development of slurred speech, difficulty in pronouncing words, the inability to pronounce some words (loss of speech).