Assessment of neurological status in the emergency room. Neurogenic suffering of the tongue

Deviation of the tongue is its deviation to the right or left of the midline. If a 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 more weak 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. Once 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 the tongue and facial muscles to return to normal as soon as possible. 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 any words (loss of speech).

The structure of a speech defect is a violation of the sound-producing side of speech. For dysarthria characteristic: violations of articulatory motility in the form of a change in the tone of the articulatory muscles, limitation of the volume of their voluntary movements, coordination disorders, various kinds of synkinesis, tremor, hyperkinesis of the tongue, lips; respiratory disorders; voice disorders. Speech with dysarthria is slurred, fuzzy.
spasticity- increased tone in the muscles of the tongue, lips, face and neck. With spasticity, the muscles are tense. The “lump” tongue is pulled back, its back is spastically curved, raised to the top, the tip of the tongue is not expressed. The tense back of the tongue raised to the hard palate helps to soften consonant sounds.
(palatalization). Sometimes spastic tongue "sting", stretched out in front. An increase in muscle tone in the circular muscle of the mouth leads to spastic tension of the lips, tight closure of the mouth (it is difficult to voluntarily close the mouth). In some cases, with a spastic condition of the upper lip, the mouth may be ajar. In this case, there is an increase in salivation (hypersalivation). Active movements with spasticity of the articulatory muscles are limited.
hypotension- decreased muscle tone.
With hypotension, the tongue is thin, flattened in the oral cavity; lips flaccid, unable to close tightly. The mouth is usually half open, hypersalivation may be expressed. Hypotension of the muscles of the soft palate prevents sufficient advancement of the palatal curtain
up and pressing it against the back wall of the pharynx; a stream of air exits through the nose. The voice takes on a nasal tone (nasalization).
Dystonia- changing nature of muscle tone. At rest, low muscle tone can be observed, while trying to speak and at the time of speech, the tone increases sharply. Dystonia distorts articulation. A feature of sound pronunciation in dystonia is the inconsistency of distortions, substitutions and omissions of sounds.
In children with neurological pathology, a mixed and variable nature of tone disturbances in the articulatory muscles (as well as in the skeletal) is often noted. For example, spasticity may be noted in the lingual muscles, and hypotension in the facial and labial muscles.
Impaired mobility of the articulatory muscles.
Limited mobility of the muscles of the articulatory apparatus is the main manifestation of paresis of these muscles.
Insufficient mobility of the articulatory muscles of the tongue and lips causes a violation of sound pronunciation. With damage to the muscles of the lips, the pronunciation of both vowels and consonants suffers. Articulation as a whole is disturbed. Sound pronunciation is especially grossly impaired with a sharp restriction of the muscles of the tongue.
The degree of impaired mobility of the articulatory muscles can be different - from complete impossibility to a slight decrease in the volume and amplitude of articulatory movements of the tongue and lips. First of all, the most subtle and differentiated movements are violated (raising the tongue up).
Specific disorders of sound pronunciation:
- the persistent nature of violations of sound pronunciation, the particular difficulty of overcoming them;
- specific difficulties of automating sounds (duration of automation time). In case of late completion speech therapy classes acquired speech skills often disintegrate;
- the pronunciation of not only consonants, but also vowels is impaired (average or reduction of vowels);
- the predominance of interdental and lateral pronunciation of whistling with s, c, and hissing sh w h sch sounds;
- stunning voiced consonants ( ringing sounds pronounced with insufficient participation of the voice;
- softening of hard consonant sounds (palatalization);
- violations of sound pronunciation are especially pronounced in the speech stream. With an increase in speech load, general blurring of speech is observed, and sometimes increases.
Depending on the type of violation, all defects in sound pronunciation in dysarthria are divided into two categories: anthropophonic (distortions of sounds) and phonological (substitutions, mixing). In dysarthria, the most typical violation of the sound structure of speech is sound distortion.
Respiratory disorders are caused by insufficiency of the central regulation of respiration. The rhythm of breathing is disturbed: at the moment it becomes more frequent. There is a violation of the coordination of inhalation and exhalation (a superficial inhalation and a shortened weak exhalation). Exhalation often occurs through the nose, despite the half-open mouth. Respiratory disorders are especially pronounced in the hyperkinetic form of dysarthria.
Voice disorders are caused by changes in muscle tone and limitation of mobility of the muscles of the larynx, soft palate, vocal folds, tongue and lips. Most often, there is insufficient voice power (quiet, weak, fading) and deviations in the timbre of the voice (deaf, nasalized, squeezed, hoarse, intermittent, tense, gotany).
Violations of prosodic (melodic-intonational and tempo-rhythmic characteristics of speech).
Melodic intonation disorders are often among the most persistent signs of dysarthria. They have a greater effect on the intelligibility, emotional expressiveness of speech. There is a weak expression or absence of voice modulations (the child cannot arbitrarily change the pitch). The voice becomes monotonous, little or unmodulated. Violations of the pace of speech are manifested in its slowdown, less often in acceleration. Sometimes there is a violation of the rhythm of speech (scanning - "chopped" speech, when there is an additional number of stresses in words).
Insufficiency of kinesthetic sensations in the articulatory apparatus.
In children with dysarthria, there is a weakness in the kinesthetic sensations of articulatory postures and movements.
With dysarthria, vegetative disorders occur.
Frequent autonomic disorder is hypersalivation. Increased salivation is associated with restriction of the movements of the muscles of the tongue, impaired voluntary swallowing, cuts in the labial muscles. This disorder is aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus and a decrease in self-control. There is a vegetative disorder, such as redness or pallor of the skin, increased sweating during speech.
In children with dysarthria, the act of eating is often difficult, and in severe cases, there is no chewing of solid food, biting off a piece. Choking and choking are often noted when swallowing. Difficulty drinking from a cup. There is a lack of coordination between breathing and swallowing.
Dysarthria disorders may be accompanied by synkinesis.
Synkinesia- involuntary accompanying movements when performing arbitrary articulatory movements (additional movements mandible and lower lip up when trying to raise the tip of the tongue)
Oral synkinesis - opening the mouth during any voluntary movement or when trying to perform it.
Increased pharyngeal (vomit) reflex.
Loss of coordination of movements (ataxia)
Ataxia manifests itself in dysmetric, asynergic disorders and in scanned speech rhythm.
Dysmetria- this is disproportion, inaccuracy of arbitrary articulatory movements. It is most often expressed in the form of hypermetry, when the desired movement is realized by a more sweeping exaggerated, slow movement than necessary (an excessive increase in motor amplitude). There is also a violation of coordination between breathing, voice formation and articulation (asynergy).
Ataxia is noted in atactic dysarthria.
The presence of violent movements (hyperkinesis and tremor) in the articulatory muscles.

Hyperkinesis- involuntary, non-rhythmic, violent movements of the muscles of the tongue.

Tremor- trembling of the tip of the tongue (most pronounced with purposeful movements). Seen in atactic dysarthria.

The current problem of dysarthria childhood intensively developed in clinical, neurolinguistic, psychological and pedagogical directions. It is described in most detail in children with cerebral palsy (M. B. Eidinova, E. N. Pravdina-Vinarskaya, 1959; K. A. Semenova, 1968; E. M. Mastyukova, 1969,1971,1979,1983; I. I. Panchenko, 1979; L. A. Danilova, 1975, etc.). AT foreign literature it is represented by the works of G. Bohme, 1966; M. Climent, T. E. Twitchell, 1959; R. D. Neilson, N. O. Dwer, 1984.
1. Badalyan L.O. Pediatric neurology. — M.: Medicine, 1984. — 575p.
2. Speech therapy / Ed. L.S. Volkova, R.I. Lalaeva, E.M. Mastkova., M .: Education, 1989. - 527p.
3. Mastyukova E.M., Ippolitova M.V. Speech disorders in children with cerebral palsy. — M.: Enlightenment, 1985. — 192p.
4. speech therapy. Methodical heritage / Ed. L.S. Volkova: In 5 books. Book.I. Part 2. Rhinolalia. Dysarthria. - M.: Vlados, 2003. - 303 p.
5. Atlas of the human nervous system structure and violation/ Ed. V.M. Astapova, Yu.V. Mikadze - M.: PER SE, 2011. - 79s.

- (new lat. deviatio, from via road). 1) deviation of the magnetic needle in the compass on the ship from acting on it large masses iron in the hold. 2) unnecessary deviation from the intended direction (it is mainly about ships). ... ... Vocabulary foreign words Russian language

deviation- and, well. deviation f. specialist. Deviation, change in development, state, movement, etc. under the influence of some kind of l. external forces, conditions, etc. Deviation of the course of the ship. ALS 2. In the literal sense of the word, a deviation from a given direction, figuratively sharp ... Historical Dictionary of Gallicisms of the Russian Language

DEVIATION- (from late Latin deviatio Deviation) 1) Deviation of a moving body (ship, aircraft, projectile, etc.) from a given direction of movement (estimated trajectory) under the influence of any random external causes. 2) Deviation of a magnetic compass ... ... Big Encyclopedic Dictionary

Deviation- (from late Latin deviatio deviation), a term used to refer to objects, phenomena that deviate from the accepted norm, a given direction of movement, etc. (for example, projectile deviation, compass deviation, deviant ... ... Illustrated Encyclopedic Dictionary

DEVIATION- compass, French avoiding it, from the action of cast iron or iron, on the ship. Deviation of the ship, trade; arbitrary evasion of the skipper from the path, calling, unnecessarily, in ports. Dictionary Dahl. IN AND. Dal. 1863 1866 ... Dahl's Explanatory Dictionary

DEVIATION- (Deviation) in commercial terminology, the deviation of a ship from its normal direction. This occurs when the vessel, without legal grounds, deviates from the flight indicated in the policy, and where this flight is not specifically indicated, from the usual ... ... Marine Dictionary

deviation- deviation Dictionary of Russian synonyms. deviation noun, number of synonyms: 4 curvature (39) … Synonym dictionary

DEVIATION- (from lat. deviatio evasion) deviation of a sea vessel from the established (by agreement) or usual route. Standard cases D. rescue of people, ships, medical assistance to persons on board, etc. In Anglo American... Law Dictionary

Deviation- A. A sharp change in the exchange rate of securities under the influence of unforeseen events and circumstances. B. Changing the course of a sea vessel due to one of the following reasons: saving people, ships and cargo, avoiding danger threatening the ship ... Glossary of business terms

DEVIATION- DEVIATION, deviations, women. (French deviation Deviation) (spec.). Deviation of the compass needle from the magnetic meridian under the influence of iron located near. Explanatory Dictionary of Ushakov. D.N. Ushakov. 1935 1940 ... Explanatory Dictionary of Ushakov

DEVIATION- [de], and, female. (specialist.). 1. Deviation of the compass needle under the influence of large masses of iron located nearby, as well as electromagnetic fields. 2. Deviation (of a moving body) from a given direction (for example, a projectile, bullet, ship) under the influence of some ... Explanatory dictionary of Ozhegov

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A person's language can become a correct indicator of the presence of certain diseases.

If there are deviations from the norm in appearance, it makes sense to contact a medical specialist and conduct a diagnosis.

1. What are language changes

Language changes are understood as violations of its color, surface integrity, pathology of shapes and sizes. AT normal condition the tongue should be moist and clean, with no plaque on the surface.

Also, its two halves must be identical in shape and size. Normal color is bright pink. When the tongue is protruding, it should be centered without deviation and the tip, and the entire tongue to the right or left.

Everything else is considered changes that may indicate the presence of a serious illness.

2. Reasons for language changes

Basically, obvious changes in the language indicate the presence of a particular disease in a person. Independent pathologies of the tongue are much less common.

Its color may change at high temperature. Also, the causes of the lesion can be injuries of the tongue as a result of biting, burns, wearing braces.

3. In what diseases does this symptom occur

The most popular pathology of the tongue is a change in its color. Depending on what shade the tongue acquires, it is possible to determine the disease that caused this:

• A red tongue can speak of severe infectious diseases, as well as impaired renal function;
• The crimson color of the tongue is associated with anemia, scarlet fever;
• The blanching of the tongue is also related to anemia, as well as to severe emaciation;
• Yellow tongue is a symptom of excess bile in the gallbladder or problems in the liver;
• A blue tint is almost always a sign of cardiovascular problems;
• The dark purple color of the tongue indicates heart failure, ischemia or bleeding disorders, as well as impaired cerebral circulation;
• The black color of the tongue can be a sign of dehydration, severe disorders of the gastrointestinal tract, liver, pancreas, gallbladder, cholera;
• Green color indicates stagnation of bile;
• Brown tongue is associated with kidney disease;
• Blue tongue speaks of bowel diseases.

A popular language change is the appearance of plaque. It can occur with such problems:

• infectious diseases;
• problems with the functioning of the gastrointestinal tract.

It is possible to determine in which organ the changes take place by the location of the plaque in the tongue and its nature:

• If the center of the tongue is white coating having a slightly grayish tint, this may indicate a high acidity of gastric juice, a stomach or duodenal ulcer;
• If white plaque is accompanied by dryness of the tongue, this may be a sign of gastritis with low acidity of the gastric juice;
• At the root of the tongue, plaque manifests itself in diseases of the intestines. Frequent constipation may also be the cause;
• Plaque along the edges of the tongue and on its root appears with kidney diseases.

4. Diagnostics for language changes

Diagnostics in this case will include the following steps:

• Analysis of complaints and anamnesis. It takes into account the nature of the changes, the time of their occurrence, the disorders that accompany them and the presence of symptoms in which the patient can associate the manifested changes;
• Life history analysis. Are taken into account chronic diseases if present, hereditary diseases, bad habits, taking certain drugs, contact with toxic substances;
• Physical examination. In the process, the shape of the tongue and its size, shade, presence of plaque, and surface are determined. It also takes into account general state sick;
• Scraping from the surface of the tongue and its study. Performed when there is a risk of infectious diseases;
• Consultations of medical specialists narrow direction. It can be a dentist, neuropathologist, gastroenterologist, dermatovenereologist.

Additional research methods. Performed in accordance with individual indicators in order to clarify the diagnosis.

These can be laboratory methods, such as urine and blood tests, as well as instrumental methods: ultrasound and fibroesophagogastroduodenoscopy.

5. Treatment

Preparations

Treatment in this case will be aimed at eliminating the disease that provoked changes in the language. For tumors of the tongue, this can be radiation treatment and surgery.

With such infectious disease like candidiasis, antifungal drugs may be prescribed.

At home

At home, you can resort to rinsing the mouth with drugs that relieve inflammation. It could be decoctions medicinal herbs, such as chamomile or calendula, as well as alkaline solutions like soda.

Rinse your mouth after every meal. Rinses are especially useful in violation of the integrity of the lingual surface, for example, in the presence of cracks or desquamation of the epithelium.

6. Preventive measures

To prevent diseases that can cause language changes, it is worth observing the following preventive measures:

• Proper Diet, suggesting restrictions on fatty, spicy and fried foods. Balanced diet helps to prevent diseases of the digestive system;
• It is recommended to stop smoking, since the superficial cells of the oral cavity die because of it, the risk of infectious diseases increases and the blood supply worsens, both in the oral cavity and in the digestive organs;
• Be sure to maintain oral hygiene which will help to prevent the development of bacteria.

Diagnostics by language

7. Forecast

With any changes in the language, the prognosis will be favorable if the diagnosis is made on time and, accordingly, the correct treatment is prescribed.

If a person does not take any action, he can cause serious damage to himself. Firstly, because the underlying disease will progress. And secondly, because the change itself can provoke such complications as speech disorders, misalignment of teeth and malocclusion and, of course, psychological discomfort.

Based on the above, we can draw the following conclusions:

• Language changes are deviations from the norm of its color, size, shape, plaque manifestation and abnormal phenomena;
• Language changes can indicate a variety of diseases, in particular, diseases of the gastrointestinal tract;
• Timely diagnosis and treatment is important, which may include medical preparations, and home methods such as gargling with herbal teas.

He is engaged in the prevention, diagnosis and treatment of diseases of the stomach, esophagus and duodenum, diseases of the pancreas and liver of alcoholic etiology. Treats intestinal dysbacteriosis and constipation.

Underdeveloped muscles of the mouth or weak muscle tone of the face are among the causes of deviations in speech development.

Based on the position of N.A. Bernstein about the level organization of voluntary movements and actions, a number of researchers, specialists in this field (in particular, Sheremetyeva E.V.) suggested that articulation, as the highest symbolic level of voluntary movement, can be formed while maintaining all the underlying levels of voluntary movement. The peripheral part of articulation is built on top of the objective level of oral movements that fulfill life-supporting nutritional needs: sucking, biting, chewing, swallowing. Therefore, they considered it possible to assess the potential possibility of articulation by observing the objective level of movements of articulators - lips, tongue, lower jaw - in the process of eating and the state of facial expressions in free activity.

After analyzing the results of the study by E.V. Sheremetyeva, in the oral base of articulation, the precursors of speech underdevelopment (indicators of deviations from the normal course of speech development) at an early age were identified:

refusal of solid food: the child prefers homogeneous, well-ground masses. Often such children, so that they do not remain hungry, parents bring in Kindergarten yoghurts, curds, etc. Such eating behavior can have different causes: late introduction of solid complementary foods; parents for a long time (up to a year, or even two) crushed the child's food to a homogeneous mass; maintenance of the sucking reflex (breastfeeding) up to two, two and a half years; violation of the innervation of the mandibular muscles;

difficulties in the process of chewing and, as a result, spitting out, which is associated with a violation of the innervation of the corresponding muscle groups. With such a decrease physical activity the muscles that lift and hold the lower jaw, and the tongue muscles weaken;

general amimia in the process of eating: the child sits for a very long time over a plate or with a piece in his hand, then slowly brings the spoon to his mouth or bites off, starts chewing lazily (lack of pleasure “written” on his face from the process of eating);

liquid food or liquid is often spilled due to the insufficient formation of the lip grip: the child does not sufficiently capture the edge of the spoon, cup with the lower lip (liquid spills) or captures pieces of food from the spoon directly with the teeth. They say about such people: "Eats not neatly." In reality, the innervation of the labial muscles and, as a result, their strength, dexterity and coordination are disturbed.

an increase in the threshold of receptive sensitivity of the skin around the lips, which also indicates a violation of the innervation of the corresponding muscle groups: the child drinks kefir or jelly, the remnants of which, due to insufficient automation of object movement, remain around the lips. He does not try to reduce the irritation from the remnants of the liquid in any way. They say about such children: "Very untidy."

If the perceiving sensitivity of the perilabial space is preserved, and the innervation of the lingual muscles is impaired, then under similar conditions the following is observed:

the absence of circular licking movements of the tongue when a thick drink or liquid porridge gets on the lips or around the lips: in such cases, the child wipes the upper lip with improvised means;

pulling the back of the tongue up with an unexpressed tip of the tongue in similar conditions;

reduction of irritation of the skin surface of the lips with the help of the lower lip or other means;

raising the tip of the tongue to the level of the corner of the lips when trying to lick the upper lip.

In general, in the chewing muscles, there is a limitation of the mobility of the lower jaw; slight or fairly pronounced displacement of the lower jaw to the side at rest, during chewing and during articulation; in the pathology of the masticatory muscle tone, there is a decrease in the intensity and volume of masticatory movements, discoordination of the movements of the lower jaw during articulation; violation of the process of biting off a piece (which can also be complicated by anomalies of the dentoalveolar system); synkinesis is revealed in the motility of the lower jaw during tongue movements (especially when raising the tongue to the upper lip or pulling it to the chin).

E.G. Chigintseva is also noted for features in the lingual muscles: pathological conditions of muscle tone are observed, which in some cases are accompanied by structural features of the tongue (with spasticity, the tongue is more often massive, drawn in a lump deep into the oral cavity or elongated with a “sting”, this can be combined with a shortening of the frenulum, represented by in the form of a dense cord; with hypotension, the tongue is in most cases thin, flaccid, flattened at the bottom of the oral cavity, which can be complicated by shortening of the sublingual fold, which looks thin and translucent); there are violations of the position of the tongue (at rest and during movement) in the form of deviation to the side, protrusion of the tongue from the mouth, laying the tongue between the teeth; a slight or rather pronounced limitation of the mobility of the lingual muscles is revealed; hyperkinesis, tremor, fibrillar twitching of the tongue; increase or decrease in the pharyngeal reflex. In the muscles of the soft palate, there is a sagging of the palatine curtain (with hypotension); deviation of the uvula (uvula of the soft palate) from the midline. In the vegetative nervous system there are mainly mosaic disorders in the form of easily occurring spasms of the face (redness or blanching), cyanosis of the tongue, hypersalivation (intense salivation, which can be constant or intensify under certain conditions).

To the factors influencing the formation of speech function G.V. Chirkina also refers to later CNS lesions of traumatic or infectious origin, intoxication, severe somatic infections complicated by psycho-traumatic situations (separation from the mother, pain shock), even if they were temporary, not permanent).

In a child with rhinolalia, even with a unilateral, complete or partial cleft, inhalation is carried out more actively through the cleft, i.e. through the mouth, not through the nose. A congenital cleft contributes to a "vicious adaptation", namely, the incorrect position of the tongue, its root, and only the tip of the tongue remains free, which is pulled into the middle part of the oral cavity (the root of the tongue is excessively raised upwards, covering the cleft, and at the same time the pharyngeal space). The tip of the tongue is located at the bottom of the mouth in the middle part, approximately at the level of the fifth tooth of the lower row.

The entry of food through the cleft into the nose also seems to contribute to the overdevelopment of the root of the tongue, which closes the cleft. So, in a child with a congenital cleft, the most important, most vital functions stabilize the position of an overly raised tongue root. As a result, the air stream, when leaving the subglottic space, is directed almost perpendicular to the palate. This makes oral exhalation difficult in the speech act and creates a nasal tone of the voice. In addition, the constant position of the raised root of the tongue inhibits the movement of the entire tongue. As a result, the implementation of the necessary movements of the tongue for the articulation of speech sounds in rhinolalics fails; in addition, a weak expiratory jet, not entering the anterior part of the oral cavity, does not stimulate the formation of various articulatory bonds in the upper section speech apparatus. Both of these conditions lead to severe impairment of pronunciation. To improve the pronunciation of a particular sound, rhinolalics direct all the tension to the articulatory apparatus, thereby increasing the tension of the tongue, labial muscles, involving the muscles of the wings of the nose, and sometimes all the facial muscles.

In the process of speech dysontogenesis, adapted (compensatory) changes in the structure of the organs of articulation are formed:

high rise of the root of the tongue and its shift to the posterior zone of the oral cavity; relaxed, inactive tip of the tongue;

Insufficient participation of the lips when pronouncing labialized vowels, labial and labial and dental consonants;

Excessive tension of mimic muscles;

The occurrence of additional articulation (laryngealization) due to the participation of the walls of the pharynx.

L.P. Borsch notes that a short frenulum is a malformation, expressed by the formation of a fold of the mucous membrane, fixing the tongue sharply anteriorly, sometimes almost to the teeth. It is often detected in parents or close relatives of children, which can be considered a family feature; anomalies and occlusion are similar. When studying medical charts of the development of children with pathology of the frenulum of the tongue, the author found that in 94.7% there is a syndrome of motor disorders; in 52.7% - hip dysplasia; in 69.4% - delay psychomotor development; in 38.4% - trauma of the cervical spine; in 8.8% - for children cerebral paralysis.

Newborns with a short frenulum of the tongue have anxiety when feeding. It is due to difficulty in sucking, swallowing. Toddlers do not suck out the norm. The sleep of such children is superficial, intermittent, restless, they cry a lot.

If the correction is not carried out on time, then this is aggravated with age by the fact that speech is formed with deviations; the child is not understood by peers; adults, seeking the correct pronunciation of sounds, evoke negative emotions in response. He closes in on himself, prefers to talk less, play alone, an "inferiority complex" begins to form. This often contributes to the development bad habits. They are characterized by a decrease in the emotional-volitional sphere, mood lability. Such children are unbalanced, hyperexcitable, hardly calm down. They are very touchy, whiny, and sometimes aggressive. These children hardly come into contact, refuse to perform certain movements of the tongue at receptions.

By the beginning of schooling, speech remains fuzzy, the pronunciation of several groups of sounds is impaired. The speech is inexpressive, the intonation coloring of the voice is poor. This makes such children more vulnerable, withdrawn, although their intellectual ability quite developed. For the most part, these children are self-critical.

The revealed features of the oral motor basis of articulation made it possible to assume that in the absence of timely corrective assistance, at best, there will be disturbances in sound pronunciation and general blurring in the flow of speech.

Early diagnosis is based on the assessment of non-speech disorders, which include the following:

violation of the tone of the articulatory muscles (face, lips, tongue) according to the type of spasticity (increased muscle tone), hypotension (decreased tone) or dystonia (changing character of muscle tone);

limitation of mobility of the articulatory muscles (from the almost complete impossibility of articulatory movements to minor restrictions on their volume and amplitude);

violation of the act of eating: violation of the act of sucking (weakness, lethargy, inactivity, irregularity of sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup;

hypersalivation (increased salivation): increased salivation is associated with restriction of tongue muscle movements, impaired voluntary swallowing, paresis of the labial muscles; it is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva); hypersalivation can be constant or increase under certain conditions;

oral synkinesis (the child opens his mouth wide with passive and active hand movements and even when trying to perform them);

respiratory failure: infantile breathing patterns (the predominance of the abdominal type of breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.

During the development of speech, systemically controlled auditory-motor formations are formed, which are real, material signs of the language. For their actualization, the existence of an articulatory base and the ability to form syllables are necessary. Articulatory base - the ability to bring the organs of articulation into positions necessary for the formation, formation of sounds that are normative for a given language.

In the process of mastering pronunciation skills under the control of his hearing and kinesthetic sensations, he gradually finds and retains in memory those articulation modes that provide the necessary acoustic effect that corresponds to the norm. If necessary, these articulatory positions are reproduced and fixed. When finding the correct patterns, the child must learn to distinguish between articulation patterns that are similar in pronunciation of sounds, and develop a set of speech movements necessary for the formation of sounds.

E.F. Arkhipova, characterizing children with erased dysarthria, reveals the following pathological features in the articulatory apparatus. The paresis of the muscles of the organs of articulation is indicated, which manifest themselves as follows: the face is hypomimic, the muscles of the face are flaccid on palpation; many children do not hold the position of the closed mouth, 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.

L.V. Lopatina noted spasticity of the muscles of the organs of articulation, 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 articulation exercise"tube", i.e. stretch the lips forward, etc. The tongue with a spastic symptom is often changed in shape: thick, without a pronounced tip, inactive

L.V. Lopatina points to hyperkinesis with erased dysarthria, which manifests itself in the form of tremor, 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. 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, their mixing and deterioration in general of the prosodic side of speech.

E.F. Arkhipova, L.V. Lopatin distinguish the following articulation disorders, which manifest themselves:

in the difficulties of switching from one articulation to another;

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

in reducing the time of fixation of the articulatory form;

in reducing the number of correctly performed movements.

Research by L.V. Lopatina et al. revealed disorders in the innervation of the mimic muscles in children: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulties in raising the eyebrows, closing the eyes. Along with this, the characteristic symptoms for children with erased dysarthria are: difficulty switching from one movement to another, reduced range of motion of the lips and tongue; lip movements are not performed in full, are approximate, there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, inaccuracy of movements, difficulties in spreading the tongue, lifting and holding the tongue up, tremor of the tip of the tongue are noted; in some children - a slowdown in the pace of movements when the task is repeated.

Many children have: rapid fatigue, increased salivation, the presence of hyperkinesis of the facial muscles and lingual muscles. In some cases, a language deviation (deviation) is detected.

Features of facial muscles and articulatory motility in children with dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These disorders are most often not detected initially by a neurologist and can only be established in the process of a thorough speech therapy examination and dynamic monitoring in the course of corrective speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal, and hypoglossal nerves, which determines the characteristics and diversity of phonetic disorders in children. So, in cases of predominant damage to the facial and hypoglossal nerves, articulation disorders of sounds are observed, due to the inferior activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.

In order for a person's speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words necessary condition implementation phonetic design speech is a well-developed motor skills of the articulatory apparatus.

When pronouncing various sounds, the speech organs occupy a strictly defined position. But since in speech sounds are not pronounced in isolation, but together, smoothly following one after another, the organs of the articulatory apparatus quickly move from one position to another. A clear pronunciation of sounds, words, phrases is possible only if the organs of the speech apparatus are sufficiently mobile, their ability to quickly rebuild and work clearly, strictly coordinated, and differentiated. Which implies accuracy, smoothness, ease of movement of the articulatory apparatus, pace and stability of movement.

Thus, impaired motor abilities of the articulatory apparatus is one of the causes of deviations in the speech development of young children. An analysis of studies on the state of articulation in young children with speech development deviations allowed us to identify the following features:

There is insufficient mobility of the muscles of the tongue, lips, lower jaw;

Features of articulation are manifested in the difficulties of switching from one articulation posture to another, in the difficulty of maintaining an articulation posture;

It is possible to study the state of articulation of young children by observing the child's eating behavior.

Conclusions on Chapter I

The development of articulation is an important component of normal speech development. Articulation is the work of the speech organs (articulatory apparatus) when pronouncing syllables, words, phrases; this is the coordination of the action of the speech organs when pronouncing speech sounds, which is carried out by the speech zones of the cortex and subcortical formations of the brain. When pronouncing a certain sound, auditory and kinesthetic, or speech-motor control is realized.

In order for speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words, a necessary condition for the implementation of the phonetic design of speech is a well-developed motor skills of the articulatory apparatus. The articulatory apparatus is an anatomical and physiological system of organs, including the larynx, vocal folds, tongue, soft and hard palate, teeth of the upper and lower jaws, lips, nasopharynx and resonator cavities involved in the generation of speech and voice sounds. Any disorders in the structure of the articulatory apparatus of a congenital or early acquired nature (under the age of 7 years) invariably entail difficulties in the formation and development of speech.

All movements of the organs of articulation are determined by the work of the motor analyzer. Its function is the perception, analysis and synthesis of stimuli that go to the cortex from the movement of the organs of speech. In the motor speech zone, a complex and subtle differentiation of speech movements occurs, the organization of their sequence.

In ontogenesis, the process of development of articulation is formed sequentially: cry, cooing, early babbling; late babble; first words, phrases; further fine differentiation of articulatory structures.

Eating behavior is one of the indicators of the development of articulation. If a child prefers soft food to solid food, the organs of articulation are not sufficiently mobile during meals, then this indicates an underdevelopment of the muscles of the mouth and lips.

Deviations in speech development at an early age are an underdevelopment of the cognitive and linguistic components of speech development, due to a violation of psychophysiological prerequisites and / or inconsistency of microsocial conditions with the child's capabilities. It manifests itself in the difficulties of forming the initial children's vocabulary and phrasal speech. It can be an independent speech pathology or a part in the structure of any form of deviant development.

The study of the state of articulation in young children with deviations in speech development is possible when organizing the observation of the child's eating behavior.