Articles on rhinolalia. What is rhinolalia in children? Method for stretching the upper lip “Cupid's bow”

Rhinolalia in children is a condition in which the sound pronunciation and timbre of the voice changes due to improper interaction between the nasopharynx and the oral cavity. Rhinolalia is otherwise called nasality, and it really has such a characteristic feature as pronunciation of words and sounds “in the nose.” However, pronunciation in this condition is very roughly disrupted, very different from the nasal sound as with a runny nose. At the same time, rhinolalia also has secondary distortions related to both sound pronunciation and the development of grammatical forms of words and the expansion of vocabulary.

Normally, during the pronunciation of absolutely all sounds (except nasal ones), there should be a periodic separation of the nasopharynx from the oral and pharyngeal cavities. Rhinolalia is characterized by a distortion of this particular process; the velopharyngeal junction does not occur in this condition.

Classification of types of rhinolalia

• Open - in this case, air always flows through the nose and mouth, no matter what sound is pronounced. Both consonants and vowels are pronounced nasally.
• Closed - the air stream goes exclusively through the oral cavity. As a result, a decrease in timbre occurs, articulation is disrupted, and the sound of nasal sounds changes.
• There is also rhinolalia of the so-called mixed type, characterized by a combination of different symptoms.

Causes of rhinolalia

The most common causes of rhinolalia in children are congenital injuries resulting from impaired formation of the nasopharynx:

• “Cleft palate” is a cleft formed in the soft and hard palate;
• “Cleft lip” with a characteristic split;
• Unformed or forked small tongue;
• The soft palate is too short.

These defects appear during the intrauterine development of the child under unfavorable pregnancy conditions:

• Use of nicotine and alcohol by the mother in the first trimester of pregnancy;
• Exposure to pesticides on a pregnant woman;
• Severe illnesses suffered by the mother in the early stages of gestation (measles, rubella, mumps, toxoplasmosis, and even influenza with a complex course);
• Stressful state.

Acquired rhinolalia can develop as a result of:

• unsuccessful adenoid removal;
• the occurrence of tumors in the nasopharynx;
• deviated septum in the nose;
• proliferation of nasal polyps and adenoids;
• neurological diseases.

How to identify rhinolalia

Rhinolalia of the open type, if it is congenital, is noticeable from birth. Physical impairment is noticeable externally. In addition, these children have impaired breathing and eating processes. Due to the fact that the inhaled air does not encounter any obstacles on its way, it does not heat up and the child becomes susceptible to frequent diseases such as bronchitis, pneumonia, otitis media, etc.

Some of the most significant symptoms include:

• Absence of babbling at an early age.
• Slurring of spoken words and sounds.
• Small vocabulary.
  Mouth breathing.
• Neurological abnormalities - drooping of the upper eyelid, eye nystagmus, increased reflexes.
• Mental disorders - irritability, isolation, mood instability.

To diagnose rhinolalia, you need to contact several specialists, because only comprehensive measures will help bring speech back to normal.
An orthodontist, otolaryngologist, facial surgeon, or dental surgeon will be able to correct the physiological disorder. However, subsequently, hard work by defectologists and speech therapists, neurologists and neuropsychologists is necessary in order to correct deviations in.

Comprehensive correction of rhinolalia

Treatment for rhinolalia should begin as early as possible. The result largely depends on the general condition of the child and the presence of concomitant diseases.

• Surgery is required to correct physiological defects. An early solution to this problem contributes to a more correct formation of speech in the child, and therefore to his successful development.
• In some situations, orthodontists take corrective measures.
• In others - otolaryngologists.
• A specialist should also work with neurological disorders.

However, this work is only help in restoring and preparing the speech apparatus. But using it as a tool and setting it up will be much more difficult.
Even before the operation, speech therapy classes should begin to prepare the correct functioning of all speech organs. This is also necessary for the operation itself to be successful.
The specialist works on the formation of correct exhalation, strengthening the muscles of the lips and soft palate. The surgeon only creates the conditions for speech production.

After the restoration of organic disorders, active speech therapy and pedagogical work continues:

• Restoring proper nasal breathing.
• Work on the formation of correct articulation.
• Production of sound pronunciation.
• Elimination of “wrong” nasal, nasal pronunciation.
• Work on the development of vocabulary and phonemic perception of speech.
• Relieving stress, mental and psychological disorders in the child’s condition, developing his social skills.
• Didactic classes on speech development.

As a rule, correction of rhinolalia is successful. It is important to start work as early as possible so that the child can develop clear speech and its correct understanding. After all, a lag in its development can lead to dysgraphia, dyslexia, and possible psychological stress.

Children with rhinolalia often experience great difficulty communicating with peers, so the recovery period must necessarily include consultations with a psychologist.

Department of Special Pedagogy and Psychology

GRADUATE WORK

Subject

Corrective work for open rhinolalia

Introduction

Chapter 1. Analysis of theoretical sources of research on open rhinolalia

1.1 The structure of the speech apparatus in normal and pathological conditions

1.2 Causes of speech impairment with open rhinolalia

1.3 Psychological and pedagogical characteristics of children with open rhinolalia (physical, speech and mental development)

1.4 The relevance of corrective work for open rhinolalia in the preoperative period

Chapter 2. Experimental activities

2.1 Comprehensive examination of children with open rhinolalia in the postoperative period (ascertaining stage)

2.2 Corrective work for open rhinolalia in the postoperative period (formative stage)

2.2.1 Activation of velopharyngeal closure, disinhibition of the soft palate, correction of breathing, voice, vowel sounds

2.2.2 Correction of consonant sounds, reduction of nasalization, production of speech voice

2.2.3 complete automation of new skills, removal of residual rhinophony

2.2.4 Work on fine motor skills of the hands

2.3 Comparative analysis of the level of speech development in children with open rhinolalia at the final stage of research work

Conclusion

Bibliography

Applications

Introduction

In domestic and foreign literature, among speech pathologies, rhinolalia is distinguished as one of the complex clinical forms. Rhinolalia is a violation of voice timbre and sound pronunciation, caused by anatomical and physiological defects of the speech apparatus. With rhinolalia, a nasal timbre of the voice is observed, articulation and phonation differ significantly from the norm.

In Russia, the development of methodological techniques for rhinolalia was carried out by E.F. Rau, 1933, F.A. Rau, 1933, Z.G. Nelyubova, 1938, V.V. Kukol, 1941, A.G. Ippolitova, 1955, 1963, S.G. Taptapova, 1963, T.N. Vorontsova, 1966, N.N. Serebrova, 1969, L.I. Vansovskaya, 1977, I.I. Ermakova, 1980, 1984.

In correctional work, it is important to know the specifics of speech therapy.

The system developed by A.G. is of great importance. Ippolitova, who suggested starting classes from the preoperative period with open rhinolalia (using a combination of breathing and articulation exercises, following a certain sequence of practicing sounds).

The originality of A.G.’s methods Ippolitova is that initially the child’s attention is directed only to the articuloma. The content of classes includes the formation of speech breathing, differentiation of inhalation and exhalation, education of long oral exhalation during the implementation of vowels with articles (without the inclusion of voice) and fricative voiceless consonants, differentiation of short and long oral and nasal exhalation during the formation of sonorant phonemes and affricates, production of soft sounds.

N.I. Serebrova proposed an x-ray method that allows one to predict the possibility of restoring the function of the soft palate using speech therapy techniques. Comparison of these data before speech therapy work reveals the degree of compensation for the speech defect by generally accepted means.

S.L. Taptapova has developed a correction technique for adult rhinoplasty. She proposed a unique mode of silence (pronouncing vowels to oneself), which helps eliminate nasalization and relieves grimaces characteristic of this pathology.

I.I. Ermakova, established the age-related characteristics of functional voice formation disorders in children with congenital clefts and modified orthophonic exercises in relation to them.

She developed a step-by-step method of sound pronunciation and voice:

1. Preparation of the articulatory apparatus for the manufacture of a functional pharyngeal obturator for uranoplasty surgery.

2. Activation of velopharyngeal closure after applying an obturator or disinhibition of the soft palate after surgery, as well as accustoming the child to new kinesthesia.

3. Elimination of nasalization, correction of sound pronunciation.

4. Full automation of new skills.

I.I. Ermakova believes that early speech therapy reduces the percentage of degenerative changes in the muscles of the pharynx.

L.I. Vansovskaya suggested starting to eliminate nasalization not with the traditional sound, but with front vowels "And ,uh", because It is they that allow you to focus the exhaled air stream in the anterior part of the oral cavity and direct the tongue to the lower incisors. At the same time, the clarity of kinesthesia increases when sound and the wall of the pharynx come into contact, and the soft palate participates more actively.

The child pronounces sounds in a low voice with the jaw slightly pushed forward, with a half-smile, with increased tension of the soft palate and pharyngeal muscles. After eliminating the nasalization of vowels, work is carried out on sonorators " l, R", then fricative and stop consonants.

In the complex impact on a child with rhinolalia, the extremely active participation of parents is necessary. For this purpose, special guidelines are created (Yakovenko V.N., 1962; Ekaterinburg Center “Bonum”, 1990; Vansovskaya L.I., 1994), the tasks of which are defined in the following basic recommendations:

The requirement for the right role model is for adults to pronounce words and simple sentences slowly and clearly;

The importance of relaxed communication in a group of children with normal speech;

Visiting a mass kindergarten, participating in games that develop auditory, visual, kinesthetic perception, attending music and singing classes;

Development of attention and perseverance in specially created game situations, a gradual transition to games-activities that create conditions for future learning:

Development of speech praxis, education of breathing, fine motor skills in a playful way;

Expanding vocabulary and developing the ability to communicate and form concepts.

Due to the deterioration of the environmental situation and the decline in the standard of living of families, the number of children with congenital clefts is not decreasing, but increasing. Therefore, it is extremely necessary to identify such children as early as possible and provide them with comprehensive medical, psychological and speech therapy assistance.

In our work we used the methods of the following authors: A.G. Ippolitova, L.I. Vansovskaya, I.I. Ermakova.

Relevance Our research is that at present the formation of correct speech skills is of great importance, therefore the search for the most effective forms of work is very important.

Purpose of the study– testing of effective methods for overcoming speech impairment with open rhinolalia.

Subject of study– a system of speech therapy for eliminating speech deficiencies in preschool children with congenital anatomical and functional disorders caused by open rhinolalia.

Object of study- features of speech impairment in children with open rhinolalia caused by a congenital cleft of the speech apparatus.

Research hypothesis– we believe that properly organized correctional work makes it possible to significantly improve the timbre of the voice and correct the violation of sound pronunciation caused by anatomical and physiological defects of the speech apparatus.

In accordance with the goal and the hypothesis put forward, the following tasks must be solved:

1. Analyze special literature on the problem.

2. To study the features of physiology, anatomy, speech and psyche of children with open rhinolalia.

3. Determine the system of methodological techniques that influence the effectiveness of rhinolalia correction.

Research methods determined in accordance with the purpose, hypothesis and objectives of the work.

Theoretical methods– analysis of literature on the research problem, generalization of the results of research work.

Empirical methods– study of medical documentation, examination of the speech of rhinolalic patients, observation of children in the process of correctional work.

The thesis consists of an introduction, two chapters, a conclusion, a list of references, and appendices.

In the first chapter, we analyzed the theoretical sources of research on open rhinolalia.

In the second chapter, the stages of experimental activities on the problem posed were revealed.

In conclusion, conclusions for each chapter are presented and confirmation of the hypothesis is given.

The list of references is presented by 20 sources, applications include didactic material, medical documentation, and a long-term work plan.

Theoretical significance The research is that the effectiveness of proven methodological techniques for correcting speech disorders in open rhinolalia and the possibility of using these materials in classes with children has been proven.

Practical significance: a system of correctional work with children with open rhinolalia has been proposed, recommendations have been developed for parents and teachers.

Chapter 1. Analysis of theoretical sources of research on open rhinolalia

1.1 The structure of the speech apparatus in normal and pathological conditions

Normally, the palate is a formation that separates the oral cavity, nose and pharynx. It consists of the hard and soft palate. The hard palate has a bony base. It is framed in front and on the sides by the alveolar process of the upper jaw with teeth, and behind by the soft palate. The hard palate is covered with a mucous membrane, the surface of which behind the alveoli has increased tactile sensitivity. The height and configuration of the hard palate affect resonance.

The soft palate is the posterior part of the septum between the cavities of the nose and mouth. The soft palate itself is a muscular formation. The front third of it is practically motionless, the middle third is most actively involved in speech, and the back third is in tension and swallowing. As you rise, the soft palate lengthens.

The soft palate is anatomically and functionally connected to the pharynx. Together they form the velopharyngeal mechanism, which is involved in breathing and swallowing speech. When breathing, the soft palate is lowered and partially covers the opening between the pharynx and the oral cavity. When swallowing, the soft palate stretches, rises and approaches the back wall of the pharynx, which accordingly moves towards and comes into contact with the palate. At the same time, other muscles contract: the tongue, the side walls of the pharynx, and its superior constrictor.

During speech, a very rapid muscle contraction is constantly repeated, which brings the soft palate closer to the back wall of the pharynx upward and behind. When raised, it comes into contact with the Passavan roller. The soft palate moves up and down very quickly during speech, the time for opening or closing the nasopharynx ranges from 0.01 to 1 second. The degree of its elevation depends on the fluency of speech, as well as on the phonemes that are currently being pronounced. The maximum elevation of the palate is observed when pronouncing the sounds “ a, s", and its greatest voltage is at " And". This voltage decreases slightly when "y" and insignificantly by “oh, ah, uh.”

In turn, the volume of the pharyngeal cavity changes with the phonation of different vowels. The pharyngeal cavity occupies the largest volume when pronouncing sounds "And, y", smallest at a and intermediate between them at "uh, oh."

When blowing swallowing , When whistling, the soft palate rises even higher than during phonation and closes the nasopharynx, while the pharynx narrows.

There is also a functional connection between the soft palate and the larynx. It is expressed in the fact that the slightest change in the position of the velum affects the position of the vocal cords. And an increase in tone in the larynx entails a higher rise of the soft palate.

In congenital organic open rhinolalia, defects in the structure of the articulatory apparatus cause disruption of its function.

Types of congenital clefts are distinguished by size, shape, length, location (on the lips, hard, soft palate).

Crevices

Through Isolated

One-sided Double-sided Complete Hidden Incomplete

I. Isolated clefts

1. Isolated complete cleft lip - teeth and palate are normal, the lower part of the nasal opening is involved with damage to the cutaneous-cartilaginous part; There is one-sided (left- or right-sided) and two-sided.

1. Incomplete cleft lip - part of the lip is affected, non-union along the edge of the lip, there is no damage to the cutaneous-cartilaginous part of the nose.

2. Isolated complete cleft of the hard palate - nonunion reaches the incisive bone; There are left-sided and right-sided.

3. Isolated incomplete cleft of the hard palate – small in size from 0.5 cm; left- and right-handed.

4. Isolated submucous (hidden) cleft of the hard palate - the mucous membrane of the hard palate is normal, the bone tissue is damaged, the cleft is detected by palpation.

5. Isolated clefts of the soft palate: complete - the cleft reaches the hard palate, incomplete - bifurcation of a small uvula or a small cleft of the soft palate.

II. Through cleft - nonunion passes through the teeth, lips, alveolar process, hard and soft palate

1. Through bilateral cleft - the cleft runs on both sides of the premaxillary bone, on either side there is no fusion of the palate with the nasal septum, while the incisive bone is moved forward and can occupy a horizontal position, a violation of the dentition occurs - incorrect position of the teeth, their excess or flaw.

2. One-sided through cleft - one of the sides is fused with the nasal septum.

1.2 Causes of speech impairment with open rhinolalia

There are two forms of open rhinolalia: organic and functional.

Functional open rhinolalia occurs when the function of the velopharyngeal seal is impaired and is caused by:

Insufficient lifting of the soft palate in children with sluggish articulation is general (somatic weakness, decreased muscle tone);

After removal of the adenoids;

Consequences of diphtheria, severe focal tonsillitis (due to prolonged restriction of the mobility of the soft palate - swallows less, speaks less: the soft palate sags and air enters the nasal cavity)

Functional open rhinolalia manifests itself in the nasal pronunciation of vowel sounds.

This form of rhinolalia disappears after physiotherapeutic procedures, massage of the soft palate, phoneatric (voice) exercises and articulatory gymnastics.

Organic, open rhinolalia can be congenital or acquired.

Acquired organic open rhinolalia occurs:

In case of injury (perforation of the hard or soft palate);

With a tumor (scarring changes);

With paralysis or paresis of the soft palate (due to damage to the glossopharyngeal and vagus nerves).

Congenital organic open rhinolalia occurs:

For congenital clefts of the face, lips, hard and soft palate;

With congenital shortening of the soft palate.

1.Lack or excess of microelements in the mother’s metabolism during pregnancy (copper, manganese, especially zinc).

2. Use of medications by the mother during pregnancy, especially in the first trimester (antipyretics, antibiotics, anticonvulsants, excess vitamin A);

3. Diseases suffered by the mother in the 1st half of pregnancy (influenza, mumps, dysentery, rubella measles, malaria, typhoid fever).

4. Interaction with chemicals in the 1st half of pregnancy (gasoline, pesticides, bleach, nitric oxide).

5. Mental trauma, shock, stress in the mother during pregnancy.

6. Gynecological diseases and their drug treatment.

7.Endocrine diseases of the mother.

8. Parents' age

9.Number of previous pregnancy terminations

10. Poor nutrition.

11. Irradiation.

The critical periods of exposure to hazards on the formation of the face, upper lip and palate of the embryo are from four to eight weeks of pregnancy, from four to six weeks - facial clefts, from seven to eight weeks - cleft lip and palate.

1.3 Psychological and pedagogical characteristics of children with open rhinolalia (physical, speech and mental development)

The severity of speech disorders in persons with rhinolalia depends on the totality of structural and functional changes and, to a large extent, on the socio-psychological conditions of the child’s development. As a rule, a number of disorders in the musculoskeletal system of speech: narrowing of the upper jaw, hard palate, deformation of the upper row of teeth, changes in the ratio of the bases of the jaw. The normal interweaving and tone of the muscles of the palate and their necessary physical tension are also disrupted. The muscles are significantly weakened, the vessels supplying them narrow, which leads to the development of scar tissue. The mucous membrane of the posterior wall of the pharynx becomes thinned and atrophic, while the pharyngeal reflex decreases. Sluggishness of the articulatory apparatus (lips, lower jaw and tongue) is manifested in weakness of the orbicularis oris muscle, up to the inability to hold the softest objects with the lips. When the lip and palate are not fused, a number of adaptive movements of the lips, nose and soft palate are developed. With their help, children, articulating sounds, try to prevent air from escaping through the nose. Closures are formed at the level of the root of the tongue, vocal cords, by compression and retraction of the wings of the nose. A pathological connection between articular movements and the work of facial muscles is gradually established. “The play” of facial muscles is especially pronounced when pronouncing stop and fricative sounds. Speech is accompanied by movements of the wings of the nose, eyebrows, narrowing of the nostrils, contraction of the frontal muscles and raising of the upper lip. The more extensive the defect, the greater the disturbances the child’s body undergoes during its development.

The presence of clefts makes breastfeeding impossible. The fading of the sucking reflex, loss of lip movements (movements of the muscles of the upper lip are either absent or significantly weakened) leads to a weakening of the entire facial muscles, and facial expressions are impoverished.

Due to incorrect anatomical conditions, coordinated and differentiated work of the tongue does not develop. He practically does not participate in the articular act; the need to adapt to vicious anatomical conditions develops a position of the tongue in which its root rises upward, preventing air from escaping through the mouth and further increasing the nasal tone of speech and reducing its intelligibility. In this case, there is a significant limitation in the mobility of the tongue, a displacement of its anterior part towards the middle of the oral cavity, blurred and sluggish articulation.

The muscle relationship changes when eating. When feeding, children squeeze the pacifier not with their lips, but with the root of their tongue and fragments of the palatine vault. With such sucking, along with the movement of the root part of the tongue, the facial muscles are activated, this further affects the quality of babbling and influences the formation of pronunciation. With this disorder, there is a deficiency not only of the phonemic level, but also of a higher language level, namely, semantic-lexical development. The set of words and concepts in children does not always correspond to their age due to the fact that the development of speech is associated with the accuracy of articulation and phonemic differentiation, which are insufficient in them.

In children with open rhinolalia, physiological breathing conditions worsen. Under normal conditions, air enters the nasal cavity and the internal respiratory tract warmed and does not irritate the mucous membrane of the respiratory tract and pharynx, protecting the child from colds. With open rhinolalia, the air is not warmed or purified, hence frequent colds. As a result, inflammatory processes spread to the upper respiratory tract, in the area of ​​the mouth of the auditory tubes, and the middle ear, which causes a decrease in hearing sensitivity. Functional changes in hearing are especially evident in the fact that children do not perceive or notice distortions in their own speech.

Children with open rhinolalia develop incorrect mechanisms of speech breathing: uneconomical upper thoracic, or clavicular, in which movement of the upper chest, shoulder girdle and shoulder blades occurs.

With shallow clavicular breathing, the shoulders, collarbones, shoulder blades and the upper seven pairs of ribs rise up. In this case, the diaphragm, following the movement of the lungs, is pulled upward. Thus, the entire chest is pulled upward, although it will still be very slightly expanded.

This type of breathing is the most irrational and unhealthy. The chest is narrower at the top than in the middle and at the base: the expansion is minimal. Pulling up the collarbones and shoulder blades causes quite a lot of tension. Exhaled air during speech is consumed superficially, uneconomically, and rapidly (exhalation duration is about 1.5–1.8 seconds), while 70–80% of exhaled air rushes uncontrollably through the nose.

Inhalation during speech, shallow and rapid, is carried out through the mouth. The raised chest immediately falls, causing a forced and uneven distribution of air throughout the spoken word or phrase. Already by the middle of the word, the exhalation dries up, the sounds are weak and blurred. Breathing in the flow of speech is chaotic with blurring of the inhalation and exhalation phases. In this case, posture is disturbed, stooping, stiffness or excessive muscle flaccidity appears.

There is a lag in the development of gross and fine motor skills of the dominant hand. The muscles of the fingers and hand are weak, get tired quickly, and movements are not sufficiently coordinated. Speech is often accompanied by tension in the outstretched fingers of both hands. Children later begin to hold their heads, sit and walk. The neuromuscular apparatus of speech adapts early to the unique conditions of swallowing and breathing. With the delay in the development of speech and the overstrain and effort that the child spontaneously expends on articulation, the gradually formed pathological compensations increase and become stronger.

Thus, with congenital clefts the following are violated:

1.Baby nutrition

2. Physiological and speech breathing.

3.The nature of the work of the facial muscles

4. The incorrect position of the tongue in the oral cavity is stabilized (excessive elevation of the root of the tongue)

5. Hearing loss, impaired formation of phonemic perception.

Children with congenital clefts often experience functional disorders of the nervous system, pronounced psychogenic reactions to their defect, increased excitability, etc.

Speech deficiency in rhinolalia affects the formation of all mental functions of the patient and, first of all, the formation of personality: “... there are peculiarities of mental experiences associated with the position of such children in the team (M.D. Dubov). Clinical picture of clefts, chronicle. p.122). The child develops isolation, shyness, and irritability. Often communication with the team is one-sided, and the result of communication traumatizes children; peers do not want to communicate with the patient, because his speech is sometimes accompanied by compensatory grimace-like movements of the facial muscles, especially the wings of the nose. The child, as it were, strives to delay the passage of the air stream by moving the wings of his nose.

Along with the movement of the wings of the nose. In some patients, when speaking, the frontal muscles contract and the eyebrows wrinkle. According to Dorreys, “talking with their faces” (Dubov H.R. p. 124)

Rhinolalia characteristic of children is a change in oral sensitivity in the oral cavity. The reason lies in the dysfunction of sensorimotor pathways caused by inadequate feeding conditions in infancy.

Pathological features of the structure and activity of the speech apparatus cause various deviations in the development of not only the sound side of speech. The structural components of speech suffer to varying degrees. Oral speech is characterized by impoverishment and abnormal conditions for the development of linguistic development in children with rhinolalia. Due to a violation of the speech motor periphery, the child is deprived of intense babbling, thereby impoverishing the stage of preparatory tuning of the speech apparatus. The most typical babbling sounds "p, b, t, d" are articulated by the child silently or very quietly due to air leakage through the nose and thus do not receive auditory reinforcement in children. muscle activity gradually decreases (Volosovets T.V., 1995)

There is a late onset of speech, a significant time interval between the appearance of the first syllables of words and phrases already in the early period, which is synthetic for the formation of not only its sound, but also its semantic content, i.e. a distorted path of speech development as a whole begins.

In the structure of speech activity in rhinolalia, defects in the phonetic-phonemic structure are the leading element of the disorder, and the primary one is a violation of the phonetic design of speech.

As a result of peripheral insufficiency of the articulatory apparatus, adaptive changes in the structure of the organs of articulation are formed during the production of sounds: high elevation of the root of the tongue and its shift to the posterior zone of the oral cavity, insufficient participation of the lips when pronouncing labialized vowels, labiolabial and labiodental consonants, etc.

The most significant manifestations of defective phonetic design of oral speech are violations of all oral speech sounds due to the connection of a nasal resonator and changes in the aerodynamic conditions of phonation. The sounds become nasal. Combinations of nasalization of speech and distortions in the articulation of individual sounds are very diverse. Much depends on the relationship between the resonating cavities and the variety of individual configuration features of the oral and nasal cavities. There are factors that are less specific, but also influence the degree of intelligibility of sound pronunciation: age, individual psychological properties, socio-psychological, etc.

The child's speech is generally unintelligible. Violation of the phonetic structure of speech leaves some imprint on the formation of the lexico-grammatical structure of speech, but deep qualitative changes in it usually occur when rhinolalia is combined with other speech disorders.

In the literature there are indications of the uniqueness of the formation of written speech in rhinolalia. We do not dwell separately on the analysis of the causes of writing defects in rhinolalia, but we will point out that the proposed method of work prevents writing disorders and eliminates them in cases of early speech therapy assistance (in preschool age).

Purposeful work to overcome speech impediments contributes to the development of positive character traits and stimulates the development of higher mental functions. Follow-up information presented in the literature and our observations show that the majority of children with rhinolalia are capable of a high degree of compensation for the defect and rehabilitation of functions.

1.4 The relevance of corrective work for open rhinolalia in the preoperative period

Early work on speech correction before surgery is aimed at strengthening and training motor articulation (relaxing the tense state of the tongue root and bringing the tip of the tongue closer to the lower incisors), freeing the face from grimaces, and creating skills for directional articulation of sounds.

Target: Prevent the formation of compensatory pathological habits and create the basis for the development of normal speech. During this period, it is necessary to prepare the velum for velopharyngeal closure after surgery, and, if possible, prevent degeneration of the pharyngeal muscles. Create the prerequisites for proper sound formation, move the tongue forward in the oral cavity, lower its root and strengthen the tip, activate the lips and cheeks, prevent the fixation of the clavicular type of breathing, slow down wasteful accelerated speech exhalation, develop a directed air stream, and prevent the displacement of phonemes in oral speech.

The task of speech therapists in the preoperative period:

1. Physical development of the child in connection with the training of active speech organs; creation for the basis of speech normalization.

2. Establishment of diaphragmatic breathing.

3.Development of auditory and visual attention (imitation of the speech of adults, the child’s presence in their company).

Correction for rhinolalia in the preoperative period is carried out by two means: medical and pedagogical.

Medical supplies

Surgical intervention (operation). Lip surgery - cheiloplasty - is performed at 2-3 months or in the second half of the child’s life (according to health indications).

Closing the cleft palate in two stages: at 6–12 months the soft palate is operated on (veloplasty), resulting in intensive rapprochement of the cleft fragments of the hard palate (up to 3–5 mm) by 1.5–2 years (in some children by 3 years) ); finally, surgery on the hard palate (uranoplasty) is performed in a gentle manner that does not affect the growth zones. To form the vault of the hard palate, the child wears a plate with a high stens for a month after surgery. Subsequently, the child is observed by a surgeon and an orthodontist with periodic visits to rehabilitation centers for children with cleft palates, which are available in many cities.

The operation, without directly eliminating the speech disorder, creates the necessary prerequisites for the successful training and development of new articulatory attitudes.

Pedagogical means

Basic principles of speech therapy work for rhinolalia:

1. Systematicity and functioning of language in activity.

2. Taking into account the mechanism of the disorder and features of symptoms (structure of the dental system, condition of the palatine muscles and their functions, features of the respiratory apparatus, speech and general motor skills, originality of articulations of the positions of the tongue, lips of the lower jaw, state of hearing and auditory-speech differentiation, etc.).

3.Use of physiological breathing, which serves as the basis for the transition to speech diaphragmatic breathing with oral exhalation.

4. Reliance on preserved analyzers and functions (in particular, visual and potentially preserved kinesthetic and tactile).

5. Unity of the speech system (for example, manifested in the simultaneous activation of the velopharyngeal parts of the articulation and breathing apparatus by increasing the functional load on these systems).

6. Education of the natural functioning of speech mechanisms and support of the regularities of the phonetic structure of the Russian language (use of a soft attack of sound, selection, construction and application of speech material as a means of correcting phonetic disorders).

7. The sequence of work on sounds is determined by the preparedness of the articulatory base of sounds (the presence of full-fledged sounds of one group is the basis for the formation of the next group of sounds).

8. Taking into account age characteristics.

9. Taking into account the principles of development, according to which all mental processes, including speech, have certain qualitative stages in their development (for example, 3 years is a critical age in the development of speech).

10. Correct speech skills are reinforced by a speech therapist and only partially by parents.

11. Individual approach during classes with a small group.

Speech therapy classes with children should only be conducted individually. This is due to several reasons.

Differences in changes in functions in depth and volume require the selection of certain targeted exercises. Even at the same stage of training, children of the same age may need different recommendations. Since each child’s body has individual endurance, the number of exercises, as well as their content and ratio, is selected individually.

Because unclear repetition leads to the consolidation of pathological skills, and only the visual analyzer serves as the basis for control. Therefore, the possibilities of correct repetitions are limited; not a single movement or sound of a word should be left without the attention of the speech therapist. At the same time, the child needs constant reinforcement with verbal instructions. And in a group it is often not possible to notice deviations in small subtle movements of the articulatory apparatus and the sound of phonemes.

The inability to correctly complete a task that is easily given by others often gives rise to negativity and even a complete refusal to study in young children. The elders awaken a feeling of inferiority, they lose faith in their strength.

The excitement that usually occurs in a group when doing exercises distracts children from purposeful activities.

The first lesson begins with an introductory conversation with a specialist, in which the tasks facing the children are explained in detail. It is necessary to convince parents and the child that positive results are possible only with active, conscious work on speech education. The lesson requires the presence of parents or other people who will study with the child at home. They observe the work of the speech therapist, and the specialist, in turn, checks how he was understood and how the parents will complete the tasks at home. The help and participation of elders, character and personality education, control over speech, the formation of new skills, their consolidation in kindergarten, school, in games and other situations are of paramount importance. One lesson lasts 20–30 minutes at a time.

Main areas of work

Speech work presupposes an individual approach and continuity by speech therapists in the pre- and postoperative period, taking into account such components of mental development as mental neoplasms, developmental crises, stable periods, the social situation of development and leading activities. The role of parents here is extremely important and responsible. Under the guidance of a speech therapist, they carry out the early, correct development, education and training of the child. There is a specific age period for speech development - the first three years. After this period, the process of auditory-speech development and learning slows down sharply and requires more effort.

The auditory analyzer takes on the leading role. Auditory concentration on the human voice appears already on the 14th day after birth. The main mechanism underlying speech acquisition is the process of imitation. An indispensable condition for the preservation and development of the innate imitative reflex is live verbal and emotional communication between adults and each child individually. Through imitation, the child acquires virtually the entire native language. During the period of imitation, the child’s future own speech is prepared. That is why adults are required to speak correctly and impeccably.

From the first days of life, direct emotional communication between an adult and a child takes place. Thanks to this, such a mental formation as the need for communication is formed. The speech therapist teaches parents to be attentive to the child’s perceptual development. The main thing is not to leave the child alone and safe, to be attentive and observant, to quickly determine what he needs and what is interesting.

One of the important conditions for speech development is objectively effective communication between a child and an adult and improvement of hand function. The adult stimulates the accumulation of sensory experience together with the child, studying and examining surrounding objects using vision, hearing, and hand movements.

It is in the presence of an adult that the child plays most actively, which contributes to the development of oriented behavior - the formation of grasping as the basis of objective actions. This activity must be led. In the future, parents are also taught to select active games in which they productively implement speech programs.

When forming the prerequisites and needs for communication, it is important to show constant love and respect, interest and approval to the child. Only success and joy create motivation; it should be taken into account that at different age levels a child has different anatomical and physiological capabilities for mastering and improving his speech. In the first year of life, the speech apparatus is still developing. The lungs and vocal folds develop intensively in the first 3 months of life, and this development must be stimulated.

After cheiloplasty, the speech therapist teaches the mother how to do gymnastics for the upper lip so that it becomes mobile and the scars become soft and elastic. Often, in infants with a cleft palate, the lower jaw is underdeveloped and it requires correction with passive gymnastics, massage, from 2 to 3 months of life. Up to one year, it is recommended to place the child on his side and stomach, in position 6, which stimulates the retention of the tongue at the lower incisors. For the physical development of the speech organs, motor and sensory development, general strengthening and breathing exercises are carried out, conditions are created for the coordinated work of the entire articular apparatus. At the same time, as many analyzers as possible are activated: visual, auditory, motor, skin-tactile, vibration. The program of correctional influence on speech development is built according to ontogenesis, phonetic and phonological development.

Tactics show that in families where the demands are not too low, children achieve high results. Their early social interaction with healthy peers and the development of independence should be fully promoted. Speech, influencing the development of other higher mental functions, organizes the structure of perception, forms the architectonics of memory, selectivity and arbitrariness of education, develops verbal-logical thinking, operating with generalizations and ideas. Successful early surgical and orthodontic treatment and early speech development programs reduce the impact of the cleft on the acquisition, consolidation of articulatory, language deviations and harmful compensatory processes.

Activation of the muscles of the soft palate

Preliminary preparation of the segments of the velum palatine for participation in velopharyngeal closure reduces the time for disinhibition of the palate and allows increasing its mobility after surgery.

The most physiological approach seems to be the education of closure during phonation. With it, a conditioned reflex connection between the sensation of lifting the velum and sound production is more easily developed due to the participation of the speech motor, speech-auditory and kinesthetic analyzers. The child simultaneously feels the rise of the segments of the palate, pronounces the sound and hears it changed, improved compared to the usual sound.

Features of articulations "ah, uh" allow them to be used to develop mobility of the palate segments.

Sound , A is the only low vowel in the Russian language; when pronounced, the root of the tongue falls the lowest.

Sound, uh- middle rise, but in the front row, therefore it is characterized by the greatest forward movement of the wall of the tongue with its moderate rise.

When pronouncing these phonemes, compared to other vowels, there is a lower density of pharyngeal closure, tension in the soft palate and the number of contacts of the tongue with the pharynx, which occur with rhinolalia. All this explains the least pronounced nasal tint A And uh in auditory perception. In addition, both sounds are non-labialized. Pronouncing them with your mouth wide open provides visual control.

Exercise with vowels “a, e”

Opening his mouth wide, the child repeats after the speech therapist. The sound must be pronounced softly, not with a firm attack, with the tongue moved towards the teeth. If the tongue is pulled towards the pharynx, then practice placing it on the lower lip, then touching the lower incisors with the tip of the tongue, holding it in the lower position.

Long pronunciation: a or e

Saying a, a (uh, eh) twice

Saying a, a, a, three times (uh, uh, uh)

After 4-5 lessons, move on to a continuous and somewhat extended pronunciation of the combinations aaeeeeaa

Repeat the exercise 2-3 times in a row 6-8 times a day. At the beginning, the segments of the palate may remain almost motionless; only a slight trembling is observed. But with regular training, they begin to rise, diverging somewhat to the sides. The extent to which the velum segments can move apart depends on the severity of the defect. The mobility of the palate segments is monitored visually. If observation is hampered by a hypertrophied root of the tongue, the child needs to stick it out and the speech therapist needs to lightly press it downwards with a spatula.

Activation of the muscles of the pharynx

The development of the dystrophic process in the muscles of the pharynx is prevented by increased load: the volume and motor activity of the muscles increases, preparation is made for wearing a functional obturator or for surgery. For this purpose, imitation of the pharyngeal reflex and yawning is used. Both exercises are repeated by imitation 3 times in a row 6-8 times a day.

If the child fails to reproduce the pharyngeal reflex, the speech therapist causes it by touching the back wall of the pharynx or the root of the tongue with a spatula. At home, parents do this with the handle of a teaspoon. These exercises are done regularly until surgery.

Preparing the articulatory apparatus for proper sound production

This process takes a long time and includes training the mobility of the lips and cheeks, moving the tongue forward, strengthening its tip and lowering its root. Changes in the position of the tongue in the oral cavity affect speech distortion more than insufficient velopharyngeal closure. Moving the tongue forward creates the conditions for establishing correct articulation, lowering the nasal tone of the voice, normalizing phonation breathing, and reducing pharyngeal closures. Therefore, this section needs to be given close attention. When explaining any exercise, be sure to clarify the position of the tongue and monitor its position, and prescribe a number of special articulation exercises (articulation gymnastics, massage).

All exercises are performed counting, in front of a mirror 3-4 times a day for 5 minutes.

Since kinesthesia in people with congenital clefts is reduced, I work on no more than three types of exercises at the same time, because With a greater load, children may confuse tasks or perform them inaccurately. Articulatory gymnastics exercises should be selected taking into account the individual characteristics of each child and be strictly targeted. It is recommended to avoid fast, sharp articulatory movements. They require a lot of voltage and are ineffective because... the child does not have time to remember the shift using kinesthesia and often blurs the movements. It has been noted that during the first lessons, excessive tension in the muscles of the forehead, wings of the nose, jaws and neck appears, which is transmitted to the larynx and pharynx. To reduce it, it is useful to interrupt the exercises several times during the session with short-term relaxations of the muscles of the face, neck, and throat, and during training to avoid sudden movements.

Exercises for the tongue and cheeks

1. Articulatory gymnastics - stick out, remove, lift, lower, move right - left, relax with a “pancake”, strain with a “sting”, relying as much as possible on involuntary movements.

2.Reach your tongue to your nose, to your chin.

3.Licking lips smeared with sweets (each separately and in a circle).

4. Stroking the cheeks from the inside, resting the tongue on the mucous membrane.

5. Biting the tongue over the entire surface, gradually sticking it out and retracting it.

6. Slapping the tip of the tongue with a spatula (relaxing the tongue)

7.Licking plates and the convex side of tablespoons with the entire surface of the tip of the tongue.

8. Licking drops from the concave surface of the spoon (the size of the spoon is successively reduced from a tablespoon to a mustard spoon - the formation of more subtle and precise movements).

9. Scratching the tip of the tongue on the upper incisors; counting the teeth, resting on each one.

10. Stroking the cheeks, pressing forcefully on the inside; carefully circling the vestibule of the oral cavity.

11. Rolling (if the structure of the palate allows) a round candy, pressing it with the tip of the tongue to the alveoli.

Lip exercise

1. Raising and lowering the upper lip - the child bites the lower lip, and then, counting, raises and lowers the upper lip 5-6 times in a row (other facial organs do not move).

2. Unclosed, limp lips - holding a piece of cracker, sugar, candy (the smaller, rounder and smoother the piece, the tighter the lips close), making sure that the lips are not pulled out by the proboscis.

3. Pulling both lips into the mouth (if the upper lip sinks, place an oblong roller under it and try to wrap the lip over the incisors).

Lip massage

1. Using the pads of your thumb and forefinger (one finger from the inside, the other from the outside), take the upper lip and rub the scar.

2. Place the pads of your thumbs and index fingers in the same way, but at the corners of your mouth, bring your fingers together, pressing on the lip just above the red border and pulling it forward (repeat 10-15 times).

3.Movement of the tongue in the vestibule of the oral cavity, pressing firmly on the frenulum.

Exercises should be selected taking into account the individual characteristics of each child, and be strictly targeted. You should not massage the tongue of a three-year-old child if the tongue has not yet moved to the pharynx and the root of the tongue has a normal structure and size. It is recommended to avoid fast and sudden articulatory movements.

It is useful to interrupt articulatory gymnastics with short-term relaxations of the muscles of the face, neck, and throat.

Development of speech breathing

Normally, the abdominal cavity and internal intercostal muscles actively participate in speech exhalation, which ensure lengthening of exhalation and sufficient pressure of the air stream. This explains the improvement in speech when rhinolalic patients are taught diaphragmatic breathing. As you know, such breathing is not typical for children, so it is advisable for them to use costo-abdominal (diaphragmatic-costal) breathing. It allows you to increase the vital volume of the lungs, regulate the rate of exhalation with the diaphragm and phonation in the chest register, due to which exhalation is lengthened and nasalization is reduced.

At this stage, work on the formation of speech breathing is limited to teaching only long-term oral exhalation.

Beginning of work. It is necessary to determine the type of physiological breathing of the child by placing your palm on the side surface above his waist. If the breathing is lower costal (diaphragmatic), the speech therapist adapts his breathing to the child’s breathing rhythm and begins work. If a child has upper clavicular breathing, it is corrected in the physical therapy room.

You should try to induce lower costal breathing by imitation. To do this, you can place the child's palm on your side and check his breathing with your palm. If this does not work, then before breathing correction is carried out in the physical therapy room, the child should first be taught directional blowing, since children with clefts do not have a directional air stream and the air flows into their nose when exhaling. The directed air flow will subsequently ensure sufficient intraoral air pressure for the formation of consonant sounds.

Stage I. Formation of enhanced pharyngeal exhalation with the mouth slightly open

1. The necessary pressure is caused by simulating “spitting”: the child slightly sticks the tip of his tongue between the teeth and then tries to spit it out. The tongue is moved forward. And its tip sticks out minimally, which forces you to strain your lips more and creates more subtle movements. Attention is focused on the sensation of the lips. At the same time, the child controls the temperature and the direction of the air stream with the back of his hand. During the first lessons, you can pinch the wings of your nose with your fingers. The exercise is repeated 6-8 times in a row 3-4 times a day.

2. If “spitting” is accompanied by tension in the muscles of the neck and even movement of the anterior wall of the pharynx forward (a sound similar to k is obtained), then they resort to tactile control of the front surface of the neck, silent “spitting” or spitting out small crumbs. The size of the crumbs gradually decreases, and the desired movement is gradually absorbed.

3. By slowing down and prolonging the “spitting,” you get a light puff, which is strengthened by breathing exercises with a ball of cotton wool, fluff, or strips of paper.

Before surgery, it is advisable to use exercises that require increased effort (rolling a pencil with a blown stream, inflating a balloon), because they increase tension in the facial and pharyngeal muscles, intensify grimaces, and speed up exhalation. The main goal during this period is to obtain an air stream.

Stage II. Differentiation of oral and nasal breathing

It is necessary to explain to the child that there are different types of inhalation and exhalation through the nose; with the mouth open, various combinations of inhalation and exhalation are possible. The child is asked to do specific breathing exercises, the sequence of their implementation is recorded in drawings in a table in the child’s notebook:

The purpose of these exercises is to strengthen the diaphragmatic inhalation and gradual, calm exhalation in the process of learning various types of inhalation and exhalation.

These exercises lay the foundations for the rhythm of speech breathing with a pause after inhalation. The formation of a speech pause during breathing occurs spontaneously, because the child holds the exhalation, paying attention to how it should be done: through the nose or mouth during the transition from inhalation to exhalation. With further training in the pronunciation of vowels and consonants, this pause will gradually increase and become stronger.

During these exercises, it is necessary to accustom the child to the sensation of a directed stream of air passing through the mucous membranes of the oral and pharyngeal cavities during inhalation and exhalation.

The direction of the stream exhaled through the mouth is controlled by the movement of a cotton swab placed on a smooth surface (sheet of paper, palm) so that the child can see the direction of its movement and correct this direction as directed by the speech therapist. Such an exhalation, which is in no way identified with blowing, forms the direction of a full, calm oral exhalation.

To organize proper oral exhalation, it is necessary to change the position of the tongue in the oral cavity: during oral exhalation, the tip of the tongue is at the lower incisors, the root is lowered; if the root does not decrease, you can temporarily allow the tongue to protrude between the teeth or press on the root of the tongue with a spatula (as a last resort).

Sequence of exercises:

1. The exercise is performed lying down. The child learns to inhale through a full belly, exhaling smoothly and for a long time, the accuracy of the execution is controlled by the palm.

2. The same thing, but reclining.

3. Sitting.

4. Standing.

5. In motion (various sets of physical and breathing exercises).

Vowel nasalization exercise

Although it is known that it is vowels that give the voice a nasal timbre, it often seems that many children pronounce them correctly. However, when articulating, the tongue is shifted deeper into the oral cavity, and the lips are hyperactive. Correction of vowels involves moving the tongue towards the lower incisors and pronouncing them with a diaphragmatic exhalation in the chest register. Reducing the participation of head resonance in phonation immediately noticeably reduces the nasal tone of the voice even before surgery.

1. Extended pronunciation of the vowels a-a-a, uh-e with a soft exhalation in the chest register. The child sits with his back resting on the back of a chair, his chin slightly lowered and his palm on his chest for tactile control. The feet are parallel to the floor. When performing the exercise correctly, a fine vibration of the chest is felt. This exercise is performed by imitation: the speech therapist shows it and then performs it together with the child. Start pronouncing vowels 2-3 times and increase to 5 repetitions of each sound 4-5 times a day for a month.

Next they move on to the vowels o, i, u, s. This sequence is based on a change in the force required to hold the segments of the palate in a horizontal position, and on an increase in the volume of the pharyngeal cavity of the mouth during the articulation of vowels, of which y and have the most pronounced nasal connotation.

2. Chanted, continuous pronunciation of vowel combinations; combinations do not begin with u, i, y, because Nasalization remains in their pronunciation, but if a functional pharyngeal obturator is installed, then the exercises are practiced with all vowels:

Combination of two vowels: ae, ao, ay; ea, eo, eu; oh, oh, oh.

Combination of three vowels: aoa, aea, aua; uh, uh, uh; oae, oau, oau

First, vowels are pronounced with a voice of medium height at the bottom tone, then the range is expanded. Exercises are pronounced: in a low voice - “bear”; in the middle voice - “fox”; in a high voice - “squirrel”. But more often they turn to midtones, because... they are the most natural for a child.

4.Vocal exercises.

Before surgery, vocal exercises stimulate the elevation of segments of the soft palate, mobility of the posterior wall of the pharynx, and lengthen exhalation. Vocal exercises are reduced to singing vowels in the third range (for a description of the technique, see In the postoperative period).

1.Teach to distinguish the sounds of speech of others.

2. Differentiated perception of one’s own pronunciation.

In the process of evolution, human sonorous speech is formed for hearing and under the direct control of hearing, therefore speech and hearing are closely related functions. Encouraging the child to compare his distorted pronunciation with the correct sound of speech speeds up the acquisition of normal pronunciation. Systematic hearing training, especially phonemic hearing, leads to the development of self-control of speech.

In acoustic differentiation exercises, one should move gradually from simple to complex, from dissimilarity to similarity, from non-speech sounds to speech sounds.

Differentiation of non-speech sounds

Students are offered tasks to recognize sounding instruments, objects (a bunch of keys, coins in a box, a rattle, the rustling of leaves, rustling paper), recognition of actions (flapping, creaking, knocking, ticking of a clock, gurgling of water), vocal onomatopoeia (imitating the cry of a crow, barking , grunting), melodies (guess what they are playing; what they are playing), etc.

Differentiating sounds in a word

Older ones are asked to recognize words that are similar in auditory composition (gender, ox, dol, stake); appositional syllables. Words (fa-va, pa-ba, concrete - bidon, delo - body, uncle - aunt), definition of a sound sheet in a word, definition of a sound before or after a highlighted sound, sequence of sounds in a word; determining the number of sounds and syllables; selecting a word with the desired sound from a group of words.

They use the games “Help the sound...”, “What sound is missing?”. All this provides conditions for guiding children’s research activities, develops and consolidates the stock of existing ideas about the sound-letter side of a word, and develops the ability to pose a specific problem and solve it independently.

Development of melodic and intonation-auditory experience

They offer to identify voices that change in pitch: “Who sings (speaks)?” – dad, mom, son; by strength (medium, loud, quiet). They test the ability to navigate by the strength of sound while searching for an object hidden in the game (quiet - far away, loud - close).

Differentiated perception of nasalized and “pure” sounds

Children learn to distinguish correct sounds from distorted ones by listening to a speech therapist. In the process of working on vowel sounds, they repeatedly demonstrate the difference in speech sound with a lowered soft palate and compressed wings of the nose, increasing the degree of rhinophony. And “pure” vowel sounds when pronounced in the mouth with a tense palate. Gradually, auditory-speech capabilities, phonemic perception and phonemic representations of children are formed, and such functions of mental activity as voluntary attention, perception, thinking, and memory develop. We should not forget that the assimilation of correct speech, the laying of its standards is carried out from a very early age (from 3-10 months of life). When communicating with the child and focusing his attention on the face of the speaker, it is necessary to activate the first pre-speech vocalizations: hooting, humming, babbling - practically this process realized by listening to impeccably correct speech.

Auditory perception is the very first stage in the acquisition of speech skills. At this time, adults should adhere to certain laws: speak quietly as often as possible, but clearly, clearly, slowly, and repeat what has been said many times. In this case, from early childhood, the skill of listening is stimulated and developed, and the sound patterns of words are memorized. In the future, correction is also carried out in a low voice.

Requirements for conducting exercises for differentiated perception of correct and distorted sound:

When speaking, the speech therapist covers his lips with a screen;

Pronounce sounds clearly and distinctly;

It is impossible in the preoperative period to analyze words with consonants of close acoustic groups (several hissing, whistling, etc.)

The meaning of words accessible to children;

Response pronunciation, if the child can correctly pronounce the studied phoneme;

If the sound is not available for pronunciation, then the reaction should be motor (raising a hand, clapping, etc.);

Carry out the exercise for 7-10 minutes, analyzing no more than 3-4 words in one lesson.

Differentiated perception of one's own pronunciation

In developing correct pronunciation skills, the ability to imagine and evaluate the sound of one’s own speech is of great importance. This is quite difficult to do: the child hears himself differently than those around him. His speech seems quite correct to him, so for self-control the “Listen to yourself” technique is used (according to P.A. Neumann).

Self-listening is organized as follows:

1. The hands are given the position that is usually obtained when collecting water for washing - a handful, with the first (thumb) finger fitting tightly to the palm.

2. Without changing the half-bent position given to the hands, one of them (for example, the left one) is applied to the corresponding (left) auricle behind it, and the upper part of the auricle is slightly pulled down and significantly bent towards the cheek. At the same time, the elbow is brought closer to the chest.

3. The other hand (right), also in an unchanged half-bent position, is placed with the palmar surface of the wrist on the corresponding (right) corner of the mouth and covers the mouth, without placing it on the lips, with the exception of the thumb placed on the upper lip.

This position of the hands forms a mouthpiece connecting the opening of the mouth with the auricle - a sound duct. With this position of the hands, the sound of a quiet own voice is heard amplified, and obvious timbre errors or any features of the voice are different and clear. When using this technique, you need to speak quietly.

The speech material for training includes sounds that are accessible to the child (except "m, n"). Using the “listen to yourself” technique when producing sounds in the future, he identifies and overcomes the nasal tone of speech. The most important feedback connections are gradually formed on the basis of hearing the muscular senses.

Conclusions:

Congenital clefts negatively affect the formation of the child’s body and the development of higher mental functions. Patients find unique ways to compensate for the defect, resulting in the formation of an incorrect relationship between the muscles of the articulatory apparatus. This is a violation of the phonetic frame of speech, and acts as a leading disorder in the structure of the defect. This entails a number of secondary disorders in the speech and mental status of the patient. However, this group of patients has great adaptive and compensatory capabilities for the rehabilitation of impaired functions.

The presence of congenital clefts deeply affects the entire development of the child: these children are sickly, somatically weakened, and they often experience hearing loss. With rhinolalia, a speech defect may be accompanied by deviations in the development of higher mental functions. These patients are characterized by peculiar features of personality development and the formation of activity.

The speech defect of the rhinolalic from birth is due to a number of reasons. First of all, ensuring the vital functions of breathing and nutrition leads to a specific position of the tongue (with an excessively raised root), which leads to a violation of its functionality on the one hand, and to defective compensation for the violation on the other hand (during speech, muscles are involved in articulation forehead, face, various synkinesis occur). With rhinolalia, the formation of atypical specific breathing, the development of hypenasalization and defects in the articulation of sounds are noted. In the picture of a speech disorder, the leading factor is defective sound pronunciation; lexico-grammatical structure, phonemic hearing, and written speech may suffer secondarily.

Correction of the defect is carried out by means of medical, speech therapy and psychological and pedagogical influence.

Therefore, with open rhinolalia, work in the preoperative period to develop correct speech skills is very important.

The main condition for the work is the activation of healthy parts of the speech apparatus and the preparation of impaired parts as a basis for the formation of correct sound pronunciation.

Correcting sound pronunciation before surgery means moving the barrier when pronouncing consonants into the anterior part of the oral cavity, introducing conscious use of the organs of articulation into everyday speech, nurturing the connection between articulation and the phoneme, and the ability to isolate this phoneme in the flow of speech. At the same time, one often has to be content with approximate articulation and analogue sounds, which is natural for the development of children’s speech and is sufficient for the formation and development of phonemic concepts and sound analysis skills (for example, dental-labial "p, b", if lip closure is not possible). Although it is not possible to achieve the normal sound of many phonemes, the communicative function of speech is still improved by increasing its intelligibility.

Before the operation, they do not draw attention to the leakage of air into the nose, but ensure its perfection and precise movements of the tongue and lips. The speech therapist should not be embarrassed that many consonants remain silent, nasal.

If you do not work on sound pronunciation before surgery, then the child will still speak after palate surgery. Correction of sound pronunciation takes quite a long time, because... it is difficult to overcome existing pathological compensations and form a new complex stereotype.

If correction was carried out before surgery, then after surgery, despite temporary deterioration, correct articulation is quickly restored.

Before starting work on producing consonant sounds, classes on establishing diaphragmatic-costal breathing must be completed.

rhinolalia speech therapy correctional treatment

Chapter 2. Experimental activities

2.1 Comprehensive examination of children with open rhinolalia in the postoperative period (ascertaining stage)

Experimental testing of the hypothesis was carried out on the basis of MDOU No. 1 “Solnyshko” in the city of Kholmsk.

In the process of research work at the ascertaining stage, we examined children and drew up a plan for correctional and educational work to correct speech disorders in children.

Researched:

Anatomical features of the structure of the entire articulatory apparatus and the congenital defect itself;

General speech development;

Changes in the emotional-volitional sphere of a child with defects in appearance and speech (see appendix)

The ascertaining “cut” was made in October 2002. We included two children with open rhinolalia in the experimental group.

Vova A. Enrolled in a senior speech therapy group with a speech diagnosis: open rhinolalia (postoperative).

An examination of the speech apparatus revealed scars on the hard palate and a postoperative suture on the soft palate. The absence of all consonant sounds and their soft variants except for sound was revealed "m".

Breathing is clavicular superficial, quickly exhausted, an unformed directed stream due to leakage through the nose. Speech intelligibility is poor.

Nikita I. was enrolled in the senior speech therapy group in September 2002 by decision of the Ministry of Education and Science of September 22, 2001. with a speech diagnosis: open rhinolalia (postoperative). The examination revealed cicatricial changes in the upper lip and soft palate. Speech is unintelligible, with hypernasalization due to hyperprotection in the family, it is absolutely impossible to be alone, withdrawn, uncommunicative. The child is somatically weakened due to frequent diseases of the upper respiratory tract.

In the process of research work at the ascertaining stage in the experimental group, we used the following research methods: observation, survey according to the speech card plan, study of medical documents, conversations with parents.

The examination begins with a conversation with the child’s mother. We find out the state of the family, the level of development and occupation of the parents, the attitude towards the child in the family, the child’s attitude towards his defect.

Speech card

1.F.I.O. baby

2. Age of the child.

3.Where did you come from (kindergarten, school, etc.).

4.F.I.O. parents, place of work, age.

5.History:

Pregnancy - what kind of pregnancy the child was born from, how the previous pregnancies ended, whether other children have clefts, whether there were premature children, whether there was a premature birth before, what caused it, whether measures were taken to eliminate this pregnancy, the course of pregnancy, well-being mothers from the first days of pregnancy (1st trimester), the presence of harmful factors during this period;

Childbirth: nature - difficult, easy, urgent, rapid, etc., whether labor was stimulated;

The child’s condition at birth (cryed immediately or after stimulation).

6.Early child development:

Breastfeeding, up to what age;

From when on complementary feeding?

How did you develop physically (from when did you hold your head, all childhood characteristics);

What diseases did the child have in the first year of life?

7. Condition of the hearing organs - conclusion of an ENT specialist.

8. Speech development. When did babbling appear, what is its activity, when and how the first words began to form, since when has full words been used? When phrasal speech appeared, does the child know poetry, fairy tales, does the mother notice any difficulties in the development of the child’s speech, and how does she evaluate them.

9. Mental characteristics of the child (together with a psychologist) how the child navigates the environment, the setting, what games and toys he likes to play, his attitude towards books, pictures, what he does independently, perseverance, distractibility, attention, memory.

10. Self-care skills.

11. Treatment of the child, when the lip and palate surgery was performed, whether medication and speech therapy were used, results.

12. Nature of the defect:

Cleft of the hard and soft palate (complete or incomplete);

Hidden (submucosal) fissure;

Cleft lip (one-sided, two-sided);

Time of surgical treatment, information about repeated operations;

Age at which the operation was performed;

Features of the postoperative course (were there any complications in the form of suture dehiscence, residual defects);

The structure and shape of the hard palate, the presence of fistula tracts;

The nature of the bite, the condition of the teeth and the structure of the alveolar process of the upper jaw.

13. Condition of the soft palate and uvula.

Length of the soft palate, mobility when pronouncing the vowel sound “a” or "uh" or when inducing a pharyngeal reflex by touching the palatine arches with a spatula;

The presence or absence of passive (the ability to mechanically move the soft palate until it touches the back wall of the pharynx), active (the ability of the soft palate to reach the back wall of the pharynx when pronouncing vowels "A" or "uh") and functional reflex (the ability to close the nasopharynx during mechanical irritation of the mucous membrane of the soft palate) closing the soft palate with the posterior wall of the pharynx;

The severity of scar changes;

High or low position of the soft palate.

14. Functional state of the pharyngeal muscles: reflexes are lively, inhibited; the presence or absence of pharyngoplasty, cicatricial changes.

15. State of articulatory motility:

Immobility of the lower jaw, lips, cheeks, spontaneously and on instructions;

Compensatory movements of facial muscles (wings of the nose, cheeks, forehead);

Facial expressions (alive, sluggish, constrained);

Features of the position of the tongue, the condition of its root and tip; its excessive tension or lethargy, limited mobility of the tongue (suggest placing a wide tongue on the lower lip, extended with a “sting,” raise, lower, move left - right, etc. - all movements are performed by imitation, then according to the instructions of the speech therapist in front of the mirror and without him).

16. Breathing:

Type of physiological breathing (upper clavicular, diaphragmatic, mixed).

Type of speech breathing, depth, duration of speech exhalation;

Absence or presence of air leakage through the nose during speech.

Timbre - brightness, sonority, dullness;

Nasality – open, closed, mixed;

17. The nature of spontaneous speech (during a simple dialogue, pronouncing test syllables and phrases, counting to 10 - 20);

Speech intelligibility;

Degree of nasalization (weak, moderate, hypernasalization);

Violation of sound pronunciation - absence, replacement or distortion of sounds;

Volume of active and passive vocabulary;

Degree of proficiency in grammatical structure;

Rate, pauses and melody of speech;

Isolated pronunciation of vowels and consonants.

Start the examination with vowel sounds: “a, uh, o, s, y, i, i, e, e, yu”; (in isolation and at the beginning of a word under stress). Then an examination of consonant sounds is carried out: hard, soft, voiced, deaf, whistling, hissing, sonar. When selecting words, it is taken into account that the sound under study is first between two vowels: ifi - afa, ivi - ava, or - ala, ipi - apa, ibi - aba, etc. This allows you to observe what position and what movements the tongue makes, then the sound should be located at the beginning, middle and end of the word.

18. Study of extended speech:

Availability of detailed speech (communicates using individual words or phrases);

Ability to use monologue speech;

State of coherent speech;

Features of the lexical and grammatical structure of speech;

Lexicon;

Reading skill (in schoolchildren): speech improves or speech deteriorates during the reading process.

19. Examination of phonemic hearing.

The child repeats, following the speech therapist, whose face is covered with a screen, isolated sounds, syllables and words that differ slightly and are contrasting.

Requirements for the content of didactic material:

1. The material is presented on cards or in reflected pronunciation.

2. Suitable for the child’s age and development.

3.Use of subject, subject pictures.

4.Use photographs of familiar things.

5.Tables with syllables, words, phrases, etc.

20. Conclusion of a speech therapist.

Analyzing the results obtained, it is necessary to note a very low level of development of speech skills. The dysfunction of the articulatory apparatus in both children is due to both a congenital defect and postoperative factors (swelling, pain, scar changes); frequent colds and somatic weakness complicate speech development.

Nasalization of sounds is due to the absence of velopharyngeal closure; the inability to articulate consonant sounds is due to the fact that the hard palate has scarred postoperative changes and reduced kinesthesia; the soft palate after the operation is motionless, swollen, shortened; the tongue is tense, retracted into the depths of the oral cavity. Pronunciation of words comes down to pronouncing vowels: “machine” - “aya”.

Therefore, the speech is unintelligible, the phrase is not formed, the active vocabulary is poor.

But at the same time, their intelligence is preserved, children understand speech addressed to them well, follow instructions, and try to answer questions. Changes are observed in the emotional and volitional sphere, children are aware of their defect, are withdrawn, and shy.

We assume that the methods and techniques we have chosen for correcting open rhinolalia will allow us to form velopharyngeal closure, develop speech breathing - this will help eliminate nasalization of speech, as well as correct distorted sounds and add missing ones, and then introduce new skills into spontaneous speech.

2.2 Corrective work for open rhinolalia in the postoperative period (formative stage)

2.2.1 Activation of velopharyngeal closure and disinhibition of the soft palate, correction of breathing, voice, vowel sounds

Correctional pedagogical work at this stage begins 15-20 days after the operation. During this period, due to a long period of silence and protective inhibition, speech deteriorates. The soft palate is swollen, practically motionless, there is no sensitivity, and some movements cause pain.

Nasalization increases, so it is important to form the mobility of the soft palate. Six months after plastic surgery, the scarring process ends, which irreversibly reduces the effectiveness of exercises for the soft palate. Therefore, in the first months after the operation, speech therapy classes should be conducted regularly - 3 times a week, and parents should work with the child every day at home.

Activation of the soft palate and pharyngeal muscles

▪ Pronouncing vowels "ah, uh" calmly, slightly drawlingly, in a voice of medium volume, simultaneously with the phonation of the vowel, a pharyngeal reflex is evoked (children, having felt an unusual movement, immediately remember and reproduce it). When pronounced on a hard attack, the soft palate makes a sharp rise (the number of rises is usually from 1 to 4). Therefore, we pronounce the vowels one by one, 1.5 hours after meals, with an interval of 30 minutes between classes on average, repeat "ah, uh" 2 times in a row 5-6 times a day for 2 days, 6-8 times a day for 3 days, 3 times in a row 6-8 times for 5 days, and then 3 times 8-10 times a day within a month. Then: 6-8 times a day - 10 days, 4-6 times - 10 days, 3 times for 4 months, but at one time all this time the vowels are pronounced 3 times in a row.

▪ Pronouncing vowels in pairs, adjacent "ae - ea"(start with the vowel from which the sky rises higher and at the beginning drag it out longer:

« ahhh, uhhh" then the duration of the sound is compared).

▪ Vocal exercises– singing vowels: at the beginning of sounds "ah, uh", after 2-3 lessons "O", in another week "And" and last "y"(with daily classes the time limits are reduced). Start vocal exercises in the 3-4th lesson, when at least slight mobility of the soft palate appears. He is trained in singing vowels in the range of thirds of the first octave with children and triads with teenagers and adults.

Vocal exercises stretch the velum, disinhibit and activate all the muscles of the laryngopharynx, force the child to open his mouth wider and increase the strength of sound.

▪ Dry ingestion. According to I.S. Rubinov, the intensity of muscle contraction increases with a decrease in the contents of the pharynx, and with repeated swallowing of saliva, the duration of velopharyngeal closure also increases. These exercises are used only to stretch the scars of the soft palate for 5-6 months after the operation, until the scarring process is completed, so that children become more aware of the expression “tighten, raise the soft palate” and, after repeated training, feel its movement (Vansovskaya L. AND.). The exercises consist of swallowing your saliva 2, then 3 times in a row 5 - 6 times a day between other exercises. During the exercise, the lips are closed; they cannot be opened slightly. To make the exercise easier, you can drip liquid onto the root of the tongue, but this reduces the intensity of contractions.

▪ To increase the mobility of the pharyngeal muscles:

Imitation of the sensation when swallowing an “inflated balloon” (Vansovskaya L.I.), “hot potato” (Ermakova I.I.);

Yawning with vowels "and, e, I, uh, a, o, y, s" ;

Inhale with yawning through the mouth - exhale through the mouth (the soft palate is tense) (Vansovskaya L.I.);

Gargling with “thick” liquids (jelly, juice with pulp).

These exercises are effective for children under 8-9 years old; they have to be repeated 5-6 times a day for several months in order to cause a persistent increase in the pharyngeal muscles in volume sufficient for closure.

This type of shutter improves speech and reduces nasalization, but the voice usually has a dull, compressed timbre, so its education is less desirable (Ermakova I.I.).

▪ Soft palate massage

Kneading scars causes a rush of blood in the area of ​​the wound surface, which improves tissue nutrition. The palate is stroked over the entire surface with the pad of the thumb in the direction from the alveoli to the edge of the soft palate along the midline, then to the right and left of it. In this case, as soon as the finger touches the soft palate, a gag reflex is triggered, as a result of which the pharyngeal ring sharply narrows. Gradually, the tongue begins to take a flat position at the bottom of the mouth, and the gag reflex fades.

Methodology: stroking – 30 seconds; stroking is intermittent and energetic - 30 seconds, while the finger moves jerkily and rhythmically towards the pharynx; then spiral rubbing – 1 minute, then intense rubbing and kneading at a slow pace.

Dosage: for Ermakova - start with 1-5 minutes 1 time a day (stroke and knead the palate once) and increase to 10 times a day for 30 minutes. (with an interval of one hour, iron and knead the palate 3 times in a row); at Vansovskaya - from 5 to 8 times a day for 2 minutes. For 6-8 months, with simultaneous pronunciation of sounds during massage "uh, ah, oh."

Activation of speech motor skills.

Articulatory gymnastics is carried out differentiated for different organs of the speech apparatus (lower jaw, lips, tongue). Exercises are performed clearly, effortlessly, with mirror control and in compliance with a certain rhythm (see appendix).

Exercises for the lower jaw

With massive scarring in the area of ​​the palatine arches, it limits the opening of the mouth, which complicates articulation and increases nasalization. You need to practice until the mouth opens to three fingers of the child.

1. Mouth half open - wide open - closed.

2.Movement of the lower jaw forward with the mouth half open.

3. Voluntary movement of the lower jaw to the right - to the left.

4. Imitation of chewing, during which vigorous contraction of the muscles of the larynx, pharynx, soft palate, and tongue occurs.

5. Moving the lower jaw forward while “scratching” the upper lip with the lower teeth and lowering the lower lip and moving it back while “scratching” the lower lip with the upper teeth.

You should clearly demonstrate the relaxation of the lower jaw and masticatory muscles by placing your hands in the joint of the lower jaw at the moment of its lowering. Exaggerated protrusion of the lower jaw when pronouncing vowels "i, e, s", leads to a wider open and intelligible pronunciation of sounds (the wider the oral cavity at the time of speech, the narrower the pharynx).

Lip exercises

1. Pulling out the vibration of the lips (coachman’s “pprrrr”).

2. Lowering and raising (alternately and simultaneously) the upper and lower lips.

3. Pulling the lips to the sides: “Frogs really like pulling the lips straight towards the ears. They smile, laugh, and their eyes are like saucers” (according to Plotnikova).

4. Relaxation and lightly patting the upper lip on the lower lip.

5. Holding thin tubes (from lollipop) with your lips.

6. Imitation of rinsing teeth with sharp pressure on the lips, followed by their relaxation and exhalation.

7. Lowering and raising the lower jaw with tightly compressed lips.

Upper lip massage

Massage the scarred lip with the terminal phalanges of the II and III fingers of both hands from the base of the nose down to the edge of the upper lip, as well as to the side with a slight stretching of the scar; carry out stroking, rubbing, kneading and vibration for 2 minutes.

Method for stretching the corners of the mouth:

1.Use the knuckles of your index fingers to press on the corners of your mouth.

2.Pressing. Move them 3 times in the opposite direction.

Method for horizontal stretching of the upper lip:

1. Place the first finger on the lip from above, the second - under the upper lip.

2.I use your finger to roll the upper lip firmly, II – act in the opposite direction.

3. Perform these movements in the opposite direction.

4. Make the same movements with your fingers moved at a distance of 1 cm 2-3 times.

5.Continue to perform these movements in a circle of the upper and lower lips, including the corners of the mouth, then change fingers.

Method for stretching the upper lip “Cupid’s bow”:

1. Bent finger II is under the upper lip, and finger I is on the upper lip.

2.Turn your lip onto the first finger.

4. Repeat this movement to the sides, to the center, around the upper lip 3 times (according to D. Beckman).

Tongue exercise

The following are added to the exercises carried out at stage I:

1. Raising and lowering the tip of the tongue to the upper and lower teeth with the mouth wide open, as well as touching the right and left corners of the mouth, various points of the lips, palate, the front and back of each tooth.

2. Laying the wide front part of the tongue (in the form of a cup) tightly holding the lateral edges of the tongue and the upper lateral teeth, blowing onto the front part of the tongue and blowing out vibration (“Put your tongue with a spatula and hold it one count at a time - one, 2, 3, 4 , 5. The tongue must be relaxed. Place the tongue wide and raise the edges. It turns out to be a bowl, it is rounded. We will bring it into the mouth and press the sides to the teeth,” according to Plotnikova).

3. Sliding the tongue deep into the hard palate in the shape of a hook, first silently, then with utterance "oh, s" .

4. Holding a wide tongue in the mouth for a long time with a lollipop lying on its back.

5. Compression of the lateral edges of the tongue with the chewing surfaces of the teeth, spread out in width, with control of the position (in front of the mirror).

6. Relaxation of the neck muscles with reflexive relaxation of the tongue muscles: the head was dropped forward, to the right, to the left “Oh, Misha’s neck is weak, you sew it with a thread. Then Mishutka’s head won’t fall off.”

Of the proposed methods, the main place is given to the formation of relaxation skills, flattening the tongue forward, because This does not happen spontaneously after surgery.

Development of speech breathing

If children exercised before surgery, they quickly recover old skills and exercises to strengthen the directed air stream usually do not hinder them (see preoperative period).

With children who did not study before the operation. We have to simultaneously work on establishing costo-abdominal breathing and teach how to supply a directed air stream.

Children are explained that in speech formation, for the respiratory apparatus to function properly, you need to have trained respiratory muscles, and the proposed breathing exercises will help increase the vital capacity of the lungs, the mobility of the pectoral and abdominal muscles, the diaphragm, and will develop the intensity and duration of oral exhalation.

Speech is a voiced exhalation. Here it is appropriate for children to figuratively imagine the respiratory and phonation organs, like an inverted tree, where the foliage is the lungs and the trunk is the trachea, play with the emphasis in the word organ and learn about the participation of the bronchotracheal region in resonating.

Elimination of nasalization of vowel sounds (phonopedic exercises)

I.I. Ermakova suggests starting work with vowels "ah, uh, oh"; the rationale for this method is described at stage I (see preoperative period).

At stage II, she suggests resuming the pronunciation of vowels on a soft exhalation in the chest register: first isolated, then in combination in twos, threes “ae, ao, ea, eo, oa,.aeo, eoe, aoa, oao, eoa, aoe, etc.). All sounds are pronounced stretched out and together.

2.2.2 Correction of consonant sounds, reduction of nasalization, staging of speech voice

Pathological sound formation in rhinolalia has anthropophonic and phonological characteristics, i.e. There is a distortion of the sound of phonemes (nasalization, approximate sound) and the replacement of one phoneme with another (they are interchanged within groups that are similar in the method of formation and acoustic characteristics).

Correction of each sound involves the creation of the correct articular structure and the development of auditory differentiation.

When starting to correct sounds, children are tested for their ability to reproduce phonemes by imitation, which allows them to identify the most accessible sounds.

When producing sounds, you need to make maximum use of the movements and phonemes available to the child, and not create completely new models. This approach facilitates the introduction of sound into speech, reduces tension and expresses the principles of relying on already formed skills and the transition from simple to complex.

Techniques for evoking consonants described in speech therapy are not always suitable for rhinolalia due to organic changes in the articulatory apparatus, decreased kinesthesia and auditory differentiation. The choice of methods and exercises is always strictly individual. However, even in this case, organic defects may prevent the achievement of ideal articulation. Therefore, striving for the acoustic usefulness of phonemes, deviations in articulation can be allowed.

Children with reduced kinesthesia and phonemic hearing disorders have to linger on intermediate, coarser articulations: interdental, single-stroke, etc., i.e. use sounds - analogues (pronunciation of consonants - Appendix No.).

The introduction of new skills into speech begins:

1. Pronunciation of syllabic exercises, where the consonant sound is in an intervocalic position - between two vowels. The easiest way to repeat exercises is with sonorous sounds. "l, l" and fricatives "v, v, f, f" which are easier and simpler to install after surgery "ava, avya, ala, ala, afa, afu and so on.". The child, pronouncing sound combinations, sits deeply on a chair, placing his hand on his chest. He repeats the sound combinations on a soft exhalation, mirrored by the speech therapist, and then independently. When performing the exercise correctly, the palm feels a slight vibration.

3. Pronouncing open syllables - silently pronouncing the first vowel phoneme in an intervocalic syllable and pronouncing an open syllable.

4.Introduction of evoked phonemes into words and sentences when pronouncing short phrases. To do this, use words that include only delivered sounds. Therefore, words and phrases are selected individually, taking into account age and level of development.

Having at the beginning of stage III a still limited number of phonemes, it is necessary to pronounce as many word combinations and phrases from them as possible, so as not to fix the development of the skill on the pronunciation of stable didactic material, but to get as close as possible to the conditions of colloquial speech.

BB, FF, LL: Valya Lala there Vova Valya caught Alya

Vova Lyova over there is the lion Lyalya took Vilya away

For younger preschoolers, sounds and syllables sound abstract, so their sounds sound better in words.

The system of working on sound includes: practicing an isolated sound, then in a closed syllable, in an interval syllable, in an open syllable, in a combination of consonants. Gradually increases the speed of pronunciation, changes the emphasis in combinations and words.

Removing nasalization begins with the clear pronunciation of closed syllables. In a closed syllable, both sounds are clearly heard, their less unity is noted, so they are most distinguishable in this position.

Pronunciation is carried out on a soft attack, using the “pulsating sound” technique to ensure “pushing” of the entire sound forward, which leads to correct articulation and overcoming the nasalization of speech. At the same time, vowels firmly become “helping sounds.”

A sustained and, as it were, elongated vowel carries out a leap of energy and “pulls” into the anterior parts of the oral cavity all the sounds of a combination of syllables, words and phrases.

Exercises

1. Pronouncing syllables with sonorants "y, l, r" sounds at a soft beginning, techniques “warming hands”, “listen to yourself”, “pulsating sound” : “il, ate, yal, ate, yul, iyi, eee, barely, yulyu, ele, eye, el-elyu. al-al, ul-ul."

2. Pronunciation of inflections, syllables, words with sonorants in the final position “lily, riy, lil, lyr, swarm, dug, ly-li-ly, re-re-rye, saw-saw-dust.”

3. Pronouncing onomatopoeia (“chicks talking,” calling, joy, fatigue, laughter, fear, crying, barking, bleating, grunting, etc.) together with the child for two exhalations in the created situation or showing the corresponding picture (for all utterances, the language is at the lower incisors): And I: and, and, and. And you: and and and.

And I: oh oh oh. And you: oh oh oh

And me: pee pee pee. And you: pee pee pee

Then in the exercises replace You with You.

4.Pronouncing vowels and sonorants in sentences

And I ate, and you ate. I caught and you caught

5. Pronouncing words with emphasizing their endings.

Scarlet, fanned, ardent, alder, cherished, caught, rolled

6. Pronouncing phrases with an emphasis on the endings of words.

Ira and Ella ate fish soup. Famously! Have you watered the lily?

7. Pronouncing words - chips with the intonation of enumeration.

Lira, Iya, Ulya, idea, believe, Lara, Ilya, Julia, her, him, yacht

After sonorants, they begin to work on noisy fricatives (frictional) sounds, and then stops. At the same time, noisy consonants should not be pronounced exaggeratedly, but the air should be directed to the places where the organs come together with articulations or bows without visible effort, easily and briefly. And vowels and sonorants should be pronounced expressively. Here, simplification of the articulatory work of the speech organs is allowed, but not distortion of pronunciation.

To develop fluency, smoothness and naturalness of speech Vansovskaya L.I. suggests moving on to exercises in extended live speech as soon as possible. At the same time, the shorter the consonants are pronounced and the longer the vowels, the faster the skill of unity and rhythm of speech is realized. In spontaneous speech, changes in intonation occur as a result of verbal and logical stress. This must be taken into account when developing the skill of dividing sentences into syntagms.

The role of pauses is great for short-term rest and relaxation of articulators (tongue, lips, soft palate), education of auditory attention and rhythm of speech.

Changing pauses and pronunciations helps develop a productive and moderate speech rate.

Development of speech-hearing differentiations

The development of phonemic hearing is aimed at differentiating a child’s defective sound pronunciation from normal ones.

Learning begins with an analysis of articulation and new sensations experienced when correctly pronouncing the phoneme “Which teeth did the tongue touch: the upper or the lower? What kind of breeze was it: cold or warm? Where did you feel the breeze: in your throat or on your tongue?” Each time the child pronounces a new sound, the child receives a “correct” or “incorrect” rating. During this period, he discusses all the material with a speech therapist. He listens, pronounces and evaluates every sound, syllable, word. To control the purity of pronunciation, a nasal listener is used (the work of the soft palate is controlled by listening to sound phenomena in the nose). The method of listening to the nasal cavity is based on the fact that if air and sound waves enter the nose, they are felt through a rubber tube, one end of which is inserted into the speaker’s ear and the other into his nostril. If the soft palate does not work and does not block the entrance to the nasopharynx, then noises accompanying speech are heard in the tube and pressure is felt in the speaker’s ear.

The “listen to yourself” technique is also used (see preoperative period) and some other techniques described when working with vowel sounds. They again practice distinguishing regular and broken phonemes in words and syllables pronounced by adults. But it is still too early to analyze the sound of words with a combination of consonant phonemes or containing several acoustically close phonemes.

Until a clear pronunciation of the sound is achieved, all answers to tasks must be gestural.

Phonopedic exercises to correct voice deficiencies (expanding the range, increasing the strength of the voice).

Once children have a kinesthetic sense and can differentiate correct phonation by ear, they will be able to perform exercises to expand the range and strength of their voice:

1.Long pronunciation of sound "m" with fixation of attention on the nasal resonance of the consonant (pronunciation with closed lips, lowered root of the tongue and a small gap between the teeth - at first briefly, gradually lengthening the sound) on a comfortable tone of voice.

2. Continuous pronunciation of open syllables with sound "m" based on this sound "ma, mo, mu, meh, we"(exercise 6-8 times a day immediately after short chanting three times "m"; when pronouncing syllables, the consonant is spoken protractedly, and the vowel - short; there is no need to articulate it, vowels can sound reduced - silent).

3.Switch to sounds "l, n, r, v, z, g"(same requirements).

4. The combination of these consonants with all vowels: "mom-mom-mom, momomemums"(equally stressed syllables and syllables with shifting stresses). Loud, smooth pronunciation of a syllable series shows the child’s mastery of his voice.

5.Speech exercises (combinations of two words and conjugations of verbs with consonants "m, n, j, l, r, v, z, g")

There's Valya, there's mom, there's Nina, there's the pit

I washed Mila. I was driving Vilya. I feel sorry for Zhenya

6. Gradual spread of the phrase.

I watered. I watered the gilly leaves. I watered the leaves with water

I watered the leaves with warm water

7. Preparation for introducing sounds into speech through the repetition of short tongue twisters and poems based on sonors.

Principles for selecting speech material:

The phrases are short,

Must include only correctly pronounced phonemes,

Phrases must contain a sufficient number of sonorants and voiced fricatives.

First, the child repeats one phrase at a time after the speech therapist. He pronounces the words together, slightly intoning, exaggerating the sonors:

We caught burbot in the shallows

Neil caught tench: one small, two longer

Masha has poppies and daisies in her pocket

Vocal exercises

Target: expanding the range and increasing the strength of the voice.

The greatest rise of the velum palatine is observed during singing, which helps to activate the muscles of the laryngopharynx, because The child opens his mouth wide to increase the strength of his voice. These activities can lengthen the velum by 1 cm.

Each movement begins with chanting thirds (triads) for vowel sounds “a, uh, ae, ea.” Sound is added after 2-3 days "O", a week later "And", last "y" or "moo". At the same time, they change the key and volume (they start singing on the piano, moving on to the forte, and vice versa). Then they begin to sing short musical phrases and songs.

Selection requirements:

Simple and softly memorable;

With a light rhythmic pattern that does not require long exhalation;

The range does not go beyond the limits of the worked triad;

The melody of the phrase is built on intervals no less than a third;

Sing only in the speech range of the student, without tension:

3-4 years "mi - sol", 5-6 years "mi - si", 7-10 years "re-re" 10-14 years "Mi –re".

Once the child learns the melody and learns to take breath at the right moments, then you can move on to singing with words (you need to learn the words). Songs are selected with words based on the sounds covered; they begin to sing slowly, smoothly, switching from sound to sound. To study, take one song (for song lyrics, see Appendix No.).

2.2.3 Full automation of new skills, removal of residual rhinophony. Introducing new sounds into spontaneous speech

The introduction of assigned sounds into spontaneous speech is carried out taking into account the age of the children. Younger preschoolers (3-5 years old) reinforce a new sound in a lively situational environment: games such as lotto, guessing riddles, adding words to a sentence, story games with the naming of a large number of homogeneous objects (games and conversations gradually become more complex and their duration increases).

The form of classes should include free, freely constructed and emotionally charged answers.

At this stage, tongue twisters, proverbs, and poems can only be used to consolidate articulation. They do not help improve lively, casual speech.

Children of older preschool age need to get rid of shyness (embarrassed about correct pronunciation, does not want to attract attention to themselves). Conversations are held with the child, and parents and the kindergarten teacher are involved in the correction process. When a child learns to pronounce new sounds in words and short phrases, they are included in spontaneous speech, games in question-and-answer form and short conversations on a given topic (in colloquial speech) are used.

To automate a new sound in everyday speech, parents and their child select 10 words with this sound. During the week, pay attention to the quality of pronunciation of only these words. At the same time, this phoneme is consolidated and differentiated in poetry, fairy tales, and stories. After 5-7 days, another 10 words are introduced. After 2-3 weeks the sound is successfully automated.

Vocal exercises

Target: automation of the movements of the velum, overcoming the exhaustion of the motor function of the soft palate.

For the final vocal exercises, songs are selected in phrases in which the tones are arranged according to the scale, i.e. the intervals between them do not exceed one tone. This helps to keep the palatal curtain in closure for a longer time (see Appendix No.).

Vocal exercises end with singing folk jokes in one tone. This type of training is especially difficult and is only possible with a well-moving palate.

2.2.4 Work on fine motor skills of the hand

Target: develop grapho- and visual-motor skills, attention, perception, spatial orientation, correct motor function, normalize the rhythm of movements, improve speech development.

Exercise value:

Strengthens arm muscles;

Promote the development of both expressive and internal speech;

Activate imaginative and logical thinking;

Relieves psychological stress during the transition to learning to write.

A series of tasks is offered:

1.Drawing on large cells.

2.Drawing by points.

3.Drawing symbols of objects.

Large checkered paper is used for drawing dots - a large blank sheet with a small pattern - a symbol at the top (see Appendix No.)

While doing the work, the child comments on his actions and describes what he has done based on questions from adults (see Appendix No.).

Attention is paid to the ability to hold a pencil correctly. Before starting to draw, the graphic structure or figure is analyzed, visually and tactilely examined. The child works with an adult for a long time, receiving support and approval.

The tasks are gradually made more difficult, the figures drawn in the cells are then laid out on shelves.

Conclusion: I would like to note that over the past 1.5 years, children’s speech has undergone great changes:

1. Both children had sufficient velopharyngeal closure.

2. The tone of articulatory and facial muscles has increased.

3. A directed air stream has been generated.

4. Slight nasalization of speech was preserved.

5. Distorted and missing sounds are introduced and introduced into speech.

6. The muscles of the fingers and hand are sufficiently developed.

Thus, it was confirmed that early orthodontic and surgical measures, scientifically based methods of pre- and postoperative speech correction, taking into account the individual characteristics of each child, make it possible to normalize speech and ensure full communication of the child by the end of preschool age.

2.3 Comparative analysis of the level of speech development in children with open rhinolalia at the final stage of research work

In accordance with the plan of research work on the correction of speech disorders in open rhinolalia, we conducted a repeat study in March 2004. using the same methods as at the ascertaining stage.

It should be noted that during the examination we drew attention to changes in the state of children’s speech that occurred as a result of correctional and educational work (see Appendix: table No.)

After a set of physical breathing exercises, gymnastics for the masticatory muscles for scars of the hard palate, facial gymnastics for the oral area, massage for muscle tension in the forehead, nose and cheek-zygomatic area, vocal and orthophonic exercises, Vova’s speech nasalization significantly decreased (remained small nasal tint), the soft palate has become more flexible and mobile, the tongue has taken the correct position.

All vowel and consonant sounds except "r, r", "R"- only called and automated in words.

Such results were achieved thanks to the help of relatives (mother, grandmother), who took an active part in raising the child’s correct speech. Constantly attended individual lessons and conscientiously completed the speech therapist’s assignments. It is recommended to continue the session with a speech therapist.

In Nikita, nasalization was preserved to a slightly greater extent due to the shortening of the soft palate and severe cicatricial changes on it. The position of the tongue corresponds to the norm; all sounds except

"l", "l"(these sounds are only caused).

The parents tried to help the speech therapist. Difficulties arose due to disturbances in the emotional-volitional sphere. The child was withdrawn, embarrassed by his new correct pronunciation, so it was difficult to introduce independent speech. It is recommended to continue classes with a speech therapist at school.

We reflected the data from the initial and final survey in Table No. 2 (see Appendices). For better clarity, we built a diagram (appendix).

Comparing the survey results at the beginning and at the end of the experiment. I would like to note that we managed to significantly reduce nasalization and deliver almost all sounds. The children’s speech became understandable to others, which ensured its communicative function. The children gained self-confidence. All this created the prerequisites for successful schooling.

Conclusion

A theoretical review of scientific and pedagogical literature and a study conducted on the problem of early elimination of speech disorders with open rhinolalia in preschool children using evidence-based methods of pre- and postoperative speech correction allows us to note the following.

At the beginning of our work, we believed that early comprehensive medical, psychological, and speech therapy assistance (in preschool age) is extremely necessary for open rhinolalia. This technique includes 3 stages.

At the first stage, the main attention was paid to the examination of children, the first conversations with children and (separately) with the child’s relatives.

At the second stage, the content of individual rehabilitation programs is developed using the following methods of correctional work:

Stimulation of the palatine and pharyngeal muscles;

Practicing the basic parameters of speech breathing (gradual direction, duration and the most rational diaphragmatic type);

Translation of the entire articulatory base of sounds into the anterior parts of the oral cavity using purposefully selected phonetic material;

Vowel “helper sounds” and consonant sounds are corrected;

Automation of developed skills in pronouncing sounds in spontaneous speech (children learn to speak consciously, clearly without unnecessary repetitions at a moderate pace) with the simultaneous introduction of orthophonic and vocal exercises.

Throughout the entire course of learning new pronunciation skills, auditory perception and auditory attention are formed, as well as phonemic hearing, which are so necessary for differentiating nasal and pure sounds and their combinations. Words of speech in general.

Elementary graphic skills develop graphic and visual-motor skills, attention, perception, spatial orientation, correct motor function, normalize rhythm, tempo, coordination of movements and improve speech development.

The purpose of our study was to experimentally substantiate the effectiveness of early comprehensive medical, psychological and speech therapy assistance for open rhinolalia in preschool children. Carrying out the results of the study allows us to consider, in general, the tasks set as solved and the hypothesis confirmed.

The results of the research work made it possible to draw theoretical and experimental conclusions and give recommendations for parents and teachers that will help organize work on speech correction for open rhinolalia.

We experienced some difficulties in working with children, because... a child with open rhinolalia needs the complex influence of a speech therapist, doctors and psychologists. The help of a psychologist would help us correct the emotional-volitional sphere of the child (psychotherapeutic conversations); qualified medical massage would help us achieve better results in correcting disturbances in the functioning of the facial muscles of the palate and tongue.

We believe that further research on the problem of speech correction in children with open rhinolalia should be continued and built on a differentiated approach to each child, because Disturbances in the anatomical and physiological structure of the articulatory apparatus are heterogeneous in different children. The results of surgical intervention may also be different. Therefore, it is necessary to publish more popular literature with variable methods for correcting speech impairment in children with rhinolalia, which could be useful for both teachers and parents who have children with an open form of rhinolalia.

Literature

1. Almazova E.S. “Speech therapy work on voice restoration in children” - M. 1973.

2. Bulatovskaya B.Ya. "Organization of clinical examination of children with congenital clefts of the upper lip and palate." In the book. “Congenital clefts of the upper lip and palate” - M. 1965.

3. Vansovskaya L.I. “Elimination of speech disorders in congenital cleft palate” - St. Petersburg, Hippocrates. 2000

5. Voronin L.G. and others.”Physiology of higher nervous activity and psychology”: Textbook.-Education, 1984.

6. Gerasimova A.S. and others. “Unique methodology for the development of speech in preschool children” M. Olma - Press 2002.

7. Dubov M.D. “Congenital cleft palate” - M. 1960.

8. Ermakova I.I. “Speech correction for rhinolalia in children and adolescents” /Ed. S.P. Taptapova - M. Education, 1984.

9. Zhinkin I.I. “Mechanisms of speech” - M. 1958.

10. Inshakova O.B. “Album for a speech therapist” - M. Vlados, 2000.

11. Ippolitova A.G. "Open rhinolalia"

12. Levina R.E. “Writing impairment in children with speech underdevelopment” - M. 1961.

13. Speech therapy /Ed. L.S. Volkova, S.N. Shakhovskoy - M. Vlados, 2002

14. Maksakov A.I., Tumakova G.A. “Teach by playing: Games and exercises with sounding words” - M. Prosveshchenie, 1983.

15. Povalyaeva M.A. “Speech therapist’s reference book” – Rostov-on-Don, 2002.

16. Sapin M.R., Bryksina Z.G. “Human Anatomy” - M. Enlightenment: Vlados, 1995.

17. Serebrova N.I. “From the experience of working with children with rhinoplasty in the postoperative period” - In the book. “Speech disorders in preschool children” - M. Prosveshchenie, 1969. pp.113-136.

18. Smirnova E.O. “Child Psychology” - M. School - PRESS, 1997.

19. Frolova L.E. “Congenital cleft lip and palate” - M. 1973.

20. Reader on speech therapy / Under. ed. L.S. Volkova, A.I. Seliverstova. – M. 1997, part 1.

21. Filicheva T.B., Chirkina G.V. “Preparation for school of children with special needs in a special kindergarten” - M. 1993.

Annex 1

Literary works for storytelling by roles to automate new skills

Games - dramatizations:

Kitty-murysenka

Little kitty, where have you been?

At the mill.

What were you doing there?

I ground flour.

What kind of flour did you bake with?

Gingerbread cookies.

Who did you eat gingerbread with?

Don't eat alone!

Fox and mouse

Little mouse, why is your nose dirty?

I was digging the earth.

Why did you dig the ground?

I made a mink.

Why did you make the mink?

I was hiding from you, fox.

Little mouse, I'll lie in wait for you.

And I have a bedroom in my hole.

If you want to eat, you will come out.

I have a storage room in my hole.

Little mouse, I'll dig up your hole.

And I’m a stranger to you – and I always was.

Outdoor game "Bunny"

Description of the game: children stand in a circle, the leader stands in the center of the circle and asks questions, the children answer:

Bunnies, where have you gone?

We rested in the cabbage.

Didn't you eat the leaves?

Just touched my nose.

You should be punished!

So try to catch up with us!

The leader catches up with the fleeing children.

1.When communicating with a child, pronounce words slowly, clearly, with distinct sound pronunciation.

2. Develop your child’s attention and perseverance in specially created play situations.

3.Create conditions for relaxed communication in a group of children with normal speech - visiting a mass kindergarten, participating in games that develop auditory, visual, and kinesthetic perception, attending music and singing classes.

4.Develop speech praxis, cultivate breathing, train fine motor skills in a playful way.

5.Expand your vocabulary (dictionary), develop the ability to generalize and form concepts.

Appendix 3

Level of speech development in children of senior preschool age with open rhinolalia at the final control stage

Table No. 1

№	F.I. baby	1	2	3	4	5	6	7	8	Levels
1	Vova A.
2

1. Sound pronunciation of vowels

2.Sound pronunciation of consonants

3. Pronunciation of words.

4.Development of phonemic hearing

5.Speech intelligibility

6. Compliance of the volume of the passive vocabulary with the norm

7. Volume of active dictionary

8.Presence of an expanded phrase

High level

Average level

Rhinolalia in children and adults is not so rare. A speech therapist will help you cope with this speech disorder. In this article I will try to talk about what rhinolalia is, its forms, symptoms and areas of correctional work.

Rhinolalia (nasality)

This is a pathological change in voice timbre and distortion of the pronunciation of speech sounds as a result of disruption of the normal participation of the nasal cavity in the process of speech formation. If only the timbre of the voice is disturbed (it acquires a nasal tint), but the articulation of sounds is not impaired, then such a voice disorder is called rhinophony.

In the Russian language, there is a division of sounds according to the participation in their formation of the nasal cavity. 4 sounds are nasal (these are the sonors M, Мь, Н, Нь), the remaining sounds are oral. The nasal cavity should not take part in the formation of oral sounds. Normally, the oral cavity is separated from the nasal cavity.

The soft palate is an active organ, and it is a kind of door between the oral and nasal cavities. If necessary, the soft palate can rise and close the passage into the nasal cavity, or it can fall and open this passage, if necessary.

In the case of rhinolalia, the normal participation of the nasal cavity in the process of speech formation is disrupted in two ways. In the first case, the exhaled air stream can be directed through the nose when pronouncing all sounds (nasal and oral), resulting in excessive resonance of the nasal cavity. This is open rhinolalia.

In the second case, the exhaled stream of air when pronouncing all sounds is directed through the mouth, as a result of which insufficient resonance of the nasal cavity occurs (M sounds like B, N sounds like D). This type of rhinolalia is called closed rhinolalia.

Mixed rhinolalia is also distinguished, which is caused by air leakage through the nose with a simultaneous decrease in nasal resonance and it manifests itself in a combination of disorders characteristic of both open and closed rhinolalia at the same time.

Open rhinolalia.

Symptoms:

Changes in the position and activity of the tongue (it is pulled back, the back is sharply arched, tense, the tip is weakly defined);

Impaired activity of the muscles that move the soft palate (either passively sagging or inactive);

The interaction between articulatory and facial movements has been changed, which leads to excessive movements of the facial muscles during speech;

Impaired speech breathing (speech exhalation is uneven); - total violation of sound pronunciation (all speech sounds are pronounced with a nasal connotation, vowels are especially affected, and the articulation of consonants shifts posteriorly)

Types of open rhinolalia

The largest group consists of organic open rhinolalia due to congenital clefts. In this case, parents know about the child’s problems from birth. Corrective work is carried out only using comprehensive medical, psychological and pedagogical means.

Medical influence is aimed at mechanical normalization of the structure of the articulatory apparatus, psychological influence is aimed at preventing or correcting disorders of personality development, and pedagogical (speech therapy) means are aimed at overcoming the speech defect itself. Speech therapy work to correct this form of rhinolalia is carried out both in the preoperative and postoperative periods.

Open organic rhinolalia of a central nature also occurs. It manifests itself in the same symptoms as the previous form, but with such rhinolalia there are no disturbances in the structure of the organs of articulation. This form is caused by paralysis and paresis of the muscles of the soft palate.

Due to muscle pareticity, the soft palate is passive, sags and does not perform its main function. Corrective work is also carried out comprehensively, but in this case, medical correction is carried out by a neurologist.

And finally, functional open rhinolalia, which is most often caused by a decrease in the tone of the soft palate when imitating nasal speech. It is much less common than organic and presents certain difficulties for differential diagnosis. The correction is speech therapy, sometimes psychological or psychotherapeutic help is required.

Closed rhinolalia

Symptoms:

The nasal sounds M, Мь,Н, Нь sound like the oral sounds B, Бъ, Д, Дь; in speech there is no opposition of sounds based on the participation of the nasal cavity, which affects overall intelligibility;

Vowel sounds also do not sound very natural due to deafening.

Types of closed rhinolalia

Organic closed rhinolalia. In this form, the speech defect is caused by anatomical disorders in the area of ​​the nose, pharynx, nasopharynx, and depending on where these anatomical defects are located, it is divided into anterior and posterior.

Anterior organic closed rhinolalia can be caused by hypertrophy of the nasal mucous membranes, polyps in the nasal cavity, tumors of the nasal cavity, and a deviated nasal septum. All these anomalies prevent the free passage of air through the nose.

Posterior organic closed rhinolalia can be caused by abnormalities in the pharynx and nasopharynx: adenoid growths, fusion of the soft palate with the posterior wall of the pharynx.

Correction begins with eliminating the cause of obstruction in the nasal cavity. First of all, consultation with an otolaryngologist is required. In some cases, surgery will be required. After eliminating the obstruction of the nasal cavity, speech therapy correction is needed, but it will require less time and effort than with open rhinolalia.

Functional closed rhinolalia. In this case, there is no disturbance in the structure of the articulation organs. It can be caused by imitation of defective speech, lack of auditory control. Correction is only speech therapy.

Mixed rhinolalia.

In this form, there is a combination of factors that cause both open and closed rhinolalia. Therefore, when eliminating it, a combined correction method is used, with a predominance of those exercises that are associated with a more pronounced form of rhinolalia.

Speech therapy work to eliminate rhinolalia.

It includes general directions regardless of the form, but will be implemented in different ways. Areas of speech therapy work for rhinolalia:

Normalization of speech breathing;

Formation of correct pronunciation of sounds;

The development of phonemic perception and differentiation of sounds and, on their basis, the development of phonemic analysis and synthesis.

In this article, I tried to address the main issues that relate to such a speech disorder as rhinolalia. If a child has a nasal sound, don’t expect it to go away on its own.

Start by visiting an otolaryngologist to determine the cause of this speech disorder, as in most cases medical attention will be needed first. Don’t delay your visit to a speech therapist either, because in these cases you cannot do without speech therapy work.

If you have any questions about this topic, write in the comments. If you found this information useful, please share it with your friends.

– disorders of articulation and voice formation caused by defects in the structure and functioning of the speech apparatus. Rhinolalia is characterized by gross distortions of sound pronunciation, nasalization of consonants and vowels, secondary impairment of phonemic processes and written speech, and underdevelopment of the lexico-grammatical aspect of speech. A diagnostic examination for rhinolalia includes consultation with an otolaryngologist, maxillofacial surgeon, and speech therapist to identify anatomical and functional defects of the articulatory apparatus and the degree of impairment of all aspects of speech. In order to overcome rhinolalia, surgical, physiotherapeutic, orthodontic treatment can be carried out; psychotherapy, speech therapy work.

General information

Rhinolalia is a distortion of sound pronunciation and voice timbre due to a violation of the velopharyngeal closure. Rhinolalia occurs with a frequency of 1 case in 760 people. Some authors consider rhinolalia as a form of mechanical dyslalia, however, it is generally accepted in modern speech therapy to classify rhinolalia as an independent speech disorder. To denote rhinolalia in the literature, the terms “nasality” or “rhinophonia” are sometimes used, however, both of these concepts do not fully reflect the essence of the speech disorder, since they indicate only a specific voice disorder (nasalization), while with rhinolalia the articulatory and acoustic aspects of speech suffer .

The diversity and complexity of the disorders underlying rhinolalia necessitate the participation of specialists in the field of surgical dentistry, orthodontics, otolaryngology, speech therapy, and psychology in overcoming it.

Classification of rhinolalia

The mechanism of development of rhinolalia is associated with a disruption in the interaction of the nasal cavity and oropharynx. Depending on the characteristics of this disorder, it is customary to distinguish open and closed forms of rhinolalia. Taking into account possible causes (anatomical defects or dysfunction of the speech apparatus), each of the forms can be organic and functional.

Open rhinolalia characterized by the presence of a constant open communication between the nasal and oral cavities, which determines the free passage of the air stream simultaneously through the nose and mouth during speech and the occurrence of nasal resonance during phonation.

Closed rhinolalia associated with the presence of an obstacle blocking the exit of the air stream through the nose. Depending on the level of location of the anatomical obstacle (nasal cavity or nasopharynx), closed anterior and closed posterior rhinolalia are distinguished, respectively.

With a combination of nasal obstruction and insufficiency of the velopharyngeal ring, they speak of mixed rhinolalia. In this case, there is an absence of nasal sounds and a nasal tone to the voice.

Causes of rhinolalia

Depending on the time of occurrence, open organic rhinolalia can be congenital or acquired. Congenital open rhinolalia occurs in children with clefts of the soft and hard palate (“cleft palate”), splitting of the alveolar process of the upper jaw and upper lip (“cleft lip”), shortening of the soft palate, bifurcation or absence of a small uvula, hidden (submucosal) clefts of the hard palate. The causes of congenital facial clefts can be infection of a pregnant woman in the early stages of gestation with toxoplasmosis, influenza, rubella, mumps and other infections; contact with pesticides and other harmful substances, smoking, drug and alcohol use during pregnancy, stress, endocrine disorders in the expectant mother. The critical period for the formation of facial clefts is the 7th-8th week of embryogenesis.

Acquired open organic rhinolalia occurs as a result of cicatricial deformities, traumatic perforation of the palate, paralysis and paresis of the soft palate caused by injury or tumor compression of the glossopharyngeal or vagus nerves.

Cases of open functional rhinolalia occur after removal of the adenoids or with post-diphtheria paresis of the soft palate. In this case, there is insufficient lifting of the soft palate and incomplete velopharyngeal closure during phonation.

The causes of closed organic rhinolalia are various kinds of anatomical changes in the nasal cavity or nasopharynx. Anterior closed rhinolalia may be associated with the presence of a deviated nasal septum, nasal polyps, mucosal hypertrophy, and tumors of the nasal cavity. Posterior closed rhinolalia is caused by adenoids, polyps, fibroids of the nasopharynx, growth of the unpaired pharyngeal tonsil, etc.

Closed functional rhinolalia occurs when the soft palate is hypertonic, preventing the air stream from exiting through the nose. This condition can develop as a result of adenoidectomy, neurological disorders, and also against the background of copying the nasal speech of others.

Symptoms of rhinolalia

With open organic rhinolalia caused by congenital facial clefts, the child’s vital functions of nutrition and breathing suffer from the first days of life. When feeding a baby, milk leaks out through the nose, so the newborn does not gain enough weight and does not receive the necessary nutrients. The inhaled air does not have time to warm up sufficiently in the nasal passages, because it immediately enters the lower respiratory tract through the cleft. Children with palatal clefts and open rhinolalia are predisposed to malnutrition, otitis media, eustachitis, bronchitis, and pneumonia. Congenital cleft palates are often combined with malocclusion.

The state of intelligence in children with open rhinolalia can be different - from normal to mental retardation and mental retardation of varying degrees. Neurological signs are often observed in children: nystagmus, ptosis, hyperreflexia.

The prelinguistic period in children with rhinolalia proceeds abnormally: attention is drawn to the absence of modulated and varied babbling, quiet or silent articulation of sounds. Speech development with rhinolalia is also delayed: the child often pronounces his first words after 2 years. Speech is slurred, inexpressive and incomprehensible to others.

With open organic rhinolalia, the articulation of sounds and sound pronunciation are grossly impaired. The root of the tongue is constantly in a raised position, and the tip of the tongue is in a passive, lowered position, and therefore most of the consonants acquire a “back-lingual” connotation and resemble the sound [x]. With open rhinolalia, all sounds have a strong nasal (nasal) connotation and are practically not differentiated from each other; the voice becomes dull and quiet.

In an effort to pronounce sounds more clearly, children strain their facial muscles, muscles of the lips, tongue and wings of the nose, which leads to grimaces and further worsens the overall impression of speech.

Inaccurate articulation and distorted sounds are accompanied by a secondary impairment of auditory differentiation and phonemic analysis, leading to disorders of written speech - dysgraphia and dyslexia. Limitation of speech contacts in children with rhinolalia leads to insufficient development of vocabulary and grammatical aspects of speech, i.e. ONR.

If a child with open organic rhinolalia realizes and experiences his defect, this causes him to develop secondary mental layers: isolation, irritability, shyness.

With open functional rhinolalia, it is mainly the sound pronunciation of vowels that suffers; consonant sounds remain intact due to sufficient velopharyngeal closure.

Closed organic rhinolalia is accompanied by a violation of the pronunciation of nasal sounds ([m], [m"], [n], [n"]), replacement of [m] with [b], [n] with [d]. At the same time, the timbre of the voice also suffers; Due to the impossibility of nasal breathing, children are forced to breathe through their mouths. Children with closed organic rhinolalia are prone to colds and the development of asthenic syndrome. With closed functional rhinolalia, the voice acquires a dull, unnatural, dead tone.

Diagnosis of rhinolalia

The examination of children and adults with rhinolalia is multifaceted and is carried out by various specialists: otolaryngologist, maxillofacial surgeon, orthodontist, neurologist, phoniatrist, speech therapist, psychologist. The most important instrumental studies to identify the causes of rhinolalia are radiography of the nasopharynx, rhinoscopy, pharyngoscopy, electromyography, etc.

During a speech therapy examination of a patient with rhinolalia, the main attention is paid to assessing the structure and mobility of the articulatory apparatus, physiological and phonation breathing, and voice disorders. To identify open rhinolalia, the Gutzmann test is used - pronouncing the vowels [a] and [i] with alternate closing and opening of the nasal passages. When the nostrils are pinched, the sounds are muffled, and at the same time the speech therapist feels with his fingers a strong vibration of the wings of the nose. Then the sound pronunciation of all vowels and consonants, the prosodic side of speech, phonemic processes, the state of vocabulary and grammar are examined; for schoolchildren - the state of reading and writing.

Speech therapy classes for the correction of open organic rhinolalia are carried out in the pre- and postoperative period. Before the operation, articulation exercises, breathing exercises, speech therapy massage (finger massage of fragments of the hard palate and vibration massage of the soft palate) are performed. At this stage, it is necessary to work on the production and automation of available sounds (while maintaining their nasal tone), develop the strength and flexibility of the voice, expand the child’s vocabulary, cultivate auditory attention and phonemic hearing, etc.

The goal of postoperative work to correct rhinolalia is to consolidate the achieved skills in new anatomical conditions. For this purpose, massage of postoperative scars of the palate, development of full velopharyngeal closure, development of differentiated oral and nasal exhalation, correction of sound pronunciation, elimination of the nasal tone of the voice, elimination of gaps in the lexico-grammatical structure and phrasal speech are carried out.

Forecast and prevention of rhinolalia

Functional rhinolalia, as a rule, has a favorable prognosis and is eliminated with the help of phoniatric exercises and speech therapy sessions. The effectiveness of overcoming organic rhinolalia is largely determined by the results of surgical treatment, the timing of the start and completeness of speech therapy work.

Prevention of rhinolalia consists of preventing the occurrence and timely elimination of anatomical defects and functional disorders of the speech apparatus.

Abstracts of articles on the problem of rhinolalia

“Congenital diseases of the skeletal and muscular systems of human organs and tissues.”

Newspaper "Biology" N 33-34 - 2001

The article is subtitled “Cleft palate and cleft lip.” The author writes that cleft lips and palates - the so-called “cleft palate” and “cleft lip” - are among the most common birth defects in children. In terms of prevalence, cleft lip is second only to congenital clubfoot;

In order to understand what these anomalies are, the author suggests recalling the evolution of vertebrates.

Experts disagree on the age at which uranoplasty and cheiloplasty should be performed: some prefer to perform the operation on infants at 3-6 months, others at a later date. Which method to prefer will be advised by specialists who have been observing the child since birth. But in any case, all treatment of a young patient, including rehabilitation, must be completed by the age of six.

For a long time it was believed that it should be carried out as late as possible - when the maxillofacial system in a person has already formed. Our experience, and foreign experience too, suggests the opposite - the sooner parents see a doctor, the better. Operation on the lip can be performed starting from 2 months, on the palate - up to one and a half to two years of age. It should be taken into account that in complex cases, not one, but several operations are required. In this case, the anatomical defect of the lip and palate should be eliminated by the age of 3, when the child begins to develop speech. Otherwise, he will develop peculiarities of pronunciation and characteristic “nasal” intonations.

From 3 to 7 years of age, additional cosmetic surgeries are performed in order to maximize the child's appearance. By school, the child must be completely rehabilitated, then he will be able to attend a regular secondary education institution. This is all the more important because in terms of mental and mental development such a child is absolutely no different from other children.

For help, you should only contact specialized medical centers dealing with this type of pathology. There should be all the necessary specialists - micropediatrician and pediatrician, orthodontist, surgeon, speech therapist, teacher and psychologist, social worker. The latter is important, because such children are considered disabled and must be registered with social security authorities and receive a pension. And only after completion of all rehabilitation measures can the child be removed from the disability register.

This is a rather complex pathology, but you shouldn’t give up - modern medicine is able to help such children. “Cleft lip” and “cleft palate” are, so to speak, philistine concepts, but doctors use a different definition - “congenital cleft lip and palate.”