Deviation of the tongue is its deviation to the right or left from the midline. If a healthy person is asked to stick out his tongue, he will do so without difficulty, and it will be located exactly in the middle of the oral cavity. If it somehow works incorrectly, then it will be possible to observe a deviation of the speech organ.
It is disturbances in the functioning of the nervous system that lead to problems in work and sometimes in the face. Most often, such changes occur due to diseases of the brain, for example, due to a stroke.
What is a stroke?
Stroke is a cerebral circulatory disorder associated with neurological symptoms that do not go away for several months. This is a very serious disease, resulting in death in a quarter of cases. The same proportion of patients become first-degree disabled. And some people who have suffered a stroke gradually return to normal life. However, this takes a lot of time, because in most cases, patients need to relearn how to move and speak. Patients often find themselves bedridden and unable to care for themselves.
Tongue deviation during a stroke is just one of the symptoms that may appear. As a rule, hemorrhage in the brain greatly affects the neurotic state of the patient, and in addition to deviation of the organ of speech, atrophy of the facial muscles, the inability to move the limbs on one side, and sometimes complete paralysis of the body or its individual parts may occur. Deviation of the tongue during stroke leads to serious speech impairment. Is it possible to be completely rehabilitated and get rid of the disease and how to do it?
What could be the reasons for the appearance of language deviation?
Why does the tongue deviate to the left? The reasons for this are rooted in neuroscience. Deviation can occur due to improper functioning of the hypoglossal nerve. In this case, the muscles of the speech organ on the left side become significantly weaker than on the right. Therefore, when pushing the tongue out of the oral cavity, it shifts to the weaker side. The deviation of the tongue to the right occurs similarly.
Also, deviation can appear due to facial unevenness, when on one side there are much stronger ones. In such cases, when the tongue sticks out, it will also move to one side. In some cases this happens completely unnoticed, and sometimes the pathology is very clearly visible. However, the tongue itself functions normally, and its muscles on both sides have equal strength.
Diagnosis of tongue deviation
Diagnosing the presence of language deviation is not always easy. But in most cases, it is enough for the patient to simply stick it out. Having seen the deviation, the doctor can conclude which side of the muscle is weaker. For example, if there is a deviation of the tongue to the right, the reasons lie in the fact that this area of the face is less strong.
However, deviation is not always associated with brain diseases. Sometimes such deviations can be explained by insufficient development of the facial muscles on one side.
To determine what exactly the doctor is dealing with, the patient is usually asked to make a quick movement of the tongue in both directions. In this case, it will be clear with what force these manipulations are performed.
If such measures do not help, then the patient should be asked to press his tongue on both cheeks from the inside in turn. For example, a specialist diagnoses the right side. He checks the pressure with his hand on the outside of the right cheek, trying to counteract the force of the tongue. In this case, the specialist will be able to evaluate how his muscles work and understand whether there is deviation of the tongue to the right.
Treatment of tongue deviation
It should be noted that deviation is not an independent disease, it is only a symptom that manifests itself as a result of other diseases. Therefore, getting rid of such a manifestation depends entirely on treating the disease that caused it. If the cause is a stroke, which happens most often, it is necessary to eliminate disturbances in the blood supply to the brain. Once this problem is eliminated, the nerves will return to normal and, therefore, the symptoms associated with neurology will also disappear. If the problem is in the facial muscles of the face, then you need to consult a doctor and, with the help of special exercises, develop the muscles that lag behind the other side.
Deviation of the child's tongue
A stroke or distortion of the facial muscles is an unprecedented phenomenon for a child, but children also face tongue deviation. As a rule, the cause of such a symptom is dysarthria or erased dysarthria.
This disease is caused by a disruption of the signal from the brain to the muscles of the articulatory apparatus. In this case, an incorrect nerve signal can affect both the child’s facial muscles and the tongue.
Not many children experience this phenomenon. However, cases were still recorded. Most of those suffering from such disorders outwardly look like completely healthy children, and only a doctor is able to determine that a child has dysarthria.
Symptoms of dysarthria in a child
If there are disturbances in the transmission of nerve signals, the child’s face becomes inactive and does not express any emotions through facial expressions. The patient's lips are often pursed, the corners are drawn down; the child retains this facial expression almost constantly.
In severe cases, due to the disease, the child cannot close his mouth and keep his tongue in the mouth. Also, with dysarthria, the patient often experiences tongue deviation. If you ask the baby to stick out the organ of speech, you will notice that it is difficult for the child to keep it in the midline. The tongue shakes slightly and deviates to the side.
The difference between dysarthria and erased dysarthria
As a rule, with dysarthria, there is pronounced immobility of the face, which is very easy to notice on the child’s face. Other signs can also be noted, such as lack of coordination in hand movements and disorientation in space. In general, children with dysarthria do not like to engage in drawing, modeling with clay, or any other activity that requires the use of fine motor skills.
However, more and more often there are children who cope well with any type of activity and love to draw and be creative. At the same time, they have active facial expressions, they smile and laugh a lot and are no different from an ordinary healthy child. The only thing that indicates the presence of dysarthria is a deviation of the language. As a rule, children suffering from this disease have a rather thick tongue. If you ask a child to stick it out of his mouth, you may notice that the tongue shakes and deviates to the side. The manifestation of such symptoms in medicine is called erased dysarthria.
Both diseases are combined. The child may have a lisp and swallow some sounds. At the same time, it is quite difficult to understand what a child is saying. Speech is extremely unintelligible and inarticulate.
How does dysarthria affect the child’s psyche?
Basically, all children suffering from mild or severe dysarthria have an unstable psyche. They are characterized by frequent mood swings, swinging from one extreme to another. A child may, on the one hand, be overly vulnerable and constantly cry over trifles; on the other hand, he may become aggressive, be rude to adults, and conflict with peers. Such children are rarely good students; as a rule, they are inattentive and do not delve into the essence of learning.
How to get rid of tongue deviation for a child?
In order to get rid of tongue deviation in a child, comprehensive treatment is necessary. Many parents believe that with erased dysarthria, it will be enough just to go to a speech therapist who will help the child pronounce words correctly. However, the diagnosis in this case is made by a neurologist and he should also prescribe treatment. As a rule, the child is prescribed not only classes with a speech therapist and training in the correct pronunciation of sounds, but also a course of massage of the neck, collar area and chin. Also often used in therapy are facial massage with hands and probe massage of the tongue. In this case, it is simply impossible to achieve results with the help of any medications; regular exposure to the source of the nerve impulse is necessary.
Treatment of tongue deviation in both adults and children primarily involves treating the disease that causes the tongue to deviate from the midline. It is impossible to get rid of this problem without comprehensive measures. Doctors often recommend combining therapy aimed at the disease itself, as well as symptomatic treatment, which mainly includes massages and training. These measures will allow you to return your tongue and facial muscles to normal as quickly as possible. It is necessary to pay special attention to tongue deviation in a child, since the presence of a disease can often be determined only by this sign.
The main thing is timely treatment, otherwise complications may develop. The most common are the development of slurred speech, difficulties in pronouncing words, the inability to pronounce any words (loss of speech).
A child's tongue that is very large or very thick is called macroglossia. This pathology is caused by structural abnormalities on the surface or inside the organ. Most often, this pathology appears in children. The diagnosis of macroglossia is made by a doctor when the child’s tongue is completely enlarged or certain areas of it are swollen. This disease can be congenital or acquired.
Why does the disease appear?
Congenital macroglossia develops during prenatal development of the fetus. Various factors can influence the development of pathology. It can develop independently against the background of such diseases:
- Down syndrome;
- malocclusion;
- tuberculosis;
- hormonal dysfunctions;
- syphilis;
- infectious processes in the body;
- impaired microcirculation of blood fluid, hemorrhages in the oral cavity;
- organ abscess;
- glossitis;
- bruises, injuries, neoplasms of various types;
- lymphadenitis;
- development of a purulent focus;
- abnormal structure of the tongue muscles;
- acromegaly (a disease associated with excess production of growth hormone);
- myxedema (“mucoedema” due to lack of thyroid hormones);
- acute allergic reaction;
- actinomycosis lesion.
The listed diseases may be accompanied by such a symptom. Therefore, it is important to consult a doctor in a timely manner to determine the cause of macroglossitis and prescribe adequate therapy.
How to detect pathology
Doctors distinguish between false and true macroglossitis. The first is due to the abnormal structure of the jaw apparatus. At the same time, the jaw is narrow and slightly sunken, but this is not evidence of a real disease, it is the result of an abnormal structure of the bone apparatus and tissues.
When the true form of the disease develops, the tongue is too large, its volume is several times higher than normal. In addition, additional symptoms are:
- inability to completely close the mouth, the organ is stuck out;
- increased production of salivary fluid, there is a lot of it in the mouth, it flows out or drips;
- irritation and redness of the skin under the lower lip and on the chin;
- imprints from the teeth are visible on the surface of the organ, it can also become covered with ulcers or erosions;
- presence of malocclusion;
- Difficulty eating – difficulty chewing and swallowing;
- difficulty speaking.
Diagnostic measures
When undergoing a routine ultrasound examination during the third trimester of pregnancy, the doctor may detect congenital macroglossia. It is determined after comparison with the norms of each age at a given stage of fetal development. To make an accurate diagnosis, a repeat test is scheduled.
After the birth of the child, an examination awaits from many specialists - an infectious disease specialist, geneticist, otolaryngologist, endocrinologist. An instrumental examination is carried out, and a biochemical study of the blood fluid is prescribed. Based on the results of all tests and diagnostic methods, a diagnosis is made and therapy is prescribed.
Complications and consequences
It is very important to recognize the disease at the initial stages of development. This will allow you to complete the course of treatment and prevent the development of dangerous consequences. In general, macroglossia does not greatly worsen the patient’s life, but often becomes the cause of various diseases. Children with this diagnosis become outcasts and do not experience normal socialization. Speech is slurred, there is a defect in appearance, so it is not easy for them to communicate with peers. Typically, children prefer to avoid a child with this pathology. The child grows up with complexes, inferior, and withdraws into himself.
A secondary disease that develops against the background of macroglossia is the proliferation of connective tissues of the tongue. In the presence of pathology, other diseases become more active:
- Dysfunctions in the respiratory system. Since a very large tongue prevents full breathing through the nose, the child gets used to breathing through the mouth.
- Difficulty pronouncing sounds. It is not easy to pronounce words; whistling and hissing sounds are not pronounced at all.
- Curvature of teeth.
- Oral diseases.
- Since food is not fully chewed, various problems with the digestive system arise - gastritis, colitis, ulcers.
- The tongue is constantly dry, painful, and erosions or ulcers often appear on its surface.
Therapeutic effect
When choosing the type of therapy, the doctor takes into account the form of the disease and the cause of its origin. If this pathology is caused by a secondary disease, the cause should be treated in parallel. The general treatment algorithm involves the use of the following medications:
- antibacterial drugs that are used orally or injected;
- antiseptic solutions that are used for local treatment of the surface of the muscular organ;
- the use of anti-inflammatory drugs for treating the tongue.
When treating the main disease that caused macroglossia, with an integrated approach, medications have a positive effect on the organ, it gradually becomes smaller in size. The therapy is long-term, the duration of the course of taking medications is determined by the treating doctor. It is also necessary to undergo regular examinations, since treatment adjustments may be necessary as the patient recovers.
Surgical treatment
If drug therapy does not bring the desired result, the tongue does not decrease in size, and continues to extend beyond the mouth, surgical treatment will usually be required. The main indications for surgical intervention are:
- difficulties in respiratory function, discomfort from lack of oxygen;
- great difficulty chewing or swallowing;
- distorted appearance;
- a severely disturbed bite, in which it is impossible to treat the surface of the organ;
- too much salivary fluid production;
- great difficulties in the speech apparatus, which cannot be corrected by a specialist.
Surgery involves reducing the tongue to normal size and shape. In most operations, the wedge-shaped portion of the organ is removed, due to which its size becomes smaller. The procedure is carried out under general anesthesia, the function is gradually restored.
If there is an open bite, a special prosthesis is installed that prevents the organ from falling out. In the case of a congenital form of the disease, the child undergoes surgery to ligate the arteries after birth. This way you can stop pathological growth.
If you contact a specialist in a timely manner, the likelihood of a successful recovery is maximum. If the pathological size is due to the presence of a tumor, therapy consists of surgical removal of the tumor, followed by chemotherapy and radiation therapy. With the right approach to treatment and strict adherence to all medical prescriptions, you can stop the development of pathology and get rid of it completely.
In our previous issues, we wrote about why the color of children's tongue may change. Sometimes this does not mean anything serious, and sometimes it can be caused by a number of diseases, including quite serious ones. Let's take stock and remember once again when you need to see a doctor immediately.
All children have a normal tongue color - pink. The tongue is moderately moistened: it should not be dry, but it should not be too wet. The surface of the tongue appears uniform and velvety, which is ensured by the uniform distribution of the papillae. If a child’s tongue is coated or suddenly changes color or surface texture, parents need to be careful. It doesn't happen without a reason.
White or red tongue in a child
Many parents of infants face this phenomenon. Sometimes a white coating is noticeable from birth. Harmless causes that do not require medical intervention are plaque from breast milk or formula, as well as residues after regurgitation. The plaque in this case is thin and has the appearance of a film. It is washed off with plain water - just let the baby drink from a bottle. This plaque forms because in the first months after birth, little saliva is produced in the baby’s mouth and the oral cavity is not properly irrigated.
Another common cause is candidiasis, or thrush. In this case, the plaque cannot be removed, and it is not necessary, since it is very easy to injure a child’s delicate tongue. The pediatrician will prescribe sanitation of the oral cavity with special solutions, for example, Candide, which will remove the unpleasant plaque in just a few days. A gauze swab is moistened with the solution and carefully applied to the affected areas.
A bright red tongue also certainly cannot be considered normal. If redness of the tongue is accompanied by fever, and the tongue turns crimson, most likely the baby has contracted scarlet fever. It mainly affects children aged 2 to 10 years. Later, the fever will be accompanied by a rash on the neck and shoulders. Full recovery occurs in one to three weeks.
If a child’s tongue not only turns red, but also its surface acquires a varnished, glossy texture, this is a sign of a deficiency of iron and vitamins B9 and B12. The doctor can determine this using a general blood test. It is imperative to increase the child’s hemoglobin, so you will have to reconsider his diet, including healthy and iron-rich foods, and, perhaps, the baby will take iron supplements and B vitamins for some time.
The tongue may not turn red completely, but in patches. Such spots can occur due to allergies, inflammatory processes (for example, stomatitis), malfunctions of the gastrointestinal tract, glossitis, and herpetic infections. Finally, redness can occur due to tongue injuries or ingestion of hot or spicy foods.
Color varies
Pediatricians say: tongue is an indicator of health. If a child has a yellow tongue, this may be due to poor oral hygiene. However, this phenomenon often accompanies various diseases of the internal organs. A yellow tongue in a child may indicate a number of disorders in the body:
- Stomach diseases, in particular gastritis;
- Colitis and enterocolitis;
- Liver diseases;
- Gallbladder diseases;
- Poisoning.
The yellow color of the plaque occurs due to the release of bilirubin, which increases in the baby during illness. In severe cases, the skin and eye sclera may also turn yellow. If a child's tongue color changes, heartburn, vomiting, abdominal pain, or intestinal disorders occur, you should immediately consult a doctor.
A brown tongue in a child is rare, unlike in adults. In the vast majority of cases, adults pay with a brown coating due to the abuse of strong tea, coffee, and chocolate. A child's brown tongue will most likely also be simply a coating after eating or drinking foods containing coloring pigments. In this case, it can be easily cleaned with a regular toothbrush.
If parents see that a child has a black tongue, this can undoubtedly cause panic at first. However, do not rush to conclusions: the sight, of course, is not a pleasant one, but usually the tongue darkens after eating any food. Regular berries like blueberries can produce this effect. The plaque disappears after a while on its own.
Taking iron supplements can also cause a child to develop a black tongue. After their cancellation, the tongue will turn pink. Taking antibiotics can cause a change in the color of the tongue, and the shades can be both light and dark. If the baby has dysbiosis, the tongue may also darken.
Geographical language in a child
If the color of the tongue is more or less clear, what is a child’s geographic language? Doctors use this definition because the language resembles a geographical map. It alternates between areas of thickening and desquamation - peeling and detachment of the epithelium. And such an unpleasant phenomenon occurs due to inflammatory processes in the mucous membrane of the tongue and dystrophic changes in it. In the child’s medical record, you will be able to see terms such as desquamative glossitis, benign wandering glossitis, chronic migratory erythema (oral form).
The causes are several groups of diseases: deficiency of B vitamins, diseases of the gastrointestinal tract and duodenum, diseases of the liver and biliary tract, pancreas, diabetes mellitus, some autoimmune diseases, as well as severe viral infections. In any case, a child’s geographic tongue requires a visit to a doctor and a health examination.
Don’t forget: the child must learn to take care of his mouth and brush not only his teeth, but also his tongue. Then there will be no “accidental” plaque or bad breath. And if your child’s tongue is coated, then rush to the doctor. We wish your kids health!
Text: Olga Pankratieva
According to the National Research Institute of Public Health of the Russian Academy of Medical Sciences, among the reasons for hospitalization of the adult population in the direction of emergency medical care, diseases of the circulatory system are in first place, in the structure of which cerebrovascular diseases occupy second place after coronary heart disease.
Acute cerebrovascular accidents (ACVA) are the central problem of modern neurology. Those patients who, at the first signs of a stroke, seek medical help at the emergency room have a real chance to receive modern treatment in a timely manner.
This provision determines the primary task of the emergency medical team - the correct diagnosis of stroke at the prehospital stage.
Considering the specifics of the work of mobile teams (time limit, lack of additional research methods), the only available way to assess the condition of the brain is a neurological examination.
The purpose of a neurological examination is to obtain an answer to a single question: is there damage to the central nervous system? The foundation for making a correct diagnosis, in addition to medical history, is a consistent study of the neurological status, and the only way to substantiate it is to register all the information received in the EMS call card.
The authoritative international journal Stroke proposes a simple test for prehospital rapid diagnosis of stroke - FAST. This abbreviation stands for Face-Arm-Speech-Time, or translated from English “face - hand - speech - time” by the name of the criteria being assessed. According to the authors, this test is able to detect stroke in 79–83% of cases.
All this dictates the need to develop and implement in the daily practice of emergency medical services a clear algorithm for assessing and describing the neurological status of patients not only with acute cerebrovascular pathology, but also with damage to the central nervous system of another etiology (traumatic brain injury, neuroinfection, toxic brain lesions).
For a rapid assessment of the neurological status and a confident judgment about the presence or absence of damage to the central nervous system on DGE, it is necessary and sufficient to conduct a brief neurological examination according to the proposed plan.
Algorithm for assessing neurological status
ACVA is diagnosed with the sudden appearance of focal, cerebral and meningeal neurological symptoms.
TO cerebral symptoms include: disturbances of consciousness, headache, nausea, vomiting, dizziness, convulsions.
The Glasgow Coma Scale is most commonly used to quantify consciousness. To do this, a scoring is carried out according to three criteria (eye opening, spontaneous speech and movements), and the level of impairment of consciousness is determined based on the sum of points (15 - clear consciousness, 13-14 - stupor, 9-12 - stupor, 3-8 - coma) .
Headache is most typical for hemorrhagic forms of stroke; as a rule, nausea, vomiting, photophobia, and focal neurological symptoms occur simultaneously with it. It is usually followed by depression of consciousness, vomiting, and severe neurological disorders.
With subarachnoid hemorrhage, the headache is very intense, unusual in nature, and occurs suddenly. Patients characterize it as “a feeling of a strong blow to the head” or “hot liquid spreading over the head.” Meningeal signs appear in most patients 3–12 hours after the onset of the disease.
Seizures (tonic, tonic-clonic, generalized or focal) are sometimes observed at the onset of a stroke (primarily hemorrhagic).
Nausea and vomiting are relatively common symptoms of brain damage. In any disease, nausea and vomiting, as a rule, do not appear independently, but in combination with other symptoms, which facilitates differential diagnosis. A characteristic feature of “cerebral” vomiting is the lack of connection with food intake; vomiting does not bring relief and may not be accompanied by nausea.
Dizziness can be manifested by the illusion of movement of one’s own body or objects in space (true, systemic dizziness) or a feeling of “lightheadedness” or lightness in the head (non-systemic dizziness).
Focal neurological symptoms
Focal neurological symptoms are manifested by the occurrence of the following disorders: motor (paresis, paralysis); speech (aphasia, dysarthria); sensitive (hypesthesia); coordinator (ataxia, abasia, astasia); visual (amaurosis, hemianopsia, scotoma); higher mental functions and memory (fixation or transient global amnesia, disorientation in time).
To identify focal neurological symptoms at the prehospital stage, it is necessary, first of all, to use an algorithm FAST test, and if it is impossible to carry it out or if inconclusive results are obtained, it must be supplemented with an assessment of other components of the neurological status.
The FAST test consists of four elements.
- Face(face) - ask the patient to smile or show teeth. During a stroke, a noticeable asymmetry of the face occurs - the corner of the mouth on one side is lowered.
- Arm(arm) - ask the patient to raise and hold both arms 90° in a sitting position and 45° in a supine position. During a stroke, one of the arms drops.
- Speech(speech) - ask the patient to say a simple phrase. During a stroke, it is impossible to pronounce words clearly, or there is no speech.
- Time(time) - the sooner help is provided, the greater the chance of recovery.
The foundation for making the correct diagnosis of stroke is a consistent study of the neurological status.
Speech disorders: Dysarthria is an articulation disorder in which the patient pronounces words unclearly. At the same time, a person has the feeling that he has a kind of “porridge in his mouth.”
Aphasia is a disorder in which the ability to use words to communicate with others is lost, while the function of the articulatory apparatus and hearing is preserved. The most common are sensory (inability to understand addressed speech), motor (inability to speak while maintaining understanding of addressed speech) and sensorimotor aphasia (inability to understand addressed speech and inability to speak).
From visual impairment With a stroke, various types of hemianopia may appear. Hemianopsia is the partial loss of one half of the visual field. Sometimes (with damage to the occipital lobe) hemianopsia may be the only symptom of stroke.
Approximately hemianopia can be confirmed by a test with dividing the towel. The doctor sits opposite the patient and horizontally pulls a towel (bandage) about 80 cm long with both hands. The patient fixes his gaze at one point and shows where he sees the middle of the towel. The longer end of the towel remains on the hemianopsia side.
Pupils: pay attention to the width and symmetry of the pupils, their reaction to light. Different pupil sizes (anisocoria) is a serious symptom that usually occurs when the brain stem is damaged.
Oculomotor disorders: assess the position of the eyeballs and the range of their movements. The patient is asked to follow with his eyes, without turning his head, an object moving in the horizontal and vertical plane.
During a stroke, the following oculomotor disorders may be observed: gaze paresis - limitation of the range of movement of the eyeballs in the horizontal or vertical plane; deviation of the eyeballs - forced rotation of the eyeballs to the side; nystagmus - involuntary rhythmic, oscillatory eye movements; diplopia - double vision of visible objects.
Facial symmetry: pay attention to the symmetry of the frontal folds, palpebral fissures, nasolabial folds, corners of the mouth. The patient is asked to wrinkle his forehead, frown his eyebrows, close his eyes, and show his teeth (smile).
There are two possible options for paresis of facial muscles - central and peripheral. With stroke, central paresis develops on the side opposite to the lesion, in which only the lower muscle group is affected. In this case, only smoothness of the nasolabial fold and drooping of the corner of the mouth are observed (in patients with impaired consciousness, the cheek “parusitis”).
Paresis of facial muscles: a - central, b - peripheral In the case of peripheral paresis, the upper and lower muscle groups are affected. In addition to the smoothness of the nasolabial fold and drooping of the corner of the mouth, smoothness of the folds of the forehead, incomplete closure of the eyelids (lagophthalmos), the eyeball moves upward (Bell's phenomenon), and lacrimation is possible.
If the patient has peripheral paresis of the facial muscles and there are no other neurological symptoms (hemiparesis), then the diagnosis of facial nerve neuropathy is more likely than a stroke.
Language deviation: ask the patient to show his tongue. Pay attention to its deviations from the midline (deviation of the tongue). With strokes, the tongue may deviate in the direction opposite to the lesion.
Swallowing and phonation: when the brain stem is damaged, the so-called bulbar syndrome may occur, which includes: swallowing disorder (dysphagia); loss of voice sonority (aphonia); nasal tone of voice (nasolalia); impaired articulation of sound pronunciation (dysarthria).
Movement disorders(paresis): tests for hidden paresis are carried out when vision control is turned off. Upper Barre test - ask the patient to stretch his arms forward, palms up, and hold them with his eyes closed for 10 seconds. The limb on the side of the paresis drops or bends at the joints, and the hand begins to turn palm down (turns into a pronation position).
Lower Barre test - the patient lying on his back is asked to raise both legs 30 degrees and hold them in this state for 5 seconds. The leg on the side of the paresis will begin to drop. It is necessary to distinguish the weakness of one leg from general weakness and the inability to hold the legs in principle.
In patients with impaired consciousness, paresis can be identified as follows: raise your hands above the bed and let go at the same time. A paretic hand falls more sharply than a healthy one.
It is necessary to pay attention to the shape of the hips and the position of the feet: on the side of the paresis, the thigh seems more spread out, and the foot is rotated outward more than on the healthy side. If you lift your legs by the feet, the paretic leg bends at the knee joint more than the healthy one.
Pathological reflexes: to diagnose stroke at the prehospital stage, it is enough to check the most common Babinski reflex. It is manifested by slow extension of the big toe with a fan-shaped divergence of the remaining toes, sometimes with flexion of the leg at the ankle, knee, and hip joints, in response to line irritation of the outer edge of the sole.
Sensory disorders: at the prehospital stage, it is enough to assess pain sensitivity. To do this, injections are applied to symmetrical areas of the body on the right and left, finding out whether the patient feels them equally or not.
The injections should not be too frequent or strong; you should try to apply them with equal force. With stroke, hemihypesthesia (decreased sensitivity in one half of the body) is most common.
Coordination problems: a disorder of coordination of voluntary movements with preserved muscle strength is called ataxia.
Ataxia is studied using coordination tests (for example, finger-nose tests), during which one can detect missed hits and intention tremor (shaking of the hand when approaching a target). It is also possible to walk on a broad base (with legs spread wide apart), and slow chanted (broken into syllables) speech.
Meningeal syndrome
Meningeal syndrome is a symptom complex that occurs when the meninges are irritated. It is characterized by intense headache, often nausea, vomiting, general hyperesthesia, and meningeal signs.
Meningeal signs can appear simultaneously with general cerebral and focal neurological symptoms, and with subarachnoid hemorrhages they can act as the only clinical manifestation of the disease.
These include the following symptoms.
Stiff neck. An attempt to passively bend the head to the chest reveals tension in the neck muscles and makes it impossible to bring the patient's chin closer to the sternum.
Kernig's symptom is the inability to fully straighten a leg at the knee joint that has previously been bent at a right angle at the hip and knee joints.
The upper Brudzinski symptom is when trying to bend the head of a patient lying on his back, his legs involuntarily bend at the hip and knee joints, pulling towards the stomach (checked simultaneously with neck stiffness).
Lower Brudzinski's symptom - when one leg is passively flexed at the hip joint and extended at the knee joint, involuntary flexion of the other leg occurs.
Of course, this algorithm significantly simplifies the true picture of the disease due to the loss of a number of details, but it is practical and can be used by emergency medical services teams in everyday practice, since it allows, while saving time, to carry out a rapid assessment of all neurological symptoms that may appear during stroke.
Depending on the patient’s main complaints, the most important data on the presence or absence of certain characteristic symptoms should be included in the EMS call card.
Carrying out a rapid assessment of the neurological status using the proposed algorithm allows us to judge with a high degree of confidence the presence or absence of damage to the central nervous system.
M. A. Miloserdov, D. S. Skorotetsky, N. N. Maslova
Undeveloped mouth muscles or weak facial muscle tone are among the causes of speech development deviations.
Based on the position of N.A. Bernstein about the level organization of voluntary movements and actions, a number of researchers and specialists in this field (in particular E. V. Sheremeteva) suggested that articulation, as the highest symbolic level of voluntary movement, can be formed while all underlying levels of voluntary movement are preserved. The peripheral part of articulation is built above the objective level of oral movements that fulfill life-sustaining nutritional needs: sucking, biting, chewing, swallowing. Therefore, they considered it possible to evaluate the potential possibility of articulation by observing the objective level of movements of the articulators - lips, tongue, lower jaw - in the process of eating and the state of facial expressions in free activity.
Having analyzed the results of the study by E.V. Sheremeteva, in the oral articulation base, precursors of speech underdevelopment (indicators of deviations from the normal course of speech development) at an early age were identified:
refusal of solid food: the child prefers homogeneous, well-chopped masses. Often, so that children do not go hungry, their parents bring yoghurts, curds, etc. to kindergarten. This eating behavior can have different causes: late introduction of solid foods; parents spent a long time (up to a year or even two) grinding the child’s food until smooth; maintaining the sucking reflex (breastfeeding) up to two, two and a half years; disruption of the innervation of the mandibular muscles;
difficulties in the process of chewing and, as a result, spitting, which is associated with a violation of the innervation of the corresponding muscle groups. With this reduction in physical activity, the muscles that lift and hold the lower jaw and the lingual muscles weaken;
general amicability in the process of eating: the child sits for a very long time over the plate or with a piece in his hand, then slowly brings the spoon to his mouth or takes a bite, begins to chew lazily (lack of pleasure “written” on the face from the eating process);
Liquid food or liquid is often spilled due to insufficient formation of the lip grip: the child does not sufficiently grasp the edge of a spoon or cup with his lower lip (liquid spills) or grabs pieces of food from the spoon directly with his teeth. They say about such people: “He doesn’t eat carefully.” In reality, the innervation of the labial muscles is impaired and, as a result, their strength, dexterity and coordination.
an increase in the threshold of receptive sensitivity of the skin of the circumlabial space, which also indicates a violation of the innervation of the corresponding muscle groups: the child drinks kefir or jelly, the remains of which, due to insufficient automation of objective movement, remain around the lips. He does not try in any way to reduce irritation from residual liquid. They say about such children: “Very untidy.”
If the perceptive sensitivity of the periolabial space is preserved, and the innervation of the lingual muscles is impaired, then under similar conditions the following is observed:
absence of circular licking movements of the tongue when a thick drink or liquid porridge gets on the lips or perioral space: the child in such cases wipes the upper lip with improvised means;
pulling the back of the tongue up with the tip of the tongue not expressed under similar conditions;
reducing irritation of the skin surface of the lips using the lower lip or other means;
raising the tip of the tongue to the level of the corner of the lips when trying to lick the upper lip.
In general, there is limited mobility of the lower jaw in the masticatory muscles; slight or quite pronounced displacement of the lower jaw to the side at rest, during chewing and during articulation; with pathology of the tone of the masticatory muscles, there is a decrease in the intensity and volume of chewing movements, discoordination of movements of the lower jaw during articulation; disruption of the process of biting off a piece (which can also be complicated by anomalies of the dental system); synkinesis is detected in the motility of the lower jaw during movements of the tongue (especially when raising the tongue to the upper lip or when pulling it towards the chin).
E.G. Chigintseva also notes the peculiarities in the lingual muscles: pathological conditions of muscle tone are observed, which in some cases are accompanied by structural features of the tongue (with spasticity, the tongue is often massive, drawn in a lump deep into the oral cavity or elongated as a “sting”; this can be combined with shortening of the frenulum represented by in the form of a dense cord; with hypotonia, the tongue is in most cases thin, flaccid, spread out at the bottom of the oral cavity, which can be complicated by shortening of the sublingual fold, which appears thin and translucent); There are violations of the position of the tongue (at rest and during movement) in the form of deviation to the side, protruding the tongue from the mouth, inserting the tongue between the teeth; a slight or fairly pronounced limitation in the mobility of the lingual muscles is detected; hyperkinesis, tremor, fibrillary twitching of the tongue; increase or decrease in the pharyngeal reflex. In the muscles of the soft palate, sagging of the velum palatine is noted (with hypotension); deviation of the uvulus (uvula of the soft palate) from the midline. In the autonomic nervous system, mainly mosaic disorders are observed in the form of easily occurring facial spasms (redness or pallor), cyanotic tongue, hypersalivation (intense salivation, which can be constant or intensify under certain conditions).
Factors influencing the development of speech function G.V. Chirkina also includes later lesions of the central nervous system of traumatic or infectious origin, intoxication, severe somatic infections complicated by traumatic situations (separation from the mother, pain shock), even if they were temporary and not permanent).
In a child with rhinolalia, even with a unilateral, complete or partial cleft, inhalation is carried out more actively through the cleft, i.e. through the mouth, not through the nose. A congenital cleft promotes a “vicious adaptation,” namely, an incorrect position of the tongue, its root, and only the tip of the tongue remains free, which is pulled into the middle part of the oral cavity (the root of the tongue is raised excessively upward, covering the cleft and at the same time the pharyngeal space). The tip of the tongue is located on the bottom of the mouth in the middle part, approximately at the level of the fifth tooth of the lower row.
Food entering the nose through a cleft also appears to cause excessive development of the root of the tongue, which closes the cleft. So, in a child with a congenital cleft, the most important, most vital functions stabilize the position of the excessively elevated tongue root. As a result, the air stream, when leaving the subglottic space, is directed almost perpendicular to the palate. This makes it difficult to exhale through the mouth during speech and creates a nasal tone in the voice. In addition, the constant position of the raised tongue root inhibits the movements of the entire tongue. As a result, the implementation of the necessary movements of the tongue for the articulation of speech sounds in rhinolalic patients fails; in addition, a weak exhalatory stream, not entering the front part of the oral cavity, does not stimulate the formation of various articulatory closures in the upper part of the speech apparatus. Both of these conditions lead to severe pronunciation problems. To improve the pronunciation of a particular sound, rhinolalics direct all the tension to the articulatory apparatus, thereby increasing the tension of the tongue and labial muscles, involving the muscles of the wings of the nose, and sometimes all the facial muscles.
In the process of speech dysontogenesis, adapted (compensatory) changes in the structure of the organs of articulation are formed:
· high elevation of the root of the tongue and its shift to the posterior zone of the oral cavity; relaxed, inactive tip of the tongue;
· insufficient participation of the lips when pronouncing labialized vowels, labiolabial and labiodental consonants;
· excessive tension of facial muscles;
· the occurrence of additional articulation (laryngealization) due to the participation of the walls of the pharynx.
L.P. Borsch notes that a short frenulum is a developmental defect, expressed by the formation of a fold of the mucous membrane, fixing the tongue sharply anteriorly, sometimes almost to the teeth. It is often detected in parents or close relatives of children, which can be considered a family trait; Anomalies and bite are similar. When studying medical records of the development of children with pathology of the frenulum of the tongue, the author found that in 94.7% there was a syndrome of motor disorders; 52.7% - hip dysplasia; in 69.4% - delayed psychomotor development; in 38.4% - injury to the cervical spine; 8.8% - cerebral palsy.
Newborns with a short frenulum of the tongue may experience restlessness when feeding. It is explained by difficulties in sucking and swallowing. Babies do not suck the norm. Such children's sleep is superficial, intermittent, restless, and they cry a lot.
If the correction is not carried out on time, then this is aggravated with age by the fact that speech is formed with deviations; the child is not understood by his peers; Adults, trying to pronounce sounds correctly, evoke negative emotions in response. He withdraws into himself, prefers to talk less, play alone, and an “inferiority complex” begins to form. This often contributes to the development of bad habits. They are characterized by a decrease in the emotional-volitional sphere and mood lability. Such children are unbalanced, hyperexcitable, and have difficulty calming down. They are very touchy, whiny, and sometimes aggressive. These children have difficulty making contact and refuse to perform certain tongue movements during receptions.
By the beginning of school, speech remains unclear, and the pronunciation of several groups of sounds is impaired. Speech is inexpressive, voice intonation is poor. This makes such children more vulnerable and withdrawn, although their intellectual abilities are quite developed. For the most part, such children are self-critical.
The identified features of the oral motor basis of articulation made it possible to assume that in the absence of timely correctional assistance, at best, disturbances in sound pronunciation and general blurriness in the flow of speech will occur.
Early diagnosis is carried out based on the assessment of non-speech disorders, which include the following:
violation of the tone of articulatory muscles (face, lips, tongue) such as spasticity (increased muscle tone), hypotension (decreased tone) or dystonia (changing nature of muscle tone);
limitation of the mobility of articulatory muscles (from the almost complete impossibility of performing articulatory movements to minor restrictions on their volume and amplitude);
disturbance of the act of eating: disturbance of the act of sucking (weakness, lethargy, inactivity, irregular sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup;
hypersalivation (increased salivation): increased salivation is associated with limited movements of the tongue muscles, impaired voluntary swallowing, paresis of the labial muscles; it is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva); hypersalivation may be constant or worsen under certain conditions;
oral synkinesis (the child opens his mouth wide during passive and active hand movements and even when trying to perform them);
breathing disorders: infantile breathing patterns (predominance of abdominal breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.
During the development of speech, systemically controlled auditory-motor formations are formed, which are real, material signs of language. For their actualization, the existence of an articulatory base and the ability to form syllables are necessary. Articulatory base - the ability to bring the organs of articulation into positions necessary for the formation, formation of sounds that are normative for a given language.
In the process of mastering pronunciation skills under the control of one’s hearing and kinesthetic sensations, one gradually finds and retains in memory those articulatory patterns that provide the necessary acoustic effect that corresponds to the norm. If necessary, these articulatory positions are reproduced and reinforced. When finding the correct patterns, the child must learn to distinguish articulatory patterns that are similar in the pronunciation of sounds, and develop a set of speech movements necessary for the formation of sounds.
E.F. Arkhipova, characterizing children with erased dysarthria, reveals the following pathological features in the articulatory apparatus. It is indicated that the muscles of the organs of articulation are paretic, which manifests itself in the following: the face is hypomimetic, the facial muscles are flaccid upon palpation; Many children do not maintain the closed mouth pose, because... the lower jaw is not fixed in an elevated state due to laxity of the masticatory muscles; lips are flaccid, their corners are drooping; During speech, the lips remain flaccid and the necessary labialization of sounds is not produced, which worsens the prosodic aspect of speech. The tongue with paretic symptoms is thin, located at the bottom of the mouth, flaccid, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.
L.V. Lopatina notes spasticity of the muscles of the organs of articulation, manifested in the following: the face is amicable, the facial muscles are hard and tense on palpation. The lips of such a child are constantly in a half-smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the “tube” articulation exercise, i.e. pull the lips forward, etc. With a spastic symptom, the tongue is often changed in shape: thick, without a pronounced tip, inactive
L.V. Lopatina points to hyperkinesis with erased dysarthria, which manifests itself in the form of trembling, tremor of the tongue and vocal cords. Tremor of the tongue appears during functional tests and loads. For example, when asked to support a wide tongue on the lower lip with a count of 5-10, the tongue cannot maintain a state of rest, tremors and slight cyanosis appear (i.e., blue discoloration of the tip of the tongue), and in some cases the tongue is extremely restless (waves roll through the tongue in longitudinal or transverse direction). In this case, the child cannot keep his tongue out of the mouth. Hyperkinesis of the tongue is often combined with increased muscle tone of the articulatory apparatus. When examining the motor function of the articulatory apparatus in children with erased dysarthria, the ability to perform all articulation tests is noted, i.e. Children, according to instructions, perform all articulatory movements - for example, puff out their cheeks, click their tongue, smile, stretch out their lips, etc. When analyzing the quality of performing these movements, one can note: blurriness, unclear articulation, weakness of muscle tension, arrhythmia, decreased range of movements, short duration of holding a certain pose, decreased range of movements, rapid muscle fatigue, etc. Thus, under functional loads, the quality of articulatory movements sharply falls. During speech, this leads to distortion of sounds, their mixing and deterioration in the overall prosodic aspect of speech.
E.F. Arkhipova, L.V. Lopatin identifies the following articulation disorders, which manifest themselves:
in difficulties switching from one articulation to another;
in a decrease and deterioration in the quality of articulatory movement;
in reducing the time of fixation of the articulatory form;
in reducing the number of correctly performed movements.
Research by L.V. Lopatina et al. identified disturbances in the innervation of facial muscles in children: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulties in raising the eyebrows, and closing the eyes. Along with this, characteristic symptoms for children with erased dysarthria are: difficulty switching from one movement to another, reduced range of movements of the lips and tongue; Lip movements are not performed in full, they are approximate, and there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, imprecision of movements, difficulties in spreading the tongue, lifting and holding the tongue at the top, tremor of the tip of the tongue are noted; In some children, the pace of movements slows down when performing a task repeatedly.
Many children experience: rapid fatigue, increased salivation, and the presence of hyperkinesis of the facial and lingual muscles. In some cases, a deviation of the tongue (deviation) is detected.
Features of facial muscles and articulatory motor skills in children with dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These disorders are most often not detected primarily by a neurologist and can only be identified during a thorough speech therapy examination and dynamic observation during correctional speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal and hypoglossal nerves, which determines the features and variety of phonetic disorders in children. Thus, in cases of predominant damage to the facial and hypoglossal nerves, disorders of the articulation of sounds are observed, caused by inadequate activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.
In order for a person’s speech to be articulate and understandable, the movements of the speech organs must be natural, accurate and automated. In other words, a necessary condition for the implementation of phonetic speech is well-developed motor skills of the articulatory apparatus.
When pronouncing various sounds, the speech organs occupy a strictly defined position. But since in speech sounds are not pronounced in isolation, but together, smoothly following one another, the organs of the articulatory apparatus quickly move from one position to another. Clear pronunciation of sounds, words, phrases is possible only if there is sufficient mobility of the organs of the speech apparatus, their ability to quickly rearrange and work clearly, strictly coordinated, and differentiated. Which implies accuracy, smoothness, ease of movement of the articulatory apparatus, pace and stability of movement.
Thus, disturbances in the motor capabilities of the articulatory apparatus are one of the causes of deviations in the speech development of young children. Analysis of studies on the state of articulation in young children with speech development disorders allowed us to highlight the following features:
· there is insufficient mobility of the muscles of the tongue, lips, lower jaw;
· peculiarities of articulation are manifested in difficulties in switching from one articulatory pose to another, in difficulties in maintaining an articulatory pose;
· It is possible to study the state of articulation of young children by observing the child’s eating behavior.
Conclusions on Chapter I
The development of articulation is an important component of normal speech development. Articulation is the work of the speech organs (articulatory apparatus) when pronouncing syllables, words, phrases; This is the coordination of the action of the speech organs when pronouncing speech sounds, which is carried out by the speech zones of the cortex and subcortical formations of the brain. When pronouncing a certain sound, auditory and kinesthetic or speech motor control is realized.
In order for speech to be articulate and understandable, the movements of the speech organs must be natural, accurate and automated. In other words, a necessary condition for the implementation of phonetic speech is well-developed motor skills of the articulatory apparatus. The articulatory apparatus is an anatomical and physiological system of organs, including the larynx, vocal folds, tongue, soft and hard palate, teeth of the upper and lower jaws, lips, nasopharynx and resonator cavities involved in the generation of speech and voice sounds. Any disturbances in the structure of the articulatory apparatus, whether congenital or early acquired (before the age of 7 years), invariably entail difficulties in the formation and development of speech.
All movements of the articulation organs are determined by the work of the motor analyzer. Its function is the perception, analysis and synthesis of stimuli coming to the cortex from the movement of the speech organs. In the speech motor zone, a complex and subtle differentiation of speech movements and the organization of their sequence occur.
In ontogenesis, the process of development of articulation is formed sequentially: screaming, humming, early babbling; late syllabic babble; first words, phrases; further subtle differentiation of articulatory structures.
Eating behavior is one of the indicators of articulation development. If a child prefers soft food to hard food, and the organs of articulation are not mobile enough during meals, then this indicates insufficient development of the muscles of the mouth and lips.
Deviations of speech development at an early age are underdevelopment of the cognitive and linguistic components of speech development, caused by a violation of psychophysiological prerequisites and/or a discrepancy between microsocial conditions and the child’s capabilities. It manifests itself in the difficulties of forming the initial children's vocabulary and phrasal speech. It can be an independent speech pathology or part of the structure of any form of deviant development.
Studying the state of articulation in young children with speech development disorders is possible by organizing observation of the child’s eating behavior.
Quite often, children with a speech disorder such as erased dysarthria, which has recently tended to significantly increase among other speech disorders, come to school speech therapy centers. Sometimes this speech disorder is observed as part of a general speech underdevelopment, and sometimes as a phonetic-phonemic underdevelopment. Currently, this speech pathology is considered as one of the forms of dysarthria - a complex syndrome of central organic genesis, manifested in neurological, psychological and speech problems.
Dysarthria – (according to O.V. Pravdina) is a violation of the pronunciation and prosodic (tempo, rhythm, intonation expressiveness) aspects of speech due to a violation of the innervation of the speech organs, which occurs when the central nervous system and its peripheral parts are damaged (see Table 1).
Innervation of speech organs
Table 1
Modern speech therapy distinguishes several degrees of severity of dysarthria (see Table 2)
Degrees of severity of dysarthria
table 2
| I. Light (St. Petersburg) or “erased” (Moscow) | II. Moderate | III. Heavy | IV. Anarthria |
| Only the pronunciation aspect of speech is impaired (whistles, which normally should be formed by the age of four, do not form for a long time). The rate of speech may be slightly accelerated | Gross disturbances in pronunciation of speech and voice | There is no articulate speech. | |
| If the tongue is in good shape, whistling sounds have a hissing sound or a lateral pronunciation | |||
| Externally similar to functional dyslalia | In general, speech is understandable to others | In general, the speech is difficult to understand for others |
Erased dysarthria is a complex speech disorder characterized by a combinatorial pattern of multiple disturbances in the process of motor implementation of speech activity. The leading symptom in the structure of a speech defect in erased dysarthria is phonetic disturbances, which are often accompanied by underdevelopment of the lexico-grammatical structure of speech. Violations of the phonetic side of speech are difficult to correct and negatively affect the formation of phonemic, lexical and grammatical components of the speech functional system, causing secondary deviations in their development.
There are several types of dysarthria: subcortical, extrapyramidal, pseudobulbar, cerebellar (atactic). However, only pseudobulbar dysarthria has a mild (“erased”) form. Combined variants of pseudobulbar dysarthria : spastic-rigid (an extreme manifestation of spastic disorders), spastic-paretic (open mouth, drooling, lethargy, and increased tone in the mouth), spastic (classic version: tone is equal in all muscle groups).
Giving a characterization pseudobulbar (spastic) dysarthria, It is necessary to note the symptoms of “3G”:
- hypertonicity (in general, fine and speech motor skills);
- hypertrophy;
- hyperreflexia,
which is caused by bilateral damage to the conductive nervous system.
When examining a child with this type of dysarthria, we observe:
Nasality, slurred speech;
Lack of synergies (coordinated, smooth movements in gross motor skills) ;
Tremor (increased tone of both the tongue and the edges);
Hypermetry (temporary wave-like movements of the back of the tongue);
Deviations (deviations of the tongue to the side) are a manifestation of a violation of reciprocal coordination;
Synkenesia (accompanying movements of the tongue with the lower jaw);
Hypersolivation;
Nosalization (tone of the posterior pharyngeal wall);
Dysphagia (difficulty swallowing while eating);
Intensity of the gag reflex;
Gross violation of sound pronunciation (disturbed “flight” of the vowel, nasal sound, or blurred speech sounds);
Pseudo-chandiness (diligence of pronunciation);
Slowing down the rate of speech (up to bradyllalia).
Symptoms mild (erased) form of pseudobulbar dysarthria has a neurological nature, which manifests itself in tremor, hypermetry, hypersolivation. But there are no gross violations of the pronunciation side of speech, prosody, or voice. The rate of speech may be accelerated to the point of tachylalia. Sometimes it occurs clattering (poltern, battarism) - confused speech with occasional hesitations against the background of an accelerated pace.
Studies of articulatory motor skills have shown that children with an erased form of dysarthria have dysfunction of the muscles innervated by the lower branch of the trigeminal nerve, facial, hypoglossal and glossopharyngeal nerves. Disorders of the functions of the trigeminal nerve (V pair) manifest themselves in a narrowing of the range of movements of the lower jaw. In this case, inaccuracy, limited movements, synkinesis of the lips and tongue are noted. Dysfunction of the facial nerve (VII pair) in children with an erased form of dysarthria manifests itself in smoothness, asymmetry of the nasolabial folds, insufficient volume of facial movements, and lip movements when grinning. Disturbances in the innervation of the hypoglossal nerve (XII pair) manifest themselves in the inability to maintain a static posture, tremor of the tip of the tongue, difficulty raising the tongue upward, hyper or hypotonicity of the muscles. Dysfunction of the glossopharyngeal nerve (IX pair) is manifested in insufficient elevation of the soft palate (Uvula), nasal tone of speech, salivation, limited range of movements of the middle part and root of the tongue. Quite often, in the anamnesis of children with an erased form of dysarthria, the so-called hypertensive newborn syndrome.
Due to untreated increased intracranial pressure, the child subsequently suffers from behavior for which the frontal zone of the cerebral cortex is responsible. It is the frontal zone of the cerebral cortex that innervates the programs of volitional emotions, a sense of duty, responsibility, and a critical attitude towards one’s activities, including speech. According to E.E. Shevtsova (neuropsychologist, associate professor of the Department of Speech Therapy at Moscow State Humanitarian University named after M.A. Sholokhov), these problems remain for life. And the current generation of infantile 20-30-year-old young people is clear evidence of this. In such men (women have a stronger nervous system - due to high compensatory mechanisms) volitional processes suffer: there is disinhibition, laxity in behavior, reduced motivation, and no interests. In adolescence, these children form groups because... are subject to the negative influence of others due to the lack of their own clear goals. This can lead to alcoholism and even drug addiction.
The causes of erased forms of dysarthria include:
- damage to the fetus in the early stages of pregnancy: hypoxia (oxygen starvation in the womb), infections during pregnancy. Hypoxia in the prenatal period is caused by hyper(hypo)tension, anemia, oligohydramnios, diseases of the mother's cardiovascular system, malformations of the fetal cardiovascular system (which is associated with cytomegalovirus), entanglement of the fetal umbilical cord, resulting in compression of nerve fibers in the neck area , which regulate the innervation functions of the speech motor, facial, glossopharyngeal, etc. muscles, as well as the blood supply to the brain also has its own disorders;
- prolonged labor, which leads to oxygen starvation of the fetus: first, hypoxia, then this leads to asphyxia (suffocation) after childbirth. During this period, a huge number of nerve cells die (in 10-15 hours, out of 6 billion neurons, millions die). Due to this, skills and abilities are formed more slowly, and later higher mental functions mature: memory, thinking, attention, speech, and many others. etc.;
- long anhydrous period (from 2 to 4 or more hours);
- the influence of drugs that accelerate labor, which are administered to women in labor during prolonged labor: this is an artificial hormone acidocyl, which has recently been insufficiently produced in women in labor due to decreased pituitary gland function (the influence of mobile phones, computers, and other high-frequency electromagnetic radiation). Often, labor turns from protracted to rapid, so the fetus does not have time to group, and compression of the temporal, parietal and other areas of the head occurs. Also, this artificially administered hormone subsequently causes disruption of lactation in the mother;
- caesarean section, which also entails many complications due to a large pressure difference (the fetus does not experience any obstacles along the way, the ability to overcome difficulties is not recorded in the genetic memory, which subsequently leads to infantility);
- increased intracranial pressure, hypertension syndrome in newborns.
Although erased dysarthria has a milder degree of severity of dysarthric manifestations in a child, this speech disorder deserves the close attention of speech therapists, as well as painstaking work to overcome it, since this disorder complicates the process of school learning. Today it can be considered proven that children with an erased form of dysarthria, in addition to specific violations of oral speech, have deviations in the development of a number of higher mental functions and processes responsible for the development of written speech.
General indications for dysarthria :
Reduced spasticity (providing a background for work);
Drug therapy (provided by a doctor);
Speech therapy massage (before and after class);
Restoring reciprocal coordination (cope with the paretic side, if there are deviations - “Horse” - suction of the tongue along the midline) so that the sounds are not lateral;
Staging sounds (whistles parallel to the sound R)
The rehabilitation training program for erased dysarthria includes :
1. Formation of an attitude towards correction of the pronunciation side of speech.
2. Reducing the degree of manifestation of spastic paresis in the muscles of speech historians:
Fighting drooling;
Normalization of muscle tone using massage techniques, passive and active articulatory gymnastics.
3. Development of mobility of the muscles of the articulatory apparatus:
Clarification of patterns of voluntary oral, facial, articulatory movements;
Development of the amplitude of voluntary oral, facial, articulatory movements;
Development of the speed of switching voluntary oral, facial, articulatory movements;
Development of the performance of the muscles of the articulatory apparatus.
4. Normalization of speech breathing:
Development of the depth of physiological inhalation, the duration of physiological exhalation, using static exercises, dynamic gymnastics;
Development of the duration of speech inspiration;
Development of the duration of speech exhalation;
Development of the performance of the respiratory muscles.
5. Normalization of phonetic coloring of sounds:
Clarification of articulations of distorted sounds;
Consolidating a clear implementation of sounds of all groups of isolation in the speech stream.
6. Restoration of the melodic-intonation side of speech:
Development of the range of sound-pitch transitions;
Normalization of tempo and rhythm of speech;
Recognition and reproduction of rhythmic and melodic fragments;
Formation of an intonation pattern of a phrase according to a model, according to an assignment, independently;
7. Development of control over the pronunciation side of speech.
Properly selected drug treatment provides invaluable assistance in working with children with an erased form of dysarthria. However, when neurologists are so busy, examinations often do not pay due attention to erased neurological symptoms, which is why treatment may not be effective enough. In this regard, it will be useful for the speech therapist to formalize the child’s referral to a neurologist (see below). This direction is a description of neurological symptoms characteristic of speech disorders associated with damage to the central nervous system. This direction will be convenient for both a speech therapist and a neurologist to use in their work, since specific symptoms in articulatory motor skills will be examined and described.
Referral to a neurologist
In order to conduct an additional examination and prescribe physical procedures and drug treatment, in accordance with the order of the Ministry of Health of the Russian Federation No. 311 dated August 6, 1999 on the approval of the clinical guideline “Models for the diagnosis and treatment of mental and behavioral disorders”, the child’s full name ________________________
Age___________________________________________________
The anamnesis revealed _____________________________________________
Features of the articulatory apparatus:
Muscle pareticity:
Lips (slack)____________________ Corners of mouth (lowered)_________________
Tongue (thin, at the bottom of the mouth, flaccid, tip inactive, muscle weakness increases with exercise)________________________________________________________________
Muscle spasticity:
Facial expressions (inexpressive)_____________________________________________
Facial muscles (hard to the touch, tense)___________________________
Lips (in a half-smile - the upper lip is pressed against the gums, cannot make a “pipe”)___________________________________________________________
Tongue (thick, without a pronounced tip, inactive)_________________
Tongue (trembling and slight blueness of the tip of the tongue, waves rolling through, cannot be held outside the mouth during the “spatula” exercise) _______________________________________
Deviations
Deviation of the tongue from the midline __________________
Hypersalivation (increased salivation)
Can't swallow saliva while speaking______________
Reduced volume and accuracy
articulatory movements (difficulty in performing, switching from one movement to another, “groping” for the desired articulatory posture)
____________________________________________________
Quality of movement
Blurry, unclear movements, weak muscle tension, arrhythmia, decreased range of motion, rapid muscle fatigue ( underline what is needed)
Sound pronunciation
(presence of distortions, confusions -
Indicate which ones)__________________________________________
Pronunciation of words with complex syllable structure__________
Long-term automation of sounds that are not introduced into speech for a long time_____
Prosody (intonation-expressive coloring of speech)
Exhalation (weakened)___________________________________________________________
Pace (accelerated)______________________________________________________________
Inhale (speech while inhaling)_________________________________________________________
Graphic skills (difficulties in mastering: poor handwriting, slow pace, “mirror writing”, letter substitutions)________________________________________________________________________________
Attention (impaired: increased distractibility, cannot concentrate)______________
Memory (difficulty in memorizing material (a whole sentence, poem), rapid forgetting)__________________________________________________________________________
Based on the evidence described above, the expected speech conclusion is _______________________________________________________________________
Disease code __________________ in accordance with the order of the Ministry of Health of the Russian Federation No. 311 of 08/06/1999.
“__”______________20__
Speech therapist teacher (name of institution, full name, signature, seal of institution)._____________
In the anatomy of the tongue, a muscular organ located in the oral cavity, there is a body and a root. The border between them is the border groove, which resembles an inverted letter V. The upper surface of the tongue (the back of the tongue) is covered with papillae, responsible for tactile and taste sensitivity, and has a small depression in the middle, which is called the longitudinal groove.
Normally, the tongue looks clean, moist, pink in color, with filiform papillae, and is symmetrically located in the oral cavity. Closer to the top of the tongue, along the lateral surfaces there are bright red mushroom-shaped papillae, which are responsible for taste perception. The white coating on the tongue should not exceed 0.1-0.2 mm. At the free end of the tongue, as a result of its movement, self-cleaning occurs and, as a result, the plaque layer is smaller than at the root.
Bitten tongue
The cause of a bitten tongue may be a seizure due to epilepsy or viral encephalitis. Plaque on the tongue. The formation of plaque on the tongue depends on its anatomical structure and the condition of the internal organs. Often a coated tongue is caused by something a person has currently eaten, drunk, or inhaled. Many smokers develop a characteristic brownish color to their tongue. A dense white, gray or yellowish plaque may be a manifestation of acute surgical diseases of the abdominal organs. Often combined with dry tongue.
"Shaggy Tongue"
The tongue becomes “shaggy” in diseases accompanied by a pronounced weakening of the immune system (for example, AIDS). In this case, uncontrolled reproduction of viruses that are normally located on the surface of the tongue occurs (Epstein-Barr virus), the epithelium becomes rigid, and vertical ridges form on the lateral surfaces of the tongue.
Dry tongue
A dry tongue is a sign of conditions accompanied by dehydration and mouth breathing and decreased salivation. A dry tongue in combination with other symptoms often indicates the development of acute surgical pathology, even peritonitis. Dry mouth is one of the signs of Sjögren's syndrome.
Black tongue
“Hairy” black tongue - the acquisition of black pigmentation by filiform papillae (they look like hairs, hence the name of the disease) from single black dots to complete blackening - a characteristic sign of aspergillosis, a disease caused by fungi of the genus Aspergillesniger.
Folded tongue
A folded tongue can be a congenital condition, ranging from slight to severe folding that is a normal variant.
"Geographical" language
Another condition of the tongue, “geographical” tongue, is a pathological condition characterized by the appearance of foci of inflammation and atrophy of the filiform papillae (benign migratory glossitis). As a result, the language becomes like a map of the world from an ancient engraving.
"Vacquered" tongue
A “lacquered” tongue is a smooth, red, testy tongue that occurs with glossitis, wasting, pellagra, B12 and iron deficiency anemia, lichen planus.
Leukoplakia of the tongue
Leukoplakia (keratinization of the integumentary epithelium) can affect almost all mucous membranes of the human body (in the corners of the mouth, on the lower lip, on the floor of the mouth, cheeks, tongue, clitoris, vagina, vulva, cervix, anus, glans penis and preputial sac). It is considered a precancerous disease.
Leukoplakia can be caused by frequent trauma to the mucous membranes (for example, in the presence of damaged tooth crowns, poor-quality dentures), or irritation due to alcohol abuse and smoking. The development of leukoplakia can be a consequence of chronic diseases of the gastrointestinal tract, tuberculosis, syphilis, fungal infections, and vitamin A metabolism disorders. Hereditary predisposition is noted.
Smoker's leukoplakia (hardening of the mucous membrane in the form of grayish-white plaques) often degenerates into cancer, which is confirmed by histological examination.
Big tongue
A large tongue occurs both in healthy people (with a small mouth relative to the tongue) and in patients (macroglossia). In childhood, macroglossia can be a sign of hypothyroidism (cretinism), Down syndrome, tumors of the tongue (hemangiomas, lymphangiomas). In adults, the tongue becomes enlarged with hypothyroidism (decreased thyroid function), acromegaly (enlargement of certain parts of the body under the influence of growth hormone), etc.
Deviation of the tongue from the midline (deviation)
Deviation of the tongue from the midline occurs towards paralyzed muscles on one side with normally working muscles on the other. With central paresis, the deviation of the tongue is practically not noticeable. If the paresis is bilateral, then the tongue decreases in size and is tense. Deviation and atrophy of the tongue occurs with peripheral damage to the hypoglossal nerve or damage to the central nervous system (stroke, trauma, tumors).