The true calendar of our ancestors
In the south, the Tartars bordered on their southern neighbors - the Arim, the inhabitants of Arimia, as Ancient China was called in those days. Several thousand years ago, the Arima took advantage of the weakening of the metropolis, and a difficult war ensued. As a result, victory was won over Ancient China 7521 years ago . September 22 - Day of the Creation of the World (from S.M.) - conclusion of a peace treaty. The victory was so significant and difficult that our ancestors chose this date as a new starting point for their history.
So, Russian history has more
seven and a half thousand years new
era(!), which came after victory in a difficult war with Ancient China.
The symbol of this victory was Russian warrior piercing a snake with a spear, known nowadays more as St. George the Victorious. The Serpent identified the Dragon, and Ancient China in the past was called not only Arimia, but also land of the Great Dragon. The figurative name of the country of the Great Dragon has been retained by China to this day.
This event passed into Russian folk tales, in which Ivan Tsarevich defeats the Serpent Gorynych. It is not for nothing that each of the Russian fairy tales ends with the line: “The fairy tale is a lie, but there is a hint in it, a lesson for a good fellow.”
...When the Romanovs were placed on the throne in the Moscow principality, a systematic distortion of the history of the Slavs and other peoples! Russian history was fairly “rewritten”; ancient libraries that preserved ORIGINALS texts, carefully BURNED. Peter I Romanovich in the summer of 7208 from S.M. introduced the Christian calendar on the lands of Muscovite Rus'. With one stroke of the pen, summer 7208 from S.M. by decree of Peter it turned into 1700 AD.
In 1749-1750 Lomonosov spoke out against the then new version of Russian history, created before his eyes by Miller and Bayer. However, almost all the REAL (and not rewritten later) works that Lomonosov intended to publish were were confiscated and disappeared» without a trace.
The main methods of distorting history have always been: substitution of true artifacts copies or the presentation of true artifacts (maps of Tartaria, monuments with a different chronology, etc.) as mythological. Why was all this done?..
But without studying our true past, we will not be able to determine WHAT steps need to be taken to prevent mistakes in the future and make it the way we want. It is necessary to restore logical chains and analyze the events of the past and present in the context - "cause - fact - effect". Then thinking will become logical and flexible, and not event-driven and linear.
“A people that does not know its Past has no Future”
Read more about the distortion of history on the websites levashov.info And kramola.info
Preface
Elimination of the consequences of congenital cleft lip and palate involves correction of the speech disorder, which is a component of the clinical picture of the main somatic defect. In this case, a disorder characterized only by an increase in the nasal resonance of the voice is classified as open rhinophony, and also including distorted sound formation - like rhinolalia.
According to the World Health Organization classification, rhinophonia and rhinolalia are classified as voice disorders. It is the unbalanced resonance that provokes the development of all other pathological changes in the phonetic aspect of speech. With congenital cleft palate or velopharyngeal insufficiency, the nasal cavity becomes a paired resonator of the oral cavity. In accordance with the laws of acoustics, the oscillation frequency of this paired resonator is superimposed on the oscillation frequency of the fundamental tone. As a result, the acoustic spectrum of the voice changes significantly. Additional nasalization formants appear in it. Nasal resonance or open nasalization deprives the voice of sonority and flight. The voice becomes monotonous, nasal, and dull.
But if with rhinophonia only the acoustic side of speech is disturbed, then with rhinolalia, deviations in the aerodynamic conditions of speech formation are added to this: changes in the direction of air flows in the oral and nasal cavities, a decrease in air pressure in the oral cavity. Adaptation to the created conditions leads to gross distortions of articulations.
Pathophysiological studies in recent years have revealed many detailed features of breathing, voice production and articulation in rhinophonia and rhinolalia, but only a small part of them have found application in speech therapy.
This has led to conflicting recommendations for correcting rhinophony and rhinolalia. In addition, the available literature is represented by a large number of scientific articles, each of which is devoted to a specific pathological symptom and methodological techniques for its correction.
The main objective of this manual is a consistent presentation of the methodology of correctional and educational work to correct the phonetic aspect of speech in rhinolalia. In the course of theoretical and practical development of the issue, methods of voice restoration for various voice disorders were used (A. T. Ryabchenko, E. V. Lavrova), certain techniques of vocal pedagogy (V. G. Ermolaev, N. F. Lebedeva, L. B. Dmitriev), research materials and methodological instructions of domestic and foreign phoniatrists and speech therapists (E. F. Pay, Z. G. Nelyubova, M. Morley, M. Green, A. G. Ippolitova, T. N. Vorontsova, L. I Vansovskaya, D.K. Wilson). Our own many years of practical experience have confirmed the effectiveness of the proposed methodology.
The manual consists of five sections, didactic material, a list of recommended literature and applications.
The first section describes the anatomical and functional role of the velopharyngeal apparatus normally and disorders caused by congenital cleft palate. Particular attention is paid to the characteristics of the phonetic aspect of speech in rhinolalia.
The second section outlines the basics of step-by-step correctional and pedagogical work to correct rhinophony and rhinolalia before and after plastic surgery of the palate.
The third section is devoted to the method of establishing physiologically correct voice guidance and correction of voice disorders in congenital cleft palates using phonopedic methods.
The fourth section examines individual techniques for producing sounds for rhinolalia.
The didactic material contains isolated words, phrases, sentences, poems and short stories that can be used to correct the sound pronunciation of children with rhinolalia.
The appendix presents complexes of breathing and facial exercises for children with congenital cleft palates.
ANATOMIC AND PHYSIOLOGICAL FEATURES OF THE VALOPHARYNGEAL APPARATUS IN NORMAL AND PATHOLOGICAL
Congenital cleft palates are one of the most common malformations of the face and jaws. It can be caused by a variety of exogenous and endogenous factors that affect the fetus at an early stage of its development - up to 7-9 weeks.
The normal palate is a formation that separates the cavities of the mouth, nose and pharynx. It consists of the hard and soft palate. Solid has a bone 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 ascend, the soft palate lengthens. In this case, thinning of its anterior third and thickening of the posterior third are observed.
The soft palate is anatomically and functionally connected to the pharynx; the velopharyngeal mechanism is involved in breathing, swallowing and 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 posterior 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 backward. When raised, it comes into contact with the Passavan roller. However, there are conflicting opinions in the literature regarding the indispensable participation of the latter in velopharyngeal closure. In practice, it is quite rare to observe the formation of Passavan's ridge in people with cleft palates. 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 sounds. A And s, a its highest voltage at And. This voltage decreases slightly when at and significantly by oh, uh, 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 And y, smallest at A and intermediate between them at uh And O.
When blowing, swallowing, or whistling, the soft palate rises even higher than during phonation and closes the nasopharynx, while the pharynx narrows. However, the mechanisms of velopharyngeal closure during speech and non-speech activities are different.
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 folds. And an increase in tone in the larynx entails a higher rise of the soft palate.
Congenital cleft palates disrupt this interaction.
Defects of the palate are varied in type. There are many classifications of this defect in the literature. However, all forms of clefts can be reduced to two main ones: through and isolated.
Isolated crevices split the palate in half. They can capture only a small uvula, part or all of the soft palate, and even reach the alveolar process, which itself remains intact. In these cases, the velum palatine is shortened, and its segments are spread apart. A type of isolated clefts are submucosal (submucosal) clefts hard palate. They are usually combined with shortening and thinning of the soft palate. The submucosal cleft can be detected when pronouncing a vowel A. In this case, the mucous membrane is drawn into the defect in the shape of a concave triangle, which is clearly visible.
At through crevices The integrity of the alveolar process is also compromised. These defects can be unilateral or bilateral. Usually they are accompanied by cleft lips.
With bilateral clefts, before surgery the incisive bone is advanced forward and can even occupy a horizontal position.
In such cases, one often has to deal with dentition disorders: incorrect position of teeth, caries, excess or insufficient numbers. The bite also changes very differently. Progenia, less commonly prognathia, open bite, and diastema are observed.
A cleft palate is usually shortened and stunted compared to normal, even after uranoplasty.
The functions of the soft palate are impaired due to the lack of communication between paired muscles. During phonation and swallowing, they move the segments of the soft palate apart. After the operation, his mobility does not reach normal due to the fact that the muscles that lift him are not attached at the level of the middle third, as is normal, but far in front.
The anatomical defect causes breathing, nutrition, phonation, speech and hearing disorders. Rhinolalia significantly aggravates the effect of hearing impairment on the phonetic structure of speech.
Changes in breathing with clefts are varied. Due to the lack of differentiation between the nasal and oral cavities, children constantly use mixed nasal-oral breathing, during which the duration of exhalation is sharply reduced. Breathing becomes rapid, the vital capacity of the lungs decreases, the development of the chest lags behind, and its excursion decreases.
Phonation breathing suffers deeply. It is known that people normally breathe through their mouths when speaking. In this case, the inhalation shortens, becoming deeper, the exhalation lengthens and is 5-8 times longer than the duration of inhalation, and the number of respiratory movements per minute is reduced from 16-20 to 8-10; the abdominal wall and internal intercostal muscles actively participate in speech exhalation, which helps to lengthen exhalation and ensure sufficient subglottic pressure.
Children with cleft palates, while talking, continue to breathe simultaneously through the nose and mouth with an exclusively clavicular type of breathing. When exhaling, a significant volume of air (on average 30%) flows into their nose, due to which, firstly, the duration of exhalation is sharply shortened and, secondly, the air pressure in the supraglottic space decreases. Therefore, phonation breathing remains rapid and shallow.
In an effort to reduce air leakage into the nose and maintain the pressure necessary for consonant sounds, children tense their forehead muscles and compress the wings of their nose.
These compensatory grimaces gradually become a habit that accompanies speech and become characteristic of persons with rhinolalia.
Other changes in timbre are associated with the combination of the cavities of the nose, mouth and pharynx into one, with the configuration features of the resonators in case of pronounced scars after uranoplasty, with the presence of additional folds of the mucous membrane, and limited mouth opening.
Lack of integrity of the velum palatine, limitation of its mobility and pathological changes in the pharyngeal muscles disrupt the coordination of movements of the larynx and palate. Being normally a vocal reflex exciter due to the abundance of afferent innervation, the velum palatine and the back of the pharynx cannot provide this function in clefts. However, attention is drawn to the fact that the acoustic qualities of the voice of children with cleft palates in the first year of life do not differ from the voice with a normal structure of the upper jaw. In the pre-speech period, these children scream, cry, and walk in a normal child's voice. A change in the timbre of their voice - open nasal resonance - first appears during babbling, when the child begins to articulate his first consonant phonemes.
Subsequently, until about seven years of age, children with congenital cleft palates speak (as before plastic surgery, and often after it) in a voice with nasal resonance, but in other qualities clearly no different from normal. An electroglottographic study at this age confirms the normal motor function of the larynx, and myography confirms the normal reaction of the pharyngeal muscles to a stimulus, even with extensive defects of the palate.
After 7 years, the voice begins to deteriorate: strength decreases, exhaustion and hoarseness appear, and the expansion of its range stops. The myogram reveals an asymmetrical reaction of the pharyngeal muscles, thinning of the mucous membrane and a decrease in the pharyngeal reflex are visually observed, and changes appear on the electroglottogram indicating uneven functioning of the right and left vocal folds. That is, there are all the signs of a disorder of the motor function of the voice-producing apparatus, which is finally formed and consolidated by 12-14 years. Adolescents and adults with rhinolalia suffer from voice disorders in almost 80% of cases. Specific to them are phonasthenia or paresis of the internal muscles of the larynx.
There are three main causes of voice pathology in congenital cleft palates.
Violation of the velopharyngeal closure mechanism. Due to the close functional connection of the soft palate and the larynx, the slightest tension and movement of the muscles of the palate causes a corresponding tension and motor reaction in the larynx. With cleft palates, the muscles that lift and stretch the palate, instead of being synergists, work as antagonists. At the same time, due to a decrease in the functional load, a degenerative process occurs in them, as in the muscles of the pharynx. Pathological changes in the pharyngeal ring begin to appear at 4-5 years of age. The mucous membrane becomes pale, thinned, atrophic, and ceases to respond to touch, pain, and thermal stimuli. Chronaxy of muscles lengthens with age, and then they stop contracting altogether. The pharyngeal reflex sharply decreases and disappears. These symptoms indicate atrophy of muscle fibers and degenerative changes in the sensory and trophic fibers of the pharyngeal constrictor. The pathological degenerative process in the muscles leads to their asymmetry and asymmetry of the resonator cavities of the larynx and asymmetrical movement of the vocal folds.
Incorrect formation of a number of voiced consonants in rhinolalia in the laryngeal (laryngeal) way, when closures are made at the level of the larynx and are sounded by air friction against the edges of the vocal folds. In this case, the larynx takes on, according to M. Zeeman, the additional function of an articulator, which, of course, does not remain indifferent to the vocal folds.
Voice development is influenced by behavioral characteristics. Ashamed of facial deformity and defective speech, not wanting to attract the attention of others, children get used to speaking quietly all the time, without raising the strength of their voice under any circumstances. Lack of training leads to the consolidation of a quiet sound.
Speech, which develops under pathological conditions, suffers more severely than other functions with congenital cleft palate. Spontaneous speech correction after uranoplasty does not occur in most cases.
Due to the absence of velopharyngeal closure, the nasal cavity becomes a paired resonator of the oral cavity, imparting a nasal timbre to all phonemes. The degree of severity of nasal resonance of speech depends on the lack of closure, mobility of the velum and coordination of movements of the tongue and soft palate. Nasalization can be pronounced or mild.
According to the severity of the disturbance in sound pronunciation and the degree of nasalization of speech, all children with cleft palates can be divided into three groups (according to M. Morley).
First group consists of children in whose speech there is nasal resonance, but consonant sounds are formed with correct articulations. This disorder is classified as open rhinophony. This group most often includes people with submucosal (submucosal) clefts of the hard palate, incomplete clefts and shortening of the soft palate.
Second group consists of persons with pronounced nasal resonance of speech and distorted articulation of consonant sounds. They suffer from more extensive palate defects.
U third group speech is characterized not only by a pronounced nasal resonance, but also by an almost complete absence of articulation of consonants. It only retains its rhythmic pattern. This type of speech is typical for children under five years of age who have not yet developed sound pronunciation, as well as for those who have a cleft palate combined with malocclusion, hearing loss and other abnormalities.
The speech of the second and third groups is classified as open rhinolalia. Its intelligibility averages 28.4%. The relationship between the type of cleft and the severity of speech impairment is not direct. Phoneme distortion depends on the size of the gap between the edge of the soft palate and the wall of the pharynx and, in turn, affects the degree of nasalization.
The development of defective articulations in rhinolalia is due to a number of factors. The pathological position of the tongue in the oral cavity has long been described: the flaccid, thinned tip of the tongue lies in the middle of the oral cavity, not taking part in sound production. A massive hypertrophied root covers the entrance to the pharynx.
The displacement of the body of the tongue towards the pharynx is explained by the fact that only in the laryngopharynx the pressure of the air column reaches the value necessary for the formation of consonant phonemes. In higher regions, due to air leakage into the nose, the pressure drops sharply, and breaking the stops or voicing the gaps during the articulation of consonant phonemes becomes impossible.
In addition, air leakage into the nose makes it much more difficult to produce the directed air flow in the mouth needed for consonants. Even if this stream is present, it is so weak that it cannot create a full-fledged phoneme. Voiceless consonants in such cases remain silent, and voiced consonants acquire the same vocalized sound without individual acoustic coloring.
Most often, there is no directed air stream at all, and children replace it with intense exhalation from the throat. They form closures and slits with the root of the retracted tongue and the back wall of the pharynx in the path of the air flow coming directly from the larynx. This method of articulation is called pharyngeal or pharyngeal. With rhinolalia, they pronounce almost all plosive and fricative voiceless consonant phonemes.
To form voiced consonant phonemes, they resort to another compensatory act, in which the clefts and stops are lowered to the level of the larynx. This method of sound production is called laryngeal or laryngeal.
Vowel sounds are also pronounced with the root of the tongue raised. The constant active participation of the root of the tongue in swallowing and articulation leads to its hypertrophy. There is no spontaneous displacement of the tongue to its normal position after surgery. Only speech therapy classes can help eliminate this deficiency. It is interesting that with defects of the soft palate acquired even in adulthood, a similar compensation develops and the tongue is pulled back.
Deformations of the dentofacial area, shortening of the hyoid ligament and cicatricial deformations of the lips also stimulate the development of pathological sound pronunciation. Open bite, progenia, prognathia, defects of the alveolar process interfere with the contacts of the lips, lips and teeth, tongue and teeth and do not allow the correct articulation of labiolabial, labiodental and predental consonants. Bilateral clefts of the alveolar process, in which the anterior part takes on a horizontal position, do not allow both lips and teeth to close and completely exclude the possibility of articulation of bilabial and anterior lingual phonemes. A short hyoid ligament prevents the tongue from rising for superior articulations, and massive scars from cheiloplasty make it difficult to pronounce bilabial consonants. Midlingual-palatal and posterior-lingual-palatal sounds cannot be articulated due to the absence of one of the components of the stop - the palate.
The acoustic characteristics of vowels are distorted in rhinolalia due to nasal resonance, which is enhanced due to changes in the shape of the resonators and the raising of the back of the tongue. The severity of the nasal shade of each vowel is associated with the density of the velopharyngeal closure, the degree of narrowing of the lips and changes in the shape of the pharynx. The smallest volume of the pharynx is observed during the articulation of a phoneme A, and the greatest - at and, u. Expansion of the pharynx in the absence, shortening or limited mobility of the velum palatine leads to an increase in the gap between the edge of the soft palate and the posterior wall of the pharynx. Clinically, this is expressed by an increase in nasal hue with rhinophonia from A To at in sequence A- O - uh- And- u.
The articulation and acoustic qualities of consonant phonemes in rhinolalia are characterized by the most pronounced deviations. In the flow of speech, children miss sounds, replace them with others, or form them in a defective way. The most typical replacements for plosives and fricatives are pharyngeal (pharyngeal) and laryngeal (laryngeal).
Labiolabial p, p", b, b" are silent, or are replaced by exhalation, or are articulated with such a strong nasal resonance that they turn into, respectively, mm or form at the level of the pharynx (p, p") or larynx (b, b"), turning into sounds similar to k, g.
Rear lingual k, g are formed in a similar way, since the defect makes it impossible for the back of the tongue and the palate to contact. Sound G can also be a pharyngeal fricative. Forelingual t, t", d, d" are weakened or replaced by n, n", replaced by a laryngeal or pharyngeal stop.
The vast majority of children replace fricative consonants with pharyngeal formations that are very similar in sound. Rarely, lateral or bilabial replacements occur.
Nasal disturbances in rhinolalia are most often expressed in their replacement by unformed vocalization; phoneme l can be bilabial, replaced by j, n, and its soft pair is pronounced correctly more often than other sounds in the Russian language. Replace l" on j or n" or they skip it completely.
In velopharyngeal insufficiency, consonant phonemes r, r" almost never achieve a normal sound, since vibrating the tip of the tongue requires too much pressure from the jet, which, as a rule, cannot be achieved. Therefore, the sound is skipped and replaced with a single-strike or proto sound. After the operation, the formation of velar p is possible, when the edge of the soft palate vibrates during exhalation. With rhinolalia, voicing of consonants, especially phonemes, often suffers b, b", d, d, h, z", g. They are replaced by dull vapor formations.
After plastic surgery, children are left with mixed nasal-oral breathing, defective sound production, nasal, tongue-tied speech, and a dull, quiet voice. That is, speech by itself, without special training, is not normalized.
The reason for the persistence of dyslalia lies not only in the strength of the connections of pathological sound production. In people with cleft palates, decreased kinesthesia, phonemic hearing disorder, and tongue astereognosia are a consequence of decreased air pressure in the oral cavity, which dulls the tactile perception of “explosions” and air currents. Orthodontic appliances and removable dentures, covering the mucous membrane of the palate and alveolar process, exclude important areas of the oral cavity from sensation. With age, kinesthetic sensations decrease more and more.
When studying phonemic hearing in children with cleft palates, certain features are also revealed. It is known that both auditory and speech motor analyzers are involved in speech perception. In the central nervous system there is a connection between the sound and motor images of a phoneme, which allows it to be recognized and isolated. An organic disorder of the peripheral end of the speech motor analyzer (cleft palate) inhibits its influence on the auditory perception of sounds. The development of auditory differentiation in children with rhinolalia is hampered by pathological stereotypical articulations, which generate identical kinesthesia even for acoustically contrasting phonemes. The level of auditory differentiation is directly related to the depth of damage to the phonetic side of expressive speech.
In practice, we most often encounter a mixture of consonants of close acoustic groups in both expressive and impressive speech. This is also due to the fact that due to the limited capabilities of pharyngeal and laryngeal sound formation, all fricative and plosive phonemes sound the same. This similar sound of phonemes is fixed in the central nervous system. Many children consider themselves to be normal speakers and learn about their speech impairment from others.
Regarding the vocabulary and grammatical structure of speech in rhinolalia, the literature provides a variety of opinions. Some authors point out that the degree of impairment of writing and the lexico-grammatical structure of a language depends not only on damage to the articulatory apparatus, but also on speech education, the environment, the degree of hearing loss, and characteristics of the personal and compensatory systems.
The issue of the level of development and correction of written speech and the lexico-grammatical structure of the language is a separate problem and therefore is not considered in this manual.
Classes begin 21 days after the operation. Work on this area is carried out in parallel with the correction of physiological and phonation breathing.
In the postoperative period, when anatomical and physiological conditions have been created for the development of correct speech, the activation of the velum palatine and the development of mobility of the muscles of the velopharyngeal ring become especially important. Solving these problems is facilitated by:
massage of the soft and hard palate;
gymnastics of the soft palate and the back wall of the pharynx.
The main goals of soft palate massage are:
stretching of scar tissue,
strengthening the performance of contractile muscles,
reduction in muscle atrophy,
improvement of local blood circulation,
activation of healing processes.
You should pay attention to the question of the timing of speech therapy massage. Massage of the soft palate is performed for all children who come within 6-8 months after palate surgery. It is at this time that the scarring process occurs and massage performs its main function: it promotes the formation of elasticity and mobility of the muscles of the palatine curtain. Children with good mobility of the soft palate who seek speech therapy help more than 8 months after uranoplasty do not receive massage. When working with such children, as a rule, only active gymnastics of the soft palate is used.
- 1. Before starting the massage, the speech therapist must thoroughly disinfect his hands by wiping them with cotton wool soaked in a special preparation.
- 2. The duration of the massage on one area should not exceed 3 minutes.
- 3. Massage is not performed if the child has a febrile or subfebrile condition, the presence of herpetic or pustular rashes, or convulsive readiness.
- 3. Complex massage of the hard and soft palate
with your thumb, make stroking movements along the hard palate from the front teeth and back; gradually the area of influence increases and reaches the soft palate;
with your thumb, make transverse stroking movements along the hard and soft palate from left to right and vice versa;
with your thumb, make circular stroking and rubbing movements along the hard and soft palate from left to right and vice versa; movements begin to be performed from the upper lateral teeth, gradually moving from the hard palate to the soft palate;
make similar movements from the incisors to the pharynx and back;
with the middle finger, make stroking, pressing, rubbing movements along and across the scar from the incisors to the pharynx and vice versa;
make stroking, kneading, stretching movements across the soft palate with the middle finger from the central part to the lateral edges;
tap your index or middle finger on the hard and soft palates.
In addition to massage, children are recommended to perform special gymnastics that promote the development of mobility of the muscles of the soft palate. The set of exercises aimed at restoring the functional activity of the muscles of the soft palate includes passive, passive-active and active gymnastics. These exercises help create a favorable background for the formation of precise and coordinated work of the muscles of the velopharyngeal ring, necessary for the development of a full-fledged voice.
Passive gymnastics of the soft palate.
Passive gymnastics has this name because the movements of the organs of articulation are performed by a speech therapist.
drip liquid from a pipette onto the root of the tongue, while the child’s head is tilted back slightly. This exercise stimulates the elevation of the soft palate. When performing it, you can use juice instead of water;
lightly press on the root of the tongue with a spatula; This exercise requires some caution, as sudden movements can cause a gag reflex.
Active gymnastics of the soft palate.
Passive gymnastics is combined with special exercises to activate the velum palatine:
gargle with your head thrown back in small sips. This exercise produces the greatest effect if, when performing it, instead of water, you use a heavy liquid such as kefir, thin yogurt or jelly;
cough randomly; in this case, coughing is not done at the level of the larynx, as is done when there is discomfort in the throat, but at the level of the soft palate. These actions cause a reflex contraction of the muscles of the posterior pharyngeal wall and contribute to the formation of complete velopharyngeal closure. First, coughing is done with the tongue sticking out. The air flow is directed into the oral cavity. Thus, while completing the task, in addition to activating the soft palate, children train in producing a directed air stream;
imitate yawning. Exercise improves blood circulation in the brain and increases the outflow of venous blood;
pronounce vowels A-E-O in an exaggerated manner on a hard attack. At the same time, pressure in the oral cavity increases and nasal emissions decrease;
slowly, silently pronounce the vowels A-E-O, while trying to maintain clear articulation;
sing vowels with gradual strengthening and weakening of the voice.
Let us give an example of an exercise for activating the muscles of the velopharyngeal ring in the game situation “Masha (Bear, elephant, etc.) wants to sleep,” which can be used in working with preschool children. To do this, you need several dolls or soft toys depicting various animals. The speech therapist, together with the child, chooses which toy they will put to bed.
L.: When evening comes, it becomes dark outside and all the toys must go to bed. So Mishka wants to sleep (shows how he yawns), so the dog also wants to sleep and yawns (shows). Now show them how they yawn.
L.: What about the Mashenka doll? She is a little capricious and wants to be sung a song before bed. Let's sing her a lullaby:
Bye-bye, bye-bye, go to sleep quickly! A-A-A.
The child listens carefully to the song and then chants the vowel sounds.
L.: Look, Mashenka is already closing her eyes and yawning. Show me how she does it. Well, now she's definitely asleep.
Such exercises, in addition to activating the muscles of the velopharyngeal ring, contribute to the formation in the child of a long, directed oral exhalation during phonation.
Velopharyngeal insufficiency refers to a disruption of the normal physiological interaction of the structures of the velopharyngeal ring. In children with congenital cleft palates after palate surgery, velopharyngeal insufficiency is a consequence of insufficient closure of the soft palate with the posterior wall of the pharynx and manifests itself in the form of a speech disorder - rhinolalia. Slurred speech, nasal sounds, nasal emissions (audible leakage of air from the mouth into the nasal cavity), and compensatory articulation mechanisms (including compensatory facial grimaces) are typical signs of velopharyngeal insufficiency.
The main cause of velopharyngeal insufficiency is the insufficient participation of the soft palate in the mechanism of velopharyngeal closure: in some cases the soft palate is too short, in others it is not mobile enough.
The main reasons for the formation of velopharyngeal insufficiency:
the use of surgical techniques leading to the formation of a shortened soft palate;
performing primary palate surgery after the first year of life;
disruption of normal healing processes in the postoperative period.
Methods for diagnosing velopharyngeal insufficiency
The simplest and most accessible method for diagnosing velopharyngeal insufficiency is speech therapy examination and testing. It is carried out by a highly qualified speech therapist and is based on identifying nasal sounds and nasal emissions when pronouncing special words that require complete closure of the velopharyngeal ring (read).
The most objective method for studying the function of the velopharyngeal ring is fiberoptic nasopharyngoscopy. When conducting this examination, the doctor can not only visualize all the structures of the velopharyngeal ring and assess the degree of their participation in the process of closure, but also determine the size of the residual opening between the soft palate and the posterior wall of the pharynx directly at the moment of closure.
Based on the results of speech therapy testing and nasopharyngoscopy, during a joint consultation, the operating surgeon and speech therapist choose the most optimal way to eliminate velopharyngeal insufficiency.
Nasopharyngoscopy is a standard procedure used in the diagnosis of velopharyngeal insufficiency
Treatment methods
The treatment program for children with velopharyngeal insufficiency developed at the center includes the following stages:
1. Speech therapy courses in a hospital or in a center clinic.
2. Speech therapy examination and nasopharyngoscopy.
3. Depending on the results of the examination, continuation of speech therapy training or surgical treatment (reconstruction of the soft palate or use of pharyngeal tissue to achieve velopharyngeal closure).
Note!
Rhinolalia is a speech pathology that is observed in almost 100% of cases in children with congenital cleft palates after late palate surgery.
The optimal prevention of its occurrence is to perform palate surgery before the age of 1 year. However, rhinolalia is a reversible pathology, its manifestations can be eliminated by conducting speech therapy courses.
Diagnosis palatopharyngeal - means that after repeated courses of speech therapy training, clinical signs of rhinolalia remain, and with nasopharynoscopy, there is a significant area of non-closure of the soft palate with the posterior wall of the pharynx. As a rule, this implies the need for surgical treatment.
Rhinolalia (from the Greek rhinos - nose, lalia - speech) is a violation of the timbre of the voice and sound pronunciation, caused by anatomical and physiological defects of the speech apparatus.
Rhinolalia in its manifestations differs from dyslalia by the presence of an altered nasalized (from the Latin paziz - nose) voice timbre.
With rhinolalia, the articulation of sounds and phonation differ significantly from the norm. With normal phonation, during the pronunciation of all speech sounds except nasal sounds, a person separates the nasopharyngeal and nasal cavities from the pharyngeal and oral ones. These cavities are separated by velopharyngeal closure, caused by contraction of the muscles of the soft palate, lateral and posterior walls of the pharynx. Simultaneously with the movement of the soft palate during phonation, thickening of the posterior wall of the pharynx (Passavan roller) occurs, which promotes contact of the posterior surface of the soft palate with the posterior wall of the pharynx.
During speech, the soft palate continuously lowers and rises to different heights depending on the sounds being spoken and the rate of speech. The strength of the velopharyngeal closure depends on the sounds being pronounced. It is smaller for vowels than for consonants. The weakest velopharyngeal closure is observed with the consonant “b”, the strongest with “c”, usually 6-7 times stronger than with “a”. During normal pronunciation of the nasal sounds m, m, n, n, the air stream freely penetrates into the space of the nasal resonator.
Depending on the nature of the dysfunction of the velopharyngeal closure, various forms of rhinolalia are distinguished.
Forms of rhinolalia and features of sound pronunciation
Open rhinolalia
With the open form of rhinolalia, oral sounds become nasal. The timbre of the vowels “i” and “u” changes most noticeably, during the articulation of which the oral cavity is most narrowed. The vowel “a” has the least nasal connotation, since when it is pronounced the oral cavity is wide open.
The timbre is significantly impaired when pronouncing consonants. When pronouncing sibilants and fricatives, a hoarse sound is added that occurs in the nasal cavity. Explosive “p”, “b”, “d”, “t”, “k” and “g” sound unclear, since the necessary air pressure is not generated in the oral cavity due to incomplete closure of the nasal cavity.
The air flow in the oral cavity is so weak that it is not sufficient to vibrate the tip of the tongue necessary to produce the sound “r”.
Diagnostics
To determine open rhinolalia, there are different methods of functional research. The simplest is the so-called Gutzmann test. The child is forced to alternately repeat the vowels “a” and “i”, while the nasal passages are either closed or opened. With the open form, there is a significant difference in the sound of these vowels. With the nose pinched, sounds, especially “i,” are muffled, and at the same time the speech therapist’s fingers feel a strong vibration on the wings of the nose.
You can use a phonendoscope. The examiner inserts one “olive” into his ear, the other into the child’s nose. When pronouncing vowels, especially "u" and "i", a strong hum is heard.
Functional open rhinolalia is caused by various reasons. It is explained by insufficient elevation of the soft palate during phonation in children with sluggish articulation.
One of the functional forms is “habitual” open rhinolalia. It is often observed after removal of adenoid growths or, less commonly, as a result of post-diphtheria paresis, due to prolonged restriction of the mobile soft palate.
A functional examination in the open form does not reveal any changes in the hard or soft palate. A sign of functional open rhinolalia is a more pronounced violation of the pronunciation of vowel sounds. With consonants, the velopharyngeal closure is good.
The prognosis for functional open rhinolalia is usually favorable. It disappears after phoniatric exercises, and disturbances in sound pronunciation are eliminated by the usual methods used for dyslalia.
Organic open rhinolalia can be acquired or congenital. Acquired open rhinolalia is formed with perforation of the hard and soft palate, with cicatricial changes, paresis and paralysis of the soft palate. The cause may be damage to the glossopharyngeal and vagus nerves, injuries, tumor pressure, etc.
The most common cause of congenital open rhinolalia is congenital cleft of the soft or hard palate, shortening of the soft palate.
Rhinolalia, caused by congenital clefts of the lip and palate, represents a serious problem for various branches of medicine and speech therapy. It is the subject of attention of dental surgeons, orthodontists, pediatric otolaryngologists, psychoneurologists and speech therapists. Clefts are adjacent to the most common and severe malformations.
The incidence of children born with clefts varies among different peoples, in different countries, and even in different regions of each country. A. A. Limberg (1964), summarizing information from the literature, notes that for every 600-1000 newborns, one child is born with a cleft lip and palate. Currently, the birth rate in different countries of children with congenital pathologies of the face and jaws ranges from 1 in 500 newborns to 1 in 2500, with a tendency to increase over the past 15 years.
Facial clefts are defects of complex etiology, i.e. multifactorial defects. Genetic and external factors or their combined action in the early period of embryo development play a role in their occurrence.
There are:
1. biological factors (influenza, mumps, rubella measles, toxoplasmosis, etc.);
2. chemical factors (pesticides, acids, etc.); endocrine diseases of the mother, mental trauma and occupational harm;
3. There is information about the effects of alcohol and smoking.
The critical period for nonfusion of the upper lip and palate is the 7-8th week of embryogenesis.
The presence of a congenital cleft lip or palate is a common symptom for many nosological forms of hereditary diseases. Genetic analysis shows that familial patterns of cleft lip and palate are quite rare. However, medical and genetic counseling of families for the purposes of diagnosis and prevention is of great importance. Currently, microsigns of cleft lips and palate have been identified in parents: a groove on the palate or uvula of the soft palate, a cleft uvula, an asymmetrical tip of the nose, an asymmetrical arrangement of the bases of the wings of the nose (N. I. Kasparova, 1981).
Children with congenital clefts have serious functional disorders (sucking, swallowing, external respiration, etc.), which reduce resistance to various diseases. They need systematic medical supervision and treatment. According to the state of mental development, children with clefts constitute a very heterogeneous group: children with normal mental development; with mental retardation; with mental retardation (of varying degrees). Some children have individual neurological microsigns: nystagmus, slight asymmetry of the palpebral fissures, nasolabial folds, increased tendon and peristal reflexes. In these cases, rhinolalia is complicated by early damage to the central nervous system. Much more often children experience functional disorders of the nervous system, pronounced psychogenic reactions to their defect, increased excitability, etc.
A characteristic feature of children with rhinolalia is a change in oral sensitivity in the oral cavity. Significant deviations in stereognosis in children with clefts in comparison with the norm were noted by M. Edwards. The reason is dysfunction of the 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; various structural components of speech suffer to varying degrees.
Closed rhinolalia
Closed rhinolalia occurs when physiological nasal resonance is reduced during the production of speech sounds. The strongest resonance is for the nasal m, m", n, n". When pronounced normally, the nasopharyngeal valve remains open and air enters directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like oral sounds b, b" d, d". In speech, the opposition of sounds on the basis of nasal - non-nasal disappears, which affects its intelligibility. The sound of vowel sounds also changes due to the deafening of individual tones in the nasopharyngeal and nasal cavities. In this case, vowel sounds acquire an unnatural connotation in speech.
The cause of the closed form is most often organic changes in the nasal space or functional disorders of the velopharyngeal closure. Organic changes are caused by painful phenomena, as a result of which nasal breathing becomes difficult.
M. Zeeman distinguishes two types of closed rhinolalia (rhinophonia): anterior closed - with obstruction of the nasal cavities and posterior closed - with a decrease in the nasopharyngeal cavity.
Anterior closed rhinolalia is observed with chronic hypertrophy of the nasal mucosa, mainly of the posterior inferior concha; for polyps in the nasal cavity; with a deviated nasal septum and tumors of the nasal cavity.
Posterior closed rhinolalia in children can be a consequence of adenoid growths, less often nasopharyngeal polyps, fibroids or other nasopharyngeal tumors.
Functional closed rhinolalia is often observed in children, but is not always correctly recognized. It occurs with good patency of the nasal cavity and undisturbed nasal breathing. However, the timbre of nasal and vowel sounds may be more disturbed than with organic forms.
During phonation and when pronouncing nasal sounds, the soft palate rises strongly and blocks access to sound waves to the nasopharynx. This phenomenon is more often observed in neurotic disorders in children. With organic closed rhinolalia, first of all, the causes of obstruction in the nasal cavity must be eliminated. As soon as correct nasal breathing occurs, the defect disappears. If, after eliminating the obstruction (for example, after adenotomy), rhinolalia continues to exist, resort to the same exercises as for functional disorders.
Mixed rhinolalia
Some authors (M. Zeeman, A. Mitronovich-Modrzejewska) identify mixed rhinolalia - a speech condition characterized by reduced nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The cause is a combination of nasal obstruction and insufficiency of velopharyngeal contact of functional and organic origin. The most typical are combinations of a shortened soft palate, its submucosal cleft and adenoid growths, which in such cases serve as an obstacle to air leakage through the nasal passages during the pronunciation of oral sounds.
The state of speech may worsen after adenotomy, as velopharyngeal insufficiency occurs and signs of open rhinolalia appear. In this regard, the speech therapist should carefully examine the structure and function of the soft palate, determine which form of rhinolalia (open or closed) most disrupts the timbre of speech, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the possibility of worsening the timbre of the voice. After surgery, correction techniques developed for open rhinolalia are used.
Voice disorders due to rhinolalia
It is known that with congenital cleft palate, the voice, in addition to excessive open nasalization, is weak, monotonous, non-flying, muffled, and compressed. M. Zeeman even identified this voice disorder as an independent one and called it palatophonia.
However, attention is drawn to the fact that the voice of children with cleft palate in the first year of life does not differ from the voice with a normal structure of the upper jaw. In the pre-speech period, these children scream, cry, and walk in a normal child's voice.
Subsequently, until about seven years of age, children with congenital cleft palates speak (both in the absence of plastic surgery and often after it) in a voice with a nasal tint, sometimes quiet due to behavioral characteristics, but in other qualities clearly not different from normal. An electroglottographic study at this age confirms the normal motor function of the larynx, and myography confirms the normal reaction of the pharyngeal muscles to a stimulus, even with extensive defects of the palate.
After seven years, the voice of children with congenital cleft palates begins to deteriorate: strength decreases, hoarseness and exhaustion appear, and the expansion of its range stops. Myography reveals an asymmetrical reaction of the pharyngeal muscles, thinning of the mucous membrane and a decrease in the pharyngeal reflex are visually observed, and changes appear on the electroglotogram indicating uneven functioning of the right and left vocal folds, i.e., all signs of a disorder of the motor function of the voice-producing apparatus, which is permanent is formed and consolidated by adolescence.
Three main causes of voice pathology in congenital cleft palate can be identified.
This is, firstly, a violation of the velopharyngeal closure mechanism. It is known that due to the close functional connection of the soft palate and the larynx, the slightest tension and movement of the muscles of the velum palate causes a corresponding tension and motor reaction in the larynx. With cleft palate, the muscles that lift and stretch it, instead of being synergists, work as antagonists. At the same time, due to a decrease in the functional load, a degenerative process occurs in them, as in the muscles of the pharynx. The pathological mechanism of closure is enhanced by the congenital asymmetry of the facial skeleton and laryngeal cavities, which is clearly visible on X-rays and tomograms in congenital cleft palates. Anatomical defect of the palate and pharynx leads to a functional disorder of the vocal apparatus.
Secondly, this is the incorrect formation of a number of voiced consonants in rhinolalia in the laryngeal way, when closure is carried out at the level of the larynx and air friction on the edges of the vocal folds is voiced. In this case, the larynx takes on the additional function of an articulator, which, of course, does not remain indifferent to the vocal folds.
Thirdly, the development of the voice is influenced by the behavioral characteristics of persons with rhinophony and rhinolalia. Ashamed of their defective speech, adolescents and adults often speak in a quiet voice and limit verbal communication as much as possible in the microenvironment, thereby reducing the opportunities for developing the strength of their voice and expanding its range.
Features of speech breathing in persons with cleft palate are expressed in increased breathing, in the predominance of the superficial clavicular type of breathing and in shortening of phonation exhalation, which is caused by leakage of air flow into the nasal cavity. The leakage rate depends on the shape of the crevice and can exceed 30%. The duration of exhalation is equal to inhalation. There is no differentiated oral and nasal exhalation.
Speech disorders with rhinolalia
With rhinolalia, speech develops late (the first words appear by two years and much later) and has qualitative features. Impressive speech develops relatively normally, while expressive speech undergoes some qualitative changes.
First of all, it should be noted that the patients’ speech is extremely slurred. The words and phrases that appear in them are difficult to understand for those around them, since the sounds that are formed are unique in articulation and sound. Due to the defective position of the tongue in the oral cavity, consonant sounds are formed mainly due to changes in the position of the tip of the tongue (with little participation of the tongue root in articulation) with excessive activation of the facial muscles.
These changes in the position of the tip of the tongue are relatively constant and correlate with the articulation of certain sounds. Pronunciation of some consonant sounds is particularly difficult for patients. Thus, they cannot implement the necessary barrier at the upper teeth and alveoli to pronounce the sounds of the upper position: l, t, d, ch, sh, shch, zh, r; at the lower incisors to pronounce sounds s, z, c with simultaneous oral exhalation; Therefore, whistling and hissing sounds in rhinolalics acquire a peculiar sound. The sounds k and g are either absent or replaced by a characteristic explosion. Vowel sounds are pronounced with the tongue pulled back and air exhaled through the nose and are characterized by sluggish labial articulation.
Thus, vowels and consonants are formed with a strong nasal connotation. Their articulation is often significantly changed, and the sounds are not clearly differentiated from each other. For the patient himself, such articulomes serve as kineme, i.e., a motor characteristic of a certain sound, and in his speech they perform a meaning-distinguishing function, which allows them to be used for speech communication.
All sounds pronounced by the patient are perceived by ear as defective. Their common characteristic for the listener is snoring sounds with a nasal tint. In this case, unvoiced sounds are perceived as close to the sound “x”, voiced sounds - to the fricative “g”; Of these, the labial and labiodental are close to the sound “m”, and the anterior lingual are close to the sound “n” with a slight modification of the sound.
Sometimes articulomes in the speech of a rhinolalic are very close to normal, and their pronunciation, despite this, is perceived by ear as defective (snoring), since speech breathing is impaired, and, in addition, excessive tension in the facial muscles occurs, which in turn affects articulation and sound effect.
Thus, sound pronunciation in rhinolalia is completely affected. Patients usually lack independent awareness of their speech defect or their sensitivity to it is reduced. Listening to a recording of their speech stimulates patients to take serious speech therapy classes.
Thus, in the structure of speech activity in rhinolalia, the defect in the phonetic-phonemic structure of speech is the leading element of the disorder, and the primary one is a violation of the phonetic structure of speech. This primary defect leaves some imprint on the formation of the lexico-grammatical structure of speech, but deep qualitative changes usually occur only 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. Without dwelling separately on the analysis of the causes of writing defects in rhinolali, it can be pointed out that the proposed method of working to prevent writing disorders and excludes them in cases of early speech therapy assistance (preschool education).
Speech deficiency in rhinolalia affects the formation of all mental functions of the patient and, first of all, the development of personality. The originality of its development is determined by the unfavorable living conditions in a group for rhinolalic.
Impaired speech as a means of communication makes it difficult for patients to behave in a group. Often their communication with the team is one-sided, and the result of communication traumatizes the children. They develop isolation, shyness, and irritability. Their activity is in a more favorable state, since these patients are often intellectually complete (if rhinolalia manifests itself in its pure form).
Purposeful work to overcome a speech defect contributes to the formation of positive character traits and erases the development of higher mental functions. Follow-up information presented in the literature and observations show that the majority of children with rhinolalia are capable of a high degree of compensation for the defect and rehabilitation of functions.
So, 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 incorrect interchangeability of the muscles of the articulatory apparatus. This is the cause of the primary disorder - a violation of the phonetic design of speech - and acts as a leading disorder in the structure of the defect. This disorder entails a number of secondary disturbances 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.
In oral speech, impoverishment and abnormal conditions for the prelinguistic development of children with rhinolalia are noted. Due to a violation of speech motor periphery, the child is deprived of intense babbling and articulatory “game”, 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 the leakage of air through the nasal passages and thus do not receive auditory reinforcement in children. Not only the articulation of sounds suffers, but also the development of simple elements of speech. There is a late onset of speech, a significant time interval between the appearance of the first syllables, words and phrases already in the early period, which is sensitive for the formation of not only its sound, but also its semantic content, i.e., a distorted path of development of speech as a whole begins. To the greatest extent, the defect manifests itself in a violation of its phonetic side.
As a result of peripheral insufficiency of the articulatory apparatus, adaptive (compensatory) changes in the structure of the articulation organs are formed when pronouncing 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; excessive involvement of the root of the tongue and larynx; tension of facial muscles.
The most significant manifestations of defective formation of oral speech are violations of all oral speech sounds due to the connection of nasal D and changes in the aerodynamic conditions of phonation. The sounds become nasal, that is, the characteristic tone of the consonants changes. Pharyngealization, i.e. additional articulation due to tension in the walls of the pharynx, occurs as a compensatory means.
There are also phenomena of additional articulation in the laryngeal cavity, which gives speech a peculiar “clicking” sound.
Many other more specific defects are revealed. For example:
1. lowering the initial consonant (“ak” - “so”, “am” - “there”);
2. neutralization of dental sounds according to the method of formation;
3. replacing plosives with fricatives;
4. whistling background when pronouncing hissing sounds or vice versa (“ssh” or “shs”);
5. absence of vibrant r or replacement with the sound s during strong exhalation;
6. adding additional noise to nasal sounds (hissing, whistling, aspiration, snoring, throatiness, etc.);
7. moving articulation to more posterior zones (the influence of the high position of the root of the tongue and the small participation of the lips in articulation). For example, the sound "s" is replaced by the sound "f" without changing the method of articulation. Characteristic is a decrease in the intelligibility of sounds in a combination of consonants in the final position.
The relationship between nasalization of speech and distortions in the articulation of individual sounds is very diverse.
It is impossible to establish a direct correspondence between the size of the palatal defect and the degree of speech distortion. The compensatory techniques that children use to produce sounds are too diverse. Much also depends on the ratio of the resonating cavities and on the variety of their 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 speech of a child with rhinolalia is generally unintelligible.
M. Momescu and E. Alex showed that the spoken speech of children with cleft palate contains only 50% of the information compared to the norm; the ability to transmit a child’s speech message is halved. This causes serious communication difficulties. Thus, the mechanism of disorders in open rhinolalia is determined by the following:
1) the absence of a velopharyngeal seal and, as a result, a violation of the opposition of sounds on the basis of oronasal;
2) a change in the place and method of articulation of most sounds due to defects of the hard and soft palate, flaccidity of the tip of the tongue, lips, retraction of the tongue deeper into the oral cavity, high position of the root of the tongue, participation in the articulation of the muscles of the pharynx and larynx.
Peculiarities of oral speech of children with rhinolalia in many cases are the cause of deviations in the formation of other speech processes.
Written speech.
The pronunciation features of children with rhinolalia lead to distortion and immaturity of the phonetic system of the language. Therefore, the sound images accumulated in their speech consciousness are incomplete and are not dissected for the formation of correct writing. Secondarily determined features of the perception of speech sounds are the main obstacle to mastering correct writing.
The connection between writing disorders and defects in the articulatory apparatus has various manifestations. If by the time of training a child with rhinolalia has mastered intelligible speech, can clearly pronounce most of the sounds of his native language, and only a slight nasal tone remains in his speech, then the development of sound analysis necessary for learning to read and write is proceeding successfully. However, as soon as a child with rhinolalia experiences additional obstacles to normal speech development, specific errors in writing appear. Late onset of speech, a long absence of speech therapy assistance, without which the child continues to pronounce obscure, distorted words, lack of speech practice, and in some cases reduced mental activity affect all of his speech activity.
Dysgraphic errors that are observed in the written work of children with cleft palates are varied.
Specific for rhinolalia are replacements of “p”, “b” with “m”, “t”; "d" to "n" and reverse replacements "n" - "d"; “t”, “m - “b”, “p” are due to the lack of phonological opposition of the corresponding sounds in oral speech. For example: “will come” - “will receive”, “gave” - “cash”, “lily of the valley” - “lannysh” , "ladnysh", "og" - "fire", etc.
Omissions, substitutions, and the use of extra vowels are identified: “in the canopy” - “in the blue”, “kreltsa” - “porch”, “gribimi” - “mushrooms”, “gulucote” - “dovecote”, “prshel” - “came” .
Substitutions and mixtures of hissing and whistling “zelezo” - “iron”, “whirled” - “whirled” are common.
Difficulties in using affricates are noted. The sound “ch” in writing is replaced by “sh”, “s” or “zh”; “sch” to “ch”: “hide” - “hide”, “shchulan” - “closet”, “shitala” - “read”, “serez” - “through”.
The sound "ts" is replaced with "s": "skvores" - "starling".
Mixtures of voiced and voiceless consonants are characteristic: “correct” - “correct”, “in the portfolio” - “in the portfolio”.
It is not uncommon to make mistakes by missing one letter from the sequence: “rasvel” - “bloomed”, “konatu” - “room”.
The sound “l” is replaced by “r”, “r” by “l”: “cooked” - “failed”, “swimmed up” - “swam”.
The degree of writing impairment depends on a number of factors: the depth of the defect in the articulatory apparatus, the characteristics of the child’s personal and compensatory abilities, the nature and timing of speech therapy, and the influence of the speech environment.
It is necessary to carry out special work, including the development of phonemic perception with a simultaneous impact on the pronunciation side of speech. Correction of speech disorders in children with rhinolalia is carried out differentially depending on age, the state of the peripheral part of the articulatory apparatus and the characteristics of speech development in general.
The main differentiating indicator for placing children in speech therapy institutions is the development of speech processes. Preschool children with phonetic speech disorders are provided with speech therapy assistance on an outpatient basis, in a children's clinic or in a hospital (in the postoperative period). Children with underdevelopment of other speech processes are enrolled in specialized kindergartens in groups for children with phonetic-phonemic or general speech underdevelopment.
School-age children with severe phonemic perception disorders receive help at speech centers at secondary schools. However, they constitute a specific group due to the severity and persistence of the primary defect and the severity of the writing impairment.
Therefore, correctional interventions in special schools are often more effective for them.
School-age children with rhinolalia, who have general speech underdevelopment, are characterized by insufficient development of vocabulary and grammatical structure.
Its causes are different: narrowing of social and speech contacts of children due to a gross defect in sound speech, late onset, complication of the main defect with manifestations of dysarthria or alalia.
Speech errors reflect a low level of mastery of language patterns, a violation of lexical and syntactic compatibility, and a violation of the norms of the literary language. They are due, first of all, to the small amount of speech practice. The children's vocabulary is not precise enough in its use, with a limited number of words denoting abstract and generalized concepts. This explains the stereotypical nature of their speech, the replacement of words with similar meanings.
In written speech, typical cases are the incorrect use of prepositions, conjunctions, particles, errors in case endings, i.e. manifestations of agrammatism in writing. Substitutions and omissions of prepositions, merging of prepositions with nouns and pronouns, and incorrect division of sentences are common.
Definition of rhinolalia
This is a violation of sound pronunciation and timbre of the voice due to anatomical and physiological defects of the speech apparatus. The pronunciation of both consonants (voiced and voiceless) and vowels suffers. Not only sound pronunciation suffers, but also the voice. The presence of a nasal tone of voice distinguishes rhinolalia from dyslalia, which is characterized only by a violation of sound pronunciation.
Depending on the nature of the damage to the vocal apparatus, the nature of the anatomical defect and dysfunction of the velopharyngeal closure, rhinolalia manifests itself in 3 types - open, closed and mixed. The etiology can be organic and functional.
Causes and mechanism of speech impairment in rhinolalia: modern approaches.
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; various structural components of speech suffer to varying degrees.
In oral speech, impoverishment and abnormal conditions for the prelinguistic development of children with rhinolalia are noted. Due to a violation of the speech motor periphery, the child is deprived of intense babbling and articulatory “game”, thereby impoverishing the stage of preparatory tuning of the speech apparatus.
Not only the articulation of sounds suffers, but also the development of the prosodic elements of speech.
There is a late onset of speech, a significant time interval between the appearance of the first syllables, words and phrases already in the early period, i.e., a distorted path of development of speech as a whole begins. To the greatest extent, the defect manifests itself in a violation of its phonetic side.
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.
In addition, the specific coloring of some consonant sounds (usually posterior palatal ones) is revealed due to the connection of the pharyngeal resonator.
There are also phenomena of additional articulation in the laryngeal cavity, which gives speech a peculiar “clicking” sound.
Many other more specific defects are revealed. For example: lowering the initial consonant (“ak, am” - yes, there); neutralization of dental sounds according to the method of formation, replacement of plosive sounds with fricatives; whistling background when pronouncing hissing sounds or vice versa; lack of vibrant R or replacement with sound s with strong exhalation; adding additional noise to nasal sounds (hissing, whistling, aspiration, snoring, larynx, etc.); moving articulation to more posterior zones.
The speech of a child with rhinolalia is generally unintelligible.
Thus, the mechanism of the disorder in open rhinolalia is determined by the following:
1) the absence of a velopharyngeal seal and, as a result, a violation of the opposition of sounds on the basis of oral-nasal;
2) a change in the place and method of articulation of most sounds due to defects of the hard and soft palate, laxity of the tip of the tongue, lips, retraction of the tongue deeper into the oral cavity, high position of the root of the tongue, participation in the articulation of the muscles of the pharynx and larynx.
Features of writing. The pronunciation features of children with rhinolalia lead to distortion and immaturity of the phonemic system of the language.
Secondarily determined features of the perception of speech sounds are the main obstacle to mastering correct writing.
The connection between writing disorders and defects in the articulatory apparatus has various manifestations. If by the time of training a child with rhinolalia has mastered intelligible speech, can clearly pronounce most of the sounds of his native language, and only a slight nasal tone remains in his speech, then the development of sound analysis necessary for learning to read and write is proceeding successfully. However, as soon as a child with rhinolalia has additional obstacles to normal speech development, specific writing disorders appear.
Dysgraphic errors that are observed in the written work of children with cleft palates are varied.
Substitutions specific to rhinolalia are P, b on m, t, d on n and reverse substitutions n - d, t, m - b, p, caused by the lack of phonological opposition of the corresponding sounds in oral speech, omissions, substitutions, the use of sticky vowels are identified, substitutions and mixtures of sibilants and sibilants are common, difficulties in the use of affricates, sound ts is replaced by s, mixtures of voiced and voiceless consonants are characteristic, errors of omitting one letter from the sequence are not uncommon, the sound l replaced r, r on l.
The degree of writing impairment depends on a number of factors: the depth of the defect in the articulatory apparatus, the personality characteristics and compensatory capabilities of the child, the nature and timing of speech therapy, and the influence of the speech environment.
General characteristics of rhinolalia.
Rhinolalia(from Greek nose + speech) - violation
voice timbre and sound pronunciation, determined by anatomical and physiological
speech apparatus defects.
Rhinolalia in its directions it differs from dyslalia by the presence of an altered
nasalized
(lat. nose) voice timbre.
With rhinolalia, the articulation of sounds and phonation differ significantly from the norm.
With normal phonation during the pronunciation of all speech sounds, except nasals, in humans
The nasopharyngeal and nasal cavities are separated from the pharyngeal and oral cavities.
These cavities are separated by velopharyngeal closure, caused by contraction of the muscles of the soft
palate, lateral and posterior walls of the pharynx.
Simultaneously with the movement of the soft palate during phonation, the posterior wall of the pharynx thickens
(Passavan roller), which promotes contact of the posterior surface of the soft
palate with the back wall of the pharynx.
During speech, the soft palate continuously lowers and rises to different heights depending on
on the sounds pronounced and the pace of speech. The strength of the velopharyngeal closure depends on
pronounced sounds. It is smaller for vowels than for consonants. The weakest
velopharyngeal closure is observed with a consonant V
, the strongest - at With
,
usually 6-7 times stronger than with A.
With normal pronunciation of nasal sounds mm"
,n, n"
air jet
freely penetrates into the space of the nasal resonator.
Depending on the nature of the dysfunction of the velopharyngeal closure, various
forms of rhinolalia. The presence of congenital cleft palates deeply affects the entire development of the child: this
children are sick, somatically weakened, they often have a decrease in
hearing With rhinolalia, a speech defect may be accompanied by developmental abnormalities
higher mental functions. These patients are characterized by peculiar
features of personality development and formation of activity.
Speech defect of the rhinola from birth is caused by a number of reasons.
First of all, ensuring the vital functions of breathing and nutrition leads to
specific position of the body of the tongue (with an excessively raised root). This
the position of the tongue leads to a violation of its functionality, with one
hand, and to defective compensation for the violation - on the other (during speech in
articulation involves the muscles of the face and forehead, and various synkinesis occur).
With rhinolalia, there is the formation of atypical specific breathing, the development
hypernasalization and defects in articulation of sounds.
In the picture of a speech disorder, the leading one is defective sound pronunciation;
suffer from lexico-grammatical structure of speech, phonemic hearing, written
speech. Correction of the defect is carried out by means of medical, speech therapy and psychological-pedagogical
impact.