Stages of correctional work with open rhinolalia - presentation. Presentation on the theme "rhinolalia" Complex of articulation exercises for rhinolalia presentation

06.10.2021 Sport

To use the preview of presentations, create yourself a Google account (account) and log into it: https://accounts.google.com

Slide captions:

Rinolalia Completed: Teacher - speech therapist Zakamaldina N.N.

Rinolalia is a speech disorder, expressed in a disorder of articulation and phonation of speech sounds. Rhinolalia is characterized by a pathological change in the resonance of the nasal cavity during phonation, which results in the nasality of speech. (Ippolitova A.G.) Rinolalia occurs with a frequency of 1 case per 760 people.

Classification of rhinolalia The mechanism of development of rhinolalia is associated with a violation of the interaction of the nasal cavity and oropharynx. Depending on the characteristics of this disorder, it is customary to distinguish the open and closed form of rhinolalia. Taking into account possible reasons (anatomical defects or dysfunction of the speech apparatus), each of the forms can be organic and functional. Open rhinolalia is characterized by the presence of a constant open communication between the nasal and oral cavity, which causes the free passage of the air stream simultaneously through the nose and mouth during speech and the occurrence of nasal resonance during phonation. Closed rhinolalia is associated with the presence of an obstacle blocking the exit of the air stream through the nose. Depending on the level of the location of the anatomical obstacle (nasal cavity or nasopharynx), a closed anterior and closed posterior rhinolalia are isolated, respectively. With a combination of obstruction of the nose and insufficiency of the palatopharyngeal ring, they speak of mixed rhinolalia. In this case, the absence of nasal sounds and a nasal tone of voice are noted.

Causes of rhinolalia At the time of occurrence, open organic rhinolalia can be congenital or acquired. Congenital open rhinolalia occurs in children with clefts of the soft and hard palate ("cleft palate"), cleft alveolar ridge of the upper jaw and upper lip ("cleft lip"), shortening of the soft palate, bifurcation or absence of a small uvula, hidden (submucous hard) clefts palate. The causes of congenital clefts of the face can be infection of a pregnant woman in the early stages of gestation with toxoplasmosis, influenza, rubella, mumps, and other infections; contact with pesticides and other harmful substances, smoking, drug and alcohol use during pregnancy, stress, endocrine disorders in the expectant mother. The critical period for the formation of facial clefts is 7-8 weeks of embryogenesis. Acquired open organic rhinolalia occurs as a result of cicatricial deformities, traumatic perforation of the palate, paralysis and paresis of the soft palate caused by injury or tumor compression of the glossopharyngeal or vagus nerves.

Correction of rhinolalia In organic forms of rhinolalia, elimination of anatomical defects is required: production of a pharyngeal obturator, surgical correction of facial deformities: (uranoplasty, velopharyngoplasty, cheiloplasty), adenotomy, nasal polypotomy, septoplasty, removal of pharyngeal neoplasms, etc. psychotherapy.

Speech therapy Speech therapy sessions for the correction of open organic rhinolalia are carried out in the pre- and postoperative period. Before the operation, articulatory gymnastics, breathing exercises, speech therapy massage are performed. After the operation (after 15-20 days), the repetition of special exercises is resumed, but with the primary goal of developing the mobility of the soft palate.

On the subject: methodological developments, presentations and notes

Education of the correct sound pronunciation with rhinolalia.

The education of the correct sound pronunciation is carried out by the usual corrective methods. Constant control over the direction of the air stream is specific ...

Individual program of speech therapy work with open rhinolalia

This program for the elimination of speech defects in children with open rhinolalia is designed for speech therapists in preschool and school educational institutions. The program contains a brief psychological ...

Description of the presentation for individual slides:

1 slide

Slide Description:

Correctional work with an open form of rhinolalia Examination work of the student of IDO Oksana Ivanovna Pendikova

2 slide

Slide Description:

Rhinolalia (from the Greek rhinos - nose, lalia - speech) is a violation of the timbre of the voice and sound pronunciation, due to anatomical and physiological defects of the speech apparatus. With rhinolalia, the articulation of sounds, phonation differ significantly from the norm. Depending on the nature of the dysfunction of the palatine-pharyngeal closure, various forms of rhinolalia are distinguished: OPEN, CLOSED, MIXED What is rhinolalia?

3 slide

Slide Description:

4 slide

Slide Description:

Open rhinolalia, defective articulation and abnormal acoustic effect of speech sounds: during speech, an air stream passes simultaneously through the mouth and nose, as a result of which nasal resonance occurs when all sounds are pronounced. An abnormal acoustic effect is also created by a specific timbre of the voice. Functional - lethargy of the soft palate, insufficient lifting during phonation, more pronounced violation of the pronunciation of vowels Organic - cleft lip and soft palate Acquired Congenital

5 slide

Slide Description:

Acquired: when injured (perforation of the hard or soft palate); tumors (cicatricial changes); with paralysis or paresis of the soft palate (due to damage to the glossopharyngeal and vagus nerves). Congenital: with congenital clefts of the face, lips, hard and soft palate; with congenital shortening of the soft palate. Types of organic open rhinolalia

6 slide

Slide Description:

With congenital clefts, the child's nutrition is disturbed. Physiological and speech respiration. The nature of the work of the facial muscles Stabilizes the incorrect position of the tongue in the oral cavity (excessive raising of the root of the tongue) Hearing loss Pathological features of the structure and activity of the speech apparatus cause various deviations in the development of all aspects of speech and voice. The most common speech disorder is open rhinolalia, which occurs with a congenital defect of the lip and palate.

7 slide

Slide Description:

Violation of the mechanism of the palatine-pharyngeal closure Incorrect formation of a number of voiced consonants with rhinolalia in a laryngeal (laryngeal) way The development of the voice is influenced by behavioral features Causes of voice pathology with a congenital defect

8 slide

Slide Description:

Speech develops late. Impressive is relatively normal, and expressive has qualitative changes - Speech is extremely slurred, - Pronunciation of some consonants is especially difficult for patients. So, they cannot implement the necessary barriers at the upper teeth and alveoli for pronouncing the sounds of the upper position: l, t, d, h, w, sch, g, p; at the lower incisors for pronouncing sounds with, h, c with simultaneous oral exhalation; therefore, whistling and hissing sounds in rhinolaliks acquire a peculiar sound. Sounds k, d are either absent or are replaced by a characteristic explosion produced when unjoined particles of uvuli or the walls of the pharynx join together. - Vowel sounds are pronounced with the tongue pulled backward with air exhalation through the nose and are characterized by sluggish labial articulation. Speech suffers the most with this defect. Rhinolalik speech characteristics:

9 slide

Slide Description:

Boy at the age of 3 months: before surgery and at the age of 2 years after surgery before surgery after surgery before surgery after surgery Child 6 months old with a bilateral isolated cleft of the upper lip, before surgery at the age of 1 year - 6 months after treatment.

10 slide

Slide Description:

before surgery after surgery Girl 5 months old with unilateral cleft of the upper lip: before surgery after surgery Baby with an isolated cleft of the upper lip on the right at the age of 2 months: before surgery and 1 year after surgery.

11 slide

Slide Description:

The first group is made up of children, in whose speech there is nasal resonance, but consonants are formed with correct articulations. The second group consists of persons with pronounced nasal speech resonance and distorted articulation of consonants. They suffer from more extensive defects of the palate. In the third group, speech is characterized not only by a pronounced nasal resonance, but also by an almost complete absence of consonant articulations.According to the severity of the violation of sound pronunciation and the degree of nasalization of speech, all children with cleft palates can be divided into three groups (according to M. Morley).

12 slide

Slide Description:

Correction of the defect in rhinolalia is carried out by medical and psychological-pedagogical means. Surgical methods of treatment are usually used. Their goal, first of all, is to improve the nutrition and restore normal breathing of the child, which is of great importance for the whole organism as a whole (operations: uranoplasty, cheiloplasty, cycloplasty) Unfortunately, even a perfectly performed operation without speech therapy does not create normal speech in the rhinolalik how he continues to use the familiar stereotype of articulatory movements. Correction of a defect in rhinolalia

13 slide

Slide Description:

1. Preoperative preparatory stage. 2. Postoperative stage. Setting vowel sounds. Eliminate excess nasal resonance. 3. Stage of correction of sound pronunciation, coordination of breathing, phonation and articulation. 4. Stage of complete automation of new skills. Correctional work to correct rhinolalia is carried out in 4 stages and requires action on the entire voice and speech production system:

14 slide

Slide Description:

Speech therapy in the preoperative period 1. Prepare the palatine curtain for closing after the operation and prevent dystrophy of the pharyngeal muscles. 2. Develop a directed air stream and slow down the clavicular type of breathing. 3. Strengthen the muscles of the larynx. 4. Create the prerequisites for correct pronunciation of sounds by developing oral praxis and moving the tongue forward in the oral cavity. 5. Differentiate the auditory perception of phonemes. Speech therapy influence in the postoperative period 1. Development of a full-fledged palatine-pharyngeal closure (activation of the palatine curtain) 2. Elimination of the wrong way of articulation organs when pronouncing sounds; 3. Preparation of pronunciation of all speech sounds without nasal tinge (except for nasal sounds).

15 slide

Slide Description:

Corrective work Speech therapy classes in the preoperative period prevent the occurrence of serious pathological changes in the functioning of the speech organs. At the same time, the activity of the soft palate is being prepared; the position of the root of the tongue is normalized; the muscle activity of the lips increases; a directed oral exhalation is produced. Thus, conditions are created for more effective results of the operation and subsequent correction. The following types of work are specific for the postoperative period: a) massage of the soft palate; b) gymnastics of the soft palate and the posterior pharyngeal wall;

16 slide

Slide Description:

The main directions of correctional work (appendix) Activation of the muscles of the soft palate Exercises with the vowels "A, E" Activation of the pharyngeal muscles Imitation of the pharyngeal reflex and yawning Preparation of the articulatory apparatus for correct sound production Exercises for the tongue, cheeks of the lips. Lip massage Development of speech breathing Exercises to develop the correct air stream ... Breathing exercises Nasalization of vowel sounds Phonopedic exercises Vocal exercises Development of speech-auditory differentiation Exercises of acoustic differentiation: non-speech sounds, sounds in a word. melodic, intonational and auditory experience, perception of nasalized and "pure" sounds, perception of one's own pronunciation

17 slide

Slide Description:

The structure of a speech therapy lesson in rhinolalia 1. Organizational moment. 2. Normalization of the lower jaw motility. 3. Massage of the hard and soft palate. 4. Gymnastics for the muscles of the soft palate and muscles of the posterior pharyngeal wall. 5. Facial massage. 6. Lip massage (after cheiloplasty). 7. Mimic gymnastics. 8. Articulatory gymnastics: for the lips, for the tongue in order to spread the tongue, move it forward so that it is wide. 9. Respiratory gymnastics. 10. Work on the voice. 11. Announcement of the topic. 12. Correction of sound pronunciation (staging, automation, differentiation). 13. Development of the lexical and grammatical side of speech. 14. Homework. 15. The result of a speech therapy lesson.

18 slide

Slide Description:

L.I. Vansovskaya "Elimination of speech disorders in congenital clefts of the palate" - St. Petersburg, Hippocrates. 2000 Ermakova I.I. "Speech correction for rhinolalia in children and adolescents" / Ed. S.P. Taptapova - M. Enlightenment, 1984 Ippolitova A.G. "Open rhinolalia" Used literature.

Rhinolalia

forms of rhinolalia, elimination of rhinolalia, gymnastics of the soft palate, exercises for the cheeks, lips, tongue

Rinolalia (from the Greek rhinos - nose, lalia - speech) is a violation of the timbre of the voice and sound pronunciation, due to anatomical and physiological defects of the speech apparatus.

Rinolalia in its manifestations differs from dyslalia in the presence of a changed nasalized (from Latin paziz - nose) timbre of the voice.

With rhinolalia, the articulation of sounds, phonation differ significantly from the norm. With normal phonation, during the pronunciation of all speech sounds, except for nasal ones, a person separates the nasopharyngeal and nasal cavity from the pharyngeal and oral cavity. These cavities are separated by the palatopharyngeal closure caused by the contraction of the muscles of the soft palate, lateral and posterior pharyngeal walls. Simultaneously with the movement of the soft palate during phonation, a thickening of the posterior pharyngeal wall (Passavant's roller) occurs, which contributes to the contact of the posterior surface of the soft palate with the posterior pharyngeal wall.

During speech, the soft palate continuously descends and rises to different heights depending on the sounds spoken and the rate of speech. The strength of the palatine-pharyngeal closure depends on the sounds pronounced. It is less for vowels than for consonants. The weakest palatal-pharyngeal closure is observed with the consonant "b", the strongest - with "c", usually 6-7 times stronger than with "a". With normal pronunciation of 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 palatine-pharyngeal 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 acquire nasality. The most noticeable changes in the timbre of the vowels "and" and "y", during the articulation of which, the oral cavity is most narrowed. The vowel "a" has the smallest nasal shade, since when pronouncing it, the oral cavity is wide open.

The timbre is significantly disturbed when pronouncing consonants. When pronouncing hissing and fricatives, a hoarse sound arising in the nasal cavity is added. Explosive "p", "b", "d", "t", "k" and "g" sound unclear, since the necessary air pressure does not form in the oral cavity due to incomplete overlap of the nasal cavity.

The air stream in the oral cavity is so weak that it is not sufficient to vibrate the tip of the tongue, which is necessary for the formation of the "p" sound.

Diagnostics

Functional open rhinolalia is due to various reasons. It is explained by insufficient rise of the soft palate during phonation in children with sluggish articulation.

One of the functional forms is the "habitual" open rhinolalia. It is often observed after removal of adenoid enlargements or, less often, as a result of post-diphtheria paresis, due to prolonged limitation of the mobile soft palate.

Functional examination with an open form does not reveal any changes in the hard or soft palate. A sign of a functional open rhinolalia is a more pronounced violation of the pronunciation of vowels. With consonants, the palatine-pharyngeal closure is good.

The prognosis for functional open rhinolalia is usually good. It disappears after phoniatric exercises, and pronunciation disorders 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 a congenital cleft of the soft or hard palate, shortening of the soft palate.

Rhinolalia, caused by congenital clefts of the lip and palate, is a serious problem for various branches of medicine and speech therapy. It is the subject of attention of dental surgeons, orthodontists, pediatric otolaryngologists, neuropsychiatric specialists and speech therapists. Clefts are adjacent to the most common and severe malformations.

The frequency of births of children with clefts differs among different peoples, in different countries and even in different areas of each country. A. A. Limberg (1964), summarizing information from the literature, notes that for 600-1000 newborns, one child is born with a cleft lip and palate. Currently, the birth rate in different countries of children with congenital pathology 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.

A cleft face is a malformation of complex etiology, i.e. multifactorial defects. In their occurrence, genetic and external factors play a role or their joint action in the early period of embryo development.

Distinguish:
1.biological factors (influenza, mumps, measles rubella, toxoplasmosis, etc.);
2. chemical factors (pesticides, acids, etc.); maternal endocrine diseases, mental trauma and occupational harm;
3. there is information about the effects of alcohol and smoking.

The critical period for non-union 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 the familial nature of cleft lip and palate is quite rare. However, medical and genetic counseling of families for the purposes of diagnosis and prevention is of great importance. At present, microscopic signs of a cleft lip and palate have been identified from parents: a groove in the palate or uvula of the soft palate, a cleft of the 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 oligophrenia (varying degrees). Some children have separate neurological microscopic features: nystagmus, slight asymmetry of the palpebral fissures, nasolabial folds, increased tendon and peristal reflexes. In these cases, rhinolalia is complicated by early lesion of the central nervous system. Much more often children have functional disorders of the nervous system, pronounced psychogenic reactions to their defect, increased excitability, etc.

Changes in oral sensitivity in the oral cavity are characteristic of children with rhinolalia. Significant deviations in stereognosis in children with clefts in comparison with the norm were noted by M. Edwards. The reason lies in the 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 is formed with reduced physiological nasal resonance during the pronunciation of speech sounds. The strongest resonance is in the nasal m, m ", n, n". With normal pronunciation, the nasopharyngeal seal remains open, and air enters directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like oral 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 stunning of individual tones in the nasopharyngeal and nasal cavities. In this case, vowel sounds acquire an unnatural shade in speech.

The reason for the closed form is most often organic changes in the nasal space or functional disorders of the palatine-pharyngeal closure. Organic changes are caused by painful phenomena, as a result of which, nasal breathing becomes difficult.

M. Zeeman distinguishes between two types of closed rhinolalia (rhinophonia): closed anterior - with obstruction of the nasal cavities and closed posterior - with a decrease in the nasopharyngeal cavity.

Anterior closed rhinolalia is observed in chronic hypertrophy of the nasal mucosa, mainly of the posterior inferior concha; with polyps in the nasal cavity; with curvature of the nasal septum and with tumors of the nasal cavity.

Posterior closed rhinolalia in children may be the result of adenoid growths, less often nasopharyngeal polyps, fibromas or other nasopharyngeal tumors.

Functional closed rhinolalia is common in children, but 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 can be more disturbed in this case than in organic forms.

During phonation and during the pronunciation of nasal sounds, the soft palate rises strongly and the access of sound waves to the nasopharynx is closed. This phenomenon is more often observed in neurotic disorders in children. With organic closed rhinolalia, first of all, the causes of obstruction of 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, they resort to the same exercises as in functional disorders.

Mixed rhinolalia

Some authors (M. Zeeman, A. Mitronovich-Modjeevska) distinguish mixed rhinolalia - a state of speech characterized by decreased nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The reason is a combination of nasal obstruction and insufficiency of the palatopharyngeal contact of functional and organic origin. The most typical are combinations of a shortened soft palate, its submucosal cleavage 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 palatopharyngeal 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, establish which form of rhinolalia (open or closed) more disturbs the timbre of speech, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the possibility of a deterioration in the timbre of the voice. After the operation, correction techniques are used, developed in relation to open rhinolalia.

It is known that with congenital cleft palate, the voice, in addition to excessive open nasalization, is weak, monotonous, non-flightable, deaf, squeezed. M. Zeeman even isolated this vocal 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, walk in a normal child's voice.

Later, until about seven years of age, children with congenital cleft palates speak (as in the absence of plastic surgery, so often after it) in a nasal voice, sometimes quiet due to behavior patterns, but clearly not different from normal in other qualities. Electro-glottographic examination at this age confirms the normal motor function of the larynx, and myography confirms the normal reaction of the muscles of the pharynx to an irritant, even with extensive defects of the palate.

After seven years, the voice of children with congenital cleft palates begins to deteriorate: strength decreases, hoarseness, exhaustion appear, and the expansion of its range stops. Myography reveals an asymmetric reaction of the muscles of the pharynx, visually there is a thinning of the mucous membrane and a decrease in the pharyngeal reflex, and changes appear on the electroglogram, indicating the uneven work of the right and left vocal folds, that is, to all signs of a disorder of the motor function of the vocal apparatus, which is finally formed and fixed by adolescence.

There are three main reasons for the pathology of the voice in congenital cleft palate.

This is, firstly, a violation of the mechanism of the palatine-pharyngeal closure. 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 palatine curtain causes a corresponding tension and motor reaction in the larynx. When the palate is not closed, the muscles that lift and stretch it, instead of being synergistic, act as antagonists. At the same time, due to a decrease in the functional load in them, as in the muscles of the pharynx, a dystrophic process takes place. The pathological closure mechanism is enhanced by the congenital asymmetry of the skeleton of the face and laryngeal cavities, which is clearly seen on X-ray and tomograms with congenital cleft palates. An anatomical defect in the palate and pharynx leads to a functional disorder of the vocal apparatus.

Secondly, this is an irregular formation in rhinolalia of a number of voiced consonants in a laricgeal way, when the closure is carried out at the level of the larynx and the friction of air against the edges of the vocal folds is sounded. In this case, the larynx assumes an additional function of the 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 rhinophonia and rhinolalia. Ashamed of their defective speech, adolescents and adults often speak in a low voice and limit verbal communication in the microenvironment as much as possible, thereby reducing the possibilities of developing voice strength and expanding its range.

The peculiarities of speech breathing in persons with palate clefts are expressed in increased breathing rate, in the predominance of the superficial clavicular type of breathing and in the shortening of phonation expiration, which is caused by the leakage of air flow into the nasal cavity. The leakage target depends on the shape of the crevice and can exceed 30%. The duration of the exhalation is equal to the inhalation. There is no differentiated oral and nasal exhalation.

Speech disorders with rhinolalia

With rhinolalia, speech develops with a delay (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 the extreme slurred speech of patients. The words and phrases that appear in them are hard to understand for those around them, since the sounds that are formed are peculiar in articulation and sound. Due to the defective position of the tongue in the oral cavity, consonants are formed mainly due to changes in the position of the tip of the tongue (with a slight participation of the root of the tongue 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. The pronunciation of some consonants is especially difficult for patients. So, they cannot implement the necessary barriers at the upper teeth and alveoli for pronouncing the sounds of the upper position: l, t, d, h, w, sch, g, p; at the lower incisors for pronouncing sounds with, h, c with simultaneous oral exhalation; therefore, whistling and hissing sounds in rhinolaliks acquire a peculiar sound. The sounds k, r are either absent or are replaced by a characteristic explosion. Vowel sounds are pronounced with the tongue pulled back with air exhalation through the nose and are characterized by sluggish labial articulation.

Thus, vowels and consonants are formed with a strong nasal tinge. Their articulation is often significantly changed, and sounds are not clearly differentiated among themselves. For the patient himself, such articules serve as a kinema, that is, a motor characteristic of a certain sound, and in his speech they perform a meaning-distinguishing function, which allows them to be used for verbal communication.

All sounds pronounced by the patient are perceived as defective by ear. Their general characteristic for the listener is snoring sounds with a nasal tinge. In this case, muffled sounds are perceived as close to the sound "x", voiced - to the "r" fricative; of them labial and labiodental - as close to the sound "m", and the front-lingual - to the sound "n" with a slight modification of the sound.

Sometimes the articules in the speech of a rhinolalik are very close to normal, and their pronunciation, despite this, is perceived as defective (snoring) by ear, since speech breathing is impaired, and, in addition, excessive tension of the facial muscles occurs, which in turn affects articulation and sound effect.

Thus, the pronunciation of rhinolalia is totally affected. Independent awareness of the speech impediment in patients is usually absent or the criticality to it is reduced. Listening to the recording of their speech stimulates patients to 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 link in the disorder, and the primary is the violation of the phonetic design of speech. This primary defect leaves some imprint on the formation of the lexical and grammatical structure of speech, but profound qualitative changes in it are usually found only when rhinolalia is combined with other speech disorders.

In the literature, there are indications of the originality of the formation of written speech with rhinolalia. Without dwelling separately on the analysis of the reasons for writing defectiveness 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).

Inadequacy of speech in rhinolalia affects the formation of all mental functions of the patient and, first of all, on the formation of the personality. The originality of its development is due to the conditions of life in the team that are unfavorable for the rhinolalik.

Violation of speech as a means of communication complicates the behavior of patients in a team. Often their communication with the team is one-sided, and the result of communication traumatizes children. They develop isolation, shyness, irritation. Their activity is in a more favorable state, since these patients are often intellectually full (if rhinolalia is manifested in its pure form).

Purposeful work to overcome the speech defect contributes to the formation of positive character traits, erases the development of higher mental functions. Follow-up data presented in the literature and observations show that the majority of children with rhinolalia are capable of a high degree of defect compensation and functional rehabilitation.

So, congenital clefts negatively affect the formation of the child's body and the development of higher mental functions. Patients find peculiar ways to compensate for the defect, as a result of which an incorrect interchangeability of the muscles of the articulatory apparatus is formed. This is the cause of the primary disorder - a violation of the phonetic design of speech - and appears in the structure of the defect as a leading disorder. This disorder entails a number of secondary disorders in the speech and mental status of the patient. Nevertheless, this group of patients has great adaptive and compensatory possibilities for the rehabilitation of impaired functions.

In oral speech, impoverishment and abnormal conditions for the course of the dolinguistic development of children with rhinolalia are noted. In connection with the violation of the motor speech periferation, the child is deprived of intensive babbling, articulatory "play", thereby depleting the stage of the preparatory tuning of the speech apparatus. The most typical babbling sounds "p", "b", "t", "d" are articulated by the child silently or very quietly due to air leakage through the 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 sound, but also its semantic content, that is, a distorted path of development of speech as a whole begins. To the greatest extent, the defect manifests itself in the violation of its phonetic side.

As a result of peripheral insufficiency of the articulatory apparatus, adaptive (compensatory) changes in the structure of the organs of articulation are formed when pronouncing sounds; high rise of the root of the tongue and its shift into the posterior zone of the oral cavity; insufficient participation of the lips when pronouncing labialized vowels, labial-labial and labial-dental consonants; excessive involvement of the root of the tongue and larynx; tension of facial muscles.

The most significant manifestations of defectiveness in the formation of oral speech are violations of all oral sounds of speech due to the connection of the nasal pe and changes in the aerodynamic conditions of phonation. Sounds become nasal, that is, the characteristic tone of consonants changes. Pharyngealization, that is, additional articulation due to the tension of 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 kind of "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 by the method of formation;
3. replacement of explosive sounds with fricatives;
4. whistling background during the pronunciation of hissing sounds or vice versa ("ssh" or "shs");
5. absence of vibrant r or replacement by sound y with a strong exhalation;
6. the imposition of additional noise on nasalized sounds (hiss, whistling, aspiration, snoring, larynx, etc.);
7. displacement of articulation to the more posterior zones (the influence of the high position of the root of the tongue and little participation of the lips during articulation). For example, the sound "s" is replaced by the sound "f" without changing the way of articulation. A decrease in the intelligibility of sounds in a confluence of consonants in the final position is characteristic.

The relationship between speech nasalization 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 varied. Much also depends on the ratio of the resonating cavities and on the variety of their features of the configuration of the oral and nasal cavity. There are factors that are less specific, but also affect the degree of intelligibility of sound pronunciation (age, individual psychological properties, social and psychological, etc.). The speech of a child with rhinolalia is generally not legible.

M. Momescu and E. Alex showed that the spoken language of children with a cleft palate contains only 50% of the information compared to the norm, the ability to transmit the 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 the palatine-pharyngeal seal and, as a result, a violation of the opposition of sounds on the basis of the oral-nasal one;

2) a change in the place and method of articulation of most sounds due to defects in the hard and soft palate, lethargy of the tip of the tongue, lips, moving the tongue deep into the oral cavity, high position of the tongue root, participation in the articulation of the muscles of the pharynx and larynx.

The peculiarities of the oral speech of children with rhinolalia in many cases are the cause of deviations in the formation of other speech processes.

Written speech

The peculiarities of the pronunciation of children with rhinolalia lead to the distortion and lack of formation of the phonical system of the language. Therefore, the sound images accumulated in their speech consciousness are defective and not dismembered for the formation of correct writing. The secondary conditioned peculiarities of the perception of speech sounds are the main obstacle to mastering the correct writing.
The connection between writing disorders and defects in the articulatory apparatus has various manifestations. If by the time of learning a child with rhinolalia has mastered intelligible speech, is able to clearly pronounce most of the sounds of his native language and only a slight nasal shade remains in his speech, then the development of sound analysis necessary for teaching literacy is proceeding successfully. However, as soon as a child with rhinolalia has additional obstacles to normal speech development, specific writing errors appear. Late onset of speech, prolonged absence of speech therapy assistance, without which the child continues to pronounce obscure distorted words, lack of speech practice, in some cases, reduced mental activity affect all of his speech activity.

The dysgraphic errors that are observed in the written work of children with cleft palates are varied.

Specific for rhinolalia are the substitutions "p", "b", "m", "t"; "d" for "n" and reverse substitutions "n" - "d"; "t", "m -" b "," p "are due to the absence of phonological opposition of the corresponding sounds in oral speech. , "okay", "og" - "fiery", etc.

Gaps, substitutions, the use of unnecessary vowels are revealed: "in the senem" - "in blue", "kreltsa" - "porch", "mushrooms" - "mushrooms", "gulubyatnya" - "dovecote", "passed" - "came" ...

Replacements and mixing of sibilant-whistling "zelezo" - "iron", "whirled" - "whirled" are widespread.

Difficulties in using affricates are noted. The sound "h" in the letter is replaced by "w", "s" or "w"; "u" on "h": "hiding" - "hiding", "schulan" - "closet", "shitala" - "read", "serez" - "through".

The sound "ts" is replaced by "s": "squore" - "starling".

Mixing of voiced and voiceless consonants is characteristic: "correct" - "correct", "in portvel" - "in portfolio".

There are frequent mistakes in missing one letter from the confluence: "blossomed" - "blossomed", "konatu" - "room".

The sound "l" is replaced by "p", "p" by "l": "boiled" - "failed", "boiled 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 capabilities, the nature and timing of speech therapy, the influence of the speech environment.

It is necessary to carry out special work, including the development of phonemic perception with a simultaneous effect 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 on the characteristics of speech development in general.

The main differentiating indicator for determining children in speech therapy institutions is the development of speech processes. Children of preschool age with a violation of the phonetic side of speech 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 pronounced violations of phonemic perception receive assistance 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 disorder.

Therefore, corrective action in special schools is often more effective for them.

For school-age children with rhinolalia, who have a general underdevelopment of speech, inadequacy in the development of vocabulary and grammatical structure is characteristic.

Its conditionality is 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 assimilation of linguistic patterns, violation of lexical and syntactic compatibility, violation of the norms of the literary language. They are primarily due to the small volume of speech practice. The children's dictionary is not precise enough in use, with a limited number of words denoting abstract and generalized concepts. This explains the stereotype of their speech, the replacement of words that are close in meaning.
In written speech, cases of incorrect use of prepositions, conjunctions, particles, errors in case endings, that is, manifestations of agrammatisms in writing are typical. Substitutions and omissions of prepositions, the merging of prepositions with nouns and pronouns, and incorrect division of sentences are common.

Elimination of rhinolalia

The effectiveness of speech therapy work to eliminate rhinolalia depends on the condition of the nasopharynx, on the age of the child. An important factor is the child's ability to distinguish between the nasal timbre of the voice and the normal one.

The study of the speech activity of children with rhinolalia shows that the defective anatomical and physiological conditions of speech formation, the limited motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systemic disturbance of all its components.

Early correction of deviations in speech development in children with rhinolalia is of extraordinarily important social, psychological and pedagogical significance for normalizing speech, preventing learning difficulties and choosing a profession.

Parents should be fully aware that surgical treatment does not provide normal speech, but only creates full anatomical and physiological conditions for the education of correct pronunciation.

It is also necessary to tune parents to the daily consolidation of all the results achieved.

It often happens that the somatic weakness of a child with rhinolalia, the presence of a speech defect causes constant anxiety in parents, anxiety for any reason, the need for excessive care of the baby, distrust of his capabilities.

Your child is not alone:
fertility rate and causes of occurrence

Congenital clefts of the upper lip and palate - this is how the malformations, formerly known as "cleft lip" and "cleft palate", should be called. Today, more than ever in the past, humanity is experiencing the effects of adverse factors on itself and its children. Their effect on the developing fetus is much more dangerous than on an adult. That is why in Russia 1 out of 500-1000 newborns are born with a cleft of the upper lip and palate. In 75% of cases, cleft face is an isolated fetal malformation. At the same time, as a rule, in a family of healthy parents, a child with a cleft upper lip and palate appeared for the first time.

Why? The reasons are varied. As a rule, it is impossible to establish the exact cause in each specific case. Known provoking factors are represented today by two groups:

1. Environmental factors.
Intrauterine infections. The most dangerous are cytomegalovirus infection, herpes I and II types, toxoplasmosis, rubella, influenza, viral hepatitis, chlamydia, syphilis, mycoplasmosis and other sexually transmitted infections, especially in the acute phase.
Chemical (aniline dyes, petroleum products, synthetic rubber, substances used in the production of plastics, viscose fibers) and physical agents (ionizing radiation, high temperature of industrial premises).
Medicines (folic acid antagonists, vitamin A, cortisone, barbiturates, cytostatics). Their teratogenic effect (causing fetal malformations) has been proven.
However, there are other drugs about which we do not have enough information. Alcohol, smoking and drugs. Parents-to-be often do not think about their harmful effects on the embryo. However, it has been proven that the risk of having a baby with a cleft upper lip and palate in a smoking mother is 25% higher than in a nonsmoker.
Elderly age of parents, unfavorable socio-economic conditions.

2. Hereditary factors.
The risk of having a baby with a cleft lip and palate among the population is quite low (~ 0.002%). However, in the presence of this pathology in one of the parents or a previous child, the risk of having a second baby with this disease is ~ 2-5%. The risk of recurrence of the pathology increases significantly (up to ~ 13-14%) if cleft lip and palate is diagnosed in two family members (both parents or one parent and one child) and is ~ 20-50% in the rare case when this defect took place in both parents of the baby and one of their children.
Particular attention should be paid to hereditary syndromes. Hereditary syndromes are diseases represented by a set of certain developmental defects that are passed down from generation to generation. The number of syndromes, including clefts of the upper lip and palate, is quite large - about 300. That is why, when a child is born with any type of this pathology, it is necessary to consult a geneticist. Parents have the right to receive reliable information about the prospects for the development of the child, the possible outcomes of subsequent pregnancies in a particular marriage and preventive measures.
Important: the combination of a number of signs - transverse cleft of the face, parotid pendants and malformation of the auricle, OR congenital cleft of the upper lip and palate and congenital fistulas / cysts of the lower lip - indicates the presence of a hereditary syndrome in the baby. Consultation of a geneticist in this case is required!

Prenatal diagnosis and prevention of rhinolalia. My recommendations for future parents

The most reliable information about the health of a developing baby can be obtained by performing an ultrasound diagnostic study. By the end of the 12th week of pregnancy, the formation of the baby's face is almost completely completed, therefore this period (11-12th week of pregnancy) is the optimal time for performing an ultrasound scan.

Hereditary syndromic pathology in the fetus can be excluded by studying the chromosome set of the fetus as a result of a chorionic villus biopsy (11-12 weeks) or the study of amniotic fluid through amniocentesis (16 weeks of gestation). These manipulations are performed according to the recommendations of an obstetrician-gynecologist and a geneticist and have strict indications.

Note! The purpose of the ultrasound examination is to identify fetal malformations and the characteristics of the course of pregnancy. 11-12th and 23-24th weeks of pregnancy are the optimal terms for its implementation. Today, this study can be performed in three-dimensional mode, which can significantly increase its efficiency.

A common way to prevent the birth of a child with any developmental disabilities is family planning, which is based on a number of specific conditions:

The favorable age of a woman for giving birth to a child is 18-35 years.

Treatment of all sexually transmitted infections before pregnancy - for both spouses.

Health improvement of spouses before pregnancy.

Elimination of bad habits before and during pregnancy.

Exclusion or limitation of harmful production factors, reasonable intake of medications during pregnancy.

Careful medical supervision during pregnancy with the performance of the necessary diagnostic examination.

Taking vitamins with a high content of folic acid for 3 months before conception and during the first trimester of pregnancy.

Speech therapy training

Assessment of the state of speech

At the age of 2.5 - 3 years, a speech therapist specializing in teaching children with congenital clefts of the palate can assess the state of the child's speech. During a standard examination, the speech therapist determines: the type of physiological respiration, phonation exhalation, the position of the tongue in the oral cavity. To assess the method and place of formation of sounds, speech therapy tests available for a child of this age are used, based on the pronunciation of certain words. It is their sound set (P, B, T, K, A, O, I, U) that makes it possible to determine the presence of compensatory grimaces and assess the severity of nasalness (hypernasalization) and nasal emission (air leakage). Thus, in the presence of speech pathology, its clear diagnosis can be carried out. Diagnosis: rhinophonia - indicates a speech disorder characterized by an increase in nasal resonance of the voice, rhinolalia - including, in addition to the above, improper sound production.
In a number of cases, when older patients with speech impairments (previously operated on in other medical institutions and having experience in speech therapy) contact the clinic, nasopharyngoscopy is performed in addition to speech therapy examination. This is a method of objectively assessing the functional state of all structures of the palatine-pharyngeal ring, which makes it possible to diagnose palatal-pharyngeal insufficiency and determine the tactics of further treatment of the child.

Stages and methods of speech therapy

Speech therapy training begins at the age of 2.5 - 3 - 3.5 years with the preparedness of the child and the ability to concentrate his attention throughout the lesson. The course of speech therapy training includes daily one- or two-time sessions with a highly qualified speech therapist in a polyclinic or hospital. Classes are carried out according to the method of speech therapy training.

At the initial stage, the speech therapist develops an individual approach to each child, during the conversations he makes up an idea of the range of his interests, personality traits, establishes personal contact, indicates the need for speech therapy classes and confidence in their result. It is especially important that the child hears his own sound substitutions and perceives the need to reproduce them correctly. Articulatory gymnastics is carried out simultaneously or sequentially with psychotherapeutic classes. Its main goal is to activate and restore the correct operation of all components of the articulatory apparatus (upper and lower jaw, tongue, neck muscles, larynx and vocal cords) and exclude compensatory mechanisms from the formation of sounds. An important section of articulatory gymnastics is the activation of the soft palate through active gymnastics. A special place in the classes is given to breathing exercises to obtain a long oral expiration under the control of the movements of the diaphragm and abdominal press.

After adequate preparation of the articulatory apparatus, vocal exercises begin: vocal gymnastics, singing songs, the use of games that develop the pitch of the voice. In the course of speech therapy classes, work is carried out on the formulation of sounds and then their automation at the level of syllables-words-sentences-phrases-coherent speech, the strength and timbre of the voice develops.

Note: the optimal is the active participation of parents in the course of speech therapy classes, this will allow in the period between training courses not to lose the skills acquired by the child, to repeat a significant part of the exercises at home and to control the child's pronunciation.

The duration of one course of speech therapy training is at least 3 weeks, at the time of completion of which the effectiveness of training and the dynamics of speech restoration are assessed. The full training cycle includes 3-4 full courses, after which a nasopharyngoscopy is performed. In the absence of positive dynamics in the course of speech therapy training, in accordance with the clinical data and the results of nasopharyngoscopy, the maxillofacial surgeon and the speech therapist of the center decide whether to continue speech therapy training or whether it is necessary to eliminate the pharyngeal insufficiency by surgery and determine the optimal method of surgical intervention.

Cautions for Parents

Note: various methods of teaching children with various speech disorders are proposed. However, don't try to use these techniques on your own! The best way to solve your baby's problems is to consult a highly qualified specialist in this area, who will adequately assess the state of your child's speech and determine when and how to deal with your baby specifically, which exercises should be performed in the first place, and which should not be used at all!

Early and correct determination of the tactics of speech therapy teaching your child is at least half of the success in the difficult process of restoring his speech.

The formation of phonetically correct speech in preschool children with congenital cleft palate is aimed at solving several interrelated problems:
1) normalization of "oral expiration", ie, the development of a prolonged oral stream when pronouncing all speech sounds, except for nasal ones;
2) development of correct articulation of all speech sounds;
3) elimination of the nasal tone of the voice;
4) education of the skills of differentiation of sounds in order to prevent defects in sound analysis;
5) normalization of the prosodic side of speech;
6) automation of acquired skills in free speech communication.

The solution of these specific problems is possible when taking into account the patterns of mastering the correct pronunciation skills.
When correcting the sound side of speech, the acquisition of correct pronunciation skills goes through several stages.

The first stage - the stage of "pre-speech" exercises - includes the following types of work:
1) breathing exercises;
2) articulatory gymnastics;
3) articulation of isolated sounds or quasi-articulation (since isolated pronunciation of sounds is atypical for speech activity);
4) syllabic exercises.
At this stage, motor skills are mainly taught based on the initial unconditioned reflex movements.

The second stage is the stage of differentiation of sounds, that is, the education of phonemic representations on the basis of motor (kinesthetic) images of speech sounds.

The third stage is the stage of integration, i.e. learning to positional changes of sounds in a coherent utterance.
The fourth stage is the stage of automation, that is, the transformation of correct pronunciation into normative, into the familiar so much that it does not require special control on the part of the child himself and the speech therapist.

All stages of mastering the sound system are provided by two categories of factors:
1) unconscious (through listening and playing);
2) conscious (through the assimilation of articulatory patterns and phonological signs of sounds).

The participation of these factors in the assimilation of the sound system differs depending on the age of the child and on the stage of correction.

In preschool children, imitation plays a significant role, but the elements of conscious assimilation must be present. This is due to the fact that the restructuring of a strong pathological skill of nasal pronunciation is impossible without activating all the child's personal qualities, focusing on correcting the defect and without consciously mastering new acoustic and motor stereotypes of speech sounds Correctional tasks have a certain difference depending on whether plastic surgery was performed to close cleft or not, although the main types of exercise are used both preoperative and postoperative.

Before the operation, the following tasks are solved:
1) the release of the facial muscles from compensatory movements;
2) preparation of the correct pronunciation of vowel sounds;
3) preparation of correct articulation of consonants available to the child.

After the operation, corrective tasks become much more complicated:
1) development of the mobility of the soft palate;
2) elimination of the wrong structure of the organs of articulation when pronouncing sounds;
3) preparation of pronunciation of all speech sounds without a nasal tinge (with the exception of nasal sounds).

The following types of work are specific for the postoperative period:
a) massage of the soft palate;
b) gymnastics of the soft palate and the posterior pharyngeal wall;
c) articulatory gymnastics;
d) voice exercises.

The main purpose of these exercises is to:
- to increase the strength and duration of the air stream exhaled through the mouth;
- to improve the activity of the articulatory muscles;
- to develop control over the functioning of the opharyngeal valve.

The main purpose of soft palate massage is to knead scar tissue.

You need to massage before meals, in compliance with hygiene requirements. It is carried out as follows. Stroking movements are performed along the seam line back and forth to the border of the hard and soft palate, as well as to the right and left along the border of the hard and soft palate. You can alternate stroking movements with intermittent pressing. Light pressure on the soft palate when pronouncing the sound "a" is also helpful. In this case, the mouth should be wide open.

Soft palate gymnastics

1. Swallowing water or imitation of swallowing movements. Children are encouraged to drink from a small glass or bubble. You can drip water from a pipette - a few drops at a time. Swallowing water in small portions causes the highest rise of the soft palate. A large number of successive swallowing movements lengthens the time during which the soft palate is in the ascending position.

2. Yawning with an open mouth.

3. Gargle with warm water in small portions.

4. Coughing. This is a very useful exercise, as coughing causes a vigorous contraction of the muscles in the back of the throat. When coughing, there is a complete closure between the nasal and oral cavities. By touching the hand to the larynx under the chin, the child may feel the palate rise.

5. The child is trained in voluntary coughing on one exhalation from 2-3 times to more repetitions. In the process of performing the exercise, the palate should remain closed with the back of the pharynx, and the air should be directed through the oral cavity. It is advisable that at first the child coughs with his tongue sticking out. Then a cough is introduced with arbitrary pauses, during which the child is required to maintain the occlusion of the palate with the back of the pharynx. By doing this exercise, children learn to actively raise the soft palate and direct the air stream through the mouth.

6. Clear, energetic, exaggerated pronunciation of vowel sounds in a high tone of voice. This increases the resonance in the oral cavity and decreases the nasal tone. First, the abrupt pronunciation of vowel sounds "a", "e" is trained, then - "o", "u" with exaggerated articulation.

7. Next, they gradually move on to a clear pronunciation of the sound row "a", "e", "y", "o" in different alternations. In this case, the articulatory mode changes, but the exaggerated oral expiration remains. When this skill is strengthened, they move on to smooth pronunciation of sounds. For example: a, uh, o, y _______, a, y, o, e _______.

8. Pauses between sounds increase to 1-3 s, but the rise of the soft palate, in which the passage to the nasal cavity is closed, must be maintained.

9. The exercises described above give positive results in the preoperative period and after the operation. They should be carried out continuously for a long time. Systematic exercises in the preoperative period prepare the child for the operation and shorten the time for subsequent corrective work.

10. To educate the correct sonorous speech, you need to work on the correct breathing. It is known that rhinolaliks have a very short uneconomical exhalation, in which air exits through the mouth and nasal passages. To develop the correct oral air stream, special exercises are carried out in which inhalation and exhalation through the nose alternate with inhalation and exhalation through the mouth, for example: inhalation through the nose - exhale through the mouth; inhale - exhale through the nose; inhale - exhale through the mouth.

With the systematic application of these exercises, the child begins to feel the difference in the direction of the air stream and learns to direct it correctly. It also contributes to the education of the correct kinesthetic sensations of movements of the soft palate.

It is very important to constantly supervise the child while performing these exercises, since at first it can be difficult for him to feel air leakage through the nasal passages.
Control methods are different: a mirror, cotton wool, strips of thin paper are attached to the nasal passages.

Exercises associated with blowing also contribute to the development of the correct air stream. They need to be carried out in the form of a game, introducing elements of competition. Children make some of the toys themselves with the help of their parents. These are butterflies, spinners, flowers, panicles made of paper or fabric. You can use strips of paper attached to wooden sticks, cotton balls on strings, light paper figures of acrobatics, etc. Such toys should have a specific purpose and be used only in classes to educate the correct speech.

Many parents make a mistake when, under the influence of the advice of a speech therapist, they buy balls, accordions and give them to their child for permanent use. Children are far from always able to inflate a balloon without preparatory exercises and often cannot play the harmonica, since they do not have sufficient oral exhalation force. Having failed, the child is disappointed in the toy and no longer returns to it.

Therefore, you need to start with easy, affordable exercises that give a visual effect. For example, children can blow out a candle first from a distance of 15-20 cm, then from a farther distance. A child with a weak oral exhalation can blow the cotton off the palm. If this fails, you can close his nostrils so that he feels the correct direction of the air stream. Then the nasal passages are gradually released. This technique is often useful: light lumps of cotton wool (uncompressed) are inserted into the nasal passages. If the air is mistakenly directed to the nose, then they jump out and the child is convinced of the incorrectness of his actions.

You can also blow on light plastic toys that float in the water. A good exercise is blowing through a straw into a bottle of water. At the beginning of the lesson, the diameter of the tube should be 5-6 mm, at the end - 2-3 mm. From the blast, the water begins to boil, it captivates young children. By the "storm" in the water, one can easily estimate the force of exhalation and its duration. It is necessary to show the child that the exhalation should be even and long. Time "seething" is good to mark on the hourglass.

You can ask the children to blow on balls or pencils on a smooth surface so that they roll over. You can organize a game of "soap bubbles". There are a lot of similar exercises. The most difficult of these is playing wind instruments. The speech therapist needs to keep in mind that breathing exercises quickly tire the child (they can cause dizziness), so they must be alternated with others.

Simultaneously with the children, a cycle of exercises is carried out, the main purpose of which is the normalization of speech motor skills.

It is known that in children with rhinolalia, pathological features of articulation are formed due to anatomical and physiological conditions.

The features of articulation are as follows:
1) high rise of the tongue and its displacement deep into the oral cavity;
2) insufficient labial articulation;
3) excessive participation of the root of the tongue and larynx in the pronunciation of sounds.

Elimination of these features of articulation is an important link in the correction of the defect. This is done by exercises of the so-called articulatory gymnastics, developing lips, cheeks, tongue.

Exercises for cheeks and lips:

1) inflating both cheeks at the same time;
2) puffing up the cheeks alternately;
3) retraction of the cheeks into the oral cavity between the teeth;
4) sucking movements - the closed lips are pulled forward by the proboscis, then return to their normal position (the jaws are closed);
5) grin: lips are strongly stretched to the sides, up and down exposing both rows of teeth;
6) "proboscis" followed by a grin with clenched jaws;
7) grin with opening and closing of the mouth, closing the lips;
8) stretching the lips with a wide funnel with open jaws;
9) stretching the lips with a narrow funnel (imitation of a whistle);
10) retraction of the lips into the mouth with tight pressing to the teeth with wide open jaws;
11) imitation of rinsing the teeth (the air presses heavily on the lips);
12) lip vibration;
13) movement of the lips with the proboscis left-right;
14) rotational movements of the lips with the proboscis;
15) strong puffing of the cheeks (air is retained by the lips in the oral cavity).

Exercises for the tongue:

1) sticking out the tongue with a shovel;
2) sticking out the tongue with a sting;
3) sticking out the flattened and pointed tongue alternately;
4) turning the strongly protruding tongue to the right and left;
5) raising and lowering the back of the tongue - the tip of the tongue rests on the lower gum, and the root either rises up or down;
6) suction of the back of the tongue to the palate, first with closed jaws, and then with open;
7) the protruding wide tongue closes with the upper lip, and then is pulled into the mouth, touching the back of the upper teeth and palate and curving up with the tip at the soft palate;
8) suction of the tongue between the teeth, so that the upper incisors "scrape" the back of the tongue;
9) circular licking with the tip of the tongue of the lips;
10) raising and lowering a wide protruding tongue to the upper and lower lips with an open mouth;
11) alternate bending of the tongue with a sting to the nose and chin, to the upper and lower lips, to the upper and lower teeth, to the hard palate and the bottom of the mouth;
12) the tip of the tongue touches the upper and lower incisors with the mouth wide open;
13) hold the protruding tongue with a groove or boat;
14) hold the protruding tongue with a cup;
15) teeth biting the lateral edges of the tongue;
16) resting on the lateral edges of the tongue against the lateral upper incisors, with a grin, raise and lower the tip of the tongue, touching the upper and lower gums;
17) with the same position of the tongue, drum repeatedly with the tip of the tongue on the upper alveoli (t-t-t-t-t);
18) do the movements one after the other: tongue with a sting, a cup, up, etc.

The listed exercises should not be given all in a row!

Each small lesson should consist of several elements:
- breathing exercises,
- articulatory gymnastics,
- training in the pronunciation of sounds.

Working on sounds requires a lot of attention and stress.

1. Usually, the setting of sounds begins with the sound "a". The tongue is at rest, the mouth is wide open. At the sound of the tongue, it is slightly pulled back, the lips are pushed forward; at the sound "y" the lips are pulled with tension into a tube, and the tongue is pulled back even more. At the sound "e", the tongue rises somewhat in the middle part, the mouth is half-open, the lips are stretched. These sounds are easily pronounced by imitation, the main task when setting them is to eliminate the nasal tinge. At first, the sounds are worked out in abrupt isolated pronunciation with a gradual increase in the number of repetitions per exhalation, for example:
uh uh
ahhhhhhhhhhhh
ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

With each pronunciation, control over the direction of the air stream is necessary. To do this, the child holds a mirror or light cotton wool at the wings of his nose. Then the child is trained in repetition of vowels with pauses, during which he learns to keep the soft palate in a raised position (he needs to show the correct position of the soft palate in front of a mirror). The pauses are gradually increased to 2-3 s. Then you can move on to fluent pronunciation.

2. The setting of consonants begins with the sounds "f" and "p". When pronouncing the sound "f", the tongue lies calmly at the bottom of the mouth. The upper teeth bite slightly on the lower lip. A strong oral exhalation breaks this bow and forms an abrupt "f" sound. Check for air leaks with a mirror or cotton swab.

Exercises for setting and fixing sounds should be carried out in large numbers and in a variety of combinations. Singing is a good technique to facilitate the introduction of correctly pronounced sounds in an isolated position into independent speech. During singing, the closing of the soft palate and the posterior pharyngeal wall is reflexive, and it is easier for the child to concentrate on the articulation of sounds.

Your doubts

From the moment a baby is born, you should know ABSOLUTELY for sure that his fate is in your own hands almost as much as in ours. Presenting information about the rehabilitation system for a child with a cleft upper lip and palate, I would like to convince you of the reality of achieving good treatment results. Your child may have good looks, normal speech and a beautiful dentition and bite.

I advise parents

When consulting a child with a congenital cleft of the upper lip and palate in a particular medical institution, you should receive reasoned answers to a number of questions:
- What types of surgical interventions are coming for your child and at what age?
- What caused the choice of such a tactic of surgical treatment?
- How many children with this pathology are operated on in this medical institution annually?
- How often are postoperative complications recorded (divergence of postoperative sutures, formation of palate defects)?
- What are the cosmetic results of treatment of children, presented in the form of photographs (near and distant) and how are deformities of the upper lip and nose eliminated in the future?
- What are the functional results of treatment: how often does a typical speech pathology - rhinolalia and deformities of the upper jaw / bite - develop?
- Is there a comprehensive rehabilitation system in this institution (speech therapist, orthodontist, ENT doctor, pediatrician, neurologist, pediatric anesthesiologist)? How long and how will it be carried out?

Literature

- Ermakova I.I.Correction of speech in rhinolalia in children and adolescents. - M., 1984
- Ippolitova A.G. Open rhinolalia. - M., 1983
- Speech disorders in preschoolers. Compiled by R. A. Belova-David, B. M. Grinshpun. - M., 1969
- Chirkina G. V. Children with impaired articulation apparatus. - M, 1969
- Speech therapy. Textbook for pedagogical institutes in the specialty "Defectology", ed. Volkova L. S. - M: Education, 1989
- Soboleva E. A. Rinolalia: general information about rhinolalia; classification of congenital clefts of the lip and palate; causes, mechanisms, forms of rhinolalia, etc. - M: AST Astrel, 2006

Description of the presentation for individual slides:

1 slide

Slide Description:

2 slide

Slide Description:

Rhinolalia is a distortion of sound pronunciation and timbre of the voice, caused by a violation of the resonator function of the nasal cavity, due to a violation of the palatine-pharyngeal closure.

3 slide

Slide Description:

Classification of rhinolalia Rhinolalia Mixed - air leakage through the nose, with pathologically reduced resonance => impaired articulation and acoustic characteristics of speech sounds Anterior Posterior

4 slide

Slide Description:

Open Functional - lethargy of the soft palate, insufficient rise during phonation, more pronounced violation of the pronunciation of vowels Organic - cleft lip and soft palate Acquired Congenital

5 slide

Slide Description:

A cleft lip is a congenital anomaly in the structure of the lips (usually the upper one) resulting from a delay in the fusion of the embryonic rudiments that form this part of the oral cavity, often accompanied by a cleft palate. Congenital clefts of the upper lip Hidden Incomplete Without deformation of the cartilaginous part of the nose With deformation of the cartilaginous part of the nose Complete

6 slide

Slide Description:

A cleft palate is a congenital anomaly in the structure of the hard or soft palate, resulting from a delay in the fusion of the embryonic rudiments that form this part of the oral cavity, the cause of rhinolalia. Complete cleft of the alveolar bone, hard and soft palate. Complete cleft of the alveolar process and the anterior part of the hard palate Unilateral - when one side of the intermaxillary bone is fused with the alveolar process of the upper jaw. Double-sided

7 slide

Slide Description:

Causes of rhinolalia Organic Organic Functional Functional Congenital Acquired Anterior Posterior

8 slide

Slide Description:

Symptoms of rhinolalia Open organic congenital rhinolalia Non-speech manifestations: somatic neurological intellectual personality 2. Speech manifestations: abnormal passage of the dolinguistic period impaired sound pronunciation Secondary impairments of auditory differentiation and phonemic analysis

9 slide

Slide Description:

Symptoms of rhinolalia With open functional rhinolalia, it is mainly the sound pronunciation of vowels that suffers; consonants remain intact due to sufficient palatal-pharyngeal closure Closed organic rhinolalia is accompanied by a violation of the pronunciation of nasal sounds ([m], [m "], [n], [n"]), replacing [m] with [b], [n] above]. At the same time, the timbre of the voice also suffers.With a closed functional rhinolalia, the voice acquires a dull, unnatural, dead shade

10 slide

Slide Description:

Diagnostics of rhinolalia Examination of children and adults with rhinolalia is multifaceted and is carried out by various specialists: otolaryngologist, dentist - surgeon, orthodontist, neurologist, phoniatrist, speech therapist (The main attention is paid to assessing the structure and mobility of the articulation apparatus, physiological and phonation breathing, voice disorders. the Gutzman test is used - pronouncing the vowels [a] and [and] with alternating closing and opening of the nasal passages), a defectologist, a psychologist.

11 slide

Slide Description:

Principles of speech therapy assistance for rhinolalia use and formation of correct physiological breathing parallelism in the formation of breathing and articulation formation of the correct pronunciation of all speech sounds anew the sequence of work on sounds is determined by the preparedness of the articulatory base of sounds preparation of the articulatory base of sound is carried out using special articulatory gymnastics 6.do not fix the child's attention on sound with the involvement of auditory control 7. the letter designation of sounds is introduced after the articulations are mastered 8. automation is carried out after the pronunciation of individual sounds is fixed 9. correction of personality development

12 slide

Slide Description:

Stages of corrective work in rhinolalia OPERATING PREPARATION Stage: Preparatory period Main period Postoperative stage

13 slide

Slide Description:

Preoperative stage - preparatory period The main goal is the formation of correct speech breathing in parallel with the assimilation of the article. Stages of work: 1. Formation of speech breathing during the differentiation of inhalation and exhalation through the nose and mouth. 2. Formation of prolonged oral expiration when the articulum implements vowel sounds (without including the voice) and fricative voiceless consonants. Main features: 1. Parallelism in work on breathing and articulation 2. Maximum distraction of the child from the auditory, control during the pronunciation of sounds; 3. Constant repetition of the learned set of exercises before learning new

14 slide

Slide Description:

Formation of speech breathing diaphragmatic (lower rib) breathing 2.differentiation of oral and nasal breathing (working out various types and combinations of inhalation and exhalation) The purpose of these exercises: to consolidate diaphragmatic inhalation and gradual calm exhalation in the process of learning various types of inhalation and exhalation to lay the foundations of the rhythm of speech breathing with pause after inhalation

15 slide

Slide Description:

Development of oral praxis Gymnastics of the articulatory apparatus on the articulations of vowels and consonants The clarity of speech is largely influenced by the nature of the pronunciation of vowels. Specific gymnastics begins with them, in the process of which the structure of the pronunciation organs for each vowel sound is carefully traced. The main task is the organization of oral exhalation, therefore all articulation exercises are carried out without turning on the voice

16 slide

Slide Description:

The sequence of working on sounds in the preparatory period Vowel sounds Articules of vowel sounds are formed in the following sequence: a, e, o, s, y, i, i, e, e, yu (the semi-vowel sound ends this sequence). The sounds i, e, e, yu are formed from a combination of and and the corresponding vowel sound (a, e, o, y). Consonants In the preparatory period of work, fricative voiceless consonants are formed in the following sequence: f, s, w, w, x.

17 slide

Slide Description:

Preoperative stage, the main period The main goal is the same as in the first period, that is, the formation of correct speech breathing simultaneously with the development of the articulum. Stages of work: 1. Turning on the voice during prolonged oral exhalation 2. Formation of a short oral exhalation during the implementation of explosive consonants 3. Differentiation of short and long oral and nasal expiration during the formation of the pronunciation of a group of sonorous sounds and affricates; 4. Formation of soft sounds. Features of work: 1. Parallelism in work on breathing and articulation 2. Conscious auditory control of the child over his pronunciation 3. Introduction of the letter designation of the studied sounds, which can serve to prepare for literacy 4. Automation and differentiation of sounds in different conditions (syllable, word , sentences, text); 5. Prevention of dysgraphia.

18 slide

DEFINITION Rhinolalia is a violation of the timbre of the voice and sound pronunciation, due to anatomical and physiological defects of the speech apparatus. The combination of disorders of articulation of sounds with disorders of the timbre of the voice makes it possible to distinguish rhinolalia from dyslalia and rhinophonia. Rhinophonia is a violation of the timbre of the voice during normal articulation of speech sounds. The term "rhinolalia" is appropriate only in cases where there are other violations of the articulation of sounds. In other cases, the term "rhinophonia" is used.

In rhinolalia, the mechanism of articulation, phonation and voice formation has significant deviations from the norm and is due to a violation of the participation of the nasal and oropharyngeal resonators. With normal phonation in a person, during the pronunciation of all speech sounds, except for the nasal ones, the nasopharyngeal and nasal cavity is separated from the pharyngeal and oral cavity. These cavities are separated by palatal-pharyngeal closure, carried out by contraction of the muscles of the soft palate and the lateral and posterior pharyngeal walls. Simultaneously with the movement of the soft palate during phonation, the posterior pharyngeal wall thickens, which also contributes to the contact of the posterior surface of the soft palate with the posterior pharyngeal wall. The level of contact of the soft palate with the pharyngeal wall can vary and depends on the length of the soft palate.

Figure 1. Movement of the soft palate: A - the soft palate is raised and tightly pressed against the posterior wall of the pharynx. The timbre of the voice during the pronunciation of all speech sounds, except for the nasal ones, is normal; B - the soft palate is raised and pressed against the thickened posterior wall of the pharynx. The timbre of the voice is normal; B - the soft palate is not raised enough. There is no contact between the soft palate and the walls of the pharynx. Exhaled air freely enters the nasal cavity. Nasal tone of voice

R INO LAL I OPEN CLOSED FUNCTIONAL ORGAN ICH ESK AYA FUNCTION ORGANIC FUNCTIONAL FUNCTIONAL ORGANIC FUNCTION

CLOSED RHINOLALIA Closed rhinolalia is characterized by decreased physiological nasal resonance during speech. The strongest resonance is normally observed when pronouncing the nasal m, m'n, n'. During the articulation of these sounds, the nasopharyngeal seal remains open and air enters the nasal cavity. If there is no nasal resonance, these phonemes sound like oral b, b ', d, d'. In addition to the pronunciation of nasal consonants, the pronunciation of vowels is impaired when the rhinolalia is closed. It takes on an unnatural, dead shade.

CLOSED RHINOLALIA. REASONS The causes of closed rhinolalia are most often organic changes in the nasal space or functional disorders of the palatine-pharyngeal closure. Organic changes are caused by painful phenomena, as a result of which the patency of the nose decreases and nasal breathing becomes difficult.

CLOSED RHINOLALIA occurs with chronic hypertrophy of the nasal mucosa, mainly of the posterior portions of the inferior turbinates, with polyps in the nasal cavity, with curvature of the nasal septum and with tumors of the nasal cavity. in children, it is most often the result of large adenoid growths, rarely nasopharyngeal polyps, fibroids or other nasopharyngeal tumors. Closed anterior rhinolalia Posterior closed rhinolalia

CLOSED RHINOLALIA is common in children, but not always correctly recognized, since it occurs with good patency of the nasal cavity and undisturbed nasal breathing. The timbre of nasal and vowel sounds can be more disturbed than with organic. The reason is that the soft palate during phonation and pronunciation of nasal sounds rises above normal and closes the sound waves access to the nasopharynx. Similar phenomena are more often observed in neurotic disorders in children. due to obstruction of the nasal cavity. As soon as correct nasal breathing appears, the defect also disappears. If, after eliminating the obstruction of the nasal cavity (for example, after adenotomy), closed rhinolalia or rhinophonia continues in its usual form, they resort to the same exercises as for functional disorders. Functional Closed Rhinolalia Organic Closed Rhinolalia

1. IN FUNCTIONAL CLOSED RHINOLALIA children are systematically trained in pronouncing nasal sounds. Preparatory work is being carried out to differentiate oral and nasal inhalation and exhalation. Then static breathing exercises are complicated by vocal exercises. It is also useful to apply dynamic gymnastics, in which breathing movements are combined with movements of the arms and trunk. Children are taught to draw out sounds so that a strong vibration is felt in the area of the wings of the nose and the base of the nose.

2. IN FUNCTIONAL CLOSED RHINOLALIA Preschoolers are encouraged to pronounce the syllables na, ne, pu, po, pi in such a way that the vowels sound a little in the nose. In the same way, they practice the pronunciation of consonants in a position in front of nasal sounds (syllables such as am, om, um, an). After the child learns to pronounce these syllables correctly, words are introduced that contain nasal sounds. It is necessary that he pronounce them exaggeratedly loud and drawn out with a strong nasal resonance. The final exercises are exercises for loud, short and long pronunciation of vowel sounds. In addition, vocal exercises are used. The duration of corrective work with functional closed rhinophonia is short. With rhinolalia, the timing is longer and can be difficult to predict in advance. This is due to the fact that with functional closed rhinolalia, it is also required to eliminate defects in the articulation of sounds. In addition, in children with this form of rhinolalia, some features of mental development are often observed.

OPEN RHINOLALIA Normal phonation is characterized by the presence of a seal between the oral and nasal cavities, when the voice vibration penetrates only through the oral cavity. If the separation between the nasal cavity and the oral cavity is incomplete, the vibrating sound penetrates into the nasal cavity as well. As a result of violation of the barrier between the oral and nasal cavity, the voice resonance increases.

SOUND TONE Noticeably changed. The most noticeable changes are the timbre of the vowel sounds u and u, with the articulation of which the oral cavity is most narrowed. The vowel sounds e and o sound less nasally, and the vowel a is even less disturbed, since when it is pronounced the oral cavity is wide open. The timbre of some consonants is violated: when pronouncing hissing sounds and fricatives f, v, x, a hoarse sound arising in the nasal cavity is added; explosive sounds n, b, d, t, k and d, as well as sonorous l and r sound unclear, since the air pressure necessary for their accurate pronunciation cannot form in the oral cavity. With prolonged open rhinolalia (especially organic), the air stream in the oral cavity is so weak that it is insufficient for the tip of the tongue to oscillate, which is necessary for the formation of the sound p. vowel consonants

Open rhinolalia can be organic and functional. Organic open rhinolalia can be congenital or acquired. The most common cause of the congenital form is the cleft of the soft and hard palate.

ACQUIRED OPEN RHINOLALIA is caused by trauma to the mouth and nose or from acquired paralysis of the soft palate. The causes of functional open rhinolalia can be different. For example, it happens during phonation in children with sluggish articulation of the soft palate. The functional open form manifests itself in hysteria, sometimes as an independent defect, sometimes as an imitative one.

HABITATIC OPEN RHINOLALIA One of the functional forms, observed, for example, after removal of large adenoid growths, arises as a result of prolonged limitation of the mobility of the soft palate. Functional examination with open rhinolalia does not reveal organic changes in the hard or soft palate. A sign of a functional open rhinolalia is also the fact that the pronunciation of only vowel sounds is usually impaired, while when the consonants are pronounced, the palatal-pharyngeal closure is good and nasalization does not occur. The prognosis for functional open rhinolalia is more favorable than for organic one. The nasal timbre disappears after phoniatric exercises, and pronunciation disorders are corrected by the usual methods used for dyslalia.

OPEN RHINOLALIA Rhinolalia, caused by congenital nonunion of the lip and palate, is a serious problem for speech therapy and a number of medical sciences (surgical dentistry, orthodontics, otolaryngology, medical genetics, etc.). Cleft lip and palate are the most common and severe birth defects. As a result of this defect, in the process of their physical development, children develop serious functional disorders,

1. EARLY DEVELOPMENT OF A CHILD WITH OPEN RHINOLALIA In children with congenital non-union of the lip and palate, the act of sucking is very difficult. It presents particular difficulties in children with a through cleft lip and palate, and with bilateral through clefts, this act is generally impossible. Difficulty feeding leads to a weakening of vitality, and the child becomes susceptible to various diseases. To the greatest extent, children with clefts are predisposed to catarrh of the upper respiratory tract, bronchitis, pneumonia, rickets, anemia.

Often, such children have pathological changes in the lororgan: curvature of the nasal septum, deformation of the wings of the nose, adenoids, hypertrophy (enlargement) of the tonsils. They often develop nasal inflammation. The inflammatory process can move from the mucous membrane of the nose and throat to the Eustachian tubes and cause inflammation of the middle ear. Frequent otitis media, often taking on a chronic course, are the cause of hearing loss. Approximately 60-70% of children with cleft palates have hearing loss of varying degrees (more often in one ear) - from a slight decrease that does not interfere with speech perception to significant hearing loss.

Abnormalities in the anatomical structure of the lip and palate are closely related to the underdevelopment of the upper jaw and malocclusion with defective teeth positioning. Numerous functional disorders caused by a defect in the structure of the lip and palate require constant medical supervision. In our country, conditions have been created for complex treatment in specialized centers at the Research Institute of Traumatology, at the departments of surgical dentistry, as well as in other institutions where a lot of medical and preventive work is carried out. Doctors of various specialties monitor the children and work together to agree on a comprehensive treatment plan.

During the first years of a child's life, the leading role belongs to the pediatrician, who supervises the feeding and daily regimen of the baby, carries out prevention and treatment, and, if necessary, recommends outpatient or inpatient treatment. The otolaryngologist identifies and treats all painful changes in the ear, nose, throat, nasopharynx and larynx and prepares children for surgery. With deviations in mental development and the presence of pronounced neurotic reactions, the child is consulted by a neuropathologist.

Surgery to restore the upper lip (cheiloplasty) is recommended in the first year of a child's life; it is often performed in maternity hospitals in the first days after birth. In cases of a cleft palate, the orthodontist uses various devices, including an obturator, which facilitate nutrition and create conditions for the development of speech in the preoperative period. The operation to restore the palate (uranoplasty) is performed in most cases at preschool age.

According to the state of mental development, children with cleft palates are divided into three categories: children with normal mental development; children with mental retardation; children with mental retardation (of varying degrees). On neurological examination, signs of pronounced focal brain damage, as a rule, are not observed. Some children have individual neurological micro-signs. Much more often children have functional disorders of the nervous system, sometimes significantly pronounced psychogenic reactions, increased excitability. In addition to all of the above, congenital clefts of the palate have a negative effect on the development of a child's speech. Cleft lip and palate play a different role in the formation of speech underdevelopment. It depends on the size and shape of the anatomical defect.

TYPES OF CRACKS: 1) cleft of the upper lip; upper lip and alveolar process; 2) clefts of the hard and soft palate; 3) clefts of the upper lip, alveolar ridge and palate - unilateral and bilateral; 4) submucosal (submucous) cleft palate.

Figure 2. Left-sided cleft Figure 3. Left-sided cleft of the upper lip and alveolar hard palate of the ridge

With clefts of the lip and palate, all sounds acquire a nasal or nasal tint, which grossly violates the intelligibility of speech. Typical is the imposition of additional noises on nasalized sounds, such as aspiration, snoring, larynx, etc. There is a specific violation of the timbre of the voice and sound pronunciation. To prevent the passage of food through the nose, the child from a very early age acquires the habit of raising the back of the tongue to block the passage into the nasal cavity. This position of the tongue becomes familiar and also changes the articulation of sounds. During speech, children usually open their mouths a little and raise the back of the tongue higher than required. As a result, the tip of the tongue does not move fully. This habit worsens the quality of speech, since with a high position of the jaw and tongue, the oral cavity takes on a shape that contributes to the ingress of air into the nose, which enhances nasality.

When trying to pronounce the sounds n, b, f, c, a child with rhinolalia uses "his" methods. The sounds are replaced by a pharyngeal click, which characterizes the speech of a child with severe rhinolalia in a very peculiar way. A specific click, reminiscent of the sound of a valve, is formed when the epiglottis comes into contact with the back of the tongue. A direct correspondence between the size of the palatal defect and the degree of speech distortion has not been established. This is explained by large individual differences in the configuration of the nasal and oral cavities in children, the ratio of resonating cavities and compensatory techniques that each child uses to increase the intelligibility of his speech. In addition, the intelligibility of speech depends on the age and individual psychological characteristics of children.

INTONATION COMPONENTS Intonation components Characteristic Stress A linguistic phenomenon, which is based on the intensity, strength of sound. For speech intonation, verbal stress (power and tonal vertex of a word) and semantic stress are significant: syntagmatic, phrasal, logical Melody of speech Tonal contour of speech - pitch modulation (increase - decrease) of the main tone of the voice when pronouncing a phrase Speech rate Speech pronunciation rate, acceleration or deceleration its segments (sounds, syllables, words). Depends on the style of pronunciation, the meaning of speech, the emotional state of the speaker, the emotional content of the speech Timbre Additional color of the sound that communicates various emotional-expressive shades of the voice to speech Pause Intonation means, stop in speech, break in sound

Congenital clefts of the upper lip Without deformation of the cartilaginous part of the nose With deformation of the cartilaginous part of the nose. HIDDEN INCOMPLETE Classification of congenital cleft lip and palate

Congenital cleft palate Cleft soft palate submucous COMPLETE INCOMPLETE uranostaphyloschisis submucous COMPLETE INCOMPLETE SPINA alveolar process, hard and soft palate UNILATERAL FULL DUPLEX SPINA alveolar bone and the anterior parts of the hard palate UNILATERAL DUPLEX

SOUND PERFORMANCE EXAMINATION MUST PROVIDE TWO ASPECTS. involves clarifying the features of the formation of speech sounds and the functioning of the organs of articulation in the process of pronunciation. aims to find out how the child distinguishes the system of speech sounds (phonemes) in different phonetic conditions. These two aspects are closely related. 1. Articulating 2. Phonological

A SOUND EXAMINATION BEGINS WITH A CAREFUL ISOLATED PRONUNCIATION, THEN CHECKING THE PRONUNCIATION OF SYLLABS, WORDS, AND PHRASE SPEECH. When examining each group of sounds, it is necessary to note how the child pronounces the sound in isolation, indicating the nature of the violation. The degree of nasal pronunciation of vowels and consonants and the presence of compensatory "grimaces" are also noted.

EXERCISES USE EXERCISES CONSISTING IN MULTIPLE REPETITION OF ONE SOUND, as this creates conditions that reduce articulatory switching from one sound to another.

IDENTIFICATION IS IMPORTANT FOR LOGOPEDIC ANALYSIS For this, the child repeats two sounds or syllables in a breakdown, suggesting a clear articulatory switching (for example, a cap-pack). First, sounds are given, articulatory sharply different from each other, then closer. In this case, the speech therapist records cases when the child fails to motor switch from one sound to another, and he, instead of repeating the final sound of the first syllable, pronounces the previous one. for example, instead of г and д, a semi-voiced sound is pronounced, instead of г and г ’- semi-soft). 1) the ability to clear articulatory switching 2) the appearance of "average" articulation

THEN THE LOGOPEDIST FINISHES HOW THE CHILD USES THE SOUNDS IN SPEECH. When checking, attention is paid to replacements, distortions, mixing, missing sounds. For this purpose, the pronunciation of words is examined. The child is presented with sets of pictures, including words from the tested sounds. The desired sound should be in words in different positions. For example, whistling and hissing sounds may contain the following words (pictures): dog, wheel, nose, pine, shepherd, cash register. The speech therapist pays special attention to how the child pronounces sounds in phrasal speech.

THE CHILD IS DISCOVERED THE ABILITY TO CHANGE THE ARTICULATION MOVEMENT. The child is asked to repeat the sound or syllable several times, and then the sequence of sounds or syllables is changed. The speech therapist notes: is it easy to switch. For example: a-and-u-and-a ka-pa-ta-ta-ka pl-plu-plo plo-plu-pl

IT IS DISCUSSED ABILITY TO Pronounce SIMPLE AND COMPLEX WORDS ON THE WORDS. The speech therapist presents the children with object pictures for naming, then pronounces the words for reflected reproduction. The results of both tasks are compared. The speech therapist records that the child is doing better. He especially notes the words that are pronounced without distorting the syllable and sound composition.

IT WILL FIND OUT WHAT SOUNDS ARE THE WORDS WHICH ARE DISTORTED - FROM ACCEPTED OR UNACCEPTED. 1) reduction in the number of syllables ("queens" instead of a hammer), 2) simplification of syllables ("tulle" instead of a chair); 3) assimilation of syllables ("tatuetka" instead of a stool); 4) adding the number of syllables ("kanamata" instead of room); 5) permutation of syllables and sounds ("devero" instead of a tree). The nature of the distortion is noted:

IT IS TESTED ABILITY TO PROVE SOUNDS IN THE SUGGESTIONS MADE FROM SOUNDS WHICH IN THE ISOLATED FORM A CHILD PROVIDES CORRECTLY AND DISTORTED. To identify non-gross violations of the syllable structure of words, children are offered to repeat sentences such as "Petya is drinking a bitter medicine", "There is a policeman at the crossroads."

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 and, while it is squeezed, then the nasal passages are opened. In the open form, there is a significant difference in the sound of these vowels. With a pinched nose, sounds, especially and, 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 y and and, a strong hum is heard. Functional open rhinolalia is due to various reasons. It is explained by insufficient rise of the soft palate during phonation in children with sluggish articulation. One of the functional forms is the "habitual" open rhinolalia. It is often observed after removal of adenoid enlargements or, less often, as a result of post-diphtheria paresis, due to prolonged limitation of the mobile soft palate. Functional examination with an open form does not reveal any changes in the hard or soft palate. A sign of a functional open rhinolalia is a more pronounced violation of the pronunciation of vowels. With consonants, the palatine-pharyngeal closure is good. The prognosis for functional open rhinolalia is usually good. It disappears after phoniatric exercises, and pronunciation disorders 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, injury, tumor pressure, etc. The most common cause of congenital open rhinolalia is congenital cleavage of the soft or hard palate, shortening of the soft palate.

IN LOGOPEDICS, FOUR CATEGORIES OF SOUND PERFORMANCE DEFECTS ARE DETERMINED: NO SOUND, SOUND DISTORTION, SOUND REPLACEMENT, AND SOUND MIXING. The absence of sounds, especially those difficult to articulate, is very common in children. It can manifest itself in the form of a constant loss of sound in words of varying complexity and in the child's inability to pronounce it in isolation. This type of defect is a permanent defect. Sometimes in the speech of children with good phonemic perception, instead of a complete loss of sound, overtones appear in some positions.

TYPICAL IS "FARINGEAL" SOUNDS OF BACK SOUNDS DUE TO EXCESSIVE DEEP ARTICULATION. The appearance of side-tones, especially in sound combinations of the SSG type, is also characteristic of children with excessive, exaggerated articulation, when short-term transitional phases of articulation act as independent sounds, which are not perceived by the listener in ordinary speech. In the same children, along with insertions of sounds, frequent omissions of sounds or their reduction are found, which simplifies the articulation of difficult combinations of consonants.

FREQUENTLY ABSENT SOUNDS ARE REPLACED BY DISTORTED SOUNDS WITH TIME Distortion of sound is also characterized by its stability in various forms of speech. Such categories of defects as mixing and replacement of sounds constitute a special group, since these deviations from the normative pronunciation manifest the instability of the entire sound system of the language. Sounds can be pronounced correctly in one position in a word and mixed in others. One sound can have several different substitutes. Sound substitutions can be permanent and temporary - in different forms of speech in different ways. In these two categories of phonological defects, a violation of the system of sound oppositions is manifested. Depending on the number of mixed sounds, it affects either the entire sound system of the language, or a part of the system. Such a state of sound pronunciation should alert a speech therapist, since it is diagnostic for identifying phonemic underdevelopment.

DISTURBANCES OF SOUND PRODUCTION ARE COMPARED WITH FEATURES OF RHYTHMIC-SYMBOLIC STRUCTURE. Substitution and mixing of sounds, insufficient distinction of sounds and violation of the rhythmic-syllabic structure are signs typical of general speech underdevelopment. The final conclusion can be made after examining the lexical and grammatical aspect of speech.

EXAMINATION OF THE STRUCTURE OF THE ARTICULATORY APPARATUS AND ITS MOTOR In the course of the examination it is necessary to assess the degree and quality of violations of the motor functions of the organs of articulation and to identify the level of available movements. First of all, it is necessary to characterize the structural features of the articulatory apparatus and defects of an anatomical nature. The speech therapist notes whether the following features are present: lips: cleft upper lip, postoperative scars, shortened upper lip; teeth: malocclusion and teeth landing; tongue: large, narrow; shortening of the hyoid ligament; hard palate: narrow, domed ("gothic"), soft palate: short soft palate, forked small uvula, or absence of uvula.

Submucosal cleft palate (submucosal cleft) is usually difficult to diagnose as it is covered by a mucous membrane. It is necessary to pay attention to the posterior part of the hard palate, which, during phonation, retracts in the form of a small triangle facing forward with an angle. The mucous membrane in this place is thinned and has a paler color. In unclear cases, the otolaryngologist should find out the condition of the palate by careful palpation.

Palatine clefts are usually combined with JAW DEFORMATION, INCORRECT DEVELOPMENT AND LOCATION OF THE TEETH, UNABLE UPPER LIP, DEFORMED NINES, etc. The movements of the muscles of the face, tongue and lips are sluggish, the rudiments of the soft palate and uvula are inactive, passively hanging down. The muscles of the posterior pharyngeal wall are poorly developed. The root of the tongue is overdeveloped, and the tip remains weak and does not fully move. When examining the structure of the articulatory apparatus, the speech therapist also notes the presence of deformation: drooping of one corner of the mouth, deviation to one side of the tongue, drooping of one half of the soft palate, etc.

CELEBRATE THE POWER OF MOVEMENT, ITS ACCURACY, FAST, FIXED. The pareticity of the tongue and lips is manifested in a small range of movements, in their imprecision, exhaustion, irregularity. The movements of the language should be of such force as to hold it in the desired position for as long as it takes to pronounce a particular phoneme. The speed and accuracy of articulation movements affects the intelligibility of pronunciation. It is important to note the increased tone of the tongue, which is expressed in its tension, sharp protrusion of the tip of the tongue, twitching of voluntary movements, which indicates tonic disorders.

Paralysis of the uvula of the soft palate always affects the functional state of the tongue and secondarily disrupts the articulation of lingual sounds, making the entire process of articulation tense and slow. Uvula hanging motionless along the midline indicates bilateral paresis. In cases of unilateral paresis, it deviates to the "healthy" side. It is also important to identify the state of the soft palate: the raising of the palatine curtain when vigorously pronouncing the sound a, the presence or absence of air leakage through the nose when pronouncing vowel sounds, the uniformity of the leak; the presence or absence of a pharyngeal reflex (the appearance of gagging with a light touch with a spatula to the soft palate). It should be borne in mind that articulatory difficulties in spontaneous speech can increase factors such as excitement, fatigue, complication of the content of speech intellectually or linguistically.

PHONEMATIC PERCEPTION Children with normal physical hearing often have specific difficulties in distinguishing subtle differential features of phonemes, which affect the entire process of further development of the sound side of speech. Phonemic perception in children with pronounced defects of the articulatory apparatus develops in inferior conditions and may have deviations. To identify his condition, they usually use techniques aimed at: recognizing, distinguishing and comparing simple phrases; selection and memorization of certain words in a number of others (similar in sound composition, different in sound composition); distinction of individual sounds in a series of sounds, then in syllables and words (different in sound composition, similar in sound composition); memorizing syllable rows, consisting of two to four elements (with a change in the vowel sound - ma-me-mu, with a change in the consonant sound - ka-va-ta); memorizing sound rows.

PHONEMATIC PERCEPTION In order to reveal the child's ability to perceive rhythmic structures of varying complexity, the following tasks are used: to knock out the number of syllables in words of different syllable complexity; guess which of the presented pictures corresponds to the rhythmic pattern set by the speech therapist. The study of distinguishing the sounds of speech can begin with tasks on the repetition of isolated sounds or pairs of sounds. Deviations in phonemic perception are most clearly manifested when the child repeats phonemes that are similar in sound (bn, ss, rl, etc.). In this case, the child is offered to repeat syllabic combinations consisting of the following sounds: sa-sha, sha-sa, sa-sha-sa, sha-sa-sha, sa-za, za-sa, sa-za-sa, etc. n. Particular attention should be paid to distinguishing between whistling, hissing, affricate, sonorous, as well as voiceless and voiced sounds. When performing tasks of this type, some children experience obvious difficulties in repeating sounds that differ in acoustic signs (voiced-deafness), while another category of children has difficulty in repeating sounds that differ in articulation. Cases can be identified when the task to reproduce a series of three syllables is inaccessible to the child or causes certain difficulties. The phenomena of perseveration, when the child cannot switch from pronouncing one sound to pronouncing another, should be especially noted.

PHONEMATIC PERCEPTION When examining phonemic perception, it is advisable to use tasks that exclude articulation so that articulation difficulties do not affect the quality of differentiation. So, the speech therapist pronounces the desired sound in a number of other sounds, both sharply different and similar in acoustic and articulatory characteristics. Hearing a given sound, the child raises his hand. For example, you can offer the child to select the sound u from the sound row o, a, y, o, y, s, o or the syllable sha from the syllable row sa, sha, tsa, cha, sha, shcha. The task for the selection of subject pictures, the names of which begin with a given sound (“Pick up pictures for the sound p and the sound l; for the sound s and the sound w, for the sound s and the sound z”, etc.) well reveals the shortcomings of phonemic perception. The speech therapist selects sets of pictures in advance, and then mixes them up arbitrarily. Less obvious difficulties in distinguishing speech sounds can be found when examining the skills of sound analysis.

In a survey phonetic aspects of speech and compared with data surveys of other parties of speech at a speech therapist should have a clear idea of whether the identified violations INDEPENDENT defects or part of the structure GENERAL underdevelopment of speech as one of its components. The formulation of specific correctional tasks depends on this.

CONVERSATION WITH PARENTS A skillfully constructed conversation with parents is essential for the effectiveness of the correction of a speech defect, to whom it is necessary to explain in an accessible form the mechanism of correct speech breathing and the need for daily control over sound pronunciation and voice. For a child who was born with a cleft palate and soft palate, the babbling period and the initial period of speech occurs in special conditions. The kid hears well, rejoices at the speech addressed to him and gradually begins to understand it. But due to the lack of a shutter between the oral and nasal cavities, he is unable to pronounce sounds. All vocal production has nasal resonance, and the articulation of most consonants is absolutely not realized. The kid cannot learn speech by imitation, as it happens in the norm. In such anatomical conditions, the child remains until the operation.

INTERVIEW WITH PARENTS The daily duty of parents is to encourage any child's attempts to utter a sound, a word, to try to understand even barely intelligible speech. It is important to draw their attention to the importance of medical care. Parents should be fully aware that surgical treatment does not provide normal speech, but only creates full anatomical and physiological conditions for the education of correct pronunciation. It is also necessary to tune parents to the daily consolidation of all the results achieved. It often happens that the somatic weakness of a child with rhinolalia, the presence of a speech defect causes constant anxiety in parents, anxiety for any reason, the need for excessive care of the baby, distrust of his capabilities. Such an attitude only aggravates the defect, intensifies the child's neurotic reactions and undermines his self-confidence. A speech therapist should help such children cope with indecision, inability to stand up for themselves, get rid of fear and anxiety for the quality of their speech. It is equally important to ensure that they are in contact and have meaningful relationships with their peers.

IN THE DOMESTIC LOGOPEDIA DEVELOPED METHODOLOGICAL METHODS FOR ELIMINATION OF RHINOLALIA EF Pay, 1933; F. A. Pay, 1933; 3. G. Nelyubova, 1938; V.V. Kukol, 1941; A. G. Ippolitova, 1955, 1963; 3. A. Repin, 1970; I. I. Ermakova, 1984; G.V. Chirkina, 1987; Volosovets T.V.

THE SYSTEM DEVELOPED BY AG IPPOLITOVA This system is highly effective in correcting sound pronunciation in children with no abnormalities in phonemic development. A. G. Ippolitova was one of the first to recommend classes in the preoperative period. A characteristic feature of her technique is a combination of breathing and articulation exercises, a sequence of sound training, due to articulatory interconnection. The sequence of work on sounds is determined by the preparedness of the articulatory base of the language. The presence of full-fledged sounds of one group is an arbitrary basis for the formation of the following. The so-called "reference" sounds are used. The preparation of the articulatory sound base is carried out with the help of special articulatory gymnastics, which is combined with the development of the child's speech breathing. The peculiarity of the method of A.G. Ippolitova lies in the fact that when a sound is evoked, the child's initial attention is directed only to the articulum.

THE CONTENT OF LOGOPEDIC LESSONS ON THE METHOD OF A. G. IPPOLITOVA INCLUDES THE FOLLOWING SECTIONS: 1. Formation of speech breathing during differentiation of inhalation and exhalation. 2. Formation of prolonged oral expiration when the article implements vowel sounds (without the inclusion of a voice) and fricative voiceless consonants. 3. Differentiation of short and long oral and nasal exhalation during the formation of sonorant sounds and affricates. 4. Formation of soft sounds.

METHODOLOGY L.I.VANSOVSKAYA (1977) L.I. lower incisors. This increases the clarity of kinesthesia in contact with the lower incisors; when pronouncing a sound, both the walls of the pharynx and the soft palate are more actively involved. The child is required to pronounce sounds in a low voice, with the jaw slightly pushed forward, with a half smile, with increased tension of the soft palate and pharyngeal muscles. After the elimination of vowel nasalization, work is carried out on sonors (l, p), then slit and stop consonants.

X-RAY METHOD. The improvement of methods for correcting speech defects in rhinolalia was influenced by the study by the method of radiography. It made it possible to predict the possibility of restoring the function of the palate by speech therapy techniques (NI Serebrova, 1969). Analysis of radiographs revealed the dependence of the effectiveness of speech therapy work on the mobility of the soft palate and the posterior pharyngeal wall; from the distance between the back of the pharynx and the soft palate; from the width of the middle part of the pharynx. Comparison of these data even before the start of speech therapy work makes it possible to resolve the issue of the degree of compensation for a speech defect by conventional means. Techniques for differentiated speech therapy work, depending on the anatomical and functional characteristics of the articulatory apparatus, were developed by T.N. Vorontsova (1966).

METHODS With regard to adults, S.L. This removes grimaces and prepares pronunciation without nasalization. Vocal exercises are recommended. I.I. Ermakova (1980) developed a step-by-step method for correcting sound pronunciation and voice. She established age-related features of functional disorders of voice formation in children with congenital clefts and modified orthophonic exercises for them. Special attention is paid to the postoperative period, and techniques for developing the mobility of the soft palate are recommended to prevent its shortening after surgical plasty.

LOGOPEDIC IMPACT IN OPEN RHINOLALIA Tasks of corrective work: normalization of oral expiration, development of a long oral air stream, development of correct articulation of all sounds, elimination of nasal tone of voice, education of sound differentiation skills, normalization of prosodic speech components, automation of acquired speech skills in communication; movements Preparation of correct pronunciation of vowels Preparation of correct articulation of available consonants Operation In the postoperative period: Development of mobility of the soft palate Elimination of pronunciation defects Overcoming the nasal tone of the voice Specific types of work in the postoperative period: Massage of the soft palate Gymnastics of the soft palate and posterior pharyngeal wall Articulation exercises Voice exercises Breathing exercises. Constant control over the direction of the air stream

Speech therapy classes with a child must be started in the preoperative period in order to prevent the occurrence of serious changes in the functioning of the speech organs. At this stage, the activity of the soft palate is prepared, the position of the root of the tongue is normalized, the muscular activity of the lips is enhanced, and a directed oral exhalation is developed. All this, taken together, creates favorable conditions for increasing the efficiency of the operation and subsequent correction. 15-20 days after the operation, the special exercises are repeated; but now the main goal of the classes is to develop the mobility of the soft palate. The study of the speech activity of children suffering from rhinolalia shows that the defective, anatomical and physiological conditions of speech formation, the limited motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systemic impairment of all its components.

With the age of the child, the indicators of speech development deteriorate (in comparison with the indicators of normally speaking children), the structure of the defect is complicated due to the violation of various forms of written speech. Early correction of deviations in speech development in children with rhinolalia is of extraordinarily important social, psychological and pedagogical significance for normalizing speech, preventing learning difficulties and choosing a profession. The statement of correctional tasks is determined by the results of the examination of the speech of children.

TASKS AND CONTENT OF CORRECTIVE WORK Formation of phonetically correct speech in preschool children with a congenital cleft palate is aimed at solving several interrelated tasks: 1) normalization of "oral expiration", ie, the development of a long mouth stream pronouncing all speech sounds, except for nasal ones; 2) development of correct articulation of all speech sounds; 3) elimination of the nasal tone of the voice; 4) education of the skills of differentiation of sounds in order to prevent defects in sound analysis; 5) normalization of the prosodic side of speech; 6) automation of acquired skills in free speech communication.

WHEN CORRECTING THE SOUND SIDE OF SPEECH, THE ASSASSINATION OF THE CORRECT PRODUCTION SKILLS PASSES 4 STAGES The first stage - the stage of "pre-speech" exercises - includes the following types of work: 1) breathing exercises; 2) articulatory gymnastics; 3) articulation of isolated sounds or quasi-articulation (since isolated pronunciation of sounds is atypical for speech activity); 4) syllabic exercises. At this stage, motor skills are mainly taught based on the initial unconditioned reflex movements.