Voice therapy has the ultimate goal of obtaining a sonorous "flight" sound of the voice and fixing it in the child's independent speech. The main task of corrective work in this direction is the education of correct voice leading, the activation of the muscles of the larynx, the normalization of oropharyngeal resonance.

To solve these problems, it is necessary to carry out preparatory work to strengthen the palatopharyngeal closure, activate the diaphragmatic muscles and form a targeted oral exhalation. Directly voice therapy consists of phonopedic exercises, as well as clarifying the articulation of vowel sounds. Phonopedic exercises contribute to the activation of the muscles of the entire laryngo-pharyngeal apparatus.

Speech therapy classes when working on the voice include articulation and breathing exercises, as well as voice exercises. Only after oral exhalation (even if weak), diaphragmatic breathing and moving the tongue forward in the oral cavity, work can begin on the production of vowel sounds. The main goal is to achieve the pronunciation of vowels on diaphragmatic exhalation. The combination of articulatory and simple breathing exercises allows you to form the skills of speech (phonation) breathing. Work on phonation breathing is carried out simultaneously with the setting and correction of vowels, and then consonants.

When automating the skills of pronunciation of vowels and oral exhalation, the strength and height of the voice develop. By developing the power of the voice, the child is taught to speak clearly, loudly, but not loudly, gradually changing the power of the voice from loud to medium and quiet and vice versa. To develop the pitch of the voice, exercises are used aimed at gradually expanding the range (volume) of the voice, developing its flexibility and modulations.

Work on the pronunciation of vowels should be carried out in a certain order (A-E-O-I-U-S), which is based on a change in muscle strength necessary to hold the palate segments and to increase the volume of the pharyngeal cavity.

Vocal exercises are carried out not only in speech therapy, but also in music classes. In the course of training, attention to the sound side of speech is brought up - the child begins to distinguish and reproduce individual elements of speech, keep them in memory, hear the sound of his own speech and correct mistakes.

The elimination of nasality requires a long time, as it is caused by a number of physiological and psychological factors. The older the child, the more difficult it is to eliminate this defect (it is difficult to automate normal speech skills) due to the habit of nasal sounding of one's voice.

Work on the normalization of the prosodic side of speech should be carried out on the material of poems, fables, songs, fairy tales. First, children learn, following the speech therapist, to select the right intonation, raise or lower their voice, pause, as required by punctuation marks. Then the tempo-rhythmic side of speech is improved.

To achieve these goals, preparatory work is being carried out to strengthen the palatopharyngeal closure, activate the diaphragmatic muscles and form a targeted oral exhalation.

Phonopedic exercises contribute to the activation of the muscles of the entire laryngo-pharyngeal apparatus. Learning the skills of correct voice leading begins with the singing of vowel sounds. At first, children learn to sing the vowels [a] and [o], after 2-3 lessons the sound [e] is added. The last sounds [and] and [y] are included in the work.

The exercises begin with isolated pronunciation of vowels, then move on to singing their combinations. The number of vowels in combinations gradually increases to three. Here is an example of such exercises:

A JSC AE AI AU AEO AEO AOI NPP

About OA OE OI OA UAE OEA OAI OEU

E EA EO EI EU EAO EOA EAI EOU

I IA IO IE IU IAO IAO IEA IAE IAE

U UA UO UE UI UAO UUA UEO UEO

The training begins with showing and explaining articulation. Then the child tries to repeat the necessary actions reflected by the speech therapist. First, the exercises are performed in a whisper, then a loud pronunciation is turned on. The attention of the child is drawn to the wide opening of the mouth, the position of the tongue: the tip is moved to the lower incisors, the root of the tongue is lowered down. Sound combinations should be pronounced for a long time and smoothly on one exhalation. The leakage of air through the nose is controlled by using a mirror or a vial held up to the child's nose.

In the classroom, you can offer children game situations. For example, while rocking a doll, a child sings: [a] - [a] - [a], shows how big he is: [o] - [o] - [o], how the steamer hums: [y] - [y] - [y], on a walk in the forest shouts [ay!], etc.

A good effect helps to achieve the use of static and dynamic breathing exercises.

• standing up, raise your hands through the sides up, stretch, inhale, lowering your hands to sing [a] as you exhale;
• standing, arms lowered along the body, raise your arms up, take a deep breath, tilt your torso forward, lower your arms while singing the vowel [o];
• standing, hands on the belt, inhale, sing [e] as you exhale, stretching forward the hands closed in the palms, imitating the movements of a swimmer.

At the next stage, children move on to exercises with the pronunciation of sound combinations with consonants in the intervocalic position: vowel - consonant - vowel. In the exercises, only correctly articulated consonants are used: nasal sounds [m], [n]. Sound combinations are pronounced smoothly, smoothly, at first monotonously, quietly, then with a change in the pitch of the voice.

• gradual lengthening of the pronunciation of sounds on one exhalation at an average voice volume;
• voice amplification: articulation - whisper - softly - loudly; combinations of vowels are used;
• weakening of the voice: loud - soft - whisper - articulation;
• counting to ten with a gradual increase and subsequent weakening of the voice;
• a similar pronunciation of the alphabetic series;
• Reading poems with a gradual change in the strength of the voice.

To develop the pitch of the voice, exercises are used aimed at gradually expanding the range (volume) of the voice, developing its flexibility and modulations, for example, raising and lowering the voice when pronouncing vowels, their combinations of two and three sounds. Subsequently, they use the pronunciation of poems with a change in the range of the voice.

Vocal exercises are carried out not only by a speech therapist, but also in classes with a music worker. Singing is performed to the accompaniment of the piano.

Rhinolalia

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



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

In its manifestations, rhinolalia differs from dyslalia by the presence of an altered nasalized (from Latin pazis - nose) voice timbre.

With rhinolalia, 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 cavities from the pharyngeal and oral cavities. These cavities are separated by palatopharyngeal closure, caused by contraction of the muscles of the soft palate, lateral and posterior walls of the pharynx. Simultaneously with the movement of the soft palate during phonation, a thickening of the posterior pharyngeal wall (Passavan'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 being uttered and the rate of speech. The strength of the palatopharyngeal closure depends on the sounds being uttered. It is less for vowels than for consonants. The weakest palatopharyngeal closure is observed with the consonant "v", the strongest - with "s", usually 6-7 times stronger than with "a". During 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 palatopharyngeal closure, various forms of rhinolalia are distinguished.

Forms of rhinolalia and features of sound pronunciation

Open rhinolalia

With an open form of rhinolalia, oral sounds become nasal. The timbre of the vowels "i" and "y" changes most noticeably, during the articulation of which, the oral cavity is most narrowed. The vowel "a" has the smallest nasal shade, since when it is pronounced, the oral cavity is wide open.

The timbre is significantly disturbed when pronouncing consonants. When pronouncing hissing and fricatives, a hoarse sound is added that occurs in the nasal cavity. Explosives "p", "b", "d", "t", "k" and "g" sound unclear, since the necessary air pressure is not formed 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 enough to vibrate the tip of the tongue, which is necessary for the formation of the sound "r".

Diagnostics

To determine the open rhinolalia, there are different methods of functional research. The simplest is the so-called Gutzmann test. The child is forced to alternately repeat the vowels "a" and "i", while they clamp it, then open the nasal passages. 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 the insufficient rise of the soft palate during phonation in children with sluggish articulation.

One of the functional forms is the "habitual" open rhinolalia. It occurs frequently after removal of adenoid lesions or, more rarely, 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 functional open rhinolalia is a more pronounced violation of the pronunciation of vowel sounds. With consonants, the palatopharyngeal closure is good.

The prognosis for functional open rhinolalia is usually favorable. It disappears after phoniatric exercises, and sound pronunciation disorders are eliminated by the usual methods used for dyslalia.

Organic open rhinolalia can be acquired or congenital. Acquired open rhinolalia is formed during 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, wounds, tumor pressure, etc.

The most common cause of congenital open rhinolalia is congenital splitting of the soft or hard palate, shortening of the soft palate.

Rhinolalia, caused by congenital cleft 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, neuropsychiatrists and speech therapists. Clefts are adjacent to the most frequent and severe malformations.

The frequency of birth of children with clefts is different among different peoples, in different countries and even in different areas of each country. A. A. Limberg (1964), summarizing the 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 per 500 newborns to 1 per 2500 with a tendency to increase over the past 15 years.

Facial clefts are defects of complex etiology, i.e. multifactorial defects. In their occurrence, genetic and external factors or their combined action in the early period of embryo development play a role.

Distinguish:
1. biological factors (influenza, parotitis, measles rubella, toxoplasmosis, etc.);
2. chemical factors(toxic chemicals, acids, etc.); endocrine diseases of the mother, mental trauma and occupational harm;
3. there is evidence of the effects of alcohol and smoking.

Critical period for nonunion upper lip and the 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, genetic counseling of families for the purpose of diagnosis and prevention is of great importance. At present, microsigns of cleft lips and palate have been identified in parents: a furrow in the palate or uvula of the soft palate, a cleft uvula, an asymmetric tip of the nose, an asymmetric 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 (of varying degrees). Some children have individual neurological micro-signs: nystagmus, slight asymmetry of the palpebral fissures, nasolabial folds, increased tendon and peristal reflexes. In these cases, rhinolalia is complicated by early damage to the center nervous system. Much more often, children experience functional disorders of the nervous system, pronounced psychogenic reactions to their defect, increased excitability, etc.

Characteristic for children with rhinolalia is a change in oral sensitivity in the oral cavity. Significant deviations in stereognosis in children with clefts in comparison with the norm were noted by M. Edwards. The reason lies in the dysfunction of the sensorimotor pathways, due to inadequate feeding conditions in infancy. Pathological features of the structure and activity of the speech apparatus cause a variety of deviations in development, not only sound side speech, to varying degrees, various structural components speech.

Closed rhinolalia

A closed rhinolalia is formed with reduced physiological nasal resonance during the pronunciation of speech sounds. The nasal m, m", n, n" have the strongest resonance. During their normal pronunciation, the nasopharyngeal valve remains open, and air penetrates 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. At the same time, vowel sounds acquire an unnatural connotation in speech.

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

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

Anterior closed rhinolalia is observed with chronic hypertrophy of the nasal mucosa, mainly of the posterior inferior turbinates; 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 often observed in children, but is not always correctly recognized. It occurs with good patency of the nasal cavity and undisturbed nasal breathing. However, the timbre of nasal and vowel sounds may be more disturbed in this case than with organic forms.

The soft palate during phonation and during the pronunciation of nasal sounds rises strongly and access is closed sound waves to the nasopharynx. This phenomenon is more often observed in neurotic disorders in children. With organic closed rhinolalia, first of all, the causes of obstruction of the nasal cavity must be eliminated. As soon as proper nasal breathing occurs, the defect disappears. If, after the obstruction has been eliminated (for example, after adenotomy), the rhinolalia continues to exist, they resort to the same exercises as with functional disorders.

Mixed rhinolalia

Some authors (M. Zeeman, A. Mitronovich-Modrzeevska) distinguish mixed rhinolalia - a speech condition characterized by reduced 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 splitting 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, a speech therapist should carefully examine the structure and function of the soft palate, determine which form of rhinolalia (open or closed) disrupts the timbre of speech more, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the possibility of worsening the timbre of the voice. After the operation, correction techniques developed for open rhinolalia are used.

It is known that in case of congenital cleft palate, the voice, in addition to excessive open nasalization, is weak, monotonous, non-flying, deaf, and choked. M. Zeeman even singled out this voice disorder as an independent one and called it palatophonia.

However, attention is drawn to the fact that the voice of children with cleft palate in the first year of life does not differ from the voice with a normal structure of the upper jaw. In the pre-speech period, these children scream, cry, walk in a normal children's voice.

In the future, up to about seven years old, children with congenital palatine clefts speak (as in the absence of plastic surgery, so often after it) in a voice with a nasal tinge, sometimes due to behavioral characteristics quiet, but in other qualities clearly not different from normal. An electro-glottographic study 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 in the palate.

After seven years, the voice of children with congenital cleft palate 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, thinning of the mucous membrane and a decrease in the pharyngeal reflex are visually observed, and changes appear on the electroglotogram, indicating uneven work of the right and left vocal folds, i.e., all signs of a disorder in the motor function of the voice-forming apparatus, which is finally formed and consolidated by adolescence.

There are three main causes of voice pathology in congenital palatal clefts.

This is, firstly, a violation of the mechanism of palatopharyngeal closure. It is known that due to the close functional relationship between 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 synergists, work as antagonists. At the same time, due to a decrease in the functional load in them, as in the muscles of the pharynx, there is a dystrophic process. The pathological mechanism of closure is enhanced by the congenital asymmetry of the facial skeleton and laryngeal cavities, which is clearly seen on x-rays and tomograms in congenital non-closure of the palate. An anatomical defect of the palate and pharynx leads to a functional disorder of the vocal apparatus.

Secondly, this is an incorrect formation during rhinolalia of a number of voiced consonants in the larykgeal way, when the closure is carried out at the level of the larynx and air friction against the edges of the vocal folds is sounded. In this case, the larynx takes on the additional function of an articulator, which, of course, does not remain indifferent to the vocal folds.

Thirdly, the development of the voice is influenced by the behavior of persons with rhinophony and rhinolalia. Embarrassed by 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 possibility of developing the power of the voice and expanding its range.

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

Speech disorders with rhinolalia

With rhinolalia, speech develops late (the first words appear by two years and much later) and has qualitative features. Impressive speech develops relatively normally, while expressive speech undergoes some qualitative changes.

First of all, it should be noted the extreme indistinctness of the speech of patients. The words and phrases that appear in them are obscure to others, since the emerging sounds 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 little 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 consonant sounds is especially difficult for patients. So, they cannot provide the necessary barrier at the upper teeth and alveoli to pronounce the sounds of the upper position: l, t, d, h, w, u, g, p; at the lower incisors for pronouncing sounds s, s, c with simultaneous oral exhalation; therefore, whistling and hissing sounds in rhinolalics acquire a peculiar sound. The sounds k, g are either absent or replaced by a characteristic explosion. Vowel sounds are pronounced with the tongue pulled back with the exhalation of air through the nose and are characterized by sluggish lip articulation.

Thus, vowels and consonants are formed with a strong nasal tone. Their articulation is often significantly changed, and the sounds are not clearly differentiated among themselves. For the patient himself, such articules serve as a kinema, i.e., a motor characteristic of a certain sound, and in his speech they perform a meaningful function, which makes it possible to use them for verbal communication.

All sounds uttered by the patient by ear are perceived as defective. Their common characteristic for the listener is snoring sounds with a nasal tinge. At the same time, deaf sounds are perceived as close to the sound "x", voiced - to the "g" fricative; of these, labial and labio-dental - as close to the sound "m", and front-lingual - to the sound "n" with a slight modification of the sound.

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

Thus, sound pronunciation with rhinolalia is totally affected. Independent awareness of the speech defect in patients is usually absent or criticality to it is reduced. Listening to the recording of their speech stimulates patients to serious speech therapy sessions.

Thus, in the structure speech activity with rhinolalia, a defect in the phonetic-phonemic structure of speech is the leading link in the violation, and the primary one is a 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 its deep qualitative changes usually occur only when rhinolalia is combined with other speech disorders.

In the literature there are indications of the originality of the formation of written speech in rhinolalia. Without dwelling separately on the analysis of the causes of defective writing in rhinolali, it can be pointed out that the proposed method of work prevents writing violations and excludes them in cases of early speech therapy assistance (preschool education).

The inferiority of speech in rhinolalia affects the formation of all mental functions of the patient and, first of all, the formation of personality. The peculiarity of its development is determined by the unfavorable conditions of life in the team for rhinolalika.

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 injures children. They develop isolation, shyness, irritability. Their activity is in a more favorable state, since these patients are often intellectually complete (if the rhinolalia manifests itself in its pure form).

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

So, congenital clefts negatively affect the formation of the child's body and the development of higher mental functions. Patients find original 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 acts as a leading disorder in the structure of the defect. 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 prelinguistic development of children with rhinolalia are noted. In connection with the violation of motor speech peripheration, the child is deprived of intensive babbling, articulatory "game", thereby impoverishing the stage of preparatory adjustment 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, i.e., a distorted path of speech development 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 to 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 mimic muscles.

The most significant manifestations of the defective formation of oral speech design are violations of all oral speech sounds due to the inclusion of nasal re and changes in the aerodynamic conditions of phonation. Sounds become nasal, that is, the characteristic tone of consonants changes. Pharyngealization, i.e., 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 cavity of the larynx, which gives speech a kind of "clicking" overtone.

Many other more specific defects are also revealed. For example:
1. omission of the initial consonant ("ak" - "so", "am" - "there");
2. neutralization of dental sounds according to the method of formation;
3. replacement of plosives with fricatives;
4. whistling background when pronouncing hissing sounds or vice versa ("ssh" or "shs");
5. the absence of a vibrant p or replacement by the sound s with a strong exhalation;
6. imposition of additional noise on nasalized sounds (hissing, whistling, breathing, snoring, larynx, etc.);
7. movement of articulation to more posterior zones (influence of the high position of the root of the tongue and low 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 the confluence of consonants in the final position is characteristic.

The relationship between nasalization of speech and distortions in the articulation of individual sounds is very diverse.

It is impossible to establish a direct correspondence between the magnitude of the palatine defect and the degree of speech distortion. The compensatory devices that children use to produce sounds are too diverse. Much also depends on the ratio of the resonating cavities and on the diversity of their features in the configuration of the oral and nasal cavities. There are factors that are less specific, but also affect the degree of intelligibility of sound pronunciation (age, individual psychological properties, socio-psychological, etc.). The speech of a child with rhinolalia is generally unintelligible.

M. Momescu and E. Alex showed that the conversational speech of children with cleft palate contains only 50% of information compared to the norm, the possibility of transmitting a child's speech message is halved. This causes serious communication difficulties. Thus, the mechanism of violations in open rhinolalia is determined by the following:

1) the absence of the palatopharyngeal closure and, as a result, a violation of the opposition of sounds on the basis of the oro-nasal;

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, retraction of the tongue deep into the oral cavity, high position of the root of the tongue, participation in the articulation of the muscles of the pharynx and larynx.

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

Written speech

Features of the pronunciation of children with rhinolalia lead to distortion and unformed phonetic system of the language. Therefore, the sound images accumulated in their speech consciousness are incomplete and not dissected to form the correct letter. Secondarily conditioned features of the perception of speech sounds are the main obstacle to mastering the correct letter.
The relationship of writing disorders with defects in the articulatory apparatus has a variety of manifestations. If by the time of training 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 development sound analysis required for literacy training is proceeding successfully. However, as soon as a child with rhinolalia has additional obstacles to normal speech development, specific errors in writing appear. Late onset of speech, prolonged absence of speech therapy assistance, without which the child continues to pronounce incomprehensible distorted words, lack of speech practice, and in some cases reduced mental activity affect all of his speech activity.

Dysgraphic errors that are observed in the written work of children with cleft palate are varied.

Specific for rhinolalia are the substitutions "p", "b", for "m", "t"; "d" to "n" and reverse substitutions "n" - "d"; "t", "m - "b", "p" are due to the lack of phonological opposition of the corresponding sounds in oral speech. For example: "come" - "accept", "dal" - "cash", "lily of the valley" - "lannysh" , "okay", "og" - "fiery", etc.

Omissions, substitutions, the use of extra vowels are revealed: "in the canopy" - "in the blue", "krelets" - "porch", "mushrooms" - "mushrooms", "hollow" - "dovecote", "prshel" - "came" .

Substitutions and mixtures of hissing-whistling "green" - "iron", "spun" - "spun" are common.

Difficulties in the use of affricates are noted. The sound "h" in the letter is replaced by "sh", "s" or "zh"; "u" to "h": "hide" - "hide", "schulan" - "closet", "shitala" - "read", "serez" - "through".

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

The mixture of voiced and deaf consonants is characteristic: "correct" - "correct", "in a portwell" - "in a briefcase".

Mistakes are not uncommon for the omission of one letter from the confluence: "blossomed" - "blossomed", "konatu" - "room".

The sound "l" is replaced by "r", "r" by "l": "boiled" - "failed", "swimmed" - "floated".

The degree of writing impairment depends on a number of factors: the depth of the defect in the articulatory apparatus, the characteristics of the child's personal and compensatory abilities, the nature and timing of the speech therapy impact, and the influence of the speech environment.

It is necessary to carry out special work, including the development of phonemic perception with a simultaneous impact on pronunciation side 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 identifying 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 impairments in phonemic perception receive assistance at logopoints at general education schools. However, they constitute a specific group due to the severity and persistence of the primary defect and the severity of the writing impairment.

Therefore, often the corrective impact in the conditions of special schools is more effective for them.

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

Its conditionality is different: the narrowing of social and speech contacts of children due to a gross defect in sound speech, its late onset, the complication of the main defect with manifestations of dysarthria or alalia.

Speech errors reflect a low level of assimilation of language patterns, a violation of lexical and syntactic compatibility, a violation of the norms of the literary language. They are primarily due to the small amount of speech practice. The vocabulary of children is not accurate enough in terms of usage, 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, i.e., manifestations of agrammatisms in writing, are typical. Substitutions and omissions of prepositions, 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 state of the nasopharynx, on the age of the child. An important factor is the ability of the child to distinguish the nasal timbre of the voice from the normal one.

Speech therapy sessions 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 surgery special exercises repeat; 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 inferior anatomical and physiological conditions of speech formation, the limitation of the motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systemic violation of all its components.

With the age of the child, the indicators of speech development worsen (compared to the indicators of normally speaking children), the structure of the defect is complicated due to a violation various forms written speech.

Early correction of deviations in speech development in children with rhinolalia has an extremely important social and psychological and pedagogical significance for the normalization of speech, the prevention of difficulties in learning and choosing a profession.

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

It is also necessary to set up parents for 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 abilities.

Your child is not alone:
birth rate and causes

Congenital cleft lip and palate - this is how developmental defects should be called, in the past known as "cleft lip" and "cleft palate". Today, more than ever in the past, humanity is experiencing the effects of adverse factors on itself and its children. Their influence on the developing fetus is much more dangerous than on an adult. That is why in Russia 1 out of 500-1000 newborns is born with a cleft lip and palate. In 75% of cases, facial clefts are an isolated malformation of the fetus. At the same time, as a rule, in a family of healthy parents, a child with a cleft 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 types I and II, 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, heat industrial premises).
drugs (antagonists) folic acid, vitamin A, cortisone, barbiturates, cytostatics). Their teratogenic effect (causing malformations in the fetus) has been proven.
However, there are other drugs about which we do not have enough information. Alcohol, smoking and drugs. Future parents often do not think about their harmful effects on the embryo. However, it has been proven that the risk of having a child with a cleft lip and palate in a smoking mother is 25% higher compared to a non-smoker.
Old age of parents, unfavorable socio-economic conditions.

2. Hereditary factors.
The risk of having a child 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 pathology recurrence 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 occurred 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 malformations that are transmitted from generation to generation. The number of syndromes, including cleft lip and palate, is quite large - about 300. That is why when a child is born with any kind of this pathology, genetics consultation is necessary. 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: a combination of a number of signs - a transverse cleft of the face, parotid appendages and a malformation of the auricle, OR a 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. A genetic consultation is a must in this case!

Prenatal diagnosis and prevention of rhinolalia. My advice to future parents

The most reliable information about the state of 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, so this period (11-12th week of pregnancy) is the optimal time for performing ultrasound.

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 examination of the amniotic fluid by amniocentesis (16 weeks of pregnancy). These manipulations are performed according to the recommendations of an obstetrician-gynecologist and geneticist and have strict indications.

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

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

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

Treatment of all infectious diseases, sexually transmitted before pregnancy - in both spouses.

Improvement of spouses before pregnancy.

Exclusion of bad habits before pregnancy and during the latter.

Exclusion or limitation of harmful production factors, reasonable reception medicines during pregnancy.

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

Taking vitamins with a high content of folic acid within 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 cleft palate can assess the state of the child's speech. During a standard examination, a speech therapist determines: the type of physiological breathing, phonation expiration, the position of the tongue in the oral cavity. To assess the method and place of the formation of sounds, speech therapy tests available for a child of this age, based on the pronunciation of certain words, are used. 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 nasality (hypernasalization) and nasal emission (air leakage). Thus, in the presence of speech pathology, its clear diagnosis can be carried out. The diagnosis was made: rhinophonia - indicates a speech disorder characterized by an increase in the nasal resonance of the voice, rhinolalia - including, in addition to the above, abnormal sound formation.
In some cases, when older patients with speech disorders (previously operated in other medical institutions and having experience in speech therapy training) go to the clinic, in addition to a speech therapy examination, nasopharyngoscopy is performed. This is a method for an objective assessment of the functional state of all structures of the palatopharyngeal ring, which makes it possible to diagnose palatopharyngeal insufficiency and determine the tactics for further treatment of the child.

Stages and methods of speech therapy training

Speech therapy training begins at the age of 2.5 - 3 - 3.5 years with the preparedness of the child and the possibility of concentrating 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 clinic or hospital. Classes are carried out according to the methodology of speech therapy training.

At the initial stage, the speech therapist develops an individual approach to each child, in the course of conversations he makes 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. Simultaneously or sequentially with psychotherapeutic classes, articulatory gymnastics is carried out. Its main goal is to activate and restore the correct functioning of all components of the articulatory apparatus (upper and lower jaws, tongue, neck muscles, larynx and vocal cords) and to exclude compensatory mechanisms from the process of sound formation. An important section of articulation gymnastics is the activation of the soft palate through active gymnastics. A special place in the classroom is given breathing exercises to obtain a long oral exhalation under the control of the movements of the diaphragm and abdominals.

After adequate preparation of the articulatory apparatus, voice exercises begin: vocal gymnastics, singing songs, using games that develop the pitch of the voice. In the course of speech therapy classes, work is carried out on the production 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, repeat a significant part of the exercises at home and control the child's pronunciation.

The duration of one course of speech therapy training is at least 3 weeks, at the end of which the effectiveness of training and the dynamics of speech recovery are assessed. The full training cycle includes 3-4 full courses, after which 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 speech therapist of the center decide whether it is possible to continue speech therapy training or whether it is necessary to eliminate palatopharyngeal insufficiency surgically and determine the optimal method of surgical intervention.

Parental Warnings

Note: offered a variety of methods of training with children with different speech disorders. However, don't try to use these techniques on your own! The best option The solution to your baby's problems is the consultation of a highly qualified specialist in this field, who will adequately assess the state of your child's speech and determine when and how you should do it with your baby, which exercises should be performed in the first place, and which should not be used at all!

Early and correct definition the tactics of speech therapy teaching your child is at least half 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 tasks:
1) normalization of "oral exhalation", i.e., the development of a long oral jet when pronouncing all speech sounds, except for nasal ones;
2) development of the correct articulation of all speech sounds;
3) elimination of nasal tone of voice;
4) education of sound differentiation skills in order to prevent defects in sound analysis;
5) normalization of the prosodic aspect of speech;
6) automation of acquired skills in free speech communication.

The solution of these specific tasks is possible by taking into account the patterns of mastering the correct pronunciation skills.
When correcting the sound side of speech, the assimilation of the 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 not typical for speech activity);
4) syllable exercises.
At this stage, mainly motor skills are taught based on the initial unconditional reflex movements.

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

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

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

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

In preschool children, imitation plays a significant role, but 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 the activation of all the personal qualities of the child, the focus on correcting the defect and without the conscious assimilation of new acoustic and motor stereotypes of speech sounds. Correction tasks have a certain difference depending on whether Plastic surgery to close the cleft or not, although the main types of exercises are used both in the preoperative and postoperative period.

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

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

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

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

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

Massage should be done before meals, in compliance with hygiene requirements. It is carried out as follows. Stroking movements are made 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 pressure. A light pressure on the soft palate when pronouncing the sound "a" is also useful. The mouth should be wide open.

Gymnastics of the soft palate

1. Swallowing water or imitation of swallowing movements. Children are offered to drink from a small glass or bottle. You can drip water from a pipette - a few drops. Swallowing water in small portions causes the highest elevation of the soft palate. A large number of consecutive swallowing movements lengthens the time during which the soft palate is in the lifting position.

2. Yawning with open mouth.

3. Gargling warm water in small portions.

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

5. The child is trained in voluntary coughing on one exhalation from 2-3 repetitions to more. During the exercise, the closure of the palate with the back wall of the pharynx should be maintained, and air should be directed through the oral cavity. It is advisable that the first time the child coughs with his tongue hanging out. Then, coughing is introduced with arbitrary pauses, during which the child is required to maintain the closure of the palate with the posterior pharyngeal wall. Performing this exercise, children master the ability to actively raise the soft palate and direct the air stream through the mouth.

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

7. Then they gradually move on to a clear pronunciation of the sound series "a", "e", "u", "o" in different alternations. At the same time, the articulation structure changes, but exaggerated oral exhalation is preserved. When this skill is strengthened, they move on to the smooth pronunciation of sounds. For example: a, e, 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 surgery. They should be carried out continuously for a long time. Systematic exercises in the preoperative period prepare the child for surgery and reduce the time for subsequent corrective work.

10. To cultivate correct sonorous speech, work is needed on correct breathing. It is known that rhinolalics have a very short wasteful expiration, 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 - exhalation through the mouth; inhale - exhale through the nose; inhale - exhale through the mouth.

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

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

Blowing exercises 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. Some of the toys are made by children themselves with the help of their parents. These are butterflies, turntables, 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 special purpose and be used only in the classroom for the education of correct speech.

Many parents make a mistake when, under the impression of the advice of a speech therapist, they buy balls, accordions and give them to their child for permanent use. Children are not always able to inflate a balloon without preparatory exercises and often cannot play the harmonica, since they do not have enough force to exhale with their mouths. 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 further distance. A child with weak oral exhalation may blow the cotton from the palm of his hand. 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. Often this technique is also useful: light lumps of cotton wool (unpressed) are inserted into the nasal passages. If the air is mistakenly sent to the nose, then they pop out and the child is convinced of the wrongness of his actions.

You can also blow on light plastic toys floating 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, this captivates young children. By the "storm" in the water, you can easily assess the strength of the exhalation and its duration. It is necessary to show the child that the exhalation should be even and long. It is good to mark the time of "seething" on the hourglass.

You can invite children to blow on balls or pencils lying on a smooth surface so that they roll. You can organize a game of "soap bubbles". There are many such 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.

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

The 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, which develop lips, cheeks, and tongue.

Exercises for cheeks and lips:

1) inflation of both cheeks at the same time;
2) puffing out the cheeks alternately;
3) retraction of the cheeks into the oral cavity between the teeth;
4) sucking movements - closed lips are pulled forward by the proboscis, then return to their normal position (jaws are closed);
5) grin: lips are strongly stretched to the sides, up and down exposing both rows of teeth;
6) "proboscis" with a subsequent grin with clenched jaws;
7) grin with opening and closing of the mouth, closing of 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 teeth (the air presses hard on the lips);
12) vibration of the lips;
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).

Language exercises:

1) sticking out the tongue with a shovel;
2) sticking out the tongue with a sting;
3) protrusion of a flattened and pointed tongue alternately;
4) turning a 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 then rises up, then falls down;
6) suction of the back of the tongue to the palate, first with closed jaws, and then with open ones;
7) the protruding wide tongue closes with the upper lip, and then is drawn into the mouth, touching the back of the upper teeth and the palate and bending upward 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 the mouth open;
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 oral cavity;
12) touching the upper and lower incisors with the tip of the tongue with the mouth wide open;
13) hold the protruding tongue with a groove or a boat;
14) hold the protruding tongue with a cup;
15) biting the lateral edges of the tongue with the teeth;
16) resting 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, repeatedly drum with the tip of the tongue on the upper alveoli (t-t-t-t-t);
18) make movements one after another: 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,
- articulation gymnastics,
- training in pronunciation of sounds.

Great attention and stress requires working on sounds.

1. Usually the production of sounds begins with the sound "a". The tongue is at rest, the mouth is wide open. At the sound of the tongue, the tongue is somewhat drawn out, the lips are pushed forward; with 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 slightly in the middle part, the mouth is half open, the lips are stretched. These sounds are easily pronounced by imitation, the main task in their production is to eliminate the nasal tone. At first, sounds are worked out in a jerky isolated pronunciation with a gradual increase in the number of repetitions per exhalation, for example:
oh uh
a o o o u u e
a a a o o o o u u u u u u u

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 near the wings of the nose. Then the child is trained to repeat the vowels with pauses, during which he learns to hold the soft palate in a raised position (the correct position of the soft palate must be shown to him in front of a mirror). Pauses are gradually increased to 2-3 s. Then you can move on to smooth pronunciation.

2. The setting of consonant sounds begins with the sounds "f" and "p". When pronouncing the sound "f", the tongue lies quietly at the bottom of the oral cavity. The upper teeth slightly bite the lower lip. A strong oral exhalation breaks this bow and forms a jerky sound "f". Air leakage is checked with a mirror or cotton wool.

Exercises for setting and fixing sounds should be carried out in large numbers and in a variety of combinations. A good technique that facilitates the introduction of sounds correctly pronounced in an isolated position into independent speech, is singing. During singing, the closing of the soft palate and the back of the pharynx is carried out reflexively, and it is easier for the child to concentrate on the articulation of sounds.

your doubts

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

I advise parents

When consulting a child with a congenital cleft lip and palate in a particular medical institution, you should receive reasoned answers to a number of questions:
- What types of surgery will your child have and at what age?
- What is the reason for the choice of such tactics of surgical treatment?
- How many children with this pathology are operated on in this medical institution annually?
- How often postoperative complications are recorded (discrepancy postoperative sutures, the formation of defects in the palate)?
- What are the cosmetic results of the treatment of children, presented in the form of photographs (immediate 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 develop - rhinolalia and deformities of the upper jaw / occlusion?
- 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 II Correction of speech in rhinolalia in children and adolescents. - M., 1984
- Ippolitova A. G. Open rhinolalia. - M., 1983
- Speech disorders in preschool children. Comp. R. A. Belova-David, B. M. Grinshpun. - M., 1969
- Chirkina GV Children with impaired articulation apparatus. - M, 1969
- Speech therapy. Textbook for pedagogical institutes in the specialty "Defectology", ed. Volkovoy L. S. - M: Enlightenment, 1989
- Soboleva E. A. Rhinolalia: general information about rhinolalia; classification of congenital cleft lip and palate; causes, mechanisms, forms of rhinolalia, etc. - M: AST Astrel, 2006

Rhinolalia

For the most part, moms and dads think that rhinolalia include only those cases where the child has the so-called "cleft palate" (congenital splitting of the hard and soft palate) or "cleft lip" (cleft lip and upper jaw). But the concept of "rhinolalia" (in the common people - "nasal") is much broader. We will try to cover this phenomenon in as much detail as possible.

1. What is rhinolalia?

Scientifically rhinolalia- this is a change in the timbre of the voice, which is accompanied by a distortion of sound pronunciation, due to a violation of the resonator function of the nasal cavity. As a result of these violations, the air stream goes “in the wrong direction”, and the sounds acquire a “nasal” tone:

The air jet can be directed into the nose at almost all speech sounds. In this case, one speaks of open rhinolalia (these are the same "cleft palate", "hare lip", or cleft palate and lips as a result of craniofacial injuries);

• During phonation, air flows only through the oral cavity, even when pronouncing nasal sounds. Then we are dealing with closed rhinolalia (it occurs as a result of a violation of the patency of the nasal cavity or nasopharynx: adenoid growths, curvature of the nasal septum, craniofacial injuries, etc.). This defect in speech therapy also has a name rhinophony (palatophony).
• Is there some more mixed This is when, with nasal obstruction, there is also an insufficient palatopharyngeal closure. In this case, nasal resonance decreases (for nasal phonemes [n], [n "], [m], [m"]), while the remaining phonemes of the language (not nasal!), The timbre of which becomes like with open rhinolalia, is simultaneously distorted.

2. congenital open rhinolalia

Common sign of open rhinolalia : the passage to the nasal cavity is open for one reason or another (the oral and nasal cavity is, as it were, a single whole), as a result of which most sounds are pronounced with a nasal tone. Most often it occurs in congenital cleft lip, hard and soft palate.

Birth defects of the upper lip:

No skin deformation

Hidden cleft lip department of the nasal cavity;

Incomplete cleft lip without skin deformitybut-cartilaginous department of the nasal cavity;

Incomplete cleft lipwith deformation of the skin and cartilagedepartment of the nasal cavity;

complete cleft upper lip with deformation of the skin and cartilagesection of the nasal cavity.

Birth defects of the hard palate:

Incomplete cleft of the hard palate;

Complete cleft of the hard palate;

Sumbucous (hidden) cleft palate.

Birth defects of the soft palate:

Bifurcation of a small uvula (uvula);

Absence of a small uvula (uvula);

Sumbucous (hidden) cleft palate

Complete unilateral clefts:

- complete unilateral cleft of the alveolus

- complete unilateral cleft of the upper lip, alveolar processtissue and anterior hard palate;

Complete unilateral cleft of the alveolus

Complete unilateral cleft of the upper lip, alveolar process

Complete bilateral clefts:

Complete bilateral cleft of the upper lip, alveolar process and anterior hard palate;

- tissue and anterior hard palate;

- complete bilateral cleft of the alveolar processtissue, hard and soft palate;

Complete bilateral cleft of the upper lip, alveolar processtissue, hard and soft palate.

It is difficult not to notice all of the above defects in the structure of the child's speech apparatus. The only difficult one to diagnose is sumbucous (submucosal) cleft : it is when the oral and nasal cavities are separated from each other only by a thin mucous membrane (film). To identify this cleft, it is necessary to do a test in which special attention isblows to the back surface of the soft palate. Pwith an exaggerated pronunciation of the sound [a] (with a wide openwith your mouth!), the palate mucosa is drawn upwards in the form of a trianglenickname, it is thinned and has a paler (whitish) color.

3. Congenital open rhinolalia and related disorders

A child with rhinolalia has a very peculiar position of the tongue in the oral cavity. You can observe how the entire tongue is pulled back (it seems to “sink” into the throat), while the root and back of the tongue are highly “upturned”, due to the increased muscle tone in these parts of the tongue. At the same time, the tip of the tongue is usually poorly developed, it is sluggish (paretic). The reason for such fundamental changes in the language that children from the very first days of life experience difficulties in feeding. And this position of the tongue is a kind of adaptation to the pathological condition of the nasopharynx. A rhinololic infant sucks with the root of the tongue, strongly straining the facial muscles. In the future, these difficulties persist: the baby instinctively holds the root of the tongue at the top, covering the cleft with it when eating and breathing. The root of the tongue is increasingly hypertrophied (increased), the tip of the tongue becomes even weaker and passively retracts deep into the oral cavity. Only elementary, undifferentiated movements of the tongue become available to the child. Therefore, the first words appear to him very late (around three years old), but it is difficult to understand them because of the strong distortion of sounds and the nasal tone of the voice.

Significant disturbances are noted in the soft palate. His movements are defective not only during speech phonation, but also during acts of chewing and swallowing. The soft palate does not fulfill its main function: it does not separate the nasal and oral cavities (it is impossible to close it with the back wall of the pharynx!).

It should be noted that the implementation of inspiration through the cleft causes frequent colds in such children. They have significantly impaired lung ventilation, hence the general physical weakness. Quite often, hearing loss is detected in rhinolalics (on the basis of chronic otitis media, inflammation of the Eustachian tube, cochlear neuritis).

Due to hearing loss and defective articulation, children with open rhinolalia experience underdevelopment phonemic hearing(hearing for individual sounds of the language), which, in turn, leads to difficulties in mastering the sound structure of words. This entails the underdevelopment of the lexical and grammatical structure of speech and ends with the final chord - general underdevelopment speeches (ONR), in other words - a significant lag in speech development. Hence: fear of speech, speech negativity, neurosis and other "bouquet" of concomitant diseases are already in early age.

In congenital organic rhinolalia, the interaction of the muscles of the entire peripheral part of the speech motor apparatus is not coordinated. There are disturbances in the articulatory and mimic muscles: violent, exaggerated movements. Synkinesis is observed both in the speech apparatus and in the muscles of the hands. In some cases, tick-like movements (twitching) of the facial muscles can be observed. Synchronicity in the interaction of the articulatory and respiratory apparatus is also disturbed.

Speech breathing with rhinolalia is most often superficial and rapid. Speech exhalation is uneven, it is jerky and can be made in the middle of a word or phrase, which is why speech acquires a “chopped” character.

We have already said that with organic open rhinolalia, all sounds are pronounced with a nasal tone. Vowel sounds suffer the most, as they require the strongest palatopharyngeal closure. The articulation of consonant sounds is relegated to the root of the tongue, the sounds are distorted, acquiring a hoarse (guttural) hue. Rhinolalic speech is characterized by a large number of sound substitutions, and the substitute sounds are also distorted. The pronunciation of consonant sounds that require high oral pressure is most often violated: explosive [p], [b], [t], [d]; labio-dental [v], [f], all whistling and hissing, sonors [l], [p]. It takes more than one year for a child with rhinolalia to set up sounds.

4. Surgical treatment of children with open rhinolalia.

Open congenital rhinolalia requires a comprehensive medical-pedagogical and orthodontic approaches. At the earliest stages, it is required orthodontic closure of the defect of the hard and soft palate with a temporary obturator. The soft rubber obturator is especially needed when feeding a baby. The rigid obturator is made individually and worn by the child until the surgical closure of the defect in the floor of the nasal cavity and the palatine curtain. It is removed approximately 14 days before the planned operation. Surgical treatment of rhinolalia is carried out in several stages.

Cheiloplasty (upper lip repair surgery) and uranoplasty (operations to restore the integrity of the bottom of the nasal cavity), are shown even to newborns. But! There are a number of contraindications for their implementation at such an early age ( anemia, pneumonia, acute respiratory infections, intrauterine malnutrition, birth trauma, asphyxia, prematurity, birth defects heart, spinal hernia, fistulas in the digestive tract, hypoplasia, aplasia of the lungs, the presence of other severe malformations).

Uranoplasty methods are different. Gentle uranoplasty carried out for children from one and a half years, provided there are no contraindications (see above).

The most successful way to restore the anatomical structure of the nasopharynx is radical uranoplasty . It is quite traumatic and technically difficult. For children from 3 to 5 years old, non-through crevices are corrected with its help, and at the age of 5-6 years - through crevices (unilateral and bilateral). It is not recommended to perform radical uranoplasty in early childhood (before 3 years), since this surgical intervention often provokes slow growth of the mandible.

Uranoplasty according to the method of A. A. Limberg most effective for correcting the "cleft palate" defect. According to this technique, the formation of the integrity of the palate occurs due to the mucoperiosteal flaps, and tissues of the soft palate. Part of the elements of this technique is used when performing less traumatic methods of uranoplasty. In its classical form, the Limberg method is not used in young children.

5. Acquired open rhinolalia (rhinophony).

Acquired open rhinolalia (rhinophony) , - a consequence of complications after the removal of the palatine tonsils (tonsillectomy), operations on the throat, larynx and nasopharynx (tumors, polyps, etc.); residual effects after burns and injuries of the throat, larynx and nasopharynx. The results of all this can be:

Scars of the soft palate;

Paresis, paralysis of the soft palate;

Shortening of the soft palate;

Fistulas and clefts of the soft and hard palate

As a result, when pronouncing sounds, the soft palate lags far behind the back wall of the pharynx, leaving a significant gap, it is not able to function as a valve and is not able to block the air path, as a result of which a significant part of it enters the nasal cavity. In a word, everything is very similar to congenital organic rhinolalia.

6. Functional open rhinolalia (rhinophony)

This form of rhinolalia can be with hysteria. In this case, a temporary stressful nasality occurs, due to incoming hysterical paralysis.

Functional open rhinolalia (rhinophonia) may occur after organic open rhinolalia has been overcome. Uranoplasty was performed, the mobility of the soft palate was restored, but the voice is still “nasal”! In this case, the soft palate is lowered already “out of habit”. And this habit must be removed with the help of complex speech therapy classes.

Functional open rhinolalia is much less common than organic.

7.

Closed rhinolalia (rhinophony) - a consequence of impaired patency of the nasal passages (polyps, curvature of the nasal septum, chronic rhinitis). In this case, only the shade of the voice suffers, but the pronunciation and phonetic hand speeches remain intact. Closed rhinolalia (rhinophony) is formed with reduced physiological nasal resonance during the pronunciation of phonemes. At the same time, the sounds [m], [m "], [n], [n '] sound, respectively, like [b], [b "], [d], [d ']. One of the external signs of closed rhinolalia (rhinophonia) is the child's constantly open mouth.

In other words, the causes of closed rhinolalia (rhinophony) are organic changes in the nasal or nasopharyngeal region or functional disorders of the nasopharyngeal closure. In this regard, there are:

- organic closed rhinolalia (rhinophony);

- functional closed rhinolalia (rhinophony).

Closed organic rhinolalia is subdivided into

• back;
• anterior

(rear) may be the result of adenoid expansions that cover:

The upper edge of the choan;

Half of the choanas or one of them;

Both choanae with filling of the entire nasopharynx with adenoid tissue.

Closed organic rhinolalia (rear) can develop as a result of fusion of the soft palate with the posterior pharyngeal wall after inflammation, sometimes due to nasopharyngeal polyps, fibromas or other nasopharyngeal tumors. Very rare congenital choanal atresia , which completely separates the nasopharyngeal cavity from the nasal cavity.

Closed organic rhinolalia (anterior) is observed:

With a significant curvature of the nasal septum;

In the presence of polyps in the nose;

With severe cold.

She may be transient(with inflammatory swelling of the nasal mucosa during a runny nose, allergic rhinitis) and long(with chronic hypertrophy of the nasal mucosa, with polyps, with a curvature of the nasal septum, with tumors of the nasal cavity). Anterior closed rhinolalia, in other words, is the obstruction of the nasal cavities.

Closed functional rhinolalia(rhinophony) very common in children. She is also called habitual closed rhinophony. The child has narrow nasal passages, he is prone to frequent colds, allergic diseases, his nasal mucosa periodically becomes inflamed. But even when all of the above symptoms are eliminated and the nasal passages seem to be free, the child continues to “nasal”: he is used to the fact that his nose is “clogged”. With functional rhinophony, the timbre of nasal (nasal) and vowel sounds can be disturbed even more than with organic forms of rhinolalia (rhinophony).

8. What is rhinolalia (rhinophonia) in a child?

To determine which rhinolalia (rhinophonia) a child has: closed or open, you can:

• by ear (it’s quite difficult not to hear the “nasal” shade of the voice, and even more so not to notice a clear cleft lip or palate!);
• using a mirror.

Let's take a closer look at the last method. If, when pronouncing vowel sounds (a, y, o, and), the mirror brought to the nose fogs up, then the child has - open nasality. If, when pronouncing words with nasal sounds (mother, mine, car, etc.), the mirror brought to the nose does not fog up - closed.

9. How to distinguish paresis (paralysis) of the soft palate from functional nasality?

It is important to distinguish paresis (paralysis) of the soft palate from functional (habitual) nasality. You can do this in the following ways:

The child opens his mouth wide. The speech therapist (parent) presses with a spatula (spoon handle) on the root of the tongue. If the soft palate reflexively rises to the back of the pharynx, we can talk about functional nasality, but if the palate remains motionless, there is no doubt that the nasality is of organic origin (paresis or paralysis of the soft palate).

The child lies on his back and says some phrase in this position. If the nasality disappears, it means that paresis (paralysis) of the soft palate can be assumed (the nasality disappears due to the fact that when positioned on the back, the soft palate passively falls to the back of the pharynx).

10. Eliminate nasal tone of voice with massage and exercises

First of all, it will be necessary to activate the soft palate, make it move. This will require special massage . If the child is too small, massage is done by adults:

1) clean, treated with alcohol, with the index finger (pad) of the right hand, in the transverse direction, stroking and rubbing the mucous membrane at the border of the hard and soft palate (in this case, there is a reflex contraction of the muscles of the pharynx and soft palate);

2) the same movements are done when the child pronounces the sound “a”;

3) make zigzag movements along the border of the hard and soft palate from left to right and in the opposite direction (several times);

4) with the index finger, make a point and jerky massage of the soft palate near the border with the hard palate.

If the child is already big enough, then he can do all these massage techniques himself: the tip of the tongue will do an excellent job with this task. It is important to correctly show how all this is done. Therefore, you will need a mirror and the interested participation of an adult. First, the child does massage with the help of the tongue with his mouth wide open, and then, when there are no more problems with self-massage, he will be able to perform it already with his mouth closed, and completely unnoticed by others. This is very important, because the more often the massage is performed, the sooner the result will appear.

When performing a massage, you must remember that a child can cause a gag reflex, so do not massage immediately after eating: there should be at least an hour break between eating and massage. Be extremely careful, avoid rough touches. Do not massage if you have long nails: they can injure the delicate mucous membrane of the palate.

In addition to massage, the soft palate will also need special gymnastics. Here are some exercises:

1) the child is given a glass of warm boiled water and is invited to drink it in small sips;

2) the child gargles with warm boiled water in small portions;

3) exaggerated coughing with a wide open mouth: on one exhalation at least 2-3 coughs;

4) yawning and imitation of yawning with a wide open mouth;

5) pronunciation of vowels: “a”, “y”, “o”, “e”, “i”, “s” energetically and somewhat exaggerated, on the so-called “hard attack”.

11. Restoration of breathing

First of all, it is necessary to eliminate the causes: perform appropriate operations, get rid of adenoids, polyps, fibromas, deviated nasal septum, inflammatory edema of the nasal mucosa with a runny nose and allergic rhinitis, and only then, restore proper physiological and speech breathing.

It can be difficult for a small child, and sometimes even uninteresting, to perform exercises just for show. So use playing tricks, come up with fairy tales, for example:

"Ventilate the cave"

The tongue lives in a cave. Like any room, it must be ventilated frequently, because the air for breathing must be clean! There are several ways to ventilate:

Inhale the air through the nose and slowly exhale through the wide open mouth (and so at least 5 times);

Inhale through the mouth and slowly exhale through the open mouth (at least 5 times);

Inhale and exhale through the nose (at least 5 times);

Inhale through the nose, exhale through the mouth (at least 5 times).

"Snowstorm"

An adult ties pieces of cotton wool to threads, fastens the free ends of the threads on his fingers, thus, five threads with cotton balls at the ends are obtained. The hand is held at the level of the child's face at a distance of 20 - 30 centimeters. The kid blows on the balls, they spin and deviate. The more these impromptu snowflakes spin, the better.

"Wind"

It is done similarly to the previous exercise, but instead of threads with cotton wool, a sheet of paper cut from the bottom with a fringe is used (remember, once such paper was attached to the windows to scare away flies?). The child blows on the fringe, it deviates. The more horizontal the paper strips are, the better.

"Ball"

Tongue's favorite toy is a ball. It's so big and round! He's so fun to play with! (The child “inflates” his cheeks as much as possible. Make sure that both cheeks swell evenly!)

"The ball is deflated!"

After long games, the ball at the Tongue loses its roundness: air comes out of it. (The child first puffs out his cheeks strongly, and then slowly exhales the air through rounded and protruding lips.)

"Pump"

The ball has to be inflated with a pump. (The child’s hands perform the corresponding movements. At the same time, he himself utters the sound “s-s-s-…” often and abruptly: the lips are stretched in a smile, the teeth are almost clenched, and the tip of the tongue rests on the base of the lower front teeth. The air comes out of the mouth strong jerks).

"Tongue plays football."

The tongue loves to play football. He especially enjoys scoring goals from the penalty spot. (Put two cubes on the opposite side of the table from the child. These are improvised gates. Put a piece of fleece on the table in front of the child. The kid "scores goals" by blowing from a wide tongue stuck between his lips on a cotton swab, trying to "bring" it to the gate and get in. Make sure that the cheeks do not swell, and the air flows in a trickle in the middle of the tongue.)

When performing this exercise, you need to make sure that the child does not inadvertently inhale the cotton wool and choke.

"The tongue plays the flute"

And the Tongue can also play the flute. At the same time, the melody is almost inaudible, but a strong stream of air is felt, which escapes from the hole of the flute. (The child rolls a tube from his tongue and blows into it. The baby checks for a trickle of air on his palm).

"Suok and Key"

Does the child know the fairy tale "Three Fat Men"? If so, then he probably remembers how the gymnast Suok played a wonderful melody on the key. The child tries to repeat it. (An adult shows how you can whistle into a hollow key).

If the key is not at hand, you can use a clean empty bottle (pharmacy or perfume) with a narrow neck. When working with glass vials, one must be extremely careful: the edges of the vial should not be chipped and sharp. And one more thing: watch carefully so that the child does not accidentally break the vial and does not get hurt.

As breathing exercises, you can also use playing children's musical wind instruments: pipe, harmonica, bugle, trumpet. As well as inflating balloons, rubber toys, balls.

All the above breathing exercises should be performed only in the presence of adults! Remember that when doing exercises, the child may feel dizzy, so carefully monitor his condition, and stop exercising at the slightest sign of fatigue.

12. Articulation exercises for rhinolalia

With open and closed rhinolalia, it can be very useful to perform articulation exercises for the tongue, lips and cheeks. You can find some of these exercises on the pages of our website in the sections "Classical articulation gymnastics", "Fairytale stories from the life of the Tongue".

Here are a few more. They are designed to activate the tip of the tongue:

1) "Liana": hang a long narrow tongue down to the chin, hold in this position for at least 5 seconds (repeat the exercise several times).

2) "Boa constrictor": slowly stick out a long and narrow tongue from your mouth (do the exercise several times).

3) "Language of the boa constrictor": with a long and narrow tongue, protruding as much as possible from the mouth, make several quick oscillatory movements from side to side (from one corner of the mouth to the other).

4) "Watch": the mouth is wide open, the narrow tongue makes circular movements, like the hand of a clock, while touching the lips (first in one direction and then in the other direction).

5) "Pendulum": the mouth is open, a narrow long tongue is stuck out of the mouth, and moves from side to side (from one corner of the mouth to the other) counting "one - two".

6) "Swing": the mouth is open, a long narrow tongue either rises up to the nose, then falls down to the chin, counting "one - two".

7) "Prick": a narrow long tongue from the inside presses first on one, then on the other cheek.

13. Conclusion.

The staging and automation of sounds in a rhinolalic child must be carried out in close collaboration with a speech therapist. In general, the rehabilitation course for rhinolalia is quite long, so there is no need to wait for immediate results.

^ Massage complex for hard and soft palate.

• 
  thumb to make stroking movements along the hard palate from the front teeth and back; gradually the area of ​​influence increases and reaches the soft palate;

• 
  with the thumb to make transverse stroking movements along the hard and soft palate from left to right and vice versa;

• 
  with the thumb to make circular stroking and rubbing movements on the hard and soft palate from left to right and vice versa; movements begin to be performed from the upper lateral teeth, gradually moving from the hard palate to the soft one;
• 
  make similar movements from the incisors to the pharynx and vice versa;

• 
  with the middle finger, make stroking, pressing, rubbing movements along and across the scar from the incisors to the pharynx and vice versa;

• 
  make stroking, kneading, stretching movements along the soft palate with the middle finger from the central part to the lateral edges;

• 
  tap the index or middle finger on the hard and soft palate.

In addition to massage, children are recommended to carry out special exercises that promote the development of the mobility of the muscles of the soft palate. The set of exercises aimed at restoring the functional activity of the muscles of the soft palate includes passive, passive-active and active gymnastics. These exercises help create a favorable background for the formation of accurate and coordinated work of the muscles of the palatopharyngeal ring, which are necessary for the development of a full-fledged voice.

^ Passive gymnastics of the soft palate.

Passive gymnastics is so named because the movements of the organs of articulation are performed by a speech therapist.

• 
  drip liquid from a pipette onto the root of the tongue, while the child's head is somewhat tilted back. This exercise stimulates the elevation of the soft palate. When performing it, juice can be used instead of water;
• 
  lightly press on the root of the tongue with a spatula; performing this exercise requires some caution, as sudden movements can cause a gag reflex.

^ Active gymnastics of the soft palate.

Passive gymnastics is combined with special exercises to activate the palate curtain:

• 
  gargle with your head thrown back in small sips. This exercise produces the greatest effect if, when performing it, instead of water, use a heavy liquid such as kefir, thin yogurt or jelly;
• 
  cough voluntarily; in this case, coughing is not performed at the level of the larynx, as is done when there are unpleasant sensations in the throat, but at the level of the soft palate. These actions cause a reflex contraction of the muscles of the posterior pharyngeal wall and contribute to the emergence of a full-fledged palatopharyngeal closure. First, coughing is done with the tongue hanging out. The air flow is directed into the oral cavity. Thus, while performing the task, in addition to activating the soft palate, children train in the development of a directed air jet;
• 
  imitate yawning. Exercise improves blood circulation in the brain and enhances the outflow of venous blood;
• 
  exaggerate vowels A-E-O on a hard attack. This increases the pressure in the oral cavity and decreases nasal emission;
• 
  slowly, silently pronounce the vowels A-E-O, while trying to observe a clear articulation;
• 
  sing vowels with a gradual strengthening and weakening of the voice.

Let us give an example of an exercise for activating the muscles of the palatopharyngeal ring in a game situation “Masha (Bear, elephant, etc.) wants to sleep,” which can be used in work with preschool children. To do this, you need several dolls or soft toys depicting various animals. The speech therapist together with the child chooses which toy they will put to bed.

L .: When evening comes, it becomes dark outside and all the toys should go to bed. So Mishka wants to sleep (shows how he yawns), and so the dog also wants to sleep and yawns (shows). And now you show how they yawn.

L .: And what about the Mashenka doll? She is a little capricious and wants to have a song sung to her before going to bed. Let's sing her a lullaby:

Bye-bye, bye-bye, fall asleep quickly! A-A-A.

The child listens attentively to the song, and then repeats the vowel sounds in a singsong voice.

L .: Look, Masha is already closing her eyes, yawning. Show me how she does it. Well, now she's definitely asleep.

Such exercises, in addition to activating the muscles of the palatopharyngeal ring, contribute to the formation of a long directed oral exhalation in a child during phonation.

^ Elimination of nasal tone of voice.

To achieve these goals, preparatory work is being carried out to strengthen the palatopharyngeal closure, activate the diaphragmatic muscles and form a targeted oral exhalation.

Phonopedic exercises contribute to the activation of the muscles of the entire laryngo-pharyngeal apparatus. Learning the skills of correct voice leading begins with the singing of vowel sounds. At first, children learn to sing the vowels [a] and [o], after 2-3 lessons the sound [e] is added. The last sounds [and] and [y] are included in the work.

The exercises begin with isolated pronunciation of vowels, then move on to singing their combinations. The number of vowels in combinations gradually increases to three. Here is an example of such exercises:

A JSC AE AI AU AEO AEO AOI NPP

About OA OE OI OA UAE OEA OAI OEU

E EA EO EI EU EAO EOA EAI EOU

I IA IO IE IU IAO IAO IEA IAE IAE

U UA UO UE UI UAO UUA UEO UEO

The training begins with showing and explaining articulation. Then the child tries to repeat the necessary actions reflected by the speech therapist. First, the exercises are performed in a whisper, then a loud pronunciation is turned on. The attention of the child is drawn to the wide opening of the mouth, the position of the tongue: the tip is moved to the lower incisors, the root of the tongue is lowered down. Sound combinations should be pronounced for a long time and smoothly on one exhalation. The leakage of air through the nose is controlled by using a mirror or a vial held up to the child's nose.

In the classroom, you can offer children game situations. For example, while rocking a doll, a child sings: [a] - [a] - [a], shows how big he is: [o] - [o] - [o], how the steamer hums: [y] - [y] - [y], on a walk in the forest shouts [ay!], etc.

A good effect helps to achieve the use of static and dynamic breathing exercises.

• 
  standing, raise your hands through the sides up, stretch, take a breath, lowering your hands to sing [a] as you exhale;
• 
  standing, arms lowered along the body, raise your arms up, take a deep breath, tilt your torso forward, lower your arms while singing the vowel [o];
• 
  standing, hands on the belt, inhale, sing [e] as you exhale, stretching forward the hands closed in the palms, imitating the movements of a swimmer.

At the next stage, children move on to exercises with the pronunciation of sound combinations with consonants in the intervocalic position: vowel - consonant - vowel. Only correctly articulated consonants are used in the exercises: nasal sounds [m], [n]. Sound combinations are pronounced smoothly, smoothly, at first monotonously, quietly, then with a change in voice pitch.

• 
  gradual lengthening of the pronunciation of sounds on one exhalation at an average voice volume;
• 
  voice amplification: articulation - whisper - softly - loudly; combinations of vowels are used;
• 
  weakening of the voice: loud - soft - whisper - articulation;
• 
  counting to ten with a gradual increase and subsequent weakening of the voice;
• 
  similar pronunciation of the alphabetic series;
• 
  reading poems with a gradual change in the strength of the voice.

To develop the pitch of the voice, exercises are used aimed at gradually expanding the range (volume) of the voice, developing its flexibility and modulations, for example, raising and lowering the voice when pronouncing vowels, their combinations of two and three sounds. Subsequently, they use the pronunciation of poems with a change in the range of the voice.

Phonopedic exercises are carried out not only by a speech therapist, but also in classes with a music worker. Singing is performed to the accompaniment of the piano.

In children who do not have anatomical disorders and functional disorders of the speech apparatus, it is possible to completely normalize the ratio of nasal and oral resonance and eliminate the nasal tone of the voice. In children with a defect in the anterior hard palate, hypernasalization is significantly reduced, practically remaining minimal. Restoration of the integrity of the anatomical structures of the hard palate will contribute to the final elimination of the nasal shade.

The greatest difficulties in eliminating the pathological skill of voice formation occur in the process of corrective work with children in whom nasopharyngoscopy reveals the presence of palatopharyngeal insufficiency. Elimination of hypernasalization in a conservative way in these cases is impossible. Exercises to activate the muscles of the palatopharyngeal ring allow you to achieve only visual mobility of the palatine curtain. Such children undergo an operation to eliminate palatopharyngeal insufficiency. Finally, you can judge the results of the operation after one year. All this time, children continue to attend speech therapy classes, excluding the period of postoperative rehabilitation for a period of 21 days.

^ Formation of articulatory structures and articulatory movements.

Particular emphasis in correctional work is placed on activation of speech motor skills. In children with rhinolalia, by the time of classes, as a rule, pathological features of articulation have already been formed, due to a defect in the anatomical structure of the speech apparatus. Their elimination is the most important section of the correctional impact, because to establish the correct sound pronunciation, the full work of the organs of articulation is necessary: ​​tongue, lips, upper and lower jaws. In addition, anomalies in the structure of the maxillofacial region lead to a disruption in the interaction of articulatory and facial muscles, as a result of which the child has poor control over the movements of the facial muscles.

The set of measures aimed at solving practical problems includes:

• 
  massage of articulatory and facial muscles;
• 
  gymnastics of the articulatory apparatus and facial muscles.

The tasks of speech therapy massage include:

• 
  weaken pathological manifestations in the organs of the articulatory apparatus;

• 
  prepare the articulatory apparatus to perform the muscle movements necessary for the correct sound pronunciation;
• 
  restore extinct deep reflexes;
• 
  enhance tactile sensations.

In children with congenital cleft lip and palate, the muscles are usually tense and require relaxation, but in some cases there is a reduced tone of the facial and articulatory muscles, i.e., the muscles of the face, lips, tongue are flaccid, weak, paretic. In such cases, a tonic, firming massage is needed, when the same movements are used, but the effect is more intense.

Work begins with a general relaxation of the neck, chest muscles, and arm muscles. It is especially important to relax the muscles of the neck, because this helps to relax the muscles of the tongue. Classes are carried out by a physiotherapist. Then proceed to the massage of facial and articulatory muscles. Massage is carried out in the initial position lying on the back or sitting, with complete relaxation of the muscles of the whole body.

^ Massage of the facial muscles.

• 
  stroking the forehead from the middle to the temples with the fingertips of both hands with light, even movements;
• 
  uniform movement from the eyebrows to the scalp with both hands on both sides;
• 
  stroking the face from the back of the nose to the ears with the fingertips of both hands;
• 
  stroking the face with fingertips from the middle of the upper lip to the ears;
• 
  stroking with the back of the hands from the middle of the chin to the ears, then with the palms from the ears back to the middle of the chin.

• 
  finger shower - light tapping with your fingertips from the center to the periphery;
• 
  pinching of cheeks from nose to ears;
• 
  kneading the zygomatic muscle: placing the index and middle fingers of both hands in the lower part of the temple, make spiral movements towards the chin;
• 
  pinching of the face along the zygomatic muscle from the middle to the ears and vice versa;
• 
  clapping your face with your hands.

• 
  stroking the nasolabial folds from the wings of the nose to the corners of the mouth; thus, relaxation of the facial muscles occurs;

• 
  stroking the nasolabial folds from the corners of the mouth to the wings of the nose; these movements are more intense and help strengthen the facial muscles;
• 
  stroking the back of the nose from the forehead to the tip and back with the middle finger;
• 
  stroking the wings of the nose from the bridge of the nose to the base of the nose with the middle and ring fingers of both hands.

^ Massage of the labial muscles.

In children with a through cleft, deformation of the upper lip is noted due to the formation of a postoperative scar. It is necessary to develop the upper lip in order to develop its mobility, restore the normal anatomical shape, and have a positive effect on the state of postoperative scars. This makes it necessary to conduct a massage course that promotes the development of tactile sensitivity in the skin of the upper lip, helps to develop sufficient mobility and, thus, is a preparation for the formation of labial sounds articulum.

Massage techniques:

• 
  stroke the upper lip from the periphery to the center with the middle fingers of both hands;
• 
  lightly tap with fingertips on the lips and the circular muscle of the mouth.

• 
  pull the upper lip over the teeth;
• 
  lightly stroke the upper lip from the middle to the corners with the middle fingers of both hands;
• 
  carry out pressing movements with the thumb, index and middle fingers of both hands on the upper lip.

^ Massage of the tongue.

In children with rhinolalia, the tongue is pulled back, compressed and tense, while the tip of the tongue remains flaccid and weakened. Therefore, tongue massage should be aimed both at relaxing the entire tongue and at strengthening its tip.

Massage techniques.

• 
  stroke, knead the tongue in a circular motion;
• 
  tap the tongue with a spatula;
• 
  press on the tongue with a nipple put on a spatula;
• 
  grab the tongue with the index and thumb of both hands with a bandage and stroke and knead the edges of the tongue;
• 
  pinch the edges of the tongue with the index and thumb.

In addition to massage, articulatory gymnastics contributes to the formation of correct articulation patterns and precise articulation movements.

When working with children with rhinolalia, gymnastics serves:

• 
  elimination of the high rise of the root of the tongue and its displacement deep into the oral cavity;
• 
  development of full lip articulation;
• 
  elimination of excessive participation of the root of the tongue in the pronunciation of sounds.

• 
  the consistent formation of involuntary, and then arbitrary facial movements;
• 
  development of stable motor and speech kinesthesias.

In the complexes of articulatory gymnastics, passive and active gymnastics are carried out in order to develop the functions of the speech apparatus. At the initial stages of work, children perform exercises with the help of a speech therapist (passive gymnastics). Gradually move on to training active movements.

When performing active articulation exercises, it is necessary to adhere to a number of certain rules. Classes are held in front of a mirror so that the child sees the movements made and can connect a visual analyzer for control. It is advisable to start work with exercises that are given to the child most easily. They move on to subsequent exercises only after the previous one has been mastered. The number of exercises should be strictly dosed and depend on the physical condition of the child, his individual endurance.

Exercises to activate the muscles of the neck.

• 
  Lowering the head down;
• 
  tilting the head back;
• 
  Turning the head to the right-left;
• 
  Head tilts left and right;
• 
  Hands are closed in a lock on the back of the head, tilt the head back with the resistance of the hands;
• 
  Substitute clenched hands under the chin, tilt the head forward with the resistance of the hands;
• 
  Press the palms to the ears, tilt the head to the sides with the resistance of the hands.

Exercises for the lower jaw.

• 
  Smoothly and slowly open and close your mouth to the count of five, the tip of the tongue during this exercise is at the lower teeth;
• 
  Open and close your mouth;
• 
  Simulate chewing;
• 
  Move the lower jaw forward, to the right, to the left;
• 
  Bite a wooden spatula with your teeth, try to pull it out of your mouth, overcoming resistance;
• 
  Perform movements of the lower jaw back and forth with simultaneous head tilts back and forth;
• 
  Perform movements of the lower jaw to the right and left with simultaneous turns of the head to the right and left;
• 
  Tilt your head and touch your chest with your chin, while your mouth remains closed;
• 
  Spread your arms to the sides, throw your head back, open your mouth, stretch your arms forward, lower your head, close your mouth.

Exercises for the facial muscles.

Before performing active training, passive movements are practiced in front of the mirror:

• 
  wrinkle your nose with your hands;
• 
  compress and relax the muscles of the cheeks from the side of the nose with the help of hands (imitation of alternate winking of the left and right eyes);
• 
  raise your eyebrows with your hands.

Active mimic gymnastics is carried out in front of a mirror. Sample exercises:

• 
  inflate both cheeks at the same time;
• 
  alternately inflate the right and left cheeks;
• 
  pull the cheeks into the oral cavity between the teeth;
• 
  be surprised (raise eyebrows);
• 
  alternately squint your eyes;
• 
  close both eyes;
• 
  make a cheerful face (smile);
• 
  make an angry face (frown your eyebrows).

Lip exercises.

Special exercises for the lips at the beginning of classes are carried out by a speech therapist ( passive gymnastics):

• 
  collect lips in a tube with your fingers;
• 
  with the help of index fingers placed at the corners of the lips, stretch the lips into a smile; with a reverse movement, the lips return to their original position;
• 
  raise the upper lip with index fingers from the corners of the lips along the nasolabial folds up to the wings of the nose;
• 
  lower the lower lip with the middle fingers, placing the fingers at the corners of the lips;
• 
  close the lips tightly with the index and thumb fingers of both hands to develop kinesthetic sensations of a closed mouth;
• 
  placing the index fingers on the upper lip, and the thumbs of both hands on the lower lip passively open the mouth, make pushing movements;
• 
  alternately drag the corners of the mouth to the right and left, placing the middle fingers in the corners of the mouth.

These exercises are carried out with a different position of the mouth: the mouth is closed, ajar, half-open, wide open.

Active articulation gymnastics is carried out during the day. You can invite the child to perform the following actions in front of the mirror:

• 
  stretch your lips forward with a tube, like a mother's kiss;
• 
  stretch the corners of the mouth to the sides, so that the upper and lower teeth become visible;
• 
  perform circular movements of the lips;
• 
  whistle imitation;
• 
  grasping with lips of lollipops, sticks of various diameters;
• 
  spitting out seeds, rice with lips;
• 
  spitting out similar objects from the tip of the tongue;
• 
  drinking through a straw.

Exercises to develop mobility and strengthen the labial muscles can be carried out in game form. For example, to invite the child to reach out with his lips to a candy (taffy, candy), which is at some distance from his mouth. The exercise begins at the minimum distance accessible to the child. Subsequently, the distance increases. This exercise is also carried out with resistance, if you use a straw instead of candy. The child wraps his lips around the tube and tries to hold it, despite the speech therapist's attempts to pull it out of his mouth.

^ Language exercises.

An important section when working on articulatory motor skills is the elimination of the pathological posture of the tongue. The tasks of the work include moving the tongue forward, lowering its root and strengthening the tip.

As an example passive exercises are as follows:

• 
  grab the tongue with a bandage and alternately pull it to the upper and lower lip, and also take it to the sides;
• 
  press the tip of the tongue to the bottom of the mouth with a spatula;
• 
  lift the tip of the tongue with a spatula to the hard palate, to the upper lip.

To eliminate excessive participation in the articulation of the root of the tongue, apply active articulation gymnastics:

• 
  "Pancake" - a wide, relaxed tongue lies calmly on the lower lip;
• 
  alternately pull the tongue in the direction of the nose, in the direction of the chin;
• 
  lick spoons of different sizes, smeared with something tasty, starting with a toy and ending with a dining room, a convex and concave surface;
• 
  lick the jam from the plate with the entire surface of the tongue;
• 
  rest a narrow tongue on one cheek, then on the other ("points on the cheek");
• 
  strongly press the tip of the tongue on the lower gum, then press the tongue on the hard palate, on the upper gum;
• 
  “clean” the upper and lower teeth with the tongue;
• 
  count the teeth, resting on each;
• 
  with a wide tongue, stroke the hard palate from the front teeth to the soft palate;
• 
  turn your head to the right, stick your tongue out to the left, turn your head to the left, tongue to the right;
• 
  bite the tip of the tongue over the entire surface;
• 
  "watch" - alternately move the tongue to the right and left corners of the lips, while the lower jaw should remain motionless;
• 
  lick the upper lip with a wide tongue from top to bottom;
• 
  push the tongue through clenched teeth;
• 
  stick out the tongue, hide, while not closing the mouth.

To move the tongue into the anterior part of the oral cavity, licking plates or spoons previously smeared with something tasty (honey, jam or condensed milk) is very effective. When performing this exercise, it is necessary to ensure that the tongue reaches for the spoon, and not vice versa. The head and neck should remain as still as possible. All the load should go to the muscles of the tongue. This exercise also helps to activate the tip of the tongue.

Exercises are performed with inclusion in various game situations. For example, you can tell your child “The Tale of a Cheerful Tongue”, which helps both to develop the correct articulation patterns and to form the qualitative characteristics of articulation movements (smoothness, proportionality, rhythm, amplitude, switchability). "Fairy tale ..." can be somewhat modified based on children with rhinolalia.

The speech therapist begins to tell the tale: Once upon a time there was a cheerful tongue. He lived not just anywhere, but in a very interesting house. What do you think, what kind of house is this?

If the child finds it difficult to answer, the speech therapist uses a hint: Where does your tongue live? How does is called?

As a rule, after a hint, sometimes reinforced by a show, the child gives the correct answer: The house of the tongue is a mouth.

L .: That's right, the house of the tongue is a mouth. As befits any house, it has doors. These are sponges. But he also has a second door. Let's look at them (smiles and shows the child teeth). The second door is the teeth. Now show me what kind of doors your house has.

These actions serve to consolidate the acquired skills in training the labial muscles.

L .: Once a cheerful tongue wanted to look at the sun and breathe fresh air. First, the first door opened (opens the lips), and then the second. And the tongue stuck out, but not all, but only the tip. He decided to find out if it was cold outside?

The story was accompanied by a demonstration of the described actions. After the demonstration, the child is asked to do the same.

L .: And it’s true, it turned out to be cold outside, because the summer has already passed and winter has come. And then the tongue hid back into the house. Hide him quickly, otherwise he will freeze and catch a cold. And in his house it is warm, cozy, there is a bed in which the tongue sleeps. Look how he lies quietly in his mouth (shows). Now show me how your tongue rests.

Thus, the position of the tongue in the oral cavity is worked out, which is especially important for a child with rhinolalia, whose spastically tense tongue is compressed into a ball and pulled back.

L .: But our tongue loves to play and fool around. He can jump so high that he can reach the ceiling. Do you know where the ceiling is in his house? Let me show you (strokes the sky with his tongue). Now you show me.

This action is not given immediately and requires gradual practice. After the child has mastered this exercise, you can invite him to show how the tongue clicks, reaching for the sky-ceiling.

L .: The next day, the tongue decided to check again if it had become warmer. He opened the doors again, looked out, looked left, right, up, down, and then went back to his house.

Thus, subtle differentiated movements of the tongue are worked out.

Special exercises should be provided for children with language deviation, i.e., its deviation in any direction. Deviation of the tongue to the right indicates weakness of the muscles of the left side of the tongue, and its deviation to the left indicates the same in relation to the right side.

Exercises to strengthen and develop the muscles of the tongue are carried out taking into account the load on the affected side. Children are offered to touch the teeth on the opposite side above and below, support the opposite cheek with the tongue, stick out the tongue and take it to the opposite side, resisting the spatula of the speech therapist. These exercises increase the load on the affected side of the tongue.

With the help of speech therapy massage and articulatory gymnastics, it is possible to eliminate the fixation of the tongue in the wrong position, move it to the front of the oral cavity, activate the tip of the tongue, weaken the pathological manifestations in the muscles of the articulatory apparatus, expand the possibilities of movement of the speech muscles and include them in pronunciation. Facial massage can reduce atrophy of the facial muscles and teach the child to control the movements of facial muscles.

^ Sound correction.

Normalization of the motor function of the organs of articulation is a necessary prerequisite for the development of correct pronunciation.

Starting the production of consonant sounds, you should adhere to a certain order. Correction begins with the formation of deaf sounds by the article: labial-tooth fricative [f] and labial - labial explosive [n].

The work begins with a silent display of articulation, avoiding naming a phoneme. You can not tell the child what sound we will learn to pronounce. The pathological stereotype of pronunciation, as a rule, is so strongly fixed that the child pronounces the sound in the old way. The silent display of articulation is also used in the future when setting the remaining consonants in order to prevent the reproduction of defective articulations.

Sound setting F. The child is asked to bring the lower lip closer to the upper teeth, while carrying out a long directed exhalation, worked out at the preparatory stage. In children with palatopharyngeal insufficiency, when the mobility of the muscles of the soft palate is reduced, and the oral exhalation is weak and short, it is necessary to pinch the wings of the nose to reduce air leakage into the nasal passages. Only in this way can you create the necessary intraoral pressure and help the child feel the required kinesthesia. This technique is used during the first sessions (2-3) and with each subsequent training, the mechanical assistance is reduced, bringing it to a light touch. In this way, it is possible to reduce air leakage into the nose. It is better to try to call the sound directly in the syllable in order to avoid difficulties in the transition to a combination with a vowel.

Sound setting P. Correction of the labiolabial [n], in addition to participation in the articulation of the root of the tongue and the presence of nasal emission, may be complicated by anomalies in the structure of the dento-jaw system.

For example, in children with bilateral cleft lip and palate, there is often limited mobility of the lips, lack of formation of the dentition, protrusion (protrusion) of the premaxillary bone, cleft of the alveolar process on both sides. Since the correct pronunciation of the sound [n] requires a calm, relaxed closing of the lips, interrupted by an instant exhalation of air, in this case, setting the sound causes certain difficulties. It takes a long time to develop lip articulation as close to normal as possible. The silent formation of the articulum begins with a request to show how the child kisses the mother, stretching her lips. Having achieved the ability to carry out this movement, they proceed to imitation of firing from a cannon. The speech therapist shows the child how the gun shoots and offers to repeat these actions. To perform this exercise, a directed oral exhalation is required. This exercise is performed using auditory control. For this purpose, a bottle with a narrow neck is used, which is brought to the lips of the child. The exercise is considered to be performed correctly if a characteristic noise is heard when the air stream enters the bubble.

Some speech therapists suggest putting the sound P, puffing out the cheeks. The use of such a technique is not advisable, because it helps to fix incorrect kinesthesias that are not characteristic of the normal pronunciation of sound. The child gets used to pronouncing the sound P with simultaneous puffing of the cheeks, and additional work is required to remove these movements.

After the appearance of a whispered [p], they proceed to its voiced pronunciation. For this, the child is asked to pronounce the sound louder. The speech pathologist first shows how to do this.

Consolidation of the formed pronunciation skills is carried out in static and dynamic breathing exercises:

• 
  standing, spread your arms to the sides, take a breath, tilting your torso down, sing on the exhale [a] - [fa]; similarly, an exercise with sound [n] is performed;
• 
  standing, hands lowered and closed in a lock, take a breath, then, as you exhale, tilt down while pronouncing a chain of syllables: [fa] - [fo] - [fe] - [fi] - [fu]. The sound [n] is fixed in a similar way.

Such gymnastics, in addition to automating sounds, helps to strengthen oral exhalation and consolidate the skills of bone-abdominal breathing. Performing inclinations, the child activates the work of the diaphragmatic muscles and, thus, lengthens the oral exhalation.

In the future, children increase the repetition of the syllable chain on one exhalation, first up to two, and then up to three times.

Setting T. Full-fledged articulation of the explosive anterior lingual [t] is prevented by various disorders of the dentition. The setting begins with preparatory exercises that help move the tongue to the anterior part of the oral cavity.

The sound is set from “spitting”. In order to induce correct kinesthesia, the child is offered to spit bread crumbs from the tongue. However, even with mechanical assistance, the implementation of this exercise in the first lessons may not work. Prolonged use of a pathological pronunciation skill leads to persistent pharyngeal articulation, i.e. instead of “spitting”, a “cough” is obtained when the tip of the tongue lies at the bottom of the oral cavity, and the formation of a defective sound occurs due to the work of the root of the tongue. They explain to the child that the tongue goes out for a walk and does not hide back into the house. In order to induce proper kinesthesia, you can invite the child to spit out bread crumbs lying on the tip of the protruding tongue. Thus, the tactile analyzer is included in the work. If oral exhalation is still insufficient, crumbs remain on the tongue, and the child can feel it. The crumbs will fly off the tongue only if there is a long, directed oral exhalation.

In the following lessons, the transition from “spitting” to silent articulation of the sound [t] is carried out. At this stage, the child is required to perform more complex articulatory movements compared to “spitting”. It is necessary to be able to smile so that the teeth become visible, that is, to remove the lip articulation.

Only after the child finally consolidates the formed kinesthesia, should one move from silent articulation to the pronunciation of interdental [t]. The work is carried out with the help of auditory control. For this purpose, a bottle with a narrow neck is used, which is brought to the lips of the child during exhalation. If the child correctly directs the air jet, he can hear a characteristic whistle.

The transition to denture articulation can cause particular difficulties, since in most cases children with congenital cleft lip and palate suffer from dentition disorders, up to the complete absence of upper teeth. For achievement best results work, you can use visual control. They explain to the child that now the tongue no longer wants to walk and is slowly hiding in the house. You can control the correct position of the tongue using a mirror.

The methods of work change somewhat in the case of lateral pronunciation of the anterior lingual, when the child's tongue is flattened in the oral cavity, the front part of the tongue does not form bonds with the alveoli, and the air stream has a lateral direction.

Correction is carried out in the traditional way: from “spitting” to interdental [t]. However, the main focus is on the use of auditory control. Inviting the child to “spit out” the breeze into the middle of the tongue, the bubble is brought alternately to the tip of the tongue and the corners of the mouth. At the same time, the child is explained that the whistle should be heard when the bubble is near the tip of the tongue. Explanation followed by demonstration.

The correct pronunciation of sounds is fixed in dynamic syllable breathing exercises.

Having consolidated the formed skills of the correct pronunciation of deaf labio-dental, labial-labial and front-lingual sounds, one should proceed to the formulation of voiced: [b], [c], [e]. In parallel, work is underway to prepare for the formation of whistling sounds by the article.

^ staging ringing sounds begins with the vowel [a]. During phonation, the child, imitating the soundless articulation of a speech therapist, reproduces the necessary actions and thus it is possible to obtain sound in the intervocalic position.

You can invite the child to sing [a] - [a] - [a], putting their favorite doll to bed. During singing, the lower lip is slightly bitten by the upper teeth, and the sound [v] is obtained. Clapping your lips while singing makes it possible to pronounce the sound [b]. When setting the sound [d], the child can be offered to push the tongue into the upper teeth, as if he wants to take a walk and knock on doors that are firmly closed and do not want to let him out.

In some cases, the correct pronunciation of sounds can be achieved by imitation or using a tactile analyzer. The child's hand is placed on the neck in the larynx, so that in this way he can feel the work of the vocal folds. First, the speech therapist shows how this is done, then the child reflects these actions.

Posyllabic dynamic breathing exercises are used to practice sounds in an intervocalic position.

Separate classes are devoted to the correction of soft anterior lingual [t`], [d`]. Their articulation is most different from paired solid sounds. If the formation of hard sounds is carried out due to the closing of the tip of the tongue with the upper teeth, then during the articulation of soft sounds, the tip is lowered to the lower teeth, and the closing is achieved by the participation of the anterior back of the tongue.

To work out the necessary articulatory posture, a visual analyzer is involved. In front of a mirror, children can see the difference in the position of the tongue.

^ Making whistling sounds . Whistling correction is carried out in the traditional way with some specific features. The emphasis is on the elimination of pathological stabilization of the tongue in the oral cavity and the development of a targeted air jet.

The work on the development of the articule of sound [c] can be complicated by deviation of the tongue, tremor. Children find it difficult to maintain the articulatory posture necessary to prepare the interdental pronunciation of the sound [s], when you need to calmly put a wide tongue on the lower lip. However, even having achieved a static fulfillment of the desired posture, one can encounter difficulties in the transition to exercising with blowing: when asked to blow into the middle of the tongue, children strain the lingual muscles, changing the position of the tongue from wide to narrow, leaving side slots into which air passes.

In some cases, the slackness of the muscles of the tongue prevents the formation of a groove necessary for a directed air jet.

To overcome these disorders, a long-term differentiated preparatory work on articulatory motility is carried out, a targeted air jet is produced using blowing on cotton wool, paper toys, etc.

Having worked out the correct position of the tongue and lengthening the oral exhalation, you can proceed to the development of the interdental articulum [c]. The child is invited to purposefully blow on a wide tongue stuck between the teeth. The work is carried out with the involvement of tactile and auditory analyzers. To focus on the feeling of a cool air stream going down the middle of the tongue, you can invite the child to blow a cold breeze on his palm during the exercise. If the air is warm, the task is considered incorrect. A bubble is used for auditory control. The child himself can hear when he makes an incorrect pharyngeal exhalation, and in what cases a directed air stream goes through the tongue.

Some difficulties may arise in the transition to dentate articulation. Despite the fact that the child correctly reproduces interdental articulation, when the tongue is moved to the tooth position, the lingual muscles become tense, which leads to a change in the articulatory posture. There is a sharp narrowing of the tongue and the exhaled stream of air does not go along the midline, but through the side slits. At the same time, interdental articulation is immediately performed correctly. This indicates that in addition to rhinolalia, the child has an erased form of dysarthria, in particular tongue hypertonicity.

To solve this problem, in addition to relaxing massage and articulatory gymnastics, they resort to mechanical assistance and the active involvement of the auditory analyzer.

You can remember with your child a fairy tale about a cheerful tongue, supplementing it with the necessary explanations.

L .: Your tongue walked on the street for a very long time, at first he ran, jumped, did exercises, and now he is tired and decided to hide in his cozy house-mouth and go to bed.

Thus, the child is helped to remove the tongue by the lower teeth.

L .: Tongue lay down in his soft bed, but it’s too hot in his house and he can’t fall asleep in any way. Let's help him do it. We will blow on it with a cold breeze, the same one that blew when the tongue walked on the street.

When the child slightly stretches his lips into a smile, so that the front teeth are visible, and puts his tongue behind the lower incisors, it is necessary to press the corners of his mouth with his hand and at the same time bring the vial to the front teeth. The speech therapist explains to the child that this bubble is magical and he will answer with a whistle only if he blows into it correctly.

After that, the child tries to blow in such a way that a characteristic whistle is heard, which is formed when air is rubbed against the edge of the upper incisors.

In some cases, rhinolalia is accompanied by a reduced tone of the muscles of the tongue. The lethargy and weakness of all the lingual muscles, and especially the paresis of the tip of the tongue, leads to the fact that the child cannot press the tip of the tongue against the lower incisors with sufficient force, while bending the front of the back of the tongue. As a result, instead of correctly reproducing dentate articulation, the tongue passively lies on the floor of the mouth, without forming the desired groove between its tip and the front upper teeth.

To form the necessary articulatory posture, you can use plastic candy sticks. The stick is placed in the middle of the tongue and slides behind the teeth. Due to this, a narrow groove forms between the tip of the tongue and the upper incisors. By directing the air stream along this groove, the child contributes to the appearance of the necessary whistling noise.

When working on the production of a deaf whistling [c], as a rule, they are simultaneously engaged in the automation of labial-labial, labial-dental and anterior-lingual sounds, and they are also differentiated by deafness-voicedness. Therefore, you can proceed to the correction of a voiced whistling [h] immediately after working on a deaf sound. Sound is reproduced by imitation. Showing the already worked out articulatory position, the children are offered to ring like a mosquito.

The sound [ts] is put from the sounds [t] and [s] in the traditional way used when working with children with dyslalia. It is not recommended to focus on the position of the tongue, so as not to make the articulation more tense and the children themselves successfully cope with the task.

Each delivered sound must be worked out in dynamic breathing exercises by syllables, adding it to the existing sounds.

Violations of the pronunciation of whistling sounds may persist due to the lack of formation of the dentition. The temporary absence of lateral teeth associated with a cleft of the alveolar process leads to the formation of additional noise during their pronunciation. As experience shows, the normalization of the bite contributes to the elimination of this defect.

The articulation of hissing sounds in most cases has pathological features characteristic of rhinolalia. The raised back of the back of the tongue and pharyngeal exhalation give them a specific color. The task of corrective work is to cause the correct position of the organs of articulation and develop a directed oral exhalation when pronouncing hissing sounds.

The work begins with the production of a dull sound [w]. The skills worked out at the stage of formation of articulatory structures and articulatory movements are used. The child is invited to remember the “cup” exercise, in which you need to hold a wide tongue on weight, lifting its tip up. Then the "cup" moves deep into the mouth. The child is reminded that now the tongue is not sleeping, and therefore it should not go down. Having fixed the upper position of the tongue, they move on to purposeful blowing. To avoid the wrong direction of the air stream (on the cheeks, on the lips), the child can be shown a picture of a sailing ship with inflated sails and they are asked to imagine that the mouth is a ship, and the tongue is a sail. In order for the sail to inflate, it is necessary to blow exactly on the tongue. In this case, the correct position of the lips is controlled by a speech therapist.

The sound [g], as a rule, is reproduced by children by imitation. You can use a version of the fairy tale about a cheerful tongue.

L .: Although your tongue ran a lot, jumped, did all kinds of exercises and now returned to the house, he still does not want to go to bed and continues to play, bouncing and reaching to the ceiling. Show me how he does it.

The child demonstrates a practiced articulation posture.

L .: But suddenly a bee flew into his house and began to fly and buzz-reap. The tongue was so frightened that it stuck to the ceiling from fear. I'll show you how a bee flies, flies and buzzes in the house, and then you do the same.

As a rule, children easily cope with the proposed task, because in parallel with the correction of sound pronunciation, work is carried out to differentiate previously formed sounds, including deafness-voicedness.

The production of the sound [u] should be started after the child masters the correct pronunciation of whistling and hissing sounds. The child is invited to pronounce the direct syllable [si], pulling back the tip of the tongue. In order for the lips to take the necessary position, you can recall the “fence” exercise. If the organs of articulation take the desired position, then the required sound is heard. Sometimes mechanical assistance is required to obtain a “fence” and the lips are held by hand. In the same way, it is proposed to pronounce the syllables [sya], [se], [syu].

When setting the affricate [h], each child should develop the ability to correctly determine the position of the tongue when pronouncing a sound and focus on the directed air stream. Correction is carried out in the traditional way from the sound [t`].

The timing of the production of posterior lingual sounds is determined depending on the nature of their violation and the degree of automation of explosive anterior lingual sounds. If a child enters speech therapy training with already formed and automated explosive anterior lingual sounds [t] and [d], then the decision on the timing of setting the posterior lingual sounds will depend on how their pronunciation is impaired.

In the presence of pharyngeal posterior lingual sounds, when articulation is carried out at the level of the pharynx, work on these sounds can be started after the correction of whistling and hissing, closer to the final part of the speech therapy course. This is explained by the fact that, compared with other consonants, pharyngeal back-lingual ones are closer to the norm and have less effect on the quality of speech.

If posterior lingual sounds are completely absent, then corrective work can be started in parallel with the production of whistling sounds, i.e., at an earlier date.

If the child has not formed or is not fully automated explosive anterior lingual, the setting of the posterior lingual is carried out only after the automation of the sounds [t] and [d] is fully completed.

The work to correct the deaf back-lingual [k] is traditionally carried out with mechanical assistance. By pressing the probe on the front of the back of the tongue at the moment of pronouncing the syllable [ta], in this way they help to move the tongue deep into the oral cavity and create the articulatory posture necessary for the formation of the sound [k]. Continuing to use mechanical assistance, the sound is introduced into other syllables. Gradually, the pressure of the probe weakens, and then it is completely canceled, and the child begins to pronounce the sound on his own.

The calling of the voiced back-lingual [r] is carried out similarly from the syllable [yes] using a mechanical method of setting.

The sound [x] is usually set by clarifying the position of the tongue and practicing oral exhalation.

The production of the sound [l] is preceded by lengthy targeted training, since its articulation requires subtle differentiated movements of the tip of the tongue. In children with rhinolalia, pathological stabilization of the tongue leads to the fact that its tip is constantly in a passive position and, as a result, is underdeveloped. Poor work of the lingual muscles prevents active bending of the back of the tongue down, children find it difficult to perform any actions that require muscle effort, the absence of a specific focus of education is characteristic.

For the purposeful development of the necessary sensations, speech therapy massage and articulatory gymnastics are necessary.

Setting the sound begins with obtaining interdental [l]. It is advisable to strive to cause its pronunciation directly in the syllable. To this end, you can offer the child to bite the tense protruding tongue while singing the vowel [a]. At this moment, the combination [la] is heard. Attention is drawn to the fact that the child, after biting his tongue, opens his mouth wide, as if singing the sound [a]. This technique helps to reduce nasal resonance and obtain a flight sound of the voice.

When switching to dental articulation, it is also necessary to ensure that the lower jaw is lowered, and pronunciation is carried out by raising the tongue and actively working its tip.

The production of the sound [r] is carried out last for a number of reasons. First, to vibrate the tip of the tongue, a very strong directional air jet is needed. This causes difficulties in all children with rhinolalia, and for a child with palatopharyngeal insufficiency is practically inaccessible.

The next factor that makes it difficult to set the sound is the pathological posture of the tongue. To pronounce the sound [r], such qualitative characteristics of articulatory movements as accuracy, differentiation, rhythm are required. An active, well-developed tip of the tongue is required.

The most common method of sound correction [p] from [d] does not always give the desired results. Some children cannot repeat [d] - [d] - [d] exaggeratedly, with force, while directing a large stream of air to the tip of the tongue. The lateral edges of the tongue begin to work in the child, the air stream is directed to the cheeks, salivation increases markedly. The tip of the tongue takes part in articulation insufficiently. an obstacle to correct pronunciation sound is non-observance of a specific articulation pattern. It is inappropriate to focus the child's attention on these workouts. It is better to try to put a sound from the syllable combination [for], lengthening the pronunciation of the first sound: [h] - [h] - [h]. This technique, as a rule, gives the desired result and helps to call the desired phoneme.