RU2100017C1 - Method to treat children with speech disorders - Google Patents

Abstract

FIELD: medicine, neurology, pediatrics. SUBSTANCE: method deals with carrying out combined massage, revealing spasmodic and rigid muscles for necessary massage, then massage of mimic muscles and point massage of articulation muscles is conducted followed by massage of feet and hands by paying higher attention to a great toe. Then correct physiological position of a body and all its parts should be created with the help of curative costume. This costume should be put on to do a complex of curative exercises directed for relaxation of spasmodic muscles and increased tonicity of rigid ones, strengthening of shoulder girdle, spinal and pedal muscles, development of movement coordination. Respiratory exercises directed for muscular relaxation and respiratory restoration should be done after each type of exercises. Moreover, during the whole complex of exercises a child is induced for continuous conversational speech, then curative costume is taken off and the whole complex of exercises should be repeated once more. There are 10-12 seances per treatment course which should be repeated in 2-3 months. EFFECT: higher efficiency in treating speech disorders. 3 cl

Description

 The invention relates to medicine, namely to methods of rehabilitation treatment of children with speech defects: logoneurosis, stuttering, stuttering speech.

 A known method of treating children with speech impairment (stuttering) (Fundamentals of the theory and practice of speech therapy. / Ed. By R.E. Levina, M. Enlightenment, 1968, p. 230) by mastering children by various forms of imitative and reproducing speech. The method includes the following steps: exercises of children in conjugate and reflected speech, perception of a memorized text; exercises in answers to the speech therapist's questions on the content of the picture: drawing up a detailed story from the picture; retelling of the listened text; stories on a given topic; exercises in spontaneous emotional speech. The transition to independent speech is carried out after mastering by children various forms of imitative and reproducing speech.

 However, the known method only in isolated cases allows you to prepare for free from stuttering independent speech. This is a very long process, which does not, as a rule, bring the desired results, and a positive effect usually takes place only at the initial stages of speech therapy sessions. Children who speak smoothly without hesitation in the classroom, in independent speech at home, on the street, in kindergarten, begin to stutter again. The stages of development of independent speech, which boil down to automatic pronunciation of words and phrases at a speech therapist, retelling of the content of a picture or a listened story, cannot contribute to the gradual development in children of the ability to analyze the described events, compare and generalize, draw independent conclusions and conclusions, reason aloud, plan their actions. In addition, in the existing approach, the gap between speech based on visual objects and speech devoid of any visual perceptions seems unjustified, since this does not take into account the psychological regularity of the development of speech of a preschooler, which goes through several stages from speech in a specific, visual situation to abstract statements, devoid of direct visual support.

 There is also a method of treating children with speech impairments (Harutyunyan (Andropova) L.Z. How to treat stuttering. M. Education, 1993, p. 39) by gradually moving from situational and contextual speech. Simultaneously with the speech exercises, they carry out manual activities, which helps in the process of making things to talk about the sequential performance of individual elements of the work, about the material that they use, which forms in children the skill of self-constructed phrases, the ability to answer questions in full response, describe the sequence of work etc. The method includes periods of development of pre-speech, accompanying speech, reinforcing speech, consolidation of independent speech skills, while using regimen moments: preparation for classes, fees for a walk, etc.

 However, the known method involves lengthy classes with a group of children. Most children relapse after leaving specialized institutions and treatment should be carried out first.

 As a prototype, a method has been adopted for treating children with speech disorders with the help of logo rhythmics (Volkova G. A. Logopedic rhythm. M. Education, 1985, p. 15-17). The method includes a system of various exercises and games with movements to music or in combination with speech, which are selected individually. Such exercises and games contribute to the development of general and speech motor skills, develop coordination of movements, the ability to control oneself, engage in activity on a signal, instill a sense of rhythm, relieve general stiffness, tension. Particular importance is attached to the development of attention in children. Logo rhythm classes are conducted in a complex of correctional and educational work, which involves parents, educator, teacher, who, along with specially organized classes and medical events, constantly and purposefully for 8-9 months (at least) instill confidence in the child, consciousness their usefulness, a healthy look at a speech impediment, a desire to get rid of it, support the awareness of success at each stage of classes, convincing of complete success. A positive effect can be achieved only with prolonged stay of the child in conditions that ensure compliance with all these rules. Of great importance is the attitude to the child, the correct speech of others. Violation of the rules and regime leads to relapse. Such a technique cannot be applied to children from dysfunctional large families.

Thus, the known method has significant disadvantages inherent in all other methods:
long-term continuous treatment (about a year);
the creation of special conditions in the treatment process (a variety of materials, equipment, a special psychological and speech climate, speech mode);
the presence of installation on the correct speech;
frequent development of side effects, including negativity in the classroom and the emergence of fears during verbal communication;
the need in most cases for group work, requiring special selection of children by age, development and other individual characteristics;
frequent relapses;
the presence of a disruptive effect;
age range restriction.

 The objective of the invention is to provide a highly effective method of treating children with speech disorders, which allows to increase the therapeutic effect, reduce treatment time and reduce the number of relapses.

 The essence of the invention lies in the fact that in a method of treating children with speech disorders, including physical therapy, a general massage is preliminarily performed, spasmodic and atonic muscles are identified, which are additionally massaged, then facial expressions and acupressure muscles are massaged, feet and legs are massaged and hands with an emphasis on the thumb, after which they create the correct physiological position of the body and all its parts in space using a medical suit in which the complex physical therapy exercises aimed at relaxing the cramped and increasing tone of the atonic muscles, strengthening the muscles of the shoulder girdle, back and legs, developing coordination of movements, and after each type of exercise breathing exercises are performed aimed at muscle relaxation and breathing recovery, and during the whole complex of exercises the child is encouraged to constant colloquial speech, then the medical suit is removed and the entire complex of exercises is repeated, in total 10-12 sessions are conducted for the course of treatment, which is repeated yayut 2-3 months.

 Acupressure of acupressure muscles is performed by braking simultaneously on several points in the following sequence: he-liao and di-tsan, di-tsan and jia-che, he-liao and i-feng, he-liao, di-tsan and ce- guan, he-liao, di-tsang and du-bi.

 Physiotherapy exercises begin with walking on heels with knees and socks raised high, then go for a run, perform exercises on the Swedish wall, for example, squats, after which they perform leg exercises in the supine position, lifting them alternately and both at the same time complete the set of exercises walking, during which arbitrary and involuntary movements are performed by hands.

 Using the invention allows to obtain the following technical result.

 The method is highly effective, it allows you to get a pronounced therapeutic effect: 90% of children are completely cured, in 50% of children speech is completely restored, and stuttering resumes only in extreme situations.

 A positive result can be obtained as soon as possible: 80% of children have a complete restoration of speech after I-III courses (one course 1 month).

 The method does not give side effects and does not create a negative attitude to classes, but rather maintains interest in working in suits and a positive emotional mood background.

 To work with a child, a specialist does not select a group with the same defect, but can engage in individually. The method makes it possible to work in groups of children of different ages with different levels of intelligence and varying degrees of disease. It can be used to treat children of any age.

 Using the method does not require the creation of special conditions in the institution and at home, a complex combination of various materials, it can be implemented in a clinic, kindergarten, sanatorium, home.

 The technical result is achieved due to a fundamentally new approach to the restoration of impaired brain functions, which is implemented by acting on the anti-gravity system using special rods of a medical suit, thereby directing the afferent flow from muscles, joints and ligaments, which has a corresponding normalizing effect on structures CNS, controlling movement and speech.

 The impact on the speech centers is achieved by optimizing the motor functions of feedbacks and a special directed effect on muscle groups.

 The suit strengthens the muscle corset and in a calm state (physiological rest) ensures the absence of additional afferent impulse. When performing motor acts, movements are artificially slowed down and the proper rational execution of the entire motor cycle is facilitated. Thus, the restoration of smooth speech occurs against the background of a decrease in muscle hypertonicity (a decrease in the flow of pathological impulses), restoration (reconstruction) of the architecture of free motor acts. This provides a different activity of the central department of motor analyzers, which allows the correct functioning of the speech motor centers. Perhaps in this case, the pathological foci of the activity of brain structures also disappear.

 The action of the technique extends to the motor capabilities of the body, lower limbs, and articulatory muscles.

 The restructuring of the pathological motor stereotype is extremely difficult, and to accelerate this process, it is necessary to intensify the initial relaxation of spasmodic muscles as much as possible and only then use a device that affects their activity. In turn, hypotonic muscles should be stimulated by massage.

 The method is as follows.

 A child with speech impairment, for example, with a logoneurosis, stuttering, stuttering speech, is prescribed a course of medical procedures, including massage, physical exercise exercises in a medical suit and physical therapy exercises without a medical suit.

 Massage is carried out in the supine position of the child on the couch. At the same time, the masseur sets himself two tasks: to remove, if possible, the spasticity of tense muscles, increase the tone of the atonic muscles, as well as activate the speech zones and prepare the child for work in a medical suit.

 First, a general massage is performed according to the classical European type to warm the child’s body, improve blood flow and lymph flow, during which spasmodic and atonic muscles are detected, which are additionally massaged (Vasichkin B.I. Massage Handbook. L. Medicine, 1991, p. 43, 48).

 A general massage is carried out for 15 minutes, the child lies passively on the table.

 Then massage of the facial muscles of the face is carried out for 3-5 minutes (Shterengery A. E. Belaya N. Massage for adults and children. Kiev, Health, 1994, p. 91) and acupressure of the articulatory muscles by simultaneous irritation of several biologically active points for 30-90 seconds in the following sequence: he-liao and di-tsan, di-tsan and jia-che, he-liao and i-feng, he-liao, di-tsan and ge-guan, he-liao , di-tsan and du-bi. The total time of acupressure is 5-7 minutes.

 Then a massage of the hands and feet is carried out (Belaya N.A. Petrov, IB. Therapeutic wellness massage. M. T-Eye, 1994, p. 67, 81).

 Massage of the hands is carried out by stroking and rubbing the back and then the frankincense first. When massaging the fingers, the movement is from the fingertips. After general stroking and rubbing, they specifically affect the muscles of 1 finger by stroking, rubbing, kneading with pulling. The massage time for the hands is 5-7 minutes.

 Massage of the feet begins with fingertips by stroking and rubbing the back and then the plantar surface first.

 Massage of the hands and feet is carried out for 10-15 minutes.

 After that, a medical suit is put on the child to create a physiologically correct position of the body and all its parts in space (Restorative treatment of patients with the rizidual stage of cerebral palsy. Methodical recommendations N 95/103, M. 1995).

 Medical suits are put on a cotton suit and customized for each child with the help of an instructor. The choice of a medical suit is carried out in accordance with the growth and complexion of the child, for which there is a marking on the left shoulder pad of the suit indicating the height and size.

 Before putting on a suit, it is necessary to loosen as much as possible all possible traction, namely: anteroposterior dorsal and thoracic 4 pieces NN 2,3; front straps passing along the front surface of the thigh 1 pc. N 5; 3 straps along the back of the thigh NN 6.7.9; 1 x knee pad straps 1 knee straps

 Then they put a suit on the child and fix it as follows. The belt is fixed on the waist of the child, which should tightly cover it. Fix both feet of the child, Fix the knee pad so that it coincides with the patella, for this they tighten the strap that wraps around the knee and calf muscle. Tighten the strap N 5, running along the front surface of the thighs. The straps 6,7,9 are secured, extending along the lateral and posterior thighs. Tighten the rear transverse dorsal strap. Pull front-chest straps N 24 pieces.

 The tension force of all the straps of the medical suit should help to create the correct posture in the child.

 When the suit is dressed on a child, he should feel heaviness in the shoulder and hip zones. The distance between the two white transverse ribbons on the shoulder pads should be strictly in the middle of the shoulders, the sewn knee pad should be strictly on the patella.

 After a medical suit is dressed on a child, he, under the supervision and guidance of an instructor, performs a set of exercises aimed at strengthening the muscles of the shoulder girdle, back and legs, developing coordination of movements (Handbook of Physical Medicine / Edited by V.A. Epifanov) , M. Medicine, 1987).

 The set of exercises begins with walking, aimed at adapting to the suit, for 3-5 minutes, which is carried out on the heels, then with the knees high, then on the toes. After this, run for 2-3 to 5-7 minutes, depending on the physical fitness of the child.

 Then perform exercises at the Swedish wall, for example, squats 7-10 times with control of heart rate and breathing.

 The next exercise is performed while lying on your back, by lifting alternately the right and left legs and at the same time, 5-10 times. Moreover, after each type of exercise, breathing exercises are carried out taking into account the disease. Particular attention is paid to exhalation, which should be smooth and long (Ramacharoka. The science of breathing. St. Petersburg, 1916). Breathing exercises are aimed at relaxing the muscles and restoring breathing.

 Complete the set of exercises by walking for 2-3 minutes at a moderate pace, during which hands make various movements.

 When performing exercises, great attention is paid to the pace, rhythm of walking, as well as the coordination of movements of the arms and legs.

 So the influence of the medical suit on the child’s body occurs only at the moment of movement, it is necessary to constantly move in it, not forgetting the physical condition of the child.

 During the entire complex, the instructor talks to the child, prompting him to constantly speak. Moreover, the speech can be prepared (poems, retelling, a story about a seen film, etc.) and unprepared (answers to questions, requests, a story on a given topic). The child can also finish the phrase begun by the instructor, ask a question, etc.

 After carrying out a set of exercises, the medical suit is removed and the child performs the same set of exercises of physiotherapy exercises, but without it. Exercises are aimed at consolidating the results. The intensity of their conduct can be increased depending on the physical condition and fitness of the child.

 As a result of the exercises, the child’s rhythm, walking pace improves, smoothness in movement appears, extra chaotic, uncontrolled movements disappear, and the child’s position in space is corrected.

 In total, 10-12 sessions are carried out for the course of treatment. Courses are repeated after 2-3 months.

 Clinical trials were conducted at the Center for Social Adaptation and Rehabilitation of Children with Disabilities of Mental Development and at the Department of Developmental Physiology and Alternative Treatment Methods for Children at the Russian Medical Academy of Postgraduate Education.

 The proposed method was used to treat children aged 5 to 14 years in the amount of 30 people (18 boys, 12 girls) with a diagnosis of logoneurosis 17 children, stuttering 6 children, stuttering 7 children.

Using the method allowed to obtain the following result:
reduce relapse by 1.5%
increase the number of children involved in the treatment process;
to get a pronounced clinical effect: in 90% of the children the disease went away altogether, in 50% of the speech completely recovered and disturbances resume only in emergency situations, in 80% of the children there was a complete recovery after I-III courses (I course 1 month of daily systematic classes);
a change in the clinical picture occurred to a greater or lesser extent in parallel with positive shifts in the EEG.

 Example 1. Patient A. 16 years. Diagnosis: stuttering, tonoclonic form, violation of posture by kypho-scoliotic type, neurosis of obsessive movements.

 Assigned treatment by the proposed method.

 Previously, the patient in the supine position was given a general massage for 15 minutes according to the classic European type, during which the following were revealed: increased spasticity of the pectoralis major muscle, the middle and front bundle of the deltoid muscle, the muscle that lifts the shoulder blade, the muscles leading and raising the shoulder, and neck muscles. The muscles of the arch of the foot are weakened. Increased spasticity of facial muscles. After relaxation of the spasmodic muscles for 5 minutes, facial facial muscles were massaged, with emphasis on the exit points of the trigeminal nerve and neck muscles. The total massage time of the facial muscles and neck was 10 minutes.

 Then, acupressure of the articulatory muscles was performed by simultaneously stimulating several biologically active points for 30-90 seconds in the following sequence: he-liao and dizan, di-tsan and jia-che, he-liao and i-feng, he-liao , di-tsan and ge-guan, he-liao, di-tsan and du-bi. The total time of acupressure was 5-7 minutes.

 Then they massaged the hands and feet.

 Massage of the hands was performed by stroking and rubbing the back and then the palmar surface first. When massaging the fingers, the movement is from the fingertips. After general stroking and rubbing, they specifically affect the muscles of 1 finger by stroking, rubbing, kneading with pulling. The massage time for the hands was 7 minutes.

 Foot massage began with fingertips by stroking and rubbing the back and then the plantar surface first.

 The hands and feet were massaged for 15 minutes.

 After that, the patient was dressed in a medical suit to create the correct physiological position of the body and all its parts in space.

 The costume was dressed as follows. The belt is fixed on the legs of the patient, the belt should cover it tightly. Fix both feet of the child. The knee pad is fixed so that it coincides with the knee pad, for this they tighten the strap that wraps around the knee and calf muscle. Tighten the strap N 5, running along the front surface of the thighs. Fasten the straps NN 6, 7, 9, going along the lateral and posterior thighs. Tighten the rear transverse dorsal strap quite strongly. Pull the anterior-chest straps N 2, on the right weaker, on the left more, because the child has left-sided scoliosis. The back-dorsal straps N 3 are also stretched. Such tension of the straps of the LC helps to maintain the child's correct physiological position of the body in space.

 The set of exercises begins with a walk aimed at adapting to the suit for 5 minutes, which the patient performed on the heels, then with his knees high, then on the toes. After that, he ran for 7 minutes. Then he performed squats and bending arms at the Swedish wall 10 times. Heart rate and respiration were monitored. The heart rate was: before the start of the entire complex of exercises 100, during its execution 150-170, after the completion of 130.

 After each type of exercise, breathing exercises were performed taking into account the disease. Particular attention was paid to exhalation, which should be smooth and long.

 A set of walking exercises was completed for 5 minutes, during which the patient performed voluntary and involuntary movements with his hands.

 During the entire complex of exercises, the instructor encouraged the patient to constant colloquial speech, answers to various questions.

 After removing the medical suit, the entire complex of exercises was carried out again to consolidate the results.

 A total of 12 sessions were conducted 3 times a week for 1 month. After the 3rd session, the patient's muscle tension decreased, and his working capacity increased. After 7 sessions, the strength of the muscles of the arch of the foot increased, speech became smoother. After 12 sessions, the smoothness of speech improved significantly, in all speech constructions the phrase was without hesitation, reads and answers questions quickly.

 After 2 months, a repeated course of 10 sessions was carried out. It has been observed for 12 months, no relapse of the disease has occurred.

 Example 2. Patient A. 8 years. Diagnosis: hyper excitability syndrome, left-sided hemoparesis, logoneurosis from 2.5 years of age, impaired posture, S-shaped scoliosis.

 The treatment according to the proposed method.

 A preliminary general massage was performed, during which pathological changed muscles were identified: spasticity of the muscles of the upper right half of the back, muscles of the neck, weakened muscles of the upper left limb, and the left half of the back. An additional massage was aimed at relaxing the spasmodic muscles on the right and strengthening, increasing the working capacity of the muscles on the left.

 The total massage time was 10 minutes.

 Then, facial muscles were massaged for 3 minutes and acupressure acupressure was massage for 5 minutes.

 Then they held hands massage with an emphasis on the thumb and feet for 10 minutes.

 After that, the child was dressed in a medical suit to create the correct physiological position of the body and all its parts in space.

 In a medical suit, the child performed a set of exercises of physiotherapy exercises, which he started with walking on heels, with his knees and socks raised high, then he went for a run, performed squats at the Swedish wall, and then in the lying position he performed exercises for the legs, lifting his legs alternately and both at the same time, completed a set of exercises by walking, during which he performed arbitrary and involuntary movements with his hands.

 After each type of exercise, the child performed breathing exercises.

 During the entire set of exercises, the instructor encouraged the child to constantly speak.

 After removing the costume, the entire set of exercises was carried out again to consolidate the results.

 Conducted 1 course of 10 sessions.

 By the end of the course, the child's muscle strength in the left arm increased. The speech became easy, smooth, without hesitation, even in stressful situations.

 The observation period is 12 months. Relapse of the disease did not occur.

Claims (3)

 1. A method of treating children with speech impairments, including physical therapy, characterized in that they perform a general massage, identify spasmodic and atonic muscles, which are additionally massaged, then massage mimic and acupressure of the articulating muscles, massage the feet and hands. with emphasis on the thumb, after which they create the correct physiological position of the body and all its parts in space with the help of a medical suit, in which a set of therapeutic exercises is performed from cultures aimed at relaxing the cramped and increasing tone of the atonic muscles, strengthening the muscles of the shoulder girdle, back and legs, developing coordination of movements, and after each type of exercise, breathing exercises are performed aimed at muscle relaxation and breathing recovery, and during the entire set of exercises the child they are encouraged to constant colloquial speech, then the medical suit is removed and the whole range of exercises is repeated, in total 10 12 sessions are conducted per treatment course, which is repeated after 2 3 months .  2. The method according to claim 1, characterized in that the acupressure of the articulatory muscles is carried out by braking simultaneously on several points in the following sequence: he-liao and di-tsan, di-tsan and jia-che, he-liao and and- hair dryer, he-liao, di-tsan and che-guan, he-liao, di-tsan and du-bi.  3. The method according to claim 1, characterized in that the physiotherapy exercises begin with walking on the heels with the knees and toes raised high, then go on to run, perform exercises on the Swedish wall, for example, squats, and then perform leg exercises in the prone position Raising them alternately and both at the same time, complete the set of exercises by walking, during which they perform arbitrary and involuntary movements with their hands.