RU2789972C1 - A method for correcting pronunciation defects of anterolingual sounds [t], [t'], [d], [d'] after surgical treatment in patients with oral cancer - Google Patents

Abstract

FIELD: medicine, oncology and rehabilitation and correction of pronunciation defects of anterolingual sounds, [T'], [D], [D'] after surgical treatment in patients with oral cancer.

SUBSTANCE: The pronunciation of the anterior-lingual sounds [T], [T'], [D], [D'] is carried out in the specified sequence by activating the movements of the anterior third of the tongue using articulation exercises, giving the correct position of the anterior part of the tongue with a spatula, followed by sequential utterance of speech material including anterior-lingual sounds [T], [T'], [D], [D'] in various positions in syllables, words, sentences in combination with all vowel sounds of the Russian language. Classes on the production and automation of anterior-lingual sounds are held several times during the day: 1 time with a speech therapist and 2 times independently, according to recommendations and speech material that the speech therapist determines. The duration of classes is increased to 30 minutes, taking into account the general condition of the patient.

EFFECT: The present invention enables to correct pronunciation defects of anterolingual sounds after surgical treatment in patients with oral cancer, improving the quality of life of patients.

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Description

The invention relates to the field of medicine, oncology and rehabilitation and can be used to correct defects in the pronunciation of the anterior lingual sounds, [T], [D], [D], arising after surgical treatment in patients with cancer of the oral cavity.

The generally accepted type of treatment for oral cancer is combined, with an obligatory surgical component. During surgical interventions on the organs of the oral cavity due to a malignant disease, significant volumes of tissues are removed, which is accompanied by a pronounced deformation of the anatomical structures and impaired speech function [1]. In the postoperative period, there is a speech disorder with a complex structure, characterized by a disorder of sound pronunciation. The degree of violations of oral speech can be very different - from the distortion of the pronunciation side of speech to the complete absence of verbal communication. Correction of impaired sound pronunciation is necessary in the postoperative period, but cannot be built according to the principles adopted in correctional pedagogy, since the structure of speech impairment in patients after oral surgery differs significantly from the structure of speech function impairment in children and requires other ways to correct defects in pronunciation of sounds [2] .

Front-lingual sounds (linguales priores) are consonant sounds of human speech, in the pronunciation of which the front part of the tongue is the most active organ. The tongue with these sounds can have either coronal (the position of the tip of the tongue between the upper and lower teeth), or dorsal (the tip of the tongue is lowered to the lower teeth), or lateral (lateral) articulation. In connection with these articulations, the participation of one or another passive organ of speech is also performed, with the help of which the front part of the tongue performs its articulatory movements. In Russian speech, the correct articulation of the sounds [T], [D] occurs when the tip of the tongue is positioned on the back surface of the upper teeth, the so-called dental, or post-dental articulation. For sounds [T], [D] at the position of the tip of the tongue on the alveoli. In addition, the sound [Т] is a part of the complex consonant [Ц]=[Т+С], which means that if the pronunciation of the sound [Т] is disturbed, the pronunciation of the sound [Ц] is disturbed [3].

The sounds [Τ] and [D] are the most typical babbling sounds, i.e. sounds of early ontogenesis and subject to normal speech development, the correct pronunciation of the sounds [T], [T], [D], [D] appears in children at about a year and a half. Therefore, if a child older than three years of age does not have them, the production of these sounds is required. For their production, it is necessary to take into account the features of articulation. When pronouncing [T], the lips in a neutral position take the position of the next vowel sound, the distance between the teeth is 5 mm. The tip of the tongue, when pronounced with vowels A, O, U, Y, rests on the upper teeth or alveoli, forms a bow. When pronouncing with vowels E, E, Yu, I, I, the tip of the tongue rests on the lower incisors, forms a bow. The soft palate is raised, the vocal folds are open, the air jet is jerky [3].

For successful correction of defects in the pronunciation of front-lingual sounds, you need to know: setting the sound [T] is possible in several known ways.

The first way: by imitation. Better in word or syllable. Mostly from the syllable TA.

The second way: proceed from the interdental position. Bite your tongue with your teeth and exhale strongly. You will get an interdental sound [T]. Then remove the tongue behind the teeth.

The articulation of the sound [D] is the same as when pronouncing [T], the lips in a neutral position take the position of the next vowel sound, the distance between the teeth is 5 mm. The tip of the tongue, when pronounced with vowels A, O, U, Y, rests on the upper teeth or alveoli, forms a bow. When pronouncing with vowels E, E, Yu, I, I, the tip of the tongue rests on the lower incisors, forms a bow, the air jet is jerky. The difference lies in the fact that when pronouncing the sound D, the soft palate is lowered, the vocal folds are closed, and a voice is added. Vibration of the throat is felt.

Known methods of staging the sound of D.

The first way: by imitation.

The second way: from the sound T. The child puts one hand on the larynx of the speech therapist, the other on his larynx. The speech therapist takes turns pronouncing the sounds Τ - D. Draws the child's attention to the vibration of the larynx when pronouncing the sound D.

Articulation of sound [Ть].

Lips in a neutral position take the position of the next vowel sound, the distance between the teeth is 5 mm. The tip of the tongue rests on the lower incisors. The soft palate is raised, the vocal folds are open, the air jet is jerky.

Setting the sound [T].

The first way: by imitation.

The second way: the child pronounces the syllable TA. The speech therapist presses the tip of the tongue with a spatula or finger, lowers it behind the lower teeth, and the syllable TY is obtained.

The articulation of the sound [D] is the same as the sound [D]. The difference is that when pronouncing the sound D, the tip of the tongue is lowered behind the lower teeth.

Sound setting.

The first way: by imitation.

The second way: The child pronounces the sound [D]. At this moment, the speech therapist lowers the tip of the tongue behind the lower incisors with a spatula [4, 5].

The closest in technical essence and result to the proposed method is a mixed method of staging sounds, based on conscious attempts to find articulation that allows you to pronounce a sound corresponding to what you heard from a speech therapist using an interdental position, when the child bites his tongue between his teeth and exhales strongly

In patients with oral cancer in the postoperative period, the anterior lingual sounds [Т], [Ть], [Д], [Дь] in speech are either completely absent or replaced by a sound that has no analogues in the Russian language [pf]. Due to the fact that the mobility of the anterior part of the tongue is impaired, the patient turns on the compensatory movement of the lips when pronouncing these sounds, while with normal articulation of the anterior lingual sounds [T], [T], [D], [D], the lips do not participate, they are in a neutral position or take the position following the front-lingual sounds [Т], [Ть], [Д], [Дь] vowels. As a rule, in patients with oral cancer, the pronunciation of the entire group of anterior lingual sounds [Т], [Ть], [Д], [Дь] is disturbed, and not just one of them [2].

The scope of the known methods of setting the anterior lingual sounds [T], [T], [D], [D] used in children is limited, since it is used in children with a full-fledged complex of tissues, and cannot be used in patients with organ cancer oral cavity after surgical treatment for several reasons. Firstly, in patients after surgical treatment, mobility and coordination of tongue movements are impaired. Secondly, sensations in the oral cavity are disturbed, patients feel very little touch on the front of the tongue. Thirdly, the forced displacement of the tissues of the operated tongue is not permissible, as this can cause pain and trauma to the tissues of the oral cavity.

Correction of these sounds causes difficulties in patients, because. requires good mobility and coordinated movements of the anterior part of the tongue, which causes difficulty after surgical treatment, since in all patients after surgical treatment the sounds [Τ], [Τ'], [D], [D'] are absent in speech or are pronounced incorrectly, in In connection with this, it was necessary to find a new way of staging the anterior lingual sounds [T], [T], [D], [D].

A new technical result is the development of a new method for correcting defects in the pronunciation of the anterior lingual sounds [T], [T], [D], [D] after surgical treatment in patients with oral cancer.

To achieve a new technical result in a method for correcting defects in the pronunciation of the anterior lingual sounds [T], [T], [D], [D] that occurred after surgical treatment in patients with cancer of the cavity organs, the pronunciation of the anterior lingual sounds is performed in the indicated sequence by activating the tongue with the help of articulation exercises, giving the correct position of the front of the tongue with a spatula, for this, the patient is placed on the front of the tongue with a medical spatula with a wide part for 2-3 seconds, they are asked to feel the touch of the spatula on the tongue, then touch the spatula for 2-3 seconds to the area behind the alveoli of the upper teeth, then the patient, covering his mouth, presses his tongue to the spatula, while the speech therapist fixes the patient's lower lip in a natural position with his index finger, after the speech therapist slowly removes the spatula from the patient's mouth, they are asked to say the syllable "TA" with a strong exhalation, first speech therapist shows the entire sequence of actions, then asks for pa patient to repeat the actions shown, the patient makes a series of 5-6 attempts, then pause to rest, then, as soon as the patient has mastered the sequence of actions, he performs them first under the supervision of a speech therapist, and then independently, with his leading hand (right or left), puts the spatula wide side on the front of the tongue for 2-3 seconds feels the touch of the spatula to the tongue, then touches the spatula for 2-3 seconds to the area behind the alveoli of the upper teeth, then covering the mouth, presses the tongue to the spatula, with the index finger of the free hand fixes the lower lip in a natural position , slowly removes the spatula from the oral cavity, pronounce the syllable “TA” with a strong exhalation, repeat a series of attempts 3-4 times in one session, after the patient manages to pronounce the pure syllable “TA”, proceed to automation, for this they gradually complicate the speech material , start by pronouncing open or closed syllables, then move on to words with different sound positions: at the beginning, in the middle, at the end with words, speeches and texts, then they introduce sound into colloquial speech, after automating the syllable "TA", and its clear pronunciation "in words, they proceed to setting the sound [D], setting the solid sound [D] is carried out from the solid sound [T] to imitation, then they begin to pronounce the sound “T” in combination with the vowel “O”, in parallel, they automate the sound “D” in combination with the vowel “O”, they also simultaneously automate the sounds “T” and “D” in combination with the vowels “ Y" and "Y", when, thanks to speech training, the pronunciation of the sounds "T" and "D" in combination with vowels with vowels "A", "O", "U" does not cause difficulties, automation of these sounds begins with the vowel "Y" it can also be carried out by adding a cognitive component to speech exercises, thus complicating the task, the patient is offered not only to pronounce the words after the speech therapist, but to change them so that there is a syllable “YOU” or “DY” at the end, while the sounds in the words are pronounced exaggerated , with a good expiration, as soon as the patient without difficulty pronounces the indicated speech material, proceed to pronouncing tongue twisters, which are selected with the sounds [T] and [D] in different positions in the word, pronounce them slowly, pronounce them, highlighting the indicated sounds, simultaneously with the automation of solid sounds [T] and [D] in tongue twisters, they start staging soft sounds [Th] and [Dh], and the soft sound [Th] is obtained from the correct hard sound [T], the soft sound [D] from the correct hard sound [D] by imitation when pronouncing speech material, then , fix the correct pronunciation of soft sounds [T] and [D] in words, pronouncing speech material in parallel to the syllables “TYA” and “DYA”; "THE" and "DE"; "TYU" and "DU"; "TE" and "DE"; “TI” and “DI”, tongue twisters and verses with the sound [T], and tongue twisters and verses with the sound [D], as well as classes on automating front-lingual sounds, are carried out several times during the day: 1 time with a speech therapist and 2-3 times independently, according to the recommendations and the speech material given by the speech therapist, at first the duration of the classes is gradually increased, focusing on the patient's condition from 1st to 3rd classes from 7 to 10 minutes, later the classes are more intense, their duration is increased to 30 -40 minutes, the course includes up to 6 lessons.

The method is carried out as follows.

A joint examination is carried out with an oncologist and a speech therapist, after which a decision is made to start speech rehabilitation therapy to correct speech dysfunction. On examination: pay attention to the features of the methods of communication, breathing, intonation pattern of speech, the duration of the phrase, the mobility of the stump of the tongue (forward to back, to the right to the left, up to down). Identification of violations of the pronunciation of all groups of consonant sounds, except for labials, loss of front-lingual sounds [T], [T], [D], [D], back-lingual sounds [K], [K '], [G], [Γ'] from speech ] and sonorant sounds [L], [L'], [P], [P'].

Speech therapy classes begin with exercises to activate the mimic and articulatory apparatus, for this purpose, exercises for mimic muscles, lips and exercises for the stump of the tongue are performed. After the mobility and coordination of the movements of the mimic muscles, lips and stump of the tongue improve, they proceed to correct the pronunciation of the posterior lingual sounds [K], [K '], [G], [G ']. As soon as the posterior lingual sounds were delivered (setting the sound involves the development of new neural connections involved in pronouncing a certain sound) and went through the process of automation, at the 7th speech therapy lesson, they start staging the anterior lingual sounds [T], [Th], [D], [D] . Classes are carried out in front of a large mirror so that the patient can see both herself and the speech therapist, the patient is placed on the front of the tongue with a medical spatula with a wide part for 2-3 seconds, they are asked to feel the touch of the spatula on the tongue, then they touch the spatula for 2-3 seconds to the area behind the alveoli of the upper teeth, then the patient, covering his mouth, presses his tongue against the spatula, while the speech therapist fixes the patient’s lower lip in a natural position with his index finger, after the speech therapist slowly removes the spatula from the patient’s mouth, they ask you to say the syllable “TA” with a strong exhalation, first the speech therapist shows the entire sequence of actions, then asks the patient to repeat the actions shown, the patient makes a series of 5-6 attempts, then pause to rest, then as soon as the patient has mastered the sequence of actions, he performs them first under the control of the speech therapist, and then independently, with the leading hand (right or left) puts the spatula with the wide side on the front of the tongue for 2-3 seconds about feels the touch of the spatula to the tongue, then touches the spatula for 2-3 seconds to the area behind the alveoli of the upper teeth, then covering the mouth, presses the tongue to the spatula, with the index finger of the free hand fixes the lower lip in a natural position, slowly removes the spatula from the oral cavity, on a strong exhalation, the syllable “TA” is pronounced, a series of attempts is repeated 3-4 times in one session, after the patient manages to pronounce the pure syllable “TA”, they begin automation, for this they gradually complicate the speech material, start by pronouncing open or closed syllables, then they move on to words with a different position of the sound: at the beginning, in the middle, at the end of the word, tongue twisters and texts, then they introduce the sound into colloquial speech, after automating the syllable "TA", and its clear pronunciation "in words, they move on to setting the sound [D] , the production of a solid sound [D] is carried out from a solid sound [T] by imitation, then they begin to pronounce the sound “T” in combination with the vowel “O”, in parallel they carry out av tomatization of the sound “D” in combination with the vowel “O”, the sounds “T” and “D” in combination with the vowels “U” and “Y” are also simultaneously automated, when, thanks to speech training, the pronunciation of the sounds “T” and “D” in combination with vowels with vowels "A", "O", "U" does not cause difficulties, automation of these sounds with the vowel "Y" can also be carried out by adding a cognitive component to speech exercises, thus complicating the task, the patient is offered not only pronounce the words after the speech therapist, but change them so that there is a syllable “YOU” or “DY” at the end, while the sounds in the words are pronounced exaggerated, with a good exhalation, as soon as the patient pronounces the specified speech material without difficulty, they proceed to pronouncing tongue twisters , who pick up with the sounds [T] and [D] in different positions in the word, pronounce them slowly, pronounce them, highlighting the indicated sounds, simultaneously with the automation of hard sounds [T] and [D] in tongue twisters, proceed to staging soft sounds [T ] and [D], and are soft th sound [T] is obtained from the correct hard sound [T], the soft sound [D] from the correct hard sound [D] by imitation when pronouncing speech material, then the correct pronunciation of soft sounds [T] and [D] is fixed in words, pronouncing the speech material in parallel to the syllables "TYA" and "DYA"; "THE" and "DE"; "TYU" and "DU"; "TE" and "DE"; “TI” and “DI”, tongue twisters and verses with the sound [T], and tongue twisters and verses with the sound [D], as well as classes on automating front-lingual sounds, are carried out several times during the day: 1 time with a speech therapist and 2-3 times independently, according to the recommendations and the speech material given by the speech therapist, at first the duration of the classes is gradually increased, focusing on the patient's condition from 1st to 3rd classes from 7 to 10 minutes, later the classes are more intense, their duration is increased to 30 -40 minutes, the course includes up to 6 lessons.

Clinical example No. 1: Patient S., born in 1957, Diagnosis: Cancer of the tongue on the right T2N0M0. The first stage of combined treatment in the department of head and neck tumors of the Tomsk Research Institute of Oncology on January 28, 2020, the operation was performed in the following volume: Fascial-case excision of the tissue of the neck on the right. Resection ¹ A of the tongue on the right. The postoperative period was uneventful, healing by primary intention.

A joint examination by an oncologist surgeon and a speech therapist was carried out on February 4, 2020. A decision was made to start speech rehabilitation therapy to correct speech dysfunction. On examination: the patient communicates in incomprehensible sonorous speech or with the help of writing, speech is slurred, monotonous, intonation pattern was not traced. Breathing is disorganized, through natural ways, exhalation is shortened. The duration of the phrase is 1-2 words. The stump of the tongue is sharply limited in mobility forward backward, right to left, up and down. There was a violation of the pronunciation of all groups of consonant sounds, except for the labials, loss of front-lingual sounds [T], [T], [D], [D], back-lingual sounds [K], [K'], [Γ], [Γ'] from speech ] and sonorant sounds [L], [L'], [P], [P']. Diagnosis postoperative dysarthria, polymorphic dyslalia.

Speech therapy classes began with exercises to activate the mimic and articulatory apparatus, for this purpose exercises for mimic muscles, lips and exercises for the stump of the tongue were performed. After the mobility and coordination of the movements of the mimic muscles, lips and tongue stump were improved, they proceeded to correct the pronunciation of the posterior lingual sounds [К], [К'], [Г], [Γ'] [6]. As soon as the posterior lingual sounds were delivered (sound production involves the development of new neural connections involved in the pronunciation of a certain sound) and the automation process went through [3], at the 7th speech therapy lesson (02/12/2020) they started staging the anterior lingual sounds [Т], [Ть] , [D], [D]. Classes were held in front of a large mirror so that the patient could see both herself and the speech therapist. We started by setting the sound [T], for this, the patient was placed on the front of the tongue with a medical spatula with a wide part for 2-3 seconds, after the patient felt the touch of the spatula on the tongue, touched the area behind the alveoli of the upper teeth with a spatula for 2-3 seconds, then the patient, covering her mouth, pressed her tongue against the spatula, while the speech therapist fixed the patient's lower lip in a natural position with her index finger. The speech therapist slowly removed the spatula from the patient's mouth, and asked to say the syllable "TA" with a strong exhalation. First, the speech therapist showed the entire sequence of actions, then asked the patient to repeat the actions shown. The patient makes a series of 5-6 attempts, then paused to rest. For 3 attempts, when the patient learned the sequence of actions, she began to perform them independently under the supervision of a speech therapist, with her right hand she put the spatula with the wide side on the front of the tongue for 2-3 seconds, then touched the area behind the alveoli of the upper teeth with the spatula for 2-3 seconds, then covering her mouth, she pressed her tongue against the spatula, fixed her lower lip with the index finger of her left hand. At the first lesson, patient S. managed to pronounce the pure syllable “TA”, therefore, at the same lesson, they began to automate the syllable “TA” in words. For this, words were pronounced, consisting of 4-8 sounds, beginning with the syllable "TA" in the stressed position. Before the word, the syllable “TA” is pronounced twice exaggeratedly, for example: TA-TA - Tanya, TA-TA - dance, tact, tobacco, tatami, basin, customs, wheelbarrow, slippers, tanks, willow. Since the patient freely obtained a clear sound [T], in the same lesson they began to pronounce words with the syllable “TA” at the end of the word: TA-TA - ottoman, rocket, comet, biscuit, cuff, mail, mast, dream. First, repeating the syllable “TA” twice before each word, then without repeating syllables before the words. The lesson was over at this point, the patient received the speech material that was spoken at the speech therapy lesson for independent exercises. At the 8th lesson, in parallel with the automation of "TA" in words, they began to pronounce the sound [T] in syllables with other vowels of the first row, pronounce them sequentially, each syllable 3 times: To-To-To; Tu-tu-tu; Te-Te-Te; Tu-tu-tu; You you you.

Since the patient obtained the purest sound [T] when pronouncing the syllable "You", we proceeded to automate this syllable in the exercise, the patient was asked not only to pronounce the words after the speech therapist, but to change them so that the syllable "YOU" or "DY". Planet - planets, rocket - rockets, comet - comets, dream - dreams, mast - masts, umbrella - umbrellas, cat - cats, etc. Lipstick - by - ride, panda - pandas, conversation - conversations, rent - rent, etc.

They also started staging the sound [D] from the solid sound [T] by imitation. At first the patient tried to pronounce a series of syllables: Ta-Ta-Da, then Τa-Da, TA-Da-Da. This exercise did not cause any difficulties for the patient, so we started automating [D] in the words: Yes-da-Dama, Da-Da-Dacha, far, date, old, gift, further, country, ladies', give, give, crush.

At the ninth speech therapy lesson, automation of the sounds “T” and “D” was performed in combination with the vowel “O”, “U” and “Y”.

"TO" - Tonya, Tolya, toasts, ton, sense, crowds, thick, precise, languid, thin, sloppy, tonic, brake, torso, cake, dot, toaster, toast, poplar, ice rink, skein, tray, scarf, curl, scroll.

"TO" Do-do share, daughter, house, rain, boards, doctor, long, kind, valor, to the top, argument, dogma, dollar, longer, donor, bottom, dope, satiety, dryness, daughter, clean, debt, house, dog, dose.

"TU" Tu-tu - Tula, Tula, tunnel, tube, dead end, cuff, Tunisia, tourist, Turkey, tight, tuna, tourism, mulberry, shoes, thuja, carcass, tuyuk, carcass, mortar, coil, talker, spinner .

"DU" Doo-doo - Hollow, shower, arc, perfume, stuffy, darling, duel, duet, sheepskin coat, pipe, hollow, oak, chest, pillow, tub.

Automation of the syllable "DY" was performed by the exercise, changing the syllable "YES" at the end of the word to the syllable "DY": Lipstick-lipstick, annoyance-annoyance, ambush-ambush, weather-weather, freedom-freedom, water-water, ride-ride, panda-pandas, conversation-talk, rent-rent, etc.

Since the patient could easily pronounce the sounds [T] and [D] in combination with the vowels “A”, “O”, “U” and “Y”, in the tenth speech therapy lesson, they switched to pronouncing pure tongues. Pure tongues are pronounced slowly, they pronounce, emphasizing the sounds [T] and [D].

Clean tongues with sound [T]:

From under the clatter of hooves, dust flies across the field.

The tigers are looking at the path, no one can pass there.

Cake plate, cottage cheese tart.

Petya and Anton strayed on the planet Pluto.

The weaver weaves fabrics for Tanya's scarves.

Tanya has a secret, this is Tanya's secret, And Tanya is hiding this secret.

Tanya eats cabbage with a crunch.

Tolya grew a poplar behind the field.

Across the field, across the field, Tolya walked to the poplar.

A black grouse sat on a tree, and a black grouse with black grouse on a branch.

Poor Filat, the richer he is, the more happy he is.

Your Filat is not to blame, and our Nata is not to blame.

Chatterbox chatted until she chatted.

The tailor Poto was playing loto. The dressmaker Homo knew that the tailor Poto played loto, but the tailor Poto did not know that the dressmaker Poto knew that the tailor Poto played loto.

They stomped and stomped, stomped to the poplar.

They stomped to the poplar, Yes, they stomped their feet.

Clean tongues with sound [D]:

The woodpecker hollowed out the oak, but did not finish it.

A woodpecker sits on an oak and hollows a hollow in the oak.

Daria gives Dina melons.

There is only one Domna in the house.

Two governors on one cart.

The house is at the oak, the oak is at the house.

In the Dynamo team - Diana, Diana has dominoes

Don't blow your lips on the oak, don't blow your lips on the oak.

Dima is alone at home, but Dima is not alone at home. At home, one Dima and two Vadim.

Dima has medals, Dina has orders.

Dudu, dudu, but I won’t get bread.

Since the automation of [Τ] and [D] in pure tongues was like difficulties, in the same lesson we started staging soft sounds [T] and [D]]. The soft sound [Ть] was pronounced from the correct solid sound [T], the soft sound [D] - from the correct solid sound [D] by imitation when pronouncing speech material: Ta - ta - TYa; That - that - YOU; Te - te - TE; Tu - tu - TYu; You - you - TI; Yes - yes - DYA; To - to - DYO; Doo - doo - DYU; Dy - dy - DI.

At the eleventh lesson, we continued the automation of the sounds [T] and [D] in tongue twisters and began to consolidate the correct pronunciation of the soft sounds [T] and [D] in words, pronouncing the speech material in parallel to the syllables “TY” and “DYA”; "THE" and "DE"; "TYU" and "DU"; "TE" and "DE"; "TI" and "DI". "TYA" Traction, drag, litigation, banner, chopper, pull, pull, yelp, cat, Kostya, Nastya, footcloth, hard worker, hard worker, luminous, September, handsome, coupler, quarrel., "DYA" Uncle, woodpecker, tramp , bodyaga, breeding, goner, ice, ahead of time, copper, suggestive, leaving, scoundrel, sparing.

"TE" Dark, glass, cauldron, erased, actor, usher, janitor, payment, miner, wear, fitter, clasp, cub, rock, flow.

"DE" Reliable, budenovka, baldezh, bucket, case, pull, stuntman, buzzing, clothes, waiting, foundling, nail puller.

"TYu" Seal, Tyumen, adventure, tube, bityug, bale, bale, tulip, iron.

"DU" Turkey, dozen, inch, dune, duchesse, producer, fondue, uncle, dowel.

"TE" Dough, body, shadow, black grouse, flow, steppe, insole, text, artel, idea, lost, hysteria, step, walls, university.

"DE" Student, tree, clothes, hope, academy, idea, cadet, children, girl, money, day, walking.

"TI" Children, active, positive, cambric, flooring, artist, bow, lead, bring in, silence.

"DI" Bears, swans, horses, blond, one, single, Buddhist, verdict, driver.

At the twelfth speech therapy lesson, we continued the automation of the sounds [T] and [D] in tongue twisters and began to pronounce tongue phrases with the sounds [T] and [D]:

The blizzard sweeps the white path. Wants to drown in soft snow.

The frisky wind fell asleep on the way; Do not drive through the forest, do not pass.

Temka's six kittens are playing hide-and-seek in the dark.

Two kittens - in a knapsack, two kittens - in a jacket,

Two kittens - in a cardboard box.

Do not stumble upon a kitten in the dark, Temka!

Karinka gives Katerinka the pictures, Katerinka puts the pictures in the basket.

Shadow-shadow, sweat. The net is thrown over the wattle fence.

The threads of the net will decay there, the children will not catch the birds.

The girl, Nastya, has a red dog.

The boy Kostya once came to visit her with a kitten.

Blizzards flew, blizzards swept, blizzards whistled near the white earth.

Blizzards grabbed oak branches. Blizzards rolled balls of snow.

Blizzards flew, blizzards swept aground. Blizzards weaved snowdrifts from snow.

Throughout the winter, blizzards were shallow - maples, lindens turned gray ...

And in the spring they cheered up, bloomed, turned green:

birds flew in from the south - they warmed the branches with their paws!

Blizzards flew, blizzards flew, made beds of snow in the valleys.

They circled, shoaled, howled snowstorms, over the forest, over the field they hummed and sang.

Blizzards flew, blizzards danced, forests and glades swaddled in snow.

Kalinas and lindens, maples and firs fell asleep, froze under a white snowstorm ...

Blizzards flew, blizzards flew. There were blizzards, blizzards, blizzards.

Clean tongues and poems with the sound [D]:

A day is like a day, but the year is not the same.

If you don't know the case, don't judge.

Summer day - for the winter week.

A small deed is better than a big idleness.

What is born in the summer will come in handy in the winter.

The woodpecker was hollowing out the tree, woke up the grandfather with a knock.

Denis did not sit idle - he ate sweets all day.

To be in a smart conversation is to buy a mind.

Do not look at how the mouth is tearing, but look at how things are going.

See the tree in fruit, and man in deeds.

To live without work is only to smoke the sky.

A loafer and a loafer - they have a holiday on Monday.

Monday, don't mess around.

You tell him about the case, and he: "Come in the week."

Things do not go by themselves: they are driven by people.

People are not judged by their words, but by their deeds.

Classes with patient S. were held in front of a large mirror several times during the day: 1 time with a speech therapist and 3 times on their own, according to the recommendations and speech material given by the speech therapist. At the beginning, the duration of the classes was 7-10 minutes. Subsequently, their duration increased to 30-40 minutes, the classes were more intense, while taking into account the general condition of the patient.

In total, to correct defects in the pronunciation of the anterior lingual sounds [Т], [Ть], [Д], [Дь], patient S. had 6 sessions. As a result, the sounds [Т], [Ть], [Д], [Дь] are delivered, automated and entered into spontaneous speech.

In total, rehabilitation was carried out in 5 patients with different volumes of surgical intervention.

Thus, the proposed method allows for effective rehabilitation of patients after surgical interventions on the organs of the oral cavity for a malignant disease, when significant amounts of tissue are removed, which is accompanied by a pronounced deformation of the anatomical structures and impaired speech function, and improve the quality of life of this category of patients.

Information sources

1. Kulbakin D.E., Choinzonov E.L., Mukhamedov M.R. Reconstructive plastic surgery in the combined treatment of patients with locally advanced tumors of the head and neck // Issues of Oncology. - 2017. - No. 6. - T. 63. - S. 862-866.

2. Krasavina E.A., Choinzonov E.L., Kulbakin D.E., Balatskaya L.N., Zangieva K.A. Possibilities of speech rehabilitation of patients with cancer of the oral cavity and oropharynx after reconstructive plastic surgery. Siberian journal of oncology. 2020. Vol. 19. No. 5. pp. 35-43.

3. Volkova L.S. - Speech therapy: A textbook for students of defectological faculties of pedagogical higher education. textbook establishments. Vlados, 2009. S. 703.

4. Egorova O.V. Sounds T, Th, D, D. Speech material and games for the automation and differentiation of sounds in children 5-7 years old. M .: "Publishing house" Gnome and D ", 2005. - 32 p.

5. Filicheva T.E. speech therapy. Theory and practice. Exmodestvo, 2017, p. 608.

6. A method for correcting defects in the pronunciation of posterior lingual sounds that arose after surgical treatment in patients with cancer of the oral cavity and oropharynx. Krasavina E.A., Choinzonov E.L., Kulbakin D.E., Balatskaya L.N. Patent for invention 2760173 C1, 11/22/2021. Application No. 2020137816 dated 11/17/2020.

Claims (1)

A method for correcting defects in the pronunciation of the anterior lingual sounds [T], [T], [D], [D] that occurred after surgical treatment in patients with cancer of the oral cavity, characterized in that the pronunciation of the anterior lingual sounds is carried out in the specified sequence by activating the tongue with the help of articulation exercises, giving the correct position of the front of the tongue with a spatula, for this, the patient is placed on the front of the tongue with a medical spatula with a wide part for 2 seconds, asked to feel the touch of the spatula on the tongue, then touch the spatula for 2 seconds to the area behind the alveoli of the upper teeth, then the patient, covering his mouth, presses his tongue against the spatula, while the speech therapist fixes the patient’s lower lip in a natural position with his index finger, after the speech therapist slowly removes the spatula from the patient’s mouth, they ask you to exhale the syllable “TA”, first the speech therapist shows the entire sequence of actions , then asks the patient to repeat the shown d actions, the patient makes a series of 5 attempts, then pauses to rest, then, as soon as the patient has mastered the sequence of actions, he performs them first under the supervision of a speech therapist, and then independently, with his leading hand - right or left, puts the spatula with a wide side on the front of the tongue for 2 seconds, feels the touch of the spatula to the tongue, then touches the spatula for 2 seconds to the area behind the alveoli of the upper teeth, then, covering the mouth, presses the tongue to the spatula, with the index finger of the free hand fixes the lower lip in a natural position, removes the spatula from the oral cavity, on exhalation, the syllable “TA” is pronounced, a series of attempts is repeated 3 times in one session, after the patient manages to pronounce the pure syllable “TA”, they begin automation, for this they gradually complicate the speech material, start by pronouncing open or closed syllables, then proceed to words with a different position of the sound: at the beginning, in the middle, at the end of the word, tongue twisters and texts, then the sound is introduced into colloquial speech, after automating the syllable "TA" and its clear pronunciation in words, they proceed to setting the sound [D], setting the solid sound [D] is carried out from the solid sound [T] by imitation, then they begin to pronounce the sound "T" in combination with the vowel "O", in parallel, the automation of the sound "D" in combination with the vowel "O" is carried out, the sounds "T" and "D" in combination with the vowels "U" and "Y" are also simultaneously automated, when, thanks to speech training, the pronunciation of sounds "T" and "D" in combination with the vowels "A", "O", "U" does not cause difficulties, the automation of these sounds with the vowel "Y" can also be carried out by adding a cognitive component to speech exercises, thus complicating the task, the patient is offered not only to pronounce the words after the speech therapist, but also to change them so that the syllable “YOU” or “DY” is at the end, while the sounds in the words are pronounced exaggeratedly, with a good exhalation, as soon as the patient pronounces the indicated speech material without difficulty, move on to pronouncing pure A word that picks up with sounds [T] and [D] in different positions in a word, pronounces them slowly, pronounces, highlighting the indicated sounds, simultaneously with the automation of hard sounds [T] and [D] in tongue twisters, they begin to produce soft sounds [T ] and [D], and the soft sound [T] is obtained from the correct hard sound [T], the soft sound [D] from the hard sound [D] by imitation when pronouncing speech material, then the pronunciation of soft sounds [T] and [D] is fixed ] in words, pronouncing the speech material in parallel to the syllables "TYA" and "DYA"; "THE" and "DE"; "TYU" and "DU"; "TE" and "DE"; “TI” and “DI”, tongue twisters and verses with the sound [T], and tongue twisters and verses with the sound [D], also classes on automation of front-lingual sounds are carried out several times during the day: 1 time with a speech therapist and 2 times on their own, according to recommendations and speech material given by a speech therapist, the duration is gradually increased to 10 minutes from the 1st to the 3rd lesson, later the lessons are more intense, their duration is increased to 30 minutes, the course includes up to 6 lessons.