RU2723221C1 - Correction method of verbal disorders - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, particularly to speech therapy, and can be used for drug-free treatment and correction of speech disorders. Declared result is achieved by the fact that the method of speech disorders correction includes five stages. First stage involves massage of the thoracic region, cervical region and facial region. Second stage involves external and intraoral massage of the articulation apparatus. Third stage involves massage of articulation apparatus with sounding. Fourth stage includes respiratory, vocal and articulation gymnastics with massage and automation of pronunciation of sounds. Fifth stage includes automation of sounds in syllables, words and phrases.EFFECT: technical result of using the claimed invention will be acceleration of positive dynamics and higher stability of the result, shorter time for normalizing the patient's condition, enlarging the region of verbal disorders, for which the correction method provides positive results, achievement of complex improvement of the patient's general condition.6 cl, 3 ex

Description

The invention relates to medicine, in particular to speech therapy, and can be used for non-drug treatment and correction of speech disorders.

In speech therapy practice, the correction of speech disorders is usually carried out using a complex of psychological, medical and pedagogical measures, such as medical treatment, physiotherapy, hypnosis, psychotherapy, physiotherapy exercises, general classical massage, articulation massage massage, speech therapy massage of the neck-collar zone and face , probe massage of the tongue, speech therapy sessions (E. N. Vinarskaya. Early speech development of a child and problems of defectology: Periodic of early development. Emotional prerequisites for language acquisition. M .: Education, 1987; E. A. Dyakova. Speech therapy massage: Textbook. for a student of a higher educational institution. - 2nd ed., Rev. - M: Publishing Center "Academy", 2005; OV Pravdina. Speech Therapy. Textbook for students, a defectologist of faculty ped-to-tov. 2nd ed., Revised and revised M., "Enlightenment", 1973; Martynova RI Medical and pedagogical characteristics of dislaliks and dysarthritics. In the collection "Essays on the pathology of speech and voice", edited by prof. S. S. Lyapidevsky. M, "Enlightenment", 1967; and other authors: L.A. Danilova, G.A. Kashe, R.E. Levina, S.S. Lyapidevsky, R.I. Martynova, E.M. Mastyukova, K.A. Semenova, I.I. Panchenko, M.E. Khvatcev, E.V. Novikova, A.I. Pospelov, V.K. Kramarenko).

The need for a combined approach is due to the multifaceted nature of the causes of speech disorders: this may be due to insufficient mass of speech muscles, impaired innervation of their fibers, immobility of the articulation apparatus; also caused by spasmodic phenomena in the muscles of the skeleton, muscular-fascial compression; on the other hand, it can be the result of disorders of the nervous system, injuries and diseases of the brain with the preservation of intelligence, or deeper disorders, with loss of intelligence, which destroy the very ability of speech.

For example, there is a known method for the restoration and development of human speech functions (RU 2486925), including the assessment of speech disorders and the degree of their deviations from the age norm using a 7 point maturity scale. Depending on the number of points, classes are conducted, including massage of the chest, larynx, hands, facial and articulating muscles; the use of a moderate and painful stimulus to the upper and lower parts of the respiratory system before inducing response sound reactions and vocalisms; articulatory and facial gymnastics; gymnastic stretching exercises; external stimuli - mechanical, acoustic, optical; vestibular loads, etc.

Another well-known way to eliminate stuttering (RU 2486925) involves conducting speech therapy sessions in three stages: preparatory, restorative and fixing, with each of the stages including its own set of procedures. At the preparatory stage, “pseudo-stuttering” is detected, in contrast to “true” stuttering, and released from it by adjusting the nutrition taking into account the patient’s blood group, eliminating desynchronosis by synchronizing biorhythms of the patient’s body by matching the pulse rate per minute and the rhythm of speech exhalation with a multiple the ratio to the given frequency of the rhythm of work with the fist and the rhythm of walking; perform speech therapy exercises aimed at developing smoothness of speech, coordination exercises between mental and motor ability. At the recovery stage, the causes of “true” stuttering are sequentially eliminated by activating the respiratory, laryngeal and articulating muscles, eliminating respiratory cramps in the places of the abdominal press and larynx. Then stuttering in places of localization of articulation spasms is eliminated, adding to the previous exercises exercises on the muscles of the articulation apparatus with performing facial massage, performing facial exercises aimed at mobility of the oropharyngeal and nasopharyngeal muscles. At the fixing stage, the developed speech skills are fixed to natural speech, while continuing to perform the techniques of the recovery phase.

The main disadvantages of these and similar methods (RU 229491, RU 2306153, etc.) include the duration of their conduct, which can often lead to regression of the achieved results during the correction process, the limited speech disturbances that can be corrected in this way, and a strong dependence the achieved results from the individual characteristics of the patient.

Logopedic massage techniques are used when patients have individual muscle disorders. At the same time, attention is paid to general massage, or to individual regions with the implementation of the classical technique, which is based on superficial, measured, smooth movements made in accordance with the direction of the massage lines (see Guidelines for hygienic massage of the face and neck. CIKTB, Minbyt RSFSR, 1976). With increased tone, a relaxing type of massage is performed, with a reduced tone - an activating type of massage. But in practice, people with speech pathology do not have pronounced symptoms of muscle tone (with the exception of patients with cerebral palsy). As a rule, mixed tone is observed in muscle groups even within the same myofascial region. For example, for a tongue (a single organ consisting of three groups of its own muscles, controlled by the skeletal muscles of the tongue and innervated by the hyoid nerve), when diagnosing, you can see the root of the tongue pulled back or raised uphill, which indicates spasticity. But at the same time the tip of the tongue lies at the bottom of the mouth and is sluggish, which indicates paretism. Thus, a picture of mixed genesis arises in front of a speech therapist. The cause of spasticity of the root of the tongue is the displacement of the hyoid diaphragm posteriorly to the cervical vertebrae and upwards. During a visual examination, changes in cervical lordosis, tilt or position of the head with respect to the neck, malocclusion can be recorded. During visual examination and palpation, fascial shortening and stiffness of the neck muscles can be detected, while neighboring tissues can be soft, edematous and, as it were, “superfluous”, gathered in folds, which should not be normal here. From the side of dysfunction, fascial shortening will be harder and more painful in hypertonicity, on the opposite side in normotonicity or overstretched, hypotonicity is not observed with this picture. The reason for the pareticity of the tip of the tongue is that there is no natural full articulation and speech load, the innervation of this site and the blood flow in it are disturbed, and accordingly, this site becomes “lazy." As a result of this muscle conflict, the throat pronunciation of vibrants and the lower order of hissing sounds or the defect of mitigating whistling sounds with the possible phonetic replacement with rear-language sounds are formed. None of the proposed types of massage described in the speech therapy literature, relaxing or activating, does not solve the problem and does not give a positive result. Such an ambiguity in practice often leads to a rollback from the already achieved positive dynamics or even complete regression, to a return to the initial state in speech status after completing a speech therapy session or a break in classes, to a deterioration in the state of speech with large manifestations of blurry, defective sound pronunciation and muscle condition of the tongue with signs of cyanism and increased tone.

Another problem of using speech therapy massage is the mode of its implementation. Massage of the cervical-collar zone, face and tongue should be carried out in courses of 10-20 days, daily or every other day with an interval of 3 months. Too long a break in the correctional plan of work until the moment of setting full automatism is reached does not contribute to maintaining the achieved dynamics in correcting the violation and maintaining a stable result.

In addition, traditional methods suggest an impact on the cervical-collar region, facial and articulatory muscles, without affecting the musculoskeletal complexes from the pelvic to the thoracic and cervical, the skull area as a single myofascial system of the body, which, as you know, is involved in the reproduction of speech ( Dyakova EA Logopedic massage: Textbook for students of higher educational institutions. - 2 ed., Rev. - M.: Publishing Center "Academy", 2005).

Known methods for the treatment of speech disorders by massaging the muscles of the articulation apparatus using probes. For example, a method for the treatment of speech disorders and a set of probes for massage the muscles of the articulation apparatus (RU 2143256). This method includes assessing the condition of the muscles participating in the articulation, the relationship with the nature of the disturbance of sound pronunciation and subsequent holding of finger and / or instrumental massage of the corresponding muscle group, normalizing their spastic or paretic state; characterized in that the instrumental massage is carried out with a set of nine probes made of elastic metal wire, each of which has a handle and a working part. The method suggests using massage of the tongue, zygomatic muscles and joints, lips, cheeks, soft palate separately or in a different combination, massage procedures can be carried out, starting from separate small groups, with a gradual large coverage of the affected muscle structures, while the same massage the action is repeated 30-40 times, the effect is used in the form of tingling, pricking with pumping, sliding, pressure, springy warming, chopping, springy retraction, grinding.

The disadvantages of this method include the lack of accounting for an individual defectively formed speech pattern with problems in the myofascial structures of the thoracic, cervical and facial regions, which, in fact, is a single complex of speech formation and speech reproduction, while such accounting is required for successful normalization of muscle tone and speech disorders .

Another disadvantage is the lack of a preparatory stage in the study of the tissues of the skull and facial skeleton and places of attachment of facial muscles to bone structures. The use of logopedic probes or probe substitutes on unprepared tissue can lead to microtrauma of the dentofacial zone and the mucosa of the bottom of the mouth. Also in the name of the method lies the treatment of speech disorders, while it is known from practice that effective correction of a defective pronunciation cannot be achieved only with the help of instrumental massage without other corrective pedagogical measures

A known method for the correction of speech and myofunctional disorders in children and adults and a set of probes for its implementation (RU 2652951), including the impact of a combined nature (classic manual massage, probe, point, hardware, vacuum, artificial local contrast therapy (ILA), self-massage, massage of reflexogenic zones) and involves a combination of manual classical massage with instrumental methods and the additional use of the ILA method and sensory integration.

The disadvantages include insufficient study of the muscles of the body for the use of instrumental methods. As practice shows, the use of traditional massage in people with speech pathologies and postural disorders in a significant number of cases, especially with a combination of disorders, does not give the expected effect and does not solve the problem completely. Initially, such a massage is based on the techniques of classic face, neck and décolleté massage (which actually coincides with hygienic) and cosmetic buccal massage, which have different goals and objectives than a speech therapist puts before himself. As a result, probe massage is performed on tissues that are insufficiently developed and prepared for instrumental effects, which can lead to undesirable consequences or the absence of a stable positive result.

As the author's practical activity has shown, the starting area for controlling the skeletal muscles of the tongue is the myofascial complex of the sublingual diaphragm, and the own muscles of the tongue are a means for extracting and reproducing speech sounds. Therefore, logopedic probes or probes (a teaspoon and a fork) as a finer tool when working with your own muscles of the tongue should be used exclusively after external and internal unlocking of the hyoid diaphragm by manual techniques, which is under pressure from muscle disorders in the occipital-maxillary and cervicothoracic diaphragms, since located between them. Those techniques that cannot be performed on the tongue using finger massage are supplemented by instrumental massage and probe articulation gymnastics (myofunctional gymnastics with weighting materials, in which the probes are used, and resistance exercises). Probing the bottom of the mouth with probes is an aggressive, complex and sometimes even dangerous intervention on unprepared tissues, since it is technically impossible to work out the skeletal muscles of the tongue and their attachment points using speech therapy probes or probes (a teaspoon and fork) and it is impossible to get tactile feedback from the tissues to the hands of a specialist, but it is possible to get microtrauma of the dentition and the mucosa of the bottom of the mouth.

Thus, these methods generally do not take into account the effect on the whole complex of means for extracting and reproducing speech sounds, which leads to long correction periods and an unstable result.

The inventive method for correcting speech disorders is aimed at increasing the efficiency of achieving the expected results in a shorter time due to the fact that the physiological balance is first restored at the level of horizontal diaphragms and regions between them and vertical fascial chains. Pressure, or muscle-fascial compression on the bones, joints, vertebrae, veins, arteries, nerve fibers, weakens and, as a result, posture and facial skeleton are leveled, emotional and psychological background is stabilized, cognitive activity is increased, behavior is changed, mood is improved, desire to visit appears Speech therapist’s classes and motivation for learning, many sounds, sound complexes and words are set by themselves, without special speech stimulation and lengthy training. The complex effect on the fascial system in combination with the speech therapy approach demonstrates effective positive dynamics in the correction of speech disorders in children and adults who have not previously received the expected and claimed results from other methods and classical approaches to speech therapy massage.

The technical result from the use of the claimed invention will be to accelerate positive dynamics and increase the stability of the result, reduce the time to normalize the patient’s condition, expand the area of speech disorders for which the correction method gives positive results, achieve comprehensive improvement in the general condition of the patient.

The claimed result is achieved by the fact that the method of correction of speech disorders contains five stages: the first of which includes massage of the thoracic region, cervical region, facial region; the second stage includes external and intraoral massage of the articulation apparatus; the third stage includes massage of the articulation apparatus with the production of sounds; the fourth stage includes respiratory, voice and articulatory gymnastics with massage and automation of pronunciation of sounds; the fifth stage includes the automation of sounds in syllables, words and phrases.

Here, massage refers to the contact effect on myofascial complexes or systems (pelvic diaphragm, thoracic-abdominal diaphragm, cervicothoracic diaphragm, sublingual diaphragm and occipital-maxillary diaphragm, trunk muscles (thoracic anterior, posterior and lateral), neck muscles (back , front and sides), muscle-tendon complexes of the skull and face (skeletal and facial), muscles of the tongue (skeletal and own)) through the following techniques: compression - relaxation, compression - sliding, compression - stretching, compression - vibration, compression - spiral or vector rotation, vertical / horizontal compression, one-sided and two-sided, with possible combination with other techniques, pinch compression - stretching with rolling and stretching.

The main method is a long, controlled, accurate vertical compression (the angle of entry of the finger or palm and its borders is 45-90 degrees), or pinch compression (from small to large areas) to the dysfunction site (acupuncture point, trigger point, muscle clamp) and exit from it along the fascia, stretching along the path of the fascial vector, stretching, less often kneading, rubbing, rolling, twisting, squeezing the fascia.

All types of techniques can be applied with manual, finger and instrumental massage. The movements usually have a weak or moderate intensity and a large penetration depth to the point of stopping in the body tissues, taking into account the tone or fascial contraction on a particular muscle, or muscle group, or myofascial region.

The nature of this massage is mainly determined by four components. These are massage intensity, massage rate, massage duration and frequency. The intensity will depend on the feeling of emphasis in the tissues of the developed area. The force can be small - surface pressure from 5 to 10 g / cm², medium - from 10 to 100 g / cm² and large, deep pressure - from 100 to 1000 g / cm². The pace of movement can be medium or slow and will depend on the presence of tension in the tissues. Where the tone is increased and there is muscle tension, the pace will be slow and stopping, and successful passage along these paths will indicate a decrease in the excitability of the neuromuscular system. Where there is no tension, the movements will be sliding and light, and successful passage along these paths will talk about the normalization of the state of the neuromuscular system. Where the tone is lowered, the finger or palm will sink or penetrate into the muscle tissue deeper than described with hypertonicity and normotonicity, and the rate of movement may be average or close to fast. The duration or duration of the massage will depend on the specific stage of the proposed method for the correction of speech disorders. It is worth noting that the longer the massage is performed, the higher its inhibitory effect, therefore it is recommended to work with the child no more than 45 minutes, with an adult from 45 minutes to an hour, but no more.

This use of empirically selected techniques from various massage techniques, non-drug therapy was named by the author as logo-fascial massage (LFM). Logo-fascial massage as a kind includes in a special way and in a certain sequence elements for connective tissue (fascial) massage, periosteal (scleromeric) massage, acupuncture, acupuncture, dental, cosmetic, probe massage and self-massage combined for the correction of speech disorders (Methodical recommendations for face and neck massage CPKTB, Ministry of Life of the RSFSR, 1976; E. A. Dyakova. Speech therapy massage, 2005; Hauston. Acupuncture without needles, 1974; Thomas W. Myers. Anatomical trains. Practical guide, 2007 .; AM Khantemirov. Medical massage. Private methods of medical massage, 2009; Yu.V. Chikurov. Aesthetic manual modeling of the face and body, 2012; FM N. Osminina. Resurrection of the face, or Ordinary miracle. Theory and practice of youth restoration, 2013, AP Rachin. Myofascial pain syndrome. Diagnosis, approaches to non-drug therapy and prevention, 2016).

When conducting a full course of speech therapy rehabilitation in accordance with the claimed method, the frequency of massage sessions when working with the body can be as follows: 1 time per week, or 2 times a week (with an interval of 3 days), or for an intensive course 3 times a week, but to different parts of the body (with the capture of neighboring). The frequency of intraoral oral finger or instrumental massage can be in the following modes: 1 time per week, or 2 times a week (3 days break), or 3 times a week (every other day).

During the implementation of the rehabilitation program using LFM, the parallel use of other types of massage (osteopathy, manual therapy, classical general massage, classical speech therapy massage) is not recommended in order to avoid overloading the patient's body and distorting the purity of the results obtained.

The first stage of the implementation of the proposed method for the correction of speech disorders involves LFM of the peripheral parts of the speech apparatus:

- the thoracic region, from the cervicothoracic to the abdominal diaphragm (breathing apparatus), with the implementation of the relaxation of the diaphragms while mobilizing the sternum; in addition, the patient may be trained in forced chest and abdominal breathing and / or carried out vibration massage of the myofascial complex in the upper thoracic region;

- cervical region, from the occipital-maxillary to the cervicothoracic diaphragm (voice apparatus); in addition, the patient can be trained in forced voice delivery and / or vibromassage of the myofascial complex in the larynx;

- The craniofacial region, from the sublingual diaphragm to the head as a whole (articulatory apparatus).

The peculiarity is that at first the places of muscle attachment to bone structures or weaving into the skin, neighboring muscles, and then the muscle region itself are worked out. During the massage, you should not take your hands off the surface of the skin and make sharp transitions from one area to another. Massage is performed without skin-lubricating cosmetics, such as baby powder, talcum powder or massage oil, cream. Usually, the first stage takes from 3 sessions per region with the capture of neighboring ones, until the complete removal of myofascial blocks.

Usually, a massage of the cervical spine in front is performed with the completion of all structures attached to the temporal bone of the skull, to the lower border of the lower jaw, to the front surface of the hyoid bone (with the passage of large horns of the hyoid bone), to the sternum and upper surface of the clavicle.

Massage of the craniofacial section is performed first on the structures of the occipital and frontal zones (suboccipital muscles, trapezius muscle, frontal muscle), temporal zones (temporal masticatory muscles), zygomatic zones (pterygoid muscles and upper attachment of masticatory muscles), mandibular zones (lower attachment of masticatory muscles), parietal and mandibular zones (parietal aponeurosis and chin).

The development of skeletal and facial muscles of the face is performed in the following sequence: from the lower border of the angle of the lower jaw to the zygomatic arch and further to the temporal masticatory muscle. Then the following zones are worked out with the capture of neighboring ones: frontal and temporoparietal, nasolabial triangle, eye area, chin, lips, cheeks.

Additionally, at the first stage, massages of the wrists, palms and backs and fingers, massage of the ankle joints, feet and toes can be performed (for example, performed at home after training parents for children).

It is preferable to use at the first stage the following sequence of effects on myofascial regions according to the schemes:

Scheme number 1.1. LFM of the chest region (respiratory apparatus).

- Thoracic anterior front from the shoulder girdle to the pelvic, with working out of the pectoralis major, clavicular-sternum-axillary myofascial complex, the anterior dentate muscle, the external oblique muscle, the transverse muscle and the rectus abdominis muscle, while mobilizing the sternum and training the client for forced chest and abdominal breathing .

- Thoracic posterior and neck, with working out the trapezius muscle of the middle and upper portions along the spine (indented from the vertebrae by 1-2 centimeters to the sides) to the upper ridge line on the occipital bone and the mastoid processes of the temporal bone with an uninterrupted transition along the sternocleidomic mastoid muscles to the clavicular-scapular-acromial joint (in the position of the child on the back).

Scheme number 1.2. LFM of the thoracic and cervical region (respiratory and vocal apparatus).

- Thoracic region behind, back with practicing myofascial complex from the shoulder girdle to the pelvic with the capture of neighboring regions.

- A neck with working out of the posterior and lateral myofascial structures from the margin of the occipital suture to the superior ridge line along the occipital bone, mastoid processes of the temporal bone and to the clavicular-scapular-acromial joint (in the position of the child on the stomach).

- The shoulders and the clavicular-shoulder joint with the development of myofascial chains of the deltoid and latissimus muscles to the hands and fingers (in the position of the child on the back).

- The cervical spine in front with practicing all the structures attached to the lower border of the lower jaw, to the front surface of the hyoid bone (with the passage of the large horns of the hyoid bone), to the sternum and upper surface of the clavicles (in the position of the child on the back), if necessary, with training the client to force voice supply and vibration massage of the myofascial complex in the larynx or sternum.

Scheme number 1.3. LFM of the cervical region (voice, articulatory apparatus).

- Thoracic back and neck (in the position of the child on the back), see the description in the scheme №1.1.

- Shoulders and clavicular-shoulder joint, see description in Scheme No. 1.2.

- Cervical anterior, see description in diagram No. 1.2.

Scheme number 1.4. LFM of the cervical and craniofacial region (articulatory apparatus).

- Thoracic back and neck (in the position of the child on the back), see the description in the scheme №1.1.

- Cervical anterior, see description in diagram No. 1.2.

- The head. The development of myofascial structures of the occipital and frontal zones (suboccipital muscles, trapezius muscle, frontal muscle), temporal zones (temporal masticatory muscles), zygomatic zones (pterygoid muscles and upper attachment of masticatory muscles), mandibular zones (lower attachment of masticatory muscles), parietal and mandibular zones (parietal aponeurosis and chin).

- The face. Skeletal and facial muscle training in the following sequence: from the lower border of the angle of the lower jaw to the zygomatic arch and then to the temporal masticatory muscle. Then the following zones are worked out with the capture of neighboring ones: frontal and temporoparietal, nasolabial triangle, eye area, chin, lips, cheeks.

Scheme number 1.5. LFM of the cervical and craniofacial region (articulatory apparatus).

- Shoulders and clavicular-shoulder joint, see description in Scheme No. 1.2.

- Cervical anterior, see description in diagram No. 1.2.

- Head, face, see description in scheme No. 1.3.

Scheme number 1.6. LFM of the craniofacial region (articulatory apparatus).

- Head, face (working out of individual muscle groups), see description in scheme No. 1.3.

The second stage of the implementation of the proposed method involves conducting external and intraoral LFM articulation apparatus. Massage can be both finger and instrumental. Usually, from 3 sessions to complete removal of myofascial blocks and normalization of muscle tone. It is preferable to use the sequence of practicing myofascial regions according to the following schemes (may vary from the state of muscle tone of the tongue):

Scheme number 2.1. LFM of the intraoral region of the finger (can be applied in addition to the complex of schemes No. 1.2 - 1.6 from the first stage).

- Tooth-jaw arches of the lower and upper jaw, the bottom of the mouth.

- Hard and soft palate.

Scheme number 2.2. LFM of the intraoral region of the finger (can be applied in addition to the complex scheme No. 1.2 - 1.6 from the first stage).

- Tooth-jaw arches of the lower and upper jaw, the bottom of the mouth.

- The entire myofascial TMJ region with facial muscles.

- The root of the tongue.

- Hard and soft palate.

- Sublingual ligament of the tongue (with a shortened bridle).

Scheme number 2.3. LFM of the intraoral region is digital and instrumental.

- Tooth-jaw arches of the lower and upper jaw, the bottom of the mouth.

- The entire myofascial region of the TMJ with facial muscles using exercises to relax and reconfigure the TMJ.

- Hard and soft palate.

- Own muscles of the tongue with the addition of instrumental massage to the finger massage (probes, probe substitutes) and with the inclusion of sound production samples and the use of probe gymnastics.

- Sublingual ligament of the tongue (with a shortened bridle).

Scheme number 2.4. LFM of the intraoral region is digital and instrumental.

- Tooth-jaw arches of the lower jaw, bottom of the mouth.

- Own muscles of the tongue with the addition of instrumental massage to the finger massage (probes, probe substitutes) and with the inclusion of sound production samples and the use of probe gymnastics.

- Sublingual ligament of the tongue (with a shortened bridle).

Massage can be performed with a finger, instrumental or a combination thereof. In this case, an intraoral finger massage is performed first, and after the preparation of the tissues, instrumental massage is added. Massage is performed in a certain sequence: dento-jaw arches of the lower and upper jaw, bottom of the mouth; the entire myofascial region of the TMJ with facial muscles and using exercises to relax and reconfigure the TMJ; hard and soft palate; skeletal and own muscles of the tongue with the inclusion of sound production samples and the use of probe gymnastics; sublingual ligament of the tongue (practiced with a shortened bridle).

Intraoral finger massage is recommended 1-2 times a week with interruptions of at least 3 days. For the development of the intraoral region, 3 sessions are required, depending on the existing disorder and the individual dynamics of the body. Preferably, the massage session does not exceed 45 minutes.

The third stage of the implementation of the proposed method includes working with an articulation apparatus (external and intraoral, digital, instrumental / probe) with the inclusion of sound production samples. The stage takes place over 3 sessions and until the complete removal of myofascial blocks and normalization of muscle tone. When using instrumental massage and probe gymnastics (as an additional load), classic massage and staging probes (“Double Ball”, “Sleigh”, “Hatchet”, “Logozh”, “Snake”, “Komarik”) or probe substitutes (cutlery) are used : teaspoon and dessert fork). Sounds can be set using the same probes or a teaspoon during massage of the tongue. This stage is variable and flexible, the use of massage and staging techniques will depend on the tasks assigned to the speech therapist, the individual characteristics of the muscular and speech system of the child and the induction of certain sounds. At the discretion of the speech therapist, exercises to form the correct nasal and mouth and speech breathing, articulation exercises for the tongue, lips, jaw and facial muscles are dosed. Depending on the degree of speech impairment, the third and fourth stages can be combined at the discretion of a specialist.

The fourth stage of the implementation of the proposed method includes a comprehensive speech therapy session using massage techniques. The main time in the lesson is devoted to such exercises as breathing, voice, articulatory gymnastics with the production of sounds (mechanical, probe or mixed way of setting) and their automation with the pronunciation of sounds, syllables, phrases for the sound being worked out (class structure, sequence of exercises, occupancy and linguistic texts are described in literary sources: O.P. Sakharovskaya “Logopedic album. Integrated exercises for fixing sound (h) (l) (p) (s) in preschool children”, Publishing House Phoenix, 2019). The work of the finger and probe continues to normalize muscle tone, as well as auxiliary in the production of other sounds. The duration of the complex lesson should not exceed 45 minutes (for a child 4-7 years old), from this time up to 30 minutes are allocated for pedagogical exercises, up to 15 minutes for tongue massage, probe gymnastics and sound production mechanically. Depending on the degree of speech impairment, the fourth and fifth stages can be combined at the discretion of a specialist.

LFM continues to be used until the speech therapist sees the complete automation of the ability to pronounce all sounds, fixes the ease of introducing sounds into speech, without the difficulty in switching individual muscle groups in the articulating apparatus.

From this moment, the fifth stage begins, and correctional classes can be carried out without the use of massage techniques. Usually, the duration of classes for children on the automation of sounds in syllables, words, phrases does not exceed 45 minutes. The structure of classes for automating sounds, the sequence of exercises, the number of exercises and linguistic texts are described in the author's logopedic albums (O.P. Sakharovskaya “Logopedic album. Complex lessons for fixing sound (h) (l) (p) (c) in preschool children ”, Ed. Phoenix, 2019).

Thus, the claimed invention is a method of correcting speech disorders is complex and allows one specialist to work with speech impairment until it is completely corrected, without a temporary break, with significant time and additional efforts of other specialized specialists and parents, and also helps to improve the psychological state of the child and his emotional-volitional sphere.

EXAMPLES OF IMPLEMENTATION

The essence of the proposed method is illustrated by clinical and pedagogical examples from speech therapy practice:

Example 1

Patient: girl, 4 years old. During the diagnosis, a phonetic underdevelopment of speech in a child with erased dysarthria was established.

Reason for contact: The girl’s mother a month before coming to the author of the method filed a speech therapist with a complaint about speech therapy at the district clinic. According to the results of the visit, the erased form dysarthria was diagnosed (interdental pronunciation C, W, C); advice was given - to do gymnastics of the tongue (up-down, left-right), constantly repeat to the child that the tongue should be in the house (behind the lower teeth) and engage in the development of fine motor skills. A second consultation with a speech therapist was scheduled after 3 months.

During a visual examination revealed: face amimic and pale, anxious look, unsmiling and constrained; the neck is pulled into the shoulders, with the head tilted to the right side and turned to the left, slightly downward, the hyoid bone is slightly displaced posteriorly and upward; the right shoulder is higher than the left; shoulders are anterior; the left side of the body is pulled together.

On palpation, numerous painful muscle seals are determined in the muscles of the shoulder girdle, scalene muscles and sternocleidomastoid muscle on the right, in the suboccipital muscles on the right.

Visually, mainly diaphragmatic-abdominal breathing is observed (under normal conditions, the chest-abdominal type should be observed).

Speech status: the pronunciation of two groups of sounds is violated, namely, interdental sigmatism of wheezing sounds C, H, C, lambdacism, phonetic replacement of A with W, dysarthria (erased form).

Neuropsychological test for dysarthria is positive. The tongue is restless, in the search for an articulation posture behind the lower teeth, raising the tongue by the upper teeth and to the upper lip is difficult, switching of the movements of the lips and tongue is impaired, salivation, cyanicity of the tongue, the tone is increased in the root of the tongue, lowered at the tip of the tongue.

Static and dynamic tests were given: “Window”, “Fence”, “Tubule”, “Smile”, “We clean teeth”, “Spatula”, “Sweetie”, “Horse”, “Turkey”.

Speech conclusion: Phonetic underdevelopment of speech in a child with erased dysarthria.

With the child, correction of speech, functional and muscular-fascial disorders was carried out in accordance with the claimed invention and with the connection of 3 probes - “Logoezh”, “Snake”, “Hatchet” and probe substitutes “Spoon”, “Fork”.

Stage One (4 sessions):

Scheme number 1.1. LFM of the chest region (respiratory apparatus) - 1 session.

Scheme number 1.2. LFM of the thoracic and cervical region (respiratory and vocal apparatus) - 1 session.

Scheme number 1.3. LFM of the cervical region (voice, articulatory apparatus) - 1 session.

Scheme number 1.4. LFM of the cervical and craniofacial region (articulatory apparatus) - 1 session.

Stage Two (6 sessions):

Scheme number 1.5. LFM of the cervical and craniofacial region (articulatory apparatus) in combination with scheme No. 2.2. LFM of the intraoral region of the finger - 3 sessions.

Scheme number 1.6. LFM of the craniofacial region (articulatory apparatus) in combination with scheme No. 2.4. LFM of the intraoral region of the finger - 3 sessions.

Stage three, four and five were combined, as there was a good and fast dynamics in the normalization of muscle tone of the cervical and facial regions. Comprehensive speech therapy classes using massage techniques were carried out - 6 integrated classes and 4 classes in the fifth stage.

The main time in the classroom was devoted to articulation gymnastics, probe gymnastics (myofunctional dosed reloading, with weight-enhancing tongue muscles and resistance probes), setting sounds and their automation with pronunciation of sounds, syllables, phrases for the sound being worked out. The structure of such classes, the sequence of exercises, and the number of exercises and linguistic texts are reflected in the manual “Logopedic albums with comprehensive exercises for automating sounds” O.P. Sakharovskaya, 2019.

The terms of the general correctional program amounted to 20 visits (4 months in the regime 2 times a week, with a break for holidays and absenteeism). After classes, the speech corresponds to age norms.

Typically, with the classical approach, interdental sigmatism of whistling sounds can be corrected for a period of 1 calendar year to 3 years. Thus, the inventive method can significantly reduce the time to eliminate a speech defect due to the restoration of normal biomechanics of myofascial systems and subsequent pedagogical retraining and demonstrates a stable positive 100% result in speech status.

Example 2

Patient: boy, 6 years old; During the diagnosis, the phonetic-phonemic underdevelopment of speech in a child with erased form dysarthria was established.

Reason for appeal: the boy’s mother complained that the child from 5 to 6 years old attended the senior speech therapy group (1 academic year), but did not see any results and improvement in speech status, not a single sound was delivered, although at the same time, a speech therapist made it possible to learn verses for certain sounds at home (an individual diary with notes was presented).

During the initial diagnosis revealed:

Visual inspection: puffy face in the cheeks and pale, with a prickly look; the boy is not smiling and constrained; muscles of the forehead are tense and shifted towards the scalp. The neck is pulled into shoulders, with characteristic folds - a “necklace” from ear to ear. The head is tilted to the right side, turned to the left and tilted back a little. The right shoulder is higher than the left, the shoulders are flattened anteriorly, the back is stooped, the shoulder blades are displaced upward, the left side of the body is tightened. On palpation, numerous painful seals are determined in the muscles of the shoulder and chest girdles, the clavicle, scalene muscles and the sternocleidomastoid muscle on the right, in the suboccipital muscles on both sides of the head. On palpation, painful muscle seals in the temporal masticatory muscles are also determined. The muscles of the cheeks and lips on the outside are soft, puffy and weak. Visually determined mainly diaphragmatic-abdominal type of breathing.

Health status: obstructive bronchitis from infancy, remission, is registered in the dispensary. Up to 6 years of exacerbation of the disease every six months.

Speech status: the pronunciation of four groups of sounds (10 sounds) is violated with phonetic distortions and phonemic replacements of hissing sounds with whistling sounds, namely: bilateral lateral sigmatism of hissing sounds C, Z, C, labio-dental sigmatism of hissing sounds W, F, C, lambdacism L, Ll - absent, rotacism P, Pb throat pronunciation. The neuropsychological test for dysarthria is positive, the tongue is restless, in the search for an articulatory posture for the lower teeth, the tongue is raised for the upper teeth and the upper lip is difficult, the switchability of the movements of the lips and tongue is broken, salivation, the tone of the tongue is increased, synkinesia in the area of the speech apparatus, shoulders and arms .

Static and dynamic tests were given: “Window”, “Fence”, “Tubule”, “Smile”, “We clean teeth”, “Spatula”, “Sweetie”, “Watch”, “Horse”, “Turkey”, “Comb” .

Psychological status: labile emotional-volitional sphere, low motivation for learning, weak self-control. Intellectual development corresponds to a high level of age norm.

Speech conclusion: Phonetic-phonemic underdevelopment of speech in a child with erased dysarthria.

With the child, correction of speech, functional and muscular-fascial disorders was carried out in accordance with the claimed invention with the connection of probes and probe substitutes.

Stage One (10 sessions):

Scheme number 1.1. LFM of the chest region (breathing apparatus), 3 sessions.

Scheme number 1.2. LFM of the thoracic and cervical region (respiratory and vocal apparatus), 3 sessions.

Scheme number 1.3. LFM of the cervical region (voice, articulatory apparatus), 2 sessions.

Scheme number 1.4. LFM of the cervical and craniofacial region (articulatory apparatus), 2 sessions.

Stage Two (8 sessions):

Scheme number 1.5. LFM of the cervical and craniofacial region (articulatory apparatus) in combination with scheme No. 2.2. LFM of the intraoral region of the finger, 3 sessions.

Scheme number 1.6. LFM of the craniofacial region (articulatory apparatus) in combination with scheme No. 2.4. LFM of the intraoral region of the finger, 5 sessions.

Stage three, four and five were combined, as there was a good and fast dynamics in the normalization of muscle tone of the cervical and facial regions. Conducted comprehensive speech therapy sessions using massage techniques, 30 integrated classes and 12 in the fifth stage. Most of the time in the classes was devoted to articulatory gymnastics, probe gymnastics (myofunctional metered reloading, with weighting probes for the muscles of the tongue and resistance), setting sounds and their automation with pronunciation of sounds, syllables, phrases for the sound to be worked out (class structure, sequence of exercises, exercise filling and linguistic texts are reflected in “Speech Therapy Albums with Comprehensive Lessons on Sound Automation” by O.P. Sakharovskaya, 2019).

The terms of the general correctional program amounted to 10 months, of which the first 7 months with visits 2 times a week, then 3 months 1 time per week with a break due to seasonal diseases (60 meetings in total) according to the schemes and described stages of implementation

way. After classes, the speech corresponds to age norms.

Typically, with the classical approach, the specified speech impairment can be corrected for a period of 2 years or more. During the course of the program, the emotional-volitional background gradually became more stable and even, self-control and a healthy motivation for learning appeared, adequate self-esteem was formed (they did not turn to additional help from a psychologist and a neurologist). There were no relapses of obstructive bronchitis during the indicated period. In comparison with other known methods and technologies of speech therapy correction, it was possible to significantly reduce the time needed to eliminate a speech defect and psychological disorders due to the restoration of normal biomechanics of myofascial systems and subsequent pedagogical retraining. The inventive method demonstrates a stable, positive, 100% realizable result in speech status.

Example 3

Patient: girl, 8 years old. Motor aphasia, dysphonia against the background of previous neuroinfection with left-side hemiparesis.

Reason for appeal: the girl’s mother came to a 2-week speech restoration program. According to the mother, the daughter suffered neuroinfection at 6 years old, had left-side hemiparesis, but this was quickly dealt with, but speech was lost. Hypersalivation appeared. 2 years of rehabilitation with minimal dynamics of speech status. Until the moment of illness, the child developed in accordance with the age norm, including speech. Speech therapists at the place of residence (Severodvinsk) restored the work of the muscles of the mouth, some sounds began to appear. They made various diagnoses, first motor aphasia, then rewrote to aphonia. Now she is engaged with 2 speech therapists, visits a psychologist using neuropsychological methods to relax the body.

The initial diagnosis revealed the following: the face is puffy in the cheeks and pale, the eyes are anxious, the mouth is ajar, profuse salivation. The head is tilted down to the right side, with a left turn. The sternocleidomastoid muscle is not visualized on the right, protrudes on the left, is tense and stretched. The hyoid diaphragm is displaced posteriorly and upward, the larynx is displaced posteriorly, the musculoskeletal integument from the jugular fossa to the hyoid bone area is tightened and stiff. The right shoulder is higher than the left, the shoulders are brought forward, the shoulder blades are shifted up, the right side of the body is pulled together.

On palpation, numerous painful muscle seals are determined in the muscles of the shoulder and chest girdles, the clavicle, scalene and sternocleidomastoid muscles on both sides (the neck is “stiff”), in the suboccipital muscles on both sides of the head. Painful muscle seals in the temporal masticatory muscles, in the TMJ and in the jaw muscles of the jaw are also detected.

The muscles of the cheeks and lips on the outside are soft, puffy and weak. Tongue pulled back to throat, spasmodic. The soft palate is down. Paretically, when trying to pronounce the vowel sound “A”, the tongue moves even further backward, towards the palate and upward, the air from the lungs does not pass into the oral cavity. Involuntary facial expressions are preserved (facial muscles work, blinks when crying, frowns eyebrows), but at the request of a speech therapist, follow an instruction arbitrarily, for example, close your eyes or frown, extend your lips with a tube - it cannot perform the action. The request to repeat any word or phrase cannot, suffocates.

The diaphragmatic-abdominal type of breathing is predominantly visually determined (weak movement of the lower costal part), with deep inhalation and exhalation, the chest does not change in volume (there is no upper chest breathing). Nasal breathing prevails. There is no mouth breathing (with an arbitrary inhalation it begins to choke and blush).

Health Status:

According to the conclusion of MRI: there is an MR-picture of the zone of cystic-gliotic-atrophic changes in the right frontal and parietal lobes, areas of gliotic changes in the left frontal lobe, corpus callosum. Compared with the previous MR study (2 years ago) - without significant dynamics.

The first diagnosis of a neurologist is left-sided spastic hemiparesis of the first degree against the background of transferred encephalitis caused by the herpes simplex virus type I. Bilateral peripheral paresis of 7 pairs of FMN. Motor aphasia.

Re-diagnosis - the consequences of transferred viral encephalitis. Pseudobulbar syndrome. Paresis of the pharyngeal pharyngeal nerve.

Speech status: understands the addressed speech, executes instructions. Sociable, goes to the contact, adequate. Oral nasal breathing is not formed. There is no mouth breathing. With an arbitrary speech load, it begins to choke and blush. He pronounces the sounds of the whole alphabet with gross distortions without the participation of his tongue and lips, or there are no sounds. Sounds “squeezes”.

Psychological status: completed training in the general education program of the 1st grade. Cognitive development corresponds to a high level of age norm. In mathematics 5, there is a problem with reading and the Russian language. The emotional-volitional sphere is stable.

Speech conclusion: Severe dysarthria against the background of previous neuroinfection.

Within 14 days with the girl was held 6 sessions according to the program corresponding to the claimed invention.

The first two sessions were held every other day, then followed by a break of 3 days. Then - three sessions every other day and again a break of 3 days, then the final session.

The first session was conducted according to scheme No. 1.1. LFM of the thoracic region (respiratory apparatus) with the addition of paragraph 3 of scheme No. 1.4. LFM with calling vowels A, E, S, O, U. Day break.

The second session was conducted according to scheme No. 1.2. LFM of the thoracic and cervical region (respiratory and vocal apparatus) with simultaneous mobilization of the sternum and training the client for forced chest and abdominal breathing (from Scheme No. 1.1., Point 1 of the LFM), vibration massage of the myofascial complex in the larynx with the calling of vowels A, E, Y , O, Y and the addition of paragraph 3 of Scheme No. 1.4. LFM. Added scheme number 2.2. LFM of the intraoral region of the finger.

Three days break.

The third session was conducted according to scheme No. 1.3. LFM of the cervical region (voice, articulatory apparatus) with simultaneous mobilization of the sternum and training the patient for forced chest and abdominal breathing (from Scheme No. 1.1., Point 1 of the LFM), vibration massage of the myofascial complex in the larynx with the calling of vowels A, E, Y, O , And the addition of paragraphs 3, 4 of Scheme No. 1.4. LFM. Added scheme number 2.3. LFM of the intraoral region of the finger (without instrumental massage).

Day break.

The fourth session was conducted according to scheme No. 1.4. LFM of the cervical and craniofacial region (articulatory apparatus) with simultaneous mobilization of the sternum and training the client for forced chest and abdominal breathing (from Scheme No. 1.1., Point 1 of the LFM), vibration massage of the myofascial complex in the larynx with the calling of vowels A, E, Y , O, Y, and the addition of paragraphs 3.4 of Scheme No. 1.4. LFM.

Day break.

The fifth session was conducted according to the scheme No. 1.5. LFM of the cervical and craniofacial region (articulatory apparatus) and vibromassage of the myofascial complex in the larynx with the calling of vowels A, E, S, O, U (with the addition of paragraphs 3 and 4 from scheme No. 1.4.) And scheme No. 2.3. LFM of the intraoral region of the finger (without the use of instrumental massage).

Three days break.

The sixth session was conducted according to scheme No. 1.1, point 1 of the KAV of the thoracic region (respiratory apparatus) and by adding scheme No. 1.4. LFM and with the calling of vowels A, E, S, O, U, with the addition of scheme No. 2.3. LFM of the intraoral region of the finger (without the use of instrumental massage).

Correction Results:

After the first session of LFM, the girl began to chew gum, swallowed it immediately before (temporal masticatory, medial pterygoid, lateral pterygoid muscle, chewing biceps muscle, anterior abdomen), while her mouth is closed, her lips are closed and there is no salivation.

After the fourth session, expectoration, with flakes and lumps (this had not happened before), and most importantly, the girl began to control this process and spit (skeletal and own muscles of the tongue, facial muscles).

After the fifth session, I began to stick out my tongue from my mouth, reaching for my lower lip (before I could only reach my lower teeth). With a speech load on the vowel sounds A, E, S, O, U, the soft palate began to rise, the small tongue began to move back and forth, the color of the larynx normalized, and the root of the tongue began to sink down. As part of the massage sessions were able to achieve a clear sound vowel sounds.

At the beginning of the sixth session, when inhaling, the chest volume increased only on the right side. At the end of the sixth session, full bilateral opening of the thoracic diaphragm and its synchronization with the abdominal diaphragm were achieved. After the sixth session, during the week, according to my mother, the sound and purity of those words that she could speak earlier began to change and new words began to be spoken more clearly and clearly. For example, a bathhouse, a will, a woman, a grandfather, that is, she can read any words of the first syllable class and immediately explain what she read. There was an interest in reading new words.

It is recommended to continue studies at the place of residence with a neuropsychologist and speech therapist. Arrive at an intensive course after 3 months to conduct a diagnostic section and observe the dynamics.

Thus, the proposed “Method for the correction of speech disorders” demonstrates a positive result in speech status, even in severe cases.

Claims (6)

1. A method for correcting speech disorders, including conducting speech therapy sessions, characterized in that it is carried out in five stages: the first of which includes massage of the chest region, cervical region, facial region; the second stage includes external and intraoral massage of the articulation apparatus; the third stage includes massage of the articulation apparatus with the production of sounds; the fourth stage includes respiratory, voice and articulatory gymnastics with massage and automation of pronunciation of sounds; the fifth stage includes the automation of sounds in syllables, words and phrases. 2. The method according to claim 1, characterized in that the first stage includes manual and finger massage, the second stage includes external and intraoral finger massage, the third stage includes finger and instrumental massage. 3. The method according to claim 1, characterized in that in addition to massage of the thoracic region, they train forced chest-abdominal breathing and / or perform vibration massage of the upper thoracic region. 4. The method according to claim 1, characterized in that in addition to massage the cervical region, training is conducted by forced voice supply and / or larynx vibration massage. 5. The method according to claim 1, characterized in that the third and fourth stages are combined in one session. 6. The method according to claim 1, characterized in that the fourth and fifth stages are combined in one session.