Stages of corrective work with open rhinolalia - presentation. Presentation on speech therapy "open rhinolalia" The examination of sound pronunciation should include two aspects

Rhinolalia

DEFINITION

Rhinolalia - violation of the timbre of the voice and
sound pronunciation due to anatomical and physiological defects of speech
device.
The combination of disorders of articulation of sounds with disorders
the timbre of the voice makes it possible to distinguish rhinolalia from dyslalia and
rhinophony.
Rhinophonia is a disturbance in the timbre of the voice
normal articulation of speech sounds.
The term "rhinolalia" is appropriate only in cases where
there are also other disturbances of an articulation of sounds. V
In other cases, the term "rhinophony" is used.

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

Figure 1. Movement of the soft palate:
A - the soft palate is raised and tightly pressed against the back wall of the pharynx.
The timbre of the voice during the pronunciation of all speech sounds, except nasal,
normal;
B - the soft palate is raised and pressed against the thickened back wall
throats. The timbre of the voice is normal;
B - the soft palate is not raised enough. Contact between the soft palate
and the walls of the pharynx are absent. Exhaled air is free
enters the nasal cavity. Nasal voice timbre

Classification of rhinolalia
R I N O L A L I A
OPEN
FUN
CCI
SHE
LINEN
CLOSED
OR
GAN
ICH
EU
KA
I AM
ACQUIRED
FUN
CCI
SHE
LINEN
FRONT
CONGENITAL
MIXED
org
API
CHES
KAYA
REAR

FORMS OF RINOLALIA

Closed rhinolalia

CLOSED RINOLALIA
Closed rhinolalia is characterized by reduced
physiological nasal resonance during
pronunciation of speech sounds.
The strongest resonance in the norm is observed at
pronouncing nasal m, m "n, n".
In the process of articulating these sounds, the nasopharyngeal
the shutter remains open and air enters the
nasal cavity. If nasal resonance
missing, these phonemes sound like oral b, b", d,
d".
In addition to the pronunciation of nasal consonants with
closed rhinolalia disrupted pronunciation
vowels. It acquires an unnatural, dead
shade.

Closed rhinolalia. causes

CLOSED RINOLALIA. CAUSES
The most common causes of closed rhinolalia
are organic changes in the nasal
space or functional
palatopharyngeal occlusion disorders.
Organic changes are caused
painful symptoms, as a result
which decrease nasal patency and
nasal breathing is difficult.

Closed rhinolalia

CLOSED RINOLALIA
Front closed
rhinolalia
occurs when
chronic
mucosal hypertrophy
nose, mainly
posterior sections of the lower
shells, with polyps in
nasal cavity,
curvature
nasal septum and
nasal tumors
cavities.
Rear closed
rhinolalia
most often in children
is a consequence
big
adenoid
growths,
occasionally
nasopharyngeal
polyps,
fibroma or other
nasopharyngeal
tumors.

Closed rhinolalia

CLOSED RINOLALIA
functional
closed rhinolalia
Organic Closed
rhinolalia
common in children, but not
is always correctly recognized, because
occurs with good
patency of the nasal cavity and
undisturbed nasal breathing.
The timbre of nasal and vowel sounds
may be more disturbed than
with organic. Cause
is that the soft palate
in phonation and pronunciation
nasal sounds rises higher
norms and closes with a sound
waves access to the nasopharynx.
Similar events are more common
seen in neurotic
disorders in children.
conditioned
nasal obstruction
cavities. Once
appears correct
nasal breathing disappears
and defect. If after
elimination of obstruction
nasal cavity (eg.
after adenotomy)
closed rhinolalia or
rhinophony continues in
the usual form, resort
for the same exercises
and with functional
violations.

1. With functional closed rhinolalia

1. AT FUNCTIONAL CLOSED RINOLALIA
children are systematically exercised in pronunciation
nasal sounds. Preparatory
work on the differentiation of oral and nasal
inhale and exhale.
Then static breathing exercises
aggravated by vocal exercises.
It is also useful to use dynamic
gymnastics, in which respiratory movements
combined with the movements of the arms and torso.
Children are taught how to pronounce sounds
so that a strong vibration is felt in the area
alae and base of the nose.

2. With functional closed rhinolalia

2. IN FUNCTIONAL CLOSED RINOLALIA
Preschoolers are encouraged to pronounce the syllables pa, pe, pu, po, pi
so that the vowels sound slightly nasal. Same
way to work out the pronunciation of consonants in the position before
nasal sounds (syllables like am, om, mind, an).
After the child learns to pronounce these syllables correctly,
enter words that contain nasal sounds. He needs to
pronounce them exaggeratedly loudly and drawlingly with a strong
nasal resonance.
The final exercises are loud short and
prolonged pronunciation of vowel sounds. In addition, they are used
vocal exercises.
The duration of corrective work with functional
closed rhinophony is small.
With rhinolalia, the timing is longer and can be difficult to predict
in advance. This is due to the fact that with a functional closed
rhinolalia also requires the elimination of articulation defects
sounds. In addition, children with this form of rhinolalia often
some features of mental development are observed.

Open rhinolalia

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

Timbre of sounds

TIMBER OF SOUNDS
vowels
Significantly changed.
Most notably
timbre changes
vowels and and y, with
whose articulations
mouth is larger
all narrowed.
Less nasal sound
vowels e and o, and
even less disturbed
vowel a, since
his pronunciation
wide mouth
disclosed.
consonants
The timbre of some consonants is broken:
when making hissing sounds and
fricative f, v, x is added
wheezing sound in the nose
cavities;
plosives n, b, d, t, k and d, a
also sonorous l and p sound unclear,
since in the oral cavity it cannot
build up air pressure
necessary for their accurate
pronunciation.
With prolonged open rhinolalia
(especially organic) airy
jet in the oral cavity is so
weak, which is not enough to fluctuate
tip of the tongue, which is necessary
for the formation of the sound r.

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

Acquired open rhinolalia

ACQUIRED OPEN RINOLALIA
formed with trauma to the oral and nasal
cavity or as a result of acquired
paralysis of the soft palate.
Causes of functional
open rhinolalia can be different.
For example, it occurs during phonation in children with
flaccid articulation of the soft palate.
Functional open form manifests itself
with hysteria, sometimes as an independent
a defect, sometimes as an imitative one.

habitual open rhinolalia

Habitual open rhinolalia
One of the functional forms is observable, for example,
after removal of large adenoid growths, there is
as a result of prolonged limitation of the mobility of the soft
palate.
Functional examination with open rhinolalia is not
detects organic changes in hard or soft
palate.
A sign of functional open rhinolalia is
also what is usually broken pronunciation only
vowel sounds, while when pronouncing consonants
palatopharyngeal closure is good and nasalization is not
happening.
The prognosis for functional open rhinolalia is more than
favorable than with organic. Nasal timbre
disappears after phoniatric exercises, and violations
pronunciations are eliminated by the usual methods,
used in dyslalia.

Open rhinolalia

OPEN RINOLALIA
Rhinolalia due to congenital
nonunion of the lip and palate, represents a serious
problem for speech therapy and a number of sciences
medical cycle (surgical dentistry,
orthodontics, otolaryngology, medical
genetics, etc.).
Cleft lip and palate are the most
common and severe congenital
developmental defect.
As a result of this defect in children in the process of their
physical development there are serious
functional disorders,

1. Early development of a child with open rhinolalia

1. EARLY DEVELOPMENT OF A CHILD WITH OPEN RHINOLALIA
In children with congenital nonunion of the lip and palate
the act of sucking is very difficult. Special difficulties
it presents in children with a perforated cleft
lips and palate, and with bilateral through
crevices, this act is generally impossible.
Difficulty feeding leads to
weakening of vital forces, and the child becomes
susceptible to various diseases. V
most children with clefts
predisposed to catarrh
upper respiratory tract,
bronchitis, pneumonia, rickets,
anemia.

Often these children have
pathological changes in the ENT organs:
deviated nasal septum, deformity
wings of the nose, adenoids, hypertrophy (enlargement)
tonsils. Often they have
inflammatory processes in the nasal region.
The inflammatory process can go from
mucous membrane of the nose and pharynx on the Eustachian
tubes and cause inflammation of the middle ear.
Frequent otitis, often taking chronic
course, cause hearing loss.
Approximately 60-70% of children with cleft palate
have hearing loss of varying degrees (often
one ear) - from a slight decrease, not
interfering with speech comprehension
significant deafness.

With deviations in the anatomical structure of the lips and
the palate is closely related underdevelopment of the upper jaw
and malocclusion with defective
position of the teeth.
Numerous functional disorders
caused by a defect in the structure of the lip and palate, require
constant medical supervision.
Conditions have been created in our country for a comprehensive
treatment in specialized centers at research institutes
traumatology, at the departments of surgical
dentistry, as well as in other institutions where
a lot of preventive work is being done.
Doctors of various specialties observe children
and jointly adopt a comprehensive treatment plan.

During the first years of a child's life, the leading role
owned by a pediatrician who manages
feeding and daily routine of the baby,
carries out prevention and treatment,
if necessary, recommends outpatient
or inpatient treatment.
The otolaryngologist identifies and treats all painful
changes in the ear, nasal cavities, in,
nasopharynx and larynx and prepares children for
operations.
With mental retardation and
the presence of pronounced neurotic reactions
the child is consulted by a neurologist.

Upper lip repair surgery
(cheiloplasty) recommended in the first year
child's life; often produced in
maternity hospitals in the first days after
birth.
In cases of cleft palate, the orthodontist
uses a variety of tools, including
obturator, which facilitate nutrition and create
conditions for the development of speech in the preoperative
period.
Recovery operation
palate (uranoplasty)
carried out in most
cases in preschool
age.

According to the state of mental development, children with
Cleft palate is divided into three categories:
children with normal mental development;
children with mental retardation;
children with oligophrenia (of varying degrees).
On neurological examination, signs of severe
focal brain injury, usually not
are observed. Some children have separate
neurological microsigns. Much more common in children
functional disorders of the nervous system,
sometimes significantly pronounced psychogenic reactions,
increased excitability.
In addition to all of the above, congenital cleft palate
have a negative impact on the development of the child's speech.
Cleft lip and palate play a different role in
formation of speech underdevelopment. It depends on the size
and forms of anatomical defect.

types of cracks:

TYPES OF CLEVICES:
1)
cleft lip; upper lip and
alveolar process;
2) clefts of the hard and soft palate;
3) clefts of the upper lip, alveolar
process and palate - one- and two-sided;
4) submucosal (submucosal) clefts
palate.

Figure 2.
left-sided
cleft
Figure 3
left-sided
cleft lip
and alveolar
hard palate process

With cleft lip and palate, all sounds become nasal
or a nasal tint that grossly disrupts intelligibility
speech.
Typical is the imposition on nasalized sounds
additional noises such as breathing, snoring,
throatiness, etc.
There is a specific violation of the timbre of the voice and
sound pronunciation.
To prevent the passage of food through the nose, a child with
at an early age acquires the habit of lifting
the back of the tongue to block the passage to the nasal
cavity. This position of the tongue becomes habitual and also
changes the articulation of sounds.
During speech, children usually open their mouths little and are taller than
required, raise the back of the tongue. Tip of the tongue due to
it does not move fully. This habit worsens
speech quality, as with a high position of the jaw and tongue
the oral cavity takes on a shape conducive to
air entering the nose, which increases nasality.

When trying to pronounce the sounds p, b, f, c a child with rhinolalia
uses his own methods.
The sounds are replaced by a pharyngeal click, which is very
uniquely characterizes the speech of a child with a severe form
rhinolalia.
A specific click, reminiscent of the sound of a valve,
formed when the epiglottis touches the posterior
part of the language.
Direct correspondence between the size of the palatal defect and
the degree of speech distortion was not established.
This is due to large individual differences in
changes in the nasal and oral cavities in children,
ratio of resonating cavities and compensatory
techniques that each child uses to improve
intelligibility of your speech.
In addition, the intelligibility of speech depends on age and
individual psychological characteristics of children.

Components of intonation

COMPONENTS OF INTONATION
Components
intonation
stress
Melody of speech
Speech rate
Timbre
Pause
Characteristic
linguistic phenomenon based on
intensity, power of sound. For intonation of speech
word stress is significant (power and tonal
top of the word) and semantic stresses:
syntagmatic, phrasal, logical
Speech Tone Contour - Pitch Modulation
(increase - decrease) of the main tone of the voice at
pronunciation of a phrase
Speech rate, acceleration or
slowing down its segments (sounds, syllables, words). Depends on
pronunciation style, meaning of speech, emotional
state of the speaker, emotional content
speeches
Additional coloration of sound that communicates speech
various emotional and expressive shades of voice
Intonation means, stop in speech, break
sound

Classification of congenital cleft lip and palate
CONGENITAL CLIFFS OF THE UPPER LIP
HIDDEN
INCOMPLETE
Without
deformations
skin-cartilaginous
nose
WITH
deformation
skin-cartilaginous
nose
COMPLETE

CONGENITAL CLEFT PALATE
SUBMUCOSE
cleft palate
COMPLETE
INCOMPLETE
SUBMUCOSE
CLEVICE OF SOFT AND HARD
SKY
COMPLETE
INCOMPLETE
COMPLETE CLEVICE
ALVEOLAR PROCESS,
HARD AND SOFT PALATE
SINGLE SIDE
DOUBLE SIDE
COMPLETE CLEVICE
ALVEOLAR PROCESS AND
ANTERIOR HARD PALATE
SINGLE SIDE
DOUBLE SIDE

The examination of sound pronunciation should include two aspects.

SURVEY OF SOUND PRODUCTION
MUST PROVIDE TWO ASPECTS.
1. Articulatory
suggests
clarification
features
sound formation
speech and
functioning
organs of articulation
in progress
pronunciation.
2. Phonological
aims
find out how
child distinguishes
speech system
sounds (phonemes)
various
phonetic
conditions.
These two aspects
closely connected
between themselves.

The examination of sounds begins with a thorough check of the isolated pronunciation of sounds, then they check the pronunciation of sounds in syllables, with

SOUND EXAMINATION BEGINS WITH
CAREFULL CHECK OF THE ISOLATED
PRONUNCIATIONS OF SOUNDS, THEN CHECK
PRONUNCIATION OF SOUNDS IN SYLLABLES, WORDS
AND PHRASE SPEECH.
When examining each group of sounds
note how the child pronounces
sound isolated, indicating character
violations.
The degree of nasality is also noted with
pronunciation of vowels and consonants and
the presence of compensatory "grimaces".

During the examination, exercises are used, consisting in repeated repetition of one sound,

WHEN THE EXAMINATION IS USED
EXERCISES CONSISTING IN MULTIPLE
REPEAT ONE SOUND,
because at the same time
conditions are created
reducing
articulatory
switching from
one sound per
another
This gives
opportunity
discover
peculiarities
motor area,
especially in cases
combinations
rhinolalia with
"erased" form
dysarthria.

Important for logopedic analysis is the identification

IMPORTANT FOR LOGOPEDIC ANALYSIS IS
DETECTION
1) ability to
clear
articulatory
switching
To do this, the child repeats two
sound or syllable, suggesting a clear
articulatory switching (for example,
cap-pack).
First, sounds are given, articulatory
sharply different from each other, then
closer ones.
At the same time, the speech therapist fixes cases when
child fails to motor switch
from one sound to another, and instead of
to repeat the final sound of the first
syllable, pronounces the previous one.
2) appearances
"average"
articulation
For example,
instead of d and d
pronounced
semi-voiced
sound,
instead of g and g‘ -
semi-soft).

Then the speech therapist finds out how the child uses sounds in speech.

THEN THE SPEAKING THERAPIST FINDS HOW
THE CHILD USES SOUNDS IN SPEECH.
When checking, attention is paid to substitutions,
distortion, mixing, skipping sounds. With this
The aim is to examine the pronunciation of words.
The child is presented with a set of pictures,
including words from the tested sounds.
The desired sound must be in words in different
positions. For example, on whistling and hissing
sounds can be such words (pictures): dog,
wheel, nose, pine, shepherd, cash desk.
The speech therapist pays special attention to how
the child pronounces sounds in phrasal speech.

the ability to switch articulatory movements is revealed in the child.

THE CHILD IS DETECTED TO
SWITCHING ARTICULATION MOVEMENTS.
The child is asked to repeat
sound or syllable series, and then change
sequence of sounds or syllables.
Speech therapist notes: is it easy
switching.
For instance:
a-and-y
y-and-a
ka-pa-ta
pa-ta-ka
pla-pl-plo
plo-pl-pla

The ability to pronounce simple and complex words in syllabic structure is examined.

PROnunciation is tested
SIMPLE AND COMPLEX IN SYLL STRUCTURE.
The speech therapist presents children with subject
pictures for naming, then pronounces
words for reflected reproduction.
The results of both tasks
compared.
The speech therapist fixes that the child succeeds
it is better.
He especially notes the words that are pronounced
without distortion of the syllabic and sound composition.

They find out what sounds the words consist of, the syllabic structure of which is distorted - from learned or unlearned.

FIND OUT WHAT SOUNDS THE WORDS MAKE
WHICH SYMBOLIC STRUCTURE IS DISTORTED - FROM
LEARNED OR NOT LEARNED.
The character is noted
distortion:
1) reduction in the number of syllables
("womb" instead of a hammer),
2) simplification of syllables ("tul"
instead of a chair);
3) likening syllables
("tattoo" instead of
stool);
4) adding the number of syllables
("comanamata" instead of
room);
5) permutation of syllables and
sounds ("devero" instead of
tree).

The ability to pronounce sounds in sentences made up of sounds that the child pronounces correctly and in isolation is checked.

THE ABILITY TO PRONECT SOUNDS IN SENTENCES IS TESTED,
COMPOSED FROM SOUNDS WHICH IN ISOLATED FORM
THE CHILD SPEAKS CORRECTLY AND DISTRATEDLY.
To identify
non-gross violations
syllabic structure
words for children
offered for
repetition
sentences like
"Petya drinks bitter
medicine",
"At the crossroads
a policeman is standing.

To determine open rhinolalia
There are different methods of functional
research. The simplest one is
called the Gutzmann test. child
forced to alternately repeat vowels a
and and, while either clamping or opening
nasal passages. With an open form
there is a significant difference in
the sound of these vowels. With pinched nose
sounds, especially and, are muffled and
at the same time, the speech therapist's fingers feel
strong vibration on the wings of the nose.
You can use a phonendoscope.
The examiner inserts one "olive" into his ear,

In speech therapy, four categories of sound pronunciation defects are distinguished: absence of sound, sound distortion, sound replacement and sound mixing.

IN SPEECH THERAPY THERE ARE FOUR CATEGORIES OF DEFECTS
AUDIO: NO SOUND, DISTORTION
SOUND SUBSTITUTION, SOUND SUBSTITUTION AND SOUND MIXING.
Lack of sound, especially
difficult to articulate, observed in children
Often. It may appear in the form
constant loss of sound in words
of varying complexity and in the inability of the child
pronounce it in isolation.
This type of violation is stable
defect.
Sometimes in the speech of children with good
phonemic perception instead of complete
sound dropouts appear in some
overtones positions.

Typical is the "pharyngeal" sounding of the posterior palate due to excessively deep articulation.

TYPICAL
IS A "PHARINGEAL" SOUND
POSTOPALATINE SOUNDS DUE TO EXCESSIVELY DEEP
ARTICULATIONS.
The appearance of overtones, especially in
sound combinations like SSG,
also characteristic of children with excessive,
exaggerated articulation,
when as independent sounds
there are short-term transitional phases
articulation,
in ordinary speech are not perceived by the listener.
In the same children, along with insertions of sounds
frequent omissions of sounds or their
reduction, which simplifies the articulation of difficult
consonant clusters.

Often missing sounds are replaced with distorted sounds over time

FREQUENTLY MISSING CO SOUNDS
TIME IS REPLACED BY DISTORTED
Sound distortion is also characterized by its stability in
various forms of speech.
Such categories of defects as mixing and replacement of sounds constitute
special group, since in these deviations from the norm
pronunciation manifests instability of the entire sound system
language.
Sounds can be correctly pronounced in one position in a word and
mix in others. One sound can have several different
substitutes. Sound replacements can be permanent or temporary.
character - in different forms of speech in different ways.
In these two categories of phonological defects,
there is a violation of the system of sound oppositions. V
depending on the number of mixed sounds, it affects either
the entire sound system of the language, or part of the system.
Such a state of sound pronunciation should alert the speech therapist, as
how it is diagnostic for identifying phonemic
underdevelopment.

Violations of sound pronunciation are compared with the features of the rhythmic-syllabic structure.

PRONUNCIATION DISORDERS
MATCH WITH FEATURES
Rhythmic-syllable structure.
Replacement and mixing of sounds, insufficient
distinction of sounds and violation of the rhythmic-syllabic structure - signs typical
for general underdevelopment of speech.
The final conclusion can be drawn after
surveys of lexico-grammatical
sides of speech.

examination of the structure of the articulatory apparatus and its motility

BUILDING SURVEY
ARTICULATION APPARATUS AND ITS
MOTOR SKILLS
During the examination, it is necessary to assess the degree and quality
violations of motor functions of organs
articulation and reveal the level of available movements.
First of all, it is necessary to characterize the features
structures of the articulatory apparatus and defects
anatomical character.
The speech therapist notes whether the following features are present:
lips: splitting of the upper lip, postoperative
scars, shortened upper lip;
teeth: malocclusion and planting of teeth;
tongue: large, narrow; shortening of the hyoid
ligaments;
hard palate: narrow, domed ("Gothic"),
soft palate: short soft palate, bifid
small tongue or no tongue.

Submucosal cleft palate (submucosal cleft)

SUBMUCOUS cleft palate
(SUBMUCOUS CLEFT)
usually difficult to diagnose because it
covered with mucous membrane.
You need to pay attention to the back
hard palate, which during phonation
retracts in the form of a small triangle,
angled forward.
The mucous membrane in this place is thinned and
has a paler color.
In unclear cases, the otolaryngologist should
determine the condition of the palate by carefully
palpation.

With palatine clefts, deformation of the jaws, improper development and arrangement of teeth, ununited upper lip, deformity are usually combined.

USUALLY COMBINED WITH CLIFCHES
JAW DEFORMATION, IMPROPER DEVELOPMENT AND
POSITIONING OF TEETH, NON-UNITED UPPER LIP,
DEFORMED NOSTRILS, ETC.
The movements of the muscles of the face, tongue and lips are sluggish,
the rudiments of the soft palate and uvula are inactive,
hanging passively.
Weakly developed muscles of the posterior wall of the pharynx.
The root of the tongue is overdeveloped, and the tip remains
weak and not fully moving.
When examining the structure of the articulatory
apparatus, the speech therapist also notes the presence
deformities: sagging of one corner of the mouth, deviation in
one side of the tongue, hanging one half
soft palate, etc.

note the strength of the movement, its accuracy, speed, fixity.

NOTICE THE FORCE OF MOVEMENT, ITS ACCURACY,
FAST, FIXED.
Pareticity of the tongue and lips is manifested in a small volume
movements, in their inaccuracy, exhaustion, unevenness.
The movements of the tongue must be of such force that
keep it in the right position for so long,
how long does it take to pronounce one or another
phonemes.
Speed and accuracy of articulatory movements
affects the intelligibility of pronunciation.
It is important to note the increased tone of the tongue, which
expressed in his tension, a sharp advance
tip of the tongue, twitching with arbitrary
movements, which indicates tonic disorders.

Paralysis of the uvula of the soft palate is always reflected in
functional state of the language and secondarily violates
articulation of lingual sounds, making the whole process
articulation tense and slow.
The uvula, hanging motionless along the midline,
indicates bilateral paresis. In cases of unilateral
paresis, it deviates to the "healthy" side.
It is also important to identify the condition of the soft palate: raising
palatine curtain with energetic pronunciation of the sound a,
the presence or absence of air leakage through the nose
pronunciation of vowels, uniformity of leakage;
the presence or absence of a pharyngeal reflex (appearance
emetic movements when lightly touched with a spatula to
soft palate).
It should be borne in mind that articulatory difficulties in
Spontaneous speech may be enhanced by factors such as
excitement, fatigue, complication of content
speech in intellectual or linguistic
respect.

Phonemic perception

PHONEMATIC PERCEPTION
In children with
normal
physical hearing
are often observed
specific
difficulties in
subtle
differential
signs of phonemes,
providing
impact on the whole
further
sound development
sides of speech.
Phonemic perception in children with
pronounced defects in articulation
apparatus develops in inferior conditions
and may vary.
To determine his condition, usually
methods are used to:
recognition, distinction and comparison of simple phrases;
selection and memorization of certain words in
a number of others (similar in sound composition,
different in sound composition);
distinguishing individual sounds in a series of sounds, then
in syllables and words (different in sound composition,
similar in sound composition);
memorization of syllable rows consisting of two-four elements (with a change in the vowel sound
- ma-me-mu, with a change in consonant sound - kava-ta);
memorization of sound sequences.

Phonemic perception

PHONEMATIC PERCEPTION
In order to reveal the child's ability to perceive rhythmic structures
tasks of varying difficulty are:
tap out the number of syllables in words of different syllabic complexity;
guess which of the presented pictures corresponds to the one given by the speech therapist
rhythmic pattern.
An examination of the discrimination of speech sounds can be started with repetition tasks.
isolated sounds or pairs of sounds.
Deviations in phonemic perception are most clearly manifested when
repetition by the child of phonemes close in sound (b-p, s-sh, r-l, etc.).
In this case, the child is offered to repeat syllable combinations consisting of such
sounds: sa-sha, sha-sa, sa-sha-sa, sha-sa-sha, sa-za, za-sa, sa-za-sa, etc.
Particular attention should be paid to distinguish between whistling, hissing,
affricates, sonorants, as well as deaf and voiced sounds.
When performing tasks of this type, some children experience obvious difficulties.
when repeating sounds that differ in acoustic characteristics (voicedness, deafness), while another category of children finds it difficult to repeat sounds,
differing in articulation.
Cases can be identified when the task is to reproduce a series of three syllables
is inaccessible to the child or causes certain difficulties.
Particular attention should be paid to the phenomena of perseveration, when the child cannot
switch from pronouncing one sound to pronouncing another.

Phonemic perception

PHONEMATIC PERCEPTION
When examining phonemic perception, it is advisable
use tasks that exclude articulation to
pronunciation difficulties did not affect the quality of differentiation.
So, a speech therapist pronounces the desired sound in a number of other sounds, how abruptly
different, and similar in acoustic and articulatory
signs. Having heard the given sound, the child raises his hand.
For example, you can invite the child to isolate the sound from the sound
series o, a, y, o, y, s, o or the syllable sha from the syllable series sa, sha, tsa, cha,
sha, sha.
Well reveals the shortcomings of phonemic perception task for
selection of subject pictures whose names begin with
the given sound (“Pick up pictures for sound p and sound l;
to the sound s and the sound sh, to the sound s and the sound z”, etc.).
The speech therapist selects sets of pictures in advance, and then
mix randomly.
Less obvious difficulty in distinguishing speech sounds may be
discovered during a survey of sound analysis skills.

As a result of the examination of the sound side of speech and comparison with the data of the survey of other sides of speech, the speech therapist should have a clear

AS A RESULT OF THE SURVEY
PARTIES OF SPEECH
AND COMPARISON WITH DATA
SURVEYS OF OTHER SIDES OF SPEECH
A SPEECH THERAPIST SHOULD BE SUCCESSFUL
A CLEAR VIEW OF WHAT
ARE THE DISCOVERED VIOLATIONS
INDEPENDENT DEFECT
OR INCLUDED IN THE STRUCTURE OF THE GENERAL
SPEECH UNDEVELOPMENT
AS ONE OF ITS COMPONENTS.
This depends on the setting of specific
corrective tasks.

conversation with parents

CONVERSATION WITH PARENTS
Significant for the effectiveness of speech correction
defect has a skillfully constructed conversation with parents who
in an accessible form it is necessary to explain the mechanism of correct
speech breathing and the need for daily monitoring of
sound and voice.
For a child who was born with a cleft palate and
soft palate, the period of babbling and the initial period of speech proceeds
under special conditions.
The kid hears well, rejoices at the speech addressed to him and
gradually begins to understand it. But due to the lack of a shutter
between the oral and nasal cavities, it is unable to
pronounce sounds.
All voice production has nasal resonance, and articulation
most consonants are absolutely not realized. Kid don't
can acquire speech by imitation, as occurs in
norm.
In such anatomical conditions, the child remains up to
operations.

conversation with parents

CONVERSATION WITH PARENTS
It is the daily duty of parents to encourage any attempt
pronounce a sound, a word, try to understand even a barely intelligible speech.
It is important to draw their attention to the importance of medical care.
Parents should be fully aware that surgical treatment
does not provide normal speech, but only creates full-fledged anatomical and physiological conditions for educating the correct pronunciation.
It is also necessary to set up parents for the daily consolidation of all
achieved results.
It often happens that the somatic weakness of a child with rhinolalia,
the presence of a speech defect causes constant anxiety in parents,
anxiety for any reason, the need for excessive custody of the baby,
distrust of his abilities. This attitude only exacerbates the defect,
strengthens the child's neurotic reactions and undermines his confidence in
in their power.
A speech therapist should help such children cope with indecision,
inability to stand up for oneself, get rid of fear and concern for quality
of his speech.
It is equally important to provide them with contact and full-fledged relationships with
peers.

Speech therapy impact

LOGOPEDIC IMPACT

Methodological techniques for the elimination of rhinolalia have been developed in domestic speech therapy.

IN DOMESTIC LOGOPEDICS
METHODOLOGICAL TECHNIQUES DEVELOPED
TO ELIMINATE RINOLALIA
E. F. Pay, 1933;
F. A. Pay, 1933;
3. G. Nelyubova, 1938;
V. V. Kukol, 1941;
A. G. Ippolitova, 1955, 1963;
3. A. Repina, 1970;
I. I. Ermakova, 1984;
G. V. Chirkina, 1987;
Volosovets T. V. 1995

system developed by A.G. Ippolitova

SYSTEM DEVELOPED
A.G. HIPPOLITOVOY
This system is highly effective in correcting sound pronunciation.
in children who do not have deviations in phonemic development.
A. G. Ippolitova was one of the first to recommend classes in
preoperative period. Characteristic of her methodology is
a combination of breathing and articulation exercises,
the sequence of working out sounds, due to
articulatory interconnectedness.
The sequence of work on sounds is determined
preparedness of the articulatory base of the tongue. Availability
full-fledged sounds of one group is an arbitrary basis
to form the next. The so-called
"basic" sounds.
Preparation of the articulatory sound base is carried out using
special articulation gymnastics, which is combined with
the development of the child's speech breathing.
The peculiarity of the method of A. G. Ippolitova is that when
evoking a sound, the child's initial attention is directed
only on the article.

The content of speech therapy classes according to the method of A. G. Ippolitova includes the following sections:

CONTENT OF SPEECH THERAPY CLASSES
ACCORDING TO THE METHOD OF A. G. IPPOLITOVA
INCLUDES THE FOLLOWING SECTIONS:
1.
The formation of speech breathing during
differentiation of inhalation and exhalation.
2. Formation of a long mouth
expiration when realized by the article of vowels
sounds (without including the voice) and fricatives
deaf consonants.
3. Differentiation of short and long
oral and nasal exhalation during the formation
sonorants and affricates.
4. Formation of soft sounds.

Methodology of L. I. Vansovskaya (1977)

METHOD OF L. I. VANSOVSKAYA (1977)
L. I. Vansovskaya proposed to start eliminating
nasalization not from the traditional sound but from the front vowels
and and e, since it is they that allow you to focus
exhaled stream of air in the anterior part of the oral cavity
and direct the tongue towards the lower incisors.
This enhances the clarity of kinesthesia with
contact with the lower incisors; when making a sound
and the walls of the pharynx and soft palate are more actively involved.
The child is required to pronounce sounds in a low voice,
with a slightly protruding jaw, with a half smile, with
increased tension of the soft palate and pharyngeal muscles.
After eliminating the nasalization of vowels, work is carried out
over sonors (l, p), then fricative and stop consonants.

X-ray method.

RADIOGRAPHY METHOD.
On the improvement of methods for correcting speech defects in
rhinolalia was influenced by the study method
radiography. It made it possible to predict the possibility
restoring the function of the palate with speech therapy techniques (N.I.
Serebrov, 1969).
Analysis of radiographs revealed the dependence of efficiency
speech therapy work from the mobility of the soft palate and back
throat walls; from the distance between the posterior pharyngeal wall and
soft palate; from the width of the middle part of the pharynx.
Comparison of these data even before the start of speech therapy
work makes it possible to resolve the issue of the degree of compensation
speech defect by conventional means.
Methods of differentiated speech therapy work in
depending on the anatomical and functional features
articulatory apparatus developed by T. N. Vorontsova
(1966).

Techniques

METHODS
With regard to adults, the technique of S. L.
Taptapova (1963), which suggests a peculiar mode
silence - the pronunciation of vowels to oneself. This
removes grimaces and prepares pronunciation without
nasalization. Vocal exercises are recommended.
I. I. Ermakova (1980) developed a step-by-step methodology
correction of sound pronunciation and voice. She established
age-related features of functional disorders
voice formation in children with congenital clefts and
in relation to them, orthophonic
exercises. Special attention has been paid
postoperative period and recommended methods
development of mobility of the soft palate, preventing it
shortening after surgical plastics.

Speech therapy for open rhinolalia

LOGOPEDIC
IMPACT IN OPEN RINOLALIA
Tasks of corrective work:
normalization of oral exhalation, development of a long oral
air jet
development of the correct articulation of all sounds
elimination of nasal tone of voice
education of skills of differentiating sounds
normalization of prosodic components of speech
automation of acquired speech skills in communication
In the preoperative period:
Facial release
muscles from compensatory
movements
Preparing the right
vowel pronunciation
Preparing the right
articulations available
consonants
Constant
control of
direction
air jet
Operation
Specific types of work in
postoperative period:
soft palate massage
Gymnastics of the soft palate and back
pharyngeal walls
Articulation gymnastics
Voice exercises
Breathing exercises
In the postoperative
period:
Development of mobility
soft palate
Elimination of defects
sound pronunciation
Overcoming nasal
tone of voice

Speech therapy sessions with a child
start in the preoperative period to
prevent major changes in
functioning of the organs of speech.
At this stage, the activity of the soft
palate, the position of the root of the tongue is normalized,
the muscular activity of the lips is enhanced, a directed oral exhalation is developed.
All this, taken together, creates favorable conditions
to improve the efficiency of the operation and
subsequent correction. 15-20 days after the operation, special exercises are repeated; but now
the main purpose of the classes is to develop
mobility of the soft palate.
The study of the speech activity of children suffering from
rhinolalia, shows that inferior, anatomical and physiological conditions of speech formation,
limitation of the motor component of speech does not lead to
only to the anomalous development of its sonic side, but
in some cases and to a deeper systemic disorder

With the age of the child, the indicators of speech
development worsens (compared with
indicators of normally speaking children),
the structure of the defect is complicated by
violations of various forms of written speech.
Early correction of speech deviations
development in children with rhinolalia has
extremely important social and psychological and pedagogical significance for the normalization
speech, prevention of learning difficulties and
choice of profession.
Setting Corrective Tasks
determined by the results of a speech examination
children.

OBJECTIVES AND CONTENT OF CORRECTIONAL WORK

Formation of phonetically correct speech in children
preschool age with congenital cleft
palate, aimed at solving several
interrelated tasks:
1) normalization of "oral exhalation", i.e. development
long oral jet when pronouncing all sounds
speech other than nasal;
2) development of the correct articulation of all speech sounds;
3) elimination of nasal tone of voice;
4) educating the skills of differentiating sounds in order to
prevention of defects in sound analysis;
5) normalization of the prosodic aspect of speech;
6) automation of acquired skills in free
verbal communication.

When correcting the sound side of speech, the assimilation of the correct pronunciation skills goes through 4 stages

WHEN CORRECTING THE SOUND SIDE OF SPEECH
LEARNING THE RIGHT SKILLS
SPEECH IS PASSING
4 STAGES
The first stage is the stage of "pre-speech"
exercises - includes the following types
works:
1) breathing exercises;
2) articulatory gymnastics;
3) articulation of isolated sounds or
quasi-articulation (since isolated
pronunciation of sounds is atypical for speech
activities);
4) syllable exercises.
At this stage, mainly
motor skill training
initial unconditioned reflex movements.

Rhinolalia

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

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

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

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

During speech, the soft palate continuously descends and rises to different heights depending on the sounds being uttered and the rate of speech. The strength of the palatopharyngeal closure depends on the sounds being uttered. It is less for vowels than for consonants. The weakest palatopharyngeal closure is observed with the consonant "v", the strongest - with "c", usually 6-7 times stronger than with "a". During normal pronunciation of nasal sounds m, m", n, n" the air stream freely penetrates into the space of the nasal resonator.

Depending on the nature of the dysfunction of the palatopharyngeal closure, various forms of rhinolalia are distinguished.

Forms of rhinolalia and features of sound pronunciation

Open rhinolalia

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

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

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

Diagnostics

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

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

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

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

Organic open rhinolalia can be acquired or congenital. Acquired open rhinolalia is formed during perforation of the hard and soft palate, with cicatricial changes, paresis and paralysis of the soft palate. The cause may be damage to the glossopharyngeal and vagus nerves, wounds, tumor pressure, etc.

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

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

The frequency of birth of children with clefts is different among different peoples, in different countries and even in different areas of each country. A. A. Limberg (1964), summarizing the information from the literature, notes that for 600-1000 newborns, one child is born with a cleft lip and palate. Currently, the birth rate in different countries of children with congenital pathology of the face and jaws ranges from 1 per 500 newborns to 1 per 2500 with a tendency to increase over the past 15 years.

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

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

The critical period for nonunion of the upper lip and palate is the 7-8th week of embryogenesis.

The presence of a congenital cleft lip or palate is a common symptom for many nosological forms of hereditary diseases. Genetic analysis shows that the familial nature of cleft lip and palate is quite rare. However, genetic counseling of families for the purpose of diagnosis and prevention is of great importance. At present, microsigns of cleft lips and palate have been identified in parents: a furrow in the palate or uvula of the soft palate, a cleft uvula, an asymmetric tip of the nose, an asymmetric arrangement of the bases of the wings of the nose (N. I. Kasparova, 1981).

Children with congenital clefts have serious functional disorders (sucking, swallowing, external respiration, etc.), which reduce resistance to various diseases. They need systematic medical supervision and treatment. According to the state of mental development, children with clefts constitute a very heterogeneous group: children with normal, mental development; with mental retardation; with oligophrenia (of varying degrees). Some children have individual neurological micro-signs: nystagmus, slight asymmetry of the palpebral fissures, nasolabial folds, increased tendon and peristal reflexes. In these cases, rhinolalia is complicated by early damage to the center of the nervous system. Much more often, children have functional disorders of the nervous system, pronounced psychogenic reactions to their defect, increased excitability, etc.

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

Closed rhinolalia

Closed rhinolalia is formed with reduced physiological nasal resonance during the pronunciation of speech sounds. The nasal m, m", n, n" have the strongest resonance. During their normal pronunciation, the nasopharyngeal valve remains open, and air penetrates directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like oral b, b "d, d". In speech, the opposition of sounds on the basis of nasal - non-nasal disappears, which affects its intelligibility. The sound of vowel sounds also changes due to the stunning of individual tones in the nasopharyngeal and nasal cavities. At the same time, vowel sounds acquire an unnatural connotation in speech.

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

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

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

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

Functional closed rhinolalia is often observed in children, but is not always correctly recognized. It occurs with good patency of the nasal cavity and undisturbed nasal breathing. However, the timbre of nasal and vowel sounds may be more disturbed in this case than with organic forms.

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

Mixed rhinolalia

Some authors (M. Zeeman, A. Mitronovich-Modrzeevska) distinguish mixed rhinolalia - a speech condition characterized by reduced nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The reason is a combination of nasal obstruction and insufficiency of the palatopharyngeal contact of functional and organic origin. The most typical are combinations of a shortened soft palate, its submucosal splitting and adenoid growths, which in such cases serve as an obstacle to air leakage through the nasal passages during the pronunciation of oral sounds.

The state of speech may worsen after adenotomy, as palatopharyngeal insufficiency occurs and signs of open rhinolalia appear. In this regard, a speech therapist should carefully examine the structure and function of the soft palate, determine which form of rhinolalia (open or closed) disrupts the timbre of speech more, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the possibility of worsening the timbre of the voice. After the operation, correction techniques developed for open rhinolalia are used.

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

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

In the future, up to about seven years old, children with congenital palatine clefts speak (as in the absence of plastic surgery, so often after it) in a voice with a nasal tone, sometimes quiet due to behavioral characteristics, but in other qualities clearly not different from normal. An electro-glottographic study at this age confirms the normal motor function of the larynx, and myography confirms the normal reaction of the muscles of the pharynx to an irritant, even with extensive defects in the palate.

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

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

This is, firstly, a violation of the mechanism of palatopharyngeal closure. It is known that due to the close functional connection of the soft palate and the larynx, the slightest tension and movement of the muscles of the palatine curtain causes a corresponding tension and motor reaction in the larynx. When the palate is not closed, the muscles that lift and stretch it, instead of being synergists, work as antagonists. At the same time, due to a decrease in the functional load in them, as in the muscles of the pharynx, there is a dystrophic process. The pathological mechanism of closure is enhanced by the congenital asymmetry of the skeleton of the face and laryngeal cavities, which is clearly seen on x-rays and tomograms in congenital non-closure of the palate. An anatomical defect of the palate and pharynx leads to a functional disorder of the vocal apparatus.

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

Thirdly, the development of the voice is influenced by the behavior of persons with rhinophony and rhinolalia. Embarrassed by their defective speech, adolescents and adults often speak in a low voice and limit verbal communication in the microenvironment as much as possible, thereby reducing the possibility of developing the power of the voice and expanding its range.

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

Speech disorders with rhinolalia

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

First of all, it should be noted the extreme indistinctness of the speech of patients. The words and phrases that appear in them are obscure to others, since the emerging sounds are peculiar in articulation and sound. Due to the defective position of the tongue in the oral cavity, consonants are formed mainly due to changes in the position of the tip of the tongue (with little participation of the root of the tongue in articulation) with excessive activation of the facial muscles.

These changes in the position of the tip of the tongue are relatively constant and correlate with the articulation of certain sounds. The pronunciation of some consonant sounds is especially difficult for patients. So, they cannot provide the necessary barrier at the upper teeth and alveoli to pronounce the sounds of the upper position: l, t, d, h, w, u, g, p; at the lower incisors for pronouncing sounds s, s, c with simultaneous oral exhalation; therefore, whistling and hissing sounds in rhinolalics acquire a peculiar sound. The sounds k, g are either absent or replaced by a characteristic explosion. Vowel sounds are pronounced with the tongue pulled back with the exhalation of air through the nose and are characterized by sluggish lip articulation.

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

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

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

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

Thus, in the structure of speech activity in rhinolalia, a defect in the phonetic-phonemic structure of speech is the leading link in the violation, and the primary one is a violation of the phonetic formation of speech. This primary defect leaves some imprint on the formation of the lexical and grammatical structure of speech, but its deep qualitative changes usually occur only when rhinolalia is combined with other speech disorders.

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

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

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

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

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

In oral speech, impoverishment and abnormal conditions for the course of the prelinguistic development of children with rhinolalia are noted. In connection with the violation of motor speech peripheration, the child is deprived of intensive babbling, articulatory "game", thereby impoverishing the stage of preparatory adjustment of the speech apparatus. The most typical babbling sounds "p", "b", "t", "d" are articulated by the child silently or very quietly due to air leakage through the nasal passages and thus do not receive auditory reinforcement in children. Not only the articulation of sounds suffers, but also the development of simple elements of speech. There is a late onset of speech, a significant time interval between the appearance of the first syllables, words and phrases already in the early period, which is sensitive for the formation of not only sound, but also its semantic content, i.e., a distorted path of speech development as a whole begins. To the greatest extent, the defect manifests itself in the violation of its phonetic side.

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

The most significant manifestations of the defective formation of oral speech design are violations of all oral speech sounds due to the inclusion of nasal D and changes in the aerodynamic conditions of phonation. Sounds become nasal, that is, the characteristic tone of consonants changes. Pharyngealization, i.e., additional articulation due to the tension of the walls of the pharynx, occurs as a compensatory means.

There are also phenomena of additional articulation in the cavity of the larynx, which gives speech a kind of "clicking" overtone.

Many other more specific defects are also revealed. For instance:
1. omission of the initial consonant ("ak" - "so", "am" - "there");
2. neutralization of dental sounds according to the method of formation;
3. replacement of plosives with fricatives;
4. whistling background when pronouncing hissing sounds or vice versa ("ssh" or "shs");
5. the absence of a vibrant p or replacement by the sound s with a strong exhalation;
6. imposition of additional noise on nasalized sounds (hissing, whistling, breathing, snoring, larynx, etc.);
7. movement of articulation to more posterior zones (influence of the high position of the root of the tongue and low participation of the lips during articulation). For example, the sound "s" is replaced by the sound "f" without changing the way of articulation. A decrease in the intelligibility of sounds in the confluence of consonants in the final position is characteristic.

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

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

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

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

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

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

Written speech

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

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

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

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

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

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

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

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

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

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

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

It is necessary to carry out special work, including the development of phonemic perception with a simultaneous impact on the pronunciation side of speech. Correction of speech disorders in children with rhinolalia is carried out differentially depending on age, the state of the peripheral part of the articulatory apparatus and on the characteristics of speech development in general.

The main differentiating indicator for identifying children in speech therapy institutions is the development of speech processes. Children of preschool age with a violation of the phonetic side of speech are provided with speech therapy assistance on an outpatient basis, in a children's clinic or in a hospital (in the postoperative period). Children with underdevelopment of other speech processes are enrolled in specialized kindergartens in groups for children with phonetic-phonemic or general speech underdevelopment.

School-age children with pronounced impairments in phonemic perception receive assistance at logopoints at general education schools. However, they constitute a specific group due to the severity and persistence of the primary defect and the severity of the writing impairment.

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

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

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

Speech errors reflect a low level of assimilation of language patterns, a violation of lexical and syntactic compatibility, a violation of the norms of the literary language. They are primarily due to the small amount of speech practice. The vocabulary of children is not accurate enough in terms of usage, with a limited number of words denoting abstract and generalized concepts. This explains the stereotype of their speech, the replacement of words that are close in meaning.
In written speech, cases of incorrect use of prepositions, conjunctions, particles, errors in case endings, i.e., manifestations of agrammatisms in writing, are typical. Substitutions and omissions of prepositions, merging of prepositions with nouns and pronouns, and incorrect division of sentences are common.

Elimination of rhinolalia

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

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

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

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

It is also necessary to set up parents for the daily consolidation of all the results achieved.

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

Your child is not alone:
birth rate and causes

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

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

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

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

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

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

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

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

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

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

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

Improvement of spouses before pregnancy.

Exclusion of bad habits before pregnancy and during the latter.

Exclusion or limitation of harmful production factors, justified intake of drugs during pregnancy.

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

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

speech therapy training

Assessment of the state of speech

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

Stages and methods of speech therapy training

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

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

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

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

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

Parental Warnings

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

An early and correct determination of the tactics of speech therapy training for your child is at least half the success in the difficult process of restoring his speech.

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

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

The first stage - the stage of "pre-speech" exercises - includes the following types of work:
1) breathing exercises;
2) articulatory gymnastics;
3) articulation of isolated sounds or quasi-articulation (since isolated pronunciation of sounds is not typical for speech activity);
4) syllable exercises.
At this stage, mainly motor skills are taught based on the initial unconditional reflex movements.

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

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

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

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

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

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

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

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

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

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

Massage should be done before meals, in compliance with hygiene requirements. It is carried out as follows. Stroking movements are made along the seam line back and forth to the border of the hard and soft palate, as well as to the right and left along the border of the hard and soft palate. You can alternate stroking movements with intermittent pressure. A light pressure on the soft palate when pronouncing the sound "a" is also useful. The mouth should be wide open.

Gymnastics of the soft palate

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

2. Yawning with open mouth.

3. Gargling with warm water in small portions.

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

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

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

7. Then they gradually move on to a clear pronunciation of the sound series "a", "e", "u", "o" in different alternations. At the same time, the articulation structure changes, but exaggerated oral exhalation is preserved. When this skill is strengthened, they move on to the smooth pronunciation of sounds. For example: a, e, o, y_______, a, y, o, e_______.

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

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

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

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

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

Blowing exercises also contribute to the development of the correct air stream. They need to be carried out in the form of a game, introducing elements of competition. Some of the toys are made by children themselves with the help of their parents. These are butterflies, turntables, flowers, panicles made of paper or fabric. You can use strips of paper attached to wooden sticks, cotton balls on strings, light paper figures of acrobatics, etc. Such toys should have a specific purpose and be used only in classes for educating correct speech.

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

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

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

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

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

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

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

The elimination of these features of articulation is an important link in the correction of the defect. This is done by exercises of the so-called articulatory gymnastics, which develop lips, cheeks, and tongue.

Exercises for cheeks and lips:

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

Language exercises:

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

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

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

Great attention and stress requires working on sounds.

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

With each pronunciation, control over the direction of the air stream is necessary. To do this, the child holds a mirror or light cotton wool near the wings of the nose. Then the child is trained to repeat the vowels with pauses, during which he learns to hold the soft palate in a raised position (the correct position of the soft palate must be shown to him in front of a mirror). Pauses are gradually increased to 2-3 s. Then you can move on to smooth pronunciation.

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

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

your doubts

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

I advise parents

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

Literature

- Ermakova II Correction of speech in rhinolalia in children and adolescents. - M., 1984
- Ippolitova A. G. Open rhinolalia. - M., 1983
- Speech disorders in preschool children. Comp. R. A. Belova-David, B. M. Grinshpun. - M., 1969
- Chirkina GV Children with impaired articulation apparatus. - M, 1969
- Speech therapy. Textbook for pedagogical institutes in the specialty "Defectology", ed. Volkovoy L. S. - M: Enlightenment, 1989
- Soboleva E. A. Rhinolalia: general information about rhinolalia; classification of congenital cleft lip and palate; causes, mechanisms, forms of rhinolalia, etc. - M: AST Astrel, 2006

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

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

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

RINOLALIA OPEN CLOSED FUNCTION L-N ORGANIC FUNCTION L-N ORGANIC FUNCTION L-N ORGANIC ANTERIOR POSTERIC ACQUIRED CONGENITAL MIXED Classification of rhinolalia

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

CLOSED RINOLALIA. CAUSES The causes of closed rhinolalia are most often organic changes in the nasal space or functional disorders of the palatopharyngeal closure. Organic changes are caused by painful phenomena, as a result of which the patency of the nose decreases and nasal breathing is difficult.

CLOSED RINOLALIA occurs with chronic hypertrophy of the nasal mucosa, mainly the posterior sections of the inferior turbinates, with polyps in the nasal cavity, with a curvature of the nasal septum, and with tumors of the nasal cavity. in children, it is most often the result of large adenoid growths, occasionally nasopharyngeal polyps, fibromas, or other nasopharyngeal tumors. Anterior closed rhinolalia Posterior closed rhinolalia

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

1. WITH FUNCTIONAL CLOSED RINOLALIA, children are systematically exercised in pronouncing nasal sounds. Preparatory work is underway to differentiate oral and nasal inhalation and exhalation. Then static breathing exercises are complicated by voice exercises. It is also useful to use dynamic gymnastics, in which respiratory movements are combined with movements of the arms and torso. Children are taught to draw out sounds so that a strong vibration is felt in the area of \u200b\u200bthe wings of the nose and the base of the nose.

2. WITH FUNCTIONAL CLOSED RINOLALIA Preschoolers are encouraged to pronounce the syllables pa, pe, pu, po, pi in such a way that the vowels sound a little nasally. In the same way, they work out the pronunciation of consonants in a position in front of nasal sounds (syllables like am, om, mind, an). After the child learns to pronounce these syllables correctly, words are introduced that contain nasal sounds. It is necessary that he pronounce them exaggeratedly loudly and drawlingly with a strong nasal resonance. The final exercises are loud short and long pronunciation of vowel sounds. In addition, vocal exercises are used. The duration of corrective work with functional closed rhinophony is short. With rhinolalia, the timing is longer and it can be difficult to predict in advance. This is explained by the fact that with a functional closed rhinolalia, the elimination of defects in the articulation of sounds is also required. In addition, in children with this form of rhinolalia, some features of mental development are often observed.

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

timbre of sounds Noticeably changed. The timbre of the vowels u and y changes most noticeably, during the articulation of which the oral cavity is most narrowed. The vowels e and o sound less nasal, and the vowel a is even less disturbed, since the oral cavity is wide open during its pronunciation. The timbre of some consonants is disturbed: when pronouncing hissing sounds and fricatives f, v, x, a hoarse sound is added that occurs in the nasal cavity; explosive sounds p, b, d, t, k and r, as well as sonorous l and r sound unclear, since the air pressure necessary for their accurate pronunciation cannot form in the oral cavity. With prolonged open rhinolalia (especially organic), the air stream in the oral cavity is so weak that it is not enough to fluctuate the tip of the tongue, which is necessary for the formation of the sound r. consonant vowels

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

ACQUIRED OPEN RINOLALIA is formed by trauma to the oral and nasal cavities or as a result of acquired paralysis of the soft palate. The causes of functional open rhinolalia can be different. For example, it occurs during phonation in children with sluggish articulation of the soft palate. The functional open form manifests itself in hysteria, sometimes as an independent defect, sometimes as an imitative one.

Habitual open rhinolalia One of the functional forms, observed, for example, after the removal of large adenoid growths, occurs as a result of a long-term limitation of the mobility of the soft palate. Functional examination with open rhinolalia does not reveal organic changes in the hard or soft palate. A sign of a functional open rhinolalia is also the fact that the pronunciation of only vowels is usually disturbed, while when pronouncing consonants, the palatopharyngeal closure is good and nasalization does not occur. The prognosis for functional open rhinolalia is more favorable than for organic. Nasal timbre disappears after phoniatric exercises, and pronunciation disorders are eliminated by the usual methods used for dyslalia.

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

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

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

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

During the first years of a child's life, the leading role belongs to the pediatrician, who manages the feeding and daily routine of the baby, carries out prevention and treatment, and, if necessary, recommends outpatient or inpatient treatment. The otolaryngologist detects and treats all painful changes in the ear, nasal cavities, in, nasopharynx and larynx and prepares children for surgery. With deviations in mental development and the presence of pronounced neurotic reactions of the child, a neuropathologist consults.

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

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

TYPES OF CLEFTS: 1) cleft of the upper lip; upper lip and alveolar process; 2) clefts of the hard and soft palate; 3) clefts of the upper lip, alveolar process and palate - one- and two-sided; 4) submucosal (submucosal) cleft palate.

Figure 2. Left-sided cleft Figure 3. Left-sided cleft lip and alveolar hard palate

With cleft lip and palate, all sounds acquire a nasal or nasal tone, which grossly violates the intelligibility of speech. Typical is the imposition of additional noises on nasalized sounds, such as breathing, snoring, larynx, etc. There is a specific violation of the timbre of the voice and sound pronunciation. To prevent the passage of food through the nose, the child from a very young age acquires the habit of lifting the back of the tongue to block the passage into the nasal cavity. This position of the tongue becomes habitual and also changes the articulation of sounds. During speech, children usually open their mouths a little and raise the back of the tongue higher than required. The tip of the tongue therefore does not move fully. Such a habit impairs the quality of speech, since with a high position of the jaw and tongue, the oral cavity takes on a shape that contributes to the entry of air into the nose, which increases nasality.

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

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

CONGENITAL CLIFFS OF THE UPPER LIP Without deformation of the skin and cartilage of the nose With deformation of the skin and cartilage of the nose. HIDDEN INCOMPLETE Classification of congenital cleft lip and palate

Congenital Sky Safety Square Soft Square Soft Square Soft And Solid Square Soft Soft Solid And Solid Semucose Full Incomplete Defective Alveolar Cell Process, Solid and Soft Heaven Single Bilateral Solid Alveolar Cell Process and Front Solid Unilateral Front Division Bilateral

THE SURVEY OF SOUND PRODUCTION SHOULD PROVIDE TWO ASPECTS. involves clarifying the features of the formation of speech sounds and the functioning of the organs of articulation in the process of pronunciation. aims to find out how the child distinguishes the system of speech sounds (phonemes) in various phonetic conditions. These two aspects are closely related. 1. Articulatory 2. Phonological

THE EXAMINATION OF SOUNDS BEGINS WITH A CAREFULL CHECK OF THE ISOLATED PRONUNCIATION OF SOUNDS, THEN CHECK THE PRONUNCIATION OF SOUNDS IN SYLLABLES, WORDS AND PHRASSAL SPEECH. When examining each group of sounds, it is necessary to note how the child pronounces the sound in isolation, indicating the nature of the violation. The degree of nasality in the pronunciation of vowels and consonants and the presence of compensatory "grimaces" are also noted.

DURING THE EXAMINATION, EXERCISES CONSISTING IN THE MULTIPLE REPETITION OF ONE SOUND are USED, since this creates conditions that reduce articulatory switching from one sound to another. This makes it possible to detect features of the motor sphere, especially in cases of combination of rhinolalia with an “erased” form of dysarthria.

IMPORTANT FOR SPEECH THERAPY ANALYSIS IS IDENTIFICATION To do this, the child repeats two sounds or syllables at random, suggesting a clear articulatory switch (for example, cap-pak). First, sounds are given, articulatory sharply different from each other, then closer. At the same time, the speech therapist fixes cases when the child fails to motor switch from one sound to another, and instead of repeating the final sound of the first syllable, he pronounces the previous one. for example, instead of g and d, a semi-voiced sound is pronounced, instead of g and g ‘, a semi-soft sound). 1) the ability to clear articulatory switching 2) the appearance of "average" articulation

THEN THE SPEECH THERAPIST FINDS HOW THE CHILD IS USING THE SOUNDS IN SPEECH. When checking, attention is paid to substitutions, distortions, mixings, omissions of sounds. For this purpose, the pronunciation of words is examined. The child is presented with sets of pictures that include words from the tested sounds. The desired sound should be in words in different positions. For example, for whistling and hissing sounds there can be such words (pictures): dog, wheel, nose, pine, shepherd, cash desk. The speech therapist pays special attention to how the child pronounces sounds in phrasal speech.

A CHILD'S ABILITY TO SWITCH ARTICULATION MOVEMENTS IS DETECTED. The child is offered to repeat a sound or syllable series several times, and then change the sequence of sounds or syllables. The speech therapist notes: is it easy to switch. For example: a-i-u y-i-a ka-pa-ta pa-ta-ka pla-pl-plo plo-pl-pla

THE ABILITY TO PROnounce SIMPLE AND COMPLEX WORDS IN SYLL STRUCTURE IS EXPLORED. The speech therapist presents the children with subject pictures for naming, then pronounces the words for reflected reproduction. The results of both tasks are compared. The speech therapist fixes that the child is doing better. He especially notes words that are pronounced without distortion of the syllabic and sound composition.

FIND OUT WHAT SOUNDS THE WORDS CONSIST OF WHICH SYLLOGICAL STRUCTURE IS DISTORTED - FROM LEARNED OR NOT LEARNED. 1) reduction in the number of syllables (“wombs” instead of hammer), 2) simplification of syllables (“tul” instead of chair); 3) likening syllables (“tattoo” instead of a stool); 4) adding the number of syllables (“komanamata” instead of room); 5) permutation of syllables and sounds (“devero” instead of a tree). The nature of the distortion is noted:

THE ABILITY TO PROnounce SOUNDS IN SENTENCES COMPOSED FROM SOUNDS WHICH IN ISOLATED FORM THE CHILD PRODUCES CORRECTLY AND DISTORTED IS TESTED. To identify non-rough violations of the syllabic structure, words are offered to children to repeat sentences like “Petya drinks bitter medicine”, “A policeman is standing at the crossroads”.

To determine the open rhinolalia, there are different methods of functional research. The simplest is the so-called Gutzmann test. The child is forced to alternately repeat the vowels a and and, while either clamping or opening the nasal passages. In the open form, there is a significant difference in the sound of these vowels. With a pinched nose, sounds, especially and, are muffled and at the same time the speech therapist's fingers feel a strong vibration on the wings of the nose. You can use a phonendoscope. The examiner inserts one "olive" into his ear, the other into the child's nose. When pronouncing vowels, especially at and and, a strong rumble is heard. Functional open rhinolalia is due to various reasons. It is explained by the insufficient rise of the soft palate during phonation in children with sluggish articulation. One of the functional forms is the "habitual" open rhinolalia. It occurs frequently after removal of adenoid lesions or, more rarely, as a result of post-diphtheria paresis, due to prolonged restriction of the mobile soft palate. Functional examination with an open form does not reveal any changes in the hard or soft palate. A sign of functional open rhinolalia is a more pronounced violation of the pronunciation of vowel sounds. With consonants, the palatopharyngeal closure is good. The prognosis for functional open rhinolalia is usually favorable. It disappears after phoniatric exercises, and sound pronunciation disorders are eliminated by the usual methods used for dyslalia. Organic open rhinolalia can be acquired or congenital. Acquired open rhinolalia is formed during perforation of the hard and soft palate, with cicatricial changes, paresis and paralysis of the soft palate. The cause may be damage to the glossopharyngeal and vagus nerves, injuries, tumor pressure, etc. The most common cause of congenital open rhinolalia is congenital splitting of the soft or hard palate, shortening of the soft palate.

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

A "PHARYNGEAL" POSITORAL SOUND IS TYPICAL BECAUSE OF EXCESSIVELY DEEP ARTICULATION. The appearance of overtones, especially in sound combinations of the SSG type, is also characteristic of children with excessive, exaggerated articulation, when short-term transitional phases of articulation act as independent sounds, which are not perceived by the listener in ordinary speech. In the same children, along with insertions of sounds, frequent omissions of sounds or their reduction are found, which simplifies the articulation of difficult consonant clusters.

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

PRONUNCIATION DISTURBANCES ARE COMPARISONED WITH THE FEATURES OF THE RHYTHMIC-SYLL STRUCTURE. Replacement and mixing of sounds, insufficient discrimination of sounds, and violation of the rhythmic-syllabic structure are signs typical of a general underdevelopment of speech. The final conclusion can be drawn after examining the lexico-grammatical aspect of speech.

EXAMINATION OF THE STRUCTURE OF THE ARTICULATION APPARATUS AND ITS MOTOR SKILLS During the examination, it is necessary to assess the degree and quality of violations of the motor functions of the organs of articulation and to identify the level of available movements. First of all, it is necessary to characterize the structural features of the articulatory apparatus and anatomical defects. The speech therapist notes whether there are the following features: lips: splitting of the upper lip, postoperative scars, shortened upper lip; teeth: malocclusion and planting of teeth; tongue: large, narrow; shortening of the hyoid ligament; hard palate: narrow, domed (“gothic”) soft palate: short soft palate, small uvula bifurcated or absent.

Submucosal cleft palate (SUBMUCOUS CLEFT) is usually difficult to diagnose because it is covered by mucous membranes. It is necessary to pay attention to the back part of the hard palate, which, during phonation, retracts in the form of a small triangle, angled forward. The mucous membrane in this place is thinned and has a paler color. In unclear cases, the otolaryngologist should determine the condition of the palate by careful palpation.

DEFORMATION OF THE JAWS, IMPROPER DEVELOPMENT AND LOCATION OF TEETH, NON-UNITED UPPER LIP, DEFORMED NOSTRILS, ETC. The movements of the muscles of the face, tongue and lips are sluggish, the rudiments of the soft palate and uvula are inactive, passively hanging down. Weakly developed muscles of the posterior wall of the pharynx. The root of the tongue is overdeveloped and the tip remains weak and does not move fully. When examining the structure of the articulatory apparatus, the speech therapist also notes the presence of deformation: sagging of one corner of the mouth, deviation to one side of the tongue, drooping of one half of the soft palate, etc.

NOTICE THE FORCE OF MOVEMENT, ITS ACCURACY, SPEED, FIXEDNESS. Pareticity of the tongue and lips is manifested in a small volume of movements, in their inaccuracy, exhaustion, and unevenness. The movements of the tongue must be strong enough to keep it in the right position for as long as it takes to pronounce this or that phoneme. The speed and accuracy of articulatory movements affects the intelligibility of pronunciation. It is important to note the increased tone of the tongue, which is expressed in its tension, sharp protrusion of the tip of the tongue, twitching of voluntary movements, which indicates tonic disorders.

Paralysis of the uvula of the soft palate always affects the functional state of the tongue and secondarily disrupts the articulation of lingual sounds, making the entire process of articulation tense and slow. A tongue hanging motionlessly along the midline indicates bilateral paresis. In cases of unilateral paresis, it deviates to the "healthy" side. It is also important to identify the condition of the soft palate: raising the palatine curtain with an energetic pronunciation of the sound a, the presence or absence of air leakage through the nose when pronouncing vowel sounds, the uniformity of leakage; the presence or absence of a pharyngeal reflex (appearance of vomiting when lightly touching the soft palate with a spatula). It should be borne in mind that articulatory difficulties in spontaneous speech can be aggravated by such factors as arousal, fatigue, complication of the content of speech in an intellectual or linguistic sense.

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

PHONEMATIC PERCEPTION In order to reveal the child's ability to perceive rhythmic structures of varying complexity, the following tasks are used: tap out the number of syllables in words of varying syllabic complexity; guess which of the presented pictures corresponds to the rhythmic pattern given by the speech therapist. An examination of the discrimination of speech sounds can be started with tasks for the repetition of isolated sounds or pairs of sounds. Deviations in phonemic perception are most clearly manifested when the child repeats phonemes that are close in sound (b-p, s-sh, r-l, etc.). In this case, the child is offered to repeat syllable combinations consisting of such sounds: sa-sha, sha-sa, sa-sha-sa, sha-sa-sha, sa-za, za-sa, sa-za-sa, etc. n. Particular attention should be paid to the distinction between whistling, hissing, affricates, sonorants, as well as deaf and voiced sounds. When performing tasks of this type, some children experience obvious difficulties in repeating sounds that differ in acoustic characteristics (voicedness-deafness), while another category of children finds it difficult to repeat sounds that differ in articulation. Cases can be identified when the task to reproduce a series of three syllables is inaccessible to the child or causes certain difficulties. Particular attention should be paid to the phenomena of perseveration, when the child cannot switch from pronouncing one sound to pronouncing another.

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

As a result, surveys of the sound side of speech and comparison with the data of the survey of other parties speech from the speech the speech should be a clear idea of whether the identified violations of the independent defect are or included in the structure of the general underdevelopment of speech as one of its components. It depends on the setting of specific correctional tasks.

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

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

IN DOMESTIC SPEECH THERAPY DEVELOPED METHODOLOGICAL TECHNIQUES FOR THE ELIMINATION OF RINOLALIA EF Pay, 1933; F. A. Pay, 1933; 3. G. Nelyubova, 1938; V. V. Kukol, 1941; A. G. Ippolitova, 1955, 1963; 3. A. Repina, 1970; I. I. Ermakova, 1984; G. V. Chirkina, 1987; Volosovets T.V.

THE SYSTEM DEVELOPED BY A. G. IPPOLITOVA This system is highly effective in correcting sound pronunciation in children who do not have deviations in phonemic development. A. G. Ippolitova was one of the first to recommend classes in the preoperative period. Characteristic of her methodology is the combination of breathing and articulation exercises, the sequence of sound processing, due to articulatory interconnectedness. The sequence of work on sounds is determined by the readiness of the articulatory base of the language. The presence of full-fledged sounds of one group is an arbitrary basis for the formation of the following. So-called "reference" sounds are used. The preparation of the articulation base of sound is carried out with the help of special articulation gymnastics, which is combined with the development of the child's speech breathing. The peculiarity of the method of A. G. Ippolitova lies in the fact that when evoking a sound, the child's initial attention is directed only to the article.

THE CONTENT OF SPEECH THERAPY LESSONS ACCORDING TO THE METHOD OF A. G. IPPOLITOVA INCLUDES THE FOLLOWING SECTIONS: 1. The formation of speech breathing during the differentiation of inhalation and exhalation. 2. Formation of a long oral exhalation when the article implements vowel sounds (without including the voice) and fricative unvoiced consonants. 3. Differentiation of short and long oral and nasal expiration during the formation of sonorous sounds and affricates. 4. Formation of soft sounds.

METHOD OF L. I. VANSOVSKAYA (1977) L. I. Vansovskaya suggested starting the elimination of nasalization not with the traditional sound a, but with the front vowels and and e, since it is they that allow you to focus the exhaled stream of air in the anterior part of the oral cavity and direct the tongue to lower incisors. This enhances the clarity of kinesthesia in contact with the lower incisors; when pronouncing a sound, both the walls of the pharynx and the soft palate participate more actively. The child is required to pronounce sounds in a low voice, with a slightly protruding jaw, with a half smile, with increased tension in the soft palate and pharyngeal muscles. After eliminating the nasalization of vowels, work is carried out on sonors (l, p), then fricative and stop consonants.

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

METHODS As applied to adults, the technique of S. L. Taptapova (1963) was developed, which offers a kind of silence mode - the pronunciation of vowels to oneself. This removes grimaces and prepares pronunciation without nasalization. Vocal exercises are recommended. I. I. Ermakova (1980) developed a step-by-step method for correcting sound pronunciation and voice. She established the age-specific features of functional disorders of voice formation in children with congenital clefts and modified orthophonic exercises in relation to them. Special attention is paid to the postoperative period and techniques for developing soft palate mobility are recommended to prevent its shortening after surgical plasty.

LOGOPEDIC IMPACT IN OPEN RINOLALIA Tasks of corrective work: normalization of oral exhalation, development of a long oral air jet development of correct articulation of all sounds elimination of nasal tone of voice education of skills of differentiation of sounds normalization of prosodic components of speech automation of acquired speech skills in communication In the preoperative period: Release of facial muscles from compensatory movements Preparation of the correct pronunciation of vowels Preparation of the correct articulation of available consonants Operation In the postoperative period: Development of the mobility of the soft palate Elimination of defects in sound pronunciation Overcoming the nasal tone of the voice Specific types of work in the postoperative period: Massage of the soft palate Gymnastics of the soft palate and the back wall of the pharynx Articulatory gymnastics Voice exercises Breathing exercises. Constant control of the direction of the air jet

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

With the age of the child, the indicators of speech development worsen (compared to the indicators of normally speaking children), the structure of the defect is complicated due to the violation of various forms of written speech. Early correction of deviations in speech development in children with rhinolalia has an extremely important social and psychological and pedagogical significance for the normalization of speech, the prevention of difficulties in learning and choosing a profession. The setting of correctional tasks is determined by the results of the examination of children's speech.

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

WHEN CORRECTING THE SOUND SIDE OF SPEECH, LEARNING THE CORRECT PRONUNCIATION SKILLS PASSES 4 STAGES The first stage - the stage of "pre-speech" exercises - includes the following types of work: 1) breathing exercises; 2) articulatory gymnastics; 3) articulation of isolated sounds or quasi-articulation (since isolated pronunciation of sounds is not typical for speech activity); 4) syllable exercises. At this stage, mainly motor skills are taught based on the initial unconditional reflex movements.

Rhinolalia (from Greek rhinos nose, lalia speech) (from Greek rhinos nose, lalia speech) violation of the timbre of voice and sound pronunciation, due to anatomical and physiological defects of the speech apparatus. AUTHOR OF THE PRESENTATION TEACHER-SPEECH THERAPIST: ANASTASIA SERGEEVNA DUBROVA

Closed forms of rhinolalia: Characterized by reduced physiological nasal resonance during the pronunciation of speech sounds. Speech exhalation is directed only through the mouth at all sounds. Characterized by reduced physiological nasal resonance during the pronunciation of speech sounds. Speech exhalation is directed only through the mouth at all sounds. There is no nasal resonance, so nasal sounds sound like mouth sounds: There is no nasal resonance, so nasal sounds sound like mouth sounds: [M] [B], mother woman [M] [B], chalk is white. [N] [D], nose dos. [N] [D], no det. Or they sound like a combination of sounds mb, nd.

Open forms of rhinolalia: The air stream is weak, during speech it passes simultaneously through the mouth and nose, as a result of which the timbre of all sounds changes, nasal resonance occurs when they are pronounced. The air stream is weak, during speech it passes simultaneously through the mouth and nose, as a result of which the timbre of all sounds changes, nasal resonance occurs when they are pronounced. At the same time, nasal sounds are characterized by an increased nasal tone - hypernasalization. At the same time, nasal sounds are characterized by an increased nasal tone - hypernasalization.

So let's sum it up: What is rhinolalia? What problems is she always associated with? What is rhinolalia? What problems is she always associated with? What is the difference between open and closed rhinolalia? What is the difference between open and closed rhinolalia? What characterizes functional rhinolalia? What types of it do you remember? What characterizes functional rhinolalia? What types of it do you remember? What are the features of organic rhinolalia? What are the features of organic rhinolalia? What types of defects lead to the appearance of organic rhinolalia? What types of defects lead to the appearance of organic rhinolalia? How will rhinolalia affect the development of a child's speech? How will rhinolalia affect the development of a child's speech? What non-speech symptoms will accompany speech defects in rhinolalia? What non-speech symptoms will accompany speech defects in rhinolalia?

Correction of sound pronunciation with rhinolalia

Durneva Marina Alekseevna, teacher-speech therapist, MBDOU kindergarten No. 17, Kamensk-Shakhtinsky.
Target: formation of ideas among young teachers about the ways of correcting sound pronunciation in rhinolalia.
Tasks:
1. Formulate the general provisions for the correction of sound pronunciation in rhinolalia.
2. Identify the main sections of the normalization of the sound side of speech in rhinolalia.
3. Show how to correct sound pronunciation in rhinolalia.

Description: Rhinolalia is a violation of the timbre of the voice and sound pronunciation, due to anatomical and physiological defects of the speech organs. It is not as common in children as other speech disorders (dyslalia, dysarthria). Therefore, having started my pedagogical activity as a speech therapist, it was very difficult for me to work with this particular speech disorder. Having studied a lot of methodological literature, I systematized my knowledge in this article. This article will be useful to beginner speech therapists, students of defectological faculties. 1. General provisions for the correction of sound pronunciation in rhinolalia.
Pathological sound formation in rhinolalia has anthropophonic and phonological features. The former consist in distorting the sound of phonemes, and the latter in replacing one phoneme with another. Almost all sounds in rhinolalia are nasalized, many of them sound only approximately, and at the same time they are interchanged within groups that are similar in the method of formation and acoustic features. Therefore, the work to correct the sound pronunciation takes a long period of time. Organic defects and many years of experience in pathological articulation of phonemes make correction even more difficult.
Correction of each sound provides:
1) the ability to distinguish him from others;
2) correlate with a certain article;
3) correctly reproduce the article;
4) apply this skill in the flow of coherent speech.
As mentioned above, the development of auditory differentiations precedes the creation of an articulatory structure. Starting to set the sound, the child should already be able to isolate the phoneme on which he is working, which does not contradict the method of initial learning of the article without naming the consonant sound.
Children who do not differentiate the features of their own speech by ear are attracted to visual, tactile and kinesthetic analyzers in the process of sound production. Tactile and visual observations cannot constantly accompany everyday speech. Kinesthesia in the future remain the only type of control over spontaneous speech. In addition, kinesthetic control is carried out at the moment of speech, while auditory control is triggered after pronunciation. Therefore, the correlation of a phoneme with a certain article is a very important point in working on sound.
Sound reproduction involves the formation of a barrier in the desired area, the supply of a directed air jet to it, the provision of sufficient intraoral pressure, and, if necessary, the inclusion of phonation.
The value of air pressure in the oral cavity does not depend on an arbitrary effort. It is achieved only through compensated palatopharyngeal closure. If the latter is insufficient, the pressure in the mouth drops due to air leakage into the nose. Any attempt to replace the leak by forceful exhalation or constriction of the pharynx and nasal passages increases airflow velocity, increases nasal tone, and reduces speech intelligibility. There is a direct dependence of the volume of air leakage on the size of palatopharyngeal insufficiency. Nevertheless, the success of correctional and educational work is largely determined by the individual compensatory abilities of children.
In case of insufficiency of the palatopharyngeal closure, the child’s attention is not fixed on the volume of the flowing air stream, but they try to make it as silent as possible.
This is helped by the smooth execution of all exercises without sharp exaggerated movements and chanting.
Starting to correct sounds, children are tested for the ability to reproduce articulations and phonemes by imitation, which makes it possible to identify the most accessible sounds.
When evoking sounds, one should try to make the most of the movements and phonemes already available to the child, and not create completely new models. This approach reduces tension, facilitates the introduction of sound into syllables and expresses the principles of relying on already formed skills and the transition from simple to complex for each student.
Techniques for evoking consonants are described in the special pedagogical literature in some detail. However, with congenital cleft palate and lip, they are not always suitable due to organic changes in the articulatory apparatus, decreases in kinesthesia and auditory differentiation. The peculiarity of all corrective techniques for rhinolalia is that they should be quite noticeable, without causing pressure on the articulators along the way, which increases air leakage into the nose and lengthens the already increased bowing time.
Correction of sounds begins with the most accessible to this child. The choice of method and exercises is set strictly individually. However, pronounced organic defects can prevent the achievement of ideal articulation. Cicatricial changes in the lip limit its mobility: open bite, progeny, prognathia, dentition disorders in the anterior part of the upper jaw, constant wearing of a massive orthodontic appliance complicate the production of labial and anterior lingual sounds. Significant cicatricial changes flatten the palatine vault and limit the opening of the mouth. Therefore, striving for the acoustic usefulness of phonemes, one can allow deviations in articulation.
Children with reduced kinesthesia and disorders of phonemic hearing have to linger on intermediate, coarser articulations: interdental, single-strike, etc., i.e., use analogue sounds. It should be noted that preparatory exercises for the correction of individual sounds can last quite a long time until a clear kinesthetic stereotype is developed.

2. The main sections of the normalization of the sound side of speech in rhinolalia.
Normalization of the sound side of speech in rhinolalia includes a number of special sections:
- Sounds to be staged, corrected, refined or differentiated. Attention is drawn to the violation of the actual articulation of sounds and the degree of nasalization during their pronunciation.
- Rhythmic-syllabic structure. Difficulties in pronunciation of sounds in complex positions (such as SSG), as well as in polysyllabic words and at the end of a phrase, are singled out.
- Phonemic perception and the state of auditory control over one's own speech.
In the first period of education in kindergarten in individual lessons, the following is carried out:
- clarification of the pronunciation of vowels [a], [e], [o], [y], [s] and consonants [p], [p "]; [c], [c"]; [f], [f "]; [t], [t "];
- setting and initial consolidation of sounds [k], [k "]; [x], [x"]; [s], [s "]; [g], [g "]; [d], [d "]; [b], [b "].
In the second period, the sounds [i], [d], [d "], [h], [h "], [w], [p] are sounded.
In the third period, the sound [g] of the affricate is worked out and work continues on refining the articulation of the previously passed sounds. At the same time, intensive work is underway to eliminate the nasal shade. A large place is given to the differentiation of oral and nasal sounds [m] - [n], [m "] - [n"], [n] - [d], [n] - [t], [m] - [b], [m "] - [b"].

3. Techniques for correcting sound pronunciation in rhinolalia.
In the formation of plosive phonemes, the most important point is to ensure sufficient intraoral pressure to instantly break through the barrier. Leakage of air into the nose during shortening and fistulas of the palate leads to irritation of the pressure, and the strength of the sounds is weakened.
In addition to this difficulty, inherent in the entire group of explosives, the correction of sounds [p], [p "], [b], [b"] can be complicated by an inactive upper lip, tightened with scars; [t], [t "], [d], [d"] - cleft of the alveolar process and violations of the dentition; [k], [k "], [g], [g"] - a pronounced shortening of the palate and fistulas on the border of the hard and soft palate.
Setting a two-lip [p] is possible in various ways. So, in the presence of a directed air jet, the child is offered to clap his lips during soft, quiet blowing. At the same time, a whispered pa - pa - pa is heard. Moisturizing the lips creates a slight stickiness and makes it easier to close.
As an initial technique, you can use “spitting” with your lips if the child has already learned to do this exercise with his tongue hanging out.
With a long movable palate, it is recommended to puff out your cheeks and clap your palms on them so that the air from your mouth breaks sharply through closed lips. This is followed by repeated repetition of this movement with a gradual decrease in the volume of air in the mouth with and without hands. The child actually proceeds to "spitting" the lips.
It is impossible to inflate the cheeks with palatopharyngeal non-closure. In this case, pinch the wings of the nose with your fingers to reduce air leakage, and learn to lightly “spit”. Then do the same exercise with open wings of the nose.
Contradictory opinions are expressed in the specialized literature regarding pinching of the wings of the nose. The use of this technique is advisable during the period of sound evoking. Before surgery, it allows you to strengthen the directed air stream, provide the necessary air pressure, as a result of which the child feels the articuloma.
After the operation, the kinesthesia strengthened in this way is better restored. The child understands what one should strive for, learns to reproduce them, and after a few days, with a sufficient length of the palate, repeats the sound without pinching the wings of the nose.
Using this technique, it is necessary to explain that the nostrils are taken “in a pinch” with the left hand: the thumb lies on the left nostril, the other four on the right. The elbow is raised up, which allows you to follow the articulations in the mirror. By pinching the nose with only two fingers (usually the thumb and forefinger), children squeeze it very hard and cause discomfort.
With a shortened palate, when the pressure drops when the nose is opened and the sound weakens sharply, one nostril can also be temporarily clamped. With the pad of the index finger, the wing of the nose is slightly pressed against the face (not against the nasal septum).
Sometimes before the operation it may be advised to place the index finger horizontally on the upper lip under the nose. This will somewhat restrict the outflow of air without changing the shape of the articulators.
It should be noted that the sound [p], caused by patting the lips, is easier to enter into direct syllables, and from "spitting" and puffing out the cheeks - into reverse ones.
You can offer the child to blow and at the same time alternately close and open the lower and upper lip with the index finger. In this case, the finger lies horizontally under the red border of the lower lip, raises and lowers it with light rhythmic movements. As a result, the sound [p] is heard repeatedly.
The sound [t] is noted by some researchers among the least legible in rhinolalia. Interdental [t] is easy to get from "spitting" - the preparatory exercise of stage I. To do this, you need to smile so that your teeth are exposed, and spit, slightly sticking out the tip of your tongue.
The sound [t] can be called from [n]. The syllables pa - pa - pa are repeated several times in a row, putting a wide tongue on the lower lip. Then they reproduce the same syllables, smiling to turn off the lips from articulation. It is also possible to evoke sound in isolation in this way. But syllable-by-syllable pronunciation greatly facilitates the introduction of a new sound into words.
The interdental phoneme [s] also allows you to go to [t] with the rhythmic closing and opening of the incisors biting the tongue.
Calling a phoneme from existing sounds is more desirable, since the sound is pronounced less intensely and is easily introduced into syllables and words.
Usually, they try to briefly slow down classes on interdental articulation [t] in order to consolidate stronger sensations and rough movements with visual control. The transition to dental articulation does not cause difficulties, for this it is enough to ask the child to reproduce the sound with closed teeth.
The sound [k] in rhinolalia is either absent or replaced by a pharyngeal parasound. It is traditionally corrected by shifting the front part of the back of the tongue into the depths of the oral cavity with a spatula while pronouncing the syllables ta - ta - ta.
As the tongue moves, the syllable ta becomes cha, then ka, and finally ka. The phoneme is introduced into other syllables, while continuing to use mechanical assistance. The child independently presses the tongue with the index finger. An unexpected abduction of the hand for the student causes the correct pronunciation of the subsequent word by inertia. Then mechanical assistance is completely cancelled.
Correction of sound is not possible with a narrow, high Gothic hard palate or with a pronounced shortening of the soft palate, when the back of the tongue does not have a support for the bow. In such cases, it is possible not to inhibit the pharyngeal articulation of the sound, since acoustically it differs slightly from the normal one. However, you should first try pronouncing the sound [k] when the root of the tongue contacts the palate at various points of the arch, since various combinations of localization of the contact of the tongue and palate are possible. They depend on the subsequent vowel sound and the compensatory abilities of the child.
Fricative consonants in congenital clefts are most often formed by the pharyngeal method (pharyngeal).
The effectiveness of their correction is closely related to the presence of a directed air jet. If air leaks into the nose, correction is also possible. But the sound is attenuated.
According to A. G. Ippolitova, it is easiest to set the sound [f] from fricative consonants. To do this, the patient, according to the instructions or with mechanical help, brings the lower lip closer to the upper teeth and blows on it.
The sound [s] is most often corrected in the traditional way. They teach to blow on cotton wool, to blow with a wide tongue stuck between the lips, to blow on the tongue between the teeth (interdental [s]), to blow on the tongue pushed up to the lower incisors. But at the same time, the blast should be quiet, soundless.
A feature of sound correction [s] in case of palatopharyngeal insufficiency is the impossibility of using exercises with exaggerated blowing. If the first two preparatory techniques do not cause noticeable difficulties, then as soon as the children begin exercises with parted lips, almost all of them switch to exhalation through the throat.
To prevent this phenomenon and to prepare in advance the formation of a groove on the tongue, it is recommended to blow through a straw. The plastic straw lies in the middle of the protruding tongue. It is retracted 2-2.5 cm behind the teeth along the tongue between the incisors. The child learns to blow on his hand or down through a straw, holding it first with his lips, and then only with his teeth and tongue. Gradually, the straw is pulled out of the mouth, and the child independently reproduces the tooth [s].
The [s] sound is sometimes used as a test to predict the effectiveness of consonant production. The use of this consonant is explained by the highest density of closing of the palate and pharynx during its articulation.
The affricate [ts] is easily obtained in the usual way from the fusion of the sounds [t] and [s]. It should only be recalled in this case about the articulation of the sound [t] in the lower incisors. But the child can cope without a reminder, since any indication of the position of the tongue, the details of the articulation, makes it more tense.
Introduction to words, phrases and even spontaneous speech of interdental articulations is used to enhance kinesthetic and visual control in case of clefts of the alveolar process, difficulty opening the mouth, wearing massive orthodontic appliances, reducing auditory differentiation and severe palatopharyngeal insufficiency. Setting and upper articulation is possible.
The transfer to the tooth articulation of whistlers is possible only in the complete absence of pharyngeal overtones.
The difficulties of correcting hissing are associated with their complex articulation. Crowded teeth interfere with visual control. All elements of the hissing articulation have to be studied separately (position of the lips, tongue, air jet supply to the tongue).
When staging the sound [w], it takes a lot of time to learn to raise the tongue in the form of a “dipper”. It is also difficult for students to direct the air stream upwards, while simultaneously moving the tongue in the form of a "ladle" into the oral cavity. Instead of a directed air jet, children often switch to exhaling through their nose.
Therefore, with an accessible upper articulation, it is suggested to simultaneously blow on the lower teeth, “blow” with the teeth or “whistle” through the teeth. Moreover, preparation for blowing begins long before exercises in raising the tongue.
In the presence of a proton sound [p], the most simple is the production of the sound [w] from its whispered pronunciation with close teeth and rounded lips.
If the child easily succeeds in imitation of the lower articulation of the sound [w], it is fixed and introduced into speech.
Indications for setting the lower hissing can be considered defects in the anterior hard palate, a massive hyoid frenulum, and the absence of auditory differentiation.
To correct the sound [u], it is enough to pronounce [s], rounding your lips and pulling back the tip of your tongue. Using this technique, you can not call an isolated sound, but try to immediately pronounce direct syllables: sya, sho, sho, syu, si. If the tip of the tongue moves away, then they are heard respectively: shcha, shch, shcho, shch, shch. If the child already knows the clear correct [w], then you can call [w] from this sound. Draw out [w], lowering the wide tip of the tongue down. The back of the tongue and its root remain motionless.
In cases where it is difficult for a child to change the position of the organs of articulation according to the instructions, [u] can be called as a soft version of [sh]. They first explain that the consonant sound can be pronounced strictly, firmly, for example: [m], [l], [s], and, you can gently, softly: [m "], [l"], [s"]. Then they ask : "Tell me strictly, firmly [sh]! And now tell me affectionately, softly ...".
The affricate [h] is put from [t "] or from the merger of [t"] and [u]. Its introduction into syllables begins with closed ones.
The sound [x] usually does not cause difficulties and is stimulated by exhalation or prolonged pronunciation of the sound [k].
The sound [j] is obtained by merging a vowel with [and] in words, for example: iakor instead of "anchor", etc. But the absence of this phoneme with rhinolalia is observed only in children under 5 years old.
The sound [l], especially its soft variant, is preserved more often than other consonants. If it is violated or absent, staging this sound from [s], or [a] usually does not cause difficulties. It is only necessary to keep the narrowed "peg" tongue sticking out. The prolonged pronunciation of the vowel [s] with a bitten tongue allows you to call an isolated [l], and the rhythmic biting of a tense protruding tongue during the phonation of the vowel [a] stimulates syllables like la - la - la.
A vibrating sound [p] is quite rarely possible to deliver with insufficiency of the palatopharyngeal closure. In these cases, the directed air jet cannot reach the proper force to vibrate the tip of the tongue. At the same time, the strength of the jet is affected not only by the length, but also by the degree of automation of the palatine curtain.
Leakage of air into the nasal cavity allows you to get the vibration of the tip of the tongue only when you pinch the wings of the nose. Uncoordinated slow movements of the soft palate do not allow the vibrating [r] to be reproduced in the flow of speech, although it is possible to correctly pronounce it in isolated words.
In such cases, they teach a single-stroke or proton sound and introduce it into speech. These analogue sounds are suitable for developing auditory differentiations and teaching literacy due to the originality of articulation and sound.
Of course, if there are appropriate conditions, they do not refuse to receive a vibrant. Sound correction is carried out in traditional ways, but most often the initial phonemes are [g] and [h]
Closing nasal sounds [m], [n] can also be disturbed with rhinolalia. This disorder is of two types: the sounds are replaced by vocalization or pharyngeal closure, or after surgery they lose their nasal tone, when children switch completely to oral resonance.
Correcting these shortcomings is not difficult. Children are offered to close their lips, open their teeth and pronounce the vowel [a] for a long time, to achieve a sensation of vibration in the nose. Having thus received [m], they are asked to reproduce it, holding the tongue between the teeth. At the same time, interdental [n] is clearly heard.
There is evidence in the literature that with rhinolalia, the reproduction and intelligibility of voiceless explosive and fricative consonant phonemes suffer more than voiced ones.
Nevertheless, it is usually with deaf sounds that they begin to correct the sound pronunciation. The conditions of classes in this case are facilitated by the absence of one of the components of voiced phonemes - vocalization, which reduces nasal resonance. Working without a voice also makes it possible, if necessary, to prepare and stimulate sounds without naming them, which helps to prevent manifestations of the action of a fixed pathological set.
Adolescents who used laryngeal sound formation in the past, when phonation is turned on when pronouncing an isolated sound, simultaneously turn on a laryngeal sound. This symptom does not allow relying on tactile control of the larynx when placing. Practice confirms the inefficiency of this technique. After surgery, in adolescents with clefts, some discoordination of the organs of the oral cavity and larynx is observed, which leads to preemption or delay of phonation when calling voiced consonants. In addition, with rhinolalia, it is not recommended to pronounce consonants in a drawn out and exaggerated way, since tension increases, exhalation increases and the time of the bow lengthens.
You can use two methods of voicing.
The first is effective when working with children without voice disorders. The child pronounces or sings a vowel sound on the main tone of voice for a long time. During phonation, he should calmly, without increasing tension, but quickly reproduce the desired articulation without interrupting the voice formation.
A speech therapist's verbal instruction may look something like this: "Pull or sing a - a - a, but in the middle touch your lower lip to your upper teeth." Thus, the child reproduces the sounds [b] and [c] in the intervocalic position. The speech therapist simultaneously silently performs the task so that the child can articulate synchronously and not slow down on the bows.
It is impossible to name a sound in advance, even its deaf pair. Otherwise, children reproduce a defective voiced or interrupt phonation on a deaf one.
Calling sounds [b], [c], [g], [e], [g] begin with the vowel [a]. The vowel [a] is used when calling voiced consonant phonemes, since the wide-open mouth allows the student to observe himself, and relaxed lips do not interfere with articulation. When pronouncing the sound [d], one should touch the protruding tongue with the teeth. Working on the sound [g], they stop at the following points:
1) the student pulls the sound [a] and at the same time raises the tongue with a “ladle”;
2) the student pulls the sound [a] and at the same time raises the tongue with a “ladle”, brings the teeth together and rounds the lips.
Of course, calling the sound [g] from [r] is easier.
The sound [g] is called with mechanical help in the same way as [k], but during phonation.
It is more expedient to stimulate whistling [h] using the vowel [e]. During the articulation of the latter, the lips are slightly moved apart, and the danger of turning on the nasal resonance is small. The child is asked to stick out his tongue slightly and bring his teeth together.
Next, they practice pronouncing voiced in an intervocalic position between different vowels, for example:
ava eva ova uva iva
ave eve ove uwe ive
avo evo ovo uvo ivo
woo woo woo woo woo
avy eva ovy alas willow
These combinations phonate with a voice of different loudness, amplifying the first vowel and drowning out the second and vice versa. Thus, they gradually learn to pronounce one of the vowels in a whisper, that is, they prepare for the isolated pronunciation of direct and reverse syllables.
During the exercises with the intervocalic position, the speech therapist selects words in which the desired sound would stand between the vowels. Turning to the pronunciation of syllables, they try not to linger on this, but quickly start pronouncing individual words.
The second technique is more difficult, its use is less desirable. It is used in teaching adolescents with voice disorders and soft palate paresis. The voice of the latter is deaf, unmodulated, vowels sound tense and unnatural.
The use of the second technique implies that the children already know how to voice “into the mask”. The child is asked to sound the nasal sonor [m] for a long time, and then, smiling, slightly stick out his tongue, i.e., they try to reproduce a combination like mmmzzz. Combinations mmmzhzhzh or mmmvvv are stimulated in a similar way.
A similar method can only be recommended for evoking fricative sounds. Using it, work on voiced plosives has to be postponed to the end of training.
In cases of pronounced nasalization of the consonant, a combination of both methods is possible. Then “mooing into the mask” is used to evoke the correct clean soft voice, and then they move on to a vowel that stimulates the rise of the palatine curtain, for example: mmmaazhzhzhaaa, mmmeezhzhzheeee. These combinations are pronounced on the same tone.
It is also possible to use both the initial and oral sonor [l]. Correcting the pronunciation of voiced plosives and fricative consonants, one cannot completely identify their articulation with the articulation of the deaf. When pronouncing the latter, slower movements are possible, a greater tension of the organs of articulation is necessary. Voiced phonemes sound clear, without a squeezed tone, only with smooth, unexaggerated switching from sound to sound.
Significantly facilitates the consolidation of voiced consonants singing. You can sing syllables to any musical exercises and phrases known to students. But you need to start the melody with a vowel sound, for example: [a] - for - for - for.
Literature.
1. Volkova V. S. Speech therapy: textbook. for stud. defectol. fak. ped. textbook establishments. - M .: "Vlados", 2007.
2. Handbook of a teacher-defectologist / T. B. Epifantseva - Rostov-on-Don: "Phoenix", 2007.
3. Povalyaeva M.A. Handbook of a speech therapist. - Rostov-on-Don: "Phoenix", 2008.
4. Home speech therapist. Complete guide. / Yu. Yu. Eleseeva - M .: "Eksmo", 2007.
5. Shakhovskaya S. N., Paramonova L. G. Speech therapy. methodological legacy. In 5 books. Book. I: Violations of the voice and the sound-producing side of speech: At 2 hours. Part 2 .: Rhinolalia. Dysarthria. - M .: "Vlados", 2006.