Methodology of speech therapy work to eliminate rhinophony. Nasality: RDJ without speech defects How to remove nasal tone with dysarthria

Rhinolalia (from the Greek rhinos-hoc, lalia - speech) is a violation of the timbre of the voice and sound pronunciation, caused by anatomical and physiological defects of the speech apparatus. The combination of sound articulation disorders with voice timbre disorders makes it possible to distinguish rhinolalia from dyslalia and rhinophonia (FOOTNOTE: Rhinophonia is a violation of voice timbre with normal articulation of speech sounds).

With rhinolalia, the mechanism of articulation, phonation and voice formation has significant deviations from the norm and is caused by 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 nasal sounds, the nasopharyngeal and nasal cavities are separated from the pharyngeal and oral cavities.

Rice. 30. Movement of the soft palate: A - the soft palate is raised and pressed tightly against the back wall of the pharynx. The timbre of the voice when pronouncing all speech sounds, except nasal ones, is normal; B - the soft palate is raised and pressed against the thickened posterior wall of the pharynx. Voice timbre 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 penetrates into the nasal cavity. Voice timbre: nasal

These cavities are separated by velopharyngeal 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 wall of the pharynx occurs, which also contributes to the contact of the posterior surface of the soft palate with the posterior wall of the pharynx.

The level of contact of the soft palate with the pharyngeal wall can vary and depends on the length of the soft palate (Fig. 30).

During speech, the soft palate continuously lowers and rises to different heights depending on the sounds being spoken and the fluency of speech. The strength of the velopharyngeal closure depends on the sounds being pronounced. It has been established that there is less shutter for vowels than for consonants. Vowels with a nasal connotation appear if there is a space of about 6 mm between the posterior edge of the soft palate and the posterior wall of the pharynx.

The weakest velopharyngeal closure is observed with the consonant in, the strongest - with the consonant with (6-7 times stronger than with the vowel c). When pronouncing nasal sounds m, m, n, n, the air stream freely penetrates into the space of the nasal resonator.

Forms of rhinolalia

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

Closed rhinolalia (FOOTNOTE: The term “rhinolalia” is appropriate only in cases where there are other disorders of the articulation of sounds. In other cases, the term “rhinophonia” is used.). Closed rhinolalia is characterized by decreased physiological nasal resonance during the production of speech sounds. The strongest resonance is normally observed when pronouncing the nasal m, m, n, n". During the articulation of these sounds, the nasopharyngeal valve 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 closed rhinolalia, the pronunciation of vowels is impaired. It takes on an unnatural, dead hue.

The causes of closed rhinolalia are most often organic changes in the nasal space or functional disorders of the velopharyngeal closure. Organic changes are caused by painful phenomena, as a result of which the nasal passage decreases and nasal breathing becomes difficult. Anterior closed rhinolalia occurs with chronic hypertrophy of the nasal mucosa, mainly the posterior parts of the inferior conchae, with polyps in the nasal cavity, with a deviated nasal septum and with tumors of the nasal cavity. Posterior closed rhinolalia in children is most often the result of large adenoid growths, occasionally nasopharyngeal polyps, fibroids or other nasopharyngeal tumors.

Functional closed rhinolalia occurs frequently in children, but is not always correctly recognized. It is characterized by the fact that it occurs with good conductivity of the nasal cavity and undisturbed nasal breathing. With functional closed rhinolalia, the timbre of nasal and vowel sounds may be more disturbed than with organic rhinolalia. The reason is that the soft palate rises above normal during phonation and pronunciation of nasal sounds and blocks sound waves from accessing the nasopharynx. Similar phenomena are more often observed in neurotic disorders in children.

With organic closed rhinolalia, the causes of obstruction in the nasal cavity are first eliminated. As soon as correct nasal breathing appears, the defect disappears. If, after eliminating the obstruction of the nasal cavity (for example, after adenotomy), closed rhinolalia or rhinophonia continues in the usual form, resort to the same exercises as for functional disorders. With functional closed rhinolalia, children are systematically trained in pronouncing nasal sounds. Preparatory work is being carried out 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 breathing movements are combined with movements of the arms and torso. Children are taught to pronounce sounds in a drawn-out manner so that a strong vibration is felt in the area of the wings of the nose and the base of the nose. Next, preschoolers are encouraged to pronounce the syllables pa, pe, pu, po, pi in such a way that the vowels sound slightly nasal. In the same way, they practice the pronunciation of consonants in the position before nasal sounds (syllables like am, om, um, an).

After the child learns to pronounce these syllables correctly, words containing nasal sounds are introduced. It is necessary that he pronounce them exaggeratedly loudly and drawlingly with a strong nasal resonance.

The final exercises are for loud short and long pronunciation of vowel sounds. In addition, vocal exercises are used.

The duration of correction work for functional closed rivophony is short. With rhinolalia, the timing is longer and can be difficult to predict in advance. This is explained by the fact that with functional closed rhinolalia, the elimination of defects in the articulation of sounds is also required. In addition, children with this form of rhinolalia often exhibit some features of mental development.

Open rhinolalia. Normal phonation is characterized by the presence of a seal between the oral and nasal cavities, when vocal vibration penetrates only through the oral cavity. If the separation between the nasal cavity and the oral cavity is incomplete, the vibrating sound penetrates into the nasal cavity. As a result of disruption of the barrier between the oral and nasal cavities, vocal resonance increases. At the same time, the timbre of sounds, especially vowels, changes. The timbre of the vowel sounds u and u changes most noticeably, during the articulation of which the oral cavity is most narrowed. The vowel sounds e and o are less nasal, and the vowel a is even less disturbed, since when it is pronounced the oral cavity is wide open.

In addition to the timbre of vowel sounds, with open rhinolalia the timbre of some consonants is disrupted. When pronouncing hissing sounds and fricatives f, v, x, a hoarse sound is added that occurs in the nasal cavity. Plosive sounds p, b, d, t, k and g, as well as sonorant l and r sound unclear, since the air pressure necessary for their accurate pronunciation cannot be generated in the oral cavity. With prolonged open rhinolalia (especially organic), the air flow from the oral cavity is so weak that it is insufficient to vibrate the tip of the tongue, which is necessary to produce the sound p.

Open rhinolalia can be organic and functional.

Organic open rhinolalia can be congenital or acquired.

The most common cause of the congenital form is a cleft of the soft and hard palate.

Acquired open rhinolalia is formed due to 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.

One of the functional forms is habitual open rhinolalia, observed, for example, after removal of large adenoid growths, and occurs as a result of long-term restriction of the mobility of the soft palate.

A functional examination of open rhinolalia does not reveal organic changes in the hard or soft palate. A sign of functional open rhinolalia is also the fact that usually the pronunciation of only vowel sounds is impaired, while when pronouncing consonants, the velopharyngeal closure is good and nasalization does not occur.

The prognosis for functional open rhinolalia is more favorable than for organic one. The nasal timbre disappears after phoniatric exercises, and pronunciation disorders are eliminated by the usual methods used for dyslalia.

Rhinolalia, caused by congenital nonunion of the lip and palate, represents a serious problem for speech therapy and a number of medical sciences (dentistry surgery, orthodontics, otolaryngology, medical genetics, etc.). Cleft lip and palate are the most common and severe congenital malformations.

As a result of this defect, children experience serious functional disorders during their physical development.

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.

Difficulty feeding leads to a weakening of vitality, and the child becomes susceptible to various diseases. Children with clefts are most susceptible to upper respiratory tract catarrh, bronchitis, pneumonia, rickets, and anemia.

Often, such children experience pathological changes in the ENT organs: curvature of the nasal septum, deformation of the wings of the nose, adenoids, hypertrophy (enlargement) of the tonsils. They often experience inflammatory processes in the nasal area. 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 media, often taking a chronic course, cause hearing loss. Approximately 60-70% of children with cleft palates have varying degrees of hearing loss (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 defective arrangement of teeth.

Numerous functional disorders caused by defects 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 from various specialties observe children and jointly decide on 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.

Surgery to restore the upper lip (cheiloplasty) is recommended in the first year of a child’s life; it is often performed 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 speech development in the preoperative period. The otolaryngologist identifies and treats all painful changes in the ear, nasal cavities, nasopharynx and larynx and prepares children for surgery.

In case of deviations in mental development and the presence of pronounced neurotic reactions, the child is consulted by a neurologist.

Palate restoration surgery (uranoplasty) is performed in most cases in preschool age.

According to the state of mental development, children with cleft palates are divided into three categories:

1) children with normal mental development;

2) children with mental retardation;

3) children with olegophrenia (of varying degrees). During a neurological examination, signs of significant focal brain damage are usually not observed. Some children have individual neurological microsigns. Much more often, children experience functional disorders of the nervous system, sometimes significantly pronounced psychogenic reactions, and increased excitability.

In addition to all of the above, congenital cleft palates have a negative impact on the development of a child’s speech.

Cleft lip and palate play different roles in the formation of speech underdevelopment. This depends on the size and shape of the anatomical defect.

The following types of clefts are found:

1) cleft lip; upper lip and alveolar process (Fig. 31);

2) clefts of the hard and soft palate (Fig. 32);

3) clefts of the upper lip, alveolar process and palate - unilateral and bilateral;

4) submucosal (submucosal) cleft palate. With cleft lips and palates, all sounds acquire a nasal or nasal tone, which grossly interferes with the intelligibility of speech.

It is typical to superimpose additional noises on nasal sounds, such as aspiration, snoring, larynx, etc. A specific disturbance in voice timbre and sound pronunciation occurs.

To prevent food from passing through the nose, children from a very early age acquire the habit of raising the back of the tongue to block the passage into the nasal cavity. This tongue position becomes habitual and also changes the articulation of sounds.

Rice. 31. Left-sided cleft of the upper

Rice. 32. Left-sided cleft lip and alveolar process of the hard palate

When speaking, children usually open their mouths little and raise the back of their tongue higher than required. Due to this, the tip of the tongue does not move fully. This habit worsens the quality of speech, since with a high position of the jaw and tongue, the oral cavity takes on a shape that allows air to enter 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 very uniquely 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 palatal defect and the degree of speech distortion has not been established. This is explained by large individual differences in the configuration of the nasal and oral cavities in children, the ratio of resonating cavities and compensatory techniques that each child uses to increase the intelligibility of his speech. In addition, speech intelligibility depends on the age and individual psychological characteristics of children.

Speech therapy sessions with the child must begin in the preoperative period in order to prevent the occurrence of serious changes in the functioning of the speech organs. At this stage, the activity of the soft palate is prepared, the position of the root of the tongue is normalized, the muscular activity of the lips is enhanced, and directed oral exhalation is produced. All this taken together creates favorable conditions for increasing the effectiveness of the operation and subsequent correction. 15-20 days after surgery, 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 defective anatomical and physiological conditions of speech formation, limited motor component of speech lead not only to the abnormal development of its sound side, but in some cases to a deeper systemic disorder of all its components.

As the child ages, the indicators of speech development worsen (compared to the indicators of normally speaking children), the structure of the defect is complicated by impairment of various forms of written speech.

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

The setting of correctional tasks is determined by the results of an examination of children’s speech.

Examination of the state of sound pronunciation in children

The examination of sound pronunciation should include two aspects. One aspect - articulation - involves elucidating the peculiarities of the formation of speech sounds and the functioning of the organs of articulation in the process of pronunciation.

The second aspect - phonological - aims to find out how the child distinguishes the system of speech sounds (phonemes) in different phonetic conditions. These two aspects are closely related.

The examination of sounds begins with a thorough check of the isolated pronunciation of sounds. Then they check the pronunciation of sounds in syllables, words and phrasal 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 disorder.

The degree of nasality when pronouncing vowels and consonants and the presence of compensatory “grimasks” are also noted.

During the examination, exercises are used that consist of repeated repetition of one sound, 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.

Also useful for speech therapy analysis is the child’s repetition of two sounds or syllables, suggesting a clear articulatory switch (for example, cap-pack). First, sounds are given that are sharply different from each other in articulation, then closer ones. At the same time, the speech therapist records cases when the child fails to motorly switch from one sound to another, and instead of repeating the final sound of the first syllable, he pronounces the previous one. The appearance of “average” articulation is also noted (for example, instead of “gida” a semi-voiced sound is pronounced, instead of “t and t” - a semi-soft sound).

The speech therapist then finds out how the child uses sounds in speech. When checking, attention is paid to substitutions, distortions, confusions, and 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 sounds being tested. The desired sound must be in different positions in words. For example, the following words (pictures) can be used for whistling and hissing sounds: dog, wheel, nose, pine, shepherd, cash register. The speech therapist pays special attention to how the child pronounces sounds in phrasal speech.

A number of tasks should be aimed at identifying the child’s ability to switch articulatory movements. So, he is asked to repeat a sound or syllable series several times, and then the sequence of sounds or syllables is changed. The speech therapist notes whether switching occurs easily. For example:

The ability to pronounce simple and complex words according to their syllable structure is also examined. The speech therapist presents children with object pictures for naming, then pronounces words for reflected reproduction. The results of both tasks are compared. The speech therapist notes that the child is doing better. He especially notes words that are pronounced without distortion of syllabic and sound composition.

It is important to find out what sounds the words whose syllable structure is distorted consist of - learned or unlearned. The nature of the distortion is noted:

1) reduction in the number of syllables (“uterus” instead of hammer);

2) simplification of syllables (“tul” instead of chair);

3) assimilation of syllables (“tattoo” instead of stool);

4) adding the number of syllables (“komanamata” instead of room);

5) rearrangement of syllables and sounds (“devero” instead of tree).

The ability to pronounce sounds in sentences composed of sounds that, in isolated form, the child pronounces correctly and distortedly is tested.

To identify minor violations of the syllable structure of words, children are offered to repeat sentences like “Letya drinks bitter medicine”; “There’s a policeman standing at the crossroads.”

The speech therapist groups the identified sound defects in accordance with phonetic classification.

In speech therapy, it is customary to distinguish four categories of sound pronunciation defects: absence of sound, distortion of sound, replacement of sound and confusion of sound. The absence of sounds, especially those that are difficult to articulate, is very common in children. It can manifest itself in the form of constant loss of sound in words of varying complexity and in the child’s inability to pronounce it in isolation. This type of disorder is a stable defect. Sometimes in the speech of children with good phonemic perception, instead of complete loss of sound, overtones appear in some positions.

The typical “pharyngeal” sound of posterior palatal sounds is due to excessively deep articulation.

The appearance of overtones, especially in sound combinations of the SSG type, is also typical for children with excessive, exaggerated articulation, when short-term transitional phases of articulation, which are not perceived by the listener in ordinary speech, act as independent sounds. In the same children, along with insertions of sounds, frequent omissions of sounds or their reduction are found, simplifying the articulation of difficult combinations of consonants.

It is not uncommon for missing sounds to be replaced by distorted ones over time. Sound distortion is also characterized by its stability in different forms of speech. This defect does not affect the phonological system of the language.

Categories of defects such as mixing and substitution of sounds constitute a special group, since these deviations from standard pronunciation reveal the instability of the entire sound system of the language. Sounds can be pronounced correctly in one position in a word and mixed in others. One sound can have several different substitutes. Sound replacements can be permanent or temporary - in different forms of speech in different ways. In these two categories of defects, which are phonological in nature, a violation of the system of sound oppositions is manifested. Depending on the number of sounds mixed, it affects either the entire sound system of the language or part of the system.

This state of sound pronunciation should alert the speech therapist, since it is diagnostic for identifying phonemic underdevelopment.

Violations of sound pronunciation are compared with the peculiarities of the rhythmic-syllable structure.

Replacement and confusion of sounds, insufficient discrimination of sounds and disruption of the rhythmic-syllabic structure are signs typical of general speech underdevelopment. The final conclusion can be made after examining the lexical and grammatical aspects of speech.

A thorough detailed examination of the structure of the articulatory apparatus and its motor functions is important for planning corrective exercises. During the examination, it is necessary to assess the degree and quality of violations of the motor functions of the organs of articulation and 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 the following features are present:

1) lips: cleft upper lip, postoperative scars, shortened upper lip;

2) teeth: incorrect bite and teeth alignment;

3) tongue: large, narrow; shortening of the hyoid ligament;

4) hard palate: narrow, dome-shaped (“Gothic”), cleft of the hard palate - submucosal cleft. A submucosal cleft palate (submucosal cleft) is usually difficult to diagnose because it is covered by mucous membrane. You need to pay attention to the back of the hard palate, which, during phonation, is retracted in the shape of a small triangle, angled forward. The mucous membrane in this place is thinner and has a paler color. In unclear cases, the otolaryngologist should determine the condition of the palate through careful palpation;

5) soft palate: short soft palate, cleft palate, bifurcated small uvula or absence of uvula.

Cleft palates are usually accompanied by deformation of the jaws, abnormal development and position of teeth, unfused 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 and hang passively. The muscles of the posterior pharyngeal wall are poorly developed. The root of the tongue is overdeveloped, but 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 of the tongue to one side, drooping of one half of the soft palate, etc.

It is not enough to reveal the ability of the organ of the articulatory apparatus to produce movement; it is necessary to note the strength of the movement, its accuracy, speed, and fixity. Pareticity of the tongue and lips is manifested in a small range of movements, in their inaccuracy, exhaustion, and lack of fluency. The movements of the tongue must be of such strength as to hold it in the desired position for as long as it takes to pronounce a particular 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 during 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 articulation process tense and slow.

A tongue hanging motionless in 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 velum when vigorously pronouncing the sound a; the presence or absence of air leakage through the nose when pronouncing vowel sounds, the uniformity of the leakage; the presence or absence of a pharyngeal reflex (the appearance of gag movements when lightly touching the soft palate with a spatula).

It must be taken into account that articulatory difficulties in spontaneous speech can be aggravated by factors such as excitement, fatigue, and complication of the content of speech in an intellectual or linguistic sense.

Children with normal physical hearing often experience specific difficulties in distinguishing subtle differential features of phonemes, which influence the entire process of further development of the sound side of speech.

Phonemic perception in children with severe defects of the articulatory apparatus develops in inferior conditions and may have deviations. In order to identify its condition, techniques are usually used aimed at: recognizing, distinguishing and comparing simple phrases; highlighting and memorizing certain words among 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); memorizing syllable series consisting of two to three elements (with a change in the vowel sound - ma-me-mu, with a change in the consonant sound - ka-va-ta); memorizing sound sequences.

In order to identify 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 different syllabic complexity; guess which of the presented pictures corresponds to the rhythmic pattern specified by the speech therapist.

Examination of speech sound discrimination can begin with tasks for repeating isolated sounds or pairs of sounds. Deviations in phonemic perception are most clearly manifested when the child repeats phonemes that are similar in sound (b-p, s-sh, r-l, etc.). In this case, the child is asked to repeat syllable combinations consisting of such sounds. For example: sa-sha, sha-sa, sa-sha-sa, sha-sa-sha, sa-za, za-sa, sa-za-sa, etc.

Particular attention should be paid to distinguishing between whistling, hissing, affricates, sonorants, as well as voiceless and voiced sounds. When performing tasks of this type, some children experience obvious difficulties when repeating sounds that differ in acoustic characteristics (voiced-voiced), while another category of children find it difficult to repeat sounds that differ in articulatory structure.

Cases may be identified when the task of reproducing 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 a child cannot switch from pronouncing one sound to pronouncing another.

When examining phonemic perception, it is advisable to use tasks that exclude articulation so that difficulties in pronunciation do not affect the quality of differentiation. Thus, the speech therapist pronounces the desired sound among other sounds, both sharply different and similar in acoustic and articulatory characteristics. Having heard the given sound, the child raises his hand. For example, you can ask the child to isolate the sound u from the sound series o, a, u, o, u, ы, o or the syllable sha from the syllabic series so, 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 ("Select pictures for the sound p and the sound l; for the sound s and the sound w, for the sound s and the 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 when examining sound analysis skills.

As a result of examining the sound aspect of speech and comparing it with examination data of other aspects of speech, the speech therapist should have a clear idea of whether the identified disorders are an independent defect or are part of the structure of general speech underdevelopment as one of its components. The formulation of specific correction tasks depends on this.

Essential for the effectiveness of correction of a speech defect is a skillfully structured conversation with parents, who need to be explained in an accessible form the mechanism of correct speech breathing and the need for daily monitoring of sound pronunciation 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 occurs under special conditions. The baby hears well, rejoices at speech addressed to him and gradually begins to understand it. But due to the lack of a seal 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 through imitation, as happens normally. The child remains in such anatomical conditions until surgery.

The daily duty of parents is to encourage any attempts by the child to pronounce some sound, word, to try to understand even 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 ensure normal speech, but only creates full-fledged anatomical and physiological conditions for the development of correct pronunciation. It is also necessary to encourage parents to consolidate all achieved results every day.

It often happens that the somatic weakness of a child with rhinolalia, the presence of a speech defect causes constant anxiety in parents, anxiety about any reason, the need for excessive care of the baby, and distrust in his capabilities. Such an attitude only aggravates the defect, strengthens the child’s neurotic reactions and undermines his self-confidence. ,

The teacher must help children cope with indecision, the inability to stand up for themselves, and get rid of fear and anxiety about the quality of their speech. It is equally important to provide them with contact and meaningful relationships with peers.

Objectives and content of correctional work

The formation of phonetically correct speech in preschool children with a congenital cleft palate is aimed at solving several interrelated problems:

1) normalization of “oral exhalation,” i.e., the production of a long-lasting oral stream when pronouncing all speech sounds, except nasal ones;

2) development of correct articulation of all speech sounds;

4) developing the skills of differentiating sounds 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.

Solving these specific problems is possible by taking into account the patterns of mastering correct pronunciation skills.

When correcting the sound aspect of speech, the acquisition of correct sound 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) articulation gymnastics;

3) 3) articulation of isolated sounds or quasi-articulation (since isolated pronunciation of sounds is atypical for speech activity);

4) 4) syllabic exercises.

At this stage, motor skills are mainly trained on the basis of initial unconditioned reflex movements.

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

The third stage is the stage of integration, i.e. learning the positional changes of sounds in a coherent utterance.

The fourth stage is the stage of automation, that is, the transformation of correct pronunciation into normative, so familiar that it does not require special control on the part of the child himself and the speech therapist.

All stages of sound system acquisition are ensured by two categories of factors:

1) unconscious (through listening and reproduction);

2) conscious (through the assimilation of articulatory patterns and phonological characteristics of sounds).

The participation of these factors in the acquisition of the sound system varies depending on the age of the child and 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 child’s personal qualities, focusing on correcting the defect, and without consciously assimilating new acoustic and motor stereotypes of speech sounds.

Corrective tasks have a certain difference depending on whether plastic surgery to close the cleft is performed or not, although the main types of exercises are used both in the preoperative and postoperative periods.

For children with rhinolalia who are in a special kindergarten for children with speech impairments, dividing them into groups during the preoperative and postoperative periods is impractical, since their education is organized in accordance with the basic requirements of the program and is carried out regardless of the duration of the operation. Only the nature of specific correctional tasks for individual lessons is different.

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 correct articulation of consonant sounds accessible to the child.

After surgery, correction tasks become much more complicated:

1) development of mobility of the soft palate;

2) elimination of incorrect arrangement of articulation organs when pronouncing sounds;

3) preparation of the pronunciation of all speech sounds without nasal connotation (with the exception of nasal sounds).

The following types of work are specific for the postoperative period:

1) massage of the soft palate;

2) gymnastics of the soft palate and posterior pharyngeal wall;

3) articulation gymnastics;

The main goal of these exercises is to:

1) increase the strength and duration of the air stream exhaled through the mouth;

2) improve the activity of articulatory muscles;

3) develop control over the functioning of the velopharyngeal seal.

The main purpose of soft palate massage is to knead scar tissue. Massage should be carried out before meals, in compliance with hygienic requirements. It is carried out as follows. Stroking movements are made along the suture line back and forth to the border of the hard and soft palate, as well as left and right along the border of the hard and soft palate. You can alternate stroking movements with intermittent pressing ones. It is also useful to apply light pressure on the soft palate when pronouncing the sound a. The mouth should be wide open.

Gymnastics of the soft palate includes a number of exercises:

1. Swallowing water or simulating swallowing movements. Children are offered to drink from a small glass or bottle. Swallowing water in small portions causes the highest rise of the soft palate. A large number of successive swallowing movements lengthens the time during which the soft palate is in the upward position.

2. Yawning with your mouth open.

3. Gargling with warm water in small portions.

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

The child is trained to cough voluntarily on one exhalation from 2-3 repetitions to more. During the exercise, the palate should remain closed with the back wall of the pharynx, and the air should be directed through the oral cavity. It is advisable for the child to cough with his tongue hanging out for the first time. Then coughing is introduced with arbitrary pauses, during which the child is required to maintain the closure of the palate with the back wall of the pharynx. By performing this exercise, children master the ability to actively lift the soft palate and direct the air stream through the mouth.

5. Clear, energetic, exaggerated pronunciation of vowel sounds in a high pitch of voice. At the same time, the resonance in the oral cavity increases and the nasal tint decreases. First, the abrupt pronunciation of vowel sounds a, e, then o, u with exaggerated articulation is trained.

Then they gradually move on to clearly pronouncing the sound series a, e, u, o in different alternations. In this case, the articulatory pattern changes, but exaggerated oral exhalation remains. When this skill is strengthened, they move on to smoothly pronouncing sounds.

For example: a, uh, o, y ______, a, y, oh, uh ________.

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.

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

To develop correct sonorous speech, it is necessary to work on correct breathing. It is known that rhinolalics have a very short, wasteful exhalation, in which the air comes out through the mouth and nasal passages. To develop the correct oral air stream, special exercises are performed 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 helps to develop the correct kinesthetic sensations of movements of the soft palate.

It is very important to constantly monitor your child while performing these exercises, since at first it may be difficult for him to feel air leaking through the nasal passages. Control techniques are different: a mirror, cotton wool, or strips of thin paper are placed at 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, pinwheels, 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 on teaching correct speech.

Many parents make the mistake of buying balloons and accordions, inspired by the advice of a speech therapist, and giving them to their child for constant use. Children are not always able to inflate a balloon without preparatory exercises and often cannot play the harmonica because they do not have sufficient force to exhale through the mouth. Having failed, the child becomes disappointed in the toy and never returns to it. Therefore, you need to start with easy, accessible exercises that give a clear 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 wool from his palm. 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 freed. This technique is often useful: light lumps of cotton wool (unpressed) are inserted into the nasal passages. If the air is mistakenly directed into the nose, they pop out and the child becomes convinced that his actions were wrong.

You can also blow on light plastic toys floating in water. A good exercise is to blow 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. As the water blows, it begins to bubble, which captivates small children. By looking at the “storm” in the water, you can easily estimate the strength of the exhalation and its duration. It is necessary to show the child that the exhalation should be smooth and long. It is good to mark the time of “seething” on an 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 a lot of similar exercises. The more difficult of them is playing wind instruments. The teacher (speech therapist) must keep in mind that breathing exercises quickly tire the child (they can cause dizziness), so they must be alternated with others.

At the same time, children are given a series of exercises, the main goal of which is to normalize speech motor skills. It is known that children with rhinolalia develop pathological articulation features due to anatomical and physiological conditions. Features of articulation are as follows:

1) high elevation of the tongue and its displacement deep into the oral cavity;

2) insufficient labial articulation;

3) excessive participation of the root of the tongue and larynx in the pronunciation of sounds.

Elimination of these articulation features is an important link in the correction of the defect. This is achieved through so-called articulatory gymnastics exercises that develop the lips, cheeks, and tongue. We list the most effective of them:

1) inflating 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 - the closed lips are pulled forward with the proboscis, then return to their normal position. The jaws are closed;

5) grin: lips stretch strongly to the sides, up and down, exposing both rows of teeth;

6) “proboscis” followed by a 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 the jaws open;

9) stretching the lips with a narrow funnel (imitation of whistling);

10) retraction of the lips into the mouth, pressing tightly against the teeth with the jaws wide open;

11) imitation of rinsing teeth (the air presses heavily on the lips);

12) lip vibration;

13) movement of the lips with the proboscis left and right;

14) rotational movements of the lips with the proboscis;

15) strong puffing of the cheeks (air is retained in the oral cavity by the lips).

Tongue exercises:

1) sticking out the tongue with a shovel;

2) sticking out the tongue with a sting;

3) protruding the flattened and pointed tongue alternately;

4) turning the strongly protruding tongue left and right;

5) raising and lowering the back of the tongue - the tip of the tongue rests on the lower gum, and the root either rises or falls;

6) suction of the back of the tongue to the palate, first with the jaws closed, and then with the jaws open;

7) the protruding wide tongue closes with the upper lip, and then retracts into the mouth, touching the back of the upper teeth and palate and bending the tip 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 of the lips with the tip of the tongue;

10) raising and lowering a wide protruding tongue to the upper and lower lips with the mouth open;

11) alternately bending 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 floor 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 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 on the upper lateral incisors, while grinning, raise and lower the tip of the tongue, touching the upper and lower gums;

17) with the same position of the tongue, repeatedly drum the tip of the tongue on the upper alveoli (t-g-t-t);

18) make movements one after another: tongue with a sting, cup, up, etc.

The listed exercises should not be given all in a row. Each small lesson should consist of several elements: breathing exercises, articulatory gymnastics and training in pronouncing sounds.

Working on sounds requires a lot of attention and effort. Usually, the production of sounds begins with the sound e. The tongue is at rest, the mouth is wide open. When making a sound, the tongue is slightly retracted, the lips are pushed forward; at the sound, the lips are stretched out into a tube with tension, and the tongue is pulled back even more. When making the sound e, the tongue rises slightly in the middle part, the mouth is half-open, the lips are stretched. These sounds are easy to pronounce by imitation; the main task in their production is to eliminate the nasal connotation. Initially, sounds are practiced in abrupt, isolated pronunciation with a gradual increase in the number of repetitions per exhalation, for example:

With each pronouncement, 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 in repeating vowels with pauses, during which he learns to keep the soft palate in a raised position (he needs to be shown the correct position of the soft palate in front of a mirror). Pauses are gradually increased to 2-3 s. Then you can move on to smooth pronunciation.

The production of consonant sounds begins with the sounds f and l. When pronouncing the sound f, the tongue lies calmly at the bottom of the mouth. The upper teeth lightly bite the lower lip. A strong oral exhalation breaks this stop and forms a jerky f sound. Air leaks are checked using a mirror or cotton wool.

Exercises for setting and consolidating sounds should be carried out in large quantities 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 wall of the pharynx occurs reflexively and it is easier for the child to concentrate on articulating sounds.

Literature

1. Ermakova I. I. Speech correction for rhinolalia in children and adolescents. - M., 1984.

2. Ippolitova A. G. Open rhinolalia. - M., 1983.

3. Speech disorders in preschool children / Comp. R. A. Belova-David, B. M. Grinshpun. - M., 1969.

Voice therapy has the ultimate goal of obtaining a ringing “flight” sound of the voice and consolidating it in the child’s independent speech. The main task of correctional work in this direction is the development of correct voice guidance, activation of the muscles of the larynx, and normalization of oropharyngeal resonance.

To solve these problems, it is necessary to carry out preparatory work to strengthen the velopharyngeal closure, activate the diaphragmatic muscles and form a targeted oral exhalation. Voice therapy itself consists of phonopedic exercises, as well as clarifying the articulation of vowel sounds. Phonopedic exercises help activate the muscles of the entire laryngopharyngeal apparatus.

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

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

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

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

Eliminating nasality takes a long time, as it is caused by a number of physiological and psychological factors. The older the child, the more difficult it is to eliminate this defect (normal speech skills are difficult to automate) due to the habit of the nasal sound of his voice.

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

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

Phonopedic exercises help activate the muscles of the entire laryngeal-pharyngeal apparatus. Learning proper voice skills begins with singing vowel sounds. At first, children learn to sing the vowels [a] and [o], after 2-3 lessons the sound [e] is added. The last sounds to be included are [i] and [u].

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

A JSC AE AI AU AOE AEO AOI AEU

About OA OE OI OU UAE OEA OAI OEU

E EA EO EI EU EAO EOA EAI EOU

IA IO IE IU IAO IOA IEA IAE

U UA UO UE UI UAO UOA UEO UOE

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

During classes, you can offer children game situations. For example, rocking a doll, a child will hum: [a]-[a]-[a], showing how big he is: [o]-[o]-[o], how the steamboat hums: [u]-[u]- [y], on a walk in the forest he screams [ay!], etc.

The use of static and dynamic breathing exercises helps to achieve a good effect.

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

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

· gradual lengthening of the pronunciation of sounds on one exhalation at an average volume of the voice;
· voice amplification: articulation - whisper - quiet - loud; combinations of vowel sounds are used;
· weakening of the voice: loud - quiet - whisper - articulation;
· counting to ten with gradual strengthening and subsequent weakening of the voice;
· similar pronunciation of the alphabetical series;
· reading poems with a gradual change in voice strength.

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

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

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

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

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

The child lies on his back and says some phrase in this position. If the nasal sound disappears, then we can assume paresis (paralysis) of the soft palate (the nasal sound disappears due to the fact that when lying on the back, the soft palate passively falls to the back wall of the pharynx).

First of all, you will need to activate the soft palate and make it move. For this you will need special massage . If the child is too small, adults do the massage:

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

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

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

4) with your index finger, perform acupressure and jerk-like massage of the soft palate near the border with the hard palate.

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

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

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

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

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

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

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

5) pronouncing vowel sounds: “a”, “u”, “o”, “e”, “i”, “s” energetically and somewhat exaggerated, on the so-called “hard attack”.

Restoring breathing

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

It can be difficult, and sometimes even uninteresting, for a small child to perform exercises just for demonstration. Therefore, use gaming techniques, come up with fairy-tale stories, for example these:

“Ventilating the cave”

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

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

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

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

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

"Snowstorm"

An adult ties pieces of cotton wool onto strings and fastens the free ends of the threads onto his fingers, thus making five strings with cotton balls at the ends. The hand is held at the level of the child’s face at a distance of 20–30 centimeters. The baby blows on the balls, they spin and deviate. The more these impromptu snowflakes spin, the better.

"Wind"

This is done in the same way as the previous exercise, but instead of threads with cotton wool, a sheet of paper is used, cut with a fringe at the bottom (remember, such paper was once attached to the windows to repel flies?). The child blows on the fringe, it deviates. The more horizontal the strips of paper take, the better.

"Ball"

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

“The ball deflated!”

After prolonged games, the tongue's ball loses its roundness: air comes out of it. (The child first strongly inflates his cheeks, and then slowly exhales air through his rounded and elongated lips.)

"Pump"

The ball has to be inflated using a pump. (The child’s hands perform the appropriate movements. At the same time, he himself pronounces the sound “s-s-s-..." often and abruptly: the lips are stretched in a smile, the teeth are almost clenched, and the tip of the tongue rests against the base of the lower front teeth. The air comes out of the mouth strongly pushes).

"The tongue plays football."

Tongue loves to play football. He especially likes scoring goals from the penalty spot. (Place two cubes on the side of the table opposite from the child. This is an improvised goal. Place a piece of cotton wool on the table in front of the child. The baby “scores goals” by blowing from a wide tongue inserted between his lips onto a cotton swab, trying to “bring” it to the goal and get into them. Make sure that your cheeks do not swell and the air flows in a trickle down the middle of your tongue.)

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

"The tongue plays the pipe"

Tongue also knows how to play the pipe. The melody is almost inaudible, but a strong stream of air is felt, which escapes from the hole of the pipe. (The child rolls a tube from his tongue and blows into it. The child checks the presence of a stream of air on his palm).

"Block and Key"

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

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

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

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

Articulation exercises for rhinolalia

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

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

1) “Liana”: hang your long, narrow tongue down toward your chin and hold in this position for at least 5 seconds (repeat the exercise several times).

2) “Boa constrictor”: slowly stick your long and narrow tongue out of your mouth (do the exercise several times).

3) “Boa Tongue”: With a long and narrow tongue, sticking out as much as possible from the mouth, make several quick oscillatory movements from side to side (from one corner of the mouth to the other).

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

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

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

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

You can also diversify articulation gymnastics

GASTRONOMIC AND Speech Therapy GAMES

Fun articulation exercises for children that they will have great fun doing because all the exercises are done with sweets!