Paralysis of the tongue muscles. Damage to the hypoglossal nerve (neuropathy of the hypoglossal nerve, neuropathy of the hypoglossal nerve). What is paralysis

We continue to introduce readers to various speech disorders with the help of L. Paramonova’s book “Speech Therapy for Everyone.” in general and in particular we have already talked. Today we will talk about dysarthria.

Dysarthria is a disorder of the sound pronunciation side of speech, which is caused by an organic lesion central department speech motor analyzer and associated disruption of the innervation of speech muscles. The term “dysarthria” itself means “a disorder of articulate speech” (“arthron” translated into Russian means “articulation”, and “diz” means “disorder”). The prevalence of dysarthria among mentally normal children ranges from 3 to 6%, but these figures have a clear upward trend.

Dysarthria most often is not an independent speech disorder, but is only one of the symptoms of a serious illness, which is usually congenital or occurs before the age of two years. Depending on the location of the brain lesion, dysarthria manifests itself in different ways, and therefore there are several types of it, which are inappropriate to consider here due to the impossibility of practical use of this information by non-specialists.

With complete paralysis of the articulatory muscles, anarthria occurs - a complete absence of pronunciation in the child. The main manifestations of severe dysarthria will be discussed further. But so-called erased dysarthria can often be observed, which needs to be discussed in a little more detail, since it is very widespread and, moreover, can be difficult to distinguish from dyslalia.

Erased dysarthria

Erased dysarthria is based on very small, literally pinpoint organic lesions of the cerebral cortex. Their presence leads to paresis of only certain small groups of articulatory muscles (for example, only the tip of the tongue or only one side of it). Under such conditions, the child suffers from the pronunciation of only individual sounds at an almost normal rate and rhythm of speech and in the absence of pronounced disorders of speech breathing and voice.

For a long time, such disorders in the pronunciation of sounds were classified as functional motor dyslalia, without noticing their specificity. However, the difficulties of overcoming them forced specialists to study this issue more carefully, as a result of which erased dysarthria was separated from the group of functional motor dyslalia. (During a neurological examination, paresis of individual articulatory muscles was discovered in these children, leading to definite disturbances in the pronunciation of sounds.)

Sound pronunciation disorders with erased dysarthria have not only a different causality compared to dyslalia, but also a different external manifestation. In particular, erased dysarthria is characterized by interdental pronunciation of sounds associated with weakness (pareticity) of the muscles of the tip of the tongue - it simply cannot be held behind the teeth. Often there is a “lateral” pronunciation of some consonants, which is associated with paresis of one side of the tongue. In these cases, the tongue, when protruding from the mouth, usually deviates to one side, and when articulating some sounds it becomes an “edge” in the mouth, which contributes to the lateral leakage of air. Such disturbances in the pronunciation of sounds at any age cannot be attributed to age-related peculiarities of sound pronunciation due to their being due to pathological reasons. Erased dysarthria never goes away with age, as evidenced by its presence in many adults.

Causes of cerebral palsy and dysarthria

The causes of cerebral palsy, and therefore the causes of dysarthria, are organic lesions of the child’s nervous system, which can occur in utero, during childbirth or as a result of early childhood diseases (meningitis, meningoencephalitis, traumatic lesions or vascular disorders).

Until relatively recently, the main cause of cerebral palsy (and therefore dysarthria) was considered to be birth trauma, causing cerebral hemorrhage, birth asphyxia and other complications during childbirth. However, it has now become clear that in more than 80-90% of cases, damage to the fetal nervous system occurs in utero. It is the insufficient usefulness of the fetus and its “unpreparedness” for active participation in the process of childbirth that leads to its complicated course and possible additional brain damage. These injuries can be the result of cesarean section, asphyxia at birth, or birth trauma during the provision of mechanical assistance, which is a forced means and is used only in cases of extreme necessity. Knowledge of this circumstance is extremely important both from the point of view of preventing cerebral palsy and, in most cases, the dysarthria that accompanies it.

If the main reason for the occurrence of both is not “for some unknown reason” that labor is so difficult, then the main content of prevention should be concern for the normal course of pregnancy, which very much depends on the seriousness of the woman’s attitude towards this most important period of her life. It has full power to exclude such harmful intrauterine development fetus, but, nevertheless, often present pathogenic factors, such as smoking and drinking alcoholic beverages even during pregnancy, constant overwork and non-compliance with a healthy daily routine, continued work in hazardous industries and on the night shift, lifting heavy objects and generally having large physical activity, “emergency” flights and transfers to other cities or even to other continents almost before the birth itself, which in such cases often begin right on the road and therefore, in principle, cannot proceed normally.

Speech and non-speech symptoms of dysarthria

Speech symptoms. The speech of children suffering from a severe form of dysarthria actually loses its articulation and becomes almost incomprehensible to others (“like porridge in the mouth”). What's the matter here? As previously noted, motor commands from the central part of the speech motor analyzer to the peripheral speech organs are transmitted along nerve pathways. With organic damage to these speech parts of the brain or directly to the motor nerves, full transmission of nerve impulses becomes impossible, and phenomena of paralysis or paresis develop in the muscles themselves. And since these paresis can spread not only to the muscles of the tongue and lips, but also to the muscles of the soft palate, vocal cords and respiratory organs, with dysarthria not only the articulation of sounds is impaired, but also voice formation and speech breathing.

With severe paresis of the tongue, the articulation of almost all speech sounds, including vowels, suffers. Paresis of the soft palate causes the appearance of a nasal tone of voice, paresis of the vocal cords causes a disturbance in the process of voice formation and a change in voice timbre, paresis of the respiratory muscles causes a dysfunction of speech breathing, which becomes superficial and arrhythmic, and therefore does not provide a full air stream for voice formation.

In addition to impaired motor function of the speech muscles due to the presence of paralysis and paresis, the sensitivity of these muscles also suffers, and therefore the child does not feel the position of his articulatory organs well enough. For this reason, it is difficult for him to find the necessary articulations, which creates additional difficulties both in mastering sound pronunciation and in correcting it.

All this taken together leads to the fact that dysarthria, in its external manifestations, differs sharply from dyslalia. So, if with dyslalia (with the exception of mechanical dyslalia due to congenital cleft palates) defects in sound pronunciation appear against the background of normal tempo and rhythm of speech, normal speech breathing and voice formation, then with dysarthria there is a picture of a general phonetic disadvantage of speech as a whole, as a result of which it loses its intelligibility, articulation.

Constantly hearing a child's own slurred speech in many cases leads to the appearance of secondary disorders of auditory differentiation of sounds.

The imperfection of auditory differentiation of sounds, in turn, secondarily causes difficulties in mastering the phonemic analysis of words.

Poor orientation in the sound composition of speech, associated with impaired auditory differentiation of sounds and difficulties in phonemic analysis of words, inevitably leads to the appearance of specific writing disorders in children - corresponding types of dysgraphia.

Difficulty and insufficiency verbal communication Secondarily, it may also be due to the poverty of the child’s vocabulary and the unformation of his grammatical structure of speech.

Thus, with severe dysarthria, speech suffers primarily or secondarily, in fact, in all its links, and not just in relation to sound pronunciation itself.

Non-speech symptoms. Dysarthria against the background of cerebral palsy is characterized by the presence of not only the speech symptoms discussed above, but also a number of non-speech symptoms, which ultimately also, in one way or another, make it difficult to master speech. These symptoms include the following.

1. Paralysis and paresis of the muscles of the limbs and torso. Paresis of the legs sharply limits (or even completely eliminates) the child’s ability to move in space, which disrupts the development of his visual-spatial concepts, since he perceives space by the measure of his own steps. Otherwise, he cannot even judge the degree of distance from him of certain objects, so it is not by chance that a child who has not yet mastered the skill of walking tries to reach the moon from the sky, stretching out his little hand to it - it seems to him that it is very close.
   Paralysis and paresis of the hands limit (or exclude) the possibility of manipulating objects, which in the second year of a child’s life plays a decisive role in his knowledge of the world around him (the activity of the “cognitive hand”). Holding various toys in his hands, and also often bringing them to his mouth and trying to lick and even “taste” them, the child gradually gets an idea of ​​their shape, size, smoothness or roughness of the surface, temperature, which is different for cold metal objects and much warmer wooden ones. and plush, etc.

It is quite understandable that if in his sensory experience a child has not received an idea of ​​the spatial and other characteristics of objects, then he will also have difficulty in verbally denoting these characteristics. It will be very difficult for him not only to express in words what is further and what is closer, which object is higher and which is lower, etc., but even to understand these spatial relationships between objects.
2. Commonly observed paresis oculomotor muscles. With paresis of these muscles, the child is impaired in such important visual functions as fixing the gaze on an object, “feeling” it with the gaze, “tracing” a moving object with the eyes and its active visual search. It also leads to developmental delays cognitive activity child, including a delay in the formation of his visual-spatial concepts, which are formed with the active participation of not only the above-mentioned motor, but also the visual analyzer. In the future, this can lead to specific reading and writing disorders, to difficulties in mastering such subjects as geometry, geography, drawing, drawing, etc.
3. Often existing emotional-volitional disorders, the degree of severity and features of manifestation of which largely depend on the location and time of brain damage.
4. Secondary mental layers associated with the child’s experience of his speech and other inferiority. With dyslalia, such layers are much less common.

It is clear that the presence of all these complex non-speech symptoms cannot but have an additional negative impact on the state of the child’s speech function and on the very course and effectiveness of correctional work with him.

Dysarthria is a speech disorder that is expressed in difficulty pronouncing certain words, individual sounds, syllables, or in their distorted pronunciation. Dysarthria occurs as a result of brain damage or a disorder of the innervation of the vocal cords, facial, respiratory muscles and muscles of the soft palate, in diseases such as cleft palate, cleft lip and due to lack of teeth.

A secondary consequence of dysarthria may be a violation of written speech, which occurs due to the inability to clearly pronounce the sounds of words. In more severe manifestations of dysarthria, speech becomes completely inaccessible to the understanding of others, which leads to limited communication and secondary signs of developmental disabilities.

Dysarthria causes

The main cause of this speech disorder is considered to be insufficient innervation of the speech apparatus, which appears as a result of damage to certain parts of the brain. In such patients, there is a limitation in the mobility of the organs involved in speech production - the tongue, palate and lips, thereby complicating articulation.

In adults, the disease can manifest itself without concomitant collapse of the speech system. Those. is not accompanied by a disorder of speech perception through hearing or a disorder of written speech. Whereas in children, dysarthria is often the cause of disorders leading to reading and writing impairments. At the same time, the speech itself is characterized by a lack of smoothness, a broken breathing rhythm, and a change in the tempo of speech in the direction of slowing down or speeding up. Depending on the degree of dysarthria and the variety of forms of manifestation, there is a classification of dysarthria. The classification of dysarthria includes the erased form of dysarthria, severe and anarthria.

The symptoms of the erased form of the disease have an erased appearance, as a result of which dysarthria is confused with a disorder such as dyslalia. Dysarthria differs from dyslalia in the presence of a focal form of neurological symptoms.

In a severe form of dysarthria, speech is characterized as inarticulate and practically incomprehensible, sound pronunciation is impaired, disorders also manifest themselves in the expressiveness of intonation, voice, and breathing.

Anarthria is accompanied by a complete lack of ability to reproduce speech.

The causes of the disease include: incompatibility of the Rh factor, toxicosis of pregnant women, various pathologies of the formation of the placenta, viral infections of the mother during pregnancy, prolonged or, conversely, rapid labor, which can cause hemorrhages in the brain, infectious diseases of the brain and its membranes in newborns.

There are severe and mild degrees of dysarthria. Severe dysarthria is inextricably linked with childhood cerebral palsy. A mild degree of dysarthria is manifested by a violation of fine motor skills, pronunciation of sounds and movements of the organs of the articulatory apparatus. At this level, speech will be understandable but unclear.

The causes of dysarthria in adults can be: stroke, vascular insufficiency, inflammation or brain tumor, degenerative, progressive and genetic diseases of the nervous system (Huntington), asthenic bulbar palsy and multiple sclerosis.

Other causes of the disease, much less common, are head injuries, poisoning carbon monoxide, drug overdose, intoxication due to excessive consumption of alcoholic beverages and drugs.

Dysarthria in children

With this disease, children experience difficulties with the articulation of speech as a whole, and not with the pronunciation of individual sounds. They also experience other disorders associated with fine and gross motor skills, difficulties with swallowing and chewing. For children with dysarthria, it is quite difficult, and sometimes completely impossible, to jump on one leg, cut out of paper with scissors, fasten buttons, and it is quite difficult for them to master written language. They often miss sounds or distort them, distorting words in the process. Sick children mostly make mistakes when using prepositions and use incorrect syntactic connections of words in sentences. Children with such disabilities should be educated in specialized institutions.

The main manifestations of dysarthria in children are impaired articulation of sounds, voice formation disorder, changes in the rhythm, intonation and tempo of speech.

The listed disorders in children vary in severity and in various combinations. This depends on the location of the focal lesion in the nervous system, the time of occurrence of such a lesion and the severity of the disorder.

Partially complicating or sometimes completely preventing articulate sound speech are disorders of phonation and articulation, which is the so-called primary defect, leading to the appearance of secondary signs that complicate its structure.

Conducted research and studies of children with this disease show that this category of children is quite heterogeneous in terms of speech, motor and mental disorders.

Classification of dysarthria and its clinical forms is based on the identification of various foci of localization of brain damage. Children suffering from various forms of the disease differ from each other in certain defects in sound pronunciation, voice, articulation, and their disorders varying degrees may be subject to correction. That is why for professional correction it is necessary to use various techniques and methods of speech therapy.

Forms of dysarthria

There are the following forms of speech dysarthria in children: bulbar, subcortical, cerebellar, cortical, erased or mild, pseudobulbar.

Bulbar dysarthria of speech is manifested by atrophy or paralysis of the muscles of the pharynx and tongue, and decreased muscle tone. With this form, speech becomes unclear, slow, and slurred. People with the bulbar form of dysarthria are characterized by weak facial activity. It appears due to tumors or inflammatory processes in the medulla oblongata. As a result of such processes, the destruction of the nuclei of the motor nerves located there occurs: the vagus, glossopharyngeal, trigeminal, facial and sublingual.

The subcortical form of dysarthria consists of impaired muscle tone and involuntary movements (hyperkinesis), which the baby is not able to control. Occurs with focal damage to the subcortical nodes of the brain. Sometimes a child cannot pronounce certain words, sounds or phrases correctly. This becomes especially relevant if the child is in a state of calm in the circle of relatives whom he trusts. However, the situation can change radically in a matter of seconds and the baby becomes unable to reproduce a single syllable. With this form of the disease, the tempo, rhythm and intonation of speech suffer. Such a baby can pronounce whole phrases very quickly or, conversely, very slowly, while making significant pauses between words. As a result of a disorder of articulation in combination with irregular voice formation and impaired speech breathing, characteristic defects in the sound-forming side of speech appear. They can manifest themselves depending on the baby’s condition and affect mainly communicative speech functions. Rarely, with this form of the disease, disturbances in the human hearing system can also be observed, which are a complication of a speech defect.

Cerebellar speech dysarthria in its pure form is quite rare. Children susceptible to this form of the disease pronounce words by chanting them, and sometimes simply shout out individual sounds.

A child with cortical dysarthria has difficulty producing sounds together when speech flows in one stream. However, at the same time, pronouncing individual words is not difficult. And the intense pace of speech leads to modifications of sounds, creating pauses between syllables and words. A fast speech rate is similar to reproducing words when you stutter.

The erased form of the disease is characterized by mild manifestations. With it, speech disorders are not identified immediately, only after a comprehensive specialized examination. Its causes are often various infectious diseases during pregnancy, fetal hypoxia, toxicosis of pregnant women, birth injuries, and infectious diseases of infants.

The pseudobulbar form of dysarthria occurs most often in children. The cause of its development may be brain damage suffered in infancy, due to birth injuries, encephalitis, intoxication, etc. With mild pseudobulbar dysarthria, speech is characterized by slowness and difficulty in pronouncing individual sounds due to disturbances in the movements of the tongue (movements are not precise enough) and lips. Moderate pseudobulbar dysarthria is characterized by a lack of facial muscle movements, limited tongue mobility, a nasal tone of voice, and profuse salivation. The severe degree of the pseudobulbar form of the disease is expressed in complete immobility of the speech apparatus, an open mouth, limited lip movement, and facial expression.

Erased dysarthria

The erased form is quite common in medicine. The main symptoms of this form of the disease are slurred and inexpressive speech, poor diction, distortion of sounds, and replacement of sounds in complex words.

The term “erased” form of dysarthria was first introduced by O. Tokareva. She describes the symptoms of this form as mild manifestations of the pseudobulbar form, which are quite difficult to overcome. Tokareva believes that children with this form of the disease can pronounce many isolated sounds as needed, but in speech they do not sufficiently differentiate sounds and poorly automate them. Pronunciation deficiencies can be completely different character. However, they are united by several common features, such as blurriness, smearing and unclear articulation, which manifest themselves especially sharply in the speech stream.

An erased form of dysarthria is a speech pathology, which is manifested by a disorder of the prosodic and phonetic components of the system, resulting from microfocal brain damage.

Today, diagnostics and methods of corrective action are rather poorly developed. This form of the disease is often diagnosed only after the child reaches the age of five. All children with suspected erased form of dysarthria are referred to a neurologist to confirm or not confirm the diagnosis. Therapy for an erased form of dysarthria should be comprehensive, combining drug treatment, psychological and pedagogical assistance and speech therapy assistance.

Symptoms of erased dysarthria: motor clumsiness, limited number of active movements, rapid muscle fatigue during functional loads. Sick children do not stand very stable on one leg and cannot jump on one leg. Such children are much later than others and have difficulty learning self-care skills, such as fastening buttons and untying a scarf. They are characterized by poor facial expressions and the inability to keep the mouth closed, since the lower jaw cannot be fixed in an elevated state. On palpation, the facial muscles are flaccid. Due to the fact that the lips are also flaccid, the necessary labialization of sounds does not occur, therefore the prosodic side of speech deteriorates. Sound pronunciation is characterized by mixing, distortion of sounds, their replacement or complete absence.

The speech of such children is quite difficult to understand; it lacks expressiveness and intelligibility. Basically, there is a defect in the reproduction of hissing and whistling sounds. Children can mix not only sounds that are close in their method of formation and complex, but also sounds that are opposite in sound. A nasal tone may appear in speech, and the tempo is often accelerated. Children have a quiet voice, they cannot change the pitch of their voice, imitating some animals. Speech is characterized by monotony.

Pseudobulbar dysarthria

Pseudobulbar dysarthria is the most common form of the disease. It is a consequence of organic brain damage suffered in early childhood. As a result of encephalitis, intoxication, tumor processes, and birth injuries in children, pseudobulbar paresis or paralysis occurs, which is caused by damage to the conductive neurons that go from the cerebral cortex to the glossopharyngeal, vagus and hypoglossal nerves. In terms of clinical symptoms in the area of ​​facial expressions and articulation, this form of the disease is similar to the bulbar form, but the likelihood of full mastery of sound pronunciation in the pseudobulbar form is significantly higher.

As a result of pseudobulbar paresis, children experience a disorder of general and speech motor skills, the sucking reflex and swallowing are impaired. The facial muscles are sluggish, and there is drooling from the mouth.

There are three degrees of severity of this form of dysarthria.

A mild degree of dysarthria is manifested by difficulty in articulation, which consists of not very accurate and slow movements of the lips and tongue. At this degree, mild, unexpressed disturbances in swallowing and chewing also occur. Due to not very clear articulation, pronunciation is impaired. Speech is characterized by slowness and blurred pronunciation of sounds. Such children most often have difficulty pronouncing letters such as: r, ch, zh, c, sh, a ringing sounds are reproduced without proper voice input.

Also difficult for children and soft sounds, which require the tongue to rise to the hard palate. Due to incorrect pronunciation, phonemic development also suffers, and written speech is impaired. But violations of the structure of the word, vocabulary, and grammatical structure are practically not observed with this form. With mild manifestations of this form of the disease, the main symptom is a violation of speech phonetics.

The average degree of pseudobulbar form is characterized by amicity and lack of facial muscle movements. Children cannot puff out their cheeks or stretch out their lips. The movements of the tongue are also limited. Children cannot lift the tip of their tongue up, turn it to the left or right and hold it in this position. It is extremely difficult to switch from one movement to another. The soft palate is also inactive, and the voice has a nasal tint.

Also characteristic signs are: excessive drooling, difficulty chewing and swallowing. As a result of violations of articulation functions, rather severe pronunciation defects appear. Speech is characterized by slurredness, slurring, and quietness. This degree of severity of the disease is manifested by unclear articulation of vowel sounds. The sounds ы, и are often mixed, and the sounds у and а are characterized by insufficient clarity. Of the consonant sounds, t, m, p, n, x, k are most often correctly pronounced. Sounds such as: ch, l, r, c are reproduced approximately. Voiced consonants are more often replaced by voiceless ones. As a result of these disorders, children's speech becomes completely unintelligible, so such children prefer to remain silent, which leads to a loss of experience in verbal communication.

A severe degree of this form of dysarthria is called anarthria and is manifested by deep muscle damage and complete immobilization of the speech apparatus. The face of sick children is mask-like, the mouth is constantly open, and the lower jaw droops. A severe degree is characterized by difficulty chewing and swallowing, a complete absence of speech, and sometimes inarticulate pronunciation of sounds.

Diagnosis of dysarthria

When diagnosing, the greatest difficulty is distinguishing dyslalia from pseudobulbar or cortical forms of dysarthria.

The erased form of dysarthria is a borderline pathology, which is on the border between dyslalia and dysarthria. All forms of dysarthria are always based on focal brain lesions with neurological microsymptoms. As a result, a special neurological examination must be performed to make a correct diagnosis.

It is also necessary to distinguish between dysarthria and aphasia. With dysarthria, speech technique is impaired, not practical functions. Those. with dysarthria, a sick child understands what is written and heard, and can logically express his thoughts, despite the defects.

A differential diagnosis is made on the basis of a general systemic examination developed by domestic speech therapists, taking into account the specifics of the listed non-speech and speech disorders, age, and psychoneurological condition of the child. How younger child and the lower his level of speech development, the more significant the analysis of non-speech disorders in diagnosis. Therefore, today, based on the assessment of non-speech disorders, methods have been developed early detection dysarthria.

The presence of pseudobulbar symptoms is the most common manifestation of dysarthria. Its first signs can be detected even in a newborn. Such symptoms are characterized by a weak cry or its absence at all, a violation of the sucking reflex, swallowing or their complete absence. The cry in sick children remains quiet for a long time, often with a nasal tint, poorly modulated.

When suckling at the breast, children may choke, turn blue, and sometimes milk may leak from the nose. In more severe cases, the child may not take the breast at all at first. Such children are fed through a tube. Breathing may be shallow, often arrhythmic and rapid. Such disorders are combined with leakage of milk from the mouth, facial asymmetry, sagging lower lip. As a result of these disorders, the baby is unable to latch onto the pacifier or nipple.

As the child grows up, the insufficiency of intonation expressiveness of the cry and vocal reactions becomes more and more apparent. All sounds made by a child are monotonous and appear later than normal. A child suffering from dysarthria cannot bite or chew for a long time, and may choke on solid food.

As the child grows up, the diagnosis is made on the basis of the following speech symptoms: persistent pronunciation defects, insufficiency of voluntary articulation, vocal reactions, incorrect placement of the tongue in the oral cavity, voice formation disorders, speech breathing and delayed speech development.

The main signs used for differential diagnosis include:

- the presence of weak articulation (insufficient bending of the tip of the tongue upward, tremor of the tongue, etc.);

— presence of prosodic disorders;

- the presence of synkinesis (for example, movements of the fingers that occur when moving the tongue);

— slowness of the tempo of articulations;

- difficulty maintaining articulation;

— difficulty in switching articulations;

- persistence of disturbances in the pronunciation of sounds and difficulty in automating the delivered sounds.

Functional tests also help to establish a correct diagnosis. For example, a speech therapist asks a child to open his mouth and stick out his tongue, which should be held motionless in the middle. At the same time, the child is shown an object moving laterally, which he needs to follow. The presence of dysarthria during this test is indicated by the movement of the tongue in the direction in which the eyes move.

When examining a child for the presence of dysarthria, it is necessary Special attention pay attention to the state of articulation at rest, during facial movements and general movements, mainly articulatory. It is necessary to pay attention to the volume of movements, their pace and smoothness of switching, proportionality and accuracy, the presence of oral synkinesis, etc.

Dysarthria treatment

The main focus of treatment for dysarthria is the development of normal speech in the child, which will be understandable to others and will not interfere with communication and further learning of basic writing and reading skills.

Correction and therapy for dysarthria must be comprehensive. In addition to constant speech therapy work, medication treatment prescribed by a neurologist and exercise therapy are also required. Therapeutic work should be aimed at treating three main syndromes: articulation and speech breathing disorders, voice disorders.

Drug therapy for dysarthria involves the prescription of nootropics (for example, Glycine, Encephabol). Their positive effect is based on the fact that they specifically affect the higher functions of the brain, stimulate mental activity, improve learning processes, intellectual activity and memory of children.

Physiotherapy exercises consist of regular special gymnastics, the effect of which is aimed at strengthening the facial muscles.

Massage has proven itself well for dysarthria, which must be done regularly and daily. In principle, massage is the first step in treating dysarthria. It consists of stroking and lightly pinching the muscles of the cheeks, lips and lower jaw, bringing the lips together with the fingers in a horizontal and vertical direction, massaging the soft palate with the pads of the index and middle fingers for no more than two minutes, and movements should be forward and backward. Massage for dysarthria is needed to normalize the tone of the muscles that take part in articulation, reduce the manifestation of paresis and hyperkinesis, activate poorly working muscles, and stimulate the formation of areas of the brain responsible for speech. The first massage should take no more than two minutes, then gradually increase the massage time until it reaches 15 minutes.

Also, to treat dysarthria, it is necessary to train respiratory system child. For this purpose, exercises developed by A. Strelnikova are often used. They involve sharp inhalations when bending over and exhalations when straightening up.

A good effect is observed with self-study. They consist in the fact that the child stands in front of a mirror and trains to reproduce the same movements of the tongue and lips that he saw when talking with others. Gymnastics techniques to improve speech: open and close your mouth, stretch your lips like a “proboscis,” hold your mouth in an open position, then in a half-open position. You need to ask the child to hold a gauze bandage between his teeth and try to pull the bandage out of his mouth. You can also use a lollipop on a shelf that the child must hold in his mouth and the adult must take it out. The smaller the lollipop, the more difficult it will be for the child to hold it.

The work of a speech therapist for dysarthria consists of automating and staging the pronunciation of sounds. You need to start with simple sounds, gradually moving on to sounds that are difficult to articulate.

Also important in the treatment and correction of dysarthria is the development of fine and gross motor skills of the hands, which are closely related to speech functions. For this purpose, finger gymnastics, assembling various puzzles and construction sets, sorting small objects and sorting them out are usually used.

The outcome of dysarthria is always ambiguous due to the fact that the disease is caused by irreversible disturbances in the functioning of the central nervous system and brain.

Correction of dysarthria

Corrective work to overcome dysarthria must be carried out regularly along with drug treatment and rehabilitation therapy (for example, treatment and preventive exercises, therapeutic baths, hirudotherapy, acupuncture, etc.), which is prescribed by a neurologist. Non-traditional correction methods have proven themselves well, such as dolphin therapy, isotherapy, touch therapy, sand therapy, etc.

Correctional classes conducted by a speech therapist imply: development of motor skills of the speech apparatus and fine motor skills, voice, formation of speech and physiological breathing, correction of incorrect sound pronunciation and consolidation of assigned sounds, work on the formation of speech communication and expressiveness of speech.

The main stages of correctional work are identified. The first stage of the lesson is a massage, with the help of which the muscle tone of the speech apparatus develops. The next step is to conduct an exercise to form correct articulation, with the goal of subsequently correctly pronouncing sounds by the child, to produce sounds. Then work is carried out on automation of sound pronunciation. The last stage is learning the correct pronunciation of words using already supplied sounds.

Equally important for a positive outcome of dysarthria is the psychological support of the child from loved ones. It is very important for parents to learn to praise their children for any of their achievements, even the smallest ones. The child must be given a positive incentive for independent study and confidence that he can do anything. If a child has no achievements at all, then you should choose a few things that he does best and praise him for them. A child should feel that he is always loved, regardless of his victories or losses, with all his shortcomings.

If a child was injured in utero or suffered a birth injury, special attention should be paid to his speech.

We continue to introduce readers to various speech disorders with the help of L. Paramonova’s book “Speech Therapy for Everyone.”

We have already talked about sound pronunciation disorders in general and dyslalia in particular. Today we will talk about dysarthria.

Dysarthria is a disorder of the sound pronunciation side of speech, which is caused by organic damage to the central part of the speech motor analyzer and the associated disruption of the innervation of the speech muscles. The term “dysarthria” itself means “disorder of articulate speech” (“artron” translated into Russian means “articulation”, and “diz” means “disorder”). The prevalence of dysarthria among mentally normal children ranges from 3 to 6%, but these figures have a clear upward trend.

Dysarthria most often is not an independent speech disorder, but is only one of the symptoms of a serious illness - cerebral palsy, which is usually congenital or occurs before the age of two years. Depending on the location of the brain lesion, dysarthria manifests itself in different ways, and therefore there are several types of it, which are inappropriate to consider here due to the impossibility of practical use of this information by non-specialists.

With complete paralysis of the articulatory muscles, anarthria occurs - a complete absence of pronunciation in the child. The main manifestations of severe dysarthria will be discussed further. But so-called erased dysarthria can often be observed, which needs to be discussed in a little more detail, since it is very widespread and, moreover, can be difficult to distinguish from dyslalia.

Erased dysarthria

Erased dysarthria is based on very small, literally pinpoint organic lesions of the cerebral cortex. Their presence leads to paresis of only certain small groups of articulatory muscles (for example, only the tip of the tongue or only one side of it). Under such conditions, the child suffers from the pronunciation of only individual sounds at an almost normal rate and rhythm of speech and in the absence of pronounced disorders of speech breathing and voice.

For a long time, such disorders in the pronunciation of sounds were classified as functional motor dyslalia, without noticing their specificity. However, the difficulties of overcoming them forced specialists to study this issue more carefully, as a result of which erased dysarthria was separated from the group of functional motor dyslalia. (During a neurological examination, paresis of individual articulatory muscles was discovered in these children, leading to definite disturbances in the pronunciation of sounds.)

Sound pronunciation disorders with erased dysarthria have not only a different causality compared to dyslalia, but also a different external manifestation. In particular, erased dysarthria is characterized by interdental pronunciation of sounds associated with weakness (pareticity) of the muscles of the tip of the tongue - it simply cannot be held behind the teeth. Often there is a “lateral” pronunciation of some consonants, which is associated with paresis of one side of the tongue. In these cases, the tongue, when protruding from the mouth, usually deviates to one side, and when articulating some sounds it becomes an “edge” in the mouth, which contributes to lateral air leakage. Such disturbances in the pronunciation of sounds at any age cannot be attributed to age-related peculiarities of sound pronunciation due to their being due to pathological reasons. Erased dysarthria never goes away with age, as evidenced by its presence in many adults.

Causes of cerebral palsy and dysarthria

The causes of cerebral palsy, and therefore the causes of dysarthria, are organic lesions of the child’s nervous system, which can occur in utero, during childbirth or as a result of early childhood diseases (meningitis, meningoencephalitis, traumatic lesions or vascular disorders).

Until relatively recently, the main cause of cerebral palsy (and therefore dysarthria) was considered to be birth trauma, causing cerebral hemorrhage, birth asphyxia and other complications during childbirth. However, it has now become clear that in more than 80-90% of cases, damage to the fetal nervous system occurs in utero. It is the insufficient usefulness of the fetus and its “unpreparedness” for active participation in the process of childbirth that leads to its complicated course and possible additional brain damage. These injuries can be the result of cesarean section, asphyxia at birth, or birth trauma during the provision of mechanical assistance, which is a forced means and is used only in cases of extreme necessity. Knowledge of this circumstance is extremely important both from the point of view of preventing cerebral palsy and, in most cases, the dysarthria that accompanies it.

If the main reason for the occurrence of both is not “for some unknown reason” that labor is so difficult, then the main content of prevention should be concern for the normal course of pregnancy, which very much depends on the seriousness of the woman’s attitude towards this most important period of her life. It has complete power to exclude such pathogenic factors, which are harmful to the intrauterine development of the fetus, but, nevertheless, are often present, such as smoking and drinking alcoholic beverages even during pregnancy, constant overwork and non-compliance with a healthy daily routine, and continued work in hazardous industries. and on the night shift, heavy lifting and generally heavy physical exertion, “emergency” flights and transfers to other cities or even to other continents almost before the birth itself, which in such cases often begins right on the road and therefore, in principle, cannot proceed Fine.

Speech and non-speech symptoms of dysarthria

Speech symptoms. The speech of children suffering from a severe form of dysarthria actually loses its articulation and becomes almost incomprehensible to others (“like porridge in the mouth”). What's the matter here? As previously noted, motor commands from the central part of the speech motor analyzer to the peripheral speech organs are transmitted along nerve pathways. With organic damage to these speech parts of the brain or directly to the motor nerves, full transmission of nerve impulses becomes impossible, and phenomena of paralysis or paresis develop in the muscles themselves. And since these paresis can spread not only to the muscles of the tongue and lips, but also to the muscles of the soft palate, vocal cords and respiratory organs, with dysarthria not only the articulation of sounds is impaired, but also voice formation and speech breathing.

With severe paresis of the tongue, the articulation of almost all speech sounds, including vowels, suffers. Paresis of the soft palate causes the appearance of a nasal tone of the voice, paresis of the vocal cords - a violation of the process of voice formation and a change in the timbre of the voice, paresis of the respiratory muscles - a violation of the function of speech breathing, which becomes superficial and arrhythmic, and therefore does not provide a full air stream for voice formation.

In addition to impaired motor function of the speech muscles due to the presence of paralysis and paresis, the sensitivity of these muscles also suffers, and therefore the child does not feel the position of his articulatory organs well enough. For this reason, it is difficult for him to find the necessary articulations, which creates additional difficulties both in mastering sound pronunciation and in correcting it.

All this taken together leads to the fact that dysarthria, in its external manifestations, differs sharply from dyslalia. So, if with dyslalia (with the exception of mechanical dyslalia due to congenital cleft palates) defects in sound pronunciation appear against the background of normal tempo and rhythm of speech, normal speech breathing and voice formation, then with dysarthria there is a picture of a general phonetic disadvantage of speech as a whole, as a result of which it loses its intelligibility, articulation.

Constantly hearing a child's own slurred speech in many cases leads to the appearance of secondary disorders of auditory differentiation of sounds.

The imperfection of auditory differentiation of sounds, in turn, secondarily causes difficulties in mastering the phonemic analysis of words.

Poor orientation in the sound composition of speech, associated with impaired auditory differentiation of sounds and difficulties in phonemic analysis of words, inevitably leads to the appearance of specific writing disorders in children - corresponding types of dysgraphia.

The difficulty and insufficiency of verbal communication may also be secondary to the poverty of the child’s vocabulary and the unformed grammatical structure of his speech.

Thus, with severe dysarthria, speech suffers primarily or secondarily, in fact, in all its links, and not just in relation to sound pronunciation itself.

Non-speech symptoms. Dysarthria against the background of cerebral palsy is characterized by the presence of not only the speech symptoms discussed above, but also a number of non-speech symptoms, which ultimately also, in one way or another, make it difficult to master speech. These symptoms include the following.

1. Paralysis and paresis of the muscles of the limbs and torso. Paresis of the legs sharply limits (or even completely eliminates) the child’s ability to move in space, which disrupts the development of his visual-spatial concepts, since he perceives space by the measure of his own steps. Otherwise, he cannot even judge the degree of distance from him of certain objects, so it is not by chance that a child who has not yet mastered the skill of walking tries to reach the moon from the sky, stretching out his little hand to it - it seems to him that it is very close.

Paralysis and paresis of the hands limit (or exclude) the possibility of manipulating objects, which in the second year of a child’s life plays a decisive role in his knowledge of the world around him (the activity of the “cognitive hand”). Holding various toys in his hands, and also often bringing them to his mouth and trying to lick and even “taste” them, the child gradually gets an idea of ​​their shape, size, smoothness or roughness of the surface, temperature, which is different for cold metal objects and much warmer wooden ones. and plush, etc.

It is quite understandable that if in his sensory experience a child has not received an idea of ​​the spatial and other characteristics of objects, then he will also have difficulty in verbally denoting these characteristics. It will be very difficult for him not only to express in words what is further and what is closer, which object is higher and which is lower, etc., but even to understand these spatial relationships between objects.

It is clear that the presence of all these complex non-speech symptoms cannot but have an additional negative impact on the state of the child’s speech function and on the very course and effectiveness of correctional work with him.

Dysarthria

Dysarthria is a disorder of the pronunciation organization of speech associated with damage to the central part of the speech motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. The structure of the defect in dysarthria includes violations of speech motor skills, sound pronunciation, speech breathing, voice and prosodic aspects of speech; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics (EEG, EMG, ENG, MRI of the brain, etc.) and speech therapy examination of oral and written speech are performed. Corrective work for dysarthria includes therapeutic interventions (medication courses, exercise therapy, massage, physical therapy), speech therapy classes, articulation gymnastics, speech therapy massage.

Dysarthria

Dysarthria is a severe speech disorder, accompanied by a disorder of articulation, phonation, speech breathing, tempo-rhythmic organization and intonation coloring of speech, as a result of which speech loses its articulation and intelligibility. Among children, the prevalence of dysarthria is 3-6%, but in recent years there has been a pronounced upward trend in this speech pathology. In speech therapy, dysarthria is one of the three most common forms of oral speech disorders, second only to dyslalia in frequency and ahead of alalia. Since the pathogenesis of dysarthria is based on organic lesions of the central and peripheral nervous system, this speech disorder is also studied by specialists in the field of neurology and psychiatry.

Causes of dysarthria

Most often (in 65-85% of cases) dysarthria accompanies cerebral palsy and has the same causes. In this case, organic damage to the central nervous system occurs in the prenatal, birth or early periods of child development (usually up to 2 years). The most common perinatal factors of dysarthria are toxicosis of pregnancy, fetal hypoxia, Rhesus conflict, chronic somatic diseases of the mother, pathological course of labor, birth injuries, birth asphyxia, kernicterus of newborns, prematurity, etc. The severity of dysarthria is closely related to the severity of motor disorders during Cerebral palsy: for example, with double hemiplegia, dysarthria or anarthria is detected in almost all children.

In early childhood, damage to the central nervous system and dysarthria in a child can develop after suffering neuroinfections (meningitis, encephalitis), purulent otitis media, hydrocephalus, traumatic brain injury, severe intoxication.

Classification of dysarthria

The neurological classification of dysarthria is based on the principle of localization and a syndromic approach. Taking into account the localization of damage to the speech-motor apparatus, the following are distinguished:

• bulbar dysarthria associated with damage to the nuclei of the cranial nerves (glossopharyngeal, sublingual, vagus, sometimes facial, trigeminal) in the medulla oblongata
• pseudobulbar dysarthria associated with damage to the corticonuclear pathways
• extrapyramidal (subcortical) dysarthria associated with damage to the subcortical nuclei of the brain
• cerebellar dysarthria associated with damage to the cerebellum and its pathways
• cortical dysarthria associated with focal lesions of the cerebral cortex.

Depending on the leading clinical syndrome, cerebral palsy may include spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, ataxic-hyperkinetic dysarthria.

Speech therapy classification is based on the principle of speech intelligibility for others and includes 4 degrees of severity of dysarthria:

1st degree (erased dysarthria) – defects in sound pronunciation can only be identified by a speech therapist during a special examination.

2nd degree - defects in sound pronunciation are noticeable to others, but overall speech remains understandable.

3rd degree - understanding of the speech of a patient with dysarthria is available only to those close to him and partially to strangers.

4th degree – speech is absent or incomprehensible even to the closest people (anarthria).

Symptoms of dysarthria

The speech of patients with dysarthria is slurred, unclear, and incomprehensible (“porridge in the mouth”), which is due to insufficient innervation of the muscles of the lips, tongue, soft palate, vocal folds, larynx, and respiratory muscles. Therefore, with dysarthria, a whole complex of speech and non-speech disorders develops, which constitute the essence of the defect.

Impaired articulatory motor skills in patients with dysarthria may manifest as spasticity, hypotonia, or dystonia of the articulatory muscles. Muscle spasticity is accompanied by constant increased tone and tension in the muscles of the lips, tongue, face, and neck; tightly closed lips, limiting articulatory movements. With muscle hypotonia, the tongue is flaccid and lies motionless on the floor of the mouth; the lips do not close, the mouth is half open, hypersalivation (salivation) is pronounced; Due to paresis of the soft palate, a nasal tone of voice appears (nasalization). In the case of dysarthria occurring with muscular dystonia, when attempting to speak, muscle tone changes from low to increased.

Sound pronunciation disturbances in dysarthria can be expressed to varying degrees, depending on the location and severity of damage to the nervous system. With erased dysarthria, individual phonetic defects (sound distortions) and “blurred” speech are observed.” With more pronounced degrees of dysarthria, there are distortions, omissions, and substitutions of sounds; speech becomes slow, inexpressive, slurred. General speech activity is noticeably reduced. In the most severe cases, with complete paralysis of the speech motor muscles, motor speech becomes impossible.

Specific features of impaired sound pronunciation in dysarthria are the persistence of defects and the difficulty of overcoming them, as well as the need for a longer period of automation of sounds. With dysarthria, the articulation of almost all speech sounds, including vowels, is impaired. Dysarthria is characterized by interdental and lateral pronunciation of hissing and whistling sounds; voicing defects, palatalization (softening) of hard consonants.

Due to insufficient innervation of the speech muscles during dysarthria, speech breathing is disrupted: exhalation is shortened, breathing at the time of speech becomes rapid and intermittent. Voice disturbances in dysarthria are characterized by insufficient strength (quiet, weak, fading voice), changes in timbre (deafness, nasalization), and melodic-intonation disorders (monotony, absence or inexpressibility of voice modulations).

Due to slurred speech in children with dysarthria, auditory differentiation of sounds and phonemic analysis and synthesis suffer secondarily. The difficulty and insufficiency of verbal communication can lead to an undeveloped vocabulary and grammatical structure of speech. Therefore, children with dysarthria may experience phonetic-phonemic (FFN) or general speech underdevelopment (GSD) and associated corresponding types of dysgraphia.

Characteristics of clinical forms of dysarthria

Bulbar dysarthria is characterized by areflexia, amymia, disorder of sucking, swallowing solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is slurred and extremely simplified. All the variety of consonants is reduced into a single fricative sound; sounds are not differentiated from each other. Nasalization of voice timbre, dysphonia or aphonia is typical.

With pseudobulbar dysarthria, the nature of the disorder is determined by spastic paralysis and muscle hypertonicity. Pseudobulbar paralysis manifests itself most clearly in impaired tongue movements: great difficulty is caused by attempts to raise the tip of the tongue upward, move it to the sides, or hold it in a certain position. With pseudobulbar dysarthria, switching from one articulatory posture to another is difficult. Typically selective impairment of voluntary movements, synkinesis (conjugal movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is blurred, slurred, and has a nasal tint; the normative reproduction of sonors, whistling and hissing, is grossly violated.

Subcortical dysarthria is characterized by the presence of hyperkinesis - involuntary violent muscle movements, including facial and articulatory ones. Hyperkinesis can occur at rest, but usually intensifies when attempting to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic aspect of speech; Sometimes patients emit involuntary guttural screams.

With subcortical dysarthria, the tempo of speech may be disrupted, such as bradylalia, tachylalia, or speech dysrhythmia (organic stuttering). Subcortical dysarthria is often combined with pseudobulbar, bulbar and cerebellar forms.

A typical manifestation of cerebellar dysarthria is a violation of the coordination of the speech process, which results in tremor of the tongue, jerky, scanned speech, and occasional cries. Speech is slow and slurred; The pronunciation of front-lingual and labial sounds is most affected. With cerebellar dysarthria, ataxia is observed (unsteadiness of gait, imbalance, clumsiness of movements).

Cortical dysarthria in its speech manifestations resembles motor aphasia and is characterized by a violation of voluntary articulatory motor skills. There are no disorders of speech breathing, voice, or prosody in cortical dysarthria. Taking into account the localization of lesions, kinesthetic postcentral cortical dysarthria (afferent cortical dysarthria) and kinetic premotor cortical dysarthria (efferent cortical dysarthria) are distinguished. However, with cortical dysarthria there is only articulatory apraxia, while with motor aphasia not only the articulation of sounds suffers, but also reading, writing, understanding speech, and using language.

Diagnosis of dysarthria

The examination and subsequent management of patients with dysarthria is carried out by a neurologist (children's neurologist) and speech therapist. The extent of the neurological examination depends on the expected clinical diagnosis. The most important diagnostic value is given by electrophysiological studies (electroencephalography, electromyography, electroneurography), transcranial magnetic stimulation, MRI of the brain, etc.

Speech therapy examination for dysarthria includes assessment of speech and non-speech disorders. Assessment of non-speech symptoms involves studying the structure of the articulatory apparatus, the volume of articulatory movements, the state of facial and speech muscles, and the nature of breathing. The speech therapist pays special attention to the history of speech development. As part of the diagnosis of oral speech in dysarthria, a study of the pronunciation aspect of speech (sound pronunciation, tempo, rhythm, prosody, speech intelligibility) is carried out; synchronicity of articulation, breathing and voice production; phonemic perception, level of development of the lexico-grammatical structure of speech. In the process of diagnosing written speech, tasks are given for copying text and writing from dictation, reading passages and comprehending what is read.

Based on the examination results, it is necessary to distinguish between dysarthria and motor alalia, motor aphasia, and dyslalia.

Correction of dysarthria

Speech therapy work to overcome dysarthria should be carried out systematically, against the background of drug therapy and rehabilitation (segmental reflex and acupressure, acupressure, exercise therapy, therapeutic baths, physiotherapy, mechanotherapy, acupuncture, hirudotherapy), prescribed by a neurologist. A good background for correctional and pedagogical classes is achieved by using non-traditional forms of restorative treatment: dolphin therapy, touch therapy, isotherapy, sand therapy, etc.

On speech therapy classes to correct dysarthria, the development of fine motor skills (finger gymnastics), motor skills of the speech apparatus (speech therapy massage, articulation gymnastics) is carried out; physiological and speech breathing (breathing exercises), voice (orthophonic exercises); correction of impaired and consolidation of correct sound pronunciation; work on the expressiveness of speech and the development of verbal communication.

The order of production and automation of sounds is determined by the greatest availability of articulation patterns at the moment. Automation of sounds in dysarthria is sometimes carried out until complete purity of their isolated pronunciation is achieved, and the process itself requires more time and persistence than in dyslalia.

Forecast and prevention of dysarthria

Only early, systematic speech therapy work to correct dysarthria can give positive results. A major role in the success of correctional pedagogical intervention is played by the therapy of the underlying disease, the diligence of the dysarthric patient himself and his close circle.

Under these conditions, one can count on almost complete normalization of speech function in the case of erased dysarthria. Having mastered the skills of correct speech, such children can successfully study in a comprehensive school, and receive the necessary speech therapy help in clinics or at school speech centers.

At severe forms dysarthria, it is only possible to improve the state of speech function. The continuity of various types of speech therapy institutions is important for the socialization and education of children with dysarthria: kindergartens and schools for children with severe speech disorders, speech departments of psychoneurological hospitals; friendly work of a speech therapist, neurologist, psychoneurologist, massage therapist, and physical therapy specialist.

Medical and pedagogical work to prevent dysarthria in children with perinatal brain damage should begin from the first months of life. Prevention of dysarthria in early childhood and adulthood involves preventing neuroinfections, brain injuries, and toxic effects.

Tongue paresis in children

Paresis of the muscles of the tongue and oropharynx leads to impaired swallowing, phonation and articulation, as well as the inability to whistle.

Variable severity of paresis:

It increases in the evening, as well as when the affected muscles are stressed - during a long conversation or when eating. No muscle atrophy is observed. Symptoms appeared several weeks or months ago, and their severity varies. We are talking about myasthenia gravis, less often about a space-occupying process that compresses the brain stem.

If an elderly person develops masticatory paresis while chewing and is accompanied by pain, this raises the suspicion of “intermittent claudication of the masticatory muscles” associated with giant cell arteritis or other vasculitis.

Articulation disturbances may be intermittent in nature during paroxysmal dysarthria, for example, as part of multiple sclerosis. However, it is not a sign of true paresis of the laryngeal muscles and is accompanied by a history and objective symptoms characteristic of multiple sclerosis.

The severity of paresis is constant:

Paresis and swelling of the masticatory muscles, which is sometimes accompanied by pain, may be a sign of a tumor, as well as localized myositis with spontaneous recovery. These two reasons can only be distinguished by using histological examination. With benign myositis, damage to other muscles of the head and face is sometimes associated.

Bilateral tongue atrophy and fasciculations are detected (which are better visible if the tongue is inside the oral cavity). In most cases, fasciculations, as well as paresis and atrophy, are observed in other muscles. We are talking about bulbar palsy in amyotrophic lateral sclerosis.

When collecting anamnesis, it turns out that the disorder slowly progresses over several months. Differential diagnosis in such cases is carried out with space-occupying processes near the brain stem, in particular, meningiomas of the foramen magnum region. If hearing loss occurs, this raises suspicion of a rare disease - Brown-Vialetto-van Laere syndrome.

Exclusively bilateral paresis of the tongue, in the absence of fasciculation and signs of damage to other muscles of the oropharynx, indicates a bilateral lesion of the hypoglossal nerve, for example, with cranial polyradiculopathy. Atrophy of the tongue becomes noticeable only three weeks or more after the onset of the disease. There are no atrophies or fasciculations in the affected muscles.

Perioral and nasopalpebral reflexes are animated, bilateral pyramidal signs are revealed on the extremities, and walking with small steps is characteristic. Patients are mostly elderly and/or have vascular risk factors. Paresis progresses slowly over many months or develops acutely after a hemispheric stroke: we are talking about pseudobulbar palsy due to bilateral damage to the central motor neuron, especially the corticobulbar tracts.

Unilateral paresis of the tongue muscles is a sign of damage to the hypoglossal nerve or the region of its nuclei. With peripheral damage, taste disturbances may also occur. The cause may be a glomus tumor or carotid artery dissection. With a nuclear lesion, signs of dysfunction of the brain stem are always associated, and fasciculations are also possible.

Paresis of the pharyngeal muscles may result from:

Lesions of the wandering and glossopharyngeal nerves. Unilateral paresis is characteristic of peripheral damage to the nerve trunks, for example, in the opening of the jugular vein, and in this case is one of the elements of Siebenmann syndrome; unilateral nuclear damage develops as part of the Avellis, Tapia and Vernet syndromes with a trunk stroke,

Bilateral paresis raises suspicions of diphtheria, cranial polyradiculopathy, or, if the severity of paresis is variable, myasthenia gravis.

Tongue paresis in children

Dysarthria is a speech disorder that is expressed in difficulty pronouncing certain words, individual sounds, syllables, or in their distorted pronunciation. Dysarthria occurs as a result of brain damage or a disorder of the innervation of the vocal cords, facial, respiratory muscles and muscles of the soft palate, in diseases such as cleft palate, cleft lip and due to lack of teeth.

A secondary consequence of dysarthria may be a violation of written speech, which occurs due to the inability to clearly pronounce the sounds of words. In more severe manifestations of dysarthria, speech becomes completely inaccessible to the understanding of others, which leads to limited communication and secondary signs of developmental disabilities.

Dysarthria causes

The main cause of this speech disorder is considered to be insufficient innervation of the speech apparatus, which appears as a result of damage to certain parts of the brain. In such patients, there is a limitation in the mobility of the organs involved in speech production - the tongue, palate and lips, thereby complicating articulation.

In adults, the disease can manifest itself without concomitant collapse of the speech system. Those. is not accompanied by a disorder of speech perception through hearing or a disorder of written speech. Whereas in children, dysarthria is often the cause of disorders leading to reading and writing impairments. At the same time, the speech itself is characterized by a lack of smoothness, a broken breathing rhythm, and a change in the tempo of speech in the direction of slowing down or speeding up. Depending on the degree of dysarthria and the variety of forms of manifestation, there is a classification of dysarthria. The classification of dysarthria includes the erased form of dysarthria, severe and anarthria.

The symptoms of the erased form of the disease have an erased appearance, as a result of which dysarthria is confused with a disorder such as dyslalia. Dysarthria differs from dyslalia in the presence of a focal form of neurological symptoms.

In a severe form of dysarthria, speech is characterized as inarticulate and practically incomprehensible, sound pronunciation is impaired, disorders also manifest themselves in the expressiveness of intonation, voice, and breathing.

Anarthria is accompanied by a complete lack of ability to reproduce speech.

The causes of the disease include: incompatibility of the Rh factor, toxicosis of pregnant women, various pathologies of the formation of the placenta, viral infections of the mother during pregnancy, prolonged or, conversely, rapid labor, which can cause hemorrhages in the brain, infectious diseases of the brain and its membranes in newborns.

There are severe and mild degrees of dysarthria. Severe dysarthria is inextricably linked with cerebral palsy. A mild degree of dysarthria is manifested by a violation of fine motor skills, pronunciation of sounds and movements of the organs of the articulatory apparatus. At this level, speech will be understandable but unclear.

The causes of dysarthria in adults can be: stroke, vascular insufficiency, inflammation or brain tumor, degenerative, progressive and genetic diseases of the nervous system (Alzheimer's, Huntington's disease), asthenic bulbar palsy and multiple sclerosis.

Other causes of the disease, much less common, are head injuries, carbon monoxide poisoning, drug overdose, and intoxication due to excessive consumption of alcoholic beverages and drugs.

Dysarthria in children

With this disease, children experience difficulties with the articulation of speech as a whole, and not with the pronunciation of individual sounds. They also experience other disorders associated with fine and gross motor skills, difficulties with swallowing and chewing. For children with dysarthria, it is quite difficult, and sometimes completely impossible, to jump on one leg, cut out of paper with scissors, fasten buttons, and it is quite difficult for them to master written language. They often miss sounds or distort them, distorting words in the process. Sick children mostly make mistakes when using prepositions and use incorrect syntactic connections of words in sentences. Children with such disabilities should be educated in specialized institutions.

The main manifestations of dysarthria in children are impaired articulation of sounds, voice formation disorder, changes in the rhythm, intonation and tempo of speech.

The listed disorders in children vary in severity and in various combinations. This depends on the location of the focal lesion in the nervous system, the time of occurrence of such a lesion and the severity of the disorder.

Partially complicating or sometimes completely preventing articulate sound speech are disorders of phonation and articulation, which is the so-called primary defect, leading to the appearance of secondary signs that complicate its structure.

Conducted research and studies of children with this disease show that this category of children is quite heterogeneous in terms of speech, motor and mental disorders.

The classification of dysarthria and its clinical forms is based on the identification of various foci of localization of brain damage. Children suffering from various forms of the disease differ from each other in certain defects in sound pronunciation, voice, articulation; their disorders of varying degrees can be corrected. That is why for professional correction it is necessary to use various techniques and methods of speech therapy.

Forms of dysarthria

There are the following forms of speech dysarthria in children: bulbar, subcortical, cerebellar, cortical, erased or mild, pseudobulbar.

Bulbar dysarthria of speech is manifested by atrophy or paralysis of the muscles of the pharynx and tongue, and decreased muscle tone. With this form, speech becomes unclear, slow, and slurred. People with the bulbar form of dysarthria are characterized by weak facial activity. It appears due to tumors or inflammatory processes in the medulla oblongata. As a result of such processes, the destruction of the nuclei of the motor nerves located there occurs: the vagus, glossopharyngeal, trigeminal, facial and sublingual.

The subcortical form of dysarthria consists of impaired muscle tone and involuntary movements (hyperkinesis), which the baby is not able to control. Occurs with focal damage to the subcortical nodes of the brain. Sometimes a child cannot pronounce certain words, sounds or phrases correctly. This becomes especially relevant if the child is in a state of calm in the circle of relatives whom he trusts. However, the situation can change radically in a matter of seconds and the baby becomes unable to reproduce a single syllable. With this form of the disease, the tempo, rhythm and intonation of speech suffer. Such a baby can pronounce whole phrases very quickly or, conversely, very slowly, while making significant pauses between words. As a result of a disorder of articulation in combination with irregular voice formation and impaired speech breathing, characteristic defects in the sound-forming side of speech appear. They can manifest themselves depending on the baby’s condition and affect mainly communicative speech functions. Rarely, with this form of the disease, disturbances in the human hearing system can also be observed, which are a complication of a speech defect.

Cerebellar speech dysarthria in its pure form is quite rare. Children susceptible to this form of the disease pronounce words by chanting them, and sometimes simply shout out individual sounds.

A child with cortical dysarthria has difficulty producing sounds together when speech flows in one stream. However, at the same time, pronouncing individual words is not difficult. And the intense pace of speech leads to modifications of sounds, creating pauses between syllables and words. A fast speech rate is similar to reproducing words when you stutter.

The erased form of the disease is characterized by mild manifestations. With it, speech disorders are not identified immediately, only after a comprehensive specialized examination. Its causes are often various infectious diseases during pregnancy, fetal hypoxia, toxicosis of pregnant women, birth injuries, and infectious diseases of infants.

The pseudobulbar form of dysarthria occurs most often in children. The cause of its development may be brain damage suffered in infancy, due to birth injuries, encephalitis, intoxication, etc. With mild pseudobulbar dysarthria, speech is characterized by slowness and difficulty in pronouncing individual sounds due to disturbances in the movements of the tongue (movements are not precise enough) and lips. Moderate pseudobulbar dysarthria is characterized by a lack of facial muscle movements, limited tongue mobility, a nasal tone of voice, and profuse salivation. The severe degree of the pseudobulbar form of the disease is expressed in complete immobility of the speech apparatus, an open mouth, limited lip movement, and facial expression.

Erased dysarthria

The erased form is quite common in medicine. The main symptoms of this form of the disease are slurred and inexpressive speech, poor diction, distortion of sounds, and replacement of sounds in complex words.

The term “erased” form of dysarthria was first introduced by O. Tokareva. She describes the symptoms of this form as mild manifestations of the pseudobulbar form, which are quite difficult to overcome. Tokareva believes that children with this form of the disease can pronounce many isolated sounds as needed, but in speech they do not sufficiently differentiate sounds and poorly automate them. Pronunciation deficiencies can be of a completely different nature. However, they are united by several common features, such as blurriness, smearing and unclear articulation, which manifest themselves especially sharply in the speech stream.

An erased form of dysarthria is a speech pathology, which is manifested by a disorder of the prosodic and phonetic components of the system, resulting from microfocal brain damage.

Today, diagnostics and methods of corrective action are rather poorly developed. This form of the disease is often diagnosed only after the child reaches the age of five. All children with suspected erased form of dysarthria are referred to a neurologist to confirm or not confirm the diagnosis. Therapy for an erased form of dysarthria should be comprehensive, combining drug treatment, psychological and pedagogical assistance and speech therapy assistance.

Symptoms of erased dysarthria: motor clumsiness, limited number of active movements, rapid muscle fatigue during functional loads. Sick children do not stand very stable on one leg and cannot jump on one leg. Such children are much later than others and have difficulty learning self-care skills, such as fastening buttons and untying a scarf. They are characterized by poor facial expressions and the inability to keep the mouth closed, since the lower jaw cannot be fixed in an elevated state. On palpation, the facial muscles are flaccid. Due to the fact that the lips are also flaccid, the necessary labialization of sounds does not occur, therefore the prosodic side of speech deteriorates. Sound pronunciation is characterized by mixing, distortion of sounds, their replacement or complete absence.

The speech of such children is quite difficult to understand; it lacks expressiveness and intelligibility. Basically, there is a defect in the reproduction of hissing and whistling sounds. Children can mix not only sounds that are close in their method of formation and complex, but also sounds that are opposite in sound. A nasal tone may appear in speech, and the tempo is often accelerated. Children have a quiet voice, they cannot change the pitch of their voice, imitating some animals. Speech is characterized by monotony.

Pseudobulbar dysarthria

Pseudobulbar dysarthria is the most common form of the disease. It is a consequence of organic brain damage suffered in early childhood. As a result of encephalitis, intoxication, tumor processes, and birth injuries in children, pseudobulbar paresis or paralysis occurs, which is caused by damage to the conductive neurons that go from the cerebral cortex to the glossopharyngeal, vagus and hypoglossal nerves. In terms of clinical symptoms in the area of ​​facial expressions and articulation, this form of the disease is similar to the bulbar form, but the likelihood of full mastery of sound pronunciation in the pseudobulbar form is significantly higher.

As a result of pseudobulbar paresis, children experience a disorder of general and speech motor skills, the sucking reflex and swallowing are impaired. The facial muscles are sluggish, and there is drooling from the mouth.

There are three degrees of severity of this form of dysarthria.

A mild degree of dysarthria is manifested by difficulty in articulation, which consists of not very accurate and slow movements of the lips and tongue. At this degree, mild, unexpressed disturbances in swallowing and chewing also occur. Due to not very clear articulation, pronunciation is impaired. Speech is characterized by slowness and blurred pronunciation of sounds. Such children most often have difficulty pronouncing letters such as: r, ch, zh, ts, sh, and voiced sounds are reproduced without proper participation of the voice.

Also difficult for children are soft sounds that require raising the tongue to the hard palate. Due to incorrect pronunciation, phonemic development also suffers, and written speech is impaired. But violations of the structure of the word, vocabulary, and grammatical structure are practically not observed with this form. With mild manifestations of this form of the disease, the main symptom is a violation of speech phonetics.

The average degree of pseudobulbar form is characterized by amicity and lack of facial muscle movements. Children cannot puff out their cheeks or stretch out their lips. The movements of the tongue are also limited. Children cannot lift the tip of their tongue up, turn it to the left or right and hold it in this position. It is extremely difficult to switch from one movement to another. The soft palate is also inactive, and the voice has a nasal tint.

Also characteristic signs are: excessive drooling, difficulty chewing and swallowing. As a result of violations of articulation functions, rather severe pronunciation defects appear. Speech is characterized by slurredness, slurring, and quietness. This degree of severity of the disease is manifested by unclear articulation of vowel sounds. The sounds ы, и are often mixed, and the sounds у and а are characterized by insufficient clarity. Of the consonant sounds, t, m, p, n, x, k are most often correctly pronounced. Sounds such as: ch, l, r, c are reproduced approximately. Voiced consonants are more often replaced by voiceless ones. As a result of these disorders, children's speech becomes completely unintelligible, so such children prefer to remain silent, which leads to a loss of experience in verbal communication.

A severe degree of this form of dysarthria is called anarthria and is manifested by deep muscle damage and complete immobilization of the speech apparatus. The face of sick children is mask-like, the mouth is constantly open, and the lower jaw droops. A severe degree is characterized by difficulty chewing and swallowing, a complete absence of speech, and sometimes inarticulate pronunciation of sounds.

Diagnosis of dysarthria

When diagnosing, the greatest difficulty is distinguishing dyslalia from pseudobulbar or cortical forms of dysarthria.

The erased form of dysarthria is a borderline pathology, which is on the border between dyslalia and dysarthria. All forms of dysarthria are always based on focal brain lesions with neurological microsymptoms. As a result, a special neurological examination must be performed to make a correct diagnosis.

It is also necessary to distinguish between dysarthria and aphasia. With dysarthria, speech technique is impaired, not practical functions. Those. with dysarthria, a sick child understands what is written and heard, and can logically express his thoughts, despite the defects.

A differential diagnosis is made on the basis of a general systemic examination developed by domestic speech therapists, taking into account the specifics of the listed non-speech and speech disorders, age, and psychoneurological condition of the child. The younger the child and the lower his level of speech development, the more important the analysis of non-speech disorders in diagnosis. Therefore, today, based on the assessment of non-speech disorders, methods for the early detection of dysarthria have been developed.

The presence of pseudobulbar symptoms is the most common manifestation of dysarthria. Its first signs can be detected even in a newborn. Such symptoms are characterized by a weak cry or its absence at all, a violation of the sucking reflex, swallowing or their complete absence. The cry in sick children remains quiet for a long time, often with a nasal tint, poorly modulated.

When suckling at the breast, children may choke, turn blue, and sometimes milk may leak from the nose. In more severe cases, the child may not take the breast at all at first. Such children are fed through a tube. Breathing may be shallow, often arrhythmic and rapid. Such disorders are combined with leakage of milk from the mouth, facial asymmetry, and sagging lower lip. As a result of these disorders, the baby is unable to latch onto the pacifier or nipple.

As the child grows up, the insufficiency of intonation expressiveness of the cry and vocal reactions becomes more and more apparent. All sounds made by a child are monotonous and appear later than normal. A child suffering from dysarthria cannot bite or chew for a long time, and may choke on solid food.

As the child grows up, the diagnosis is made on the basis of the following speech symptoms: persistent pronunciation defects, insufficiency of voluntary articulation, vocal reactions, incorrect placement of the tongue in the oral cavity, voice formation disorders, speech breathing and delayed speech development.

The main signs used for differential diagnosis include:

The presence of weak articulation (insufficient bending of the tip of the tongue upward, tremor of the tongue, etc.);

Presence of prosodic disorders;

The presence of synkinesis (for example, movements of the fingers that occur when moving the tongue);

Slowness of the tempo of articulations;

Difficulty maintaining articulation;

Difficulty in switching articulations;

Persistence of disturbances in the pronunciation of sounds and difficulty in automating the delivered sounds.

Functional tests also help to establish a correct diagnosis. For example, a speech therapist asks a child to open his mouth and stick out his tongue, which should be held motionless in the middle. At the same time, the child is shown an object moving laterally, which he needs to follow. The presence of dysarthria during this test is indicated by the movement of the tongue in the direction in which the eyes move.

When examining a child for the presence of dysarthria, special attention must be paid to the state of articulation at rest, during facial movements and general movements, mainly articulatory. It is necessary to pay attention to the volume of movements, their pace and smoothness of switching, proportionality and accuracy, the presence of oral synkinesis, etc.

Dysarthria treatment

The main focus of treatment for dysarthria is the development of normal speech in the child, which will be understandable to others and will not interfere with communication and further learning of basic writing and reading skills.

Correction and therapy for dysarthria must be comprehensive. In addition to constant speech therapy work, medication treatment prescribed by a neurologist and exercise therapy are also required. Therapeutic work should be aimed at treating three main syndromes: articulation and speech breathing disorders, voice disorders.

Drug therapy for dysarthria involves the prescription of nootropics (for example, Glycine, Encephabol). Their positive effect is based on the fact that they specifically affect the higher functions of the brain, stimulate mental activity, improve learning processes, intellectual activity and memory of children.

Physiotherapy exercises consist of regular special gymnastics, the effect of which is aimed at strengthening the facial muscles.

Massage has proven itself well for dysarthria, which must be done regularly and daily. In principle, massage is the first step in treating dysarthria. It consists of stroking and lightly pinching the muscles of the cheeks, lips and lower jaw, bringing the lips together with the fingers in a horizontal and vertical direction, massaging the soft palate with the pads of the index and middle fingers for no more than two minutes, and movements should be forward and backward. Massage for dysarthria is needed to normalize the tone of the muscles that take part in articulation, reduce the manifestation of paresis and hyperkinesis, activate poorly working muscles, and stimulate the formation of areas of the brain responsible for speech. The first massage should take no more than two minutes, then gradually increase the massage time until it reaches 15 minutes.

Also, to treat dysarthria, it is necessary to train the child’s respiratory system. For this purpose, exercises developed by A. Strelnikova are often used. They involve sharp inhalations when bending over and exhalations when straightening up.

A good effect is observed with self-study. They consist in the fact that the child stands in front of a mirror and trains to reproduce the same movements of the tongue and lips that he saw when talking with others. Gymnastics techniques to improve speech: open and close your mouth, stretch your lips like a “proboscis,” hold your mouth in an open position, then in a half-open position. You need to ask the child to hold a gauze bandage between his teeth and try to pull the bandage out of his mouth. You can also use a lollipop on a shelf that the child must hold in his mouth and the adult must take it out. The smaller the lollipop, the more difficult it will be for the child to hold it.

The work of a speech therapist for dysarthria consists of automating and staging the pronunciation of sounds. You need to start with simple sounds, gradually moving on to sounds that are difficult to articulate.

Also important in the treatment and correction of dysarthria is the development of fine and gross motor skills of the hands, which are closely related to speech functions. For this purpose, finger gymnastics, assembling various puzzles and construction sets, sorting small objects and sorting them out are usually used.

The outcome of dysarthria is always ambiguous due to the fact that the disease is caused by irreversible disturbances in the functioning of the central nervous system and brain.

Correction of dysarthria

Corrective work to overcome dysarthria must be carried out regularly along with drug treatment and rehabilitation therapy (for example, treatment and preventive exercises, therapeutic baths, hirudotherapy, acupuncture, etc.), which is prescribed by a neurologist. Non-traditional correction methods have proven themselves well, such as dolphin therapy, isotherapy, touch therapy, sand therapy, etc.

Correctional classes conducted by a speech therapist imply: development of motor skills of the speech apparatus and fine motor skills, voice, formation of speech and physiological breathing, correction of incorrect sound pronunciation and consolidation of assigned sounds, work on the formation of speech communication and expressiveness of speech.

The main stages of correctional work are identified. The first stage of the lesson is a massage, with the help of which the muscle tone of the speech apparatus develops. The next step is to conduct an exercise to form correct articulation, with the goal of subsequently correctly pronouncing sounds by the child, to produce sounds. Then work is carried out on automation of sound pronunciation. The last stage is learning the correct pronunciation of words using already supplied sounds.

Equally important for a positive outcome of dysarthria is the psychological support of the child from loved ones. It is very important for parents to learn to praise their children for any of their achievements, even the smallest ones. The child must be given a positive incentive for independent study and confidence that he can do anything. If a child has no achievements at all, then you should choose a few things that he does best and praise him for them. A child should feel that he is always loved, regardless of his victories or losses, with all his shortcomings.

People without medical education can hardly imagine what the hypoglossal nerve is. But in some cases this information can be very important. There are a number of problems that impair a person's quality of life associated with the tongue and hypoglossal nerve. Let's take a closer look at them.

Just something complicated

The hypoglossal nerve innervates, that is, it connects the nerve endings of the tongue with the central nerve. It provides motor (efferent) innervation, allowing the central nervous system to control the activity of the tongue and the orbicularis oris muscle. The nerve is paired; it emerges from the anterolateral sulcus, and its core is located along the medulla oblongata.

The mylohyoid nerve sends impulses and provides activity to the superior, inferior, longitudinal, transverse and vertical muscles. It is responsible for the movement of the genioglossus, hyoglossus and styloid muscles.

How to understand a doctor. Meaning of terms

Since information about the hypoglossal nerve is a little difficult to understand, patients do not always understand what the specialist is talking about. To understand the diagnosis, you need to know some terms:

1. Hemiglossoplegia. This term refers to paralysis of half the tongue.
2. Glossoplegia is a state of complete paralysis of the tongue.
3. "Dysarthria." A diagnosis indicating a violation of articulate speech. Slurring is accompanied by a sensation of a foreign substance in the mouth.
4. “Anarthria” is a diagnosis that specifies that articulate speech is impossible.

These terms appear quite frequently in medical histories related to the hypoglossal nerve. It is better to remember their meaning.

What does the patient complain about?

When visiting a doctor, patients mainly complain of tongue weakness. They have difficulty speaking and sometimes even swallowing. Gradually the problem grows, and the tongue moves worse and worse. The patient may feel as if he has a “mouthful of porridge” that makes his speech difficult to understand. In difficult cases, speech disappears completely.

Medical examination

If a specialist suspects that the hypoglossal nerve is affected, he will determine the symptoms by examining the tongue in the oral cavity. First of all, the doctor asks you to stick out your tongue. Don't be surprised, this simple action can indicate the underlying problem. The doctor will be able to visually determine the extent of the disease. If the hypoglossal nerve does not function well, the tongue deviates to the side. This is due to muscle hypotonia on one side. The entire surface of the organ looks wrinkled and becomes uneven. But here it must be taken into account that many patients purposefully tilt their tongue towards the doctor so that he can better examine it. If there is any doubt as to whether the tongue is voluntarily or involuntarily rejected, the patient is asked to touch the upper lip with the tip. If there is no pathology, then the tip will be located in the middle, if the nerve is affected, it will move to the side.

In addition to deviation, the doctor should pay attention to atrophy and fibrillary twitching.

Bilateral damage to the hypoglossal nerve is observed in approximately 20% of cases. This disease is less treatable and can lead to complete loss of speech.

Diagnosis options. Neuropathy

Essentially, neuropathy is a nerve damage that is non-inflammatory in nature. In the case of the hypoglossal nerve, this diagnosis is divided into central and peripheral neuropathy.

The central one affects the corticonuclear pathways of the nerve. The problem affects the cortex and nucleus of the twelfth pair of cranial nerves. This type of neuropathy is usually associated with facial nerve problems. When protruding, the tongue deviates in the direction opposite to the lesion, since the nucleus of the hypoglossal nerve has connections with the opposite hemisphere. Atrophy and fibrillary twitching are not observed.

The process may have several stages. If the hypoglossal nerve is affected only in the area of ​​the internal section, then only the functions of the lingual muscles are affected.

If the lesion begins below the exit of the hypoglossal nerve canal, then the problem affects the nerve fibers connected to the cervical roots. This leads to disruption of the functioning of the muscles that hold the larynx. When swallowing, there will be a shift to the healthy side.

Peripheral neuropathy

Signs: immobility of the epiglottis, larynx and soft palate, change in voice, loss of intelligible speech, difficulty swallowing (liquid food can flow into the nose), difficulty breathing. The vocal cords are in a “cadaverous position”, the tongue twitches fibrillarly. If the facial and trigeminal nerves are additionally affected, the masticatory muscles atrophy and the lower jaw sag.

Very similar to bulbar, but it is a lesion of the corticonuclear connections on both sides. A larger number of cranial nerves are affected, including the hypoglossal nerve. Symptoms include drooling, reflex movements of the eyeballs, bouts of crying or laughter, dementia and decreased intelligence.

Diagnostic methods and treatment

The doctor collects anamnesis, performs a visual examination, and prescribes a CT or MRI of the brain to confirm the diagnosis. This allows us to find out the cause of compression of the hypoglossal nerve.

Any treatment is prescribed after confirmation of the diagnosis. The main goal is a positive effect on the underlying disease. Self-medication is unacceptable!