A pseudobulbar type of dysarthria appears in a child due to paresis of the muscles of the articulatory apparatus (cheeks, tongue, larynx, lips). More often, the pathology occurs in patients with cerebral palsy (CP). In adults, the disease provokes ischemic damage to brain tissue. Pseudobulbar dysarthria in children occurs after birth injuries, infections and other causes. External manifestations of the disease are characterized by impaired swallowing, sucking, changes in facial expressions, flow of saliva and other manifestations. Therapy of the disease is aimed at eliminating the cause of paresis of facial and articulatory muscles, as well as restoring speech function.
The concept of pseudobulbar dysarthria, types, causes
Pseudobulbar dysarthria in childhood is a pathology that is caused by bilateral paralysis of the articulatory apparatus due to damage to the pathways approaching the nuclei of the glossopharyngeal, vagus and hypoglossal nerves. Since the crossover of the pathways in the brain from these nuclei is not complete, with unilateral damage to the pathways the patient does not experience a clinical picture of pseudobulbar dysarthria. The causes of the disease can be injuries during labor, prolonged hypoxic conditions during pregnancy and obstetrics, and infectious lesions of brain tissue.
Etiology of the disease:
- Hypoxic conditions - the disease is caused by prolonged hypoxia throughout pregnancy or childbirth. Hypoxia during gestation is provoked by placental abruption, chronic maternal diseases (diabetes, hypertension, hypotension, etc.), and increased uterine tone. Hypoxic brain damage during childbirth is often caused by very long labor (more than 12 hours), weakness of labor, asphyxia, and entanglement of the umbilical cord.
- Head injuries. Children often receive injuries during childbirth during incorrect provision of obstetric care: the use of obstetric forceps, a vacuum extractor, physical pressure on the abdomen by an obstetrician, excessive stimulation of labor. Injuries throughout life occur during falls, blows to the head, and car accidents.
- Intrauterine infections and neuroinfections (encephalitis, neurosyphilis, tuberculosis).
- Degenerative processes in brain tissue - leukodystrophy, progressive supranuclear palsy.
- Oncopathology.
The pseudobulbar variety of dysarthria is divided into several types depending on the severity and forms of pathology. The classification of the disease is of great importance when making a diagnosis. The diagnosis must include the severity and form of the disease.
Pathology severity:
- Easy.
- Average.
- Heavy.
Pseudobulbar dysarthria can also be divided into spastic, erased, paretic, and mixed forms of the disease. The spastic form is characterized by muscle spasm. The paretic variety is manifested by paresis of the tongue, cheeks, and facial muscles. Mixed - has several signs (spastic and paretic forms). The erased form manifests itself as a latent or dimly expressed course of pathology.
Psychological and pedagogical characteristics
Children diagnosed with dysarthria in most cases do not have intellectual disabilities . In this case, hearing is completely preserved, but the perception of sounds is impaired. The main sign of pathology is the presence of an undeveloped speech apparatus.
The consequences of this condition can be a poor vocabulary , difficulties in explaining thoughts, inconsistency of intonation with spoken words, deviations in the grammatical structure of speech and pronounced distortion of words.
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Clinical manifestations
Pseudobulbar dysarthria has its own specific manifestations. The child’s speech function, motor skills, and facial expressions are impaired. There is a flow of saliva, impaired swallowing and sucking function. While drinking, the patient choke or choke due to impaired innervation of the larynx.
A mild degree of pathology is manifested by a mild impairment of articulatory function. The tongue and lips move slowly and not accurately enough, so the patient has mild deviations in chewing and swallowing. Choking is rare. Speech reproduction is slow, words are unclear, sounds in words are blurred. Children are not able to clearly pronounce the sounds “Zh”, “Sh”, “R”, “Ch”, “C”. The voice strength is not enough to reproduce ringing sounds. The child is not able to pronounce soft sounds normally due to difficulty raising the back of the tongue to the palate.
In a child with a mild degree of pathology, the correctness of writing is impaired. In the writing of words, there is a replacement of the sound “T” with the sound “D”, the sound “Ch” with the sound “C”, and so on. The structure of the word, grammar and vocabulary in such patients is preserved.
Patients with the moderate form of the disease have no facial expressions. The patient is unable to puff out his cheeks, stretch out and close his lips tightly. Motor activity of the tongue is severely limited. In a child, the tip of the tongue does not rise to the palate, does not turn to the sides, or is not fixed in one position. Children with moderate pathology speak through their noses. In such patients, there is a flow of saliva and a pronounced impairment of chewing and swallowing functions.
With moderate dysarthria, sound reproduction is severely impaired. Speech is slurred, quiet, lips move slowly and heavily. Vowels are produced by nasal exhalation. Children speak the sounds “A”, “U” indistinctly, and the sounds “I” and “Y” are mixed when pronounced. The child is able to speak the sounds “P”, “T”, “M”, “N”, “K”, “X”. The sounds “Ch”, “C”, “R”, “L” are difficult and are reproduced during nasal exhalation with clapping accompaniment.
The exhalation force is negligible. Voiced consonants in patients are replaced by dull sounds during speech. The speech of patients is incomprehensible to others, so they do not want to speak. Patients cannot attend regular schools. Such patients are sent to specialized correction schools.
Patients with severe forms of pathology are characterized by almost complete damage to the articulatory apparatus. The patient's face looks like a mask, the jaw drops, the mouth is always open. The tongue does not move and lies on the bottom of the lower jaw. Lip movements are severely limited. Chewing and swallowing functions are difficult.
The child has no speech function. There are only isolated incomprehensible sounds. Education of patients with severe dysarthria is carried out in special educational institutions. With the right approach, patients can master general education subjects, but this requires long-term work by speech therapists.
Degrees of pronunciation impairment
Dysarthria develops gradually.
The first symptoms of pathology can be recognized even in newborns. Such babies have difficulty swallowing milk and sucking at their mother's breast.
Such signs often go away on their own. Symptoms of dysarthria clearly appear at the age of 4-5 years. During its development, the disease goes through several stages. In medical practice, there are several degrees of pathology.
Degrees of dysarthria:
- First degree (an erased form of dysarthria with corresponding symptoms develops).
- Second degree (the child’s speech is accompanied by pronounced defects).
- Third degree (the child’s speech becomes incomprehensible).
- Fourth degree (stable pathology of the speech apparatus is formed).
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Diagnostic measures
Diagnostic measures include consultation with specialists and a pediatrician, speech therapy examination, instrumental and laboratory research techniques. The child is referred to specialized specialists: a neurologist, a traumatologist, a geneticist, an infectious disease specialist. The main thing is an examination by a neurologist, which allows you to assess the neurological status. Laboratory research techniques include analysis for the presence of neuroinfections.
Magnetic resonance imaging (MRI) is indicated for patients with dysarthria. It helps to assess the condition of the brain, identify foci of degeneration, tumors, hematomas, traumatic injuries, and ischemic areas. If there are contraindications to MRI, computed tomography is performed. To check cerebral hemodynamics, the child is prescribed Doppler ultrasound examination and duplex scanning.
An examination by a speech therapist includes an assessment of the state of the articulatory apparatus, oral and written speech, and memory. In patients, a speech therapist identifies delayed speech development, phonetic-phonemic disorders, and general insufficiency of speech function. After assessing the condition, the speech therapist draws up a speech card and prescribes correctional classes.
Features of education
When raising children diagnosed with dysarthria, parents need to pay special attention to the development of fine motor skills and active verbal communication .
You need to talk through as many situations as possible with your baby.
For example, during walks you should ask your child questions related to the environment. The answers should be detailed .
Children with dysarthria often try to remain silent due to a complex of undeveloped speech. The task of parents is to support the child and help him cope with pathology.
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Therapeutic measures
Treatment of the pseudobulbar variety of dysarthria is aimed at eliminating the causes of the disease, as well as restoring speech function. Depending on the causes of the disease, the patient can be treated by a neurologist, neurosurgeon, rehabilitation specialist, speech therapist, psychologist, physical therapy specialist, and massage therapist. To eliminate the cause of the pathology, surgical treatment (removal of tumors and hematomas), antibacterial and antiviral therapy is possible.
After eliminating the cause of dysarthria, speech therapy treatment is prescribed. The speech therapist massages the facial muscles and produces incorrectly pronounced sounds. The specialist tries to increase the emotionality of facial expressions and teaches the child smooth facial movements.
Simultaneously with correctional classes, the child is prescribed physical therapy, massage procedures, reflexology, and treatment using computer simulators. They actively conduct psychological conversations and trainings. During the recovery period, children are advised to take nootropic drugs, neuroprotectors, and vitamin complexes.
Treatment should be started as early as possible. The chances of cure are higher if you consult a doctor in a timely manner.
How dangerous is the disease?
Dysarthria can impair the performance of systems not related to the speech apparatus. In most cases, complications affect fine motor skills .
Children with this diagnosis find it difficult to hold a pen, tie shoelaces, or perform basic manual actions.
This feature can lead to difficulties in perceiving educational material and cause the child to become complex. The complexes, in turn, will cause serious psycho-emotional disorders.
Consequences of dysarthria in children:
- impaired fine motor skills of the hands;
- learning difficulties;
- difficulties in social adaptation.
Forecast, preventive measures
Restoration of speech function in patients with pseudobulbar dysarthria depends on the severity of symptoms, as well as on the causes of the pathology. When the treatment of the underlying disease is successful, then speech therapy correction will have a good effect. If a child has cerebral palsy, the prognosis depends on the severity of the damage to the brain structures, the qualifications of the neurologist and speech therapist.
Prevention of dysarthria includes planning pregnancy, avoiding contact with infectious patients during gestation, preventing injuries during childbirth through the provision of high-quality assistance during delivery. Pregnant patients are advised to immediately treat infectious and chronic diseases. After birth, if symptoms of dysarthria are detected, parents are advised to promptly consult a doctor. Complications of pseudobulbar dysarthria can be prevented by following all the recommendations of doctors, including a speech therapist.
Features of phonemic hearing
Speech deviations due to dysarthria lead to impairments in phonemic hearing in the child. Children with this diagnosis not only accumulate their own vocabulary at a slower pace, but also experience difficulty in perceiving musical works .
Children literally do not hear music and its rhythm. In addition, dysarthria causes incorrect perception of words.
Due to this factor, persistent difficulties arise in differentiating sounds that are similar in sound.
Prognosis and prevention
Dysarthria does not threaten the child’s physical health. However, if a child's speech problems are ignored, they can cause psychological and social difficulties in the future. Correct diagnosis and diligent implementation of doctors' recommendations are necessary.
With regular and thorough exercises, as well as the inclusion of all necessary types of rehabilitation, the symptoms of erased dysarthria can be dealt with and in the future speech disorders will completely disappear.
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