RHINOLALIA, ITS CLASSIFICATION AND ETIOLOGICAL CAUSES

RHINOLALIA, ITS CLASSIFICATION AND ETIOLOGICAL CAUSES

Anna Bessonova

student, Belgorod State University,

Russia, Belgorod

To understand the problem of speech disorders in children within the framework of the chosen topic, it is advisable to familiarize yourself with the concept of rhinolalia.

Rhinolalia is defined as a violation of the timbre of the voice and sound reproduction as a result of anatomical and physiological defects of the speech apparatus. It is the combination of a disorder of articulation of sounds with disorders of the timbre of the voice that is the distinguishing feature of rhinolalia from rhinophony (a violation of the timbre of the voice with normal articulation of sound speech)[5].

It should be noted that in rhinolalia, there is a significant deviation from the norm of the mechanism of articulation, phonation and vocalization, due to a violation of the participation of the nasal and oropharyngeal resonators. If a person has a normal intonation during the utterance of all speech sounds, with the exception of nasal ones, then this indicates the separation of the nasopharyngeal and nasal cavities from the pharyngeal and oral cavities.

It should be noted that the level of contact of the soft palate with the pharyngeal wall varies depending on the length of the soft palate. Schematically, this is shown in Figure 1.

In the process of speech, the soft palate continuously descends and rises to different heights, depending on the fluency of speech and the sounds uttered. In practice, it has been found out that the strength of palatopharyngeal closure directly depends on the sounds uttered.

In the theoretical foundations of speech therapy, it is noted that the vowel closure is smaller than for consonants. This is due to the fact that nasal-tinged vowels arise as a result of the appearance of a space of about 6 mm between the posterior edge of the soft palate and the posterior wall of the pharynx. It is important to note that the weakest palatopharyngeal closure is the closure with the consonant "c", which is 6-7 times stronger than with the vowel "c".

Thus, the concept of "rhinolalia" should be understood as a violation of the sound reproduction and timbre of the voice, which is caused by anatomical and physiological defects of the speech apparatus. In the direction of speech therapy development, rhinolalia are classified into three large groups[8]:

1. Open rhinolalia. This type of pathology can also be organic and functional. Organic rhinolalia, in turn, can be congenital and acquired.

2. Closed rhinolalia are also classified into organic and functional, with organic being anterior and posterior.

3. Mixed rhinolalia.

To understand the problem of rhinolalia in writing, it is advisable to familiarize yourself with its various types that occur in the practice of speech therapy.

Thus , by the nature of pathological disorders of uncomfortable pharyngeal closure , such forms of rhinolalia are distinguished as:

• Closed, resulting from a reduced nasal resonance due to physiological reasons.
• Open, due to the free simultaneous origin of the air jet through the mouth and nose[5].

Turning to the ideological causes of the occurrence of the considered pathological condition, it is advisable to characterize organic and functional disorders. For example, the most common causes of the closed form of rhinolalia are functional disorders of palatopharyngeal closure or organic disorders of the nasal space. As for the organic causes of closed rhinolalia, there are a variety of diseases or changes that lead to poor nasal patency and difficulty nasal breathing.

Among the most common, the following reasons stand out:

• adenoid growths;
• nasal cavity polyps;
• chronic hypertrophy of the posterior inferior shells of the nasal mucosa[3].

As practice shows, functional closed rhinolalia is more common in children and is observed with normal nasal patency. Open rhinolalia can be caused by organic and functional reasons. Organic causes, as noted earlier, are congenital and acquired.

Congenital open rhinolalia of organic origin is formed as a result of splitting of the soft or hard palate, which are congenital in nature.

The acquired form of open rhinolalia is formed as a result of paralysis of the soft palate or as a result of the appearance of an opening between the oral and nasal cavities. As for functional open rhinolalia, it is observed in children with poor articulation. Speech therapists note that hysterical behavior of children is not a rare phenomenon of the cause of functional open rhinolalia[4].

Among the organic causes of open rhinolalia, congenital non-fusion of the face and palate are distinguished. There are such non - compounds as:

• cleft upper lip
• cleft of the soft or hard palate
• cleft of the upper lip and alveolar process
• submucosal cleft palate, etc.[19].

It is important to note that the above pathologies occur in the prenatal period as a result of the negative impact on the fetus of various external and internal factors. From a medical point of view, these factors are considered to be:

• receptions of various medications;
• infectious diseases of the mother during pregnancy;
• alcohol;
• Smoking;
• combination of several factors at the same time;
• psychological shocks of a pregnant woman[11].

Thus, the above pathologies will directly depend on the size and shape of the birth defect. Emerging pathologies most often do not lead to any one problem in the formation of a child. So problems with rhinolalia affect not only the sound speech of the child, but also the written speech, leading to the problem of dysgraphy and serious difficulties in fully mastering literacy.

PREVENTION OF DYSGRAPHY IN CHILDREN WITH RHINOLALIA

Correctional work with children with rhinolalia in speech therapy practice is a rather complex multi-stage process. Children with rhinolalia suffering from problems with written speech undergo three methods of working with a speech therapist during the correction process:

1. Normalization of articulatory praxis;

2. Staging of physiological and speech breathing;

3. Correction of the phonetic side of speech, development of phonemic hearing and perception[17].

At the initial stage, pronunciation is corrected by creating conditions for the ordering of the phonetic side of speech. This is due to the fact that the main cause of pronunciation defects lies in the improper development and functioning of the organs of speech, which is caused by a violation of the anatomical integrity of the palate, thereby correctional training begins with the normalization of articulatory praxis.

In speech therapy practice, articulation exercises are widely used to improve kinesthetic analysis, which plays a very important role in the formation of phonemic representations of the child. In the process of speech therapy work on the development of articulatory praxis, a system of exercises is provided to stimulate the movements of the lower jaw, lips, tongue, soft palate and pharynx. The complex of speech therapy work includes the following exercises[9]:

• lower jaw gymnastics;
• gymnastics and lip massage;
• gymnastics of the cheek muscles;
• language gymnastics;
• stimulation of palatine and pharyngeal reflexes;
• stimulation of the maxillofacial muscles;
• stimulation of palatine and pharyngeal reflexes.

It should be noted that children with congenital cleavage of the lip and palate lack palatopharyngeal closure, resulting in difficulties in the normal development of speech breathing from the moment of birth of the child. In pathology, the exhaled jet of air exits simultaneously through the nose and mouth, quickly weakens, thereby the air in the oral cavity does not have the pressure that is necessary for the formation of various articulatory bows. This is one of the main reasons for the severe violation of sound reproduction and the consequence of the acquired nasal tone of speech sounds[3].

This is where the second method of speech therapy training with a child originates. The speech therapist takes measures to develop the skill of directing the inhaled stream of air through the mouth. Getting started on correcting breathing as a result of air leakage in the process through the nose, speech therapists recommend developing the skill of directing an air jet through the mouth in order to ensure sufficient intraoral air pressure for the formation of consonant phonemes.

As practice shows, in the first months of training, children are offered a variety of playful breathing exercises that are not related to speech, the purpose of these exercises is to teach children to take a deep breath through a strong long and economical exhalation. Further, in the process of speech therapy training, the speech therapist takes measures to educate diaphragmatic-rib breathing[8]. The speech therapist tries to induce diaphragmatic-rib breathing with the help of a lesion. For this process, it is necessary to put the child's palm on his side and check his breathing with his palm. When the speech therapist's ribs move, the child, imitating him, switches to lower-rib breathing.

Phonemic design in the written speech of children with rhinolalia is characterized by distortion of vowels and consonants on all differential signs, as a result of which they are mixed in perception, to difficulties of phonemic analysis and synthesis, as well as reading disorders. Based on this, speech therapy training provides interrelated areas of work, which include the correction of pronunciation and voice, as well as the development of phonemic hearing and perception[19].

Correction of the phonetic side of speech is based on didactic principles, such as scientific, systematic, consistency, accessibility, strength, consciousness, activity, consideration of age and individual characteristics of development in learning, visibility. In addition, didactic principles are highlighted, which are formed within the framework of the features of pathology:

1. Correction combines pronunciation and sound analysis skills. Within the framework of this principle of learning, it is arranged so that children can consolidate the correct pronunciation of the sounds set and at the same time acquire sound analysis skills. Phonemic analysis includes sounds that children know how to pronounce correctly, and then they are taught to compare these sounds with other paired sounds, recognize differences in a word, distinguish from similar sounds, analyze and synthesize. In the process, phonemic analysis expands to corrected sounds[21].

2. Compliance with a specific sequence in the process of working on the sounds of one phonetic group. Sounds that require less complex articulation settings are subject to correction after sequential processing of sounds of one phonetic group. For example, the order of correction of hard and soft consonants depends on the nature of the violation. First, they master the one of the paired (hard or soft) consonants that is preserved, and then the preserved paired sound [21].

3. Selection of speech material for correctional classes. The development of articulation, according to speech therapists, is more effective if there are no sounds in the speech material that are close to those that are being worked on at one time or another. This is done in order to firmly consolidate the articulatory-acoustic image of this sound, as well as to prevent confusion when writing and reading letters that denote close sounds [21].

4. Speech therapy training involves simultaneous work on sounds from different phonetic groups. In children with rhinolalia, the entire sound background is distorted. Therefore, it is recommended to start correction simultaneously on several sounds that are taken from different phonetic groups, for example, you can simultaneously work on the sounds "c", "b", "l".

5. In the course of correctional work, it is necessary to observe the interval in mastering sounds that are close in articulation and acoustic properties. This principle provides that sounds from the same phonetic group should be separated from each other in terms of study time in order to help children establish and consolidate strong links between articulatory and acoustic properties of sound[21].

6. Reliance on safe premises. Correctional training is based on visual perception, through which the child learns the oral image of sound, some movements of the organs of articulation. On the tactile-vibrational sensation, the child receives more meaningful information about the phonetic elements of speech. On auditory perception, the child can catch the acoustic features of the regulated sound. At the same time, the speech of the speech therapist becomes the standard to which the child will strive.

Thus, it can be concluded that the degree of formation of written speech in children with articulatory apparatus defects is directly related to the severity of the primary defect. Pathology affects not only the level of formation of written speech, but also the personal characteristics and abilities of the child.