1.Evaluation and diagnosis of language disorders in children
1.1. Clinical characteristics of children’s language disorders
1.1.1, aphasia (aphasia): is a disorder after the acquisition of speech, is due to brain damage caused by the impairment or loss of speech function, often manifested as listening, speaking, reading, writing, calculation and other aspects of the disorder.
1.1.2, motor dysarthria (dysarthria): is due to neuromuscular lesions caused by the motor disorders of the organ of speech formation, vocalization and dysarthria and other symptoms called motor dysarthria.
1.1.3. Speech disorders due to hearing impairment: refers to the speech disorders caused by hearing impairment. Children’s speech is usually completed around the age of seven, which can be called the acquisition of speech. After the acquisition of speech, the treatment of auditory disorders is only a matter of hearing compensation, before the acquisition of speech, especially the speech disorders caused by moderate hearing impairment in infancy and early childhood, it will be very difficult to acquire speech without auditory speech rehabilitation.
1.1.4. Delayed language development in children: This is a state in which the child’s speech development lags behind the actual age during growth and development.
1.1.5. Deformity dysarthria: Dysarthria due to abnormalities in the morphological structure of the organ of speech is called organic dysarthria, represented by cleft palate, which can be repaired by surgery, but some children still have dysarthria, which can be cured or improved by speech training.
1.1.6, Stuttering stutter,: is a fluency disorder of speech. The exact cause is unclear. Some children inadvertently learn to stutter during speech development, or it is related to genetic and psychological disorders and other factors, which can manifest as repetition of the initial word or phonetic sounds, trailing sounds and so on. Some children can self-heal as they grow up.
1.1.7, vocal disorder dysphonia,: is caused by the presence of organic or functional abnormalities in respiratory and laryngeal regulation, commonly due to inflammation of the vocal cords and larynx, neoplastic and neurological dysfunctions.
1.1.8, Functional dysarthria: It refers to partial dysphonia in the absence of any motor disorders, hearing disorders and morphological abnormalities. This disorder can be completely recovered through training.
1.2.Evaluation method
1.2.1. Hearing examination: you can choose auditory behavioral response examination BOA,, conditioned exploration hearing response examination COR,, matching scenario
Audiological examination PS,, play audiological examination PA,, audiometer examination method, auditory evoked brainstem response examination ABR,.
1.2.2, Peabody Picture Vocabulary Test PPVT,: for ages 2.5-18 years.
1.2.3. Idenos Mental Language Ability Test ITPA: for ages 3 years-8 years and 11 months.
1.2.4. Bailey Infant Developmental Scale-Intelligence Scale: applicable to children aged 0-3 years.
1.2.5. Wechsler Intelligence Check for School-age Children Revised WISC-R: applicable to 6-16 years old, it is an intelligence check, divided into two parts: language test and operational test.
1.2.6 The Wechsler Preschooler’s Intelligence Scale WPPSI, for ages 4-6.5 years.
1.2.7. Dysarthria examination
1.2.8. Speech act assessment: S-S method
The S-S method was developed in 1977 by the Sub-Committee on Delayed Speech and Language of the Japanese Society of Phonetic and Phonetic Medicine for children with speech disorders.
The Chinese version was developed by the Chinese Rehabilitation Research Center according to the linguistic characteristics and cultural habits of the Chinese language. It is suitable for children with speech delay from 1 year old to 6.5 years old.
1. Rehabilitation of language disorders
2.1. Modern medical rehabilitation
2.1.1. Speech and Language Therapy ST.
Language Training Program Short Form
Category
Treatment program
Pronunciation function training
Tongue function training
Stretching the tongue and licking the upper and lower lips
Tongue movement
Tongue and accessory muscle group movement
Tongue body movement training
Air blowing
Lip movements
Comprehension training
Verbal comprehension training
Auditory, such as name calling
Visual comprehension such as looking at pictures, objects, etc.
Non-verbal comprehension training
Comprehension of gestures
Identifying commonly heard sounds
Clap hands in rhythm with music
Expression training
Verbal Expression Training
Imitation of pronunciation
Pronunciation training
Saying the names of objects on the pictures
Imitate actions to practice speaking
Retelling stories
Non-verbal expressive skills training
Expressing needs
Expressing the use of objects
2.Methods of language training
There are many language training methods, some of which can be done by parents, while others have to be carried out by professional speech therapists.
1.Training treatment of dysarthria
Dysarthria, also known as motor dysarthria, refers to the dysfunction of the respiratory organs, larynx, mouth, jaw, tongue and lips related to vocal speech, so the treatment of language disorders should first be the training of motor dysarthria, the specific training methods are as follows.
Breathing training
Correct control of the air flow between breaths is the basis of articulation, and control of breathing can reduce the tension of the throat muscles to facilitate vocalization. Therefore, breathing training must be conducted before speech training, and not only speech training alone, but also comprehensive training with physiotherapist and occupational therapist. The development of anti-gravity muscles plays an important role in respiratory function.
Motor training of the mouth, lips and jaw: children with jaw movement disorders have difficulty opening and closing the mouth and lips normally, and therefore cannot compose sounds, so we can use the following methods to stimulate the muscles around the jaw and mouth and lips to make them contract and achieve mouth and lip closure.
For children with good intelligence, we can use language to instruct them to open their mouths, close their mouths, pout, show their teeth, grin, round their lips, puff their cheeks, suck their cheeks, and smile, and repeat until they become proficient.
Stimulation with tongue depressor: When the child’s mouth does not close, the tongue depressor can be inserted into the child’s mouth with slight pressure, and when the tongue depressor is pulled outward, the child will have a lip-closing action to prevent the tongue depressor from being pulled out.
Ice stimulation method: Ice can be rubbed around the lips or mouth to promote the continuous action of lip closure and opening with cold stimulation.
Brush method: Use a soft brush to quickly stimulate the local skin at a rate of 5 times per second in and around the mouth and lips, which can also play a role in lip closure
Patting the jaw method: Patting the skin near the jaw and jaw joint with the hand can promote lip closure. The trainer-hands are placed above the child’s head and one hand is placed at the child’s jaw, and forcefully helps the patient’s jaw action to promote jaw lifting and promote lip closure action.
Sucking back with a straw, sucking with a pacifier, and putting food in the mouth can all promote the mouth-lip closing action. Using blowing bubbles, blowing feathers, looking at the mirror and blowing bubble gum in large affected children can achieve better results.
The training of both lips is very important for vocalization and must be persisted. The coordinated movement of mouth and lips and jaw is the initial foundation for pronunciation.
Tongue training
Tongue movement training: including tongue extension and retraction, tongue lifting up to lick the palate, backward tongue roll, and tongue movement of both sides. The use of chewing movement, sucking action, so that the tongue and lip action coordination, increase the tongue stirring action; tongue forward stage, so that the child’s mouth open, with food or toys or small spoons placed in front of the lips of the mouth, so that the child appears to lick the tongue out of the action, and can control themselves; tongue forward, back, left, right action stage, with honey coated around the mouth, to encourage the child to appear to lick the tongue of the action of sugar. In addition, you can also use the tongue depressor to do passive resistance training. Such as using tongue depressor to press the tip of the tongue, so that the child’s tongue tip force up, etc., to promote the movement of the tongue.
Improve oral sensation: normal children often put objects in the mouth, through the oral cavity can feel the shape and characteristics of the object, while the affected children due to motor dysfunction, oral sensory dysfunction, can not identify the shape of objects in the mouth, so to improve the oral sensation, commonly used a variety of different shapes, different hardness of objects placed in the mouth for stimulation, so that the experience of sensation. Therapists often use washed fingers to massage different parts of the child’s mouth, which is very beneficial to mobilize the movement of the lips, tongue and soft palate, and will also play a positive role in development.
Training for tardive dyskinesia with involuntary movements: use the antagonistic muscles to regulate their mutual balance by resisting each other, such as the up and down movement of the tongue to make it stable, let the child stretch the tongue, use the tongue depressor to lift the tongue upward and press the tongue downward to give the tongue muscles to alternate resistance, so that the active and antagonistic muscles of the tongue muscles can be balanced to make the tongue movement stable. Light touch method: When the child is made to pout and grin random movements, the speech therapist can use the finger to lightly touch the lips of the mouth or lightly touch the two cheeks of the child with the finger, which can inhibit its involuntary movements, relieve the lip and mouth twitching, and gradually achieve the ability to self-control.
Pronunciation training
Individuals with dysarthria vary greatly and should be analyzed on a case-by-case basis, and training plans should be developed with both immediate and long-term goals. The training should be in accordance with the laws of language development, and with the visual, auditory, tactile and other functions closely, using the child has been able to sound, starting with the easy to sound, such as lip b, p, m line, and then more difficult sound training, such as soft palate k, g, etc., alveolar and lingual-dental sounds t, d, n, etc.. You can also train to pronounce vowels such as a, u, etc., then train to pronounce consonants such as b, p, m, etc., and then combine the acquired consonants with vowels such as ba, pa, ma, fa, etc. When training, let the child look at the trainer’s pronunciation with his eyes and imitate it repeatedly. After mastering it, then use the form of vowel + consonant + vowel, such as ama, apa, etc. to continue the training, and finally over to the practice of words and sentences. In the training of language clarity, but also pay attention to the volume, tone and rhyme control.
Vocalization training: first pronounce bilabial sounds p, b, m. When pronouncing bilabial sounds, the child can listen to the sounds issued by the trainer through visual and auditory effects, look at the mouth shape of the trainer’s pronunciation with his eyes, and imitate it repeatedly. During the training, we constantly encourage the practice of opening and closing the mouth and lips, which is required to reach more than 3~4 times per second. If the above requirements are not met, the language trainer can help the child to close the lips with his fingers to help pronunciation.
The child can be placed in a supine position with legs bent toward the chest, slightly backward or sitting on a chair with a backrest, head slightly backward and torso slightly backward, and the therapist can use fingers to lightly press the tongue root or tongue depressor to restrict the tongue tip from touching the palate or use fingers to lightly press the tongue root at the lower jaw, while encouraging the child to pronounce, when the fingers or tongue depressor are removed from the tongue root. When the finger or tongue depressor is removed from the root of the tongue, the k and g sounds are produced.
Finally, the training of alveolar and lingual-alveolar sounds t, d, n. The posture of the child is very important during the training. The child can be placed in a supine position with the limbs stretched out and the therapist holding the child’s head up and slightly bending forward; or the child can be placed in a prone position with both elbows supporting the child, making the head bend forward or the head and trunk in a straight line; or the child can be placed in a sitting position with both hands supporting the trunk and the head slightly bending forward. In any case, no matter which position is taken, the head must be flexed forward, and when the head is flexed forward, the lower jaw is pressed from the bottom to the top, so that the lower jaw is pushed upward passively. Pronunciation training starts with bilabial sounds, such as p, b, m, then combined with vowels to form pa, ba, ma, and finally vowels, consonants, and vowels combined to form apa, aba, ama, etc., gradually transitioning to words and sentences or short texts.
Sustained pronunciation: Take a breath when constructing sound training, prolong the pronunciation time as much as possible, transition from a single vowel to 2~3 vowels, gradually increase, practice repeatedly and sustain pronunciation. Ask the child to do cheek puffing, blowing, inhalation and exhalation during the training, which is helpful for pronunciation.
Do training to overcome nasal sounds: children with motor disorders can’t close the pharyngeal palate when pronouncing due to the weakened movement of soft palate, and pronounce non-nasal sounds as nasal sounds, which nasalized constructions obviously affect the clarity of speech and difficult to hear clearly, and affect the communication of language. Therefore, it is necessary to do training to overcome nasalization when training children with motor disorders. The method is to guide the airflow through the mouth, such as blowing a flute, blowing a candle, blowing a trumpet, or training the child to force the “ah” sound or “card” sound, which can promote the soft palate muscle contraction and uplift, enhance the soft palate muscle tension and motor function, to promote the normal closure of the pharyngeal palate This will help the child to overcome nasal sounds.
Train the child to control the volume, tone and rhythm: children with motor disorders, due to motor dysarthria, the volume of pronunciation is small, the tone is low, there is no accent change, lack of intonation change, so we should train the child to control the volume, change the volume, such as from small to large, from large to small, a large and a small alternately, expand the range of tones, from low, medium and high three different tones for training. At the same time, we can use voice-activated toys, electronic piano, piano, etc. to adjust the volume and pitch, and to develop a certain sense of rhythm, we can use a metronome to adjust the rhythm of pronunciation.
2.Training treatment of language delay
Types of delayed language development.
Language symbol disorder: mainly because the child has not mastered the language symbols, the purpose of training is to make the child master the language symbols through various language symbols, gestures, children’s language, to establish the basis of interpersonal communication, and then do the training of understanding symbols.
Language expression disorder: The child cannot express his or her will in language. The purpose of training for this part of the child should be to express the goal, and the training should be matched with the ability to understand language, and there should be field training of sign language and language, so that the child can acquire the ability to express language.
Language level lags behind that of children of the same age: this part of children with motor disorders account for the majority of children with motor disorders, showing language level lags behind, symbol comprehension disorder and expression disorder, so we should strengthen training, strengthen language comprehension and expression ability, and promote language development.
Comprehension of language symbols but not expression: The goal of training for this group of children is to improve the ability to express language on the basis of strengthening language understanding, starting with sign language training, followed by expression training.
Language communication attitude disorder: this part of the patients can understand language symbols, have some ability to express, but have communication attitude disorder, withdrawn, afraid of people, can not communicate with others, training should focus on the communication attitude work.
Most of the children with delayed speech and language are also lagging behind or have varying degrees of impairment in the motor function of the whole body, so it is important to do speech therapy training along with physiotherapy and occupational therapy training to help children with delayed speech and language.
Training for delayed speech and language
The training of children with language delay must be based on a specific rehabilitation plan and training method according to the child’s stage. In training, attention should be paid to two-way development, i.e., expanding horizontally and then improving vertically. For example, learning to say the nouns “hat”, “glove”, “pants”, etc., horizontal development, and further increase the vocabulary “yellow hat “, “red gloves”, “blue pants” to improve vertically.
Play therapy: For younger children with motor disabilities, attention should be paid to learning language in the process of play, adding different game content at different developmental stages, so that children with disabilities can apply their learned vocabulary and phrases during play to promote the development of communication behavior.
Training of gesture symbols: Gesture symbols are symbols that use one’s own gestures as a gesture of certain meaning, through which one can express one’s will and communicate with others non-verbally. Children with moderate or severe language developmental delays or children who have not mastered language symbols and children who have difficulty expressing themselves can use sign language as an introduction to expression training and gradually transition to the goal of expressing themselves in early childhood language and spoken language.
Word training: Normal children’s word learning is based on a comprehensive mastery of language. However, for children with language delays who have difficulty learning speech, it is a very effective learning method if written symbols are used as a medium for the formation of language behavior. In addition it can be used as a substitute for speech. Word training is appropriate for: children with delays in both comprehension and expression; children who understand speech well but have difficulty expressing it; and children who have both of these reasons as well as dysarthria and poor speech intelligibility. The sequence of word training is the identification of word shape → the combination of word symbols and meaning → the combination of word symbols and sound → the combination of word symbols and meaning, sound and constructive correspondence.
Communication training: Communication training does not require special teaching materials, but mainly involves the selection of appropriate training programs according to the child’s developmental level. Communication training should be conducted not only in the training room, but also at home and in the community. The child should be helped to participate in family and social activities as much as possible, encouraged to play with other children, and encouraged to do the same activities as other children. Enhance his ability of social interaction. Be careful not to limit the means of expression to language only, but to make full use of gestural language, expressions and other casual movements that may be utilized. As the ability to communicate in daily life improves, it will greatly promote the development of language and prepare the child to be able to enter society in the future.
3. Precautions for speech therapy
Language training should be conducted in a soundproof and sound-absorbing language training room, which should be quiet, spacious and safe. The room should avoid visual distractions as much as possible and should not have any apparatus unrelated to training to avoid affecting the child’s attention. The training method should be a combination of one-on-one training or group training, and a combination of professional training and family training: the color of the training utensils should be fresh to arouse the child’s interest and make it easy to accept the treatment. The more frequent and longer the training, the greater the effect, but according to the child’s ability to accept it. The training time is usually in the morning when the child is more focused, and should be done one hour after waking up and 30 minutes after meals, for 30 ~ 60 minutes, once a day, and attention should be paid to the child’s reaction during training.
2.1.1.1, SUT ultrasonic scanning cerebrovascular therapy: with the help of the mechanical, thermal and physicochemical effects of ultrasound to cause local tissue
intracellular material movement, make the cells subject to microscopic massage, increase the temperature on the tissue dividing surface, enhance the biofilm diffusion process, change the membrane potential, enhance the ion and colloid permeability, promote blood circulation, soften the tissue, stimulate the cell function, accelerate the chemical reaction, strengthen the metabolism, affect the function of enzymes and biochemical substance content, and change the PH value of the tissue; thus effectively play a role in reducing blood lipids, making the atherosclerotic This can effectively lower blood lipids, ablate atherosclerosis, enhance the efficacy of thrombolytic drugs, dilate blood vessels, accelerate blood flow, improve blood circulation, facilitate the establishment of collateral circulation in ischemic areas, maintain the normal excitatory function of peripheral neurons, and accelerate the recovery of limb function.
2.1.1.2. Cerebellopontine nucleus stimulation therapy instrument: using bioinformatics simulation technology and computer software technology to synthesize pulse combination wave
The mechanism is that the intrinsic nerve conduction pathways in the brain are subjected to specific electrical stimulation, which will affect the cerebral circulation and cerebrovascular auto-regulation function and improve cerebral blood flow rCBF,.
2.1.2. See the section on rehabilitation of motor disorders for sensory integration training.
2.2. Traditional medical rehabilitation
2.2.1. Brain-awakening acupuncture
Method: First, stab the bilateral Neiguan, using a combination of lifting and twisting the laxative method, apply the technique for 1 minute, then stab the Yintang acupuncture point, light bird pecking technique, to the degree of tears or wet eyes, followed by stabbing the Shangxing acupuncture point, along the skin through the stabbing to the Baihui point, the needle handle rotates 90 degrees, rotation speed 100-120 rpm, about 1 minute, then stab the Sanyinjiao, into the needle 0.5-1 inch, using lifting and plugging the tonic method.
For cognitive disorders, use Si Shen Cong; for dysarthria, use Lian Quan, Feng Chi, Cataract, and Language Gate; for delayed speech development, use Mute Gate, Shen Men, and Tong Li.
Effects: According to TCM theory, this disease is caused by congenital deficiency of fetal endowment, deficiency of liver and kidney, void of medulla oblongata, and the absence of the spirit to guide the qi. The Governor Vessel is the sea of the Yang Vessel and is closely related to the brain and the viscera. Yin Tang is an extra-meridian point, belongs to the head and is located on the Directing Vessel, and has the function of awakening the mind and clearing the orifices. The Shangxing point is located on the head and is unified with the Baihui, which is the rendezvous point of the Sanyang meridian, the Liver meridian, and the Governor’s meridian. The Directing Vessel travels into the brain, and the upward reversal coincides with the Liver meridian, and the Directing Vessel is connected to the Ren Vessel, which has the same origin as the Chong Vessel. Therefore, acupuncture on the star through the hundredth session can regulate yin and yang, calm the liver and calm the wind, fill the essence and replenish the marrow, benefit the qi and nourish the blood, awaken the spirit and open the orifice.
The Nei Guan point is one of the eight rendezvous points and is connected to the Yin Wei, which is a ligament point of the sympathetic Yin pericardium meridian and has the function of nourishing the heart and calming the mind and unblocking the Qi and blood. Sanyinjiao is the intersection of the Foot Taiyin Spleen meridian, the Foot Convulsive Yin Liver meridian, and the Foot Shao Yin Kidney meridian. This point has the function of nourishing the kidneys, nourishing the yin and generating marrow, and generating marrow to awaken the brain. Sishencong can strengthen the brain and enlighten the intellect, Lianquan has the function of opening the pharynx and opening the voice, with Mute Gate opening the voice and awakening the brain, which is effective for swallowing difficulties, tongue shrinkage and salivation, strong tongue and inarticulate voice. The combined use of the points, together with the awakening of the mind and open the orifices, the brain and educational function. On the basis of language training, it can improve the child’s dysarthria as well as improve the child’s cognitive level.
This acupuncture method can also improve cerebral microcirculation, promote brain cell repair, dilate cerebral blood vessels, increase cerebral blood flow, improve the nutritional metabolism of brain tissue, and promote the functional compensation of central nerve cells. In order to achieve the motor coordination recovery of muscle groups related to motor diction, there is a significant improvement in the articulation of language.
Course of treatment and precautions: acupuncture every other day, 10 times per acupuncture, rest 10 – 15 days, a total of 30 times a course of treatment.
Those who are weak and 2-3 years old usually do not keep the needles, and those who are 3.1-7 years old keep the needles for 30 minutes.
2.2.2. Traditional Chinese medicine treatment.
2.2.2.1.Musk injection
Main ingredients: musk, ice chips.
Functional effects: Promoting awakening, antispasmodic, aromatic and enlightening.
Usage: static point, acupoint injection, intramuscular injection.
2.2.2.2, speech delay rehabilitation punch (Shi Chang Pu Wan plus or minus)
Main ingredients: Astragalus, Radix Codonopsis, Fructus, Fructus, Shi Chang Pu, Fu Shen, etc.
Effects: Nourishing the blood and nourishing the heart, enlightening and opening the mind.
2.2.3, Ear acupuncture point therapy: that is, auricular acupoint stimulation therapy, is part of the external treatment methods of Chinese medicine.
Commonly used are auricular point massage, auricular point pressure, auricular point paste, auricular point magnetic method.
Selected areas: brainstem, Shen Men, heart, liver, kidney, spleen, subcortical, brain points, etc.
2.2.4, perioral massage.
Select Lianquan, Diquan, Buccal car, cataract and other points for point pressure.