An integrated approach to the treatment of stuttering. Stuttering correction techniques Speech impairment and their correction during stuttering
Introduction
2. Ways to overcome stuttering in preschoolers
2.1 Prevention of stuttering
2.2 An integrated medical and pedagogical approach to overcoming stuttering
Conclusion
Bibliography
Introduction
Stuttering is a common speech disorder. It occurs in young children during the period of the most active formation of their speech and personality, and further impedes the development of many of the child's personal characteristics, complicates his social adaptation.
Since stuttering is closely related to the emerging personality, it should be considered in the structure of personality traits and its activities. This position is based on the fact that during stuttering, personality development occurs in cramped conditions and this often leads to its deformation.
The human personality is a set of social relations, manifests itself in communication and joint activities with other people. In some stuttering social, relations are broken due to the developed stuttering, in others they are not even formed. The study of the degree of sociability, imitation, independence, activity of stuttering children, the nature of their play activity testifies to the disharmonious development of the personality of the stuttering child. It is expressed mainly in the uneven now slowed down, then accelerated development of individual aspects of the personality. Therefore, we should talk about stuttering as a complex symptom complex of dysontogenesis.
Stuttering usually occurs during a period of intensive speech development, most often at the age of 2-5 years, when the child begins to speak in phrases. Moreover, stuttering occurs in boys 4 times more often than in girls. If even a slight stuttering appears, which after a while has passed by itself, subsequent relapses are possible, especially pronounced during critical periods of development (at 6-7 years of age and puberty).
In recent years, in the most developed countries, there has been an increase in the frequency of stuttering in children, which is associated with the rapid introduction into everyday life of electronic media, video games, which unleash huge amounts of audiovisual data on the fragile nervous system of a child.
Therefore, it is so important to identify the causes of stuttering in time and start treating it. Recognizing the need for a comprehensive impact on a stuttering child, it is important to emphasize the importance of a differentiated approach in the development, re-education of the personality and speech of the stutter.
1. Stuttering, its causes and manifestations
Stuttering is usually attributed to violations of the tempo and rhythm of speech, caused by cramps of the muscles of the speech apparatus in the process of speech. In a person suffering from stuttering, such cramps can occur in the muscles of the tongue, then in the muscles of the lips, then in the area of the vocal cords or in the muscles of the respiratory apparatus. This leads to periodic "stuck" on individual sounds, and hence to a violation of the correct alternation of stressed and unstressed syllables, that is, the speech rhythm. The tempo of speech during stuttering is characterized by unevenness: either it slows down sharply due to interruption of speech by spasms of the speech muscles, then some segments of speech in the intervals between seizures are pronounced at an accelerated rate (while it is "going").
Stuttering in children develops in close interaction with personality and behavioral disorders and largely depends on the neuropsychic state of the child, which causes complex symptoms and speech disorders proper. Changes in the neuropsychic state of children are often associated not only, and sometimes not so much with the emerging stuttering, but with the peculiarities of the development of the individual. Speech disorder, as a rule, only exacerbates the manifestation of those developmental abnormalities that the child has already had or has been outlined. Defects of upbringing, uneven attitude towards the child (sometimes they caress him, sometimes they scold him excessively for the slightest offense), conflict situations in the family, etc. sometimes lead to stuttering imitation of the incorrect speech of parents or one of the relatives.
The severity of stuttering is usually determined by the state of speech of the stuttering. This is not enough. It is necessary to take into account the nature of communication, behavior in activities and consider the severity of the defect as follows. Easy degree - children freely enter into communication in any situations with strangers, participate in a collective game, in all types of activities, carry out assignments related to the need for verbal communication. Convulsions are observed only in independent speech. Medium - children have difficulty communicating in new and significant situations for them, in the presence of unfamiliar people, they refuse to participate in collective games with their peers. Convulsions are observed in various parts of the speech apparatus, during independent, question-and-answer and reflected speech. Severe degree - stuttering is expressed in all communication situations, complicates speech communication and collective activity of children, distorts the manifestation of behavioral reactions.
The causes of stuttering are conventionally divided into two large groups - predisposing, or distant, and producing, or closest.
The first group of reasons, as the name itself shows, does not yet cause stuttering, but only predisposes to it. Such a predisposing role can be played by the following factors unfavorable for speech development.
1. Burdened heredity (the presence of stuttering in parents, various neuropsychic and other chronic diseases, initially causing some weakening of the child's nervous system). The child's genetic code may contain pathological features of the motor sphere and certain personality traits (accentuations), which, under unfavorable conditions, can lead to stuttering. The incidence of stuttering in siblings is 18%. Moreover, in dizygotic twins, stuttering occurs in 32%, and in monozygotic twins - in 77%. For stuttering men, the percentage of stuttering sons is 22%, and for daughters - 9%, and for women - 36% and 17%, respectively.
2. Complicated course of pregnancy and childbirth in the mother, which may further adversely affect the state of the child's nervous system - cause its instability to various kinds of adverse effects. Such diseases as schizophrenia, tuberculosis, syphilis, etc., harmful chemical factors of production, increased radioactivity in many cases affect the nervous system of an unborn child first of all.
3. Severe or frequently recurring somatic diseases of an early age, which have a depleting effect on the nervous system and reduce its resistance to adverse external influences.
4. Lagging child in speech development, which can further complicate the already difficult period of mastering phrasal speech and thereby significantly increase the likelihood of stuttering. This is especially the case for nervously impaired children;
5. Overloading with speech material, too early learning of complex poems with the subsequent demonstration of "achievements", is unbearable for the still immature speech apparatus of the child.
6. Nervous, restless atmosphere in the family, wrong educational methods, due to which the child is in constant nervous tension.
All of these and many other unfavorable factors to one degree or another weaken the child's nervous system and make it less stable, more vulnerable. This is precisely their predisposing role. Now, just a small external push is enough - and a breakdown will occur, which can result in a variety of neurotic disorders, including stuttering. But while it has not yet come, much can be done in relation to its prevention. This should never be forgotten, and it would be extremely unforgivable to miss such an opportunity.
Another group of reasons, the so-called producing ones, already directly cause stuttering, as it were, "produce" it. These reasons play the role of an immediate push. They are extremely diverse, so we will name just a few of them for example.
1. The action of the so-called super-strong stimulus, which in everyday life is often called "fright". The concept of "super-strength" of a stimulus is very relative and in each case depends on the degree of weakening of the child's nervous system and the characteristics of his upbringing. One of the most common external producing causes of stuttering is acute trauma from domestic or wild animals, natural disasters, disasters, entertainment, family quarrels, physical trauma, and medical manipulation.
During the functioning of the nervous system, two main nervous processes constantly interact in it - excitation and inhibition, which are normally well balanced and can freely replace each other. A constant change of excitement and inhibition occurs during speech. Under the action of a "superstrong" stimulus, there is a sharp overstrain of the excitatory process, leading to disruption of the normal interaction between excitation and inhibition. One of the manifestations of this disorder is the occurrence of stuttering.
Now let's imagine a specific life situation. A small group of children are returning from school. Suddenly, a big dog rushes at them, Everyone was frightened to one degree or another, but after that only one child began to stutter. This is exactly the child in relation to whom the predisposing causes of stuttering had already worked, due to which the stimulus, which was relatively painlessly perceived by all other children for this child, turned out to be super-strong and played the role of "the last drop".
Both adults and children face the problem of stuttering. Regardless of age, this defect in diction causes a lot of discomfort and inconvenience. Children often become the subject of ridicule by their classmates, receive poor marks for oral answers in class. For adults, a lack of speech can be a career barrier. The methods described below, aimed at treating stuttering in both adults and children, include psychological work and special exercises.
Causes of stuttering
The repetition of the same sounds or whole syllables is nothing more than a spasm during the work of the articulatory apparatus. Involuntary contractions occur during an attempt to pronounce certain words. Speech therapists have been researching the phenomenon of stuttering for many years.
The main reasons are named as follows:
- Childhood injuries during the period of active development of speech - from one to three years. A child's stuttering can be associated with really terrible events - the death of a relative, a serious illness, but sometimes it occurs due to a coincidence of circumstances. For example, if a baby at this age is frightened by a large dog or even the screams of mom or dad.
- Biological reasons that may be associated with stuttering in a child include diseases of the brain, nervous system. Meningitis suffered in childhood, intracranial pressure, head blows - all this refers to organic prerequisites. This type of stuttering is the hardest to deal with.
- Neurotic experiences associated with the process of speech. Such children or adults can talk quite normally in "ordinary" life, but start to stutter in responsible situations when it is required to speak, speak in public. Logoneurosis has no "age", stuttering in an adult of this type occurs most often.
Doctors say that men are more likely to suffer from this lack of speech than women, linking the predisposition to the peculiarity of the functions of the nervous system and brain. Speech therapists also highlight "disguised" stuttering, when a person does not swallow syllables and does not repeat them, but inserts meaningless interjections into speech - "uh-uh", "khem" and others. An adult's stuttering is often masked by these phonetic pauses, which is why speech also does not become more beautiful.
Stuttering Center "Prichal"
The method of eliminating stuttering of the Center "Prichal" (patent No. 2497555) of the city of the federal resort of Belokurikha has proved to be highly effective and efficient. It is there, the basis is the psychological work with the patient to destroy the existing reflexes and habits in the production of speech. Stuttering, according to the authors of the method, is a "speech injury" accompanied by difficulty in speech movements.
The process of training at the Prichal Stuttering Center is built so harmoniously that it allows for a relatively short period of time, 10-12 days, to harmonize and regulate metabolic processes in the nervous and respiratory systems, vocal and articulatory apparatus. Due to systematic and daily activities, stuttering disappears like a bad habit. A new program for a calm speech is formed and fixed at the subconscious level.
The advantage of the Prichal Center is its location. Clean mountain air, unique mineral water, an atmosphere of benevolence, tranquility, the possibility of receiving (recommended) the PRAK procedure (program of resonant-acoustic vibrations), allow patients to deeply concentrate and concentrate, and as a result, get a healthy, calm, reliable and confident Speech !! !
This simple, unique and effective course is a must for people with stuttering, regardless of age. And there are many of them in our country (2% of the population).
How to cure stuttering in adults
Situational stuttering can occur even in a perfectly healthy person. However, before getting rid of the symptom, it is necessary to determine the cause of the problem. If it is associated with organic disorders, then the ways to cure stuttering will be alone, aimed at eliminating biological causes. With a different etiology, psychotherapy will be more effective.
The following violations must be excluded:
- stroke and its consequences;
- encephalitis, complications of the disease;
- oral pathology - for example, cleft lip;
- neurological disorders.
How to get rid of stuttering in adults, if one of the diseases or its consequences is found, will be determined by the attending physician. Prescribed drugs, physiotherapy, special exercises. Some of them can be used by people without organic pathologies. Only therapy and self-therapy, aimed at combating neuroses, relieve psychological problems.
Stuttering exercises
Can stuttering be cured at home? Yes, especially if we are not talking about serious pathological changes. Non-drug and psychological techniques, exercises will tell you whether stuttering can be cured without referring to speech therapists.
1. Respiratory gymnastics
Breathing exercises are useful for anyone who wants to know how to cure stuttering at home. The technique is simple, it can be performed by a child and an adult:
- In a sitting position, lower your head slightly forward, inhale deeply through your nose, exhale through your mouth. Repeat 10-15 times. The inhalation should be as fast as possible, and the exhalation should be slow.
- While standing, turn your head on its axis. The body should remain relaxed, arms at the seams, legs apart in a comfortable position. Repeat up to twenty times.
- Sit on a hard surface, close your eyes and breathe, trying to push air forcefully into the diaphragm and back.
Breathing work helps to correct the diction defect by strengthening the muscles of the oral cavity. This is one of the key points in how to cure stuttering. Strong muscles are less prone to spasms, and this also applies to the articulatory muscles.
2. Rehearsals in front of the mirror
The psychological trick used by actors and other people who work professionally with speech will help stutterers too. How to cure stuttering with rehearsals? It's very simple: recite poetry aloud, read books, rehearse speeches. Gradually, your speech will become smoother.
3. Meditation
Like any neurosis, stuttering manifests itself in moments of emotional excitement, equally in children and adults. Understanding this feature will help you understand how to learn to relax or teach your child in the face of a potentially traumatic situation. Meditation practices will help you focus on the meaning of the speech and not on the speech impediment.
4. Aromatic oils
Herbal medicine will help you calm down. Lavender, thyme, and sage are recommended as mild sedatives to help stop the anxiety of having to talk. Additionally, you can drink a cup of mint tea, which also has a harmless soothing effect.
5. Silence
When treating stuttering, it is necessary to maintain a speech regime so as not to overload the muscles of the mouth and larynx. It is advisable to be silent for most of the day. For children, you can come up with special play situations, for example, to portray fish.
6. Massage
Treatments with a specialist or self-massage of the neck and throat area will help relieve and prevent spasms. Movements should be soft, smooth, aimed at maximizing the relaxation of the articulatory apparatus.
Speech defects can ruin the life of both the child and the adult. It is better to show babies with stuttering problems to a specialist as soon as negative symptoms appear. An adult can also see a psychotherapist and neurologist. And exercises used at home will be useful in any case.
Watch the video in which Elena Malysheva, in the program "Health", on the first channel, tells how to cure stuttering
Stuttering is a speech disorder that is expressed in involuntary stops of the speech flow, repetition of syllables, words and individual sounds. The disease manifests itself in a mild (when it is barely noticeable to others) and in a severe form (when a person makes great efforts to pronounce the right word). There are many ways to treat stuttering today.
TREATMENT WITH TABLETS
This method is based on the intake of anticonvulsants and tranquilizers that inhibit the psyche. One of these drugs is Phenibut. Scientists are now opposed to drug treatment for stuttering, as such drugs cause serious side effects. In patients, concentration of attention decreases, rapid weight gain occurs, and with prolonged use, drowsiness, nausea, allergic reactions, headaches, irritability were noted. In addition, after the abolition of drugs, stuttering returns.
COMPUTER PROGRAMS
The essence of the method is in the synchronization of the human speech and auditory centers. The patient speaks into the microphone, and the Speech corrector software automatically delays speech for a fraction of a second. Thus, a person who hears his own voice with some delay tries to adapt to it. His speech becomes smooth and continuous. The developers claim that this program reduces speech impairment by 70-80%, and with regular exercise, it completely eradicates it. However, we note that a person using such programs only develops a habit of fluent and calm speech. Although for many, this is enough to get rid of stuttering.
One of the most popular computer programs for stuttering treatment today is Demosthenes-07. The computer creates certain situations that arise during communication: criticism, discontent, anger, objection, and so on. The person is invited to answer into the microphone to the "call" of the program. After that, the machine evaluates how you coped with your task, and suggests what needs to be improved.
The person transfers the developed skills to the real world, where he will no longer have problems with speech in such situations
METHOD OF PROFESSOR ANDRONOVA-HARUTYUNYAN
The essence of the method is to synchronize a person's speech with the movements of the fingers of the leading hand. This is easy to imagine if you remember that we all gesture during a conversation.
The hand does not interfere with the conversation, but, on the contrary, becomes a kind of support for the stutterer. It does not allow a person to stutter, "moving" his speech forward.
Place your leading hand on your knee. The fingers are slightly bent, as if you were playing the piano. When pronouncing the first syllable of the phrase, press your thumb to your knee. Do not let go of it until the end of the phrase or word. Separate each next syllable by pressing the following fingers: index, middle, and so on.
Hand movements determine the tempo and rhythm of speech, due to this, the tempo of speech slows down. It may be intimidating at first, but soon you will see its advantages: speech becomes free and fluent, without stuttering.
A person will depend on the hand only for the first time. The technique is structured in such a way that soon he simply will not need it. You just need to practice more.
The most ancient method is considered to be the method used by Demosthenes. He spoke words and phrases, typing small rounded pebbles into his mouth.
HOW TO CONDUCT YOURSELF WITH STUFFING PEOPLE
When speaking, it is better to pay attention to what they are saying, rather than how they say. Speak a little more slowly, with pauses. Be relaxed and calm.
Don't look away if they falter. But at the same time, you don't need to look too closely at them.
Don't interrupt or finish a sentence for them. You don't need to tell them “speak slower”, “relax”, “catch your breath” - this does not help. This often only increases stress and increases stuttering.
11 RULES OF FLOORING SPEECH
1. Speak slowly and calmly, that is, pronounce syllable by syllable, word by word, sentence by sentence.
2. Always make it clear to yourself what and how you will speak.
3. Don't speak too loudly or too quietly.
4. When talking, stand or sit upright.
5. Before you start speaking, breathe in quickly and deeply through your mouth.
6. Spend your breath sparingly. During the conversation, try to hold your breath as much as possible.
8. Never click on consonants; if necessary, speak below your usual tone and stretch all vowels somewhat.
9. When a word begins with a vowel, start it quietly and in a slightly lowered tone.
10. Stretch the first vowels in a sentence for a long time and link all the words of the sentence together, as if the whole sentence is one polysyllabic word.
11. Always try to speak clearly and euphoniously.
REMINDER FOR TEACHERS
It is necessary to treat such babies with special sensitivity, in no case focus on the defects of their speech and make sure that other children do not do this - they are not teased.
It is useful to combine them in games with good-speaking children so that, by imitating them, the little ones learn to pronounce the words correctly.
You should ask stuttering children only after the answers of other children and, in case of difficulty, help them pronounce the first phrase or word.
Do not allow watching TV for a long time, especially before bed. This is not only harmful to the eyes, but also overexcites the child. For the same reasons, excessive interest in computer games is undesirable.
You cannot indulge all the whims of children. Refusal to fulfill the next "want" can turn into a mental trauma - a reasonable restriction is required here.
Stuttering is often nervous in nature, which means that soothing herbal preparations can be of significant help.
You should not intimidate the child with punishment, leave him alone in a room, moreover, dark.
You can imperceptibly help the child to change the manner of speech, for this, try to speak less yourself and slowly, in short and understandable phrases, using simple words familiar to the child. Your speech should be clear, clear, concise.
Think about how to organize your life together with your child so that he does not need to be rushed. Your task is to teach your child to speak more slowly. And it becomes completely impossible when you start rushing and rushing the child, making his life even more stressful.
Playing with sand and water greatly strengthens the nervous system. Probably all children love playing with water, they can launch boats for hours, pour water, just watch how it flows.
Breathing exercises
One of the most famous programs related to the traditional method of treatment is Strelnikova's breathing exercises. Well, a person engaged in singing never experiences problems with speech. His voice is free and natural. Here are some effective exercises.
We chant
Take some text, start reading it aloud, observing the following technology: a smooth inhalation, a slight breath holding, a smooth exhalation. The essence of this technique is that you begin to speak after the exhalation has begun, you speak without straining, slowly and slowly. As soon as you feel that the air is almost running out, take a short hold of your breath, then inhale again, start talking again, just as slowly, freely. If you feel a certain difficulty in this technique, remember your favorite not very fast motive. And rearrange the entire text on it: while reading the texts in a chant, watch your breath. Try not to worry or rush.
Chanting is only a small fraction of a very large proportion of the practice.
You can do this breathing exercise: stand up straight, bend forward and relax your arms and neck so that your head hangs, as it were. Take a deep breath with a sound that sounds like inhaling a scent, then begin to straighten up, but not completely. Take a regular breath. Repeat the exercise 8 more times from the beginning. Take a short break and repeat all over again. It is recommended to carry out 12 approaches, but you are not in a hurry, increase the load gradually.
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Introduction
Chapter 1. Theoretical aspects of studying stuttering and methods of its elimination
1.1 The concept of stuttering, phenomenology and etiology of stuttering
1.2 Study of anxiety and self-esteem in the structure of stuttering in adolescents and adults
1.4 Art therapy technologies in the system of complex elimination of stuttering in adolescents and adults
Chapter 2. Organization, methods and results of experimental research of speech and personality disorders during stuttering in adolescents and adults
2.1 Organization of experimental research
2.2 Methods of experimental research
2.3 Results of the ascertaining stage of the experimental study
3.2 Results of the control section of the experimental study
Conclusion
Bibliographic list
Introduction
stuttering anxiety sensory relaxation
Stuttering is one of the most common and difficult to overcome speech disorders with a complex combined structure of speech (convulsive) and non-speech (psychophysiological) manifestations.
Various approaches to the study and overcoming of stuttering allow us to consider this disorder from clinical (I.A. B. Khavin), psychological and pedagogical (R. E. Levina, S. A. Mironova, N. A. Cheveleva, A. V. Yastrebova and others), clinical pedagogical (L. I. Belyakova, E. V. Oganesyan, E. A. Dyakova, Yu. O. Filatova and others), neuropsychological (I. V. Danilov, T. G. Vizel, Z. G. Turovskaya, V. V. Suvorova), psycholinguophysiological (N. I. Zhinkin , I. Yu. Abeleva), speech psychocorrection (K. M. Dubrovsky, Yu. B. Nekrasova, E. Yu. Rau, V. P. Merzlyakova, O. A. Beglova, etc.) positions.
Despite the variety of approaches, most authors emphasize the connection between the speech defect proper and the personality of stuttering, describing a number of personality disorders (I. Yu. Abeleva, N. M. Asatiani, N. L. Karpova, Yu. B. Nekrasova, E. Yu. Rau, V.I.Seliverstov, V.M.Shklovsky and others). So, Yu. B. Nekrasova considers stuttering in adults as a problem of personality. In her opinion, stuttering is "suffering that summarizes three phenomena in the reverse reception of its own signals" (muscle tension, the perception of "stuttering" speech by ear and one's own defectiveness in the assessments of other people), which constantly causes and maintains acute emotional discomfort during communication , fixing itself at the level of a persistent pathological conditioned reflex.
A large role in the development of personality disorders in stuttering, according to V.I.Seliverstov, is played by the "phenomenon of fixation on a speech defect" that appears from childhood, contributing to the formation of obsessive fear of speech (logophobia) in adolescents and adults, which in turn leads to , according to V. M. Shklovsky, to the pathological mechanism of "vicious circle" in the communication of stuttering, making speech convulsiveness heavier and developing the so-called "secondary neurosis" in adults.
A number of authors describe changes in the specific personal properties of stutters, the “polar nature” of self-esteem (self-confidence regarding mental abilities and uncertainty in their speech implementation) (E. Yu. Rau). An inadequate nature of self-esteem contributes to an increase in the level of general and verbal anxiety, which can cause deceptive, defensive forms of communicative behavior with avoidance of most communicative situations. According to T. A. Boldyreva, "speech activity for adult stuttering becomes meaningful", manifesting itself in cases of speech inconsistency, in the dominance of negative emotions of stressful and frustrating origin, the basis of which is fear (E. Yu. Rau), causing, according to I. A. Povarova, anxiety-phobic disorders.
These facts actualize the need to include classes in the correctional process to relieve neuro-emotional stress.
It should be noted that emotional and muscle states are closely related, therefore, their regulation in stuttering is carried out by relieving muscle tension, using exercises to relax the muscles of the arms, legs, neck, face. (E. F. Rau, V. I. Rozhdestvenskaya, M. I. Merlis, L. M. Vinokurova, N. P. Mirovskaya, S. M. Lyubinskaya and others).
The current state of the development of art therapy and art pedagogy makes their application in the field of speech therapy especially relevant. A striking example of the introduction and use of combined technologies in the system of stuttering correction with elements of creativity (kinesio-, bibli-, fairytale, symbolic, play-, rhythm-, dance-therapeutic directions) can be considered the works of Yu. B. Nekrasova, LZ Harutyunyan , E. Yu. Rau, V. P. Merzlyakova, O. A. Beglova, E. N. Sadovnikova and others.
Thus, E. L. Pellinger, L. P. Vygodskaya, A. I. Lubenskaya and L. P. Uspenskaya proposed a relaxation technique for stuttering preschoolers through short formulas of rhymed text, accessible and easily remembered by children in the form of the game "Magic Dream".
In the modification of autogenous training (relaxation technique A.I. Lubenskaya), the main methodological techniques are the "formula of calmness" and imagotherapy, and "the onset of relaxation is recorded in the patient's muscle memory by correlating relaxation with the word." To enhance the brightness of the evoked sensations, patients are invited to imagine those situations for which the evoked sensation is characteristic (for example, when invoking warmth in the hands, the trainees are advised to imagine themselves warming their hands by the fire, in the sun).
Yu. B. Nekrasova, in her work with adult stuttering, used techniques of static and dynamic relaxation, allowing to reduce muscle tone and emotional stress, by using a "healing symbol" (a figurative formula expressing the patient's feelings, causing him to have certain mental states that program for recovery ).
In the special psychological literature on the diagnosis of self-esteem and the level of anxiety (as significant properties for the personality of stuttering), special attention was paid to adapted and author's projective techniques, the basis of which is the associative principle of diagnosis (Lusher, Jung, etc.).
Their essence lies in identifying the necessary data based on the images and perceptions of patients, relying mainly on "sensory-shaped" associations.
In this regard, a special relevance, in our opinion, the issues of the development of integrative logopsychodiagnostic and logopsychocorrection technologies in the form of a combination of psychodiagnostic, psychocorrectional and art-pedagogical methods acquire.
Hence , the object of this study are speech and personality disorders (speech self-esteem and the level of anxiety) in the structure of stuttering in adolescents and adults.
The subject of research is the process of identifying and correcting speech and personality disorders (speech self-esteem and the level of anxiety) in the structure of stuttering, by means of sensory-shaped relaxation technologies.
Due to this, the purpose of this study is aimed at identifying speech and personality (speech self-esteem and level of anxiety) disorders in the structure of stuttering in adolescents and adults and developing a program for the use of sensory-shaped relaxation technologies in the system of complex logo-psychodiagnostics and logo-psychocorrection.
In connection with the purpose , research hypothesis There is an assumption that a special role in the structure of speech and personality disorders during stuttering in adolescents and adults is played by the indicators of self-esteem and the level of anxiety manifested in speech stimuli (which must be taken into account in the system of complex logopsychodiagnostics and logopsychocorrection). These indicators have a mutual influence both on the aggravation of speech convulsiveness and on the nature of communication and socialization of the stutter in general, contributing to the formation of stereotypes of speech behavior and, motivating the stutter to avoid speech failure, instead of achieving speech success. In this regard, it is advisable to develop such combined technologies of corrective action, which, in the system for eliminating stuttering, could have an indirect effect on the above-mentioned personal properties by developing "sanogenic" speech and psychoemotional states in the process of using special types of relaxation with elements of sensory-shaped art therapy ...
To achieve this goal and test the hypothesis, it is necessary to solve the following tasks:
Conduct a theoretical analysis of scientific and methodological literature on this topic.
Identify speech (convulsive) disorders in the structure according to the data of speech therapy examination.
To conduct a study of personal manifestations (speech self-esteem and level of anxiety) in the structure of stuttering of adolescents and adults of the experimental group according to the data of special psychodiagnostic techniques, as well as diary entries and video materials.
To develop special types of technologies for logo-psychodiagnostics of speech and personal manifestations (speech self-assessment and level of anxiety) in the structure of stuttering in adolescents and adults of the experimental group using technologies of sensory-shaped associations in a playful way.
To develop a program for the use of sensory relaxation technologies in the system of complex logopsychodiagnostics and logopsychocorrection using technologies of sensory-shaped associations in a playful way.
To test a program for the use of sensory relaxation technologies in the system of complex logopsychodiagnostics and logopsychocorrection using technologies of sensory-shaped associations in a playful way, followed by analysis of data from the control experimental section of the study.
The work used the following methods:
theoretical analysis of scientific and methodological literature;
ascertaining experimental research using the methods of speech therapy examination and other special psychodiagnostic techniques;
control and comparative analysis;
qualitative and quantitative interpretation of benchmarking data collected by different methods.
Structure of this work was presented with all the necessary sections: introduction, 3 chapters, conclusion, list of used literature with 49 presented literary sources in Russian.
1. Theoretical aspects of the studystuttering and methods of its elimination
1.1 The concept of stuttering, phenomenology and etiology of stuttering
Stuttering (logoneurosis) is a violation of the tempo-rhythmic organization of speech, which are caused by the convulsive state of the muscles of the speech apparatus. This disorder refers to a disorder of the phonation of an utterance. In the psychological and pedagogical classification of speech disorders, impairment in the use of communication means. According to ICD-10 (F98.5), stuttering is characterized by “frequent repetition or prolongation of sounds or syllables or words; or frequent stops or indecision in speech, breaking its rhythmic flow. "
This speech disorder begins, as a rule, during the formation of phrasal speech and speech function in general (2-6 years). That is why Yu.A. Florenskaya and some other researchers call it evolutionary stuttering or developmental stuttering. If stuttering began in children before entering school, then it is considered as an independent speech pathology. If this speech pathology arose as a result of brain diseases (organic genesis) or a number of neuropsychiatric disorders, then such stuttering is called symptomatic or “secondary”.
MI Buyanov and B. 3. Drapkin proposed to differentiate stuttering into the following forms: neurotic, neurosis-like, mixed. In addition to these forms, V.M.Shklovsky notes the presence of pseudo-stuttering syndromes, imitation stuttering (imitation), and also distinguishes stuttering as a syndrome in other diseases - like polterna and cluttering. E.R.Saitbaeva says that stuttering neurotic forms have difficulties in actualizing words, since they do not know how to operate with words that are in long-term memory. In the case of a neurosis-like form of stuttering, this is due to a lack of lexical means.
As L.I.Belyakova and E.A. Dyakova write, early speech and motor development is characteristic of the neurotic form of stuttering. In this case, phrasal speech appears before speech impairment, which occurs acutely at the age of 2-6 years. As a rule, these children are sensitive and anxious. The number of convulsive stutters depends on the emotional state and the conditions of verbal communication. At 11-12 years old, logoophobia appears, a secondary determinant can become dominant. The neurotic form of stuttering may have a progressive or recurrent course, but in some cases a regreduated course is also possible due to compensation or adequate correction of the disorder.
The neurosis-like form of stuttering is characterized by a delay in speech development, a slow accumulation of vocabulary, and a violation of sound pronunciation. As a rule, stuttering of this form is not immediately detected. Stuttering convulsive by 3-4 years of age. Organic brain damage is noted, the regulatory influence is weakened from the higher departments. Motor disinhibition is revealed, higher mental functions suffer. With a neurosis-like form of stuttering, periods of fluency of speech are absent. Timely corrective assistance helps to eliminate stuttering; in its absence, stuttering becomes resistant. By drawing active attention to the speaking process, the number of stutters decreases, and physical or mental fatigue worsens speech.
Quite often, in practice, stuttering has a mixed clinical picture of stuttering.
It is believed that in the chronic course of stuttering, the difference between neurotic neurosis-like forms is erased.
There are several types of stuttering (LI Belyakova, EA Dyakova). With a regreduated type of course, the symptoms of stuttering weaken, with a progreduated type, on the contrary, it intensifies, and with a stationary type of stuttering, as a rule, the symptoms are stable and monotonous. With a recurrent type of flow, the fluency of speech is constantly changing. With the wavy type of stuttering flow, periodic fluctuations also occur, either towards improvement or towards deterioration of speech, but the complete disappearance of stuttering is not observed. According to the results of research by R.E. Levina, stuttering in children is noticeably weaker or even disappears if the child's speech is associated with visualization or with a specific situation.
The fact that alone the stutter speaks without difficulty makes it possible to assume that in stuttering a large role is played by factors of a psychological nature, associated primarily with the attitude towards oneself and other people. A vicious chain of interactions is formed: stuttering - violation of speech communication - violation of personality - aggravation of stuttering.
Stuttering in adults, as a rule, is considered one of the varieties of speech pathology, which has taken on an extremely long, essentially chronic course.
Convulsions of speech when stuttering.
Yu. O. Filatova writes that during stuttering there are features of the functional state of the area of the additional motor zone, in connection with which, the "launch" of the syllable of oral speech is disturbed, which is outwardly expressed in the form of a convulsive hesitation.
There are severe, moderate and mild seizures. Assessment of severity of muscle cramps does not always coincide with assessment of severity of stuttering, because this concept includes many factors. A slight degree of stuttering qualifies if convulsive stutters are only in spontaneous coherent speech. If stutters in monologue and dialogical forms of speech
This is a moderate degree of speech defect. In the event that the stutter stutters in all forms of speech (even in reflected form), then a severe degree is recorded.
The main symptom of stuttering is muscle cramps of the speech apparatus during oral speech. Speech cramps - an involuntary contraction of the muscles of the speech apparatus during the speech process or when trying to start speech. They have different localization, type and strength of expression.
Scientists distinguish tonic and clonic seizures.
With tonic speech cramps, an increase in muscle tone is observed, which appears violently and abruptly, and can capture several muscle groups. Acoustically, tonic spasm can be defined as a prolonged pause in speech or tense, prolonged vocalization.
Clonic speech seizures are characterized by the repetition of sounds or syllables due to the violent repeated rhythmic contraction of the muscles of the speech apparatus.
In the event that both those and other speech convulsions are often observed in the same stutter, a clono-tonic and tonoclonic type of stuttering is revealed according to the predominant nature of the seizures.
A.I. Sikorsky in 1889 in his work "On stuttering" described the classification of seizures, which is now generally accepted. Depending on the prevalence of seizures in certain organs of speech, respiratory, vocal and articulatory are distinguished. Mixed convulsions are more common.
EE Shevtsova writes in her work that seizures differ in form (tonic, clonic and mixed), in localization (respiratory, vocal, articulatory and mixed) and in frequency.
There are three forms of breathing disorders during stuttering: expiratory (convulsive exhalation), inspiratory (convulsive inhalation, sometimes with a sobbing) and respiratory (convulsive inhalation and exhalation, often with a break in the word).
In the articulatory apparatus, convulsions are distinguished - labial, lingual and soft palate. They appear more often and sharply when pronouncing explosive consonants (k, g, n, b, t, d); less often and less intensely - slotted.
According to ME Khvatsev, "overcoming stuttering is achieved by influencing not seizures, but the phenomena that cause them, and the consequences of stuttering."
Non-speech manifestations during stuttering.
Stuttering is a very heterogeneous disorder in its manifestations. It is naive to believe that it concerns only the speech function. Weakness of the regulatory mechanisms of the nervous system of stuttering, disorders of their physical health, general and speech motility, and the presence of psychological characteristics are also revealed.
Physiological symptoms include speech cramps, disorders of the central nervous system and physical health, general and speech motility. Psychological - speech stutters and other violations of expressive speech, logophobia, tricks and stuttering are convulsions during the speech act, etc.
The fundamental factor that determines the nature and complexity of the psychological characteristics of stuttering, according to V.I.Seliverstov, is fixation on one's defect, which is "a reflection of an objectively existing speech defect (speech stutters) in the entire mental activity of a stuttering person" and manifests itself in the peculiarities of interaction with a social environment.
Some defectologists have tried to explain the dynamics of stuttering only in terms of behavior. There have been studies in which subjects received positive or negative rewards depending on how much they were able to maintain their fluency. Ultimately, however, the purely behavioral approach faded into oblivion.
Non-verbal breathing of stutters is often shallow, dysrhythmic, and confused. Violation of the regulation of the respiratory function has led some scientists to believe that this is the reason for stuttering.
Accompanying movements often accompany the speech of stuttering people: someone close their eyes, someone's nose wings swell, others have individual stereotypical ritual movements, sometimes even with the whole body. Such movements are violent or are of a subtle nature. Oral speech in stuttering adolescents and adults is usually accompanied by autonomic reactions. M. Sovak examined stuttering and found out that 300 of them have autonomic nervous system dystonia in 84.6% of cases. A large number of stuttering adolescents develop logoophobia (fear of speech communication, accompanied by a fear of speech seizures).
We will talk about this in more detail later.
Etiology of stuttering
At the turn of the XVII - XVIII centuries. they tried to explain stuttering as a consequence of the imperfection of the peripheral speech apparatus.
Unfortunately, to date, no common view has been identified on the causes of stuttering. In the etiology of stuttering, a combination of exogenous and endogenous factors is noted (V. A. Gilyarovsky, M. E. Khvatsev, N. A. Vlasova, N. I. Krasnogorsky, N. P. Tyapugin, M. Zeeman, etc.). As E. A. Dyakova and L. I. Belyakova write, all researchers agree that when stuttering occurs, the following number of factors play an important role:
Child's age.
The state of the child's central nervous system.
Features of the course of speech ontogenesis.
Features of the formation of functional asymmetry of the brain.
The presence of mental trauma.
Genetic factor.
Sexual demorphism.
We propose to consider these etiological factors in more detail. A certain age of the child.
Of course, the listed etiological factors do not exhaust all the reasons that may be associated with the appearance of stuttering.
LZ Harutyunyan writes in his works that “the etiology of stuttering is associated with the emergence of a stable pathological state (UPS). The use of neurophysiological methods to combat a stable pathological state leads to the conclusion about the need for destabilization, destruction of this pathological state by erasing the corresponding matrix in long-term memory and then creating new connections that bring the disturbed processes back to normal. "
TG Wiesel speaks of "interhemispheric conflict" when the right hemispheric and left hemispheric ways of speaking (rhythmized and non-rhythmized speech) are fighting for dominance.
In the work of EE Shevtsova "Overcoming the recurrence of stuttering" the predisposing causes of stuttering are indicated. Among them are those known to us that lead not only to the development of stuttering, but also to delayed speech development, as well as pathologies in the somatic and mental spheres.
Adverse conditions include irritants that can cause a nervous breakdown and, as a result, stuttering.
L. Ya. Missulovich identified 8 main groups of psychotraumas, which are usually attributed to the productive causes. Often, stuttering appears in connection with entering school. According to R. E. Levina, “speech difficulties depend on the type of the nervous system, the conversational environment, the general and speech modes”. S. Lyapidevsky, who conducted a medical and pedagogical study of stuttering adolescents, noted in 92% of cases with a healthy physical condition, violations of the autonomic system. R. Kyung believes that the cause of stuttering is due to the abnormal discharge of the respiratory organs.
Thus, scientists have identified a whole range of conditions that contribute to the appearance of stuttering. Stuttering from the point of view of various scientific directions.
In the literature of the past, there are very diverse interpretations of the mechanisms of stuttering. At that time, there were many erroneous guesses about the etiology of stuttering, we will now consider them in more detail.
So, for example, at the turn of the 17th and 18th centuries, the Santorini anatomist looked for holes in the hard palate at the stuttering ones. He suggested that mucus seeps through these holes, gets on the tongue and makes speech more difficult. Professor Wutzer (XIX century) believed that in the lower jaw of stuttering there are some pathological depressions, in which the tip of the tongue of stutters is hidden in the process of speech. Herve de Cheguan believed that the problem of stuttering lies in the too short bridle.
According to the English physicist Arnot and the Swiss physiologist Schultess, the cause of stuttering lies in the convulsive closure of the glottis. Professor Becquerel, in turn, found that it is the excessively rapid exhalation during speech that causes stuttering in stuttering individuals.
Preacher Blume was one of the first to talk about the connection between the cause of stuttering and the "convulsive state" of the muscles of the speech apparatus. Here is how he expressed his views: “Stuttering arises because a person either thinks quickly, or, on the contrary, speech movements“ outpace the thinking process ”.
Merkel, professor of anatomy, in turn, believed that stuttering is a speech disorder that arises from the imperfection of a person's will. In his opinion, imperfect will weakens the muscles of the speech motor apparatus.
Since the twentieth century, scientists have been considering the mechanism of stuttering from different positions: clinical, physiological, neurophysiological, psychological, linguistic. In this regard, the following areas were distinguished: clinical, psychological and pedagogical, pedagogical, psycholinguophysiological, logopsychotherapeutic, clinical and psychological, neuropsychological, etc. So, at the end of the XIX-beginning of the XX century. it becomes obvious that stuttering is a complex psychophysical disorder. As MI Buyanov writes, "stuttering almost always in one way or another coexists with other neuropsychiatric disorders." Many researchers argue that the pathogenesis of stuttering, as in the case of subcortical dysarthria, is the discoordination of respiratory, vocal and articulatory processes.
LI Belyakova, a representative of the clinical and pedagogical direction, notes that in persons with a neurotic form of stuttering, the functional speech system is preserved, and against its background a pathological one is formed. With a neurosis-like form of stuttering, the functional speech system is underdeveloped or destroyed (with OHP or aphasia), stuttering cannot be suppressed by accident. Striopallidal structures of the brain are organically damaged, the regulatory mechanisms of the brain are decompensated, therefore, a pathological speech system is formed.
NI Zhinkin, M. Zeyman and VM Shklovsky (representatives of the clinical and psychological direction) believe that the mechanism of stuttering consists in a failure "between the cerebral cortex and subcortical structures." EE Shevtsova writes in her work about the dysregulation of the cortex and the activity of the striopallidal system during stuttering.
E. A. Dyakova, a representative of the psycholinguistic approach, believes that during stuttering, the process of internal programming of speech utterance, the transition from the mental to the motor level of production itself, is disturbed. At the same time, speech errors of stuttering have a different root cause depending on the form of stuttering. In the neurotic form of stuttering, they are mainly associated with the emotional state, and in the neurosis-like form, with the difficulties of inflection and word formation, as well as an insufficient volume of active vocabulary.
Representatives of the neuropsychological direction (IV Danilov, IM Cherepanov, MI Lokhov) considered stuttering from the standpoint of activity and the relationship of the right and left hemispheres. MI Lokhov in his research confirmed that in stuttering there is a violation of interhemispheric relationships. The presence of functional asymmetry of the brain in stuttering was confirmed by L.I. Belyakova, V.M. Shklovsky, M.E. Khvatsev, E.A. Dyakova, and other authors.
The representative of the psychological and pedagogical direction of stuttering GA Volkova considers stuttering as "a complex speech disorder caused by dysontogenesis of mental functions and disharmonious personality development." Research by R.V. Levina and A.V. Yastrebova prove the need to develop a planning function of speech in stuttering.
According to V.N. Myasishchev (clinical and psychological direction), some authors explain stuttering in children in childhood from the standpoint of acute disorders of higher nervous activity (reactive neurosis).
N.I. Zhinkin, the founder of the psycholinguophysiological direction, is sure that the theory of the origin of stuttering can be clarified only when the mechanism of speech is clarified. He notes the disorder of voluntary and involuntary control during stuttering. In his work "Mechanisms of speech" the author writes: "Stuttering is defined as a type of neurosis, but there is no theory of this neurosis." I.I. Tartakovsky refers stuttering to psychoneuroses known as psychosthenia and introduces the term "logoneurosis".
According to I. Yu. Abeleva (a supporter of the psycholinguo-physiological approach to the study of stuttering), "stuttering occurs at the time of the transition from internal to external speech." E. Pichon and S. Borel-Mesonny mention in their works the following: whatever the level of intelligence of a stutterer, it is difficult for them to reproduce their thoughts in linguistic form.
VP Merzlyakova and E. Yu. Rau mention in their work that Yu. B. Nekrasov, a follower of the founder of the logopsychocorrectional direction, KM Dubrovsky, considered stuttering from the standpoint of a violation of communication. Calling this speech impairment “personality suffering”, Yu. B. Nekrasova spoke about three phenomena due to which a stutter feels his speech defect and fixes this suffering: “Echo phenomenon”,
"Kinesi phenomenon" and "Mirror phenomenon". G. D. Netkachev considered stuttering as "purely mental suffering." The followers of K.M. Dubrovsky (L.Z. Andronova, B.Z.Drapkin, Yu. B. Nekrasova, NL Karpova, E. Yu. Rau, etc.) focus on the disharmonious development of the personality of stuttering and its therapeutic re-education in the process of rehabilitation.
In the methods of the logopsychotherapeutic approach presented in the works of L.Z. combining in the same methods and techniques. The rehabilitation process for stuttering is not "split" between several specialists, but is carried out by one specialist - a speech psychotherapist who has the knowledge of both a psychotherapist and a speech therapist together. The authors of the school, Yu. B. Nekrasova, in order to reeducate the speech and personality of stuttering, use a whole system of "sanogenic mental states". The leading principle of this kind of influence is the principle of logopsychodiagnostics, which combines the traditionally accepted pedagogical diagnostics aimed at studying the speech of patients and diagnosing their personal and communicative characteristics, regardless of their belonging to the clinical group (neurotic or neurosis-like type). The main task of such diagnostics is not to reveal the picture of the patient's illness, but to draw up an "internal picture of his health", according to the recommendations of Yu.B. Nekrasova. As E.N. Sadovnikov, this means that when identifying personal and communicative problems of a person, you need to focus not so much on them, but on the search and development of those personality traits that contribute, or can contribute to, the adaptation of the personality.
So, despite numerous studies aimed at studying this speech defect; on the vast knowledge available today in this area, the mechanisms of stuttering are not fully understood. There is no unambiguous theory explaining the cause of this speech disorder.
1. 2 The studyanxiety and self-esteem in adolescents and adults in pukture stuttering and normal
The concept of anxiety was first introduced by S. Kierkegaard, who wrote about the significant influence of anxiety on personality development. Anxiety is sometimes defined as generalized, vague and pointless fear, or as a condition caused not by the presence of danger, but by the inability to avoid it if it appears. A number of authors point to the need to strictly distinguish between anxiety as a mental state and as a more or less stable character trait.
N.F. Lukyanova and E.N. Lobovoy showed that the complete absence of anxiety, as well as overestimated anxiety, are among the reasons leading to the disorganization of activity. L.N. Individuals with moderate (optimal) levels of anxiety have been found to be best at controlling their mental state. While individuals with high anxiety are prone to reactions of confusion and panic under stress, low-anxious people easily fall into a sleep-like or sleepy state, their ability to self-control is sharply reduced.
Self-esteem, as defined by G.A. Self-esteem plays an important role in the organization of effective management of human behavior. The characteristics of many feelings, the attitude of the individual to self-education, and the level of aspirations depend on the characteristics of self-esteem. The formation of an objective assessment of the people around and an adequate self-assessment of one's own capabilities is an important link in the upbringing of the younger generation.
Self-esteem, according to V.N. Kunitsyna, has a number of dimensions: it can be correct or false, relatively high or low, stable or unstable. A distinctive feature of mature self-esteem is differentiated self-esteem: a person clearly recognizes and identifies those areas of life, those areas of activity in which he is strong, can achieve high results, overcome significant difficulties.
In a preschooler, the content of his ideas about himself includes a reflection of his properties, qualities, and capabilities. Data on their capabilities are accumulated gradually due to the experience of various activities, communication with adults and peers. By establishing contacts with people, comparing himself with them, comparing the results of his activities with the results of other children, the child gains new knowledge not only about another person, but also about himself.
According to A.I. Kravchenko, an adequate level of self-esteem contributes to the formation of a teenager's self-confidence, self-criticism, perseverance or excessive self-confidence, not criticality.
The ideas, on the basis of which adolescents form criteria for self-esteem, are acquired in the course of self-knowledge.
The main form of adolescent self-knowledge is comparing himself with adults and peers.
KR Sidorov believes that adolescents with a tendency to a strong overestimation of self-esteem show sufficient limitation in the types of activity and a greater focus on communication, moreover, with little content. Aggressive adolescents are characterized by extreme self-esteem (either maximally positive or maximally negative), increased anxiety and egocentrism. Teens with low self-esteem are prone to depressive tendencies. Moreover, some studies have revealed that such self-esteem precedes or is the cause of depressive reactions, while others - that the depressive affect appears first and then is incorporated into low self-esteem.
An adequate assessment of one's own characteristics, from the point of view of N.E.Shafazhinskaya, largely determines the effectiveness of activities due to conscious management and regulation of it, while inadequate self-assessment leads to the choice of the wrong strategy in performing actions, which contributes to a decrease in their effectiveness.
In adulthood, the balanced ratio of the I-real and the I-ideal changes with an increase in the significance of the I-real. A negative assessment of the real self-concept removes the ideal self-image in personal space and time.
The psychological aspect of studying the problem of stuttering and socio-rehabilitation of stuttering adults and adolescents is presented in the works of E. Frechels, G. D. Netkachev, V. M. Shklovsky, I. Yu. Abeleva, A. B. Khavin, Zh.M. Glozman, Yu. B. Nekrasova, E. Yu. Rau, V. P. Merzlyakova, N. L. Karpova and others.
E. Frechels wrote that persons with stuttering, as a rule, have more or less pronounced mental disorders. To them he attributed the fear of pronouncing certain words and sounds, thoughts about the inferiority of the whole “I”, a mental state leading to “consciousness of speech disorder”.
General and speech self-esteem of stuttering has its own characteristics. Often, along with high self-esteem, the same person with stuttering has low speech self-esteem. This is evidenced by the data of E. Yu. Rau about the "pole properties" of stuttering. Low self-esteem manifests itself in increased anxiety, constant fear of a negative opinion about oneself, increased vulnerability, prompting the stutter to reduce contacts with other people. Such self-esteem destroys hopes for a good attitude towards himself, success, and he perceives his real successes and a positive assessment of others as temporary and accidental. With an overestimated self-esteem, the patient confidently takes on work that exceeds the real possibilities.
According to V.I. Selivyorstov, the self-esteem of stuttering is directly affected by the fixation on their own defect. The more the patient pays attention to him, the more pronounced the symptoms of stuttering become. It follows from this that stuttering is a defect that affects self-esteem, the significance of which is very high in corrective work. An optimistic attitude and self-confidence favorably affect its outcome, rather than self-doubt.
According to L.I.Belyakova L.I., E. A. Dyakova, with age, stuttering appears to lack confidence in their abilities, and later develop low self-esteem and fear of verbal communication.
V.P. Merzlyakova and E. Yu. Rau talk about self-esteem in the course of activities, as the most important regulator, a kind of "trigger" of personality activity, as a factor that affects the ability to quickly and accurately respond to specific situations, necessary to predict the results of their own actions in the future. Studying the self-esteem of stuttering adolescents and adults, E. Yu. Rau and V. P. Merzlyakova came to the conclusion that speaking about stuttering, one can say about the "contradictory nature of self-esteem." . In this regard, stutters often attribute the reason for many failures not to a lack of ability or their own efforts, but to the presence of stuttering. The authors point out the need to correct self-esteem (including speech) in the system of complex treatment of stuttering. A contradictory and inadequate idea of a person about his own capabilities affects the nature of the goals that he sets for himself, leads either to their underestimation or to overestimation, which adversely affects the productivity of activity. Based on the study data, 66.1% of patients had a high level of speech anxiety. The coincidence of the level of speech and personal anxiety in the majority of stuttering may indicate that a violation of communication leads not only to the appearance of fear of verbal communication and feelings about their own speech, but also contributes to the formation of a negative personal response to the presence of a speech defect. Increased anxiety affects not only the speech sphere. It leads to disorganization of the entire personality of a person, forming a type of avoidant behavior, manifested in the desire to protect oneself from possible experiences and difficulties not only in speech, but also in non-speech situations. The inconsistency of self-esteem is explained by an inadequate attitude to one's own capabilities and a tendency to evaluate oneself through the “prism” of stuttering, regardless of its severity.
I.A.Povarova points to the presence of anxiety-phobic or situational-phobic disorders in adult stuttering, sometimes logovegetophobic syndrome, notes some features in the structure of their personality: low self-esteem, enslavement of behavior, restriction in gestures.
V.A.Kalyagin et al. Notes that the level of speech anxiety in stuttering is, on average, three times higher than in non-stuttering. Moreover, it is the speech defect that is primary, to which a certain mental reaction arises, and not "a breakdown of higher nervous activity." The predominantly high level of personal and verbal anxiety indicates the presence of not only a fear of verbal communication and worries about speech, but also the appearance of anxiety as a character trait.
With increased anxiety, stuttering tends to have logophobic disorders. As N.M. Asatiani writes, the first logoophobia occurs in the prepubescent and early puberty periods. At first, the fear of speech appears only at the moment of direct speech communication and is most pronounced in situations of special significance. Over time, logoophobia appears not only in speech situations, but also in anticipation of the upcoming speech communication. Gradually, the fear of speech becomes obsessive and arises under the influence of only one thought about the need for verbal communication or when recalling speech failures in the past.
L.A. Samoilyuk writes in his work that among the secondary symptoms of stuttering are called anxiety, avoidance of communication, distortion of self-esteem, and the psychological mechanisms formed in adolescence determine the fate of the individual. Conventionally, the author identifies 4 motivational strategies for adolescents: Leo, Tiger, Panther and Bear. (see Appendix, Fig. 2)
Lions (35% of cases) have the best indicator, they have the best prospects for compensation. Their self-esteem was adequate in half of the cases, and overestimated in 42% of cases. Leos are active in self-presentation, average level of speech anxiety is typical.
Motivation strategy Tiger was noted in 21% of cases, the indicator of adaptation in these adolescents was worse than in Lions.
Self-esteem is adequate only in 12% of cases, and underestimated in 44% of cases. In this group, psychological problems are more pronounced, indicators of primitive psychological defenses (denial) are high, externally accusing, aggressive thoughts are often found. There is a discrepancy between claims to real achievements. These adolescents are much more in need of psychological correction.
Motivational strategy Panther is less common (12%). The failure of individuals in this strategy is due to the lack of effort. The concept depends on the intellectual characteristics. Panthers are characterized by insufficient psychological maturity, and this must be taken into account in corrective work.
The last type of motivational strategy is Bear. Has a very low level of achievement and relationship motivation, self-descriptions were infantile. Low self-esteem was common (36%). Speech anxiety is pronounced or high. Self-blame and self-consolation are combined. Primitive psychological defenses are actively used by the Bears. Representatives of this group need not only correctional, but also psychotherapeutic work.
So, the psychological characteristics of stutters, which are largely due to the social situation of their development and individual characteristics of motivation, differ and require different corrective approaches.
Speaking about stuttering adolescents with low self-esteem, L.A. Samoilyuk believes that they use a wide repertoire of unconscious psychological defenses and conscious defensive feelings to compensate for this self-esteem. Conscious defensive experiences in stuttering are more important. At the same time, the lower the self-esteem, the more often self-deprecating thoughts, auto-aggression, etc. appear. It is also obvious that with low self-esteem there is a desire to get away from a traumatic situation, a teenager demonstrates the motivation to avoid failure. Projection, on the other hand, avoids the need to accept a suboptimal self-image, all of its shortcomings are attributed to others. Thus, we can conclude that most authors point to a special role in the structure of speech and personality disorders during stuttering in adolescents and adults, where self-esteem and anxiety levels play. These indicators have a mutual influence both on the aggravation of speech convulsions and on the nature of communication and socialization of the stutter in general.
1.4 Arttherapeutic technologies in the system of complex eliminationsaikania in adolescents and adults
Long-term experience of speech therapists from various practical institutions has shown that when correcting stuttering, only speech therapy techniques are not enough - a complex effect on the psyche and speech activity of the stutter is necessary. Since speech therapy stands at the junction of several sciences, the complex impact includes the use of psycho-art therapy technologies.
According to K.E. Rudestam, the widest range of forms and techniques of group psychotherapy is used for neuroses: group discussion, psychodrama, pantomime, psychogymnastics, projective drawing, music therapy, movement therapy, etc. For the first time, Yu. B wrote about group speech therapy. Nekrasov. BZ Drapkin wrote about psychotherapy in the complex treatment of stuttering in adolescents in his work.
In the process of correcting stuttering, rational and suggestive psychotherapy is used. Rational psychotherapy refers to coherent or explanatory psychotherapy. The method of the doctor's mental influence on the patient with the help of verbal suggestion is called suggestive psychotherapy. According to PI Buhl, suggestive psychotherapy includes suggestion in a state of wakefulness and suggestion in a state of hypnotic sleep.
During an attack of stuttering, you can see how the muscles of the lips, tongue, neck, as well as the organs of voice and respiration, are tense at the stuttering. Intensive attempts to overcome this condition lead to the tension of new muscle groups (the whole face, body, arms, legs). All of this exacerbates stuttering. In order to be able to freely and accurately control them (i.e., speak without hesitation), it is necessary to relieve the tension of all muscle groups.
It is known that a person who is in a state of calm and complete muscle relaxation becomes especially suggestible. The technique of autogenous training is aimed at mastering the skills of mental self-regulation using relaxation methods. Autogenic training is carried out in several stages, aimed at mastering exercises to relieve neuromuscular tension, followed by the formation of a "rest habit". The issue of using autogenic training in the treatment of stuttering was developed by L. Ya. Missulovich and others. According to A. I. Lubenskaya, it is recommended to use autogenous training in a complex of therapeutic and corrective measures along with other methods of psychotherapeutic influence.
Many speech therapists, working with stuttering children, used exercises that helped to relax the muscles of the arms, legs, face (E. F. Rau, V. I. Rozhdestvenskaya, M. I. Merlis, L. M. Vinokurova, N. P. Mirovskaya , S. M. Lyubinskaya, etc.).
EL Pellinger, LP Uspenskaya in their work said that in preschoolers, relaxation begins with relaxation of the most familiar, large muscles of the arms, legs, body, neck. So, clenching and unclenching the fists, they can feel the relaxation of the muscles of the hands. In this case, the tension should be short-term, and the relaxation - long-term.
The authors recommend conducting a session of suggestion with stuttering children using a special game called "Magic Dream". The purpose of this game is to help children get rid of emotional stress: to induce calmness, poise, confidence in their speech, as well as to reinforce in the minds of children the need to use muscle relaxation and the technique of correct speech when communicating in any situation. Relaxation is caused by specially selected play techniques. Each is given a figurative name (For example, "Deer", "Ship"). Children are fascinated by this. They perform relaxing exercises not just imitating the presenter, but enter into a given image, reincarnating.
The ability to evoke in the patient's soul an emotional reaction of the desire to recover has a great similarity with a special therapy - aretotherapy. (For example, the famous slogan of K.M.Dubrovsky "We can!")
The method of K.M.Dubrovsky, the purpose of which in a short period of time to change the nature of the patient's attitude to his suffering, played a huge role in a radical turn in the attention of specialists to the psychotherapy of stuttering and was a significant contribution to the correction of impaired verbal communication. From that moment on, psychotherapy in the rehabilitation process of stuttering became from concomitant - initial and leading.
It is possible to help stutters get rid of emotional stress, reduce their level of anxiety and correct their level of self-esteem by using art therapy technologies in their work with stuttering. E.A. Medvedeva, I. Yu. Levchenko, and others wrote about the role of art therapy in special education in their works.
The concept of "art therapy" has several meanings:
viewed as a collection of arts used in treatment and correction;
as a complex of art therapy techniques;
as a direction of psychotherapeutic and psychocorrectional practice;
as a method of art therapy is used both independently and in combination with medications, pedagogical means.
The purpose of art therapy is seen in the appeal to the strengths of the personality, in internal support and restoration of the integrity of the personality. Classes with the use of art therapy methods contribute to the development of fine motor skills of the hands, an increase in self-esteem and the disclosure of their internal resources.
The indications for art therapy are:
difficulties in emotional development, stress, decreased emotional tone, lability, impulsivity of emotional reactions;
increased anxiety, fears, phobic reactions;
negative "I" concept, low, disharmonious, distorted self-esteem, low degree of self-activity;
uncoordinated twitching of various muscles (nervous tic), neuroses, etc.
There are many types of art therapy. We will only mention a few of them.
The method of group bibliotherapy is a means with which it is possible to creatively and productively carry out functional training (speech training), indirectly built into all speech therapy work, and, thus, to form and consolidate situational and spontaneous speech, to develop its dialogical forms that require high speed. expressive reactions. Yu. B. Nekrasova got the idea of using bibliotherapy in the works of AM Miller and IZ Vel'vovsky. Analyzing works, stutters often identify themselves with the main characters and project certain qualities onto themselves. It is important that these works are used at this stage for building and conducting psychotherapeutic conversations and functional training.
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Working with schoolchildren has its own characteristics.
The type of leading activity is changing. The main activity is learning, although elements of play activities coexist with learning.
The game form of classes is replaced by a lesson.
If for preschoolers all work is carried out through the family, educators, then at school age the speech therapy influence is carried out by the speech therapist in collaboration with the teacher.
At preschool age, all elements of speech are brought up on the basis of imitation of a speech therapist in the process of playing activities; at school age, the mindset on consciously overcoming the defect, on independent exercises over speech, becomes more important.
Stuttering is eliminated in the process of passing all the subjects at school.
Along with indirect psychotherapy, types of rational psychotherapy are more widely used.
Speech material and types of speech therapy classes are close to school practice.
In eliminating stuttering, the role of the school teacher is great: he creates an atmosphere of careful attitude towards the stutter in the classroom, gradually brings him to independent answers at the blackboard. The teacher maintains close contact with the speech therapist and the stuttering family. In the case of a depressed student's mood, he should encourage him, switch his attention to the positive aspects of the personality, to the activity that interests him. The teacher involves the stuttering in the social life of the class, and then the school, in the circles. It is the primary school teacher that arouses the stutter's main interest in working on speech and contributes to the development of the child. Corrective speech work should not be limited to formal exercises. It is necessary to talk not only about the system of speech lessons (correction), but also about the rehabilitation education of the stuttering schoolchild.
In speech therapy classes with stuttering schoolchildren, methodological recommendations are currently used that are proposed for work either with preschool children (for younger students), or with adolescents and adults (for older students).
For example, N.A. Cheveleva proposes a system for correcting speech among stuttering schoolchildren in grades I-IV in the process of manual activity. Fundamentally, this technique differs little from the previously proposed system of speech therapy classes with stuttering preschool children. Basically, the choice and complexity of crafts that are offered for work with schoolchildren are changing. According to the academic quarters, the author identifies four periods of sequential speech therapy classes: 1) accompanying speech; 2) the final speech; 3) anticipatory speech; 4) consolidating the skills of independent speech.
N. A. Cheveleva considers it possible to conduct classes to correct the speech of stuttering children in the process of manual labor at school and polyclinic speech therapy centers, in special schools.
The system of speech therapy classes with stuttering schoolchildren in the conditions of a speech therapy room of a polyclinic, a specialized hospital or a sanatorium, proposed by V.I.Seliverstov, also does not fundamentally differ from the complex methodology described above for teaching preschoolers. Changes in B are not associated only with the older age of children, the increased level of their development, which requires a speech therapist to rely more on the conscious activity of the children themselves.
In the system of speech therapy classes A. V. Yastrebova singled out three periods in the teaching of students.
In the first period, stuttering schoolchildren clarify and disseminate their knowledge in the field of language both through purposeful observation over the sound side of speech, and in the process of active exercises to regulate its tempo and smoothness.
In second period lessons, the knowledge gained by students in the field of language is activated and the skill of smooth, rhythmic and expressive speech is fixed on more complex speech material in order to further expand the vocabulary, linguistic concepts and concepts.
In third, In the final period of classes, work continues on the sound and intonation side of speech, the requirement for the conscious use of knowledge in the field by students is being implemented. phonetic-phonemic, lexical-grammatical and intonational composition of the language and the skill of fluent, expressive speech in any life situation.
Thus, the state of oral and written speech of stuttering schoolchildren with elements of general speech underdevelopment determines the following main directions of speech therapy work:
purposeful and comprehensive development of the main interacting components of speech (phonetics, vocabulary, grammar) in the process of working on its tempo and fluency;
the close relationship of the speech material of speech therapy classes with the content of the program in the Russian language of elementary school;
development of speech activity in children.
In our country, seasonal (summer) speech therapy sanatoriums and sanatorium-type camps for stuttering children are organized. Correctional-pedagogical and medical-health-improving work with stuttering schoolchildren is carried out in their free time at school and combined with rest. At the same time, climatic and natural factors are widely used.
The personnel of LOU (summer health institutions) are faced with the tasks of general health improvement of children, strengthening of their nervous system, prevention and elimination of mild forms of stuttering and its relapses.
An indication for referral to seasonal specialized sanatoriums is the presence of stuttering in children of varying degrees, up to the most severe, as well as stuttering in conjunction with other speech defects. Children are sent to camps after a course of treatment for stuttering, as well as those with mild forms of stuttering and other forms of disorders of fluency and tempo of speech (bradilalia, tachilalia).
The seasonal sanatorium and health camp for stuttering children complement each other.
Speech therapy work with stuttering adolescents and adults
In the overwhelming majority of adolescents and adults, stuttering is a consequence of a long-term process that arose in childhood. In these age periods, the speech defect is most pronounced, stable in its manifestations, welded to the personality, with a disturbed system of personality relations and therefore it is difficult to eliminate, often prone to relapses. When eliminating stuttering, it is necessary to apply methods of corrective action differentiated in accordance with its characteristics within the framework of the existing complex therapeutic and pedagogical approach to stuttering. The following provisions should be considered as the basis for the therapeutic and pedagogical influence.
1. Complexity as the interpenetration of medical and pedagogical techniques. For example, a psychotherapeutic technique - autogenic training includes speech, speech therapy material, individual speech therapy sessions, in turn, are carried out using the psychotherapeutic technique of functional training, etc.
2. The complexity of the clinical picture of stuttering in adolescents and adults highlights medical measures in the complex overcoming of stuttering. This significantly affects the place, and the specifics of speech therapy work with stuttering. Therefore, nowadays, this work is increasingly designated as logotherapy, logopsychotherapy.
3. A phased approach, according to which all types of loads (speech therapy, psychotherapeutic, logorhythmic) should gradually increase from simple to complex both in the selection of speech material and in the construction of a system of functional training. Each of the stages should allow the stutter to achieve some success from the very beginning.
4. Nosological differentiation and individualization of therapeutic effects.
Specialized assistance to stuttering adolescents and adults in our country is provided in the health care system: in speech therapy offices and inpatient units of neuropsychiatric dispensaries and hospitals.
I. Yu. Abeleva, L. Z. Andronova, L. P. Golubeva, A. Ya. Evgenova, M. N. Kiseleva, A. I. Lubenskaya, M. I. Merlis, Yu.B. Nekrasova, N.F. Sichnitsina, M.V. Smirnova, M.E. Khvatsev, A.G. Shembel, V.M. Shklovsky and others.
A technique for eliminating stuttering in adolescents in a hospital setting, developed by the staff of the State Research Institute of the Ear, Throat and Nose under the guidance of prof. S. S. Lyapidevsky, contains 6 main stages of speech therapy work: 1) preparatory (2-3 days); 2) setting (introductory conference, special instruction in terms of psychotherapy); 3) maximum limitation of speech (10-14 days); 4) active restructuring of speech skills (3-4 weeks); 5) consolidation of correct speech skills (3-4 weeks); 6) the final stage (graduation conference, special instruction).
Speech lessons with stuttering begin with the setting stage, when they receive an incentive for their own healing based on positive examples of those who had been treated before them. At the stage of maximum speech limitation, stuttering are in complete silence for 3-5 days, and in the remaining 7-9 days - relative speech rest. Under the guidance of a speech therapist, they master the conjugated, semi-reflected and reflected speech, and then the small phrases necessary for everyday life in the department. In the same period, breathing exercises and articulatory gymnastics are carried out with stuttering.
At the stage of active speech restructuring, a speech mode is introduced, work on a dialogue, conversations on a given topic, small independent retellings on a free topic. During speech practice, stutters consolidate the acquired skills of independent speech in various situations (training for extra stimuli).
At the final stage (graduation conference with the participation of parents and friends, service personnel, etc.), adolescents answer questions from the audience, recite or read excerpts from works of art, act out small scenes from plays, and make reports.
Speech therapy work with adults stuttering in outpatient settings is divided (in order of complication) into three periods (A. Ya. Evgenova and MV Smirnova).
The first period (14 sessions) contains articulation and breathing exercises; counting and phrasal charging; Questions and answers; uncomplicated message; short poem (by heart).
The second period (12 sessions) includes speech exercises; reading, presentation of what has been read; a story on this topic; speaking practice; combined activities.
In the third period (12 sessions), short reports are offered to stutters; work with artistic material (poem, fiction); dramatization; excursions (individual and group); reports of the treated as a special form of speech work.
According to the methodology of I. Yu. Abeleva, L. P. Golubeva, A. Ya. Evgenova, N. F. Sinitsina, M. V. Smirnova, it is recommended to start classes with breathing, voice and articulation exercises.
Further, work on vowel sounds is provided; words (with a stressed vowel on the first, second, third, fourth syllable); phrases (starting with words with an initial vowel, consonant sound; phrases with one, two, three breathing pauses). In the sequential complication of speech exercises, work on songs follows; poetic speech (fairy tales in verse, poems, fables); by reading; memorizing texts by heart; retelling of the read text; a message on a given topic; the text of dramatic works. After all this, the practice of speaking follows (dialogues, scenes, telephone conversations, speech games).
In connection with the increased interest in the study of the psychological characteristics of stutters in recent years, the need for psychotherapeutic influence has been significantly substantiated.
Suggestive forms of psychotherapy (imperative suggestion in the waking state, auto-training, self-hypnosis, hypnosis) find a place in the system of logopsychotherapeutic work with adolescents and adults.
In the complex system developed by V. M. Shklovsky, the course of treatment of stuttering (2.5-3 months) includes five stages: preparatory (diagnostic); restructuring of pathological speech skills and disorders of personality relationships; consolidation of the achieved results; medical examination and prophylaxis; spa treatment.
At the preparatory (diagnostic) stage (10-15 days), the patient is examined by a neuropathologist, a defectologist and a psychotherapist; anamnestic and clinical data are being studied, psychotherapeutic and speech therapy measures, drug treatment are planned.
At the stage of restructuring pathological speech skills and disturbed personality relationships (from 1 to 1.5 months), speech therapy classes are conducted to normalize respiratory, voice functions, develop speech standards, etc. At the same time, autogenic training and rational psychotherapy begin. Then (after 15-20 days) a session of suggestion is carried out in the waking state. After the session, active speech therapy work begins. The achieved results are consolidated during sessions of hypnotherapy, self-hypnosis and rational psychotherapy.
Continuous speech skills are automated, stutters are taught various techniques that help them cope with arising speech difficulties: they practice pronouncing a number of vowel sounds, then numbers, individual phrases, etc. and reflected pronunciation. Speech therapy work is carried out along with active suggestive psychotherapy.
Speech lessons during the day are given at least 3-4 hours.
Psychotherapeutic work at the stage of restructuring pathological speech skills and disturbed personality relationships has various forms. With the help of rational psychotherapy, the patient is explained the reasons for stuttering, the need for an active attitude to classes for the successful treatment of stuttering.
Hypnotherapy begins on the 3-4th day after the start of active speech training. It is carried out at first 3 times a week, and then once every 7-10 days. During the suggestion, special attention is paid to the normalization of the emotional-volitional sphere and the activity of the articulatory-vocal and respiratory apparatus. In some cases, hypnotherapy is a good preparation for conducting a suggestion session while awake.
Used conversations against the background of strong emotional stress of patients, ending with an imperative suggestion; imperative suggestion with the inclusion of demonstrative moments. The session is scheduled in advance for a certain day, which is especially expected by patients, since it is a turning point in their treatment.
In the process of self-hypnosis, stutters strive to present themselves as good speakers, evoke an idea of how they speak without stuttering at home, in school at work and in other situations. A self-hypnosis session is also recommended before bedtime.
At the stage of consolidating the achieved results (within a month), the patient's speech is trained in a life setting.
VM Shklovsky emphasizes the need for prophylaxis and prophylaxis as important sections of work, without which the problem of stuttering treatment cannot be solved. For those who stutter with profound neurotic disorders and pronounced vegetative dystonia, the author advises to carry out spa treatment using climatic and balneological effects, exercise therapy and physiotherapeutic measures. ]
All modern systems of speech therapy classes with stuttering adolescents and adults are united by the presence in them (in addition to consistently complicated speech exercises) of various forms of psychotherapy. They differ from each other mainly in the importance and place assigned to certain types of psychotherapy in speech therapy work.
Speech exercises in the systems of speech therapy sessions with stuttering are based on the principles generally accepted in children's speech therapy, but taking into account the age characteristics of patients. Elimination of stuttering in adolescents, young men and adults requires a necessarily differentiated approach both in the study and in the very elimination of stuttering. The generally accepted comprehensive medical and pedagogical approach in working with stutters of different ages is specified, differentiated depending on the state of the stutter and the need for priority work on certain aspects of the patient's speech and personality. In the laboratory of functional and other types of speech pathology, V.I. VP Serbsky treatment of stuttering in adults is carried out taking into account the nosological heterogeneity of patients (stuttering with neurotic disorders; with psychopathies; with phenomena of early organic damage to the central nervous system; with sluggish schizophrenia).
Treatment includes a complex of medical and pedagogical measures: medication, psychotherapeutic, speech therapy, logorhythmic (N. M. Asatiani, V. G. Kazakov, L. I. Belyakova, A. I. Lubenskaya, B. V. Oganesyan, etc.).
When patients are admitted for treatment, medical care is provided, then during the first 10 days of stuttering in the clinic, a diagnosis is made based on clinical studies, speech therapy observations and paraclinical examinations.
Speech therapy examination, along with medical examination, is carried out in the first 10 days of the patients' stay in the clinic: they establish the depth and severity of the speech defect, especially the neuropsychic state, outline a plan for individual work with stutters within the framework of an integrated approach. The following stages of inpatient treatment are distinguished: preparatory (5-7 days), active therapy (20 days), active training (10 days), final, during which the utmost complication of speech situations occurs (3-5 days).
During the preparatory stage, it is recommended to restrict verbal communication, groups of patients are formed to conduct classes (according to clinical signs, according to the parameters of age, intellectual level and gender). The main form of work is collective, but, given the nature of secondary neurotic layers, individual psychotherapeutic work is carried out in parallel.
From the 2nd week, with the beginning of the stage of active therapy, patients are included in collective sessions of autogenic training, as well as in systematic individual sessions with a speech therapist. By this time, the main medication prescriptions, the focus of individual psychotherapy conducted by the attending physician are determined. At the stage of active training, patients go outside the hospital for functional speech training under the guidance of psychotherapists and speech therapists (talking on the street, in a store with a seller, at the checkout, by phone, etc.).
The final stage contains an extremely difficult speech load - individual and collective speech performances in front of a large audience. The performances take the form of a concert program with the inclusion of musical numbers (melodic reclamation, solo and choral singing).
Before being discharged from the hospital, everyone is given recommendations for further independent work within the framework of supportive speech therapy classes, autogenic training, and the repetition of some elements of speech therapy rhythm.
The entire course of treatment in a hospital is permeated with direct and indirect psychotherapeutic influence on patients in the form of collective and individual psychotherapeutic conversations. Autogenic training course includes examination of stuttering; their assimilation of the basic techniques of self-regulation; working out the skills of local relaxation of muscles in which pathological tension occurs; mastering abbreviated formulas of self-hypnosis, methods of active regulation of muscle tone and the use of local relaxation skills in the process of speech activity.
Speech therapy, didactic, correctional and logotraining work carried out by a speech therapist is based on the clinical affiliation of the stuttering person, his age, development, and personal characteristics. For example, the emphasis on speech therapy classes is most appropriate in relation to patients with neurosis-like stuttering against the background of residual organic cerebral insufficiency. For patients with neurotic stuttering, psychotherapeutic techniques are more effective.
The practical material of the classes is aimed at correcting disturbances in breathing, voice, articulation, at developing the motor skills of the articulatory apparatus and training motor function in general, at training all types of sonorous speech (conjugate and reflected speech, reading poetry and prose, question-and-answer speech, etc.). ). Particular attention is paid to speech functional training, which makes it possible to consolidate the acquired speech skills in an office, hospital and in ordinary life situations and help stuttering to develop the correct attitude to difficult speech situations. According to the authors, the effectiveness of eliminating stuttering in adults is due to the use of the entire arsenal of a comprehensive medical and pedagogical approach, psychotherapy, pharmacotherapy, functional speech training, individual, group and collective exercises, speech therapy rhythmics and physiotherapy exercises, physiotherapy and restorative treatment.
Some authors find it useful to communicate to stutters and then regularly repeat the rules for practicing planned speech with them. It is assumed that as the speech therapy course progresses, the rules of speech will be fulfilled by stuttering automatically and contribute to the normalization of their speech. For the first time, 12 rules for exercise in fluent speech were developed by A. Gutzman and G. Gutzman in 1924. They are of cognitive interest at the present time, since they are used in the practice of speech therapists.
Rules for Exercising Fluent Speech
Speak slowly and calmly, that is, pronounce syllable by syllable, word by word, sentence by sentence.
Always understand what and how you are going to speak.
Don't speak too loudly or too softly.
When speaking, stand or sit upright and calm.
Take a quick, deep breath through your mouth before speaking.
Spend your breath sparingly. During the conversation, try to hold your breath as much as possible.
Always go decisively and definitely into the position for pronouncing the vowels.
Direct the exhalation not towards the consonant sound, but towards the vowel.
Never click on consonants; if necessary, speak below your normal tone and stretch all vowels somewhat.
10. When a word begins with a vowel, start it quietly and in a slightly lowered tone.
11. Stretch the first vowels in a sentence for a long time and link all the words of the sentence together, as if the whole sentence is one polysyllabic word.
12. Always try to speak clearly and euphoniously.
The effectiveness of stuttering elimination and the strength of the obtained correction results depend on many factors.
In speech therapy practice, it is customary to assess the effectiveness of overcoming stuttering on the following scale: speech is fluent, without stuttering, with significant improvement, with slight improvement and no improvement. The stutter's speech is assessed here in comparison with its initial state before the start of the speech therapy course.
Control questions and tasks
Expand the mechanism of stuttering from the standpoint of a physiological approach.
Expand the psychological and psycholinguistic aspects of stuttering mechanisms.
Describe the history of the development of the doctrine of stuttering.
What are the main directions in the treatment and correction of stuttering have been formed since antiquity to the present time?
What are the prerequisites for creating an integrated approach to eliminating stuttering?
What is the etiology of stuttering?
What are the symptoms of stuttering?
Tell us about the course of stuttering in different age periods.
Expand the features of stuttering symptoms in preschoolers, schoolchildren, adolescents and adults.
Tell us about the methodology for examining stuttering.
Give a general description of the integrated medical and pedagogical approach to the elimination of stuttering.
What are the main tasks and forms of medical and recreational work with stuttering children?
Expand the main tasks and forms of correctional and pedagogical work with stuttering children.
List the types of psychotherapy and its importance in eliminating stuttering at different age periods.
Describe the modern methods of speech therapy classes with stuttering preschool children.
What are the features of speech therapy classes with stuttering schoolchildren?
Expand the features of speech therapy work with stuttering adolescents and adults.
How is a graded approach implemented in eliminating stuttering?
Tell us about the possibilities of using visual aids and technical teaching aids in speech therapy classes with stuttering.
Compare the forms of organizing speech therapy for stuttering in education and health care systems.
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Volkova G.A. Play activities in eliminating stuttering in preschoolers. M., 1983.
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Vygodskaya I. G. and other Elimination of stuttering in preschoolers in the game. M., 1984.
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