Praxis to correct speech difficulties in children
There are several reasons why a child may need to go to a speech therapist, where the professional will use praxis to help improve the articulation of sounds.
When we hear that a child goes to the speech therapist, we immediately associate it with the idea that he is going to “learn to speak” or that he is going to “learn to speak well” because he does not pronounce this or that sound.
However, both children and adults can go to the speech therapist for various reasons. In general, we distinguish difficulties in three different areas: voice problems, language difficulties and speech difficulties.
SPEECH DIFFICULTIES
Within this third type, in speech difficulties, a multitude of disorders are included. Although there are different classifications, following the well-known speech therapist and speech therapist Perelló, some of them are:
– Dysglossia : These are disorders that prevent proper articulation of phonemes, due to alterations in the organs involved in speech, without central neurological damage. For example, cases of cleft lip or palate.
– Dyslalias : They are disorders of the articulation of the phonemes by functional alterations of the peripheral organs of speech. In these cases there is no organic cause that justifies the difficulty in pronouncing a phoneme, as in the case of dysglossia, but nevertheless there are difficulties in one or more of them. One of the most typical is rotacism or the difficulty of pronouncing in the phoneme / r /
– Dysarthria : They are difficulties in the oral expression of language due to a disorder of the tone and movements of the muscles of the phonatory organs, as a consequence of injuries to the Central Nervous System.
In any of these difficulties, it is necessary to intervene on those structures that intervene in speech . In the face we have multiple muscles and structures and all of them must work in a coordinated and adequate way to be able to carry out all the sounds of our tongue.
The teeth, the palate, the tongue, etc., in addition to all the resonators of the voice (pharynx, oral cavity, nostrils …) also intervene in the correct emission of the different phonemes.
HOW DO YOU WORK ON SPEECH DIFFICULTIES?
When we work on these structures we say that we stimulate at the orofacial level . We can also find that we refer to this type of practice as Myofunctional Therapy, which would be the combination of muscle re-education and re-education of oral functions, applicable in different contexts: atypical swallowing, breathing or articulation.
According to the main authors in this field, we would differentiate four stages in a general Myofunctional Therapy treatment:
– Muscle exercises in the organs that intervene in the voice and in the articulation, to adapt the tone and mobility, as well as sensitivity exercises.
– Training of the resting position of the lips and tongue, looking for the right position when not speaking.
– Training of the new articulation patterns that are learned during the intervention sessions.
– Generalization of the learned patterns to all contexts of daily life.
WHAT ARE PRAXIAS?
Praxis can be defined as voluntary and organized motor exercises to work on all those structures that intervene in the articulation of different sounds.
In combination with praxis exercises, the speech therapist will take into account parafunctional habits, that is, those that go against normal orofacial development. Some of them, common in children and that we should try to avoid are:
– To bite nails.
– Thumb sucking .
– An excessive use of the pacifier or its use at an inappropriate age.
– Suck the cheeks.
– Bruxism.
HOW ARE PRAXIAS WORKED?
Returning to praxis, in speech training when working on articulation , all the points of articulation necessary to emit the different phonemes must be taught.
If we do the test, we can see how we place the tip of the tongue between the upper incisors while letting air pass to pronounce the / z / sound. However, for example, for the / p / sound, we use both lips making a dull, airless sound.
For each of the phonemes we use different support points to articulate and this is what is intended to be taught through praxis, either because there is an organic or nervous injury or because the child or adult has not learned to pronounce it correctly. . The vowels must also be worked on in a specific way.
In order to work on these points of articulation, it is first necessary to stimulate all the structures that we mentioned before and that intervene in speech: stimulate the different movements that can be made with the tongue or with the lips, work on the muscles that intervene in speech, etc. Through praxis, the speech therapist will prepare the patient to finally work on the appropriate points to articulate the different sounds. Just as an athlete must work their muscles, elasticity and agility before competition exercises, a person must be able to voluntarily and consciously control all the structures that intervene in speech and then put it into practice correctly, until they are able to do so automatically.
To work on praxis, it is common for the speech therapist and the patient to stand in front of a mirror, in order to see the correct model and correct the image of oneself. Different support instruments, such as tongue depressors or vibrators, can also be used to help achieve the correct points of articulation.
WHEN IS IT NECESSARY TO GO TO THE SPEECH THERAPIST TO WORK ON THESE PRAXIS?
In speech therapy intervention, treatment must be individualized, therefore it is difficult to establish a general answer to answer this question.
In the case of children, there is sometimes the presence of an evolutionary dyslalia, that is, that period in which children speak “half a language”, without being able to articulate and pronounce all the sounds or exchange them with each other.
There are developmental errors, which usually appear in all children and are normal in development. In general, despite these errors, speech intelligibility, that is, the ability to be understood by others, is preserved.
If this intelligibility does not occur, if it is totally impossible to understand what the child tells us, it is probably advisable to go to the speech therapist at an early age, between two and five years old. This professional will be in charge of determining if the errors in the articulation are developmental or may be characteristic and suspect some type of disorder that should be intervened early, such as a Specific Language Disorder. The evolution observed during the treatment will determine the confirmation or not of the suspicion.
As we mentioned earlier, some sounds take longer than others to appear. The sound / r / is difficult for children to articulate and it is understood as normal for children up to the age of five to have difficulties in their articulation. However, if the difficulty persists after that age, it should be consulted with the speech therapist.
Working through praxis allows patients with difficulties in the articulation of sounds to improve their quality of life , if we understand communication as a key and basic piece in people’s social development. In addition, in the case of children, it helps prevent future difficulties in other areas, such as literacy.
Dr. Tabriella Perivolaris, Sara's mother and fan of fashion, beauty, motherhood, among others, about the female universe. Since 2018 she has been working as a copywriter, always bringing to her articles a little of her experience and experience as a mother and woman.