The Dysglosia Is a disorder of the articulation of the phonemes due to malformations or anatomical and / or physiological alterations of the peripheral articulatory organs.
All this hinders the linguistic functioning of people without detectable neurological or sensory impairments.
Etiology of dysglosia
Craniofacial malformations, growth disorders, peripheral paralyzes and / or anomalies acquired as a result of lesions in the orofacial structure or removal of the lesions are the causes that may lead to dysglossia.
There are three aspects that can be related to dysglosia. However, we must bear in mind that these aspects are not a direct cause of dysglosias, although they do worsen the picture, since it makes it difficult for the affected person to implement compensatory mechanisms to improve spontaneous speech.
These aspects are:
to Intellectual disability in varying degrees : Very close to syndromes that affect the craniofacial structure.
B) The Psychosocial deprivation Derived from the physical aspect and the physiological difficulties that derive from the anatomical alterations.
C) The Hearing loss As a result of an inadequate structure or alterations of the hearing organs of a particular syndrome.
These aspects interfere in the course of treatment preventing the individual from improving as expected.
symptom
Among the symptoms of dysglosia, we can distinguish, on the one hand, the nuclear symptomatology, and, on the other hand, the associated symptomatology.
A) Nuclear symptoms
The central symptomatology is characterized by an alteration in the articulation of different phonemes by anatomical malformations of the peripheral organs of speech and of central non-neurological origin.
B) Associated symptomatology
The symptoms associated with dysglosia are the presence of rhinophonies, which are alterations of the voice derived from lesions in the resonance cavities.
In addition, we find psychological disorders consistent with the problem of speech, for example, that the person with this disorder present refusal to speak.
In addition, this disorder may be associated with school delay, difficulties in reading and writing, difficulties in normal speech fluency, hearing loss (especially in the cleft palate) and other difficulties related to long hospital stays.
On the other hand, we also find the lack of adequate stimulation to its level of development and the mistaken belief that the disglosia is inevitably linked with an intellectual delay.
Classification of disglosias and main characteristics
1- Lip Disorders
Lip dislocations are a disorder of the articulation of the phonemes due to the alteration of the shape, mobility, strength or consistency of the lips.
The most frequent ones are due to:
to) Harelip : It is a congenital anomaly that goes from the simple depression of the lip to its total cleavage.
The malformation may be unilateral and bilateral depending on the affected side. So the cleft lip can be unilateral or bilateral and simple or total.
The most severe form of this malformation is called middle or central cleft lip.
B) Hypertrophic upper lip cleft : The membrane between the upper lip and the incisors develops excessively. They have difficulty articulating the phonemes / p, / b /, / m /, / u /.
C) Fissure of lower lip : Cleft in the lower lip.
(D) Facial paralysis : A frequent consequence of forceps producing lesions and anomalies in the middle ear. They have difficulty pronouncing phonemes / f /, / n /, / or /, / u /.
and) Macrostomia : Elongation of the buccal cleft that may be associated with malformations in the ear.
F) Lip wounds : Some wounds in the area of the lip that could cause alterations in the articulation of the phonemes.
G) Trigeminal Neuralgia : Short, short-term pain that appears on the face in the ophthalmic, upper and lower jaw areas.
2 - Mandibular Disorders
Mandibular disglosias refer to the alteration of the articulation of the phonemes produced by an alteration of the shape of one or both jaws.
The most frequent causes are:
to) Resection of jaws : The upper jaw separates from the lower jaw.
B) Mandibular atresia : Anomaly caused by a detention of the development of the lower jaw of congenital origin (endocrine disorders, rickets, etc.) or acquired (use of the pacifier, sucking the finger, etc.), which ends up producing bad occlusion of the jaws .
C) Maxillofacial dysostosis : Is a rare inherited disease characterized by mandibular malformation derived from other abnormalities and gives rise to the typical aspect of"fish face".
(D) Progeny : Growth of the lower jaw that produces bad occlusion of the jaws.
3- Dental discolours
Alteration of the shape and position of teeth by inheritance, hormonal imbalances, feeding, orthodontics or prosthesis.
4- Lingual Disglosia
It is characterized by the alteration of the articulation of phonemes by an organic disorder of the tongue that affects the speed, accuracy and synchronization of the movements of the tongue.
The most frequent causes are:
to) Ankyloglossia or short frenulum : The membrane under the tongue is shorter than normal.
B) Glosectomy : Total or partial removal of the tongue.
C) Macroglossia : Excessive size of the tongue producing respiratory problems (characteristic in the Down's Syndrome ).
(D) Congenital malformations of the tongue : Arrest in the embryological development.
and) Microglossia : Minimum size of the tongue.
F) Hypoglossal paralysis : When the tongue can not move and there are problems talking and chewing. It can be bilateral or unilateral.
5- Disglosia palatina
It is an alteration in the articulation of phonemes caused by organic alterations of the bony palate and the veil of the palate.
The pathologies in which the normal structure is affected are called:
to) Cleft palate : Congenital malformation of the two halves of the palate severely impairs swallowing and speech.
The cleft lip or palate originate in the first weeks of gestation.
B) Submucosal fissure Malformation where the palate is cleft.
Evaluation
To begin with the evaluation of the disglosias, it is appropriate to make an anamnesis to know:
- The reason for the evaluation.
- Family background.
- Pregnancy and childbirth.
- Psychomotor development.
- The development of speech.
- Development of the dentition.
- Feeding.
- Breathing (day and night - presence or not of snoring).
- Adenoid problems, in the Tonsils , rhinitis Y otitis .
- Use of pacifier, drooling, sucking lip, digital, of cheeks, lingual, of objects, bite of objects, etc.
- Hospitalizations, surgical interventions and relevant diseases.
- Medication.
Subsequent to this, we proceed to the exhaustive evaluation of the orthodox organs:
Lips
Observe the lips at rest: we must indicate if they are closed, open or very open.
- As well, We must attend to the form Of the same to know if they are symmetrical or asymmetrical, the form of the upper lip and inferior indicating if it is short, normal or long, and the presence of scars, as well as its location and characteristics.
- The Lip mobility Is evaluated by asking the child to move their lips to the sides, project them, stretch them, make them vibrate and wrinkle them as if to kiss. We will record if the lips move normally, with difficulty or no movement.
- Tonicity : We will observe the lip tone through the exercise of the kiss and we will touch with the finger the upper and lower lip to notice the resistance of the same and we will label it of normotonía, hipertonía or hypotonía.
- Lip balm : Through observation we will evaluate if the inferior or superior labial frenulum is short and if the superior is hypertrophic.
Language
- We will observe the tongue at rest And we will see if it is placed leaning on the hard palate, interposed between the dental arches, pressing laterally the arcades or projected on the upper or lower arch.
- Shape : We ask the child to remove the tongue and we take care of the form that the language presents, it can be normal, microglosia / macroglosia, wide / narrow and voluminous. It is important to note if there are side marks of the teeth.
- Mobility : The child is asked to move the tongue to the sides, raise it, project it, make it vibrate, etc. So we will evaluate if it moves with normality, with difficulty or no movement.
- Tonicity : In order to detect the tone of the tongue we use a lingual depressor and push the tip of the tongue while the child resists. Through this exploration we can detect if the language is normotonic, hypertonic or hypotonic.
- Frenulum : We ask the child to raise his tongue to verify its shape. If it is difficult we ask you to suck the tongue against the hard palate and keep it. This allows us to see if the lingual frenulum is normal, short or with little elasticity.
Hard palate
- Shape : When observing the palate we must look at the form that it presents, it can be normal, high, ogival, wide or narrow, flat, short, with scars.
- Palatal folds : Observe whether the folds of the hard palate are normal or hypertrophic.
Soft palate
- We observe the soft palate at the end of the oral cavity . One of the elements that we must attend is the uvula. When observing it, we must indicate if it has a bifid structure or if it is long, short or non-existent.
- We must detect the presence of scars Or fistulas on the white palate.
- We will observe its dimension , Indicating whether it has a conventional dimension or is shorter than would be expected.
- Mobility : In order to be able to observe the mobility of this area of the orator apparatus we must ask the individual to emit the phoneme / a / during the exploration. Thus we can see if the mobility is good or is diminished or absent.
- Dental / maxillary arches: or Observe if the dentition is temporary, mixed or permanent.
- Attending to the absence of dental pieces .
- See if there is separation in the dental pieces , Where and how it can influence language.
- Malformation of teeth .
- Indicate if you wear dentures , Fixed or removable.
- Gum Condition Normal, inflamed or bleeding.
- How is the person's bite .
- Ability to open mouth : Difficult, does not open, disengages the jaw, etc.
- Check for frontal symmetry Between the right and left sides of the face.
- Face profile : Normal, retrusion or forward projection of the mandible.
Another relevant aspect for dysglosia is the evaluation of orofacial functions. To do this, we must consider:
Breathing
Observe if the breathing occurs nasal, buccal or mixed, if there is respiratory coordination. In addition, it is also important to evaluate breath control and measure lung capacity.
Swallowing
To evaluate the way of swallowing, the individual is offered water or yogurt and we observe the placement of the lips, the league and the pressure that is exerted to be able to swallow the food.
Chewing
To evaluate the chewing, the subject is offered a food type rosquilletas or cookies and the movements that are realized with the mouth and with the tongue are evaluated.
Phonation
It is important to take into account the tone of voice, the existence or not of hypernasality and the existence of articulatory difficulties.
As discussed earlier, people with dysglossia may have hearing problems, so it is also important to assess the ability of hearing discrimination.
For this, we will attend to:
Auditory Discrimination of Sounds
Sounds of everyday objects are presented and you are asked to identify them. For example, sounds of coins or paper wrinkling.
Hearing Discrimination of Words
Words are presented with similar phonemes and the person has to identify the difference.
Treatments
In the treatment of dysglosias, it is important to perform a multidisciplinary intervention given the nature and character of this language disorder.
Because disgloisa is a disorder that affects several areas of the individual, through the coordination of a team of professionals we can get the patient to achieve a normative development.
The professionals that would integrate this multidisciplinary team would be:
- Neonatologist : Is the first professional with whom the child enters the contact and with which the treatment is initiated.
This professional makes rapid assessments of growth and neonatal development, is that he makes an assessment of the abnormality or malformation detected and thus can determine the best way to feed and mobilize the resources available for the child to be operated by the team.
- Pediatrician : It is the one who will follow up, it is the professional who has a direct contact with the parents and has the mission to inform and accompany during the treatment.
In addition, it must be in communication with the other members of the multidisciplinary team.
- Orthodontist : It is the professional who is responsible for correcting initially and during the evolution of the treatment a correct dentition, accommodation of the palate and teeth.
- Speech therapist : Specialist who will treat the functional part of the initial part of the digestive and respiratory system. The goal is for the individual to achieve a correct phonation function.
- Psychologist : This professional will work with the parents and the child.
On the one hand, in the first place the work will be directed towards the parents to try to alleviate the pain that they feel before the malformation and the treatment of their son.
On the other hand, the psychologist will work directly with the child so that he can achieve a standardized social integration and A self-esteem Appropriate.
- Surgeon : Coordinates the treatment explaining, supporting and sending the child to consult and integrate the treatment until the surgical correction is performed. It is advisable to initiate surgical treatment during infancy so that altered orthodontic organs can be repaired before speech is initiated.
Operations are likely to be repeated when the patient is an adult.
- Others professionals : Social workers, aesthetic surgeons, otolaryngologists, anesthesiologists, etc.
And you, did you know anything about dysglosia?
References
- Belloch, A., Sandín, B., and Ramos, F. (2011). Manual of psychopathology (vol.1 and 2) McGraw-Hill: Madrid.
- . Difficulties in language acquisition. Innovation and educational experiences 39.
- Soto, M.P. (2009). Language evaluation in a student with dysglossia. Innovation and educational experiences 15.
- Prieto, M.A. (2010). Alterations in language acquisition. Innovation and educational experiences 36.
- De los Santos, M. (2009). The disglosias. Innovation and educational experiences 15.
- Protocol for the evaluation of dislo- Group Lea.