Sensomotor alalia is a mixed form of speech pathology that combines elements of motor and sensory alalia . In modern speech therapy, it refers to severe speech pathologies, since it affects all levels of speech organization. In the children’s population, various types of alalia are detected in 1% of preschoolers. Since all types of speech are closely interrelated, the perception and understanding of speech is often secondarily impaired in motor alaliks, and in sensory ones – their own speech. With sensorimotor alalia, speech motor or phonemic insufficiency may predominate.

Sensorimotor alalia is caused by organic damage to the cortical parts of the auditory-verbal and speech-motor analyzers and their pathways of the dominant (more often left) hemisphere in speech. Pathological changes occur at the stage of intrauterine development or in early childhood (up to 3 years). The immediate etiofactors of sensory-motor alalia can be:

• Prenatal trouble . This group of causes includes various negative effects on the fetus. These include gestational complications (toxicosis, immunological incompatibility, fetoplacental insufficiency ), diseases (heart defects, endocrinopathies, TORCH infections) and bad habits of a pregnant woman (nicotine or drug addiction), external influences (vibration, radiation).
• Natal damage . During childbirth, traumatic or hypoxic-ischemic damage to the central nervous system occurs more often. During this period, TBI, repeated or tight cord entanglement , instrumental obstetric interventions (forceps delivery) are dangerous .
• Perinatal lesions . This refers to a combined harmful effect that acts both in utero and in the first days after birth (for example, fetal hypoxia , birth trauma, and severe neonatal jaundice).
• Postnatal diseases . Diseases of an early age (especially in the first year of life), occurring with cerebral complications or exhausting the child, can also cause sensorimotor alalia. The most significant of them are: head injuries, neuroinfections , brain tumors, malnutrition , rickets.

Risk factors

Certain conditions in themselves do not cause speech impairment, but potentiate the influence of biological causes. Such risk factors for speech underdevelopment can be:

• hereditary burden (the presence of alalia in childhood from a father or mother);
• unfavorable social conditions ( hospital syndrome , pedagogical neglect, conflict relations in the family);
• bilingualism (as a factor potentially contributing to the development of alalia, is a subject of debate).

Some researchers believe that there are no “pure forms of alalia (only impressive or only expressive). All types of alalia are of a mixed nature with varying degrees of severity of the sensory or motor component.

Various pathogenic influences lead to damage to the neurons of the motor and sensory centers of speech (postcentral, premotor, superior temporal cortex and the arcuate bundle), as well as the pathways that provide interhemispheric connections (corpus callosum). At the same time, nerve cells remain functionally immature, their excitability is reduced, and the transmission of nerve impulses is impaired. There is auditory agnosia , oral-articulatory apraxia .

With sensorimotor alalia, speech ontogenesis is grossly disturbed, the underdevelopment covers the entire speech system: the pronunciation component, speech understanding, vocabulary, and the skill of constructing a phrase suffer. The child does not acquire language skills within the specified time frame. Sensomotor alalia is observed in children with primarily normal intellectual development and peripheral hearing.

Mixed alalia is diagnosed in children over 3 years of age who have no speech initially. The leading symptoms are persistent misunderstanding of someone else’s speech and the absence of their own speech production. In the anamnesis there is a late formation of speech reactions: humming, babbling, the first words. From an early age, the child does not respond to non-speech sounds, the mother’s voice, or his name.

An impressive vocabulary is not formed: the preschooler does not know the names of objects, does not show them in the picture, does not follow elementary verbal instructions. Characterized by instability of auditory attention, a decrease in the volume of auditory memory, distraction to various external stimuli. A child with sensorimotor alalia is not attracted to listening to audiobooks, reading and telling stories. Contact is possible only with the help of elementary gesture instructions, emotional reactions, facial expressions.

Speech activity is either completely absent, or has a babbling character in the form of sound chains. Sometimes echolalia , perseveration are noted , but incoherent and inarticulate repetition of words is unstable, does not carry a semantic load and is not fixed in speech. Due to the difficulties in finding the correct kinesthesia during word repetitions, multiple sound substitutions , errors in stress, and distortion of syllable filling are allowed.

The behavior of children with sensorimotor alalia is often hyperactive , sometimes it has autistic features (a tendency to solitude, stereotyped actions, outbursts of aggression). Awkwardness of movements, impaired coordination and switchability, difficulties in performing actions (drawing, appliqué, dressing, buttoning) are noted. In older preschoolers and younger schoolchildren, the formation of graphomotor skills is slow.

Deficient speech development does not provide the child with the necessary communication with relatives and peers, proper socialization. As a result, personality disorders develop: behavioral problems, peculiarities of the emotional-volitional sphere ( anxiety , aggressiveness), secondary mental retardation . At school, students with sensorimotor alalia have significant difficulties in mastering the skills of writing and reading. The training is carried out according to the correctional program, but even its assimilation is given with difficulty.

Sensorimotor alalia is often disguised as hearing impairment and various forms of general dysontogenesis, therefore it presents certain difficulties for diagnosis. Only a multidisciplinary approach allows you to correctly identify the problem and build a competent corrective route:

1. Consultation with a pediatric neurologist . At the initial admission, perinatal risk factors, psychomotor development of the child, and the current neurological status are studied. According to the indications, instrumental diagnostics are prescribed: EEG , ultrasound of the vessels of the head and neck , Rg of the craniovertebral junction, cerebral MRI .
2. Pediatric otolaryngologist consultation . Allows you to assess the state of physical hearing and eliminate its decline For this purpose, the registration of audiogram , acoustic stem EP is carried out . If necessary, the child is consulted by an audiologist.
3. Consultation with a neuropsychologist. The neuropsychological approach reveals deficits in auditory-speech memory and attention, articulatory apraxia, and auditory agnosia. The features of the motor, behavioral, volitional sphere are investigated. Preserved mental resources are determined for building correctional work. Sensorimotor alalia symptoms classification
4. Speech therapist consultation . In the process of diagnosing oral speech, the structure and symptoms of speech failure are assessed. With sensorimotor alalia, the lack of formation of expressive (colloquial) and receptive speech is determined: the child does not understand the meaning of what has been said, it is difficult to repeat what he has heard. As a compensatory means, mimic-gesticulatory speech can be used.

Differential diagnosis

At the diagnostic stage, it is necessary to exclude the temporal delay of speech development, sensorineural and conductive hearing loss, autism spectrum disorders , and oligophrenia. Sometimes the correct diagnosis can be established only with the dynamic observation of the child, which requires repeated visits to specialists.

Medical treatment

A biopsychosocial approach is used in the treatment of sensorimotor alalia. To normalize neurodynamic processes and create favorable conditions for logotherapy, drug therapy is prescribed (nootropics, neuroprotectors, neuropeptides, B vitamins, vascular drugs). Physiotherapy ( transcranial micropolarization , microcurrent reflexotherapy , magnetotherapy and electrophoresis on the SHOP ), manual techniques ( massage , osteopathy ) have a proven stimulating effect on the central nervous system .

Speech therapy correction

Children with sensorimotor speech impairment need daily classes with a speech therapist , therefore, a child with alalia must be assigned to a speech therapy group in a kindergarten (for children with OHP ). At the initial stage, the child is taught to perceive first non-speech ambient sounds, then speech. In the future, work is underway to expand the vocabulary, both passive and active due to verb constructions. The reliance is used on a preserved visual analyzer (display of pictures, objects), the correlation of the visual and sound image of the word is formed.

From the age of 4, children with sensorimotor alalia are taught literacy: writing, global reading. With the expansion of the vocabulary and the appearance of the phrase, the emphasis is shifted to the improvement of the phonetic-phonemic system, the syllable structure of the word. Classes should be held 4-5 times a week in compliance with a single speech regime, both in the group and at home. The duration of the correction of sensorimotor alalia is 3-4 years.

To develop speech kinesthesia, articulatory gymnastics and logomassage are performed . Of the methods of neurocorrection for sensorimotor alalia, exercises for interhemispheric interaction, cerebellar stimulation, and Tomatis therapy are effective .