Cappacism : Causes, Symptoms, Diagnosis & Treatment

• Causes Of Cappacism
• Characteristics Of Back-Lingual
• Types Of Cappacism
• Diagnostics
• Correction
• Medical Support
• Logopedic Help

Cappacism in the narrow sense means defects in the pronunciation of [K] and [K ′], in a broader sense - the shortcomings of all back-lingual sounds, including [G] and [G ′], [X] and [X ′]. With this speech disorder, phonemes are either completely absent in speech, or are pronounced with a guttural, nasal, lateral overtone. Diagnosis is carried out by a speech therapist by examining the articulatory apparatus and sound pronunciation. Sometimes additional dental or neurological diagnostics are required. Correction of cappacism consists of the formation of an articulation pattern, setting and fixing a normative sound. According to the indications, orthodontic treatment, operations on the maxillofacial area, logomassage, physiotherapy are carried out.

The name of the defect was given by the tenth letter of the Greek alphabet - "kappa". Capacisms include shortcomings in the articulation of the posterior sounds [К-К ′], [Г-Г ′], [Х-Х ′]. Sometimes in classical speech therapy, the last two phonetic defects are separated into independent groups - gamacism and chitism. Capacisms are less common than sigmatisms and rotacisms. However, in speech therapy practice, they are among the most persistent, complex and difficult to correct defects. The substitution of posterior sounds with other phonemes of the Russian language is called paracapacism, paragammacism, parachitism.

Causes of cappacism

For the normative pronunciation of the posterior lingual, a high rise of the root of the tongue, its bow with the soft palate and an energetic oral exhalation are necessary. If any of the three conditions is not met, then the articulation of the posterior palatine sounds becomes defective. The causes of paracapacism are deficiencies in phonemic hearing or hearing loss. Capacisms are observed in the following conditions:

• Palate clefts. The splitting of the soft palate (cleft palate) violates the anatomical and functional conditions in the oral cavity, necessary for the pronunciation of the posterior lingual. The palatal curtain does not block the entrance to the nasal cavity, so air leaks. The root part of the tongue is shifted back, the walls of the pharynx are connected to the articulation of the posterior palate.
• Gothic sky. Of the dento-maxillary anomalies, the most significant for the occurrence of cappacism is the arched palatine vault. In this case, the bond of the root of the tongue with the sky becomes impossible, mechanical dyslalia develops.
• Violation of the tone of the articulatory muscles. noted in dysarthria. The tongue may be spastic, tense, or flaccid and flattened. Such conditions prevent the correct pronunciation of not only posterior lingual, but also others in terms of the way sounds are formed.
• Functional dyslalia. In some cases, cappacism-type distortion is the result of inaccurate and undifferentiated articulatory movements, copying incorrect speech patterns, and infantile swallowing. A similar mechanism is observed in somatically weakened children, bilinguals, children with pathological oral habits.
• Features of the local dialect. The fricative [Г] can be heard in the South Russian, Ukrainian, Belarusian languages ​​(gekanye). Paracapacisms (replacing [G] with [X] at the end of a word) are typical for northern dialects (Vologda, Arkhangelsk region, Transbaikalia).

Cappacism

Characteristics of back-lingual

The consonants [К], [Г], [Х] ​​are oral, posterior lingual at the place of formation. [K] and [G] - stop-explosive, paired in deafness-voicedness, [X] - slotted, deaf, unpaired.

When articulating [K], the upper and lower teeth are slightly open, the front of the tongue is in the lower position, the tip does not touch the lower incisors. The back third of the back of the tongue forms a bow with the palatine curtain. During the pronunciation of a sound, the tongue and palate open under the pressure of an air stream, which creates a characteristic noisy overtone when leaving the oral cavity. Articulation [G] is similar, with the difference that the vocal folds are in a closed position, the sound is sonorous.

When articulating [X], the bow is incomplete, a gap remains between the back of the tongue and the palate. Soft back-lingual phonemes differ from hard ones by moving the bow or gap forward into the middle sections of the palate.

Types of cappacism

There are three main types of cappacism: guttural, nasal, lateral. Sounds may also be missing.

• Absence of back tongues. The sounds [G], [K], [X] and their soft paired variants are not pronounced at all, they “fall out” of the words, which makes speech difficult to understand.
• guttural . With this variant of cappacism, instead of a sound, a click of the vocal folds is heard, similar to crackling.
• Lateral . It is more common in dysarthria, when air does not exit along the midline of the tongue, but through the lateral sections of the oral cavity.
• Bow . It is characteristic of open rhinolalia, in which case the posterior palate sounds acquire a nasal coloration.

With paracapacism, the sound [K] is usually replaced with [T] or [X], with paragammacism, [G] should be replaced with [D] or [K], with parachitism, instead of [X], [K], [T], [C] are used ]. Paracapacisms are reflected in writing, causing the phenomena of articulatory-acoustic dysgraphia.

Diagnostics

Since posterior lingual deficiencies are often associated with maxillofacial anomalies, their diagnosis requires an interdisciplinary approach with the participation of speech pathologists, speech pathologists, dental surgeons, pediatric neurologists, and ENT doctors. To identify cappacism and establish its cause helps:

• Speech therapist consultation. It consists of several blocks: assessment of the state and mobility of the articulatory organs, verification of the phonetic side of speech, phonemic hearing, lexical and grammatical structure. On examination, clefts of the maxillary fossa, gothic palate, paresis / spasticity of the muscles of the tongue can be detected. The type of cappacism, other sound defects (distortions, substitutions of sounds) are determined, a conclusion is made about the nature of the violation of the language function.
• Assessment of dental status. To clarify the anatomical defects of the maxillofacial region and prepare for their surgical elimination, CT of the jaws and facial skeleton is performed. In order to assess the function of the palatopharyngeal closure, nasopharyngoscopy is performed. Diagnostic models are being made for early stage treatment.
• Neurological diagnostics. Electroneuromyography, EEG, and, according to indications, MRI of the brain, help to identify concomitant neurological pathology.
• Surdological examination. Assessing physical hearing is required to rule out hearing loss, associated paracapacism, and other sound substitutions. For this, an audiogram, impedancemetry, registration of auditory EPs, and otoacoustic emission are performed.

Cappacism Correction

Correction

Medical support

In the presence of defects in the upper palate, a phased surgical intervention is indicated: uranoplasty, velopharyngoplasty, and, if necessary, cheilorhinoplasty. Orthodontic correction is carried out between operations. Violation of the tone of the articulatory muscles requires a combination of drug therapy with general massage, physiotherapy (electrical stimulation, SMT therapy), and acupuncture. Hearing deficiencies are corrected with the help of hearing aids.

Logopedic help

The stages of correctional and speech therapy work with cappacism include the preparation of the articulatory apparatus, sound production, and automation. At the preparatory stage is used:

• Articulation gymnastics. Its goal is to develop mobility and lift the back third of the back of the tongue. The exercises “Slide”, “Reel”, “Blow the snowflake off the hill”, “Warm the handles” are performed. Useful imitation of yawning, coughing, hiccups, swallowing drops of water from a pipette.
• Logopedic massage. It is aimed at normalizing the tone of the lingual muscles (activation or relaxation). Massage of the articulatory organs is often carried out using speech therapy probes.

Sound production is carried out imitatively or mechanically from the supporting syllables by moving the tongue deep into the oral cavity (Ta - Ka, Da - Ga, Sa - Ha). After receiving the normative sound, they proceed to the stage of fixing. With kappacisms, this completes the work, with paracapacisms, differentiation of mixed sounds is additionally required.