Aphasia: causes and mechanisms of speech disorders. Characteristics of afferent motor aphasia: mechanism, symptoms, leading directions of rehabilitation training Causes and mechanisms of aphasia
Aphasia. The concept of aphasia…………………………………………………………….
Etiology of aphasia…………………………………………………………
Classification of forms of aphasia………………………………………………………………
Forms of aphasia……………………………………………………………..
Restoration work……………………………………………………………….
Methodological basis for speech restoration in aphasia……………
Scheme of examination of a patient with aphasia………………………………..
necessary for a speech therapy room,
hospitals and clinics………………………………………………………………
Aphasia. Concept of aphasia
Aphasia is a systemic speech disorder consisting of complete loss or partial loss of speech and caused by local damage to one or more speech areas of the brain.
In the vast majority of cases, aphasia occurs in adults, but it is also possible in children if brain damage occurs after speech has been at least partially formed.
The term "aphasia" comes from the Greek. “fasio” (I say) and the prefix “a” (“not”) literally means “I don’t say.”
Since aphasia does not always have a complete absence of speech, it could be called dysphasia. However, in science there is the concept of a busy term. In this case, this is precisely the obstacle to designating incomplete speech destruction as “dysphasia.” In the literature, especially Western literature, the term “dysphasia” refers to various disorders of speech development in children, similar to how dyslalia refers to disorders of sound pronunciation, and not partial underdevelopment of speech (alalia).
The above explains a certain convention of the terms “aphasia” and “alalia”. From the point of view of strict logic, there is a certain paradox: it can be stated that the patient has moderate or mild aphasia, while at the same time the term itself implies the absence of speech. This terminological inaccuracy is a tribute to the traditions that led to the emergence of these not entirely accurate designations.
Regardless of such terminological conventions, the concept of aphasia has now been fully defined. It comes down to recognizing:
Systematic speech disorder, which implies the presence of a primary defect and secondary speech disorders arising from it, covering all language levels (phonetics, vocabulary and grammar);
Mandatory disruption of the processes of not only external, but also internal speech.
This situation is due to the specifics of the speech function itself:
a) its division into internal and external speech;
b) systematic, i.e. the dependence of some parts on others, as in any system.
Etiology of aphasia
Aphasia can have different etiologies: vascular; traumatic (traumatic brain injury); tumor.
Vascular lesions of the brain have different names: strokes, or cerebral infarctions, or cerebrovascular accidents
They, in turn, are divided into subspecies. The main types of strokes (cerebral infarctions, cerebrovascular accidents) are ischemia and hemorrhage. The term ischemia means starvation. The term “hemorrhage” means “hemorrhage” (from the Latin gemorra - blood). “Starvation” (ischemia) leads to the death of brain cells, because they are left without the main “food” - blood. Hemorrhage (hemorrhage) also destroys brain cells, but for other reasons: either they become filled with blood (figuratively speaking, “choking” in blood and softening, forming foci of softening in the brain, or a blood sac forms at the site of the hemorrhage - a hematoma. With its weight, the hematoma destroys (softens) nearby nerve cells. Sometimes hematomas turn into hard sacs - cysts - “cysts”. In this case, the danger of their rupture decreases; the danger of crushing the brain matter remains.
The cause of ischemia can be:
Stenosis (narrowing of blood vessels in the brain), resulting in difficulty in the passage of blood through the vascular bed;
Thrombosis, embolism or thromboembolism blocking the vascular system (“a thrombus is a blood clot that plays the role of a “plug”, an embolus is a foreign body (an air bubble, a torn piece of flabby tissue of a diseased organ, even the heart; thromboembolism is the same emboli, but enveloped blood clots);
Sclerotic “plaques” on the walls of blood vessels that impede blood flow;
Prolonged arterial hypotension, when the walls of blood vessels do not receive the necessary blood pressure, weaken and collapse, becoming unable to push blood through;
The cause of hemorrhage can be:
High blood pressure, tearing the walls of the vessel;
Congenital vascular pathology, for example, aneurysm, when the curved wall of the vessel becomes thinner and ruptures more easily than its other parts;
Sclerotic layers on the walls of blood vessels, making them brittle and susceptible to rupture even at low blood pressure.
Brain injuries can be open or closed. Both of them destroy the brain, including speech areas. In addition, with injuries, especially those associated with blows to the skull, to a greater extent than with strokes, there is a danger of pathological effects on the entire brain - contusions. In these cases, in addition to focal symptoms, changes in the course of nervous processes may occur (slowdown, weakening of intensity, exhaustion, viscosity, etc.).
For open brain injuries, surgical intervention is used to clean the wounds, for example, from bone fragments, blood clots, etc.), for closed injuries, surgical intervention (craniotomy) can be performed, or conservative treatment can be used, in which the therapy is designed to mainly for the resorption of intracranial hematomas.
Brain tumors can be benign or malignant. Malignant ones grow faster. Just like hematomas, tumors compress the substance of the brain, and by growing into it, they destroy nerve cells. Tumors are subject to surgical treatment. Currently, neurosurgery techniques make it possible to remove tumors that were previously considered inoperable. Nevertheless, there remain some tumors, the removal of which is dangerous due to damage to vital centers, or they have already reached such a size that the brain substance is destroyed, and removal of the tumor will not give significant positive results.
The most severe consequences of local brain lesions of any etiology are the following disorders:
a) speech and other skills (orientation in space, ability to write, read, count, etc.);
b) movements. They can be present simultaneously, but they can also appear in isolation: the patient may have movement disorders, but speech disorders may not be present, and vice versa.
Movement disorders most often occur on one side of the body and are called hemiplegia (complete loss of movement on one side of the body) or hemiparesis. “Hemi” means “half”, “paresis” means partial, incomplete paralysis. Paralysis and paresis can affect only the arm or only the leg, or can spread to both the upper and lower limbs.
Since aphasia is a speech disorder that occurs predominantly in the left hemisphere, hemiparalysis and hemiparesis in patients with aphasia occur on the right half of the body. When the right hemisphere is damaged, left-sided hemiparesis or paralysis develops, while aphasia is not always present or appears in a “weakened” form. In this case, as is generally accepted, the patient has obvious or hidden (potential) left-handedness. It is the reason that part of the speech function in such patients is located not in the left hemisphere, as in most people, but in the right. In other words, there is a point of view according to which left-handers have a special distribution of HMF across the cerebral hemispheres.
Classification of forms of aphasia
The most widespread and recognized in domestic and foreign aphasiology is the neuropsychological classification created by A.R. Luria. It replaced the classical neurological classification of forms of aphasia, the origins of which were P. Broca and K. Wernicke.
The concept of aphasia is based on A.R. Luria put forward the idea that the lesion is always located at the level of the secondary fields of the cortex of the left hemisphere. It leads to one or another type of speech agnosia or apraxia, which have a systemic pathological effect on the functioning of the tertiary fields of the cortex. As a result, the patient experiences difficulties in using the means of language necessary to convey the meaning of the message. Thus, according to A.R. Luria, tertiary (semantic) fields of the cortex remain unaffected in aphasia, but cannot fully function, having lost gnostic or praxic supports. Schematically the point of view of A.R. Luria can be represented as follows:
Algorithm for the development of aphasia as a result of focal brain damage
Level of tertiary fields of the cortex - semantic level of speech (use of language)
The level of secondary fields of the cortex - various types of gnosis and praxis.
The focus of brain damage can be located in different parts of the secondary fields of the cortex - frontal, postfrontal, premotor, postcentral (nucnetoparietal), temporal, occipital. It can cover (either one or several) departments. A.R. Luria believes that in this case the “prerequisite” necessary for the implementation of these functions has been violated. Thus, within the framework of understanding speech, a prerequisite is speech auditory gnosis, within the framework of one’s own oral speech - articulatory praxis, etc.
The form of aphasia depends on which particular precondition is affected, and therefore where the lesion is located.
Classification of forms of aphasia, according to A.R. Luria (6 forms):
1.Motor aphasia of the afferent type.
2.Motor aphasia of the efferent type.
3. Dynamic aphasia.
4.Sensory (acoustic-gnostic) aphasia.
5.Acoustic-mnestic aphasia.
6. Semantic aphasia.
Amnestic and conduction aphasia, observed in practice and diagnosed by clinicians, are not included in this classification.
The clinical picture of each form of aphasia (volume of symptoms, their severity, etc.) is influenced by the size of the lesion, its depth, etiology and stage of the disease. Depth refers to the spread of the lesion not only to the cortex, but also to deeper parts of the brain, including the subcortical level.
Forms of aphasia
Afferent motor aphasia . This form of aphasia occurs when the lower parts of the postcentral zone of the left dominant (in right-handed) hemisphere are damaged at the level of the secondary cortical fields.
The primary defect is afferent articulatory apraxia, described above. The main manifestation of this apraxia is the collapse of the generalized articulatory postures of speech sounds - the article. This leads to the inability to reproduce speech sounds - to articulate them. As a result, the patient’s speech is either absent or severely limited in volume. Often speech sounds are reproduced distortedly, especially if they are similar in the method and place of formation, those that are pronounced by the same organ, for example, the lips, tip or root of the tongue. Such sounds are called homorgan sounds (“homo” - “homogeneous”, “organ” - “relating to an organ”). Thus, homorgan sounds include “t-d-l-n”, “b-m-p”, “g-k”.
Patients confuse sounds that are more distant in their articulation patterns less often. These sounds are designated as heteroorganic (pronounced by different organs of articulation). For example, these include “p” and “m”, “d” and “k”, etc.
The most characteristic symptoms of afferent motor aphasia are either a complete inability to articulate, or a search for articulation, when the patient makes seemingly random movements of the tongue and lips before pronouncing a particular sound. The search for the articulation of a separate sound (articulome) often ends unsuccessfully, i.e. the wrong sound is pronounced, but even if it is possible to find the correct article, the speech does not look normative, because constantly interrupted by pauses that interrupt its flow.
Secondary, systemic disturbances of speech activity in afferent motor aphasia manifest themselves in the fact that other aspects of the speech function are upset.
Often afferent articulatory apraxia is combined with an even more elementary disorder of the pronunciation side of speech, namely oral apraxia. It consists in the inability to reproduce voluntary movements by organs located in the oral cavity (“oral” means “mouth”). Patients lose the ability to click, click their tongue on a task, blow, etc. Involuntarily, these same movements can be performed by these patients, sometimes even easily, since they do not have paresis that limits the range of oral movements.
Patients with severe articulatory apraxia and an almost complete absence of expressive speech at certain moments associated with a special emotional upsurge can involuntarily utter highly automated speech cliches such as “come on”, “how can this be?”, “I don’t know”, “oh!” etc. At the same time, they gesticulate intensely and give exaggerated facial grimaces. They often have a so-called speech “embolus”. Most often this is a “splinter” of a highly consolidated word, for example, the name of a loved one, or a fragment of a word pronounced at the time of illness (stroke), or a word of abusive language, which is highly consolidated among many people. Unfortunately, the words of favorite poetic works or prayers, which acted as speech emboli in patients of the past, are practically not found in the present population. The term “embolus” was introduced by clinical neurologists and reflects their system of views on clinical phenomena. They regarded a fragment of a word in the patient’s residual speech as a “plug,” similar to an embolus that “plugs” the blood flow through the vascular bed. Speech emboli are pronounced forcefully; the patient is usually unable to “suppress” them on his own. Despite its intrusive and uncontrollable nature, embolus often has important communicative functions. It is richly intonated, accompanied by gestural and facial reactions, and through the use of these paralinguistic means, it often allows the patient to express his thoughts quite clearly.
Speech represented by automatisms of ordinal speech (conjugate or reflected, ordinal counting, singing with words, finishing proverbs, phrases with a rigid context, etc.) is close to speech emboli.
With a less severe degree of speech defect in patients with afferent motor aphasia, repeated speech is present, however, as a rule, it is also grossly impaired. It is not possible to pronounce even individual sounds, including vowels. The patient often peers at the visual image of the interlocutor’s articulome. This helps him.
The naming of objects is not primarily impaired. Patients remember words, but cannot pronounce them, i.e. find articulomes corresponding to internal sounds. If articulatory apraxia is not severe, then patients reproduce quite a lot of word names (nominations).
The state of phrasal, including dialogical, speech depends on the degree of severity of the articulatory defect. Most often, patients remain able to pronounce the words “yes” and “no”.
Patients with afferent motor aphasia understand speech, and primarily situational speech. Sometimes - in a fairly large volume. When showing objects, as well as when following oral instructions, mistakes are sometimes made, as well as when showing objects and body parts. It is generally accepted that these difficulties are due to the inability to fully rely on pronunciation due to articulation disorders.
The differentiation of phonemes, including oppositional ones (from another phoneme by only one acoustic-articulatory feature), is not primarily impaired, although errors are often present. Their reason is the same as when understanding speech: insufficiency of articulatory supports. The volume of auditory-speech memory in most cases cannot be determined due to the severity of the primary defect.
Reading and writing are impaired, but to varying degrees, depending on the severity of the aphasia. In patients with severe aphasia, reading is predominantly global or “to oneself.” This means that they are able to read ideogram words and label pictures. Patients have difficulty reading even individual letters out loud. However, they are often correctly shown by name. Writing often comes down to the ability to write only your last name. Patients with mild aphasia have writing errors in which letter substitutions are found. They are based on the articulatory proximity of the speech sounds denoted by these letters. An interesting phenomenon is observed in patients with gross afferent motor aphasia when copying. They try to reproduce the copied text exactly as it was presented to them. This is called “slave copying.” The sound-letter analysis of the word composition suffers. Patients find it difficult to determine the number of letters in a word, as well as to fill in missing letters.
If the severity of aphasia is not severe, the letter is accessible to patients, but it contains errors. The main reason for their appearance is the primary disintegration of the associative connection between the articulum and the grapheme. When trying to write, patients repeatedly repeat each sound of a word, try to “attach” some fixed word to it (“mmm... mom”), as a rule, they allow a large number of omissions, literal paragraphs, etc. The sound-letter analysis of the composition of a word suffers significantly. Patients make mistakes in determining the number of letters in a word, their quality, and the order in which they appear.
Afferent motor aphasia is characterized by the fact that patients often retain the outline of the word. The sound content in a word may be incorrect, but the overall sound is preserved. This is explained by the fact that their primary defect consists in the disintegration of isolated articles, and not the sound image of the word as a whole.
The tempo of speech is most often slow, and the intonation is exaggerated. Speech activity in this form of aphasia is sufficient, but communicative speech is mainly dialogical in nature.
In patients with gross afferent motor aphasia, phrase speech is naturally absent. The inability to construct and pronounce a sentence is considered in the neuropsychological classification of aphasias as a systemic consequence of the articulatory incompetence of patients. Patients with a mild degree of afferent motor aphasia can, although with distortions (agramatisms), pronounce fairly detailed phrases, varied in logical and syntactic structure. Vocabulary composition without sharp restrictions. Patients are also able to give a verbal account of any event. They willingly engage in verbal communication. Speech activity is quite high.
Efferent motor aphasia . This form of aphasia is caused by damage to the secondary fields of the cortex of the lower parts of the premotor zone of the left dominant (in right-handed) hemisphere of the brain. This area is often referred to as Broca's area, which was the first to argue that it is responsible for motor speech. True, Broca's patient had complex motor aphasia, and accordingly the area of brain damage was more extensive, but his name was assigned primarily to the premotor area.
Normally, this area of the brain ensures a smooth change from one oral or articulatory act to another. Since we do not speak with separate articles, for example, k, o, w, k, a, it is necessary that they merge into successive series, which L.S. Vygotsky called successive (sequential), and A.R. Luria - “kinetic melodies”.
With efferent motor aphasia, the reproduction of smooth speech suffers due to the pathological inertia of articulatory acts. It manifests itself most clearly in perseverations, which prevent free switching from one articulatory posture to another. As a result, the patients’ speech becomes fragmented and is accompanied by getting stuck on some fragments of the statement.
These defects in the pronunciation side of speech cause systemic disorders in other aspects of speech functions: reading, writing and partially understanding speech. Thus, in contrast to articulatory apraxia in patients with afferent motor aphasia, in patients with efferent motor aphasia, apraxia of the articulatory apparatus refers to a series of articulatory acts, and not a single posture. Patients pronounce individual sounds relatively easily, but experience significant difficulties when pronouncing words and phrases.
With gross efferent motor aphasia, spontaneous speech of patients is extremely poor. It consists mainly of well-reinforced words, mainly nominations. There are significant pronunciation difficulties, manifested in “getting stuck” on individual fragments of a word. Words are “torn”; their outlines, as a rule, are not preserved. The intonation is poor and monotonous. There are errors in accent. In general, the statement lacks fluency; it is fragmented. Speech activity is low.
The phrase is practically absent. Sometimes there is agrammatism of the telegraphic style, in which the vocabulary is represented mainly by nouns and frequency verbs in the infinitive. In words with a complex sound structure, difficulties in articulatory switching are expressed. Errors associated with perseverative “attachment” to any of the operations that make up a speech act are identified. They make it impossible to switch to another link of action. In most cases, patients, even with severe speech defects, have elements of automated speech, represented by severe speech stereotypies: conjugate and reflected counting, singing with words. Pronunciation difficulties in this type of speech are somewhat smoothed out. Reverse automated speech (for example, counting from 10 to 0), unlike direct speech, is inaccessible to patients mainly due to the large number of perseverations.
It is possible to repeat individual sounds both based on an articulatory image and according to an acoustic model. Repeated speech is better than spontaneous speech, however, it is also difficult due to the inability to make articulatory switches. Patients are unable to merge consonant and vowel sounds into an open simple syllable. Reproduction of the word, as a rule, fails. Repeated speech appears in the process of restoration of speech function before spontaneous speech.
Oral praxis is grossly violated in terms of the serial organization of the act. Patients cope with reproducing individual poses, but find it difficult to make switches. When trying to reproduce a series of oral positions, distortions and stuckness on individual elements occur. The same is observed in articulatory praxis: patients repeat isolated sounds relatively freely, but the task of reproducing a series of sounds causes a significant articulatory failure.
There are no primary disorders of speech understanding, but there are difficulties in its perception due to inertia in the area of switching auditory attention. In addition, patients with this form of aphasia are characterized by an incomplete understanding of speech structures in which grammatical elements carry a significant semantic load.
Written speech is grossly impaired. Not only writing, but also reading words and phrases is practically absent. The ability to read individual letters remains, since there is no primary disintegration of the “article-grapheme” connection. Most patients have elements of global reading (laying out captions under pictures, etc.)
With an average degree of severity of efferent motor aphasia, the spontaneous speech of patients is quite developed, the phrase is monotonous in syntactic structure, but there is a large number of speech cliches that mask the existing difficulties. Individual agrammatisms are identified, which are defects in the field of word formation and inflection. The vocabulary is varied. The statement is not always situational in nature. Monologue speech on certain topics is possible. Repeated speech, as a rule, is present in one volume or another. Patients cope with the repetition of sounds, syllables, words and simple phrases. However, in phrases that are more complex in syntactic structure, agrammatisms are allowed. There are articulatory difficulties when pronouncing words. The prosodic component of the utterance also suffers. Patients have difficulty conveying the intonation of a question or exclamation.
Simple types of dialogic speech (mostly of a situational nature) are accessible to most patients. In this case, frequent echolalia and direct use of the text of the question to answer are noted. Dialogues of a non-situational nature are practically impossible.
Repeated speech with significant pronunciation difficulties, manifested in the absence of main articulatory transitions within a word (tendency towards syllable-by-syllable pronunciation).
Dialogue speech is generally preserved, but stereotypical responses and perseveration (getting stuck on fragments of previous answers) are observed. Difficulties in switching from one word fragment to another are expressed. Situational dialogue is the most accessible.
Based on the plot picture, patients make up only phrases. There are frequent omissions of names of actions, auxiliary parts of speech, endings, etc. However, in addition to these elements of telegraphic style, there are also pronunciation difficulties. When retelling texts, there are some difficulties in constructing phrases, elements of agrammatism such as telegraphic style. The utterances are somewhat poor prosodically, and there are occasional articulatory jams.
Within the framework of naming, it is possible to produce individual high-frequency words, but there are obstacles in the form of perseverations, which manifest themselves in “getting stuck” on previous nominations. The difficulties of the sound (articulatory) organization of a word are quite significant. The kinetic melody of the word has been changed. The syllable structure is often disrupted. Patients rarely “give” low-frequency names and avoid words with a complex sound structure. Phrasal speech is simplified in semantic and syntactic structure.
Features of speech understanding, as in patients with gross afferent motor aphasia, are secondary in nature, being a systemic consequence of insufficient articulatory reinforcement. The volume of auditory-speech memory is narrowed, traces of speech series perceived by ear are, as a rule, weakened.
Written speech is impaired, but reading is much less so than writing. In dictation writing there is a large number of literal paraphasias caused by perseverations and omissions of not only consonants, but also vowels. This is mainly due to violations of the sound-letter analysis of the composition of a word, namely the difficulties of organizing its successive sound structure. It should be noted that in general, with efferent motor aphasia, the decay of the “articulome-grapheme” connection is less pronounced than with afferent motor aphasia.
Most patients have oral praxis disorders. Switching from pose to pose, from articule to articule is difficult, especially in difficult conditions.
Dynamic aphasia. With dynamic aphasia, brain damage occurs in the posterior frontal parts of the left hemisphere, located anterior to Broca's area at the level of the tertiary fields of the cortex. This form of aphasia was first identified and described by A.R. Luria. According to studies of dynamic aphasia conducted by TV. Akhutina and being a development of the ideas of A.R. Luria, it has two main options.
Option 1 is characterized by a predominant violation of the speech programming function, and therefore patients mainly use ready-made speech stamps that do not require special “programming activities.”
In dynamic aphasia II, the primary defect is a dysfunction of grammatical structuring: in the speech of patients it appears in the form of expressive agrammatism, most grossly manifested in the absence or extreme impoverishment of the grammatical design of the statement - “telegraphic style”. Pronunciation difficulties in both options are not significant. It is very important that in both forms there is speech inactivity and aspontaneity.
With a rough degree of severity of dynamic aphasia, spontaneous speech is practically absent, with the exception of individual cliches of a conversational nature, strengthened in previous speech practice. When pronouncing these stereotypical figures of speech, no pronunciation difficulties are detected. The intonation picture is monotonous. Speech activity is low. Echolalia is common. Patients constantly need stimulation to speak from the outside.
Patients cope with all types of direct automated speech, but the reverse is accompanied by perseverations, exhaustion of attention, slipping into the direct order of enumeration, etc. Repeated speech is mainly echolalia. Repeated words and phrases, as a rule, are not meaningful. Perseverations are expressed in the form of “additional” speech production of the type of “getting stuck” on previous fragments of sound and semantic slippage.
Dialogue speech is practically absent. Patients are only able to answer with the words “yes” or “no”, and also use individual interjections as answers.
Most patients succeed in naming individual everyday objects. Composing a phrase based on a plot picture poses significant difficulties. Retelling texts is almost impossible. Elements of “field behavior” are identified due to exhaustion of attention and perseverations: the patient is distracted by what is within the field of vision.
Sometimes there is a lack of understanding of grammatically complex speech. The phenomena of “pseudo-alienation of the meaning of a word” are noted due to the difficulties of inclusion in the task. It is usually difficult to study the volume of auditory-speech memory due to defects in understanding.
Written speech is impaired. Reading individual letters in simple words is accessible to patients. Reading phrases with distortions caused by perseverations, leading to getting stuck on individual words and the inability to switch to the next ones. Writing individual letters and simple words is in most cases accessible to patients. When copying or writing from dictation of complex words and phrases, patients make a number of distortions, mainly in the form of omissions and perseverative “insertions” of text elements. Writing “from oneself” is practically inaccessible due to the general decrease in speech activity.
Oral and articulatory praxis are practically without disturbances. In different types of activity, “delayed” perseverations may occur, manifested in the emergence of fragments of the action after a certain time after its completion. Patients also find it difficult to switch from one type of activity to another, for example, from hand and finger tests to oral ones, from oral to articulatory ones.
With a less severe degree of severity of Dynamic aphasia, the spontaneous speech of patients consists of short phrases, monotonous in syntactic structure. Speech cliches, both colloquial and professional, are common. In general, the statement looks poor, monotonous in intonation. The same “sayings”, previously reinforced in everyday and professional speech, are often repeated. The overall pattern is characterized by insufficient intonation expressiveness. The morphological structure of speech is characterized by a decrease in modal-evaluative words, auxiliary parts of speech, etc. Some patients have agrammatisms associated with difficulties in constructing phrases. Pronunciation difficulties are not identified.
Vocabulary composition without sharp restrictions. Speech activity is low. Dialogue speech predominates. Echolalia is noted, mainly “due to fatigue.”
In repeated speech, patients are more proficient than in other types of speech activity, however, echolalia also occurs in it, mainly “at exhaustion.” There is a tendency to use a large number of rigid speech cliches that arise involuntarily, perseveratively. The prosodic component has been changed in the direction of reducing expressiveness and emotional clarity.
The nominative function of speech is without gross violations, but the subject vocabulary is significantly superior to the verbal one. Patients can participate in dialogue, but their answers are mostly stereotypical, and question-and-answer types of speech are not sufficiently developed. Situational dialogue is the most accessible.
Patients are able to compose a simple phrase based on a plot picture, but true expressive agrammatism is characteristic. If the plot of the picture contains both a subject and an animate object of action, difficulties arise in speech programming at the level of the deep structure of the phrase. They are associated mainly with the difficulties of defining the subject and “attributing” to him the fact of committing the corresponding action. In some patients, errors in inflections, prepositions and other grammatical elements of the statement predominate.
Retelling of texts is carried out by patients most often in the form of answers to questions or according to a very detailed plan. In this case, a clear “attachment” of the plots to the syntactic model of the question is revealed.
The volume of auditory-speech memory is initially narrowed, there are elements of “distraction” of attention when perceiving speech series.
Written speech as a function is preserved, however, there are phenomena of “getting stuck” on individual fragments of text, both when reading and when writing, omissions of words and entire phrases. Reading comprehension suffers significantly. When using special techniques that concentrate the patient’s attention, the possibilities of understanding are greatly expanded. Writing from dictation is much better than writing from yourself. The latter is limited to stereotypical speech constructions, indicating the speech aspontaneity of patients with this form of aphasia not only in oral, but also in written speech. There are no gross violations in the field of sound-letter analysis of the word composition, although there are errors due to lack of attention, as well as perseverations. Oral-articulatory apraxia, as a rule, is not detected, or it is detected in complicated conditions.
Sensory (acoustic-gnostic) aphasia . It occurs with damage to the superotemporal regions, the so-called Wernicke's area, who first discovered it as responsible for understanding speech and designated the aphasia that occurs with its damage as sensory. The primary defect in sensory aphasia is a violation of the ability, which is considered to be directly dependent on the state of phonetic hearing. It consists in differentiating the semantic distinctive features of speech sounds adopted in a given specific language. Phonemic hearing disorders cause, according to the neuropsychological concept of aphasia, gross impairments of impressive speech - understanding. The phenomenon of “alienation of the meaning of a word” appears, which is characterized by a “stratification” of the sound shell of the word and its subject relevance. Speech sounds lose their constant, stable sound for the patient and are perceived distorted each time, mixed with each other according to one or another parameter. As a result of this sound lability, characteristic defects appear in the expressive speech of patients: logorrhea (an abundance of speech production) as a result of the “chase of elusive noise”, the replacement of some words with others, some sounds with others: verbal and literal paraphasia.
With a severe degree of sensory aphasia, the scope of speech understanding is extremely limited. Patients are able to comprehend only purely situational speech, which is close to them in topic. A gross alienation of the meaning of the word is revealed when showing body parts and objects. Verbal instructions are not followed or are carried out with gross distortions. These phenomena are based on a primary gross violation of phonemic hearing. When perceiving speech, patients rely heavily on facial expressions, gestures, and intonation of the interlocutor. Written speech suffers primarily due to the collapse of the associative connection between phoneme and grapheme. This is most crude in relation to oppositional phonemes. Patients try to find a letter, relying on words in which it is most firmly established (for example, “m..m..m - mother; ko...ko - cat”, etc.), however, this path often does not lead to the desired result.
With a less severe degree of sensory aphasia, patients generally understand situational speech, but the perception of more complex non-situational types of speech is difficult. There are errors in understanding words - paragnosis, as well as alienation of the meaning of a word in the names of individual objects and parts of the body. Sometimes patients are able to differentiate words with oppositional phonemes, but make mistakes in the corresponding syllables. There is no sharply expressed dissociation between the ability to understand words with abstract and concrete meanings, although the subject relatedness suffers more often than the figurative meaning of the word. The ability to understand speech is significantly influenced by the rate of speech of the interlocutor and its prosodic features. In the task of assessing the correctness of a speech construction, patients, as a rule, distinguish grammatically distorted constructions from correct ones, but do not notice semantic inconsistencies in them. They are able to notice only gross semantic distortions and have difficulty perceiving detailed texts. Understanding texts that require a number of sequential logical operations poses a certain problem. Sometimes in complicated conditions of depletion of auditory attention. Verbal instructions are often followed with errors. Written speech is characterized by the same features as oral speech, moreover, expressed more prominently.
Acoustic-mnestic aphasia . This form of aphasia is caused by a lesion located in the middle and posterior parts of the temporal region. Unlike acoustic-gnostic aphasia, the acoustic defect manifests itself here not in the sphere of phonemic analysis, but in the sphere of auditory mnestic activity. Patients lose the ability to retain information perceived by ear in memory, thereby exhibiting a narrowing of the volume of auditory-speech memory and the presence of weakness of acoustic traces. These defects lead to certain difficulties in understanding detailed types of speech that require the participation of auditory-speech memory. In the own speech of patients with this form of aphasia, the main manifestation is a vocabulary deficit, associated both with a secondary impoverishment of the associative connections of a word within a given semantic bush, and with a lack of visual representations of the subject. Thus, according to A.R. Luria, acoustic-mnestic aphasia also includes a component of amnestic aphasia.
Semantic aphasia occurs when the temporo-parietal-occipital areas of the left dominant hemisphere are damaged - the so-called TPO zone (temporal-parietal-occipital). Semantic aphasia was first described by G. Head under the same name. A.R. Luria conducted a neuropsychological factor analysis of semantic aphasia and, in accordance with his concept, identified the primary defect and its systemic consequences. The main manifestation of speech pathology in this type of aphasia A.R. Luria designated as impressive agrammatism, i.e. inability to understand complex logical and grammatical figures of speech. It is based on a more elementary premise, namely, one of the types of general disorder of spatial gnosis - a violation of the ability to simultaneous synthesis. Since in speech the main “details” that connect words into a single whole (logical-grammatical structure) are grammatical elements, the main difficulty is associated with isolating these elements, understanding their semantic role and combining them into a single simultaneous whole. Most of all, such patients have difficulty with words with spatial meaning (spatial prepositions, adverbs, etc.).
Residual effects of speech dysfunction manifest themselves only in a slower pace of oral and written speech, sometimes there are difficulties in selecting the right word (in a detailed statement), isolated errors in writing and rare agrammatisms of “coordination” when using syntactically complex speech structures. Due to the state of speech function, such patients are suitable for work not related to linguistic activities.
With mild semantic aphasia, patients write summaries, essays on a given topic, and read with almost no difficulty, if they do not have to operate with logical and grammatical figures of speech.
Restoration work.
Patients after ischemic stroke achieve maximum recovery (“ceiling”) often within 2-4 years.
Therefore, the number of repeat courses may be limited to 2-3 internships, and the total duration of work to 3-4 years.
The beginning of rehabilitation training should be preceded by a thorough examination of the patient’s speech condition. Such an examination, conducted by a doctor, neuropsychologist or speech therapist, should reveal the nature and depth of disorders in various aspects of speech. Its task is also to detect preserved elements of speech and other cortical functions. The examination should, if possible, cover all aspects of speech, as well as the state of praxis, gnosis, counting, etc.
Based on the examination, taking into account the clinical examination data, a general conclusion is entered that determines the form of the speech disorder and the stage of restoration of speech functions.
Individual and collective speech therapy sessions are conducted with patients with aphasia. The individual form of work should be considered the main one, since it is this that ensures maximum consideration of the patient’s characteristics, the closest personal contact with him, as well as a greater possibility of psychotherapeutic influence.
During classes in hospitals and clinics, constant medical supervision is required. The speech therapist (or teacher leading the classes) must be in constant contact with the doctor and be the first to signal changes in the patients’ condition during classes (increased speech disorders, increased distractibility, etc.).
When conducting classes with patients with aphasia, the frequency and duration of these classes, intervals, and changes in forms of work are determined by the condition of the patients and the degree of their individual exhaustion. They are also associated with various tasks of rehabilitation training at different stages of the dynamics of speech functions after a stroke (see below).
The duration of each lesson at the early stage after a stroke is on average 10-15 minutes, preferably 2 times a day.
The average time for individual lessons at the late and residual stages should be considered 30-45 minutes, preferably daily, but at least three times a week. For collective classes (no more than three to five people in a group), class time is 45-60 minutes.
At the beginning of working with patients and as speech functions are restored, it is necessary to periodically, based on the patient’s speech status, determine the tasks and proposed methods of restorative training for a patient with aphasia. They should be recorded in a special speech therapy record for each patient. In the medical history, the speech therapist should also briefly record changes in the patients’ speech state at least twice a month.
When organizing collective classes, it is advisable to form groups with similar forms of speech disorders and relatively the same stage of recovery.
It is advisable to conduct evening classes with patients in inpatient settings. They must wear a homework uniform for patients. Their main task is to consolidate the methods of overcoming certain speech defects mastered in classes with a speech therapist.
Evening work with patients with aphasia may, however, include activities that go beyond just deepening the basic program of rehabilitation education.
This refers to collective activities that bring together patients with different forms of aphasia and include accessible elements of “club” work: conversations on current events, showing transparencies such as “movie travel”, discussion of a television film. So-called speech games, games like lotto, guessing riddles, etc. are also useful.
Constant contact between the speech therapist and the family of a patient with aphasia is desirable. Family members, according to the instructions of the speech therapist, can exercise the patient in certain types of speech activities and do homework with him.
The speech therapist must explain to the relatives of a patient with aphasia the features of his personality associated with the severity of the disease and the loss, to one degree or another, of the possibility of verbal communication.
Using specific examples, it is necessary to explain the obligation of a careful, patient and at the same time respectful attitude towards the patient and the desirability of his feasible participation in the life of the family.
The speech therapist can also help the patient's family members and friends understand the need to constantly encourage the patient in his attempts to communicate verbally, without focusing, especially in the early stages after a stroke, on the irregularities of his speech.
Upon discharge from the hospital and completion of the stages of outpatient training, it is recommended to use four assessments of the results of rehabilitation training: 1) “significant restoration”: the availability of free oral and written expression with elements of agrammatism and with very rare errors in writing; 2) “general improvement”: the ability to communicate using phrases, composing simple texts based on a series of plot pictures, relative restoration of writing and reading, and in case of sensory aphasia, also a general improvement in listening comprehension of speech; 3) “partial improvement”: improvement of certain aspects of speech function (for example, it became possible to communicate using individual words, speech understanding improved, reading and writing were restored to one degree or another, etc.); 4) “no change”: lack of positive dynamics in the state of speech
Methodological basis for speech restoration in aphasia
The question of methods of rehabilitation treatment for patients with aphasia is a priority.
At an early stage after a stroke, a mechanism is used to disinhibit temporarily suppressed speech functions and involve them in activities.
At later, residual stages, when a speech disorder acquires the character of a persistent, established syndrome (form) of a speech disorder, the essence of the recovery process is rather a compensatory restructuring of organically impaired functions using intact aspects of the psyche, as well as stimulation of the activity of intact elements of the analyzers.
When developing a methodological program for rehabilitation work, its individualization is mandatory: taking into account the characteristics of speech disorders, the patient’s personality, his interests, needs, etc.
It should be taken into account that when setting goals for rehabilitation therapy (developing its program), the following is necessary:
Differentiation of rehabilitation therapy methods for different forms of aphasic disorders;
When organizing and choosing a method of rehabilitation therapy, one must proceed from the stage principle, i.e., take into account the stage of restoration of speech functions;
With aphasia, it is necessary to work on all aspects of speech, regardless of which one is primarily impaired;
In all forms of aphasia, it is necessary to develop both the generalizing and communicative (used in communication) side of speech
Restore speech function not only with a speech therapist, in the family circle, but also in a wider social environment;
In all forms of aphasia, development of the ability of self-control over one’s own speech production.
The step-by-step construction of speech restoration in aphasia refers not only to the difference in the speech therapy methods used, but also to taking into account the unequal share of the conscious participation of patients in the recovery process. It is naturally less in the initial stages after a stroke. The principle of differentiation of methods in connection with the form of aphasia is also significant in the early stages. Speech therapy techniques for disinhibiting speech functions and “reliance” on involuntary speech processes (habitual speech stereotypes, emotionally significant words, songs, poems, etc.) are more useful here. These techniques help relieve inhibitory phenomena and involve patients in verbal communication with the help of conjugate (carried out simultaneously with the speech therapist), reflected (following the speech therapist) and elementary dialogic speech.
A common feature of these early stage techniques is that they are aimed at restoring all aspects of impaired speech, mainly with the patient’s passive participation in the recovery process, as well as preventing the occurrence and fixation of some symptoms of speech pathology; These techniques also make it possible to enhance the restoration of speech functions in patients with various forms of aphasia.
When using singing for the purpose of disinhibition, the speech therapist must take into account: whether the patient sang before illness, the patient’s age, his premorbid level, familiarity of the song, etc. It is not recommended to linger on these types of work for a long time; As soon as the patient begins to restore the outline (contour) of the word, it is advisable to move on to stimulating the patient’s oral independent completion of phrases, short answers to questions, composing phrases from pictures, etc.
It should be emphasized that at an early stage, when the patient has just emerged from the period of acute stroke, work with him should be especially gentle and psychotherapeutic.
At the next stages (1.2-3 months after the stroke), with an already defined stable syndrome (form) of aphasia, techniques are used that not only stimulate the overall development of speech, but also contribute to the restructuring of impaired speech functions.
The difference from the early stage lies in the much greater differentiation of recovery methods depending on the main broken link in one form or another of aphasia.
When restoring speech in patients with aphasia, reliance on its semantic side is of particular methodological importance. The semantic side of speech is used not only in restoring verbal concepts or the grammatical structure of speech, but also in restoring acoustic-gnostic processes, the so-called phonemic hearing, and overcoming many other disorders characteristic of aphasia.
With aphasia, comprehensive work on speech as a whole is necessary. Aphasia is always a syndrome that covers all speech functions. Therefore, rehabilitation therapy should affect all aspects of the patient’s speech. For any aphasia, one should work on sound analysis and synthesis of the composition of words, on reading and writing, restoration of the generality of verbal concepts, their polysemy, development of free and detailed utterance, etc.
Fundamental methodological provisions include the need, when restoring any speech function, to first use an expanded system of external means as a support, so that in the future they will be gradually phased out. This gradual “collapse” of the external support leads to the fact that the action begins to be performed as an internal, mental action. For example, in case of violations of the grammatical structure of speech, especially at the initial stages, grammatical relations are first depicted in the form of visual spatial diagrams, which only gradually turn into internal rules for combining words in a phrase, using prepositions, etc. (L.S. Tsvetkova, 1975 ).
It is necessary to emphasize the role of the emotional factor in the rehabilitation process. Therefore, establishing the right relationship with the patient, taking into account his individual, personal characteristics, and a psychotherapeutic approach to each patient is of paramount importance.
Scheme of examination of a patient with aphasia.
1. Study of the patient’s general ability for verbal communication - a conversation to find out:
a) the completeness of the patient’s own speech;
b) his understanding of situational, everyday speech;
c) degree of speech activity;
d) tempo of speech, its general rhythmic and melodic characteristics, degree of intelligibility2.
2. Study of speech understanding. For this purpose, the following are presented aurally:
a) special verbal instructions (single-term, such as “open your mouth!”, “raise your hand!” and polynomial, such as “pick up the phone!”, “take the pen from the table, put it on the windowsill, and then hide it in your pocket!” ;
b) finding objects: “show the window!”, “show your nose!”, a series of objects, for example: “show the door, window, ceiling!” or “show your nose, ear, eye!”;
c) short plot texts;
d) logical-grammatical constructions, for example: “show where the circle is under the cross, where is the daughter’s mother, and where is the mother’s daughter, show your right ear with your left little finger,” etc.
3. Study of automatic speech:
a) direct counting to 10 and reverse counting (from 10 to 0);
b) listing the days of the week, months;
c) the ending of proverbs and phrases with a “hard” context such as: “I wash my hands with cold...”, with a “free” context, such as: “They brought me a new one...”, etc.;
d) singing songs with words.
4. Repeated speech research:
a) repetition of sounds, syllables, words, different in sound structure (for example, “porridge”, “office”, “disaster”), phrases (for example, “The boy draws an airplane”, “Groceries were brought to the store”) and tongue twisters (“ Whey from curdled milk").
5. Study of the naming function:
a) real objects and their pictures;
b) actions (answers to questions - “what to do?”, “What are they doing?” - based on plot pictures;
c) flowers;
d) fingers;
e) letters;
e) numbers.
6. Special studies of the features of phrasal speech:
a) compiling phrases with and without prepositions based on plot pictures;
b) constructing phrases from given words;
c) filling in gaps in phrases, for example:
“A jet is flying high in the sky...”; “I always wash my face cold...”; “They brought it to the store...”; “I always look forward to...”
d) a story based on a plot picture.
7. Study of phonemic hearing:
a) repetition of pairs of syllables and words with oppositional phonemes, for example “ba-pa”, “pa-ba”, etc., or “barrel - kidney”, “cat - year”, “corner - coal”, “soap” - Mila”, etc.
b) showing one of the paired syllables or words presented in writing (“show where it is written “pa”, where it is written “ba”, where it is written “year”, where it is written “cat”, etc.);
c) the patient’s assessment of the quality of repetition of syllables and words with oppositional phonemes pronounced by a speech therapist, who specifically pronounces correct and incorrect options in random order.
8. Study of auditory-speech memory. It is suggested to repeat:
a) a series of sounds, for example “asu” or “b sh a”;
b) a series of words: “house - forest - cat”, “house - forest - cat - night”;
c) short and long complex phrases.
9. Study of the meaning of words:
a) an explanation of the direct meanings of individual words, for example, answers to the question: “what are glasses, what are they for? ", "What is joy? ", what is the difference between the words: "deception" and "mistake";
b) an explanation of the figurative meanings of words and phrases, for example, answers to the question of what a “golden field”, “iron hand!” is, how to understand the proverb “What goes around comes around!” etc.
10. Study of reading and writing:
a) reading and writing from dictation of individual letters, syllables, words, phrases, as well as short texts;
b) independent writing of words and phrases from pictures;
c) sound-letter analysis of the composition of a word, i.e. determining the number of letters in a word; listing these letters; folding words from letters of the split alphabet (accounting).
11. Study of oral and spatial praxis. The following tasks are presented:
a) stick out your tongue, lift it up, put it behind your cheek, blow, click your tongue, stretch out your lips, etc.
b) blow twice and click your tongue twice, alternating these movements several times in a row;
c) repetition of spatial finger poses and series of movements (for example: fist, palm, rib).
12. Account research:
a) solving simple arithmetic examples, for example:
7+ 2 = 8 + 15 = 21 + 7 =
b) filling in the missing arithmetic sign:
5 7 = 35 20 4=5
The speech therapist must maintain the following documentation:
1) a journal or card of the initial admission of patients, which indicates the patient’s last name, first name, patronymic, age, date of illness, diagnosis, by whom he was referred, date of visit to the clinic or admission to the hospital, date of discharge, number of classes performed, description of the patient’s speech status, tasks and methods of rehabilitation training, the effectiveness of rehabilitation training and stay in other speech therapy rooms in the city;
2) cards - card indexes containing the same columns, arranged in alphabetical order for the convenience of quickly finding information about a particular patient;
3) a log of daily patient intake;
4) a diary, which reflects a summary of each session with the patient;
5) a log of visiting patients at home, stored in “Help at Home” (for outpatient patients);
6) annual reports.
An approximate list of teaching aids (of varying degrees of complexity) necessary for a speech therapy office, hospital and clinic.
1. Special aids for the restoration of phonemic differentiation (a set of paired subject pictures corresponding to words with initial sounds, close and distant in sound, and varying complexity of sound and syllabic structures); sets of pictures corresponding to words with different letter locations: at the beginning, in the middle, at the end.
2. Sets of individual words and pictures for making sentences; a set of reference phrases for composing stories; phrases with omissions of words that differ in their grammatical affiliation and in the degree [the nature of their connection with the phraseological context ("rigid" connections, "loose" connections)].
3. Sets of sentences corresponding to various logical-grammatical structures, and spatial patterns of prepositions.
4. Sets of words with missing letters; texts of sentences and stories with missing words; dictation texts.
5. A set of words: antonyms, synonyms and homonyms.
6. Sets of letters in different fonts; sets of numbers; sets of elements of letters and numbers; sets of arithmetic examples and elementary problems; sets of geometric shapes; sets of elements of geometric shapes for design.
7. Poems, proverbs, fables with developed questions for them, sayings, humorous stories.
8. Sets of texts with a missing beginning, middle, and end.
9. Pictures depicting objects and actions; story pictures of varying complexity; sequential series of pictures reflecting gradually developing events; reproductions of works of art (paintings); sets of subject pictures with missing elements.
10. Books for reading, collections of dictations, alphabet books, geographical maps, sets of records of various colors and shades.
Aphasia is a complete or partial loss of speech caused by local lesions of the brain. Etiology: can occur at any age, causes may be cerebral circulation, trauma, brain tumors. As a rule, aphasia of vascular origin occurs in adults. Luria distinguishes 6 forms of aphasia: 1. acoustic-gnostic, sensory (sound recognition) and 2. acoustic-mnestic - both occur with damage to the temporal lobe of the cerebral cortex. 3. semantic and 4. afferent-motor - arise from lesions of the lower parietal parts of the cerebral cortex. 5. efferent-motor and 6. dynamic - occur with damage to the premotor and posterior parts of the brain. The study of aphasia was carried out by Tatyana Grigoriev. Vizel, Vlad. Mikh. Shklovsky, Elena Nikolaev. Pravdina-Vinarskaya and other scientists. In children's speech therapy there are two forms - sensory and motor.
39. Characteristics of motor aphasia.
Motor aphasia occurs when the speech-motor center (broca) is damaged. The patient either cannot speak at all, or his speech is preserved. does not mean. speech capabilities. He hears and understands it, but is unable to reproduce speech. Sometimes he gets it. fragments of words (support words can be saved - yes, no, here, don’t). At the same time, spontaneous speech is impossible because the triggering mechanism of speech is disrupted. In children with aphasia, very often their reading and writing skills almost completely disintegrate, and reading is impaired. more than a letter. The patient experiences his defect very hard, they understand it. Correction of this defect is complex, in consultation with the attending physician/neurologist. Treatment lasts for many months.
40. Characteristics of sensory aphasia.
Sensory aphasia.
With sensory aphasia, speech perception is impaired.
The patient hears speech, but does not understand it.
Wernicke's centers are affected, speech is blurred as a result of:
The hearing of perception is compromised and the person loses control over his own speech
Speech understanding is poor, as the patient does not differentiate between background sounds and does not control her own speech.
Words are greatly distorted, syllables are rearranged, and reading and writing skills disintegrate.
Aphasia must be distinguished from similar conditions, that is, from alalia.
Speech restoration in sensory aphasia
Correction for sensory aphasia takes a long time, because the patient’s understanding of speech is reduced.
Conducted under the supervision of a doctor, the lesson can last no more than 5 minutes, all work is carried out using visual material.
Development of phonemes. Perceptions
Speech understanding training
Distinguishing by ear and pronunciation of words that are close in sound but different in meaning
nurturing the patient’s auditory control over his own speech and the speech of others
Work on correcting written speech
Although it is diverse in its manifestation, a speech therapist in his work must be based on an individual plan for each child.
Recovery lasts from several months to several years.
41. Impairment of written speech. Types and their characteristics.
Impaired written speech:
1. violation of the reading process:
Alexia
Dyslexia: semantic, tactile, grammatical, mnestic, optical, phonemic
2. violation of the writing process:
Agraphia
Dysgraphia: articulatory-acoustic, phonemic (acoustic), grammatical, optical, dysgraphia due to impaired language analysis and synthesis
Dysorphography
Alexia - the impossibility of the reading process
Dyslexia is a partial specific disorder of the reading process, caused by the immaturity of higher mental functions, manifested in repeated persistent errors and eliminated only as a result of speech therapy.
Biological factors include any damage to the cerebral cortex
Social factors: somatic weakness of the child, incorrect speech environment, pedagogical neglect, etc.
Dyslexia is caused by the immaturity of mental functions that are responsible for the reading process (visual analysis and synthesis, spatial representations, phonemic analysis and synthesis, underdevelopment of the lexical and grammatical structure of speech)
Semantic dyslexia - mechanical reading.
It manifests itself in a violation of the understanding of the text read with correct technical reading, sometimes it manifests itself in post-syllable reading, when a child, having read a word syllable by syllable, does not understand its meaning, cannot show the word in the picture.
Agrammatic dyslexia is caused by underdevelopment of the grammatical structure of speech, morphological and syntactic generalizations, i.e. the child reads text, incorrectly coordinates words in phrases and sentences, incorrectly uses gender endings and other prepositional constructions.
Nap: “from under the leaves”, “in the slipper”, “the wind rushed by”, “such a car”.
Mnestic dyslexia - manifests itself in difficulties in learning letters and their undifferentiated substitutions.
This is due to a violation of the connection between sounds and letters and speech memory.
Children cannot perceive 3-5 sounds or words in a row, and when repeated, they pick them up last, do not remember them, abbreviate them, that is, the association between the visual image of the letter and the sound image is broken.
Optical dyslexia - manifests itself in the difficulty of mastering and mixing 2 graphically similar letters, distinguished only by individual elements (r-f, n-p, e-s), that is, when reading, the child has difficulty recognizing letters and confuses them with graphically similar ones. This is due to lack of formation. Visual gnosis.
Phonemic dyslexia is caused by underdevelopment of the functions of phonemic analysis and synthesis.
1. Reading impairment is caused by underdevelopment of phoneme perception; when reading, phonemes are similar acoustically, but are mixed articulatory. (b-k, s-sh, d-t; sees d reads t)
2. Caused by underdevelopment of the function of continuous reading, manifested itself in letter-by-letter reading and in distortion. Nap: shovel-chamber, duck-pipe, ran and ran away.
Tactile dyslexia - (in persons with visual impairments) observed in hearing-impaired children, read using the Brailler alphabet.
Agrofia – it is impossible to carry out the writing process
Dysorphrophia is the inability to master the harpograph. Rules
Dysgraphia is a partial specific violation of the writing process, caused by the immaturity of the VPF) or their violation) manifested in persistent repeated errors when writing and can be eliminated only as a result of speech therapy.
A letter is a complex form of human speech; this process is multi-level and various analyzers take part in it
(tactile, speech-auditory, speech = motor, visual, general motor)
Articulatory-acoustic dysgr- The child writes the way he pronounces, i.e., the deficiencies in pronunciation are transferred to the letter, that is, the child has not formed the correct kinesthetic image and sound.
Phonemic imbalance - manifested in the replacement of letters with phonetically similar sounds (eg: z-s, ch-t) as well as in the replacement of soft agreements with hard ones (loves-lubits)
Agrammatical dysgram - manifested in violation of morphological and grammatical patterns. Connections between words.
Optical distortion - due to underdevelopment of vision gnosis, space and representation and expression in the distortion of similar letters in writing (Z-E)
Aphasia – complete or partial loss of speech caused by local brain lesions . In other words, a person (child or adult) initially had speech, but as a result of some reason it was lost.
The term denoting this disease contains the Greek bases: “a” - negation, absence and “phasis” - speech. Thus, the literal translation of this word is “lack of speech.” This term was first introduced by the French doctor Trousseau. Many foreign and domestic neurologists, psychologists and speech therapists have dealt with the problems of aphasia, especially intensively in the last three centuries. The study of this disease makes it possible to understand the basics of human mental functions and establishes the connection between speech and other higher mental processes. People dealing with aphasia problems call themselves aphasiologists .
Causes of aphasia
The main causes of aphasia:
- cerebrovascular accidents(ischemic or hemorrhagic strokes);
- injuries brain (open and closed);
- tumors brain (benign and malignant);
Infectious diseases of the brain (meningitis and encephalitis of various etiologies).
Many people think that aphasia is the lot of older people, because they are the ones who most often have strokes. But, alas... I was contacted by mothers with preschool children who were diagnosed with ischemic stroke after vaccinations or after illnesses accompanied by high fever. Cases, of course, are isolated, but they exist, and this is very sad.
Children can lose speech as a result of brain injuries (injuries), this also happens in our lives. And cases of brain cancer in children have recently been diagnosed more and more often, not to mention meningitis and encephalitis, which in some areas of the country are reaching epidemic proportions.
Forms of aphasia.
Professor F.R. Luria in the seventies of the 20th century developed a classification of aphasias. He identified seven main forms:
- acoustic-gnostic (amnestic) aphasia (damage to the posterior temporal and parieto-occipital region of the cortex of the left hemisphere of the brain);
- acoustic-mnestic aphasia(damage to the middle temporal gyrus);
- semantic aphasia(damage to the parieto-temporo-occipital region);
- sensory aphasia(damage to the posterior third of the superior temporal gyrus, Wernicke’s area);
- afferent motor aphasia(damage to the posterior postcentral sections of the motor analyzer, lower parietal sections);
- efferent motor aphasia(damage to the posterior frontal cortex, Broca's area);
- dynamic aphasia(damage to parts of the brain located anterior to Broca’s area and the additional speech “Penfield area”).
This classification was based on two main principles:
principle of analysis of topically limited brain lesions;
the principle of identifying those factors that underlie the entire complex of disorders that arise from local brain lesions.
Acoustic-gnostic (amnestic) aphasia
Central symptoms: difficulty naming objects .
Immediately after a stroke or injury, there is a complete loss of speech understanding; the patient perceives other people's speech as a stream of inarticulate sounds. At later stages of the disease and with less severe disorders, there is only a partial misunderstanding of speech, the replacement of accurate perception of words with guesses.
Difficulty in choosing the right word from several words that pop up in the patient’s mind, according to A.R. Luria, is the main mechanism of naming impairment. When trying to name an object, patients usually list several words related to the same semantic field (generalizing concept). For example, the patient is shown a picture of a pear. He: “Yes, it’s not an apple, you can eat it, it grows in the garden, but it’s not a lemon, it’s not a plum, it’s sweet, tasty. I know, but I don’t know how to say...”
When reading, multiple literal paraphasias appear, the choice of stress in a word is difficult, and therefore understanding what is read is complicated, but the mechanical process of reading itself is preserved. Written speech is impaired to a greater extent.
Acoustic-mnestic aphasia
With this form of aphasia the following symptoms are present:
- impaired understanding of speech (direct speech, subtext, allegories, allegories);
- violation of oral expressive (spontaneous) speech;
- violation of the nominative function of speech .
In this form of aphasia, phonemic hearing and sound discrimination processes are preserved, as well as the ability to repeat individual words. But the patient cannot repeat a series of three or four words that are not related to each other in meaning. Usually the patient repeats the first and last word of the series, and in more severe cases - only one word. Impaired retention of speech information leads to difficulties in understanding phrases consisting of five to seven or more words. The patient has difficulty navigating a conversation with two or three interlocutors.
The patient’s attempts to name an object result in a search for exactly the right word-name, choosing it by choosing from a number of other words of the same semantic field (“This is not a fork, not a spoon”), or listing its functions (“This is used to cut, clean”). At the same time, the patient’s reading and writing remain intact; he can write and read the word (KNIFE).
The central factor of this form of aphasia is A.R. Luria considered a violation of working memory. Images of words are recorded in the patient’s memory, but they are “clogged” with subsequent information, and the phenomenon of retroactive inhibition occurs: fresh traces are read better than previously received ones. At the same time, the sounding word does not evoke in memory the necessary object images or graphic image of the word. This indicates a disruption in the interaction of the visual and auditory analyzers. There is also a significant narrowing of the volume of acoustic perception. Hence - a violation of the understanding of addressed and repeated speech.
Semantic aphasia
The central defect of this form of aphasia: impaired understanding of logical and grammatical structures .
This form of aphasia is not based on speech defects, but on a violation of perceptual processes. There is usually no severe impairment of expressive speech in this form of aphasia. Recognition and understanding of the meanings of lexical and grammatical structures suffers. These patients can speak using simple sentences, they can understand simply structured spoken speech, but any complication of speech grammar leads to complete misunderstanding. They follow the instructions: “Give me a notebook and pen” correctly, but they do not understand the phrase “Show me your notebook with a pen” and cannot complete the tasks. Patients are completely lost when they hear phrases like: “Kolya went to the store after his mother said that the house was out of food.”
The perception of individual objects in patients is not difficult, but the patient cannot understand spatial relationships and interactions with other objects. Hence the complete misunderstanding when studying a geographical map, when determining time by a clock, and during counting operations.
By the way, such patients do not have writing or reading impairments. But their written speech is poor, it uses stereotypes of syntactic forms and grammatical structures, there are almost no complex and complex sentences, and the use of adjectives is reduced to a minimum.
Sensory aphasia
Sensory aphasia syndrome involves:
Violation of all types of oral expressive speech;
Reading disorder;
Writing violation
Impaired mental counting;
Impaired assessment and reproduction of rhythm (rhythmic tapping);
Violation of the emotional sphere (patients are anxious, their emotional reactions are unstable)
The central defect of this form of aphasia isphonemic hearing disorder .
It is expressed in defective acoustic perception of the sound composition of a word, in which sound discrimination becomes impossible. In speech there is a large number of paraphasias (replacement of one sound with another): table – moan, cucumber – oculet,painting – curtain etc. Speech consists of a set of unrelated speech elements or parts thereof. The ability to repeat words is grossly impaired: patients cannot correctly repeat sounds and words. By the same principle, the naming of objects is also disrupted: knowing the object and its purpose, they cannot find its correct sound structure (shape).
Patients with this form of aphasia are sociable; they compensate for difficulties in pronouncing words with facial expressions, gestures, and intonation; they are distinguished by their verbosity (logorrhea). The speech is grammatically incoherent. Repetition is grossly impaired: patients are practically unable to correctly repeat either sounds or words. Logorrhea (verbosity) is very common. The speech of such patients is emotionally colored and richly intonated.
Afferent motor aphasia
Central defect:violation of the addressing of nerve impulses, which normally provide the strength, amplitude and direction of movements of the articulatory organs (lips, tongue, lower jaw).
In the patient’s speech, some sounds are replaced by others that are close in place and method of formation. The patient cannot quickly and without tension articulate individual sounds, words and sentences; when trying to speak, he searches for a long time and unsuccessfully for the desired articulatory position. Automated forms of speech: singing, reading poetry, exclamations (“Oh, damn it”) remain more or less intact (the involuntary level of speech implementation is preserved). Difficulties begin when you need to consciously pronounce or repeat a sound, word, phrase. With this form of aphasia, all functions of speech, its types and forms are disrupted.
The degree of impairment of written speech and reading depends on the severity of apraxia of the articulatory apparatus. Restoring the ability to correctly articulate sounds during speech therapy also leads to the restoration of reading and writing. In some cases, a paradox is observed: the patient has a complete absence of oral speech, but some preservation of written speech, which serves as a means of communication with others.
Efferent motor aphasia
The central mechanism is a form of aphasia is pathological inertia of once established stereotypes that appear due to a violation of the change of innervations, ensuring timely switching from one series of articulatory movements to another.
In the speech of patients there are numerous perseverations that make oral speech difficult or completely impossible. The pronunciation of individual speech sounds is preserved, but speech is disrupted during the transition to the serial pronunciation of sounds and words. Defects in switching and perseveration occur against the background of disturbances in stress, rhythmic and melodic structure of speech, and intonation. Patients have a poorly modulated voice, scanned speech, uniformly stressed, replete with cliches, stereotypes, non-sentential expressions, and profanity.
With this form of aphasia, the construction of the phrase is severely disrupted; it contains crude agrammatisms; sometimes the construction of the phrase takes the form of a “telegraphic style.” There are invariably reading (alexia) and writing (agraphia) impairments.
Patients with efferent motor aphasia can pronounce automated series (direct ordinal counting), but reverse counting (from 10 to 0) is not available to them.
Dynamic aphasia
The central defects of dynamic aphasia are:
- violation of active, productive speech;
- violation of the predicativeness of the verb.
Dynamic aphasia is the most mysterious: the patient retains the sensory and motor mechanisms of speech, but lacks the ability to speak. There is either a complete absence of spontaneous (independent) speech, or unsuccessful attempts to participate in dialogue. Patients cannot construct any understandable and correctly constructed phrase. At the same time, patients with this form of aphasia are able to speak, they have no violations of articles and phonemes, and their speech memory is preserved; They perfectly repeat sounds, words, sentences, and name objects.
In the motor sphere, in the absence of paralysis and paresis, there is hypomimia , general stiffness and slowness of movements. These patients experience a decrease in general activity and a “dull” expression of emotions. Writing and reading remain intact.
Violations in the use of the predicate, the main organizer of the phrase, disturbances in the programming of internal speech, disturbances in general and speech activity - these are the main signs of dynamic aphasia. In addition, there is an omission of the subject, pronouns, and excessive use of introductory words and conjunctions. In the speech of patients there are many phrases-templates, statements are “chopped” in nature.
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Question No. 29
Aphasia: definition, causes, mechanisms of impairment, classification.
Aphasia is a complete or partial loss of speech caused by local
brain lesions.
The causes of aphasia are brain disorders
blood circulation (ischemia, hemorrhoids), trauma, tumors, infectious
brain diseases. Aphasia of vascular origin most often occurs in
adults. As a result of rupture of brain aneurysms, thrombus
boembolism caused by rheumatic heart disease, and traumatic brain injury.
Aphasia is often observed in adolescents and young adults.
Aphasia occurs in about a third of cases of brain disorders
blood circulation, motor aphasia is most often observed.
in children, aphasia occurs less frequently as a result of traumatic brain injury,
tumor formation or complications after an infectious disease.
Aphasia is one of the most severe consequences of brain damage, with
in which all types of speech activity are systematically impaired. Complexity
speech disorder in aphasia depends on the location of the lesion (for example,
location of the lesion during hemorrhage in the subcortical regions of the brain
allows us to hope for spontaneous restoration of speech), the size of the lesion
lesions, features of residual and functionally preserved elements
speech activity, with left-handedness. The patient’s personality reaction is non-speech
defect and features of the premorbid structure of the function (for example, the degree
reading automation) determine the background of remedial learning.
The basis of any phoneme of aphasia is one or another primary disorder
neurophysiological and neuropsychological background (for example, a violation
dynamic or constructive praxis, phonemic hearing, apraxia
articulatory apparatus, etc., which leads to a specific systemic
impaired understanding of speech, writing, reading, and counting. For aphasia specifically
the implementation of different levels, aspects, types of speech is systematically disrupted
activities (oral speech, speech memory, phonemic hearing, speech understanding,
writing, reading, counting, etc.). Major contributions to the understanding of speech disorders
in aphasia, it is introduced by both neurophysiology and neuropsychology and neuroling
Vistika.
In 1861, the French doctor P. Broca demonstrated the brain of an aphasic patient with
extensive softening in the area of the left middle cerebral artery, involving
posterior parts of the third frontal gyrus. Broca thought he had proof
localization of the center of oral speech in the frontal regions of the brain. In 1874 Wernicke described
10 patients with lesions of the temporal parts of the cerebral cortex on the left from to
impairment of speech understanding and peculiar expressive speech disorders,
writing and reading. This gave him reason to connect the development of sensory aphasia with
localization of the pathological focus in the posterior third of the superior temporal gyrus.
The discoveries of Broca and Wernicke marked the beginning of a debate among scientists in two directions:
"localizationists" and "anti-localizationists". The discussion lasted for
fifty years old. The first tied complex mental functions to certain
areas of the brain (Lichtheim, 1855; Liebmann, 1905). They stood on progressive
positions. However, among the “localizationists” there were also paradoxical narrow localizations
Zionist trends. Thus, Kleist localized not only entire counting functions,
writing, reading in separate areas of the brain, but also personal and social self, love
to the Motherland. etc. There is no doubt that the early works of Kleist and other narrow
localizationists. gave rise to violent protests by anti-localizationists., a number
whom he also expressed rational objections. But among them, in turn,
There were also orthodox views, for example, P. Marie considered patients with aphasia
demented, mentally ill. The leading aphasiologist Goldstein believed that
violations of complex functions cannot be correlated with individual areas of the cortex and that
The human brain works as a whole.
He associated the impairment of complex mental functions in diseases of the brain
brain with changes in intellectual activity, with damage to deep
“instincts”, with a violation of the “abstract attitude” and “categorical
behavior."
Particular contributions to the understanding of complex mental functions have been made by
Jackson, who back in 1863 showed that every function has a complex
"vertical" organization, and argued that it is possible to localize a symptom, but
it is impossible to localize a function, since it has a complex hierarchical structure
from the lowest level to the highest.
Special studies of particular manifestations of violations were carried out
higher mental functions, for example, various types of apraxia, including
apraxia of the articulatory apparatus (Liebmann), agrammatism (A. Pick); Naru
understanding complex forms of speech activity (understanding complex logical
grammatical phrases), manifested in semantic aphasia,
works devoted to x. Heda.
In Russia, the study of problems of localization of higher mental functions
preceded the publication of the monograph and. M. Sechenov “Reflexes of the brain”,
which had a great influence on the works of V. M. Tarkovsky, N. D. Rodossky,
S. I. Davidenkov, M. I. Astvatsaturov, M. B. Krol and other Russian scientists.
There are different classifications of aphasia: classical, neurological
Wernicke Lichtheim classification,
linguistic classifications by H. Head and others, each of which reflects
level of development of neurological, psychological, physiological and
linguistic sciences, characteristic of a particular historical period
development of the doctrine of speech. Currently it is generally accepted
neuropsychological classification of aphasia A. R. Luria.
Neuropsychological approach to the organization of higher cortical functions A. R.
Luria is a continuation of neurophysiological discoveries and. P. Pavlova, N.
A. Bernstein and P. K. Anokhin about the systemic organization of functions and “reverse
afferentation”, as well as the neuropsychological and psychological views of L.S.
Vygotsky, A. N. Leontiev and other psychologists. In 1947 A. R. Luria
formulates the principle of system structure and dynamic, phased locale
tion of higher cortical functions. He developed methods for studying violations
mental activity, various human cognitive processes.
The neuropsychological technique proposed by A. R. Luria allows
explore various symptoms and syndromes, natural combinations
symptoms that occur when certain brain structures are damaged.
The use of this technique allows not only to draw a conclusion about the presence of that
or another form of aphasia, but also to diagnose the location of the brain lesion.
They showed that in any form of aphasia the implementation of speech is impaired.
activities.
The basis of modern neuropsychology and neurolinguistics is the doctrine of
the role of inner speech and thinking. At the origins of psycholinguistics are the names of F.
de Saussure and I. A. Baudouin de Courtenay, who laid the foundation for differentiation
the concepts of “language” and “speech”, “paradigmatic” and “syntagmatic” relations,
“statics” of language and “dynamics” of speech.
Paradigmatic units of speech mean all signs
language: phonemes, syllabic system, vocabulary, prefixes, suffixes, certain
phrases, i.e., what characterizes a particular language. Every paradigm
for example, a phoneme has a certain number of characteristics, the replacement of which
the semantic quality of the phoneme changes, therefore the paradigmatic features
characterized by the principle of interchangeability. or. .or.: or oral, or
nasal, or labial, or lingual, or voiced, or voiceless. These
phonemes, lexemes differ in contrastive features (to arrive
leave, house, house, etc.).
In speech, all paradigmatic units are interconnected syntagmatically
principle.i. .i., not allowing interchangeability; so, in the word phonemes
have their own rigid, linear order, a preposition cannot appear in a sentence
before a verb or adverb, etc., i.e. paradigmatic relations
are built on a spatial, simultaneous principle, and syntagmatic
according to a temporary, linear, successive principle.
Different forms of aphasia are affected differently. Paradigmatic
organization of impressive and expressive speech (A. R. Luria, 1975).
A. R. Luria distinguishes six forms of aphasia: acoustic-cognitive and
acoustic-comnesic aphasia, which occurs with damage to the temporal lobes
cerebral cortex, semantic aphasia and afferent motor
aphasia resulting from damage to the inferior parietal cortex
brain, efferent motor aphasia and dynamic aphasia arising
with damage to the premotor and posterior frontal parts of the cerebral cortex (left
for right-handers).
Aphasia that occurs with damage to the superior temporal and inferior parietal zones,
included in the second functional block (A. R. Luria, 1979), are called
posterior forms of aphasia. These are aphasias in which the paradigmatics are disrupted
ical relations. Aphasias arising from lesions of the posterior frontal regions
brain included in the third functional block are called anterior aphasia.
In these forms of aphasia, syntagmatic relationships are disrupted.
When speech zones are damaged, the so-called primary
prerequisites that carry out specific activities corresponding
analyzer system. Based on the primary analyzer violation
a secondary, also specific, disintegration of the entire functional arises"
systems of language and speech, i.e., a violation of all types of speech activity occurs:
understanding of speech, oral and written speech, counting, etc. Nature and degree
impairments in understanding speech, its expressive form, reading and writing depend on
first of all, not on the size of the lesion in the cerebral cortex, but on those
Gnostic (kinesthetic, acoustic or optical) premises,
which contribute differently to the implementation of various speech
processes.
ACOUSTIC-GNOSTIC SENSORY APHASIA
Sensory aphasia was first described by the German psychiatrist Wernicke. He showed that
aphasia, which he called sensory, occurs when the posterior third is affected
superior temporal gyrus of the left hemisphere (Fig. 18, field 22). Distinctive
a feature of this form of aphasia is a violation of the understanding of speech when perceiving it
aurally. Long-term causes of impaired understanding in this Form of aphasia
remained unclear. Only in the 30s of our century did domestic psychologists
It was found that the basis of speech acoustic agnosia is a violation
phonemic hearing.
Impaired understanding.
Early after stroke or trauma with sensory aphasia
There is a complete loss of speech understanding: someone else’s speech is perceived as
an inarticulate stream of sounds. Lack of understanding of the speech of others and lack of
obvious motor disorders leads to the fact that patients do not always immediately
realize that they have a speech disorder. They may be excited
mobile, talkative. At later stages and with less pronounced
disorders, there is only a partial misunderstanding of speech, substitution of the exact
perception of words by guesswork: different words sound to such a person
the same (for example: tailnail bone cane). The same word can
be perceived differently, the words house tom, barrel nochka, dot are mixed
daughter, etc. due to the fact that the sound composition of inflections, prefixes and suffixes
homogeneous and they are more frequent in the flow of speech than the sound composition
different root words (for example, sugar bowl, inkwell, teacher), with
sensory aphasia, it is difficult to hear the root, i.e., lexical
semantic part of the word, as a result of which its loss is detected
subject relatedness. However, the categorical attribution of a word can be
perceived, for example, upon hearing the word bell, such a patient says: .This
something small, but I don’t know what..
In some cases, when both (left and right) temporal lobes of the brain are affected
a picture of severe acoustic-cognitive aphasia appears in combination with
acoustic agnosia. Not only phonemic hearing is impaired, but not
voice timbre, speech intonation differ by ear, are not differentiated
non-speech sounds: bells, beeps, rustling paper, the sound of pouring water, etc.
Expressive speech impairment.
Due to a violation of phonemic perception of audible speech in
Acoustic-cognitive sensory aphasia disrupts auditory control of
with your speech. As a result of this, many literal and
verbal paraphasias.
Early after a stroke or injury, the patient's speech may be
absolutely incomprehensible to others, since it consists of random
a set of sounds, syllables and phrases, which is called “jargonophasis”
or “speech okroshka”. So, patient M. answered the question: “Do you have a headache?”
answered: “Since it’s us who are harassing us, we are them and so it’s been a long time since about five years ago.”
It was the same in recent years. What a very sick shadow, well, the head is on here.”
Due to a violation of phonemic perception, word repetition suffers secondarily,
and often the initial word is automated and globally repeated
true, but when listening to it and during subsequent attempts to repeat it, a person
loses not only the sound components of the word, but also loses the rhythmic
its melodic basis.
The period of jargon phase lasts no more than 1.52 months, gradually giving way to
logorrhea (long-winded speech) with pronounced agrammatism. At the middle stage
speech restoration, literal paraphasias are observed less frequently, but are noted
abundant verbal paraphasias.
E. S. Bein (1964) and I. T. Vlasenko (1972) showed the diversity of verbal
paraphasias, the occurrence of which is associated with both similar acousticophonemic
the structure of words and the semantic organization of their meaning. Choice of op
the specific meaning of the word is determined by the context, which creates the need
inhibiting side semantic associations.
Thus, words similar in meaning are bold, heroic, courageous, gloomy,
cold, rainy, etc. require their precise selection depending on
context. Disruption of this mechanism of inhibition of side connections
can lead to the replacement of one word with another that is not adequate in the context
this statement; for example, instead of a suitcase - a closet or a well only
based on the fact that both objects have common signs of deepening their wounds.
Let's give a few more examples: “The wolf saw the hunters and delicately (instead of
slowly) disappeared into the bush”, “The kid (calf) ran around the cow and didn’t
the shepherd obeyed.” These defects in the choice of lexical means of design
thoughts in acoustic-cognitive aphasia appear against the background of intact
rhythmic and melodic, intonation basis of the utterance.
In the study of the nominative function in sensory, acoustic-cognitive
aphasia, along with correct naming, there are attempts to explain the meaning
words or find it through phraseological context. For example, when calling
apple is pronounced: “well, of course... I know perfectly well that this is a pear, no, not a pear, but
orange, orange... not an orange, but a sour apple... growing in the forest and in the garden
growing..
At the late stage of recovery, sensory-specific
aphasia agrammatism, manifested in the lack of agreement between the members of the sentence
in gender and number, incompleteness of statements, omissions of words, substitutions of nouns
personal pronouns. Less distressed in sensory aphasia is the use of prepositions and
inflections of nouns.
Impaired reading, writing and counting. When reading in the speech of a person with sensory aphasia
a lot of literal paraphasias appear, difficulty in finding the place
stress in the word, which makes reading comprehension more difficult. However, reading
remains the most preserved speech function in sensory aphasia, since it
carried out by involving optical and kinesthetic control.
Written speech in acoustic-cognitive aphasia, in contrast to reading, is impaired in
to a greater extent and is directly dependent on the state of phonemic hearing.
At an early stage after a stroke with severe acoustic aphasia, there is no impairment
only writing from dictation, but also copying words. Patients who are not aware of their speech
defects, visually grasping the image of the word being copied, uncontrollably begins it
reproduce. With such uncontrolled reproduction of the word when copying, they
instead of the three letters included, for example, in the word house, they write eighty letters, constantly
pronouncing an indefinite set of sounds. Attracting intact optical control by
gradually leads to exact copying of the letter composition of the word, however, in auditory
In dictations, literal paragraphs have been observed for a long time.
Severe counting disorders in sensory acoustic-cognitive aphasia are observed only
at a very early stage, since counting requires pronouncing the words included in the counting
operations. Patients, not understanding the instructions, can passively copy, copy examples,
without performing arithmetic operations, they can write a number incorrectly, for example: .4 + 1
= 4 + 1, 4 + 1 = 15, 5 + 2 = 3.
ACOUSTIC-MNESTIC APHASIA
The process of auditory, acoustic memorization is a direct continuation
process of perception, i.e. acoustic-gnostic analysis of sound composition
words. Any external influence, and especially the need to remember the trace
a leading word that is not related in meaning to the previous word, a distraction to it
attention, inevitably slows down and blocks acoustic-comnestic processes.
Acoustic-comnestic aphasia occurs with damage to the middle and posterior
departments of the temporal region (A. R. Luria, 1969, 1975; L. S. Tsvetkova, 1975) (Fig. 18,
fields 21 and 37).
A. R. Luria believes that it is based on a decrease in auditory-verbal memory,
which is caused by increased inhibition of auditory traces. When perceiving
With each new word and its awareness, the patient loses the previous word. This
the disorder also manifests itself when repeating a series of syllables and words.
Impaired understanding. Acoustic-comnestic aphasia is characterized by
dissociation between the relatively intact ability to repeat individual
words and a violation of the ability to repeat three or four unrelated
meaning of words (for example: hand house sky; spoon sofa cat; forest house ear and
etc.). Typically, patients repeat the first and last word, in more severe
cases, only one word from a given series of words, explaining this by the fact that I did not remember
lost all the words. When listening again, they also do not hold onto them either
sequence, or omit one of them.
Impairment of auditory-verbal memory is also observed in other forms of aphasia,
however, in acoustic-comnestic aphasia this is a violation of speech memory
is the main defect
because they are safe
phonemic hearing, articulatory side of speech. Patients have
increased speech activity, compensating for communication difficulties.
L.S. Tsvetkova (1975) explains the impossibility of maintaining a speech sequence without
only by inhibiting auditory-verbal memory, but also by narrowing its volume.
Violation of the volume of retention of speech information, its inhibition lead to
difficulties in understanding long, polysyllabic words in this form of aphasia
statements consisting of five seven words: a person can indicate or give not
the object in question arises its acoustic-comnestic
disorientation, difficulty navigating conversation with two or three
interlocutors, “turns off. in a difficult speech situation, cannot attend
reports, lectures, gets tired when listening to music and radio broadcasts.
In the second variant of acoustic-comnestic aphasia, the so-called optical
aphasia, difficulties in listening to the semantic aspects of speech lie in
weakening and impoverishment of visual ideas about the subject, in the ratio
perceived aurally with its visual representation. This weakness is explained
visual representations in that the posterior temporal regions (field 37, according to Brodmann)
are adjacent to the occipital, opticognostic departments. Decline
optical processes leads to the fact that the visual representation of
the subject becomes incomplete. When drawing certain objects they are omitted,
details that are significant for their identification are not drawn. So, a person may not
finish drawing the spout for the teapot, the comb for the rooster, and the handle for the cup. It is characteristic that it is not
those elements of objects that, on the one hand, are specific, are completed
specifically for them, and on the other hand are associated with the polysemy of the word (for example, the words:
spout, comb, pen). The patient draws an indefinite shape instead of a rooster
a bird, instead of a teapot something similar to a sugar bowl, instead of a cup a bowl or glass
etc.
Expressive speech impairment. In this form of aphasia, expressive speech
characterized by difficulties in finding the words necessary to organize
statements. Speech in acoustic-comnestic aphasia, as in acoustic
gnostic aphasia, retains its pronounced predicative character.
Difficulties in finding words are explained by the impoverishment of visual representations of
subject, weakness of the optognostic component. Semantic blur
meaning of words leads to the occurrence of abundant verbal paraphasias, rare
literal substitutions, merging two words into one, for example, “Nozhilka” (knife + fork).
Violation of the nominative function of speech in acoustic-comnestic aphasia
manifests itself not only in difficulties in naming, but also in the selection of words in
own speech, in stories based on pictures, etc. When telling a story based on a series of plot
pictures, text retelling, in spontaneous speech nouns are replaced
pronouns. Agrammatism in acoustic-comnestic aphasia is characterized by
mixing inflections of verbs and nouns in gender and number.
In contrast to acoustic-gnostic aphasia, the utterance in acoustic
mnestic aphasia is characterized by greater completeness; there is no “speech
okroshka."
Reading and writing impairment. With acoustic-comnestic aphasia in
in written speech, phenomena of expressiveness appear more than in oral speech
agrammatism, i.e. confusion of prepositions, as well as inflections of verbs,
nouns and pronouns, mainly in gender and number. Nominative
the side of written speech turns out to be more preserved, since patients have
more time for selecting words, choosing synonyms, as well as phraseological units,
contributing to the “recall” of the necessary words, are occasionally observed
literal paraphasias of acoustic type (mixture of voiced and voiceless
phonemes). When recording text from dictation, patients experience significant
difficulties in retaining in auditory verbal memory even a phrase consisting of three
words, while asking them to repeat each fragment of the phrase.
With acoustic-comnestic aphasia, significant difficulties arise in
understanding the text being read. This is explained by the fact that printed text consists of
sentences of considerable length, and the fact that retention of the read text in memory
also requires the preservation of auditory-verbal memory.
Defects in auditory-verbal memory also affect solving arithmetic problems.
examples. For example, when adding the numbers 27 and 35, the patient writes “2” and says
“one in mind”, and even if the unit is written close to the example, he forgets
add it to the next terms.
Thus, with acoustic-comnestic aphasia, auditory-verbal impairments
memory secondarily lead to difficulties in the normal implementation of writing, reading and
accounts.
AMNESTIC-SEMANTIC APHASIA
Amnestic-semantic aphasia occurs when there is damage to the parietal
occipital region of the speech-dominant hemisphere (Fig. 18, field 39). At
damage to the parieto-occipital (or posterior inferior parietal) parts of the hemisphere
brain, the smooth syntagmatic organization of speech is preserved, not
there are no searches for the sound composition of the word, there are no phenomena
decreased auditory-verbal memory or impaired phonemic perception.
There are specific amnestic difficulties when searching for the right word
or arbitrary naming of an object, when patients have difficulty finding
lexical paradigm refers to the description of the functions and qualities of this object
syntagmatic means, i.e. they do not replace one word with another (verbal
paraphasia), but replace the word with a whole phrase, say: “Well, this is what they write,” this
what they cut with. etc., and on the other hand, there is a characteristic of this form
aphasia complex impressive agrammatism.
Impressive agrammatism and amnestic difficulties in aphasia have many
common with pronounced spatial constructive apraxia, since it is primarily
a disrupted prerequisite for this form of aphasia is orientation in
spatially organized semantic coordinates characteristic of
complex paradigms, paradigmsynonyms: for example, father’s brother is uncle (invariant
the meaning of the word uncle is a man, and not a specific relative of the father,
located in a complex semantic space of related
relationships).
Impaired understanding. Impaired understanding of complex semantic and
grammatical relationships between words expressed by prepositions and inflections,
called impressive agrammatism. For semantic aphasia
understanding of ordinary phrases conveying “event communication” is maintained.
Patients understand well the meaning of individual prepositions and freely put
a pencil under a spoon or a spoon to the right of the fork, but difficult to position
three items according to the instructions: “Put the scissors to the right of the fork and to the left of
pencil." They experience even greater difficulties in positioning
geometric figures, are unable to solve such a logical-grammatical
problem of how to draw a cross under a circle and over a square, and they can’t figure out
to use comparative phrases like: Kolya is taller than Misha and shorter than Vasya.
Which one is the tallest? Who's the shortest? The same difficulties arise for
when understanding comparative phrases with adverbs, they are closer,
left right, etc.
No less grossly impaired in semantic aphasia is the decoding of inflectional
inverted phrases included in the instructions: “Show the comb
with a pen, show the pen with a pencil.” When performing these tasks,
slipping to direct order of actions with objects, ignored
inflectional semantic features of the spatial direction of action.
The same difficulties in determining the direction of action arise when
mania of sentences: Kolya was hit by Petya (Who is a fighter?), when he found
a similar sentence from the two presented: The Sun is illuminated by the Earth;
The Earth is illuminated by the Sun or the Earth is illuminated by the Sun; The sun shines
Earth.
The greatest difficulties arise with semantic aphasia in solving logical
grammatical phrases conveying “relational communication” like
“father’s brother” “brother’s father”, which can only be solved by correlating with certain
semantic categories: uncle brother father.
Patients also find it difficult to understand complex syntactic structures,
expressing cause-and-effect, temporal and spatial relationships,
adverbial and participial phrases. So, they find it difficult to understand
sentences like I went to the cafeteria after I talked to
sister. They do not detect the illogicality of sentences like It rained, because
that it was wet.
With semantic aphasia, the understanding of metaphors, proverbs,
sayings, popular words, no figurative meaning is found in them. So,
metaphors “heart of stone”, “iron hand”, proverb “Don’t spit in the well,
it will be useful to drink some water” are understood in the literal, concrete sense.
Violation of oral and written speech. Expressive speech
Semantic aphasia is characterized by the preservation of the articulatory side of speech.
However, pronounced amnestic difficulties may be observed, prompt
the first syllable or sound of a word helps the patient. Words are replaced by descriptions
functions of the object: “Well, this is what they look at the street through” or “This is what
shows the time."
The basis of amnestic difficulties in semantic aphasia is
violation of the so-called “law of force” (A. R. Luria), which normally allows
accurately select a word from a series of words that are similar in category
relevance, in meaning. Violation of this “law of force” seems to block
search for a word as a paradigm in a certain semantic field, and therefore
patients resort to a syntagmatic method of describing a function or
categorical affiliation of the object: “What they eat fish with”, “What they cut it with”
(they write, etc.).” Verbal paraphasias are not characteristic of semantic aphasia,
since patients do not replace one paradigm with another. Poverty of vocabulary
expressed in the rare use of adjectives, adverbs, descriptive
phrases, participial phrases, participle and participial phrases,
proverbs, sayings, in the absence of searching for the exact or “aimed” word.
In this form of aphasia, written speech is poor,
stereotyped syntactic forms, there are few complex and
complex sentences, the use of adjectives is reduced.
In semantic aphasia, severe violations of counting skills are observed.
operations.
Patients mix up directions of action when deciding
arithmetic examples, experience difficulties when operating with transition through
ten, have difficulty writing multi-digit numbers by ear. :for example, instead of
people write down the numbers 1081 as 1801, 1108, since it is difficult to determine
bit depth of the number. Numeracy disorders manifest themselves in difficulties in understanding text
tasks, since they include the same logical elements more less, further
closer, how much, how many times, etc., which is also explained by the violation
simultaneous analysis and synthesis of the same logical-grammatical structures.
AFFERENT KINESTHETIC MOTOR
APHASIA
Afferent kinesthetic motor aphasia occurs when there is a lesion
secondary zones of the postcentral and inferior parietal parts of the cerebral cortex,
located behind the central, or Rolandic sulcus (Fig. 18, field 7,
40). The secondary fields of the postcentral and inferior parietal regions are closely related to
primary fields, which are characterized by a clear somatotopic structure.
Nerve fibers carrying impulses from the lower opposite limbs
are located in the upper parts of this zone. Nerve fibers carrying impulses
from the upper extremities, in the middle sections, impulses coming from the face, lips,
tongue, pharynx, in the lower postcentral sections. This projection is not based on
geometric, but according to the functional principle: the greater the importance of that
or another area of peripheral tactile-kinesthetic receptors of one or another
another active organ and the greater degree of freedom this or that
motor segment: joint, phalanx of fingers, tongue, lips, etc., the larger
territory has its representation in the somatotopic projection of the cortex.
It is important that the somatotopic projection of the organs involved in
articulation of sounds, is significantly more represented in the left, dominant
speech hemisphere.
It is known that every speech sound is pronounced by simultaneous activation
or turning off a certain group of spatially organized
articulatory organs. Thus, secondary fields that take a complex si
multanal participation in the organization of a particular phoneme are associated with primary,
projection fields. However, it is not always taken into account that the closure of the lips and tongue
when pronouncing m and n is less tense than with b and n, d and t. Most
The stop is more tense when pronouncing the voiceless phonemes k and t, but when
In this case, the vocal folds are in a relaxed state. Difficulties
definitions of these subtle differential kinesthetic features of phonemes
explains the occurrence of gross agraphia in afferent motor aphasia,
alexia, speech understanding disorders.
Expressive speech impairment. A. R. Luria notes (1969, 1975) that
There are two types of afferent kinesthetic motor aphasia. First
characterized by a violation of spatial, simultaneous synthesis of movements
various organs of the articulatory apparatus and the complete absence of situational
speech with severe severity of the disorder. Second option, worn in the clinic
the name "conduction aphasia", is distinguished by significant preservation
situational, cliché-like speech with a rough breakdown of repetition, naming and
other arbitrary types of speech. This variant of afferent kinesthetic
motor aphasia is characterized primarily by impaired differentiation
controlled choice of articulation method and simultaneous synthesis of sound and
syllabic complexes included in a word.
In the first variant of afferent kinesthetic motor aphasia
severe apraxia of the articulatory apparatus can lead to complete
lack of spontaneous speech. Attempts to voluntarily repeat sounds
lead to chaotic movements of the lips and tongue, to literal (sound)
replacements. The patient’s close scrutiny of the speech therapist’s articulation leads
only to finding either a method or an organ of articulation, which gives rise to
displacement of sounds m n 6, n d t l., and s, o y, etc., which is explained
violation of the kinesthetic assessment of the degree of closure of the articulatory organs during
pronunciation of sounds, disintegration of movements of organs such as the soft palate and
vocal folds. At later stages, patients pronounce the word robe as
“khanat” or “hodat”, house as “crowbar” or “tom”, i.e. one phonemic
the paradigm is replaced by another.
Afferent kinesthetic motor aphasia is characterized by difficulties in
analysis of the structure of complex syllables. Large ones split a closed syllable into two
open, split up consonant clusters in a syllable, omit consonant sounds.
Therefore, often the words here, there, here, table, hat, etc. sound like “here”, “that”
m., “vot”, “s’tol”, “hat”, etc.
As the pronunciation side of speech is restored,
preservation of the syntagmatic side of the speech utterance. In some
In cases, light articulatory sounds may remain, reminiscent of
in some cases dysarthria (pseudodysarthria as a consequence of apraxia
articulatory apparatus), in others a slight foreign accent,
expressed not in a change in intonation, but in slowness and artificiality
pronunciation of words, deafening of voiced consonants and absence of soft consonants, in rare cases
literal paraphasias.
Impaired understanding. Early after injury or stroke
Afferent aphasia may result in severe impairment of speech understanding. This
is explained by the fact that in the process of understanding a significant role is played by
kinesthetic control, conjugate, hidden pronunciation of what is perceived on
hearing message.
Period of significant misunderstanding of speech in patients with afferent
kinesthetic motor aphasia is short-lived (from one day to
several days after the stroke), after which they experience rapid
restoration of understanding of situational conversational speech, understanding of meanings
individual words, the ability to follow simple instructions.
For a long time, patients have observed specific features
violations of understanding. They consist of secondary violations
phonemic hearing. For afferent kinesthetic motor aphasia
difficulties arise in recognizing by ear words with sounds that have
general characteristics by place and method of articulation (gy6nye: b m n,
front lingual: d l m n, consonant fricatives: k x w, consonant and vowels
etc.). These difficulties in phonemic analysis are generally compensated for by
redundancy of phonemic differences between words in colloquial speech and
allow them to understand it, but are reflected in the letters of the patients. Violation
understanding of a word deteriorates in cases where the patient tries to
to speak, i.e., includes primarily impaired kinesthetic control.
Along with articulatory disorders leading to blurred
auditory perception of speech, with afferent kinesthetic motor aphasia
there are difficulties in understanding the lexical means of the language that convey
various complex spatial relationships. These include first
the most characteristic prepositional impressive for this form of aphasia
agrammatism: with preservation of understanding of the meanings of individual prepositions
the possibility of arranging three objects in space is impaired,
for example, placing or drawing a pencil under the brush and above the scissors,
i.e., there are violations of understanding characteristic of semantic
aphasia.
Verbs with prefixes cause significant difficulties in understanding
(wrap, return, etc.), which, in addition to the spatial attribute,
They also differ in their polysemy. Particular difficulties are experienced in understanding
meanings of personal pronouns used in indirect cases, which
explained by the lack of subject relevance in them, the presence of various
spatial orientation, an abundance of phonemic changes (for example,
me me me).
With afferent kinesthetic aphasia, as a rule, there is
constructive spatial apraxia, and in the second option,
spatial disorientation. The latter exacerbates the idea of
poor understanding of speech by the patient; for example, patients experience extreme
difficulty choosing a book, album or other item on a bookshelf.
The complexity and diversity of features of impaired understanding in
afferent kinesthetic motor aphasia is compensated in everyday life
speech redundancy, concreteness of the situation, which creates a picture
their relative preservation of speech understanding.
Reading and writing impairment. With afferent kinesthetic motor
aphasia, the degree of reading and writing impairment depends on the severity of apraxia
articulatory apparatus. Reading and writing are most severely impaired when
severe apraxia of the entire articulatory apparatus. Reading recovery and
writing occurs in parallel with its overcoming. Restoring internal
reading may outpace the recovery of written language. When writing words under
dictation, when naming objects in writing, when trying to write
communication with others is affected by all articulation difficulties, i.e.
many literal paragraphs appear, reflecting a mixture of vowels and
consonant phonemes close in place and method of articulation are skipped
consonants (sonorant).
In the second variant of afferent kinesthetic motor aphasia, patients with
with difficulty maintaining the order of letters in a word, representing them in mirror images (water -
“davo”, window “onko”), omit vowels or write all consonants first, and
then vowels, and, as a rule, they retain the idea of
presence of a sound in a word, for example, by omitting the letter e in the word leads, the patient puts
two dots above d.
In some cases, with gross afferent kinesthetic motor
aphasia, there is a dissociation between the complete absence of oral speech and
some preservation of written speech, which serves as a means of communication with
those around you. This preservation of written language is explained by the presence
predominant apraxia of only the pharynx and larynx, performing in Russian
language the role of pre-tuning all articulatory movements (N. I. Zhinkin, 1958)
and performing phonation of vowels and voiced consonants.
As reading and writing are restored, the number of literal paragraphs
decreases.
The second variant of afferent kinesthetic motor aphasia is characteristic of
persons with hidden left-handedness with damage to the parietal parts of the left hemisphere.
EFFERENT MOTOR APHASAIA
Linear, temporary organization of movement is carried out by premotor
areas of the cerebral cortex. Syntagmatic chains of sounds are formed and
syllables in a word, words in a sentence, subject to a strict law
subordination: in the word house only this and not another order of sounds is required, in
in a sentence, an adjective or preposition cannot come before a verb or
adverb, etc.
Effective motor aphasia occurs when the anterior branches of the left
middle cerebral artery (Fig. 18, fields 44, 45). It is usually accompanied by
kinetic apraxia, expressed in difficulties in assimilation and reproduction
motor program.
Damage to the premotor parts of the brain causes pathological inertia
speech stereotypes leading to sound, syllabic and lexical
permutations and perseverations, repetitions. Perseverations, involuntary
repetitions of words, syllables, resulting from the impossibility of timely
switching from one articulatory act to another makes it difficult, and sometimes
make speaking, writing, and reading completely impossible.
Expressive speech impairment. With gross efferent motor aphasia on
early stage after cerebrovascular accident can completely
lack of own speech.
Apraxia of the articulatory apparatus in this form of aphasia does not manifest itself in
difficulties in repeating individual sounds, and in the loss of the ability to repeat a series
sounds or syllables. The patient repeats them many times; when asked, repeat two
a series of sounds or syllables perseveres sounds from a previous sound or
syllabic series, without experiencing difficulties in the very act of sound pronunciation. This
the most severe variant of efferent motor aphasia. With him completely
there is no naming function, and when the first syllable of a word is suggested,
either automated completion of it, or slipping to another word,
starting with the same syllable, for example, naming object pictures, sick,
Having received a syllable hint from Mo, instead of the word milk he pronounces “sea”,
“carrots”, “ice cream”, etc.
Due to the inertia of articulation of individual words, there may be observed
contamination caused by hyphenation of the syllable of the previous word: “stack”
(table, spoon).
In another variant of efferent motor aphasia with spontaneous
restoration of speech and communication, a pronounced expressive ability is often formed
agrammatism: patients miss verbs, have difficulty using prepositions,
inflection of nouns reveals the so-called agrammatism of the type
“telegraphic style, which arises as a result of a violation of the predicative
functions of inner speech. In easier cases, verbs are moved to the end
offers.
For example, when telling a story based on a series of plot pictures “An Incident on the River” there was
the following text is pronounced: “This is a boy... a boy and here is a river and a raft and
boy how is it... falling into the water and calling the raft there is far away... And the boy is Pio
ner shoes need to be taken off... what is it calling... help.....
With the third variant of efferent motor aphasia, such
gross agrammatism, and extreme inertia in the choice of words is revealed, in
there are long pauses in the utterance,
paraphrases, pronunciation of words becomes drawn out.
perseveration,
verbal
Long pauses caused by the inertia of speech processes,
outwardly resemble amnesic difficulties characteristic of semantic
aphasia, but they are based on inertia in the choice of lexical means. Violation
regulation of word choice also leads to verbal paraphrases, which
due to switching inertia when extracting them from different
"semantic fields". For example, composing the phrase: “The boy is fishing,”
a person suffering from aphasia proceeds to compose a phrase based on another plot picture
ke and instead of the phrase “The boy is bathing in the river,” he says: “The boy is fishing,
caught in the river" or instead of "The blacksmith is forging a horseshoe" he says "The blacksmith is blacksmithing
something."
And finally, among the various variants of efferent motor aphasia
there is one in which speech is disrupted only in the smooth part,
melodious change from one syllable to another. The speech of these patients is grammatically
correctly formed, but due to violations of the rhythmic and melodic side of speech
Not only does the emphasis on stressed syllables suffer, but also the intonation coloring
psychological predicate, i.e., that new thing that is mentioned in the message, on
that the logical stress falls. Unlike afferent motor aphasia
the sound structure of syllables in efferent motor aphasia is not simplified,
collapses, but loses its intonation coloring, becomes viscous,
monotonous. Literal paraphasias are not typical for the oral speech of patients with
efferent motor aphasia, but there are many of them in written speech.
Reading and writing impairment. With efferent motor aphasia, there is
severe agraphia: writing a word or phrase is possible only when spoken
words by syllables. In more severe cases, with correct repetition of the word
not only is it impossible to write it down, but also to fold the split letters from the already selected letters
ABCs. There is an unsuccessful rearrangement of the letters of a word, even a very short one, with
It's hard to find the right order of letters. Often patients cannot find the right
letter, correctly pronouncing the entire sound composition of the word. In milder cases
patients can write down a word from hearing, omitting vowels and consonants in conjunctions
consonants, rearranging letters and syllables; for example, the word room is written as
“kmata”, “komata., window as “nko”, “onko”, “kono”, “nok”, etc. Perseveration is frequent
letters from previous words, perseverations of the same syllable: car
“mashishina”, milk “momoloko”, “momko”, etc.
In the later stages of recovery, when independently composing a text using
a series of paintings reveals agrammatism, expressed in difficulties in coordinating
words in a sentence. Inflections, both case and gender indicating, are mixed.
Agrammatism of written speech of patients with efferent motor aphasia
overcome with great difficulty.
In the most severe cases, reading is guessing in nature, display is available
one or another written word, adding captions to pictures. These
.severe reading and writing impairments are caused by the breakdown of the ability to
programming the sound-letter composition of a word. With the “telegraph style” they can
be safe reading, writing nouns and short phrases under dictation,
and later, independent recording of the names of objects, but not available with
coherent, grammatically correct written composition
phrases. In easier cases, it is possible to read individual words and short
sentences, but reading comprehension is difficult, especially sentences with
complex syntactic structure.
If only the rhythm is violated
the melodic component of speech, written speech and reading remain intact.
Impaired understanding. At the heart of the disorder of understanding with efferent
motor aphasia is the inertia of the flow of all types of speech activity,
violations of the so-called sense of language. and predicative function of internal
speech.
In severe efferent aphasia, perseverations appear already at
following simple instructions. Showing individual body parts may be
available if there are long pauses between spoken words. However
with a slight acceleration in the pace of tasks for showing pictures or body parts
or individuals experience perseveration. Somewhat better, but still with great difficulty
Patients show object pictures upon repeated requests.
Auditory-verbal memory is secondarily impaired, showing a series of subject objects is difficult
pictures, when showing 10 pictures in 3 or 4 pictures,
perseveration of previous tasks.
With efferent motor aphasia, hearing does not differ grammatically
correctly constructed statements and incorrect ones.
In this form of aphasia, the figurative meaning of metaphors is poorly understood,
proverbs, which is explained by the difficulty of switching to another, hidden meaning
statements (A.R. Luria, 1975), there is a violation of understanding polysemy
These words, such as spit, key, go. This is due to the difficulty
switching from a specific lexical meaning of a word to another.
The premotor regions of the speech-dominant hemisphere are
completing the process of encoding a speech utterance. On the one side,
they carry out a smooth switching formed in the postcentral
departments of articulatory and lexical complexes, on the other hand they complete the process
planning and grammatical design of the intent of the statement,
programmed in the frontal and posterior frontal regions.
DYNAMIC APHASAIA
Dynamic aphasia occurs when the posterior frontal parts of the left
speech-dominant hemisphere, i.e. departments of the third functional block
block of activation, regulation and planning of speech activity.
The main speech defect in this form of aphasia is difficulty, and
sometimes there is a complete impossibility of actively developing the utterance. At
dynamic aphasia individual sounds are pronounced correctly, repeated
without articulatory difficulties words and short sentences, however
the communicative function of speech is still impaired. For rough
the severity of the disorder is noted not only in speech, but also in general
spontaneity, lack of initiative, pronounced echolalia occurs, and sometimes
echopraxia, when they mechanically repeat after the interlocutor not only
the words he spoke, the questions, but also the movements.
Expressive speech impairment. There are several options
dynamic aphasia, characterized by varying degrees of impairment
communicative function, from a complete lack of expressive speech to
some degree of speech communication impairment. Based on dynamic
aphasia is a violation of the internal programming of utterances,
manifested in the difficulties of its planning when drawing up individual
phrases. Patients need constant speech stimulation. Their speech is different
primitiveness of the syntactic structure, the presence of speech patterns, with
no agrammatism is observed in this case.
The central link in dynamic aphasia is a violation
spontaneous extended utterance. When retelling from a plot picture
separate, unrelated fragments are pronounced and are not highlighted
main semantic links; for example: “Here... the owner had a chicken... and
golden eggs... and he killed her... there! (example A.R. Luria, 1975).
With dynamic aphasia, pseudoamnesic difficulties may be observed when
naming objects and especially when remembering the names of acquaintances
people, names of cities, streets, etc. Unlike patients with acoustic-comnestic
and semantic aphasia, these patients do not resort to the help of phraseological
descriptions of the functions of an object, the hint of the first syllable of a word can be a trigger
a push that unblocks the inertia of the speech search for words. Izza
due to the inertia of speech processes, significant difficulties are experienced
when asked to count backwards, for example, from twenty to one.
With more massive lesions of the left frontal lobe, deep
violation of the generation of complex motives, plans and programs of behavior (A.R.
Luria, 1969, 1975), interest in the environment is not shown, is not formulated
neither
what requests, no questions asked. Spontaneous speech may be completely absent.
Dialogue speech is grossly impaired and characterized by echolalic
repeating questions.
In easier cases, part of the interlocutor’s question is echolically borrowed, with
this gives it the correct grammatical form. For example, to the question: “Are you
Did you have breakfast today?” The answer is: “We had breakfast today.” In speech it is observed
a lot of perseverations. For example, naming pencils using a suggested word
colored, the patient continues to name the following objects presented to him
“fragrant pencils”, “tea pencils” (instead of the words flowers, spoons).
Impaired speech understanding. When the premotor systems are damaged,
not only the process of unfolding speech intent, but also collapsing speech
structures necessary to understand the meaning of the text.
With a mild degree of dynamic aphasia, understanding of elementary situational
speech, especially when presented at a slightly slower pace, with pauses between
instructions remains intact. However, when accelerating the presented
tasks, when showing object pictures, parts of the face may be observed
arises
perseveration,
difficulty finding an object quickly,
pseudo-alienation of the meaning of the word.
With severe dynamic aphasia, as with efferent motor
aphasia, a violation of the sense of language is detected, difficulties arise in
understanding complex phrases, especially inverted ones, which require
attention to rearranging elements of a sentence.
These difficulties in understanding complex statements are associated with insufficient
activity of patients, inert fixation of their attention on the meaning of individual
elements with impaired understanding of the grammatical means of the language.
With dynamic aphasia, reading and writing remain intact and serve
the task of restoring the plan of utterance.
Elementary counting in dynamic aphasia remains intact even with
gross breakdown of expressive speech. However, with this form of aphasia, sharply
the solution of arithmetic problems that require for their implementation is disrupted
building an action plan (A. R. Luria, L. S. Tsvetkova, 1966).
Often there are patients with so-called complex ones. aphasia:
afferent-efferent,
efferent with a dynamic component,
sensorimotor aphasia, etc., due to the fact that in case of injury or
cerebrovascular accident affects nearby speech areas or
There are several lesions. For “complex” aphasias, first of all
lower level disorders such as apraxia should be addressed
articulatory apparatus and impaired phonemic hearing up to
overcoming the symptoms of efferent motor aphasia or acoustic-comnesic
aphasia, etc.
When the first “functional block” (subcortical parts of the brain,
performing the functions of tone and wakefulness of the cerebral cortex) arise
impairment of attention, memory, clattering (stuttering-like stumbling in the process
speech) and short-term temporary pseudoaphasic speech disorders of the type
efferent motor and acoustic-comnestic aphasia, which is explained
decreased activation of the posterior frontal and temporal parts of the brain. The special feature of these
speech disorders is their fluctuation or “unsteadiness”: during
during the same activity, these speech disorders either appear or disappear, and
also the safety of reading and writing.
Aphasia in left-handers. Only 4042% of the population are absolutely right-handed.
58% are absolutely left-handed, the remaining 50% of the population are either
hidden, latent, partial or retrained from the left hand to the right
left-handed people, or right-handed people with signs of left-handedness. Often aphasic
disorders in persons retrained from the left hand to the right are reduced spontaneously in
for 17 days, and therefore these patients did not receive speech therapy assistance
need. Left-handers with persistent speech disorders account for about 30%
of the total number of patients with aphasia.
Aphasia in left-handers, arising from damage to the right hemisphere, is less
expressed, which is explained by the high compensatory capabilities of the left
hemispheres. Speech disorders manifest themselves more severely in left-handed people; when they are affected
niya of the left hemisphere, which is probably explained by the fact that in the process
retraining a left-handed child from the left hand to the right and teaching him to write with the right
with his hand, additional speech zones are formed in the left hemisphere in
premotor, postcentral and temporal lobes of the brain.
A number of aphasic disorders in overtrained or partial left-handers are several
differs from the same forms of aphasia in right-handers. First of all, this concerns aphasia,
arising from damage to the secondary fields of the cerebral cortex, in which
afferent (“conduction”) motor aphasia occurs, efferent
motor aphasia and acoustic cognitive aphasia (Burlakova M.K., 1988, 1989,
1997), in connection with which they should be called partial afferent motor
aphasia, partial efferent motor aphasia and partial acoustic
Gnostic aphasia in left-handers.
True acoustic aphasia in left-handers is practically not observed in
connection with the high interchangeability of the functions of the temporal lobes of both hemispheres.
However, in left-handed people, sometimes when the temporal lobe is damaged, a peculiar
sensory aphasia, which in the classical classification is called
transcortical sensory aphasia. With this variant of acoustic diagnostic
aphasia, there is a dissociation between a complete lack of understanding of speech, relative
preservation of understanding of the text being read, the ability to record words under dictation
without understanding the meaning of the word. In the speech of these patients there is no jargon and
literal paraphasias. Speech is ungrammatical.
Partial afferent and efferent motor aphasia in left-handers
characterized by relative preservation of situational, cliché-like speech
if it is impossible to compose a phrase based on the picture. Moreover, with afferent
(“conduction” according to the classical classification) motor aphasia is detected
along with preserved own speech, the grossest apraxia of articulatory
device, leading to a complete violation of word repetition (even just
freely pronounced by the patient), complete impossibility due to articulatory
difficulties in naming object pictures, composing a phrase based on a picture,
reading aloud and writing down words from dictation. these patients may experience severe
the greatest violation of counting even within the first ten, which is not observed in
right-handers with the same form of aphasia, and a gross violation of the understanding of all means
language that conveys the spatiotemporal relationships of objects and concepts,
antonyms, prepositions, adverbs. Difficulties arise in orientation in space
when showing objects and drawings, when
complete preservation of phonemic hearing. These gross violations in
space extend to 4 mechanisms. reading and writing not only in connection
with the possibility of mirror writing of individual letters, but also with a tendency to read
words from right to left and write the final syllables first: words. This is how it manifests itself in
these patients' writing, reading and comprehension skills are impaired constructively
spatial praxis. Due to the violation of situational speech and
amnestic difficulties, these patients are similar to patients with temporal lobe aphasia,
however, their phonemic hearing and auditory-verbal memory are preserved, rough
violations of constructive praxis and apraxia of the articulatory apparatus
indicates the lower parietal localization of the speech disorder. In some
In cases of left-handers, complex afferent (conductor) is observed.
aphasia and acoustic-comnestic aphasia.
With partial efferent motor aphasia in left-handers, the main difficulties are
arise when composing a phrase based on a plot picture, mild agraphia,
perseveration in oral speech and writing with significant preservation of situational
speech, realized as in the “conduction” phase, is preserved in these patients
the primarily speech-dominant right hemisphere (M.K. Burlakova, 1990, 1997).
With partial efferent and afferent motor aphasia in left-handed people
stages of the middle and late stages of recovery, a phenomenon is observed
“pre-grammatical” writing, which reveals the loss of all elementary
writing skills: spelling prepositions and prefixes, unstressed vowels,
the use of a soft sign, capital letters in personal names, mirror
writing some letters, etc. For example, such a patient writes: “The boy is
I was driving to my grandmother. “Pre-grammatical” writing is noted only in
patients with left-handed aphasia, is not observed in right-handed people and has nothing to do with
dysgraphia or agraphia in all forms of aphasia.
With these forms of aphasia, left-handers have prospects for restoration of speech functions
slightly better than right-handers.
Methods of correctional pedagogical work for aphasia in left-handed and right-handed people
are the same, so without overcoming the apraxia of the articulatory apparatus with so.
so-called “conduction” aphasia, it is impossible to overcome agraphia and alexia,
restore repetition and naming functions. However, left-handers with acoustic
mnestic and semantic aphasia, speech disorders remain persistent and
difficult to overcome. Dynamic aphasia is practically not observed in left-handers,
which is explained by the high interchangeability of left-handed functions of the posterior frontal
parts of the brain (M. K. Burlakova, 1997).
The so-called crossover is very rarely observed. aphasia, i.e. true
picture of non-partial afferent motor aphasia in left-handers, with damage
the left hemisphere for left-handers and the right hemisphere for right-handers. "these patients speak
is completely absent until systematic treatment begins with them
speech therapy classes.
The study of higher cortical functions in aphasia is carried out according to
following diagram:
1. Study of the general ability for verbal communication conversation with the purpose
clarifying the completeness of the patient’s own speech, his understanding of situational,
everyday speech, the degree of speech activity.
2. Study of speech understanding. Special one is presented aurally
and multi-link instructions; tasks to find objects;
a retelling of short texts listened to is offered; the solution is logical
grammatical structures.
Phonemic hearing is examined;
auditory-verbal memory; understanding the meaning of proverbs.
3. Study of expressive speech: automated speech, repetition
sounds, syllables, words of varying degrees of complexity, naming objects
pictures, naming actions, composing phrases and texts based on plot
pictures, retelling the text read.
4. Study of reading, writing and arithmetic.
5. Study of oral, spatial and dynamic praxis.
6. Study of acoustic and optical gnosis.
Handedness testing (i.e. tests for left-handedness) in adults
patients with aphasia.
1. Last name. Name. Surname. 2. Side of the brain lesion. 3. Is there
left-handedness in the family. Who is left-handed? 4. Does he consider himself left-handed, ambidextrous, or right-handed? 5.
Did you change your training from your left hand to your right hand when you were a child? Who in the family itself
retrained? 6. Have you had any injuries, burns or other illnesses in childhood or later?
right hand. 7. Is there a history of stuttering in the family? Did you stutter yourself? When did you start
speak? Were there any difficulties in learning Russian language and writing in elementary school?
8. Neuropsychological tests for determining left-handedness or right-handedness: a) leader,
target eye (L, R); b) interlacing of fingers: upper position of the thumb
fingers (L, R); c) “Napoleon pose.: upper arm (L, R); d) Applauding: top
palm; e) the size of the bottom of the nail of the thumb or little finger (L, R); f) development
venous system in the arms (L, P); g) which hand is 12 mm longer; h) leading
foot in sports (L, R). Availability of a number of psychological tests for signs of left-handedness
right-handedness speaks of the degree of partiality of “handedness.” Availability is examined next.
9. Labor and household skills in which the patient used his left hand: a)
which hand holds a spoon, cup, pencil; b) can write, draw, draw; V)
sew, knit, wring clothes; d) brushes teeth, clothes, shoes; d) which hand
combs one's hair, which side is parted on the head; e) which hand is more convenient for washing?
dishes, windows, unlocking the door, cutting paper, nails; g) which hand sweeps the floor,
digs, saws, hammers NAILS, screws in a light bulb; h) which hand plays better?
on a musical instrument.
The same tests are carried out on the patient’s closest relatives.
The main signs of left-handedness are the presence of a genetically determined
left-handedness in the patient's relatives on the father's and mother's sides, taking into account the influence not
related lines of the patient, identification using tests of the leading eyes and hands, and
as well as a number of professional skills.
When summing up the results of the examination of the patient’s higher cortical functions
a general description of his speech is compiled subject to the following plan:
the presence of left-handedness (according to A.R. Luria, 1969), the degree of contact of the sufferer
aphasia, his orientation in the environment, his exhaustion. Characterized by
the degree of impairment of speech understanding, what predominates in the picture of the impairment
understanding: phonemic awareness, impressive agrammatism, perseveration
when performing tasks, understanding complex instructions and individual words,
phraseological units, features of auditory-verbal memory. The degree is fixed
disintegration of expressive speech, the presence of perseverations, the nature of verbal and
literal paraphasias; the ability to repeat individual sounds, words, series of words
and proposals; the ability to name, compose phrases based on a simple plot and
based on a series of plot pictures. It is possible to read silently, perform
written instructions, recognition of individual words in cases of severe reading impairment,
recording letters, words and phrases under dictation, independent writing, required
the presence of literal and verbal paraphasias, omissions and rearrangements is noted
letters, syllables and words in a sentence, the presence of perseverations.
The patient’s fulfillment of the plan of mathematical actions is checked, the possibility
transition through ten, the presence of oral and articulatory apraxia, dynamic
or constructive spatial apraxia, preservation of optical and
acoustic gnosis. A thorough examination of the patient is carried out (questioning,
tests) for the presence of left-handedness.
Based on the analysis of a neuropsychological comprehensive examination
a final conclusion is made about the form of aphasia, the degree of decay of all
functions.
CORRECTIONAL PEDAGOGICAL WORK ON
OVERCOMING APHASIA
A major contribution to the development of principles and techniques for overcoming aphasia was made by E.
With. Bein, M. K. Burlakova (Shokhor Trotskaya), T. G. Wiesel, A. R. Luria, l. With. Tsvetkova.
In speech therapy work to overcome aphasia, general
didactic principles of teaching (visuality, accessibility, awareness, etc.)
etc.), however, due to the fact that the restoration of speech functions differs from
formative learning that the higher cortical functions of the speaker and
of a writing person are organized somewhat differently than those of a person beginning to speak
child (A.R. Luria, 1969, l.s. Vygotsky, 1984), when developing a plan
correctional pedagogical work should adhere to the following
provisions:
1. After completing the examination of the patient, the speech therapist determines which area
second or third. Functional block. the patient's brain was damaged in
as a result of a stroke
or injury, which areas of the patient’s brain are preserved: in most patients with
with aphasia, the functions of the right hemisphere are preserved; for aphasia,
arising from damage to the temporal or parietal lobes of the left hemisphere, first
planning, programming and control functions are used in total
left frontal lobe, providing the principle of consciousness of the restorative
training. It is the preservation of the functions of the right hemisphere and the third
"functional block. the left hemisphere allows you to educate the patient
installation for restoration of impaired speech.
Duration
speech therapy sessions with patients with all forms of aphasia is two to three
years of systematic (inpatient and outpatient) training. However, it is impossible
inform the patient about such a long period of restoration of speech functions.
2. The choice of methods of correctional pedagogical work depends on the stage, or
stage of restoration of speech functions. In the first days after a stroke, work
is carried out with relatively passive participation of the patient in the recovery process
speech. Techniques are used to disinhibit speech functions and
preventing such speech disorders as
agrammatism of the “telegraph style” type. with efferent motor aphasia and
abundance of literal paraphasias in afferent motor aphasia. For more
in the later stages of restoration of speech functions, the structure of the
and a lesson plan, tools are given that he can use when performing
assignments, etc.
3. The correctional pedagogical system of classes presupposes such a choice
methods of work that would allow either to restore the initially damaged
prerequisite (if it is not completely broken), or reorganize the preserved links of the re
chevy functions. For example, compensatory development of acoustic control during
afferent motor aphasia is not just a replacement of impaired
kinesthetic control acoustic for the restoration of writing, reading and
understanding, and the development of intact peripherally located analytical
elements, the gradual accumulation of the possibility of using them for
activity of the defective function. In sensory aphasia, the recovery process
phonemic hearing is carried out through the use of intact
optical, kinesthetic, and most importantly, semantic differentiation of words that are close
by sound.
4. Regardless of what the primary neuropsychological background
turns out to be impaired, with any form of aphasia work is being done on all
aspects of speech: expressive speech, comprehension, writing and reading.
5. In all forms of aphasia, the communicative function of speech is restored,
self-control develops over it. Only when the patient understands the nature of his
mistakes, you can create conditions for him to control his speech, his plan
narratives for the correction of literal or verbal paraphasias, etc.
b. For all forms of aphasia, work is being done to restore verbal
concepts, including them in various phrases.
7. The work uses deployed external supports and
gradual and?t interiorization as the restructuring and automation of the disturbed
functions. Such supports include in case of dynamic aphasia of the sentence scheme
and the method of chips, allowing you to restore your own deployed
utterance, in other forms of aphasia - a scheme for choosing methods of articulation
with arbitrary organization of articulatory structures of phonemes, schemes,
used to overcome impressive agrammatism.
The dynamics of restoration of impaired speech functions depends on the location and
the volume of the lesion, the form of aphasia, the timing of the start of rehabilitation
education and premorbid level of the patient.
For aphasia,
speech
recovers better than with cerebral thromboembolism or
resulting from cerebral hemorrhage,
extensive brain injuries. Aphasic disorders in 56 year old children (in
in most cases of traumatic origin) are overcome faster,
than among schoolchildren and adults.
Correctional pedagogical work begins with the first.
weeks and days from the moment of stroke or injury with the permission of a doctor and under his
control. Early start of classes prevents the fixation of pathological
symptoms and guides recovery along the most appropriate path.
Restoration of impaired mental functions is achieved with long-term
speech therapy classes.
For aphasia, individual and group speech therapy sessions are provided.
The individual form of work is considered the main one, since it is
ensures maximum consideration of the patient’s speech characteristics, close personal
contact with him, as well as a greater possibility of psychotherapeutic influence.
The duration of each lesson at an early stage after a stroke averages from 10 to
15 minutes 2 times a day, in the later stages 30-40 minutes at least 3 times a week. For
group classes (three to five people) with the same types of speech forms
disorders and relatively the same stage of speech recovery time
classes 4550 minutes.
The speech therapist should explain to the family the patient’s personality traits associated with
severity of the disease. Specific examples explain the mandatory nature of it
feasible participation in family life. Instructions are given for working on
restoration of speech.
CORRECTIONAL PEDAGOGICAL WORK
WITH ACOUSTICOGNOSTIC SENSORY
APHASIA
For acoustic-cognitive sensory and acoustic-comnestic aphasia
There is an increased performance of the patient and an active desire for
overcoming speech disorders.
At the same time, he may experience a state of depression, and therefore a speech therapist
must constantly encourage him, give him only what he can to do his homework
tasks, inform the doctor about a depressed or excited state
sick.
In case of acoustic-cognitive sensory aphasia, the task of corrective
pedagogical work is the restoration of phonemic hearing and
secondarily impaired expressive speech, reading, writing.
The speech therapist relies on intact optical and kinesthetic analyzers
system, as well as the preserved functions of the frontal lobes, which together create
prerequisites and compensatory restructuring of impaired acoustic-cognitive
functions.
Restoration of phonemic awareness at early and residual stages
carried out according to a single plan, with the only difference being that at an early stage
impairment of phonemic awareness may be more pronounced.
In particularly severe cases of sensory aphasia at an early stage of recovery
non-verbal forms of work are used, the purpose of which is to establish
contact with the patient, explanation of the fact of the disease, organization of his studies
activity (performing feasible tasks), concentration.
Copying short words to pictures and solving simple ones is used
arithmetic examples. As a rule, the patient willingly begins to
cheating, but retains in visual memory only the first letter of the word, and then
writes a series of letters that are not related to the word being copied. They show it to him
mistakes, they are asked to write down the word letter by letter, dividing them into cells. IN
In the process of these tasks, a partial awareness of the very fact of one’s
disease, the patient, as a rule, experiences it seriously, and in the future
carefully performs all speech therapist tasks. Stage of non-speech period of work with
For patients, it may last several days.
Work on restoring phonemic perception contains the following
stages: first stage differentiation of words contrasting in length, sound and
rhythmic pattern (house shovel, spruce bicycle, "from the car").
Pictures are selected for each pair of words, and on separate strips of paper
words are written in clear handwriting. The patient correlates the sound image of the word with
drawing and signature, he is asked to choose one or another picture, divided
live captions for pictures, pictures for captions.
In parallel with this work, the consolidation of sound perception begins
individual words in the process of copying them,
pronouncing words while copying and developing auditory control. For
This means short words consisting of one or two syllables. Upbringing
The patient's acoustic attention begins with the revival of optical attention.
The second stage is the differentiation of words with a close syllable structure, but distant
by sound, especially in the root part of the word: fish legs, trach fence, watermelon
axe. The work is carried out based on pictures, captions, copying, reading;
Acoustic control of one's speech is developed.
THIRD STAGE differentiation of words with a similar syllable structure, but with
distant-sounding initial sounds (ra" ma", ru "a mu"a); with common first
sound and various final sounds (“luv” luch, night zero, lion forest).
The patient is asked to choose words that begin with one sound or another,
based on subject pictures and captions to them.
The fourth stage is the differentiation of phonemes that are similar in sound (house volume,
house smoke, etc.).
To consolidate the unambiguous perception of phonemes, various
exercise options for filling in missing letters, words with
oppositional sounds, the meaning of which is clarified not through the drawing, but
through phraseological context. For example, the patient is asked to insert into
text words carcass, shower, body, business, etc.
P I th stage consolidation of acoustic differential features
phonemes when selecting a series of words for a given letter from texts.
Restoration of phonemic awareness lasts from 2 months to 11.5 years,
since in many cases understanding the meaning of a word occurs only in context
and difficulties in differentiating close phonemes have been experienced for a long time when
independent written presentation of thoughts.
In addition, work is underway on the semantic attribution of words through various
phraseological contexts: select all sharp ones shown in the pictures
objects, anything made of wood, metal or glass, that which relates to
dishes, tools, shoes, etc. Such work aimed at revitalizing
various semantic connections of a word, facilitates the choice of words in the process of communication,
reduces the number of verbal paraphasias.
The greatest difficulties in overcoming speech disorders are observed when
combination of acoustic agnosia and acoustic-gnostic aphasia arising
with bilateral damage to the temporal zones. Restoring speech in this case
variant of aphasia relies on guarded reading to oneself, lip reading and residual
auditory perception capabilities that allow you to correlate what you read,
visually perceived articulatory position of the sound, its ability
simulated repetition with an aurally perceived sound signal.
Overcoming verbal paraphasias is carried out through discussion
various signs of objects and actions according to their contiguity and contrast, according to
function, tool affiliation, on a categorical basis. To the patient
you are asked to fill in the missing verbs and nouns, select
nouns and adverbs to the verb, adjectives and verbs to
noun, etc. It is not always necessary to correct the patient during
his statements, this can traumatize him, cause him irritation,
break contact with him. The speech therapist records verbal paraphasias in his daily
Nick and, based on their analysis, selects a series of exercises to overcome them.
To overcome verbosity and agrammatism, the patient is offered a scheme
sentences, examples of direct and inverted sentences of three to five words.
One of the effective methods for restoring expressive speech when
sensory aphasia (as with other forms of aphasia) is the use
written speech. The patient is asked to write phrases and texts using simple
story pictures. This work allows him to find the right word, polish
make a statement. Overcoming errors in agreement between verbs, nouns and
pronouns in gender and number are carried out by inserting those missing in the text
flexions.
Restoration of reading, writing and written speech is carried out in parallel with
overcoming phonemic hearing impairment. Letter recovery
precedes the restoration of reading, based on sound-letter analysis
composition of the word. Attempts to pronounce a readable word, the realization that
mixing sounds changes the meaning of the word, creates a basis for restoration
analytical reading and then writing.
CORRECTION-P~GOPIC WORK WITH
ACOUSTIC-MNESTIC APHASIA
The main tasks of correctional pedagogical work in acoustics
mnestic aphasia are overcoming impairments in auditory-verbal memory,
restoration of visual ideas about the essential features of an object, and
also overcoming amnestic difficulties and elements of expressive
agrammatism.
During a neuropsychological examination, the acoustic variant is clarified
mnestic aphasia. Then a correctional pedagogical program is drawn up
work.
Speech therapist in overcoming speech disorders in acoustic-comnestic aphasia
uses a mechanism for encoding the intent of a speech utterance, description
signs of an object, introducing words into various contexts, composing external
supports that allow the patient to maintain varying amounts of auditory-speech load.
Restoration of auditory-verbal memory occurs based on visual
perception. A series of subject pictures, different
according to semantic interconnectedness, and the task is given to choose from them two three four
subject. Due to the fact that in speech words are connected by the intent of the statement, then at first
among “by chance. Selected pictures depicting, for example, a hare, a plate,
STOJIE., guns, scaffolding, etc., he is invited to show objects that can
be fit into a given situation. For example, it is proposed to show a fork, a table,
cucumber or forest, hunter, hare, etc. Then words are given that are not included in one
semantic field.
At the next stage of restoration of auditory-verbal memory, object pictures
are given in the form of a stack. The patient, having listened to a series of names of objects, finds them
images and sets them aside. This achieves some detachment
execution of instructions in time. Subsequently, it is proposed to repeat the series
words worked through in previous lessons, without resorting to pictures. WITH
First, words denoting objects are given for memorization, then actions and
qualities of objects and, finally, numbers combined into telephone numbers.
In parallel with this, auditory dictations of phrases consisting of two, three,
four words, based on a plot picture, and later without it.
In the second variant of acoustic-comnestic aphasia for recovery
visual representations, it is recommended to carry out a number of exercises,
including analysis of objects that are similar in design, shape, and differ
one or two signs (for example, a cup, a teapot, a sugar bowl; a cabinet,
refrigerator, buffet), in which a change or absence of one of the parts
changes the function of an object, its content and designation. A task is given
construct objects from elements, find errors in the image
objects (for example, a rooster is depicted without a tail, a cat with long ears, etc.)
etc.), it is proposed to complete the drawing of the object, describe its properties and functions,
recognize an object half hidden by a sheet by its part, etc.
Overcoming the alienation of the meaning of words with complex syllable structure
carried out by listening and repeating them syllable by syllable.
Difficulties in finding the right word, as in acousticagnostic aphasia,
are overcome by expanding and sometimes narrowing the semantic boundaries of the word, i.e.
by clarifying and systematizing their meanings. To do this, the word “is played out. V
various phraseological contexts, is carried out
work on understanding the polysemy of a word, for example, the words ruch, luch, mashina,
"wasp, peso", pen, to clarify the meaning of synonyms, antonyms and homonyms.
Restoring a written statement is one of the forms of consolidation
achieved results in overcoming amnestic disorders.
Preservation of understanding of the sound-letter composition of a word and significant
preservation of phonemic hearing allows correctional treatment from the very first days
pedagogical work use the preparation of written texts, which
helps to overcome the poverty of vocabulary and characteristic of the back.
Form of the agrammatism phase.
Violation of agreement in gender and number of main members of a sentence
overcome by replacing nouns with pronouns and pronouns
nouns, composing phrases based on supporting words, ability to complete
sentence, insert missing prepositions and inflections of nouns.
CORRECTIONAL PEDAGOGICAL
WORK WITH SEMANTIC AFASIA
The main objectives of speech therapy work for semantic aphasia
are: overcoming difficulties in finding the names of objects, rubbing
overcoming
lexical and syntactic composition of patients’ speech,
impressive agrammatism.
Correctional pedagogical assistance to overcome semantic aphasia
relies on the control of all intact analytical systems (vision, auditory-verbal
memory), and most importantly, on the planning and regulating functions of the frontal regions
brain, on the intact linear organization of oral speech.
Due to the fact that the basis of speech disorders in semantic aphasia
lies a violation of simultaneous spatial gnosis, restorative
learning in this form of aphasia begins with the development of constructive
spatial activity. This requires visual exercises.
analysis of geometric shapes, ornaments made up of elements,
reconstructed according to a visual model and according to instructions, restoration
the patient’s orientation in left and right, in parts of the world. In geographical
map. Constructive spatial apraxia is overcome by
teaching a plan for dividing an ornament or design into certain
segments and completing the task according to plan (for example, first the lower floor.,
then the second, third, etc. or first the first column on the left, then the second and
etc.).
To overcome amnestic difficulties, comparison is necessary
different semantic connections of words according to features that form different
semantic fields. So, for example, those characteristics of objects are analyzed
which unite them into specific categories (profession, furniture, clothing
etc.), and at the same time the commonality of words is determined by their
root part
(gardener,
garden,
landings),
by suffix
and prefixal signs (gardener, inkwell, sugar bowl). Underway
work on describing the differences and similarities of synonyms, antonyms, homonyms,
the use of qualitative definitions of objects in writing,
complex and complex sentences (with various
allied words), the subordinate part of which is at the beginning, middle or
end of the sentence and refers to different parts of the main clause.
Overcoming impressive agrammatism begins with clarification
meanings of individual prepositions and adverbs, mastering the scheme of prepositions with
moving a point (object) around a drawn table, house, glass.
The patient is asked to repeatedly describe the location of the central
object in relation to objects located to the left and right of it (later
above and below it). The average of three objects schematically depicted in a notebook
patient (for example, a Christmas tree, a house, a cup), circled, near it or above it
it puts a question mark, arrows outline the outline of the description
arrangement of objects. The patient makes up phrases like: The Christmas tree is drawn
to the right of the house and to the left of the cup or The house is drawn to the left of the cup and
to the right of the tree. The location is also described later
three items with prepositions above under, with adverbs above
lower, further closer, lighter darker, etc. Preliminary study
of these patterns in expressive speech prepares the basis for understanding logically
grammatical structures by ear when reading.
Using the same method of comparing and describing sticks of different heights (for example,
T S V Sonya is taller than Tony and shorter than Vasya), LENGTH, i.e. by attracting
preserved expressive, syntagmatically organized speech, master
comparative and inverted logicogrammatical constructions like:
Sonya is taller than Olya and shorter than Tony; Kursk is further from Moscow than Orel and closer
Kharkov, and it is decided who is larger and smaller than everyone else, what is further or closer. Only
after the patient begins to freely secrete the central, middle
object and freely describe the location of compared objects, he
given the task of decorating the tasks he has just compiled.
Switching the patient from a verbal description of mutually located positions
objects for their schematic representation, i.e. for the implementation of the plan compiled by him
logical-grammatical task, leads to the development of a solution plan and other
similar tasks.
To overcome acalculia, the categories included in the
number (tens, hundreds, thousands, etc.), the meanings of the synonyms minus are fixed
subtraction plus addition. Patients are asked to perform actions in advance
cases of one to two dozen, then within hundreds and thousands. A special place in
overcoming defects in counting operations
takes the solution of arithmetic problems in 234 operations using
adverbs more, less and verbs take away, add, send, unload and
etc., i.e. verbs with prefixes conveying spatial
relationships between actions and objects.
Overcoming optical alexia is carried out through verbal description
sick elements included in a particular letter, constructing letters from
elements (various sizes of cardboard or plastic sticks and ovals),
reading (naming) letters after identifying their elements, reading words through
sliding on it.oKomko. (a square slot in a strip of cardboard), through
.OKOmko., covering several letters included in the word, reading the line with
ruler covering the bottom lines of text.
Mirror or constructive spatial agraphia can be overcome
by restoring the orientation of patients in the left and right in different
options for the arrangement of objects (for example, a cup is on the bottom, a cup
turned upside down, etc.), copying (copying)
sick individual letters or words with a colored pencil fixing the left side
sheet and direction (arrow),
where to start writing a series of letters or elements, with the definition of
which side is he looking at? letter.
CORRECTIONAL PEDAGOGICAL WORK WITH
AFFERENT MOTOR APHASAIA
correctional and pedagogical assistance to overcome afferent motor
aphasia relies on the inclusion of intact visual and acoustic control, and
also controlling the function of the frontal parts of the left hemisphere in right-handed people, in
a complex that carries out visual and auditory analysis of what is read and perceived
to hear a speech signal, control over the optical synthesis of visible elements
ticulatory structure, etc.
General objectives of correctional pedagogical work with afferent
motor aphasia is to overcome kinesthetic disorders
articulatory praxis, which ensures overcoming agraphia, alexia,
disturbances in speech understanding, and then the restoration of detailed oral and
written statement.
Working methods are determined. degree of speech disorder.
With grossly expressed afferent motor aphasia at the initial stage
correctional pedagogical work tasks of restorative education
are: 1) disinhibition or restoration of the pronunciation aspect of speech;
2) overcoming violations of understanding; 3) restoration of analytical reading and
letters; stimulation of elementary situational speech.
With a moderate degree of severity, the tasks of correctional pedagogical work
are: 1) consolidation of articulation skills; 2) overcoming literal
paraphasia; 3) stimulation of expressive speech, overcoming sound defects
letter analysis of word composition and literal paragraphs when writing words; 4)
overcoming expressive and impressive agrammatism: understanding the meanings and
the use of prepositions that convey the spatial relationship of objects.
For mild afferent motor aphasia, tasks
correctional pedagogical work are to overcome residual
articulatory difficulties when pronouncing polysyllabic words with a confluence
consonants, elimination of literal paraphasias and paragraphs, overcoming elements
expressive and impressive agrammatism.
To solve these problems with gross afferent motor aphasia, it is used
global, conjugate pronunciation reading of automated speech series
copying them and reading them to oneself, and then visual dictation and reading aloud phrases in
topics of the day, reading and writing individual letters from dictation, folding from cut paper
the alphabet of three-to-five letter words, introducing these words into active speech.
With relatively intact reading to oneself and some preservation
written speech is formed by the restoration of written speech when composing
phrases based on plot pictures. To overcome apraxia of the articulation appa
Rata uses a visual-auditory imitation technique. All work according to the method
imitation of sounds excludes the use of a mirror, probes, spatulas, since they
with aphasia, the degree of voluntary movement increases, aggravates
articulation difficulties of patients. Before calling one or
another sound, the patient is asked to perform non-speech movements of the tongue, lips,
cheeks, soft palate in a semantic, “playful” form that imitates these movements, i.e.
e. oral apraxia is overcome. Calling sounds begins with imitation
available sounds, usually labial and anterior lingual.
It is advisable to start with calling the contrasting vowel phonemes a and u. For them
differentiation, the speech therapist draws large and narrow circles in the patient’s notebook
or wide and narrow
open lips and teaches him to imitate these sounds, then adds sounds.m and
V.
The calling of sounds must be “subject to the following conditions: it is impossible
simultaneously evoke the sounds of one articulatory group; sounds should
introduced not into nouns in the nominative case, but into words and phrases,
necessary for communication (yes, no, here, I will, I want, etc.).
For gross afferent motor aphasia for faster translation
patient from visual imitation of sound (“lip reading”) to independent
pronunciation of sounds in the process of reading non-complex words, used
placement of superscripts over letters: and a circle imitating widely
open mouth; have a narrow circle; .m – closed lips, later just straight
line; s chin extended in profile; t arrow from left to right,
imitating the direction of movement of the tongue in its interdental position; And
mouth stretched in a smile; o vertical oval; bitten lower lip; with
a horizontal whistle, and later two parallel lines; uh
a wide opening of the mouth with the tongue resting on the teeth; ", drawing of the wings of the nose in
profile; e horizontal oval of the mouth; w square, imitating exaggerated
pronouncing this sound; lC arrow from right to left showing direction
movements of the tongue into the depths of the mouth; n. two opposing brackets imitating inflated ones
cheeks, and a line between them, imitating
clenched and suddenly opened lips; I am an arrow pointing from bottom to top; r
wavy line; H and h are transmitted by a combination of an arrow (t) and two parallel
lines (c) and square (w); iotated vowels are indicated by “sum. superscript
signs for i = and + 4; yu = and + y, etc. To determine voiced consonants 6, d, g, :ne, a
The same superscripts are used with an exclamation point above them.
A. suggested using superscripts for afferent motor aphasia.
R. Luria (1948). their use facilitates the patient’s transition from visual
perception of the articulatory structure of the sound pronounced in conjunction with a speech therapist,
to reading simple words, then phrases and texts. This is the most severe form of aphasia
both right-handers and left-handers are successfully overcome within 23 years and in
in most cases, with an adequate setting for significant recovery
articulation side of speech, patients return to active work. Speech therapist
so as not to cause depression in the patient, does not tell him about such a long period
restorative training.
In order to consolidate articulation skills when mastering new sounds
the speech therapist must repeat the previous material many times, reducing
the use of superscripts as the patient overcomes apraxia
articulatory apparatus. To overcome it completely, the entire
The material must be repeated two or three times.
As apraxia of the articulatory apparatus is overcome, they move on to
conjugate and reflected pronunciation of phrases of everyday life in
pictures, stimulate the patient’s independent speech.
Restoration of situational,
colloquial speech is one of
priority tasks as the initial stage of correctional pedagogical work,
and with moderate severity of afferent motor aphasia.
The reconstructed sounds are introduced into words and phrases needed for communication
(okay, I’ll be there, tomorrow, today, in the morning; there was a doctor, I’ve already eaten, etc.).
As situational dialogical speech arises,
restoration of monologue speech. The main goal of its restoration is
expansion of the patient’s vocabulary, prevention of agrammatism, development of expanded
oral and written statements, preparation of free dialogical speech.
The patient masters the scheme of direct and inverted phrase construction according to
plot picture, outline of a statement based on a series of plot pictures. As
restoration of sound-letter analysis" of the composition of the patient's words is translated from
oral compilation of phrases from pictures to writing, recording achievements
sick. Written speech turns out to be a support for restoring oral skills
saying
At the residual stage of correctional pedagogical work, i.e. if with a patient
speech therapy classes were not conducted for a long time,
restoration of reading and writing begins from the very first lesson with overcoming
articulatory difficulties. Each spoken sound (word, phrase) is read
first in conjunction with a speech therapist, then independently. Big role in
restoration of reading and writing is given to visual dictation of individual words,
phrases and short sentences.
In case of gross afferent motor aphasia to restore composition analysis
words, a split alphabet is used, entering missing letters into a word and phrase.
Overcoming gross articulatory disorders in afferent motor
aphasia is a long process (from 3 months to 1 year), but residual effects
disturbances in sound pronunciation are also observed when the patient has afferent
motor aphasia becomes moderate to mild in severity.
For moderate afferent motor aphasia, the main focus is
focuses on overcoming agraphia and agrammatism. The patient is offered visual
and auditory dictations, special attention is paid to words with consonant clusters,
filling in missing syllables in a word, in a sentence of words. Overcoming
agrammatism is facilitated by the use of preposition schemes, ending schemes
nouns (mainly in the genitive and accusative cases). Special
attention is required when working with prepositions consisting of one sound: in, with, ", since
they merge with the word, forming an additional consonant cluster, and with difficulty
amenable to auditory analysis in patients with afferent motor aphasia.
With mild afferent motor aphasia, articulatory difficulties are overcome
difficulties in pronouncing affricates, consonant clusters, sounds, fixed
the patient's auditory control of his speech in order to overcome literal
paraphasia and agrammatism, the rate of pronunciation gradually accelerates in
proverbs, sayings, tongue twisters, when retelling what you read and in stories based on
series of plot pictures, reproductions of paintings by artists, masters
professional vocabulary of the patient. The patient writes texts based on a series of pictures and
postcards.
Restoring understanding. For severe disorders of expressive speech, the main
attention is paid to the restoration of phonemic hearing, orientation in
space, clarifying the meanings of prepositions, adverbs, understanding personal
pronouns in oblique cases, antonyms, synonyms.
In later stages, when reading and writing can be relied upon,
impressive agrammatism is overcome.
CORRECTIONAL PEDAGOGICAL WORK
WITH EFFERENT MOTOR APAEIA
The main tasks of correctional pedagogical work with efferent
motor aphasia are overcoming pathological inertia in the
generating the syllabic structure of a word, restoring the sense of language, overcoming
inertia of word choice, agrammatism, restoration of the structure of oral and
written expression, overcoming alexia and agraphia.
At.front. efferent motor and dynamic aphasia work is based on
on the intact paradigmatic system and on the introduction from the outside by a speech therapist
programs and schemes of speech utterance, ranging from programming and
planning the syllable structure of a word and ending with the restoration of planning
phrases and text.
, It is the means brought from outside that program the structure of words and phrases
(schemes, plans, programs) allow to overcome in patients with efferent
motor aphasia - difficulty switching from one syllable or word to another,
restore the kinesthetic melody of speech, overcome perseveration, echolalia,
difficulties of syllables included in a word and words included in a phrase.
Overcoming the impaired pronunciation side of speech with efferent
motor aphasia begins with the restoration of the rhythmic-syllable pattern of the word, its
kinetic melody.
In case of severe impairment of reading and writing, work begins with the merging of sounds into
syllables. The patient, repeating the syllable, puts it together from the letters of the split alphabet. Then from
mastered syllables, a simple word such as hand, water, jolokoi, etc. is formed.
relying on the rhythmically clapping syllabic structure of the word, as well as on patterns
words. Work is used to automate words with a certain rhythmic
structure: it is proposed to read a series of words with one syllable structure,
written in a column. Gradually the syllable structure of the word becomes more complex. Sick
in conjunction with a speech therapist, and then independently reads divided into syllables
rhyming words.
Simultaneously with the restoration of the sound and syllabic structure of the word,
work on restoring narrative speech.
Overcoming narrative speech disorders begins with restoring
the so-called sense of language, capturing the consonances of rhymes in poetry, proverbs and
proverbs. It is especially useful to use proverbs and sayings with reef
muting verbs.
When restoring expressive speech, special attention is paid to overcoming
pathological inertia in finding the right words to speak.
Playing with an object drawing, the speech therapist asks the patient questions about why
the object is intended, what can or should be done with it, for example, to eat
(needs to be washed, cooked, etc.), what are the properties of the object, etc.
In case of efferent motor aphasia, overcoming inertia in choosing a verb
not only the phraseological context contributes, but also the expressive
pantomimic imitation by a speech therapist of movements with objects.
Later, the patient is given the task of finishing a homogeneous phrase with different words,
for example: I'm a hedgehog... (potato soup, porridge, white bread, etc.) or I
I’m waiting... (for a doctor, a doctor, a daughter, a wife, etc.). Beforehand, the speech therapist clearly pronounces
phrases to several pictures, then stimulates their pronunciation by asking questions
based on various proposal patterns.
An important part of the work on accumulating a verbal dictionary is
selection of several verbs to a noun or several nouns to
one verb. The first oral texts spoken by the patient according to
the plan set by the speech therapist are stories about the daily routine: I got up, washed my face,
brushed my teeth...", etc. Preventing and overcoming prepositional inflection
agrammatism, various exercises are used to fill in missed inflections,
then inflections and prepositions and, finally, verbs and nouns in indirect
cases. The patient learns to use the restored vocabulary in
conversations with medical personnel, with relatives, later masters vocabulary,
necessary when visiting a doctor, shops, pharmacy, etc.
With gross efferent motor aphasia, reading and writing may be limited.
state of complete collapse. In this regard, for patients,
individual alphabets, in which each letter corresponds to a specific
a picture or word that is meaningful to the patient. For example, a watermelon, b grandmother "a, c
Vasily, etc. Later, work is carried out on composing words from the syllables of the usual
split alphabet.
To restore smooth writing, the patient is taught to write repeatedly
with the left hand, first individual capital letters, then words and phrases. Healthy
conduct a course of preparatory capital exercises to prevent
perseveration of letter elements when writing words. At the stage of partial
restoration of sound-letter analysis of word composition from a split alphabet
move on to recording words and light phrases during auditory dictations. Wherein
the patient must pronounce each word sound by word, sometimes first
form difficult words from a split alphabet.
The restoration of reading goes in parallel with the restoration of sound and letters
analysis of words, but, of course, somewhat ahead of it. At first the patient is syllable by syllable
reads words with different syllable structures, then simple texts.
At the later stages of restoration of the sound-letter analysis of the word composition
simple crossword puzzles are solved, short words are formed from letters
polysyllabic words, letters and essays of varying degrees of complexity are written,
diaries are kept, etc.
Overcoming speech understanding defects is carried out by performing
various attention tasks, switching from one subject to another,
tasks of a provocative nature, when the speech therapist asks to show the object
which is not among those lying in front of the patient, correlate the phrase with the plot
picture.
As auditory attention is restored, the display of pictures is stimulated
task, while the patient is asked not “where is the spoon drawn.,” but “show me
spoon. or “show WHAT we eat., put a spoon on the glass. and so on.
In this case, the logical stress should fall either on the preposition or on
noun. Using intonation or logical stress, speech therapist
emphasizes the transition to other types of tasks: put the glass down, turn it over
glass upside down, etc.
CORRECTIONAL PEDAGOGICAL RA&OTA WITH
DYNAMIC APHASAIA
The main task of working with dynamic aphasia is to overcome
defects in internal speech programming.
If aspontainment is significantly pronounced, the patient is given various
exercises to classify objects according to various criteria (furniture, clothing,
dishes, KpYГJIJ>le objects, square, wooden, metal, etc.);
forward and reverse ordinal counting is used, subtraction from 100 by 7, by 4 and
etc.
Internal programming defects are overcome
creating speech programs for patients using various external
supports (questions, sentence patterns, counters), gradual reduction in their number
and subsequent internalization, collapsing this scheme
“inside.. The patient, moving his index finger from one chip to another,
gradually unfolds the speech utterance according to the plot picture, then
proceeds to visually following the plan for the unfolding of the utterance without
associated motor reinforcement and, finally, composes
these phrases without external support, resorting only to internal speech planning
statements.
The restoration of the linear development of the utterance is facilitated by
the use of words included in questions for a story picture or in a question for
relevant to the situation discussed in class. For example, to the question:
“Where are you going today? the patient answers: “I’ll go to the hairdresser.” or me
I'll go for an x-ray. etc., i.e. he adds only one word. Another trick
restoring the structure of an utterance is the use of support words,
from which the patient makes a sentence. Gradually the number of proposed
words to compose a sentence of 56 words is reduced, the patient is free,
at his own discretion, adds words in the desired grammatical form.
Due to the fact that in dynamic aphasia the composition of not
phrases, and texts, a series of sequential
pictures, for example, a series of pictures about a child who independently built a shamplott and
set off on a voyage, and about the consequences of such a voyage, a series of everyday
drawings by artist H. Bidstrup.
With dynamic aphasia, speech inactivity is overcome,
conditions for increasing speech initiative, for this the patient is instructed orally
convey to someone this or that request from a speech therapist, etc. Speech activity
increases in the process of creating special speech situations and staging, in
during which the initiative for dialogue is transferred to the patient. Dialogue topic
pre-discussed with the patient, he is given interrogative and key words
and a plan that he can use in the conversation. In stimulation classes
speech activity, conversations with a doctor, in a store, in a pharmacy, at a party and
etc. The patient can be the leader in a conversation about the work of a writer, artist or
composer, when discussing a work of art, television programs.
In milder forms of dynamic aphasia, tasks are given to retell the text
first with a detailed questionnaire, then with key questions
to individual paragraphs of text, then based on the plan. At the same time, the patient is studying
make independent plans for texts, first detailed, then short,
folded, after which, having previously drawn up a plan, he retells the text, without
looking into it. Thus, the plan is internalized when retelling
read.
In severe dynamic aphasia, understanding of situational speech is restored
by discussing various events of the day. Then the speech therapist switches again
the patient's attention to a new topic, for example, about who visited him the day before.
Intonationally, the speech therapist highlights the predicate of the statement, collecting attention
patient on one fragment or another. Later he is asked to do as
single-link and multi-link instructions.
As the patient develops attention to the speech of others, the
its understanding, the difficulties of switching acoustic perception from
one topic of conversation to another.
In parallel with the restoration of expressive oral speech, work is underway to
restoration of missing prepositions, verbs, adverbs into texts; in writing
sentences are drawn up based on supporting words, answers to questions about texts,
essays are written on series of pictures, statements, power of attorney to receive
pensions, letters to friends, etc.
Speech therapist in the process of individual and collective work with patients with
aphasia modifies the techniques and methods available in the arsenal of defectology
correctional pedagogical work, bringing their individual experience.
In many ways, the results of correctional pedagogical work depend on
the persistence of the speech therapist and the patient, who are essentially collaborators in
achieving one goal: maximum speech restoration during treatment.
Conclusions and problems
When restoring speech in patients with aphasia, preliminary
non-verbal work with them, using workarounds to solve problems
correctional pedagogical work.
Due to the systemic nature of aphasic disorders, work is being done on
all aspects of speech, taking into account the specifics of each speech disorder
functions in different forms of aphasia.
In the process of rehabilitation training for aphasia, a specific
long-term goal and work is carried out step by step in accordance with
individual characteristics and capabilities of the patient.
Speech restoration programs for various forms of aphasia are
differentiated nature, but at an early stage after a stroke with a number of
forms of aphasia to overcome secondary impaired semantic aspects of speech
methodological techniques that are similar in nature are used. One of the important
problems of aphasiology is the study of variants of different forms of aphasia. They
require further research in order to develop a modification
remedial training techniques.
2. Reveal the initially violated premise when
acoustic-comnestic aphasia.
3.
What are the specifics
semantic aphasia? 4. Compare afferent and efferent
motor
aphasia. 5. Describe dynamic aphasia. 6. Expand
basic provisions of a correctional therapist
gogical work for aphasia.
7. Show the specifics of correctional pedagogical
work with different forms of aphasia.
8. Select speech and didactic material for
speech therapy work with patients suffering
various forms of aphasia.
Literature
1. Bein e. S., Burlakova M. K., Vizel T. G. Vosstanov
speech therapy in patients with aphasia. M., 1982.
2. Burlakova M.K. Correctional pedagogical work
with aphasia. M., 1989.
3. Burlakova M.K. (ShokhorTrotskaya) Speak and write right
right. A collection of exercises for overcoming difficult problems
mental disorders. M., 1997.
4. Burlakova M.K. Speech and aphasia. M., 1997.
5. L u R i Ya A. R. Restoration of brain functions after war
injuries. M., 1948.
6. Luria A. R. Higher cortical functions of humans. M.,
1969.
7. L U r and I A. R. Basic problems of neurolinguistics. M.,
1975.
8. L u r i ~ A. R. Functional organization of the brain // Natural
scientific foundations of psychology. M., 1978.
9. Reader on speech therapy / Ed. L.S. Volkova, V.I. Xie
Liverstova. M., 1997. Part 11. P. 140282.
10.
Tsvetkova L. S. Aphasia and remedial training.
M., 1988.
11.
S h o hor T r o T s k a i M. K. Speech therapy work for afa
sia at an early stage of recovery. M., 1972.
Sensory aphasia occurs when the posterior third of the superior temporal gyrus of the left hemisphere (22nd field) is damaged. Central mechanism, underlying this defect is violation of acoustic analysis and synthesis of speech sounds. This manifests itself in violation phonemic hearing, serving as central defect sensory aphasia. In this case, a level violation occurs phonetic organization of speech, which creates difficulties in sound discrimination. The sound of a word loses its constancy and stability; therefore understanding, repeating, pronouncing words becomes difficult or impossible. The discrimination of correlative phonemes is impaired, which differ in the language: a) by voicedness-voicelessness (b-p, d-t), b) by hardness-softness (l-l, t-t), c) by nasality (n-t and m-d). Patients with sensory aphasia cannot differentiate these signs of sounds, and therefore replace them with close phonemes, which leads to central symptom– impairment of speech understanding.
IN clinical picture this defect manifests itself in the phenomenon of alienation of the meaning of words, in a violation of the understanding of words, verbal constructions, and addressed speech. In all types of oral speech, the abundance of literal paraphasias attracts attention. Spontaneous speech is unproductive or completely unproductive; it is grammatically impaired. In such grossly disrupted speech, the general outline of the phrase remains intact. The general intonation structure of the utterance may remain undisturbed, i.e. the syntagmatic organization of speech is more preserved. Patients with sensory aphasia are sociable; they replace the deficit of verbal means of communication with paralinguistic methods: facial expressions, gestures, and preserved intonation. Patients with such aphasia are not able to perceive differences in the sound of words such as class - voice, can - python, byl - dust - was - drank, as a result of which paragnosis and disturbances in understanding the meaning of words arise. The naming of objects is also disrupted: ceiling - dragged - pokolo - striped - toposkal. Oral speech is characterized by multiple attempts at repetition and general verbosity. Their speech is emotionally colored, richly intonated, and the tempo is significantly accelerated.
Impaired speech understanding begins with a lack of understanding of the simplest instructions, but patients can grasp the meaning of the statement.
IN neuropsychological syndrome sensory aphasia includes: 1) impairment of all types of oral expressive speech; 2) impairment of reading and writing; 3) violation of oral counting due to defects in the analysis of sounds; 4) disturbances in rhythm reproduction; 5) disturbance of emotions: patients are anxious, they are easily excitable, easily and quickly move from one emotional state to the opposite.
The psychological picture reveals violations of almost all speech functions. Their psychological level of understanding of the general meaning is preserved; in the lexico-grammatical sense, the sound distinction link is grossly violated. They have a violation of the objective attribution of the word due to the collapse of the sound structure. All mental processes not associated with acoustic gnosis remain intact.
An example of oral speech of a patient with sensory aphasia.
Psychologist: “Tell me about the North.” Answer: “I was in the army in Vladivostok...March...sailors? Yes, the sailors... were all there... watching... packing up and leaving... Sailors... how could this be? Lord, metro stations... It’s generally good there.” Understanding words(the patient is given a word, he must find the corresponding picture): bread - points to the ball, eyes - points to the mouth, suitcase - points to the phone. Understanding instructions: “Get up and go to the door” - gets up and stands. "Here you are". “Come to the door” - (stands). Here I am... well, you can here (comes to the window).
Acoustic-mnestic aphasia
As a result of damage to the middle parts of the left temporal lobe (fields 21 and part of the 37th), another form of temporal aphasia occurs, which is distinguished by the presence of several central mechanisms: a narrowing of the volume of acoustic perception and a violation of visual object images and representations. Its central defects are a violation of speech understanding, repetition, spontaneous oral speech is secondarily impaired, which is accompanied by a large number of verbal paraphasias.
Phonemic hearing remains intact.
Clinical picture manifests itself in a slight violation of the understanding of speech and alienation of the meaning of words, in a misunderstanding of the meaning of the hidden subtext of a statement, in a violation of the naming of objects, in a slight violation of oral speech. There is a symptom of alienation of the meaning of words when repeated correctly. Violation of oral expressive and impressive speech occurs against the background of significantly intact reading and writing. In expressive speech there is no incoherent, unproductive conversational speech; speech can be understandable to the interlocutor. Often these patients notice their mistakes in speech, they do not have verbosity, and the emotional side of speech is not increased. In acoustic-amnestic aphasia, patients' attempts to name an object are aimed at searching for the desired word-name.
IN neuropsychological syndrome symptoms include: impaired speech understanding; alienation of the meaning and meaning of words; disorders of oral expressive speech – spontaneous, repeated; violations of the nominative function of speech, perception and evaluation of rhythms. All types of praxis and gnosis are preserved.
IN psychological picture impairment of speech understanding, alienation of the meaning of a word occurs against the background of intact phonemic hearing and the process of sound discrimination. The central mechanism of this aphasia is considered impairment of operational auditory-speech memory. In patients, fresh memory traces are read better than previous ones, so an increase in information strengthens the defect. While not experiencing difficulty repeating individual words, patients find it difficult as soon as they are asked to repeat a series of words. Violation of the process of naming objects is associated with defects in object images, the sensory basis of the word. This defect can appear against the background of good spontaneous speech and a mild impairment of speech understanding. The phenomenon of alienation of meaning words is associated with the instability of visual object images. There is another mechanism - narrowing of the scope of perception, which leads to defects in repeated speech and understanding of addressed speech. Reading and writing are accessible to patients.
An example of oral speech of a patient with acoustic-mnestic aphasia.
Psychologist: “Tell me how you were wounded?” Answer: “Wounded... in August... around this... I’ll tell you right now... well, this... the company commander was... a lieutenant... I had to leave... It was in this... what is it called... and this... in a trench... for every trench.
Naming objects after presenting their drawing: suitcase– a watch... no, it’s not a watch, I’m on a business trip; tree- forest; closet- well, it happened just now, I know, there are all sorts of things there.
Semantic aphasia
The parieto-occipital regions of the left hemisphere (fields 39, 40, part 19 and 37) connect the visual, auditory and skin sensitivity fields. This zone turns information into simultaneous patterns. Speech disorders with damage to these fields are called semantic aphasia. This aphasia is based on defects in simultaneous, simultaneous grasping of information, disturbances in spatial perception.
The central mechanism (factor) of impaired understanding of speech will be a violation of simultaneous spatial perception, and the central defect will be a violation of the understanding of logical-grammatical structures.
In the clinical picture There is no gross impairment of expressive speech: patients can speak using simple sentence structures and understand simply constructed speech. They do not have reading or writing impairments. They find it difficult to navigate in space. Complicating the grammar of speech leads to misunderstanding of the interlocutor’s speech and confusion.
Semantic aphasia occurs in neuropsychological syndrome simultaneous agnosia, astereognosis, disturbance of the body diagram, spatial and constructive apraxia and primary acalculia (impaired counting). The perception of subtle spatial relationships and the relationships of objects in space is disrupted. Patients recognize objects, understand the meaning of a plot picture, but cannot correctly perceive the spatial relationships of objects relative to one another. They cannot mentally flip a figure in space. They have impaired perception of a geographical map, recognition of time by a clock, impaired understanding of number digits, and counting operations. So, all mental processes are disrupted in them, the structure of which includes factor of simultaneous spatial perception. This syndrome involves peculiar speech disturbances. There is a defect in the simultaneous perception of an entire complex sentence, and the meaning of the sentence can only be understood on the basis of simultaneous perception of a logical-grammatical structure. With this aphasia, the understanding of constructions with prepositions is impaired ( under, over, from, to, for, in, on, because of etc.) since they reflect real spatial relationships. The understanding of comparative constructions is impaired ( a pug is smaller than an elephant), phrases with words before, after, without, instrumental case constructions ( show the map with a pointer), genitive case constructions ( grandfather's boat, baby's pacifier). When assessing such constructions, the patient is unable to access the relationships and interactions of objects and phenomena.
Psychological picture. Patients with semantic aphasia understand everyday speech addressed to them, answer questions adequately, and difficulties in oral speech do not go beyond easy forgetting of words. They have a gross violation of the semantic structure of speech. Understanding of speech is available within simply constructed phrases, while the perception and understanding of complex grammatical and logical-grammatical relationships of words in a phrase is impaired. These patients have impaired understanding of the meaning of words united by the instrumental case construction.
Inversions, i.e. phrases with reverse word order (the grass is blown by the wind) are inaccessible to understanding, while understanding simple phrases with direct word order (the wind blows on the grass) is intact. Comparative phrase construction makes it difficult to recognize the meaning behind them (Grandfather is taller than grandson. Who is shorter?). Defects in speech understanding are especially pronounced when perceiving speech with prepositions. Thus, with semantic aphasia the word falls out of the system of grammatical concepts and is perceived only as a carrier of meaning. They classify the words crying, running as verbs, and blushing, becoming prettier as adjectives. Patients cannot be distracted from the material side of the word.
We give an example of speech understanding in patients with semantic aphasia.
The speech therapist asks you to repeat the phrase: “The elm leaf rustles in the wind.”
Patient: “I don’t understand... The knitted leaf is rustling... I don’t understand.”
The speech therapist helps him parse the sentence: “What are we talking about here?”
Patient: “Well, the tree is growing, the leaves are rustling.”
Speech therapist: “Tell me which sentence is correct: A sparrow is larger than an eagle or an eagle is larger than a sparrow.”
Patient: “Oh, this is very difficult.”
Speech therapist: “Which sentence is correct?”
Patient: “So...(Reads aloud)...No...that’s what I don’t understand.”
Amnestic aphasia
Amnestic aphasia occurs when the posterior temporal and parieto-occipital regions of the brain are damaged. The only and central symptom is difficulty in naming objects. This aphasia is based on two factors. The first is associated with defects in the optical perception of an object, with defects in identifying its essential features. The second is associated with a pathological condition of the cortex, which makes it difficult to select a word from several alternatives.
IN clinical picture in the first place comes the abundance of searches for word names, the abundance of verbal paraphasias in spontaneous oral speech. Of all the functions of speech, the nominative function is the first and most severely disrupted. When trying to name an object, patients list a group of words, but always from the same semantic field. Unlike sensory and acoustic-mnestic aphasia, a hint helps. This indicates that acoustic gnosis is preserved.
IN psychological picture a violation of the nominative function of speech can be noted. All types and forms of speech are not impaired. Reading and writing preserved. This form of aphasia is rare.
All forms of aphasia differ in clinical and psychological presentation and neuropsychological syndrome. The difference is based on a central mechanism (factor). The first task of a neuropsychologist is to isolate the mechanism and analyze the syndrome. Vascular lesions of the brain often lead to complex, mixed forms of aphasia.
Alalia
Alalia is the absence or limitation of speech in children, caused by underdevelopment or damage in the pre-speech period to the speech areas of the cerebral cortex: frontal or temporal. When making this diagnosis, deafness, mechanical anarthria and dementia must be excluded. Distinguish motor, sensory and total alalia. At motor Alalia's speech is impaired, but her understanding is preserved. Noteworthy is the absence or limitation of humming, late appearing and very poor babbling. The lack of speech in a 2-3 year old child should cause concern. If, with normal speech development, babbling appears in the second half of the first year of life, then in children with motor alalia babbling appears in the second and third years of life, which is why they are called “speechless.” By the end of the third year and later, children develop individual onomatopoeias or syllabic elements that are retained for a long time. The accumulation of vocabulary proceeds slowly and, as a rule, at the expense of nouns most often pronounced by parents. The structure of the word is disrupted: children use the first or stressed syllable, and simplification of syllabic elements is observed. At the age of 4-5 years, there is some activation of speech, enrichment of the vocabulary due to the simplest words in structure. Nouns are used in the nominative case, verbs - in the indefinite form. During this period, the lag in speech development becomes clearly visible. Gradually, a phrase begins to form, the structure of which is sharply disrupted due to agrammatisms. The poverty of the vocabulary remains. After 5 years of age, speech activation is noted; verbs appear along with nouns, but prepositions and objects are absent in speech. Thus, the stages of speech development can be traced: late speech development, slow accumulation of vocabulary, disruption of word structure, late accumulation of vocabulary and the formation of phrasal speech with pronounced agrammatisms, insufficient or complete absence of the communicative function of speech. Classes with children on speech development revealed difficulties in memorizing and composing phrases. The story based on the picture took place in the form of question-and-answer speech with the naming of individual objects; actions were not taken into account. Children showed insufficient interest in the speech of others.
Children with severe alalia should begin classes early with a speech therapist on speech development and attend a school for children with speech disorders. In milder cases, children should work with a speech therapist before school and during school, and continue classes with a school speech therapist to prevent dysgraphia.
In contrast to motor alalia with sensory Children are verbose even during the period of babbling speech. Against the background of preserved hearing, children have a speech perception disorder. In some cases, children hear words, repeat them, but do not correlate them with the object that denotes them. The “word-object” connection is not formed even with repeated repetitions. Children's behavior is correct, there is sufficient interest in their surroundings, and expressive speech is developing. A more severe version of sensory disorders are sensory disorders, when children do not understand the speech of the people around them and cannot repeat a word after the teacher. They perceive quiet or medium-volume sounds better, while loud sounds irritate them. They better perceive the speech of a person who constantly communicates with them, but do not perceive the speech of a stranger at all. With sensory and total alalia, children's learning is extremely complicated.
All children with alalia need early identification and medical and pedagogical assistance to prepare for school. The intellectual development of children with alalia may approach normal.
Dysarthria
Dysarthria is a speech disorder caused by damage to the central nervous system, which manifests itself in disorders of articulation, phonation and breathing. Depending on the location of the lesion, several forms are distinguished: bulbar, pseudobulbar, cortical, mixed and cerebellar.
At bulbar form The pathological process involves the nuclei of the cranial nerves: trigeminal, facial, glossopharyngeal, vagus, sublingual, which innervate muscle groups of the articulatory apparatus involved in sound production, phonation and breathing. When the nuclei of the cranial nerves are damaged, paresis or paralysis is peripheral in nature, while the conduction of the nerve impulse is disrupted and the muscles atrophy. Dysarthritic disorders are especially noticeable when the hypoglossal nerve is damaged on one side, while the tip of the tongue deviates towards the paresis.
More common are pseudobulbar dysarthria. They arise when the cortical-stem pyramidal tract, which innervates the nuclei of the motor cranial nerves involved in articulatory movements, is affected. Dysarthria is complicated by secondary disturbances in the formation of the premotor and parietotemporal regions of the brain that occur after birth. In infants, there is a delay in humming and babbling. Subsequently appearing sounds turn out to be monotonous, quiet, rare, short-lived, without intonation. With age, the lexical development of a child’s speech is delayed. As a result of articulation disorders, the phonetic side of speech suffers. At the initial stage of speech development, many sounds are absent, which makes contact with others difficult. Subsequently, some sounds are formed, but speech remains blurred, poorly modulated, and slurred. Speech motor difficulties secondarily lead to disruption of the analysis of the sound composition of a word. Children do not distinguish sounds by ear and have difficulty repeating sounds and isolating sounds in words, which gives grounds to consider these disorders as phonetic-phonemic disorders.
Neurological symptoms, against which pseudobulbar dysarthria develops, are characterized by paresis and paralysis of the limbs and dysfunction of other cranial nerves.
Cortical dysarthria. In cases of damage to articulatory praxis, when the lower part of the postcentral gyrus is affected, a variant of cortical afferent apraxic dysarthria is observed. In these cases, the pronunciation of consonant sounds is disrupted, and articulation disorders are not constant. There is a search for the articulatory structure of speech, which slows down its pace and disrupts its smoothness.
The kinetic variant of cortical afferent apraxic dysarthria occurs when the lower parts of the premotor cortex of the left hemisphere are damaged. It is characterized by difficulty pronouncing complex sentences. The child’s speech is tense and slow. When studying articulatory praxis, difficulties in reproducing a series of sequential movements according to a task are noted.
At mixed dysarthria(extrapyramidal) muscular dystonia is observed in general and articulatory motor skills. Dystonia significantly distorts articulation, causing replacement and omission of sounds. Dystonia of the articulatory muscles is usually combined with hyperkinesis of the muscles of the face, tongue, lips, diaphragm, intercostal muscles, and therefore dysarthritic disorders are combined with breathing and phonation disorders.
Cerebellar form of dysarthria occurs when the pathways connecting the motor zone of the cerebral cortex with the brainstem and cerebellum are damaged. It is characterized by hypotonia of the articulatory muscles, as well as desynchronized breathing, phonation and articulation. Speech is slow, jerky, with impaired modulation, and the voice fades towards the end of the phrase. The neurological status of the patients is ataxia, movement coordination disorder.
Along with well-defined forms of dysarthria, erased, subtle ones are observed, in which articulatory and cerebral disorders are revealed during examination or functional load. Children with such disorders require special therapeutic and educational measures from an early age.
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