Corrective pedagogical work for semantic aphasia

Aphasia is a systemic speech disorder that occurs with organic lesions of the brain, covers different levels of speech organization, affects its connections with other mental processes and leads to disintegration of the entire mental sphere of a person.

Aphasia includes four components - a violation of speech itself and verbal communication, a violation of other mental processes associated with speech, a change in personality and personal reaction to the disease.

The causes of aphasia are cerebral circulation disorders (ischemia, hemorrhage), trauma, tumors, and infectious diseases of the brain. Aphasia of vascular origin most often occurs in adults. As a result of rupture of cerebral aneurysms, thromboembolism caused by rheumatic heart disease, and traumatic brain injuries, aphasia is often observed in adolescents and young adults.

The complexity of the speech disorder in aphasia depends on the location of the lesion. A.R. Luria distinguishes six forms of aphasia:

• acoustic-gnostic and acoustic-mnestic aphasia, which occurs when the temporal parts of the cerebral cortex are damaged,
• semantic aphasia and afferent motor aphasia, arising from damage to the lower parietal parts of the cerebral cortex,
• efferent motor aphasia and dynamic aphasia, which occur with damage to the premotor and posterior frontal parts of the cerebral cortex (on the left in right-handed people).

When speech zones are damaged, there is a violation of the so-called primary prerequisite that carries out the specific activity of the corresponding analyzer system. Based on the primary analytical disturbance, a secondary, also specific, collapse of the entire functional system of language and speech occurs, i.e. There is a violation of all types of speech activity: understanding speech, oral and written speech, counting, etc.

ACOUSTIC-GNOSTIC SENSORY APHASIA

This form of aphasia is characterized by impaired understanding of speech when perceiving it by ear. The basis of speech acoustic agnosia is a violation of phonemic hearing. Someone else's speech is perceived as an inarticulate stream of sounds. Inability to understand the speech of others and the absence of obvious motor disorders leads to the fact that patients do not always immediately realize that they have a speech disorder associated with a stroke or injury.

With sensory aphasia, the root lexical-semantic part of a word is difficult to catch by ear, resulting in a loss of its subject relevance. However, the categorical attribution of a word can be “perceived.” For example, hearing the word bell, the patient says: “It’s something small, but I don’t know what.” In patients with acoustic-gnostic sensory aphasia, auditory control of their speech is disrupted. Because of this, many literary and verbal paraphasias arise.

The patient’s early speech may be completely incomprehensible to others; it consists of random sets of sounds, syllables, and phrases, which is called “jargonophasis” or “speech hash.”

Due to a violation of phonemic perception, the repetition of words suffers a second time, and the rhythmic and melodic basis is lost. The period of jargonophasia lasts no more than 1.5 - 2 months, gradually giving way to logorrhea with pronounced agrammatism. In the study of the nominative function in sensory, acoustic-gnostic aphasia, along with correct naming, attempts are observed to explain the meaning of the word or find it through the phraseological context. For example, when naming an apple, it is said: “Well, of course, I know very well that it is a pear, not a pear, a sour apple,” etc.

When reading, many literary paraphasias appear, difficulty arises in finding the place of stress in a word, which makes reading comprehension more difficult. But reading remains the most preserved speech function in sensory aphasia.

Written speech is impaired to a greater extent and is directly dependent on the state of phonemic hearing. Severe counting disorders in sensory acoustic-gnostic aphasia are observed only at a very early stage.

How to recognize?

By a number of signs you can find out that a person is beginning or progressing in the form of aphasia we are considering.

Anomie

Inability to remember the names of objects; the difficulty of “finding the right word.” The affected person may not be able to name the picture of the truck or may substitute another word in the same category, such as “car” instead of “truck.”

Abbreviated understanding of one word

The affected person cannot remember what words mean, especially words that are less familiar or used less frequently. For example, he might ask “What is a truck?”

When the patient is asked to bring an orange, he may return with an apple because the meaning of the word "orange" has been lost. This does not mean that the object is not recognized, as evidenced by the fact that the patient will not attempt to eat an orange without peeling it.

Forgetting familiar objects

Inability to remember what a familiar object is or how it is used. For example, the victim may be unable to identify common kitchen utensils and how they are used in food preparation. This is very unusual in the initial stages of semantic aphasia, but may appear later.

Surface dyslexia/dysgraphia

Difficulty reading and writing words that do not follow the rules of pronunciation or spelling; such words are written or pronounced “as if” they were following rules.

Dyslexic speech disorders

ACOUSTIC-MNESTIC APHASIA

Acoustic-mnestic aphasia occurs when the middle and posterior parts of the temporal region are damaged. It is believed that it is based on a decrease in auditory-verbal memory, which is caused by increased inhibition of auditory traces. Acoustic-mnestic aphasia is characterized by a dissociation between the relatively intact ability to repeat individual words and the impaired ability to repeat three or four unrelated words (for example: hand-house-sky, etc.)

In acoustic-mnestic aphasia, speech memory impairment is the main defect, because phonemic hearing and the articulatory side of speech are preserved. Increased speech activity compensates for communication difficulties. The auditory verbal memory of these patients is characterized by great inertia.

Violation of the volume of retention of speech information, its inhibition leads to difficulties in understanding in this form of aphasia long, polysyllabic statements consisting of five to seven words. Patients find it difficult to navigate a conversation with two or three interlocutors, “switch off” in a difficult speech situation, cannot attend reports, lectures, and get tired when listening to music and radio broadcasts. This fact should be taken into account when prescribing such treatment methods as “art therapy”, etc.

With optical aphasia, the second variant of acoustic-mnestic aphasia, difficulties arise in retaining the semantic aspect of speech by ear; they consist in weakening and impoverishment of visual representations of an object, in the relationship between what is perceived by ear and its visual representation. The visual representation of an object becomes incomplete; those elements of objects that, on the one hand, are specific to them, and on the other hand, are associated with the polysemy of the word (for example, the words spout, comb, pen) are not completed.

Patients understand the meaning of individual words. They do not have articulatory difficulties, they are not only verbose, but also hyperactive. However, with all this, they only partially understand speech due to the narrowing of auditory-verbal memory to 1-2 out of 3 words perceived by ear. Speech is abundant, little informative, replete with verbal paraphasias, but intonation-colored.

In written speech with acoustic-mnestic aphasia, the phenomena of expressive agrammatism appear more prominently, i.e. displacement of prepositions, as well as inflections of verbs, nouns and pronouns, mainly in gender and number. The nominative side of written speech turns out to be more preserved. When recording text from dictation, patients experience significant difficulties in retaining even a phrase in their auditory-verbal memory. Consisting of three words, they are asked to repeat each fragment of the phrase.

With acoustic-mnestic aphasia, it is difficult to perceive printed text when reading. This is due to impaired preservation of auditory-verbal memory.

Treatment

Treatment of aphasia takes place in two stages. At the first stage, several options are possible:

• Surgical removal of tumors, hemorrhages, restoration of vascular patency;
• Drug treatment with antibacterial drugs, nootropics, angioprotectors;
• Rehabilitation therapy using exercise therapy and physiotherapy.

The second stage of treatment for the disease is sessions with a speech therapist. With its help, individual exercises are selected to correct speech function.

At the medical clinic, you can undergo aphasia treatment from a neurologist. Using modern equipment, our specialists will conduct a comprehensive examination, and then develop basic methods of treating the disease, with the help of which speech function will be restored. You can get detailed information and make an appointment at the reception or by phone.

SEMANTIC APHASIA

Semantic aphasia occurs when there is damage to the overlap area of ​​the three lobes of the cerebral cortex - parietal, occipital and temporal. Speech disorders of the amnestic aphasia type are based on the collapse of the semantic structure of the word, the impoverishment of the near and far connections of the word.

Semantic aphasia is combined with pronounced spatial-constructive apraxia and apraxia of finger posture. Patients with semantic aphasia retain their understanding of elementary phrases that convey “communication of events,” for example: “The children are going into the forest. They will collect mushrooms. They should return home by evening." Such phrases can consist of 7-11 elements and can be easily understood by patients with this form of aphasia.

Patients understand well the meaning of individual prepositions, freely place a pencil under a spoon or a spoon to the right of a fork, but cannot place three objects. Patients cannot navigate comparative phrases like “Kolya is taller than Misha and shorter than Vasya.”

Difficulties arise with semantic aphasia in solving logical-grammatical phrases that convey communication of relationships such as “father’s brother” - “brother’s father,” etc.

Patients also find it difficult to understand complex syntactic structures expressing cause-and-effect, temporal and spatial relationships, adverbial and participial phrases. They do not understand metaphors, proverbs, sayings, popular words, and the figurative meaning is not found in them.

Expressive speech is articulatory preserved, there are no literary paraphasias, there is no pronounced agrammatism, but in written and oral speech patients do not use complex lexical complexes, which is why the vocabulary becomes semantically poor. Poverty of vocabulary is expressed in the rare use of adjectives, adverbs, descriptive phrases, participial and participial phrases, proverbs, sayings. There is no semantic intonation in speech.

Written speech is distinguished by its poverty, stereotypical syntactic forms, and there are few complex, complex sentences in it. The use of adjectives is reduced. Gross violations of counting operations are often observed. Patients confuse the direction of action when solving multi-digit arithmetic examples, they experience certain arithmetic difficulties when working with the transition through ten, and have difficulty writing multi-digit numbers by ear.

Hidden factor

Semantic aphasia is a subtle disease, it is often disguised as other disorders, and it is quite difficult to detect.
Doctors and teachers were able to describe the disease, observing severe forms, which are extremely rare, and distinguish three stages: 1) mild - it is difficult for the patient to establish cause-and-effect relationships, so he is poor at solving logical problems and cannot find synonyms and antonyms for words;

2) moderately severe - problems arise with counting and mathematical problems, the patient does not understand logical and grammatical constructions, the figurative meaning of words is inaccessible to him, he interprets sayings and proverbs literally;

3) severe - in addition to speech disorders, spatial perception disorders are added, up to confusion when naming parts of one’s own body; grammatical structures, even case endings, are not perceived.

The most common form is mild. The child constructs sentences that are too simple and sometimes makes grammatical errors. He ceases to distinguish parts of speech. If a noun implies an action, such as “walking,” the patient will think of it as a verb. Simple instructions like “point your finger at the table” can be carried out incorrectly or simply not understood.

AFFERENT MOTOR APHASIA

Afferent motor aphasia occurs with damage to the secondary zones of the postcentral and inferior parietal parts of the cerebral cortex, located posterior to the central or Rolandic sulcus.

There are two types of this aphasia. The first type of aphasia is observed with damage to the postcentral parts of the left hemisphere in both right-handers and left-handers, and is characterized by a complete loss of expressive speech. The second type of aphasia is observed in persons who were retrained in preschool and primary school age from the left hand to the right.

In the first variant of afferent kinesthetic motor aphasia, severe apraxia of the articulatory apparatus can lead to a complete absence of spontaneous speech. Attempts to arbitrarily repeat sounds lead to chaotic movements of the lips and tongue and literary substitutions. Patients split a closed syllable into two open ones, split up consonant clusters in a syllable, and omit consonant sounds. And at the same time the words here, there, here, etc. sound like tu-t, ta-t, vo-t, etc.

In the process of complex treatment of patients after a stroke at the Vremena Goda clinic, there is a rapid restoration of understanding of situational conversational speech, understanding of the meanings of individual words, and the ability to follow simple instructions. Patients have been experiencing specific features of impaired understanding for a long time. This is due to secondary phonemic hearing impairment. With this form of aphasia, difficulties arise in recognizing by ear words with sounds that have common features in the place of words with sounds that have common features in the place and method of articulation (rough - front-lingual, sonorant - vowels, etc. There are difficulties in understanding lexical means languages ​​that convey various complex spatial relationships.

Difficulties in understanding are caused by verbs with prefixes (wrap, return, etc.), in understanding the meanings of personal pronouns used in indirect cases, which is explained by the lack of subject orientation in them, the abundance of phonemic changes (for example, me-me-me).

Reading and writing disorders depend on the severity of apraxia of the articulatory apparatus. In the process of neurorehabilitation in our clinic, the restoration of internal reading often precedes the restoration of written speech. When writing words under dictation, when naming objects in writing, when trying to communicate in writing with others, all articulatory difficulties affect themselves, i.e. There are numerous literary paragraphs reflecting a mixture of vowel and consonant phonemes that are close in place and method of articulation; consonants (sonorant) are omitted.

In the second variant of afferent motor aphasia, patients have difficulty maintaining the order of letters in a word, imagining their mirroring, skipping vowels, or writing all the consonants first, and then the vowels, and they retain the idea of ​​the presence of a sound in a word, for example, skipping the letter “е” ", in the word "leads", the patient puts two dots over the "d".

Classification

Semantic aphasia has three stages:

1. Easy. The consistent connection between phenomena is disrupted, and errors occur in distinguishing cause and effect. Difficulties arise in the contextual selection of a particular word and the interpretation of complex speech structures. There are difficulties in solving logic problems.
2. Medium-heavy. There are difficulties in understanding grammatical constructions and allegorical phrases, and in performing arithmetic operations.
3. Heavy. Characterized by pronounced disorders of visual-spatial perception. Understanding grammatical phrases and prepositional structures is significantly difficult or inaccessible.

Since this disorder primarily affects the temporal lobe of the brain, this process can be called irreversible.

Most often, semantic aphasia is observed in people aged 50-60 years and can last for 12 years. Although these figures are approximate and may deviate in one direction or another.

Often, in addition to speech disorders, behavioral deviations appear. Unfortunately, there are no medications to cure this condition yet. There are medications that can improve the condition and help retain certain moments from life in memory. However, no one can give a more favorable prognosis.

Research has shown that exercise helps improve brain health and improves mood and overall fitness. Eating a balanced diet, getting enough sleep and limiting alcohol consumption are other important ways to promote good brain health.

Other diseases that affect the brain, such as diabetes, high blood pressure and high cholesterol, should also be treated if present.

EFFERENT MOTOR APHASAIA

When the premotor zone is damaged, efferent motor aphasia occurs. The linear, temporary organization of movement is carried out by the premotor areas of the cerebral cortex. In case of damage to the secondary fields of the nuclear zone, motor skills are disrupted; while individual movements are preserved, motor persistence occurs. When different parts of the frontal lobes are disturbed, inactivity, persistence, duration of pause in activity occur, mental and motor processes lose their smoothness, “dynamic” or “kinestatic” replacement of one movement or action by another. The smoothness and melody of not only movements, but also speech disappears.

Several patients undergoing neurorehabilitation after a stroke at the Vremena Goda clinic, among other disorders, had motor aphasia with pathological inertia of speech stereotypes, leading to sound, syllable, lexical rearrangements and repetitions. This was explained by the impossibility of timely switching from one articulatory act to another; such violations make it difficult, and sometimes completely impossible, to speak, write, and read.

The sound structure of syllables in efferent motor aphasia is not simplified or destroyed, but loses its intonation coloring and becomes stringy and 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.

Impaired reading and writing are characteristic of efferent motor aphasia. Recording a word or phrase is possible only when pronouncing the words syllable by syllable. Perseverations of letters from previous words and perseverations of the same syllable are frequent. At the later stages of recovery, when independently compiling a text based on a series of paintings, agrammatism is revealed, and inflections, both case and indicating gender, are mixed. In severe cases, reading is guessing in nature.

Diagnostics

Diagnosis of aphasia lies in the competence of speech therapists, neuropsychologists and neurologists. The following studies may be prescribed:

• computed tomography of the brain
• magnetic resonance imaging of the brain
• lumbar puncture
• duplex scanning of cerebral vessels
• Doppler ultrasound of head and neck vessels
• magnetic resonance angiography

The following examinations should be carried out if aphasia is suspected:

• letter diagnostics
• diagnostics of oral speech (impressive and expressive)
• auditory-verbal memory test
• motor memory test
• diagnostics of the state of visual memory

They also carry out diagnostics:

• intelligence
• constructive-spatial activities
• visual gnosis
• praxis (dynamic, somato-spatial, finger, hand, facial, oral)

Differential diagnosis of aphasia with the following diseases is required

• mental retardation
• hearing loss
• dysarthria
• children's alalia

DYNAMIC APHASAIA

This aphasia occurs when there is damage to the posterior frontal parts of the left, speech-dominant hemisphere, the block of activation, regulation and planning of speech activity. And dynamic aphasia is characterized by the main speech defect - this is the difficulty, and sometimes the complete impossibility, of actively developing a statement. We can say that the basis of dynamic aphasia is a violation of the internal programming of the utterance, manifested in the difficulties of its planning when composing individual phrases.

Dynamic aphasia is based on a violation of spontaneous, detailed utterance. When retelling a plot picture, separate, unrelated fragments are pronounced, and the main semantic links are not highlighted.

Pseudo-amnestic difficulties may be observed when naming objects, especially when remembering the names of familiar people, names of cities, etc. The hint of the first syllable of a word can be a trigger that releases the inertia of the speech search for words. Significant difficulties are experienced when asked to perform a reverse ordinal count. For example, from ten to one.

Dynamic aphasia is characterized by intact reading and writing. Elementary counting in dynamic aphasia remains intact, but with this aphasia the solution of arithmetic problems that require the construction of an action plan is sharply impaired.

Organic lesions of the motor parts of the central nervous system caused by stroke (ischemic stroke, hemorrhage) contribute not only to speech impairment in the form of aphasia, but also to such speech disorders as dysarthria.

Causes

The cause of aphasia is organic damage to the cerebral cortex, namely those areas that have a direct effect on speech. Moreover, for the diagnosis, the individual’s normal speech existing before the onset of the disorder is required. The course and outcome of the disease largely depend on the cause.

Most often the disorder is provoked by vascular diseases of the brain . First of all, these are ischemic stroke and hemorrhagic stroke. With the latter, mainly mixed or total aphasic syndrome is recorded. And sensory or motor aphasia is observed by specialists in those patients who have previously had problems with blood circulation in the brain. The latter are likely to have a total form of aphasia.

The second place among common causes is occupied by inflammatory processes in the brain :

• abscess
• leukoencephalitis
• encephalitis

Also, aphasia in many cases is caused:

• received a traumatic brain injury
• progressive diseases of the central nervous system that occur in a chronic form, for example, Pick's disease
• brain surgery

Risk factors for aphasia:

• presence of the same disorder in close relatives
• old age person
• arterial hypertension
• cerebral atherosclerosis
• head injuries
• past transient ischemic attacks
• rheumatic heart defects

Factors that influence the severity of the disorder:

• extent of the lesion
• location of the affected area of ​​the brain
• compensatory capabilities of the brain
• causes
• premorbid background
• patient's age

For example, the gradual development of speech impairment is observed during tumor processes in the brain. And acute disorders of cerebral circulation, on the contrary, cause a sharp appearance of aphasia. With traumatic brain injury, the development of the disorder is also dramatic. The younger the patient, the faster and better his compensatory mechanisms work; he recovers in a fairly short time after treatment of the underlying disease, the cause of aphasia.

DYSARTHRIA

Dysarthria is a violation of the pronunciation side of speech, caused by a violation, insufficiency, of the innervation of the speech apparatus.

Clinical forms of dysarthria are determined depending on which part of the motor system is affected. In all forms of dysarthria, sound pronunciation is impaired due to inaccurate motor installation for reproducing phonemic features. The intelligibility of pronunciation decreases due to increased salivation and the appearance of characteristic squelching sounds. The prosodic characteristics of speech are also impaired.

Depending on the location of the lesion, bulbar, pseudobulbar, extrapyramidal, cerebellar and cortical forms are distinguished. Topical classification of dysarthria according to E.N. Vinarskaya.

Bulbar form of dysarthria

Caused by damage to the nuclei, roots or peripheral trunks of the cranial nerves located in the medulla oblongata. With such lesions, flaccid paralysis develops in the muscles of the speech organs, leading to the loss of any movements - voluntary and involuntary. Due to the fact that the lesion may be focal in nature, the actions of certain muscles are therefore excluded from the act of pronunciation. Restricted muscle movement leads to persistent pronunciation problems. With the most severe disorders, the range of pronounced sounds can be narrowed to 2-3. Additional overtones appear in the speech of patients, caused by the disorder due to additional muscle tension. Speech intelligibility suffers in proportion to the severity and prevalence of paralysis and paresis in the oral region. Both voluntary and involuntary movements are impaired. There is vagueness, muffled sound pronunciation, and nasalization of sounds.

Pseudobulbar form of dysarthria

Occurs when the pyramidal tracts are damaged in the area from the cortex to the medulla oblongata. With this localization of the lesion, spastic paralysis with impaired control of voluntary movements is characteristic. Highly automated movements, regulated at the subcortical level, are preserved. In speech, sounds that are complex in articulation and require more precise muscle movements are selectively affected. Increased tone of the muscles of the tongue and pharynx, limited movement of the lips and tongue, drooling, and oral synkinesis are detected. Speech is monotonous, blurred, voice is unmodulated.

Extrapyramidal dysarthria

It is a consequence of damage to the extrapyramidal system. Control of muscle tone is impaired. Dystonia occurs and the most characteristic symptoms are hyperkinesis. Hyperkinesis manifests itself in the form of rhythmic muscle contractions (choreic hyperkinesis) and wave-like movements (athetoid hyperkinesis). Hyperkinesis intensifies as the movement becomes more complex and the level of its arbitrariness increases. Therefore, with extrapyramidal dysarthria, disorders in the pronunciation of articulatory complex sounds and pronounced disturbances in the prosodic components of speech are observed.

Cortical dysarthria

Consequence of focal lesions of the motor areas of the cerebral cortex. Characteristic disorders include disorganization of complex motor skills. The hierarchical structure of movements disintegrates, and all its elements are essentially equalized. There is no fluency of speech, there may be salivation.

Cerebellar dysarthria

Occurs when the cerebellum or its pathways are damaged, speech is slow, jerky, and scanned. Reduced tone and mobility of the tongue muscles. Severe disturbances in the tempo and fluency of speech.

Can't do it alone

Symptoms of semantic aphasia resemble other language disorders, such as amnestic aphasia, which is much more common. The two main specialists who begin the diagnosis are a neurologist and a speech therapist.

A neurologist determines what kind of brain damage caused the speech disorder. To do this, a complete neurological examination is carried out, reflexes and symmetry of muscle tone are assessed. The doctor checks how the patient navigates space, whether he recognizes objects and sounds, and whether he is able to perform actions upon request.

The speech therapist determines which speech structures are affected. Since the main mechanism of semantic aphasia is the loss of understanding of the meaning of speech patterns and, less often, individual words, the main examination is aimed at finding out how deeply the pathology extends.

Article:

Treatment of aphasia - restoration of speech in patients who have lost speech, its methods were initially borrowed from the experience of teaching the deaf and mute (deaf pedagogy) and methods of working with children suffering from peripheral speech disorders. Later, special speech therapy techniques were developed for patients with aphasia. Although today, relatives of patients who have suffered a stroke often do not know how to restore speech, and there is no speech therapist in the hospital. It is impossible to put speech restoration on hold; in six months it will be too late. You should definitely find a speech therapist at the nearest Speech Correction Center, consult with him and immediately after discharge from the hospital, begin classes, using some techniques at home on your own. Left-handed or right-handed? After making a diagnosis, before starting rehabilitation work, it is very important to know which hemisphere of the patient’s brain is dominant. In other words, is he left-handed or right-handed, since the left hemisphere is dominant in speech and other mental activities in right-handers, and the right in left-handers. According to statistics, only 40-42% of the population are absolute right-handers, 5-8% are absolute left-handers. The remaining 50% are retrained from the left hand to the right or hidden left-handers. It often happens that in retrained left-handers, aphasia goes away spontaneously within 2-7 days. When the right hemisphere is damaged in left-handers, aphasia is less pronounced, since the functions of the affected areas are compensated by the high capabilities of the left hemisphere. Speech disorders in latent left-handers with damage to the left hemisphere manifest themselves most severely, since when relearning from the left hand to the right, additional speech zones are formed in the left hemisphere in the premotor and temporal lobes. So, to determine whether a patient is left-handed or right-handed, you need to pass the following test. Tests to determine left-handedness or right-handedness (right-handedness/left-handedness) Determine the dominant eye. The patient is asked to look through a kaleidoscope or telescope (to which eye he brings the left or right one first). Interlocking of fingers: upper position of the thumb (left, right). Cross your arms over your chest: “Napoleon pose”, which hand is on top - left, right. Determination of the size of the thumb nail. On which arm (left, right) is the venous system more developed? Determine which hand is 1-2 mm longer. Observe which leg is dominant in the sport. Which hand holds a pen, fork, spoon, brushes teeth, shoes. Which hand combs the hair, which side is the parting on the head. Which hand washes, digs, screws, cuts paper, cuts nails, unlocks a door, hammers nails, saws, etc. Which hand is more comfortable to play a musical instrument? The patient's closest relatives should answer these questions to the doctor. The test can determine not only the leading hand (more than half of the answers), but also hidden left-handedness, if a left-handed type of reaction is detected in three or more questions. Typically, left-handed aphasics have better prospects for speech restoration than right-handers, since the functions of the right hemisphere remain largely intact. When the parietal and temporal lobes of the left hemisphere are damaged, speech restoration occurs based on the planning function of the frontal lobe of the left hemisphere, which allows the patient to gain motivation to learn. Difficulties in restoring speech in left-handers arise only with acoustic-mnestic and semantic aphasia. In left-handed people, dynamic aphasia practically does not manifest itself due to the high interchangeability of the functions of the posterior frontal parts of the brain. Methods of correction work for aphasia The same teaching methods are used for left-handers and right-handers. The main principle of speech restoration is to use the compensatory capabilities of the undamaged area of ​​the brain. The duration of speech therapy sessions for all forms of aphasia is two to three years (in the hospital, then at home), but the patient should not be told about this. After examining the patient, the neurologist determines the form of aphasia. Corrective and rehabilitation work with a speech therapist begins with permission and under the supervision of the attending physician from the first weeks after a stroke or injury. In the early stages, the duration of classes should not exceed 15 minutes twice a week. In the later stages it lasts 30-40 minutes three times a day. The first stage is the same for all types of aphasia: speech disinhibition. They talk to the patient, observe his auditory perception, answers to questions, and understanding of speech. Further work is carried out depending on the form of the disease on all aspects of speech. Speech correction for sensory aphasia The main task for acoustic-gnostic (sensory) aphasia is the restoration of phonemic perception and understanding of simple speech instructions (for example, raise your hand). Using intact analyzers (visual, motor), non-speech forms of work are used: copying short words from pictures, gestures. Exercises Work on restoring phonemic hearing (special exercises) is carried out using plot pictures labeled below. First, two words of contrasting length are taken, for example, car and house. “Show me where the car is and where the house is.” The patient correlates the sound image with the letter image. At the same time, work is underway to perceive the sound of words during the process of copying. Then pictures are taken with words of the same syllable structure, but different in sound (na-sos, zabor). At the third stage, words with the same syllable structure and different sounding first (mak-rak) or last sounds (les-lion) are taken, and the patient is asked to choose a picture with a word that begins or ends with one sound or another. Then he is asked to fill in the missing letters in the words. The work on restoring sounds lasts 2-3 months, then the skills are consolidated in speech, restoring the subject attribution of the word. For example, select all the wooden objects, all the clothes or shoes in the picture. In addition, the ability to read analytically and globally is restored. Work is underway to understand the semantics of words by selecting definitions for words, differentiating homonyms, homographs, homophones, selecting antonyms and synonyms for words. An effective technique for sensory aphasia is copying a text, which gives the patient the opportunity to find the right word in his mind, coordinating it with others. At the same time, reading restoration is underway. Work with acoustic-mnestic aphasia In the case when the patient has impaired auditory-verbal memory, treatment (corrective work) is carried out based on visual ideas about the signs of the object. Exercises At the first stage, they work to restore the subject attribution of words. They show the patient pictures of objects and ask them to arrange the captions for them or select the desired one from the list of objects. For example, “an ambulance arrived...”; “I went to the grocery store...”, etc. They explain the functional purpose of the objects and ask them to choose from a variety of pictures those that best suit the situation, for example, a family having lunch or a walk in the forest. In parallel with this, auditory dictations of two or three words are carried out based on plot pictures. We are working on a body diagram: show the body parts in yourself and in the picture according to the instructions. At the second stage, they work on restoring situationally determined speech. The patient follows the instructions, points to the named object, fills out a questionnaire, and conducts a situational conversation. Subsequently, the patient is asked to repeat a series of words or automated series, for example, count to 10, identify and complete the missing element of an object, for example, the spout of a teapot, etc. Work is also underway to understand the polysemy of words, select synonyms, antonyms, homonyms, compose a story based on plot pictures, and retell the listened text. Preservation of phonemic hearing and understanding of the sound-letter content of a word allows one to compose detailed written statements from the very first days of correctional work, preventing poor vocabulary and agrammatisms. Up Speech correction (treatment) for semantic aphasia The main task of speech therapy work is to eliminate difficulties in selecting names for objects, enriching vocabulary and syntactic structures of statements. Reliance is placed on intact analyzers: vision, auditory-verbal memory, and the planning function of speech. Exercises First of all, work is being done to overcome spatial agnosia: restoring the body diagram, overcoming disturbances in visual-spatial perception, restoring the connection between a word and an object image. Constructive-spatial apraxia is corrected through teaching the sequence of dividing a drawing into certain segments. To understand the names of objects, it is necessary to compare the various properties and functions of a whole group of words, breaking them down into categories: furniture, clothes, dishes, etc. The commonality of words is also determined by their root part (forest, forester, lumberjack), and by suffixal characteristics (table, knife). Work is underway on understanding synonyms, polysemantic words, the figurative meaning of a word, restoring the cause-and-effect relationships of an event, differentiating prepositional-case constructions (“the mother fed her son, who ate?”), composing complex and complex sentences, explaining persistent speech expressions, interpreting proverbs , catching logical and grammatical errors made in the text. To overcome acalculia, the patient is asked to solve logical and mathematical problems, clarify the digit of a number (tens, hundreds), reinforce the concepts of “minus”, “plus”, and solve arithmetic problems. When writing letters in mirrors, the emphasis is on restoring the patient’s orientation in different arrangements of objects (left, right), where to start writing the letter, in which direction it “looks.” Restoring speech in afferent motor aphasia Overcoming speech difficulties in afferent motor aphasia relies on the preservation of visual and acoustic perception. Exercises In the case of a roughly expressed form, work is first carried out to disinhibit speech, to overcome embolophrasia, and to highlight the first articles in words. Before causing a sound, the patient must “read” it from the lips, from the tongue. It is more effective to start work by calling contrasting sounds: a, k, u. For better assimilation, the speech therapist uses diagrams for each sound: a - large circle, y - narrow circle, p - wavy line, etc. After consolidating articulatory skills, they move on to pronouncing a series of sounds and sound-letter analysis of the word in order to avoid rearrangements and replacements of sounds in the word. Used: conjugate speech, the speech therapist together with the patient pronounce words, and then stable expressions; reading automated series; reading and recording dictation of individual sounds; forming words from a split alphabet. Then they move on to the reflected pronunciation of words. With the help of dialogue, they work on situational understanding of speech and call for answers. -Are you hungry? - Yes, yes. -Are you going to eat? - Will. -Will you have soup? - I'll have soup. In addition, work is underway to restore analytical reading and writing. Work with efferent motor aphasia The main task is to restore the kinetic motor program, overcome inertia in switching from one articulatory pattern to another, restore the clarity of oral and written statements. Exercises For this purpose, written tasks are used in which you need to choose the correct sequence of syllables in a word. For example, Le (rtstvo, ka), mo (twa, whether). In case of severe violation of reading and writing, they begin to work on adding syllables from a split alphabet, composing first two and then three syllable words (vo-da, so-ba-ka). For ease of reading, phrases can be translated from horizontal to vertical. Conjugate reading of words with a certain rhythmic structure is practiced. Using the preserved speech planning function, they draw a diagram or plan of a word or phrase that allows them to overcome the difficulties of switching from one syllable to another, perseveration and echolalia. Overcoming agrammatisms is achieved by adding endings, inserting prepositions, and restoring the semantic structure of the word. When restoring expressive speech, the child is given the task to complete the phrase: “I changed the bed sheets...” or to tell why, what item is needed. To develop verbal vocabulary, it is used to draw up some kind of plan or daily routine: “I got up, got dressed, washed...” etc. If reading is completely impaired, then special alphabets with pictures are used: A - watermelon, B - wolf, etc. Restoration of reading is carried out in parallel with sound-letter analysis of words. In the later stages, the patient is advised to solve simple crossword puzzles. Corrective work for dynamic aphasia The main task for this form of aphasia is to restore the programming function of speech. Exercises The patient is recommended to draw up an action plan, a program of statements based on questions, diagrams, according to a series of plot pictures with increasing action. An aphasic must be able to determine the sequence of actions of the hero of the pictures, be able to classify objects using the example of a group of images: furniture, transport, etc. The speech therapist creates conditions for speech activity, conducts role-playing conversations, playing out this or that situation: “The Clothing store is located to the right of the pharmacy and to the left of the grocery store, how can I get from the opposite side of the street first to the pharmacy, and then to the store where I need to buy bread". The patient is also taught to overcome difficulties in understanding the figurative meaning of words, asked to convey the doctor’s request, compose a story on a given topic, and retell the text according to a preliminary plan. Speech activity is also facilitated by discussion of the events of the day, quick switching from one topic to another: what happened the day before, what will happen tomorrow. In parallel, written work is being carried out to restore missing parts of speech in the text and correct use of prefixed verbs. At the final stage, an essay is written based on a series of pictures, statements, powers of attorney, and letters to friends are drawn up.

Aphasia after stroke and more

Aphasia is most common in older people who have had a stroke

. However, speech destruction occurs in young people and even in children who have suffered infectious diseases, traumatic brain injuries, or brain tumors. The form of aphasia depends on which part of the brain is affected. And the direction in which speech restoration specialists will work depends on the form.

Diagnosis of aphasia

Experts from different fields are involved in uncovering the mechanisms of this complex disease: neurophysiologists, neurologists, speech therapists, psychologists, etc. The diagnosis is made after the localization of the lesion in the brain has been determined. The complexity of the disorder depends on the size of the lesion, the nature of the circulatory disorder and the characteristics of the intact components of speech activity.

It is known that the highest mental functions of a person are carried out as a result of the work of the cortex of the two hemispheres of the brain and its subcortical structures. Aphasia is caused by damage to the dominant hemisphere, the right in left-handed people and the left in right-handed people.

This is how the frontal lobes of the cortex carry out programming, regulation of mental activity and correction of its results. The right frontal lobe carries out non-speech actions, the left is responsible for the movement of the tongue and the entire body, plans speech and mental activity, and predicts its impact on the situation. The temporal lobes of the cortex are responsible for listening and understanding speech. The right temporal lobe captures and differentiates non-speech sounds, the left is responsible for the perception of both individual sounds of language and their synthesis into groups of words. The occipital lobes of the cortex perform the functions of collecting and processing information through vision, the parietal lobes - through the tactile-kinesthetic sense.

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Main forms of aphasia

There are several classifications of aphasia; in our country, the classification of A.R. is widespread. Luria, abroad – Lichtheim-Wernicke classification. There is also a simplified classification: posterior form of aphasia - damage to the superior temporal and inferior parietal areas of the brain, and anterior form - damage to the posterior frontal regions. Classic descriptions examine not only lesions of the speech areas of the brain, but also adjacent non-speech areas of the cortex.

Features of the development of aphasia are different. In cases of circulatory disorders and brain injuries, speech disorder occurs sharply and immediately. With sluggish circulatory disorders and gradual growth of a brain tumor, the symptoms of aphasia appear slowly, as the brain zones are covered.