RESTORATION OF SPEECH IN PATIENTS WITH APHASIA AT THE EARLY STAGE AFTER STROKE

What is dynamic aphasia?

Dynamic aphasia is a local absence or disturbance of already formed speech due to the inability to form internal speech and express it. Most often it occurs as a result of damage to the prefrontal region of the left hemisphere in right-handed people and vice versa, that is, the departments of the third functional block - activation, regulation and planning of speech function.

Dynamic aphasia syndrome was first discovered in the middle of the last century in 1934 by physician and researcher Karl Kleist. He put forward the hypothesis that with this type of aphasia there is a violation of the formation of spontaneous speech. Later, A.R. became interested in this topic. Luria, who in turn suggested that despite the impairment of developed spontaneous speech, the motor and sensory components are preserved in the victim.

The dynamic form of aphasia is characterized by a violation of the formation of written and oral active speech; difficulties arise in perceiving some information and performing certain thought processes. At the same time, patients with such forms of aphasia are not able to independently construct a sentence and have difficulty in correctly constructing words, which leads to a large number of grammatical errors. It is difficult for such people to perceive verbs and carry out any commands and actions.

Impressive speech

Sensory or impressive speech - understanding and perception of speech. In the cerebral cortex in the temporal gyrus there is an area (Wernicke's area) that is responsible for the perception of sensory speech.

In this zone, the assimilation and accumulation of all previously acquired words and their sound images occurs. When this zone is damaged, a person hears words, but ceases to understand their meaning. With normal hearing intact, the patient does not perceive words addressed to him, since they are meaningless to him.

Speech apparatus device

The functioning of the nervous system of the human brain is designed in such a way that we do not have to think every second about every action we take. Most parts of the central nervous system operate autonomously, i.e. independent mode and all this thanks to millions of electrochemical connections both between individual neurons and between higher nerve centers. The speech apparatus of an adult consists of several centers and is a complex structure that, thanks to nerve connections, functions as a single whole. The main role in the development and activation of speech function is played by the brain speech and analytical centers of Wernicke and Broca.

Causes of dynamic aphasia

The formation of the pathological process is based on a disruption in the functioning of cortical structures in the region of the speech center of the brain. In the case of dynamic aphasia, patients suffer damage to the posterior frontal parts of the left hemisphere - in a place located in close proximity to Broca's area. This fact influences the characteristics of the manifestation of this form of aphasia - a decrease in spoken speech. The patient’s speech becomes “poor”, verbs are missing or skipped, and the patient requires stimulating questions.

There are quite a large number of risk factors, the main ones of which include:

• Complicated family history;
• Elderly and senile age;
• Vascular diseases including atherosclerosis;
• Arterial hypertension;
• Rheumatic heart diseases;
• Mechanical injuries and surgical interventions on the brain.

Among the causes of aphasia, the primacy is occupied by vascular diseases of the brain - discirculatory encephalopathies, acute cerebrovascular accidents. In addition, aphasia is caused by inflammatory diseases (meningo-encephalitis, brain abscess), diseases of the central nervous system of a chronic course - Pick's disease, Alzheimer's disease, oncogenic diseases of a benign and malignant nature, traumatic brain injuries.

MOTOR APHASIA OF EFFERENT TYPE

Stage of severe disorders

The recovery program is the same as for afferent motor aphasia.

Moderate stage of disorders

1. Overcoming disorders of the pronunciation side of speech:

- development of articulatory switches within a syllable:

with vowels contrasting in articulation pattern (“a” – “u”, etc.); with various vowels, including soft ones; in syllables, for example,

M A A S T R E C E P T

- development of articulatory switching within a word: merging syllables into words with a simple, and later with a complex sound structure (for example, recipe, etc.);

- exteriorization of the sound-rhythmic side of the word, dividing words into syllables, highlighting the stress in the word, reproducing the outline of the word in the voice, selecting words with an identical sound-rhythmic structure, rhythmic pronunciation of words and phrases with the use of external supports - tapping, clapping, etc. , capturing various consonances, including the selection of rhyming words.

2. Restoration of phrasal speech:

— overcoming agrammatism at the level of the syntactic scheme of a phrase: composing “core” phrases of models like S (subject) + P (predicate); S+P+O (object) with the involvement of external supports-chips and their gradual “collapse”; highlighting the predicative center of the phrase; exteriorization of its semantic connections;

— overcoming agrammatism at the formal grammatical level: catching grammatical distortions—inflectional, prepositional, etc. in order to revive the sense of language; differentiation of singular and plural meanings, generic meanings, meanings of the present, past and future tenses of the verb; filling in missing grammatical elements in words; composing phrases based on plot pictures; answering questions with a simple phrase, grammatically formatted; retelling a simple text; stimulation to use incentive and interrogative sentences, various prepositional structures.

Stage of mild disorders

The program is the same as for the corresponding stage of afferent motor aphasia.

When restoring written speech in patients with motor aphasia of the efferent type, as a rule, the independent task of developing the “articulome-grapheme” connection is not highlighted.

The emphasis is on:

1. Restoring the ability to analyze the sound-rhythmic side of a word:

— differentiation of words by length and syllabic composition;

- highlighting the stressed syllable;

- selection of words identical in sound-rhythmic structure;

- highlighting identical elements in words - syllables, morphemes and, in particular, endings (underlining them, writing them out, etc.).

2. Restoring the ability to sound-letter analysis of the composition of a word.

3. Restoring the skill of merging letters into syllables, syllables into words.

4. Restoring the skill of detailed written speech (specific teaching methods - see the program for restoring learning for afferent motor aphasia - paragraphs 2,3,4).

Classification

Currently, there are a large number of different classifications of aphasia. In the Russian Federation, the classification most often used is A.R. Luria, which reflects all clinical types of aphasia:

• Efferent motor aphasia, this form occurs in case of damage to the lower parts of the cortex - Broca's center. It is characterized by the collapse of grammatical structures into sentences and the difficulty of restructuring from one word to another. Serious reading and writing impairments occur.
• Afferent motor aphasia. Occurs when an area of ​​the parietal cortex or posterior area is affected. The key disorder in this aphasia is the inability to detect the necessary articulatory position of the lips, tongue and speech facial muscles for the correct pronunciation of a word.
• Dynamic aphasia - occurs when the prefrontal or perifrontal part of the cerebral cortex is damaged. It is manifested by the lack of possibility of adequate construction of internal speech and its implementation aurally.
• Semantic aphasia - it is based on a defect in understanding complex speech structures and simultaneous analysis of information.

SENSORY APHASIA

Stage of severe disorders

1. Accumulation of everyday passive vocabulary:

— display of pictures depicting objects and actions by their names, functional, classification and other characteristics

— display of pictures depicting objects belonging to certain categories (“clothing”, “dishes”, “furniture”, etc.);

- showing body parts in the picture and in yourself;

- choosing the correct name of the object and action among the correct and conflicting designations based on the picture.

2. Stimulation of understanding of situational phrasal speech:

- answering questions with words “yes”, “no”, affirmative or negative gesture;>

- following simple oral instructions;

— capturing semantic distortions in simple phrases deformed in meaning.

3. Preparation for restoration of written speech:

— laying out captions for subject and simple plot pictures;

— answers to questions in a simple dialogue based on visual perception of the text of the question and answer;

- writing words, syllables and letters from memory;

- “voiced reading” of individual letters, syllables and words (the patient reads “to himself”, and the teacher reads out loud);

- development of the “phoneme-grapheme” connection by selecting a given letter and syllable by name, writing letters and syllables under dictation.

Moderate stage of disorders

1. Restoration of phonemic hearing:

- differentiation of words that differ in length and rhythmic structure;

- highlighting the same 1st sound in words of different lengths and rhythmic structures, for example: “house”, “sofa”, etc.;

- highlighting different 1st sounds in words with the same rhythmic structure, for example, “work”, “care”, “gate”, etc.;

- differentiation of words that are similar in length and rhythmic structure with disjunctive and oppositional phonemes by identifying differentiated phonemes, filling in gaps in words and phrases; capturing semantic distortions in a phrase; answers to questions containing words with oppositional phonemes; reading texts with these words.

2. Restoring understanding of the meaning of a word:

— development of generalized concepts by classifying words into categories; selection of a generalizing word for groups of words belonging to one or another category;

— filling in gaps in phrases;

- selection of definitions for words.

3. Overcoming oral speech disorders:

— “imposing a framework” on a statement by composing sentences from a given number of words (instructions: “Make a sentence of 3 words!”, etc.);

— clarification of the lexical and phonetic composition of the phrase using the analysis of verbal and literal paraphasias admitted by the patient;

— elimination of elements of agrammatism using exercises to “revitalize” the sense of language, as well as analysis of grammatical distortions.

4. Restoration of written speech:

- strengthening the “phoneme-grapheme” connection by reading and writing letters under dictation;

— various types of sound-letter analysis of the composition of a word with a gradual “collapse” of external supports;

- writing from dictation of words and simple phrases;

- reading words and phrases, as well as simple texts, followed by answers to questions;

- independent writing of words and phrases from pictures or written dialogue.

Stage of mild disorders

1. Restoring understanding of extended speech:

— answers to questions in an expanded, non-situational dialogue;

- listening to texts and answering questions about them;

— capturing distortions in deformed compound and complex sentences;

— understanding of logical and grammatical figures of speech;

— implementation of oral instructions in the form of logical and grammatical figures of speech.

2. Further work to restore the semantic structure of the word:

- selection of synonyms as homogeneous members of a sentence and out of context;

- work on homonyms, antonyms, phraseological units.

3. Correction of oral speech:

— restoration of the self-control function by fixing the patient’s attention on his mistakes;

- compiling stories based on a series of plot pictures;

- retelling texts according to plan and without plan;

— drawing up plans for texts;

- composing speech improvisations on a given topic;

— speech sketches with elements of “role-playing games”.

4. Further restoration of reading and writing:

— reading expanded texts, various fonts;

- dictations;

- written statements;

- written essays;

- mastering samples of congratulatory letters, business notes, etc.

Specialists

Aphasia is a neurological disease, which means that this pathology is treated by a specialist - a neurologist. Aphasia is treated either in multidisciplinary municipal hospitals in neurological departments, or in specialized centers. One of the most progressive and largest neurological centers is the Clinical Brain Institute. The clinic has a polyclinic, day and 24-hour hospitals that provide prevention, treatment and rehabilitation of patients with a wide variety of neurological pathologies. A speech restoration center operates on the basis of the rehabilitation block. It is in this center that patients who have suffered traumatic brain injuries, acute cerebrovascular accident and suffering from various forms of aphasia undergo treatment and correction.

In addition to the neurologist, a rehabilitation specialist, psychotherapist and speech therapist must take part in the treatment of patients with aphasia.

Aphasia correction

The correction includes two components:

• speech therapy
• medical

It is necessary to treat the disease that led to aphasia. Moreover, control should be carried out by a neurosurgeon or an experienced neurologist. Medicines are used for treatment. But sometimes the help of surgeons is also needed. Rehabilitation measures include massage, physiotherapy, mechanical therapy and physical therapy.

To restore normal speech, the patient must attend special speech therapy classes. Correction should be made regarding all components of speech:

• impressive
• expressive
• writing skills
• reading and understanding texts

Treatment for aphasia should begin immediately after injury or stroke, as determined by the attending physician. The sooner treatment is started, the greater the chances of getting rid of pathological symptoms, preventing them from becoming “chronic”. Speech therapy work aimed at restoring normal speech in a patient usually lasts two or three years.

Diagnostics

Aphasia should be distinguished from alalia, in which the speech function is not initially formed. With aphasia, the loss of speech function is disrupted after its formation in childhood. This is why this diagnosis can be confidently made only in children who have reached three years of age or older. As a rule, aphasia is combined and affects various forms of speech activity, which requires a detailed study of the symptoms of each individual patient. Dynamic aphasia can be established as a result of composing a story based on a specific plot device or a series of sequential pictures. Retelling certain text passages or writing an essay on a specific topic can also help in establishing a clinical diagnosis.

In order to determine the cause of aphasia and the exact localization of the area of ​​damage to the speech center, the specialist must prescribe one of the following studies:

• Tomographic studies – computer or magnetic resonance imaging of the brain;
• Ultrasound Doppler mapping of blood vessels in the brain, head and neck;
• Magnetic resonance angiography;
• Lumbar puncture.

Diagnostics and establishment of a clinical diagnosis of dynamic aphasia are carried out by specialists in related fields, namely: a neurologist, a neurosurgeon, a speech therapist, a psychotherapist.

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.

Treatment

First of all, you need to cure the underlying disease that caused the development of aphasia. To correct emerging symptoms, an integrated approach is used, including drug therapy, physiotherapeutic treatment, active rehabilitation, speech correction together with a speech therapist, as well as neuropsychological correction. Rehabilitation therapy should begin as early as possible, from the first days or weeks after the incident, as soon as the patient’s general condition allows. This is necessary to prevent the consolidation of pathological speech symptoms, the main of which are:

• Paraphasia is a speech disorder in which the logical structure of a sentence is disrupted and its semantic load is lost;
• Agrammatism is a difficulty in understanding sentences, especially those with complex syntax. Agrammatism occurs with a pathological focus localized in the Sylvian fissure;

At each stage of rehabilitation therapy, the joint work of the attending physician, psychologist, speech therapist, and especially the patient’s relatives is necessary. Only constant contact and communication will help achieve maximum effectiveness of treatment and rehabilitation procedures, as well as stabilize the patient’s general condition and mood. The speed of recovery processes and the mood in line with the patient’s wishes depend on how often and how much close and relatives communicate with the victim.

Drug therapy

Treatment of the underlying disease is carried out under the supervision of a neurologist or neurosurgeon. Drug therapy includes the following classes of drugs:

• Antioxidants and vitamins. These drugs are necessary to maintain a sufficiently active metabolic function of neurocytes. Antioxidants help accelerate regenerative and repair processes at the ultracellular level, stabilize cell membranes and protect them from lipid peroxidation. Among vitamins, a special role is played by B vitamins, which have a pronounced neuroprotective effect. B vitamins include: pyridoxine, pyrimidine, thiamine, folic acid, cyanocobalamin, riboflavin. Complex preparations of vitamins and antioxidants effective for dynamic aphasia include: Mexidol, Glycine (Lipoic acid), Aspirin, Emoxipin.
• Nootropic drugs. This group of drugs improves cerebral circulation and has a positive effect on metabolism in brain tissue. Nootropics have an antihypoxic and tranquilizing effect without inhibiting the activity of the central nervous system, which makes their use safe for everyday independent use. Taking nootropics is not accompanied by drowsiness, lethargy and relaxation of skeletal muscles. In addition, the drugs have a psychostimulating effect, restore mental performance and physical activity. This group of drugs includes all racetam derivatives (Piracetam, Nootropil), Picamelon, Cerebrolysin.
• Cerebroprotectors. Prescribed to prevent the development of complications and irreversible damage to neurocytes as a result of metabolic disorders or hypoxic shock, it affects metabolism, thereby improving blood supply to the brain. The main representatives are Vinpocetine, Cinnarizine, Coplamin.
• Vasoactive drugs - improve cerebral blood supply. This includes several different groups of drugs: antiplatelet agents (Clopidogrel, Plavix), anticoagulants (Sincumar, Warfarin, Heparin), calcium channel blockers (Nimodipine), methylxanthines (Pentoxtrental).

Speech therapy correction

The choice of a correctional work program primarily depends on the volume of the affected area of ​​the brain and the severity of the clinical manifestations of dynamic aphasia. At the very beginning of rehabilitation, a restoration process is carried out, which begins with passive work with the patient, while methods are used to promote speech disinhibition and prevent the development of further speech disorders. Subsequently, the speech therapist draws up an individual plan and selects individual exercises for a particular patient. The duration of speech therapy correction for disorders associated with the development of aphasia averages about two to three years. The work uses special techniques for constructing sentences that allow the patient to reconstruct a detailed statement on his own. Work is also underway to correct the communicative function and self-control over it. Only when the patient understands the nature of his grammatical errors can one create opportunities for him to independently control his speech, the course of the narrative, and correct paraphasias.

The main emphasis of speech therapy work for dynamic aphasia is the elimination of defects in internal planning and programming of speech, as well as stimulation of speech activity.

Neuropsychic correction

Neuropsychological correction of speech in dynamic aphasia, regardless of the form of aphasia, deals with correction of all aspects of speech, namely its understanding, reproduction, writing and reading. The goal of neuropedagogical speech restoration for aphasia is to generally disinhibit speech, reduce the number of errors, improve the patient’s mental state and his interest in communication, as well as activity in general. The program plan is developed taking into account the individual characteristics of the lesion and the severity of the pathology. For this purpose, specific techniques are used, such as:

• “Having completed the mind” - the poem is read to the patient several times, after which the specialist begins the sentence, and the patient finishes it;
• Verbalization of one’s own actions - the patient is asked to talk about the progress of his day using drawing, reading and writing;
• Rhythmic-myological exercises – the patient learns light rhythmic songs, tongue twisters;
• Techniques of conjugate and reflected repetition;
• Semantic selection of words.

Physiotherapeutic treatment

Physiotherapy is prescribed in cases of traumatic brain injury, stroke and neurosurgery. The majority of patients are prescribed neuromyostimulation, which helps restore and strengthen the tone and strength of the facial muscles. Thanks to this method, myocytes are stimulated due to electric current pulses, which makes it possible to restore the lost motor function of the facial muscles.

Patients are also recommended to engage in physical therapy according to an individually drawn up plan together with a personal approach to each person. After physical therapy exercises, tissue metabolism and a wide variety of metabolic processes are activated in the body and cerebral blood flow increases. At the same time, the patient becomes more active and his mood improves.

Another significant means of physiotherapeutic treatment is therapeutic massage. Massage has a tonic, relaxing, antispasmodic effect, activates the excitability of the nervous system, and increases muscle performance.

He understands everything, but cannot say

The main characteristic of dynamic aphasia is the inability to speak.
A person understands what is said, pronounces sounds correctly, repeats what others say, but cannot construct his own presentation of thoughts. With this disease, the regulatory function of speech is impaired - the patient is not able to construct a phrase plan and conduct an internal monologue, hence the impossibility of speaking. Therefore, the patient tries not to start a dialogue with strangers first: he is unable to construct a question or ask for something, and he is aware of this. Speech grammar is impaired, patients avoid verbs, prepositions and pronouns are omitted. Nouns are often used only in the nominative case.

Analysis of addressed speech in dynamic aphasia shows that reading and counting are not impaired, but when reading aloud, people with this disease may miss words and phrases and are unable to explain the meaning of the text. The ability to communicate through writing is retained in most cases, but only in simple phrases. Difficulties begin if you need to compose something yourself or write a complex grammatical structure from dictation.

Patients almost always lose the ability to maintain concentration on something for a long time and often become irritable or, conversely, indifferent because of this.

Prevention and prognosis for patients

Restoring the victim’s speech depends on a whole range of factors, the most important of which are:

• Localization and volume of affected brain tissue;
• Level of speech disorder;
• Time from the start of rehabilitation after injury or vascular lesion;
• The age of the victim and his general condition.

The best results are expected to be observed in younger people, however, do not be discouraged, since the reactivity of compensatory-restorative reserves is developed differently in each person and with intensive rehabilitation it can be significantly activated.

Prevention mainly consists of preventing the occurrence of repeated or recurrent episodes of the disease that provokes the development of aphasia. For this purpose, it is necessary to undergo timely and regular diagnostic examinations and correct even minor deviations from the norm. Patients who have already encountered clinically pronounced forms of aphasia and have undergone rehabilitation should still be periodically observed by neurologists or neurosurgeons.

Complications

The lack of ability for independent active speech and the inability to express one’s thoughts leads to a decrease or loss of communication skills.

The patient cannot complain of pain or discomfort. He is unable to ask others for help or express his concerns. In the absence of adequate, attentive support from loved ones or medical personnel, such a patient may not satisfy basic needs for a long time, which leads to the development of other somatic diseases.

Persistent impairment of speech function makes professional implementation impossible, and the patient becomes disabled.