Restorative learning for different forms of aphasia
The article discusses the program, specific steps and methods of remedial training for the following forms of aphasia: efferent motor aphasia, dynamic aphasia, afferent motor, sensory, acoustic-mnestic, semantic and amnestic aphasia.
Depending on the form of aphasia, the severity of the defect, the stage of the disease, and the individual characteristics of speech disorders, the integrated use of the considered methods for restoring oral and written speech will help a person adapt to life with this acquired disorder. Restorative learning is based on one of the most important properties of the brain—the ability to compensate. To restore impaired functions, both direct and bypass compensatory mechanisms are used.
Direct disinhibitory methods of work are mainly used in the individual stage of the disease and are designed to activate reserve intrafunctional capabilities. Bypass methods imply compensation based on the restructuring of the most impaired function due to cross-functional restructuring. In other words, the restorative effect is achieved through the introduction of new, “workaround” ways of performing certain speech or gnostic-praxic operations.
It is also necessary to strictly take into account the characteristics of each specific case of the disease.
Rehabilitation training is carried out according to a special, pre-developed program. The program should include certain tasks and corresponding work methods, differentiated depending on the form of aphasia (apraxia, agnosia), severity of the defect, stage of the disease, individual characteristics of speech disorders, but rehabilitation work in it should be carried out on all aspects of the impaired function, and not only over those who suffered primarily.
In addition, rehabilitation training should primarily be aimed at restoring the communication abilities of patients. It is necessary to involve the patient in communication not only in classes, but also in the family, as well as in public places.
Treat or cure?
For any type of aphasia, the cause of the disease is treated first. This is done by neurologists in a hospital setting, since the situations that led to loss of speech threaten the health and sometimes the life of the child. Correction of speech disorders begins at the beginning of the recovery period, when the baby is out of danger. It is necessary to start such classes as early as possible, but not earlier than the attending physician allows it.
The Neurospectr Center for Children's Speech Neurology and Rehabilitation offers a comprehensive approach to rehabilitation for various forms of motor aphasia. In children, this disease has a favorable prognosis: as a rule, speech can be restored in full.
Our center’s specialists have the necessary qualifications to monitor patients in the early recovery period. Experienced neurologists continued the treatment prescribed in the hospital and will adjust it as the condition improves. Doctors, together with speech therapists, will accurately establish a diagnosis and develop a plan of correctional work that takes into account both motor aphasia and related problems that require rehabilitation. Working with a psychologist will help overcome the stress associated with the inability to communicate as usual. A speech therapist and psychologist will help the child establish contact with parents if there are difficulties with this.
An integrated approach allows you to correct several violations at the same time. This happens quite often: in case of poisoning, infections, severe traumatic brain injuries, there may be several lesions. In such cases, in addition to speech therapy, other types of correction may be required. We work with impaired motor activity, with increased excitability and hyperactivity, which appeared after damage to the nervous system or existed before. The center has all the necessary equipment; our doctors, speech pathologists and rehabilitation specialists have extensive experience in working with complex disorders. Taking into account the nature and needs of young patients, we will do everything to achieve the best possible result as soon as possible.
MOTOR APHASIA OF AFFERENT TYPE
Stage of severe disorders
1. Overcoming disorders of understanding situational and everyday speech:
- display of pictures and real images of the most commonly used objects and simple actions by their names, categorical and other characteristics. For example: “Show a table, a cup, a dog, etc.”, “Show pieces of furniture, clothing, transport, etc.” “Show someone who flies, who talks, who sings, who has a tail, etc.”
— classification of words by topic (for example: “Clothing”, “Furniture”, etc.) based on a subject picture;
— answers with an affirmative or negative gesture to simple situational questions. For example, “Is it winter now, summer..?”; "You live in Moscow?" and etc.
2. Disinhibition of the pronunciation side of speech:
- conjugate, reflected and independent pronunciation of automated speech series (ordinal counting, days of the week, months in order, singing with words, ending proverbs and phrases with a “hard” context), modeling situations that stimulate the pronunciation of onomatopoeic pronouns (“ah!” “oh” !" and so on.);
- conjugate and reflected pronunciation of simple words and phrases;
- inhibition of the speech embolus by introducing it into a word (ta, ta..-Tata, so), or into a phrase (ma..ma-mama...; this is mom).
3. Stimulating simple communicative types of speech:
— answers to questions in one or two words in a simple situational dialogue;
— modeling situations that contribute to the evocation of communicatively significant words (yes, no, want, will, etc.);
— answers to situational questions and composing simple phrases using a pictogram and a gesture accompanied by the pronunciation of simple words and phrases.
4. Stimulating global reading and writing:
— laying out captions under pictures (subject and subject);
- writing the most common words-ideograms, copying simple texts;
— conjugate reading of simple dialogues.
Moderate stage of disorders
1. Overcoming disorders of the pronunciation side of speech:
- isolating sounds from words;
— automation of individual articles in words with different syllabic structures;
— overcoming literal paraphasias by selecting first discrete and then gradually converging sounds in articulation.
2. Restoration and correction of phrasal speech:
- composing phrases based on a plot picture: from simple models (subject-predicate, subject-predicate-object) to more complex ones, including objects with prepositions, negative words, etc.;
- composing phrases on questions, on key words;
- exteriorization of grammatical-semantic connections of the predicate: “who?”, “why?”, “when?”, “where?” etc.;
— filling in gaps in a phrase with a grammatical change in a word;
— detailed answers to questions;
- compiling stories based on a series of plot pictures;
- retelling texts based on questions.
3. Work on the semantics of the word:
— development of generalized concepts;
- semantic play on words (subject and verbal vocabulary) by including them in various semantic contexts;
— filling in the gaps in a phrase;
- completing sentences with different words that are appropriate in meaning;
- selection of antonyms, synonyms.
4. Restoration of analytical-synthetic writing and reading:
- the sound-letter composition of the word, its analysis (one-two-three-syllable words) based on diagrams that convey the syllabic and sound-letter structure of the word, a gradual reduction in the number of external supports;
- filling in missing letters and syllables in words;
- copying words, phrases and small texts with an emphasis on self-control and independent error correction;>
- reading and writing from dictation of words with a gradually more complex sound structure, simple phrases, as well as individual syllables and letters;
- filling in missing words in texts when reading and writing, practiced in oral speech.
Stage of mild disorders
1. Further correction of the pronunciation aspect of speech:
— clarification with articles of individual sounds, especially affricates and diphthongs;
— differentiation of acoustic and kinesthetic images that are similar in articulation of sounds in order to eliminate literal paraphasias;
- practicing the purity of pronunciation of individual sounds in a sound stream, in phrases, with a combination of consonant sounds, in tongue twisters, etc.
2. Formation of detailed speech, complicated in semantic and syntactic structure:
- filling in the missing main sentence, as well as a subordinate sentence or subordinating conjunction in a complex sentence;
- answering questions with complex sentences;
- retelling texts without relying on questions;
— drawing up detailed plans for texts;
— preparation of thematic messages (short reports);
- speech improvisations on a given topic.
3. Further work to restore the semantic structure of the word:
- interpretation of individual words, mainly with abstract meaning;
— explanation of homonyms, metaphors, proverbs, phraseological units.
4. Work on understanding complex logical and grammatical figures of speech:
— execution of instructions, including logical and grammatical phrases;
— introduction of additional words, pictures, questions that facilitate the perception of complex speech structures.
5. Further restoration of reading and writing:
- reading and retelling expanded texts;
- dictations;
— written presentation of texts;
— writing letters, greeting cards, etc.;
- essays on a given topic.
1) Restoring the “articuleme-phoneme” connection
- writing letters corresponding to the names of sounds in expressive speech, reading these letters immediately after writing;
- isolating the first sound from simple words, fixing attention on the articulatory, acoustic, and then graphic image of this sound; independent selection of words for this sound and writing them;
- writing practiced sounds and syllables under dictation;
— identification of letters in different fonts;
— finding given letters in various texts (underlining, writing out).
2) Restoring the ability to sound-letter analysis of the composition of a word:
- dividing words into syllables, syllables into letters (sounds) based on various graphic schemes;
- highlighting any sound in a word;
- recalculation and listing of words by letter (orally);
- filling in gaps in words;
- writing words from letters given separately.
3) Restoring the skill of detailed written speech:
- writing words of different sound structures with and without support from an object picture: a) under dictation, b) when naming an object or action;
- writing proposals: a) from memory, b) from dictation, c) in the form of a written statement based on a plot picture for the purpose of communication with others;
- written statements and essays.
General characteristics of aphasia
The term “aphasia” means a violation of already formed speech (in adults or in children over 3 years of age) in the form of partial or complete loss. What is the basis of aphasia? It occurs as a result of damage to the responsible areas of the brain with intact articular apparatus and sufficient hearing. The diversity of the nature of the disorders depends on the damage to one or another part of the speech functional system.
The speech system, as a functionally complex structure, consists of afferent (from the receptor apparatus to the nerve center) and efferent (from the nerve center to the working organs) nerve conduction systems. Speech perception is carried out by analyzing and synthesizing parts (elements) of the sound stream with the help of the parts of the visual, auditory and skin-kinesthetic analyzers. The processes of verbal pronunciation are a system of articulatory coordinated movements. The latter are formed in the patient’s previous experience, and the afferent basis of their functioning is the auditory and kinesthetic (related to movement, motor) analyzers.
Most often, pathology develops as a result of:
- cerebrovascular accidents (stroke) of ischemic or hemorrhagic type (aphasia after stroke occurs in 15-38% of patients);
- traumatic brain injury or surgical intervention on it, craniotomy;
- brain tumor development;
- infectious diseases of the brain (encephalitis, meningoencephalitis, leukoencephalitis, brain abscess);
- parasitic infestations - in cases where the localization of parasites during their development cycle includes brain tissue;
- chronic progressive diseases of the central nervous system, for example, focal forms of Alzheimer's disease and Pick's disease.
Speech, as a very complex mental activity, is divided into various forms and types. In accordance with the psychological structure, it is divided into:
- expressive, which is pronounced out loud;
- impressive, representing the speech perception of other people.
Expressive speech consists of such stages as the idea of a statement, internal speech, and the stage of an external expanded statement. Many pathological processes are reflected in disturbances in the tempo, smoothness, and rhythm of this type of speech. It can become, for example, intermittent, slow, scanned (with Parkinson's disease) or with stuttering on the first syllables (with atrophic age-related processes in the brain).
Features of impressive speech, or the processes of understanding the addressed speech utterance, consist in the understanding of oral (reading) and written speech. The psychological structure of this type consists of the following stages:
- Primary perception of speech information.
- Decoding this speech information, which is an analysis of the composition of letter or sound forms.
- Correlations of information with certain semantic categories.
In general terms, we can say that the meaning of impressive speech lies in a person’s reaction to the meaning of words. Speech understanding is possible with the normal functioning of Wernicke's center, which is the central link of the speech auditory analyzer.
In children with mental retardation, damage to this center causes a violation of the understanding of the meaning of addressing them. The leading symptom is a disorder of varying degrees in the perception of the sound composition of a word, that is, phonemic perception. This is manifested by a lack of reaction to words and verbal structures in general, difficulty in auditory perception of oral communication, excessive sensitivity to loud sounds, better perception of soft and even whispered speech.
In a simplified generalization of various types of aphasia, they are conditionally grouped into three types of disorders:
- Expressive speech, or impaired reproduction when understanding it.
- Impressive speech, that is, its understanding.
- Naming objects while maintaining the ability to understand and reproduce, but losing the basis (matrix) of word formulation in the cerebral cortex. In this case, the patient correctly describes the purpose of the object, but does not remember its name.
These forms of aphasia are called (respectively) motor, sensory and amnestic. The identification of one of these forms and their varieties is the basis for the diagnosis of the location, volume of the lesion, and therefore the presumptive prognosis of the pathological condition.
Thus, aphasia is characterized by the destruction of speech thinking, which consists both in the impaired understanding of the speech addressed to him by the sick person, and in various own speech defects. This syndrome, also called sensorimotor aphasia, occurs as a result of damage to the cortex and certain areas of subcortical structures in the left (for right-handed people) hemisphere of the brain. At the same time, in the symptoms of the syndrome, one of the components is predominant - motor, in which expressive speech is impaired, or sensory, which is a disorder of expressive speech.
Aphasia must be differentiated from such speech disorders that occur as a result of brain damage, such as:
- disorders in pronunciation without impairment of auditory speech perception, as well as speech perception in writing and reading (dysarthria);
- absence or severe congenital speech disorder in the presence of normal hearing and primary intelligence, caused by damage to the speech centers in the cerebral cortex (alalia).
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).
Forms and signs of motor aphasia
In case of local disorders of cerebral circulation, the clinical manifestations of the speech disorder coincide, as a rule, with the area of the brain subject to depression. In accordance with the existing classification, seven forms of pathology are distinguished, three of which are various forms of motor aphasia, which is a disorder of expressive speech. In other words, a patient with motor aphasia suffers from a violation of articulate speech due to damage to the corresponding center of the brain.
Its forms are as follows:
- Motor afferent, or motor afferent kinesthetic (articular).
- Motor efferent, or Broca's motor aphasia (verbal).
- Motor dynamic as one of two types of transcortical motor aphasia.
Complex (mixed) forms of aphasia are also quite common. The development of a certain form, the nature of the course of the pathology and the timing of recovery of motor aphasia are mainly influenced by factors such as:
- localization of the lesion and the extent of its extent;
- the nature of the circulatory disturbance in areas of the brain;
- the degree of possibility of compensatory functions being carried out by undamaged areas of the brain, which depends on their condition.
Basically, the degree of severity (listed in the subsection of each of these forms) of the pathological condition depends on these factors - gross (and even complete) or partial motor aphasia can occur.
Afferent motor aphasia (articular)
This form is one of the most severe speech disorders. It is often combined with the efferent form. With this combination, such severe motor aphasia develops that overcoming it is a particularly difficult and lengthy process.
It occurs in cases of damage by a pathological process to the postcentral zone of the brain in the region of its lower parts, the secondary speech zones of the cerebral cortex, located in the left (for right-handed people) inferior parietal region, located posterior to the Rolland's (central) gyrus. These secondary zones have a direct and close connection with secondary zones (fields), which are characterized by a clear somatotopic structure.
Afferent-motor aphasia is characterized by loss of a portion of the afferent kinesthetic (feedback between muscles and sensations) speech system. In other words, with pathology, in the process of a speech act, clear sensations disappear, that is, the link in the conduction of the flow of impulses from the proprioceptors of the articulation apparatus to the corresponding parts of the cerebral cortex.
Of course, a healthy person in the process of pronouncing certain words is not aware of the sensations entering his brain. Nevertheless, the role of kinesthetic speech afferentation is very large both in cases of speech formation in childhood, and in the pronunciation of words and ensuring normal speech function.
With this form of pathology, a disorder of the entire speech system occurs - the pronunciation of words is disrupted, some speech sounds or letters (when writing) are replaced by others (literal paraphasia). This occurs due to difficulties in differentiating sounds that are similar in articulation (articulomes). They are necessary when pronouncing sounds and whole words, which is the primary defect. Literal paraphasias lead to distortion of words.
Afferent-motor aphasia is caused by depression of the lower sections in the postcentral gyrus and adjacent inferior parietal sections (40, 7 areas according to Brodmann)
That is, there is a mixture (confusion) of sounds that are similar in the nature of their pronunciation. For example, such front-lingual sounds as “d”, “l”, “n” are formed mainly due to the participation of the anterior parts of the tongue in their pronunciation, and the sounds “g”, “k” and “x” are rear-lingual, then There are predominantly posterior parts of the tongue involved in their pronunciation.
These sounds differ in their sound characteristics, but they are formed through close articles. In patients with lesions in the lower parts of the left parietal region of the cerebral cortex, there is a confusion of closely related articles, as a result of which they can pronounce, for example, instead of the word “elephant” - “slod” or “slol”, “robe” - “galat”, etc. d.
It is significant that such patients not only pronounce articulomes that are close to each other incorrectly, but also perceive them incorrectly. This is explained by the close interaction of the parietal articulatory zones with the perceptive temporal zones. The afferent form is characterized by a disorder of all types of speech - spontaneous, automated, repeated, nominative (naming).
There is also often a violation of non-speech (oral) abilities to carry out purposeful sequential actions (praxis) - licking lips, puffing out one and both cheeks, sticking out the tongue, etc. Despite the primitiveness of these oral movements, however, their implementation is very often impossible due to generally difficult voluntary control of the oral apparatus.
In addition, verbs with prefixes (“unscrew”, “turn”, “wrap”), as well as personal pronouns pronounced in indirect cases, are difficult to understand. It is difficult to articulate sounds in words with repeated consonant sounds, which are pronounced using close articles, as well as repetition of words with double consonants or with a combination of them, which are difficult in terms of articulation, for example, “bestseller”, “sidewalk”, “standard”.
It is also characteristic that such patients understand the incorrect pronunciation of words. However, when you feel your mistakes and apply volitional efforts to correct them, there seems to be no subordination of the mouth (articulatory apparatus). In addition, there is a secondary violation of other speech forms, disturbances in writing, both independently and under dictation, while difficulties in articulation when following instructions (“hold your tongue with your teeth”, “open your mouth slightly”, etc.) not only do not improve, but also as a rule, they only worsen the writing. Despite the fact that familiar simple words are read aloud more or less correctly, the pronunciation of rather complex words is incorrect and occurs with the replacement of sounds.
Thus, a distinctive feature of afferent kinesthetic motor aphasia is impaired kinesthetic afferentation of oral (oral) movements, as a result of which the patient loses the ability to carry out movement of the articulatory organs (lips, tongue, etc.) according to instructions. Since there are no muscle paresis that can limit the range of articulatory movements, involuntary articulation movements are preserved.
This disorder is called oral apraxia. It is the basis of articulatory apraxia, which directly affects the pronunciation of speech sounds. Depending on the severity of the latter, this pathology can manifest itself:
- lack of articulate speech;
- distortion of the reproduction of articulatory poses;
- searching for articulations;
- secondary systemic impairment of other aspects of speech function.
Severity of motor afferent aphasia:
- Rough - absence of spontaneous speech, the presence of only a speech “embolus” (“stuck”, repetition of the same word or words), disintegration of automated speech (listing a series of numbers from 1 to 10 in forward and reverse order, as well as the alphabet, poems) .
- Medium - difficulty repeating and naming, preservation of automated speech and its stereotypy, the presence of literal paraphasias.
- Mild - difficulties with oral and articulatory praxis, reflected in oral and written speech.
Efferent motor aphasia (Broca's)
This pathological condition has a predominantly acute development and usually develops as a result of circulatory disorders in the middle cerebral artery. This form of speech disorder is usually combined with hemiparesis, more pronounced on the face and hand.
Broca's motor aphasia occurs with damage to the lower parts of the cerebral cortex in the premotor region, the posterior part of the inferior frontal gyrus of the 44th - 45th fields, called Broca's areas, in the dominant hemisphere (for right-handers - left, for left-handers - right). Through this area of the brain, a smooth change in oral-articulatory acts is ensured, which is a necessary condition for articulatory fusions and the formation of sequentially organized rows.
Broca's and Wernicke's areas
Damage to Broca's area leads to disruption of the reproduction of individual or all sounds, as well as the formation of syllables and words. Often there is a loss of spontaneous speech altogether, and when attempting to express something, only individual sounds or words “emboli” are uttered.
Patients are very often unable to switch from one word to another, as a result of which individual phonemes, syllables, words, and short phrases are repeated (speech perseverations). Even in mild and erased cases of the disease, they cannot pronounce words and phrases that are complex in the “motor” sense, like tongue twisters. In severe cases, such patients are able to communicate only with the help of facial expressions and gestures. At the same time, the ability to understand addresses addressed to them, oral and written speech is preserved. Writing and reading are impaired secondary to speech automation disorders.
Severity of efferent motor aphasia:
- Rough - the impossibility of spontaneous speech and the collapse of automated speech.
- Average - agrammatism (difficulty in perceiving or expressing sentences) of spontaneous speech, the occurrence of perseverations in cases of naming or repetition, the presence in dialogue of echolalic responses, which are the automatic repetition of heard phrases or words in the absence of their deep semantic understanding.
- Easy - in cases of naming, the absence of smooth articular transitions in words is noted. The speech itself is developed, minor pronunciation difficulties are noted.
Brief generalizing comparative characteristics of efferent and afferent motor aphasia:
Dynamic motor aphasia
The disorder develops when the lesion is localized in an area anterior to Broca's area. This area corresponds to the anterior and middle parts of the inferior frontal gyrus, located in the dominant hemisphere of the brain. This area of the brain is responsible for the activation, regulation and planning of speech activity.
The dynamic form, as one of two variants (dynamic and classic), differing only in expressive speech disorder, includes transcortical motor aphasia. In addition, both options are almost completely identical in description. Most often, dynamic motor aphasia develops with acute circulatory disorders in the anterior cerebral artery (left). One of the main signs is a violation of speech activation, or initiative. In this regard, another name for the disorder is speech initiative defect.
For speech initiation, the patient always needs encouragement, an additional impulse, initial stimulation. After one or two short narrative responses, the patient usually falls silent, and to continue the story he needs additional, repeated stimulation. It seems that he does not want to engage in conversation and communicate with the interlocutor. Characteristic are echolalia (mechanical involuntary repetition of what was said by interlocutors or strangers), their number increases with fatigue.
There are no speech motor impairments in these patients, and understanding of oral speech is also preserved. While the ability to pronounce all sounds and words is preserved, their motivation to speak is sharply reduced, which is especially evident during spontaneous narration, which requires constant stimulation. At the same time, repeated and automated speech, as well as the naming or nominative function of speech in dynamic motor aphasia are preserved or very slightly impaired.
The main and distinctive feature of this form is the violation of consistency in the organization of speech utterance. It is not a simple difficulty in the process of constructing phrases, but represents deeper disorders in which independent statements are almost absent.
Patients with dynamic aphasia are deprived of the ability to construct elementary phrases, their speech is “poor”, they cannot give a complete, detailed answer to even the simplest question, they answer in monosyllables with frequent repetition in their answer of the words contained in the question. This defect is detected using the “prescribed association method”. The latter consists of asking the patient to list several objects of the same type, for example, the color blue, northern animals, etc. The patient is able to name a maximum of 1-2 objects, after which he becomes silent, even despite the doctor’s prompts or encouraging words.
Their specific lack of literacy is manifested in the use of stereotyped phrases, omission of pronouns and prepositions. Particular difficulties are associated with the actualization of verbs. When asked to name nouns and verbs, the patient may recall several noun words, but not a single verb. At the same time, the possibility of writing under dictation and the safety of reading are noted.
Severity of dynamic aphasia:
- Rough - practically no spontaneous speech, the need for its constant stimulation.
- Average - spontaneous statements are presented in short phrases with a specific lack of literacy, verbal “weakness” and the predominance of stereotypical two-way dialogue with constant stimulation of communication by the interlocutor.
- Easy - spontaneous statements are developed quite fully, but they are stereotypical, and difficulties are noticeable when proposing a solution to a logical problem.
DYNAMIC APHASAIA
Stage of severe disorders
1. Increasing the level of general activity of the patient, overcoming speech inactivity, organizing voluntary attention:
- performing various types of non-verbal activities (drawing, modeling, etc.);
— assessment of distorted images, words, phrases, etc.;
- situational, emotionally significant dialogue for the patient;
- listening to plot texts and answering questions about them in the form of affirmative-negative gestures or words “yes”, “no”.
2. Stimulating simple types of communicative speech:
— automation in dialogical speech of communicatively significant words: “yes”, “no”, “can”, “want”, “will”, “must”, etc.;
— automation of individual cliches of communicative, incentive and interrogative speech: “give”, “come here”, “who’s there?”, “hush!” etc.
3. Overcoming speech programming disorders:
- stimulation of answers to questions with a gradual decrease in the answer of words borrowed from the question;
- constructing phrases of the simplest syntactic models based on chips and a simple plot picture;
- performing simple grammatical transformations to change words that make up a phrase, but are presented in nominative forms;
- laying out a series of sequential pictures according to the plot contained in them.
4. Overcoming grammatical structuring disorders
5. Stimulating written speech:
— laying out captions under pictures;
- reading ideogram words and phrases.
Moderate stage of disorders
1. Restoration of communicative phrasal speech:
— construction of a simple phrase;
- composing phrases based on a plot picture using the chip method and gradually “collapsing” the number of external supports;
- compiling a story based on a series of sequential pictures;
— detailed answers to questions in the dialogue;
- compiling simple dialogues like speech sketches: “In a store” - a dialogue between a buyer and a seller, “In a savings bank”, “In an atelier”, etc.
2. Overcoming perseverations in independent oral and written statements:
- display of objects in pictures and in the room, parts of the body (in random order, by individual names and by series of names);
- ending phrases with different words;
- selection of words of given categories and in given quantities, for example, two words related to the topic “Clothing” and one word related to the topic “Tableware”, etc.;
- writing numbers and letters broken down (from dictation);
- writing from dictation of words and phrases that contribute to the development of semantic and motor switching;
— elements of sound-letter analysis of the composition of a word: folding simple words from letters of a split alphabet;
- filling in gaps in words;
- writing simple words from memory and dictation.
Stage of mild disorders
1. Restoration of spontaneous communicative phrasal speech:
- extensive dialogue on various topics;
- constructing phrases based on a plot picture with a gradual decrease in the number of external supports;
— automation of phrases of certain syntactic models in spontaneous speech;
- accumulation of a verbal dictionary and “revitalization” of the semantic connections behind the predicate (with the help of questions posed to it);
- reading and retelling texts;
- “role-playing conversations”, playing out a certain situation;
- “speech improvisations” on a given topic;
- detailed presentations of texts, essays;
- drafting greeting cards, letters, etc.
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.
Usually in left-handed aphasics
the prospects for speech restoration are better than for 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.
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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.
ACOUSTIC-MNESTIC APHASIA
Stage of disorders of moderate and mild severity
1. Expanding the scope of auditory perception:
— display of objects (real and in pictures) by name, presented in pairs, triplets, etc.;
- showing body parts according to the same principle;
— implementation of 2-3-level oral instructions;
— answers to detailed questions, complicated by syntactic structure;
- listening to texts consisting of several sentences and answering questions about the content of the texts;
- writing from dictation with a gradual increase in phrases;
- reading gradually increasing phrases, followed by reproduction (from memory) of each of the sentences and the entire set as a whole.
2. Overcoming weakness of auditory-speech traces:
- repetition from memory of read letters, words, phrases with a gradual increase in the time interval between reading and reproduction, as well as filling the pause with some other type of activity;
— memorizing short poems and prose texts;
— repeated display of objects and pictures after 5-10 seconds, after 1 minute. after the first presentation;
- reading texts with time-delayed retelling (after 10 minutes, 30 minutes, the next day, etc.);
- composing orally sentences using reference words perceived visually;
- listing words by letter with a gradually more complex sound structure, and gradually moving away from the written example of these words.
3. Overcoming naming difficulties:
- analysis of visual images and independent drawing of objects denoted by name words;
- semantic play in contexts of various types of words denoting objects, actions and attributes of objects;
— classification of words with independent finding of a generalizing word;
— exercises on the interpretation of words with concrete, abstract and figurative meaning.
4. Organization of a detailed statement:
- compiling a story based on a series of plot pictures;
- retelling of texts, first according to a detailed plan, then according to a condensed plan, then without a plan;
- extensive dialogues on non-situational topics (professional, social, etc.); practicing samples of communicative and narrative writing (greeting cards, letters, statements, essays on a given topic, etc.).
Methods of correctional work for aphasia
The same teaching methods are used for left- and right-handed people. 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.
SEMANTIC APHASIA
Stage of disorders of moderate and mild severity
1. Overcoming spatial apractognosia:
— a schematic representation of the spatial relationships of objects;
- image of the plan of the path, room, etc.;
- design according to a model, according to a verbal task;
— work with a geographical map, hours.
2. Restoring the ability to understand words with spatial meaning (prepositions, adverbs, verbs with “movement” prefixes, etc.):
— a visual representation of simple spatial situations denoted by prepositions and other parts of speech;
— filling in missing “spatial” elements in words and phrases;
- composing phrases with words that have spatial
3. Construction of complex sentences:
— clarification of the meanings of subordinating conjunctions;
— filling in missing main and subordinate clauses;
- composing sentences with given conjunctions.
4. Restoring the ability to understand logical and grammatical situations:
- a picture depiction of the plot of the structure;
- the introduction of additional words that provide semantic redundancy (“my brother’s father”, “a letter from a beloved friend”, etc.);
— introduction of logical-grammatical constructions into a detailed semantic context;
- presenting designs in writing and then orally.
5. Work on an extended statement:
- presentations, essays;
— improvisation on a given topic;
- interpretation of words with complex semantic structure...
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