home General biology Motor aphasia and ways of corrective and restorative learning. Features of restorative learning in aphasia in the early stages and in the residual period. Differentiated methods of restorative training at the later stages of work with different forms

Motor aphasia and ways of corrective and restorative learning. Features of restorative learning in aphasia in the early stages and in the residual period. Differentiated methods of restorative training at the later stages of work with different forms

Semantic aphasia is a type of neurological disease associated with a violation of the verbal apparatus, speech abilities in patients. The main reason is organic brain injury. Patients fully understand the meaning of simple phrases consisting of 7-12 elements, and even speech (dialogical, spontaneous, automated) is normal. But forgetfulness is traced, the impossibility of capturing the details of what was said, the lack of understanding of the text read (even a simple, short one).

Semantic aphasia is included in the syndrome of damage to the functions of the cortex of the dominant hemisphere of the brain, mainly in the lower parietal part (field according to Brodman - 39-40). Some patients may experience damage to the temporal, occipital lobe of the cerebral cortex. A feature of this type of aphasia is a violation of the perception (understanding) of speech, logical and grammatical structures.

In general, many functions of the speech apparatus are preserved, so even if the patient forgets a single word in a sentence, he can quickly remember, but with a prompt from the outside, and in subsequent speech, he will no longer replace words with others in a conversation. Although when retelling even a short text, obvious defects begin to be traced.

The patient is quite well aware and fluently pronounces individual words in the context, but the reading of sentences becomes slow and occurs in syllables. Understanding written sentences is easier, because patients can go back to what they read and remember quickly. On hearing the text begins to be perceived with difficulty. The proposals sound abrupt.

There is clearly no connection between them. The patient may skip prepositions, pronouns, function words and adverbs necessary to reproduce constructions in the genitive case or to reflect spatial relationships between objects.

With semantic aphasia, visual-spatial gnosis suffers, so patients begin to experience difficulty in arranging the letters in the word in the correct sequence. For example, they can no longer put together a word from individual letters of the split alphabet.

Reference! A feature of the semantic form of aphasia is the inability of patients to give meaning to endings, suffixes, adverbs, prepositions in a sentence (above, behind, before, under, below). For example, phrases are difficult to understand - father's brother, husband's sister, daughter's son, second cousins; or it is difficult to produce on paper a square at the top of a triangle, in a circle a rectangle.

Disease classification

Semantic aphasia - inability to understand comparative phrases, loss of orientation in comparison by patients, for example - Nina is taller than Yulia. Taking into account the linguistic, psychological, anatomical features of speech recognition, semantic aphasia is classified into the following separate types:

motor;
acoustic-gnostic;
amnestic-semantic;
acoustic-semantic;

In the case of progression of the pathology, it is possible to combine several forms of the disease at once with damage to another area of the brain. For example, when a vessel is damaged in the parietal part (in the lower section), a joint development of semantic, efferent-motor and amnestic-semantic aphasia is observed.

Causes of manifestation

Semantic aphasia occurs when the vessels of the brain are damaged, against the background of a stroke (ischemic, hemorrhagic). Other reasons:

Pick's disease, Alzheimer's;
injury, mechanical damage brain;
encephalitis, meningitis with inflammatory course;
surgical intervention on the head area;
oncology, the development of a tumor-like process in the brain.

The risk group includes elderly people over 55 years old, suffering from cerebral atherosclerosis, hypertension, rheumatoid heart disease, and CNS diseases.

Signs and symptoms of the disease

Diagnosis of the disease

It can be difficult for doctors to diagnose semantic aphasia, since the clinical symptoms are similar to other neurological diseases and forms of aphasia (acoustic-mnestic).

Semantic aphasia is a rare occurrence among all known forms. At the same time, the clinic of focal lesions of the brain is not always traced. Speech in patients, at first glance, is quite expressive. There are no violations in the pronunciation of phrases, sentences. At the same time, automated speech can persist for a long time.

Reference! A distinctive feature of amnestic-semantic aphasia is the periodic occurrence of disturbances when repeating long sentences that are complex in structure.

The main methods of examination to detect pathology:

blood test (clinical, general);
Ultrasound of the cervical vessels;
puncture with the collection of cerebrospinal fluid;
speech therapy, neuropsychological examination;
duplex scanning of cerebral vessels;
angiography;
tests to identify the degree of deviations in oral, written speech and listening memory.

Diagnosis is differential. It is important to distinguish aphasia from diseases with similar symptoms: dementia, dysarthria, dyslalia, acalculia,.

Important! With deviations in the pronunciation of sounds and intellectual capabilities in a person, a violation of speech functions, it is almost impossible to diagnose on your own.

The staging is often carried out by a whole council of doctors with considerable experience in the treatment of patients with similar brain dysfunctions. It is important to identify the differences between the pathology and other similar diseases and to understand, for example, why semantic aphasia is often accompanied by acalculia on presentation.

The goal of therapy is to restore speech to the maximum, therefore, medicines are the basis. Main groups:

nootropics (Phezam, Piracetam);
statins (Atorvastatin, Liprimar, Torvakard);
thrombolytic drugs (Metalise, Actilyse);
vitamins (riboflavin, pyridoxine, thiamine);
blood thinners (Xarelto, Fraxiparin, Heparin, Pradaxa);
diuretics (Diacarb, Furosemide, Lasix);
steroid (Prednisolone);
thrombolytic agents (Actilyse).

In addition, anti-inflammatory drugs (Actovegin, pyridoxine hydrochloride) can be prescribed to improve metabolic processes in brain structures.

The note! Traditional medicine methods are absolutely ineffective, since they cannot positively affect speech with aphasia.

An operation for semantic aphasia is prescribed in case of oncology, cerebral hemorrhage, detection of local tumor-like foci. Indications for surgical intervention:

aneurysm of cerebral vessels;
tissue abscess;
atherosclerosis with lesions of the carotid arteries, narrowing of the lumen of the vessel by plaques.

With hemorrhage, it is possible to carry out trepanation of the skull, with atherosclerotic plaques - the method of endarterectomy.

Treatment will not be complete without speech therapy and this is the basis of the impact in such a neurological disease. The goal is to restore written and oral speech, conduct corrective work in case of semantic aphasia to consolidate linguistic skills in patients, exercises and procedures to restore the affected areas of the brain. In addition:

physiotherapy with the supply of electrical impulses to stimulate the muscles;
biofeedback to influence the muscles of the speech apparatus;
acupuncture for correction, restoration of efferent links in speech.

Prevention

To prevent the development of semantic aphasia means for patients (especially in the elderly):

keep blood pressure indicators under control and always at hand - a measuring device;
timely treat diseases of a hypertensive nature (diabetes mellitus, atherosclerosis, atrial fibrillation);
detect a tumor at an early stage, undergo therapy;
adjust carbohydrate metabolism if diabetes mellitus is detected;
vaccinate against a viral, bacterial infection in case of brain damage.

Semantic aphasia is characterized as a complex disorder of speech functions, when the treatment requires the help of close relatives, highly specialized doctors (speech therapist, neurologist, neuropathologist, oncologist). Patients must strictly comply with all recommendations and appointments.

In general, the prognosis for semantic aphasia is favorable. Although one can hardly hope for a complete cure with serious deviations in speech development in children under 5 years of age (in case of birth defects) or in elderly patients over 55 years of age. The degree of speech restoration will depend entirely on the size, location of the pathological focus in the cerebral cortex. The prognosis is much worse if the speech centers of the brain are strongly compressed, and the operation is often fraught with complications and side effects:

suppuration (infection) of wounds;
development of anemia;
large blood loss;
irreversible immobilization of the upper (lower) limbs;
outbreaks of new neurological foci against the background of damage to neighboring brain structures.

In difficult cases, semantic aphasia is fraught with a fatal outcome. In fact, it is an incurable pathology that is difficult to diagnose and treat. The relatives of the patient play an important role. The outcome of treatment will be affected by their attitude, care, love, understanding.

Unfortunately, often people already at a young age experience difficulties in speech, but they are in no hurry to consult doctors, they ignore the symptoms. But aphasia is a slowly progressive pathology. The consequences can be quite serious.

Introduction

1. Aphasias and their classification

Conclusion

Bibliography

Introduction

Aphasias and their classification

5. Semantic aphasia - occurs when there is a lesion on the border of the temporal, parietal and occipital regions of the brain (or the region of the supramarginal gyrus). It is quite rare in clinical practice. For a long time, speech changes with lesions of this zone were assessed as an intellectual defect. A more thorough analysis revealed that this form of pathology is characterized by a weakened understanding of complex grammatical structures that reflect the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, genus-species, expressed - in complex logical, inverted, fragmented forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, function words and pronouns is disturbed. These disturbances do not depend on whether the patient reads aloud or silently. Defectiveness and slowness of retelling appear short texts, often turning into disordered fragments. The details of proposed, heard or read texts are not captured or transmitted, but in spontaneous utterances and in dialogue, speech turns out to be coherent and free from grammatical errors. Separate words out of context are also read at normal speed and are well understood. Apparently, this is due to the fact that global reading involves such a function as probabilistic prediction of the expected meaning. Semantic aphasia is usually accompanied by violations of counting operations - acalculia (R48.8). They are directly related to the analysis of spatial and quasi-spatial relations implemented by the tertiary cortical zones associated with the nuclear part of the visual analyzer.

6. Dynamic aphasia - the areas anteriorly and superiorly adjacent to Broca's area are affected. At the heart of dynamic aphasia lies a violation of the internal program of utterance and its implementation in external speech. Initially, the intention or motive that directs the development of thought in the field of future action suffers, where the image of the situation, the image of the action and the image of the result of the action are “represented”. As a result, speech adynamia or a defect in speech initiative occurs. Understanding of ready-made complex grammatical structures is slightly or not violated at all. In severe cases, patients do not have independent statements; when answering a question, they answer in monosyllables, often repeating the words of the question in the answer (echolalia), but without pronunciation difficulties. It is absolutely impossible to write an essay on a given topic due to the fact that "there are no thoughts." There is a tendency to use speech stamps. In mild cases, dynamic aphasia is experimentally detected when asked to name several objects belonging to the same class (for example, red). Words denoting actions are especially poorly updated - they cannot list verbs or use them effectively in speech (predicativity is violated). Criticism of their condition is reduced, and the desire of such patients to communicate is limited.

7. Conduction aphasia - occurs with large lesions in the white matter and cortex of the middle-upper sections of the left temporal lobe. Sometimes it is interpreted as a violation of the associative links between the two centers - Wernicke and Broca, which suggests the involvement of the lower parietal departments. The main defect is characterized by severe repetition disorders with relative safety. expressive speech. Reproduction of most speech sounds, syllables and short words is basically possible. Rough literal (literal) paraphasias and additions of extra sounds to the endings occur when repeating polysyllabic words and complex sentences. Often only the first syllables in words are reproduced. Errors are recognized and attempts are made to overcome them with the production of new errors. Understanding of situational speech and reading is preserved, and, being among acquaintances, patients speak better. Since the mechanism of dysfunction in conduction aphasia is associated with a violation of the interaction between the acoustic and motor centers of speech, sometimes this variant of speech pathology is considered either as a kind of mild sensory or afferent motor aphasia. The latter variety is observed only in left-handers with damage to the cortex, as well as the nearest subcortex of the posterior sections of the left parietal lobe, or in the zone of its junction with the posterior temporal sections (40th, 39th fields).

In addition to those mentioned, contemporary literature you can meet the outdated concept of "transcortical" aphasia, borrowed from the Wernicke-Lichtheim classification. It is characterized by phenomena of impaired understanding of speech with its intact repetition (on this basis, it can be opposed to conduction aphasia), that is, it describes those cases when the connection between the meaning and sound of a word is broken. Apparently, "transcortical" aphasia is also due to partial (partial) left-handedness. The diversity and equivalence of speech symptoms indicates mixed aphasia. Total aphasia is characterized by a simultaneous violation of the pronunciation of speech and the perception of the meaning of words and occurs with very large foci, or in the acute stage of the disease, when neurodynamic disorders are pronounced. With a decrease in the latter, one of the above forms of aphasia is identified and specified. Therefore, it is advisable to conduct a neuropsychological analysis of the structure of HMF disorders outside the acute period of the disease. An analysis of the degree and rate of speech recovery indicates that in most cases they depend on the size and location of the lesion. A gross speech defect with relatively poor speech recovery is observed in pathology that extends to the cortical-subcortical formations of two or three lobes of the dominant hemisphere. With a superficially located focus of the same size, but without spreading to deep formations, speech is restored quickly. With small superficial foci, located even in the speech zones of Broca and Wernicke, there is, as a rule, a significant restoration of speech. The question of whether deep brain structures can play an independent role in the development of speech disorders remains open.

In connection with studies of deep brain structures that are directly related to speech processes, the problem of differentiating aphasias from categorically different speech disorders, called pseudoaphasias, has arisen. Their appearance is associated with the following circumstances. Firstly, during operations on the thalamus and basal ganglia in order to reduce motor defects - hyperkinesis (F98.4), parkinsonism (G20) - immediately after the intervention, such patients develop symptoms of speech adynamia in active speech and in the ability to repeat words, as well as Difficulties in understanding speech with increased volume speech material. But these symptoms are unstable and soon regress. With damage to the striatum, in addition to the actual motor disorders, deterioration in the coordination of a motor act as a motor process is possible, and with dysfunction of the pale ball, the appearance of monotony and lack of intonation of speech. Secondly, pseudo-aphasic effects occur during operations or when organic pathology occurs in the depths of the left temporal lobe, in cases where the cerebral cortex is not affected. Thirdly, a special type of speech disorders, as already mentioned, are the phenomena of anomia and dysgraphia, which occur when the corpus callosum is dissected due to violations of interhemispheric interaction.

Speech disorders that occur with lesions of the left hemisphere of the brain in childhood (especially in children under 5-7 years old) also proceed according to other laws than aphasia. It is known that people who have undergone the removal of one of the hemispheres in the first year of life develop in the future without a noticeable decrease in speech and its intonational component. At the same time, materials have been accumulated that indicate that speech disorders can occur in early brain lesions regardless of the lateralization of the pathological process. These violations are erased and to a greater extent relate to auditory-speech memory, and not to other aspects of speech. Restoration of speech without serious consequences with lesions of the left hemisphere is possible up to 5 years. The period of this recovery, according to various sources, ranges from several days to 2 years. At the end of puberty, the possibility of forming a full-fledged speech is already sharply limited. Sensory aphasia, which appeared at the age of 5-7 years, most often leads to the gradual disappearance of speech and the child does not reach its normal development in the future.

Introduction

1. Aphasias and their classification

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

2.2 Correctional and pedagogical work with semantic aphasia

2.3 Correctional and pedagogical work with sensory aphasia

2.4 Correctional and pedagogical work with dynamic aphasia

2.5 Correctional and pedagogical work with efferent motor aphasia

2.6 Correctional and pedagogical work with afferent motor aphasia

Conclusion

Bibliography

Introduction

In recent decades, since the Great Patriotic War, increased theoretical and practical interest in the problems of aphasia, its dynamics, the role of rational restorative learning and spontaneous changes in speech defects. Many researchers are pushing the study of aphasia, methods of overcoming it, its dynamics into an independent field of knowledge: aphasiology. In many countries, the number of laboratories and offices in hospitals, clinics, and individual specialized centers has increased, which are busy working to restore speech in patients with aphasia. Systematic work to overcome these defects made it possible for researchers to observe the state of speech in aphasia for a long time and aroused great interest among specialists in studying the dynamics of speech in aphasia. It became known that speech disorders in aphasia are not stable, but have their own dynamics, which is determined by a number of interacting factors, and that these changes can vary within wide limits.

Different researchers point to different factors that affect the dynamics of speech in aphasia, but they all agree that factors such as the location and extent of brain damage, the age and level of education of the patient, the initial severity of impairment and the form of aphasia, as well as measures taken to eliminate the defect are important and actually operating conditions for the dynamics of speech in aphasia.

Aphasias and their classification

Aphasia (R47.0) - speech disorders with local lesions of the left hemisphere and the preservation of the movements of the speech apparatus, which provides articulate pronunciation, with the preservation of elementary forms of hearing. They must be distinguished from: dysarthria (R47.1) - pronunciation disorders without a disorder in hearing speech perception (with damaged articulatory apparatus and subcortical nerve centers serving it and cranial nerves), anomies - naming difficulties arising from violations of interhemispheric interaction, dyslalia (alalia) - speech disorders in childhood in the form of initial underdevelopment of all forms of speech activity and mutism - silence, refusal to communicate and the impossibility of speech in the absence of organic disorders of the central nervous system and the preservation of the speech apparatus (occurs with some psychoses and neuroses). In all forms of aphasia, in addition to specific symptoms, disorders of receptive speech and auditory memory are usually recorded. There are various principles for the classification of aphasias, due to the theoretical views and clinical experience of their authors. In accordance with the 10th International Classification of Diseases, it is customary to distinguish two main forms of aphasia - receptive and expressive (a mixed type is possible). Indeed, most of the recorded symptoms gravitate towards these two semantic accents in the formalization of speech disorders, but are not limited to them. Below is a variant of the classification of aphasias, based on a systematic approach to higher mental functions, developed in Russian neuropsychology by Luria.

1. Sensory aphasia (impaired receptive speech) - associated with damage to the posterior third of the upper temporal gyrus of the left hemisphere in right-handers (Wernicke's area). It is based on a decrease in phonemic hearing, that is, the ability to distinguish the sound composition of speech, which manifests itself in impaired understanding of oral speech. mother tongue up to a lack of response to speech in severe cases. Active speech turns into "verbal okroshka". Some sounds or words are replaced by others, similar in sound, but distant in meaning ("voice-ear"), only familiar words are pronounced correctly. This phenomenon is called paraphasia. In half of the cases, there is speech incontinence - logorrhea. Speech becomes poor in nouns, but rich in verbs and introductory words. Dictation writing is broken, but understanding of what is read is better than what is heard. In the clinic, there are erased forms associated with a weakening of the ability to understand fast or noisy speech and requiring the use of special tests for diagnosis. The fundamental foundations of the patient's intellectual activity remain intact.

2. Efferent motor aphasia (violations of expressive speech) - occurs when the lower parts of the cortex of the premotor region are damaged (44th and partially 45th fields - Broca's area). With the complete destruction of the zone, patients utter only inarticulate sounds, but their articulatory abilities and understanding of the speech addressed to them are preserved. Often in oral speech there is only one word or a combination of words pronounced with different intonation, which is an attempt to express one's thought. With less severe lesions, suffers general organization speech act - its smoothness and clear temporal sequence ("kinetic melody") is not ensured. This symptom is included in a more general syndrome of premotor movement disorders - kinetic apraxia. In such cases, the main symptomatology is reduced to speech motor disorders, characterized by the presence of motor perseverations - patients cannot switch from one word to another (proceed to a word) both in speech and in writing. Pauses are filled with introductory, stereotyped words and interjections. There are paraphasias. Another content factor of efferent motor aphasia is the difficulty in using the speech code, leading to outwardly observable amnestic-type defects. At all levels of oral independent speech, reading and writing, the laws of language are forgotten, including spelling. The style of speech becomes telegraph - predominantly nouns in the nominative case are used, prepositions, copulas, adverbs and adjectives disappear. Broca's area has close bilateral connections with the temporal structures of the brain and functions with them as a whole, therefore, with efferent aphasia, there are also secondary difficulties in the perception of oral speech.

3. Amnestic aphasia is heterogeneous, multifactorial and, depending on the dominance of the pathology on the part of the auditory, associative or visual component, can occur in three main forms: acoustic-mnestic, amnestic proper and optical-mnestic aphasia.

Acoustic-mnestic aphasia is characterized by the inferiority of auditory-speech memory - a reduced ability to keep a speech range within 7 ± 2 elements and synthesize a rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence, while searching for the right word, there are pauses filled introductory words, unnecessary details and perseverations. Derivative is grossly violated narrative speech, retelling ceases to be adequate to the model. The best transfer of meaning in such cases is provided by excessive intonation and gestures, and sometimes speech hyperactivity.

In the experiment, the elements that are at the beginning and at the end of the stimulus material are better remembered, the nominative function of speech begins to suffer, which improves when the first letters are prompted. The interval of presentation of words in a conversation with such a patient should be optimal, based on the condition "not yet forgotten." Otherwise, the understanding of complex logical and grammatical structures presented in speech form also suffers. For persons with acoustic-mnestic defects, the phenomenon of verbal reminiscence is characteristic - a better reproduction of the material a few hours after its presentation. A significant role in the structure of the causality of this aphasia is played by impaired auditory attention and narrowing of perception. In the nominative function of speech at the level of the image, this defect manifests itself in a violation of the actualization of the essential features of an object: patients reproduce the generalized features of a class of objects (objects) and, due to the indistinguishability of the signal features of individual objects, they are equalized within this class. This leads to the equiprobability of choosing the right word within the semantic field (Tsvetkov). Acoustic-mnestic aphasia occurs when the mid-posterior sections of the left temporal lobe are affected (21st and 37th fields).

Self-amnestic (nominative) aphasia manifests itself in the difficulties of naming objects rarely used in speech, while maintaining the volume of the retained speech series by ear. According to the word heard, the patient cannot identify the object or name the object when it is presented (as in the acoustic-mnestic form, the nomination function suffers). Attempts are made to replace the forgotten name of an object with its purpose ("this is what they write") or a description of the situation in which it occurs. There are difficulties in choosing the right words in a phrase, they are replaced by speech stamps and repetitions of what has been said. A hint or context helps to remember what has been forgotten. Amnestic aphasia is the result of damage to the posterior-lower parts of the parietal region at the junction with the occipital and temporal lobes. With this variant of localization of the lesion focus, amnestic aphasia is characterized not by the poverty of memory, but by an excessive number of pop-up associations, due to which the patient is unable to choose the right word.

Optical-mnestic aphasia is a variant of a speech disorder that is rarely distinguished as an independent one. It reflects the pathology of the visual link and is better known as optical amnesia. Its occurrence is due to the defeat of the posterior-lower parts of the temporal region with the capture of the 20th and 21st fields and the parietal-occipital zone - the 37th field. With general speech disorders such as the nomination (naming) of objects, this form is based on the weakness of visual representations of the object (its specific features) in accordance with the word perceived by ear, as well as the very image of the word. These patients do not have any visual gnostic disorders, but they cannot depict (draw) objects, and if they draw, they miss and underdraw the details that are significant for the identification of these objects.

Due to the fact that memory retention readable text also requires the preservation of auditory-speech memory, more caudal (literally - to the tail) located lesions within the left hemisphere aggravate losses from the visual link of the speech system, expressed in optical alexia (reading disorder), which can manifest itself in the form of unrecognition of individual letters or whole words (literal and verbal alexia), as well as writing disorders associated with defects in visual-spatial gnosis. With the defeat of the occipito-parietal parts of the right hemisphere, unilateral optical alexia often occurs, when the patient ignores the left side of the text and does not notice his defect.

4. Afferent (articulatory) motor aphasia - is one of the most severe speech disorders that occurs when the lower parts of the left parietal region are affected. This is a zone of secondary fields of the skin-kinesthetic analyzer, which are already losing their somatotopic organization. Its damage is accompanied by the occurrence of kinesthetic apraxia, which includes apraxia of the articulatory apparatus as a component. This form of aphasia is apparently due to two fundamental circumstances: firstly, the disintegration of the articulatory code, that is, the loss of special auditory-speech memory, which stores the complexes of movements necessary for pronouncing phonemes (hence the difficulties in the differentiated choice of articulation methods); secondly, the loss or weakening of the kinesthetic afferent link of the speech system. Gross violations of the sensitivity of the lips, tongue and palate are usually absent, but there are difficulties in synthesizing individual sensations into integral complexes of articulatory movements. This is manifested by gross distortions and deformations of the article in all types of expressive speech. In severe cases, patients generally become similar to the deaf, and the communicative function is carried out with the help of facial expressions and gestures. In mild cases, the external defect of afferent motor aphasia consists in the difficulty of distinguishing speech sounds that are close in pronunciation - (for example, "d", "l", "n" - the word "elephant" is pronounced like "snol"). Such patients, as a rule, understand that they pronounce words incorrectly, but the articulatory apparatus does not obey their volitional efforts. Non-speech praxis is also slightly disturbed - they cannot puff out one cheek, stick out their tongue. This pathology also leads to a second misperception of "difficult" words by ear, to errors in writing from dictation. Silent reading is preserved better.

Patients with acoustic-mnestic aphasia have increased working capacity, emotional lability, frequent bouts of depression due to even minor speech errors.

When drawing up a plan for correctional and pedagogical work, the speech therapist clarifies with the doctor the form of aphasia, the safety or dysfunction of the lower parietal departments, which are determined by the study of constructive-spatial praxis, counting operations, etc.

To overcome speech memory impairment, it is necessary either to restore the system of visual representations of the subject, its essential, distinctive features, or to gradually expand the volume of auditory-speech memory, impaired purely by acoustic signs of the perception of the phrase, as well as to overcome expressive agrammatism, which is close in its features to expressive agrammatism in acoustic -gnostic aphasia.

To overcome speech disorders in patients with acoustic-mnestic aphasia, the speech therapist relies on the mechanisms of coding of the speech utterance that they have preserved, that is, on the description of the signs of the object, the introduction of the word into various contexts, on the compilation of external supports that allow the patient to hold a different amount of speech load.

Written speech plays a special role in the process of restoring acoustic-mnestic speech functions. With one or another mnestic aphasia, the sound-letter analysis of the composition of the word is preserved, which makes it possible to use the recording of words that precede auditory stimulation, to overcome in patients the tendency to verbal paraphasia, as well as the agrammatism characteristic of their oral speech. The preservation of written speech gradually prepares, at the intra-speech level, the syntagmatic division of the phrase into segments (the syntagma consists of two or three words), connected with each other by meaning, since the subject, as a rule, is in one syntagma, the predicate in another or the main sentence in the first syntagma, the secondary one - in the second (Children went to the forest to collect mushrooms); fragments of one part of the sentence perceived by ear allow the patient to predict its second part.

Recovery of auditory memory. Improvement of auditory-speech memory occurs with the support of visual perception. A series of subject pictures are laid out in front of the patient, the names of which are previously read and written several times. Thus, the patient knows what he will hear. This is how the premises of acoustic anticipation are formed. The speech therapist does not fix the patient's attention on the need to show the subject in the order presented. In speech, words are connected by a certain intention of the utterance, so at first the patient is offered pictures of one, then two, three semantic groups: a hare, a plate, a table, a gun, a forest, a fork, a fox, a cup, a stove, a saucepan, a knife, a cucumber, an apple, a hunter , grandmother, etc., then they ask him to show objects that can be inscribed in a particular situation.

The speech therapist does not lay out object pictures in front of the patient, but gives them in a pile, so that the patient, after listening to the named objects, finds these objects in the pictures and puts them aside. This achieves some temporary delay in the execution of instructions by the patient. Subsequently, the speech therapist suggests repeating a series of words worked out in previous classes, but without resorting to the help of pictures. For memorization, the speech therapist gives words denoting objects, then the actions and qualities of objects, and finally numbers combined into phone numbers. In parallel with this, auditory dictations of phrases consisting of 2-3-4 words are carried out, based on a plot picture, and later without a plot picture. To restore visual representations, a series of exercises can be carried out, including an analysis of objects that are close in drawing, in shape, differing in one or two features (for example, a cup, teapot, sugar bowl; cupboard, refrigerator, sideboard; sofa, bed, couch; rooster and chicken; squirrels , foxes, cats and hare, etc.), in which the change or absence of one of the details changes the function of the object, its content and designation. In addition, patients are given the task of constructing objects from elements, finding specially made mistakes in their image (for example, a rooster is depicted with a comb, but without a tail, a hare is depicted without long ears, and a cat with long ears, etc.), to finish drawing the object to the whole, verbally describe in detail all its properties and functions, recognize an object half-hidden by a sheet, by its part, etc. Particular attention is paid to the oral and written definition of the essential features of the object, writing essays about the object.

All of the above methods of overcoming auditory-speech memory impairments help to overcome amnestic difficulties in this form of aphasia and reduce the number of verbal paraphasias. The difficulties of finding the right word are overcome by expanding and sometimes narrowing the semantic fields of the word, that is, by clarifying and systematizing their meanings. For this specific word played out in various phraseological contexts, attention is drawn to the ambiguity of the word (pen, key, mother's). Much attention is paid to the work on clarifying the meaning of synonyms, antonyms and homonyms, compiling various variants of sentences with these words.

The restoration of a written utterance is one of the main forms of expanding the lexical composition of speech. The composure of the sound-letter analysis of the composition of the word and the significant preservation of phonemic hearing allows, from the very first days of correctional and pedagogical work, to connect patients to the compilation of written texts, active work to expand vocabulary, to overcome agrammatism.

It is better to start working on writing written texts by writing phrases based on simple plot pictures, and then using various cartoons in magazines and newspapers. This will allow the patient to build specific, small phrases and small texts. Then you can offer to compose written texts based on reproductions of famous paintings by various artists. All work on the written text is combined with oral speech. The speech therapist selects light texts that are close to reproductions and asks the patient to retell them.

The agrammatism of agreement in the gender and number of the main members of the sentence is overcome by replacing nouns with pronouns and pronouns with nouns, as well as by composing phrases according to key words.

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MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION

NON-STATE EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION

TEST

ON APHASIA

Topic: "CORRECTIONAL WORK FOR EACH FORM OF APHASIA"

Introduction

1. Aphasias and their classification

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

2.2 Correctional and pedagogical work with semantic aphasia

2.3 Correctional and pedagogical work with sensory aphasia

2.4 Correctional and pedagogical work with dynamic aphasia

2.5 Correctional and pedagogical work with efferent motor aphasia

2.6 Correctional and pedagogical work with afferent motor aphasia

Conclusion

Bibliography

Introduction

In recent decades, since the Great Patriotic War, the theoretical and practical interest in the problems of aphasia, its dynamics, the role of rational restorative learning and spontaneous changes in speech defects has increased. Many researchers are pushing the study of aphasia, methods of overcoming it, its dynamics into an independent field of knowledge: aphasiology. In many countries, the number of laboratories and offices in hospitals, clinics, and individual specialized centers has increased, which are busy working to restore speech in patients with aphasia. Systematic work to overcome these defects made it possible for researchers to observe the state of speech in aphasia for a long time and aroused great interest among specialists in studying the dynamics of speech in aphasia. It became known that speech disorders in aphasia are not stable, but have their own dynamics, which is determined by a number of interacting factors, and that these changes can vary within wide limits.

1. Aphasias and their classification

1. Sensory aphasia (impaired receptive speech) - associated with damage to the posterior third of the upper temporal gyrus of the left hemisphere in right-handers (Wernicke's area). It is based on a decrease in phonemic hearing, that is, the ability to distinguish the sound composition of speech, which manifests itself in a violation of understanding of the spoken native language, up to a lack of response to speech in severe cases. Active speech turns into "verbal okroshka". Some sounds or words are replaced by others, similar in sound, but distant in meaning ("voice-ear"), only familiar words are pronounced correctly. This phenomenon is called paraphasia. In half of the cases, there is speech incontinence - logorrhea. Speech becomes poor in nouns, but rich in verbs and introductory words. Dictation writing is broken, but understanding of what is read is better than what is heard. In the clinic, there are erased forms associated with a weakening of the ability to understand fast or noisy speech and requiring the use of special tests for diagnosis. The fundamental foundations of the patient's intellectual activity remain intact.

2. Efferent motor aphasia (violations of expressive speech) - occurs when the lower parts of the cortex of the premotor region are damaged (44th and partially 45th fields - Broca's area). With the complete destruction of the zone, patients utter only inarticulate sounds, but their articulatory abilities and understanding of the speech addressed to them are preserved. Often in oral speech there is only one word or a combination of words pronounced with different intonation, which is an attempt to express one's thought. With less severe lesions, the general organization of the speech act suffers - its smoothness and clear temporal sequence ("kinetic melody") are not ensured. This symptom is included in a more general syndrome of premotor movement disorders - kinetic apraxia. In such cases, the main symptomatology is reduced to speech motor disorders, characterized by the presence of motor perseverations - patients cannot switch from one word to another (proceed to a word) both in speech and in writing. Pauses are filled with introductory, stereotyped words and interjections. There are paraphasias. Another content factor of efferent motor aphasia is the difficulty in using the speech code, leading to outwardly observable amnestic-type defects. At all levels of oral independent speech, reading and writing, the laws of language, including spelling, are forgotten. The style of speech becomes telegraph - predominantly nouns in the nominative case are used, prepositions, copulas, adverbs and adjectives disappear. Broca's area has close bilateral connections with the temporal structures of the brain and functions with them as a whole, therefore, with efferent aphasia, there are also secondary difficulties in the perception of oral speech.

Acoustic-mnestic aphasia is characterized by the inferiority of auditory-speech memory - a reduced ability to keep a speech range within 7 ± 2 elements and synthesize a rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence, while searching for the right word there are pauses filled with introductory words, unnecessary details and perseverations. Derivative is grossly violated narrative speech, retelling ceases to be adequate to the model. The best transfer of meaning in such cases is provided by excessive intonation and gestures, and sometimes speech hyperactivity.

Actually amnestic (nominative) aphasia manifests itself in the difficulties of naming objects rarely used in speech, while maintaining the volume of the retained speech series by ear. According to the word heard, the patient cannot identify the object or name the object when it is presented (as in the acoustic-mnestic form, the nomination function suffers). Attempts are made to replace the forgotten name of an object with its purpose ("this is what they write") or a description of the situation in which it occurs. There are difficulties in choosing the right words in a phrase, they are replaced by speech stamps and repetitions of what has been said. A hint or context helps to remember what has been forgotten. Amnestic aphasia is the result of damage to the posterior-lower parts of the parietal region at the junction with the occipital and temporal lobes. With this variant of localization of the lesion focus, amnestic aphasia is characterized not by the poverty of memory, but by an excessive number of pop-up associations, due to which the patient is unable to choose the right word.

Due to the fact that the retention of a readable text in memory also requires the preservation of auditory-speech memory, more caudally (literally - to the tail) located lesions within the left hemisphere aggravate losses from the visual link of the speech system, expressed in optical alexia (violation reading), which can manifest itself in the form of unrecognition of individual letters or whole words (literal and verbal alexia), as well as writing disorders associated with defects in visual-spatial gnosis. With the defeat of the occipito-parietal parts of the right hemisphere, unilateral optical alexia often occurs, when the patient ignores the left side of the text and does not notice his defect.

5. Semantic aphasia - occurs when there is a lesion on the border of the temporal, parietal and occipital regions of the brain (or the region of the supramarginal gyrus). It is quite rare in clinical practice. For a long time, speech changes with lesions of this zone were assessed as an intellectual defect. A more thorough analysis revealed that this form of pathology is characterized by a weakened understanding of complex grammatical structures that reflect the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, genus-species, expressed - in complex logical, inverted, fragmented forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, function words and pronouns is disturbed. These disturbances do not depend on whether the patient reads aloud or silently. There is a defectiveness and slowness in the retelling of short texts, often turning into disordered fragments. The details of proposed, heard or read texts are not captured or transmitted, but in spontaneous utterances and in dialogue, speech turns out to be coherent and free from grammatical errors. Separate words out of context are also read at normal speed and are well understood. Apparently, this is due to the fact that global reading involves such a function as probabilistic prediction of the expected meaning. Semantic aphasia is usually accompanied by violations of counting operations - acalculia (R48.8). They are directly related to the analysis of spatial and quasi-spatial relations implemented by the tertiary cortical zones associated with the nuclear part of the visual analyzer.

7. Conduction aphasia - occurs with large lesions in the white matter and cortex of the middle-upper sections of the left temporal lobe. Sometimes it is interpreted as a violation of the associative links between the two centers - Wernicke and Broca, which suggests the involvement of the lower parietal departments. The main defect is characterized by severe repetition disorders with relative preservation of expressive speech. Reproduction of most speech sounds, syllables and short words is basically possible. Rough literal (literal) paraphasias and additions of extra sounds to the endings occur when repeating polysyllabic words and complex sentences. Often only the first syllables in words are reproduced. Errors are recognized and attempts are made to overcome them with the production of new errors. Understanding of situational speech and reading is preserved, and, being among acquaintances, patients speak better. Since the mechanism of dysfunction in conduction aphasia is associated with a violation of the interaction between the acoustic and motor centers of speech, sometimes this variant of speech pathology is considered either as a kind of mild sensory or afferent motor aphasia. The latter variety is observed only in left-handers with damage to the cortex, as well as the nearest subcortex of the posterior sections of the left parietal lobe, or in the zone of its junction with the posterior temporal sections (40th, 39th fields).

In addition to these, in modern literature one can find the outdated concept of "transcortical" aphasia, borrowed from the Wernicke-Lichtheim classification. It is characterized by phenomena of impaired understanding of speech with its intact repetition (on this basis, it can be opposed to conduction aphasia), that is, it describes those cases when the connection between the meaning and sound of a word is broken. Apparently, "transcortical" aphasia is also due to partial (partial) left-handedness. The diversity and equivalence of speech symptoms indicates mixed aphasia. Total aphasia is characterized by a simultaneous violation of the pronunciation of speech and the perception of the meaning of words and occurs with very large foci, or in the acute stage of the disease, when neurodynamic disorders are pronounced. With a decrease in the latter, one of the above forms of aphasia is identified and specified. Therefore, it is advisable to conduct a neuropsychological analysis of the structure of HMF disorders outside the acute period of the disease. An analysis of the degree and rate of speech recovery indicates that in most cases they depend on the size and location of the lesion. A gross speech defect with relatively poor speech recovery is observed in pathology that extends to the cortical-subcortical formations of two or three lobes of the dominant hemisphere. With a superficially located focus of the same size, but without spreading to deep formations, speech is restored quickly. With small superficial foci, located even in the speech zones of Broca and Wernicke, there is, as a rule, a significant restoration of speech. The question of whether deep brain structures can play an independent role in the development of speech disorders remains open.

In connection with studies of deep brain structures that are directly related to speech processes, the problem of differentiating aphasias from categorically different speech disorders, called pseudoaphasias, has arisen. Their appearance is associated with the following circumstances. Firstly, during operations on the thalamus and basal ganglia in order to reduce motor defects - hyperkinesis (F98.4), parkinsonism (G20) - immediately after the intervention, such patients develop symptoms of speech adynamia in active speech and in the ability to repeat words, as well as there are difficulties in understanding speech with an increased volume of speech material. But these symptoms are unstable and soon regress. With damage to the striatum, in addition to the actual motor disorders, deterioration in the coordination of a motor act as a motor process is possible, and with dysfunction of the pale ball, the appearance of monotony and lack of intonation of speech. Secondly, pseudo-aphasic effects occur during operations or when organic pathology occurs in the depths of the left temporal lobe, in cases where the cerebral cortex is not affected. Thirdly, a special type of speech disorders, as already mentioned, are the phenomena of anomia and dysgraphia, which occur when the corpus callosum is dissected due to violations of interhemispheric interaction.

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

Patients with acoustic-mnestic aphasia have increased working capacity, emotional lability, frequent bouts of depression due to even minor speech errors.

All of the above methods of overcoming auditory-speech memory impairments help to overcome amnestic difficulties in this form of aphasia and reduce the number of verbal paraphasias. The difficulties of finding the right word are overcome by expanding and sometimes narrowing the semantic fields of the word, that is, by clarifying and systematizing their meanings. To do this, a particular word is played out in various phraseological contexts, attention is drawn to the ambiguity of the word (pen, key, mother's). Much attention is paid to the work on clarifying the meaning of synonyms, antonyms and homonyms, compiling various variants of sentences with these words.

2.2 Correctional and pedagogical work in case of semantic aphasia

Semantic aphasia is characterized by both a violation of the arbitrary finding of the names of objects, the poverty of the dictionary and syntactic means of expressing thoughts, and difficulties in understanding complex logical and grammatical structures. These patients are quite active in the process of overcoming speech disorders. However, they often experience the emergence of inferiority complexes, high vulnerability due to difficulties in understanding complex logical and grammatical phrases, proverbs, sayings, and the content of fables. In this regard, overcoming the defects of impressive speech in this form of aphasia should be carried out bypassing the main defect.

The basis for overcoming impressive agrammatism and amnestic difficulties is reliance on the preserved mechanisms of a detailed, planned written and oral utterance. Defects of the highest paradigmatic level of coding and decoding of a speech message are overcome by involving the highest levels of the syntagmatic level, namely planning, building mental actions carried out by the frontal sections in relationship with all gnostic sections that provide a lower, phonemic level of the speech act.

The main task of correctional and pedagogical work in this form of aphasia is the restoration of semantic units normally encoded in a complex system of synonyms and inverted phrases, as well as overcoming the equivalence of all semantically significant signs of the subject, creating prerequisites for capturing the main feature of the subject when finding the word denoting it.

Recovery of expressive speech. The most complete method for overcoming amnestic disorders was developed by V. M. Kogan in 1960. He showed that each word is associated with a complex system of words with varying degrees of proximity semantic connections. Each object is characterized by a set of features that are characteristic both for this object and for others. Words denoting objects are combined into different semantic fields according to their various characteristics: according to their instrumentality, species affiliation, etc. In order to overcome amnestic difficulties, the patient learns to find the signs of an object, first by listening to the system for describing near and far semantic connections, and later by independent descriptions of the features of the object, its connections with other groups of objects. For example, during the initial stages of recovery, the speech therapist lists to the patient all the signs of glasses: what they are made of, what they serve for, what they are in shape, in what situations they may be needed (poor vision, bright light when welding, bright sunlight on the beach, bright color snow in the mountains, etc., it is specified who wears glasses, one can recall Krylov's fable, etc.). The word is introduced into various phraseological contexts. Then the patient makes a story about the subject.

Patients with semantic aphasia in expressive speech use the same type, little expanded sentences. The same is true of their written language. In order to restore, expand the use of various syntactic constructions by the patient at the initial stage of recovery, exercises are used to compose various complex sentences with the use of allied words if, so that, when, after, no matter how ... etc.

As the structures of complex sentences are restored, patients are encouraged to use certain phrases when writing essays based on pictures by famous artists, taking into account the era depicted in the picture, the plot, its details, explaining the reason for their introduction and the plot of the picture.

Overcoming impressive agrammatism. Patients with semantic aphasia have a hard time understanding impaired understanding of seemingly easy tasks. Work on overcoming impressive agrammatism should be carried out bypassing the direct explanation to the patient of his difficulties, and mainly in those cases when the patient can or should return to study or work. A sufficient degree of preservation of understanding of situational speech in semantic aphasia in patients who do not return to educational or labor activity due to their advanced age, it allows them to limit themselves to restoring their orientation in the clock face, in solving simple arithmetic operations (addition, subtraction, multiplication and division within one to two thousand).

In everyday everyday speech, the visibility of the situation, the presence of elementary paradigmatic synonyms, allows patients to freely cope with the same paradigms encoded in complex logical and grammatical units. For example, we never say in everyday life: Put the knife to the right of the fork and to the left of the spoon, use turns Put the knife between the fork and spoon. Put the volume of Pushkin to the left of the volume of Yesenin, etc. In everyday life, we did not use the expressions brother of the father and father of the brother; replacing them with the words uncle and father. With semantic aphasia, correctional and pedagogical work to overcome impressive agrammatism does not begin with a direct explanation to the patient of spatial landmarks, schemes for solving a logical-grammatical problem, but bypassing this defect, by writing a description of the location of various objects.

The patient is given a simple scheme for describing these objects, indicating the central object or subject, from which it is necessary to lead, as from the point of departure, the sequence of description. In other words, in working with the patient, the preserved, planning, syntagmatic functions of the anterior speech departments are used. For example, when analyzing the drawings “a man with a hat”, “a fox near a hole”, “a girl with a doll”, “mother and daughter”, “master with a dog”, etc., the patient is asked to decide who or what he is talking about. will say what is the subject of his attention. A question is raised over the subject that is being discussed, a question is posed, and appropriate definitions are given that are characteristic only for this subject: a man’s wide-brimmed felt hat, a girl’s knitted hat with a bow, a girl’s doll, a boy’s car, a young mother’s little daughter, an adult daughter of an elderly woman, a smart dog of a kind owner , an evil dog of an unkind owner (based on the corresponding drawings). Some of the most common breeds of dogs are analyzed, children with different characters are discussed, and phrases are compiled in connection with this: a caring daughter, a caring son, that is, the main paradigm in the future of the folded phrase is being worked out.

Then they proceed to the description of the indirect part of the word-combination paradigm with a clarification of who this object belongs to, who and why cannot do without it. A comparison is made of the easiest phrases mother's daughter, daughter's mother. The patient clarifies the person in question: the mother of the daughter, the daughter of the mother, introduces these phrases into various contexts, supplying them with epithets and pointing to different pictures of daughters and mothers in different situations. Comic extended play-outs of phrases are very helpful: Mom sits in a stroller and plays with a rattle, and her daughter rolls her. The daughter feeds her mother from a spoon (this option can take place in life: a daughter can feed a seriously ill mother from a spoon, but this must be stipulated).

When describing the spatial arrangement of three objects, the patient masters complex constructions, including phrases with prepositions and adverbs: above - below, left - right, above - below, etc.

Restoration of understanding of complex logical and grammatical structures goes through the stage of a detailed, repeated description and discussion in various contexts.

From drafting simple sentences you can go to the description of reproductions (postcards) of paintings by famous artists indicating the era, season, using the phrase winter morning, autumn forest, the era of Peter I, merchant's house, Moscow courtyard, owner of the house. For these purposes, the description of famous paintings is used, the patient learns to describe different actors drawing, find the main and secondary word.

So imperceptibly for himself, in a non-traumatic environment that does not create an intellectual inferiority complex, about the process of creative, interesting work, the patient masters in expressive speech various syntactic constructions, cause-and-effect subordinate clauses, involved and participle turns.

Reading his "compositions", the patient decodes texts close to him, after which he proceeds to reading texts of varying degrees of complexity, retelling them, clarifying the meaning of various phrases in cases where he misunderstood them.

2.3 Correctional and pedagogical work with sensory aphasia

In the majority of patients with acoustic-gnostic sensory and acoustic-mnestic aphasia, as a rule, their working capacity and desire to overcome speech disorders are increased. They can work for many hours a day, sometimes in the evening and at night, that is, they are often in a constant "working" state. These patients have a pronounced state of depression, in connection with which the speech therapist must constantly encourage them, give them only what they can to do homework, inform the doctor about their condition, not allow them to work in the evenings and at night, and reduce the amount of homework.

The primary task of correctional work will be the restoration of phonemic hearing and secondarily impaired reading, writing and expressive speech.

Recovery of phonemic hearing. The restoration of phonemic hearing at the early and residual stages is carried out according to a single plan, with the only difference being that at an early stage the impairment of phonemic hearing is more pronounced.

Special work on the restoration of phonemic hearing goes through the following stages:

The first stage is the differentiation of words that are contrasting in length, sound and rhythmic pattern (house - shovel, spruce - bicycle, cat - car, flag - crow, ball - tree, wolf - parachutist, lion - plane , mouse - cabbage, etc.).

At first, the speech therapist gives contrasting pairs of words separately (for example, cat - grapes), selects the corresponding pictures for each pair of words and writes the corresponding words in clear handwriting on separate strips of paper. Then, the patient is given to listen to these words, to correlate the sound image of the elephant with the drawing and the caption under it. choose one or another picture according to the assignment, lay out captions for pictures, pictures for captions. At the first stages of classes, with a rough manifestation of a violation of phonemic hearing, the number of elephants being worked out should not exceed four. Then, from lesson to lesson, the speech therapist brings the number of contrasting words differentiated by ear to 10-12, lays out in front of the patient not 4, but 6 or 8 pictures with captions and invites the patient to first lay out the captions, and then find the pictures on the task: Show standing. Show me the bike. Show where the cancer is, etc.

At the second stage, words with a close syllabic structure, but far in sound, are differentiated, especially in the root part of the word: fish - legs, fence - t tractor, watermelon - ax, paddle - cat, hat - brand, cup - - a spoon, etc. Work at this and all subsequent stages of restoring phonemic hearing is also based on subject pictures, captions to them, copying, reading aloud, and developing acoustic control over speech.

At the third stage, work is underway to differentiate words with a similar syllabic structure, but with far-sounding initial sounds: cancer - poppy, hand - flour, oak - tooth, house - catfish, cat - mouth, stump - shadow , hand - pike; with a common first sound and various final sounds: beak - key, knife - nose, night - zero, lion - forest, rum - mouth, crowbar - forehead, etc.

At the next, fourth stage, work is already being done on the differentiation of phonemes that are similar in sound, that is, words with oppositional sounds: house - tom, daughter - dot, day - shadow, dacha - wheelbarrow, barrel - kidney , beam - stick, butterfly - daddy, eye - class, curtain - picture, goal - stake, corner - coal, bow - hatch, tower - arable land, bot - sweat, fence - constipation , a duck is a fishing rod, a tub is a coil, fruits are rafts, a path is a pellet,: a fence is a cathedral, goats are braids.

With acoustic-gnostic aphasia, there are difficulties in differentiating phonemes not only on the basis of sonority - deafness, but also on other grounds. Patients mix whistling and hissing, hard and soft, as well as acoustically close vowels. The speech therapist should provide tasks for differentiating words with phonemes similar in acoustic features: house - smoke, side - tank, drink - sing, path - five, shelf - stick, bow - varnish, table - chair, litter - cheese, etc.

To consolidate the unambiguous perception of phonemes, various tasks are used to fill in the missing letters in the word and phrase, words missing in the phrase with oppositional sounds, the meaning of which is clarified no longer with the help of a picture, but through the phraseological context. For example: insert the words carcass, shower, business, body, be, path, moisture, flask, daughter, dot, Don, tone, viburnum, Galina, etc. into the text.

And finally, the consolidation of acoustic differential features of phonemes occurs in the form of selecting a series of words for a given letter: the patient first selects words from texts, including newspapers, and then selects words for a given letter from memory.

Restoring the lexical composition of speech and overcoming expressive agrammatism. The difficulties of finding individual nouns and verbs are overcome by enlivening various semantic connections, describing various signs of an action or object, its functions, comparing this word with other semantically relatively close words. For example, the patient may use instead of the word knife - "axe", "saw" or "scissors", referring to objects that also divide the whole into parts. The speech therapist specifies all the signs of these objects, their different tool orientation, shape, nature of movement, etc. In another case, the patient can replace the word knife with the words “fork”, “spoon”, “cutter”, combining the verb with a feminine noun suffix. Accordingly, the speech therapist will tell the patient that the knife is a cutting object, is most often an integral part of table setting, work in the kitchen, will show its distinctive functional role when using various cutlery: soup, porridge, fish cannot be eaten with a knife, while relying on visual perception various features of the object, its description, image. In connection with the tendency of patients with sensory aphasia to mix inflections on a generic basis, the speech therapist will focus on hearing the endings of nouns male.

Overcoming verbal paraphasia is carried out by discussing with the patient various signs of objects by their contiguity and contrast, by function, tool affiliation, by category. The speech therapist suggests filling in the verbs and nouns missing in the sentence, picking up noun adverbs to the verb, adjectives and verbs to the noun.

Patients with sensory, acoustic-gnostic aphasia have difficulties not only in the use of nouns, but also in the use of verbs. In this regard, the speech therapist offers various work to restore the meanings of verbs, for example: walks, runs, hurries, flies, jumps, climbs; eats, feeds, drinks; sits, lies, sleeps, rests, dozes.

One of the main techniques for restoring expressive speech in sensory aphasia is the use of written speech. The speech therapist suggests that the patient, whose phonemic hearing has somewhat recovered, initially write phrases and texts according to simple plot pictures, and later according to postcards, which he gives him as homework. Paperwork with plot pictures allows the patient to slowly find the right word, polish the statement.

The restoration of reading, writing and written speech is carried out in parallel with overcoming the violation of phonemic hearing. The restoration of writing, sound analysis and synthesis of words, written utterance is preceded by the restoration of reading, based on the skills of global optical reading and intact kinesthesia involved in analytical reading. Attempts to pronounce a readable word, visual perception of its syllabic structure, awareness of the defectiveness of copying and written naming of an object, the realization that the meaning of a word changes from mixing sounds, create the basis for restoring analytical reading, and then writing. The restoration of reading and writing begins with writing off one-syllable and two-syllable words, different in sound composition, with filling in the missing oppositional letters in them, with the gradual development of the structure of words consisting of 2-3 syllables, with varying degrees of complexity of the sound composition of the syllable and word.

aphasia speech corrective pedagogical

2.4 Correctional and pedagogical work with dynamic aphasia

With dynamic aphasia, the main task of correctional and pedagogical work is to overcome inertia in speech utterance. In the first variant, this will be overcoming the defects of internal speech programming, in the second variant, the restoration of grammatical structuring.

Recovery of expressive speech. With significantly pronounced aspontaneity, the patient is given tasks to restore word order in deformed sentences (for example: B, children, quickly, school, go), various exercises for classifying objects according to various criteria (“Furniture”, “Clothes”, “Dishes”, round, square, wooden, metal objects, etc.). Direct and reverse ordinal counting is used, subtraction from 100 by 7, by 4.

Overcoming defects in internal programming is carried out by creating external utterance programs for patients with the help of various external supports (schemes, sentences, chips, etc.), gradually reducing their number and subsequent internalization, folding this scheme inward. The patient, moving his index finger from one token to another, gradually deploys the speech statement according to the plot picture, then proceeds to visually follow the plan for deploying the statement without conjugate motor reinforcement and, finally, composes these phrases without external supports, resorting only to intra-speech planning. statements.

The restoration of the linear deployment of the statement in time is facilitated by the use of words included in the questions to the plot picture or to the corresponding situation discussed in the lesson. So, to the question Where are you going today? the patient replies: “I will go to the hairdresser” or “I will go for an x-ray”, etc., t. adds only one word. Another method of restoring the structure of the utterance is the use of key words, from which the patient makes up a sentence. Gradually, the number of proposed words for making sentences is reduced and the patient freely, at his own discretion, adds words and finds their grammatical forms.

In view of the fact that in the first variant of dynamic aphasia, the composition of not a phrase, but texts, is mainly violated, series of consecutive pictures connected by one plot are used as external supports.

Speech activity of patients will increase in the process of creation by a speech therapist of special speech situations-staging, where the initiative for dialogue belongs to the patient. To facilitate the dialogue, the speech therapist first discusses the topic with the patient, offering him interrogative, “key” words that he can use in the conversation, and a plan. It also facilitates the conduct of a dialogue by using an appeal to a speech therapist or other interlocutors by name and patronymic. In classes to stimulate speech activity, you can stage a conversation with a doctor, in a store, in a pharmacy, at a party, etc. The patient can be the leader in a conversation about the work of a writer, artist or composer, when discussing artwork when discussing TV shows. He can be given instructions so that he verbally conveys to someone the request of a speech therapist.

In milder forms of dynamic aphasia, the speech therapist invites the patient to retell the text first with the help of a detailed questionnaire, then with the help of key questions to individual paragraphs of the text, based on a monosyllabic, folded plan. At the same time, the speech therapist teaches him to make independent plans for texts, first expanded, then short, folded. Finally, after a previously drawn up plan, the patient retells the text without looking into this plan. Thus, there is an internalization of the plan of retelling what has been read.

Restoring understanding. In gross dynamic aphasia, understanding of situational speech is restored by discussing various events of the day. For example, a speech therapist, having found out the question of the patient's well-being, says: Now let's talk about your tastes. Do you love poetry? Did you know...? Or by turning his attention to new theme, asks: Who visited you the day before? In the future, patients begin to use intonation for communication purposes, to attract the attention of others, to follow single-link and multi-link instructions.

As attention to the speech of others is brought up, its understanding is restored, and the difficulties of switching acoustic perception from one conversation to another are reduced.

Recovery of written speech. Dysgraphic disturbances in the writing of patients are rare. However, they experience significant difficulties when compiling a written text. The presence of errors in writing suggests that patients have signs of efferent aphasia.

In parallel with the restoration of expressive speech, it becomes possible to fill in missing prepositions, verbs, adverbs, syllables and letters in texts, write phrases using key words, answer questions about texts, write essays based on a series of plot pictures, statements, powers of attorney for receiving pensions, letters to friends etc.

2.5 Correctional and pedagogical work with efferent motor aphasia

The main tasks of correctional and pedagogical work in efferent motor aphasia are to overcome pathological inertia in the generation of the sound and syllabic structure of a word, restore a sense of language, overcome the inertia of word choice, overcome agrammatism, restore the structure of oral and written utterance, overcome alexia and agraphia.

Recovery of expressive speech. Overcoming the disturbed pronunciation side speech begins with the restoration of the rhythmic-syllabic scheme of the word, its kinetic melody.

With very gross efferent motor aphasia with a total impairment of reading and writing, work begins with the merging of sounds into syllables. In this case, the patient not only imitates a syllable that was previously slowly pronounced by a speech therapist several times, but also simultaneously puts it together from the letters of the split alphabet. Then, from the mastered syllables, it makes up a simple word such as hand, water, milk, etc. Various word schemes are compiled, the syllabic structure of the word is beaten rhythmically.

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Pathogenetic bases of speech disorders in children with cerebral palsy. Features of the development of speech and its disorders. Comparative analysis methods of correctional and speech therapy work with cerebral palsy. Experimental work to overcome speech disorders.

thesis, added 08/15/2014

Psychological and pedagogical characteristics of children with motor alalia. Principles, methods of corrective action. Experimental study of children with motor alalia. Methodology for the study of the level of speech underdevelopment. Ascertaining experiment, its analysis.

MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION

NON-STATE EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION

TEST

ON APHASIA

Topic: "CORRECTIONAL WORK FOR EACH FORM OF APHASIA"

Introduction

.Aphasias and their classification

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

2 Correctional and pedagogical work with semantic aphasia

3 Correctional and pedagogical work with sensory aphasia

4 Correctional and pedagogical work with dynamic aphasia

5 Correctional and pedagogical work with efferent motor aphasia

Conclusion

Bibliography

Introduction

1. Aphasias and their classification

Sensory aphasia (impaired receptive speech) - associated with damage to the posterior third of the upper temporal gyrus of the left hemisphere in right-handers (Wernicke's area). It is based on a decrease in phonemic hearing, that is, the ability to distinguish the sound composition of speech, which manifests itself in a violation of understanding of the spoken native language, up to a lack of response to speech in severe cases. Active speech turns into "verbal okroshka". Some sounds or words are replaced by others, similar in sound, but distant in meaning ("voice-ear"), only familiar words are pronounced correctly. This phenomenon is called paraphasia. In half of the cases, there is speech incontinence - logorrhea. Speech becomes poor in nouns, but rich in verbs and introductory words. Dictation writing is broken, but understanding of what is read is better than what is heard. In the clinic, there are erased forms associated with a weakening of the ability to understand fast or noisy speech and requiring the use of special tests for diagnosis. The fundamental foundations of the patient's intellectual activity remain intact.

Efferent motor aphasia (violations of expressive speech) - occurs when the lower parts of the cortex of the premotor region are damaged (44th and partially 45th fields - Broca's area). With the complete destruction of the zone, patients utter only inarticulate sounds, but their articulatory abilities and understanding of the speech addressed to them are preserved. Often in oral speech there is only one word or a combination of words pronounced with different intonation, which is an attempt to express one's thought. With less severe lesions, the general organization of the speech act suffers - its smoothness and clear temporal sequence ("kinetic melody") are not ensured. This symptom is included in a more general syndrome of premotor movement disorders - kinetic apraxia. In such cases, the main symptomatology is reduced to speech motor disorders, characterized by the presence of motor perseverations - patients cannot switch from one word to another (proceed to a word) both in speech and in writing. Pauses are filled with introductory, stereotyped words and interjections. There are paraphasias. Another content factor of efferent motor aphasia is the difficulty in using the speech code, leading to outwardly observable amnestic-type defects. At all levels of oral independent speech, reading and writing, the laws of language, including spelling, are forgotten. The style of speech becomes telegraph - predominantly nouns in the nominative case are used, prepositions, copulas, adverbs and adjectives disappear. Broca's area has close bilateral connections with the temporal structures of the brain and functions with them as a whole, therefore, with efferent aphasia, there are also secondary difficulties in the perception of oral speech.

Amnestic aphasia is heterogeneous, multifactorial and, depending on the dominance of the pathology on the part of the auditory, associative or visual component, can occur in three main forms: acoustic-mnestic, amnestic proper and optical-mnestic aphasia.

Acoustic-mnestic aphasia is characterized by the inferiority of auditory-speech memory - a reduced ability to keep a speech range within 7 ± 2 elements and synthesize a rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence, while searching for the right word there are pauses filled with introductory words, unnecessary details and perseverations. Derivative is grossly violated narrative speech, retelling ceases to be adequate to the model. The best transfer of meaning in such cases is provided by excessive intonation and gestures, and sometimes speech hyperactivity.

Afferent (articulatory) motor aphasia is one of the most severe speech disorders that occurs when the lower parts of the left parietal region are affected. This is a zone of secondary fields of the skin-kinesthetic analyzer, which are already losing their somatotopic organization. Its damage is accompanied by the occurrence of kinesthetic apraxia, which includes apraxia of the articulatory apparatus as a component. This form of aphasia is apparently due to two fundamental circumstances: firstly, the disintegration of the articulatory code, that is, the loss of special auditory-speech memory, which stores the complexes of movements necessary for pronouncing phonemes (hence the difficulties in the differentiated choice of articulation methods); secondly, the loss or weakening of the kinesthetic afferent link of the speech system. Gross violations of the sensitivity of the lips, tongue and palate are usually absent, but there are difficulties in synthesizing individual sensations into integral complexes of articulatory movements. This is manifested by gross distortions and deformations of the article in all types of expressive speech. In severe cases, patients generally become similar to the deaf, and the communicative function is carried out with the help of facial expressions and gestures. In mild cases, the external defect of afferent motor aphasia consists in the difficulty of distinguishing speech sounds that are close in pronunciation - (for example, "d", "l", "n" - the word "elephant" is pronounced like "snol"). Such patients, as a rule, understand that they pronounce words incorrectly, but the articulatory apparatus does not obey their volitional efforts. Non-speech praxis is also slightly disturbed - they cannot puff out one cheek, stick out their tongue. This pathology also leads to a second misperception of "difficult" words by ear, to errors in writing from dictation. Silent reading is preserved better.

Semantic aphasia - occurs when there is a lesion on the border of the temporal, parietal and occipital regions of the brain (or the region of the supramarginal gyrus). It is quite rare in clinical practice. For a long time, speech changes with lesions of this zone were assessed as an intellectual defect. A more thorough analysis revealed that this form of pathology is characterized by a weakened understanding of complex grammatical structures that reflect the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, genus-species, expressed - in complex logical, inverted, fragmented forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, function words and pronouns is disturbed. These disturbances do not depend on whether the patient reads aloud or silently. There is a defectiveness and slowness in the retelling of short texts, often turning into disordered fragments. The details of proposed, heard or read texts are not captured or transmitted, but in spontaneous utterances and in dialogue, speech turns out to be coherent and free from grammatical errors. Separate words out of context are also read at normal speed and are well understood. Apparently, this is due to the fact that global reading involves such a function as probabilistic prediction of the expected meaning. Semantic aphasia is usually accompanied by violations of counting operations - acalculia (R48.8). They are directly related to the analysis of spatial and quasi-spatial relations implemented by the tertiary cortical zones associated with the nuclear part of the visual analyzer.

Dynamic aphasia - areas anteriorly and superiorly adjacent to Broca's area are affected. At the heart of dynamic aphasia lies a violation of the internal program of utterance and its implementation in external speech. Initially, the intention or motive that directs the development of thought in the field of future action suffers, where the image of the situation, the image of the action and the image of the result of the action are “represented”. As a result, speech adynamia or a defect in speech initiative occurs. Understanding of ready-made complex grammatical structures is slightly or not violated at all. In severe cases, patients do not have independent statements; when answering a question, they answer in monosyllables, often repeating the words of the question in the answer (echolalia), but without pronunciation difficulties. It is absolutely impossible to write an essay on a given topic due to the fact that "there are no thoughts." There is a tendency to use speech stamps. In mild cases, dynamic aphasia is experimentally detected when asked to name several objects belonging to the same class (for example, red). Words denoting actions are especially poorly updated - they cannot list verbs or use them effectively in speech (predicativity is violated). Criticism of their condition is reduced, and the desire of such patients to communicate is limited.

Conduction aphasia - occurs with large lesions in the white matter and cortex of the middle-upper sections of the left temporal lobe. Sometimes it is interpreted as a violation of the associative links between the two centers - Wernicke and Broca, which suggests the involvement of the lower parietal departments. The main defect is characterized by severe repetition disorders with relative preservation of expressive speech. Reproduction of most speech sounds, syllables and short words is basically possible. Rough literal (literal) paraphasias and additions of extra sounds to the endings occur when repeating polysyllabic words and complex sentences. Often only the first syllables in words are reproduced. Errors are recognized and attempts are made to overcome them with the production of new errors. Understanding of situational speech and reading is preserved, and, being among acquaintances, patients speak better. Since the mechanism of dysfunction in conduction aphasia is associated with a violation of the interaction between the acoustic and motor centers of speech, sometimes this variant of speech pathology is considered either as a kind of mild sensory or afferent motor aphasia. The latter variety is observed only in left-handers with damage to the cortex, as well as the nearest subcortex of the posterior sections of the left parietal lobe, or in the zone of its junction with the posterior temporal sections (40th, 39th fields).

In connection with studies of deep brain structures that are directly related to speech processes, the problem of differentiating aphasias from categorically different speech disorders, called pseudoaphasias, has arisen. Their appearance is associated with the following circumstances. Firstly, during operations on the thalamus and basal ganglia in order to reduce motor defects - hyperkinesis (F98.4), parkinsonism (G20) - immediately after the intervention, such patients develop symptoms of speech adynamia in active speech and in the ability to repeat words, as well as there are difficulties in understanding speech with an increased volume of speech material. But these symptoms are unstable and soon regress. With damage to the striatum, in addition to the actual motor disorders, deterioration in the coordination of a motor act as a motor process is possible, and with dysfunction of the pale ball, the appearance of monotony and lack of intonation of speech. Secondly, pseudo-aphasic effects occur during operations or when organic pathology occurs in the depths of the left temporal lobe, in cases where the cerebral cortex is not affected. Thirdly, a special type of speech disorders, as already mentioned, are the phenomena of anomia and dysgraphia, which occur when the corpus callosum is dissected due to violations of interhemispheric interaction.

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

Patients with acoustic-mnestic aphasia have increased working capacity, emotional lability, frequent bouts of depression due to even minor speech errors.

Written speech plays a special role in the process of restoring acoustic-mnestic speech functions. With one or another mnestic aphasia, the sound-letter analysis of the composition of the word is preserved, which makes it possible to use the recording of words that precede auditory stimulation, to overcome in patients the tendency to verbal paraphasia, as well as the agrammatism characteristic of their oral speech. The preservation of written speech gradually prepares, at the intra-speech level, the syntagmatic division of the phrase into segments (the syntagma consists of two or three words), connected with each other by meaning, since the subject, as a rule, is in one syntagma, the predicate in another or the main sentence in the first syntagme, secondary - in the second (Children went to the forest. to collect mushrooms); fragments of one part of the sentence perceived by ear allow the patient to predict its second part.

All of the above methods of overcoming auditory-speech memory impairments help to overcome amnestic difficulties in this form of aphasia and reduce the number of verbal paraphasias. The difficulties of finding the right word are overcome by expanding and sometimes narrowing the semantic fields of the word, that is, by clarifying and systematizing their meanings. To do this, a particular word is played out in various phraseological contexts, attention is drawn to the ambiguity of the word (pen, key, mother's). Much attention is paid to the work on clarifying the meaning of synonyms, antonyms and homonyms, compiling various variants of sentences with these words.

2.2 Correctional and pedagogical work with semantic aphasia

Recovery of expressive speech. The most complete method for overcoming amnestic disorders was developed by V. M. Kogan in 1960. He showed that each word is associated with a complex system of words with varying degrees of closeness of semantic connections. Each object is characterized by a set of features that are characteristic both for this object and for others. Words denoting objects are combined into different semantic fields according to their various characteristics: according to their instrumentality, species affiliation, etc. In order to overcome amnestic difficulties, the patient learns to find the signs of an object, first by listening to the system for describing near and far semantic connections, and later by independent descriptions of the features of the object, its connections with other groups of objects. For example, during the initial stages of recovery, the speech therapist lists to the patient all the signs of glasses: what they are made of, what they serve for, what they are in shape, in what situations they may be needed (poor vision, bright light when welding, bright sunlight on the beach, bright color snow in the mountains, etc., it is specified who wears glasses, one can recall Krylov's fable, etc.). The word is introduced into various phraseological contexts. Then the patient makes a story about the subject.

Overcoming impressive agrammatism. Patients with semantic aphasia have a hard time understanding impaired understanding of seemingly easy tasks. Work on overcoming impressive agrammatism should be carried out bypassing the direct explanation to the patient of his difficulties, and mainly in those cases when the patient can or should return to study or work. A sufficient degree of preservation of understanding of situational speech in case of semantic aphasia in patients who do not return to educational or work activities due to advanced age allows us to limit ourselves to restoring their orientation in the clock face, in solving simple arithmetic operations (addition, subtraction, multiplication and division within one or two thousand).

When describing the spatial arrangement of three objects, the patient masters complex structures, including phrases with prepositions and adverbs: above - below, left - right, above - below, etc.

Restoration of understanding of complex logical and grammatical structures goes through the stage of a detailed, repeated description and discussion in various contexts.

From compiling simple sentences, you can move on to describing reproductions (postcards) of paintings by famous artists indicating the era, season, using the phrase winter morning, autumn forest, the era of Peter I, a merchant's house, a Moscow courtyard, the owner of the house. For these purposes, the description of famous paintings is used, the patient learns to describe the different characters in the picture, to find the main and secondary word.

So imperceptibly for himself, in a non-traumatic environment that does not create an intellectual inferiority complex, about the process of creative, interesting work, the patient masters in expressive speech various syntactic constructions, causal subordinate clauses, participial and participle turns.

2.3 Correctional and pedagogical work with sensory aphasia

The primary task of correctional work will be the restoration of phonemic hearing and secondarily impaired reading, writing and expressive speech.

Special work on the restoration of phonemic hearing goes through the following stages:

The first stage is the differentiation of words that are contrasting in length, sound and rhythmic pattern (house-shovel, spruce - bicycle, cat - car, flag - crow, ball - tree, wolf - parachutist, lion - plane, mouse - cabbage, etc. .).

At the second stage, differentiation of words with a close syllabic structure, but far in sound, is carried out, especially in the root part of the word: fish - legs, fence - tractor, watermelon - axe, paddle - cat, hat - mark, cup - spoon, etc. Work at this and all subsequent stages of restoring phonemic hearing is also based on subject pictures, captions to them, copying, reading aloud, and developing acoustic control over speech.

At the third stage, work is underway to differentiate words with a similar syllabic structure, but with far-sounding initial sounds: cancer - poppy, hand - flour, oak - tooth, house - catfish, cat - mouth, stump - shadow, hand - pike; with a common first sound and various final sounds: beak - key, knife - nose, night - zero, lion - forest, rum - mouth, crowbar - forehead, etc.

At the next, fourth stage, work is already being done on the differentiation of phonemes that are similar in sound, that is, words with oppositional sounds: house - tom, daughter - dot, day - shadow, dacha - wheelbarrow, barrel - kidney, beam - stick, butterfly - daddy, eye - class, curtain - picture, goal - stake, corner - coal, bow - hatch, tower - arable land, bot - sweat, fence - constipation, duck - fishing rod, tubing reel, fruits - rafts, path - pellet: fence - cathedral, goats - braids.

With acoustic-gnostic aphasia, there are difficulties in differentiating phonemes not only on the basis of voicedness - deafness, but also on other grounds. Patients mix whistling and hissing, hard and soft, as well as acoustically close vowels. The speech therapist should provide tasks for differentiating words with phonemes similar in acoustic features: house - smoke, side - tank, drink - sing, path - five, shelf - stick, bow - varnish, table - chair, rubbish - cheese, etc. .

Restoring the lexical composition of speech and overcoming expressive agrammatism. The difficulties of finding individual nouns and verbs are overcome by enlivening various semantic connections, describing various signs of an action or object, its functions, comparing this word with other semantically relatively close words. For example, the patient may use instead of the word knife - "axe", "saw" or "scissors", referring to objects that also divide the whole into parts. The speech therapist specifies all the signs of these objects, their different tool orientation, shape, nature of movement, etc. In another case, the patient can replace the word knife with the words “fork”, “spoon”, “cutter”, combining the verb with a feminine noun suffix. Accordingly, the speech therapist will tell the patient that the knife is a cutting object, is most often an integral part of table setting, work in the kitchen, will show its distinctive functional role when using various cutlery: soup, porridge, fish cannot be eaten with a knife, while relying on the visual perception of various signs of the object, its description, image. In connection with the tendency of patients with sensory aphasia to mix inflections on a generic basis, the speech therapist will focus on listening to the endings of masculine nouns.

One of the main techniques for restoring expressive speech in sensory aphasia is the use of written speech. The speech therapist suggests that the patient, whose phonemic hearing has somewhat recovered, initially write phrases and texts based on simple plot pictures, and later on postcards that he gives him as homework. Written work with plot pictures allows the patient to slowly find the right word, polish the statement.

The restoration of reading, writing and written speech is carried out in parallel with overcoming the violation of phonemic hearing. The restoration of writing, sound analysis and synthesis of words, written utterance is preceded by the restoration of reading, based on the skills of global optical reading and intact kinesthesia involved in analytical reading. Attempts to pronounce a readable word, visual perception of its syllabic structure, awareness of the defectiveness of copying and written naming of an object, the realization that the meaning of a word changes from mixing sounds, create the basis for restoring analytical reading, and then writing. The restoration of reading and writing begins with writing off one-syllable and two-syllable words, different in sound composition, with filling in the missing oppositional letters in them, with the gradual mastering of the structure of words consisting of 2-3 syllables, with varying degrees of complexity of the sound composition of the syllable and word.

aphasia speech corrective pedagogical

2.4 Correctional and pedagogical work with dynamic aphasia

With dynamic aphasia, the main task of correctional and pedagogical work is to overcome inertia in speech utterance. With the first option, this will be overcoming the defects of internal speech programming, with the second option - restoring grammatical structuring.

Speech activity of patients will increase in the process of creation by a speech therapist of special speech situations-staging, where the initiative for dialogue belongs to the patient. To facilitate the dialogue, the speech therapist first discusses the topic with the patient, offering him interrogative, “key” words that he can use in the conversation, and a plan. It also facilitates the conduct of a dialogue by using an appeal to a speech therapist or other interlocutors by name and patronymic. In classes to stimulate speech activity, you can stage a conversation with a doctor, in a store, in a pharmacy, at a party, etc. The patient can be the leader in a conversation about the work of a writer, artist or composer, when discussing a work of art, when discussing television programs. He can be given instructions so that he verbally conveys to someone the request of a speech therapist.

Restoring understanding. In gross dynamic aphasia, understanding of situational speech is restored by discussing various events of the day. For example, a speech therapist, having found out the question of the patient's well-being, says: Now let's talk about your tastes. Do you love poetry? Did you know...? Or, turning his attention to a new topic, he asks: Who visited you the day before? In the future, patients begin to use intonation for communication purposes, to attract the attention of others, to follow single-link and multi-link instructions.

As attention to the speech of others is brought up, its understanding is restored, and the difficulties of switching acoustic perception from one conversation to another are reduced.

2.5 Correctional and pedagogical work with efferent motor aphasia

Recovery of expressive speech. Overcoming the disturbed pronunciation side of speech begins with the restoration of the rhythmic-syllabic scheme of the word, its kinetic melody.

Then work begins on the automation of words, with a certain rhythmic structure. To do this, the patient is asked to read a series of words with one syllabic structure written in a column. Gradually, the syllabic structure of the word becomes more complex. The patient is associated with a speech therapist, and then independently reads rhyming words divided into syllables.

To clarify the syllabic and. sound composition of the word, the method of a visual image of the word scheme is used.

Simultaneously with the restoration of the sound and syllabic structure of the word, work begins on the restoration of phrasal speech. Overcoming impaired phrasal speech begins with the restoration of the so-called sense of language, capturing consonance, rhymes in poetry, proverbs and sayings. It is especially useful to use proverbs and sayings with rhyming verbs: “What you sow, you will reap,” etc.

When restoring expressive speech, special attention is paid to overcoming pathological inertia in finding the necessary articulatory components - syllables and words for utterance.

Movement is a process that takes place in time and implies the presence of a chain of successive impulses. As motor skills are formed, individual impulses are synthesized, combined into whole “kinetic structures” or “kinetic melodies”. Therefore, sometimes it is enough to prompt the patient with one word in order to reveal a whole dynamic speech stereotype, for example, the words of a proverb or saying that automatically replace each other. The development of such a dynamic stereotype is the formation of a motor skill, which, as a result of exercises, becomes automatic.

In working with patients, plot and subject pictures are used, which are repeatedly played out by a speech therapist. In this case, one word or another is highlighted.

For example, in the phrase to the picture “The boy goes to school”, the speech therapist first stimulates the call of the word to school, and then proceeds with the help of leading questions to the word goes.

In a playful way, the speech therapist teaches the patient to listen to the question, emotionally respond to it, especially if it does not match the picture. For example, a speech therapist asks: Is the boy flying to school? Maybe the boy goes to school by car? Look carefully, maybe this is not a boy, but a grandmother? Patients, as a rule, answer these questions on an emotional rise: “No, this is not a grandmother, but a child” (or a boy), “not by car, but on foot”, “does not fly, but walks”. Playing with the object drawing, the speech therapist asks the patient questions about what the object is intended for, what can or should be done with it, for example, to eat (it is necessary to wash, cook, etc.), what are the properties of the object, etc.

With efferent motor aphasia, overcoming inertia in the choice of verbs is facilitated not only by a rigid phraseological context, but also by the speech therapist's expressive pantomimic imitation of movements with objects.

For example, a speech therapist, stimulating the patient to build a phrase according to a simple plot picture, says: This woman took the scissors with them (the speech therapist expressively depicts the movement of the hand with the scissors cutting the material). This technique, which clearly demonstrates movement, makes it much easier for patients to find the right verbs.

Later, the speech therapist gives the task to complete the same type of phrase with different words, for example: I eat ... (potato vulture, semolina porridge, white bread, etc.) or I'm waiting ... (the attending physician, youngest daughter, beloved wife, etc.). Similar tasks are carried out based on a picture and a diagram.

According to the plan drawn up by the speech therapist, the first oral texts are stories about the daily routine: “And I got up, washed, brushed my teeth ...”, etc. These stories vary and are supplemented depending on the events of the day. First, the patient talks about himself in the past tense, then makes a plan for the following days, mastering equal forms of the future tense: “I will read”, “I will speak”, “I will speak well”, “I will go for a massage”, etc. The vocabulary worked out in the classroom should provide the patient with the opportunity to communicate with others.

Recovery of reading and writing. In gross efferent motor aphasia, reading and writing may be in a state of complete disintegration. In this regard, individual picture alphabets are developed for patients, in which each letter corresponds to a certain picture or word that is significant for the patient, for example: a - “watermelon”, b - “grandmother”, c - “Vasily”, etc. Using familiar words, the patient finds in the alphabet the letters necessary for composing the syllable and the word. With the help of the usual split alphabet, it is possible, by combining syllables, to compose different words. At first, these will be monosyllabic words, then two-syllable, three-syllable, etc.

Most patients have right-sided hemiparesis, so they are taught to write with their left hand first. capital letters, then words and phrases. Left hand should lie flat on the page of the notebook, without raising the hand and wrist. A course of preparatory exercises is conducted to prevent the perseveration of letters and their elements.

In the future, patients with gross efferent motor aphasia are given tasks to fill in the missing vowels and consonants in simple words ah below the pictures, filling in letters in phrases and texts. A sound-letter analysis of the composition of a word is carried out with the help of leading questions, an analysis of syllables. Having added a word from a split alphabet, the patient writes it down in a notebook.

After mastering the sound-letter analysis, the speech therapist gives an auditory dictation from light phrases. In this case, the patient must pronounce each word by sounds, sometimes pre-folding especially difficult words from the letters of the split alphabet.

At the later stages, patients can be offered the solution of simple crossword puzzles, the compilation of various short words from the letters of a polysyllabic word, i.e., patients are offered speech games, but in a lighter form.

Restoration of reading with a rough expression of efferent aphasia begins with a global reading of words and phrases by the patient, with putting these words to subject and plot pictures, selecting words that are related to each other in meaning.

Restoring understanding. Restoration of speech understanding in case of gross efferent motor aphasia begins with the development of auditory attention, the ability to single out a word from a question that carries the main semantic load, accentuated by logical stress or intonation. Patients are asked provocative questions. For example, when showing the picture "house" the patient is asked: Is this a table? This is a pencil? As auditory attention is restored, the speech therapist invites the patient to look at the pictures and at the same time asks: Where is the spoon drawn? Show spoon or: Show what we eat. Such tasks in the patient lay the prerequisites for restoring a sense of language. Later, tasks are given to put one or another object on, under, behind another object. logical stress in this case, it should fall either on a preposition or on an object.

An important place in the restoration of the "sense of language" is occupied by exercises for presenting patients with grammatically correct and specially distorted grammatical structures. Previously, the speech therapist explains to the patient which constructions correspond to grammatical laws and rules, and which do not.

Thus, with efferent motor aphasia, a speech therapist restores those higher cortical functions that gradually developed in a child from the very beginning. early age: the syllabic organization of the word, the "sense of language", the elementary combination of words in a sentence.

6 Correctional and pedagogical work with afferent motor aphasia

Afferent motor aphasia is the most severe form, often overcome only as a result of three or even five years of systematic speech therapy assistance to the patient. When overcoming this form of aphasia, not only gross articulatory disorders are observed, but also agraphia, alexia of varying severity, acalculia, and impressive agrammatism.

The main task of correctional and pedagogical classes is to overcome violations of kinesthetic gnosis and praxis. The goal is to restore the articulatory kinesthetic basis of speech production, to overcome agraphia, to establish a potentially preserved extended oral and written statement.

With a roughly pronounced afferent motor aphasia, at the initial stage, correctional and pedagogical work will be built according to plan. 1) restoration of the pronunciation side of speech; 2) overcoming violations of understanding; 3) restoration of elements of analytical reading and writing.

At medium degree gravity, work is carried out to consolidate articulatory skills, to overcome literal paraphasias, to stimulate expressive speech, difficulties in pronouncing words with a confluence of consonants, expressive and impressive agrammatism: understanding the meaning and use of prepositions that convey the spatial relationship of objects.

At mild degree gravity, work is carried out to overcome articulatory difficulties when pronouncing polysyllabic words with a confluence of consonants, to get rid of literal paraphasias and paragraphs, to overcome elements of expressive, mostly prepositional agrammatism, to prepare the patient for returning to study or work.

Restoration of the pronunciation side of speech. In working with patients, global pronunciation, associated with a speech therapist, reading automated speech sequences, and then phrases on the topics of the day, copying and reading, pronouncing words to oneself, reading and writing under dictation of individual letters corresponding to the difficulties of articulating individual sounds overcome in oral speech are used. , folding simple words from the restored sounds from the split alphabet, introducing these words into active speech. At the same time, work is underway to isolate the sounds in a word during their acoustic perception, to overcome the secondarily disturbed phonemic hearing by differentiating words with oppositional vowels and consonants that are similar in place and method of formation (u-o, a-i, a-o, m- p-b-c, n-d-t-l, d-g, t-k, m-n, etc.). With safe reading to oneself and some preservation of written speech, in order to overcome apraxia of the articulatory apparatus, the speech therapist uses a visual-auditory imitation technique in work, speeds up the restoration of written speech when compiling a phrase based on plot pictures.

All work on this method excludes the use of a mirror, probes, spatulas, as they increase the degree of arbitrariness of movement, exacerbate the articulatory difficulties of patients.

When trying to pronounce the sounds y, o, s, and, as well as consonants, patients either silently exhale air or wheeze, making chaotic movements with their lips or tongue.

Distracting from voluntary articulation to playing and imitating activities, the speech therapist asks patients to moan, as if a toothache, breathe into their hands, as if they were cold, this enables patients to perform not only oral, but also articulatory movements dictated by the action plan, its semantics.

The degree of apraxia of different organs of the articulatory apparatus can be different, therefore it is advisable to start working with the imitation of available sounds, usually labial and anterior lingual, but not with several, but with one sound, since at the initial stages there is an abundance of literal paraphasia. Classes begin with the challenge of contrasting vowels a and y.

The speech therapist draws in the patient's notebook several circles of different configurations or lips, wide open and not too wide, and asks the patient to try to copy it himself, that is, open his lips wide, squeeze them loosely, first silently, and then pronouncing the sounds mi in, so that work out the primary bow and gap on voiced consonants.

Voiced sounds are restored more slowly than deaf ones, so that the restoration of the sounds of the wills greatly alleviates the tendency to deafen them, which is characteristic of patients with afferent motor aphasia.

In the first 2-3 lessons, it is necessary to repeatedly read the syllables and words made up of the sounds a, y, m. Gradually other sounds are evoked.

A speech therapist can follow any sequence in calling sounds, but the following conditions must be taken into account:

-you can not call the sounds of one at the same time articulation group

-sounds should be introduced into phrases, avoiding nouns in the nominative case.

Recovery of narrative speech. It is traditionally believed that expressive speech in patients with afferent motor aphasia is potentially preserved due to the preservation of the anterior speech regions that program speech utterance. And yet, a gross violation of the articulatory side of speech, as it were, blocks the possibility of a detailed statement. Even in "pure" cases of moderate afferent motor aphasia, there may be difficulty in selecting words, especially prepositions and verbs with prefixes that convey a spatial relationship. These word-choice difficulties and "telegraphic style" paragrammatism are many times easier to overcome than the true "telegraphic style" agrammatism characteristic of efferent motor aphasia.

In afferent motor aphasia, as in acoustic-gnostic sensory aphasia, the difficulties in deploying an utterance are associated with ambiguity, with a diffuse idea of the sound and syllabic composition of a word. In this regard, as the sound-letter analysis of the composition of the word is restored and articulatory difficulties are overcome, in patients with afferent motor aphasia, the possibility of nominating all objects, actions, and qualities is restored. Quite quickly, the vocabulary of patients becomes unlimited, especially when composing phrases according to plot pictures. However, situational speech remains slow for a long time, poor both in terms of its lexical composition and grammatical forms of expression. Patients at the residual stage of the disease "get used" to the fact that others understand them by gestures and facial expressions, by separate words that are difficult to pronounce, with intact inner speech, which patients use in communication.

Restoration of situational, colloquial speech is one of the priorities initial stage correctional and pedagogical work. As the sound pronunciation is restored, the newly evoked sounds are introduced into the words necessary for communication. Often, in patients with afferent motor aphasia, after 12-16 newly formed sounds (as well as when stimulating oral utterance with the help of automated speech sequences), it is possible to evoke, by conjugate repetition, the still fuzzy sound of words necessary for communication. These are adverbs question words and verbs: now, well, tomorrow, yesterday, when, why, I don’t want, I will, etc. The introduction of newly evoked sounds into predicative utterances is relatively easy.

The speech therapist in conversations on the topics of the day works out with them the articulatory programs of the words included and the cliché-like lexicon of colloquial speech. The main lexical and didactic material The initial stage of work is not plot pictures, but various kinds of dialogues.

As the dialogical, very brief, cliche-like colloquial speech is restored, the speech therapist proceeds to restore monologue speech. Its main goal is the development of a detailed oral and written statement in the patient. A patient with afferent motor aphasia quickly masters the scheme of direct and inverted construction of a phrase according to a plot picture, a plan of utterance based on a series of plot pictures. As the sound-letter analysis of the composition of the word is restored, the speech therapist switches the patient from the oral compilation of phrases from pictures to the written one. In the presence of gross apraxia of the articulatory apparatus oral speech may lag behind the letter. Written speech in these cases turns out to be a support for the restoration of oral utterance. Oral and written speech will be characterized by paragrammatisms, expressed in the difficulties of using adverbs, prepositions, pronouns, noun inflections, verbs that convey different directions of movement. To prevent and overcome this paragrammatism, at the stage total absence speech and later, the patient’s understanding of the meanings of prepositions, pronouns, adverbs, etc. is clarified, the missing prepositions and noun inflections are filled in, the use of verbs with prefixes is clarified: flew away, ran away, left, ran, came, etc. differentiation of the meanings of prepositions n prefixes: on - on, under - over, etc.

With afferent motor aphasia, situational cliche-like speech in patients is preserved and serves the purposes of communication, but the arbitrary composition of phrases according to a series of pictures, according to individual plot pictures, is grossly violated. A common feature for these forms of aphasia will be the appearance of pseudo-agrammatism of the "telegraphic style" type, caused by the restored ability to name all surrounding objects. This pseudo-agrammatism does not serve as a means of communication for them; it manifests itself only when composing phrases according to plot pictures at an early stage of the transition from a nomination word to a phrase. This is overcome by explaining to the patient that he should not be distracted by listing the secondary objects shown in the figure, it is necessary to isolate the main thing when composing a phrase. Patients with afferent motor aphasia have a fairly well-preserved fantasy, a sense of humor, which are reflected in their written, and then in oral statements.

Recovery of reading and writing. At the residual stage of correctional and pedagogical work, the restoration of reading and writing begins with the very first lesson to overcome articulatory difficulties. Each spoken sound, word, phrase is read by the patient first in conjunction and reflection with the speech therapist, then independently. Very much attention in the restoration of reading and writing is given to visual dictations of individual words, phrases and short sentences.

With gross afferent motor aphasia, to restore the sound-letter analysis of the composition of the word, split alphabet, filling in the missing letters in the word and phrase.

Dictations, especially at the initial and middle stages of recovery, consist of words and phrases previously worked out with the patient, read by him, since it is difficult for a patient with severe articulatory disorders to retain a relatively detailed text in auditory-speech memory, consisting of a large number syllables, sounds, words. Auditory dictations should be interspersed with visual ones.

At the initial stages of recovery, special attention is paid to vowel sounds, since they are often in a reduced position and are poorly felt by patients. Preliminary listening to the text contributes to the improvement of the reading process, since overcoming the difficulties of articulation in the process of reading distracts the patient's attention from the content of the story, understanding some phrases. Reading aloud and writing from dictation in patients with afferent aphasia is restored only after overcoming the main articulatory difficulties, mainly as a result of prolonged copying of words, sentences of various syllable and sound complexity, and small texts.

Restoring understanding. Overcoming impairments of understanding in afferent motor aphasia at the residual stage depends on the severity speech disorder, the degree of violation of reading and writing.

With gross violations of expressive speech, the main attention is paid to the restoration of secondary impaired phonemic hearing, restoration of orientation in space, clarification of the meanings of prepositions, adverbs, understanding of personal pronouns in indirect cases, understanding of elementary pairs of antonyms, synonyms.

Secondarily disturbed phonemic hearing is restored by fixing the patient's attention on sounds that are close in place and method of articulation, when listening to words that begin with these sounds, when selecting pictures for a particular letter that begin with the corresponding vowel or consonant sound, when choosing from various texts words that have practiced sounds at the beginning, middle and end of the word.

Differentiation of the meaning of words of one semantic field, part and whole, synonyms, homonyms, antonyms is carried out with speechless patients based on pictures when listening to various phrases, clarifying the meaning of words. At later stages, as reading and writing are restored, filling in the missing words of synonyms, homonyms, making sentences with them is used. For example, insert into the sentence the words: brave, brave, heroic, courageous and clarify in which cases these words can be used.

With conductive afferent motor aphasia, the understanding of the meanings of nouns included in one semantic field is restored, for example, the possibility of using the words pipe, wall, ceiling is clarified. Door. These exercises prevent the occurrence of verbal paraphasias in the speech of patients. Improving orientation in space is facilitated by working with geographical map, the presence of seas, mountains, cities, oceans, countries, etc. on it.

At later stages, when reading and writing can be relied upon, impressive agrammatism is overcome. The patient describes the location of the central object in relation to the objects located from it to the left and right, above and below it. First, the drawings of one space group are described, then another, that is, either horizontally or vertically. The speech therapist draws three objects in the patient's notebook (for example, a Christmas tree, a house, a cup), circles the middle object and poses a question near it or above it, outlines a plan for describing objects with arrows. The patient composes phrases on it: "The Christmas tree is drawn to the right of the house and to the left of the cup" or "The house is drawn to the left of the cup and to the right of the Christmas tree." This work is carried out by the patient during ~ 8-10 sessions. Then, the location of objects with prepositions above - below, with adverbs above - below, further - closer, lighter - darker, etc. is also described. schemes in expressive speech, for example: Draw a Christmas tree to the right of the cup and to the left of the table. This prepares the patient to understand logical-grammatical structures by ear or by reading.

Conclusion

Speech is interesting for studying from many sides: for example, as a device that generates physical sounds, as well as perceiving and differentiating them; or as some kind of apparatus that translates meaning into words. Moreover, this apparatus is in close connection with the consciousness and emotions of a person; its important feature is the presence in it of a language system produced by a community of people and individually assimilated and used by each person.

There is no society without speech. Speech is very important in human life, it is especially important for a person as a member of society. Through speech modern world and exists in such a developed form. Thanks to speech, the experience accumulated by all mankind in its entire history is transferred to the younger generation.

Knowing the mechanisms of speech, one can understand the causes of speech dysfunction, find the source of the disease and successfully treat the speech disorder.

Bibliography

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.Wiesel T.G. Neurolinguistic classification of aphasias // Glezerman T.B. Neurophysiological bases of impaired thinking in aphasia. - M.: Nauka, 1986. - p.154-200.

.Wiesel T.G. Neurolinguistic analysis of atypical forms of aphasia (systemic integrative approach): author. doc. dis. - M., 2002.

.Luria A.R. Traumatic aphasia. - M.: AMS RSFSR, 1947. - 367p.

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