Directions of corrective work in efferent motor aphasia. Correctional and pedagogical work with afferent motor aphasia. The program of work with patients on the restoration of speech with gross sensory aphasia
1 Question. Aphasia. Classification. The structure of the speech defect. The main directions of work in different forms of aphasia.
Aphasia-complete or partial loss of speech due to local lesions of the brain.
The causes of aphasia are cerebrovascular accidents (ischemia, hemorrhage), trauma, tumors, infectious diseases of the brain. Aphasia of vascular origin most often occurs in adults. As a result of rupture of cerebral aneurysms, thromboembolism caused by rheumatic heart disease, and traumatic brain injuries. Aphasia is often observed in adolescents and young people.
In children, aphasia occurs less frequently as a result of traumatic brain injury, tumor formation, or complications after an infectious disease.
Aphasia- one of the most severe consequences of brain damage, in which all types of speech activity are systemically disturbed. The complexity of the speech disorder in aphasia depends on the location of the lesion (for example, the location of the lesion in case of hemorrhage in the subcortical regions of the brain allows us to hope for spontaneous restoration of speech), the size of the lesion, the characteristics of residual and functionally intact elements of speech activity, with left-handedness. The reaction of the patient's personality to a speech defect and the features of the premorbid structure of the function (for example, the degree of automation of reading) determine the background of restorative learning.
A. R. Luria distinguishes six forms of aphasia:
acoustic-gnostic
acoustic-mnestic aphasia that occurs when the temporal parts of the cerebral cortex are damaged,
semantic aphasia
afferent motor aphasia, arising from the defeat of the lower parietal parts of the cerebral cortex,
efferent motor aphasia
dynamic aphasia that occurs when the premotor and posterior frontal sections of the cerebral cortex are affected (left in right-handed people).
ACOUSTIC-GNOSTIC SENSORY APHASIA
A distinctive feature of this form of aphasia is a violation of the understanding of speech when perceiving it by ear.
Breakdown of understanding. Early after stroke or trauma sensory aphasia there is a complete loss of understanding of speech: someone else's speech is perceived as an inarticulate stream of sounds. Misunderstanding of the speech of others and the absence of obvious motor disorders leads to the fact that patients do not always immediately realize that they have a speech disorder. They can be excited, mobile, verbose. The same word can be perceived in different ways, the words house - volume, barrel - kidney, dot - daughter, etc. are mixed.
In connection with the violation of the phonemic perception of audible speech in acoustic-gnostic sensory aphasia, auditory control over one's speech is upset. So, sick M. to the question: “Does your head hurt?” - answered: “Since we are gramming it, we are them, and so it has long been about five years, the same thing happened in recent years. What a very disease of the shadow, well, the head is nadim.
Due to a violation of phonemic perception, the repetition of words suffers for the second time, and often at first the word is automated, it is globally repeated correctly, but when listening to it and with the next attempts to repeat it, a person loses not only the sound components of the word, but also loses its rhythmic-melodic basis.
The period of jargonaphasia lasts for more than 1.5-2 months, gradually giving way to logorrhea (long-windedness) with pronounced agrammatism.
Reading and writing impairment. When reading in the speech of a person with sensory aphasia, a lot of literal paraphasias appear, it becomes difficult to find the place of stress in a word, which makes it difficult to understand what is read. However, reading remains the most preserved speech function in sensory aphasia, as it is carried out by involving optical and kinesthetic control.
Written speech with acoustic-gnostic aphasia, in contrast to reading, it is disturbed to a greater extent and is directly dependent on the state of phonemic hearing.
ACOUSTIC-MINESTIC APHAASIA
A.R. Luria believes that it is based on a decrease in auditory-speech memory, which is caused by increased inhibition of auditory traces. With the perception of each new word and its awareness, the patient loses the previous word. This disturbance also manifests itself in the repetition of a series of syllables and words.
Breakdown of understanding. Acoustic-mnestic aphasia is characterized by dissociation between a relatively intact ability to repeat individual words and a violation of the possibility of repeating three or four words that are not related in meaning (for example: hand - house - sky; spoon - sofa. - cat; forest - house - ear, etc. d.). Usually patients repeat the first and the last word, in more severe cases - only one word from a given series of words, explaining this by the fact that they did not remember all the words. When listening again, they also do not retain either their sequence or omit one of them.
Violation of expressive speech. With this form of aphasia, expressive speech is characterized by difficulties in choosing the words necessary to organize the utterance. Difficulties in finding words are explained by the impoverishment of visual representations of the subject, the weakness of the optical-gnostic component. The semantic blurring of the meaning of words leads to the occurrence of abundant verbal paraphasias, rare literal substitutions, and the merging of two words into one, for example, “knife” (knife + fork).
Reading and writing impairment. With acoustic-mnestic aphasia in writing, a mixture of prepositions, as well as inflections of verbs, nouns and pronouns, mainly in gender and number. When writing a text from dictation, patients experience significant difficulties in retaining even a phrase consisting of three words in their auditory-speech memory, while they ask to repeat each fragment of the phrase.
With acoustic-mnestic aphasia, there are significant difficulties in understanding the text being read.
AMNESTIC-SEMANTIC APHAASIA
Amnestic-semantic aphasia occurs when the parieto-occipital region of the speech-dominant hemisphere is affected. With damage to the parietal-occipital (or posterior lower-parietal) parts of the cerebral hemisphere, a smooth syntagmatic organization of speech is preserved, no searches for the sound composition of a word are noted, there are no phenomena of a decrease in auditory-speech memory or a violation of phonemic perception.
There are specific amnesic difficulties when searching for the right word or arbitrarily naming an object, when patients, with difficulties in finding a lexical paradigm, turn to describing the functions and qualities of this object by syntagmatic means, i.e., do not replace one word with another (verbal paraphrasies), but replace the word with a whole phrase , they say: “Well, this is what they write with”, “... this is what they cut with”, etc., and on the other hand, there is a complex impressive agrammatism characteristic of this form of aphasia.
Breakdown of understanding. Patients well understand the meaning of separate prepositions, freely put a pencil under a spoon or spoon to the right of the fork, but find it difficult to arrange three objects according to the instructions: "Put the scissors to the right of the fork and to the left of the pencil." They experience even greater difficulties when arranging geometric figures, being unable to solve such a logical and grammatical problem.
Patients also find it difficult to understand complex syntactic structures expressing causal, temporal and spatial relationships, participial and participial phrases.
Violation of oral and written speech. Expressive speech in semantic aphasia is distinguished by the preservation of the articulatory side of speech. However, pronounced amnestic difficulties may be noted, prompting the first syllable or the sound of a word helps the patient. The words are replaced with a description of the object's function: "Well, this is what one looks at the street through" or "This is what time shows."
The poverty of vocabulary is expressed in the rare use of adjectives, adverbs, descriptive phrases, participial phrases, participial and participial phrases, proverbs, sayings, in the absence of searches for an exact or "accurate" word.
AFFERENT KINESTHETIC MOTOR APHAASIA
Violation of expressive speech. A. R. Luria notes (1969, 1975) that there are two variants of afferent kinesthetic motor aphasia.
The first is characterized by a violation of the spatial, simultaneous synthesis of movements of various organs of the articulatory apparatus and the complete absence of situational speech with a gross severity of the disorder. The second variant, which is called “conduction aphasia” in the clinic, is distinguished by the significant preservation of situational, cliché-like speech with a gross breakdown of repetition, naming, and other arbitrary types of speech. This variant of afferent kinesthetic motor aphasia it is characterized mainly by a violation of the differentiated choice of the method of articulations and a simultaneous synthesis of sound and syllabic complexes included in the word.
Therefore, often the words here, there, here, table, hat, etc. sound like “tu-t”, “ta-m”, “vo-t”, “s-to-l”, “sha-p- ka", etc.
Breakdown of understanding. At an early stage after an injury or stroke with afferent aphasia, a gross violation of speech understanding can be observed.
With afferent kinesthetic motor aphasia, there are difficulties in recognizing by ear words with sounds that have common signs in place and method of articulation (labial: b - m - n, anterior lingual: d - l - m - n, sonorant fricative: n - x - w , sonorants and vowels, etc.). These difficulties of phonemic analysis are generally compensated by the redundancy of phonemic differences between words in colloquial speech and allow them to understand it, but they are reflected in the letters of patients. Violation of the understanding of the word worsens in cases where the patient tries to pronounce it, i.e., it includes the initially impaired kinesthetic control.
Reading and writing impairment. In afferent kinesthetic motor aphasia, the degree of impaired reading and writing depends on the severity of apraxia of the articulatory apparatus. Reading and writing are most grossly impaired in severe apraxia of the entire articulatory apparatus. The restoration of reading and writing occurs in parallel with overcoming it.
EFFERENT MOTOR APHASIA
Linear, temporal organization of movement is carried out by the premotor areas of the cerebral cortex. Syntagmatic chains of sounds and syllables are formed in a word, words in a sentence, subject to a strict law of subordination: in a word, only this and not another order of sounds is obligatory; in a sentence, an adjective or preposition cannot be placed before a verb or adverb, etc. leading to sound, syllabic and lexical permutations and perseverations, repetitions. Perseverations, involuntary repetitions of words, syllables, which are the result of the impossibility of timely switching from one articulatory act to another,
make it difficult, and sometimes completely impossible, to speak, write, and read.
Violation of expressive speech. With gross efferent motor aphasia at an early stage after a violation of cerebral circulation, one's own speech may be completely absent.
Apraksin of the articulatory apparatus in this form of aphasia is manifested not in the difficulty of repeating individual sounds, but in the loss of the ability to repeat a series of sounds or syllables.
Reading and writing impairment. With efferent motor aphasia, pronounced agraphia is observed: writing a word or phrase is possible only when pronouncing words in syllables. In more severe cases, with the correct repetition of the word, it is impossible not only to write it down, but also to add up from already selected letters split alphabet.
Breakdown of understanding. At the heart of the disorder of understanding in efferent motor aphasia is the inertia of the course of all types of speech activity, the violation of the so-called "sense of language" and the predicative function of inner speech.
With gross efferent aphasia, perseverations appear even when simple instructions are followed. The display of individual parts of the body may be available if there are large pauses between spoken words.
DYNAMIC APHAASIA.
The main speech defect in this form of aphasia is the difficulty, and sometimes the complete impossibility of active deployment of the utterance. With dynamic aphasia, individual sounds are correctly pronounced, words and short sentences are repeated without articulatory difficulties, however, the communicative function of speech is still impaired.
Violation of expressive speech. There are several variants of dynamic aphasia, characterized by varying degrees of impaired communicative function, from the complete absence of expressive speech to some degree of impaired speech communication. Dynamic aphasia is based on a violation of the internal programming of the utterance, which manifests itself in the difficulties of planning it when composing individual phrases. Patients need constant stimulation of speech. Their speech is characterized by a primitive syntactic structure, the presence of speech patterns, and there is no agrammatism.
Impaired understanding of speech. With a mild degree of dynamic aphasia, understanding of elementary situational speech, especially presented at a somewhat slow pace, with pauses between instructions, remains intact. However, with the acceleration of the tasks presented, when showing subject pictures, parts of the face, perseveration can be observed, difficulties in quickly finding the object, and pseudo-alienation of the meaning of the word arises.
Aphasia in lefties. Absolute right-handers are only 40-42% of the population.
CORRECTIONAL AND PEDAGOGICAL WORK WITH ACOUSTIC-GNOSTIC SENSORY APHAASIA
With acoustic-gnostic sensory and acoustic-mnestic aphasia, the patient's increased working capacity and an active desire to overcome speech disorders are noted.
At the same time, he may experience a state of depression, in connection with which the speech therapist must constantly encourage him, give him only what he can do to complete homework, and inform the doctor about the depressed or excited state of the patient.
With acoustic-gnostic sensory aphasia, the task of correctional and pedagogical work is to restore phonemic hearing and secondarily impaired expressive speech, reading, and writing.
The speech therapist relies on the preserved analyzer optical and kinesthetic systems, as well as the preserved functions of the frontal lobes, which together create the prerequisites for the compensatory restructuring of impaired acoustic-gnostic functions.
In particularly severe cases of sensory aphasia at an early stage of recovery, non-verbal forms of work are used, the purpose of which is to establish contact with the patient, explain the very fact of the disease, organize his educational activities (perform feasible tasks), and concentrate. Used to copy short words to pictures and solve simple arithmetic examples.
The work on restoring phonemic perception includes the following steps:
the first stage is the differentiation of words that are contrasting in length, sound and rhythmic pattern (house - shovel, spruce - bicycle, cat - car).
Pictures are selected for each pair of words, and words are written in clear handwriting on separate strips of paper. The patient correlates the sound image of the word with the picture and the caption, he is offered to choose one or the other picture, to lay out captions for pictures, pictures for captions.
The second stage is the differentiation of words with a similar syllabic structure, but far in sound, especially in the root part of the word: fish - legs, fence - tractor, watermelon - axe. The work is based on pictures, captions to them, copying, reading; acoustic control over their speech is brought up.
The third stage is the differentiation of words with a similar syllabic structure, but with initial sounds that are distant in sound (cancer - poppy, hand - flour); with a common first sound and various final sounds (beak - key, night - zero, lion - forest). The patient is invited to choose words that begin with a particular sound, based on subject pictures and captions to them.
The fourth stage is the differentiation of phonemes that are similar in sound (house - volume, house - smoke, etc.).
To consolidate the unambiguous perception of phonemes, various variants of the exercise are used to fill in the missing letters in the word and phrase, words with oppositional sounds, the meaning of which is clarified not through the drawing, but through the phraseological context. For example, the patient is asked to insert the words carcasses, souls, body, business, etc. into the text.
The fifth stage is the consolidation of acoustic differential features of phonemes when selecting a series of words for a given letter from texts.
CORRECTIONAL AND PEDAGOGICAL WORK WITH ACOUSTIC-MINESTIC APHASIAS
The main tasks of correctional and pedagogical work in acoustic-mnestic aphasia are to overcome violations of auditory-speech memory, restore visual representations of the essential features of the subject, as well as overcome amnestic difficulties and elements of expressive agrammatism.
In overcoming speech disorders in acoustic-mnestic aphasia, the speech therapist uses the mechanism of coding the intent of the speech statement, describing the features of the object, introducing the word into various contexts, compiling external supports that allow the patient to maintain a different amount of auditory and speech load.
Restoration of auditory-speech memory occurs based on visual perception. A series of subject pictures, different in their semantic interconnectedness, is laid out in front of the patient, and the task is given to choose two, three, or four objects from them. Due to the fact that in speech the words are connected by the intention of the utterance, at first, among the “randomly” selected pictures depicting, for example, a hare, a plate, a table, a gun, a forest, etc., he is asked to show objects that can be inscribed in this or that situation. For example, it is proposed to show a fork, a table, a cucumber or a forest, a hunter, a hare, etc. Then, words are already given that are not included in one semantic field.
At the next stage of auditory-speech memory recovery, subject pictures are given in the form of a stack. The patient, after listening to a series of names of objects, finds their images and puts them aside. This achieves some delay in the execution of the instruction in time. Subsequently, it is proposed to repeat a series of words worked out in previous lessons, without resorting to the help of pictures. First, words for objects are given for memorization, then actions and qualities of objects, and finally numbers combined into phone numbers. In parallel with this, auditory dictations of phrases consisting of two, three, four words are held, based on the plot picture, and later without it.
Restoration of a written statement is one of the forms of consolidating the results achieved in overcoming amnestic disorders. The preservation of the understanding of the sound-letter composition of the word and the significant preservation of phonemic hearing make it possible to use the compilation of written texts from the very first days of correctional and pedagogical work, which helps to overcome poverty vocabulary and characteristic of the "rear" forms of aphasia agrammatism.
Violation 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, composing phrases according to key words, the ability to complete a sentence, insert missing prepositions and noun inflections.
CORRECTIONAL AND PEDAGOGICAL WORK WITH SEMANTIC APHASIAS
The main tasks of speech therapy work with semantic aphasia are: overcoming the difficulties of finding the names of objects, expanding the lexical and syntactic composition of patients' speech, overcoming impressive agrammatism.
Correctional and pedagogical assistance in overcoming semantic aphasia relies on the control of all intact analytical systems (vision, auditory-speech memory), and most importantly, on the planning and regulating functions of the frontal parts of the brain, on the intact linear organization of oral speech.
Exercises are needed in the visual analysis of geometric figures, ornaments, composed of elements reconstructed according to a visual model and instructions, restoring the patient's orientation in the left and right, in parts of the world, in a geographical map. Structural-spatial apraxia is overcome by learning a plan for dividing an ornament or pattern into certain segments and completing a task according to the plan (for example, first the lower “floor”, then the second, third, etc. or first the first column on the left, then the second, etc. .).
Overcoming impressive agrammatism begins with clarifying the meanings of individual prepositions and adverbs, mastering the scheme of prepositions with moving a point (object) around a drawn table, house, glass.
To overcome acalculia, the digits included in the number (tens, hundreds, thousands, etc.) are clarified, the meanings of synonyms minus - subtraction, plus - addition are fixed. Patients are asked to perform actions within one or two dozen, then within a hundred and a thousand. A special place in overcoming defects in counting operations is occupied by the solution of arithmetic problems in 2-3-4 actions using adverbs more, less and verbs to subtract, add, send, unload, etc., i.e. verbs with prefixes that convey spatial relationships actions and objects.
CORRECTIONAL AND PEDAGOGICAL WORK WITH AFFERENT MOTOR APHASIA
Correctional and pedagogical assistance in overcoming afferent motor aphasia is based on the inclusion of intact visual and acoustic control, as well as the controlling function of the frontal regions of the left hemisphere in right-handed people, in a complex performing visual and auditory analysis of the speech signal read and perceived by ear, control over the optical synthesis of visible elements articulatory structure, etc.
The general tasks of correctional and pedagogical work in afferent motor aphasia are to overcome violations of the kinesthetic articulatory praxis, which ensures the overcoming of agraphia, alexia, impaired speech understanding, and then the restoration of a detailed oral and written statement.
CORRECTIONAL AND PEDAGOGICAL WORK IN EFFERENT MOTOR APHASIAS
The main tasks of correctional and pedagogical work in efferent motor aphasia are to overcome pathological inertia in the generation of the syllabic structure of a word, restore a sense of language, overcome the inertia of word choice, agrammatism, restore the structure of oral and written utterance, overcome alexia and agraphia.
Overcoming the disturbed pronunciation side speech in efferent motor aphasia begins with the restoration of the rhythmic-syllabic scheme of the word, its kinetic melody.
Simultaneously with the restoration of the sound and syllabic structure of the word, work begins on the restoration of narrative speech.
Overcoming violations of narrative speech begins with the restoration of the so-called sense of language, capturing the consonance of rhymes in poetry, proverbs and sayings. It is especially useful to use proverbs and sayings with rhyming verbs.
To restore smooth writing, the patient is taught to repeatedly write with his left hand, first individual capital letters, then words and phrases.
CORRECTIONAL AND PEDAGOGICAL WORK WITH DYNAMIC APHASIAS
The main task of working with dynamic aphasia is to overcome defects in internal speech programming.
With significantly pronounced aspontaneity, the patient is given various exercises to classify objects according to various criteria (furniture, clothing, dishes, round objects, square, wooden, metal, etc.); direct and reverse ordinal counting, subtraction from 100 by 7, by 4, etc. are used.
Overcoming defects in internal programming is carried out by creating utterance programs for patients with the help of various external supports (questions, sentence schemes, chips), a gradual reduction in their number and subsequent internalization, folding this scheme “inside”. 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 conjugated motor reinforcement and, finally, composes these phrases without external supports, resorting only to intra-speech planning of the statement. .
Ticket number 24
The theoretical basis of restorative education in aphasia is modern ideas in psychology about higher mental functions as functional systems, their systemic and dynamic localization, about their formation in life, their socio-historical origin and indirect structure. Based on these theoretical positions, psychologists, physiologists, neurologists and speech therapists have developed and practically applied the way of restructuring functional systems by the method of restorative learning. This path has two directions practical work: 1st - broken link in psychological structure functions are replaced by others; 2nd - the creation of new functional systems, including in the work of new links that did not previously participate in the now impaired function.
The basis for the effectiveness of speech restoration in aphasia is the correctly developed principles of restorative education, which were formulated by L.S. Tsvetkova based on the ideas of A.R. Luria. Conventionally, the principles can be divided into psycho-physiological, psychological and psychological-pedagogical. Psychophysiological: the principle of defect qualification, on which the use of adequate methods depends; the use of secure analyzer systems as a support in training; the creation of new functional systems based on afferentations (links) that did not previously directly participate in the administration of the affected function; reliance on different levels of organization of mental functions, including speech; support during training on the entire mental sphere of a person as a whole and on individual preserved mental processes.
To psychological principles include: the principle of accounting for the individual; the principle of relying on preserved forms of activity; the principle of organization of activities; the principle of programmed learning; the principle of systemic impact on the defect (not only on speech, but also on other mental functions); the principle of taking into account the social nature of man.
Psychological and pedagogical principles the following: the principle “from simple to complex”; the principle of taking into account the volume and degree of diversity of the material; the principle of the complexity of verbal material; the principle of taking into account the emotional side of the material.
Tasks of restorative learning in aphasia L.S. Tsvetkova are called the socio-psychological aspect of restorative education. This aspect involves a complex impact on speech, behavior and the entire mental sphere as a whole. This approach requires solving the following tasks: 1) the restoration of speech as a mental function, and not the adaptation of a person with aphasia to his defect; 2) restoration of the activity of verbal communication, and not isolated private sensorimotor operations of speech; 3) restoration, first of all, of the communicative function of speech, and not of its individual aspects; 4) the return of a person with aphasia to a normal speech environment, and not to a simplified one, that is, a return to professional activity.
To solve these problems, a group form of classes is provided, and not individual. As a method of work in group classes, such forms and functions of speech can be used that are not subject to use in individual work - dialogical and communicative. It is the dialogic form of speech that can be an effective means of the communicative function of speech. Group speech creates an emotional upsurge, releases all the “dormant” abilities of a person to communicate. In addition, the advantages of the group form of the lesson: imitation, support, mutual assistance, cooperation, the presence of positive emotions, connections between group members, etc. Main task speech therapy impact is the restoration of an impressive and expressive vocabulary.
There are two periods in working with people with aphasia: spicy- up to two months after the disease; residual after two and beyond. In the acute period, the main tasks are: 1) disinhibition of temporarily oppressed speech structures; 2) prevention of the occurrence and fixation of some symptoms of aphasia: agrammatism, verbal and literal paraphasias, speech embolus; 3) prevention of the attitude of a person with aphasia to himself as to an inferior person, to a person who cannot speak. The main task in the residual period is the inhibition of pathological connections.
Disinhibition of speech function on the basis of old speech stereotypes should be carried out on stimuli of low strength (in a whisper, in an undertone). The material is selected according to its semantic and emotional significance for a person with aphasia, and not on the basis of ease or difficulty of pronunciation. To do this, you should get acquainted with the medical history, talk with your doctor, relatives to identify inclinations, hobbies, interests. You can use the usual speech stereotypes - count, days of the week, months; emotionally significant passages of poetry, the negotiation of running phrases, expressions. Over time, work from material close to the student is translated into issues of specialty, profession.
Dialogic speech is at the heart of the restoration work on the disinhibition of the speech function. You can use the following scheme for restoring dialogic speech: repetition of a ready-made answer formula (reflected speech) - hints of one, two syllables of each word of the answer - a spontaneous answer with a choice of two, three, four, etc. words used by a speech therapist when posing a question - a spontaneous answer to the question posed without taking into account the number of words used in the question, and asking questions by the person with aphasia himself.
The appearance of agrammatism in aphasia, as a rule, is the result of an incorrect organization of the initial recovery period, when disinhibition is carried out, either only the nominative function of speech, or only the predicative one. Speech should immediately be complete in terms of vocabulary, and pronunciation defects that do not reduce the correct construction of the sentence can be tolerated for the time being. This is the essence of the prevention of agrammatism. Work to overcome agrammatism is carried out not only in oral, but also, when the writing skill is restored a little, in written speech. The exercises (oral and written) to prevent the development of agrammatism are based on the dialogical form of speech.
The most difficult pathological symptom in terms of prevention and overcoming is a speech embolus, often formed in the first weeks after the lesion. There are two main types of speech emboli: single word or a sentence that is possible to pronounce, or a trigger mechanism necessary for pronouncing other words (V.V. Opel). Since a speech embolism is the result and manifestation of stagnation, inertia of nervous processes, it cannot serve as a starting point for recovery activities. The following conditions contribute to the inhibition of a speech embolus (speech perseveration): 1) compliance with optimal intervals between speech stimuli, allowing the excitation to “extinguish” after completing each task; 2) the presentation of material at a low voice strength, since in mild cases perseveration almost does not occur with a low strength of the sound stimulus, and in cases of occurrence they fade faster; 3) a pause in classes at the first hint of the occurrence of perseveration; 4) temporary restriction of conversations with others, with the exception of a speech therapist.
To prevent a person with aphasia from treating himself as inferior, one should speak with respect to him, passionately and sincerely experience all his successes and sorrows, trying to constantly emphasize achievements, calmly and confidently explain difficulties, creating confidence in his abilities.
In the residual period, a more thorough differentiation of methodological techniques depending on the form of aphasia is necessary. According to the severity of the violation, two groups are distinguished: 1st - the most neglected houses, with which no one talks; 2nd - more complex - persons with speech embolism, agrammatism. With both groups, work should begin with the disinhibition of speech, however, with the second group, it is necessary to simultaneously deal with the speedy elimination of the embolus. To do this, without fixing attention on the use of the embolus, bypass all sound combinations that contribute to its pronunciation.
Since restorative education is aimed primarily at restoring communication skills, it is necessary to involve in communication not only in the classroom, but also in the family and public places.
The main task of restorative learning in acoustic-gnostic sensory aphasia is to overcome defects in differentiated perception of sounds, to restore phonemic hearing. Only the restoration of the sound discrimination process can ensure the revival of all affected aspects of speech, mainly speech understanding. L.S. Tsvetkova identified five stages in restorative education. At the first stage, contact is established with a person with aphasia, logorrhea is inhibited, attempts at the verbal method of communication are transferred to non-verbal activities, and the student's attention is switched from speech to non-verbal actions. At the second stage, they move on to learning to listen and hear addressed speech. The main task of the third is to isolate individual words from one's own speech. The central task of the fourth stage is the restoration of differentiated perception of speech sounds, that is, work to restore phonemic hearing. On the fifth stage, they move on to the conscious and differentiated selection of a word from a phrase, a phrase from a text.
In the acoustic-mnestic (amnestic) form of aphasia, the central task of learning is to restore (expand) the volume of acoustic perception, overcome defects in auditory-speech memory and restore stable visual images-representations of objects. There are three stages of restorative learning in this form of aphasia (L.S. Tsvetkova). The task of the first stage is the restoration of visual object images. Work, as in sensory aphasia, begins not with speech methods, but with the restoration of visual object images by drawing objects (the first method). The second method is the classification of objects, first according to a visual pattern, and then according to a word. The following system of methods is aimed at restoring the process of identifying and naming objects: constructing objects from separate parts; comparison and finding common and different; finding errors in the image, and other techniques.
The main task of restorative learning at the second stage is the restoration of repeated speech. Repetition in itself is not communication, but is included in this process as one of the elements of the structure of understanding addressed speech. The main method of this stage is the method of breaking down words (sentences) into understandable parts. The third stage has as a special task the restoration of speech understanding. The most effective method is the method of reconstructing a text from disparate semantic parts. At this stage, in order to overcome paraphasias, the classification of words according to a given attribute and the gradual generalization of words are used.
In restorative learning with semantic aphasia, L. S. Tsvetkova identified two stages. At the first stage, training begins with the recognition of drawn geometric shapes by comparing two given samples. Then they proceed to the reproduction of the given figures according to the model: first - drawing, then - active construction from sticks, cubes. Later, a verbal instruction is attached to the sample: “put a square under a triangle, a circle, to the right, up”, etc. subsequently, they work out the concepts: “less - more”, “darker - lighter”, etc. Then they proceed to the restoration of awareness of the scheme of their body, its position in space.
The main task of teaching at the second stage is to restore the process of understanding speech, its logical and grammatical structures. The focus is on restoring the understanding of prepositional and inflectional constructions. Restoring the understanding of prepositions begins with the restoration of the analysis of the spatial relationships of objects. In general, learning proceeds from the restoration of the spatial relationships of objects with a gradual transfer of action to the speech level.
The central task of restorative learning in motor afferent aphasia is the restoration of articulatory activity, and the goal is the restoration of oral expressive speech. The main method of restoring speech in this form of aphasia is the method of semantic-auditory stimulation of the word. This method involves the pronunciation of not a sound, but a whole word. The restoration of sound-articulatory analysis and the kinetic basis of the word is carried out on the basis of the restored active and passive vocabulary. L.S. Tsvetkova divided all the work on restoring speech into four stages. The main task of the first stage is the disinhibition of involuntary speech processes (counting, days of the week, singing, etc.). It is important to use the remnants of emotional speech, the reproduction of the names of loved ones, reading poetry.
The main task of the second stage is to restore the pronunciation of words by restructuring the impaired speech function, that is, revitalization and enrichment semantic connections. The work begins with attempts to restore the pronunciation of the word as a whole, without a clear articulation of its constituent sounds. The main way is to switch attention from the articulatory side of speech to the general semantic and sound structure of the word. At the third stage, the main task is solved - the sound-articulation analysis of the constituent elements of the word. The main method is the rhythmic selection of word elements by tapping it syllabic structure with exercises in chanting. At this stage, work is carried out on writing and reading, since in the previous stages all attention is paid to switching attention from the pronunciation side of speech to the semantic level. Written speech is an arbitrary and conscious form. It is when writing that a conscious sound-letter analysis is needed.
The main task of the fourth stage is the transfer of a person with aphasia from the ability to isolate the sound-letter elements of a word to the ability to articulate them, that is, the restoration of the actual kinesthetic schemes of articulation. The main method is to imitate the postures of the articulatory apparatus of a speech therapist with control in front of a mirror. The next method used is the method of extracting a sound from a word in the active dictionary. Coherent phrasal speech is restored quickly, immediately after the restoration of the articulation system, does not require special training.
With motor efferent aphasia, the main task is to overcome pathological inertia and restore the dynamic scheme of the spoken word. The purpose of training is recovery oral speech, writing, reading. The implementation of this goal is possible when solving the following problems: 1) general disinhibition of speech; 2) overcoming perseverations, echolalia; 3) restoration of general mental and verbal activity. There are two stages of learning (L.S. Tsvetkova). The task of the first stage is to restore the ability of active selection, conjugated-reflected repetition of words and pronunciation of a word or a series of words from a strengthened automated speech series. The goal is to remove perseverations, echolalia, disinhibition of speech. The main thing is to transfer speech to an arbitrary level, that is, to restore awareness of one's speech and arbitrary speaking. Subsequently, it is necessary to switch consciousness from the pronunciation side of speech to its semantic side. The second stage of training has the main task - the actualization of verbal forms of speech. This is necessary both to overcome the expressive agrammatism - telegraphic style, and to overcome the defect in the predicativeness of speech. The attention of a person with aphasia should be diverted from articulation and fixed on the semantic organization of the word, rhythmic-intonational structure.
The three most important tasks of restorative learning in dynamic aphasia were identified by L.S. Tsvetkova: 1) the ability to program and plan an utterance; 2) predicativity of speech (restoration of actualization of verbs); 3) activity of speech (restoration of the active phrase). All restoration work is divided into five stages of learning. The first stage as the main task has the actualization of verbs in order to disinhibit the pronunciation of stereotypical phrases. Non-verbal, verbal-non-verbal and verbal methods are used. Non-verbal include board games, walking to music, pantomime, drawing method, etc. Verbal-non-verbal: verbalization of gestures, melodic declamation. Verbal: verbal associations, intonation during dialogue (interrogative, exclamatory, narrative).
The main task of the second stage is the restoration of the functional connections of words on phrases of a complicated structure (subject - predicate - object). The main method is the method of polysemy of the word, which helps to restore the polysemy of the predicative connections of the word. At the third stage, the main task is solved - the restoration of broader connections of words by introducing them into other semantic meanings. The main method is the enrichment of the "grid of meanings" of words and the enrichment of subject-functional relationships of previously worked out words. The task of the fourth stage is the restoration of one's own coherent speech. The most widely used method is to complete a given phrase to an integer. First, phrases that have no alternatives are offered, then the end of which may be ambiguous. This helps to restore the ability to actively build a phrase. At the fifth stage, the main task is to restore the scheme of the whole story. The main method is drawing up a plan of expression.
In the complex of rehabilitation measures for aphasia, psychotherapeutic work occupies an important place. In most cases, aphasia leads to disability and social maladjustment: deprivation of the usual norms of communication, which complicates relationships with the family and society. In the initial period after a stroke and neurotrauma, there may be states of both acute experience of what happened, and insufficient awareness of the severity of the disease. Over time, the "internal picture" of the pathological condition undergoes a certain evolution. In most cases, people with aphasia begin to acutely experience their feelings, which manifests itself in neurotic reactions of a secondary nature. Premorbid personality traits are sharpened, sometimes suicidal tendencies appear. At the same time, mental disorders can occur against the background of both a slight restoration of speech and other higher mental functions, and in cases where there is a positive clinical trend. The foregoing determines the need for a psychotherapeutic effect on a person with aphasia.
General psychotherapy presupposes the presence of a favorable psychological climate. Special types - individual and group psychotherapy. The leading role belongs to group psychotherapy. In particular, L.S. Tsvetkova, V.M. Shklovsky and others emphasized such an advantage of group psychotherapy as the possibility of creating a speech environment that stimulates communication, and, consequently, the focus on solving the socio-psychological problems of rehabilitation. Group psychotherapeutic classes through the organization of communication in a team contribute to the correction of personality changes.
An important place in the structure of the personality of people with the consequences of stroke and neurotrauma is occupied by the attitude towards their defect: both underestimation and overestimation of their capabilities take place. Some have elements of logophobia, insecurity in behavior, attempts to “avoid” verbal contacts, while others, without avoiding social interaction, simply do not make sufficient efforts to realize their potential.
Group lessons allow you to objectively assess the state of the communicative function on the part of other members of the group, which contributes to the development of an objective self-assessment. Indications for group psychotherapy are given by a neuropathologist and a neuropsychologist based on the results of a neuropsychological examination, as well as according to medical records available upon discharge from the hospital. A speech therapist also participates in determining the appropriateness and prescribing indications for group psychotherapy. This type of work is indicated for persons with mild speech disorders who do not experience a serious vocabulary deficit or pronounced difficulties in programming a speech statement. However, even with the positive dynamics of recovery, the emerging belief in one's inferiority is quite stable, which complicates the possibility of achieving the maximum recovery effect.
Persons with aphasia avoid extended speech contacts, explaining this by their "inferiority in speech". Therefore, it is advisable to use psychotherapy and autogenic training aimed at developing a setting to overcome the “feelings of illness and hopelessness”. Pronounced personality changes act as contraindications: negativism in behavior with others, aggressiveness, hypochondria, psychopathic traits.
The experience of conducting group psychotherapy is described by V.M. Shklovsky and T.G. Wiesel. The authors indicated that differences in the forms of aphasia are not a factor that necessitates division into separate groups. The mild severity of the defect makes it possible to combine individuals with motor and sensory aphasia into one group. The specificity of speech disorders in aphasia requires mobilizing psychotherapy. The most effective is the creation of closed groups, that is, with a constant composition of participants, as it creates a background that facilitates the work - interconnection, mutual influence, example, self-esteem. Mastering autogenic training is based on the principles of sequence and stages. Its course lasts approximately 4-6 weeks, the optimal number of participants is 5-6 people. V.M. Shklovsky pointed out the benefits of keeping diaries in which students would note their successes, difficulties in mastering auto-training after each lesson. Oral self-reports of those undergoing rehabilitation training help to develop adequate working methods.
A necessary condition for the use of psychotherapeutic influence is the formation of the correct attitude towards one's own defect. For this you should:
1. Explain to people with aphasia that the brain has great, but not unlimited, compensatory capabilities. Clarification of this is necessary in order to avoid setting up a “super task”. It is expedient to gradually lead to the idea that the absence of this or that ability does not prevent social adaptation. It is important to convince students of the inevitability of deterioration in the condition with excessive loads.
2. Conduct conversations on the topic of the connection "hands and speech." Explaining that one helps the other stimulates more active participation in mastering work skills and increases the effectiveness of speech restoration classes.
3. Communicate that drugs will not work miracles. Patience and accuracy are needed in fulfilling the prescriptions of a doctor, a speech therapist, and the active participation of the recovering person in the treatment process.
4. Explain to persons with aphasia that neither thinking nor the mental sphere as a whole was affected, but the ability to speak was lost.
5. Convince that a more active and bold use of the remaining and restored skills will contribute to a quick return to normal life.
An important link in restorative education is family psychotherapy. A psychotherapist and a speech therapist teach relatives the correct reaction to the negative attitude of a person with aphasia to a series family problems associated with a change in his status in the family. For example, a decrease in authority among close people can lead to serious consequences in the form of affective states. The experience of V.M. Shklovsky shows that the normalization of the behavior of a person with aphasia, his emotional status creates a favorable background for the restoration of actually impaired functions.
With aphasia, it is necessary to restore not only speech, but also non-speech functions, since various mental processes, cognitive, emotional-volitional spheres suffer. Persons with aphasia are characterized by: aspontaneity, inactivity, inertia; visual, auditory, tactile agnosia, apraxia. Asspontaneity is expressed in the inability to independently engage in any activity. It can manifest itself in a quick shutdown from the task. Inactivity is an increase in the duration of activities within a particular function. Inertia is characterized by difficulties in switching in the process of performing various operations or switching from one type of activity to another. In severe cases, it is completely impossible to switch from one action to another, that is, there is an impossibility to carry out normal activities. Work to eliminate these disorders involves the use of exercises aimed at concentration of attention, its activation, the development of skills of self-control and control of the ability to purposeful activity, expanding its mnestic scope.
For the correctional and pedagogical process, it is recommended to use emotionally significant for the student speech material. Preliminary work is carried out to clarify the premorbid interests and inclinations of persons undergoing rehabilitation training, the range of immediate interests is clarified, topics that cause a positive emotional effect are selected, psycho-traumatic topics are excluded. Emotionally significant material can be presented in the form of a free conversation, in the form of a story about an event, etc. It is useful to set up a gradual but steady reduction in the time available for these tasks.
With aphasia, the following types of agnosia can be observed: object, optical-spatial (apraktognosia), alphabetic and digital, agnosia for colors, agnosia for faces. The main task in overcoming object agnosia is the restoration of a generalized image of the object. In correctional and pedagogical work, they use: a) analysis of the visual image of real objects and their sketched images; b) comparative analysis visual image of objects of the same class with the allocation of differential features (cup - glass, etc.); c) identification of visual images of various image methods (for example: choose images of people, houses, cats, trees, vehicles, etc. from a set of pictures); d) sketching subject images, as well as drawing them from memory with a preliminary analysis characteristic features; e) designing given objects with similar discrete features from separate parts.
With apractognosia, the main directions in corrective work are: a) restoration of schematic representations of the spatial relationships of objects of reality (rotation of a figure in space); b) work with geographical map(finding the sides and parts of the world, specific objects); c) work with the clock (setting the hands according to the given time, writing off the numbers according to the placed hands). Overcoming disorders of constructive activity begins with the revival of the concepts of "shape", "size": the development of a differentiated perception of round and coal shapes; sketching objects and geometric shapes; drawing objects; drawing objects and geometric shapes from memory; cubes of Koos; construction of various parts. The restoration of praxic and gnostic functions also includes the following types of work: development of orientation in space; restoration of the ability for simultaneous perception of objects (attraction of feeling); overcoming dressing apraxia (performing various dressing operations with preliminary analysis and verbalization of actions).
Overcoming violations of letter gnosis implies the restoration of reading (elimination of alexia).
With agnosia for colors, corrective pedagogical work is aimed at developing a generalized categorical relationship to color. The following techniques are used: a) "semantic play" on the concept of a particular color based on the revival of the most stereotypical image associated with it (red - tomato, mountain ash; green - grass, grapes, etc.); b) presentation of contour images of objects “beaten” in the previous task for coloring them according to samples (transferring color from one drawing to another); c) classification of colors and their shades, etc.
Face agnosia requires special work to overcome it, starting with finding out the degree of recognition of faces famous people on portraits. Then, involving the most familiar portraits, they “revive” the visual image of a person based on the verbal, musical, pictorial and other associations associated with it (listening to poems, songs, looking at pictures).
Occupational therapy is of great importance in restorative education in aphasia. In its process, special types of classes are used with the use of subject-practical operations. These classes are aimed at solving several restorative tasks: 1) overcoming manual (manual) and constructive praxis disorders; 2) mastering a number of everyday and labor skills, which is possible with a certain degree of restoration of non-speech functions of visual, spatial, constructive modalities; 3) professional diagnostics and career guidance for the future; 4) expanding the scope of communication with others. Classes with the use of subject-practical activities include various types of household and labor operations.
Main form - group lessons. Methodically, training is based on the principle of gradual mastery of the technology of a particular type of activity and parallel stimulation of speech. Subject-practical household and labor activity solves the problems of communication with others, vocational diagnostics, career guidance and employment.
annotation: The paper provides a detailed description of the main contingent of patients with whom speech therapy classes are conducted in a polyclinic, an analysis of speech disorders in local lesions of the anterior parts of the left hemisphere of the brain and methods of restorative education from the point of view of neurolinguistics is given, which is rarely covered in special literature. A speech therapist, having 39 years of experience with patients with HMF pathology, summarizes the techniques and methods of teaching in patients with a gross form of predominantly motor aphasia, offers interesting modifications of these techniques for early stages restoration work, describes his own original techniques and gives examples of didactic material for work on restoring a sense of the language in relation to its grammatical norms.
Most frequent violations the speeches that a speech therapist has to work with in a clinic is.
Aphasia, according to the definition of L. S. Tsvetkova, “this is a special speech disorder that occurs with organic brain damage, covering different levels of organization and implementation of speech, revealing a connection with defects in other mental functions, leading to changes in the patient’s personality and to the disintegration of the entire mental sphere, which manifest themselves before only in violation of the communicative function of speech. Moreover, among aphasias, speech disorders that occur as a result of local lesions of the anterior speech zones of the left hemisphere of the brain predominate. According to the neuropsychological classification, these include:
- dynamic,
- efferent motor,
- complex motor aphasia
- and cases of mixed aphasia with a predominance of motor.
Collected over the years great material on the peculiarities of speech restoration in patients with various forms of aphasia, especially motor aphasia.
Types and forms of speech disorders
R. Jacobson proposed to distinguish between two types of speech disorders.
- In one of them, the leading place is occupied by defects in paradigmatic operations, in other words, the assimilation of those codes of the language that include mutually preparing relations in their composition.
- In another type of violation, the leading place is occupied by defects in syntagmatic processes, that is, units of smooth contextual utterance.
In case of damage to the anterior speech zones of the left hemisphere, the leading place is occupied by defects in syntagmatic connections.
Speech defects in these patients manifest themselves in different ways: in some, expressive speech becomes completely impossible, in others it loses its active character, and the patient, who correctly repeats words and sentences, is unable to independently formulate a detailed statement, in others, the defect takes the form of a “telegraphic style", in which all predicates and connectives fall out of the patient's speech, while the communicative components remain intact. Common to these patients is a gross violation of coherent, intonationally expressive speech.
With dynamic aphasia, lesions are located in the anterior parts of the speech zone of the left hemisphere and there are disorders that are specifically speech in nature. The central symptom for this group of patients is a pronounced violation of spontaneous expanded speech, up to its practical absence. Speech disorders here affect those deep levels of organization of speech processes that relate to the formation of inner speech and extend to the levels of semantic recording and deep syntactic structures. Speech disorders in these patients are not accompanied by gross agrammatism, but there is a tendency to reduce complex syntactic structures to more elementary constructions. Probably, the main violation in the correct formation of an independent utterance is located in these patients at the level of formation of the semantic scheme of the utterance and refers to the shortcomings of inner speech.
Another form of speech disorders differs in significantly different features, in which not so much the general programming of the utterance is violated as its grammatical structure. This group of patients does not have a pronounced defect in the semantic scheme of the message. The difficulties that arise here move much closer to the surface-syntactic structure of the utterance, and the coding of the speech message begins to suffer distinctly in the most basic syntactic links. The predicative part of the sentence is either omitted, or the number of verb forms is simply reduced, the proportion of nouns increases, mainly in the nominative case, unions, prepositions are omitted. This fact indicates a rough disintegration of superficial-syntactic structures, as the main defect in the patient's speech.
Not always, however, violations of the coding of an active utterance are of such a specific nature. Much more often in practice there are cases when the violation of utterances is of a more gross and complex nature and when the general inactivity and inertia of the nervous processes are combined with specially speech disorders of message coding. In these cases, we observe a picture with a predominance of gross motor aphasia, leading to a complex disintegration of speech activity. This is especially true in the early stages of rehabilitation education.
It should be noted that in patients with damage to the anterior parts of the brain, along with defects in expressive speech, and is also disturbed. In addition to the narrowing of the meanings of the word and impaired understanding of verb words, patients in this group have a violation of the understanding of sentences, since the patient ignores grammatical indicators. Patients correctly understand the content of sentences with direct word order (the boy drew a house), but there are significant difficulties in understanding sentences with reverse word order (the house is drawn by a boy), as well as sentences where it is the grammatical factor that matters for understanding (for example, the patient is “Show a pen with a pencil” - patients alternately show a pencil and a pen).
In addition, patients with damage to the anterior parts of the brain do not always notice errors in incorrect syntactic constructions. The sentences “The cat is sitting under the table” and “The cat is sitting under the table (table)” sound the same to them. In understanding speech, they rely on the meaning of words, and not on the grammatical factor.
It is necessary to point out such a phenomenon in lesions of the anterior parts of the speech zone of the brain as a violation of the sense of language, which is expressed in the absence or violation of the function of control, assessment of the correctness of the linguistic phenomenon, the correspondence of the form of expression to its content. So, when evaluating the correctness of a sentence, one often hears from patients: “I don’t know, I don’t feel, this way or not.”
Apparently, the violation of the grammatical formation of speech in patients with aphasia is associated with defects in the sense of language due to the destruction of dynamic stereotypes that underlie the process of grammatical formation of an utterance. Deautomatization of speech processes is one of the main properties of aphasia.
Turning off any of the speech mechanisms leads to the disintegration of the entire dynamic stereotype that controls this type of speech. Most grossly, these disturbances are manifested in efferent motor aphasia.
Efferent motor aphasia - tasks
Methods for restoring speech.
On the basis of taking into account a number of features of aphatic disorders, methods of restoring speech are also being developed.
Based on the predominance of neurodynamic or organic disorders in the picture of speech disorder, a milestone principle for organizing restorative education in patients with aphasia was put forward. But at the initial stages of restorative education, the principle of differentiation of methodological techniques depending on the form of aphasia is less important than at subsequent ones.
Yes, work to revive the sense of language you can start already at the early stages of rehabilitation training, when the patient still has virtually no phrasal speech, but there are various neurodynamic disorders in the form of a decrease in mental activity, criticism of one’s condition, exhaustion of attention, there are motor disorders such as right-sided hemiparesis, up to plegia, which exacerbates the difficulties of restoration work.
A feature of the work at the early stages is that, with known modifications, some methodological techniques can also serve the goals of prevention. Due to this, it is often possible to prevent the occurrence and fixation of agrammatism in aphasia.
So, even at the stage of pronounced neurodynamic and speech disorders in patients with a predominance of motor aphasia, when one of the main tasks is to restore understanding of situational and everyday speech, patients are offered to show pictures depicting actions (sitting, standing, running, etc.) or pictorial images of objects with a proposal to show them by actions (how they dig the ground, how they write, how they hammer nails). Considering the decrease in mental activity, the exhaustion of attention, the patient is given a limited number of pictures (2-3 at the beginning of work), gradually increasing their number. Here you can use not only showing, but also, if possible, naming the action, if necessary, use repeated and conjugated speech, as the most preserved types of speech in patients with anterior lesions of the speech zone of the brain. The same technique can be used when laying out the captions under the pictures.
In order to move on to making sentences, the patient is first asked to divide the sentence into words (for example: “the weather is good today”). It is better to do this without writing this sentence, but first lay it out from the letters of the split alphabet so that the patient has options for completing the task, because. letters can be freely moved without fear of making a mistake.
When the patient begins to correctly allocate individual words, he is given the task to make sentences of a certain model, and to begin with, the words are written on separate cards for a more free combination of these words, and a sample is given. At first they are given completely simple sentences(a girl reads a book; students take exams; a cow gives milk). Then the sentences become more complicated, prepositions are introduced; the task is given to compose 2 sentences each from the same words (direct and reverse word order) to overcome perseverations, for example:
- The plane flies over the sea.
- An airplane flies over the sea.
This task already presents some difficulties for patients with lesions of the anterior parts of the speech zones due to a decrease in activity and inertia.
As the sense of language revives and recovers grammatical structure patients are encouraged to make longer and more complex sentences from individual words. But first, sentences of a certain construction are given with the presentation of a sample and the writing of words on separate cards, for example:
- The children released the bird from the cage.
- We bought theater tickets.
- I love pancakes with sour cream.
Then sentences are given with several prepositions, for example:
- The children were walking with their grandmother in the park.
- We went boating on the lake.
- The owner goes to the grocery store.
Often patients find it difficult to make sentences like:
- The crow sits on a tree branch.
- The guys are sunbathing on the river bank.
- We approached the trolleybus stop.
The card system also helps here.
With further recovery, patients are given longer sentences of various models without a sample, as well as the task of making sentences from individual words in the whole story. For example, make sentences in the story “Who wrote what?”:
Papers, it was, in, not, times, distant. Manuscripts, tablets, on, first, clay, first appeared. On, they wrote, metal, then. Paper, bone, on, ivory, east, replaced. Letters, used, animals, for, skin, often. There are many books, preserved, such. Russia, in, on, bark, ancient, birch, they wrote.
While the patient does not have phrasal speech and there are various neurodynamic disorders, it is better for patients to give ready-made forms, that is, do not allow missing endings to be filled in, but insert the same word with different endings into short sentences of frequently used models:
- It … .
- I have no … .
- Give me … .
- I drink tea from ... .
- I admire the beautiful ... .
- Cup, cup, cup, cup.
For clarity, you can accompany this exercise with a drawing of the object, and also write these words on cards so that the patient can insert one or the other word. At the same time, the speech therapist reads the composed sentence aloud, that is, the patient evaluates the correctness of the construction presented from hearing and in writing.
You can also work with other parts of speech, especially relevant for motor and dynamic aphasia working with verbs.
First, verbs are given only in the singular or plural, or in various numbers of one person in order to have fewer choices, which is especially important for patients with severe neurodynamic disorders.
For example:
He ... a song.
You ... a song.
I ... a song.
She ... a song.
Sing, sing, sing.
You ... a song.
They ... a song.
We ... song.
Sing, sing, sing.
- You ... this book?
- No, we are all ... this magazine, and I ... a newspaper.
“Are you… a textbook?”
— Yes, I am … a textbook.
Girl ... a book.
Boy... a magazine.
Read, read, read, read, read, read.
You can give the patient a task to fill in the missing endings, prepositions, at first no more than 2-3.
For example, insert the missing noun endings "e" or "y":
We study at the institute. .
There was a delay at the airport. .
It's good to rest on the sea. .
A worker works at a factory. .
To the snow. traces are visible.
On the floor. carpet is laid.
On the walls. hanging picture.
Insert missing prepositions: in, on, by.
... there are many mushrooms in the forest.
We walked ... in the forest.
We walked ... a beautiful path.
We stopped right on the... footpath.
The squirrel lives ... in a hollow.
Squirrel jumps ... branches.
The squirrel sits ... on a branch.
The cat runs ... the yard.
Children play ... in the sandbox.
Grandmothers are sitting ... on a bench.
These techniques can also be used in restorative learning with patients with sensory and acoustic-mnestic aphasia.
Stages of speech therapy work
At the initial stages of speech restoration, a more frequent dictionary is offered than at later ones, but here needs an individual approach. In the work of a high premorbid level, less frequent vocabulary can be used at an early stage of work. An individual approach is also necessary at the later stages of restorative learning, especially when restoring a detailed statement.
At later stages, when the severity of the neurodynamic component decreases significantly and speech disorders proper come to the fore, exercises to restore the sense of language, phrasal speech are differentiated depending on the form of aphasia.
So, with dynamic aphasia, the main work is carried out on the compilation of sentences of varying complexity according to the scheme from the simplest to detailed sentences with a gradual decrease in the number of external supports.
As for patients with motor aphasia, here exercises aimed at overcoming agrammatism, especially verbal, come to the fore.
Exercises are widely used to fill in the missing endings of verbs, nouns, adjectives; missed suggestions.
On the final stage work is underway to compile a complex detailed phrase. Of particular difficulty is the compilation and use in one's own speech. complex sentences. The patient is given the task of filling in the missing union, the main or subordinate part of the sentence. Didactic material Various works of art, newspaper articles, manuals for classes in the Russian language and teaching foreigners the Russian language.
At all stages of rehabilitation training, consistency, gradualness and gradation in the organization of rehabilitation training are necessary both in terms of content and the number of techniques and exercises used in working with patients. It is harmful both to get stuck on one and the same thing, and to move too hastily to the subsequent points of the program of restoration work.
Even using a lot of exercises to restore any side of the impaired speech function, it is far from always possible to achieve automation of this process. But the patient often experiences an improvement in speech function, which is not related to those aspects of speech that were being worked on. Progress is often in the nature of the general development of speech, and not specific, that is, associated with the direct orientation of the restorative technique. This integration effect is especially valuable. It is apparently associated with the systemic interaction of the parties of speech in the process of restoration. The value of such a generalized effect compared to a purely specific one (when the patient begins to distinguish and use only what he was worked on) is much greater. This opportunity for integration lies at the core of organized, directed recovery.
Rehabilitation assistance to patients in a polyclinic and rehabilitation training at home does not allow the development of a tendency to the rapid disintegration of personality, loss of self-service skills, motor activity, characteristic of patients left without timely restorative speech training, allows achieving positive dynamics even in patients with severe speech and neurodynamic disorders.
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Recovery steps:
1. early stage– from one week to 6 months after a stroke.
Stage features:
We take into account the severity of the condition of patients in the period after brain damage.
During this period, total aphasia is observed.
It is impossible to determine the specific form of aphasia.
Target:
Maximum assistance to the spontaneous process of recovery, activation of the rate of recovery of oppressed and impaired functions;
Prevention of some symptoms of aphasia in the later stages of development
Tasks:
Promoting listening comprehension.
Disinhibition of expressive speech.
Stimulation of oral speech in patients.
Prevention of literal paraphasias, agrammatism such as "telegraph style", "speech emboli"
Classes should be psychotherapeutic in nature
A direct disinhibitory method of restorative therapy is used, directly aimed at restoring impaired functions.
The work is carried out with the passive participation of patients in the learning process, patients are gradually drawn into verbal communication, into conversation.
Methodology for the early stage of speech restoration in aphasia.
1. Stimulation of listening comprehension.
An incentive form of speech is used, intonational and grammatical features make it possible to prevent the occurrence of different types agrammatism. Including agrammatism such as "telegraphic style", since such speech is saturated with verbs.
At an early stage after a stroke, in all forms of aphasia, a violation of speech understanding is often detected. At the same time, patients usually retain the perception of facial expressions and intonation. V.A. Artemov shows that the perception of intonation accompanies any speech, from the word to the speech period, and is "the first door in understanding what is heard." With the help of intonations, the thought conveyed in the sentence is quite complete.
2. Disinhibition of expressive speech
Disinhibition of oral speech with the help of singing, automated speech sequences.
To achieve the possibility of a clear conjugated and reflected repetition of these series.
3. Stimulation of oral expression:
Development of active, proactive communication with other people. Aimed at removing the patient's speech passivity.
4. Setting sounds (if necessary). All sounds are introduced into speech based on visual and auditory perception.
The pronunciation of individual sounds is not so much fixed as in a monosyllabic word.
5. Getting Started to Encourage Reading and Writing. But more often such work is carried out at a later stage.
6. Establishing contact with the patient, strengthening his confidence in him that as a result of classes, his speech will gradually recover.
7. The personality of a speech therapist is of great importance.
At an early stage, in most cases, the pronunciation side of speech is restored.
At a late stage of rehabilitation training, scheduled classes are held. At this stage, the aphasia syndrome takes on a specific form.
Correctional and pedagogical work at the residual stage.
The residual stage is a long period of recovery of speech functions a year after a stroke or injury.
Target: restoration of speech using the preserved aspects of the psyche, stimulating the activity of the intact elements of the analyzers.
Tasks:
1. continuation of work with patients who have completed a course of rehabilitation training at an early recovery stage.
2. restoration of the speech of patients who have not completed a course of rehabilitation training.
Sick speechless,
Patients with speech embolism: these patients are characterized by a peculiar mental state, the presence of persistent agrammatisms and speech emboli.
A speech embolus is a sound complex, a word that a patient can pronounce or a trigger mechanism without which it is impossible to pronounce a single word.
3. Differentiation of methods of rehabilitation therapy for various forms of aphasic disorders, the choice of methods of rehabilitation therapy, taking into account the stage of restoration of speech functions.
At the residual stage, not only the form and severity of aphasia is determined, but also the degree of combination of different forms. The speech disorder takes on the character of a persistent, established syndrome (form) of SPEECH DISORDER.
The use of techniques that stimulate the overall development of speech, contributing to the restructuring of impaired speech functions.
4. Rehabilitation work takes into account the work on all aspects of speech, regardless of which one is primarily impaired.
5. development of the generalizing and communicative side of speech.
6. At this stage, the conscious active participation of the patient in the recovery process is required. Development of the ability to self-control over one's own speech.
MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION
NON-STATE EDUCATIONAL INSTITUTION
HIGHER PROFESSIONAL EDUCATION
BRANCH "MOSCOW PSYCHOLOGICAL AND SOCIAL UNIVERSITY" IN KANSK, KRASNOYARSK REGION
Faculty "Special (defectological) education"
TEST
PO Aphasia
Topic: "Correctional work in aphasia"
Completed by student 11/45/BDZ-3.5s-3
(Group No.)
Pugacheva Yu.O
(full name of the student)
checked
teacher: Shapovalenko L.O., st. pr-l
(F.I.O. pr-la, academic degree)
G. KANSK
2013
Content
Introduction 1 page
The concept of aphasia page 4
Etiology of aphasia page 5
Classification of forms of aphasia 8 pages
Correctional and pedagogical work to overcome aphasia 15 pages
Restorative education in various forms of aphasia 18str
Motor aphasia of the afferent type page 23
Motor aphasia of efferent type page 28
Dynamic aphasia page 30
Sensory aphasia page 33
Acoustic-mnestic aphasia page 36
Semantic aphasia page 38
Opto-mnestic aphasia 40str
Conclusion page 42
References 44pp
INTRODUCTION
The human brain is the most important organ, which IP Pavlov rightly called the highest apparatus for integrating all organic processes and organizing active interaction between a person and the surrounding reality. Brain damage, due to its high importance in the whole human body, leads to severe disorders of mental processes, such as speech and understanding, memory and perception, counting and constructive activity, etc.
Often life confronts us with people who have lost the ability to speak and understand the speech of the people around them, who have lost the skills of counting and counting operations, who have difficulty navigating in space, who have lost the idea of \u200b\u200b"left" and "right". These people, in general, with a safe personality, correct behavior, understanding and acutely experiencing their defects, cannot count money, buy goods in a store, or cross the street on their own. Such violations of speech and intellectual skills often occur as a result of various kinds of brain diseases (stroke, traumatic brain injury, brain tumor, etc.). Naturally, people who have lost these abilities lose the opportunity to communicate with the people around them, contact with them. All these defects complicate the personal, family and social life of a person in general. Helping these people, returning them to public life, to work is one of the most important and humane tasks of our health care. In this regard, the task arises of qualified assistance to these people, restoration of lost skills and knowledge, impaired mental functions in order to overcome the patient's adaptation to the defect and prevent his disability.
At the beginning of the disease, first of all, the tasks of treating the patient and often saving his life are solved. But already at the stage of treatment, doctors, psychologists, defectologists gradually begin to work with patients for rehabilitation purposes. One of the most important requirements for neuropsychological rehabilitation (NPR) of neurological and neurosurgical patients is the early start of rehabilitation work. Doctors save these people's lives, psychologists and speech pathologists return them to social life, to the family, to work, primarily by restoring impaired mental functions.
The task of restoring disturbed skills and knowledge is not only humane, but also socially significant. A properly organized system of neuropsychological rehabilitation of patients, including restorative education, allows you to return a person not only to his social environment, but also to make him able to work. By returning this contingent of patients to work, neuropsychological rehabilitation thus solves the problem of not only social, but also state significance.
A number of difficulties faced by practitioners stand in the way of solving these critical tasks. These difficulties primarily include the widespread practice of an empirical approach to the rehabilitation of patients, the still ongoing neglect of scientific foundations in solving practical problems of restorative education, the transfer of teaching methods (without sufficient scientific analysis) from other areas of practice, insufficient and often one-sided knowledge of the defect that needs to be overcome, that is, the lack of knowledge of the nature and mechanisms of the defect, its connection with other mental processes, with the personality of the patient. The effectiveness of rehabilitation measures, including restorative education, is directly related to the high qualification of a psychologist, doctor, speech therapist and other specialists involved in rehabilitation practice.
The concept of aphasia
Aphasia is a systemic speech disorder, consisting in the complete loss or partial loss of speech, and is caused by a local lesion of one or more speech areas of the brain.
In the vast majority of cases, aphasia occurs in adults, but it is also possible in children if brain damage occurs after speech is at least partially formed. The term "aphasia" comes from the Greek. “fasio” (I say) and the prefix “a” (“not”) and literally means “I don’t say”.
Since speech is not always completely absent in aphasia, one could call it dysphasia. However, in science there is the concept of a busy term. In this case, this is precisely what is an obstacle to the designation of incomplete speech destruction as “dysphasia”. In the literature, especially Western, the term "dysphasia" refers to various disorders of speech development in children, similar to how dyslalia is called impaired sound pronunciation, and not partial underdevelopment of speech (alalia). The above explains a certain conventionality of the terms "aphasia" and "alalia". From the point of view of strict logic, there is a certain paradox: it can be stated that the patient has aphasia in moderate or mild severity, at the same time, the term itself implies the absence of speech. This terminological inaccuracy is a tribute to the traditions that led to the emergence of these not quite accurate designations.
Regardless of such terminological conventions, the concept of aphasia has by now been well defined. It boils down to acknowledging:
systemic speech disorder, which implies the presence of a primary defect and secondary speech disorders arising from it, covering all language levels (phonetics, vocabulary and grammar);
obligatory violation of the processes of not only external, but also internal speech.
This situation is due to the specifics of the speech function itself: a) its division into internal and external speech; b) consistency, i.e. dependence of some parts on others, as in any system.
Etiology of aphasia
Aphasia can have different etiologies: vascular; traumatic (traumatic brain injury); tumor.
Vascular lesions of the brain have various names: strokes, or cerebral infarctions, or cerebrovascular accidents
They, in turn, are divided into subspecies. The main types of strokes (cerebral infarctions, cerebrovascular accidents) are ischemia and hemorrhage. The term "ischemia" means "starvation". The term "hemorrhage" means "hemorrhage" (from the Latin gemorra blood). "Starvation" (ischemia) leads to the death of brain cells, because. they are left without the main "food" of blood. Hemorrhage (hemorrhage) also destroys brain cells, but for other reasons: either they are filled with blood (figuratively speaking, they “choke” in the blood and soften, forming softening foci in the brain, or a hematoma forms at the site of the hemorrhage. With its weight, the hematoma destroys ( crushes) nearby nerve cells.Sometimes hematomas turn into hard sacs cysts "cystic".In this case, the risk of their rupture decreases, but the risk of crushing the substance of the brain remains.
The cause of ischemia can be:
stenosis (narrowing of the vessels of the brain), as a result of which the passage of blood through the vascular bed is difficult;
thrombosis, embolism or thromboembolism, blocking the vascular bed (thrombus is a blood clot that plays the role
"gags", embolus foreign body (air bubble, detached piece of flabby tissue of a diseased organ, even the heart; thromboembolism is the same emboli, but enveloped in blood clots);
sclerotic "plaques" on the walls of blood vessels that impede blood flow;
prolonged arterial hypotension, when the walls of the vessels do not receive the necessary pressure of blood, weaken and fall off, becoming unable to push the blood;
The cause of hemorrhage can be:
high blood pressure, tearing the walls of the vessel;
congenital pathology of blood vessels, for example, aneurysms, when the curved wall of the vessel becomes thinner and ruptures more easily than other parts of it;
sclerotic layers on the walls of blood vessels, making them brittle and amenable to rupture even at low blood pressure. (Wiesel T.G. Fundamentals of neuropsychology - M / AST, 2005 224-226pp.)
Brain injuries can be open or closed. Both those and others destroy the brain, including the speech zones. In addition, with injuries, especially those associated with blows to the skull, to a greater extent than with strokes, there is a danger of a pathological effect on the entire brain of contusion. In these cases, in addition to focal symptoms, there may be changes in the course of nervous processes (slowdown, weakening of intensity, exhaustion, viscosity, etc.).
With open brain injuries, they resort to surgical intervention to clean wounds, for example, from fragments of bone tissue, blood clots, etc.), with closed injuries, surgical intervention (craniotomy) can be performed, or conservative treatment can be applied, in which therapy is calculated in mainly on the resorption of intracranial hematomas.
Brain tumors can be benign or malignant. Malignant ones are characterized by faster growth. Just like hematomas, tumors compress the substance of the brain, and growing into it, destroy nerve cells. Tumors are subject to surgical treatment. Currently, the technique of neurosurgery allows you to remove those tumors that were previously considered inoperable. Nevertheless, some tumors remain, the removal of which is dangerous due to damage to vital centers, or they have already reached such a size that the substance of the brain is destroyed, and removal of the tumor will not give significant positive results.
The most severe consequences of local brain lesions of any etiology are disorders of: a) speech and other HMFs (orientation in space, the ability to write, read, count, etc.); b) movements. They can be present at the same time, but they can also act in isolation: movement disorders in a patient may be present, but speech disorders may be absent, and vice versa.
Movement disorders most often appear on one side of the body and are called hemiplegia (complete loss of movement on one side of the body) or hemiparesis. "Gemi" means "half", "paresis" partial, incomplete paralysis. Paralysis and paresis may involve only the arm or only the leg, or may extend to both the upper and lower extremities.
Since aphasia is a speech disorder, which is carried out mainly by the left hemisphere, hemiparalysis and hemiparesis in patients with aphasia on the right half of the body. With damage to the right hemisphere, left-sided hemiparesis or paralysis develops, while aphasia is not always present or appears in a “weakened” form. In this case, as is commonly believed, the patient has a clear or hidden (potential) left-handedness. It is the reason that part of the speech function is located in such patients not in the left hemisphere, as in most people, but in the right. In other words, there is a point of view according to which left-handers have a special distribution of HMF in the cerebral hemispheres.
Classification of forms of aphasia
As a result of local lesions of the brain, severe speech disorders occur. The most common of these are aphasias. With aphasia, systemic disorders of speech function are manifested, covering all language levels of phonology, including phonetics, vocabulary and grammar. Clinical pictures of aphasia are heterogeneous. The differences between them are primarily due to the localization of the lesion. There are so-called speech zones of the brain: the posterior sections of the lower frontal gyrus, the temporal gyrus, the lower parietal region, as well as the zone located at the junction of the parietal, temporal and occipital regions of the left dominant hemisphere of the brain.
In domestic and foreign aphasiology, there are various classification systems of aphasic disorders. The most common among them is the classification of A.R. Luria. According to this classification, the following forms of aphasia exist:
Motor aphasia of the afferent type.
Motor aphasia of the efferent type.
dynamic aphasia.
Sensory (acoustic-gnostic) aphasia.
Acoustic-mnestic aphasia.
semantic aphasia.
In clinical practice, it is also customary to single out amnestic and conduction aphasias, which are included in the classical neurological classification.
In addition to the localization of the lesion and its size, the severity and stage of the disease determine the specifics of speech impairment in each form of aphasia. Pathogenetic mechanisms also play an important role. So, for example, in vascular lesions of the brain, the nature of cerebrovascular accident, the degree of severity of the neurodynamic component, the state of unaffected areas of the brain, etc. are of great importance. In aphasias with traumatic or tumor etiology, the most significant are the severity of the destructive defect, as well as the timing and nature of the surgical intervention. Definite value also have premorbid intellectual and character traits of the patient's personality.
To understand the specifics of speech disorders in one form or another of aphasia, and therefore to provide a differentiated approach to overcoming them, it is extremely important to identify the mechanism, or otherwise, the disturbed prerequisite that determines the nature of the aphasiological syndrome.
All forms of aphasia arise as a result of damage to the parietal speech zone of the left dominant in speech (in right-handers) hemisphere of the brain. The characteristics of the forms of aphasia given below correspond to the ideas of neuropsychology created by A.R. Luria.
(Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia. M .: “Association of defectologists”, V. Sekachev, 2000 5-7 pages)
Afferent motor aphasia is caused by damage to the lower parts of the postcentral zone of the brain. The central disorder is a violation of the kinesthetic afferentation of voluntary oral movements. Patients lose the ability to perform certain movements on the instructions of the tongue, lips and other organs of articulation. Involuntarily, these movements can be easily performed by them, since there are no paresis that limits the range of oral movements. This is called oral apraxia. Oral apraxia underlies articulatory apraxia, which is directly related to the pronunciation of speech sounds. It manifests itself in the disintegration of individual articulatory poses or, in other words, the articulation. In the oral speech of patients, depending on the degree of rudeness of apraxia, this manifests itself in:
lack of articulated speech;
distorted reproduction of poses;
looking for articulation.
Secondarily, other aspects of the speech function are systemically impaired.
Efferent motor aphasia is caused by damage to the lower parts of the premotor zone. Normally, it provides a smooth change from one oral or articulatory act to another, which is necessary for the merging of articulations into successively sequentially organized rows of “kinetic motor melodies” (in the terminology of A.R. Luria).
With focal lesions of the premotor zone, pathological inertia of articulatory acts occurs, perseverations appear that prevent free switching from one articulatory position to another. As a result, the speech of patients becomes torn, accompanied by a stuck on separate fragments of the utterance. These defects in the pronunciation side of speech cause systemic disorders in other aspects of the speech function: reading, writing, and partially understanding speech. Thus, in contrast to afferent motor aphasia, where articulatory apraxia refers to single postures, in efferent it refers to their series. Patients pronounce individual sounds relatively easily, but experience significant difficulties in pronouncing words and phrases.
(Tsvetkova L.S., Torchua N.G. Aphasia and perception 171, 172, 173, 175).
With dynamic aphasia, brain damage occurs in the posterior frontal regions of the left hemisphere, located anterior to the "Broca's area". The speech defect manifests itself here mainly in speech aspontaneity and inactivity. Currently, two variants of dynamic aphasia have been identified (T.V. Akhutina). Option I is characterized by a predominant violation of the function of speech programming, in connection with which patients use mostly ready-made speech stamps that do not require special “programming activities”. Their speech is characterized by poverty, monosyllabic answers in the dialogue. In option II, violations of the function of grammatical structuring predominate: in the speech of patients in this group, expressive agrammatism is expressed, which manifests itself in the form of "coordination" errors, as well as "telegraphic style" phenomena. Pronunciation difficulties in both variants are insignificant. (Akhutina T.V. Neupolinguistic analysis of dynamic aphasia. - M. MSU, 1975.)
Sensory (acoustic-gnostic) aphasia occurs when the upper temporal parts of the so-called Wernicke's area are affected. Speech auditory agnosia, which underlies phonetic hearing disorders, is considered as a primary defect. Patients lose the ability to differentiate phonemes, i.e. highlight the signs of speech sounds that carry semantic-distinctive functions in the language. Disorders of phonemic hearing, in turn, cause gross violations of the impressive speech of understanding. The phenomenon of “alienation of the meaning of the word” appears, which is characterized by the “stratification” of the sound shell of the word and the object designated by it. Speech sounds lose their constant (stable) sound for the patient and each time they are perceived distorted, mixed with each other according to one or another parameter. As a result of this sound lability, characteristic defects appear in the expressive speech of patients: logorrhea (an abundance of speech production) as a result of “chasing an elusive sound”, replacing some words with others, some sounds with others, verbal and literal paraphasias.
Acoustic-mnestic aphasia is caused by a lesion located in the middle and posterior parts of the temporal region. Unlike acoustic-gnostic (sensory) aphasia, the acoustic defect manifests itself here not in the sphere of phonemic analysis, but in the sphere of auditory mnestic activity. Patients lose the ability to retain information perceived by ear in memory, thereby demonstrating the weakness of acoustic traces. Along with this, they show a narrowing of the volume of memorization. These defects lead to certain difficulties in understanding extended texts that require the participation of auditory-speech memory. In the own speech of patients with this form of aphasia, the main symptom of aphasia is a vocabulary deficit associated both with secondary impoverishment associations words with other words of a given semantic bush, and with a lack of visual representations of the subject. . (Luria A. R. Higher cortical functions of a person and their disturbances in local lesions p. 282, 283,285).
Semantic aphasia occurs when the parieto-occipital regions of the left dominant hemisphere are affected. The main manifestation of speech pathology in this type of aphasia is impressive agrammatism, i.e. inability to understand complex logical and grammatical turns of speech. This defect is, as a rule, one of the types of a more general disorder of spatial gnosis, namely, the ability for simultaneous synthesis. Since in phrasal speech the main “details” linking words into a single whole (logical-grammatical construction) are the grammatical elements of words, The main difficulty for patients is to isolate these elements from the text and understand their semantic role, especially the spatial one (spatial prepositions, adverbs, etc.). At the same time, the ability to catch formal grammatical distortions (errors of "coordination") remains intact in these patients.). (Luria A.R. Traumatic aphasia p. 282).
Recovery of speech function in aphasia is gradual. Naturally, in the early stages of the disease, regardless of the specific form of aphasia, the task is to include mainly involuntary, automated levels of speech activity. During this period, the most effective is the use of automated speech series, the "speech" of emotionally significant situations, the "revival" of speech stereotypes, well established in the previous speech practice.
Work with patients who are in the acute stage of the disease should be strictly dosed depending on the characteristics of the general condition of the patient, be sparing, psychotherapeutic in nature. In addition, they put special tasks establishing contact with the patient, involving him in purposeful activities. As a rule, the method of conversation on various topics close to the patient is used for this, as well as methods consisting in connecting “non-speech” activities: the simplest design, drawing, modeling from plasticine, etc.
At the subsequent stages of the disease, restorative training is carried out with the expectation of an increasingly active, conscious involvement of the patient in the restorative process. To do this, restructuring techniques are used. Their use is impossible without transferring the work to an arbitrary, conscious level. This does not mean that a complete rejection of reliance on speech automatisms is necessary, but the main emphasis is on the conscious assimilation of certain methods of compensating for a defect.
Restoration of speech function in any form of aphasia requires a systematic approach, i.e. implies the normalization of all disturbed language levels. However, with each of the aphasic forms, there are also specific tasks associated with overcoming the primary speech defect.
Afferent motor aphasia: restoration of articulation schemes of individual sounds and, consequently, elimination of literal paraphasias arising from the mixing of speech sounds close in articulation.
Efferent motor aphasia: restoration of the ability to perform serial articulatory acts. Such a task requires the development of a switch from one article to another, from one word fragment to another. This, in turn, is closely related to the task of restoring the kinetic motor melodies of the word and phrase, as well as the internal linear syntactic scheme of the phrase.
Sensory aphasia: restoration of phonemic hearing, i.e. the ability to differentiate aurally close-sounding phonemes, and on this basis to understand speech as a whole.
Dynamic aphasia: 1st option - restoration of the function of speech programming; The second option is to overcome grammatical structuring disorders.
Acoustic-mnestic aphasia: expansion of auditory-speech memory, as well as overcoming the weakness of traces of perceived speech.
Semantic aphasia: elimination of impressive agrammaticism, i.e. restoration of the ability to perceive complex logical and grammatical turns of speech.
Work on overcoming secondary disorders of speech understanding, accumulation of an active vocabulary, normalization of the grammatical side of speech, reading, writing is shown in all forms of aphasia, since these sides of speech suffer to one degree or another in each of them. The scope of this work is determined by the severity of a particular defect, its specific weight in the overall clinical picture of a given case of aphasia.
(Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia. M .: “Association of defectologists”, V. Sekachev, 2000 89-90)
Correctional and pedagogical work to overcome aphasia
E. S. Bein, M. K. Burlakova (Shokhor-Trotskaya), T. G. Wiesel, A. R. Luria, L. S. Tsvetkova made a great contribution to the development of principles and techniques for overcoming aphasia.
In speech therapy work to overcome aphasia, general didactic principles of learning (visibility, accessibility, consciousness, etc.) are used, however, due to the fact that the restoration of speech functions differs from formative learning, that the higher cortical functions of an already speaking and writing person are organized somewhat differently than in a child who is starting to speak (A. R. Luria, 1969, L. S. Vygotsky, 1984), when developing a plan for correctional and pedagogical work, one should adhere to the following provisions:
(Shokhor - Trotskaya M.K. Correctional - pedagogical work with aphasia. (guidelines) - M, 2002)
1. After completing the examination of the patient, the speech therapist determines which area of the second or third "functional block" of the patient's brain has suffered as a result of a stroke or injury, which areas of the patient's brain are preserved: in most patients with aphasia, the functions of the right hemisphere are preserved; in case of aphasias that occur when the temporal or parietal lobes of the left hemisphere are affected, the planning, programming and controlling functions of the left frontal lobe are primarily used, providing the principle of consciousness of restorative learning. It is the preservation of the functions of the right hemisphere and the third "functional block" of the left hemisphere that makes it possible to instill in the patient an attitude to restore impaired speech. Duration speech therapy classes with patients with all forms of aphasia is two to three years of systematic (inpatient and outpatient) classes. However, it is impossible to inform the patient about such a long period of restoration of speech functions.
2. The choice of methods of correctional and pedagogical work depends on the stage, or stage of restoration of speech functions. In the first days after a stroke, work is carried out with a relatively passive participation of the patient in the process of restoring speech. Techniques are used that disinhibit speech functions and prevent at an early stage of recovery such speech disorders as agrammatism of the “telegraphic style” type in efferent motor aphasia and an abundance of literal paraphasia in afferent motor aphasia. At the later stages of the restoration of speech functions, the structure and plan of classes are explained to the patient, means are given that he can use when performing the task, etc.
3. The correctional-pedagogical system of classes presupposes such a choice of methods of work that would allow either to restore the initially violated prerequisite (in case of its incomplete breakdown), or to reorganize the preserved links of the speech function. For example, the compensatory development of acoustic control in afferent motor aphasia is not just the replacement of impaired kinesthetic control with acoustic control to restore writing, reading and understanding, but the development of intact peripherally located analyzer elements, the gradual accumulation of the possibility of their use for the activity of the defective function. With sensory aphasia, the process of restoring phonemic hearing is carried out by using a preserved optical, kinesthetic, and most importantly, semantic differentiation of words that are similar in sound.
4. Regardless of which primary neuropsychological prerequisite is violated, with any form of aphasia, work is carried out on all aspects of speech: on expressive speech comprehension, writing and reading.
5. With all forms of aphasia, the communicative function of speech is restored, self-control over it develops. Only when the patient understands the nature of his mistakes, it is possible to create conditions for his control over his speech, over the plan of narration, over the correction of literal or verbal paraphasia, etc.
6. In all forms of aphasia, work is underway to restore verbal concepts, including them in various phrases.
7. The work uses deployed external supports and their gradual internalization as the disturbed function is restructured and automated. Such supports include, in dynamic aphasia, sentence schemes and the chip method, which allow restoring an independent detailed statement; in other forms of aphasia, a scheme for choosing the patient's participation in the process of speech restoration. Techniques are used that disinhibit speech functions and prevent at an early stage of recovery such speech disorders as agrammatism of the “telegraphic style” type in efferent motor aphasia and an abundance of literal paraphasia in afferent motor aphasia. At the later stages of the restoration of speech functions, the structure and lesson plan are explained to the patient, means are given that he can use when performing the task, etc. (Shokhor - Trotskaya M.K. Correctional - pedagogical work with aphasia. (guidelines) - M , 2002)
Restorative learning in different forms of aphasia
(typical programs)
Rehabilitation training is carried out with adult patients with HMF disorders, and primarily speech, and is an important section of neuropsychology and neurolinguistics. To date, the methodology, principles of restorative education have been defined, and a fairly large arsenal of evidence-based methods of work has been created. A fundamental contribution to these developments was made by A.R. Luria, who laid the foundation of a new science in the form of a theory of higher mental functions, their brain organization, a description of the etiology, clinic, pathogenesis and diagnosis of HMF disorders. Numerous studies have been carried out on this basis, summarizing the research and practical experience of working with patients (V.M. Kogan, V.V. Oppel, E.S. Bein, L.S. Tsvetkova, M.K. Burlakova, V. M. Shklovsky, T. G. Wiesel and others). (Shokhor-Trotskaya M.K. Speech therapy work with aphasia at an early stage of recovery. M.: 2002.)
The position that the return of the lost function to the patient is possible in principle is based on one of the most important properties of the brain, the ability to compensate. In the process of restoring impaired functions, both direct and bypass compensatory mechanisms are involved, which leads to the presence of two main types of directional effects. The first is associated with the use of direct disinhibitory methods of work. They are mainly used in the initial stage of the disease and are designed to use reserve intrafunctional capabilities, to “exit” nerve cells from a state of temporary depression, usually associated with changes in neurodynamics (speed, activity, coordination of the course of nervous processes).
The second type of targeted overcoming of HMF disorders implies compensation based on the restructuring of the method of implementing the impaired function. For this, various -interfunctional relationships are involved. Moreover, those of them that were not leading before the disease are specially made so. This "bypass" of the usual way of performing a function is needed to attract spare reserves (afferentations). For example, when restoring a disintegrated articulatory posture of a speech sound, an optical-tactile method is often used. In this case, the reliance is not on the sound of the sound being worked out, but on its optical image and the tactile sense of the articulatory posture. In other words, such external supports are connected as leading, which in speech ontogenesis (when mastering sound pronunciation) were not basic, but only additional. Due to this, the way the speech sound is produced changes. Only after the optically perceived and tactilely analyzed articulatory posture is fixed in the patient, it is possible to fix his attention on the acoustic image and try to return to him the role of the leading support. It is important at the same time that direct teaching methods are designed for involuntary soldering of premorbidly strengthened skills in the memory of patients. Bypass methods, on the contrary, imply an arbitrary mastering of the ways of perceiving speech and one's own speaking. This is due to the fact that bypass methods require the patient to implement the affected function in a new way, which differs from the usual, strengthened in premorbid speech practice.
Since in most patients aphasia is combined with a violation of non-speech HMF, their recovery is a significant section of restorative education in terms of volume. Some of the non-speech functions do not require a thorough verbal accompaniment, others are restored only on the basis of speech. The restoration of a number of speech functions requires the connection of non-speech supports. In this regard, the sequence of work on speech and non-verbal functions is decided in each specific case, depending on the combination of verbal and non-verbal components of the syndrome. (Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia.)
Work on the restoration of complex types of speech activity (phrasal, written speech, listening to extended texts, understanding logical and grammatical structures, etc.) is predominantly arbitrary, but not due to the restructuring of the mode of action, but due to the fact that they assimilation in a natural way was to some extent arbitrary, i.e. was under conscious control. Essentially, here is the revival of the action algorithm, while involuntary, direct methods stimulate the speech act directly.
An important clarification of the pathological syndromes caused by local lesions of the brain was made at the beginning of the 20th century by the neurologist K. Monakov (Mopasou). Based on clinical observations, he concluded that within a few days or even weeks after a brain disease, there are symptoms that are not explained by the lesion, but by a phenomenon that he called diaschisis and consisting in the occurrence of edema, swelling of the brain tissue, inflammatory processes, etc. .P. Accounting for these features is important not only for the correct treatment tactics, but also for the selection of adequate methods of rehabilitation work with patients in the initial stages of the disease. The need for early psychological and pedagogical intervention in the treatment of patients with focal brain lesions is currently one of the absolutely proven provisions.
Restoration of speech in patients with aphasia is carried out by both neuropsychologists and speech therapists, who must have special knowledge, and first of all, in the field of neuropsychology. Specialists working with patients with aphasia are increasingly referred to as aphasiologists. This is quite justified, given that the term "aphasiology" has by now become completely legalized and used both in scientific literature, as well as in practice.
Rehabilitation training is carried out according to a special, pre-designed program, which should include certain tasks and the corresponding methods of work, differentiated depending on the form of aphasia (apraxia, agnosia), the severity of the defect, the stage of the disease.
(Problems of aphasia and restorative learning: In 2 volumes / Edited by L.S. Tsvetkova. - M .: MGU, 1975. Vol. 1 1979. Vol. 2.)
It is also necessary to observe the principle of consistency. This means that restoration work should be carried out on all sides of the impaired function, and not only on those that suffered primarily.
The correct organization of restorative education also requires a strict consideration of the characteristics of each specific case of the disease, namely: individual personality traits, the severity of the somatic condition, living conditions, etc.
An important point in organizing and predicting the results of restorative education is to take into account the coefficient of hemispheric asymmetry in a particular patient. The higher it is, the more reason to conclude that the patient is a potential left-hander or ambidexter. Consequently, he has a non-standard distribution of HMF over the cerebral hemispheres, and part of speech and other dominant (left-hemispheric) functions can be implemented by the right hemisphere. A lesion of the left hemisphere that is identical in size and localization in a left-handed person or an ambidexter leads to milder consequences, and the final result of recovery, other things being equal with right-handed patients, is better. For practicing aphasiologists, this information is extremely important. (Shokhor-Trotskaya M.K. Logopedic work with aphasia at an early stage of recovery. M .: 2002.)
Motor aphasia of the afferent type
I. Stage of gross disorders
1. Overcoming disorders of understanding situational and everyday
speeches: showing pictorial and real images of the most used objects and simple actions by their names, categorical and other features. For example: “Show a table, a cup of a dog, etc.”, “Show pieces of furniture, clothes, transport, etc.”, “Show someone who flies, who talks, who sings, who has a tail, etc.”;
classification of words by topic (for example: “Clothes”, “Furniture”, etc.) based on a subject picture;
answers with an affirmative or negative gesture to simple situational questions. For example, “Now is winter, summer ..?”; "You live in Moscow?" and etc.
2. Disinhibition of the pronunciation side of speech:
conjugated, reflected and independent pronunciation of automated speech sequences (ordinal counting, days of the week, months in order, singing with words, ending proverbs and phrases with a “hard” context), modeling situations that stimulate the pronunciation of onomatopoeic pronouns (“ah!” “Oh!” and etc.);
conjugated and reflected pronunciation simple words ifraz;
inhibition of a speech embolus by introducing it into a word (ta, ta .. - Tata, so), or into a phrase (mother - mother ...; this is mother).
3. Stimulation of simple communicative types of speech:
answers to questions in one or two words in a simple situational dialogue;
modeling situations that contribute to the call of communicatively significant words (yes, no, I want, I will, etc.);
answering situational questions and composing simple phrases using a pictogram and a gesture1 with conjugated pronunciation of simple words and phrases.
4. Promoting Global Reading and Writing:
laying out captions under the pictures (subject plot);
writing the most familiar words - ideograms, writing off simple texts;
conjugated reading of simple dialogues.
II. Stage of disorders of moderate severity
1. Overcoming disorders of the pronunciation side of speech:
- selection of sound from the word;
automation of individual articles in words with different syllable-rhythmic structure;
overcoming literal paraphasias by selecting at first discrete, and then gradually converging in articulation sounds.
2. Recovery and correction of phrasal speech:
composing phrases according to the plot picture: from simple models (subject-predicate, subject-predicate-object) - to more complex ones, including objects with prepositions, negative words, etc.;
composing phrases on questions, on key words;
exteriorization of the grammatical-semantic connections of the predicate: “who?”, “why?”, “when?”, “where?” etc.;
filling gaps in a phrase with a grammatical change in the word;
detailed answers to questions;
retelling texts based on questions.
3. Work on the semantics of the word:
development of generalized concepts;
semantic play on words (subject and verbal vocabulary) by including them in various semantic contexts;
filling in gaps in a phrase;
completion of sentences with different words suitable in meaning;
selection of antonyms, synonyms.
4. Recovery of analytical-synthetic writing and reading:
the sound-letter composition of the word, its analysis (one-two-three-syllable words) based on schemes that convey the syllabic and sound-letter structure of the word, the gradual reduction in the number of external supports;
filling in missing letters and syllables in words;
writing off words, phrases and small texts with an attitude towards self-control and self-correction of errors;
- reading and writing under the dictation of words with a gradually becoming more complex sound structure, simple phrases, as well as individual syllables and letters;
- filling in the texts when reading and writing the missing words that are practiced in oral speech.
1. Further correction of the pronunciation side of speech:
- clarification by the article of individual sounds, especially affricates and diphthongs;
differentiation of acoustic and kinestatic images that are similar in articulation of sounds in order to eliminate literal paraphasias;
working out the purity of pronouncing individual sounds in the sound stream, in phrases, with a confluence of consonants, in tongue twisters, etc.
2. Formation of extended speech, complicated by semantic and syntactic structure:
filling in the missing main, as well as a subordinate clause or a subordinating union in a complex subordinate sentence;
answers to questions with a complex sentence;
retelling texts without relying on questions;
drawing up detailed plans for texts;
preparation of thematic reports (short reports);
speech improvisations on a given topic.
3. Further work to restore the semantic structure of the word:
interpretation of individual words, mainly with an abstract meaning;
explanation of homonyms, metaphors, proverbs, phraseological units.
4. Work on understanding complex logical and grammatical turns of speech:
execution of instructions, including logical and grammatical phrases;
the introduction of additional words, pictures, questions that facilitate the perception of complex speech structures.
5. Further restoration of reading and writing reading and retelling of expanded texts;
dictations;
written presentation of texts;
drafting letters, greeting cards, etc.;
essays on a given topic.
1. Restoring the connection "articule phoneme":
writing letters corresponding to the sounds named in expressive speech, reading these letters immediately after writing;
selection of the 1st sound from simple words, fixing attention on the articulatory, acoustic, and then graphic image of this sound; independent selection of words for this sound and writing them;
writing practiced sounds and syllables from dictation;
identification of letters in different fonts;
finding given letters in various texts (underlining, writing out).
2. Restoration of the ability for sound-letter analysis of the composition of the word:
division of words into syllables, syllables into letters (sounds) based on various graphic schemes;
selection of any sound in a word in a word;
recalculation and enumeration of words by letters (orally);
writing words from letters given randomly.
3. Restoring the skill of detailed written speech:
writing words of various sound structures with and without support from an objective picture: a) under dictation, b) when naming an object or action;
writing sentences: a) from memory, b) from dictation, c) in the form of a written statement based on a plot picture in order to communicate with others;
written presentations and essays.
Motor aphasia of the efferent type
I. Stage of gross disorders "
The recovery program is the same as for afferent motor aphasia.
P. Stage of disorders of moderate severity
1. Overcoming disorders of the pronunciation of speech: the development of articulatory switches within the syllable: with
vowels contrasting in articulation pattern (“a”, “y”, etc.); with various vowels, including soft ones; in syllables, for example,
Development of articulatory switching within a word: merging syllables into words with a simple, and later with a complex sound structure (for example, a recipe, etc.);
exteriorization of the sound-rhythmic side of the word, division of words into syllables, emphasis in the word, reproduction of the voice of the word, selection of words with an identical sound-rhythmic structure, rhythmic pronunciation of words and phrases with the involvement of external supports, tapping, slapping, etc., catching various consonances, in including the choice of rhyming words.
2. Recovery of phrasal speech:
overcoming agrammatism at the level of the syntactic scheme of the phrase: compiling "nuclear" phrases of models of the type S (subject) + P (predicate); S + P + O (object) with the involvement of external supports of chips and their gradual “folding”; highlighting the predicative center of the phrase; exteriorization of its semantic connections;
overcoming agrammatism at the formal grammatical level: capturing grammatical distortions of inflectional, prepositional, etc. in order to revive the sense of language; differentiation of singular and plural meanings, generic meanings, meanings of the present, past and future tenses of the verb; completion of missing grammatical elements in words; drawing up phrases according to plot pictures; answers to questions with a simple phrase, grammatically designed; retelling of a simple text; stimulation to use incentive and interrogative sentences, various prepositional constructions.
III. Stage of mild disorders
The program is the same as for the corresponding stage of afferent motor aphasia.
When restoring written speech in patients with motor aphasia of the efferent type, as a rule, no independent task development of the connection "articule grapheme".
The emphasis is on:
1. Restoring the ability to analyze sound-rhythmic
sides of the word:
differentiation of words by length and syllabic composition;
highlighting the stressed syllable;
selection of words identical in sound-rhythmic structure;
highlighting identical elements in words of syllables, morphemes and, in particular, endings (underlining them, writing them out, etc.).
Restoration of the ability to sound-letter analysis of the composition of the word.
Restoring the skill of merging letters into syllables, syllables into words.
4. Restoration of the skill of detailed written speech (for specific teaching methods, see the program of restorative education for afferent motor aphasia, paragraphs 2, 3, 4).
Dynamic aphasia
1. Stage of gross disorders
1. Increasing the level of the patient's general activity, overcoming speech inactivity, organizing voluntary attention:
performing various types of non-verbal activities (drawing, modeling, etc.);
assessment of distorted images, words, phrases, etc.;
situational, emotionally significant dialogue for the patient;
listening to plot texts and answering questions is understood in the form of affirmative-negative gestures or with the words "yes", "no".
2. Stimulate simple species communicative speech:
automation in dialogical speech of communicatively significant words: “yes”, “no”, “can”, “want”, “I will”, “must”, etc.;
automation of individual cliches of communicative, motivating and interrogative speech: “give”, “come here”, “who is there?”, “quiet!” etc.
3. Overcoming speech programming disorders:
stimulation of answers to questions with a gradual decrease in the answer of words borrowed from the question;
construction of phrases of the simplest syntactic models based on chips and a simple plot picture;
performing simple grammatical transformations to change the words that make up a phrase, but presented in nominative forms;
unfolding a series of sequential pictures according to the plot contained in them.
Overcoming disorders of grammatical structuring (see paragraph 2 of section "Disorders moderate severity with efferent motor aphasia" in the program of rehabilitation education).
Stimulation of written speech:
laying out captions under pictures;
reading ideogram words and phrases.
I. Stage of disorders of moderate severity
1. Restoration of communicative phrasal speech:
construction of a simple phrase;
composing phrases according to the plot picture using the chip method and gradually “curtailing” the number of external supports;
compiling a story based on a series of sequential pictures;
detailed answers to questions in the dialogue;
compiling simple dialogues according to the type of speech studies: "In the store" dialogue between the buyer and the seller, "In the savings bank", "In the studio", etc.
2. Overcoming perseverations in an independent oral and written statement:
showing objects in pictures and in the room, body parts (in random order, by separate names and series of names);
ending phrases with different words;
selection of words of given categories and in given quantities, for example, two words related to the topic “Clothes”, and one word related to the topic “Dishes”, etc.;
writing numbers and letters in a breakdown (from dictation);
writing under the dictation of words and phrases that contribute to the development of semantic and motor switching;
elements sound-letter analysis word composition: folding simple words from the letters of the split alphabet;
filling in gaps in words;
writing simple words from memory and from dictation.
III. Stage of disorders of mild severity
1. Restoration of spontaneous communicative phrasal speech:
extended dialogue on various topics;
construction of phrases according to the plot picture with a gradual decrease in the number of external supports;
automation of phrases of certain syntactic models in spontaneous speech;
the accumulation of the verbal dictionary and the "revival" of the semantic connections behind the predicate (with the help of questions posed to it);
reading and retelling texts;
“role-playing conversations” that play out a certain situation;
"speech improvisations" on a given topic;
detailed presentations of texts, essays;
compiling greeting cards, letters, etc.
(Akhutina T.V. Neupolinguistic analysis of dynamic aphasia. - Moscow State University, 1975.)
Sensory aphasia
I. Stage of gross disorders
1. Accumulation of everyday passive vocabulary:
displaying pictures depicting objects and actions by their names, functional, classification and other features;
displaying pictures depicting items belonging to certain categories (“clothes”, “dishes”, “furniture”, etc.);
showing body parts in the picture and on your own;
choosing the correct name of the object and action among the correct and conflicting designations based on the picture.
2. Stimulation of understanding of situational phrasal speech:
answering questions with the words "yes", "no", affirmative or negative gesture;
following simple oral instructions;
capturing semantic distortions in simple phrases deformed in meaning.
3. Preparation for the restoration of written speech:
laying out captions for subject and simple plot pictures;
answers to questions in a simple dialogue based on the visual perception of the text of the question and answer;
writing words, syllables and letters from memory;
“voiced reading” of individual letters, syllables and words (the patient reads “to himself”, and the teacher reads aloud);
development of the "phoneme-grapheme" connection by selecting a given letter and syllable by name, writing letters and syllables from dictation.
II. Stage of disorders of the middle degree
1. Recovery of phonemic hearing:
differentiation of words that differ in length and rhythmic structure;
highlighting the same 1st sound in words of various lengths and rhythmic structures, for example: “house”, “sofa”, etc .;
highlighting different 1st sounds in words with the same rhythmic structure, for example, “work”, “care”, “gate”, etc.;
differentiation of words close in length and rhythmic structure with disjunctive and oppositional phonemes by highlighting differentiable phonemes, filling in gaps in words and phrases, capturing semantic distortions in a phrase; answers to questions containing words with oppositional phonemes; reading texts with these words.
2. Restoring understanding of the meaning of the word:
development of generalized concepts by classifying words into categories; selection of a generalizing word for groups of words belonging to a particular category;
filling in gaps in phrases;
selection of definitions for words.
3. Overcoming speech disorders:
"imposing frames" on the statement by composing sentences from a given number of words (instruction: "Make a sentence of 3 words!", Etc.);
clarification of the lexical and phonetic composition of the phrase through the analysis of verbal and literal paraphasias admitted by patients;
elimination of elements of agrammatism using exercises to "revive" the sense of language, as well as the analysis of grammatical distortions.
4. Recovery of written speech:
consolidation of the "phoneme-grapheme" connection by reading and writing letters under dictation;
various types of sound-letter analysis of the composition of the word by the gradual "folding" of external supports;
writing under the dictation of words and simple phrases;
reading words and phrases, as well as simple texts with subsequent answers to questions;
independent writing of words and phrases from a picture or a written dialogue.
III. Stage of mild disorders
1. Restoring understanding of extended speech:
answers to questions in a detailed non-situational dialogue;
listening to texts and answering questions about them;
capturing distortions in deformed compound and complex sentences;
comprehension of logical and grammatical turns of speech;
execution of oral instructions in the form of logical and grammatical turns of speech.
2. Further work to restore the semantic structure of the word:
selection of synonyms homogeneous members sentences and out of context;
- work on homonyms, antonyms, phraseological units.
3. Correction of oral speech:
restoration of the function of self-control by fixing the patient's attention on their mistakes;
compiling stories based on a series of plot pictures;
retelling of texts according to plan and without plan;
drawing up plans for texts;
compiling speech improvisations on a given topic;
speech etudes with elements of "role-playing games".
4. Further restoration of reading and writing:
reading extended texts, various fonts;
dictations;
written statements;
written essays;
assimilation of samples of congratulatory letters, business records, etc.
Acoustic-mnestic aphasia
1. Expanding the scope of auditory perception:
display of items (real and in pictures) by name presented in pairs, triplets, etc.;
showing body parts on the same principle;
execution of 2-3-link oral instructions;
answers to detailed questions, complicated by the syntactic structure;
listening to texts consisting of several sentences and answering questions about the content of the texts;
writing under dictation with a gradual increase in phrases;
reading gradually built-up phrases, followed by reproduction (from memory) of each of the sentences and the entire set as a whole.
2. Overcoming the weakness of auditory-speech traces:
repetition from memory of read letters, words, phrases with a gradual increase in the time interval between reading and reproduction, as well as filling the pause with some other type of activity;
memorizing short poems and prose texts;
re-display of objects and pictures after 5-10 seconds, after 1 min. after the first presentation
reading texts with a retelling “delayed” in time (in 10 minutes, 30 minutes, the next day, etc.);
compiling oral sentences on key words perceived visually;
spelling out words with a gradually more complex sound structure, and gradually moving away from the written pattern of these words.
3. Overcoming the difficulties of naming:
analysis of visual images and independent drawing of objects denoted by words-names;
semantic playing in the contexts of various types of words denoting objects, actions and various signs of objects;
classification of words with an independent finding of a generalizing word;
exercises on the interpretation of words with a specific, abstract figurative meaning.
4. Organization of a detailed statement:
compiling a story based on a series of plot pictures;
retelling of texts, first according to a detailed plan, then folded, then without a plan;
detailed dialogues on non-situational topics (professional, public, etc.);
working out samples of communicative and narrative written speech (greeting cards, letters, presentations, essays on a given topic, etc.).
Semantic aphasia
Stage of disorders of moderate and mild severity
1. Overcoming spatial apractognosia:
a schematic representation of the spatial relationships of objects;
image of the plan of the path, room, etc.;
designing according to a model, according to a verbal task;
work with a geographical map, hours.
2. Restoration of the ability to understand words with a spatial meaning (prepositions, adverbs, verbs with prefixes "movement", etc.):
a visual representation of simple spatial situations indicated by prepositions and other parts of speech;
filling in the missing "spatial" elements in the word and phrase;
composing phrases with words that have a spatial meaning.
3. Construction of complex sentences:
clarification of the meanings of subordinating conjunctions;
filling in the missing main and subordinate clauses;
making sentences with given conjunctions.
4. Restoring the ability to understand logical and grammatical situations:
pictorial image of the construction plot;
the introduction of additional words that provide semantic redundancy (“my brother's father”, “a letter from a beloved friend”, etc.);
the introduction of logical and grammatical constructions into a detailed semantic context;
presentation of structures in writing, and then orally.
5. Work on a detailed statement:
presentations, essays;
improvisation on a given topic;
interpretation of words with complex semantic structure.
(Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia. M .: "Association of Defectologists", V. Sekachev, 2000; Shokhor-Trotskaya M.K. Logopedic work with aphasia at an early stage restoration. M.: 2002)
Optic-mnestic aphasia (optical amnesia)
Opto-mnestic aphasia occurs when the posterior inferior parts of the temporal region are affected. In classical neurology, this form is called nominative amnestic aphasia or optical amnesia. This form of aphasia is based on the weakness of visual representations - visual images of words. The visual-mnestic link of the speech system, the links between the visual images of words and their names are disintegrating. Patients are not able to correctly name objects and try to give them verbal description. For example, Well, this is what they write. There are no clear visual images in the description. Usually this is an attempt to characterize the functional purpose of the object. At the same time, patients do not have obvious visual gnostic disorders. They are well oriented both in space and in objects. They often have an impaired ability to depict objects. Often they can copy objects, but they cannot draw from memory. AT independent speech they have a harder time naming objects than actions. Written speech. In cases of gross violations, literal alexia, verbal alexia, one-sided optical alexia are noted (they do not see the left side of the text and do not notice it).
Conclusion
So, summing up all of the above, it should be noted that the goal of this work has been achieved.
A lot of literary sources devoted to the stated topic have been studied and analyzed; in addition, in the process of work, materials taken from the World Wide Web were worked out.
In the first chapter of the work, a description is given: the etiology of aphasia, all 6 forms of aphasia are briefly characterized, and optical-spatial disturbances are also described for each specific type of aphasia.
The second chapter of the presented work describes and briefly characterizes the correctional and pedagogical work to overcome aphasia.
As the main conclusion of this work, it should be noted that, according to modern scientific ideas The question of the methods of restorative treatment of patients with aphasia is a priority.
At an early stage after a stroke, the mechanism of disinhibition of temporarily suppressed speech functions and their involvement in activities is used.
At later, residual stages, when speech disorder acquires the character of a persistent, established syndrome (form) of speech disorder, the essence of the recovery process is rather a compensatory restructuring of organically impaired functions using the intact aspects of the psyche, as well as stimulating the activity of the intact elements of the analyzers.
When developing methodological program rehabilitation work, its individualization is mandatory: taking into account the characteristics of speech disorders, the personality of the patient, his interests, needs, etc.
It should be borne in mind that when setting the goals of rehabilitation therapy (developing its program), it is necessary:
differentiation of rehabilitation therapy methods for various forms of aphasic disorders;
when organizing and choosing a method of rehabilitation therapy, it is necessary to proceed from the stage-by-stage principle, i.e., take into account the stage of restoration of speech functions;
with aphasia, it is necessary to work on all aspects of speech, regardless of which one is primarily impaired;
in all forms of aphasia, it is necessary to develop both generalizing and communicative (used in communication)
side of speech<...>
restore speech function not only with a speech therapist, in the family circle, but also in a wider social environment;
in all forms of aphasia, the development of the ability to control one's own speech production.
The phased construction of speech recovery in aphasia refers not only to the difference in the speech therapy methods used, but also to taking into account the unequal proportion of conscious participation of patients in the recovery process. It is naturally less in the initial stages after a stroke. The principle of differentiation of methods in connection with the form of aphasia is also significant in the early stages. Here, speech therapy techniques for disinhibiting speech functions, “reliance” on involuntary speech processes (habitual speech stereotypes, emotional meaningful words, songs, poems, etc.). These techniques contribute to the removal of inhibitory phenomena and draw patients into verbal communication with the help of conjugated (carried out simultaneously with a speech therapist), reflected (following a speech therapist) and elementary dialogic speech.
A common feature of these early stage methods is that they are aimed at restoring all aspects of impaired speech, mainly with the patient's passive participation in the recovery process, as well as at preventing the occurrence and fixing of some symptoms of speech pathology; these techniques also make it possible to activate the restoration of speech functions in patients with various forms of aphasia.
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