Methods of speech restoration for semantic aphasia.

- image of the plan of the path, room, etc.;. The sudden onset of speech disorders indicates cerebrovascular disease. Subacute onset may be due to a tumor, abscess, or other process with a moderately progressive course. Slow onset indicates a degenerative disease such as Alzheimer's or Pick's disease. Collecting a family history and interviewing relatives is decisive when the patient’s speech disorders limit the clarification of the disease history directly from him.

Focal neurological symptoms. A detailed neurological examination allows us to identify motor, sensory or visual disorders that accompany speech disorders, which facilitates topical diagnosis. Important “associated” symptoms are hemiparesis, homonymous or quadrant hemianopia, and apraxia.

Mental status examination. It is important to assess the patient's level of wakefulness and attention to avoid misinterpreting speech errors resulting from inattention as purely linguistic. In the case of severe speech impairment, before routine testing, it should be assessed using nonverbal tests of memory function, visuospatial perception and command execution. 3. Speech research. A detailed assessment of all components of speech functions is necessary for an accurate syndromic and topical diagnosis.

– Spontaneous speech. The patient's spontaneous speech during conversations and answers to general questions should be assessed in terms of fluency and the presence of paraphasia. It is necessary to ask open-ended questions such as “Why are you in the hospital?” or “What do you usually do during the day while at home?”, since the main speech disorders in patients can be hidden behind monosyllabic answers “yes - no” and other short remarks.

Repetition. The patient is asked to repeat complex sentences. In case of obvious difficulties, in order to determine the degree of damage, simpler phrases are proposed - from monosyllabic words to multi-syllable words and short phrases. Finally, a single sentence with multiple grammatical and functional structures, such as “No ifs, ands, or buts,” should be used to identify isolated or overt repetition disorder, as may be seen in motor aphasia or other anterior brain aphasias. .

Understanding aphasia. An initial judgment about listening comprehension can be made during the process of obtaining anamnesis or during normal conversation. Tests that require no or minimal speech response are needed to assess speech understanding in patients with severe speech disorders or in intubated patients.

Teams. A simple test is used on a patient lying in bed - he is asked to follow single or multi-step commands, for example, “Pick up a piece of paper, fold it in half and place it on the table.” Test results should be interpreted with caution because (1) apraxia and other movement disorders may cause test performance impairment in the absence of language comprehension impairments; (2) the execution of commands such as closing or opening the eyes and standing up is determined by special anatomical and functional systems and can be preserved even with severe impairments in speech understanding.

The answers are “yes - no”. If the patient can provide verbal or gestural yes-no responses, this can be used to assess listening comprehension. Questions of varying degrees of difficulty should be used to accurately assess the degree of comprehension impairment.

Ability to show objects. This simple motor response also makes it possible to determine the characteristics of the comprehension disorder using questions of varying degrees of difficulty. The doctor should use both simple tasks (“Show the chair, nose, door”) and more complex ones in syntactic and lexical terms (“Show the source of lighting in this room”).

Ability to name objects. Difficulties in naming objects are present in all types of aphasia. Therefore, object naming tests, while not specific, are highly sensitive for detecting aphasia.

Naming objects in comparison. The patient is asked to name objects and their parts, body parts and colors, objects indicated by the doctor. Typically, both frequently occurring words (lace, watch) and rare words (lace knot, watch bracelet) are used.

Enumeration. The patient is asked to list words that belong to the same category (animals, cars) or words that begin with a specific letter (F, A, S). A healthy person is able to name at least 12 words starting with a certain letter in 1 minute.

Speech automatisms. Patients with severe speech impairment are asked to reproduce: (1) a series of learned words, including the numbers 1 to 10 and days of the week; (2) memorized speech structures, for example, “Our Father”; (3) familiar songs, for example, “A Christmas tree was born in the forest.” The anatomical substrate of speech automatisms are subcortical structures, as well as zones of the cortex of the non-dominant hemisphere. The preservation of speech automatisms in a patient indicates the degree of reserve capabilities that are used during rehabilitation. ? Reading. The patient is asked to read aloud. Written commands such as “Close your eyes” allow you to simultaneously explore reading aloud and reading comprehension. g. Letter. The patient is asked to write letters, simple words and short sentences. It should be borne in mind that the ability to sign can be maintained even if all other writing functions are lost.

2. Examination of persons with aphasia

To organize effective rehabilitation training, it seems necessary to have a comprehensive examination of people with aphasia, carried out by specialists of different profiles - neuropsychologists, speech therapists, doctors. The examination option under consideration represents one of the many modifications of the neuropsychological diagnostic system of A. R. Luria, proposed by T. G. Wiesel.

A preliminary conversation is of fundamental importance for determining the tactics of a diagnostic examination. It is structured so that the researcher in each specific case can draw a conclusion about what special attention should be paid to in the future. Based on the conversation, a preliminary general description of a person with aphasia is drawn up, which reflects: 1) the level of awareness of the situation of the conversation; 2) orientation in the environment; 3) the state of the ability to verbally express thoughts; 4) the presence or absence of a speech embolus, rigid speech automatisms (“oh, damn!, how can this be?, I can’t…”, etc.), dissociation between the ability to make involuntary utterances and the inability to make voluntary ones; 5) the volume of paralinguistic means of communication (gesture, facial expressions, intonation); 6) criticality towards one’s condition.

After the conversation, they move on to identifying the state of movements and actions, namely, they examine: 1) kinesthetic hand and finger praxis (reproduction of individual hand and finger poses); 2) kinetic (dynamic) praxis (reproduction of a series of hand and finger poses, symmetrical and asymmetrical tapping); 3) constructive praxis (construction from parts); 4) reciprocal coordination (Ozeretsky test, which allows us to identify the state of interhemispheric motor coordination). Next, visual, somatosensory gnosis (stereognosis) and acoustic gnosis are examined.

In the visual sphere, the state of object gnosis, facial, optical-spatial, color, and finger gnosis is revealed. The study of stereognosis includes: determining the location of touch on the body (with eyes closed); recognizing an object by touch (“Magic bag”). Determining the state of acoustic gnosis involves identifying the ability to recognize non-speech noises and familiar melodies.

In the diagnostic system, special attention is paid to the study of speech function. The actual speech therapy part of the examination is aimed at identifying the state of impressive and expressive forms of speech. The study of the impressive side of speech includes the study of: 1) understanding of speech (situational and non-situational dialogue); 2) correlating the name with the object (showing objects and body parts by name); 3) understanding complexly constructed speech (explanation of logical and grammatical constructions). The study of expressive speech includes the study of: 1) automatisms of ordinal speech (ordinal counting to 10, days of the week, months, ending familiar proverbs, phrases with a strict context, reading reinforced poems, singing with the words of well-known songs); 2) affectively colored automatisms (“oh, damn!”, “I don’t know!”, “how can this be?!”, etc.; 3) the ratio of the volumes of voluntary (according to the task) and involuntary speech; 4) repetition of sounds and syllables, words and phrases; 5) naming objects, actions and states of spontaneous speech, as well as spontaneous speech in a monologue (retelling, story, improvisation); 6) global and analytical reading of letters, syllables, phrases, texts; 7) writing letters, words, phrases, texts (copying, dictation, independent writing).

When examining the state of intelligence of persons with aphasia, attention is focused on studying: 1) categorical thinking (classification, exclusion of unnecessary things, extraction of analogies, combining objects by similarity); 2) analytical-synthetic thinking (cause-and-effect relationships, arithmetic calculation, arithmetic problems); 3) conceptual thinking (antonyms, synonyms, metaphors). The memory examination is carried out in the following areas: 1) modality-specific working memory (auditory-verbal, visual); 2) long-term (memory for events in one’s biography in the premorbid period of life, for well-known historical events and dates).

3. Corrective pedagogical work for aphasia

The theoretical basis of restorative training for aphasia is modern ideas in psychology about higher mental functions as functional systems, their systemic and dynamic localization, their formation during life, their socio-historical origin and indirect structure. Based on these theoretical positions, psychologists, physiologists, neurologists and speech therapists developed and practically applied a way to rebuild functional systems using the method of restorative training. This path has two directions in practical work: 1st – the broken link in the psychological structure of the function is replaced by another; 2nd - the creation of new functional systems that include new links in the work that were not previously involved in the now disrupted function.

The basis for the effectiveness of speech restoration in aphasia is the correctly developed principles of restorative training, which were formulated by L. S. Tsvetkova based on the ideas of A. R. Luria. Conventionally, the principles can be divided into psychophysiological, psychological and psychological-pedagogical. Psychophysiological: principle of defect qualification, what determines the use of adequate methods; use of preserved analysis systems as a support for learning; creation of new functional systems on the basis of afferentations (links) that were not previously directly involved in the performance of the affected function; reliance on different levels of organization of mental functions, including speeches; Reliance during training on the entire mental sphere of a person as a whole and on individual preserved mental processes.

Psychological principles include: personality accounting principle; the principle of relying on preserved forms of activity; principle of organizing activities; principle of programmed learning; the principle of systemic influence on the defect(not only for speech, but also for other mental functions); the principle of taking into account the social nature of man.

The psychological and pedagogical principles are as follows: principle “from simple to complex”; the principle of taking into account the volume and degree of variety of material; principle of complexity of verbal material; the principle of taking into account the emotional side of the material.

The tasks of remedial training for aphasia by L. S. Tsvetkova are called the socio-psychological aspect of regenerative training. This aspect involves a complex effect on speech, behavior and the entire mental sphere as a whole. This approach requires solving the following problems: 1) restoration of speech as a mental function, and not adaptation of a person with aphasia to their defect; 2) restoration of the activity of speech 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, rather than individual. As a method of work in group classes, such forms and functions of speech can be used that cannot be used in individual work - dialogic and communicative. It is the dialogical form of speech that can be an effective means of the communicative function of speech. Group speech creates an emotional uplift and releases all the “dormant” abilities of a person to communicate. In addition, the advantages of the group form of classes: imitation, support, mutual assistance, cooperation, the presence of positive emotions, connections between group members, etc. The main task of speech therapy is the restoration of impressive and expressive vocabulary.

There are two periods in working with people with aphasia: spicy– up to two months after illness; residual– after two and beyond. In the acute period, the main tasks are: 1) disinhibition of temporarily suppressed speech structures; 2) prevention of the occurrence and fixation of some symptoms of aphasia: agrammatism, verbal and literal paraphasias, speech embolus; 3) preventing a person with aphasia from treating themselves as inferior, as a person who cannot speak. The main task in the residual period is to inhibit pathological connections.

Disinhibition of speech function based on old speech stereotypes should be carried out with low-strength stimuli (in a whisper, in a low voice). The material is selected based on 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 your medical history, talk with your doctor, relatives to identify inclinations, hobbies, and interests. You can use familiar speech stereotypes - counting, days of the week, months; emotionally significant passages of poetry, finishing of common phrases and expressions. Over time, work from material close to the student is transferred to issues of specialty and profession.

The basis of restorative work to disinhibit speech function is dialogic speech. You can use the following scheme for restoring dialogical speech: repetition of a ready-made answer formula (reflected speech) - hints of one or two syllables of each word of the answer - spontaneous answer with a choice of two, three, four, etc. words used by the speech therapist when asking the 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.

The appearance of agrammatism in aphasia is usually the result of improper organization of the initial recovery period, when disinhibition is carried out either only of the nominative function of speech, or only of the predicative one. Speech should immediately be complete in terms of vocabulary, and pronunciation defects that do not reduce the correctness of sentence construction can be tolerated for now. This is the essence of preventing agrammatism. Work to overcome agrammatism is carried out not only in oral speech, but also, when writing skills are slightly restored, in written speech. The basis of exercises (oral and written) to prevent the development of agrammatism is the dialogical form of speech.

The most difficult pathological symptom to prevent and overcome is a speech embolus, which often forms in the first weeks after the lesion. There are two main types of speech emboli: a single word or sentence that can be pronounced, or a trigger mechanism necessary for pronouncing other words (V.V. Opel). Since the speech embolus is the result and manifestation of stagnation and inertia of nervous processes, it cannot serve as a starting point for rehabilitation exercises. The following conditions contribute to the inhibition of the speech embolus (speech perseveration): 1) observance of optimal intervals between speech stimuli, allowing the resulting excitation to “fade away” after completing each task; 2) presenting the material at low voice strength, since in mild cases, perseveration almost does not occur with low strength of the sound stimulus, and when it does occur, it fades away 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 the speech therapist.

To prevent a person with aphasia from treating oneself as inferior, one should talk to him with respect, warmly and sincerely experience all his successes and disappointments, trying to constantly emphasize achievements, calmly and confidently explain difficulties, creating confidence in one’s abilities.

In the residual period, a more careful differentiation of methodological techniques is necessary depending on the form of aphasia. 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 disinhibiting speech; however, with the second group, it is necessary to simultaneously work on eliminating the embolus as quickly as possible. To do this, without focusing on the use of the embolus, you should avoid all sound combinations that contribute to its pronunciation.

Since restorative education is aimed primarily at restoring communication abilities, it is necessary to be involved in communication not only in the classroom, but also in the family and public places.

The main task of rehabilitation training in acoustic-gnostic sensory aphasia is to overcome defects in differentiated perception of sounds and restore phonemic hearing. Only restoration of the process of sound discrimination can ensure the revival of all affected aspects of speech, mainly speech understanding. In rehabilitation training, L. S. Tsvetkova identified five stages. On first stage establish contact with a person with aphasia, inhibit logorrhea, transfer attempts at verbal communication to nonverbal activities, and switch the student’s attention from speech to nonverbal actions. On second stage move on to learning to listen and hear spoken speech. The main task third is the selection of individual words from one’s own speech. Central task fourth stage– restoration of differentiated perception of speech sounds, that is, work to restore phonemic hearing. On fifth move on to the conscious and differentiated selection of a word from a phrase, a phrase from a text.

At acoustic-mnestic (amnestic) form of aphasia, the central task of training is to restore (expand) the volume of acoustic perception, overcome defects in auditory-speech memory and restore stable visual images of objects. There are three stages of remedial learning for this form of aphasia (L. S. Tsvetkova). The task first stage is the restoration of visual-object images. Work, as with sensory aphasia, begins not with speech methods, but with the restoration of visual-object images using drawing objects (the first method). The second method is to classify objects first by visual pattern and then by word. The following system of methods is aimed at restoring the process of recognizing and naming objects: constructing objects from individual parts; comparison and finding common and different; finding errors in the image and other techniques.

The main task of rehabilitation training in 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 the addressed speech. The main method of this stage is the method of breaking words (sentences) into understandable parts. Third stage restoration of speech understanding is a special task. The most effective method is the method of reconstructing text from disparate semantic parts. At this stage, in order to overcome paraphasia, classification of words according to a given characteristic and gradual generalization of words are used.

In remedial training semantic aphasia L. S. Tsvetkova identified two stages. On first learning begins with recognizing drawn geometric figures by comparing two given samples. Then they move on to reproducing the given figures according to the model: first – drawing, then – active construction from sticks and cubes. Subsequently, verbal instructions are added to the sample: “put the square under the triangle, circle, right, up,” etc. subsequently they practice the concepts: “less - more”, “darker - lighter”, etc. Then they move on to restoring awareness of the diagram of their body, its position in space.

The main objective of training in second stage is the restoration of the process of understanding speech, its logical and grammatical structures. The main focus is on restoring understanding of prepositional and inflectional constructions. Restoring the understanding of prepositions begins with restoring the analysis of the spatial relationships of objects. In general, learning comes from restoring the spatial relationships of objects with a gradual transfer of action to the speech level.

The central task of restorative education in motor afferent aphasia – restoration of articulatory activity, and the goal is restoration of oral expressive speech. The main method of speech restoration in this form of aphasia is the method of semantic-auditory stimulation of the word. This method involves pronouncing not a sound, but a whole word. Restoration of sound-articulatory analysis and the kinetic basis of a word is carried out on the basis of the restored active and passive vocabulary. L. S. Tsvetkova divided all the work on speech restoration into four stages. The main task 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, reproducing the names of loved ones, reading poetry.

The main task second stage– restoration of the pronunciation of words by restructuring the impaired speech function, that is, revitalization and enrichment of semantic connections. The work begins with attempts to restore the pronunciation of the word as a whole, without 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. On third stage the main task is solved - sound-articulatory analysis of the constituent elements of a word. The main method is to rhythmically highlight the elements of a word by tapping its syllabic structure with exercises in melodic pronunciation. At this stage, work is carried out on writing and reading, since at the previous stages all attention was paid to switching attention from the pronunciation side of speech to the semantic level. Written speech is a voluntary and conscious form. It is when writing that conscious sound-letter analysis is necessary.

The main task 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 patterns of articulation. The main method is to imitate the postures of the articulation apparatus of a speech therapist with control in front of a mirror. The next method used is the method of extracting sound from a word in the active dictionary. Coherent phrasal speech is restored quickly, immediately after the articulation system is restored, and does not require special training.

At motor efferent aphasia the main task is to overcome pathological inertia and restore the dynamic scheme of the spoken word. The goal of training is to restore oral speech, writing, and reading. The implementation of this goal is possible by solving the following tasks: 1) general disinhibition of speech; 2) overcoming perseverations, echolalia; 3) restoration of general mental and verbal activity. Two stages of training have been identified (L. S. Tsvetkova). Task first stage– restoration of the ability of active selection, conjugate-reflected repetition of words and pronunciation of a word or a series of words from strengthened automated speech series. The goal is to remove perseverations, echolalia, and disinhibit speech. The main thing is to transfer speech to a voluntary level, that is, to restore awareness of your speech and voluntary speaking. Subsequently, it is necessary to switch consciousness from the pronunciation side of speech to its semantic side. Second stage training has the main task of updating verbal forms of speech. This is necessary both to overcome expressive agrammatism - telegraphic style, and to overcome the defect of predicative speech. The attention of a person with aphasia should be diverted from articulation and focused on the semantic organization of the word, rhythmic and intonation structure.

The three most important tasks of remedial training in dynamic aphasia defined by L. S. Tsvetkova: 1) the ability to program and plan statements; 2) predicativeness of speech (restoration of the actualization of verbs); 3) speech activity (restoration of the active phrase). All restoration work is divided into five stages of training. First stage its main task is the actualization of verbs in order to disinhibit the pronunciation of stereotypical phrases. Nonverbal, verbal-nonverbal and verbal methods are used. Non-verbal include Board games, walking to music, pantomime, drawing method, etc. Verbal-non-verbal: verbalization of gestures, melodic recitation. Verbal: verbal associations, intonation during dialogue (interrogative, exclamatory, narrative).

The main task second stage– restoration of functional connections of words in phrases of complex construction (subject – predicate – object). The main method is the method of polysemy of a word, which helps to restore the polysemy of predicative connections of a word. On third stage The main task being solved is to restore broader connections between words by introducing them into other semantic meanings. The main method is to enrich the “grid of meanings” of words and enrich the subject-functional connections of previously worked words. Task fourth stage– restoration of one’s own coherent speech. The most widely used method is to complete a given phrase to the whole. First, phrases are proposed that have no alternatives, then the end of which may be ambiguous. This helps restore the ability to actively construct a phrase. On fifth stage The main task is to restore the scheme of the whole story. The main method is to draw up a plan for the statement.

Psychotherapeutic work occupies an important place in the complex of rehabilitation measures for aphasia. In most cases, aphasia leads to disability and social maladjustment: deprivation of habitual norms of communication, complicating relationships with 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, persons with aphasia begin to acutely experience their sensations, which manifests itself in neurotic reactions of a secondary nature. Premorbid personality traits become sharper, and sometimes suicidal tendencies appear. In this case, mental disorders can occur against the background of both slight restoration of speech and other higher mental functions, and in cases where positive clinical dynamics are noted. The foregoing determines the need for psychotherapeutic influence 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 the advantage of group psychotherapy as the possibility of creating a speech environment that stimulates communication, and, consequently, a focus on solving socio-psychological problems of rehabilitation. Group psychotherapeutic sessions through the organization of communication in a team also contribute to the correction of personality changes.

An important place in the personality structure of persons with consequences of stroke and neurotrauma is occupied by the attitude towards their defect: there is both an underestimation and an overestimation of their capabilities. Some develop elements of logophobia, uncertainty in behavior, attempts to “escape” verbal contacts, while others, without avoiding social interaction, simply do not make sufficient efforts to realize their potential.

Group classes allow you to objectively assess the state of the communicative function on the part of other group members, which contributes to the development of objective self-esteem. Indications for group psychotherapy are given by a neuropathologist and neuropsychologist based on the results of a neuropsychological examination, as well as according to medical documentation available upon discharge from the hospital. A speech therapist also participates in determining the feasibility and prescribing indications for group psychotherapy. This type of work is indicated for people with mild speech impairments who do not experience a serious vocabulary deficit or pronounced difficulties in programming speech utterances. However, even with positive dynamics of recovery, the emerging belief in one’s inferiority is quite persistent, which complicates the possibility of achieving the maximum restorative effect.

Persons with aphasia avoid extensive speech contacts, explaining this by their “speech inferiority.” Therefore, it is advisable to use psychotherapy and autogenic training aimed at developing an attitude to overcome “feelings of illness and hopelessness.” Contraindications include pronounced personality changes: 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 forms of aphasia are not a factor necessitating separation 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 impairment 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 makes work easier - interconnection, mutual influence, example, self-esteem. Mastering autogenic training is based on the principles of consistency and phasing. 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 and difficulties in mastering auto-training after each lesson. Oral self-reports from those undergoing rehabilitation training help to develop adequate work techniques.

A necessary condition for the use of psychotherapeutic influence is the formation of the correct attitude towards one’s own defect. To do this you should:

1. Explain to people with aphasia that the brain has great, but not unlimited, compensatory capabilities. Clarification of this is necessary so that a “super task” mindset is not created. It is advisable to gradually lead to the idea that the absence of one or another ability does not impede social adaptation. It is important to convince students of the inevitability of deterioration of the condition due to excessive stress.

2. Conduct conversations on the topic of the connection between “hand 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. Make it known that medications will not work miracles. Patience and accuracy are required in carrying out the prescriptions of the doctor, speech therapist, and the active participation of the person recovering in the treatment process.

4. Explain to people with aphasia that neither thinking nor the mental sphere as a whole has been affected, but the ability to speak has been lost.

5. Convince that more active and courageous use of remaining and restored skills will contribute to a rapid return to normal life.

An important link in restorative education is family psychotherapy. A psychotherapist and speech therapist teach relatives the correct reaction to the negative attitude of a person with aphasia to a number of 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 work experience of V. M. Shklovsky shows that the normalization of the behavior of a person with aphasia and his emotional status creates a favorable background for the restoration of the impaired functions themselves.

With aphasia, it is necessary to restore not only speech, but also non-speech functions, since various mental processes, cognitive, emotional and volitional spheres suffer. Persons with aphasia are characterized by: aspontaneity, inactivity, inertia; visual, auditory, tactile agnosia, apraxia. Aspontaneity is expressed in the inability to independently engage in any activity. May manifest itself in rapid disengagement from completing a task. Inactivity consists in increasing the time of activity within a particular function. Inertia characterized by difficulties switching in the process of performing various operations or switching from one type of activity to another. In severe cases, the ability to switch from one action to another is completely absent, that is, it is impossible to carry out normal activities. Remediation work These disorders involve the use of exercises aimed at concentrating attention, activating it, developing self-control skills and controlling the ability to perform purposeful activities, and expanding its mnestic framework.

For the correctional pedagogical process, it is recommended to use speech material that is emotionally significant for the student. 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, and 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 a goal of gradually but steadily reducing the time allotted for completing these tasks.

With aphasia, the following types of agnosia can be observed: object, optical-spatial (apractognosia), letter and number, color agnosia, face agnosia. The main task in overcoming subject agnosia– restoration of a generalized image of an object. In correctional pedagogical work they use: a) analysis of the visual image of real objects and their sketched images; b) comparative analysis of the visual image of objects of the same class, highlighting differential features (cup - glass, etc.); c) identification of visual images of various types (for example: select from a set of pictures images of people, houses, cats, trees, vehicles, etc.); d) sketching object images, as well as drawing them from memory with a preliminary analysis of characteristic features; e) construction of given objects with similar discrete characteristics from individual parts.

At apractognosia the main directions in correctional work are: a) restoration of schematic ideas about the spatial relationships of objects of reality (rotation of a figure in space); b) working with a geographical map (finding sides and parts of the world, specific objects); c) working with a clock (setting the hands according to a given time, writing off numbers according to the arranged hands). Overcoming disorders of constructive activity begins with reviving the concepts of “shape” and “size”: developing a differentiated perception of round and coal shapes; drawing objects and geometric figures; finishing drawing of objects; drawing objects and geometric figures from memory; Koos cubes; design of various parts. Restoring praxic and gnostic functions also includes the following types of work: developing orientation in space; restoration of the ability to simultaneously perceive objects (involvement of palpation); overcoming apraxia of dressing (performing various dressing operations with preliminary analysis and verbalization of actions).

Overcoming violations alphabetic Gnosis implies restoration of reading (elimination of alexia).

At color agnosia correctional pedagogical work is aimed at developing a generalized categorical attitude towards 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, rowan; green – grass, grapes, etc.); b) presenting contour images of objects “played out” 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.

Agnosia on faces requires special work to overcome it, starting with determining the degree of recognition of the faces of famous people in portraits. Then, using the most familiar portraits, they “revive” the visual image of a particular person based on the verbal, musical, pictorial and other associations associated with him (listening to poems, songs, looking at paintings).

Important in remedial training for aphasia is occupational therapy. In its process, special types of classes are used using subject-related practical operations. These classes are aimed at solving several rehabilitation problems: 1) overcoming disorders of manual (manual) and constructive praxis; 2) mastering a number of everyday and work 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 using subject-based practical activities include various types of household and work operations.

The main form is group classes. Methodologically, training is based on the principle of gradual mastery of the technology of a particular type of activity and parallel stimulation of speech. Subject-based practical everyday and work activities solve problems of communication with others, professional diagnostics, career guidance and employment.

Topic 1. Aphasia, historical aspect, causes and mechanism

Objectives of the lesson: to update and expand knowledge about the essence of aphasia, about the history of the development of the doctrine of aphasia; analyze the causes and mechanism of aphasia, a modern approach to understanding aphasia.

1. Questions for discussion:

· History of the development of the doctrine of aphasia.

· Definition, general characteristics of aphasia.

· Neurolinguistic approach to understanding aphasia at the present stage.

· Etiology and pathogenetic mechanisms of aphasia.

2. Micro message “Criteria for identifying forms of aphasia in the classifications of G. Head, V. K. Orfinskaya, A. R. Luria.”

Expand the concepts of “higher mental functions”, “functional systems”, “factor” (as a neuropsychological concept), “syntagmatic connections”, “paradigmatic connections”, “simultaneous analysis and synthesis”, “successive analysis and synthesis”.

Literature: 1, 2, 3, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21.

Topic 2. Forms of aphasia

Objectives of the lesson: to update and expand knowledge about the classification of aphasia, the structure of the defect and the symptoms of forms of aphasia (according to the classification of A. R. Luria); develop the ability to differentiate various forms of aphasia.

1. Questions for discussion:

· Forms of aphasia (according to A. R. Luria), correlation with the localization of lesions of the cerebral cortex.

· The structure of the defect and the main symptoms of acoustic-gnostic sensory, acoustic-mnestic, semantic, afferent motor, efferent motor and dynamic aphasia.

· Degree of severity of aphasic disorders.

2. Micro-message “Children’s aphasia, its similarities and differences in comparison with aphasia in adults and alalia in children.”

Assignment for independent work:

Compile a table “Comparative characteristics of forms of aphasia” (comparison of forms - according to the following criteria: localization of lesions of the cerebral cortex, central mechanism and defect, clinical, neuropsychological and psychological pictures).

Literature: 2, 3, 7, 9, 10, 18, 19, 22.

Topic 3. Specifics of examination of persons with aphasia

Objectives of the lesson: update and expand knowledge about the features of examining speech and non-speech functions in aphasia; to develop the ability to select techniques for examining people with aphasia.

Issues for discussion:

· Principles and organization of examination of persons with aphasia.

· Factors determining the state of speech and prognosis for aphasia of various forms.

Tasks for independent work:

· Compile a card index of techniques for examining higher cortical functions.

· To study the standardized method for assessing the dynamics of speech of persons with aphasia by L. S. Tsvetkova.

Literature: 3, 5, 6, 9, 10, 12, 18, 21, 23.

Topic 4. General organization of correctional and restorative education for aphasia

Objectives of the lesson: to update and expand knowledge about the strategy of rehabilitation training for aphasia, tasks, principles and methods of speech restoration for aphasia; to develop the ability to select techniques and means of speech therapy at different stages of rehabilitation work for aphasia.

Issues for discussion:

· Principles, objectives and methods of restoration work.

· Main tasks and content of rehabilitation training in acute and residual periods.

Assignment for independent work:

Develop the text of the conversation “Preventing the occurrence of aphasia.”

Literature: 2, 3, 4, 9, 10, 18, 19, 22, 24.

Topic 5. Specifics of correctional and restorative training for different forms of aphasia

Objectives of the lesson: to update and expand knowledge about the features of remedial training for various aphasias; to develop the ability to select differentiated techniques and means of speech therapy at different stages of rehabilitation work for aphasia.

Issues for discussion:

· Specifics of correctional and educational work for different forms of aphasia.

Assignment for independent work:

Compile a table “Comparative characteristics of correctional and educational work for different forms of aphasia” (use of intact analyzers for restructuring functional systems, restorative training in the acute period, restorative training in the residual period).

Literature: 2, 3, 4, 9, 10, 18, 20, 21, 22, 24.

Topic 1. Rehabilitation training in the acute period

Objective of the lesson: to consolidate students’ knowledge about the process of speech disinhibition during the acute period.

Preparation for the lesson:

Study of speech maps.

Lesson plan:

1. Observation of a speech therapist’s classes on speech disinhibition during the acute period with persons suffering from aphasia.

3. Conclusions on the lesson (specifics of speech therapy work, taking into account the nature of the violation, the specifics of the students’ personality).

Literature: 1, 3, 8, 19, 20, 21, 22, 24.

Topic 2. Rehabilitation training for persons suffering from various forms of aphasia in the residual period

Objective of the lesson: to consolidate students’ knowledge about the process of restorative learning for persons with aphasia in the residual period.

Preparation for the lesson:

Study of speech maps.

Lesson plan:

1. Observation of speech therapist’s classes on correctional work with persons suffering from aphasia.

2. Discussion of classes, analysis of the speech therapist’s work.

3. Conclusions on the lesson (specifics of speech therapy work for different forms of aphasia, taking into account the specific personality of students).

Literature: 1, 3, 5, 19, 20, 21, 22, 24.

GLOSSARY OF TERMS

AGNOSIA is a violation of various types of perception that occurs when the cerebral cortex and nearby subcortical structures are damaged.

AGRAMMATISM is a persistent violation of the understanding and use of grammatical means of a language.

ALALIA is the absence or underdevelopment of speech due to damage to the speech areas of the cerebral cortex in the prenatal or early (pre-speech) period of a child’s development. There is a bilateral lesion, that is, not just one specific area, but several areas of the cerebral cortex.

ALEXIA – the impossibility of the reading process.

ANALYZER is a relatively independent organic, anatomical and physiological system responsible for the perception and processing of information that generates sensations in a person.

APRAXIA is a violation of purposeful movements and actions, which is not a consequence of elementary movement disorders (paralysis, paresis, etc.), but refers to disorders of the highest level of organization of motor acts.

ASTEREOGNOSIS - failure to recognize familiar objects when feeling them with eyes closed.

AUTOGENIC TRAINING is a method of practical psychology and psychotherapy, including a system of sequentially performed exercises designed to develop a variety of skills related to physical and mental self-regulation.

IMPRESSIVE SPEECH - internal, not accompanied by sounds.

LOGORHREA is an incoherent speech stream as a manifestation of speech activity.

LOGOPHOBIA is an obsessive fear of generating a speech utterance.

INTERHEMISPHERE ASYMETRY is the inequality of the cerebral hemispheres in ensuring human neuropsychic activity, in which in some cases the left hemisphere dominates, and in others, the right hemisphere.

NEUROPSYCHOLOGY is a branch of psychological science aimed at studying the brain mechanisms of higher mental functions using the material of local brain lesions.

PARAPHASIA is a violation of speech expression, manifested in the incorrect use of sounds (literal) or words (verbal) in oral and written speech.

PERSEVERATION - pathological repetition or persistent reproduction of any action or syllable or word.

PRAXIS is an organized, coordinated conscious action.

PREDICATIVITY is a property of internal speech, expressed in the absence in it of words that represent the subject of the statement, that is, what is said in a given statement, or what is represented by the subject in the grammatical structure of the sentence.

PREMORBID – occurring before the onset of the disorder.

CAREER GUIDANCE is a system of psychological, pedagogical and medical activities that help you choose a profession, taking into account the needs of society and your own capabilities.

PROFESSIONAL DIAGNOSTICS is a psychological assessment of a person’s personality from the perspective of his professional abilities and social conditions of activity.

PSYCHOTHERAPY is a field of medicine that includes psychological methods of diagnosis and treatment (therapy) of various types of diseases.

SENSO-MOTOR – the unity of the sensory and the motor.

SYMPTOM is a sign.

SYNDROME – a combination of symptoms (signs).

SYNTAGMA is a syntactic intonation-semantic unit.

SOCIAL DISADAPTATION is a violation of a person’s normal relationship with society and others.

EVOLUTION is a natural, gradual and orderly development, the process of the emergence of something new.

EXPRESSIVE SPEECH – external, sounding and conscious.

ECHOLALIA - automatic repetition of words after they are reproduced.

1. Aphasia and remedial education: Texts / Ed. L. S. Tsvetkova, Zh. M. Glozman. M., 1983.

2. Bein E. S. Aphasia and ways to overcome it. L., 1964.

3. Burlakova M.K. Correctional and pedagogical work for aphasia. M., 1991.

4. Wiesel T. G. How to regain speech. M., 1998.

5. Wiesel T. G. Neuropsychological blitz examination: Tests for the study of higher mental functions. M., 2005.

6. Vinarskaya E. N. Dysarthria. M., 2005, p. 95–104.

7. Vinarskaya E. N. Clinical problems of aphasia. M., 1971.

8. Restoration of speech function in patients with different forms of aphasia: Met. rec. Part 1. M., 1985.

9. Speech therapy / Ed. L. S. Volkova, S. N. Shakhovskaya. M., 2003.

10. Speech therapy. Methodological heritage / Ed. L. S. Volkova: In 5 books. M., 2003. – Book 3.

11. Luria A. R. Basic problems of neurolinguistics. M., 1975.

12. Luria A. R. Writing and speech: Neurolinguistic studies. M., 2002.

13. Luria A. R. Traumatic aphasia. M., 1947.

14. Oppel V.V. Restoration of speech after a stroke. L., 1972.

15. Problems of aphasia and remedial learning / Ed. L. S. Tsvetkova. M., 1979.

16. Speech disorders in children and adolescents / Ed. S. S. Lyapidevsky. M., 1969, pp. 176 – 190.

17. Stolyarova L. G. Aphasia in cerebral stroke. M.: Med., 1973.

18. Reader on speech therapy / Ed. L. S. Volkova, V. I. Seliverstova. M., 1997. – T.2.

19. Tsvetkova L. S. Aphasia and rehabilitation training. M., 1988.

20. Tsvetkova L. S. Restorative training for local brain lesions. M., 1972,

21. Tsvetkova L. S. Neuropsychological rehabilitation of patients. M., 1985.

22. Shklovsky V. M., Vizel T. G. Restoration of speech function in patients with different forms of aphasia. M., 2000.

Literature... dictionary scientific psychological concepts in the form of images and metaphors. I deliberately chose brief ... recommendatory ...

MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION

NON-GOVERNMENTAL EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION

TEST

ON APHASIA

Topic: “CORRECTIONAL WORK FOR EACH FORM OF APHASIA”

Introduction

.Aphasias and their classification

2.1 Correctional and pedagogical work for acoustic-mnestic aphasia

2 Corrective pedagogical work for semantic aphasia

3 Corrective pedagogical work for sensory aphasia

4 Corrective pedagogical work for dynamic aphasia

5 Corrective pedagogical work for efferent motor aphasia

Conclusion

Bibliography

Introduction

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

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

1. Aphasias and their classification

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

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

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

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

Acoustic-mnestic aphasia is characterized by inferior auditory-verbal memory - a reduced ability to retain a speech sequence within 7 ± 2 elements and synthesize the rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence; while searching for the right word, pauses occur, filled with introductory words, unnecessary details and perseverations. Derivatively, narrative speech is grossly violated, the retelling ceases to be adequate to the model. The best conveyance of meaning in such cases is ensured by excessive intonation and gestures, and sometimes by speech hyperactivity.

In the experiment, elements located at the beginning and end of the stimulus material are better remembered, and the nominative function of speech begins to suffer, which improves when the first letters are prompted. The interval for presenting words in a conversation with such a patient should be optimal, based on the condition “before you forget.” Otherwise, the understanding of complex logical and grammatical structures presented in speech form also suffers. Persons with acoustic-mnestic defects are characterized by the phenomenon of verbal reminiscence - better reproduction of material several hours after its presentation. Impaired auditory attention and narrowing of perception play a significant role in the causal structure of this aphasia. In the nominative function of speech at the image level, this defect manifests itself in a violation of the actualization of the essential features of an object: the patient reproduces the generalized features of a class of objects (objects) and, due to the failure to distinguish the signal features of individual objects, they are equalized within this class. This leads to equal probability of choosing the desired word within the semantic field (Tsvetkova). Acoustic-mnestic aphasia occurs with damage to the middle-posterior parts of the left temporal lobe (21st and 37th fields).

Actually, amnestic (nominative) aphasia manifests itself in difficulties in naming objects that are rarely used in speech while maintaining the volume of speech retained by ear. Based on the word heard, the patient cannot recognize an object or name the object when it is presented (as in the acoustic-mnestic form, the nomination function suffers). Attempts are being made to replace the forgotten name of an object with its purpose (“this is what it is written with”) or with a description of the situation in which it occurs. Difficulties arise when choosing the right words in a phrase; they are replaced by speech cliches and repetitions of what was said. A hint or context helps you remember something you’ve forgotten. Amnestic aphasia is the result of damage to the posterior inferior parts of the parietal region at the junction with the occipital and temporal lobes. With this variant of localization of the lesion, amnestic aphasia is characterized not by poor memory, but by an excessive number of pop-up associations, which is why the patient is unable to select the right word.

Optical-mnestic aphasia is a variant of a speech disorder that is rarely identified as an independent one. It reflects pathology on the part of the visual system and is better known as optical amnesia. Its occurrence is caused by damage to the posterior-inferior parts of the temporal region, involving the 20th and 21st fields and the parieto-occipital zone - the 37th field. In general nestic speech disorders such as the nomination (naming) of objects, this form is based on the weakness of visual representations of the object (its specific features) in accordance with the word perceived by ear, as well as the image of the word itself. These patients do not have any visual gnostic disorders, but they cannot depict (draw) objects, and if they do draw, they miss and under-draw details that are significant for identifying these objects.

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

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

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

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

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

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

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

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

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work for acoustic-mnestic aphasia

Patients with acoustic-mnestic aphasia experience increased performance, emotional lability, and frequent bouts of depression due to even minor speech errors.

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

To overcome a violation of speech memory, it is necessary either to restore the system of visual representations of an object, its essential, distinctive features, or to gradually expand the volume of auditory-verbal memory, impaired purely by the acoustic signs of the perception of a word combination, as well as to overcome expressive agrammatism, which is close in its characteristics to expressive agrammatism in acoustics. - Gnostic aphasia.

To overcome speech disorders in patients with acoustic-mnestic aphasia, the speech therapist relies on their preserved mechanisms for encoding speech utterances, i.e., describing the characteristics of an object, introducing words into various contexts, and drawing up external supports that allow the patient to maintain varying amounts of speech load.

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

Restoration of auditory-verbal memory. Improvement of auditory-verbal memory occurs based on visual perception. A series of subject pictures are laid out in front of the patient, the names of which are first read and written several times. This way the patient knows what he will hear. This is how the prerequisites for acoustic anticipation are formed. The speech therapist does not focus the patient’s attention on the need to show the object in the order presented. In speech, words are connected by a certain intention of the statement, so first the patient is offered pictures of one, then two, three semantic groups: hare, plate, table, gun, forest, fork, fox, cup, stove, pan, knife, cucumber, apple, hunter , grandmother, etc., then ask him to show objects that can be included in a given situation.

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

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

Restoring a written statement is one of the main forms of expanding the lexical composition of speech. The comprehensiveness of the sound-letter analysis of the composition of the word and the significant preservation of phonemic hearing allows, from the very first days of correctional pedagogical work, to involve patients in the compilation of written texts, active work on expanding vocabulary, and overcoming agrammatism.

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

Agrammatism of agreement in the gender and number of the main members of a sentence is overcome by replacing nouns with pronouns and pronouns with nouns, as well as by composing phrases based on supporting words.

2.2 Corrective pedagogical work for semantic aphasia

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

The basis for overcoming impressive agrammatism and amnestic difficulties is to rely on the preserved mechanisms of detailed, planned written and oral expression. Defects of the highest paradigmatic level of encoding and decoding of speech messages are overcome by involving the higher stages of the syntagmatic level, namely planning, constructing mental actions carried out by the frontal regions in relationship with all gnostic departments, providing a lower, phonemic level of the speech act.

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

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

Patients with semantic aphasia use similar, poorly developed sentences in expressive speech. Their written speech is also monotonous. In order to restore and expand the patient’s use of various syntactic structures, at the initial stage of recovery, exercises are used to compose various complex sentences using the conjunction words if, so that, when, after, however... etc.

As the constructions of complex sentences are restored, patients are asked to use certain word combinations when writing essays based on pictures by famous artists, taking into account the era depicted in the picture, the plot, its details, an explanation of the reason for their introduction and the plot of the picture.

Overcoming impressive agrammatism. Patients with semantic aphasia have a hard time experiencing problems with understanding seemingly simple tasks. Work to overcome impressive agrammatism should be carried out without directly explaining to the patient his difficulties and mainly in cases where the patient can or should return to study or work. A sufficient degree of preservation of the understanding of situational speech in semantic aphasia in patients who do not return to educational or work activities due to old age allows us to limit ourselves to restoring their orientation in the clock dial, in solving simple arithmetic operations (addition, subtraction, multiplication and division within one to two thousand).

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

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

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

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

Restoring the understanding of complex logical and grammatical constructions goes through the stage of detailed, repeated description and discussion in various contexts.

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

So, unnoticed by himself, in a non-traumatic environment that does not create an intellectual inferiority complex, about the process of creative, interesting work, the patient masters in expressive speech various syntactic constructions, cause-and-effect subordinate clauses, participial and adverbial phrases.

While reading his “works,” the patient decodes texts that are close to him, after which he proceeds to read texts of varying degrees of complexity, retell them, and clarify the meaning of various phrases in cases where he misunderstood them.

2.3 Corrective pedagogical work for sensory aphasia

The majority of patients with acoustic-gnostic sensory and acoustic-mnestic aphasia, as a rule, have increased performance and desire to overcome speech disorders. They can work for many hours a day, sometimes in the evening and at night, i.e. they are often in a constant “working” state. These patients have a pronounced state of depression, and therefore the speech therapist must constantly encourage them, give them only feasible homework to complete, inform the doctor about their condition, not allow them to work in the evenings and at night, and reduce the amount of homework.

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

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

Special work to restore phonemic hearing goes through the following stages:

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

First, the speech therapist gives contrasting pairs of words separately (for example, cat - grapes), selects corresponding pictures for each pair of words and writes the corresponding words in clear handwriting on separate strips of paper. Then, the patient is allowed to listen to these words and correlate the sound image of the elephant with the picture and signature underneath it. choose one or another picture according to the assignment, arrange captions for pictures, pictures for captions. At the first stages of classes, with severe severity of phonemic hearing impairment, the number of elements worked on should not exceed four. Then, from lesson to lesson, the speech therapist brings the number of contrasting words differentiated by ear to 10-12, places in front of the patient not 4, but 6 or 8 pictures with captions and invites the patient to first sort out the captions and then find the pictures according to the assignment: Show while standing. Show me the bike. Show where the cancer is, etc.

At the second stage, differentiation is carried out between words with a similar syllable structure, but distant in sound, especially in the root part of the word: fish - legs, fence - tractor, watermelon - ax, paddle - cat, hat - brand, cup - spoon, etc. Work at this and all subsequent stages of restoring phonemic hearing is also carried out based on object pictures, captions, copying, reading aloud, and developing acoustic control of speech.

At the third stage, work is carried out to differentiate words with a similar syllable structure, but with initial sounds that are distant in sound: cancer - poppy, hand - flour, oak - tooth, house - catfish, cat - mouth, stump - shadow, hand - pike; with a common first sound and different final sounds: beak - key, knife - nose, night - zero, lion - forest, rum - mouth, crowbar - forehead, etc.

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

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

To consolidate the unambiguous perception of phonemes, various tasks are used to fill in missing letters in a word and phrase, words with oppositional sounds missing in a phrase, the meaning of which is clarified not with the help of a picture, but through the phraseological context. For example: insert into the text the words carcass, shower, business, body, be, path, moisture, flask, daughter, dot, Don, tone, viburnum, Galina, etc.

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

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

Overcoming verbal paraphasia is carried out by discussing with the patient various characteristics of objects according to their contiguity and contrast, by function, instrumental affiliation, by categorical basis. The speech therapist offers to fill in the missing verbs and nouns in the sentence, select nouns, adverbs to the verb, adjectives and verbs to the noun..

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

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

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

aphasia speech correctional pedagogical

2.4 Corrective pedagogical work for dynamic aphasia

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

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

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

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

Due to the fact that in the first variant of dynamic aphasia it is mainly the composition of texts, rather than phrases, that is disrupted, a series of sequential pictures connected by one plot are used as external supports.

The speech activity of patients will increase in the process of creating special speech situations-stages by the speech therapist, where the initiative to conduct a dialogue belongs to the patient. To facilitate dialogue, the speech therapist first discusses the topic with the patient, offering him interrogatives, “key” words that he can use in the conversation, and a plan. It also makes it easier to conduct a dialogue by addressing the speech therapist or other interlocutors by name and patronymic. In classes to stimulate speech activity, you can stage a conversation with a doctor, in a store, in a pharmacy, at a party, etc. The patient can be the leader in a conversation about the work of a writer, artist or composer, when discussing work of art, when discussing television programs. He can be given instructions to verbally convey to someone the speech therapist’s request.

In milder forms of dynamic aphasia, the speech therapist asks the patient to retell the text, first using an expanded questionnaire, then using key questions for individual paragraphs of the text, based on a monosyllabic, condensed plan. At the same time, the speech therapist teaches him to make independent plans for texts, first expanded, then short, collapsed. Finally, after a preliminary plan has been drawn up, the patient retells the text without looking at this plan. Thus, the plan for retelling what was read is internalized.

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

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

Restoration of written speech. Dysgraphic disorders in the writing of patients are rarely observed. However, they experience significant difficulties in composing written text. The presence of errors when writing indicates that patients have signs of efferent aphasia.

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

2.5 Corrective pedagogical work for efferent motor aphasia

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

Restoration of expressive speech. Overcoming the impaired pronunciation aspect of speech begins with the restoration of the rhythmic-syllabic scheme of the word, its kinetic melody.

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

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

To clarify the syllabic and. sound composition of a word, a visual representation of the word diagram is used.

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

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

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

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

For example, in the phrase for the picture “The boy goes to school,” the speech therapist first stimulates calling the word to school, and then, using leading questions, moves on to the word goes.

In a humorous manner, the speech therapist teaches the patient to listen attentively to the question and answer it emotionally, especially if it does not correspond to the picture. For example, a speech therapist asks: Is the boy flying to school? Maybe the boy goes to school by car? Look carefully, maybe it’s not a boy, but a grandmother? To these questions, patients, as a rule, respond emotionally: “No, this is not a grandmother, but a child” (or a boy), “not by car, but on foot,” “not flying, but walking.” Playing out an object drawing, the speech therapist asks the patient questions about what the object is intended for, what can or should be done with it, for example, to eat (it must be washed, cooked, etc.), what are the properties of the object, etc.

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

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

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

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

Restoration of reading and writing. With gross efferent motor aphasia, reading and writing may be in a state of complete collapse. In this regard, individual picture alphabets are being developed for patients, in which each letter corresponds to a specific picture or word that is significant for the patient, for example: a - “watermelon”, b - “grandmother”, c - “Vasily”, etc. Using familiar words, the patient finds in the alphabet the letters necessary to compose a syllable and a word. Using the usual split alphabet, you can combine syllables to form different words. At first these will be one-syllable words, then two-syllable, three-syllable, etc.

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

Subsequently, patients with gross efferent motor aphasia are given tasks to fill in missing vowels and consonants in simple words under pictures, and fill in letters in phrases and texts. A sound-letter analysis of the composition of a word is carried out using leading questions and an analysis of syllables. Having composed a word from a cut alphabet, the patient writes it down in a notebook.

After mastering the sound-letter analysis, the speech therapist gives an auditory dictation from easy phrases. In this case, the patient must pronounce each word according to its sounds, sometimes first putting together especially difficult words from the letters of the split alphabet.

In the later stages, patients can be offered to solve simple crossword puzzles, compose various short words from the letters of a polysyllabic word, i.e., patients are offered speech games, but in a simplified form.

Restoration of reading in cases of severe severity of efferent aphasia begins with the patient’s global reading of words and phrases, with the addition of these words to subject and plot pictures, and the selection of words related to each other in meaning.

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

An important place in restoring the “sense of language” is occupied by exercises for presenting grammatically correct and specially distorted grammatical constructions to patients. First, the speech therapist explains to the patient which constructions correspond to grammatical laws and rules and which do not.

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

6 Corrective pedagogical work for afferent motor aphasia

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

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

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

With moderate severity, work is carried out to consolidate articulatory skills, to overcome literal paraphasia, stimulate expressive speech, difficulties in pronouncing words with a combination of consonants, expressive and impressive agrammatism: understanding the meaning and use of prepositions that convey the spatial relationship of objects.

With a mild degree of severity, work is carried out to overcome articulatory difficulties when pronouncing polysyllabic words with a combination of consonants, eliminating literal paraphasias and paragraphs, overcoming elements of expressive, mainly prepositional agrammatism, preparing the patient to return to study or work.

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

All work using this method excludes the use of a mirror, probes, and spatulas, since they increase the degree of voluntary movement and aggravate the articulatory difficulties of patients.

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

Distracting from voluntary articulation for play and imitation activities, the speech therapist asks patients to groan, as if a tooth hurts, to breathe on their hands, as if they were frozen, this gives the patient the opportunity to make not only oral, but also articulatory movements dictated by the intent of the action, its semantics.

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

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

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

During the first 2-3 lessons, it is necessary to repeatedly read syllables and words made up of the sounds a, u, m. Repeatedly reading the syllables am-am, ay, ua, am, um, and the words mom improves the ability to switch from one sound to another. Gradually other sounds are evoked.

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

-sounds of one articulatory group cannot be evoked simultaneously

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

Restoration of narrative speech. It is traditionally believed that expressive speech in patients with afferent motor aphasia is potentially preserved due to the preservation of the anterior speech regions that program speech utterance. And yet, a gross violation of the articulatory side of speech seems to block the possibility of a detailed statement. Even in “pure” cases of moderate afferent motor aphasia, difficulties may arise in the selection of words, especially prepositions and verbs with prefixes that convey spatial relations. These difficulties in choosing words and paragrammatism of the “telegraphic style” type are many times easier to overcome than the true agrammatism of the “telegraphic style”, characteristic of efferent motor aphasia.

With afferent motor aphasia, as with acoustic-gnostic sensory aphasia, difficulties in developing utterances are associated with ambiguity and diffuseness of the idea of ​​the sound and syllabic composition of a word. In this regard, as the sound-letter analysis of word composition is restored and articulatory difficulties are overcome, patients with afferent motor aphasia regain the ability to nominate all objects, actions, and qualities. Quite quickly, the patient’s vocabulary becomes unlimited, especially when composing phrases based on plot pictures. However, situational speech remains slow for a long time, poor both in its lexical composition and grammatical forms of expression. Patients at the residual stage of the disease “get used” to the fact that others understand them by gestures and facial expressions, by individual words that are difficult to pronounce, with intact internal speech, which patients use in communication.

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

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

As dialogic, very short, cliché-like conversational speech is restored, the speech therapist moves on to restoring monologue speech. Its main goal is the development of detailed oral and written expression in the patient. A patient with afferent motor aphasia quickly masters the scheme of direct and inverted construction of a phrase based on a plot picture, and the plan of a statement based on a series of plot pictures. As the sound-letter analysis of the composition of the word is restored, the speech therapist switches the patient from oral composing phrases from pictures to writing. In the presence of severe apraxia of the articulatory apparatus, oral speech may lag behind writing. Written speech in these cases turns out to be a support for restoring oral expression. Oral and written speech will be characterized by paragrammatisms, expressed in difficulties in using adverbs, prepositions, pronouns, inflections of nouns, verbs conveying different directions of movement. To prevent and overcome this paragrammatism at the stage of complete absence of speech and later, the patient’s understanding of the meanings of prepositions, pronouns, adverbs, etc. is clarified, missing prepositions and inflections of nouns are filled in, the use of verbs with prefixes is clarified: flew away, ran away, left, came running , came, etc. differentiation of the meanings of prepositions and prefixes: on - by, under - above, etc.

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

Restoration of reading and writing. At the residual stage of correctional pedagogical work, the restoration of reading and writing begins with the very first lesson on overcoming articulatory difficulties. Each pronounced sound, word, phrase is read by the patient, first in conjunction and reflected with the speech therapist, then independently. Much attention in restoring reading and writing is given to visual dictations of individual words, phrases and short sentences.

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

Dictations, especially in the initial and middle stages of recovery, consist of words and phrases previously worked out with the patient and read to him, since it is difficult for a patient with severe articulatory disorders to retain in auditory-verbal memory a relatively expanded text consisting of a large number of syllables, sound combinations, and words. Auditory dictations should alternate with visual ones.

In the initial stages of recovery, special attention is paid to vowel sounds, since they are often in a reduced position and are poorly felt by the patient. Preliminary listening to the text helps improve the reading process, since overcoming difficulties in articulation during the reading process distracts the patient’s attention from the content of the story and the understanding of certain phrases. Reading aloud and writing from dictation in patients with afferent aphasia is restored only after overcoming the basic articulatory difficulties, mainly as a result of prolonged copying of words, sentences of varying syllabic and sound complexity, and small texts.

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

In case of severe violations of expressive speech, the main attention is paid to restoring secondary impaired phonemic hearing, restoring orientation in space, clarifying the meanings of prepositions, adverbs, understanding personal pronouns in indirect cases, understanding elementary pairs of antonyms and synonyms.

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

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

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

At later stages, when one can rely on reading and writing, impressive agrammatism is overcome. The patient describes the location of the central object in relation to objects located to his left and right, above and below him. First, the drawings of one space group are described, then the other, that is, either horizontally or vertically. The speech therapist draws three objects in the patient’s notebook (for example, a Christmas tree, a house, a cup), circles the middle object and asks a question near it or above it, and uses arrows to outline a plan for describing the objects. The patient makes up phrases from it: “The Christmas tree is drawn to the right of the house and to the left of the cup” or “The house is drawn to the left of the cup and to the right of the Christmas tree.” This work is carried out by the patient for ~8-10 sessions. Then the arrangement of objects is also described with the prepositions above - below, with the adverbs above - below, further - closer, lighter - darker, etc. After the patient has mastered the description of the spatial arrangement of three objects, the speech therapist moves on to tasks for understanding written instructions, having previously worked through these diagrams in expressive speech, for example: Draw a Christmas tree to the right of the cup and to the left of the table. This prepares the patient to understand logical-grammatical structures by listening or reading.

Conclusion

Speech is interesting to study from many aspects: for example, as a device that generates physical sounds, as well as perceives and differentiates them; or as some apparatus that translates meaning into words. Moreover, this apparatus is in close connection with human consciousness and emotions; Its important feature is the presence in it of a language system produced by a community of people and individually acquired and used by each person.

Without speech there is no society. Speech is very important in a person’s life, especially important for a person as a member of society. Thanks to speech modern world and exists in such a developed form. Thanks to speech, the experience accumulated by all of humanity throughout its history is transferred to the younger generation.

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

Bibliography

1.Bein E.S. Aphasia and ways to overcome it. - M., 1964.

.Bernstein N.A. About the construction of movements. - M.: Medgiz, 1947. - 255 p.

.Burlakova M.K. Speech and aphasia. - M.: Medicine. - 279s.

.Wiesel T.G. Neurolinguistic classification of aphasia // Glererman T.B. Neurophysiological bases of thinking disorders in aphasia. - M.: Nauka, 1986. - pp. 154-200.

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

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

.Luria A.R. Higher cortical functions of humans. - M.: MSU, 1962. - 504 p.

.Tsvetkova L.S. Neuropsychological rehabilitation of patients. - Moscow State University: 1985. - 327 p.

.Shklovsky V.M., Vizel T.G. Restoration of speech function in patients with different forms of aphasia Part 1 and Part 2. (Guidelines). - M., 1985. - 348 p.

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– a disorder of previously formed speech activity, in which the ability to use one’s own speech and/or understand spoken speech is partially or completely lost. Manifestations of aphasia depend on the form of speech impairment; Specific speech symptoms of aphasia are speech emboli, paraphasia, perseveration, contamination, logorrhea, alexia, agraphia, acalculia, etc. Patients with aphasia need examination of their neurological status, mental processes and speech function. For aphasia, treatment of the underlying disease and special rehabilitation training are carried out.

General information

Aphasia is a decay, loss of existing speech caused by local organic damage to the speech areas of the brain. Unlike alalia, in which speech is not formed initially, with aphasia the possibility of verbal communication is lost after the speech function has already been formed (in children over 3 years old or in adults). In patients with aphasia, there is a systemic speech disorder, i.e., expressive speech (sound pronunciation, vocabulary, grammar), impressive speech (perception and understanding), inner speech, and written speech (reading and writing) suffer to one degree or another. In addition to speech function, the sensory, motor, personal sphere, and mental processes also suffer, so aphasia is one of the most complex disorders studied by neurology, speech therapy and medical psychology.

Causes of aphasia

Aphasia is a consequence of organic damage to the cortex of the speech centers of the brain. The action of factors leading to the occurrence of aphasia occurs during the period of speech already formed in the individual. The etiology of aphasic disorder leaves an imprint on its nature, course and prognosis.

Among the causes of aphasia, the largest share is occupied by vascular diseases of the brain - hemorrhagic and ischemic strokes. At the same time, in patients who have suffered a hemorrhagic stroke, total or mixed aphasic syndrome is more often observed; in patients with ischemic cerebrovascular accidents - total, motor or sensory aphasia.

In addition, aphasia can be caused by traumatic brain injury, inflammatory diseases of the brain (encephalitis, leukoencephalitis, abscess), brain tumors, chronic progressive diseases of the central nervous system (focal variants of Alzheimer's disease and Pick's disease), and brain surgery.

Risk factors that increase the likelihood of aphasia include old age, family history, cerebral atherosclerosis, hypertension, rheumatic heart disease, previous transient ischemic attacks, and head injuries.

The severity of aphasia syndrome depends on the location and extent of the lesion, the etiology of the speech disorder, compensatory capabilities, the patient’s age and premorbid background. Thus, with brain tumors, aphasic disorders increase gradually, and with TBI and stroke they develop sharply. Intracerebral hemorrhage is accompanied by more severe speech impairments than thrombosis or atherosclerosis. Speech restoration in young patients with traumatic aphasia occurs faster and more completely due to greater compensatory potential, etc.

Classification of aphasia

Attempts to systematize forms of aphasia based on anatomical, linguistic, and psychological criteria have been repeatedly made by various researchers. However, the classification of aphasia according to A.R. satisfies the needs of clinical practice to the greatest extent. Luria, taking into account the localization of the lesion in the dominant hemisphere, on the one hand, and the nature of the resulting speech disorders, on the other. In accordance with this classification, motor (efferent and afferent), acoustic-gnostic, acoustic-mnestic, amnestic-semantic and dynamic aphasia are distinguished.

Aphasia correction

Corrective action for aphasia consists of medical and speech therapy. Treatment of the underlying disease that caused aphasia is carried out under the supervision of a neurologist or neurosurgeon; includes drug therapy, if necessary, surgical intervention, active rehabilitation (physical therapy, mechanotherapy, physiotherapy, massage).

Restoration of speech function is carried out in speech therapy classes for the correction of aphasia, the structure and content of which depend on the form of the disorder and the stage of rehabilitation training. In all forms of aphasia, it is important to develop in the patient a mindset to restore speech, develop intact peripheral analyzers, and work on all aspects of speech: expressive, impressive, reading, writing.

With efferent motor aphasia, the main task of speech therapy classes is the restoration of the dynamic pattern of word pronunciation; with afferent motor aphasia - differentiation of kinesthetic features of phonemes. With acoustic-gnostic aphasia, it is necessary to work on restoring phonemic hearing and speech understanding; with acoustic-mnestic – overcoming defects in auditory-verbal and visual memory. The organization of training for amnestic-semantic aphasia is aimed at overcoming impressive agrammatism; for dynamic aphasia – to overcome defects in internal programming and speech planning, and to stimulate speech activity.

Corrective work for aphasia should begin in the first days or weeks after a stroke or injury, as soon as the doctor allows it. An early start of rehabilitation training helps prevent the fixation of pathological speech symptoms (speech embolus, paraphasia, agrammatism). Speech therapy work to restore speech in aphasia lasts 2-3 years.

Forecast and prevention of aphasia

Speech therapy work to overcome aphasia is very long and labor-intensive, requiring the cooperation of a speech therapist, the attending physician, the patient and his relatives. Speech restoration in aphasia is more successful the earlier correctional work is started. The prognosis for the restoration of speech function in aphasia is determined by the location and size of the affected area, the degree of speech disorders, the date of commencement of rehabilitation training, the age and general health of the patient. The best dynamics are observed in young patients. At the same time, acoustic-gnostic aphasia, which arose at the age of 5-7 years, can lead to complete loss of speech or subsequent severe speech development disorder (SSD). Spontaneous recovery from motor aphasia is sometimes accompanied by the onset of stuttering.

Prevention of aphasia consists, first of all, in the prevention of cerebrovascular accidents and TBI, and timely detection of tumor lesions of the brain.

Sections: Speech therapy

Introduction

In recent years, the healthcare system has been intensively working to improve speech therapy care for adults suffering from various speech disorders. Particular attention is paid to the problems of speech restoration in patients who have suffered a cerebral infarction (stroke), traumatic brain injury and other disorders of higher mental functions (HMF). Speech therapists at city clinics work closely with the Center for Speech Pathology and Neurorehabilitation (TSPRiN), the Institute of Defectology and Medical Psychology, and constantly improve their professional level by attending regular conferences and seminars at scientific Centers; participate in the analysis of patients on the basis of the methodological department of the Central Clinical Hospital. Correctional pedagogical work for aphasia is one of the components of speech therapy work to overcome speech disorders. It is based on the work of leading specialists in Russian neuropsychology - A.R. Luria, E.S. Bain, E.D. Chomsky, L.S. Tsvetkova, V.M. Shklovsky and their students. A.R. Luria - based on the study of higher cortical functions of humans, developed a classification of aphasias, which allows, when identifying a primary impaired neuropsychological prerequisite, to qualify the form of aphasia and their compatibility in various brain diseases. Using the developed A.R. Luria’s methods for studying impaired speech functions, as well as a number of other methods built on its basis, in particular, in the method of V.M. Shklovsky and T.G. Wiesel (1995), allows not only to determine the patient’s form of aphasia, but also to create a program of rehabilitation training, as well as to select methods and techniques for restoring speech, writing, reading and counting.

The return of lost speech function to a patient is, in principle, possible due to the brain’s ability to compensate. In the process of restoring impaired functions, both direct and bypass compensatory mechanisms take part, which determines the presence of two main types of directed influence. The first is associated with the use of direct disinhibiting methods of work. They are mainly used in the initial stage of the disease and are designed to use reserve intrafunctional capabilities. The second type of targeted overcoming of HMF disorders involves compensation based on restructuring the way the impaired function is realized. For this, various functional connections are involved. Those of them who were not leaders before the disease deliberately become so. This “bypass” of the function is needed to attract spare reserves. Direct teaching methods are designed to involuntarily recall premorbidly strengthened skills in the memory of patients. Bypass methods involve voluntary mastery of the way 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 one established in premorbid speech practice. Restoring a number of speech functions requires the connection of non-speech supports. Therefore, the sequence of work on speech and non-speech functions is decided in each specific case, depending on the combination of verbal and non-verbal components of the syndrome.

This didactic material is presented in the form of a manual for conducting examinations and further correction of speech in patients who have suffered a cerebral infarction in the initial period. The creation of this manual was caused by practical necessity, because... Many patients turn to a speech therapist after an illness, experiencing difficulties in communication, as well as after hospitals where there was no specialist (speech therapist) who gave them the first instructions on speech and social rehabilitation. Such patients need emotional and psychological correction, adapting them to the world around them. The manual also demonstrates the stimulating influence of nonverbal activity on speech function, creates conditions for listening to the speech therapist; reduces patient inactivity; increases concentration; promotes the development of self-control skills and control of the ability to perform purposeful activities. At an early stage of rehabilitation, it is very important for a speech therapist to instill in the patient and his family members an attitude toward restoring everyday speech. Constantly conducting psychotherapeutic conversations and encouraging the patient can not only lead him to social adaptation, but also, often, return him to work or study.

This manual consists of interconnected sections that make it possible to maximally identify the patient’s speech capabilities that have been preserved after the illness and use them for further rehabilitation. Work with the patient begins with identifying violations of subject gnosis using subject pictures:

a) analysis of the visual image (real objects and their images);
b) copying object images, drawing them from memory;
c) automation of words - names of objects by means of their “semantic play” in different contexts;
d) recognizing an object by its verbal description - the “riddle” technique.

Detection of violations of facial gnosis:
a) determining the degree of familiarity of the faces of famous people depicted in the pictures;
b) “revival” of the visual image of a person on the basis of verbal, cultural and other associations associated with him;
c) discussion of persons using the concepts “kind - evil, open - gloomy, smart - stupid”, etc.;
d) comparing faces, identifying similarities and differences.

Identification of impaired color gnosis:
a) semantic “playing out” of the concept of this or that color, its shades;
b) finding a given color in a series of multi-colored geometric shapes.

Identification of disorders of optical-spatial apraktoagnosia according to the dominant type. Restoration of higher generalized levels of spatial orientation activity.

Working with the clock:

a) “revival” of the role of numbers, arrows, divisions for minutes;
b) placing the hands on the clock according to the given time;
c) independent designation of a given time on a clock without hands.

Identification of spatial situations in which various objects are involved. Correlation of real spatial situations with their schematic representation.

Overcoming disorders in constructive activities:
a) “revival” of the concepts of shape and size;
b) identification of various objects and geometric shapes, unequal in size;
c) drawing objects and geometric figures from memory;
d) independent drawing of given objects and figures.

Identifying violations of the body diagram, overcoming violations of the body diagram:
a) showing parts of the body in a drawing, on oneself;
b) sketching, independent drawing of people and animals.

Identification of elements of affectively colored speech automatisms. Stimulation of understanding of situational and everyday speech (showing objects, answering questions in situational dialogue).

Disinhibition of the pronunciation side of speech:
a) conjugate, reflected and independent pronunciation of automated speech sequences;
b) singing songs with words;
c) reciting poetry.

Identification of phonemic hearing disorder. Stimulating understanding of everyday passive vocabulary:
a) display of real objects, pictures depicting objects and actions by their names.

Preparation for restoration of written speech:
a) selecting a given letter or syllable from the presented series by their name.

Reading Status Study:
a) recognizing and showing given words;
b) finding captions for pictures;
c) reading a sentence and matching a picture to it.

Intelligence Research. Categorical thinking:
a) display of objects, classification by topic (furniture, clothing, dishes, food);
b) “fourth extra” – exclusion of the fourth “extra” item.

Analytical-synthetic thinking:
a) understanding the meaning of plot pictures and stories.

Account Research:
a) display of numbers with different bit structures;
b) solving arithmetic examples;
c) determination of the arithmetic sign in given examples.

This manual is intended for a wide range of specialists involved in the restoration of speech and other HMF in patients with cerebral infarction in the initial period.