The lesion in afferent motor aphasia. Afferent (articulatory) motor aphasia. What to do in case of severe aphasia

It is a systemic disorder of speech activity with the leading role of a violation of the kinetic aspect.

Localization of the focus - mainly in the posterior-lower parts of the premotor region (posterior frontal cortex) of the left, dominant in speech, hemisphere of the brain ("Broca's area") - field 44 and partially 45.

With the complete destruction of the zone, patients cannot utter almost a single word. When trying to say something, they make inarticulate sounds. At the same time, they understand the speech addressed to them (and individual words and whole phrases). Often in the oral speech of patients there is one word or a combination of words (a verbal stereotype - "embolus"), which becomes a replacement for all words. Patients pronounce it with different intonations, trying to express their thoughts.

In the mechanisms of speech impairment, two interacting moments can be distinguished here.

1. A speech defect caused by a violation of the kinetic melody, when the organization of speech motility is disturbed, a smooth change in articulatory movements, a defect in the unfolding of an action, i.e., the use of the so-called current successive (sequential) synthesis. This is expressed in speech by gross perseveration, as well as by difficulties in coordinating simultaneously performed actions (for example, the combined implementation of an answer with a gesture and a word), an inability to analyze what was heard, an inability to retain a speech-auditory series, and alienation of the meaning of words. It is often accompanied by gross pronunciation speech disorders: deautomatization (loss of fluency of speech), stammering, blurred pronunciation.

Example. The phrase "My eldest son is a student of the institute" is pronounced by the patient as follows: "Son., my... mon... now... you see... her... her... how it is., son.. . old-fashioned ... a hundred ... chilling ... ". Patients with this form of aphasia can pronounce individual sounds (sometimes words or whole short sentences, depending on the severity of aphasia), but all difficulties begin as soon as you need to move on to pronouncing a series of sounds (words, sentences). Difficulties in inhibiting previous speech acts and switching to subsequent ones lead to perseverations.

To a lesser extent, the repetition of words and short simple phrases, the negotiation of unfinished simple sentences are disturbed. Independent and dialogic speech is either absent (embolophasia) or very poor, monosyllabic. The choice of words is difficult, pauses are filled with introductory and stereotyped words, interjections.

Difficulties in the smooth flow of active oral speech, a violation of its automation lead to a secondary defect in such forms of speech activity as reading (reading aloud and to oneself is grossly disturbed), writing (all types) and understanding oral speech (with certain sensitized samples).

Violations of the melody of a motor act can also be detected outside of speech activity in the form of defects in dynamic praxis - perseveration, synkinesis, sometimes motor disinhibition is observed.

2. The second moment in the syndrome of efferent motor aphasia is inhibition or disintegration of previously formed conditioned reflex connections between speech units. The oppression of past experience, previously hardened stereotypes, is expressed in the fact that at all levels of oral independent speech, reading and writing - from letters to words, phrases, speech turns - there are defects of the amnestic type. Therefore, the efferent form of aphasia is sometimes called "verbal", since the names of objects, letters, the laws of the language, including spelling rules, are forgotten. In speech there are no prepositions, ligaments, adverbs, adjectives. Mostly nouns in the nominative case are used and less often - verbs in the infinitive ("telegraphic style"). One's own sense of grammatical stereotypes is lost, while the ability to distinguish grammatical inconsistencies in sentences proposed by ear is preserved.

Patients with efferent motor aphasia can easily pronounce automated sequences (for example, ordinal counting) and ordinary speech with a small choice of alternatives (for example, "At the very blue ..."). However, counting backwards (from 10 to 1) is practically unavailable, i.e. minimal arbitrariness reduces the possibilities of oral speech.

Reflected speech is also not grossly disturbed, with the exception of the repetition of complex words and polysyllabic phrases. Gross reading disorders, up to complete disintegration, are typical for gross and severe aphasia, but occur in moderate and, as an exception, in mild aphasia. Reading is more dependent on the preservation of oral speech and is more complete than writing. Spelling errors are very diverse: omissions of letters, especially vowels, difficulties in finding the right grapheme, less often - rearrangement of letters, spelling errors (they write as they hear). The telegraph style is more pronounced in written presentations than in oral ones. The restoration of writing, as a rule, lags far behind the restoration of speech. In patients with efferent motor aphasia, there are no signs of parietal syndrome (although there may be difficulties associated with keeping instructions for the corresponding samples).

The state of oral praxis is assessed separately according to its three types: elementary, articulatory and symbolic. Disorders of articulatory praxis are not detected in this form of aphasia. Pronounced violations of elementary oral praxis occur in severe aphasia: gross or severe. In all patients, to some extent, violations of symbolic oral praxis are observed.

Afferent motor aphasia

Afferent motor aphasia occurs when the lower parts of the parietal lobe of the left dominant hemisphere are affected. There are two variants of afferent motor aphasia. The first is characterized by a violation of the spatial simultaneous (i.e., simultaneous) synthesis of the movements of various organs of the articulatory apparatus and the complete or partial absence of situational speech. The second variant is called conductive aphasia and is characterized by a significant preservation of situational speech with a gross breakdown of repetition, naming, and other arbitrary types of speech. Speech understanding in afferent motor aphasia is impaired due to a secondary impairment of phonemic hearing. With afferent motor aphasia, constructive-spatial apraxia is usually observed, and with conduction aphasia, spatial disorientation is also observed. The second variant (conduction aphasia) is typical for persons with latent left-handedness.

AFFERENT KINESTHETIC MOTOR APHAASIA

Afferent kinesthetic motor aphasia occurs when the secondary zones of the post-central and lower parietal regions of the cerebral cortex are damaged, located behind the central, or Roland, furrow (Fig. 18, fields 7, 40). The secondary fields of the postcentral and lower parietal regions are closely related to the primary fields, which are characterized by a clear somatotopic structure. Nerve fibers that carry impulses from the lower opposite limbs are located in the upper sections of this zone. Nerve fibers carrying impulses from the upper limbs - in the middle sections, impulses coming from the face, lips, tongue, pharynx - in the lower post-central sections. This projection is built not according to a geometric, but according to a functional principle: the more important this or that area of peripheral tactile-kinesthetic receptors of one or another active organ is and the greater the degree of freedom this or that motor segment has: joint, phalanx of fingers, tongue, lips etc., the greater the territory of its representation in the somatotopic projection of the cortex. It is significant that the somatotopic projection of the organs involved in the articulation of sounds is much more represented in the left hemisphere, which is dominant in speech.

It is known that each speech sound is pronounced by the simultaneous switching on or off of a certain group of spatially organized articulatory organs. Thus, the secondary fields, which take a complex, simultaneous part in the organization of one or another phoneme, are connected with the primary, projection fields. However, it is not always taken into account that the bow of the lips and tongue during pronunciation m And n is less stressful than at b and p, d etc. The most tense is the bow when pronouncing deaf phonemes whale, but the vocal folds are in a relaxed state. Difficulties in determining these subtle differential kinesthetic signs of phonemes explain the occurrence of gross agraphia, alexia, and impaired speech understanding in afferent motor aphasia.

Violation of expressive speech. A. R. Luria notes (1969, 1975) that there are two variants of afferent kinesthetic motor aphasia. The first is characterized by a violation of the spatial, simultaneous synthesis of the movements of various organs of the articulatory apparatus and the complete absence of situational speech with a gross severity of the disorder. The second variant, which is called “conduction aphasia” in the clinic, is distinguished by the significant preservation of situational, cliché-like speech with a gross breakdown of repetition, naming, and other arbitrary types of speech. This variant of afferent kinesthetic motor aphasia is characterized mainly by a violation of the differentiated choice of the method of articulations and a simultaneous synthesis of sound and syllabic complexes included in the word.

In the first variant of afferent kinesthetic motor aphasia, severe apraxia of the articulatory apparatus can lead to a complete absence of spontaneous speech. Attempts to arbitrarily repeat sounds lead to chaotic movements of the lips and tongue, to literal (sound) substitutions. Careful peering of the patient into the articulation of a speech therapist leads only to finding either a method or an organ of articulation, which generates a shift in sounds m - P. - b, n - d -m- l, and - s, o - at etc., which is explained by a violation of the kinesthetic assessment of the degree of closure of the articulatory organs when pronouncing sounds, the disintegration of the movements of such organs as the soft palate and vocal folds. At later stages, patients pronounce the word robe as "khanat" or "walk", house as "scrap" or "volume", i.e. one phonemic paradigm is replaced by another.

Afferent kinesthetic motor aphasia is characterized by difficulties in analyzing the structure of complex syllables. Patients split a closed syllable into two open ones, split consonant clusters in a syllable, omit consonant sounds. Therefore, words are often here, there, here, table, hat etc. sound like “tu-t”, “ta-m”, “vo-t”, “s-to-l”, “sha-p-ka”, etc.

As the pronunciation side of speech is restored, the preservation of the syntagmatic side of the speech utterance is revealed. In some cases, slight articulatory overtones may remain, resembling dysarthria in some cases (pseudodysarthria as a result of apraxia of the articulation apparatus), in others - a slight foreign accent, expressed not in a change in intonation, but in slowness and artificiality of pronunciation of words, deafening of voiced voices and the absence of soft consonants. , in rare literal paraphrasies.

Breakdown of understanding. At an early stage after an injury or stroke with afferent aphasia, a gross violation of speech understanding can be observed. This is explained by the fact that in the process of understanding a significant role is played by kinesthetic control, the conjugated, hidden pronunciation of a message perceived by ear.

The period of significant incomprehension of speech in patients with afferent kinesthetic motor aphasia is short (from one day to several days after a stroke), after which they have a rapid recovery of understanding of situational colloquial speech, understanding the meanings of individual words, and the ability to follow simple instructions.

For a long time, patients have specific features of impaired understanding. They consist in secondary violations of phonemic hearing. With afferent kinesthetic motor aphasia, there are difficulties in recognizing by ear words with sounds that have common signs in place and method of articulation (labial: b - m- P, anterior lingual: d - l -m- n, sonorous fricative: n - X - sh, sonorants and vowels, etc.). These difficulties of phonemic analysis are generally compensated by the redundancy of phonemic differences between words in colloquial speech and allow them to understand it, but they are reflected in the letters of patients. Violation of the understanding of the word worsens in cases where the patient tries to pronounce it, i.e., it includes the initially impaired kinesthetic control.

Along with articulatory disorders, leading to blurred speech perception, in afferent kinesthetic motor aphasia, there are difficulties in understanding the lexical means of the language that convey various complex spatial relationships. These include, first of all, the prepositional impressive agrammatism characteristic of this form of aphasia: while understanding the meanings of individual prepositions is preserved, the possibility of arranging three objects in space is violated, for example, putting or drawing a pencil under a brush and over scissors, i.e., there are violations of understanding characteristic of semantic aphasia.

Significant difficulties in understanding cause verbs with prefixes (turn, return etc.), which, in addition to the spatial feature, also differ in ambiguity. Particular difficulties are experienced in understanding the meanings of personal pronouns used in indirect cases, which is explained by the lack of subject relatedness in them, the presence of a different spatial orientation, an abundance of phonemic changes (for example, to me -me - by me).

With afferent kinesthetic aphasia, as a rule, constructive-spatial apraxia is observed, and in the second variant, spatial disorientation. The latter exacerbates the idea of a poor understanding of speech by patients; for example, patients have extreme difficulty choosing a book, album, or other item on a bookshelf.

The complexity and variety of features of impaired understanding in afferent kinesthetic motor aphasia is compensated in everyday speech by redundancy, the specificity of the situation, which creates a picture of the relative safety of their understanding of speech.

Reading and writing impairment. In afferent kinesthetic motor aphasia, the degree of reading and writing impairment depends on the severity of apraxia of the articulatory apparatus. Reading and writing are most grossly impaired in severe apraxia of the entire articulatory apparatus. The restoration of reading and writing occurs in parallel with overcoming it. The recovery of internal reading may outpace the recovery of written speech. When writing words from dictation, when naming objects in writing, when trying to communicate in writing with others, all articulatory difficulties affect, i.e., a lot of literal paragraphs appear, reflecting a mixture of vowels and consonant phonemes that are close in place and method of articulation, consonants (sonor) are skipped .

In the second variant of afferent kinesthetic motor aphasia, patients with difficulty maintain the order of letters in a word, represent them in a mirror image (water - yes, window __

"onko"), skip vowels or write all consonants first, and then vowels, and, as a rule, they retain the idea of the presence of a sound in a word, for example, skipping a letter yo in a word leads, the patient puts two dots over d.

In some cases, with gross afferent kinesthetic motor aphasia, there is a dissociation between the complete absence of oral speech and some preservation of written speech, which serves as a means of communication with others. This preservation of written speech is explained by the presence of predominant apraxia only of the pharynx and larynx, which in the Russian language perform the role of presetting all articulatory movements (N. I. Zhinkin, 1958) and performing phonation of vowels and voiced consonants.

As reading and writing recover, the number of literal paragraphs decreases.

The second variant of afferent kinesthetic motor aphasia is typical for individuals with latent left-handedness with damage to the parietal parts of the left hemisphere.

This is a violation of the motor link of speech, due to damage to the premotor zone of the cerebral cortex. The basis of the clinical picture is the difficulty of transition between articulatory postures, the inertness of speech processes, dysprosody, the presence of perseverations, repetitions, and a secondary disorder of written speech. Efferent motor aphasia is diagnosed by neurological and speech therapy examination, cerebral MRI, if necessary, a lumbar puncture is performed, and cerebral circulation is assessed. Speech therapy correction is combined with drug treatment, carried out against the background of etiopathogenetic therapy of the causative pathology.

ICD-10

R47.0 Dysphasia and aphasia

General information

In 1861, the Parisian surgeon Paul Broca discovered the motor speech center located in the lower frontal gyrus of the left hemisphere, which was later called Broca's center. The specified zone of the cerebral cortex is the motor (motor) center of speech, which controls the articulatory organs. When it is damaged, efferent motor aphasia occurs, described in detail by the founder of neuropsychology, Professor A. R. Luria. Most often, pathology is observed after a stroke in the basin of the left middle cerebral artery. The peak incidence occurs at the age of 55-65 years. Specialists in the field of clinical neurology note that in almost 50% of patients, combined efferent and afferent motor aphasia occurs.

Causes

The basis of the disease is a violation of the kinetic program for the implementation of the statement, associated with an organic lesion of Broca's center (field 44, 45 according to Brodman). Etiofactors leading to damage and dysfunction of the premotor cortex are very numerous. The main ones are:

Disorders of cerebral circulation. Acute or chronic disturbance of blood flow (thromboembolism, atherosclerosis, spasm) in the anterior branch of the middle cerebral artery on the left leads to hypoxic damage to the cerebral tissues of the speech center. Hemorrhagic stroke in the region of the precentral gyrus causes blood soaking and compression of the cortex of Broca's area.
Infectious and inflammatory diseases. Encephalitis, meningoencephalitis, brain abscess with localization of inflammatory changes in Broca's center potentiate its dysfunction. Slow infections of the CNS are characterized by activation of inflammation after many years of latency.
Traumatic brain injury. Possible direct destruction of the cortex at the time of injury. Secondary damage in brain contusion, subarachnoid hemorrhage, post-traumatic hematoma is associated with edema and compression of cerebral structures.
Tumors of the brain. Malignant neoplasias infiltratively germinate and destroy tissues, benign neoplasias compress them as they grow. Compression of the speech center is possible with a tumor lesion of the cerebral membranes located above it.
Epilepsy. The presence of an epileptogenic focus near Broca's center can cause its dysfunctional changes. Inadequate bioelectrical activity provokes malfunctions in the functioning of the center itself and the nerve pathways connecting it with other structures.
Degenerative processes. Multiple sclerosis, REM are accompanied by demyelination of nerve fibers. The absence of the myelin sheath disrupts the functioning of the efferent and afferent connections of the motor speech center.

Pathogenesis

Broca's center plays a leading role in the formation of complex muscle activity necessary for the coordinated work of the speech-motor organs (lips, cheeks, jaws, tongue, pharynx). Its defeat leads to a violation of efferent impulsation, which ensures timely denervation of the previous and innervation of the subsequent speech act. There is a disorder of oral-articulatory praxis, a distinctive feature of which is the difficulty of moving from one articulatory posture to another.

The consequence of the difficult transition between articles is involuntary repetitions of words, individual syllables, permutations, perseverations (obsessive repetitions of individual words, phrases). The disintegration of the skill of compiling a program of the sound-letter composition of a word becomes the cause of a violation of writing (dysgraphia), reading (dyslexia). Inertia extends to all speech processes, which leads to the loss of the "sense of language" - a poor understanding of figurative and hidden semantic meaning. Secondarily, auditory-speech memory is impaired.

Classification

The clinical symptoms of a speech defect vary considerably depending on the severity of the disorder. Accordingly, approaches and methods of speech therapy correction differ. Taking into account the characteristics of speech dysfunction, efferent motor aphasia is classified into three degrees of severity:

Light. Speech is expanded, there are speech stamps in it. Sometimes there is a syllable pronunciation of words. Difficulties in pronunciation are revealed when trying to repeat phrases after the doctor and name objects. Dialogic speech is stereotyped, insufficiently developed.
Medium heavy. Spontaneous speech is agrammatic, telegraphic style is observed. The statement is broken. Automated speech saved. When repeating and naming, perseverations arise. The dialogue contains echolalic responses.
heavy. Spontaneous speech production is absent, an attempt to speak turns into a repetition of a word fragment. There is a breakdown of the automated speech function, the difficulty of understanding inverted speech.

Symptoms

The syndrome is manifested by a violation of the timely transformation of articulation postures. There are numerous perseverations, repetitions of words and syllables. Defects in switching, perseveration are observed against the background of speech prosodic disorders - intonation, stress, rhythm of the speech flow. Speech is inexpressive, accompanied by errors in stress, is scanned. The construction of the phrase is broken. In a number of patients, nouns in the nominative case and verbs in the infinitive prevail, which determines the telegraphic type of statements.

The inertia of the flow of speech processes leads to the appearance of long pauses. A disorder in the regulation of word choice underlies the emergence of verbal paraphrasies - the use of artificially created words that distort the meaning and grammatical construction of a phrase. The repetition of individual sounds is completely preserved, difficulties are revealed when trying to repeat a series of sounds, a syllable, a word. In some cases, gross efferent aphasia is manifested by the inability to merge a consonant and a vowel into a single syllable. With a mild degree of defect, only the smoothness of articulatory transitions is lost.

Efferent aphasia is accompanied by gross dysgraphia. In severe cases, the patient cannot form a word from a set of letters; in milder cases, he allows perseveration, rearrangement and omission of letters and syllables. With gross dyslexia, reading is guessing, the patient correctly lays out the captions under the corresponding pictures. With an average degree of disorder, reading short sentences is available, but there are difficulties with reading comprehension. Mild motor aphasia proceeds without severe disorders of writing and reading.

Understanding of speech is mostly preserved, there are some difficulties in perceiving grammatically complex statements, misunderstanding of the figurative meaning, polysemy of the word, the meaning of proverbs. Patients are aware of their speech defect, but they cannot overcome it on their own. In most cases, aphasia is combined with right-sided hemiparesis, more pronounced in the upper limb and half of the face.

Complications

Mild efferent aphasia does not lead to a pronounced limitation of the patient's communication abilities. Moderate and severe degree of disorder significantly reduces the possibility of verbal communication up to the complete impossibility to express one's thoughts, desires, experiences. The situation is aggravated by motor insufficiency, which limits the patient's motor activity. Under the current conditions, in the absence of proper speech therapy and psychological support, there is a high risk of developing depressive neurosis and other neurotic disorders.

Diagnostics

Diagnostic search includes verification of the type of speech disorder, determination of the nature and extent of brain tissue damage. Basic diagnostic measures are neurological and speech therapy examinations. The list of required studies includes:

Consultation of a speech therapist-aphasiologist. Detects a disorder of the pronunciation side of speech (motor aphasia) with difficulty switching articulatory positions, chanting, telegraphism, perseverations, repetitions, agrammatisms. When diagnosing written speech, secondary dyslexia, dysgraphia is determined.
Neurologist's consultation. Examination of the neurological status states the presence of central hemiparesis and dysfunction of the facial nerve on the right. The data obtained indicate the location of the lesion in the area of the motor cortex of the left hemisphere.
brain MRI. Allows you to establish the morphological substrate of the disease. Visualizes intracranial volumetric formations (neoplasia, hematoma, cyst, abscess), stroke zones, inflammatory foci, demyelinating processes.
Study of cerebral hemodynamics. Helps to assess the nature and degree of cerebral blood supply disorders. It is carried out using MR angiography, duplex scanning, ultrasound of cerebral vessels.
Analysis of cerebrospinal fluid. Liquor is obtained by lumbar puncture if an infectious-inflammatory nature of the pathology is suspected. The analysis makes it possible to identify inflammatory changes, to isolate the pathogen.

Efferent motor aphasia is differentiated from other speech dysfunctions. Long pauses due to the inertness of speech processes are similar to stops in semantic aphasia associated with amnestic difficulties in finding the name of an object. However, the semantics of the word is not violated. Unlike the afferent variant, the efferent form of motor aphasia is not accompanied by literal paraphrasies in oral speech; the sound structure of syllables is preserved. It differs from dynamic motor aphasia in the preservation of the grammatical construction of phrases, and from acoustic-gnostic aphasia in reduced speech production.

Treatment of efferent motor aphasia

The basis of therapy is the etiopathogenetic treatment of the causative pathology. In stroke, general and differentiated therapy with vascular, thrombolytic or hemostatic agents is prescribed. With an infectious lesion, appropriate etiotropic therapy (antibacterial, antimycotic, antiviral) is carried out. Volumetric formations are an indication for a consultation with a neurosurgeon to decide on their radical removal. Speech defect correction is carried out as part of rehabilitation therapy, it includes two main components:

speech therapy classes. The general tasks of correction are the normalization of the work of the motor program of utterance with overcoming the difficulties of articulatory switching, the prevention of agrammatisms, and the restoration of sound-letter analysis. Rehabilitation work is carried out in stages in accordance with the severity of the speech defect.
Pharmacotherapy. It is aimed at the speedy restoration of the function of Broca's center by improving the metabolism of its neurons. In combined treatment, vasoactive, neuroprotective, vitamin, amino acid, nootropic pharmaceuticals are used. Equally important is adequate psychotherapeutic support for the patient.

Forecast and prevention

With successful treatment of the underlying disease, persistent speech therapy classes, a gradual restoration of speech function is observed. To overcome dyslexia, dysgraphia, special additional classes are required. In the case of a degenerative pathology, a tumor process, the prognosis is doubtful. Preventive measures are reduced to the prevention of cerebral lesions. Among them are proper nutrition, a healthy lifestyle, correction of arterial hypertension, prevention of injuries, toxic and carcinogenic effects, anti-epidemic measures.

Motor aphasia, or Broca's aphasia, is a severe speech disorder that occurs due to damage and dysfunction of the left frontal lobe of the brain, characterized by severe speech defects and difficulty in choosing words. Violation often occurs as a post-stroke complication, or the consequences of severe traumatic brain injury. Motor aphasia is not limited only to a violation of the articulatory functions of the speech apparatus.

The main types of motor aphasia and their description

Despite the prevalence in the adult population due to past illnesses and mechanical injuries, the syndrome also occurs in children. It proceeds in a mild and complicated form.

The first case is the preservation of the child's individual speech skills and vocabulary. In severe cases, the child stops talking at all, or utters exclusively meaningless and incoherent phrases.

The disorder is classified into several main types, which differ in their clinical presentation and degree of complexity. In total, physicians distinguish six main types of disorders.

Afferent (kinesthetic) aphasia

It occurs as a result of damage to the surface of the parietal lobe of the hemisphere responsible for speech. The mildest form of aphasia, which is characterized by general fluency and the absence of pauses. At the same time, there is a violation of articulation and paraphasic defects during reading, speaking and spontaneous speech.

The patient has an understanding and analysis of someone else's and his own pronunciation. Words that the patient cannot say are replaced with similar pronunciations.

Efferent aphasia

Systemic violation of speech function, characterized by the pronunciation of incoherent phrases and grammatically incorrect phrases by the patient.

Expressive speech is not initiated by the patient. Most patients are silent and prefer not to say the words out loud.

They are explained by the so-called "telegraphic style", where verbs are used in a single participle, or not used at all. There are long intervals in speech.

Gross violations of written speech are noted: the patient makes many mistakes, skips or changes some syllables and letters. Reading is significantly difficult, as is the name of the objects on the demonstration.

However, the patient can improve if he hears a literal prompt from a loved one or a specialist. The analysis of someone else's speech (both oral and written) is preserved in the patient.

Sensory motor aphasia

Motor aphasia develops when large vessels are damaged. Most often occurs due to previous heart attacks, when a large area of the cerebral artery is affected. In medical practice, it is called "total aphasia". It is characterized by a complete disorder of initiation, speech articulation and phonemic hearing.

Dynamic aphasia

The patient's speech is intermittent, has no intonation coloring; there is a difficult initiation of expressive speech and a slow restructuring of speech programs. The patient speaks slowly and indistinctly, his narration is telegraphic, characterized by pronounced monotony.

The disorder has certain similarities with afferent and efferent aphasia. The possibility of repeating individual words and phrases after the specialist is preserved.

Gross aphasia

The disorder is a transient complication of total aphasia and is characterized by severe speech disorders.

With gross aphasia, the patient cannot speak whole words or phrases. His speech is limited to monotonous snippets of words or lowing sounds, sometimes with intonational coloring.

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Recovery and correction of speech

The basis of corrective speech therapy measures is the reconstruction of the dynamic scheme of speech pronunciation. Produced methods for the development of oral, written, expressive and impressive speech.

On the advice of a speech therapist-aphasiologist, when working with motor aphasia, intensive classes are usually held to restore written speech and reading. As a rule, work with a specialist begins in the first weeks of a head injury or stroke, as soon as the permission of the attending physician is received.

The minimum terms of rehabilitation of speech function are 2 years.

On the video lesson on restoring speech with afferent / efferent aphasia:

Forecast and preventive measures

In some cases, motor aphasia tends to progress rapidly. If the speech disorder can be corrected, speech therapy treatment continues for a long time, and is more successful if it is started immediately at the time of detection of the disorder.

The result directly depends on the area of brain damage and the severity of the disease. Self-elimination of motor aphasia can provoke severe forms of stuttering in patients.

Effective preventive measures are to reduce the risk of traumatic brain injury or vascular accidents. Patients who are prone to transient ischemic attacks or who have had a stroke should always receive supportive care. The aspect of timely detection in the cerebral cortex is important.

Motor aphasia is a severe disorder that requires immediate medical attention. The patient needs both drug therapy and speech therapy correction, as well as constant work with a psychologist.

Ignoring the disorder and neglecting treatment can lead to a complete loss of articulatory speech functions. The sooner the treatment of the syndrome begins, the faster and easier it will be eliminated.

Kinesthetic disorder of formed speech, caused by a violation of the central regulation of the speech-motor apparatus. Occurs when the articulatory zone of the postcentral gyrus is damaged. It is clinically manifested by a decrease in speech production, articulation difficulties, a mixture of phonemes with a similar articulation mechanism, secondary dyslexia and dysgraphia. The basis for the diagnosis of afferent motor aphasia is speech therapy, neurological examination, MRI of the brain. The main pathology is being treated, medical support for cerebral functions (neurometabolites, vascular pharmaceuticals), speech therapy correction is being carried out.

General information

Expressive speech is the result of the coordinated work of all components of the articulatory apparatus: lips, tongue, pharynx, larynx, facial muscles. Cortical regulation of the speech process is carried out with continuous afferentation - informing the corresponding sections of the cortex about the location of each of the indicated speech organs. The motor aphasia caused by disturbance of processes of afferentation received the name "afferent". The term was introduced by the domestic researcher of aphasia, Professor A. R. Luria in 1969. The disease is common mainly among middle-aged and elderly patients; afferent childhood aphasia is rare. The defeat of several zones of the cortex leads to combined disorders - afferent-efferent motor, sensorimotor aphasia develops.

Causes of afferent motor aphasia

The disease occurs with an organic lesion of the parietal lobe in the region of the lower parts of the postcentral gyrus. Pathological changes can be ischemic, inflammatory, post-traumatic, toxic, compression in nature. The main etiological factors of damage are:

Strokes. They are the most common cause of aphasia. With a focal lesion of the lower parietal parts of the left postcentral gyrus, an afferent motor form of speech dysfunction is observed. In ischemic stroke, the death of neurons in this area is due to impaired blood supply due to thromboembolism or spasm of the supplying cerebral artery, in hemorrhagic stroke - compression of the tissues by the outflowing blood.
Traumatic brain injury. Brain contusions with crushing of tissues in the lower parietal areas lead to damage to neurons that receive afferent information from the articulatory organs. The formation of intracerebral hematoma, the increase in post-traumatic edema causes compression of neurons. As a result, afferent motor aphasia develops.
brain tumors. Gliomas, astrocytomas, medulloblastomas of the parietal lobe have a damaging effect by compressing surrounding tissues or destroying neurons due to their invasive growth. An increase in the volume of an intracerebral tumor causes the growing nature of speech disorders.
neurodegenerative processes. Alzheimer's disease, leukodystrophy, Pick's disease are accompanied by atrophic changes in the cortex. Atrophy can occur with a long-term epileptogenic focus of parietal localization. Progressive demyelination causes destruction of afferent connections. The result is a dysfunction of the affected parts of the parietal cortex - motor aphasia of the afferent form.
infections. Etiologically, various infectious lesions of the brain (encephalitis, encephalomyelitis, cerebral abscess), localized in the parietal lobe, lead to edema, microcirculation disorders, and intracellular changes in neurons. Dysfunction and death of the latter, violation of interneuronal interactions provokes the appearance of a speech disorder.

Pathogenesis

Normally, expressive speech is carried out due to the interaction of the departments of the post- and precentral cortex, in which the articulatory organs are represented. The efferent impulses that regulate the muscle contractions necessary for phonation are generated by the neurons of the precentral gyrus, taking into account information from the neurons of the postcentral gyrus. The latter receive afferent impulses from the muscles and ligaments involved in the process of sound formation. Etiofactors cause organic changes and dysfunction of the postcentral region. As a result, the mechanism of perception of afferentation, the connection with the precentral gyrus, is disrupted.

Without sufficient feedback on the state of the articulatory apparatus, the precentral regions cannot adequately regulate the phonation process. The result is speech apraxia - the loss of motor articulation skills, which in severe cases leads to a complete absence of speech production. Since kinesthetic control plays an essential role in the process of understanding what is heard, secondary disorders of phonemic hearing arise.

Classification

Afferent motor aphasia can have two forms that differ in their manifestations. The variability is due to the different representation of the articulatory organs in the postcentral gyrus of right-handed and left-handed patients. The classification was proposed by A. R. Luria:

First option accompanied by a disorder of spatial synthesis of movements providing articulation. With gross disorders, situational speech production is completely absent. Apraxia of the articulatory organs is observed.
Second option is called "conduction aphasia". Characteristic is the predominant preservation of cliché-like situational statements with pronounced violations of arbitrary types of speech. It occurs with left-sided (less often right-sided) lesions of the parietal hemisphere in ambidexters and patients with latent left-handedness.

Symptoms of afferent motor aphasia

Articulatory apraxia results in the inability to independently reproduce individual sounds. Making an attempt, the patient makes erratic movements of the tongue, lips, produces sound substitutions. The patient does better when trying to reproduce the sound by mimicking the doctor's articulation. However, a disorder in the kinesthetic analysis of the force of contact, the direction of movement of the articulatory organs, causes a mixture of sounds m-p-b, o-o, n-d-t, etc.

Phonemic substitutions persist for a long time against the background of a gradual restoration of speech function. The patient pronounces "house" as "tom", "Vova" as "Voma". Closed syllables are more difficult to pronounce, their fragmentation with the help of vowels is observed. The word "smoke" is pronounced as "smoke", "hat" as "sha-pa-ka". Difficulties in expressive speech force patients to use speech emboli for communication - short words, separate syllables that have a pronounced emotional coloring.

In the early period after TBI, stroke, afferent motor aphasia is accompanied by a misunderstanding of the heard speech. The condition is transient, lasting a few days. Difficult recognition by ear of individual phonemes with a common method of articulation (n-sh, b-m-p) persists for a longer time. The redundancy of the phonemic diversity of words allows patients to understand the statements addressed to them. Along with speech apraxia, constructive-spatial perception is impaired - patients cannot place three objects according to the instructions, are disoriented in a geographical map, etc.

Forecast and prevention

With successful treatment of the causative disease, persistent, correctly selected speech therapy correction, the prognosis is favorable. Along with the restoration of speech motor skills, writing and reading disorders regress. Some patients retain articulatory overtones that give the impression of a slight accent, and rare literal paraphasias may be present. Preventive measures include the whole range of techniques to prevent the impact of etiological factors. The main points are the prevention and timely treatment of cerebrovascular pathology, the prevention of injuries, infectious diseases, the exclusion of oncogenic influences.