Attack of aphasia. Aphasia - what is it? Aphasia: forms, types, treatment. Efferent type of disease

Speech is a human ability that distinguishes him from an animal. However, it happens that this function is violated for a number of reasons. Aphasia (what it is, will be discussed in the article) is a violation of the function of speech due to various kinds of organic lesions of those parts of the cerebral cortex that are directly responsible for the ability to speak.

Violations affect only already formed speech.

Causes of the problem

The main cause of this disease is an organic lesion of certain areas of the cerebral cortex. Factors that can provoke the development of the disease can affect the function of speech only during the period when the latter is already fully formed. In addition, various forms of speech are affected.

The most common causes of aphasia are:

ischemic stroke;
hemorrhagic stroke.

Aphasic syndrome is more often observed in those patients who have suffered a hemorrhagic stroke. This is especially true of mixed and total forms. If an ischemic stroke has been suffered, a completely different type of aphasia develops.

Other reasons

Other reasons include:

neoplasms in the brain, in particular both malignant and benign tumors;
surgical intervention in the cranium;
inflammatory processes in the brain, such as encephalitis, abscess or leukoencephalitis;
diseases of the central nervous system that progress, such as Pick's and Alzheimer's diseases;
traumatic brain injury.

Features of the course of the disease

The causes of the disease also affect the course of aphasia. In addition, the vastness and localization of brain damage, the premobid background (the state of the body before the onset of the disease) and the patient's compensatory capabilities have an impact. For example, if the cause of aphasia is cerebral hemorrhage, then the severity of the disease will be higher than with atherosclerosis or thrombosis.

Risk factors

Not always this or that event provokes the development of aphasia, since there are certain risk factors in the presence of which the likelihood of the disease increases significantly. These include:

old age (recovery of speech in young people is much faster than in the elderly);
development of hypertension;
cerebral atherosclerosis;
various kinds of head injuries (and even old ones);
rheumatic heart defects.

Classification: types of aphasia

The correct definition of the type of disease will allow the attending physician to draw up the optimal tactics for the treatment of this disease, to form a prognosis. There are several qualifications, but the most common is the one created by A. R. Luria. He identifies the following types of aphasia:

Sensory aphasia, or Wernicke's aphasia. Sensory zones are affected, which are located in the upper parts of the temporal gyrus of the brain. This type of disease is characterized by impaired phonetic hearing. This is expressed by the fact that the patient confuses some sounds. This leads to the fact that the words that the patient hears are completely incomprehensible to him. If the lesion is severe, then in addition to impaired phonetic hearing, other aspects of speech also suffer: expressive and impressive, and the person cannot read and write words correctly.
Acoustic-mnestic aphasia. The main reason is the defeat of the middle third of the temporal gyrus. With this type of disease, auditory-speech memory first of all suffers, that is, a person understands what is said to him, but cannot remember it. He can read and write off information without problems. In connection with such disorders, speech becomes more scarce, it is often possible to observe omissions of nouns or their replacement with other similar words.
Afferent motor aphasia develops as a result of damage to the lower parts of the postcentral cerebral cortex. As the name suggests, problems can be associated not only with speech, but also with movements. In particular, the patient has difficulty with articulatory movements. In severe disorders, the patient can pronounce only some sounds. This form is also characterized by the fact that the patient speaks only some words that were often used before the illness. With an external examination of the articulatory apparatus, one can notice that a person does not speak his own language, for example, he cannot touch his lips or puff out his cheeks.
Efferent motor aphasia associated with disorders in Broca's area. It is located in the lower parts of the premotor zone of the brain. Violations are as follows: problems with switching from one articulation form to another. If the lesion is mild, then the patient chooses those words that have the same syllables. Also often there are stereotyped expressions, the so-called emboli. It is from them that the whole conversation can consist. In such a person, speech can resemble a telegram, that is, pauses are made between words, there are no verbs. If the impairment of this part of the brain is severe, speech consists of individual sounds. Written language also suffers.
Optical-mnestic, or amnestic aphasia is a consequence of damage to the temporo-occipital areas of the left hemisphere. The main manifestation: the connection between words and their meanings is broken. For example, the name of a certain subject may take some time, this causes pauses in the conversation.
Dynamic aphasia(What is it, described above). With this form of the disease, the premotor areas of the brain, which are located near Broca's area, are affected. In such a patient, the integrity of the statement is violated, while independent speech is absent. The answers of such a patient are monosyllabic, the last words are often repeated during the conversation.

Symptoms

Despite the fact that there are different forms of aphasia, the disease can be suspected by common signs for all forms. It is worth paying attention to:

pronunciation of sounds;
style of speech (with aphasia, it resembles a telegraph);
whether there are long pauses in the speech, which are unmotivated;
hypophony, namely the transition during a conversation to a quiet voice, almost a whisper;
violations of the pace and rhythm of the conversation;
pronunciation of incoherent sounds;
writing violations;
inability to remember the names of objects;
violations of the account and other operations with numbers;
repetition of words that were in someone else's statement, and the repetition is thoughtless, mechanical.

Features of diagnostics

If you find any speech disorders, you should immediately consult a doctor for advice and diagnosis. This is done by a neuropathologist, a neurosurgeon, a psychiatrist, a defectologist, a speech therapist. Only a specialist can diagnose "aphasia" (what it is is described at the beginning of the article).

The diagnostic process includes the following procedures and techniques:

tomography of the head (magnetic resonance or computer);
Ultrasound of the vessels of the neck and brain;
Doppler scanning of blood vessels;
magnetic resonance angiography;
lumbar puncture;
checking the oral and written speech of the patient using specially developed techniques.

In addition, auditory memory is assessed.

It also requires differential diagnosis in order to exclude the presence of dysarthria, alalia, hearing loss. For this, a comprehensive diagnosis is carried out. And only then comes the final diagnosis.

How is the treatment going?

Despite the organic nature of the lesion, treatment of aphasia is possible. First of all, such a person needs constant attention from both medical staff and close circle. The peculiarity of patients lies in speech impairment, therefore, very often, to announce the results of diagnostics when prescribing treatment, the doctor uses several notification methods at once, for example, using pictures, gestures, or playing similar actions. As a rule, the treatment is carried out by a speech therapist who specializes specifically in aphasia. It should be borne in mind that the process of restoring speech can be delayed for a long time.

The choice of methods depends entirely on the diagnosis, the form of the disease. The main goal of the first classes is to develop a desire for recovery. The work is carried out in all directions of speech: oral, written, even if there are no obvious violations.

During treatment, the prevention of such conditions that may accompany the underlying disease is carried out:

depression;
aggressiveness;
lack of desire to go on the mend.

Regular exercise plays an important role in the treatment process, as it can speed up the recovery process, and with a diagnosis of aphasia, speech recovery can take a long time. Therefore, together with a speech therapist, a psychologist works with the patient.

Also, in some cases, you may need to take medications, less often - surgical intervention.

Treatment prognosis

Many factors can affect the recovery process, in particular, the causes of the disease, the age of the patient, the severity of the organic lesion of a particular part of the brain. For example, patients with aphasia at a young age have a greater chance of a successful recovery than pensioners.

In addition, the success of the treatment of a disease such as aphasia (what it is described above) depends both on the qualifications of the specialist and on the assistance provided by the patient's relatives.

How can loved ones help?

The help of relatives during the patient's work with a speech therapist and psychologist can be really invaluable. However, they need to follow certain rules:

Do not discuss the patient's illness with third parties.
Relatives need to stimulate the patient's desire to start a dialogue.
In no case should difficult words be spoken instead of the patient.
When it is difficult to follow the instructions of a doctor, a person needs help. Everything needs to be carefully explained and controlled.
Patients need to be in constant communication. This will help prevent the occurrence of other speech disorders. Neither TV nor newspapers can replace a live conversation with a person.
Patience must be shown in everything, even if you have to explain the same things several times.

Fundamentals of Prevention

It is unlikely that it will be possible to completely prevent aphasia, but it is quite possible to significantly reduce the risk of its development. In most cases, preventive measures are aimed not at preventing the disease itself, but at preventing the appearance of the causes that provoke it. That is, prevention of strokes and other possible organic brain lesions is carried out. That is why it is worthwhile to undergo regular cerebral diagnostic examination, which will allow you to identify tumors in the early stages of development or other brain diseases.

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This is a systemic neurological disorder of speech that has already been formed, that is, the loss of the ability to speak due to organic lesions of the speech sections of the cerebral cortex, as a result of trauma, tumors, strokes, inflammatory processes, and in some mental illnesses. Aphasia affects various forms of speech activity.

Patients partially or completely lose the ability to understand speech or express their thoughts in words. But the ability to perceive sounds remains, and speech sounds like an unknown signal, a foreign language. The patient hears speech, but does not understand it. Sometimes there is a simultaneous violation of pronunciation and perception of the meaning of words.

There are various classifications of aphasias, within the framework of a simplified classification, “motor aphasia” can be distinguished - when the patient cannot speak, although he understands oral speech, and “sensory aphasia”, when he does not understand speech, although he can pronounce words and phrases.

Symptoms of aphasia

Speech disorders can take many forms. Their diversity reflects the complex nature of speech. One person may only lose the ability to understand written words (alexia), while another may not remember the names of familiar objects (anomia). With anomie, some people cannot remember the right word at all, while others retain it in memory, but they are not able to say it.

In severe cases, speech is completely impossible; in the lighter ones, it is difficult: speech is poor, wears a telegraphic style. The grammatical structure of speech is violated (declensions and conjugations are not respected), permutations and replacement of letters in the word are noted, logorrhea (speech incontinence), verbal paraphasia (the word is replaced by a similar sound, but different in meaning), perseveration is when a person gets stuck on separate words .

In Wernicke's aphasia (a condition resulting from damage to the temporal lobe), patients speak quickly, but their speech is a nonsensical jumble of words. In Broca's aphasia (expressive aphasia), people largely understand the meaning of words and know what they want to say, but it is difficult for them to pronounce the words: patients speak slowly and with great effort, often interrupting speech with interjections.

Aphasia must be distinguished from dysarthria- inability to clearly pronounce words. Although it looks like a speech disorder, dysarthria is caused by damage to the part of the brain that controls the muscles used to make sounds and coordinate vocal movements. And also from alalia - this is the absence or underdevelopment of speech in children with normal hearing and initially intact intelligence; the cause of alalia, most often is damage to the speech areas of the cerebral hemispheres during childbirth, as well as brain diseases or injuries suffered by the child in the pre-speech period of life; heavy
degrees of alalia are expressed in children by a complete lack of speech; in milder cases, the beginnings of speech are observed, characterized by a limited vocabulary, agrammatism, and difficulties in learning to read and write.

Causes of aphasia

The left temporal lobe and the nearby area of the frontal lobe are mainly associated with the function of speech. Damage to any part of this small area as a result of a stroke, tumor growth, head trauma or infection, at least partially, but impairs the function of speech.

Damage to the left in both the temporal and frontal lobes can initially lead to an almost complete loss of speech. In the process of recovery after such a complete (global) aphasia, a person has disorders of speech (dysphasia), writing (agraphia or dysgraphia) and understanding of oral speech.

Factors that increase the likelihood of aphasia:

Age (closer to the elderly);
Family history;
A history of transient ischemic attack (TIA).

Diagnosis of aphasia

To identify aphasia, the study of oral speech is used (colloquial speech, storytelling, repetitions, automatic speech - numbers, months, poems), the desire to speak, poverty or richness of speech, grammatical structure, the presence of paraphasias and perseverations are taken into account. As well as the analysis of written speech (copying, dictation, retelling), understanding of oral speech, that is, words, phrases, obviously ridiculous instructions.

Diagnostic activities also include regular reading to understand the patient's reading abilities and comprehension.

The patient's spontaneous speech is assessed, according to the following indicators: fluency, number of spoken words, ability to initiate speech, the presence of spontaneous errors, pauses for word selection, doubts, verbosity and prosody.

Aphasias are studied within the framework of speech therapy, neuropsychology and psycholinguistics (neurolinguistics). Specialists have at their disposal a wide range of different formal tests for diagnosing aphasia (for example, the Boston Diagnostic Aphasia Test, the Western Aphasia Detection Test, the Boston Name Test, the Nominative Test, the Action Name Test, etc.). ).

CT or MRI (with or without angiography) is performed to clarify the nature of the lesion (infarction, hemorrhage, volumetric education). Further research
are carried out to clarify the etiology of the disease in accordance with the previously described algorithm.

Treatment and prognosis for aphasia

Treatment of aphasia consists in the treatment of the underlying disease that led to speech impairment. The effectiveness of treatment has not been reliably established, but it is believed that the involvement of a professional speech therapist in the earliest stages of the disease gives the best results: the earlier treatment is started, the greater the chance of success.

With the development of aphasia after a stroke, a head injury, or some other condition that caused a deterioration in speech, speech therapists can help the patient.
They usually start treatment as soon as the person's physical condition allows.

Sometimes, even without treatment, there is a complete recovery of speech and the disappearance of signs of aphasia - usually after a short-term violation of blood flow to the brain.
Therefore, the degree of recovery also depends on the size and location of the lesion, the degree of speech impairment, and, to a lesser extent, on the age, educational level and general health of the patient.

In almost all children under the age of 8, speech function is restored completely after severe damage to any of the hemispheres. At a later age, the most active recovery occurs during the first three months, but the final stage can last up to 1 year. In most cases, however, recovery of speech functions is far from being as quick or complete. Although many people with aphasia experience a spontaneous partial recovery of speech function within a few weeks or months after a brain injury, some signs of aphasia usually persist.

The participation of family members in the treatment of aphasia in a patient is considered a very important component of therapy, therefore, the patient's relatives are advised to adhere to the following rules:

Simplify speech by building simple, short sentences.
Repeat keywords as needed.
Maintain a normal communication style (that is, do not try to talk to the sick person as if they were a small child or a mentally retarded person).
Invite the patient to participate in the conversation.
Support all types of communication, whether it be speech or sign language.
Correcting a person with aphasia as little as possible
Give the person the necessary time to build and pronounce sentences.

Prevention of aphasia

The most common cause of aphasia is stroke. To reduce its probability it is necessary:

Do physical exercises regularly;
There are many fruits and vegetables;
Limit salt and fat intake;
Quit smoking;
Drink alcohol in moderation;
Maintain a healthy weight;
Monitor blood pressure;
Consider taking low-dose aspirin if your doctor recommends doing so;

Seek immediate medical attention if you have symptoms of a stroke!

Important! Treatment is carried out only under the supervision of a doctor. Self-diagnosis and self-treatment are unacceptable!

Aphasia refers to neurological pathologies in which speech is impaired, but there are no disorders of the articulatory apparatus and hearing. The causes of aphasia lie in the violation of cerebral circulation in strokes, injuries, the presence of tumors and organic lesions of the brain. A distinctive feature of the pathology is the complete preservation of intelligence and the absence of speech disorders in the past.

Aphasia refers to acquired diseases. In medical practice, it is customary to distinguish several types of deviations, which are grouped into three main categories:

partial violation, in which the ability to pronounce the names of certain things is lost (for example, a person sees an object, understands its purpose, but the ability to name it is lost);
an expressive disorder in which the ability to reproduce speech is lost (a person understands everything, but cannot say);
an impressive disorder in which there is a loss of the ability to understand addressed speech.

A variety of aphasia is determined by the part of the brain in which the changes have occurred. For example, efferent motor aphasia is a pathology of expressive speech (reproduction in general), and amnestic is a violation of the reproduction of individual names.

Sensory aphasia includes two types:

Pure - observed in the case of damage to the center of Wernicke. This is the posterior part of the temporal gyrus of the dominant hemisphere. The patient hears speech addressed to him, but perceives it inarticulately. There is a distorted perception of sounds. In severe cases, a person with preserved hearing completely loses the ability to understand speech and fulfill the simplest requests. With a mild degree, the perception of similar-sounding words is disturbed (for example, “stump-day”).

A person is not able to write words correctly, as he will replace letters; cannot comprehend the meaning of the text. A feature of patients with sensory aphasia is that they themselves do not realize the presence of a problem. It seems to them that they pronounce words correctly and build speech structures, but those around them do not understand.

Semantic - with this type of disease, disturbances occur in the lower part of the parietal zone of the dominant hemisphere. Speech is understood correctly, words are pronounced without distortion, but the logical connection is broken. It is difficult for such a patient to understand phrases that are used in a figurative sense, it is impossible to distinguish spatial concepts. A person is able to read the text, but not able to retell it.

motor aphasia

Broca's aphasia refers to severe disorders in which the left frontal lobe of the brain is affected. This is fraught with consequences in which changes occur not only in the speech apparatus. Most often occurs in an adult after suffering a traumatic brain injury or stroke. But it can also be observed in children, and they can proceed both in mild and severe form.

There are such types of Broca's aphasia:

kinesthetic - affects the parietal zone of the hemisphere, which is responsible for the speech apparatus. Refers to mild forms. A person understands someone else's and his own speech, but his pronunciation is fluent without pauses. If there are difficulties in pronouncing certain words, he can replace them with others;
efferent - it is characterized by the presence in the conversation of incorrect grammatical turns and incoherent phrases. A person with such a pathology tries to be more silent. His speech contains almost no verbs and is characterized by long pauses. Efferent motor aphasia makes reading and writing difficult, but learning is possible with cues. The patient can normally analyze his own and other people's speech;
sensory-motor - its cause is damage to large vessels (for example, a cerebral artery in a heart attack). This is a severe form of the disease, in which phonemic hearing, speech, and initiation are impaired;
dynamic - characterized by the absence of emotional coloring of speech. The patient speaks slowly, monotonously and indistinctly;
rough - is a complication of the total form of aphasia. With it, there are severe deviations, up to a complete loss of speech and the replacement of words with lowing.

This deviation is typical in the case of damage to the lower lobe of the temporal region of the dominant hemisphere. The name speaks for itself: it is difficult for a person to remember the name of an object, although he understands its purpose well. Example: he sees a plate, knows what is eaten from it, but cannot pronounce the name. If the assistant gives him a hint, then the patient is able to repeat the word, but in the future he forgets again. Speech structures are characterized by the absence of numerals and an abundance of verbs. A person is able to read and write, as before. The most common causes of amnestic aphasia are strokes, organic brain lesions, and malignant tumors.

Conventionally, amnestic aphasia can be divided into two types:

acoustic-mnestic, in which the connection between memory and hearing is damaged. In colloquial speech, the patient skips nouns, replaces words, the conversation is slow, without intonation;
optical-mnestic, which is characterized by a violation of the connection between vision and the center of memory. The speech of such a person is fluent, but there are many substitutions of concepts in it.

In its pure form, these two types of aphasia are rare, most often there is a combination of different ones.

In the practice of neurologists, patients with mixed types of aphasia are most often encountered. Motor symptoms may overlap with sensory symptoms, making diagnosis difficult.

Mixed forms of aphasia include:

efferent-motor with sensory;
afferent-motor with sensory;
total.

The last form of the disease is the most severe, since the patient's speech apparatus is completely destroyed. It can be observed with extensive strokes. A person does not understand other people's speech well, cannot reproduce the words himself, there are difficulties in reading and writing.

A neurologist or aphasiologist may suggest that a person undergo a few simple tests to determine the presence and extent of disorders. Diagnostic methods include:

asking the patient to tell about himself;
a request to repeat after the specialist a number of similar-sounding words;
please list the days of the week, months of the year;
answers to simple questions (name objects, define phenomena);
analysis of the ability to fulfill simple requests;
text reading;
dictation;
analysis of understanding of grammatical structures, the meaning of proverbs.

As additional diagnostic methods, encephalography, magnetic resonance imaging, and angiography are used.

Based on the results of such simple tests, it is easy for a specialist to make the correct diagnosis and choose methods of recovery.

- a disorder of previously formed speech activity, in which the ability to use one's own speech and / or understand addressed 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 to be examined for neurological status, mental processes, and speech function. With aphasia, the underlying disease is treated and special rehabilitation training is carried out.

General information

Aphasia is the disintegration, loss of already existing speech, caused by a local organic lesion of 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 older than 3 years or in adults). Patients with aphasia have a systemic speech disorder, that is, expressive speech (sound pronunciation, vocabulary, grammar), impressive speech (perception and understanding), inner speech, written speech (reading and writing) suffer to one degree or another. In addition to the 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 an organic lesion of 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 affects 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 had a hemorrhagic stroke, a total or mixed aphasic syndrome is more often noted; in patients with ischemic disorders of cerebral circulation - total, motor or sensory aphasia.

In addition, 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), brain surgery can lead to aphasia.

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

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

Aphasia classification

Attempts to systematize the forms of aphasia on the basis of anatomical, linguistic, psychological criteria have been repeatedly undertaken by various researchers. However, the classification of aphasia according to A.R. 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 in aphasia consists of medical and speech therapy directions. 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 (exercise therapy, mechanotherapy, physiotherapy, massage).

The restoration of speech function is carried out in speech therapy classes for the correction of aphasia, the structure and content of which depends 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 an attitude to restore speech, to develop intact peripheral analyzers, to work on all aspects of speech: expressive, impressive, reading, writing.

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

Corrective work with aphasia should begin from the first days or weeks after a stroke or injury, as soon as the doctor allows. The early start of restorative education 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 laborious, requiring the cooperation of a speech therapist, the attending physician, the patient and his relatives. Restoration of speech in aphasia proceeds the more successfully, the earlier correctional work is started. The prognosis for the recovery of speech function in aphasia is determined by the location and size of the affected area, the degree of speech disorders, the start date of rehabilitation training, the age and general health of the patient. The best dynamics is observed in young patients. At the same time, acoustic-gnostic aphasia, which occurs at the age of 5-7 years, can lead to a complete loss of speech or a subsequent gross violation of speech development (OHD). Spontaneous recovery from motor aphasia is sometimes accompanied by the onset of stuttering.

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

What actions can be taken to speed up the recovery of speech after a stroke? What forms of speech impairment may the patient's relatives face, does the rehabilitation program depend on the type of speech disorder? We will answer these and other questions in the framework of the material offered to your attention.

Forms of speech disorders

It must be understood that speech impairment in stroke can take one of two radically different forms - aphasia and dysarthria. This knowledge will be useful to us when drawing up a therapy plan. What are the main differences between these disorders?

1. Aphasia - violation of the very phenomenon of speech as a manifestation of higher nervous activity. The patient cannot comprehend oral or written speech, although he hears and “sees” sounds and words (sensory aphasia); cannot pronounce a word due to the fact that the necessary impulse is not formed in the corresponding parts of the neocortex (motor aphasia, which is also called speech apraxia).

With sensorimotor, or total aphasia, a person does not understand the speech addressed to him and does not speak himself (speech "emboli", repeated sounds of the same type do not count). This form of speech disorder often occurs when the pathological process is localized in the basin of the middle left cerebral artery. There are other forms of aphasia, but to understand the essence of the ongoing processes, the three mentioned are enough.

2. Dysarthria - This speech disorder after a stroke is inherently a defect in the pronunciation of sounds and words. A person perfectly understands the speech addressed to him, can read and even write, but does not speak, because the work of the muscles responsible for the pronunciation of sounds is disrupted. This speech disorder is also called a violation of articulation, it is characteristic of the defeat of the posterior sections of the frontal lobes and subcortical structures.

Treatment of dysarthria

Let's go directly to the topic of the material: how to restore speech after a stroke? We start with dysarthria, because it is easier to explain the structure of treatment in this case, and you should always start with a simple one.

With dysarthria, we must teach a person to pronounce words, and for this we need to re-teach the necessary skills to the muscles of the oral cavity, lower jaw, etc. How to do it? We will announce a program of action, a therapy strategy, and a speech therapist will recommend specific exercises.

A patient with dysarthria should regularly perform exercises for the tongue: stick out a tense or relaxed tongue, rest the tongue against the teeth, and perform circular movements. The complex should include articulation exercises for the lower jaw, lips, facial muscles (all areas, including the forehead and even the area around the eyes).
Speech therapy correction should take place with the participation and under the supervision of a speech therapist, who, if necessary, will prescribe a set of exercises that will help restore swallowing function (these disorders often occur together).
According to the indications, drug therapy is carried out, aimed at preventing complications, improving trophism and blood supply to brain structures.

Treatment of aphasia

Is aphasia harder to treat? From a psychological point of view, it is more difficult, because it is not easy to return speech itself after a stroke, as a phenomenon of higher nervous activity, due to the fact that control with the patient is very difficult. With sensory aphasia, you will not be able to communicate your wishes to the patient. With motor aphasia, he will not be able to answer you in any way - written speech and reading of texts are also impaired. With total aphasia, the task becomes ten times more difficult. Exit? Be patient and work hard!

When diagnosed with a stroke, speech loss persists for a long time period, during which it is necessary to deal with the patient daily.
The patient, when he is trying to say something, you need to listen very carefully and patiently, you can’t interrupt the patient, you can’t correct him, and don’t try to finish a phrase for him, the meaning of which, as you think, you have already caught.
A healthy person should initiate the conversation.
With sensory aphasia, for entry-level classes, it is recommended to use pictures with captions, the pictures should show simple household items, animals.
To improve contact with the patient with sensory aphasia, develop alternative (non-verbal) ways of communication.
With motor aphasia, one should begin with the repetition of automated speech sequences, such as days of the week, ordinal count, seasons, twelve months. For the treatment of motor aphasia, you can use affirmative answers to the simplest everyday questions: “Will you eat?” - "Will".
With motor aphasia, pictures with captions are also suitable, but this time they should not depict objects, but actions and simple plots.

Conclusion

As you understand, speech therapists will help you tenfold expand the arsenal of tools that can be used to restore speech after a stroke. We only outlined the strategy, showed which ways you can and should move, what to expect along the way. The success of treatment depends on the patient himself, his relatives, medical workers, namely, on the coherence of the actions of all participants in the process.

aphasia after stroke

Aphasia is called complete or partial loss of speech as a result of local brain damage. It occurs against the background of cerebral circulation disorders and the most common cause of aphasia is a stroke.

The complexity of the speech disorder is directly dependent on the location and size of the affected area. Much longer than other functions of the body is the restoration of speech after a stroke. With aphasia, there is a systemic violation of all types of human speech activity - speaking, listening, reading and writing, so the patient needs regular classes with a speech therapist-aphasiologist for a long period of time.

Forms of aphasia

The form of aphasia depends on the location of the damage to the brain tissue in the dominant hemisphere in speech:

Localization of the lesion in the temporal regions of the cerebral cortex leads to acoustic-gnostic and acoustic-mnestic aphasia;

Localization of the lesion in the lower parietal regions of the cerebral cortex leads to afferent motor and semantic aphasia;

Localization of the lesion in the posterior frontal and premotor regions of the cerebral cortex leads to dynamic and efferent motor aphasia.

In speech therapy, it is customary to distinguish 6 forms of aphasia.

Acoustic-gnostic form of aphasia

It is characterized by a gross violation of speech understanding. Immediately after a stroke and in the presence of extensive foci of brain damage, there is a complete lack of understanding of speech, multiple substitutions of sounds that distort the speech of the patient beyond recognition.

Somewhat later, and with less extensive lesions, speech can partially recover and become quite clear, but at the same time, many substitutions of some words for others, agrammatisms, and errors in matching words in sentences remain. Reading and writing disorders of varying severity consist of substitutions of sounds and letters.

Afferent motor (articulatory) form of aphasia

It is characterized by impaired articulation of speech sounds. When performing movements of the tongue, lips, the patient cannot find their desired articulation position, as a result of which he has no oral speech.

As it gradually recovers, there are omissions of prepositions, words, an erroneous sequence of words in sentences, substitutions between sounds that have similar kinesthetic characteristics. Written speech is grossly impaired, but silent reading and speech comprehension remain relatively intact.

Acoustic-mnestic form of aphasia

It is characterized by impaired auditory-speech memory. With this form, patients do not understand long and complex speech segments well, since they cannot keep a series of words in memory.

Despite the relative safety of oral speech, it is difficult for them to name actions and objects; numerous verbal substitutions are observed in sentences.

Efferent motor form of aphasia

It is characterized by a violation of phrasal speech. Pauses and repetitions of words in sentences make oral speech extremely difficult or impossible. Patients have difficulty following multi-step instructions. The isolated pronunciation of sounds is preserved, but there is no understanding of the endings of nouns and the meanings of prepositions.

Violations of written speech are due to difficulties in the sound-letter analysis of the composition of words, which leads either to the complete disintegration of writing skills or to omissions and rearrangements of letters and syllables.

Dynamic form of aphasia

It is characterized by a lack of speech activity. Such patients can "echo" the words from the interlocutor's questions, short answers to questions, writing from dictation, reading aloud, repetition and naming are available to them. The most significant difficulties for them are caused by the process of active deployment of the utterance and the choice of words; they need constant stimulation of independent speech.

Semantic form of aphasia

This form is characterized by a disorder in understanding complex logical and grammatical phrases, proverbs, prepositions, and adverbs of place. Patients have a violation of the account, they do not always understand and can retell even short, simple texts. Dialogic and spontaneous speech, understanding of simple phrases are usually preserved, but patients have difficulty following instructions containing prepositions and adverbs.

Recovery of speech function after a stroke

The form of aphasia is determined by a speech therapist based on a survey of understanding and speech reproduction. Classes to restore lost speech functions should be started as early as possible, in the first few weeks after a stroke. The same applies to the restoration of motor functions with the help of special exercises and massage.

If rehabilitation is started later, then the violations can become persistent and it will take much more time and effort to overcome them. Classes with a speech therapist-aphasiologist should be regular, their duration is determined by the individual capabilities of the patient. Relatives should take an active part in the rehabilitation process, follow all the recommendations and tasks of a specialist, show maximum patience, tact and attention to the patient.

Aphasia

Almost all stroke survivors experience speech impairment in the first days and weeks. Some cannot remember the names of objects and actions, express their thoughts, others are not able to understand what others are saying. However, both intellect and memory (figurative) are preserved, vision and hearing are in order. Using these channels, you can recover a lot.

Depending on which parts of the brain are affected, they speak of different forms aphasia after stroke(speech disorders).

You can judge them, and therefore choose a method for restoring speech, as early as two weeks after the onset of the disease.

motor aphasia

At motor aphasia a person, as a rule, understands the speech of others, but is not able to express his thoughts, answer questions coherently, read, write. In response to a question, he most often nods his head and gestures that he cannot say anything, or, uttering individual words, finds it difficult to correctly name objects, actions.

There are times when the patient is unable to either repeat or pronounce a sound or word on his own. When trying to speak for a long time and often unsuccessfully looking for the position of the lips, tongue. However, he can sing and recite well-known poems.

Sensory aphasia

In those who suffer sensory aphasia impaired understanding of speech addressed to them. There is also no control over one's own speech. It is uninformative, consists of fragments of words and phrases. A person cannot write, does not understand what they read.

Some patients unsuccessfully try to repeat something, name it. Their speech is verbose, emotional, richly intoned, accompanied by facial expressions and gestures. But this “verbal okroshka”, or “verbal salad”, as experts say, exists as if by itself: the patient does not understand either what he is saying, or the simplest words, requests, instructions addressed to him. These signs are characteristic of the first form of sensory aphasia.

In other cases, simple commands reach the patient's consciousness only if they consist of 1-2 words, no more. This is the second form of sensory aphasia.

Those suffering from its third form understand only simple sentences. Complex text is beyond their power. They are poorly oriented in space, get confused in counting, do not distinguish what “under”, “above”, “to”, “from” means, do not evaluate comparative constructions (a fly is smaller than an elephant).

Treatment of aphasia

What to do? The answer is clear: do aphasia treatment. We repeat: not everything is hopelessly destroyed - there is intellect, memory, attention, hearing. It is better, of course, to take the help of a speech restoration specialist (speech therapist-aphasiologist), but this is not always possible. Usually the burden falls on family and friends. In order to make the most of the time allotted for training, we will try to give the necessary recommendations.

You will have to constantly stimulate and correct the patient's speech. Be prepared for the fact that in the first lessons your student will quickly get tired. Make pauses and be sure to fill them with stories about simple things and events, about what your ward was very interested in before the illness.

When and how much to exercise depends on the condition of the patient, but keep in mind: the frequency and regularity of training are of great importance.

If your ward is conscious, start the lessons from the first days of a stroke.

At first, do no more than 10-15 minutes, preferably 2-3 times a day. After 2-3 weeks, the average duration of classes can already be 40-60 minutes.

Treatment of motor aphasia

At treatment of motor aphasia First of all, it is necessary to disinhibit speech, to create psychological readiness in the patient, the conditions under which the intention and desire to speak arise.

Here is one of the tricks. Pick up colorful magazines with photos in advance (you can use old ones). Open the family album. Say a phrase with a specific intonation, such as joy: “I'm happy to see you!” - and ask the mentee to choose the picture or photograph with which this phrase is associated.

It is very useful to hum or listen to the songs recorded on a tape recorder known to him together with the patient. It helps to cheer up, evokes memories, revives expensive images in memory. Ask him to sing along with you. He will slowly pick up the melody and suddenly pronounce quite distinctly some word, often rhymed.

Repeat the same on the second day, the third. The patient will begin to pronounce other words, and in a week or two after singing his favorite tunes many times, singing together will not be difficult for him. Now you can ask him to finish stereotypical sentences, familiar poems, proverbs. For example: “Quietly you go - further. (you will)”, “Seven troubles - one. (answer)".

In parallel, train the patient on the so-called automated speech sequences. Offer to count together with you (one, two, three, four.), List the days of the week (Monday, Tuesday.).

He may be interested in reading an emotionally rich story. Show pictures, separately written words - this helps to revive emotions and former speech connections. Suddenly, your ward breaks out adequately to the content: “Ah, damn it!”, “Ai-yay-yay!”, “Not good!”, “Great!”.

In addition, be sure to ask the patient as often as possible to name the names of people close to him, terms related to his profession or favorite thing.

In the process of everyday communication, try to make him remember as many nouns, verbs, other parts of speech as possible - first in separate sentences, then in simple dialogues, conversations. So, approaching the table, you say: “I sit down on. (chair). I take. (pencil) to. (paint)". Preparing to wash: “Where is our toilet. (soap) to hands. (wash)? And here is the tooth. (brush) to teeth. (clean). Now you need terry. (towel). We are their face. (we wipe)”.

If the patient suddenly uttered a word, for example, “bread” or “ball”, praise him, rejoice at his success and do not miss the chance to move on - recall the actions with which these words are associated: “We are bread. (we eat). Children in the ball. (play)".

Do not try to teach your ward grammar, rely on his “sense of language”. Vary the same word: “Bread lies on a hundred. (le). The ball lies under a hundred. (scrap). I went to a hundred. (lu)". Words do not need to be crammed, written down - they must constantly occur in your conversations.

When talking with the patient, be sure to take into account his interests and hobbies. With women it is more convenient to talk about cooking, fashion, cosmetics, with men - about fishing, cars, sports, helping with gestures, showing things or pictures that depict what is being discussed. For example: “Here is a river. It is found in it. (fish). Do you like fish. (catch). You catch her. (rod). But first you need to dig. (worms). You put the worm on. (hook). Fish. (pecking)”, etc.

As time goes by, the dialogue gets more complicated. Coherent speech in motor aphasia, if it is not roughly expressed, usually appears after an increase in the patient's vocabulary.

Treatment of sensory aphasia

At treatment of sensory aphasia the emphasis of the classes is on restoring understanding of what was said. And in order to facilitate this process, we must try to slow down the flow of plentiful and uninformative speech (it breaks out of the patient’s mouth), to revive the sphere of visual images that are necessary for conscious perception of the surrounding world.

Speech inhibition involves switching the patient's attention to other activities. Any work with numbers and numbers, playing chess, loto, drawing from patterns, drawing pictures from children's blocks, performing various tasks is useful - cutting cards, strips of paper, font from newspapers, magazines, as well as washing dishes, cleaning the apartment, if he it is already possible.

Be sure to accompany with brief explanations of what, how and why to do. As few words as possible! Only jerky specific instructions and assessments: “Cut the paper into strips”, “Good”, “Correct”, “Help wash the dishes”, “No”, “Not like that”. Control how your ward realizes everyday commands: “Come to the table”, “Sit down here”, “Open the notebook”, “Start drawing”. No matter how difficult it is, allow the patient only short statements, remarks, questions: “Is this so?”, “What should I do?”, “I don’t know how. " - not more.

It is very important to teach him to listen. The process is divided into a number of successive stages - first understanding the general meaning and content of the sounding text, then sentences, and only then individual words, sounds.

After all, it is much easier for a patient with sensory aphasia to pronounce a tirade of words himself than to single out one, the right one.

Before starting a conversation, be sure to state what the conversation will be about now in the story that you intend to read. For example, “about nature”, “about animals and plants of the North”, “about school”. This will help create a state of expectation, readiness to listen to a text of a certain content, the necessary emotional mood. Prepare pictures in advance: one corresponds to the text, the other is close to it, the third is neutral. Put them in front of the patient, read the text slowly and expressively and ask them to find the right picture. Read the text again and ask them to say what it is about, count the number of sentences. Highlight one phrase. Let him find the corresponding fragment in the picture. Do the same with a separate sentence, then with a word. Leaf, flower, plane, river. - the sound of each he needs to correlate with the corresponding element of the picture. The plot depicted on it should evoke only positive emotions. Yes, and the text is small - 3-7 sentences of 3 - 5 words. Study 7-10 texts in this way, which differ sharply in content and vocabulary. And after such a common work - the restoration of the ability to listen and understand, begin to teach to distinguish sounds.

Cut pictures of various objects from old magazines. Lay them out in front of the patient. Write large letters on three sheets of paper, for example, B, L, C. Invite him to distribute the pictures in accordance with the initial letter of the depicted object. New task: attach its sound to the optical image of the letter. Repeat: “Add the pictures to the letter L”, etc. Later, the patient should classify the pictures, focusing only on the sound of the named letters (remove sheets with written letters). After working out the first three sounds, move on to the next pair or three.

In those suffering from sensory aphasia, writing skills are preserved to a certain extent. But such a patient can write down only what he himself says. To streamline this process, invite him to first add words from the split alphabet. You can make schematic drawings and captions to them from words that sound similar: “house-tom”, “daughter-point”, “mountain-bark”, “baba-papa”. Gradually, in the process of training, he begins to distinguish between these similar-sounding words, to understand which signature corresponds to which picture.

It is useful to write down on paper and read with him again the words just spoken. This is how reading skills are gradually restored. And if at the same time the patient also hears a recording of these words on a tape recorder, the effect will be higher: he listens to the sound of the words he utters and corrects the mistakes.

Medicines for aphasia

Restoration of speech is facilitated by medications. They disinhibit the nerve elements around the lesion that have not died, but appear to be incapacitated, as it were.

Figuratively speaking, nootropil helps to awaken speech and memory from hibernation. It must be taken for a long time (several months) at 2.4 g (in the first weeks after a brain accident much more - 3.6-4.8 g) three times a day.

If the drug excites the patient and his sleep becomes restless, move the drug to the first half of the day. Part of the course can be carried out in the form of intramuscular injections of nootropil 5 g daily for 20-30 days.

Effective, especially in violation of memory and attention, cerebrolysin. It is administered at 5 mg intramuscularly daily for 20-30 days.

Both drugs - nootropil and cerebrolysin - can be used simultaneously. They are well tolerated by patients.

As you can see, there are various ways to restore speech. Try the ones we have suggested, but do not force them on your ward without fail. Consider his individual abilities.

However, one rule is inviolable. Do not think that after diligently conducting classes, you are free and free to do your own thing. If you really want to help a loved one return to normal life, you need to talk with him as much as possible, talk about family affairs, the events of the day, watch TV shows together, listen to the radio, go to the theater if possible.

Do not forget for a minute: the main thing that helps to restore speech and other functions impaired as a result of a stroke is a kind, benevolent atmosphere in the family, not eliminating, but involving the patient in discussing household chores, doing work that is feasible for him. Patience to you and health!