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

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

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

The patient is quite aware and fluently pronounces individual words in context, but the reading of sentences becomes slower and occurs in syllables. Understanding the written sentences is easier, because patients can return to what they read and quickly remember. By ear, the text begins to be perceived with difficulty. Sentences sound clipped.

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

With semantic aphasia, visually-spatial gnosis suffers, so patients begin to experience difficulties in arranging letters in a word in the correct sequence. For example, they can no longer add a word from separate letters of the split alphabet.

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

Disease classification

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

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

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

Reasons for manifestation

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

1. Pick's disease, Alzheimer's;
2. trauma, mechanical damage to the brain;
3. encephalitis, meningitis with an inflammatory course;
4. operative surgical intervention on the head area;
5. oncology, the development of a tumor-like process in the parts of the brain.

The risk group includes the elderly from 55 years old, suffering from cerebral atherosclerosis, hypertension, rheumatoid heart disease, and diseases of the central nervous system.

Signs and symptoms of the disease

Diagnosis of the disease

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

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

Reference! A distinctive feature of amnestic-semantic aphasia is the periodic occurrence of violations during the repetition of long, complex sentences.

The main examination methods for detecting pathology:

1. blood test (clinical, general);
2. Ultrasound of the cervical vessels;
3. puncture with the collection of cerebrospinal fluid;
4. speech therapy, neuropsychological examination;
5. duplex scanning of cerebral vessels;
6. angiography;
7. tests to identify the degree of deviations in speaking, writing and hearing.

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

Important! With deviations in the pronunciation of sounds and intellectual capabilities in a person, impaired speech functions, it is almost impossible to identify the diagnosis on our own.

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

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

• nootropic drugs (Phezam, Piracetam);
• statins (Atorvastatin, Liprimar, Torvakard);
• thrombolytic medicines (Metalize, Aktilize);
• vitamins (riboflavin, pyridoxine, thiamin);
• blood thinners (Ksarelto, Fraxiparin, Heparin, Pradaxa);
• diuretics (Diacarb, Furosemide, Lasix);
• steroid (Prednisolone);
• thrombus-dissolving (Aktilize).

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

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

Operation for semantic aphasia is prescribed in the case of oncology, cerebral hemorrhage, detection of local tumor foci. Indications for surgical intervention:

1. cerebral aneurysm;
2. tissue abscess;
3. atherosclerosis with damage to the carotid arteries, narrowing of the vessel lumen by plaques.

With hemorrhage, craniotomy is possible, with atherosclerotic plaques - the method of endarterectomy.

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

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

Prophylaxis

Preventing the development of semantic aphasia means for patients (especially in old age):

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

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

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

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

In difficult cases, semantic aphasia is fatal. In fact, this is an incurable pathology that is difficult to diagnose and treat. The patient's relatives play an important role. The outcome of treatment will be influenced by their attitude, care, love, understanding.

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

E. S. Bein, M. K. Burlakova (Shokhor-Trotskaya), T. G. Vizel, A. R. Luria, L. S. Tsvetkova made a great contribution to the development of principles and techniques for overcoming aphasia.

In speech therapy work to overcome aphasia, general didactic principles of teaching (visibility, accessibility, consciousness, etc.) are used, however, due to the fact that the restoration of speech functions differs from formative teaching, that the higher cortical functions of the already speaking and writing person are organized somewhat differently than in a child beginning to speak (A.R. Luria, 1969, L.S.Vygotsky, 1984), when developing a plan for correctional pedagogical work, the following provisions should be adhered to:

1. After completing the examination of the patient, the speech therapist determines which area of ​​the second or third "functional block" of the patient's brain has suffered as a result of a stroke or trauma, which areas of the patient's brain are preserved: in most patients with aphasia, the functions of the right hemisphere are preserved; in case of aphasias arising from damage to the temporal or parietal lobes of the left hemisphere, planning, programming and controlling functions of the left frontal lobe are primarily used, providing the principle of consciousness of restorative learning. It is the preservation of the functions of the right hemisphere and the third "functional block" of the left hemisphere that makes it possible to instill in the patient the mindset to restore impaired speech. The duration of speech therapy sessions with patients with all forms of aphasia is two to three years of systematic (inpatient and outpatient) sessions. However, it is impossible to inform the patient about such a long period of restoration of speech functions.

2. The choice of methods of correctional and pedagogical work depends on the stage or stage of restoration of speech functions. In the first days after a stroke, work is carried out with a relatively passive participation of the patient in the process of restoring speech. Techniques are used that disinhibit speech functions and prevent, at an early stage of recovery, such speech disorders as “telegraph style” agrammatism in case of efferent motor aphasia and an abundance of literal paraphasias in case of afferent motor aphasia. At the later stages of the restoration of speech functions, the structure and plan of classes are explained to the patient, the means that he can use when performing the task are given, etc.

3. The correctional-pedagogical system of classes presupposes such a choice of methods of work that would allow either to restore the initially disturbed premise (in case of its incomplete breakdown), or to reorganize the intact links of the speech function. For example, the compensatory development of acoustic control in afferent motor aphasia is not just the replacement of impaired kinesthetic control with acoustic control to restore writing, reading and understanding, but the development of preserved peripherally located analyzer elements, the gradual accumulation of the possibility of using them for the activity of a defective function. In sensory aphasia, the process of restoring phonemic hearing is carried out by using preserved optical, kinesthetic, and most importantly, semantic differentiation of words that are similar in sound.

4. Regardless of which primary neuropsychological prerequisite is violated, for any form of aphasia, work is carried out on all aspects of speech: on expressive speech, understanding, writing and reading.

5. With all forms of aphasia, the communicative function of speech is restored, self-control over it develops. Only when the patient understands the nature of his mistakes can conditions be created for him to control his speech, the narrative plan for the correction of literal or verbal paraphasias, etc.

6. For all forms of aphasia, work is underway to restore verbal concepts, including them in various phrases.

7. The work uses deployed external supports and their gradual internalization as the restructuring and automation of the impaired function. Such supports include, in the case of dynamic aphasia, the sentence scheme and the method of chips, which make it possible to restore an independent expanded utterance, in other forms of aphasia - the scheme for choosing the methods of articulation with the arbitrary organization of articulatory patterns of phonemes, schemes used to overcome impressive agrammatism.

The dynamics of restoration of impaired speech functions depends on the location and volume of the lesion, on the form of aphasia, the timing of the onset of restorative learning and the patient's premorbid level.

With aphasias resulting from cerebral hemorrhage, speech is restored better than with thromboembolism of cerebral vessels or extensive brain trauma. Aphasic disorders in 5-6 year old children (in most cases of traumatic origin) are overcome faster than in schoolchildren and adults.

Correctional and pedagogical work begins from the first weeks and days after a stroke or injury with the permission of a doctor and under his supervision. The early start of classes prevents the fixation of pathological symptoms and guides the recovery along the most expedient path. Restoration of impaired mental functions is achieved with prolonged speech therapy sessions.

With aphasia, individual and group speech therapy sessions are conducted. The individual form of work is considered the main one, since it is it that ensures the maximum consideration of the patient's speech characteristics, close personal contact with him, as well as a great opportunity for psychotherapeutic influence. The duration of each lesson at the early stage after a stroke is on average 10 to 15 minutes 2 times a day, in the later stages - 30-40 minutes at least 3 times a week. For group lessons (three - five people) with the same type of speech disorders and relatively the same stage of speech recovery, the duration of the lessons is 45-50 minutes.

The speech therapist should explain to the family the characteristics of the patient's personality associated with the severity of the disease. Specific examples explain the obligation of his feasible participation in the life of the family. Instructions are given to work on speech restoration.

annotation: The work provides a detailed description of the main contingent of patients with whom speech therapy classes are conducted in a polyclinic, an analysis of speech disorders in local lesions of the anterior left hemisphere of the brain and methods of restorative learning from the point of view of neurolinguistics is given, which is rarely covered in special literature. A speech therapist, having experience of working with patients with HMF pathology for 39 years, summarizes the techniques and methods of teaching in patients with a severe form of predominantly motor aphasia, suggests interesting modifications of these techniques at the initial stages of recovery work, describes his own original techniques and gives examples of didactic material for work to restore the sense of the language in relation to its grammatical norms.

The most frequent speech disorders that a speech therapist has to work with in a polyclinic is.

Aphasia, according to LS Tsvetkova's definition, “this is a special speech disorder that occurs with organic brain lesions, covering different levels of organization and implementation of speech, revealing a connection with defects in other mental functions, leading to changes in the patient’s personality and to the disintegration of the entire mental sphere, manifested before all in violation of the communicative function of speech. " Moreover, among aphasias, speech disorders prevail, resulting from local lesions of the anterior speech zones of the left hemisphere of the brain. According to the neuropsychological classification, these include:

• dynamic,
• efferent motor,
• complex motor aphasia
• and cases of mixed aphasia with a predominance of motor.

Over the years, a large amount of material has been collected on the features of speech restoration in patients with various forms of aphasia, especially motor aphasia.

Types and forms of speech disorders

R. Jacobson proposed to distinguish between two types of speech impairment.

1. In one of them, the leading place is occupied by the defects of paradigmatic operations, in other words, the assimilation of those language codes that include mutually preparing relations.
2. In another type of violations, the leading place is occupied by the defects of syntagmatic processes, that is, units of a smooth contextual statement.

With the defeat of the anterior speech zones of the left hemisphere, the leading place is occupied by defects in syntagmatic connections.

Speech defects in these patients manifest themselves in different ways: in some, expressive speech becomes completely impossible, in others it loses its active character and the patient, who correctly repeats words and sentences, is unable to independently formulate a detailed statement, in others the defect takes the form of a "telegraph style ", in which all predicates and connectives drop out of the patient's speech, while the communicative components remain intact. Common to these patients is a gross violation of coherent, intonationally expressive speech.

With dynamic aphasia, the lesions are located in the anterior parts of the speech zone of the left hemisphere, and there are disorders that are specifically speech in nature. The central symptom for this group of patients is a pronounced violation of spontaneous detailed speech, up to its practical absence. Speech disturbances here affect those deep levels of the organization of speech processes that relate to the formation of internal speech and extend to the levels of semantic recording and deep-syntactic structures. Speech disorders in these patients are not accompanied by gross grammatism, but there is a tendency to reduce complex syntactic structures to more elementary constructions. Probably, the main violation in the correct formation of independent utterance is located in these patients at the level of the formation of the semantic scheme of utterance and refers to the shortcomings of inner speech.

Another form of speech disorders, in which not so much the general programming of the utterance as its grammatical structure, is disturbed, is distinguished by significantly different features. This group of patients does not have a pronounced defect in the semantic scheme of the message. The difficulties that arise here move much closer to the surface-syntactic structure of the utterance, and the coding of the speech message begins to suffer clearly in the most basic syntactic links. The predicative part of the sentence is either omitted, or the number of verb forms simply decreases, the proportion of nouns increases, mainly in the nominative case, conjunctions and prepositions are omitted. This fact indicates a gross disintegration of surface-syntactic structures, as the main defect in the patient's speech.

However, violations of the coding of an active utterance are not always of such a specific nature. Much more often in practice there are cases when the violation of utterances is of a more rude and complex nature and when the general inactivity and inertia of nervous processes is combined with specially speech disorders of the coding of messages. In these cases, we observe a picture with a predominance of gross motor aphasia, leading to a complex decay of speech activity. This is especially often noted in the initial stages of restorative education.

It should be noted that in patients with lesions of the anterior parts of the brain, along with defects in expressive speech, and are impaired. In addition to narrowing the meanings of a word and impaired understanding of verb words, patients in this group have a violation of the understanding of sentences, since the patient ignores grammatical indicators. Patients correctly understand the content of sentences with direct word order (the boy drew a house), but there are significant difficulties in understanding sentences with reverse word order (the house is drawn by a boy), as well as sentences where it is the grammatical factor that matters for understanding (for example, the patient is hampered by the task "Show a pen with a pencil" - patients alternately show a pencil and a pen).

In addition, patients with lesions of the anterior parts of the brain do not always notice errors in incorrect syntactic constructions. The sentences "The cat is sitting under the table" and "The cat is sitting under the table (table)" sound the same to them. In understanding speech, they rely on the meaning of words, and not on the grammatical factor.

It is necessary to point out such a phenomenon in lesions of the anterior parts of the speech zone of the brain, as a violation of the sense of language, which is expressed in the absence or violation of the control function, the assessment of the correctness of the linguistic phenomenon, the correspondence of the form of expression to its content. So, when assessing the correctness of a sentence, one often hears from patients: “I don’t know, I don’t feel it, so or not.”

Apparently, the violation of the grammatical formulation of speech in patients with aphasia is associated with defects in the sense of language due to the destruction of the dynamic stereotypes that underlie the process of grammatical formulation of the utterance. Disautomation of speech processes is one of the main properties of aphasia.

Turning off any of the speech mechanisms leads to the disintegration of the entire dynamic stereotype that controls this type of speech. These disorders are most severely manifested in efferent motor aphasia.

Efferent Motor Aphasia - Quests

Reception of speech.

Taking into account a number of features of aphatic disorders, speech restoration techniques are also being developed.

Based on the predominance of neurodynamic or organic disorders in the picture of speech disorder, a stage-by-stage principle was put forward for organizing restorative education in patients with aphasia. But at the initial stages of restorative learning, the principle of differentiation of methodological techniques, depending on the form of aphasia, is of less importance than at subsequent ones.

So, work to revive the sense of language it is possible to start already at the early stages of restorative learning, when the patient has no phrasal speech yet, but there are various neurodynamic disorders in the form of a decrease in mental activity, criticism of his condition, depletion of attention, there are motor disorders such as right-sided hemiparesis, up to plegia, which exacerbates the difficulties of recovery work.

A feature of work in the early stages is that, with known modifications, some methodological techniques can also serve the purposes of prevention. Thanks to this, it is often possible to prevent the onset and fixation of agrammatism in aphasia.

So, even at the stage of pronounced neurodynamic and speech disorders in patients with a predominance of motor aphasia, when one of the main tasks is to restore understanding of situational and everyday speech, patients are offered to show pictures depicting actions (sitting, standing, running, etc.) or pictorial images of objects with a proposal to show them by actions (how they dig the ground, how they write, how they hammer in nails). Taking into account the decrease in mental activity, exhaustion of attention, the patient is given a limited number of pictures (2-3 at the beginning of work), gradually increasing their number. Here, you can use not only showing, but also, if possible, naming the action, if necessary, use repeated and conjugated speech, as the most preserved types of speech in patients with anterior lesions of the speech zone of the brain. The same technique can be used when adding captions under pictures.

In order to move on to the preparation of sentences, the patient is first asked to divide the sentence into words (for example: "the weather is good today"). It is better to do this without writing this sentence, but first put it out of the letters of the split alphabet so that the patient has options for completing the task, because letters can be moved freely without fear of making a mistake.

When the patient begins to correctly select individual words, then he is given the task of making sentences of a certain model, and for the beginning the words are written on separate cards for a more free combination of these words and a sample is given. First, very simple sentences are given (a girl reads a book; students take exams; a cow gives milk). Then sentences become more complicated, prepositions are introduced; the task is given to compose 2 sentences each from the same words (direct and reverse word order) to overcome perseverations, for example:

1. The plane is flying over the sea.
2. An airplane is flying over the sea.

This task already presents some difficulties for patients with lesions of the anterior sections of the speech zones due to a decrease in activity and inertia.

As the feeling of language revives and the grammatical structure is restored, the patients are invited to compose longer and more complex sentences from individual words. But first, sentences of a certain construction are given with the presentation of a sample and the writing of words on separate cards, for example:

• The guys released the bird from the cage.
• We bought theater tickets.
• I like pancakes with sour cream.

Then sentences are given with several prepositions, for example:

• Children walked with their grandmother in the park.
• We rode a boat on the lake.
• The hostess goes to the grocery store.

Often patients find it difficult to compose sentences such as:

• A crow sits on a tree branch.
• The guys are sunbathing on the river bank.
• We came to a trolleybus stop.

The card system also helps here.

With further recovery, patients are given longer sentences of various models without a sample, as well as the task of making sentences from individual words in the whole story. For example, make sentences in the story "Who wrote what?":

Papers were, in, not, times, distant. Manuscripts, tablets, on, first, clay, first, appeared. On, they wrote, metal, then. Paper, bone, on, ivory, east, replaced. Letters, used, animals, for, leather, often. There are many such books that have survived. Russia, in, on, bark, ancient, birch, wrote.

While the patient does not have phrasal speech and various neurodynamic disorders are present, it is better for patients to give ready-made forms, that is, do not allow missing endings to be filled in, but insert the same word with different endings into short sentences of frequently used models:

• This … .
• I do not have … .
• Give me … .
• I drink tea from….
• I admire the beautiful….
• A cup, a cup, a cup, a cup.

For clarity, you can accompany this exercise with a drawing of an object, and also write these words on cards so that the patient can insert one or the other word. At the same time, the speech therapist reads the prepared sentence aloud, that is, the patient assesses the correctness of the design presented by ear and in writing.

You can also work with other parts of speech, especially relevant for motor and dynamic aphasia. work with verbs.

First, verbs are given only in the singular or plural, or in different numbers of the same person, so that there are fewer choices, which is especially important for patients with severe neurodynamic disorders.

For instance:

He's ... a song.
You ... a song.
I ... a song.
She's ... a song.
Singing, singing, singing.
You ... a song.
They are ... a song.
We are ... a song.
Sing, sing, sing.

"You ... this book?"
- No, we are all ... this magazine, and I ... a newspaper.
"Are you ... a textbook?"
“Yes, I am… a textbook.

A girl ... a book.
Boy ... magazine.

I read, read, read, read, read, read.

You can give the patient a task to fill in the missing endings, prepositions, at first no more than 2-3.

For example, insert the missing endings of nouns "e" or "y":

We are studying at the institute. ...
The delay occurred at the airport. ...
It is good to rest on the pestilence. ...
A worker works at a factory. ...
On the snow. traces are visible.
On the floor. the carpet is laid.
On the walls. hanging picture.

Insert Omitted Prepositions: in, on, on.

… There are many mushrooms in the forest.
We walked ... in the forest.
We walked ... along a beautiful path.
We stopped right on ... the path.
The squirrel lives ... in a hollow.
The squirrel is jumping ... to the branches.
The squirrel is sitting ... on a branch.
The cat runs ... to the yard.
Children play ... in a sandbox.
The grandmothers are sitting ... on the bench.

These techniques can also be used in restorative teaching with patients with sensory and acoustic-mnestic aphasia.

Stages of speech therapy work

At the initial stages of speech restoration, a more frequent vocabulary is proposed than at later ones, but here an individual approach is required... In work of a high premorbid level, less frequent vocabulary can be used at an early stage of the work. An individual approach is also necessary at the later stages of restorative learning, especially when restoring a detailed utterance.

At later stages, when the severity of the neurodynamic component is significantly reduced and speech disorders proper come to the fore, exercises to restore the sense of language, phrasal speech are differentiated depending on the form of aphasia.

So, with dynamic aphasia, the main work is carried out on the preparation of sentences of varying complexity according to the scheme from the simplest to detailed sentences with a gradual decrease in the number of external supports.

As for patients with motor aphasia, exercises aimed at overcoming agrammatism, especially the verbal one, come to the fore.

Exercises for filling in missing endings of verbs, nouns, adjectives are widely used; missed prepositions.

At the final stage, work is carried out to draw up a complex detailed phrase. Of particular difficulty is the compilation and use of complex sentences in your own speech. The patient is given the task of replenishing the missed union, the main or subordinate part of the sentence. Didactic material for this work is various works of art, newspaper articles, manuals for classes in the Russian language and teaching Russian to foreigners.

At all stages of restorative training, consistency, gradualness and graduation in the organization of restorative training is necessary, both in content and in the number of techniques and exercises used in working with patients. It is harmful both to get stuck on the same one, and too hasty transition to the subsequent points of the program of restoration work.

Even using a lot of exercises to restore any side of the impaired speech function, it is far from always possible to achieve automation of this process. But the patient often has an improvement in speech function that is not associated with those aspects of speech on which the work was carried out. Progress is often in the nature of the general development of speech, and not specific, that is, associated with the direct orientation of the restorative technique. This integration effect is especially valuable. It is apparently associated with the systemic interaction of the parties of speech in the recovery process. The significance of such a generalized effect compared to a purely specific one (when the patient begins to distinguish and use only what he was working on) is much greater. This ability to integrate is central to organized, targeted recovery.

Rehabilitation assistance to patients in the conditions of a polyclinic and conducting restorative education at home does not allow the development of a tendency towards a rapid disintegration of the personality, loss of self-care skills, motor activity characteristic of patients who are left without timely restorative speech training, allows to achieve positive dynamics even in patients with coarse speech and neurodynamic violations.

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MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION

NON-STATE EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION

TEST

AFASIA

Topic: "CORRECTIVE WORK FOR EACH FORM OF APHASIA"

Introduction

.Aphasias and their classification

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

2 Correctional pedagogical work with semantic aphasia

3 Correctional pedagogical work with sensory aphasia

4 Correctional pedagogical work with dynamic aphasia

5 Correctional pedagogical work with efferent motor aphasia

Conclusion

Bibliography

Introduction

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

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

1. Aphasias and their classification

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

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

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

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

Acoustic-mnestic aphasia is characterized by an inferiority of auditory-speech memory - a reduced ability to maintain a speech line within 7 ± 2 elements and synthesize a rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence; during the search for the desired word, pauses appear, filled with introductory words, unnecessary details and perseverations. In a derivative way, the narrative speech is grossly violated, the retelling ceases to be adequate to the model. The best transfer of meaning in such cases is provided by excessive intonation and gestures, and sometimes speech hyperactivity.

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

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

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

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

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

Semantic aphasia - occurs when a lesion occurs on the border of the temporal, parietal and occipital regions of the brain (or the area of ​​the supra-marginal gyrus). In clinical practice, it is quite rare. For a long time, changes in speech with the defeat of this zone were assessed as an intellectual defect. A more thorough analysis revealed that this form of pathology is characterized by a weakened understanding of complex grammatical structures reflecting the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, genus-specific, expressed in complex logical, inverted, fragmentarily spaced forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, official words and pronouns is disturbed. These disorders do not depend on whether the patient reads aloud or to himself. There appears defectiveness and slowness in the retelling of short texts, which often turn into disordered scraps. The details of the proposed, heard or read texts are not captured and conveyed, but in spontaneous utterances and in dialogue, speech turns out to be coherent and free from grammatical errors. Individual words out of context are also read at a normal speed and are well understood. Apparently, this is due to the fact that the global reading involves such a function as probabilistic prediction of the expected meaning. Semantic aphasia is usually accompanied by a violation of counting operations - acalculia (R48.8). They are directly related by the analysis of spatial and quasi-spatial relations, realized by the tertiary zones of the cortex, coupled with the nuclear part of the visual analyzer.

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

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

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

In connection with studies of deep brain structures that are directly related to speech processes, the problem of differentiating aphasias from categorically different speech disorders, called pseudo-phasias, arose. Their appearance is associated with the following circumstances. Firstly, during operations on the thalamus and basal nuclei in order to reduce motor defects - hyperkinesis (F98.4), parkinsonism (G20) - immediately after the intervention, such patients develop symptoms of speech adynamia in active speech and in the ability to repeat words, as well as difficulties arise in understanding speech with an increased volume of speech material. But these symptoms are unstable and soon reverse. In case of injuries of the striatum, in addition to the actual motor disorders, there may be deterioration in the coordination of the motor act as a motor process, and with dysfunction of the pallidum - the appearance of monotony and non-intonation of speech. Secondly, pseudo-phase effects occur during operations or when organic pathology occurs deep in the left temporal lobe, in cases where the cerebral cortex is not affected. Thirdly, a special type of speech disorders, as already indicated, are the phenomena of anomie and dysgraphia, which occur when the corpus callosum is dissected due to disorders of interhemispheric interaction.

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

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

In patients with acoustic-mnestic aphasia, there is an increased efficiency, emotional lability, frequent bouts of depression due to even minor speech errors.

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

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

To overcome speech disorders in patients with acoustic-mnestic aphasia, the speech therapist relies on the coding mechanisms of the speech utterance that are preserved in them, i.e., on the description of the features of the object, the introduction of a word into various contexts, on the compilation of external supports that allow the patient to maintain a different volume of speech load.

Written speech plays a special role in the process of restoration of acoustic-mnestic speech functions. With one or another mnestic aphasia, the sound-letter analysis of the composition of the word is preserved, this allows using the recording of words preceding auditory stimulation, overcoming in patients the tendency to verbal paraphasias, as well as the agrammatism characteristic of their oral speech. The preservation of written speech gradually prepares at the intra-speech level the syntagmatic division of the phrase into segments (a syntagma consists of two or three words), related to each other by meaning, since the subject, as a rule, is in one syntagma, the predicate in another, or the main sentence in the first syntagma, secondary - in the second (Children went to the forest to pick up mushrooms); the audible fragments of one part of the sentence allow the patient to predict its second part.

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

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

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

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

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

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

2.2 Correctional pedagogical work with semantic aphasia

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

The basis for overcoming impressive agrammatism and amnestic difficulties is relying on the intact mechanisms of a detailed, planned written and oral utterance. Defects of the higher paradigmatic level of coding and decoding of a speech message are overcome by attracting the higher stages of the syntagmatic level, namely planning, building mental actions carried out by the frontal regions in relationship with all gnostic departments, providing a lower, phonemic level of the speech act.

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

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

Patients with semantic aphasia in expressive speech use the same type, little detailed sentences. Their written language is also monotonous. In order to restore, expand the use of various syntactic structures by the patient at the initial stage of recovery, exercises are used to compose various complex sentences with the use of union words if, so that, when, after, no matter how ... etc.

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

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

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

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

Then they move on to describing the indirect part of the word-collocation paradigm, specifying who this object belongs to, who and why cannot do without it. A comparison is made of the lightest phrases of mother's daughter, daughter's mother. The patient specifies the person in question: the mother of the daughter, the daughter of the mother, introduces these phrases into various contexts, supplying them with epithets and pointing to various pictures of daughters and mothers in different situations. The comic detailed play on phrases helps a lot: Mom sits in a stroller and plays with a rattle, and her daughter rolls it around. The daughter feeds her mother from a spoon (this option can take place in life: a daughter can feed a seriously ill mother from a spoon, but this must be stipulated).

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

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

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

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

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

2.3 Correctional and pedagogical work with sensory aphasia

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

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

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

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

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

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

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

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

At the next, fourth stage, work is being carried out to differentiate phonemes that are close in sound, that is, words with opposition sounds: house - volume, daughter - point, day - shadow, summer cottage - wheelbarrow, barrel - kidney, beam - stick, butterfly is a daddy, an eye is a class, a curtain is a picture, a goal is a stake, an angle is coal, a bow is a hatch, a tower is arable land, a bot is a sweat, a fence is a constipation, a duck is a fishing rod, a tub is a reel, fruits are rafts, a path is pellet: fence - cathedral, goats - scythes.

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

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

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

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

Overcoming verbal paraphasias is carried out by discussing with the patient various signs of objects according to their contiguity and contrast, according to function, tool accessory, according to categorical criteria. The speech therapist suggests filling in the missing verbs and nouns in the sentence, choosing nouns for adverbs to the verb, adjectives and verbs for the noun ..

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

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

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

aphasia speech correction pedagogical

2.4 Correctional and pedagogical work with dynamic aphasia

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

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

Overcoming the defects of internal programming is carried out by creating external programs of expression for patients with the help of various external supports (schemes, sentences, chips, etc.), gradually reducing their number and subsequent internalization, rolling this scheme inward. The patient, transferring his index finger from one token to another, gradually develops the speech utterance according to the plot picture, then proceeds to visually tracking the plan for the deployment of the utterance without associated motor reinforcement and, finally, compiles these phrases without external supports, resorting only to intra speech planning statements.

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

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

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

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

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

As attention is raised to the speech of others, its understanding is restored, the difficulties of switching acoustic perception from one conversation to another decrease.

Restoration of written speech. Dysgraphic disorders in the writing of patients are rare. However, they have significant difficulties in composing the written text. The presence of errors in writing suggests that patients have signs of efferent aphasia.

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

2.5 Correctional pedagogical work with efferent motor aphasia

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

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

With very gross efferent motor aphasia with total impairment of reading and writing, work begins with the fusion of sounds into syllables. In this case, the patient not only imitates the syllable, which was previously slowly pronounced by the speech therapist several times, but also simultaneously adds it from the letters of the split alphabet. Then, from the syllables mastered, he composes a simple word such as hand, water, milk, etc. Various schemes of the word are composed, the syllable structure of the word is rhythmically repulsed.

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

To clarify the syllabic and. the sound composition of the word uses the technique of a visual image of the word scheme.

Simultaneously with the restoration of the sound and syllable structure of the word, work begins on the restoration of phrasal speech. Overcoming disturbed phrasal speech begins with the restoration of the so-called sense of language, catching consonance, rhymes in poetry, proverbs and sayings. It is especially useful to use proverbs and sayings with rhyming verbs: "As you sow, so you reap", etc.

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

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

In working with patients, subject and subject pictures are used, which are repeatedly played up by the speech therapist. At the same time, one or the other word is highlighted.

For example, in the phrase to the picture "A boy is going to school," the speech therapist first stimulates the call of the word to school, and then proceeds with the help of leading questions to the word goes.

In a playful form, the speech therapist teaches the patient to listen to the question, emotionally answer it, especially if it does not correspond to the picture. For example, a speech therapist asks: Is the boy flying to school? Maybe the boy is driving to school? Look carefully, maybe this is not a boy, but a grandmother? To these questions, patients, as a rule, on an emotional upsurge, answer: "No, this is not a grandmother, but a child" (or a boy), "not by car, but on foot," "not flying, but walking." Playing on the object drawing, the speech therapist asks the patient questions about what the object is intended for, what can or should be done with it in order, for example, to eat (it is necessary to wash, cook, etc.), what are the properties of the object, etc.

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

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

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

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

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

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

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

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

At the later stages, patients can be offered a solution to simple crosswords, composing various short words from letters of a polysyllabic word, that is, speech games are offered to patients, but in a lightweight form.

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

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

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

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

6 Correctional pedagogical work with afferent motor aphasia

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

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

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

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

With a mild degree of severity, work is carried out to overcome articulatory difficulties when pronouncing polysyllabic words with a confluence of consonants, to get rid of literal paraphasias and paragraphs, to overcome elements of expressive, mainly prepositional agrammatism, to prepare the patient to return to school or work.

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

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

When trying to pronounce the sounds u, o, s, and, as well as consonants, patients either breathe out soundlessly, or wheeze, making chaotic movements with their lips or tongue.

Distracting from voluntary articulation to play and imitation exercises, the speech therapist asks the patients to moan, as if a toothache, breathe on their hands, as if they were frozen, this enables the patients to perform not only oral, but also articulatory movements dictated by the concept of the action, its semantics.

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

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

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

In the first 2-3 lessons, it is necessary to repeatedly read the syllables and words composed of the sounds a, y, m. Repeated soaking of the syllables am-am, ay, ya, am, mind, words mother improves the ability to switch from one sound to another. Other sounds are gradually evoked.

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

-sounds of the same articulation group cannot be called up at the same time

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

Restoration of narrative speech. Traditionally, it is believed that expressive speech in patients with afferent motor aphasia is potentially preserved due to the preservation of the anterior speech divisions that program speech utterance. And yet, a gross violation of the articulatory side of speech, as it were, blocks the possibility of a detailed utterance. Even in "pure" cases of moderately severe afferent motor aphasia, difficulties may arise in the selection of words, especially prepositions and verbs with prefixes that convey spatial relation. These difficulties in choosing words and paragrammatism of the "telegraph style" type are overcome many times more easily than the true agrammatism of the "telegraph style" characteristic of efferent motor aphasia.

In afferent motor aphasia, as in acousto-gnostic sensory aphasia, difficulties in developing an utterance are associated with the ambiguity, with diffuseness of the idea of ​​the sound and syllable composition of the word. In this regard, as the sound-letter analysis of the composition of the word is restored and articulatory difficulties are overcome in patients with afferent motor aphasia, the possibility of nominating all objects, actions, qualities is restored. Quite quickly, the patient's dictionary becomes unlimited, especially when composing phrases based on plot pictures. However, situational speech for a long time remains slow, poor both in its lexical composition, and in grammatical forms of expression. Patients at the residual stage of the disease "get used" to the fact that others understand them by gestures and facial expressions, by individual words with difficulty pronounced with intact internal speech, which patients use in communication.

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

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

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

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

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

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

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

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

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

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

Secondarily impaired phonemic hearing is restored by fixing the patient's attention to sounds close in place and method of articulation, when listening to words starting with these sounds, when selecting pictures for one letter or another, starting with the corresponding vowel and consonant sounds, when choosing from various texts of words with practiced sounds at the beginning, middle and end of a word.

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

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

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

Conclusion

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

There is no society without speech. Speech is very important in a person's life, it is especially important for a person as a member of society. Thanks to speech, the modern world exists in such a developed form. Thanks to speech, the experience accumulated by all of humanity throughout its history is transmitted to the younger generation.

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

Bibliography

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

.Bernshtein N.A. About the construction of movements. - M .: Medgiz, 1947 .-- 255s.

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

.T.G. Wiesel Neuro-linguistic classification of aphasias // Glezerman T.B. Neurophysiological bases of thought disorder in aphasia. - M .: Nauka, 1986 .-- p. 154-200.

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

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

.Luria A.R. Higher cortical functions of a person. - M .: Moscow State University, 1962 .-- 504s.

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

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

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Introduction

1. Aphasias and their classification

Conclusion

Bibliography

Introduction

Aphasias and their classification

5. Semantic aphasia - occurs when a lesion occurs at the border of the temporal, parietal and occipital regions of the brain (or the area of ​​the supra-marginal gyrus). In clinical practice, it is quite rare. For a long time, changes in speech with the defeat of this zone were assessed as an intellectual defect. A more thorough analysis revealed that this form of pathology is characterized by a weakened understanding of complex grammatical structures reflecting the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, genus-specific, expressed in complex logical, inverted, fragmentarily spaced forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, official words and pronouns is disturbed. These disorders do not depend on whether the patient reads aloud or to himself. There appears defectiveness and slowness in the retelling of short texts, which often turn into disordered scraps. The details of the proposed, heard or read texts are not captured and conveyed, but in spontaneous utterances and in dialogue, speech turns out to be coherent and free from grammatical errors. Individual words out of context are also read at a normal speed and are well understood. Apparently, this is due to the fact that the global reading involves such a function as probabilistic prediction of the expected meaning. Semantic aphasia is usually accompanied by a violation of counting operations - acalculia (R48.8). They are directly related by the analysis of spatial and quasi-spatial relations, realized by the tertiary zones of the cortex, coupled with the nuclear part of the visual analyzer.

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

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

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

In connection with studies of deep brain structures that are directly related to speech processes, the problem of differentiating aphasias from categorically different speech disorders, called pseudo-phasias, arose. Their appearance is associated with the following circumstances. Firstly, during operations on the thalamus and basal nuclei in order to reduce motor defects - hyperkinesis (F98.4), parkinsonism (G20) - immediately after the intervention, such patients develop symptoms of speech adynamia in active speech and in the ability to repeat words, as well as difficulties arise in understanding speech with an increased volume of speech material. But these symptoms are unstable and soon reverse. In case of injuries of the striatum, in addition to the actual motor disorders, there may be deterioration in the coordination of the motor act as a motor process, and with dysfunction of the pallidum - the appearance of monotony and non-intonation of speech. Secondly, pseudo-phase effects occur during operations or when organic pathology occurs deep in the left temporal lobe, in cases where the cerebral cortex is not affected. Thirdly, a special type of speech disorders, as already indicated, are the phenomena of anomie and dysgraphia, which occur when the corpus callosum is dissected due to disorders of interhemispheric interaction.

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

Introduction

1. Aphasias and their classification

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

2.2 Correctional pedagogical work with semantic aphasia

2.3 Correctional and pedagogical work with sensory aphasia

2.4 Correctional and pedagogical work with dynamic aphasia

2.5 Correctional pedagogical work with efferent motor aphasia

2.6 Correctional pedagogical work with afferent motor aphasia

Conclusion

Bibliography

Introduction

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

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

Aphasias and their classification

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

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

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

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

Acoustic-mnestic aphasia is characterized by an inferiority of auditory-speech memory - a reduced ability to maintain a speech line within 7 ± 2 elements and synthesize a rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence; during the search for the desired word, pauses appear, filled with introductory words, unnecessary details and perseverations. In a derivative way, the narrative speech is grossly violated, the retelling ceases to be adequate to the model. The best transfer of meaning in such cases is provided by excessive intonation and gestures, and sometimes speech hyperactivity.

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

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

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

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

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

5. Semantic aphasia - occurs when a lesion occurs at the border of the temporal, parietal and occipital regions of the brain (or the area of ​​the supra-marginal gyrus). In clinical practice, it is quite rare. For a long time, changes in speech with the defeat of this zone were assessed as an intellectual defect. A more thorough analysis revealed that this form of pathology is characterized by a weakened understanding of complex grammatical structures reflecting the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, genus-specific, expressed in complex logical, inverted, fragmentarily spaced forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, official words and pronouns is disturbed. These disorders do not depend on whether the patient reads aloud or to himself. There appears defectiveness and slowness in the retelling of short texts, which often turn into disordered scraps. Details proposed, heard