Afferent motor aphasia — the kinestetichesky frustration of the created speech caused by violation of the central regulation of the rechedvigatelny device. Arises at defeat of an articulation zone of the post-central crinkle. It is clinically shown by decrease in speech production, difficulties of an articulation, mixture of phonemes with the similar articulation mechanism, a secondary dyslexia and a dysgraphia. The basis of diagnosis of afferent motor aphasia is made by logopedic, neurologic inspection, brain MRT. Treatment of the main pathology is carried out, medicamentous support of cerebral functions (neurometabolites, vascular pharmaceuticals), logopedic correction is carried out.
Afferent motor aphasia
The expressional speech is result of the coordinated work of all components of the articulation device: lips, language, throat, throat, facial muscles. Cortical regulation of speech process is carried out at a continuous afferentation — informing the relevant departments of bark on an arrangement of each of the specified speech bodies. The motor aphasia caused by violation of processes of an afferentation received the name "afferent". The term is entered by the domestic researcher of aphasias professor A. R. Luriya in 1969. The disease is widespread mainly among patients of middle and advanced age, afferent children's aphasia meets seldom. Defeat of several zones of bark leads to the combined violations – afferent and efferent motor, sensomotorny aphasia develops.
Reasons of afferent motor aphasia
The disease arises at organic defeat of a parietal share in area of the lower departments of the post-central crinkle. Pathological changes can have ischemic, inflammatory, post-traumatic, toxic, compression character. Act as the main etiofaktor of damage:
- Strokes. Are the most frequent reason of aphasia. At focal defeat of nizhnetemenny departments of the left post-central crinkle the afferent motor form of speech dysfunction is observed. At an ischemic stroke death of neurons of the specified area is caused by violation of blood supply owing to a thrombembolia or a spasm of the feeding cerebral artery, at hemorrhagic — a sdavleniye of fabrics the streamed blood.
- Craniocereberal injuries. Brain bruises with a razmozzheniye of fabrics in nizhnetemenny areas lead to damage of neurons which perceive afferent information from articulation bodies. Formation of an intracerebral hematoma, increase of post-traumatic hypostasis becomes the reason of a sdavleniye of neurons. As a result afferent motor aphasia develops.
- Brain tumors. Gliomas, astrotsitoma, medulloblastoma of a parietal share have the damaging effect by a compression of surrounding fabrics or destruction of neurons owing to the invasive growth. Increase in volume of an intracerebral tumor causes the increasing nature of speech violations.
- Neurodegenerate processes. Alzheimer's disease, leykodistrofiya, a disease of Peak are followed by atrophic changes in bark. The atrophy can arise at is long the existing epileptogenny center of parietal localization. The progressing demiyelinization causes destruction of afferent communications. Dysfunction of the struck departments of parietal bark — motor aphasia of an afferent form is result.
- Infections. Various infectious damages of a brain (encephalitis, encephalomyelitis, cerebral abscess) which are localized in a parietal share lead Etiologicheski to hypostasis, disorder of microcirculation, intracellular changes of neurons. Dysfunction and death of the last, violation of mezhneyronalny interactions provokes emergence of speech frustration.
Normal the expressional speech is carried out thanks to interaction of departments of post-and pretsentralny bark to whom articulation bodies are presented. The efferent impulses regulating muscular contractions, necessary for a fonation, are generated by neurons of a pretsentralny crinkle taking into account information from neurons of the post-central crinkle. To the last the afferent impulsation from the muscles and ligaments participating in sound education process arrives. Etiofaktora cause organic changes and dysfunction of the post-central region. The mechanism of perception of an afferentation, communication with a pretsentralny crinkle is as a result broken.
Without having sufficient return information on a condition of the articulation device, pretsentralny departments cannot adequately regulate process of a fonation. Speech apraxia — loss of movement articulation skill is result that in the expressed cases causes total absence of speech production. As kinestetichesky control plays an essential role in the course of the understanding heard there are secondary disorders of phonemic hearing.
Afferent motor aphasia can have the forms differing on the manifestations two. Variability is caused by various representation of articulation bodies in the post-central crinkle of right-and left-handed patients. Classification was offered A. R. Luriya:
- The first option is followed by disorder of spatial synthesis of the movements providing an articulation. At rough frustration situational speech production completely is absent. Apraxia of articulation bodies is observed.
- The second option carries the name "conduction aphasia". Primary safety of klisheobrazny situational statements at the expressed violations of any types of the speech is characteristic. Occurs at left-side (more rare right-hand) defeat of a parietal hemisphere at ambidexters and patients with the hidden levshestvo.
Symptoms of afferent motor aphasia
Articulation apraxia results in inability to independently reproduce separate sounds. Doing attempt, the patient makes random motions by language, lips, makes sound replacements. The patient tries to obtain bigger success, trying to reproduce a sound by imitation of an articulation of the doctor. However frustration of the kinestetichesky analysis of force of contact, the direction of the movement of articulation bodies would cause mixture of sounds, about-at, N-d-t and so forth.
Phonemic substitutions it is long remain against the background of gradual restoration of speech function. The patient says "house" as "volume", Vova as Vom. The closed syllables are more difficult for a pronunciation, their crushing by means of vowels is observed. The word "smoke" is pronounced as "smoke", "cap" as "sha-pas-@". Difficulties of the expressional speech force patients to use for communication speech embola — the short words, separate syllables having the expressed emotional coloring.
In the early period after ChMT, a stroke afferent motor aphasia is followed by misunderstanding of the heard speech. The state is passing, lasts several days. Is longer the complicated recognition aurally of the separate phonemes having the general way of an articulation remains (N-sh, the IFV). Redundancy of a phonemic variety of words allows patients to understand the statements turned to them. Along with speech apraxia constructive and spatial perception is broken – patients cannot arrange according to the instruction three subjects, are disoriented in the map, etc.
Degree of expressiveness of a dyslexia, dysgraphia correlates with weight of aphasia. Articulation difficulties are shown on the letter by literal paragraphias, admissions of consonants. In some cases the expressed motor form of aphasia dissociates with relative safety of the letter which remains the only way of communication of the patient. Restoration of a written language happens in process of normalization of speech production. Reading without pronunciation aloud can quicker be restored letters.
Conduction aphasia proceeds with safety of the automated situational speech. Patients are capable to communicate with relatives, using often used phrases and the words ("cannot be", "I will surely make", "yes", it is "good"), but experience considerable difficulties of any speech if necessary to repeat the word, to make the story according to the picture. Patients well hear own mistakes, try to overcome them. Violations of the letter consist in complexity of observance of an order of letters in the word. Typically mirror writing: "" instead of "window".
Patients crucially perceive own speech defect, the emotional sphere is kept. Thereof the probability of early depressive processing of the arisen state is high. As defeat affects motor fields of bark, the accompanying expressed motive deficiency is observed. Motive limitation, impossibility of self-service aggravate the psychological discomfort of the patient caused by violation of verbal communication. For lack of psychological and logopedic support developing of a depression is possible that considerably complicates further rehabilitation of the patient.
Diagnostic actions are carried out by joint efforts of experts in the sphere of logopedics and neurology. Search is directed to verification of a type of speech frustration, definition of an etiology and volume of cerebral defeat. Basic stages of diagnostics are:
- Consultation of the logopedist. Diagnostic inspection of the speech reveals decrease in the general speech production, in hard cases — its total absence. Patognomonichen a symptom of "search of a pose" – selection by the patient of a certain position of lips, language for pronouncing a necessary sound. Disorder of phonemic hearing, a dysgraphia, a dyslexia is defined.
- Consultation of the neurologist. Finds articulation apraxia, a right-hand spastic hemiparesis, a gemigipesteziya. Cognitive violations, mental deviations are absent. The obtained data confirm defeat of the left parietal area.
- Brain MRT. It is necessary for specification of a morphological substratum of a disease. Allows to diagnose volume education (abscess, a hematoma, aneurism of cerebral vessels), a zone of a gemorragiya, ischemia, tumoral process, an atrophy, a demiyelinization, the inflammatory centers. Results of scanning interpret according to a clinical picture of a disease.
- Lyumbalny puncture. It is carried out for receiving and a research of tserebrospinalny liquid. The analysis gives the chance to diagnose infectious and inflammatory changes, to verify the causative agent of a neuroinfection, to reveal blood traces, tumor cells.
Afferent motor aphasia demands a differentiation from other violations of the speech. Motor aphasia differs in restriction of speech production, difficulty of an articulation from akustiko-Gnostic, akustiko-mnestichesky forms with peculiar to them logorey. At dynamic aphasia the patient can be silent, but answers the simple questions asked him, is capable to consider aloud, to repeat words.
Treatment of afferent motor aphasia
Therapy of causal pathology has paramount value. Infectious and inflammatory defeats are stopped by specially picked up etiotropny medicines (antibacterial, antiviral, antimikotichesky). At strokes the general and differentiated vascular therapy is carried out. In case of tumors, traumatic damages, hematomas consultation of the neurosurgeon is necessary for the solution of a question of expediency of neurosurgical treatment. Correction of aphasia begins in the early recovery period, includes two main components:
- Logopedic occupations. At the beginning of any occupation the articulation and mimic gymnastics is carried out. All types of rastormazhivayushchy exercises are applied: the interfaced and reflected pronouncing the automated ranks, pronunciation of phrases with a rigid context, repetition of verses. Classes are given with a mimic prop: the doctor settles down opposite to the patient, pronounces sounds, is exaggerated showing statement of lips, cheeks, teeth, language.
- Drug treatment. It is directed to improvement of blood supply and metabolism of neurons of the struck area that promotes more bystry and full rehabilitation of patients. The pharmacotherapy is carried out by complex use of neurotyre-tread, nootropic, vazoaktivny, neurometabolic medicines.
Cognitive safety, awareness of speech defect form high interest of the patient in treatment. Support of relatives, regular independent trainings in house conditions is of great importance. In need of additional psychological support conversations with the psychologist, psychotherapy are shown.
Forecast and prevention
At successful treatment of a causal disease, the persistent, correctly picked up logopedic correction the forecast favorable. Together with restoration of speech motility violations of the letter, reading regress. At some patients the articulation additional sounds making an impression of a light accent remain, there can be rare literal paraphasias. Preventive actions include all range of the techniques allowing to prevent influence of etiologichesky factors. Highlights are the prevention and timely therapy of tserebrovaskulyarny pathology, prevention of traumatism, infectious diseases, an exception of onkogenny influences.