Children's aphasias are a heterogeneous group of pathologies of TsNS which are shown by partial or total loss of earlier being present speech. Besides, they can be followed by violations of reading, the letter, perception, the account, emotional and behavioural reactions. A basis of diagnosis of children's aphasias – direct assessment speech and the TsNS nonverbal functions, and also definition of structural and functional violations of a cerebral cortex by means of KT, MRT and EEG. Treatment includes passing of a course of special recovery training and elimination of an etiologichesky factor (whenever possible). At Landau-Kleffnera's syndrome anticonvulsive therapy is also carried out.
Children's aphasias are a group of polietiologichesky violations of the central nervous system which are characterized by partial or total loss of speech functions at children with earlier created speech. In pediatrics such states meet seldom – these pathologies are more widespread among adults. Total occurrence among children – less than 1%. Children's aphasias are more often observed at boys. At children's age of aphasia are shown less variously, than at adults as the speech at children is not so developed. Than the child is younger – the clinical symptoms of children's aphasia are less various. Also bystry regress of the arisen symptoms is characteristic of patients of children's age – several months later speech functions can be restored completely.
Reasons of children's aphasias
Children's aphasia is a heterogeneous state. It develops as a result of defeat of the TsNS speech systems in the period of the created speech. In most cases similar states are diagnosed against the background of craniocereberal injuries and pathology of vessels, krovosnabzhayushchy a brain – an internal sleepy or average brain artery. Among ChMT the leading role is played by the open damages which are followed by loss of brain substance. The closed injuries of a brain provoke children's aphasias much less often.
Also as etiologichesky factors tumors, aneurisms, hematomas, brain abscesses, encephalitis act. At Landau-Kleffnera's syndrome loss of the speech arises together with epileptic seizures. The exact etiology of this form of children's aphasia is not established. According to many authors, it can be caused by the genetic or acquired structural tendency to epileptiformny activity. Development of the acquired epileptic aphasia presumably can provoke earlier postponed encephalitis.
Classification of children's aphasias
According to the International classification of diseases (MKB-10) children's aphasias can be divided into two groups:
1. The children's aphasias which resulted from organic or structural change of a cerebral cortex. Here speech violations owing to tumors, injuries, pathology of vessels, etc. belong. Depending on the place of defeat and pathogenetic mechanisms this group is divided into subgroups which will be considered further.
2. Landau-Kleffnera's syndrome or the acquired epileptic children's aphasia. In this case speech violations arise without organic pathologies of a brain, a basis of their development is epileptiformny activity.
Separately it is worth allocating a combination of these syndromes. This state develops in those situations when against the background of a new growth, a hematoma or other structural changes of a brain there are convulsive attacks which significantly are making heavier a clinical picture and stimulating progressing of children's aphasia.
Symptoms of children's aphasias
Characteristic age for children's aphasias – 3-7 years. However in many cases time of the beginning of a disease depends on at what moment the etiologichesky factor worked – there was a hematoma or there was a trauma. Depending on speech and nonverbal symptoms, and also localizations of defeat in pediatrics and logopedics allocate the following forms of structural children's aphasias: akustiko-Gnostic or touch, akustiko-mnestichesky, afferent and efferent motor, dynamic. The semantic form which is present at adults at children's age is not observed as in this period the system of symbolical and sign generalization of signals is not created yet.
Akustiko-gnostichesky or touch form. A defeat zone – back 1/3 top temporal crinkles of the left half of a brain. This form of children's aphasia arises because of violation of the acoustic analysis and processing of sounds of the speech that is characterized by defeat of phonemic hearing. It is clinically shown by violation of all forms of an oral and written language, reading and the oral account, rhythmic reproduction. Also at such children the excessive alarm and excitability, emotional instability is observed.
Akustiko-mnestichesky aphasia. Defeat localization – average and back sites of the temporal area. An essence of this children's aphasia – the increase in a tormozimost of acoustical traces leading to violation of acoustical and speech memory. Also there is a defect of visual and subject images representations. Such children do not understand implication, allegories, cannot call objects. Moderate violation of oral speech and its perception is noted. There can be a hyperactivity and emotional instability, alarm.
Afferent motor aphasia. The place of defeat – the lower parietal sites of the dominating hemisphere. Pathogenetic is based on violations of kinestetichesky perception. The main sign – anomalies of small articulation movements of lips and language. Such children or are incapable of the expressional speech or have a large number of literal paraphasias. Involuntary and automated (songs, verses) the speech, the letter and reading are kept.
Efferent motor form of children's aphasia. At this form back frontal sites are surprised. Inertness of the created stereotypes suffers that is shown by perseveration. Ability to oral statements minimum or completely is absent. Separate sounds, the automated speech can remain. Violation of reading, the letter, apraxia is observed.
Dynamic aphasia. Extremely rare form in pediatrics, can be observed at children of the senior age groups. Localization of the pathological center – back frontal departments. Pathogenetic this kind of a disease is caused by defects of the internal speech, violation of the suktsessivny organization of the statement. It is shown by frustration of the productive speech, inability of active communication – normal offers are replaced with stereotypes or templates, verbs completely are absent. Patients with this form of children's aphasia almost never ask anything and do not enter dialogues, but willingly answer the questions posed. Reading and the letter can be kept.
Landau-Kleffnera's syndrome. Localization of paroksizmalny activity can be different, temporal areas most often are surprised. Loss of the speech can happen both sharply (most often), and gradually, for several months. Also ability to perception of the speech is lost, violations of behavior and the emotional sphere – hyper excitability, emotional lability are possible. Characteristic feature of this form of children's aphasia – convulsive attacks which, however, are observed not at all patients.
Diagnosis of children's aphasias
Diagnosis of children's aphasias includes collecting anamnestichesky data, objective survey and communication with the child, laboratory and tool methods of a research. At clarification of the anamnesis at parents establish etiologichesky factors (injuries, associated diseases), and also dynamics of symptoms from emergence until inspection. At objective survey of the child pay attention to possible neurologic frustration which can indicate the nature of damage of a brain. At communication with the child the pediatrician or the children's psychiatrist estimate ability of the patient to oral speech, the letter, reading and the account, other speech and nonverbal functions that allows to define a form of children's aphasia.
Laboratory analyses, as a rule, maloinformativna. In certain cases they can point to a possible etiology ( with shift of a formula to the left at abscess etc.). Among tool methods EEG, a X-ray analysis of a skull, KT and MPT are applied. EEG is used for assessment of activity of this or that site of a cerebral cortex, and at Landau-Kleffnera's syndrome – for detection of epileptiformny attacks. The X-ray analysis and KT of a skull are shown at head injuries as allow to define a condition of bones of a skull, to diagnose their changes. Brain MRT – the most informative method of assessment of structure of TsNS. It almost always gives the chance to establish an etiologichesky factor of children's aphasia and prevalence of pathological process and to define further therapeutic tactics.
Treatment of children's aphasias
Treatment of children's aphasias means special recovery training by control of the logopedist. Its essence consists in activation of compensatory mechanisms of a brain by means of direct and indirect ways. Direct methods are shown on early terms, based on use of activation of reserve abilities of cages. Indirect or roundabout methods compensate the lost functions due to functional reorganizations. Depending on a situation and a form of children's aphasia as materials texts, cards, pictures, computer programs, various objects are applied to training, however the leading role is played by exercises with the logopedist.
Efficiency of recovery training depends on a number of factors: form and duration of a disease, weight of defeat of TsNS, etiologichesky factor, age of the child and moment of the beginning of therapy. The children's brain is very plastic therefore at easy forms bystry regress of symptoms is often observed. At structural children's aphasias of easy severity ability to communication comes back for 3-5 weeks, at average – in 1-6 months. At Landau-Kleffnera's syndrome besides training the corresponding drug anticonvulsive treatment can be used. However even against the background of positive dynamics of age norm it is possible to reach rather seldom.
Forecast and prevention of children's aphasias
The forecast at children's aphasia often favorable. At early diagnostics and in due time begun recovery training at an extent of the first several weeks or months it is possible to achieve bystry regress of pathology. At severe forms of defeat of TsNS or Landau-Kleffnera's syndrome the forecast doubtful. Predictively an adverse sign lack of positive dynamics for the first several weeks is considered. Specific prevention of children's aphasias does not exist. Nonspecific measures mean an exception of all possible etiologichesky factors: early diagnostics and treatment of background diseases of TsNS and vessels which can cause ischemia of a cerebral cortex, minimization of risk of injuries of the head.