Aphasia – disorder of earlier created speech activity at which ability to use own speech is partially or completely lost and/or to understand the turned speech. Displays of aphasia depend on a form of violation of the speech; specific speech symptoms of aphasia are speech embola, paraphasias, perseveration, contaminations, , Alexia, agraphia, an akalkuliya, etc. Patients with aphasia need inspection of the neurologic status, mental processes and speech function. At aphasia treatment of the main disease and special recovery training is carried out.
Aphasia – disintegration, the loss of already being available speech caused by local organic defeat of speech zones of a brain. Unlike an alaliya at which the speech is not formed initially at aphasia the possibility of verbal communication is lost after speech function was already created (at children is more senior than 3 years or at adults). At patients with aphasia system violation of the speech takes place, i.e. the expressional speech (a sound pronunciation, the dictionary, grammar), the impressivny speech (perception and understanding), the internal speech, a written language (reading and the letter) in a varying degree suffers. Except speech function the touch, motive, personal sphere, mental processes therefore aphasia is among the most difficult frustration in which studying the neurology, logopedics and medical psychology are engaged also suffers.
Aphasia is a consequence of organic defeat of bark of the speech centers of a brain. Action of the factors leading to developing of aphasia happens in the period of the speech which is already created at the individual. The etiology of afazichesky frustration leaves a mark on its character, a current and the forecast.
Among the aphasia reasons the largest specific weight is occupied by vascular diseases of a brain – hemorrhagic and ischemic strokes. At the same time at the patients who had a hemorrhagic stroke the total or mixed afazichesky syndrome is more often noted; at patients with ischemic violations of brain blood circulation, - total, motor or touch aphasia.
Besides, craniocereberal injuries, inflammatory diseases of a brain (encephalitis, leykoentsefalit, abscess), brain tumors, the chronic progressing TsNS diseases (focal options of Alzheimer's disease and disease of Peak), brain operations can lead to aphasia.
Advanced age, the family anamnesis, atherosclerosis of vessels of a brain, hypertension, rheumatic heart diseases, the postponed tranzitorny ischemic attacks, head injuries belong to the risk factors increasing probability of developing of aphasia.
Weight of a syndrome of aphasia depends on localization and extensiveness of the center of defeat, an etiology of violation of the speech, compensatory opportunities, age of the patient and a premorbidny background. So, at brain tumors afazichesky frustration accrue gradually, and at ChMT and ONMK develop sharply. Intracerebral hemorrhage is followed by heavier violations of the speech, than thrombosis or atherosclerosis. Recovery of the speech at young patients happens to traumatic aphasias quicker and more stoutly at the expense of bigger compensatory potential etc.
Classification of aphasia
Attempts of systematization of forms of aphasia on the basis of anatomic, linguistic, psychological criteria were repeatedly undertaken by various researchers. However most to inquiries of clinical practice the classification of aphasia by A. R. Luriya considering localization of the center of defeat in a prepotent hemisphere - on the one hand and the nature of the violations of the speech arising at the same time – with another satisfies. According to this classification distinguish motor (efferent and afferent), akustiko-Gnostic, akustiko-mnestichesky, amnestiko-semantic and dynamic aphasia.
Efferent motor aphasia is connected with defeat of the lower departments of premotorny area (Brock's zone). As the central speech defect at Brock's aphasia the kinetic articulation apraxia making impossible switching from one artikulyatorny position to another acts.
Afferent motor aphasia develops at defeat of the lower departments of the post-central bark adjoining a rolandovy furrow. In this case as the leading violation serves kinestetichesky articulation apraxia, i.e. difficulty of search of a separate artikulyatorny pose necessary for pronouncing the necessary sound.
Akustiko-gnostichesky aphasia arises at localization of the pathological center in the field of a back third of the top temporal crinkle (Vernike's zone). The main defect accompanying Vernike's aphasia - violation of phonemic hearing, the analysis and synthesis and, as result, - loss of understanding of the turned speech.
Akustiko-mnestichesky aphasia is a consequence of defeat of an average temporal crinkle (extra nuclear departments of acoustical bark). At akustiko-mnestichesky aphasia owing to the raised tormozimost of acoustical traces slukhorechevy memory suffers; sometimes – visual ideas of a subject.
Semantic aphasia develops at defeat of perednetemenny and zadnevisochny departments of a cerebral cortex. This form of aphasia is characterized by specific amnestichesky difficulties – a zabyvaniye of names of objects and the phenomena, violation of understanding of difficult grammatical constructions.
Dynamic aphasia pathogenetic is connected with defeat of zadnelobny departments of a brain. It results in inability of creation of the internal program of the statement and its realization in the external speech, i.e. to violation of communicative function of the speech.
In case of the extensive damages of bark of a prepotent hemisphere taking motor and touch speech zones total aphasia – i.e. violation of ability to tell and understand the speech develops. Quite often the mixed aphasias meet: afferent and efferent, sensomotorny, etc.
Irrespective of the mechanism, at any form of aphasia violation of the speech in general is observed. It is connected with the fact that primary loss of this or that party of speech process inevitably involves secondary disintegration of all difficult functional system of the speech.
Owing to difficulty of switching from one speech element to another, in the speech of patients with efferent motor aphasia numerous shifts of sounds and syllables, perseveration, literal paraphasias, contaminations are observed. "cable style" of the speech, long pauses, a gipofoniya, violation of the rhythmomelodic party of the speech is characteristic. The pronunciation of separate sounds at efferent motor aphasia is not broken. Disintegration of ability to the sound-alphabetic analysis of the word is followed by gross violations of reading and the letter (dyslexia/Alexia, dysgraphia/agraphia).
Afferent motor aphasia can proceed in two options. At the first option articulation apraxia or total absence of the spontaneous speech, existence of a speech embol takes place. At the second option - conduction aphasia, the situational speech remains safe, however repetition, naming and other types of any speech is roughly broken. At afferent motor aphasia phonemic hearing and, therefore, understanding of informal conversation, values of separate words and instructions, and also a written language is again broken.
Unlike motor aphasias, at akustiko-Gnostic (touch) aphasia acoustical perception of the speech at normal physical hearing is broken. At Vernike's aphasia of the patient does not understand the speech of people around and does not control own speech stream that is followed by development of compensatory verbosity. In the first 1,5-2 months after brain accident the speech of patients includes a casual set of sounds, syllables and words ("speech okroshka" or a zhargonafaziya) therefore its sense is not clear to people around. Then the zhargonafaziya gives way to loquacity (logory) with the expressed agrammatisms, literal and verbal paraphasias. As at touch aphasia phonemic hearing initially suffers, violation of the letter is noted; reading remains to the most safe as relies more on optical and kinestetichesky control.
At akustiko-mnestichesky aphasia at patients recur difficulties with deduction to the memory of information apprehended aurally. At the same time storing volume considerably decreases: the patient cannot repeat after the logopedist a sheaf from 3-4 words, does not catch sense of the speech in the complicated conditions (the long phrase, bystry speed, a conversation with 2-3 interlocutors). Difficulties of speech communication at akustiko-mnestichesky aphasia are compensated by the increased speech activity. At optiko-mnestichesky aphasia violation of visual memory, weakening of communication of a vision of a subject and the word, difficulty in naming of objects takes place. Disorder of slukhorechevy and visual memory involves violation of the letter, understanding of the readable text, calculating operations.
Amnestiko-semantichesky aphasia is shown by a zabyvaniye of names of objects (anomy); violation of understanding of the difficult turns of speech reflecting temporary, spatial, cause and effect relationship; participial and verbal adverb phrases, proverbs, metaphors, familiar expressions, figurative sense and so forth. Also at semantic aphasia the akalkuliya is noted, the understanding of the readable text is broken.
At dynamic aphasia, despite the correct pronouncing separate sounds, words and short phrases, the safe automated speech and repetition, the spontaneous narrative speech becomes impossible. Verbal activity is sharply reduced, at the speech of patients there are ekholaliya and perseveration. Reading, the letter and the elementary account at dynamic aphasia remain safe.
Diagnosis of aphasia
Diagnostics, recovery treatment and training of patients with aphasia is provided by team of experts of neurologists, neuropsychologists, logopedists. For clarification of immediate causes of aphasia and localization of the center of defeat brain KT or MPT, the MR-angiography, UZDG of vessels of the head and neck, duplex scanning of vessels of a brain, a lyumbalny puncture is carried out.
Inspection of the speech at aphasia includes diagnostics of oral speech (expressional and impressivny); diagnostics of a written language (writing off, letter from dictation, reading and understanding of read). The neuropsychologist working with patients with aphasia carries out diagnostics of slukhorechevy memory and other modal and specific forms of memory (visual, motive), a praksisa (oral, mimic, hand, manual, somato-spatial, dynamic), a visual gnozis, constructive and spatial activity, intellectual processes.
Correction of aphasia
Correctional influence at aphasia consists of the medical and logopedic direction. Treatment of the main disease which caused aphasia is carried out under observation of the neurologist or neurosurgeon; includes medicamentous therapy, if necessary – surgical intervention, active rehabilitation (LFK, mechanotherapy, physical therapy, massage).
Restoration of speech function is carried out on logopedic classes in correction of aphasia, structure and which contents depends on a form of violation and a stage of recovery training. At all forms of aphasia it is important to develop at the patient installation on recovery of the speech, to develop safe peripheral analyzers, to conduct work on all parties of the speech: expressional, impressivny, reading, letter.
At efferent motor aphasia recovery of the dynamic scheme of a pronunciation of words becomes the main task of logopedic occupations; at afferent motor aphasia – differentiation of kinestetichesky signs of phonemes. At akustiko-Gnostic aphasia it is necessary to work on restoration of phonemic hearing and understanding of the speech; at akustiko-mnestichesky – over overcoming defects of slukhorechevy and visual memory. The organization of training at amnestiko-semantic aphasia is directed to overcoming an impressivny agrammatism; at dynamic aphasia – on overcoming defects of internal programming and planning of the speech, stimulation of speech activity.
Correctional work at aphasia should be begun from the first days or weeks after the had stroke or a trauma as soon as the doctor resolves. The early beginning of recovery training allows to prevent fixing of pathological speech symptoms (a speech embol, paraphasias, an agrammatism). Logopedic work on recovery of the speech at aphasia is continued 2-3 years.
Forecast and prevention of aphasia
Logopedic work on overcoming aphasia very long and labor-consuming, demanding cooperation of the logopedist, the attending physician, the patient and his relatives. Recovery of the speech at aphasia proceeds the more successfully, than correctional work is begun earlier. The forecast of restoration of speech function at aphasia is defined by localization and the size of area of defeat, extent of speech frustration, starting date of recovery training, age and the general state of health of the patient. The best dynamics is observed at patients of young age. At the same time, the akustiko-Gnostic aphasia which arose at the age of 5-7 years can lead to full loss of the speech or the subsequent gross violation of speech development (ONR). A spontaneous exit from motor aphasia sometimes is followed by developing of stutter.
Prevention of aphasia consists, first of all, in the prevention of vascular brain accidents and ChMT, timely identification of tumoral damages of a brain.