Cortical dizartriya — violation of a speech articulation owing to frustration of mechanisms of the central muscular innervation and a praksis of articulation bodies at the level of cerebral bark. It is clinically shown by loss of articulateness, speed and rhythm of the speech, replacement of separate sounds, division of affrikat at preservation of a semantic part of the statement. Diagnostics is performed by methods of a logopedic, neurologic research. For definition of an etiology of defeat of bark neurovisualization techniques are in addition appointed. Treatment includes therapy of causal pathology, logopedic correction, pharmacotherapy, a kinezioterapiya, massage, psychocorrection.
Dizartriya — the Latin term designating violation of an articulation. Division of a dizartriya into central and peripheral was for the first time carried out in 1911. In 1926 domestic professor neurologist M. S. Margulies offered more detailed classification based on localization of the center of cerebral defeat, the cortical form of a dizartriya is allocated. Clinically cortical dizartriya is similar to motor forms of aphasia that complicates its diagnostics and demands the careful neurolinguistic analysis. Exact data on prevalence of pathology in neurologic and logopedic practice are absent. At children the cortical dizartriya is a consequence of perinatal defeats of TsNS, at adults more often — tumors and ChMT.
Reasons of a cortical dizartriya
This form of violations of the speech is observed at focal organic defeat of the lower sites pre-and the post-central areas of bark on which articulation bodies are projected: language, lips, soft palate, jaws, throat, cheeks. The Etiologichesky factors causing defeat of bark, a polimorfna differ at children and adults also a little. The most significant etiofaktor are:
- Craniocereberal injuries. Traumatizing happens at open damages to a vdavleniye of bones of a skull, the closed injuries to a bruise, heavy concussion of a brain. Perhaps sdavleny bark the increasing post-traumatic subduralny or epiduralny hematoma.
- Brain tumors. Konveksitalny new growths of a brain, covers (meningioma) cause a focal compression of cerebral bark. The intracerebral tumors (gliomas, astrotsitoma) which are subject to the relevant departments of bark in case of infiltrative growth cause their destruction, for lack of infiltration — a sdavleniye.
- Meningoentsefalita. Inflammatory defeat of covers and substance of a brain can become a complication of various all-infectious diseases (measles, herpes, a rubella, a SARS), the centers of a chronic purulent infection (otitis, sinusitis, okolochelyustny abscess), specific infectious process (tuberculosis, syphilis). Swelling of brain covers, puffiness of cerebral substance provoke a sdavleniye of certain cortical sites and the vessels feeding them that leads to dysfunction of the neurons participating in regulation of the articulation mechanism.
- Strokes. The ischemic stroke becomes the reason of a hypoxia of cortical neurons owing to insufficient blood supply. The hemorrhagic stroke causes a sdavleniye of cortical fabrics the streamed blood. Lack of bystry restoration of a cerebral blood-groove, increase of an intracerebral hematoma leads to death of neurons, responsible for an articulation.
- Perinatal pathology. In pediatric practice the cortical dizartriya is most often formed under the influence of adverse pre-natal conditions of development (a hypoxia of a fruit, a pre-natal infection, a hemolytic disease), injuries and asphyxia of the newborn during childbirth. Treat risk factors heavy , bystry childbirth, application of obstetric nippers, operations (vacuum extraction).
Violation differs in pathogenetic polymorphism. In its framework distinguish two main mechanisms of formation of speech violations. The first is implemented at defeat of a forward central crinkle. Difficulties of an articulation arise owing to the central paresis of muscles of language and mimic muscles. The arrangement of representation of a brush, close to articulation bodies, in a motor cortical zone causes a frequent combination of speech frustration to increase in a tone in hand muscles.
The second pathogenetic mechanism is defined at localization of the center in the post-central departments. It is connected with violation of processing of the received afferent impulses informing on a condition of articulation bodies. Lack of the return information makes impossible the adequate correction of articulation movements which is carried out by the relevant departments of a motor zone. There is articulation apraxia — violation of programming of the sequence and force of the movements realizing speech function.
Heterogeneity of violations, various extent of their manifestations cause application of two classifications in practical neurology. Like other types of a dizartriya, the cortical form on expressiveness of speech dysfunction is divided into four degrees – from the erased dizartriya to a full anartriya. Taking into account localization of the pathological center and the pathogenetic mechanism the dizartriya is classified on two main options:
- Afferent (kinestetichesky). Arises at defeat of the post-central cortical areas of a prepotent hemisphere. It is combined with oral apraxia, apraxia of movements of a counterlateral brush. It is characterized by search of the correct articulation laying for pronouncing a necessary sound.
- Efferent (kinetic). It is formed at the center in forward central areas of bark. It is often combined with a counterlateral hemiparesis. Slowness, lack of speech smoothness, sometimes — poslogovy pronunciation is typical.
Symptoms of a cortical dizartriya
The first symptoms of speech frustration are tempo-rhythmic violations: slowness of the expressional speech, loss of its smoothness and automatism. An impression is made that it is difficult for patient to move lips and language that quite is true. The disorder of pronouncing peredneyazychny sounds connected with violation of an innervation of muscles of language acts as key manifestation. In speech production there is a replacement or the admission artikulyatsionno of difficult sounds. As a result the speech of the patient becomes greased, unclear. The substantial part of speech remains safe.
The afferent cortical dizartriya is characterized by search of the correct position of articulation bodies that does the speech faltering, tolchkoobrazny. The increased tension of an articulation causes strengthening of loudness of a voice, selective devocalization of sonants. Delay of transitional stages of an articulation leads to emergence of sounds inserts. Separate or partial pronunciation of affrikat ("c" = "t" + "with"), replacement of slot-hole concordants by smychny is observed. Some frustration of a front gnoziz is noted, the patient it is inexact specifies the place of a touch to various points on a face.
The efferent cortical dizartriya is followed by the complicated transition between sounds, lengthening of the stressed vowels concordant at the beginning and the end of the word (for example, to "vvvniz"). Violation of an articulation apikalny and cacuminal (, p) the concordants demanding participation of a tip of language, their replacement with dorzalny sounds is defined (t, e). Average pronouncing separate sounds is characteristic ("" and "t" are said as CU). Difficulties of deduction of an articulation pose, an insert and admissions of sounds in words come to light. The abundance of pauses in the word, in hard cases — a rupture of the word on separate syllables is typical. The articulation is supplemented with a set of sinkineziya: language vysovyvaniye, forehead namorshchivaniye, zazhmurivaniye of eyes. Dizartriya is quite often combined with a right-hand hemiparesis.
At children's age the cortical dizartriya negatively affects the general condition of TsNS and formation of the speech. Decrease in attention, ability to storing of information is noted. The lexicon is badly gathered, the general underdevelopment of the speech is formed. Defect of the proiznositelny party of the speech involves violation of perception of phonemes, there is a fonetiko-phonemic underdevelopment. The specified frustration interfere with successful training of the child in the letter, reading. The secondary dysgraphia, a dyslexia develops. The problems of communication caused by speech defect cause an imbalance of the psychoemotional sphere in adults. Patients sharply endure current situation, become stubborn, irritable or, on the contrary, closed, inclined to a depression.
Diagnostic difficulties are represented by a cortical dizartriya at children 2 years are younger. Violations of the speech at them can be suspected on the reduced speech activity. The type of speech frustration is established by comprehensive logopedic and neurologic inspection. Tool researches are necessary for specification of an etiology of defeat. The full complex of diagnostic procedures includes:
- Consultation of the neurologist. In the neurologic status asymmetry of the person, paresis of mimic muscles, a hyper tone of muscles of language, a deviation of its tip from the average line often is defined. Elements of apraxia of the articulation device, difficulty when performing the sequence of actions on a task come to light. Existence of the central spastic hemiparesis, a gemigipesteziya is possible.
- Consultation of the logopedist. Confirms the speech tension, slowness, intermittence of speech production. At a research of oral speech replacement of sounds, loss of separate phonemes, emergence of inserted sounds is observed. The substantial party of the statement, speech breath are not broken, phonemic hearing is kept. FFN and ONR can be diagnosed for children.
- Neurovisualization. Tomographic methods of a research allow to establish a morphological substratum of a disease. At injuries, obolochechny hematomas and tumors brain KT is more informative. Preference is given in diagnosis of strokes, cerebral new growths, inflammatory focuses to brain MRT. In difficult diagnostic cases carrying out both researches, and also PET-KT is recommended.
- Lyumbalny puncture. It is carried out at suspicion on an inflammatory and infectious etiology for a likvor fence. The research of tserebrospinalny liquid (likvor) allows to reveal inflammatory changes, to carry out , IFA, PTsR-diagnostics for verification of the activator.
The cortical dizartriya demands a differentiation from other speech frustration. It differs from akustiko-Gnostic, akustiko-mnestichesky, dynamic aphasia in safety of semantic aspect of the statement, complexity of an articulation of separate sounds. Distinctions with afferent motor aphasia consist in articulation difficulties both in any, and in the automated statements, lack of speech embol, at adults — safety of the letter and reading. In difference from a bulbarny dizartriya, cortical is not followed by an atrophy and fastsikulyation of language.
Treatment of a cortical dizartriya
Therapy of speech frustration is carried out against the background of etiopatogenetichesky treatment of causal pathology (post-traumatic violations, a stroke, encephalitis, tumor, perinatal encephalopathy). Successful recovery of the speech is possible at an integrated approach to rehabilitation of the patient, is reached by efforts of the logopedist, neurologist, a reabilitolog, the clinical psychologist. Recovery therapy includes the following medicamentous and non-drug methods:
- Logopedic occupations. Work on correction of a dizartriya has to begin in early terms, be followed by development of motivation of the patient. The main methods are the articulation gymnastics, logopedic massage, statement of difficult sounds in an articulation and their automation, development of small motility. At children in the subsequent classes are given in correction of FFN.
- Pharmacotherapy. Medicamentous support is necessary for activation of metabolic processes in TsNS for the purpose of restoration of the lost functions. Neurometabolites, nootropic pharmaceuticals, medicines are applied to improvement of cerebral haemo dynamics. According to indications medicamentous psychocorrection is carried out by sedatives, antidepressants.
- General rehabilitation. The general massage, a kinezioterapiya, reflexotherapy is used. Massage, mechanotherapy and physiotherapy exercises for paretichny extremities is carried out. An important point is the psychological rehabilitation of the patient including psychological consultation, art therapy, relaxation techniques, group trainings.
Forecast and prevention
In case of successful treatment of the main pathology and complex logopedic rehabilitation forecast favorable. Extent of recovery of the speech depends on an etiology of defeat, expressiveness of speech violations, age and psychological state of the patient. Most difficult the cortical dizartriya against the background of cerebral palsy, perinatal injuries of TsNS, advanced age, a depression gives in to correction. Injury prevention, treatment of tserebrovaskulyarny pathology, an exception of onkogenny influences, increase in resilience of an organism to infectious agents belong to measures of prevention. Prevention of a dizartriya at children includes competent conducting pregnancy and childbirth, timely correction of complications of pregnancy, the adequate choice of a way of a rodorazresheniye.