The work of a speech therapist for sensory-motor aphasia. Features of rehabilitation learning for aphasia in the early stages and in the residual period

With significantly pronounced aspontaneitythe patient is given variousexercises to classify objects according to different criteria(furniture, clothing, dishes, round objects, square, wooden, metal, etc.); direct and reverse ordinal counting, subtraction from 100 by 7, by 4, etc. are used.

Internal programming defects are overcomecreating speech programs for patients using various external supports(questions, sentence schemes, counters), a gradual reduction in their number and subsequent internalization, folding this scheme “inward”.

The restoration of the linear development of the utterance is facilitated by the use of words included in the questions for the plot picture or in the question for the corresponding situationdiscussed in class.

To others A technique for restoring the structure of an utterance is the use of support words, from which the patient composes a sentence.Gradually, the number of proposed words to compose a sentence of 5 words is reduced, the patient freely, at his own discretion, adds words in the desired grammatical form.

Due to the fact that in dynamic aphasia it is mainly the composition of texts, rather than phrases, that is disrupted, a series of sequential pictures are used as external supports.

For dynamic aphasiaspeech inactivity is overcome, conditions are created for increasing speech initiative,To do this, the patient is instructed to verbally convey to someone this or that request of the speech therapist, etc. Speech activity increases in the process of creating special speech situations-staged, during which the initiative to conduct a dialogue is transferred to the patient. The topic of the dialogue is previously discussed with the patient, he is given interrogatives, key words and a plan that he can use in the conversation. In classes to stimulate speech activity, conversations are staged with a doctor, in a store, in a pharmacy, at a party, etc. The patient can be the leader in a conversation about the work of a writer, artist or composer, when discussing a work of art, television programs.

For milder forms of dynamic aphasiaassignments are given to retell the text, first using an extensive questionnaire, then using key questions for individual paragraphs of the text, then based on the plan. At the same time, the patient learns to draw up independent plans for texts, first expanded, then short, collapsed, after which, having previously drawn up a plan, he retells the text without looking at it. Thus, the interiorization of the plan occurs when retelling what has been read.

In severe dynamic aphasia, understanding of situational speech is restored through discussion of various events of the day.Then the speech therapist again switches the patient’s attention to a new topic, for example, about who visited him the day before. Intonationally, the speech therapist identifies the predicate of the statement, collecting the patient’s attention on one or another fragment. Later, it is asked to execute both single-link and multi-link instructions.

As the patient develops attention to the speech of others, its understanding is also restored, and the difficulties of switching acoustic perception from one topic of conversation to another are reduced.

In parallel with the restoration of expressive oral speech, work is underway to restore missing prepositions, verbs, and adverbs into the texts; sentences on supporting words are drawn up in writing, answers to questions about texts are written, essays are written based on a series of pictures, applications, a power of attorney for receiving a pension, letters to friends, etc.

A speech therapist, in the process of individual and collective work with patients with aphasia, modifies the techniques and methods of correctional pedagogical work available in the arsenal of defectology, bringing his individual experience.

Let's take a closer look.

Training is distributed in stages.

Preliminary stage.
Main tasks:

1. Development of general motor activity. Daily morning exercises for arms, legs, and torso are planned.

Incorporating logorhythmics into the lesson. Dramatization.
Dramatizations using paralinguistic means of language (pantomime).

All these activities make it possible to restore melody to some extent.
2. Restoration of the rhythmic-melodic side of speech. The rhythmic pronunciation of individual phrases is practiced, using such supports as a picture, tapping, clapping the rhythm of a sentence. Logical stress is highlighted. Gradually the supports are removed; the same sentence is processed with different intonation. Much attention is paid to the rhythmization of individual words. The word is tapped, slammed, the stressed syllable is highlighted by the voice. Words with the same rhythmic structure are invented.

Stage I of training.

Main tasks:

1) updating of words-verbs;
2) expansion of the valence of verb words;
3) expanding the meaning of verb words.

^ System of receptions.

1. The task is given to create a grid of predicative connections for words denoting actions.
Operation 1 – a word-verb is given,for example, “goes”, Question “Who?” "What?" – a number of plot pictures are given.

Task: select pictures that are inherent in the word goes.

2nd operation. Having selected the pictures, the patient must find their verbal verbal designation. "Snow, man, train."

3rd operation. The patient names objects or phenomena, then makes up word relationships and writes them down in a notebook in the form of a diagram. WHO'S COMING? What? – Man, Snow, Rain.

The task is given to create a grid of predicative connections for words denoting an object or phenomenon.

The word object is given. Rain, what does it do? – a series of plot pictures.

Task: select pictures depicting actions

Having selected the picture, patients must find the verbal, i.e. verbal designation. The patient names the word - the action, and then makes up the relationships between the words and writes them down in the form of diagrams in a notebook. We move on to the second technique when we have worked out the 1st technique, etc. First conjugate, then reflected, and semi-independent.

Expansion of previously developed grids in the meaning of words. For this purpose, the method of consistently increasing semantic connections and meanings of words is used. For example: Rain - Falling, Knocking, Noisy / What is it doing? Man, rain, time / Who? Works, rests, reads. \ Woodpecker makes noise, Street, Baby / hammers, etc.

A large number of new words are being updated. Associative connections and valences expand, sentences are built. And the grid itself creates the structure of the sentence. Next: the actualization of verb words comes from working with synonyms and antonyms; various methods of word formation are widely used.

Thus, the work done at this stage prepares the solution to the main task - the ability to structure.

^ II stage of training.

Task: Restoring a coherent statement.

The work is divided into two stages.

Stage I – To structure a sentence, the method of externalizing the linear scheme of the sentence is used - the method of chips. The essence of the method: the patient is presented with a picture. What to do? The girl catches the ball. A number of chip cards are laid out under the pictures. Each card represents a chip, and together they form a linear diagram of the sentence.

The patient is equipped with a work program:

Look at the picture and think about its content.
Break the picture into semantic parts (words) and circle them with a pencil.
Use arrows to connect those parts of the picture that are related to each other in content (girl, ball).
Think of a verb that you represent with an arrow.
Count the number of words in your sentence.
Check whether the number of words in the sentence corresponds to the number of chip cards.
Fixing each chip card with your finger while looking at the picture, say the phrase out loud.

At the beginning, this method is performed in conjunction with a speech therapist, and when the patient masters this action, you can work independently. It is important that he understands that with the chip fixed he understands the long-range action. Gradually, the supports seem to be removed, first the chip cards are removed. We produce the sentence diagram with the movement of a finger, then reproduce the linear scheme of the sentence with the movement of the eyes. Thus, such external supports as a picture, chip cards, and eye movements provide significant assistance in structuring a sentence.

What is the psychological essence?
1. chip cards materialize a linear spatial scheme of a sentence.
2. chip cards divide the phrase into separate elements.
3. Chip cards materialize the quantitative composition of the phrase.
4. Chip cards allow you to determine the sequence of elements in a phrase.
Stage II – Drawing up a diagram of the whole statement.It has a more complex psychological structure. To restore the utterance, it is taken outside: the intent of the utterance, i.e. content, plan and supporting words. To materialize a plan, a plot picture is used first, then text, and at the end - a given plan.

Program No. 1.
A plot picture is given

Graphic cards with basic words and a task - a coherent retelling of the plot of the picture.
The operating algorithm is set:

Take a picture and think about its content.
Divide the picture into semantic parts (sentences).
Divide the first semantic part of the picture into subparts. (Girls sledding).
Connect with arrows those parts of the picture that are connected to each other.
Think about the verb that you represented with an arrow.
Check if you did everything correctly.
Select the necessary words and make sentences.

Exactly the same with parts 2, 3, 4 of the picture. Then we complicate the work a little. More complex pictures are given and patients work independently. Sometimes 300-500 pictures are processed.

Program No. 2

Involves retelling the test. At the beginning there are simple texts by type.
*The boat moored to the shore. The shore is strewn with pebbles.
* The bear loved honey. The honey was in the hives. The hives stood in the bushes. Bees were flying in the bushes.

Chain organization text. A graphic outline of the text is given and subject pictures for this text are given.

The panel contains subject pictures related and not related to the text. There is a first reading of the text, then a second is planned, but with an additional task. They must select all the subject pictures related to the content. Then the 3rd reading is planned and the task is given to decompose the picture in a graphic plan, thus, a subject graphic plan is obtained and therefore the retelling begins with the graphic plan.

We have been studying for a long time. Working with these texts varies and the task becomes more complicated. Several tasks. You need to compose several versions of the story using the same graphic scheme.

verbal repetition can be replaced by a pronoun or synonyms.
We need to work on the variability of verbal vocabulary. We compose stories according to a partially compiled program, for example, we remove only one word, or we can remove an entire linear sentence or the end or the beginning. We sit on these texts for a long time. This is where they capture the dynamics. Then they move on to more complex texts. The texts are not of a chain organization, but of a parallel connection. Then ready-made texts of the parallel organization are given. Based on these texts, we teach how to draw up a retelling plan.

break the text into meaningful parts.
separate one semantic part from another - with a pencil
highlight the main idea of the first part of the story. Underline the words that express this idea.
come up with and write a title for this part of the story.

You can use words from the text. And according to such a program, each semantic part is analyzed.

The text is first retold in parts, and then as a whole. They need to write it down, put what was said on paper, read everything again, record it well on a tape recorder and listen to it. A sample retelling must be given at the initial stages. You can divide individual semantic parts into subparts and title them.

Programs on a given topic by design. Thus, from all programs the patient learns the following:

Orientation in general from one picture, text, design.
Orientation in drawing up a general outline of a statement, namely, they learn to isolate the main, semantic parts.

They learn to establish connections, semantic connections between these parts.
Select basic words for the statement.

They learn how to draw up proposals for each item of the plan.
Thus, having mastered these skills, they begin to independently compose messages and statements. At home, it is recommended to widely use audio-video or video techniques. That is, questions are asked about the content, and patients answer.

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 are used (visuality, accessibility, consciousness), however, due to the fact that the restoration of speech functions differs from formative training, that the higher cortical functions of an already speaking and writing person are organized somewhat differently than those of a beginner to speak a child (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 was damaged as a result of a stroke or injury, 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 aphasia that occurs due to damage to the temporal or parietal lobes of the left hemisphere, the planning, programming and controlling functions of the left frontal lobe are primarily used, ensuring 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 an attitude toward restoring 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 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 the patient’s relatively passive participation in the process of speech restoration. Techniques are used that disinhibit speech functions and prevent, at an early stage of recovery, such speech disorders as agrammatism of the “telegraphic style” type in efferent motor aphasia and an abundance of literal paraphasia in afferent motor aphasia. At later stages of restoration of speech functions, the structure and plan of classes are explained to the patient, tools are given that he can use when performing the task, etc.

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

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

5. In all forms of aphasia, the communicative function of speech is restored and 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, his narrative plan, the correction of literal or verbal paraphasia, etc.

6. In all forms of aphasia, work is being done to restore verbal concepts and include them in various word combinations.

7. The work uses deployed external supports and their gradual interiorization as the disturbed function is restructured and automated. Such supports include, in dynamic aphasia, sentence schemes and the method of chips, which allow the restoration of an independent detailed utterance; in other forms of aphasia, a scheme for choosing methods of articulation in the arbitrary organization of articulatory structures of phonemes, schemes used to overcome impressive agrammatism.

The dynamics of restoration of impaired speech functions depend on the location and volume of the lesion, the form of aphasia, the timing of the beginning of rehabilitation training and the premorbid level of the patient.

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

Corrective pedagogical work begins in the first weeks and days after a stroke or injury with the permission of a doctor and under his supervision. Early start of classes prevents the fixation of pathological symptoms and directs recovery along the most appropriate path. Restoration of impaired mental functions is achieved through long-term speech therapy sessions.

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

The speech therapist should explain to the family the personality characteristics of the patient 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 for working on speech restoration.

The problem of compensation.

The brain has an important property - the ability to compensate, this suggests that the return of speech to a patient with aphasia is in principle possible. Two types of compensatory mechanisms are used: direct and bypass. Accordingly, two types of directed influence are used in training.

The first type is direct disinhibiting methods of work. Used at the initial stage and designed to use reserve capabilities . As a result of the lesion, neurodynamic changes occurred in the CGM (speed, activity, coordination of nervous processes). These methods promote the release of nerve cells from a state of temporary oppression.

The second type of directed influence involves compensation based on restructuring the implementation method. For this, various interfunctional connections are involved, and those that were not leading before the disease. The formation of a “bypass” path is carried out by attracting other afferentations. For example, when overcoming articulatory apraxia, the optical-tactile method is often used. Optical-tactile external supports are connected, which in ontogenesis were additional, and not main.

Direct methods are designed to involuntarily bring up well-established skills in the memory of patients. Bypass methods involve the arbitrary development of ways of perceiving speech and one’s own speaking. The affected function will now be implemented in a new, unusual way for the patient.

Principles of remedial learning for aphasia (E.S. Bain).

Taking into account the stage or stage of restoration of speech functions.

At an early stage, work is carried out with the relatively passive participation of the patient. At later stages of speech restoration, the patient is explained the structure, lesson plan, and tasks assigned to him.

Taking into account the primary - impaired precondition, the neuropsychological factor underlying one or another form of aphasia. Based on this, differentiated learning objectives are set and differentiated teaching methods are selected.

The principle of systematicity is based on the idea of speech as a complex functional system, the structural components of which are closely interconnected. Speech therapy for any form of aphasia is aimed at all aspects of speech, since no matter which premise is violated, expressive speech, understanding, reading and writing are disrupted.

Restoration of verbal concepts.

With all forms of aphasia, patients find it difficult to choose lexical means of language. Poor vocabulary and verbal paraphasia are observed.

The control principle was formulated by P.K. Anokhin, N.A. Bernstein and A.R. Luria and proceeds from the position that only a constant flow of feedback signaling ensures comparison of the action with the program and timely correction of errors. Only when the patient understands his mistakes can conditions be created for monitoring speech, correcting verbal language, literal paraphasias and the narrative plan. Control of speech becomes a matter of consciousness for the patient.

The principle of a person-centered approach.

The patient at all stages experiences a feeling of powerlessness in overcoming speech disorders and changing social status. Overcoming the state of depression and instilling in the patient an attitude toward restoring speech function is the primary task of a speech therapist.

The principle of communicative orientation.

Corrective training is based on the tasks of restoring the communicative function of speech, and not eliminating the manifestations of certain symptoms. It is necessary to make it as easy as possible for the patient to communicate with people in different situations.

The principle of using external supports.

It is necessary to use a system of extensive external means that program one or another speech action, subsequently promote its internalization and develop self-control in patients with aphasia.

The principle of complexity.

It is necessary to restore not only impaired speech functions, but also non-speech higher functions, because the stimulating influence of nonverbal activity on speech function has been proven.

Methodological requirements for the material:

The material should not “overload” the patient’s attention. The work is carried out on a small volume and small variety of material. And only after the relative restoration of the ability to speak and understand the volume of material increases.

The complexity of verbal material must correspond to the patient’s capabilities (phonetics, length of words, length of phrases, text).

The material must be emotionally rich. It is necessary to rely on the personal and professional preferences of the patient. The topic of the lesson should stimulate positive emotions.

The effectiveness of remedial training for aphasia depends on the following factors:

Location and volume of the lesion. With aphasia resulting from cerebral hemorrhage, speech is restored better than with thromboembolism or head injury. Aphasia in children 5-6 years old is overcome faster than in schoolchildren and adults.

Form of aphasia and severity of manifestations

Presence of signs of left-handedness

Dates for the start of rehabilitation training

General somatic condition

Possibility of organizing outpatient classes

Premorbid level

Relationships with relatives

All these are factors that ensure the duration and systematic nature of speech therapy sessions.

Organization of correctional work.

Corrective and developmental work begins in the first weeks and days after a stroke or after an injury with the permission of a doctor and under his supervision. The earlier rehabilitation training began, the less likely it is that pathological symptoms will be recorded. Speech restoration is a long process of persistent, systematic studies with maximum persistence not only from the speech therapist, but also from the patient himself.

For aphasia, individual and group speech therapy sessions are provided. The individual form of work is considered the main one, since it is this that ensures maximum consideration of the speech manifestations of aphasia in each individual patient, etc. at the early stage 2 times a day for 10-15 minutes, at the later stage every day or at least three times a week for 30-40 minutes. Group lessons of 45–50 minutes are possible, but with the same impairments and no more than 5 people. A huge role belongs to explanatory work with the patient’s relatives and friends.

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

In speech therapy work to overcome aphasia, general didactic teaching principles are used (visuality, accessibility, consciousness, etc.). However, it must be remembered that the restoration of speech functions differs from formative training, that the higher cortical functions of a person who has spoken and written are organized somewhat differently than those of a child beginning to speak. In this regard, when developing a plan for cor.-ped. work should adhere to the following provisions:

1. After completing the examination of the patient, the speech therapist determines which area of the second or third “functional block” of the brain was damaged as a result of a stroke or injury, and which areas of the patient’s brain are preserved. In most patients with aphasia, the functions of the right hemisphere are preserved. It is the preservation of the functions of the right hemisphere and the third “functional block” of the left hemisphere that allows the patient to develop installation for restoration of impaired speech. Duration of speech therapy classes with patients with all forms of aphasia is two to three years of systematic training.

2. Selection of techniques core-ped. work depends on the stage of restoration of speech functions. In the first days after a stroke, work is carried out with the patient’s relatively passive participation in the process of speech restoration. At later stages of restoration of speech functions, the structure and plan of the lessons are explained to the patient, tools are given that he can use when performing the task, etc.

3. Cor.-ped. the system of classes presupposes such a choice of work methods that would allow either to restore the initially damaged premise, or to reorganize the intact links of the speech function.

4. For any form of aphasia, work is carried out on all aspects of speech: expressive, understanding, writing and reading.

6. In all forms of aphasia, work is being done to restore verbal concepts and include them in various word combinations.

7. The work uses expanded external supports (sentence diagrams, the method of chips, which make it possible to restore an independent expanded utterance; a scheme for choosing methods of articulation in the arbitrary organization of articulatory patterns of phonemes).

With aphasia resulting from cerebral hemorrhage, speech is restored better than with extensive brain injuries. Aphasic disorders in 5-6 year old children are overcome faster than in schoolchildren and adults.

Cor.-ped. work begins in the first weeks and days after a stroke or injury with the permission of a doctor and under his supervision. Early start of classes prevents the fixation of pathological symptoms and directs recovery along the most appropriate path. Restoration of impaired mental functions is achieved through long-term speech therapy sessions.

For aphasia, individual and group speech therapy sessions are provided. The individual form of work is considered the main one.

The speech therapist should explain to the family the personality characteristics of the patient associated with the severity of the disease. Instructions are given for working on speech restoration.

The theoretical basis of restorative training for aphasia is modern ideas in psychology about higher mental functions as functional systems, their systemic and dynamic localization, their lifetime formation, their socio-historical origin and indirect structure. Based on these theoretical positions, psychologists, physiologists, neurologists and speech therapists developed and practically applied a way to rebuild functional systems using the method of restorative training. This path has two directions in practical work: 1st – the broken link in the psychological structure of the function is replaced by another; 2nd - the creation of new functional systems that include new links in the work that were not previously involved in the now disrupted function.

To solve these problems, a group form of classes is provided, rather than individual. As a method of work in group classes, such forms and functions of speech can be used that cannot be used in individual work - dialogic and communicative. It is the dialogical form of speech that can be an effective means of the communicative function of speech. Group speech creates an emotional uplift and releases all the “dormant” abilities of a person to communicate. In addition, the advantages of the group form of classes: imitation, support, mutual assistance, cooperation, the presence of positive emotions, connections between group members, etc. The main task of speech therapy is the restoration of impressive and expressive vocabulary.

There are two periods in working with people with aphasia: acute – up to two months after the disease; residual – after two and beyond. In the acute period, the main tasks are: 1) disinhibition of temporarily suppressed speech structures; 2) prevention of the occurrence and fixation of some symptoms of aphasia: agrammatism, verbal and literal paraphasias, speech embolus; 3) preventing a person with aphasia from treating themselves as inferior, as a person who cannot speak. The main task in the residual period is to inhibit pathological connections.

Disinhibition of speech function based on old speech stereotypes should be carried out with low-strength stimuli (in a whisper, in a low voice). The material is selected based on its semantic and emotional significance for a person with aphasia, and not on the basis of ease or difficulty of pronunciation. To do this, you should get acquainted with your medical history, talk with your doctor, relatives to identify inclinations, hobbies, and interests. You can use familiar speech stereotypes - counting, days of the week, months; emotionally significant passages of poetry, finishing of common phrases and expressions. Over time, work with material that is close to the student is transferred to issues of specialty and profession.

The basis of restorative work to disinhibit speech function is dialogic speech. You can use the following scheme for restoring dialogical speech: repetition of a ready-made answer formula (reflected speech) - hints of one or two syllables of each word of the answer - spontaneous answer with a choice of two, three, four, etc. words used by the speech therapist when asking the question - a spontaneous answer to the question posed without taking into account the number of words used in the question, and asking questions by the person with aphasia.

The appearance of agrammatism in aphasia is usually the result of improper organization of the initial recovery period, when disinhibition is carried out either only of the nominative function of speech, or only of the predicative one. Speech should immediately be complete in terms of vocabulary, and pronunciation defects that do not reduce the correctness of sentence construction can be tolerated for now. This is the essence of preventing agrammatism. Work to overcome agrammatism is carried out not only in oral speech, but also, when writing skills are restored a little, in written speech. The basis of exercises (oral and written) to prevent the development of agrammatism is the dialogical form of speech.

The most difficult pathological symptom to prevent and overcome is the speech embolus, which often forms in the first weeks after the lesion. There are two main types of speech emboli: a single word or sentence that can be pronounced, or a trigger mechanism necessary for pronouncing other words (V.V. Opel). Since the speech embolus is the result and manifestation of stagnation and inertia of nervous processes, it cannot serve as a starting point for rehabilitation exercises. The following conditions contribute to the inhibition of the speech embolus (speech perseveration): 1) observance of optimal intervals between speech stimuli, allowing the resulting excitation to “fade away” after completing each task; 2) presenting the material at low voice strength, since in mild cases, perseveration almost does not occur with low strength of the sound stimulus, and when it does occur, it fades away faster; 3) a pause in classes at the first hint of the occurrence of perseveration; 4) temporary restriction of conversations with others, with the exception of the speech therapist.

To prevent a person with aphasia from treating oneself as inferior, one should talk to him with respect, warmly and sincerely experience all his successes and disappointments, trying to constantly emphasize achievements, calmly and confidently explain difficulties, creating confidence in one’s capabilities.

In the residual period, a more careful differentiation of methodological techniques is necessary depending on the form of aphasia. According to the severity of the violation, two groups are distinguished: 1st - the most neglected houses with which no one talks; 2nd – more complex – persons with speech embolus, agrammatism. With both groups, work should begin with disinhibiting speech; however, with the second group, it is necessary to simultaneously work on the speedy elimination of the embolus. To do this, without focusing on the use of the embolus, you should avoid all sound combinations that contribute to its pronunciation.

Since restorative education is aimed primarily at restoring communication abilities, it is necessary to be involved in communication not only in the classroom, but also in the family and public places.

The main task of restorative training for acoustic-gnostic sensory aphasia is to overcome defects in differentiated perception of sounds and restore phonemic hearing. Only restoration of the process of sound discrimination can ensure the revival of all affected aspects of speech, mainly speech understanding.

With acoustic-mnestic (amnestic) form of aphasia The central task of training is to restore (expand) the volume of acoustic perception, overcome defects in auditory-verbal memory and restore stable visual images of objects.

In remedial training for semantic aphasia L. S. Tsvetkova identified two stages. At the first stage, learning begins with recognizing drawn geometric figures by comparing two given samples. Then they move on to reproducing the given figures according to the model: first – drawing, then – active construction from sticks and cubes. Subsequently, verbal instructions are added to the sample: “put the square under the triangle, circle, right, up,” etc. Subsequently, they practice the concepts: “less - more”, “darker - lighter”, etc. Then they move on to restoring awareness of the diagram of their body, its position in space.

The main task of training at the second stage is to restore the process of understanding speech and its logical and grammatical structures. The main focus is on restoring understanding of prepositional and inflectional constructions. Restoring the understanding of prepositions begins with restoring the analysis of the spatial relationships of objects. In general, learning comes from restoring the spatial relationships of objects with a gradual transfer of action to the speech level.

The central task of restorative education with motor afferent aphasia – restoration of articulatory activity, and the goal is restoration of oral expressive speech. The main method of speech restoration in this form of aphasia is the method of semantic-auditory stimulation of the word. This method involves pronouncing not a sound, but a whole word. Restoration of sound-articulatory analysis and the kinetic basis of a word is carried out on the basis of the restored active and passive vocabulary.

With motor efferent aphasia the main task is to overcome pathological inertia and restore the dynamic scheme of the spoken word. The goal of training is to restore oral speech, writing, and reading. The implementation of this goal is possible by solving the following tasks: 1) general disinhibition of speech; 2) overcoming perseverations, echolalia; 3) restoration of general mental and verbal activity.

The Three Most Important Objectives of Restorative Training with dynamic aphasia defined by L. S. Tsvetkova: 1) the ability to program and plan statements; 2) predicativeness of speech (restoration of the actualization of verbs); 3) speech activity (restoration of the active phrase).

With acoustic-gnostic sensory and acoustic-mnestic aphasia, the patient’s increased performance and an active desire to overcome speech disorders are noted.

At the same time, he may experience a state of depression, and therefore the speech therapist must constantly encourage him, give him only feasible homework to complete, and inform the doctor about the patient’s depressed or excited state.

In case of acoustic-gnostic sensory aphasia, the task of correctional pedagogical work is to restore phonemic hearing and secondarily impaired expressive speech, reading, and writing.

The speech therapist relies on the intact analytical optical and kinesthetic systems, as well as the intact functions of the frontal lobes, which together create the prerequisites for compensatory restructuring of impaired acoustic-gnostic functions.

The restoration of phonemic perception at the early and residual stages is carried out according to a single plan, with the only difference being that at the early stage the violation of phonemic perception is more pronounced.

In particularly severe cases of sensory aphasia, at the early stage of recovery, non-speech forms of work are used, the purpose of which is to establish contact with the patient, explain the very fact of the disease, organize his educational activities (perform feasible tasks), and concentrate attention. Copying short words to pictures and solving simple arithmetic examples are used. As a rule, the patient willingly begins to copy, but retains in visual memory only the first letter of the word, and then writes a series of letters that are not related to the word being copied. They show him his mistakes and ask him to write down the word letter by letter, dividing them into cells. In the process of these tasks, a partial awareness of the very fact of his illness appears; the patient, as a rule, experiences it hard, and in the future carefully performs all the tasks of the speech therapist. The non-speech stage of working with the patient can last several days.

The work on restoring phonemic perception contains the following stages: the first stage is the differentiation of words that are contrasting in length, sound and rhythmic pattern (house - spade, spruce - bicycle, cat - car).

Pictures are selected for each pair of words, and the words are written in clear handwriting on separate strips of paper. The patient correlates the sound image of the word with a picture and a signature, he is asked to choose one or another picture, arrange captions to pictures, pictures to captions.

In parallel with this work, the perception of the sound of individual words begins to be consolidated in the process of copying them, pronouncing the word while copying, and developing auditory control. To do this, take short words consisting of one or two syllables. Education of the patient's acoustic attention begins with the revitalization of optical attention.

The second stage is the differentiation of words with a similar syllable structure, but distant in sound, especially in the root part of the word: fish - legs, fence - tractor, watermelon - axe. The work is carried out based on pictures, captions, copying, reading; Acoustic control of one's speech is developed.

The third stage is the differentiation of words with a similar syllable structure, but with initial sounds that are distant in sound. (Cancer - poppy, hand - flour); With common first sound and various ending sounds (beak - key, night - zero, lion - forest). The patient is asked to choose words starting with a particular sound, based on the subject pictures and captions to them.

The fourth stage is the differentiation of phonemes that are similar in sound (house. - Tom, house - smoke etc.).

To consolidate the unambiguous perception of phonemes, various exercise options are used to fill in missing letters in words and phrases, words with oppositional sounds, the meaning of which is clarified not through a picture, but through a phraseological context. For example, the patient is asked to insert the words into the text touch, shower, body, business etc.

The fifth stage is the consolidation of acoustic differential features of phonemes when selecting a series of words for a given letter from texts.

The restoration of phonemic perception lasts from 2 months to 1-1.5 years, since in many cases understanding the meaning of a word occurs only in context and difficulties in differentiating close phonemes are experienced for a long time when independently expressing thoughts in writing.

In addition, work is being done on the semantic attribution of the word through various phraseological contexts: select all the sharp objects depicted in the pictures, all wooden, metal or glass, what relates to dishes, tools, shoes, etc. Such work, aimed at reviving various semantic connections of a word, facilitates the choice of words in the process of communication, and reduces the number of verbal paraphasias.

The greatest difficulties in overcoming speech disorders are observed with a combination of acoustic agnosia and acoustic-gnostic aphasia, which arise with bilateral damage to the temporal zones. Speech restoration in this variant of aphasia is based on protective silent reading, lip reading and residual auditory perception capabilities, which make it possible to correlate the read, visually perceived articulatory position of the sound, the ability of its simulated repetition with the auditorily perceived sound signal.

Overcoming verbal paraphasia is carried out by discussing various characteristics of objects and actions according to their contiguity and contrast, according to function, instrumental affiliation, and according to categorical characteristics. The patient is asked to fill in the missing verbs and nouns, select nouns and adverbs for the verb, adjectives and verbs for the noun, etc. It is not always necessary to correct the patient during his statement, this can injure him, cause him irritation, and disrupt contact with him .

The speech therapist records verbal paraphasias in his diary and, based on their analysis, selects a series of exercises to overcome them.

To overcome verbosity and agrammatism, the patient is offered a sentence diagram, examples of direct and inverted sentences of three to five words.

One of the effective methods for restoring expressive speech in sensory aphasia (as well as in other forms of aphasia) is the use of written speech. The patient is asked to write phrases and texts based on simple plot pictures. This work allows him to find the right word and polish the statement. Overcoming errors in the agreement of verbs, nouns and pronouns in gender and number is carried out by inserting inflections missing in the text.

Restoration of reading, writing and written speech is carried out in parallel with overcoming phonemic hearing impairment. The restoration of writing is preceded by the restoration of reading, based on the sound-letter analysis of the composition of the word. Attempts to pronounce a readable word, the realization that mixing sounds changes the meaning of the word, creates the basis for restoring analytical reading, and then writing.