Abstract: The program offers a system of effective methods of correctional work that ensures the restoration of speech activity in patients with sensory aphasia in the first weeks after organic brain damage.
Program for working with patients to restore speech with severe sensory aphasia
One of the main conditions for the successful restoration of speech in patients with aphasia is the early start of rehabilitation therapy during the period when the greatest effectiveness of rehabilitation training is observed. The program offers a system of effective methods of correctional work that ensures the restoration of speech activity in patients with sensory aphasia in the first weeks after organic brain damage.
According to statistics:
- Stroke is one of the five major non-communicable diseases.
- In the Russian Federation, the incidence of cerebrovascular diseases is estimated at 350–400 people per 100 thousand population.
- By the end of the first year after a stroke, about 20% of surviving patients of working age are able to return to work, about 60% of patients do not need outside help, fully care for themselves, and do some housework, 20% require help only when performing complex tasks (for example , when using the bathroom), 15% are more dependent on others, and only 5% are completely helpless in everyday life and need constant care.
- According to the Union of European Phoniatricians (1994), of stroke survivors, 40 to 47% suffer from aphasia
Aphasias occupy a special place among various types of speech disorders. This is explained by the fact that with aphasia, not only the already established speech function is disrupted, but also all aspects of speech. The problem of overcoming speech disorders in aphasia and social readaptation of this large group of patients still remains acute.
Speech activity is a process of active, purposeful, language-mediated and situation-conditioned communication between people (with each other). Deviations in speech proficiency make it difficult to communicate with others and negatively affect the processes of perception and thinking; these disorders are most painfully experienced by patients; a violation of the communicative function of speech greatly worsens the quality of life and leads to social maladjustment.
Aphasia is one of the severe speech disorders of organic central origin. More often it occurs due to cerebrovascular accidents. Speech restoration in aphasia is one of the main problems of modern speech therapy.
Purpose of the program:
Selection of optimal methods for restoring speech activity in patients with sensory aphasia in the first weeks after organic brain damage, adaptation of classical methods of correctional work.
Program objective:
1. To select a system of effective methods of correctional work that ensures the restoration of speech activity in patients with sensory aphasia in the first weeks after organic brain damage.
With a rough degree of severity of sensory aphasia:
The scope of speech understanding is extremely limited. Patients are able to comprehend only purely situational speech, which is close to them in topic. A gross alienation of the meaning of the word is revealed when showing body parts and objects. Verbal instructions are not followed or are carried out with gross distortions. When perceiving speech, patients rely heavily on facial expressions, gestures, and intonation of the interlocutor.
In most cases, it is not possible to study the volume of auditory-speech memory.
Spontaneous speech is grossly altered, incomprehensible to others, consists of a random set of sounds, syllables, phrases (“jargonophasia”, “speech hash” or “word salad”), which later leads to logorrhea, speech as a whole gives the impression of a “flow”. The intonations are rich, the tempo is somewhat rapid, there are errors in stress, the vocabulary is varied, verbs predominate, as well as interjections and other auxiliary parts of speech. Patients accompany their statements with a variety of appropriate facial expressions and gestures. Despite gross distortions of the phonemic and lexico-grammatical side of the utterance, its general semantic orientation, as a rule, is conveyed to patients. Self-control is practically absent.
Repeated speech is extremely limited. They repeat only well-known words, allowing a large number of sound distortions in them.
Dialogue speech is extremely limited due to difficulties in understanding the issue. In cases where a purely situational question turns out to be understandable, patients give an answer to it that is full of various distortions. There is practically no specific information in the answer; only the general semantic orientation is captured (not always).
Attempts at naming are accompanied by numerous distortions of the sound structure of the word, verbal paraphasias based on the acoustic and semantic proximity of the words. Naming common actions is somewhat easier than naming objects.
Attempts to compose a phrase based on a plot picture come down to the production of individual words or phrases, not always connected in meaning and interspersed with numerous interjections.
Retelling of texts is not available.
Reading in a state of decay. Patients cannot read aloud or recognize individual letters. The associative connection “phoneme-grapheme” is grossly broken. There are only elements of global reading.
Writing as a function is missing. Patients usually write only their last name, first name, and the most highly reinforced words. Copying letters, syllables and phrases is accompanied by numerous errors due to sound lability. Self-control and attempts at correction are absent. The sound-letter analysis of the word composition is grossly violated.
With moderate severity of sensory aphasia:
The scope of speech understanding is limited. Patients generally understand situational speech, but understanding more complex non-situational types of speech is difficult. There are paragnoses (errors in comprehension), alienation of the meaning of a word into the names of individual objects and parts of the body. Sometimes patients are able to differentiate words with oppositional phonemes, but make mistakes in the corresponding syllables. There is no pronounced dissociation between the ability to understand words with abstract and concrete meanings. The ability to understand speech is significantly influenced by the rate of speech of the interlocutor and its prosodic features. In speech structures, patients, as a rule, distinguish grammatically distorted from correct ones, but do not notice semantic inconsistencies in them (only gross semantic distortions are noticed). Verbal instructions are followed with frequent errors.
The volume of auditory-speech memory is significantly limited.
Spontaneous speech is characterized by the presence of literal and verbal paraphasias and elements of logorrhea. There is agrammatism of “coordination”.
The pace of speech is somewhat accelerated, but there are pauses within and between words, which are caused by attempts at self-control and self-correction. The lexical composition of a statement is represented by various parts of speech, but more often verbs, interjections, and pronouns predominate. There are words with concrete and abstract meanings. There are speech cliches in which their own paraphasias are woven. As a result of this, individual fragments of the statement acquire a non-standard, bizarrely ornate meaning. Despite the limited number of highly informative words, the general meaning of the statement can be conveyed in most cases. Substitutions of one word for another appear (suitcase-wardrobe or well...). For example, “The wolf saw the hunters and delicately (slowly) disappeared into the bushes,” “The child (calf) ran around the cow and did not obey the shepherd.” The intonation is bright. Facial expressions and gestures are emphasized. There are no pronunciation difficulties identified.
Repeated speech - when repeating sounds, substitutions are noted based on their acoustic proximity; when repeating syllables, a tendency towards their transformation is revealed; when repeating phrases, the length of the sentence, its syntactic and prosodic pattern are preserved, with gross distortions of the lexical composition.
Dialogical speech is possible, but the answers are not always sufficiently informative. The patient often does not understand questions that are laconic in form and have to introduce additional words to explain them.
Naming - patients are able to name everyday objects and common actions. In less frequent nominations, various distortions are allowed - literal and verbal.
Composing a phrase based on a plot picture - patients cope with verbal presentation of the plot of a picture. However, most often they consist of only a few fragmentarily constructed phrases, which often convey information that is not directly related to the plot. The task of speaking concisely (2-3 words) is practically impossible.
Patients retell the text, but often make distortions characteristic of expressive speech in general. The general semantic orientation of the plot is conveyed to the patients. Elements of logorrhea and some pretentiousness in the style of presentation are often noted.
Reading aloud is possible, but is accompanied by the same distortions as expressive speech. Recognizes individual letters and reads them aloud.
Severe violations of written speech are noted. Patients copy words and even simple phrases, but writing from dictation is replete with numerous literal and verbal distortions of a non-standard type. There is a tendency to “attach” a sound to a word and thus facilitate the correlation of its acoustic and graphic image. When attempting to analyze the sound-letter composition of a word, gross errors are made in determining the quantity and quality of sounds.
For mild sensory aphasia:
Comprehension - patients understand speech relatively freely, but there are certain difficulties in perceiving detailed texts that require a number of sequential logical operations. Sometimes, in complicated conditions, elements of alienation of the meaning of a word are revealed. Therefore, defects in phonemic hearing also appear rarely, mainly in conditions of depleted auditory attention. Verbal instructions are available.
The volume of auditory-speech memory is only somewhat limited.
Spontaneous speech is quite extensive, diverse in lexical composition and syntactic structure. Rare paraphasias, often controlled by patients. The proportion of auxiliary parts of speech has been slightly increased compared to the significant ones. The pace of speech is accelerated. There are some errors in accent. The intonations are varied and expressive. There are no pronunciation difficulties. Sometimes speech has an “intricate”, “florid” stylistic pattern.
Repeated speech approximately corresponds to the level of restoration of spontaneous speech. There are paraphasias in complex speech structures.
Dialogue speech is practically unimpaired; there are some difficulties in understanding questions that have a complex semantic structure.
Naming as a function practically does not suffer. Sometimes there are difficulties in the sound organization of words - names.
A phrase based on a plot picture is possible, but it is characterized by some “complication” of the syntactic and lexical structure.
The retelling of the text is coped with, elements of logorrhea and some pretentiousness in the style of presentation are noted.
The state of the reading function is that they can read phrases and even texts freely. Sometimes verbal and literal distortions are noted in text elements that are complex in sound and semantic structure.
The condition of the writing function is without gross distortions. Mainly reflects the state of oral speech. There is a letter not only from dictation, but also from oneself. The “floridness” of formulating thoughts is more pronounced in writing than in oral speech.
Based on these speech characteristics, we developed a speech function correction program.
Speech function correction program
The conditions for successful speech restoration in patients with aphasia are the early start of rehabilitation therapy. It is recommended to begin speech therapy classes in the first 1-2 weeks after organic brain damage. It is at this time that the greatest effectiveness of remedial training is observed.
The goal of correctional work for sensory aphasia is to restore phonemic hearing and secondary disorders of expressive speech, reading, and writing. The work is based on intact optical and kinesthetic systems.
Work with patients in the acute stage of the disease should be strictly dosed depending on the characteristics of the patient’s general condition, and be gentle and psychotherapeutic in nature. In addition, special tasks are set to establish contact with the patient and involve him in purposeful activities. As a rule, for this purpose, the method of conversation is used on various topics close to the patient, as well as methods consisting of incorporating “non-verbal” activities: simple design, sketching, modeling from plasticine, etc.
Before going to the patient’s bedside, you need to familiarize yourself with his medical history in the most detailed way. It is necessary to establish, by asking, if possible, the patient’s relatives, roommates, and staff, what are his interests, what are the home conditions, what are the names of the closest and most beloved people, are there any such names and such issues that cannot be touched upon in communication with the patient.
We have repeatedly witnessed how a carelessly posed question or a carelessly pronounced name brought the patient into such a state that there was no talk of any activities with him. Therefore, when communicating with a patient, great caution and delicacy are needed. They are necessary both in choosing a topic for conversation and in choosing words and expressions.
Having studied the methods of correctional work with patients with aphasia, developed by: Oppel V.V. “Restoration of speech in aphasia”, “Restoration of speech after a stroke”; Wiesel T.G. “How to get your speech back”; Shklovsky V.M., Vizel T.G. “Restoration of speech function in patients with different forms of aphasia” (standard programs)”; Bein E.S., Burlakova (Shokhor-Trotskoy) M.K., Wiesel T.G. “Speech restoration in patients with aphasia”; Burlakova (Shokhor-Trotskaya) M.K. “Correction of complex speech disorders”, “Speech therapy work for aphasia at the early stage of recovery” and “Correctional pedagogical work for aphasia”, based on the fact that the primary speech defect in sensory aphasia is a violation of speech understanding, we come to the conclusion that the main task restorative training is to overcome one of the most severe disorders of impressive speech in sensory aphasia - alienation of the meaning of the word.
Within the framework of this type of work, the most effective are the standard programs developed by V.M. Shklovsky. and Wiesel T.G., designed for direct teaching methods, allowing you to select working materials and adapt them to patients, depending on the severity of sensory aphasia:
I. For patients in the stage of severe disorders
1. Accumulation of everyday passive vocabulary
2. Stimulation of understanding of situational phrasal speech.
3. Preparation for the restoration of written speech.
II. For patients in the stage of moderate disorders
1. Restoration of phonemic hearing.
2. Restoring understanding of the meaning of a word.
3. Overcoming oral speech disorders.
4. Restoration of written speech.
III. Mild disorder stage
1. Restoring understanding of extended speech.
2. Further work to restore the semantic structure of the word.
4. Further restoration of reading and writing.
Using the above methods, standard programs developed by V.M. Shklovsky. and Wiesel T.G. and methodological materials by Amosova N.N. ; Kaplina N.I.; Kosheleva N.V.; Avdeeva I.M.; Rumova A.G. ; Klepatskaya L.B.; Efimenkova L.N.; Tinina V.A.; Kochetkova N.A., Aksenova E.V., Petrenko V.M. and others, exercises were selected and tested that allow effective correctional work for sensory aphasia in an acute neurological department with patients with aphasia of varying severity.
As mentioned above, the primary task at this stage is to establish contact with patients and make them aware of their speech defect. The first lesson should be devoted to this problem.
The patient is given a pen (pencil) and, using facial expressions and gestures, is asked to write down:
HOUSE __________
HAND __________
CHAIR __________
1 + 1 = _______
3 x 2 = _______
In this case, the patient makes a number of mistakes. In the process of completing tasks, a partial awareness of one’s illness appears.
It is necessary to delicately show the patient his mistakes. Since his understanding of speech is impaired, he again has to explain himself using facial expressions and gestures. If the patient ignores the speech therapist’s gestures and facial expressions, you can highlight his mistakes with a red pencil.
In order to establish contact, organize the patient’s activities, and concentrate the attention process at the beginning of correctional work for severe sensory aphasia, it is advisable to use non-speech forms of work.
Folding cut pictures, constructing figures from elements
- develop the ability to recreate a complete image of an object from its parts.
- attention training,
- cause active work of thinking and memory.
Equipment: cut-out pictures, elements of figures.
First, cards with images of objects are offered for folding, cut into three parts, then into 4 or more parts.
Exercises to develop the perception of non-speech sounds
- develop the ability to recognize and distinguish non-speech sounds;
- develop concentration of auditory attention, auditory
- gnosis, auditory memory based on non-speech sounds.
"Listen to the street"
“What does it sound like?”
Equipment: metal box, glass jar, plastic cup, wooden box, pencil, screen.
Note: the exercise begins with the sound of 2 contrasting objects with a visual basis. The exercise continues until stable differentiation of sounds is achieved.
“Guess who sings like that?”
Equipment: tape recorder, audio cassette with bird sounds.
Rhythm restoration exercises
- development of auditory attention, auditory memory;
- restoration of rhythmic abilities on verbal and non-verbal material;
"Clap as many dots"
Equipment: a cube with a certain number of dots on each side.
Note: It is advisable to repeat this in many lessons. To maintain interest, you can suggest varying the sounds.
Subsequent versions of this game should be carried out on verbal material. The game options can be as follows:
- say the sound as many times as there are dots on the die;
- pronounce the syllable as many times as there are dots on the die;
- come up with a word with as many syllables as there are dots on the cube.
"Woodpecker"
Equipment: wooden stick.
1st option. The speech therapist invites the patient to listen carefully to the rhythm he taps and repeat it as accurately as possible.
(!-!; !-!!; !!-!!-!;…)
2nd option. Tasks with tapping the rhythm using stress to highlight part of the rhythmic pattern can also be used.
(!-!; !-!; !-!-!;…)
"Echo"
OOO
- A - U - I -O
- AU - IA - OA
- AUI - IAU
- AUIA - IUAO
This stage lasts several days. Then we move on to working with speech.
Working with speech
1. Exercises to accumulate everyday passive vocabulary:
- overcoming the alienation of words from objects, actions
- restoration of listening comprehension in patients (facilitates differentiation):
- formation of a general concept.
« Displaying pictures of objects belonging to certain categories(“clothing”, “dishes”, “furniture”, etc.)”
After mastering the material, continue classes in the series furniture, dishes, vegetables, fruits, animals, transport, etc.
“Showing body parts in the picture and in yourself”
Equipment: set of pictures
1. The speech therapist shows the parts of the body shown in the pictures and in himself and clearly names them.
« Selecting the correct name of an object and action among correct and conflicting designations based on the picture»
Equipment: set of pictures
Show the dress, show the pants, show the jacket, etc.
Girl trying on a dress? Girl trying on a fur coat?
When defects in understanding are particularly pronounced, the speech therapist asks to show
- what women wear"
- then they put it on their feet, etc.
Such expanded equivalents of names at the initial stages of training are perceived by patients more easily than names that are laconic in their form (from a larger volume of sound it is easier to isolate at least some fragments that allow one to interpret the meaning)
After mastering the material, continue classes on furniture, dishes, vegetables, fruits, animals, transport, etc., body parts.
Equipment: set of pictures
2. Exercises to stimulate the understanding of situational phrasal speech.
- restoration of understanding of situational phrasal speech
"Answers YES and NO, with an affirmative or negative gesture"
Is your name Borya?
Is your name Misha?
Your name is____?
Do you live in Paris?
You live in Moscow?
Have you been to the moon?
Have you hunted an elephant? etc.
"Following simple instructions"
For simple movements
"Stand up";
"Sit down":
"Come";
"Clap";
Differentiation of instructions that differ in sound
“Stand up”, “Clap”;
“Stand up”, “Come”;
Differentiation of instructions that sound similar
“Clap”, “Stomp”;
Follow instructions with 1 item
"Take a pen";
“Take a glass”;
Follow instructions with 2 objects (book and pen on table)
"Take a pen";
"Take a book";
“Catching semantic distortions in simple phrases deformed in meaning”
Equipment: set of pictures
3. Exercises to prepare for the restoration of written speech
Restoring grapheme-phoneme unity
“Laying out captions for subject pictures”
Equipment: a set of pictures, cards with the names of objects
“Laying out captions for simple plot pictures”
Equipment: a set of pictures, cards with the names of the plot pictures
“Answers to questions in a simple dialogue based on visual perception of the text of the question and answer”
WHO DID YOU SEE? (DOCTOR) _______________________
WHAT DO YOU SWEEP THE FLOOR WITH? (BROOM)______________
WHAT DO YOU WASH YOUR HANDS WITH? (SOAP)______________________
WHO DO YOU TREASURE? (OTHER)_______________________
WHO STUDIES AT THE INSTITUTE? (STUDENT)_______________
WHO WATCHES THE CONCERT? (VIEWER)__________________
WHO DRIVES THE CAR? (DRIVER)___________________
WHAT IS NOT IN THE BUCKET? (WATER)__________________________
“Writing words, syllables and letters from memory”
“Audible reading” of individual letters, syllables”
"Parrot"
a) reproduction of syllable combinations with common consonants and different vowels:
TA-TO-TU; YOU-TA-TO
MU-WE-MA; MO-MA-WE
VA-VO-YOU; WOO-WA-WO
YES-YES-DO; DU-DU-DA
BO-BA-BA; BOO-BO-BA
b) reproduction of syllable combinations with common vowels and various consonants:
TA-KA-PA; PA-KA-TA
KA-NA-PA; GA-WA-DA
FA-HA-KA; KA-FA-HA
BA-DA-GA; WA-MA-NA
c) reproduction of syllabic series with consonants,
differing in deafness and voicedness:
PA-BA PA-BA-PA KA-GA-KA
TA-DA BA-PA-BA GA-KA-GA
FA-WA TA-DA-TA WA-FA-WA
KA-TA DA-TA-DA FA-WA-FA
then syllable combinations with vowel sounds are pronounced - o, u, y.
d) reproduction of syllabic combinations with consonants,
differing in hardness and softness:
PA-PYA PO-PYO PU-PY PU-PI
MA-MYA MO-MYO MU-MY WE-MI
VA-VYA VO-VYU VU-VY YOU-VI
TA-TYA TO-THO TU-TY YOU-TY
DA-DA DO-DE DU-DU DU-DI
FA-FYA FO-FYO FU-FYU FY-FI
e) reproduction of syllable pairs with an increase in one consonant sound (to form combinations):
PA-TKA NA-KNA
TA-PTA PA-FKA
FA-TFA KA-TKA
TA-FTA KA-PKA
MA-KMA TA-KTA
NA-FNA NA-KNA
the same thing with vowel sounds - o, u, s.
f) reproduction of syllabic combinations with a common combination of two consonants and different vowels:
PTA PTO PTU PTU
WHO WHO KTU KTY
FTA FTO FTU FTY
TPA TPO TPU TPA
KNA KNO KNU KNY
g) reproduction of syllable pairs with changing positions of consonant sounds
in their confluence
PTA-TPA KTA-TKA FTA-TFA
PKA-KPA KDA-DKA HTA-THA
“Development of the phoneme-grapheme connection, writing letters and syllables under dictation”
Considering the severity of the disorder, during the patients’ stay in the acute department, work on correcting the defect is completed at this stage, as the patients are discharged with recommendations to continue correctional training.
The result of the first stage of correctional training is a number of positive changes in the state of the patient’s speech function:
The scope of speech understanding expands, patients are able to answer simple situational questions and follow simple instructions;
The functions of auditory attention are partially restored, primary phonemic hearing disorders are overcome;
In one’s own speech, the word salad remains, but the number of adequate words increases;
The active vocabulary is growing;
Patients begin to recognize individual letters, and the phoneme-grapheme connection is restored;
The behavior of patients becomes more even;
At the same time, significant defects in understanding remain, alienation of the meaning of the word remains, logorrhea remains in spontaneous speech, word salad remains, and the skill of self-control is insufficient.
Continued studies are required. The work should be carried out in accordance with standard methods in the direction of:
4. Restoration of phonemic hearing:
Differentiation of words that differ in length and rhythmic structure;
Isolation of the same 1st sound in words of different lengths and rhythmic structures, for example: “house”, “sofa”, etc.;
Identification of different 1st sounds in words with the same rhythmic structure, for example, “work”, “care”, “gate”, etc.;
Differentiation of words that are similar in length and rhythmic structure with disjunctive and oppositional phonemes by identifying differentiated phonemes, filling in gaps in words and phrases; capturing semantic distortions in a phrase; answers to questions containing words with oppositional phonemes; reading texts with these words.
5. Restoring understanding of the meaning of a word:
Developing generalized concepts by classifying words into categories; selection of a generalizing word for groups of words belonging to one or another category;
Filling in gaps in phrases;
Selection of definitions for words.
6. Overcoming oral speech disorders:
- “imposing a framework” on a statement by composing sentences from a given number of words (instructions: “Make a sentence of 3 words!”, etc.);
Clarification of the lexical and phonetic composition of the phrase through the analysis of verbal and literal paraphasias admitted by the patient;
Elimination of elements of agrammatism using exercises to “revitalize” the sense of language, as well as analysis of grammatical distortions.
7. Restoration of written speech:
Strengthening the phoneme-grapheme connection by reading and writing letters under dictation;
Various types of sound-letter analysis of the composition of a word with a gradual “collapse” of external supports;
Writing from dictation of words and simple phrases;
Reading words and phrases, as well as simple texts, followed by answers to questions;
Independent writing of words and phrases from pictures or written dialogue.
8. Restoring understanding of extended speech:
Answers to questions in a detailed, non-situational dialogue;
Listening to texts and answering questions about them;
Catching distortions in deformed compound and complex sentences;
Understanding logical and grammatical figures of speech;
Carrying out oral instructions in the form of logical and grammatical figures of speech.
9. Further work to restore the semantic structure of the word:
Selection of synonyms as homogeneous members of a sentence and out of context;
Work on homonyms, antonyms, phraseological units.
10. Correction of oral speech:
Restoring the self-control function by focusing the patient’s attention on his mistakes;
- compiling stories based on a series of plot pictures;
- retelling texts according to plan and without plan;
- drawing up plans for texts;
- composing speech improvisations on a given topic;
- speech sketches with elements of “role-playing games”.
11. Further restoration of reading and writing:
Reading expanded texts, various fonts;
- dictations;
- written statements;
- written essays;
- mastering samples of congratulatory letters, business records, etc.
Using the above methods, standard programs
Literature
1. Bein E. S. “Aphasia and ways to overcome it.” L., Medicine 1964;
2. Bein E.S., Ovcharova P.A. “Clinic and treatment of aphasia” - S. Medicine and Physical Education, 1970;
3. Wiesel T. G. “Fundamentals of neuropsychology” - M., Astrel, 2006;
4. Zimnyaya I.A. “Functional psychological scheme for the formation and formulation of thoughts through language // Study of speech thinking in psycholinguistics. – M., 1985;
5. Luria A.R. Basic problems of neurolinguistics. M., Moscow State University, 1975;
6. Luria A.R. “Higher cortical functions of humans and their disturbances in local brain lesions” Second updated edition. - M., 1969.
7. Luria A.R. Higher cortical functions of humans. - M.: MGU.1962;
8. Maklakov A.G. “General Psychology” - St. Petersburg, Peter, 2001;
9. Khomskaya E.D. “Neuropsychology” Textbook, St. Petersburg, Peter, 2003;
10. Tsvetkova L.S. “Aphasia and remedial training”, M., Education, 1988;
11. Shklovsky V.M. Wiesel T.G. “Restoration of speech function in patients with different forms of aphasia” - M., Sekachev, 2011;
Seryabkina Rita Anatolevna,
speech therapist
In speech therapy work to overcome aphasia, general didactic principles of teaching are used (visuality, accessibility, consciousness, etc.), however, due to the fact that the restoration of speech functions differs from formative training, that the higher cortical functions of a person who is already speaking and writing are organized somewhat differently than for a child beginning to speak (A. R. Luria, 1969, L. S. Vygotsky, 1984), when developing a plan for correctional pedagogical work, the following provisions should be adhered to:
(Shokhor - Trotskaya M.K. Correctional and pedagogical work for aphasia. (methodological recommendations) - M, 2002)
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, the 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, the 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 the patient’s 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 the lessons are explained to the patient, tools are given that he can use when performing the task, etc.( Shokhor - Trotskaya M.K. Correction and pedagogical work for aphasia. (methodological recommendations) - M, 2002)
Restorative learning for different forms of aphasia
(standard programs)
Rehabilitation training is carried out with adult patients who have disorders of the HMF, and especially speech, and is an important branch of neuropsychology and neurolinguistics. To date, the methodology and principles of restorative training have been defined, and a fairly large arsenal of scientifically based work methods has been created. A.R. made a fundamental contribution to these developments. Luria, who laid the foundation of a new science in the form of a theory of higher mental functions, their brain organization, a description of the etiology, clinical picture, pathogenesis and diagnosis of HMF disorders. On this basis, numerous studies have been carried out, summarizing research and practical experience in working with patients (V.M. Kogan, V.V. Oppel, E.S. Bein, L.S. Tsvetkova, M.K. Burlakova, V. M. Shklovsky, T.G. Vizel and others). ( .)
The position that it is in principle possible for a patient to return a lost function is based on one of the most important properties of the brain - the ability to compensate. In the process of restoring impaired functions, both direct and bypass compensatory mechanisms take part, which determines the presence of two main types of directed influence. The first is associated with the use of direct disinhibiting methods of work. They are mainly used in the initial stage of the disease and are designed to use reserve intrafunctional capabilities, to “exit” nerve cells from a state of temporary depression, usually associated with changes in neurodynamics (speed, activity, coordination of the course of nervous processes).
The second type of targeted overcoming of HMF disorders involves compensation based on restructuring the way the impaired function is realized. For this, various interfunctional connections are involved. Moreover, those of them who were not leading before the disease are specially made so. This “bypass” of the usual way of performing a function is necessary to attract spare reserves (afferentations). For example, when restoring a broken articulatory posture of a speech sound, the optical-tactile method is often used. In this case, the leading factor is relying not on the sound of the sound being practiced, but on its optical image and tactile sense of articulatory posture. In other words, such external supports are connected as leading ones, which in speech ontogenesis (when mastering sound pronunciation) were not the main ones, but only additional ones. This changes the way speech sounds are produced. Only after the patient’s optically perceived and tactilely analyzed articulatory posture has been fixed, can one fix his attention on the acoustic image and try to return him to the role of the leading support. It is important that direct teaching methods are designed to involuntarily instill in the memory of patients premorbidly strengthened skills. Bypass methods, on the contrary, involve the voluntary development of ways of perceiving speech and one’s own speaking. This is due to the fact that bypass methods require the patient to implement the affected function in a new way, which differs from the usual one, strengthened in premorbid speech practice.
Since in most patients aphasia is combined with a violation of non-speech HMF, their restoration constitutes a significant section of rehabilitation training. Some of the non-speech functions do not require thorough verbal support, others are restored only on a speech basis. Restoring a number of speech functions requires the connection of non-speech supports. In this regard, the sequence of work on speech and non-speech functions is decided in each specific case, depending on the combination of verbal and non-verbal components of the syndrome. ( Shklovsky V.M., Vizel T.G.Restoration of speech function in patients with different forms of aphasia.)
Work to restore complex types of speech activity (phrase, written speech, listening comprehension of detailed texts, understanding of logical-grammatical constructions, etc.) is predominantly voluntary, however, not due to the restructuring of the method of action, but due to the fact that their assimilation in a natural way was to one degree or another voluntary, i.e. occurred under the control of consciousness. Essentially, here the action algorithm is revived, while involuntary, direct methods stimulate the speech act directly.
An important clarification of pathological syndromes caused by local brain lesions was made by neurologist K. Monakov (Mopasou) at the beginning of the 20th century. Based on clinical observations, he concluded that for several days or even weeks after a brain disease, there are symptoms that are explained not by the lesion, but by a phenomenon he called diaschisis and which consists of the occurrence of edema, swelling of brain tissue, inflammatory processes, etc. .P. Taking these features into account is important not only for correct treatment tactics, but also for choosing adequate methods of rehabilitation work with patients in the initial stages of the disease. The need for early psychological and pedagogical intervention in the treatment of patients with focal brain lesions is currently one of the absolutely proven provisions.
Speech restoration in patients with aphasia is carried out by both neuropsychologists and speech therapists, who must have special knowledge, and first of all, in the field of neuropsychology. Specialists working with patients with aphasia are increasingly called aphasiologists. This is quite justified, given that the term “aphasiology” has now become completely legalized and used both in the scientific literature and in practice.
Rehabilitation training is carried out according to a special, pre-developed program, which must include certain tasks and corresponding work methods, differentiated depending on the form of aphasia (apraxia, agnosia), the severity of the defect, and the stage of the disease.
(Problems of aphasia and remedial education: In 2 volumes / Ed. L.S. Tsvetkova.- M.: MSU, 1975. T.1 1979. T.2.)
It is also necessary to adhere to the principle of consistency. This means that restoration work should be carried out on all aspects of the impaired function, and not just on those that were primarily affected.
The correct organization of rehabilitation training also requires strict consideration of the characteristics of each specific case of the disease, namely: individual personality traits, the severity of the somatic condition, living conditions, etc.
An important point in organizing and predicting the results of rehabilitation training is taking into account the coefficient of hemispheric asymmetry in a particular patient. The higher it is, the more grounds there are to conclude that the patient is a potential left-hander or ambidextrous person. Consequently, he has a non-standard distribution of HMF across the cerebral hemispheres, and part of the speech and other dominant (left-hemisphere) functions can be implemented by the right hemisphere. A lesion of the left hemisphere identical in size and location in a left-handed or ambidextrous person leads to milder consequences, and the final result of recovery, all other conditions being equal to right-handed patients, is better. For practicing aphasiologists, this information is extremely important. ( Shokhor-Trotskaya M.K. Speech therapy work for aphasia at the early stage of recovery. - M.: 2002.)
Motor aphasia of afferent type
I. Stage of severe disorders
1. Overcoming disorders of understanding situational and everyday life
speech: showing pictures and real images is most important
removable objects and simple actions by their names, categories
real and other signs. For example: “Show me the table, the cup
dog, etc.”, “Show pieces of furniture, clothing, transport and
etc.”, “Show someone who flies, who talks, who sings, who has
there is a tail, etc.”;
classification of words by topic (for example: “Clothing”, “Fur
underwear”, etc.) based on an object picture;
responding with an affirmative or negative gesture to
simple situational issues. For example, “Is it winter now, summer..?”; "You
do you live in Moscow? and etc.
conjugated, reflected and independent utterance
automated speech sequences (ordinal counting, days of the week,
months in order, singing with words, ending proverbs and phrases
with a “hard” context), modeling situations, stimulating
those who pronounce onomatopoeic pronouns (“ah!” “oh!”
and so on.);
conjugated and reflected pronunciation of simple words and
phrases;
inhibition of a speech embolus by introducing it into a word
(ta, ta.. - Tata, so), or in the phrase (Mother - Mother...; this is mom).
answers to questions in one or two words in a simple situation
active dialogue;
modeling situations conducive to inducing comma
nikatively meaningful words (yes, no, I want, I will etc.);
answering situational questions and composing simple phrases
using an icon and gesture 1 with associated pronunciation
simple words and phrases.
laying out captions under pictures (subject and
plot);
writing the most common words - ideograms, copying
simple texts;
conjugate reading of simple dialogues.
1. Overcoming disorders of the pronunciation side of speech:
Isolating sound from a word;
automation of individual articles in words with different
slogorhythmic structure;
overcoming literal paraphasias by selecting first
discrete, and then gradually converging in articulation
sounds.
composing phrases based on a plot picture: from simple models
(subject-predicate, subject-predicate-object) - to more complex ones,
including objects with prepositions, negative words, etc.;
composing phrases based on questions and key words;
exteriorization of grammatical-semantic connections of the predicate:
“who?”, “why?”, “when?”, “where?” etc.;
filling in the gaps in a phrase with grammatical change
eat words;
detailed answers to questions;
compiling stories based on a series of plot pictures;
retelling texts based on questions.
development of generalized concepts;
semantic play on words (subject and verb lek
sika) by including them in various semantic contexts;
filling in gaps in a phrase;
completing sentences with different words that fit
within the meaning of;
selection of antonyms, synonyms.
sound-letter composition of the word, its analysis (one-two-three syllables-
words) based on schemes that convey syllabic and sound-letter
the structure of the word, the gradual reduction of the number of external supports;
filling in missing letters and syllables in words;
copying words, phrases and small texts with an emphasis on self-control and independent error correction;
Filling in missing texts when reading and writing
words practiced in oral speech.
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 slightly restored, 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 a 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 abilities.
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 eliminating the embolus as quickly as possible. 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 scope 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).
MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION
NON-STATE EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION
TEST
ON APHASIA
Topic: “CORRECTIONAL WORK FOR EACH FORM OF APHASIA”
Introduction
.Aphasias and their classification
2.1 Correctional and pedagogical work for acoustic-mnestic aphasia
2 Corrective pedagogical work for semantic aphasia
3 Corrective pedagogical work for sensory aphasia
4 Corrective pedagogical work for dynamic aphasia
5 Corrective pedagogical work for efferent motor aphasia
Conclusion
Bibliography
Introduction
In recent decades, since the Great Patriotic War, theoretical and practical interest in the problems of aphasia, its dynamics, the role of rational remedial training and spontaneous changes in speech defects has increased. Many researchers are pushing the study of aphasia, methods of overcoming it, and its dynamics into an independent field of knowledge: aphasiology. In many countries, the number of laboratories and offices in hospitals, clinics, and individual specialized centers has increased, which are engaged in work to restore speech in patients with aphasia. Systematic work to overcome these defects has enabled researchers to observe the state of speech in aphasia for a long time and has aroused great interest among specialists in studying the dynamics of speech in aphasia. It has become known that speech impairments in aphasia are not stable, but have their own dynamics, which are determined by a number of interacting factors and that these changes can vary within wide limits.
Different researchers point to different factors influencing the dynamics of speech in aphasia, but they all agree that factors such as the location and volume of brain damage, the age and level of education of the patient, the initial severity of the disorders and the form of aphasia, as well as measures undertaken to eliminate the defect are important and actually operating conditions for the dynamics of speech in aphasia.
1. Aphasias and their classification
Aphasia (R47.0) - speech disorders with local lesions of the left hemisphere and the preservation of movements of the speech apparatus, which ensures articulate pronunciation, while the elementary forms of hearing are preserved. They must be distinguished from: dysarthria (R47.1) - pronunciation disorders without a disorder of speech perception by ear (with damage to the articulatory apparatus and the subcortical nerve centers and cranial nerves that serve it), anomia - naming difficulties arising from disturbances of interhemispheric interaction, dyslalia (alalia) - speech disorders in childhood in the form of initial underdevelopment of all forms of speech activity and mutism - silence, refusal to communicate and inability to speak in the absence of organic disorders of the central nervous system and preservation of the speech apparatus (occurs in some psychoses and neuroses). In all forms of aphasia, in addition to special symptoms, disturbances in receptive speech and auditory-verbal memory are usually recorded. There are different principles for classifying aphasias, determined by the theoretical views and clinical experience of their authors. In accordance with the 10th International Classification of Diseases, it is customary to distinguish two main forms of aphasia - receptive and expressive (a mixed type is possible). Indeed, most of the recorded symptoms gravitate towards these two semantic accents in the formalization of speech disorders, but are not exhausted by them. Below is a variant of the classification of aphasia, based on a systematic approach to higher mental functions, developed in the domestic neuropsychology of Luria.
Sensory aphasia (impaired receptive speech) is associated with damage to the posterior third of the superior temporal gyrus of the left hemisphere in right-handed people (Wernicke's area). It is based on a decrease in phonemic hearing, that is, the ability to distinguish the sound composition of speech, which manifests itself in impaired understanding of the oral native language, up to a lack of reaction to speech in severe cases. Active speech turns into “verbal okroshka”. Some sounds or words are replaced by others, similar in sound, but distant in meaning (“voice-ear”), only familiar words are pronounced correctly. This phenomenon is called paraphasia. In half of the cases, speech incontinence is observed - logorrhea. Speech becomes poor in nouns, but rich in verbs and introductory words. Writing under dictation is impaired, but understanding what is read is better than what is heard. In the clinic, there are erased forms associated with a weakened ability to understand fast or noisy speech and requiring the use of special tests for diagnosis. The fundamental foundations of the patient's intellectual activity remain intact.
Efferent motor aphasia (impaired expressive speech) - occurs when the lower parts of the cortex of the premotor region are damaged (the 44th and partially the 45th fields - Broca's area). With complete destruction of the zone, patients utter only inarticulate sounds, but their articulatory abilities and understanding of speech addressed to them are preserved. Often in oral speech there remains only one word or a combination of words pronounced with different intonations, which is an attempt to express one’s thought. With less severe lesions, the overall organization of the speech act suffers - its smoothness and clear temporal sequence are not ensured ("kinetic melody"). This symptom is part of a more general syndrome of premotor movement disorders - kinetic apraxia. In such cases, the main symptoms come down to speech motor disorders, characterized by the presence of motor perseverations - patients cannot switch from one word to another (start a word) both in speech and in writing. Pauses are filled with introductory, stereotypical words and interjections. Paraphasias occur. Another significant factor in efferent motor aphasia is difficulties in using the speech code, leading to externally observable amnestic-type defects. At all levels of oral independent speech, reading and writing, the laws of language, including spelling, are forgotten. The style of speech becomes telegraphic - predominantly nouns in the nominative case are used, prepositions, connectives, adverbs and adjectives disappear. Broca's area has close bilateral connections with the temporal structures of the brain and functions with them as a single whole, therefore, with efferent aphasia, secondary difficulties in the perception of oral speech occur.
Amnestic aphasia is heterogeneous, multifactorial and, depending on the dominance of pathology on the part of the auditory, associative or visual component, can occur in three main forms: acoustic-mnestic, amnestic proper and optical-mnestic aphasia.
Acoustic-mnestic aphasia is characterized by inferior auditory-verbal memory - a reduced ability to retain a speech sequence within 7 ± 2 elements and synthesize the rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence; while searching for the right word, pauses occur, filled with introductory words, unnecessary details and perseverations. Derivatively, narrative speech is grossly violated, the retelling ceases to be adequate to the model. The best transmission of meaning in such cases is ensured by excessive intonation and gestures, and sometimes by speech hyperactivity.
In the experiment, elements located at the beginning and end of the stimulus material are better remembered, and the nominative function of speech begins to suffer, which improves when the first letters are prompted. The interval for presenting words in a conversation with such a patient should be optimal, based on the condition “before you forget.” Otherwise, the understanding of complex logical and grammatical structures presented in speech form also suffers. Persons with acoustic-mnestic defects are characterized by the phenomenon of verbal reminiscence - better reproduction of material several hours after its presentation. Impaired auditory attention and narrowing of perception play a significant role in the causal structure of this aphasia. In the nominative function of speech at the image level, this defect manifests itself in a violation of the actualization of the essential features of an object: the patient reproduces the generalized features of a class of objects (objects) and, due to the failure to distinguish the signal features of individual objects, they are equalized within this class. This leads to equal probability of choosing the desired word within the semantic field (Tsvetkova). Acoustic-mnestic aphasia occurs with damage to the middle-posterior parts of the left temporal lobe (21st and 37th fields).
Actually, amnestic (nominative) aphasia manifests itself in difficulties in naming objects that are rarely used in speech while maintaining the volume of speech retained by ear. Based on the word heard, the patient cannot recognize an object or name the object when it is presented (as with the acoustic-mnestic form, the nomination function suffers). Attempts are being made to replace the forgotten name of an object with its purpose (“this is what it is written with”) or with a description of the situation in which it occurs. Difficulties arise when selecting the right words in a phrase; they are replaced by speech cliches and repetitions of what was said. A hint or context helps you remember something you’ve forgotten. Amnestic aphasia is the result of damage to the posterior inferior parts of the parietal region at the junction with the occipital and temporal lobes. With this variant of localization of the lesion, amnestic aphasia is characterized not by poor memory, but by an excessive number of pop-up associations, which is why the patient is unable to select the right word.
Optical-mnestic aphasia is a variant of a speech disorder that is rarely identified as an independent one. It reflects pathology on the part of the visual system and is better known as optical amnesia. Its occurrence is caused by damage to the posterior-inferior parts of the temporal region, involving the 20th and 21st fields and the parieto-occipital zone - the 37th field. In general nestic speech disorders such as the nomination (naming) of objects, this form is based on the weakness of visual representations of the object (its specific features) in accordance with the word perceived by ear, as well as the image of the word itself. These patients do not have any visual gnostic disorders, but they cannot depict (draw) objects, and if they do draw, they miss and under-draw details that are significant for identifying these objects.
Due to the fact that retention of a readable text in memory also requires the preservation of auditory-speech memory, more caudal (literally - to the tail) located lesions within the left hemisphere aggravate losses on the part of the visual part of the speech system, expressed in optical alexia (impaired reading), which can manifest itself in the form of failure to recognize individual letters or entire words (literal and verbal alexia), as well as writing disorders associated with defects in visuospatial gnosis. When the occipito-parietal parts of the right hemisphere are damaged, unilateral optical alexia often occurs, when the patient ignores the left side of the text and does not notice his defect.
Afferent (articulatory) motor aphasia is one of the most severe speech disorders that occurs when the lower parts of the left parietal region are damaged. This is the zone of secondary fields of the skin-kinesthetic analyzer, which are already losing their somato-topic organization. Its damage is accompanied by the appearance of kinesthetic apraxia, which includes apraxia of the articulatory apparatus as a component. This form of aphasia is apparently determined by two fundamental circumstances: firstly, the disintegration of the articulatory code, that is, the loss of special auditory-speech memory, which stores the complexes of movements necessary for pronouncing phonemes (hence the difficulties in the differentiated choice of methods of articulation); secondly, loss or weakening of the kinesthetic afferent link of the speech system. Gross disturbances in the sensitivity of the lips, tongue and palate are usually absent, but difficulties arise in synthesizing individual sensations into integral complexes of articulatory movements. This is manifested by gross distortions and deformations of the article in all types of expressive speech. In severe cases, patients generally become like deaf people, and the communicative function is carried out with the help of facial expressions and gestures. In mild cases, the external defect of afferent motor aphasia consists of difficulties in distinguishing speech sounds that are similar in pronunciation (for example, “d”, “l”, “n” - the word “elephant” is pronounced “snol”). Such patients, as a rule, understand that they are pronouncing words incorrectly, but the articulatory apparatus does not obey their volitional efforts. Non-speech praxis is also slightly impaired - they cannot puff out one cheek or stick out their tongue. This pathology secondarily leads to incorrect perception of “difficult” words by ear and to errors when writing from dictation. Silent reading is preserved better.
Semantic aphasia - occurs when there is a lesion at the border of the temporal, parietal and occipital regions of the brain (or the region of the supramarginal gyrus). In clinical practice it is quite rare. For a long time, changes in speech due to damage to this zone were assessed as an intellectual defect. A more thorough analysis revealed that this form of pathology is characterized by a weakened understanding of complex grammatical structures, reflecting the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, gender-species, expressed in complex logical, inverted, fragmentarily spaced forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, function words and pronouns is impaired. These disturbances do not depend on whether the patient reads aloud or silently. The retelling of short texts appears defective and slow, often turning into disordered fragments. The details of the texts proposed, heard or read are not captured or transmitted, but in spontaneous utterances and in dialogue, speech turns out to be coherent and free of grammatical errors. Individual words out of context are also read at normal speed and are well understood. Apparently, this is due to the fact that when reading globally, such a function as probabilistic prediction of the expected meaning is involved. Semantic aphasia is usually accompanied by violations of counting operations - acalculia (R48.8). They are directly related to the analysis of spatial and quasi-spatial relationships realized by the tertiary zones of the cortex, associated with the nuclear part of the visual analyzer.
Dynamic aphasia - affects areas anterior and superior to Broca's area. The basis of dynamic aphasia is a violation of the internal program of utterance and its implementation in external speech. Initially, the plan or motive that directs the deployment of thought in the field of future action, where the image of the situation, the image of the action and the image of the result of the action are “represented”, suffers. As a result, speech adynamia or a defect in speech initiative occurs. Understanding of ready-made complex grammatical structures is impaired slightly or not at all. In severe cases, patients do not make independent statements; when answering a question, they answer in monosyllables, often repeating the words of the question in the answer (echolalia), but without pronunciation difficulties. It is completely impossible to write an essay on a given topic due to the fact that “there are no thoughts.” There is a pronounced tendency to use speech cliches. In mild cases, dynamic aphasia is experimentally detected when asked to name several objects belonging to the same class (for example, red). Words denoting actions are especially poorly actualized - they cannot list verbs or use them effectively in speech (predicativity is violated). Criticism of their condition is reduced, and the desire of such patients to communicate is limited.
Conduction aphasia - occurs with large lesions in the white matter and cortex of the middle-upper parts of the left temporal lobe. Sometimes it is interpreted as a violation of associative connections between two centers - Wernicke and Broca, which suggests the involvement of the lower parietal areas. The main defect is characterized by severe repetition disorders with relative preservation of expressive speech. Reproduction of most speech sounds, syllables and short words is generally possible. Rough literal (letter) paraphasias and additions of extra sounds to endings occur when repeating polysyllabic words and complex sentences. Often only the first syllables of words are reproduced. Errors are recognized and attempts are made to overcome them, producing new errors. Understanding of situational speech and reading is preserved, and when among friends, patients speak better. Since the mechanism of dysfunction in conduction aphasia is associated with a violation of the interaction between the acoustic and motor centers of speech, sometimes this variant of speech pathology is considered either as a type of mild sensory or afferent motor aphasia. The latter type is observed only in left-handers with damage to the cortex, as well as the nearest subcortex of the posterior sections of the left parietal lobe, or in the area of its junction with the posterior temporal sections (40th, 39th fields).
In addition to these, in modern literature one can find the outdated concept of “transcortical” aphasia, borrowed from the Wernicke-Lichtheim classification. It is characterized by the phenomena of impaired understanding of speech with intact repetition (on this basis it can be contrasted with conduction aphasia), that is, it describes those cases when the connection between the meaning and sound of a word is disrupted. Apparently, “transcortical” aphasia is also caused by partial (partial) left-handedness. The diversity and equivalence of speech symptoms indicates mixed aphasia. Total aphasia is characterized by a simultaneous impairment of speech pronunciation and perception of the meaning of words and occurs with very large lesions, or in the acute stage of the disease, when neurodynamic disorders are sharply expressed. With a decrease in the latter, one of the above forms of aphasia is identified and specified. Therefore, it is advisable to carry out a neuropsychological analysis of the structure of HMF disorders outside the acute period of the disease. Analysis of the degree and rate of speech restoration indicates that in most cases they depend on the size and location of the lesion. A severe speech defect with relatively poor speech recovery is observed in pathology that extends to the cortical-subcortical formations of two or three lobes of the dominant hemisphere. With a superficially located lesion of the same size, but without spreading to deep formations, speech is restored quickly. With small superficial lesions located even in Broca's and Wernicke's speech areas, as a rule, significant restoration of speech occurs. The question of whether deep brain structures can play an independent role in the development of speech disorders remains open.
In connection with studies of deep brain structures that are directly related to speech processes, the problem of differentiating aphasia from categorically other speech disorders, called pseudoaphasia, has arisen. Their appearance is due to the following circumstances. Firstly, during operations on the thalamus and basal ganglia in order to reduce motor defects - hyperkinesis (F98.4), parkinsonism (G20) - immediately after the intervention, such patients develop symptoms of speech adynamia in active speech and in the ability to repeat words, as well as Difficulties arise in understanding speech with an increased volume of speech material. But these symptoms are unstable and soon reverse. With damage to the striatum, in addition to the actual motor disorders, there may be a deterioration in the coordination of the motor act as a motor process, and with dysfunction of the globus pallidus, the appearance of monotony and lack of intonation in speech. Secondly, pseudoaphasic effects occur during operations or when organic pathology occurs deep in the left temporal lobe, in cases where the cerebral cortex is not affected. Thirdly, a special type of speech disorders, as already indicated, consists of the phenomena of anomia and dysgraphia, which arise when the corpus callosum is dissected due to disturbances in interhemispheric interaction.
Speech disorders that occur with lesions of the left hemisphere of the brain in childhood (especially in children under 5-7 years of age) also occur according to different laws than aphasia. It is known that people who have undergone the removal of one of the hemispheres in the first year of life subsequently develop without a noticeable decrease in speech and its intonation component. At the same time, materials have accumulated indicating that with early brain lesions, speech impairments can occur regardless of the lateralization of the pathological process. These impairments are erased and relate more to auditory-verbal memory than to other aspects of speech. Restoration of speech without serious consequences in case of lesions of the left hemisphere is possible up to 5 years. The period of this recovery, according to various sources, ranges from several days to 2 years. At the end of puberty, the ability to form full-fledged speech is already sharply limited. Sensory aphasia, which appears at the age of 5-7 years, most often leads to the gradual disappearance of speech and the child subsequently does not achieve its normal development.
2. Corrective work for each form of aphasia
2.1 Correctional and pedagogical work for acoustic-mnestic aphasia
Patients with acoustic-mnestic aphasia experience increased performance, emotional lability, and frequent bouts of depression due to even minor speech errors.
When drawing up a plan for correctional and pedagogical work, the speech therapist clarifies with the doctor the form of aphasia, the preservation or dysfunction of the lower parietal parts, which are determined by the study of constructive-spatial praxis, counting operations, etc.
To overcome a violation of speech memory, it is necessary either to restore the system of visual representations of an object, its essential, distinctive features, or to gradually expand the volume of auditory-verbal memory, impaired purely by the acoustic signs of the perception of a word combination, as well as to overcome expressive agrammatism, which is close in its characteristics to expressive agrammatism in acoustics. - Gnostic aphasia.
To overcome speech disorders in patients with acoustic-mnestic aphasia, the speech therapist relies on their preserved mechanisms for encoding speech utterances, i.e., describing the characteristics of an object, introducing words into various contexts, and drawing up external supports that allow the patient to maintain varying amounts of speech load.
Written speech plays a special role in the process of restoring acoustic-mnestic speech functions. With one or another mnestic aphasia, the sound-letter analysis of the composition of the word is preserved, this makes it possible to use a recording of words that precedes auditory stimulation, to overcome in patients the tendency to verbal paraphasia, as well as the agrammatism characteristic of their oral speech. The preservation of written speech gradually prepares, at the intraspeech level, the syntagmatic division of a phrase into segments (a syntagma consists of two or three words) connected to each other by meaning, since the subject, as a rule, is in one syntagma, the predicate in another, or the main clause in the first syntagme, secondary - in the second (The children went to the forest to pick mushrooms); fragments of one part of a sentence perceived aurally allow the patient to predict its second part.
Restoration of auditory-verbal memory. Improvement of auditory-verbal memory occurs based on visual perception. A series of subject pictures are laid out in front of the patient, the names of which are first read and written several times. This way the patient knows what he will hear. This is how the prerequisites for acoustic anticipation are formed. The speech therapist does not focus the patient’s attention on the need to show the object in the order presented. In speech, words are connected by a certain intention of the statement, so first the patient is offered pictures of one, then two, three semantic groups: hare, plate, table, gun, forest, fork, fox, cup, stove, pan, knife, cucumber, apple, hunter , grandmother, etc., then ask him to show objects that can be included in a given situation.
The speech therapist does not lay out object pictures in front of the patient, but gives them in a pile, so that the patient, after listening to the named objects, finds these objects in the pictures and puts them aside. This achieves some temporary delay in the patient's compliance with instructions. Subsequently, the speech therapist suggests repeating a series of words worked out in previous lessons, but without resorting to the help of pictures. For memorization, the speech therapist gives words denoting objects, then actions and qualities of objects, and, finally, numbers combined into telephone numbers. In parallel with this, auditory dictations of phrases consisting of 2-3-4 words are carried out, based on a plot picture, and later without a plot picture. To restore visual representations, you can carry out a series of exercises, including analysis of objects that are similar in design and shape, differing in one or two characteristics (for example, a cup, a teapot, a sugar bowl; a closet, a refrigerator, a sideboard; a sofa, a bed, a couch; a rooster and a chicken; squirrels). , foxes, cats and hare, etc.), in which a change or absence of one of the details changes the function of the object, its content and designation. In addition, patients are given the task of constructing objects from elements, finding specially made errors in their depiction (for example, a rooster is depicted with a comb but without a tail, a hare is depicted without long ears, and a cat with long ears, etc.), and complete the drawing of the object. to the whole, verbally describe in detail all its properties and functions, recognize an object half hidden by a sheet by its part, etc. Particular attention is paid to the oral and written definition of the essential features of an object, writing essays about the subject.
All of the above methods for overcoming auditory-verbal memory impairments help overcome amnestic difficulties in this form of aphasia and reduce the number of verbal paraphasias. Difficulties in finding the right word are overcome by expanding and sometimes narrowing the semantic fields of the word, that is, by clarifying and systematizing their meanings. To do this, a specific word is played out in various phraseological contexts, attention is drawn to the polysemy of the word (pen, key, mother’s). Much attention is paid to clarifying the meaning of synonyms, antonyms and homonyms, and composing various versions of sentences with these words.
Restoring a written statement is one of the main forms of expanding the lexical composition of speech. The comprehensiveness of the sound-letter analysis of the composition of the word and the significant preservation of phonemic hearing allows, from the very first days of correctional pedagogical work, to involve patients in the compilation of written texts, active work on expanding vocabulary, and overcoming agrammatism.
It is better to start working on composing written texts by writing phrases based on simple plot pictures, and then use various cartoons in magazines and newspapers. This will allow the patient to construct specific, small phrases and short texts. Then you can offer to compose written texts based on reproductions of famous paintings by various artists. All work on written text is combined with oral speech. The speech therapist selects easy texts that are close to the reproductions and asks the patient to retell them.
Agrammatism of agreement in the gender and number of the main members of a sentence is overcome by replacing nouns with pronouns and pronouns with nouns, as well as by composing phrases based on supporting words.
2.2 Corrective pedagogical work for semantic aphasia
Semantic aphasia is characterized by a violation of the arbitrary finding of the names of objects, a poverty of vocabulary and syntactic means of expressing thoughts, and difficulties in understanding complex logical and grammatical structures. These patients are quite active in the process of overcoming speech disorders. However, they often experience inferiority complexes and high vulnerability due to difficulties in understanding complex logical and grammatical phrases, proverbs, sayings, and the content of fables. In this regard, overcoming impressive speech defects in this form of aphasia should be carried out bypassing the main defect.
The basis for overcoming impressive agrammatism and amnestic difficulties is to rely on the preserved mechanisms of detailed, planned written and oral expression. Defects of the highest paradigmatic level of encoding and decoding of speech messages are overcome by involving the higher stages of the syntagmatic level, namely planning, constructing mental actions carried out by the frontal regions in relationship with all gnostic departments, providing a lower, phonemic level of the speech act.
The main task of correctional pedagogical work in this form of aphasia is the restoration of semantic units, normally encoded in a complex system of synonyms and inverted phrases, as well as overcoming the equivalence of all semantically significant signs of the subject, creating the prerequisites for capturing the main feature of the subject when finding the word denoting it.
Restoration of expressive speech. The most complete method for overcoming amnestic disorders was developed by V. M. Kogan in 1960. He showed that each word is associated with a complex system of words with varying degrees of proximity of semantic connections. Each item is characterized by many features that are characteristic both of this item and of others. Words denoting objects are combined into various semantic fields according to their various characteristics: by instrumentation, by species, etc. In order to overcome amnestic difficulties, the patient learns to find the signs of an object, first by listening to a system for describing short- and long-range semantic connections, and later by independently descriptions of the characteristics of an object, its connections with other groups of objects. For example, during the initial stages of recovery, a speech therapist lists to the patient all the signs of glasses: what they are made of, what they serve, what shape they come in, in what situations they may be needed (poor vision, bright light when welding, bright sunlight on the beach, bright color snow in the mountains, etc., it is specified who wears glasses, one can recall Krylov’s fable, etc.). The word is introduced into various phraseological contexts. Then the patient makes up a story about the subject.
Patients with semantic aphasia use similar, poorly developed sentences in expressive speech. Their written speech is also monotonous. In order to restore and expand the patient’s use of various syntactic structures, at the initial stage of recovery, exercises are used to compose various complex sentences using the conjunction words if, so that, when, after, however... etc.
As the constructions of complex sentences are restored, patients are asked to use certain word combinations when writing essays based on pictures by famous artists, taking into account the era depicted in the picture, the plot, its details, an explanation of the reason for their introduction and the plot of the picture.
Overcoming impressive agrammatism. Patients with semantic aphasia have a hard time experiencing problems with understanding seemingly simple tasks. Work to overcome impressive agrammatism should be carried out without directly explaining to the patient his difficulties and mainly in cases where the patient can or should return to study or work. A sufficient degree of preservation of the understanding of situational speech in semantic aphasia in patients who do not return to educational or work activities due to old age allows us to limit ourselves to restoring their orientation in the clock dial, in solving simple arithmetic operations (addition, subtraction, multiplication and division within one to two thousand).
In everyday everyday speech, the clarity of the situation and the presence of elementary paradigmatic synonyms allows patients to freely cope with the same paradigms encoded into complex logical-grammatical units. For example, we never say in everyday life: Put the knife to the right of the fork and to the left of the spoon, use revolutions Put the knife between the fork and the spoon. Place the volume of Pushkin to the left of the volume of Yesenin, etc. In everyday life, we did not use the expression brother of father and father of brother; replacing them with the words uncle and father. With semantic aphasia, correctional and pedagogical work to overcome impressive agrammatism begins not with a direct explanation to the patient of spatial landmarks, schemes for solving a logical-grammatical problem, but bypassing this defect, by means of a written description of the location of various objects.
The patient is given a simple scheme for describing these objects, indicating the central object or subject from which the sequence of description must be carried out, as the point of departure. In other words, when working with a patient, the preserved, planning, syntagmatic functions of the anterior speech departments are used. For example, when analyzing the drawings “a man with a hat”, “a fox near a hole”, “a girl with a doll”, “a mother with a daughter”, “an owner with a dog”, etc., the patient is asked to decide who or what he is talking about will say what is the subject of his attention. A question is posed over the subject that is being discussed, and appropriate definitions are given that are characteristic only of this subject: a husband’s felt wide-brimmed hat, a girl’s knitted hat with a bow, a girl’s doll, a boy’s car, a young mother’s little daughter, an elderly woman’s adult daughter, a good owner’s smart dog , an evil dog of an unkind owner (based on the corresponding drawings). Some of the most common breeds of dogs are examined, children with different characters are discussed, and phrases are composed in this regard: caring daughter, caring son, i.e., the main paradigm for the future of the collapsed phrase is being worked out.
Then they move on to a description of the indirect part of the word-combination paradigm, clarifying who this object belongs to, who and why cannot do without it. A comparison is made of the easiest phrases: mother's daughter, daughter's mother. The patient clarifies the person in question: daughter's mother, mother's daughter, introduces these phrases into various contexts, providing them with epithets and pointing to various pictures of daughters and mothers in different situations. Comic, detailed plays on phrases are very helpful: Mom sits in a stroller and plays with a rattle, and her daughter rolls it around. A daughter feeds her mother with a spoon (this option can take place in life: a daughter can feed a seriously ill mother with a spoon, but this must be specified).
When describing the spatial arrangement of three objects, the patient masters complex constructions, including phrases with prepositions and adverbs: above - below, left - right, above - below, etc.
Restoring the understanding of complex logical and grammatical constructions goes through the stage of detailed, repeated description and discussion in various contexts.
From composing simple sentences, you can move on to describing reproductions (postcards) of paintings by famous artists indicating the era, season, using the phrase winter morning, autumn forest, the era of Peter I, merchant's house, Moscow courtyard, owner of the house. For these purposes, a description of famous paintings is used. The patient learns to describe the different characters in the picture, find the main and secondary word.
So, unnoticed by himself, in a non-traumatic environment that does not create an intellectual inferiority complex, about the process of creative, interesting work, the patient masters in expressive speech various syntactic constructions, cause-and-effect subordinate clauses, participial and adverbial phrases.
While reading his “works,” the patient decodes texts that are close to him, after which he proceeds to read texts of varying degrees of complexity, retell them, and clarify the meaning of various phrases in cases where he misunderstood them.
2.3 Corrective pedagogical work for sensory aphasia
The majority of patients with acoustic-gnostic sensory and acoustic-mnestic aphasia, as a rule, have increased performance and desire to overcome speech disorders. They can work for many hours a day, sometimes in the evening and at night, i.e. they are often in a constant “working” state. These patients have a pronounced state of depression, and therefore the speech therapist must constantly encourage them, give them only feasible homework to complete, inform the doctor about their condition, not allow them to work in the evenings and at night, and reduce the amount of homework.
The primary task of correctional work will be the restoration of phonemic hearing and secondarily impaired reading, writing and expressive speech.
Restoration of phonemic hearing. Restoration of phonemic hearing at the early and residual stages is carried out according to a single plan, with the only difference being that at an early stage the impairment of phonemic hearing is more pronounced.
Special work to restore phonemic hearing goes through the following stages:
The first stage is the differentiation of words that are contrasting in length, sound and rhythmic pattern (house-shovel, spruce - bicycle, cat - car, flag - crow, ball - tree, wolf - parachutist, lion - plane, mouse - cabbage, etc. .).
First, the speech therapist gives contrasting pairs of words separately (for example, cat - grapes), selects corresponding pictures for each pair of words and writes the corresponding words in clear handwriting on separate strips of paper. Then, the patient is allowed to listen to these words and correlate the sound image of the elephant with the drawing and signature underneath it. choose one or another picture according to the assignment, arrange captions for pictures, pictures for captions. At the first stages of classes, with severe severity of phonemic hearing impairment, the number of elements worked on should not exceed four. Then, from lesson to lesson, the speech therapist brings the number of contrasting words differentiated by ear to 10-12, places in front of the patient not 4, but 6 or 8 pictures with captions and invites the patient to first sort out the captions and then find the pictures according to the assignment: Show while standing. Show me the bike. Show where the cancer is, etc.
At the second stage, differentiation is carried out between words with a similar syllable structure, but distant in sound, especially in the root part of the word: fish - legs, fence - tractor, watermelon - ax, paddle - cat, hat - brand, cup - spoon, etc. Work at this and all subsequent stages of restoring phonemic hearing is also carried out based on object pictures, captions, copying, reading aloud, and developing acoustic control of speech.
At the third stage, work is carried out to differentiate words with a similar syllable structure, but with initial sounds that are distant in sound: cancer - poppy, hand - flour, oak - tooth, house - catfish, cat - mouth, stump - shadow, hand - pike; with a common first sound and different final sounds: beak - key, knife - nose, night - zero, lion - forest, rum - mouth, crowbar - forehead, etc.
At the next, fourth stage, work is carried out on the differentiation of phonemes that are similar in sound, that is, words with oppositional sounds: house - tom, daughter - dot, day - shadow, dacha - wheelbarrow, barrel - kidney, beam - stick, butterfly - daddy, eye - class, curtain - picture, goal - stake, corner - coal, bow - hatch, tower - arable land, bot - sweat, fence - constipation, duck - fishing rod, reel-reel, fruits - rafts, path - pellet: fence - cathedral, goats - braids.
With acoustic-gnostic aphasia, difficulties are noted in differentiating phonemes not only on the basis of voicedness - deafness, but also on other characteristics. Patients mix whistling and hissing, hard and soft, as well as acoustically close vowels. The speech therapist should provide tasks for differentiating words with phonemes that are similar in acoustic characteristics: house - smoke, side - tank, drink - sing, path - five, shelf - stick, bow - varnish, table - chair, rubbish - cheese, etc. .
To consolidate the unambiguous perception of phonemes, various tasks are used to fill in missing letters in a word and phrase, words with oppositional sounds missing in a phrase, the meaning of which is clarified not with the help of a picture, but through the phraseological context. For example: insert into the text the words carcass, shower, business, body, be, path, moisture, flask, daughter, dot, Don, tone, viburnum, Galina, etc.
And finally, the consolidation of acoustic differential features of phonemes occurs in the form of selecting a series of words for a given letter: the patient first selects words from texts, including newspapers, and then selects words for a given letter from memory.
Restoring the lexical composition of speech and overcoming expressive agrammatism. Difficulties in finding individual nouns and verbs are overcome by reviving various semantic connections, describing various signs of an action or object, its functions, comparing this word with other semantically relatively similar words. For example, a patient may use “axe”, “saw” or “scissors” instead of the word knife, meaning objects that also divide the whole into parts. The speech therapist clarifies all the signs of these objects, their different instrumental orientation, shape, nature of movement, etc. In another case, the patient can replace the word knife with the words “fork”, “spoon”, “cutter”, combining the verb with a feminine noun suffix. Accordingly, the speech therapist will tell the patient that a knife is a cutting object, it is most often an integral part of table setting, work in the kitchen, and will show its distinctive functional role when using various cutlery: you cannot eat soup, porridge, fish with a knife, while relying on the visual perception of various signs of an object, its description, image. Due to the tendency of patients with sensory aphasia to mix inflections according to gender, the speech therapist will focus on the auditory perception of the endings of masculine nouns.
Overcoming verbal paraphasia is carried out by discussing with the patient various characteristics of objects according to their contiguity and contrast, by function, instrumental affiliation, and by categorical characteristics. The speech therapist offers to fill in the missing verbs and nouns in the sentence, select nouns, adverbs to the verb, adjectives and verbs to the noun.
Patients with sensory, acoustic-gnostic aphasia experience difficulties not only in the use of nouns, but also in the use of verbs. In this regard, the speech therapist offers various work to restore the meanings of verbs, for example: walks, runs, hurries, flies, jumps, climbs; eats, feeds, drinks; sits, lies, sleeps, rests, dozes.
One of the main techniques for restoring expressive speech in sensory aphasia is the use of written speech. For a patient whose phonemic hearing has somewhat recovered, the speech therapist suggests initially writing phrases and texts based on simple plot pictures, and later using postcards, which he gives him as homework. Written work with plot pictures allows the patient to slowly find the right word and polish the statement.
Restoration of reading, writing and written speech is carried out in parallel with overcoming phonemic hearing impairment. The restoration of writing, sound analysis and synthesis of words, and written expression is preceded by the restoration of reading, which is based on the skills of global optical reading and intact kinesthesia, which takes part in analytical reading. Attempts to pronounce a readable word, visual perception of its syllabic structure, awareness of the defectiveness of copying and written naming of an object, awareness that mixing sounds changes the meaning of the word, create the basis for restoring analytical reading, and then writing. The restoration of reading and writing begins with copying out monosyllabic and two-syllable words, different in sound composition, with filling in the missing oppositional letters in them, with the gradual development of the structure of words consisting of 2-3 syllables, with varying degrees of complexity of the sound composition of the syllable and word.
aphasia speech correctional pedagogical
2.4 Corrective pedagogical work for dynamic aphasia
With dynamic aphasia, the main task of correctional pedagogical work is to overcome inertia in speech utterance. In the first option, this will be overcoming defects in internal speech programming; in the second option, it will be the restoration of grammatical structuring.
Restoration of expressive speech. With significantly expressed aspontaneity, the patient is given tasks to restore the order of words in deformed sentences (for example: In, children, quickly, school, go), various exercises for classifying objects according to various criteria (“Furniture”, “Clothing”, “Dishes”, round, square, wooden, metal objects, etc.). Direct and reverse ordinal counting is used, subtraction from 100 by 7, by 4.
Overcoming defects in internal programming is carried out by creating external programs of expression for patients with the help of various external supports (schemes, proposals, chips, etc.), gradually reducing their number and subsequent internalization, collapsing this scheme inward. The patient, moving his index finger from one chip to another, gradually unfolds the speech utterance according to the plot picture, then proceeds to visually follow the plan for the unfolding of the utterance without associated motor reinforcement and, finally, composes these phrases without external supports, resorting only to internal speech planning statements.
The restoration of the linear development of an utterance in time is facilitated by the use of words included in questions about a plot picture or a corresponding situation discussed in class. So, to the question Where are you going today? the patient answers: “I’ll go to the hairdresser” or “I’ll go for an x-ray,” etc., etc. adds only one word. Another technique for restoring the structure of a statement is the use of support words, from which the patient composes a sentence. Gradually, the number of proposed words for making sentences is reduced and the patient freely, at his own discretion, adds words and finds their grammatical forms.
Due to the fact that in the first variant of dynamic aphasia it is mainly the composition of texts, rather than phrases, that is disrupted, a series of sequential pictures connected by one plot are used as external supports.
The speech activity of patients will increase in the process of creating special speech situations-stages by the speech therapist, where the initiative to conduct a dialogue belongs to the patient. To facilitate dialogue, the speech therapist first discusses the topic with the patient, offering him interrogatives, “key” words that he can use in the conversation, and a plan. It also makes it easier to conduct a dialogue by addressing the speech therapist or other interlocutors by name and patronymic. In classes to stimulate speech activity, you can stage a conversation 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, when discussing television programs. He can be given instructions to verbally convey to someone the speech therapist’s request.
In milder forms of dynamic aphasia, the speech therapist asks the patient to retell the text, first using an expanded questionnaire, then using key questions for individual paragraphs of the text, based on a monosyllabic, condensed plan. At the same time, the speech therapist teaches him to make independent plans for texts, first expanded, then short, collapsed. Finally, after a preliminary plan has been drawn up, the patient retells the text without looking at this plan. Thus, the plan for retelling what was read is internalized.
Restoring understanding. In severe dynamic aphasia, understanding of situational speech is restored by discussing various events of the day. For example, a speech therapist, having clarified the question about the patient’s well-being, says: Now let’s talk about your tastes. Do you like poetry? Did you know...? Or, turning his attention to a new topic, he asks: Who visited you the day before? Subsequently, patients begin to use intonation for the purpose of communication, attract the attention of others, and carry out single-link and multi-link instructions.
As attention to the speech of others is cultivated, its understanding is also restored, and the difficulties of switching acoustic perception from one topic of conversation to another are reduced.
Restoration of written speech. Dysgraphic disorders in the writing of patients are rarely observed. However, they experience significant difficulties in composing written text. The presence of errors when writing indicates that patients have signs of efferent aphasia.
In parallel with the restoration of expressive speech, it becomes possible to fill in missing prepositions, verbs, adverbs, syllables and letters in texts, compose phrases in writing using key words, answer questions about texts, write essays based on a series of plot pictures, statements, powers of attorney for receiving a pension, letters to friends etc.
2.5 Correctional and pedagogical work for efferent motor aphasia
The main objectives of correctional pedagogical work for efferent motor aphasia are to overcome pathological inertia in the generation of the sound and syllabic structure of a word, restore the sense of language, overcome the inertia of word choice, overcome agrammatism, restore the structure of oral and written utterances, overcome alexia and agraphia.
Restoration of expressive speech. Overcoming the impaired pronunciation aspect of speech begins with the restoration of the rhythmic-syllabic scheme of the word, its kinetic melody.
In very severe efferent motor aphasia with a total impairment of reading and writing, work begins with the merging of sounds into syllables. In this case, the patient not only imitates a syllable that was previously slowly pronounced several times by the speech therapist, but also simultaneously puts it together from the letters of the split alphabet. Then, from the mastered syllables, he composes a simple word such as hand, water, milk, etc. Various word patterns are compiled, and the syllabic structure of the word is rhythmically beaten out.
Then the work of automating words begins, with a certain rhythmic structure. To do this, the patient is asked to read a series of words with one syllable structure, written in a column. Gradually the syllable structure of the word becomes more complex. The patient interacts with a speech therapist, and then independently reads rhyming words divided into syllables.
To clarify the syllabic and. sound composition of a word, a visual representation of the word diagram is used.
Simultaneously with the restoration of the sound and syllabic structure of the word, work begins to restore phrasal speech. Overcoming impaired phrasal speech begins with restoring the so-called sense of language, capturing consonance and rhymes in poems, proverbs and sayings. It is especially useful to use proverbs and sayings with rhyming verbs: “As you sow, so shall you reap,” etc.
When restoring expressive speech, special attention is paid to overcoming pathological inertia in finding the necessary articulatory components - syllables and words for utterance.
Movement is a process that occurs over time and involves the presence of a chain of successive impulses. As motor skills are formed, individual impulses are synthesized and combined into entire “kinetic structures” or “kinetic melodies.” Therefore, sometimes it is enough to prompt the patient with one word to reveal a whole dynamic speech stereotype, for example, words of a proverb or saying that automatically replace each other. The development of such a dynamic stereotype is the formation of a motor skill, which as a result of exercises becomes automatic.
When working with patients, plot and subject pictures are used, which are played out repeatedly by the speech therapist. In this case, one word or another is highlighted.
For example, in the phrase for the picture “The boy goes to school,” the speech therapist first stimulates calling the word to school, and then, using leading questions, moves on to the word goes.
In a humorous manner, the speech therapist teaches the patient to listen attentively to the question and answer it emotionally, especially if it does not correspond to the picture. For example, a speech therapist asks: Is the boy flying to school? Maybe the boy goes to school by car? Look carefully, maybe it’s not a boy, but a grandmother? To these questions, patients, as a rule, respond emotionally: “No, this is not a grandmother, but a child” (or a boy), “not by car, but on foot,” “not flying, but walking.” Playing out an object drawing, the speech therapist asks the patient questions about what the object is intended for, what can or should be done with it, for example, to eat (it must be washed, cooked, etc.), what are the properties of the object, etc.
With efferent motor aphasia, overcoming inertia in the choice of verbs is facilitated not only by a rigid phraseological context, but also by the speech therapist’s expressive pantomimic imitation of movements with objects.
For example, a speech therapist, stimulating the patient to construct a phrase based on a simple plot picture, says: This woman took scissors and used them (The speech therapist expressively depicts the movement of a hand with scissors cutting material). This technique, which clearly demonstrates movement, makes it much easier for patients to find the necessary verbs.
Later, the speech therapist gives the task to complete the same type of phrase with different words, for example: I am eating... (potato vulture, semolina porridge, white bread, etc.) or I am waiting for... (the attending physician, youngest daughter, beloved wife, etc.). d.). Such tasks are carried out based on a picture and diagram.
The first oral texts according to the plan drawn up by the speech therapist are stories about the daily routine: “And got up, washed, brushed my teeth...”, etc. These stories vary and are supplemented depending on the events of the day. First, the patient talks about himself in the past tense, then makes a plan for the following days, mastering equal forms of the future tense: “I will read,” “I will speak,” “I will speak well,” “I will go for a massage,” etc. n. The vocabulary studied in classes should provide the patient with the opportunity to communicate with others.
Restoration of reading and writing. With gross efferent motor aphasia, reading and writing may be in a state of complete collapse. In this regard, individual picture alphabets are being developed for patients, in which each letter corresponds to a specific picture or word that is significant for the patient, for example: a - “watermelon”, b - “grandmother”, c - “Vasily”, etc. Using familiar words, the patient finds in the alphabet the letters necessary to compose a syllable and a word. Using the usual split alphabet, you can combine syllables to form different words. At first these will be one-syllable words, then two-syllable, three-syllable, etc.
Most patients have right-sided hemiparesis, so they are taught to write capital letters first with their left hand, then words and phrases. The left hand should lie flat on the notebook page, without raising the hand or wrist. A course of preparatory exercises is conducted to prevent perseveration of letters and their elements.
Subsequently, patients with gross efferent motor aphasia are given tasks to fill in missing vowels and consonants in simple words under pictures, and fill in letters in phrases and texts. A sound-letter analysis of the composition of a word is carried out using leading questions and an analysis of syllables. Having composed a word from a cut alphabet, the patient writes it down in a notebook.
After mastering the sound-letter analysis, the speech therapist gives an auditory dictation from easy phrases. In this case, the patient must pronounce each word according to its sounds, sometimes first putting together especially difficult words from the letters of the split alphabet.
In the later stages, patients can be offered to solve simple crossword puzzles, compose various short words from the letters of a polysyllabic word, i.e., patients are offered speech games, but in a simplified form.
Restoration of reading in cases of severe severity of efferent aphasia begins with the patient’s global reading of words and phrases, with the addition of these words to subject and plot pictures, and the selection of words related to each other in meaning.
Restoring understanding. Restoring speech understanding in severe efferent motor aphasia begins with the development of auditory attention, the ability to isolate from a question the word that carries the main semantic load, accentuated by logical stress or intonation. Patients are asked provocative questions. For example, when showing a drawing of a “house,” the patient is asked: Is this a table? This is a pencil? As auditory attention is restored, the speech therapist invites the patient to look at the pictures and at the same time asks: Where is the spoon drawn? Show a spoon or: Show what we eat with. Such tasks lay the foundations for the patient to restore the sense of language. Later, tasks are given to put this or that object on, under, behind another object. The logical emphasis should fall either on the preposition or on the subject.
An important place in restoring the “sense of language” is occupied by exercises for presenting grammatically correct and specially distorted grammatical constructions to patients. First, the speech therapist explains to the patient which constructions correspond to grammatical laws and rules and which do not.
Thus, with efferent motor aphasia, the speech therapist restores those higher cortical functions that gradually developed in the child from a very early age: the syllabic organization of a word, the “sense of language,” the elementary connection of words in a sentence.
6 Corrective pedagogical work for afferent motor aphasia
Afferent motor aphasia is the most severe form, often surmountable only as a result of three or even five years of systematic speech therapy assistance to the patient. When overcoming this form of aphasia, not only severe articulatory disorders are observed, but also agraphia, alexia of varying severity, acalculia, and impressive agrammatism.
The main task of correctional pedagogical classes is to overcome violations of kinesthetic gnosis and praxis. The goal is to restore the articulatory kinesthetic basis of speech production, overcome agraphia, and establish a potentially intact detailed oral and written statement.
With grossly expressed afferent motor aphasia at the initial stage, correctional and pedagogical work will be built according to plan. 1) restoration of the pronunciation aspect of speech; 2) overcoming violations of understanding; 3) restoration of elements of analytical reading and writing.
With moderate severity, work is carried out to consolidate articulatory skills, to overcome literal paraphasia, stimulate expressive speech, difficulties in pronouncing words with a combination of consonants, expressive and impressive agrammatism: understanding the meaning and use of prepositions that convey the spatial relationship of objects.
With a mild degree of severity, work is carried out to overcome articulatory difficulties when pronouncing polysyllabic words with a combination of consonants, eliminating literal paraphasias and paragraphs, overcoming elements of expressive, mainly prepositional agrammatism, preparing the patient to return to study or work.
Restoration of the pronunciation aspect of speech. In working with patients, global pronunciation, coupled with a speech therapist, is used, reading automated speech series, and then phrases on the topics of the day, copying and reading, pronouncing words to oneself, reading and writing under dictation of individual letters corresponding to the difficulties of articulating individual sounds overcome in oral speech , folding simple words from reconstructed sounds from a split alphabet, introducing these words into active speech. In parallel, work is underway to isolate sounds in a word during their acoustic perception, to overcome secondary impaired phonemic hearing by differentiating words with oppositional vowels and consonants that are close in place and method of formation (u-o, a-i, a-o, m- p-b-v, n-d-t-l, d-g, t-k, m-n, etc.). With intact reading to oneself and some preservation of written speech, to overcome apraxia of the articulatory apparatus, the speech therapist uses a visual-auditory imitation technique in his work, speeds up the restoration of written speech when composing phrases based on plot pictures.
All work using this method excludes the use of a mirror, probes, and spatulas, since they increase the degree of voluntary movement and aggravate the articulatory difficulties of patients.
When trying to pronounce the sounds u, o, y, and, as well as consonants, patients either silently exhale air or wheeze, making chaotic movements with their lips or tongue.
Distracting from voluntary articulation for play and imitation activities, the speech therapist asks patients to groan, as if a tooth hurts, to breathe on their hands, as if they were frozen, this gives the patient the opportunity to make not only oral, but also articulatory movements dictated by the intent of the action, its semantics.
The degree of apraxia of different organs of the articulatory apparatus may be different, so it is advisable to start working with imitation of available sounds, usually labial and anterior lingual, but not with several, but with one sound, since at the initial stages there is an abundance of literal paraphasia. Classes begin with calling out the contrasting vowels a and u.
The speech therapist draws in the patient’s notebook several circles of different configurations or lips, wide open and not too wide, and asks the patient to try to copy this himself, that is, open his lips wide, compress them loosely, first silently, and then pronouncing the sounds mi in, so that practice the primary stop and gap on voiced consonants.
Voiced sounds are restored more slowly than deaf ones, so that the restoration of mv sounds greatly alleviates the tendency to deafen them, which is characteristic of patients with afferent motor aphasia.
During the first 2-3 lessons, it is necessary to repeatedly read syllables and words made up of the sounds a, u, m. Repeatedly reading the syllables am-am, ay, ua, am, um, and the words mom improves the ability to switch from one sound to another. Gradually other sounds are evoked.
A speech therapist can follow any sequence in working to call sounds, but the following conditions must be taken into account:
-sounds of one articulatory group cannot be evoked simultaneously
-sounds should be introduced into phrases, avoiding nouns in the nominative case.
Restoration of narrative speech. It is traditionally believed that expressive speech in patients with afferent motor aphasia is potentially preserved due to the preservation of the anterior speech regions that program speech utterance. And yet, a gross violation of the articulatory side of speech seems to block the possibility of a detailed statement. Even in “pure” cases of moderate afferent motor aphasia, difficulties may arise in the selection of words, especially prepositions and verbs with prefixes that convey spatial relations. These difficulties in choosing words and paragrammatism of the “telegraphic style” type are many times easier to overcome than the true agrammatism of the “telegraphic style”, characteristic of efferent motor aphasia.
With afferent motor aphasia, as with acoustic-gnostic sensory aphasia, difficulties in developing utterances are associated with ambiguity and diffuseness of the idea of the sound and syllabic composition of a word. In this regard, as the sound-letter analysis of word composition is restored and articulatory difficulties are overcome, patients with afferent motor aphasia regain the ability to nominate all objects, actions, and qualities. Quite quickly, the patient’s vocabulary becomes unlimited, especially when composing phrases based on plot pictures. However, situational speech remains slow for a long time, poor both in its lexical composition and grammatical forms of expression. Patients at the residual stage of the disease “get used” to the fact that others understand them by gestures and facial expressions, by individual words that are difficult to pronounce, with intact internal speech, which patients use in communication.
Restoring situational, colloquial speech is one of the primary tasks of the initial stage of correctional pedagogical work. As sound pronunciation is restored, newly evoked sounds are introduced into words necessary for communication. Often, in patients with afferent motor aphasia, after 12-16 newly formed sounds (as well as when stimulating oral utterance with the help of automated speech series), it is possible to evoke, through conjugate repetition, the still unclear sound of words necessary for communication. These are adverbs, question words and verbs: now, good, tomorrow, yesterday, when, why, don’t want, will, etc. The introduction of newly evoked sounds into predicative utterances is relatively easy.
The speech therapist, in conversations on the topics of the day, works with them on the articulatory programs of words included and the cliché-like vocabulary of colloquial speech. The main lexical and didactic material at the initial stage of work is not plot pictures, but various kinds of dialogues.
As dialogic, very short, cliché-like conversational speech is restored, the speech therapist moves on to restoring monologue speech. Its main goal is the development of detailed oral and written expression in the patient. A patient with afferent motor aphasia quickly masters the scheme of direct and inverted construction of a phrase based on a plot picture, and the plan of a statement based on a series of plot pictures. As the sound-letter analysis of the composition of the word is restored, the speech therapist switches the patient from oral composing phrases from pictures to writing. In the presence of severe apraxia of the articulatory apparatus, oral speech may lag behind writing. Written speech in these cases turns out to be a support for restoring oral expression. Oral and written speech will be characterized by paragrammatisms, expressed in difficulties in using adverbs, prepositions, pronouns, inflections of nouns, verbs conveying different directions of movement. To prevent and overcome this paragrammatism at the stage of complete absence of speech and later, the patient’s understanding of the meanings of prepositions, pronouns, adverbs, etc. is clarified, missing prepositions and inflections of nouns are filled in, the use of verbs with prefixes is clarified: flew away, ran away, left, came running , came, etc. differentiation of the meanings of prepositions and prefixes: on - by, under - above, etc.
With afferent motor aphasia, situational cliché-like speech in patients is preserved and serves the purposes of communication, but the arbitrary composition of phrases from a series of pictures, from individual plot pictures is grossly impaired. A common feature for these forms of aphasia will be the appearance of pseudo-agrammatism of the “telegraphic style” type, caused by the restored ability to name all surrounding objects. This pseudo-agrammatism does not serve as a means of communication for them; it manifests itself only when composing phrases based on plot pictures at the early stage of the transition from a nominated word to a phrase. This can be overcome by explaining to the patient that he should not be distracted by listing the secondary items shown in the figure; he needs to isolate the main thing when composing a phrase. Patients with afferent motor aphasia have a fairly intact imagination and sense of humor, which are reflected in their written and then oral statements.
Restoration of reading and writing. At the residual stage of correctional pedagogical work, the restoration of reading and writing begins with the very first lesson on overcoming articulatory difficulties. Each pronounced sound, word, phrase is read by the patient, first in conjunction and reflected with the speech therapist, then independently. Much attention in restoring reading and writing is given to visual dictations of individual words, phrases and short sentences.
In case of gross afferent motor aphasia, to restore the sound-letter analysis of the composition of a word, a split alphabet is used, filling in the missing letters in a word and phrase.
Dictations, especially in the initial and middle stages of recovery, consist of words and phrases previously worked out with the patient and read to him, since it is difficult for a patient with severe articulatory disorders to retain in auditory-verbal memory a relatively expanded text consisting of a large number of syllables, sound combinations, and words. Auditory dictations should alternate with visual ones.
In the initial stages of recovery, special attention is paid to vowel sounds, since they are often in a reduced position and are poorly felt by the patient. Preliminary listening to the text helps improve the reading process, since overcoming difficulties in articulation during the reading process distracts the patient’s attention from the content of the story and the understanding of certain phrases. Reading aloud and writing from dictation in patients with afferent aphasia is restored only after overcoming the basic articulatory difficulties, mainly as a result of prolonged copying of words, sentences of varying syllabic and sound complexity, and small texts.
Restoring understanding. Overcoming understanding impairments in afferent motor aphasia at the residual stage depends on the severity of the speech disorder, the degree of reading and writing impairment.
In case of severe violations of expressive speech, the main attention is paid to restoring secondarily impaired phonemic hearing, restoring orientation in space, clarifying the meanings of prepositions, adverbs, understanding personal pronouns in indirect cases, understanding elementary pairs of antonyms and synonyms.
Secondarily impaired phonemic hearing is restored by fixing the patient’s attention on sounds that are close in place and method of articulation, when listening to words beginning with these sounds, when selecting pictures for a particular letter that begin with the corresponding vowel and consonant sound, when choosing from various texts of words that have practiced sounds at the beginning, middle and end of the word.
Differentiation of the meaning of words of one semantic field, part and whole, synonyms, homonyms, antonyms is carried out with speechless patients based on pictures when listening to various phrases, clarifying the meaning of words. At later stages, as reading and writing are restored, missing words of synonyms and homonyms are filled in and sentences are composed with them. For example, insert into the sentence the words: brave, courageous, heroic, courageous and clarify in what cases these words can be used.
With conduction afferent motor aphasia, the understanding of the meanings of nouns included in one semantic field is restored, for example, the possibility of using the words pipe, wall, ceiling is clarified. door. These exercises prevent the occurrence of verbal paraphasias in the speech of patients. Improving orientation in space is facilitated by working with a geographical map, finding seas, mountains, cities, oceans, countries, etc. on it.
At later stages, when one can rely on reading and writing, impressive agrammatism is overcome. The patient describes the location of the central object in relation to objects located to his left and right, above and below him. First, the drawings of one space group are described, then the other, that is, either horizontally or vertically. The speech therapist draws three objects in the patient’s notebook (for example, a Christmas tree, a house, a cup), circles the middle object and asks a question near it or above it, and uses arrows to outline a plan for describing the objects. The patient composes phrases from it: “The Christmas tree is drawn to the right of the house and to the left of the cup” or “The house is drawn to the left of the cup and to the right of the Christmas tree.” This work is carried out by the patient for ~8-10 sessions. Then the arrangement of objects is also described with the prepositions above - below, with the adverbs above - below, further - closer, lighter - darker, etc. After the patient has mastered the description of the spatial arrangement of three objects, the speech therapist moves on to tasks for understanding written instructions, having previously worked through these diagrams in expressive speech, for example: Draw a Christmas tree to the right of the cup and to the left of the table. This prepares the patient to understand logical-grammatical structures by listening or reading.
Conclusion
Speech is interesting to study from many aspects: for example, as a device that generates physical sounds, as well as perceives and differentiates them; or as some apparatus that translates meaning into words. Moreover, this apparatus is in close connection with human consciousness and emotions; Its important feature is the presence in it of a language system produced by a community of people and individually acquired and used by each person.
Without speech there is no society. Speech is very important in a person’s life, especially important for a person as a member of society. Thanks to speech, the modern world exists in such a developed form. Thanks to speech, the experience accumulated by all of humanity throughout its history is transferred to the younger generation.
Knowing the mechanisms of speech, you can understand the causes of speech dysfunction, find the source of the disease and successfully treat speech disorder.
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