Aphasia is a disease that is characterized by problems with speech recognition and speech communication, which occur due to damage to the areas of the brain responsible for speech. Aphasia is not a congenital disease. It appears suddenly after injury or illness. It can be as much as a head injury, as well as a heart attack, a stroke, an infection or insanity. Acquired aphasia manifests itself as a complete or partial inability to perceive speech (oral and / or written) and speak.

There are various classifications of aphasias: classical, neurological classification of Wernicke-Lichtheim, linguistic classifications of H. Head and others. At present, the neuropsychological classification of aphasias by A.R. Luria, who distinguishes six forms of aphasia: acoustic-gnostic acoustic-mnestic (occurs when the temporal cortex is damaged), semantic and afferent motor aphasia (occurs when the lower parts of the cerebral cortex are damaged), efferent motor and dynamic aphasia (occurs when the brain is damaged). premotor posterior frontal cortex).

Directions of corrective work

Corrective action in all forms of aphasia consists of two directions:

1. Medical direction - direct restoration of the affected function using medications. The course of treatment is carried out as prescribed and under the supervision of doctors.

2. Logopedic direction - direct restorative training in specially organized classes.

As observations show, in childhood the effectiveness of classes is higher than in adults. As a rule, in adults, speech cannot be completely restored, but in children it is possible to achieve the norm, and in a fairly short time.

There are general provisions for restoring speech in children with motor and sensory aphasia.

The restoration of speech function involves the use of various techniques for disinhibition of the remaining elements of the speech system. One of the leading directions in the work is the restoration of passive and active vocabulary.

In terms of the form of conducting speech therapy classes, they should be mostly individual in nature, since children differ sharply from each other in their speech and personality characteristics. In addition, the restoration of speech always proceeds in different children in different ways.

MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION
NON-STATE EDUCATIONAL INSTITUTION
HIGHER PROFESSIONAL EDUCATION

BRANCH "MOSCOW PSYCHOLOGICAL AND SOCIAL UNIVERSITY" IN KANSK, KRASNOYARSK REGION
Faculty "Special (defectological) education"

TEST
PO Aphasia

Topic: "Correctional work in aphasia"

Completed by student 11/45/BDZ-3.5s-3
(Group No.)
Pugacheva Yu.O
(full name of the student)

checked
teacher: Shapovalenko L.O., st. pr-l
(F.I.O. pr-la, academic degree)

G. KANSK
2013
Content

Introduction 1 page
The concept of aphasia page 4
Etiology of aphasia page 5
Classification of forms of aphasia 8 pages
Correctional and pedagogical work to overcome aphasia 15 pages
Restorative education in various forms of aphasia 18str
Motor aphasia of the afferent type page 23
Motor aphasia of efferent type page 28
Dynamic aphasia page 30
Sensory aphasia page 33
Acoustic-mnestic aphasia page 36
Semantic aphasia page 38
Opto-mnestic aphasia 40str
Conclusion page 42
References 44pp

INTRODUCTION
The human brain is the most important organ, which IP Pavlov rightly called the highest apparatus for integrating all organic processes and organizing active interaction between a person and the surrounding reality. Due to its high importance in the whole human body, brain lesions lead to severe disorders of mental processes, such as speech and understanding, memory and perception, counting and constructive activity, etc.
Often life confronts us with people who have lost the ability to speak and understand the speech of the people around them, who have lost the skills of counting and counting operations, who find it difficult to orient themselves in space, who have lost the idea of ​​\u200b\u200b"left" and "right". These people, on the whole, with a safe personality, correct behavior, understanding and acutely experiencing their defects, cannot count money, buy goods in a store, or cross the street on their own. Such violations of speech and intellectual skills often occur as a result of various kinds of brain diseases (stroke, traumatic brain injury, brain tumor, etc.). Naturally, people who have lost these abilities lose the opportunity to communicate with the people around them, contact with them. All these defects complicate the personal, family and social life of a person in general. Helping these people, returning them to public life, to work is one of the most important and humane tasks of our health care. In this regard, the task arises of qualified assistance to these people, restoration of lost skills and knowledge, impaired mental functions in order to overcome the patient's adaptation to the defect and prevent his disability.
At the beginning of the disease, first of all, the tasks of treating the patient and often saving his life are solved. But already at the stage of treatment, doctors, psychologists, defectologists gradually begin to work with patients for rehabilitation purposes. One of the most important requirements for neuropsychological rehabilitation (NPR) of neurological and neurosurgical patients is the early start of rehabilitation work. Doctors save these people's lives, psychologists and defectologists return them to social life, to family, to work, primarily by restoring disturbed mental functions.
The task of restoring disturbed skills and knowledge is not only humane, but also socially significant. A properly organized system of neuropsychological rehabilitation of patients, including restorative education, allows you to return a person not only to his social environment, but also to make him able to work. By returning this contingent of patients to work, neuropsychological rehabilitation thus solves the problem of not only social, but also state significance.
A number of difficulties faced by practitioners stand in the way of solving these critical tasks. These difficulties primarily include the widespread practice of an empirical approach to the rehabilitation of patients, the still ongoing neglect of scientific foundations in solving practical problems of restorative education, the transfer of teaching methods (without sufficient scientific analysis) from other areas of practice, insufficient and often one-sided knowledge of the defect. , which needs to be overcome, i.e., the lack of knowledge of the nature and mechanisms of the defect, its connection with other mental processes, with the personality of the patient. The effectiveness of rehabilitation measures, including restorative education, is directly related to the high qualification of a psychologist, doctor, speech therapist and other specialists involved in rehabilitation practice.

The concept of aphasia

Aphasia is a systemic speech disorder, consisting in the complete loss or partial loss of speech, and is caused by a local lesion of one or more speech areas of the brain.
In the vast majority of cases, aphasia occurs in adults, but it is also possible in children if brain damage occurs after speech is at least partially formed. The term "aphasia" comes from the Greek. "fasio" (I say) and the prefix "a" ("not") and literally means "I do not say."
Since speech is not always completely absent in aphasia, one could call it dysphasia. However, in science there is the concept of a busy term. In this case, this is precisely what is an obstacle to the designation of incomplete speech destruction as “dysphasia”. In the literature, especially Western, the term "dysphasia" refers to various disorders of speech development in children, similar to how dyslalia is called impaired sound pronunciation, and not partial underdevelopment of speech (alalia). The above explains a certain conventionality of the terms "aphasia" and "alalia". From the point of view of strict logic, there is a certain paradox: it can be stated that the patient has aphasia in moderate or mild severity, at the same time, the term itself implies the absence of speech. This terminological inaccuracy is a tribute to the traditions that led to the emergence of these not quite accurate designations.
Regardless of such terminological conventions, the concept of aphasia has by now been well defined. It boils down to acknowledging:
systemic speech disorder, which implies the presence of a primary defect and secondary speech disorders arising from it, covering all language levels (phonetics, vocabulary and grammar);
obligatory violation of the processes of not only external, but also internal speech.
This situation is due to the specifics of the speech function itself: a) its division into internal and external speech; b) consistency, i.e. dependence of some parts on others, as in any system.

Etiology of aphasia

Aphasia can have different etiologies: vascular; traumatic (traumatic brain injury); tumor.
Vascular lesions of the brain have various names: strokes, or cerebral infarctions, or cerebrovascular accidents
They, in turn, are divided into subspecies. The main types of strokes (cerebral infarctions, cerebrovascular accidents) are ischemia and hemorrhage. The term "ischemia" means "starvation". The term "hemorrhage" means "hemorrhage" (from the Latin gemorra blood). "Starvation" (ischemia) leads to the death of brain cells, because. they are left without the main "food" of blood. Hemorrhage (hemorrhage) also destroys brain cells, but for other reasons: either they are filled with blood (figuratively speaking, they “choke” in the blood and soften, forming softening foci in the brain, or a hematoma forms at the site of the hemorrhage. With its weight, the hematoma destroys ( crushes) nearby nerve cells. Sometimes hematomas turn into hard sacs cysts "cystic". In this case, the risk of their rupture decreases, but the risk of crushing the substance of the brain remains.
The cause of ischemia can be:
stenosis (narrowing of the vessels of the brain), as a result of which the passage of blood through the vascular bed is difficult;
thrombosis, embolism or thromboembolism, blocking the vascular bed (thrombus is a blood clot that plays the role

"gags", embolus foreign body (air bubble, detached piece of flabby tissue of a diseased organ, even the heart; thromboembolism is the same emboli, but enveloped in blood clots);
sclerotic "plaques" on the walls of blood vessels that impede blood flow;
prolonged arterial hypotension, when the walls of the vessels do not receive the necessary pressure of blood, weaken and fall off, becoming unable to push the blood;
The cause of hemorrhage can be:
high blood pressure, tearing the walls of the vessel;
congenital pathology of blood vessels, for example, aneurysms, when the curved wall of the vessel becomes thinner and ruptures more easily than other parts of it;
sclerotic layers on the walls of blood vessels, making them brittle and amenable to rupture even at low blood pressure. (Wiesel T.G. Fundamentals of neuropsychology - M / AST, 2005 224-226pp.)
Brain injuries can be open or closed. Both those and others destroy the brain, including the speech zones. In addition, with injuries, especially those associated with blows to the skull, to a greater extent than with strokes, there is a danger of a pathological effect on the entire brain of contusion. In these cases, in addition to focal symptoms, there may be changes in the course of nervous processes (slowdown, weakening of intensity, exhaustion, viscosity, etc.).
In case of open brain injuries, they resort to surgical intervention to clean wounds, for example, from fragments of bone tissue, blood clots, etc.), in case of closed injuries, surgical intervention (craniotomy) can be performed, or conservative treatment can be applied, in which therapy is calculated in mainly on the resorption of intracranial hematomas.
Brain tumors can be benign or malignant. Malignant ones are characterized by faster growth. Just like hematomas, tumors compress the substance of the brain, and growing into it, destroy nerve cells. Tumors are subject to surgical treatment. Currently, the technique of neurosurgery allows you to remove those tumors that were previously considered inoperable. Nevertheless, some tumors remain, the removal of which is dangerous due to damage to vital centers, or they have already reached such a size that the substance of the brain is destroyed, and removal of the tumor will not give significant positive results.
The most severe consequences of local brain lesions of any etiology are disorders of: a) speech and other HMFs (orientation in space, the ability to write, read, count, etc.); b) movements. They can be present at the same time, but they can also act in isolation: movement disorders in a patient may be present, but speech disorders may be absent, and vice versa.
Movement disorders most often appear on one side of the body and are called hemiplegia (complete loss of movement on one side of the body) or hemiparesis. "Gemi" means "half", "paresis" partial, incomplete paralysis. Paralysis and paresis may involve only the arm or only the leg, or may extend to both the upper and lower extremities.
Since aphasia is a speech disorder, which is carried out mainly by the left hemisphere, hemiparalysis and hemiparesis in patients with aphasia on the right half of the body. With damage to the right hemisphere, left-sided hemiparesis or paralysis develops, while aphasia is not always present or appears in a “weakened” form. In this case, as is commonly believed, the patient has a clear or hidden (potential) left-handedness. It is the reason that part of the speech function is located in such patients not in the left hemisphere, as in most people, but in the right. In other words, there is a point of view according to which left-handers have a special distribution of HMF in the cerebral hemispheres.
Classification of forms of aphasia
As a result of local lesions of the brain, severe speech disorders occur. The most common of these are aphasias. With aphasia, systemic disorders of speech function are manifested, covering all language levels of phonology, including phonetics, vocabulary and grammar. Clinical pictures of aphasia are heterogeneous. The differences between them are primarily due to the localization of the lesion. There are so-called speech zones of the brain: the posterior sections of the lower frontal gyrus, the temporal gyrus, the lower parietal region, as well as the zone located at the junction of the parietal, temporal and occipital regions of the left dominant hemisphere of the brain.
In domestic and foreign aphasiology, there are various classification systems of aphasic disorders. The most common among them is the classification of A.R. Luria. According to this classification, the following forms of aphasia exist:
Motor aphasia of the afferent type.
Motor aphasia of the efferent type.
dynamic aphasia.
Sensory (acoustic-gnostic) aphasia.
Acoustic-mnestic aphasia.
semantic aphasia.
In clinical practice, it is also customary to single out amnestic and conduction aphasias, which are included in the classical neurological classification.
In addition to the localization of the lesion and its size, the severity and stage of the disease determine the specifics of speech impairment in each form of aphasia. Pathogenetic mechanisms also play an important role. For example, in case of vascular lesions of the brain, the nature of cerebrovascular accident, the degree of severity of the neurodynamic component, the state of unaffected areas of the brain, etc. are of great importance. In aphasias with traumatic or tumor etiology, the most significant are the severity of the destructive defect, as well as the timing and nature of the surgical intervention. The premorbid intellectual-characterological traits of the patient's personality are also of some importance.
To understand the specifics of speech disorders in one form or another of aphasia, and therefore to provide a differentiated approach to overcoming them, it is extremely important to identify the mechanism, or otherwise, the disturbed prerequisite that determines the nature of the aphasiological syndrome.
All forms of aphasia arise as a result of damage to the parietal speech zone of the left dominant in speech (in right-handers) hemisphere of the brain. The characteristics of the forms of aphasia given below correspond to the ideas of neuropsychology created by A.R. Luria.
(Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia. M .: “Association of defectologists”, V. Sekachev, 2000 5-7 pages)

Afferent motor aphasia is caused by damage to the lower parts of the postcentral zone of the brain. The central disorder is a violation of the kinesthetic afferentation of voluntary oral movements. Patients lose the ability to perform certain movements on the instructions of the tongue, lips and other organs of articulation. Involuntarily, these movements can be easily performed by them, since there are no paresis that limits the range of oral movements. This is called oral apraxia. Oral apraxia underlies articulatory apraxia, which is directly related to the pronunciation of speech sounds. It manifests itself in the disintegration of individual articulatory poses or, in other words, the articulation. In the oral speech of patients, depending on the degree of rudeness of apraxia, this manifests itself in:
lack of articulated speech;
distorted reproduction of poses;
looking for articulation.
Secondarily, other aspects of the speech function are systemically impaired.
Efferent motor aphasia is caused by damage to the lower parts of the premotor zone. Normally, it provides a smooth change from one oral or articulatory act to another, which is necessary for the merging of articulations into successively sequentially organized rows of “kinetic motor melodies” (in the terminology of A.R. Luria).
With focal lesions of the premotor zone, pathological inertia of articulatory acts occurs, perseverations appear that prevent free switching from one articulatory posture to another. As a result, the speech of patients becomes torn, accompanied by a stuck on separate fragments of the utterance. These defects in the pronunciation side of speech cause systemic disorders in other aspects of the speech function: reading, writing, and partially understanding speech. Thus, in contrast to afferent motor aphasia, where articulatory apraxia refers to single postures, in efferent it refers to their series. Patients pronounce individual sounds relatively easily, but experience significant difficulties in pronouncing words and phrases.
(Tsvetkova L.S., Torchua N.G. Aphasia and perception 171, 172, 173, 175).
With dynamic aphasia, brain damage occurs in the posterior frontal regions of the left hemisphere, located anterior to the "Broca's area". The speech defect manifests itself here mainly in speech aspontaneity and inactivity. Currently, two variants of dynamic aphasia have been identified (T.V. Akhutina). Option I is characterized by a predominant violation of the function of speech programming, in connection with which patients use mostly ready-made speech stamps that do not require special “programming activities”. Their speech is characterized by poverty, monosyllabic answers in the dialogue. In option II, violations of the grammatical structuring function predominate: in the speech of patients in this group, expressive agrammatism is expressed, which manifests itself in the form of “coordination” errors, as well as “telegraphic style” phenomena. Pronunciation difficulties in both variants are insignificant. (Akhutina T.V. Neupolinguistic analysis of dynamic aphasia. - M. MSU, 1975.)
Sensory (acoustic-gnostic) aphasia occurs when the upper temporal parts of the so-called Wernicke's area are affected. Speech auditory agnosia, which underlies phonetic hearing disorders, is considered as a primary defect. Patients lose the ability to differentiate phonemes, i.e. highlight the signs of speech sounds that carry semantic-distinctive functions in the language. Disorders of phonemic hearing, in turn, cause gross violations of the impressive speech of understanding. The phenomenon of “alienation of the meaning of the word” appears, which is characterized by the “stratification” of the sound shell of the word and the object designated by it. Speech sounds lose their constant (stable) sound for the patient and each time they are perceived distorted, mixed with each other according to one or another parameter. As a result of this sound lability, characteristic defects appear in the expressive speech of patients: logorrhea (an abundance of speech production) as a result of “chasing an elusive sound”, replacing some words with others, some sounds with others, verbal and literal paraphasias.
Acoustic-mnestic aphasia is caused by a lesion located in the middle and posterior parts of the temporal region. Unlike acoustic-gnostic (sensory) aphasia, the acoustic defect manifests itself here not in the sphere of phonemic analysis, but in the sphere of auditory mnestic activity. Patients lose the ability to retain information perceived by ear in memory, thereby demonstrating the weakness of acoustic traces. Along with this, they show a narrowing of the volume of memorization. These defects lead to certain difficulties in understanding extended texts that require the participation of auditory-speech memory. In the own speech of patients with this form of aphasia, the main symptom of aphasia is a vocabulary deficit, associated both with the secondary impoverishment of the associative links of the word with other words of this semantic cluster, and with the lack of visual representations of the subject. . (Luria A. R. Higher cortical functions of a person and their disturbances in local lesions p. 282, 283,285).
Semantic aphasia occurs when the parieto-occipital regions of the left dominant hemisphere are affected. The main manifestation of speech pathology in this type of aphasia is impressive agrammatism, i.e. inability to understand complex logical and grammatical turns of speech. This defect is, as a rule, one of the types of a more general disorder of spatial gnosis, namely, the ability for simultaneous synthesis, since in phrasal speech the main “details” linking words into a single whole (logical-grammatical construction) are the grammatical elements of words, The main difficulty for patients is to isolate these elements from the text and understand their semantic role, especially the spatial one (spatial prepositions, adverbs, etc.). At the same time, the ability to catch formal grammatical distortions (errors of "coordination") remains intact in these patients.). (Luria A.R. Traumatic aphasia p. 282).
Recovery of speech function in aphasia is gradual. Naturally, in the early stages of the disease, regardless of the specific form of aphasia, the task is to include mainly involuntary, automated levels of speech activity. During this period, the most effective is the use of automated speech series, the "speech" of emotionally significant situations, the "revival" of speech stereotypes, well established in the previous speech practice.
Work with patients who are in the acute stage of the disease should be strictly dosed depending on the characteristics of the general condition of the patient, be sparing, psychotherapeutic in nature. In addition, special tasks are set for establishing contact with the patient, involving him in purposeful activities. As a rule, for this, the method of conversation is used on various topics close to the patient, as well as methods consisting in connecting “non-speech” activities: the simplest design, drawing, modeling from plasticine, etc.
At the subsequent stages of the disease, restorative training is carried out with the expectation of an increasingly active, conscious involvement of the patient in the restorative process. To do this, restructuring techniques are used. Their use is impossible without transferring the work to an arbitrary, conscious level. This does not mean that a complete rejection of reliance on speech automatisms is necessary, but the main emphasis is on the conscious assimilation of certain methods of compensating for a defect.
Restoration of speech function in any form of aphasia requires a systematic approach, i.e. implies the normalization of all disturbed language levels. However, with each of the aphasic forms, there are also specific tasks associated with overcoming the primary speech defect.
Afferent motor aphasia: restoration of articulation schemes of individual sounds and, consequently, elimination of literal paraphasias arising from the mixing of speech sounds close in articulation.
Efferent motor aphasia: restoration of the ability to perform serial articulatory acts. Such a task requires the development of a switch from one article to another, from one word fragment to another. This, in turn, is closely related to the task of restoring the kinetic motor melodies of the word and phrase, as well as the internal linear syntactic scheme of the phrase.
Sensory aphasia: restoration of phonemic hearing, i.e. the ability to differentiate aurally close-sounding phonemes, and on this basis to understand speech as a whole.
Dynamic aphasia: 1st option - restoration of the function of speech programming; The second option is to overcome grammatical structuring disorders.
Acoustic-mnestic aphasia: expansion of auditory-speech memory, as well as overcoming the weakness of traces of perceived speech.
Semantic aphasia: elimination of impressive agrammaticism, i.e. restoration of the ability to perceive complex logical and grammatical turns of speech.
Work on overcoming secondary disorders of speech understanding, accumulation of an active vocabulary, normalization of the grammatical side of speech, reading, writing is shown in all forms of aphasia, since these sides of speech suffer to one degree or another in each of them. The scope of this work is determined by the severity of a particular defect, its specific weight in the overall clinical picture of a given case of aphasia.
(Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia. M .: “Association of defectologists”, V. Sekachev, 2000 89-90)

Correctional and pedagogical work to overcome aphasia
E. S. Bein, M. K. Burlakova (Shokhor-Trotskaya), T. G. Wiesel, A. R. Luria, L. S. Tsvetkova made a great contribution to the development of principles and techniques for overcoming aphasia.
In speech therapy work to overcome aphasia, general didactic principles of learning (visibility, accessibility, consciousness, etc.) are used, however, due to the fact that the restoration of speech functions differs from formative learning, that the higher cortical functions of an already speaking and writing person are organized somewhat differently than in a child who is starting to speak (A. R. Luria, 1969, L. S. Vygotsky, 1984), when developing a plan for correctional and pedagogical work, one should adhere to the following provisions:
(Shokhor - Trotskaya M.K. Correctional - pedagogical work with aphasia. (guidelines) - 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 has suffered 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 aphasias that occur when the temporal or parietal lobes of the left hemisphere are affected, the planning, programming and controlling functions of the left frontal lobe are primarily used, providing 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 to restore impaired speech. The duration of speech therapy classes with patients with all forms of aphasia is two to three years of systematic (inpatient and outpatient) classes. 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 and 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 a relatively passive participation of the patient in the process of restoring speech. Techniques are used that disinhibit speech functions and prevent at an early stage of recovery such speech disorders as agrammatism of the "telegraph style" type in efferent motor aphasia and an abundance of literal paraphasia in afferent motor aphasia. At the later stages of the restoration of speech functions, the structure and plan of classes are explained to the patient, means are given that he can use when performing the task, etc.
3. The correctional-pedagogical system of classes presupposes such a choice of methods of work that would allow either to restore the initially violated prerequisite (in case of its incomplete breakdown), or to reorganize the preserved links of the speech function. For example, the compensatory development of acoustic control in afferent motor aphasia is not just the replacement of disturbed kinesthetic control with acoustic control to restore writing, reading and understanding, but the development of preserved peripherally located analyzer elements, the gradual accumulation of the possibility of their use for the activity of the defective function. With sensory aphasia, the process of restoring phonemic hearing is carried out by using a preserved optical, kinesthetic, and most importantly, semantic differentiation of words that are similar in sound.
4. Regardless of which primary neuropsychological prerequisite is violated, with any form of aphasia, work is carried out on all aspects of speech: on expressive speech, understanding, writing and reading.
5. With all forms of aphasia, the communicative function of speech is restored, self-control over it develops. Only when the patient understands the nature of his mistakes, it is possible to create conditions for his control over his speech, over the plan of narration, over the correction of literal or verbal paraphasia, etc.
6. In all forms of aphasia, work is underway to restore verbal concepts, including them in various phrases.
7. The work uses deployed external supports and their gradual internalization as the disturbed function is restructured and automated. Such supports include, in dynamic aphasia, sentence schemes and the chip method, which allow restoring an independent detailed statement; 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 "telegraph style" type in efferent motor aphasia and an abundance of literal paraphasia in afferent motor aphasia. At the later stages of the restoration of speech functions, the structure and lesson plan are explained to the patient, means are given that he can use when performing the task, etc. (Shokhor - Trotskaya M.K. Correctional - pedagogical work with aphasia. (guidelines) - M , 2002)
Restorative learning in different forms of aphasia
(typical programs)
Rehabilitation training is carried out with adult patients with HMF disorders, and primarily speech, and is an important section of neuropsychology and neurolinguistics. To date, the methodology, principles of restorative education have been defined, and a fairly large arsenal of evidence-based methods of work has been created. A fundamental contribution to these developments was made by A.R. 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, clinic, pathogenesis and diagnosis of HMF disorders. Numerous studies have been carried out on this basis, summarizing the research and practical experience of working with patients (V.M. Kogan, V.V. Oppel, E.S. Bein, L.S. Tsvetkova, M.K. Burlakova, V. M. Shklovsky, T. G. Wiesel and others). (Shokhor-Trotskaya M.K. Logopedic work with aphasia at an early stage of recovery. M .: 2002.)
The position that the return of the lost function to the patient is possible in principle 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 are involved, which leads to the presence of two main types of directional effects. The first is associated with the use of direct disinhibitory 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 inhibition, usually associated with changes in neurodynamics (speed, activity, coordination of the course of nervous processes).
The second type of targeted overcoming of HMF disorders implies compensation based on the restructuring of the method of implementing the impaired function. For this, various -interfunctional relationships are involved. Moreover, those of them that were not leading before the disease are specially made so. This "bypass" of the usual way of performing a function is needed to attract spare reserves (afferentations). For example, when restoring a disintegrated articulatory posture of a speech sound, an optical-tactile method is often used. In this case, the reliance is not on the sound of the sound being worked out, but on its optical image and the tactile sense of the articulatory posture. In other words, such external supports are connected as leading, which in speech ontogenesis (when mastering sound pronunciation) were not basic, but only additional. Due to this, the way the speech sound is produced changes. Only after the optically perceived and tactilely analyzed articulatory posture is fixed in the patient, it is possible to fix his attention on the acoustic image and try to return to him the role of the leading support. It is important at the same time that direct teaching methods are designed for involuntary soldering of premorbidly strengthened skills in the memory of patients. Bypass methods, on the contrary, imply an arbitrary mastering of the 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, strengthened in premorbid speech practice.
Since in most patients aphasia is combined with a violation of non-speech HMF, their recovery is a significant section of restorative education in terms of volume. Some of the non-speech functions do not require a thorough verbal accompaniment, others are restored only on the basis of speech. The restoration of a number of speech functions requires the connection of non-speech supports. In this regard, the sequence of work on speech and non-verbal functions is decided in each specific case, depending on the combination of verbal and non-verbal components of the syndrome. (Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia.)

Work on the restoration of complex types of speech activity (phrasal, written speech, listening to extended texts, understanding logical and grammatical structures, etc.) is predominantly arbitrary, but not due to the restructuring of the mode of action, but due to the fact that they assimilation in a natural way was to some extent arbitrary, i.e. was under conscious control. Essentially, here is the revival of the action algorithm, while involuntary, direct methods stimulate the speech act directly.
An important clarification of the pathological syndromes caused by local lesions of the brain was made at the beginning of the 20th century by the neurologist K. Monakov (Mopasou). Based on clinical observations, he concluded that within a few days or even weeks after a brain disease, there are symptoms that are explained not by the lesion, but by a phenomenon that he called diaschisis and consisting in the occurrence of edema in patients, swelling of the brain tissue, inflammatory processes, etc. .P. Accounting for these features is important not only for the correct treatment tactics, but also for the selection of 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.
Restoration of speech 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 referred to as aphasiologists. This is quite justified, given that the term "aphasiology" has by now become completely legalized and used both in scientific literature and in practice.
Restorative training is carried out according to a special, pre-designed program, which should include certain tasks and the corresponding methods of work, differentiated depending on the form of aphasia (apraxia, agnosia), the severity of the defect, the stage of the disease.
(Problems of aphasia and restorative learning: In 2 volumes / Edited by L.S. Tsvetkova. - M .: MGU, 1975. Vol. 1 1979. Vol. 2.)
It is also necessary to observe the principle of consistency. This means that restoration work should be carried out on all sides of the impaired function, and not only on those that suffered primarily.
The correct organization of restorative education also requires a 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 restorative education is to take into account the coefficient of hemispheric asymmetry in a particular patient. The higher it is, the more reason to conclude that the patient is a potential left-hander or ambidexter. Consequently, he has a non-standard distribution of HMF over the cerebral hemispheres, and part of speech and other dominant (left-hemispheric) functions can be implemented by the right hemisphere. A lesion of the left hemisphere identical in size and localization in a left-handed person or an ambidexter leads to milder consequences, and the final result of recovery, other things being equal with right-handed patients, is better. For practicing aphasiologists, this information is extremely important. (Shokhor-Trotskaya M.K. Logopedic work with aphasia at an early stage of recovery. M .: 2002.)

Motor aphasia of the afferent type
I. Stage of gross disorders
1. Overcoming disorders of understanding situational and everyday
speeches: showing pictorial and real images of the most used objects and simple actions by their names, categorical and other features. For example: “Show a table, a cup of a dog, etc.”, “Show pieces of furniture, clothes, transport, etc.”, “Show someone who flies, who talks, who sings, who has a tail, etc.”;
classification of words by topic (for example: “Clothes”, “Furniture”, etc.) based on a subject picture;
answers with an affirmative or negative gesture to simple situational questions. For example, “Now is winter, summer ..?”; "You live in Moscow?" and etc.
2. Disinhibition of the pronunciation side of speech:
conjugated, reflected and independent pronunciation of 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 that stimulate the pronunciation of onomatopoeic pronouns (“ah!” “Oh!” and etc.);
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 into a phrase (mother - mother ...; this is mother).
3. Stimulation of simple communicative types of speech:
answers to questions in one or two words in a simple situational dialogue;
modeling situations that contribute to the call of communicatively significant words (yes, no, I want, I will, etc.);
answering situational questions and composing simple phrases using a pictogram and a gesture1 with conjugated pronunciation of simple words and phrases.
4. Promoting Global Reading and Writing:
laying out captions under the pictures (subject plot);
writing the most familiar words - ideograms, writing off simple texts;
conjugated reading of simple dialogues.
II. Stage of disorders of moderate severity
1. Overcoming disorders of the pronunciation side of speech:
- selection of sound from the word;
automation of individual articles in words with different syllable-rhythmic structure;
overcoming literal paraphasias by selecting at first discrete, and then gradually converging in articulation sounds.
2. Recovery and correction of phrasal speech:
composing phrases according to the plot picture: from simple models (subject-predicate, subject-predicate-object) - to more complex ones, including objects with prepositions, negative words, etc.;
composing phrases on questions, on key words;
exteriorization of the grammatical-semantic connections of the predicate: “who?”, “why?”, “when?”, “where?” etc.;
filling gaps in a phrase with a grammatical change in the word;
detailed answers to questions;

retelling texts based on questions.
3. Work on the semantics of the word:
development of generalized concepts;
semantic play on words (subject and verbal vocabulary) by including them in various semantic contexts;
filling in gaps in a phrase;
completion of sentences with different words suitable in meaning;
selection of antonyms, synonyms.
4. Recovery of analytical-synthetic writing and reading:
the sound-letter composition of the word, its analysis (one-two-three-syllable words) based on schemes that convey the syllabic and sound-letter structure of the word, the gradual reduction in the number of external supports;
filling in missing letters and syllables in words;
writing off words, phrases and small texts with an attitude towards self-control and self-correction of errors;
- reading and writing under the dictation of words with a gradually becoming more complex sound structure, simple phrases, as well as individual syllables and letters;
- filling in the texts when reading and writing the missing words that are practiced in oral speech.

1. Further correction of the pronunciation side of speech:
- clarification by the article of individual sounds, especially affricates and diphthongs;
differentiation of acoustic and kinestatic images that are similar in articulation of sounds in order to eliminate literal paraphasias;
working out the purity of pronouncing individual sounds in the sound stream, in phrases, with a confluence of consonants, in tongue twisters, etc.
2. Formation of extended speech, complicated by semantic and syntactic structure:
filling in the missing main, as well as a subordinate clause or a subordinating union in a complex subordinate sentence;
answers to questions with a complex sentence;
retelling texts without relying on questions;
drawing up detailed plans for texts;
preparation of thematic reports (short reports);
speech improvisations on a given topic.
3. Further work to restore the semantic structure of the word:
interpretation of individual words, mainly with an abstract meaning;
explanation of homonyms, metaphors, proverbs, phraseological units.
4. Work on understanding complex logical and grammatical turns of speech:
execution of instructions, including logical and grammatical phrases;
the introduction of additional words, pictures, questions that facilitate the perception of complex speech structures.
5. Further restoration of reading and writing reading and retelling of expanded texts;
dictations;
written presentation of texts;
drafting letters, greeting cards, etc.;
essays on a given topic.
1. Restoring the connection "articule phoneme":
writing letters corresponding to the sounds named in expressive speech, reading these letters immediately after writing;
selection of the 1st sound from simple words, fixing attention on the articulatory, acoustic, and then graphic image of this sound; independent selection of words for this sound and writing them;
writing practiced sounds and syllables from dictation;
identification of letters in different fonts;
finding given letters in various texts (underlining, writing out).
2. Restoration of the ability for sound-letter analysis of the composition of the word:
division of words into syllables, syllables into letters (sounds) based on various graphic schemes;
selection of any sound in a word in a word;
recalculation and enumeration of words by letters (orally);

writing words from letters given randomly.
3. Restoring the skill of detailed written speech:
writing words of various sound structures with and without support from an objective picture: a) under dictation, b) when naming an object or action;
writing sentences: a) from memory, b) from dictation, c) in the form of a written statement based on a plot picture in order to communicate with others;
written presentations and essays.

Motor aphasia of the efferent type
I. Stage of gross disorders "
The recovery program is the same as for afferent motor aphasia.
P. Stage of disorders of moderate severity

1. Overcoming disorders of the pronunciation of speech: the development of articulatory switches within the syllable: with
vowels contrasting in articulation pattern (“a”, “y”, etc.); with various vowels, including soft ones; in syllables, for example,

Development of articulatory switching within a word: merging syllables into words with a simple, and later with a complex sound structure (for example, a recipe, etc.);
exteriorization of the sound-rhythmic side of the word, division of words into syllables, emphasis in the word, reproduction of the voice of the word, selection of words with an identical sound-rhythmic structure, rhythmic pronunciation of words and phrases with the involvement of external supports, tapping, slapping, etc., catching various consonances, in including the choice of rhyming words.
2. Recovery of phrasal speech:
overcoming agrammatism at the level of the syntactic scheme of the phrase: compiling "nuclear" phrases of models of the type S (subject) + P (predicate); S + P + O (object) with the involvement of external supports of chips and their gradual “folding”; highlighting the predicative center of the phrase; exteriorization of its semantic connections;
overcoming agrammatism at the formal grammatical level: capturing grammatical distortions of inflectional, prepositional, etc. in order to revive the sense of language; differentiation of singular and plural meanings, generic meanings, meanings of the present, past and future tenses of the verb; completion of missing grammatical elements in words; drawing up phrases according to plot pictures; answers to questions with a simple phrase, grammatically designed; retelling of a simple text; stimulation to use incentive and interrogative sentences, various prepositional constructions.
III. Stage of mild disorders
The program is the same as for the corresponding stage of afferent motor aphasia.
When restoring written speech in patients with motor aphasia of the efferent type, as a rule, an independent task of developing the “grapheme articulum” connection is not singled out.
The emphasis is on:
1. Restoring the ability to analyze sound-rhythmic
sides of the word:
differentiation of words by length and syllabic composition;
highlighting the stressed syllable;
selection of words identical in sound-rhythmic structure;
highlighting identical elements in words of syllables, morphemes and, in particular, endings (underlining them, writing them out, etc.).
Restoration of the ability to sound-letter analysis of the composition of the word.
Restoring the skill of merging letters into syllables, syllables into words.
4. Restoration of the skill of detailed written speech (for specific teaching methods, see the program of restorative education for afferent motor aphasia, paragraphs 2, 3, 4).
Dynamic aphasia
1. Stage of gross disorders
1. Increasing the level of the patient's general activity, overcoming speech inactivity, organizing voluntary attention:
performing various types of non-verbal activities (drawing, modeling, etc.);
assessment of distorted images, words, phrases, etc.;
situational, emotionally significant dialogue for the patient;
listening to plot texts and answering questions is understood in the form of affirmative-negative gestures or with the words "yes", "no".
2. Stimulation of simple types of communicative speech:
automation in dialogic speech of communicatively significant words: “yes”, “no”, “can”, “want”, “I will”, “must”, etc.;
automation of individual cliches of communicative, motivating and interrogative speech: “give”, “come here”, “who is there?”, “quiet!” etc.
3. Overcoming speech programming disorders:
stimulation of answers to questions with a gradual decrease in the answer of words borrowed from the question;
construction of phrases of the simplest syntactic models based on chips and a simple plot picture;

performing simple grammatical transformations to change the words that make up a phrase, but presented in nominative forms;
unfolding a series of sequential pictures according to the plot contained in them.

Overcoming disorders of grammatical structuring (see paragraph 2 of section "Disorders of moderate severity in efferent motor aphasia" in the program of rehabilitation education).
Stimulation of written speech:

laying out captions under pictures;
reading ideogram words and phrases.
I. Stage of disorders of moderate severity
1. Restoration of communicative phrasal speech:
construction of a simple phrase;
composing phrases according to the plot picture using the chip method and gradually “curtailing” the number of external supports;
compiling a story based on a series of sequential pictures;
detailed answers to questions in the dialogue;
compiling simple dialogues according to the type of speech studies: "In the store" dialogue between the buyer and the seller, "In the savings bank", "In the studio", etc.
2. Overcoming perseverations in an independent oral and written statement:
showing objects in pictures and in the room, body parts (in random order, by separate names and series of names);
ending phrases with different words;
selection of words of given categories and in given quantities, for example, two words related to the topic “Clothes”, and one word related to the topic “Dishes”, etc.;
writing numbers and letters in a breakdown (from dictation);
writing under the dictation of words and phrases that contribute to the development of semantic and motor switching;
elements of the sound-letter analysis of the composition of the word: the folding of simple words from the letters of the split alphabet;
filling in gaps in words;
writing simple words from memory and from dictation.
III. Stage of disorders of mild severity
1. Restoration of spontaneous communicative phrasal speech:
extended dialogue on various topics;
construction of phrases according to the plot picture with a gradual decrease in the number of external supports;
automation of phrases of certain syntactic models in spontaneous speech;
the accumulation of the verbal dictionary and the "revival" of the semantic connections behind the predicate (with the help of questions posed to it);
reading and retelling texts;
“role-playing conversations” that play out a certain situation;
"speech improvisations" on a given topic;
detailed presentations of texts, essays;
compiling greeting cards, letters, etc.
(Akhutina T.V. Neupolinguistic analysis of dynamic aphasia. - Moscow State University, 1975.)
Sensory aphasia
I. Stage of gross disorders
1. Accumulation of everyday passive vocabulary:
displaying pictures depicting objects and actions by their names, functional, classification and other features;
displaying pictures depicting items belonging to certain categories (“clothes”, “dishes”, “furniture”, etc.);
showing body parts in the picture and on your own;
choosing the correct name of the object and action among the correct and conflicting designations based on the picture.
2. Stimulation of understanding of situational phrasal speech:
answering questions with the words "yes", "no", affirmative or negative gesture;
following simple oral instructions;
capturing semantic distortions in simple phrases deformed in meaning.
3. Preparation for the restoration of written speech:
laying out captions for subject and simple plot pictures;
answers to questions in a simple dialogue based on the visual perception of the text of the question and answer;
writing words, syllables and letters from memory;
“voiced reading” of individual letters, syllables and words (the patient reads “to himself”, and the teacher reads aloud);
development of the "phoneme-grapheme" connection by selecting a given letter and syllable by name, writing letters and syllables from dictation.
II. Stage of disorders of the middle degree
1. Recovery of phonemic hearing:
differentiation of words that differ in length and rhythmic structure;
highlighting the same 1st sound in words of various lengths and rhythmic structures, for example: “house”, “sofa”, etc .;
highlighting different 1st sounds in words with the same rhythmic structure, for example, “work”, “care”, “gate”, etc.;
differentiation of words close in length and rhythmic structure with disjunctive and oppositional phonemes by highlighting differentiable 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.
2. Restoring understanding of the meaning of the word:
development of generalized concepts by classifying words into categories; selection of a generalizing word for groups of words belonging to a particular category;
filling in gaps in phrases;
selection of definitions for words.
3. Overcoming speech disorders:
"imposing frames" on the statement by composing sentences from a given number of words (instruction: "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 patients;
elimination of elements of agrammatism using exercises to "revive" the sense of language, as well as the analysis of grammatical distortions.
4. Recovery of written speech:
consolidation of the "phoneme-grapheme" connection by reading and writing letters under dictation;
various types of sound-letter analysis of the composition of the word by the gradual "folding" of external supports;
writing under the dictation of words and simple phrases;
reading words and phrases, as well as simple texts with subsequent answers to questions;
independent writing of words and phrases from a picture or a written dialogue.
III. Stage of mild disorders
1. Restoring understanding of extended speech:
answers to questions in a detailed non-situational dialogue;
listening to texts and answering questions about them;

capturing distortions in deformed compound and complex sentences;
comprehension of logical and grammatical turns of speech;
execution of oral instructions in the form of logical and grammatical turns of speech.
2. Further work to restore the semantic structure of the word:
selection of synonyms as homogeneous members of the sentence and out of context;
- work on homonyms, antonyms, phraseological units.
3. Correction of oral speech:
restoration of the function of self-control by fixing the patient's attention on their mistakes;
compiling stories based on a series of plot pictures;
retelling of texts according to plan and without plan;
drawing up plans for texts;
compiling speech improvisations on a given topic;
speech etudes with elements of "role-playing games".
4. Further restoration of reading and writing:
reading extended texts, various fonts;
dictations;
written statements;
written essays;
assimilation of samples of congratulatory letters, business records, etc.
Acoustic-mnestic aphasia

1. Expanding the scope of auditory perception:
display of items (real and in pictures) by name presented in pairs, triplets, etc.;
showing body parts on the same principle;
execution of 2-3-link oral instructions;
answers to detailed questions, complicated by the syntactic structure;
listening to texts consisting of several sentences and answering questions about the content of the texts;
writing under dictation with a gradual increase in phrases;
reading gradually built-up phrases, followed by reproduction (from memory) of each of the sentences and the entire set as a whole.
2. Overcoming the weakness of auditory-speech traces:
repetition from memory of read letters, words, phrases with a gradual increase in the time interval between reading and reproduction, as well as filling the pause with some other type of activity;
memorizing short poems and prose texts;
re-display of objects and pictures after 5-10 seconds, after 1 min. after the first presentation
reading texts with a retelling “delayed” in time (in 10 minutes, 30 minutes, the next day, etc.);
compiling oral sentences on key words perceived visually;
spelling out words with a gradually more complex sound structure, and gradually moving away from the written pattern of these words.
3. Overcoming the difficulties of naming:
analysis of visual images and independent drawing of objects denoted by words-names;
semantic playing in the contexts of various types of words denoting objects, actions and various signs of objects;
classification of words with an independent finding of a generalizing word;
exercises on the interpretation of words with a specific, abstract figurative meaning.
4. Organization of a detailed statement:
compiling a story based on a series of plot pictures;
retelling of texts, first according to a detailed plan, then folded, then without a plan;
detailed dialogues on non-situational topics (professional, public, etc.);
working out samples of communicative and narrative written speech (greeting cards, letters, presentations, essays on a given topic, etc.).
Semantic aphasia
Stage of disorders of moderate and mild severity
1. Overcoming spatial apractognosia:
a schematic representation of the spatial relationships of objects;
image of the plan of the path, room, etc.;
designing according to a model, according to a verbal task;
work with a geographical map, hours.
2. Restoration of the ability to understand words with a spatial meaning (prepositions, adverbs, verbs with prefixes "movement", etc.):
a visual representation of simple spatial situations indicated by prepositions and other parts of speech;
filling in the missing "spatial" elements in the word and phrase;
composing phrases with words that have a spatial meaning.
3. Construction of complex sentences:
clarification of the meanings of subordinating conjunctions;
filling in the missing main and subordinate clauses;
making sentences with given conjunctions.
4. Restoring the ability to understand logical and grammatical situations:
pictorial image of the construction plot;
the introduction of additional words that provide semantic redundancy (“my brother's father”, “a letter from a beloved friend”, etc.);
the introduction of logical and grammatical constructions into a detailed semantic context;
presentation of structures in writing, and then orally.
5. Work on a detailed statement:
presentations, essays;
improvisation on a given topic;
interpretation of words with complex semantic structure.
(Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia. M .: “Association of defectologists”, V. Sekachev, 2000; Shokhor-Trotskaya M.K. Logopedic work with aphasia at an early stage restoration. M.: 2002)

Optic-mnestic aphasia (optical amnesia)
Opto-mnestic aphasia occurs when the posterior inferior parts of the temporal region are affected. In classical neurology, this form is called nominative amnestic aphasia or optical amnesia. This form of aphasia is based on the weakness of visual representations - visual images of words. The visual-mnestic link of the speech system, the links between the visual images of words and their names are disintegrating. Patients are not able to correctly name objects and try to give them a verbal description. For example, Well, this is what they write. There are no clear visual images in the description. Usually this is an attempt to characterize the functional purpose of the object. At the same time, patients do not have obvious visual gnostic disorders. They are well oriented both in space and in objects. They often have an impaired ability to depict objects. Often they can copy objects, but they cannot draw from memory. In independent speech, it is more difficult for them to name objects than actions. Written speech. In cases of gross violations, literal alexia, verbal alexia, one-sided optical alexia are noted (they do not see the left side of the text and do not notice it).
Conclusion
So, summing up all of the above, it should be noted that the goal of this work has been achieved.
A lot of literary sources devoted to the stated topic have been studied and analyzed; in addition, in the process of work, materials taken from the World Wide Web were worked out.
In the first chapter of the work, a description is given: the etiology of aphasia, all 6 forms of aphasia are briefly characterized, and optical-spatial disturbances are also described for each specific type of aphasia.
The second chapter of the presented work describes and briefly characterizes the correctional and pedagogical work to overcome aphasia.
As the main conclusion of this work, it should be noted that, according to modern scientific ideas, the question of methods of restorative treatment of patients with aphasia is a priority.
At an early stage after a stroke, the mechanism of disinhibition of temporarily suppressed speech functions and their involvement in activities is used.
At later, residual stages, when the speech disorder takes on the character of a persistent, established syndrome (form) of speech disorder, the essence of the recovery process is rather a compensatory restructuring of organically impaired functions using the intact aspects of the psyche, as well as stimulating the activity of the intact elements of the analyzers.
When developing a methodological program of rehabilitation work, its individualization is mandatory: taking into account the characteristics of speech disorders, the patient's personality, his interests, needs, etc.
It should be borne in mind that when setting the goals of rehabilitation therapy (developing its program), it is necessary:
differentiation of rehabilitation therapy methods for various forms of aphasic disorders;
when organizing and choosing a method of rehabilitation therapy, it is necessary to proceed from the stage-by-stage principle, i.e., take into account the stage of restoration of speech functions;
with aphasia, it is necessary to work on all aspects of speech, regardless of which one is primarily impaired;
in all forms of aphasia, it is necessary to develop both generalizing and communicative (used in communication)
side of speech<...>
restore speech function not only with a speech therapist, in the family circle, but also in a wider social environment;
in all forms of aphasia, the development of the ability to control one's own speech production.
The phased construction of speech recovery in aphasia refers not only to the difference in the speech therapy methods used, but also to taking into account the unequal proportion of patients' conscious participation in the recovery process. It is naturally less in the initial stages after a stroke. The principle of differentiation of methods in connection with the form of aphasia is also significant in the early stages. Here, speech therapy techniques for disinhibiting speech functions, “reliance” on involuntary speech processes (habitual speech stereotypes, emotionally significant words, songs, poems, etc.) are more shown. These techniques contribute to the removal of inhibitory phenomena and draw patients into verbal communication with the help of conjugated (carried out simultaneously with a speech therapist), reflected (following a speech therapist) and elementary dialogic speech.
A common feature of these early stage methods is that they are aimed at restoring all aspects of impaired speech, mainly with the patient's passive participation in the recovery process, as well as at preventing the occurrence and fixation of some symptoms of speech pathology; these techniques also make it possible to activate the restoration of speech functions in patients with various forms of aphasia.
Bibliography
1. Akhutina T.V. Neupolinguistic analysis of dynamic aphasia. - Moscow State University, 1975.
2. Bain E. S. Aphasia and ways to overcome it. - L .: Medicine, 1964.
3. Badalyan L.O. Neuropathology - M, 2007
4. Wiesel T.G. Fundamentals of neuropsychology - M / AST, 2005
5. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. M.: Humanit. ed. center VLADOS, 1998.
6. Luria A.R. Traumatic aphasia. – M.: Medicine, 1947.
7. Luria A. R. Higher cortical functions of a person and their disorders in
local lesions. - M.: MGU, 1962, 1st ed.; 1969, 2nd ed; M.:
Academ. Project, 2000, 3rd ed.
8. Luria A.R. Basic problems of neurolinguistics. - M, 2007.
9. Luria A.R. Speech and thinking. – M.: MSU, 1975
10. Luria A.R. Functional organization of the brain
fundamentals of psychology. - M .: Pedagogy, 1978
11. Luriya A.R., Karpov B.A., Yarbus A.L. Impaired perception of complex
visual objects in lesions of the frontal lobe of the brain // Questions
psychology, 1965. - No. 3
12. Problems of aphasia and restorative learning: In 2 volumes / Ed. L.S.
13. Chomskaya E.D. Neuropsychology: 4th edition. - St. Petersburg: Peter, 2008.
14. Khrakovskaya M.G. Reserve ability to restore higher
mental functions in patients with aphasia / I International
conference in memory of A.R. Luria: Sat. reports / Ed. E.D. Chomsky,
T.V. Akhutina.-M.: RPO, 1998.
15. Tsvetkova L.S. Neuropsychology of writing, reading and counting. - M.: Lawyer,
1979.
16. Tsvetkova L.S., Torchua N.G. Aphasia and perception. Voronezh: Alice,
1997.
17. L.S. Tsvetkova Neuropsychological rehabilitation of patients. –M-Voronezh, 2004
18. Shokhor-Trotskaya M.K. Logopedic work with aphasia at an early stage of recovery. M.: 2002.
19. Shohor - Trotskaya M.K. Correctional - pedagogical work with aphasia. (guidelines) - M, 2002
20. Shklovsky V.M., Wiesel T.G. Recovery of speech function in patients with various forms of aphasia. M .: "Association of Defectologists", V. Sekachev, 2000

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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 with acoustic-mnestic aphasia

2 Correctional and pedagogical work with semantic aphasia

3 Correctional and pedagogical work with sensory aphasia

4 Correctional and pedagogical work with dynamic aphasia

5 Correctional and pedagogical work with efferent motor aphasia

Conclusion

Bibliography

Introduction

In recent decades, since the Great Patriotic War, the theoretical and practical interest in the problems of aphasia, its dynamics, the role of rational restorative learning and spontaneous changes in speech defects has increased. Many researchers are pushing the study of aphasia, methods of overcoming it, 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 busy working to restore speech in patients with aphasia. Systematic work to overcome these defects made it possible for researchers to observe the state of speech in aphasia for a long time and aroused great interest among specialists in studying the dynamics of speech in aphasia. It became known that speech disorders in aphasia are not stable, but have their own dynamics, which is determined by a number of interacting factors, and that these changes can vary within wide limits.

Different researchers point to different factors that affect the dynamics of speech in aphasia, but they all agree that factors such as the location and extent of brain damage, the age and level of education of the patient, the initial severity of impairment and the form of aphasia, as well as measures taken 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 the movements of the speech apparatus, which provides articulate pronunciation, with the preservation of elementary forms of hearing. They must be distinguished from: dysarthria (R47.1) - pronunciation disorders without a disorder in hearing speech perception (with damaged articulatory apparatus and subcortical nerve centers and cranial nerves serving it), anomies - naming difficulties arising from violations 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 the impossibility of speech in the absence of organic disorders of the central nervous system and the preservation of the speech apparatus (occurs with some psychoses and neuroses). In all forms of aphasia, in addition to specific symptoms, disorders of receptive speech and auditory memory are usually recorded. There are various principles for the classification of aphasias, due to 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 limited to them. Below is a variant of the classification of aphasias, based on a systematic approach to higher mental functions, developed in Russian neuropsychology by Luria.

Sensory aphasia (impaired receptive speech) - associated with damage to the posterior third of the upper temporal gyrus of the left hemisphere in right-handers (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 a violation of understanding of the spoken native language, up to a lack of response 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, there is speech incontinence - logorrhea. Speech becomes poor in nouns, but rich in verbs and introductory words. Dictation writing is broken, but understanding of what is read is better than what is heard. In the clinic, there are erased forms associated with a weakening of the 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 (violations of expressive speech) - occurs when the lower parts of the cortex of the premotor region are damaged (44th and partially 45th fields - Broca's area). With the complete destruction of the zone, patients utter only inarticulate sounds, but their articulatory abilities and understanding of the speech addressed to them are preserved. Often in oral speech there is only one word or a combination of words pronounced with different intonation, which is an attempt to express one's thought. With less severe lesions, the general organization of the speech act suffers - its smoothness and clear temporal sequence ("kinetic melody") are not ensured. This symptom is included in a more general syndrome of premotor movement disorders - kinetic apraxia. In such cases, the main symptomatology is reduced to speech motor disorders, characterized by the presence of motor perseverations - patients cannot switch from one word to another (proceed to a word) both in speech and in writing. Pauses are filled with introductory, stereotyped words and interjections. There are paraphasias. Another content factor of efferent motor aphasia is the difficulty in using the speech code, leading to outwardly 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 telegraph - predominantly nouns in the nominative case are used, prepositions, copulas, adverbs and adjectives disappear. Broca's area has close bilateral connections with the temporal structures of the brain and functions with them as a whole, therefore, with efferent aphasia, there are also secondary difficulties in the perception of oral speech.

Amnestic aphasia is heterogeneous, multifactorial and, depending on the dominance of the 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 the inferiority of auditory-speech memory - a reduced ability to keep a speech range within 7 ± 2 elements and synthesize a rhythmic pattern of speech. The patient cannot reproduce a long or complex sentence, while searching for the right word there are pauses filled with introductory words, unnecessary details and perseverations. Derivative is grossly violated narrative speech, retelling ceases to be adequate to the model. The best transfer of meaning in such cases is provided by excessive intonation and gestures, and sometimes speech hyperactivity.

In the experiment, the elements at the beginning and at the end of the stimulus material are better remembered, the nominative function of speech begins to suffer, which improves when the first letters are prompted. The interval of presentation of words in a conversation with such a patient should be optimal, based on the condition "not yet forgotten." Otherwise, the understanding of complex logical and grammatical structures presented in speech form also suffers. For persons with acoustic-mnestic defects, the phenomenon of verbal reminiscence is characteristic - a better reproduction of the material a few hours after its presentation. A significant role in the structure of the causality of this aphasia is played by impaired auditory attention and narrowing of perception. In the nominative function of speech at the level of the image, this defect manifests itself in a violation of the actualization of the essential features of an object: patients reproduce the generalized features of a class of objects (objects) and, due to the indistinguishability of the signal features of individual objects, they are equalized within this class. This leads to the equiprobability of choosing the right word within the semantic field (Tsvetkov). Acoustic-mnestic aphasia occurs when the mid-posterior sections of the left temporal lobe are affected (21st and 37th fields).

Actually amnestic (nominative) aphasia manifests itself in the difficulties of naming objects rarely used in speech, while maintaining the volume of the retained speech series by ear. According to the word heard, the patient cannot identify the object or name the object when it is presented (as in the acoustic-mnestic form, the nomination function suffers). Attempts are made to replace the forgotten name of an object with its purpose ("this is what they write") or a description of the situation in which it occurs. There are difficulties in choosing the right words in a phrase, they are replaced by speech stamps and repetitions of what has been said. A hint or context helps to remember what has been forgotten. Amnestic aphasia is the result of damage to the posterior-lower parts of the parietal region at the junction with the occipital and temporal lobes. With this variant of localization of the lesion focus, amnestic aphasia is characterized not by the poverty of memory, but by an excessive number of pop-up associations, due to which the patient is unable to choose the right word.

Optical-mnestic aphasia is a variant of a speech disorder that is rarely distinguished as an independent one. It reflects the pathology of the visual link and is better known as optical amnesia. Its occurrence is due to the defeat of the posterior-lower parts of the temporal region with the capture of the 20th and 21st fields and the parietal-occipital zone - the 37th field. In case of general 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 very image of the word. These patients do not have any visual gnostic disorders, but they cannot depict (draw) objects, and if they do, they miss and underdraw the details that are significant for the identification of these objects.

Due to the fact that the 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 from the visual link of the speech system, expressed in optical alexia (violation reading), which can manifest itself in the form of unrecognition of individual letters or whole words (literal and verbal alexia), as well as writing disorders associated with defects in visual-spatial gnosis. With the defeat of the occipito-parietal parts of the right hemisphere, one-sided 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 affected. This is a zone of secondary fields of the skin-kinesthetic analyzer, which are already losing their somatotopic organization. Its damage is accompanied by the occurrence of kinesthetic apraxia, which includes apraxia of the articulatory apparatus as a component. This form of aphasia is apparently due to 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 articulation methods); secondly, the loss or weakening of the kinesthetic afferent link of the speech system. Gross violations of the sensitivity of the lips, tongue and palate are usually absent, but there are difficulties 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 similar to the deaf, 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 in the difficulty of distinguishing speech sounds that are similar in pronunciation - (for example, "d", "l", "n" - the word "elephant" is pronounced like "snol"). Such patients, as a rule, understand that they pronounce words incorrectly, but the articulatory apparatus does not obey their volitional efforts. Non-speech praxis is also slightly disturbed - they cannot puff out one cheek, stick out their tongue. This pathology also leads to a second misperception of "difficult" words by ear, to errors in writing from dictation. Silent reading is preserved better.

Semantic aphasia - occurs when there is a lesion on the border of the temporal, parietal and occipital regions of the brain (or the region of the supramarginal gyrus). It is quite rare in clinical practice. For a long time, speech changes with lesions of 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 that reflect the simultaneous analysis and synthesis of phenomena. They are realized in speech through numerous systems of relations: spatial, temporal, comparative, genus-species, expressed - in complex logical, inverted, fragmented forms. Therefore, first of all, in the speech of such patients, the understanding and use of prepositions, adverbs, function words and pronouns is disturbed. These disturbances do not depend on whether the patient reads aloud or silently. There is a defectiveness and slowness in the retelling of short texts, often turning into disordered fragments. The details of proposed, heard or read texts are not captured or transmitted, but in spontaneous utterances and in dialogue, speech turns out to be coherent and free from grammatical errors. Separate words out of context are also read at normal speed and are well understood. Apparently, this is due to the fact that global reading involves such a function as probabilistic prediction of the expected meaning. 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 relations implemented by the tertiary cortical zones associated with the nuclear part of the visual analyzer.

Dynamic aphasia - areas anteriorly and superiorly adjacent to Broca's area are affected. At the heart of dynamic aphasia lies a violation of the internal program of utterance and its implementation in external speech. Initially, the intention or motive that directs the development of thought in the field of future action suffers, where the image of the situation, the image of the action and the image of the result of the action are “represented”. As a result, speech adynamia or a defect in speech initiative occurs. Understanding of ready-made complex grammatical structures is slightly or not violated at all. In severe cases, patients do not have 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 absolutely impossible to write an essay on a given topic due to the fact that "there are no thoughts." There is a tendency to use speech stamps. 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 updated - 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 sections of the left temporal lobe. Sometimes it is interpreted as a violation of the associative links between the two centers - Wernicke and Broca, which suggests the involvement of the lower parietal departments. 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 basically possible. Rough literal (letter) paraphasias and additions of superfluous sounds to the endings occur when repeating polysyllabic words and complex sentences. Often only the first syllables in words are reproduced. Errors are recognized and attempts are made to overcome them with the production of new errors. Understanding of situational speech and reading is preserved, and, being among acquaintances, 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 kind of mild sensory or afferent motor aphasia. The latter variety 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 zone 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 phenomena of impaired understanding of speech with its intact repetition (on this basis, it can be opposed to conduction aphasia), that is, it describes those cases when the connection between the meaning and sound of a word is broken. Apparently, "transcortical" aphasia is also due to partial (partial) left-handedness. The diversity and equivalence of speech symptoms indicates mixed aphasia. Total aphasia is characterized by a simultaneous violation of the pronunciation of speech and the perception of the meaning of words and occurs with very large foci, or in the acute stage of the disease, when neurodynamic disorders are pronounced. With a decrease in the latter, one of the above forms of aphasia is identified and specified. Therefore, it is advisable to conduct a neuropsychological analysis of the structure of HMF disorders outside the acute period of the disease. An analysis of the degree and rate of speech recovery indicates that in most cases they depend on the size and location of the lesion. A gross 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 focus of the same size, but without spreading to deep formations, speech is restored quickly. With small superficial foci, located even in the speech zones of Broca and Wernicke, there is, as a rule, a significant restoration of speech. 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 aphasias from categorically different speech disorders, called pseudoaphasias, has arisen. Their appearance is associated with 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 there are difficulties in understanding speech with an increased volume of speech material. But these symptoms are unstable and soon regress. With damage to the striatum, in addition to the actual motor disorders, deterioration in the coordination of the motor act as a motor process is possible, and with dysfunction of the pale ball, the appearance of monotony and lack of intonation of speech. Secondly, pseudo-aphasic effects occur during operations or when organic pathology occurs in the depths of the left temporal lobe, in cases where the cerebral cortex is not affected. Thirdly, a special type of speech disorders, as already mentioned, are the phenomena of anomia and dysgraphia, which occur when the corpus callosum is dissected due to violations of interhemispheric interaction.

Speech disorders that occur with lesions of the left hemisphere of the brain in childhood (especially in children under 5-7 years old) also proceed according to other laws than aphasia. It is known that people who have undergone the removal of one of the hemispheres in the first year of life develop in the future without a noticeable decrease in speech and its intonational component. At the same time, materials have been accumulated that indicate that speech disorders can occur in early brain lesions regardless of the lateralization of the pathological process. These violations are erased and to a greater extent relate to auditory-speech memory, and not to other aspects of speech. Restoration of speech without serious consequences with 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 possibility of forming a full-fledged speech is already sharply limited. Sensory aphasia, which appeared at the age of 5-7 years, most often leads to the gradual disappearance of speech and the child does not reach its normal development in the future.

2. Corrective work for each form of aphasia

2.1 Correctional and pedagogical work with acoustic-mnestic aphasia

Patients with acoustic-mnestic aphasia have increased working capacity, emotional lability, 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 safety or dysfunction of the lower parietal departments, which are determined by the study of constructive-spatial praxis, counting operations, etc.

To overcome speech memory impairment, it is necessary either to restore the system of visual representations of the subject, its essential, distinctive features, or to gradually expand the volume of auditory-speech memory, impaired purely by acoustic signs of the perception of the phrase, as well as to overcome expressive agrammatism, which is close in its features to expressive agrammatism in acoustic -gnostic aphasia.

To overcome speech disorders in patients with acoustic-mnestic aphasia, the speech therapist relies on the mechanisms of coding of the speech statement that are preserved in them, that is, on the description of the signs of the object, the introduction of the word into various contexts, on the compilation of external supports that allow the patient to hold a different amount of speech load.

Written speech plays a special role in the process of restoring acoustic-mnestic speech functions. With this or that mnestic aphasia, the sound-letter analysis of the composition of the word is preserved, this makes it possible to use the recording of words that precede 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 intra-speech level, the syntagmatic division of the phrase into segments (the syntagma consists of two or three words), connected with each other by meaning, since the subject, as a rule, is in one syntagma, the predicate in another or the main sentence in the first syntagme, secondary - in the second (Children went to the forest. to collect mushrooms); fragments of one part of the sentence perceived by ear allow the patient to predict its second part.

Recovery of auditory memory. Improvement of auditory-speech memory occurs with the support of visual perception. A series of subject pictures are laid out in front of the patient, the names of which are previously read and written several times. Thus, the patient knows what he will hear. This is how the premises of acoustic anticipation are formed. The speech therapist does not fix the patient's attention on the need to show the subject in the order presented. In speech, words are connected by a certain intention of the utterance, therefore, at first, the patient is offered pictures of one, then two, three semantic groups: a hare, a plate, a table, a gun, a forest, a fork, a fox, a cup, a stove, a saucepan, a knife, a cucumber, an apple, a hunter , grandmother, etc., then they ask him to show objects that can be inscribed in a particular 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 execution of instructions by the patient. Subsequently, the speech therapist suggests repeating a series of words worked out in previous classes, but without resorting to the help of pictures. For memorization, the speech therapist gives words denoting objects, then the actions and qualities of objects, and finally numbers combined into phone 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, a series of exercises can be carried out, including an analysis of objects similar in drawing, in shape, differing in one or two features (for example, a cup, teapot, sugar bowl; cupboard, refrigerator, sideboard; sofa, bed, couch; rooster and chicken; squirrels , foxes, cats and hare, etc.), in which the 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 mistakes in their image (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.), to finish drawing 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 the object, writing essays about the object.

All of the above methods of overcoming auditory-speech memory impairments help to overcome amnestic difficulties in this form of aphasia and reduce the number of verbal paraphasias. The difficulties of 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 particular word is played out in various phraseological contexts, attention is drawn to the ambiguity of the word (pen, key, mother's). Much attention is paid to the work on clarifying the meaning of synonyms, antonyms and homonyms, compiling various variants of sentences with these words.

The restoration of a written utterance is one of the main forms of expanding the lexical composition of speech. The composure 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 and pedagogical work, to connect patients to the compilation of written texts, active work to expand vocabulary, to overcome agrammatism.

It is better to start working on writing written texts by writing phrases based on simple plot pictures, and then using various cartoons in magazines and newspapers. This will allow the patient to build specific, small phrases and small texts. Then you can offer to compose written texts based on reproductions of famous paintings by various artists. All work on the written text is combined with oral speech. The speech therapist selects light texts that are close to reproductions and asks the patient to retell them.

Agrammatism of agreement in the gender and number of the main members of the sentence is overcome by replacing nouns with pronouns and pronouns with nouns, as well as by composing phrases according to key words.

2.2 Correctional and pedagogical work with semantic aphasia

Semantic aphasia is characterized by both a violation of the arbitrary finding of the names of objects, the poverty of the dictionary 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 the emergence of inferiority complexes, high vulnerability due to difficulties in understanding complex logical and grammatical phrases, proverbs, sayings, and the content of fables. In this regard, overcoming the defects of impressive speech in this form of aphasia should be carried out bypassing the main defect.

The basis for overcoming impressive agrammatism and amnestic difficulties is reliance on the preserved mechanisms of a detailed, planned written and oral utterance. Defects of the highest paradigmatic level of coding and decoding of a speech message are overcome by involving the highest levels of the syntagmatic level, namely planning, building mental actions carried out by the frontal sections in relationship with all gnostic sections that provide a lower, phonemic level of the speech act.

The main task of correctional and 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 prerequisites for capturing the main feature of the subject when finding the word denoting it.

Recovery 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 closeness of semantic connections. Each object is characterized by a set of features that are characteristic both for this object and for others. Words denoting objects are combined into various semantic fields according to their various characteristics: according to their instrumentality, species affiliation, etc. In order to overcome amnestic difficulties, the patient learns to find signs of an object, first by listening to the system for describing near and far semantic connections, and later by independent descriptions of the features of the object, its connections with other groups of objects. For example, during the initial stages of recovery, the speech therapist lists to the patient all the signs of glasses: what they are made of, what they serve for, what they are in shape, 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 a story about the subject.

Patients with semantic aphasia in expressive speech use the same type, little expanded sentences. The same is true of their written language. In order to restore, expand the use of various syntactic constructions by the patient at the initial stage of recovery, exercises are used to compose various complex sentences with the use of allied words if, so that, when, after, no matter how ... etc.

As the structures of complex sentences are restored, patients are encouraged to use certain phrases when writing essays based on pictures by famous artists, taking into account the era depicted in the picture, the plot, its details, explaining the reason for their introduction and the plot of the picture.

Overcoming impressive agrammatism. Patients with semantic aphasia have a hard time understanding impaired understanding of seemingly easy tasks. Work on overcoming impressive agrammatism should be carried out bypassing the direct explanation to the patient of his difficulties, and mainly in those cases when the patient can or should return to study or work. A sufficient degree of preservation of understanding of situational speech in case of semantic aphasia in patients who do not return to educational or work activities due to advanced age allows us to limit ourselves to restoring their orientation in the clock face, in solving simple arithmetic operations (addition, subtraction, multiplication and division within one or two thousand).

In everyday everyday speech, the visibility of the situation, the presence of elementary paradigmatic synonyms, allows patients to freely cope with the same paradigms encoded in complex logical and 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 turns Put the knife between the fork and spoon. Put the volume of Pushkin to the left of the volume of Yesenin, etc. In everyday life, we did not use the expressions brother of the father and father of the brother; replacing them with the words uncle and father. With semantic aphasia, correctional and pedagogical work to overcome impressive agrammatism does not begin with a direct explanation to the patient of spatial landmarks, schemes for solving a logical-grammatical problem, but bypassing this defect, by writing a 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 one must lead, as from the point of departure, the sequence of description. In other words, in working with the 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”, “mother and daughter”, “master 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 raised over the subject that is being discussed, a question is posed, appropriate definitions are given that are characteristic only for this subject: a man’s wide-brimmed felt hat, a girl’s knitted hat with a bow, a girl’s doll, a boy’s car, a young mother’s little daughter, an adult daughter of an elderly woman, a smart dog of a kind owner , an evil dog of an unkind owner (based on the corresponding drawings). Some of the most common breeds of dogs are analyzed, children with different characters are discussed, and phrases are compiled in connection with this: a caring daughter, a caring son, that is, the main paradigm in the future of the folded phrase is being worked out.

Then they proceed to the description of the indirect part of the word-combination paradigm with a clarification of 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: the mother of the daughter, the daughter of the mother, introduces these phrases into various contexts, supplying them with epithets and pointing to different pictures of daughters and mothers in different situations. Comic extended play-outs of phrases are very helpful: Mom sits in a stroller and plays with a rattle, and her daughter rolls her. A daughter feeds her mother from a spoon (this option can take place in life: a daughter can feed a seriously ill mother from a spoon, but this must be stipulated).

When describing the spatial arrangement of three objects, the patient masters complex structures, including phrases with prepositions and adverbs: above - below, left - right, above - below, etc.

Restoration of understanding of complex logical and grammatical constructions goes through the stage of detailed, repeated description and discussion in various contexts.

From compiling 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, a merchant's house, a Moscow courtyard, the owner of the house. For these purposes, the description of famous paintings is used, the patient learns to describe the different characters in the picture, to find the main and secondary word.

So imperceptibly for 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, causal subordinate clauses, participial and participle turns.

Reading his "compositions", the patient decodes texts close to him, after which he proceeds to reading texts of varying degrees of complexity, retelling them, clarifying the meaning of various phrases in cases where he misunderstood them.

2.3 Correctional and pedagogical work with sensory aphasia

In the majority of patients with acoustic-gnostic sensory and acoustic-mnestic aphasia, as a rule, their working capacity and desire to overcome speech disorders are increased. They can work for many hours a day, sometimes in the evening and at night, that is, they are often in a constant "working" state. These patients have a pronounced state of depression, in connection with which the speech therapist must constantly encourage them, give them only what they can to do homework, 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.

Recovery of phonemic hearing. The 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 on the restoration of 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. .).

At first, the speech therapist gives contrasting pairs of words separately (for example, cat - grapes), selects the corresponding pictures for each pair of words and writes the corresponding words in clear handwriting on separate strips of paper. Then, the patient is given to listen to these words, to correlate the sound image of the elephant with the drawing and the caption under it. choose one or another picture according to the assignment, lay out captions for pictures, pictures for captions. At the first stages of classes, with a gross severity of phonemic hearing impairment, the number of elephants being worked out should not exceed four. Then, from lesson to lesson, the speech therapist brings the number of contrasting words differentiated by ear to 10-12, lays out in front of the patient not 4, but 6 or 8 pictures with captions and invites the patient to first lay out the captions, and then find the pictures on the task: Show standing. Show me the bike. Show where the cancer is, etc.

At the second stage, differentiation of words with a close syllabic structure, but far in sound, is carried out, especially in the root part of the word: fish - legs, fence - tractor, watermelon - ax, paddle - cat, hat - mark, cup - spoon, etc. Work at this and all subsequent stages of restoring phonemic hearing is also based on subject pictures, captions to them, copying, reading aloud, and developing acoustic control over speech.

At the third stage, work is underway to differentiate words with a similar syllabic structure, but with far-sounding initial sounds: cancer - poppy, hand - flour, oak - tooth, house - catfish, cat - mouth, stump - shadow, hand - pike; with a common first sound and various final sounds: beak - key, knife - nose, night - zero, lion - forest, rum - mouth, crowbar - forehead, etc.

At the next, fourth stage, work is already being done 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, tubing reel, fruits - rafts, path - pellet: fence - cathedral, goats - braids.

With acoustic-gnostic aphasia, there are difficulties in differentiating phonemes not only on the basis of voicedness - deafness, but also on other grounds. 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 similar in acoustic features: 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 the missing letters in the word and phrase, words missing in the phrase with oppositional sounds, the meaning of which is clarified no longer 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 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. The difficulties of finding individual nouns and verbs are overcome by enlivening various semantic connections, describing various signs of an action or object, its functions, comparing this word with other semantically relatively close words. For example, the patient may use instead of the word knife - "axe", "saw" or "scissors", referring to objects that also divide the whole into parts. The speech therapist specifies all the signs of these objects, their different tool 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 the knife is a cutting object, is most often an integral part of table setting, work in the kitchen, will show its distinctive functional role when using various cutlery: soup, porridge, fish cannot be eaten with a knife, while relying on the visual perception of various signs of the object, its description, image. In connection with the tendency of patients with sensory aphasia to mix inflections on a generic basis, the speech therapist will focus on listening to the endings of masculine nouns.

Overcoming verbal paraphasia is carried out by discussing with the patient various signs of objects by their contiguity and contrast, by function, tool affiliation, by category. The speech therapist suggests filling in the verbs and nouns missing in the sentence, picking up noun adverbs to the verb, adjectives and verbs to the noun.

Patients with sensory, acoustic-gnostic aphasia have 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. The speech therapist suggests that the patient, whose phonemic hearing has somewhat recovered, initially write phrases and texts based on simple plot pictures, and later on postcards that he gives him as homework. Written work with plot pictures allows the patient to slowly find the right word, polish the statement.

The restoration of reading, writing and written speech is carried out in parallel with overcoming the violation of phonemic hearing. The restoration of writing, sound analysis and synthesis of words, written utterance is preceded by the restoration of reading, based on the skills of global optical reading and intact kinesthesia involved 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, the realization that the meaning of a word changes from mixing sounds, create the basis for restoring analytical reading, and then writing. The restoration of reading and writing begins with writing off one-syllable 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 corrective pedagogical

2.4 Correctional and pedagogical work with dynamic aphasia

With dynamic aphasia, the main task of correctional and pedagogical work is to overcome inertia in speech utterance. With the first option, this will be overcoming the defects of internal speech programming, with the second option - restoring grammatical structuring.

Recovery of expressive speech. With significantly pronounced aspontaneity, the patient is given tasks to restore the word order in deformed sentences (for example: B, children, quickly, school, go), various exercises for classifying objects according to various criteria (“Furniture”, “Clothes”, “Dishes”, round, square, wooden, metal objects, etc.). Direct and reverse ordinal counting is used, subtraction from 100 by 7, by 4.

Internal programming defects are overcome by creating external utterance programs for patients with the help of various external supports (schemes, sentences, chips, etc.), gradually reducing their number and subsequent internalization, folding this scheme inward. The patient, moving his index finger from one chip to another, gradually develops the speech statement according to the plot picture, then proceeds to visually follow the plan of the statement deployment without conjugate motor reinforcement and, finally, composes these phrases without external supports, resorting only to intra-speech planning. statements.

The restoration of the linear deployment of the statement in time is facilitated by the use of words included in the questions to the plot picture or to the corresponding situation discussed in the lesson. So, to the question Where are you going today? the patient replies: “I will go to the hairdresser” or “I will go for an x-ray”, etc., t. adds only one word. Another method of restoring the structure of the utterance is the use of key words, from which the patient makes up 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.

In view of the fact that in the first variant of dynamic aphasia, the composition of not a phrase, but texts, is mainly violated, a series of successive pictures connected by one plot are used as external supports.

Speech activity of patients will increase in the process of creation by a speech therapist of special speech situations-staging, where the initiative for dialogue belongs to the patient. To facilitate the dialogue, the speech therapist first discusses the topic with the patient, offering him interrogative, “key” words that he can use in the conversation, and a plan. It also facilitates the conduct of a dialogue by using an appeal to a 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 so that he verbally conveys to someone the request of a speech therapist.

In milder forms of dynamic aphasia, the speech therapist invites the patient to retell the text first with the help of a detailed questionnaire, then with the help of key questions to individual paragraphs of the text, based on a monosyllabic, folded plan. At the same time, the speech therapist teaches him to make independent plans for texts, first expanded, then short, folded. Finally, after a previously drawn up plan, the patient retells the text without looking into this plan. Thus, there is an internalization of the plan of retelling what has been read.

Restoring understanding. In gross dynamic aphasia, understanding of situational speech is restored by discussing various events of the day. For example, a speech therapist, having found out the question of the patient's well-being, says: Now let's talk about your tastes. Do you love poetry? Did you know...? Or, turning his attention to a new topic, he asks: Who visited you the day before? In the future, patients begin to use intonation for communication purposes, to attract the attention of others, to follow single-link and multi-link instructions.

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

Recovery of written speech. Dysgraphic disturbances in the writing of patients are rare. However, they experience significant difficulties when compiling a written text. The presence of errors in writing suggests 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, write phrases 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 with efferent motor aphasia

The main tasks of correctional and pedagogical work in efferent motor aphasia are to overcome pathological inertia in the generation of the sound and syllabic structure of a word, restore a sense of language, overcome the inertia of word choice, overcome agrammatism, restore the structure of oral and written utterance, overcome alexia and agraphia.

Recovery of expressive speech. Overcoming the disturbed pronunciation side of speech begins with the restoration of the rhythmic-syllabic scheme of the word, its kinetic melody.

With very gross 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 by a speech therapist several times, but also simultaneously puts it together from the letters of the split alphabet. Then, from the mastered syllables, it makes up a simple word such as hand, water, milk, etc. Various word schemes are compiled, the syllabic structure of the word is beaten rhythmically.

Then work begins on the automation of words, with a certain rhythmic structure. To do this, the patient is asked to read a series of words with one syllabic structure written in a column. Gradually, the syllabic structure of the word becomes more complex. The patient is associated with a speech therapist, and then independently reads rhyming words divided into syllables.

To clarify the syllabic and. sound composition of the word, the method of a visual image of the word scheme is used.

Simultaneously with the restoration of the sound and syllabic structure of the word, work begins on the restoration of phrasal speech. Overcoming impaired phrasal speech begins with the restoration of the so-called sense of language, capturing consonance, rhymes in poetry, proverbs and sayings. It is especially useful to use proverbs and sayings with rhyming verbs: “What you sow, you will 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 takes place in time and implies the presence of a chain of successive impulses. As motor skills are formed, individual impulses are synthesized, combined into whole “kinetic structures” or “kinetic melodies”. Therefore, sometimes it is enough to prompt the patient with one word in order to reveal a whole dynamic speech stereotype, for example, the 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.

In working with patients, plot and subject pictures are used, which are repeatedly played out by a speech therapist. In this case, one word or another is highlighted.

For example, in the phrase to the picture “The boy goes to school”, the speech therapist first stimulates the call of the word to school, and then proceeds with the help of leading questions to the word goes.

In a playful way, the speech therapist teaches the patient to listen to the question, emotionally respond to it, especially if it does not match 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 this is not a boy, but a grandmother? Patients, as a rule, answer these questions on an emotional rise: “No, this is not a grandmother, but a child” (or a boy), “not by car, but on foot”, “does not fly, but walks”. Playing with the subject 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 is necessary to wash, cook, 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 build a phrase according to a simple plot picture, says: This woman took the scissors with them (the speech therapist expressively depicts the movement of the hand with the scissors cutting the material). This technique, which clearly demonstrates movement, makes it much easier for patients to find the right verbs.

Later, the speech therapist gives the task to complete the same type of phrase with different words, for example: I eat ... (potato vulture, semolina porridge, white bread, etc.) or I'm waiting ... (the attending physician, younger daughter, beloved wife, etc.). d.). Similar tasks are carried out based on a picture and a diagram.

According to the plan drawn up by the speech therapist, the first oral texts are stories about the daily routine: “And I 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. The vocabulary worked out in the classroom should provide the patient with the opportunity to communicate with others.

Recovery of reading and writing. In gross efferent motor aphasia, reading and writing may be in a state of complete disintegration. In this regard, individual picture alphabets are developed for patients, in which each letter corresponds to a certain 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 for composing the syllable and the word. Using the usual split alphabet, you can combine syllables to compose 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 with their left hand first in capital letters, then words and phrases. The left hand should lie flat on the page of the notebook, without raising the hand and wrist. A course of preparatory exercises is conducted to prevent the perseveration of letters and their elements.

In the future, patients with gross efferent motor aphasia are given tasks to fill in the missing vowels and consonants in simple words under pictures, to fill in letters in phrases and texts. A sound-letter analysis of the composition of a word is carried out with the help of leading questions, an analysis of syllables. Having added a word from a split alphabet, the patient writes it down in a notebook.

After mastering the sound-letter analysis, the speech therapist gives an auditory dictation from light phrases. In this case, the patient must pronounce each word by sounds, sometimes pre-folding especially difficult words from the letters of the split alphabet.

At the later stages, patients can be offered the solution of simple crossword puzzles, the compilation of 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 with a rough expression of efferent aphasia begins with a global reading of words and phrases by the patient, with putting these words to subject and plot pictures, selecting words that are related to each other in meaning.

Restoring understanding. Restoring speech understanding in gross efferent motor aphasia begins with the development of auditory attention, the ability to isolate from a question a word that carries the main semantic load, accentuated by logical stress or intonation. Patients are asked provocative questions. For example, when showing the picture "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 spoon or: Show what we eat. Such tasks in the patient lay the prerequisites for restoring a sense of language. Later, tasks are given to put one or another object on, under, behind another object. The logical stress should then fall on the preposition, then on the subject.

An important place in the restoration of the "sense of language" is occupied by exercises for presenting patients with grammatically correct and specially distorted grammatical structures. Previously, the speech therapist explains to the patient which constructions correspond to grammatical laws and rules, and which do not.

Thus, with efferent motor aphasia, a speech therapist restores those higher cortical functions that gradually developed in a child from an early age: the syllabic organization of a word, the “sense of language”, the elementary combination of words in a sentence.

6 Correctional and pedagogical work with afferent motor aphasia

Afferent motor aphasia is the most severe form, often overcome 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 gross articulatory disorders are observed, but also agraphia, alexia of varying severity, acalculia, and impressive agrammatism.

The main task of correctional and pedagogical classes is to overcome violations of kinesthetic gnosis and praxis. The goal is to restore the articulatory kinesthetic basis of speech production, to overcome agraphia, to establish a potentially preserved extended oral and written statement.

With a roughly pronounced afferent motor aphasia, at the initial stage, correctional and pedagogical work will be built according to plan. 1) restoration of the pronunciation side of speech; 2) overcoming violations of understanding; 3) restoration of elements of analytical reading and writing.

With a moderate degree of severity, work is carried out to consolidate articulatory skills, to overcome literal paraphasias, to stimulate expressive speech, difficulties in pronouncing words with a confluence 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 confluence of consonants, to get rid of literal paraphasias and paragraphs, to overcome elements of expressive, mostly prepositional agrammatism, to prepare the patient for returning to study or work.

Restoration of the pronunciation side of speech. In working with patients, global pronunciation, associated with a speech therapist, reading automated speech sequences, 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 are used. , folding simple words from the restored sounds from the split alphabet, introducing these words into active speech. At the same time, work is underway to isolate the sounds in a word during their acoustic perception, to overcome the secondarily disturbed phonemic hearing by differentiating words with oppositional vowels and consonants that are similar in place and method of formation (u-o, a-i, a-o, m- p-b-c, n-d-t-l, d-g, t-k, m-n, etc.). With safe reading to oneself and some preservation of written speech, in order to overcome apraxia of the articulatory apparatus, the speech therapist uses a visual-auditory imitation technique in work, speeds up the restoration of written speech when compiling a phrase based on plot pictures.

All work on this method excludes the use of a mirror, probes, spatulas, as they increase the degree of arbitrariness of movement, exacerbate the articulatory difficulties of patients.

When trying to pronounce the sounds y, o, s, and, as well as consonants, patients either silently exhale air or wheeze, making chaotic movements with their lips or tongue.

Distracting from voluntary articulation to play and imitative activities, the speech therapist asks patients to moan, as if a toothache, breathe into their hands, as if they were cold, this enables patients to perform not only oral, but also articulatory movements dictated by the action plan, its semantics.

The degree of apraxia of different organs of the articulatory apparatus can be different, therefore it is advisable to start working with the 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 the challenge of contrasting vowels a and y.

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 it himself, that is, open his lips wide, squeeze them loosely, first silently, and then pronouncing the sounds mi in, so that work out the primary bow and gap on voiced consonants.

Voiced sounds are restored more slowly than deaf ones, so that the restoration of the sounds of the wills greatly alleviates the tendency to deafen them, which is characteristic of patients with afferent motor aphasia.

In the first 2-3 lessons, it is necessary to repeatedly read the syllables and words made up of the sounds a, y, m. Gradually other sounds are evoked.

A speech therapist can follow any sequence in calling sounds, but the following conditions must be taken into account:

-it is impossible to simultaneously call the sounds of one articulation group

-sounds should be introduced into phrases, avoiding nouns in the nominative case.

Recovery 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, as it were, blocks the possibility of a detailed statement. Even in "pure" cases of moderate afferent motor aphasia, there may be difficulty in selecting words, especially prepositions and verbs with prefixes that convey a spatial relationship. These word-choosing difficulties and "telegraphic style" paragrammatism are many times easier to overcome than the true "telegraphic style" agrammatism characteristic of efferent motor aphasia.

In afferent motor aphasia, as in acoustic-gnostic sensory aphasia, the difficulties in deploying an utterance are associated with ambiguity, with a diffuse idea of ​​the sound and syllabic composition of a word. In this regard, as the sound-letter analysis of the composition of the word is restored and articulatory difficulties are overcome, in patients with afferent motor aphasia, the possibility of nominating all objects, actions, and qualities is restored. Quite quickly, the vocabulary of patients becomes unlimited, especially when composing phrases according to plot pictures. However, situational speech remains slow for a long time, poor both in terms of 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 separate words that are difficult to pronounce, with intact inner speech, which patients use in communication.

The restoration of situational, colloquial speech is one of the priorities of the initial stage of correctional and pedagogical work. As the sound pronunciation is restored, the newly evoked sounds are introduced into the 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 sequences), it is possible to evoke, by conjugate repetition, the still fuzzy sound of words necessary for communication. These are adverbs, interrogative words and verbs: now, well, tomorrow, yesterday, when, why, I don’t want, I 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 out with them the articulatory programs of the words included and the cliché-like lexicon of colloquial speech. The main lexical and didactic material of the initial stage of the work is not plot pictures, but various kinds of dialogues.

As dialogic, very brief, cliche-like colloquial speech is restored, the speech therapist proceeds to restore monologue speech. Its main goal is the development of a detailed oral and written statement in the patient. A patient with afferent motor aphasia quickly masters the scheme of direct and inverted construction of a phrase according to a plot picture, a plan of utterance 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 the oral compilation of phrases from pictures to the written one. In the presence of gross apraxia of the articulatory apparatus, oral speech may lag behind writing. Written speech in these cases turns out to be a support for the restoration of oral utterance. Oral and written speech will be characterized by paragrammatisms, expressed in the difficulties of using adverbs, prepositions, pronouns, noun inflections, verbs that convey different directions of movement. To prevent and overcome this paragrammatism at the stage of still complete absence of speech and later, the patient’s understanding of the meanings of prepositions, pronouns, adverbs, etc. is clarified, the missing prepositions and noun inflections are filled in, the use of verbs with prefixes is clarified: flew away, ran away, left, ran , came, etc. differentiation of the meanings of prepositions and prefixes: on - on, under - over, 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 according to a series of pictures, according to individual plot pictures, is grossly violated. 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 according to plot pictures at an early stage of the transition from a nomination word to a phrase. This is overcome by explaining to the patient that he should not be distracted by listing the secondary objects shown in the figure, it is necessary to isolate the main thing when composing a phrase. Patients with afferent motor aphasia have a fairly well-preserved fantasy, a sense of humor, which are reflected in their written, and then in oral statements.

Recovery of reading and writing. At the residual stage of correctional and pedagogical work, the restoration of reading and writing begins with the very first lesson to overcome articulatory difficulties. Each spoken sound, word, phrase is read by the patient first in conjunction and reflection with the speech therapist, then independently. Very much attention in the restoration of reading and writing is given to visual dictations of individual words, phrases and short sentences.

With gross afferent motor aphasia, a split alphabet is used to restore the sound-letter analysis of the composition of a word, filling in the missing letters in a word and phrase.

Dictations, especially at the initial and middle stages of recovery, consist of words and phrases previously worked out with the patient, read by him, since it is difficult for a patient with severe articulatory disorders to retain a relatively detailed text in auditory memory, consisting of a large number of syllables, sound combinations, words. Auditory dictations should be interspersed with visual ones.

At 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 patients. Preliminary listening to the text contributes to the improvement of the reading process, since overcoming the difficulties of articulation in the process of reading distracts the patient's attention from the content of the story, understanding some phrases. Reading aloud and writing from dictation in patients with afferent aphasia is restored only after overcoming the main articulatory difficulties, mainly as a result of prolonged copying of words, sentences of various syllable and sound complexity, and small texts.

Restoring understanding. Overcoming comprehension disorders in afferent motor aphasia at the residual stage depends on the severity of the speech disorder, the degree of reading and writing impairment.

With gross violations of expressive speech, the main attention is paid to the restoration of secondary impaired phonemic hearing, restoration of orientation in space, clarification of the meanings of prepositions, adverbs, understanding of personal pronouns in indirect cases, understanding of elementary pairs of antonyms, synonyms.

Secondarily disturbed 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 that begin with these sounds, when selecting pictures for a particular letter that begin with the corresponding vowel or 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, filling in the missing words of synonyms, homonyms, making sentences with them is used. For example, insert the words into the sentence: brave, brave, heroic, courageous and clarify in which cases these words can be used.

With conductive 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 reading and writing can be relied upon, impressive agrammatism is overcome. The patient describes the location of the central object in relation to the objects located from it to the left and right, above and below it. First, the drawings of one space group are described, then another, 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 poses a question near it or above it, outlines a plan for describing objects with arrows. The patient composes phrases on 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 during ~ 8-10 sessions. Then, the location of objects with prepositions above - below, with adverbs above - below, further - closer, lighter - darker, etc. is described. schemes 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 ear or by reading.

Conclusion

Speech is interesting for studying from many sides: for example, as a device that generates physical sounds, as well as perceives and differentiates them; or as some kind of apparatus that translates meaning into words. Moreover, this apparatus is in close connection with the consciousness and emotions of a person; its important feature is the presence in it of a language system produced by a community of people and individually assimilated and used by each person.

There is no society without speech. Speech is very important in human life, it is 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 mankind in its entire history is transferred to the younger generation.

Knowing the mechanisms of speech, one can understand the causes of speech dysfunction, find the source of the disease and successfully treat the speech disorder.

Bibliography

1.Bein E.S. Aphasia and ways to overcome it. - M., 1964.

.Bernstein N.A. On the construction of movements. - M.: Medgiz, 1947. - 255p.

.Burlakova M.K. speech and aphasia. - M.: Medicine. - 279s.

.Wiesel T.G. Neurolinguistic classification of aphasias // Glezerman T.B. Neurophysiological bases of impaired thinking in aphasia. - M.: Nauka, 1986. - p.154-200.

.Wiesel T.G. Neurolinguistic analysis of atypical forms of aphasia (systemic integrative approach): author. doc. dis. - M., 2002.

.Luria A.R. Traumatic aphasia. - M.: AMS RSFSR, 1947. - 367p.

.Luria A.R. Higher cortical functions of a person. - M.: MGU, 1962. - 504 p.

.Tsvetkova L.S. Neuropsychological rehabilitation of patients. - Moscow State University: 1985. - 327p.

.Shklovsky V.M., Wiesel T.G. Restoration of speech function in patients with various forms of aphasia Part 1 and Part 2. (Guidelines). - M., 1985. - 348s.

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All forms of aphasia are united by a common feature: in all cases, there is a deep pathology of speech as the most complex mental function, closely related to other higher mental processes, as well as directly to the personality of a person.

In the first place is the violation of the communicative function of speech. Speech disorders such as aphasia are relatively rare in an isolated form. This is explained by the fact that these disorders are only one of the symptoms of a complex complex of various other defects that occur after a particular brain injury, and therefore they are accompanied by motor, sensory, and often intellectual impairments.

Particularly difficult in these cases can be movement disorders that most often accompany aphasia - "apraxia".

Apraxia- violation of purposeful action. These movement disorders are not caused by paralysis or paresis, as well as impaired coordination or disease of the musculoskeletal system. In these cases, with the integrity of the organs of movement and the ability to produce them, the necessary sequence in the production of individual components of a complex motor act is lost. Movements lose their purpose. This also includes the loss of a number of professional motor skills.

There are the following types of apraxia: motor, ideological, constructive, apraxia of spatial relationships, graphic, oral.

Motor - the most severe form of apraxic disorders. Violated actions and imitation, and spontaneous. The simplest everyday actions are forgotten. Ideotor apraxia is characterized by the preservation of imitative actions in violation of elementary actions, more often their sequence. With constructive apraxia - the impossibility of constructive actions either according to written or oral instructions. Apraxia of spatial relationships is manifested in the impossibility of orientation on the ground. With graphic, the ability to reproduce the graphic image of letters is lost. Oral apraxia is a violation of the habitual movements of the tongue during the formation of individual phonemes, both by hearing and by imitation.

With aphasia, there may be agnosia: object, optical-spatial (apraktognosia), alphabetic and digital, color agnosia, face agnosia.

The main task in overcoming object agnosia- restoration of a generalized image of the object. In correctional and pedagogical work, they use: a) analysis of the visual image of real objects and their sketched images; b) comparative analysis of the visual image of objects of the same class with the allocation of differential features (cup - glass, etc.); c) identification of visual images of various image methods (for example: choose images of people, houses, cats, trees, vehicles, etc. from a set of pictures); d) copying subject images, as well as drawing them from memory with a preliminary analysis of characteristic features; e) designing given objects with similar discrete features from separate parts.

At apractognosia the main directions in correctional work are: a) restoration of schematic representations of the spatial relationships of objects of reality (rotation of a figure in space); b) work with a geographical map (locating the sides and parts of the world, specific objects); c) work with the clock (setting the hands according to the given time, writing off the numbers according to the placed hands). Overcoming disorders of constructive activity begins with the revival of the concepts of "shape", "size": the development of a differentiated perception of round and coal shapes; sketching objects and geometric shapes; drawing objects; drawing objects and geometric shapes from memory; cubes of Koos; construction of various parts. The restoration of praxic and gnostic functions also includes the following types of work: development of orientation in space; restoration of the ability for simultaneous perception of objects (attraction of feeling); overcoming dressing apraxia (performing various dressing operations with preliminary analysis and verbalization of actions).

Overcoming violations letter gnosis implies the restoration of reading (elimination of alexia).

At agnosia for colors correctional and pedagogical work is aimed at developing a generalized categorical attitude to color. The following techniques are used: a) "semantic play" on the concept of a particular color based on the revival of the most stereotypical image associated with it (red - tomato, mountain ash; green - grass, grapes, etc.); b) presentation of contour images of objects “beaten” in the previous task for coloring them according to samples (transferring color from one drawing to another); c) classification of colors and their shades, etc.

Agnosia for faces requires special work to overcome it, starting with finding out the degree of recognition of faces of famous people in portraits. Then, involving the most familiar portraits, they “revive” the visual image of a person based on the verbal, musical, pictorial and other associations associated with it (listening to poems, songs, looking at pictures).

Restorative learning in aphasia suggest a complex effect on speech, behavior and the entire mental sphere as a whole.

For this you need:

1) the restoration of speech as a mental function, and not the adaptation of a person with aphasia to his defect;

2) restoration of the activity of verbal communication, and not isolated private sensorimotor operations of speech;

3) restoration, first of all, of the communicative function of speech, and not of its individual aspects;

4) the return of a person with aphasia to a normal speech environment, and not to a simplified one, that is, a return to professional activity.

There are two periods in working with people with aphasia:

spicy- up to two months after the disease;

In the acute period, the main tasks:

1) disinhibition of temporarily oppressed speech structures;

2) prevention of the occurrence and fixation of some symptoms of aphasia: agrammatism, verbal and literal paraphasias, speech embolus;

3) prevention of the attitude of a person with aphasia to himself as to an inferior person, to a person who cannot speak.

The main task in the residual period is the inhibition of pathological connections.

Disinhibition of speech function on the basis of old speech stereotypes should be carried out on stimuli of low strength (in a whisper, in an undertone). The material is selected according to 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 the medical history, talk with your doctor, relatives to identify inclinations, hobbies, interests. You can use the usual speech stereotypes - count, days of the week, months; emotionally significant passages of poetry, the negotiation of running phrases, expressions. Over time, work from material close to the student is translated into issues of specialty, profession.

Dialogic speech is at the heart of the restoration work on the disinhibition of the speech function. You can use the following scheme for restoring dialogic speech: repetition of a ready-made answer formula (reflected speech) - hints of one, two syllables of each word of the answer - a spontaneous answer with a choice of two, three, four, etc. words used by a speech therapist when posing a 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 himself.

The appearance of agrammatism in aphasia, as a rule, is the result of an incorrect organization of the initial recovery period, when disinhibition is carried out either only on the nominative function of speech, or only on the predicative one. Speech should immediately be complete in terms of vocabulary, and pronunciation defects that do not reduce the correct construction of the sentence can be tolerated for the time being. This is the essence of the prevention of agrammatism. Work to overcome agrammatism is carried out not only in oral, but also, when the writing skill is restored a little, in written speech. The exercises (oral and written) to prevent the development of agrammatism are based on the dialogical form of speech.

The most difficult in terms of preventing and overcoming the pathological symptom is a speech embolus, often formed in the first weeks after the lesion.

There are two main types of speech emboli: a single word or sentence that can be spoken, or a trigger needed to pronounce other words. Since a speech embolus is the result and manifestation of stagnation, inertia of nervous processes, it cannot serve as a starting point for recovery activities. The following conditions contribute to the inhibition of speech embolism (speech perseveration):

1) observance of optimal intervals between speech stimuli, allowing the excitation to “extinguish” after the completion of each task;

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 a speech therapist.

To prevent a person with aphasia from treating himself as inferior, one should speak with respect to him, passionately and sincerely experience all his successes and sorrows, trying to constantly emphasize achievements, calmly and confidently explain difficulties, creating confidence in his abilities.

In the residual period, a more thorough differentiation of methodological techniques depending on the form of aphasia is necessary.

According to the severity of the violation, two groups are distinguished:

1st - the most neglected houses with which no one speaks;

2nd - more complex - persons with speech embolism, agrammatism.

With both groups, work should begin with the disinhibition of speech, however, with the second group, it is necessary to simultaneously deal with the speedy elimination of the embolus. To do this, without fixing attention on the use of the embolus, bypass all sound combinations that contribute to its pronunciation.

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

The main task of restorative education in acoustic-gnostic sensory aphasia is to overcome defects in differentiated perception of sounds, restore phonemic hearing. Only the restoration of the sound discrimination process can ensure the revival of all affected aspects of speech, mainly speech understanding. L. S. Tsvetkova identified five stages in restorative education. On first stage establish contact with a person with aphasia, inhibit logorrhea, transfer attempts of the verbal method of communication to non-verbal activity, switch the student's attention from speech to non-verbal actions. On second stage move on to learning to listen and hear addressed speech. Main task third is the selection of individual words from one's own speech. Central task fourth stage- restoration of differentiated perception of speech sounds, that is, work to restore phonemic hearing. On fifth they move on to the conscious and differentiated selection of a word from a phrase, a phrase from a text.

At acoustic-mnestic(amnestic) form of aphasia, the central task of teaching is to restore (expand) the volume of acoustic perception, overcome defects in auditory-speech memory and restore stable visual images-representations of objects. There are three stages of restorative learning in this form of aphasia (L. S. Tsvetkova). task first stage is the restoration of visual-subject images. Work, as in sensory aphasia, begins not with speech methods, but with the restoration of visual object images by drawing objects (the first method). The second method is the classification of objects, first according to a visual pattern, and then according to a word. The following system of methods is aimed at restoring the process of identifying and naming objects: constructing objects from separate parts; comparison and finding common and different; finding errors in the image, and other techniques.

The main task of restorative education in second stage is the restoration of repeated speech. Repetition in itself is not communication, but is included in this process as one of the elements of the structure of understanding addressed speech. The main method of this stage is the method of breaking down words (sentences) into understandable parts. Third stage as a special task has the restoration of understanding of speech. The most effective method is the method of reconstructing a text from disparate semantic parts. At this stage, in order to overcome paraphasias, the classification of words according to a given attribute and the gradual generalization of words are used.

In restorative education semantic aphasia L. S. Tsvetkova identified two stages. On first learning begins with the recognition of drawn geometric shapes by comparing two given patterns. Then they proceed to the reproduction of the given figures according to the model: first - drawing, then - active construction from sticks, cubes. Later, a verbal instruction is attached to the sample: “put a square under a triangle, a circle, to the right, up”, etc. subsequently, they work out the concepts: “less - more”, “darker - lighter”, etc. Then they proceed to the restoration of awareness of the scheme of their body, its position in space.

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

The central task of restorative education in motor afferent aphasia- restoration of articulatory activity, and the goal is the restoration of oral expressive speech. The main method of restoring speech in this form of aphasia is the method of semantic-auditory stimulation of the word. This method involves the pronunciation of not a sound, but a whole word. The restoration of sound-articulatory analysis and the kinetic basis of the word is carried out on the basis of the restored active and passive vocabulary. L. S. Tsvetkova divided all the work on restoring speech into four stages. Main task first stage is the disinhibition of involuntary speech processes (counting, days of the week, singing, etc.). It is important to use the remnants of emotional speech, the reproduction of the names of loved ones, reading poetry.

The main task second stage- restoration of the pronunciation of words by restructuring the impaired speech function, that is, the revival and enrichment of semantic connections. The work begins with attempts to restore the pronunciation of the word as a whole, without a clear articulation of its constituent sounds. The main way is to switch attention from the articulatory side of speech to the general semantic and sound structure of the word. On third stage the main task is solved - the sound-articulation analysis of the constituent elements of the word. The main method is the rhythmic selection of the elements of the word by tapping its syllabic structure with exercises in chanting pronunciation. At this stage, work is carried out on writing and reading, since at the previous stages all attention is paid to switching attention from the pronunciation side of speech to the semantic level. Written speech is an arbitrary and conscious form. It is when writing that a conscious sound-letter analysis is needed.

Main task fourth stage is the transfer of a person with aphasia from the ability to isolate the sound-letter elements of a word to the ability to articulate them, that is, the restoration of the actual kinesthetic schemes of articulation. The main method is to imitate the postures of the articulatory apparatus of a speech therapist with control in front of a mirror. The next method used is the method of extracting a sound from a word in the active dictionary. Coherent phrasal speech is restored quickly, immediately after the restoration of the articulation system, does not require special training.

At motor efferent aphasia the main task is to overcome pathological inertia and restore the dynamic scheme of the spoken word. The purpose of training is the restoration of oral speech, writing, reading. The implementation of this goal is possible when solving the following problems: 1) general disinhibition of speech; 2) overcoming perseverations, echolalia; 3) restoration of general mental and verbal activity. There are two stages of learning (L. S. Tsvetkova). Task first stage- restoration of the ability of active selection, conjugated-reflected repetition of words and pronunciation of a word or a series of words from strengthened automated speech series. The goal is to remove perseverations, echolalia, disinhibition of speech. The main thing is to transfer speech to an arbitrary level, that is, to restore awareness of one's speech and arbitrary speaking. Subsequently, it is necessary to switch consciousness from the pronunciation side of speech to its semantic side. Second stage learning has the main task - the actualization of verbal forms of speech. This is necessary both to overcome the expressive agrammatism - telegraphic style, and to overcome the defect in the predicativeness of speech. The attention of a person with aphasia should be diverted from articulation and fixed on the semantic organization of the word, rhythmic-intonational structure.

The three most important tasks of restorative learning in dynamic aphasia defined by L. S. Tsvetkova: 1) the ability to program and plan an utterance; 2) predicativity of speech (restoration of actualization of verbs); 3) activity of speech (restoration of the active phrase). All restoration work is divided into five stages of learning. First stage as the main task, it has the actualization of verbs in order to disinhibit the pronunciation of stereotypical phrases. Non-verbal, verbal-non-verbal and verbal methods are used. Non-verbal include board games, walking to music, pantomime, the method of drawing, etc. Verbal-non-verbal: verbalization of gestures, melodic declamation. Verbal: verbal associations, intonation during dialogue (interrogative, exclamatory, narrative).

The main task second stage- restoration of functional connections of words on phrases of a complicated structure (subject - predicate - object). The main method is the method of polysemy of the word, which helps to restore the polysemy of the predicative connections of the word. On third stage as the main task is solved - the restoration of broader connections of words by introducing them into other semantic meanings. The main method is the enrichment of the "grid of meanings" of words and the enrichment of subject-functional relationships of previously worked out words. Task fourth stage- restoration of own coherent speech. The most widely used method is to complete a given phrase to an integer. First, phrases that have no alternatives are offered, then the end of which may be ambiguous. This helps to restore the ability to actively build a phrase. On fifth stage the main task is to restore the scheme of the whole story. The main method is drawing up a plan of expression.

In the complex of rehabilitation measures for aphasia, psychotherapeutic work occupies an important place.

1) to form an adequate attitude towards the defect (there can be both an acute experience of what happened, and insufficient awareness of the severity of the disease; an adequate assessment of one's capabilities);

2) creation of a favorable psychological climate (creation of a speech environment that stimulates communication, and, consequently, focus on solving the socio-psychological problems of rehabilitation, correction of personality changes).

3) Overcoming the elements of logophobia, insecurity in behavior, “avoiding” speech contacts, while others, without avoiding social interaction, simply do not make sufficient efforts to realize their potential.

Autogenic training is aimed at developing a setting for overcoming "feelings of illness and hopelessness." Pronounced personality changes act as contraindications: negativism in behavior with others, aggressiveness, hypochondria, psychopathic traits.

The most effective is the creation of closed groups, that is, with a constant composition of participants, as it creates a background that facilitates the work - interconnection, mutual influence, example, self-esteem. Mastering autogenic training is based on the principles of sequence and stages. Its course lasts approximately 4-6 weeks, the optimal number of participants is 5-6 people.

A useful psychotherapeutic technique is keeping diaries in which students note their successes, difficulties in mastering auto-training after each lesson. Oral self-reports of those undergoing rehabilitation training help to develop adequate working methods.

4) the formation of a correct reaction in relatives to the negative attitude of a person with aphasia to a number of family problems associated with a change in his status in the family. For example, a decrease in authority among close people can lead to serious consequences in the form of affective states.

With aphasia, it is necessary to restore not only speech, but also non-speech functions, since various mental processes, cognitive, emotional-volitional spheres suffer. Persons with aphasia are characterized by: aspontaneity, inactivity, inertia; visual, auditory, tactile agnosia, apraxia.

aspontaneity expressed in the inability to independently engage in any activity. It can manifest itself in a quick shutdown from the task.

inactivity It consists in increasing the time of the course of activity within the framework of a particular function.

inertia characterized by difficulties in switching in the process of performing various operations or switching from one type of activity to another. In severe cases, it is completely impossible to switch from one action to another, that is, there is an impossibility to carry out normal activities. Work to eliminate these disorders involves the use of exercises aimed at concentrating attention, activating it, developing skills of self-control and controlling the ability to purposeful activity, expanding its mnestic scope.

Important in restorative learning in aphasia is occupational therapy. In its process, special types of classes are used with the use of subject-practical operations.

These classes are aimed at solving several restorative tasks: 1) overcoming manual (manual) and constructive praxis disorders;

2) mastering a number of everyday and labor skills, which is possible with a certain degree of restoration of non-speech functions of visual, spatial, constructive modalities;

3) professional diagnostics and career guidance for the future;

4) expanding the scope of communication with others. Classes with the use of subject-practical activities include various types of household and labor operations.

Duration of classes with each patient is different and is largely determined by the individual fatigue of the patient. At the initial stages of work, the lesson lasts 15-20 minutes, during which breaks are made every 3-4 minutes (on average). The duration of the break itself depends on the condition and fatigue of the patient. Thus, the patient is actively engaged in no more than 6-9 minutes. Gradually, the time of classes is lengthened and brought up to an hour for a speech therapist and 40 minutes for a patient (including breaks).

For the first three to four weeks, it is advisable to conduct classes daily for 15-20 minutes, then every other day, giving assignments on days free from classes both for independent work and for working with any of the relatives or staff specially instructed for each lesson . Working with patients twice a week is not enough. From time to time the patient should be given complete rest for a few days.

When correcting aphasia, it is necessary:

1. From the first day, it is necessary to restore the communication of the patient with the help of speech. To do this, the patient must be treated as a speaking person, that is, one must talk a lot with him on emotionally significant topics close to him, seeking answers to the questions posed. It is necessary to use all the patient's speech capabilities, disinhibiting for this the potentially preserved speech by working in a whisper, observing the optimal, individual intervals for each patient. The vocabulary that is mastered by the patient is selected according to emotional and semantic significance, and not according to the principle of "phonetic difficulty".

2. To prevent the development and strengthening of aggramatisms in the patient's speech, each new word from the very first day is taught to him in various forms. In other words, the entire vocabulary restored from the patient is immediately given to him in various phraseological contexts.

3. Classes to restore speech begin simultaneously with the start of active physical therapy exercises and are carried out first daily, then every other day, with a gradual expansion of the circle of people with whom the patient communicates. Such an organization of speech therapy work excludes the fixation of the patient's attitude towards himself as a person who cannot master speech.

4. Work on the restoration of writing and reading begins when the patient's speech has recovered enough to be able to perform a phonemic analysis of the word. Quite often, fragments of global reading that remain in the patient are used at first only as a psychological stimulant at the moments when the patient begins to doubt recovery. In case of writing and reading disorders, which are based on visual-spatial disorders, the method of constructing and reconstructing letters from elements should be widely used.

- a disorder of previously formed speech activity, in which the ability to use one's own speech and / or understand addressed speech is partially or completely lost. Manifestations of aphasia depend on the form of speech impairment; specific speech symptoms of aphasia are speech emboli, paraphasia, perseveration, contamination, logorrhea, alexia, agraphia, acalculia, etc. Patients with aphasia need to be examined for neurological status, mental processes, and speech function. With aphasia, the underlying disease is treated and special rehabilitation training is carried out.

General information

Aphasia is the disintegration, loss of already existing speech, caused by a local organic lesion of the speech areas of the brain. Unlike alalia, in which speech is not formed initially, with aphasia, the possibility of verbal communication is lost after the speech function has already been formed (in children older than 3 years or in adults). Patients with aphasia have a systemic speech disorder, that is, expressive speech (sound pronunciation, vocabulary, grammar), impressive speech (perception and understanding), inner speech, written speech (reading and writing) suffer to one degree or another. In addition to the speech function, the sensory, motor, personal sphere, and mental processes also suffer, so aphasia is one of the most complex disorders studied by neurology, speech therapy and medical psychology.

Causes of aphasia

Aphasia is a consequence of an organic lesion of the cortex of the speech centers of the brain. The action of factors leading to the occurrence of aphasia occurs during the period of speech already formed in the individual. The etiology of aphasic disorder affects its nature, course and prognosis.

Among the causes of aphasia, the largest share is occupied by vascular diseases of the brain - hemorrhagic and ischemic strokes. At the same time, in patients who have had a hemorrhagic stroke, a total or mixed aphasic syndrome is more often noted; in patients with ischemic disorders of cerebral circulation - total, motor or sensory aphasia.

In addition, traumatic brain injury, inflammatory diseases of the brain (encephalitis, leukoencephalitis, abscess), brain tumors, chronic progressive diseases of the central nervous system (focal variants of Alzheimer's disease and Pick's disease), brain surgery can lead to aphasia.

Risk factors that increase the likelihood of aphasia include advanced age, family history, cerebral atherosclerosis, hypertension, rheumatic heart disease, transient ischemic attacks, and head trauma.

The severity of the aphasia syndrome depends on the location and extent of the lesion, the etiology of speech impairment, compensatory capabilities, the patient's age and premorbid background. So, with brain tumors, aphasic disorders increase gradually, and with TBI and stroke, they develop abruptly. Intracerebral hemorrhage is accompanied by more severe speech disorders than thrombosis or atherosclerosis. Speech recovery in young patients with traumatic aphasia is faster and more complete due to greater compensatory potential, etc.

Aphasia classification

Attempts to systematize the forms of aphasia on the basis of anatomical, linguistic, psychological criteria have been repeatedly undertaken by various researchers. However, the classification of aphasia according to A.R. Luria, taking into account the localization of the lesion in the dominant hemisphere, on the one hand, and the nature of the resulting speech disorders, on the other. In accordance with this classification, motor (efferent and afferent), acoustic-gnostic, acoustic-mnestic, amnestic-semantic and dynamic aphasia are distinguished.

Aphasia Correction

Corrective action in aphasia consists of medical and speech therapy directions. Treatment of the underlying disease that caused aphasia is carried out under the supervision of a neurologist or neurosurgeon; includes drug therapy, if necessary - surgical intervention, active rehabilitation (exercise therapy, mechanotherapy, physiotherapy, massage).

The restoration of speech function is carried out in speech therapy classes for the correction of aphasia, the structure and content of which depends on the form of the disorder and the stage of rehabilitation training. In all forms of aphasia, it is important to develop in the patient an attitude to restore speech, to develop intact peripheral analyzers, to work on all aspects of speech: expressive, impressive, reading, writing.

With efferent motor aphasia, the main task of speech therapy classes is to restore the dynamic scheme of pronunciation of words; with afferent motor aphasia - differentiation of kinesthetic signs of phonemes. With acoustic-gnostic aphasia, it is necessary to work on the restoration of phonemic hearing and understanding of speech; with acoustic-mnestic - over overcoming defects in auditory and visual memory. The organization of training in amnestic-semantic aphasia is aimed at overcoming impressive agrammatism; with dynamic aphasia - to overcome defects in internal programming and planning of speech, stimulation of speech activity.

Corrective work with aphasia should begin from the first days or weeks after a stroke or injury, as soon as the doctor allows. The early start of restorative education helps to prevent the fixation of pathological speech symptoms (speech embolus, paraphasia, agrammatism). Speech therapy work to restore speech in aphasia lasts 2-3 years.

Forecast and prevention of aphasia

Speech therapy work to overcome aphasia is very long and laborious, requiring the cooperation of a speech therapist, the attending physician, the patient and his relatives. Restoration of speech in aphasia proceeds the more successfully, the earlier correctional work is started. The prognosis for the recovery of speech function in aphasia is determined by the location and size of the affected area, the degree of speech disorders, the start date of rehabilitation training, the age and general health of the patient. The best dynamics is observed in young patients. At the same time, acoustic-gnostic aphasia, which occurs at the age of 5-7 years, can lead to a complete loss of speech or a subsequent gross violation of speech development (OHD). Spontaneous recovery from motor aphasia is sometimes accompanied by the onset of stuttering.

Prevention of aphasia consists, first of all, in the prevention of cerebral vascular accidents and TBI, in the timely detection of tumor lesions of the brain.