Localization of the lesion. primary defect. neuropsychological signs. Speech status of the patient. Violation of writing, reading, counting, understanding of speech, thought processes. Variants of efferent motor aphasia.

Efferent motor aphasia occurs when the anterior branches of the left middle cerebral artery are damaged (fields 44, 45). It is accompanied, as a rule, by kinetic apraxia, which is expressed in the difficulties of assimilation and reproduction of the motor program.

The defeat of the premotor parts of the brain causes pathological inertia of speech stereotypes, leading to sound, syllable and lexical permutations and perseverations, repetitions. Perseverations, involuntary repetitions of words, syllables, which are the result of the impossibility of timely switching from one articulatory act to another, make it difficult, and sometimes completely impossible, for oral speech, writing, and reading.

Efferent motor aphasia is multivariate. There are five variants of this form. A. R. Luria singled out and described in detail 4 of its variants.

Violation of expressive speech in different options efferent motor aphasia. With gross efferent motor aphasia at an early stage after a violation of cerebral circulation, one's own speech may be completely absent. Apraxia of the articulatory apparatus in this form of aphasia is manifested not in the difficulty of repeating individual sounds, but in the loss of the ability to repeat a series of sounds or syllables. The patient repeats them many times, when asked to repeat two series of sounds or syllables, he persists sounds from the previous sound or syllable series, without experiencing difficulties in the very act of sound pronunciation. This is the most severe variant of efferent motor aphasia.

Due to the inertia of the articulation of individual words, contamination can be observed due to hyphenation of the syllable of the previous word: “stack” (table, spoon).

In another variant of efferent motor aphasia, with spontaneous recovery of speech and communication, pronounced expressive agrammatism is often formed: patients skip verbs, hardly use prepositions, inflection of nouns, the so-called agrammatism of the "telegraphic style" type is revealed, which occurs due to a violation of the predicative function of inner speech. In milder cases, verbs are transferred to the end of the sentence. For example, when telling a story based on a series of plot pictures “The Incident on the River”, the following text was uttered:

“This is a boy ... a boy and here is a river and a raft and a boy how it is ... to fall into the water and the raft to call far away ... And the pioneer boy needs to take off his shoes ... he calls like this ... help ... "

In the third variant of efferent motor aphasia, such gross agrammatism is not observed, but extreme inertia in the choice of words is revealed, long pauses, perseverations, verbal paraphasias are noted in the utterance, the pronunciation of words becomes stretched. Long pauses caused by the inertness of the flow of speech processes outwardly resemble the amnestic difficulties characteristic of semantic aphasia, but they are based on the inertia of the choice of lexical means.

Violation of the regulation of the choice of words also leads to verbal paraphasias, which are due to the inertia of switching when they are extracted from different "semantic fields". For example, having composed the phrase: “A boy is fishing”, a person suffering from aphasia proceeds to compose a phrase based on another plot picture and instead of the phrase “The boy is swimming in the river”, he says: “The boy is fishing, caught in the river” or instead of “The blacksmith forges a horseshoe” says “ The blacksmith is smithing something."

Another variant of efferent motor aphasia is observed, in which speech is disturbed only in the link of a smooth, melodic change from one syllable to another. The speech of these patients is grammatically correct, but due to violations of the rhythmic-melodic side of speech, the allocation of not only stressed syllables suffers, but also the intonational coloring of the psychological predicate, that is, the new one that is said in the message, on which the logical stress falls.

Naming function. In a severe form of speech impairment, the naming function is completely absent, and when the first syllable of the word is prompted, either its automated completion occurs or it slips to another word starting with the same syllable. For example, naming subject pictures, the patient, having received a syllable prompt mo, instead of a word milk pronounces "sea", "carrot", "ice cream", etc.

Letter violation. With efferent motor aphasia, pronounced agraphia is observed: writing a word or phrase is possible only when pronouncing words in syllables.

In severe cases, with the correct repetition of the word, it is impossible not only to write it down, but also to fold it from the already selected letters of the split alphabet.

Reading disorder. In the most rude cases, reading is of a guessing nature, a display of one or another written word is available, and captions are added to the pictures. These gross violations of reading and writing are due to the disintegration of the ability to program the sound-letter composition of the word. With the "telegraph style" reading can be safe.

In milder cases, it is possible to read individual words and short sentences, but it is difficult to understand what is read, especially sentences with a complex syntactic structure.

Breakdown of understanding. At the heart of the disorder of understanding in efferent motor aphasia is the inertia of the course of all types of speech activity, the violation of the so-called "sense of language" and the predicative function of inner speech. Do not distinguish by ear grammatically well-formed statements and incorrect. The figurative meaning of metaphors, proverbs is poorly understood, which is explained by the difficulty of switching to a different, hidden meaning of the statement (A.R. Luria, 1975), there is a violation of understanding the polysemy of words. For example, words scythe, key, go- Patients perceive as wrong.

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A speech motor disorder is characterized by a partial or complete loss of the patient's ability to speak correctly. At the same time, the understanding of the speech addressed to him is preserved, the victim is able to notice his own mistakes. The disease can proceed according to several scenarios: afferent disorder, Broca's aphasia, sensorimotor disorder. Each of the conditions has its own characteristics and characteristics, which affects the principles of treatment. Most often, the disorder becomes a consequence of acute or chronic cerebrovascular accident, traumatic brain injury. It is not limited to articulation problems and can present in varying degrees of severity.

Most often, the disorder becomes a consequence of acute or chronic cerebrovascular accident.

The main types of motor aphasia and their description

Depending on the location and area of ​​the CNS lesion, motor aphasia can proceed in one of three main forms - afferent, efferent, sensorimotor. Separately, doctors distinguish dynamic and gross types of speech disorder. The first is distinguished by the intermittent and monotonous way of issuing information by the patient. The patient speaks indistinctly and slowly, but is able to repeat individual syllables or words after the speech therapist. Gross motor aphasia is characterized by vivid speech disorders, as a result of a transient complication of total pathology. The patient is expressed by scraps of words, sounds, intonation lowing.

Afferent aphasia

Afferent motor aphasia refers to a type of speech disorder in which problems arise due to a malfunction in the regulation of the speech motor apparatus. Already formed speech in a person suffers due to the defeat of the postcentral gyrus, its articulatory zone. As a result of limiting the connection between a number of departments of the region, the patient's motor articulation skill is disturbed, leading to a partial or complete absence of speech. Additionally, there are failures on the part of phonemic hearing, the quality of understanding of what is heard is reduced.

The course of afferent motor aphasia can occur in one of two ways. The first is disorder

reactions responsible for providing the movements necessary for articulation. Violation is noted

purposefulness of actions when trying to use the articulatory organs. In severe situations, speech production becomes completely impossible. The second variant is known as "conduction aphasia". With it, the victim suffers arbitrary types of speech, but the ability to use situational clichés in his conversation remains.

Efferent aphasia

This type of speech disorder has another name - Broca's aphasia. It is due to the location of the focus of the problem in the center of the same name of the lower frontal gyrus of the left hemisphere of the brain. Signs of efferent motor aphasia occur when the premotor cortex of the CNS organ is damaged. This leads to a violation of the motor link of speech and causes defects, the variability of which depends on the indicator of changes in the structure of tissues.

Broca's aphasia, depending on the severity, can be:

• light - the speech is expanded, but with the presence of stamps and clichés. Can skip the pronunciation of words by syllables. Most of the difficulties arise when naming objects, repeating words or phrases after a speech therapist. The possibility of dialogue remains, but the conversation is monotonous, based on stereotypes;
• moderate - spontaneous statements make obvious difficulties with the construction of sentences. The speech is ragged, has the characteristics of a telegraphic style. Attempts to name an object or repeat what the doctor said lead to the obsessive pronunciation of the same syllables or words. When conducting a dialogue, the patient can answer the interlocutor with his own phrases or questions;
• severe - spontaneous speech is absent. If the victim tries to say something on his own, he simply repeats some syllables. The clinical picture is complemented by the difficulties of understanding the words addressed to the patient.

The type of efferent form affects the approach to the treatment of pathology. In particular, it affects the selection of speech therapy methods and techniques necessary to restore speech function.

Sensory motor aphasia

The most severe and dangerous speech disorder, in which difficulties with pronouncing words are supplemented by problems understanding the speech of others and one's own. Human contact with the outside world is disrupted. He does not understand people, cannot speak articulately. The severity of the signs characteristic of the condition depends on the area and type of damage to the cerebral cortex, age, and the general condition of the patient. In most situations clinical picture supplemented by neurological symptoms indicating the nature of the underlying disease.

Reasons for the development of pathology

The development of pathology is based on a change in the structure of certain parts of the brain under the influence of degenerative, inflammatory, necrotic and other processes.

A provoking factor can be organic tissue damage, somatic disease, physical or chemical external influences.

The success of the treatment of motor aphasia depends on the correctness of the main diagnosis and the elimination of the focus of the problem in the brain.

Common Causes speech disorder:

• acute or chronic cerebrovascular accident (ischemic or hemorrhagic stroke, transient ischemic attacks);
• head trauma - speech impairment can be a delayed complication of traumatic brain injury;
• abscesses in the cranium, which become a source of inflammation, swelling, pressure on the cerebral cortex;
• inflammatory and infectious diseases of the central nervous system;
• cancerous tumors id benign neoplasms in the cranium, brain;
• pathologies that are accompanied by degeneration of the nervous tissue (Pick's disease, Alzheimer's disease);
• undergone neurosurgical operations.

The risks of developing motor aphasia are especially high for individuals with a family history exacerbated by these conditions. The likelihood of lesions in the brain increases with chronic hypertension, cerebral atherosclerosis, rheumatism, diabetes, heart disease. Drug abuse, smoking, alcohol or drug use also create favorable conditions for the development of pathologies.

Clinical picture of the disorder

Regardless of whether a person suffers from afferent motor aphasia or another form of speech impairment, he will show a number of common features. They can have different degrees of severity depending on the specifics of the situation. Combinations of manifestations are different, which sometimes complicates the process of making a diagnosis.

The condition is characterized by the following symptoms:

• permutations of syllables and sounds in the composition of words;
• skipping sounds in oral speech and letters on the letter;
• the use of words in a conversation that do not fit the meaning. Difficulties in making sentences due to the inability to find an adequate word;
• the narrative is mainly based on the use of the same type of verbs, without connecting other parts of speech. This makes it monotonous, inexpressive, incoherent and uninformative;
• the patient often makes long pauses;
• the emotional coloring of the story is strongly blurred or absent;
• when the patient realizes his illness, he becomes silent;
• the disease can be manifested by severe stuttering, problems with remembering the names of objects;
• reading and writing are accompanied by errors, omissions of letters, syllables, words;
• in especially severe cases, the sounds made by the patient are reduced to lowing, which slightly changes due to intonation.

Motor aphasia is characterized by progression in the absence of treatment, a gradual aggravation of the situation. This is due to further destruction of the speech apparatus, the appearance of other neurological symptoms, mental disorders.

When the patient realizes his illness, he becomes silent.

Diagnostic Measures

Features of the symptomatology allow only to suspect a disorder of a particular type in the patient. In some cases, this helps to understand in which part of the brain the lesion is concentrated, to make the main diagnosis. To confirm suspicions, the patient may be prescribed MRI or CT, ultrasound of cerebral vessels, lumbar puncture. The victim should be examined by a neurologist and a speech therapist. The latter, through special techniques, evaluates the indicators of motor, visual and auditory memory, checks the quality of writing and reading. It is important not only to confirm the presence of a speech disorder, but to understand what kind of form it has in a particular patient - Broca's aphasia, afferent or sensorimotor.

Correction methods and treatment of the disorder

Therapy for motor aphasia should be complex, consisting of two equally important directions. The first involves the fight against the underlying disease. If the cause of the problem is not eliminated, no methods of traditional or traditional medicine will relieve the disorder. In parallel with this, work should be started with a neurologist and a speech therapist specifically on the fact of speech impairment. The principles of treatment are selected individually, based on the age and general condition of the patient, the form and severity of the pathology, and the specifics of the situation.

Medical therapy

Medications, the action of which is aimed at increasing the functionality of the brain in the affected area in order to restore speech, should be selected by a neurologist. With motor aphasia, these can be nootropics, vitamins and mineral complexes, vasodilators, muscle relaxants, tonics. Antihypoxants, neuroprotectors, neurostimulators often act as auxiliary medicines. Today, more and more doctors prescribe biologically active supplements to their patients to enhance the effect of drug therapy.

Speech therapy techniques

Working with a speech therapist with afferent or efferent motor aphasia can take months. In the case of a sensorimotor disorder or a severe degree of impairment, treatment lasts for years. The principles and techniques of the approach are selected individually, adjusted in accordance with the signs of positive dynamics or progression of the pathology.

The basis of therapy is the development of speech skills and intonation, the improvement of writing, and an increase in the volume of the patient's auditory-speech memory. Under the supervision of a specialist, the victim works with pictures, texts, and the world around him.

Increasingly, modern computer programs and mechanisms are used.

Operational interventions

Surgical impact on the brain is applied in relation to the cause of the problem, and not for the purpose of improving speech. These can be manipulations to stop bleeding, neutralize edema, remove tumors or damaged tissues. It is important to understand that the neurosurgical actions themselves can cause motor aphasia or other types of speech disorders.

Physiotherapy

The effectiveness of such options for influencing the human body with motor aphasia is still in doubt. In practice, the use of acupressure, acupuncture, magnetic or electrical stimulation, as well as physiotherapy exercises shows good results. Such approaches cannot be the main way to treat pathology. They should go in combination with taking medications, visiting a speech therapist.

The disease can be treated with acupuncture.

Forecast and preventive measures

The chances of a complete recovery or achieving results sufficient to lead a normal life depend on the severity of the case and the quality of the treatment. When ignoring the underlying problem or refusing to work with a speech therapist, the disorder can rapidly progress. In such situations, there is a risk of a gradual deterioration in the patient's condition, the development of disability due to the inability to communicate with others. Prevention of pathology consists in preventing the development of diseases that act as its provoking factors.

Some take the blurred symptoms of an illness as the result of chronic fatigue or a logical consequence of old age, so they do not go to the doctor. Motor aphasia is not only one of the manifestations of brain damage, but also a condition that can significantly reduce the quality of human life. At the first signs of a disorder, it is necessary to contact a neurologist, undergo a full diagnosis, and then profile treatment.

Sensorimotor aphasia, often referred to as Broca's aphasia, is a severe neurological disorder that manifests itself as severe speech impairment. The disease has several forms, which are accompanied by various symptoms.

Motor or sensory aphasia develops due to damage to the left frontal lobe, which is responsible for the functions of the speech apparatus. Damage to this part of the cerebral cortex can be triggered by:

• craniocerebral injuries;
• suffered a stroke;
• brain abscess;
• encephalitis of various nature;
• chronic disorders of the functioning of the central nervous system;
• malignant and benign neoplasms of the brain with a tendency to rapid growth;
• and Alzheimer.

The risk group for the development of the disease is made up of hypertensive patients, patients with a tendency to intracranial hemorrhage and ischemic disease. In most cases, pathology is diagnosed in older patients.

Types of violation

There are two main types of disorders - this is motor aphasia and sensory.

With motor, there is a complete loss of coherent speech. The patient cannot pronounce words, but is able to understand someone else's speech. At the same time, the pronunciation of individual sounds does not cause difficulties.

Sensory - accompanied by a specific deafness, characterized by an inability to perceive speech. The patient's hearing does not suffer, the disturbance is observed in the part of the brain that is responsible for understanding speech, but not for hearing. The patient retains the ability to speak, but is not able to hear what he says himself, therefore, over time, speech loses intelligibility, words are replaced by meaningless sounds.

A separate type is sensory-motor aphasia, characterized by the simultaneous inability to pronounce words and perceive speech by ear. This form is characterized by both motor and sensory symptoms. Such a violation is the most difficult and practically untreatable.

Clinical forms of motor aphasia

There are two separate types:

• efferent motor aphasia;
• afferent motor aphasia.

Efferent is accompanied by the possibility of pronunciation of syllables, but the complete inability of the patient to put words out of them. A characteristic feature of this clinical form of the disease is a kind of fixation of the patient on certain sounds that come out well for him. At the same time, switching from one group of sounds to another is very difficult, which is the main obstacle to the normal coherent speech of the patient.

Afferent motor aphasia is characterized by the inability to deliberately pronounce certain sounds. Nevertheless, this form of pathology is characterized by the arbitrary pronunciation of certain syllables and sounds, without direct effort on the part of the patient. If such a patient is asked to say any combination of sounds, he will not be able to do this, but after a while the required sound will be uttered arbitrarily.

Other forms of pathology

Broca's aphasia is divided into the following types:

• amnestic;
• semantic disease;
• total violation.

Amnestic aphasia leads to the fact that the nominative meaning of words is lost. In this form, the patient is unable to name certain objects. Causes memory impairment in which the patient forgets the name of the object, but not its function. For such patients, it is common to name objects according to their function, for example, the patient will call a ballpoint pen "an object that writes." The disease is also characterized by the ability to recall the name of an object if the patient is prompted by the first letters or the first syllable.

As the name implies, the semantic form of pathology is accompanied by the inability to understand the semantics of certain words or phrases. This form is often accompanied by a violation of the understanding of phrases. Often, semantic and amnestic forms of pathology are diagnosed simultaneously in one patient.

Total aphasia is a complex form of pathology that develops due to extensive brain damage. With this disease, the patient cannot perceive speech and speak, and in addition, he loses his writing and reading skills.

How the disease manifests itself

Aphasia occurs when the part of the brain responsible for speech and its perception is damaged. A feature of the disease is that it is steadily progressing.

Typical symptoms of the disorder:

• arbitrary permutation of sounds in words;
• tendency to skip letters when writing and speaking;
• violation of the pronunciation of words;
• difficulty in choosing the correct word in speech;
• increased pauses in conversation;
• lack of emotions when talking;
• an increase in the number of errors in writing and reading;
• violations of memory and analysis of colloquial speech;
• sudden stuttering.

The patient's speech changes greatly. With an adequate assessment of their own capabilities, patients become withdrawn and silent. The emotional coloring of speech is lost, the pauses between words increase, during which the patient tries to remember a word or pronounce a certain sound.

Diagnosis of pathology

Diagnosis is based on an examination of the brain (MRI) and an analysis of the number of damaged areas.

Also, patients are prescribed vascular dopplerography and lumbar puncture. The doctor assesses the patient's speech, for which the patient is asked to read an excerpt from a book and write a few sentences.

Depending on the degree of damage to the frontal lobe of the brain, drug treatment and exercises are selected.

Features of therapy

Treatment of pathology is carried out with the help of medications and speech therapy exercises. Of the drugs used:

• vasoactive agents;
• antidepressants and sedatives;
• drugs to normalize muscle tone (muscle relaxants);
• nootropics.

Particular attention in drug treatment is given to nootropic drugs that improve cognitive function and normalize metabolic processes in the brain.

On a par with drug treatment, the patient is shown speech correction by a speech therapist, as well as physiotherapy procedures to normalize metabolic processes and improve blood circulation.

Timely treatment will help restore speech abilities, but this will take at least two years. In advanced cases, without qualified treatment, a complete loss of speech and the ability to perceive it is possible.

Aphasia is a speech disorder due to problems with the cortical speech centers in the brain. At the same time, there are no hearing impairments and the articulation apparatus is completely preserved, that is, there are no other anatomical reasons for speech disorders. Most often, aphasia occurs in acute disorders of cerebral circulation (), with tumors, infectious and inflammatory lesions of the brain tissue (). Thus, aphasia is a symptom of a formidable neurological disease. Let's try to figure out how exactly aphasia manifests itself, what varieties of it exist and how it is diagnosed. This article is devoted to these questions.

The term aphasia was proposed back in 1864 by A. Trousseau, comes from the Greek prefix "a", denoting negation, and the word "phasis", which means speech. Since then, a lot of time has passed, various variants of speech impairment have been studied (from complete absence to minor changes imperceptible to the average person), but the wording remains exactly the same to this day.

Aphasia as a symptom of a neurological disease is said to be when the intellect does not suffer and speech was not initially impaired, that is, under the condition of normal development of speech before the disease. The underdevelopment of the ability to speak from childhood is called alalia, and this is a completely different disorder.

Varieties of aphasia

There are quite a few varieties of aphasia, all of which are denoted by not entirely clear neurological terms. It is in this terminology that we will try to understand.

All types of aphasia can be conditionally divided into three groups:

• impaired ability to speak;
• impaired ability to understand addressed speech;
• violation of the naming of individual objects.

The first group of speech disorders consists in problems with speech reproduction, that is, when a person understands what needs to be said, but cannot (there is a wording in the head, but it is not reproduced speech apparatus or reproduced with violations). In medicine, this is referred to as a violation of expressive speech.

The second group is a violation of the ability to understand the meaning of what was said. This is referred to as a violation of impressive speech.

The third group of disorders is said to be when both understanding and reproduction do not suffer, but the wording (matrix) of the word in the brain is lost. In this case, a person realizes, for example, what kind of object is in front of him, what they are doing to him, but he cannot name it. That is, at the sight of a spoon, he will say: “This is what they eat and stir food with.”

Each of the above described groups of speech disorders is divided into additional varieties. This classification is based on the anatomical principle. The fact is that there are well-defined areas of the cerebral cortex that provide certain types speech. All these areas have been studied, they are identical in most people. Accordingly, one or another type of speech disorder occurs at a certain location of the pathological process in the brain. The logical chain is quite simple: such and such a speech disorder is such and such a place of pathology in the brain. This is based on the diagnosis of the site of brain damage. It is for this that the doctor determines the type of aphasia.

In violation of expressive speech, the so-called motor aphasia occurs, in violation of impressive speech - sensory aphasia, in violation of the naming of individual objects - amnestic. Let's talk about each type of aphasia in more detail.

motor aphasia

Such patients understand speech, but they have problems with its reproduction.

This type of speech disorder is heterogeneous in its structure. Motor aphasia is divided into:

• efferent motor aphasia;
• afferent (articulatory) motor aphasia;
• dynamic motor aphasia.

Efferent motor aphasia occurs when the pathology is localized in the region of the posterior part of the lower frontal gyrus of the predominant hemisphere (left in right-handers and right in left-handers). This area is called Broca's area, so sometimes efferent motor aphasia is called Broca's aphasia. When the neurons of Broca's area are damaged in a person, syllable and word formation, the reproduction of all or individual sounds are disturbed. In the most severe cases, spontaneous speech is lost altogether, the patient is explained only by facial expressions and gestures.

Sometimes the whole speech of the patient is verbal or syllabic residues (for example, “ba”, “for”). A particular manifestation of efferent motor aphasia may be the word embolus, that is, one single word that the patient can pronounce. For any question, he only says it.

With a lesser severity of the defect, speech becomes poor, consists mainly of nouns, seems illiterate due to the lack of consistency (there are no cases, no genders, no prepositions). The patient is explained as a foreigner, badly knowing the language. For example, "morning-doctor-bypass". At the same time, the patient is fully aware of his speech defect and tries to help himself with gestures.

Efferent motor aphasia is characterized by the patient's looping on parts of words. For example, you ask the patient to repeat the word "ax". Instead of a whole word, a person pronounces “so-and-so”, unable to pronounce the end of the word.

This type of aphasia is characterized by a confusion of letters, and they are different in pronunciation. For example, instead of the word "mother" the patient says "lady", instead of "work" - "cohort" and so on.

Another feature of efferent motor aphasia is impaired reading aloud.

Afferent motor aphasia occurs when the pathological focus is located behind the lower part of the posterior central gyrus of the predominant hemisphere (parietal lobe). In this case, in a person's brain, the connection between the sound expression of individual letters and articulatory capabilities is, as it were, broken. Distinctive feature This type of aphasia is a confusion of sounds close in pronunciation (“b” and “p”, “z” and “s”, “g”, “k”, “x”), which distorts the meaning of what was said. For example, instead of "we write on paper," the patient says "we squeak on the cuff." In addition, the patient is unable to perform simple language gestures, for example, fold the tongue into a tube, put the tongue between the upper teeth and upper lip, click the tongue. With this type of motor aphasia, reading is also impaired.

Dynamic motor aphasia develops when the anterior and middle sections of the inferior frontal gyrus of the predominant hemisphere are affected, that is, the area located next to Broca's area. This kind of motor aphasia is characterized by a decrease in spontaneous speech, as if by a decrease in speech initiative. At the same time, the patient is able to correctly articulate sounds, pronounce all the words. You can identify such violations in spontaneous narrative speech by asking the patient to tell about himself. The story will be poor, meager, as if slowed down. More stimulating questions are needed. In speech there are few verbs, adjectives, there are no interjections. The patient seems to be reluctant to make contact.

Sensory aphasia

With sensory aphasia, the patient loses the ability to understand speech.

This kind of speech disorders is divided into two groups: purely sensory and semantic aphasia.

Purely sensory aphasia occurs when the posterior sections of the superior temporal gyrus of the predominant hemisphere are affected, which is called Wernicke's center. With this speech disorder, the patient loses the ability to understand sounds, syllables and words. That is, hearing is completely preserved, but any sounds seem inarticulate. It's like talking to you in a completely unfamiliar language.

In severe sensory aphasia, a person does not fully understand speech addressed to him, he cannot even follow simple verbal instructions (for example, “raise your hands”). In milder forms of sensory aphasia, understanding of individual similar sounds is impaired. For example, a person is offered to answer the question: “Where is the crop harvested - on the tower or on the arable land?”, “Do they paint the fence or constipation with paint?”. If such a patient is asked to repeat a word, then he will not be able to do it correctly (for example, instead of "daughter" he will say "dot").

Another feature of sensory aphasia is a complete misunderstanding of his defect, that is, the patient does not notice errors in his speech. He is sure that he pronounces everything correctly, that those around him do not understand, therefore he is often offended.

In addition to impaired understanding of addressed speech, with sensory aphasia, one's own pronunciation is secondarily violated, since semantic control over words is lost. Often the speech of such patients is wordy, inconsistent and completely meaningless. This situation is called "verbal okroshka".

In addition to the above, sensory aphasia is characterized by impaired reading and writing. A person does not understand the essence of the proposed text, and when writing, he replaces one letter with another (especially under dictation).

Semantic aphasia develops with damage to the lower parietal lobule of the prevailing hemisphere. With this type of speech disorder, a person understands addressed speech, pronounces words correctly, and even follows instructions. But at the same time, the understanding of logical connections in speech instructions is violated. For example, if you ask the patient to draw a circle and a square, he will easily do this, and if you ask him to draw a circle inside a square, this will cause difficulties. That is, temporal and spatial relationships are violated (including the meaning of the prepositions "under", "above", "for", and so on). Also, the patient will not be able to explain the difference in statements like “mother's daughter” and “daughter's mother”.

With semantic aphasia, an inability to understand the figurative meaning of what was said develops, written between the lines, proverbs and sayings lose all meaning.

Amnestic aphasia

Amnestic aphasia develops when the lower temporal region of the prevailing hemisphere is affected. The essence of this type of speech disorder is forgetfulness. A person cannot remember and pronounce a word denoting an object, while perfectly understanding what the object is intended for. For example, the patient will say to a match "this is what they light with." If you suggest a word by naming the first syllable, the patient will pronounce it (as if remembering), but in a minute he will not be able to repeat it on his own.

Spontaneous narrative speech of such patients contains mainly verbs and is poor in nouns. But reading and writing are not violated at all.

Mixed and total aphasia

In most cases, one patient has several types of speech disorders at the same time, which is associated with the anatomical proximity of speech control zones in the brain. Then they talk about mixed aphasia.

There is also the concept of total aphasia, when all types of speech are violated at the same time. Typically, this situation occurs with an extensive stroke, when the affected area captures almost the entire frontotemporal region of the prevailing hemisphere.

How to detect aphasia?

To determine the type of speech impairment, special methods have been developed. There is even a separate specialist in speech disorders (aphasiologist). In most cases, a neurologist detects aphasia in clinical practice. He conducts a series of simple tests, according to which this or that type of speech disorder is established. What are these tests? Let's find out:

• To study speech, the patient is asked to tell about himself. A simple collection of complaints is thus also a test for speech impairment;
• then the patient is asked to list the days of the week or months, to repeat individual sounds and syllables (similar and different: “sh” and “u”, “g” and “o”, “rama-lady”, and so on);
• give any text and offer to read aloud, and then retell what was read;
• the patient is shown famous items(chair, table, door, handle) and asked to name them;
• are asked to answer a question containing words that differ in pronunciation (for example, “what drives the wind - dust or ardor?”);
• offer to explain the meaning of any well-known proverb;
• voice instructions for performing some action and ask to perform it (for example, "touch your left hand to the lobe of your right ear");
• ask questions to understand logical and grammatical constructions (“who is the brother of the father and the father of the brother?”), spatio-temporal relationships (“what comes first: summer before spring or spring before summer?”);
• they suggest drawing a triangle under the square, a circle to the left of the triangle, and so on;
• they ask you to write your passport details (name, age) and any phrase, as well as a phrase under dictation.

This group is quite simple tests usually enough to detect one or another type of speech disorder. As you can see, the technique is simple and does not require any additional tools or devices, which is an indisputable plus for diagnostics.

So, aphasia is a neurological symptom of a brain disease. It is either a pronunciation disorder or a speech comprehension disorder, or both. There are many varieties of a symptom, the occurrence of each of which is clearly associated with a specific area of ​​​​the brain. To identify the disease, special methods have been created. However, even at a regular outpatient appointment, simple tests can detect one or another type of aphasia.

Informative video on the topic "Types of aphasia":

Video lesson on the topic "Restoration of speech in afferent aphasia":

Video lesson on the topic "Restoration of speech in efferent aphasia":

Loss of speech in full or in part for a person is a difficult situation that significantly impairs the quality of life and leads to disability.

In medicine, this problem is called aphasia. It occurs when functional activity is inhibited due to damage to certain areas of the cerebral cortex and is a symptom of a serious injury or injury.

Depending on the localization of the pathological focus, speech disorders can have different manifestations; this is the reason for the identification of several main types of aphasia.

One of the most severe forms is sensorimotor aphasia, which is a combination of two types of speech disorders (and). What is the peculiarity of this clinical symptom and how to cope with it?

Factors provocateurs of the violation

The development of aphasia is always associated with a pathological process or damage to the areas of the brain responsible for speech. This function in each hemisphere has motor (motor) and sensory (sensitive) support.

For example, afferent and efferent aphasia (impaired ability to pronounce words) appears when the area of ​​the cortex that is responsible for movement is affected (the lower frontal gyrus of the left hemisphere).

(lack of understanding the meaning of one's own and other people's words) is associated with pathology in the cortical section of the auditory analyzer (the upper part of the temporal lobe of each hemisphere). The combined defeat of these areas leads to the development of total (sensory-motor) aphasia.

The main causes of this symptom:

Predisposing factors are:

• respectable age;
• unfavorable family history;
• concomitant severe diseases - atherosclerosis, decompensated diabetes mellitus, arterial hypertension, coronary artery disease, frequent, heart and vascular diseases.

Clinical manifestations

Sensorimotor aphasia is a combination of symptoms that are characteristic of both types of speech disorders. Such a complex clinical situation causes significant communication difficulties for people with preserved intelligence and leads them to disability.

It appears in two forms:

• afferent form- the patient is not able to pronounce individual sounds at will or at the request of someone due to problems with articulation, however, spontaneous pronunciation of such sounds is possible at other times;
• efferent form- a person can speak individual sounds or syllables, but cannot put them into words, he does not have the ability to switch from one sound to another, so such a patient often repeats the same syllable or gets stuck immediately at the first pronunciation and stops talking at all.

Sensory (acoustic-gnostic aphasia) is characterized by a complete or partial lack of understanding of one's own or someone else's speech with normal hearing.

Such patients can correctly pronounce words and build phrases, they often speak quickly and often without understanding the meaning of what they hear. Both spontaneously appearing speech suffers, as well as repetition after a speech therapist, description of objects and pictures, or reading aloud.

The combination of symptoms of sensory and motor aphasia results in a clinic of sensorimotor disorder, as the most severe among all. The patient at the same time does not understand others and cannot speak normally himself.

The degree of loss of one's speech and the ability to correctly recognize the conversation of people around will depend on the individual characteristics and the severity of the damage.

This complex view aphasia is also called total because of the violation of all aspects of human speech functions. Often it can be combined with other neurological manifestations (for example, with) or general symptoms (absent-mindedness, apathy, drowsiness).

Medical help

For patients with aphasia, the organization of two directions of treatment is necessary.

The prognosis depends on the individual characteristics of each patient - his age, health status, the presence of concomitant diseases and family predisposition, as well as on the location and size of the lesion in the cerebral cortex.

In any case, recovery will be more successful when early start rehabilitation work and the implementation of all the recommendations of the doctor in full, as well as with the active participation and assistance of relatives and friends of the patient with aphasia.