Aphasia

Aphasia
Aphasia is a localized violation of the centers of the cerebral cortex responsible for the formation of human speech. The disorder is characterized by localization in the pathways of the brain. Patients have a partial or complete violation of the perception of the interlocutor’s speech, there is no opportunity to correctly build a sentence, pronounce words and individual sounds.

If we speak in a language understandable to an ordinary person, then pathology can be characterized as a violation of the actions of a nerve impulse that signals to the brain that a person wants to express his thought with speech.

Content of the article:
Aphasia: causes of the violation
Classification of the disorder
Efferent motor aphasia
Afferent motor aphasia
Acoustic-gnostic aphasia
Acoustic-mnestic aphasia
Amnestic-semantic aphasia
Dynamic aphasia
Symptomatic manifestation of aphasia
Methods of diagnosis of aphasia
Correction of aphasia
Prevention of the disorder and prognosis for recovery
Aphasia
Aphasia: causes of the disorder
The disorder has several types. If we talk about motor or sensory aphasia, then it is provoked by dystrophic processes occurring in the nervous tissue and — as a result — disrupting the work of neurons. This is the main cause of the disease. Aphasia develops when a person’s speech is formed, that is, in infancy, dystrophic processes in the cerebral cortex are not detected.

If we talk about negative factors that can provoke the development of disorders, then it is necessary to identify vascular pathologies localized in the brain. Doctors note that motor aphasia of speech and other forms of impairment are the result of a stroke. At the same time, it does not matter whether there was damage to brain tissue or an acute rupture of blood vessels with subsequent hemorrhage into the brain.

Stroke refers to a pathology that provokes the development of severe consequences. If you do not take into account that the patient had a similar attack, then surgical interventions or head trauma with brain damage can provoke aphasia. Often, patients are diagnosed with a disorder, the main cause of which is a long-flowing inflammatory process that has spread to the brain. The cause of inflammation may be:

meningitis;
encephalitis;
malignant brain tumors;
violation of the central nervous system in the progress stage;
epilepsy;
Creutzfeld-Jakob disease.
In the last two cases, there is a violation of the proper functioning of the brain. When diagnosed with Creutzfeld-Jakob disease, the patient suffers from dementia, the cause of which is an infection.

In addition to the main factors of the development of aphasia, doctors identify a number of circumstances in which the disorder develops. These include:

old age;
genetic predisposition;
hypertension;
rheumatic heart disease;
ischemic attacks.
Classification of the disorder
Aphasia has many forms of manifestation. The principle of classification is based on anatomy, linguistics and psychology. In modern medicine, it is customary to take the Luria distribution as a basis, since it is his definition of the forms of disorders that have a great similarity with the clinic of each type. The researcher suggested considering the main area of brain damage, as well as what happens to the patient during the disease.

Efferent motor aphasia
The disorder is the result of damage to the area of the brain at the base of the middle frontal gyrus. The patient has no possibility of changing the position of the articulation apparatus. That is, when he utters one sound, it takes him a certain amount of time to switch to another. In medicine, the disorder is also called Broca’s aphasia in accordance with the affected area of the brain.

In addition to the delay in switching from one sound to another, the patient suffers from impaired motor processes. All movements are robot-like, smoothness is lost, there is inhibition.

The patient’s speech itself is present, but there is also no smoothness of sounds, intonations, emotions in it. If the patient wants to write something, then he can do it only in combination with the pronunciation of the desired letter or word. There is a mixture of letters, that is, a person takes a letter from one word in a sentence and automatically substitutes it into another.

Afferent motor aphasia
The disorder develops when the lesion is localized in the postcentral sulcus and the inferior parietal lobule of the brain. The patient has certain difficulties with changing the position of the articulatory apparatus, which affects his speech. Depending on whether a person is left—handed or right-handed, the pathology manifests itself in different ways.

When the left half of the brain is damaged, there is a total violation of speech in right-handed and left-handed people. If the speech function is still preserved, when talking, patients include synonyms in their vocabulary, pronunciation of consonant letters is difficult, and some of them are not pronounced at all. The patient breaks each word into syllables, otherwise it is impossible to speak. If the patient has to listen to someone, then the interlocutor should speak in simple words, composing them into short sentences, since the patient’s perception of someone else’s speech is impaired. Also, the patient cannot write, intelligence and coordination of movements are preserved at the same time.

If the disorder occurred in a person who wrote with his left hand, but in childhood was retrained to the right, then the patient has difficulty writing and pronouncing words, he swaps or does not pronounce (does not spell) letters. If you need to write something, it is easier for a person to first write one type of letters, for example, vowels, then the second (consonants). Characteristically, the patient understands how to write and speak correctly, in what order to put the letters, but he cannot do this.

Acoustic-gnostic aphasia
When a speech disorder (aphasia) of this form is diagnosed, a person ceases to perceive the words of the interlocutor by ear. That is, the patient lacks the ability to analyze and synthesize sounds. If you put yourself in the patient’s place, then he will hear someone else’s speech as sounds that are indistinct to him, an incorrectly constructed sentence or words. The danger of this type of aphasia lies in the fact that the patient cannot independently diagnose speech abnormalities that have arisen against the background of an injury or stroke attack, which is due to the preservation of motor activity.

An outsider can determine the development of pathology if he pays attention to the patient. The patient understands the meaning of the subject, but cannot name it exactly. If you show him, for example, a doorbell, he will say that it is a small object, but he will not be able to express the idea in one word. This concerns sensory aphasia, and when it is combined with acoustic-gnostic, the patient ceases to pay attention to the fact that his own speech is impaired.

At the beginning of the disease, the patient talks in such a way that even close relatives will not be able to understand him, because it consists exclusively of individual letters and sounds.

Acoustic-mnestic aphasia
It develops as a result of damage to the posterior and middle areas of the brain in the temporal zone. It is characterized by a violation of a decrease in the ability to remember what you have heard. This happens as a result of the fusion of auditory sensations. A characteristic feature of pathology is the lack of correlation between what is heard and what is spoken. That is, the patient hears the phrase and can remember no more than two or three words from it, while repeating only one or two. There is also no ability to memorize and then pronounce words that are not related in meaning to each other, for example: flower — castle — tin — hand.

The above is the basis of this type of aphasia. The patient’s phonemic hearing and articulation ability remain within normal limits. Difficulties in communicating with other people are compensated by high speech activity. Auditory-speech memory in patients is characterized by increased inertia.

If a healthy person wants to talk to a patient who has acoustic-mnestic aphasia, he should use simple sentences and words. It is also difficult for the patient to communicate in a company where there are more than two people. Patients are not recommended to attend public speeches such as lectures, seminars or reports, this provokes an aggravation of the violation.

Amnestic-semantic aphasia
A type of disorder that develops with complex damage to three areas of the brain: parietal, temporal and occipital. Patients lack the ability to isolate the semantic core of a word and understand its meaning, the associative series is poor.

Often, amnestic-semantic aphasia is accompanied by a violation of the visual-spatial motor act, that is, a person finds it difficult to perform movements in different planes, purposeful finger movements are also impossible. When communicating, the patient understands simple sentences and phrases that are easy to perceive, for example: “I’m going to the store. I’ll buy bread and milk there. I’ll be home at seven o’clock.” The number of words can reach 11, the main thing is that they can be easily recognized by the patient.

A characteristic feature of the violation is the inability to work with three subjects. That is, the patient can take a plate and place a fork to the right of it, but if he is also given a spoon, the task will become impossible, there is also no understanding of comparative sentences: “This apple is more than a plum, but less than a pear.” It is also difficult for the patient to understand such expressions where there is a logical meaning, for example: “mother’s sister” — “sister’s mother”.

The causal relationship in the proposals will also not be determined. Patients do not understand proverbs and sayings, metaphors.

Dynamic aphasia
Speech aphasia of this type appears as a result of a violation of the posterior areas of the left hemisphere of the brain, which is responsible for the function of speech. Pathology is characterized by the difficulty or inability of the patient to compose a detailed sentence or statement. A person finds it difficult in situations when he is asked to retell the meaning of the video he saw. At this moment, the spontaneous expanded utterance is blocked. The patient says fragments of what he saw, often unrelated.

The patient forgets the names of cities or streets, he has difficulties when asked to give the name of a familiar person. However, if he is prompted by the beginning of the word, then the pulse is unblocked, and the patient can continue the word or phrase to the end. Patients with dynamic aphasia cannot count backwards, for example, from five to one.

The ability to write is preserved, but it will be possible to do this with simultaneous pronunciation and spelling of the word. The ability to do arithmetic is lost, although patients can count in order.

Symptomatic manifestation of aphasia
The main signs of the disorder provoke the appearance of characteristic features in the behavior of the patient. This is primarily due to brain injury. However, sometimes these symptoms are the result of a concomitant disease, for example, dysarthria or apraxia.

Depending on the localization of the injured areas of the brain, symptoms may manifest to a greater or lesser extent. At the same time, depending on the type of aphasia, the following signs may be present or absent. In some cases, patients, realizing that something is wrong with them, mask violations by replacing elementary words with synonyms.

Possible symptoms of aphasia:

inability to recognize language speech;
the patient cannot spontaneously express his thought;
impaired pronunciation of letters or words (if not provoked by paralysis);
violation of the ability of word formation;
lack of ability to designate an object in one word;
broken pronunciation of letters;
excess of neologisms;
attempts to repeat a simple phrase end unsuccessfully;
constant repetition of the same syllables or words;
propensity to replace letters;
it is impossible to construct a correct sentence from the point of view of grammar;
incorrect intonation, pronunciation or stress in words;
drafting incomplete sentences;
lack of ability to read or write;
vocabulary is limited;
the ability to call names, cities and surnames is limited;
speech disorder;
incoherent speech (nonsense);
lack of understanding of simple requests, as well as failure to fulfill them.
Methods of diagnosis of aphasia
To make a correct diagnosis requires the involvement of a speech therapist, neurologist and neuropsychologist. The true cause of the disorder can be determined by the results of CT or MRI of the brain. Also, in order to establish the location of the injured area, ultrasound of the vessels of the head and neck, MR angiography, scanning of brain vessels, lumbar puncture are performed.

It helps to establish the degree of speech disorder:

oral examination;
written verification;
research of auditory-speech memory;
determining the possibility of identifying objects;
constructive-spatial research.
Aphasia should be differentiated from alalia, dysarthria, hearing loss and UO.

Correction of aphasia
The treatment of the disorder is specific and depends on the reason why the pulse does not reach the speech analyzer.

The right way to treat, if possible, is to eliminate the cause of aphasia, which provoked the appearance of signs of a neurological disorder. If this is caused by a concomitant disease of a purulent or tumor process, then a surgical method of treatment is recommended.

In case of a violation after a stroke, emergency therapy is carried out — depending on the type of attack.

When the disease occurs against the background of the inflammation process, a course of treatment with antibacterial agents is prescribed. If the process is protracted, then hormone therapy is carried out, provided that another, conservative method will not bring the desired effect.

During therapy, constant work with a speech therapist is required, but longer speech support (1-2 years) by a professional may also be required.

Prevention of the disorder and prognosis for recovery
No specialist can determine the exact time of recovery — due to the fact that it depends on the duration, prevalence and localization of the process in the brain, as well as the therapy started in a timely manner. Depending on the patient’s condition, the dynamics of recovery is determined.

In 90% of cases, with the support of a team of specialists, patients manage to return the speech function in full. Treatment is better in young and middle-aged patients, but at the same time, if the pathology developed in early childhood, then there is a possibility that severe consequences will appear against its background in the future.

The longer the correction of aphasia, the higher the chance of recovery.

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