Aphasia — Total or partial loss of speech due to the defeat of the speech centers of the cerebral cortex, or their pathways at safety features of speech muscles (tongue, lips, throat). Aphasia occurs when a cerebral hemorrhage, thrombosis of brain abscesses, traumatic brain injuries, etc., often accompanied by aphasia disorder reading — Alex, letters — agraphia, account — dyscalculia. Depending on the affected areas to develop different forms of aphasia.
Logaphasia characterized by difficulty or inability to speak the words while keeping the pronunciation of individual sounds and understanding speech. In the most severe aphasia it is completely absent. In these cases, even after the restoration of speech in a patient remain difficult in the complex utterances, by repeating a series of words (house, forest, cat) phrases.
Sensory aphasia characterized by impaired speech understanding (verbal deafness) while maintaining the ability to speak. In mild cases, the patient can understand individual words and even short phrases, especially the familiar ("open mouth", "show the language"). In contrast, patients with motor aphasia, these patients are chatty, but because they do not understand and the words, they lose control of his speech, and it too is broken, there are replacement letters, syllables and even whole words.
Semantic (semantic) aphasia characterized by impaired understanding the meaning of sentences, which are connected by prepositions, conjunctions, and so the patient is well say to them and understand it, but can not understand the difference in such phrases as "the brother of the father" and "father's brother", can show a pencil the key, but do not understand the job to show pencil key or pencil. Semantic aphasia is often associated with amnestic disorder of speech.
At amnestic aphasia Patients forget the names of things. Rather than call a spoon, a pencil, they describe their quality and purpose: "it is — what they eat," "it is — what they write." Often, however, by saying the first syllable, the patient remembered word and said it, but after a few minutes he forgets it again.
At total aphasia the patient does not speak or understand the language. Reading and writing are quite possible.
In all forms of aphasia to treat the underlying disease, and spend long sessions with a speech therapist. We must remember that aphasia is not a mental disorder, and these patients can not be treated psychiatrists.
Aphasia (from the Greek. Aphasia — loss of speech) — speech impairment due to changes within the actual or the second system (Pavlov), carrying out the analysis and synthesis of words, which are "signals of signals", or the relations of the second signaling system with the first. Thus, from aphasia, dysarthria excluded (see), and the speech disorders that depend on deaf (deaf not to hear speech in aphasia patient hears it, but does not understand its meaning, does not perceive the word as a "signal of signals").
Second signaling system, as well as in the first, there are afferent and efferent parts, the word is not only pronounced the man to communicate with their peers, but also perceived them. Therefore we can speak of expressive speech, which includes both oral and written language (at the last written or printed word is the same as a "signal of signals", but by moving the brush and perceived by sight), and impressive speech — speech understanding with hearing and reading. Speech process is one, but it can be broken in a variety of its components, whereby the aphasic disorders are characterized by great variety.
A breach may be predominantly expressive (motor aphasia) or impressive speech (sensory A.), speaking (actually A.) or written (alexia — violation read agraphia — violation of writing).
Study aphasic disorders. Speaking. The study re-speech (letters, words, phrases), Private speech (number series, listing days of the week, months, etc.), the naming of objects displayed, Conversation (answers to questions), the story. In the study to pay attention to the desire or reluctance to speak on poverty of speech or circumlocution (logoreya). When amnestic aphasia drop specific designations, names of objects. A. When the motor suffer most of the grammatical structure of speech (cases and declination) — the so-called agrammatism. Literal paraphasia characterized rearrangement or replacement of letters in a word, the verbal — the replacement of words in a sentence.
Writing section. Patient give written off, take dictation, writing previously memorized words, names displayed items; asked to write answers to the questions orally or in writing, a story on the same topic, a retelling of the literary work.
Understanding speech. Understanding the meaning of words, phrases, showing of known objects, understanding and implementation of simple and complex (mnogozvenevyh) instructions (to exclude apraxia), understanding the story with simple and complex content semantically. It is essential to determine the diffusivity of speech perception, which are designed phrases and instructions with ridiculous content, with extra words, grammatical and syntactical irregularities, etc.
Reading. Separately examined reading aloud and reading comprehension himself because there are cases where these functions are broken more or less independently of each other. Also study music as expressive speech, and an impressive (auditory and visual). Violations of musical language are called amusia.
Aphasia syndromes. In cases where the lesion is very large (stroke, trauma) and the initial stage of a lesion (diaschisis, irradiation of inhibition), impaired speech covers all aspects of the process and there is a total aphasia. A total sometimes remains in the future, but in many cases, to some extent recovered and identified syndromes exhibiting dissociation of speech functions, in milder cases can be observed in the initial phase of the disease. Basic forms of aphasia, characterized by dissociated speech disorder, are motor, sensory, conduction, amnestic aphasia, alexia.
Motor aphasia (aphasia B rock) is characterized mainly by a violation of expressive speech and most of the written language. In severe cases, it is either not possible, or is limited to "the remains of speech" — interjections stereotypical meaningless constellations of sound, the usual oaths, etc. In less severe cases, common symptoms are aspontannost speech, agrammatism, literal paraphasias. Repetition and ordinary speech violated, but often to a lesser extent than spoken language and story. Violation letters have the same character as the violation of speech. Much less common so-called clean (subcortical, in Wernicke) motor aphasia, which is broken only by the spoken word, and the letter is intact, indicating the preservation of inner speech. There are cases (A. Transcortical motor) when disturbed only spontaneous speech and writing, and repetition, ordinary speech and copying saved.
Sensory aphasia (Wernicke's aphasia). The main symptom — violation understanding of oral and written language. In severe cases, the patient relates to speech, as any noise that has no meaning. In less severe in the chaos of sounds, it still catches a few words — the most common usage, especially the name. Expressive speech is also broken, but quite differently than motor A. When the last patient said reluctantly, and little, if A touch it unnecessarily verbose (logoreya), said smoothly, without pressure. However, this product can be long-winded so rich verbal paraphasias and perseveration that it becomes quite confusing. The patient does not understand what they read and speaking correctly picks in the text only the individual, the most familiar words. In more rare cases, the "pure" (subcortical, in Wernicke) sensory A. oral and written language, and reading comprehension (inner speech) are preserved, broken only understanding speech. There are also cases of sensory A. (A. Transcortical touch by Wernicke), when maintained in violation of the repetition of understanding speech.
Conduction aphasia is characterized by Wernicke, paraphasias, impaired repetition, reading and writing while preserving speech understanding and cheating.
A. When amnestic patient "forgets" the names of objects with well-preserved structure of sentences and the lack of paraphasias. The same "forgetful" signs characterized and writing.
Alexia, agraphia as is observed in varying degrees, in most cases, motor and sensory, A., but is sometimes found in isolation, as a "pure spiritual blindness": the patient sees the written word, but does not understand its meaning.
Topikodiagnosticheskoe value aphasic syndromes. The nature of aphasic syndromes defined lesion, the nature of the pathological process, the general state, especially the state of the vascularization of the brain, the age of patients, their premorbid state, the type of higher nervous activity. When aphasia defeat is localized to the area of distribution of the anterior branches of the left (right-handed) of the middle cerebral artery, most often (though not always) with damage to Broca's gyrus.
Sensory aphasia occurs in lesions of the left (right-handed), the temporal region. And in such cases it is impossible to speak of any narrow localization within this zone, but still defeat most often found in the posterior part of the superior temporal gyrus (posterior field 22). Amnestic A more common in cases where the center is located in the transition of the temporo-parietal-occipital subregion (Area 37), pure alexia — with the defeat angular gyrus (field 39).
Course and prognosis aphasia depend largely on the nature of the underlying disease. As temporary A. occurs in rare cases during a migraine attack or due to an epileptic seizure. Forecast ceteris paribus more favorable in sensory A. than the motor, and a much more favorable in the younger age than in the elderly. Therapy should be directed to the treatment of the underlying disease, are very important and special events — systematic exercises in speech and writing.