Motor aphasia. Afferent motor aphasia

Motor aphasia in medicine has another name - Broca's aphasia, in honor of the researcher who described the ailment. This is a serious speech disorder that occurs against the background of the defeat of the frontal part of the left hemisphere and the violation of its functions. Similar problems often arise as a result of a stroke or severe trauma of the skull and brain.

This pathology is expressed by strong defects in speech, difficulties in choosing words in the process of speaking, and, unfortunately, it is not only a violation of articulation.

What distinguishes afferent aphasia?

One of the varieties of pathological speech disorders is afferent motor aphasia, also called kinesthetic.

In the patient, the lower-stratified parts of the brain (the leading hemisphere) are affected. Right-handers - this is the left hemisphere, which is responsible for the process of speaking. With this type of speech disorder (in mild form), the patient has a special fluency in speech with no pauses between words. At the same time, violations of articulation, as well as paraphase defects (that is, replacing some sounds or syllables in words with others) are noticeable during the process of reading or spontaneous speaking.

In a severe case, the patient is difficult to pronounce the sounds. And afferent aphasia has an interesting feature - a person, for example, can involuntarily pronounce some of them, and at the request - no, because at that moment he has to solve the problem, exactly how one should put his lips together, where to put the tongue, etc., To make this or that sound.

Additional signs of afferent motor aphasia

It should be noted that in addition to the presence of speech problems, patients with a diagnosis of "afferent motor aphasia" also violate oral (i.e., non-verbal) praxis.

This condition is expressed in the inability to perform various oral movements (by the way, both independently and after demonstrating them by someone), for example, to inflate both or one cheek, stick out the tongue, etc.

And as a result of the kinesthetic defect, patients have problems with writing (both dictated and independent). By the way, quite often the listed disorders are accompanied also by passivity of the patient caused by inertness of processes in nerve fibers.

What is efferent aphasia

Efferent motor aphasia is another type of speech pathology, in which the posterior part of the inferior frontal gyrus is affected. The patient is often able to pronounce individual sounds, but to collect them in a word, "switch" from the first sound to the next, he is not able to. In patients with this type of pathology, the process of organization of the speech act, the so-called "kinetic melody" (as the researcher AR Luria said) is violated.

For such patients, it is characteristic to "hang" on the first sound or the first syllable of the word with subsequent long repetitions. Speech loses its smoothness, the choice of words is difficult, there are so-called emboli - words or sets of sounds that the patient tries to replace everything that is not able to pronounce.

Speech features with efferent aphasia

And most often in the process of speech (with the diagnosis of "efferent motor aphasia"), the patient uses only nouns and verbs in the initial form, for example: "House ... it's ... stand." What the patient says is usually a telegraphic style, but the truth is that the phrases are quite informative.

Correction work in motor aphasia, by the way, often implies the use of melodic-intonation technique. Patients are offered to sing, and also slowly and singingly utter words. And it is interesting that with such exercises (even with deep articulation disorders) the pronunciation process becomes almost normal.

Severe cases of motor aphasia

If motor aphasia is severe, then the patient's speech can consist only of indistinct sounds or the words "yes" and "no." Patients try to pronounce all the phonemes available to them with different intonations so that the interlocutor can understand their attitude to what they heard. By the way, as already mentioned above, oral speech by such patients is perceived almost to the full, exceptions can only be complex speech or parables.

By the way, the emotional background of people with motor aphasia of any severity is also violated. Patients usually become whiny and easily fall into a state of despair or depression. Neurological signs of pathology are characterized by the weakness of facial muscles, as well as the inability to use the muscles of the face, throat and mouth at the same time. The field of vision of these patients also shifts from conventional boundaries.

What is sensory aphasia

The most severe type of speech disorder is sensory-motor aphasia, or in a different way - acoustic-gnostic. It is caused by the defeat of the posterior third of the superior temporal gyrus and is expressed in a violation of the understanding of the spoken sounds, although the processes of pronunciation and articulation in patients, as a rule, are not violated. Problems with phonemic hearing, which appeared in such patients, lead to a lack of control over their own speech.

One should also note one more feature of this type of speech disorder: sensory-motor aphasia is characterized by the fact that, in contrast to previous types of pathology, the patient does not realize his problem.

Patients with this diagnosis, as a rule, speak quickly, but use words with an arbitrary meaning. And all this looks to the listener as a kind of verbal "salad", in severe cases completely devoid of meaning.

Speech restoration in motor aphasia: what to remember

Practice shows that even with the same forms of aphasia in each patient, it manifests itself in different ways. It depends not only on the state of health and age, but also on the educational, cultural levels of a person, as well as on the characteristics of his personality.

In acute course (after a stroke), total aphasia at once can arise, in which the patient is unable to utter a sound. But, fortunately, often speech begins to recover with time.

At the same time, those close to those who want to help the injured person should not be shouting at a conversation with him, trying to encourage him to talk - he hears you perfectly. Do not, too, referring to the patient, speak with complex phrases, since the process of perception of what was said at this time is very difficult for him. But at the same time, it should be remembered that the patient has not violated the intellect. The problem for this person is precisely the difficulty of pronunciation!

Motor aphasia - treatment depends on many factors

Unfortunately, it is quite difficult to return the speech in full after a stroke or brain trauma. But the patient, with the right attitude toward this environment, manages to restore his communicative abilities to a sufficient degree.

Of course, first of all, a comprehensive examination of the patient should be carried out in order to find out the cause of the violations. As you have already understood, the method of speech restoration depends to a large extent on the exact area of the brain affected.

To work with a speech therapist add and drug therapy. With the diagnosis of motor aphasia, treatment usually involves taking medications such as Cavinton, Korsavin, TeleTot, etc., which have a vasoactive orientation (they improve the blood supply to the brain). No less popular are anticholinesterase substances such as Amiridin and Galantamine (they have a stimulating effect on the autonomic nervous system), as well as muscle relaxants, which reduce muscle tone in the paralyzed limbs (preparations "Elatin" and "Midokalm"), and nootropic Substance.

Important and physiotherapy activities in the form of acupuncture, massage, physiotherapy exercises and electrical stimulation.

How to restore speech at the initial stage

Already in the early stages after detection of the problem, motor aphasia requires correction, since the most effective recovery of speech is possible only in the first month after the onset of the illness (later, significant positive changes are usually not noticed).

At the same time, one should try to "disengage" the speech, cause the patient to have a flow of speech. That is, those who help the patient, should provoke his pronunciation of at least some sounds, use all the possibilities. For example, suggest imitating any sounds: "Tell me, how does the water drip?" "Cap, cap." Or: "How does the wind howl?" - "U-y-u". Another example: "How does the car go?" - "F-f-g". Thus sounds should be strongly articulated, that the patient could understand, how at the speaker thus lips move.

Some features of motor aphasia correction

If the patient has motor aphasia light degree, do not encourage him to use gestures or facial expressions instead of words, try to stimulate speech. But do not force events, get clean and clear pronunciation. Do not constantly correct everything the patient said.

Ask the patient to finish talking to you, for example, the well-known sayings: "Quiet go - on ..." At first he can not utter the entire word, even an imitation of sounds that will cause an urge to speak. This will also help and photos of loved ones. You need to ask someone to show them and name him.

As soon as disinhibition has begun, try to use verbs, connect all kinds of communication: speech, writing, reading. For example: "What does a cat do?" "He's asleep." Let the patient not only utter this word, but also find among the proposed signatures the one that corresponds to the picture.

What to do in case of severe aphasia

As mentioned above, a severe degree of aphasia leads to the fact that a person is not able to pronounce even a syllable, and not just a word. In this case, it will come in handy for the ordinal account, the repetition of the names of the days of the week or singing.

The fact is that these processes are the most automated, and control over them is transferred to other parts of the brain. Therefore, considering after you: "One, two, three, four," the patient utters sounds without hesitation. By the way, the same thing happens in the process of singing. The song should be familiar and simple. First, sing it along with the patient, and then encourage everything, even indistinct attempts at independent singing or counting.

Remember that at all stages of rehabilitation, patients need encouraging conversations and positive motivation for classes, since the emotional factor is an important component that successfully overcomes the motor forms of aphasia.

A few words at a time

Work to restore speech is a rather lengthy and difficult process. It requires joint efforts of the attending physician, speech therapist and, of course, the close environment of the victim. Moreover, correction of motor aphasia should be carried out necessarily at a professional level, and the earlier it is started, the more chances for success.

Particularly pronounced positive dynamics in young patients. A spontaneous exit from the state of motor aphasia, among other things, may be accompanied by the emergence of stuttering.

Consider all this, do not lose faith in success - and you will succeed!