Loss of speech in full or partial volume for a person is a difficult situation that significantly affects 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 serious injury or trauma.
Depending on the location of the pathological focus, speech disorders can have different manifestations, and this is associated with 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 provoking violations
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 damaged (the inferior frontal gyrus of the left hemisphere).
(lack of understanding of the meaning of one’s own and others’ words) is associated with pathology in the cortical part of the auditory analyzer (the upper part of the temporal lobe of each hemisphere). Combined damage to these areas leads to the development of total (sensorimotor) aphasia.
The main reasons for the appearance of this symptom:
Predisposing factors are considered:
- venerable age;
- unfavorable family history;
- concomitant severe diseases - atherosclerosis, decompensated diabetes mellitus, arterial hypertension, coronary artery disease, frequent heart and vascular defects.
Clinical manifestations
Sensorimotor aphasia is a combination of symptoms characteristic of both types of speech disorders. Such a complex clinical situation causes significant difficulties in communication in people with preserved intelligence and leads them to disability.
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 similar sounds at other times is possible;
- 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 on the first utterance and stops speaking further 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 pronounce words correctly and construct phrases; they often speak quickly and frequently, without understanding the meaning of what they hear. Both spontaneously emerging speech and repetition after a speech therapist, describing objects and pictures, or reading aloud suffer.
The combination of symptoms of sensory and motor aphasia results in the clinical picture of a sensorimotor disorder, as the most severe of all. The patient does not understand others and cannot speak normally himself.
The degree to which you lose your speech and the ability to correctly recognize the conversation of people around you will depend on individual characteristics and the severity of existing injuries.
This complex type of aphasia is also called total because of the disruption of all aspects of a person’s speech functions. Often it can be combined with other neurological manifestations (for example, with) or general symptoms (absent-mindedness, apathy, drowsiness).
Medical assistance
For patients with aphasia, it is necessary to organize two directions of treatment.
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 if rehabilitation work begins early and all doctor’s recommendations are followed in full, as well as with the active participation and help of relatives and friends of the patient with aphasia.
Motor aphasia is a violation of articulate speech due to damage to the speech center in the brain. The speech organs themselves (tongue, lips, teeth) retain full functionality. The “central control” of these bodies is being violated. Aphasia can be a symptom of various diseases.
The severity of the condition with aphasia can vary significantly - from difficulties in pronouncing individual words and composing sentences to a complete absence of intelligible speech. Aphasia is usually combined with a writing pathology - agraphia, and the severity of the speech disorder is the same for them.
Causes of aphasia
Damage to the areas of the cerebral cortex responsible for the reproduction of articulate speech leads to aphasia. The causes of such damage are extremely varied:
- Stroke of ischemic or hemorrhagic nature;
- Chronic circulatory pathology in the corresponding areas of the cortex, for example due to an aneurysm or atherosclerosis;
- Epilepsy if the epileptogenic focus falls on the center of speech or is located next to it;
- Traumatic damage to brain tissue;
- Brain tumors of various etiologies;
- Abscess (limited purulent inflammation) of the brain substance;
- Exposure to toxins (poisons, heavy metal salts);
- Demyelinating processes, such as multiple sclerosis and encephalomyelitis. They lead to the destruction of the membranes of neurons with a gradual loss of their functions;
- Degenerative diseases of the brain with a progressive decrease in its mass and number of neurons. The most characteristic diseases of this genus are prion infections (Creutzfeldt-Jakob disease and kuru).
The prevalence and severity of the process influence the severity of aphasia. Its types are determined by the specific localization of the process. Symptoms depend on the type of aphasia.
Afferent motor aphasia
It develops when the pathological process is localized in the speech zones of the postcentral and inferior parietal gyrus. At the same time, it is difficult for the patient to reproduce the position of the articulatory apparatus necessary to pronounce a sound. There are two types of afferent motor aphasia:
When these areas are damaged in the left hemisphere, in right-handed and left-handed people, motor aphasia is extremely pronounced, up to the complete absence of coherent speech. While speech is intact, patients are often forced to replace words with synonyms. They have difficulty pronouncing consonant sounds; they cannot pronounce individual letters at all. Words, even the simplest ones, are pronounced syllable by syllable. It is also difficult to understand someone else’s speech, in particular complex sentences, verbs with prefixes, and pronouns in different forms. This form of aphasia is characterized by a combination with agraphia.
Damage to these same areas in left-handers who were retrained at an early age to be right-handed proceeds differently. Patients have difficulty writing and pronouncing letters in the correct order. They may completely skip vowels or consonants in a word, or write one type of letter first, then another. At the same time, the understanding of the required order of letters is preserved and patients try to compensate for it. For example, having missed the letter “th”, the patient puts a dash over the next or previous letter.
Efferent motor aphasia
Occurs when the premotor cortex is damaged. In this case, the patient cannot change the position of the articulatory apparatus - having uttered one sound, he cannot switch to the next. Efferent motor aphasia is also called Broca's aphasia, after the name of the causal zone of the cerebral cortex.
Efferent motor aphasia is combined with motor disorders - they become “mechanical”, lacking smoothness, with periodic freezing.
The pronunciation of sounds in this type of motor aphasia is preserved, but speech loses smoothness and intonation, it becomes monotonous. Writing is possible only when the words being written are spoken simultaneously. In speech, there are permutations of letters between adjacent words.
Motor aphasia can be combined with other types of speech impairment when the pathological process spreads to neighboring areas of the cortex. This is how afferent-efferent aphasia, sensorimotor aphasia (lack of understanding of speech with healthy hearing organs, combined with speech impairment), total aphasia (impaired understanding, pronunciation and writing at the same time) appear.
Diagnostics
Identifying motor aphasia is not difficult, so its diagnosis is aimed at finding out the cause of the speech disorder. To do this, the neurologist:
- Carefully asks about the circumstances of the onset of aphasia and the events preceding it;
- Conducts an in-depth neurological examination to identify concomitant neurological disorders;
- Takes an electroencephalogram to identify foci of pathological activity in the brain, which will help diagnose epilepsy and suspect the presence of a space-occupying lesion.
- CT or MRI is prescribed if a tumor, aneurysm is suspected, or to clarify the location and size of a stroke.
- Additionally, a contrast-enhanced examination of the vessels of the head may be performed to exclude an aneurysm.
Treatment
With motor aphasia, the first step is to eliminate its cause:
- In case of a tumor - its surgical removal or courses of chemotherapy and radiation therapy;
- For stroke, the use of nootropics, neurometabolic drugs, antioxidants, angioprotectors. In case of large-volume hemorrhagic stroke, removal of the clot;
- Treatment of an abscess is carried out with antibiotics in combination with anti-inflammatory drugs; if conservative treatment is ineffective, surgical drainage of the abscess is possible;
- Anticonvulsants for epilepsy;
- Glucocorticoid therapy for demyelinating and degenerative processes;
- Surgical or conservative treatment of injury;
- Surgery to reduce the size of the aneurysm.
For all forms, classes with a speech therapist are indicated. Regular classes for aphasia will help partially restore articulate speech, which will also improve writing. There are methods of treating aphasia through singing. They are often very effective, because when singing, each sound is pronounced longer than when speaking, and the patient’s articulatory apparatus has time to rebuild.
Prevention
There is no specific prevention for aphasia. It is recommended to regularly take antihypertensive drugs in the presence of high blood pressure to prevent strokes. You should also be very careful about ear infections; do not leave ear infections untreated - this can lead to a brain abscess.
Localization of the lesion. Primary defect. Neuropsychological signs. Speech status of the patient. Violation of writing, reading, counting, understanding 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 usually accompanied by kinetic apraxia, which is expressed in difficulties in assimilating and reproducing a motor program.
Damage to the premotor parts of the brain causes pathological inertia of speech stereotypes, leading to sound, syllable and lexical rearrangements, perseverations, and repetitions. Perseverations, involuntary repetitions of words and syllables, resulting from the impossibility of timely switching from one articulatory act to another, make oral speech, writing, and reading difficult and sometimes completely impossible.
Efferent motor aphasia is multivariate. There are five variations of this form. A.R. Luria identified and described in detail 4 of its options.
Expressive speech impairment in different types of efferent motor aphasia. With severe efferent motor aphasia at an early stage after a cerebrovascular accident, one’s own speech may be completely absent. Apraxia of the articulatory apparatus in this form of aphasia is manifested not in difficulties in 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 perseverates sounds from the previous sound or syllable series, without experiencing difficulties in the very act of sound pronunciation. This is the most severe type of efferent motor aphasia.
Due to the inertia of articulation of individual words, contaminations may be observed due to syllable transfers of the previous word: “stack” (table, spoon).
In another variant of efferent motor aphasia, with spontaneous restoration of speech and communication, pronounced expressive agrammatism is often formed: patients miss verbs, have difficulty using prepositions, inflections of nouns, so-called agrammatism of the “telegraphic style” type is revealed, which arises as a result of a violation of the predicative function of inner speech. In easier cases, verbs are moved to the end of the sentence. For example, during a story based on a series of plot pictures “An Incident on the River,” the following text was spoken:
“This is a boy... a boy and here is a river and a raft and a boy, how is it... to fall into the water and a raft to call there far away... And the pioneer boy needs to take off his boots... he is calling, how is it... 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, and the pronunciation of words becomes drawn out. Long pauses caused by the inertia of speech processes superficially resemble the amnestic difficulties characteristic of semantic aphasia, but they are based on the inertia of the choice of lexical means.
Dysregulation of word choice also leads to verbal paraphasias, which are caused by inertia in switching when extracting them 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,” says: “The boy is fishing, being caught in the river,” or instead of “The blacksmith is forging a horseshoe,” he says “ A blacksmith is forging something.”
Another variant of efferent motor aphasia is observed, in which speech is disrupted only at the level 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 aspect of speech, the emphasis not only on stressed syllables suffers, but also on the intonation coloring of the psychological predicate, i.e., that new thing that is mentioned in the message, on which the logical stress falls.
Naming function. In severe forms of speech impairment, the naming function is completely absent, and when the first syllable of a word is prompted, it either ends automatically or slips into another word starting with the same syllable. For example, when naming object pictures, the patient, having received a syllable prompt mo, instead of the word milk pronounces “sea”, “carrot”, “ice cream”, etc.
Violation of writing. With efferent motor aphasia, pronounced agraphia is observed: writing a word or phrase is possible only when pronouncing the words syllable by syllable.
In severe cases, when repeating a word correctly, it is not only impossible to write it down, but also to put together the already selected letters of the split alphabet.
Reading impairment. In the most severe cases, reading is guessing in nature, showing one or another written word, adding captions to pictures. These gross violations of reading and writing are caused by the disintegration of the ability to program the sound-letter composition of a word. With the “telegraph style” reading can be preserved.
In milder cases, reading individual words and short sentences is possible, but reading comprehension is difficult, especially sentences with a complex syntactic structure.
Impaired understanding. The basis for the disorder of understanding in efferent motor aphasia is the inertia of the flow of all types of speech activity, a violation of the so-called “sense of language” and the predicative function of inner speech. There is no auditory distinction between grammatically correct and incorrect statements. The figurative meaning of metaphors and proverbs is poorly understood, which is explained by the difficulty of switching to a different, hidden meaning of a statement (A. R. Luria, 1975); there is a violation of the understanding of the polysemy of words. For example, words braid, key, go- patients perceive them as incorrect.
Sensory aphasia is manifested by impaired understanding of words due to damage to the area of the cerebral cortex responsible for speech analysis. Therefore, sensory aphasia can manifest itself in two groups of symptoms - impaired understanding and impaired oral speech.
The area of the cortex that recognizes the meaning of words is located in the temporal region, in the left hemisphere of most people. It is also called the auditory analyzer or Wernicke's area. Accordingly, sensory aphasia is also called Wernicke's aphasia.
Reasons
In most cases, aphasia is caused by damaging effects on the brain. In adults this may be:
- Strokes. The most common cause of aphasia. Both hemorrhagic and ischemic strokes in Wernicke's area result in sensory aphasia.
- Temporal region injuries
- Tumors of various origins
- Aneurysms of cerebral vessels. In this case, aphasia can develop in two ways - due to the pressure of the aneurysm on the temporal region or when it ruptures and subsequent bleeding
- Infectious diseases – encephalitis
- Abscesses of the temporal region can develop as a complication of otitis media
- Degenerative and demyelinating diseases.
Aphasia in children most often occurs as a result of trauma, tumors, aneurysms, and infections. Stroke is extremely rare in them, but stroke cannot be completely excluded as the cause of aphasia. Cases of epilepsy combined with acquired aphasia have also been described in children, named after the scientists who first described the disease.
Aphasia manifests itself in two large groups of symptoms - the first combines a violation of speech perception, the second - a violation of word pronunciation.
Impaired speech perception in sensory aphasia is associated with the inability to recognize words and sounds. They are perceived as an incoherent mixture of sounds, speech seems foreign. Patients do not understand the meaning of words. At the initial stages of the disease, the ability to determine the group membership of a named object is sometimes retained - small or large, living or non-living, etc.
A distinctive feature of sensory aphasia is a preserved response to action-related instructions. For example, the patient correctly understands the commands “raise your hand” or “nod,” but will not be able to answer the name of an object.
In the future, if left untreated, the perception disorder worsens until speech is completely misunderstood.
Spoken speech impairment occurs due to the inability to auditory control of spoken sounds. The patient speaks in separate, unrelated words and sounds, can swap sounds in a word, and pronounce only part of them. The transmission of intonation in speech is disrupted. Gradually, the pronunciation of words is restored, the patient becomes verbose, tries to explain his thoughts, selects synonyms for words that he cannot remember.
The absence of criticality in patients is characteristic. They are confident that they speak correctly and clearly and get annoyed when they are not understood.
Accordingly, when oral speech is impaired, written speech is also impaired. Reading suffers minimally - the patient confuses the position of stress in words, reads some letters incorrectly, which interferes with understanding what is read. However, in general, the ability to understand the meaning of a written text is preserved quite fully.
Associated symptoms
Sensory aphasia is rarely the only symptom of the underlying disorder. It is often accompanied by signs of paranoia and agitation. Aphasia after a stroke can be combined with impaired mobility in the right half of the face, smoothing of the right nasolabial fold. Characteristic loss of parts of the visual field on the right. Significant neurological impairment is usually absent.
In case of aphasia due to an abscess or encephalitis, there are general signs of an infectious process - fever, signs of intoxication; in the case of encephalitis - characteristic changes in the cerebrospinal fluid.
Features of sensory aphasia in children
Aphasia in children can be confused with alalia (primary absence of speech). The main difference between these syndromes is that with aphasia there is a regression of developed speech, while with alalia speech does not develop initially. Due to insufficient development of the speech apparatus, aphasia in children has some characteristic signs:
- Aphasia in children occurs very quickly and speech functions are restored just as quickly. The absence of noticeable improvement within several weeks significantly worsens the prognosis for recovery.
- Manifestations of aphasia, especially in young children, are extremely scarce. Their speech is not yet developed enough for the full development of the clinic. Most often in children it is only possible to differentiate between motor aphasia and sensory aphasia.
- To restore speech, the child’s speech center functions must be restored or compensated by neighboring areas of the cortex. In adults, compensation is often possible due to a developed system of logical connections in speech and a developed conceptual apparatus.
Forms of sensory aphasia
The addition of additional lesions in the cortex leads to the appearance of additional speech disorders. This is how the forms of aphasia are distinguished:
- Semantic aphasia is a violation of understanding the relationship between words and objects, especially spatial ones;
- -aphasia – violation of counting;
- Sensory-motor aphasia is a violation of speech understanding combined with the inability to formulate correctly;
- Total aphasia is the degradation of all types of oral and written speech along with a disorder of speech understanding.
Diagnosis of sensory aphasia
It consists of searching for the causative disease. This requires a set of measures:
- Careful questioning of the patient to identify risk factors preceding the disease;
- Neurological examination to look for associated disorders that may not be noticeable externally;
- A set of instrumental examinations - electroencephalogram, CT or MRI, contrast angiography of the vessels of the head will help to identify a volumetric formation of the cranial cavity, vascular aneurysms, the presence of hemorrhages or consequences of ischemic stroke, abscesses and other pathologies.
Treatment of sensory aphasia
A rather long and multicomponent process, a significant part of which depends on the cause of aphasia. Treatment necessarily includes sessions with a speech therapist. It is advisable to divide the methods of treating aphasia into medication and speech therapy.
Speech therapy correction of sensory aphasia
Classes with a speech therapist will help restore the correct pronunciation of sounds, expand your vocabulary, and restore meaningful speech. For this purpose, special exercises and equipment are used, which only a professional speech therapist can work with. At home, you can also perform a number of simple exercises: ask the patient to name surrounding objects, parts of the body, and combine a written word with its image. Communicate more with the patient - at first, mostly ask simple questions that can be answered “yes” or “no”, then move on to open questions, practice thematic dialogues.
It is important to create a comfortable environment for the patient. The patient with aphasia actually found himself transported to a foreign country with an unfamiliar language. Talk to him calmly and slowly, let him feel supported.
Drug treatment of sensory aphasia
Universal drugs prescribed for aphasia of any origin are nootropics, B vitamins and neurotrophics.
The choice of other drugs for treatment depends on the cause of the aphasia. Thus, for a stroke, it is possible to prescribe thrombolytics or hemostatic drugs, depending on its form. Antibiotics and anti-inflammatory drugs are used to treat brain infections.
Video lesson on sensory correction
Sensorimotor aphasia, often called Broca's aphasia, is a severe neurological disorder characterized by 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 caused by:
- traumatic brain injuries;
- suffered a stroke;
- brain abscess;
- encephalitis of various nature;
- chronic disorders of the functioning of the central nervous system;
- malignant and benign brain tumors with a tendency to rapidly grow;
- and Alzheimer's.
The risk group for developing the disease includes 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: motor aphasia and sensory aphasia.
With motor, there is a complete loss of coherent speech. The patient cannot pronounce words, but is able to understand someone else's speech. In this case, the pronunciation of individual sounds does not cause difficulties.
Sensory - accompanied by specific deafness, characterized by the inability to perceive speech. The patient’s hearing is not affected; the disorder 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 himself is saying, so over time, speech loses intelligibility, words are replaced by meaningless sounds.
Sensory-motor aphasia is considered a separate type, characterized by the simultaneous inability to pronounce words and perceive speech by ear. This form is characterized by both motor and sensory symptoms. This disorder is the most complex and practically impossible to treat.
Clinical forms of motor aphasia
There are two separate types:
- efferent motor aphasia;
- afferent motor aphasia.
Efferent is accompanied by the ability to pronounce syllables, but the patient’s complete inability to put them together into words. A characteristic feature of this clinical form of the disease is the patient’s peculiar fixation on certain sounds that he can produce well. At the same time, switching from one group of sounds to another is very difficult, which is the main obstacle to the patient’s normal coherent speech.
Afferent motor aphasia is characterized by the inability to specifically pronounce certain sounds. However, this form of pathology is characterized by 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 pronounced voluntarily.
Other forms of pathology
Broca's aphasia is divided into the following types:
- amnestic;
- semantic disorder;
- total violation.
Amnestic aphasia leads to the loss of the nominative meaning of words. With this form, the patient is unable to name certain objects. Causes memory impairment, in which the patient forgets the name of an object, but not its function. It is common for such patients to name objects by their function, for example, the patient will call a ballpoint pen “an object that writes.” The disease is also characterized by the ability to remember the name of an object if the patient is prompted by the first letters or the first syllable.
As the name suggests, 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 loses writing and reading skills.
How does the disease manifest itself?
Aphasia occurs when the part of the brain responsible for speech and its perception is damaged. The peculiarity of the disease is that it progresses steadily.
Characteristic symptoms of the disorder:
- arbitrary rearrangement of sounds in words;
- tendency to omit letters when writing and speaking;
- violation of word pronunciation;
- difficulty choosing the right word in speech;
- increased pauses in conversation;
- lack of emotion when speaking;
- an increase in the number of errors when writing and reading;
- impaired memory and analysis of spoken language;
- 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, 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 a brain examination (MRI) and analysis of the number of damaged areas.
Patients are also prescribed vascular Doppler ultrasound and lumbar puncture. The doctor evaluates 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. The following drugs are used:
- vasoactive agents;
- antidepressants and sedatives;
- drugs to normalize muscle tone (muscle relaxants);
- nootropic drugs.
Particular attention in drug treatment is paid to nootropic drugs that improve cognitive function and normalize metabolic processes in the brain.
Along with drug treatment, the patient is prescribed speech correction by a speech therapist, as well as physiotherapeutic procedures to normalize metabolic processes and improve blood circulation.
Timely treatment will help restore speech abilities, but this will require at least two years. In advanced cases, without qualified treatment, complete loss of speech and the ability to perceive it is possible.