Motor aphasia, or Broca's aphasia is a severe speech disorder that occurs due to the defeat and dysfunction of the left frontal lobe of the brain, characterized by pronounced speech defects and difficulty in selecting words. The disorder often occurs as a post-stroke complication, or the consequences of severe craniocerebral trauma. Motor aphasia is not limited only to a violation of the articulatory functions of the speech apparatus.
The main types of motor aphasia and their description
Despite the prevalence in the adult population due to the diseases and mechanical injuries suffered, the syndrome occurs in children. It proceeds in an easy and complicated form.
The first case is the preservation of the child's individual speech skills and stock words. In severe cases, the child ceases to speak at all, or utters only meaningless and incoherent phrases.
Afferent( kinesthetic) aphasia
Occurs as a result of damage to the surface of the parietal lobe of the hemisphere responsible for speech. The easiest form of aphasia, which is characterized by general fluency of speech and the absence of pauses. At the same time, there is a violation of articulation and paraphase defects during reading, talking and spontaneous speech.
The patient has understanding and analysis of someone else's and own pronunciation. Words that the patient can not tell, are replaced by similar in pronunciation.
Efferent aphasia
Systemic impairment of the speech function, characterized by pronouncing the patient incoherent phrases and grammatically incorrect turns.
Expressive speech is not initiated by the patient. Most patients are silent and prefer not to say a word out loud.
Explain the so-called "telegraphic style", where verbs are used in a single participle, or are not used at all. Long intervals are observed in the speech.
Violent violations of written speech are noted: the patient admits a lot of mistakes, skips or changes some syllables and letters. Reading is much more difficult, as is the name of the demonstration items.
However, the patient can correct if he or she hears a literal prompt from a loved one or specialist. The analysis of someone else's speech( both oral and written) is preserved in the patient.
Sensory-motor aphasia
Motor aphasia develops when large vessels are affected. Most often occurs due to the transferred heart attacks, when the vast area of the cerebral artery is affected. In medical practice is called "total aphasia."It differs by a complete breakdown of initiation, speech articulation and phonemic hearing.
Dynamic aphasia
The patient's speech is intermittent, does not have an intonational color;noted the difficult initiation of expressive speech and the slow reorganization of speech programs. The patient speaks slowly and indistinctly, his narrative is telegraphic, differs marked monotony.
Coarse aphasia
The disorder is a transitory complication of total aphasia and is characterized by serious speech disorders.
With rough aphasia, a patient can not speak whole words or phrases. His speech is limited to monotonous scraps of words or moozing sounds, sometimes with intonational coloring.
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Causes of pathology development
The development of any type of aphasia is directly related to the extensive lesions of certain parts of the cerebral cortex, which are dominant for the speech apparatus.
This can be both internal factors, and external, for example, severe open and closed craniocerebral trauma. Treatment of aphasia is selected based on the underlying cause of the disorder.
The syndrome can be caused by the following factors:
- Strokes: ischemic and hemorrhagic;
- Open and closed craniocerebral trauma;
- Leukoencephalitis;
- Encephalitis;
- Abscessed brain tissue;
- Other inflammatory diseases occurring in the cerebral cortex;
- Oncology;Benign neoplasms in the brain, which tend to proliferate;
- Focal form of Alzheimer's disease;
- Disease of the Peak;
- Chronic dysfunction of the central nervous system;
- Surgical interventions in the brain tissue.
It should also be noted the risk factors of , which may contribute to the further evolution of the disease in severe circulatory disorders in the cerebral cortex, and as a result, to initiate the development of motor aphasia:
- Family history( genetic predisposition);
- Older and older age category;
- Chronic hypertension;
- Cerebral atherosclerosis;
- Congenital heart disease;
- Rheumatism;
- Severe head injuries;
- Transient ischemic attacks;
- Intracranial hemorrhages.
Clinical picture of the disorder
Regardless of the mechanism of the disease, it is characterized by a systemic impairment of the speech function and tends to progress.
Symptoms of the disease are expressed in the following changes:
- Chaotic permutations of sounds and syllables for patients;
- Literal paraphasia( skipping letters and syllables in spoken and written speech);
- Difficult choice of words and their incorrect pronunciation;
- Telegraphic type of speech: the patient is limited to a small set of verbs without declensions and participles, so his narrative becomes incoherent;
- Long pauses between words and phrases;
- Speech acquires a monotonous style, often not accompanied by intonation coloring;
- There are violations in reading and writing, the patient makes many grammatical, lexical and spelling errors, skips syllables and letters in words;
- In especially complicated cases, the disorder can flow into the form of a complete loss of normal speech function. In this case, the patient is limited to repeated moozing sounds, which in some situations differ only in intonation;
- Dysfunction of phonemic hearing;
- Regression of situational speech;
- Complications in the perception of auditory information, its analysis and storage in memory;
- Silence( with adequate perception of the disease in yourself);
- "Speech okroshka" - the presence in the narrative of incoherent abrupt syllables and individual letters;
- Echolalia( inappropriate inclusion of sentences in sentences);
- Failure to memorize the names of items;
- Stuttering.
Clinical manifestations of aphasias:
Diagnostic measures
Objective differential diagnosis can be performed only by a doctor's consultation. Studies are conducted by neuropsychologists, speech therapists and neurologists.
An important aspect of establishing a diagnosis is the search for the cause of aphasia.
Studies that are conducted for diagnostic purposes:
- Computerized tomography of the brain;
- MRI( magnetic resonance imaging) of the head;
- Magnetic resonance angiography;
- Lumbar puncture;
- Duplex scanning;
- Ultrasonic dopplerography of cerebral vessels;
- Full-time study of oral and written speech;
- Evaluation of family history;
- Study of auditory, motor and visual memory.
Correction methods and treatment of
disorder Usually, the treatment is performed by taking some medications with the patient, as well as logopedic correction methods. If the syndrome is complicated or neglected, surgical intervention can be used.
An important aspect of complex treatment is the visit to patients of some physiotherapeutic procedures.
Drug Therapy
- Vasoactive drugs( Cavinton, Vinpocetine, Telectol, Korsavin);
- Anticholinesterase substances( Amiridin, Galantamine);
- Muscle relaxants( Elatin, Midokalm);
- Antidepressants;
- Preparations of general toning action( Caffeine, Glutomate, Ginseng Root);
- Nootropic substances( Pikamilon, Pyracetam, Gammolon).
Speech therapy methods
- Training of linguistic skills;
- Intonation therapy;
- Correction of speech using modern computer equipment.
Operational interventions
Extraincranial microanastomosis operation. It is used in special cases and rarely. It is carried out in certain clinics and is characterized as an extreme measure when other methods of therapy are ineffective, or threaten the life of the patient.
Physiotherapy
- Acupuncture;
- Magnetic therapy;
- Massages;
- Therapeutic physical training;
- Electrostimulation;
- Mechanotherapy.
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Speech Reconstruction and Correction
The corrective speech therapy measures are based on the reconstruction of the dynamic scheme of speech pronunciation. Methods are developed for the development of oral, written, expressive and impressive speech.
On the advice of the aphasiology speech therapist, when working with motor aphasia, usually, intensive sessions are held to restore written speech and reading. As a rule, work with a specialist begins with the first weeks of the suffered head trauma or stroke, as soon as the permission of the attending physician comes in.
The minimum time for rehabilitation of the speech function is 2 years.
On video lesson on speech restoration with afferent / efferent aphasia:
Prognosis and preventive measures
In some cases, motor aphasia tends to progress rapidly. If the speech disorder is amenable to correction, logopedic treatment lasts a long time, and passes more successfully, provided it begins immediately during the detection of the disorder.
The result directly depends on the area of the brain damage and the severity of the disease. Self-elimination of motor aphasia can provoke severe forms of stuttering in patients.
Effective preventive measures are to reduce the risk of a craniocerebral trauma or collide with vascular accidents. Patients who are prone to transient ischemic attacks, or who have suffered a stroke, always receive maintenance therapy. The aspect of timely detection of tumors in the cerebral cortex is important.
Ignoring the disorder and neglecting treatment can result in a complete loss of articulatory speech functions. The earlier the treatment of the syndrome begins, the faster and easier it will be to eliminate it.