Sensory impairment in children - causes of symptoms, methods of treatment

Aphasia refers to an acquired speech disorder, which is the result of organic damage to the speech center of the cerebral cortex. The cause of the disease is damage to different parts of the neocortex by tumors, strokes, inflammatory diseases, and brain injuries.

In children, aphasia is caused by damage or delay in the development of language function, which is associated with the biological maturation of the brain in infancy and early childhood.

Aphasia is characterized by an impoverished vocabulary, a change in the structure of speech, and the patient’s inability to form simple sentences. There are times when the patient understands the meaning of a particular object, but he is not able to pronounce its name. In order to fully learn about the disease, it is necessary to familiarize yourself with the forms of aphasia and consider some of them in more detail.

Sensory aphasia is speech agnosia. It is characterized by partial or complete loss of speech understanding while maintaining hearing. The patient hears what is said to him, but does not understand the meaning of the words. He perceives the sounds of speech as inarticulate noise. In some cases, there is no understanding of speech at all. With sensory aphasia, one can observe in the patient a lack of motor speech, which is manifested by a violation of the structure of words, their repetitions, and the presence of paraphasias.

This disease is also characterized by: logorrhea, impaired control over one’s own speech, increased speech activity with alienation of the meaning of words. With sensory aphasia, a person has problems with both reading and writing (rearrangement of words and syllables, distortion of the meaning of words, omissions).

When the pathological focus is localized in Wernicke's area (posterior third of the superior temporal gyrus), sensory (acoustic-gnostic) aphasia occurs. The main defect that accompanies Wernicke's aphasia is a violation of synthesis and analysis, phonemic hearing, which results in a loss of understanding of addressed speech. If the lesion spreads to the parietal region of the left hemisphere, then the disease is accompanied by a violation of the ability to count - acalculia syndrome.

When the temporo-parietal-occipital region of the left hemisphere is affected, a symptom complex of semantic aphasia occurs (impairments occur in the understanding of complex logical-grammatical structures that express spatial relationships (right, left, front, back). In this case, the patient forgets words, but if he was told a syllable or sound, he will be able to reproduce the entire word.

Aphasia after stroke: types, treatment, exercises

When an elderly person tries to explain something to relatives, but he comes up with either a meaningless set of sounds or words that are completely inappropriate for the situation, this is called aphasia. Its main cause in older people is a cerebral stroke, as a result of which cells die in one or more centers of the brain responsible for speech. And to prevent your elderly relative from becoming severely depressed and making suicidal attempts associated with aphasia after a stroke, it is necessary to begin its treatment as early as possible. Most of the treatment measures fall on the shoulders of the patient’s relatives.

Children with sensory and motor impairments

Children with sensory impairments are divided into deaf and hard of hearing, blind and visually impaired.

Underdevelopment of the organs of hearing or vision deprives the child of the most important sources of information, which causes him to lag not only mentally, but also physically. The severity of the delay largely depends on the severity and time of occurrence of sensory disorders, as well as the early start of special correctional and rehabilitation work.

1.Children with hearing impairments. The main reason for the mental retardation of a child with hearing impairment is a violation of speech development, since the child does not hear his own voice and the speech of others and, therefore, cannot imitate it. The nature of speech defects directly depends on the severity of hearing loss and the time of occurrence of the auditory anomaly. L.S. Vygotsky emphasized that “...compensation and maturation take place along the paths of cultural development of a deaf child. The tragedy of a deaf-mute child, and, in particular, the tragedy in the development of his attention, lies not in the fact that he is naturally endowed with worse attention than an ordinary child, but in his cultural underdevelopment” (21).

The sociocultural adaptation of children with hearing impairments is often (40%) complicated by emotional and behavioral disorders, which are formed as secondary due to sensory and social deprivation that occurs under inadequate conditions of raising a child both in the family and in a child care institution. In most cases, such children are withdrawn, prefer to communicate with their own kind, and react painfully when their defect is discovered. Their speech is characterized by quantitative insufficiency and qualitative originality. Violations of the sound-letter composition of words are often observed: the child does not catch some sounds, perceives others incorrectly, clearly hears only the stressed parts of the word, and does not clearly differentiate prefixes and word endings by ear. Thus, as N.D. points out. Shmatko, the child hears the word distortedly, remembers it distortedly and pronounces it distortedly, writes (26). All this determines the need for an extremely early start in audiological educational work.

2.Children with visual impairments. The degree of severity of mental retardation in such children depends on the etiology, severity and time of occurrence of visual defects, as well as on the timely start of correctional and rehabilitation work. Features of the mental development of blind and visually impaired children are weakness of abstract-logical thinking, limited knowledge and ideas about the environment with a predominance of general, non-specific knowledge. Characterized by a small amount of sensory experience, a formal vocabulary and insufficiently precise subject-specific correlation of words. Visual defects inhibit the development of motor skills and abilities, spatial orientation and determine the child’s small motor activity and general slowness. Such children, as N.D. points out. Shmatko, they often try to “hide” or deny a defect if others find out about it. They feel constrained, unnatural and uncomfortable. They are embarrassed to ask for help. They are vulnerable and sensitive to criticism. With profound visual impairment, obsessive movements may occur. Children press on their eyes to get a feeling of light, sway, and make stereotypical sounds.

3. Children with musculoskeletal disorders. There are three groups of children in whom voluntary movements are impossible or difficult. The first group includes children suffering from residual manifestations of peripheral paralysis and paresis, isolated defects of the foot or hand, and mild manifestations of scoliosis (curvature of the spine). The second group includes children suffering from various orthopedic diseases caused mainly by primary lesions of the musculoskeletal system (with preservation of the motor mechanisms of the central and peripheral nervous system), as well as children suffering from severe forms of scoliosis (68). A special group consists of children with consequences of polio and cerebral palsy, in whom disorders of the musculoskeletal system are associated with developmental pathology or damage to the motor mechanisms of the central nervous system.

The basis of cerebral palsy (CP) is early (usually intrauterine - up to 50% of cases) damage or underdevelopment of the brain due to endocrine, infectious and chronic diseases of the mother, intoxication, incompatibility of the blood of mother and fetus in terms of the Rh factor, immunological characteristics and others, sometimes arising as a result of birth trauma or asphyxia of the newborn, less often as a consequence of encephalitis. As a rule, cerebral palsy is not a hereditary disease. The main symptom of cerebral palsy is movement disorders that can be observed in one limb (monoparesis or monoplegia), both upper or lower limbs (upper/lower paraparesis or paraplegia), on one half of the body (hemiparesis and hemiplegia), in all 4 limbs ( tetraparesis or tetraplegia). A common clinical manifestation of cerebral palsy is drooling. In general, with cerebral palsy there is a synthesis of motor, speech, mental, emotional and volitional defects. The complexity of the general development of children with cerebral palsy lies in the presence of pronounced impairments in coordinated motor work ( asynergy - from the Greek a - a prefix with the meaning of negation, sin - together and ergon - work).

The mental development of children with cerebral palsy has typical features that are caused by both organic damage to the central nervous system and limited independent movement and self-care. Firstly, it is slow, and secondly, it is characterized by disproportionality in the development of higher mental functions, in particular thinking. In some forms of the disease, there is a discrepancy between a satisfactory general level of development of abstract-logical thinking and insufficient spatial concepts, which subsequently causes specific difficulties in the child’s mastery, for example, of counting operations. Mental impairment often occurs. The level of intellectual development varies widely - from normal intelligence (IQ about 110) to forms of mental retardation that vary in structure and severity (up to IQ = 20). The majority of children with cerebral palsy have a specific mental retardation (70%). The norm is observed in 10% of cases, mental retardation - in 20%.

Such children are vulnerable, impressionable, and have emotional, behavioral and personality disorders. There is a strong attachment to parents or people replacing them.

Deviations of mental development in most cases are caused by a lack of practical activities (in particular, play) and sociocultural experience of children with cerebral palsy, as well as the inability in most cases to carry out productive communication with people around them. More than half of children have dysarthric speech disorders.

Test questions and assignments for the topic:

1. Identify groups of children with sensory impairments.

2. Describe the group of children with hearing impairments.

3. Describe children with visual impairments.

4. Disorders of the musculoskeletal system: types and causes.

5. Describe the features of psychophysical development of children with cerebral palsy.

6. Study the article by I.I. Mamaichuk, G.V. Pyatakova “Study of personal characteristics of children with cerebral palsy” // Defectology. - No. 3. — 1990.

Literature on the topic:

1. Boskis R.M. Deaf and hard of hearing children. - M., 1963.

2. Boskis R.M. To the teacher about children with hearing impairments. - M., 1988.

3. Gudonis V. Criteria for assessing a person with vision deprivation in ancient times // Defectology. - 1996. - N5. — P.51.

4. Gudonis V. Integration of persons with impaired vision // Defectology. - 1993. - No. 4.

5. Ermakov V.P. Development, training and education of children with visual impairments. - M., 1990.

6. Kozlov M.Ya., Levin A.L. Pediatric audiology. - L., 1989.

7. Komarov K.V. Features of teaching hearing impaired children. - M., 1985.

8. Correctional and educational work with children with profound visual and hearing impairments / Collection of scientific works. Ed. V.N. Chulkova, 1986.

9. Leongard E.A., Samsonova E.G., Ivanova E.A. I don't want to be silent! - M., 1990.

10. Litvak A.G. Typhlopsychology. - M., 1985.

11. Mastyukova E.M., Ippolitova M.V. Speech disorders in children with cerebral palsy. - M., 1985.

12. Features of the development and education of children with hearing and intelligence impairments / Ed. L.P. Noskova. - M., 1984.

13. Features of psychophysical development of students in special schools for children with musculoskeletal disorders / Ed. T.A. Vlasova. - M., 1985.

14. Rau F.F. Formation of oral speech in deaf children. - M., 1981.

15. Semenova K.A. Clinic and rehabilitation therapy for cerebral palsy. - M., 1972.

16. Semenova K.A., Makhmudova N.M. Medical rehabilitation and social adaptation of patients with cerebral palsy. - Tashkent, 1979.

17. Solntseva L.I. Development of compensatory processes in blind children. -M., 1980.

18. Uzun O.V. On the social adaptation of graduates of boarding schools for children with cerebral palsy // Defectology. - 1993. - N4.

19. Fleury V.I. About deaf-mute // Deaf-mute, considered in relation to their condition and methods of education, most characteristic of their nature. - St. Petersburg, 1835.

20. Khalilova L.B., Shakhovskaya S.N. Speech and sensory systems. Theoretical course of authorized presentation / Ed. IN AND. Seliverstova. - M., 1995.

21. Shipitsyna L.M., Ivanov E.S., Danilova L.A., Smirnova I.A. Rehabilitation of children with problems in intellectual and physical development. - St. Petersburg: Education, 1995. - P.14.

What causes aphasia during a stroke?

In the human brain there are several interconnected centers responsible for oral speech: for its understanding, reproduction, analysis of complex speech structures, and the ability to construct correct sentences. All of them are interconnected by nerve fibers and are located mainly in the central part of the brain, as well as in the temporal and parietal lobes. Some of these speech centers are symmetrical in both hemispheres (that is, they are duplicated in each of them), but there are also areas that right-handers have only in the left hemisphere, and left-handers have in the right.

When a stroke occurs, part of the brain dies. If death occurs in one of the speech centers, or the nerve endings connecting these zones are damaged, aphasia develops. Thus, aphasia is a violation of the understanding or reproduction of already formed oral speech, sometimes up to its complete absence. If the disorder concerns written speech, then such a neurological syndrome will already have a different name (alexia, agraphia).

How to recognize aphasia

Aphasia after a stroke can be recognized by various symptoms, the combination of which makes it possible to distinguish several types of this syndrome.

So, we can talk about sensory aphasia (Wernicke) if the patient has:

misunderstanding of spoken speech;
misunderstanding of allegories, sayings, proverbs;
complaints that everyone around them began to speak as if “in a foreign language”;
forgetting the initial part of a long sentence of the interlocutor, loss of understanding of long speech structures, which encourages the patient to ask questions about words that have slipped from memory.

At the same time, the patient can formulate his own proposal. And although it will be laconic, without descriptive phrases, there will be meaning in it.

If mnestic aphasia , an elderly person:

can retain in memory only a few words from a listened phrase;
having started to speak, he forgets what he wanted to say;
speaks slowly, choosing his words carefully;
replaces some words with others that do not fit the meaning.

This is acoustic-mnestic aphasia. There is also an optical-mnestic type of syndrome, then:

a person can read the headlines in books or newspapers, but the meaning of the text itself is lost;
It is difficult for him not only to describe what he sees (in the world around him or in the image), but also to name objects.

There is also amnestic aphasia , which develops with a stroke of the parietotemporal lobe. In this case, a person forgets what individual objects are called, but remembers what they are needed for. Such a patient, instead of “pen,” may say “thing that is used to write,” and the like.

Semantic aphasia is not immediately noticeable . In this case, a person who has suffered a stroke is thrown into a stupor by long sentences describing logical actions and spatial relationships.

All of these types of syndrome - Wernicke's aphasia, mnestic, semantic and amnestic types - are united under the general name " sensory aphasia ", when a person after a stroke has difficulty understanding speech. Often the patient himself does not understand what he is saying.

The second main type of disease is motor aphasia . In this case, the person, on the contrary, perfectly understands the addressed speech, but cannot reproduce it, from which he suffers greatly morally. Motor aphasia is divided into 3 types:

Afferent motor aphasia . In this case, the patient confuses similar voiceless and voiced consonants and rearranges sounds in words.
Dynamic aphasia . The patient understands the addressed speech and tries to answer, but the words in his sentence are so out of place that the whole phrase loses its meaning. A person hears and understands this, but cannot correct it, which is why he suffers.
Broca's aphasia . It occurs in people who, due to a stroke, have lost an area of the brain near the frontal lobe of the left hemisphere (Broca's center is located there, which is responsible for the coordination of movements through which speech is reproduced). This is characterized by a change in communication style: a person speaks in separate words, pauses between them, and even between individual syllables, as it is difficult for him to switch from one syllable to a completely different one. Such a person begins to write and read with gross errors. He may repeat the same syllable all the time, name words that have opposite meanings, and speak unintelligibly.

The speech of a patient with motor aphasia is very short, consisting almost entirely of nouns and verbs, between which the person pauses. He may repeat one syllable (for example, “la”) or sound (for example, moo), trying to convey meaning into it using intonation. During a conversation, such a person often cries, as he suffers from the fact that he is unable to convey his thoughts.

The diagnosis of motor aphasia should be made by a neurologist, since in everyday life it can be difficult to distinguish this particular syndrome from the one called dysarthria. Dysarthria occurs when the centers of the brain are damaged, which carry commands to the muscles involved in the formation of speech (movement of the tongue, lips, vocal cords). Patients with dysarthria understand spoken speech and form sentences correctly. But due to changes in their voice timbre and the inability to pronounce individual sounds, their speech becomes unintelligible. If this is accompanied by breathing difficulties, this forces the sick elderly person to speak in short sentences. Descriptions, adjectives, and adverbs do not disappear from speech.

Broca's motor aphasia

Broca's motor aphasia has 3 types of disorders:

Afferent speech disorder. Refers to mild forms. The patient speaks fluently without pauses. The examination reveals defects during reading and incorrect articulation.
Efferent speech disorder. A severe form in which the patient utters incoherent phrases at long intervals or remains silent. Severe violations of written speech are noted. The patient may have difficulty reading.
Sensorimotor aphasia. Complete disorder of understanding and pronunciation of oral and written speech.

The causes of motor aphasia are:

embolism of the superior branch of the cerebral artery;
hemorrhage;
injury;
inflammation;
tumors;
degenerative processes (Alzheimer's disease, Pick's disease).

Motor aphasia is mainly detected after a stroke. In mild forms, patients experience moderate impairments in the ability to speak and write, but understanding what is said and written suffers minimally. Only during examination with the execution of complex commands are deviations detected.

In some cases, the patient loses his speech for a short period, but at the same time understands others and can comprehend the text read. As a rule, this state is replaced by impoverished speech. The patient pronounces words with effort, while being aware of pronunciation defects.

He cannot perform voluntary movements of the tongue and lips on command, despite the fact that automatic movements are preserved in them. On examination, weakness of the muscles of the lower right part of the face, right arm and hand is determined. In case of mild impairments, speech is fully or partially restored.

With severe impairments, the patient cannot speak or understand speech normally. When recovering during treatment, the patient responds only with formulaic phrases in response to all questions asked of him. In other cases, speech appears slow and pronounced with effort. Usually the pronunciation of phrases is grammatically incorrect, without prepositions or conjunctions. The patient speaks without intonation or fluency.

How to treat aphasia

As everyone is taught from childhood, “nerve cells do not regenerate.” In fact, this is not entirely true: even in very old people, new connections can be formed between living neurons - “bridges” along which information will flow from the nerve cell on one side from the source of the stroke to the neuron on the other side. But for this you need:

daily activities that will use areas of the brain located next to the dead zone;
sufficient blood supply to the brain, especially in the affected area;
providing the brain with the necessary amount of oxygen;
elimination of additional chaotic impulses that arise in the brain during stress and prevent the flow of impulses from being directed to the area near the site of dead cells. Stress in aphasia is caused by the fact that a person understands his inability to convey his thoughts to others.

Aphasia after a stroke is also treated according to these principles. It needs to be started as early as possible - as soon as the swelling of the brain is stopped, which is manifested by depression of consciousness (from drowsiness to coma), convulsions, and hallucinations.

started as early as possible;
carried out daily, to the extent that the patient can handle;
is aimed at correcting not only oral, but also written speech, if such a syndrome occurs in your relative.

In some cases, aphasia after a stroke can resolve on its own, but this is extremely rare, so you should not count on such an outcome. Basically, treatment of this syndrome is a long and painstaking process, requiring great dedication from relatives.

Let's look at each type of therapy in detail.

Drug treatment

It is prescribed by a neurologist at the hospital where the stroke patient is located, and begins as early as possible. Drug therapy includes drugs that improve the delivery of oxygen and nutrients to the brain, strengthen nerve connections in it, and optimize metabolism in it. This:

Physiotherapy

To treat aphasia after a stroke, physiotherapeutic procedures are performed to improve cerebral circulation. This:

acupuncture;
electromyostimulation (exposure to current pulses) of the muscles involved in articulation;
exposure of the cerebral cortex to a magnetic field.

Classes with a speech therapist

A special speech therapist, an aphasiologist, deals with the relief of aphasia after a stroke. Typically, these specialists work in the same medical institution that treats stroke, but in some cases, relatives have to find such a specialist on their own.

Classes with an aphasiologist should begin in the neurological department, a week after the patient is transferred from the intensive care ward. This doctor trains an older person who has had a stroke for 5-7 minutes at first, gradually increasing the training time to 15 minutes. It works like this:

Build a dialogue with the patient.
Seek understanding.
Practice reading.
Recall writing skills.

Before starting classes with a patient with sensory aphasia, if he does not understand his condition, he is asked to write a word (usually he writes a set of letters), then read it. They communicate with him through facial expressions and gestures. On a piece of paper with a set of letters, underline with a pencil or pen.

The aphasiologist must show the relatives the exercises he performs with the patient so that they can repeat them in the evening.

Examples of exercises:

Bloating of the cheeks.
Licking the tongue alternately between the upper and lower lips.
Stretching your lips with a tube, after which you need to hold them in this position for 5 seconds, then relax.
Tongue movements: to the tip of the nose - to the chin.
Attempts to form a tube in front of a mirror.
Move the lower jaw forward and upward to grab the upper lip with your teeth. Then do the same with the lower jaw.
With your mouth closed, you need to try to reach the tongue with your tongue.
Clicking the tongue against the roof of the mouth.
Image of kisses.
Pronunciation of simple familiar words.

With an aphasiologist, they learn a phrase or word with which to start communication, “remember” counting from 1 to 10 and in reverse order.

Melodic intonation therapy is effective in the treatment of aphasia: while singing, articulation improves and self-confidence appears. They begin singing with a familiar song, supporting the patient in every possible way, even if he could not utter a single intelligible sound.

For sensory aphasia, training with cards with pictures on them helps. You can use special computer programs (for example, a program for speech therapists by Ryabtsun) or applications on your phone. The aphasiologist asks the patient to explain what he wants to say using pictures. Also, if a person confuses letters in words, he asks to show where, for example, “barrel” is depicted and where “kidney” is depicted.

Helping a sick person

Restoring speech in sensory aphasia is a rather labor-intensive and lengthy process. To achieve the best results, maximum consolidation of efforts of both the specialist and the patient is required.

The process is complicated by the fact that normal communication between the doctor and the patient is very difficult given the fact that the latter has completely lost the ability to understand human speech. The patient is also unable to graphically describe the sensations he experiences.

Features of speech therapy correction

Speech therapy classes help restore speech in sensory aphasia. Thanks to mini-trainings, the correct pronunciation of sounds is restored. The person regains the ability to speak meaningfully.

Treatment is carried out through specific activities. These activities can also be done at home. At first, the patient should:

Name body parts and objects;
Work from the picture, combining the image with the inscription.
Answer simple questions.

A little later you can move on to thematic dialogues.

A comfortable environment is the most important condition for working with a patient.

You need to talk to an aphasic person slowly and calmly. He must feel that he is understood and supported.

Sensorimotor aphasia after stroke

In terms of the degree of danger to human life and health, cerebral circulatory disorders can be placed on a par with cancer. In most cases, a stroke results in disability. As is known, damage to brain cells negatively affects the patient’s quality of life, depriving him of control over his own body, including the ability to walk, speak, and perceive communication.

Treatment of childhood aphasias

First of all, therapy for aphasia in children should be aimed at eliminating the factor that provokes the speech disorder. In pediatrics, preference is given to the most gentle integrated approaches, and, if possible, limited to conservative techniques. At the same time, they are working on aphasia itself. Methods for its elimination are selected by a whole group of doctors, consisting of a pediatrician, neurologist, speech therapist, and defectologist. It is important to understand that even in the best scenario, achieving age-standard indicators is rare.

Speech therapy classes are aimed at launching the compensatory properties of brain cells surrounding the affected area. Direct methods are used, based on stimulating the reserve functions of the nervous tissue, and indirect ones - aimed at functional changes within the problem area. In children's speech therapy, cards, oral and written exercises, work with objects, and software are actively used. Today, alternative medicine techniques are increasingly being used, in which children spend time with various animals.

Due to the characteristics of the brain in children and the flexibility of the processes occurring in it, the prognosis for aphasia in most cases is favorable. In each specific situation, the type of disorder, the area of damage to the nervous tissue, and the correctness of the selected treatment play an important role. In mild forms of the disorder, signs of positive dynamics appear after just a few weeks of therapy. After about a month, communication function is restored. With moderate severity of the condition, it takes up to six months to obtain a lasting effect.

Cause of speech impediment

Sensorimotor aphasia after stroke is one of the most serious complications. Complete or partial loss of speech occurs when certain brain functions are suppressed and the activity of specific areas of the cortex decreases. Sensorimotor aphasia can also be a consequence of trauma, indicate the presence of benign or malignant tumors, encephalitis, and meningitis. Unlike other speech disorders that occur with brain damage, this form is considered the most severe. The combination of symptoms of sensory and motor aphasia is a difficult to treat consequence of a stroke, since it is associated with the development of a pathological process in the hemisphere responsible for speech and motor activity.

Reasons for appearance

With aphasia, certain areas of the brain that are responsible for speech are damaged. Most often this occurs against the background of a stroke, traumatic brain injury, or vascular aneurysm. Adolescents and young adults are at risk of developing the disease.

Childhood aphasia occurs due to the following reasons:

brain tumors;
injuries;
severe infectious disease.

This is a severe disorder that affects all types of speech activity. The severity of the problem depends on the location of the lesion, its size, and impaired functions.

What matters is the person’s reaction to the defect and its awareness. The degree of development of skills, such as reading, before the appearance of the defect is taken into account.

Aphasia should not be confused with other problems: alalia, dysarthria. The child develops a number of specific symptoms. The cause of the violation is always organic in nature.

Aphasia rarely occurs in children - about 10% of cases occur in preschool and school age. The rest of the patients are people over 18 years of age.

Due to a sedentary lifestyle and worsening crime situation, strokes and traumatic brain injuries are significantly younger. The number of tumor diseases has increased. Therefore, the development of speech restoration methods is relevant.

Children are more often diagnosed with motor and sensory aphasia. In adults, the forms of the disease are varied.

What are the symptoms of the disease?

Why does sensorimotor aphasia occur, what is it? After a stroke, in some cases, the functionality of the inferior frontal gyrus, which provides a person with the ability to pronounce words, is impaired. In parallel with the development of this pathology, a malfunction occurs in the cortical region of the brain, in particular the upper lobe of the temporal regions of both hemispheres, which leads to a loss of the ability to understand the meaning of speech. The patient continues to hear himself and those around him, but can no longer perceive words.

The second name of the disease is acoustic-gnostic aphasia. The progression of the disease leads to spontaneously appearing speech, which, if left untreated, becomes more like an inarticulate mooing. The degree of loss of the ability to speak correctly and recognize what others say is determined by the severity of the brain damage and the individual characteristics of the person. With total or severe sensorimotor aphasia, which implies impairment of all speech functions, other symptoms may occur. The most common manifestations are:

absent-mindedness;
drowsiness;
apathy to what is happening;
inability to concentrate;
partial paralysis of the muscles of the body.

What can interfere with recovery?

A patient’s chances of recovery from sensorimotor aphasia depend on a number of factors, which include the general condition of the patient, the presence of concomitant diseases and the effectiveness of the rehabilitation therapy used. Indeed, it is much more difficult to regain the lost ability to speak and understand speech if the patient:

repeated hemorrhage occurred;
atherosclerosis, arterial hypertension or other cardiovascular diseases are diagnosed;
ischemic attacks often occur;
progressive diabetes mellitus.

How to regain speech after a stroke: treatment methods

Motor and sensory aphasia after stroke is treated in at least two areas. Speech therapy and conservative medicine are the main ways to restore speech function.

neurosurgical treatment (including in the presence of an abscess, intracranial hematoma),
exercise therapy course;
physiotherapeutic procedures;
massage;
sessions of psychological influence.

Reasons for the development of sensory aphasia

There are many reasons for the development of sensory aphasia.

Here are some of them:

Traumatic brain injury;
Encephalitis, leukoencephalitis;
Damage to some parts of the neocortex by the tumor process;
Strokes, Pick's disease;
Inflammatory diseases.

Experts also say that certain types of mental disorders can provoke aphasia.

A patient who suffers from sensory aphasia syndrome can only reproduce fragments of words that have no connection with each other. Also, this condition may be accompanied by pronounced motor activity and increased general emotionality. In frequent cases, the patient is able to perform simple commands, such as: wave his hand, sit down, close his eyes.

At the request of a specialist, the patient can repeat certain phrases and words after him, but at the same time he does not see any meaning in them at all and is not aware of their meaning. With sensory aphasia, the patient’s speech is saturated with echololies, neologisms, and verbal paraphasias. The patient may also exhibit jargon-aphasia, logorrhea - polyphony.

This disease is characterized by an altered speech structure. The patient is unable to form simple sentences and has a very limited vocabulary. Very often there are cases when the patient realizes and imagines what this or that object looks like, but finds it difficult to remember, or cannot reproduce its name at all.

To have a better understanding of such violations, it is necessary to familiarize yourself with their classification and highlight some of their forms. In this article we will look at sensory aphasia in more detail.

It is important! Wernicke's aphasia is another name for sensory aphasia. Loss of the ability to perceive oral speech is the most characteristic feature of this disease. If other people are talking next to the patient, he will not participate in the conversation, since he does not understand the meaning of the conversation. Besides this, the text in written form also means nothing to him.

A feature of this pathology is that the patient may have perfect hearing, but since there is damage to the cortical part of the auditory analyzer, the patient is not able to interpret a conversation.

Incoherent sounds are what a person with sensory aphasia hears, regardless of volume or pitch. Also, the patient may perceive his native language as foreign. This is due to the fact that sensory aphasia is also called acoustic-gnostic aphasia.

It is very difficult to understand such patients, so others may mistake them for mentally unbalanced people. The patient cannot write from dictation; his writing and reading are grossly impaired. In rare cases, the patient may copy the text.

This disease is characterized by the following symptoms: acalculia, superior quadratic hemianopsia, impaired orientation (right-left). There are cases when sensory aphasia occurs in a milder form, in which case it is difficult for the patient to understand complex phrases and metaphors. Cases of “pure” aphasia are very little known in medicine. Motor and sensory aphasia in its “pure” form are extremely rare; complex diseases can be observed more often.

Medicines to stimulate cerebral circulation

So, perhaps, we should start with the drugs that are prescribed to patients with speech disorders. A course of medications usually consists of neurotrophic drugs, the action of which is aimed at normalizing metabolic processes in the brain and increasing blood circulation. For total aphasia, doctors prescribe:

Piracetam is a nootropic drug used for speech and cognitive disorders. The duration of the course is determined by a neurologist and most often ranges from 2 to 6 months. The medicine is used by injection, administered intravenously or intramuscularly.
"Pyritinol" - activates cholinergic processes in the brain. After a stroke, aphasia is prescribed for 3-4 months.
"Vasobral" is a combination drug whose active components stimulate the functioning of the central nervous system. The duration of the course is on average 2-3 months.
"Cerebrolysin" is a nootropic generation drug that provides metabolism, neuroprotection, neuromodulation functionality and neurotrophic activity. The course of therapy can be up to 12 months.

ORIGINALITY OF SENSORY INTEGRATION OF CHILDREN WITH COMPLEX DEVELOPMENTAL DISORDERS

44.04.03 “Special (defectological) education”

ORIGINALITY OF SENSORY INTEGRATION OF CHILDREN WITH COMPLEX DEVELOPMENTAL DISORDERS

Terakyan Lyubov Viktorovna

Russia, Rostov-on-Don, Southern Federal University

The article presents a brief description of the sensory system and the uniqueness of sensory integration of children with complex developmental disorders.

Key words: complex developmental disorders, sensory system, originality of sensory integration.

THE ORIGINALITY OF SENSORY INTEGRATION OF CHILDREN WITH COMPLEX DEVELOPMENTAL DISORDERS

Terakian Lobov Viktorovna

Russia, Rostov-on - don, southern Federal University

The article presents a brief description of the sensory system and originality of sensory integration of children with complex developmental disorders.

Keywords: complex developmental disorders, sensory system, the uniqueness of sensory integration.

The child learns about the entire world around him with the help of his senses. The sensory system (from the Latin “sensus” - feeling, feeling) system: hearing, vision, touch, smell) is a sensor for the perception of the surrounding world. This is a system that reads information from the outside, relying on previously formed sensory standards. Perception is formed on the basis of the synthesis of different sensations: auditory, visual, tactile, kinesthetic, olfactory, etc. Children’s knowledge of the surrounding reality begins with the analysis of information that they receive through visual observation, sounds, smells, various tastes, etc. Sensory development is the development of sensations and perceptions, ideas about objects, objects and phenomena of the surrounding world. Information from them is analyzed in the corresponding parts of the brain and produces a holistic picture.

The sensory development of children with various developmental disorders was given much attention by such famous research scientists as I. M. Sechenov (1952), P. F. Lesgaft (1956), L. S. Vygotsky (1983), I. A. Sokolyansky ( 1989), N. A. Bernstein (1990), Lauren J. Lieberman, Jim F. Cowart, (1996); N.P. Wiseman (1997), U Kisling (2010) [4, 7] and others. They all agree that the interaction of the senses is necessary for the movement of speaking and playing - this is the foundation of a more complex integration that accompanies reading and writing and appropriate behavior. In order to develop and function normally, the brain needs a constant supply of sensory information.

The main subsystems of the human sensory system are:

visual - a system that ensures the performance of complex visual functions, involves distinguishing objects in the surrounding world by color, shape, size, and direction of movement. It is the most powerful source of information about the outside world;

The auditory system is one of the most important distant sensory systems in humans in connection with the emergence of speech as a means of interpersonal communication. Acoustic (sound) signals are air vibrations with different frequencies and strengths. They stimulate the auditory receptors located in the cochlea of the inner ear. Receptors activate the first auditory neurons, after which sensory information is transmitted to the auditory area of the cerebral cortex through a number of successive sections, which are especially numerous in the auditory system;

vestibular - a system for maintaining balance; it perceives signals about the position of the body and head in space, changes in speed and direction of movement, and provides a unified function of perception and orientation in space. The vestibular system, along with the visual and somatosensory systems, plays a leading role in human spatial orientation;

tactile - skin sensitivity system. Includes tactile sensations (distinguishing objects by texture - smooth/rough, hard/soft), tactile sensations (determining the shape of an object by touch - flat/volume), temperature characteristics (heat/cold), vibration. Tactile sensations also include: pressure and movement of air and clothing, friction arising from touching toys, sports equipment, household items, etc. The tactile system is the largest sensory system, significantly influencing behavior, both physical and mental;

proprioceptive - a system that provides kinesthetic perception (muscular-joint feeling), with the help of which the position of the body in space and the relative position of its parts are controlled. Kinesthetic sensations are signals that occur when muscles contract and stretch, as well as when joints change position (flexion, extension, abduction, adduction, etc.). Proprioceptors are located in muscles, tendons and ligamentous-articular apparatus. Information coming from proprioceptors allows you to control the posture and accuracy of voluntary movements, dose the force of muscle contractions when counteracting external resistance. It is known that the sensory-perceptual sense is basic for the development of a child. Therefore, sensory development is inextricably linked and is the basis of its psychophysical development.

American researcher and therapist E. J. Ayres, in her book “The Child and Sensory Integration” (2009), defines the concept of “Sensory Integration”. Based on the author’s interpretation, sensory integration is the interaction of all senses, the whole body and the brain. The central nervous system, and especially the brain, is designed in such a way that it can organize countless pieces of sensory information into a coherent system. It organizes information received through the senses (taste, sight, sounds, smell, color, size, touch, movement, gravity and position in space), and also forms the basis for theoretical learning and social behavior. Sensory integration is evidenced, for example, by the fact that all types of sensory impulses converge in the vestibular nucleus and the reticular formation of the brain stem. Some of this flow is then sent to the thalamus in the superior brainstem for subsequent integration. Sensory integration is completed in the hemispheres of the brain, where data from distant receptors - visual and auditory - are processed, turning into accurate perceptual images and associations. A number of authors [1, 2, etc.] describe the mechanisms of the influence of vestibular activity on the processing of visual and auditory signals in the cerebral cortex, indicate the relationship between the auditory and vestibular analyzers can be traced in anatomical unity: the peripheral part of the auditory system is located in the labyrinth, in the same place where peripheral receptors that perceive vestibular stimulation. The vestibular system forms the connection between bodily sensations and external events. It is known that tactile sensations enter the brain from every millimeter of skin and go to almost all areas of the brain. In the absence of tactile contacts, the nervous system, as a rule, cannot work in a balanced way. In this regard, a disorder in almost any part of the brain will most likely affect tactile sensitivity. Sensory functions [3] develop in close connection with motor skills, forming a holistic integrative activity—sensory-motor behavior that underlies the development of intellectual activity and speech.

The whole life of a child is connected with the endless perception of the world around him, with its colors, sounds, shapes. In this regard, the development of sensory-perceptual basic standards is important in the development and education of all categories of children, especially children with complex developmental disorders. Children with complex developmental disorders are, as a rule, children with congenital combined pathology of primary genesis, who predominantly have abnormalities of the sensory organs (mainly vision and hearing), which means that from the first days of their life they are brought up in conditions of sensory and motor deprivation . Analysis of scientific and methodological literature, practice of teaching and upbringing, pedagogical observations of these children make it possible to highlight some of the uniqueness of the sensory integration of children with complex developmental disorders.

One of the reasons for sensory integration impairment may be a lack of sensory (tactile, visual, auditory) stimuli. Foreign studies [10, etc.] show the influence of sensory deprivation on sensorimotor development, emotionality, adaptability, etc. I. A. Shapoval [cit. according to 7], in turn, notes that as a result of insufficient sensory analysis, the process of understanding the construction of a motor action may be disrupted. Neurophysiological studies of children in this category have established deviations from the norm in the formation of mechanisms of visual and auditory perception. These children not only have a more pronounced delay in sensorimotor development compared to children without sensory impairment, but also a secondary delay in psycho-emotional-volitional and cognitive development.

In children with bisensory impairments (deaf-blind), skin sensitivity and motor memory become a special way of understanding the world around them. For example, Sokolyansky I.A. [8] described how easily deaf-blind children find windows and doors in an unfamiliar room due to the perception by the facial skin of changes in the air wave and temperature emitted by the window. Tactile sensitivity allows them to perceive objects only by touching and acting with them in direct contact. However, a person deprived of sight and hearing can receive information from the surrounding space at a distance - remotely. Deaf-blind children have an unusually subtle sense of smell. The sense of smell allows almost all deaf-blind people to find a familiar or unfamiliar person at a distance, recognize the weather outside by smells from an open window, determine the features of rooms and find the necessary objects in them. Vibration sensations are the basis for the perception and formation of oral speech in a deaf-blind child. For example, deaf-blind children are taught to perceive oral speech with the palm of a hand placed on the neck of the interlocutor and to control their own speech in a similar way. With the help of vibration of the vocal cords, the child learns to identify different sounds. Thanks to tactile-vibrational sensitivity to sounds produced by the movement of objects and people, a child can sense what is happening around him also at a certain distance. With age, deaf-blind people are able to identify approaching people at a distance by their gait, recognize that someone has entered a room, listen to the sounds of music with their hands, determine with their feet the direction of loud sounds made in the house and on the street, etc. Along with these completely intact capabilities olfactory, gustatory, tactile, tactile-vibration sensitivity of the deaf-blind must be taught, if possible, to use residual vision and hearing.

For example, special classes on the development of visual perception in children with residual impairments (with loss of vision up to light perception) can teach them to correctly use even the most minimal remaining vision, which the child can use in the process of physical exercises, spatial orientation, in educational and work activities . Advances in modern medicine have made it possible for some deaf-blind people to regain the ability to hear through cochlear implantation [5].

It should be noted that among children with complex developmental disorders, there is a violation of tactile sensitivity, manifested in the form of tactile hyperesthesia. Hyperesthesia (hyperaesthesia; from the Greek word hyper - over, aesthesis - sensation) - increased sensitivity to irritants, affecting the senses. The reasons for its manifestation include: increased sensitivity of nerve endings, which is observed in pathologies of the skin and mucous membranes (for example, wounds, burns); increased excitability of neurons in the sensory system: mainly sensory fields of the cerebral cortex, nuclei of the amygdala complex, etc. This occurs, for example, in neuroses, some forms of mental disorders, and encephalitis. With tactile hyperesthesia, even light touches (tactile stimuli) cause unpleasant and sometimes painful sensations. Children's behavior may include rejecting and emotional reactions to the sensation of touch. Children who reject tactile contact avoid the sensations of certain types of clothing (wool, synthetics, coarse fabrics, etc.), prefer clothes with long sleeves, avoid walking barefoot on grass or sand, they do not like swimming because splashing water overstimulates their nervous system. system. The child reacts not only to someone else’s touch, but also to a pat on the head, a friendly hug on the shoulders, which can cause him a feeling of discomfort, and responds to unexpected touches with aggression. In such cases, it should be remembered that exercises in pairs, joint games, for example, playing tag, can cause agitation, a strong emotional reaction or other behavioral disorders in the child. Such a child avoids play tasks with soft toys. However, some of them have pleasant tactile stimulation - a favorite toy that they prefer not to part with. Avoiding tactile touch has a negative impact on the development of motor skills, especially hand movements and fine motor skills. Practice with such children shows that confident, strong pressure on the skin (such pressure as not to harm the child) usually brings children not only pleasure, but also calm. E. Jean Ayres suggests putting a padded weighted vest on your child.

The originality of sensory development can manifest itself in the form of a violation of heat exchange (disturbance of the body’s heat balance), which is expressed in two variants: hypothermia - cooling; hyperthermia-overheating, which, in turn, also complicates the life of children.

Children with complex developmental disorders often have impaired proprioceptive sensations. Children with impaired integration of proprioceptive signals tend to have great difficulty in activities that they cannot see.

It is known that the vestibular system is connected to almost all areas of the brain. It is so sensitive that any change in position and any movement affects the brain. Vestibular disorders, common in children with complex disabilities, can cause dizziness, disturbances, or loss of balance, which may be caused by disruptions in sensory processing in the vestibular system.

Children whose sensory integration is ineffective or impaired do not integrate these sensations properly. For example, when testing a child’s vision, visual dysfunctions are not detected, but he experiences difficulties in spatial orientation and visual imitation. Such children do not adequately assess the distance to and between objects and are unable to assess their position relative to their body. If the function of the vestibular apparatus is impaired, muscle tone decreases, and the child quickly gets tired. Because of this, children whose brains do not process vestibular signals effectively have difficulty keeping their heads upright while sitting at a table. All these phenomena characterize disorders of the vestibular mechanism. Insufficient processing and integration of muscle and joint sensations in the cerebellum and vestibular nuclei causes the child to frequently stumble and move awkwardly. Children prefer a sedentary lifestyle, and as a result, physical activity decreases and physical inactivity is noted. And, as is known, with a deficiency of physical activity and games that involve all muscle groups, the child does not receive the sensory food necessary for brain development.

The peculiarity of sensory integration of children with complex disorders lies in the underdevelopment of their abilities to receive, process and store information, insufficient verbal mediation, as well as in the occurrence of various kinds of functional restructuring. Thus, with deafblindness in the process of child development, a very complex relationship is formed between intact analyzers and external afferentation, that is, information coming from the outside through touch, smell, taste, and in some cases through partially intact vision and hearing. Violation of the analysis of visual information in these children is combined with a deficit of visual attention, i.e., basic sensory standards are not formed, which makes it difficult to distinguish the characteristics of objects. Children have little understanding of the outside world, which leads to a decrease in figurative memory.

One of the features of the development of children with a complex structure of the disorder is a reduced stock of knowledge and ideas, due to the paucity of external information due to congenital damage to the most important sensory channels in mental development. Characteristic features of the ideas of children with sensory impairments are fragmentation, schematism, low level of generalization and verbalism [6]. The famous deafblind woman O.I. Skorokhodova [9] draws attention to the fact that deafblind people are in constant physical stress. After all, a deaf-blind person, deprived of visual and auditory analyzers, senses and perceives the outside world with the whole organism, and his hands are modified “eyes”, “ears” and “tongue”. Even walking for the deaf-blind is associated with a number of difficulties and extreme stress, because they need to feel the road under their feet, imagine the surrounding space, feel smells, temperature changes and air fluctuations, and much more.

A child with a complex developmental disorder, as a result of insufficient sensory-motor experience and a violation of the conceptual apparatus, is not immediately included in the task offered to him. Even with specially organized teaching methods, the results are different; the child’s psyche remains deeply undeveloped.

Based on the above-described uniqueness of the sensory integration of children in the category under consideration, it is obvious that poor development of perception turns out to be one of the main reasons for the delayed mastery of activities, vital motor, social and everyday skills, which negatively affects the entire course of the physical and mental development of children. In this regard, before presenting educational material to a child, it is first recommended to create such sensory-stimulating conditions under which the child’s psychomotor capabilities can be optimally used.

Literature

Ayres E. J. The child and sensory integration. Understanding hidden developmental problems /E. Gene Ayres; [transl. from English Yulia Dara]. M.: Terevinf, 2009.
Baykina N. G. Methods of adaptive physical education for children with hearing impairment / N. G. Baikina, Y. V. Kret, L. D. Khoda. / Private methods of adaptive physical culture: textbook / Ed. L. V. Shapkova. - M.: Soviet Sport, 2007. - P. 43-50.
Krasnoshchekova N.V. Development of sensations and perceptions in children from infancy to primary school age: games, exercises, tests /N. V. Krasnoshchekova. -Rostov n/a: Phoenix, 2007. (School of Development).
Kisling Ulla. Sensory integration in dialogue: understand the child, recognize the problem, help find balance / Ulla Kisling; edited by E. V. Klochkova; [transl. with him. K. A. Sharr]. - M.: Terevinf, 2010.
Kuznetsova L.V. Fundamentals of special psychology: textbook. aid for students avg. ped. textbook establishments /L. V. Kuznetsova, Peresleni L. I., Solntseva L. I. /Ed. L. V. Kuznetsova. - M.: Academy, 2002.
Litvak A. G. Typhlopsychology /A. G. Litvak. - St. Petersburg, Publishing House of the Russian State Pedagogical University named after. A. I. Herzen, 1998.
Rostomashvili L.N. Adaptive physical education of children with complex developmental disorders. Textbook /L. N. Rostomashvili. - M.: Soviet sport, 2009.
Sokolyansky I. A. Sokolyansky, I. A. Education of deaf-blind children /I. A. Sokolyansky. //Defectology. - 1989, No. 2. — P. 7-12.
Skorokhodova O. I. Skorokhodova, O. I. Adaptation of a deaf-blind person to life / O. I. Skorokhodova. — //Special school, 1968, No. 1 (105). — P. 58-62.

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Help from a speech therapist: exercises to correct speech function

Speech therapy correction for sensorimotor aphasia is as fundamental a treatment method as the use of medications. To restore the patient’s speech, various exercises are used to activate the activity of the right cerebral hemisphere. The set of training sessions described below for a patient who has suffered a stroke is aimed at restoring in his memory the skills of mobility of the jaws, tongue, and lips. It must be performed together with the patient - he must repeat after the instructor.

Fold your lips into a tube, stretch them out as much as possible and hold them in this position for a few seconds, then relax. The exercises are repeated 10 times.
You need to lightly grab your lower lip with your teeth, as if trying to bite it, then let go and relax. Do the same with the upper lip.
Stick your tongue out as far as possible, tense your neck and hold your breath for 3 seconds, then exhale. Repeat several times.
Lick your lips with your tongue, confidently moving it in a circle clockwise and in the opposite direction.
With maximum tongue tension, try to roll it into a tube, and then touch the tip of it to the upper palate.

Melodic chants to restore speech

When performing exercises for sensorimotor aphasia, experts also focus on the therapy of melodic intonation. This technique is based on activating the functions of the legal cerebral hemisphere. Singing or simply your favorite musical compositions will help you achieve the desired result. If you often hum melodic tunes previously familiar to the patient, he will one day want to sing along with his instructor, trying to pronounce the endings of phrases or individual words. Tongue twisters that are spoken to a patient who is already recovering also help. This method works effectively, contributing to the speedy restoration of speech.

Surgery for incurable aphasia

The surgical method of treating the consequences of a stroke involves direct intervention in the patient’s skull to perform revascularization of the impaired speech area. Today, such intervention is carried out through extra-intracranial craniotomy. Microanastomosis helps improve blood circulation in the brain and optimize the condition of nerve cells, returning them to normal functionality.

Physiotherapy for speech restoration

Physiotherapeutic procedures are useful for stimulating the speech muscles. For aphasia, acupuncture and electrophoresis are prescribed. However, to date, physical therapy after stroke is not widespread. With local and shallow damage to an area of the cerebral cortex, the techniques actually help to correct articulation, but they are ineffective in restoring the perception of speech heard by the patient. Biofeedback tactics also lack precise confirmation of effectiveness. Meanwhile, today this treatment tactic is used for visual control over the restoration of the patient’s speech.

What is the likelihood of recovery?

The prognosis of sensorimotor aphasia after a stroke is relative, since it is impossible to say exactly how much time it will take to rehabilitate the patient. As a rule, long-term hard work with specialists gives noticeable results after 6 months. You should not hope for spontaneous recovery. On average, with comprehensive speech therapy correction, patients’ speech is restored only after 2-3 years.

The prognosis for recovery also depends on the individual characteristics of the patient and his age. More often, older people have a more difficult time coping with speech impairment; it is extremely rare that they are able to fully restore their previous ability to communicate with others. However, with significant damage to the cerebral cortex, there is little chance of complete rehabilitation even in relatively young people. It is important to start treatment as early as possible and unquestioningly follow all medical instructions. The success of a patient with sensorimotor aphasia in recovery is unlikely without the help of loved ones.

Aphasia. Lost speech after a stroke or injury.

Speech with aphasia takes a long time to recover - this can take up to two to three years of rehabilitation procedures. Motor or sensory aphasia is a systemic speech disorder that contributes to the development of affective, mental states, aggression, emotional lability and depression in the person suffering from aphasia. To eliminate speech impairment, it is always better to involve various specialists - speech therapist, psychologist, neuropsychologist, rehabilitation specialist. When correcting aphasia, restorative treatment should begin as early as possible, when the patient’s condition allows for various types of procedures to begin. World experience shows that rehabilitation begun in the first three months after stopping the process that caused speech impairment provides the highest percentage of recovery and socialization of the patient.

Rehabilitation (from the Late Latin rehabilitatio - restoration) is a set of medical, pedagogical, professional measures aimed at restoring or compensating for impaired body functions and the working capacity of sick and disabled people. The goal of rehabilitation of persons with health problems is to ensure their ability to implement the lifestyle of normally developing people. It follows from this that persons with health problems are integrated into the social environment. Adaptive rehabilitation is closely related to the problem of adaptation (Latin adaptio - adaptation) of the entire recovery system (rehabilitation) to ensure motor activity and restore speech of people with aphasia, which should be considered one of the current problems. One of the main tasks of adaptive rehabilitation is the restoration of lost functions and systems of the body, maintaining a person’s natural desire to return to society, his physical and spiritual status. The concept of adaptive rehabilitation reveals such an opportunity to help achieve the optimal level of development of lost functions of the human body in accordance with its potential capabilities.

To implement this process it is necessary to comply

the following conditions:

creating conditions to meet the rehabilitation needs of each person based on adjusting the pedagogical process to the patient’s needs;
providing the patient with real opportunities for self-affirmation, where his abilities are revealed to the maximum extent, and focusing on the reserve capabilities of the body;
formation in the hospital and at home of an emotional field of relationships that ensure respect for the patient’s personality at the levels of communication between the patient and the doctor, instructor, teacher, relative, and other patient;
ensuring a high level of continuous rehabilitation process in accordance with the individual characteristics of each patient and the relationship of all rehabilitation means used.

Organizing home rehabilitation is a rather complex process that requires discipline, responsibility and perseverance in overcoming all the difficulties on the way to restoring the affected organs and systems of the body of a person who has suffered a stroke (brain injury or brain surgery) and has a speech disorder. When organizing rehabilitation at home, you can focus on the following options for its application:

— home visits by a rehabilitation specialist, physical therapy instructor, neurologist, psychologist, speech therapist and other rehabilitation treatment specialists;

— training in rehabilitation techniques for family, friends, and relatives;

- basic assistance from a nurse;

— combined organization of work of a specialist and relatives during home rehabilitation;

— the use of advisory assistance from various rehabilitation specialists;

— use of information media: computer assistance, specialized literature, methodological and teaching aids;

— distance learning (by a speech therapist) for the patient and his relatives in speech restoration techniques.

Restoring speech in people suffering from aphasia is one of the most significant tasks that needs to be solved in the near future. This category of people is treated by a speech therapist, as well as a speech therapist-aphasiologist. Restoring speech during aphasia in the first three months significantly increases the chances of its recovery. There are developed methods for working with aphasia. The methodological program of rehabilitation work is individual for each patient and depends on the characteristics of his speech disorder, personality, interests, needs, etc.

Basic principles in working with people with aphasia:

- in case of any form of speech disorder, it is necessary to work with a speech therapist as early as possible;

— work must begin with overcoming disorders of understanding of addressed speech, and if this aspect is preserved, then with the restoration of the semantic structure of speech, a violation of which occurs in almost all forms of aphasia;

— work should be carried out on all aspects of speech, taking into account the specifics of the violation of each speech function in different forms of aphasia;

- it is necessary to include reading and writing in the recovery period or work on their restoration if they are as grossly impaired as speech;

— everyone who surrounds the patient should be involved in the restoration work: relatives, acquaintances, neighbors, medical staff, having previously consulted them.

Classes are held at least two to three times a week, and preferably daily for several months. The work is carried out in two modes: with a speech therapist and independently. If help is not provided by a speech therapist in the first weeks, speech disorders become permanent.

The main efforts in restoring speech function in speechless patients - with aphasia - are aimed at disinhibiting speech. This is carried out on the basis of past speech stereotypes, in order to obtain at least some sounds and words. To disinhibit speech, material is selected that is of great importance in terms of semantic and emotional content. They take simple speech images that easily come to life in memory and set the language in motion as if automatically. This could be counting to ten, days of the week, months, etc. Automated speech sequences, emotional words, everyday expressions, and exclamations contribute to speech disinhibition. Sometimes such expressions “open the way” for other words, and speech begins to recover. First, the patient repeats the words together with the teacher, then repeats after him, and then speaks independently. A good remedy would be proverbs, sayings where it is necessary to finish words, singing familiar songs, reciting familiar poems.

The greatest difficulty in the rehabilitation of patients with aphasia is the group of patients in whom impressive speech disorders dominate. In this case, the severity of the course and the difficulties of recovery are due to the fact that patients are not able to recognize the presence of a speech defect. Auditory control of perceived speech is impaired, so a positive prognosis for recovery is difficult. The work begins not with individual sounds, but with words. At the moment the patient examines the object and the written word, the teacher pronounces this word out loud several times. The sound being practiced is pronounced with exaggeration of sound and articulation. Having learned to distinguish sounds, patients, as a rule, begin to understand those words that they did not understand before. In addition, the word is combined with the subject. Thus, the restoration of phonemic hearing provides the basis for restoring speech understanding in general.

When working with patients who have a severe degree of severity, bordering on total, the task of recovery techniques is to stimulate the compensatory capabilities of the subdominant (hemisphere opposite to the dominant (in right-handed people the left hemisphere is dominant)) hemisphere. At this stage, restoration of mental function in its previous form is impossible; restructuring is necessary to radically change its psychophysiological structure. There is a certain pattern of restoration of function in patients after they have suffered a cerebral infarction. Near the focus of brain damage, zones of plasticity ( capable of recovery ) and secondary replacement of lost functions are formed, while similar zones of hypermetabolism are formed in symmetrical areas of the opposite hemisphere of the brain. A number of scientists believe that a favorable prognosis for the restoration of speech thinking in patients with aphasia directly depends on whether the right hemisphere is able to temporarily take over the function of the left hemisphere in the initial stages. Therefore, at the first stage of recovery, patients with acoustic-gnostic aphasia are offered the technique of global text reading, and with acoustic-mnestic aphasia, work on normalizing visual-object gnosis is offered. So, for example, the patient must look at the half-drawn object pictures and name them. With patients with semantic aphasia, work is carried out to restore visual-spatial perception and overcome acalculia. At the next stage, when working with patients with moderate severity, the activity of the depressed dominant hemisphere (the hemisphere that has suffered) is stimulated. At the same time, the methods take into account the need for further participation of the subdominant hemisphere to increase the effectiveness of recovery. In patients with acoustic-gnostic aphasia, phonemic perception and semantics of speech are restored by introducing the word into context. To expand the volume of auditory-speech memory, patients with acoustic-mnestic aphasia are asked to remember addresses and telephone numbers. With patients with semantic aphasia, work is carried out to restore the deep meaning of a word using the interpretation of proverbs. At the third, final stage, when restoring a mild degree of severity of speech disorders in each individual case, not only the lesion site is taken into account, but also its connections with other, more complex in organization parts of the cerebral cortex, which are the tertiary parts of the second functional block (in acoustic syndromes). -gnostic and acoustic-mnestic aphasia) and prefrontal coranterior parts of the brain, corresponding to the tertiary fields of the third functional block (with semantic aphasia syndrome). This is reflected in the following types of tasks: for acoustic-gnostic aphasia, it is proposed to solve crossword puzzles, as well as explain logical-grammatical phrases; with acoustic-mnestic - retell texts and explain the figurative meanings of words; with semantics - to identify logical and stylistic errors made in the text. Due to the systemic nature of aphasic disorders, work is carried out on all aspects of speech, taking into account the specifics of the violation of each speech function. Practice shows that the same form of aphasia manifests itself differently in different people depending on their educational and cultural level, knowledge of languages, and personality traits. Often, different patients experience seemingly identical speech symptoms at first glance. But, as experience shows, the mechanisms of these symptoms differ from each other. In such cases, despite the similarity of speech disorders, various methods of speech therapy rehabilitation work should be used.

Speech restoration in aphasia is more successful the earlier correctional work is started.

The prognosis for the restoration of speech function in aphasia is determined by the location and size of the affected area, the degree of speech disorders, the start date of rehabilitation training, the age and general health of the patient.

Speech therapy work for aphasia is a long and labor-intensive process that requires the cooperation of a neurologist, neuropsychologist, speech therapist, patient and his immediate environment, and speech restoration should not take place empirically, but skillfully, at a serious professional level.

What to do if there is a patient with aphasia in the family

Relatives of a person who has suffered a stroke should be patient and prepare for a long, difficult road to rehabilitation. It is not easy to restore speech functions with sensorimotor aphasia, but you cannot give up prematurely. An extremely positive attitude of the patient, his determination and desire to work on himself will play an important role in recovery. First of all, the patient must be sure that he is not a burden to his environment, and feel the love of his closest and dearest people.

To regain speech after a stroke, you must follow all the recommendations of specialists and regularly perform speech therapy exercises. Yes, the rehabilitation process does require significant effort, but the main thing is not to despair! Even minimal changes will become an incentive to continue treatment and recovery.

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