Motor aphasia in medicine has another name - Broca aphasia, in honor of the researcher who described this ailment. This is a severe speech disorder that occurs against the background of damage to the frontal part of the left hemisphere and a violation of its functions. Similar problems most often arise as a result of a stroke or severe injuries to the skull and brain.
This pathology is expressed by severe speech defects, difficulties in selecting words in the process of speaking and, unfortunately, is not limited only to articulation disorders.
What distinguishes afferent aphasia?
One of the varieties of pathological speech disorders is afferent motor aphasia, also called kinesthetic.
At the same time, the patient is affected by the lower dark parts of the brain (the leading hemisphere). For right-handed people, this is the left hemisphere, which is responsible for the process of speaking. With this type of speech disorder (in mild form), the patient has a special fluency of speech with the absence of pauses between words. At the same time, articulation disturbances are noticeable, as well as paraphase defects (i.e., replacing some sounds or syllables in a word with others) during reading or spontaneous speaking.
In a severe case, the patient is hardly given the pronunciation of sounds. Moreover, afferent aphasia has an interesting feature - a person, for example, can spontaneously pronounce some of them, but not at the request, because at that very moment he has to solve the problem of how to put his lips together, where to put his tongue, etc., to get this or that sound.
Additional signs of afferent motor aphasia
It should be noted that, in addition to the presence of problems with speech, in patients with a diagnosis of afferent motor aphasia, oral (ie, non-speech) praxis is also impaired.
This condition is expressed in the inability to perform various oral movements (by the way, both independently and after someone has demonstrated them), for example, to inflate both or one cheek, stick out the tongue, etc.
And as a result of a kinesthetic defect, patients have problems with writing (both dictated and independent). By the way, quite often the listed disorders are also accompanied by the patient’s passivity, caused by the inertness of processes in the nerve fibers.
What is efferent aphasia
Efferent motor aphasia is another type of speech pathology in which the back of the lower frontal gyrus is affected. The patient is often able to pronounce individual sounds, but to collect them into a word, "switch" from the first sound to the next, he is not able to. In patients with this type of pathology, it is the process of organizing a speech act, the so-called “kinetic melody”, that is what the researcher A. R. Luria said.
Such patients are characterized by "freezing" on the first sound or first syllable of the word with subsequent long repetitions. Speech loses fluidity, the selection of words is difficult, the so-called emboli appear - words or sets of sounds with which the patient tries to replace everything that he is not able to pronounce.
Features of speech in efferent aphasia
And most often in the process of speech (with a diagnosis of "efferent motor aphasia"), the patient uses only nouns and verbs in the initial form, for example: "Home ... it ... stand." What is said by such a patient has, as a rule, a telegraphic style, but at the same time, however, the phrases turn out to be quite informative.
Correctional work in motor aphasia, by the way, often involves the use of melodic-intonational techniques. Patients are invited to sing, as well as slowly and chantingly pronounce the words. And it is interesting that with such exercises (even with deep disorders of articulation) the pronunciation process becomes almost normal.
Severe cases of motor aphasia
If motor aphasia is difficult, then the patient's speech can consist only of slurred sounds or the words "yes" and "no." At the same time, patients try to pronounce the entire set of phonemes available to them with different intonations, so that the interlocutor can understand their attitude to what they hear. By the way, as mentioned above, oral speech by such patients is almost completely perceived, with the exception of only complicated speech or allegory.
Incidentally, the emotional background of people with motor aphasia of any severity is also disturbed. Patients usually become tearful and easily fall into a state of despair or depression. The neurological signs of pathology are characterized by weak facial muscles, as well as the inability to use the muscles of the face, throat and mouth at the same time. The field of view in these patients also shifts from normal boundaries.
What is sensory aphasia?
The most severe type of speech disorder is sensory-motor aphasia, or in another way, acoustic-gnostic. It is caused by a lesion of the posterior third of the superior temporal gyrus and is expressed in a violation of the understanding of pronounced sounds, although the processes of pronunciation and articulation in patients are usually not disturbed. Problems with phonemic hearing that occurred in such patients lead to a lack of control over their own speech.
At the same time, one more feature of this type of speech disorder should be noted - sensory-motor aphasia is characterized by the fact that, unlike previous types of pathology, the patient does not realize his problem.
Patients with the specified diagnosis, as a rule, speak quickly, but use words in an arbitrary meaning. And all this looks to the listener as a kind of verbal "salad", in severe cases, completely devoid of meaning.
Speech restoration in motor aphasia: what you need to remember
Practice shows that even with the same forms of aphasia in each patient, it manifests itself in different ways. It depends not only on the state of health and age, but also on the educational, cultural levels of a person, as well as on the characteristics of his personality.
In the acute course (after a stroke), total aphasia can immediately occur, in which the patient is not able to utter a sound. But, fortunately, often speech begins to recover over time.
At the same time, relatives who want to help the injured person should not shout during a conversation with him, try to induce him to talk, he hears you perfectly. Also, referring to the patient, one should not speak in complex phrases, since the process of perceiving what was said at that time is very difficult for him. But at the same time, it should be remembered that the patient has not impaired intelligence. The problem for this person is precisely the difficulties of pronunciation!
Motor aphasia - treatment depends on many factors
Unfortunately, returning full speech after a stroke or brain injury is quite difficult. But the patient, with the right attitude of others around him, manages to sufficiently restore his communicative abilities.
Of course, first of all, a comprehensive examination of the patient should be carried out to find out the cause of the violations. As you already understood, the method of speech restoration largely depends on which particular part of the brain is affected.
Drug therapy is also added to work with a speech therapist. With a diagnosis of motor aphasia, treatment usually involves taking drugs such as Cavinton, Korsavin, Telektol, and others that have a vasoactive focus (they improve blood supply to the brain). No less popular are anticholinesterase substances, such as Amiridin and Galantamine (they have a stimulating effect on the autonomic nervous system), as well as muscle relaxants that reduce muscle tone in paralyzed limbs (Elatin and Midokalm preparations), and nootropic substances.
Physiotherapeutic measures in the form of acupuncture, massage, physiotherapy exercises and electrical stimulation are also important.
How to restore speech at the initial stage
Already in the early stages after the detection of the problem, motor aphasia requires correction, since the most effective restoration of speech is possible only in the first month from the onset of the disease (later, as a rule, no significant positive changes are noticed).
In this case, you need to try to "slow down" the speech, to cause the patient's speech flow. That is, those who help the patient should provoke pronunciation of at least some sounds in him, use all the possibilities. For example, suggest simulating any sounds: "Tell me, how does water drip?" - "Cap, cap." Or: "How does the wind howl?" - "Oooo." Another example: "How does the car ride?" - "Ms." In this case, the sounds should be strongly articulated so that the patient can understand how the speaker’s lips move.
Some features of the correction of motor aphasia
If the patient has mild motor aphasia, do not encourage him to use gestures or facial expressions instead of words, try to stimulate speech. But at the same time do not force events, achieve a clean and clear pronunciation. Do not constantly correct everything said by the patient.
Offer the patient to agree with you, for example, the well-known sayings: "Slow down, go further ..." Let him at first fail to utter the whole word, even an imitation of sounds, which will cause an incitement to speech, is enough. Photos of loved ones will also help. You need to ask to show someone to them and give his name.
As soon as disinhibition has begun, try to use verbs, connect all types of communication: speech, writing, reading. For example: "What is a cat doing?" - "Asleep." Let the patient not only pronounce the given word, but also find among the proposed signatures the one that corresponds to the picture.
What to do in case of severe aphasia
As mentioned above, a severe degree of aphasia leads to the fact that a person is not able to pronounce even a syllable, and not just a word. In this case, a serial account, repeating the names of the days of the week or singing will come in handy.
The fact is that it is these processes that are most automated, and control over them passes already to other parts of the brain. Therefore, counting after you: “One, two, three, four,” the patient makes sounds without hesitation. By the way, the same thing happens in the process of singing. The song should be well-known and as simple as possible. First, sing it along with the patient, and then encourage everyone, even inarticulate attempts to sing or score independently.
Remember that at all stages of rehabilitation, patients need encouraging conversations and positive motivation for classes, since the emotional factor is an important component that successfully overcomes motor forms of aphasia.
A few words in the end
Speech restoration work is a rather lengthy and difficult process. It requires the joint efforts of the attending physician, speech therapist and, of course, the close environment of the victim. Moreover, the correction of motor aphasia should be carried out necessarily at a professional level, and the sooner it is started, the greater the chance of success.
The positive dynamics in young patients is especially pronounced. A spontaneous exit from a state of motor aphasia, among other things, may be accompanied by the occurrence of stuttering.
Consider all this, do not lose faith in success - and you will succeed!