The term "dynamic aphasia" refers to a pathological process characterized by a violation of the formation and utterance of normal speech. A person uses only monosyllabic phrases during a conversation. He has a lack of expressive speech, in addition, he does not fully understand the meaning of long sentences voiced by the interlocutor. If the first signs of the disease occur, contact a neurologist. The doctor will draw up a referral to a comprehensive diagnosis and, after receiving its results, will draw up the most effective treatment regimen for speech disorders. Aphasia also requires regular speech therapy sessions. With timely access to a doctor, the prognosis is favorable.
Pathogenesis
The posterior elements of the frontal lobe of the brain belong to the speech section. The latter is responsible for both programming and the regulation of mental activity. If the frontal lobe of the brain is damaged, grammatical construction is violated. A natural consequence is a speech disorder. How is this manifested? Violation of the regulatory function of speech leads to the fact that a person begins to talk in incoherent sentences. He gives only monosyllabic answers to all questions. His speech does not contain any emotions.
Dynamic aphasia as a separate type of disorder was identified by a German scientist in 1934. Later, the Soviet doctor Luria A.R. studied the pathology. The followers of the scientist were able to identify and prove that dynamic aphasia is nothing more than a violation of internal speech. Moreover, this pathological condition is due to a disorder in proposal planning.
According to statistics, the disease is least often diagnosed in left-handed people. This is due to the fact that the departments of the right hemisphere of their brain have powerful compensatory capabilities.
There are several forms of aphasia:
- Afferent motor. It is considered one of the most serious violations. Patients cannot move their tongue and lips.
- Efferent motor. It is characterized by the occurrence of perseveration. It is a constant repetition of the same word. Sometimes the patient literally wedges on any one emotion. Perseveration is also a condition characterized by persistent sensations.
- Dynamic. As mentioned above, it is characterized by a disorder of planning and normal speech design.
- Sensory. It is characterized by a violation of the understanding of someone else's speech. In this case, the patient hears everything well. As the disease progresses, other people's speech begins to be perceived in a distorted form.
- Acoustic-mnestic. The patient hears someone else's speech and understands the meaning of the words spoken by the interlocutor, but very quickly received information is erased from memory.
- Semantic. It is characterized by an inability to perceive complex sentences.
The form of aphasia directly depends on which part of the brain is affected. Often, the disease is accompanied by a violation of the functions of reading and writing.
Etiology
The main reason for the development of the disease is damage to the speech center of the brain. The main etiological factors are the following diseases and conditions:
- Traumatic brain injuries. Tissue damage is most often the result of internal bleeding, concussion and crushing. Against the background of the formation of post-traumatic edema, damage to neurons occurs. In addition, a pronounced inflammatory process develops and the hematoma resulting from an injury increases in size. A natural consequence is the compression of adjacent tissues.
- Cerebrovascular disease. Most often, the occurrence of dynamic aphasia is associated with acute vascular catastrophes. A striking example is hemorrhagic or ischemic stroke. In addition, the cause of the development of pathology can be cerebral ischemia, characterized by a chronic course. The latter develops against the background of diabetes mellitus, hypertension, cerebral atherosclerosis, amyloidosis of blood vessels.
- Infectious and inflammatory diseases. If there is a focus of pathology in the front of the brain, sooner or later the frontal cortex is affected. The consequence is a violation of its interaction with other cerebral structures. Against the background of this pathological process, speech defects become pronounced.
- Cerebral neoplasms localized in the frontal zone. The consequence of tumor growth is the death of neurons due to their destruction or compression. Compression of the frontal zone can also occur as a result of the formation of melanomas or meningiomas in the membranes of the brain.
- Degenerative pathology. Neuronal dysfunction is most often observed in Peak, Alzheimer's disease, as well as leukodystrophy.
Thus, pathology in almost all cases is associated with a violation of the frontal structures.
Severity
Of great clinical importance is the fact at which stage of speech formation the failure occurred. Depending on this, in neuropsychology (this is a science that studies the relationship between the functioning of the brain and mental processes, as well as human behavior), it is customary to divide patients into two groups:
- This includes all patients with primary internal programming disorder. Such patients have practically no motivation for recovery. As practice shows, rehabilitation is extremely difficult and takes a long time.
- This group includes persons suffering from a violation of grammatical construction. Such patients remain criticized, they are also characterized by pronounced motivation. Treatment is usually quick and easy.
There are several methods for correcting a violation. So that the doctor can choose the most effective, in the process of speech therapy examination, the severity of the disease is revealed.
She may be:
- Easy. This degree is characterized by spontaneous utterances that can be complex. The patient’s speech is stereotyped, the grammar in it is broken. In addition, the examination reveals verbal weakness and inability to correctly understand the meaning of statements in a figurative sense.
- Average. Speech is spontaneous. The patient speaks in short stereotypical phrases. Speech is characterized by the absence of verbs and agrammatism. A person speaks very little, more willingly he takes part in dialogues, most often in monosyllabic answers to questions.
- Heavy. This degree is characterized by the absence of spontaneous speech. The patient can take part in dialogues, but his answers are always monosyllables (yes / no). A person needs external stimulation, but even so, his speech has a telegraphic style.
A mild degree of dynamic aphasia, as a rule, can be cured quite quickly. In other cases, a longer correction is required.
Clinical manifestations
The main symptom of the disease is the presence of difficulties in the formation of active speech. How is this manifested:
- The patient does not turn to people with requests, he does not ask anyone questions.
- The lack of basic links of utterance. You can catch individual fragments, but they are difficult to combine in meaning.
- In speech, there are practically no prepositions, pronouns and verbs. Nouns are pronounced in the nominative case.
- Emotional coloring and expressiveness of phrases are significantly reduced.
- Sometimes a person can answer the question with a normal speech, but at the same time he repeats the words behind the interlocutor ("Did you eat today?" - "I ate today"). Often the patient copies and gestures.
- Reduced attention span.
- Slowing down the speed of thought processes.
- Lack of criticism regarding the existing pathology.
- Impaired understanding of speech. If a person is still able to analyze light phrases a little, then complex phrases are no longer there.
Most patients retained written language. Dysgraphy can appear only when trying to write complex sentences dictated or to display your own text on paper.
Dynamic aphasia is also characterized by dyslexia and acalculia. What are they manifested in:
- Inattention.
- Missing words.
- Poor reading comprehension.
- Difficulties in determining the sequence of arithmetic operations.
It is worth noting that patients are able to solve elementary problems. They also have access to a consistent account.
Diagnostics
If disturbing signs occur in a person, it is necessary to deliver him to a medical institution as soon as possible and show him to a neurologist. Speech defects are detected during the initial examination, when the doctor tries to establish verbal contact with the patient. Based on the history, a neurologist can suggest the nature of the lesion. During the examination, the doctor evaluates the following indicators:
- Behavioral features.
- Speed of thinking.
- The degree of care.
- Emotionality
- The presence / absence of active speech, apraxia.
- The nature of the movements.
In order to make an accurate diagnosis, a neurologist draws up a referral for a comprehensive examination, including:
- Consultation with a speech therapist. This specialist diagnoses oral speech. During the speech therapy examination, the doctor can determine the type of aphasia and its severity. In addition, during the appointment, the doctor evaluates the patient’s written language, if necessary. The indicator of its safety allows us to differentiate dynamic aphasia from other disorders.
- Psychiatrist consultation. During the reception, the specialist talks with the patient, conducts specific tests and monitors the behavior of the subject. This is necessary in order to exclude mental disorders in a person.
- Cerebral tomography. During the study, the doctor gets the opportunity to determine the morphology of the underlying disease. In the presence of traumatic brain injuries, CT is more preferable than MRI.
- The study of blood vessels. As part of the diagnosis, MRI, duplex scanning and ultrasound dopplerography are performed. During the study, the doctor estimates the speed of blood flow. He can also determine the exact localization of the focus of the pathology.
- Lumbar puncture. It is carried out if the doctor suspects the presence in the patient's body of an inflammatory process of an infectious nature. Analysis of cerebrospinal fluid is carried out by ELISA or PCR.
During the differential diagnosis, the doctor's task is to exclude acoustic-mnestic and afferent motor aphasia, as well as psychogenic mutism. If the presence of these pathologies is not confirmed, the final diagnosis is made. The next step is to develop a treatment regimen.
Drug treatment
Its goal is to eliminate the root cause, that is, the disease, which acted as the main etiological factor. Its treatment is carried out by a neurologist or neurosurgeon.
The scheme of drug therapy consists of the following items:
- The intake of vitamins and antioxidants. Against the background of treatment, the metabolic function of neurocytes is supported, regeneration processes are accelerated, and cell membrane protection is enhanced. As a rule, doctors prescribe the following drugs: Pyridoxine, Riboflavin, Glycine, Emoxipin, Mexidol.
- Taking nootropic drugs. The active components of these drugs contribute to improving blood circulation in the brain and normalize metabolic processes in its tissues. Examples of drugs: Nootropil, Piracetam, Cerebrolysin, Picamilon.
- Reception or intravenous administration of cerebroprotectors. These drugs prevent the development of complications and contribute to improving blood circulation in the brain. As a rule, doctors prescribe “Vinpocetine”, “Koplamin”, “Cinnarizine”.
- Taking vasoactive drugs. They also contribute to improving cerebral circulation. Examples of funds: Plavix, Heparin, Nimodipine, Warfarin.
All drugs are prescribed exclusively by a doctor. The specialist takes into account not only the severity of dynamic aphasia, but also the individual characteristics of the patient's body.
Logopedic correction
The main task of working with the patient is to eliminate inertia. In other words, working with children with severe speech impairments and adults involves overcoming defects in internal programming or grammatical structuring of speech.
A set of exercises is compiled by a doctor based on the results of the diagnosis. According to statistics, a pronounced positive trend occurs 2-3 years after regular classes.
The following exercises are required for each scheme:
- The doctor makes a sentence and changes the order of words in it. The patient is invited to recover it.
- The specialist voices several classification features. The patient should correctly divide objects on them. For example, a doctor asks you to name all the round things in the room.
- The specialist suggests counting to 100. Then arrange the numbers in the reverse order.
- The doctor asks a simple question. The patient should answer him by adding one word (“Where will you go?” - “I will go home”).
- A detailed discussion of the events of the day.
- Retelling of the text, drawing up a plan for it.
- The specialist asks questions, and the patient must answer them in writing.
During classes, the doctor can use schemes, chips, drawings. After some time, the patient manages to form his speech correctly and express it with appropriate emotionality. In addition, speech therapists often perform dramas, where the leading dialogue role is given to the patient.
Complications
Against the background of the lack of active speech, communication opportunities are disrupted and subsequently completely lost. The patient is not able to satisfy his own needs, he also can not simply ask for help.
The recovery process is much more difficult if changes in the psychoemotional sphere have already occurred in the human body. In such situations, dynamic aphasia becomes persistent. In the absence of attempts to correct it, a person remains disabled until the end of his life.
Forecast
The outcome of the disease depends not only on the timeliness of going to the doctor, but also on the root cause of the development of the disease. It is important to understand that dynamic aphasia is an extremely complex disease that requires patience and responsibility of close relatives of the patient. The patient himself, due to lack of motivation, will not be occupied with taking medications.
If neoplasms and pathologies of a degenerative nature are the cause of aphasia, the prognosis is poor. In other cases, treatment usually ends successfully. A positive result can be seen after 2-3 years.
Finally
Dynamic aphasia is a disease characterized by a disorder in the formation and expression of speech. In addition, often patients are not able to perceive the information voiced by the interlocutor. In neuropsychology (this is a science that studies the relationship between brain function and mental processes), it is customary to divide all patients into 2 groups. The first includes people with a lack of motivation, which greatly complicates the recovery process. Patients in the second group recover much faster. They continue to criticize their own defect and motivation.