home > Natural science > Control work: “Correctional work with aphasia. From the experience of working to revitalize the sense of language in relation to its grammatical norms in motor aphasia of severe severity. Work of a speech therapist in sensory-motor aphasia

Control work: “Correctional work with aphasia. From the experience of working to revitalize the sense of language in relation to its grammatical norms in motor aphasia of severe severity. Work of a speech therapist in sensory-motor aphasia

The theoretical basis of restorative training for aphasia is modern ideas in psychology about higher mental functions as functional systems, their systemic and dynamic localization, their lifetime formation, their socio-historical origin and indirect structure. Based on these theoretical positions, psychologists, physiologists, neurologists and speech therapists developed and practically applied a way to rebuild functional systems using the method of restorative training. This path has two directions in practical work: 1st – the broken link in the psychological structure of the function is replaced by another; 2nd - the creation of new functional systems that include new links in the work that were not previously involved in the now disrupted function.

To solve these problems, a group form of classes is provided, rather than individual. As a method of work in group classes, such forms and functions of speech can be used that cannot be used in individual work - dialogic and communicative. It is the dialogical form of speech that can be an effective means of the communicative function of speech. Group speech creates an emotional uplift and releases all the “dormant” abilities of a person to communicate. In addition, the advantages of the group form of classes: imitation, support, mutual assistance, cooperation, the presence of positive emotions, connections between group members, etc. The main task of speech therapy is the restoration of impressive and expressive vocabulary.

There are two periods in working with people with aphasia: acute – up to two months after the disease; residual - after two and more. In the acute period, the main tasks are: 1) disinhibition of temporarily suppressed speech structures; 2) prevention of the occurrence and fixation of some symptoms of aphasia: agrammatism, verbal and literal paraphasias, speech embolus; 3) preventing a person with aphasia from treating themselves as inferior, as a person who cannot speak. The main task in the residual period is to inhibit pathological connections.

Disinhibition of speech function based on old speech stereotypes should be carried out with low-strength stimuli (in a whisper, in a low voice). The material is selected based on its semantic and emotional significance for a person with aphasia, and not on the basis of ease or difficulty of pronunciation. To do this, you should get acquainted with your medical history, talk with your doctor, relatives to identify inclinations, hobbies, and interests. You can use familiar speech stereotypes - counting, days of the week, months; emotionally significant passages of poetry, finishing of common phrases and expressions. Over time, work with material that is close to the student is transferred to issues of specialty and profession.

The basis of restorative work to disinhibit speech function is dialogic speech. You can use the following scheme for restoring dialogical speech: repetition of a ready-made answer formula (reflected speech) - hints of one or two syllables of each word of the answer - spontaneous answer with a choice of two, three, four, etc. words used by the speech therapist when asking the question - a spontaneous answer to the question posed without taking into account the number of words used in the question, and asking questions by the person with aphasia.

The appearance of agrammatism in aphasia is usually the result of improper organization of the initial recovery period, when disinhibition is carried out either only of the nominative function of speech, or only of the predicative one. Speech should immediately be complete in terms of vocabulary, and pronunciation defects that do not reduce the correctness of sentence construction can be tolerated for now. This is the essence of preventing agrammatism. Work to overcome agrammatism is carried out not only in oral speech, but also, when writing skills are slightly restored, in written speech. The basis of exercises (oral and written) to prevent the development of agrammatism is the dialogical form of speech.

The most difficult pathological symptom to prevent and overcome is a speech embolus, which often forms in the first weeks after the lesion. There are two main types of speech emboli: a single word or sentence that can be pronounced, or a trigger mechanism necessary for pronouncing other words (V.V. Opel). Since the speech embolus is the result and manifestation of stagnation and inertia of nervous processes, it cannot serve as a starting point for rehabilitation exercises. The following conditions contribute to the inhibition of the speech embolus (speech perseveration): 1) observance of optimal intervals between speech stimuli, allowing the resulting excitation to “fade away” after completing each task; 2) presenting the material at low voice strength, since in mild cases, perseveration almost does not occur with low strength of the sound stimulus, and when it does occur, it fades away faster; 3) a pause in classes at the first hint of the occurrence of perseveration; 4) temporary restriction of conversations with others, with the exception of the speech therapist.

To prevent a person with aphasia from treating oneself as inferior, one should talk to him with respect, warmly and sincerely experience all his successes and disappointments, trying to constantly emphasize achievements, calmly and confidently explain difficulties, creating confidence in one’s abilities.

In the residual period, a more careful differentiation of methodological techniques is necessary depending on the form of aphasia. According to the severity of the violation, two groups are distinguished: 1st - the most neglected houses with which no one talks; 2nd – more complex – persons with speech embolus, agrammatism. With both groups, work should begin with disinhibiting speech; however, with the second group, it is necessary to simultaneously work on eliminating the embolus as quickly as possible. To do this, without focusing on the use of the embolus, you should avoid all sound combinations that contribute to its pronunciation.

Since restorative education is aimed primarily at restoring communication abilities, it is necessary to be involved in communication not only in the classroom, but also in the family and public places.

The main task of restorative training for acoustic-gnostic sensory aphasia is to overcome defects in differentiated perception of sounds and restore phonemic hearing. Only restoration of the process of sound discrimination can ensure the revival of all affected aspects of speech, mainly speech understanding.

With acoustic-mnestic (amnestic) form of aphasia the central task of training is the restoration (expansion) of the volume of acoustic perception, overcoming defects in auditory-speech memory and the restoration of stable visual images-representations of objects.

In remedial training for semantic aphasia L. S. Tsvetkova identified two stages. At the first stage, learning begins with the recognition of drawn geometric shapes by comparing two given samples. Then they proceed to the reproduction of the given figures according to the model: first - drawing, then - active construction from sticks, cubes. Subsequently, verbal instructions are added to the sample: “put the square under the triangle, circle, right, up,” etc. Subsequently, they practice the concepts: “less - more”, “darker - lighter”, etc. Then they move on to restoring awareness of the diagram of their body, its position in space.

The main task of training at the second stage is to restore the process of understanding speech and its logical and grammatical structures. The main focus is on restoring understanding of prepositional and inflectional constructions. Restoring the understanding of prepositions begins with restoring the analysis of the spatial relationships of objects. In general, learning comes from restoring the spatial relationships of objects with a gradual transfer of action to the speech level.

The central task of restorative education with motor afferent aphasia – restoration of articulatory activity, and the goal is restoration of oral expressive speech. The main method of speech restoration in this form of aphasia is the method of semantic-auditory stimulation of the word. This method involves pronouncing not a sound, but a whole word. Restoration of sound-articulatory analysis and the kinetic basis of a word is carried out on the basis of the restored active and passive vocabulary.

With motor efferent aphasia the main task is to overcome pathological inertia and restore the dynamic scheme of the spoken word. The goal of training is to restore oral speech, writing, and reading. The implementation of this goal is possible by solving the following tasks: 1) general disinhibition of speech; 2) overcoming perseverations, echolalia; 3) restoration of general mental and verbal activity.

The Three Most Important Objectives of Restorative Training with dynamic aphasia defined by L. S. Tsvetkova: 1) the ability to program and plan statements; 2) predicativeness of speech (restoration of the actualization of verbs); 3) speech activity (restoration of the active phrase).

A great contribution to the development of principles and techniques for overcoming aphasia was made by E.S. Bain, M.K. Burlakova (Shokhor-Trotskaya), T.G. Wiesel, A.R. Luria, L.S. Tsvetkova.

In speech therapy work to overcome aphasia, general didactic teaching principles are used (visuality, accessibility, consciousness, etc.). However, it must be remembered that the restoration of speech functions differs from formative training, that the higher cortical functions of a person who has spoken and written are organized somewhat differently than those of a child beginning to speak. In this regard, when developing a plan for cor.-ped. work should adhere to the following provisions:

1. After completing the examination of the patient, the speech therapist determines which area of the second or third “functional block” of the brain was damaged as a result of a stroke or injury, and which areas of the patient’s brain are preserved. In most patients with aphasia, the functions of the right hemisphere are preserved. It is the preservation of the functions of the right hemisphere and the third “functional block” of the left hemisphere that allows the patient to develop installation for restoration of impaired speech. Duration of speech therapy classes with patients with all forms of aphasia is two to three years of systematic training.

2. Selection of techniques core-ped. work depends on the stage of restoration of speech functions. In the first days after a stroke, work is carried out with the patient’s relatively passive participation in the process of speech restoration. At later stages of restoration of speech functions, the structure and plan of classes are explained to the patient, tools are given that he can use when performing the task, etc.

3. Cor.-ped. the system of classes presupposes such a choice of work methods that would allow either to restore the initially damaged premise, or to reorganize the intact links of the speech function.

4. For any form of aphasia, work is carried out on all aspects of speech: expressive, understanding, writing and reading.

5. In all forms of aphasia, the communicative function of speech is restored and self-control over it develops. Only when the patient understands the nature of his mistakes can conditions be created for him to control his speech, his narrative plan, etc.

6. In all forms of aphasia, work is being done to restore verbal concepts and include them in various word combinations.

7. The work uses expanded external supports (sentence diagrams, the method of chips, which make it possible to restore an independent expanded utterance; a scheme for choosing methods of articulation in the arbitrary organization of articulatory structures of phonemes).

The dynamics of restoration of impaired speech functions depend on the location and volume of the lesion, the form of aphasia, the timing of the beginning of rehabilitation training and the premorbid level of the patient.

With aphasia resulting from cerebral hemorrhage, speech is restored better than with extensive brain injuries. Aphasic disorders in 5-6 year old children are overcome faster than in schoolchildren and adults.

Cor.-ped. work begins in the first weeks and days after a stroke or injury with the permission of a doctor and under his supervision. Early start of classes prevents the fixation of pathological symptoms and directs recovery along the most appropriate path. Restoration of impaired mental functions is achieved through long-term speech therapy sessions.

For aphasia, individual and group speech therapy sessions are provided. The individual form of work is considered the main one.

The speech therapist must explain to the family the patient’s personality traits associated with the severity of the disease. Instructions are given for working on speech restoration.

Aphasia is a disease characterized by problems with speech recognition and verbal communication that arise due to damage to the areas of the brain responsible for speech. Aphasia is not a congenital disorder. It appears suddenly after injury or illness. This could be a head injury, heart stroke, stroke, infection or insanity. Acquired aphasia manifests itself as a complete or partial inability to perceive speech (oral and/or written) and speak.

There are various classifications of aphasia: classical, neurological classification of Wernicke-Lichtheim, linguistic classifications of H. Head and others. Currently, the neuropsychological classification of aphasia by A.R. is generally accepted. Luria, who distinguishes six forms of aphasia: acoustic-gnostic acoustic-mnestic (occurs with damage to the temporal parts of the cerebral cortex), semantic and afferent motor aphasia (occurs with damage to the lower parts of the cerebral cortex), efferent motor and dynamic aphasia (occurs with damage to premotor posterior frontal cortex).

Directions of correctional work

Corrective action in all forms of aphasia consists of two directions:

1. Medical direction - direct restoration of the affected function using medications. The course of treatment is carried out as prescribed and under the supervision of doctors.

2. Logopedic direction - direct restorative training in specially organized classes.

As observations show, in childhood the effectiveness of classes is higher than in adults. As a rule, in adults, speech cannot be completely restored, but in children it is possible to achieve the norm, and in a fairly short time.

There are general provisions for restoring speech in children with motor and sensory aphasia.

The restoration of speech function involves the use of various techniques for disinhibition of the remaining elements of the speech system. One of the leading directions in the work is the restoration of passive and active vocabulary.

In terms of the form of conducting speech therapy classes, they should be mostly individual in nature, since children differ sharply from each other in their speech and personality characteristics. In addition, speech restoration always proceeds differently for different children.

E. S. Bein, M. K. Burlakova (Shokhor-Trotskaya), T. G. Wiesel, A. R. Luria, L. S. Tsvetkova made a great contribution to the development of principles and techniques for overcoming aphasia.

In speech therapy work to overcome aphasia, general didactic principles of learning (visibility, accessibility, consciousness, etc.) are used, however, due to the fact that the restoration of speech functions differs from formative learning, that the higher cortical functions of an already speaking and writing person are organized somewhat differently than in a child who is starting to speak (A. R. Luria, 1969, L. S. Vygotsky, 1984), when developing a plan for correctional and pedagogical work, one should adhere to the following provisions:

1. After completing the examination of the patient, the speech therapist determines which area of the second or third “functional block” of the patient’s brain was damaged as a result of a stroke or injury, which areas of the patient’s brain are preserved: in most patients with aphasia, the functions of the right hemisphere are preserved; in case of aphasia that occurs due to damage to the temporal or parietal lobes of the left hemisphere, the planning, programming and controlling functions of the left frontal lobe are primarily used, ensuring the principle of consciousness of restorative learning. It is the preservation of the functions of the right hemisphere and the third “functional block” of the left hemisphere that makes it possible to instill in the patient an attitude toward restoring impaired speech. The duration of speech therapy sessions with patients with all forms of aphasia is two to three years of systematic (inpatient and outpatient) sessions. However, it is impossible to inform the patient about such a long period of restoration of speech functions.

2. The choice of methods of correctional pedagogical work depends on the stage or stage of restoration of speech functions. In the first days after a stroke, work is carried out with the patient’s relatively passive participation in the process of speech restoration. Techniques are used that disinhibit speech functions and prevent, at an early stage of recovery, such speech disorders as agrammatism of the “telegraphic style” type in efferent motor aphasia and an abundance of literal paraphasia in afferent motor aphasia. At later stages of restoration of speech functions, the structure and plan of classes are explained to the patient, tools are given that he can use when performing the task, etc.

3. The correctional pedagogical system of classes presupposes such a choice of work methods that would allow either to restore the initially damaged premise (if it is not completely broken) or to reorganize the intact links of the speech function. For example, the compensatory development of acoustic control in afferent motor aphasia is not simply the replacement of impaired kinesthetic control with acoustic control to restore writing, reading and understanding, but the development of intact peripherally located analyzer elements, the gradual accumulation of the possibility of using them for the activity of the defective function. In sensory aphasia, the process of restoring phonemic hearing is carried out by using intact optical, kinesthetic, and most importantly, semantic differentiation of words that sound similar.

4. Regardless of which primary neuropsychological premise is violated, with any form of aphasia, work is carried out on all aspects of speech: on expressive speech, comprehension, writing and reading.

6. In all forms of aphasia, work is being done to restore verbal concepts and include them in various word combinations.

7. The work uses deployed external supports and their gradual interiorization as the disturbed function is restructured and automated. Such supports include, in dynamic aphasia, sentence schemes and the method of chips, which allow the restoration of an independent detailed utterance; in other forms of aphasia, a scheme for choosing methods of articulation in the arbitrary organization of articulatory structures of phonemes, schemes used to overcome impressive agrammatism.

With aphasia resulting from cerebral hemorrhage, speech is restored better than with cerebral thromboembolism or extensive brain injury. Aphasic disorders in 5-6 year old children (in most cases of traumatic origin) are overcome faster than in schoolchildren and adults.

Corrective pedagogical work begins in the first weeks and days after a stroke or injury with the permission of a doctor and under his supervision. Early start of classes prevents the fixation of pathological symptoms and directs recovery along the most appropriate path. Restoration of impaired mental functions is achieved through long-term speech therapy sessions.

For aphasia, individual and group speech therapy sessions are provided. The individual form of work is considered the main one, since it is this that ensures maximum consideration of the patient’s speech characteristics, close personal contact with him, as well as a greater opportunity for psychotherapeutic influence. The duration of each lesson at the early stage after a stroke is on average 10 to 15 minutes 2 times a day, in the later stages - 30-40 minutes at least 3 times a week. For group classes (three to five people) with similar forms of speech disorders and relatively the same stage of speech recovery, class time is 45-50 minutes.

The speech therapist must explain to the family the patient’s personality traits associated with the severity of the disease. Specific examples explain the obligation of his feasible participation in the life of the family. Instructions are given for working on speech restoration.

The article discusses the program, specific steps and methods of remedial training for the following forms of aphasia: efferent motor aphasia, dynamic aphasia, afferent motor, sensory, acoustic-mnestic, semantic and amnestic aphasia. Depending on the form of aphasia, the severity of the defect, the stage of the disease, and the individual characteristics of speech disorders, the integrated use of the considered methods for restoring oral and written speech will help a person adapt to life with this acquired disorder.

Restorative learning is based on one of the most important properties of the brain—the ability to compensate. To restore impaired functions, both direct and bypass compensatory mechanisms are used.

Direct disinhibiting methods of work are mainly used in the individual stage of the disease and are designed to activate reserve intrafunctional capabilities. Bypass methods imply compensation based on the restructuring of the most impaired function due to cross-functional restructuring. In other words, the restorative effect is achieved through the introduction of new, “workaround” ways of performing certain speech or gnostic-praxic operations.

It is also necessary to strictly take into account the characteristics of each specific case of the disease.

Rehabilitation training is carried out according to a special, pre-developed program. The program should include certain tasks and the methods of work corresponding to them, differentiated depending on the form of aphasia (apraxia, agnosia), the severity of the defect, the stage of the disease, the individual characteristics of speech disorders, but the restoration work in it should be carried out on all sides of the impaired function, and not only over those who suffered primarily.

In addition, rehabilitation training should primarily be aimed at restoring the communication abilities of patients. It is necessary to involve the patient in communication not only in classes, but also in the family, as well as in public places.

MOTOR APHASIA OF AFFERENT TYPE

1. Stage of severe disorders

1. Overcoming disorders of understanding situational and everyday speech:

Displaying pictures and real images of the most commonly used objects and simple actions by their names, categorical and other characteristics. For example: “Show a table, a cup, a dog, etc.”, “Show pieces of furniture, clothing, transport, etc.” “Show someone who flies, who talks, who sings, who has a tail, etc.”

Classification of words by topic (for example: “Clothing”, “Furniture”, etc.) based on a subject picture;

Answering simple situational questions with an affirmative or negative gesture. For example, “Is it winter now, summer..?”; "You live in Moscow?" and etc.

2. Disinhibition of the pronunciation side of speech:

Conjugate, reflected and independent pronunciation of automated speech series (ordinal counting, days of the week, months in order, singing with words, ending proverbs and phrases with a “hard” context), modeling situations that stimulate the pronunciation of onomatopoeic pronouns (“ah!” “oh! " and so on.);

Conjugate and reflected pronunciation of simple words and phrases;

Inhibition of a speech embolus by introducing it into a word (ta, ta..–Tata, so), or into a phrase (ma..ma–mama…; this is mom).

3. Stimulating simple communicative types of speech:

Answers to questions in one or two words in a simple situational dialogue;

Modeling situations that facilitate the evocation of communicatively significant words (yes, no, want, will, etc.);

Answering situational questions and composing simple phrases using a pictogram and a gesture accompanied by pronouncing simple words and phrases.

4. Stimulating global reading and writing:

Laying out captions under pictures (subject and subject);

Writing the most common words – ideograms, copying simple texts;

Conjugate reading of simple dialogues.

Isolating sound from a word;

Automation of individual articles in words with different syllabic structures;

Overcoming literal paraphasias by selecting first discrete and then gradually converging sounds in articulation.

2. Restoration and correction of phrasal speech:

Composing phrases based on a plot picture: from simple models (subject-predicate, subject-predicate-object) to more complex ones, including objects with prepositions, negative words, etc.;

Compiling phrases based on questions and key words;

Exteriorization of grammatical-semantic connections of the predicate: “who?”, “why?”, “when?”, “where?” etc.;

Filling in gaps in a phrase with a grammatical change in a word;

Detailed answers to questions;

Retelling texts based on questions.

3. Work on the semantics of the word:

Development of generalized concepts;

Semantic play on words (subject and verbal vocabulary) by including them in various semantic contexts;

Filling in gaps in a phrase;

Completing sentences with different words that are appropriate in meaning;

Selection of antonyms, synonyms.

4. Restoration of analytical-synthetic writing and reading:

The sound-letter composition of a word, its analysis (one-two-three-syllable words) based on diagrams that convey the syllabic and sound-letter structure of the word, a gradual reduction in the number of external supports;

Filling in missing letters and syllables in words;

Copying words, phrases and small texts with the intention of self-control and independent error correction;>

Reading and writing from dictation of words with gradually more complex sound structures, simple phrases, as well as individual syllables and letters;

Filling in texts when reading and writing missing words practiced in oral speech.

3. Stage of mild disorders

1. Further correction of the pronunciation aspect of speech:

Clarification with articles of individual sounds, especially affricates and diphthongs;

Differentiation of acoustic and kinesthetic images that are similar in articulation of sounds in order to eliminate literal paraphasias;

Practicing the purity of pronunciation of individual sounds in a sound stream, in phrases, with a combination of consonant sounds, in tongue twisters, etc.

2. Formation of detailed speech, complicated in semantic and syntactic structure:

Filling in the missing main sentence, as well as a subordinate clause or subordinating conjunction in a complex sentence;

Answering questions with complex sentences;

Retelling texts without relying on questions;

Drawing up detailed plans for texts;

Preparation of thematic messages (short reports);

Speech improvisations on a given topic.

3. Further work to restore the semantic structure of the word:

Interpretation of individual words, mainly with abstract meaning;

Explanation of homonyms, metaphors, proverbs, phraseological units.

4. Work on understanding complex logical and grammatical figures of speech:

Execution of instructions, including logical and grammatical expressions;

Introduction of additional words, pictures, questions that facilitate the perception of complex speech structures.

5. Further restoration of reading and writing:

Reading and retelling expanded texts;

Dictations;

Written presentation of texts;

Drafting letters, greeting cards, etc.;

Essays on a given topic.

1) Restoring the “articuleme-phoneme” connection

Writing letters corresponding to the names of sounds in expressive speech, reading these letters immediately after writing;

Isolating the first sound from simple words, fixing attention on the articulatory, acoustic, and then graphic image of this sound; independent selection of words for this sound and writing them;

Writing practiced sounds and syllables from dictation;

Identification of letters in different fonts;

Finding given letters in various texts (underlining, writing out).

2) Restoring the ability to sound-letter analysis of the composition of a word:

Dividing words into syllables, syllables into letters (sounds) based on various graphic schemes;

Isolating any sound in a word;

Recounting and listing words by letter (orally);

Writing words from letters given separately.

3) Restoring the skill of detailed written speech:

Writing words of different sound structure based on a subject picture and without it: a) under dictation, b) when naming an object or action;

Letter of proposals:
a) from memory,
b) by dictation,
c) in the form of a written statement on the plot picture in order to communicate with others;

Written presentations and essays.

MOTOR APHASIA OF EFFERENT TYPE

1. Stage of severe disorders

The recovery program is the same as for afferent motor aphasia.

2. Stage of moderate severity of disorders

1. Overcoming disorders of the pronunciation side of speech:

Development of articulatory switches within a syllable:

with vowels contrasting in articulation pattern (“a” – “u”, etc.); with various vowels, including soft ones; in syllables, for example,

M A A S T R E C E P T

Development of articulatory switching within a word: merging syllables into words with a simple, and later with a complex sound structure (for example, a recipe, etc.);

Exteriorization of the sound-rhythmic side of the word, dividing words into syllables, highlighting the stress in the word, reproducing the outline of the word with the voice, selecting words with an identical sound-rhythmic structure, rhythmic pronunciation of words and phrases with the involvement of external supports - tapping, slapping, etc., capturing various consonances, including the selection of rhyming words.

2. Restoration of phrasal speech:

Overcoming agrammatism at the level of the syntactic scheme of the phrase: compiling "nuclear" phrases of models of the type S (subject) + P (predicate); S + P + O (object) with the involvement of external supports-chips and their gradual “folding”; highlighting the predicative center of the phrase; exteriorization of its semantic connections;

Overcoming agrammatism at the formal-grammatical level: capturing grammatical distortions - inflectional, prepositional, etc. in order to revive the sense of language; differentiation of singular and plural meanings, generic meanings, meanings of the present, past and future tenses of the verb; filling in missing grammatical elements in words; composing phrases based on plot pictures; answering questions with a simple phrase, grammatically formatted; retelling a simple text; stimulation to use incentive and interrogative sentences, various prepositional constructions.

3. Stage of mild disorders

The program is the same as for the corresponding stage of afferent motor aphasia.

When restoring written speech in patients with motor aphasia of the efferent type, as a rule, an independent task of developing the "articulum-grapheme" connection is not singled out.

The emphasis is on:

1. Restoring the ability to analyze the sound-rhythmic side of a word:

Differentiation of words by length and syllabic composition;

Isolation of stressed syllable;

Selection of words that are identical in sound-rhythmic structure;

Highlighting identical elements in syllable words, morphemes and, in particular, endings (underlining them, writing them out, etc.).

2. Restoring the ability to sound-letter analysis of the composition of a word.

3. Restoring the skill of merging letters into syllables, syllables into words.

4. Restoration of the skill of detailed written speech (specific teaching methods - see the program of restoration. learning with afferent motor aphasia - paragraphs 2,3,4).

DYNAMIC APHASAIA

1. Stage of severe disorders

1. Increasing the level of the patient's general activity, overcoming speech inactivity, organizing voluntary attention:

Performing various types of non-verbal activities (drawing, modeling, etc.);

Evaluation of distorted images, words, phrases, etc.;

Situational, emotionally significant dialogue for the patient;

Listening to plot texts and answering questions about them in the form of affirmative-negative gestures or with the words "yes", "no".

2. Stimulation of simple types of communicative speech:

Automation in dialogic speech of communicatively significant words: “yes”, “no”, “can”, “want”, “I will”, “must”, etc.;

Automation of individual cliches of communicative, motivating and interrogative speech: “give”, “come here”, “who is there?”, “quiet!” etc.

3. Overcoming speech programming disorders:

Stimulation of answers to questions with a gradual decrease in the answer of words borrowed from the question;

Construction of phrases of the simplest syntactic models based on chips and a simple plot picture;

Performing simple grammatical transformations to change the words that make up the phrase, but presented in nominative forms;

Laying out a series of sequential pictures according to the plot contained in them.

4. Overcoming grammatical structuring disorders

5. Stimulating written speech:

Laying out captions under pictures;

Reading ideogram words and phrases.

2. Stage of moderate severity of disorders

1. Restoration of communicative phrasal speech:

Constructing a simple phrase;

Compilation of phrases according to the plot picture using the chip method and the gradual “folding” of the number of external supports;

Compiling a story based on a series of sequential pictures;

Detailed answers to questions in the dialogue;

Compilation of simple dialogues according to the type of speech studies: “In the store” - a dialogue between the buyer and the seller, “In the savings bank”, “In the studio”, etc.

2. Overcoming perseverations in an independent oral and written statement:

Showing objects in pictures and in the room, body parts (in random order, by separate names and series of names);

Ending phrases with different words;

Selection of words of given categories and in given quantities, for example, two words related to the topic “Clothing” and one word related to the topic “Utensils”, etc.;

Writing numbers and letters broken down (from dictation);

Writing from dictation of words and phrases that promote the development of semantic and motor switching;

Elements of sound-letter analysis of word composition: folding simple words from letters of a split alphabet;

Filling in gaps in words;

Writing simple words from memory and dictation.

3. Stage of mild disorders

1. Restoration of spontaneous communicative phrasal speech:

Extensive dialogue on various topics;

Constructing phrases based on a plot picture with a gradual decrease in the number of external supports;

Automation of phrases of certain syntactic models in spontaneous speech;

Accumulation of the verbal dictionary and "revitalization" of the semantic connections behind the predicate (with the help of questions posed to it);

Reading and retelling texts;

- “role-playing conversations”, playing out a certain situation;

- “speech improvisations” on a given topic;

Detailed summaries of texts, essays;

Drafting greeting cards, letters, etc.

SENSORY APHASIA

1. Stage of severe disorders

1. Accumulation of everyday passive vocabulary:

Showing pictures depicting objects and actions by their names, functional, classification and other features

Displaying pictures depicting items belonging to certain categories (“clothes”, “dishes”, “furniture”, etc.);

Showing body parts in the picture and in yourself;

Choosing the correct name of the object and action among the correct and conflicting designations based on the picture.

2. Stimulation of understanding of situational phrasal speech:

Answering questions with the words "yes", "no", affirmative or negative gesture;>

Follow simple verbal instructions;

Catching semantic distortions in simple phrases deformed in meaning.

3. Preparation for restoration of written speech:

Laying out captions for subject and simple plot pictures;

Answering questions in a simple dialogue based on the visual perception of the text of the question and answer;

Writing words, syllables and letters from memory;

- “voiced reading” of individual letters, syllables and words (the patient reads “to himself”, and the teacher reads aloud);

Development of the "phoneme-grapheme" connection by selecting a given letter and syllable by name, writing letters and syllables from dictation.

2. Stage of moderate disorders

1. Restoration of phonemic hearing:

Differentiation of words that differ in length and rhythmic structure;

Isolation of the same 1st sound in words of various lengths and rhythmic structures, for example: “house”, “sofa”, etc .;

Isolation of different 1st sounds in words with the same rhythmic structure, for example, “work”, “care”, “gate”, etc.;

Differentiation of words close in length and rhythmic structure with disjunctive and oppositional phonemes by highlighting differentiable phonemes, filling in gaps in words and phrases; capturing semantic distortions in a phrase; answers to questions containing words with oppositional phonemes; reading texts with these words.

2. Restoring understanding of the meaning of the word:

Development of generalized concepts by classifying words into categories; selection of a generalizing word for groups of words belonging to a particular category;

Filling in gaps in phrases;

Selection of definitions for words.

3. Overcoming speech disorders:

- "imposing frames" on the statement by making sentences from a given number of words (instruction: "Make a sentence of 3 words!", etc.);

Clarification of the lexical and phonetic composition of the phrase using the analysis of verbal and literal paraphasias admitted by patients;

Elimination of elements of agrammatism using exercises to "revive" the sense of language, as well as the analysis of grammatical distortions.

4. Recovery of written speech:

Strengthening the “phoneme-grapheme” connection by reading and writing letters from dictation;

Various types of sound-letter analysis of the composition of a word with a gradual "folding" of external supports;

Writing under the dictation of words and simple phrases;

Reading words and phrases, as well as simple texts with subsequent answers to questions;

Independent writing of words and phrases from a picture or a written dialogue.

2. Stage of mild disorders

1. Restoring understanding of extended speech:

Answers to questions in a detailed non-situational dialogue;

Listening to texts and answering questions about them;

Capturing distortions in deformed compound and complex sentences;

Comprehension of logical and grammatical turns of speech;

Execution of oral instructions in the form of logical and grammatical turns of speech.

2. Further work to restore the semantic structure of the word:

Selection of synonyms as homogeneous members of the sentence and out of context;

Work on homonyms, antonyms, phraseological units.

3. Correction of oral speech:

Restoring the function of self-control by fixing the patient's attention on their mistakes;

Compilation of stories based on a series of plot pictures;

Retelling of texts according to plan and without plan;

Drawing up plans for texts;

Compilation of speech improvisations on a given topic;

Speech etudes with elements of "role-playing games".

4. Further restoration of reading and writing:

Reading expanded texts, various fonts;

Dictations;

Written presentations;

Written essays;

Mastering samples of congratulatory letters, business notes, etc.

ACOUSTIC-MNESTIC APHASIA

1. Expanding the scope of auditory perception:

Showing objects (real and in pictures) by name, presented in pairs, triplets, etc.;

Showing body parts follows the same principle;

Carrying out 2-3 level oral instructions;

Answers to detailed questions, complicated by syntactic structure;

Listening to texts consisting of several sentences and answering questions about the content of the texts;

A letter from dictation with a gradual increase in phrases;

Reading gradually increasing phrases, followed by reproduction (from memory) of each of the sentences and the entire set as a whole.

2. Overcoming weakness of auditory-speech traces:

Repetition from memory of read letters, words, phrases with a gradual increase in the time interval between reading and reproduction, as well as filling the pause with some other type of activity;

Memorizing short poems and prose texts;

Repeated display of objects and pictures after 5-10 seconds, after 1 minute. after the first presentation;

Reading texts with time-delayed retelling (after 10 minutes, 30 minutes, the next day, etc.);

Compiling orally sentences using reference words perceived visually;

Listing words by letter with a gradually more complex sound structure, and gradually moving away from the written example of these words.

3. Overcoming naming difficulties:

Analysis of visual images and independent drawing of objects denoted by name words;

Semantic play in contexts of various types of words denoting objects, actions and attributes of objects;

Classification of words with independent finding of a generalizing word;

Exercises on the interpretation of words with concrete, abstract and figurative meanings.

4. Organization of a detailed statement:

Compiling a story based on a series of plot pictures;

Retelling texts, first according to a detailed plan, then according to a condensed plan, then without a plan;

Extended dialogues on non-situational topics (professional, social, etc.); practicing samples of communicative and narrative writing (greeting cards, letters, statements, essays on a given topic, etc.).