If in the previous “paragraphs” we considered tactics for overcoming aphasia that arises in the central part of the basin of the left middle cerebral artery, which provides blood flow to the primary and secondary fields of the temporal, parietal and posterior frontal regions, formed in childhood, the main zones for the development of speech in a child up to four or five years, of course, not without the participation of the deep parts of the brain activating these receptors, then another group of aphasias - acoustic-mnestic, amnestic-semantic and dynamic - is not directly related to the “receptor” zones, and with these forms of aphasia writing, reading, and phonemic hearing are preserved , literal paraphasias and disturbances in the sound-letter analysis of word composition are not observed. These disorders are not observed in left-handed people with damage to the right hemisphere of the brain. When the right hemisphere of the brain was damaged, left-handers experienced blurred, less severe acoustic-gnostic, afferent motor and efferent motor aphasia.
If the tactics remedial training aphasias that arise from damage to the secondary fields of the cerebral cortex, we started with temporal, acoustic-gnostic aphasia, then we will begin to overcome speech disorders due to damage to the tertiary fields of the cerebral cortex with amnestic-semantic aphasia of the second functional block of receiving, processing and storing information . Verbalization, the storage of acquired speech information based on visual, auditory, tactile, olfactory and gustatory perceptions, is completed mainly before the child is 5-6 years old, constituting the core of his vocabulary. Information acquired in the process of studying at school, when reading books and acquiring a profession, acquiring knowledge on the Internet, significantly expands the volume of vocabulary that goes beyond the core of the lexicon. And in this process, undoubtedly, the entire first functional block, which tones the processing of information, plays a huge role.
But in the process of forming the core of the lexicon of the native language, there are certain laws. First of all, this is that: 1) each word is extremely polysemantic, not only depending on the intonation with which it is pronounced, but also on historically established lexical traditions, so the words “window” and “cage” have many concrete and abstract meanings (“ window to Europe”, “open the prison for me”); 2) many synonyms, antonyms and homonyms; 3) each word can be “overgrown” with many epithets expressed by adjectives and other parts of speech; 4) each noun can be replaced by a fairly narrow number of pronouns, etc.; 5) an abundance of variety of cognate words, the root of which is not so easy to discover, many of which have firmly entered the Russian language from other languages, etc.; 6) each word root is a multi-valued paradigm depending on the suffixes and prefixes attached to them.
In 1989-1990 At the Institute of the Russian Language of the Academy of Sciences, a large team of employees created the multi-volume “Russian Associative Dictionary” (an associative thesaurus of the modern Russian language) in seven books: “a direct dictionary from stimulus to reaction” and “a reverse dictionary from reaction to stimulus.” This excellent dictionary deepens our understanding of A.R.'s thesis. Luria that with amnestic-semantic aphasia, what primarily suffers is orientation in the quasi-spatial, “conditionally, as it were, spatial” wealth of the lexical composition of speech, stored in the posterior parietal parts of the brain, the so-called TPO zone by neurologists, that is, the zone of interaction of all three lobes of the second functional block.
What are the tactics for overcoming this form of aphasia?
Let us recall that with this form of aphasia, situational speech remains intact without any literal paraphasia, but the patient often complains of forgetting the names of objects. A thorough examination of a patient with HMF reveals that he has preserved writing from dictation not only of individual words, but also of simple sentences, written naming of object pictures is possible, reading short texts is also possible, and auditory-verbal memory is also preserved. Amnesic difficulties are revealed when asked to show household items unexpectedly for the patient: watches, glasses, buttons, dial hands, laces, etc. In addition, a characteristic feature of this form of aphasia is a violation of understanding regarding light grammatical structures, conveying the spatial relationships of objects, mainly prepositional-case - inflectional. What is original is that with this form of aphasia, impressive agrammatisms are revealed: successive-inflective agrammatism, characteristic of efferent motor aphasia, and “prepositional” spatial, simultaneous agrammatism, characteristic of afferent motor aphasia.
The pathways coming from the premotor and postcentral secondary fields “gather” together in the tertiary fields of the posterior parietal region. Moreover, if the impressive agrammatism of efferent motor and afferent motor aphasia can be overcome, then, as our almost forty years of work experience has shown, confirming the point of view of A.R. Luria, impressive agrammatism in amnestic-semantic aphasia is essentially insurmountable or can be overcome only for a short time in the process of working with a speech therapist, and then, six months later, the patient returns with the same spatial-lexical-logical difficulties in determining paired concepts, antonyms on the left -right, higher-lower, further-closer, above-under, etc. The patient has impaired planning when solving logical-grammatical lexical problems.
So what to do? Not working with a sick person? Study and be sure to study, but in such a way that he does not develop an inferiority complex due to the fact that he forgets words, does not understand something and does not explain it as well as he could have explained before. The main thing is to dispel the patient’s depressive background and overcome the amnestic side of his speech disorder with the help of reading and writing. For this purpose, we have developed, tested and presented in the “Manual”, a collection of exercises “Correction of complex speech disorders” (section II, 2, pp. 264-315).
Here are some tips for relatives of a patient with semantic aphasia and a series of tasks.
Relatives of a patient who has been diagnosed with “semantic aphasia” must be very delicate in their interactions with the patient so that they do not tell him: “How come you don’t understand such trifles.” If the patient suffers from difficulties in understanding these phrases, do not point out his mistakes and nullify tasks with these complex prepositions, since we never say: “Put a volume of Pushkin’s poems to the right of Lermontov’s poems and to the left of Tyutchev’s poems,” but rather: “ Place the volume of Pushkin between the volumes of Lermontov and Tyutchev or next to Lermontov.” Since semantic aphasia most often occurs in older people, they can do without such complex speech and mental operations.
Task No. 1. Read the words and explain why, when you say the word “friend,” mostly pleasant words come to mind. Make up phrases with pleasant words and 4-5 sentences with them.
Faithful, good, my, close, real, brother, dear, reliable, devoted, friend, bosom, best, beloved, girl, youth, childhood, only, woman, love; and with the word “enemy” - bad, meanness, traitor, opponent, bad.
Task No. 6. Read the words, explain why so many words come to mind when you think about the word “history”.
Geography, life, interesting, ancient, science, story, funny, love story, extraordinary, unpleasant, worldwide, funny, fascinating, deep, one life, humanity, sad, love, our time, the Middle Ages, cheerful, cheerful, art, wars, romantic, old, strange, era, amusing, deceitful, my life, one family, Russian, boring, difficult.
Task No. 7. The task is designed for 6 lessons. Make up a series of sentences using these words.
Painting, love, film, forest, literature; promise, help, answer, man, sing, write; drink, bad, buy, lose, holiday, ask; work, talk, child, do, sit, think; confuse, hear, see, look, try, table; Saturday, be able to, morning, bread, clean, funny.
Task No. 8. Explain the meaning of the sayings (Fig. 152, 153) (The numbering of the pictures is given in the “Manual.”).
1. Burn the ships; 2. light head; 3. burn with shame; 4. black and white; 5. kill two birds with one stone; 6. pull the tongue; 7. lose your head; 8. stands rooted to the spot; 9. look through your fingers; 10. remove foam.
Task No. 17. Find the extra word. Explain what the other words have in common and how the extra word differs from the others.
1. Decrepit, old, worn out, small, dilapidated. 2. Brave, courageous, courageous, angry, determined. 3. Victor, Nikolay, Sergey, Ivanov, Konstantin. 4. Milk, quickly, hastily, hastily. 5. Milk, cream, cheese, lard, sour cream. 6. Deep, high, light, low, shallow.
Task No. 18. Find the extra word. Explain what the words have in common and how the extra word differs from the others.
1. Leaf, bud, bark, tree, branch. 2. House, barn, hut, hut, building. 3. Birch, pine, tree, oak, spruce. 4. Hate, despise, be indignant, be indignant, punish. 5. Dark, light, blue, clear, dim. 6. Nest, hole, ant, chicken coop, den.
Gradually, the patient regains attention to the polysemy of words, quasi-spatial orientation in the lexicon, and the patient can move on to the patient’s orientation in numbers, days of the week, left and right, etc. Due to the fact that patients with amnestic-semantic aphasia have intact reading, they are given the opportunity to independently perform a series of tasks.
Task No. 39. Subtract starting from 100 by 3, 7, 13, 17. Count from 1 to 30, skipping every fourth digit, every fifth digit, every sixth digit.
Task No. 40. Name the days of the week and months of the year in reverse order, skipping every second day and month.
Task No. 42. Let’s remember which side is our heart? Which side is the liver on? Focusing on the sides where the heart and liver are located, we will remember that the heart is on the left and the liver is on the right. And if we say that to the left or left of something, it means closer to the heart, and if we say to the right or to the right, then it means closer to the liver. Slowly, slowly, show where your left hand is. Where is the left leg? Where is the right shoulder? Where is the right eye? Where is the left ear? Where is the left leg? Where is the right ear? Where is the right knee?
This exercise on your attentiveness should be repeated from time to time; it will help you with your orientation on the street. The heart is on the left, the liver is on the right. To turn left means to turn towards the heart, towards the left hand; turn right means turn towards the liver and right hand.
Task No. 51. Draw:
1) the ball is to the left of the apple and to the right of the donut; 2) a pencil to the right of the egg and to the left of the book; 3) an apple to the left of the donut and to the right of the book; 4) a book to the right of the apple and to the left of the ball.
Task No. 52. Open the notebook so that on the left side you can describe the arrangement of objects, and on the right side you can draw the location of the same objects according to the assignment.
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Rice. 24. Illustration of one of the tasks to overcome amnestic-semantic aphasia.
1) On the left side, using the words left and right, describe the location of the house, the tree and the cup (the tree should be in the center); 2) describe the location of the table, chair and spoon (the table should be in the center); 3) describe the location of the mushroom, cup and ball (the cup should be in the center); 4) describe the location of the cherry, table and cup (the table should be in the center), etc.
Only after restoring orientation in “left” and “right” can one move on to understanding complex texts with the prepositions “above” and “under” with the obligatory support of drawings.
It is advisable to conduct classes on orientation in numbers, days of the week, etc., on the polysemy of words in proverbs.
Rice. 25. Illustration for the section on overcoming amnestic-semantic aphasia.
Task No. 63. Tell me what time is indicated on the clock. Read the exact time on your watch.
The manual contains quite a lot of pictures illustrating various proverbs, sayings, idioms, adverbial and participial phrases, subordinate clauses, etc.
Task No. 80. Complete the sentences by writing subordinate clauses with conjunctions: since, so that, if, when. Maybe you are experiencing different variants sentence endings? Write them down.
I bought a new coat because
We were in a hurry to........
I will come to you if.........
We were going to the dacha when…..
Assignment No. 81. The assignment is designed for 10 lessons. Read proverbs and sayings. Which of them did you use in your speech?
Grandma said in two. Without a hitch. White crow. Hit with the key. Fight like a fish on ice. Wander in the dark. Sore spot. Sore point. Take it by heart. Take under your wing. Take from the ceiling. Come to your senses. Throwing pebbles into someone else's garden. Strike the eye. Throwing around words. Throw words to the wind. Be on friendly terms. Be a cut above. Be in seventh heaven. Have the pip. Be not a timid person.
One of the main conditions for successfully overcoming amnestic-semantic aphasia, observed in vascular diseases of the brain, is “not noticing” the mistakes made by the patient, since you can always offer the patient the same or a similar task a few days later. A sick, elderly person, from the point of view of the average person, who is already “an out-of-mind grandfather or grandmother,” should be comfortable and interested in the speech therapist’s classes, he should constantly feel that he is “not so bad,” assert himself in his activity in life and “wave hand" on "unreasonable" children and grandchildren. At the end of a course of classes (inpatient and outpatient), lasting from four to six months, during which the patient’s inferiority complex will be “erased,” it is advisable to have conversations with the patient about the works of famous writers and poets, through reproductions famous artists(elderly people do not visit art galleries very often), about the collections collected by the patient, his “hobbies”, etc. The patient should feel healthy person, not getting confused in “left” and “right”, in “above” and “under” in their complex variations.
Appropriate drug therapy that increases the patient’s attention and memory, antidepressants prescribed to the patient by the doctor, as well as appropriate conversations with the patient’s relatives help him overcome the deficit in the lexical scope of word ambiguity and other semantic errors.
In all forms of aphasia, elementary counting skills are impaired in one way or another. With amnestic-semantic aphasia, violations of counting skills manifest themselves in difficulties in determining the digit size of a number (tens, hundreds, thousands, etc.). The patient, for example, writes 182 instead of 1082 or vice versa, has poor understanding of quasi-spatial mathematical operations of addition, subtraction, division and multiplication. In everyday life, these operations are necessary when paying rent and other household services, when making purchases in a store, pharmacy, transport, etc. To restore these operations, the speech therapist can give the patient tasks to “read” the electric meter, fill out receipts for the phone, etc. and summing these numbers. The patient understands that this is “a little difficult” for him, and is happy to engage in “useful” activities.
Let's summarize the tactics speech therapy sessions with a patient with amnestic-semantic aphasia: 1) an extremely gentle, antidepressant background of the lesson, which, by the way, applies to work with all patients with aphasia; 2) expanding the scope of the patient’s vocabulary, clarifying in the patient’s memory the meanings of synonyms, antonyms and homonyms and the ambiguity of words and phrases; 3) “ignoring” impressive agrammaticism, detected by neuropsychological tests to determine the focus of brain damage.
So, damage to the temporal parts of the cerebral cortex - Wernicke's area (22nd field, according to Brodmann) and the cortex of the second temporal gyrus (21st and 37th fields) lead to the loss, respectively, of such factors as phonemic hearing, auditory-verbal memory, narrowing of volume perception, disturbance of visual object images. Based on these central defects, a violation of the understanding of the meanings of individual words arose, and in the first case, secondary, and in the second, primarily - the understanding of sentences and statements. Impaired understanding of words in the first case occurred due to defects in the clear and constant perception of the sound structure of a word, as a result of which patients begin to confuse closely sounding words and paragnosis arising on this basis underlies a misunderstanding of the meanings of words. In the second case, the same symptom of misunderstanding of the meanings of words arises for at least three reasons: due to a violation of perception, but in terms of its volume, due to defects in auditory-verbal memory, and due to a violation of the level of visual object images. The symptom of impaired understanding of speech with semantic aphasia, arising from damage to the parieto-occipital regions of the left hemisphere. In this case, the understanding of individual words remains intact, revealing only a slight narrowing of the polysemy of words and a slight shift in their meanings. The mechanism of this form of aphasia is a violation of the ability to simultaneously perceive elements of speech and the ability to place ideas in internal simultaneous schemes. Therefore this the defect manifests itself at the speech level in the impossibility or difficulty of understanding logical and grammatical structures, which convey a system of relationships between words, and understanding the meaning of these constructions requires not only and not so much an understanding of the meaning of individual words, but a simultaneous internal comparison of the elements included in the sentence and a holistic understanding of the construction (sentence).
It is known that sentences in the Russian language have different grammatical and syntactic structures - they can be simple and complex. Complex sentences are divided into different syntactic forms - direct and indirect, reversible and irreversible, passive and active, negative, etc. Syntactic forms differ in the difficulty of transcoding them into units of meaning by patients with semantic aphasia. It is known that for a full understanding it is necessary to highlight that system of relationships of words within a phrase that is invisible with the naked eye, but plays a leading role in combination with the selection and understanding of individual elements of a phrase (Luria, 1975). There is also a certain hierarchy of complexity in understanding the content of sentences, depending on their construction. Simple constructions are easiest to understand. Among complex constructions, irreversible constructions are easier to understand, most likely because the words of these constructions contain redundant information.
Let's give an example: Girl washes with soap. But you cannot say: “The girl washes the soap.” The laundry is washed by a woman. But you can’t - “A woman washes herself with laundry.” It is even more difficult to understand such constructions as: The earth is illuminated by the sun- “The sun illuminates the earth.” The coast is washed by the sea- “The sea is washed by the shore.” It is very difficult to understand the meaning of reversible constructions: Petya hit Kolya. Who's the fighter?
The next layer of syntactic structures also presents difficulties for recoding. These are the so-called indirect constructions: “Petya hit Kolya. Who’s a fighter?”, “A girl walked through the field,” etc.
It is also very difficult for these patients to understand the attributive constructions of the genitive case (father’s brother, son of the regiment), prepositional constructions (earth under the sky, metro underground; the words “earth” and “sky” contain redundant information and a familiar situation, so such sentences can be understood, since the earth is always under the sky). But patients are unable to solve the problem of showing a “triangle under a square”, since they do not understand the relationship of these words.
Individual words and their subject relationships are well understood by patients, but the ability to grasp their relationships within constructions and understand its content as a whole is impaired. These patients can understand what (who) we are talking about, but they don’t understand what is being said.
Unlike sensory and acoustic-mnestic aphasia, with this form of aphasia there are no violations of the object-relatedness of the word. These patients cannot move from the plane of material situations to the grammatical plane. The word falls out of the system of grammatical concepts and is perceived only as a carrier of immediate meaning. Unable to understand the grammatical relationships of words in a phrase, the patient is unable to understand complex written or oral speech, despite the complete preservation of sensorimotor mechanisms.
Restorative training In patients with semantic aphasia, first of all, it should be aimed at overcoming defects in the gnostic sphere, defects in simultaneous perception and perception of “left” and “right,” and the relationships of objects in space. This is the central task of teaching these patients, and the goal is to restore understanding of complex speech, understanding of various syntactic structures of the Russian language.
At the first stage of training patients are taught to understand “left” and “right” and the ability to navigate in real space - in finding their room, doctor’s office, study room, first in one way, and then in other ways (in order to generalize the ability to navigate in relation to given objects, in a given case of rooms). The work begins with the reproduction of spatially oriented various geometric figures with an awareness of their main elements indicating their spatial orientation. After reproduction, patients are transferred to designing various figures based on the model; their comparative analysis, verbal designation of the spatial orientation of details, etc. are carried out.
Later, the verbalization of these actions with drawings and constructed figures is introduced (“Put the stick on the right, and this one on top”, “Where is the red stick?”, etc.).
Restoring awareness of the body diagram begins with restoring awareness of the role and position of the right hand. To do this, a working object (pencil, notebook, comb, key, spoon, etc.) is placed in the patient’s right hand. Patients get used to the feeling of an object in the right hand, and from this sensation the awareness of its leading role and the concept of “right leading hand” is restored. Performing any exercises on orientation in space begins with drawing the patient’s attention to the right hand as a starting point in spatial orientation. From understanding the place and role of the right hand, the transition easily occurs to understanding the presence and role of the left hand, the left and right half of the body; left and right parts of space, etc.
After mastering the concept of the body diagram and understanding “right” and “left” in space, they move on to teaching the patient how to move around the room and along the floors of the clinic. Work begins with the actual passage of the path, and then its schematic representation. Later, the work is carried out in reverse - it begins with drawing a diagram of the passage of a familiar path along a mental image, and then its implementation. The work described is usually carried out over a long period of time, with strict implementation of the entire “system of techniques.”
After this, they move on to working with diagrams depicting the spatial arrangement of objects. First, the work is carried out according to the model. The procedure is as follows:
1) the patient is given a sample of two real objects, which the teacher manipulates, placing them in different spatial relationships. The patient must reproduce samples using his objects. Then all spatial relationships of objects are sketched in the form of a diagram;
2) after long-term non-verbal work, the transition to work on generalizing and schematizing the spatial relationships of objects begins. For this purpose, the patient is asked to draw diagrams that correspond to given samples (from real objects).
After such extensive and lengthy work on restoring a conscious analysis of the relationships of objects in space, they move on to formulating these relationships in speech using certain syntactic constructions. This work is already underway second stage training.
The task third stage is to restore understanding of structures With prepositions. At this stage of training, it is necessary to bring to the awareness of patients relativity factor spatial arrangement of objects, which requires taking into account at least two components: on the one hand, the spatial arrangement of objects can be established only in the presence of another object and precisely in relation to it, on the other hand, in each given situation there is always one object (the one, the position in the space of which is determined) is the main one, and the second object (in relation to which the position in the space of the main object is considered) is secondary. The use of certain prepositions (under and above, to and from etc.) is directly dependent on the understanding of this factor. For example, the spatial relationship of two objects (table - lamp) can be expressed in speech in two ways: 1) the lamp hangs above table, 2) the table is under the lamp. In the first phrase the main subject lamp, and in the second - table.
A whole series of exercises is carried out with the aim of further understanding the connection of prepositions with certain spatial relationships of objects. Patients sign the corresponding prepositions with given schemes and, conversely, based on these prepositions they create the necessary schemes, expressing given spatial schemes in oral and written phrases. Exercises with plot pictures that depict objects in space are very useful. Their position is marked by arrows, which are indicated by the corresponding prepositions, and, conversely, patients indicate the prepositions inscribed in the pictures with the corresponding arrows.
All knowledge acquired in this way is transferred to the level of abstraction from specific objects. For this purpose, exercises are performed with abstract concepts (“put a cross under a circle”, “triangle in a square”, etc.).
The principles of restoration outlined above are also preserved when restoring the understanding of all other logical-grammatical constructions: learning comes from restoring the spatial relationships of objects with a gradual transfer of action to the speech level.
Both the first and second stages of learning provide the basis for restoring the understanding of those logical-grammatical constructions, the connection of which with the perception of spatial relations is not striking, but nevertheless takes place. Therefore, restoring the understanding of such speech structures as the attributive genitive case, comparative constructions, etc., begins immediately at speech level, but only after and on the basis of restoring the process of analyzing real spatial relationships. The task here is to restore a conscious analysis of the relationships and connections between words within a phrase. Only such a conscious attitude to the grammatical structure of a statement can create conditions for understanding speech.
You can detect and clarify the connections and relationships of words in a phrase by correct setting corresponding questions for each word within the phrase.
For this purpose, the patient is first taught to perform a series of operations, which gradually lead him to an understanding of the relationships between words. The patient is taught to parse a sentence into parts of a sentence, based on their semantic role in it, and only then connect the semantic role of a word in a sentence with its grammatical form. First highlighted main word in the sentence, which is the object in question, then a word is highlighted that denotes the action of the object, then - words that define the main object from its qualities, etc. These analyzes help the patient understand the semantic connections of the word within the sentence.
After this, individual words of the sentence are omitted one by one, without which the thought expressed in it remains unfinished and even incomprehensible. This incompleteness of information necessitates asking the right question. So, for example, the patient is verbally informed: “...I read an interesting lecture today!” The patient involuntarily asks: “Who?” Then his attention is fixed on this question, the sentence is written down, and this question that has arisen is written down above the corresponding word, etc.
This is followed by a series exercises which combine semantic and grammatical (by parts of a sentence) analysis of a sentence, and also conduct exercises in which patients are required to compose a sentence that corresponds to given connections between words.” To do this, a sentence structure is given in the form of interconnected questions: Who? What does? (did?) what? (What is where?).(“The boy painted a ship with paints.”) Such work facilitates the restoration of understanding of such complex constructions as the attributive genitive case. In this case, first a semantic and then a grammatical analysis is carried out, asking the necessary questions to individual words of the structure. However, it is also necessary to expand this construction, supplementing it with a word that clarifies the meaning and relationships between these words of the phrase. The process of understanding this kind of grammatical constructions takes on a conscious and detailed character. Given: father's brother. Who is this? Reasoning and operations of the patient:
1. “Who? Brother, he is mentioned in the sentence. Who? Brother".
2. “Father, brother’s characteristics. What kind of brother... no, it doesn’t fit. Whose brother? Paternal, father. Which one? Mine. Yeah! My brother... my father. Who? Brother. Whose? My, no, my father's. Yeah! This is my uncle."
Thus, with the help of the described technique, understanding of other complex logical and grammatical constructions of speech is restored.
Restorative training, aimed at the intrasystem restructuring of speech disorders by transferring it from one level of implementation to another, higher, conscious and voluntary, is productive in this form of aphasia.
Laboratory lesson No. 2.
In semantic aphasia, the primary defect is a violation of simultaneous optical-spatial gnosis and praxis. In this regard, the primary task of restorative education is overcoming spatial apraktoagnosia.
This section of remedial training includes:
Schematic representation of the spatial relationships of objects;
Image of the plan of the path, room, etc.;
Construction according to a model, according to a verbal task;
Work with geographical map, for hours;
Restoring the ability to understand words with spatial meaning (prepositions, adverbs, verbs with “movement” prefixes, etc.);
A visual representation of simple spatial situations denoted by prepositions and other parts of speech.
Based on the skills acquired in this regard, the ability to use words and phrases that reflect the quantitative-optical-spatial relationships of objects is restored:
Filling in missing “spatial” elements in words and phrases;
Composing phrases with words that have spatial meaning ( “further, closer, yesterday, tomorrow, long ago, soon” etc.), as well as containing the corresponding morphemes (prefixes,
prepositions, suffixes). Such morphemes are presented based on a picture or a real situation like “come up, move away; go around, drive off, fist, fist...".
Construction of complex sentences.
Provided that the elementary spatial, quantitative and temporal categories of the verbal level are accessible to the patient, they move on to restoring the ability to understand logical-grammatical structures. For this we use:
Picture depiction of the plot of the structure;
Introduction of additional words providing semantic redundancy (“my brother’s father”, “a letter from a beloved friend” etc.);
Introduction of logical-grammatical constructions into a detailed semantic context;
Presentation of designs in writing and then orally.
Questions on the topic “Restoration of non-speech and speech HMF”:
1. What determines the specifics of the methods of restorative* training used to restore gnostic functions?
2. What is the main object of reconstruction in kinesthetic apraxia?
3. What is the main object of reconstruction in kinetic apraxia?
4. What are the direct methods of speech restoration?
5. What methods of speech restoration are specific?
6. In what cases is the optical-tactile method used to restore speech in patients with motor aphasia?
7. What are the main goals of remedial training for sensory aphasia?
8. In what form of aphasia is the main task of learning to restore the predicative side of speech?
9. In what form of aphasia is it necessary to work to increase the volume of auditory-speech perception and consolidate acoustic traces?
10. In which form of aphasia is a special task set to restore simultaneous synthesis?
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Semantic aphasia occurs when the TPO zone (tertiary cortex of the parietal-temporo-occipital regions, abbreviation for temporal-parietal-occipital) of the left hemisphere (in right-handed people) is damaged.
This form of aphasia is based on defects in simultaneous (simultaneous) analysis and synthesis (difficulties in assessing spatial and “quasi-spatial” relationships).
How does semantic aphasia manifest? Semantic aphasia manifests itself in the form of:
- Impaired understanding of certain logical-grammatical constructions (for example: father's brother, brother's father, spring before summer, etc.) - impressive agrammatism.
- Patients also show a lack of understanding of instructions with spatial relationships;
- Inability to show body parts and their images due to impaired knowledge of the “body diagram”;
- Finger agnosia;
- Violation of word formation due to incorrect use of morphological units of language (suffixes, prefixes) reflecting “quasi-spatial” relationships.
Patients diagnosed with “isolated semantic aphasia” are quite rare in practice. However, as elements in afferent motor aphasia and acoustic-mnestic aphasia, violations of spatial and quasi-spatial relationships are detected quite often.
Exercises and tasks to overcome semantic aphasia
We bring to your attention some types of exercises and tasks used in speech therapy work on overcoming semantic aphasia.
Overcoming spatial apraktoagnosia.
The patient is offered:
- Determine the position of objects in space. Show the office door, window, floor, vase on the table, vase on the windowsill.
- Draw a schematic representation of the spatial relationships of objects (the house to the right of the tree, the point under the circle, the square between the point and the circle, etc.);
- Draw an image of the route plan (how can you get from the ward to the office, from the metro to the Center?),
- Draw a picture of the room;
- Design according to a sample (from the proposed sets of geometric shapes, cut-out pictures),
- Construction according to a verbal assignment (you need to put a circle on top, put a large rectangle on the bottom of the circle, put small rectangles on the right and left of the rectangle, put 2 small rectangles on the bottom of the rectangle - a stylized image of a person);
- Working with clocks (show half past six, a quarter to three, fifteen o'clock, noon, half past eight; recognizing the time from a watch with a drawn dial, with a partially drawn dial, with a “blind” dial);
- Working with a geographic map (locations of specified objects on the map: Kyiv, it is west of Moscow; Murmansk, it is north of Kyiv, which cities are east of Moscow).
Restoring the ability to understand words with spatial meaning:
- Fill in the missing prepositions.
The boy enters... the bus
The plane flies... through the clouds
- Fill in the missing verbs.
She ran up, ran out, ran away,
The dog... is from home.
Daughter... to mom.
Boy... from the stairs.
- Composing phrases with words that have spatial meaning.
Come up with a sentence with the words: right, left, right, left, above, below.
Working on complex sentences.
- Clarification of subordinating conjunctions.
I took an umbrella... it started to rain.
I'll take an umbrella...it's going to rain.
- Filling in missing main and subordinate clauses.
We didn't go for a walk because...
A student will be late for lecture if...
..., although it was pouring rain outside.
...if we get tickets.
- Compiling sentences with given conjunctions.
…, because …
…, If …
…, When …
Word formation.
- Change the word according to the example.
What? Which?
Eye Eye...
Forest Forest...
Mushroom Mushroom...
Which? What to do?
Yellow Yellow…
Shiny Shine...
Tolstoy Tolstoy…
Who? Who?
Petitioner Petitioner...
Teacher Teacher...
Writer Writer...
What to do? What to do?
Write...write
Sing...sing
Draw...draw
- Insert word.
Forest, forest, forester, forest.
On the edge of the field a young... grew up.
I love to inhale... the aroma.
In the hut... he treated us to hot tea.
An oak tree rustled across the river...
Transition, walkers, hike, walk, quick-witted.
Fun on the wall...
Tourists gathered in...
A pedestrian crossing has been marked at the intersection...
The baby learned...
My grandmother had... character.
Construction of complex sentences:
- Make up a sentence with prepositions before and around.
For example: “The car drove around the house and stopped in front of the entrance.”
- Come up with a sentence using the prepositions “from” and “in”.
For example: “The plane rolled onto the tarmac and took off into the sky.”
- Come up with a sentence using the prepositions “on” and “from”.
For example: “There was a faience plate on the table.”
Restoring the ability to understand logical-grammatical situations:
- A pictorial representation of the plot of the structure (can be depicted schematically).
Draw:
The dog jumped out from behind a bush.
The dog is lying under a bush.
The dog is sitting near a bush.
A bird flies over a bush.
The cat is sleeping behind a bush.
- Introduction of additional words providing semantic redundancy.
- Solving arithmetic problems.
- Introduction of logical-grammatical constructions into a detailed semantic context;
You need to send a telegram. Where are you going to go? Where is the post office? What is to the right and left of the building in which the post office is located?
You are standing in line. Is this woman standing in front of you or behind you? Are you standing in front of a man or behind a man?
Working on an extended statement:
- Presentations, essays (based on picture material);
Where did the boy go?
Which side of the tree did the branch break off from?
Where did the boy fall?
Who did the girl run to?
Make up a story based on the picture.
- Improvisation on a given topic.
Tell us how you collect mushrooms.
- Interpretation of words with complex semantic structure.
What do the words mean: teacher, writer, student. How did you understand that these were females?
Sugar bowl, ashtray, soap dish. What indicates that it is a repository for something?
Solodovnikova Lyudmila Mikhailovna,
speech therapist TsPRiN DZM,
Moscow