Sensory aphasia after stroke: signs, recovery and treatment

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Olga

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neurologist, head of the office for diagnostics and treatment of cognitive disorders

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A disease in which a person experiences a decrease in verbal and logical thinking and other speech perception disorders are manifested is called sensory aphasia. Unlike other forms, sensory is considered mild; the patient is not able to perceive individual words and short phrases in all cases. A person with this type of disorder hears, but not as expected; words sound as if they are in another language. Against this background, anxiety intensifies, and disorientation in space is possible.

Signs and causes of sensory aphasia

Sensory aphasia can result from a wide range of causes. This disease can be caused by both diseases of the cardiovascular system and traumatic injuries to the head and central nervous system. The most common causes of sensory aphasia are:

Acute and transient disorders of cerebral blood flow, for example, embolism or hemorrhagic stroke. Embolization can occur as a result of the presence of an unstable atherosclerotic plaque in the bed of one of the carotid arteries or as a result of thrombus entry from the left atrial appendage in arthimogenic conditions.
Traumatic head injuries, most often occurring in transport accidents. Contusions and traumatic brain injuries can lead to immediate damage to cortical and subcortical structures or delayed damage with the development of cerebral edema.
Oncological processes localized in the cranium. Benign or malignant tumors can be a significant factor in the development of sensory aphasia.

It is important to note that the following branches entering the middle cerebral artery basin are most often involved in the formation of the lesion:

Inferior branch of the middle cerebral artery;
Posterior temporal artery;
Artery of the angular gyrus.

Communication Guide

You can and should communicate with people with aphasia. Patients retain some communicative abilities that need to be activated through communication, without allowing them to “fade away.” Those who suffer from a severe form of aphasia retain the ability to understand the meaning of what is said (although not every word individually). Often the patient may not understand what is being said to him because he does not remember the meaning of individual words or forgets the beginning of a phrase.

How to communicate with people with aphasia:

sit down and catch the person's eye
if you are afraid of communication, you should start with simple topics, for example, tell how your day was in the simplest terms, then you need to ask a simple question
It’s better to speak at a slow pace, focusing your voice on key words in the text
You can do the following practice: write down the key words of the future conversation on paper, then repeat what was said and show the paper to the patient. This will be his cue for conversation.
use not only the spoken word to communicate, but also writing, drawings, gestures, and pointing at objects. Forgive a person to do the same, let him use a dictionary if it will be easier to communicate
if the patient is trying to convey some idea to you, determine who he is talking about, what exactly happened and in what place
it is important to be able to ask leading questions
do not ask questions that require monosyllabic answers
be patient, because communication with a person with aphasia is far from easy, but it is necessary

Forms of sensory aphasia

There are several significant clinical forms of sensory aphasia that are characteristic of sensory aphasia. When additional pathological foci of the cortical substance join the affected Wernicke's area, new symptoms of impaired speech function appear. In this regard, neurologists distinguish the following forms of aphasia:

Semantic aphasia

With this aphasia, there is a violation of the recognition of logic and the relationship of words and objects. This is especially true for spatial perception.

Acalculia-aphasia

In this case, the key symptom is the formation of a localized disorder of speech function. Namely, counting violations. At the same time, the patient’s other forms of speech are not affected.

Sensorimotor aphasia

Lack of speech awareness is associated not only with damage to the cortical part of the auditory analyzer, but also with a violation of articulatory function. In other words, a person cannot correctly evaluate gestures when pronouncing a specific word like another person. Same with myself. The patient himself is not aware of his illness and is very irritated in situations where he is not understood.

Total aphasia

With this option, the victim has a combination of different types of functional speech disorder. The patient has impairments in written and oral speech. In this case, the patient does not perceive someone else’s speech and also cannot answer anything himself.

Main types of aphasia: clinical picture

In accordance with the severity of the pathology, a distinction is made between partial (when full speech alternates with disturbances) and total (when speech has significant disturbances) aphasia. Depending on the damage to a particular brain area, there are six main types; let’s look at each in more detail.

Semantic aphasia

This form appears when the parieto-occipital region of the left hemisphere is affected. People have a complete misunderstanding of speech formulations that reflect spatial relationships, and their understanding of the text they are viewing is impaired. Also, there are difficulties in completing tasks containing complex syntactic structures. In this case, understanding is not impaired when perceiving simple sentences, but the person forgets the names of familiar objects. Speech is preserved, but writing and reading slow down significantly. Many people develop acalculia, a pathology in which a person does not understand numbers and arithmetic operations.

To diagnose this form of the disease, experts come up with tasks that require quasi-spatial synthesis. For example, comparative sentences: “Ira’s curls are darker than Masha’s, but lighter than Dasha’s curls. Who has the darkest hair?" They also resort to solving simple arithmetic problems.

Acoustic-mnestic aphasia

It appears when the middle parts of the temporal region are affected, which are located outside the nuclear zone of the auditory analyzer. With this form, a person suffers from difficulty retaining information received by ear in memory. The volume of memorization is significantly reduced, as a result of which a person is not able to repeat a simple combination of several words after a speech therapist, or to grasp the meaning of speech in difficult conditions (for example, at a fast pace, during a conversation with several people at once). It is worth noting that difficulties with speech communication are compensated for by increased speech activity. Some people have distorted visual representations of an object and have severe problems in naming various objects. Memory disorder occurs with impairment of writing.

Sensory aphasia

It manifests itself when a person suffers damage to the main organ of the central nervous system in the area of the temporal lobes. Sensory aphasia is divided into three subtypes: cortical, subcortical and transcortical. The cortical subtype is a severe disorder that affects Wernicke's speech area (responsible for the perception and processing of sounds). In such a situation, a person does not understand and does not pronounce sounds. With the subcortical subtype, a person experiences a distortion in the transmission of impulses from the centers that perceive sound information.

With the transcortical type of aphasia, a disturbance in the conduction of nerve impulses between Wernicke's and Broca's centers occurs. But the ability to perceive light speech structures remains. In the first 4-8 weeks after injuries of this type, the patients’ speech consists of a chaotic set of sounds and syllables, so the meaning of the phrases is incomprehensible to other people. Regardless of the subtype, the following symptoms of sensory aphasia are distinguished:

lack of ability to perceive speech normally (with intact hearing);
deviations from the nervous system (anxiety and aggression associated with a lack of understanding of what is happening);
the ability to pronounce sounds and words, but devoid of meaning;
cramps (spasms) in the body;
deterioration of visual function.

Motor aphasia

It is of two types - afferent and efferent. The disease can progress in different ways. In the first case, the patient has a lack of instinctive speech, a speech embolus. Due to the fact that articulation is severely impaired, a person is not able to determine what needs to be done to pronounce a specific sound. During conversations, patients often rearrange individual letters or words.

In the second case, the person retains situational speech, but repetition is severely impaired. In this form, a violation of the understanding of oral speech is diagnosed. Characterized by uncontrolled speech, which often consists of a random collection of letters and words. Speech is poor and many patients do not use prepositions.

Patients are bothered by kinetic apraxia, which makes it impossible to switch from one position to another. Against this background, rearrangements of sounds and syllables occur in human speech. The key difference between this form of the disease is long stops. In this case, the pronunciation of individual sounds is not impaired at all. Also, gross violations are noted (in particular, dyslexia).

Dynamic aphasia

This form appears when parts of the left dominant hemisphere are damaged. The main speech defect is the difficulty or impossibility of active speech. A person pronounces individual sounds without problems, repeats phrases without difficulty, but the communicative function is impaired. With a strong severity of the disorder, not only a speech defect is diagnosed: pronounced echolalia and echopraxia appear (when a person mechanically repeats his opponent’s actions).

The patient has impaired expressive speech. There are several variants of dynamic aphasia, which differ in varying degrees of impairment of communicative function: from the absence of expressive speech to a slight impairment of speech communication. Such patients require regular speech stimulation. Their speech is characterized by the presence of speech patterns. The patients' spontaneous, detailed utterance is impaired. For example, when retelling a story he has read, he pronounces out loud certain moments that are not connected with each other (there is no semantic link).

Total aphasia

With severe damage to the cortex of the dominant hemisphere, which affects the motor and sensory speech areas, total aphasia appears. The person has no speech at all; he does not perceive the phrases of others. Damage occurs to many speech areas of the brain. This is the most severe degree of damage. All types of aphasia can be corrected, but treatment for total aphasia takes the longest. It is worth noting that sometimes mixed forms occur, for example, afferent-efferent.

Great importance is paid to developmental activities. They are compiled individually for each patient, taking into account age and psychological characteristics. In a calm and familiar environment, the patient is given a set of exercises that perfectly develop the functioning of the senses and contribute to the development of correct perception of information. Such classes are practiced in different formats: in the form of active motor exercises in a special room, and in the patient’s room.

Symptoms

Clinical manifestations of sensory aphasia have a number of specific signs that help make a quick and effective differential diagnosis. These signs include:

Fluent speech or logorrhea, replete with a large number of allegorical expressions and paraphrases. The patient misses nouns, and I compensate for such speech defects with a large number of verbs, prepositions and conjunctions. Speech becomes verbose, but uninformative.
“Jargnonic aphasia” is a continuous stream of neologisms, proverbs, sayings and paraphrases.
Strong excitement up to the development of a paranoid state.
Impaired understanding and perception of speech. The patient has difficulty or does not perceive simple questions at all, for example, a request to introduce himself or say who he is, but is able to follow simple commands, for example, turn his head or introduce himself. It is also important to note that the patient does not understand his own problem and becomes very irritated when the interlocutor does not perceive his speech well.
Right-sided hemianopsia or upper quadrant hemianopsia. Loss of visual fields - when reading books, the victim will completely not notice the left page when reading the text.
Smoothing of the nasolabial fold - the face becomes like a mask.
Impairment of written speech.

There is also pure sensory aphasia (subcortical), when only the understanding of oral speech is impaired, but the understanding of written information, and therefore what is read, is preserved. Another form is also distinguished - transcortical sensory aphasia, which is characterized by the preservation of the ability to repeat oral speech, despite the lack of its perception and understanding. The main problem is that the patient hears the address to himself, but cannot interpret the meaning of what the interlocutor said. The native language is perceived as if it were foreign.

Sensory aphasia in rare cases occurs as an independent lesion of the auditory zones located in the brain, since in almost 85% of cases the damage involves several areas of the brain responsible for a wide variety of functions of the victim’s body. For example, with a stroke, sensory aphasia is often combined with paresis or paralysis of skeletal muscles on the side opposite the lesion. In the case of an infectious-inflammatory process: abscess, meningitis, encephalitis, there will be signs of general intoxication of the body and febrile syndrome, as well as cerebral symptoms. In the case of encephalitis, specific changes will be added to the cerebrospinal fluid - cerebrospinal fluid.

Specific signs of sensory aphasia in children

Sensory aphasia in childhood can be confused with alalia - the primary absence of speech, but there is a difference: if with alalia speech does not shift from the initial level of development, i.e. does not progress and does not undergo regression, then with aphasia a sharp degradation in the development of speech function, which has already been formed in a person, is noticeable. Since in childhood the speech function is not yet fully formed, there are specific signs for aphasia:

As a rule, there is a rapid development of the disease and rapid recovery of speech function. Lack of recovery progress over several weeks is a poor prognostic sign for further recovery and indicates more serious brain damage.
Restoration of speech function is carried out by increasing the activity of neighboring areas of the cortex, which to some extent are able to compensate for the neurological deficit. In adults, the restoration of speech function is carried out due to the formation of new logical connections and a developed conceptual apparatus.
Scanty symptoms. Very often, it is difficult to determine the specific type of aphasia in children, since their speech function is not sufficiently developed. As a result, the conditions for revealing the full clinical picture of sensory aphasia are not created.

Manifestations of the disease

The group of symptoms that manifests itself to a greater extent depends on which area of the brain is affected when sensory aphasia occurs. In any case, this is Wernicke’s area, where the speech analyzer is located, but the specific characteristics of sensory aphasia depend on whether the left or right hemisphere is affected: the perception or reproduction of speech is more impaired.

For a patient with sensory aphasia, words are just a collection of sounds. In some cases, recognition is partially preserved: the patient can identify the object shown to him as living or non-living, large or small. But he is unable to name the object itself. At the same time, the patient, as a rule, can perform simple actions on command - stand up, raise his hand, turn around. Without treatment, the disease progresses and leads to a complete misunderstanding of what is being said. Your own words are also not perceived as speech. Due to the lack of control by hearing, words become incoherent and are pronounced incorrectly and sometimes unrecognizable. Intonation also suffers. Pronunciation may be restored, but the construction of phrases will not appear on its own. Patients try to talk, and get angry when those around them do not understand them: a patient with sensory aphasia is sure that he speaks clearly.

Writing is also impaired to the same extent as speech. But the ability to read is lost only slightly - mainly due to confused stresses that distort the meaning of words.

Diagnostics

Diagnosis of sensory aphasia is primarily aimed at identifying the cause of the disease. The diagnostic study must be comprehensive and consist of the following stages:

Consultation and questioning of the patient to determine the history of life and illness. Also, during the initial appointment, the doctor examines the patient and studies specific symptom complexes. The neurologist looks for concomitant diseases that manifest themselves not only by external signs, but also by conducting additional tests and studies. During the examination, a specialist neurologist determines the lesions, the nature and course of the pathological process, assesses the general condition of the patient, as well as the blood supply to the brain. Makes a prognosis and subsequent treatment plan in accordance with the patient’s age. Its individual characteristics and concomitant somatic diseases. As well as the level of damage to the central nervous system.
Consultation with a speech therapist, psychologist and other specialists. They determine the severity of the speech function defect and coordinate further tactics for restoring lost functions with the attending physician.
Conducting additional instrumental and laboratory studies to verify and clarify the clinical diagnosis. Studies such as computer and magnetic resonance imaging, electroencephalography, angiography of cerebral vessels are carried out. These studies are carried out to identify the level and area of brain damage, the presence of space-occupying formations in the nervous tissue, aneurysms and hemorrhages in the brain tissue, foci of abscess, and the consequences of a stroke.

Acoustic-mnestic aphasia

Cause

acoustic-mnestic aphasia - damage to the middle and posterior parts of the temporal region.
It is characterized by symptoms such as a decrease in auditory-verbal memory
due to inhibition of auditory control. When listening to each new word, the patient loses understanding of the previous one, hence the repeated repetition of the same syllable or word. An aphasic who suffers from the acoustic-mnestic form cannot repeat 3-4 words in a row with different meanings. For example, sky, hand, grass, spoon, repeats either the first or the last word. Phonemic hearing and correct articulation are preserved, which results in verbosity that compensates for communication difficulties. The nominative function of speech, retelling based on plot pictures, suffers. Misunderstanding of the meaning of words leads to verbal paraphasia - substitution of words in a sentence, merging one word into one in writing. Along with writing, counting and reading are impaired.

Treatment

The treatment process aimed at restoring the consequences resulting from aphasia requires a long time and enormous dedication, both from the patient and his relatives, and from medical personnel and specialists who have undergone special training. The restoration work of such a pathological condition consists of the following points:

Pharmacological (drug) therapy. It mainly includes the use of drugs from the group of nootropics, drugs that increase the metabolism and trophic potential of the brain, vitamin therapy with neuroprotective B vitamins. Additional therapy is selected individually and prescribed in accordance with the cause of sensory aphasia. For example, in the case of a stroke, thrombolytic or hemostatic drugs are added, in the case of an infectious inflammatory lesion, antibiotics, non-steroidal anti-inflammatory drugs or antifungal agents are added.
Session with a speech therapist. The main difficulty that arises when attempting to contact the victim is the lack of understanding of the specialist’s approach to the patient. Violation of communicative activity requires long-term correction and perseverance. There are also difficulties in interpreting what the patient says. Because his speech is uninformative. It is very difficult to identify the main idea. Consultations with a speech therapist help restore the patient’s vocabulary, correct pronunciation of sounds and meaningful speech. With the help of special exercises and equipment, you can actively interact with the patient even at home.
Surgical interventions. In some cases, with deep or severe brain damage, the patient requires emergency surgery to eliminate the threat to life. In case of an aneurysm, clipping or sclerosis of the aneurysm can be performed using X-ray control. If aphasia is caused by tumor growth, then stereotactic surgery can be performed to destroy the tumor focus.
Additional treatment methods can speed up the recovery processes in the victim’s nervous tissue, and also increase the effectiveness of the main therapy. In the treatment of sensory aphasia, methods such as physical therapy, massage, physiotherapeutic methods, and the use of computer programs that stimulate the speech center and improve speech abilities are used. A positive effect has also been noted in contact with animals, so the following can be used in therapy: hippotherapy, feline therapy and dolphin therapy.

At the Clinical Institute of the Brain there is a specialized rehabilitation and recovery center that deals with the correction of disorders in patients with aphasia. Together with treatment, we manage to achieve a quick, step-by-step recovery process. There is a close connection between treatment and rehabilitation, which helps to quickly adapt the patient to new living conditions, thereby significantly increasing the effectiveness of therapy and recovery.

How to treat aphasia, get rid of aphasia?

Sarklinik knows how to treat aphasia , speech disorders characterized by partial or complete loss of the ability to use words and phrases, how to get rid of aphasia in Saratov. A variety of reflexology treatment methods have helped many of our patients get rid of aphasia in right-handed and left-handed people. Effective treatment of aphasia gives excellent results; patients (children and adults) restore lost speech abilities and begin to understand their thoughts and the speech of others. On our website sarclinic.ru you can see a doctor for free and get a short answer on the treatment of aphasia.

Rehabilitation

Only daily classes with a speech therapist and other specialists will contribute to an active rehabilitation process. It is very important to correctly build a rehabilitation plan from simple to complex. To begin with, the victim must be adapted to new conditions. Only after a course of psychotherapy can one begin rehabilitation measures, since the patient must be motivated to recover.

The patient can also perform the following exercises at home:

Simple questions: the patient is first asked questions with monosyllabic yes or no answers, then later they move on to open questions.
Thematic dialogues are practiced with the gradual development of dialogue on specific topics;
Writing and reading. Correction of the spelling and pronunciation of letters begins. Then syllables, which the patient then puts into words. In the future, with successful progress, they move on to writing dictations and reading short texts. The patient is asked to retell in his own words the story he read and answer questions about its content;
A task aimed at matching pictures and text. The patient is asked to build a story, while laying out the pictures sequentially;
Structuring pictures according to general properties and characteristics. The patient is given the task of arranging the pictures according to categories and highlighting common characteristics, for example, to separate some animals from others.

Diagnosis and treatment methods for aphasia in Moscow

The problem can be resolved with the help of qualified specialists. The disease requires elimination of the main cause and further correction. The speed of its correction largely depends on the degree of brain damage, so it is important not to delay a visit to a specialist. Diagnosis and treatment of speech disorders is carried out by specialists from the Department of Neurology.

At the initial appointment, the doctor collects anamnesis, collects complaints (in the case of aphasia, if it is impossible to independently describe the condition, close relatives are involved in the diagnosis), conducts a general examination for the presence of external abnormalities (in particular, drooping corners of the lips, decreased tone of the limbs).

Additionally, an examination by a neurologist in a team with a speech pathologist-speech pathologist is required so that the nature of the disorder can be assessed and appropriate corrective measures can be selected. Initiation of therapy requires testing, including assessment of the following symptoms:

Spontaneous speech. Speech is assessed by the number of words spoken, the presence of spontaneous errors, and the frequency of pauses to select suitable words.
Understanding. The patient is asked to point to objects that the specialist names and answer basic questions (“yes” or “no”).
Enumeration of objects. The patient is asked to say the name of the specific object that the specialist points to.
Reading and writing. The patient is given the task of writing any phrase and saying it out loud. This allows you to assess the degree of understanding and pronunciation.
Semantic activity. The doctor demands to name all the animals that the patient remembers in one minute.

Disinhibition of speech at the initial stages of aphasia development

The most effective method of eliminating aphasia and preventing the problem from worsening is to bring speech sequences to an automatic level by performing exercises such as singing, repeating phrases, finishing sentences, tongue twisters, etc.

When disinhibiting, the speech therapist completely pronounces the sentence to the last word, pronouncing only one syllable. The patient’s task is to finish the last word. First, the speech therapist examines the patient, determines what is easier for the patient, verbs, nouns, adjectives.

For example: the goat bleats, and the dog ... (barks); grass in the yard, firewood on the grass); Summer, sun, ... (heat); take matches, light... (fire).

Also, when disinhibiting, it is possible to achieve very good results using sayings. For example: you can’t even pull a fish out of ... (pond) without difficulty.

If such exercises cause difficulties for the patient, and more often than not, the song helps. The speech therapist begins to sing and when the patient begins to recognize the song, a smile spreads across his face.

Up the steps

Sensorimotor aphasia can occur with varying degrees of severity. During correction, the stages change from more severe to easier, so the recovery process can be compared to climbing up the stairs - from complete muteness to normal speech function. Unfortunately, if the patient is not treated, the situation gets worse. This is especially true for children: not being able to communicate through speech, they begin to lag behind in mental development.

With sensorimotor aphasia, the following degrees of damage to the speech apparatus are distinguished:

mild - understanding and reproduction of speech are slightly impaired, the patient confuses sounds, admits agrammatism, but in general he can be understood;
pronounced - automatic speech is preserved, understanding addressed speech causes significant difficulties;
deep (gross) sensorimotor aphasia - automatisms are inaccessible, monosyllabic answers to simple questions are possible;
total - the patient makes inarticulate sounds and does not respond to spoken speech.

Total sensorimotor aphasia is a difficult case both for the patient and for rehabilitation specialists, but even in such a situation there is not only hope for a complete recovery, it has serious grounds.

Capacity in cases of gross and total sensorimotor aphasia, as a rule, is partially limited, since the person does not understand the speech addressed to him and there is no confidence that he fully understands the text. But to temporarily deprive a person of certain rights in each specific case, a court decision is required, which will request the expert opinion of doctors. We must not forget that in children sensorimotor aphasia is most often a transient phenomenon. The potential for speech restoration is also high in adults. A residual speech defect in itself, with preserved understanding of the conversation and text, is not a reason to deprive a person of the right to make transactions.

Efferent motor aphasia

Efferent motor aphasia occurs when the premotor parts of the frontal lobes of the brain (Broca's area) are damaged and is accompanied by symptoms such as movement disorders

and difficulties in mastering the motor program.
In severe cases, when there is poor circulation after a stroke, speech may be completely absent. The motor function of the articulatory apparatus suffers, since the signal about the beginning and termination of a speech act is delayed, which causes inertia, stereotypical speech, and perseveration
- repetitions of the same syllable or word. The patient cannot switch from one articulatory posture to another in a timely manner, which is why expressive speech suffers. Difficulties arise in repeating a series of sounds or syllables, in naming objects. In conversation, patients miss verbs, prepositions, and swallow endings. Speech is ungrammatical, reminiscent of telegraphic style. In written speech, they confuse the order of letters in a word and find it difficult to choose the correct letter. In severe cases, reading and writing are completely impossible. In mild cases, the patient can write down the word by ear, omitting sounds at the junction of consonants or rearranging them. Understanding of speech is also impaired, especially the figurative meaning of expressions and polysemantic words.