Neuropsychologist in rehabilitation and education

Aphasiology: stages of development and current issues

Key words: speech therapy, aphasia, rehabilitation, speech
Aphasia is one of the oldest and most interesting problems in medicine, psychology and special pedagogy. Back in 1874 the famous neuropathologist and psychiatrist A.Ya. Kozhevnikov noted: “The painful speech disorder known as “aphasia” is of great interest not only from a medical, but also from an anthropological point of view.”

There are two stages in the development of the doctrine of aphasia. The first stage began in the second half of the 19th century. and is associated with the emergence of two scientific directions: localizationism (P. Broca, K. Wernicke, etc.) and anti-localizationism (P. Marie, etc.), which are important for further brain research: the first direction laid the foundation for the doctrine of the localization of functions in the cortex brain, the second pointed to the importance of the activity of the brain as a whole.

At the first stage of studying aphasia, motor (P. Broca, 1861), sensory (K. Wernicke, 1874), semantic (G. Head, 1926), dynamic (K. Kleist, 1934) and other forms of aphasia were identified. Various classifications of aphasia have been created, including the well-known Wernicke-Lichtheim classification (1885), echoes of which can be found in modern textbooks on neurology.

Research by major neurologists and psychologists of the 19th and early 20th centuries. significantly advanced ideas about aphasia. However, in general, the first stage of aphasiology was characterized by a descriptive approach. The views of researchers for more than a hundred years did not undergo any significant changes, which caused a crisis in aphasiology: the need for an analytical approach to the study of aphasia became obvious.

The second stage of the study of aphasia is associated with the name of A.R. Luria, who became one of the founders of neuropsychology - a science that studies the brain foundations of higher mental (cortical) functions of a person.

A significant contribution to modern ideas about aphasia were the achievements of neurology, physiology, neurophysiology (N.M. Sechenov, 1863-1903; I.P. Pavlov, 1903-1935; V.M. Bekhterev, 1905-1910; P.K. Anokhin , 1940-1956; I.N. Filimoshkin, 1940-1957; R. Penfield, 1964, etc.), which made it possible to develop the concept of dynamic localization of functions in the cerebral cortex, which was an important step in understanding the mechanisms of speech in normal and pathological conditions.

A.R. Luria created a neuropsychological classification of aphasias, based on the idea of ​​speech activity as a complex but unified functional system consisting of many afferent and efferent links. He undertook a syndromic analysis of various forms of aphasia, as well as a study of pseudoaphasic disorders in lesions of the deep parts of the brain. A study of speech disorders with damage to the convexital parts of the right hemisphere and a study of the neurophysiological nature of various aphasic syndromes were begun.

According to A.R. Luria, aphasic disorders are the result of a violation of the analytical and synthetic activity of various analyzers of the cerebral cortex, combined into a complex functional system, the “speech zone”. The form of aphasia depends on damage to one or another part of the “speech zone” of the cortex of the cerebral hemisphere dominant for speech (mainly the left). One cannot ignore the fact that brain lesions of different etiologies cause differences in the symptom complex of speech disorders. Aphasias differ from each other in their underlying mechanism and in their clinical and psychological characteristics.

Currently, aphasia is understood as “a systemic speech disorder that occurs with organic lesions of the brain, covers different levels of speech organization, affects its connections with other mental processes and leads to disintegration of the entire mental sphere of a person, disrupting primarily the communicative function of speech; aphasia includes four components - a violation of speech and verbal communication, a violation of other mental processes, a change in personality and a personal reaction to the disease.” (L.S. Tsvetkova, 1988, p. 15).

Aphasia is predominantly observed in adults; oral speech impairments are accompanied by impairments in reading, writing, and counting operations.

In modern aphasiology, in accordance with the classification of A.R. Luria distinguishes the following forms of aphasia:

1. Motor aphasia of the afferent type - occurs when the lower parts of the parietal lobe are damaged in the speech-dominant left hemisphere of the brain. Briefly it can be described as articulatory aphasia. The central symptom of this form of aphasia is a violation of the kinesthetic afferentation of voluntary movements, which results in impaired articulation of sounds and the inability to find the desired articulatory position.

In severe cases, patients are unable to pronounce not only words, but also individual sounds. In milder cases, literal paraphasias are observed in speech (replacement of some sounds with others, similar in place and method of formation).

It is characteristic that a patient with gross afferent motor aphasia can involuntarily utter a word or an entire phrase, but is not able to repeat it consciously.

With afferent motor aphasia, there may be a speech embolus (the only word or sentence that the patient is able to utter) used when communicating with others. Automated, conjugate and reflected forms of speech are impaired. Naming, as an act of speaking, is absent, but as a function it can be preserved: i.e. the patient knows the names of objects, actions, etc. There are impairments in understanding the speech of others. Reading is impaired, but elements of mental reading may be noted. The letter is missing. Patients are able to perform simple counting operations presented in writing.

2. Motor aphasia of the efferent type - occurs when the lower posterior frontal parts of the speech-dominant hemisphere are damaged. Briefly, it can be described as a violation of phrasal speech. The central symptom is pathological inertia of expressive speech, as a result of which it is difficult or impossible to timely switch from one article to another.

Patients pronounce individual words relatively easily, but have difficulty pronouncing words and phrases. It becomes impossible to construct and pronounce sentences. There are difficulties in inhibiting previous speech acts and switching to subsequent ones, which leads to perseverations (persistent involuntary repetition of a sound or word), the number of which increases with repeated attempts to pronounce a word or sentence. As a result, speech becomes disorganized, accompanied by getting stuck on individual fragments of the utterance. Pathological inertia of one’s own speech causes disorders in other aspects of speech function: reading, writing, counting and, partially, understanding speech.

With efferent motor aphasia, voluntary speech is predominantly impaired (monologue, dialogue, naming, etc.). Involuntary, automated forms of speech (agreeing and pronouncing a direct count from 1 to 10, counting in tens from 10 to 100, singing well-known songs, finishing proverbs, poems, etc.) are intact.

3. Dynamic aphasia – occurs when the posterior frontal parts of the speech-dominant hemisphere are damaged. Briefly, this form of aphasia can be characterized as a violation of speech initiative.

The central symptom of dynamic aphasia is a violation of independent, active, productive speech.

A characteristic feature of patients with this form of aphasia is speech spontaneity and inactivity. When meeting a person with dynamic aphasia for the first time, the layperson usually gets the mistaken impression that he or she does not show a desire to communicate. Difficulties in creating a speech plan and its systematic deployment are noted.

In the absence of paresis, there is general stiffness and slowness of movements, gestures, gait, and hypomimia is noted. There are changes in the emotional sphere: euphoria, laughter, insufficiently critical attitude towards speech impairment. There is a decrease in overall activity.

There is an impoverishment of the vocabulary. Characterized by echolalia (involuntary, mechanical repetition of the speech of others), the number of which increases when the patient is tired.

There are no pronounced sensorimotor or grammatical-semantic deficits in the speech of patients with dynamic aphasia. However, they are characterized by specific agrammatism, which manifests itself in the omission of verbs, prepositions, pronouns, the use of template phrases, and undeveloped simple sentences. The phrases are short and grammatically unrelated.

Patients with dynamic aphasia constantly need external stimulation of speech.

4. Sensory (acoustic-gnostic) aphasia – occurs when the posterior parts of the superior temporal gyrus of the speech-dominant cerebral hemisphere are damaged. Briefly, this form of aphasia can be characterized as a gross impairment of speech understanding. The central symptom of this form of aphasia is a violation of phonemic hearing, i.e. disintegration of the ability to acoustically analyze phonemes (speech sounds), each of which has a meaning-distinguishing function.

Phonemic hearing disorders cause severe impairments in speech understanding. A “phenomenon of alienation of the meaning of words” appears, which is characterized by the “separation” of the sound shell of a word from its objective correlation. The patient hears the word, but does not understand its meaning. Speech sounds lose their stable sound for the patient and are perceived distorted each time, mixed with each other.

As a result, patients’ own speech exhibits unproductive verbosity; logorrhea is disorganized speech consisting of a set of unrelated speech elements or parts thereof. Your own speech becomes incoherent. Verbal and literal paraphasias, echolalia, agrammatisms, and distortions of the sound structure of words are noted. Often in such disorganized speech there are correctly pronounced words and short phrases, but this happens spontaneously, without awareness on the part of the speaker.

Patients with sensory aphasia are very emotional. They talk a lot and unproductively, gesticulate, and when perceiving speech addressed to them, they rely on facial expressions, gestures and intonation of the interlocutor. It should be noted that when the context of the conversation is clear to them, the quality of their own (expressive) speech improves. Conversely, with fatigue, the symptoms of sensory aphasia intensify, the quality of speech understanding, as well as one’s own speech, deteriorate.

Automated speech, repetition, and naming are grossly impaired. Reading as a function is quite preserved; reading can often be used during remedial training. The letter and account are broken.

5. Acoustic-mnestic aphasia - occurs when the middle and posterior parts of the temporal region of the speech-dominant hemisphere are damaged. Briefly, it can be described as a violation of auditory-verbal memory.

The main speech symptom in this form of aphasia, as well as in sensory (acoustic-gnostic) aphasia, is a violation of the understanding of spoken speech. However, in this case, this is due not so much to a violation of phonemic hearing, but to a violation of auditory-verbal memory. The volume of auditory-speech perception decreases. There is also some weakening and impoverishment of visual representations of objects. The inability to retain speech information perceived by ear in memory leads to deficiencies in understanding long speech segments and hidden subtext.

Patients are characterized by mild impairment of their own speech, difficulties in updating words, and verbal paraphasia (word substitutions). There are difficulties in naming and repetition. Reading and writing are generally intact.

Patients with acoustic-mnestic aphasia do not have incoherent, unproductive speech, and they can be understood by the interlocutor.

6. Semantic aphasia - occurs when the parieto-occipital regions of the speech-dominant hemisphere are damaged. Briefly, this form of aphasia can be characterized as a violation of the understanding of complex logical and grammatical structures.

The central symptom of semantic aphasia is a violation of the understanding of grammatical structures of speech and semantic connections between words. This is especially clearly evidenced by the difficulties of understanding spatial prepositions: “above”, “under”, “behind”, etc. The understanding of comparative constructions (“daughter is taller than mother”), the difference between constructions such as “brother’s father” and “father’s brother”, phrases with the words “before”, “after”, “earlier”, “later”, etc. is impaired. The understanding of phrases whose meaning depends on the order of words in a sentence or on the endings of words is impaired.

Patients with semantic aphasia easily understand individual words and simple phrases, but do not understand long and complex sentences. They usually do not experience gross impairment of their own speech, because they speak using simple speech structures. There are no pronounced reading and writing impairments, but when reading there is a violation of the understanding of complex phrases and texts. Disorders of counting function are noted.

Concluding the description of the main forms of aphasia, it should be noted that mixed (complex) forms of aphasia are often observed in patients with focal brain lesions.

Our available data have shown that various forms of aphasia account for 81.5% of the total number of cases of speech pathology resulting from organic brain lesions. Other speech disorders (dysarthria, dysphonia, stuttering, etc.) are observed only in 18.5% of patients [4]. It is quite obvious that the problem of aphasia is one of the central focal brain lesions in the clinic.

Long-term speech restoration was recommended to begin 6–8 months after the stroke. Only in the 80s of the last century was the question of the timing of the start of speech therapy classes reconsidered and it was proven that only an early start of correctional pedagogical work can lead to lasting positive changes.

Currently, there are early (up to 6 months) and residual stages of speech restoration, each of which has its own specifics and poses a number of special tasks for the speech therapist. It has become obvious that the methodology of speech therapy work is differentiated not only depending on the form of aphasia, but also on the stage of recovery [2].

At an early stage, classes begin within the first 2 to 3 weeks after the patient exits the “stunning stage.” At this stage, the speech therapist needs to take into account not only the severity of the patients’ physical condition, but also the severity of the experience of sudden loss of speech, i.e. the work must be psychotherapeutic in nature. The main task of the early stage is to activate the process of speech restoration, disinhibit and stimulate depressed speech function, as well as prevent the occurrence of some pathological symptoms of aphasia (agrammatisms, perseverations, etc.).

The residual stage of recovery begins six months after organic brain damage. By this time, the form and degree of aphasia, as well as the degree of its combination with another or other forms of aphasia, are finally determined. At this stage, the patient's conscious, active participation in the recovery process is required. The essence of the speech disorder and the purpose of performing this or that exercise are explained to the patient in an accessible form. Special psychotherapeutic work is being carried out to develop an attitude towards speech restoration as a result of persistent, long-term and systematic speech therapy sessions.

Speech therapy work is preceded by a thorough neuropsychological examination of the patient’s higher mental functions, based on the results of which a diagnosis is made. Repeated examinations are carried out periodically to monitor the dynamics of recovery, as well as to clarify the rehabilitation training program.

Speech restoration in patients with aphasia depends on a number of factors: localization, extent and depth of the lesion, etiology of the disease, form and severity of aphasia, hemisphere dominance, severity of the speech defect, time of onset of the disorder (without influencing it), age and personality patient, presence of left-handedness, knowledge of more than one language, etc.

The listed factors are interrelated and most directly determine the process of speech restoration - spontaneous or directed.

In the specialized literature, the difficulties of distinguishing between spontaneous and directed (speech therapy) recovery are rightly noted, because they constantly overlap each other.

In the recovery process, the “meeting” of spontaneous and directed speech recovery is important, when the early start of classes coincides with the most intense period of spontaneous recovery. The very concept of “directed” (as opposed to spontaneous) contains the idea of ​​​​the possibility of directing the restoration of speech functions of patients with aphasia along the most appropriate path. Experience shows that speech restoration uncontrolled by a specialist and left to chance leads to emboli, perseverations, and sometimes makes the process of restoring spontaneous speech impossible [2]. Sometimes, with rapid spontaneous restoration of speech, pathological symptoms such as slurred pronunciation, stutter-like disturbances in the tempo and rhythm of speech, agrammatisms, etc. may occur, which can be avoided by using speech therapy [6].

In turn, the presence or absence of spontaneous speech restoration is important for the results of rehabilitation training. You should pay attention to the dynamics of aphasia before the start of speech therapy training, the presence or absence of spontaneous speech recovery, i.e. against the background against which targeted rehabilitation therapy is carried out. Spontaneous speech recovery is of great importance in the early period of the disease, and in the late period, the role of spontaneous recovery decreases and targeted rehabilitation therapy becomes of primary importance [6].

M.K. Shokhor-Trotskaya (Burlakova), based on 40 years of experience in overcoming aphasia, notes that spontaneous restoration of impaired higher mental functions in patients who have suffered a stroke does not occur (with the exception of restoration of mental functions in left-handed people and partially in partial left-handedness) [ 8].

Practical experience shows that it is advisable to carry out speech therapy training in all cases: both in cases of spontaneous speech restoration and in cases of its absence. Speech therapy acts as a factor that has a “trigger value” and realizes reserves from the outside for the restoration of impaired functions [1].

During 1986-2003. In the department of general and vascular neurology of the Scientific and Medical Association “Grigor Lusavorich” in Yerevan, we conducted a neuropsychological examination of 552 people with various forms of aphasia of vascular etiology at various stages of recovery. Analysis of the results of speech restoration showed that only 56 people (28 women and 28 men) had spontaneous speech restoration, which is about 10% of the total number of patients with aphasia we examined. In the remaining 496 cases (90%), i.e. In the overwhelming majority of subjects, spontaneous speech recovery was not observed. All of them needed targeted speech therapy assistance.

For a long time, a skeptical attitude prevailed among neurologists in assessing the effectiveness of a specially organized speech restoration process. To be fair, it should be noted that there are echoes of this attitude even now. However, doctors are increasingly convinced of the effectiveness of speech therapy work, of the productivity of the early start of classes, which coincides with the most intense period of spontaneous recovery.

The study of aphasic disorders has served and continues to serve as an impetus for the development of many branches of science: medicine, psychology, pedagogy, linguistics, speech therapy, the theory of human functional asymmetry, etc.

Today, aphasiology is experiencing the next stage of its development, which is primarily due to the emergence of new technical means: computer and nuclear magnetic tomography, Dopplerography, etc.

Thus, in connection with the development of neuroimaging methods, it has become possible to identify a significant number of patients with “subcortical” aphasia. It has been established that local lesions of subcortical formations lead to disorders of mental functions that differ significantly from cortical ones in the structure of the defect: instability of certain manifestations of disorders, when the quality of task performance often depends on mental activity, less often on the degree of complexity; persistence of speech disorders, etc. Features of “subcortical” aphasia determine the need to modify the main directions of traditional speech therapy work, change the duration of classes and stages of recovery [3].

One of the current problems of aphasiology is the study of cases of aphasia in multilinguals. Interest in the problem is due to the increase throughout the world in the number of people who speak two or more languages. Advances in medicine that make it possible to save the lives of patients with focal brain lesions make the issues of their socio-psychological rehabilitation significant. In addition, the fact of the existence of various variants of aphasic syndromes, including aphasia in multilinguals, is of great importance for further improvement of the theory and practice of speech restoration. Our studies have shown that in multilingualism, along with the usual aphasic symptoms, there are also specific ones: increased interference (linguistic pseudoparaphasias and pseudoagrammatisms; interference phenomena in written speech), involuntary and inadequate switching from one language to another in a given speech situation, difficulties (impossibility) of voluntary translation, change in the status of languages ​​(activation of a subdominant language and/or dialect, use of only one of the restored languages), “forgetting” of the language. Three main types of spontaneous speech restoration in aphasia in multilinguals were identified: parallel, sequential and mixed, methods, programs and guidelines for speech restoration in multilinguals were developed [5].

Like other speech therapists, we are forced to note that restoration of speech does not always mean restoration of speech communication. Therefore, to restore speech communication, it is necessary to search for new ways, methods and forms of speech therapy work, in particular, the organization of the patient’s free time with the help of his immediate environment, as well as the cooperation of the speech therapist with the patient’s family. It is the family that is the primary social and communicative environment that facilitates a person’s return to society.

In the field of aphasiology, domestic speech therapists still have a lot to do. In particular, there is practically no specialized literature in the Armenian language. We are trying to fill this gap: we have developed a scheme for neuropsychological examination of patients with aphasia [9], speech therapy advice for relatives [10], and a methodological guide to speech restoration in aphasia, intended for speech therapists, psychologists, doctors and other specialists working in the field of rehabilitation therapy people with focal brain lesions [11].

Rehabilitation of patients with aphasia can rightfully be considered an independent branch of clinical medicine, and the growing number of patients with vascular lesions of the brain, traumatic brain injuries, neuroinfections and the consequences of neurosurgical intervention makes the issues of aphasia and speech restoration very important and relevant.

Received 12/27/10

Literature

1. Bein E.S., Burlakova M.K., Wiesel T.G. Restoring speech in patients with aphasia. M., 1982.
2. Burlakova M.K. Corrective pedagogical work for aphasia. M., 1991.
3. Kuchumova T.A. “Subcortical” aphasia: features of the neuropsychological syndrome. Modern approaches to the diagnosis and correction of speech disorders. Rep. ed. M.G. Khrakovskaya. SPb., 2001, p. 112 -119.
4. Pailozyan Zh.A. On speech therapy assistance for patients with aphasia. Honey. Science of Armenia NAS RA, 2001, vol. XLI, 1, pp. 103 – 107.
5. Pailozyan Zh.A. From the experience of correctional pedagogical work for aphasia in multilinguals. Defectology. M., 2002, 6, p. 82 – 84.
6. Stolyarova L.G. Aphasia in cerebral stroke. M., 1973.
7. Tsvetkova L.S. Aphasia and remedial learning. M., 1988.
8. Shokhor-Trotskaya (Burlakova) M.K. Speech and aphasia. M., 2001.
9. Աճեմյան Ժ.Հ. cordial ությունը և կյանքը - Երևան, 2002, 2, էջ 67 – 74.
10. Պայլոզյան Ժ.Հ. // կ մանկավարժություն և հոգեբանություն: Միջբուհական գիտամեթոդական հոդ Journal: Երևան, 2008, էջ 42 – 44.
11. Պայլոզյան Ժ.Հ. cordial ն, 2010:

Neuropsychologist in rehabilitation and education

A.A. Gypsy

Impaired word understanding in various forms of aphasia

A shortened version of the abstract of the dissertation by A.A. Tsyganok for the degree of candidate of psychological sciences in medical psychology, Moscow: Faculty of Psychology of Moscow State University, 1983.

Knowledge of the pathophysiological and psychological foundations of aphasic syndrome is a necessary condition for an accurate neuropsychological analysis of disorders of higher mental functions, making a topical and differential diagnosis of brain damage and developing adequate methods of rehabilitation training.

Impairments in speech understanding that occur with local brain lesions in patients suffering from aphasia have long attracted the attention of researchers - neurologists, psychologists, and linguists. In aphasiology, there is a large number of works devoted to this issue, but they are very contradictory. Many authors still, following the first researchers of aphasia, believe that speech understanding is impaired only in sensory aphasia and does not suffer in motor aphasia. There is another view on this problem: disturbance of speech, as an integral speech activity, leads to disorganization of the entire speech system as a whole, and therefore, to one degree or another, with any aphasic syndrome, various forms and types of speech suffer.

Despite the great interest in this problem, impaired speech understanding at the level of a single word has been studied mainly in patients suffering from sensory forms of aphasia. There have been virtually no systematic experimental studies of this process in other forms of aphasia. On the other hand, the question of the influence of various parameters of a word on its understanding in different forms of aphasia is still insufficiently studied.

The solution to this problem will make it possible to clarify and deepen our understanding, on the one hand, about aphasia, about the syndromes of its various forms, about the nature and mechanisms of speech impairment in aphasia, on the other hand, it will make a certain contribution to the doctrine of the psychology of speech, the interaction of expressive and impressive speech, about their complex unity. Based on the concept of speech understanding as a complex multi-level and multi-link process of processing verbal information, we attempted an experimental study of impaired understanding of spoken words using the methods of neuropsychological and psychological analysis, and also tried to investigate the influence of some phenomena known in the clinic of aphasia, such as a form of aphasia, various characteristics of the word, etc. on the formation of a speech understanding defect.

In this regard, we formulated a number of specific tasks for this study: 1) to determine whether the understanding of a single word is impaired in various forms of aphasia, including motor ones; 2) study of the influence or absence of common symptoms at the basis of impaired word comprehension in various forms of aphasia; 3) elucidation of the influence of specific features of different forms of aphasia on word understanding; 4) study of the influence of various psycholinguistic parameters of a word on its understanding in aphasia; 5) study of the influence of the volume of the visual field on word comprehension in aphasia.

Within the general problem of understanding, understanding speech occupies a special place, although understanding in general often comes down to understanding speech (J. Locke et al.). However, most researchers consider speech understanding as a private independent problem. So. L.S. Vygotsky defined understanding speech as a process consisting of establishing relationships, highlighting what is important, and moving from individual elements to the meaning of the whole. A.R. Luria, considering speech understanding as a complex multi-link and multi-level activity, identified a number of conditions necessary for its full implementation. Firstly, according to A.R. Luria, the subject must have all the features of phonemic hearing and be able to use the phonemic codes of the language. Secondly, it is necessary to have a firm knowledge of the words and logical-grammatical codes of the language. Thirdly, the preservation of simultaneous decoding of logical-grammatical structures is important. And, fourthly, the normal course of inhibitory processes is necessary to isolate the essential and inhibit the unnecessary.

The problem of understanding speech was further developed in the works of L.S. Tsvetkova, who identified 2 forms of understanding: simple, proceeding on the basis of a contextual guess, and complex, analytical-synthetic, which occurs when getting acquainted with a complex, previously unknown text. L.S. Tsvetkova believes that in the process of understanding it is necessary to carry out work on restructuring the lexical meaning, as well as grammatical and semantic, into a “psychological meaning”. Following N.G. Morozova L.S. Tsvetkova distinguishes 2 levels of speech understanding: linguistic, where the analysis of meanings is carried out, and psychological, where the meaning of information is analyzed.

In aphasiology, a form of speech understanding impairment in sensory aphasia is known and studied. For a long time, the literature was dominated by the idea of ​​complete preservation of impressive speech in motor aphasia. The famous Russian neurologist M.B. Krol believed that with motor aphasia, speech understanding does not suffer, but if such disorders are noted, then the researcher simply did not notice the concomitant sensory aphasia. This point of view is still found in educational and reference literature on neurology.

There is another view on the state of impressive speech in motor aphasia. P. Marie and K. Goldstein noted impairments in speech understanding in this form of aphasia, linking them with intellectual disorders. But more often in the literature there are simply indications of speech understanding defects in motor aphasia in the form of assumptions without phenomenological or, what is especially important, experimental evidence, without hypotheses about the possible nature of such disorders (M.S. Lebedinsky, V.M. Kogan, E. .S. Bain and others).

For the first time, raising the question of the mechanisms and structure of speech understanding disorders became possible after the creation of A.R. Luria's theories about the systemic nature of the localization of higher mental functions in the human cerebral cortex, about their disintegration in cases of local brain lesions. A.R. Luria showed the incorrectness of the position about the localization of an entire function in a separate area of ​​the brain - factors that are part of various mental functions are localized. Therefore, the process of understanding speech, as a complex mental function, cannot be disrupted only when a certain part of the brain is damaged, for example, its temporal regions. With brain lesions of different locations, different levels and links in the process of speech understanding are affected. Even with damage to the left temporal region of the cerebral cortex, two different factors can be disrupted, depending on which part of the temporal lobe is affected, which leads to manifestations of impressive speech defects that differ in psychological structure.

Neuropsychological factor analysis, introduced by A.R. Luria's contribution to psychology allowed him to come close to studying speech understanding impairments in various forms of aphasia. A.R. Luria assumed that secondary disturbances in speech understanding can be observed in afferent motor aphasia due to the pathology of speech kinesthesia, and in efferent motor aphasia due to a violation of kinetic analysis, etc. Theoretical provisions of A.R. Luria were confirmed in further research, and also made it possible to explain the previously obtained facts. A detailed analysis of speech understanding impairments with local brain lesions is given in the works of L.S. Tsvetkova, who, in particular, studied the mechanisms of speech understanding impairments with lesions of the frontal lobes of the brain. It has been shown that in these cases, active work on decoding the meaning of the message suffers due to the lack of text analysis and the inability to inhibit emerging side associations. L.S. Tsvetkova also describes the mechanisms of speech understanding impairment in acoustic-mnestic aphasia and gives a new interpretation of them. Thus, neuropsychological analysis makes it possible to identify individual links and levels in the structure of the implementation of the process of speech understanding, to clarify their role, correspondence and connection with certain brain structures. We proceeded from the ideas in psychology, linguistics and psycholinguistics about speech as a complex, highly integrated process in which its various aspects, as well as links and levels, are interconnected. Aphasia, as a disorder of speech production and speech perception, affecting various components of the process of speech understanding, can affect it differently depending on its mechanism and primary defect. Based on the analysis of literary data and our own clinical observations, we put forward the hypothesis that impaired understanding of speech in various forms of aphasia can manifest itself already at the level of an individual word, since the word is an important element of speech, understanding the whole text begins with the understanding of a single word, and it is impossible without an adequate assessment of the meanings of individual words. In turn, the word is also characterized by a complex internal structure, therefore, based on literature data, we have identified a number of parameters of the word that affect the impairment of its understanding in aphasia.

To solve the problems posed in the study, a technique was used to select a picture in accordance with the sounding word, which has an undoubted advantage over verbal methods, since it excludes the participation of patients with impaired oral speech in the experiment. We modified the methodology and was designed in such a way that it made it possible to study the influence on the understanding of a word of those of its parameters that were noted in the studied literature: sound and semantic composition, the attribution of a word to a certain grammatical category, its length and frequency. Participation in the experiment of patients with various forms of aphasia made it possible to study the influence of the specific features of each form of aphasia on word understanding. The verbal material of the experiment consisted of groups of words, and each group included: 1) a test word, 2) a word semantically close to the test word, 3) a word phonologically close to the test word, 4) a word not related to the test word in any way. sound, nor in meaning (neutral). There should be no other connections between words connected in a certain way. All words of one group belonged to the same grammatical category and had the same length - the number of syllables and morphemes. All words of one group were mid-frequency. The existing differences in the impairment of word understanding made it possible to evaluate the role of this parameter when analyzing the results. For our experiment, we selected 25 groups of nouns and 10 groups of verbs (140 words in total). The verbal stimuli included one-syllable, two-syllable, and three-syllable words.

In the first series of the experiment, we set ourselves the task of identifying the mechanisms and structure of impaired understanding of a single word in various forms of aphasia. Pictures were selected that corresponded to the test word of each group. Experiment I of the series consisted of 2 experiments: on the understanding of nouns and on the understanding of verbs. The experimental procedure in Series I was as follows: the subject had to make a choice from two stimuli: on the table in front of him lay a picture corresponding to the test word and a blank card. The psychological meaning of an empty card is to materialize the possible absence of a picture analogue to the sounding word. The presence of an empty card removes the element of uncertainty when answering and organizes the patient’s behavior. The subject was presented with words from the corresponding group aurally. Then the picture changed and the words of the next group were presented in random order.

In the second series of the experiment, special tasks were set for the study: 1) studying the influence of an expanded visual field (number of pictures) on the understanding of a single word in aphasia, 2) studying the nature of semantic substitutions. The same verbal material was used as in Series I, only the subjects had to correlate the sounding word with 5 visual stimuli - four pictures in accordance with the four words of the group and an empty card, that is, 4 pictures and an empty card were placed on the table in front of the subject, then all 4 words of the group were pronounced in turn, and the correctness of the choice of picture and understanding of the word was recorded.

The impairment of word understanding in both series was measured according to two criteria: the latent reaction time (understanding time) was noted using a stopwatch, and a detailed quantitative and qualitative analysis of the errors made was carried out.

63 subjects took part in the experiment: 20 adult healthy subjects (2 control groups of 10 people each) and 43 patients with aphasia. The first control group of subjects participated in the selection of methodological - verbal and picture material. All words and pictures that raised doubts among this group of subjects were excluded from the methodology. Patients with aphasia, based on neuropsychological findings, were divided into 6 groups: 5 subjects with dynamic aphasia, 7 with efferent and 9 with afferent motor aphasia, 6 with sensory, 10 with acoustic-mnestic and 6 with semantic aphasia.

During the experiment, 29,680 responses were processed. Analysis of the results obtained allowed us to identify several types of errors: gross errors of understanding - paragnosia without a visible connection with the test word, literal and verbal paragnosis. When processing the data obtained, the average time for understanding a word, indices of impairment in word understanding, and the proportion of each type of error were calculated. To study the statistical significance of the differences between the obtained data series, the White criterion was used, which is used to evaluate unrelated observations of quantitative characteristics in samples of both the same and different sizes.

The data obtained showed that for the control group of subjects the experiment did not present any difficulties, the subjects of this group did not make errors of understanding, the time of understanding in both series did not exceed one second.

We identified a violation of word understanding in dynamic aphasia. Errors were mainly made in understanding those words that denote actions (verbs), while the vast majority of errors were of the nature of verbal paragnosis. The effect of word length on its comprehension in dynamic aphasia was not detected in our experiment. The oral speech defects known for this form of aphasia, such as a violation of active utterance, “verbal weakness,” are combined with mild but distinct difficulties in understanding a single word.

With efferent motor aphasia, the central mechanism of which is the inertia of emerging stereotypes, a violation of the understanding of a single word is also revealed: defects in the understanding of both nouns and verbs are noted, but the violation of the understanding of verbs is more pronounced. Against the background of various types of errors made by subjects in this group, verbal paragnosis predominates. The influence of word length on its understanding in efferent motor aphasia, as well as in dynamic aphasia, was not revealed.

Considering the data that was obtained in a group of patients suffering from afferent motor aphasia, we came to the conclusion that the understanding of a single word in this case is more crudely expressed than in the two forms of aphasia already discussed. In this group of patients, there was a violation of the understanding of both nouns and verbs, although here, too, a violation of the understanding of verbs predominated. When performing experimental tasks, errors of various types were encountered: a significant percentage of literal paragnosis, which is associated with the primary defect underlying this form of aphasia - a violation of kinesthetic analysis. However, difficulties in distinguishing words that are similar in meaning prevail; apparently, semantic rearrangements occur, which arise secondarily due to the disintegration of the entire speech activity of the patient with aphasia. The influence of word length on its understanding in this form of aphasia was pronounced: two-syllable words were easiest to understand, while short words consisting of one closed syllable were the most difficult.

Defects in speech understanding in sensory aphasia are well known in aphasiology and described by many authors. This fact was once again confirmed in our experiment. It was found that subjects in this group also found it more difficult to understand verbs compared to nouns. Although the percentage of phonological errors here is very high (higher than in all other groups), difficulties in distinguishing words with similar meanings predominate. As with afferent motor aphasia, it is most difficult for patients in this group to understand short monosyllabic words, which apparently carry insufficient sound information, not having it to a sufficient or excessive extent, which helps to put forward a hypothesis about the role of the meaning of the word with impaired sound discrimination for more accurate and quick understanding of it.

In acoustic-mnestic aphasia, the phenomenon of impaired word understanding was also confirmed. The impairment in understanding words denoting actions turned out to be more pronounced compared to words denoting objects. As in other groups of subjects suffering from aphasia, we obtained a predominance of verbal paragnosis, i.e. It is more difficult for patients to distinguish between words that are similar in meaning. An increase in the length of a word in this form of aphasia leads to a deterioration in its understanding.

In the group of patients with semantic aphasia, a violation of speech understanding at the level of a single word was also revealed. These defects are not as severely expressed as, for example, with sensory or acoustic-mnestic aphasia, but they are of a distinct nature. Understanding of verbs suffers more. In the virtual absence of sound discrimination errors, verbal paragnosis is identified. The deterioration in the understanding of a word with an increase in its length is mildly expressed.

In the second series of the experiment, the following main result was obtained: it was found that increasing the volume of the visual field (the number of pictures) does not lead to an easier process of understanding a single word, as might be expected, but makes it more difficult, which is expressed in an increase in the time of understanding. Let us note that in the control group of adult healthy subjects there were no differences in the time of understanding the sounding word in series I and II of the experiment. The nature of the errors made by subjects with aphasia, their absolute indicators and distribution by type do not differ from the data that were obtained in the first series of the experiment.

Having conventionally divided verbal paragnosis identified in patients with different forms of aphasia into errors associated with “narrowing” or “expanding” the meaning of a word, we found in patients with the so-called “anterior” forms of aphasia a tendency to “narrow” the meaning of the word, in while in “posterior” forms of aphasia, a predominance of “expansion” of the meaning of the word was noted.

Thus, in the course of our study, the influence of specific features of different forms of aphasia on the process of understanding a single word was revealed, which was expressed in the nature of the errors made, their distribution by type, and in the severity of the process of impaired speech understanding. However, the fact that there are common symptoms of impaired word understanding that occur in various forms of aphasia has been obtained. These include, firstly, a more pronounced impairment in the understanding of verbs compared to nouns, which is explained by the different internal structure of the verb and noun and their different roles in the process of speech production and speech perception. The verb is a more capacious part of speech with a more complex semantic structure, carrying the property of predicativity; the verb can practically be identified with the whole statement. Another symptom common to various forms of aphasia is a violation of the understanding of words with similar meanings.

The study of the influence of the frequency factor on the understanding of a word allowed us to conclude that for the phonological level of a word this parameter does not play a decisive role in the process of understanding, but at the semantic level the influence of frequency is clearly expressed, which once again allows us to speak about the connection between the frequency of a word, first of all , with its semantic organization.

The results regarding the effect of word length on word comprehension in aphasia were also interesting. Thus, with dynamic, efferent motor and semantic aphasia, increasing the length of a word in our experiment did not affect its understanding. In acoustic-mnestic aphasia, as one would expect, increasing the length of a word worsens its understanding. In sensory and afferent motor aphasia, the most difficult words to understand were short words consisting of one closed syllable, apparently carrying too little sound information to make a hypothesis about their meaning in conditions of sound discrimination deficit.

The main results of the study are presented in Fig. 1, 2 and 3.

Rice.
1. Average indices (A) of impaired understanding of nouns and verbs in different forms of aphasia (I series)

Rice.
2. Distribution of specific weights (D) of error types for different forms of aphasia in experiments on understanding nouns (I series)

Rice.
3. The influence of the volume of the visual field on the average time of word understanding (tav in sec.) in different groups of patients.
Our data can make a certain contribution to the study of the process of understanding spoken speech, once again drawing the attention of researchers to the important role of motor (both kinesthetic and kinetic) ) links in its structure. When analyzing sound information perceived by a person, it is necessary to take into account the dominant role of its semantic characteristics, as well as the fact that the frequency of a word is associated primarily with its semantic organization.

Identification of impaired understanding of a single word as a common symptom for various forms of aphasia, in our opinion, is interesting from the point of view of neuropsychology, since it allows us to clarify the syndromes of various forms of aphasia, taking into account those specific features of the process we studied that are associated with the central mechanisms underlying each from forms of aphasia.

The results of our study are not only of theoretical significance, allowing us to clarify and deepen our understanding of the mechanisms of impairment of impressive speech in aphasia, and of the hierarchy of individual components of a word in the process of its understanding. Our data will find application in the practice of neuropsychological diagnosis of local brain lesions and rehabilitation of patients with aphasia in the development of new, more effective methods of diagnostic examination and rehabilitation training of patients with aphasia.

conclusions

1. Impaired understanding of a single word occurs in all forms of aphasia we have studied: dynamic, efferent and afferent motor, sensory, acoustic-mnestic and semantic.

2. In all forms of aphasia, difficulties are identified in understanding words that are similar in semantic characteristics.

3. In all forms of aphasia, a worse understanding of verbs is found compared to nouns, which can be explained by the complex semantic structure of the verb and its special role in the process of speech production and speech perception.

4. The influence of specific mechanisms of different forms of aphasia on word comprehension is expressed in varying degrees of disruption of the process being studied, as well as in the distribution of various types of errors.

5. The length of a word does not affect its understanding in dynamic, efferent motor and semantic aphasia. Increasing the length of a word negatively affects its understanding in acoustic-mnestic aphasia. In afferent motor and sensory aphasia, short monosyllabic words are most difficult to understand.

6. At the level of sound discrimination, the frequency parameter does not significantly affect the understanding of a word; at the level of choosing the meaning of a word, words with high frequency are most easily understood.