These include tremor, dystonia, athetosis tics and ballism, dyskinesias and myoclonus.
Classification of causes, symptoms, signs of movement disorders
| Movement disorder | Classification, causes, symptoms, signs |
|---|---|
| Tremor = rhythmic oscillatory movements of a body part |
Classification: resting tremor, intentional tremor, essential tremor (usually postural and action), orthostatic tremor Parkinsonism is characterized by a resting tremor. Essential tremor has often been present for many years before seeking medical attention and is usually bilateral; in addition, a positive family history is often noted. Intentional and action tremors are often combined with damage to the cerebellum or efferent cerebellar pathways. Orthostatic tremor is expressed mainly by instability in the standing position and high-frequency trembling of the muscles of the legs. Causes of increased physiological tremor (according to the standard of the German Society of Neurology): hyperthyroidism, hyperparathyroidism, renal failure, vitamin B2 deficiency, emotions, stress, exhaustion, cold, drug/alcohol withdrawal syndrome Drug tremor: neuroleptics, tetrabenazine, metoclopramide, antidepressants (mainly tricyclics), lithium preparations, sympathomimetics, theophylline, steroids, antiarrhythmia drugs, valproic acid, thyroid hormones, cytostatics, immunosuppressive drugs, alcohol |
| Dystonia = long-lasting (or slow), stereotyped and involuntary muscle contraction, often with repeated twisting movements, unnatural postures and abnormal positions | Classification: Adult idiopathic dystonias are usually focal dystonias (eg, blepharospasm, torticollis, dystonic writing spasm, laryngeal dystonia), segmental, multifocal, generalized dystonias, and hemidystonias. Rarely, primary dystonias (autosomal dominant dystonias, eg, dopa-responsive dystonia) or dystonias within an underlying degenerative disease (eg, Hallerforden-Spatz syndrome) occur. Secondary dystonias have also been described, for example, in Wilson's disease and in syphilitic encephalitis. Rare: dystonic status with respiratory failure, muscle weakness, hyperthermia and myoglobinuria. |
Tics = involuntary, sudden, brief and often repetitive or stereotyped movements. Tics can often be suppressed for a period of time. Often there is an obsessive desire to perform a movement with subsequent relief. |
Classification: motor tics (clonic, dystonic, tonic, eg, blinking, grimacing, head nodding, complex movements, eg grasping objects, adjusting clothing, copropraxia) and phonic (vocal) tics (eg, coughing, coughing, or complex tics → coprolalia, echolalia). Juvenile (primary) tics often develop in association with Tourette's syndrome. Causes of secondary tics: encephalitis, trauma, Wilson's disease, Huntington's disease, drugs (SSRIs, lamotrigine, carbamazepine) |
|
Choreiform movement disorders = involuntary, non-directional, sudden and brief, sometimes complex movements Athetosis = slow choreiform movement, accentuated distally (sometimes worm-like, writhing) Ballismus/hemiballismus = severe form with throwing motion, usually unilateral, affecting the proximal limbs |
Huntington's chorea is an autosomal dominant neurodegenerative disease that is typically accompanied by hyperkinetic and often choreiform movements (the lesion is located in the striatum). Non-genetic causes of chorea: lupus erythematosus, chorea minor (Sydenham), chorea of pregnancy, hyperthyroidism, vasculitis, drugs (eg, levodopa overdose), metabolic disorders (eg, Wilson's disease). Causes of hemiballismus/ballisma are typical lesions of the contralateral subthalamic nucleus, but other subcortical lesions should also be considered. Most often we are talking about ischemic foci. Rarer causes are metastases, arteriovenous malformations, abscesses, lupus erythematosus, and drugs. |
| Dyskinesias = involuntary, prolonged, repetitive, purposeless, often ritualized movements |
Classification: simple dyskinesias (eg, tongue sticking out, chewing) and complex dyskinesias (eg, stroking, repetitive leg crossing, marching movements). The term akathisia describes motor restlessness with complex stereotyped movements (“the inability to sit still”), its cause is usually neuroleptic therapy. Tardive dyskinesia (usually in the form of dyskinesia of the mouth, cheeks and tongue) occurs due to the use of antidopaminergic drugs (neuroleptics, antiemetics, such as metoclopramide). |
| Myoclonus = sudden, involuntary, brief muscle twitches with visible motor effects of varying degrees (from barely perceptible muscle twitches to severe myoclonus affecting the muscles of the body and limbs) |
Classification: Myoclonus can occur at the cortical, subcortical, reticular and spinal levels. They may be focal segmental, multifocal, or generalized.
|
Diagnosis of movement disorders
Hyperkinetic movement disorder is initially diagnosed based on the clinical presentation:
- Rhythmic, such as tremor
- Stereotypic (same repetitive movement), e.g. dystonia, tic
- Irhythmic and non-stereotypical, such as chorea, myoclonus.
Attention: drugs that were taken several months ago can also be responsible for the movement disorder!
In addition, brain MRI should be performed to differentiate between primary (eg, Huntington's disease, Wilson's disease) and secondary (eg, drug) causes.
Routine laboratory tests should primarily include electrolyte levels, liver and kidney function, and thyroid hormones.
It seems appropriate, in addition, the study of cerebrospinal fluid to exclude a (chronic) inflammatory process in the central nervous system.
In myoclonus, EEG, EMG and somatosensory evoked potentials help to determine the topographic and etiological characteristics of the lesion.
Differential diagnosis of movement disorders
- Psychogenic hyperkinesias: In principle, psychogenic movement disorders can mimic the entire range of organic movement disorders listed in the table. Clinically, they appear as abnormal, involuntary, and non-directional movements associated with walking and speech disturbances. Movement disorders usually begin acutely and progress rapidly. Movements, however, are most often heterogeneous and variable in severity or intensity (unlike organic movement disorders). It is not uncommon for several movement disorders to be present as well. Often, patients can be distracted and thereby interrupt movement. Psychogenic movement disorders may increase if they are observed ("spectators"). Often, movement disorders are accompanied by "inorganic" paralysis, diffuse or difficult to classify anatomically sensitization disorders, as well as speech and walking disorders.
- Myoclonus may also occur "physiologically" (=without underlying disease), such as sleep myoclonus, post-syncopal myoclonus, hiccups, or post-exercise myoclonus.
Treatment of movement disorders
The basis of therapy is the elimination of provoking factors, such as stress in essential tremor or drugs (dyskinesia). The following options are considered as options for specific therapy for various movement disorders:
- For tremor (essential): beta-receptor blockers (propranolol), primidone, topiramate, gabapentin, benzodiazepine, botulinum toxin with insufficient action of oral drugs; in treatment-resistant cases with severe disability - according to indications, deep brain stimulation.
Tremor in Parkinson's disease: Initial treatment of torpor and akinesis with dopaminergics, with persistent tremor, anticholinergics (note: side effects, especially in elderly patients), propranolol, clozapine; with therapy-resistant tremor - according to indications, deep brain stimulation
- With dystonia, in principle, physiotherapy is also always carried out, and sometimes orthoses are used.
- for focal dystonia: trial therapy with botulinum toxin (serotype A), anticholinergics
- with generalized or segmental dystonia, first of all, drug therapy: anticholinergics (trihexphenidyl, piperiden; attention: visual impairment, dry mouth, constipation, urinary retention, cognitive impairment, psychosyndrome), muscle relaxants: benzodiazepine, tizanidine, baclofen (in severe cases, sometimes intrathecal), tetrabenazine; in severe treatment-resistant cases, according to indications - deep brain stimulation (globus pallidus internus) or stereotaxic surgery (thalamotomy, pallidotomy)
- children often have dopa-responsive dystonia (often also responds to dopamine agonists and anticholinergics)
- dystonic status: observation and treatment in the intensive care unit (sedation, anesthesia and mechanical ventilation if indicated, sometimes intrathecal baclofen)
- With tics: explanation to the patient and relatives; drug therapy with risperidone, sulpiride, tiapiride, haloperidol (second choice due to unwanted side effects), aripiprazole, tetrabenazine, or botulinum toxin for dystonic tics
- For chorea: tetrabenazine, tiapride, clonazepam, atypical antipsychotics (olanzapine, clozapine) fluphenazine
- For dyskinesias: cancel provocative drugs, trial therapy with tetramenazine, for dystonia - botulinum toxin
- For myoclonus (usually difficult to treat): clonazepam (4-10 mg/day), levetiracetam (up to 3000 mg/day), piracetam (8-24 mg/day), valproic acid (up to 2400 mg/day)
Features of a child with disorders of the musculoskeletal system.
With all the variety of congenital and early acquired diseases and injuries musculoskeletal system most of these children have similar problems. Leading in the clinical picture is a motor defect (delayed formation, underdevelopment, impairment or loss of motor functions).
Some children with this pathology do not have deviations in the development of cognitive activity and do not require special training and education. But all children with disorders of the musculoskeletal system need special living conditions, education and subsequent work.
Most of the children with disorders of the musculoskeletal system are children with cerebral palsy. CEREBRAL PALSY (ICP) is a severe disease of the nervous system, which often leads to a child's disability.
Cerebral palsy occurs as a result of underdevelopment or damage to the brain in the early stages of development (during the prenatal period, at the time of birth and in the first year of life). Movement disorders in children with cerebral palsy are often combined with mental and speech disorders, with impaired functions of other analyzers (vision, hearing). Therefore, these children need medical, psychological, pedagogical and social assistance.
Causes of disorders of the musculoskeletal system
1. Intrauterine pathology(Currently, many researchers have proven that more than 400 factors can affect the CNS of a developing fetus, especially in the period up to 4 months of intrauterine development):
Infectious diseases of the mother: microbial, viral (in recent years, the prevalence of neuroinfections has increased, especially viral ones, such as influenza, herpes, chlamydia, etc.);
consequences of acute and chronic somatic diseases of the mother (cardiovascular, endocrine disorders);
Severe toxicosis of pregnancy;
incompatibility by Rh factor or blood groups;
Injuries, bruises of the fetus;
intoxication;
environmental hazards.
2. Birth trauma, asphyxia.
3. Pathological factors affecting the child's body in the first year of life:
neuroinfections (meningitis, encephalitis, etc.);
Injuries, bruises of the child's head;
complication after vaccinations.
The combination of intrauterine pathology with birth trauma is currently considered one of the most common causes of cerebral palsy.
Classification of disorders of the musculoskeletal system.
Different types of pathology of the musculoskeletal system are noted.
1. Diseases of the nervous system:
· cerebral palsy
poliomyelitis.
2. Congenital pathology of the musculoskeletal system:
Congenital dislocation of the hip
torticollis,
clubfoot and other deformities of the feet,
anomalies in the development of the spine (scoliosis),
underdevelopment and defects of the limbs,
anomalies in the development of the fingers,
Arthrogryposis (congenital deformity).
3. Acquired diseases and injuries of the musculoskeletal system:
traumatic injuries of the spinal cord, brain and extremities,
polyarthritis,
diseases of the skeleton (tuberculosis, bone tumors, osteomyelitis),
Systemic diseases of the skeleton (chondrodystrophy, rickets).
FEATURES OF MANIFESTATION OF DISORDERS
IN CHILDREN WITH CEREBRAL PALSY.
In children with cerebral palsy, the formation of all motor functions is delayed and impaired: holding the head, sitting, standing, walking, manipulation skills.
At an early stage of cerebral palsy, motor development may be uneven. The child may not yet hold his head at 8-10 months, but he is already beginning to turn and sit down. He does not have a support reaction, but he already reaches for the toy, captures it. At 7-9 months. the child can only sit with support, but stands and walks in the arena, although the installation of his body is defective.
A variety of motor disorders is due to the action of a number of factors:
1. pathology of muscle tone (by type of spasticity, rigidity, hypotension, dystonia);
2. limitation or impossibility of voluntary movements (paresis and paralysis);
3. the presence of violent movements (hyperkinesis, tremor);
4. violation of balance, coordination and sense of movement.
Movement disorders in children with cerebral palsy have varying degrees of severity: from severe, when the child cannot walk and manipulate objects, to mild, in which the child walks and takes care of himself.
Deviations in mental development in cerebral palsy are also specific. They are determined by the time of brain damage, its degree and localization. Lesions at an early stage of intrauterine development are accompanied by gross underdevelopment of the child's intellect. A feature of mental development in lesions that developed in the second half of pregnancy and during childbirth is not only its slow pace, but also its uneven nature (accelerated development of some higher mental functions and unformedness, lagging behind others).
Children with cerebral palsy are characterized by:
various disorders of cognitive and speech activity;
a variety of disorders of the emotional-volitional sphere (in some - in the form of increased excitability, irritability, motor disinhibition, in others - in the form of lethargy, lethargy), a tendency to mood swings;
The originality of personality formation (lack of self-confidence, independence; immaturity, naivety of judgments; shyness, timidity, hypersensitivity, touchiness).
Task 4. Definitions of speech disorders
- Dysphonia(aphonia) - the absence or disorder of phonation due to pathological changes in the vocal apparatus. Synonyms: voice disorder, phonation disorder, phonotic disorders, vocal disorders.
- Bradilalia- Pathologically slow pace of speech.
- tahilalia- Pathologically accelerated rate of speech.
- Stuttering- violation of the tempo-rhythmic organization of speech, due to the convulsive state of the muscles of the speech apparatus (logoneurosis).
- Dyslalia- violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus (defects in sound pronunciation, phonetic defects, shortcomings in the pronunciation of phonemes).
- Rhinolalia- violations of the timbre of the voice and sound pronunciation, due to anatomical and physiological defects of the speech apparatus.
- dysarthria- violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus.
- Alalia- the absence or underdevelopment of speech due to organic damage to the speech zones of the cerebral cortex in the prenatal or early period of child development.
- Aphasia- complete or partial loss of speech due to local lesions of the brain.
- Dyslexia- partial specific violation of the reading process.
- Dysgraphia- partial specific violation of the writing process.
Disturbances in motor functions are largely associated with damage to the central nervous system, i.e. certain parts of the brain and spinal cord, as well as peripheral nerves. Disorder of movements is more often caused by organic damage to the nerve pathways and centers that carry out motor acts. There are also so-called functional motor disorders, for example, in neuroses (hysterical paralysis). Less often, the cause of movement disorders is anomalies in the development of the musculoskeletal organs (malformations), as well as anatomical damage to bones and joints (fractures, dislocations). In some cases, motor insufficiency is based on a disease of the muscular system, for example, in certain muscle diseases (myopathy, etc.). A number of departments of the nervous system take part in the reproduction of a motor act, sending impulses to the mechanisms that directly perform the movement, i.e. to the muscles.
The leading link of the motor system is the motor analyzer in the cortex of the frontal lobe. This analyzer is connected by special pathways with the underlying parts of the brain - subcortical formations, midbrain, cerebellum, the inclusion of which gives the movement the necessary smoothness, accuracy, plasticity, as well as with the spinal cord. The motor analyzer closely interacts with afferent systems, i.e. with systems conducting sensitivity. Through these pathways, impulses from proprioreceptors enter the cortex, i.e. sensitive mechanisms located in the motor systems - joints, ligaments, muscles. Visual and auditory analyzers exert a controlling influence on the reproduction of motor acts, especially during complex labor processes.
Movements are divided into voluntary, the formation of which in humans and animals is associated with the participation of the motor sections of the cortex, and involuntary, which are based on automatisms of stem formations and the spinal cord.
The most common form of movement disorders in both adults and children are paralysis and paresis. Paralysis means the complete absence of movement in the corresponding organ, in particular in the arms or legs (Fig. 58). Paresis includes such disorders in which the motor function is only weakened, but not completely turned off.
The causes of paralysis are infectious, traumatic or metabolic (sclerosis) lesions that directly cause a violation of the nerve pathways and centers or upset the vascular system, as a result of which the normal supply of these areas with blood stops, for example, in strokes.
Paralysis varies depending on the localization of the lesion - central and peripheral. There are also paralysis of individual nerves (radial, ulnar, sciatic, etc.).
It matters which motor neuron is affected - central or peripheral. Depending on this, there are a number of features in the clinical picture of paralysis, taking into account which the specialist doctor can determine the localization of the lesion. With central paralysis, increased muscle tone (hypertension), increased tendon and periosteal reflexes (hyperreflexia), often the presence of pathological reflexes of Babinsky (Fig. 59), Rossolimo, etc. are characteristic. There is no weight loss of the muscles of the arms or legs, and even a paralyzed limb may be somewhat swollen due to circulatory disorders and inactivity. On the contrary, with peripheral paralysis, there is a decrease or absence of tendon reflexes (hypo- or areflexia), a drop in muscle tone
(atony or hypotension), a sharp weight loss of muscles (atrophy). The most typical form of paralysis in which a peripheral neuron suffers is cases of infantile paralysis - poliomyelitis. It should not be thought that all spinal lesions are characterized only by flaccid paralysis. If there is an isolated lesion of the central neuron, in particular the pyramidal pathway, which, as you know, having begun in the cortex, also passes in the spinal cord, then the paralysis will have all the signs of a central one. This symptomatology, expressed in a milder form, is referred to as "paresis". The word "paralysis" in medical terminology is defined as "plegia". In this regard, there are: monoplegia (monoparesis) with the defeat of one limb (arm or leg); paraplegia (paraparesis) with damage to both limbs; hemiplegia (hemiparesis) with damage to one half of the body (arm and leg on one side suffer); tetraplegia (tetraparesis), in which both arms and legs are affected.
Paralysis resulting from an organic lesion of the central nervous system is not completely restored, but under the influence of treatment can be weakened. Traces of the lesion can be detected at different age periods in varying degrees of severity.
The so-called functional paralysis or paresis basically does not have structural disorders of the nervous tissue, but develops as a result of the formation of congestive foci of inhibition in the region of the motor zone. More often they are caused by acute reactive neuroses, especially hysteria. In most cases, they have a good outcome.
In addition to paralysis, movement disorders can be expressed in other forms. So, for example, violent inappropriate, superfluous movements may occur, which are combined under the general name of hyperkinesis. To them
These include such forms as convulsions, i.e. involuntary muscle contractions. There are clonic convulsions, in which contractions or muscle relaxations rapidly following each other, acquiring a peculiar rhythm, are observed. Tonic convulsions are characterized by prolonged contraction of muscle groups. Sometimes there are intermittent twitches of individual small muscles. This is the so-called myoclonus. Hyperkinesis can manifest itself in the form of peculiar violent movements, more often in the fingers and toes, resembling, as it were, the movements of a worm. Such peculiar manifestations of seizures are called athetosis. Tremor is a violent rhythmic vibration of the muscles, acquiring the character of trembling. There is a tremor of the head, arms or legs, or even the whole body. In school practice, hand tremor is reflected in the writing of students, which acquires an irregular character in the form of rhythmic zigzags. Tics - they usually mean stereotypically repetitive twitches in certain muscles. If a tick is observed in the muscles of the face, then there are peculiar grimaces. There is a tick of the head, eyelids, cheeks, etc. Some types of hyperkinesis are more often associated with lesions of the subcortical nodes (striatum) and are observed with chorea or in the residual stage of encephalitis. Certain forms of violent movements (tics, tremors) may be functional in nature and accompany neuroses.
Disorders of movements are expressed not only in violation of their strength and volume, but also in violation of their accuracy, proportionality, friendliness. All these qualities determine the coordination of movements. Proper coordination of movements depends on the interaction of a number of systems - the posterior columns of the spinal cord, trunk, vestibular apparatus, cerebellum. The lack of coordination is called ataxia. The clinic distinguishes between various forms of ataxia. Ataxia is expressed in the disproportion of movements, their inaccuracy, as a result of which complex motor acts cannot be correctly performed. One of the functions resulting from the coordinated actions of a number of systems is walking (the nature of the gait). Depending on which systems are especially disturbed, the nature of the gait changes dramatically. When the pyramidal tract is damaged due to the resulting hemiplegia or hemiparesis, a hemiplegic gait develops: the patient pulls up the paralyzed leg, the entire paralyzed side
The torso, when moving, seems to lag behind a healthy one. Ataxic gait is more often observed with damage to the spinal cord (posterior columns), when the paths that carry deep sensitivity are affected. Such a patient walks, spreading his legs wide to the sides, and strongly hits the floor with his heel, as if he puts his foot on a grand scale. This is observed with dorsal dryness, polyneuritis. The cerebellar gait is characterized by particular instability: the patient walks balancing from side to side, which creates a resemblance to the walking of a very intoxicated person (drunk gait). In some forms of neuromuscular atrophy, such as Charcot-Marie's disease, the gait acquires a peculiar type: the patient seems to act, raising his legs high ("circus horse gait").
Features of movement disorders in abnormal children. Children who have lost their hearing or sight (blind, deaf), as well as those suffering from underdevelopment of the intellect (oligophrenic), in most cases are characterized by the originality of the motor sphere. Thus, pedagogical practice has long noted that the majority of deaf children have a general lack of coordination of movements: when walking, they shuffle their soles, their movements are jerky and abrupt, and uncertainty is noted. A number of authors in the past (Kreidel, Brook, Bezold) carried out various experiments aimed at studying both the dynamics and the statics of the deaf and dumb. They checked the gait of deaf-mutes on the plane and when lifting, the presence of dizziness during rotation, the ability to jump on one leg with closed and open eyes, etc. Their opinions were rather contradictory, but all authors noted the motor retardation of deaf children compared to hearing students.
Prof. F.F. Zasedatelev carried out the following experiment. He forced normal schoolchildren and deaf-mutes to stand on one leg. It turned out that hearing schoolchildren can stand with their eyes open and closed on one leg for up to 30 s, deaf children of the same age could stand in this position for no more than 24 s, and with their eyes closed, the time sharply decreased to 10 s.
Thus, it has been established that the deaf from the side of the motor sphere lag behind the hearing both in dynamics and statics. The unstable balance of the deaf was attributed by some to the insufficiency of the vestibular apparatus of the inner ear, while others attributed it to disorders of the cortical centers and the cerebellum. Some observations made by O.D. Kudryasheva, S.S. Lyapidevsky showed that, with the exception of a small
Groups - deaf with a pronounced lesion of the motor sphere, in most of them motor insufficiency is transient. After systematically conducted classes in physical education and rhythm, the movements of the deaf acquire quite satisfactory stability, speed and smoothness. Thus, the motor retardation of the deaf often has a functional character and can be overcome with appropriate exercises. Physiotherapy exercises, dosed occupational therapy, sports are a powerful stimulus in the development of the motor sphere of the deaf.
The same can be said about blind children. It is quite natural that the lack of vision reduces the volume of motor abilities, especially in a wide space. Many blind people, writes Prof. F. Workshop, indecisive and timid in their movements. They stretch their arms forward so as not to stumble, drag their feet, feeling the ground, and walk bent over. Their movements are angular and awkward, there is no flexibility in them when bending, during a conversation they do not know where to put their hands, they grab onto tables and chairs. However, the same author points out that as a result of proper education, a number of shortcomings in the motor sphere of the blind can be eliminated.
Studies of the motor sphere of the blind, which we conducted at the Moscow Institute of the Blind in 1933-1937, showed that severe motor insufficiency occurs only in the first years of education, with the exception of a small group of children who have had severe brain diseases (meningoencephalitis, consequences of a remote tumor of the cerebellum and etc.). In the future, conducting special classes in physical education perfectly developed the motor skills of the blind. Blind children could play football, volleyball1, jump over obstacles, and perform complex gymnastic exercises. The sports olympiads for blind children organized every year (Moscow school) once again confirm what successes can be achieved with children deprived of sight by means of special pedagogy. However, this is not easy and involves a lot of work for both the blind child and the teacher. The development of compensatory adaptations based on the plasticity of the nervous system
1 With blind children, football and volleyball games are played with a sounding ball.
We also concern the motor sphere, which, under the influence of special corrective measures, noticeably improves. Of great importance is the time of onset of blindness and the conditions in which the blind person was. It is known that people who have lost their sight at a later age do not compensate well for their motor sphere. Early blind as a result of appropriate training from a young age, better control their movements, and some freely orient themselves in a wide space. However, the conditions of upbringing also matter here. If an early blind child, while in the family, was under the vigilant supervision of his mother, grew pampered, did not encounter difficulties, did not train in orientation in a wide space, then his motor skills will also be limited. It is in this group of children that the above-mentioned fear of a wide space is observed, sometimes acquiring the character of a special fear (phobia). The study of the anamnesis of such children shows that their early development took place in conditions of constant "holding the mother's hand."
We encounter more severe changes in the motor-motor sphere in children with an intellectual disorder (oligophrenic). This is determined primarily by the fact that dementia is always the result of underdevelopment of the brain in the prenatal period due to certain diseases or its damage during childbirth or after birth. Thus, the child's mental inferiority arises on the basis of structural changes in the cerebral cortex caused by a neuroinfection (meningoencephalitis) or under the influence of craniocerebral trauma. Naturally, inflammatory, toxic, or traumatic lesions of the cortex often have a diffuse localization and affect, to one degree or another, the motor areas of the brain. Deep forms of oligophrenia are more often accompanied by severe disorders of motor functions. In these cases, paralysis and paresis are observed, and more often spastic hemiparesis or various forms of hyperkinesis. In milder cases of oligophrenia, local motor disturbances are rare, but there is a general insufficiency of the motor sphere, which is expressed in some lethargy, clumsy, awkward movements. At the heart of such insufficiency, apparently, most likely lie neurodynamic disorders - a kind of inertia of nervous processes. In these cases, a significant correction of the backwardness of the motor sphere is possible by carrying out special corrective measures (physiotherapy exercises, rhythm, manual labor).
Apraxia is a form of movement disorder. In this case, paralysis is absent, but the patient cannot perform a complex motor act. The essence of such disorders is that such a patient loses the sequence of movements necessary to perform a complex motor act. So, for example, a child loses the ability to make habitual movements, straighten, fasten clothes, lace up shoes, tie a knot, thread a needle, sew on a button, etc. Such patients also fail to perform imaginary actions on orders, for example, to show how they eat soup with a spoon, how they repair a pencil, how they drink water from a glass, etc. The pathophysiological mechanism of apraxia is very complex. Here there is a disintegration, due to the action of certain harmful agents, motor stereotypes, i.e. well-coordinated systems of conditioned reflex connections. Apraxia often occurs when the supra-marginal or angular gyrus of the parietal lobe is affected. Writing disorders in children (dysgraphia) is one of the types of apraxic disorders.
The role of the motor analyzer is exceptionally great in our nervous activity. It is not limited only to the regulation of voluntary or involuntary movements that are part of ordinary motor acts. The motor analyzer also takes part in such complex functions as hearing, sight, and touch. For example, full vision is impossible without the movement of the eyeball. Speech and thinking are based on movement, since the motor analyzer moves all speech reflexes formed in other analyzers * "The beginning of our thought," wrote I.M. Sechenov, "is muscle movement."
Treatment of movement disorders such as paralysis, paresis, hyperkinesis was considered ineffective for a long time. Scientists relied on previously created ideas about the nature of the pathogenesis of these disorders, which are based on irreversible phenomena, such as the death of nerve cells in cortical centers, atrophy of nerve conductors, etc.
However, a deeper study of pathological mechanisms in violations of motor acts shows that the previous ideas about the nature of motor defects were far from complete. An analysis of these mechanisms in the light of modern neurophysiology and clinical practice shows that a movement disorder is a complex complex, the components of which are not only local (often irreversible) defects, but also a number of functional changes caused by neurodynamic disorders that enhance the clinical picture of a movement defect. These violations, as studies by M.B. Eidinova and E.N. Pravdina-Vinarskaya (1959), with the systematic implementation of therapeutic and pedagogical measures (the use of special biochemical stimulants that activate the activity of synapses, as well as special exercises in physiotherapy exercises, in conjunction with a number of educational and pedagogical measures aimed at educating the child's will, purposeful activity to overcome the defect) in a significant number of cases remove these pathological layers. This, in turn, leads to the restoration or improvement of impaired motor function.
Visual disorders
Causes and forms of visual disturbances. Severe visual disturbances are not an obligatory result of a primary lesion of the nerve devices of vision - the retina, optic nerves and cortical visual centers. Visual disturbances can also occur as a result of diseases of the peripheral parts of the eye - the cornea, lens, refractive media, etc. In these cases, the transmission of light stimuli to receptor nerve devices may completely stop (complete blindness) or have a limited character (poor vision).
The causes of severe visual impairment are various infections - local and general, including neuroinfections, metabolic disorders, traumatic eye lesions, and anomalies in the development of the eyeball.
Among visual disorders, first of all, there are such forms in which visual acuity suffers, up to complete blindness. Visual acuity can be impaired if the eye apparatus itself is damaged: the cornea, lens, retina.
The retina is the inner membrane of the eyeball that lines the fundus of the eye. In the central part of the fundus
There is an optic disc from which the optic nerve originates. A feature of the optic nerve is its structure. It consists of two parts that carry irritation from the outer and inner parts of the retina. First, the optic nerve departs from the eyeball as a whole, enters the cranial cavity and goes along the base of the brain, then the fibers that carry irritations from the outer parts of the retina (central vision) go posteriorly on their side, and the fibers that carry irritation from the inner parts of the retina (lateral vision), completely intersect. After the decussation, the right and left visual tracts are formed, which contain fibers both on their side and on the opposite side. Both visual tracts go to the geniculate bodies (subcortical visual centers), from which the Graziole bundle begins, carrying irritation to the cortical fields of the occipital lobe of the brain.
When the optic nerve is damaged, blindness in one eye occurs - amaurosis. Damage to the optic chiasm is manifested by a narrowing of the visual fields. When the function of the optic tract is impaired, half of the vision is lost (hemianopsia). Visual disturbances with damage to the cerebral cortex in the occipital region are manifested by partial loss of vision (scotoma) or visual agnosia (the patient does not recognize familiar objects). A common case of this disorder is alexia (reading disorder), when a child loses the signal meaning of alphabetic images in memory. Visual disturbances also include loss of color perception: the patient does not distinguish some colors or sees everything in gray.
In special pedagogical practice, two groups of children are distinguished who require education in special schools - the blind and the visually impaired.
Blind children. Usually, blind people are those with such a loss of vision in which there is no light perception, which is rare. More often these people have a weak light perception, distinguish between light and darkness, and, finally, some of them have slight remnants of vision. Usually the upper limit of such a minimum vision is considered to be 0.03-0.04!. These remnants of vision may somewhat facilitate the orientation of the blind in the external environment, but are of no practical importance in teaching.
Normal vision is taken as one.
Chenia and labor, which therefore have to be carried out on the basis of tactile and auditory analyzers.
On the part of the neuropsychic sphere, blind children have all the qualities that are characteristic of a sighted child of the same age. However, the absence of vision causes a number of special properties in the blind person in his nervous activity, aimed at adapting to the external environment, which will be discussed below.
Blind children study in special schools, training is carried out mainly on the basis of skin and auditory analyzers by specialist tiflopedagogues.
visually impaired children. This group includes children who have preserved some remnants of vision. It is generally accepted to consider visually impaired children whose visual acuity after correction with glasses ranges from 0.04 to 0.2 (according to the accepted scale). Such residual vision in the presence of special conditions (special lighting, use of a magnifying glass, etc.) makes it possible to teach them on a visual basis in classes and schools for the visually impaired.
Features of nervous activity. Severe visual disturbances always cause changes in the general nervous activity. The age at which the loss of vision occurred (congenital or acquired blindness), the localization of the lesion in the region of the visual analyzer (peripheral or central blindness) matters. Finally, the nature of the disease processes that caused severe visual impairment should be taken into account. In this case, it is especially important to single out those forms that are caused by previous brain lesions (meningitis, encephalitis, brain tumors, etc.). Proceeding from the foregoing, changes in nervous activity will differ in some originality. Thus, in cases of onset of blindness due to causes not related to brain damage, nervous activity in the process of growth and development will be accompanied by the formation of compensatory adaptations that make it easier for such a person to participate in socially useful work. In cases of blindness resulting from a previous brain disease, the described pathway for the development of compensatory adaptations may be complicated by the influence of other consequences that may have occurred after a brain injury. We are talking about possible violations in the field of other analyzers (except for vision), as well as intellect and emotional-volitional sphere.
In these cases, there may be difficulty in learning, and in the future, disability. Finally, one should keep in mind the influence of the time factor on the nature of nervous activity. Observations show that in those who were born blind or who lost their sight at an early age, its absence often does not cause severe changes in the psyche. Such people have never used sight, and it is easier for them to endure its absence. In those who lost their sight at a later age (school, adolescence, etc.), the loss of this important function is often accompanied by certain disorders in the neuropsychic sphere in the form of acute asthenic conditions, severe depression, pronounced hysterical reactions. Some blind children have special phobias - fear of large spaces. They can only walk by holding their mother's hand. If such a child is left alone, then he experiences a painful state of uncertainty, he is afraid to take a step forward.
Some originality of nervous activity, in contrast to the blind, is observed in persons belonging to the visually impaired. As mentioned above, such children have vestiges of vision that allow them, under special conditions in a special class, to learn on a visual basis. However, their volume of visual afferentation is insufficient; some have a tendency to progressive visual impairment. This circumstance makes it necessary to acquaint them with the method of teaching the blind. All this can cause a certain overload, especially in persons belonging to a weak type of nervous system, which can result in overstrain and disruption of nervous activity. However, observations show that reactive shifts in nervous activity in the blind and visually impaired are more often observed at the beginning of learning. This is due to the significant difficulties that children experience in general at the beginning of education and adaptation to work. Gradually, as compensatory adaptations are developed and stereotypes are created, their behavior noticeably levels out and balances out. All this is the result of the remarkable properties of our nervous system: plasticity, the ability to compensate to some extent for lost or weakened functions.
Let us briefly describe the main stages in the development of scientific thought on the development of compensatory adaptations in persons with severe visual impairments.
Loss of vision deprives a person of many advantages in the process of adapting to the external environment. However, loss of vision is not a violation in which labor activity is completely impossible. Experience shows that the blind overcome primary helplessness and gradually develop in themselves a number of qualities that allow them to study, work and actively participate in socially useful work. What is the driving force that helps the blind to overcome his severe defect? This issue has been the subject of controversy for a long time. Various theories arose, trying in different ways to determine the path of adaptation of the blind to the conditions of reality, mastering various forms of labor activity. Hence, the view of the blind has changed. Some believed that the blind, with the exception of some restriction in freedom of movement, have all the qualities of a full-fledged psyche. Others attached great importance to the absence of visual function, which, in their opinion, has a negative effect on the psyche of the blind, up to the violation of intellectual activity. The mechanisms of adaptation of the blind to the external environment were also explained in different ways. There was an opinion that the loss of one of the sense organs causes an increased work of others, which, as it were, make up for the missing function. In this sense, the role of hearing and touch was singled out, believing that in the blind, the activity of hearing and touch increases compensatory, with the help of which the blind person orients himself in the external environment, masters labor skills. Experimental studies were carried out, which tried to prove that the blind have sharpened (compared to the sighted) skin sensitivity, especially in the fingers, and that hearing is exceptionally developed. Using these features, the blind can compensate for the loss of vision. However, this position was disputed by studies of other scientists who did not find that hearing and skin sensitivity in the blind are better developed than in the sighted. In this sense, they completely denied the accepted position that the blind have a highly developed ear for music. Some have come to the conclusion that the musical talent of the blind is no less and no more than that of the sighted. The very problem of the psychology of the blind turned out to be controversial. Is there a special psychology for the blind? A number of scientists, including individual typhlopedagogues, denied the existence of such. Others, in particular Geller, believed that the psychology of the blind should be considered as one of the branches of general psychology. It was believed that the upbringing and education of a blind child, as well as his adaptation to socially useful activities, should be based on taking into account those features of his psychology that arise as a result of loss of sight. Attempts to uncover the mechanisms of compensation rested on the contradictory results of the study of hearing and touch in the blind. Some scientists found a special hyperesthesia (increased skin sensitivity) in the blind, others denied it. Similar conflicting results have been observed in the field of auditory nerve function research in the blind. As a result of these contradictions, attempts arose to explain the compensatory possibilities of the blind by processes of a mental order. In these explanations, the question of the increased work of the peripheral sections of the auditory and skin receptors, supposedly replacing the lost function of vision, the so-called vicariate of the senses, was no longer put forward in the first place, and the main role was assigned to the mental sphere. It was assumed that a special mental superstructure is created in the blind, which arises as a result of his contact with various influences of the external environment and is that special property that allows the blind to overcome a number of difficulties on the path of life, i.e. first of all, navigate in the external environment, move around without outside help, bypass obstacles, study the outside world, acquire labor skills. However, the very concept of a mental superstructure, undoubtedly considered in an idealistic aspect, was rather vague. The material essence of the processes that took place in such cases was in no way explained by the hypothesis put forward about the role of the mental superstructure. Only much later by the works of domestic scientists (E.A. Asratyan, P.K. Anokhin, A.R. Luria, M.I. Zemtsova, S. Zimkina, V.C. Sverlov, I.A. Sokolyansky), who based their studies on the teachings of I.P. Pavlov about higher nervous activity, significant progress has been made in resolving this complex problem.
Neurophysiological mechanisms of compensatory processes in the blind. The psyche is a special property of our brain to reflect the external world that exists outside of our consciousness. This reflection is carried out in the brain of people through their sense organs, with the help of which the energy of external irritation is converted into a fact of consciousness. The physiological mechanisms of the function of reflecting the external world in our brain are conditioned reflexes that ensure the highest balance of the body with constantly changing environmental conditions. In the cortex of a sighted person, conditioned reflex activity is due to the influx of stimuli from all analyzers. However, a sighted person does not use sufficiently, and sometimes not at all, those analyzers that are not leading for him in this act. So, for example, while walking, a sighted person primarily focuses on vision; hearing and especially touch are used to a small extent. And only in special conditions, when a sighted person is blindfolded or when moving in the dark (at night), he uses his hearing and touch - he begins to feel the soil with his soles, listen to the surrounding sounds. But such provisions for the sighted are atypical. Hence, the increased formation of conditioned reflex connections with hearing and touch during certain motor acts, for example, when walking, is not a vital necessity for a sighted person. A powerful visual analyzer sufficiently controls the execution of the indicated motor act. We notice something completely different in the sensory experience of the blind. Being deprived of a visual analyzer, the blind rely on other analyzers in the process of orientation in the external environment, in particular on hearing and touch. However, the use of hearing and touch, in particular when walking, is not of an auxiliary nature, as in a sighted person. A peculiar system of nervous connections is actively formed here. This system in the blind is created as a result of prolonged exercises of auditory and cutaneous afferentation, caused by vital necessity. On this basis, a number of other specialized systems of conditional connections are formed that function in certain forms of adaptation to the external environment, in particular, when mastering labor skills. This is the compensatory mechanism that allows the blind to get out of the state of helplessness and engage in socially useful work. It is debatable whether any particular changes occur in the auditory nerve or sensory apparatus in the skin. As is known, studies of peri-
The pheric receptors - hearing and touch - in the blind have given conflicting results. Most researchers do not find local changes in terms of increased auditory or cutaneous peripheral afferentation. Yes, this is no coincidence. The essence of the complex compensatory process in the blind lies elsewhere. It is known that peripheral receptors produce only a very elementary analysis of incoming stimuli. A subtle analysis of stimuli takes place in the cortical ends of the analyzer, where higher analytical-synthetic processes are carried out and sensation turns into a fact of consciousness. Thus, by accumulating and training in the process of daily life experience numerous specialized conditioned connections with the indicated analyzers, the blind person forms in his sensory experience those features of conditioned reflex activity that the sighted person does not need in full measure. Hence, the leading adaptation mechanism is not a special sensitivity of the finger gauge or the cochlea of the inner ear, but the higher part of the nervous system, i.e. the cortex and the conditioned reflex activity proceeding on its basis.
These are the results of many years of disputes about ways to compensate for blindness, which could only be correctly resolved in the aspect of modern brain physiology created by I.P. Pavlov and his school.
Features of the pedagogical process in teaching blind and visually impaired children. The education and upbringing of blind and visually impaired children is a complex process that requires the teacher not only to have special knowledge of typhlopedagogy and typhlotechnics, but also to understand those psychophysiological characteristics that occur in persons who are completely or partially deprived of vision.
It has already been said above that with the exclusion from the sphere of perception of such a powerful receptor as vision, which is part of the first signal system, the cognitive activity of the blind person is carried out on the basis of the remaining analyzers. The leading ones in this case are tactile and auditory reception, reinforced by the increasing activity of some other analyzers. Thus, conditioned reflex activity acquires some peculiar features.
In pedagogical terms, the teacher faces a number of difficult tasks. In addition to purely educational (educational work,
Teaching literacy, etc.) problems of a purely specific order arise, for example, the development of spatial representations in a blind child (orientation in the environment), without which the student is helpless. This also includes the development of motor skills, self-service skills, etc. All these moments related to education, at the same time, are closely related to the educational process. For example, poor orientation in the environment, a kind of motor clumsiness and helplessness will sharply affect the development of literacy skills, the development of which in the blind is sometimes associated with a number of specific difficulties. As for the peculiarities of teaching methods, in particular teaching literacy, the latter is carried out on the basis of touch and hearing.
The leading point here is the use of skin reception. Technically, training is carried out with the help of a special dotted font of the system of the teacher L. Braille, accepted all over the world. The essence of the system is that each letter of the alphabet is represented by a different combination of the arrangement of six convex points. A number of studies conducted in the past have shown that the point is physiologically better perceived by the skin surface of the finger than a linear raised font. Passing the soft surface of the tip of both index fingers over the lines of raised dotted type in a specially printed book, the blind man reads the text. In the physiological aspect, the same thing happens here as when reading with a sighted person, only the skin receptor acts instead of the eyes.
The blind write with the help of special techniques, which consist in the fact that the letters of the dotted alphabet are squeezed out with a metal rod on paper inserted in a special device. On the reverse side of the sheet, these impressions form a convex surface, which makes it possible for another blind person to read the written text. Tactile (skin) reception is also involved in other sections of the educational process, when it is necessary to acquaint a blind child with the shape of various objects, mechanisms, the structure of the body of animals, birds, etc. Feeling these objects with his hand, the blind person gets some impression of their external features. However, these representations are far from accurate. Therefore, an equally strong receptor, hearing, is involved in the educational process to help skin reception, which makes it possible for the teacher to accompany the tactile display (feeling objects) with verbal explanations. The ability of the blind to abstract thinking and speech (which indicates a good development of the second signaling system) helps, on the basis of the teacher's verbal signals, to make a number of adjustments in the cognition of various subjects and to clarify their ideas about them. At subsequent stages of development, the hearing and speech of others acquire special significance in the cognitive activity of the blind.
Further development of typhlopedagogy is impossible without taking into account the advances that are taking place in technology. We are talking about the use, for example, of devices that help the blind to orient themselves in space, the creation of devices that allow the blind to use a book with a regular font, and so on. Consequently, the current level of development of special pedagogy (especially in teaching the blind and deaf and dumb) requires finding ways to use the achievements that take place in the field of radio engineering (radar), cybernetics, television, requires the use of semiconductors (transistor hearing devices), etc. In recent years, work has been underway to create devices that facilitate the training of people with visual and hearing impairments.
As for the education of visually impaired children, in these cases the pedagogical process is mainly based on the use of the remnants of vision that the child has. A specific task is to enhance visual gnosis. This is achieved by choosing appropriate glasses, using magnifiers, paying special attention to good classroom lighting, improving desks, etc.
To help visually impaired children, contact lenses, contact orthostatic loupes, special machines for reading the usual type of graphic font have been created. The use of contact lenses proved to be quite effective; they increase the efficiency of a visually impaired student, reduce fatigue. Taking into account that in some forms of low vision, the progression of the disease process occurs, accompanied by a further decrease in vision, children receive the appropriate skills to master the dotted Braille alphabet.
Features of the visual analyzer in deaf children. With the exception of rare cases when deafness is combined with blindness (deaf-blind), the vision of most deaf people does not present any deviations from the norm. On the contrary, the observations of former researchers, who proceeded in solving this problem from the idealistic theory of the vicariate of the senses, showed that the deaf have increased visual acuity due to the loss of hearing, and there were even attempts to explain this by a special hypertrophy of the optic nerve. At present, there is no reason to speak about the special anatomical qualities of the optic nerve of the deaf. The visual adaptation of deaf-mutes basically has the same patterns that were mentioned above - this is the development of compensatory processes in the cerebral cortex, i.e. enhanced formation of specialized conditioned reflex connections, the existence of which is not needed in such a volume by a person with normal hearing and vision.
Features of the visual analyzer in mentally retarded children. Special pedagogical practice has noted for a relatively long time that mentally retarded children do not clearly perceive the features of those objects and phenomena that arise before their eyes. The poor handwriting of some of these children, the slipping of letters behind the lines of the notebook, also gave the impression of reduced visual function. Similar observations were made in relation to auditory functions, which in most cases were considered to be weakened. In this regard, an opinion was created that the basis of mental retardation is an inferior function of the sense organs, which poorly perceive the irritations of the outside world. It was believed that a mentally retarded child sees poorly, hears poorly, feels poorly, and this leads to reduced excitability, sluggish brain function. On this basis, special teaching methods were created, which were based on the tasks of the selective development of the sense organs in special lessons (the so-called sensorimotor culture). However, such a view of the nature of mental retardation is already a past stage. On the basis of scientific observations, both psychological, pedagogical and medical, it is known that the basis of mental retardation is not selective defectiveness of individual sense organs, but underdevelopment of the central nervous system, in particular the cerebral cortex. Thus, against the background of an inferior structure, insufficient physiological activity develops, characterized by a decrease in higher processes - cortical analysis and synthesis, which is characteristic of the feeble-minded. However, taking into account that oligophrenia occurs as a result of previous brain diseases (neuroinfections, traumatic brain injuries), there may be individual cases of damage to both the visual organ itself and the nerve pathways. A special study of the visual organ in oligophrenic children, conducted by L.I. Bryantseva gave the following results:
A) in 54 cases out of 75 no abnormalities were found;
B) in 25 cases, various refractive errors were found (the ability of the eye to refract light rays);
C) in 2 cases, anomalies of a different nature.
Based on these studies, Bryantseva comes to the conclusion that the organ of vision of some students of auxiliary schools differs to some extent from the organ of vision of a normal student. A distinctive feature is a lower percentage of myopia compared to normal schoolchildren and a high percentage of astigmatism - one of the forms of refractive error1.
To this it should be added that in some mentally retarded children as a result of meningoencephalitis, there are cases of progressive weakening of vision due to atrophy of the optic nerve. More often than in normal children, there are cases of congenital or acquired strabismus (strabismus).
Sometimes, with deep forms of oligophrenia, underdevelopment of the eyeball, an irregular pupil structure, running nystagmus (rhythmic twitching of the eyeball) are observed.
It should be noted that teachers of special schools are not attentive enough to the peculiarities of the vision of their students and rarely refer them to ophthalmologists. Often timely selection of glasses and special treatment dramatically improve the child's vision and improve his performance in school.
1 Astigmatism - a lack of vision due to incorrect refraction of rays due to the unequal curvature of the cornea of the lens in different directions.
| Discipline: | Psychology |
| Type of work: | abstract |
| Language: | Russian |
| Date added: | 31.05.2009 |
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| Speech as a specific mental process. The emergence of speech pathology. Disorders of the motor sphere and their causes. Organic and functional disorders of speech. Afferent effect on the brain. Parkinson's and Huntington's diseases and their symptoms. | |
Introduction -1. Disorders of the motor sphere2. Speech pathology. Organic and functional disorders of speech - Conclusion - Bibliography - Introduction - Speech as a specific mental process develops in close unity with motor skills and requires the fulfillment of a number of necessary conditions for its formation - such as: anatomical safety and sufficient maturity of those brain systems that participate in the speech function; preservation of kinesthetic, auditory and visual perception; a sufficient level of intellectual development that would provide the need for verbal communication; normal structure of the ᴨȇ rhetoric speech apparatus; adequate emotional and speech environment. The occurrence of speech pathology (including cases of a combination of such disorders with movement disorders) is due to the fact that, on the one hand, its formation is caused by the presence of a different degree of severity of organic lesions of individual cortical and subcortical structures of the brain involved in providing speech functions , on the other hand, secondary underdevelopment or delayed "maturation" of the premotor-frontal and parietal-temporal cortical structures, disturbances in the rate and nature of the formation of visual-auditory and auditory-visual-motor nerve connections. With motor disorders, the afferent effect on the brain is distorted, which in turn enhances existing cerebral dysfunctions or causes the appearance of new ones, leads to asynchronous activity of the cerebral hemispheres. Based on studies of the causes of these disorders, we can talk about the relevance of considering this problem. The topic of the essay is devoted to the consideration of the causes and types of speech pathologies and movement disorders. 1. Movement disorders
If we talk about the causes of movement disorders, it can be noted that most of them arise as a result of a violation of the functional activity of mediators in the basal ganglia, the pathogenesis can be different. The most common causes are degenerative diseases (congenital or idiopathic), possibly triggered by medication, organ system failure, CNS infections, or basal ganglia ischemia. All movements are carried out through the pyramidal and parapyramidal pathways. As for the extrapyramidal system, the main structures of which are the basal nuclei, its function is to correct and refine movements. This is achieved mainly through influences on the motor areas of the hemispheres through the thalamus. The main manifestations of damage to the pyramidal and parapyramidal systems are paralysis and spasticity. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, S. 154.
Paralysis can be complete (plegia) or partial (paresis), sometimes it is manifested only by the awkwardness of the hand or foot. Spasticity is characterized by an increase in the tone of the limb according to the "jackknife" type, increased tendon reflexes, clonus and pathological extensor reflexes (for example, the Babinski reflex). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.155 It can also manifest itself only as awkward movements. Frequent symptoms also include spasms of the flexor muscles, which occur as a reflex to constant uninhibited impulses from skin receptors.
Correction of movements is also provided by the cerebellum (The lateral sections of the cerebellum are responsible for the coordination of limb movements, the middle sections are responsible for posture, gait, body movements. Damage to the cerebellum or its connections is manifested by intentional tremor, dysmetria, adiadochokinesis and a decrease in muscle tone.), mainly through influences on the vestibulospinal path, and also (with switching in the nuclei of the thalamus) to the same motor areas of the cortex as the basal nuclei (motor disorders that occur when the basal nuclei are damaged (extrapyramidal disorders) can be divided into hypokinesia (decrease in the volume and speed of movements; an example is Parkinson's disease or parkinsonism of another origin) and hyrkinesis (excessive involuntary movements; an example is Huntington's disease). Tics also belong to hyrkinesis.). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.156
With certain mental illnesses (primarily with catatonic syndrome), one can observe conditions in which the motor sphere receives some autonomy, specific motor acts lose contact with internal mental processes, and cease to be controlled by the will. In this case, the disorders become similar to neurological symptoms. It should be recognized that this similarity is only external, since, unlike hyrkinesis, paresis, and motor coordination disorders in neurological diseases, movement disorders in psychiatry have no organic basis, are functional and reversible.
Those suffering from a catatonic syndrome cannot somehow psychologically explain the movements they make, they are not aware of their painful nature until the moment of copying psychosis. All disorders of the motor sphere can be divided into gyrkinesia (excitation), hypokinesia (stupor) and parakinesia (movement perversion).
Excitation, or hyrkinesia, in mentally ill patients is a sign of an exacerbation of the disease. In most cases, the patient's movements reflect the richness of his emotional experiences. He may be controlled by the fear of persecution, and then he flees. In a manic syndrome, the basis of his motor skills is an indefatigable thirst for activity, and in hallucinatory states, he may look surprised, strive to draw the attention of others to his visions. In all these cases, gyrkinesia acts as a symptom secondary to painful mental distress. This type of arousal is called psychomotor.
With a catatonic syndrome, movements do not reflect the internal needs and reactions of the subject, in connection with this, excitation in this syndrome is called purely motor. The severity of gyrkinesia often indicates the degree of severity of the disease, its severity. However, at times there are severe psychoses with arousal limited to the bed.
Stupor - a state of immobility, an extreme degree of motor inhibition. The stupor can also reflect vivid emotional states (depression, asthenic affect of fear). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.158 In catatonic syndrome, on the contrary, stupor is devoid of internal content, meaningless. The term "substupor" is used to refer to states accompanied by only partial inhibition. Although stupor implies a lack of motor activity, in most cases it is considered a productive psychopathological symptom, since it does not mean that the ability to move is irreversibly lost. Like other productive symptoms, stupor is a temporary condition and responds well to treatment with psychotropic drugs.
The catatonic syndrome was originally described by K. L. Kalbaum (1863) as an independent nosological unit, and today it is considered as a symptom complex. Yasᴨȇrs K. General psychopathology / / Per. with him. L. O. Akopyan, ed. doc. honey. Sciences VF Voitsekh and Ph.D. philosophy sciences O. Yu. Boytsova.- M.: Practice, 1997, p.97. One of the important features of the catatonic syndrome is the complex, contradictory nature of the symptoms. All motor phenomena are meaningless and are not connected with psychological modes. Characterized by tonic muscle tension. Catatonic syndrome includes 3 groups of symptoms: hypokinesia, hyperkinesia and parakinesia. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.159
Hypokinesias are represented by the phenomena of stupor and substupor. Complex, unnatural, sometimes uncomfortable postures of patients attract attention. There is a sharp tonic contraction of the muscles. This tone allows patients sometimes for some time to hold any position that the doctor gives them. This phenomenon is called catalepsy, or waxy flexibility.
Hyrkinesia in catatonic syndrome is expressed in bouts of excitement. Characterized by the commission of meaningless, chaotic, non-purposeful movements. Motor and speech stereotypes (rocking, bouncing, waving arms, howling, laughing) are often observed. An example of speech stereotypes are verbigerations, which are manifested by the rhythmic repetition of monotonous words and meaningless sound combinations.
Parakinesias are manifested by strange, unnatural movements, such as frilly, mannered facial expressions and pantomime.
With catatonia, a number of echo symptoms are described: echolalia (repeating the words of the interlocutor), echopraxia (repetition of other people's movements), echomimicry (copying the facial expressions of others). These symptoms can occur in the most unexpected combinations.
It is customary to distinguish lucid catatonia, which occurs against the background of a clear consciousness, and oneiroid catatonia, accompanied by clouding of consciousness and partial amnesia. With the outward similarity of the set of symptoms, these two conditions differ significantly in course. Oneiroid catatonia is an acute psychosis with dynamic development and a favorable outcome. Lucid catatonia, on the other hand, is a sign of remission-free malignant variants of schizophrenia. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.159
Hebephrenic syndrome has a significant similarity with catatonia. The predominance of movement disorders with unmotivated, meaningless actions is also characteristic of hebephrenia. The very name of the syndrome indicates the infantile nature of the behavior of patients.
Speaking of other syndromes accompanied by arousal, it can be noted that psychomotor agitation is one of the frequent components of many psychopathological syndromes.
Manic excitation differs from catatonic in the purposefulness of actions. Facial expressions express joy, patients seek to communicate, talk a lot and actively. With pronounced arousal, the acceleration of thinking leads to the fact that not everything said by the patient is understandable, but his speech is never stereotyped.
Agitated depression is manifested by a combination of severe melancholy and anxiety. Facial expressions reflect suffering. Lamentations, crying without tears are characteristic. Often, anxiety is accompanied by nihilistic megalomaniac delusions with ideas of the death of the world (Cotard's syndrome). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.159 Acute hallucinatory - delusional states are also often expressed by psychomotor agitation. Acute hallucinosis can also be manifested by psychomotor agitation.
Quite often, the cause of psychomotor agitation is clouding of consciousness. The most common among the syndromes of clouding of consciousness - delirium - is manifested not only by disorientation and pig-like true hallucinations, but also by extremely pronounced arousal. Yasᴨȇrs K. General psychopathology / / Per. with him. L. O. Akopyan, ed. doc. honey. Sciences VF Voitsekh and Ph.D. philosophy sciences O. Yu.
The amental syndrome is characterized by an even greater severity of the condition. Patients are emaciated, unable to get out of bed. Their movements are chaotic, uncoordinated (yactation): they wave their arms, make meaningless cries, crumple in their hands and tear the sheet, shake their heads.
Oneiric stupefaction is manifested by the catatonic symptoms described above. With twilight stupefaction, there are both automated actions that are safe for others, and attacks of ridiculous chaotic excitement, often accompanied by violent anger, brutal aggression.
Another variant of epileptic arousal is history attacks, although not accompanied by clouding of consciousness and amnesia, but also often leading to dangerous, aggressive actions.
The danger of psychomotor agitation forced psychiatrists until the middle of the twentieth century. often use various means of restraint (belts, straitjackets, isolation chambers). The appearance at the beginning of the century of powerful barbiturates, and especially the introduction of new psychotropic drugs into practice at the end of the 50s, made it possible to almost completely abandon the use of restraint measures. Currently, various antipsychotics are used to relieve psychomotor agitation, and benzodiazepine tranquilizers are somewhat less common. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.162
Stupor is less common in psychiatric practice than excitement. In addition to the catatonic syndrome, it can be a manifestation of severe depression, apatico-abulic syndrome and hysteria.
Among other syndromes accompanied by stupor, the presence of a depressive stupor, closely related in its manifestations to the affect of melancholy, is noted. The face of the sick expresses suffering. The whole state is characterized by integrity, the absence of paradoxes.
Apathetic stupor is observed relatively rarely. The face of such patients is amimic, expresses indifference. In apathico-abulic syndrome, there is no suppression of desires, in connection with this, patients never refuse food. From prolonged inactivity, they become very stout. Unlike patients with catatonic stupor, they express dissatisfaction aloud if someone violates their comfort, makes them get out of bed, wash or cut their hair. The causes of apathetic stupor are schizophrenia or damage to the frontal lobes of the brain. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.163
Hysterical stupor, like hysterical excitement, appears immediately after the occurrence of a traumatic situation. The clinical picture can take the most unexpected forms.
In addition to hysterical, psychogenic stuporous states are described in life-threatening situations. Stupor in most cases is not a socially dangerous condition, since motor inhibition is only one of the manifestations of any syndrome.
2. Speech pathology.Organic & fFunctional speech disorders
The problem of the etiology of speech disorders has gone through the same path of historical development as the general doctrine of the causes of disease states.
Since ancient times, there have been two points of view - brain damage or disorders of the local speech apparatus, as the causes of disorders. Luria.A.R. Stages of the traveled path: Scientific autobiography. M.: Publishing House of Moscow. un-ta, 1982., p.110
Despite this, only in 1861, when the French physician Paul Broca showed the presence of a field in the brain that was socially related to speech, and connected the loss of speech with his defeat. Luria.A.R. Stages of the traveled path: Scientific autobiography. M.: Publishing House of Moscow. un-ta, 1982., p.110 In 1874, a similar discovery was made by Wernicke: a connection was established between understanding and the preservation of a certain area of the cerebral cortex. Since that time, the connection of speech disorders with morphological changes in certain parts of the cerebral cortex has become proven. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998? C.25.
The most intensive questions of the etiology of speech disorders began to be developed from the 20s of this century. During these years, domestic researchers made early attempts to classify speech disorders depending on the causes of their occurrence. So, S. M. Dobrogaev (1922) singled out “diseases of higher nervous activity”, pathological changes in the anatomical speech apparatus, lack of education in childhood, as well as “general neuropathic conditions of the body” among the causes of speech disorders. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998., S.26.
M. E. Khvattsev first divided all the causes of speech disorders into external and internal, emphasizing their close interaction. He also singled out organic (anatomical, physiological, morphological), functional (psychogenic), socio-psychological and neuropsychiatric causes. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.26.
Underdevelopment and brain damage in the intrauterine period were attributed to organic causes. They identified organic central (brain lesions) and organic rhyme causes (lesion of the organ of hearing, cleft palate and other morphological changes in the articulatory apparatus). M. E. Khvattsev explained the functional reasons by the teachings of I. P. Pavlov about violations of the ratio of the processes of excitation and inhibition in the central nervous system. He emphasized the interaction of organic and functional, central and rhyme reasons. He attributed mental retardation, impaired memory, attention, and other disorders of mental functions to neuropsychiatric causes.
The important role of M.E. Khvattsev also attributed socio-psychological reasons, understanding them as various adverse environmental influences. So, he first substantiated the understanding of the etiology of speech disorders on the basis of a dialectical approach to assessing cause-and-effect relationships in speech pathology. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. - M.: Humanit. ed. center VLADOS, 1998, p.27.
The cause of speech disorders is understood as the impact on the body of an external or internal harmful factor or their interaction, which determine the specifics of a speech disorder and without which the latter cannot occur. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.27.
The motor mechanism of speech is also provided by the following higher brain structures:
With damage to the subcortical-cerebellar nuclei and pathways that regulate muscle tone and the sequence of muscle contractions of the speech muscles, synchrony (coordination) in the work of the articulatory, respiratory and vocal apparatus, as well as the emotional expressiveness of speech, there are individual manifestations of central paralysis (paresis) with violations of muscle tone, increased individual unconditioned reflexes, as well as with a pronounced violation of the prosodic characteristics of speech - its pace, smoothness, loudness, emotional expressiveness and individual timbre.
The defeat of the conduction systems that ensure the conduction of impulses from the cerebral cortex to the structures of the underlying functional levels of the motor apparatus of speech (to the nuclei of the cranial nerves located in the brain stem) causes central paresis (paralysis) of the speech muscles with an increase in muscle tone in the muscles of the speech apparatus, strengthening of unconditioned reflexes and the appearance of reflexes of oral automatism with a more selective nature of articulatory disorders.
With damage to the cortical parts of the brain, which provide both a more differentiated innervation of the speech muscles and the formation of speech praxis, various central motor speech disorders occur.
Speech disorders often occur with various mental traumas (fear, sedation due to separation from loved ones, a long-term traumatic situation in the family, etc.). This delays the development of speech, and in some cases, especially with acute mental trauma, causes psychogenic speech disorders in the child: mutism, neurotic stuttering. These speech disorders, according to the classification of M. E. Khvattsev, can conditionally be classified as functional. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. Center VLADOS, 1998, C 30.
Functional speech disorders also include disorders associated with adverse effects on the child's body: general physical weakness, immaturity due to prematurity or intrauterine pathology, diseases of internal organs, rickets, metabolic disorders.
So, any general or neuropsychiatric disease of a child in the first years of life is usually accompanied by a violation of speech development. Hence, it is legitimate to distinguish between defects in formation and defects in formed speech, considering the age of three as their conditional subdivision.
The leading place in the rinatal pathology of the nervous system is occupied by asphyxia and birth trauma.
The occurrence of intracranial birth trauma and asphyxia (oxygen starvation of the fetus at the time of birth) is facilitated by a violation of intrauterine development of the fetus. Birth trauma and asphyxia exacerbate fetal brain development disorders that occurred in utero. Birth trauma leads to intracranial hemorrhage and death of nerve cells. Intracranial hemorrhages can also capture the speech zones of the cerebral cortex, which entails various speech disorders of cortical origin (alalia). In premature babies, intracranial hemorrhages occur most easily as a result of the weakness of their vascular walls.
In the etiology of speech disorders in children, immunological incompatibility of the blood of the mother and fetus (according to the Rh factor, the ABO system and other erythrocyte antigens) can play a certain role. Rhesus or group antibodies, penetrating the placenta, cause the breakdown of fetal red blood cells. Under the influence of a substance toxic to the central nervous system - indirect bilirubin - the subcortical parts of the brain, the auditory nuclei are affected, which leads to specific disorders of the sound-producing side of speech in combination with hearing impairment. With intrauterine lesions of the brain, the most severe speech disorders are noted, combined, as a rule, with other polymorphic developmental defects (hearing, vision, musculoskeletal system, intelligence). At the same time, the severity of speech disorders and other developmental defects largely depends on the time of brain damage in the prenatal period. Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher ᴨȇd. head. - M.: Humanit. ed. center VLADOS, 2003., S. 372
Infectious and somatic diseases of the mother during pregnancy can lead to uteroplacental circulation disorders, nutritional disorders and oxygen starvation of the fetus. Violations of intrauterine development of the fetus - embryopathies - can occur in connection with viral diseases, medication, ionizing radiation, vibration, alcoholism and smoking during pregnancy. The adverse effect of alcohol and nicotine on offspring has been noted for a long time.
Toxicosis of pregnancy, prematurity, non-prolonged asphyxia during childbirth cause unsharply pronounced minimal organic brain damage (children with minimal brain dysfunction - MMD).
At present, with mild cerebral insufficiency, a special type of mental dysontogenesis is distinguished, which is based on the superior age-related immaturity of individual higher cortical functions. With minimal brain dysfunction, there is a delay in the rate of development of the functional systems of the brain that require integrative activity for their implementation: speech, behavior, attention, memory, spatio-temporal representations and other higher mental functions. Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher ᴨȇd. head. - M.: Humanit. ed. center VLADOS, 2003, p. 379
Children with minimal brain dysfunction are at risk for developing speech disorders.
Speech disorders can also occur as a result of the impact of various adverse factors on the child's brain and at subsequent stages of its development. The structure of these speech disorders is different depending on the time of exposure to harmfulness and localization of brain damage. Hereditary factors also play a certain role in the etiology of speech disorders in children. Often they are predisposing conditions that are realized in speech pathology under the influence of even minor adverse effects.
So, the etiological factors that cause speech disorders are complex and polymorphic. The most common combination of hereditary predisposition, unfavorable environment and damage or impaired brain maturation under the influence of various unfavorable factors.
When dwelling on the types of speech disorders, one should focus directly on the existing deviations and pathologies of speech associated with congenital or acquired causes of their occurrence.
Violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus, or dyslalia, Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher ᴨȇd. head. - M.: Humanit. ed. center VLADOS, 2003., p.108 is one of the most common pronunciation defects. There are two main forms of dyslalia, depending on the location of the violation and the reasons for the defect in sound pronunciation; functional and mechanical (organic). Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 68.
In cases where there are no organic disorders (ᴨȇ ripherally or centrally conditioned), they speak of functional dyslalia. With deviations in the structure of the rhyme speech apparatus (teeth, jaws, tongue, palate), they speak of mechanical (organic) dyslalia. Functional dyslalia includes defects in the reproduction of speech sounds (phonemes) in the absence of organic disturbances in the structure of the articulatory apparatus. The causes of occurrence are biological and social: the general physical weakness of the child due to somatic diseases; mental retardation (minimal brain dysfunction), delayed speech development, selective impairment of phonemic perception; unfavorable social environment that hinders the development of communication of the child.
Rhinolalia (violation of the timbre of voice and sound pronunciation due to anatomical and physiological defects of the speech apparatus) Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 69. in its manifestations it differs from dyslalia by the presence of an altered nasalized voice timbre. Depending on the nature of the dysfunction of the palatopharyngeal closure, various forms of rhinolalia are distinguished. With an open form of rhinolalia, oral sounds become nasal. Functional open rhinolalia is due to various reasons. It is explained by the insufficient rise of the soft palate during phonation in children with sluggish articulation.
One of the functional forms is the "habitual" open rhinolalia. It occurs frequently after removal of adenoid lesions or, more rarely, as a result of post-diphtheria paresis, due to prolonged restriction of the mobile soft palate. Organic open rhinolalia can be acquired or congenital. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 70. Acquired open rhinolalia is formed during rforation of the hard and soft palate, with cicatricial changes, paresis and paralysis of the soft palate. The cause may be damage to the glossopharyngeal and vagus nerves, injuries, tumor pressure, etc. The most common cause of congenital open rhinolalia is congenital splitting of the soft or hard palate, shortening of the soft palate.
Dysarthria is a violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 70.
The leading defect in dysarthria is a violation of the sound-producing and prosodic side of speech, associated with an organic lesion of the central and ᴨȇripheric nervous systems.
Violations of sound pronunciation in dysarthria manifest themselves in varying degrees and depend on the nature and severity of the damage to the nervous system. In mild cases, there are separate distortions of sounds, "blurred speech", in more severe cases, distortions, substitutions and omissions of sounds are observed, the tempo, expressiveness, modulation suffer, in general, the pronunciation becomes slurred.
With severe lesions of the central nervous system, speech becomes impossible due to complete paralysis of the speech motor muscles. Such violations are called anartria (a - the absence of a given sign or function, artron - articulation). Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher ᴨȇd. head. - M.: Humanit. ed. center VLADOS, 2003., p.115.
Dysarthric speech disorders are observed in various organic lesions of the brain, which in adults have a more pronounced focal character. Less pronounced forms of dysarthria can be observed in children without obvious movement disorders, who have suffered from mild asphyxia or birth trauma, or who have a history of other mild adverse effects during fetal development or during childbirth.
In 1911, N. Gutzmann defined dysarthria as a violation of articulation and identified two of its forms: central and ᴨȇriferic. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 75.
The initial study of this problem was carried out mainly by neuropathologists in the framework of focal brain lesions in adult patients. The works of M. S. Margulis (1926) had a great influence on the modern understanding of dysarthria, who for the first time clearly distinguished dysarthria from motor aphasia and divided it into bulbar and cerebral forms. The author proposed a classification of cerebral forms of dysarthria based on the localization of the brain lesion.
The pathogenesis of dysarthria is determined by an organic lesion of the central and peripheral nervous system under the influence of various unfavorable external (exogenous) factors affecting the prenatal period of development, at the time of childbirth and after birth. Among the causes of great importance are asphyxia and birth trauma, damage to the nervous system during hemolytic disease, infectious diseases of the nervous system, craniocerebral trauma, less often - cerebrovascular accidents, brain tumors, malformations of the nervous system, for example, congenital aplasia of the nuclei of the craniocerebral nerves (Mobius syndrome), as well as hereditary diseases of the nervous and neuromuscular systems.
Clinical and physiological aspects of dysarthria are determined by the localization and severity of brain damage. The anatomical and functional relationship in the location and development of motor and speech zones and pathways determines the frequent combination of dysarthria with motor disorders of a different nature and severity.
Violations of sound pronunciation in dysarthria occur as a result of damage to various structures of the brain necessary to control the motor mechanism of speech (ᴨȇrhypheric motor nerves to the muscles of the speech apparatus; the nuclei of these ᴨȇrhypheric motor nerves located in the brainstem; nuclei located in the trunk and in the subcortical regions of the brain) . The defeat of the listed structures gives a picture of rifferic paralysis (paresis): nerve impulses do not reach the speech muscles, metabolic processes in them are disturbed, the muscles become lethargic, flabby, their atrophy and atony are observed, as a result of a break in the spinal reflex arc, the reflexes from these muscles disappear, sets in. areflexia. Yasᴨȇrs K. General psychopathology / / Per. with him. L. O. Akopyan, ed. doc. honey. Sciences VF Voitsekh and Ph.D. philosophy sciences O. Yu. Boytsova.- M.: Practice, 1997, p.112.
Voice disorders are also referred to as speech disorders. Violation of the voice is the absence or disorder of phonation due to pathological changes in the vocal apparatus. There are two main terms for denoting the pathology of the voice: aphonia - the complete absence of voice and dysphonia - partial violations of pitch, strength and timbre.
Voice disorders associated with various diseases of the vocal apparatus are common in both adults and children. The pathology of the larynx in children has increased over the past two decades, which is associated with the expansion of resuscitation activities.
Voice disorders are divided into central and rhyme, each of them can be organic and functional. Most of the violations manifest themselves as independent, the causes of their occurrence are diseases and various changes in the vocal apparatus only. But they can also accompany other more severe speech disorders, entering the structure of the defect in aphasia, dysarthria, rhinolalia, stuttering. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 106.
Voice pathology resulting from anatomical changes or chronic inflammation of the vocal apparatus is considered organic. The rhyme organic disorders include dysphonia and aphonia in chronic laryngitis, paresis and paralysis of the larynx, conditions after removal of tumors. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 106.
Central paresis and paralysis of the larynx depend on the damage to the cerebral cortex, bridge, medulla oblongata, pathways. In children, they are found in cerebral palsy.
The most common and diverse are functional voice disorders. They are not accompanied by inflammatory or any anatomical changes in the larynx. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 125 Phasthenia, hypo- and hypertonic aphonias and dysphonias belong to functional disorders.
Phonasthenia - a violation of the voice in some cases, especially in the initial stages, is not accompanied by visible objective changes in the vocal apparatus. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 134. Phasthenia manifests itself in violation of the coordination of breathing and phonation, the impossibility of owning the voice - to strengthen and weaken the sound, the appearance of detonation and a number of subjective sensations.
Hypotonic dysphonia (aphonia) is caused, as a rule, by bilateral myopathic paresis, i.e., paresis of the internal muscles of the larynx. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 147. They occur with certain infections (SARS, influenza, diphtheria), as well as with a strong voice strain. Pathology of the voice can manifest itself from mild hoarseness to aphonia with symptoms of voice fatigue, tension and pain in the muscles of the neck, neck and chest.
Hypertonic (spastic) voice disorders are associated with an increase in the tone of the laryngeal muscles with a predominance of tonic spasm at the time of phonation. The causes of their occurrence are not fully understood, but spastic dysphonia and aphonia develop in individuals who force their voice.
Rhinophonia and rhinolalia stand somewhat apart from other voice disorders, since their pathophysiological mechanism lies in the abnormal function of the soft palate of an organic or functional nature. With closed rhinophony, nasal consonants acquire oral resonance, vowels lose their sonority, and the timbre becomes unnatural.
Open rhinophony manifests itself in the pathological nasalization of all oral sounds, while the voice is weak, choked. Voice defects, in addition to impaired resonance, are due to the fact that the soft palate is functionally connected with the internal muscles of the larynx and affects the symmetry and tone of the vocal folds.
Functional voice disorders of central origin include functional or psychogenic aphonia. It arises suddenly as a reaction to a traumatic situation in persons prone to hysterical reactions, more often in girls and women.
Speech disorders include bradilalia and takhilalia. With these disorders, the development of both external and internal speech is disturbed. Speech is incomprehensible to others.
Bradilalia is a pathologically slow rate of speech. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 230. With bradylalia, the voice is monotonous, loses modulation, constantly maintains the same pitch, sometimes a nasal tone appears. The musical accent also changes when pronouncing individual syllables, the pitch of the voice fluctuates up or down. Non-verbal symptoms in bradilalia are expressed in violations of general motor skills, fine motor skills of the hands, fingers, facial muscles. Movements are slow, sluggish, insufficiently coordinated, incomplete in volume, motor awkwardness is observed. Amicable face. There are also features of mental activity: slowness and disorders of perception, attention, memory, thinking.
Tahilalia is a pathologically accelerated rate of speech. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 230. M. E. Khvattsev (1959) considered the main cause of takhilalia to be congenital motor speech insufficiency of the speech apparatus, as well as sloppy, uneven speech of others, lack of attention and timely correction of the child’s fast speech. A. Liebmann distinguished between shortcomings in motor and acoustic perception that underlie takhilalia. G. Gutzman argued that this disorder is a consequence of a violation of perception. According to E. Frechels, accelerated speech occurs due to the fact that thoughts rush extremely quickly and one concept is replaced by the next before the first one can be pronounced. M. Nedolechny considered articulation deficiency to be the cause of accelerated speech, since patients have difficulty pronouncing unusual and long words. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 243
Stuttering is a violation of the tempo-rhythmic organization of speech, due to the convulsive state of the muscles of the speech apparatus. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 248
Alalia is the absence or underdevelopment of speech due to an organic lesion of the speech zones of the cerebral cortex in the prenatal or early period of a child's development. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.86. Intrauterine pathology leads to diffuse damage to the substance of the brain, birth traumatic brain injury and asphyxia of newborns cause more local disorders. Somatic diseases only exacerbate the impact of pathological causes of a neurological nature, which are leading.
Some authors (R. Cohen, 1888; M. Zeeman, 1961; R. Luhzinger, A. Salei, 1977, etc.) Logodia: Textbook for students of defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.86. emphasize the role of heredity, family predisposition in the etiology of alalia. However, there is no convincing scientific data on the role of heredity in the origin of alalia in the literature. In recent years, the significant role of minimal brain damage (minimal brain dysfunction) has been emphasized in the occurrence of alalia.
Aphasia is a complete or partial loss of speech due to local lesions of the brain. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.180.
The causes of aphasia are cerebrovascular accidents (ischemia, hemorrhage), trauma, tumors, infectious diseases of the brain. Aphasia of vascular origin most often occurs in adults. As a result of rupture of cerebral aneurysms, thromboembolism caused by rheumatic heart disease, and traumatic brain injury. Aphasia is often observed in adolescents and young people.
Aphasia occurs in about a third of cases of cerebrovascular accidents, with motor aphasia being the most common.
Aphasia is one of the most severe consequences of brain damage, in which all types of speech activity are systemically disturbed. The complexity of the speech disorder in aphasia depends on the location of the lesion. With aphasia, the realization of different levels, sides, types of speech activity (oral speech, speech memory, phonemic hearing, speech understanding, written speech, reading, counting, etc.) is systematically and systematically disrupted.
Acoustic-gnostic sensory aphasia was first described by the German psychiatrist Wernicke. He showed that aphasia, which he called sensory, occurs when the posterior third of the superior temporal gyrus of the left hemisphere is affected. A distinctive feature of this form of aphasia is a violation of the understanding of speech when perceiving it by ear. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.93.
Acoustic-mnestic aphasia occurs when the middle and posterior sections of the temporal region are affected (A. R. Luria, 1969, 1975; L. S. Tsvetkova, 1975). Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher ᴨȇd. head. - M.: Humanit. ed. center VLADOS, 2003, p.177. A.R. Luria believes that it is based on a decrease in auditory-speech memory, which is caused by increased inhibition of auditory traces. With the perception of each new word and its awareness, the patient loses the previous word. This disturbance also manifests itself in the repetition of a series of syllables and words. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.93
Amnestic-semantic aphasia occurs when the parieto-occipital region of the speech-dominant hemisphere is affected. With damage to the parietal-occipital (or posterior lower-parietal) parts of the cerebral hemisphere, a smooth syntagmatic organization of speech is preserved, no searches for the sound composition of a word are noted, there are no phenomena of a decrease in auditory-speech memory or a violation of phonemic perception. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.184.
Afferent kinesthetic motor aphasia occurs when the secondary zones of the post-central and lower parietal regions of the cerebral cortex are damaged, located behind the central, or Roland, furrow. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.184.
Effective motor aphasia occurs when the middle branches of the left middle cerebral artery are damaged. It is accompanied, as a rule, by kinetic apraxia, which is expressed in the difficulties of assimilation and reproduction of the motor program. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 95.
The defeat of the premotor parts of the brain causes pathological inertia of speech stereotypes, leading to sound, syllabic and lexical permutations and ᴨȇrseveration, repetitions. Perseverations, involuntary repetitions of words, syllables, which are the result of the impossibility of timely switching from one articulatory act to another.
Dynamic aphasia occurs when the posterior frontal sections of the left hemisphere, dominant in speech, are affected, that is, the sections of the third functional block - the block of activation, regulation and planning of speech activity. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.187.
The main speech defect in this form of aphasia is the difficulty, and sometimes the complete impossibility of active deployment of the utterance. With a rough severity of the disorder, not only speech is noted, but also a general lack of initiative, there is a pronounced echolalia, and sometimes echopraxia.
In the aspect of speech pathologies, a violation of written speech is also considered. These include: alexia, dyslexia, agraphia, dysgraphia.
Dyslexia is a partial scifi violation of the reading process, due to the immaturity (violation) of higher mental functions and manifested in repeated errors of a persistent nature. Logoᴨȇdia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 176.
The etiology of dyslexia is associated with the impact of biological and social factors. Dyslexia is caused by organic damage to the areas of the brain involved in the process of reading. Functional causes may be related to the impact of internal and external factors. So, both genetic and exogenous factors are involved in the etiology of dyslexia (pathology of pregnancy, childbirth, asphyxia, a “chain” of childhood infections, head injuries).
Dysgraphia is a partial scifi violation of the writing process. This violation is due to the underdevelopment (disintegration) of higher mental functions that carry out the process of writing normally.
- Conclusion -
Based on the research experience of such scientists as P. Broca, Wernicke, K.L. Kalbaum, S.M. Dobrogaev, M.E. Khvattsev, L.S. Volkova, A.R. Luria, M. S. Margulis, A. Liebmann, G. Gutzman, E. Freshels, M. Nedolechny and others, who made a significant contribution to the study of the problems of speech and motor pathologies, modern trends (both theoretical and practical) in the field of studying the mechanisms of violation of motor and speech disorders, it provides an opportunity not only to get a deeper and more thorough understanding of the essence of this problem, but also creates ᴨȇᴨȇactive conditions for direct corrective and adaptive assistance to people suffering from these disorders. In order for assistance to be as effective as possible, it is necessary not only to know the essence of the mechanisms of mental processes and the action of motor skills, the mechanism of their violation. Socialists involved in the research of these problems need to constantly and continuously orient their activities towards preventing the occurrence of pathologies, as well as systematically monitor the state of impaired functions, preventive activities of disorders, and provide specific assistance in this area to patients.
Bibliography
1. Zharikov M.N., Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002.
2. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986.
3. Liebmann A. Pathology and therapy of stuttering and tongue-tiedness. (St. Petersburg - 1901) / / Reader on logoᴨȇdia (extracts and texts). Textbook for students of higher and secondary educational institutions: In 2 vols. T.I / Ed. L.S. Volkova and V.I. Seliverstov. - M.: Humanit. ed. center VLADOS, 1997.
4. Logodia: Textbook for students defectol. fak. ᴨȇd. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998.
5. Luria.A.R. Stages of the traveled path//Scientific autobiography. - M.: Publishing House of Moscow. un-ta, 1982.
6. Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher ᴨȇd. head. - M.: Humanit. ed. center VLADOS, 2003.
7. Yasᴨȇrs K. General psychopathology / / Per. with him. L. O. Akopyan, ed. doc. honey. Sciences VF Voitsekh and Ph.D. philosophy sciences O. Yu. Boytsova.- M.: Practice, 1997.
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Introduction
1. Movement disorders
2. Pathology of speech. Organic and functional speech disorders
Conclusion
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Introduction
Speech as a specific mental process develops in close unity with motor skills and requires the fulfillment of a number of necessary conditions for its formation, such as: anatomical safety and sufficient maturity of those brain systems that are involved in the speech function; preservation of kinesthetic, auditory and visual perception; a sufficient level of intellectual development that would provide the need for verbal communication; normal structure of the peripheral speech apparatus; adequate emotional and speech environment.
The occurrence of speech pathology (including cases of a combination of such disorders with movement disorders) is due to the fact that, on the one hand, its formation is caused by the presence of varying degrees of severity of organic lesions of individual cortical and subcortical structures of the brain involved in providing speech functions, on the other hand, secondary underdevelopment or delayed "maturation" of the premotor-frontal and parietal-temporal cortical structures, disturbances in the rate and nature of the formation of visual-auditory and auditory-visual-motor nerve connections. With motor disorders, the afferent effect on the brain is distorted, which in turn enhances existing cerebral dysfunctions or causes new ones to appear, leading to asynchronous activity of the cerebral hemispheres.
Based on studies of the causes of these disorders, we can talk about the relevance of considering this problem. The topic of the essay is devoted to the consideration of the causes and types of speech pathologies and movement disorders.
1. Movement disorders
If we talk about the causes of movement disorders, it can be noted that most of them arise as a result of a violation of the functional activity of mediators in the basal ganglia, the pathogenesis can be different. The most common causes are degenerative diseases (congenital or idiopathic), possibly triggered by medication, organ system failure, CNS infections, or basal ganglia ischemia. All movements are carried out through the pyramidal and parapyramidal pathways. As for the extrapyramidal system, the main structures of which are the basal nuclei, its function is to correct and refine movements. This is achieved mainly through influences on the motor areas of the hemispheres through the thalamus. The main manifestations of damage to the pyramidal and parapyramidal systems are paralysis and spasticity. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, S. 154.
Paralysis can be complete (plegia) or partial (paresis), sometimes it is manifested only by the awkwardness of the hand or foot. Spasticity is characterized by an increase in the tone of the limb according to the "jackknife" type, increased tendon reflexes, clonus and pathological extensor reflexes (for example, the Babinski reflex). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M .: Medicine, 2002, p. 155 It can also manifest itself only by awkwardness of movements. Frequent symptoms also include spasms of the flexor muscles, which occur as a reflex to constant uninhibited impulses from skin receptors.
Correction of movements is also provided by the cerebellum (The lateral sections of the cerebellum are responsible for the coordination of movements of the limbs, the middle sections are responsible for postures, gait, body movements. Damage to the cerebellum or its connections is manifested by intentional tremor, dysmetria, adiadochokinesis and a decrease in muscle tone.), mainly through influences on the vestibulospinal path, as well as (with switching in the nuclei of the thalamus) to the same motor areas of the cortex as the basal nuclei (motor disorders that occur when the basal nuclei are damaged (extrapyramidal disorders), can be divided into hypokinesia (a decrease in the volume and speed of movements; an example is Parkinson's disease or parkinsonism of another origin) and hyperkinesis (excessive involuntary movements; an example is Huntington's disease). Tics also belong to hyperkinesis.). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.156
With certain mental illnesses (primarily with catatonic syndrome), one can observe conditions in which the motor sphere receives some autonomy, specific motor acts lose their connection with internal mental processes, cease to be controlled by the will. In this case, the disorders become similar to neurological symptoms. It should be recognized that this similarity is only external, since, unlike hyperkinesis, paresis, and motor coordination disorders in neurological diseases, movement disorders in psychiatry have no organic basis, are functional and reversible.
Those suffering from a catatonic syndrome cannot somehow psychologically explain the movements they make, they are not aware of their painful nature until the moment of copying psychosis. All disorders of the motor sphere can be divided into hyperkinesia (excitation), hypokinesia (stupor) and parakinesia (distortion of movements).
Excitation, or hyperkinesia, in mentally ill patients is a sign of an exacerbation of the disease. In most cases, the patient's movements reflect the richness of his emotional experiences. He may be controlled by the fear of persecution, and then he flees. In a manic syndrome, the basis of his motor skills is an indefatigable thirst for activity, and in hallucinatory states, he may look surprised, strive to draw the attention of others to his visions. In all these cases, hyperkinesia acts as a symptom secondary to painful mental experiences. This type of arousal is called psychomotor.
In catatonic syndrome, movements do not reflect the internal needs and experiences of the subject, therefore, excitation in this syndrome is called purely motor. The severity of hyperkinesia often indicates the severity of the disease, its severity. However, at times there are severe psychoses with arousal limited to the bed.
Stupor - a state of immobility, an extreme degree of motor inhibition. Stupor can also reflect vivid emotional experiences (depression, asthenic affect of fear). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.158 In catatonic syndrome, on the contrary, stupor is devoid of internal content, meaningless. The term "substupor" is used to refer to states accompanied by only partial inhibition. Although stupor implies a lack of motor activity, in most cases it is considered a productive psychopathological symptom, since it does not mean that the ability to move is irreversibly lost. Like other productive symptoms, stupor is a temporary condition and responds well to treatment with psychotropic drugs.
The catatonic syndrome was originally described by KL Kalbaum (1863) as an independent nosological unit, and is currently considered as a symptom complex. Jaspers K. General psychopathology//Trans. with him. L. O. Akopyan, ed. doc. honey. Sciences VF Voitsekh and Ph.D. philosophy sciences O. Yu. Boytsova.- M.: Practice, 1997, p.97. One of the important features of the catatonic syndrome is the complex, contradictory nature of the symptoms. All motor phenomena are devoid of meaning and are not associated with psychological experiences. Characterized by tonic muscle tension. Catatonic syndrome includes 3 groups of symptoms: hypokinesia, hyperkinesia and parakinesia. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.159
Hypokinesias are represented by the phenomena of stupor and substupor. Complex, unnatural, sometimes uncomfortable postures of patients attract attention. There is a sharp tonic contraction of the muscles. This tone allows patients sometimes for some time to hold any position that the doctor gives them. This phenomenon is called catalepsy, or waxy flexibility.
Hyperkinesia in catatonic syndrome is expressed in bouts of excitement. Characterized by the commission of meaningless, chaotic, non-purposeful movements. Motor and speech stereotypes (rocking, bouncing, waving arms, howling, laughing) are often observed. An example of speech stereotypes are verbigerations, which are manifested by the rhythmic repetition of monotonous words and meaningless sound combinations.
Parakinesias are manifested by strange, unnatural movements, such as frilly, mannered facial expressions and pantomime.
With catatonia, a number of echo symptoms are described: echolalia (repeating the words of the interlocutor), echopraxia (repetition of other people's movements), echomimicry (copying the facial expressions of others). These symptoms can occur in the most unexpected combinations.
It is customary to distinguish lucid catatonia, which occurs against the background of a clear consciousness, and oneiroid catatonia, accompanied by clouding of consciousness and partial amnesia. With the outward similarity of the set of symptoms, these two conditions differ significantly in course. Oneiroid catatonia is an acute psychosis with dynamic development and a favorable outcome. Lucid catatonia, on the other hand, is a sign of remission-free malignant variants of schizophrenia. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.159
Hebephrenic syndrome has a significant similarity with catatonia. The predominance of movement disorders with unmotivated, meaningless actions is also characteristic of hebephrenia. The very name of the syndrome indicates the infantile nature of the behavior of patients.
Speaking of other syndromes accompanied by arousal, it can be noted that psychomotor agitation is one of the frequent components of many psychopathological syndromes.
Manic excitation differs from catatonic in the purposefulness of actions. Facial expressions express joy, patients seek to communicate, talk a lot and actively. With pronounced arousal, the acceleration of thinking leads to the fact that not everything said by the patient is understandable, but his speech is never stereotyped.
Agitated depression is manifested by a combination of severe melancholy and anxiety. Facial expressions reflect suffering. Lamentations, crying without tears are characteristic. Often, anxiety is accompanied by nihilistic megalomaniac delusions with ideas of the death of the world (Cotard's syndrome). Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.159 Acute hallucinatory - delusional states are also often expressed by psychomotor agitation. Acute hallucinosis can also be manifested by psychomotor agitation.
Quite often, the cause of psychomotor agitation is clouding of consciousness. The most common among the syndromes of clouding of consciousness - delirium - is manifested not only by disorientation and pig-like true hallucinations, but also by extremely pronounced arousal. Jaspers K. General psychopathology//Trans. with him. L. O. Akopyan, ed. doc. honey. Sciences VF Voitsekh and Ph.D. philosophy sciences O. Yu.
The amental syndrome is characterized by an even greater severity of the condition. Patients are emaciated, unable to get out of bed. Their movements are chaotic, uncoordinated (yactation): they wave their arms, make meaningless cries, crumple in their hands and tear the sheet, shake their heads.
Oneiric stupefaction is manifested by the catatonic symptoms described above. With twilight stupefaction, there are both automated actions that are safe for others, and attacks of ridiculous chaotic excitement, often accompanied by violent anger, brutal aggression.
Another variant of epileptic arousal is history attacks, although not accompanied by clouding of consciousness and amnesia, but also often leading to dangerous, aggressive actions.
The danger of psychomotor agitation forced psychiatrists until the middle of the twentieth century. often use various means of restraint (belts, straitjackets, isolation chambers). The appearance at the beginning of the century of powerful barbiturates, and especially the introduction of new psychotropic drugs into practice at the end of the 50s, made it possible to almost completely abandon the use of restraint measures. Currently, various antipsychotics are used to relieve psychomotor agitation, and benzodiazepine tranquilizers are somewhat less common. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.162
Stupor is less common in psychiatric practice than excitement. In addition to the catatonic syndrome, it can be a manifestation of severe depression, apatico-abulic syndrome and hysteria.
Among other syndromes accompanied by stupor, the presence of a depressive stupor, closely related in its manifestations to the affect of melancholy, is noted. The face of the sick expresses suffering. The whole state is characterized by integrity, the absence of paradoxes.
Apathetic stupor is observed relatively rarely. The face of such patients is amimic, expresses indifference. In apathico-abulic syndrome there is no suppression of desires, so patients never refuse food. From prolonged inactivity, they become very stout. Unlike patients with catatonic stupor, they express dissatisfaction aloud if someone violates their comfort, makes them get out of bed, wash or cut their hair. The causes of apathetic stupor are schizophrenia or damage to the frontal lobes of the brain. Zharikov MN, Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002, p.163
Hysterical stupor, like hysterical excitement, appears immediately after the occurrence of a traumatic situation. The clinical picture can take the most unexpected forms.
In addition to hysterical, psychogenic stuporous states are described in life-threatening situations. Stupor in most cases is not a socially dangerous condition, since motor inhibition is only one of the manifestations of any syndrome.
2. Speech pathology. Organic & fFunctional speech disorders
The problem of the etiology of speech disorders has gone through the same path of historical development as the general doctrine of the causes of disease states.
Since ancient times, there have been two points of view - brain damage or disorders of the local speech apparatus, as the causes of disorders. Luria.A.R. Stages of the traveled path: Scientific autobiography. M.: Publishing House of Moscow. un-ta, 1982., p.110
Despite this, only in 1861, when the French physician Paul Broca showed the presence in the brain of a field specifically related to speech, and associated the loss of speech with its defeat. Luria.A.R. Stages of the traveled path: Scientific autobiography. M.: Publishing House of Moscow. un-ta, 1982., p.110 In 1874, a similar discovery was made by Wernicke: a connection was established between understanding and the preservation of a certain area of the cerebral cortex. Since that time, the connection of speech disorders with morphological changes in certain parts of the cerebral cortex has become proven. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998? C.25.
The most intensive questions of the etiology of speech disorders began to be developed from the 20s of this century. During these years, domestic researchers made the first attempts to classify speech disorders depending on the causes of their occurrence. So, S. M. Dobrogaev (1922) singled out “diseases of higher nervous activity”, pathological changes in the anatomical speech apparatus, lack of education in childhood, as well as “general neuropathic conditions of the body” among the causes of speech disorders. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998., S.26.
M. E. Khvattsev for the first time divided all the causes of speech disorders into external and internal, emphasizing their close interaction. He also singled out organic (anatomical, physiological, morphological), functional (psychogenic), socio-psychological and neuropsychiatric causes. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.26.
Underdevelopment and damage to the brain in the prenatal period were attributed to organic causes. They singled out organic central (brain lesions) and organic peripheral causes (lesion of the organ of hearing, cleft palate and other morphological changes in the articulatory apparatus). M. E. Khvattsev explained the functional reasons by the teachings of I. P. Pavlov about violations of the ratio of the processes of excitation and inhibition in the central nervous system. He emphasized the interaction of organic and functional, central and peripheral causes. He attributed mental retardation, impaired memory, attention, and other disorders of mental functions to neuropsychiatric causes.
The important role of M.E. Khvattsev also attributed socio-psychological reasons, understanding them as various adverse environmental influences. Thus, he was the first to substantiate the understanding of the etiology of speech disorders on the basis of a dialectical approach to assessing causal relationships in speech pathology. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. - M.: Humanit. ed. center VLADOS, 1998, p.27.
The cause of speech disorders is understood as the impact on the body of an external or internal harmful factor or their interaction, which determine the specifics of a speech disorder and without which the latter cannot occur. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.27.
The motor mechanism of speech is also provided by the following higher brain structures:
With damage to the subcortical-cerebellar nuclei and pathways that regulate muscle tone and the sequence of muscle contractions of the speech muscles, synchrony (coordination) in the work of the articulatory, respiratory and vocal apparatus, as well as the emotional expressiveness of speech, there are individual manifestations of central paralysis (paresis) with violations of muscle tone, increased individual unconditioned reflexes, as well as with a pronounced violation of the prosodic characteristics of speech - its pace, smoothness, loudness, emotional expressiveness and individual timbre.
The defeat of the conduction systems that ensure the conduction of impulses from the cerebral cortex to the structures of the underlying functional levels of the motor apparatus of speech (to the nuclei of the cranial nerves located in the brain stem) causes central paresis (paralysis) of the speech muscles with an increase in muscle tone in the muscles of the speech apparatus, strengthening of unconditioned reflexes and the appearance of reflexes of oral automatism with a more selective nature of articulatory disorders.
With damage to the cortical parts of the brain, which provide both a more differentiated innervation of the speech muscles and the formation of speech praxis, various central motor speech disorders occur.
Speech disorders often occur with various mental traumas (fear, feelings of separation from loved ones, a long-term traumatic situation in the family, etc.). This delays the development of speech, and in some cases, especially with acute mental trauma, causes psychogenic speech disorders in the child: mutism, neurotic stuttering. These speech disorders, according to the classification of M. E. Khvattsev, can conditionally be classified as functional. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. Center VLADOS, 1998, C 30.
Functional speech disorders also include disorders associated with adverse effects on the child's body: general physical weakness, immaturity due to prematurity or intrauterine pathology, diseases of internal organs, rickets, metabolic disorders.
Thus, any general or neuropsychiatric disease of a child in the first years of life is usually accompanied by a violation of speech development. Hence, it is legitimate to distinguish between defects in formation and defects in formed speech, considering the age of three as their conditional subdivision.
The leading place in the perinatal pathology of the nervous system is occupied by asphyxia and birth trauma.
The occurrence of intracranial birth trauma and asphyxia (oxygen starvation of the fetus at the time of birth) is facilitated by a violation of intrauterine development of the fetus. Birth trauma and asphyxia exacerbate fetal brain development disorders that occurred in utero. Birth trauma leads to intracranial hemorrhage and death of nerve cells. Intracranial hemorrhages can also capture the speech zones of the cerebral cortex, which entails various speech disorders of cortical origin (alalia). In premature babies, intracranial hemorrhages occur most easily as a result of the weakness of their vascular walls.
In the etiology of speech disorders in children, immunological incompatibility of the blood of the mother and fetus (according to the Rh factor, the ABO system and other erythrocyte antigens) can play a certain role. Rhesus or group antibodies, penetrating the placenta, cause the breakdown of fetal red blood cells. Under the influence of a substance toxic to the central nervous system - indirect bilirubin - the subcortical parts of the brain, the auditory nuclei are affected, which leads to specific disorders of the sound-producing side of speech in combination with hearing impairment. With intrauterine lesions of the brain, the most severe speech disorders are noted, combined, as a rule, with other polymorphic developmental defects (hearing, vision, musculoskeletal system, intelligence). At the same time, the severity of speech disorders and other developmental defects largely depends on the time of brain damage in the prenatal period. Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher pedagogical textbook head. - M.: Humanit. ed. center VLADOS, 2003., S. 372
Infectious and somatic diseases of the mother during pregnancy can lead to uteroplacental circulation disorders, nutritional disorders and oxygen starvation of the fetus. Violations of intrauterine development of the fetus - embryopathies - can occur in connection with viral diseases, medication, ionizing radiation, vibration, alcoholism and smoking during pregnancy. The adverse effect of alcohol and nicotine on offspring has been noted for a long time.
Toxicosis of pregnancy, prematurity, non-prolonged asphyxia during childbirth cause unsharply pronounced minimal organic brain damage (children with minimal brain dysfunction - MMD).
At present, with mild cerebral insufficiency, a special type of mental dysontogenesis is distinguished, which is based on the superior age-related immaturity of individual higher cortical functions. With minimal brain dysfunction, there is a delay in the rate of development of the functional systems of the brain that require integrative activity for their implementation: speech, behavior, attention, memory, spatio-temporal representations and other higher mental functions. Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher pedagogical textbook head. - M.: Humanit. ed. center VLADOS, 2003, p. 379
Children with minimal brain dysfunction are at risk for developing speech disorders.
Speech disorders can also occur as a result of the impact of various adverse factors on the child's brain and at subsequent stages of its development. The structure of these speech disorders is different depending on the time of exposure to harmfulness and localization of brain damage. Hereditary factors also play a certain role in the etiology of speech disorders in children. Often they are predisposing conditions that are realized in speech pathology under the influence of even minor adverse effects.
Thus, the etiological factors that cause speech disorders are complex and polymorphic. The most common combination of hereditary predisposition, unfavorable environment and damage or impaired brain maturation under the influence of various unfavorable factors.
When dwelling on the types of speech disorders, one should focus directly on the existing deviations and pathologies of speech associated with congenital or acquired causes of their occurrence.
Violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus, or dyslalia, Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher pedagogical textbook head. - M.: Humanit. ed. center VLADOS, 2003., p.108 is one of the most common pronunciation defects. There are two main forms of dyslalia, depending on the location of the violation and the reasons for the defect in sound pronunciation; functional and mechanical (organic). Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 68.
In cases where no organic disorders (peripherally or centrally conditioned) are observed, they speak of functional dyslalia. With deviations in the structure of the peripheral speech apparatus (teeth, jaws, tongue, palate), they speak of mechanical (organic) dyslalia. Functional dyslalia includes defects in the reproduction of speech sounds (phonemes) in the absence of organic disturbances in the structure of the articulatory apparatus. The causes of occurrence are biological and social: the general physical weakness of the child due to somatic diseases; mental retardation (minimal brain dysfunction), delayed speech development, selective impairment of phonemic perception; unfavorable social environment that hinders the development of communication of the child.
Rhinolalia (violation of the timbre of voice and sound pronunciation due to anatomical and physiological defects of the speech apparatus) Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 69. in its manifestations it differs from dyslalia by the presence of an altered nasalized voice timbre. Depending on the nature of the dysfunction of the palatopharyngeal closure, various forms of rhinolalia are distinguished. With an open form of rhinolalia, oral sounds become nasal. Functional open rhinolalia is due to various reasons. It is explained by the insufficient rise of the soft palate during phonation in children with sluggish articulation.
One of the functional forms is the "habitual" open rhinolalia. It occurs frequently after removal of adenoid lesions or, more rarely, as a result of post-diphtheria paresis, due to prolonged restriction of the mobile soft palate. Organic open rhinolalia can be acquired or congenital. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 70. Acquired open rhinolalia is formed during perforation of the hard and soft palate, with cicatricial changes, paresis and paralysis of the soft palate. The cause may be damage to the glossopharyngeal and vagus nerves, injuries, tumor pressure, etc. The most common cause of congenital open rhinolalia is congenital splitting of the soft or hard palate, shortening of the soft palate.
Dysarthria is a violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 70.
The leading defect in dysarthria is a violation of the sound-producing and prosodic side of speech, associated with an organic lesion of the central and peripheral nervous systems.
Violations of sound pronunciation in dysarthria manifest themselves to varying degrees and depend on the nature and severity of the damage to the nervous system. In mild cases, there are separate distortions of sounds, "blurred speech", in more severe cases, distortions, substitutions and omissions of sounds are observed, the tempo, expressiveness, modulation suffer, in general, the pronunciation becomes slurred.
With severe lesions of the central nervous system, speech becomes impossible due to complete paralysis of the speech motor muscles. Such violations are called anartria (a - the absence of a given sign or function, artron - articulation). Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher pedagogical textbook head. - M.: Humanit. ed. center VLADOS, 2003., p.115.
Dysarthric speech disorders are observed in various organic lesions of the brain, which in adults have a more pronounced focal character. Less pronounced forms of dysarthria can be observed in children without obvious movement disorders, who have undergone mild asphyxia or birth trauma, or who have a history of other mild adverse effects during fetal development or during childbirth.
In 1911, N. Gutzmann defined dysarthria as a violation of articulation and identified two of its forms: central and peripheral. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 75.
The initial study of this problem was carried out mainly by neuropathologists in the framework of focal brain lesions in adult patients. The works of M. S. Margulis (1926), who for the first time clearly delimited dysarthria from motor aphasia and divided it into bulbar and cerebral forms, had a great influence on the modern understanding of dysarthria. The author proposed a classification of cerebral forms of dysarthria based on the localization of the brain lesion.
The pathogenesis of dysarthria is determined by an organic lesion of the central and peripheral nervous system under the influence of various unfavorable external (exogenous) factors affecting the prenatal period of development, at the time of childbirth and after birth. Among the causes of great importance are asphyxia and birth trauma, damage to the nervous system during hemolytic disease, infectious diseases of the nervous system, craniocerebral trauma, less often - cerebrovascular accidents, brain tumors, malformations of the nervous system, for example, congenital aplasia of the nuclei of the craniocerebral nerves (Mobius syndrome), as well as hereditary diseases of the nervous and neuromuscular systems.
Clinical and physiological aspects of dysarthria are determined by the location and severity of brain damage. The anatomical and functional relationship in the location and development of motor and speech zones and pathways determines the frequent combination of dysarthria with motor disorders of various nature and severity.
Sound pronunciation disorders in dysarthria occur as a result of damage to various brain structures necessary to control the motor mechanism of speech (peripheral motor nerves to the muscles of the speech apparatus; nuclei of these peripheral motor nerves located in the brain stem; nuclei located in the trunk and in the subcortical regions of the brain) . The defeat of these structures gives a picture of peripheral paralysis (paresis): nerve impulses do not reach the speech muscles, metabolic processes in them are disturbed, the muscles become lethargic, flabby, their atrophy and atony are observed, as a result of a break in the spinal reflex arc, reflexes from these muscles disappear, sets in. areflexia. Jaspers K. General psychopathology / / Per. with him. L. O. Akopyan, ed. doc. honey. Sciences VF Voitsekh and Ph.D. philosophy sciences O. Yu. Boytsova.- M.: Practice, 1997, p.112.
Voice disorders are also referred to as speech disorders. Violation of the voice is the absence or disorder of phonation due to pathological changes in the vocal apparatus. There are two main terms for denoting the pathology of the voice: aphonia - the complete absence of voice and dysphonia - partial violations of pitch, strength and timbre.
Voice disorders associated with various diseases of the vocal apparatus are common in both adults and children. The pathology of the larynx in children has increased over the past two decades, which is associated with the expansion of resuscitation activities.
Voice disorders are divided into central and peripheral, each of them can be organic and functional. Most of the violations manifest themselves as independent, the causes of their occurrence are diseases and various changes in the vocal apparatus only. But they can also accompany other more severe speech disorders, entering the structure of the defect in aphasia, dysarthria, rhinolalia, stuttering. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 106.
Voice pathology resulting from anatomical changes or chronic inflammation of the vocal apparatus is considered organic. Peripheral organic disorders include dysphonia and aphonia in chronic laryngitis, paresis and paralysis of the larynx, conditions after removal of tumors. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 106.
Central paresis and paralysis of the larynx depend on the damage to the cerebral cortex, bridge, medulla oblongata, pathways. In children, they are found in cerebral palsy.
The most common and diverse are functional voice disorders. They are not accompanied by inflammatory or any anatomical changes in the larynx. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 125 Peripheral functional disorders include phonasthenia, hypo- and hypertonic aphonia and dysphonia.
Phonasthenia - a violation of the voice in some cases, especially in the initial stages, is not accompanied by visible objective changes in the vocal apparatus. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 134. Phasthenia manifests itself in violation of the coordination of breathing and phonation, the impossibility of owning the voice - to strengthen and weaken the sound, the appearance of detonation and a number of subjective sensations.
Hypotonic dysphonia (aphonia) is caused, as a rule, by bilateral myopathic paresis, i.e., paresis of the internal muscles of the larynx. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 147. They occur with certain infections (SARS, influenza, diphtheria), as well as with a strong overstrain of the voice. Pathology of the voice can manifest itself from mild hoarseness to aphonia with symptoms of voice fatigue, tension and pain in the muscles of the neck, neck and chest.
Hypertonic (spastic) voice disorders are associated with an increase in the tone of the laryngeal muscles with a predominance of tonic spasm at the time of phonation. The causes of their occurrence are not fully understood, but spastic dysphonia and aphonia develop in individuals who force their voice.
Rhinophonia and rhinolalia stand somewhat apart from other voice disorders, since their pathophysiological mechanism lies in the abnormal function of the soft palate of an organic or functional nature. With closed rhinophony, nasal consonants acquire oral resonance, vowels lose their sonority, and the timbre becomes unnatural.
Open rhinophony manifests itself in the pathological nasalization of all oral sounds, while the voice is weak, choked. Voice defects, in addition to impaired resonance, are due to the fact that the soft palate is functionally connected with the internal muscles of the larynx and affects the symmetry and tone of the vocal folds.
Functional voice disorders of central origin include functional or psychogenic aphonia. It arises suddenly as a reaction to a traumatic situation in persons prone to hysterical reactions, more often in girls and women.
Speech disorders include bradilalia and takhilalia. With these disorders, the development of both external and internal speech is disturbed. Speech is incomprehensible to others.
Bradilalia is a pathologically slow rate of speech. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 230. With bradylalia, the voice is monotonous, loses modulation, constantly maintains the same pitch, sometimes a nasal tone appears. The musical accent also changes when pronouncing individual syllables, the pitch of the voice fluctuates up or down. Non-verbal symptoms in bradilalia are expressed in violations of general motor skills, fine motor skills of the hands, fingers, facial muscles. Movements are slow, sluggish, insufficiently coordinated, incomplete in volume, motor awkwardness is observed. Amicable face. There are also features of mental activity: slowness and disorders of perception, attention, memory, thinking.
Tahilalia is a pathologically accelerated rate of speech. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 230. M. E. Khvattsev (1959) considered the main cause of takhilalia to be congenital motor speech insufficiency of the speech apparatus, as well as sloppy, uneven speech of others, lack of attention and timely correction of the child’s fast speech. A. Liebmann distinguished between shortcomings in motor and acoustic perception that underlie takhilalia. G. Gutzman argued that this disorder is a consequence of a violation of perception. According to E. Freschels, accelerated speech occurs due to the fact that thoughts rush extremely quickly and one concept is replaced by the next before the first can be uttered. M. Nedolechny considered articulation deficiency to be the cause of accelerated speech, since patients have difficulty pronouncing unusual and long words. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 243
Stuttering is a violation of the tempo-rhythmic organization of speech, due to the convulsive state of the muscles of the speech apparatus. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 248
Alalia is the absence or underdevelopment of speech due to an organic lesion of the speech zones of the cerebral cortex in the prenatal or early period of a child's development. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.86. Intrauterine pathology leads to diffuse damage to the substance of the brain, birth traumatic brain injury and asphyxia of newborns cause more local disorders. Somatic diseases only exacerbate the impact of pathological causes of a neurological nature, which are leading.
Some authors (R. Cohen, 1888; M. Zeeman, 1961; R. Luhzinger, A. Salei, 1977, etc.) Speech therapy: A textbook for students of defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.86. emphasize the role of heredity, family predisposition in the etiology of alalia. However, there is no convincing scientific data on the role of heredity in the origin of alalia in the literature. In recent years, the significant role of minimal brain damage (minimal brain dysfunction) has been emphasized in the occurrence of alalia.
Aphasia is a complete or partial loss of speech due to local lesions of the brain. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.180.
The causes of aphasia are cerebrovascular accidents (ischemia, hemorrhage), trauma, tumors, infectious diseases of the brain. Aphasia of vascular origin most often occurs in adults. As a result of rupture of cerebral aneurysms, thromboembolism caused by rheumatic heart disease, and traumatic brain injury. Aphasia is often observed in adolescents and young people.
Aphasia occurs in about a third of cases of cerebrovascular accidents, with motor aphasia being the most common.
Aphasia is one of the most severe consequences of brain damage, in which all types of speech activity are systemically disturbed. The complexity of the speech disorder in aphasia depends on the location of the lesion. With aphasia, the implementation of different levels, sides, types of speech activity (oral speech, speech memory, phonemic hearing, speech understanding, written speech, reading, counting, etc.) is specifically systemically disturbed.
Acoustic-gnostic sensory aphasia was first described by the German psychiatrist Wernicke. He showed that aphasia, which he called sensory, occurs when the posterior third of the superior temporal gyrus of the left hemisphere is affected. A distinctive feature of this form of aphasia is a violation of the understanding of speech when perceiving it by ear. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.93.
Acoustic-mnestic aphasia occurs when the middle and posterior sections of the temporal region are affected (A. R. Luria, 1969, 1975; L. S. Tsvetkova, 1975). Neiman L.V., Bogomilsky M.R. Anatomy, physiology and pathology of the organs of hearing and speech / / Textbook. for stud. higher pedagogical textbook head. - M.: Humanit. ed. center VLADOS, 2003, p.177. A.R. Luria believes that it is based on a decrease in auditory-speech memory, which is caused by increased inhibition of auditory traces. With the perception of each new word and its awareness, the patient loses the previous word. This disturbance also manifests itself in the repetition of a series of syllables and words. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p.93
Amnestic-semantic aphasia occurs when the parieto-occipital region of the speech-dominant hemisphere is affected. With damage to the parietal-occipital (or posterior lower-parietal) parts of the cerebral hemisphere, a smooth syntagmatic organization of speech is preserved, no searches for the sound composition of a word are noted, there are no phenomena of a decrease in auditory-speech memory or a violation of phonemic perception. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.184.
Afferent kinesthetic motor aphasia occurs when the secondary zones of the post-central and lower parietal regions of the cerebral cortex are damaged, located behind the central, or Roland, furrow. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.184.
Effective motor aphasia occurs when the anterior branches of the left middle cerebral artery are damaged. It is accompanied, as a rule, by kinetic apraxia, which is expressed in the difficulties of assimilation and reproduction of the motor program. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 95.
The defeat of the premotor parts of the brain causes pathological inertia of speech stereotypes, leading to sound, syllable and lexical permutations and perseveration, repetitions. Perseverations, involuntary repetitions of words, syllables, which are the result of the impossibility of timely switching from one articulatory act to another.
Dynamic aphasia occurs when the posterior frontal sections of the left hemisphere, dominant in speech, are affected, that is, the sections of the third functional block - the block of activation, regulation and planning of speech activity. Zeigarnik B.V. Pathopsychology. - M.: Moscow University Publishing House, 1986, p.187.
The main speech defect in this form of aphasia is the difficulty, and sometimes the complete impossibility of active deployment of the utterance. With a rough severity of the disorder, not only speech is noted, but also a general lack of initiative, there is a pronounced echolalia, and sometimes echopraxia.
In the aspect of speech pathologies, a violation of written speech is also considered. These include: alexia, dyslexia, agraphia, dysgraphia.
Dyslexia is a partial specific violation of the reading process, due to the lack of formation (violation) of higher mental functions and manifested in repeated errors of a persistent nature. Speech therapy: Textbook for students defectol. fak. ped. universities / Ed. L.S. Volkova, S.N. Shakhovskaya. -- M.: Humanit. ed. center VLADOS, 1998, p. 176.
The etiology of dyslexia is associated with the impact of biological and social factors. Dyslexia is caused by organic damage to the areas of the brain involved in the process of reading. Functional causes may be related to the impact of internal and external factors. Thus, both genetic and exogenous factors are involved in the etiology of dyslexia (pathology of pregnancy, childbirth, asphyxia, a “chain” of childhood infections, head injuries).
Dysgraphia is a partial specific violation of the writing process. This violation is due to the underdevelopment (disintegration) of higher mental functions that carry out the process of writing normally.
Conclusion
Based on the research experience of such scientists as P. Broca, Wernicke, K.L. Kalbaum, S.M. Dobrogaev, M.E. Khvattsev, L.S. Volkova, A.R. Luria, M. S. Margulis, A. Liebmann, G. Gutzman, E. Freshels, M. Nedolechny and others, who made a significant contribution to the study of the problems of speech and motor pathologies, modern trends (both theoretical and practical) in the field of studying the mechanisms of motor and speech disorders, it provides an opportunity not only to get a deeper and more thorough understanding of the essence of this problem, but also creates promising conditions for direct corrective and adaptive assistance to people suffering from these disorders. In order for assistance to be as effective as possible, it is necessary not only to know the essence of the mechanisms of mental processes and the action of motor skills, the mechanism of their violation. Specialists involved in the study of these problems need to constantly and continuously orient their activities towards preventing the occurrence of pathologies, as well as systematically monitor the state of impaired functions, preventive activities of disorders, and provide specific assistance in this area to patients.
List of used literature
1. Zharikov M.N., Tyulpin Yu.G. Psychiatry. - M.: Medicine, 2002.
2. Zeigarnik B.V. Pathopsychology. - M.: ...........