Paraphasia is a symptom of a number of speech and neurological disorders, characterized by the replacement of correct sounds, letters, syllables, words with others that do not comply with the norms and rules of the language. It occurs in patients with aphasia, alalia, various types of dementia. Substitutions can be literal, verbal, mirror. Paraphasias are detected as part of the diagnosis of the leading clinical syndrome. Correctional work is carried out in several directions: minimizing the consequences of cerebral damage, correcting impaired mental functions, and speech rehabilitation.
The term "paraphasia" comes from two Greek words: "para" - "about", "rhasis" - "speech" and can be interpreted as "approximate statement". The essence of the disorder is the replacement of a part or a whole word with another one that distorts the structure and meaning of a unit of speech. Substitutions in writing are called paragraphs, while reading - paralexia. In modern speech therapy, 3 types of paraphasia are distinguished:
Both literal and verbal paraphasias occur in Alalik speech. In the case of motor alalia, this symptom is based on difficulties in finding and switching the articulatory position, problems in mastering the motor scheme of the word, and poor vocabulary. Speech negativism (unwillingness to speak) is characteristic. All stages of speech development are delayed and distorted. The syllabic structure of the word is violated, grammatical categories are not assimilated, vocabulary and coherent speech suffer. In gross cases, speech remains at the level of onomatopoeia, babble, facial expressions and gestures.
The occurrence of paraphasia with sensory alalia is due to the inability of the child to differentiate speech sounds by ear. This leads to their numerous substitutions, approximate articulation, distortion of the sound content of the word. Typical manifestations are perseveration, contamination, echolalic repetitions. The meaning of speech is lost.
Alalia and its accompanying symptoms are caused by congenital or early acquired (in the preverbal period) lesions of the speech zones of the cerebral cortex. Damaging factors can be:
Paraphasia with alalia
The phenomena of paraphasia are present in the speech of patients with various forms of aphasic disorders. Violation of auditory control and auditory attention underlies acoustic-gnostic aphasia. With sensory aphasia, both verbal and phonemic paraphasias occur, which is associated with the phenomenon of alienation of the meaning of a word - the loss of the constant sound of phonemes and words. Along with paraphasias, there is logorrhea, floridity of statements, and rapid depletion of auditory attention.
Acoustic-mnestic aphasia is characterized by a defect in auditory-speech memory. It is manifested by the rapid forgetting of information, vocabulary deficit, difficulties in understanding. This explains the presence in speech of a large number of verbal paraphasias, difficulties in naming objects.
Motor aphasias (efferent and afferent) are due to the presence of articulatory difficulties in the implementation of the motor program of utterance. In both cases, literal paraphasias arise: in the afferent form, they are expressed in substitutions of articulatory close sounds, in the efferent form, in syllables. Similar difficulties are present in writing.
Aphatic disorders are caused by organic lesions of the speech systems of the brain that occurred during the period of speech proficiency. Among the main reasons:
Patients with moderate dementia have memory problems and associated verbal paraphasias. A person forgets the names of objects, denoting them with words similar in meaning or sound. Reading and writing skills fall apart. There is an impoverishment of the lexical stock, a decrease in fluency of speech. In the severe stage, speech activity is reduced to single words and phrases or is completely lost. Paraphasias are present in the clinic of vascular (cerebral atherosclerosis), atrophic (Alzheimer's, Pick's, Parkinson's), senile and other dementias.
Paraphasia is a speech symptom indicating the presence of a neurological deficit, therefore, along with a speech therapist, patients should be examined by a neuropathologist, a neuropsychologist. The specific plan and content of the diagnostic stages depends on the desired pathology. In most cases, you need:
speech therapy classes
Paraphasia is not an independent disorder, therefore its elimination directly depends on the treatment of the underlying disease. Neurorehabilitation for brain lesions consists of medication and supportive treatment. Patients are prescribed courses of nootropics, antihypoxants, vasoactive, anticonvulsant drugs. In the recovery period, exercise therapy, physiotherapy (transcranial micropolarization, darsonvalization, electromyostimulation), mechanotherapy are shown.
It is aimed at overcoming speech negativism, activation of interhemispheric connections, correction of HMF disorders, slowing down the progression of cognitive deficit. In childhood, the basis of training with a neuropsychologist is play therapy. In all age groups, neurodynamic gymnastics, neuropsychological exercises, auto-training, psychotherapy are useful. It is important to work with the patient's relatives.
Speech rehabilitation aimed at overcoming paraphasia and other speech disorders is carried out in parallel with the previous stages. Its content depends on the structure of the speech defect, mainly on the violation of the motor or sensory component of speech.
In case of disorders of the motor link of the speech act, the tasks of speech therapy correction are:
With paraphasia caused by sensory speech disorders, the work is aimed at: