RU2012229C1 - Method of vocal rehabilitation in case of motor aphasia in adults - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: vocal exercises such as pronunciation of words and word combinations, reading, recitation of texts, and free talking were conducted in tempo of light and aural stimulation at preset initial frequency of 1 H z and then 0.5 to 1.5 Hz which is equal to frequency of patient's motor rhythm proper. EFFECT: higher efficiency of rehabilitation.

Description

 The invention relates to medicine, namely to the rehabilitation of speech disorders (motor aphasia) in the pathology of the cerebral cortex.

 A known method of melodic-intonational therapy of speech, when when restoring expressive speech, short (roundabout) phrases are introduced into a simple melody. When pronouncing phrases, the patient makes a hand tapping the rhythm of the phrase.

 The disadvantage of this method is the relative low efficiency of rehabilitation in adults, especially during treatment in the later stages from the onset of the disease.

 The closest in technical essence to the proposed method is the rhythmic-melodic structure of speech, chosen as a prototype, when, when restoring speech disorders, the rhythm of the melody and poem is used, which is reproduced by the patient (tapping the fingers with a brush on the plane) simultaneously with the pronunciation of the text.

However, this prototype method has the following disadvantages:
with cortical pathology, a violation of the generation and reproduction of temporhythms is possible;
the relatively low effectiveness of rehabilitation, especially in the treatment in the later stages from the onset of the disease.

 The purpose of the proposed invention is to increase the effectiveness of rehabilitation.

 This goal is achieved by the fact that as an organizing and stimulating effect in speech rehabilitation, an exogenously presented light-sound temporal rhythm is used. Light and sound stimulation is performed through the operation of a standard photo-phonostimulator with an EEG 8S apparatus (f. "Medicor"). The initial stimulation frequency is 1 Hz. In the pace of presented stimulation, the patient reads specially prepared texts (autobiographical, poems, etc.), conducts a dialogue with the doctor.

 After several days of training, when mastering the rhythm with a frequency of 1 Hz, the frequency of exogenous stimulation is used, which is equal to the natural frequency of the cyclic movements of the patient’s hand, performed at an arbitrary pace. The natural frequency of cyclic brush movements (tapping at an arbitrary pace) is determined by the method of functional analysis of reproductive tapping: the patient at a random pace puts a series of strokes with the palm of the hand on a plane, and an electromyogram of movement is recorded in parallel. At a known speed of the electromyograph tape, the average duration of an individual motor cycle and the frequency of cycles in the sequence are calculated. The frequency obtained in this way (usually in the range from 0.5 to 1.5 Hz) is supplied to the patient through light and sound stimulation during rehabilitation. The duration of one lesson is 30-40 minutes (fatigue usually occurs with a longer duration of the lesson). Classes are held daily, in addition to this, the patient practices independently every day - he works on reading texts in a light-sound tempo.

 The duration of the course of treatment as a whole is until the defect is completely eliminated (usually a significant improvement occurs within 4-5 weeks).

 A comparative analysis of the claimed invention with the prototype shows that the claimed method differs from the known one in that when restoring motor aphasia (speaking words, phrases, reading texts, conversation), light and sound stimulation with an initial frequency of 1 Hz is used as an organizing and stimulating effect on the central nervous system and subsequent use of the frequency of its own motor rhythm (from 0.5 to 1.5 Hz). Thus, the claimed method meets the criteria of the invention of "novelty." A technical solution is known in which the feast for the restoration of speech disorders uses the rhythm of a melody, a poem, reproduced by the patient (striking the brush on the plane) simultaneously with the pronunciation of the text, which, however, does not allow for sufficiently effective rehabilitation, especially during treatment in the later stages from the onset of the disease that is achieved in the claimed technical solution. This allows us to conclude that it meets the criterion of "significant differences".

 EXAMPLE of a specific application of the method: Patient K., 32 g, case history No. 44, was admitted to the clinic of nervous diseases of the Central Clinical Hospital 01/08/91.

 Diagnosis: consequences of acute cerebrovascular accident in the pool of the left middle cerebral artery with motor aphasia syndrome, right-sided spastic hemiparesis.

 From the anamnesis: in 1986 she suffered an acute violation of cerebral circulation (against the background of aneurysm of the left middle cerebral artery).

 During a conversation with a patient, a picture of gross motor aphasia is revealed - he understands the speech, he follows the instructions. In colloquial speech, the patient uses only interjections, emboli (well...,...., Thirty..., Natasha...).

 In neurological status: smoothness of the right nasolabial fold, deviation of the tongue to the right. Hypertonicity of the right limbs. Decrease in muscle strength in the right hand from 3 (proximal sections) to 1.5 points (wrist), in the right leg decrease in muscle strength to 3 points. Tendon reflexes d> S, on the right pathological reflexes of Babinsky, Oppenheim. There are no disorders of sensitivity. PNP, PPC on the left performs confidently, on the right it cannot perform due to weakness and high tone. In the Romberg position, staggering without the dominance of the parties.

 Fundus: optic nerve discs with fuzzy contours, pale.

 Rheoencephalogram from 11.01.91g. - interhemispheric asymmetry, decreased blood flow on the left, on the right on the lower border of the norm.

 EEG from 01/11/91. A picture of the disorganization of cortical rhythm. Interhemispheric asymmetry is revealed: the main rhythms on the left (α, β) are 20% lower in amplitude. Dysfunction of stem structures is noted. Epiactivity is not registered.

Within 2 months, the patient was treated according to the described method:
First week:
pronunciation of phrases of the type: cat, tiger, lynx according to the tempo of the photo-phonostimulator (stimulation frequency 1 Hz); shield, sword, helmet, etc.
speaking in an exogenous tempo (tempo of stimulation frequency 1 Hz) of short sentences like: My name is Natasha. I have two children, etc.

Second week:
determination of the frequency of its own motor rhythm in a healthy (left) hand, for which the electrode of the electromyograph ("Medicor") was superimposed on m. Exstensor disitorum of the left forearm, an electromyogram of the movements of the brush made (applying a series of strokes with the palm of the hand along the plane) at an arbitrary pace was recorded. The speed of the electromyograph tape is 25 mm / s. For calculation were taken 12 sequentially recorded on the electromyogram of motor cycles. The average duration of the motor cycle is 31.2 ± 0.8, i.e., the frequency of its own motor rhythm is 1.25 Hz. Subsequently, the frequency of exogenous light and sound stimulation in all cases was 1.25 Hz;
development of phrases used in the first week of rehabilitation in an exogenous tempo (1.25 Hz);
reading in exogenous tempority (1.25 Hz) of simple texts compiled by a doctor from 6-8 sentences;
retelling of read texts at the rate of exogenously presented light-sound stimulation (1.25 Hz).

Third week:
work on the program of the second week with the gradual complication of texts for reading and retelling;
conducting free conversations (mainly answers to questions), stimulation frequency 1.25 Hz. In the future, more and more complex texts (verses, articles) were selected for reading, retelling, topics and the volume of free conversation expanded in the tempo of exogenous light-sound stimulation with a frequency of 1.25 Hz were expanded. Classes were held daily, in addition, the patient independently prepared assignments (read and retold texts in the tempo of exogenous light and sound stimulation with a frequency of 1.25 Hz).

 As a result of a 2-month treatment, the patient reads the texts prepared by her well, conducts a free conversation (sentences are short, of 3-4 words), the words emboli practically disappeared from the speech. Speech is much freer when talking in the tempo of exogenous light and sound stimulation with a frequency of 1-1.25 Hz.

 Using this method, 15 patients were treated: 10 men and 5 women aged 20 to 50 years with residual effects of traumatic and vascular pathology: 7 patients with severe motor aphasia, patients communicate interjections, emboli; 8 patients with moderate motor aphasia, in whose communication interjections, words-emboli, sentences of 2-3 words prevail. The statute of limitations from the onset of the disease is 0.5 to 5 years.

 Rehabilitation sessions were conducted from 3 weeks to 2 months. A good effect of treatment was observed in 6 patients (all patients with moderate aphasia): patients can communicate freely, have a conversation, independently make sentences of 3-5 words, read texts well (in 4 of them, aphasia was completely regressed). A satisfactory effect was observed in 7 patients (1 patient with moderate and 6 with severe motor aphasia): patients can communicate in short sentences of 2-3 words, read well prepared texts. In 2 patients, the effect of treatment is practically absent due to a decrease in volitional processes, a lack of desire to engage, due to a deeper damage to the brain structures and the presence of encephalopathy.

Using the proposed method of speech rehabilitation for motor aphasia in adults compared with existing methods has the following advantages:
a) increasing the effectiveness of rehabilitation in patients, especially during treatment in the later stages from the onset of the disease;
b) the possibility of an individual choice of the rate of exogenous light-sound stimulation corresponding to the frequency of the patient’s own motor rhythm. (56) Tsvetkova L.S. Aphasia and restorative education. M.: Education, 1988, p. 75.

Claims (1)

 METHOD OF SPEECH REHABILITATION AT MOTORAFASIA IN ADULTS by pronouncing words and texts in a given rhythm, characterized in that the rhythm is set by light and sound stimulation initially with a frequency of 1.0 Hz, then the individual frequency of an arbitrary tempo of movements of the wrist is measured and subsequent exercises are carried out in the rhythm of the found frequency range 0.5 - 15.0 Hz.