Causes
The main factor in the appearance of this deviation is damage to the cerebral cortex. This may happen due to the following reasons:
- head injuries of varying severity;
- tumor processes of benign and malignant nature;
- infectious diseases with inflammatory process;
- hemorrhage or ischemic stroke;
- poisoning with toxic substances.
A person's loss of the ability to express thoughts and feelings through spoken language is called aphasia. It is also a prerequisite for writing disorders. But most often it manifests itself as a symptom of some other disease.
These factors are the cause of the disease in adults. In infancy, agraphia can appear due to birth trauma to the head or pathology during pregnancy. And also because of alalia, in which the child cannot learn to speak, and, accordingly, write.
Types of agraphia
- Sensory agraphia is characterized by a violation of writing texts aurally and independently. When copying from a source, this deviation is not noticeable. A person simply copies what he sees or copies one letter at a time. This disorder occurs due to a defect in phonetic hearing, and is accompanied by impaired speech understanding and deterioration in sound recognition. But the main defect in this type of agraphia is a violation of written speech, mainly writing by ear.
- The afferent motor form arises due to pathologies of the lower segments of the postcentral gyrus. This type is manifested by writing disorders of all types, except for cheating. The person begins to skip letters. Most often this occurs in the middle of a word and can be missing from one letter to an entire syllable. It can also replace some letters or sounds (when writing down dictation text) with consonant or similar ones.
- Due to deviation or damage to the posterior frontal gyri, an efferent motor form appears. Agraphia manifests itself when writing words or syllables. The patient may not complete a word or replace syllables in it, or miss letters. The clinical picture consists of errors when writing text and can lead to a complete loss of this skill.
- Impaired perception of the image of letters and individual words is called optical form. It occurs due to damage to the lower segments of the occipital and parietal cortex. They are precisely responsible for the visual perception of images. First of all, this type is characterized by the impossibility of writing words due to the lack of images of letters.
These types of agraphia are the most common. Medical workers name several more varieties of this disease. For example, the cause of a defect in phonetic hearing and auditory-verbal memory is called damage to the left segment of the temporal cortex, or an aphasic type of agraphia.
If the symptoms of agraphia do not appear in conjunction with any other disorder, then such agraphia is called pure. Constructive and apractical agraphia arises against the background of constructive and ideational aphasia, respectively.
A defect in independent writing due to a disorder in the design and control of writing letters causes damage to the frontal segment of the brain; this is an atypical type of agraphia.
Let's complete the clinical picture
The most striking manifestation of the disease is the complete and irreversible loss of the ability to write. There is a strong disturbance in the structure of the word itself, letters are missing, the patient is not able to connect syllables, but the intellect remains unaffected, and previously developed writing skills are not impaired.
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A child or an adult cannot write a text from dictation or simply rewrite it from the original; the mirror placement of letters, words and entire sentences manifests itself.
Diagnosis of the disease
Diagnosis of the disease usually does not cause difficulties for medical specialists. Because the symptoms of this defect in humans are clearly expressed. The diagnosis can be made even with a simple examination by a neurologist.
It is more difficult to diagnose a person with the etiological factor of argafia. To do this, the doctor must understand in which part of the brain the focus of the disease is located. After that, they need to find out the reasons. First, the doctor interviews the patient’s relatives. He then carries out various diagnostic procedures and tests using a computer.
Establishing diagnosis
The process of diagnosing the disorder itself is not difficult. At the very beginning, the doctor conducts a detailed examination of the patient, conducts a neurological examination, and studies an example of the patient’s text. In practice, it is more difficult to diagnose the root cause that leads to the development of this disease.
First, the brain is examined and the lesion is identified and, as a result, the cause of the disorder. To do this, the doctor conducts a survey of the patient and parents, if it is a child, then additional methods of neurological examination are used - MRI or CT, X-ray examination of the skull.
Doctors also use electroencephalography and ECHO – encephalography in the diagnostic process.
Treatment
Correction of agraphia is characterized by a long and labor-intensive process for the doctor and the patient. Treatment does not guarantee a complete recovery, but it helps people return to normal life and the child to develop together with his peers. First of all, a person registers with a neurologist.
He prescribes a specific course of treatment and practical writing classes, which can be individual or group. Before starting to correct the writing of the text, the specialist studies the patient’s oral speech. He corrects and corrects gaps in her development.
In addition to a neurologist, a speech therapist and a psychiatrist work with the person. This is done to make it easier for the patient to master sounds and prepare for writing text. Often the doctor prescribes gymnastics. Exercise has been proven to improve skills. Such loads can even begin with the movement of the fingers or hand.
With constant exercise, sensitivity increases. The patient is prescribed to practice singing and listen to music. Thanks to this, the vocal cords develop and the perception of sounds improves. Playing musical instruments helps develop hand motor skills. The most important factor contributing to effective treatment is the attitude of the patient and his relatives. The more positive emotions the patient receives, the faster he will recover.
Neuropsychological analysis of various forms of agraphia and methods for overcoming it
Home Favorites Random article Educational New additions Feedback FAQSpeech forms of agraphia Sensory agraphia
The clinic has long been aware of the symptoms of sensory agraphia. For the correct flow of the writing process, first of all, a clear, constant perception of the phonemic structure of the language is necessary, which creates the necessary prerequisites for the correct sound-letter analysis of the word. Impairment of phonemic hearing inevitably leads to impairment of sound-letter analysis. In these cases, the letter may either be completely disintegrated and then the patient cannot write a single letter or word, either in independent writing or from hearing. He only has ideogram writing, and even then not always. In cases of a less pronounced degree of impairment, the writing of these patients is replete with literal and sometimes verbal paraphasias; sounds are replaced by the patient according to the phonemic rule. Here are examples of sensory agraphia.
The given examples indicate blurriness and unclearness of the auditory analysis of speech in these patients, which was reflected in the writing, violating it from the sound analysis of the word.
The central mechanism of sensory agraphia is a violation of the acoustic perception of speech, its phonemic
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hearing The central defect is the practical collapse of all types of writing, and above all writing by ear.
The clinical picture of sensory agraphia reveals either a complete loss of the ability to write, or rough literal paragraphs, which are a replacement of oppositional sounds in acoustic perception.
In the psychological structure of writing, the sensorimotor level of organization of this process in the sound discrimination link is disrupted, and the linguistic level - all its sublevels - sounds, words, sentences, texts is secondarily disrupted. The psychological level of organization and implementation of writing (intention, design, motives) remains intact.
Control functions of writing are also impaired, but not as a type of purposeful activity, but secondarily, due to defects in phonemic hearing.
Sensory agraphia occurs in the syndrome of sensory aphasia: in the syndrome of impaired oral expressive and impressive speech. With sensory agraphia, the following are impaired: a) auditory writing (dictations, summary notes of what was heard), b) independent writing, c) copying is relatively more intact, but it is also impaired: the automated method is replaced by the conscious process of letter-by-letter copying, and often simply copying.
The main principle of learning in this case is the way of using intact analyzers - visual, kinesthetic and speech motor as a support for restoring the basic prerequisites for writing. The creation of a new afferent system from intact analyzers effectively influences the restoration of impaired function. In the process of the dynamics of reverse development, the residual capabilities of the acoustic analyzer are gradually brought into play to normalize the writing function to the extent possible.
The central task of restorative training for sensory agraphia is the restoration of a clear awareness of each individual sound, the ability to isolate it from a whole sounding word, i.e., the restoration of a conscious analytical-synthetic process of writing. This task is common to both the restoration of writing and the restoration of oral speech in sensory aphasia, and work to restore the two functions is carried out in parallel. With properly constructed training, the reverse development of two forms of speech successfully influences one another.
The first stage of training for patients with sensory agraphia does not aim to work on the perception of individual speech sounds and does not provide for the restoration of writing. Work at this stage is carried out with extensive use of the preserved general semantic sphere: all efforts here are aimed at restoring the patient’s ability to listen and hear speech, to isolate and identify first entire texts, then entire sentences.
statements from these texts, and later - the ability to follow verbal instructions and highlight individual words from the proposed text.
At the second stage, the patient is taught to know letters, since in the rough form of sensory agraphia, knowledge of the alphabet and its letters is often lost.
After learning to know and name several, the most frequent letters, patients are taught to recognize sounds from the ear, but work on differentiated perception of sound goes through the word by correlating the sounding word with the corresponding picture and with a graphic representation of this word according to the following scheme: sounding word -> object -> written word. The patient is given a word to hear (pronounced by the teacher or from a tape recorder), he must find the corresponding picture (choose from several) and then select the desired written word from 3-5 words lying in front of him, select the first letter, correlate it with the sound, then find letter in the split alphabet, write it down from memory and at the end write down the whole word. In this way, recognition of sounds is practiced, correlating them with the corresponding letters, but only through the word and its semantic content.
A number of exercises serve to consolidate the connection between a sound and the corresponding grapheme: 1) choosing the desired letter in a split alphabet, 2) writing a letter in a notebook, 3) underlining it in a given text, 4) choosing real objects (or pictures), the name of which begins with sound-letter being practiced, 5) filling in missing letters in a word, etc.
The restoration of differentiated and constant perception of speech sounds becomes the subject of special training only at the third stage of training, at which work begins on the restoration of written speech itself. First, the patient is taught to know the letter, i.e., to name it, to recognize it by ear using certain methods1.
During this period of training, the method of feeling three-dimensional letters is used: the patient, having heard the sound, finds the desired letter, feels it, writes it down, then places it under the desired picture, the name of which begins with this letter, etc. The work is carried out according to the scheme: sound palpation letters writing letters, i.e. based on kinesthetic and optomotor skills. At this stage of training, there are also tasks related to the restoration of analytical writing by restoring the generalized perception of sounds.
One of these methods is to orient the patient to the positional relationships of sounds within a word, which is
1 For more details, see: Luria A. R. Restoration of brain functions after war trauma.— M., 1948; Tsvetkova L. S. Restorative training for local brain lesions. - M., 1972.
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provides the prerequisites for restoring the generalized perception of sounds. The patient is taught to distinguish not pure sounds, for example t, d, k, g, etc., but all possible variants of their sounds (t-te-ti-to-tu-tu-ta-oto-atu, etc.) . Teaching practice shows that often patients, having learned to isolate and recognize a sound in a certain combination with one or two other sounds, do not recognize it in all other combinations. Therefore, at all stages of learning, the patient is oriented toward the perception not of an isolated sound, but of the entire system of sound relationships within a word. That is why one of the most important tasks of learning to write at the fourth stage is restoration
ability to distinguish sounds within a word and on its basis - restoration of the writing of whole words. An effective technique here is to identify the quantitative and qualitative structure of the word.
The patient is given a picture with an object (phenomenon, action) depicted on it, the name of which is a simple word consisting of 1-2 syllables. Below the picture is a ready-made quantitative diagram of the word (in the form of squares or dashes). The patient first listens to the name of the object, then repeats it. And only after that he begins to isolate each sound that is part of the word, using for this a mirror, an oral image of a sound, etc. He sequentially writes each isolated sound into the corresponding square; Gradually the analyzed words become more complex. Over time, the patient begins to analyze the composition of the word independently and from a qualitative perspective.
The described method of work, consisting of a series of sequential operations: 1) listening to a word, 2) repeating it, 3) isolating the first sound based on a mirror, 4) oral
image, 5) isolating the subsequent sound, 6) recording each sound in the corresponding cell, 7) correlating the sound with the letter,
writing the letter from memory - uses materialized means as an external support and is one of the effective ways to restore the writing of words. A significant role is played here by materialized supports, for example: a picture with a depicted object, which helps to retain the entire word with which analytical work is being carried out; squares (quantitative scheme) for recording already identified sounds, the ability to separate that part of the word that has already been analyzed from the one that still needs to be analyzed. Gradually, this expanded method of analyzing a word is reduced due to the loss of certain materialized means.
In order to normalize the writing process, a defective acoustic analyzer is later put into operation. To do this, various exercises on sound discrimination using a tape recorder are included: dictations of sounds and words recorded on a tape with analysis of detected errors, their written practice, etc. are useful. Only after maximum success in restoring the processes of sound discrimination, the ability to write letters, words (based on intact kinesthetic sensations and optomotor coordination) move on to restoring oral speech and writing.
Thus, the method of restoring writing in sensory agraphia is aimed at overcoming defects in phonemic hearing and creating methods for the process of sound discrimination using a certain system of techniques that uses intact afferentations from other analytical systems, relying on the semantics of the word. The most effective techniques are pronunciation when analyzing and recording words, oral and kinesthetic (feeling) methods of analyzing sounds, working on the meaningful role of phonemes, conscious control of all operations (Fig. 7, 8, 9).
Afferent motor agraphia
A completely different picture of the breakdown of writing is observed with damage to the lower parts of the retrocentral region of the left hemisphere, often accompanied by afferent motor aphasia and agraphia. It is known that in order to correctly write a word, and especially a series of words, it is not enough to isolate and clarify its sound characteristics. It is also necessary to clearly differentiate sounds according to their kinesthetic foundations, according to the place and method of their formation. It is known that the act of writing necessarily involves hidden articulations. With afferent motor agraphia, patients, due to disturbances in speech kinesthesia, lose articulatory boundaries between sounds that are close in place of origin. Central
The main mechanism of writing impairment in afferent motor agraphia is defects in kinesthetic sensations, which lead to disruption of fine articulatory movements and the inability to clearly differentiate sounds according to their kinesthetic bases, which leads to a central defect in writing - impairment of the writing of individual sounds that are similar in method and place of education.
Violations of the kinesthetic mechanisms of speech lead to defects in the formation of articulations, as a result of which patients “do not feel,” in their own words, the sounds that they should write down. When trying to write a dictated word or sound, the patient tries to pronounce it, but impaired speech kinesthesia does not give him the opportunity to correctly repeat the heard sound, and therefore in his own speech some sounds are replaced by others, adjacent in articulation. A patient who has lost internal patterns of articulation, despite the preservation of the acoustic and visual analysis of the word, is unable to write it correctly either by ear or independently. Violation of writing in this case appears in a rough form, but for different reasons. In the clinical picture of these writing disorders, the patient exhibits literal paragraphs. The most common mistakes are: 1) replacing some sounds with others that are close in location; 2) omissions of consonants when they are combined; 3) omission of vowels in words; 4) omissions of entire syllables from the middle of a word (“Pov” instead of Pskov,
“potvy” instead of
tailor
, etc.).
The most common and characteristic errors in this form of agraphia are substitutions of sounds: t-d-l-n; m-v-n; t-k; e-s-sh-h; v-f , etc. Usually patients complain that they do not “feel” these sounds. Many of the patients, instead of the word table,
usually write “slom”, or “snol”, or “elephant”, and the word
moment
is written either as “bomet”, sometimes as “mobel”,
outside
- “stdaruzhi”,
swim
- “ bnavat”, etc.
As in the case of sensory agraphia, in the case of a writing disorder that accompanies afferent motor aphasia, the psychological picture of the disorder reveals defects at the sensorimotor level in the structure of writing, in the level of sound discrimination, but for other reasons - due to defects in the kinesthetic basis of writing.
Afferent motor agraphia occurs in the syndrome of afferent motor aphasia, in which oral expressive speech is impaired by the same mechanisms, defects of which affect writing. With this form of agraphia, almost all types of writing are impaired, except for copying. Independent writing (presentation, composition) and writing from hearing (dictation) are especially seriously violated.
The main task of restorative training for this form of agraphia is to restore the process of sound production.
learning, which leads to correct sound-letter analysis when writing. For this purpose, work is carried out based on intact acoustic and visual analyzing systems.
To restore writing, work is carried out at a conscious and voluntary level of its implementation; all operations of writing letters, words, phrases, text are performed under the control of consciousness and with the assistance of external supports.
In working with sensory agraphia, as we have seen, the leading role belongs to vision and kinesthetic sensations - pronunciation, while the auditory analyzer comes into play later.
In cases of violation of the articulatory analysis of sound, on the contrary, the auditory analyzer is turned on together with the visual analyzer from the very beginning. However, in these cases, a defective speech motor analyzer must be connected immediately, but only in combination with sound and visual control, since, as practice has shown, pronunciation is one of the most necessary components of writing.
Since learning to write always goes hand in hand with the restoration of oral speech, at the first stage of training maximum attention is paid to learning the pronunciation of words. The work here is carried out by switching the patient’s attention from the articulatory, pronunciation side of the word to its semantic sphere. Work is carried out on pronouncing a whole word using the method of semantic and auditory stimulation, which is described above.
They move on to sound-letter analysis of the composition of words being practiced only after the patient has accumulated a certain passive and active vocabulary. The central task of training at stage I is to teach the patient to pronounce whole words and the ability to isolate individual sounds from a word. The goal of the act of writing during this period of learning becomes the word, and not a separate sound-letter, which, as is known, does not carry any information. Relying on the meaning of a word when writing it helps restore its graphic image.
Teaching how to write a word should take into account a number of conditions: 1) selection of a word, taking into account some of its parameters - a) frequency - objective and subjective, b) phonemic complexity, c) length, d) semantics of the word (the selection of words comes first from different semantic groups, and later - from relatives or from the same field, for example: porridge, window, tree
etc.,
tomato, milk, pear,
etc.,
tomato, cucumber, potato, beet
, etc.; 2) work on writing a small number of words; 3) obligatory reliance on the semantics of the word, i.e. the connection of words with their meaning, sense, and subject matter; 4) reliance on an object or its image (picture) with the simultaneous sound of the corresponding word-name, ensuring its fixation and meaning.
Before writing a word, the patient is aroused
the concept of its polysemy, semantic sphere, correlates the word with the subject. After this, the patient repeats the word to be written, controls its articulatory composition through a mirror, conducts an element-by-element analysis of the audible and spoken word, then composes it using the letters of the split alphabet, copies it, writes from memory - and all these operations are necessarily accompanied by pronunciation.
It is known that the restoration of oral speech, writing and reading usually occurs together and the restoration of one form of speech affects the restoration of others. However, teaching practice and special studies of the mutual influence of different forms of speech on each other in the process of reverse development have shown that with afferent motor aphasia there are certain patterns that indicate the different roles of different forms of speech at different stages of reverse development.
Thus, restoration of writing can have a negative impact on the restoration of the patient’s oral speech if it is started against the background of a complete absence of oral articulate speech and any passive or active vocabulary. Since writing is a highly voluntary act, and oral speech begins to be restored by reviving its involuntary level, it is impossible to fix the patient’s attention on the pronunciation side of speech. Studies have shown that many patients can only write those words that they have in their active vocabulary, that is, those that they can pronounce. And, therefore, at this stage of learning, the leading role belongs to oral speech - oral speech (the accumulation of active and passive vocabulary) contributes to the restoration of writing.
Let's give an example. Patient R. with a severe form of afferent motor aphasia and agraphia (a condition after a gunshot wound in the posterior-frontal, inferior parietal parts of the left hemisphere) is offered a dictation of words that were in his active dictionary and words that he did not pronounce (Fig. 10).
These facts confirm the importance of speech kinesthesia in the act of writing: words that are not yet in the patient’s oral speech, he analyzes and writes with great difficulty, making many mistakes, and most often refuses to write altogether.
Therefore, at the very beginning of recovery of writing in patients with afferent motor aphasia and agraphia, they work on oral speech, on the ability to pronounce words when writing. They begin to work on writing only when they have accumulated the necessary vocabulary of oral speech. And only then the writing of these words, in turn, begins to have a positive effect on the purity of their pronunciation and on their consolidation in oral speech. Subsequently, an inverse relationship occurs: writing (and reading) precedes the restoration of oral spontaneous speech and serves as a support for its restoration, positively influencing
growth of active vocabulary, speed and clarity of pronunciation of individual words and statements.
As oral speech is restored and spontaneously arising words appear in the patient’s dictionary, the ability to write words not only from the patient’s active dictionary, but also words that are not yet in his active spontaneous speech is restored.
After teaching the patient to independently write the words he has in his active dictionary, as well as under dictation, they move on to teaching analytical writing - writing individual sound letters, isolating letters from a word and writing letters, etc. This stage of training is important, since practicing knowledge of individual letters and the ability to write them, restoration of the patient’s ability to correlate a sound with an articulome (pronunciation), and then with the corresponding letter in subsequent writing
will help restore speed and accuracy of writing.
At this (second) stage of writing restoration, various exercises are used with a tape recorder: 1) dictation of words with the speaker highlighting the first sounds and recording these letters (for example, the speaker pronounces the leg,
the patient writes
leg
and underlines the letter n); 2) dictation of individual sounds based on the letters lying in front of the patient (the patient listens - sees - writes); 3) dictation of sounds without relying on letters.
The restoration of written phrases goes in parallel with the restoration of oral expressive speech and largely depends on it. The structure of the phrase in this form of aphasia does not suffer severely, and writing defects continue to remain at the level of isolating sounds, at the level of writing individual words. Therefore, the effectiveness of restoring the writing of a phrase depends on the effectiveness of overcoming the main defects in this form of agraphia.
Thus, the first and main difficulty in writing a phrase is still associated with defects in the analytical writing of individual words, which remains an arbitrary and detailed action, requiring the patient to fully concentrate his attention. In this regard, a second difficulty arises - deterioration in memorization (or recall) of the content and lexical composition of the phrase. The third difficulty is the impressive and expressive agrammatism of the oral speech of patients, which occurs when writing phrases and texts and manifests itself primarily in a violation of the coordination and control of words within the phrase. It is especially difficult for patients to find the necessary inflections and write them down correctly, which is due, in particular, to the presence of iotated sounds in some endings of words (ey, ii, aya, y, etc.), which present difficulties for these patients to pronounce them correctly, and therefore, and for writing them. Therefore, methods for restoring the writing of a phrase involve eliminating (gradually removing) these difficulties with the help of external materialized supports. Such supports are: 1) plot pictures that bring out the content of the phrase and fix it; 2) strips of cardboard (or any other cards) that provide materialization and fixation of the quantitative side of the phrase (the number of cards corresponds to the number of words in the phrase); 3) letters of the split alphabet, with the help of which the sound highlighted by pronunciation is immediately designated (the desired letter is laid out).
Later, when the unit of work becomes not a letter, but a word, the patient selects the necessary one from a series of words written on cards and places it under the corresponding picture.
The phrase is read to the patient in its entirety and copied while pronouncing it loudly, then written from memory. As the patient masters this method of writing phrases, he practices
writing phrases using a reduced number of supports. First, strips of cardboard are removed (the patient replaces them with counting on his fingers), later both the cut alphabet and the written words are removed, and at the end of the work the plot picture is also removed, and instead of it the phrase is pronounced by the teacher (dictation) or the patient himself comes up with a sentence (independent writing) . Work on restoring the correct writing of the endings of words is also carried out with external support on
subject or subject pictures with various endings labeled. When writing a phrase, the patient selects the desired ending of the word (out of 3-7 given inflections). The method of written answers to questions is also used. The patient is given an object picture, which he names, and then answers the questions in writing with one word in the required case. For example, the picture shows a knife. The speech therapist asks him a question: “What is shown in the picture?” - "Knife".
- “Do you have a knife?”
- “No knife.”
- “How do they cut bread?”
- “With a knife.”
Etc. When working on restoring the writing of a phrase, a number of exercises are also used: filling in the missing words in a phrase, filling in the missing sentences in the text, composing a letter to relatives based on questions, etc. The described methods of work and the corresponding procedure for their application lead to positive results in restoring writing in afferent motor agraphia (Fig. 11, 12, 13).
Efferent motor agraphia
In the cases discussed above, the patients suffered from a clear sound structure of the word due to the breakdown of sound-letter analysis operations, either due to acoustic disturbances or due to articulatory defects. These defects in acoustic and kinesthetic gnosis caused disturbances in the perception of sound, which led to impairments in writing. Preserving the order of sounds in a word was not a major difficulty for them. To write a word correctly, it is not enough to analyze its sound-letter composition; you also need to understand the sequence of sounds in the word. Maintaining the required sequence of sounds when writing a word is one of the most significant difficulties in the initial development of writing skills in children. Damage or dysfunction of the posterior frontal regions of the left hemisphere of the brain leads to precisely these defects in writing. The process of writing individual letters does not present any difficulties in these cases; in contrast to previous forms of writing impairment, difficulties arise when writing syllables and words. These defects are based on a violation of the switching mechanism, i.e., denervation mechanisms.
The central mechanism underlying efferent motor agraphia is a violation of the kinetic organization of the motor side of oral speech, defects in the timely denervation of the previous and innervation of the subsequent speech act, which leads to pathological inertia of emerging stereotypes in oral and written speech. This mechanism leads to defects in switching from one sound (word, sentence) to another in the process of oral speech and from one sign to another in written speech. Violation of the switching process is the central defect in efferent motor agraphia. In the clinical picture of agraphia, this defect manifests itself in a number of errors in writing, up to its gross collapse. The main mistake is perseveration. In second place after this error and due to the collapse of the patient’s awareness of the internal scheme of the word and the sequence of letters in it are rearrangements of letters in the word; then - omissions of letters indicating vowel sounds or consonants when they are combined; repetitions of the same syllable (word) are often encountered; underwriting of words, etc. Patients experience significant difficulties not only when writing words, but also when laying them out from letters of the split alphabet.
With afferent motor agraphia, there is also an error of underwriting words, but it differs significantly from the same error with efferent motor agraphia. In the first case, patients can write the outline of a word, omitting its middle, and in the second, they omit the end of the word, which is associated with a violation of writing as a successive process.
Efferent motor agraphia occurs in the neuropsychological syndrome of efferent motor aphasia, disorders of dynamic praxis. The psychological picture of a writing disorder is characterized by a violation of the internal scheme of words and sentences, a violation of awareness of the sequence of letters in a word (words in a sentence). Word and sentence do not consist of individual sounds (words), but a certain internal scheme is assumed, within which words are in complex syntactic and grammatical relationships. In patients with this form of agraphia, awareness of the complex relationships of words within a sentence is impaired, and the dynamic relationships of words are also lost, thanks to which not the word, but the sentence becomes the unit of meaning and sense. These patients find it difficult to create “in their minds” a diagram of an entire grammatical structure, to place and link individual words into sentences.
In severe cases of violations, this contingent of patients lacks all types of writing, with the exception of ideogram. Even when copying, which is the most secure, these patients make many mistakes, the process of copying itself takes on the character of an expanded, conscious and letter-by-letter letter, while the patients pronounce every sound and syllable. The general goal of rehabilitation training in this case is to restore analytical writing in patients .
The goal of the first stage of training is to restore the writing of individual words, and the task is to teach patients to analyze the structure of a word, recognize and retain the sequence of letters within it. At this stage, a number of methods are used to help solve this problem. This is, first of all, a method of conscious analysis of a word, consisting of a sequential series of operations: 1) element-by-element pronunciation of the word; 2) quantitative analysis of a word (counting the number of sounds in a word) using external means (abacus, sticks, etc.); 3) drawing up a word diagram based on the analysis (letter-by-letter and syllable-by-syllable scheme); 4) sequential filling of the diagram with the corresponding letters. The psychological essence of this method of analyzing a word using materialized means is that the entire process of writing a word (and later a sentence) is taken outside, becomes the subject of conscious activity, and chip cards and arrows in a materialized form represent the structure of the word and the sequential connection of letters in German Consolidating the analytical skill of writing words is carried out by a number of exercises: 1) analyzing a given word by syllables and letters (first based on the corresponding picture and the written word, then only on the picture, and later - analysis of the word by ear); 2) analyzes of words that are similar in phonetic structure and serial organization, but different in meaning (Colonel
-
ladle
-
fan;
magnolia -
Mongolia;
cancer -
acre
and
etc.); 3) completing unfinished words; 4) filling in the missing letters (or syllables) in a given word; 5) composing (and writing) a word from various syllables given randomly (ra, ta, bo, kan
and etc.).
The second method is to form words by rearranging letters. Patients are given a word from which they must make as many other words as possible (for example, typography - type, graph, vulture, graphite, pir, tiger
and etc.).
In psychological essence, the method of composing words based on one syllable or the root part of words (for example, steam - locomotive , steamboat, greenhouse, partner, steam room, steamer, etc.
) is also close to this method.
These methods are aimed at analyzing a word on a morphological basis and ensure the restoration of awareness of the connection between the sequence of letters in a word and its meaning (court
-
mole;
mor -
rum;
they say - -
scrap;
cat -
current;
three -
shooting range
, etc.). The words found in this way, analyzed in terms of the sequence of letters in the word, are written down by the patients, pictures corresponding to them are found, these pictures are signed from memory, and at the end the words worked out in this way are written under dictation.
All these and a number of other methods stimulate the patient to analyze the sequence of letters in a word and restore awareness of its role in understanding the meaning of the word. They, by fixing the patient's attention on the structure of the word, on the significant role of the sequence of letters, are thereby an effective means of eliminating the main defect. At the first stage of training, patients usually master a wide system of auxiliary means and independently use them when writing words and short, simple-structured phrases. The requirements for the material on which writing is taught remain the same - frequency, phonetic complexity, word length - all this should become more complex gradually. The entire wide system of supports, as well as operations, is gradually reduced, and when writing words, patients turn only to letter-by-letter or syllabic pronunciation.
Then they move on to the second stage of training, the task of which is to restore the writing of the phrase. A phrase, as we know, does not consist of independent words, but presupposes a certain internal scheme in which words are in complex syntactic and grammatical relationships. With efferent motor aphasia and agraphia, a violation of the knowledge of these relationships is detected, which manifests itself in syntagmatic defects: patients find it difficult to create “in their mind” a diagram of an integral grammatical structure, to place and connect individual words within a sentence, which is the central defect in writing at the level of sentences and texts . Work on restoring the writing of phrases involves, first of all, teaching patients oral speech, the ability to compose sentences,
knowledge of certain grammatical structures. We described methods to help restore this skill in Chapter V.
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Prevention
Prevention is any physical activity related to fine motor skills of the hands. Drawing, practice writing letters and words, gymnastics. Such exercises should be carried out constantly and as often as possible.
Treatment does not provide accurate prognosis. Much depends on the patient’s mood and the degree of brain damage. Agraphia cannot be cured on its own. Therefore, even with the slightest symptoms of the disease, you should contact medical professionals. Only a set of restorative procedures and the necessary drug treatment will help a person keep in touch with the outside world.
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Types of disorders - their characteristics
The following types of agraphia are distinguished:
- Pure or amnestic - in this case, the patient experiences a failure in writing, when the text is written under dictation or it is written from an audio original, and when copied, the ability to write is preserved to a greater or lesser extent. Often in its course it is combined with Gerstmann's syndrome, acting as its clear symptom, and in a severe form of its course it manifests itself in the mirror spelling of words. In the latter case, a mirror subtype of pure agraphia develops.
- The apraxic form of pathology manifests itself as an independent disease or can be a manifestation of ideational apraxia. The child is simply unable to understand how to hold a pen, and subsequent movements do not contribute to the correct writing of letters and words, or their sequence. This form of the disorder is diagnosed in any type of writing, both under oral dictation and when copying text independently.
- The aphasic form of the disorder is formed by aphasia, in which the left temporal cortex in the structure of the brain is affected, which causes problems with auditory and speech memory, as well as the phonemic type of hearing.
- Constructive form of the disorder - develops with a constructive type of pathological changes in the brain.
What parts of the brain are affected?
When the left temporal cortex is damaged in the brain, an aphasic form of pathology develops, which provokes a violation of the auditory-verbal type of memory and damage to the phonemic type of hearing.
If disturbances are diagnosed in the functioning of the posterior sections of the 2nd frontal gyrus, located in the patient’s dominant hemisphere, then doctors diagnose a pure form of agraphia, not associated with other pathologies and diseases.
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If the patient writes in a mirror order, a mirror subtype of the disorder develops, and this form of pathology is most often diagnosed in left-handed people, in intellectually retarded patients, when there is a failure in the interaction between the hemispheres of the brain.
Dysgraphia is a special case of agraphia
Dysgraphia is a specific disorder of written speech, which manifests itself in persistent errors and occurs in the event of a disorder in the higher parts of the central nervous system. The causes of the pathology may be heredity and disease, injuries and infections of the central nervous system suffered in infancy, uneven development of both hemispheres of the brain.
The list of reasons also includes other neurological problems, excessive addiction to TV or computer.
Often the occurrence of dysgraphia contributes to the development of dyslexia.
The symptoms of the pathology may vary - it depends on the root cause of the disease. Children diagnosed with dysgraphia are smart, with a high level of intelligence, they can do well in other school subjects, but they make a lot of mistakes in their notebooks, confusing the spelling of letters such as R and Z, E and Ъ.
