Semantic agraphia of certain complex ones. General characteristics of agraphia. Classification of agraphia according to Luria – Tsvetkova. Afferent motor agraphia

Agraphia is a limitation in the ability to write that arises from dysfunction of speech processes. Agraphia can be detected in the absolute loss of a skill or in gross distortion of words, omission of letters, or a violation in the merging of syllables or letters in a word. Often, writing impairment occurs in the absence of coordination dysfunction of the upper limbs, against the background of intact mental activity. Agraphia arises as a result of damage to the posterior segments of the frontal gyrus. In children, agraphia is a manifestation of alalia (immaturity of speech function), which occurs as a result of brain damage. In addition, the deviation in question is also noted in children with speech disorders caused by problems with mastering the sound sequence of words and deviations in the sound parsing of words. In adults, agraphia is a manifestation of aphasia (speech dysfunction).

Causes of agraphia

Writing is considered a complex process of the psyche, since it is directly related to mental processes and, in addition, involves the motor sphere.

Agraphia what is it? The deviation in question implies a writing defect caused by speech deviations while maintaining the motor function of the upper extremities. Frequently encountered factors that provoke the disease in question are defects in graphic symbolization and anomalies in phonemic perception. As a rule, agraphia arises in children suffering from immature oral speech, which is often not obvious. They cannot comprehend the entire sound sequence of a word. Children perceive a word only from the meaning side. The phoneme of a word does not correlate with its speech meaning, therefore, establishing a letter-sound association is difficult.

The main factor in the origin of the deviation in question is considered to be damage to the cortex, which is caused by the following reasons: various tumor processes, head trauma, cerebral hemorrhage or ischemic stroke, infectious and inflammatory processes, toxic poisoning.

In addition to the listed factors, signs of agraphia in the smallest inhabitants of the planet may appear as a result of birth trauma. There are variations of injury in which the baby cannot learn to speak, and therefore he is not able to write. In other words, a deviation in writing accompanies it.

Agraphia in adults is accompanied by aphasia, characterized by the loss of the ability to express one’s own thoughts through oral speech function. Moreover, the more often described illness is a symptom of another pathology, and does not occur as a separate disease.

The symptoms of agraphia are quite monotonous. First of all, the disease in question is manifested by deviations in writing, expressed either in the complete loss of skill, or in a violation of the structure of the word, omission of letters or syllables, or the inability to connect individual letters into syllables or words. Along with this, intellectual function is preserved, writing skills are formed.

Types of agraphia

It is possible to distinguish such types of agraphia as sensory and optical, afferent and efferent motor deviations.

Letter-sound analysis disorder occurs as a result of defects in phonemic hearing, which leads to a sensory form of the disease. Its core mechanism is an anomaly in the acoustic understanding of speech, a violation of sound discrimination. The main defect is represented by the collapse of all variations of writing, but first of all writing by ear.

Symptoms of agraphia, the variety under consideration, consist in the absolute loss of the ability to write or in serious, literal paragraphs, which are expressed in the replacement of the perception of sounds that differ in acoustic-articulatory characteristics.

With the sensory variety of agraphia, auditory writing and independent writing are impaired; fewer deviations are observed when copying. The patient either copies letter by letter or copies what is written.

The afferent motor form arises as a result of damage to the lower segments of the postcentral gyrus. During the writing operation, hidden articulations always take part. Due to the presence of defects in speech kinesthesia, with this type of agraphia, patients lose articulatory boundaries between sounds that are similar in genesis. The central manifestation is a disorder in writing sounds that are similar in place and method of their formation.

Signs of agraphia of this variety are represented by literal paragraphs, expressed in the substitution of other sounds, when consonants are merged, their omissions occur, and omissions in the middle of a word of entire syllables are also noted. With this form of the disease, all variations of writing are upset, except for cheating.

The efferent motor form arises as a result of damage or deviation in the functioning of the posterior segments of the frontal gyri. Here there is no difficulty in writing individual letters. Difficulties arise when trying to write a whole word or syllable. The basis of these disorders is a failure in the switching mechanism, in other words, a disorder of denervation mechanisms occurs. The clinical picture is manifested in mistakes when writing until the skill disappears, perseverations, rearrangements or omissions of letters, and under-writing of words. Difficulties are observed when forming words from individual letters.

The optical form of the disease occurs due to damage to the lower segments of the parietal and occipital cortex, which integrate visual experience. This causes a disturbance in the perception of letter images. The form of the disease in question is manifested primarily by alphabetic-spatial paragraphs.

In addition to the listed variations of the disease, agraphia is also classified into:

- aphasic, which appears in aphasia due to damage to the left segment of the temporal cortex, manifested by a defect in auditory speech and anomalies in phonemic hearing;

- pure, that is, not caused by other syndromes, resulting from damage to the posterior segments of the frontal gyri of the main hemisphere;

- constructive, arising as a result of constructive aphasia;

- apractical, arising against the background of ideational aphasia.

A specific type of agraphia consists of writing disorders caused by damage to the frontal segments, when writing suffers simultaneously with other types of purposeful voluntary mental processes. Here, defects in independent active writing are observed to a greater extent due to a disorder in the design, coding of the writing process and control over the writing of letters.

Diagnosis and treatment of agraphia

Since writing dysfunction is characterized by clear clinical signs and is often observed in combination with other symptoms, diagnosing the pathology in question is quite simple. The diagnosis can be determined directly after a thorough examination by a neurologist. It is much more difficult to determine the etiological factor of the disease. First of all, doctors need to determine the location of the abnormal focus in the brain. After determining the location of the source of the pathology, specialists move on to the stage of identifying the cause.

The diagnostic procedure begins with a detailed interview with the patient’s adult relatives. Then, various neurological studies are carried out using specific diagnostic methods, such as: ECHO-encephalography (study of the structural units of the brain), radiography of the skull, rheovasography (study of blood circulation), computer (layer-by-layer study of the structure of the organ) and magnetic resonance imaging, electroencephalography.

Treatment of agraphia is characterized by duration. The basis of corrective action is considered to be etiological therapy determined by the genesis of the disease. In addition, psychotherapy, training with a speech therapist (logorhythmics), therapeutic exercises, and music therapy occupy a special place in successful therapy. The foundation for success in treating writing disorders is: timely initiation of treatment, its multi-stage and comprehensive nature.

Treatment of agraphia also involves regular training in writing skills, including copying text and dictations. Drug therapy is based on the prescription of pharmacopoeial drugs that affect the improvement of brain nutrition and activation of its processes.

The next subgroup of speech agraphia (its sensory forms) is sensory (or acoustic-gnostic) and acoustic-mnestic. These forms of writing and written speech disorders also occur in the syndrome of corresponding forms of aphasia, which differ from each other in all respects - in mechanisms (factors), clinical and psychological picture, and in neuropsychological syndromes. The same differences are observed in these forms of agraphia.

When describing the psychological content and structure of writing, we noted that written speech is carried out through the interaction of a number of HMFs. In the case of sensory forms of agraphia, the processes of acoustic perception are disrupted due to defects in phonemic hearing (sensory agraphia) and a decrease in the volume of acoustic perception and impairment of auditory-speech memory (acoustic-mnestic agraphia). In these forms of agraphia, structural disorders are also found, but at different levels. In the first case - at the level of sound discrimination, in the second - in the level of operational auditory-speech memory and in the level of perception volume.

Sensory agraphia

It is known that for the normal course 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 a word. Impairment of phonemic hearing inevitably leads to impairment of sound-letter analysis and the process of sound discrimination.

Sound-letter analysis is carried out on the basis sensorimotor mechanism of acoustic perception speech sounds. Correct perception of sound is possible only if phonemic hearing is intact (or fully developed in children). It is known that a phoneme is not a sound, but only one of its essential components, which carries meaning, meaning. The acoustic uniqueness of a phoneme lies in the fact that the same sound in different positions and in different combinations can acquire different acoustic forms (sounds), but remaining the same phoneme, carrying the same meaning, i.e. always fulfills its meaningful role. Patients have difficulty perceiving and understanding phonemes due to their different sounds depending on positional position in a word(for example, “whale”, “window”, “current”). Therefore, it is important to preserve in adult patients (and formation in children) not just the perception of phonemes, but their positional sounds. Impaired phonemic hearing underlies sound discrimination defects in sensory aphasia and agraphia.

Writing has many features, one of which is its later appearance in the human mental sphere compared to other HMFs. Grammar and writing provide the child with the opportunity to rise to the highest level in the development of speech and other mental functions. Modern Russian psychology considers writing from a fundamentally different perspective and considers it a complex conscious form of speech and speech activity + as a complex mental formation. In addition to speech, the psychological content of writing also includes processes of perception of different modalities - sight, hearing, acoustics, spaces, and also motor processes - of a kinesthetic and kinetic nature, visual images - representations of letter characters, working memory, etc. The processes of writing (5-7 years old, formed consciously, intentionally in the process of voluntary learning, gradually automated) and oral (2d, formed in the process of interaction and communication with adults, involuntarily formed and proceeds automatically) speech differ in: origin, method of formation and flow, psychological content and functions. The fact that written speech is thought and not pronounced is one of the main features of these two types of speech and a significant difficulty in the formation of written speech.

Writing is ensured by the interaction of the inferior frontal, inferior parietal, temporal and occipital zones of the cortex of the left hemisphere of the brain. + the frontal lobes provide the general organization of writing (control, programming and regulation of speech activity). Writing disorders began to be studied later than aphasia (from the Greek A - denial, grapho - writing), but the first mentions were already in 1798, and in 1829 by Jackson (USA).

Letter: intention for writing - the plan about what? - the general meaning of the content what? - regulation of activity and control over writing

Psychological level of implementation of the writing program: Sound discrimination process - volume of acoustic perception and auditory-verbal memory - actualization of images of representations and recoding into letters - actualization of the motor image of a letter and its recoding into subtle movements of the hand - writing letters, words, phrases...

Psychophysiological level: sound discrimination is ensured by the joint work of the speech motor and acoustic analyzers - the volume of perception is provided by the acoustic analyzer, possibly together with the kinesthetic one, and ensures short-term selection and retention of the necessary information for its processing - recoding from sound to the letter _TRO - recoding from optics to letter letters - joint work of vision and the engine of analyzer systems.

Speaking process: motive - intention - internal program of the statement (semantics and predicates) - implementation in external speech (grammar and syntax)

Classification:

*Speech agraphia, which are based on speech disorders (occurs in syndromes of various forms of aphasia)

-efferent motor agraphia (kinetic): occurs in the syndrome of ef aphasia, dynamic praxis, defects in the process of understanding speech (violation of the semantics of oral speech, the syntagmatic side - the structure of the phrase and its grammar - agrammatism - violation in external speech). Agraphia - Damage to the posterior frontal regions of the left hemisphere. Compliance with the required sequence of sounds when writing a word (syllables). Mechanism: disturbances in switching (kinetic organization of the motor side of oral speech) from one letter to another, from syllable to syllable, from word to word. Macro and micrographies are possible. Perseveration (introduction of previous letters, words...). Rearrangement of letters in a word, omission of letters, repetition of the same word, underwriting of words (violation of writing as a successive process). Violation of the internal scheme of words and sentences, awareness of the dynamic relationships of words is lost.

-afferent motor agraphia (kinesthetic): occurs in aphasia syndrome (impaired oral expressive speech). Damage to the inferior parietal parts of the left hemisphere. Due to a violation of speech kinesthesia, articulatory boundaries between sounds that are similar in origin are lost (td, l, n, b-p-m, n-m-, z-s-ch-sh, f-v). Central mechanism: defects in kinesthetic sensations, which lead to disruption of fine articulatory movements and the inability to differentiate sounds according to their kinesthetic bases. The main defect is a violation of the writing of individual sounds and letters. They don't feel like they have to write. Literal paraphasias, paragraphs - in writing! (replacement of letters with others close in place of origin, omission of vowels, comparison of consonants, omission of syllables). Almost all forms of writing are impaired except for copying. Writing becomes a conscious and de-automated process. Unlike efferent agraphia, the syntagma and grammatical side of speech remain relatively intact.

-sensory agraphia (acoustic-gnostic): in the corresponding sensory aphasia syndrome (damage to the posterior third of the superior temporal gyrus - 22 Wernicke - impairment of oral expressive and impressive speech). The processes of acoustic perception are disrupted due to defects in phonemic hearing (central mechanism) - the perception and understanding of phonemes is difficult (central defect in aphasia) due to their different sounds depending on their position in the word (whale, window, current). In this form of agraphia, structural disturbances are also found - in the sound discrimination department. The letter either completely falls apart or is grossly violated. Literal paragraphs, sounds are replaced according to phonemic characteristics (p-b, g-k, g-x, d-l,) The central defect in agraphia is the collapse of all types of writing, and primarily by ear. Preserved: intention, design, motives of the letter. Control over writing is impaired secondarily due to defects in phonemic hearing and a violation of the operation of matching sounds and letters.

*nonspecific forms:

-acoustic-mnestic: a form of sensory agraphia?. In a-aphasia syndrome there is a violation of the volume of acoustic perception and the naming of objects. Violation of perceptual images and images of representations. Lesion of the 2nd temporal gyrus of the left temporal zone. The highest level of organization of writing is violated - the level of written speech, and not writing as a skill. Central mechanism: violation of the volume of perception, mismatch of the sign and its meaning, violation of images and representations. A defect is a violation of written speech as the highest form of writing.

-dynamic:(loss of initiative, spontaneous speech, writing). Aphasia - Disorder of the anterior parts of the speech zone anterior to Broca's area and the posterior parts of the first frontal gyrus. The central mechanism is a violation of internal speech, general and verbal predicativity (fewer verbs and putting them in last place). These mechanisms lead to disruption of activity in creating the structure of a phrase, its dynamics, and their interaction in the structure of the text. The central defect is a violation of the actualization and construction of the structure of a phrase, a violation of the order of managing the coordination of words within a phrase and phrases within a text, and phasia is a violation of productive speech.. (aphasia is a violation of the level of implementation of a plan in internal speech)

-semantic: damage to the SRW zone. Center mech-zm - Violation of the process of simultaneous spatial perception defect - aphasia - perception of logical-gram structures. Violation of the high level of organization of writing. Difficulties arise in using complex logical and grammatical constructions (comparative constructions, prepositions, complex sentences)

*Gnostic (non-speech)) forms of optical agraphia, based on disorders of different types of gnosis (in various agnosia syndromes): Agraphia: occipital and parieto-occipital systems of the left hemisphere (optical and spatial disorders). Occurs in a syndrome of various agnosias. Violation of the grapheme as a unit of optical and spatial perception.

– optical agraphia: loss of a generalized optical image of a letter denoting a specific sound. The central mechanism is a violation of the constancy and generalization of the letter (based on the identification of essential features) + alexia. They isolate speech sounds well. The central defect is a violation of the differentiation of the optical image of a letter, the replacement of some letters with others that are similar in global optical image, and construction (a-o-e, i-sh-p, b-v-r) ... this type of agraphia occurs in the optical object syndrome agnosia, acalculia, alexia. They write d, only asD, etc.

- optical-spatial agraphia: violation of the inferior parietal(the most complex forms of orientation in space are right-left, although it does not affect the structural organization of perceived images) and parieto-occipital (coarser - holistic visual perception - optical alienation of graphemes - image of sound letters) areas of the left hemisphere of the brain. Violation of writing according to the optical principle. Mechanism: decay of optical and optical-spatial patterns of letters. The recoding of sound into letters is disrupted. The graphic image of the sound-grapheme is preserved, but the perception and actualization of the spatial arrangement of the elements of the letter - the central mechanism - is disrupted. Central defect: Difficulties in writing letters with a clear spatial orientation (i-p, e-e, b-d). literal spatial paragraphs.+spatial acalculia. (mirror-letter)

-optical-mnestic agraphia: correctly distinguish sounds from the speech stream and those that do not correspond to letters. Pathology of speech organization of optical gnosis. The junction of speech and optical processes. – in amnestic aphasia syndrome. Mismatch of speech and perceptual images.

HISTORY OF THE STUDY OF AGRAPHY. v Writing disorders began to be studied later than aphasia, but the first mentions were already in 1798, then appeared in 1829 in the observations of S. Jackson (USA). In 1837, writing impairment was described by R. Chapter, in 1856, the French physician A. Trussougt cited one observation, and, finally, in 1864, H. Jackson for the first time gave a deep analysis of writing and defined writing impairment as a defect in a conscious voluntary process.

DEFINITION OF THE TERM "AGRAPHY". Agraphia is a complex and heterogeneous disorder of writing and writing (“a” - denial, “grapho” - writing). The term "agraphia" is attributed to V. Benedict (1865), as well as W. Ogle.

FORMS OF AGRAPHIA: speech agraphia, which are based on speech disorders; v gnostic (non-speech) forms of agraphia, which are based on disorders of different types of gnosis. Non-speech forms: va) optical agraphia (simultaneous and literal), vb) optical-spatial, vc) optical-mnestic.

SPEECH FORMS OF AGRAPHIA: v Efferent (kinetic) motor agraphia. v Afferent (kinesthetic) motor agraphia. v Sensory forms of agraphia. Sensory gnostic) and acoustic-mnestic. v Dynamic and semantic forms of agraphia. (acoustic

EFFERENT (KINETIC) MOTOR AGRAPHY. The central mechanism underlying efferent motor agraphia is a violation of the kinetic organization of the motor side of oral speech and defects in the timely denervation of the previous and innervation of the subsequent speech act or act of writing, which leads to pathological inertia of stereotypes in oral and written speech.

EFFERENT (KINETIC) MOTOR AGRAPHY. v 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. v The psychological picture of writing impairment is characterized by a violation of the internal scheme of words and sentences, awareness of the sequence of letters in a word (words in a sentence).

AFFERENT (KINESTHETIC) MOTOR AGRAPHY. The central 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 the main defect in writing - impairment of the writing of individual sounds that are similar in method and place of formation (such as B-P-M - labial-labial, occlusive; F-V - labial-dental, fricative, etc.).

SENSORY AGRAPHIA. The clinical picture of sensory agraphia reveals either a completely disintegrated letter or a gross violation of it. In these cases, the patient cannot write independently, and especially under dictation, not a single sound letter or their combinations, not a single word. The central mechanism of sensory agraphia is a violation of the acoustic perception of speech and phonemic hearing. The central defect is the practical collapse of all types of writing and, above all, writing by ear.

ACOUSTIC-MNESTIC AGRAPHY. v In the objective clinical picture, what primarily attracts attention is the arbitrariness and awareness of the act of writing, slowness, and de-automation. The patient’s subjective feeling of inability to write is also important. v. The central mechanism of writing impairment in this case is, in our opinion, a violation of the scope of perception, a mismatch between the sign and its meaning, and a violation of image representations. v. The central defect is a violation of written speech as the highest form of writing.

DYNAMIC AGRAPHY. v The central mechanism is a violation of internal speech, general and verbal predicativity. These mechanisms lead to disruption of activity in creating the structure of a phrase, its dynamics, and their interaction in the structure of the text. v. The central defect is a violation of the actualization and construction of the structure of a phrase, a violation of the order of managing the coordination of words within a phrase and phrases within a text.

SEMANTIC AGRAPHY. vdifficulties arise in the use of certain complex logical and grammatical constructions (use of prepositions, comparative constructions, constructions of complex sentences, etc.).

Letter: intention for writing - the plan about what? - the general meaning of the content what? - regulation of activity and control over writing

Speaking process: motive - intention - internal program of the statement (semantics and predicates) - implementation in external speech (grammar and syntax)

Classification:

*Speech agraphia, which are based on speech disorders (occurs in syndromes of various forms of aphasia)

*nonspecific forms: