Motor Alalia
The content of the article:
- Causes and risk factors
- Alalia forms
- Symptoms of motor alalia
- Diagnostics
- Treatment of motor alalia
- Possible complications and consequences
- Forecast
- Prevention
Motor alalia is an underdevelopment or lack of speech, which is caused by organic damage to the brain (cortical speech centers) that occurred in the prenatal period of development or in children in the first years of life. At the same time, the child understands someone else's speech, but cannot reproduce it on his own. This pathological condition is diagnosed in about 1% of preschool children, as well as in 0.2–0.6% of schoolchildren. Boys are more susceptible to motor alalia, in whom the disease is recorded approximately twice as often as in girls.
Motor alalia - absence or underdevelopment of speech in a child
Speech is an important component of a child's neuropsychic development. The formation of speech occurs during the first years of a child's life, later this determines the quality of speech in all age periods. The speech act is carried out through the system of organs that belong to the speech apparatus. The speech apparatus consists of a central and peripheral parts. The central part of the speech apparatus is represented by the structures of the nervous system (speech areas of the cerebral cortex, cerebellum, pathways, subcortical nodes, nerves that innervate the vocal, articulatory, respiratory muscles, etc.). The peripheral part of the speech apparatus consists of the vocal (larynx with vocal cords), articulatory (lips, tongue, upper and lower jaws, hard and soft palate) and the respiratory sections (chest with trachea, bronchi and lungs).
Violations in one or another of these structures lead to the development of different types of speech disorders. The main reasons for the development of motor alalia include the pathology of the Broca center and the pathways related to it. Broca's center is a section of the cerebral cortex located in the posterior inferior part of the third frontal gyrus of the left hemisphere of the brain in right-handers and provides motor organization of speech.
Causes and risk factors
Motor alalia is a polyetiological pathological condition, that is, one that can be caused by the negative effects of many factors. The main reasons that can cause organic damage to the speech centers of the cerebral cortex include:
- infectious diseases that are infected in utero or during childbirth;
- fetal hypoxia;
- toxicosis;
- trauma to the fetus (for example, when a pregnant woman falls);
- high risk of spontaneous abortion;
- the presence of chronic diseases in a pregnant woman (arterial hypo- or hypertension, heart or pulmonary failure, etc.).
Motor alalia occurs due to damage to the speech centers of the brain
In addition, prematurity, newborn asphyxia, intracranial birth trauma can lead to the development of motor alalia. In children of the first years of life, the causes of pathology include a genetic predisposition, traumatic brain injury, encephalitis, meningitis, and some somatic diseases that lead to depletion of the central nervous system. Risk factors for the development of motor alalia can be frequent illnesses in children in the first years of life (endocrinological pathologies, acute respiratory viral infections, pneumonia, rickets), surgical interventions under general anesthesia, insufficient speech contacts, pedagogical neglect, hospitalism (a combination of somatic and mental disorders, which are due to a long stay in a hospital in isolation from loved ones and at home).
Alalia forms
According to the classification by V. A. Kovshikov, the following forms of alalia are distinguished:
- motor (expressive);
- sensory (impressive);
- mixed (motosensory or sensorimotor, depending on the prevalence of impaired development of expressive or impressive speech).
Motor alalia, in turn, depending on the location of the damaged area, is divided into:
- afferent - the lower parietal parts of the left hemisphere are affected, which is accompanied by kinesthetic articulatory apraxia;
- efferent - the premotor parts of the cerebral cortex are affected.
Symptoms of motor alalia
Motor alalia is characterized by the presence of both non-speech and speech symptoms.
The non-speech manifestations of pathology, first of all, include such motor disorders as insufficient coordination of movements, awkwardness, poor development of motor skills of the fingers. Motor alalia in a child can also be accompanied by difficulties in the formation of self-care skills (for example, lacing shoes, buttoning up buttons), as well as in performing precise small movements with the hands and fingers (folding puzzles, constructors, mosaics, etc.). Also, in children with motor alalia, there are often disorders of memory (in particular, hearing and speech), perception, attention, emotional and volitional spheres of the personality. Patients with alalia can have both hyperactive and hypoactive behavior. In patients, as a rule, there is rapid fatigue and reduced performance. Besides,in patients with alalia, there are frequent disturbances in the movements of the facial muscles, increased irritability and aggression, poor adaptation to the conditions of the surrounding world.
With motor alalia, the child has a limited vocabulary or a complete lack of speech
Of the speech symptoms of motor alalia in patients, it is noted:
- erroneous replacement of sounds in words by others (literal paraphasia);
- loss of sounds from the word (elision);
- steady repetition of a word or phrase (perseveration);
- limitation of vocabulary (primarily verbs, verbal forms);
- combining syllables of different words (contamination); replacing words with similar ones in meaning or sound;
- loss of prepositions from the phrase, incorrect agreement of words in the phrase.
There is an absolute predominance of nouns in the nominative case in the patient's speech with alalia. In addition, with this pathology, there may be a complete or partial rejection of speech (speech negativism). Against the background of the main symptoms of the pathology, the child may develop stuttering.
With afferent motor alalia, the patient is potentially able to perform various articulatory movements, however, sound pronunciation is impaired.
In the case of efferent motor alalia, the main speech defect is the impossibility of performing a series of successive articulatory movements, this is accompanied by a strong distortion of the syllable structure of words.
The vocabulary of a patient with alalia is significantly poorer than the age norm. The patient has difficulty learning new words, the active vocabulary consists mainly of words and phrases of everyday use. Insufficient vocabulary can lead to misunderstanding of the meaning of a word, inappropriate use of words. Patients with alalia, as a rule, express themselves in simple short sentences, which leads to a gross violation of the formation of coherent speech in the child. Patients have difficulties in determining the cause and effect, the main and the secondary, temporary connections, the transfer of the meaning of events, their sequential presentation. In some cases, with motor alalia, the child has only onomatopoeia, babbling words, the use of which is accompanied by active facial expressions and / or gestures.
Mental impairment in patients with alalia occurs due to speech impairment. With the development of speech, these violations are gradually compensated.
All stages of the formation of speech skills (humming, babbling, words, phrases, contextual speech) in a patient with alalia are late. The development of speech skills in patients with alalia is influenced by a number of factors, among which the most important are the degree of damage to the child's brain, the age at which the pathology was diagnosed, general development, and the regularity of parenting with the child. In some cases, after prolonged speech negativism, the child begins to speak and quickly masters speech, in other patients, an early onset of the formation of speech skills is observed, but in the future speech remains scarce for a long time, other options are also possible.
Diagnostics
To diagnose motor alalia, it is necessary to examine the child by a pediatric otorhinolaryngologist, neurologist, speech therapist, and psychologist.
When conducting a speech therapy examination of a child, considerable attention is paid to the collection of a perinatal history and the characteristics of the patient's early development. To diagnose motor alalia, it is necessary to assess the child's desire to speak, determine the presence of difficulties in repetition of what he heard, auditory perception, active use of facial expressions and gestures, perception and understanding of speech, the presence of echolalia. In addition, the level of active and passive vocabulary, syllabic structure of words, pronunciation of sounds, grammatical structure of speech and phonemic perception are noted.
To assess the severity of brain damage, electroencephalography, echoencephalography, magnetic resonance imaging of the brain, and X-ray examination of the skull may be required.
MRI of the child's brain allows confirming the diagnosis of "motor alalia"
For differential diagnosis with sensory alalia and hearing loss, audiometry, otoscopy and some other methods of studying auditory function are used.
Differential diagnosis with dysarthria, autism, oligophrenia, delayed speech development is required.
Treatment of motor alalia
Treatment of motor alalia is complex. The formation of speech skills is carried out against the background of drug therapy, the main purpose of which is to stimulate the maturation of brain structures. Patients are prescribed nootropic drugs, vitamin complexes.
Physiotherapeutic methods such as electrophoresis, magnetotherapy, laser therapy, decimetwave therapy, transcranial electrical stimulation, acupuncture, electropuncture, and hydrotherapy are effective in the treatment of motor alalia.
An important role in the treatment of motor alalia is given to the development of general (large) and manual (fine) motor skills of the child, as well as memory, thinking, attention.
In the treatment of motor alalia, an important role is given to the development of fine and gross motor skills in a child
Speech therapy correction of motor alalia includes work with all aspects of speech and includes not only classes with a speech therapist, but also regular specially selected exercises at home. At the same time, the active and passive vocabulary of the child is formed, work is underway on phrasal speech, grammar, sound pronunciation, and coherent speech develops. A good result is also provided by speech therapy massage and logo rhythmic exercises.
With motor alalia, it is recommended to start teaching children how to read and write early, as reading and writing help control oral speech and better consolidate the material learned.
Possible complications and consequences
Motor alalia in children can lead to impairments in writing (dyslexia and dysgraphia). In addition, patients may develop stuttering, which manifests itself when the child is developing oral skills.
Forecast
Successful correction of alalia is most likely with an early start of treatment (starting from 3-4 years), an integrated approach and systemic impact on all components of speech. With timely and adequate treatment, the prognosis is favorable.
The degree of organic damage to the patient's brain is also important. With minor injuries, the pathology is completely curable.
Prevention
In order to prevent the development of motor alalia, all the necessary conditions for the normal course of pregnancy, childbirth, as well as the health and development of the child should be provided. For this, women during pregnancy are advised to take a number of preventive measures:
- when pregnancy occurs, you should register on time, undergo all necessary examinations in a timely manner and follow the doctor's recommendations;
- minimize the risk of contracting infectious diseases, treat existing diseases in a timely manner;
- avoid traumatic activities;
- avoid excessive physical exertion;
- to refuse from bad habits;
- eat balanced;
- perform a set of gymnastics exercises for pregnant women.
To ensure the child's normal development, it is recommended:
- visit a pediatrician and other doctors regularly (as needed);
- give the child the necessary vaccinations for age (in the absence of contraindications);
- perform developmental exercises with the child that are suitable for his age;
- avoid injury to the child, especially head injuries;
- kindly communicate with the child, pay attention to him, talk to him;
- maintain a normal psychological climate in the family.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
