REVIEW OF A CASE OF CHILD WITH ACQUIRED APHASIA

od pr akt i kat a za pr akt i kat a

from practice to practice

P RI KA Z N A S LU^ A J N A DETE

S O S TEKN A TA A F A ZI JA

M ar e S T O JM E N O V S K A

S i l vana

L ogopedska ambul ant a, zdr avst ven dom -

N egot i no

(podr a~na edi ni c a na Zavod za sl uh, govor

i gl as - S kopje)

REVIEW OF A CASE OF CHILD

WITH ACQUIRED APHASIA

Mare

Silvana

Speech Therapy First Aid Station, Health

Center Negotino

(regional unit of the Institute for Hearing,

Speech and Voice - Skopje)

Rezi me

Abstract

S t eknat i t e jazi ~ni nar u{ uvawa kaj

dc at a se mani f est i r aat na opr edel en st

e-pen vo r azvojot na jazi kot od t r et at a do

dvanaeset t at a godi na vozr ast . Dodeka

ja-zi ~ni t e nar u{ uvawa kaj dec at a me| u pr

va-t a i va-t r eva-t ava-t a godi na i maava-t kar akva-t er i sva-t i ka

kako r azvojni , a i kako st eknat i . Kaj st

ek-n at at a af azi ja i l i di sf azi ja t o~ek-no se

znae koga do{ l o do o{ t et uvawe i zo{ t o.

Kaj det e so st eknat a af azi ja i l i di sf azi ja

{ t o go sl edi r anot o o{ t et uvawe na

mo-zokot so pomo{ na pr avi l no l ekuvawe i

navr emen r ehabi l i t ac i ski t r et man i ma

r el at i vno podobr uvawe. Toa e poo~i gl

ed-no ot kol ku kaj vozr asni t e.

O va pobr zo kompl et no zakr epnuvawe se

dol ` i na pl ast i ~nost a na det ski ot mozok

i na mo` nost a za i nt r ahemi sver nat a i i

n-t er hemi sver nan-t a r eor gani zac i ja na jazi

~-ni t e f unkc i i vo det st vot o.

Achieved children speech disabilities are

mani-fested at certain level of development of speech

from the age of 3 to 12 years. The speech dis

-abilities with children from the age of one to

three years have developmental and acquired

characteristics. It is well-known when and why

the disabilities occurr at acquired aphasia or

disphasia.

The child with acquired aphasia or disphasia has

early brain impairements and a relative

im-provement happens with adequate treatment and

prompt rehabilitation treatment. It is more

obvi-ous with children than with adults.

This fast and complete rehabilitation happens

due to the plastic character of child’s brain and

the possibilities for introhemisphere and inter

-hemisphere reorganization of speech functions

in childhood.

K l u~ni zbor ovi : st ek nat a af azi ja, ek

spr esi ven govor , r ec ept i ven govor , ver bal

-na k omuni k ac i ja

Key words

: acquiring aphasia, expressive

speech, receptive speech, verbal comunication

Vov ed

Introduction

N ar u{ uvaw et o na jazi k ot k aj dec at a

se k l asi f i c i r aat k ak o r azvojni i

st ek nat i , vo zavi snost od vr emet o

k oga nast anal e

(Ludlow, 1980).

The speech disabilities with children are

classi-fied as developmental and acquired ones,

de-pending on time they occurred (Ludlow, 1980).

A dr esa za kor espondenc i ja: Corresponding Address:

M ar e S T O JM E N O V S K A Mare STOJMENOVSKA

Ver a Joc i } 109, Del ~evo Mob: 070/688-538

E-mail: [email protected]

Razvojni t e jazi ~ki nar u{ uvawa se oni e

{ t o nast anal e pr ed po~et okot na jazi ~ki

-ot r azvoj (od r a| awet o do pr vat a godi na),

i ako si mpt o mi t e se javuvaat mnogu podoc

-na. S t eknat i t e jazi ~ki nar u{ uvawa kaj

de-c at a se pojavuvaat po pojavat a na jazi kot

od 3-12 godi ni ; dodeka jazi ~ki t e nar u{

uva-wa kaj dec at a me| u pr vat a i t r et at a

go-di na, i maat kar akt er i st i ka kako r azvojni

i kako st eknat i . (1)

Vo st eknat i t e jazi ~ki nar u{ uvawa se

vbr ojuva sekundar nat a st eknat a af azi ja

i l i di sf azi ja, koja se javuva po l ezi ja na

mozokot i t oa po t r et at a godi na od ` i

vo-t ovo-t , koga bazavo-t a na govor ovo-t e govo-t ova, koga

det et o ve}e po~nal o da se i zr azuva so r

e-~ eni c i i koga poe-~nuva da gi upot r ebuva

si t e vi dovi zbor ovi . Kaj st eknat at a af

azi ja i l i di sf aazi ja t o~no se znae koga do{

-l o do o{ t et uvawe i zo{ t o. (2)

O voj vi d nar u{ uvavaw e se pojavuva od t r

e-t ae-t a do desee-t e-t ae-t a godi na od ` i voe-t oe-t , vo

vr emet o koga det et o i nt enzi vno go u~i

gvor ot i koga gogvor ot po~nuva da se avt

o-mat i zi r a. A vt oo-mat i zac i jat a na govor ot

nas t anuva koga vo mozokot se f or mi r aat

zoni za r azbi r awe i za pr odukc i ja na

govo-r ot . Vo ni v se skl adi govo-r aat si t e podat oc i za

gl asot , gr amat i kat a, r e~eni c at a, i

zgovo-r ot i si t e dvi ` ewa na govozgovo-r nat a muskul

at ur a pr eku koi jazi ~noat o znaewe se pr eat

-vor uva vo go-vor . Kaj dec at a kaj koi

sekun-dar nat a st eknat a af azi ja i l i di sf azi ja

nas t api l a podoc na, r azbi r awet o mo` e da

bi de poo{ t et eno ot kol ku govo r ot

(sen-zor na), t aka { t o govor ot mo` e da bi de t

e~en so dobr a mel odi ja i r i t am i so pr avi l

-na gr amat i ka, a r azbi r awet o da bi de -

nama-l eno. Dokonama-l ku o{ t et uvawet o nast ananama-l o

por ano, mo` e da bi de pove}e i zr azena mo

-t or na-t a komponen-t a i r azbi r awe-t o ne e

i l i e mo{ ne mal ku o{ t et eno. Toga{ vo

govor ot e o{ t et ena r e~eni c at a, koja se

sve duva na i menka, gl agol i pokazna

zamen-ka. A r t i k ul ac i jat a e t e{ ka neve{ t a, se

skr at uvaat zbor ovi t e i doa| a do zamena na

gl asovi t e. O vi e dve r el at i vno ~i st i f or

-mi se mnogu r et ki . N aj~est o i mame me{

a-ni senzomot or a-ni vi dovi , kade { t o e o{ t

e-t eno i r azbi r awee-t o i govor oe-t vo pomal

i l i pogol em st epen. Zabel e` ani se i

am-nes t i ~ki vi do vi { t o se mani f est i r aat

kako zabor avawe na zbor ovi t e, i t oa

gl avno na i menki t e, dodeka r azbi r awet o i

si t e dr ugi modal i t et i na govor ot se vo

r ed. Det et o }e ja opi { uva f unkc i jat a na

pr edmet ot -zo{ t o sl u` i , a dodeka za i met o

ne mo` e da se set i . O sven r azbi r awet o i

govor ot , ovi e dec a i maat t e{ kot i i so

~i t awet o, pi { uvawet o i smet awet o. (3)

or larger level. The amnesic types are indicated,

manifested with forgetting words, mainly

nouns, while understanding and all other speech

modalities are correct. Children will describe

the function of the object – its purpose, but

can-not remember the name. Besides under standing

and speech, these children have difficulties with

reading, writing and calculating. (3)

P r i kaz na sl u~ajot

Review of the case

Ma{ ko det e B. T. r odeno vo 1990 godi na,

upat eno e na l ekuvawe na Kl i ni ka za N

ev-r ol ogi ja.

Boy B.T. born in 1990, sent for treatment at

Neurology Clinic .

F ami l i jar na anamneza

Family anamnesis

B.T. e vt or o det e od vt or a ur edna i r

e-dovno kont r ol i r ana br emenost . P er i i

posnat al en per i od ur eden. Dosega det et o

psi homot or no dobr o se r azvi val o, ne

bol eduval o od nekoi poser i ozni bol est i ,

osven od r espi r at or ni i nf ekc i i koi bi l e

ambul ant ski t r et i r ani .

S t at us: Det et o e somnol ent no, af ebr i l no,

eukogdi ~no, euf or i ~no. OMG i P MT

sr edno i zr azeni , ko` at a bl eda so za~uvan

t ur gor i el ast i c i t et . Gl ava so nor mal na

konf i gur ac i ja.

Pulmo et cor

so ur eden naod.

E kst r emi t et i pr avi l ni , so desnost r ana

hemi par eza. Babi nski obost r ano pozi t i

-ven, t et i vni t e r ef l eksi se zajaknat i . A

b-domi nal ni r ef l eksi at enui r ani i vi dl i v

desnost r an f ac i jal i s.

S ega{ nat a bol est po~nal a dva dena pr ed

pr i em koga det et o po~nal o da se ` al i na

gl avobol ki od l evat a st r ana, za sl edni ot

den da ja i zgubi svest a, so pojava na f i ksi

-r an uko~en pogl ed i uko~eni ekst -r emi t et i

so ni vno t r esewe.

E E G: 1: l evost r an { i l ec br an f okus.

2: osnovna akt i vnost nest abi l na so i

i zo l i r an del t a f okus l evost r ano.

KTM: nehomogena ekspanzi vna t vor ba vo

l evat a c er ebr al na hemi sf er a. MR -angi

o-gr af i ja na kar ot i di t e i na mozokot .

B.T. is the second child of the second, regular

and controlled pregnancy. Perinatal and

post-natal periods are regular. The child has good

psycho-motor development, he was not ill of

any serious diseases except some respiratory

infections, treated at First Aid Station.

Status:

The child is somnolent, afebrile,

eucog-dic, euphoric. OMG and PMT are mean

ex-pressed, pale skin with preserved turgor and

elasticity. The head is with normal

configura-tion. Pulmo et cor with regular finding. Correct

extremities, with chemi-paresis on the right

side. Babinski positive on both sides, tendon

reflexes strengthened. The abdominal reflexes

attenuated and noticed facialis on the right side.

The present illness started two days before the

admission when the child started to complain of

headaches in the left side. The next day he lost

his conscious, with fixed and stiff vision, stiff

and shaking extremities.

EEG: 1: Left sided pick wave focus.

2: Basic activity unstable with isolated

left sided delta focus.

MR-naodot zbor uva za t r ombot i ~ni masi

vo l evat a ar t er i ja, c er ebr i ant er i or i

medi ja.

N ajver ojat no se r abot i za c el osna okl uzi

-ja na spomenat i ot segment , ko-ja sega post

e-p eno se r ekonal i zi r a.

P o pr i emot det et o e post aveno na ant i

e-demat ozna t er api ja. S ost ojbat a na det et o

post epeno se podobr uva, muskul ar nat a

si l a se zajaknuva. P ar ezat a na f ac i jal i s

post epeno se povl ekuva, a u{ t e i ma af azi

ja (gubewe na govor ot ) i desnost r ana hemi

-p ar eza.

P o t r et manot koga sost ojbat a se po dobr

uva, det et o e upat eno na f i zi kal na t er api

-ja i l ogopedski t r et man.

MR-finding states trombone masses in the left

artery, cerebral anterior and media.

The most probably, this is the case of complete

occlusion of the mentioned segment, which now

gradually reconalizes.

After the admission, the child was under

anti-edematosis therapy. The child’s condition

gradually improves and the muscle structure

strengthens. The paresis facialis gradually

re-treats with still present aphasia (lost of speech)

and right-sided chemi-paresis.

After the treatment, when the condition

im-proves, the child is sent to physical therapy and

speech therapeutics.

L ogopedski t r et man-st at us

Speech Therapeutics – Status

N a l ogopedski ot t r et man det et o doa| a po

eden mesec o d pojava na pr vi t e si mpt omi .

O r al nat a pr aksi ja por adi del umnat a vi

d-l i vost na par ezat a na n. f ac i ad-l i s e sd-l aba.

A r t i kul ac i ja: P oedni ne~no gl asovi t e gi

i zgovar a so ~est o zamenuvawe na gl asovi

-t e { -t o se sl i ~ni po zvu~nos-t i l i po mes-t o

na f or mi r awe. A r t i kul ac i jat a e t e{ ka i

neve{ t a.

P ovt or uvawe: P ovt or uva poedi ne~ni sl

o-govi ; ne e vo sost ojba da povt or i ni

dvsl o` en zbor . P r i povt or uvawe na zbor

o-vi t e doa| a do i spr evr t uvawe na sl ogoo-vi t e

vo zbor ot i l i na zamenuvawe i nedi skr i

-mi ni r awe na gl asovi t e sl i ~n i po

zvu~-nost .

^ i t awe: Bukvi t e gi pr epoznava, ne e vo

sost ojba da gi povr ze vo zbor . P r vi ot sl og

vo zbor ot go ~i t a pr avi l no, a ve}e vt or i

-ot go zamenuva so sl og sl i ~en po i zgovor

so pr vi ot .

P i { uvawe: P oedi ne~ni sl ogovi e vo

sos-t ojba da gi napi { e, dodeka ni za od sl ogovi

ne mo` e da gi napi { e. P r i mer : N a bar awe

da napi { e "N at a{ a# pi { uva "N at at a#.

N abr ojuvawe: Vo sost ojba e da i zbr oi do

deset , a denovi t e vo nedel at a ne mo` e da

gi nabr oi .

Razbi r awe: Gi r azbi r a post aveni t e pr a-

The child comes for speech therapeutics after

one month since the first symptoms occurred.

Oral practice, due to partial presence of paresis

on n. facialis, is weak.

Articulation:

He pronounces separate voices

with often replacement of voices similar in

sound or place of their shaping. The articulation

is heavy and clumsy.

Repetition:

He repeats single syllables; he is

not able to repeat two-syllable words. While

repetition of words, the syllables in the word

become mixed or replaced and

non-discrimi-nated of voices with similar sounds.

Reading:

He recognizes the letters but is unable

to compose the word. He correctly reads the

first syllable in the word and replaces the sec

-ond syllable with a syllable similar to the first

one.

Writing:

He is able to write down separate

syllables and is unable to write down line of

syllables.

Example: Asked to write down “Natasha”, he

writes “Natata”.

Listing:

He is able to count to ten, but unable to

count the days of the week.

{ awa. Rec ept i vnat a komponent a na

govo-r ot ne e o{ t et ena.

N a t r et man doa| a sekojdnevno. L

ogoped-ski ot t r et man go po~nuvame so ve` bi za

podobr uvawe na mot or i kat a na govor ni t e

or gani { t o gi i zveduvame pr ed ogl edal o.

P ot oa ve` bi t e gi pr o{ i r uvame so ve` b

a-we na poedi ne~ni t e gl asovi vo sl ogovi so

samogl aski vo r azni pozi c i i (i ni c i jal na,

medi jal na, f i nal na) vkl u~uvame i ve` bi

za di skr i mi nac i ja na gl asovi t e. Vedna{

po~nuvame so pr eve` buvawe na r akat a, so

c el da post i gneme i nt r ohemi sf er na i i

nt r ehemi sf er na r eor gani zac i ja na jazi ~ki

-t e f unkc i i . S os-t ojba-t a na pac i en-t o-t

odden naodden se podobr uva. O r al nat a pr aksi

-ja, kako r ezul t at na podobr enat a mot or i ka

na govor ni t e or gani , st anuva sé podobr a.

A r t i kul ac i jat a st anuva s é podobr a i

pol esna.

P o t r et manot od okol u dva mesec a pac i en

-t o-t e vo sos-t ojba da pov-t or i i

pove}e-sl o` ni zbor ovi . A r t i kul ac i jat a e sé p

o-dobr a i posi gur na. Gr af omot or i kat a e

post abi l na. Vo sost ojba e da pr epi { e i

podol g t ekst . Di kt at u{ t e ne e vo sost ojba

da pi { uva. P i { uvawet o so desnat a r aka

mu e pol esna ot kol ku so l evat a.

^ i t awe: Vo sost ojba e da pr o~i t a pokusi

zbor ovi , a podol gi t e mo` e da gi pr o~i t a

bukva po bukva.

S pont an govor : Vo govor ot spont ano ne se

vkl u~uva. N a ve` bi t e e mi r en i ne post

a-vuva pr a{ awa. S o r odi t el i t e vo doma{ na

sr edi na komuni c i r a, no r e~eni c at a mu e

nekompl et na i gr amat i ~ki nepr avi l na.

Di jal og: O dgovar a na post aveni t e pr a{

a-wa kuso, so kusi r e~eni c i , gr amat i ~ki

ne-pr avi l ni . Govor ot e br adi l al i ~en so

bavno t empo i mel ahol i ~en.

P o t r et manot po~nuva da doa| a t r i pat i

n edel no. Ve` bi t e se svr t eni kon kompl

e-t i r awe na r e~eni c ae-t a. P o e-t r ee-t manoe-t od 4

mesec i , govor ot sé pove}e se podobr uva.

P ovt or uvawet o na sl ogo vi i zbor ovi e

do-br o i bez ar t i kul at or ni gr e{ ki . Vo

sos-t ojba e da povsos-t or i i pr ossos-t a r e~eni c a.

The receptive component of the speech is not

damaged.

He regularly comes for treatment. We start the

speech therapeutics with exercises for motor

improvement of speech organs in front of the

mirror. Later, we broadened the exercises with

separate voices in syllables consisted of vowels

in vario us positions (initial, medial, final ones),

as well as exercises for voice discrimination.

We immediately start with repeated exercise of

hand in order to achieve intro-hemisphere and

inter-hemisphere reorganization of speech

functions. The patient’s condition improves day

by day. The oral practice, as a result of

im-proved motor of speech organ becomes better.

The articulation is better and easier.

After 2-month treatment, the patient is able to

repeat words with more syllables. The articula

-tion is better and surer. The graph-motor is

more stable. He is able to rewrite longer text.

He is unable to write a dictation. He uses right

hand more than left for writing.

Reading:

He is able to read shorter words and

reads longer words letter by letter.

Spontaneou s speech:

His speech is not

sponta-neous. He is quiet at exercises and does not put

questions. He communicates with parents at

home, but his sentence is incomplete and

grammatically incor rect.

Dialogue:

He briefly replies all questions with

short sentences, but grammatically incorrect.

His speech is bradilalic with slow tempo and

melancholic.

He comes for treatment three times a week. The

exercises are focused on sentence completion.

After a 4-month treatment, his speech is

obvi-ously improved.

Di jal og: N a pr a{ awat a dava t o~ni

odgovo-r i , no odgovo-r e~eni c at a e kusa sost avena od

i menka, gl agol i ponekoj pr edl og.

S pont an govor : U{ t e i ma t e{ kot i i vo

spont ani ot govor . Br adi l al i jat a ne e t ol

-ku upadl i va.

Opi s na sl i ka: P r i opi s na sl i ka gi

na-br o juva pr edmet i t e { t o gi gl eda. N a

pot-pr a{ awa, so c el da mu se pomogne, dava

poc el osen odgovor .

Dialogue:

He gives correct answers, but the

sentence is short and composed of noun, verb

and some preposition.

Spontaneous speech:

He still has difficulties in

spontaneous speech. The bradilalia is not so

noticeable.

Description of pictures:

While describing pic

-tures, he counts the objects he sees. He gives

complete answer when being asked in order to

help him.

L ogopedski t r et man

Speech therapeutics

L ogopedski ot t r et man go i zveduvame so

pomo{ na ve` bi za:

•

or al na pr aksi ja,

•

podobr uvawe na ar t i kul ac i jat a,

•

za di skr i mi nac i ja na gl asovi t e,

•

zbor ovi so povt or uvawe na dadena sl i

-ka,

•

i menuvawe na sl i ki ~ki ,

•

boi , pr epi { uvawe kus t ekst (doma), l

e-va r aka,

•

f or mi r awe kusa r e~eni c a,

•

di jal og,

•

opi s na sl i ka.

We carry out speech therapeutics with exercises

for:

•

oral practice,

•

articulation improvement,

•

voice discrimination,

•

words with repetitions on given picture,

•

naming flash cards,

•

colors, rewriting of short text (at home), left

hand,

•

forming short sentence,

•

dialogue,

•

description of a picture.

Zakl u~ok

Conclusion

O d dadeni ot pr i kaz na det e so st eknat a

af azi ja i l i di sf azi ja { t o go sl edi r

ano-t o o{ ano-t eano-t uvawe na mozokoano-t , so pomo{ na

pr avi l no l ekuvawe i navr emen r ehabi l i

-t ac i ski -t r e-t man, i ma r el a-t i vno podobr

u-vawe, koe e poo~i gl edno ot kol ku kaj

voz-r as ni t e.

O va pobr zo kompl et no opor avuvawe se

dol ` i na pl ast i ~nost a na det ski ot mozok

i na mo` nost a na i nt r ahemi sver nat a i i

n-t er hemi sver nan-t a r eor gani zac i ja na jazi

~-ki t e f unkc i i vo det st vot o.

Det et o pr odol ` uva vo pr vo oddel eni e i ne

povt or uva: so pomo{ na u~i t el kat a go

na-domest uva i zgubeni ot nast aven mat er i jal .

The given review of a child with acquired

apha-sia or disphaapha-sia, which resulted in brain damage

in early childhood, assisted by correct treatment

and prompt rehabilitation treatment, shows

relative improvement that is more obvious than

with adults.

This fast and complete rehabilitation occurs due

to the plastic character of child’s brain and the

possibilities for introhemisphere and inter

-hemisphere reorganization of speech functions

in childhood.

The child keeps on attending the first grade of

elementary school and does not repeat it: he

compensates the lost teaching material assisted

by his teacher.

L i t er at ur a / References

1. Gol ubovi } S . A f azi ol ogi ja, Def ekt ol o{ ki f akul t et Uni ver zi t et a u Beogr adu, Beogr ad, 1996.

2. Mary Coates Longerich, Jean Bordeaux, Apha-sia Therapeutics, the Macmillian Company -New York, 1954.