Speech comprehension disorder occurs in a number of different speech and neuropsychiatric syndromes: alalia, aphasia, autism, oligophrenia, dementia, etc. It is characterized by a lack of adequate response to audible speech, inability to follow instructions, increased attention exhaustion. Sometimes understanding is partially disrupted. Own speech production may be preserved or absent. To determine the causes of the violation, neurological, audiological, neuropsychological, speech therapy examination is carried out. Treatment is carried out within the framework of the identified syndrome.
Causes of speech comprehension disorders
The understanding of reversed speech is absent in children who have no experience of human communication – the so-called “Mowgli children”. The child’s speech development is imitative based on the sounds he hears around him and the articulation he observes from others. If a child has been isolated in a confined space since early childhood or grew up among animals and has never heard human speech, then he is not able to perceive and give an adequate response to words. Along with impaired understanding, children with Mowgli syndrome also lack their own speech.
Misunderstanding of speech is observed in deaf children from birth or early deafened children. They do not even perceive non-speech sounds. Cognition of the outside world is limited, which is why intellectual deficiency develops a second time, and learning difficulties arise. Sometimes they may have access to the rhythmic pattern of the word, certain intonations. Deaf-mute children do not speak and do not understand others.
The degree of severity of the violation of receptive speech varies with different forms of autism. The worst level of auditory perception is demonstrated by persons with low-functional autism, the best – with high-functional autism, Asperger’s syndrome.
In general, speech comprehension is accessible to people with autism spectrum disorders, but often has an involuntary, selective nature. The peculiarity of thinking in autism is such that the child reacts only to those topics that arouse his emotions and lively interest. Autistic children do not pay attention to other verbal information, do not respond to names, requests. At the same time, intonation and gestures are well perceived.
The disease is characterized by the breakdown of speech skills at the age of 3-7 years. First, the understanding of speech is lost, then the possibility of independent utterance. Regression of speech function occurs suddenly and quickly, approximately within six months. In Landau-Kleffner syndrome, a violation of the receptive side of speech is combined with epileptic seizures. Nonverbal intelligence is relatively preserved: patients retain the ability to self-care and manual labor.
Sensory alalia develops with perinatal lesion of the speech-hearing region (Wernicke center). A child with sensory alalia perceives the speech of others as background noise devoid of any meaning. He does not differentiate non-speech and speech sounds by ear, he has no connection between the sound shell of the word and the object that it designates. To facilitate understanding, children “read from the face”.
In mild cases, an understanding of individual words and household instructions is available, in severe cases, there is a complete lack of perception of verbal information. Physical hearing is not impaired, active speech is present, intelligence is primarily preserved. With sensorimotor alalia, children not only do not understand verbal treatment, but also do not speak themselves.
Speech perception disorder in various forms of aphasic syndrome has its own characteristics. In some cases, there is a complete misunderstanding of any verbal statements, in others – the difficulties are partial, selective. Speech comprehension disorders occur in the following forms of aphasia:
- Acoustic-gnostic. Auditory perception is extremely limited and almost impossible outside of the situation, without the use of facial expressions, gestures, intonation expressiveness by the interlocutor. Patients do not follow oral instructions or perform them with errors.
- Semantic. The main defect in this type of aphasia is impressive agrammatism, i.e. the inability to understand complex speech patterns reflecting temporal, causal and spatial relationships.
- Acoustic-mnestic. Patients, as a rule, perceive short speech utterances without difficulty. Violation of understanding occurs when presenting detailed instructions, long speech sequences. This is due to the weakness of acoustic traces, the inability of the patient to retain in memory the voluminous information perceived by ear.
- Dynamic. The perception of oral speech is incomplete due to perseverations, increased attenuation and distraction.
- Total. With global aphasia, both the generation and the perception of speech suffer. Often, only situational understanding is preserved, abstract topics inaccessible to awareness and comprehension by patients.
- Primary progressive. Violation of speech comprehension is characteristic of the semantic and combined forms of PAP. This mainly concerns rarely used words, reading texts.
With motor aphasias (afferent, efferent), receptive speech is disrupted only in severe forms of the disorder. At the same time, situational and everyday statements are accessible to the understanding of patients, difficulties arise only with the perception of complex logical and grammatical constructions. Aphasias are most often the result of CVA, traumatic brain injuries, neurodegenerative diseases.
Impaired understanding of written speech is demonstrated by students with semantic dyslexia. With a satisfactory reading technique and the absence of pronunciation problems, dyslexics do not grasp the meaning of what they read. They find it difficult to retell the text, answer the questions posed, and write essays on literary works. Reading is mechanical, uninformative.
With congenital oligophrenia, systemic underdevelopment of speech is noted: scarcity of vocabulary, lack of grammar, violations of sound pronunciation. There are difficulties with analyzing the speech flow coming to the child. The level of speech comprehension impairment depends on the degree of MR.
In the most severe form – idiocy – the perception of speech information is practically inaccessible. With moderate idiocy, a relative understanding of facial expressions, gestures, elementary speech, recognition of faces and voices of loved ones is possible.
In persons with imbecility, understanding is limited to a range of certain everyday topics, is of a specific situational nature. New information is perceived and comprehended with difficulty. Imbeciles do not understand the meaning of many words, cause-and-effect relationships, etc.
In case of imbecility, the understanding of speech has an everyday character. Most patients can maintain a dialogue on everyday topics, but abstract and logical thinking is difficult. There is no understanding of idioms, phraseological units, metaphors, humor.
Dementia occurs in the clinic of many diseases: Alzheimer’s disease, cerebral atherosclerosis, Pick’s disease, neuroinfections, in children ‒ Geller syndrome, etc. The weakening of intelligence is accompanied by a violation of all VPF, including speech. In severe stages, speech activity is sharply reduced or absent, the response to the appeal disappears. In general, speech disorders in deep dementia correspond to total aphasia.
Patients with disorders of impressive speech require comprehensive neurological, audiological, speech therapy, psychological and psychiatric diagnostics, consultations of relevant specialists:
- Neurological examination. At the neurologist’s appointment, perinatal risk factors, features of early development of children are found out; the current neurological status is determined in all patients. To understand the etiology of speech disorders, instrumental diagnostics are prescribed: cerebral MRI scanning, MR arteriography of the brain, EEG, ultrasound of the vessels of the head and neck.
- Research of auditory function. In order to exclude hearing loss as the dominant factor of speech misunderstanding, acoustic VP, audiogram are examined, acoustic impedancometry, CT of the temporal bones are performed. Along with the examination of an otolaryngologist, a consultation of a surdologist is conducted.
- Neuropsychological testing. It involves the study of higher mental functions (memory, perception, thinking), auditory and speech memory. During the diagnosis, attention is paid to the state of various types of gnosis and praxis. Make a conclusion about the cognitive abilities of the patient.
- Speech therapy examination. When analyzing the speech function, the speech therapist conducts an in-depth study of impressive speech. Evaluates the patient’s understanding of situational and non-situational questions, verbal instructions, complex prepositional turns. Explores phonemic perception, the ability to meaningful reading, as well as expressive speech.
- Consultation of a psychiatrist. It is necessary to assess the mental status of the patient, to exclude congenital forms of MR, acquired dementia, ASD. The methods used are conversation, observation, pathopsychological research, neurotests.
Therapeutic tactics depend on the etiology of speech perception disorders. In case of organic brain lesions, drug therapy with neuroprotectors, neuropeptides, vitamins, correctors of cerebral circulation is necessary. Physical rehabilitation methods are used: physiotherapy (darsonvalization, electrophoresis, magnetotherapy), therapeutic gymnastics, mechanotherapy.
Patients with dementia are prescribed pharmacotherapy by a psychiatrist. Most often, nootropics, antidepressants, antioxidants, cholinesterase inhibitors, and neuroleptics are used to correct mental disorders.
Patients with congenital hearing loss may be recommended various types of hearing restoration: electroacoustic correction (selection of a hearing aid), cochlear implantation. In the future, to develop understanding of speech and active utterance, patients need classes with a sign language teacher.
Neuropsychological correction methods are used in the complex therapy of alalia, aphasia, mental retardation, autistic disorders. Within the framework of cognitive rehabilitation, work is underway on the development of VPF, sensorimotor correction involves the formation of a body schema, spatial representations, non-verbal expression of their needs, etc. Various methods are used: neurohymnastics, exercises for interhemispheric interaction, cerebellar stimulation, sand therapy, various types of sensory integration. For autism, AVA therapy is recommended.
Speech therapy correction
Speech therapy classes aimed at activating auditory perception play an important role in correcting speech comprehension disorders. The main directions of logotherapy:
- the development of perception of non-speech sounds (recognition of sounds of nature, animal voices, musical instruments, household noises);
- fixing the subject image of the word (pronouncing the word, showing the object designated by it and writing it);
- work on understanding situational speech (affirmative and negative answers, assimilation of short oral instructions);
- development of phonemic processes (phoneme differentiation, sound-letter analysis);
- work on the semantic side of speech (working out the understanding of off-topic questions, complex sentences and grammatical turns, developing the skill of meaningful reading).
A positive effect for the restoration of speech comprehension was noted from the use of finger games, mnemonics, auditory training using the Tomatis method. In children with ASD, a choice can be made in favor of developing verbal or alternative communication (using gestures, PECS cards).