In modern society, there are more and more cases of speech development disorders, especially in children. The study of this problem is critical since the speech function is the key one for the development of thinking and intelligence. Deducing the characteristic features of such disorders, their treatment, and their consequences can be used in medical practice for better prevention and the introduction of new and effective ways to combat them.
Depending on certain characteristics and violations of fluency of speech, comprehension, and repetition, there are several so-called aphasias. One of the most common types of human speech function disorders is Broca’s aphasia (Acharya & Wroten, 2021). Most of these diseases are characterized by focal lesions of subcortical structures of the brain. Sources state that “it is also known as non-fluent aphasia and expressive aphasia, and severity can range from mild to severe” (“Broca’s aphasia,” n.d., para. 1). The time of occurrence of aphasia plays one of the main roles in its formation. After an acute violation of cerebral circulation, edema and other mechanisms of dialysis lead to the appearance of neurological deficits. Aphasias are often diagnosed within up to three months after the occurrence.
Aphasia is characterized by damage to the part of the brain responsible for speech and motor functions. Often in right-handed people, it occurs when the left hemisphere is affected. This is due to the fact that it is the main thing in the formation and reproduction of speech processes. In left-handed people, speech is centralized in the right hemisphere or both at once. Some experts believe that at the moment, not the affected areas of the brain play a role, but the pathways leading to them. With any severity of aphasia, people have difficulty building their thoughts into words. At the same time, their thought processes are in perfect order.
Before considering the characteristics of Broca’s aphasia, it is necessary to consider the sources of its occurrence. Therefore, in the nineteenth century, surgeon Paul Broca discovered a motor speech center in the lower frontal gyrus of the left hemisphere. This center was named after its discoverer. This zone is responsible for the motor center of speech, which controls the articulatory organs; in case of malfunction of which, efferent motor aphasia occurs. Most often, this deviation is diagnosed after a stroke in the area of the left medial artery (Berube & Hillis, 2019). The age of patients most at risk, in this case, is 55-65 years. Moreover, it is noted that almost half of patients have two types of motor aphasia at once: efferent and afferent.
Broca’s aphasia is a violation of a person’s speech or any utterance caused by the defeat of the center responsible for this process. Among the numerous factors affecting the development of the deviation, the following can be distinguished:
- Violation of cerebral circulation, which leads to hypoxic damage to the tissues of Broca’s speech center. In this case, its classification depends on the purpose of the lesion. It can develop due to stroke and circulatory disorders of the brain (Johnson et al., 2019). The most common disorders are ischemia and hemorrhage. Moreover, negative consequences can be caused by a stroke in the precentral gyrus.
- Infectious and inflammatory diseases. These deviations can cause inflammatory changes and develop as a result of diseases such as encephalitis or meningoencephalitis.
- Traumatic brain injuries. This reason may cause physical damage and, subsequently, disruption of the Broca’s center. This type is also characterized by the presence of a concussion, traumatic brain injury, blows, or contusion. Moreover, injuries can cause swelling and compression of cerebral structures.
- Brain tumors can germinate and destroy tissues or squeeze them as they grow. In such cases, various kinds of malignant neoplasms grow and thereby affect mnestic activity.
- Epilepsy. This disease can provoke malfunctions in the functioning of the center and the nerve pathways connecting it with other structures.
- Degenerative processes can gradually lead to the destruction of nerve fibers. This process subsequently disrupts the functioning of the efferent and afferent connections of the motor speech center.
At the same time, it is important to take into account that aphasia can occur only if the brain is damaged.
In addition to speech disorders, the Broca’s center is also responsible for the formation of complex muscle activity. Therefore, it is responsible for the work of speech-motor organs, such as lips, jaw, and tongue. That is why, in addition to speech abnormalities, Broca’s aphasia can affect the feeding process. The defeat of the above organs can lead to a violation of the transmission of impulses that ensure the process of reproducing a speech act. In its course, there is difficulty in moving from one articulatory pose to another. Because of this, multiple repetitions of words, syllables, and permutations occur. Vega (2020) states that “speech lacks normal fluency or rhythm and people have a hesitant, interrupted speech pattern” (para. 3). In turn, these characteristics can lead to a violation of writing and reading. Moreover, speech processes subject to such a negative influence lead to a poor understanding of the figurative and hidden semantic meaning by people, and auditory-speech memory is disrupted.
The speech defect and its characteristics vary depending on the severity of the violation. Taking into account the features of this dysfunction, motor aphasia is classified into three degrees of severity. The mild degree is characterized by a detailed speech with the presence of speech stamps. In most cases, the syllabic pronunciation of words is also noted. When diagnosing, patients are asked to repeat phrases after the doctor or name the subject, which with this type of aphasia can cause difficulties. Dialogic speech is sufficiently developed but not expanded. A mild form of aphasia occurs without pronounced disorders of writing and reading. The moderate stage is set with insufficient literacy of spontaneous speech. Utterances are limited by the variety of reproduction. Moreover, automated speech is preserved, but perseverations occur when phrases are repeated. In the dialogue, uncontrolled repetition of words or replicas is manifested.
The most severe type of aphasia is characterized by a lack of spontaneity in speech. With arbitrary speech, there are repetitions of fragments of the word. Automated speech does not function well, and there are difficulties in understanding when another person speaks. Often this stage occurs in younger patients with a violation of the nervous system. In addition, the patient cannot correctly formulate complete sentences and, consequently, build a dialogue. Moreover, there are also many grammatical and phonetic errors. Diagnosing Broca’s aphasia involves conducting a comprehensive study. It should include procedures such as speech, hearing, and intelligence analysis. Effective practice in this process is considered to be a test for the memory of chains of words. In some cases, magnetic resonance imaging of the brain, angiography, or ultrasound of the cerebral vessels may be prescribed.
Common average symptoms of Broca’s aphasia are the understanding of their own speech by patients. However, there are some difficulties in the perception of complex statements, misunderstanding of the figurative meaning, the meaning of proverbs, and specific sayings (Nasrullah et al., 2021). It is also noted that patients fully understand and realize that they have a defect, but independent treatment and the fight against deviation are difficult for them.
Such a disease as aphasia has certain consequences and complications. For a mild degree, there is no justification for a strong negative impact on the patient’s communicative abilities, as well as on feeding (Pallavi et al., 2018). The moderate and severe stages of speech impairment are characterized by a significant decrease in the ability to communicate verbally, which can lead to the inability to express thoughts. Moreover, the disease adversely affects motor functions, causing insufficiency and limitations in the patient’s activity. In such cases, patients may develop psychological and neurotic problems, such as depressive neurosis.
First of all, diagnosis consists in determining the type of speech disorder and establishing the nature and extent of damage to the brain center. The main ones in this process are neurological and speech therapy studies of the patient. Consultation of a speech therapist-aphasiologist is one of the first diagnostic measures. A specialist works with a patient to detect a disorder of pronouncing speech, that is, motor aphasia. This deviation is put with difficulty in the transition of articulatory poses, telegraphic speech, repetitions of phrases, words, syllables, and agrammatism. This process also includes the diagnosis of written speech for dyslexia and dysgraphia.
Next, the patient is referred for consultation with a neurologist. This examination shows the presence of central hemiparesis and dysfunction of the facial nerve on the right side. The data acquired during this procedure prove the presence and location of the lesion in the area of the motor cortex of the cerebral hemisphere. This differential diagnosis helps to eliminate cases of speech dysfunctions that are not associated with deviations in the work of Broca’s center. As already mentioned, this disease is characterized by long pauses in speech due to the inertia of the processes of reproducing the patient’s thoughts. The semantics of the word, in this case, does not bear any changes.
Magnetic resonance imaging of the brain is the most important aspect of diagnostic measures when exposing the diagnosis of Broca’s aphasia. This study allows us to establish the morphological justification of the disease. It shows the presence of abnormalities such as a hematoma, cyst, or abscess in the event of an external head injury. Moreover, MRI detects stroke zones and inflammatory foci. The study of cerebral hemodynamics makes it possible to determine and measure the nature and degree of blood supply disorders in the brain. In some cases, employees of medical organizations use such a method as analysis of cerebrospinal fluid. With the help of a puncture, a certain amount of fluid is taken, which helps to determine and justify the suspicion of an infectious and inflammatory nature of the disease.
Currently, for Broca’s aphasia disease, a radical and complete treatment that would be universal for each patient has not yet been established. Moreover, the most advanced technological innovations, therapeutic and rehabilitation schemes cannot give an accurate, effective fight against brain damage. The complexity of their compilation and application is due to the fact that with this violation of speech and brain function, the work of the patient’s cognitive sphere is affected.
The treatment program is based on a course to eliminate the disease. It includes improving the condition and reducing the risk of worsening damage to the Broca’s center and adjacent brain structures. These actions also include stopping and preventing trophic disorders by reducing the area of damage to the nervous tissue of the patient’s brain. Pharmacological therapy in the form of a specially selected course acts as a basis. It includes drugs with neuroprotective action, as well as metabolic drugs that improve neurocirculatory processes. Factors affecting further recovery and the possibility of relapses affect the initial severity of the disease, the focus and age, and the general condition of the patient.
In the absence of critical internal lesions of the brain, the patient is given the correction of a speech defect with the help of rehabilitation therapy. Crosson et al. (2019) underline that “functional and structural neuroimaging studies indicate that aphasia treatments can recruit both residual and new neural mechanisms to improve language function and that neuroimaging modalities may hold promise in predicting treatment outcome” (p. 1147). First of all, it implies employment with a speech therapist. The main tasks of this type of correction are the stabilization of the motor component of the formation and reproduction of utterances. It includes overcoming the difficulties of articulatory transition and restoring sound-letter analysis. Depending on the severity of the disease, the doctor determines the duration of treatment and what stages it will be divided into.
Another source suggests such a productive treatment method as the expressive verbal skills management program (VESMP). Shamim et al. (2017) define this approach as “a software which developed augmented management for patients to enhance verbal expressive skills for patients with severe Broca’s aphasia” (p. 138). The main task of VESMP is to support and restore the patient’s vocabulary and conversational needs. It allows specialists to carry out the individually selected treatment. A distinctive feature of this technique is to increase the independence of the patient.
The last method of treating Broca’s aphasia is considered to be resorting to pharmacological drugs. With the help of medical intervention, the work and metabolism of neurons are normalized, which stabilizes the work of Broca’s center. Depending on the diagnosis, the doctor may prescribe vasoactive, neuroprotective, amino acid, or nootropic drugs. Since depressive neurosis and other diseases associated with the mental and neurological health of the patient cause diseases in particularly difficult cases, psychotherapeutic support and visiting a specialist in this field are of particular value.
While working with a speech therapist, depending on the nature of aphasia, various procedures are performed. Furthermore, when working with a sensory view, the phonemic aspect of speech comprehension is restored. Acoustic aphasia requires the elimination of defects in auditory and visual memory (Silagi et al., 2020). With the dynamic form of deviation, defects in the planning and reproduction of speech processes are eliminated (Thompson, 2019). In addition, measures may include working with the speech apparatus itself, which can disrupt not only the functions of speech but also feeding.
All of the above measures should contribute to improving the patient’s speech function. When diagnosing dyslexia or dysgraphia, the patient requires long-term special classes with a specialist. Moreover, further preventive measures focus their attention on the prevention of cerebral abnormalities in the work of the body of patients. The main points for the prevention of the disease are following a healthy lifestyle and proper nutrition; in the presence of arterial hypertension, specialists are prescribed treatment to correct it. Moreover, patients should avoid traumatic situations and toxic and carcinogenic effects and observe anti-epidemic measures. It is worth noting that physiotherapy procedures are an integral part of treatment and prevention. The list includes electrophoresis, special physical therapy, and massage.
Most of the widely used traditional methods of treating aphasia are based on component and contextual approaches. In their study, Ali et al. (2018) give an example of using a scenario method of treatment and correction of the disease. Authors emphasize that “this approach tends to restore automatic, natural and unforced context-specific speech production” (Ali et al., 2018, p. 1). Thus, they prove the effectiveness of including this method in the treatment of patients with aphasia, especially in severe cases.
An important tool for accelerating the treatment and rehabilitation of a patient can be a close environment. For those who care for patients, special communication devices can be used. It can be a book or specialized boards for communication with the use of pictures or symbols. They may reflect the mood, well-being, and needs of the patient. If the equipment of the medical institution allows, modern computer technologies and devices can also be used. With properly selected and performed therapy, a favorable prognosis is maintained. It implies the achievement of the restoration of human speech and motor functions. The effectiveness of treatment is affected by early and timely diagnosis and the application of further measures for the correction and treatment of the disease.
When working and communicating with a patient with Broca’s aphasia, it is necessary to remember some aspects. Despite the fact that the speech of patients is meaningless, although they do not realize it, and often the patient understands the speech of others well, it is important to follow certain rules of conversation with them. Thus, when communicating with a person, it is impossible to raise one’s voice since aphasia does not affect auditory functions. Moreover, patients with this diagnosis are characterized by increased sensitivity to noise. Therefore, it is important that the contact is carried out with one person and not with several at the same time. In addition, it is not difficult for the patient to remove various devices such as radio, telephone, or TV in the background.
When certain errors or deviations appear, it is necessary to carefully let the patient understand that his speech is perceived, despite grammatical and auditory errors. People exposed to aphasia should keep a positive attitude and see the results of their treatment for the disease. The improvement of speech functions in this case with the addition of properly organized treatment and therapy is observed during the first year. However, it is worth noting that this indicator depends on the initial severity and stage of development of the disease. The last recommendation is the elimination of such a phenomenon as speech isolation of the patient. Thus, patients always need to maintain a communication process with someone for a more effective and rapid treatment process.
The next criterion of interaction is a short and understandable speech of a specialist or a person from a close environment. Moreover, the interlocutor needs to speak slowly and use simple sentences. If necessary, the specialist can repeat phrases and express some thoughts with gestures. It is also important to use simple questions that do not require a detailed answer. In addition, it is important to give a person with Broca’s aphasia the opportunity to fully express their thoughts. It is necessary to listen carefully and try to understand the speech and thoughts of the patient, paying attention to the forms of expression of thoughts. Thus, a specialist or close people give patients the opportunity to realize that their non-verbal communication skills are critically important.
In cases of incomplete restoration of the damaged speech function, course rehabilitation is carried out for the patient. Motor aphasia requires special speech exercises during rehabilitation for the new formation of the lost speech skills of the patient. The prognosis for Broca’s aphasia depends on the severity of brain damage, symptoms, and etiology of the disease. It is worth noting that not in all cases do doctors manage to completely get rid of the violation and its consequences. However, it is important to note that such patients require special attention due to the fact that aphasia is a life-threatening disease. On the other hand, proper therapeutic measures for metabolic disorders and comprehensive rehabilitation can help a person adapt to life with this deviation.
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