Agraphia - causes, types, diagnosis, treatment of agraphia

There are several types of agraphia - a writing disorder that is closely related to the patient's speech disorders. Treatment is carried out only by speech therapists and psychiatrists, specialists who understand the medical causes of this phenomenon. First, a diagnosis is carried out to identify the degree of agraphia, and then a set of exercises and procedures is prescribed.

The online magazine psytheater.com ranks writing skills alongside other complex mental and mental abilities. It is only human nature to master speech in all its diversity, and then add motor activity of the hands to this. Writing is a complex skill that requires some preparation.

To write anything, a person must know the letters of the alphabet, their pronunciation and writing. Also, a person must speak the language, at least some words. The process becomes more complex when it is necessary to compose sentences. Here you also need to have knowledge of grammar and spelling. The whole process involves the activity of the hand, which is subordinate to certain areas of the brain.

If we are talking about agraphia, then its origins begin from the moment of acquisition of oral language. A person can speak, but with some impairments. His mental and intellectual abilities are preserved. Also, the problem of agraphia does not lie in the motor activity of the hands. The problem lies in brain damage:

The right hemisphere in left-handed people.
Left hemisphere in right-handed people.

What is agraphia?

Agraphia implies some impairment in the development of writing skills, when the child distorts words, cannot form syllables, misses words, etc. The ability to express his thoughts in writing is impaired.

Agraphia is not always a congenital anomaly. A person can acquire this pathology in mid-life, for example, if a segment of the posterior part of the brain is damaged. In this case, the functionality of hand movements may be impaired, or the person will simply partially lose the skill of writing texts.

Agraphia involves a person’s partial or complete inability to write texts. In children, agraphia often develops against the background of:

Alalia – unformed speech functions.
Brain lesions.
Speech disorder, which is associated with problems with speech acquisition.

In adults, it occurs against the background of aphasia – speech dysfunction.

go to top

Treatment

Correction of agraphia in children is a long and difficult process for both parties (patient and doctor). You need to understand that treatment does not guarantee complete relief from the disorder, but it can help and move along in development with your peers. The child must be registered with a neurologist and visit him regularly. The frequency is determined by the doctor who is caring for the patient. He also determines an individual course of treatment. Correction classes can be group or individual. This condition is also determined by a speech therapist or neurologist.

Before starting correctional work on the ability to write, the specialist must pay attention to speech. In many cases, special gymnastics and physical activity are prescribed. Such classes help consolidate skills and increase the effectiveness of correctional work. The patient may be prescribed singing songs, reciting poetry, or expressive reading aloud.

Types of agraphia

Writing impairments can be divided into three broad categories:

Agraphia.
Dysgraphia is a persistent violation of grammar and spelling during writing, which is associated with lesions of the higher central nervous system. The reasons for this are hereditary pathologies, infections, injuries and diseases of the central nervous system, uneven development of individual hemispheres, which is observed in infancy. Dysgraphia can develop against the background of a strong passion for the computer or TV. Children may be quite smart and developed in other subjects, but at the writing level they constantly make numerous mistakes.
Dysorphography.

Each of the writing disorders is divided into types. Agraphia happens:

Amnestic (pure) - manifests itself in the form of an inability to write a normal text under dictation or when accompanied by an audio analogue. However, a person does not have problems when cheating. In a mild form, it may be accompanied by Gerstmann's syndrome (when a person partially does not feel his body). In severe form, a mirror subtype of spelling of words is formed.
Apraxic is an independent disease or a consequence of ideation apraxia. A person is not only incapable of writing some words, but even holding a pen at all. This applies to both writing from dictation and copying.
Aphasic – develops against the background of aphasia (speech disorder), in which auditory and speech memory, the phonemic type of hearing, suffers.
Constructive – a consequence of constructive changes in the structure of the brain.
Afferent – the inability to recognize which sound is located in which place in a word. A person is not able to recognize identical sounds. In such a situation, a person simply uses those letters that sound similar.
Efferent - when a person can write letters, but difficulties arise when writing syllables or whole words. Here, in a letter, the spelling of individual letters, unfinished words, and rearrangement of letters may be noted, which is associated with the inability of the brain to switch from one letter to another.

Dysgraphia is divided into the following types:

Acoustic.
Optical - a person is not able to perceive how letters are written because his visual memory is impaired.
Ungrammatical.
Articulatory-acoustic.
Due to a violation of sound synthesis and analysis.
Sensory – a disorder of letter-sound analysis. It arises against the background of the inability to write a text from dictation, since a person is not able to understand and distinguish sounds when they are heard. A person is able to write down letter by letter or copy.

Specific agraphia occurs when you are unable to write a text on your own, which is associated with the inability to come up with a text, plan its writing, and also control the writing process.

go to top

Prevention

Prevention consists of performing speech exercises as often as possible. Parents are advised to monitor how the child expresses his thoughts, how he connects words, as well as how his speech develops. Any manifestation of delays or limitations in speech should not be overlooked. In this case, you need to contact a neurologist to conduct research and prescribe treatment. By responding to the problem in a timely manner, parents will be able to ensure the normal development of their child and protect him from many problems that may arise in the future due to agraphia. It is also necessary to ensure that the child is not injured, to treat inflammatory and infectious diseases in a timely manner, to prevent intoxication, and to closely monitor the health of your children. Adults are recommended to lead a healthy lifestyle, avoid traumatic brain injuries, and prevent circulatory disorders in the blood vessels of the brain. Prevention of congenital disease is a conscious attitude towards the birth of a child, which will make it possible to prevent the development of pathology during pregnancy and childbirth.

Causes of agraphia

Doctors call the main cause of agraphia organic damage to the cerebral cortex, which can be caused by the following factors:

Head injury.
Hemorrhagic or ischemic forms of stroke.
Neoplasms of a benign or malignant nature.
Inflammatory processes of an infectious nature.
Negative effects of toxins on the body and brain.

The cause is also called birth trauma, when in infancy the baby does not try to speak, over the years is not interested in writing, and at an older age cannot even express his thoughts at the level of oral speech.

The development of writing skills is influenced by how the brain works when perceiving oral speech, and whether the child is even able to hear and recognize various sounds. Also, writing depends on the level of development of oral speech, vocabulary and richness of words.

With agraphia, various brain lesions can be observed:

When the temporal lobe of the brain is damaged, a person is unable to normally perceive and reproduce sounds.
Damage to the posterior segments of the 2nd frontal gyrus leads to the development of pure agraphia.
If there is a malfunction between the hemispheres, a mirror type of agraphia is reproduced, which is more common in left-handed people or in intellectually retarded patients.

Agraphia manifests itself in a partial or complete impairment of writing, when a person is unable to write a letter, syllable, whole word, connect letters, form sentences, skips or rearranges letters in a word. At the same time, intellectual skills and previously developed writing skills are not impaired.

Agraphia can be recognized by the fact that a person is not able to write, take dictation, or rewrite independently. Mirror spelling of words, letters and even sentences may also be noted.

go to top

Features of agraphia types

Amnestic agraphia is often accompanied by a number of neurological disorders caused by lesions of the cerebral cortex. One of them is Gerstmann's syndrome. The apraxic variety arises as a result of the ideational type of apraxia. In this case, the patient does not understand how the hand should be positioned when writing, he does not understand how to correctly move the hand and fingers.

Also, such a child is not able to understand the sequence of movements, which explains the incorrect arrangement of letters; sometimes this phenomenon can have a mirror spelling of words. In severe cases, the structure of words may completely disintegrate; the child depicts only individual fragments. Apraxic agraphia is observed in all types of writing - dictation, independent writing, copying. In this case, the order of movements, organization, and structuring of the writing of a word or phrase are disrupted.

Material for the topic General speech underdevelopment: classification of OHP, prognosis and correction

This type is a consequence of lesions of the angular and supramarginal gyri located in the left hemisphere. In the case of aphasia, aphasic agraphia develops. When it occurs, damage occurs in the temporal part of the cerebral cortex in the left hemisphere. There is loss or deterioration in phonetic hearing and auditory-verbal memory. Constructive aphasia is characteristic of constructive aphasia.

Diagnosis and treatment of agraphia

Only a specialist can prescribe treatment that will partially or fully help in recovery. To begin with, agraphia is diagnosed, which is not difficult, since even when examining the text written by the patient himself, his illness becomes obvious. Diagnosis is also made through examination and neurological tests. A survey is conducted of the patient and his parents, if we are talking about a child.

Next, you need to identify the cause of the disease. This is much more difficult to do, since the patient himself does not know at what point he developed agraphia, unless we are talking about an adult. So, a brain function test is prescribed to identify the lesion:

MRI.
CT.
X-ray.
ECHO.
Electroencephalography.

Treatment is carried out by registering with a neurologist, who prescribes a course of medications and prescribes a special course to restore writing skills. The patient undergoes both individual and group training, which promotes recovery. Before correcting writing skills, specialists focus on oral speech, eliminating gaps in its development, and then move on to eliminating inertia and gaps in writing.

The patient is also registered with a psychiatrist and speech therapist. Speech therapy classes are aimed at improving oral speech skills, when a person will practice sounds and letters, get used to their pronunciation and writing.

It is connected to exercise therapy training, which has been proven by practical exercises, when physical exercises contribute to the rapid acquisition of knowledge. Moreover, writing is part of physical activity. Even when teaching healthy children, training first occurs at the level of fine motor movement of the hand. If you constantly train your hand to write letters, then this will help improve your skills.

Music and singing are also used to develop vocal cords, perceive sounds and pronounce words. Playing musical instruments contributes to the development of motor activity.

The most important thing in treatment remains the mood of the parents, who must promptly seek help from doctors, as well as support the child throughout the entire path of his recovery. Also, parents themselves should work with the child, and not shift all the work to specialists. Emotional and verbal communication, reading books, and conducting dialogues with the child are important here. You can also get your baby interested in drawing, which will help strengthen and develop fine motor skills.

The more positive emotions a child receives from oral communication and written work, the faster he will learn everything. This will be facilitated by treatment of the main cause, which lies in the functioning of the brain. If doctors are able to eliminate brain pathology, then agraphia can be cured completely.

go to top

Diagnosis of the disease

With agraphia there are rarely problems with accurate diagnosis. The doctor must conduct a neurological examination of the patient and then render his verdict. It is necessary to establish the exact cause of the formation, to understand what triggered it.

This requires a conversation with the patient, or his parents, if we talk about a child. MRI of the head, radiography, rheovasography, EEG and other research methods may be required. To prevent agraphia, it is necessary to engage in special speech classes with the child. They should be carried out frequently and correctly.

Material on the topic How to get rid of a lisp at any age

Forecasts

Agraphia does not give clear prognoses, since its causes lie not in psychological factors, but in brain damage. If doctors are able to eliminate the problem at the physiological level, then agraphia can be completely cured.

Specialists should work with the patient. The problem should not be ignored or left uncorrected. Agraphia itself will not disappear, but the person will be significantly unadapted to society. In some cases, children with agraphia manage to study with healthy children in secondary schools. If the problems are serious enough, then home schooling and attending classes with a specialist are suggested.

Agraphia cannot be eliminated on its own, especially if the causes are brain damage. Only doctors are able to identify the affected area and eliminate it.

Diagnostics

There are no difficulties when making a diagnosis. First of all, a neurologist conducts an examination and can immediately make a diagnosis. It is difficult to establish the cause of the development of pathology. It is necessary first to determine the lesion in the brain and its cause. In this case, the parents or close relatives of the patient are first interviewed in detail. Then the doctor prescribes neurological studies: MRI, skull radiography, ECHO-encephalography, CT, blood circulation, electroencephalography, etc.

Efferent (kinetic) motor agraphia

⇐ PreviousPage 7 of 13Next ⇒

It is known that in order to write a word correctly, it is not enough to analyze its sound-letter composition; it is also necessary to understand the sequence of sounds in the word. Maintaining the required sequence of sounds when writing a word is one of the most significant difficulties in the initial development of writing skills in children.

Damage, or dysfunction,
of the posterior frontal cortex of the left hemisphere of the brain
leads to precisely these defects in writing. The process of writing individual letters does not present any difficulties in this case. Unlike other forms of writing impairment, difficulties arise when writing syllables and words. These defects are based on a violation of the mechanism of switching from one letter to another (or from syllable to syllable, from word to word).

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. This mechanism leads to defects in switching from one sound (word, sentence) to another in

the process of oral speech and from one sign to another - in written speech. 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.

If the patient retains the ability to write, then it becomes extremely slow and arbitrary, the handwriting changes, the letters become angular and are often written separately, often the letters either enlarge or become small (macro- and micrography). perseverations are already detected at the word level.

previous letters (or words).
In the rough form of perseverations, writing becomes completely impossible; it is replaced by the writing of individual letters, syllables or parts of a word. Even ideogram writing (first name, last name, city in which the patient lives, names of loved ones, etc.) turns out to be difficult and has many errors. The main mistake is perseveration.
In the next place after this error and due to the collapse of the patient’s awareness of the internal scheme of the word and the sequence of letters in it are
rearrangements of letters in the word, omissions of letters denoting vowel sounds or consonants when they are combined, repetition of the same syllable (word), underwriting of words
( which is associated with a violation of writing as a successive process), etc. Patients experience significant difficulties not only when writing words, but also when laying them out from the letters of the split alphabet.

Efferent motor agraphia occurs in a neuropsychological syndrome

efferent motor aphasia, disorders of dynamic praxis, defects in the process of understanding speech, decreased understanding of the meanings of words and a defect in understanding their meaning.
Violation of the semantics
of oral speech also affects the state of written speech and is one of the types of difficulties in restoring written speech.
The second type of difficulty is a gross violation of the syntagmatic aspect of speech,
the structure of the phrase and its grammar. Agrammatism in this form of aphasia appears in rough forms, which also underlies the difficulties in restoring written speech.

For the psychological picture

Writing disorders are 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). Word and sentence do not consist of

individual sounds (words), but a certain internal scheme is assumed, within which words are in complex syntactic and grammatical relationships. In patients with this form of agraphia, awareness of the complex relationships of words within a sentence is impaired; they lose awareness of those dynamic relationships of words, thanks to which not the word, but the sentence becomes the unit of meaning and meaning.

These patients find it difficult to create “in their minds” a diagram of an entire grammatical structure, to place and link individual words into sentences.

In severe cases of violations, this contingent of patients lacks all types of writing with the exception of ideogram. Even when copying, which is the most secure, these patients make many mistakes, the process of copying itself takes on the character of an expanded, conscious and letter-by-letter letter, while the patients pronounce every sound and syllable.

When teaching writing to primary schoolchildren

These defects in switching from one letter (syllable, word) to another often underlie their difficulties in forming writing. Particular attention should be paid to perseveration in writing when teaching children to write, because they are generally associated with the structure of words and phrases and have a negative impact on the writing of words, phrases, texts and generally retard the development of written speech. However, it should be remembered that children rarely make errors of the same type. Typically, the mechanisms of difficulties in the formation or impairment of writing in children with mental retardation and other forms of abnormal development are complex. And such characteristics of writing, representing arbitrariness, awareness and expansion, which are symptoms of writing impairment in efferent motor agraphia, in children are a normal stage in the process of formation and development.

Methods for restoring writing in case of efferent motor agraphia

Restorative teaching of writing is divided into a number of stages, each of which has its own tasks and methods, but all of them are aimed at restoring the normal process of writing and written speech. Central

task and goal - restoration of analytical writing: awareness

knowledge of the sequence of sounds and letters in the word and its role in the meaning of the word.

At the first stage, work is carried out from the whole word, its meaning to its letter composition - this is a synthetic method.

The work is carried out as follows: the patient is offered pairs or triplets of subject pictures, the names of which differ only
in the order of the letters
in them, but this also leads to their different meanings. Under each picture there is a word made up of letters.

The patient’s first task is: a) read pairs of given words, b) match with a picture, c) show what the difference is in these words, d) copy these words in pairs, e) write from memory. For example, magnolia - Mongolia; tok - cat; thief-ditch; hump - fob, etc. Second task:

a) rearrange the letters in the given words so that you get a word with a different meaning, b) explain the difference in the spelling of words, c) copy them, d) write from memory. For example: gift; cat; cable, etc. (the corresponding pictures are in front of the patient).

After working using the synthetic method

(from the whole - to the part, from the meaning of the word - to its structure) you can move on to
the analytical method,
which is aimed at a conscious analysis of the composition of the word. The work proceeds according to a program consisting of a number of sequential operations:

1) element-by-element pronunciation of the word;

2) quantitative analysis of a word (counting and recording the number of sounds in a word using external means - abacus, sticks, etc.);

3) drawing up a word diagram based on the analysis (letter-by-letter and syllable-by-syllable scheme) □—»□—»□;

□—»□—»□ —»□

4) sequential filling of the diagram with the corresponding letters.

The psychological essence of this method of analyzing words using materialized means is that the entire process of writing a word (and later a sentence) is taken outside, becomes the subject of conscious activity, and chip cards and arrows in a materialized form represent the structure of the word and the sequential connection of letters in German Consolidating the analytical skill of writing words is carried out by a number of exercises: a) analyzing a given word by syllables and letters (first based on the corresponding picture and the written word, then only on the picture, and later - analysis

words by ear), b) parsing words that are similar in phonetic structure and serial organization, but different in meaning (rak - acre, ditch - thief, etc.), c) completing unfinished words, d) filling in missing letters in a given word or syllables (Ebbinghaus method), e) composing and writing a word from given (randomly) different syllables (ra; ta; bo; ka, etc.).

At the third stage, learning to compose words by rearranging letters occurs (method of verbal games). Patients are given a word, from the letters of which they must form as many other words as possible (for example, the word “typography”—type, graph, vulture, tiger, pie, graphite, etc.). In terms of psychological essence, the method of composing words based on one syllable or the root part of words is close to this method (for example, the syllable “steam” is given - locomotive, steamship, greenhouse, partner, etc.).

These methods are aimed at analyzing a word on a morphological basis and ensure the restoration of awareness of the connection between the sequence of letters in a word and its meaning (court - mole, mor - rum, mole - crowbar, cat - current, three - shooting range, etc.). The words found in this way, analyzed in terms of the sequence of letters in the word, are written down by the patients, pictures corresponding to them are found, they are signed under these pictures from memory, and at the end of the work they are written under dictation. This method is best used in working with children in the form of a “word game”, and it is better if the lesson is carried out with a group of children (two or three), which will allow the use of a whole range of group methods - competition, mutual assistance, collective work on mistakes, encouragement etc., which enhance the effectiveness of the verbal method itself.

All these and a number of other methods stimulate the patient to analyze

sequences of letters in a word,
restore awareness of its connection with the meaning of the word and teach him this analysis.
They, by fixing the patient’s attention on the structure of the word, on the significant role of a stable sequence of letters, thereby become an effective means of eliminating the main defect. At the first stage of training, patients usually master a wide system of auxiliary means and independently use them in writing words and short, simple-structured phrases. There are a number of requirements for the selection of material on which writing is taught (verbal, picture).

ny: frequency, phonetic complexity, word length - all these parameters of the word should gradually become more complex. The entire wide system of supports, as well as operations, should be gradually reduced with the help of the teacher, i.e. From the operational action, certain operations should be gradually eliminated, which at this stage are already more automated than others and can take place at the internal level, without pronunciation. For example, you can remove the first operation (pronouncing a word), later the second, etc., and thereby transfer all operations to the internal execution plan.

Methods for restoring the letter of a phrase

After patients have restored the ability to write a whole range of words - simple and complex, high and low frequency, long and short - they move on to the second stage

training, the task of which is to restore the writing of a phrase. A phrase, as we know, does not consist of independent words, but presupposes a known internal scheme in which words are in complex syntactic and grammatical connections and relationships. With efferent motor aphasia and agraphia, patients exhibit a violation of knowledge of these relationships, which manifests itself in syntagmatic defects when writing a phrase: patients find it difficult to create “in their mind” a diagram of an integral grammatical structure, to place and connect individual words within a sentence, which is the central defect of writing at the level of sentences and texts. Work on restoring the writing of phrases involves, first of all, teaching patients oral speech and the ability to compose sentences of certain grammatical structures.

The following system of methods contributes to restoring the structure of a phrase both during its pronunciation and when writing . Method of composing picture phrases

consists in rearranging a number of pictures that separately depict objects, actions, objects. After composing a phrase from pictures, the patient must choose the appropriate endings for each word within the phrase. Let's give an example. In front of the patient there is a series of pictures on which are drawn: a woman, a man, washing, cutting, reading, combing his hair, newspaper, book, comb, etc. He is given the task - to put together one sentence from the pictures, find a corresponding word for each word included in the sentence.

the corresponding picture, the desired ending, pronounce the resulting phrase, write it down, come up with a new similar phrase, write it down, etc.

Semantic construction of a phrase

later replaced by a phrase scheme, consisting of appropriate questions to the words of the phrase, contributing to the restoration of the “sense of language”, “sense of the structure of the phrase” (who? what? ->
what
is doing? - “what? (what? whom? to whom?). Given The patient first fills the diagram with the necessary pictures, and later with words with the corresponding case endings. And this “system of methods” ends with the method of parsing the phrase into parts of the sentence and parts of speech by independently asking questions for each picture and correspondingly recording the sentence compiled in this way. The second defect, making it difficult to write a phrase, the difficulty of switching and perseveration remains. As for the methods for eliminating perseverations when writing, the main ones are: the method of slowly pronouncing words and phrases while consciously writing;
the method of “pausing” writing,
which involves increasing the pauses between writing each word of the phrase. These pauses can be realized only through their materialization, the role of which is not only to implement pauses when writing individual elements (syllables, words), but also to switch the patient’s attention from writing the previous element to another type of activity.
In this case, in the intervals between writing the elements of a phrase (words), the patient is asked to perform some other short-term operation, for example, to find a number written on the cards in front of him, corresponding to the serial number of the word he wrote, or to choose among three (no more) subject pictures of the one whose name the patient has to write, etc. The action of writing a phrase in this case will consist of a number of heterogeneous operations: writing a word
->
choosing a number (picture)
->
writing the next word
->
a simple arithmetic operation
->
writing a word, etc.
Gradually, filling pauses with extraneous operations is replaced only by pictures corresponding to words or pictures denoting verbs, and after working with this program, you can move on to the stage of slow, conscious writing of phrases.

This and a number of other similar methods make it possible to overcome perseveration when writing not only phrases, but also

text. Methods for eliminating perseverations in restorative teaching of writing may be different, but they must meet two requirements - increasing pauses between elements of a phrase and switching the patient from one type of operation to another within one action - writing a phrase or text. The described methods of work lead to effective restoration of writing in case of efferent motor agraphia.

In children with writing dynamics defects,

manifested in perseverations of previous letters (words) due to defects in the switching of the innervatory act to the denervator one, the same general principles of restorative training are used in general - from the general to the part, the meaningfulness of the work, etc. But this work should be carried out after (or in parallel) with work on the motor skills of the child’s hands and body - on restoring mobility, dexterity, speed and other characteristics of movements and objective actions, and most importantly, on their ability to switch from one action to another. For these purposes, methods of singing, drawing, classifying objects, arranging objects (figurines, etc.) in a certain order, moving hands in a certain order, etc. are useful.

At all stages, the musical method, or the singing method, is useful as a “warm-up” .

Children and their teacher sing their favorite song.
They then work
on this song and perform a series of sequential operations:

1. The teacher and children sing together (entirely or one verse) a song they know (for example, “A Christmas tree was born in the forest...” or “May there always be sun, may there always be mother...”).

2. After this, draw the objects (objects, phenomena) that are sung in the song, always taking into account each line of the song.

3. While drawing, the corresponding line is sung, and the entire verse is sketched in this way.

4. Then the verbal composition of each line is analyzed (forest - [in the forest] - [born] - Christmas tree).

5. Together with the teacher, substitute the corresponding words for each picture.

6. Children sing the line while looking at the pictures and the corresponding words.

7. Later, after 5 - 7 similar lessons, the drawings are removed and only the words remain.

8. Children look at the words and sing a verse.

9. Then they listen to this verse from a tape recorder.

10. At the same time they sing and look at the written words.

11. Then all the words are removed, the children sing

and
listen to the verse
and choose from 6 - 7 different words those that they
drew, sang and heard.
The psychological essence of this method lies in the actualization of the most consolidated melodies and their connection with certain images-representations and with certain spoken words. These connections are brought out with the help of singing and drawing, which makes it possible to connect them with the way of perceiving what is written

words: melody + object image + spoken word + written word. Working on the melody of a word and its semantics is an important method in work, which creates a semantic basis for writing and actualizes all possible connections of the word. This method should be used at all stages of remedial learning to write and for all forms of agraphia.

Drawing method.

In this case, children are given the task of drawing different figures, initially located far from each other.
Then these figures are brought together (for example, -»->-» + -» Z) and arrows are placed between them, which indicate (materialize) the dynamic connection of the figures with each other (A -»-»-»+Z... +Z; w
- »
t
-»
w
-»
t
-
> w
-
> t,
etc.). In parallel (or after these exercises), it is useful to complete tasks on sequentially laying out subject pictures (following a model), figures, etc.

After this preparatory stage, you can move on to learning to write whole words. Children can write a letter to someone, but they can also write “for themselves” and “to themselves.” You can arouse a child’s interest not only in writing entire phrases and texts, but also in writing individual words, if you include these words in the child’s system of relationships and comprehend the work on writing individual words. In teaching the writing of individual words, the path from the whole to the part is more effective, i.e. from phrase -> to word -” to letter. The child does not yet know how to write a phrase, but it is given to him in the form of a simple plot picture, under which the words of the phrase corresponding to the picture are written on separate cards, but in this phrase the word is missing, the teacher is working on writing it. The child must: a) find this word from 3 words lying in front of him, b) insert it into an empty space, c) write it from memory, d) conduct a sound-letter analysis

this word, e) write it separately, etc. This context method

can be used at all linguistic levels: writing letters - through a word, words - through a phrase, phrases - through a text, using the “missing element method”, the letter of which is being worked on, followed by a sound-letter analysis of the composition of the word.

After working on the contextual method, it is useful to work on the analysis and writing of individual words out of context (analytical method), but included in the system of relations

child (words denoting favorite and unloved objects, phenomena, objects, etc.) and into the semantic system (according to the situational or categorical principle of connection of words, for example, dog, cat, cow or dog, booth, bone). Before writing a word, it is necessary to carry out its semantic analysis, establish its various connections and meaning, name the word from the picture, talk about the object - what it is made of, why it is needed (where it grows, etc.), name the word again, i.e. introduce the word into a semantic and meaningful context for the child and known to him. After this, find the corresponding letters (or syllables) and insert them into the given pattern (m o -» l o -» k o). Then copy down this word, write it from memory and write it into a sentence in which it is absent (the cow gives ...; there are ... on the table; flies across the sky ...).

They move on to learning how to write words at the next stage, and only after completing work at the stage from a sentence to a word can one move on to working on writing syllables and letters. At the last stage of training, it is again necessary to return to the formation of writing phrases: according to a plot picture, by the method of composing sentences from given words (written on cards), by the method of filling in missing places in the text, etc.

During all this work

directly above the restoration of the letter, i.e.
at all its stages, work should be carried out using national rhythms
(walking, tapping out the structure of words and phrases), on drawing a series of rows of figures, on switching from drawing a series of one figures to drawing another row of figures. All these and similar exercises should be the background against which work on the formation of writing is carried out. There are a number of other methods, techniques and exercises, but it should be remembered that all of them should be aimed at restoring the dynamics of motor processes and dynamics in writing, and all work should go through meaning, through context and from the whole.

go to part, which is one of the general principles of restoring (or forming) writing in children.

Analysis of the dynamics and methods of restoring writing in efferent motor agraphia

Let us give an example of the dynamics of writing restoration in efferent motor agraphia.

Patient K. (30 years old, bookbinder, 7th grade education). A sarcoma-like arachnoid endethelioma of the left and premotor region was removed from the patient; the tumor grew from the falciform process and was predominantly parasagittal in location. The neurological status of the patient included right-sided hemiparesis, efferent motor aphasia, agraphia, alexia, and mild concentric narrowing of the visual fields.

Neuropsychological research,

carried out after the operation, established the presence of severe disorders of oral speech such as efferent motor aphasia, accompanied by severe impairment of writing and reading. These defects in oral and written speech occurred against the background of intact phonemic hearing and good understanding of spoken speech. Difficulty in understanding occurred whenever the patient heard rapid speech.

By the beginning of training, the patient completely lacked independent writing.

The patient could not write by ear either: having written 1–2 letters of the dictated word, he refused to write further. The patient wrote individual letters correctly both independently and by ear. Copying was more secure, but even here the patient could write correctly only by copying letters and pronouncing the word element by element. The main errors in the patient's writing were: omission of vowels and consonants when they are combined, rearrangement of letters and omission of entire syllables from the middle of a word, underwriting of words. The process of writing was extremely extensive, carried outward in all its operations.

The patient's inpatient training lasted 2 months. First of all, the patient was taught to write individual words

using
a method of recognizing and maintaining the order of sounds in a word.
This was the task of the second stage of learning to write, which began against the background of the patient’s already existing

some active stock of words, updated semantic characteristics of words, their polysemy, understanding of the connection between the meaning of a word and the order of letters in a word, etc. The work began with writing simple words. The main techniques at this stage of learning were forming words from letters of the split alphabet and element-by-element pronunciation of the word.

In severe cases of writing impairment, relying on pronunciation alone is insufficient. The action in these cases can be completed only if a sequential series of operations is implemented, making the writing of a word an extremely expanded and externalized process. At the beginning of training, our patient wrote each word from 3 to 5 minutes: he pronounced each syllable of the word (often returning to it), beat out the rhythmic structure of the word with his hand (or foot), laid out the required number of chips corresponding to the number of syllables, then pronounced each sound inside the word, found the corresponding letter, etc. Such a detailed analysis of the composition of a word ended with its copying, writing in its tracks. At the same time, he often resorted to visual support on the oral image of sound.

Example. The patient is given the task of writing a few words by ear (with pronunciation):

bed sand rabbit Kozlov

rip + r... krlik +

It took me over 15 minutes to write these 4 words. The patient refused for a long time the task of writing words, not including pronunciation, but then tried to write: tailor’s bed

k... r... por... (refusal)

Writing words including pronunciation: tailor's bed

fuck porn

This was the letter from patient K. at the beginning of his studies. But after 2 weeks of daily special training, the patient learned to write some words independently, using all the supports (the entire system of deployed action - programs of operations), and with their help he could write many simple words: autumnwintersummer Masha kashanebo river

axle + + + + + +

It was more difficult to write complex words:

logic lamp book

loka 1)paw2)+ 1)knia2)+

Then the patient was given words to write (dictation), without being allowed to use the split alphabet. In this case, the number of errors and writing time increased:

tire_______ car_______ lampshade___

+ 1) m-sh-i-a 2) m-a-sh-n-a 1) abjur 2) abou 3) +

It is clear from the protocol that the exclusion of one of the operations from the program greatly complicated the writing process, which indicates the need to perform all operations sequentially.

Gradually, the effect of the patient’s writing was reduced: he pronounced the word only syllable by syllable (omitting letter-by-letter pronunciation), almost eliminated the reliance on his fingers when quantitatively analyzing the composition of the word, the pronunciation became shorter (without repetitions). In this regard, the speed of writing has increased.

By the end of the second week of training, the patient had mastered the method of writing individual words and began to use it independently. The method (program) itself has been significantly reduced. The patient wrote many words while speaking in a whisper.

Dictation: The milk is boiling A voice is heard

+ whale..boiling + + Rye is earing City of Pskov + + + + etc.

After obvious success, the patient began to be taught to write entire phrases. Work on the phrase went in parallel with work on restoring oral speech. By the end of the 2nd month of training, the patient could write short dictations. For example: “Autumn. The leaves have turned yellow. It's raining. There is dirt underfoot. There are menacing clouds in the sky." He almost always wrote simple words silently; when writing more complex words, he used whispered speech, and in difficult cases he always resorted to loud pronunciation. The latter method was not the only remaining external support for writing. During dictations that were large in volume and had complex words or when writing independently, the patient resorted not only to pronunciation, but also to counting sounds using his fingers or a graphic diagram. Moreover, the letter was almost error-free. We were not able to automate the writing skill at the “mental” level,

although the writing process became significantly more reduced in terms of the composition of the auxiliary operations included in the Negro and proceeded faster. If at the beginning of training the patient needed 15 minutes to write four words, and 12 minutes to write a phrase consisting of three words, then at the end of training the patient took 15 minutes. wrote 30 words, and in 12 minutes he could write 4 - 5 sentences of three words each. The illustration shows the dynamics of writing during the patient’s learning process (Fig. 3).

5.3.
Afferent (kinesthetic) motor agraphia
Methods for restoring writing in afferent motor agraphia

Let us consider the neuropsychological and psychological picture of writing impairment,

which are observed with damage to the lower parts of the retrocentral region of the left hemisphere, often accompanied by afferent motor aphasia and agraphia.
It is known that in order to correctly write a word, and especially a series of words, it is not enough to clarify its sound characteristics, the place of the sound in the word; it is also necessary to clearly differentiate sounds according to their kinesthetic foundations, according to the place and method of their formation, since hidden articulations are necessarily involved in the act of writing . With afferent motor agraphia, articulatory boundaries between sounds close in place of origin are lost due to disturbances in speech kinesthesia. 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
place of formation (such as B-P-M - labial-labial, occlusive; F-V - labial-dental, fricative, etc.).

Violations of the kinesthetic mechanisms of speech lead to defects in the formation of articulations, as a result of which patients “do not feel” (in their own words) the sounds that they should write down. When trying to write a dictated word or sound, the patient tries to pronounce it, but impaired speech kinesthesia does not

give him the opportunity to correctly repeat the heard sound, and therefore in his own speech some sounds are replaced by others. This defect leads to literal paraphasias in oral speech, and in written speech to literal paraphasias of the afferent motor type. A patient who has lost internal patterns of articulation, despite the preservation of the acoustic and visual analysis of the word and its successive structure, is unable to write it correctly either by ear or independently. Violation of writing in this case also appears most often in a rough form, but for different reasons.

In the clinical picture

Due to these writing disorders, the patient exhibits literal paragraphs. The most common mistakes are: a) replacing some sounds with others that are close in place of origin, b) omitting consonants when they are combined, c) omitting vowels in words, d) omissions of entire syllables (or combinations of consonants) from the middle of a word are also common (“ Pov" instead of "Pskov", "potvy" instead of "tailor", etc.). The mechanism of these errors is clear: patients retain the ability to pronounce the general motor outline of a word based on the preservation of its sound image, but the sound composition is impaired. The most frequent and characteristic substitutions in this form of agraphia are substitutions of the following groups of sounds: T-D-L-N; M-V-N; 3-S-SH-H; V-F, etc. Many of the patients, instead of the word “table”, usually write “slom”, or “snol”, or “elephant”, and the word “moment” is written either as “bomet” or “mobel” , the word “outside” is “stdaruzhi”, the word “swim” is “bnavat”, etc.

In the psychological picture

violations are detected in the sound discrimination link due to defects in the kinesthetic basis of writing. With this form of agraphia, almost all types of writing are impaired, except for copying. Independent writing (presentation, composition) and writing by ear (dictation) are especially seriously violated. Writing proceeds arbitrarily and with the obligatory inclusion of oral speech: patients cannot write a single letter without pronouncing it. It is in this structural link - the link of formation of sound articulation, its pronunciation and separation from other sounds - that the close interaction of writing and oral speech is revealed, and the position of psychology on the kinesthetic basis of speech is confirmed.

Afferent motor agraphia occurs in the syndrome of afferent motor aphasia, in which the

oral expressive speech using the same mechanisms, defects of which negatively affect writing. Writing becomes a de-automated and conscious process; writing impairment occurs in conjunction with a decrease in understanding of what is written. However, unlike efferent motor agraphia, in this case the syntagma and grammatical organization of the written sentence remain more intact.

The main task of remedial training for this form of agraphia is to restore the process of sound discrimination, which will lead to correct sound-letter analysis when writing and to the restoration of the articulome. For this purpose, work is carried out based on intact acoustic and visual analyzing systems and their interaction.

To restore writing, training is carried out at a conscious and voluntary level of its implementation. All operations of writing letters, words, phrases, text are performed under the control of consciousness and with the assistance of external supports. When teaching writing to patients with sensory agraphia, as we will see below, the leading role belongs to vision and kinesthetic sensations - pronunciation, while the auditory analyzer comes into play later. In cases of violation of the articulatory analysis of sound, on the contrary, the auditory analyzer is turned on together with the visual analyzer from the very beginning. However, in these cases, a defective speech motor analyzer must be connected immediately, but only in complex work with sound and visual analyzers, since, as our practice has shown, pronunciation is one of the most necessary components of writing (A.R. Luria, L.K. Nazarova, M.N. Kadochkin, L.S. Tsvetkova

and etc.).

Since learning to write always goes hand in hand with the restoration of oral speech, at the first stage of training maximum attention is paid to learning to pronounce words. To do this, they switch the patient’s attention from the articulatory, pronunciation side of the word to its semantic sphere, and also use the method of semantic and auditory stimulation that we have developed when pronouncing the whole word1.

1Tsvetkova L.S.

Rehabilitation training for local brain lesions.
- M.: Pedagogika, 1972; Tsvetkova L.S.
Neuropsychological rehabilitation of patients. - M: Moscow State University Publishing House, 1985.

They move on to sound-letter analysis of the composition of words being practiced only after the patient has accumulated a certain passive and active vocabulary. Central learning objective

at the first stage - teach the patient to pronounce whole words and the ability to isolate individual sounds from a word.
The goal of the act of writing during this period of learning becomes the word, and not a separate sound-letter, which, as is known, does not carry any information and has no meaning for a person, since it is not included either in semantics or in the system of relations of the subject. Relying on the meaning of a word or its meaning when writing it helps restore the graphic image of the word. We see that in this case, too, the strategy from the whole to the part is used and the words being practiced are included in the system of semantic relations of words.
Teaching how to write words must take into account a number of conditions:

⇐ Previous7Next ⇒

Where to look for the reason?

The main reason that provokes the development of agraphia, doctors call damage to the cerebral cortex of an organic nature.

The following factors can also provoke this disorder:

benign or malignant neoplasm of the brain;
head injury or development of ischemic or hemorrhagic stroke;
negative effects of toxins on the body and brain;
inflammatory processes provoked by infection.

Often the cause of the development of this pathology is birth trauma - at a younger age, the child cannot speak, does not learn to write, at an older age, a failure in written speech is combined with an inability to express his thoughts through oral speech.

Also, a failure in the ability to write can also be a sign of the development of another pathology, the course of the underlying disease, for example, with the development of Gerstmann syndrome - this disorder indicates the development of a lesion on the border of the temporal and parietal lobes of the brain. In children or adults, phonemic perception of information and its interpretation into graphic symbols are impaired.

As medical statistics show, agraphia most often affects children who have underdeveloped oral speech and whose language and vocabulary development has not reached their age level of development.

Treatment and correction

First of all, the patient is registered with a neurologist, prescribed a course of medication, and re-taught writing skills using a specially developed program.

In it, first of all, the goal is to overcome inertia in the links responsible for the structure of the syllable, the choice of words and the restoration of all language functions, speech - both its written and oral forms. With adults and children, specialists conduct both individual and group lessons; this is the only way to achieve a positive effect.

The patient is monitored by a psychiatrist and speech therapist, where he undergoes a course of psychiatry and speech therapy lessons. As an example, rhythmic exercises will help restore the functioning of the cerebral cortex.

Exercise therapy also has a positive effect on the level of mental development of the patient, since the relationship between movement, physical and motor activity and mental training of a particular affected part of the brain has been scientifically proven.

Music and singing help develop motor skills of the vocal cords, muscles and ligaments of the larynx. Playing musical instruments helps develop finger motor skills, which also has a beneficial effect on the functioning of the cerebral hemispheres.

The treatment is carried out by a speech therapist - logo-rhythms and musical exercises have the most positive results in the treatment of agraphia.

The main thing is that when you first experience problems with writing, you should not start the disease, but you should consult a specialist. Among them are a speech therapist or a neurologist, a psychotherapist. You should never take risks and you need to consult a doctor in a timely manner. This is the only way to eliminate the pathology in a timely manner.

The right hemisphere in left-handed people.
Left hemisphere in right-handed people.