Anomic Aphasia

Anomic aphasia is one of the milder forms of aphasia. The term is applied to persons who are left with a persistent inability to supply the words for the very things they want to talk about, particularly the significant nouns and verbs. Their speech is fluent and grammatically correct but it is full of vague words (such as ‘thing’) and circumlocutions (attempts to describe the word they are trying to find). The feeling is often that of having the word on the tip of one’s tongue, which results in their speech having lots of expressions of frustration. 

People with anomic aphasia understand speech well and they can repeat words and sentences.  In most cases they can read adequately. Difficulty finding words is as evident in writing as it is in speech. 

Primary Progressive Aphasia

Primary Progressive Aphasia (PPA) is a rare neurological syndrome in which language capabilities become slowly and progressively impaired, while other mental functions remain preserved. Unlike other forms of aphasia resulting from stroke or traumatic brain injury, PPA is a degenerative brain condition. It results from deterioration of brain tissue affecting areas of the brain that are important for speech and language.

PPA commonly begins as a subtle disorder of language, progressing to a nearly total inability to speak, in its most severe stage. The type or pattern of the language deficit may differ from patient to patient. The initial language disturbance may be fluent aphasia (i.e., the person may have normal or even increased rate of word production) or non-fluent aphasia (speech becomes effortful and the person produces fewer words). A less common variety begins with impaired word-finding and progressive deterioration of naming and comprehension, with relatively preserved articulation.

As with aphasia that results from stroke or brain trauma, the manifestations of PPA depend on what parts of the left hemisphere are relatively more damaged at any given point in the illness. The person may or may not have difficulty understanding speech. Eventually, almost all patients become mute and unable to understand spoken or written language, even if their behavior seems otherwise normal.

Signs and symptoms of other clinical syndromes are not found through tests used to determine the presence of other conditions. PPA is not Alzheimer’s disease. Most people with PPA maintain ability to take care of themselves, pursue hobbies, and, in some instances, remain employed.

Is there any treatment or assistance for people with ppa?

People with primary progressive aphasia are fighting against a condition in which they will continue to lose their ability to speak, read, write, and/or understand what they hear. Usually people with aphasia that results from stroke or head injury will experience improvement over time, often aided by speech therapy. This is not the case for people with primary progressive aphasia. However, individuals with PPA may benefit during the course of their illness by acquiring new communication strategies from speech-language pathologists. Some families have also learned new strategies through participation in Aphasia Community Groups.

Many people with aphasia find it helpful to carry identification cards and other materials that can help explain the person’s condition to others. Some communication-assistive devices may also be helpful. Non-verbal techniques for communicating, such as gesturing and pointing to pictures, may help people with PPA express themselves.

Other varieties in addition to the foregoing syndromes that are seen repeatedly by speech clinicians, there are many other possible combinations of deficits that do not exactly fit into these categories.Some of the components of a complex aphasia syndrome may also occur in isolation. This may be the case for disorders of reading (alexia) or disorders affecting both reading and writing (alexia and agraphia), following a stroke. Severe impairments of calculation often accompany aphasia, yet in some instances patients retain excellent calculation in spite of the loss of language.

Answer the questions

1. What is aphasia ?

2. What kinds of aphasia do you know?

Dysarthria

Dysarthria (from Ancient Greek δυσ- dys, "hard, difficult, bad" and ἄρθρωσις arthrosis, "articulation") is a motor speech disorderresulting from neurological injury of the motor component of the motor-speech system and is characterized by poor articulation of phonemes (cf. aphasia: a disorder of the content of language). In other words, it is a condition in which problems effectively occur with the muscles that help produce speech, often making it very difficult to pronounce words. It is unrelated to any problem with understanding cognitive language.Any of the speech subsystems (respiration, phonation, resonance, prosody, and articulation) can be affected, leading to impairments in intelligibility, audibility, naturalness, and efficiency of vocal communication.

Dysarthria that has progressed to or presents as a total loss of speech may be referred to as anarthria.

Neurological injury due to damage in the central or peripheral nervous system may result in weakness, paralysis, or a lack of coordination of the motor-speech system, producing dysarthria.These effects in turn hinder control over the tongue, throat, lips or lungs for example; swallowing problems (dysphagia) are also often present.

The term dysarthria does not include speech disorders from structural abnormalities, such as cleft palate, and must not be confused with apraxia of speech, which refers to problems in the planning and programming aspect of the motor-speech system.

Articulation problems resulting from dysarthria are treated by speech language pathologists, using a variety of techniques. Techniques used depend on the effect the dysarthria has on control of the articulators. Traditional treatments target the correction of deficits in rate (of articulation), prosody (appropriate emphasis and inflection, affected e.g. byapraxia of speech, right hemisphere brain damage, etc.), intensity (loudness of the voice, affected e.g. in hypokinetic dysarthrias such as in Parkinson's), resonance (ability to alter the vocal tract and resonating spaces for correct speech sounds) and phonation (control of the vocal folds for appropriate voice quality and valving of the airway). These treatments have usually involved exercises to increase strength and control over articulator muscles (which may be flaccid and weak, or overly tight and difficult to move), and using alternate speaking techniques to increase speaker intelligibility (how well someone's speech is understood by peers). With the speech language pathologist, there are several skills that are important to learn; safe chewing and swallowing techniques, avoiding conversations when feeling tired, repeat words and syllables over and over in order to learn the proper mouth movements, and techniques to deal with the frustration while speaking. Depending on the severity of the dysarthria, another possibility includes learning how to use a computer or flip cards in order to communicate more effectively.

More recent techniques based on the principles of motor learning (PML), such as LSVT (Lee Silverman voice treatment)speech therapy and specifically LSVT may improve voice and speech function in PD.For Parkinson's, aim to retrain speech skills through building new generalized motor programs, and attach great importance to regular practice, through peer/partner support and self-management. Regularity of practice, and when to practice, are the main issues in PML treatments, as they may determine the likelihood of generalization of new motor skills, and therefore how effective a treatment is.

Augmentative and alternative communication (AAC) devices that make coping with a dysarthria easier include speech synthesis and text-based telephones. These allow people who are unintelligible, or may be in the later stages of a progressive illness, to continue to be able to communicate without the need for fully intelligible speech.

GLOSSARY

dysarthria- term for a collection of motor speech disorders due to impairment originating in the central or peripheral nervous system. Respiration, articulation, phonation, resonation, and/or prosody may be affected

gammatsizm - wrong pronunciation of [ g ] .

hitizm-wrong pronunciation of the sound [ h ]

phonetic speech disorder - a violation of the pronunciation of individual sounds , one or more groups of sounds (eg , whistling , hissing and whistling ) during normal physical hearing

Nasality (disorder)

In normal speech, nasality is referred to as nasalization and is a linguistic category that can apply to vowels or consonants in a specific language. The primary underlying physical variable determining the degree of nasality in normal speech is the opening and closing of a velopharyngeal passageway between the oral vocal tract and the nasal vocal tract. In the normal vocal tract anatomy, this opening is controlled by lowering and raising the velum or soft palate, to open or close, respectively, the velopharyngeal passageway.

In some types of abnormal speech, the term nasality, or more formally hypernasality, refers to an auditory impression about the speech, and is not a precise physical variable. Excess nasality is often observed in the speech of hearing impaired persons, who cannot adequately monitor this subtle characteristic of speech. It is also common with persons having a cleft palate, for whom another passage or passages may exist between the oral and nasal vocal tract, or distortion of the palate prevents or hinders an adequate velopharyngeal closure. Since nasality is a subtle characteristic of speech, it is sometimes not readily controlled in learning a foreign language or in child language learning.

Hypernasality is generally segmented into so-called 'resonance' effects in vowels and some voiced or sonorant consonants and the effects of excess nasal airflow during those consonants requiring a buildup of oral air pressure, such as stop consonants (as /p/) or sibilants (as /s/). The latter nasal airflow problem is termed 'nasal emission', and acts to prevent the buildup of air pressure and thus prevent the normal production of the consonant. In testing for resonance effects without the aid of technology, speech pathologists are asked to rate the speech by listening to a recorded sentence or paragraph, though much variability in such subjective ratings, for at least two reasons. First, the acoustic effect of a given velopharyngeal opening varies greatly depending on the degree of occlusion of the nasal passageways. (This is the reason why a stuffy nose from an allergy or cold will sound more nasal than when the nose is clear.) Secondly, for many persons with hypernasal speech, especially hearing impaired, there are also mispronunciations of the articulation of the vowels. It is extremely difficult to separate the acoustic effects of hypernasality from the acoustic effects of mispronounced vowels. Of course, in speech training of the hearing impaired, there is little possibility of making nasality judgments aurally, and holding a finger to the side of the nose, to feel voice frequency vibration, is sometimes recommended.

Without the use of a technological aid, nasal emission is sometimes judged by listening for any turbulence that may be produced by the nasal airflow, as when there is a small velopharyngeal opening and there is some degree of mucous in the opening. More directly, methods recommended include looking for the fogging of a mirror held near the nares or listening through a tube, the other end of which is held in or near a nares opening.

There have been many attempts to use technological augmentation more than a mirror or tube to aid the speech pathologist or provide meaningful feedback to the person attempting to correct their hypernasality. Among the more successful of these attempts, the incompleteness of velopharyngeal closure during vowels and sonorants that causes nasal resonance can be estimated and displayed for evaluation or biofeedback in speech training through the nasalance of the voice, with nasalance defined as a ratio of acoustic energy at the nostrils to that at the mouth, with some form of acoustic separation present between the mouth and nose. In the nasalance measurement system sold by Wevosys, the acoustic separation is provided by a mask-tube system, nasalance measurement system sold by Kay-Pentax, the acoustic separation is provided by a solid flat partition held against the upper lip, while in the system sold by Glottal Enterprises the acoustic separation can be by either a solid flat partition or a two-chamber mask.

However, devices for measuring nasalance do not measure nasal emission during pressure consonants. Because of this, a means for measuring the degree of velopharyngeal closure in consonants is also needed. A commercially available device for making such measurements is the Perci-Sar system from Microtronics. The Nasality Visualization System from Glottal Enterprises allows both the measurement of Nasal Emission and Nasalance. In the presence of a cleft palate, either of these systems can be helpful in evaluating the need for an appliance or surgical intervention to close the cleft or the success of an appliance or a surgical attempt to close the cleft.

GLOSSARY

Hypernasality-speech produced with excessive resonance in the nasal cavity, often due to dysfunction of the soft palate. Synonym(s): hyperrhinophonia

Hearingloss

Hearing loss, also known as hearing impairment, is a partial or total inability to hear. A deaf person has little to no hearing.Hearing loss may occur in one or both ears. In children hearing problems can affect the ability to learn language and in adults it can cause work related difficulties.In some people, particularly older people, hearing loss can result in loneliness.Hearing loss can be temporary or permanent.

Hearing loss may be caused by a number of factors, including: genetics, ageing,exposure to noise, someinfections, birth complications, trauma to the ear, and certain medications or toxins. A common condition that results in hearing loss is chronic ear infections. Certain infections during pregnancy such as rubella may also cause problems. Hearing loss is diagnosed when hearing testing finds that a person is unable to hear 25 decibels in at least one ear.Testing for poor hearing is recommended for all newborns.Hearing loss can be categorized as mild, moderate, severe, or profound.

Half of hearing loss is preventable. This includes by immunization, proper care around pregnancy, avoiding loud noise, and avoiding certain medications.The World Health Organization recommends that young people limit the use of personal audio players to an hour a day in an effort to limit exposure to noise.Early identification and support are particularly important in children. For manyhearing aids, sign language, cochlear implants and subtitles are useful. Lip reading is another useful skill some develop. Access to hearing aids, however, is limited in many areas of the world.

As of 2013 hearing loss affects about 1.1 billion people to some degree. It causes disability in 5% (360 to 538 million) and moderate to severe disability in 124 million people. Of those with moderate to severe disability 108 million live in low and middle income countries.Of those with hearing loss it began in 65 million during childhood.Those who use sign language and are members of Deaf culture see themselves as having a difference rather than an illness. Most members of Deaf culture oppose attempts to cure deafnessand some within this community view cochlear implants with concern as they have the potential to eliminate their culture. The term hearing impairment is often viewed negatively as it emphasizes what people cannot do.

For a classroom setting, children with hearing loss often benefit from direct instruction and communication. One option for students is to attend a school for the Deaf, where they will have access to the language, communication, and education. Another option is to have the child attend a mainstream program, with special accommodation such as providing favorable seating for the child. Having the student sit as close to the teacher as possible improves the student's ability to hear the teacher's voice and to more easily read the teacher's lips. When lecturing, teachers can help the student by facing them and by limiting unnecessary noise in the classroom. In particular, the teacher can avoid talking when their back is turned to the classroom, such as while writing on a whiteboard.

Some other approaches for classroom accommodations include pairing deaf or hard of hearing students with hearing students. This allows the deaf or hard of hearing student to ask the hearing student questions about concepts that they have not understood. The use of CART (Communication Access Real Time) systems, where an individual types a captioning of what the teacher is saying, is also beneficial.The student views this captioning on their computer. Automated captioning systems are also becoming a popular option. In an automated system, software, instead of a person, is used to generate the captioning. Unlike CART systems, automated systems generally do not require an Internet connection and thus they can be used anywhere and anytime. Another advantage of automated systems over CART is that they are much lower in cost. However, automated systems are generally designed to only transcribe what the teacher is saying and to not transcribe what other students say. An automated system works best for situations where just the teacher is speaking, whereas a CART system will be preferred for situations where there is a lot of classroom discussion.

For those students who are completely deaf, one of the most common interventions is having the child communicate with others through an interpreter using sign language.

GLOSSARY

cochlear implant is a surgical treatment for hearing loss that works like an artificial human cochlea in the inner ear, helping to send sound from the ear to the brain. It is different from a hearing aid, which simply amplifies sound.

gesture speech- the primary means of interpersonal dialogue of the deaf. sign learning system includes two kinds of speech : calking and conversational.

Answer the questions

1. What may hearing loss be caused by ?

Correction of the personal development of disabled children by

means of fine art activities in school and additional education

  The methods of the correction of personal development of children with disabilities by means of fine art is effective. Attention to this problem is at present paid in a world-wide measure.

            In connection with the propositions I consider it necessary to stress that art more than any other field of social life influences positively personal development of disabled as well as intact (not disabled) children.  Equally, creativity is not a privilege only of intact individuals. These facts are based on history, science, but also on the experience from theory and practice of special education.

            For example READ writes,   that “the work of art has nothing to do with thinking, but rather with feeling; it is more a symbol than a direct statement of truth.” 

            The term art in sense of “fine arts” (in Latin ars, French beaux-arts, German Kunst, Russian isskustvo, Polish sztuka, Hungarian umuvészet)  shows in its historical stream and in a certain social context many semantic changes. This contribution does not concern the definition of this term.

            In general it is presented that the art originated from a desire of men to imitate reality, but also from pleasure from the imitation of reality. Art edifies a man above the everydayness, it is the expression of emotional excitement and enthusiasm, it is part of religious, cult rituals.

            Fine art is a visual expression of everything what surrounds us. Every civilizational period lefts behind its artistic message. In the professional literature prevails the opinion that art arises as the result of aesthetic response of an artist to the environment in which he/she lives and the situation which he/she experiences – it is the expression of his/her aesthetic relation to the reality.

            The importance of art in life of people is clear also from the history of mankind in every period of its development. The only difference is that in different periods it uses different arguments.  In course of the historical development there changed only relations of a man towards art and the character of these relations.

Art education has its important share in realisation of more elements of the complex education of pupils with special educational needs. It cultivates aesthetic feeling, develops sensual perception and rational thinking, intellectual abilities, forms moral qualities of pupils, contributes to the polytechnic education, provides necessary cultural habits and work skills necessary for life. Besides the educational (aesthetic-educational) function in special schools and establishments it also fulfils not less important educational-rehabilitation, relaxation and diagnostic functions.

            Fine art as the teaching subject in school and additional education fulfils its unique function also in correction of personal development of disabled children. This subject is characterised by some special features and signs that are significantly different from other teaching subjects' characteristics. From this result certain requirements aimed at the organisation of educational process and methodology of work in fine art lessons as well as special requirements for a teacher's personality and his/her professional – special educational preparation. Special characteristics of the subject fine art together with individual special characteristics of mentally and in other way disabled children significantly determine the content and aims of study of special didactics of fine art. The content basis of the subject fine art education is fine art and environment.

        Today we can say that the above mentioned project influenced positively also the area of correction of the personal development of children with health limitations by means of fine art.  Looking for new methods, forms and means of special education which support their social integration is  permanently actual task. The work with computers and at present also with multimedia computers presents an inseparable part and the unique way of mediation of knowledge, but in some cases also the only way of communication of disabled persons. Thus the computer fulfils not only the educational function, but also diagnostic, compensation, educational-rehabilitation and relaxation functions. It removes barriers in communication and becomes an irreplaceable means of information and integration.

From this knowledge comes out the art-therapy – treatment by art, supportive treatment method used in Slovakia mostly in psychiatry, but at present also in special and remedial pedagogy – as the special aesthetic education – the means of educational rehabilitation of disabled individuals. In art–therapy a product of the activity is not important, but important is the activity itself – own creation which even without further processing strengthens the awareness of one's own identity and reveals the inner world of an individual. The quality or the completeness of fine art products are not important.

        The term art-therapy is derived from the Latin word ars – art and the Greek word terape – treatment. At the most general level it concerns so called “treatment by art”. In a wider sense of the word it means the use of all kinds of art (fine art, music art, literary art, theatre art). With education and treatment with use of art deals a set of scientific disciplines (aesthetics, pedagogy – mainly special and remedial pedagogy, psychology and medical sciences – first of all psychiatry.

            Hanus characterises art-therapy as an organised therapeutic process of real individuals or groups led by a specially trained person, art-therapist. It is used also for the remedial-pedagogical purposes as the means of education and social integration.

            According to Zicha the term art-therapy denotes the special fine art education (special aesthetic education) which is different from fine art education in school practice.                        

            In art-therapy of children with health limitations very important is first of all the appropriate choice of fine art activity what demands not only a certain amount of the professional erudition in the area of special education of disabled, but also the ability to use the means of fine art communication. The choice of a theme, technique, fine art materials and means must be done with regard to the kind and level of disability, or multiple disability. Every art-therapeutic training requires certain fine art skills and the ability to use the means of fine art communication. In case of mentally disabled, or, multiple disabled individuals these possibilities are very individual and limited. In introductory exercises we therefore recommend to find out and select the appropriate as well as inappropriate procedures individually by means of playing fine art activities, especially decorative activities such as e.g.

 

• play with a point, line, stain, colour in dry materials

• play with the same means in wet materials

• play with surface and shape

• play with modelling materials.

 

To the most frequently used techniques in art-therapy of disabled people belong:

 

• painting with a finger, fingers, music-painting

• relaxing painting on a blackboard, on a big paper surface, sand, snow

• modelling (clay, ceramic clay, modelling materials Dasand Jovi, mock up

• technique)

• simple techniques of printing, monotype, printing from carton and textile 

• collage

• use of Body-Art, Pop-Art, Performance, Happening.

 

Very important in art-therapy are relaxation exercises, breathing exercises, elements of autogenous training and creative imagination, as well as simple physical exercises which come out of yoga elements. Fine art activities represent many possibilities of realisation and application of various combinations of art-therapy with music-therapy, motion, dance, drama-therapy and bibliotherapy.