Rehabilitation of stroke aphasia

Stroke aphasia is a common complication after cerebrovascular accidents, and the proportion of aphasia in stroke disability rates is as high as 20% to 30%.

Manifested as difficulty in oral expression, incomprehensibility, difficulty in naming, poor repetition; Reduced speaking fluency, loss of syntax and grammar; Inability to participate in normal social activities, and even daily life is affected
to some extent.

The theoretical basis, examination, evaluation and rehabilitation training and value of aphasia rehabilitation in recent years are reviewed
.

1 Theoretical basis

There are many
theoretical bases for aphasia rehabilitation.

The function of the lesion area is replaced by the function of the external brain area of the lesion;

Mobilizing basic brain functions;

Mobilizes advanced brain functions
.

The central nervous system is extremely malleable, although neuronal death can not be reborn, but its surrounding neural tissue can be sprouted through the lateral branches of the axon, which can make the adjacent tissue that has lost its innervation regain innervation, therefore, the emergence of aphasia, rehabilitation and functional training as early as possible
.

2 Methods of examination for aphasia

In order to accurately detect the different aspects of language function disorders in patients with aphasia, make a classified diagnosis of different aphasia according to the examination results, and formulate a targeted language rehabilitation plan, it is first necessary to have standardized formal examination methods
.

The main tests for Chinese aphasia are as follows:

2.

According to the patient's volume, intonation, pronunciation, and whether it takes effort to speak, whether there are grammatical words or grammatical structures, whether there are errors in substantive words, and whether they can achieve meaning, their spoken language is divided into: fluent or non-fluent
.

2.

The main thing is to ask the patient to perform oral instructions
.

2.

The patient is asked to repeat the examiner's language, telling him to "learn from me" and "you can say whatever I say.

2.

This includes finger naming, color naming, and reaction naming
.

2.

Includes reading aloud and comprehension of
words.
Ask the patient to read word cards, words or explanations from books and newspapers, and read short sentences
aloud.

2.
6 Writing (calculation)

Simple writing and arithmetic
.

3 Aphasia training

3.
1 Training timing

Domestic scholars believe that the natural recovery of aphasia generally does not exceed 6 months
.
Natural improvement of the most pronounced time of recovery from aphasia: mild within 2 weeks; Moderate within 6 weeks; severe within 10 weeks; The near-disappearance
of language function after 1 year.
Therefore, the appropriate training time is to start
as soon as possible once the patient is awake and stable, while treating the primary disease.

In general, it is better to train when the patient is not tired in the morning; The venue is preferably a single-room treatment room with no people and no noise interference; Take a "one-on-one" approach; The time is generally 30~60 min, 2 times/day, training for about 2 months; Family members may be present, and patients with strong dependence are preferably absent from the family
.
The time, frequency, and intensity of daily training should be based
on patient tolerance and interest.
Training tools are generally prepared with tape recorders, song or conversation pronunciation tapes, paper, pencil, homemade cards, pictures, newspapers and daily necessities
.

3.
2 Training methods

The basic methods are listening comprehension, text comprehension, copying, imitation, retelling, reading, naming, description, lip and tongue exercises, etc
.

3.
2.
1 Kinesiology (Broca) aphasia

The lesion is in the center of word movement, and the movement impression of the word is partially or completely lost, which is manifested by a significant decrease in oral expression ability and a distortion of spoken language with a
small amount of expression.
This kind of aphasia is mainly based on orthodontic expression and text reading training, as well as pronunciation training, oral imitation, oral pronunciation training, and picture pronunciation training
.
Speak slowly than normal with short and clear sentences during training, allowing patients to directly answer "yes" or "no"
.

3.
2.
2 Sensory (Wernicke) aphasia

The lesion affects the listening center and causes partial or total loss of the impression of
the listening word.
Manifested as comprehension and repetition disorders
.
Significant results
can be achieved by playing songs and training patients with severe sensory aphasia in different tones to improve listening comprehension and increase patient interest.

Training for the job:

(1) Listening training: sound stimulation, such as listening to music, listening to the radio, or melodic intonation therapy
.

(2) Word auditory recognition: show the physical picture or word card, let the patient answer, from easy to difficult, from the name of the item to the function and attributes of
the item.

(3) Memory training: let patients recall relevant things and things in order, if the answer is correct, increase the difficulty, repeat practice, and enhance memory
.

(4) Visual training: such as "send a glass of water, toothpaste, toothbrush to the patient, and then say: "wipe the teeth.
"
See if the patient executes a password to stimulate visual understanding
.

3.
2.
3 Conductive aphasia

It is damage
between the verbal sensory center and the speech-motor center.
It is manifested as fluent and unattainable self-speech, oral repetition is quite difficult, hearing comprehension is normal or mild impairment, and naming and reading are difficult
.
Dyslexia and a lot of misspellings of
words.

Training Method:

(1) Monologue expression training, such as self-introduction, family member introduction, and picture narration
.

(2) Conversation exchange training, "bilateral" or "multilateral" conversation communication
.

(3) Repetition training, repeat words, words, and phrases
with the therapist.

3.
2.
4 Nomenclature aphasia

Refers to aphasia
that cannot be named as unique or predominant.
True nomenclature aphasia is less common, but all types of aphasia recovery period can show clinical aphasia patterns
dominated by naming disorders.

The training method is generally based on speaking, naming, writing, and salutation
training.
In conjunction with the corresponding movements during treatment, the patient becomes interested and deepens the memory of
the word.

(1) Training strengthens the memory
of names.

(2) Restore memories
by telling the patient's previous interests through family members.

3.
2.
5 Complete aphasia

Also known as mixed aphasia, it manifests itself as severe impairment or almost total loss of
all language function.
The focus of treatment for patients with complete aphasia should be based on listening comprehension and text comprehension, and sign language should be used as the main means
of communication for patients with complete aphasia.
All patients with severe language dysfunction or severe aphasia can use gestures and language stimulation methods to communicate
using the combination of expression-gesture-language at the beginning of training.

4 Aphasia assessment

The examination and evaluation of aphasia is to understand the specific level of listening, speaking, reading and writing of patients, and is the process of initially mastering the language function, and the results can be used as the basis for
comparing the effects before and after training.
Aphasia assessment is generally performed 3 times, the initial assessment is one week of onset, the interstage assessment is for some time after intensive treatment of patients, and the outcome assessment is at the highest level
after speech rehabilitation.

At present, there are 8 kinds of aphasia examination and evaluation methods commonly used in China: 3 of which are to divide the degree of aphasia into 0 to 5 levels, such as the classification criteria for the severity of aphasia in the Boston Diagnostic Aphasia Examination (BDAE):

Level 0: No meaningful language and listening comprehension skills;

Level I: Discontinuous language expression in all language communication, most of which requires the listener to speculate, ask and guess, the scope of information that can be exchanged is limited, and the listener feels difficult in language communication;

Level II: With the help of the listener, familiar topics can be discussed, patients are often unable to express their thoughts, and it is difficult to communicate with the examiner;

Level III: With little or no help, patients can discuss almost any everyday problem
.
However, due to the weakening of language or comprehension, some conversations are difficult or impossible;

Level IV: language fluency but observable comprehension impairment, no obvious limitations in thought expression and language expression;

V-Grade: Rarely distinguishable speech impairment
.

The other 4 are evaluated from the aspects of listening, speaking, reading and writing, with a full score of 100, such as the Chinese aphasia examination method, the Chinese aphasia examination method, and the efficacy evaluation criteria: language fluency, writing, memory, and comprehension ability are normal; Effective: the severity of aphasia after treatment is graded at or above 4 levels; Effective: increase the severity of aphasia by at least 1 level or more after treatment; Ineffective: no change
in the severity rating of aphasia after treatment.

5 The Value of Aphasia Rehabilitation

Rehabilitation of aphasia depends on compensatory and low-level functional re-formation
of ipsilateral or contralateral brain function.
Although there is a pronounced natural recovery phenomenon in patients with aphasia, the positive effects of rehabilitation training are certain
.
It can make full use of the residual function of the language center of the human brain and gradually improve the ability of
language expression.

Some scholars' research has suggested that rehabilitation training can increase the speed and degree of recovery of speech function, and that language correction is carried out at the same time as drug treatment, and its treatment is not the same as the expected consequences of not treatment; Studies have also shown that patients with stroke complete aphasia who have a course of illness after 6 months also have some therapeutic value
.
In contrast, different types of aphasia have different degrees of training recovery, with nominal aphasia, conductive aphasia, and subcortical aphasia (including thalamic aphasia and basal ganglia aphasia) having good efficacy, followed by motor aphasia, sensory aphasia having poor efficacy, and complete aphasia having the worst prognosis
.

6 Summary

Language function is a complex cognitive process that contains many different psychophysiological bases
.
Therefore, in the process of language training, it is necessary to have a strong sense of humanity, care for and respect for patients, understand the dynamic changes of patients' psychology, and give timely psychological counseling and related knowledge education, so that patients can maintain psychological balance and emotional stability, so that they can actively cooperate with treatment
.
In addition, choosing interesting training content and creating a comfortable training environment is also a condition for
maintaining a good psychological state.
The key to training is the active participation of patients, and 70% of patients with aphasia are depressed, so psychotherapy
is strengthened while language training.

In short, when clinically formulating rehabilitation training programs, it is necessary to vary from person to person, evaluate the functions of patients in all aspects, determine the type and degree of aphasia according to the score, and determine the aphasia training program
based on the patient's background information such as occupation, hobbies, dialect type, family situation, education level, personality, etc.
Trainers must master certain aphasia expertise, such as preliminary identification of the type of aphasia, proficiency in the use of aphasia assessment form, accurate recording of aphasia rehabilitation medical records, etc.
, which is of great significance
for therapists who are clinically engaged in aphasia rehabilitation training.