Perseveration refers to psychological, mental and neuropathological phenomena in which there is an obsessive and frequent repetition of actions, words, phrases and emotions.

Moreover, repetitions appear both in oral and written form. Repeating the same words or thoughts, a person often does not control himself when communicating verbally. Perseveration can also manifest itself in nonverbal communication based on gestures and body movements.

Manifestations

Based on the nature of perseveration, the following types of its manifestation are distinguished:

Perseveration of thinking or intellectual manifestations. It is distinguished by the “settling” in the human creation of certain thoughts or its ideas, manifested in the process of verbal communication. A perseverative phrase can often be used by a person when answering questions to which it has absolutely nothing to do. Also, a person with perseveration can pronounce such phrases out loud to himself. A characteristic manifestation of this type of perseveration is constant attempts to return to the topic of conversation, which has long been stopped talking about or the issue in it has been resolved.
Motor type of perseveration. Such a manifestation as motor perseveration is directly related to a physical disorder in the premotor nucleus of the brain or subcortical motor layers. This is a type of perseveration that manifests itself in the form of repeating physical actions repeatedly. This can be either the simplest movement or a whole complex of different body movements. Moreover, they are always repeated equally and clearly, as if according to a given algorithm.
Speech perseveration. It is classified as a separate subtype of the motor type perseveration described above. These motor perseverations are characterized by constant repetition of the same words or entire phrases. Repetition can manifest itself in oral and written form. This deviation is associated with lesions of the lower part of the premotor nucleus of the human cortex in the left or right hemisphere. Moreover, if a person is left-handed, then we are talking about damage to the right hemisphere, and if a person is right-handed, then, accordingly, to the left hemisphere of the brain.

Reasons for the manifestation of perseveration

There are neuropathological, psychopathological and psychological reasons for the development of perseveration.

Repetition of the same phrase, caused by the development of perseveration, can occur against the background of neuropathological reasons. These most often include:

Traumatic brain injuries that damage the lateral region of the orbitofrontal cortex. Or it is due to the physical types of damage to the frontal convexities.
For aphasia. Perseveration often develops against the background of aphasia. It is a condition characterized pathological abnormalities previously formed human speech. Similar changes occur in the event of physical damage to the centers in the cerebral cortex responsible for speech. They can be caused by trauma, tumors or other types of influences.
Transferred local pathologies in the frontal lobe of the brain. It can be similar pathologies, as is the case with aphasia.

Psychiatrists, as well as psychologists, call perseveration deviations of a psychological type that occur against the background of dysfunctions occurring in the human body. Often, perseveration acts as an additional disorder and is an obvious sign of the formation of a complex phobia or other syndrome in a person.

If a person has signs of the formation of perseveration, but at the same time he did not tolerate severe forms stress or traumatic brain injury, this may indicate the development of both psychological and mental forms of deviation.

If we talk about the psychopathological and psychological reasons for the development of perseveration, there are several main ones:

Tendency to increased and obsessive selectivity of interests. Most often this manifests itself in people characterized by autistic disorders.
The desire to constantly learn and learn, to learn something new. It occurs mainly in gifted people. But the main problem is that that person may become fixated on certain judgments or his activities. The existing line between perseveration and such a concept as perseverance is extremely insignificant and blurred. Therefore, with an excessive desire to develop and improve oneself, serious problems can develop.
Feeling of lack of attention. Occurs in hyperactive people. The development of perseverative inclinations in them is explained by an attempt to attract increased attention to themselves or their activities.
Obsession with ideas. Against the background of obsession, a person can constantly repeat the same physical actions caused by obsession, that is, obsession with thoughts. The simplest, but very understandable example of obsession is the desire of a person to constantly keep his hands clean and wash them regularly. The person explains this by saying that he is afraid of getting infected. terrible infections, but such a habit can develop into a pathological obsession, which is called perseveration.

It is important to be able to distinguish when one person simply has strange habits in the form of constant hand washing, or whether it is obsessive-compulsive disorder. It is also not uncommon for repetitions of the same actions or phrases to be caused by a memory disorder, and not by perseveration.

Features of treatment

There is no universally recommended treatment algorithm for perseveration. Therapy is carried out based on the use of a whole range of different approaches. One method should not be used as the only method of treatment. It is necessary to take new methods if the previous ones did not produce results. Roughly speaking, treatment is based on constant trial and error, which ultimately makes it possible to find the optimal method of influencing a person suffering from perseveration.

The presented methods of psychological influence can be applied alternately or sequentially:

Expectation. It is the basis in psychotherapy for people suffering from perseveration. The point is to wait for changes in the nature of the deviations that have arisen against the background of the use of various methods of influence. That is, the waiting strategy is used in conjunction with any other method, which we will discuss below. If no changes occur, switch to other psychological methods of influence, expect results and act according to the circumstances.
Prevention. It is not uncommon for two types of perseveration (motor and intellectual) to occur together. This makes it possible to prevent such changes in time. The essence of the technique is based on the exclusion of physical manifestations that people most often talk about.
Redirection. This psychological technique, based on a sharp change in ongoing actions or current thoughts. That is, when communicating with a patient, you can suddenly change the topic of conversation or move from one physical exercise or movement to another.
Limitation. The method is aimed at consistently reducing a person’s attachment. This is achieved by limiting repetitive actions. A simple but clear example is to limit the amount of time a person is allowed to sit at a computer.
Abrupt cessation. This is a method of actively getting rid of perseverative attachment. This method is based on exposure by introducing the patient into state of shock. This can be achieved through harsh and loud phrases, or by visualizing how harmful they can be. intrusive thoughts or movements, actions of the patient.
Ignoring. The method involves completely ignoring the manifestations of the disorder in a person. This approach manifests itself the best way, if the violations were caused by attention deficit. If a person does not see the point in what he is doing, since there is no effect, he will soon stop repeating obsessive actions or phrases.
Understanding. Another relevant strategy with which the psychologist recognizes the patient’s train of thought in case of deviations or in the absence of them. This approach often allows a person to independently understand his thoughts and actions.

Perseveration is a fairly common disorder that can be caused by various reasons. When perseveration occurs, it is important to choose a competent treatment strategy. Medication is not used in this case.

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Perseveration in speech therapy

PERIPHERAL - external, distant from the center of something; eg peripheral section analyzer.

PERIFOCAL [Greek. peri about + lat. fokalis focal] - perifocal.

PERMUTATIONS [per+ mutations] - enhanced modifications.

PERSEVERATION [lat. perseveratio persistence] - cyclical repetition or persistent reproduction, often contrary to conscious intention, k.-l. actions, thoughts or experiences.

VISUAL PERSEVERATION - a violation of visual perception in the form of preservation or re-emergence of the visual image of an object after it disappears from the field of view.

PERSEVERATION OF THINKING - see Perseverative thinking.

PERTINENT - see Relevant.

PERCEPTUAL SYSTEM - a set of analyzers that provide a given act of perception.

PERCEPTION - see Perception.

PETAL [lat. peto approach] - centripetal; see Afferent.

PEERELISM - children's infantile behavior, regression to childhood experiences.

PICKNIC TYPE - a body type of a person with a wide, stocky figure..

PICTOGRAPHIC LETTER [lat. pictus drawn + gr. grapho I write] - a reflection of the general content of a message in the form of a picture, usually for memorization purposes.

PYRAGID PATHWAYS - paths running from the cerebral cortex to the effectors of the speech apparatus through the anterior horns of the spinal cord and the motor nuclei of the cranial nerves.

PYRAMID PATH - the path of excitation along nerve fibers from the motor area of the cerebral cortex (from Betz's giant cells) to the motor cells of the spinal cord and further along the corresponding fibers directly to the muscles.

WRITTEN SPEECH - see Written speech.

LETTER - 1) a sign system for recording speech, allowing, with the help of graphic elements fix speech in time and transmit it over a distance; 4 main types of P.: ideographic, verbal-syllabic (ideographic-rebus), syllabic (syllabic) and letter-sound (alphabetic) P., as well as shorthand; 2) P. as a literary genre.

Formation of the syllable structure of words in children with general speech underdevelopment

Every year the number of children suffering from general speech underdevelopment increases. This type of disorder in children with normal hearing and intact intelligence is a specific manifestation of a speech abnormality, in which the formation of the main components of the speech system is disrupted or lags behind the norm: vocabulary, grammar, phonetics. Most of these children, to one degree or another, have a distortion of the syllabic structure of words, which are recognized as leading and persistent in the structure of the speech defect of children with general speech underdevelopment.

The practice of speech therapy shows that correction of the syllabic structure of a word is one of the priority and most difficult tasks in working with preschoolers who have systemic speech disorders. It should be noted that this type of speech pathology occurs in all children with motor alalia, in whom phonetic speech disorders are not leading in the syndrome, but only accompany vocabulary disorders. The importance of this problem is also evidenced by the fact that the insufficient degree of correction of this type of phonological pathology in preschool age subsequently leads to the development of dysgraphia in schoolchildren due to a violation of language analysis and synthesis of words and phonemic dyslexia.

Research by A.K. Markova on the peculiarities of mastering the syllabic structure of a word by children suffering from alalia shows that the speech of children is replete with pronounced deviations in the reproduction of the syllabic structure of a word, which persist even in reflected speech. These deviations are in the nature of one or another deformation of the correct sound of a word, reflecting the difficulties of reproducing the syllabic structure. It follows from this that in cases of speech pathology, age-related disorders do not disappear from children’s speech by the age of three, but, on the contrary, acquire a pronounced, persistent character. A child with general speech underdevelopment cannot independently master the pronunciation of the syllabic structure of a word, just as he is unable to independently master the pronunciation of individual sounds. Therefore, it is necessary to replace the long process of spontaneous formation of the syllabic structure of a word with a purposeful and conscious process of teaching this skill.

Numerous studies carried out within the framework of the topic under consideration contribute to clarifying and concretizing the prerequisites that determine the assimilation of the syllabic structure of a word. There is a dependence of mastering the syllabic structure of a word on the state of phonemic perception, articulatory capabilities, semantic insufficiency, and the child’s motivational sphere; and according to recent studies, on the developmental features of non-speech processes: optical-spatial orientation, rhythmic and dynamic organization of movements, the ability to serially process information (G.V. Babina, N.Yu. Safonkina).

The study of syllable structure in children with systemic speech disorders is most widely represented in the domestic literature.

A.K. Markova defines the syllabic structure of a word as an alternation of stressed and unstressed syllables varying degrees difficulties. The syllabic structure of a word is characterized by four parameters: 1) stress, 2) number of syllables, 3) linear sequence of syllables, 4) model of the syllable itself. The speech therapist must know how the structure of words becomes more complex, and examine the thirteen classes of syllable structures that are the most frequent. The purpose of this examination is not only to determine those syllable classes that have been formed in the child, but also to identify those that need to be formed. The speech therapist also needs to determine the type of violation of the syllabic structure of the word. As a rule, the range of these disorders varies widely: from minor difficulties in pronouncing words of complex syllable structure to severe violations.

Violations of syllabic structure modify the syllabic composition of a word in different ways. Distortions consisting of a pronounced violation of the syllabic composition of the word are clearly distinguished. Words can be deformed due to:

1. Violations of the number of syllables:

The child does not fully reproduce the number of syllables of a word. When reducing the number of syllables, syllables may be omitted at the beginning of the word (“na” - moon), in the middle (“gunitsa” - caterpillar), the word may not be spoken to the end (“kapu” - cabbage).

Depending on the degree of speech underdevelopment, some children shorten even a two-syllable word to a monosyllabic one (“ka” - porridge, “pi” - wrote), others find it difficult only at the level of four-syllable structures, replacing them with three-syllable ones (“puvitsa” - button):

Deletion of the syllabic vowel.

The syllabic structure can be shortened due to the loss of only syllabic-forming vowels, while the other element of the word - the consonant - is preserved (“prosonic” - pig; “sugar bowl” - sugar bowl). This type of syllable structure disorder is less common.

2. Violation of the sequence of syllables in a word:

Rearrangement of syllables in a word (“devore” - tree);

Rearrangement of sounds of adjacent syllables (“gebemot” - hippopotamus). These distortions occupy a special place, with them the number of syllables is not violated, while the syllable composition undergoes gross violations.

3. Distortion of the structure of an individual syllable:

This defect is identified by T.B. Filichev and G.V. Chirkin as the most common when pronouncing words of different syllable structures by children suffering from OHP.

Insertion of consonants into a syllable (“lemont” - lemon).

4. Anticipations, i.e. likening one syllable to another (“pipitan” - captain; “vevesiped” - bicycle).

5. Perseveration (from the Greek word “I persist”). This is an inert stuckness on one syllable in a word (“pananama” - panama; “vvvalabey” - sparrow).

Perseveration of the first syllable is most dangerous, because this type of syllable structure disorder can develop into stuttering.

6. Contaminations – connections of parts of two words (“refrigerator” - refrigerator and bread bin).

All of the listed types of distortions of the syllabic composition of words are very common in children with systemic speech disorders. These disorders occur in children with speech underdevelopment at different (depending on the level of speech development) levels of syllabic difficulty. The retarding effect of syllabic distortions on the process of speech acquisition is further aggravated by the fact that they are highly persistent. All these features of the formation of the syllabic structure of a word interfere normal development oral speech (accumulation of vocabulary, assimilation of concepts) and make it difficult for children to communicate, and also, undoubtedly, prevent sound analysis and synthesis therefore interfere with literacy learning.

Traditionally, when studying the syllabic structure of a word, the possibilities of reproducing the syllabic structure of words of different structures are analyzed according to A.K. Markova, who distinguishes 14 types of syllabic structure of a word according to increasing degrees of complexity. Complication consists in increasing the number and using different types of syllables.

Types of words (according to A.K. Markova)

Grade 1 – two-syllable words made from open syllables (willow, children).

Grade 2 – three-syllable words made from open syllables (hunting, raspberry).

Grade 3 – monosyllabic words (house, poppy).

Grade 4 – two-syllable words with one closed syllable (sofa, furniture).

Grade 5 – two-syllable words with a cluster of consonants in the middle of the word (jar, branch).

Grade 6 – two-syllable words with a closed syllable and a consonant cluster (compote, tulip).

7th grade – three-syllable words with a closed syllable (hippopotamus, telephone).

8th grade – three-syllable words with a combination of consonants (room, shoes).

9th grade – three-syllable words with a combination of consonants and a closed syllable (lamb, ladle).

Grade 10 – three-syllable words with two consonant clusters (tablet, matryoshka).

11th grade – monosyllabic words with a consonant cluster at the beginning of the word (table, closet).

Grade 12 – monosyllabic words with a consonant cluster at the end of the word (elevator, umbrella).

Grade 13 – two-syllable words with two consonant clusters (whip, button).

Grade 14 – four-syllable words made from open syllables (turtle, piano).

In addition to the words included in 14 classes, pronunciation and more are assessed difficult words: “cinema”, “policeman”, “teacher”, “thermometer”, “scuba diver”, “traveler”, etc.

The possibility of reproducing the rhythmic pattern of words, the perception and reproduction of rhythmic structures (isolated beats, a series of simple beats, a series of accented beats) are also explored.

Name the subject pictures;

Repeat the words as reflected by the speech therapist;

Answer the questions. (Where do they buy food?).

Thus, during the examination, the speech therapist identifies the degree and level of violation of the syllabic structure of words in each specific case and the most typical mistakes which the child allows for speech, identifies those frequency classes of syllables whose syllabic structure is preserved in the child’s speech, classes of the syllabic structure of words that are grossly violated in the child’s speech, and also determines the type and type of violation of the syllabic structure of the word. This allows you to set the boundaries of the level accessible to the child, from which corrective exercises should begin.

Many modern authors deal with the issue of correcting the syllabic structure of words. In the methodological manual by S.E. Bolshakova “Overcoming violations of the syllabic structure of words in children,” the author describes the reasons for the difficulties in forming the syllabic structure of words, types of errors, and methods of work. Attention is paid to the development of such prerequisites for the formation of the syllabic structure of a word as optical and somato-spatial representations, orientation in two-dimensional space, dynamic and rhythmic organization of movements. The author proposes a method of manual reinforcement that makes it easier for children to make articulatory switches and prevent omissions and substitutions of syllables. The order of mastering words with consonant clusters is given. Games at each stage contain speech material selected taking into account speech therapy training programs.

The procedure for practicing words with different types of syllabic structure was proposed by E.S. Bolshakova in the manual “The work of a speech therapist with preschoolers,” where the author proposes a sequence of work that helps clarify the contour of the word. (Types of syllables according to A.K. Markova)

IN educational manual“Formation of the syllabic structure of a word: speech therapy tasks” by N.V. Kurdvanovskaya and L.S. Vanyukova highlight the features of correctional work on the formation of the syllabic structure of a word in children with severe speech disorders. The material was selected by the authors in such a way that when working on the automation of one sound, the presence of other sounds that are difficult to pronounce in words is excluded. The presented illustrative material is aimed at developing fine motor skills (pictures can be colored or shaded), and the order of its arrangement will help the formation of a syllable structure at the stage of onomatopoeia.

In his manual “Speech therapy work to overcome violations of the syllabic structure of words in children,” Z.E. Agranovich also proposes a system of speech therapy measures to eliminate such a difficult-to-correct, specific type of speech pathology as a violation of the syllabic structure of words in children of preschool and primary school age. The author summarizes all the correctional work from the development of speech-auditory perception and speech-motor skills and identifies two main stages:

Preparatory (work is carried out on non-verbal and verbal material; the goal of this stage is to prepare the child to master the rhythmic structure of words in his native language;

Actually correctional (the work is carried out on verbal material and consists of several levels (level of vowel sounds, level of syllables, word level). At each level, the author assigns special importance to “inclusion in the work”, in addition to the speech analyzer, also auditory, visual and tactile. The purpose of this stage – direct correction of defects in the syllabic structure of words in a particular speech-language pathologist child.

All authors note the need for specific, targeted speech therapy work to overcome violations of the syllabic structure of words, which is part of the general correctional work in overcoming speech disorders.

Conducting specially selected games in group, subgroup and individual speech therapy classes creates the maximum favorable conditions for the formation of the syllabic structure of words in children with general speech underdevelopment.

For example, the didactic game “Funny Houses”.

This didactic game consists of three houses with pockets for inserting pictures, envelopes with a set of subject pictures for many game options.

Option #1

Goal: developing the ability to divide words into syllables.

Equipment: three houses with different numbers of flowers in the windows (one, two, three), with pockets for putting pictures, a set of subject pictures: hedgehog, wolf, bear, fox, hare, elk, rhinoceros, zebra, camel, lynx, squirrel, cat, rhinoceros, crocodile, giraffe...)

Progress of the game: the speech therapist says that new houses have been made for the animals at the zoo. The child is asked to determine which animals can be placed in which house. The child takes a picture of an animal, pronounces its name and determines the number of syllables in the word. If it is difficult to count the number of syllables, the child is asked to “clap” the word: pronounce it syllable by syllable, accompanying the pronunciation by clapping his hands. Based on the number of syllables, he finds a house with the corresponding number of flowers in the window for the named animal and puts the picture in the pocket of this house. It is advisable that the children’s answers be complete, for example: “The word crocodile has three syllables.” After all the animals have been placed in their houses, you must once again say the words shown in the pictures.

Option No. 2

Goal: to develop the ability to guess riddles and divide guessing words into syllables.

Equipment: three houses with different numbers of flowers in the windows (one, two, three), with pockets for putting pictures, a set of subject pictures: squirrel, woodpecker, dog, hare, pillow, wolf).

Progress of the game: the speech therapist invites the child to listen carefully and guess the riddle, find a picture with the answer word, determine the number of syllables in the word (by clapping, tapping on the table, steps, etc.). Based on the number of syllables, find a house with the corresponding number of windows and insert a picture into the pocket of this house.

Who deftly jumps through the trees

And climbs oak trees?

Who hides nuts in a hollow,

Drying mushrooms for the winter? (Squirrel)

Who goes to the owner

She lets you know. (Dog)

Is it under your ear? (Pillow)

It knocks all the time

But it doesn't hurt them

But it only heals. (Woodpecker)

Doesn't offend anyone

And he's afraid of everyone. (Hare)

Who is cold in winter

He wanders around angry and hungry. (Wolf)

You can simply use pictures whose names consist of a different number of syllables. The child takes a card, names the picture depicted on it, determines the number of syllables in the word and independently inserts it into the appropriate pocket of the house, depending on the number of colors in the window.

Dictionary of speech therapy terms

Automation (of sound) is the stage of correcting incorrect sound pronunciation, which follows after setting a new sound; aimed at developing the correct pronunciation of sounds in coherent speech; consists in the gradual, consistent introduction of a given sound into syllables, words, sentences and into independent speech.

Automated speech sequences are speech actions implemented without the direct participation of consciousness.

Agnosia is a violation of various types of perception that occurs with certain brain lesions. There are visual, tactile, and auditory agnosias.

Agrammatism is a violation of the understanding and use of grammatical means of a language.

Adaptation is the adaptation of an organism to living conditions.

Acalculia is a violation of counting and counting operations as a result of damage to various areas of the cerebral cortex.

Alalia is the absence or underdevelopment of speech in children with normal hearing and initially intact intelligence due to organic damage to the speech zones of the cerebral cortex in the prenatal or early period of the child’s development.

Alexia is the impossibility of the reading process.

Amorphous words are grammatically unchangeable root words, “abnormal words” of children's speech - words-fragments (in which only parts of the word are preserved), onomatopoeic words (words-syllables that the child uses to designate objects, actions, situations), contour words ( in which stress and number of syllables are correctly reproduced).

Amnesia is a memory disorder in which it is impossible to reproduce ideas and concepts formed in the past.

Anamnesis is a set of information (about a person’s living conditions, events preceding the disease, etc.) obtained during the examination from the person being examined and (or) persons who know him; used to establish a diagnosis, prognosis of the disease and select corrective measures.

Ankyloglossia is a shortened hypoglossal ligament.

Anticipation – the ability to foresee the manifestation of the results of an action, “anticipatory reflection”, for example, premature recording of sounds included in the final motor acts.

Apraxia is a violation of voluntary purposeful movements and actions that are not a consequence of paralysis and cuts, but related to disorders of the highest level of organization of motor acts.

Articulation is the activity of the speech organs associated with the pronunciation of speech sounds and their various components that make up syllables and words.

The articulatory apparatus is a set of organs that ensure the formation of speech sounds (articulation), including the vocal apparatus, muscles of the pharynx, larynx, tongue, soft palate, lips, cheeks and lower jaw, teeth, etc.

Ataxia is a disorder/lack of coordination of movements.

Atrophy is pathological structural changes in tissues associated with inhibition of metabolism (due to a disorder in their nutrition).

Asphyxia - suffocation of the fetus and newborn - cessation of breathing with continued cardiac activity due to a decrease or loss of excitability of the respiratory center.

An audiogram is a graphical representation of hearing test data using a device (audiometer).

Aphasia is a complete or partial loss of speech caused by local lesions of the brain. See also video lessons “Forms of aphasia and methods of speech restoration.”

Main forms of aphasia:

acoustic-gnostic (sensory) – violation of phonemic perception;
acoustic-mnestic – impairment of auditory-verbal memory;
semantic – impaired understanding of logical and grammatical structures;
afferent motor – kinesthetic and articulatory apraxia;
efferent motor – violation of the kinetic basis of series of speech movements;
dynamic – violation of the sequential organization of utterances, planning of utterances.

Afferent kinesthetic praxis is the ability to reproduce isolated speech sounds, their articulatory patterns (postures), which are often also called speech kinesthesia or articulomes.

Aphonia – lack of sonority of the voice while maintaining whispered speech; The immediate cause of aphonia is the failure of the vocal folds to close, resulting in air leakage during phonation. Aphonia occurs as a result of organic or functional disorders in the larynx, in case of disorder nervous regulation speech activity.

Bradylalia is a pathologically slow rate of speech.

Broca's Center is a section of the cerebral cortex located in the posterior third of the inferior frontal gyrus of the left hemisphere (in right-handed people), providing motor organization of speech (responsible for expressive speech).

Wernicke's Center is an area of the cerebral cortex in posterior section top temporal gyrus the dominant hemisphere, which provides speech understanding (responsible for impressive speech).

Gammacism is a lack of pronunciation of the sounds [Г], [Гь].

Hemiplegia is paralysis of the muscles of one half of the body.

Hyperkinesis - automatic violent movements due to involuntary muscle contractions.

Hypoxia is oxygen starvation of the body. Hypoxia in newborns is a fetal pathology that develops during pregnancy (chronic) or childbirth (acute) due to oxygen deficiency. Lack of oxygen supply to the fetus at the beginning of pregnancy can cause delays or disturbances in fetal development, and in later stages it affects the baby’s nervous system, which can significantly affect speech development.

The following factors may put you at risk for developing hypoxia:

presence of anemia, STDs, as well as serious illnesses respiratory or cardiovascular system in the expectant mother;
disturbances in the blood supply to the fetus and labor activity, gestosis, post-term pregnancy;
pathologies of the fetus and Rh conflict between mother and baby;
smoking and drinking alcohol by a pregnant woman.

Also, the green color of amniotic fluid indicates oxygen deficiency.

If the doctor suspects hypoxia, he may decide whether a cesarean section is necessary. Newborn with severe oxygen starvation is resuscitated, and with a mild degree receives oxygen and medications.

Dysarthria is a violation of the pronunciation side of speech, caused by insufficient innervation of the speech apparatus.

Dyslalia is a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus.

Dyslexia is a partial specific disorder of the reading process, caused by the immaturity (impairment) of higher mental functions and manifested in repeated persistent errors.

Dysgraphia is a partial specific disorder of the writing process, caused by the immaturity (impairment) of higher mental functions and manifested in repeated errors of a persistent nature.

Delay speech development(ZRR) – a lag in speech development from the age norm of speech development at the age of up to 3 years. From 3 years of age and older, the immaturity of all components of speech is classified as GSD (general speech underdevelopment).

Stuttering is a violation of the tempo-rhythmic organization of speech, caused by the convulsive state of the muscles of the speech apparatus.

Onomatopoeia is a conditional reproduction of natural sounds and sounds that accompany certain processes (laughter, whistling, noise, etc.), as well as animal cries.

Impressive speech – perception, understanding of speech.

Innervation - providing organs and tissues with nerves and, therefore, communication with the central nervous system.

Stroke is an acute disorder caused by a pathological process cerebral circulation(CVA) with the development of persistent symptoms of damage to the central nervous system. Hemorrhagic stroke is caused by bleeding in the brain or its membranes, ischemic stroke is caused by a cessation or significant decrease in blood supply to a region of the brain, a thrombotic stroke is caused by blockage of a cerebral vessel with a thrombus, an embolic stroke is caused by blockage of a cerebral vessel by an embolus.

Kappacism is a lack of pronunciation of the sounds [К], [Кь].

Kinesthetic sensations are sensations of the position and movement of organs.

Compensation is a complex, multidimensional process of restructuring mental functions in the event of disruption or loss of any body functions.

Contamination is the erroneous reproduction of words, which consists of combining syllables belonging to different words into one word.

Lambdacism is the incorrect pronunciation of the sounds [L], [L].

Speech therapy is the science of speech disorders, methods of their prevention, identification and elimination by means of special training and education.

Speech therapy massage is one of the speech therapy techniques that helps normalize the pronunciation side of speech and emotional state persons suffering from speech disorders. Speech therapy massage is part of a comprehensive medical and pedagogical system of rehabilitation for children, adolescents and adults suffering from speech disorders.

Logorrhea is an uncontrolled, incoherent flow of speech, often representing an empty collection of individual words, devoid of logical connection. Observed in sensory aphasia.

Logorhythmics is a system of motor exercises in which various movements are combined with the pronunciation of special speech material. Logorhythmics is a form of active therapy, overcoming speech and related disorders through the development and correction of non-speech and speech mental functions.

Localization of functions - according to the theory of systemic dynamic localization of higher mental functions, the brain is considered as a substrate consisting of departments differentiated by their functions, working as a single whole. Local – local, limited to a certain area, area.

Macroglossia – pathological enlargement of the tongue; observed with abnormal development and in the presence of a chronic pathological process in the language. With M., significant pronunciation disturbances are observed.

Microglossia is a developmental anomaly, small size of the tongue.

Mutism is the cessation of verbal communication with others due to mental trauma.

Speech disorders are deviations in the speaker’s speech from the language norm accepted in a given language environment, manifested in partial (partial) disorders (sound pronunciation, voice, tempo and rhythm, etc.) and caused by disorders of the normal functioning of the psychophysiological mechanisms of speech activity.

Neuropsychology is the science of the brain organization of higher mental functions of a person. N. studies the psychological structure, brain organization of non-speech HMF and speech function. N. studies disorders of speech and other HMF depending on the nature of brain damage (local, diffuse, interzonal connections), as well as the diagnosis of these disorders and methods of correctional and rehabilitation work.

General speech underdevelopment (GSD) is a variety of complex speech disorders in which children have impaired formation of all components of the speech system related to its sound and semantic side, with normal hearing and intelligence.

Reflected speech is speech repeated after someone.

Finger games are a generally accepted name for activities to develop fine motor skills in children. Finger games develop fine motor skills, and its development stimulates the development of certain areas of the brain, in particular speech centers.

Paraphasia is a violation of speech utterances, manifested in omissions, erroneous replacement or rearrangement of sounds and syllables in words (literal paraphasia, for example, mokolo instead of milk, cheekbones instead of chair) or in the replacement of necessary words with others that are not related to the meaning of the utterance (verbal paraphasia) in oral and written speech.

Pathogenesis is the mechanism of development of a specific disease, pathological process or condition.

Perseverations are cyclical repetition or persistent reproduction, often contrary to the conscious intention of any actions, thoughts or experiences.

Prenatal period – pertaining to the period before birth.

Speech decay is the loss of existing speech and communication skills due to local brain damage.

Reflex - in physiology - a natural response of the body to a stimulus mediated by the nervous system.

Disinhibition is the cessation of the state of internal inhibition in the cerebral cortex under the influence of extraneous stimuli.

Disinhibition of speech in children - activation of speech development in children with delayed speech development.

Disinhibition of speech in adults – restoration of speech function in speechless patients.

Rhinolalia is a violation of voice timbre and sound pronunciation, resulting from excessive or insufficient resonance in the nasal cavity during speech. Such a violation of resonance occurs from the incorrect direction of the voice-exhalatory stream due to either organic defects of the nasopharynx, nasal cavity, soft and hard palate, or disorders of the function of the soft palate. There are open, closed and mixed rhinolalia.

Rotacism is a disorder in the pronunciation of the sounds [P], [Rb].

Sensory – sensitive, feeling, relating to sensations.

Sigmatism is a disorder in the pronunciation of whistling ([С], [Сь], [З], [Зь], [Ц]) and hissing ([Ш], [Х], [Ч], [Ш]) sounds.

A syndrome is a natural combination of signs (symptoms) that have a common pathogenesis and characterize a specific disease state.

Somatic is a term used to designate various kinds phenomena in the body associated with the body, as opposed to the psyche.

Conjugate speech is the joint simultaneous repetition by two or more persons of words or phrases spoken by someone.

Cramps are involuntary muscle contractions that occur during epilepsy, brain injuries, spasmophilia and other diseases. Convulsions are characteristic of a state of excitation of subcortical formations and can be caused reflexively.

Clonic seizures are characterized by rapid alternations between muscle contraction and relaxation. Tonic cramps are characterized by prolonged muscle contraction, which causes a prolonged forced tense position.

Tahilalia is a speech disorder, expressed in excessive speed of its tempo (20-30 sounds per second), related in nature to battarism. In contrast to the latter, tachylalia is a deviation from normal speech only in relation to its tempo, with full preservation of phonetic design, as well as vocabulary and grammatical structure.

Tremor – rhythmic oscillatory movements of the limbs, head, tongue, etc. with damage to the nervous system.

Phonetic-phonemic underdevelopment is a violation of the process of formation of the pronunciation system of the native language in children with various speech disorders due to defects in the perception and pronunciation of phonemes.

Phonemic analysis and synthesis are mental activities of analyzing or synthesizing the sound structure of a word.

Phonemic hearing is a subtle, systematized hearing that has the ability to carry out operations of discrimination and recognition of phonemes that make up the sound shell of a word.

Phoniatrics is a branch of medicine that studies dental problems and pathologies of the vocal cords and larynx, leading to voice disorders (dysphonia), methods of treatment and prevention of voice disorders, as well as methods of correcting a normal voice in the desired direction. Voice disturbances can also occur as a result of certain psychological disorders. The solution to some problems in phoniatrics is closely related to the problems of speech therapy.

Cerebral – cerebral, belonging to the brain.

Expressive speech is active oral and written expression.

Extirpation (of the larynx) – removal.

An embolus is a substrate circulating in the blood that is not found under normal conditions and can cause blockage of a blood vessel.

Speech embolus is one of the most common words, part of a word or short phrase before the disease, repeated many times by the patient when trying to speak. It is one of the speech symptoms of motor aphasia.

Etiology is the cause of a disease or pathological condition.

Efferent kinetic praxis is the ability to produce a series of speech sounds. Efferent articulatory praxis is fundamentally different from afferent one in that it requires the ability to switch from one articulatory posture to another. These switches are complex in the way they are executed. They involve mastering inserted fragments of articulatory actions - coarticulations, which are “connections” between individual articulatory poses. Without coarticulation, a word cannot be pronounced, even if every sound included in it is available for reproduction.

Echolalia – involuntary repetition audible sounds, words or phrases.

Where did you get the idea that with alalia, intellect is primarily preserved. Volkova, Kornev, Kovshikov just note the possibility of UO in children with alalia. And from the definition of alalia, it in no way follows that the intellect is primarily preserved. You are confusing with the definition of OHP.

This definition was accepted in speech therapy and was published in the “Conceptual and Termenological Dictionary of Speech Therapists” edited by V. I. Seliverstov (Reviewers: Academician of the Russian Academy of Education, Doctor of Psychology, Professor V. I. Lubovsky, Honored Scientist of the Russian Federation, Academician of the Russian Academy of Education, Doctor of Psychology Sciences, Professor V. A. Slastenin, Honored Scientist of the Russian Federation, Academician of the Academy of Sciences, Doctor pedagogical sciences, Professor L. S. Volkova, Doctor of Medical Sciences, Professor E. M. Mastyukova). You can argue with these respected experts.

Read the definitions more carefully. With mental retardation, alalia can appear, but alalia can also appear with initially intact intelligence - due to organic damage to the speech zones of the cerebral cortex in the prenatal or early period of a child’s development (this definition is published in the classic textbook “Speech Therapy. Textbook for Higher Education”)

The speech therapist should clearly understand that alalia does not equate to mental retardation and carry out an accurate diagnosis of the child. This is extremely important for constructing correctional work; it is necessary to distinguish between such diagnoses and be well aware of the difference between these concepts. Naturally, serious violations speech during alalia can lead to a delay in some mental processes, but specifically to mental retardation, and not to mental retardation.

Alalia is an independent diagnosis that can be diagnosed both in cases of mental retardation and in children with primarily intact intelligence.

Perseveration (Latin perseveratio - persistence, perseverance, from persevere - I persist, I continue), persistent resumption in a person of any mental image, action or state. We can talk about P.

In the motor (the so-called “matory P.”), sensory (for example, in some forms of eidetism), emotional (P. affect) or intellectual spheres. P. are observed both in everyday life (in the form of erroneous actions, slips of the tongue, slips of the tongue, etc.), especially with fatigue or strong emotional stress (see Stress), and in pathology (with some mental illness, and also when certain types local brain lesions). Actually, P., as phenomena that are largely isolated and random in the general context of a person’s mental life, should be distinguished from idee fixe (obsessive thoughts) known in psychiatry. Intellectual perseveration Intellectual perseveration is an obsessive reproduction of the same (inadequate) intellectual operations, which: - appears in the form of serial intellectual actions: arithmetic calculation, establishing analogies, classification; - occurs when the cortex of the frontal lobes of the brain (left hemisphere) is damaged, when control over intellectual activity is impaired. Motor perseveration is an obsessive reproduction of the same movements or their elements. There are: - elementary motor perseveration; - systemic motor perseveration; as well as motor speech perseveration. Motor speech perseveration Motor speech perseveration is motor perseveration, which: - manifests itself in the form of multiple repetitions of the same syllable or word in oral speech and writing; and - occurs as one of the manifestations of efferent motor aphasia with damage to the lower parts of the premotor region of the cortex of the left hemisphere (in right-handed people). Sensory perseveration Sensory perseveration is the obsessive reproduction of the same sound, tactile or visual images, which occurs when the cortical parts of the analytical systems are damaged.

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Symptoms

Depending on how perseveration manifests itself, experts distinguish motor and mental (intellectual) forms.

With motor perseveration, a person constantly repeats the same movement. Sometimes you can see a whole system of repetitive actions in a patient. Such actions have a certain algorithm that does not change for a long time. For example, when having difficulty opening a box, a person constantly hits it on the table, but this leads to nothing. He understands the pointlessness of such behavior, but repeats these actions. Children may constantly call a new teacher by the name of the previous one, or look for a toy where it was stored before, but its storage location has long been changed.

Intellectual perseveration is characterized as an abnormal stuckness of ideas and judgments. It is expressed through the constant repetition of phrases or words. This form of the disease is easily diagnosed when the specialist asks several questions, and the patient answers everything with the very first answer. In a mild form, perseveration can be observed when a person constantly returns to the discussion of a long-resolved issue, the topic of conversation.

Doctors draw the attention of parents to the need to monitor their child’s behavior to see if he has any even the most minor perseverations.

The Positive Side of Persistent Repetition

It is believed that obsessive repetitions of thoughts or actions characterize a person as sick or abnormal. But almost every one of us has been subject to perseveration at least once in our lives. But in people without additional neurological or psychiatric dysfunctions, this state is called careful analysis, worry, perseverance.

Sometimes repetition of thoughts or actions helps people adapt to specific situation. Perseveration is useful or at least not pathological when:

a person needs to understand something in detail;
calm strong emotions and overcome psychological trauma;
a person tries to remember something for a long time;
you need to see something new in an already known fact;
take into account all the probabilities of the phenomenon.

Persistent repetition is useful during learning when it does not interfere with achieving goals. In other cases, this phenomenon requires correction or treatment.

Treatment

It is a known fact that perseverations accompany some mental or neurological diseases, such as Alzheimer's disease, arteriosclerosis, genetic epilepsy, organic dementia, Down syndrome, OCD, autism. If you have a history of such diseases, then you first need to treat the root cause of frequent recurrences with medication.

Medicines for perseveration

As a symptom, perseveration cannot be treated, but thanks to drug therapy of the underlying disease, its intensity is reduced. Neuroleptics are often used for the above diseases. This is a group of drugs that have a calming effect.

With their constant use, a person does not react to external stimuli in the same way, that is, excessive experience of situations goes away, which can cause annoying repetition of actions or thoughts. Psychomotor agitation is reduced, aggressiveness is weakened, and the feeling of fear is suppressed. Some antipsychotics are used as sedatives, while others, on the contrary, are used when mental functions need to be activated. Each drug is selected individually by the doctor.

Along with the use of drugs, it is important to provide psychotherapeutic support to the person, especially if perseverations are caused by stress and other psychological factors.

Psychotherapeutic assistance

Before conversations and the use of psychotherapy, psychological tools are used to diagnose the patient’s condition. This is a technique that includes 7 subtests that help assess the degree pathological manifestations in the patient's behavior and thoughts. After this, the need is determined medication assistance and directions in psychotherapeutic work with him.

When working psychotherapeutically with a patient, it is important to teach him new mental and motor skills, as well as create rational attitudes and support existing ones. positive characteristics person to overcome constant repetition in actions, conversation and thoughts. For this, the following methods and techniques can be used (their use can be done in sequence or alternated).

Persistent and annoying repetitions often interfere with a person’s life. In this case, you need the help of a specialist who will determine the need to use medications and also help you get rid of such a phenomenon as perseveration with the help of psychotherapeutic methods.

Timely and qualified assistance with persistent repetition of actions, ideas, thoughts and phrases will help a person better adapt to the reality around him.

Constant repetition of the same psychiatry. Types of speech stereotypies

associated with visual, auditory, skin-kinesthetic, vestibular afferentation. Defeat

cerebellum is accompanied by a variety of movement disorders (primarily disorders

coordination of motor acts). Their description is one of the well-developed sections

modern neurology.

Damage to pyramidal and extrapyramidal structures spinal cord comes down to dysfunction

motor neurons, as a result of which the movements controlled by them are lost (or disrupted). Depending on the

level of damage spinal cord motor functions of the upper or lower extremities are impaired (on

one or both sides), and all local motor reflexes are carried out, as a rule,

normally or even increase due to the elimination of cortical control. All these movement disorders are also discussed in detail in the neurology course.

Clinical observations of patients who have damage to one or another level of the pyramidal or extrapyramidal system,

made it possible to clarify the functions of these systems. The pyramidal system is responsible for the regulation of discrete, precise movements, completely subordinate to voluntary control and well afferented by “external” afferentation (visual, auditory). It controls complex spatially organized movements in which the whole body is involved. The pyramidal system primarily regulates phasic type of movements, that is, movements precisely dosed in time and space.

The extrapyramidal system controls mainly the involuntary components of voluntary movements; To besides the regulation of tone (that background motor activity, on which phasic short-term motor acts) relate:

♦ maintaining posture;

♦ regulation of physiological tremor;

♦ physiological synergies;

♦ coordination of movements;

♦ general coordination of motor acts;

♦ their integration;

♦ body plasticity;

♦ pantomime;

♦ facial expressions, etc.

The extrapyramidal system also controls a variety of motor skills, automatisms. In general, the extrapyramidal system is less corticolized than the pyramidal system, and the motor acts regulated by it are less voluntary than the movements regulated by the pyramidal system. It should, however, be remembered that the pyramidal and extrapyramidal systems are single efferent mechanism, different levels of which reflect different stages of evolution. The pyramidal system, as an evolutionarily younger system, is to a certain extent a “superstructure” over the more ancient extrapyramidal structures, and its emergence in humans is primarily due to the development of voluntary movements and actions.

Disorders of voluntary movements and actions

Disturbances of voluntary movements and actions are complex movement disorders that are primarily associated with damage to cortical level motor functional systems.

This type of violation motor functions received the name in neurology and neuropsychology apraxia. By apraxia we mean such disturbances of voluntary movements and actions that are not accompanied by clear elementary movement disorders - paralysis and paresis, obvious disturbances of muscle tone and tremor, although combinations of complex and elementary movement disorders are possible.

Apraxia primarily refers to disorders of voluntary movements and actions performed with objects.

The history of the study of apraxia goes back many decades, but until now this problem cannot be considered completely solved. The difficulties of understanding the nature of apraxia are reflected in their classifications. The most famous classification, proposed at one time by G. Lipmann ( H. Lirtapp, 1920) and recognized by many modern researchers, distinguishes three forms of apraxia: ideational, which involves the disintegration of the “idea” of movement, its concept; kinetic, associated with a violation of the kinetic “images” of movement; ideomotor, which is based on the difficulties of transmitting “ideas” about movement to “movement execution centers.” G. Lipmann associated the first type of apraxia with diffuse brain damage, the second with damage to the cortex in the lower premotor region, and the third with damage to the cortex in the lower parietal region. Other researchers identified forms of apraxia in accordance with the affected motor organ (oral apraxia, apraxia of the trunk, apraxia of the fingers, etc.) (Ya. Nesaep, 1969, etc.) or with the nature of the disturbed movements and actions (apraxia of expressive facial movements, object apraxia, apraxia of imitative movements, apraxia of gait, agraphia, etc.) ( J. M.Nielsen, 1946, etc.). To date, there is no unified classification of apraxia. A. R. Luria developed a classification of apraxia based on a general understanding of the psychological structure and brain organization of a voluntary motor act. Summarizing his observations of disorders of voluntary movements and actions, using the method of syndromic analysis, which identifies the main leading factor in the origin of disorders of higher mental functions (including voluntary movements and actions), he identified four forms of apraxia(A. R. Luria, 1962, 1973, etc.). First he designated it as kinesthetic apraxia. This form of apraxia, first described by O.F.

Foerster (O. Foerster, 1936) in 1936, and later studied by G. Head (Ya. Head, 1920), D. Denny-Brown

(D. Denny- Brown, 1958) and other authors, occurs when there is a lesion lower sections postcentral cortex cerebral hemispheres(i.e., the posterior sections of the cortical nucleus of the motor analyzer: 1, 2, partially 40th fields, predominantly of the left hemisphere). In these cases, there are no clear motor defects, muscle strength is sufficient, there are no paresis, but the kinesthetic basis of movements suffers. They become undifferentiated and poorly controlled (the “shovel hand” symptom). Patients have impaired movements when writing, the ability to correctly reproduce various hand postures (postural apraxia); They cannot show without an object how this or that action is performed (for example, how tea is poured into a glass, how a cigarette is lit, etc.). While the external spatial organization of movements is preserved, the internal proprioceptive kinesthetic afferentation of the motor act is disrupted.

With increased visual control, movements can be compensated to a certain extent. When the left hemisphere is damaged, kinesthetic apraxia is usually bilateral in nature; when the right hemisphere is damaged, it often manifests itself only in one left hand.

Second form apraxia, identified by A. R. Luria, - spatial apraxia, or apraktoagnosia, - occurs with damage to the parieto-occipital cortex at the border of the 19th and 39th fields, especially with damage to the left hemisphere (in right-handed people) or with bilateral lesions. The basis of this form of apraxia is a disorder of visual-spatial synthesis, a violation of spatial representations (“top-bottom”, “right-left”, etc.). Thus, in these cases, visuospatial afferentation of movements is affected. Spatial apraxia can also occur against the background of intact visual gnostic functions, but more often it is observed in combination with visual optical-spatial agnosia. Then a complex picture of apraktoagnosia arises. In all cases, patients experience apraxia of posture and difficulties in performing spatially oriented movements (for example, patients cannot make the bed, get dressed, etc.). Strengthening visual control of movements does not help them. There is no clear difference when performing movements with open and closed eyes. This type of disorder also includes constructive apraxia- difficulties in constructing a whole from individual elements (Koos cubes, etc.). With left-sided lesions of the parieto-occipital cortex

often arises optical-spatial agraphia due to difficulties correct spelling letters differently oriented in space.

Third form apraxial - kinetic apraxia- associated with damage to the lower parts of the premotor area of the cerebral cortex (fields 6 and 8 - the anterior parts of the “cortical” nucleus of the motor analyzer). Kinetic apraxia is part of the premotor syndrome, i.e., it occurs against the background of impaired automation (temporal organization) of various mental functions. Manifests itself in the form of the disintegration of “kinetic melodies”, i.e. a violation of the sequence of movements, the temporary organization of motor acts. This form of apraxia is characterized by motor perseverations(elementary perseveration - as defined by A.R. Luria), manifested in the uncontrolled continuation of a movement that has once begun (especially one performed serially; Fig. 36, A).

Rice. 36. Perseveration of movements in patients with lesions of the anterior sections

brain.

A- elementary perseveration of movements when drawing and writing in a patient with a massive intracerebral tumor

left frontal lobe: A- drawing a circle, b - writing the number 2, c - writing the number 5;

B- perseveration of movements when drawing a series of figures in a patient with an intracerebral tumor of the left frontal lobe

(By L. R. Luria, 1963)

This form of apraxia was studied by a number of authors - K. Kleist ( TO.Kleist, 1907), O. Foerster ( ABOUT.Foerster, 1936), etc. It was studied in particular detail by A. R. Luria (1962, 1963, 1969, 1982, etc.), who established in this form of apraxia the commonality of disturbances in the motor functions of the hand and speech apparatus in the form of primary difficulties in automating movements and developing motor skills . Kinetic apraxia manifests itself in a violation of a wide variety of motor acts: object actions, drawing, writing, and in the difficulty of performing graphic tests, especially with the serial organization of movements ( dynamic apraxia). With damage to the lower premotor cortex of the left hemisphere (in right-handed people), kinetic apraxia is observed, as a rule, in both hands.

Fourth form apraxia - regulatory or prefrontal apraxia- occurs when the convexital prefrontal cortex is damaged anterior to the premotor areas; occurs against the background of almost complete preservation of tone and muscle strength. It manifests itself in the form of violations of the programming of movements, the disabling of conscious control over their execution, and the replacement of necessary movements with motor patterns and stereotypes. With a gross breakdown of voluntary regulation of movements, patients experience symptoms echopraxia in the form of uncontrolled imitative repetitions of the experimenter’s movements. With massive lesions of the left frontal lobe (in right-handed people), along with echopraxia, echolalia - imitative repetitions of heard words or phrases.

Regulatory apraxia is characterized by systemic perseverations(as defined by A.R. Luria), i.e., perseveration of the entire motor program as a whole, and not its individual elements (Fig. 36, B). Such patients, after writing under dictation in response to a proposal to draw a triangle, trace the outline of the triangle with movements characteristic of writing, etc. The greatest difficulties in these patients are caused by changing programs of movements and actions. The basis of this defect is a violation of voluntary control over the implementation of movement, a violation of speech regulation of motor acts. This form of apraxia most clearly manifests itself when the left prefrontal region of the brain is damaged in right-handed people. The classification of apraxia created by A. R. Luria is based mainly on the analysis of motor dysfunction in patients with damage to the left hemisphere of the brain. The forms of disturbance of voluntary movements and actions with damage to various cortical zones of the right hemisphere have been studied to a lesser extent; This is one of the urgent tasks of modern neuropsychology.

From the works of A. R. Luria

It is easy to see that all these mechanisms, which play a central role in the construction of types of voluntary movement of varying complexity, create a new idea of voluntary movement as complex functional system, the activity of which, along with the anterior central gyri (which are only the “exit gates” of the motor act), involves a large set of cortical zones that extend beyond the anterior central gyri and provide (together with the corresponding subcortical apparatus) required types afferent syntheses. Such sections that take an intimate part in the construction of a motor act are the postcentral sections of the cortex (providing kinesthetic syntheses), the parieto-occipital sections of the cortex (providing visuospatial syntheses), the premotor sections of the cortex (playing a significant role in ensuring the synthesis of successive impulses into a single kinetic melody ) and, finally, the frontal parts of the brain, which have important functions in subordinating movements to the original intention and in comparing the resulting effect of the action with the original intention.

It is natural therefore that damage to each of the mentioned areas can lead to disruption of voluntary motor acts. However, it is just as natural that a violation of a voluntary motor act when each of these zones is affected will have a unique character, different from other disorders.(A. R. Luria. The human brain and mental processes. - M.: Pedagogy, 1970. - P. 36-37.)

Rice. 37. Differentiation of the human cerebral cortex in accordance with thalamo-cortical projections.

A- convexital; B- medial surface of the right hemisphere: 1 - central region of the cortex, receiving projections from the anteroventral and lateral ventral nuclei of the thalamus; 2 - central region of the cortex, receiving projections from the posteroventral nucleus; 3 - frontal cortex, receiving projections from the dorsomedial nucleus; 4 - parietal-temporo-occipital region of the cortex, receiving projections from the lateral dorsal and lateral posterior nuclei; 5 - parietal-temporo-occipital region of the cortex, receiving projections from the pillow of the visual thalamus; 6 - occipital region of the cortex, receiving projections from the lateral geniculate body; 7 - supratemporal region of the cortex, receiving projections from the internal geniculate body; 8 - limbic area of the cortex, receiving projections from the anterior nuclei of the visual thalamus; CF - central sulcus (along T. Riilyu)

Apraxia– this is a violation of voluntary movements and actions with damage to the cerebral cortex, not accompanied by clear elementary movement disorders (paresis, paralysis, impaired tone, etc.).

Luria identified 4 types of apraxia, which depend on the lesion factor:

Kinesthetic apraxia. Inferior parietal zone. 1, 2 and partially 40 fields. Mostly left hemisphere. Afferentation is disrupted. The person does not receive feedback. Praxis of posture suffers (the inability to give parts of the body the desired position). Can't feel the position of fingers, etc. "Shovel hand." All substantive actions are impaired, writing, and cannot grasp a pen correctly. Test: apraxia - posture (we show hand postures, the Patient must repeat). Strengthening your visual control helps. With eyes closed - inaccessible.

Kinetic apraxia. Lower parts of the premotor area (lower forehead). Smooth switching from one operation to another is disrupted. Elementary perseverations - having started to move, the Patient gets stuck (repeat of the operation). Violation of writing. They realize their inadequacy. Test: fist – palm – rib; fences

Spatial apraxia. Parieto-occipital regions, especially with left lesions. Visual-spatial contacts of movements are disrupted. Difficulty performing spatial movements: getting dressed, preparing food, etc. Everyday life is difficult. Head's Samples : repeat the movement. Optical-spatial agraphia occurs. Elements of letters. Inability to relate your body to the world around you.

A feature of the structure of the cerebral cortex is the arrangement of nerve cells in six layers lying on top of each other.

the first layer - lamina zonalis, zonal (marginal) layer or molecular - is poor in nerve cells and is formed mainly by a plexus of nerve fibers

the second - lamina granularis externa, the outer granular layer - is so called because of the presence in it of densely located small cells with a diameter of 4-8 microns, which on microscopic preparations have the shape of round, triangular and polygonal grains

the third - lamina pyramidalis, pyramidal layer - has a greater thickness than the first two layers. It contains pyramidal cells of different sizes

the fourth is lamina dranularis interna, the internal granular layer - like the second layer, it consists of small cells. This layer may be absent in some areas of the cerebral cortex of an adult organism; for example, it is not in the motor cortex

fifth - lamina gigantopyramidalis, layer of large pyramids (giant Betz cells) - a thick process extends from the upper part of these cells - a dendrite, which branches repeatedly in the surface layers of the cortex. Another long process - an axon - of large pyramidal marks goes into the white matter and goes to subcortical nuclei or to the spinal cord.

sixth - lamina multiformis, polymorphic layer (multiform) - consists of triangular and spindle-shaped cells

Motor (motor) perseveration - obsessive reproduction of the same movements or their elements

There are:
- elementary motor perseveration;

Systemic motor perseveration; and

Motor speech perseveration.

- “elementary” motor perseveration, which manifests itself in repeated repetition of individual elements of movement and occurs when the premotor parts of the cerebral cortex and underlying subcortical structures are damaged;

- “systemic” motor perseveration, which manifests itself in repeated repetition of entire movement programs and occurs when the prefrontal parts of the cerebral cortex are damaged;

Motor speech perseveration, which manifests itself in the form of multiple repetitions of the same syllable or word in oral speech and writing and occurs as one of the manifestations of efferent motor aphasia with damage to the lower parts of the premotor area of the cortex of the left hemisphere (in right-handed people).

Sensory perseveration is an obsessive reproduction of the same sound, tactile or visual images, which occurs when the cortical parts of the analyzing systems are damaged.

28. Forms of apraxia.

Luria identified 4 types of apraxia, which depend on the lesion factor:

1. Kinesthetic apraxia. Inferior parietal zone. 1, 2 and partially 40 fields. Predominantly left hemisphere. Afferentation is disrupted. The person does not receive feedback. Praxis of posture suffers (the inability to give parts of the body the desired position). Can't feel the position of fingers, etc. "Shovel hand." All substantive actions are impaired, writing, and cannot grasp a pen correctly. Test: apraxia - posture (we show hand postures, the Patient must repeat). Strengthening your visual control helps. With eyes closed - inaccessible.

2. Kinetic apraxia. Lower parts of the premotor area (lower forehead). Smooth switching from one operation to another is disrupted. Elementary perseverations - having started to move, the Patient gets stuck (repeat of the operation). Violation of writing. They realize their inadequacy. Test: fist – palm – rib; fences

3. Spatial apraxia. Parieto-occipital regions, especially with left lesions. Visual-spatial contacts of movements are disrupted. Difficulty performing spatial movements: getting dressed, preparing food, etc. Everyday life is complicated. Head's samples : repeat the movement. Optical-spatial agraphia occurs. Elements of letters. Inability to relate your body to the world around you. Occurs with damage to the parieto-occipital cortex at the border of the 19th and 39th fields, especially with damage to the left hemisphere or bilateral lesions. The junction of the parietal, temporal and occipital lobes is often defined as the zone of the statokinesthetic analyzer, since with local lesions of this zone, disturbances in spatial relationships occur when performing complex motor acts.
This form of apraxia is based on a disorder of visual-spatial synthesis, a violation of spatial representations. Thus, visuospatial afferentation of movements is primarily affected in patients. Spatial apraxia can occur against the background of intact visual gnostic functions, but is more often observed against the background of visual optical-spatial agnosia, then a complex picture of apraktoagnosia arises. In all cases, patients experience apraxia of posture and difficulty performing spatially oriented movements. Strengthening visual control of movements does not help them. There is no clear difference when performing movements with open and closed eyes.

This type of disorder also includes constructive apraxia - special and most common forms of praxis impairment, mainly related to the construction of figures from parts and drawing.
Patients find it difficult or unable to depict, according to instructions, to copy directly or from memory simple geometric figures, objects, animal and human figures. The contours of the object are distorted (instead of a circle - an oval), its individual details and elements are not drawn (when drawing a triangle, one corner turns out to be under-drawn). It is especially difficult to copy more complex geometric shapes- a five-pointed star, a rhombus (for example, the star is drawn in the form of two intersecting lines or in the form of a deformed triangle). Particular difficulties arise when copying irregular geometric shapes.

Similar difficulties arise when drawing according to instructions or sketching animal figures and “little men”, human faces. The contours of a person turn out to be distorted, incomplete, with disproportionate elements. Thus, when copying a person’s face, the patient can place one eye in an oval (sometimes in the form of a rectangle) or place one eye above the other, omit some parts of the face in the drawing, the ears are often located inside the oval of the face, etc.

IN to the greatest extent Drawing from memory is disrupted when the sample presented to the patient is removed or not presented at all, if we are talking about well-known figures. Drawing a three-dimensional, three-dimensional image of an object (cube, pyramid, table, etc.) also causes great difficulty; for example, when drawing a table, the patient places all 4 legs on the same plane.

Difficulties arise not only when drawing, but also when constructing figures from sticks (matches) or cubes according to a given pattern (adding, for example, simple drawings from Kos cubes).
Disorders of constructive praxis appear especially clearly when copying unfamiliar figures that do not have a verbal designation (“non-verbal figures”). This technique is often used to identify hidden disorders of constructive praxis.

A characteristic manifestation of constructive apraxia is also difficulty in choosing a place to draw an object on a sheet of paper - the drawing can be located in the upper right corner of the paper or in the lower left, etc. When copying objects, a “switching on symptom” may be observed when the patient draws or draws very close to the sample or superimposes your drawing on the sample. Often, with right hemisphere damage, the left field of space is ignored in the drawings.

Constructive apraxia, according to the literature, occurs when there is a lesion parietal lobe(angular gyrus) of both the left and right hemispheres. A more frequent occurrence of this HMF defect and a more severe degree of severity in left-sided lesions in right-handed people have been noted.
There are other points of view about the dependence of the severity of defects in design and drawing on the lateralization of lesions. THEM. Tonkonogiy (1973) indicates a greater overall severity of disorders in patients with damage to the right parietal lobe. In these cases, a more detailed type of drawing is noted, the presence more elements (“extra lines”), deformation of the spatial relationships of parts with elements of “ignoring” the left part of the structure, etc. Particular difficulties are caused by operations of “rotation” of drawings (in relation to the sample) by 90° or 180°.
With damage to the left hemisphere, it was noted that the patients’ drawings are more primitive, poor in details, there is a desire of patients to copy samples rather than drawing according to instructions, difficulties in identifying corners, joints between structural elements. Many elements of this disorder are revealed by analyzing writing (constructing letters and numbers).

Regulatory apraxia. Prefrontal parts of the brain. Speech regulation disorder. Control over movements and actions suffers. The patient cannot cope with motor tasks. Systemic perseverations occur (repetition of the entire action). Difficulty in mastering the program. Skills are lost. There are patterns and stereotypes that remain. The result does not match the intention. The lesion is localized in the area of the convexital prefrontal cortex anterior to the premotor regions. It occurs against the background of preservation of tone and muscle strength.

The defect is based on a violation of voluntary control over the implementation of movement, a violation of speech regulation of motor acts. It manifests itself in the form of violations of the programming of movements, the disabling of conscious control over their execution, and the replacement of necessary movements with motor patterns and stereotypes. Systemic perseverations (according to Luria) are characteristic - perseverations of entire motor programs. The greatest difficulties for such patients are caused by changing programs of movements and actions.
With a gross breakdown of voluntary regulation of movements, patients experience symptoms of echopraxia in the form of imitative repetitions of the experimenter’s movements.

This form of apraxia is most pronounced when the left prefrontal region of the brain is damaged.
According to Lipmann, there are the following types apraxia: a) kinetic apraxia of the limbs; b) ideomotor apraxia; c) ideational apraxia; d) oral apraxia; e) apraxia of the trunk; e) apraxia of dressing.
Writing disorder is identified as a relatively independent form of these disorders.

29. Prefrontal frontal regions and their role in the regulation of activity.

As is known, the frontal lobes of the brain, and in particular their tertiary formations (which include the prefrontal cortex), are the most recently formed part of the cerebral hemispheres.

The prefrontal regions of the brain - or the frontal granular cortex - are mainly composed of cells in the upper (association) layers of the cortex. They have the richest connections both with the upper sections of the trunk and the formations of the visual thalamus (see Fig. 35, a), and with all other zones of the cortex (see Fig. 35, b). Thus, the prefrontal cortex is built not only over the secondary sections of the motor area, but actually over all other formations big brain. This ensures a two-way connection of the prefrontal cortex with both the underlying structures of the reticular formation, which modulate the tone of the cortex, and with those formations of the second block of the brain, which ensure the receipt, processing and storage of exteroceptive information, which allows the frontal lobes to regulate general state cerebral cortex and the course of the main forms of human mental activity.

The prefrontal regions play a decisive role in the formation of intentions, programs, and in the regulation and control of the most complex forms of human behavior. They consist of fine-grained cells with short axons and have powerful bundles of ascending and descending connections with the reticular formation. Therefore, they can perform an associative function, receiving impulses from the first block of the brain and have an intense modulating effect on the formation of the reticular formation, bringing its activating impulses into accordance with the dynamic patterns of behavior that are formed directly in the prefrontal (frontal) cortex. The prefrontal sections are actually built on top of all sections of the cerebral cortex, performing the function of general regulation of behavior.

It should be noted that, entering into work at the very latest stages of development, the prefrontal parts of the cerebral cortex are at the same time the most vulnerable and most susceptible to involution. Their higher (“associative”) layers atrophy especially sharply in such diffuse diseases as Pick’s disease or progressive paralysis.

The fact that the frontal cortex is close in structure to the motor and premotor areas and, according to all data, is included in the system central departments motor analyzer, suggests its immediate participation in the formation of the analysis and synthesis of those excitations that underlie motor processes.

On the other hand, the frontal lobes of the brain have the closest connections with the reticular formation, receiving constant impulses from it and directing corticofugal discharges to it, which makes them important body regulation of active states of the body. This function of the frontal lobes of the brain is especially important because the frontal lobes themselves are closely connected with all other parts of the brain and allow impulses, previously processed with the participation of the most complex cortical apparatus, to be sent to the underlying subcortical formations.

The prefrontal parts of the brain belong to tertiary systems that form late in both phylo- and ontogenesis and reach the greatest development in humans (25% of the total area of the cerebral hemispheres). According to A.R. Luria, the frontal cortex is, as it were, built on top of all brain formations, ensuring the regulation of their activity states.

In addition to direct participation in ensuring the operating mode of cortical tone when solving various problems, the prefrontal sections, as clinical and psychological data show, are directly related to the integrative organization of movements and actions throughout their implementation and, above all, at the level of voluntary regulation. What does voluntary regulation of activity imply? Firstly, the formation of intention, in accordance with which the goal of the action is determined and the image is predicted based on past experience final result, corresponding to the goal and satisfying the intention. Secondly, the means necessary to achieve the result are selected in their sequential connection, i.e. the program. Thirdly, the implementation of the program must be monitored, since the conditions for achieving the result may change and require correction. Finally, it is necessary to compare the achieved result with what was expected to be obtained and, again, make corrections, especially if there is a discrepancy between the forecast and the result. Thus, the arbitrarily planned execution of a task is in itself a complex, multi-link process, during which the correctness of the chosen path to the realization of the original intention is constantly checked and corrected.

One of the features of the “frontal syndrome”, usually associated with dysfunction of the prefrontal regions, complicating both its description and clinical neuropsychological diagnostics, is the variety of options in terms of the severity of the syndrome and its symptoms. A. R. Luria and E. D. Chomskaya (1962) point to a large number of determinants that determine variants of frontal syndrome. These include the localization of the tumor within the prefrontal regions, the massiveness of the lesion, the addition of cerebral clinical symptoms, the nature of the disease, the age of the patient and his premorbid characteristics. It seems to us that the individual typological characteristics of a person, the level of the psychological structure that L. S. Vygotsky designated as the “core” of the personality, largely determines the possibilities of compensation or masking of the defect. We are talking about the complexity of activity stereotypes formed during life, the breadth and depth of the “buffer zone” within which the decline occurs. general level regulation of mental activity. It is known that a high level of established forms of behavior and professional characteristics, even with severe pathology of the prefrontal sections, determines the patient’s ability to perform sufficiently complex species activities.

Everything that has been said about the variants of the frontal syndrome, about the mystery of the function of the frontal lobes (according to G.L. Teuber) to some extent can serve as an excuse for the lack of clarity with which the syndrome of damage to the prefrontal parts of the brain will be described in this work. Nevertheless, we will make an attempt to systematize the main components of this form of local pathology, based on the ideas of A. R. Luria.

One of the leading features in the structure of frontal syndrome, in our opinion, is the dissociation between the relative preservation of the involuntary level of activity and the deficiency in the voluntary regulation of mental processes. This dissociation may take extreme degree severity, when the patient is practically unable to perform even simple tasks that require minimal voluntary activity. The behavior of such patients is subject to stereotypes, cliches and is interpreted as a phenomenon of “responsiveness” or “field behavior”. Such cases have been described

“field behavior”: when leaving the room, instead of opening the door, the patient opens the doors of the closet located at the exit; When following the instructions to light a candle, the patient takes it into his mouth and lights it like a cigarette. A. R. Luria often said that it is better to judge the state of mental processes and the level of achievements during a neuropsychological examination of a patient with frontal syndrome if one examines not the patient, but his neighbor in the ward. In this case, the patient is involuntarily included in the examination and can detect a certain productivity when involuntarily performing a number of tasks.

The loss of the function of voluntary control and regulation of activity is especially clearly manifested when following instructions for tasks that require constructing a program of action and monitoring its implementation. In this regard, patients develop a complex of disorders in the motor, intellectual and mnestic spheres.

In frontal syndrome, a special place is occupied by the so-called regulatory apraxia, or apraxia of target action. It can be seen in such experimental tasks as performing conditioned motor reactions. The patient is asked to perform the following motor program: “when I hit the table once, you raise your right hand, when twice, raise your left hand.” The repetition of the instructions is accessible to the patient, but its implementation is grossly distorted. Even if the initial execution may be adequate, when repeating the sequence of stimulus beats (I - II; I - II; I - II), the patient develops a stereotype of hand movements (right - left, right - left, right - left). When the sequence of stimuli changes, the patient continues to carry out the stereotyped sequence he has developed, not paying attention to the change in the stimulus situation. In the most severe cases, the patient may continue to update the existing stereotype of hand movements when the supply of stimuli stops. So, following the instruction “squeeze my hand 2 times,” the patient shakes it repeatedly or simply squeezes it once for a long time.

Another variant of a violation of the motor program may be its initial direct subordination to the nature of the presented stimuli (echopraxia). In response to one blow, the patient also performs one tap, and in response to two blows, he knocks twice. In this case, it is possible to change hands, but there is an obvious dependence on the stimulus field, which the patient cannot overcome. Finally (as an option), when repeating instructions at a verbal level, the patient does not carry out the motor program at all.

Similar phenomena can be seen in relation to other motor programs: mirror uncorrected execution of the Head test, echopraxic execution of a conflict conditioned reaction (“I will raise my finger, and you will raise your fist in response”). Replacement of the motor program with echopraxia or a formed stereotype is one of the typical symptoms in the case of pathology of the prefrontal regions. In this case, the actualized stereotype replacing the real program may refer to well-established stereotypes of the patient’s past experience. As an illustration, consider the example above of lighting a candle.

A description of the symptoms characteristic of target action apraxia will be incomplete without touching upon one more feature in the disruption of the execution of motor programs, which, however, has a broader significance in the structure of prefrontal frontal syndrome and can be identified as the second leading symptom. This violation is classified as a violation of the regulatory function of speech. If we turn again to how the patient performs motor programs, we can see that the speech equivalent (instruction) is absorbed and repeated by the patient, but does not become the lever with which control and correction of movements is carried out. The verbal and motor components of activity seem to be torn off and split off from each other. In its crudest forms, this can manifest itself in the replacement of movement by the reproduction of verbal instructions. Thus, a patient who is asked to squeeze the examiner’s hand twice repeats “squeeze twice,” but does not perform the movement. When asked why he does not follow the instructions, the patient says: “squeeze twice, I’ve already done it.” Thus, the verbal task not only does not regulate the motor act itself, but is also not a trigger mechanism that forms the intention to perform the movement.

Both the violation of voluntary regulation of activity and the violation of the regulatory function of speech are in close connection with each other and in connection with another symptom - the inactivity of a patient with a prefrontal lesion.

Inactivity as insufficient intention in organizing behavior in performing movements and actions can be presented at various stages. At the stage of formation of intention, it manifests itself in the fact that the instructions and tasks offered to the patient are not included in the internal plan of his activity, according to which the patient, if included in the activity, replaces the task required by the instructions with a stereotype or echopraxia. If activity is preserved at the first stage (the patient accepts the instructions), inactivity can be seen at the stage of forming the execution program, when the correctly started activity is ultimately replaced by an already established stereotype. Finally, the patient’s inactivity can be identified at the third stage - comparison of the sample and the obtained result of the activity.

Thus, prefrontal frontal syndrome is characterized by a violation of the voluntary organization of activity. , violation of the regulatory role of speech, inactivity in behavior and when performing neuropsychological research tasks. This complex defect is especially clearly manifested in motor, intellectual, mnestic and speech activity.

Character movement disorders has already been considered. In the intellectual sphere, as a rule, purposeful orientation in the conditions of the task and the program of actions necessary for the implementation of mental operations are disrupted.

A good model of verbal-logical thinking is counting serial operations (subtraction from 100 to 7). Despite the availability of single subtraction operations, under serial counting conditions, task performance is reduced to replacing the program with fragmented actions or stereotypies (100 - 7 = 93, 84,... 83, 73 63, etc.).

A more sensitized test is solving arithmetic problems. If the task consists of one action, its solution does not cause difficulties. However, in relatively more complex tasks, as shown by A. R. Luria and L. S. Tsvetkova (1966), the general orientation in the conditions is also disrupted (this is especially true for the question of the task, which is often replaced by the patient due to the inert inclusion of one of the elements in it conditions), and the course of the decision itself, which does not obey the general plan or program.

In visual-mental activity, the model of which is the analysis of the content of a plot picture, similar difficulties are observed. From the general “field” of the picture, the patient impulsively snatches some detail and subsequently makes an assumption about the content of the picture, without comparing the details with each other and without correcting his assumption in accordance with the content of the picture. Thus, having seen the inscription “Caution” in a picture depicting a skater who has fallen through the ice and a group of people attempting to save him, the patient concludes: “High voltage current.” The process of visual thinking is replaced here by the actualization of a stereotype caused by a fragment of a picture.

The mnestic activity of patients is disrupted primarily at the level of its volition and purposefulness. Thus, writes A.R. Luria, these patients do not have primary memory impairments, but the ability to create strong motives for remembering, maintain active tension and switch from one set of traces to another is extremely difficult. When memorizing 10 words, a patient with frontal syndrome easily reproduces 4-5 elements of the sequence that are accessible to direct memorization upon the first presentation of the series, but upon repeated presentation there is no increase in the productivity of reproduction. The patient inertly reproduces the initially imprinted 4-5 words, the learning curve has a “plateau” character, indicating the inactivity of mnestic activity.

Particularly difficult for patients are mnestic tasks that require sequential memorization and reproduction of two competing groups (words, phrases). Adequate reproduction is replaced by inert repetition of one of the groups of words, or one of 2 phrases.

Defects in voluntary regulation of activity in combination with inactivity also appear in the speech activity of patients. Their spontaneous speech is impoverished, they lose speech initiative, echolalia predominates in the dialogue, speech production is replete with stereotypes and cliches, meaningless statements. Just as in other types of activity, patients cannot construct a program for an independent story on a given topic, and when reproducing a story proposed for memorization, they slip into side associations of a stereotypical situational plan. Such speech disorders are classified as speech spontaneity, speech adynamia or dynamic aphasia. The question of the nature of this speech defect has not been fully resolved: whether it is actually speech or occurs in a syndrome of general inactivity and aspontaneity. It is obvious, however, that the general radicals that form the syndrome of impaired goal setting, programming and control with damage to the prefrontal parts of the brain find their clear expression in speech activity.

In the characteristics of prefrontal syndrome, its lateral features remained unconsidered. Despite the fact that all the described symptoms are most clearly manifested with bilateral damage to the anterior parts of the frontal lobes of the brain, the unilateral location of the lesion introduces its own characteristics. With damage to the left frontal lobe, a violation of the regulatory role of speech, impoverishment of speech production, and a decrease in speech initiative are especially clear. In the case of right hemisphere lesions, there is disinhibition of speech, an abundance of speech production, and the patient’s willingness to explain his mistakes quasi-logically. However, regardless of the side of the lesion, the patient’s speech loses its meaningful characteristics and includes cliches and stereotypes, which in the case of right-hemisphere lesions gives it a “reasoning” coloring. More roughly, when the left frontal lobe is damaged, inactivity appears; decrease in intellectual and mnestic functions. At the same time, localization of the lesion in the right frontal lobe leads to more pronounced defects in the area of visual, nonverbal thinking. Violation of the integrity of the assessment of the situation, narrowing of the volume, fragmentation - characteristic of right hemisphere dysfunctions of the previously described brain zones are fully manifested in the frontal localization of the pathological process.

30.Mediobasal sections of the cortex and their functional significance.

Note. The following levels of deep brain structures are distinguished: brain stem (medulla oblongata, pons, midbrain), interstitial brain - upper floor brain stem(hypothalamus and thalamus), mediobasal cortex of the frontal and temporal lobes (hippocampus, amygdala, limbic structures, basal ganglia old bark, etc.). The deep structures also include the median commissure of the brain - the corpus callosum. The topical diagnosis of damage to deep brain structures is based mainly on the totality of clinical and paraclinical data. The results of a neuropsychological study - in contrast to damage to cortical structures - are of an auxiliary, phenomenological nature.

All these facts, associated with profound changes in the physiological mechanisms that regulate the normal behavior of the animal, undoubtedly indicate that mediobasal sections of the neocortex, together with the entire complex of phylogenetically ancient cortical, subcortical and stem formations of the brain associated with them, are closely related to the regulation of the internal states of the body, perceiving the signals of these states and their changes and accordingly “tuning” and “rebuilding” each time the active activity of the animal, aimed outside. Close connections between these formations and especially between the limbic region and the basal frontal cortex justify general conclusion that in the frontal region there is a comparison and functional unification of two most important types of feedback signaling. We mean here, on the one hand, signaling coming from the motor activity of the body, aimed at the outside world and formed under the influence of information about events occurring in the environment, and on the other hand, signaling coming from internal sphere body. Thus, a comprehensive account is provided of everything that happens outside the body and inside it as a result of its own activities. In view of this, it can be assumed that the frontal cortex, in which the most complex syntheses of external and internal information take place and their transformation into final motor acts, from which integral behavior is formed, is of very significant importance in humans as the morphophysiological basis of the most complex types of mental activity.

The first - energy - block includes nonspecific structures of different levels: the reticular formation of the brain stem, nonspecific structures of the midbrain, diencephalic regions, the limbic system, the mediobasal regions of the cortex of the frontal and temporal lobes of the brain. This block brain regulates activation processes: general generalized changes in activation, which are the basis of various functional states, and local selective changes in activation, necessary for the implementation of HMF. Functional meaning The first block in ensuring mental functions consists, first of all, in the regulation of activation processes, in providing a general activation background on which all mental functions, in maintaining the general tone of the central nervous system necessary for any mental activity. This aspect of the work of the first block is directly related to the processes of attention - general, indiscriminate and selective, as well as in consciousness as a whole. The first block of the brain is directly associated with memory processes, with the imprinting, storage and processing of multimodal information.

The first block of the brain is the direct brain substrate of various motivational and emotional processes and states. The first block of the brain perceives and processes various interoceptive information about the states of the internal environment of the body and regulates these states using neurohumoral, biochemical mechanisms. Thus, the first block of the brain is involved in the implementation of any mental activity and especially in the processes of attention, memory, regulation of emotional states and consciousness as a whole.

Syndromes of lesions of the mediobasal cortex temporal region brain Because the mediobasal sections of the cortex are an integral part of the first (energy) block. Damage to this zone of the cortex leads to disruption of modally nonspecific factors, manifested in disorders of various mental functions.

The three groups of symptoms included in these syndromes have been most studied.

The first group is modality-nonspecific memory impairment (auditory-speech and other types). As A. R. Luria noted, defects " shared memory“manifest in these patients in difficulties in directly retaining traces, that is, in primary impairments of short-term memory.

The second group of symptoms is associated with disturbances in the emotional sphere. Damage to the temporal regions of the brain leads to distinct emotional disorders, which are classified in the psychiatric literature as affective paroxysms. They manifest themselves in the form of attacks of fear, melancholy, horror and are accompanied by violent vegetative reactions.

The third group of symptoms consists of symptoms of impaired consciousness. In severe cases, these are drowsy states of consciousness, confusion, and sometimes hallucinations; in milder cases, difficulties in orientation in place, time, confibulation. These symptoms have not yet become the object of special neuropsychological study.

31 Neuropsychological analysis of memory disorders.

Memory is one of the mental functions and types of mental activity designed to preserve, accumulate and reproduce information.