Logopedist's Role in Performing Intraoperative Mapping of Speech Zones under Awake Craniotomy Conditions

В статье рассматривается важность и необходимость логопедической поддержки лиц с онкологическими заболеваниями головного мозга в процессе нейрохирургического воздействия, также представлена схема методов речевой диагностики при интраоперационном картировании.Awake craniotomy is a neurosurgical intervention aimed at identifying and preserving functionally significant areas of the brain while removing tumors located near the cortical and subcortical speech centers. The authors present a review of the modern literature devoted to this problem. The article outlines the strategy of active pedagogical intervention at pre-operative and operative stages, and presents the scheme of the methods of speech diagnostics during intraoperative mapping and the results of the evaluation of the patient's impressive and expressive speech before and after the operation. The aim of the study was to substantiate the importance and necessity of logopedic support for individuals with brain cancer in the course of neurosurgery. The pedagogical aspects concerning the methods of speech examination, their influence on the rehabilitation potential and the opportunities of logopedic intervention are considered for the first time in the domestic speech therapy. The authors consider the logopedist to be the key specialist in the multidisciplinary rehabilitation team, without whom effective recovery of the patient is impossible

Communication Disorders in Patients with Extrapyramidal Disorders

В статье рассматриваются проявления речевых расстройств у лиц с орфанным заболеванием - болезнью Вильсона-Коновалова.The article analyzes the manifestations of speech disorders in persons with an orphan disease - Wilson-Conovalov disease (VCD). The rare occurrence of this disorder leads to a late diagnosis, while an early start of rehabilitation-educational work contributes to a favorable speech prognosis and an improved quality of life. The aim of the study was to substantiate the importance and necessity of logopedic support for individuals with extrapyramidal disorders and to develop an effective technology of objectivization of communicative disorders in persons with BVC depending on gender, age, form of disease and severity of speech underdevelopment

Examination and rehabilitation of speech disorders in a patient with subcortical aphasia

The article presents a case of clinical observation of subcortical aphasia. It analyzes the manifestations of speech disorders and disorders of higher mental functions in a patient with a stroke in the basin of the left middle cerebral artery and a hematoma of the left internal carotid artery,В статье рассматриваются проявления речевых расстройств и нарушений высших психических функций у пациентки с инсультом

Хронические нарушения сознания: клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов»

Хронические нарушения сознания (ХНС) представляют собой синдромы тяжелого поражения центральной нервной системы, приводящие к длительной грубой инвалидизации и требующие значительных усилий по лечению и реабилитации, которые ложатся на медицинские учреждения и на плечи близких пациентов. ХНС развиваются у пациентов после комы и характеризуются наличием бодрствования при полном или практически полном отсутствии признаков осознанного поведения. К ХНС относятся вегетативное состояние (ВС) и состояние минимального сознания (СМС). Также для описания начальных стадий этих состояний используется термин «продленное нарушение сознания» (ПНС). Отдельно выделяют выход из СМС — состояние, которое формируется по мере восстановления когнитивных функций. Диагностика ХНС основывается на многократном структурированном клиническом осмотре с применением специализированных шкал при условии исключения обратимых причин нарушения сознания. Лечение пациентов с ХНС включает в себя поддержание жизненно важных функций, обеспечение оптимального питания и борьбу с типичными осложнениями и сопутствующими состояниями (пролежни, спастичность, боль, пароксизмальная симпатическая гиперактивность и др.). У пациентов с ХНС должна проводиться реабилитация с участием мультидисциплинарной реабилитационной команды в объеме, который определяется проблемами и возможностями конкретного пациента. Наиболее эффективной реабилитация является при условии ее раннего начала. На данный момент однозначных доказательств эффективности каких-либо специфических методов, направленных на восстановление сознания, не получено; изучается ряд соответствующих фармакологических и нефармакологических вмешательств, обязательным условием применения которых является максимально возможная коррекция соматических проблем пациента. Важную роль в ведении пациентов с ХНС играет вовлечение близких пациента, которые, в свою очередь, нуждаются в получении объективной практической информации о состоянии своего родственника и о направлениях реабилитации, а также в психологической помощи

Post-stroke dysphagia: novel treatment approaches

The paper presents the results of examination and treatment in patients in the early recovery period of ischemic stroke. It considers the concurrent use of drug and speech therapies to improve the rehabilitation of patients with post-stroke speech and swallowing disorders. Objective: to identify the role of speech-language therapy and neuropsychology sessions in the treatment of speech and swallowing disorders in the early recovery period of ischemic hemispheric stroke. Patients and methods. A total of 45 patients (32 (71%) men and 13 (29%) women) with a 2–3-month history of ischemic hemispheric stroke were examined. The follow-up period was 2 months. The patients were divided in two groups. Group 1 (a study group) included 30 patients who received combination therapy (drug treatment; sessions with a speech-language pathologist; and compensatory treatments for restoring swallowing function). All the patients had moderate dysphagia accompanied by speech disorders. Moderate sensorimotor aphasia was observed in 15 patients; moderate dysarthria was also seen in 15 patients. Vinpocetine (Cavinton®) and its dispersible tablets (Cavinton® Comfort) were chosen as an agent for vasoactive therapy. Group 2 (a comparison group) consisted of 15 patients with dysphagia who had only standard therapy and speech therapy sessions. There was sensorimotor aphasia in 2 (4%) patients and dysarthria in 13 (29%). A complex psychological and logopedic examination was carried out using the Mann Assessment of Swallowing Ability (MASA), dysarthria assessment, and the scale designed by L.I. Vasserman for estimating the degree of speech disorders in patients with local brain injuries. Results and discussion. Posttreatment swallowing function improved in all the 45 patients; however, more pronounced positive changes were recorded in the patients of Group 1 (p< 0.05). Survey data, possible diet modification, better patient communications, improved quality of life in the patients, and the opinions of their relatives and medical staff served as criteria for the effectiveness of the model used to recover swallowing function. A subjective improvement showed itself as an increased ability to initialize the pharyngeal phase of swallowing in 25 (56%) patients and none mild delays (up to 5 sec) in the movement of a food bolus in the oral cavity in 10 (22%) patients and in the intake of the food of different consistency in 10 (22%). After a treatment cycle in Group 1, the number of patients with mild dysphagia increased up to 30%; moderate swallowing disorders were present in 63% of patients, which required that medical and speech correction should be continued. A significant improvement in swallowing function was noted in 10% of Group 1 patients with medium-sized cortical and cortical-subcortical lesions; a moderate improvement was seen in 67% with medium and small cerebral foci at the same location. At the same time, in Group 2 there were insignificant positive changes only in 20% of patients, most of whom had dysarthria. Conclusion. The high incidence of post-stroke makes it reasonable to use speech therapy methods in a set of multidisciplinary specialized types of care. This care should be personalized; prescribing easy-to-swallow dispersible drugs plays an important role in this case. This will improve quality of life in the patient and protect him from unwanted complications

Personalized approach in speech rehabilitation: focus on the patient

В статье рассматривается персонифицированный подход с позиции восстановительного обучения взрослых пациентов с нарушением речи.The article deals with the concepts of "personalization", "personalized medicine", "individual" and "differentiated" approaches from the position of rehabilitation training of adult patients with speech and voice disorders and with cognitive deficit