ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 4 of 68
УЖМБС 2021, 6(5): 28–37
Medicine. Reviews

Post-Stroke Aphasia in the Context of Modern Views on the Neurophysiology of Speech Function

Nekrasova N. O., Rudenko S. Yu., Tykhonova L. V.

The purpose of the study is to highlight the clinical experience of specialists from various countries, clinics and neurological specialties, in order to form an up-to-date review of the speech function neurophysiology, as well as the features of pathology, diagnosis and treatment of aphasia, as one of the most disabling symptoms accompanying ischemic stroke. Results. The speech function does not only limit communication options between doctor and patient, but it is also an important factor that makes it difficult to collect anamnesis and interpret the results of a neurological examination. In addition, the quality of life of patients with speech disorders is significantly reduced, they experience remarkable difficulties in interacting with society, and they stop building new communication connections. Taking into account the intensive use of modern neuroimaging methods in scientific studies, a large amount of new data has appeared about the brain functioning in normal and pathological conditions. Due to significant disadvantages, the classical model of the functioning of such a cognitive domain as speech has not just undergone significant changes, but has been almost completely revised. Now, it is not limited only by the two key regions – Broca and Wernicke, and also does not ignore the existence of subcortical structures and connections. The whole set of structures that provide the speech functioning is combined into the concept of "speech connectome". It includes four main groups of associative connections: frontotemporal, occipito-parietal, occipito-temporal and fronto-frontal. The lesion of each of the groups is manifested by certain symptoms, which are combined into several typical clinical patterns. This approach allows clinicians to take a fresh look at the diagnosis of speech disorders, as well as significantly expand therapeutic opportunities in this area. Usage of diagnostic scales and tests, neuroimaging methods, as well as biomarkers of cognitive-aphasic decline is now focused not only on finding the affected structures of the cerebral cortex, but also at interpreting the clinical picture in the form of so-called disconnection syndromes, which is the result of lesions of the neural pathways in the white matter. Conclusion. Speech-language therapy remains the gold standard and an integral part of the treatment of aphasia, and the use of drugs is mainly focused on modulating the work of various neurotransmitter systems. But therapeutic and rehabilitation options based on modern neuroimaging data (in particular, using diffusion-weighted magnetic resonance imaging) can significantly improve the effectiveness of treatment and functional recovery. However, this area remains very promising for further study and more extensive scientific research

Keywords: aphasia, poststroke aphasia, ischemic stroke, cognitive impairment

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