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Dysphasia. Aphasias

The term dysphasia has been agreed by different authors and efforts have focused in making diagnoses by exclusion of disorders that may not fit within this category. Dysphasia, then, " generally applies to children with severe language disorder, and whose causes are not due to obvious reasons such as: deafness, mental retardation, a motor impairment, emotional disorders or personality disorders. "(Seron and Aguilar, 1992, p.331).

The dysphasia is characterized by severely impaired language development in intellectually normal children older than 5 years, both in the understanding and the language issue, not possible to explain and intellectual problems, sensory, motor or neurological damage, along with associated problems (wandering attention, isolation, emotional lability). The deficit in oral language is characterized not only by chronological delay in the acquisition of language (Aidex, 2000b)

Differential characteristics .

is necessary to make differential diagnosis, mental retardation, autism, hearing impairment, neurological disorders (aphasia).

is difficult to establish the boundary between language delay and dysphasia, many times, the diagnosis is determined by the lack of evolution before the intervention and the level of symptom severity. Dysphasic disorders have worse outcomes with a systematic intervention. Be considered as criteria of differentiation, increased severity of the indicators and the persistence of this severity. In the speech delay, although at one time could be found and the same gravity as dysphasia, find a better outcome, therefore, not only intervention but also because environmental factors associated dificultantes, are losing ground compared to intervention and guidance that good school and family.

The dysphasic problem is further complicated by the greatest difficulty in basic learning and greater and more persistent educational failure.

diagnostic criteria dysphasia

According to DSM-IV (1995), the criteria for diagnosis of dysphasia are:.

· persistent deficit in the language at all levels, understanding and expression.

· chronological delay deviation from normal patterns of acquisition and development.

· Serious communication problems.

· difficulties in school learning.

· All in all it is because a sensory, intellectual or severe motor.

Descriptive characteristics of dysphasia.

Country language

1. expressive deficiency: can range from near silence to dyslalia tables. In general, the communicative purpose is poor and have great difficulty adapting to the speaker, in relation to language itself, there are difficulties to repeat phrases and properly structured syntactic structures (agrammatism) and there is deficiency in auditory integration and vocabulary (Aidex, 2000b). According Ajuriaguerra (1975, in Aguilar, and Seron, 1992, p.331), the dysphasic, in terms of production, can be classified into those who are frugal and simple phrases occupy - producing emissions that can go from a word- telegraphic sentence to expression (Aidex, 2000b) - and those who are poorly controlled, which do not respect the order of the words and present gap between understanding and expression.

2. Deficiencies in the receptive field, can occur from a severe impairment in recognizing sound with meaning, to milder forms where there is confusion in the discrimination of phonemes or the semantic (Seron and Aguilar, 1992), in general, you can see difficult to repeat and remember to extended speech and problems with recall, reflected in expressions interrupted by substitutions of words, using words and catch phrases. (Aidex, 2000b)

Country nonlinguistic.

According Monfort and Juárez (1997), dysphasic children presented the following non-linguistic field:

Cognitive Aspects

· difficulties in the development of symbolic play and other symbolic functions

· Difficulties in the construction of mental images

· sequential memory deficit, auditory verbal short-term and

· Alterations in the structure of time and space

· Heterogeneity results in different scales subtests of nonverbal intelligence.

perceptual aspects

· discrimination Difficulties auditory stimuli.

· longer latency time required for auditory perception.

· Problems lateralization in the processing of auditory stimuli.

psychomotor aspects

· praxical Difficulties.

· lateralization process disturbances.

· immaturity of motor skills.

behavioral aspects

· Impaired attention span, hyperactivity.

· Altered relationships and control of emotions.

social and emotional world of dysphasic children.

According Monfort and Juárez (1997), difficulties in the progress in language development, along with a lack of clear justification for them, created within the family situation of great stress and anxiety, guilt feelings expressed toward yourself or another member of the couple parents. The alteration in normal patterns of family interaction, produces a quantitative alteration of external stimulation (less spontaneous interactions) and qualitative (policy interventions, less flexible and not set the level of development of the child).

is important to consider that parents adjust their level of language to the child's level, although in severe cases presents a very large gap between the complexity of the content you want to communicate and the ability of children to assimilate, which greatly limits the possibility of interaction.

abnormalities of social interaction can also be seen in the child's contact with their peers, receiving fewer requests for establishing communication and shorter interactions.

Etiology.

Seeman (1965, in Aguilar, and Seron, 1992, p.332) considers that early in the onset of dysphasia indicate that the constitutional factor would be important, perhaps not a cause, but as a predisposing factor, on the other hand, different authors suggest that dysphasia is a product of both inherited factors and environmental.

auditory perceptual component is essential in the development of dysphasia. You can find children with word deafness (hearing sounds without verbal stimulus discrimination perception problems at central level).

Evaluation of dysphasia

As Seron and Aguilar (1992), the diagnosis of dysphasia only be done after 6-7 years because if done in early confused with simple box of language delay.

An evaluation of a case of dysphasia should consider the following points:

1. The evaluation of production processes and language comprehension should be assessed in qualitative and quantitative not be distinguished from the tables do not dysphasic.

2. should consider the cognitive processes that act on the acquisition of language and that we can shed light on the etiology of this disorder:

or Sustained attention , imitation generalized symbolization habits that are seen as prerequisites for language.

or formal language requirements, spontaneous vocalizations (babbling), auditory discrimination and tracking of rhythmic sequences.

or social requirements, early settlement patterns of social interaction with children or adults. Eye contact, social smile.

3. study the processes of production speech exploring the oral-facial praxis and the articulation of the child.

4. Study of the general behavior of the child and see behavioral alterations or isolation.

5. perform complementary: audiometric (to rule out hearing impairment) and neurological tests.

6. Exploration with psychometric tests, since in many cases the child presents dysphasic related psychomotor disorders such as alterations of space, knowledge of left, right, altered body image and gestural expression.

Intervention dysphasic children.

Early intervention

According Monfort and Juárez (1997), there 10 general principles of intervention for children with dysphasia. These are:

· Top intensity and long duration: it is, essentially, to allow and facilitate access to communication and language in spite of a deficiency in base , which usually remain throughout the process of language development. Thus, the intervention should take place in an intensive, continuous and stable, especially in the early years.

· earliness principle: the intervention should be made as early as possible and that learning is best done in the critical period, the earlier changes occur the child will have greater flexibility and control brain more effectively the potential ineffective interactions of the child's environment.

· Top etiologic be taken into account the child's family and hacérsele participate in the intervention, since its role is essential in the development of oral language.

· Top priority to communication: it is necessary to keep each activity and each learning process the highest possible level of communication functionality.

· attitudes empowerment principle: they must register those aspects that present the highest levels of development to maximize, and its usefulness in the construction project language

· multi-sensory principle: it is preferable from the beginning to the best possible chance of success the child and do not restrict the use of augmentative sensory reinforcements to cases that fail to strictly intervention stimulation via normal audio-oral.

· principle reference to normal language development: the contents of the intervention programs and their sort sequence must be guided by what is known about the child's language development normal, provided that specific characteristics presented dysphasia in a particular case do not indicate otherwise.

· Top of enabling systems dynamics: the idea is to provide maximum assistance to the child who is in trouble from the start, and then lowering them to As the child becomes more independent of them.

· continuous review principle: it must conduct a regular evaluation of each case adapt the guidelines to its characteristics at each point in its evolution.

· time adjustment principle: data generally recommended in slowing the pace of interaction and greater clarity in the presentation of the initial relationship between the referent and verbal models, so not only with regard to speak slower and clearer, but mainly to lengthen the waiting times of the responses.

intervention strategies

According to the statement by Monfort and Juárez (1997), intervention in children dysphasia can be divided into three levels:

1. enhanced level of stimulation: the model is to shore up natural language acquisition, within its own dynamic performance. It is present communicative and verbal stimuli in an enabling environment, increasing the intensity of dual interactions with adults, increasing their intensity, controlling behavior that adults have over the process of language acquisition.

This level of stimulation includes stimulation sessions functional models aimed at providing clear and stable enabling environment, and family programs, which aim to inform the child's language disorder and train them new ways of interacting with the child.

2. Level restructuring: it is necessary to modify certain aspects of linguistic communication and the acquisition process itself that is trying to develop despite the deficit using, if necessary, and for some time, unreleased tracks and underused in normal child, with the introduction of visual, tactile, or motor to normal linguistic communication, this must be combined with the Level One guidelines, since the introduction of these systems should not only exercise sessions.

3. alternative communication system: the system chosen must be inserted into the open interaction, following the principles of natural stimulation enhanced the level one. The overall objective is to get the child to achieve adequately communicate with their environment occupying, if necessary, alternative to oral language.

4. Family programs: it consists of information and training. In the first family are informed of the nature of the condition of their children, changes to expect and the importance of their role in their education.

The formation consists of six main points:

· develop observational skills.

· reduce the tendency of directors.

· Learning to better align our language.

· Learn how to create active communicative situations.

· Eliminate negative behaviors.

Learn techniques for augmentative and alternative communication.

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can be defined as "a language impairment due to brain lesions produced after the acquisition of language or during it. "(Seron and Aguilar, 1992, p.337). It is possible to identify different types of aphasia, according to the mode of expression involved, which are almost never found in pure form: oral, written , gestures and reception. For purposes of differentiating aphasia from other disorders, there must be a central nervous system injury that affects the language, which usually occurs in areas fronto-temporo-parietal-dominant hemisphere usually left - the one encephalopathy, a cardio-vascular accident, a TEC or a tumor. aphasia is considered, more clearly, when it occurs after 3 years of age, approximately. The loss of language is sharp and straight to a period of coma. At first the child may remain silent, or make just a few words. (Aidex, 2000a).

Criteria for the diagnosis of childhood aphasia

According to DSM-IV (1995), the criteria necessary to diagnose a child aphasia are:

1. total or partial loss of language so sharp in children who already had language. (After an approximate age 3 years and 6 months).

2. localized brain injury, diagnosed or highly presumptive.

3. is not due to cerebral palsy, pervasive developmental disorders, or mental deficiency.

Differential characteristics:

The linguistic manifestation of childhood aphasia can resemble other disorders whose essential characteristics belong to other types of non-specific disorders Language: psychomotor disorder, mental disorder (oligophrenias), disorganization biological, psychological disorders.

dysarthria In no disorder in the language field, but only involvement of motor component in the degree of realization of the joint. (Aidex, 2000a)

Classification.

Depending on the type of damage and disruption caused to the various factors involved in language, aphasia can be classified in:

Sensory or Wernicke's aphasia.

occurring following an injury to the posterior third of temporary bypasses the left hemisphere cortex responsible for hearing function. It is expressed in difficulty analyzing the sounds of language, disrupt language comprehension and oral expression, making the correct read of isolated linguistic elements and preventing the perception of sound sets as having meaning.

acoustic-amnestic aphasia

is a variant of Wernicke's aphasia, which presents difficulties in retaining some features of language aids. The patient may repeat sounds and words in isolation, but can not repeat series of 3 or 4 words together or accelerated sound sequences.

motor aphasia.

According to the location of the lesion, these can be classified as:

· or kinesthetic afferent motor aphasia: there is an impossibility to find the combination of moves required to broadcast sound phonemes or chains that make up words or phrases that, due to the difficulty in perceiving their phonatory organs and the exact position in which they should be for a phoneme. In severe cases the patient can not make a sound, whereas in milder forms may do so, but confusing those who are similar in form of joint.

· efferent motor aphasia or Broca: results from an injury in the pre-motor speech area. Causes a lack of fluency in the joint, an inability to string together various joints in correct grammatical order, but the process itself is not affected.

· dynamic aphasia, is caused by an injury to the lower area of \u200b\u200bthe frontal lobe of the left hemisphere, presenting difficulties in organizing the ideas into utterances. Was observed among those deficits in the initiative to speak spontaneously, being echolalic or stereotyped expressions.

· Semantic aphasia: aphasia in these subjects have difficulty in establishing the meaning of a sentence according to the positions of the various words in grammatical structure. In addition, there might be other cases of anomie, in which the subject can not find the name of the objects.

· Aphasia pragmatic: "The words information display the proper syntax but the links are inadequate. The message is messy and chaotic and vocabulary show restraint." (Aguilar, and Seron , 1992, p.341)

· global aphasia or total: Named when oral language is virtually abolished in all its aspects: sensory and motor studies. It is called by Broca and Wernicke's aphasia. Usually this disorder is associated with a stroke and the prognosis is severe.

child Aphasia

"child Aphasia is a disorder of emitter aspect of language. To get a clearer, infantile acquired aphasia is between condition called dysphasia ( described above) and a specific disorder language. In the first, the deficit is in the structuring of language, in the second, the disturbance occurs in the initiation and development of language. "This is infantile acquired aphasia resulting from the appearance of brain injury between the two - three years of life." (Seron and Aguilar, 1992, p.341). It differs from adult aphasia by the type of disorder that produces and not by the injury itself, since the child (depending on age), not being fully developed neuro-linguistic patterns, the injury does not produce much alteration and in adults.

As a cause of brain injury aphasia are causing encephalitis, stroke or brain tumors. The most favorable prognosis is less clear as was the hemispheric lateralization of language in the area at the time of the injury.

According Barraquer Bordas (1977, in Aguilar, and Seron, 1992, p.341), childhood aphasia, unlike the adult where no reduction of spontaneous speech, together with poverty and telegraphic style vocabulary (words juxtaposed in a sentence without grammatical links), sometimes the sentences issued are properly articulated and proper grammar, no stereotypes or paraphasias and recovery is faster than in adults.

The acquired aphasia disorders predominates over the receptive expressive, especially a reduction of spontaneous speech, occurring disorders of written language and reading can become permanent. The criteria for diagnosis of aphasia are: severe retardation of language comprehension and expression, dysfunction in the perception of stimuli presented, disruption in information storage, normal intelligence. .

found in the aphasia one or more deficits in language construct, but may not necessarily an injury, as in acquired aphasia. In addition to these signs, children with aphasia often have disorders in discrimination and phonetic association, together with problems in auditory sequential memory. As a result of aphasia, has suggested a delay in the maturation of centers responsible for the integration of sounds, or the presence of early brain injury. (Seron and Aguilar, 1992)

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Dysphemia

The stuttering is "a stuttering or difficulty in the normal flow of speech. Causes repetitions of syllables or words or work stoppages that disrupt spasmodic verbal fluency "(Seron and Aguilar, 1992, p.294), to speech disorders are added, usually manifestations of muscle tension as hand movements, eye closure, facial gestures and body movements. It usually occurs at an early age (88% of them occurring before age 7) and is more common in men.

For objects of early diagnosis, one must distinguish between disfluency characteristic of stuttering, and the influx or inflow, which is normal in the development of children. The first would involve the repetition of sounds and syllables and their extensions, the second, repetition of phrases and words and phrases and interjections review.

Type

According to where the difficulty occurs in the joint

1. Dysphemia tone: the jam in the flow occurs at the start of talks

2. Dysphemia clone: \u200b\u200bthe hesitation occurs in the word once it has begun to talk.

3. Dysphemia tonic-clonic: a combination of the two.

According to the severity

· Light: Stutters 2% of the words, imperceptible tension, a few blocks and no more than a second in duration.

· Soft: Repeat 2-5% of the words, tension is felt, has several blocks of time less than one second.

· Regular: Repeat 5-8% of the words, some tension, regular blocks of a second. Is some associated movements and facial expression.

· Moderately severe: Stuttering 8-12% of the words. Perceptible tension, locking in two seconds.

· Severo: stutters between 12-25% of words, significant stress, block 3 and 4 seconds. Is associated movements.

· Grave: Repeat for 25% of words, a lot of tension, locks longer than 4 seconds. Is associated with many movements and gestures.

Etiology.

three models have been developed that seek to explain stuttering. They are:

Model of physiological factors.

Research in identical twins have shown a genetic predisposition to stutter, but not in all cases. Other studies have shown an induction time (VOT) higher than in normal children, as well as slower reaction times in the field manual and vocal.

psychosocial model.

The onset of stuttering, as Johnson (1984, in Aguilar, and Seron, 1992, p.296), would be given the stressful reactions to non-family influences the child's normal. In addition, the child tries to solve its inflows through various actions, which are reinforced through operant conditioning, which would explain the origin of the various signs of physical tension in the stutterer.

psycholinguistic model.

Research has estimated that at dysphemism language and vocabulary understanding involves a delay of about 6 months. In addition, repeated more conjunctions and pronouns, repeated more at the beginning of sentences, etc.. Along with this, it is interesting the relationship between the child's speech and non-acceptance by the mother, reflected in a major disruption of the child's speech.