2 English reference aphasia
3 Overview Aphasia refers to the clinical syndrome that the nerve center is damaged, which leads to the disorder of abstract signal thinking and the loss of the ability to express and understand oral and written words. Aphasia does not include language symptoms caused by consciousness disorder and common mental retardation, nor does it include language, reading and writing disorders caused by sensory and motor organ damage such as hearing, vision, writing and pronunciation. Learning difficulties caused by congenital or childhood diseases and language functional defects are not aphasia.
4 Etiology, Pathology and Pathogenesis Speech function is dominated by one hemisphere, which is called the dominant hemisphere. Except for a few people, the dominant hemisphere of most people is located in the right cerebral cortex and its connecting fibers. Aphasia often occurs when the dominant hemisphere is damaged. Different types of aphasia can occur when different specific parts of the dominant hemisphere are damaged: the posterior part of the third frontal gyrus is the oral center, which loses the ability of oral expression when damaged, that is, motor aphasia; The posterior part of the first transverse temporal gyrus is auditory pathway. When it is damaged, it can't understand other people's language, that is, sensory aphasia. The posterior part of the third frontal gyrus is the writing center, which can not be expressed in writing when the lesion occurs, which is agraphia; The angular gyrus is the reading center. When it is damaged, you can't read the pronunciation of words and don't know its meaning. This is alexia. The area between the first temporal gyrus and the angular gyrus is the naming center of the object. When the lesion occurs, the name of the person you see cannot be said, which is called aphasia. The most common diseases that cause aphasia are cerebrovascular diseases, followed by brain inflammation, trauma and degeneration.
5 Clinical manifestations 5. 1 motor aphasia Motor aphasia is also called expressive aphasia, oral aphasia and cortical motor aphasia. It is caused by the damage of speech and motor center in Bullokar area, that is, the posterior part of the third frontal gyrus. The symptoms are that patients can understand other people's languages, the activities of vocal organs are not barrier-free, and some people can pronounce but cannot form languages.
With complete aphasia, patients can't express their thinking activities with comments at all, and even individual words, words and syllables can't be pronounced. Most patients are incomplete motor aphasia. Patients can pronounce individual sounds, but they can't group words by sounds and arrange the language in the necessary order, so these comments are confusing and incomprehensible. Some patients may save the most familiar fragments of a single word, word or sentence, such as "no", "good", "eat", "sit", "yes" and "goodbye". However, no matter how hard the patient tries, he can only say those simple words that have been preserved. Because of the barrier-free language and movements, patients are still restrained, and close contacts may understand the meaning expressed by patients according to their intonation. Lighter patients often have rich vocabulary, but due to the loss of the use of function words and articles, they can only express their words with a few subjects, forming a telegraph language. Language repetition is also common. After a word or syllable is spoken, it is forced to repeat itself automatically and involuntarily enters the next language production process.
Patients with mild motor aphasia can retain the ability of dictation and silent reading.
5.2 Sensory aphasia, also known as receptive aphasia and wernicke aphasia. The focus is located in Wernicke area and auditory contact area, which is caused by the interruption of communication with speech center, which hinders the activation of auditory word "image". Its characteristic is that the patient's hearing is normal, but he can't understand the meaning of others' comments. Although they have the ability to speak, they are confused in vocabulary and grammar and often answer irrelevant questions. The content of their speeches is not really understandable, but they can often imitate other people's languages correctly.
"Difficulties in oral comprehension" is the most prominent symptom. In severe cases, people can't understand simple sentences such as sticking out tongue, opening mouth and closing eyes, and the imitation ability of patients is also reduced. Patients' own speech function also has great obstacles, such as many mistakes in words, disorder, and the language is not in one sentence, the grammatical relationship is chaotic, they are unaware of their own speech errors, and spontaneous speech often increases. Mild patients can understand short sentences commonly used in daily life, but they can't understand more complicated sentences.
Patients can retain the ability to imitate speech, reading, writing and dictation.
5.3 The lesion of alexia is mainly located in the angular gyrus, which is characterized by patients who have no visual impairment, but can't see the pronunciation clearly, and don't know the meaning when they see the original characters and symbols, and are often accompanied by agraphia, calculation errors, body image disorder, spatial agnosia, etc. Simple alexia has a normal function in other languages. It can speak automatically, retell spoken English, understand spoken English, but can't understand words, so it loses the ability to read aloud and silently and cannot be copied. Simple alexia has normal intelligence and calculation ability.
5.4 agraphia Simple agraphia rarely occurs, and whether it can appear alone is still controversial. It is generally believed that the Exner area located at the back of the middle frontal gyrus is damaged. Although patients can understand other people's languages, it is impossible to write, write and copy automatically, and it is impossible to piece together the pattern fragments of words into complete words.
5.5 Named aphasia Named aphasia, also known as amnesia aphasia, is characterized by the patient's ability to speak and write, but he forgets many words, especially the names of objects. It is even more difficult for patients to name the specified items. If prompted, they can immediately name the item, but they will soon forget it. Named aphasia is damaged at the junction of occipital lobe and temporal lobe, mainly at the back of zone 37 and zone 2 1 and zone 22 of Brodmann37.
6 Diagnosis (1) Acute onset aphasia of cerebrovascular disease is the most common in cerebrovascular disease, which is mostly the result of pathological changes in the branches of the middle cerebral artery or the posterior cerebral artery. Right-handed patients are generally accompanied by right hemiplegia.
1. Transient ischemic attack (TIA): The onset age is mostly over 50 years old, and most of them have a history of arteriosclerosis, which usually lasts for several minutes to several hours. Generally, the patient will recover completely within 24 hours, with recurrent attacks and intermittent attacks without neurological symptoms. It may be accompanied by symptoms and signs of nervous system, such as brain stem blindness, contralateral hemiplegia and unilateral sensory disturbance. It is often caused by atherosclerotic plaque microembolization, cerebral arteriolar spasm, cardiac insufficiency and acute hypotension.
2. Cerebral thrombosis: the onset age is higher, and the incidence rate is significantly higher over 60 years old, and most of them are accompanied by hypertension, diabetic arteriosclerosis and other organ sclerosis history, and there may be a history of transient ischemic attack before the disease. There are many diseases when it is quiet, and symptoms are often found after waking up in the morning. Symptoms often get worse gradually in a few hours or a long time, showing trapezoidal progress. Consciousness is still clear, and there are local nerve dysfunction, such as hemiplegia. Cerebrospinal fluid generally does not contain blood 6 hours after onset. Cerebral angiography and CT are helpful to the final diagnosis.
3. Cerebral embolism (cerebral embolism * * *): Most patients are young people, who may have heart disease with atrial fibrillation and thrombosis of other reasons, often accompanied by evidence of arterial embolism in other parts. The onset is sudden, and the symptoms reach the peak in a few seconds or a short time, and there may be short-term disturbance or restriction of consciousness, generalized convulsions, depressed cerebrospinal fluid and no red blood cells. Routine examination is normal, and brain CT examination can be seen early.
4. Cerebral hemorrhage): Hypertensive patients over 50 years old are more common, and they begin to get sick during activities. The inducement is emotional excitement and overwork. Sudden onset, most patients have different degrees of consciousness disorder, accompanied by headache, nausea, vomiting and other acute intracranial hypertension symptoms. There is low fever in acute stage and high peripheral blood picture. Cerebrospinal fluid pressure increases, which may be bloody. The CT scan of the head shows high-density shadow at the bleeding site, and there are often low-density edema areas around the focus.
5. Lacunar cerebral infarction usually occurs after 50 years old and has a long history of hypertension and arteriosclerosis. The onset is usually gradual, and the symptoms peak in a few hours to a few days. The clinical symptoms are mild, and most of them have disturbance of consciousness, headache, vomiting and so on. Signs of nervous system are obviously isolated, such as pure motor hemiplegia and aphasia. Most patients can recover and have a good prognosis. CT examination can confirm the diagnosis, but if the cavity is less than 2mm, it is not easy to find it.
6. Intracranial venous and sinus thrombosis: Sagittal sinus, cavernous sinus and transverse sinus thrombosis are common. Inflammatory patients have a history of facial, oral, eye, pharynx, middle ear or intracranial infection, while non-inflammatory patients have a history of general failure, dehydration, puerperal fever, craniocerebral trauma and hematological diseases before illness. The clinical manifestations are fever, headache, progressive intracranial pressure increase, often accompanied by brain symptoms such as disturbance of consciousness and seizures. Focal symptoms are related to the affected part, such as ophthalmoplegia, focal epilepsy and limb paralysis. It often presents the course of progressive stroke. Cerebrospinal fluid pressure increases, and hemorrhagic infarction can be bloody or yellow. Head CT, MRI and venography are helpful for diagnosis.
Cerebral watershed infarction, cerebral arteritis, intracranial aneurysm and moyamoya disease can also cause aphasia.
(2) Acute fever, headache, lethargy and local brain symptoms may appear at the beginning of brain abscess, and neutrophils in peripheral blood, neutrophils and proteins in cerebrospinal fluid may increase, and brain occupying damage symptoms may appear after abscess formation and gradual increase. Because otogenic brain abscesses account for more than 50% of the total number of brain abscesses, and they often occur in the temporal lobe, clinical sensory aphasia and named aphasia are more common. CT and MRI can confirm the diagnosis.
(3) With the progressive growth of intracranial tumors, headache and vomiting are increasing in clinic. Physical examination showed that there was no edema in the optic papilla. There are focal symptoms of progressive aggravation, and corresponding types of aphasia can occur when the frontal lobe, parietal lobe and temporal lobe are involved. Most patients' aphasia symptoms at the initial stage of onset are temporary seizures, some of which are accompanied by localized motor epilepsy, or constitute the precursor symptoms of grand mal seizures. Named aphasia is the most common clinical manifestation. CT and MRI can confirm the diagnosis.
(4) The visual impairment and location of craniocerebral trauma are different, and the symptoms of aphasia are also different, such as sensory aphasia caused by temporal lobe trauma and ipsilateral hemianopia in the lower quadrant; Angular gyrus trauma often manifests as mild sensory aphasia, and reading difficulties are more prominent.
(5) Brain parasitic pain: Brain paragonimiasis is more common in children, mainly manifested as headache, visual impairment, paralysis and seizures. The diagnosis is mainly based on epidemiological history, paragonimiasis history, paragonimiasis eggs in sputum, cerebrospinal fluid complement fixation test, brain CT and MRI. The main clinical manifestations of cerebral cysticercosis are headache, vomiting, mental disorder and epilepsy, which can be diagnosed by subcutaneous cysticercosis nodule biopsy, cerebrospinal fluid eosinophilia, positive complementary binding test and skull CT and MRI examination. Other cerebral malaria and cerebral schistosomiasis can also cause aphasia.
(6) Meningitis, encephalitis and arachnoiditis caused by various causes of intracranial bacterial and viral infections can also cause aphasia, among which aphasia caused by encephalitis is often obvious and difficult to recover. According to the clinical manifestations of various diseases, cerebrospinal fluid changes and their respective specific examinations can be used for diagnosis.
(7) Pick's disease and Alzheimer's disease. Aphasia in the early stage of Pick's disease can be named aphasia. The oral vocabulary is getting worse and worse, there are more and more mistakes, and finally I am completely aphasia. Because of the mental decline at the same time, although aphasia is getting more and more serious, patients can't consciously. Sensory aphasia often occurs in Alzheimer's disease, and the wrong language is more prominent. Clinically, there are progressive aphasia, no stroke, no hemiplegia, and mental decline, so we should pay attention to exclude these two diseases.
Aphasia assessment 7. 1 indications 1. Impaired language disorder syndrome such as aphasia caused by acquired language loss or brain injury.
2. Advanced neurological disorders related to speech function, such as mild and moderate dementia, amnesia, miscalculation, apraxia, agnosia and other cognitive dysfunction.
7.2 Contraindications There are no special contraindications.
7.3 Prepare 1. Standardized aphasia diagnostic test (including complete sets of watches and appliances). For example: Boston Aphasia Diagnostic Test (BDAE), Western Aphasia Complete Test (WAB) and Chinese Aphasia Diagnostic Test (ABC).
2. tape recorders and tapes.
3. Stopwatch, paper and pen.
4. Data collection: clinical specialist data, patient's personal medical history, living environment data, etc.
7.4 Method 1. Preliminary observation of general communication and language ability impression.
2. Evaluation method
(1) Specific examination steps: Take the Western Aphasia Complete Test (WAB) as an example, and take the following sub-tests (other scales are similar in principle):
① Spontaneous speech (recording, full score of 20): The information content (10) and fluency (10, including grammatical functions and errors) of patients' spontaneous speech were detected in the form of dialogue and picture narration.
② Listening comprehension (full mark 10): point out the pictures or body parts corresponding to the words you hear, answer questions with "yes" or "no" and execute oral instructions.
(3) Retell sentences and numbers (full mark 10).
(4) Naming (recording, full mark 10): naming objects or pictures, listing animals, completing sentences (filling in the blanks with names), responding briefly with names, etc.
⑤ Reading (full score: 10): sentence comprehension, word instruction execution, word graph matching, word listening and reading (recording), stroke recognition, word structure recognition, word structure description, etc.
⑥ Writing (full mark 10): automatic writing (writing names, etc.). ), sequential writing, copying, picture writing, description (scene painting) writing, dictation of sentences, dictation of words according to things, etc.
⑦ Related cognitive functions (full score 10): application, operation, drawing, building block combination, raven inspection, etc.
(2) aphasia quotient (or aphasia index, AQ) calculation:
AQ (from 100) = [( 1)+(2)+(3)+(4)] × 2.
Normal AQ = 98.4 ~ 99.6.
If AQ < 93.8, it can be judged as no language.
When AQ is greater than 93.8 and less than 98.4, it may be diffuse brain injury and subcortical injury.
③ Classification of aphasia: See table 1.
(4) aphasia severity classification (BDAE):
Level 0: Lack of meaningful speech or listening comprehension.
1 grade: there are discontinuous verbal expressions in verbal communication, but most of them need the listener to guess, ask and guess; The range of information that can be exchanged is limited, and it is difficult for listeners to communicate in language.
Level 2: With the help of the listener, you can communicate on familiar topics, but you can't express your thoughts on unfamiliar topics, which makes it difficult for patients and evaluators to communicate orally.
Level 3: Patients can discuss almost all daily problems with little or no help, but some conversations are difficult or impossible due to the weakening of speech or understanding ability.
Grade 4: Fluent in speech, but can be observed with understanding obstacles, and there is no obvious restriction on thinking and verbal expression.
Grade 5: There are few recognizable speech disorders. Patients may feel some difficulties subjectively, but listeners may not be able to perceive them clearly.
(5) Speed measurement: Play back the recording of the dialogue part in spontaneous speech, and calculate the number of syllables (words) uttered by the patient within 1min (normally, 100 ~ 120 words /min).
7.5 Precautions 1. Aphasia assessment should not be accepted under the following circumstances.
(1) Those with poor general condition, advanced illness or poor physical strength are hard to tolerate examination.
(2) People with consciousness disorder.
(3) Severe dementia is difficult to cooperate with.
(4) Those who refuse to check or have no training motivation and requirements at all.
2. The staff should know that when the patient is in acute stage, unstable condition or physical exhaustion, it is not necessary to carry out detailed systematic examination, and a standardized systematic examination can be completed at an appropriate time according to the patient's recovery.
(1) Check the environment: choose a quiet room to avoid interference.
(2) Preparation:
(1) After knowing the patient's background information, the examination contents (including instruments) and doctor's orders should be prepared in advance according to the patient's situation.
(2) before the examination, explain the purpose, requirements and main contents of the examination to patients or their families, and obtain consent and full cooperation.
③ Patients who need to wear glasses, hearing AIDS and dentures should wear them before examination.
(3) The examination should be conducted in a harmonious atmosphere, and the patient's state, cooperation and fatigue should be observed during the examination.
(4) Don't arbitrarily correct the patient's wrong reaction during the examination.
(5) During the examination, not only should the patient's reaction be recorded, but also the patient's original reaction (including alternative language, gestures, body language, written expression, etc.) should be recorded. ).
(6) It is best to do it one-on-one (that is, between the therapist and the patient). When the companion is around, ask him not to hint or prompt the patient.
(7) When the patient's physical condition is poor or his mood is obviously unstable, he shall not be forced to continue the examination.
8 indications for aphasia treatment 8. 1 aphasia Various types of aphasia and communication disorders caused by brain lesions.
8.2 Contraindications for aphasia There are no special contraindications.
8.3 Prepare 1. Recorders and tapes for instruments and articles, orthodontics glasses (for two people to use side by side), metronome, stopwatch, breathing training tools (matches, candles, straws, etc. ), tongue depressor, disinfection equipment, etc.
2. There are about 300 picture cards and word cards for nouns and verbs, about 50 picture cards and sentence cards for scenes, Chinese radical cards and stroke cards, commonly used objects or models, various newspapers, books, colored paper, pigments, various paper and pens, etc.
3. Explain the purpose, methods and precautions of treatment to patients, and fully obtain the cooperation of patients.
8.4 Method 8.4. 1 1. Evaluation and analysis of speech and related obstacles.
8.4.2 2. Choose training topics mainly in everyday language, and try to choose the content that patients are interested in and related to their careers or hobbies; The success rate of topic selection design in training should be above 70% ~ 90%. The following is a reference for selecting training topics according to language patterns and severity.
8.4.3 3. Language function training (1) Listening comprehension training: The core is listening to language to promote communication.
① Speech recognition.
② Word cognition (listening to words, referring to pictures): The therapist puts a few pictures on the desktop, names a word, and asks patients to point out the pictures of the words they hear (generally, from 3 choices 1 to 6 choices 1).
③ Enlarge the breadth of listening memory: use the method similar to ② (from 6-choice 1 to 6-choice 2, 6-choice 3, and finally to 6-choice 5) or use scene painting (therapists gradually increase the number of objects, people and events spoken so that patients can point them out on the map), maps, etc.
Comprehension of sentences: the therapist narrates the contents of the scene painting with sentences or essays, and asks the patient to point out the corresponding picture; Or after listening to a short story, the patient answers related questions with "yes" or "no".
⑤ Perform oral instructions: First, give some simple oral instructions for patients to perform, such as "close your eyes" and "touch your left ear". If it can be carried out smoothly, it will gradually increase the difficulty, such as "take out the spoon first, then give me the cup" and "put the pencil on the exercise book without an eraser on the table"
(2) Oral expression training:
① Phonetic practice: On the basis of speech recognition practice, practice with functional reorganization method.
② Automatic language practice: use sequential language (such as 1, 2, 3 ...) and your own name to induce words.
③ Retelling exercise: Patients with mild symptoms can directly retell monosyllables, words, short sentences, long sentences and meaningless syllables to the therapist (such as "Too Big to Fly" in An Bi Shu). Severe patients will talk to the therapist when they look at objects or pictures. If you can repeat it naturally and correctly, you can adjust the operation, for example, the therapist says it once and the patient repeats it twice; Or when you hear what the therapist says, don't repeat it immediately, and try to repeat it after a few seconds.
(4) Naming exercise (naming by looking at pictures): You can show the patients one by one and let them tell what is in the pictures; If you have difficulty exhaling directly, you can repeat it first, and then point to the corresponding picture or thing with words that are easy to repeat successfully and ask, "What is this?" If you have difficulties, you can give tips on pronunciation, meaning and mouth shape. You can also use related words (antonyms, related words, idioms, proverbs, epigrams, etc. ) to design induction. For example, taking "mountain" as the target word of practice, if it can't be completed under normal circumstances, we can first use idioms such as "Qianshan" and "Gong Yu Yishan" to induce patients to complete the practice aloud, and then gradually let them transition to self-naming. In addition, the blockage removal method can also be used.
⑤ Narrative practice: Use pictures with actions or plots for oral narrative practice, and you can also propose a theme, such as "About drinking" and "What did you do yesterday?" Wait a minute. Please note that patients should not be forced to interrupt or deliberately correct their narrative. Therapists only use interruptions to guide patients to continue when they pause, and master them without deviating from the subject.
(3) Reading and reading training:
① word cognition (word-picture matching): visual cognition-first, you can put three pictures on the table, and then give a word card to let patients choose the corresponding pictures for pairing and combination. If the patient can successfully select 1, the number of pictures displayed at the same time can be gradually increased. Auditory cognition-three word cards can be placed on the table at first, and the therapist can read one word, so that the patient can choose the corresponding word card. Adjust visual cognition.
② Word reading: Show the word card, the therapist will read it to the patient repeatedly, and then encourage the patient to read it together. Finally, the therapist will quit at an appropriate time and let the patient read alone.
③ Read and read sentences and texts.
(4) Writing training:
① Numeric writing: try to write Arabic numerals in sequence, such as1~10; Then try to write Chinese lowercase numbers in order, such as one to ten. If it is successful or partially successful, you can start writing exercises.
(2) Naming writing: try to write the names of the patients themselves, their families and relatives. If successful or partially successful, it can also be used as a starting point for entering writing practice.
③ Single-word supplement: select familiar words, and deliberately leave out one stroke for patients to try to supplement. If one stroke is easier for patients, you can increase the number of missed strokes.
④ Word-to-word matching: including: a. Look at the picture and write; B. dictation exercises; C. writing exercises of sentences and texts.
8.4.4 4. The training of speech-related functions and comprehensive abilities includes: facial and oral movements, gesture imitation, digital concept cognition, calculation exercises, building block combination, painting exercises, dictionary lookup, etc.
8.4.5 5. Communication ability training (1) Methods and techniques to improve communication effect:
Methods: Put a stack of pictures face down on the table, the therapist and the patient alternately touch, but don't let the other side see the contents of the pictures, and then use various expressions (such as swearing, narrative function, gestures, pointing, writing, drawing, etc. ) pass the information to the other party, and the receiver will give appropriate feedback through repeated confirmation, speculation and repeated questions. Therapists can provide appropriate demonstrations according to patients' actual abilities.
② Rating: 0 ~ 5, where 0 means that the information cannot be delivered and 5 means that the information was delivered successfully for the first time; If the evaluation cannot be recorded as u.
(2) the application of compensation means:
① Gesture training: At the beginning, the therapist says the name of the gesture (such as goodbye), and then carries out training in the following order: gesturing with the patient at the same time-the patient imitates the gesture-gesturing after hearing the gesture name-gesturing after reading the instructions-gesturing to answer the corresponding questions.
② Application of communication board or communication book: it is suitable for patients who have serious obstacles in oral expression but can still use gestures (fingers). Methods: The communication board can be designed to be about 45cm×45cm. According to patients' daily activities, needs, preferences, etc. , designed a text map and photos of relatives and friends. Communication could have collected patients' daily language and common information (such as address and telephone number). ) and photos of relatives and friends. After the production of communication board or communication book is completed, train patients to establish the awareness of using communication board or communication book and the skills of using communication board or communication book in conversation.
③ Others: such as painting expression and the application of computer speakers.
8.4.6 6. Guidance of patient communication strategy training (1):
① Try to ask patients to keep their daily communication habits.
② Inform patients that they have problems and consult speech therapists for evaluation, treatment and cooperation.
(3) If the patient's speech is not good, different communication methods can be adopted, such as pictures, books, words, gestures or facial expressions.
④ Instruct patients to try to use other communication methods besides oral expression.
⑤ Try to guide patients to talk about familiar topics, and don't let them enter new topics without assistance.
⑥ Speech therapists should guide patients to acquire special skills of initial speech, such as speech speed, breath control or oral practice.
⑦ Speech therapists and patients should gain a consistent understanding of communication, make sure that patients understand the purpose and process of things to be done and the communication methods to be used, and both use the same communication technology. For example, when patients need to communicate completely with their fingers, speech therapists and others no longer require writing or oral expression.
⑧ When patients communicate with their families and people corresponding to their age, try to make the conversation simple and direct.
Pet-name ruby rehabilitation and compensation strategies should include the skills of asking questions and expressing expectations. Compensation strategies for learning and education.
Attending whether the success is big or small, speech therapists and patients should enjoy the communication process and success.
(2) Guidance to family members: While training aphasic patients in communication strategies, their family members and people around them should also participate in the activities of adjusting communication strategies. The following contents are matters needing attention when family members and people around them communicate with aphasia patients.
① Patients' mood swings should be tolerated, especially when they are tired or sick, and their listening and understanding are worse than usual.
(2) Try to reduce external noise when talking.
③ Talk to patients as much as possible. When expressing, add rich expressions, supplemented by gestures or with body language.
④ Try to use short sentences.
⑤ Try to talk about specific things that patients care about in front of patients to avoid sudden changes in topics.
Don't repeat the same words when the patient doesn't understand. Let's put it another way, don't shout loudly, shout repeatedly.
⑦ Provide more questions for patients to answer with "yes" or "no".
Give patients enough time to express themselves and allow pauses between sentences.
Pet-name ruby don't force the patient to speak or directly correct mistakes.
Attending when patients have the correct response, should be encouraged and praised with sincere joy.
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8.5 Precautions 1. The training place and the requirements of voice assessment are basically the same.
2. Preparation before training Before each training, a specific training plan should be made according to the patient's evaluation and the reaction of the last training. Prepare training supplies in advance to minimize sundries and unnecessary items in the patient's field of vision.
3. The training time is 3 ~ 5 days per week (chronic period 1 ~ 3 days per week), 1 ~ 2 times /d, 30 ~ 60 min each time. Those with poor tolerance can also start from 15 ~ 20 min.
4. Therapist's attitude
(1) fully understand the patient.
(2) Respect the patient's personality.
(3) Let patients have a correct understanding of their own obstacles.
(4) Pay attention to positive guidance to avoid directly denying patients. Enhance patients' self-confidence and improve their desire for training.
5. Aphasia treatment is not suitable.
(1) Those with poor general condition, advanced illness or poor physical strength are hard to tolerate examination.
(2) People with consciousness disorder.
(3) Severe dementia is difficult to cooperate with.
(4) Those who refuse to check or have no training motivation and requirements at all.
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