(Introduction to) Language History and Use 1

Aphasia
Rachael-Anne Knight
Aphasia
Introduction
Aphasia literally means 'without speech' and reers to the disruption o language a!ilities ater trauma to the
!rain" #uch trauma is most oten caused !y a stro$e !ut may also !e caused !y surgery% a !low to the head or
a missile wound"
1 Early descriptions of aphasia
In the mid-1&
th
century doctors !egan to in'estigate patients with 'arious speech diiculties" (roca (1)*+)
and ,ernic$e (1)-.) !oth ound areas o the let hemisphere that seemed to !e damaged in their patients"
,hat came to !e $nown as (roca's area is ound in the let rontal lo!e whilst ,ernic$e's area is in the
superior temporal gyrus (urther !ac$ in the !rain)" /heory at the time was that (roca's area was responsi!le
or memories or the phonological orm o words whilst ,ernic$e's are was responsi!le or semantics" /he
classical names or two 'ery dierent types o aphasia still hold at least in the clinical en'ironment today"
1.1 Broca's aphasia
An e0ample o speech rom a patient diagnosed with (roca's aphasia trying to descri!e the 'coo$ie thet'
picture"
Cookie jar fall overchairwaterempty
(roca's aphasics are traditionally descri!ed as ha'ing slow% la!orious speech% dysprosody (little intonation)%
apra0ia (articulation diiculties) and diiculties in ordering words" In addition it is clear that grammatical
elements are produced seldom% i e'er"
1.2 Wernicke's aphasia
An e0ample o speech rom a patient descri!ing the 'coo$ie thet' picture1
Well this is mother is away here working her work out o' here to get her better, but when she's looking, the
two boys looking in the other part. One their small tile into here time here. She's working another time
because she's getting to. So two boys work together an one is sneakin' aroun here, making his work an' his
further funnas his time he ha.
Figure 1 Anatomy of the brain
(Introduction to) Language History and Use 2
Aphasia
Rachael-Anne Knight
,ernic$e's aphasics are traditionally descri!ed as ha'ing luent !ut oten meaningless speech containing
well-ormed sentences with lots o grammatical elements" /hey ha'e normal prosody !ut poor
comprehension" /hey suer word-inding diiculties and oten ma$e su!stitutions and neologisms"
1.3 More Recent terms for aphasia
In the more recent (especially non-clinical) literature% the terms (roca's and ,ernic$e's aphasia are largely
a!andoned" 3ore oten indi'idual patients' language diiculties are classed according to 2 actors4 how well
they comprehend speech and how luent their speech is in production" /hus the traditional (roca's patient is
non-luent !ut with spared comprehension whilst the typical ,ernic$e's patient is luent with impaired
comprehension" 3any other terms are ound in the literature and this can !e conusing" (elow is a summary
o the main terms ound and how they can !e roughly di'ided !etween the two traditional classiications"
(roca's /ype ,ernic$e's type
5on-6luent 6luent
7ood comprehension 8oor comprehension
90pressi'e Recepti'e
3otor #ensory
Agrammatic 5eologistic:
;argonistic
Figure 2 The Cookie Theft Picture
(Introduction to) Language History and Use <
Aphasia
Rachael-Anne Knight
2 Agrammatism
2.1 Introduction
Agrammatism is considered to !e the grammatical deicit e0perienced !y (roca's type patients" 8atients
diagnosed with agrammatism (usually) suer with < separate components1
2.1.1 Sentence construction deficit
Agrammatic patients ha'e diicult ordering words and putting them together in a sentence"
2.1.2 Selective impairment of grammatical elements
,hilst content words are relati'ely spared% agrammatic patients ha'e diiculty producing unction words and
!ound morphemes"
2.1.3 Syntactic comprehension deficit
Although a traditional distinction would classiy agrammatic : (roca's type aphasics as ha'ing intact
comprehension% detailed testing re'eals that comprehension is not completely spared especially when there
are no semantic cues" 6or e0ample i as$ed to choose who is the 'pusher' in the ollowing 2 sentences they
would usually !e right or sentence a !ut would perorm at chance le'el (suggesting that they are guessing)
or sentence !"
a" /he girl pushed the !oy
!" /he !oy was pushed !y the girl
2.2 The agrammatism debate
/here are comple0 issues surrounding agrammatism" /he main issue in the de!ate concerns whether
agrammatism is a syndrome or not" A syndrome is deined as a set o symptoms that co-occur oten enough
to suggest a single cause" =rucial issues then concern whether patients actually ha'e the same symptoms and
i so whether these symptoms always cluster together" /his de!ate has important conse>uences or !oth
e0perimental methodology and theory"
2.2.1 Implications for methodology
/here is a crucial de!ate in cogniti'e neuroscience concerning how e0perimental research into aphasia
should !e conducted" /he choice o method is !etween group studies or single case studies and the de!ate
hinges on whether or not agrammatism is a syndrome"
2.2.1.1 Group-studies
In most scientiic research groups o su!?ects are tested so that the results may !e generalised to a larger
population" /he assumption !ehind such studies is that the group is homogenous% i"e" that all normal people
are similar enough to ma$e their results compara!le" I howe'er% agrammatism is not a syndrome then it is
pointless to com!ine clinically deined groups o suerers as they may actually !e suering rom dierent
symptoms caused !y dierent things
(Introduction to) Language History and Use .
Aphasia
Rachael-Anne Knight
2.2.1.2 Single case studies
#ingle case studies are the o!'ious answer to the pro!lems o group studies" I each patient is dierent and
aphasia is not a syndrome then it ma$es sense to only loo$ at the detailed proile o indi'idual cases"
Howe'er there are many pro!lems with this method" It is diicult to see why any results are useul to theory
i they cannot !e generalised to a wider population and it is diicult to see how results can !e pro'ed as 'alid
i they cannot !e replicated"
2.2.2 Implications for theory
I agrammatism is a syndrome then any theoretical e0planation should !e a!le to e0plain all < components"
I it is not a syndrome then dierent e0planations can !e used to or each o the three components"
2.2.3 The evidence
2.2.3.1 Quantitative differences et!een patients
/he irst set o e'idence concerns whether or not agrammatic patients actually ha'e the same symptoms
2.2.3.1.1 Sentence construction deficit
/here are many dierences !etween the output o patients" @ne study compared + agrammatic patients
description o a picture o a girl gi'ing lowers to a woman"
a" /he youngAthe girlAtheAlittle girl is Athe lower
!" /he girl is lower the woman
c" /he girl isAgoing to lowers
d" /he girl is gi'ingAgi'ing the teacherAgi'ing it teacher
e" /he girl isAis roses" /he girl is rosin'"
#u!?ects 'ary in terms o how luent they are% whether or not main 'er!s are used% whether there are word
inding diiculties etc"
2.2.3.1.2 Impairment of grammatica eements
@ne study showed that dierent types o grammatical elements may !e more or less impaired in dierent
indi'iduals" 6or e0ample one patient omitted )<B o prepositions !ut only 2<B o deinite articles whilst
another omitted only 1&B o prepositions !ut *.B o deinite articles"
2.2.3.2 Qualitative differences
5ot e'ery patient suers rom all three o the components which ma$e up agrammatism" In particular there
are reports o some patients (rom single-case studies) who are impaired in production !ut not in
comprehension suggesting that these elements may !e dissociated"
2.2.3.3 "onclusion
Cuantitati'e dierences are% as the name implies merely dierences in the e0act details o impairment" I we
concentrate on what is dierent !etween patient's speech then we will always !e a!le to ind some dierence
in >uantity" 9'en i the e0act details are dierent all the patients descri!ed do ha'e pro!lems constructing
sentences and diiculty in using grammatical elements" /he dierences can perhaps !e e0plained as !eing
(Introduction to) Language History and Use +
Aphasia
Rachael-Anne Knight
due to the se'erity o the condition% additional impairments or dierent adaptations to the same common
pro!lem"
Cualitati'e dierences create a more serious pro!lem or agrammatism as a syndrome as it seems certain
elements can !e dissociated" Dissociation is used in cogniti'e neuropsychology to indicate that two
processes can !e separately disrupted" /his would indicate that pro!lems with production and comprehension
o synta0 could !e due to dierent causes and thereore not part o an agrammatic syndrome" Howe'er% there
are 'ery ew patients who show this pattern o dissociation and the 'ast ma?ority o patients with one
symptom suer rom all o them" /hese e0ception cases may perhaps ha'e su!tly dierent lesion locations"
It is also worth noting that the o!scure term 'oten enough' in the deinition o a syndrome is pro!lematic in
itsel and ma$es it harder to decide one way or the other"
/here is still no deiniti'e answer in the agrammatism de!ate" (oth single-case and group studies are still
conducted and !oth types o e0planations are still put orward although most e0planations cannot e0plain all
three aspects o agrammatism"
2.2.4 Explanations of agrammatism
Although we $now that agrammatism results rom damage to (roca's area o the let-hemisphere this does
not e0plain how e0actly language is damaged" ,e must consider speciically what a!ilities or processes are
aected in order to produce agrammatic symptoms" 3ost theories cannot e0plain all three elements o
agrammatism"
2.2.#.1 Grod$ins%y&s trace-deletion hypothesis
7rodEins$y suggests that agrammatics patients' syntactic comprehension pro!lems occur !ecause they ha'e a
limitation in constructing syntactic representations o sentences" /his theory is rooted in 7o'ernment and
(inding theory" In 7( theory there are two le'els o syntactic representation D (deep) and # (surace)
structure which are related !y mo'ement rules" ,hen a 58 is mo'ed it lea'es a trace !ehind in the surace
structure" #o% in sentence 2"1"<"! a!o'e a trace (mar$ed !y FtG) has !een let !ehind !ecause the 58 'the !oy'
has !een mo'ed to orm the passi'e"
/he !oy was pushed FtG !y the girl"
,hen a normal person comes to assign thematic roles (such as agent) to a sentence% 58s that ha'e !een
mo'ed do not recei'e their role directly" Instead% the trace recei'es the role and the mo'ed 58 recei'es it
only indirectly" 7rodEins$y argues that agrammatic patients cannot represent traces and are thereore una!le
to assign thematic rules to any 58 that has !een mo'ed" 58s that cannot !e assigned a thematic role
grammatically ha'e their role assigned !y an agent-irst strategy" /hereore i a sentence has a thematically
unspeciied 58 agrammatic patients assume the irst 58 in a sentence ('the !oy' in this case) is the agent"
/his can lead to sentences !eing assigned 2 agents" /he irst is assigned !y the normal grammatical strategy%
using the !y-phrase and the second is assigned !y the non-grammatical% agent -irst strategy" /hereore the
patient has to guess which one o the two is really the agent leading to their random perormance"
/his theory cannot e0plain all three components o agrammatism" @riginally concei'ed to e0palin syntactic
deicits in comprehension and production it is now only said to e0pain the comprehension deicit" In addition
(Introduction to) Language History and Use *
Aphasia
Rachael-Anne Knight
it can't e'en e0plain all the pro!lems agrammatics ha'e in comprehension as not all in'ol'e sentences in
which 58s ha'e !een mo'ed"
2.2.#.2 'ean&s (honological )eficit *ypothesis
Kean posited that agrammatics production deicits were due to damage to the phonological system whilst the
rest o the language system remained intact" In this theory agrammatics omit items that are unstressed
resulting in content words !eing spared and grammatical elements lost" /his can possi!ly e0plain the
diiculties producing unction words and !ound morphemes !ut is not suicient t e0plain the sentence
construction deicit"
2.2.#.3 Sch!art$
#chwartE related agrammatism to 7arrets model o normal speech production" #he suggested that
agrammatics are una!le to translate rom the unctional to the positional le'el o representation" /hereore a
rame would not !e constructed or the sentence and the grammatical elements would not !e retrie'ed" /his
goes some way to e0plaining the sentence construction deicit and the selecti'e impairment o grammatical
elements" It does not% howe'er% e0plain the syntactic comprehension pro!lems o agrammatic patients% as
the 7arrett model is speciically a model o production"
(Introduction to) Language History and Use -
Aphasia
Rachael-Anne Knight
3 +argon Aphasia
;argon aphasia is an e0treme 'ersion o luent aphasia and would thus !e classically classiied as ,erni$e's
type aphasia" 8eople with ?argon aphasia are oten unaware that there is anything wrong with their speech"
Unli$e agrammatic patients% people with ?argon aphasia ha'e relati'ely normal syntactic a!ilities" /heir
pro!lems lie in their content-word inding diiculties" /heir semantic a!ilities seem generally good as most
patients perorm well on picture matching tas$s% or e0ample"
3.1 Types of errors in ord finding
3.1.1 Content ord su!stitutions or paraphasias
Unrelated paraphasias thermometer typewriter
#emantic paraphasias scroll letters
6ormal paraphasias pencil pepper
8honemic 8araphasias swan swam
3.1.2 "ade up ords or neologisms
/hese are words that are not ound in the dictionary and that the patient has seeming made up"
8honemic Distortions o the intended target whistle swiEl
A!struse Distortions H $wailai
3.2 !upport for "arrets Mode# from $argon aphasia
8eople with ?argon aphasia generally produce appropriate unction words in their speech" In addition they
are o!ser'ed to produce syntactically appropriate ai0es attached to their neologisms" /his supports the
claim that content and unction words are processed separately"
3.3 %&p#anations of $argon aphasia
90planations normally ocus on the processes that cause the patient to produce neologisms
3.3.1 #ailure of phonological form retrieval
(utterworth is one o the main proponents o this e0planation and has suggested that neologisms and other
errors are accentuated normal speech errors" In particular errors are seen as normal lemma retrie'al !ut
ailure o phonological retrie'al" I no phonology can !e retrie'ed the patient uses a random generator to
produce sound" /here are se'eral strands o e'idence or this 'iew drawn rom a single case study o the
patient K=
Hesitations are more li$ely to occur !eore errors than real words
/he (iconic) gestures in these hesitations are the same as those or normal spea$ers
/here are a high num!er o word !lend errors in K='s speech
(Introduction to) Language History and Use )
Aphasia
Rachael-Anne Knight
3.3.2 #ailure of the scan copier device
#hattuc$-Hunagel e0tended 7arrets' model o speech production to include a scan copier% which copies the
phonemes o a word rom the le0icon and outputs them into the syntactic rame" 9rrors in this de'ice ha'e
!een used to e0plain normal errors such as phoneme addition% su!stitution or deletion" (uc$ingham has
suggested that in people with ?argon aphasia this de'ice malunctions most o the time causing muddling up
o phonemes or generating random sylla!les and causing neologisms"
!eading
Harley% /" (2II1) /he 8sychology o Language% Ho'e1 8sychology 8ress" =h" 12 p"<-* onwards
Kol!% (" and ,ishaw I"C" (1&)I)% 6undamentals o =ogniti'e 5europsychology% 5ew Jor$1 6reeman% =h"
1-
8ar$in% A";" (1&&*) 90plorations in =ogniti'e 5europsychology% @0ord1(lac$well% =hs"1 and -
Lesser% R"% and 3ilroy% L" (1&&<) Linguistics and Aphasia1 8sycholinguistic and 8ragmatic Aspects o
Inter'ention% London1 Longman% =hs" 1-+ depending on interest
#arno% 3"/" (1&&)) Ac>uired Aphasia% London1 Academic 8ress (/hird 9dition)% 9specially =hs" 1% 2% +% *
and - !ut others i interested
Kuri% 9"(" and #winney% D"A (1&&.) L/he neuropsychology o languageL in 3"A" 7erns!acher (9d")%
Hand!oo$ o 8sycholinguistics% London1 Academic 8ress% 1I++-1I-.
All e0cept Lesser and 3ilroy and #arno are a'aila!le on o'ernight loan at the 33L li!rary"