Differential effects of unilateral lesions on language production in children and adults.

We present the first direct comparison of language production in brain-injured children and adults, using age-corrected z scores for multiple lexical and grammatical measures. Spontaneous speech samples were elicited in a structured biographical interview from 38 children (5-8 years of age), 24 with congenital left-hemisphere damage (LHD) and 14 with congenital right-hemisphere damage (RHD), compared with 38 age- and gender-matched controls, 21 adults with unilateral injuries (14 LHD and 7 RHD), and 12 adult controls. Adults with LHD showed severe and contrasting profiles of impairment across all measures (including classic differences between fluent and nonfluent aphasia). Adults with RHD (and three nonaphasic adults with LHD) showed fluent but disinhibited and sometimes empty speech. None of these qualitative or quantitative deviations were observed in children with unilateral brain injury, who were in the normal range for their age on all measures. There were no significant differences between children with LHD and RHD on any measure. When LHD children were compared directly with LHD adults using age-corrected z scores, the children scored far better than their adult counterparts on structural measures. These results provide the first systematic confirmation of differential free-speech outcomes in children and adults and offer strong evidence for neural and behavioral plasticity following early brain damage.     

Productive use of the English past tense in children with focal brain injury and specific language impairment

In this study, 22 children with early left hemisphere (LHD) or right hemisphere (RHD) focal brain lesions (FL, n=14 LHD, n=8 RHD) were administered an English past tense elicitation test (M=6.5 years). Proportion correct and frequency of over-regularization and zero-marking errors were compared to age-matched samples of children with specific language impairment (SLI, n=27) and with typical language development (TD, n=27). Similar rates of correct production and error patterns were observed for the children with TD and FL; whereas, children with SLI produced more zero-marking errors than either their FL or TD peers. Performance was predicted by vocabulary level (PPVT-R) for children in all groups, and errors did not differ as a function of lesion side (LHD vs. RHD). Findings are discussed in terms of the nature of brain-language relations and how those relationships develop over the course of language learning.     

Role of the left hemisphere in sign language comprehension

We investigated the relative role of the left versus right hemisphere in the comprehension of American Sign Language (ASL). Nineteen lifelong signers with unilateral brain lesions [11 left hemisphere damaged (LHD) and 8 right hemisphere damaged (RHD)] performed three tasks, an isolated single-sign comprehension task, a sentence-level comprehension task involving simple one-step commands, and a sentence-level comprehension task involving more complex multiclause/multistep commands. Eighteen of the participants were deaf, one RHD subject was hearing and bilingual (ASL and English). Performance was examined in relation to two factors: whether the lesion was in the right or left hemisphere and whether the temporal lobe was involved. The LHD group performed significantly worse than the RHD group on all three tasks, confirming left hemisphere dominance for sign language comprehension. The group with left temporal lobe involvement was significantly impaired on all tasks, whereas each of the other three groups performed at better than 95% correct on the single sign and simple sentence comprehension tasks, with performance falling off only on the complex sentence comprehension items. A comparison with previously published data suggests that the degree of difficulty exhibited by the deaf RHD group on the complex sentences is comparable to that observed in hearing RHD subjects. Based on these findings we hypothesize (i) that deaf and hearing individuals have a similar degree of lateralization of language comprehension processes and (ii) that language comprehension depends primarily on the integrity of the left temporal lobe.     

Comprehension of humorous and nonhumorous materials by left and right brain-damaged patients

Right hemisphere-damaged (RHD) and left hemisphere-damaged (LHD) aphasic patients were tested on a nonverbal cartoon completion task that included a humorous (Joke) and a nonhumorous (Story) condition. In both conditions, RHD patients performed worse than LHD patients. More importantly, the qualitative difference between the errors produced by the two groups suggests that right and left hemisphere brain damage impairs different components of narrative ability. RHD patients showed a preserved sensitivity to the surprise element of humor, and a diminished ability to establish coherence. Conversely, LHD patients, when they erred, showed an impaired sensitivity to the surprise element of humor, and a preserved ability to establish coherence by integrating content across parts of a narrative. These results suggest that the observed humor comprehension deficits of RHD patients result specifically from right hemisphere disease and not from brain damage irrespective of locus. The performances of the RHD and LHD patients groups together support a separation of narrative ability from the traditional aspects of language ability typically disrupted in aphasia.     

To drive or not to drive: Neuropsychological assessment for driver's license among stroke patients

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception , (II) spatial attention , (III) visuospatial processing , and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.     

Sources of performance on theory of mind tasks in right hemisphere-damaged patients

Patients with right hemisphere (RHD) or left hemisphere brain damage (LHD) were tested on Theory of Mind (ToM) tasks presented with visual aids that illustrated the relevant premises. As a measure of pragmatic ability, patients were also asked to judge replies in conversation that violated Gricean maxims. Both RHD and LHD patients performed well on the ToM tasks presented with visual aids, but RHD patients displayed difficulty when the same tasks were presented only verbally. In addition, RHD patients showed reduced sensitivity to pragmatic violations. These findings point to the role of right hemisphere structures in processing information relevant to conversations. They indicate that a crucial source of RHD patients' errors in ToM tasks may involve difficulties in utterance interpretation owing to impairments of visuospatial processing required for the representation of textual information.     

Language acquisition following hemidecortication: Linguistic superiority of the left over the right hemisphere

The language development of three 9- and 10-year-old children possessing only a right or a left hemisphere was studied. Surgical removal of one brain half antedated the beginning of speech, so each child has acquired speech and language with only one hemisphere. Different configurations of language skill have developed in the two isolated hemispheres: phonemic and semantic abilities are similarly developed but syntactic competence has been asymmetrically acquired. In relation to the left, the right brain half is deficient in understanding auditory language, especially when meaning is conveyed by syntactic diversity; detecting and correcting errors of surface syntactic structure; repeating stylistically permuted sentences; producing tag questions which match the grammatical features of a heard statement; determining sentence implication; integrating semantic and syntactic information to replace missing pronouns; and performing judgments of word interrelationships in sentences. Language development in an isolated right hemisphere, even under seizure-free conditions, results in incomplete language acquisition.     

Language Outcome After Perinatal Stroke: Does Side Matter?

The goal of this study was to examine structured language skills in children with perinatal strokes. Participants were 28 school-age children with early focal brain lesions (17 with left hemisphere [LH] damage, 11 with right hemisphere [RH] damage), and 57 controls. A standardized test of language (Clinical Evaluation of Language Fundamentals–Revised) was administered. Receptive, Expressive, and Total Language scores, as well as subtest scores, were analyzed. Control participants scored within the normal range, whereas the LH and RH groups scored significantly more poorly than did controls. There were no differences between the LH and RH groups on any of the language scores, and all scores were below the 14th percentile. Within the lesion group as a whole, scores were not related to lesion laterality, site, or severity. Results also were not accounted for by socioeconomic status or IQ. However, children who experienced seizures demonstrated significantly poorer performance than did children who did not experience seizures. Damage to either the LH or RH early in development adversely affects later language abilities, particularly on tasks with structured and complex linguistic demands. Although lesion side has little effect, the presence or absence of seizures is a major contributor to language outcome.     

Contextual mood priming following left and right hemisphere damage

This research examined the influence of mood-congruent and mood-incongruent contexts on recognizing affective prosody after brain damage. Predictions stemmed from an associative network theory of learning and memory. Thirty-three male subjects, 11 each in right hemisphere damaged (RHD), left hemisphere damaged (LHD), and normal control groups judged moods from the prosody of semantically neutral phrases. In one task, the prosodic stimulus phrases were judged in isolation. In another task, the phrases were preceded by short paragraphs which were either congruent or incongruent in emotional tone with the prosodic stimuli. These paragraphs were designed to prime specific mood choices. As anticipated, LHD subjects' prosodic mood recognition was more accurate when given congruent rather than incongruent affective contexts. Congruent contexts facilitated, and incongruent contexts disrupted, their prosodic mood judgments to the same extent as normals. RHD subjects showed a partial context decrement. They were less accurate than normal or LHD subjects in the congruent condition, and were unaffected by incongruent contexts. When given congruent biasing paragraphs, however, RHD subjects did experience facilitation on a par with that found for the other groups, indicating spared sensitivity to certain contextual factors. The distinction between automatic and effortful processes is offered as a potential explanation for the RHD group's pattern of performance.     

Sensitivity to prosodic structure in left- and right-hemisphere-damaged individuals

An experiment was conducted in order to determine whether left- (LHD) and right-hemisphere-damaged (RHD) patients exhibit sensitivity to prosodic information that is used in syntactic disambiguation. Following the work of, a cross-modal lexical decision task was performed by LHD and RHD subjects, as well as by adults without brain pathology (NC). Subjects listened to sentences with attachment ambiguities with either congruent or incongruent prosody, while performing a visual lexical decision task. Results showed that each of the unilaterally damaged populations differed from each other, as well as from the NCs in terms of sensitivity regarding prosodic cues. Specifically, the RHD group was insensitive to sentence prosody as a whole. This was in contrast to the LHD patients, who responded to the prosodic manipulation, but in the unexpected direction. Results are discussed in terms of current hypotheses regarding the hemispheric lateralization of prosodic cues.     

"Frog, where are you?" Narratives in children with specific language impairment, early focal brain injury, and Williams syndrome

In this cross-population study, we use narratives as a context to investigate language development in children from 4 to 12 years of age from three experimental groups: children with early unilateral focal brain damage (FL; N=52); children with specific language impairment (SLI; N=44); children with Williams syndrome (WMS; N=36), and typically developing controls. We compare the developmental trajectories of these groups in the following domains: morphological errors, use of complex syntax, complexity of narrative structure, and types and frequency of evaluative devices. For the children with early unilateral brain damage, there is initial delay. However, by age 10, they are generally within the normal range of performance for all narrative measures. Interestingly, there are few, if any, side specific differences. Children with SLI, who have no frank neurological damage and show no cognitive impairment demonstrate significantly more delay on all morphosyntactic measures than the FL group. Quantitatively, on morphosyntactic measures, the SLI group clusters with those children with WMS who are moderately retarded. Together these data help us to understand the extent and nature of brain plasticity for language development and those aspects of language and discourse that are dissociable.     

Narrative Discourse in Children with Early Focal Brain Injury

Children with early brain damage, unlike adult stroke victims, often go on to develop nearly normal language. However, the route and extent of their linguistic development are still unclear, as is the relationship between lesion site and patterns of delay and recovery. Here we address these questions by examining narratives from children with early brain damage. Thirty children (ages 3;7–10;10) with pre- or perinatal unilateral focal brain damage and their matched controls participated in a storytelling task. Analyses focused on linguistic proficiency and narrative competence. Overall, children with brain damage scored significantly lower than their age-matched controls on both linguistic (morphological and syntactic) indices and those targeting broader narrative qualities. Rather than indicating that children with brain damage fully catch up, these data suggest that deficits in linguistic abilities reassert themselves as children face new linguistic challenges. Interestingly, after age 5, site of lesion does not appear to be a significant factor and the delays we have witnessed do not map onto the lesion profiles observed in adults with analogous brain injuries.     

Associations and dissociations of transitive and intransitive gestures in left and right hemisphere stroke patients

The study investigated performance on pantomime and imitation of transitive and intransitive gestures in 80 stroke patients, 42 with left (LHD) and 38 with right (RHD) hemisphere damage. Patients were also categorized in two groups based on the time that has elapsed between their stroke and the apraxia assessment: acute–subacute (n = 42) and chronic (n = 38). In addition, patterns of performance in apraxia were examined. We expected that acute–subacute patients would be more impaired than chronic patients and that LHD patients would be more impaired than RHD patients, relative to controls. The hemisphere prediction was confirmed, replicating previous findings. The frequency of apraxia was also higher in all LHD time post-stroke groups. The most common impairment after LHD was impairment in both pantomime and imitation in both transitive and intransitive gestures. Selective deficits in imitation were more frequent after RHD for transitive gestures but for intransitive gestures they were more frequent after LHD. Patients were more impaired on imitation than pantomime, relative to controls. In addition, after looking at both gesture types concurrently, we have described cases of patients who suffered deficits in pantomime of intransitive gestures with preserved performance on transitive gestures. Such cases show that the right hemisphere may be in some cases critical for the successful pantomime of intransitive gestures and the neural networks subserving them may be distinct. Chronic patients were also less impaired than acute–subacute patients, even though the difference did not reach significance. A longitudinal study is needed to examine the recovery patterns in both LHD and RHD patients.     

Language outcome after perinatal stroke: does side matter?

The goal of this study was to examine structured language skills in children with perinatal strokes. Participants were 28 school-age children with early focal brain lesions (17 with left hemisphere [LH] damage, 11 with right hemisphere [RH] damage), and 57 controls. A standardized test of language (Clinical Evaluation of Language Fundamentals-Revised) was administered. Receptive, Expressive, and Total Language scores, as well as subtest scores, were analyzed. Control participants scored within the normal range, whereas the LH and RH groups scored significantly more poorly than did controls. There were no differences between the LH and RH groups on any of the language scores, and all scores were below the 14th percentile. Within the lesion group as a whole, scores were not related to lesion laterality, site, or severity. Results also were not accounted for by socioeconomic status or IQ. However, children who experienced seizures demonstrated significantly poorer performance than did children who did not experience seizures. Damage to either the LH or RH early in development adversely affects later language abilities, particularly on tasks with structured and complex linguistic demands. Although lesion side has little effect, the presence or absence of seizures is a major contributor to language outcome.     

Language after temporal or frontal lobe surgery in children with epilepsy

The purpose of this study was to compare language function in children undergoing temporal or frontal lobe surgery to control intractable epilepsy. Language measures (expressive vocabulary, receptive vocabulary, comprehension, reading, spelling, phonemic fluency, and category fluency) were administered to 9 children with frontal lobe epilepsy (mean age: 10.8 +/- 2.7 years) and 10 children with temporal lobe epilepsy (11.5 +/- 2.6 years). The results indicate that no differences exist, in language function, before and after surgery between children with frontal and temporal lobe epilepsy (all p > or = .05). Children with left hemisphere lesions had significantly lower scores than those with right on category fluency and comprehension, but laterality effects were not seen on the other measures. In both groups, language function was not significantly affected by surgery.     

Speech-Language Outcomes of Hemispherectomy in Children and Young Adults

Children and young adults who had undergone right or left hemispherectomy for intractable seizures after a period of normal language acquisition were compared with respect to scores on speech and language tests. The majority of the subjects had full scale IQs in the borderline to mentally retarded range. Language scores were computed in relation to estimated mental age, not chronological age. On this basis, the left hemispherectomized children were more likely to show syntactic comprehension and rapid-rate auditory processing deficits than the right hemispherectomized. The two groups were similar to one another and to normal children in speech production. The findings are discussed in relation to developmental language disorders.     

Vocabulary growth rate from preschool to school‐age years is reflected in the connectivity of the arcuate fasciculus in 14‐year‐old children

The acquisition of language involves the functional specialization of several cortical regions. Connectivity between these brain regions may also change with the development of language. Various studies have demonstrated that the arcuate fasciculus was essential for language function. Vocabulary learning is one of the most important skills in language acquisition. In the present longitudinal study, we explored the influence of vocabulary development on the anatomical properties of the arcuate fasciculus. Seventy‐nine Chinese children participated in this study. Between age 4 and age 10, they were administered the same vocabulary task repeatedly. Following a previous study, children's vocabulary developmental trajectories were clustered into three subgroups (consistently good, catch‐up, consistently poor). At age 14, diffusion tensor imaging data were collected. Using ROI‐based tractography, the anterior, posterior and direct segments of the bilateral arcuate fasciculus were delineated in each child's native space. Group comparisons showed a significantly reduced fractional anisotropy in the left arcuate fasciculus of children in the consistently poor group, in particular in the posterior and direct segments of the arcuate fasciculus. No group differences were observed in the right hemisphere, nor in the left anterior segment. Further regression analyses showed that the rate of vocabulary development, rather than the initial vocabulary size, was a specific predictor of the left arcuate fasciculus connectivity.     

Language ability in right and left hemiplegic children

The language abilities of three right and three left hemiplegic children between 6 and 8 years of age were compared. All children presented pre- or perinatally acquired unilateral lesions confirmed by CT scan, normal hearing, comparable performance I.Q.'s, and were being educated in regular classrooms. Right hemiplegic children were found to be inferior to the left hemiplegics on tasks of speech production, vocabulary comprehension, and syntactic comprehension and formulation. Right hemiplegics also acquired single words and two-word combinations later than did left hemiplegics.     

Prosodic facilitation in the resolution of syntactic ambiguities in subjects with left and right hemisphere damage

The purpose of this study was to determine if prosody facilitates the comprehension of sentences containing temporary syntactic ambiguities in control, and left (LHD) and right hemisphere damaged (RHD) subjects. To test for effects of prosodic facilitation, sentences were created where prosodic boundaries coincided with (cooperating), were absent (baseline), or conflicted (conflicting) with syntactic boundaries in three response times (RTs) experiments. Despite differences in overall RTs and response accuracy for each group, all three groups responded faster and more accurately to sentences in the cooperating than in the baseline and conflicting conditions across experiments, indicating that prosody facilitates syntactic parsing in brain-damaged subjects just as it does with normal control subjects. Results are discussed in relation to psycholinguistic theories of syntactic parsing and neurolinguistic theories of hemispheric specialization in processing the acoustic properties of prosodic structures.