Paralinguistic aspects of auditory comprehension in aphasia.

Eight severe aphasics were given sentences with either emotional or neutral content, presented once directly by the examiner and once via a tape recorder. Sentences with emotional content produced a greater number of responses than their neutral counterparts. Sentences spoken by the examiner also produced a significantly greater number of responses than the same items originating from a tape recorder. These results confirm the view that elements not related to the linguistic aspects of a message (and therefore referred to as paralinguistic) play a significant role in auditory comprehension.     

Deficits in temporal sequencing of verbal material: The effect of laterality of lesion

Temporal sequencing of verbal materials (digits, words, and geometric forms) presented in two sensory modalities (auditory and visual) to three groups of subjects (Broca's with left anterior lesions, patients with right hemisphere lesions, and normals) was examined. Each subject was asked to point to a set of stimuli in the same sequence as presented by the examiner. Results indicated that patients with left hemisphere lesions were more impaired on all tasks than the right hemisphere lesioned patients who, in turn, were impaired compared to normal controls. Response to auditory presentation was superior to response to visual presentation. Also, digits were the easiest for all groups, and words were easier than geometric forms. Of special interest was the finding which suggested that right hemisphere lesions are associated with impairment of verbal temporal sequencing under either auditory or visual presentation.     

A different form of agraphia: Syntactic writing errors in patients with motor speech and movement disorders

Three patients are described who displayed syntactic writing errors in combination with a motor speech disturbance and impaired motor limb function. Two of the patients had bulbar amyotrophic lateral sclerosis (ALS). Agraphia appeared when verbal communication was no longer possible. Autopsy in one patient disclosed only lesions consistent with ALS. The third patient had palilalia and chorea and, although not aphasic, his written language showed persistent syntactic errors. We hypothesize that the agraphia in these patients occurred because of the combination of disordered feedback from the motor speech apparatus and limbs.     

Psychometric and CT scan measurements in a case of crossed aphasia in a dextral

A case of crossed aphasia with lesion deep to the right supramarginal gyrus was studied to determine (1) if this patient behaved similar to patients with the same lesion site in the left hemisphere, (2) if visuospatial deficits were present, and (3) if the CT scan asymmetries were similar to those of other right-handers. Speech and language skills were similar to those patients with similar lesions in the left hemisphere. Visuospatial and arithmetic deficits were similar to those described after right-hemisphere and left-hemisphere damage. CT scan asymmetries were atypical. These results provide behavioral and neuroradiological confirmation of atypical hemispheric dominance.     

Semantic field,naming, and auditory comprehension in aphasia

The status of semantic fields for 16 target nouns was compared in high and low comprehension aphasics, brain damaged, and normal controls, by measuring latency and miss rate for recognition of six classes of associates, which were presented orally on tape. The ability to name each target was also examined as a function of the integrity of the subject's semantic field for that word. Low comprehension aphasics showed both quantitative and qualitative changes in semantic fields, while milder aphasics showed only mild quantitative impairment, as compared to controls. Both latency and miss rate measures indicated that failure to name a word is associated with reduced semantic field for that word. This result is interpreted as supporting the view that nameing is, in part, determined by the convergence of associations.     

A case of cortical deafness: Clinical and electrophysiological data

A patient suffering from a primary myocardiopathy is suddenly no longer able to recognize speech and environmental sounds, in spite of good peripheral hearing; he remains able to speak, read, and write. The C.T. scan shows lesions involving both supratemporal planes. The cortical sensory deficit documented by the absence of late acoustic evoked potentials leads to a diagnosis of cortical deafness rather than of auditory agnosia.     

Speech in mania: Syntactic aspects

In this study, we observed and linguistically analyzed the verbal behavior of six manic subjects, looking specifically for those linguistic capacities which were intact and for those which were disrupted. From interviews and tape-recordings of manic subjects in both analytic-protocol and discourse situations, we observed a preservation of basic speech capacities, including the ability to comprehend and generate grammatical sentences and to utilize highly complex linguistic transformations. We noted, however, a disruption in the ability to properly utilize ellipsis and semantic (discourse) anaphora such that manic subjects did not maintain a meaningful progression of thought in discourse.     

Temporal ordering deficits following anterior temporal lobectomy

Subjects were required to report the pitch sequence of two 10-msec tones of different frequency presented monaurally while the stimulus onset asynchrony (SOA) between the two tones was varied. The value of the SOA at which the subjects achieved an 80% correct sequence report was determined by an adaptive procedure without feedback. This measure was compared in the right and left ears, on subjects with a right or left anterior temporal lobectomy and on a normal control group. The results reveal an elevated threshold for performing temporal order judgments in the ear contralateral to the surgical lesion.     

Reading and listening comprehension in Broca's aphasia: Lexical versus syntactical errors

Ten agrammatic Broca's aphasics were presented with a series of four picture plates together with a spoken or written sentence stimulus. All sentence stimuli were of the structure, the + N + is/are + V + ing + the + N. The four pictures on each stimulus plate represented (a) the correct response, (b) a reversal of the stimulus sentence subject and object, (c) a change in the number of the subject of the stimulus sentence, and (d) a change in one of the major lexical items of the stimulus sentence. Subjects selected the correct picture most often. When they erred, they usually selected a subject-object reversal. Number errors were less frequent, and the patients seldom selected a change in major lexical item. This pattern occurred with both written and spoken sentences. These results were interpreted as reflecting the dependence of agrammatic Broca's aphasics on the semantic interpretation of the lexicon for decoding sentences in the face of deficits in syntactical-grammatical interpretation, irrespective of comprehension modality.     

Selective deficit of conceptual structures in aphasia: Class versus thematic relations

Conceptual structures in aphasia were investigated by means of a nonverbal test. The understanding of class and thematic relationships was demonstrated to be selectively impaired according to varieties of aphasic deficit. Broca's aphasics showed difficulty evaluating a thematic relationship and did not differ from normal controls as far as class relationships were concerned. The opposite happened for Wernicke's aphasics whose defect seems to be selectively restricted to class relationships.     

Some aspects of phonological impairment in aphasia

The relationships between expressive and receptive phonemic disorders and between disturbances of phoneme processing and general disorders of auditory comprehension were studied in 69 aphasic patients, by means of a phoneme discrimination test and of a standard aphasia battery. A significant but incomplete correlation between disorders of phonemic output and of phoneme analysis was found. The view is put forth that in some patients only phoneme encoding or decoding is disturbed, whereas in others a central level of phoneme processing is impaired. A significant but partial correlation was also found between disorders of phonological analysis and general disorders of auditory comprehension. This supports the view that, besides sequential phonological analysis, other processes operate in auditory comprehension.     

Comprehension of symbolic gestures in aphasia

One-hundred-and-twenty-eight patients with unilateral hemispheric damage (53 aphasics, 26 nonaphasic left, and 49 right brain-damaged patients) and 25 normal controls were given a test of symbolic gesture comprehension and other tests of verbal comprehension and of reproduction of symbolic gestures. On the test of symbolic gesture interpretation aphasic patients performed significantly worse than any other group of brain-damaged patients. Within the aphasic patients the inability to understand the meaning of symbolic gestures was highly related to the number of semantic errors obtained at a verbal comprehension test. On the contrary, only a mild relationship was found between comprehension and reproduction of symbolic gestures. Some implications of these findings are discussed.     

Text comprehension in aphasia

The semantic and pragmatic strategies in the comprehension of spoken texts are investigated in four subgroups of aphasic patients and in normal and brain-damaged controls. Short texts of similar linguistic structure were read to the subjects, who were required to choose the picture, from a multiple choice set of five, that was appropriate to the story. Besides a picture showing the main event of the story, one picture depicted the literal sense of a metaphorical comment, and the others misrepresented semantic functions expressed in the text. With respect to these types of responses, both aphasics and controls exhibited the same pattern of reaction. It is concluded that the redundancy of texts makes up for the difficulties aphasics have in comprehending isolated words and sentences.     

Acalculia: Historical development and current significance

Acalculia is a loss of calculating abilities occurring as a result of cerebral damage. This paper reviews the development of the notion of acalculia from an expected concomitant of aphasia or dementia to that of a sometimes autonomous disorder. Current evidence indicates that acalculia tends to occur particularly in lesions of the left posterior hemispheric areas.     

Preservation of orthographic knowledge in aphasia

A simple untimed lexical decision task was designed to test implicit letter recognition in aphasic patients. Half of the nonwords used in this task were orthographically regular pronounceable pseudowords, and half were orthographically irregular unpronounceable letter strings. Twenty-five randomly chosen aphasic patients with mild to severe degrees of aphasia participated in the study. Although only six of the patients performed the lexical decision task successfully, all 25 demonstrated the ability to distinguish orthographically regular from irregular letter strings and, by implication, the ability to recognize and make use of the identities of written letters.     

Numerical taxonomy of aphasia

Two hundred consecutively seen aphasics, 142 of them with infarcts, were examined by tests of fluency, comprehension, repetition, naming, and information content. The language scores were subjected to a minimum variance clustering algorithm separately for the total and for the infarct groups. The latter generated 10 clusters on a dendrogram. Attribute analysis of each cluster provided a clinically meaningful profile of language performance for these groups. The degree of correlation of most computer generated clusters with clinically recognized groups was high, and the homogeneity of some of the clusters is striking. An exception appears to be “conduction aphasia,” which is bimodally distributed. One of these clusters, with high fluency and low comprehension scores, was renamed “afferent conduction” aphasia, and the other, with lower fluency and higher comprehension, was renamed “efferent conduction” aphasia. The Principal Components Analysis was used to evaluate the discriminatory value of language characteristics, and the Nearest Neighbor Network Analysis was used to evaluate the significance of clustering. The dendrogram for all aphasics showed a less specific and less homogenous six clusters.     

Dichotic listening in the recovery of aphasia after stroke

Three different dichotic listening tests were given to a group of aphasic patients at various stages of the recovery process. Results were different for each test and in the course of time fluent aphasics demonstrated a tendency to increase right ear preference while nonfluent aphasics showed an increase of left ear preference in the test of dichotic words. The importance of these findings to the understanding of recovery of function is discussed in terms of the role played by the right hemisphere.