Acoustic features of palilalia: a case study

While a number of authors have suggested that patients with palilalia typically show a tendency to repeat words or phrases with an increasing rate, others maintain that an accelerating speech rate is not essential. The present paper reports the results of an instrumental analysis of the reiterations in a 60-year-old man with palilalia. Results indicate that there is not necessarily an increasing rapidity in palilalia. Duration of the repetition trains, duration of the pauses between the trains, and average number and average duration of the components within a train were variable but did not show a pattern indicative of a systematically increasing rate. The variation in the reiterations suggests that novel or varying motor processes are deployed to produce the elements in a sequence rather than an invariant motor program.     

Palilalia and repetitive speech: two case studies.

Palilalia, a disorder of speech characterized by compulsive repetitions of utterances has been found in various neurological and psychiatric disorders. It has commonly been interpreted as a defect of motor speech. This article describes palilalia and other variants of verbal repetitive behavior, such as monosyllabic iterations and conduite d'approche. The clinical features of palilalia, its prevalence in different language tasks, and the individual patterns of verbal repetitive behavior are illustrated in two patients with a long-standing cerebrovascular disease. An attempt is made to locate the origin of different forms of verbal repetitions in a standard model of speech production (Butterworth, 1980a; Garrett, 1980; Levelt, 1989) by analysis of their morphology and correlation with impairments of lexical or phonological processes. From these observations it is suggested that palilalia results from control malfunctions at the level of the Articulator, whereas other variants of pathological verbal iterations result from an impairment of the Formulator or from malfunctions of both the Articulator and the Formulator.     

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.     

口吃者加工汉语歧义短语的神经过程

韵律边界是口语韵律特征的有机组成部分, 在语言理解中发挥着重要作用。口吃作为一种言语节律性障碍, 主要表现为音节经常性的重复、拖长或停顿等。本研究采用ERP, 考察口吃者完成词汇判断和结构判断两种任务时, 加工歧义短语(动宾/偏正歧义结构)内部韵律边界的认知过程。结果发现口吃者和言语流畅者在加工汉语歧义短语过程中, 所诱发的反映韵律切分的脑电成分CPS (closure positive shift)不存在显著差异。在0~300 ms, 不论中线还是两侧, 口吃者和言语流畅者加工两类短语时, 动宾短语韵律边界诱发正效应的头皮分布范围小于偏正短语。在300~600 ms, 中线上, 口吃和言语流畅者在完成两种任务时, 两类短语的韵律边界均稳定诱发了正效应; 在两侧, 结构判断任务中两类短语的韵律边界都诱发了正效应, 但词汇判断任务中只有偏正短语稳定诱发该效应。综上, 口吃者和言语流畅者一样对口语韵律边界敏感, 并且他们加工歧义短语内部韵律边界时, 诱发的脑电效应受到实验任务和短语结构类型的影响。     

Aphasia following a right thalamic hemorrhage

A left-handed patient with a right thalamic hemorrhage and disordered speech is described. Sequential examinations and aphasia testing were done during a 1-year follow-up period and the results are reported. This case supports those authors who have described characteristics they feel are helpful in diagnosing disordered speech associated with thalamic lesions. Paucity of speech, reduced voice volume, anomia, some paraphasia, and severe dysgraphia were present, but comprehension and repetition were relatively preserved. She showed modest improvement with time. This case also confirms that thalamic involvement in speech is a dominant, rather than a specifically left hemispheric function.     

Progressive dysfluency associated with right hemisphere disease

A late onset progressive dysfluency following a right hemisphere stroke occurred in a 62-year-old male. Dysfluency was characterized by pronounced word and phrase reiterations, and sound and syllable reiterations to a lesser degree. Spontaneous speech was significantly more dysfluent than oral reading and repetition. Recitation and singing were minimally dysfluent. Reiterations were accompanied by reduced vocal loudness and increased rate of speech. Reiterations occurred in initial, medial, and final sentence position. Secondary symptoms such as facial grimacing were absent. In contrast to acquired cortical stuttering which is characterized by a preponderance of sound and syllable sentence initial repetitions, dysfluency was more closely characteristic of palilalia. The dysfluency occurred as a symptom of a diffuse nonspecific subcortical projection system defect related to massive infarction in the right middle cerebral artery distribution with associated atrophy.     

Left thalamic hemorrhage with dysphasia: a report of five cases.

A specific type of “thalamic speech” is being recognized with increasing frequency. Paucity of spontaneous speech, fading vocal volume, anomia, perseveration, and neologisms, with intact comprehension and word repetition, characterize the speech disorder associated with thalamic lesions. Nine cases of left thalamic hemorrhage and speech disturbance have been reported previously. This report details the speech, neurological, and neuroradiological findings in five additional cases of thalamic hemorrhage with dysphasia.     

Implementing a long-term computerized remedial reading program with synthetic speech feedback: Hardware,software, and real-world issues

This paper discusses hardware choices, software developments, implementation issues, and preliminary results from an ongoing long-term remedial reading study. Reading-disabled children read books on microcomputers linked to speech synthesizers, obtaining speech feedback on difficult words at whole-word, syllable, or subsyllable levels of segmentation. Word-recognition ability and attitude about reading improved for children using the system. In addition, segmented feedback especially benefited phonological word-decoding skills for most of the children.     

Deficits in prospective memory following damage to the medial subdivision of the mediodorsal thalamic nucleus

Identifying the neurocognitive mechanisms that lead individuals remembering to execute an intention at the right moment (prospective memory, PM) and how such mechanisms are influenced by the features of that intention is a fundamental theoretical challenge. In particular, the functional contribution of subcortical regions to PM is still unknown. This study was aimed at investigating the role of the medial subdivision of the mediodorsal thalamic nucleus (mMDT) in PM, with particular focus on the processes that are mediated by the projections from/to this structure. We analysed the performance of a patient (OG) with a right-sided lesion involving the mMDT in a series of PM tasks that varied for focality (i.e., overlapping of processes for the PM and ongoing tasks) and emotional valence of the stimuli, comparing the patient's performance with that of a control group. We found that the mMDT damage led to deficits in PM that were modulated by focality and emotional valence. OG indeed showed: a greater cost in the ongoing performance when a non-focal PM task was added; a slowing down in retrieving the intentions, in particular when these were associated with focal PM cues; an abnormal performance in the task with positive PM cues. Our findings provide evidence of a contribution of mMDT to PM and suggest a modulation of prefrontal-dependent strategic monitoring and a possible interaction with the limbic structures in the integration of emotion and PM processes. They also give support to the still controversial idea that connections with the perirhinal cortex mediate familiarity-based recognition.     

The contribution of apraxic speech to working memory deficits in Parkinson's disease

This article links two formerly separate areas of research associated with Parkinson's disease (PD): speech and memory. It is proposed that speech deficits occur in PD not merely at the level of muscular control, as is commonly termed dysarthria, but also at the level of speech planning and programming, more aptly described as a form of apraxia. It is further argued that PD patient groups exhibit small deficits in verbal span, and the link between apraxic speech and verbal span is elucidated via Baddeley's (1986) model of working memory. An experiment is described in which aspects of speech of 36 PD and 43 healthy control subjects were rated and classified, and measures of span and articulation rate for words of different syllable lengths were taken. Twenty-three PD subjects had dysarthric speech, while 14 of them had apraxic speech, which was associated with lower memory span scores for longer words. It is concluded that apraxic speech can be a source of reduced memory span in PD. In addition to implications for rehabilitation and therapeutic work with PD sufferers, these findings advance our theoretical understanding of the Parkinsonian syndrome.     

Gender, personality, and involuntary autobiographical memory

We utilised the recently developed continuous word association task (CWAT) to investigate whether attributes of involuntary autobiographical memory, including gender and cue valence effects, were similar to those found for voluntary autobiographical memory, as well as investigating the role of individual differences in memory production. A total of 80 undergraduate volunteers reported involuntary memories that came to mind during the word association task and completed measures of trait dissociation and psychosis-proneness. Involuntary memories showed similar cue valence effects to those typically found with voluntary memories but the usual gender effect was only apparent once participants learned the task involved autobiographical memory. The total number of involuntary autobiographical memories produced in response to negative cue words was related to greater trait dissociation and psychosis-proneness. The implications for differences between voluntary and involuntary autobiographical memory are discussed.     

Reinforcing effects of prerecorded words and delayed speech feedback on the verbal behavior of a neologistic schizophrenic

The possibility of using prerecorded words and 2-sec. delayed speech feedback as reinforcement in the reconditioning of intelligible verbal responses in a chronic, neologistic schizophrenic patient was investigated. A test situation was devised which involved daily presentation of 100 stimulus word-picture cards to elicit verbal responses. The results indicated that both singly presented prerecorded words and delayed speech feedback apparently strengthened correct and intelligible verbal responding.     

The beginnings of word segmentation in english-learning infants

A series of 15 experiments was conducted to explore English-learning infants' capacities to segment bisyllabic words from fluent speech. The studies in Part I focused on 7.5 month olds' abilities to segment words with strong/weak stress patterns from fluent speech. The infants demonstrated an ability to detect strong/weak target words in sentential contexts. Moreover, the findings indicated that the infants were responding to the whole words and not to just their strong syllables. In Part II, a parallel series of studies was conducted examining 7.5 month olds' abilities to segment words with weak/strong stress patterns. In contrast with the results for strong/weak words, 7.5 month olds appeared to missegment weak/strong words. They demonstrated a tendency to treat strong syllables as markers of word onsets. In addition, when weak/strong words co-occurred with a particular following weak syllable (e.g., "guitar is"), 7.5 month olds appeared to misperceive these as strong/weak words (e.g., "taris"). The studies in Part III examined the abilities of 10.5 month olds to segment weak/strong words from fluent speech. These older infants were able to segment weak/strong words correctly from the various contexts in which they appeared. Overall, the findings suggest that English learners may rely heavily on stress cues when they begin to segment words from fluent speech. However, within a few months time, infants learn to integrate multiple sources of information about the likely boundaries of words in fluent speech.     

Cognitive behavioural and neuropsychiatric treatment of post‐traumatic conversion disorder: a case study

Conversion disorder consists of involuntary sensory or motor symptoms and deficits that cannot be explained by a general medical condition. There are several treatment options, although none has emerged as the treatment of choice. The present case study examined the effects of adding cognitive behaviour therapy to neuropsychiatric management of conversion disorder (motor subtype). The patient, a retired emergency services worker, presented with a history of intermittent episodes of speech disruption (inability to speak or difficulty speaking properly). Although episodes of speech disturbance sometimes occurred unexpectedly, they were more likely to occur under conditions of stress and fatigue, and were triggered by reminders of work‐related traumatic events. The patient was treated with pharmacotherapy and psychoeducation from a neuropsychiatrist. With the aim of improving treatment outcome, cognitive behaviour therapy was added, involving imaginal exposure to trauma memories, along with cognitive restructuring. The frequency of between‐ and within‐session speech disturbance episodes declined over the course of cognitive behaviour therapy to the point that the patient was essentially symptom‐free. Within‐session distress ratings also decreased, which suggested habituation to trauma‐related memories. This case study demonstrates how particular cognitive behaviour therapy interventions can be usefully applied to one form of conversion disorder.     

Cognitive behavioural and neuropsychiatric treatment of post-traumatic conversion disorder: a case study

Conversion disorder consists of involuntary sensory or motor symptoms and deficits that cannot be explained by a general medical condition. There are several treatment options, although none has emerged as the treatment of choice. The present case study examined the effects of adding cognitive behaviour therapy to neuropsychiatric management of conversion disorder (motor subtype). The patient, a retired emergency services worker, presented with a history of intermittent episodes of speech disruption (inability to speak or difficulty speaking properly). Although episodes of speech disturbance sometimes occurred unexpectedly, they were more likely to occur under conditions of stress and fatigue, and were triggered by reminders of work-related traumatic events. The patient was treated with pharmacotherapy and psychoeducation from a neuropsychiatrist. With the aim of improving treatment outcome, cognitive behaviour therapy was added, involving imaginal exposure to trauma memories, along with cognitive restructuring. The frequency of between- and within-session speech disturbance episodes declined over the course of cognitive behaviour therapy to the point that the patient was essentially symptom-free. Within-session distress ratings also decreased, which suggested habituation to trauma-related memories. This case study demonstrates how particular cognitive behaviour therapy interventions can be usefully applied to one form of conversion disorder.     

Assessment of retrieval strategy in incidental, intentional, and inclusion tests with word-fragment cues

The purpose of this study was to assess retrieval strategy in incidental, intentional, and inclusion tests with word-fragment cues following a levels-of-processing manipulation at study. The results of Exp. 1 showed small levels-of-processing effects in incidental tests, and most subjects reported involuntary rather than voluntary retrieval of study-list words. In an intentional test, although levels of processing had a much greater effect, quite a few subjects also reported involuntary rather than voluntary retrieval of study-list words, and these subjects showed a smaller effect of levels of processing than subjects reporting voluntary retrieval. These results suggest that subjects given instructions for both voluntary and involuntary retrieval of study-list words in an inclusion test might not in fact attempt voluntary retrieval at all, but simply adopt an involuntary retrieval strategy. The results of Exp. 2 provided evidence to support this suggestion. The general implication is that where test contamination refers to subjects' failure to use retrieval strategies in accordance with test instructions, inclusion tests can be contaminated, as well as incidental or intentional tests, and that it is always necessary to obtain converging evidence about the actual strategies subjects use.