Aphasia in a polyglot

A Greek-born aphasic who had been able to speak four languages (Romanian, Russian, Greek, German) was tested quantitatively for verbal expression (standard interview indexes) and verbal reception (fifth part of the Token Test). The form of aphasia (qualitative aspect) was found to be identical for all four languages. Quantitatively, his performance in the four languages was different, with the languages used most during the past 20 years (Romanian and Russian) being less impaired. Nevertheless, verbal reception was equally impaired quantitatively in all four languages. Treatment with semantic-syntagmatic methods performed in Romanian had a beneficial effect on speech in the other languages as well. The authors feel that the expressive disturbance noted in aphasia reflects involvement of deep as well as of surface structures of language, but the receptive disturbance reflects involvement of the deep structures only. This may account for quantitative discrepancies in expression without discrepancy in reception among the four languages, as well as the qualitatively identical features of the disturbance in verbal expression and reception.     

Sentence interpretation in normal and aphasic Hindi speakers.

In interpreting a sentence, listeners rely on a variety of linguistic cues to assign grammatical roles such as agent and patient. The present study considered the relative ranking of three cues to agenthood (word order, noun animacy, and subject-verb agreement) in normal and aphasic speakers of Hindi. Because animacy plays a grammatical role in Hindi (determining the nature and acceptability of sentences without accusative marking), this language is relevant to the claim that Broca's aphasia involves a dissociation between grammar and semantics. Results of Study 1 with normal Hindi-dominant speakers showed that animacy is the strongest cue in this language, while agreement is the weakest cue. In Study 2, Hindi-English bilinguals were tested in both their languages. Most showed the normal animacy-dominant monolingual pattern in Hindi, with a mixture of strategies from both languages in their interpretation of English. A substantial minority showed mixed strategies in both languages. Only 5 of 48 subjects displayed a complete separation between languages, with animacy dominance in Hindi and word order dominance in English. In Study 3, two Hindi-English bilinguals with Broca's aphasia were tested in both languages. Results indicate (a) greater use of animacy in Hindi than in English and (b) greater use of word order in English than in Hindi. The strategies displayed by these patients fall well within the range observed among bilingual normals. We conclude that the use of animacy in sentence interpretation by these aphasic patients reflects preservation of normal, language-specific processing strategies; it cannot be interpreted as a nonlinguistic strategy developed to compensate for receptive agrammatism. Results are discussed in light of other cross-linguistic evidence on sentence comprehension in monolingual and bilingual aphasics.     

Gestural impairment and gestural ability in aphasia: A review

Studies of gestural ability in aphasic subjects have found impairment of gestural expression and comprehension, with a close relationship between severity of aphasia and degree of gestural impairment. A few investigators have correlated gestural ability with specific language functions or subcategories of aphasia. Reading appears to correlate better with gestural recognition than does auditory comprehension. Despite the general findings of gestural impairment in aphasia, successes have been reported with gestural training including artificial language techniques, pantomime, Amerind, and American Sign Language. Future studies of gestural therapy in aphasia should examine specific language deficits in order to identify those aphasic individuals who can benefit from gestural training.     

Cross-language lexical connections in the mental lexicon: evidence from a case of trilingual aphasia

Despite anecdotal data on lexical interference among the languages of multilingual speakers, little research evidence about the lexical connections among multilinguals' languages exists to date. In the present paper, two experiments with a multilingual speaker who had suffered aphasia are reported. The first experiment provides data about inter-language activation during natural conversations; the second experiment examines performance on a word-translation task. Asymmetric patterns of inter-language interference and translation are evident. These patterns are influenced by age of language learning, degree of language recovery and use, and prevalence of shared lexical items. We conclude that whereas age of language learning plays a role in language recovery following aphasia, the degrees of language use prior to the aphasia onset and of shared vocabulary determine the ease with which words are accessed. The findings emphasize the importance of patterns of language use and the relations between the language pair under investigation in understanding lexical connections among languages in bilinguals and multilinguals.     

Importance of treatment efficacy research on language comprehension in MR/DD research

The purpose of this review is to discuss the importance of treatment efficacy research in language comprehension in MR/DD populations. Although receptive language deficit is an integral part of most MR/DD typologies, there have been relatively few studies evaluating the effectiveness or efficacy of treatment for this condition. Recently, there has been increased attention placed on auditory processing in children with disabilities, an aspect of cognition related to receptive language, but there have also been few studies investigating the effectiveness or efficacy of training designed to improve auditory processing. In addition to arguing that additional studies in this area are needed, the review includes several theoretical frameworks for addressing the treatment of receptive language deficits in MR/DD.     

Quantitative and qualitative evaluation of neuromotor behaviour in children with a specific speech and language disorder

Several studies have described problems in a wide area of motor functions in language impaired children. The purpose of this study was to identify the nature of the motor deficits in two subgroups of language impaired children. A standard neurological examination was performed on 18 children with an expressive language disorder and 21 children with a receptive language disorder. The motor performance of the language disordered children was compared with the motor performance of 23 normal children. The standard neurological examination allowed for a qualitative and quantitative assessment of five specific neurological subsystems. Handedness was determined for all children. The language impaired children had more motor problems than the control children on most neurological subsystems. There were few statistically significant differences between the two groups of language impaired children. An excess in left‐handedness was established in the group of children with a receptive language disorder. There was a co‐occurrence of verbal and non‐verbal deficits in language impaired children. As these motor problems put an additional burden on the development of language impaired children, they should be diagnosed as early as possible. Copyright © 2002 John Wiley & Sons, Ltd.     

Phonological transformations in conduction aphasia

Different explanations and subtypes of conduction aphasia are analyzed. Characteristics of literal paraphasias in parietal-insular conduction aphasia are discussed, emphasizing that paraphasias in conduction aphasia are articulatory-based (articulatory literal paraphasias) and due mainly to phoneme substitutions and phoneme deletions; they result basically in switches in phoneme manner and place of articulation. Similarities between errors in ideomotor apraxia and conduction aphasia language deficits are presented. It is proposed that language deviations (in oral as in written language) in conduction aphasia can be understood as a segmentary apraxia of speech.     

Semantic dementia and persisting Wernicke's aphasia: linguistic and anatomical profiles

Few studies have directly compared the clinical and anatomical characteristics of patients with progressive aphasia to those of patients with aphasia caused by stroke. In the current study we examined fluent forms of aphasia in these two groups, specifically semantic dementia (SD) and persisting Wernicke’s aphasia (WA) due to stroke. We compared 10 patients with SD to 10 age- and education-matched patients with WA in three language domains: language comprehension (single words and sentences), spontaneous speech and visual semantics. Neuroanatomical involvement was analyzed using disease-specific image analysis techniques: voxel-based morphometry (VBM) for patients with SD and overlays of lesion digitized lesion reconstructions in patients with WA. Patients with SD and WA were both impaired on tasks that involved visual semantics, but patients with SD were less impaired in spontaneous speech and sentence comprehension. The anatomical findings showed that different regions were most affected in the two disorders: the left anterior temporal lobe in SD and the left posterior middle temporal gyrus in chronic WA. This study highlights that the two syndromes classically associated with language comprehension deficits in aphasia due to stroke and neurodegenerative disease are clinically distinct, most likely due to distinct distributions of damage in the temporal lobe.     

The recovery processes of two English-Japanese bilingual aphasics

The recovery processes of two English-Japanese bilingual aphasics, one with Broca's aphasia and the other with Wernicke's aphasia, were investigated with special emphasis on the effect of language therapy. The degree of impairment initially manifested in English and Japanese was almost equivalent in each case, the pattern of impairment corresponding to the respective types of aphasia. In both cases, systematic, controlled language therapy was conducted. Analysis of the recovery courses revealed that language therapy was one decisive variable in the relative degree of recovery of a bilingual aphasic's two languages. The type of aphasia appeared to exert a crucial influence on the relative recovery rate of different modalities.     

Linguistic and nonlinguistic priming in aphasia

Studies of real-time processing in aphasia suggest that linguistic symptoms may be due to deficits in activation dynamics rather than loss of linguistic knowledge. To investigate the domain specificity of such processing deficits, we compared performance by Italian-speaking fluent aphasics, nonfluent aphasics, and normal controls in a linguistic priming task (grammatical gender) with their performance in a color-priming task that requires no verbal mediation. Normal or larger than normal color-priming effects were demonstrated in both aphasic groups. Gender priming did not reach significance in either group, even though the patients displayed above-chance sensitivity to gender class and gender agreement in their accuracy scores. The demonstration of spared gender knowledge despite impaired gender priming underscores the utility of on-line techniques in the study of aphasia. The demonstration of spared color priming suggests that priming deficits in aphasia are either (1) specific to speech and language or (2) specific only to those sensorimotor and attentional processes that language shares with other nonlinguistic systems.     

Literacy acquisition in multilingual educational contexts: Evidence from Coastal Kenya

Literacy is a powerful tool against poverty, leading to further education and vocational success. In sub‐Saharan Africa, schoolchildren commonly learn in two languages—African and European. Multiple early literacy skills (including phonological awareness and receptive language) support literacy acquisition, but this has yet to be empirically tested in sub‐Saharan Africa, where learning contexts are highly multilingual, and children are often learning to read in a language they do not speak at home. We use longitudinal data from 1,100 schoolchildren spanning three groups of native languages [Mijikenda languages (Digo, Duruma, Chonyi, and Giriama), Kiswahili, Kikamba] in coastal Kenya (language of instruction: Kiswahili and English). We find that baseline phonological awareness and receptive language are differentially important in predicting literacy skills in English and in Kiswahili, and these relations are moderated by the degree of shared cross‐linguistic features between home and school languages. Importantly, the relative importance of these factors changes over development. Implications for language development and literacy acquisition in linguistically diverse contexts are discussed.     

Home environmental influences on children's language and reading skills in a genetically sensitive design: Are socioeconomic status and home literacy environment environmental mediators and moderators?

This twin study examined how family socioeconomic status (SES) and home literacy environment (HLE) contributes to Chinese language and reading skills. It included 312 Chinese twin pairs aged 3 to 11. Children were individually administered tasks of Chinese word reading, receptive vocabulary and reading‐related cognitive skills, and nonverbal reasoning ability. Information on home environment was collected through parent‐reported questionnaires. Results showed that SES and HLE mediated shared environmental influences but did not moderate genetic influences on general language and reading abilities. Also, SES and HLE mediated shared environmental contributions to receptive vocabulary and syllable and rhyme awareness, but not orthographic skills. The findings of this study add to past twin studies that focused on alphabetic languages, suggesting that these links could be universal across languages. They also extend existing findings on SES and HLE's contributions to reading‐related cognitive skills.     

Crossed aphasia in Chinese: a clinical survey.

According to our clinical observations from various aspects of stroke patients, such as the total incidence of aphasia, the incidence of aphasia after left brain damage of the dextrals, the aphasia that occurs in patients without hemiplegia, and the types of aphasia, a much higher incidence of crossed aphasia is seen among the stroke patients of the Han (the largest ethnic group in China) as compared with the Uighur-Kazaks (U-K) in China and the Occidentals documented in the literature. Motor aphasia is most common and pure sensory or posterior aphasia is rarely seen in Han patients. The distinct features of the Chinese language is a possible explanation for this difference. We suspect that language function of the Han is not localized in the left brain but in the right or both hemispheres. There is no definite Wernicke's area in the left brain of the Chinese people and the neural pathway of the language function in the brain of the Chinese people is not similar to people who speak phonetic languages. Consequently the universal applicability of the theories of cerebral laterality of the language function and dominant hemisphere established by Dax and Broca are questioned in this paper.     

Subcortical Aphasia

We critically review the literature on subcortical aphasia, suggest that a number of traditional concepts regarding mechanisms of aphasia are inconsistent with now abundant data, and propose several new hypotheses. The absence of aphasia in 17 reported cases of dominant hemisphere striatocapsular infarction and the finding of nearly every conceivable pattern of language impairment in 33 different reported cases of striatocapsular infarction provide strong evidence against a major direct role of the basal ganglia in language and against disconnection or diaschisis as mechanisms of nonthalamic subcortical aphasia. However, detailed consideration of the vascular events leading to striatocapsular infarction strongly suggests that associated linguistic deficits are predominantly related to sustained cortical hypoperfusion and infarction not visible on structural imaging studies. Thalamic disconnection, as may occur with striatocapsular infarcts with extension to the temporal stem and putamenal hemorrhages, may also contribute to the language deficits in some patients. Review of the literature on thalamic infarction, in conjunction with previously unreported anatomic details of four cases, suggests that what infarcts in the tuberothalamic artery territory and the occasional infarcts in the paramedian artery territory associated with aphasia have in common is damage to the frontal lobe–inferior thalamic peduncle–nucleus reticularis–center median system that may be involved in regulating the thalamic gate in attentional processes. Disruption of attentional gating in the pulvinar and lateral posterior nuclei resulting from such lesions may impair selection of specific neuronal networks in the projection field of these nuclei that serve as the substrate for lexical–semantic function, which is in effect a disruption of a type of working memory, as defined by Goldman–Rakic. We define this as a defect of selective engagement.     

The bilingual brain: bilingual aphasia.

Since most people in the world know more than one language, bilingual aphasia is an important line of research in clinical and theoretical neurolinguistics. From a clinical and ethical viewpoint, it is no longer acceptable that bilingual aphasics be assessed in only one of the languages they know. Bilingual aphasic patients should receive comparable language tests in all their languages. In the present work, language recovery of 20 bilingual Friulian-Italian aphasics was investigated. Thirteen patients (65%) showed a similar impairment in both languages (parallel recovery), four patients (20%) showed a greater impairment of L2, while three patients (15%) showed a greater impairment of L1. Despite the many hypotheses advanced to account for nonparallel recovery, none of them seems to provide satisfactory explanations. The study of bilingual aphasics with parallel impairment of both languages allows us to verify the hypothesis whereby grammatical disorders in aphasia depend on the specific structure of each language. As far as rehabilitation programs for multilingual aphasics are concerned, several questions have been raised, many of which still need a satisfactory answer.     

Two sets of twins with selective mutism: neuropsychological findings.

Neuropsychological data are reviewed from two sets of dizygotic twins presenting with selective mutism characterized by situation specific anxiety, extreme passive behavior, lack of responsivity, lack of peer interaction, and a chronic course of selective mutism. Both sets of twins had a history of prematurity and delayed speech development. One set of twins presented with normal intelligence and normal receptive language skills but with expressive language and oral motor sequencing difficulties. The second set of twins presented with Verbal IQ deficits and significant receptive and expressive language deficits. A summary of current conceptualizations regarding etiology and treatment of selective mutism is provided.     

Spontaneous translation and language mixing in a polyglot aphasic

The literature on language mixing in polyglot aphasics is reviewed and a case report of a patient with spontaneous translation is presented. A microgenetic model of language processing provides an interpretive framework for language mixing and spontaneous translation as symptoms of polyglot aphasia. It is suggested that language mixing reflects a deficit at the linguistic level while spontaneous translation reflects a deficit at the prelinguistic level of language processing. A hypothesis about the organization of multiple languages in a single speaker is proposed.     

Differential recovery of languages in a bilingual patient: a case study using selective amytal test.

We performed a selective Wada test on a bilingual patient. While a left middle cerebral artery (MCA) injection produced global aphasia for both (Spanish and English) languages, the patient could only speak Spanish (his mother tongue) 1 min after he started to speak English. No language disturbances were observed after a right MCA amytal injection. These findings suggest that all of a multilingual's languages are stored within the verbal-dominant perisylvian region, and while the second language may be organized within the central Sylvian core, the first language may be better represented in more distal perisylvian areas.     

The bilingual brain: cerebral representation of languages.

The present article deals with theoretical and experimental aspects of language representation in the multilingual brain. Two general approaches were adopted in the study of the bilingual brain. The study of bilingual aphasics allows us to describe dissociations and double dissociations between the different subcomponents of the various languages. Furthermore, symptoms peculiar to bilingual aphasia were reported (pathological mixing and switching and translations disorders) which allowed the correlation of some abilities specific to bilinguals with particular neurofunctional systems. Another approach to the study of the bilingual brain is of the experimental type, such as electrophysiological investigations (electrocorticostimulation during brain surgery and event-related potentials) and functional neuroanatomy studies (positron emission tomography and functional magnetic resonance imaging). Functional neuroanatomy studies investigated the brain representation of languages when processing lexical and syntactic stimuli and short stories. Neurophysiologic and neuroimaging studies evidenced a similar cerebral representation of L1 and L2 lexicons both in early and late bilinguals. The representation of grammatical aspects of languages seems to be different between the two languages if L2 is acquired after the age of 7, with automatic processes and correctness being lower than those of the native language. These results are in line with a greater representation of the two lexicons in the declarative memory systems, whereas morphosyntactic aspects may be organized in different systems according to the acquisition vs learning modality.