Semantic errors reconsidered in the procedural light of stack concepts

The purpose of this paper is to demonstrate the relevance of the stack concept in neuropsycholinguistics, a stack being a file with serially ordered elements. Number names (one, two, three, …) and the names of the days in the week may be viewed in this way. In a stack structure, any element is identified by two pieces of information: the particular stack to which it belongs and its position within that stack. Two experiments are reported that demonstrate a double dissociation. A deep dyslexic patient with agrammatism was found to sort stack elements on the basis of identity of position-within-stacks, while a fluent aphasic with semantic verbal paraphasias used another criterion, grouping together the items of the same stack. First revealed when handling number names, the two psycholinguistic procedures are also shown to be differentially operative with other linguistic material. Introducing the stack concept thus permits a procedural reinterpretation of some “semantic confusions,” particularly but not exclusively those dealing with quantities.     

Sentence understanding and knowledge of the world: Evidences from a sentence-picture matching task performed by aphasic patients

The abilities of aphasic patients to perform a sentence-picture matching task were investigated on simple declarative reversible sentences. Two factors were found to differentially affect Broca's versus Wernicke's aphasics' performance: sentence plausibility and spatial arrangement. Sentence plausibility, that is to say, the liability of two given nouns in a sentence to act as agent and recipient according to normal subjects' expectancies, had a significant effect on the frequency of correct responses of Broca's aphasics but not on those of Wernicke's. Conversely, the latter were found to be more sensitive to a match or mismatch in the left-to-right spatial arrangement of the grammatical subject and object in a sentence on the one hand, and the order of the corresponding personages in the picture on the other. The results are discussed in terms of “frame selection” and the handling of ordered structure strategies contributing to normal system, but selectively disturbed in the case of brain damage.     

Part of speech and phonological form implied in written-word comprehension: Evidence from homograph disambiguation by normal and aphasic subjects

A sentence construction experiment examining the effect of part of speech and phonological form in written-word comprehension is reported. Normal and aphasic subjects had to write sentences incorporating a given word pair, one word was a homograph (e.g., “bank”) whose meaning was context-biased by the other (e.g., “money”/“river”). The effect of three psycholinguistic factors on subjects' performance was questioned: (i) The relative frequency of one meaning of the homograph as compared to the other meaning; (ii) The lexical/syntactic ambiguity (“ball”/“can”); (iii) The same/different phonological forms of the two meanings (“fair”/“bass”). The results are discussed in the framework of a model in which multiple special-purpose procedures are involved in normal processing, some of them being differentially impaired by brain disease in Broca's and Wernicke's aphasics.     

Surface dyslexia: A case report and some theoretical implications to reading models

This paper reports on the psycholinguistic investigation of a surface dyslexic aphasic patient's abilities to handle written material. The analysis of paralexic errors produced in reading aloud single words and nonwords classically suggested that the patient was using an analytical strategy parsing the letter string stimulus, from left to right, into graphemes, and assigning phonemic values to graphemes. The patient's results were found to be sensitive to irregularities in correspondence between graphemes and phonemes not only in reading aloud but in lexical decisions, writing on dictation, rhyming, and written-word comprehension. Moreover, the patient's linguistic behavior brought out the reverse pattern observed in deep-dyslexic performances within word/nonword and content/function word dimensions. It was found that some semantic information about written words could be retrieved from both phonological and nonphonological processes presumably operating concurrently and both providing converging or conflicting pieces of meaning to the understanding of written words. Some considerations derived from the observation of this pathological reading behavior are discussed, contributing to a psycholinguistic model of normal reading.     

Syntactical knowledge in a case of agrammatism: Evidence from transcoding Roman and Arabic numerals

The ability of an aphasic subject with agrammatism in both comprehension and production to transcribe quantities from Roman numerals to Arabic and the reverse was investigated. Systematic errors in the transcoding processes were observed that could not be accounted for by the peculiarities of the two ideographic coding systems or by difficulties with direct transcoding rules. The results are discussed in the framework of the current debate on preserved/impaired hierarchical syntactical knowledge of agrammatic subjects. The findings paralleled the results of previous studies on the transcoding skills of agrammatics from/to alphabetic numerals to/from digital forms. In the case of this particular patient, it is therefore tentatively concluded in favor of preserved syntactical knowledge.     

Dysarthric symptomatology of Friedreich's ataxia

Subjective judgments of 16 speech dimensions were used to rate the speech of 22 Friedreich's ataxics. The study attempted to determine what groupings of speech dimensions describe the ataxic speech and if the subjects could be grouped by their speech symptoms. The results indicated that two speech factors were present, a general dysarthric factor and a phonatory stenosis factor. Subject groupings revealed three groups, the first characterized by a general dysarthria without vocal stenosis, the second characterized by phonatory stenosis and mild general dysarthric symptoms, and the third characterized by mild symptoms on both speech factors. Evidence was presented to show that more than one pattern of dysarthria could occur in one family.     

Parameters for vowel substitutions in Broca''s aphasia

Most phonological investigations of aphasic speech have focused on consonants. In this study, the vowel substitutions of five English-speaking Broca's aphasics were investigated with respect to several major explanatory hypotheses. An important possible motivating factor for aphasic substitutions, phonological environment, is an unlikely origin for these errors, since most substitutions occur along the paradigmatic axis. Another prominent hypothesis, markedness, also has no predictive power for the data of this sample. However, an analysis of the five Chomsky and Halle (1968, (The Sound Pattern of English), New York: Harper and Row) vowel features indicates that the two features for vowel height are selectively impaired: There is a strong tendency for lower vowels to replace higher targets. Moreover, the substitution sounds tend to be close to their target sounds along the height axis. Four possible hypotheses are advanced to account for this consistent lowering tendency.     

Influence of linguistic complexity,rate of presentation,and interphrase pause time on auditory-verbal comprehension of adult aphasic patients

Among the variables affecting comprehension of linguistic stimuli by aphasic subjects are syntactic complexity and processing time. Comprehension performance of 15 aphasic adults was studied while altering the rate of speech presentation and varying the pause time between the major phrases within sentences of increasing grammatical complexity.Simple Active Affirmative Declarative Sentences, Negative, and Passive sentences were presented (1) at the rate of 150 words per minute (wpm) with 1-sec interphrase pause time (IPT); (2) 150 wpm with no pauses; (3) 120 wpm with 1-sec IPT; (4) 120 wpm with no pauses added.Performance was seen to vary with increasing syntactical complexity and as a function of processing time. Greater comprehension was seen with active affirmative than negative; greater with passive affirmative than with active negative. Clinical implications are discussed. Subjects demonstrated greater comprehension when sentences were presented at slower than normal rate; addition of interphrase pause time intervals aided comprehension. Combining slower rate of presentation and IPT intervals provided greatest increase in auditory processing time and showed concomitant increase in comprehension performance.     

The significance of pauses in spontaneous speech

Studies of filled and silent pauses performed in the last two decades are reviewed in order to determine the significance of pauses for the speaker. Following a brief history, the theoretical implications of pause location are examined and the relevant studies summarized. In addition, the functional significance of pauses is considered in terms of cognitive, affective-state, and social interaction variables.     

Speech sound errors in patients with conduction and Broca's aphasia

Speech sound errors exhibited by three conduction and three Broca's aphasic patients on naming and word-repetition tasks were subjected to phonemic and subphonemic analyses. In the conduction aphasic patients, errors occurred equally often on consonants and vowels in both the naming and word-repetition tasks, while in the Broca's aphasic patients errors occurred selectively on consonants. Transposition errors occurred almost as often as substitution errors in the conduction aphasic patients, while substitution errors constituted the majority of errors in the Broca's aphasic patients. The Broca's aphasic patients, as compared to the conduction aphasic patients, exhibited a markedly higher number of substitution errors occurring between phonemes separated by a single subphonemic feature on the naming task. On the basis of these findings, it was hypothesized that the differences in the error patterns of the two types of aphasia reflected differences in the underlying mechanisms of the impairment in each type.     

Feature analysis and the token test

In a picture-matching task pictures of objects had to be arranged into pairs by aphasic and nonaphasic patients and normal controls. Aphasic patients were also given the Token Test. Correlation between the rank order of error scores in both tests was highly significant in aphasic patients. The pictures were also given to a normal group for free matching. Overlapping of normal performance on free matching and aphasic performance on bound matching occurred. We hypothesized that aphasic impairment was due to a difficulty in calling up associations, difficulty in feature analysis, and in moving from one concept to another. These findings are discussed in the light of abilities needed for Token Test performance. The results indicate that the traditionally presumed fundamental difference between verbal and nonverbal cognitive tasks is rather unsatisfactory.     

Schizophasia and jargonaphasia : A comparative description with comments on Chaika's and Fromkin's respective looks at “schizophrenic” language

Different varieties of deviant spoken language segments (phonemic, morphemic, verbal, and syntagmic paraphasias and télescopages, neologisms) and different forms of deviant spoken language behaviors (thematic production, dyssyntaxia, glossolalia, and glossomania) are defined and exemplified. Their production is shown to be rule-governed at phonetic and phonological levels; it is shown to be rule-governed or rule-deviant at morphological and/or syntactic levels. Their qualitative and quantitative attributes in normal discourse in the jargonaphasias and in schizophasia are compared. It is underlined that the latter is a behavior episodically observed in only a small proportion of subjects considered to be schizophrenics. Awareness of, and deliberateness in, deviant language production are discussed. A distinction is made between deviations testifying to diminished ability, which betray the speaker's intention, and deviations testifying to singular but rigorous use of ability, which are adapted to the speaker's intentions. The former are contended to be common in the jargonaphasias and occasional in standard discourse and schizophasia, the latter to be characteristic of schizophasia and of various forms of “literary” language, but incompatible with aphasia. In lapidary terms, this implies that ordinary speakers think and talk standard, that (most) jargonaphasic speakers think standard but talk deviant, that schizophasic speakers think quaint and talk accordingly. It is further suggested that the differential diagnosis of jargonaphasia and schizophasia, when made on the sole basis of tape recorded samples of discursive language, resorts mainly to quantitative appraisal of different types of deviant segments on one hand, and, on the other, to the listener's interpretations of the speaker's mode of ideation. Within the realm of pathological language production, nearly exclusive and important production of phonemic transformations is said to be characteristic of conduction aphasia; combined production of numerous phonemic and verbal transformations, and of neologisms, is said to be characteristic of Wernicke's aphasia proper; nearly exclusive and important production of verbal transformations is said to be possible in so-called transcortical sensory aphasia; and predominant production of morphemic transformations and of glossomaniac utterances is said to be characteristic of schizophasia. Linguistic definitions of the “disturbances” behind schizophasic utterances are reviewed. Indications are given concerning the evolution of language behavior in jargonaphasia and schizophasia.     

Pauses and syntax in American sign language

Research on spoken languages has shown that the durations of silent pauses in a sentence are strongly related to the syntactic structure of the sentence. A similar analysis of the pauses (holds) in a passage in American Sign Language reveals that sequences of signs are also interspersed with holds of different lengths: long holds appear to indicate the ends of sentences; shorter holds, the break between two conjoined sentences; and the shortest holds, breaks between internal constituents. Thus, pausal analysis is a guide to parsing sentences in ASL.     

Reinforcement from the sucking environment and subsequent modification of sucking behavior in the human neonate

The reinforcing aspects of sucking behavior in 36 human newborns was examined in a limited instrumental conditioning paradigm where sucking was both operant and reinforcer. During training, response density (rate based on sucking opportunity time) and latency were measures of two components of nonnutritive sucking, contingent negative pressure suction, and incidental jaw movement. The strategy for determining the reinforcing aspects of sucking involved comparisons of three types of sucking stimuli as reinforcers. The nature of modified operant sucking was investigated during extinction by examining number of sucks per burst, number of bursts emitted, and interburst interval time. The feedback from sucking which acted as reinforcement was concluded to be response density. Sucking was modified by changes in pausing behavior, including response latency and pauses between bursts of sucks. The number of sucks per burst also showed a significant change under certain conditioning arrangements.     

Sequences of phonemic approximations in aphasia

The trends of sequences of phonemic approximations to a single target were studied in three types of aphasia (Broca's, conduction, and Wernicke's), as gathered in five tasks (spontaneous speech, repetition of meaningful words, repetition of nonsense words, reading aloud, and automatized sequences). A phonemic error ratio was defined in order to quantify the distance between each approximation of a given sequence and its target. The results of a computer analysis based on this ratio were analyzed according to three parameters. A study of three types of patients revealed that conduction aphasics exhibited the most regular trend toward the target in sequences of phonemic approximations; the analysis of the various tasks indicated that sequences produced in repetition by conduction aphasics form an exception to the regularity of this trend, and an examination of the various lengths of sequences indicated that longer sequences showed a less decisive trend toward the target than shorter sequences. The discussion bears on some theoretical aspects of the phonological production mechanism and its control: the initial strength and permanence of the internal representation of the target emerge as important factors required for the good functioning of this mechanism.     

The unsaid in the psychotherapy narrative: Voicing the unvoiced

In research interviews, psychotherapy clients, from different therapeutic approaches, identified silent moments entailing processes that facilitated their therapeutic progress. A grounded theory method was used to analyse these interviews resulting in three categories of productive pauses: emotional, expressive and reflective pauses. This study examines these categories in relation to their narrative context, and, more broadly, to narrative theory. It highlights what remains unsaid in the psychotherapy narrative, describes these silent processes that transform narration into a therapeutic experience and reframes the therapeutic narrative as a method for structuring introspective silences.     

Depression in aphasic patients: Frequency, severity, and clinical-pathological correlations

Twenty-five hospitalized nonfluent, fluent, and global aphasic patients who were several months past the onset of their illness were compared for presence and severity of depression based on four psychopathological measures. The nonfluent aphasic patients had both greater frequency and severity of depression than the other two groups. CT scans showed that the global aphasic patients had the largest lesion size (volumetric) and showed a strong correlation between lesion size and degree of depression. In contrast, patients with fluent aphasias showed an inverse correlation between severity of depression and lesion size; among the nonfluent aphasic patients there was no significant correlation. Depression appears to be common in this population of hospitalized aphasic patients with chronic illness and nonfluent patients are the most depressed group within this population. The increased frequency and severity of depression in the nonfluent patients did not appear to be related to their overall physical or cognitive impairment; two possible mechanisms are discussed.     

Increased susceptibility of aphasics to a distractor task in the recall of verbal commands

The ability of 15 control, 15 nonaphasic brain-damaged, and 15 aphasic patients to carry out three-word commands on the Token Test was studied under three conditions: no delay, 20-sec unfilled delay, and 20-sec delay filled with a counting task. Only aphasics with mild to moderate comprehension deficit participated in the experiment and their scores in the no-delay condition were not inferior to those of the other two groups. The 20-sec unfilled delay did not bring about a decrement of the performance in any group, while all of them were impaired with 20-sec filled delay. The rate of forgetting was, however, significantly greater in aphasics than in patients without language disorders, even when the scores of the no-delay condition were introduced as covariates in the analysis of the filled-delay condition. The same result was obtained when, in a second experiment, 4 sec elapsed between the end of the command and the beginning of the counting activity. The increased susceptibility of aphasics to the disruptive effect of the distractor task is viewed as following a failure in organizing verbal information, a deficit that may contribute to lowering their comprehension level.     

Development of clinical vignettes to assess healthcare decision-making capacity in elderly with mild cognitive impairment and Alzheimer's disease

IntroductionCognitive impairment can constrict healthcare decision-making capacity, as it affects the ability to understand, appreciate, and reason with information, as well as communication abilities. Therefore, decision-making capacity of elders with mild cognitive impairment or Alzheimer's disease should be carefully assessed when patients are asked to make decisions regarding their health. Vignettes are particularly relevant to assess healthcare decision capacity, since they can come close to real life situations and improve statistical reliability of capacity assessment instruments.ObjectiveThis paper describes the construction and development process of three hypothetical vignettes, to be included in a new Portuguese assessment tool of healthcare decision-making capacity (CAI-Health).MethodFor vignettes’ development, examples from other assessment tools were first reviewed to summarize their text length, language complexity and health information contained. Most prevalent causes of mortality and morbidity in Portuguese elders were then identified, in order to select the health issues to include in CAI-Health’ vignettes. Seven vignettes were developed, and three were selected to be included in CAI-Health. After vignette's selection, these were reviewed by three experienced medical experts, during a focus group.ConclusionVignettes final version include cases of increased complexity, presenting situations of mild cognitive impairment, lung tumor and knee arthrosis.