Comparison of the performances of a fluent and a nonfluent aphasic on a pantomimic referential task

The pantomimic performances of a typical Broca's (nonfluent) and Wernicke's (fluent) aphasic were compared with each other and with four normal control subjects on a simple task of nonverbal referential communication. Both aphasic subjects demonstrated only about 50% accuracy in their pantomimic communication. Also, measures were obtained of the motoric fluency of the pantomimes of all subjects and comparisons were made between the fluent and nonfluent aphasics. These measures demonstrated distinct differences in the fluency patterns of the pantomimes of the two aphasic subjects similar to the differences in speech fluency which distinguish and characterize these two types of aphasia; that is, the fluent aphasic pantomimed fluently and like the control subjects and the nonfluent aphasic pantomimed nonfluently. The quantitative and qualitative similarities in the fluency patterns of the speech and the pantomimic behaviors of the aphasic subjects are discussed in terms of their implications for a definition of aphasia.     

An Acoustic Analysis of Rate of Speech Effects on Vowel Production in Aphasia

The present investigation examined the production of tense and lax vowel duration differences at two speaking rates in the speech of 10 nonfluent aphasics, 8 fluent aphasics, and 10 normal control subjects. Subjects produced four repetitions of each of the vowels [i e æ o u I ε υ Λ] at each speaking rate. Acoustic analyses revealed that subjects in all three groups were able to manipulate overall rate of speech. In addition, normal controls and fluent aphasic subjects produced vowels under the fast rate condition which were significantly shorter than those under the slow rate condition. Despite a change in overall speaking rate, the nonfluent aphasics did not exhibit a significant difference in vowel duration at the two rates of speech, suggesting a deficit in the implementation of this temporal parameter. Both normal controls and fluent aphasic patients produced nonoverlapping distributions of tense and lax vowels at both speaking rates. In contrast, the nonfluent aphasics demonstrated a great deal of overlap in the distribution of tense and lax vowel durations at the fast rate. Results are discussed in relation to the nature of the speech production deficits in nonfluent and fluent aphasic patients.     

Effects of morphological complexity on phonological output deficits in fluent and nonfluent aphasia

This study examined the effects of morphological complexity on aphasic speakers with lexical-phonological output deficits. Subjects were two fluent and two nonfluent aphasic speakers who repeated morphologically simple words at the same level of accuracy and whose errors were virtually all phonological in nature. They were asked to repeat a variety of morphologically complex (i.e., affixed) words. Results were interpreted within our two-stage model of lexical-phonological production (Kohn & Smith, 1994, 1995), which we expand to include a distinction between derivational and inflectional morphology. When comparing overall performance levels between morphologically simple and complex words, only three subjects exhibited more difficulty repeating the morphologically complex targets. Nevertheless, when comparing repetition accuracy between different types of morphologically complex words (e.g., derived vs. inflected), all four subjects displayed similar patterns. These findings suggested that while morphological complexity has different effects on the two stages within the lexical-phonological output system, the relative effects of different morphological structures are constant. At the level of error analysis, patterns of affix errors distinguished the nonfluent from the fluent subjects in ways that are reminiscent of the affix errors associated with agrammatic and paragrammatic speech. This finding raised questions concerning the relationship between morphosyntactic and morphophonological deficits.     

Syntactic loss versus processing deficit: an assessment of two theories of agrammatism and syntactic comprehension deficits

This research evaluated Grodzinsky's (1984, 1986a) syntactic loss and Kolk and van Grunsven's (1985) working memory impairment explanations of syntactic comprehension deficits in agrammatic aphasics. Four aphasic patients were evaluated who showed different patterns of impairment on morphological and structural aspects of production. The comprehension tasks compared performance on full and truncated passive sentences. The syntactic loss hypothesis predicted worse performance on truncated than full passives, while the working memory deficit hypothesis predicted the reverse. Neither hypothesis was supported, as the patients performed at a similar level on both types of passives. In addition, there was little relation between the patients' production indices and their comprehension level. The results argue against any global theory of agrammatism that attempts to attribute all agrammatic speech and co-occurring syntactic comprehension deficits to the same source.     

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.     

Compensation for Jaw Fixation by Aphasic Patients

The ability to compensate for fixation of the jaw by a bite block was investigated in 6 nonfluent aphasics, 6 fluent aphasics, and 10 normal control subjects. Acoustic analyses of the vowels [i u a æ] and fricatives [s s] revealed substantial but incomplete compensation for the perturbation in all three subject groups. Perceptual identification scores and quality ratings by naive and phonetically trained listeners indicated poorer identification of the high vowels [i u] under compensatory conditions relative to normal production. Of particular interest was the fact that all three groups of subjects exhibited similar patterns of results. The findings suggest that any deficit in speech motor programming demonstrated by the nonfluent aphasic patients did not affect compensatory abilities. Results are discussed with respect to normal speech adaptation skills and the nature of articulatory breakdown in nonfluent aphasia.     

Anticipatory Coarticulation in Aphasia: Effects of Utterance Complexity

The magnitude and extent of anticipatory coarticulation were examined in groups of fluent and nonfluent aphasic patients and normal control subjects. One- and two-syllable target utterances were elicited at slow and fast rates of speech with or without a consonant intervening between the target consonant and vowel, and with or without a preceding schwa, to manipulate utterance complexity. Acoustic analyses (F2 and centroid frequencies) revealed that both groups of aphasic patients exhibited relatively normal patterns of anticipatory coarticulation. However, small but significant differences among the groups emerged in certain conditions. Surprisingly, increased utterance complexity was not found to reduce coarticulatory effects to a greater degree in the nonfluent relative to the fluent aphasic group. Perceptual tests largely confirmed the acoustic analyses.     

Contextual influences on phonetic identification in aphasia: the effects of speaking rate and semantic bias

Two experiments examined the influence of context on stop-consonant voicing identification in fluent and nonfluent aphasic patients and normal controls. Listeners were required to label the initial stop in a target word varying along a voice onset time (VOT) continuum as either voiced or voiceless ([b]/[p] or [d]/[t]). Target stimuli were presented in sentence contexts in which the rate of speech of the sentence context (Experiment 1) or the semantic bias of the context (Experiment 2) was manipulated. The results revealed that all subject groups were sensitive to the contextual influences, although the extent of the context effects varied somewhat across groups and across experiments. In addition, a number of patients in both the fluent and nonfluent aphasic groups could not consistently identify even endpoint stimuli, confirming phonetic categorization impairments previously shown in such individuals. Results are discussed with respect to the potential reliance by aphasic patients on higher level context to compensate for phonetic perception deficits.     

Regular and irregular morphology and its relationship with agrammatism: evidence from two Spanish-Catalan bilinguals

We report the performance of two aphasic patients in a morphological transformation task. Both patients are Spanish-Catalan bilingual speakers who were diagnosed with agrammatic Broca's aphasia. In the morphological transformation task, the two patients were asked to produce regular and irregular verb forms. The patients showed poorer performance with irregular than regular morphological transformations in both of their languages. These results are at odds with the proposal that agrammatic speech is always or even preponderantly associated with poorer performance in processing regular versus irregular verb form. Instead, these results support the view that a major component of agrammatic production is a deficit in morphosyntactic processing, independently of whether this processing ultimately involves regular or irregular forms.     

MANUAL ACTIVITY DURING SPEAKING IN APHASIC SUBJECTS*

Samples of free conversations were recorded in 6 normal and 12 aphasic subjects. Manual activity during speech was observed. Groups were shown to behave in an opposite way for the verbal and nonverbal measures: while aphasic subjects' verbal behavior is impaired, they produce more speech-related movements than normals. No differences appear concerning other movements (automanipulation, hand-to-hand posture, miscellaneous movements). Analysis of the aphasie group reveals no difference between the fluent and the nonfluent aphasies. Verbal fluency is shown to be a non-critical factor in the explanation of gesture production. Increased gestural production in aphasies may be interpreted according to the hypothesis that gestures are cues for the difficulties the speaker experiences in the verbal encoding process.     

Quantitative analysis of aphasic sentence production: further development and new data

The narrative production of patients with Broca's aphasia and age-and education-matched control subjects was analyzed using the Quantitative Production Analysis (Saffran et al., 1989), a procedure designed to provide measures of morphological and structural characteristics of aphasic production. In addition to providing data for a larger number of subjects than in the original study, we provide data on interrater and test-retest reliability. The data were also submitted to factor and cluster analyses. Two factors characterized the data and the cluster analysis yielded four sets of patients who performed differently on these factors. In particular, there is evidence that agrammatic patients can differ in their production of free and bound grammatical morphemes, substantiating earlier claims in the literature.     

Verb processing during sentence comprehension in aphasia

This study examines verb processing during on-line sentence comprehension in aphasia. We describe two experiments that explore whether a group of Broca's aphasics, who were agrammatic in comprehension as well as speech, a group of fluent aphasics, and a group of normal controls are sensitive to the argument structure arrangements of verbs. Subjects had to perform a complex secondary task both in the immediate vicinity of the verb and also at a point well past the verb while listening to sentences for meaning. Reaction times to this secondary task show that both normal controls and agrammatic Broca's aphasic subjects activate multiple argument structure possibilities for a verb in the vicinity of the verb, yet at a point downstream from the verb such effects disappear. These data suggest that the problems agrammatic subjects show with verbs in sentence comprehension, and the general lexical access deficit also recently claimed to be part of the agrammatics' problem, may not extend to the real-time processing of verbs and their arguments. Fluent aphasic subjects, on the other hand, do not show sensitivity to the argument structure properties of verbs, suggesting that these patients may have a semantic-like sentence processing deficit.     

Speech-related body movement in aphasia: period analysis of upper arms and head movement.

The effects of aphasia on coverbal body movement have important implications for the understanding of both normal and pathological speech processes. The related findings were often inconsistent, partly due to inherent methodological difficulties which could be reduced by the use of advanced techniques of movement monitoring (Hadar, 1991). The present study employed a new computerized system, CODA-3, which locates small prismatic markers and computes by triangulation their three-dimensional position at 100 Hz. Movement of the head and the upper arms was monitored in 15 aphasic and normal subjects engaged in speech during a naturalistic interview. Movement analysis was based on automatized identification of successive movement extrema ("period analysis") and the computation of amplitude, duration, and velocity of each period. The results showed higher incidence and amplitude of all body movement in the aphasic population. Fluent aphasics showed this particularly with "symbolic," content-bearing movements, while nonfluent aphasics were higher than controls in both symbolic and "motor" (simple and small) movements. No deficit in the internal organization of movement was seen in the aphasic population. These results indicate that aphasics increase their coverbal movement in compensation for their speech impairment: fluent aphasics compensate primarily for a symbolic impairment, while nonfluent aphasics compensate more for a motor impairment.     

Retention of verbal information by rehearsal in relation to the fluency of verbal output in aphasia

The purpose of the present study was to determine if aphasic subject groups differentiated by the fluency of their verbal output employed rehearsal as a strategy for maintaining verbally coded information in primary memory. A task based upon the Brown-Peterson paradigm was administered to 10 fluent aphasic patients, 10 nonfluent aphasic patients, 10 right-brain-damaged patients, and 10 nonneurological patients. The findings indicate that the nonfluent aphasic patients did not rehearse the verbal information while the fluent aphasic, right-brain-damaged, and nonneurological patients did rehearse. In addition, both fluent and nonfluent aphasic patients encoded significantly less information into the memory system initially and performed worse on the task overall than right-brain-damaged and nonneurological patients.     

Syntactic comprehension deficits in agrammatism

Eleven agrammatic and 16 fluent aphasic patients were given a comprehension task consisting of simple, active and passive reversible sentences. The purpose of the study is to reconsider the comprehension disorders in agrammatism, and particularly of passive reversible sentences, to test to what extent Grodzinsky's trace deletion hypothesis (TDH) is generalizable to other types of NP-movement, and finally to ascertain whether the pattern of impairment observed in agrammatism differs from that of fluent aphasic patients. The study confirms that trace analysis may be selectively impaired in agrammatism. However, this deficit is not the only mechanism underlying comprehension disorders and cannot be said to occur in all agrammatic patients. Comprehension disorders also involve the processing of clitic object pronouns which also underly NP-movement. Finally, the impairment found in fluent aphasic patients differs, both in type and severity, from that of agrammatic patients, thus confirming the peculiar aspects of the agrammatic comprehension deficit suggested by Grodzinsky's TDH.     

A psychometric analysis of functional category production in English agrammatic narratives

Hierarchical models of agrammatism propose that sentence production deficits can be accounted for in terms of clausal syntactic structure [Friedmann, N., & Grodzinsky, Y. (1997). Tense and agreement in agrammatic production: Pruning the syntactic tree. Brain and Language, 56, 397-425; Hagiwara, H. (1995). The breakdown of functional categories and the economy of derivation. Brain and Language, 50, 92-116]. Such theories predict that morpho-syntactic elements associated with higher nodes in the syntactic tree (complementizers and verb inflections) will be more impaired than elements associated with lower structural positions (negation markers and aspectual verb forms). While this hypothesis has been supported by the results of several studies [Benedet, M. J., Christiansen, J. A., & Goodglass, H. (1998). A cross-linguistic study of grammatical morphology in Spanish- and English-speaking agrammatic patients. Cortex, 34, 309-336; Friedmann, N. (2001). Agrammatism and the psychological reality of the syntactic tree. Journal of Psycholinguistic Research, 30, 71-88; Friedmann, N. (2002). Question production in agrammatism: The tree pruning hypothesis. Brain and Language, 80, 160-187], it has also been challenged on several grounds [Burchert, F., Swoboda-Moll, M., & De Bleser, R. (2005a). Tense and agreement dissociations in German agrammatic speakers: Underspecification vs. hierarchy. Brain and Language, 94, 188-199; Lee, M. (2003). Dissociations among functional categories in Korean agrammatism. Brain and Language, 84, 170-188; Lee, J., Milman, L. H., & Thompson, C. K. (2005). Functional category production in agrammatic speech. Brain and Language, 95, 123-124]. In this paper the question of hierarchical structure was re-examined within the framework of Item Response Theory [IRT, Rasch, G. (1980). Probabilistic models for some intelligence and attainment tests (Expanded ed.). Chicago: University of Chicago Press]. IRT is a probabilistic model widely used in the field of psychometrics to model behavioral constructs as numeric variables. In this study we examined production of functional categories (complementizers, verb inflections, negation markers, and aspectual verb forms) in narrative samples elicited from 18 individuals diagnosed with nonfluent aphasia and 18 matched controls. Data from the aphasic participants were entered into an IRT analysis to test (1) whether production of clausal functional categories can be represented as a variable on a numeric scale; and (2) whether production patterns were consistent with hierarchical syntactic structure. Pearson r correlation coefficients were also computed to determine whether there was a relation between functional category production and other indices of language performance. Results indicate that functional category production can be modeled as a numeric variable using IRT. Furthermore, although variability was observed across individuals, consistent patterns were evident when the data were interpreted within a probabilistic framework. Although functional category production was moderately correlated with a second measure of clausal structure (clause length), it was not correlated with more distant language constructs (noun/verb ratio and WAB A.Q.). These results suggest that functional category production is related to some, but not all, measures of agrammatic language performance.     

Frontal-opercular aphasia.

The standard nomenclature divides nonfluent aphasic syndromes with relatively spared comprehension into Broca's aphasia and transcortical motor aphasia. We report on a patient with a persistent nonfluent aphasia from a discrete, primarily cortical, frontal-opercular lesion who had impaired syntax but intact repetition and, therefore, did not conform to the traditional classification. Based on this patient's behavior and a review of other cases, we have divided the nonfluent aphasias with intact comprehension into five disorders. (1) Verbal akinesia-exhibiting diminished intention or drive to speak and associated with medial frontal lesions (supplementary motor area and cingulate gyrus) or with lesions damaging the efferent projections from these areas. (2) Disorders of syntax-telegraphic and agrammatic utterances that may be associated with dominant pars opercularis lesions. (3) Phonemic disintegration-a failure to correctly produce phonemes, which may be associated with injury to the opercular primary motor cortex or efferent projections from this area. (4) Defects of lexical access-patients who struggle to find words and are impaired at timed word-generation tasks. Defects of lexical access may be associated with lesions of the pars triangularis and adjacent prefrontal cortex. (5) Mixed defects. According to this model, the traditional patient with Broca's aphasia would exhibit disorders of syntax, phonemic disintegration, and defects of lexical access, whereas the traditional patient with transcortical motor aphasia would have verbal akinesia or defects of lexical access or both. Our patient had defects of lexical access and syntax, but only mild symptoms of phonemic disintegration, suggesting that his opercular primary motor cortex was relatively intact. Our patient's ability to repeat normally while his propositional speech remained telegraphic suggests that different neural mechanisms subserve these functions.     

Recovery from aphasia: Spontaneous speech versus language comprehension

Seventy-four aphasic patients, subdivided into four groups (fluent, mixed, nonfluent, and severely nonfluent), were tested three times in the course of 1 year to assess recovery of spontaneous speech and sentence comprehension. Although 12 of the 28 spontaneous speech variables employed showed significant time changes, some of these changes indicated improvement and others deterioration. There was no overall clinical improvement in spontaneous speech in any group. On the sentence comprehension tests, however, all four groups did show considerable, significant improvement. There were no qualitative or quantitative differences among the groups in the course of recovery, despite the fact that the groups differed in the severity of aphasia as well as on the fluency dimension. In certain patients there was also some improvement in spontaneous speech, but this did not in most cases correlate with an improvement in either fluency or sentence comprehension. Possible reasons why receptive abilities improved more than expressive abilities are discussed.