Dissociations of language function in dementia: A case study

In this report we describe and attempt to characterize the deterioration in semantic knowledge occurring in a victim of a progressive dementing disease. The subject was unable to match even highly familiar naming words with their actual or pictured referents; instead, she consistently overextended verbal labels to closely associated distractors. The alteration in scope of referential meanings suggested by this overextension effect was apparently related to a breakdown in the structure of underlying categories. On a nonverbal match-to-sample procedure, for example, dogs were treated as exemplars of the cat family. Evidence for the breakdown of semantic knowledge was not limited to picture labeling paradigms. Thus, we found that the subject was unable to utilize semantic context in the written disambiguation of spoken homophones but could, at the same time, use even minimal syntactic cues as the basis for proper lexical selection. This last result was consistent with other lines of evidence pointing to the relative preservation of syntactic operations, in marked contrast to the semantic loss. The importance of this dissociation of function in organic pathology is considered from a number of perspectives, including its relevance to models of language organization in the brain.     

Speech production mechanisms in aphasia: A delayed auditory feedback study

Data collected from a delayed auditory feedback (DAF) study conducted by F. Boller, P. B. Vrtunski, Y. Kim, and J. L. Mack (1978, Cortex, 14, 212–226) were reanalyzed to determine if speech quality measures which were significantly affected during DAF could be operationalized and to ascertain which type of errors are responsible for the judgement. A second goal of this study was to determine if Conduction aphasics were relatively spared under conditions of DAF, as has been shown in previous studies. Twenty aphasic patients and ten controls were presented with several speech production tasks under two delay conditions and two simultaneous feedback conditions. Results indicated that only the category of vowel length produced a significant number of errors, suggesting that DAF affects articulatory implementation. Conduction aphasics showed the least effect of all the groups. These results support Wernicke's and Geschwind's model, in which Conduction aphasics have a disconnection between the sensory and motor images of words. In contrast, Broca's aphasics were the most affected group under DAF, suggesting that a major component of their disorder is phonetic in nature.     

Neologistic jargon aphasia: A case report

This study examined aspects of speech produced by an aphasic subject with neologistic jargon. Grammatical category, syllabic structure, and phonemic characteristics of neologisms, paraphasias, and correct productions were analyzed and compared. Results tended to confirm an anomic component in this type of aphasia and to support a role for the postactivation of phonemic units from prior utterances in the phonemic composition of some neologistic productions. In opposition to prior claims, however, the results also showed a striking similarity between neologisms and paraphasias, suggesting that similar mechanisms may be involved in both types of aphasic error.     

Iconic reading in a case of alexia without agraphia caused by a brain tumor: a tachistoscopic study

The lack of nonverbal reading comprehension in the clinical disconnection syndrome, alexia without agraphia, has been contradictory to the relative reading comprehension of the right hemisphere in split brains. We report a 39-year-old patient with verbal alexia without agraphia caused by brain tumor. On rapid tachistoscopic presentation of object names, he denied seeing anything but showed nonverbal reading comprehension by pointing to the corresponding objects. He lost this ability when he recovered ability to name individual letters of the object names. Our results suggest that even partial verbal reading such as the naming of single letters makes demonstration of iconic reading impossible and that total functional disconnection from verbalization, as initially noted in this case or in split brain studies, is necessary to show nonverbal reading comprehension.     

Comprehension disorders in aphasia: a historical review.

This paper reviews the clinical reports and theoretical inferences made by early scientists in regard to the impairment of auditory comprehension so often found in aphasics. It first presents an analysis of the literature on and the interpretation of comprehension disorders in aphasia up to the time of Pierre Marie and Arnold Pick. It then reviews early attempts to assess and quantify receptive impairment. Finally, it discusses the historical origin of some of the questions on comprehension currently under investigation by contemporary researchers.     

On the role of the anterior cingulate cortex in phonation: A case report

A 41-year-old male patient is presented with a lesion in the anterior cingulate cortex, medial orbital cortex, and rostral striatum bilaterally and supplementary motor area on the left side. The patient first exhibited a state of akinetic mutism which lasted about 6 weeks. During this state, no volitional vocal utterances were made; there were, however, occasional groans of pain. During recovery, the mute phase was replaced by a state in which the patient could whisper but not phonate verbal utterances. About 10 weeks after the accident, phonation was restored. The speech was characterized, however, by monotonous intonation and a very low frequency of spontaneous utterances. While the frequency of spontaneous speech improved noticeably during the following months, emotional intonation remained permanently defective. A comparison of the present case with other cases from the literature as well as experimental monkey data suggest that the anterior cingulate cortex is involved in the volitional control of emotional vocal utterances.     

Acquired aphasia with convulsive disorders in children: a case study with a seven-year follow-up.

In a 7-year follow-up a case of the “syndrome of acquired aphasia with convulsive disorder” is described. In particular, attention is paid to EEG patterns and linguistic analysis. Although seizures have been controlled medically and EEG abnormalities have tended to improve, no close parallel improvement has been observed in the patient's language disorders.     

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.     

Crossed dextral aphasia: A clinical radiological correlation

Three lifelong right-handed patients with clinically and radiologically well-defined right-hemispheric infarctions became aphasic. Their language functions in the rehabilitative, subacute phase of their illness were characterized by fluent, literal paraphasic output, dyslexia, and dysgraphia. Auditory comprehension was fair for contextual conversation, and the combination of language abilities enabled them to reach a “functional communication” stage. This study was unable to determine why these three patients had crossed dextral aphasias resulting from their otherwise typical clinical and radiological right-hemispheric infarcts. Of interest, the radiologically well-defined lesions, aside from being ipsilateral, fitted well the “posterior” fluency localization in two of the three patients, but was more extensive in the third.     

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.     

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.     

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.     

The selective impairment of phonological processing: A case study

A case study is reported of an aphasic patient with fluent speech and markedly superior comprehension of written vs. spoken words. Results of extensive testing supported the hypothesis that the patient suffers from a phonological processing deficit that affects performance in all tasks that require the generation of a phonological code. This selective deficit is interpreted as the underlying cause of diverse symptoms such as asyntactic comprehension of written sentences, the commission of spelling errors in writing, and the production of literal paraphasias and neologisms in spontaneous speech. Alternative possibilities for the classification of this patient are discussed.     

Production deficits in aphasia: A voice-onset time analysis

An experimental study was conducted to examine phonetic and phonemic deficits in the speech production of aphasics. Subjects included four Broca's aphasics, four Conduction aphasics, five Wernicke's aphasics, one nonaphasic dysarthric patient, and four normal controls. The subjects read a list of words containing word-initial stop consonants which were subsequently measured acoustically for voice-onset time. The results showed that Broca's aphasics exhibit a more severe production disorder than Conduction aphasics who in turn exhibit a more severe disorder than Wernicke's aphasics, in accord with clinical observations. In addition, although Broca's aphasics produced both phonetic and phonemic errors, the results showed that they have a pervasive phonetic disorder which affects their correct target productions as well as the total number of phonetic errors produced. This deficit however seems to be a speech deficit rather than a low-level motor control problem. In contrast, the Wernicke's aphasics show a deficit characterized by isolated phonemic mistargeting errors. Finally, the pattern of productions for the Conduction aphasics indicates that some patients show a predominantly phonetic disorder similar to the Broca's aphasics and others show predominantly a phonemic disorder similar to the Wernicke's aphasics.     

Semantic processing in aphasia: Evidence from an auditory lexical decision task

W. Milberg and S. E. Blumstein (1981, Brain and Language 14, 371–385) demonstrated semantic facilitation effects in a visual lexical decision task administered to Wernicke and other aphasics with severe comprehension deficits. In an attempt to explore the generalizability of these findings in a task where the acoustic-phonetic system could not be bypassed to access meaning, Wernicke's, Global, Broca's, and Conduction aphasics were administered a lexical decision task in the auditory modality. The patients were also given a simple semantic judgment task using the word pairs from the lexical decision task. The aphasic patients showed evidence of semantic facilitation whether they were categorized by diagnostic group or comprehension level. Performance of the semantic judgment task correlated with the severity of auditory comprehension deficits, whereas the consistency of the semantic facilitation effect did not. Even patients with severe comprehension deficits showed semantic facilitation. These results decrease the likelihood that auditory comprehension deficits are due to semantic organization per se and increase the likelihood that the deficits lie in one of the many processes involved in access to that information.     

A case report on the use of flooding in stuttering therapy

The last several years have seen the development and use of anxiety-reduction procedures in stuttering therapy. Among these types of methods, systematic desensitization and reciprocal inhibition have been employed almost exclusively. Emotional de-conditioning by means of flooding or implosive techniques has been attempted far less often. This article presents a case report on the utilization of the flooding tactic. Results are offered and discussed relative to the question of whether the elimination of anxiety is a realistic goal in therapy. The suggestion is offered that what many stutterers may really need to develop is the ability to generate fluency-enhancing behaviors in spite of the presence of heightened emotionality.     

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.     

Clinician attitudes toward stuttering in the United States and Great Britain: A cross-cultural study

The attitudes toward stutterers and stuttering of 702 speech-language clinicians in the United States and Great Britain were studied. Three hundred seventy-one clinicians from six states in the U.S. and 331 clinicians from England and Wales completed the Clinician Attitudes Toward Stuttering (CATS) Inventory. Results of the study were analyzed in terms of differences and similarities in attitudes between the two groups with respect to the etiology of stuttering, early intervention, the effectiveness of stuttering therapies, various therapy techniques, stutterers and their personality, parents of stutterers, clinicians, and reactions of others to stutterers.     

Optic aphasia, optic apraxia, and loss of dreaming

A 47-year-old man with a left temporo-occipital infarct in the area of the posterior cerebral artery is presented. The neuropsychological examination did not reveal aphasia or gross mental deficits. The patient presented with alexia without agraphia, color agnosia, but few visual perceptual deficits. The main impairment was in confrontation naming; he was incapable of naming objects and pictures, not from lack of recognition (excluding visual agnosia) but from lack of access to the appropriate word (optic aphasia). The patient also exhibited a deficit in the evocation of gesture from the visual presentation of an object (optic apraxia) and a difficulty in "conjuring up" visual images of objects (impaired visual imagery) and loss of dreams. The fundamental deficit of this patient is tentatively explained in terms of visuoverbal and visuogestural disconnection and a deficit of mental imagery.