Nonspeech and speech processing skills in patients with aphasia and apraxia of speech

Nonspeech and speech auditory processing skills as well as internal speech processing skills were assessed among four patients with acquired "pure" apraxia of speech, 10 with acquired aphasia, 10 with aphasia plus apraxia of speech, and 11 neurologically normal adults. Fourteen tasks were administered and performances on 68 variables were examined using both nonparametric and parametric analyses controlling for the effects of advancing age and associated hearing loss. In all cases, the "pure" apractic patients performed as normal subjects. Few differences were noted among the performances of the aphasic and aphasic-apractic subjects. Results led to three major conclusions: (1) apraxia of speech is a disorder distinct from aphasia; (2) aphasic individuals, despite locus of lesion, demonstrate disabilities for processing nonspeech and speech materials presented auditorily and for analytically evaluating speech evoked internally; and (3) aphasic individuals demonstrating similar severity levels of language impairment show similar performance patterns for these types of processing tasks, despite locus of lesion or coexistence of apraxia of speech.     

The processing of the sounds and meanings of ongoing speech by aphasic subjects

The ability of aphasic subjects to process the sounds and meanings of ongoing speech was tested. Subjects, 10 aphasic and 20 control, heard test sentences which contained one member of phonemically similar word pairs in one of three semantic contexts: congruent, neutral, and noncongruent. Immediately after hearing a sentence, subjects were to indicate which member of the word pair had been in the sentence. All subject groups had similar overall patterns of response to the different semantic contexts. The division of aphasic subjects into groups of high and low comprehenders revealed response differences. High comprehending aphasic subjects, like control subjects, demonstrated interactive processing of the sounds and meaning of speech while low comprehending aphasic subjects did not.     

Reaction time methodology and the aphasic patient: a reply to Hagoort (1988)

P. Hagoort (1988, Brain and Language, 36, 335-348) suggests that the results of an experiment conducted with aphasic patients reported by W. Milberg, S. E. Blumstein, and B. Dworetzky (1987, Brain and Language, 31, 138-150) are "difficult to interpret in terms of a selective access model for normal processing because of a confound caused by the use of repeated lexical decision targets." We argue that the use of repeated lexical decision targets and other methodological compromises are necessary for using the lexical decision reaction time paradigm with aphasic patients. Furthermore, the minor differences between our data and those presented by Hagoort do not undermine our claims concerning semantic processing in different subgroups of aphasics, nor our comparisons of these patients to normal subjects.     

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.     

Spoken-word processing in aphasia: effects of item overlap and item repetition

Two studies were carried out to investigate the effects of presentation of primes showing partial (word-initial) or full overlap on processing of spoken target words. The first study investigated whether time compression would interfere with lexical processing so as to elicit aphasic-like performance in non-brain-damaged subjects. The second study was designed to compare effects of item overlap and item repetition in aphasic patients of different diagnostic types. Time compression did not interfere with lexical deactivation for the non-brain-damaged subjects. Furthermore, all aphasic patients showed immediate inhibition of co-activated candidates. These combined results show that deactivation is a fast process. Repetition effects, however, seem to arise only at the longer term in aphasic patients. Importantly, poor performance on diagnostic verbal STM tasks was shown to be related to lexical decision performance in both overlap and repetition conditions, which suggests a common underlying deficit.     

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.     

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.     

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.     

Anticipatory coarticulation in aphasia: acoustic and perceptual data

Two experiments investigated speech motor planning in aphasia by contrasting the degree of labial and lingual anticipatory coarticulation evident in normal subjects' speech with that found in the speech of aphasic subjects. In the first experiment, Linear Predictive Coding (LPC) analyses were conducted for the initial consonants of CV [si su ti tu ki ku] and CCV [sti stu ski sku] productions by 6 normal and 10 aphasic (5 anterior, 5 posterior) subjects. For normal subjects' productions, reliable coarticulatory shift was found for almost all measurements, indicating that acoustic correlates for anticipatory coarticulation obtain for [s], [t], and [k] in a prevocalic environment, as well as when [s] is the initial consonant of a CCV syllable. The data for the aphasic subjects were statistically indistinguishable from those of the normal subject group, and there were no differences noted as a function of aphasia type. In the second experiment, a subset of the consonantal stimuli produced by the normal and aphasic subjects was presented to a group of 10 naive listeners for a vowel identification task. Listeners were able to identify the productions of all subjects at a level well above chance. In addition, small but statistically significant Group differences were observed, with the [sV], [skV], and [tV] productions by anterior aphasics showing significantly lower perceptual scores than those of normal subjects.     

Rhyme Priming in Aphasia: The Role of Phonology in Lexical Access

The present experiment was conducted to explore the facilitory effects of rhyme in lexical processing in brain-damaged individuals. Normal subjects and non-fluent and fluent aphasic subjects performed auditory lexical decision and rhyme judgement tasks, in which prime-target pairs were phonologically related (either identical or rhyming) or unrelated. Results revealed rhyme facilitation of lexical decisions to real-word targets for normal and non-fluent aphasic subjects; for fluent aphasic subjects, results were equivocal. In the rhyme judgement task, facilitory effects of rhyme were found for all three groups with real-word targets. None of the groups showed clear rhyme facilitation effects with non-word targets in either task. Findings are discussed with reference to the role of phonology in lexical processing in normal and aphasic populations.     

On the specification of input units in speech perception.

The first part of this paper considers the experimental evidence concerning a primary recognition unit in speech decoding. Considerations of general human information processing abilities lead to the suggestion that this primary unit must be a fairly long, but clearly identifiable, stretch of speech. Further evidence for the need of a primary recognition unit arises from a consideration of human abilities to identify the order of sounds in a repeated sequence of nonspeech sounds. In spite of the obvious ease with which the order of elements is perceived in speech, listeners have a great deal of difficulty determining the order of sounds in a repeated sequence of nonspeech sounds. Yet there is quite compelling evidence that speech and the perception of order are functions of the same cerebral hemisphere, and, further, that aphasic deficits are accompanied by deficits in the perception of temporal order. The data in the literature suggest that syllables, and phrases defined by suprasegmentals, might function as primary recognition units.In the second part of the paper, the results of an experiment are reported, showing that if a sequence of nonspeech sounds is provided with organization analogous to the organization provided by suprasegmentals in speech then normal subjects' performance on the task of determining the temporal order of the sequence is improved. Aphasic patients, however, appear to be unable to take advantage of such organizing parameters since their performance is not significantly affected by providing organization of the stimulus.     

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.     

On-line syntactic processing in aphasia: studies with auditory moving window presentation

Twenty-eight aphasic patients with left hemisphere strokes and matched control subjects were tested on an auditory moving windows task in which successive phrases of a sentence were presented in response to subjects' self-paced button presses and subjects made timed judgments regarding the plausibility of each sentence. Pairs of sentences were presented that differed in syntactic complexity. Patients made more errors and/or took longer in making the plausibility judgments than controls, and were more affected than controls by the syntactic complexity of a sentence in these judgments. Normal subjects showed effects of syntactic structure in self-paced listening. On-line syntactic effects differed in patients as a function of their comprehension level. High-performing patients showed the same effects as normal control subjects; low performing patients did not show the same effects of syntactic structure. On-line syntactic effects also differed in patients as a function of their clinical diagnosis. Broca's aphasic patients' on-line performances suggested that they were not processing complex syntactic structures on-line, while fluent aphasics' performances suggested that their comprehension impairment occurred after on-line processing was accomplished. The results indicate that many aphasic patients retain their ability to process syntactic structure on-line, and that different groups of patients with syntactic comprehension disorders show different patterns of on-line syntactic processing.     

Syntactic gender processing in the human brain: a review and a model

Despite the increasing number of neuroimaging studies of syntactic gender processing no model is currently available that includes data from visual and auditory language comprehension and language production. This paper provides a systematic review of the neural correlates of syntactic gender processing. Based on anatomical information from cytoarchitectonic probability maps it is argued that the left BA 44 plays a central role for the active use of gender information, e.g., for explicit decisions as well as for subsequent morphological encoding. The left BA 45 is involved in the strategic generation of morphological cues that facilitate gender processing. Model implications for aphasic patients with lesions including or excluding parts of Broca's speech region are discussed.     

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.     

Response organization in selective adaptation to speech sounds

Previous experiments in speech perception using the selective adaptation procedure have found a shift in the locus of the category boundary for a series of speech stimuli following repeated exposure to an adapting syllable. The locus of the boundary moves toward the category of the adapting syllable. Most investigators have interpreted these findings in terms of feature detector models in which specific detectors are reduced in sensitivity through repeated adaptation. The present experiment was conducted to determine whether the adaptation results might be due to changes in response organization as a consequence of the labeling instructions presented to subjects in selective adaptation experiments. A perceptually ambiguous speech stimulus was selected from the middle of a [bi]-[di] test series and used as an adaptor under two different sets of instructions. One group of subjects was told that the adapting stimulus was the syllable [bi], while another group was told that the stimulus was the syllable [di]. The acoustically ambiguous adaptor failed to produce a shift in the locus of the category boundary in the direction predicted on the basis of the labeling instructions presented to subjects. These results indicate that the acoustic attributes and perceived quality of the adapting stimulus determine the direction and magnitude of the adaptation effects rather than the labels provided by the experimenter.     

Verbal self-correction behaviors of fluent and nonfluent aphasic subjects

This investigation examined the use of six explicitly defined verbal self-correction behaviors by fluent and nonfluent aphasic subjects of high and low verbal ability, and by subjects further classified into six groups according to type of aphasia (Broca's, Anomic, Wernicke's etc.). Aphasic groups, on the average, generated some type of verbal self-correction effort on more than half of their initially erroneous responses, and the proportions of these efforts did not differ between aphasic patient groups. Significant differences in self-correction success were found, however, between groups classified according to fluency and severity, as well as among the six groups based on type of aphasia. In the former case, distinctions in self-correction skill favored high-verbal-ability groups regardless of fluency classification. In the latter instance, the subgroups typically formed by less severely impaired patients (Anomic and Broca's) had significantly higher proportions of successful self-correction behaviors than those comprised of individuals with more severe involvement (Wernicke's and Broca's plus severely limiting apraxia of speech). Between-group differences for specific types of self-correction behaviors occurred rarely, but those which were found could be related to characteristics of the particular aphasic groups under consideration. Verbal self-correction behavior is discussed as a behavioral reaction to an erroneous response or dissatisfaction with the quality of an intended response. These behaviors are viewed as indicators of the intactness of an aphasic individual's self-monitoring system, and of his tolerance for responses that are qualitatively limited by his verbal deficits.     

The quantitative analysis of agrammatic production: procedure and data

Despite the long-standing interest in structural aspects of aphasic production, no method has emerged for the systematic analysis of aphasic speech. This paper attempts to address that need by outlining a procedure for the quantitative assessment of narrative speech which yields measures for both morphological and structural characteristics of aphasic production. In addition to complete instructions for carrying out this analysis, data for three groups of subjects are presented: agrammatic aphasics, aphasics who are similarly nonfluent but not clinically judged as agrammatic, and normal controls. While the agrammatics were distinguishable from the nonagrammatic patients on most measures, both nonfluent groups showed comparable reductions in the structural complexity of their propositional utterances. Other findings include indications from individual patient data that aspects of grammatical morphology may dissociate in agrammatism.     

The relation between oral movement control and speech

A large series of neurological patients, selected solely on the basis that they had damage restricted to one hemisphere of the brain, was given a variety of tests of basic speech and praxic function. Within the left-damaged group, patients were further identified as aphasic or nonaphasic, based on preexisting standard tests of aphasia. Subgroups of aphasics were studied on the basis of lesion location, rather than on the basis of aphasia type. The focus of the study was the relation between the production of speech and nonspeech oral movements, particularly across anterior and posterior lesions. Reproduction of single nonverbal oral movements and of single isolated speech sounds was found to be very highly correlated, and both depended selectively on the left anterior region of the brain. This same region was critically important for rapid repeated articulation of a syllable, suggesting that it mediates control at some "unit" level of movement, in a phenomenological sense, for both speech and nonspeech movements. Other "speech" regions in the left hemisphere appeared to be dispensable for the production of single oral movements, whether these were verbal or nonverbal movements. However, for most aphasic patients, an area in the left posterior region was inferred to be essential for production of multiple oral movements, whether nonverbal or verbal, suggesting a critical role in the accurate selection of movements. Within the posterior region, there was further differentiation for multisyllabic speech into a parietal system, which appeared to mediate primarily praxic function, and a temporal system, which appeared to mediate verbal-echolalic function. Aphasias from anterior and posterior lesions resembled "Broca's" and "Wernicke's" aphasia only insofar as they differed in fluency, with anterior aphasics clearly less fluent. Tests of speech comprehension did not differentiate the groups. It is suggested that classifying aphasic patients via lesion location rather than aphasic typology might yield a view of functional subsystems different from those commonly accepted.