The crucial role of tense for verb production

The case of an aphasic patient whose spontaneous speech contains very few lexical verbs is reported. Instead of sentences with lexical verbs, the patient produces many (grammatical) copular constructions. He also substitutes lexical verbs with the copula. Although this results in ungrammatical utterances, by doing so, a resemblance of sentence structure and a degree of grammaticality of his utterances are preserved. Although the patient is more impaired in naming action than object pictures, it is unlikely that lexical retrieval difficulties are solely responsible for the paucity of lexical verbs in his speech. A series of tests revealed a profound deficit in producing tense marking inflections and in understanding their significance. We argue that the unavailability of tense features is the primary reason for the lack of lexical verbs in his speech. An alternative possibility, that the tense deficit interacts with the verb retrieval deficit, is also discussed. The patient has a complex lesion and language profile, with features associated with both Broca's and Wernicke's aphasia. However, since the study focuses on his verb and tense deficits and the grammaticality of his utterances, issues that are often discussed in relation to agrammatic Broca's aphasia, the literature that is relevant to these topics and to Broca's aphasia is reviewed, despite the different diagnostic profile of the patient.     

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.     

Does the right hemisphere take over after damage to Broca's area? the Barlow case of 1877 and its history

In 1877 Thomas Barlow, a London physician, published a remarkable case of functional recovery of speech following brain damage. It involved a 10-year-old boy who had lost his speech, regained it, and lost it again before he died from a disorder that affected his heart and produced embolisms that subsequently affected other organs, including his brain. Examination of the boy's brain revealed two focal regions of softening; one that affected Broca's area and the left facial-motor area, and another, which occurred weeks later, in the homologous regions of the right hemisphere. Although Barlow was most concerned with motor deficits, others at the turn of the century began to cite this case as strong evidence that the corresponding region of the right hemisphere can take over speech functions for Broca's area on the left. Whether this case really provides good support for functional takeover or vicariation theory is critically evaluated in the light of contemporary research, including PET scan studies involving damage to Broca's speech region.     

Recurrent fluent aphasia associated with a seizure focus

The relationship between dominant hemisphere seizure activity and aphasia is unclear. Although speech arrest, expressive speech problems, and comprehension difficulties have often been associated with temporal lobe seizure activity, neologistic, paraphasic speech is rare. We report a patient with seizures following encephalitis who had recurrent episodes of fluent, severely aphasic speech with impaired comprehension which correlated with continuous, high voltage spike and slow wave activity in the left temporal region. During a several-day period of intermittent electrographic seizure activity, he had fluctuating receptive aphasia, and he developed transient paranoid psychosis following treatment. We discuss the behavioral manifestations of his left temporal seizures and correlate the changing nature of his behavior with therapeutic interventions. This case, as well as a review of others, suggests that paroxysmal fluent aphasia results from a partially treated electrographic seizure focus in the dominant temporal lobe.     

Relating selective brain damage to impairments with voicing contrasts

Research is reviewed concerning the performance of several neurological groups on the perception and production of voicing contrasts in speech. Patients with cerebellar damage, Parkinson's disease, specific language impairment, Broca's aphasia, apraxia, and Wernicke's aphasia have been reported to be impaired in the perception and articulation of voicing. The types of deficits manifested by these neurologically impaired groups in creating and discriminating voicing contrasts are discussed and the respective contributions of separate neural areas are identified. A model is presented specifying the level of phonemic processing thought to be impaired for each patient group and critical tests of the model's predictions are identified.     

Interaction between verbal and gestural language in progressive aphasia: a longitudinal case study.

The objective of this longitudinal study is to investigate the on-line interaction between praxis and linguistic abilities in a progressive aphasia case. During 3 years of evolution, procedural discourse of a progressive aphasic patient was videotaped five times, allowing us to analyze the progression of both language and gestural production as well as the interaction between these two. We anticipated that, in the absence of apraxia, the patient would compensate for her speech deficit by producing progressively more and more meaningful gestures. Our compensatory hypothesis was confirmed but the compensation was not as efficient as one would expect given the absence of apraxia. With the progression of the speech deficit, the patient could not replace some verbs by pantomimes that were otherwise accompanying her discourse in the preceding testing sessions. We suggest that such a compensatory ability may constitute one important characteristic of the progressive aphasia syndrome.     

Does Gustave Dax deserve to be forgotten? The temporal lobe theory and other contributions of an overlooked figure in the history of language and cerebral dominance.

Gustave Dax played an important role in the early history of cerebral dominance for language. He not only sent the 1836 memoir of Marc Dax, his deceased father, to Paris in 1863, but saw to it that this important document was published before Paul Broca's own article on cerebral dominance appeared later in 1865. In addition, he supported his father's contention that the left hemisphere is special for speech with 140 additional clinical cases. Gustave Dax's own unique contribution, however, has been almost completely overlooked. Although his theory lacked specificity, he preceded Meynert, Schmidt, and Wernicke in suggesting that the left temporal lobe may be especially important for speech.     

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.     

Cerebral control for speech in right-handers and left-handers: an analysis of the views of Paul Broca, his contemporaries, and his successors

According to several recent historical accounts, Broca (1865a) stated that left-handers are the mirror-reverse of right-handers for cerebral control of speech, with the right hemisphere being dominant in left-handers, and the left hemisphere dominant in right-handers. The same accounts then note Broca's error in light of current evidence that the majority of left-handers are left-dominant for speech just as are nearly all right-handers. Eling (1984) has called such statements misrepresentations of Broca's position and has argued that Broca's analysis actually was more compatible with the current view that there is a disjunction, meaning an absence of an intimate anatomical relationship, between cerebral control for handedness and speech. The current paper looks again at Broca's work, describes the context in which his views were first articulated, and traces the development of the mirror-reversal principle. The conclusion is reached that, judged by a narrow reading of the 1865 paper, Broca's views could indeed be construed as an anticipation of the modern disjunction principle. However, judged by a broader reading, by consideration of his other writing, and in the context of the philosophical and scientific tradition that shaped his work, it is suggested that it was the mirror-reversal principle to which Broca was actually disposed.     

Acalculia in a patient with severe language disturbances: how do we test it?

The present paper describes a case of a patient with severe Wernicke aphasia, which when tested with a number processing and calculation battery adapted to his difficulties showed remarkable arithmetic skills. These findings suggest that the patients with severe cognitive impairments (e.g., aphasia, apraxia) should be tested with batteries adapted to their disturbances because using a standard test may bias the results.     

Phrenological studies of aphasia before Broca: Broca's aphasia or Gall's aphasia?

The history of aphasia is usually taken to begin with Broca's (1861a,b) discovery of the correlation of aphemia with damage to the posterior inferior portion of the frontal lobes and the subsequent relation to left hemisphere. That there were prior, even biblical, references to aphasia is not in dispute, nor that, according to Benton and Joynt (1960), almost all the clinical forms of aphasia had been described prior to 1800. The significance of Broca's case studies, therefore, lies in the association of motor aphasia with focal pathology in the frontal lobe. This paper examines the status of aphasia localization prior to Broca, and, specifically, the extent to which Broca's discovery may have been anticipated by the phrenologists.     

Broca's aphasia, verbs and the mental lexicon

Verb production is notoriously difficult for individuals with Broca's aphasia, both at the word and at the sentence level. An intriguing question is at which level in the speech production these problems arise. The aim of the present study is to identify the functional locus of the impairment that results in verb production deficits in Broca's aphasia. Levelt's (1989) model is used as a theoretical framework for this study. Two experiments have been conducted, one on verb movement and one on verbs with alternating transitivity. The results suggest that the functional impairment in Broca's aphasia should be located in Levelt's "grammatical encoder."     

The neurology of syntax: language use without Broca's area

A new view of the functional role of the left anterior cortex in language use is proposed. The experimental record indicates that most human linguistic abilities are not localized in this region. In particular, most of syntax (long thought to be there) is not located in Broca's area and its vicinity (operculum, insula, and subjacent white matter). This cerebral region, implicated in Broca's aphasia, does have a role in syntactic processing, but a highly specific one: It is the neural home to receptive mechanisms involved in the computation of the relation between transformationally moved phrasal constituents and their extraction sites (in line with the Trace-Deletion Hypothesis). It is also involved in the construction of higher parts of the syntactic tree in speech production. By contrast, basic combinatorial capacities necessary for language processing--for example, structure-building operations, lexical insertion--are not supported by the neural tissue of this cerebral region, nor is lexical or combinatorial semantics. The dense body of empirical evidence supporting this restrictive view comes mainly from several angles on lesion studies of syntax in agrammatic Broca's aphasia. Five empirical arguments are presented: experiments in sentence comprehension, cross-linguistic considerations (where aphasia findings from several language types are pooled and scrutinized comparatively), grammaticality and plausibility judgments, real-time processing of complex sentences, and rehabilitation. Also discussed are recent results from functional neuroimaging and from structured observations on speech production of Broca's aphasics. Syntactic abilities are nonetheless distinct from other cognitive skills and are represented entirely and exclusively in the left cerebral hemisphere. Although more widespread in the left hemisphere than previously thought, they are clearly distinct from other human combinatorial and intellectual abilities. The neurological record (based on functional imaging, split-brain and right-hemisphere-damaged patients, as well as patients suffering from a breakdown of mathematical skills) indicates that language is a distinct, modularly organized neurological entity. Combinatorial aspects of the language faculty reside in the human left cerebral hemisphere, but only the transformational component (or algorithms that implement it in use) is located in and around Broca's area.     

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.     

Optic aphasia and the right hemisphere: a replication and extension.

Optic aphasia is a rare, visual modality-specific naming disorder. We describe a patient who developed this disorder subsequent to a left occipital lobe infarction. Like another case that we described previously, this patient performed normally on a variety of tasks assessing the recognition of objects he could not name. Additionally, although he never read aloud a single word, his performance on lexical decision and word comprehension tasks was far better than chance. We suggest that his performance was mediated by a right hemisphere semantic system.     

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.     

The noun-verb problem in Chinese aphasia.

Previous studies have shown that Broca's aphasics experience a selective difficulty with action naming inside or outside of a sentence context. Conversely, it has been suggested that Wernicke's aphasics are particularly impaired in object naming. A number of explanations have been offered to account for this double dissociation, including grammatical accounts according to which the main verb problem in agrammatic Broca's aphasics is viewed as a by-product of their syntactic and/or morphological impairment, due perhaps to the greater morphological load carried by verbs (compared with nouns). In the Chinese language, there are no verb conjugations and no declensions. Hence there is no reason to expect a relationship between morphological impairment and deficits in action naming. We examined comprehension and production of object and action names, outside of a sentence context, in a sample of Chinese-speaking Broca's and Wernicke's aphasics. There was an interaction between patient group and object/action naming, but no corresponding interaction on the comprehension task. We conclude that action-naming deficits in Broca's aphasia (and/or the corresponding sparing of action names in Wernicke's aphasia) cannot be attributed to morphological differences between nouns and verbs. We also found a sublexical variant of the noun/verb dissociation applied to the internal structure of compound words made up of a verbal and a nominal element: Broca's aphasics tended to lexicalize the verbal portion of these words more often than the nominal compound, while Wernicke's showed the opposite pattern. These sublexical effects are difficult to explain in syntactic terms nor do they fit the standard lexical view. A modified lexical account is proposed, emphasizing semantic/conceptual effects in a distributed lexicon.     

Contrasting speech patterns in apraxia of speech and phonemic paraphasia

This study was designed to determine if perceptual phonological analysis would reveal distinctions between patients with apraxia of speech and patients with phonemic paraphasic speech. Test findings from 10 Broca's aphasics with apraxia of speech were compared to findings from 10 paraphasic speakers (5 conduction and 5 Wernicke's aphasics). Several marked differences were revealed. Predominant locus of errors and relative difficulty of different classes of phonemic segments were significant discriminators. There was a nonsignificant trend for substituted phonemes to be further from target phonetically in the paraphasic patients. In addition, the two groups showed certain consistent differences in the types of errors they produced. Apraxic patients produced many errors of transitionalization, while sequencing errors were more typical of the patients with phonemic paraphasia. The findings are interpreted in relation to a neuropsychological model of speech. It is suggested that phonemic paraphasia represents a breakdown mainly in the retrieval of phonological word patterns, while apraxia of speech is characterized predominantly by a disturbance in encoding phonological patterns into appropriate speech movements.     

Persisting apraxia in two left-handed, aphasic patients with right-hemisphere lesions

Apraxia usually follows a left hemisphere lesion in right-handers with left hemisphere speech representation. Apraxia following a right hemisphere lesion in left-handers is rare, however, and not well documented in the literature. Two left-handed patients are described in whom apraxia and aphasia followed a right hemisphere lesion. Both the apraxic and the aphasic deficits improved but were still demonstrable 6 weeks following the infarct. The data are consistent with those for right-handers with left hemisphere lesions in suggesting some overlap of anatomical structures for the control of speech and praxis.     

Impairment of syntax and lexical semantics in a patient with bilateral paramedian thalamic infarction

Bilateral vascular thalamic lesions are rare. Although a variety of neurobehavioral manifestations have been described, the literature is less documented with regard to accompanying linguistic disturbances. This article presents an in-depth neurolinguistic analysis of the language symptoms of a patient who incurred bilateral paramedian ischemic damage of the thalamus. In the post-acute phase of the stroke, a unique combination of transcortical sensory aphasia with syntactic impairment was found. Because of this atypical semiological association, additional analyses of spontaneous speech were performed. In spite of the typological affinity with the grammatic characteristic of marked simplification of syntax observed in Broca's aphasia, only a wordclass specific, lexical-semantic deficit for verbs was objectified. The hypothesis that lexical-semantic disturbances in our patient might result from a functional deafferentiation of both thalami with the frontal lobe is supported by: (1) associated neuropsychological deficits of frontal origin and (2) frontal-like behavioral disturbances.