Auditory processing of brain-damaged adults under competitive listening conditions

Right CVAs, mild left CVAs, and non-brain-damaged adults received the Token Test under three conditions: quiet, white noise, and speech babble. Left CVAs performed most poorly of all groups in all conditions experiencing difficulty with subtests III, IV, and V. Right CVAs were inferior to controls on each of these three subtests in the speech babble condition only. Thus, right CVA difficulty with both memory and syntactic tasks was demonstrated in speech babble. These results are explained by the hypothesis that both hemispheres are necessary to process auditory information under complex listening conditions. Total brain capacity of right CVA patients may be overloaded if either memory load or linguistic complexity is increased in the presence of certain types of listening competition.     

Hemispheric asymmetry in a perceptual priming task: evidence from patients with unilateral brain damage.

The present study examined the relationship between unilateral brain damage and the effect of nonverbal perceptual priming using a picture-fragment completion task. Subjects consisted of 11 left brain-damaged patients, 8 right brain-damaged patients, and 10 healthy normal controls. The mean score of normal controls was significantly higher than those of left and right brain-damaged patients. Although there were significant effects of priming in all the groups, a significant difference in amplitude of priming effects was found only between right brain-damaged patients and normal controls. The correlation between amount of fragmentation at which there was identification and priming effect was not significant. We conclude that the right hemisphere is more involved in perceptual priming of form than is the left hemisphere, and form-dependent processing in the perceptual priming task has an asymmetrical distribution in the right and left hemispheres.     

Effects of right and left hemisphere damage on performance of the "Right Hemisphere Communication Battery"

A Hebrew adaptation of Gardner and Brownell's (1986) "Right Hemisphere Communication Battery" (HRHCB) was administered to 27 right brain-damaged (RBD) patients, 31 left brain-damaged (LBD) patients, and 21 age-matched normal controls. Both patient groups showed deficits relative to controls and overall there was no difference between the two patient groups. A factor analysis of patients' scores on the HRHCB yielded two interpretable factors, a verbal and a nonverbal one. These factors were not lateralized. Performance of patients on the HRHCB correlated significantly and positively with performance on most tests of basic language functions, measured with a Hebrew adaptation of the "Western Aphasia Battery" (HWAB) and with other cognitive functions measured with standardized neuropsychological tests. There were stronger correlations of HRHCB with subtests of the HWAB in LBD patients and with nonlanguage cognitive tests in RBD patients. In the LBD group, HRHCB subtests' scores correlated negatively with lesion extent in frontal and temporal perisylvian regions. Such localization was not observed in RBD patients. The results argue against selective right hemisphere (RH) involvement in the RHCB, alleged to measure pragmatic aspects of language use, and show, instead, bilateral involvement. The results also argue against a modular organization of these functions of language use, especially in the RH.     

Perception and production of tone in aphasia

An acoustical and perceptual study of lexical tone was conducted to evaluate the extent and nature of tonal disruption in aphasia. The language under investigation was Thai, a tone language which has five lexical tones--mid, low, falling, high, and rising. Subjects included six left brain-damaged aphasics (two Broca's, one transcortical motor, one global, one conduction, one Wernicke), one right brain-damaged nonaphasic, one cerebellar dysarthric, and five normals. High-quality tape recordings of each subject's productions of a minimal set of five, monosyllabic Thai words were presented to 10 adult Thai listeners for identification. Results from the phonemic identification tests indicated that tone production is relatively spared in aphasic patients with unilateral left hemisphere lesions. The performance of the global aphasic, however, was considerably below normal. Patterns of tonal confusions further revealed that the performance of all aphasics, except the global, differed from that of normal speakers primarily in degree rather than in kind. Tonal contrasts were signaled at a high level of proficiency by the right brain-damaged and dysarthric patients. Acoustical analysis revealed that F0 contours associated with the five tones for all aphasics, except the global, were similar in overall shape as well as position in the tone space to those of normals. F0 contours for the right brain-damaged patient and the dysarthric also generally agreed with those of normals in terms of shape and position. F0 ranges of both aphasic and nonaphasic brain-damaged speakers were generally larger than those of normals for all five tones. The relationship between tone and vowel duration was generally similar to that of normals for all brain-damaged speakers. A comparison of aphasics' performance on tone perception (J. Gandour & R. Dardarananda, 1983, Brain and Language, 18, 94-114) and tone production indicated that, for the normal and right brain-damaged subjects, performance on the perception task was higher than on production, whereas the opposite was true for the aphasics. These data are brought to bear on issues related to tone production in aphasia, consonant and vowel production in aphasia, hemispheric specialization for tone production, intonation production in aphasia, relationship between speech perception and speech production, and tone production in dysarthria with cerebellar disease.     

Comprehension of Idioms in Turkish Aphasic Participants

Brain damaged participants offer an opportunity to evaluate the cognitive and linguistic processes and make assumptions about how the brain works. Cognitive linguists have been investigating the underlying mechanisms of idiom comprehension to unravel the ongoing debate on hemispheric specialization in figurative language comprehension. The aim of this study is to evaluate and compare the comprehension of idiomatic expressions in left brain damaged (LBD) aphasic, right brain damaged (RBD) and healthy control participants. Idiom comprehension in eleven LBD aphasic participants, ten RBD participants and eleven healthy control participants were assessed with three tasks: String to Picture Matching Task, Literal Sentence Comprehension Task and Oral Idiom Definition Task. The results of the tasks showed that in overall idiom comprehension category, the left brain-damaged aphasic participants interpret idioms more literally compared to right brain-damaged participants. What is more, there is a significant difference in opaque idiom comprehension implying that left brain-damaged aphasic participants perform worse compared to right brain-damaged participants. On the other hand, there is no statistically significant difference in scores of transparent idiom comprehension between the left brain-damaged aphasic and right brain-damaged participants. This result also contribute to the idea that while figurative processing system is damaged in LBD aphasics, the literal comprehension mechanism is spared to some extent. The results of this study support the view that idiom comprehension sites are mainly left lateralized. Furthermore, the results of this study are in consistence with the Giora’s Graded Salience Hypothesis.     

PET activation studies comparing two speech tasks widely used in surgical mapping

"Automatic" speech, especially counting, is frequently preserved in aphasia, even when word production is severely impaired. Although brain sites and processes for automatic speech are not well understood, counting is frequently used to elicit fluent speech during preoperative and intraoperative cortical mapping for language. Obtaining both behavioral and functional brain imaging measures, this study compared counting with a word production task (generation of animal names), including non-verbal vocalizations and quiet rest as control states, in normal and aphasic subjects. Behavioral data indicated that normal and aphasic groups did not differ in counting or non-verbal vocalizations, but did differ significantly in word production ("naming" animals). Functional brain imaging results on normal subjects using partial least squares analysis of PET rCBF images revealed three significant latent variables (LVs): one for naming and vocalizing, identifying bilateral anterior areas, with left predominating over right; a second LV for naming, identifying left and right frontal and temporal areas. For the third, only marginally significant LV, which was associated with automatic speech alone (counting), right and subcortical sites predominated. For patients, two LVs emerged, identified with naming and vocalization, and corresponding to a variety of cerebral sites; the analysis failed to find a specific latent variable for counting. A comparison between group data for normal subjects and patients suggested that the naming, counting, and vocalization tasks were performed differently by the two groups. These results suggest that word generation as a verbal task is more likely to elicit activity in classical language areas than counting. Further studies are suggested to better understand differences between neurological substrates for non-propositional and automatic speech.     

Disorders of classificatory activity in aphasia

Two nonverbal tasks of classificatory activity ("class inclusion" and "class intersection") were administered to 46 aphasics, 28 normal controls, 19 nonaphasic left-brain-damaged and 17 right-hemisphere-damaged patients in order to study if aphasic patients are more impaired than nonaphasic brain-damaged patients on these two tasks of elementary logic and if a relationship exists within the aphasic patients between inability to perform the tasks of classifiactory activity and impairment of the semantic-lexical level of integration of language. Results were for the most part in line with expectations because aphasics scored worse than normal controls and nonaphasic brain-damaged patients (even if the difference reached the level of statistical significance only on the test of "class intersection") and within the aphasic patients the worst results were obtained by subjects presenting clear signs of semantic-lexical disintegration.     

Voice onset time in aphasia: Thai. I. Perception

This study investigated left brain-damaged aphasic and right brain-damaged non-aphasic patients' ability to label synthetic speech continua differing in voice onset time (VOT) at three places of articulation. The language chosen for investigation was Thai, which exhibits 3 contrasting labial and apical stop categories (voiced, voiceless unaspirated, voiceless aspirated) and 2 contrasting velar stop categories (voiceless unaspirated, voiceless aspirated). Results of the labelling task indicated an impairment in VOT perception at all three places of articulation across clinical types of aphasia. Normal performance by the right brain-damaged patient indicated that deficits in VOT perception can be attributed to pathology specific to the language-dominant hemisphere. No relation was found between the aphasic patient's level of auditory language comprehension and his performance on the VOT perception task. It is suggested that the aphasics' impairment reflects a deficit in phonological processing at the linguistic level.     

Analytical competence and language impairment in aphasia

Matched groups of Broca's and Wernicke's aphasics, brain-damaged patients without aphasia and chronic schizophrenics were tested in a nonverbal matching task where the subject had to indicate which of two pictures was more closely linked to a clue picture. Eight additional verbal and nonverbal reference tasks were administered. Both aphasic groups performed worse than brain-damaged controls when the identification of individual attributes or actions shared by clue and referent was required, but were unimpaired when the two had a set of referential-situational associations in common. Factor analyses resulted for both groups in two factors, one of which represents general Language Impairment. For the Broca's aphasics this factor was closely related to general organic deficit as measured by the Trail Making Test; for the Wernicke's aphasics it was associated with tasks which might be considered illustrative of analytical competence in isolating and comparing individual features of objects or concepts.     

Confrontation naming impairment in dementia

In tone languages pitch variations (tones) serve to distinguish the lexical meanings of words. This study was conducted to examine the extent and nature of impairment in the perception of tones by aphasic patients who were monolingual speakers of Thai, a tone language which has five contrastive tones (mid, low, falling, high, rising). Six subjects participated in the study: two Broca aphasics, one transcortical motor aphasic, one conduction aphasic, one right brain-damaged nonaphasic, and one normal control. Three sets of stimuli (two real-speech, one synthetic-speech) were presented for identification, each set containing five Thai words minimally distinguished by tone. Results of the perception tests indicated that the performance of all four left brain-damaged aphasics differed significantly from that of the normal control, while the performance of the right brain-damaged nonaphasic did not. The normal performance of the right brain-damaged nonaphasic patient on this tone identification task suggests that deficits in the perception of tone exhibited by left brain-damaged patients can be attributed specifically to pathology in the language dominant hemisphere rather than to a general brain-damage effect. No difference in performance among the left brain-damaged patients could be attributed to a specific type of aphasic syndrome. The pattern of tonal confusions of the aphasics in comparison to that of normals suggests that their deficit is primarily quantitative rather than qualitative. Although two (mid, low) of the five tones accounted for a large percentage of the aphasics' errors, no uniform rank order of tones in terms of identifiability could be established across aphasic subjects, which suggests that their deficit is general to all five tones rather than selective to individual tones.     

Development of procedures for rating posed emotional expressions across facial, prosodic, and lexical channels.

A number of rating systems are available to evaluate emotional communication in a single modality. The main purpose of this study was to develop procedures to train human raters to evaluate posed expressions of emotion across three different channels of communication, i.e., facial, prosodic/intonational, and lexical/verbal. These procedures were used to evaluate posed emotional expressions produced by individuals with unilateral brain lesions from stroke. Posers in this preliminary report were two right brain-damaged, two left brain-damaged, and two normal control right-handed adults who were matched on demographic and neurological factors. Eight emotional expressions, both positive and negative, were produced in three channels and rated for intensity, pleasantness, and category accuracy. 15 normal adults served as raters, five per channel. The rating procedures were comparable across channels, with analogous properties, and yielded substantial interrater agreement. In this small sample of posers, it was observed that the expressions of the right brain-damaged group were rated as the least accurate and those of the left brain-damaged group as the most intense. When patterns of individual performance across the channels were examined, performance was quiet consistent for the normal controls yet variable for the right brain-damaged persons. These observations are in keeping with the notion that patients with right hemisphere pathology have difficulty in emotional communication. In summary, these findings suggest that comparison of emotional expressions across multiple channels is feasible.     

Sex differences in spatial task performance of patients with and without unilateral cerebral lesions

Two visuospatial tasks, the WAIS Block Design and the Street Gestalt Completion Test, were administered to men and women with and without unilateral cerebral lesions. These two tasks represent different categories of visuospatial functions. The Street test is a visual-perceptual gestalt task, requiring the closure of fragmented pictures, whereas Block Design is an analytical, manipulospatial task requiring rotation of spatial coordinates. For the non-brain-damaged group, the men showed a nonsignificant trend toward better Block Design performance relative to the women, whereas there was no sex-related difference in Street performance. For the brain-damaged groups, patients with right hemisphere lesions performed significantly worse than patients with left hemisphere lesions on both the Street test and Block Design, indicating that both tasks were more sensitive to right hemisphere functioning. There was, however, a significant sex X side of lesion interaction on Block Design only, with the men showing a more asymmetrical pattern of scores. These results suggest that sex differences in functional lateralization may underlie sex differences in visuospatial ability, and that sex differences in functional lateralization may be present for only certain visuospatial processes.     

Colour, face, and visuospatial imagery abilities in low-vision individuals with visual field deficits

This study investigates to what extent visual perception integrity is necessary for visual mental imagery. Sixteen low-vision participants with severe peripheral visual field loss, 16 with severe central field loss, 6 left brain-damaged patients with right homonymous hemianopia, 6 right brain-damaged patients with left homonymous hemianopia, and 16 normally sighted controls performed perceptual and imagery tasks using colours, faces, and spatial relationships. Results showed that (a) the perceptual and mental image>ry disorders vary according to the type of visual field loss, (b) hemianopics had no more difficulties imagining spatial stimuli in their contralesional hemispace than in their ipsilesional one, and (c) the only hemianopic participant to have perceptual and mental imagery impairments suffered from attentional deficits. Results suggest that (a) visual memory is not definitively established, but rather needs perceptual practice to be maintained, and (b) that visual mental imagery may involve some of the attentional-exploratory mechanisms that are employed in visual behaviour.     

Impact of emotional content on discourse production in patients with unilateral brain damage.

A picture story task was developed to examine expression of emotion via the verbal/lexical channel. The task elicited discourse with either emotional, visual-spatial, or neutral content and was administered to right brain-damaged (RBD), left brain-damaged (LBD), and normal control (NC) right-handed adults. Subjects were matched for gender, age, education, and occupational status. The brain-damaged groups were matched for months post-CVA onset and were similar with respect to intrahemispheric site of lesion. While the number of words produced was equivalent for each of the subject groups, the RBDs and LBDs expressed quantitatively less content than did the NCs. When content differences were examined within each subject group, there were no differences for LBDs and NCs, but the RBDs showed a selective deficit when producing emotional content. This finding suggests a special role for the right hemisphere in the production of emotional content in verbal discourse.     

Bilateral capacity for speech sound processing in auditory comprehension: evidence from Wada procedures

Data from lesion studies suggest that the ability to perceive speech sounds, as measured by auditory comprehension tasks, is supported by temporal lobe systems in both the left and right hemisphere. For example, patients with left temporal lobe damage and auditory comprehension deficits (i.e., Wernicke's aphasics), nonetheless comprehend isolated words better than one would expect if their speech perception system had been largely destroyed (70-80% accuracy). Further, when comprehension fails in such patients their errors are more often semantically-based, than-phonemically based. The question addressed by the present study is whether this ability of the right hemisphere to process speech sounds is a result of plastic reorganization following chronic left hemisphere damage, or whether the ability exists in undamaged language systems. We sought to test these possibilities by studying auditory comprehension in acute left versus right hemisphere deactivation during Wada procedures. A series of 20 patients undergoing clinically indicated Wada procedures were asked to listen to an auditorily presented stimulus word, and then point to its matching picture on a card that contained the target picture, a semantic foil, a phonemic foil, and an unrelated foil. This task was performed under three conditions, baseline, during left carotid injection of sodium amytal, and during right carotid injection of sodium amytal. Overall, left hemisphere injection led to a significantly higher error rate than right hemisphere injection. However, consistent with lesion work, the majority (75%) of these errors were semantic in nature. These findings suggest that auditory comprehension deficits are predominantly semantic in nature, even following acute left hemisphere disruption. This, in turn, supports the hypothesis that the right hemisphere is capable of speech sound processing in the intact brain.     

Colour,face, and visuospatial imagery abilities in low-vision individuals with visual field deficits

This study investigates to what extent visual perception integrity is necessary for visual mental imagery. Sixteen low-vision participants with severe peripheral visual field loss, 16 with severe central field loss, 6 left brain-damaged patients with right homonymous hemianopia, 6 right brain-damaged patients with left homonymous hemianopia, and 16 normally sighted controls performed perceptual and imagery tasks using colours, faces, and spatial relationships. Results showed that (a) the perceptual and mental image>ry disorders vary according to the type of visual field loss, (b) hemianopics had no more difficulties imagining spatial stimuli in their contralesional hemispace than in their ipsilesional one, and (c) the only hemianopic participant to have perceptual and mental imagery impairments suffered from attentional deficits. Results suggest that (a) visual memory is not definitively established, but rather needs perceptual practice to be maintained, and (b) that visual mental imagery may involve some of the attentional–exploratory mechanisms that are employed in visual behaviour.     

Comprehension of symbolic gestures in aphasia

One-hundred-and-twenty-eight patients with unilateral hemispheric damage (53 aphasics, 26 nonaphasic left, and 49 right brain-damaged patients) and 25 normal controls were given a test of symbolic gesture comprehension and other tests of verbal comprehension and of reproduction of symbolic gestures. On the test of symbolic gesture interpretation aphasic patients performed significantly worse than any other group of brain-damaged patients. Within the aphasic patients the inability to understand the meaning of symbolic gestures was highly related to the number of semantic errors obtained at a verbal comprehension test. On the contrary, only a mild relationship was found between comprehension and reproduction of symbolic gestures. Some implications of these findings are discussed.