Intonation unit analysis of conversational discourse in closed head injury.

This study employed a modification of the intonation unit analysis for conversational discourse developed by Mentis and Prutting. The percentage of total intonation units produced within separate ideational categories was calculated for groups of closed head-injured and normal control subjects as well as the examiner. No significant differences were found between subject groups or the examiner's performance within the two groups. However, significant differences were noted between the examiner's production of intonation units and the performances of both subject groups. Findings suggest the manner in which samples of conversation were elicited may have constrained the context, thereby masking potential differences between groups.

The assessment of limb apraxia: an investigation of task effects and their cause.

To test the effects of variations in the structure of tasks used to assess limb apraxia, eight tasks--differing in their modes of elicitation (tactile, verbal, visual, imitation) and/or types of movement elicited (transitive, intransitive, meaningless)--were administered to 25 carefully selected subjects with idiomotor limb apraxia. When standardized scores (based on the performance of 10 nonneurologically impaired control subjects) were used to measure the differences between tasks, no clinically significant task effects were found. Additional investigation was made of two causal hypotheses regarding the processes underlying limb apractic performance. The results of factor analyses and a search for double dissociations among individual subjects were consistent with the (severity) hypothesis that differences in task performances (raw scores) reflect degrees of task difficulty; and they failed to support the (disconnection) hypothesis that posits separate and independent neural/mental processes underlying task performances.

An investigation of a method of simplified scoring for the Kaufman Hand Movements test as a measure of limb apraxia.

A simplified, 3-category method for scoring the Kaufman Hand Movements test was devised to replace a previously used, more complex 21-category scoring method. The concurrent validity and diagnostic sensitivity of the rescored test as a measure of limb apraxia were investigated in a reanalysis of the test protocols of 23 aphasic adults. Using the Limb Apraxia Test as the criterion measure, a Pearson r of .71 and predictive validity of 100% were obtained. These results encourage further investigation of the Kaufman Hand Movements test as an efficient measure of limb apraxia.

Impairments of discourse abilities and executive functions in traumatically brain-injured adults.

Preliminary findings from an ongoing investigation of the potential relationship between narrative discourse performance and executive functions in adults with traumatic brain injuries (TBI) are reported. Narrative stories were elicited from 32 adults with TBI. Stories were analysed at three levels: sentence production, intersentential cohesive adequacy, and story episode structure. These measures were then correlated with scores from the Wisconsin Card Sorting Test (WCST), the primary measure of executive function. A significant correlation was noted between a factor score from the WCST and the measure of story structure, but not sentence production or cohesive adequacy. These results suggest that executive functions may be a promising avenue to pursue in the search for underlying causal factors of narrative discourse dysfunction and, therefore to better delineate the nature of communicative deficits secondary to TBI.

Measurement of narrative discourse ability in children with language disorders.

Narratives from three studies differing in subject pools, elicitation procedures, and story content were analyzed using seven variables hypothesized to measure a variety of language abilities used in narrative production. Two questions were addressed: (a) To what extent did multiple variables represent common factors? and (b) To what extent did these variables distinguish children with language disorder from their nondisordered peers? Results indicated that: (a) The seven variables represented two factors; Factor I measured global organization of content (i.e., episode structure), and Factor II measured within- and across-sentence structure (i.e., grammatical sentence structure, within subordinate clause productivity, and textual cohesion), and (b) regardless of study, only the variables representing Factor II were selected as the most effective in predicting group membership.

Concurrent validity of the Kaufman Hand Movement Test as a measure of limb apraxia.

The concurrent validity of the Kaufman Hand Movement Test as a measure of limb apraxia was investigated. For 23 adult aphasic subjects, a Pearson r of 0.84 was obtained between scores on this test and on the Limb Apraxia Test, a battery of tasks often used in the assessment of limb apraxia. The Kaufman test is a shorter and simpler test to administer than the Limb Apraxia Test. The concurrent validity of the Kaufman test encourages its use in the assessment of limb apraxia.

The use of discourse analyses for the evaluation of higher level traumatically brain-injured adults.

Higher level traumatically brain-injured (TBI) adults often present a challenge in assessment as well as in the measurement of recovery. Traditional clinical measures of language abilities have not been adequate to identify and describe precisely what is deviant about their communication. Assessment has generally consisted of aphasia tests and measures of general cognitive abilities. Although such measures may be sensitive to deficits in lower level TBI patients or those in the early stages of recovery, their usefulness with higher functioning patients is questionable due to the often subtle nature of their residual communication problems. An overview of discourse analyses is presented and recent applications of these procedures with TBI patients reviewed.

Discourse analyses with closed head injured adults: evidence for differing patterns of deficits.

To better characterize the verbal impairments of higher level closed head injured (CHI) adults, we used narrative stories to longitudinally sample their discourse abilities. Stories were analyzed at the levels of intersentential cohesion and story grammar. Two differing patterns of deficits that emerged are described. In the first, a CHI subject demonstrated excessive verbalization characterized by poorly organized, but task-appropriate, content. In the second, a CHI subject demonstrated fair to good organization but little appropriate content. Prognostically, the presence of appropriate, although disorganized, content was an early indication that the subject was able to appreciate potential relationships of characters in the stimulus picture. The second pattern represented a more severe cognitive dysfunction. This subject's attempts at stories, although well organized, were merely elaborate descriptions of the picture. Discourse analyses appear to be well suited for the assessment of CHI adults.

Contextual influences on narrative discourse in normal young adults.

In an effort to provide some expectation regarding the influences of task and rehearsal, the narrative ability of 20 normal young adults was examined under the conditions of story retelling and story generation. Each task was repeated after a 1-week interval in order to investigate a possible practice effect. Sentence production, intersentential cohesion, and story grammar organization were analyzed. Results indicated that the subjects' performance varied as a function of task presentation as well as the measure used to describe narrative production. The only across-trials difference noted was an increase in cohesive adequacy from trial 1 to trial 2 for one of the story generation tasks. It may be concluded that (a) context does influence the manner and competence of narrative presentation, and (b) that rehearsal of a complex narrative improves narrative coherence.

Effects of elicitation procedures on the narratives of normal and closed head-injured adults.

Stories were elicited under two conditions--story retelling and story generation--from a group of 23 normal young adults and 4 closed head-injured (CHI) adults who had reached a high level of language recovery. Sentence production, intersentential cohesion, and story grammar were analyzed. The results demonstrated that the two elicitation tasks differentially influenced the performance of both normal and CHI subjects at all levels of analysis, and the two groups differed in the cohesive and story grammar measures only in the story generation task. It is concluded that comparing performance across tasks of story retelling and story generation is a useful procedure for characterizing the discourse problems of CHI subjects with recovery of high-level language skills.

An investigation of body part as object (BPO) responses in normal and brain-damaged adults.

A test of simple pantomime was administered to three groups of adults and comparisons were made across groups of the incidence of subjects who exhibited body part as object (BPO) responses and of the mean frequency of occurrence of BPO in each group. The three groups were left-hemisphere-damaged aphasics (N = 28), right-hemisphere-damaged (N = 24), and normal controls (N = 28). The results indicated no significant differences among groups on the BPO measures. Also, to test the strength of association between the frequency of occurrence of BPO and measures of limb apraxia and severity of aphasia for the left-hemisphere-damaged aphasic group, correlation coefficients were obtained. The correlations were low and nonsignificant. The results of this investigation do not support the common clinical assumption that the occurrence of BPO during the performance of simple pantomimes is pathognomic for left-hemisphere pathology or associated with limb apraxia.

Communication skills in an aphasic deaf adult.

A case study is presented of a 64-year-old, right-handed, congenitally deaf man who suffered a single, unilateral, left CVA resulting in a right hemiplegia and moderate aphasia. The relationship between his verbal (reading and writing), manual, and pantomimic performances is examined in two ways. First, a comparison of the three modes of communication shows whether or not these systems can be dissociated by pathology. Second, the extent to which one mode recovers more fully than the others indicates whether the three modes function independently. Results of testing conducted at six weeks and at 18 months postonset revealed that this individual's manual, verbal, and pantomimic communication skills were all similarly impaired as a result of his CVA. Furthermore, at 18 months no single mode had recovered more rapidly or to a greater extent than any other. These results support the notion that aphasia in the deaf and hearing population is similar, and is consistent with the view that aphasia is the result of a central symbolic/cognitive process which manifests itself in parallel dysfunctions of verbal, manual, and pantomimic communication.

The relationship of the acquisition of manual signs to severity of aphasia: a training study.

To investigate the relationship between success in the acquisition of signs and the degree of severity of aphasic impairment 12 chronic severely aphasic subjects participated in a training program for the acquisition of a vocabulary of manual signs. The results demonstrate a clear and significant relationship between severity of aphasia and success in the acquisition and generalization of manual signs. The results also indicate that there may be a threshold of severity of aphasia below which acquisition is negligible. Discussion is presented relative to the theoretical, clinical, and methodological implications of these findings.

Effects of iconicity, motoric complexity, and linguistic function on sign acquisition in severe aphasia.

The influence of three features of manual signs (iconicity, motoric complexity, linguistic function) on their successful acquisition by aphasic subjects was investigated. 12 severe chronic aphasic subjects were presented 37 signs in a training program for the production of manual signs. Analysis indicates that the three signs features affected the successful acquisition of signs. As a group the subjects acquired a larger percentage of high and medium iconic than of low iconic signs; a larger percentage of low and medium motorically complex signs than high; and a larger percentage of verb than noun or adjective signs. The implications of these findings with regard to selecting a manual sign vocabulary for training are discussed.

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.

Path analysis: a strategy for investigating multivariate causal relationships in communication disorders.

This tutorial paper explains, illustrates, and discusses path analysis, a powerful strategy for examining the plausibility and degree of causal relationships which are postulated to exist among a set of variables. In addition to its strength as a method of theory testing, path analysis is highly compatible with the kind of retrospective research which is so often used to study speech and language pathologies. One of its major advantages is that it allows explicit recognition of multiple, interacting causes of communication disorders and allows the researcher to evaluate the logical consequences of assumptions made about the specific nature of those causal relationships. A summary of the meaning of causal relationships is followed by a presentation of the principles underlying path analysis, as well as an outline of its basic procedures. Also presented is an illustrative example of the application of path analysis to the evaluation of some competing causal theories of a communication disorder. Finally, the general advantages of path analysis and its applicability to the investigation of causal relationships in speech and language pathologies are summarized and discussed.

Three studies of deficits in pantomimic expression and pantomimic recognition in aphasia.

Studies were conducted to investigate aphasic deficits in pantomimic behaviors. Three groups of subjects were used: 47 aphasics; 27 right-hemisphere-damaged; and 11 controls. Study I replicates a previous study of pantomimic recognition deficits (Duffy, Duffy, & Pearson, 1975) and essentially duplicates the previous findings of significant deficits of pantomimic recognition in aphasic subjects that are highly correlated with their verbal deficits. Study II examines the relationship between deficits in pantomimic recognition and expression; and the relationships between these two nonverbal behaviors and aphasic verbal deficits. Zero order correlations, partial correlations, and multiple regression analyses are presented. The results show that aphasics exhibit significant deficits in both pantomimic expression and recognition; and, that both of these are highly correlated with aphasic verbal deficits. Study III is an investigation of four causal theories of aphasic deficits in pantomimic expression. Zero order correlations, partial correlations, and multiple regression analyses are presented. It is concluded that aphasic pantomimic expressive deficits are not caused by general intellectual deficit or limb apraxia; but, they are associated with a central symbolic disorder or a verbal mediation deficit. The implications of these studies for an understanding of the nature of aphasia as a syndrome which includes both verbal and nonverbal impairments are discussed.

Nonverbal communication of affect in brain-damaged patients.

A slide viewing technique designed to assess spontaneous nonverbal expressiveness was administered to 37 male patients including 8 left hemisphere damaged (aphasic), 10 right hemisphere damaged, 9 Parkinson's disease, and 10 non brain-damaged (control) patients. Patients watched different types of affective slides while their facial/gestural responses were videotaped. Judges watching the video tapes without audio guessed the types of slide being viewed. Results indicated that aphasic patients were equal to or more expressive than controls, while right hemisphere damaged and Parkinson's disease patients were less expressive. The possibility that spontaneous non verbal expressiveness is mediated by the right cerebral hemisphere, with the left hemisphere playing an inhibitory role, was discussed as a tentative explanation.