The Relationship Between Confrontation Naming and Story Gist Production in Aphasia.

Purpose: The purpose of this study was to examine the relationship between picture naming performance and the ability to communicate the gist, or essential elements, of a story. We also sought to determine if this relationship varied according to Western Aphasia Battery-Revised (WAB-R; Kertesz, 2007) aphasia subtype. Method: Demographic information, test scores, and transcripts of 258 individuals with aphasia completing 3 narrative tasks were retrieved from the AphasiaBank database. Narratives were subjected to a main concept analysis to determine gist production. A correlation analysis was used to investigate the relationship between naming scores and main concept production for the whole group of persons with aphasia and for WAB-R subtypes separately. Results: We found strong correlations between naming test scores and narrative gist production for the large sample of persons with aphasia. However, the strength of the correlations varied by WAB-R subtype. Conclusions: Picture naming may accurately predict gist production for individuals with Broca's and Wernicke's aphasia, but not for other WAB-R subtypes. Given the current reprioritization of outcome measurement, picture naming may not be an appropriate surrogate measure for functional communication for all persons with aphasia. Supplemental Materials: https://doi.org/10.23641/asha.5851848.

Phonological, lexical, and semantic errors produced by impairment at the output buffer in a Spanish aphasic patient.

We present a single case of a right-handed female patient, RH, who was categorized as suffering from conduction aphasia. She presented no articulatory problems during spontaneous speech but made a significant number of phonological paraphasias in naming and repetition tasks. The number of errors increased for long words and pseudowords. This pattern of results points to damage in the "Phonological Output Buffer" (POB) as the basis of this disorder. However, this patient did not make mistakes when reading words and pseudowords aloud, even when we introduced a delay between the presentation of the word and its production to test the working memory resources of the phonological buffer. Furthermore, the patient's ability to name objects, repeat words, and write to dictation improved with her degree of familiarity with the items. The damage could be situated at the point where phonemes are selected and ordered to produce words. We posit that the deficits observed in this patient, and the differences encountered between her performance and that of others described in the literature, in particular in reading tasks, can be explained by considering POB damage to be gradual in nature. According to this explanation, the performance of patients with damage to the POB will depend on the amount of information provided by the stimulus (word/nonword), the language particularities (regular/irregular), and the nature of the task demands (repetition, writing, naming, or reading).

Conduction aphasia with intact visual object naming.

Conduction aphasia, most often caused by damage to the inferior parietal lobe and arcuate fasciculus, is usually characterized by mildly dysfluent speech with frequent phonemic paraphasic errors, impaired repetition, and impaired word finding and naming, but with relatively spared comprehension. We report an 86-year-old right-handed man with conduction aphasia caused by an infarction that damaged his right temporoparietal region. On testing with the Western Aphasia Battery, however, he named objects almost perfectly. To test his naming ability further, we showed him half the items in the Boston Naming Test; we described or defined the other half of the items, but did not show them to the patient. He performed excellently when naming the objects that he could see, but he had difficulty naming the objects that were only described or defined. These observations suggest that visual word naming may be mediated by a network that is somewhat independent of the networks that mediate spontaneous word finding and word finding based on verbal descriptions or definitions.

Masked and unmasked priming effects as a function of semantic relatedness and associative strength

The study presented in this paper aimed to investigate the pattern of semantic priming effects, under masked and unmasked conditions, in the lexical decision task, manipulating type of semantic relation and associative strength. Three different kinds of word relations were examined in two experiments: only-semantically related words [e.g., codo (elbow)-rodilla (knee)] and semantic/associative related words with strong [e.g., mesa (table)-silla (chair) and weak association strength [e.g., sapo (toad)-rana (frog)]. In Experiment 1 a masked priming procedure was used with a prime duration of 56 ms, and in Experiment 2, the prime was presented unmasked for 150 ms. The results showed that there were masked priming effects with strong associates, but no evidence of these effects was found with weak associates or only-semantic related word pairs. When the prime was presented unmasked, the three types of relations produced significant priming effects and they were not influenced by association strength (AU)

El presente estudio tenía como objetivo investigar el patrón de efectos de priming enmascarado y no enmascarado en la tarea de decisión léxica, manipulando el tipo de relación semántica y la fuerza asociativa entre prime y target. Se llevaron a cabo dos experimentos donde se examinaron tres tipos de relaciones: palabras relacionadas solo semánticamente [e.g., codo (elbow)-rodilla (knee)], palabras semánticamente relacionadas con una asociación fuerte [e.g., mesa (table)-silla (chair)] y palabras con una relación semántica asociativa débil [e.g., sapo (toad)-rana (frog)]. En el Experimento 1 se utilizó un procedimiento de priming enmascarado con una duración del prime de 57 ms, y en el Experimento 2, un procedimiento no enmascarado presentándose el prime durante 150 ms. Los resultados mostraron efectos de priming enmascarado significativos con pares de palabras que eran asociados fuertes pero no cuando eran asociados débiles o tenían una relación sólo semántica (no asociativa). Cuando el prime se presentaba en condiciones no enmascaradas, los tres tipos de relaciones produjeron efectos de priming significativos y no se vieron influidos por la fuerza asociativa (AU)

Aphasia induced by gliomas growing in the ventrolateral frontal region: assessment with diffusion MR tractography, functional MR imaging and neuropsychology.

INTRODUCTION: Lesions in the ventrolateral region of the dominant frontal lobe have been historically associated with aphasia. Recent imaging results suggest that frontal language regions extend beyond classically defined Broca's area to include the ventral precentral gyrus (VPCG) and the arcuate fasciculus (AF). Frontal gliomas offer a unique opportunity to identify structures that are essential for speech production. The aim of this prospective study was to investigate the correlation between language deficits and lesion location in patients with gliomas. METHODS: Nineteen patients with glioma and 10 healthy subjects were evaluated with diffusion tensor imaging magnetic resonance (MR) tractography, functional MR (verb generation task) and the Aachener Aphasie Test. Patients were divided into two groups according to lesion location with respect to the ventral precentral sulcus: (i) anterior (n=8) with glioma growing in the inferior frontal gyrus (IFG) and underlying white matter; (ii) posterior (n=11) with glioma growing in the VPCG and underlying white matter. Virtual dissection of the AF, frontal intralobar tract, uncinate fasciculus (UF) and inferior frontal occipital fasciculus (IFOF) was performed with a deterministic approach. RESULTS: Seven posterior patients showed aphasia classified as conduction (4), Broca (1), transcortical motor (1) and an isolated deficit of semantic fluency; one anterior patient had transcortical mixed aphasia. All posterior patients had invasion of the VPCG, however only patients with aphasia had also lesion extension to the AF as demonstrated by tractography dissections. All patients with language deficits had high grade glioma. Groups did not differ regarding tumour volume. A functional pars opercularis was identified with functional MR imaging (fMRI) in 17 patients. CONCLUSIONS: Gliomas growing in the left VPCG are much more likely to cause speech deficits than gliomas infiltrating the IFG, including Broca's area. Lesion extension to the AF connecting frontal to parietal and temporal regions is an important mechanism for the appearance of aphasia.

Negotiation of identity in group therapy for aphasia: the Aphasia Café.

BACKGROUND: There has been increasing interest in ensuring that aphasia intervention includes attention to the negotiation of a robust identity after the life-altering changes that often accompany the onset of aphasia. But how does one go about simultaneously improving communication and positive identity development within aphasia therapy? Socially oriented group therapy for aphasia has been touted as one means of addressing both psychosocial and communicative goals in aphasia. AIMS: This article describes the results of a sociolinguistic analysis of group therapy for aphasia in which positive personal and group identity are skilfully negotiated. METHODS & PROCEDURES: Sociolinguistic microanalysis of discourse in a group therapy session was undertaken. The session, described as group conversation therapy, included eight adults with aphasia, a speech-language pathologist and an assistant. The session was videotaped and transcribed, and the data were analysed to identify 'indices of identity' within the discourse. This included discourse that exposed members' roles, values or beliefs about themselves or others. The data were further analysed to identify 'patterns' of discourse associated with identity. The result is a detailed description of identity-enhancing discourse within group therapy for aphasia. OUTCOMES & RESULTS: The findings included several categories associated with the negotiation of identity in therapy including: (1) discourse demonstrating that group members were 'being heard', (2) that the competence of group members was assumed, (3) that 'solidarity' existed in the group, (4) that saving face and promoting positive personal identity was important, and (5) that markers of group identity were made visible via discourse that referenced both member inclusion as well as non-member exclusion. CONCLUSIONS & IMPLICATIONS: The results suggest that it is possible to create identity-enhancing interactions as part of therapy for aphasia; the analysis demonstrates the potential role of the group leader/clinician in managing identity negotiation in aphasia therapy.

¿Síndromes o síntomas en la evaluación de los pacientes afásicos? / Syndromes or symptoms in the assessment of aphasic patients?

El procedimiento generalmente empleado para diagnosticar a los pacientes afásicos consiste en analizar sus síntomas y en base a esos síntomas clasificarlos en uno de los síndromes clásicos. Sin embargo, esa taxonomía tiene algunos problemas importantes, el principal que no tiene en cuenta la variedad de pacientes afásicos existentes, ya que hay muchos más trastornos de los que recogen los síndromes. Con objeto de comprobar el grado de homogeneidad de una muestra de pacientes pertenecientes a diferentes síndromes, en este estudio se aplicaron nueve tareas de comprensión y producción oral a quince pacientes (cinco afásicos de Broca, cinco de Wernicke y cinco de Conducción) y a cinco personas sanas, con edades comprendidas entre 38 y 81 años. Los resultados muestran la existencia de una gran heterogeneidad entre los pacientes etiquetados bajo un mismo síndrome, tal como indica la variabilidad de puntuaciones dentro de los grupos en cada tarea. Por otra parte se observa un escaso ajuste al perfil esperado, ya que algunos pacientes presentan síntomas correspondientes a otros síndromes. Nuestros resultados sugieren la necesidad de estudiar a cada paciente de forma individual e interpretar sus trastornos independientemente de los síndromes (AU)

The procedure generally used to diagnose aphasic patients consists of classifying them in one of the classic syndromes on the basis of the analysis of their symptoms. However, this taxonomy has several important problems, the main one being that it does not take into account the variability of aphasic patients, as there are many more disorder profiles than those included in the syndromes. In order to test the homogeneity of a sample of patients diagnosed with the classic taxonomy, 15 aphasic patients (5 Broca, 5 Wernicke and 5 Conduction) and 5 healthy controls were tested with nine comprehension and production tasks. Participants were aged 38 to 81 years old. The results indicate the existence of great variability in patients labeled with the same diagnosis, as revealed by the differences in within-group scores in each task, and a limited adjustment to the expected profile, with some patients showing symptoms allegedly corresponding to other syndromes. Our results call attention to the need to study each patient individually and interpret their disorders regardless of the syndromes (AU)

Watt de Beckett: o cômico e a privação da linguagem / Watt de Beckett: the comic and the deprivation of language / Watt de Beckett: el cómico e la privación del lenguaje

Nesse trabalho primeiramente lemos Watt de Samuel Beckett como parábola de uma suposta temporalidade do cômico (riso amargo, riso amarelo e riso sem alegria) a qual aproximamos aos três lugares de comparação que segundo Freud propiciam o efeito cômico (o outro, o eu frente a um outro e o eu). Em um segundo momento, partindo de uma indicação de Lacan sobre o efeito cômico da fala dos sujeitos afásicos, investigamos a pertinência do reconhecimento de um semelhante deslocamento por esses três tempos/lugares afins ao cômico para a compreensão do percurso a ser percorrido pelo sujeito atingido pela privação da linguagem. (AU)

In this paper, first I read Beckett's novel Watt as a parable of a presumed timing of the comic (bitter laugh, hollow laugh and mirthless laugh) which I colligate with the trhree places of comparison that, according to Freud, promote the comical effect (the other, the ego opposite to another, and the ego). Second, beginning from a hint made by Lacan about acknowledgement of such a move in those three times / places belonging to the comic is pertinent to the understanding of the path that the individual suffering from language deprivation has to pass through. (AU)

Watt de Beckett: o cômico e a privação da linguagem / Watt de Beckett: the comic and the deprivation of language / Watt de Beckett: el cómico e la privación del lenguaje

Nesse trabalho primeiramente lemos Watt de Samuel Beckett como parábola de uma suposta temporalidade do cômico (riso amargo, riso amarelo e riso sem alegria) a qual aproximamos aos três lugares de comparação que segundo Freud propiciam o efeito cômico (o outro, o eu frente a um outro e o eu). Em um segundo momento, partindo de uma indicação de Lacan sobre o efeito cômico da fala dos sujeitos afásicos, investigamos a pertinência do reconhecimento de um semelhante deslocamento por esses três tempos/lugares afins ao cômico para a compreensão do percurso a ser percorrido pelo sujeito atingido pela privação da linguagem.

In this paper, first I read Beckett's novel Watt as a parable of a presumed timing of the comic (bitter laugh, hollow laugh and mirthless laugh) which I colligate with the trhree places of comparison that, according to Freud, promote the comical effect (the other, the ego opposite to another, and the ego). Second, beginning from a hint made by Lacan about acknowledgement of such a move in those three times / places belonging to the comic is pertinent to the understanding of the path that the individual suffering from language deprivation has to pass through.

Pre-lexical disorders in repetition conduction aphasia.

At the level of clinical speech/language evaluation, the repetition type of conduction aphasia is characterized by repetition difficulties concomitant with reduced short-term memory capacities, in the presence of fluent spontaneous speech as well as unimpaired naming and reading abilities. It is still unsettled which dysfunctions of the pre-lexical processing stage of spoken word recognition contribute to this syndrome and whether there is any relevant top-down impact of the mental lexicon upon the phonetic/phonological level of speech perception. In order to further specify the underlying pathomechanisms, a comprehensive battery of psycholinguistic tests was applied to a patient suffering from repetition conduction aphasia. The obtained results point at a pre-lexical disorder in this subject. To further specify the assumed pre-lexical dysfunction, computer simulations of single-word processing, based upon an interactive activation model (IAM), were conducted. An attenuation of the features-to-phonemes inhibition value was found to simulate the observed profile of psycholinguistic deficits. Conceivably, these pre-lexical disorders interfere with the task-dependent adjustment of the temporal windows of signal analysis, giving rise to compromised sequencing of auditory-verbal information.

The many places of frequency: evidence for a novel locus of the lexical frequency effect in word production.

The effect of lexical frequency on language-processing tasks is exceptionally reliable. For example, pictures with higher frequency names are named faster and more accurately than those with lower frequency names. Experiments with normal participants and patients strongly suggest that this production effect arises at the level of lexical access. Further work has suggested that within lexical access this effect arises at the level of lexical representations. Here we present patient E.C. who shows an effect of lexical frequency on his nonword error rate. The best explanation of his performance is that there is an additional locus of frequency at the interface of lexical and segmental representational levels. We confirm this hypothesis by showing that only computational models with frequency at this new locus can produce a similar error pattern to that of patient E.C. Finally, in an analysis of a large group of Italian patients, we show that there exist patients who replicate E.C.'s pattern of results and others who show the complementary pattern of frequency effects on semantic error rates. Our results combined with previous findings suggest that frequency plays a role throughout the process of lexical access.

Comprehension of sentences with stylistic inversion by French aphasic patients.

Three French-speaking agrammatic aphasics and three French-speaking Conduction aphasics were tested for comprehension of Active, Passive, Cleft-Subject, Cleft-Object, and Cleft-Object sentences with Stylistic Inversion using an object manipulation test. The agrammatic patients consistently reversed thematic roles in the latter sentence type, and the Conduction aphasics performed at chance. The results are discussed in relationship to existing models of aphasic impairments in assigning syntactic structures and using them to determine thematic roles in sentences. We conclude that the results for the agrammatic patients demonstrate the importance of compensatory mechanisms underlying aphasic comprehension and the results in the Conduction aphasics indicate the importance of working memory deficits in determining such deficits. The results are also relevant to models of normal syntactic structure.

Neuroanatomical correlates of the post-stroke aphasias studied with cerebral blood flow SPECT scanning.

BACKGROUND: Researchers are not in complete agreement over the extent to which specific language functions are subserved by certain brain areas. The purpose of this article was to determine neuroanatomical correlates of aphasia following cerebrovascular accident. MATERIAL/METHODS: The participants included 50 stroke patients with a single left-hemisphere lesion and residual mild to severe aphasia. Language, assessed by the Boston Diagnostic Aphasia Examination (BDAE), was affected to various degrees by a wide range of pathologies. Single-photon emission computed tomography (SPECT) images of the brain were acquired with 740 MBq (20 mCi) of Tc-99m-labeled ECD on a triple-headed gamma camera equipped with low-energy, high-resolution collimator. Correlation between reduced cerebral perfusion and the BDAE score was analyzed. RESULTS: The most prominent perfusion abnormalities in Broca's aphasia, as determined by the laterality index, were found in the frontal lobe, and to a lesser degree, the parietal lobe and striatum, whereas the most prominent deficits in Wernicke's aphasia were found in the left temporal and parietal areas. In global aphasia, SPECT images evidenced the most extensive damage throughout the perisylvian region of the left hemisphere. CONCLUSIONS: There is need for reinterpretation of the anatomical correlation of selected aphasic syndromes, especially classic Broca's and Wernicke's aphasias. The present study highlights the integrative role of some subcortical structures in language and speech functions. The results support the usefulness of regional cerebral blood flow SPECT imaging as a diagnostic aid in the post-stroke aphasias.

Mechanism of short-term memory and repetition in conduction aphasia and related cognitive disorders: a neuropsychological, audiological and neuroimaging study.

To evaluate the role of the sub-cortical white matter and cortical areas of the supramarginal gyrus in short-term memory impairment (shortened digit or letter span) and repetition difficulty, four patients with conduction aphasia and impaired short-term memory and two patients with only short-term memory impairment were given digit span, letter span, speech audiometry and dichotic listening tests. The results showed that in most of the patients letter span was inferior to digit span and that bilateral ear suppression in the dichotic listening test was observed in two patients with a lesion in the inferior part of the supramarginal gyrus, suggesting that what was affected was phonological information and that the supramarginal gyrus was the storage site. The overlapped lesion of conduction aphasia patients with short-term memory impairment was the periventricular white matter at the upper to middle part of the trigone, while patients with only short-term memory impairment had a lesion in the inferior supramarginal gyrus in common. Thus, damage to the periventricular white matter at the trigone may yield the phonemic paraphasia characteristic of conduction aphasia, while damage to the inferior part of the supramarginal gyrus may result in the impairment of short-term memory. We believe that as a part of the mechanisms of short-term memory and repetition, phonological information is processed in the primary auditory cortex and goes through the periventricular white matter to the inferior part of the supramarginal gyrus and is temporarily stored there.

The importance of word-initial phonology: error patterns in prolonged naming efforts by aphasic patients.

Whether multiple conscious efforts at word search bring a subject closer to an elusive word and to eventual successful retrieval remains a subject of debate. Previous work with normal participants has shown that multiple attempts eventuating in correct retrieval are not usually associated with a systematic progression toward target word phonology in the intervening attempts. In this study we analyzed the naming errors produced by 30 aphasic patients who had received the Boston Naming Test. The analyses were designed to elucidate the characteristics of responses that led to eventual success. Our data showed that among aphasics, as with normal subjects, the presence of target-initial phonology in the subject's first response was the most important predictor of correct retrieval. Moreover, progression towards target phonology in the course of multiple attempts was unrelated to eventual correct retrieval.

The relevance of patient individuality in the evaluation and treatment of aphasia. Case report.

The usual approach to language disorders relies on standardised evaluations in which pattern-tests characterise the subject's status according to the classical aphasiological typology. Those data are then analysed to support a traditional prevalent criterion for the distinction between "normal" and "pathological" linguistic performance, which is strictly focused on a quantitative approach. In the present study a method for evaluation and treatment of aphasia is proposed in which socio-cultural conditions are emphasised, in order to expand this conventional criterion as to encompass a qualitative (individualised) one. Although the methodology draws the attention, the results here obtained also point to the importance of re-evaluating what is presently considered as the most appropriate criterion for "normal" cognitive processes, particularly those related to language.

Coherence violations and propositional usage in the narratives of fluent aphasics.

Aphasic patients have been generally assumed to produce coherent narratives, despite their numerous surface structure deficits. The current study is designed to analyze three types of coherence violations (i.e., information gaps, repetitions of propositions, and irrelevant propositions) in the narratives of mildly impaired conduction, anomic, and Wernicke's aphasics. Results reveal that the three aphasic groups produce qualitatively different patterns of coherence violations. It is hypothesized that these coherence violations reflect adaptive strategies used by the aphasic patients to compensate for their underlying impairments. While the anomic and conduction aphasics appear to compensate for surface structure deficits, the Wernicke's aphasics seem to have an underlying coherence deficit.