Auditory semantic, syntactic, and retention errors made by aphasic subjects on the token test

The Token Test was administered to 25 mild aphasic and 25 matched normal subjects for the purpose of determining the linguistic nature of the auditory verbal comprehension error responses. As was expected,the aphasic subjects obtained significantly poorer scores on the Token Test than did the normal subjects, with minimal overlap between the two groups. In Parts I–IV, the errors were exclusively semantic, and reflected only the amount of required verbal memory. Im Part V, the syntactic structures vary, and the aphasic subjects showed a similar pattern of difficulty as did the normal subjects. Syntactic errors were more prevalent than semantic errors in Part V, suggesting that syntactic complexity was the most important factor in verbal comprehension on this part. In comparison to previous research utilizing the Token Test with normal children, the aphasic subjects in the present study generally had high error rates on the same items as did the children.     

Variations in aphasic language behaviors

This study reports intraindividual variations in the semantic and syntactic complexity of language and in the linguistic errors produced by mildly and moderately impaired aphasic and nonneurologically impaired control subjects in different communication contexts. Aphasic patients, compared to control subjects, evidenced as many, if not more, linguistic variations in response to changing communication requirements. In conditions that restricted visual contact between speaker and listener, aphasic patients produced fewer communicative gestures and more complex verbalizations. Verbal complexity and language errors also varied significantly with different contents of communication. Measures of verbal complexity and errors in verbal communications were found to vary independently across different communication contexts, contents, and tasks. These findings demonstrate that despite their linguistic impairments, aphasic patients show appropriate and predictable linguistic changes in response to nonlinguistic social contextual variables.     

Effects of clinician behaviors on acceptability of patients' responses in aphasia treatment sessions.

Records of the content of 40 videotaped samples of aphasia treatment sessions were prepared. These records were analyzed to determine (a) whether certain clinician behaviors and task characteristics are related to the occurrence of patient error responses in speech and language treatment sessions for aphasic individuals, and (b) whether "errors generate errors"; that is, whether error responses tend to occur in clusters rather than being distributed uniformly throughout the treatment session. The results of these analyses indicated that a number of event categories were significantly related to the occurrence of unacceptable patient responses. These results suggest that certain clinician behaviors generate patient error responses and also that clinicians tend to response to patient errors in characteristic ways. An analysis of these results also confirmed that unacceptable patient responses tended to occur in clusters.     

Recognition of auditory sequences by aphasic, right-hemisphere-damages and non-brain-damaged subjects.

Non-brain-damaged, nonaphasic right-hemisphere-damaged and aphasic left-hemisphere-damaged subjects performed in a task in which they reported whether pairs of sequences of one, two or four pure tones were the "same" or "different" in pitch. Brain-damaged subjects performed less well than non-brain-damaged subjects. Subjects with right hemisphere damage performed progressively less well as the number of tones within tone sequences increased, but non-brain-damaged and aphasic subjects more accurately reported four-tone than two-tone sequences. The results suggested that the deficits in temporal sequencing by aphasic subjects previously reported in the literature do not result from output disorders, and that subjects with hemisphere lesions exhibit deficits that are consistent with deficits in the ability to process melodic materials.     

Cognitive loci of impairments in picture naming by aphasic subjects

In order to identify the process or processes responsible for impaired naming by aphasic patients, ten aphasic adults and ten normal adults performed three independent tasks--picture naming, modified Sternberg picture recognition, and modified Sternberg random shape recognition (Sternberg, 1966). Response times and error percentages were the dependent variables. Independent variables in naming were stimulus codability measured in bits of uncertainty (two levels) and number of naming trials (three trials). Independent variables in the recognition tasks were uncertainty (two levels), number of stimuli to be remembered (two or four stimuli) and response type ("yes" or "no"). The results showed that uncertainty had significant effects on naming but not on recognition performance. The aphasic group produced significantly longer naming response times regardless of uncertainty level. The differences between groups were much greater for high-uncertainty pictures (1100 msec) than for low-uncertainty pictures (270 msec). A comparison of estimates of word retrieval times showed that the two subject groups differed significantly for high-uncertainty but not for low-uncertainty items. It was concluded that (1) use of the term "word retrieval problem" rather than "loss of memory problem" was justified to describe the major component in the aphasic naming impairment for high-uncertainty items, and (2) when naming low-uncertainty items these aphasic subjects did not demonstrate a word retrieval problem. The results indicate that treatment procedures designed to improve naming should be process rather than content oriented.     

Comprehension of lexical subcategory distinctions by aphasic patients: proper/common and mass/count nouns

Previous research has found that agrammatic Broca aphasic patients have particular difficulty using determiners like "a" and "the" for the purposes of sentence comprehension. In this study, we test whether or not such difficulty extends to the level where lexical subcategories are distinguished by these articles. The absence or presence of a determiner distinguishes proper from common nouns (e.g., "ROSE" vs. "A ROSE"), and mass from count nouns (e.g., "GLASS" vs. "A GLASS"). Groups of agrammatic Broca and fluent aphasic subjects were required to point to one of two pictures in response to a sentence such as "Point to the picture of rose" or "Point to the picture of a rose". Sentences were presented in either printed or spoken form. Results indicated that for the agrammatic Broca patients, printed presentation yielded significant improvement over spoken presentation only for the proper noun/common noun distinction. Performance was significantly poorer for the mass noun/count noun distinction as compared to the proper/common distinction for these patients, and mass nouns proved particularly difficult. Interpretable patterns were not observed on either subcategory distinction for the fluent aphasic subjects. Current theories of agrammatism cannot fully explain these data. An independent explanation is offered that suggests proper noun/common noun is a universal semantic distinction. On the other hand, the mass noun/count noun distinction is more purely syntactic, and thus is particularly difficult for agrammatic Broca patients.     

A word-ordering test to differentiate between aphasia and schizophrenia

The capacity of a word-ordering task to differentiate aphasic and schizophrenic patients was assessed. Cards containing words from 10 types of sentences were given to the patients. Each sentence was presented individually with the words in jumbled order and patients were asked to reorder them to produce a gramatically correct sentence. Process and reactive schizophrenics were differentiated from aphasic patients using the dual criteria of more than three incorrect sentences or an average of more than 90 sec per sentence as indicative of aphasia. These criteria were initially tested on a group of aphasics matched with the schizophrenics on age and education and cross-validated using a second more representative sample (unmatched) of aphasics. Both comparisons showed no errors of classification. Further analyses indicated no need for separate norms or classification criteria related to the sex, age, or educational level of the patients.     

An investigation of emphatic stress comprehension in adult aphasia: a replication

The differential effects of normal and emphatic stress on the auditory comprehension performance of 9 aphasic and 5 normal adults were assessed. As a partial replication of Pashek and Brookshire (1982), four paragraph-length stimuli were used from the original study. Each paragraph was presented twice. One version was recorded with one fact per sentence receiving normal stress, the second version with emphatic stress. Following each paragraph, subjects answered 16 "yes/no" questions about the eight target facts in each paragraph. This procedure allowed for direct comparison of performance across conditions on the same paragraph rather than on different paragraphs as in the original study. Analysis of the results revealed that the aphasic subjects demonstrated significantly better performance for stimuli presented with emphatic stress. In addition, no significant learning effect was observed over two repetitions of each paragraph. These data are interpreted as successfully replicating the findings of Pashek and Brookshire. The results suggest that emphatic stress plays an important role in auditory comprehension. However, the observed effect of emphatic stress should not be attributed solely to changes incumbent upon the stress bearing word. Alternative explanations are discussed.     

"Tuning in" and "fading out": performance of aphasic patients on ordered PICA subtests

Performance of 182 aphasic patients was examined on 11 PICA subtests for which the order of presentation of items is specified in an attempt to determine possible "tuning in" and "fading out" behavior. Results indicate that these phenomena occur as measurable patterns, which are to some degree dependent on the severity of aphasia as measured by each patient's overall PICA percentile.     

Repetition deficits in three aphasic syndromes

This study examined the repetition errors of three aphasic subgroups during a repetition task. A total of 95 subjects, including 32 conduction, 38 Broca's, and 25 Wernicke's aphasics, repeated phrases and sentences from the Repeating Phrases Subtest of the Boston Diagnostic Aphasia Examination. Conduction aphasics exhibited a greater number of phonemic attempts, word revisions, and word and phrase repetitions. Broca's aphasics demonstrated more phonemic errors and omissions. Finally, Wernicke's aphasics showed more unrelated words and jargon.     

Veterans Administration cooperative study on aphasia: a comparison of individual and group treatment

Five Veterans Administration Medical Centers participated in an investigation designed to compare individual with group treatment for aphasic patients who had suffered a left hemisphere cerebral vascular accident. Patients who met selection criteria were assigned randomly to either traditional, individual, stimulus-response type treatment of specific language deficits or group therapy designed to improve communication through group interaction and discussion with no direct treatment of specific language deficits. All patients received eight hours of therapy each week beginning at four weeks postonset and continuing until 48 weeks postonset or until they dropped out of the study. A battery of language measures and a clinical neurologic evaluation were administered at intake and every 11 weeks a patient was in the study. Results show both individually and group-treated patients made significant improvement in language abilities. Individual treatment resulted in significantly better overall performance on the Porch Index of Communicative Ability; however, no significant differences were observed between groups on the other language measures. If the traditional belief is correct that significant spontaneous recovery is complete by three to six months postonset, significant improvement in both groups beyond 26 weeks postonset indicates both individual and group treatment are efficacious methods for managing aphasic patients.     

Spouses' understanding of the communication disabilities of aphasic patients.

The language skills of 11 aphasic patients were assessed through the use of the PICA. Spuses's understanding of the aphasic partner's language deficits was measured by rating the aphasic spouse on the Functional Communication Profile. Results indicate that spouses of aphasic patients view the patient's communication to be less impaired than it actually is. Implications for the counseling role of the speech pathologist in language therapy are discussed.     

Verbal training to improve explanations of conservation with aphasic adults

Recent research has indicated a need to study the relationship between the language of the adult aphasic and his attempts at cognitive processing. Nine aphasic adults who demonstrated a minimal ability to explain conservation (as defined by Piaget), a cognitive task which they understood, were given verbal model training to improve their explanations of weight and liquid conservation. Each subject was given a pretest, an experimental condition during which explanations for weight conservation only were trained, a control condition during which subjects named pictured common objects, and a posttest. Order of presentation of the experimental and control conditions was varied. As a result of training, a greater number of explanations (quantitative improvement) and a greater number of explanatory concepts (qualitative improvement) were expressed for both the trained and nontrained conservation tasks. It is suggested that the improvement in conservation explanations is the result of "response facilitation effects" as described by Bandura. Furthermore, the improvement in conservation explanations is supportive of Schuell's concept of impaired linguistic retrieval mechanisms in aphasia.     

Delayed recall deficits in aphasic stroke patients: evidence of Alzheimer's dementia?

In a comparative study of the performance of patients with Alzheimer's disease (AD), aphasia resulting from stroke, and normal elders on a variety of neuropsychological tasks, 3 aphasic patients performed similarly to AD patients in the delayed recall of verbal material. The memory deficit of these aphasic patients raised the question of incipient dementia because memory impairment is the hallmark characteristic of AD. However, when the performance profiles of the aphasic patients on all four memory measures administered in the study were compared to those of AD patients, differences made the presence of dementia unlikely. Nonetheless, the possibility remained that a deficit in delayed free recall might be the primordial symptom of dementia. Therefore, the four memory tasks were readministered to the 3 aphasic patients 2 years later, and intergroup performance comparisons again were made. The performance profiles of the aphasic patients obtained 2 years later were superior to and distinct from the AD patients, confirming the absence of dementia at Test Time 1.     

Effects of apparent listener knowledge and picture stimuli on aphasic and non-brain-damaged speakers' narrative discourse

This experiment investigated whether aphasic adults' assumptions regarding listener knowledge of the topic of discourse affects the content of their narrative discourse. Aphasic and non-brain-damaged adults told two stories about sequences of black-and-white line drawings in two conditions. In a knowledgeable listener condition, subjects told the stories to a listener while the subject and listener were looking at the pictures portraying the story. In a naive listener condition, subjects told the stories to a listener whom the subject had not met before, who did not have access to pictures about the stories, and who the subject was led to believe had no knowledge of the pictures upon which the stories were based. The differences in performance between non-brain-damaged and aphasic subjects were greater than the differences between listener conditions and between stories. Non-brain-damaged subjects produced significantly more words, more information, a greater percentage of words that communicated relevant and accurate information, and longer grammatical units than aphasic subjects did. There were no significant differences between non-brain-damaged and aphasic subjects in their use of four kinds of cohesive ties. Listener conditions and stories had few significant effects on non-brain-damaged or aphasic subjects' performance, and the few statistically significant effects that were observed did not appear to be clinically important.     

Semantic comprehension in Aphasia

The AA constructed a multiple choice test to evaluate the ability of the aphasic patients to understand the meaning of words in clusters of semantically similar alternatives.

The clinical usefulness and the psychometric characteristics of the test are discussed.

The results of the patients in this test were compared with other tests for phonetic and syntactic comprehension; an attempt was made to specify the psycholinguistic characteristics of the receptive disorders in different aphasic syndromes.     

Spouse attitudes toward the person with aphasia

This investigation evaluated the attitudes of individuals towards their aphasic spouse. Using modified Q-methodology, 15 spouses of fluent aphasic patients, 15 spouses of nonfluent aphasic patients, and 30 matched controls completed a 70-item Q-sort. The spouses of nonfluent aphasic patients had a significantly greater number of negative attitudes toward their spouses than the spouses of fluent aphasic patients. The spouses of patients in both aphasia groups had a significantly greater number of negative attitudes toward their spouses than the matched controls. The most common attitudes of spouses of patients in both aphasic groups divided into six factors: compliance, desirability, egocentricity, independence, maturity, and sociability.