Introduction to “On Agrammatism” (Ueber Agrammatismus), by Max Isserlin, 1922

The aim of the thesis was to test empirically Grodzinsky's account of agrammatism. Grodzinsky's account is based on Chomsky's Government and Binding theory and it claims that the comprehension deficit in agrammatism is due to the deletion of 'trace' present in passive and relative clauses. English and Hebrew speaking patients were tested. The experiment exploited a special feature of the Hebrew language in which it is possible to construct passive sentences without trace. In addition to passive and obJect relative clause sentences, other sentence types were also used. The results did not support the trace deletion hypothesis of Grodzinsky. An alternative version of his hypothesis, according to which sentences that require coindexation between two elements in the sentence are difficult for agrommatic aphasics did obtain support. The results also suggested that reversible sentences are particularly difficult for agrammatic patients. Grodzinsky's account also claimed that in agrammatism governed prepositions are impaired and ungoverned prepositions are preserved. In order to test this part of the theory an indepth case study of a Hebrew speaking agrammatic patient who never used prepositions in her spontaneous speech was carried out. The study tested the hypotheses of Grodzinsky and Friederici and it concluded that Grodzinsky's hypothesis according to which governed prepositions are impaired and ungoverned prepositions are preserved is not supported by the evidence. Meaningful prepositions as Friederici suggested, were more likely to be produced in certain tasks. Although this also cannot explain the total omission of prepositions of this patient. In addition to the preposition case study, the patient's ability to deal with the Hebrew verb system was investigated. Both the preposition and the verb study suggested that in agrammatism it is not the principles of Universal Grammar that are violated but the particular features of individual languages.

This presentation video is from the Research Symposium at the 2018 annual convention of the American Speech-Language-Hearing Association held in Boston, MA.The abstract for the accompanying article is below. This article is part of the JSLHR Forum: Advances in Neuroplasticity Research on Language Recovery in Aphasia.Purpose: Reorganization of language networks in aphasia takes advantage of the facts that (a) the brain is an organ of plasticity, with neuronal changes occurring throughout the life span, including following brain damage; (b) plasticity is highly experience dependent; and (c) as with any learning system, language reorganization involves a synergistic interplay between organism-intrinsic (i.e., cognitive and brain) and organism-extrinsic (i.e., environmental) variables. A major goal for clinical treatment of aphasia is to be able to prescribe treatment and predict its outcome based on the neurocognitive deficit profiles of individual patients. This review article summarizes the results of research examining the neurocognitive effects of psycholinguistically based treatment (i.e., Treatment of Underlying Forms; Thompson & Shapiro, 2005) for sentence processing impairments in individuals with chronic agrammatic aphasia resulting from stroke and primary progressive aphasia and addresses both behavioral and brain variables related to successful treatment outcomes. The influences of lesion volume and location, perfusion (blood flow), and resting-state neural activity on language recovery are also discussed as related to recovery of agrammatism and other language impairments. Based on these and other data, principles for promoting neuroplasticity of language networks are presented.Conclusions: Sentence processing treatment results in improved comprehension and production of complex syntactic structures in chronic agrammatism and generalization to less complex, linguistically related structures in chronic agrammatism. Patients also show treatment-induced shifts toward normal-like online sentence processing routines (based on eye movement data) and changes in neural recruitment patterns (based on functional neuroimaging), with posttreatment activation of regions overlapping with those within sentence processing and dorsal attention networks engaged by neurotypical adults performing the same task. These findings provide compelling evidence that treatment focused on principles of neuroplasticity promotes neurocognitive recovery in chronic agrammatic aphasia.Thompson, C. K. (2019). Neurocognitive recovery of sentence processing in aphasia. Journal of Speech, Language, and Hearing Research, 62(11), 3947–3972. https://doi.org/10.1044/2019_JSLHR-L-RSNP-19-0219

Background: When conducting a speech and language therapy intervention study, one essential part lies in the evaluation of the outcomes. The underlying therapy itself and its delivery are aspects which are mostly done in the background. There is little focus on the question: Was therapy delivered with fidelity, i.e. to what extent does the actual therapy delivery correspond to the planned delivery? If treatment fidelity (TF) is discussed in a paper, researchers often report on therapy manuals, training and supervision of therapists, or adherence to the therapeutic techniques. However, according to Cherney et al. (2013), TF is regarded as a crucial component of any behavioural treatment study (ibid.) and should therefore be assessed in a speech and language therapy intervention study. Aim: The present thesis is part of a wider research project in which a new conversation-based therapy - called Better Conversations with Aphasia (BCA; Beeke et al., 2011; Beeke et al., submitted; Beckley et al., 2013) – was designed. The therapy was provided to eight people with agrammatism and their conversation partners (CPs), together called a dyad. It is an adaptation of a conversation training programme called SPPARC (Supporting Partners of People with Aphasia in Relationships and Conversation; Lock et al., 2001a). Every dyad was treated by the same speech and language therapist (SLT) and all therapy sessions were videotaped. The aim of the present thesis is to examine aspects of TF retrospectively and thereby assess the degree of uniform therapy delivery as planned. Methods: The multifaceted concept of TF is introduced and applied to the wider research project. Using this concept, the degree to which the BCA therapy programme was delivered as planned, can be measured. This can be achieved by developing a pilot fidelity tool, which is based on a conceptual framework of TF (Carroll et al., 2007), on practices reported in the TF literature and on the generic session plans of the BCA therapy. The first step was to observe 23% of the therapy sessions and rate them with the tool. These observations were conducted on data of seven dyads. In addition, descriptive data were collected to enlarge the fidelity evaluation. In a last step, inter-rater reliability (IRR) of parts of the fidelity tool was also assessed with the help of a second observer who rated 20% of the sessions already used for the fidelity check. Results: The results indicate that, in terms of therapy content, a high fidelity level of 91.9% was reached for the BCA therapy programme. Dyad-specific fidelity scores thereby ranged between 86% and 97%, which shows a certain degree of variability, even when only one therapist was delivering the intervention. It also suggests that each dyad received a satisfactorily equivalent intervention. The duration and frequency of the therapy sessions varied across the dyads. However, this reflects the individual and interactive nature of a conversation-based therapy. Qualitatively, the therapist showed a high degree of desired behaviour associated with the delivery of the BCA therapy programme (averaged across the dyads: 96.7%). Other potential moderators of fidelity, such as the acceptance of components of the therapy programme and the clients’ motivation, were also investigated in the present thesis, providing a multifaceted evaluation of TF. In terms of the inter-rater reliability of the designed fidelity tool, acceptable levels have been reached for almost all of the sessions observed by two qualified SLTs. Future directions: For future investigations, the procedural section of the fidelity tool could be refined in terms of fewer, essential elements of the BCA therapy. Moreover, clearer rating guidelines are necessary for rating the fidelity tool reliably. A potential next step for future research might be to identify potential essential components of the BCA therapy and to relate the outcomes of the main BCA research project to TF data. However, the importance and value of a fidelity evaluation is already being demonstrated in the present thesis.

Agrammatism and Paragrammatism

Approaches to treatment of agrammatism

Agrammatism and paragrammatism

Agrammatism

Agrammatism

Failure to agree in agrammatism

Agentive versus Non-agentive Passives in Catalan Agrammatism

In defense of agrammatism

Agrammatism

Negation in agrammatism: Evidence from greek

Agrammatism revisited

Competence, performance, and agrammatism: A reply to Grodzinsky