Processes of Confrontation Naming and Oral Reading of Kanji —a Case Report of Language Therapy

Abstract

A 20-year-old patient suffered from subarachnoidal hemorrhage, resulting from A-V malformation, and was admitted to our hospital three months after onset. At the time of admission, he exhibited amnestic aphasia, right homonimous hemianopia, and hyperreflexia in the right upper and lower extremities and also in the left upper extremity. He had marked difficulty in confrontation naming, and writing and oral reading of kanji, while his performance in other language tasks was relatively intact. We assumed that these three tasks required in some part the common neurolinguistic processes, which might be impaired in this patient. In confrontation naming, visual information undergoes semantic and phonological processing before being realized as speech sounds. Writing and oral reading of kanji also requires both semantic and phonological processing, since a kanji represents certain semantic information as well as phonological information. It follows from the above assumption, that training of one of the three tasks may restore the common impaired processes, thus improving the patient's performance in the other two tasks. A naming-training and an oral-reading-training of kanji were conducted successively. Use of language modalities was strictly controlled during the training so that the other two tasks would not be trained at the same time. Examination of the three tasks before and after each training revealed parallel improvement in confrontation naming and oral reading of kanji for the drilled words, but no improvement in writing. A similar error pattern was observed in confrontation naming and oral reading of kanji. Thus the result supported a part of our assumption that confrontation naming and oral reading of kanji shared the same processes, which were impaired in this patient. Error analysis based upon Fromkin's speech production model, together with other such findings as absence of neither visual agnosia nor articulatory disorders, and relatively intact repetition and kana manipulation suggested the impairment of semantic processing and /or the connexion between semantic and phonological processing. Writing ability of kanji did not improve in either training, which suggested involvement of other processes than those mentioned above.