Aphasic Disturbances Research Articles

A refined method to relate morphological and functional aspects of aphasia.

A method is described to relate brain morphology and neuropsychological disturbances such as aphasia. By mapping lesions with computerized tomography onto a grid model of five brain slices, it is possible to compare aphasiological information and lesion site by data processing, allowing the quantitative and qualitative manipulation of a large number of data. The soundness of the method is investigated in a pilot study on the localization of aphasic disturbances. Data processing was performed on a preliminary group of 70 patients with different aphasic syndromes (Broca, Wernicke, and global aphasics with and without recurring utterances). The results confirmed the findings of older studies, with the typical locus of Wernicke's aphasia being Wernicke's area. In conformity to more recent studies, the main lesion for Broca aphasics was found to be in the insular cortex, with a relatively important participation of the frontal white matter. The implications of this refined method for more vigorous aphasiological and neuropsychological research are briefly indicated.

Anatomical Asymmetries in the Adult and Developing Brain and their Implications for Function

The left cerebral hemisphere is dominant for language function. Thus, lesions involving this hemisphere in children and adults are more likely to cause disorders in language function than the same or even larger lesions in the opposite hemisphere. Lesions that interfere with language tend to be clustered around the Sylvian fissure. Two regions appear to be especially important: one in the posterior frontal opercular area, the other in the posterior third of the superior temporal gyrus and adjacent parietal operculum. Lesions in other language regions that occupy more posterior portions of the inferior parietal lobule appear to result in disorders of written language; supplementary motor and sensory areas located on the medial portion of the left hemisphere surrounding the cingulate gyrus appear to influence spontaneous language activity. Finally, lesions in the left posterior pulvinar may also produce short-lived aphasic disturbances. The brain exhibits both gross anatomical and microscopic asymmetries in the region of the language areas. Sylvian fissure asymmetries suggest a greater development of the posterior temporal region and of the parietal operculum on the left. The greater development of the left posterior temporal region is also illustrated by a larger posterior upper surface (planum temporale) on that side. Furthermore, the anterior speech area on the frontal operculum may be more convoluted and therefore larger on the left. Asymmetries in the Sylvian fissures and in the relative widths of portions of the hemispheres can be demonstrated during life by radiologic means. Gross anatomical asymmetries appear to reflect side differences in areas of distinctive microscopic structure (architectonic areas) and function. Thus, in the posterior speech area the auditory field Tpt is larger on the left, and in the frontal lobe an opercular motor field is also larger on the left. Area 39, an inferior parietal association cortex, may be thicker on the left side, and its corresponding thalamic projection nucleus, nucleus lateralis posterior, is also larger on the left. The normally occurring asymmetry may be altered in pathology and pathological lesions may be asymmetrically distributed. Thus, the analysis of a brain of a dyslexic patient has disclosed an abnormally large left hemisphere as well as cortical malformations restricted to the left side of the brain. Later-alized abnormalities may occur in other disease entities and may be linked to genetic abnormalities, as evidenced by the familial occurrence of some dyslexias as well as of similar brain malformations. On the other hand, lateralized abnormalities may result from early lesions, as illustrated by limb malformations in rats and reversals of habenular asymmetries in newts. Lateralized limb malformations with a male preponderance also occur in man, although genetic or environmental factors have not been identified. Finally, lateralized malformations in fiber connectivities may be the result of early lesions in the brain, as shown by experimental data from fetal monkeys and newborn hamsters. Thus, knowledge of functional and structural lateralization of the human brain has begun to play an increasingly important role in our understanding of the neurologic bases of normal language function and of some disorders of functional lateralization of which developmental dyslexia is an example. Future improvements in the anatomical model of language and related functions will come from additional studies of anatomical lateralization. It is likely that anatomical lateralization results from genetic and prenatal environmental influences, and that a clearer picture of the factors leading to normal and abnormal manifestations of asymmetry will come from animal models of lateralization. Until recently, lateralization in function has been thought to be an exclusively human trait. However, animal models appear to be emerging with the discovery of functional lateralization in rats35, 67 and monkeys.61 Furthermore, the effects of early lesions on recovery and laterality are under current investigation in these animal models.36, 66 Finally, the possible identification of intrauterine environmental insults leading in some manner to abnormalities in lateralization of structure and function provide additional hope for improvement of our ability to prevent and treat disorders of brain asymmetry.

Schizophrasia: case study of a paranoid schizophrenic's language

ABSTRACTThe various descriptions of schizophrenic language have concentrated on a structural treatment of the schizophrenic's spoken or written language or an elucidation of the relationship between linguistic and cognitive disturbances. The structural treatments in fact often focus on the content of schizophrenic discourse, e.g. circumstantiality, flight of ideas, etc., rather than on grammatical structure. In this paper, the linguistic performance of a chronic schizophrenic, paranoid type (DSM-II:295.3) is examined via a large corpus of continuous spoken and written narrative texts collected over a three-year period. A striking agreement was noted in the oral and written language of this subject in features such as the types of agrammatic errors which occur and extreme perseveration. The data reveal important differences with the six characteristics of schizophrenic language noted by Chaika (1974). A brief comparison is made with aphasic and similar neurolinguistic disturbances suggesting organicity in the present case.

Impairments of nonverbal oral movements after left hemisphere damage: A followup analysis of errors

Acquisition of a task requiring the imitation of a series of nonverbal oral movements is most severely impaired in patients with aphasic disturbance. However, nonaphasic patients with left hemisphere damage also perform more poorly than patients with right hemisphere damage or normal control subjects. Analysis of the errors made on the multiple oral movements task reveals that left, but not right, hemisphere damage is highly associated with perseverative responses. Patients with right hemisphere damage do not differ significantly from normal control subjects in the acquisition of or in the type of errors made on the task. It is suggested that the left hemisphere plays an important role in the control of nonverbal oral movement production.

Aphasic disorder in patients with closed head injury.

Quantitative assessment of 50 patients with closed head injury disclosed that anomic errors and word finding difficulty were prominent sequelae as nearly half of the series had defective scores on tests of naming and/or word association. Aphasic disturbance was associated with severity of brain injury as reflected by prolonged coma and injury of the brain stem.

Word Category Aphasia

The syndrome of word category aphasia is characterized by a non-modalityspecific anomia plus a comprehension defect limited to words in specific semantic categories. This defect may be found in the absence of other aphasic disturbances. In particular, spontaneous speech, repetition of -spoken language, oral written language comprehension may be intact, aside from the limited defects described. Analysis of the unusual case described in this report permits the following tentative suggestions: 1) There may be a two-step mechanism in the process of the comprehension of spoken language: word-sound perception and word-meaning comprehension. 2) Categories, such as body parts, room objects, or colors, may have a more or less -independent existence in the complex neuropsychological process of meaning decoding.

Aphasia, Apraxia and Agnosia: Clinical and Theoretical Aspects

ABSTRACT In the preface of this book the author promises to develop a new theory that will interpret aphasic disturbances as interruptions in successive planes in the process of language formation. The rest of the monograph is then divided into sections, chapters and subchapters bearing the titles of conventional concepts of disturbances of higher cortical function, from anomia to alexia. In each chapter or section, the author gives a historical survey and a clinical description of each of these concepts. A total of 14 cases evaluated by the author are described in some detail. Many clinical neurologists will find some of the tests used in evaluating these patients somewhat unfamiliar. However, on many occasions the author has given some effort to describing the tests and his interpretations of them.Observing signs and symptoms demonstrated by a patient, then subjecting these to an interpretation, then choosing a test procedure appropriate to this

Cerebral Dominance in Left-Handed Subjects

In the first part of this study we have compared the frequencies of disturbances of language, gestures, and perception, according to the hemisphere involved, in series of left- and right-handed subjects with verified unilateral lesions (left-handers: 73 cases, 26 with right-sided lesions and 47 with left-sided lesions; right-handers: 487 cases, 194 with right-sided lesions and 293 with left-sided lesions). The left hemisphere syndrome in left-handed subjects consists of aphasic disturbances similar to those found in right-handers with the exception that there is lower frequency of defects of verbal comprehension and writing and a higher frequency of disturbances of reading. The pattern of disorganization of calculation, praxis and visual gnosis is also similar to that seen with lesions of the left hemisphere in right-handers. However, some of the symptoms that are generally seen with right-sided lesions in right-handers are observed here (hemiasomatognosia, unilateral spatial agnosia). The right hemisphere syndrome in left-handed subjects is characterized by the comparatively high frequency of disturbances of oral and written language, while disturbances of calculation, praxis and visual gnosis are similar to those found in right handers with right hemisphere lesions. The comparison between the right and left hemisphere syndromes in left-handers shows much less difference between the frequencies of symptoms than the same comparison in right-handers. These results indicate that there is a certain cerebral ambilaterality in the left-handed subjects. However, the left-handers do not seem to represent a single group. In the second part of the study we have evaluated the language disturbances in a series of 49 left-handed subjects with verified unilateral cerebral lesions, dividing this group according to the side of the lesion (17 right; 32 left) and to the presence or absence of a family history of left-handedness. In the “familial” type of left-handers, disturbances of oral language and of reading occurred with similar frequency following either right or left-sided lesions. However, in the “non-familial” type of left-handers these disturbances were almost absent with right-sided lesions. On the basis of these results, which are consistent with the findings of the dichotic test of Broadbent in normal left-handers, we suggest that cerebral ambilaterality is not a characteristic of all left-handers, but only of those who belong to the so-called “familial” type.

Neologistic Jargon: A Clinicopathological Study

This paper presents 10 patients suffering from a severe and specific aphasic disturbance. Five of these came to autopsy. All spoke with fluent, neologistic jargon. This speech was copious, often under pressure, filled with unintelligible words, but resembled English language by retaining inflection, volume and a semblance of syntax. The patients demonstrated lack of awareness of speech disturbance, severe difficulty comprehending spoken and written language, inability to repeat and name, impaired writing. Hemianopia or visual neglect was more often found than hemiplegia. Their neologisms consisted of multiple substitutions of English phonemes, or literal paraphasia, a feature present in “conduction” aphasia, which is associated with pathology in the arcuate fasciculus. From the clinical and pathological evidence presented, neologistic jargon appears to follow disturbance affecting both the auditory association area (Wernicke's Aphasia) and the arcuate fasciculus (Conduction Aphasia).

Comparison of verbal behavior in right-handed and non right-handed patients with anatomically verified lesion of one hemisphere

Paired data are presented from 57 right-handed and 57 non right-handed patients with almost identical anatomically verified cerebral lesions. Aphasic disturbances are observed in patients with both left and right hemispheric lesions. These findings support the hypothesis that most NRH patients show less marked dominance for language in comparison with RH patients. The NRH patients do not, however, represent a uniform group and some significant differences in language disturbance are found, depending on which hand is used for writing.

Clinical observations on adult aphasia

Behavioral and communicative patterns of adult aphasic patients were evaluated empirically under varied conditions. Certain levels of linguistic function were found to be diagnostically and prognostically helpful in evaluating aphasic disturbances.

Differential Diagnosis of Aphasia With the Minnesota Test.

University Ave, SE, Minneapolis 55414, 1965. This little book is intended for users of the new<i>Minnesota Test for Differential Diagnosis of Aphasia.</i>The test itself is intended not only as an instrument in the observation of problems in the principal aspects of language but also as a means to quantification of whatever deficits may be present. The author defines "aphasia" as a "reduction of available language that crosses all language modalities and may or may not be complicated by perceptual or sensorimotor involvement, by various forms of dysarthia, or by other sequelae of brain damage." While many clinicians, whether they be neurologists, speech therapists, or clinical psychologists, may find this statement faulty, the author appears to use this definition in a thoroughly consistent and vigorous fashion to offer a new classification of aphasic disturbances. According to this classification, "simple aphasia" is said to exist when

A method of disparities for evaluating aphasic disturbances.

A method of disparities for evaluating aphasic disturbances.

Recent trends in aphasic research.

This article is confined to a limited survey of contemporary literature and research on aphasia. An attempt has been made to correlate 3 different approaches to the subject in order to bring some unification to the problems involved. These 3 approaches investigate the pathological phenomena of speech and language, labelled aphasia, from the anatomic-physiological, the psycho-mechanistic, and the structural- linguistic points of view. Wiener's theory, which compares the human brain and nervous system to a highly complicated calculating machine or to a telephone switchboard service, was confirmed by Penfield and Rasmussen's anatomical findings on the operating table. Their findings refute the theory of previous authors that association areas utilize transcortical pathways. Penfield suggests that the mechanism responsible for the coordination of the speech centers is more probably mediated by subcortical projection pathways. Penfield distinguishes between inborn and acquired connection patterns. With the exception of the temporal cortex, Penfield and his co-workers could not discover any positive evidence for acquired neuron connection patterns. In the temporal cortex only, electrical stimulation and epileptic discharge were able to bring to consciousness visual memories, auditory memories, and combined memories. They deduce, therefore, that "memory" is filed in the temporal cortex. The linguistic-structural point of view is represented by the Dutch scientist Grewel. His observations in regard to aphasic patients whose linguistic faculties have suffered seem to indicate the presence of lesions in the temporal lobe of the dominant hemisphere. According to Penfield and Rasmussen it is there, as a result of a high level of neuronal integration, that memory patterns activating speech are formed. The different phenomena of aphasic disturbances can best be explained by lesions in the dominant hemisphere that involve the destruction or disruption of acquired patterns of neuronal pathways. The symptoms may evidence injuries to acquired afferent and efferent synaptic chains of neuronal mechanisms.

School problems in children of average or superior intelligence; a preliminary report.

I cannot tell whether it is purely a matter of chance that in Uppsala, a university town, I have had to treat difficulties at school in children of average or superior intelligence to a greater extent than in Stockholm where I practised earlier. It is obvious that everywhere the most usual cause of such difficulties is either subnormal intelligence or special difficulties in reading and writing, that can be classed among the aphasic disturbances, most commonly in the form of dyslexia. In Uppsala, however, I have encountered a relatively large number of cases with difficulties of other kinds that are not described, or only mentioned, in current textbooks on child psychiatry.

Stage Fright and Neuroses in Professional Life

Stage fright is according to our present nomenclature and present-day knowledge, a neurosis belonging to the group of diseases caused by a profession. It may be looked upon as the most classical, sovereign human neurosis. The phenomena of. stage fright demonstrate very well a long series of psycho-vegetative, psycho-organic and psycho-somatic reciprocal effects and correlations. Besides vasomotor, vagotonic and sympatheticotonic relations, serological and humoral alterations, there is also a radical change of matter and various peculiarities of the glandular function associated with this apparently innocuous kind of neurosis which is often treated so lightly. Stage fright as well as other occupational neuroses, oratorical troubles, the “esprit d'escalier”, aphasic disturbances in speaking, stuttering, stammering, etc., which were considered hitherto as “nervous”, “fictitious” functional diseases deprived of an organic basis, cause in every-day life grievous sufferings, and form cultural problems which are too grave to be overlooked.

APRAXIAS AND OTHER NEUROLOGICAL SEQUELÆ OF CARBON MONOXID ASPHYXIA

The general problem of carbon monoxid asphyxia is reviewed. The serious neurological complications are enumerated. Special attention is given to the reports of aphasic disturbances. The fact that the damage to the nervous system can be widespread, and not simply confined to the globus pallidus, is pointed out. A case is reported, where the patient was revived after a suicidal attempt. He showed loss of the ability to perform certain skilled acts. Agraphia was present. A convulsive disorder has more recently supervened. Due to severe visuo-motor incoordination, he was unable to learn through concrete example, and a carefully planned retraining program, in which all instructions were completely verbalized, was the means by which the function of written speech was returned to the patient.

Possible Effects of the Imaginal Type of the Subject on Aphasic Disturbances

Possible Effects of the Imaginal Type of the Subject on Aphasic Disturbances