Cases reported "Aphasia"

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1/53. Traumatic aphasia in children: a case study.

    Traumatic aphasia in children has been recognized as a distinct clinical pathology, differing from adult aphasia in symptomatology and course of recovery. The upper limit for complete recovery has been identified as age 10. However, there is a paucity of literature documenting recovery of children with traumatic aphasia. It is apparent that definitive statements of the upper age limit for complete recovery from traumatic aphasia in children cannot be made at this time. This article reviews the literature concerning traumatic aphasia and presents case information of a 10-year-old traumatic aphasic girl seen at the North texas State University speech and hearing Center. The design, execution, and assessment of therapeutic interaction and the observed language abilities of the client are reported.
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2/53. Written communication in undifferentiated jargon aphasia: a therapy study.

    A subject, R.M.M., with a 2-year history of jargon aphasia is described. At the beginning of this study she had minimal meaningful spoken output and showed little awareness of her speech despite having relatively well-preserved auditory comprehension. Her spoken output had proved resistant to earlier periods of therapy. In contrast, R.M.M.'s written output showed some ability to access orthographic information and monitoring of this modality was shown by an acute awareness of her errors. A 3-stage therapy programme is described. This was designed to improve R.M.M.'s writing of single words and to encourage use of writing as an alternative means of communication. The initial stage of therapy aimed to increase R.M.M.'s access to written word forms by use of picture stimuli. She showed significant improvement in writing treated items in response to pictures both immediately after therapy and at re-assessment 6 weeks later. Despite the acquisition of these skills, R.M.M. failed to use them in communicative contexts. A second stage of therapy replicated the results of the first and sought to facilitate R.M.M.'s functional use of her written vocabulary by asking her to write words to spoken questions. She again showed improved written naming of the treated items and could now produce written names appropriately in a questionnaire-type assessment. Generalization of this ability extended to items that had not been trained in this way. Functional use of writing in everyday communication remained absent, however. The final stage of therapy made explicit the potential links between items which R.M.M. could now write and functional messages which they might convey. She again showed significant changes in the acquisition of new vocabulary and, encouragingly, progress was also seen in her use of the strategy in functional communication. R.M.M.'s speech is almost entirely incomprehensible. It has remained unchanged for 2 years and has not responded to therapy. Relatively well-preserved auditory comprehension and good monitoring of written output allowed therapy to effectively target a small written vocabulary. Despite significant progress in the acquisition of new items, transfer of this skill to functional communication was initially absent. Further therapy which specifically targeted the impairment causing this failure was needed before functional use was seen. The potential for treating written output in cases of jargon aphasia which have been resistant to therapy for spoken language is discussed.
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3/53. Application of the correct information unit analysis to the naturally occurring conversation of a person with aphasia.

    The Correct Information Unit (CIU) analysis for measuring the communicative informativeness and efficiency of connected speech (Nicholas & Brookshire, 1993) was applied to the naturally occurring conversation of a person with moderate aphasia. Results indicated that, in this instance, reliable CIU measures could not be obtained. Intrarater reliability for CIU and %CIU was low, reaching only 72%, and interrater reliability was never greater than 63%. However, reliability of word counts was good. Post hoc analysis of rater disagreements in application of the CIU analysis revealed that the majority (72%) resulted from insufficiencies in the scoring rules that were originally designed to measure single speaker connected discourse. Two descriptive categories of disagreements were identified: interpretations of informativeness and absence of rules. The remaining 28% of disagreements were attributable to human error in the application of scoring rules. Comparison of findings with previous research and implications for future research are discussed.
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4/53. Pathological switching between languages after frontal lesions in a bilingual patient.

    Cerebral lesions may alter the capability of bilingual subjects to separate their languages and use each language in appropriate contexts. patients who show pathological mixing intermingle different languages within a single utterance. By contrast, patients affected by pathological switching alternate their languages across different utterances (a self contained segment of speech that stands on its own and conveys its own independent meaning). Cases of pathological mixing have been reported after lesions to the left temporoparietal lobe. By contrast, information on the neural loci involved in pathological switching is scarce. In this paper a description is given for the first time of a patient with a lesion to the left anterior cingulate and to the frontal lobe-also marginally involving the right anterior cingulate area-who presented with pathological switching between languages in the absence of any other linguistic impairment. Thus, unlike pathological mixing that typically occurs in bilingual aphasia, pathological switching may be independent of language mechanisms.
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5/53. Direct and indirect therapy for word sound deafness.

    This paper evaluates two therapy programmes conducted with PK, an aphasic individual with word sound deafness. The first aimed directly to improve discrimination skills, using minimal pair tasks supported with lip reading. Disappointingly, there were no changes on discrimination tests after this therapy, even when PK could benefit from lip reading information. The second, indirect, programme of therapy aimed to change the communication behaviours of PK's wife. Strategies such as writing and simplifying information were modelled and practiced. A detailed information booklet, outlining the target strategies and explaining PK's main strengths and weaknesses supported the programme. Evaluation of this therapy involved pre- and post-therapy analysis of interactions between PK and his wife, with biographical questions forming the basis of the interactions. There were several changes after therapy on this measure. The number and length of communication breakdowns were reduced, and more questions were answered accurately. This study suggests that, in some cases of severe word sound deafness, indirect therapies may be most effective.
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6/53. Semantic information is used by a deep dyslexic to parse compounds.

    We report a case study of a 48 year-old patient, J.O., who was tested 20 years after the removal of a tumor in the left temporal-parietal region. This surgery and subsequent radiation resulted in right side paralysis and numerous language problems. Tests of J.O.'s single word reading abilities indicate that she could be classified as a deep dyslexic with over 16% of her errors in word naming having a clear semantic relationship with the target word (Coltheart, 1980). We examined her ability to read compound words aloud and following Libben (1993) we provide evidence that J.O. is a second case in which there is obligatory access of morphological constituents of compound words. These data are discussed within the context of Libben's (1998) compound word processing model.
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7/53. Deep dysphasic performance in non-fluent progressive aphasia: a case study.

    We present a patient (PW) with non-fluent progressive aphasia, characterized by severe word finding difficulties and frequent phonemic paraphasias in spontaneous speech. It has been suggested that such patients have insufficient access to phonological information for output and cannot construct the appropriate sequence of selected phonemes for articulation. Consistent with such a proposal, we found that PW was impaired on a variety of verbal tasks that demand access to phonological representations (reading, repetition, confrontational naming and rhyme judgement); she also demonstrated poor performance on syntactic and grammatical processing tasks. However, examination of PW's repetition performance also revealed that she made semantic paraphasias and that her performance was influenced by imageability and lexical status. Her auditory-verbal short-term memory was also severely compromised. These features are consistent with 'deep dysphasia', a disorder reported in patients suffering from stroke or cerebrovascular accident, and rarely reported in the context of non-fluent progressive aphasia. PW's pattern of performance is evaluated in terms of current models of both non-fluent progressive aphasia and deep dysphasia.
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8/53. Dystypia: isolated typing impairment without aphasia, apraxia or visuospatial impairment.

    We report a 60-year-old right-handed Japanese man who showed an isolated persistent typing impairment without aphasia, agraphia, apraxia or any other neuropsychological deficit. We coined the term 'dystypia' for this peculiar neuropsychological manifestation. The symptom was caused by an infarction in the left frontal lobe involving the foot of the second frontal convolution and the frontal operculum. The patient's typing impairment was not attributable to a disturbance of the linguistic process, since he had no aphasia or agraphia. The impairment was not attributable to the impairment of the motor execution process either, since he had no apraxia. Thus, his typing impairment was deduced to be based on a disturbance of the intermediate process where the linguistic phonological information is converted into the corresponding performance. We hypothesized that there is a specific process for typing which branches from the motor programming process presented in neurolinguistic models. The foot of the left second frontal convolution and the operculum may play an important role in the manifestation of 'dystypia'.
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9/53. Intonation in partner accommodation for aphasia: a descriptive single case study.

    Previous research has suggested that speaking partners adjust their intonation when conversing with people who are ill or elderly. In the descriptive case study presented in this paper we ask, what adjustments in intonation might be made by the communication partner of an aphasic speaker? A sociolinguistic, semantic analysis of intonation was used to describe the intonation pattern used by the neighbor of an aphasic speaker, during a 15-min natural interaction with the aphasic speaker, his wife, and the first author. The neighbor was found to make more use of two dimensions of intonation that reflected differences in her relationship to the information conveyed, when addressing the aphasic speaker in contrast to when addressing his wife. Firstly, she made proportionally more use of pitch movements associated with referring to shared information, and secondly, she made more use of marked tones (rising-falling, and rising tones). We discuss whether the observed differences may represent an accommodation to speaking to a person with aphasia. learning Outcomes: The reader will be able: (1) to recognize the role of intonation in discourse as a resource for the exchange of interpersonal meaning, and (2) to identify when speakers are using intonation as part of their speech accommodation for aphasia.
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10/53. Exploring aphasic grammar. 2: Do language testing and conversation tell a similar story?

    This paper investigates the grammatical difficulties of an English-speaking person with non-fluent aphasia using clinical assessments based on picture description and story telling. The same individual's conversation grammar, which was investigated in detail in a linked article is reviewed here, and the notion that interactional grammatical phenomena may not necessarily be visible in elicited language data is explored. Data analysis shows that the aphasic speaker's grammar looks considerably different in the context of clinical assessment than it does in conversation. Analysis of elicited grammar reveals that the majority of utterances produced are subject-verb-object (SVO) type sentences, whereas prior analysis of conversation data indicated patterns of interactional grammatical phenomena that differ from such sentence types. It is suggested that language tests and conversation provide complementary but essentially different information about grammatical abilities. The clinical implications of this finding are discussed.
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