Cases reported "Aphasia"

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1/9. 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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2/9. Repeating without semantics: surface dysphasia?

    We describe our investigations of MNA, who had a progressive, severe and global loss of semantic knowledge (semantic dementia). Her verbal vocabulary was restricted to a few common words and she was also unable to recognize common objects from sight. By contrast, she had a well-preserved digit span (7-8 digits). In this series of experiments, we focused on her ability to repeat lists and sentences in which familiarity, meaningfulness, morphology and syntactic structure were manipulated. In list repetition tasks, we found that MNA showed a reliable effect of phonological similarity, word frequency and stimulus lexicality, but was unaffected by linguistic complexity, word length, semantic coherence or the status of individual stimuli as "known" or "unknown". In sentence repetition, her performance was not influenced by any semantic variables. However, there was a substantial effect of the frequency of the constituent vocabulary, even for words outside the range of her retained vocabulary. The influence of syntax was restricted to minor effects of morphology. The phonemes of syllables and the syllables of words are bound by their co-occurrence rather than their meaning. We conclude that the phonological representation of words is functionally independent of the semantic system.
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3/9. Narrative and procedural discourse production by severely aphasic patients.

    Five cbronically aphasic subjects were trained on a computerized iconographic communication system (C-VIC). Their performance in producing single sentences scripts. and narratives was assessed using both spoken English and C-VIC. The requisite vocabulary necessary and the narrative complexity of the target productions were controlled. Subject performance using C-VIC indicates that the ability to construct discourse at the macrostructural level is largely intact. Despite significant improvements in spoken production after C-VIC training, especially at the single sentence level, the subjects' spoken discourse remains severely impaired by their failures at the microlinguistic level. These results point to the limits of currently available approaches to the remediation of aphasia and suggest avenues for future research.
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4/9. Semantic dementia. Progressive fluent aphasia with temporal lobe atrophy.

    We report five patients with a stereotyped clinical syndrome characterized by fluent dysphasia with severe anomia, reduced vocabulary and prominent impairment of single-word comprehension, progressing to a stage of virtually complete dissolution of the semantic components of language. A marked reduction in the ability to generate exemplars from restricted semantic categories (e.g. animals, vehicles, etc.) was a consistent and early feature. Tests of semantic memory demonstrated a radically impoverished knowledge about a range of living and man-made items. In contrast, phonology and grammar of spoken language were largely preserved, as was comprehension of complex syntactic commands. reading showed a pattern of surface dyslexia. Autobiographical and day-to-day (episodic) memory were relatively retained. Non-verbal memory, perceptual and visuospatial abilities were also strikingly preserved. In some cases, behavioural and personality changes may supervene; one patient developed features of the kluver-bucy syndrome. Radiological investigations have shown marked focal temporal atrophy in all five patients, and functional imaging by single positron emission tomography and positron emission tomography (one case) have implicated the dominant temporal lobe in all five. In the older literature, such cases would have been subsumed under the rubric of Pick's disease. Others have been included in series with progressive aphasia. We propose the term semantic dementia, first coined by Snowden et al. (1989), to designate this clinical syndrome.
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5/9. Cross-language lexical connections in the mental lexicon: evidence from a case of trilingual aphasia.

    Despite anecdotal data on lexical interference among the languages of multilingual speakers, little research evidence about the lexical connections among multilinguals' languages exists to date. In the present paper, two experiments with a multilingual speaker who had suffered aphasia are reported. The first experiment provides data about inter-language activation during natural conversations; the second experiment examines performance on a word-translation task. Asymmetric patterns of inter-language interference and translation are evident. These patterns are influenced by age of language learning, degree of language recovery and use, and prevalence of shared lexical items. We conclude that whereas age of language learning plays a role in language recovery following aphasia, the degrees of language use prior to the aphasia onset and of shared vocabulary determine the ease with which words are accessed. The findings emphasize the importance of patterns of language use and the relations between the language pair under investigation in understanding lexical connections among languages in bilinguals and multilinguals.
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6/9. Aphasic victim as investigator.

    The author (a classics professor) suffered a cerebrovascular accident, resulting in aphasia. In order to learn whether speech therapy helps aphasic patients to recover, the patient worked on Greek vocabulary and grammar and ignored Latin. (Both languages were equally well-known before the accident; skills in both languages had been totally lost afterward.) This case demonstrates the value of retraining an aphasic. After three years, testing demonstrated a professorial level of the Greek language, but Latin was essentially still missing.
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7/9. The double dissociation of short-term memory for lists and sentences. Evidence from aphasia.

    We document the sentence and list repetition skills of 3 aphasic patients. Cases 1 and 2 were classified as span-impaired conduction aphasics and Case 3 was classified as a span-preserved transcortical sensory aphasic. We found that repetition by the span-impaired cases was facilitated by increasing the 'meaningfulness' of lists, whereas this had no effect on the performance of the span-preserved case. The patients' ability to repeat sentences was contrasted with their ability to repeat three words contained in the sentences, and a double dissociation was obtained: the span-impaired cases were better at repeating sentences than in repeating three word lists whereas the span-preserved case showed the opposite pattern of difficulty. The repetition of sentences containing a known and unknown vocabulary was tested in the span-preserved case. His repetition of sentences containing words which he still knew was significantly better than his ability to repeat sentences containing a vocabulary of words which he had 'forgotten' as a consequence of his aphasia. The patients' ability to repeat complete, incomplete, and nonsense sentences was contrasted: overall the span-impaired patients were somewhat better at repeating complete sentences than incomplete sentences. Finally we examined the patients' ability both to comprehend and repeat word strings in an abbreviated 'naming from description' task: the span-impaired patients were able to comprehend three word strings, but unable to repeat them, the span-preserved case was able to repeat but not comprehend. On the basis of these double dissociations we conclude that the evidence indicates two dissociable short-term memory systems, one a relatively passive phonological store subserving list repetition, the other a dynamic, anticipatory, and integrative memory system which underpins sentence repetition.
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8/9. Categories of knowledge. Further fractionations and an attempted integration.

    In this study we investigated the category specificity of the comprehension impairments of Y.O.T., a patient with a severe global dysphasia. Using matching to sample techniques it was possible to demonstrate selective impairments and selective preservations not only of broad categories of semantic knowledge but also of particular subsets of such categories. Specifically, Y.O.T.'s comprehension of 'objects' was, in general, significantly more impaired than for foods or living things. Within the broad class of objects she was significantly more impaired in the comprehension of small manipulable objects than large man-made objects. Within her proper noun vocabulary there was a significant dissociation between her good comprehension of proper nouns having a unique and well-known referent (e.g., Churchill) and common proper nouns without such a referent (e.g., Jones). Her error responses were not consistent, semantic similarity and significant rate effects were observed, and it was therefore considered that her category specific comprehension deficits were primarily ones of access to a full semantic representation. We attempt to give a principled account of the increasing number of seemingly arbitrary instances of fine-grain categorical impairments of semantic knowledge. We have suggested that different weighting values from multiple sensory channels will be important in the acquisition of different categories of knowledge and that such differential weightings could be the basis of the categorical organization of systems in the brain subserving semantic knowledge.
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9/9. The modality-specific organization of grammatical categories: evidence from impaired spoken and written sentence production.

    We describe the case of a brain-damaged individual whose speech is characterized by difficulty with practically all words except for elements of the closed class vocabulary. In contrast, his written sentence production exhibits a complementary impairment involving the omission of closed class vocabulary items and the relative sparing of nouns. On the basis of these differences we argue: (1) that grammatical categories constitute an organizing parameter of representation and/or processing for each of the independent, modality-specific lexicons, and (2) that these observations contribute to the growing evidence that access to the orthographic and phonological forms of words can occur independently.
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