Cases reported "Language Disorders"

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1/33. Sentence processing in the face of semantic loss: a case study.

    The modularity of the sentence processor, or lack thereof, remains a much-debated issue in psycholinguistics. The authors present evidence from a semantically impaired patient (DM) that bears on this issue. As demonstrated elsewhere (S. D. Breedin, E. M. Saffran, & H. B. Coslett, 1994), DM suffered a significant loss of semantic knowledge. Here, the authors show that this impairment did not compromise DM's ability to process syntactic information. DM performed well on grammaticality judgment tasks and on sentence comprehension tasks that required the use of syntactic information for the assignment of thematic roles. The resistance of syntactic operations to semantic loss would seem to pose a challenge for models in which "the syntactic and conceptual aspects of processing are ... inextricably intertwined" (J. L. McClelland, M. St. John, & R. Taraban, 1989, p. 329).
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2/33. 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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3/33. Auditory neuropathy: case study with hyperbilirubinemia.

    Auditory neuropathy (AN) has been described in the literature as presenting with a combination of audiometric findings that include elevated behavioral audiometric thresholds, auditory brainstem response findings that are not consistent with audiometric findings, poor speech recognition, and present otoacoustic emissions (OAEs) and/or cochlear microphonics. Since the availability of clinical OAE testing, AN has come to be identified with increasing frequency; however, incidence and prevalence figures are unavailable. There is a great deal of discussion about the accurate diagnosis of AN, its characteristics, and its treatment. Some of this discussion is occurring on the internet and over the telephones. The need to continue to provide information in accessible peer-reviewed journals is paramount. Following a review of the literature, a case study is presented of a boy who was diagnosed with AN as a newborn. He experienced hyperbilirubinemia and other neonatal health complications. His educational intervention was managed elsewhere until recently. Information is presented about the progression of the case over a 5-year period that includes audiologic data and communication development results.
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4/33. Treatment of story grammar following traumatic brain injury: a pilot study.

    Recent investigations have documented a variety of discourse deficits following traumatic brain injuries (TBI). However, there is a paucity of information relating to the treatment of such deficits. The present study investigated the treatment of discourse production deficits, specifically story grammar ability, in an individual with TBI. Treatment emphasized meta-linguistic comprehension of story grammar structure and the identification and generation of episode components within stories. Over the course of treatment, a marked increase in the number of complete episodes generated by the individual with TBI was noted in story grammar probes. Follow-up probes at 1 and 3 months post-treatment, however, indicated limited carryover and poor generalization of the treatment effects. Findings are interpreted in terms of the individual's chronic cognitive deficits, disruptions in managerial knowledge, and the limitations of treating discourse acontextually.
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5/33. The role of phonological and orthographic information in lexical selection.

    We report the performance of two patients with lexico-semantic deficits following left MCA CVA. Both patients produce similar numbers of semantic paraphasias in naming tasks, but presented one crucial difference: grapheme-to-phoneme and phoneme-to-grapheme conversion procedures were available only to one of them. We investigated the impact of this availability on the process of lexical selection during word production. The patient for whom conversion procedures were not operational produced semantic errors in transcoding tasks such as reading and writing to dictation; furthermore, when asked to name a given picture in multiple output modalities--e.g., to say the name of a picture and immediately after to write it down--he produced lexically inconsistent responses. By contrast, the patient for whom conversion procedures were available did not produce semantic errors in transcoding tasks and did not produce lexically inconsistent responses in multiple picture-naming tasks. These observations are interpreted in the context of the summation hypothesis (Hillis & Caramazza, 1991), according to which the activation of lexical entries for production would be made on the basis of semantic information and, when available, on the basis of form-specific information. The implementation of this hypothesis in models of lexical access is discussed in detail.
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6/33. speech and language in primary progressive anarthria.

    We describe a patient with a progressive loss of speech up to muteness due to frontal atrophy. The clinical and neuropsychological examination documented a severe progressive articulatory disorder associated with a mild language deficit consisting of agrammatic production and spelling errors. Investigation of the patient's auditory-verbal short-term memory system revealed a selective impairment of the articulatory rehearsal system (covert re-circulation of verbal information), suggesting that not only overt but also covert articulation is impaired in this pathology. The conclusion is drawn that pure anarthria is a disorder of executive aspects of language. The hypothesis is advanced that language deficits such as spelling errors and agrammatic features might be due to ineffective covert articulation.
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7/33. Semantic paralexias facilitated by tachistoscopic reading in a patient with impairment of phonological recoding.

    This study of a dyslexic patient supports the view that the level of impairment of the phonological route plays a role in the production of semantic paralexias. The patient's reading was based on a defective phoneme-to-grapheme transcoding, in spite of evidence that semantic information was available through non phonological routes. The hypothesis that the residual ability to carry out phonological recoding could block the production of semantic paralexias was confirmed by tachistoscopic reading, assumed to interfere with phonological recoding in this patient, that provoked a definite rise of this type of error. The relationship between the degree of damage of phonological route and the clinical expression of the syndromes of phonological dyslexia and deep dyslexia is also discussed.
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8/33. Slowed lexical access in nonfluent aphasia: a case study.

    A list priming paradigm (LPP) was used to examine the hypothesis that nonfluent aphasics are literally slowed down in automatic access to lexical information. In this paradigm, words are presented visually, and the subject's task is to make a lexical decision on each word as quickly as possible after its presentation. As soon as a lexical decision is made on one word, that word is removed and, after a predetermined interword interval, the next word is presented. In this way, a continuous "list" effect is obtained. Prior studies with both college-age and elderly subjects using the LPP have shown that, independently of age, on the LPP, priming obtains at interword delays of 500 to 800 msec, but not at either shorter or longer interword delays. In the study reported here, the LPP was used to examine delays at which priming obtained for LD, a nonfluent aphasic with a lesion primarily in the left frontal region. Examining interword delays ranging from 500 to 1800 msec, the subject showed priming only at a delay of 1500 msec, a considerably longer delay than that at which neurologically intact subjects have shown priming. Based on these results, it is argued that while automatic access is retained, that access is much slower in a nonfluent aphasic than in neurologically intact elderly subjects. These results are discussed in terms of how slowed lexical access might impact on discourse comprehension.
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9/33. Clinical ethics in the context of language and cognitive impairment: rights and protections.

    Ethical dilemmas are particularly complex when a patient has a communication disorder. Questionable decision-making capacity can affect an individual's ability to participate in the informed consent process. When other cognitive impairments as well as language deficits are present, the risk of losing one's right to autonomy is greatly increased. Alternatively, the protection afforded those who are clearly incompetent may be limited if a person appears to have decision-making capacity but is unable to adequately process information. These challenges are illustrated in this article by use of clinical case descriptions. They also serve to demonstrate ways in which speech-language pathologists can provide the expertise needed to assist patients and medical teams in addressing these particular issues and ensuring patient autonomy.
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10/33. Dissociation of lexical syntax and semantics: evidence from focal cortical degeneration.

    The question of whether information relevant to meaning (semantics) and structure (syntax) relies on a common language processor or on separate subsystems has proved difficult to address definitively because of the confounds involved in comparing the two types of information. At the sentence level syntactic and semantic judgments make different cognitive demands, while at the single word level, the most commonly used syntactic distinction (between nouns and verbs) is confounded with a fundamental semantic difference (between objects and actions). The present study employs a different syntactic contrast (between count nouns and mass nouns), which is crossed with a semantic difference (between naturally occurring and man-made substances) applying to words within a circumscribed semantic field (foodstuffs). We show, first, that grammaticality judgments of a patient with semantic dementia are indistinguishable from those of a group of age-matched controls, and are similar regardless of the status of his semantic knowledge about the item. In a second experiment we use the triadic task in a group of age-matched controls to show that similarity judgments are influenced not only by meaning (natural vs. manmade), but also implicitly by syntactic information (count vs. mass). Using the same task in a patient with semantic dementia we show that the semantic influences on the syntactic dimension are unlikely to account for this pattern in normals. These data are discussed in relation to modular vs. nonmodular models of language processing, and in particular to the semantic-syntactic distinction.
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