Frederic L. Darley

Language changes after neurosurgery for parkinsonism

Approximately one-fourth of a series of 123 patients with parkinsonism and other movement disorders showed language changes after thalamotomy, pallidectomy, and mixed pallidectomy-thalamotomy. Incidence of language change was higher in cases of left thalamotomy, multiple thalamotomies, and mixed procedures. Language impairments were predominantly of higher language functions and were not attributable to generalized intellectual impairment.

Phonemic Behavior of Aphasic Subjects Without Dysarthria or Apraxia of Speech

Thirty adult aphasic subjects without apraxia of speech or dysarthria were tested for their ability to produce phonemes in single test words and in spontaneous contextual speech. Results indicated that 75% of the total phonemic errors were due to a whole-word phenomenon apparently associated with faulty processing of the word rather than faulty production of the phoneme. True phonemic errors comprised 25% of the total errors or about 2% of all responses. Phoneme substitutions were by far the most frequent error (61%). Of the 30 subjects, 28 made no phonemic errors in spontaneous contextual speech. Aphasic behavior is not characterized by significant breakdown of articulatory performance. Observed patterns of error do not clearly support a phonemic regression hypothesis.

Effect of prestimulation on sentence comprehension by aphasic subjects

Aphasic subjects and controls were tested to determine whether comprehension of spoken sentences was enhanced by prestimulation concerning their contents. For each of the 20 test points, the subject listened to the test sentence and selected the corresponding picture from among four pictures presented simultaneously. The preparatory suggestions were given in one test condition and withheld in the other. Each prestimulation consisted of one or two sentences that indicated the persons, objects, or general situation to be presented in the test sentence. Analysis of variance indicated that the effect of the prestimulation was not significant.

II. Stroke Rehabilitation

Rehabilitation offers means by which persons disabled after a stroke can be returned to patterns of daily living as close to normal as possible. Often simple and readily available restorative techniques suffice, but sophisticated methods and facilities may be needed in many cases. Certain complex problems require specialized attention by persons with detailed knowledge and specific training. Among these are rehabilitation of language and the management of incontinence, sensory loss, pain, spasticity, and psychosocial problems. High-quality rehabilitation is best delivered by a closely cooperating team, including the family physician, medical specialists, nurses, allied health professionals (physical therapist, occupational therapist, social worker, dietitian, rehabilitation counselor, speech therapist, psychologist), the patients family, and also the patient. To accomplish these ends, hospitals, rehabilitation centers, extended care facilities, and nursing homes should give specific attention to the special needs of stroke patients. Careful discharge planning and follow-up are necessary in all cases. The home environment and the family attitudes may require considerable revision to meet the patients individual needs. The family physician can offer many rehabilitation services in his office, and additional education in medical school and on a postgraduate level will belp him to reach his full potential in aiding both the acutely ill and the chronically disabled stroke patient.

Effects of Intensity Variations on Auditory Processing in Aphasia I. Equal Intensities at Each Ear

Clinical observations have led several authors to suggest that talking louder improves auditory comprehension for the aphasic patient, while others suggest that it does nothing to help comprehension. To clarify these observations under experimental conditions, four measures of auditory processing (cortical-evoked responses, nonverbal intensity sequencing, phoneme in word discrimination and sequencing, and a semantic-syntactic measure of comprehension) were used in diotic presentation of stimuli to 10 aphasic subjects with left temporal lobe damage. The stimuli were presented at 70, 85, and 100 dB SPL. Results suggest that a simple diotic (true binaural) increase of stimulus intensity is not a potent variable for influencing auditory processing in patients with aphasia. Although a few subjects improved their performances on selected levels when stimulus intensity was increased, the performances of others decreased. Auditory-evoked response (AER) latencies and amplitudes generally were not significantly different between the damaged and intact hemispheres. The time-intensity trading function was demonstrated with the AER, particularly for the N2 component. The ear with the greatest advantage on dichotic listening was contralateral to the lesion and was contralateral to the hemisphere that had the shorter P1 latencies, longer N2 latencies, and smaller AER amplitudes.

The Effect of Auditory Rhythmic Stimulation on Articulatory Accuracy in Apraxia of Speech

In order to study the effects of different rates of rhythmic auditory stimulation on the phonemic accuracy of speakers who have apraxia of speech, eight apraxic subjects read four equated monosyllabic passages under one control and three experimental conditions. In the experimental conditions, rhythmic auditory stimulation provided by a metronome was imposed at each subjects oral reading rate as well as 75% and 125% of this established rate. In the control condition, the subjects read without any accompanying rhythmic stimulation. It was found that the stimulus supplied by an auditory metronome did not significantly improve the phonemic accuracy of these subjects. Articulatory accuracy tended to deteriorate under imposed rhythmic stimulation.