Peter Roger

Improving interpreting performance through theatrical training

Abstract Aspiring interpreting professionals need to possess skills which allow them to think quickly in order to deal with unexpected situations that will inevitably arise in the course of interpreting assignments. The complex and inherently unpredictable nature of interpreting can be a major source of anxiety for student interpreters, particularly when they are called upon to perform in a language in which their proficiency and confidence levels are limited. Specific techniques for managing this anxiety, however are often lacking in interpreter training programmes. This study examines the effects of a programme based on theatrical techniques commonly used in the training of professional actors but tailored specifically for novice interpreters. Two groups of interpreting students each received seven weeks of training in a sequential manner, allowing an external rating of the participants’ performance to be carried out before and after the training took place. Results of the external ratings and the participants ‘own evaluation of their learning revealed significant benefits, with gains particularly evident in the areas of confidence, delivery and rapid problem solving abilities.’

Lost in translation? Issues of content validity in interpreter-mediated aphasia assessments

In many parts of the world, speech-language pathologists (SLPs) are frequently called upon to assess aphasia in bilingual speakers, or in speakers of languages of which they have little or no knowledge. One of the strategies that SLPs employ in these situations is to involve an interpreter in the assessment process. Three authentic interpreter-mediated aphasia assessments were analysed for the present study, which aimed to determine the degree to which the content validity of the individual tests was compromised in the process of their administration through an interpreter. Findings reveal that content validity was frequently weakened either at the point of administration of the test or at the point at which responses were reported back by the interpreter to the SLP. Based on these findings, it is argued that the conduct of interpreter-mediated aphasia assessments needs to be fundamentally re-thought to take account of the limitations inherent in the interpreting process. To this end, this study presents a number of practical recommendations for the involvement of interpreters in aphasia assessments, with a view to making optimal use of existing assessment materials and enhancing the quality of diagnostic information to emerge from such clinical sessions.

Transcortical sensory aphasia due to a left frontal subcortical haemorrhage.

A case of transcortical sensory aphasia caused by a cerebral haemorrhage in the left frontal lobe is presented. A 72-year-old right-handed woman was admitted to the hospital, with a history of acute onset of speech disturbance and headache. On initial assessment, her spontaneous speech was fluent. She had no difficulty initiating speech, articulated normally, and did not exhibit logorrhea. Her ability to repeat phonemes and short sentences (5-6 words) was fully preserved, however she had severe difficulty with visual recognition of words, and with aural comprehension at the word level, although she was able to read words aloud. Computed tomography and magnetic resonance imaging showed cerebral haemorrhage in the left frontal lobe, involving the superior and middle frontal gyrus. Single photon emission CT revealed a wider area of low perfusion over the entire left frontal lobe, including the superior, middle and inferior frontal gyrus. The aphasia symptoms, mainly poor comprehension, disappeared quickly several weeks after the event. This may have been due to a reduction in the size of the haematoma and a resolution of the oedema around the haematoma. Clinically, the transcortical sensory aphasia in this case was indistinguishable from that caused by damage to the posterior language areas. Further case reports of transcortical sensory aphasia associated with frontal lobe lesions would help to confirm whether a relatively rapid recovery is characteristic in cases such as this.

Transcortical mixed aphasia due to cerebral infarction in left inferior frontal lobe and temporo-parietal lobe

Abstract. We present a case of transcortical mixed aphasia caused by a cerebral embolism. A 77-year-old right-handed man was admitted to our hospital with speech disturbance and a right hemianopia. His spontaneous speech was remarkably reduced, and object naming, word fluency, comprehension, reading and writing were all severely disturbed. However, repetition of phonemes and sentences and reading aloud were fully preserved. Although magnetic resonance imaging (MRI) showed cerebral infarcts in the left frontal and parieto-occipital lobe which included the inferior frontal gyrus and angular gyrus, single photon emission CT revealed a wider area of low perfusion over the entire left hemisphere except for part of the left perisylvian language areas. The amytal (Wada) test, which was performed via the left internal carotid artery, revealed that the left hemisphere was dominant for language. Hence, it appears that transcortical mixed aphasia may be caused by the isolation of perisylvian speech areas, even if there is a lesion in the inferior frontal gyrus, due to disconnection from surrounding areas.

Transient crossed aphasia and persistent amnesia after right thalamic haemorrhage

A 45-year-old right-handed woman suffered transient aphasia and persistent amnesia after a right thalamic haemorrhage. This patient appeared to have crossed aphasia, although it disappeared within 8 weeks. It is noteworthy that the patient had a unilateral right thalamic lesion but exhibited both verbal and non-verbal memory impairment. Computed tomography and magnetic resonance imaging revealed cerebral haemorrhage in the right thalamus involving the ventral anterior nucleus, medioventral nucleus, mamillothalamic tract, internal medullary lamina, and mediodorsal nucleus. An amytal test was performed and suggested that the right hemisphere was dominant for language functions and the left hemisphere was dominant for visuospatial functions. Single photon emission CT revealed a low perfusion area only in the right thalamus. These findings suggest that the right hemisphere might be dominant for both verbal and non-verbal memory function in this patient, although visuospatial function was lateralized in the left hemisphere.

Trust, talk and the dictaphone: Tracing the discursive accomplishment of trust in a surgical consultation:

Using discourse analytical methods, this article examines the interactional accomplishment of trust. Focusing on a case study drawn from a corpus of 28 surgical consultations collected in a gastro-intestinal clinic, it traces the trust-building process in a specific, communicatively challenging encounter where the patient is seeking a second opinion following an operation that she deems unsuccessful. Discourse analytical findings make visible the doctor’s strategic interactional work to build interpersonal trust with the patient and to regain her trust in the surgical profession. This work extends beyond interaction with the patient to include dictation of a letter to the referring doctor in the patient’s presence. Close analysis of the encounter reveals how this co-constructed consultation letter is deployed to strengthen the fragile patient–doctor trust engendered thus far. The article therefore provides insights into the discursive processes of trust building that could potentially be of considerable practical relevance to the medical profession.

Agraphia in Kanji after a contusional haemorrhage in the left temporo-occipital lobe.

The Japanese language has two different writing systems, Kana (Japanese syllabograms) and Kanji (Japanese ideograms), and Japanese sentences usually consist of combinations of both. Recently, there has been speculation that different pathways are involved in Kanji and Kana reading and writing.1 It has been suggested that the processing of Kanji and Kana involves different intrahemispheric mechanisms, as judged mainly through studies on patients with alexia and agraphia.2 Wernickes area and its surrounding left middle temporal lobe may play the most important part in Kanji reading when visual information is transmitted by any pathway. We recently had the opportunity to examine a patient who had mild transient aphasia and persistent agraphia of Kanji after a discrete contusional haemorrhage in the left temporo-occipital lobe. A 66 year old right handed man (pensioner) with 12 years of school education was involved in a traffic accident and sustained a closed head injury. He was admitted to our hospital the next day. He had no history of neurological problems. His parents, brothers, and sisters are all right handed. On examination, he was alert and cooperative. Neurological examination disclosed no motor or …

Into the Spotlight: Exploring the Use of the Dictaphone During Surgical Consultations

The study of computer use during consultations and in clinical communication teaching has generated considerable research interest in recent decades, but few studies have investigated how the use of other technological devices such as the dictaphone may be linked to the acquisition of interpersonal communication skills. Research on the dictaphone has focused on “backstage” activity such as dictating consultation letters after consultations, and largely neglected its potential in “frontstage” interactions with patients or as an educational tool in teaching clinical communication. This article draws on 28 consultations recorded in a gastrointestinal clinic and a follow-up interview with the participating surgeon to explore the use of the dictaphone during consultations. All data were transcribed and reiterative thematic analyses were conducted. The analyses presented here show how the dictaphone can serve a range of important relational and medical functions when used to co-construct consultation letters with patients. These functions include establishing and maintaining rapport, building trust, checking and clarifying information, aiding information accuracy, and closing the consultation. This study shows how a technological device usually reserved for “backstage” medical communication can be successfully used as a communicative tool in “frontstage” interactions and illustrates the multifaceted and beneficial functions of the dictaphone.

Assessment and management of aphasia in a linguistically diverse society

Abstract This paper reports the results of a survey conducted in metropolitan Sydney, Australia, which was designed to look at the assessment and treatment practices adopted by speech-language pathologists when working with individuals with aphasia from language backgrounds other than English. The results of the survey high-light a number of areas of concern for speech-language pathologists. These include the need for a range of appropriate assessment and treatment materials, as well as the need to improve the way that speech-language pathologists and interpreters work cooperatively in the assessment and treatment of aphasia in a linguistically diverse environment. The study also revealed that many speech-language pathologists wish to improve aspects of their own knowledge and skills relevant to their work with individuals who come from a variety of language and cultural backgrounds. These needs, some of the ways in which they might be addressed, and their implications in terms of further research are discussed in detail.

Transcortical mixed aphasia from ischaemic infarcts in a non-right handed patient

Sirs: Transcortical mixed aphasia (TMA), which is characterized by a severely reduced verbal output and impaired language comprehension in the presence of echolalic repetition and automatic completion of openend sentences [9, 10], has only rarely been reported. The localization of lesions producing TMA is variable [16, 20]. Albert et al. [1] reported that the syndrome is seen most often with diffuse or multifocal pathological changes that involve both anterior and posterior left hemisphere cortical association areas but spare the perisylvian language core. Similarly, Geschwind et al. [9] maintain that this condition is caused by anterior and posterior lesions of the left hemisphere when the perisylvian speech area is intact, and refer to it as ‘the syndrome of isolation of speech areas’. Recently some investigators [3, 5] have suggested that the mechanism which preserves repetition in transcortical aphasia is linked to an exceptional ability for repetition of the right hemisphere. We describe a patient with TMA who underwent an amytal test to determine hemispheric language dominance. The patient was a 53-year-old Japanese man with 9years of school education and employed as an office worker. His hand dominance can best be described as “mixed”; as a child he was taught to write, draw and use chopsticks with his right hand, and as an adult these activities are thus performed with the right hand, while throwing, brushing and cutting are performed with the left hand. His daughter is left-handed. He had a 10-year history of diabetes mellitus and hypertension, but no prior history of neurological problems. He suddenly began to exhibit speech disturbance and was referred for diagnosis to our Neurological Surgery Unit. Initially he was completely conscious and fully oriented but manifested a right homonymous hemianopsia. There was no apparent motor paralysis or sensory disturbance. The patient spoke little of his own volition, and often demonstrated echolalia when he was questioned. His phonological structure was clear. Formal language assessment was undertaken 2 weeks after the onset of symptoms, using the Standard Language Test of aphasia [18]. The results are presented in Fig. 1. When presented with picture-description tasks, the patient exhibited perseveration and literal paraphasic errors. This was in contrast to the full ability to repeat phonemes and short sentences (some five or six words). Reading aloud of kanji (Chinese characterbased) words was preserved and reading aloud of kana (syllable-based) letters was partially spared; however, the patient was unable to read aloud kana words or short sentences. Agraphia was almost total for both kanji and kana; however, writing to dictation of kana letters and single words (kanji and kana) was partially preserved. Testing also revealed some constructional apraxia but no evidence of oral, ideomotor or ideational apraxia. On the Wechsler Adult Intelligence Scale-Revised his performance intelligence quotient (IQ) was 55. Verbal IQ was unmeasurable in the presence of aphasia. Magnetic resonance imaging revealed cerebral infarcts in the left LETTER TO THE EDITORS J Neurol (1999) 246 :504–506