Robert C. Marshall

Self-monitoring behavior in a case of severe auditory agnosia with aphasia ☆

This case report describes an unusual combination of speech and language deficits secondary to bilateral infarctions in a 62-year-old woman. The patient was administered an extensive series of speech, language, and audiologic tests and was found to exhibit a fluent aphasia in which reading and writing were extremely well preserved in comparison to auditory comprehension and oral expression, and a severe auditory agnosia. In spite of her auditory processing deficits, the patient exhibited unexpected self-monitoring ability and the capacity to form acoustic images on visual tasks. The manner in which she corrected and attempted to correct her phonemic errors, while ignoring semantic errors, suggests that different mechanisms may underlie the monitoring of these errors.

Verbal self-correction behaviors of fluent and nonfluent aphasic subjects☆

Abstract This investigation examined the use of six explicitly defined verbal self-correction behaviors by fluent and nonfluent aphasic subjects of high and low verbal ability, and by subjects further classified into six groups according to type of aphasia (Brocas, Anomic, Wernickes etc.). Aphasic groups, on the average, generated some type of verbal self-correction effort on more than half of their initially erroneous responses, and the proportions of these efforts did not differ between aphasic patient groups. Significant differences in self-correction success were found, however, between groups classified according to fluency and severity, as well as among the six groups based on type of aphasia. In the former case, distinctions in self-correction skill favored high-verbal-ability groups regardless of fluency classification. In the latter instance, the subgroups typically formed by less severely impaired patients (Anomic and Brocas) had significantly higher proportions of successful self-correction behaviors than those comprised of individuals with more severe involvement (Wernickes and Brocas plus severely limiting apraxia of speech). Between-group differences for specific types of self-correction behaviors occurred rarely, but those which were found could be related to characteristics of the particular aphasic groups under consideration. Verbal self-correction behavior is discussed as a behavioral reaction to an erroneous response or dissatisfaction with the quality of an intended response. These behaviors are viewed as indicators of the intactness of an aphasic individuals self-monitoring system, and of his tolerance for responses that are qualitatively limited by his verbal deficits.

Effects of a palatal lift prosthesis upon the speech intelligibility of a dysarthric patient

Abstract This report describes the construction and objective evaluation of the effects of a palatal lift prosthesis upon the speech intelligibility of a single dysarthric patient. Tape recordings of three 50 item word lists were made prior to insertion of the prosthesis (L1), 7 days after insertion of the appliance (L2), and 68 days after insertion of the device (L3). Six judges listened individually to each list and wrote down each word as they heard it from the tape. In all instances the patient was most intelligible after 68 days and least intelligible before the appliance was inserted. Differences between the intelligibility score means for L1 and L3 and L2 and L3 were statistically significant (P

Selective impairment of phonation: A case study

A 47-year-old right-handed man underwent craniotomy for clipping of an aneurism at the trifurcation of the left middle cerebral artery. Subsequently, he suffered a left hemisphere CVA after which his speech and language resembled that of Brocas aphasia with accompanying apraxia of speech. Medical, behavioral, and acoustical data amassed over a period of several months indicated numerous contraindications to traditional diagnoses of Brocas aphasia, apraxia of speech, and dysarthria. Ultimately, it was determined that the patient had a selective impairement of phonation or laryngeal apraxia. This was illustrated dramatically when he was taught to use an electrolarynx which allowed him to bypass his disrupted phonatory system. Speaking with the electrolarynx, the patient communicated normally. Any semblance of Brocas aphasia disappeared. Supralaryngeal articulation was normal; apraxia of speech behaviors were absent. This case report indicates that dissociation of oral and laryngeal gestures due to brain injury is possible. Mechanisms underlying such a dissociation for this case are reviewed. The possibility of discrete center lesions in the frontal motor association area causing different types of apraxia of speech is discussed.

Effects of delayed auditory feedback on acquired stuttering following head injury

Abstract This study examined the effects of Delayed Auditory Feedback (DAF) with three cases of acquired stuttering following head injury. To determine the effects of DAF on stuttering behavior a multiple baseline design across three speaking tasks was employed. All subjects reduced stuttering with application of DAF. Stuttering behavior on untreated tasks continuing in baseline was not affected by DAF. When treatment was applied to the untreated tasks, stuttering events decreased for all three subjects. Results indicate DAF has potential as a treatment procedure with cases of acquired stuttering in a way similar to cases of developmental stuttering.

Atypical dysarthria in Munchausen syndrome

The evaluation and treatment of a 40 year old man with a diagnosis of Munchausen syndrome with accompanying dysarthria is described. the patient responded to symptomatic behavioural therapy similar to that for other functional speech and voice disorders. the speech pathologist may serve an important role in the management of such cases.

On the nature of conduction aphasia: A longitudinal case study

Abstract A longitudinal investigation is reported of an English-speaking conduction aphasic as an attempt to provide fresh insights into some unresolved issues pertaining to this syndrome. Data were collected from specially designed single word and sentence production tasks on picture naming, oral reading and repetition, conversational and expository speech, as well as standard aphasia test protocols on seven separate occasions over a six-month period. Significant changes took place gradually during the six-month recovery period that cannot be ascribed merely to an across-the-board decrease in the severity of his aphasic syndrome. The patients naming and reading performance improved substantially over the first six months, whereas repetition remained disproportionately impaired. These findings are brought to bear on notions related to proposed subgroups of conduction aphasia and the evolution of aphasic syndromes.

Idiosyncratic strategies in sentence production: A case report☆

In their case study of a patient with selective apraxia of phonation, Marshall, Gandour, and Windsor (1988, Brain and Language, 35, 313-339) reported that many of his utterances were ill-formed syntactically. In this note, a detailed syntactic analysis of his speech is presented. Although the patients syntax is deviant, it is seen to result from the application of certain consistent, identifiable, compensatory strategies. Moreover, it is shown that the particular, abnormal syntactic structures are internally consistent with his phonatory apraxia coupled with the normal rules of English prosody.

Imposed Delay of Response: Effects on Aphasics' Auditory Comprehension of Visually and Non-Visually Cued Material

Two groups of aphasics were administered an auditory comprehension task under conditions of 0-, 5-, and 10-sec. imposed delay of response. The auditory-visual group received auditory and visual cues; the auditory group received only auditory cues. Comprehension for the auditory-visual group was significantly better than for the auditory group. Increase in delay time significantly improved comprehension for the auditory-visual group but not for the auditory group.

Effects of scheduling on the communicative assessment of aphasic patients

This study determined the influence of morning and afternoon scheduling on the assessment of communicative skills of aphasic patients. Eight short-term (3 to 9 months post-onset) and eight long-term (12 or more months post-onset) aphasic subjects were administered 11 tests from the Porch Index of Communicative Ability (PICA) at specified times in the morning (A.M.) and afternoon (P.M.). Order of scheduling (A.M. first, P.M. second; P.M. first, A.M. second) was determined randomly but balanced between groups. Results indicated an absence of significant main effects for onset, scheduling, and test order; however, significant interactions between the scheduling and test-order factors were evidenced on the naming and auditory identification tests and on all overall measures. Analyses of these interactions revealed that patients scheduled first in the A.M. decreased their mean scores when assessed a second time in the P.M., whereas those scheduled first in the P.M., increased their scores when seen a second time in the A.M. Findings suggest that aphasic patients can be expected to do better on morning than afternoon assessments regardless of the order in which they are scheduled. Clinically, this indicates a need for consistency in the scheduling of periodic assessments for individual aphasic patients.