Ruth Lesser

Verbal Comprehension in Aphasia: An English Version of Three Italian Tests

Summary An English version of three Italian tests of auditory verbal comprehension in aphasia, using picture-choice, was given to four groups of subjects: two groups had suffered cerebral vascular accidents, one with left hemisphere damage and aphasia (LHD)., the other with right hemisphere damage without aphasia (RHD); a third group had undergone bilateral frontal leucotomies (BFL ); the fourth group had no known brain damage (NDB). Six other tests were also given, including the English Picture Vocabulary Test 3 and Ravens Standard Progressive Matrices. Like the Italian test, the English Syntax Test distinguished the aphasic from all the non-aphasic groups; so did the Phonological Test, but only at a confidence level of p

Therapy for naming difficulties in aphasia: Application of a cognitive neuropsychological model

Abstract In a repeated case study design, six aphasic patients with naming difficulties were selected according to criteria generated from the application of a cognitive neuropsychological model of naming. Two subjects were thought to have problems within the semantic system, and were given semantic (model-appropriate) therapy. Two subjects were thought to have problems relating to the phonological lexicon; they were given phonological (model-appropriate) therapy. Two subjects were thought to have problems at the level of phoneme assembly; they were given semantic (model-inappropriate) therapy. This was in order to test whether a treatment programme designed for one type of naming disorder could be effective if used indiscriminately (as might happen in current clinical practice). Three of the subjects receiving model-appropriate therapy showed improved naming after eight weeks of therapy; the two subjects receiving model-inappropriate therapy did not improve. The results suggest that applying a processing model in selecting patients for therapy for naming difficulties is a promising development which merits further testing.

Conversing in dementia: A conversation analytic approach

Abstract Pragmatic impairment is a major source of disruption to communication between people with dementia and their caregivers. Speech and language therapists have an important role to play in providing education and advice to caregivers that will facilitate more effective communication. This aspect of therapy has become central to the management of communication difficulties in dementia and comprehensive lists of general strategies can be found in the literature. Currently, however, there are no procedures available to guide clinicians in individually targeting advice that take into account both the range of communication problems that can arise and the unique interaction that occurs between two individuals. Furthermore, suggested communication strategies have been clinician-driven rather than led by the patient or caregiver, thereby failing to incorporate the knowledge and skill that the caregiver has already developed. Finally, there are limited empirical data about the effects of modifying linguistic variables in communication with people with dementia. A review of existing research in this area is provided and the potential contribution of conversation analysis to the assessment and management of pragmatic disorders in dementia targeted at an individual level is explored. Using a conversation analytic framework, a methodology will be described that 1. (a) identifies the interactional difficulties from the perspective of the individual patient and caregiver, 2. (b) obtains information on the strategies currently being used at home and 3. (c) determines the degree of their success. Data are presented and the implications for individually targeted education and advice to caregivers are discussed.

Towards combining the cognitive neuropsychological and the pragmatic in aphasia therapy

Abstract Given that the aim of aphasia therapy is to improve communication rather than performance on formal tests, cognitive neuropsychologically-based approaches need to provide evidence that successful outcomes generalise to communication in everyday life. One means of doing this is to address everyday communication directly by combining inferences made from a psycholinguistic assessment with analysis of natural conversation. This permits the individualised case-study approach used in cognitive neuropsychology to be applied in pragmatic intervention, since ethno-methodologically driven Conversational Analysis (CA) also uses a fine level of detail from individual language users. This can then be applied in indirect intervention achieved through caregivers. In the study reported here, the word-finding difficulties of two aphasic women were interpreted from a psycholinguistic perspective, and conversations between them and their caregivers at home analysed using CA. Inferences from both were combined in o...

Assessing functional communication in aphasia: clinical utility and time demands of three methods

A variety of methods has recently been used to assess everyday communication abilities in aphasic adults. This study compares three such methods for their clinical utility and the amount of a therapists time they use. The three methods employed a standard rating schedule completed by relatives, analysis of speech elicited through role-play and a partial analysis of everyday conversation samples. The utility of these assessments as a clinical tool was measured in terms of the therapists time needed, and the assessments ability to show stability or change of communicative effectiveness on test-re-test measures and to illuminate areas for therapeutic intervention. Eight aphasic adults (five acute and three chronic) were tested on all three assessments, then re-tested after a period of 3 months. The results suggested that, although more time-consuming, the partial conversational analysis was a more sensitive measure of stability or change of communicative effectiveness over time than the other two measures, and had the potential advantage for indirect intervention of revealing conversational strategies used by the partner as well as those used by the aphasic individual.

Cognitive neuropsychological influences on aphasia therapy

Abstract Approaches to aphasia therapy using psycholinguistic models are reviewed. Three models are described: lexical transcoding, lexical retrieval for naming, and sentence production. Examples of therapies derived from each model are cited.

Superior oral to written spelling : evidence for separate buffers ?

Abstract A brain-damaged patient with superior oral to written spelling is described. Analysis of error types in the two output forms showed different influences incompatible with Margolins (1984) proposal that oral and written spelling diverge only after a common buffer. Written spelling was influenced by word/nonword status, but not by regularity of spelling; oral spelling was influenced by regularity but not by word/nonword status. An alternative model is suggested.

Profiling conversation in Parkinson's disease with cognitive impairment

The impact of cognitive impairment on the interaction between people with Parkinsons disease (PD) and their carers was examined. A conversation analytic approach was taken to profile the nature of the communication difficulties of 12 people with PD with cognitive impairment in addition to the articulatory and prosodic disturbances typically associated with PD. Using a methodology that combined carer reports and analysis of conversational data, the complex relationship between impaired communicative behaviour, carers perceptions and the influence of changes from premorbid conversational styles and contexts was examined. The interactional consequences of altered communication behaviour were explored by analysing the types of strategies that were spontaneously used by carers when difficulties arose in conversation. The study further compared the conversational profiles of people with PD diagnosed with two putatively different pathologies in an attempt to determine whether analysis of interaction could discr...

Selective Preservation of Oral Spelling without Semantics in a Case of Multi-Infarct Dementia

A 70 year old retired van driver, with a diagnosis of multi-infarct dementia, showed features associated with transcortical sensory aphasia, with excellent repetition, a severe anomia, poor semantic comprehension and fluent speech. He was able to spell orally words which he did not understand, as well as nonwords; he wrote to dictation only after first spelling the words orally. Some of his spellings provided evidence for a dissociation between semantics and the graphemic output lexicon, the application of sub-word rules and partial lexical knowledge. These findings are interpreted in terms of a cognitive neuropsychological model.

The lexicon and sentence generation in aphasia

Abstract The experiment tested a prediction, derived from the lexicalist model of grammar (J. Bresnan 1978, in M. Halle, J. Bresnan, & G. A. Miller (Eds.), Linguistic theory and psychological reality, Cambridge, Mass.: MIT Press, pp. 1–59), that difficulty in accessing a verb from the lexicon should impair the generation of the associated to-complement clause while not significantly affecting the generation of word-independent constructions such as questions. Four aphasic subjects with word-finding difficulties but relatively high BDAE ratings on grammatical ability were examined. A modified story completion paradigm was used to elicit the favored constructions. Consistent with the hypothesis, all subjects showed greater difficulty in generating to-complements.