Notes Visuals

Aphasia Classifications
Luria’s Classification:
- Followed a lot of Vygotsky’s ideas
- Social genesis: HMFs as first external then internal
- Systemic Structure of HMFs: exist only due to interaction
of different brain areas; each part has a role in the
functional systems (FS)
- Dynamic Organization and Localization of Function: each
HMF has varied structure and localization due to 1.)
structures mature and change, 2.) structures change based
on the level of automatization, 3.) possibility to use
different means to produce the same HMF
- Functional Systems (FS): 1.) consists of a single, complex,
and labile unit of activity; 2.) can use different mechanisms
to produce a consistent result for one specific task; 3.)
components of the FS may change due to development or
pathology
- All ideas resulted into a syndrome analysis of brain lesion
symptoms wherein you must identify:
1. Primary defect
2. Secondary systemic consequences of the primary
defect
3. Tertiary compensatory reorganizations
- Evolution-Based Approach to Neuropsychology: the brain
preserves its spatial form throughout development
o New functions are built over old ones, lending a
“common factor” to be present between them
o Explains why aphasic symptoms and non-verbal
deficiencies can be linked
o Analysis of aphasia: damage to primary speech
areas lend to complex aphasia syndromes too
difficult to analyze, we must then analyze it
based on partial disturbances that arise from
damage to marginal areas
- The brain is divided into 3 blocks:
o Block I (Subcortical structures): limbic system and
brainstem for goal-directed activity
(damage=selectivity of responses)
o Block II (Post-Central cortex): receives, analyzes,
and stores information (has different levels:
modality specific perception and analysis, and
intermodality analysis; paradigmatic organization
 Paradigmatic analysis focuses on a
set of elements and their common
properties (a set like this is called a
paradigm)
o Block III (Pre-Central cortex): programs,
regulates, and controls mental activity;
syntagmatic organization
 Syntagmatic analysis focuses on
what elements are selected to
precede and follow a chosen
element.
- Aphasias are caused by damage to:
o Frontal areas: combine elements in syntagmatic
units; implementing behavioral acts varying in
complexity
o Posterior areas: selection of element from
paradigms; monitoring performance of actions
and provide adjustment and differentiation
 Luria’s Classification
Type Area of Lesion Symptoms
Dynamic Aphasia Frontal lobe just anterior to Broca’s - Primary deficit: problem with inner speech and predicative
area function for linking thoughts to language
- Secondary consequence: formulating propositional speech;
echolalia
- No problems with comprehension or naming
- Motor aspect is not impaired
- May also be viewed as a problem with verbal planning, as
primary deficit can be seen as disruption of schemata of the
“future narrative” (a template for producing a narrative); this
then causes overload in working memory
Afferent Aphasia Lower part of the post-central - Primary deficit: impairs afferent basis of articulatory
region movements; does not differentiate among similar articulatory
positions and substitutes similar phonemes in speech
production
- Secondary consequence: comprehension deficits, dysgraphia,
dyslexia
Efferent Aphasia Broca’s Area (similar to classic - Primary deficit: smooth transitions from one sound to the next
Broca’s Aphasia) is impaired (but ability to articulate is intact)
- Secondary consequence: articulatory errors (timing, place of
articulation); agrammatism (static functions of nouns are
retained, but dynamic function to form grammatical sentences
is affected); writing and repetition are also impaired
Sensory Aphasia Posterior part of superior temporal - Primary deficit: deficit in analysis and synthesis of phonemes
convolution (similar to classic (impairment in phonemic hearing); disturbs ability to parse
Wernicke’s Aphasia) phonemes; impairs sound structures or words
- Secondary consequence: Disturbances in speech production
(phonemic and verbal paraphasias), repetition, reading (less
affected, but problematic when reading unfamiliar words
phonetically), and writing
- Verbal prompting does not help in word finding unlike in
aphasias caused by parietal lesions
Acoustico-Amnestic Aphasia Middle and inferior temporal gyri, - Primary deficit: Remembering stable auditory traces and is
just below area of lesion in sensory more severe with heavier load
aphasia - Secondary consequence: Repetition of words is disturbed;
disturbances in word meanings or connection between an
image and word
- Phonological hearing is relatively intact
Semantic Aphasia Parieto-temporo-occipital junction - Primary deficit: Semantic organization is defective
- Secondary consequence: Impairment in understanding
phrases /reversible constructions/logico-grammatical relations
due to impaired simultaneous synthesis of word meanings;
problems with naming; verbal paraphasias
- Articulatory-acoustic organization is intact
- Comprehension of isolated words is intact, but categorical
meaning is impaired
 Luria’s Classification: Expressive vs. Receptive Luria’s Classification vs Boston Classification

Benson and Ardila’s Neoassociationist Classification

- Proposes “clinical syndromes” instead of clinical-anatomical
correlates, but may be difficult to determine if syndromes or
site of lesion determines diagnosis
- Aphasia can be classified into:
1. Pre-rolandic (anterior, non-fluent) and posterior
(posterior, fluent)
2. Peri-sylvian (repetition impaired) and Extra-sylvian
(repetition intact)
- Two major aphasic syndromes involve problems with:
1. Paradigmatic Axis (similarity disorder)- problem with
selecting from a paradigm (part of a system, e.g. vocabulary)
2. Syntagmatic Axis (contiguity disorder)- problem with
combining linguistic elements

Benson and Ardila Classification

Type Area of Lesion Symptoms
Perisylvian
Wernicke-Type BA 22 - Paradigmatic axis defect that cause impaired lexical access for
comprehension
- Three core deficits: phoneme discrimination impairment,
verbal memory impairments, and lexical/semantic association
deficit

Broca-Type BA 44, 45, with extension to insula, - Syntagmatic axis defect that cause impaired lexical access for
lower motor cortex, and subjacent comprehension
PVWM - Two distinguishing characteristics: motor component (loss of
fluency) and agrammatism
Conduction BA 42, insula, and subcortical white - Phonemic paraphasias and conduit d’approche
matter
Extrasylvian -
 Transcortical Sensory
Transcortical Motor
Anomic
Global
Subcortical Aphasias
TPO Junction
Prefrontal cortex
Posterior language areas
Anterior and posterior lanfuage
zones
Striatum and internal capsule,
thalamus, and general white
matter damage
- Repetition is intact compared to Wernicke’s; Verbal jargon is
frequent
- Repetition is intact compared to Broca’s; seen as an executive
dysfunction n verbal initiation rather than verbal knowledge
- “end point” of other aphasia syndromes; pronounced word-
finding difficulty
- Oral production is scarce, stereotypies maybe common
- Scarce output, hypophonia present,

Aphasia recovery patterns:

1. Acute- 2 weeks post-onset (severe, acute recovery is
possible due to reperfusion)
2. Sub-acute phase- first few months post-onset (rapid
recovery due to neural reorganization)
3. Chronic phase- couple of months post onset- recovery
through therapy, left hemisphere is activated again

REF Model keywords:

- Elementary functions (localized)
- Algorithmic Strategies (connectionist) vs. Algorithmic
Modules
- Surface Phenomenon (observable behavior)

Agrammatism
Agrammatism is characterized by:
- Non-fluent and dysprosodic speech
- Simple and poorly realized syntactic structure
- Omission of grammatical morphemes (but can be
substitution in languages wherein omission errors are not
an option)
- Verb-retrieval deficits
- Problems with producing correct word-order in non-
canonical structures
- Possible to co-occur with asyntactic comprehension
(problems with understanding the syntactic structures they
have difficulty producing)

Possible assessment tasks:

- Picture description for spontaneous speech
- Production and comprehension of reversible and
syntactically complex sentences in comparison with
simpler syntactic structures
- Production and comprehension of verbs and verb-related
structure
- Production and comprehension of grammatical
morphemes

Methods to Elicit Spontaneous Speech Spontaneous Speech

- Interview + -
- Quantitative Production Analysis - Allows examination of - Cannot explain why errors
o Using the Cinderella story, syntactic and various linguistic levels occur
morphological content of utterances are - Allow identification of mild - Performance may reflect
measured difficulties that may not be impairment and
o Thompson et. al. used measurement of verb and evident in more constrained compensatory strategies
argument structure used, as well as proportion of tasks - Not producing does not
verbs of each type produced with the correct - Helps examine variability of imply they cannot
arguments structures used as well as produce a particular
o Frequency, imageability, and phoneme length of errors in production structure
words used may also me measured

Investigations of Event Processing

- Aims to capture difficulties at the message level
representation
- The Event Perception Test
o Matching representations of the same
verb/action
- The Role Video Test
o Using a video of a reversible or non-reversible
event, the patient is asked to point to the
photograph that shows the result

Producing Semantically Reversible and Syntactically Complex

Sentences
- Picture description wherein participants can fulfil more
than one thematic role
- Story completion
- Using a scenario that would elicit the question when
examining WH sentence production
o Overall, comprehension demand is high and may
reflect this rather than disordered production.
- Priming paradigm wherein experimenter produces
sentences with target structure and asks patient to
produce a sentence using new stimuli hoping to elicit the
same structure
o Helps decrease lexical retrieval issues
o May not reflect sentence production in real life
- Sentence anagrams (ordering the given words)
o May reduce effects of speech motor concerns
 o May not reflect online processing as participants
can overthink
Production of Verbs and Verb Predicate Argument Structure
- Production of single verbs in response to picture, videos,
definitions, sentence completion, and verb category
fluency
o Verb concreteness and imageability affect
availability during retrieval
- Pictures indicate number of arguments that need to be
taken by the verbs, wherein a sentence with that verb
needs to be produced
- Delayed repetition wherein clinician describes pictures first
o Simple verbs with one argument are preferred
o Verbs may not be that imageable and would be
hard to put in pictures
o
Production of Morphology and Function Words
- Use of spontaneous speech to count accuracy frequency,
and variety of function words and inflections
- Repetition and reading aloud may also be used
- Rarely examined in single word context, but can be done
with prepositions in sentence completion tasks
o Better with prepositions that carried semantic
information
- Answering questions or sentence completion to investigate
inflection
o Possessive “s” more difficult than others
- Context are artificial and may not reflect actual online
processing

Sentence Comprehension
- Sentence-picture matching
- Sentence-picture verification
- Grammaticality judgments
- “Sentence well—formedness” may or may not be
preserved

Comprehension of semantically reversible and syntactically complex

sentences
- sentence-picture matching task with canonical and non-
canonical word order

Comprehension of Verbs and morphemes

- Sentence matching or picture matching
- Often tested with production

Interpretations of agrammatism:
- Central syntactic deficit is agreed to be present in
agrammatism, but mechanism in which this arises is still
debated
- Types of structures that are difficult are generally agreed
upon: passives, object relatives, semantically reversible
sentences
- Representational:
o Missing or inadequate linguistic
information/component (but can be retrieved!)
o “All or nothing” (either the information is there
or it is not!)
o Based on linguistic models of language’s
representational structure
o Agrammatism is caused by deletion or disruption
of this component
o Error patterns from testing the disrupted
component
o TDH, TPH
 - Processing:
o Identifies a processing deficit or asynchrony that
affects linguistic encoding
o Based on psycholinguistic models of language
processing
o Impairment is due to computational overload
resulting from reduced temporal processing
window which is why linguistic information
cannot be integrated
o Substitutions: processing deficit; omissions:
compensatory strategies; dysfluency: monitoring
o Error patterns vary in test and spontaneous
speech
o PADILIH, DOP-H, Adaptation theory, Resource
Reduction
Theories of agrammatism (syntactic comprehension deficits):
1. Trace Deletion Hypothesis (TDH, Grodzinsky)
o Thematic roles are assigned via the traces left
during movement, but representations of these
traces are deleted in agrammatism
o Default strategy is to assign thematic roles based
on position of words in the sentence (and using
the base word order, the first noun is always the
agent in English)
o Only shows one pattern of comprehension, and
cannot account for all
o Eye tracking study by Thompson disproved this:
patients were able to track the correct
antecedent regardless of comprehension
performance
2. Double Dependency Hypothesis
o Two agents cannot be assigned in the sentence,
as soon as one of the NPs are given a role, the
other one will be assigned the remaining option
3. Derived Order Problem Hypothesis (DOP-H)
o Every language as a based word order, and other
structures are derived from that (and are harder
to form)
o Cannot explain problems with tense
Theories of agrammatism (verb production):
1. Tree Pruning Hypothesis
o The syntactic tree is pruned below the tense
node (above the agreement node), which means
that only nodes under that are functional. This is
not the case in all languages. The exact hierarchy
of nodes is debated.
2. Tense Underspecification Hypothesis (TUH)
o Tense is underspecified in the tree as tense
needs extrasentential information to form, but
agreement is preserved as it only requires
intrasentential information
o No proof that agreement is better preserved
than tense in all languages
o Problem with time reference in general rather
than solely tense (e.g. mandarin Chinese has no
tense
3. Past Discourse Linking Hypothesis (PADILIH)
o Reference to the past is more difficult than to the
present because the former is discourse linked
Theories of agrammatism (en bloc):
1. Weak syntax
o Grammatical access is slowed due to the inability
to manage competition between syntax and
other grammatical operations
 o Ability to link pronouns with antecedents is
impaired as they only have access to “narrow
syntax” (happens due to slowed processing)
2. Adaptation theory
o Agrammatism is a strategic choice made by
speakers to adapt to the reduced processing
capacity available; speakers then rely on ellipsis
to communicate
3. Resource reduction
o Decrease in resources needed to apply parsing
and/or interpretive operations
o Either caused by slowed lexical access or parsing,
which then leads to failure to integrate incoming
lexical information with the structure created by
the parser or reduced VWM
Other Theories of agrammatism:
1. Agrammatism is caused by a cognitive problem in mapping
thematic roles onto grammatical roles.
o Grammaticality judgment is accurate, but
comprehension is impaired
o Active sentences should also be a problem, since
there is also mapping = theory is false
o Revision: complexity due to movement that
complicates the process of mapping
2. Delayed Lexical Access Hypothesis
o Delayed retrieval of lexical information causes
delays in syntactic reflexes
3. Selective Vulnerability
o Grammatical morphemes, which belong to a
closed class of words, are affected by a global
decrease in processing resources in agrammatism
rather than a result of a specific lesion housing
such information.
4. Grammatical items are background
o As a result of slowing down of processing,
agrammatic patients omit grammatical
(background) items as an adaptive strategy.
5. Functional Theory of Grammatical Status
o Prioritization account
o Structural Dependency account
6. Usage-based theory
o Agrammatism is a result of “good enough”
processing wherein limited resources and
inability to combine produce mostly content
words, as grammatical words cannot convey
meaning themselves.