J. COMMUN. DISORD.

26 (1993). 101-111

TREATMENT OF WERNICKE’S
APHASIA WITH JARGON:
A CASE STUDY
MONICA STRAUSS HOUGH
School of Allied Health Sciences, Department of Speech-Language & Auditory
Pathology, Easi Carolina University

This case study concerns an adult with Wernicke’s aphasia characterized by

neologistic jargon and a severe auditory comprehension deficit. No communi-
cative or linguistic improvements had been observed after eight months
poststroke. Up until this time, therapeutic intervention was aimed at managing
the patient’s rambling communicative style and improving auditory comprehen-
sion skills. A therapeutic regimen was introduced that focused on visual/written
information and included a hierarchy of visual word and sentence comprehen-
sion tasks. All auditory/verbal stimulus presentation was eliminated. After two
months on the program, improvement was noted in naming abilities and general
ability to communicate in conversation, including a reduction of neologistic
jargon and an increase in semantic jargon. No improvement was noted in audi-
tory comprehension. The visual program may have facilitated the patient’s
general attentional set, thereby possibly contributing to her improvement in
communicative style and sensitivity to conversational interactions with others.

INTRODUCTION
Jargon has been described as lengthy and fluently articulated utterances
which are replete with verbal and phonemic paraphasias and neolo-
gisms (Brown, 1981; Buckingham and Kertesz, 1976; Davis, 1993; Ellis,
Miller, and Sin, 1983; Ellis and Young, 1988; Miller and Ellis, 1987).
It has been associated with the fluent syndrome of Wernicke’s aphasia.
Other characteristics of this syndrome include poor auditory language
comprehension and word retrieval difficulties. Severe limitations in
reading and writing skills also have been reported in Wernicke’s aphasia
(Butterworth, 1985; Goodglass and Kaplan, 1983).
Jargon has been classified into two major types. Verbal output that

Requests for reprints should be sent to: Monica Strauss Hough, Ph.D., Department
of Speech-Language and Auditory Pathology, East Carolina University, Greenville, NC
27858.

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102 HOUGH

consists of a heavy concentration of neologisms is called neologistic

jargon whereas jargon that is characterized by a higher proportion of
verbal paraphasias is referred to as semantic jargon (Ellis and Young,
1988; Goodglass and Kaplan, 1983; Lecours, Osborn, Travis, Rouillon,
and Lavallee-Huynh, 1981; Martin, 1981).
In general, most literature on aphasia treatment has focused on facili-
tating and increasing the amount as well as the accuracy of verbal out-
put of nonfluent aphasic individuals. There has been limited information
available on therapeutic techniques to improve the communication
skills of fluent aphasic adults, especially those individuals with severe
auditory comprehension impairment and jargon in verbal output (Mar-
shall; 1982). Marshall (1982; 1983) has suggested that treatment offluent
aphasia should emphasize an analysis and modification of individuals’
communicative styles in communicative interactions. For the aphasic
patient who displays jargon, it is recommended that therapy focus on
the clinician gaining control of communicative interactions. One ap-
proach to the treatment of jargon aphasia has included a stop strategy
or nonverbal alerting signal to facilitate attentional set and reduce the
flow of speech (Butterworth, 1979; 1985; Kennedy, 1984). This strategy
has included hand signals and/or body gestures to direct the patient to
stop talking. These methods have been used because neologistic jargon
serves no useful communicative purpose and appears to interfere with
auditory processing (Holland, 1977) and, hence, interpersonal monitor-
ing (Martin, 1981). Traditional tasks aimed at improving auditory com-
prehension may be unsuccessful with adults with jargon aphasia be-
cause these individuals usually present with a damaged auditory
system. Martin (1981) has indicated that fluent aphasic adults may be
more responsive if therapeutic attention is directed to the entire process
of comprehension using several modes of communication and the simul-
taneous use of at least two modalities.
This paper is a case study in which a therapeutic regimen involving
reading was incorporated in the treatment of a patient with Wernicke’s
aphasia, characterized by neologistic jargon and a severe auditory com-
prehension deficit. This individual had not benefited from any of the
reported techniques used in the intervention of jargon aphasia. The
overall goal of treatment was to improve the patient’s functional com-
munication abilities. To achieve this goal, specific emphasis was fo-
cused on improving self-monitoring skills as well as increasing the accu-
racy of verbal output. Reading was used as a treatment modality for
several reasons. First of all, it was informally observed that the patient
made limited attempts to read material at home and in the therapy
room. Second, the anatomical location of the patient’s left hemisphere
lesion provided justification for utilizing primarily the visual modality
TREATMENT OF WERNICKE’S APHASIA WITH JARGON 103

in treatment. Specifically, the patient’s lesion did not extend into the
occipital lobe. Research has revealed that reading skills may not be as
impaired as auditory skills in Wernicke’s aphasia if the lesion site does
not involve anterior portions of the occipital lobe (Kennedy, 1984; Mar-
shall, 1982). From a theoretical standpoint, another reason for using
reading as a treatment approach is because of the modularity of reading
and auditory comprehension. That is, reading and auditory comprehen-
sion systems are modular as well as modality-specific. Therefore, audi-
tory comprehension skills are not predictive of reading ability and/or
improvement of reading in treatment, and reading ability is not predic-
tive of auditory comprehension skills or increased auditory comprehen-
sion performance in therapy. In jargon aphasia, particularly the neolo-
gistic type, it has been suggested that impairments are the combined
result of problems in speech perception and difficulties in accessing the
speech output lexicon (Ellis and Young, 1988). Thus, these individuals
have difficulty using the auditory modality as a means of monitoring
their own speech and/or the speech of others as well as difficulties in
retrieving words. Therefore, although individuals’ auditory comprehen-
sion skills are severely impaired, reading may be relatively spared and
possibly could be used as a means of circumventing deficits in intraper-
sonal and interpersonal self-monitoring. This bypassing of auditory
comprehension may consequently reduce the amount of jargon in ver-
bal output.

METHOD
R.C. was a 66-year-old left-handed female who suffered two left hemi-
sphere strokes verified by CT scan and neurological examination. After
the first stroke, the CT scan revealed a lesion involving the posterior
portion of the first temporal gyrus, with a diagnosis of “Wernicke’s
aphasia.” The second stroke occurred one month after the first and
resulted in a diagnosis of “Wernicke’s aphasia with jargon.” CT scan
indicated the original lesion, plus an extension into the anterior portion
of the supramarginal gyrus.
Initial contact with the patient was at seven months’ postonset sec-
ond stroke. R.C.‘s speech consisted of differentiated, rambling, neolo-
gistic jargon with an inability to repeat, poor auditory comprehension,
and a general lack of intrapersonal and interpersonal monitoring. R.C.‘s
incessant verbalizations appeared to prevent her from “picking up”
conversational cues from the environment. Furthermore, R.C. fre-
quently did not use prosodic patterns appropriate to her communicative
intentions, thereby increasing the examiner’s difficulty in interpreting
R.C.‘s messages. Prior to this time, R.C. had received speech therapy
104 HOUGH

Table 1. Test Results

At 7 mos. 8 mos. 10 mos.

onset* postonset postonset postonset

Boston Naming Testing 0 0 0 9

BDAE
Word discrimination 0 0 1 2
Body part identification 1 0 1 1
Oral commands 0 1 1 1
Complex ideational 0 0 0 0
Automatized sequences 0 0 1 2
Repetition of words 0 0 0 3
Repeating phrases 0 0 0 1
Word reading 0 0 0 1
Responsive naming 0 0 0 3
Visual confrontation 1 2 3 18
naming
Animal naming
Oral sentence reading
Word-picture matching
Reading sentences and
paragraphs
Aphasia Severity 0 0 0
Rating
Rating Scale Profile
Melodic Line
Phrase Length
Articulatory Agility
Grammatical Form
Paraphasia
* After second stroke

twice weekly. Results on the Boston Diagnostic Aphasia Examinution

(BDAE) (Goodglass and Kaplan, 1983) and Boston Naming Test (BNT)
(Kaplan, Goodglass, and Weintraub, 1983) revealed almost no improve-
ment on any task across all modalities at seven months’ postonset.
Subtests and results of this testing are presented in Table 1. The previ-
ous clinician reported that neither she nor the family had observed any
improvement in communicative interactions with others or in R.C.‘s
ability to self-monitor errors. Speech records indicated that treatment
included unsuccessful incorporation of picture categorization tasks, a
TREATMENT OF WERNICKE’S APHASIA WITH JARGON

communicative-oriented strategy similar to Promoting Aphasics’ Com-

municative Effectiveness (PACE) (Davis and Wilcox, 1981; 1985), audi-
tory comprehension tasks, and attempts at managing the patient’s ram-
bling communicative style. Tasks aimed at reducing press for speech,
improving general comprehension, and providing a communicative con-
text, as well as activities designed to achieve control of conversational
interactions through use of exaggerated gestures and strong agreement
statements, were continued by the reporting examiner for another
month. At 8 months’ postonset, there still was no general communica-
tive or linguistic improvement in any modality.
At eight months’ postonset, the author decided to change the focus
of therapy. This was because of: 1) R.C.‘s minimal success in word-
picture matching on the BDAE (Goodglass and Kaplan, 1983); 2) no
reported improvement in any linguistic or communicative area; and 3)
R.C.‘s lack of responsiveness to control of conversational interactions.
Treatment was focused on the visual modality, with emphasis on intro-
ducing visual comprehension tasks. All auditory and verbal communi-
cative interactions and presentation of stimuli were discontinued. The
visual channel, focusing on reading, was introduced as a treatment
modality with R.C.
A hierarchy of tasks was developed to improve visual word and sen-
tence comprehension. These tasks incorporated many parameters of
Marshall’s (1978) auditory tasks in which stimulus and response vari-
ables are manipulated based on the patient’s success. The tasks and
their instructions, however, were presented entirely through the visual
modality to R.C. The visually-oriented tasks are presented in Table 2.
R.C.‘s criterion for each task was 90% accuracy over two consecutive
sessions with a large number and variety of stimulus materials.

RESULTS
Standardized test results on the BDAE and the BNT after implementa-
tion of the visual program at eight months’ postonset are presented in
Table 1. As can be seen at IO months’ postonset-CVA (after 2 months
of involvement in the visual program), some improvement was ob-
served in visual comprehension skills and verbal output, particularly
in naming ability. There were no improvements in auditory comprehen-
sion abilities as measured by the BDAE. However, it was observed
and reported that R.C. was able to respond more accurately in simple
conversational situations with the examiner and her family, possibly
relying more on contextual and pragmatic cues from her environment
and other conversational participants. Furthermore, neologistic jargon
decreased, with a corresponding increase in semantic jargon. Samples
106 HOUGH

Table 2. Visual Therapy Tasks

Word Comprehension
I. word-picture matching
2. word-word matching
Stimulus manipulations: a. same/different (“boy” vs. “boy”)
b. familiarity (“fellow” vs. “yellow”)
c. same category (“pants” vs. “dress”. “pants”
vs. “apple”)
d. word class (“pen” vs. “write”)
synonym (“couch” vs. “sofa”)
E association (“bookslbookcase” vs. “books/
rodeo”)
Response manipulations: a. choices increased to 5
b. relatedness among choices increased
C. imposed delayed of response to IO seconds
Sentence Comprehension
I. sentence-picture matching
2. following instructions
3. answering questions
Stimulus manipulations: a. increases in length
b. structural complexity (active vs. passive, re-
versibility)
c. semantic plausibility (“eat your lunch” vs.
“eat your shoes”)
d. contextual and linguistic redundancy (semant-
ically supportive words within and outside
sentence boundary)
Response manipulations: a. choices increased to 5
b. relatedness among choices increased
c. complexity of choices
d. length of choices
e. complexity of gestural response

of her responses on the BNT and visual confrontation naming from the
BDAE are in Table 3. At this time, R.C. also used more utterances that
successfully demonstrated her communicative intent.
Therapy results are presented in Table 4. On all visual tasks, baseline
data were averaged across three trials and were relatively stable. R.C.
reached criterion on all word comprehension tasks (word-picture and
word-word matching). On most of these tasks, baseline percentages
were between 65-75%. Baseline percentages for sentence comprehen-
TREATMENT OF WERNICKE’S APHASIA WITH JARGON 107

Table 3. Samples of Neologistic and Semantic Jargon

7 mos. 8 mos. IO mos.

At onset postonset postonset postonset

Boston Naming Test

“scissors” lakwr\bl lfwmol IsaIbwal lkAtmxn/
“flower” llcdil /wide/ /fenhaIl /bIumpat/
“pencil” lkwobal /bIvIk/ lgIfkul lptmresl
BDAE
“drinking” lpcpol lkIbin/ InodIkl lkr\pApl
“cactus” lkzebatl ItukItl IsAtAsl Iprlkall

sion tasks were consistently lower at approximately 45-55%. Although

R.C. did not reach criterion on any of the sentence comprehension
tasks, improvement was noted on all activities regardless of stimulus
or response manipulations.

DISCUSSION
Kennedy (1984) has reported that some Wernicke’s aphasic patients
with severe auditory impairments can make use of visual and graphic
information. When this technique is successful, it may be observed to
have an impact on attention, general comprehension, and verbal output.
That is, written information alerts the patient to the speaker’s intention
to communicate and also may elicit some accurate and appropriate
verbal output. For R.C., written information may have activated resid-
ual language competence that was visually-based, thereby improving
her naming/word retrieval abilities, communicative style, and the pro-
sodic pattern of general conversation. Furthermore, cuing in on visual
information appeared to facilitate R.C.‘s general attentional set and
hence increased her sensitivity to some rules of conversation.
It has been suggested that neologistic and semantic jargon are differ-
ent stages in the recovery pattern of Wernicke’s aphasia, with the neol-
ogistic type observed in the most severe form of the syndrome (Kertesz
and McCabe, 1977). The change from neologistic to semantic jargon in
the verbal output of Wernicke’s aphasia has been a consistent finding;
however, it usually occurs much earlier in the recovery process (Lud-
low, 1977; Prins, Snow, and Wagenaar, 1978) than was observed with
R.C. Furthermore, changes in verbal output, such as those observed
in R.C., usually have been reported to be accompanied by improvement
in auditory comprehension. This was not the case for R.C. It is possible
108 HOUGH

Table 4. Sentence Comprehension Therapy Results

Baseline* IO mos. PO.**

Sentence-picture matching+
Sword active sentences/3 unrelated 51% 73%
picture response choices (“The boy
hit the dog.“)
7-word active sentences/3 unrelated 50% 62%
picture response choices (“The boy
and girl washed the dog.“)
7-word nonreversible passive 46% 56%
sentences/3 unrelated picture
response choices (“The cat was hit
by the girl.“)
7-word reversible passive sentences/3 46% 57%
unrelated picture response choices
(“The girl was chased by the boy.“)
Following instructions +
4-word instruction/3 unrelated response 54% 79%
choices (“Pick up the cup.“)
7-word 2-item instruction with 47% 60%
conjunction/3 unrelated response
choices (“Point to the pencil and the
cup.“)
6-word instruction using preposition/3 45% 53%
unrelated response choices (“Tap
the spoon with the pencil.“)
Answering questions+
4-5 word yes/no questions (“Do you 55% 82%
eat soap?“)
4-6 word what questions13 one-word 47% 59%
noun unrelated responses (“What do
you write with?“)
4-6 word who questions13 one-word 45% 51%
unrelated responses (“Who works at
a bank‘?“)
4-6 word when questions13 one-word 45%
unrelated responses (“When do we
sleep?“)
4-6 word where questions13 one-word 46% 54%
unrelated responses (“Where do you
deposit money?“)
* Baseline data were obtained at 8 months’ postonset: ** IO months‘ postonset: + Additional tasks
requiring longer. more complex responses with increased choices were not introduced because 90%
criterion was not met.
TREATMENT OF WERNICKE’S APHASIA WITH JARGON 109

that R.C.‘s conversational improvements were the result of increased

auditory processing skill but this was not substantiated by standardized
aphasia battery performance.
R.C.‘s recovery pattern was different from the few cases classified
as exhibiting Wernicke’s aphasia, which have been reported in the liter-
ature in that improvement in linguistic and communicative skills did
not occur until quite long postonset. Her improvement also was limited
to a few specific modalities. For example, Ludlow’s (1977) two patients
with Wernicke’s aphasia as well as her other fluent subjects made the
greatest amount of recovery during the first two months postonset.
Gains were particularly evident in word fluency and naming. Prins,
et al (1978) found that fluent patients, including Wernicke’s aphasic
subjects, made the most recovery during the first six months’ postonset
with greatest improvement in auditory comprehension skills. Minimal
increases were noted in spontaneous speech. Interestingly, it has been
reported that adults with global aphasia often do not make improve-
ments in comprehension and verbal skills until after the expected period
of spontaneous recovery at six months’ postonset (Sarno and Levita,
1981). Although R.C. did not present with the classical communicative
pattern characteristic of global aphasia, she was severely impaired
across all modalities at 8 months’ poststroke. Therefore, in regard to
her recovery pattern, her severity, rather than type of aphasia, may
have determined the delayed onset of her recovery. Therapy was dis-
continued after ten months’ poststroke because R.C.‘s family moved
out-of-state. Therefore, it is possible that the extent of R.C.‘s communi-
cative and linguistic improvement may have been greater had she con-
tinued in the therapy program.
One of the major problems with pretest/posttest case study designs
as opposed to within subject designs is the lack of experimental control.
As controls are not built into the design to account for extraneous
variables, it is not possible to definitively attribute the changes ob-
served on posttesting (10 months’ postonset) to the treatment. That is,
we may not be able to conclude what accounted for the change in
R.C.‘s performance, as some other variable may have been operating
concurrently. However, because R.C. did not demonstrate notable im-
provements in communicative skills until after introduction of the visual
therapy program at 8 months’ postonset, it may be appropriate to attrib-
ute changes in performance to the visual treatment regimen. This notion
is supported, although not proved, by the temporal proximity of the
noted improvement in communication skills and introduction of the
visual therapy program.
110 HOUGH

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