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Cognitive neuropsychological approaches to word production in aphasia:

Beyond boxes and arrows
Article in Aphasiology · October 2007

DOI: 10.1080/02687030701536016
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Cognitive neuropsychological
approaches to word production in
aphasia: Beyond boxes and arrows
a
Carolyn E. Wilshire
a
Victoria University of Wellington, New Zealand
Published online: 22 Oct 2010.
To cite this article: Carolyn E. Wilshire (2008): Cognitive neuropsychological approaches to

word production in aphasia: Beyond boxes and arrows , Aphasiology, 22:10, 1019-1053
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APHASIOLOGY, 2008, 22 (10), 1019–1053
Cognitive neuropsychological approaches to word production

in aphasia: Beyond boxes and arrows
Carolyn E. Wilshire
Victoria University of Wellington, New Zealand
Background: The cognitive neuropsychological approach aims to describe aphasic

Downloaded by [Victoria University of Wellington] at 15:03 25 June 2013
disorders of word production by identifying the specific cognitive process(es) that are
impaired in each individual. This approach is becoming increasingly influential in the
assessment, investigation, and treatment of word production difficulties in aphasia. The
classical cognitive neuropsychological approach, with its signature box-and-arrow
diagrams, is now highly familiar to most aphasiologists. However, more recent
theoretical innovations are much less widely known. There is a need for an up-to-date
review that summarises the current thinking in this field in a way that is accessible to
non-specialists.
Aims: The present article reviews recent theoretical innovations in the cognitive
neuropsychology of word production. It aims to demonstrate how these have led to a
more dynamic view of word production that emphasises processes rather than
representations, and offers new ways of understanding the diversity of word production
impairments seen in aphasia.
Main Contribution: Starting from the earliest box-and-arrow theories, the article
describes how cognitive neuropsychological accounts of aphasic word production have
evolved as a result of cross-pollination from other fields, particularly cognitive
psychology. Through the use of specific examples, the review outlines some of the ways
in which newer theoretical accounts for particular types of disorders differ from more
classical explanations. The article also discusses some recent empirical approaches that
have been inspired by the new theoretical accounts, including computer simulation
studies of patterns of naming errors. It also illustrates how the tighter relationship
between theories of normal and impaired language processing has increased the
potential contribution of aphasia studies to language research more generally. The
review closes with a discussion of some current and future issues in the cognitive
neuropsychology of language, including those relating to the degree of discreteness/
continuity in the language system, and the relationship between production and
comprehension in aphasia. It also comments upon some recent research regarding the
role of sentence-level and other contextual factors in word production, which may lead
to a better understanding of the kinds of language production difficulties that are
observed in nonfluent aphasia.
Conclusions: The argument that emerges from the review is that more recent cognitive
neuropsychological approaches to word production disorders cannot be understood as
Address correspondence to: Carolyn Wilshire, School of Psychology, Victoria University of

Wellington, P.O. Box 600, Wellington, New Zealand. E-mail: Carolyn.Wilshire@vuw.ac.nz
This article is adapted from material to appear in the forthcoming book Cognitive Neuropsychology:
Exploring the Mind Through Brain Dysfunction by C. E. Wilshire, to be published by Psychology Press.
The author would like to thank Kate Smith for her feedback on an earlier version of the manuscript and
for her assistance in preparing the manuscript. I am especially grateful to Kate for creating the figures that
appear in this article.
# 2008 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/aphasiology DOI: 10.1080/02687030701536016
1020 WILSHIRE
mere extensions or refinements of the classical box-and-arrow theories. Rather, they

offer a fundamentally different view of word production, and this has important
implications for both researchers and practitioners in the field.
One of the most common problems experienced by people with aphasia is a difficulty
producing words. Regardless of their classical diagnostic classification, almost all
individuals with aphasia show significant impairment on tasks of single word
production, such as picture naming (Benson, 1979; Kohn & Goodglass, 1985; see
Goodglass & Wingfield, 1997, for an overview). Nevertheless, different people
exhibit strikingly different kinds of problems. Cognitive neuropsychology (CN) aims
to describe the various kinds of word production problems seen in people with
aphasia by identifying the specific cognitive process(es) that are impaired in each
individual. The classic CN approach, with its signature box-and-arrow diagrams, is
now familiar to many researchers and practitioners in the field of aphasiology.
Indeed, many of the terms introduced by early CN theories in the 1980s have now
become part of the standard vocabulary of those working in the field of aphasia (e.g.,
‘‘phonological output lexicon’’ and ‘‘phonological output buffer’’). Nevertheless,
more recent theoretical innovations in CN are generally less widely known. In the 20
years or so since the CN approach first emerged, its theories have evolved
considerably, largely as a consequence of cross-pollination from fields such as
cognitive psychology and cognitive science. This evolution has led to a more
dynamic view of word production that emphasises processes rather than
representations, and which describes individual performance in quantitative as well
as qualitative terms. The present article reviews these recent theoretical innovations
(see also Chialant, Costa, & Caramazza, 2002; Laine & Martin, 2006; for discussions
of related issues). It aims to demonstrate that newer approaches cannot be
understood as mere extensions or refinements of the classical CN theories; rather,
they offer a fundamentally different view of word production, and this has important
implications for both researchers and practitioners in the field.
This article begins by outlining several classic case reports that laid the
foundations for the first cognitive neuropsychological explanations of aphasic
word production. It then outlines how theoretical innovations from fields such as
cognitive psychology and cognitive science led to new ways of conceptualising
aphasic impairments, which in turn stimulated entirely new avenues of research.
A number of recent approaches and viewpoints are discussed, including: the impact
of spreading activation frameworks; the interactivity debate; computational
modelling approaches; and the possible future role of distributed, PDP-type
frameworks. The review will focus mainly on impairments involving the processes
that convert a semantic representation into a fully specified phonological
representation for oral production (little will be said about more peripheral
processes such as articulatory-motor planning, or about other word modalities such
as written word production). The majority of the cases that will be described suffer
from a form of fluent aphasia, whose characteristic grammatically well-formed,
fluently articulated speech provides an ideal context for studying word production in
relative isolation from other production processes. Nevertheless, the final section of
the review briefly considers some important contextual and grammatical factors that
are likely to be important in understanding word production difficulties in nonfluent
forms of aphasia.
COGNITIVE NEUROPSYCHOLOGY AND APHASIA 1021
WORD PRODUCTION IMPAIRMENTS: EARLY CASES AND

EARLY THEORIES
Before discussing recent theoretical innovations in the cognitive neuropsychology of
word production, it is first necessary to present an overview of early cognitive
neuropsychological theories, and the empirical studies that inspired them. In the late
1970s and early 1980s, when the CN approach first emerged, its primary objective
was to map out the major cognitive systems (‘‘components’’) involved in various tasks
and their relationships to each other (for some early examples relating to word
production, see Ellis, 1982; McCarthy & Warrington, 1984; Morton, 1980; Morton
& Patterson, 1980; for good reviews, see Cuetos, 2003; Nickels, 1997). The resultant
theories were often illustrated diagrammatically, with core components being
represented as boxes, interconnected with appropriately oriented arrows (hence the

nickname box-and-arrow theories). One of the primary sources of evidence that was
used to argue for the existence of particular cognitive components was the behaviour
of individuals with aphasia. If two individuals were found to exhibit completely
opposite patterns of performance on two different tasks or skills, this strongly
suggested that there were at least two distinguishable cognitive systems involved in
these skills (this approach is known as dissociation logic: for a detailed discussion, see
Shallice, 1988). The emphasis in these early CN approaches was squarely on the
coarse-grained organisation of major cognitive components—that is, their functional
architecture. They neither attempted to, nor purported to, address the specific
cognitive operations that supported processing within these components. These
details, it was argued, could be fleshed out at a later date.
In the area of spoken word production, the earliest CN case studies in the 1980s
supported the existence of three crucial cognitive components, each of which could
give rise to a different pattern of performance when impaired. The first pattern of
performance is exemplified by the case of JCU (Howard & Orchard-Lisle, 1984)
whose profile is summarised in Table 1. Although JCU had a global aphasia, she
TABLE 1
Summary of major features of patients JCU (Howard & Orchard-Lisle, 1984), EST (Kay & Ellis,
1987), and RL (Caplan et al., 1986)
JCU EST RL
Error types in picture semantic paraphasias semantic paraphasias, phonemic paraphasias

naming when miscued phonemic paraphasias
Variables affecting — word frequency word length
naming
Word comprehension poor; similar errors to preserved preserved
naming
Word repetition better than naming better than naming similar to naming
Nonsense word (not tested) slightly poorer than word poor
repetition repetition
a
Proposed impairment (Verbal) Semantic access to entries in Phonological Output
system Phonological Output Buffer
Lexicon
a
According to a classical functional architecture framework.
1022 WILSHIRE
could sometimes produce the correct name for a picture if cued with its first sound
(e.g., ‘‘starts with p’’). However, Howard and Orchard-Lisle (1984) found that JCU
was often misled by such a cue if it was inappropriate, particularly if it cued a
semantically related item (e.g., for the target tiger, the cue ‘‘starts with l’’ could
elicit ‘‘lion’’). JCU frequently failed to recognise her errors as incorrect. Perhaps
most importantly, JCU made similar types of semantic confusions in both
production and comprehension: for example, when asked to judge whether an
auditory word matched a given picture, she had great difficulty rejecting incorrect,
but semantically related, distractors (e.g., car vs bike). The pattern of performance
shown by JCU and other similar cases was consistent with an inability to access
stored semantic information about words; the fact that both comprehension and
production were affected suggested that the same store was accessed in both
modalities. JCU’s frequent semantic errors suggested that she could sometimes
access partial semantic descriptions of words; however, these were sometimes not
sufficiently specified to enable her to discriminate among highly similar items, or to
reject misleading cues. This led to the proposition that a crucial first step in
spontaneous word production (and naming) involved accessing representations
within a central, non-modality-specific verbal semantic store (Ellis & Young, 1988;
Hillis, Rapp, Romani, & Caramazza, 1990; Howard & Orchard-Lisle, 1984;
Howard & Patterson, 1992).
The second pattern of performance is illustrated in case EST (Kay & Ellis, 1987).
Unlike JCU, EST’s speech was fluent and informative, although it contained many
word-finding pauses and circumlocutory descriptions. On picture-naming tasks, EST
produced a range of different types of errors, including phonemic paraphasias (e.g.,
grapes R ‘‘graffs’’), and semantic paraphasias (e.g., axe R ‘‘hammer’’). These errors
were more common on low than on high-frequency words. Unlike JCU, EST’s
auditory comprehension was normal, and he could not be ‘‘miscued’’ in naming (see
Table 1 for a summary of features of EST). These two latter features suggested EST
had no difficulty accessing the semantic representations of words. Nevertheless, he
was unable to consistently access specific information required for the accurate
production of words. The phonemic paraphasias in particular suggested incomplete
access to information about the words’ phonological forms. Cases such as EST’s led
to the proposal that there was at least one further major cognitive component
involved in word production. This was conceptualised as a lexical store, separate and
distinct from the verbal-semantic store, which contained information about the
phonological forms of words needed for production. This component was commonly
known as the phonological output lexicon (see, e.g., Ellis & Young, 1988; Kay & Ellis,
1987; Patterson & Shewell, 1987).
A third distinct pattern of performance was described in the case of RL (Caplan,
Vanier, & Baker, 1986). RL spoke fluently and grammatically. His auditory
comprehension was normal on simple word–picture matching tasks. He almost never
produced semantic paraphasias. RL’s major difficulty was that he produced a
considerable number of phonemic paraphasias, particularly on longer words. Many
of these differed from the intended word by only one or two phonemes. Unlike EST,
the strongest predictor of his errors was not word frequency, but rather word length.
Crucially, RL made phonemic paraphasias not just in spontaneous speech and
picture naming, but also in word repetition and reading, and even in repetition of
nonsense words such as ‘‘splent’’. Therefore, RL’s difficulty did not appear to be
restricted to tasks that involved semantic and/or lexical processing, but was evident
even on tasks that did not explicitly require access to the mental lexicon. The
problem did not appear to involve actual motor programming of the articulators,
because RL’s articulation of phonological forms—both correct and incorrect—
sounded normal (see Table 1 for a summary of RL’s profile). In the context of
existing theoretical frameworks, RL’s profile suggested impairment to a system that
utilised a phonological code, but that operated subsequent to lexical retrieval. This
system was commonly characterised as a buffer store, whose role was to temporarily
retain phonological sequences planned for production until they were ready to be
articulated (see e.g., Bisiacchi, Cipolotti, & Denes, 1989; Bub, Black, Howell, &
Kertesz, 1987; Morton & Patterson, 1980; Patterson & Shewell, 1987; see also
Caramazza, Miceli, & Villa, 1986). This component was termed the response buffer
or the phonological output buffer.
In conclusion, what emerged from these kinds of studies was a framework that
identified at least three major processing components involved in word production.
In theoretical frameworks at the time, these three systems were usually embedded
within a more general theory which specified the cognitive components participating
in other types of single word tasks, including word repetition, word comprehension,
Figure 1. Patterson and Shewell’s (1987) functional architecture model of word processing (components
that are obligatory for successful spontaneous word production and naming are shown in bold).
1024 WILSHIRE
written word production, and oral reading. Figure 1 illustrates the most influential
theory of this type, based on Patterson and Shewell (1987; for similar proposals see
also Ellis & Young, 1988; Harris & Coltheart, 1986). The three components that
were considered crucial for spontaneous word production are shown in bold. This
basic configuration gained wide acceptance among the aphasia research community,
and indeed it is still highly influential today. The key terminology—terms such as
‘‘phonological output lexicon’’ and ‘‘phonological output buffer’’—is still frequently
used in current research to describe specific patterns of performance (for some recent
examples, see Biran & Friedmann, 2005; Goldrick & Rapp, 2007; Howard &
Gatehouse, 2006; Papagno & Girelli, 2005; Shallice, Rumiati, & Zadini, 2000). This
theoretical framework has also been highly influential in assessment and rehabilita-
tion. It forms the basis of several recent cognitively oriented aphasia assessment
batteries—e.g., The Psycholinguistic Assessment of Language Processing in Aphasia

(PALPA: Kay, Lesser, & Coltheart, 1992); The Comprehensive Aphasia Test (CAT:
Swinburn, Porter, & Howard, 2004). The general approach also inspired new
approaches to aphasia therapy, in which treatment is targeted towards the specific
cognitive components hypothesised to be impaired in each particular individual (for
reviews see Laine & Martin, 2006; Nickels & Best, 1996). One of the main reasons for
the success of these functional architecture theories was that they provided a means
of describing important differences in the patterns of performance exhibited by
different individuals, many of which were not captured well within more traditional
syndrome-based diagnostic schemes. Also, by allowing for the possibility that a
person could potentially suffer from an impairment to more than one of the major
cognitive systems, they offered considerably more flexibility than previous schemes.
Another strength was undoubtedly their conceptual transparency. These theories
could be readily represented graphically using simple box-and-arrow diagrams,
which made them not only easy to grasp, but also easy to communicate to others.
Nevertheless, there are limitations to the use of functional architecture theories.
First, the descriptive terms used in these theories are quite idiosyncratic to the
neuropsychological literature, and do not map neatly onto the terms used in
theoretical descriptions of normal word production. Consequently, a heavy reliance
on these frameworks can limit the potential contribution of patient methods to
language production research more generally. A second disadvantage is that, within
these types of functional architecture theories, it becomes deceptively easy to mistake
description for explanation. For example, within a functional architecture scheme, an
individual who makes phonological errors when attempting to produce words
(particularly rare words) may be described as being ‘‘unable to access the
phonological output lexicon’’. This description forms a useful shorthand for
describing the person’s pattern of performance and a simple way of conceptualising
their problem. However, it does not identify the precise processes that are impaired,
and offers few predictions about performance on other types of words or tasks, or
about the kinds of treatments that might be most effective. Third, although
functional architecture theories may appear to provide a useful starting point for
theorising, enabling researchers to then ‘‘fill in the details’’ of the specific impairment
through subsequent research, this enterprise may be more problematic than it might
first appear. As will be illustrated below, when researchers began to consider the
relevant cognitive processes at a finer-grained level, the number and function of the
‘‘components’’ themselves began to change dramatically. Some systems that seemed
to be required to account for particular patterns of performance suddenly became
unnecessary, and others changed their character completely. Further, as will be seen
below, certain language difficulties that are considered completely unrelated when
viewed in the context of a functional architecture framework began to reveal
commonalties when considered at a finer-grained level. It would appear that the
relationship between coarse-grained, functional architecture type theories and finer-
grained theories is not as transparent as it first seems.
The following sections of this article will review more recent approaches to
aphasic word production that aim to go beyond mere characterisation of the major
component(s) impaired within a functional architecture type framework. Many of
these have been strongly influenced by theoretical concepts from cognitive
psychology and cognitive science. Therefore, the review will begin by outlining
some of the most influential of these concepts. It will then discuss the various
theoretical accounts of aphasic word production that have been inspired by them,
and the new avenues of research that have in turn been stimulation by these
accounts.
KEY CONCEPTS FROM THEORIES OF NORMAL WORD PRODUCTION

In the late 1970s and 1980s, an idea that became popular in the cognitive psychology
literature was that the process of word retrieval took place in two major stages. The
first of these stages was generally characterised as a lexical selection stage, and its
primary purpose was to identify the most appropriate word within the mental
lexicon to match the desired concept. At this stage, the representations of individual
words were not considered to be specified in terms of their phonological form. It was
proposed that information about the selected word’s sound form was retrieved
during the second major stage, the phonological retrieval stage (e.g., Dell, 1986, 1988;
Garrett, 1975; Harley, 1984; Kempen & Huijbers, 1983; Levelt, 1989; MacKay, 1987;
Stemberger, 1985). This basic two-stage concept is illustrated in Figure 2. Individual
theories differed as to whether they also included intermediate stages (for example,
ones that decompose words into their morphemes and/or syllables, or ones that
organise phonemes into larger multi-word phrases). Nevertheless, almost all shared
the basic idea of two major steps or stages. Indeed, this two-stage concept remains a
central feature of most recent theories of word production (see, e.g., Caramazza,
1997; Levelt, Roelofs, & Meyer, 1999; Rapp & Goldrick, 2000; Roelofs, 2004; Ruml,
Caramazza, Capasso, & Miceli, 2005; Schwartz, Dell, Martin, Gahl, & Sobel, 2006).
Another idea that gained ground in cognitive psychology in the 1980s was the
description of particular cognitive processes in spreading activation terms (e.g., Dell,
1986, 1988; Harley, 1984; Roelofs, 1992, 1997; Stemberger, 1985, 1990). For
example, the simple two-stage theory illustrated in Figure 3 describes the major
stages of word production in terms of spreading activation through a very simple
neural network consisting of words, their semantic representations, and their
constituent phonemes (the example shown is from Dell & O’Seaghdha, 1991, 1992;
for similar proposals see Dell, 1986; Dell, Schwartz, Martin, Saffran, & Gagnon,
1997; Foygel & Dell, 2000). In this particular theory, the network contains units that
correspond to individual lexical items, their phonemes, and their semantic features.
Corresponding units at different levels are connected to one another: for example,
the lexical unit ‘‘cat’’ is connected to the semantic feature units ‘‘has four legs’’, ‘‘has
fur’’, and ‘‘goes meow’’, and also to the phonological units /k/, /a/ and /t/.
1026 WILSHIRE
Figure 2. Illustration of a two-stage theory of word retrieval. The figure illustrates a generic version of the
theory; individual theories differ in their specific details (cat illustration from Rossion & Pourtois, 2004).
In this theory, word production proceeds as follows. First, during the lexical
selection stage, the semantic representation of the concept, which is expressed as a
pattern of activation across semantic feature units, begins to transmit activation to
lexical units. All units of associated words receive some activation (for example, if
the target item is a cat, the lexical unit for ‘‘dog’’ will also become activated because
of its shared features). However, the word that contains the greatest number of
relevant semantic features will generally receive the most activation. The spread of
activation is continuous so each lexical unit, once activated, automatically starts
activating its corresponding phonological units. The lexical selection stage is
Figure 3. Illustration of a sample of simple network model, showing that portion of the network relating
to the word ‘‘cat’’. The model illustrated here is based on Dell and O’Seaghdha (1991, 1992).
complete when the most highly activated lexical unit is ‘‘selected’’ for production (at
which time it is given an additional activation boost). If the lexical selection stage
goes awry for some reason, an incorrect word may be produced. This will commonly
be a semantically related word because the items become partially activated during
the lexical selection stage. During the phonological retrieval stage, activation spreads
from lexical units to their corresponding phonological units. This process starts even
before lexical selection is complete, but gains greater momentum after the selected
lexical unit receives its ‘‘boost’’. The phonological retrieval stage is complete when a
phoneme has been selected for each position in the word. An incorrect selection at
this stage will most commonly lead to a phonological error, in which one or more of
the target word’s phonemes are incorrect or missing (e.g., castle R ‘‘cacksel’’).1
Spreading activation theories like these substantially changed the theoretical
landscape in the field of normal word production. They led to a shift in attention
away from the nature of the linguistic representations themselves, and towards the
processes that map between the different types of representations. In addition, they
led to a change in the way researchers viewed speech errors. In spreading activation
theories, the activation level of any unit reflects the sum of the activation it receives
from all other units—an idea sometimes called activation summation. Consequently,
each unit’s total activation depends crucially on which other units are also activated
at the time. This could vary considerably from task to task—for example, in a task
like picture naming, lexical units will receive most of their activation from their
corresponding semantic units, whereas in a task like repetition the lexical unit might
receive additional activation directly from the auditory stimulus itself. This led to a
whole new way of thinking about differences in performance across tasks. The next
section discusses how these ideas influenced explanations of aphasic disorders.
The notion of spreading activation remains central to virtually all current theories of
normal word production, despite variation in the numbers and types of units each
theory possesses, the way activation flows through the network, and the extent to which
it is modulated by network-external processes. However, recent debates in the literature
on normal word production have centred largely on the question of how activation
flows throughout the network. One hotly debated issue is whether activation in the
network is ‘‘gated’’ so that only one lexical unit substantially activates its corresponding
phonological units, or whether activation flows ‘‘in cascade’’ so that several lexical units
substantially activate their phonological units, even before a single lexical item has been
selected (Cutting & Ferreira, 1999; Navarrete & Costa, 2005; Peterson & Savoy, 1998;
Rapp & Goldrick, 2000). These two contrasting proposals are illustrated in panels (a)
and (b) of Figure 4. The theory of Dell and colleagues described earlier (Figure 3) allows
for some cascade, because activation can start spreading to phonological units even
before lexical selection is complete. However, some theories do not permit any cascade
at all (e.g., Levelt et al., 1999; Roelofs, 2004).
Another issue concerns whether activation flows only downwards—from
semantic to lexical then to phonologically units—or whether it can also feed back
from phonological to lexical units, and from lexical to semantic units. This idea is
illustrated in panel (c) of Figure 4. If activation can ‘‘feed back’’ up the network, then
it is possible for events happening during the phonological retrieval stage to
influence events occurring during lexical selection. In the Dell theory discussed
1
In this model, activation can also feed back in the reverse direction, a point we will discuss further in
the next section.
1028 WILSHIRE
Figure 4. Three different versions of a two-stage spreading activation theory of word production. In
version (a) no cascade is permitted, and only the selected lexical unit activates its phonological units. In
version (b) full cascade is allowed, so that lexical units activate their phonological units immediately and in
proportion to their own activation levels. In version (c) both cascade and feedback are permitted, so
phonological units may in turn activate the lexical units to which they are connected.
earlier (Figure 3) feedback is permitted, but in many other theories it is not (e.g.,
Laine, Tikkala & Juhola, 1998; Levelt et al., 1999; Roelofs, 2004; Ruml et al., 2005;
for a recent discussion of this issue, see Rapp & Goldrick, 2004; Roelofs, 2004).
Theories that allow for feedback (so-called ‘‘interactive’’ theories) make several
important predictions. For example, in addition to semantic and phonological
errors, they predict the occurrence of a third type of error, called a formal error or a
formal paraphasia. In a formal error, a similar-sounding real word is produced
instead of the intended word (e.g. camel R ‘‘candle’’). These errors are predicted
because activation feeds back from phonological to lexical units, and therefore
words that are phonologically similar to the target word will tend to be more
activated than unrelated words. They therefore have a greater chance of being
selected in place of the target. There is empirical support for this prediction of
interactive theories: In many collections of normal spontaneous speech errors,

formal errors have been found to occur more often than would be expected by
chance alone (Dell & Reich, 1981; Nooteboom, 2005) and they also occur at a
higher-than-chance rates in certain kinds of aphasic conditions (see detailed
discussion below).
In theories where no feedback is permitted, an explanation can be offered for the
occurrence of formal errors, but it involves making additional assumptions about the
way in which errors are monitored and corrected by the speaker prior to articulation.
One explanation that has been offered is that the formal errors themselves are chance
occurrences—that is, they are either unrelated word errors where the word just
happens to be phonologically related to the target, or they are phonological errors
where the phoneme string just happens to correspond to a real word. The reason
they occur more often than chance is that speakers are less likely to detect and
correct them than they are other types of errors, because they are so similar in form
to the target, and are also themselves legitimate words (see Levelt et al., 1999;
Roelofs, 2004).
The predictions of interactive theories are not limited to the issue of formal errors.
These theories also predict the occurrence of other types of errors, such as ‘‘mixed’’
errors (errors that are both phonologically and semantically related to the target,
such as carrot–cabbage). Several studies have found that these kinds of errors also
occur more frequently than chance in both normal speakers (Dell & Reich, 1981;
Harley, 1984) and in some individuals with aphasia (Blanken, 1990, 1998; Laine &
Martin, 1996; Rapp & Goldrick, 2000). In theories that allow for feedback, these
errors occur because a word that is both semantically and phonologically related to
the target receives activation from two sources: It receives top-down activation via
the semantic features it shares with the target, and it receives feedback activation via
the phonemes it shares with the target. In theories that do not allow for feedback,
further assumptions must be made in order to explain such errors (for example, the
error-monitoring system has to be attributed with the ability to evaluate semantic as
well as phonological appropriateness). We return a consideration of these issues in
the discussion of aphasia below.
APPLICATIONS TO APHASIC WORD PRODUCTION

These ideas from contemporary cognitive psychology offered aphasia researchers
new ways of conceptualising aphasic word production impairments. The two-stage
model of word retrieval offered an explanation for some findings from individuals
with aphasia that had previously been rather puzzling. For example, many
individuals with apparent lexical retrieval difficulties have been found to exhibit
much more selective error profiles than that shown by the classic cases such as EST.
Some produce mainly semantic and other whole word errors, but very few
phonological errors. These individuals can usually repeat words far more accurately
than they can produce them in naming (e.g., patients RGB and HW: Caramazza &
Hillis, 1990; DP: Cuetos, Aguado, & Caramazza, 2000; PW: Rapp & Goldrick, 2000;
NP: Wilshire, Keall, Stuart, & O’Donnell, 2007). Other cases produce few semantic
errors: their errors are mainly phonological, or are ‘‘tip of the tongue’’ type
responses, which contain some partial phonological information, such as the word’s
first letter or phoneme, or how it is spelled. Many of these individuals still make
substantial numbers of errors even in word repetition (Dante: Badecker, Miozzo, &
1030 WILSHIRE
Zanuttini, 1995; DPI: Bachoud-Lévi & Dupoux, 2003; GM: Henaff Gonon,
Bruckert, & Michel, 1989; CSS: Rapp & Goldrick, 2000; EL: Wilshire, 2002; GL:
Wilshire & Saffran, 2005).
This kind of variation in error patterns is nicely captured in two-stage theories.
The first type of pattern, of mainly semantic and other whole word errors, is
consistent with a difficulty involving the lexical selection stage. Here, the patient’s
errors appear to be incorrect word choices, rather than failures to retrieve
phonological information about a particular word. Such patients perform much
better on word repetition, because there the lexical item is provided, thus enabling
the person to bypass the impaired lexical stage. Conversely, the pattern of mainly
phonological errors and/or ‘‘tip of the tongue’’ type responses is consistent with a
difficulty at the phonological retrieval stage. The partial phonological information
contained in these attempts suggests that the person has identified the correct lexical
item, but cannot retrieve and/or assemble its complete phonological description. A
mix of all of the above error types, as is seen in EST, would suggest a more global
impairment affecting both major word retrieval stages. This two-stage concept
therefore captures some of the major sources of variation among individuals nicely—
but not all: there is still considerable variation within these two major groups of
cases. (This is a point we will return to later.)
Aside from the two-stage concept, the idea of spreading activation itself also had a
significant influence on theoretical accounts of aphasia. It did so in two major ways.
First, the notion of activation summation offered a new way of thinking about why
patients might perform differently in different types of production tasks. Some
findings that were previously puzzling suddenly began to make sense. Consider the
following example. As noted above, many functional architecture theories include a
phonological ‘‘buffer’’ whose role is to temporarily retain phonological information
prior to articulation (see e.g., Bub et al., 1987; Morton & Patterson, 1980; Patterson
& Shewell, 1987). This buffer provided an account for the behaviour of individuals
like RL, who produced phonological errors in both ‘‘lexical’’ tasks such as picture
naming, and ‘‘nonlexical’’ ones such as nonsense word repetition.2 Patients like RL
could not have an impairment involving the phonological output lexicon, because
this would affect only real word production, and not nonsense words. So the
problem must be at a lower, post-lexical level. However, the idea of a phonological
output buffer was always problematic. One problem was explaining why a buffer
would be needed to store phonological information for single word utterances. Some
suggested the buffer might have other purposes. Perhaps its function was to
reorganise newly retrieved phonological representations, for example by filling in
any phonological information not yet specified in the lexically stored representations
(e.g., Caplan et al., 1986) or organising the phonological information into syllables
(e.g., Nickels, 2001). It seemed to be a system in search of a purpose, its main
function being to account for cases of aphasia like RL’s and other phonological
error phenomena. Another problem was that the buffer didn’t appear to be entirely
insensitive to lexical variables, as would be predicted if it were simply a postlexical
short-term store. For example, Bub et al. (1987) were puzzled to find that cases
whose profile suggested a primary deficit at this stage were still better at repeating
real words than they were at repeating nonsense words. Indeed, more recent studies
2
This idea also has antecedents in early theories of normal word production, many of which included a
postlexical phonological processing stage (see e.g., Shattuck-Hufnagel, 1983, 1987).
suggest these kinds of lexical status effects are the rule in such cases, rather than the
exception (e.g., Franklin, Buerk, & Howard, 2002; Goldrick & Rapp, 2007; Hanley
& Kay, 1997; Hanley, Kay, & Edwards, 2002; Jefferies, Crisp, & Lambon Ralph,
2006; Saito, Yoshimura, Itakura, & Lambon Ralph, 2003; Shallice et al., 2000;
Wilshire, 2002).
However, in a spreading activation framework, all phonological errors can be
viewed as failures to correctly activate the appropriate phonological units above
their competitors—this includes errors that occur in ‘‘conceptual’’ tasks such as
naming as well as errors that occur in ‘‘nonlexical’’ tasks such as nonsense word
repetition. The only difference between tasks is in which units provide the source of
the activation: in picture naming that source is the lexical unit(s), whereas in
nonsense word repetition it is the auditory/phonological representations of the
spoken word—and in real word repetition, it is probably both (see e.g., Hillis &
Caramazza, 1994; Hanley, Dell, Kay,& Baron, 2004; Jefferies et al., 2006; Martin,
Dell, Saffran,& Schwartz, 1994). This idea is illustrated in Figure 5. In this
framework, patients like RL are considered to have a problem activating (or
sustaining activation within) the correct phonological units. That is, their
impairment involves the phonological retrieval stage. Consequently, they have
difficulties with all types of tasks requiring the production of phonemes, both
‘‘lexical’’ and ‘‘nonlexical’’. They can repeat real words more accurately than
nonsense words because the phonological units receive activation from not one, but
two different sources. This increases the chances of successfully activating the target
phonological units over their competitors, and therefore reduces the likelihood of
error. Within this framework, there is no need for a dedicated phonological ‘‘buffer’’
just to account for specific cases of aphasia (there could still be such a system; the
point is that it is not necessary just to account for cases like RL’s). Also, some of the
previously paradoxical findings about lexical status are neatly accommodated. This
example illustrates a key theme of this discussion—that by considering what might
Figure 5. An activation summation model of naming and repetition. In this model, phonological units
receive activation from lexical units and/or ‘‘auditory input units’’ (units representing the phonemes in a
recently heard word). In picture naming, the sole source of activation is the lexical unit(s). In nonsense
word repetition, the sole source is the auditory input units. In word repetition, however, both sources may
be available.
1032 WILSHIRE
be going on inside the various boxes proposed in functional architecture schemes,

some boxes become superfluous, and others change their character entirely.
A second, even more important way in which the spreading activation framework
influenced aphasia research is by encouraging researchers to consider not only which
process(es) were impaired in a particular individual, but also how exactly each one
might be malfunctioning. Within a spreading activation framework, aphasic
disorders might be characterised as problems with activation transmission along
the network’s connections. The effect of this problem will depend on which
connections are most affected. If it is semantic–lexical connections, this will affect the
lexical selection stage. Alternatively, if it is the lexical–phonological connections that
are most affected, this will impact on the phonological retrieval stage.
However, within this framework other types of malfunctions are also conceivable.
For example, there could be a problem maintaining stable levels of activation within
units, once they have been activated. This second type of malfunction provides an
elegant account for certain types of aphasic conditions that had previously seemed
rather puzzling, such as deep dysphasia. A prototypical deep dysphasia case is patient
NC, described by Martin and colleagues (Martin et al., 1994; Martin & Saffran,
1992; Martin, Saffran, & Dell, 1996b). Originally diagnosed with Wernicke’s
aphasia, NC’s picture-naming attempts contained many phonemic paraphasias and
formal paraphasias, and some occasional semantic paraphasias. In word repetition,
he also produced phonemic and formal paraphasias, but formal paraphasias were
proportionately more common—and surprisingly, so too were semantic errors. Some
examples of NC’s errors are shown in Table 2. Also, although he showed evidence of
well-preserved verbal semantics (e.g., good written word–picture matching), he
showed some unusual ‘‘semantic’’ effects in repetition. For example, he had much
more difficulty repeating abstract words (justice, contentment) than concrete words
(crayon, barrel), and he was entirely unable to repeat nonsense words. NC also had
some problems in auditory tasks, but the discussion here will focus mainly on his
production problems.
TABLE 2
Examples of NC’s responses in picture naming and word repetition
(a) Naming
Wreath R Christmas, I don’t know, a lot of people have them.
Candle R light
Cactus R cassock
Rabbit R rapid
Penguin R pigwen
Igloo R engklow
Camel R kalman
(b) Word Repetition

Parachute R plane that jumps out
Gravity R science
Dinosaur R horse
Picture R mixture
Thing R thinker
Miracle R marital
Village R vemple
Spider R smider
Within functional architecture schemes such as the one shown in Figure 1, NC

would be described as having quite a number of different impairments affecting
different components. The mixture of whole word and phonological errors NC
produced in naming, together with his preserved semantic comprehension, would
indicate an impairment to the phonological output lexicon. However, NC’s similar
difficulties in repetition and his complete inability to repeat nonsense words would
suggest additional impairments involving the phonological output buffer and/or
problems transmitting information from auditory processing systems to the word
production system. Finally, the sensitivity to semantic variables such as concreteness
would indicate an additional mild impairment affecting the verbal-semantic system
(see e.g., Howard & Franklin, 1988). Within a spreading activation framework,
however, many of these apparently unrelated symptoms can be accounted for by
proposing just one abnormality: an inability to maintain stable levels of activation in

lexical and phonological units. Martin and colleagues proposed this type of account
for patient NC. The spreading activation theory on which they based their account
was similar to the one of Dell and colleagues (Figure 3), except that the phonological
units could be activated not only by their corresponding lexical units (as they would
be in a task like naming), but also directly from auditory input (as they would in a
task like nonsense word repetition). In the model, activation was permitted to flow
not only downwards, from semantic to lexical then to phonological representations,
but also backwards, from phonological to lexical, then to semantic units.
Martin and colleagues maintained that many of the features of NC’s performance
were exactly what would be expected if activation in the lexical and phonological
units were decaying abnormally quickly.3 For example, his nonsense word repetition
is extremely poor because, in order to repeat nonsense words, the correct pattern of
activation needs to be maintained in the phonological units long enough for it to be
accurately reproduced. Real word repetition is also affected, but less so than
nonsense word repetition. This is because with real words, activation feeds back up
from the phonological units to the lexical and semantic units, and then back down
again, and this helps refresh the pattern of activation in phonological units, allowing
it to be retained longer. Further, because of the fast decay in lexical and phonological
units, repetition relies almost entirely on this activation from semantic units, so it is
in fact accomplished in a similar way to picture naming. This explains the similarity
in error patterns across the two tasks, and the high rates of semantic and other whole
word errors in repetition. The concreteness effects observed in repetition are also
consistent with this proposal: If repetition relies entirely on activation from semantic
units, the stronger and more stable that semantic activation, the more support it will
provide—and concrete might have a benefit in this respect. Finally, because the
network theory used by these researchers allows activation to feed back from lower-
to higher-level units, it also offers an explanation for the high numbers of formal
paraphasias produced by NC in both naming and repetition. These errors occur
because activation feeding back from phonological to lexical units activates sound-
related words that then compete strongly for production. In NC’s case, this feedback
activation has a disproportionately strong effect, because the original activation in
the target units may have decayed considerably before the feedback even begins to
take effect.
3
More precisely, the abnormality they proposed was fast decay combined with increased levels of noise
(random activation fluctuation) in the units.
1034 WILSHIRE
Martin and colleagues’ theory contains some controversial proposals (for

example, the idea that word production is interactive). Nevertheless, the aim of
presenting it here was not so much to evaluate its particular pros and cons as an
explanation for deep dysphasia, but rather to illustrate a more general point: that by
considering not just what representations are affected but also how they are affected,
some aphasic conditions that previously seemed to indicate multiple coincidental
impairments can be described in much simpler terms. Considering impairments at
this finer-grained level can highlight commonalties in the deficits affecting different
‘‘components’’, enabling us to reject the assumption that they are always
independent and unrelated.
COMPUTER SIMULATION STUDIES OF APHASIA

Another change that came about with spreading activation theories was the advent
of computer simulation studies. Because many spreading activation theories could be
simulated using relatively simple computer programs, it became possible to simulate
different types of impairments by altering (or ‘‘lesioning’’) one or more of the
computer model’s activation properties (parameters). For example, the researcher
might choose to reduce the strength of activation flow between certain units, or alter
the way activation builds up and/or decays in the network, and examine the kinds of
errors the computer-simulated model generates. The behaviour of the simulated
model can then be compared to the actual behaviour seen in the patient(s) under
investigation. If the two ‘‘behave’’ similarly, this would provide support for the
particular hypothesised impairment.
An early example of a computer simulation of aphasia is Martin and colleagues’
(1994) study of patient NC described earlier. To demonstrate that their theoretical
account of NC’s condition really did lead to the features of behaviour they claimed it
did, Martin and colleagues conducted several computer simulations. Starting with a
simplified version of their basic interactive activation theory, they altered the rate of
activation decay in lexical and phonological units,4 and then examined the errors
produced by the computer model. In simulations of both picture naming and
repetition, Martin and colleagues showed that the error patterns produced by the
computer model were indeed similar to those of NC in these two tasks. In other
words, their proposed malfunction really did lead to the type of behaviour they
claimed it did. This example illustrates one important purpose of computer
simulation. As theories become more and more complex, it is not always clear just
from a verbal description whether the proposed malfunction really does have the
consequences the researchers claim it does. A computer simulation can be used to
confirm that the predictions are indeed correct (for some other simulations of
individual cases of aphasia, see Harley & MacAndrew, 1992; Laine et al., 1998; Rapp
& Goldrick, 2000).
A more recent computer simulation approach is the case series modelling
approach, which involves simulating the behaviour of a range of varied cases of
aphasia by altering the computer model’s properties slightly differently for each
person (Dell, Lawler, Harris, & Gordon, 2004; Dell et al., 1997; Foygel & Dell, 2000;
Hanley et al., 2004; Ruml et al., 2005; Schwartz et al., 2006). Focusing on just one or
4
They also increased the amount of ‘‘noise’’ (the extent to which activation levels randomly fluctuated
from moment to moment).
TABLE 3
A sample of the cases modelled by Dell et al. (1997)
Percentage of responses
Connection Decay
strength rate
(normal5.1) (normal5.5) correct semantic formal nonword mixed unrelated
Weakened connections
JB .0065 .5 76 6 1 5 2 2
(78) (6) (4) (8) (1) (3)
GS .0057 .5 70 2 6 15 1 2
(69) (7) (6) (14) (1) (3)
Abnormally fast decay
BMe .1 .82 84 3 1 0 5 1
(85) (9) (1) (2) (3) (0)
NC .1 .85 75 3 7 8 1 0
(77) (11) (3) (5) (4) (0)
Both abnormalities
BMi .055 .7 83 5 1 1 2 1
(84) (8) (2) (3) (2) (1)
JG .045 .7 55 6 8 18 4 3
(57) (10) (11) (16) (2) (4)
The table shows two cases whose performance was best fit by weakening connections only, two of
whom were best fit by increasing the rate of decay only, and two who were best fit using a combination of
these two. Each patient’s actual performance is shown in bold face (the percentage of different types of
responses), and the performance of the corresponding ‘‘lesioned’’ model is shown in parentheses
immediately below.
two of the model’s dynamic properties (for example, strength of activation flow, rate
of activation decay), the researcher chooses values for these properties that best ‘‘fit’’
each individual’s actual performance. The aim is to show that variation in the chosen
properties can capture a large proportion of the variation among individuals. An
early example is the study by Dell et al. (1997). Using a spreading activation theory
based on Dell and colleagues’ original model (Figure 2), these researchers attempted
to reproduce the error patterns of a group of aphasic individuals by altering just two
activation parameters: the connection weights (that is, the amount of activation that
was permitted to pass between units at different levels of representation) and the
decay rate (the speed with which lexical and phonological units returned to their
original levels after being activated). Dell and colleagues chose different values of
these parameters for each person, based on the ones that best fitted that person’s
pattern of naming errors. They found that some of the individuals in their sample
were best modelled by reducing the connection weights only. Others were best fitted
by altering decay rate only. However, most were best fitted by altering both
parameters to different extents. Table 3 shows a sample of the patients they
simulated, together with the parameter values that best simulated their perfor-
mance.5
5
These authors have created an internet-accessible data-fitting programme, which allows researchers to
enter the error proportions of their own patients and generate parameter values based on various different
computational models. See http://langprod.cogsci.uiuc.edu/cgi-bin/webfit.cgi
1036 WILSHIRE
By varying just these two parameters, Dell and colleagues were able to explain a
great deal of the variability in the patterns of naming errors across individuals. An
important point to note is that much of the variability was explained not by
proposing an entirely different type of impairment for each individual, but rather
different degrees of impairment to just two processes. Several subsequent studies
have varied different parameters, again never varying more than two at a time. For
example, Foygel and Dell (2000) kept decay rate constant, and independently varied
two different types of connection weights: semantic to lexical connection weights;
and lexical to phonological connection weights. This model was found to produce
even better fits to the patient error data than the original Dell et al. (1997) model (see
also Schwartz et al., 2006).
There has been a great deal of debate as to the theoretical significance of these
types of modelling efforts. One major criticism is that it is difficult to establish

exactly which features of a particular model are really responsible for the success of
the simulation. For instance, in the examples given above, the original connection
weight/decay rate approach of Dell and colleagues (1997) and the semantic/
phonological connection approach of Foygel and Dell (2000) both produced
reasonably good fits to the patient error data that did not differ enormously, even
though they made very different assumptions about the types of malfunctions
underlying the individuals’ impairments. Indeed, one subsequent study has shown
that it is even possible to make substantial changes to the underlying ‘‘normal’’
theory of word production on which the model is based, without substantially
affecting the model fits (e.g., whether or not the theory permits feedback: Ruml et al.,
2005). Another criticism relates to the issue of predictive power. Although case series
modelling studies often succeed in describing the behaviours they specifically aim to
model (which is usually patterns of variability in naming errors) it has been claimed
that they offer few testable predictions about how the individuals might perform on
other, model-independent tasks. Several recent case series modelling studies have
addressed this criticism directly (Dell et al., 1997; Foygel & Dell, 2000; Martin, Dell,
& Schwartz, 2004). For example, Dell and colleagues (1997) and Foygel and Dell
(2000) both used the parameter values obtained from their naming simulations to
predict each individual’s performance on an independent task: word repetition. In
both studies, these parameter values predicted with some accuracy the number and
types of repetition each person made. Of course, the predictions tested in these
studies were very simple and not unique to theories that have been formally
modelled. Nevertheless, the use of the computer simulation approach enabled the
researchers to make more quantitatively precise predictions than would be possible
using a less formal theory. It remains to be seen whether case series modelling studies
can generate and test predictions that are uniquely derived from the simulated
models, and would not emerge from less formal theories.
Regardless of one’s view on these sorts of debates, it is clear that case series
modelling studies have significantly changed the way researchers think about
aphasia. First, they have encouraged researchers to consider not just which process
or stage might be impaired in a particular individual, but also the way in which that
process might be malfunctioning, and even more significantly, the extent of the
impairment. The modelling efforts show that altering a particular parameter can
produce quite different patterns of errors depending on whether it is altered
minimally or substantially. Second, computer simulation studies have drawn
considerable attention to the issue of theoretical parsimony—that is, the capacity
of a theory to explain a range of observations with a minimum number of theoretical

assumptions. In functional architecture approaches, parsimony was a relatively
minor consideration in model construction; the most important criterion was
empirical fit, and if additional components had to be added to account for new
phenomena, this was done without hesitation. However, in case series modelling, this
issue of parsimony becomes important because network models can potentially be
altered in so many different ways. Therefore, to obtain meaningful results,
researchers need to place limits on the network properties they allow themselves
to alter. Recall that in each of the case series modelling efforts described above, only
two parameters were varied. In the first model by Dell and colleagues (1997),
connection strength and decay rate were varied, and these variations were applied
across the entire network, without distinguishing between the two different word
retrieval stages. The modellers made the simplifying assumption that in most
patients both stages would usually be affected, at least to some extent (they called
this the globality assumption).
In the second Foygel and Dell (2000) model, only connection strength was varied
(decay was kept constant), but semantic–lexical connections were varied indepen-
dently of lexical–phonological connections (here the researchers made a different
simplifying assumption, that most patients would probably suffer from weak
connections and that the rarer pure ‘‘decay’’ deficits could be disregarded for the
time being).6 Neither model was perfect at explaining all the variability among
patients. Indeed, Schwartz et al. (2006) suggested that the ultimate explanatory
model of word production might need to allow for variability in both the locus of
impairment (the stage most affected) and the nature of the impairment (whether
weak connections or decay). However, by incorporating both these variables into a
model of aphasic production, its parsimony would be substantially reduced, a loss
they argue might outweigh the gain in explanatory power (see Schwartz et al., 2006,
for further discussion).
Nevertheless, this balance might change when researchers go beyond single word
production tasks such as naming and repetition, and begin to consider other tasks
such as word comprehension. It may turn out that the more complex model is needed
to adequately account for all the types of variation observed in aphasic individuals,
including differences in levels of comprehension as well as production. To fully
explain these differences, it may be necessary to consider not just the locus of the
deficit (which of the two word retrieval stages is most affected), but also the nature of
the deficit (whether it is best captured as a connection weight problem or a decay
problem). The example of NC considered above, whose impairments in naming,
repetition, and even auditory comprehension were all explained within a decay-type
account, illustrates how a consideration of performance across a wider range of tasks
can sometimes tip the balance in favour of one particular theoretical account. We
return to this issue in the discussion of interaction below.
6
This model also made other simplifying assumptions. For example, it assumed that all semantic errors
in aphasic naming were the result of weakened semantic-to-lexical connections. This is different from other
contemporary accounts, which also allow for the possibility of a more central, non-modality-specific
semantic impairment, affecting access to the semantic representations themselves (e.g., Howard &
Gatehouse, 2006; Rapp & Goldrick, 2000). A small and significant group of cases that could not be
successfully modelled in Foygel and Dell’s study could most probably be simulated more successfully in a
model that included this third possible type of impairment.
1038 WILSHIRE
THEORETICAL CONTRIBUTIONS OF APHASIA RESEARCH

So far, the focus in this article has been on how interpretations of aphasia have
been influenced by theories of normal word production. However, the evidence
from aphasia has in turn shaped those theories. At the simplest level, a number of
important dissociations have been documented within individuals with aphasia,
which show us that different types of tasks and words engage widely different
cognitive processes. For example, the ability to produce function words (e.g., to, at,
of) and content words (e.g., tree, sit) has been found to dissociate in aphasia, with
some individuals exhibiting greater difficulty with function words, and others
showing the reverse pattern (e.g., Miceli, Mazzucchi, Menn & Goodglass, 1983, vs
Blanken, 1993). Other examples of abilities that dissociate include: spoken and
written word production (Bub & Kertesz, 1982); noun and verb production (e.g.,
Berndt, Haendiges, Burton & Mitchum, 2002); the ability to form regularly and
irregularly inflected verb forms (e.g., jumped vs ran; Ullman et al., 1997); the
production of proper nouns and common nouns (Semenza & Zettin, 1988); and
even the production of number words and non-number words (McCloskey, Sokol,
& Goodman, 1986). These types of dissociations reveal some of the basic
organising principles of the language-processing system, and have enabled
researchers to build comprehensive functional architecture type models of the
major cognitive components involved in different kinds of language production
skills.
However, as the review below will illustrate, evidence from individuals with
aphasias can also be used to address questions that go beyond the coarse-grained
architecture of the language system. Many recent studies have addressed much finer-
grained, theory-driven questions. Examples include: whether word production is
interactive (see detailed review below); whether the phonemes of a word are retrieved
in parallel or in sequential order (e.g., Wilshire & Saffran, 2005); whether syntactic
information about a word, such as its grammatical class and gender, is accessed early
or late during production (e.g., Badecker et al., 1995; Kulke & Blanken, 2001); and
which cognitive processes are common to both production and comprehension (e.g.,
Martin & Saffran, 2002). The discussion below considers in greater detail one
question where data from aphasia has been particularly influential: the question of
whether there is interaction in word production.
Interaction or no interaction?
As noted earlier, current spreading activation theories of word production disagree
on two major (and related) issues. The first is whether or not activation flowing
down the lexical network ‘‘cascades’’, so that many units can transmit activation
even before a selection is made. The second issue is whether activation is allowed to
feed backwards, from lower- to higher-level units (for example, from phonological to
lexical representations, or from lexical to semantic representations). Studies of
aphasia have contributed to this debate in several important ways. One way is
through analyses of aphasic errors. As noted earlier, theories that allow feedback
between phonological and lexical units predict the occurrence of certain types of
errors, including formal paraphasias (e.g., camel R ‘‘camera’’), and mixed errors
(e.g., carrot R ‘‘cabbage’’). Formal errors occur because the activated phonological
units of the intended word transmit activation back to all words that contain those
phonemes. This increases the activation levels of sound-related words and increases
the likelihood of them being selected in place of the target. Mixed errors occur
because the lexical unit of a word that is related to the target in both sound and
meaning will receive a double boost to its activation levels. First, it will become
activated via the semantic features it shares with the target, and second, it will also
receive feedback activation via the phonemes it shares with the target. As noted
earlier, there is some supporting evidence for the occurrence of both these types of
errors in the ‘‘slips of the tongue’’ of normal speakers (see e.g., Dell & Reich, 1981;
Harley, 1984; Stemberger, 1985).
The evidence from analyses of aphasic errors also supports these predictions. In
the case of formal paraphasias, group studies have found that these errors may occur
at rates considerably higher than chance in aphasia (Gagnon, Schwartz, Martin,
Dell, & Saffran, 1997; but see Nickels & Howard, 1995, for a study that found no
effect). In addition, specific cases have been reported who produce particularly high
rates of formal paraphasias (e.g., case MF: Best, 1996; RB: Blanken, 1990; HZ:
Blanken, 1998; NC: Martin et al., 1994; BBC, KAC, and DAN: Schwartz et al.,
2006; MS: Wilshire & Fisher, 2004). These cases do not appear random, but rather
tend to share other common features—for example, most also have difficulty
repeating words, particularly abstract ones, and cannot repeat nonsense words at all.
This further suggests their high rates of formal paraphasias are not mere chance
occurrences, but rather reflect something fundamental about the individuals’
particular cognitive impairment. In the case of mixed errors, a number of aphasia
group studies and case studies have found that these errors occur at higher rates than
would be predicted by chance alone (group studies: Dell et al., 1997; Kulke &
Blanken, 2001; Martin et al., 1996; Schwartz et al., 2006; case studies: Blanken, 1998;
Rapp & Goldrick, 2000).
Additional evidence that these kinds of ‘‘interactive’’ errors are not random comes
from studies that have examined the form of the errors themselves. In aphasic formal
paraphasias, the incorrect word produced is more likely to be a high-frequency word
than it is to be a lower-frequency word (e.g., camel is more likely to be replaced by
‘‘camera’’ than by ‘‘cameo’’: Blanken, 1990, 1998; Gagnon et al., 1997; Goldrick &
Rapp, 2007; Martin et al., 1994; but see Best, 1996, for a null result). The incorrect
word also tends to be from the same grammatical category as the intended word
(Gagnon et al., 1997; Schwartz et al., 2006). Both observations are difficult to
explain if formal paraphasias were merely phonological errors that resulted in words
by chance alone.
A rather different approach to investigating the interactivity issue in aphasia is to
examine the effect of a word’s lexical neighbourhood on how often it gives rise to
certain types of errors. In interactive theories, words that have many phonological
‘‘neighbours’’ (that is, there exist many phonologically similar words) enjoy a special
benefit over other words. This is because their phonological units receive activation
not only from their own lexical unit, but also from activation flowing back and forth
between themselves and the lexical units of their ‘‘neighbours’’. Therefore,
interactive theories predict that words with many such neighbours should be less
prone to phonological errors than words that have few neighbours. This prediction
has been confirmed (Gordon, 2002; see also Goldrick & Rapp, 2007, for a single case
study).
Each of the above findings would seem to provide convincing support for the
interactive view. However none of the findings, considered alone, is conclusive. Each
1040 WILSHIRE
of the error phenomena described could occur as a result of a complex pattern of

chance occurrence and error monitoring biases, and the neighbourhood effects could
be due to the operation of some correlated variable, such as phonological complexity
(less complex words tend to have more neighbours). However, when all the findings
are taken together, they add considerable weight to the interactive view. This is
because all the observations emerge naturally from interactive theories as a result of
a single assumption, while each requires a special explanation to be accommodated
within a non-interactive theory.
Nevertheless, perhaps the strongest argument in support of interactivity is not
that it offers a neat explanation for certain error types and other unusual
phenomena, but because it provides a framework for understanding the relationship
between production and comprehension. Advocates of the interactive view have
frequently suggested that capability for two-way activation flow exists for one very
important reason: because the information in the lexical network must be accessible
both in language production and in comprehension. The strongest version of this
view is that comprehension and production utilise the same lexical network, with the
two differing only in the primary direction of activation flow (see e.g., Martin &
Saffran, 2002). This is quite different from the non-interactive view, which generally
postulates two independent networks of lexical and phonological representations for
production and comprehension, with overlap occurring only at higher levels (e.g.,
Levelt et al., 1999).
The potential for bidirectional flow in interactive theories provides an elegant
explanation for certain types of aphasic disorders where there are qualitatively
similar problems in both production and comprehension. A recently reported case
who showed such a condition is MS (Wilshire & Fisher, 2004). MS exhibited
‘‘phonological’’ difficulties across all types of spoken language tasks, including
production, repetition, and comprehension. For example, in naming and repetition,
his errors were almost always sound-related to the target (both phonemic and formal
paraphasias). Also, in repetition he was poorer at abstract than concrete words, and
could not repeat nonsense words at all—features that are reminiscent of the deep
dysphasic case NC described earlier, and which suggest an abnormally strong
reliance on lexical/semantic information during repetition. On auditory comprehen-
sion tasks, MS also made sound-based confusions. For example, when asked to
choose a picture in response to an auditory word, he would sometimes confuse it
with a similar-sounding distractor (e.g., cat vs cap); however, he had little difficulty
rejecting semantically related distractors (e.g., distinguishing cat from dog). Some
examples of MS’s errors on these different tasks are shown in Table 4. As already
noted, MS was similar in many ways to NC: for example, both produced high
numbers of formal paraphasias, and were sensitive to similar variables in repetition.
However, MS’s condition differed in that his difficulties seemed to be exclusively
phonological: he almost never made semantic errors, either in production, repetition
or auditory comprehension.
Wilshire and Fisher (2004) were able to explain MS’s pattern elegantly within an
interactive theory by proposing just one abnormality affecting the phonological
units. In their theory, a single network of semantic, lexical, and phonological units
subserved both production and comprehension, which differed only in the primary
direction of activation flow. In MS’s case, it was proposed that the phonological
units were subject to abnormally fast decay—an idea similar to that proposed by
Martin and colleagues (1994) to account for patient NC, but this time restricted to
TABLE 4
Examples of MS’s responses in (a) picture naming; (b) repetition; and (c) word–picture matching
(a) Picture naming

Banjo: bambono, um, balloon, wait, wait on, bambino, a banjo! (laughs)
Accordion: that’s an … amberoon, akowdion, not a piano accordion, it’s another kind …
Cork: pork, no, a cork
Tambourine: a turbo, barbecue, tomniment, getting close … a tamberoon
Envelope: elephant, I mean an eni- what did I say? An elephant, an oncave, (spells) e-n-v-e-l-o-p, envelope
(b) Repetition
Spaghetti: um … something to eat … pank.. mankshuri, sasp-. No …
Octopus: optimus… optimus … optu-, optopus …
Pyramid: peering .. no, not quite., peering
Battery: mattery, mattery, no, no such word … battery.

Canoe: coupon, a something a coupon, coupon
Cork: caught
Flower: fellow, flower.
Kite: corrupt.
(c) Word–picture matching
Steak: snake
Bear: pear
Road: rope
Money: Monkey
Scale: snail
Word–picture matching responses are taken from the Lexical Comprehension Test of the Philadelphia
Comprehension Battery (Saffran, Schwartz, Linebarger, Martin & Bochetto, 1988).
the phonological units.7 The authors argued that this ‘‘phonological decay’’ would
affect all tasks in similar but subtly different ways. For example, during word
production, some target phonological units may lose activation before they can be
articulated, so phonological errors will be common. Also, many of these errors will
be formal paraphasias, because feedback between phonological and lexical units
reinforces any pattern that corresponds to a real word (remember that in a decaying
network, feedback has an especially strong influence, because it is a late-acting
process that is more resistant to the effects of decay). During auditory
comprehension, the pattern of activation initiated in the phonological units may
become partially degraded even before it can be successfully transmitted to lexical
units, so the target stimulus may be easily confused with other, phonologically
related words. Repetition is particularly difficult because this task requires
maintenance of a pattern of phonological activation long enough to reproduce it.
Because of the fast decay in these units, MS must rely very heavily on activation
support from lexical and semantic representations to succeed in this task. This is why
he is so sensitive to the concreteness of the words, and why he cannot repeat
nonsense words at all.
In Wilshire and Fisher’s account, the idea of bidirectional flow was crucial: it was
this feature of their theory that enabled them to account for MS’s problems in both
7
Wilshire and Fisher’s (2004) basic spreading activation theory was a little different from the one
adopted by Martin and colleagues. It was more ‘‘cascading’’: activation was completely free to flow
continuously in both directions and there was no ‘‘boost’’ given to the selected lexical item.
1042 WILSHIRE
production and comprehension in terms of a single abnormality. Therefore, this very

simple account highlighted the potential of interaction to do something much greater
than explain certain kinds of errors—and that is to provide a framework for
understanding commonalities between production and comprehension (see also
Martin et al., 1994, for another example). The idea put forward by these authors,
that word comprehension is nothing more than word production ‘‘run backwards’’,
is extremely simplistic and may not be able to withstand more detailed empirical
scrutiny. However, it does raise the possibility that theories that allow for greater
integration between production and comprehension may be able to account for a
wide range of aphasic phenomena in a highly parsimonious way. This capacity of
interactive theories may turn out to have enormous theoretical potential in the
future.
DISCRETENESS AND CONTINUITY IN WORD PRODUCTION:

NEW APPROACHES
Many of the two-stage spreading activation theories discussed so far allow for some
cross-talk between the stages (via cascading activation and/or feedback). However,
in these theories, the two stages still remain distinct. This is because each stage
terminates in a selection process that ensures that one unit is the clear ‘‘winner’’.
However, Lambon Ralph, Sage, and Roberts (2000) have recently advanced the idea
that rather than there being two clearly delineated stages, the process of mapping
from semantics to phonology might be more continuous. They suggest that, in
certain types of network models (namely parallel distributed processing or PDP type
models), there may be no need for actual lexical representations at all. In these
models, the semantic-to-phonological mapping process is continuous. Nevertheless,
during the course of this process, the activation levels of the target word’s
competitors gradually change, giving rise to what are effectively two major ‘‘phases’’.
Early in the mapping process, many words that are semantically related to the target
are highly activated; however, subsequently, as more and more semantic activation
accrues, the target concept begins to gain more and more activation while its
competitors lose activation. Effectively, this is the point at which the target word
gains full control of the retrieval process and phonological retrieval can begin in
earnest (see also Lambon Ralph, Moriarty, Sage, & York Speech Therapy Interest
Group, 2002).
This rather novel idea might help us to explain a number of observations that
continue to be problematic for more conventional two-stage theories. For example,
in the conventional framework, patients who can recall partial phonological
information about the words they cannot produce are interpreted as having an
impairment affecting the phonological retrieval stage. Their knowledge of the
word’s sounds indicates they have made a correct lexical selection, but they are
unable to retrieve the word’s complete phonological form. However, surprisingly,
some such individuals have been found to be sensitive to semantic variables.
Lambon Ralph and colleagues (2000) themselves reported a case with this profile,
GM, whose naming became poorer when the pictures to be named were
interspersed with semantically related items. Within a two-stage theory, this sort
of semantic grouping would have its primary effect during the lexical selection
stage (the lexical representations of semantically related words would be even more
highly activated than usual, which would increase the competition for selection).
Consequently, we would not expect a case like GM, whose impairment appeared to
involve phonological retrieval not lexical selection, to be strongly affected by this
manipulation. However, in a more continuous model, this increased competition
may prevent the target from becoming sufficiently activated above its competitors
to fully gain control of the phonological retrieval process. Findings such as these
raise the possibility that the two lexical retrieval stages may be much less distinct
than originally proposed.
This proposal, that lexical retrieval may be a more fluid process characterised by
‘‘phases’’ rather than distinct stages, may have other empirical advantages too. Most
importantly, it may help us to explain some of the variability we see among aphasic
individuals, even those who appear to have an impairment to the same ‘‘stage’’. For
example, among patients with an apparent ‘‘phonological retrieval’’ deficit, some
produce mainly phonological errors, and others produce mainly omissions or ‘‘tip of
the tongue’’ type responses (e.g., it’s a long word, and starts with ‘‘p’’); some are
strongly affected by word frequency and other lexical properties of words, and others
almost not at all; finally, some perform markedly better in repetition than in naming,
whereas others show little such benefit (see e.g., Goldrick & Rapp, 2007). To
accommodate this kind of variation, some two-stage theories include an additional
phonological processing stage that follows phonological retrieval and that sequences,
re-syllabifies, or fleshes out the retrieved phonological information (not unlike the
phonological output buffer that featured in earlier, functional architecture frame-
works). In these frameworks, the more purely ‘‘phonological’’ cases—those who
make mainly phonological errors and show little sensitivity to lexical variables—are
proposed to have a problem at the second, postlexical phonological stage. However,
a more continuous model may help us to explain some of this variation without the
need to postulate additional stages. At present, it remains to be seen whether this sort
of approach will prove useful as a tool for generating and testing predictions about
aphasia. The idea is yet to be simulated in a computational model, so it is not clear
such a model would indeed behave in the way suggested. Indeed, one recent attempt
to produce a computer model based on a similar idea failed to generate good fits to
aphasic data (Rapp & Goldrick, 2000). Nevertheless, it is likely that we will see
further exploration of this idea in future research into normal and aphasic word
production.
WORD PRODUCTION IN CONTEXT - AND NONFLUENT APHASIA

So far, this article has focused on the production of words in isolation. We have
considered a number of individuals—mostly with fluent aphasia—whose expressive
difficulties were clearly evident even in single word tasks like naming and word
repetition. Of course, in reality, word production occurs in the context of larger
utterances like phrases and sentences. In these larger utterances, different types of
words make different semantic contributions to the sentence and have different
grammatical functions, and these properties are likely to influence how easily they
can be produced by different individuals with aphasia. And of course, the tasks of
generating a meaningful proposition to express, and structuring a sentence according
to the appropriate grammatical rules, are likely to call on their own unique cognitive
processes, none of which is properly measured in single word production tasks. And
finally, production of words in context requires something of a lexical ‘‘balancing
act’’, because several words must be retrieved in parallel without interfering with one
1044 WILSHIRE
another. This in itself could pose a particular challenge to certain individuals with
aphasia, which would not become evident at all through studies of single word
production alone.
In this article there is not enough space to discuss any of these more contextual
aspects of word production in any detail. Nevertheless, it is important to emphasise
that these considerations are essential to the development of a complete theory of
how words are produced. Also, they are likely to hold the key to understanding the
differences between fluent and nonfluent forms of aphasia. Unlike fluent aphasia,
where single word tasks are generally quite good predictors of a person’s
communication abilities, many individuals with nonfluent aphasia produce single
words comparatively well, but have profound difficulties producing connected
speech. It seems that numerous other factors, including those related to context and
grammar, are crucial in determining the extent of these individuals’ difficulties with
verbal expression. So far, our discussion has focused almost entirely on the fluent
aphasias, and we have devoted very little attention to nonfluent forms. This focus
reflects a more general bias towards fluent aphasia in cognitive neuropsychological
research, and which can also be seen in CN-inspired aphasia assessments (e.g., in
both the PALPA and the CAT, the vast majority of subtests focus on impairments
usually associated with fluent aphasia). Again, this bias can be largely blamed on the
existing theoretical frameworks: the word production difficulties observed in
nonfluent aphasia are notoriously difficult to characterise in functional architecture
terms, because they often do not reveal consistent patterns of performance across
tasks and/or clear patterns of errors that would correspond neatly to any particular
cognitive component. However, as will be illustrated in the discussion below, finer-
grained theories have recently offered promising new accounts for some of these
disorders and have stimulated new lines of empirical investigation. The following
section briefly outlines some of the most important research findings relating to
grammatical and contextual factors that influence aphasic language production,
particularly those that are relevant to our understanding of the cognitive basis of
nonfluent aphasia.
Thematic role and grammatical class

The grammatical function of a word clearly affects how it will be processed during
language production. Evidence for this can be seen in the dissociations that have
been reported among words from different grammatical classes. For example, some
aphasic individuals produce speech that contains the appropriate grammatical
function words (e.g., to, of, at) but that lacks the key substantive nouns, verbs, and
adjectives (see Table 5 examples (a) and (b), for some examples). This pattern is
commonly seen in fluent subtypes of aphasia. Conversely, many individuals with
nonfluent aphasia show the opposite pattern. That is, they successfully produce
many substantive nouns, verbs, and adjectives, but may completely omit the
grammatical function words. Some examples of this speech pattern, which is often
termed agrammatic, are shown in Table 5, examples (c) and (d). Agrammatic speech
does not seem to be simply a way of reducing the motor-articulatory demands of
connected speech. Although articulatory difficulties are often observed in individuals
with nonfluent aphasia, articulatory problems alone do not give rise to agrammatic
speech (Square-Storer, Roy, & Hogg, 1990). Rather, the pattern seems to reflect
something more central about the process of sentence construction. Agrammatic
TABLE 5
Descriptions of the ‘‘Cookie Theft’’ picture from the Boston Diagnostic Aphasia Examination
(Goodglass & Kaplan, 1983) by five individuals with aphasia
(a) Patient NW, Wernicke’s aphasia (Keall, 2003)

I can see there’s a bit of trouble going on here. Well, they’re fallen over with this thing here. Is that what
you want? He’s fell-… they’re going to fall off the chair. He’s going to be eating something, but he’s gonna
miss out I think. This one here, he be-… got the-… Oh, he’s in big /prib/.problems here. How to put it in
words? No, I can’t put that together.
(b) Patient AM, Wernicke’s aphasia (Goodglass & Kaplan, 1983).
‘‘Well this is…mother is away here working her work out o’here to get her better, but when she’s looking,
the two boys looking in the other part. On their small tile into her time here. She’s working another time
because she’s getting, too. So the two boys work together an one is sneaking around here, making
his…work an’ his further funnas his time he had. He an’ the other fellow were running around the work
here, while mother another time she was doing that without everything wrong here….’’
(c) Subject 3: Broca’s aphasia (Doyle, Goldstein, & Bourgeois, 1987)
Cookie jar.., water coming in here.. trees … mama here.., dishes.., fall down.., curtains.., cookies… what’s
name of… cook.., two cups coffee.
(d) Patient A: Broca’s aphasia (Helm-Estabrooks, Fitzpatrick, & Barresi, 1981)
Mother’s … ah … washin’ dishes but … fauza and ova-flowing.., boy … ah … stool … and … (long pause
- pt. pointed to stool) …. fall …. and cookies and sister (pointed to girl) … and…
(e) Patient JHM: Broca’s aphasia (Wilshire, Scott, & Stuart, 2006)
Um…the woman ah daydroom daybroon ah she um not um…u-, understood um …water…water
dripping o- on the floor and um a a she doesn’t notice…drooning um the children ah w-… little boy…
girl… um…s-… st- stealing ah cookies um…um…one um boy… give ah boy um… girl um… and um…
um girl um… bu-boy s- s- slip um… s- slip um… ahh stool stool um…
speech is by no means a universal feature of nonfluent aphasia: some individuals

with this condition omit function words only occasionally, and others not at all—see
Example (e) in Table 5 for an example of such a case. Some exhibit other
grammatical abnormalities, such as simplified sentence structures, or incorrect
argument structures, and in some cases, the presentation varies depending on the
complexity of the utterances being production (for discussion, see Kolk, 1987).
The ‘‘agrammatic’’ pattern of speech in particular has often been attributed to a
problem generating the appropriate grammatical structure for the desired sentence.
Consequently, the key words are simply strung together in a non-structured way
(e.g., Goodglass, Christiansen & Gallagher, 1994). A more specific proposal is that
there is a problem in mapping from the propositional representation of the sentence
to a more structural one. That is, the affected individuals are capable of constructing
an appropriate conceptual-level representation of the utterance (which specifies the
thematic roles of the nouns and verbs in the sentence) but they cannot convert this
into a structured syntactic representation of the sentence that specifies the position of
both substantive words and grammatical function words (e.g., Schwartz, Linebarger
& Saffran, 1985). The individuals therefore resort to producing the key substantive
words as an unstructured sequence (agrammatism) or alternatively, producing
incomplete or highly simplified sentences. Other theoretical accounts place less
emphasis on grammatical frame construction itself, and more on the timing of the
various other events that are necessary for sentence production. For example, it has
been suggested that individuals with agrammatism and other sentence production
disorders may be unable to activate the lexical representations required for the
sentence quickly enough for them to all be integrated into the same grammatical
1046 WILSHIRE
structure. In order to minimise the impact of this timing problem, they may resort to
strategies such as sentence simplification and/or function word omission (Kolk,
1987, 1995). An alternative suggestion is that the lexical items are successfully
activated, but cannot be maintained in an activated state long enough for integration
to take place (e.g., Freedman, Martin & Biegler, 2004). This may result in
fragmented, simplified, and/or agrammatic speech. Both of these timing-based
accounts have the advantage that they can deal with the variability across individuals
in the degree of function word omission. This is because they view function word
omission as a response to a deeper problem, rather than a specific cognitive
impairment in its own right.
Several other major dissociations relating to grammatical class have been
observed in aphasia. For example, some individuals produce verbs more accurately
than nouns, whereas others show the reverse pattern, producing nouns more
accurately than verbs. A disproportionate impairment producing verbs is
particularly common, most notably in nonfluent aphasia, and may occur even when
there is no agrammatism (see for example, Berndt et al., 2002; Miceli et al., 1983). It
is often observed even on tasks that do not involve extensive grammatical encoding,
such as those where a pictured action must be named. These dissociations,
particularly when observed on very simple action naming tasks, may reflect
differences in the underlying conceptual properties of objects and actions (e.g., Bird,
Howard, & Franklin, 2000; Breedin & Martin, 1996). When seen in the broader
context of connected speech production, a verb production difficulty may also reflect
differences in the thematic roles of nouns and verbs in utterances: specifically, unlike
nouns, which describe entities that are relatively invariant across different contexts,
verbs often describe relationships among those entities. Successful expression of
these elements therefore requires accurate conceptualisation of these relationships
(Black & Chiat, 2003).
From a more syntactic point of view, accurate verb production in context
involves specifying not just the verb but also the number and type of arguments it
can take, both obligatory and optional. This involves accessing the appropriate
syntactic information concerning the verb’s argument structure as well as
maintaining the required elements online long enough to be able to integrate
them. Indeed, there is some evidence that certain individuals appear to have greater
difficulty with verbs that take many arguments than they do with those that take
fewer arguments (see e.g., Byng, Nickels, & Black, 1994; Marshall, Pring, & Chiat,
1998). Other noun–verb differences may reflect difficulties in the extent to which
their selection is driven by semantic versus syntactic considerations. The selection
of nouns is largely determined by their specific meanings, which are relatively
invariant across different propositions. While certain types of verbs also have
relatively transparent meanings that do not vary greatly across utterances (e.g.,
substantives such as ‘‘ski’’ and ‘‘eat’’), the meanings of some are determined almost
entirely by their relationship with other words in the sentence (e.g., the so-called
‘‘light’’ verbs such as ‘‘do’’, ‘‘have’’, and ‘‘be’’). The selection of these verbs is
therefore strongly dependent on successful grammatical encoding. Indeed, some
individuals with verb production deficits who show more difficulty with these kinds
of ‘‘light’’ verbs often show other grammatical abnormalities that are consistent
with an impaired grammatical frame construction process (see e.g., Gordon & Dell,
2003).
Dynamic aspects of language production

Sentence production also differs from single word production in another important
way: it involves retrieving the representations of more than one word at a time. This
in itself may be a problem for certain individuals with aphasia. Recent evidence
suggests that for some individuals with nonfluent aphasia, word production is
powerfully influenced by the nature of the other words to be produced within the
same utterance. For example, some such individuals perform much more poorly in
picture-naming tasks when two pictures must be named together in a single utterance
(e.g., cat, dog), particularly if they are also semantically related (Freedman et al.,
2004; Schwartz & Hodgson, 2002). Indeed, in some individuals, even single picture
naming may become quite poor if the pictures are semantically grouped and
presented several times over (Schnur, Schwartz, Brecher, & Hodgson, 2006; Wilshire
& McCarthy, 2002). Importantly, neither of the tasks just described involves actual
sentence production—indeed, in the semantically grouped naming task, only one
word is produced at a time. This suggests there is a separate and distinct problem in
these individuals, which is not related to grammatical processing, but rather has
something to do with activating multiple words in close succession.
It has recently been suggested that individuals who show these kinds of context
effects may have a problem with ‘‘executive control’’ of the lexical network. One
proposal is that there is an impairment to the mechanism that controls the spread of
activation throughout the lexical network, and which usually ensures that only one
unit becomes activated enough to be selected at any one time (Martin & Hamilton,
2005; Schnur et al, 2006; Wilshire & McCarthy, 2002). Consequently, for individuals
with this impairment, any task that involves activating more than one word in close
proximity will be extremely difficult, particularly if the words also activate each
other via shared semantic features. Such an impairment would also impact
dramatically on the individual’s ability to produce words within sentences and
may therefore contribute to the sentence production difficulties that are observed in
at least some cases of nonfluent aphasia.
Grammar, context, and nonfluent aphasia: Some final remarks

As outlined in the brief review above, explanations for sentence production
difficulties in nonfluent aphasia centre around three major themes: an impairment
generating propositional and/or grammatical structures for production; a difficulty
in coordinating the timing of activation of the various lexical items required for the
sentence; and an inability to control of the spread of activation throughout the
lexical network more generally. Although these various explanations are quite
different, they may not necessarily be in direct competition. For example, each
proposed disorder may be a distinct and dissociable problem, but may often occur in
combination with one or more of the others. Or alternatively, each account may
describe different aspects of the same underlying problem, whose fundamental
nature is yet to be discovered. It is too early to distinguish among these various
possibilities. What is clear, however, is that the kinds of accounts offered for
nonfluent aphasic production difficulties differ markedly from those put forward to
explain fluent aphasic difficulties, and that understanding the influence of context on
word production, in its broadest sense, will be crucial to the development of future
accounts of these disorders.
1048 WILSHIRE
CONCLUSION
The discussion above has outlined some of the major ways in which cognitive
neuropsychological accounts of aphasic word production have recently evolved as a
result of theoretical and methodological advances in related fields. One of the
principal aims of the review was to demonstrate that these more recent theoretical
approaches are not merely refinements or extensions of earlier box-and-arrow
accounts. Rather, they offer a fundamentally different conceptualisation of word
production and its impairments. When word production is considered at a finer-
grained level, some previously proposed ‘‘boxes’’ become unnecessary and others
change their character dramatically. Even more importantly, finer-grained theories
of word production enable us to describe aphasic impairments not just in terms of
which system or component is impaired, but also how it is impaired (a nice

illustration of this was seen in Martin and colleagues’ 1994 account of case NC).
These more recent theoretical approaches have also inspired entirely new research
endeavours. For example, the use of simple spreading activation theories led to the
emergence of computational modelling studies of aphasic behaviour, which in turn
stimulated greater interest in quantitative aspects of impairment, such as degree of
severity. Also, word production impairments that were not easily ‘‘localisable’’
within functional architecture schemes—such as those observed in nonfluent
aphasia—have become more amenable to cognitive neuropsychological investiga-
tion.
From the point of view of scientific research into language more generally, the
closer relationship that has recently developed between theories of normal and
aphasic word production has greatly facilitated interchange between patient methods
and other psycholinguistic research methods. The discussion above described several
instances where evidence from aphasia has been used to address important
theoretical questions about normal functioning. These examples demonstrate that,
contrary to the beliefs of some early cognitive neuropsychologists, the contribution
of patient research can go way beyond documenting the coarse-grained architecture
of the language systems. Such research can be used to address much finer-grained,
theoretically driven questions. Perhaps the ultimate test of the impact of
neuropsychological data on normal theory is whether the work of researchers who
use more conventional methods (e.g., studies of healthy participants) includes
references to neuropsychological data. Some recent papers provide some evidence
for an emerging trend in this direction (Belke, Meyer, & Damian, 2005; Berg, 2005;
Roelofs, 2004).
Manuscript received 26 February 2007

Manuscript accepted 26 June 2007
First published online 9 October 2007
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Cognitive neuropsychological approaches to word production in aphasia:

Article in Aphasiology · October 2007

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To cite this article: Carolyn E. Wilshire (2008): Cognitive neuropsychological approaches to

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Cognitive neuropsychological approaches to word production

Background: The cognitive neuropsychological approach aims to describe aphasic

Address correspondence to: Carolyn Wilshire, School of Psychology, Victoria University of

mere extensions or refinements of the classical box-and-arrow theories. Rather, they

WORD PRODUCTION IMPAIRMENTS: EARLY CASES AND

represented as boxes, interconnected with appropriately oriented arrows (hence the

Error types in picture semantic paraphasias semantic paraphasias, phonemic paraphasias

batteries—e.g., The Psycholinguistic Assessment of Language Processing in Aphasia

KEY CONCEPTS FROM THEORIES OF NORMAL WORD PRODUCTION

interactive theories: In many collections of normal spontaneous speech errors,

APPLICATIONS TO APHASIC WORD PRODUCTION

be going on inside the various boxes proposed in functional architecture schemes,

(b) Word Repetition

Within functional architecture schemes such as the one shown in Figure 1, NC

proposing just one abnormality: an inability to maintain stable levels of activation in

Martin and colleagues’ theory contains some controversial proposals (for

COMPUTER SIMULATION STUDIES OF APHASIA

types of modelling efforts. One major criticism is that it is difficult to establish

of a theory to explain a range of observations with a minimum number of theoretical

THEORETICAL CONTRIBUTIONS OF APHASIA RESEARCH

of the error phenomena described could occur as a result of a complex pattern of

(a) Picture naming

Battery: mattery, mattery, no, no such word … battery.

production and comprehension in terms of a single abnormality. Therefore, this very

DISCRETENESS AND CONTINUITY IN WORD PRODUCTION:

WORD PRODUCTION IN CONTEXT - AND NONFLUENT APHASIA

Thematic role and grammatical class

(a) Patient NW, Wernicke’s aphasia (Keall, 2003)

speech is by no means a universal feature of nonfluent aphasia: some individuals

Dynamic aspects of language production

Grammar, context, and nonfluent aphasia: Some final remarks

which system or component is impaired, but also how it is impaired (a nice

Manuscript received 26 February 2007

Journal of Experimental Psychology, 41A(2), 293–319.

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