A time-based approach to agrammatic production

Naming as a window to word retrieval changes in healthy and pathological ageing: Methodological considerations

BACKGROUND

Word retrieval skills change across the lifespan. Permanent alterations in the form of decreased accuracy or increased response time can be a consequence of both normal ageing processes or the presence of acquired and neurodegenerative disorders (e.g., aphasia and dementia). Despite the extensive literature exploring the neuroanatomical underpinnings of word retrieval, psycholinguistic, biolinguistic and theoretical explanations, and the vast amount of evidence from primary and secondary language disorders, the best approach to consistently capture these changes is yet to be discovered.

AIMS

The goal of this paper is to determine which method(s) stand(s) as the most suitable candidate(s) to provide an accurate picture of word retrieval in the oral production of different groups of adult speakers, including cases of healthy ageing, preclinical Alzheimer's disease (AD), mild cognitive impairment (MCI), aphasia and dementia.

METHODS & PROCEDURES

Using an integrative review of recent peer-reviewed journal articles, we provide an overview of the different behavioural methods traditionally used to measure oral naming skills in research-oriented and clinical protocols and discuss their main advantages and limitations.

MAIN CONTRIBUTION

Most existing studies are based on the results of people with diagnosed language disorders. Despite the growing interest, the reliability of the majority of the tasks to detect subtle changes associated with healthy ageing, MCI and preclinical AD are yet to be demonstrated, and the delicate balance between informativeness and efficiency (especially in terms of administration time and variable control) in experimental protocols is yet to be achieved. In this article we propose the pursuit of an integrative overarching methodology to characterize all naming deficits (from anecdotal to permanent) and all adult populations (from healthy to pathological ageing).

CONCLUSIONS & IMPLICATIONS

A combination of spontaneous speech data and results from structured tasks stands as the best approach to capture changes in word retrieval skills of adult speakers with and without observable deficits. This review can guide future reflections on the necessary prerequisites of purpose-oriented, sensitive and reliable protocols for the detection of incipient word retrieval problems, thus contributing to the early diagnosis and the design of personalized multicomponent treatments.

WHAT THIS PAPER ADDS

What is already known on this subject Word retrieval skills change during adulthood as a consequence of the neurological degradation associated with ageing. These changes are more dramatic in the event of acquired and neurodegenerative disorders. Numerous studies based on people with observable language disorders have addressed the multiplicity of factors involved in word retrieval and provided evidence of potential loci of impairment from a neuroanatomical, cognitive and/or (psycho-)linguistic perspective. What this paper adds to existing knowledge This study focuses on methodological strategies to assess naming skills and provides a reflection on generally accepted good practices and unresolved challenges to inform task selection, emphasizing the necessity for a combination of methods to best capture the actual problems and needs of people confronting word retrieval difficulties in their daily lives. Task selection, variable control and administration time stand as key concepts to adjust to the requirements of research and clinical contexts. What are the potential or actual clinical implications of this work? The results of this review can orient future research towards the creation of sensitive, reliable and (ecologically) valid materials for the (early) detection of word retrieval deficits and for the customization of treatment protocols to alleviate or palliate their effects.

A reconceptualization of sentence production in post-stroke agrammatic aphasia: the synergistic processing bottleneck model

The language production deficit in post-stroke agrammatic aphasia (PSA-G) tends to result from lesions to the left inferior frontal gyrus (LIFG) and is characterized by a triad of symptoms: fragmented sentences, errors in functional morphology, and a dearth of verbs. Despite decades of research, the mechanisms underlying production patterns in PSA-G have been difficult to characterize. Two major impediments to progress may have been the view that it is a purely morphosyntactic disorder and the (sometimes overzealous) application of linguistic theory without interceding psycholinguistic evidence. In this paper, empirical evidence is examined to present an integrated portrait of language production in PSA-G and to evaluate the assumption of a syntax-specific syndrome. In light of extant evidence, it is proposed that agrammatic language production results from a combination of morphosyntactic, phonomotor, and processing capacity limitations that cause a cumulative processing bottleneck at the point of articulatory planning. This proposed Synergistic Processing Bottleneck model of PSA-G presents a testable framework for future research. The paper ends with recommendations for future research on PSA-G.

A Systematically Conducted Scoping Review of the Evidence and Fidelity of Treatments for Verb and Sentence Deficits in Aphasia: Sentence Treatments

PURPOSE

This review article synthesizes and evaluates the evidence for sentence production treatments in aphasia, systematically charting impairment-based and functional communication outcomes. It reports (a) the level of evidence and fidelity of sentence treatments; (b) the impact of treatment on production of trained and untrained verbs and sentences, functional communication, and discourse; and (c) the potential active ingredients of treatment.

METHOD

The search included studies from January 1980 to June 2019. The level of evidence of each study was documented, as was fidelity in terms of treatment delivery, enactment, and receipt. Studies were also categorized according to treatment methods used.

RESULTS

Thirty-three studies were accepted into the review and predominantly constituted Level 4 evidence (e.g., case control studies and case series). Thirty studies (90%) described treatment in sufficient detail to allow replication, but dosage was poorly reported, and fidelity of treatment was rarely assessed. The most commonly reported treatment techniques were mapping (10 studies: 30%), predicate argument structure treatment (six studies: 18%), and verb network strengthening treatment (five studies: 15%). Production of trained sentences improved for 83% of participants, and improvements generalized to untrained sentences for 59% of participants. Functional communication was rarely assessed, but discourse production improved for 70% of participants.

CONCLUSIONS

The evidence for sentence treatments is predominantly generated from Level 4 studies. Treatments were effective for the majority of participants regarding trained sentence and discourse production. However, there is inconsistent use of statistical analysis to verify improvements, and diverse outcome measures are used, which makes interpretation of the evidence difficult. The quality of sentence treatment research would be improved by agreeing a core set of outcome measures and extended by ascertaining the views of participants on sentence treatments.

Development of a measure of function word use in narrative discourse: core lexicon analysis in aphasia

BACKGROUND

Although discourse-level assessments contribute to predicting real-world performance in persons with aphasia (PWA), the use of discourse measures is uncommon in clinical settings due to resource-heavy procedures. Moreover, assessing function word use in discourse requires the arduous procedure of defining grammatical categories for each word in language transcripts.

AIMS

The purpose of this exploratory study was twofold: (1) to develop core function word lists as a clinician-friendly means of evaluating function word use in discourse; and (2) to examine the ability of the core function word measure to differentiate PWA from cognitively healthy adults and persons with fluent aphasia from non-fluent aphasia.

METHODS & PROCEDURES

The 25 most commonly used function words (core function words) were extracted from narrative language samples from 470 cognitively healthy adults, which were divided into seven age groups (20s, 30s, 40s, 50s, 60s, 70s and 80s). The percent agreement of core function words for 11 PWA (fluent aphasia = 5; non-fluent aphasia = 6) and 11 age- and education-matched controls were then calculated. Percent agreement for the core function words produced was compared between the controls and the PWA group, and between participants with fluent aphasia and non-fluent aphasia.

OUTCOMES & RESULTS

The results indicated that PWA produced fewer core function words from the lists than the control group, and that core function word use was strongly correlated with aphasia severity. Persons with non-fluent aphasia produced fewer core function words than those with fluent aphasia, although this could be a confound of aphasia classification from the use of the Western Aphasia Battery (WAB)-Revised.

CONCLUSIONS & IMPLICATIONS

Core function word lists consisting of a limited number of items for quantifying function word use in discourse remain in a nascent stage of development. However, the findings are consistent with previous studies analysing the total production of function words in language samples produced by PWA. Therefore, core function words may potentially serve as a clinician-friendly manner of quantifying function words produced in discourse. What this paper adds What is already known on the subject Function word analysis in discourse requires arduous processes of identifying the error production and grammatical category of function words in discourse. Previous studies have demonstrated that core lexicon measures are an efficient, simple means of quantifying discourse in PWA. However, function words have never been considered for generating an independent core lexicon list. What this paper adds to existing knowledge As an exploratory study, we focused primarily on developing a clinician-friendly measure to evaluate function word production in discourse, motivated by the idea of an adaptation strategy within the core lexicon framework. Our findings demonstrated that by using a simple scoring system that the core lexicon measure provides, we differentiated the control group from the PWA group, and persons with fluent aphasia from persons with non-fluent aphasia. Additionally, we found significant correlations between function word production and aphasia severity determined by WAB Aphasia Quotient (AQ). What are the potential or actual clinical implications of this work? The results add empirical evidence for the utility of core function word lists for quantifying function word usage in discourse in PWA. Counting the presence and absence of function words in discourse will allow clinicians to avoid labour-intensive preparatory work, and to obtain useful diagnostic information in a less time-consuming way.

Effect of lexical accessibility on syntactic production in aphasia: An eyetracking study

PURPOSE

Healthy speakers use both word-level and structure-level information to ease sentence production processes. Structural priming facilitates message-structure mapping in aphasia. However, it remains unclear if and how word-level information affects off-line and on-line sentence production in persons with aphasia (PWA). This eyetracking-while-speaking study examined the effect of lexical priming on production of syntactic (active/passive) structures in PWA.

METHOD

Eleven PWA and twenty healthy older adults (HOA) described transitive actions (woman pulling horse) following lexical priming, wherein the relative ease of lexical retrieval for the Agent or Theme was manipulated via an auditory probe (what is happening with the woman/horse ?). It was examined whether or not PWA produce the sentence structure that allows earlier production of the primed word (e.g., passives when Theme was primed). Participants' eye fixation times to each character (Agent, Theme) were also monitored to examine if PWA show priming-induced preferential looks to one character from the earliest stage of production, consistent with word-driven planning.

RESULTS

HOA showed increased production of passives over actives in the Theme vs. Agent prime condition. In eye fixation data, HOA showed priming-induced Theme advantage from the earliest time window (picture onset-400 milliseconds). PWA also showed a significant priming effect in off-line sentence production, with this priming effect being greater for the individuals whose syntactic processing is better preserved. In eye fixation data, however, PWA showed preferential fixations to the primed character at a later stage of sentence planning (400-800 milliseconds), following equal fixation time to Agent and Theme during the earliest time window.

CONCLUSION

HOA showed word-driven production in both off-line and real-time (eye fixations) production. Lexical accessibility effectively drove off-line syntactic production in PWA, especially for those whose syntactic capacity remains relatively preserved. However, PWA showed advanced processing of both characters in earliest eye fixation data, suggesting that successful word-driven off-line syntactic production was associated with atypical real-time sentence planning in aphasia.

Effects of Verb Overlap on Structural Priming in Dialogue: Implications for Syntactic Learning in Aphasia

Purpose Although there is increasing interest in using structural priming as a means to ameliorate grammatical encoding deficits in persons with aphasia (PWAs), little is known about the precise mechanisms of structural priming that are associated with robust and enduring effects in PWAs. Two dialogue-like comprehension-to-production priming experiments investigated whether lexically independent (abstract structural) priming and/or lexically (verb) specific priming yields immediate and longer, lasting facilitation of syntactic production in PWAs. Method Seventeen PWAs and 20 healthy older adults participated in a collaborative picture-matching task where participant and experimenter took turns describing picture cards using transitive and dative sentences. In Experiment 1, a target was elicited immediately following a prime. In Experiment 2, 2 unrelated utterances intervened between a prime and target, thereby allowing us to examine lasting priming effects. In both experiments, the verb was repeated for half of the prime-target pairs to examine the lexical (verb) boost on priming. Results Healthy older adults demonstrated abstract priming in both transitives and datives not only in the immediate (Experiment 1) but also in the lasting (Experiment 2) priming condition. They also showed significantly enhanced priming by verb overlap (lexical boost) in transitives during immediate priming. PWAs demonstrated abstract priming in transitives in both immediate and lasting priming conditions. However, the magnitude of priming was not enhanced by verb overlap. Conclusions Abstract structural priming, but not lexically specific priming, is associated with reliable and lasting facilitation of message-structure mapping in aphasia. The findings also suggest that implicit syntactic learning via a dialogue-like comprehension-to-production task remains preserved in aphasia.

Aligning sentence structures in dialogue: evidence from aphasia

Syntactic alignment in dialogue is pervasive and enduring in unimpaired speakers, facilitating language processing and learning. Recent work suggests that syntactic alignment extends to the level of event-semantic properties (syntactic entrainment). Two experiments examined whether syntactic entrainment can ameliorate impaired message-structure mapping in persons with aphasia (PWA). In Experiment 1, participants first heard twelve picture descriptions, each using one of two suitable syntactic structures, prior to describing the same twelve pictures themselves. In Experiment 2, participants also repeated the heard picture descriptions, thereby increasing the depth of encoding for prime sentences. PWA showed a robust tendency to re-use previously encountered syntactic structures in their own production only in Experiment 2. They produced fewer 'mapping' errors (e.g., thematic role reversals) in Experiment 2 than in Experiment 1. Syntactic entrainment remains resilient in aphasia, strengthening their event-semantic-to-syntax mappings, at least when active encoding of prior message-syntax associations is ensured.

Verbal short-term memory capacities and executive function in semantic and syntactic interference resolution during sentence comprehension: Evidence from aphasia

This study examined the role of verbal short-term memory (STM) and executive function (EF) underlying semantic and syntactic interference resolution during sentence comprehension for persons with aphasia (PWA) with varying degrees of STM and EF deficits. Semantic interference was manipulated by varying the semantic plausibility of the intervening NP as subject of the verb and syntactic interference was manipulated by varying whether the NP was another subject or an object. Nine PWA were assessed on sentence reading times and on comprehension question performance. PWA showed exaggerated semantic and syntactic interference effects relative to healthy age-matched control subjects. Importantly, correlational analyses showed that while answering comprehension questions, PWA' semantic STM capacity related to their ability to resolve semantic but not syntactic interference. In contrast, PWA' EF abilities related to their ability to resolve syntactic but not semantic interference. Phonological STM deficits were not related to the ability to resolve either type of interference. The results for semantic interference are consistent with prior findings indicating a role for semantic but not phonological STM in sentence comprehension, specifically with regard to maintaining semantic information prior to integration. The results for syntactic interference are consistent with the recent findings suggesting that EF is critical for syntactic processing.

Comparing phoneme frequency, age of acquisition, and loss in aphasia: Implications for phonological universals

Phonological complexity may be central to the nature of human language. It may shape the distribution of phonemes and phoneme sequences within languages, but also determine age of acquisition and susceptibility to loss in aphasia. We evaluated this claim using frequency statistics derived from a corpus of phonologically transcribed Italian words (phonitalia, available at phonitalia,org), rankings of phoneme age of acquisition (AoA) and rate of phoneme errors in patients with apraxia of speech (AoS) as an indication of articulatory complexity. These measures were related to cross-linguistically derived markedness rankings. We found strong correspondences. AoA, however, was predicted by both apraxic errors and frequency, suggesting independent contributions of these variables. Our results support the reality of universal principles of complexity. In addition they suggest that these complexity principles have articulatory underpinnings since they modulate the production of patients with AoS, but not the production of patients with more central phonological difficulties.

Verbal monitoring in Parkinson's disease: A comparison between internal and external monitoring

Patients with Parkinson's disease (PD) display a variety of impairments in motor and non-motor language processes; speech is decreased on motor aspects such as amplitude, prosody and speed and on linguistic aspects including grammar and fluency. Here we investigated whether verbal monitoring is impaired and what the relative contributions of the internal and external monitoring route are on verbal monitoring in patients with PD relative to controls. Furthermore, the data were used to investigate whether internal monitoring performance could be predicted by internal speech perception tasks, as perception based monitoring theories assume. Performance of 18 patients with Parkinson's disease was measured on two cognitive performance tasks and a battery of 11 linguistic tasks, including tasks that measured performance on internal and external monitoring. Results were compared with those of 16 age-matched healthy controls. PD patients and controls generally performed similarly on the linguistic and monitoring measures. However, we observed qualitative differences in the effects of noise masking on monitoring and disfluencies and in the extent to which the linguistic tasks predicted monitoring behavior. We suggest that the patients differ from healthy subjects in their recruitment of monitoring channels.

Recovery of Sentence Production Processes Following Language Treatment in Aphasia: Evidence from Eyetracking

Introduction: Sentence production impairments in aphasia often improve with treatment. However, little is known about how cognitive processes supporting sentence production, such as sentence planning, are impacted by treatment.

Methods: The present study used eyetracking to examine changes in sentence production resulting from a 12-week language treatment program focused on passive sentences (Treatment of Underlying Forms (TUF); Thompson and Shapiro, 2005). In two pre-treatment and two post-treatment sessions, nine participants with mild-to-moderate agrammatic aphasia performed a structural priming task, which involved repeating primed sentences (actives or passives) and then, using the same verb, producing sentences describing pictured events. Two individuals with aphasia performed the eyetracking task on the same schedule without intervening language treatment. Ten unimpaired older adults also performed the task to identify normal performance patterns. Sentence production accuracy and speech onset latencies were examined, and eye movements to the pictured Agent and Theme characters were analyzed in the first 400 ms after picture onset, reflecting early sentence planning, and in the regions preceding the production of the sentence subject and post-verbal noun, reflecting lexical encoding.

Results: Unimpaired controls performed with high accuracy. Their early eye movements (first 400 ms) indicated equal fixations to the Agent and Theme, consistent with structural sentence planning (i.e., initial construction of an abstract structural frame). Subsequent eye movements occurring prior to speech onset were consistent with encoding of the correct sentence subject (i.e., the Agent in actives, Theme in passives), with encoding of the post-verbal noun beginning at speech onset. In participants with aphasia, accuracy improved significantly with treatment, and post-treatment (but not pre-treatment) eye movements were qualitatively similar to those of unimpaired controls, indicating correct encoding of the Agent and Theme nouns for both active and passive sentences. Analysis of early eye movements also showed a treatment-induced increase in structural planning. No changes in sentence production accuracy or eye movements were found in the aphasic participants who did not receive treatment.

Conclusion: These findings indicate that treatment improves sentence production and results in the emergence of normal-like cognitive processes associated with successful sentence production, including structural planning.

Grammatical Planning Units During Real-Time Sentence Production in Speakers With Agrammatic Aphasia and Healthy Speakers

PURPOSE

Grammatical encoding (GE) is impaired in agrammatic aphasia; however, the nature of such deficits remains unclear. We examined grammatical planning units during real-time sentence production in speakers with agrammatic aphasia and control speakers, testing two competing models of GE. We queried whether speakers with agrammatic aphasia produce sentences word by word without advanced planning or whether hierarchical syntactic structure (i.e., verb argument structure; VAS) is encoded as part of the advanced planning unit.

METHOD

Experiment 1 examined production of sentences with a predefined structure (i.e., "The A and the B are above the C") using eye tracking. Experiment 2 tested production of transitive and unaccusative sentences without a predefined sentence structure in a verb-priming study.

RESULTS

In Experiment 1, both speakers with agrammatic aphasia and young and age-matched control speakers used word-by-word strategies, selecting the first lemma (noun A) only prior to speech onset. However, in Experiment 2, unlike controls, speakers with agrammatic aphasia preplanned transitive and unaccusative sentences, encoding VAS before speech onset.

CONCLUSIONS

Speakers with agrammatic aphasia show incremental, word-by-word production for structurally simple sentences, requiring retrieval of multiple noun lemmas. However, when sentences involve functional (thematic to grammatical) structure building, advanced planning strategies (i.e., VAS encoding) are used. This early use of hierarchical syntactic information may provide a scaffold for impaired GE in agrammatism.

Outcomes of treatment targeting syntax production in people with Broca's-type aphasia: evidence from psycholinguistic assessment tasks and everyday conversation

BACKGROUND

Capturing evidence of the effects of therapy within everyday communication is the holy grail of aphasia treatment design and evaluation. Whilst impaired sentence production is a predominant symptom of Broca's-type aphasia, the effects of sentence production therapy on everyday conversation have not been investigated. Given the context-sensitive nature of spoken production by people with aphasia, it is difficult to extrapolate implications for everyday conversation based on results from task-based assessment (such as picture description, story retell or interview). Thus, there are strong theoretical and clinical motivations to investigate generalization from sentence production treatment to everyday conversation.

AIMS

To evaluate a theoretically driven treatment focused on the language production skills of participants with post-stroke Broca's aphasia and to track outcomes from psycholinguistic assessment tasks to everyday conversation.

METHODS & PROCEDURES

A case series design was utilized with pragmatic selection of participants with chronic aphasia undergoing the same assessment and treatment procedures. Nine participants with Broca's aphasia and their main conversation partners took part in the study. Treatment was implemented once weekly over 8 weeks and targeted production of basic syntax-two, three and four constituent constructions-through principles of mapping and reduced syntax treatment. Use of different possible exemplars for nouns, particularly pronouns, was trained together with use of both light and heavy verbs. Participants had the opportunity to 'top-up' therapy practise by completely a homework task that mirrored the therapy task.

OUTCOMES & RESULTS

Syntactic well-formedness was assessed in samples of constrained sentence production, narrative retell and naturally occurring conversations at baseline, 1 week post-treatment, and 1 month post-treatment. Treatment showed strong direct effects in trained and untrained sentence construction tasks, with some generalization to narrative retell tasks. There was little evidence of change in everyday conversation.

CONCLUSIONS & IMPLICATIONS

Improvement in language production in constrained assessment tasks may not impact on everyday conversations. Implications for further research are discussed, e.g. the need for bridging interventions between constrained and unconstrained contexts of language production. Clinical implications include the potential to streamline therapy planning and delivery by making use of rich, hybrid therapies to treat individuals with similar symptom profiles but with a range of underlying deficits.

Agrammatism in Jordanian-Arabic speakers

The studies of agrammatism show that not all morpho-syntactic elements are impaired to the same degree and that some of this variation may be due to language-specific differences. This study investigated the production of morpho-syntactic elements in 15 Jordanian-Arabic (JA) speaking individuals with agrammatism and 15 age-matched neurologically healthy individuals. Two experiments were conducted to examine the production of complementizer, tense, agreement and negation morphology in JA. The results indicated that the speakers of JA with agrammatism had marked dissociations in producing specific morpho-syntactic elements. The observed impairment patterns overlapped, in many respects, with those observed in other linguistic groups. The findings are discussed with respect to current theories of agrammatism, including both morpho-syntactic and computational accounts.

High-level language production in Parkinson's disease: a review

This paper discusses impairments of high-level, complex language production in Parkinson's disease (PD), defined as sentence and discourse production, and situates these impairments within the framework of current psycholinguistic theories of language production. The paper comprises three major sections, an overview of the effects of PD on the brain and cognition, a review of the literature on language production in PD, and a discussion of the stages of the language production process that are impaired in PD. Overall, the literature converges on a few common characteristics of language production in PD: reduced information content, impaired grammaticality, disrupted fluency, and reduced syntactic complexity. Many studies also document the strong impact of differences in cognitive ability on language production. Based on the data, PD affects all stages of language production including conceptualization and functional and positional processing. Furthermore, impairments at all stages appear to be exacerbated by impairments in cognitive abilities.

Microlinguistic aspects of the oral narrative in patients with Alzheimer's disease

BACKGROUND

Alzheimer's disease (AD) is characterized by memory loss and cognitive impairment. Phonological, syntactic, semantic and discursive aspects of language may also be affected. Analysis of micro- and macrolinguistic abilities of discourse may assist in diagnosing AD. The aim of this study was to identify changes in the discourse (lexical errors and syntactic index) of AD patients.

METHODS

121 elderly subjects narrated a story based on a seven-figure picture description.

RESULTS

Patients with AD presented more word-finding difficulties, revisions and repetitions, and the syntactic index was lower than controls.

CONCLUSION

Performance in microlinguistics at the lexical and syntactic levels was lower than expected in participants with AD.

Production of modal and negative particles in Greek aphasia

This study aims at investigating the production of the Greek modal and negative particles by non-fluent aphasic patients. These particles belong to the highest part of the verb periphrasis, so they are likely to be impaired in non-fluent aphasia, according to some hypotheses about agrammatic language. Moreover, there is an agreement relation between modality and negation, allowing the examination of agreement relationships in the clause domain. The data are compared to the predictions of recent theories on agrammatic language. The data provide evidence that modality is impaired in agrammatic aphasia, whilst agreement relations between clausal elements are spared.

On-line processing of tense and temporality in agrammatic aphasia

Agrammatic aphasic individuals exhibit marked production deficits for tense morphology. This paper presents three experiments examining whether a group of English-speaking agrammatic individuals (n=10) exhibit parallel deficits in their comprehension of tense. Results from two comprehension experiments (on-line grammaticality judgment studies) suggest that these individuals are impaired for tense comprehension, and furthermore that their deficit is more pronounced for morphosemantic rather than morphosyntactic aspects of tense processing. Results from a third experiment (an elicited production study) indicate that these individuals exhibit parallel production and comprehension impairments for tense. Across the three experiments, the consistent pattern was that of a significant difficulty in associating verb forms with a pre-specified temporal context when compared to all other processes. Implications for current models of agrammatic tense and morphological deficits are discussed.

Decoding of temporal intervals from cortical ensemble activity

Neurophysiological, neuroimaging, and lesion studies point to a highly distributed processing of temporal information by cortico-basal ganglia-thalamic networks. However, there are virtually no experimental data on the encoding of behavioral time by simultaneously recorded cortical ensembles. We predicted temporal intervals from the activity of hundreds of neurons recorded in motor and premotor cortex as rhesus monkeys performed self-timed hand movements. During the delay periods, when animals had to estimate temporal intervals and prepare hand movements, neuronal ensemble activity encoded both the time that elapsed from the previous hand movement and the time until the onset of the next. The neurons that were most informative of these temporal intervals increased or decreased their rates throughout the delay until reaching a threshold value, at which point a movement was initiated. Variability in the self-timed delays was explainable by the variability of neuronal rates, but not of the threshold. In addition to predicting temporal intervals, the same neuronal ensemble activity was informative for generating predictions that dissociated the delay periods of the task from the movement periods. Left hemispheric areas were the best source of predictions in one bilaterally implanted monkey overtrained to perform the task with the right hand. However, after that monkey learned to perform the task with the left hand, its left hemisphere continued and the right hemisphere started contributing to the prediction. We suggest that decoding of temporal intervals from bilaterally recorded cortical ensembles could improve the performance of neural prostheses for restoration of motor function.

A model of serial order problems in fluent, stuttered and agrammatic speech

Many models of speech production have attempted to explain dysfluent speech. Most models assume that the disruptions that occur when speech is dysfluent arise because the speakers make errors while planning an utterance. In this contribution, a model of the serial order of speech is described that does not make this assumption. It involves the coordination or 'interlocking' of linguistic planning and execution stages at the language-speech interface. The model is examined to determine whether it can distinguish two forms of dysfluent speech (stuttered and agrammatic speech) that are characterized by iteration and omission of whole words and parts of words.

Informativeness ratings of messages created on an AAC processing prosthesis

BACKGROUND: SentenceShaper() (SSR) is a computer program that supports spoken language production in aphasia by recording and storing the fragments that the user speaks into the microphone, making them available for playback and allowing them to be combined and integrated into larger structures (i.e., sentences and narratives). A prior study that measured utterance length and grammatical complexity in story-plot narratives produced with and without the aid of SentenceShaper demonstrated an "aided effect" in some speakers with aphasia, meaning an advantage for the narratives that were produced with the support of this communication aid (Linebarger, Schwartz, Romania, Kohn, & Stephens, 2000). The present study deviated from Linebarger et al.'s methods in key respects and again showed aided effects of SentenceShaper in persons with aphasia. AIMS: Aims were (1) to demonstrate aided effects in "functional narratives" conveying hypothetical real-life situations from a first person perspective; (2) for the first time, to submit aided and spontaneous speech samples to listener judgements of informativeness; and (3) to produce preliminary evidence on topic-specific carryover from SentenceShaper, i.e., carryover from an aided production to a subsequent unaided production on the same topic. METHODS #ENTITYSTARTX00026; PROCEDURES: Five individuals with chronic aphasia created narratives on two topics, under three conditions: Unaided (U), Aided (SSR), and Post-SSR Unaided (Post-U). The 30 samples (5 participants, 2 topics, 3 conditions) were randomised and judged for informativeness by graduate students in speech-language pathology. The method for rating was Direct Magnitude Estimation (DME). OUTCOMES #ENTITYSTARTX00026; RESULTS: Repeated measures ANOVAs were performed on DME ratings for each participant on each topic. A main effect of Condition was present for four of the five participants, on one or both topics. Planned contrasts revealed that the aided effect (SSR >U) was significant in each of these cases. For two participants, there was also topic-specific carryover (Post-U >U). CONCLUSIONS: Listeners judged functional narratives generated on SentenceShaper to be more informative than comparable narratives spoken spontaneously. This extends the evidence for aided effects of SentenceShaper. There was also evidence, albeit weaker, for topic-specific carryover, suggesting that the program might be used effectively to practise for upcoming face-to-face interactions.

Does functional neuroimaging solve the questions of neurolinguistics?

Neurolinguistic research has been engaged in evaluating models of language using measures from brain structure and function, and/or in investigating brain structure and function with respect to language representation using proposed models of language. While the aphasiological strategy, which classifies aphasias based on performance modality and a few linguistic variables, has been the most stable, cognitive neurolinguistics has had less success in reliably associating more elaborately proposed levels and units of language models with brain structure. Functional imaging emerged at this stage of neurolinguistic research. In this review article, it is proposed that the often-inconsistent superfluity of outcomes arising from functional imaging studies of language awaits adjustment at both "ends" of the process: model and data. Assumptions that our current language models consistently and reliably represent implicit knowledge within human cerebral processing are in line for major revision; and the promise of functional brain imaging to reveal any such knowledge structures must incorporate stable correlates of the imaging signal as dependent variable.

Agrammatic sentence production: is verb second impaired in Dutch?

This study investigates effects of verb movement in nine Dutch-speaking agrammatic aphasics. According to linguistic theory, in verb second languages such as Dutch and German, the verb remains in its clause-final base position in embedded clauses, whereas it moves to second position in main clauses. In recent linguistic accounts of agrammatic sentence production, it has been suggested that the production of sentences with moved verbs is relatively difficult. However, we argue that evidence provided by previous studies on this matter is inconclusive. An experiment is reported in which the production of both types of clauses is compared. No evidence is found that sentences with moved verbs are relatively difficult to produce. In fact, there was a tendency for the base order sentences to be harder. Implications of these findings for theories of normal and agrammatic sentence production are discussed.

A structural account of phonological paraphasias

The aim of this study is to develop a partial theory of phonological paraphasias which has some cross-syndrome and cross-linguistic validity. It is based on the distinction between content and structural units and emphasizes the role of the latter. The notion of structure holds the key to an understanding of the differences among the following three types of data: slips of the tongue, slips of the pen (defined as errors committed by healthy, competent adults), and paraphasias. A comparison of these three data types reveals that slips of the pen and paraphasias display striking similarities whereas slips of the tongue stand apart. This pattern emerges very clearly in an analysis of nine empirical effects all of which are found to be of a structural nature. On the basis of these results, it is argued that both the written output of normals and the oral output of aphasics are generated under a reduced structural representation (i.e., weak activation of structural nodes). However, the reasons for the diminished sensitivity to structure are not the same in the two modalities. While the impoverished structural representation is a likely consequence of the relatively slow production rate in writing, it may stem from an impaired transmission of activation among structural nodes in aphasia. By contrast, the normal speaking process occurs under the sway of a full-fledged structural representation. Hence, slips of the tongue are highly sensitive to structural effects.

Interpretation of pronouns in VP-ellipsis constructions in Dutch Broca's and Wernicke's aphasia

In this paper, we investigate the ability of Dutch agrammatic Broca's and Wernicke's aphasics to assign reference to possessive pronouns in elided VP constructions. The assumption is that the comprehension problems in these two populations have different sources that are revealed in distinct patterns of responses. The focus is primarily on the performance of the agrammatic group whose errors in comprehension are not viewed as a consequence of a breakdown of grammatical knowledge but as a result of limited processing resources (for an overview see Grodzinsky, 2000). The results of the present study provide evidence for the psycholinguistic reality of the economy hierarchy as proposed in the Primitives of Binding (Reuland, 2001). According to the economy hierarchy proposed for the non-brain-damaged, the more economical semantic dependencies are preferred over the costlier discourse dependencies. This hierarchy is reflected in agrammatic aphasia where the semantic dependencies are available on time and preferred over the discourse dependences that are not available on time as a result of the lack of processing resources with consequences for comprehension.

Broca's Area and Inflectional Morphology: Evidence from Broca's Aphasia and Computer Modeling

In a series of articles Ullman (2001, 2004; Ullman et al., 1997) has proposed that regular inflection is critically subserved by Broca's area. This suggestion is motivated by the finding that English speaking Broca's aphasics show selective deficits with regular inflection. Here we argue that this proposal does not hold cross-linguistically but is based on a confound between inflectional suffix and regularity that is specific to the English language. We present data from two experimental studies of participle inflection with 13 German and 12 Dutch Broca's aphasics. None of these aphasic speakers are selectively impaired for regular inflection but instead most of them show selective deficits with irregular inflection. These data suggest that a selective regular deficit is not a characteristic of Broca's aphasia across languages, and that Broca's area is not critically involved in regular inflection. To investigate the nature and localization of the processes underlying inflection we present a connectionist neural network model that accounts for the deficits of the German aphasic speakers. The model implements the view that the inflection of all verb types is based on a single mechanism with multiple representations that emerge from experience-dependent brain development. We show that global damage to this model results in a selective deficit for irregular inflection that is comparable to that of the German aphasic speakers. This finding suggests that a selective impairment of irregular participles as observed by German and Dutch aphasic speakers does not presuppose two distinctly localized mechanisms or processes that can be selectively affected by brain damage.

Overt sentence production in event-related fMRI

The use of syntactic structures on a sentence level is a unique human ability. Functional imaging studies have usually investigated syntax comprehension. However, language production may be performed by different neuronal resources. We have investigated syntax generation on a sentence level with functional magnetic resonance imaging (fMRI). BOLD contrast was measured while subjects articulated utterances aloud. In the active condition 'sentence generation' (SG), subjects had to produce subject verb object (SVO) sentences (e.g. "The child throws the ball") according to syntactically incomplete stimuli (e.g. "throw ball child") presented visually. In the control condition 'word reading' (WR), subjects had to read identical stimuli without completing the syntactic structure, while in a second control condition 'sentence reading' (SR), subjects had to read complete sentences. The semantic meaning of all expressions was obvious despite the syntactically incomplete structure in conditions SG and WR. In both contrasts, SG minus WR and SG minus SR, activation was mainly present in the left inferior frontal (BA 44/45) and medial frontal (BA 6) gyri, the superior parietal lobule (BA 7) and the right insula (BA 13). A region of interest analysis revealed significantly stronger left-dominant activation in BA 45 compared to BA 44. Our data illustrates the crucial involvement of the left BA 45 in syntactic encoding and is in line with more recent imaging and brain lesion data on syntax processing on a sentence level, emphasizing the involvement of a distributed left and right hemispheric network in syntax generation.

The cerebellum and English grammatical morphology: evidence from production, comprehension, and grammaticality judgments

Three neuropsychological experiments on a group of 16 cerebellar patients and 16 age- and education-matched controls investigated the effects of damage to the cerebellum on English grammatical morphology across production, comprehension, and grammaticality judgment tasks. In Experiment 1, participants described a series of pictures previously used in studies of cortical aphasic patients. The cerebellar patients did not differ significantly from the controls in the total number of words produced or in the proportion of closed-class words. They did differ to a marginally significant extent in the production of required articles. In Experiment 2, participants identified the agent in a series of aurally presented sentences in which three agency cues (subject-verb agreement, word order, and noun animacy) were manipulated. The cerebellar patients were less affected than the controls were by the manipulation of subject-verb agreement to a marginally significant extent. In Experiment 3, participants performed a grammaticality judgment task on a series of aurally presented sentences. The cerebellar patients were significantly less able to discriminate grammatical and ungrammatical sentences than the controls were, particularly when the error was of subject-verb agreement as opposed to word order. The results suggest that damage to the cerebellum can result in subtle impairments in the use of grammatical morphology, and are discussed in light of hypothesized roles for the cerebellum in language.

Language processing: functional organization and neuroanatomical basis

Earlier formulations of the relation of language and the brain provided oversimplified accounts of the nature of language disorders, classifying patients into syndromes characterized by the disruption of sensory or motor word representations or by the disruption of syntax or semantics. More recent neuropsychological findings, drawn mainly from case studies, provide evidence regarding the various levels of representations and processes involved in single-word and sentence processing. Lesion data and neuroimaging findings are converging to some extent in providing localization of these components of language processing, particularly at the single-word level. Much work remains to be done in developing precise theoretical accounts of sentence processing that can accommodate the observed patterns of breakdown. Such theoretical developments may provide a means of accommodating the seemingly contradictory findings regarding the neural organization of sentence processing.

Structural properties of syntactically reduced speech: a comparison of normal speakers and Broca's aphasics

We carried out a study in which we elicited spatial expressions from agrammatic and normal speakers by means of a picture description test. The purpose of our study was to investigate structural properties of Dutch agrammatic speech. We focussed on syntactic simplification phenomena that show up in addition to finiteness omission. We therefore invited the normal speakers to use sentences no longer than three or two words each and compared the picture descriptions of aphasic and normal speakers. In the picture descriptions two types of structures emerged that are relatively infrequent in free conversation: verbless predicative constructions with an adjectival head and intransitive prepositions as predicates. We have been able to show that the use of these construction types is directly related to syntactic reduction in both agrammatic and normal speech: it is present primarily in the speech of Broca's aphasics who produce one- and two-word utterances and of control speakers with a word limitation by instruction in the same range. The choice of reduced construction types is determined by the syntactic complexity of the phrases involved. A compensation strategy was observed both in control and aphasic speech: if utterances are shorter, the number of utterances increases.

Sensitivity to local sentence context information in lexical ambiguity resolution: evidence from left- and right-hemisphere-damaged individuals

Using a cross-modal semantic priming paradigm, the present study investigated the ability of left-hemisphere-damaged (LHD) nonfluent aphasic, right-hemisphere-damaged (RHD) and non-brain-damaged (NBD) control subjects to use local sentence context information to resolve lexically ambiguous words. Critical sentences were manipulated such that they were either unbiased, or biased toward one of two meanings of sentence-final equibiased ambiguous words. Sentence primes were presented auditorily, followed after a short (0 ms) or long (750 ms) interstimulus interval (ISI) by the presentation of a first- or second-meaning related visual target, on which subjects made a lexical decision. At the short ISI, neither patient group appeared to be influenced by context, in sharp contrast to the performance of the NBD control subjects. LHD nonfluent aphasic subjects activated both meanings of ambiguous words regardless of context, whereas RHD subjects activated only the first meaning in unbiased and second-meaning biased contexts. At the long ISI, LHD nonfluent aphasic subjects failed to show evidence of activation of either meaning, while RHD individuals activated first meanings in unbiased contexts and contextually appropriate meanings in second-meaning biased contexts. These findings suggest that both left (LH) and right hemisphere (RH) damage lead to deficits in using local contextual information to complete the process of ambiguity resolution. LH damage seems to spare initial access to word meanings, but initially impairs the ability to use context and results in a faster than normal decay of lexical activation. RH damage appears to initially disrupt access to context, resulting in an over-reliance on frequency in the activation of ambiguous word meanings.

Prearticulatory and postarticulatory self-monitoring in Broca's aphasia

The present study examined to what extent patients with Broca's aphasia and healthy controls rely upon prearticulatory and postarticulatory monitoring processes for detecting and repairing errors in speech production. Monitoring skills were investigated in a speaking situation with normal auditory feedback, a speaking situation with white noise, and a situation in which errors had to be detected in other-produced speech. The results demonstrated that the Broca's aphasics repaired a lower percentage of errors than the controls in the situation with normal auditory feedback, whereas their performance in the noise-masked condition was comparable. In contrast to the controls, the aphasics did not suffer from the presence of white noise. In addition, the proportion of covert repairs was higher for the Broca's aphasics than for the healthy controls. These findings indicate that Broca's aphasics concentrate primarily on prearticulatory monitoring. Possible explanations for this strong reliance on prearticulatory monitoring processes are discussed.

Does agrammatic speech constitute a regression to child language? A three-way comparison between agrammatic, child, and normal ellipsis

When children are in the process of learning their mother tongue, they show frequent use of nonfinite clauses, even though they produce finite clauses at the same time, thereby demonstrating the availability of the functional domain associated with finiteness. In this study the hypothesis was tested that this behavior results from an overuse of the normal elliptical repertoire that has also been observed in agrammatic aphasia. The purpose of this overuse is prevention of computational overload. In support of the hypothesis it was found that children behaved very similar to aphasics and normal adults with respect to the following parameters: (a) distribution of types of ellipsis, (b) elaboration of ellipses, (c) word order, (d) subject omission, (e) frequency of weak subject pronouns, and (f) verb type (eventivity). The results also support the Jackson/Jakobson regression hypothesis, at least at the grammatical level.

Controversies about CP: a comparison of language acquisition and language impairments in Broca's aphasia

In both language acquisition research and the study of language impairments in Broca's aphasia there is an ongoing debate whether or not phrase-structure representations contain the Complementizer Phrase (CP) layer. To shed some light on this debate, I will provide data on German child language and on German agrammatic Broca's aphasia. Analyses of subordinate clauses, wh-questions, and verb placement indicate that early child grammars do not generate the CP layer yet, whereas the ability to project the CP layer is retained in agrammatism.

Training agrammatic subjects on passive sentences: implications for syntactic deficit theories

We trained two subjects with chronic agrammatic aphasia on production of passive sentences using a computerized, iconic-based communication system. After training, one of the subjects demonstrated significant improvements in his abilities to comprehend and verbally produce English passive voiced sentences, including sentences with conjoined subjects and objects. These results suggest that agrammatism does not represent a fixed syntactic deficit.

Grammatical encoding in aphasia: evidence from a "processing prosthesis"

Agrammatic aphasia is characterized by severely reduced grammatical structure in spoken and written language, often accompanied by apparent insensitivity to grammatical structure in comprehension. Does agrammatism represent loss of linguistic competence or rather performance factors such as memory or resource limitations? A considerable body of evidence supports the latter hypothesis in the domain of comprehension. Here we present the first strong evidence for the performance hypothesis in the domain of production: an augmentative communication system that markedly increases the grammatical structure of agrammatic speech while providing no linguistic information, functioning merely to reduce on-line processing demands.

Agrammatic production of subject-verb agreement: the effect of conceptual number

Three experiments tested the hypothesis that the deficit underlying agrammatic sentence production difficulties can be characterized as a limitation of computational resources and that these resources are not restricted to syntactic processing. This hypothesis was tested by eliciting subject-verb agreement errors in a sentence fragment completion paradigm. Sentence fragments were complex noun phrases, containing a subject (head) noun and a modifying prepositional phrase, containing a "local" noun. We varied the number of "tokens" a singular head noun referred to. Therefore, in one condition, grammatical and conceptual number of the head noun mismatched, whereas these numbers were the same in another condition. In Experiments 1 and 2, we observed an effect of this variable (i.e., more agreement errors when conceptual number was plural and grammatical number singular) in normal controls. Broca's aphasics, on the other hand, showed no effect. Experiment 3 consisted of a sentence/picture matching test. This test showed that the lack of effect with Broca's aphasics cannot be attributed to a comprehension deficit. We argue that these results are incompatible with the notion of a limitation in resources specific for syntactic processing. Instead, we interpret this as the result of a trade-off: Broca's aphasics lack computational resources to take into account both grammatical and conceptual information in morphosyntactic processing and rely on grammatical information only.

Syntactic facilitation in agrammatic sentence production

Recently, proposals have been made to relate processing difficulties in aphasic language performance to limitations in resources for grammatical processing (Carpenter et al., 1994; Hagiwara, 1995; Kolk, 1995; Martin & Romani, 1994). Such proposals may account for a defining characteristic of agrammatic sentence production: reduced syntactic complexity. Syntactic structures that require deep hierarchical processing or reversals of canonical word order make demands exceeding limited resources. In the present study, we investigate the possibility of counteracting hypothesized resource limitations by increasing the availability of relatively complex sentences (i.e., datives and passives). The phenomenon of "syntactic priming" has been observed in a number of studies with healthy adults (e.g., Bock, 1986). With respect to Broca's aphasia, we hypothesized that increased availability of a syntactic structure, due to syntactic priming, results in a lesser demand on (limited) resources for sentence production. We elicited speech from 12 Broca's aphasics and 12 control subjects in three different conditions: spontaneous speech, picture description without priming, and picture description with priming. In addition, we varied instructions, in order to determine the role of strategies. The main findings were that (a) Brocas show stronger syntactic priming effects than controls; (b) the effects are automatic rather than strategic; and (c) in conditions with priming, Brocas produce relatively complex sentences (e.g., passives). We discuss these results in relation to capacity theories.

Determinants of sentence comprehension in aphasic patients in sentence-picture matching tasks

The results of two studies of sentence comprehension in aphasic patients using sentence-picture matching tests are presented. In the first study, 52 aphasic patients were tested on 10 sentence types. Analysis of the number of correct responses per sentence type showed effects of syntactic complexity and number of propositions. Factor analysis yielded first factors that accounted for two-thirds of the variance in performance to which all sentence types contributed. Clustering analysis yielded groups of patients whose performances progressively deteriorated and in which performance was more affected by sentence types that were harder for the group overall. These results were very similar to those previously obtained using an enactment task. In the second study, 17 aphasic patients were tested on the same 10 sentence types using both sentence-picture matching and enactment tasks. Correlational analyses showed that performance on the two tests was significantly correlated across both subjects and sentences. The results provide data relevant to the determinants of the complexity of a sentence in auditory comprehension.