An Experimental Approach to the Problem of Articulation in Aphasia

A Study of Word Complexity Under Conditions of Non-experimental, Natural Overt Speech Production Using ECoG

The linguistic complexity of words has largely been studied on the behavioral level and in experimental settings. Only little is known about the neural processes underlying it in uninstructed, spontaneous conversations. We built up a multimodal neurolinguistic corpus composed of synchronized audio, video, and electrocorticographic (ECoG) recordings from the fronto-temporo-parietal cortex to address this phenomenon based on uninstructed, spontaneous speech production. We performed extensive linguistic annotations of the language material and calculated word complexity using several numeric parameters. We orthogonalized the parameters with the help of a linear regression model. Then, we correlated the spectral components of neural activity with the individual linguistic parameters and with the residuals of the linear regression model, and compared the results. The proportional relation between the number of consonants and vowels, which was the most informative parameter with regard to the neural representation of word complexity, showed effects in two areas: the frontal one was at the junction of the premotor cortex, the prefrontal cortex, and Brodmann area 44. The postcentral one lay directly above the lateral sulcus and comprised the ventral central sulcus, the parietal operculum and the adjacent inferior parietal cortex. Beyond the physiological findings summarized here, our methods may be useful for those interested in ways of studying neural effects related to natural language production and in surmounting the intrinsic problem of collinearity between multiple features of spontaneously spoken material.

A Multivariate Analytic Approach to the Differential Diagnosis of Apraxia of Speech

Purpose

Apraxia of speech (AOS) is a consequence of stroke that frequently co-occurs with aphasia. Its study is limited by difficulties with its perceptual evaluation and dissociation from co-occurring impairments. This study examined the classification accuracy of several acoustic measures for the differential diagnosis of AOS in a sample of stroke survivors.

Method

Fifty-seven individuals were included (mean age = 60.8 ± 10.4 years; 21 women, 36 men; mean months poststroke = 54.7 ± 46). Participants were grouped on the basis of speech/language testing as follows: AOS-Aphasia (n = 20), Aphasia Only (n = 24), and Stroke Control (n = 13). Normalized Pairwise Variability Index, proportion of distortion errors, voice onset time variability, and amplitude envelope modulation spectrum variables were obtained from connected speech samples. Measures were analyzed for group differences and entered into a linear discriminant analysis to predict diagnostic classification.

Results

Out-of-sample classification accuracy of all measures was over 90%. The envelope modulation spectrum variables had the greatest impact on classification when all measures were analyzed together.

Conclusions

This study contributes to efforts to identify objective acoustic measures that can facilitate the differential diagnosis of AOS. Results suggest that further study of these measures is warranted to determine the best predictors of AOS diagnosis.

Supplemental Materials

https://doi.org/10.23641/asha.5611309.

Recovering With Acquired Apraxia of Speech: The First 2 Years

PURPOSE

This study was intended to document speech recovery for 1 person with acquired apraxia of speech quantitatively and on the basis of her lived experience.

METHOD

The second author sustained a traumatic brain injury that resulted in acquired apraxia of speech. Over a 2-year period, she documented her recovery through 22 video-recorded monologues. We analyzed these monologues using a combination of auditory perceptual, acoustic, and qualitative methods.

RESULTS

Recovery was evident for all quantitative variables examined. For speech sound production, the recovery was most prominent during the first 3 months, but slower improvement was evident for many months. Measures of speaking rate, fluency, and prosody changed more gradually throughout the entire period. A qualitative analysis of topics addressed in the monologues was consistent with the quantitative speech recovery and indicated a subjective dynamic relationship between accuracy and rate, an observation that several factors made speech sound production variable, and a persisting need for cognitive effort while speaking.

CONCLUSIONS

Speech features improved over an extended time, but the recovery trajectories differed, indicating dynamic reorganization of the underlying speech production system. The relationship among speech dimensions should be examined in other cases and in population samples. The combination of quantitative and qualitative analysis methods offers advantages for understanding clinically relevant aspects of recovery.

How much is a word? Predicting ease of articulation planning from apraxic speech error patterns

BACKGROUND

According to intuitive concepts, 'ease of articulation' is influenced by factors like word length or the presence of consonant clusters in an utterance. Imaging studies of speech motor control use these factors to systematically tax the speech motor system. Evidence from apraxia of speech, a disorder supposed to result from speech motor planning impairment after lesions to speech motor centers in the left hemisphere, supports the relevance of these and other factors in disordered speech planning and the genesis of apraxic speech errors. Yet, there is no unified account of the structural properties rendering a word easy or difficult to pronounce.

AIM

To model the motor planning demands of word articulation by a nonlinear regression model trained to predict the likelihood of accurate word production in apraxia of speech.

METHOD

We used a tree-structure model in which vocal tract gestures are embedded in hierarchically nested prosodic domains to derive a recursive set of terms for the computation of the likelihood of accurate word production. The model was trained with accuracy data from a set of 136 words averaged over 66 samples from apraxic speakers. In a second step, the model coefficients were used to predict a test dataset of accuracy values for 96 new words, averaged over 120 samples produced by a different group of apraxic speakers.

RESULTS

Accurate modeling of the first dataset was achieved in the training study (R(2)adj = .71). In the cross-validation, the test dataset was predicted with a high accuracy as well (R(2)adj = .67). The model shape, as reflected by the coefficient estimates, was consistent with current phonetic theories and with clinical evidence. In accordance with phonetic and psycholinguistic work, a strong influence of word stress on articulation errors was found.

CONCLUSIONS

The proposed model provides a unified and transparent account of the motor planning requirements of word articulation.

What happens to the motor theory of perception when the motor system is damaged?

Motor theories of perception posit that motor information is necessary for successful recognition of actions. Perhaps the most well known of this class of proposals is the motor theory of speech perception, which argues that speech recognition is fundamentally a process of identifying the articulatory gestures (i.e. motor representations) that were used to produce the speech signal. Here we review neuropsychological evidence from patients with damage to the motor system, in the context of motor theories of perception applied to both manual actions and speech. Motor theories of perception predict that patients with motor impairments will have impairments for action recognition. Contrary to that prediction, the available neuropsychological evidence indicates that recognition can be spared despite profound impairments to production. These data falsify strong forms of the motor theory of perception, and frame new questions about the dynamical interactions that govern how information is exchanged between input and output systems.

Error variability and the differentiation between apraxia of speech and aphasia with phonemic paraphasia

PURPOSE

This study was conducted to evaluate the clinical utility of error variability for differentiating between apraxia of speech (AOS) and aphasia with phonemic paraphasia.

METHOD

Participants were 32 individuals with aphasia after left cerebral injury. Diagnostic groups were formed on the basis of operationalized measures of recognized articulatory and prosodic characteristics of AOS and phonemic paraphasia. Sequential repetitions of multisyllabic words were elicited as part of a motor speech evaluation and transcribed phonetically. Four metrics of variability at the syllable and word levels were derived from these transcripts.

RESULTS

The measures yielded different magnitudes of variability. There were no group differences between participants who displayed speech profiles consistent with AOS and participants who displayed speech profiles indicative of aphasia with phonemic paraphasia. Rather, correlation coefficients and analyses of covariance showed that the variability metrics were significantly mediated by overall error rate. Additionally, variability scores for individuals with salient diagnoses of AOS and conduction aphasia were inconsistent with current diagnostic guidelines.

CONCLUSIONS

The results do not support diagnostic validity of error variability for differentiating between AOS and aphasia with phonemic paraphasia. Future research using error variability metrics should account for overall error rate in the analysis and matching of participant groups.

Testing the limits of language production in long-term survivors of major stroke: A psycholinguistic and anatomic study

BACKGROUND: There is still a dearth of information about grammatical aspects of language production in aphasia. AIMS: Making novel use of methods of elicited production aimed at testing the limits of competence, we studied three cases of chronic aphasia, stemming from major stroke. We asked: (1) Whether the elicited production method reveals sparing of language abilities not readily evidenced in spontaneous utterances or on conventional aphasia tests. (2) Which language production abilities survive damage to both Broca's region and Wernicke's region? MATERIALS & PROCEDURES: Targeted words, morphological and syntactic structures were elicited by sentence completion with supporting linguistic and visual context. Targets were never modelled during the procedure. For verbs, visual and auditory contexts emphasise completed actions, targeting past tense forms. Lesion description was based on structural MRI scans. OUTCOMES & RESULTS: The three participants showed partially spared ability to produce nouns, adjectives, and verb stems in context. The elicitation method proved more productive in some cases than picture prompts or sentence prompts. Past tense inflections were usually omitted. Hence stems and inflections were dissociable. Two participants showed partial success with the passive, and no participant produced a full relative clause, including the relative pronoun, but two produced reduced forms of subject relatives. Partial sparing of production capability in these cases points to the likely importance of portions of the left hemisphere remote from Broca and Wernicke regions. CONCLUSIONS: This application of elicited production methodology demonstrates possibilities of lexical, morphological, and syntactic production not evident in spontaneous utterances or by conventional aphasia tests. Some lexical and grammatical capabilities survived massive damage to both anterior and posterior portions of the left hemisphere.

Clinical–anatomical correlation in a selective phonemic speech production impairment

Although phonemic paraphasias are common in aphasic disorders, including Broca's aphasia, conduction aphasia and transcortical motor aphasia, selective phonemic speech production impairment, or phonemic disintegration, is unusual. A patient with a selective phonemic speech production disorder underwent clinical, neuropsychological and structural neuroradiological assessment over a period of 6 years. The disorder was characterised by phonemic paraphasias (phonemic disintegration) with preserved comprehension and naming. Imaging showed a focal lesion in the white matter of the left precentral gyrus and, to a lesser extent, the posterior part of the left middle frontal gyrus, with overlying cortical atrophy. Biopsy of the lesion, after several years of observation, showed a calcified haemangioma. Clinical-anatomical correlation in this case suggests the importance of primary motor cortex of the inferior precentral (pre-Rolandic) gyrus and subjacent white matter in phoneme production, with sparing of the posterior inferior frontal gyrus (Broca's area).

Phonology: a review and proposals from a connectionist perspective

A parallel distributed processing (PDP) model of phonological processing is developed, including components to support repetition, auditory processing, comprehension, and language production. From the performance of the PDP reading model of Plaut, McClelland, Seidenberg, and Patterson (1996), it is inferred that the acoustic-articulatory motor pattern associator that supports repetition provides the basis for phonological sequence knowledge. From the observation that many patients make phonemic paraphasic errors in language production, as in repetition, it is argued that there must be a direct link between distributed concept representations (lexical semantic knowledge) and this network representation of sequence knowledge. In this way, both lexical semantic and phonotactic constraints are brought to bear on language production. The literature on phonological function in normal subjects (slip-of-the-tongue corpora) and in patients with aphasia is critically reviewed from this perspective. The relationship between acoustic and articulatory motor representations in the process of phonetic perception is considered. Repetition and reproduction conduction aphasia are reviewed in detail and extended consideration is given to the representation of auditory verbal short-term memory in the model. Finally, the PDP model is reconciled with information processing models of phonological processing, including that of Lichtheim, and with current knowledge of the anatomic localization of phonological processing. Although no simulations of the model were run, a number of simulation studies are proposed.

Voice onset time in ataxic dysarthria

In eight patients with a purely ataxic syndrome due to cerebellar atrophy the voice onset time (VOT) of word-initial stop consonants was measured at the acoustic signal. The subjects had been asked to produce sentence utterances including either one of the German minimal pair cognates "Daten" (/daten/, "data") and "Taten" (/taten/, "deeds"). In addition, a master tape comprising the target words from patients and controls in randomized order was played to six listeners for perceptual evaluation. Two major findings emerged. First, the cerebellar subjects presented with a reduced categorical distinction of the VOT of voiced and unvoiced stop consonants. Second, the patients' target words with initial unvoiced plosive gave rise to a significantly increased number of misassignments at perceptual evaluation. To some extent comparable VOT disruptions have been noted in apraxia of speech and basal ganglia disorders. Thus, different pathomechanisms might result in similar VOT abnormalities.

A new brain region for coordinating speech articulation

Human speech requires complex planning and coordination of mouth and tongue movements. Certain types of brain injury can lead to a condition known as apraxia of speech, in which patients are impaired in their ability to coordinate speech movements but their ability to perceive speech sounds, including their own errors, is unaffected. The brain regions involved in coordinating speech, however, remain largely unknown. In this study, brain lesions of 25 stroke patients with a disorder in the motor planning of articulatory movements were compared with lesions of 19 patients without such deficits. A robust double dissociation was found between these two groups. All patients with articulatory planning deficits had lesions that included a discrete region of the left precentral gyrus of the insula, a cortical area beneath the frontal and temporal lobes. This area was completely spared in all patients without these articulation deficits. Thus this area seems to be specialized for the motor planning of speech.

Anterior opercular cortex lesions cause dissociated lower cranial nerve palsies and anarthria but no aphasia: Foix-Chavany-Marie syndrome and "automatic voluntary dissociation" revisited

Anarthria and bilateral central facio-linguovelo-pharyngeo-masticatory paralysis with "automatic voluntary dissociation" are the clinical hallmarks of Foix-Chavany-Marie syndrome (FCMS), the corticosubcortial type of suprabulbar palsy. A literature review of 62 FCMS reports allowed the differentiation of five clinical types of FCMS: (a) the classical and most common form associated with cerebrovascular disease, (b) a subacute form caused by central nervous system infections, (c) a developmental form probably most often related to neuronal migration disorders, (d) a reversible form in children with epilepsy, and (e) a rare type associated with neurodegenerative disorders. Bilateral opercular lesions were confirmed in 31 of 41 patients who had CT or MRI performed, and by necropsy in 7 of 10 patients. FCMS could be attributed to unilateral lesions in 2 patients. The typical presentation and differential diagnosis of FCMS provide important clues to lesion localization in clinical neurology. FCMS is a paretic and not an apraxic disorder and is not characterized by language disturbances. Its clinical features prove divergent corticobulbar pathways for voluntary and automatic motor control of craniofacial muscles. Precise clinico-neuroradiological correlations should facilitate the identification of the structural substrate of "automatic voluntary dissociation" in FCMS.

Perceptual characteristics of consonant production by apraxic speakers

Single-word repetitions by 4 brain-damaged adults with apraxia of speech (AOS) but without concomitant aphasia were transcribed using a standard narrow phonetic transcription system. Analysis of consonant productions yielded a profile of AOS slightly different from the traditionally accepted one. Among the results was the atypical finding that consonant distortions exceeded all other error types including sound substitutions. In addition, errors predominated in the medial position of words, and monosyllabic words had approximately the same error rate per number of consonants as did multisyllabic words. Results are discussed with reference to previous perceptual descriptions of AOS and in relationship to Broca's aphasia. Results are also interpreted relative to linguistic and motoric components of speech production models.

Long-term effects of focal, cortical injuries upon articulation and discrimination performance

Residual, long-term effects of cortical injuries upon speech production are rarely examined. In this study, we examined the articulation and discrimination abilities in twelve subjects who received focal, cortical injuries in Vietnam during 1968-1971. The subjects were divided into two groups based upon the hemisphere (right or left) of lesion. Data revealed the left-hemisphere injured group produced a greater number of articulation and discrimination errors than the right-hemisphere injured group. Articulation errors occurred more often than discrimination errors in both groups. However, a feature analysis revealed the left-hemisphere injured group made predominantly combination errors and the right-hemisphere injured group made predominantly place errors. Taken overall, the data suggest the left-hemisphere injured group may experience residual difficulties with the encoding of phonological units while the right-hemisphere injured group appears to have residual problems that may be related to the spatial correlates of speech.

On categorizing aphasic speech errors

Acoustic studies of voice-onset-time in aphasics' speech suggest that fluent aphasics' errors are misselected phonemic targets whereas nonfluent aphasics' errors are of articulatory origin. However, we must be cautious when extrapolating a theory from only one measure of articulation. In this experiment, I examined utterances produced by five fluent aphasics, five nonfluent aphasics and two controls. First, the voice-onset-time findings were replicated. Second, I examined the duration of vowels preceding word-final stop consonants as an index of the consonant's voicing category. The pattern of voice-onset-times produced did not predict the pattern of vowel durations. Thus, voice-onset-time cannot be used to characterize more generally the output of the speaker.

Speech sound errors in patients with conduction and Broca's aphasia

Speech sound errors exhibited by three conduction and three Broca's aphasic patients on naming and word-repetition tasks were subjected to phonemic and subphonemic analyses. In the conduction aphasic patients, errors occurred equally often on consonants and vowels in both the naming and word-repetition tasks, while in the Broca's aphasic patients errors occurred selectively on consonants. Transposition errors occurred almost as often as substitution errors in the conduction aphasic patients, while substitution errors constituted the majority of errors in the Broca's aphasic patients. The Broca's aphasic patients, as compared to the conduction aphasic patients, exhibited a markedly higher number of substitution errors occurring between phonemes separated by a single subphonemic feature on the naming task. On the basis of these findings, it was hypothesized that the differences in the error patterns of the two types of aphasia reflected differences in the underlying mechanisms of the impairment in each type.

Voice onset time production and perception in apraxic subjects

This study explored the relationship between the perception and production of voice onset time (VOT) in apraxic subjects. Spectrograms of the words, "bees" and "peas" spoken by apraxic subjects were acoustically analyzed to obtain a measure of VOT. The subjects also identified the initial cognate ("b" or "p") from synthetically generated speech spanning a voiced to voiceless time continuum. The results suggest that apraxic subjects have production as well as perceptual errors in the voicing feature but no significant relationship was found between the two measures.

Phonetic disintegration in aphasia: acoustic analysis of spectral characteristics for place of articulation

In this study, we attempted to determine whether phonetic disintegration of speech in Broca's aphasia affects the spectral characteristics of speech sounds as has been shown for the temporal characteristics of speech. To this end, we investigated the production of place of articulation in Broca's aphasics. Acoustic analysis of the spectral characteristics for stop consonants were conducted. Results indicated that the static aspects of speech production were preserved, as Broca's aphasics seemed to be able to reach the articulatory configuration for the appropriate place of articulation. However, the dynamic aspects of speech production seemed to be impaired, as their productions reflected problems with the source characteristics of speech sounds and with the integration of articulatory movements in the vocal tract. Listener perceptions of the aphasics' productions were compared with acoustic analyses for these same productions. The two measures were related; that is, the spectral characteristics of the utterances provided salient cues for place of articulation perception. An analysis of the occurrences of errors along the dimensions of voicing and place showed that aphasics rarely produce utterances containing both voice and place substitutions.

Linguistic Universals: Implications of a Neurological Reappraisal of Jakobson's Phonological Hierarchy

An ongoing research project designed to test Jakobson's claim of a universal rank order among the elements of phonological systems is described and illustrated. The strategy is that of close analysis, on surface, feature and neuromuscular levels successively, of phonetically deviant L2 performance data. While the first two analytical stages tend to corroborate the existence of widely valid cross-language constraints, the third yields evidence for an explanatory hypothesis in terms of the properties of participant neuromuscular mechanisms. It is argued that this ‘physiological hypothesis’ is superior to rival ‘nativist’ postulates in placing Jakobson's hierarchy on a firm ontological footing.

Oral form identification as a measure of cortical sensory dysfunction in apraxia of speech and aphasia

Oral form identification scores were obtained for nine anterior and nine posterior left-hemisphere brain lesion subjects exhibiting speech apraxic behavior and aphasia. An objective measure of speech apraxic difficulty and a standardized aphasia assessment were obtained for each subject. Despite the traditional association of a cortical sensory deficit including asterognosis in posterior brain-injured patients, oral form identification scores did not differ significantly for the two subject groups. However, a previously reported heterogeneity of performance was observed in the present data. The oral form identification deficit was unrelated to the severity of apraxia but exhibited its highest correlation value with a task of linguistic symbol discrimination. Results were interpreted to suggest that oral form identification deficits are most probably not causally related to motor speech programming problems nor should such deficits in this population be viewed as a valid indicator of cortical sensory dysfunction.

The effect of auditory rhythmic stimulation on articulatory accuracy in apraxia of speech

In order to study the effects of different rates of rhythmic auditory stimulation on the phonemic accuracy of speakers who have apraxia of speech, eight apraxic subjects read four equated monosyllabic passages under one control and three experimental conditions. In the experimental conditions, rhythmic auditory stimulation provided by a metronome was imposed at each subject's oral reading rate as well as 75% and 125% of this established rate. In the control condition, the subjects read without any accompanying rhythmic stimulation. It was found that the stimulus supplied by an auditory metronome did not significantly improve the phonemic accuracy of these subjects. Articulatory accuracy tended to deteriorate under imposed rhythmic stimulation.

Linguistic and articulatory aspects of single word production in apraxia of speech

The errors of ten apraxic speakers on a single word task were analyzed to determine the effects of articulatory and linguistic variables on speech production. Results suggested that phoneme difficulty but not phoneme position or grammatical class significantly affected the errors of the subjects. A significant low positive correlation between mean word abstraction and the errors of the apraxic speakers was observed although correlations for the grammatical classes decreased with increases in abstraction. These findings were interpreted to suggest that impaired motor speech programming may be affected by linguistic and articulatory variables.

Phonemic behavior of aphasic subjects without dysarthria or apraxia of speech

Thirty adult aphasic subjects without apraxia of speech or dysarthria were tested for their ability to produce phonemes in single test words and in spontaneous contextual speech. Results indicated that 75% of the total phonemic errors were due to a whole-word phenomenon apparently associated with faulty processing of the word rather than faulty production of the phoneme. True phonemic errors comprised 25% of the total errors or about 2% of all responses. Phoneme substitutions were by far the most frequent error (61%). Of the 30 subjects, 28 made no phonemic errors in spontaneous contextual speech. Aphasic behavior is not characterized by significant breakdown of articulatory performance. Observed patterns of error do not clearly support a phonemic regression hypothesis.

Oral-movement abilities and articulatory characteristics of brain-injured adults

We compared the performance of 28 brain-injured adults who displayed articulation problems with that of 28 adults with no history of brain-injury on tests of isolated oral movement and oral-motor sequencing. An attempt was made to classify the brain-injured patients by administering an articulation test and employing three criteria for differentiating apraxia of speech from dysarthria: presence of initiation errors, more substitution errors than combined omission and distortion errors, and the presence of islands of error-free production. While the brain-injured group performed significantly worse on the isolated oral-movement and oral-motor sequencing tests than the normal adults, not all brain-injured patients demonstrated difficulty on these tasks. We were able to identify 13 patients who met all three criteria (apraxia of speech), 3 who met none (dysarthria), and 12 who met one or two but not all (mixed apraxia of speech and dysarthria). Isolated oral-movement and oral-motor sequencing deficits were found in all three groups, but no significant differences among groups on these tasks were observed.