Phonology: a review and proposals from a connectionist perspective

The Resilience of the Phonological Network May Have Implications for Developmental and Acquired Disorders

A central tenet of network science states that the structure of the network influences processing. In this study of a phonological network of English words we asked: how does damage alter the network structure (Study 1)? How does the damaged structure influence lexical processing (Study 2)? How does the structure of the intact network "protect" processing with a less efficient algorithm (Study 3)? In Study 1, connections in the network were randomly removed to increasingly damage the network. Various measures showed the network remained well-connected (i.e., it is resilient to damage) until ~90% of the connections were removed. In Study 2, computer simulations examined the retrieval of a set of words. The performance of the model was positively correlated with naming accuracy by people with aphasia (PWA) on the Philadelphia Naming Test (PNT) across four types of aphasia. In Study 3, we demonstrated another way to model developmental or acquired disorders by manipulating how efficiently activation spread through the network. We found that the structure of the network "protects" word retrieval despite decreases in processing efficiency; words that are relatively easy to retrieve with efficient transmission of priming remain relatively easy to retrieve with less efficient transmission of priming. Cognitive network science and computer simulations may provide insight to a wide range of speech, language, hearing, and cognitive disorders.

Targeted neurorehabilitation strategies in post-stroke aphasia

BACKGROUND

Aphasia is a debilitating language impairment, affecting millions of people worldwide. About 40% of stroke survivors develop chronic aphasia, resulting in life-long disability.

OBJECTIVE

This review examines extrinsic and intrinsic neuromodulation techniques, aimed at enhancing the effects of speech and language therapies in stroke survivors with aphasia.

METHODS

We discuss the available evidence supporting the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation, and functional MRI (fMRI) real-time neurofeedback in aphasia rehabilitation.

RESULTS

This review systematically evaluates studies focusing on efficacy and implementation of specialized methods for post-treatment outcome optimization and transfer to functional skills. It considers stimulation target determination and various targeting approaches. The translation of neuromodulation interventions to clinical practice is explored, emphasizing generalization and functional communication. The review also covers real-time fMRI neurofeedback, discussing current evidence for efficacy and essential implementation parameters. Finally, we address future directions for neuromodulation research in aphasia.

CONCLUSIONS

This comprehensive review aims to serve as a resource for a broad audience of researchers and clinicians interested in incorporating neuromodulation for advancing aphasia care.

Distinguishing semantic control and phonological control and their role in aphasic deficits: A task switching investigation

People use cognitive control across many contexts in daily life, yet it remains unclear how cognitive control is used in contexts involving language. Distinguishing language-specific cognitive control components may be critical to understanding aphasia, which can co-occur with cognitive control deficits. For example, deficits in control of semantic representations (i.e., semantic control), are thought to contribute to semantic deficits in aphasia. Conversely, little is known about control of phonological representations (i.e., phonological control) in aphasia. We developed a switching task to investigate semantic and phonological control in 32 left hemisphere stroke survivors with aphasia and 37 matched controls. We found that phonological and semantic control were related, but dissociate in the presence of switching demands. People with aphasia exhibited group-wise impairment at phonological control, although individual impairments were subtle except in one case. Several individuals with aphasia exhibited frank semantic control impairments, and these individuals had relative deficits on other semantic tasks. The present findings distinguish semantic control from phonological control, and confirm that semantic control impairments contribute to semantic deficits in aphasia.

Behavioral interventions for poststroke aphasia

There is a long history of behavioral interventions for poststroke aphasia with hundreds of studies supporting the benefits of aphasia treatment. However, interventions for aphasia are complex with many interacting components, and no one treatment is appropriate for all persons with aphasia. We present a novel, simple framework for classifying aphasia interventions. The framework is incorporated within the overarching International Classification of Functioning, Disability, and Health (ICF) model and is consistent with the commonly-held definition that aphasia is a multimodality disorder that impairs, in varying degrees, the understanding and expression of both oral and written language modalities. Furthermore, within the language impairment level, it distinguishes between the linguistic areas of phonology, semantics, and syntax that may be impaired individually or in combination. We define the terminology of the proposed framework and then categorize some common examples of behavioral interventions for post-stroke aphasia. We describe some of these interventions in greater detail to illustrate the extensive toolbox of evidence-based treatments for aphasia. We address some key issues that clinicians, usually speech-language pathologists, consider when selecting interventions for their specific patients with aphasia, including dose. Finally, we address various models of service delivery for persons with aphasia such as Intensive Comprehensive Aphasia Programs (ICAPs) and Aphasia Centers.

Repetition Priming in Treatment of Anomia

PURPOSE

Repetition priming has been suggested as a method for targeting implicit processes in anomia treatment. Prior studies have used masked priming for this purpose. This study extends that work with visible primes, a more clinically feasible approach.

METHOD

This study used a single-subject design across three participants with aphasia. Treatment involved repeated exposure to identity primes (trained condition) or sham primes (untrained condition) paired with pictures. Analyses assessed acquisition effects for trained items and untrained items that were seen during the training period, generalization to untrained items that had not been seen, and generalization to broader language skills, immediately and 3 months post-treatment.

RESULTS

All participants improved in naming trained items immediately after treatment, with greater improvements for trained than for untrained items. All participants maintained some degree of improvement on trained items 3 months post-treatment, although the degree differed across participants. Inconsistent generalization occurred to unexposed items. Improvements were noted in some areas of broader language ability, although these varied.

CONCLUSIONS

These data suggest a repetition priming treatment paradigm may increase naming accuracy for individuals with anomia and may benefit other aspects of language. Participant factors may have influenced response to treatment. Directions for future investigation are discussed.

Jargonaphasia as a disconnection syndrome: A study combining white matter electrical stimulation and disconnectome mapping

BACKGROUND

In jargonaphasia, speech is fluent but meaningless. While neuropsychological evaluation may distinguish a neologistic component characterised by non-word production and a semantic component where pronounced words are real but speech is senseless, how this relates to the underlying white matter anatomy is debated.

OBJECTIVE

To identify white matter pathways causally involved in jargonaphasia.

METHODS

We retrospectively screened the intraoperative brain mapping data of 571 awake oncological resections using direct cortico-subcortical electrostimulation. Jargonaphasia was induced in 17 patients (19 sites) during a naming task. Stimulation sites were normalized to the Montreal Neurological Institute template space and used to generate individual disconnectome maps. Non-parametric voxelwise one and two sample t-tests were performed to identify the underlying white matter anatomy.

RESULTS

Jargonaphasia was induced only during stimulation of the left hemisphere. No cortical stimulation generated jargonaphasia. Subcortical sites causally associated with jargonaphasia clustered in 3 regions: in the temporal lobe (middle to inferior temporal gyri; n = 12), in the parietal lobe (supramarginal gyrus; n = 3) and in the temporal stem (n = 4). Disconnectome analysis indicated the inferior-fronto-occipital fasciculus (IFOF) was damaged in both neologistic and semantic jargonaphasia, while the involvement of the arcuate fasciculus was specific to neologistic jargonaphasia.

CONCLUSION

For the first time, we show that jargonaphasia is induced by white matter stimulation, hinting at disconnection. As IFOF disconnection unites both variants, these may represent a continuum of disorders distinguished by semantic impairment. Conversely, damage to the arcuate fasciculus in addition to the IFOF is specific to neologistic jargonaphasia, thus suggesting a dual-disconnection syndrome.

The role and use of event-related potentials in aphasia: A scoping review

Event-related potentials (ERPs) can provide important insights into underlying language processes in both unimpaired and neurologically impaired populations and may be particularly useful in aphasia. This scoping review was conducted to provide a comprehensive summary of how ERPs have been used with people with aphasia (PWA), with the goal of exploring the potential clinical application of ERPs in aphasia assessment and treatment. We identified 117 studies that met inclusionary criteria, reflecting six thematic domains of inquiry that relate to understanding both unimpaired and aphasic language processing and the use of ERPs with PWA. In these studies, a wide variety of ERP components were reported. Inconsistencies in reporting of participant characteristics and study protocols limit our ability to generalize beyond the individual studies and understand implications for clinical applicability. We discuss the potential roles of ERPs in aphasia management and make recommendations for further developing ERPs for clinical utility in PWA.

Effects of Verb Network Strengthening Treatment on Sound-Level and Speech Production Errors in Individuals With Aphasia and Acquired Apraxia of Speech

Purpose This retrospective pilot study investigated whether sound-level and speech production errors decreased in confrontation naming following Verb Network Strengthening Treatment (VNeST) for four participants with acquired apraxia of speech (A-AOS) and aphasia for whom lexical retrieval was previously reported. Specifically, we investigated a potential increase in correct number of syllables per word and posttreatment changes across three domains of speech: segmental production, fluency, and prosody. It was hypothesized that treatment shown to increase lexical retrieval in persons with aphasia and A-AOS could potentially facilitate a reduction in sound-level and speech production errors consistent with dual diagnoses of A-AOS and aphasia. Method Naming responses from four participants with aphasia and A-AOS who previously participated in VNeST studies were investigated for correct number of syllables per word and measures of segmental speech, fluency, and prosody. Results Significant gains in at least one measure of speech production were reported for three of the participants. One participant demonstrated decreased segmental speech errors, two showed significant reduction on syllable segmentation, and two demonstrated a significant reduction on false starts and pauses. Significant gains in production of correct number of syllables were limited to one participant, and one participant did not demonstrate increased accuracy on any measure of speech production. Conclusions While speech production errors consistent with motor speech impairment cannot always be definitively distinguished from the confound of aphasia, two participants produced significantly decreased segmentation of syllables, a characteristic unique to A-AOS. The sound-level and speech production changes recorded may be attributed to a combination of interacting motor and language processes and resource allocation. In addition, specific components of VNeST may have contributed to speech production changes. Future work will focus on a prospective study of effects of language therapy (e.g., VNeST) on measures of speech production with investigation beyond the single-word level.

Effects of Phonomotor Therapy and Semantic Feature Analysis on Discourse Production

Background Anomia treatments typically focus on single word retrieval, although the ultimate goal of treatment is to improve functional communication at the level of discourse in daily situations. Aims The focus of this study was to investigate the impact of two effective anomia treatments on discourse production as measured by a story retell task. Method and Procedure Fifty-seven people with aphasia were randomized to receive either a phoneme-based treatment, Phonomotor Therapy (PMT; 28 participants), or a lexical-semantic treatment, Semantic Feature Analysis (SFA; 29 participants). Groups were matched for age, aphasia severity, education, and years post onset. All received 56-60 hr of treatment in a massed treatment schedule. Therapy was delivered for a total of 8-10 hr/week over the course of 6-7 weeks. All participants completed testing 1 week prior to treatment (A1), immediately following treatment (A2), and again 3 months later (A3). Discourse was analyzed through the percentage of correct information units at each time point. Outcomes and Results Both groups showed nonsignificant improvements from pretreatment to immediately posttreatment. The PMT group showed significant improvement 3 months posttreatment, while the SFA group returned to near-baseline levels. Conclusion These results add to our understanding of the effects of both PMT and SFA. Future research should address understanding variability in discourse outcomes across studies and the effects of aphasia severity and individual participant and treatment factors on treatment outcomes for both of these approaches.

Identifying Verbal Short-Term Memory and Working Memory Impairments in Individuals With Latent Aphasia

Purpose This study was undertaken to explore whether measures of verbal short-term memory and working memory are sensitive to impairments in people with latent aphasia, who score within normal limits on typical aphasia test batteries. Method Seven individuals with latent aphasia and 24 neurotypical control participants completed 40 tasks from the Temple Assessment of Language and Short-term Memory in Aphasia (TALSA) that assess various aspects of verbal short-term memory, working memory, and language processing. Subtests were identified that differentiated between the two groups of participants. Results Twenty-one TALSA tasks were identified on which the participants with latent aphasia had significantly different performance than the typical control participants. All of these subtests engaged verbal short-term memory, and some involved working memory as well. Furthermore, the TALSA detected individual differences in linguistic profiles among participants with latent aphasia. Conclusions People with latent aphasia may be identified by tests that tap verbal short-term memory and working memory. In addition, the TALSA was found to be sensitive to the heterogeneity of this population. Further development of these measures will improve identification and treatment of this challenging population.

The Challenge of Achieving Greater Generalization in Phonological Treatment of Aphasia

BACKGROUND

Stimulus selection is important to anomia treatment because similarity between trained and untrained words in the mental lexicon may influence treatment generalization. We focused on phonological similarity between trained and untrained words from a clinical trial of Phonomotor Treatment (PMT) that showed gains in confrontation naming accuracy of untrained words post-treatment. One way to capture the amount of similarity between the trained and untrained words is to consider the phonological network path distance between words. We posited that the distance between trained and untrained words in a phonological network could account for the improvement in confrontation naming accuracy post-treatment.

AIM

To define the phonological network distance between trained and untrained words that influences change in confrontation naming accuracy post-treatment.

METHODS AND PROCEDURES

We retrospectively analyzed data from 28 people with aphasia who received PMT as part of a clinical trial. Participants completed confrontation naming (baseline, post-treatment, and 3-months post-treatment) of words varying in phonological distance to the treatment stimuli. We used a phonological network to calculate the average shortest path length (ASPL), defined by number of phoneme differences, between an untrained word and all trained words. We used mixed effects regression models to predict change in confrontation naming accuracy of untrained words post-treatment from ASPL. Several post-hoc analyses were also conducted.

OUTCOMES AND RESULTS

We found no effect of ASPL on change in confrontation naming accuracy of untrained words immediately post- and 3-months post-treatment. However, post-hoc analyses indicated significant subject heterogeneity and limitations in observable path distance between trained and untrained words.

CONCLUSION

Despite the clinical trial report that confrontation naming of untrained words improved after PMT, we found no overall effect of ASPL on the amount of improvement. We discuss further investigation of the entire domain of phonological sequence knowledge (the phonological sequence knowledge landscape) and its influence on treatment generalization, and the potential importance of identifying predictors of treatment response to enhance the effects of treatment generalization.

Neural mechanisms of emotions, alexithymia, and depression

This chapter brings the powerful conceptual tools of the science of parallel distributed processing (PDP) to bear on the cognitive neuroscience of emotions discussed in this book. Cerebral representations are encoded as patterns of activity involving billions of neurons. PDP across these neuronal populations provides the basis for a number of emergent properties: (1) processing occurs and knowledge (long term memories) is stored (as synaptic connection strengths) in exactly the same networks; (2) networks have the capacity for setting into stable attractor states corresponding to concepts, symbols, implicit rules, or data transformations; (3) networks provide the scaffold for the acquisition of knowledge, but knowledge is acquired through experience; (4) PDP networks are adept at incorporating the statistical regularities of experience as well as frequency and age of acquisition effects; (5) networks enable content-addressable memory; (6) because knowledge is distributed throughout networks, they exhibit the property of graceful degradation; (7) networks intrinsically provide the capacity for inference. With this perspective, I propose a new model of emotional function that reasonably accounts for the effects of focal lesions at various points (insula, orbitofrontal cortex, convexity cortex, and intervening white matter) due to stroke, trauma, surgery, and degenerative disease, as reflected in disorders of affective prosody, facial emotional comprehension and expression, emotional behavior, and personality. I consider a modification of the James Lange theory that takes into account the role of a lifetime of subjective knowledge acquisition by the orbitofrontal cortex. Alexithymia is conceptualized as a disorder of the insula/orbitofrontal cortex/dorsolateral prefrontal cortex (DL-PFC) system, the function of which can be disrupted by degradation of knowledge at a number of different locations. Finally, I consider the possibility that depression reflects pathological learning involving the medial and lateral orbitofrontal cortices such that there is a pathologic engagement of the two regions, as suggested by Rolls. I conclude with a consideration of the peculiar responsivity of depression to serotonergic and noradrenergic agents, as well as to surgical orbitofrontal undercutting, and what that might be telling us about the mechanisms of depression and its treatment.

Phonomotor Versus Semantic Feature Analysis Treatment for Anomia in 58 Persons With Aphasia: A Randomized Controlled Trial

Purpose The ultimate goal of anomia treatment should be to achieve gains in exemplars trained in the therapy session, as well as generalization to untrained exemplars and contexts. The purpose of this study was to test the efficacy of phonomotor treatment, a treatment focusing on enhancement of phonological sequence knowledge, against semantic feature analysis (SFA), a lexical-semantic therapy that focuses on enhancement of semantic knowledge and is well known and commonly used to treat anomia in aphasia. Method In a between-groups randomized controlled trial, 58 persons with aphasia characterized by anomia and phonological dysfunction were randomized to receive 56-60 hr of intensively delivered treatment over 6 weeks with testing pretreatment, posttreatment, and 3 months posttreatment termination. Results There was no significant between-groups difference on the primary outcome measure (untrained nouns phonologically and semantically unrelated to each treatment) at 3 months posttreatment. Significant within-group immediately posttreatment acquisition effects for confrontation naming and response latency were observed for both groups. Treatment-specific generalization effects for confrontation naming were observed for both groups immediately and 3 months posttreatment; a significant decrease in response latency was observed at both time points for the SFA group only. Finally, significant within-group differences on the Comprehensive Aphasia Test-Disability Questionnaire (Swinburn, Porter, & Howard, 2004) were observed both immediately and 3 months posttreatment for the SFA group, and significant within-group differences on the Functional Outcome Questionnaire (Glueckauf et al., 2003) were found for both treatment groups 3 months posttreatment. Discussion Our results are consistent with those of prior studies that have shown that SFA treatment and phonomotor treatment generalize to untrained words that share features (semantic or phonological sequence, respectively) with the training set. However, they show that there is no significant generalization to untrained words that do not share semantic features or phonological sequence features.

The Influence of Phonomotor Treatment on Word Retrieval: Insights From Naming Errors

Purpose An increasing number of anomia treatment studies have coupled traditional word retrieval accuracy outcome measures with more fine-grained analysis of word retrieval errors to allow for more comprehensive measurement of treatment-induced changes in word retrieval. The aim of this study was to examine changes in picture naming errors after phonomotor treatment. Method Twenty-eight individuals with aphasia received 60 hr of phonomotor treatment, an intensive, phoneme-based therapy for anomia. Confrontation naming was assessed pretreatment, immediately posttreatment, and 3 months posttreatment for trained and untrained nouns. Responses were scored for accuracy and coded for error type, and error proportions of each error type (e.g., semantic, phonological, omission) were compared: pre- versus posttreatment and pretreatment versus 3 months posttreatment. Results The group of treatment participants improved in whole-word naming accuracy on trained items and maintained their improvement. Treatment effects also generalized to untrained nouns at the maintenance testing phase. Additionally, participants demonstrated a decrease in proportions of omission and description errors on trained items immediately posttreatment. Conclusions Along with generalized improved whole-word naming accuracy, results of the error analysis suggest that a global (i.e., both lexical-semantic and phonological) change in lexical knowledge underlies the observed changes in confrontation naming accuracy following phonomotor treatment.

The Link Between Verbal Short-Term Memory and Anomia Treatment Gains

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

Repetitive verbal behaviors are not always harmful signs: Compensatory plasticity within the language network in aphasia

Repetitive verbal behaviors such as conduite d'approche (CdA) and mitigated echolalia (ME) are well-known phenomena since early descriptions of aphasia. Nevertheless, there is no substantial fresh knowledge on their clinical features, neural correlates and treatment interventions. In the present study we take advantage of three index cases of chronic fluent aphasia showing CdA, ME or both symptoms to dissect their clinical and neural signatures. Using multimodal neuroimaging (structural magnetic resonance imaging and [18]-fluorodeoxyglucose positron emission tomography during resting state), we found that despite of the heterogeneous lesions in terms of etiology (stroke, traumatic brain injury), volume and location, CdA was present when the lesion affected in greater extent the left dorsal language pathway, while ME resulted from preferential damage to the left ventral stream. The coexistence of CdA and ME was associated with involvement of areas overlapping with the structural lesions and metabolic derangements described in the subjects who showed one of these symptoms (CdA or ME). These findings suggest that CdA and ME represent the clinical expression of plastic changes that occur within the spared language network and its interconnected areas in order to compensate for the linguistic functions that previously relied on the activity of the damaged pathway. We discuss the results in the light of this idea and consider alternative undamaged neural networks that may support CdA and ME.

Effects of Phonomotor Treatment on discourse production

BACKGROUND

Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with every person with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse.

AIMS

This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment, on discourse production.

METHODS & PROCEDURES

Twenty-six PWA participated in 60 hours of Phonomotor Treatment, which focuses on building a person's ability to recognise, produce, and manipulate phonemes in progressively longer non-word and real-word contexts. Language samples were collected prior to, immediately after, and three months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated.

OUTCOMES & RESULTS

Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and three months later, as well as significantly improved percent CIUs, relative to baseline, three months following treatment.

CONCLUSIONS

Phonomotor Treatment, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production.

Masked Repetition Priming Treatment for Anomia

PURPOSE

Masked priming has been suggested as a way to directly target implicit lexical retrieval processes in aphasia. This study was designed to investigate repeated use of masked repetition priming to improve picture naming in individuals with anomia due to aphasia.

METHOD

A single-subject, multiple-baseline design was used across 6 people with aphasia. Training involved repeated exposure to pictures that were paired with masked identity primes or sham primes. Two semantic categories were trained in series for each participant. Analyses assessed treatment effects, generalization within and across semantic categories, and effects on broader language skills, immediately and 3 months after treatment.

RESULTS

Four of the 6 participants improved in naming trained items immediately after treatment. Improvements were generally greater for items that were presented in training with masked identity primes than items that were presented repeatedly during training with masked sham primes. Generalization within and across semantic categories was limited. Generalization to broader language skills was inconsistent.

CONCLUSION

Masked repetition priming may improve naming for some individuals with anomia due to aphasia. A number of methodological and theoretical insights into further development of this treatment approach are discussed.

Influence of Linguistic and Nonlinguistic Variables on Generalization and Maintenance Following Phonomotor Treatment for Aphasia

PURPOSE

Although phonomotor treatment shows promise as an effective intervention for anomia in people with aphasia, responses to this treatment are not consistent across individuals. To better understand this variability, we examined the influence of 5 participant characteristics-age, time postonset, aphasia severity, naming impairment, and error profile-on generalization and maintenance of confrontation naming and discourse abilities following phonomotor treatment.

METHOD

Using retrospective data from 26 participants with aphasia who completed a 6-week phonomotor treatment program, we examined the relationships between participant characteristics of interest and change scores on confrontation naming and discourse tasks, measured pretreatment, immediately following treatment, and 3 months following treatment.

RESULTS

Although the participant characteristics of aphasia severity and error profile appeared to predict generalization to improved confrontation naming of untrained items and discourse performance, a post hoc analysis revealed that no one characteristic predicted generalization across participants at 3 months posttreatment.

CONCLUSIONS

Response to phonomotor treatment does not appear to be influenced by aphasia and anomia severity level, error profile, participant age, or time postonset. Other factors, however, may influence response to intensive aphasia treatment and are worthy of continued exploration.

Language treatment prior to anterior temporal lobe surgery: Can naming skills be preserved?

Epilepsy affects 1% of the general population and is highly prevalent among Veterans. The purpose of this phase I study was to investigate a presurgical linguistically distributed language treatment program that could potentially diminish effects of proper-name retrieval deficits following left anterior temporal lobe resection for intractable epilepsy. A single-subject multiple-baseline design was employed for three individuals with late-onset chronic left temporal lobe epilepsy. Word retrieval treatment was administered prior to anterior temporal lobe resection. The primary outcome measure was confrontation naming of proper nouns. Immediately posttreatment (before surgery), there was a positive effect for all trained stimuli in the form of improved naming as compared with pretreatment. In addition, trained stimuli were found to be better after surgery than they were at pretreatment baseline, which would not be expected had language treatment not been provided. This series of case studies introduces two fundamentally novel concept: that commonly occurring deficits associated with left temporal lobe epilepsy can be treated despite the presence of damaged neural tissue and that providing this treatment prior to surgery can lead to better preservation of language function after surgery than would be expected if the treatment were not provided.

Verbal Neuropsychological Functions in Aphasia: An Integrative Model

A theoretical framework which considers the verbal functions of the brain under a multivariate and comprehensive cognitive model was statistically analyzed. A confirmatory factor analysis was performed to verify whether some recognized aphasia constructs can be hierarchically integrated as latent factors from a homogenously verbal test. The Brief Aphasia Evaluation was used. A sample of 65 patients with left cerebral lesions, and two supplementary samples comprising 35 patients with right cerebral lesions and 30 healthy participants were studied. A model encompassing an all inclusive verbal organizer and two successive organizers was validated. The two last organizers were: three factors of comprehension, expression and a "complementary" verbal factor which included praxia, attention, and memory; followed by the individual (and correlated) factors of auditory comprehension, repetition, naming, speech, reading, writing, and the "complementary" factor. By following this approach all the patients fall inside the classification system; consequently, theoretical improvement is guaranteed.

Masked Repetition Priming in Treatment of Anomia: A Phase 2 Study

PURPOSE

Previous research has demonstrated that exposure to masked primes may improve naming accuracy for individuals with anomia. This study investigates the effect of repeated exposures to masked identity primes paired with pictures over multiple trials, sessions, and days on the ability of people with anomia to name those pictures.

METHOD

Four participants with anomia completed this single-subject, multiple-baseline design study. Twelve treatment sessions were conducted for each of 2 semantic categories. Comparisons of performance on naming probes were made between items that were primed, unprimed but seen the same number of times, and unprimed and seen only during naming probes.

RESULTS

All participants showed some gains in naming trained items although to varying degrees, and trained (primed) items generally showed greater improvement than untrained items seen the same number of times. Cross-category generalization was observed for some participants, but little to no within-category generalization occurred. Minimal changes occurred on measures of general language ability.

CONCLUSIONS

These data provide continued evidence that masked repetition priming can have a positive effect on naming for people with anomia. Factors that may influence participant response and additional questions that must be settled for this line of research to continue are discussed.

The Influence of Phonomotor Treatment on Word Retrieval Abilities in 26 Individuals With Chronic Aphasia: An Open Trial

PURPOSE

The ultimate goal of aphasia therapy should be to achieve gains in function that generalize to untrained exemplars and daily conversation. Anomia is one of the most disabling features of aphasia. The predominantly lexical/semantic approaches used to treat anomia have low potential for generalization due to the orthogonality of semantic and phonologic representations; this has been borne out in a meta-analysis of treatment studies. The intensive, neurally distributed, phonologic therapy reported here can, in principle, generalize to untrained phonologic sequences because of extant regularities in phonologic sequence knowledge and should, in principle, generalize to production of words trained as well as those untrained.

METHOD

Twenty-six persons with chronic aphasia due to stroke were treated, in a staggered (immediate vs. delayed treatment) open trial design, with 60 hr of intensive, multimodal therapy designed to enhance access to and efficiency of phonemes and phonologic sequences.

RESULTS

There was an absolute increase of 5% in confrontation naming of "untrained" nouns at 3 months, and there were 9% to 10% increases on measures of generalization of phonologic processes.

CONCLUSION

The results of this trial demonstrate generalization of training effects on laboratory measures, which were sustained at 3 months, and provide support for the theories that motivated the treatment.

Effects of intensive phonomotor treatment on reading in eight individuals with aphasia and phonological alexia

PURPOSE

The aim of this study was to investigate effects of a multimodal treatment of phonology, phonomotor treatment, on the reading abilities of persons with aphasia (PWA) with phonological alexia.

METHOD

In a retrospective, single-group design, this study presents pre-, post-, and 3-months posttreatment data for 8 PWA with phonological alexia. Participants completed 60 hr of phonomotor treatment over 6 weeks. Wilcoxon signed-ranks tests and group effect sizes comparing pre-, immediately post-, and 3-months posttreatment performance on tests of phonological processing and reading were performed.

RESULTS

Group data showed phonological processing and oral reading of real words and nonwords improved significantly posttreatment; these gains were maintained 3 months later. No group improvement was found for reading comprehension; however, one individual did show improvement immediately post- and 3-months posttreatment.

CONCLUSIONS

This study provides support that phonomotor treatment is a viable approach to improve phonological processing and oral reading for PWA with phonological alexia. The lack of improvement with comprehension is inconsistent with prior work using similar treatments (Conway et al., 1998; Kendall et al., 2003). However, this difference can, in part, be accounted for by differences in variables, such as treatment intensity and frequency, outcome measures, and alexia severity.

Divergent Task Performance in Older Adults: Declarative Memory or Creative Potential?

Divergent thinking is the ability to produce a range of responses or solutions and is an element of creative processing. Divergent thinking requires disengagement, the ability to associate between words or ideas, and the production of responses. Lesion and imaging studies have shown frontal-lobe involvement for these activities, and frontal lobe function is highly dependent on white matter pathways. Normal aging often results in deficits in functions controlled by the frontal lobes as well as decrements in white matter connectivity. The objectives of this study were to compare non time-constrained tasks of verbal divergent processing in young adults (YAs) and older adults (OAs) and correlate performance with tasks of working memory, language ability, and disengagement/inhibition. Participants were 30 YAs and 30 OAs. Contrary to the a priori hypothesis, OAs produced significantly more unique responses than YAs, although total fluency was not significantly different. Correlational analyses examining the groups together and separately revealed a number of differences suggesting that the groups were utilizing different underlying cognitive abilities to complete these tasks. The authors propose that the primary factor resulting in higher uniqueness scores for the OAs was a greater wealth of experience as well as longer exposure to language use.

Dissociated repetition deficits in aphasia can reflect flexible interactions between left dorsal and ventral streams and gender-dimorphic architecture of the right dorsal stream

Assessment of brain-damaged subjects presenting with dissociated repetition deficits after selective injury to either the left dorsal or ventral auditory pathways can provide further insight on their respective roles in verbal repetition. We evaluated repetition performance and its neural correlates using multimodal imaging (anatomical MRI, DTI, fMRI, and¹⁸FDG-PET) in a female patient with transcortical motor aphasia (TCMA) and in a male patient with conduction aphasia (CA) who had small contiguous but non-overlapping left perisylvian infarctions. Repetition in the TCMA patient was fully preserved except for a mild impairment in nonwords and digits, whereas the CA patient had impaired repetition of nonwords, digits and word triplet lists. Sentence repetition was impaired, but he repeated novel sentences significantly better than clichés. The TCMA patient had tissue damage and reduced metabolism in the left sensorimotor cortex and insula. DTI showed damage to the left temporo-frontal and parieto-frontal segments of the arcuate fasciculus (AF) and part of the left ventral stream together with well-developed right dorsal and ventral streams, as has been reported in more than one-third of females. The CA patient had tissue damage and reduced metabolic activity in the left temporoparietal cortex with additional metabolic decrements in the left frontal lobe. DTI showed damage to the left temporo-parietal and temporo-frontal segments of the AF, but the ventral stream was spared. The direct segment of the AF in the right hemisphere was also absent with only vestigial remains of the other dorsal subcomponents present, as is often found in males. fMRI during word and nonword repetition revealed bilateral perisylvian activation in the TCMA patient suggesting recruitment of spared segments of the left dorsal stream and right dorsal stream with propagation of signals to temporal lobe structures suggesting a compensatory reallocation of resources via the ventral streams. The CA patient showed a greater activation of these cortical areas than the TCMA patient, but these changes did not result in normal performance. Repetition of word triplet lists activated bilateral perisylvian cortices in both patients, but activation in the CA patient with very poor performance was restricted to small frontal and posterior temporal foci bilaterally. These findings suggest that dissociated repetition deficits in our cases are probably reliant on flexible interactions between left dorsal stream (spared segments, short tracts remains) and left ventral stream and on gender-dimorphic architecture of the right dorsal stream.

Fronto-parietal dorsal and ventral pathways in the context of different linguistic manipulations

This study investigates structural connectivity between left fronto-parietal brain regions that were identified in a previous fMRI study which used different linguistic manipulation tasks. Diffusion-weighted images were acquired from 20 volunteers. Structural connectivity between brain regions from the fMRI study was computed using probabilistic fiber tracking. For suprasegmental manipulation, left inferior parietal lobule (IPL) and left inferior frontal gyrus (IFG), pars opercularis, were connected by a dorsal pathway via the arcuate fascicle and superior longitudinal fascicle III. For segmental manipulation, left IPL and IFG, pars triangularis, were connected by a ventral pathway via the middle longitudinal fascicle and the extreme capsule. We conclude that the dorsal pathway provides a route for mapping from phonological memory in IPL to the inferior frontal articulatory network while the ventral pathway could facilitate the modulation of phonological units based on lexical-semantic aspects, mediate the complexity of auditory objects and the unification of actor-event schemata.

Repeating with the right hemisphere: reduced interactions between phonological and lexical-semantic systems in crossed aphasia?

Knowledge on the patterns of repetition amongst individuals who develop language deficits in association with right hemisphere lesions (crossed aphasia) is very limited. Available data indicate that repetition in some crossed aphasics experiencing phonological processing deficits is not heavily influenced by lexical-semantic variables (lexicality, imageability, and frequency) as is regularly reported in phonologically-impaired cases with left hemisphere damage. Moreover, in view of the fact that crossed aphasia is rare, information on the role of right cortical areas and white matter tracts underpinning language repetition deficits is scarce. In this study, repetition performance was assessed in two patients with crossed conduction aphasia and striatal/capsular vascular lesions encompassing the right arcuate fasciculus (AF) and inferior frontal-occipital fasciculus (IFOF), the temporal stem and the white matter underneath the supramarginal gyrus. Both patients showed lexicality effects repeating better words than non-words, but manipulation of other lexical-semantic variables exerted less influence on repetition performance. Imageability and frequency effects, production of meaning-based paraphrases during sentence repetition, or better performance on repeating novel sentences than overlearned clichés were hardly ever observed in these two patients. In one patient, diffusion tensor imaging disclosed damage to the right long direct segment of the AF and IFOF with relative sparing of the anterior indirect and posterior segments of the AF, together with fully developed left perisylvian white matter pathways. These findings suggest that striatal/capsular lesions extending into the right AF and IFOF in some individuals with right hemisphere language dominance are associated with atypical repetition patterns which might reflect reduced interactions between phonological and lexical-semantic processes.

The roles of the "ventral" semantic and "dorsal" pathways in conduite d'approche: a neuroanatomically-constrained computational modeling investigation

Ever since the 19th century, the standard model for spoken language processing has assumed two pathways for repetition—a phonological pathway and a semantic pathway—and this idea has gained further support in the last decade. First, recent in vivo tractography studies have demonstrated both the “dorsal” (via arcuate fasciculus) and “ventral” (via extreme capsule and uncinate fasciculus) pathways connecting from the primary auditory area to the speech-motor area, the latter of which passes through a brain area associated with semantic processing (anterior temporal lobe). Secondly, neuropsychological evidence for the role of semantics in repetition is conduite d'approche, a successive phonological improvement (sometimes non-improvement) in aphasic patients' response by repeating several times in succession. Crucially, conduite d'approche is observed in patients with neurological damage in/around the arcuate fasciculus. Successful conduite d'approche is especially clear for semantically-intact patients and it occurs for real words rather than for non-words. These features have led researchers to hypothesize that the patients' disrupted phonological output is “cleaned-up” by intact lexical-semantic information before the next repetition. We tested this hypothesis using the neuroanatomically-constrained dual dorsal-ventral pathway computational model. The results showed that (a) damage to the dorsal pathway impaired repetition; (b) in the context of recovery, the model learned to compute a correct repetition response following the model's own noisy speech output (i.e., successful conduite d'approche); (c) this behavior was more evident for real words than non-words; and (d) activation from the ventral pathway contributed to the increased rate of successful conduite d'approche for real words. These results suggest that lexical-semantic “clean-up” is key to this self-correcting mechanism, supporting the classic proposal of two pathways for repetition.

Treatment of proper name retrieval deficits in an individual with temporal lobe epilepsy

PURPOSE

Studies investigating language deficits in individuals with left temporal-lobe epilepsy have consistently demonstrated impairments in proper name retrieval. The aim of this Phase I rehabilitation study was to investigate the effects of a linguistically distributed word retrieval treatment on proper name retrieval in an individual with left temporal-lobe epilepsy.

METHOD

A 61-year old right-handed male with left temporal-lobe epilepsy (clinical onset at the age of 50) and a deficit in proper name retrieval participated in this study. A single-subject, repeated-probe ABAA design with testing before, immediately after, and 3 months after treatment completion was employed. Proper name retrieval treatment was administered 2 hr per day for 5 days.

RESULTS

Results demonstrated improved naming on trained items and maintenance of trained items 3 months after treatment completion.

CONCLUSION

Treatment, which took advantage of the individual's undamaged linguistic networks, promoted the reorganization of networks supporting proper naming, leading to improved proper name retrieval. Further research replicating these findings in individuals with varying degrees of proper name retrieval impairment is warranted. Additionally, the mechanism behind the observed improvements in proper name retrieval needs to be investigated further using functional neuroimaging.

An analysis of aphasic naming errors as an indicator of improved linguistic processing following phonomotor treatment

PURPOSE

The aim of this study was to investigate the influence of phonomotor treatment on the types of errors produced during a confrontation naming task for people with aphasia (PWA).

METHOD

Ten PWA received 60 hr of phonomotor treatment across 6 weeks. Confrontation naming abilities were measured before and after treatment, and responses were coded as correct or incorrect. Incorrect responses were coded for error type. Paired t tests comparing pre-, post- and 3 months posttreatment naming accuracy and error type were performed.

RESULTS

Group data showed that naming accuracy on trained items improved significantly immediately post treatment, and gains were maintained 3 months later. Naming accuracy on untrained items did not show significant improvement immediately post treatment or 3 months later. Results of error type analysis were not significant. However, a decrease in omission errors and an increase in mixed errors were noted immediately post treatment for naming of untrained items.

CONCLUSION

Results suggest that intensive phonomotor treatment improved lexical-retrieval abilities and may have triggered a shift in linguistic processing, as indicated by a decrease in omission errors on trained items and an increase in mixed errors on untrained items.

Conduction aphasia, sensory-motor integration, and phonological short-term memory - an aggregate analysis of lesion and fMRI data

Conduction aphasia is a language disorder characterized by frequent speech errors, impaired verbatim repetition, a deficit in phonological short-term memory, and naming difficulties in the presence of otherwise fluent and grammatical speech output. While traditional models of conduction aphasia have typically implicated white matter pathways, recent advances in lesions reconstruction methodology applied to groups of patients have implicated left temporoparietal zones. Parallel work using functional magnetic resonance imaging (fMRI) has pinpointed a region in the posterior most portion of the left planum temporale, area Spt, which is critical for phonological working memory. Here we show that the region of maximal lesion overlap in a sample of 14 patients with conduction aphasia perfectly circumscribes area Spt, as defined in an aggregate fMRI analysis of 105 subjects performing a phonological working memory task. We provide a review of the evidence supporting the idea that Spt is an interface site for the integration of sensory and vocal tract-related motor representations of complex sound sequences, such as speech and music and show how the symptoms of conduction aphasia can be explained by damage to this system.

Atypical conduction aphasia and the right hemisphere: Cross-hemispheric plasticity of phonology in a developmentally dyslexic and dysgraphic patient with early left frontal damage

We report the rare case of a patient, JNR, with history of mixed handedness, developmental dyslexia, dysgraphia, and attentional deficits associated with a Klippel-Trenaunay syndrome and a small subcortical frontal lesion involving the left arcuate fasciculus. In adulthood, he suffered a large right perisylvian stroke and developed atypical conduction aphasia with deficits in input and output phonological processing and poor auditory-verbal short-term memory. Lexical-semantic processing for single words was intact, but he was unable to access meaning in sentence comprehension and repetition. Reading and writing deficits worsened after the stroke and he presented a combination of developmental and acquired dysgraphia and dyslexia with mixed lexical and phonological processing deficits. This case suggest that a small lesion sustained prenatally or early in life could induce a selective rightward shift of phonology sparing the standard left hemisphere lateralisation of lexical-semantic functions.

Neural representations and mechanisms for the performance of simple speech sequences

Speakers plan the phonological content of their utterances before their release as speech motor acts. Using a finite alphabet of learned phonemes and a relatively small number of syllable structures, speakers are able to rapidly plan and produce arbitrary syllable sequences that fall within the rules of their language. The class of computational models of sequence planning and performance termed competitive queuing models have followed K. S. Lashley [The problem of serial order in behavior. In L. A. Jeffress (Ed.), Cerebral mechanisms in behavior (pp. 112-136). New York: Wiley, 1951] in assuming that inherently parallel neural representations underlie serial action, and this idea is increasingly supported by experimental evidence. In this article, we developed a neural model that extends the existing DIVA model of speech production in two complementary ways. The new model includes paired structure and content subsystems [cf. MacNeilage, P. F. The frame/content theory of evolution of speech production. Behavioral and Brain Sciences, 21, 499-511, 1998 ] that provide parallel representations of a forthcoming speech plan as well as mechanisms for interfacing these phonological planning representations with learned sensorimotor programs to enable stepping through multisyllabic speech plans. On the basis of previous reports, the model's components are hypothesized to be localized to specific cortical and subcortical structures, including the left inferior frontal sulcus, the medial premotor cortex, the basal ganglia, and the thalamus. The new model, called gradient order DIVA, thus fills a void in current speech research by providing formal mechanistic hypotheses about both phonological and phonetic processes that are grounded by neuroanatomy and physiology. This framework also generates predictions that can be tested in future neuroimaging and clinical case studies.

The Search for the Phonological Store: From Loop to Convolution

The phonological loop system of Baddeley and colleagues' Working Memory model is a major accomplishment of the modern era of cognitive psychology. It was one of the first information processing models to make an explicit attempt to accommodate both traditional behavioral data and the results of neuropsychological case studies in an integrated theoretical framework. In the early and middle 1990s, the purview of the phonological loop was expanded to include the emerging field of functional brain imaging. The modular and componential structure of the phonological loop seemed to disclose a structure that might well be transcribed, intact, onto the convolutions of the brain. It was the phonological store component, however, with its simple and modular quality, that most appealed to the neuroimaging field as the psychological “box” that might most plausibly be located in the brain. Functional neuroimaging studies initially designated regions in the parietal cortex as constituting the “neural correlate” of the phonological store, whereas later studies pointed to regions in the posterior temporal cortex. In this review, however, we argue the phonological store as a theoretical construct does not precisely correspond to a single, functionally discrete, brain region. Rather, converging evidence from neurology, cognitive psychology, and functional neuroimaging argue for a reconceptualization of phonological short-term memory as emerging from the integrated action of the neural processes that underlie the perception and production of speech.

Phoneme-based rehabilitation of anomia in aphasia

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.

Lexical and post-lexical phonological representations in spoken production

Theories of spoken word production generally assume a distinction between at least two types of phonological processes and representations: lexical phonological processes that recover relatively arbitrary aspects of word forms from long-term memory and post-lexical phonological processes that specify the predictable aspects of phonological representations. In this work we examine the spoken production of two brain-damaged individuals. We use their differential patterns of accuracy across the tasks of spoken naming and repetition to establish that they suffer from distinct deficits originating fairly selectively within lexical or post-lexical processes. Independent and detailed analyses of their spoken productions reveal contrasting patterns that provide clear support for a distinction between two types of phonological representations: those that lack syllabic and featural information and are sensitive to lexical factors such as lexical frequency and neighborhood density, and those that include syllabic and featural information and are sensitive to detailed properties of phonological structure such as phoneme frequency and syllabic constituency.

Sex differences in the development of neuroanatomical functional connectivity underlying intelligence found using Bayesian connectivity analysis

A Bayesian method for functional connectivity analysis was adapted to investigate between-group differences. This method was applied in a large cohort of almost 300 children to investigate differences in boys and girls in the relationship between intelligence and functional connectivity for the task of narrative comprehension. For boys, a greater association was shown between intelligence and the functional connectivity linking Broca's area to auditory processing areas, including Wernicke's areas and the right posterior superior temporal gyrus. For girls, a greater association was shown between intelligence and the functional connectivity linking the left posterior superior temporal gyrus to Wernicke's areas bilaterally. A developmental effect was also seen, with girls displaying a positive correlation with age in the association between intelligence and the functional connectivity linking the right posterior superior temporal gyrus to Wernicke's areas bilaterally. Our results demonstrate a sexual dimorphism in the relationship of functional connectivity to intelligence in children and an increasing reliance on inter-hemispheric connectivity in girls with age.

Aphasia and the diagram makers revisited: an update of information processing models

Aphasic syndromes from diseases such as stroke and degenerative disorders are still common and disabling neurobehavioral disorders. Diagnosis, management and treatment of these communication disorders are often dependent upon understanding the neuropsychological mechanisms that underlie these disorders. Since the work of Broca it has been recognized that the human brain is organized in a modular fashion. Wernicke realized that the types of signs and symptoms displayed by aphasic patients reflect the degradation or disconnection of the modules that comprise this speech-language network. Thus, he was the first to propose a diagrammatic or information processing model of this modular language-speech network. Since he first published this model many new aphasic syndromes have been discovered and this has led to modifications of this model. This paper reviews some of the early (nineteenth century) models and then attempts to develop a more up-to-date and complete model.

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.

Naming concepts: evidence of two routes

This study examines a parallel distributed processing (PDP) model (partly based on the Wernicke-Lichtheim information processing model) that posits two routes for naming concepts, whole word and phonological. To test the two naming route hypothesis of this model, we performed confrontation naming tests that were either uncued, semantically cued, or phonologically cued in a patient with naming impairment due to Broca's aphasia. In spoken language and in uncued naming to confrontation, word retrieval was severely impaired and marked by semantic but no phonemic paraphasic errors. With semantic cues, naming behavior was unchanged; however, with phonological cues, naming success was enhanced but frequent phonemic paraphasias were produced. These results suggest that the patient spontaneously engaged the whole word naming route, but when given phonological cues, he engaged an alternative phonological naming route that incorporated phonological sequence knowledge.

Cognitive modules utilized for narrative comprehension in children: a functional magnetic resonance imaging study

The ability to comprehend narratives constitutes an important component of human development and experience. The neural correlates of auditory narrative comprehension in children were investigated in a large-scale functional magnetic resonance imaging (fMRI) study involving 313 subjects ages 5-18. Using group independent component analysis (ICA), bilateral task-related components were found comprising the primary auditory cortex, the mid-superior temporal gyrus, the hippocampus, the angular gyrus, and medial aspect of the parietal lobule (precuneus/posterior cingulate). In addition, a right-lateralized component was found involving the most posterior aspect of the superior temporal gyrus, and a left-lateralized component was found comprising the inferior frontal gyrus (including Broca's area), the inferior parietal lobule, and the medial temporal gyrus. Using a novel data-driven analysis technique, increased task-related activity related to age was found in the components comprising the mid-superior temporal gyrus (Wernicke's area) and the posterior aspect of the superior temporal gyrus, while decreased activity related to age was found in the component comprising the angular gyrus. The results are discussed in light of recent hypotheses involving the functional segregation of Wernicke's area and the specific role of the mid-superior temporal gyrus in speech comprehension.

Perisylvian language networks of the human brain

Early anatomically based models of language consisted of an arcuate tract connecting Broca's speech and Wernicke's comprehension centers; a lesion of the tract resulted in conduction aphasia. However, the heterogeneous clinical presentations of conduction aphasia suggest a greater complexity of perisylvian anatomical connections than allowed for in the classical anatomical model. This article re-explores perisylvian language connectivity using in vivo diffusion tensor magnetic resonance imaging tractography. Diffusion tensor magnetic resonance imaging data from 11 right-handed healthy male subjects were averaged, and the arcuate fasciculus of the left hemisphere reconstructed from this data using an interactive dissection technique. Beyond the classical arcuate pathway connecting Broca's and Wernicke's areas directly, we show a previously undescribed, indirect pathway passing through inferior parietal cortex. The indirect pathway runs parallel and lateral to the classical arcuate fasciculus and is composed of an anterior segment connecting Broca's territory with the inferior parietal lobe and a posterior segment connecting the inferior parietal lobe to Wernicke's territory. This model of two parallel pathways helps explain the diverse clinical presentations of conduction aphasia. The anatomical findings are also relevant to the evolution of language, provide a framework for Lichtheim's symptom-based neurological model of aphasia, and constrain, anatomically, contemporary connectionist accounts of language.

Dysgraphia in two forms of conduction aphasia

Recent clinical observations, in the absence of experimental data, appear to suggest that written expression in conduction aphasics parallels their speech (Goodglass, 1992). The current study undertakes an analysis of word level writing in two conduction aphasics, and attempts to explore the posited 'parallel' relationship between speech production deficits and deficits in written expression. JL, a 66-year-old female with left posterior parietal lobe lesion and PP, a 65-year-old female with a left posterior temporo-parietal lobe lesion served as subjects of this study. Their response patterns on Boston Naming Test (BNT) and written naming task (John Hopkins Dysgraphia Battery) were utilized to verify the parallel hypothesis. Although both cases have exhibited phonological and semantic paraphasias on BNT, PP's overall performance was far superior to that of JL. JL produced numerous multiple responses to stimuli compared to PP's occasional multiple responses. PP's performance on the written naming task was far inferior to that of JL. JL's predominant error pattern in writing was the production of phonologically similar words to the target words. This paper argues that such seemingly contradictory, unpredicted patterns can be parsimoniously better explained, not by the parallel hypothesis but by current cognitive-neuropsychological models of writing.

A paradigm shift in neurorehabilitation

The practice of neurorehabilitation in the clinic has undergone a paradigm shift as a result of influences from basic and clinical research. I have identified six areas of knowledge that by advancing so rapidly have brought about this paradigm shift: first, the increased understanding of how the CNS is reorganised after training or injury; second, the knowledge of how declarative and procedural memory operates and how this can influence rehabilitation therapy; third, a greater appreciation of the chemical factors that promote learning and neural remodelling; fourth, the fact that computational neuroscience can teach us how complex behaviour can emerge from the interaction of thousands of neurons; fifth, the influence of evidence-based medicine on neurorehabilitation; and sixth, the importance of reliable outcome measures for both injury and treatment. These are young scientific disciplines that offer great opportunities for further research. The complexity of neurorehabilitation will also require greater attention to a substantially neglected problem, the incorporation of techniques that have been proven effective in clinical trials into routine and effective clinical practice.