Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Candidates for Treatment
- Individuals with nonfluent (Broca's) aphasia characterized by agrammatism
Principles for generalization
1) responsive generalization occurs with training of linguistically similar structures.
2) generalization occurs when the most complex structures are presented before simpler ones.
Treatment of Underlying Forms (TUF)
- a metalinguistic, top-down approach to promote generalization of syntactical structures
- involves careful control of the form and complexity of sentence structures by teaching the structures' underlying representations.
Agrammatism
- Agrammatic speech consists of sentence production errors where grammatical structures are "diminished or absent" (Thompson, 2008, 735)
- Higher difficulty with verbs in comparison to nouns
- Problems with processing arguments (participants) of the verb
- Agent missing from subject position
- Theme missing from object position
- Problems with noun phrase and wh- words when moved to different positions of the sentence
- Problems with grammatical morphemes like inflections (verb tense, verb agreement), complementizers (if, whether, that), and free morphemes.
• Subcortical aphasia: lesions in subcortical structures result in language disorders
• Dysfunction is secondary
• Subcortical structures include thalamus, basal ganglia, putamen and caudate, white matter pathways
• "We know of no adequately controlled scientific studies regarding the efficacy of therapy of subcortical aphasias." (Nadeau & Rothi, p. 530)
Theories of agrammatism
- Several theories for agrammatism, but not one that encompasses all aspects of agrammatic speech
-Individuals with agrammatic aphasia will have difficulty with processing/producing sentences that have constituents/components that have been displaced or moved to different positions of the sentence.
- Treatment of Underlying Forms (TUF) is based off Chomsky's theory of representational linguistics.
- Agrammatism is an impairment of processing and accessing linguistic representations.
- Shapiro, Gordon, Hack, & Killackey (1993) found that verb argument structure impacts sentences processing.
- Longer reaction time to complex verbs than simple verbs
- Normal and agrammatic speakers access representations of both the verb and its theme when listening to a sentence.
- The more complex an argument structure becomes, the harder it is for a person with agrammatic speech to process/produce the sentence.
Canonical Sentences - SVO
-The usual form of English sentences are subject-verb-object
-Different types of verbs have different features or arguments.
1 argument verb – agent and verb “The parrot laughs.”
2 argument verb – agent,. Verb, and theme “The dancer fixes her shoes.”
3 argument verb – agent, verb, theme, and goal. “The artist puts fresh flowers in the studio.”
Noncanonical Sentence Structures
- Sentences become harder to process/produce when components are moved from their canonical position.
- This theory suggests that agrammatism is the inability to trace or follow movement of components of a sentence.
Grammatical Morphology
Tree Pruning Hypothesis – “functional categories projecting from higher nodes in the syntactic tree are more at risk than those projecting from lower nodes.” (Thompson, 2008, p740)
- Impairment could occur at any level, but will impair higher levels above the level that was "pruned."
- SVO: Zack climbed Mt. Katadin
- Movements of sentence components
o Wh- movements: wh- questions and object clefts
What mountain did Zack climb?
It was Mt. Katadin that Zack climbed. (considered most complex)
o NP movements: passive sentences and subject raising sentences
Mt. Katadin was climbed by Zack.
Zack seems to have climbed Mt. Katadin.
Dr. Cynthia K. Thompson - extensive research into treatment of syntactical, lexical, and morphological deficits in aphasia
Causes:
Thalamic Aphasia
- Thalamus and its functions: "relay device"
• Sensorimotor integration
• Regulates associational cortex and cortically mediated cognitive functions (higher mental fuctions & memory)
• Sensation information to specific cortical areas
Types:
- Most common
- Characteristics: anomia in spontaneous language, good repetition, normal grammar, variable auditory comprehension, normal articulation, confrontational naming deficits
TREATMENT OF UNDERLYING FORMS
TUF(SYNTAX) - Train the underlying forms of sentences
The active form of a sentence is introduced as a foundation. Tasks are focused on improving access to thematic roles and target verbs. Then, the client is instructed on how different components of the sentence can move to new positions and still retain their thematic roles.
Purpose of Gating Mechanism
• "intentional attention" - experiment by Minamimoto and Kimura (2002)
• "selective engagement" of association cortices and supramodal cortices
• neglect, delayed reorienting of attention, extinction
Strokes and Thalamic Gate Impairment
• affects the reticular nucleus, ventral anterior nucleus (NRVA), center-median parafascicularis (CmPf), internal medullary lamina (IML),
• Ischemic strokes cause damage either the prefrontal-NRVA junction or the prefrontal-NRVA-IML-CmPf axis
• Damage NOT resulting in aphasia spares these structures
Thalamic Gating Mechanism
Regulatory systems:
- Midbrain Reticular Formation (MRF)
- Cerebral cortex projections
Four questions regarding thalamic aphasia
• How does the thalamic gating mechanism work?
• How do strokes impair its function?
• What purpose could such a gating mechanism serve?
• What is likely to be the specific impact of disorders of the thalamic gating mechanism on function of the cerebral cortex (most specifically the language cortex)?
Thalamic nuclei
• Medio-dorsal Nuclear Complex (visceral information)
• Lateral Nuclear Complex (higher mental & language functions)
• Ventral Nuclear Complex (skilled & voluntary motor movements)
• Intralaminar/Centromedian Nucleus (cortex excitability & function of basal ganglia
Resources
Impact of Disorders
• No one is 100% sure
• Linguistic deficits
o lexical-semantic access (declarative memories)
o grammar and phonologic processing spared (automatic processes)
o phonemic paraphasic errors and neologisms
Nonthalamic Subcortical Aphasias
- Anterior capsular-putaminal
- Posterior capsular-putaminal
- Global capsular-putaminal
Loloş, R. & Calomfirescu Ş.K. (2012). Clinical forms of subcortical aphasia in stroke and their recovery using the sophrology method. Palestrica of the third millennium ‒ Civilization and Sport 13(1), 13‒18.
Minamimoto, T., & Kimura, M. (2002). Participation of the thalamic Cm-Pf complex in attentional orienting. Journal of Neurophysiology, 87, 3090-3101.
Nadeau, S. E. & Gonzalez-Rothi, L. J. (2008). Rehabilitation of subcortical aphasia. In Chapey, R. (5th Ed). Language intervention strategies in aphasia and related neurogenic communication disorders. Lippincott Williams & Wilkins: Philadelphia, PA.
TUF(FUNCAT)
Functional Categories for Grammatical Morphology
1. Thematic Role Training of constituents of the sentence
2. Introduction of grammatical morpheme, its function, and placement within the sentence
3. Constituents are scrambled and client rearranges them to form the sentence
Examples:
1. The people wonder if/whether the boy is tickling the girl.
2. The boy tickled the girl.
3. The boy tickles the girl.
Use cards: IF, WHETHER, THAT, ED, and S
Behaviors that Affect the Treatment Process in Patients with Aphasia
Teaching Object Clefts
STEP 1: Thematic Role Training – explaining components of sentence
STEP 2: Sentence Building – creating a new sentence with new components “WHO,” “IT WAS”
STEP 3: Thematic Role Training – Client is asked to read aloud and repeat new target sentence
STEP 4: Practice – Client moves cards to form target object cleft sentence
Teaching Wh- questions
Same Steps as in Object Clefts, but with cards “WHO” and “IS”
Research Findings
TUF(SYNTAX)
- Results from studies have shown that TUF improves sentence production and comprehension.
- Generalization occurs to structures linguistically related to structures trained.
- Generalization from wh- movements: object clefts to wh- questions
- Generalization from NP movements: passive sentences to subject raising statements
- Generalization is enhanced when the treatment starts from more complex to less complex structures. Object clefts are the most complex.
TUF(FUNCAT)
- Generalization was seen from verb tense to verb agreement, but one is not more complex than the other.
(Thompson, 2008, p750; Thompson & Shapiro, 2005, p1034)
1. [THE BOY] [KISSED] [THE GIRL]
2. Add card [WHO]
3. [THE BOY] [KISSED] [THE GIRL] [WHO]
4. Movement: [THE GIRL] [WHO] [THE BOY] [KISSED]
5. Add card [IT WAS]
6. Movement: [IT WAS] [THE GIRL] [WHO] [THE BOY] [KISSED]
7. Arrange sentence back to active form (1) with the WHO and IT WAS cards and have the client rearrange it to the object cleft form (6) and have them read it aloud and repeat it.
Caroline Johnson & Anthony Wildfong
Resources
Shapiro, L., Gordon, B., Hack, N., & Killackey, J. (1993). Verb-argument structure processing in complex sentences in Broca's and Wernicke's aphasia. Brain and Language, 45, 423-447.
Thompson, C. K. (2008) Treatment of syntactic and morphologic deficits in agrammatic aphasia: Treatment of underlying forms. In Chapey, R. (5th Ed). Language intervention strategies in aphasia and related neurogenic communication disorders. Lippincott Williams & Wilkins: Philadelphia, PA.
Thompson, C. K. & Shapiro, L. P. (2005). Treating agrammatic aphasia whitin a linguistic framework: Treatment of underlying forms. Aphasiology, 19.10/11, 1021-1036.