Table Of ContentA MANUAL FOR RE-EDUCATION OF APHASIA PATIENTS
A Project
Presented to
the Faculty of the School of Education
The University of Southern California
In Partial Fulfillment
of the Requirements for the Degree
Master of Science in Education
by
Maurice Sklar
June 1950
UMI Number: EP46066
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TABLE OF CONTENTS
CHAPTER PAGE
I. INTRODUCTION................... 1
Nature of the Problem................. 2
Neurological Implications ............. 3
II. NATURE OF A P H A S I A ....................... 8
The Specific Nature of Aphasia . . . . 9
Classification of Types of Aphasia . . 10
Description of the Classification . . . 11
III. DIAGNOSIS ........ .. . ............. 16
Case Histories............ 16
Psychological Testing.............. . 21
Evaluation of Testing ................. 31
IV. SPEECH THERAPY............................ 32
Retraining in Reading ................. bO
Retraining in Writing ................. b2
V. LANGUAGE RETRAINING AND PHYSICAL MEDICINE
REHABILITATION if 9
VI. SUMMARY AND CONCLUSIONS................. 58
BIBLIOGRAPHY . . . ............................ 62
APPENDIX .................................. . 6b
Case S t u d y .................................. 6if
Glossary . ................................ 101
CHAPTER I
INTRODUCTION
It has been estimated that there are over M-00,000
people in the United States today who are -unable to use
language symbols because of brain damage. Each year about
20,000 additional people become disabled in a similar
manner and this number is on the increase with the greater
percentage in the population of those over fifty. Until
recently, the neurological aspects of aphasia patients were
concerned with a very extensive and minute neurological
examination and the arrival at a diagnosis. Psychological
investigations then focused the attention on personality
and behavior disorders but the patients were relegated to
a hospital bed and permitted to vegetate for ten, fifteen
or twenty years until released by death.
That the majority of patients can be rehabilitated
to lead a fairly normal, useful life is a recent concept
in medicine. Of these neurological patients, those suffer
ing with aphasic manifestations are the most challenging
to the therapist. In order for a therapist to approach
the problem of treating aphasic patients, there are several
areas of information necessary for a complete orientation.,
He should be acquainted with the neurological implications,
the psychological tools that can be used in determining
personality aberrations and the therapeutic methods that
have been used successfully. In order to help these
patients achieve a maximum amount of economic and social
adjustment, a well integrated program of physical medicine
rehabilitation is necessary. The speech therapists in
the aphasia clinic spearhead the rehabilitation program
and for them, as well as others interested in aphasia
therapy, this .project is intended.
NATURE OF THE PROBLEM
If we should suddenly be deprived of the ability to
speak, read, write or in any way express our needs, pains
or aspirations, we would be in the predicament of the
person afflicted by a cerebro-vascular-aceident. The
soft gray mass of tissue inside the cranium which assumes
the controlling influence of intelligence is disrupted
from its accustomed function and the individual is sudden
ly thrown back to a lower level of human functioning. The
brain is the organ of consciousness, of ideation and
voluntary muscular control, receiving impressions necessary
to life, such as respiration and circulation. Any damage
to any part of the brain reflects itself in the altered
reaction of the individual to himself and to his environ
ment.
3
Neurological Implications. Brain tissue is very
delicate and may be injured by disease or accident. One
of the most common causes of brain damage, especially
o among older people, is the bursting of a blood vessel in
the brain, called a "stroke". Another type of damage
z, frequently occuring in the brain is an embolism or blood
clot in one of the blood vessels feeding the brain. A
3 third type of injury may be caused by a tumor which also
acts like an embolism by creating pressure and disturbing
or destroying the functions of the adjacent areas. The
f brain may also be damage by physical accidents which cut
5- or tear parts of the delicate tissues. Infection or
disease is another cause of possible damage to the brain.
All these organic changes in the brain cause corresponding
changes in total personality functioning depending upon
the degree and severity of the damage.
During the process of learning, people favor the
development of one side of their bodies. In most people
the right side of the body is-stronger than the left. side.
The brain is likewise divided into two distinct hemi
spheres. The right hemisphere controls the left side of
the body and the left hemisphere controls the right side
of the body. The person who uses his left hand for
writing, throwing, etc. has developed a dominance in the
if
right hemisphere of the brain. The right handed person
develops cerebral dominance in the left hemisphere. When
the dominant hemisphere of the brain is injured, aphasia
usually results and the extent of damage determines the
type and degree of dysfunction.
The brain acts as a control tower or switchboard
for all physiological, emotional, psychological and
intellectual functions. The three major communication
lines controlled are:
1. Sensory nerves: Lines reporting sensation from
all the sense organs of the body such as ear,
eye, nose, skin, etc. and viscera organs such as
stomach, heart, etc.
2. Motor nerves: Lines originating in the brain,
extending to all the muscles to control and
stimulate them for bodily activity.
3. Association nerves: Lines solely within the brain
to correlate and integrate the functions of the
different sections of the brain. Although the
nervous system is divided into three distinct
parts, it is well to remember that they are
mutually dependent and cooperative. The central
nervous system which comprises the brain and
spinal cord, serves to correlate and integrate
the various parts of the body to make them work
as a good team. The peripheral nervous system con
tains the nerve fibers that pass from the receptors,
to the central nervous system, to muscles and glands.
The autonomic nervous system controls the unconscious
actions of the visceral organs such as chest, abdomen
and glandular tissue.
The nervous system reacts at three levels of com
plexity. The spinal cord contains switching centers that
make simple acts possible. The brain-stem which is in part
a continuation of the spinal cord controls the more complex
behavior patterns. The cerebral cortex controls complex
behavior such as learning, thinking and conscious exper
ience. Connections between the elements of the nervous
systems appear in three different ways. We are born with
certain connections already functioning. Others become
functional through a process of maturation independent of
learning. The complex connections become functional only
through a process of learning and adaptation.
An important aspect of the nervous system to consider
in retraining is that many duplicate pathways are provided
for the simplest stimulus response act. Often the duplicate
connections lie side by side but there are many instances
in which the duplicate nerve path takes quite a different
course from the receptor of the sense organ to the effect
ors. This is biologically advantageous since injury
6
resulting in loss of function is greatly reduced by the
possibility of compensation. Injuries to the brain need
not bring permanent disability since the brain is
especially rich in duplications which may be fertile for
training to assist or take over the impaired function.
The nervous system provides a means for the formation of
new connections between receptors and effectors.
When specific items of motor or sensory behavior
become modified or exaggerated due to brain lesion it can
be inferred that the damaged area is solely responsible
for the behavior in question. The electrical currents
employed- to stimulate the brain can to some extent help us'
localize the areas of the brain that dominate specific
activity. The use of drugs applied directly to cortical
tissue can also be used to destroy or exaggerate certain
types of responses. The doctrine of Johannes Mueller
states that a given sensory nerve will produce a certain
type of experience no matter how it is stimulated. The
sensation produced depends upon the nerve cells that have
been stimulated and not upon the stimulus applied. When
the area of the cortex immediately in front of the fissure
of Rolando is stimulated some voluntary muscles respond.
The long motor neurons lead down from this area through
the spinal cord to the muscles of the body and extremities.
Any damage to this area of the brain produces an impairment
