Table Of ContentDisorders of Human Communication 2
Edited by G. E. Arnold, F. Winckel, B. D. Wyke
Clinical Aspects
of Dysphasia
Springer-Verlag Wien New York
~
Martin L. Albert, M. D.
Professor of Neurology and Clinical Director, Aphasia Research Center, Boston University
Medical School, and Chief, Clinical Neurology Section, Boston Veterans Administration
Medical Center, Boston, Mass., U.S.A.
Harold Goodglass, Ph. D.
Professor of Neurology (Neuropsychology), Boston University Medical School, and Director,
Aphasia Research Center, Boston University Medical School, and Director, Psychology
Research, Boston Veterans Administration Medical Center, Boston, Mass., U.S.A.
Nancy A. Helm, D. Sc.
Assistant Professor of Neurology (Speecil Pathology) and Director of Audiology/Speecil
Pathology Program, Neurology Service, Boston Veterans Administration Medical Center, and
Boston University Medical Scilool, Boston, Mass., U.S.A.
Alan B. Rubens, M. D.
Associate Professor of Neurology, University of Minnesota Medical School, and Director,
Neurobehavior Unit, Hennepin County Medical Center, and Assistant Chief of Neurology,
Hennepin County Medical Center, Minneapolis, Minn., U.S.A.
Michael P. Alexander, M. D.
Assistant Professor of Neurology, Boston University Medical Scilool, and Chief, Neuro
behavior Unit, Boston Veterans Administration Medical Center, Boston, Mass., U.S.A.
This work is subject to copyright.
All rights are reserved, whether the whole or part of the material is concerned, specifically
those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photo
copying machine or similar means, and storage in data banks.
© 1981 by Springer-VerlagIWien
Softcover reprint of the hardcover 1st edition 1981
With 12 Figures
Library of Congress Cataloging in Publication Data. Main entry under title: Clinical aspects of
dysphasia. (Disorders of human communication ; 2.) Bibliography: p. Includes index. 1. Language
disorders.!. Albert, Martin L. II. Series. [DNLM: 1. Aphasia. WI D1762 v. 2 I WL 340.5 c641.J
RC423.C55. 616.85'52. 81-4483
ISSN 0173-170X
ISBN-13:978-3-7091-8607-7 e-ISBN-13:978-3-7091-8605-3
DOl: 10.1007/978-3-7091-8605-3
Editors' Foreword
This volume is one in a series of monographs being issued under the general
title of "Disorders of Human Communication". Each monograph deals in
detail with a particular aspect of vocal communication and its disorders, and
is written by internationally distinguished experts. Therefore, the series will
provide an authoritative source of up-to-date scientific and clinical informa
tion relating to the whole field of normal and abnormal speech communication,
and as such will succeed the earlier monumental work "Handbuch der Stimm
und Sprachheilkunde" by R. Luchsinger and G. E. Arnold (last issued in
1970). This series will prove invaluable for clinicians, teachers and research
workers in phoniatrics and logopaedics, phonetics and linguistics, speech
pathology, otolaryngology, neurology and neurosurgery, psychology and
psychiatry, paediatrics and audiology. Several of the monographs will also
be useful to voice and singing teachers, and to their pupils.
G. E. Arnold, Jackson, Miss.
F. Winckel, Berlin
B. D. Wyke, London
Preface
Neurologists, neuropsychologists, speech pathologists and other clinicians who
care for dysphasic patients have often complained that available books on
dysphasia tend to be parochially theoretical, and insufficiently directed towards
clinical reality. These books provide the categories, labels, and theoretical
speculations of one school or another; but dysphasic patients as often as not
do not fit neatly into a specific theoretical category. Clinical patterns of
dysphasic syndromes of most patients with dysphasia rarely conform fully
to the pictures painted in the textbooks. This clinical reality is especially
puzzling to those new to the field, who have assiduously learned the theories
and labels, and who now expect dysphasic patients to comply. How often
has the experienced clinician heard the student ask, "But what shall I call it?
I have to put something down on the report."
What is needed then is not another book describing the syndromes of
dysphasia but a book describing an "approach" to the dysphasic patient. In
such a book the emphasis would be shifted from a concern for the name of
a dysphasic syndrome to a concern for the patient. Key questions would be:
what are the clinical manifestations of this patient's problems? what neuro
logical disruptions underlie these problems? what preserved pockets of strength
does this patient have which may be called on for rehabilitation? and what
therapeutic approaches are available for such a patient?
In this book we have attempted to relate current trends in aphasiological
research to the needs of clinicians for the benefit of their patients. Specifically,
this book was designed around two issues: 1. What clinical approaches may
be useful in dealing with dysphasic patients? and why? 2. Once a diagnosis
of dysphasia has been made, what can be done? and why?
Although the work of others is summarized and discussed, the emphasis
here is on our own clinical and research experience. Bedside testing techniques
as well as more formal diagnostic approaches are provided. Syndromes of
dysphasia are presented in a manner as to relate contemporary neuropsycho-
VIII Preface
logical and neurolinguistic knowledge to what is actually seen at the bedside.
Approaches to therapy are described which derive directly from the clinical
symptomatology and which lead to specific functional goals.
A unique form of collaboration was developed for this book-unique in
the sense that so many authors worked together to co-author a single mono
graph on dysphasia. This book was not developed as a collection of indepen
dent, unrelated segments. Although each co-author was primarily responsible
for writing the initial draft of a particular portion, each was also responsible
for reviewing all sections. We have attempted to avoid providing just
another review of the literature. Our goal has been to write a comprehensive,
integrated, palatable guide for the clinician-a guide which is not only
informative on a theoretical level but also practical for every day use.
Weare indebted to our many colleagues for constructive comments and
criticisms in conversations and at meetings over the years. Our current opinions
derive not only from our own clinical observations and research but also from
interaction with and reaction to ideas and approaches of our colleagues. In
particular, we wish to thank Professor Norman Geschwind who suggested
that we undertake this project and who continually encouraged us in it.
Boston, Mass., and Minneapolis, Minn., Martin L. Albert
March 1981 Harold Goodglass
Nancy A. Helm
Alan B. Rubens
Michael P. Alexander
Contents
Part I. Examination of the Dysphasic Patient 1
A. General Clinical Considerations . 3
B. Brief, Clinical (Bedside) Examination for Dysphasia. 6
C. Clinical Guide to Classification of Dysphasic Syndromes . 9
D. Formal Language Evaluation . 11
1. Five Aspects of Assessment in Dysphasia 11
Dysphasia Testing as an Inventory of Language Input and Output
Modalities 11
Linguistic Aspects of Dysphasia Testing. 12
Diagnostic Aims of Dysphasia Testing. 17
The Dysphasia Examination as a Case Study. 19
Quantitative Aspects of Assessment . 20
2. Non-Language Aspects of Assessment . 21
Non-Specific Indicators . 22
Specific (Localizing) Non-Language Deficits 23
3. Assessment and Therapy. 23
4. The Formal Dysphasia Examination. 24
a) The Free Conversational Sample. 24
b) The Evaluation of Auditory Comprehension. 32
c) The Assessment of Productive Speech. 38
d) Repetition 39
e) Tests of Word Retrieval. 41
f) Reading . 45
g) Examination of Writing Ability 47
5. Testing for Dyspraxia. 49
6. Beyond the Formal Examination . 50
x
Contents
Part II. Clinical Features of Dysphasic Syndromes 51
A. Introduction. . . 53
B. Neuroanatomical and Neurophysiological Considerations. 57
C. Dysphasia with Repetition Disturbance . 69
1. Broca's Dysphasia. . 69
2. Wernidte's Dysphasia. 76
3. Conduction Dysphasia 80
4. Global Dysphasia . 84
5. Aphemia . . . . . 86
6. Pure Word Deafness. 88
D. Dysphasia without Repetition Disturbance. 92
1. Transcortical Dysphasias. . . 92
2. Transcortical Motor Dysphasia. 94
3. Transcortical Sensory Dysphasia 98
4. Mixed Transcortical Dysphasia. 99
5. Anomic Dysphasia. . . . . 100
6. Dysphasia from Left Subcortical Lesions. 103
E. Disturbances of Reading and Writing. 107
1. Dyslexias. . . . . . . . . . 108
Disorders of Written Language Associated with Dysphasia: Dys-
phasic Dyslexia . ............ 108
Dyslexia with Dysgraphia in the Absence of Dysphasia. . . 110
Dyslexia without Dysgraphia (Pure Dyslexia, Agnostic Dyslexia) 113
2. Dysgraphias. . . . . . . . 118
F. Special Clinical Forms of Dysphasia. 121
1. Crossed Dysphasia. . . . 121
2. Dysphasia in Polyglots. . 122
3. Dysphasia in Left-Handers. 124
4. Dysphasia in Deaf-Mutes. 125
5. Dysphasia in Dementia. . 127
Part III. Therapy of Dysphasia in Adults 129
A. Is Dysphasia Rehabilitation Effective? 132
1. Introduction. . . . . . . . 132
2. Measuring Response to Treatment. 133
3. Studies of Dysphasia Treatment. 134
4. Conclusion . . . . . . . . 138
B. What Approaches to Dysphasia Rehabilitation Are Felt to Be Most
Effective? . 139
1. Introduction. . . . . . . . . . . . . 139
Contents XI
2. Treatment of Global Dysphasia. . 140
Specific Approaches to Global Dysphasia. 140
3. Treatment of Non-Fluent Dysphasia. . 143
Specific Approaches to Non-Fluent Dysphasia 144
A Case Report of Treatment with Melodic Intonation Therapy. 147
4. Treatment of Agrammatism. 152
5. Treatment of Anomia. . . . 156
6. Treatment of Comprehension Disorders. 159
C. General Considerations for Dysphasia Rehabilitation 162
1. Group versus Individual Language Therapy. 162
2. The Influence of Fatigue and Perseveration on Dysphasia Re-
habilitation . . . . . . . . . . . . . . .. 164
3. The Influence of Reinforcement and Feedback on Dysphasia Re-
habilitation . . . 166
4. The Influence of Repetition on Dysphasia Rehabilitation. 166
5. The Influence of Sensory Input Variables on Dysphasia Re-
habilitation 167
6. Conclusion 168
References 169
Subject Index 187
Part I
Examination of the Dysphasic Patient
