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Animal analogue studies show that damaged adult brains reorganize to accommodate compromised functions. In the human arena, functional magnetic resonance imaging (fMRI) and other functional neuroimaging techniques have been used to study reorganization of language substrates in aphasia. The resulting controversy regarding whether the right or the left hemisphere supports language recovery and treatment progress must be reframed. A more appropriate question is when left-hemisphere mechanisms and when right-hemisphere mechanisms support recovery of language functions. Small lesions generally lead to good recoveries supported by left-hemisphere mechanisms. However, when too much language eloquent cortex is damaged, right-hemisphere structures may provide the better substrate for recovery of language. Some studies suggest that recovery is particularly supported by homologues of damaged left-hemisphere structures. Evidence also suggests that under some circumstances, activity in both the left and right hemispheres can interfere with recovery of function. Further research will be needed to address these issues. However, daunting methodological problems must be managed to maximize the yield of future fMRI research in aphasia, especially in the area of language production. In this review, we cover six challenges for imaging language functions in aphasia with fMRI, with an emphasis on language production: (1) selection of a baseline task, (2) structure of language production trials, (3) mitigation of motion-related artifacts, (4) the use of stimulus onset versus response onset in fMRI analyses, (5) use of trials with correct responses and errors in analyses, and (6) reliability and stability of fMRI images across sessions. However, this list of methodological challenges is not exhaustive. Once methodology is advanced, knowledge from conceptually driven fMRI studies can be used to develop theoretically driven, mechanism-based treatments that will result in more effective therapy and to identify the best patient candidates for specific treatments. While the promise of fMRI in the study of aphasia is great, there is much work to be done before this technique will be a useful clinical tool.

Caramazza et al. [Caramazza, A., Chialant, D., Capasso, R., & Miceli, G. (2000). Separable processing of consonants and vowels. Nature, 403(6768), 428-430.] report two patients who exhibit a double dissociation between consonants and vowels in speech production. The patterning of this double dissociation cannot be explained by appealing to sub-phonemic distinctions, such as sonority level or damage to specific phonological features. They argue that consonant/vowel status is an autonomous level of representation. Monaghan and Shillcock [Monaghan, P., & Shillcock, R. (2003). Connectionist modelling of the separable processing of consonants and vowels. Brain and Language, 86(1), 83-98.] present computational models which supposedly exhibit a similar double dissociation. They contend that these models can explain the patient data, without appeal to such supra-phonemic distinctions as consonant/vowel status. Here we argue that their claim fails to meet two necessary criteria. Their models do not fit the pattern of the patient data, either quantitatively or qualitatively. Furthermore, the motivation for these models is unclear beyond just being an attempt to explain this specific phenomenon. We conclude that these models, in their current form, do not provide an alternative explanation to the representation of consonants and vowels.

Objectives: To investigate the relationship between language functions and cognitive and functional outcome and to evaluate the effects of a conventional language rehabilitation programme on aphasic adult patients in the post-acute stage of traumatic brain injury (TBI)., Design: Non-concurrent prospective study. Patients were assessed pre-treatment and post-treatment with standardized assessment tools., Subjects: Sixty-one aphasic patients with TBI who were admitted to a rehabilitation centre in the post-acute phase for a late inpatient rehabilitation programme., Methods: The motor sub-scales of the Functional Independence Measures and Disability Rating Scale were used to assess functional status and disability. Cognitive status was evaluated with the Mini-Mental Status Examination and the Functional Independence Measure cognitive sub-scale. The language function was evaluated with the Gülhane Aphasia Test., Results: All functional, cognitive and language scores increased significantly during the rehabilitation programme. Language functions at admission were correlated with the Functional Independence Measure motor change scores and the Mini-Mental Status Examination change scores. Regression analyses revealed that auditory comprehension at admission was the most important independent determinant of functional and cognitive gain during rehabilitation., Conclusion: Post-acute language functions after late admission to a rehabilitation centre appear to be related to measures of cognitive and functional progress in patients with TBI. Functional and cognitive outcome is mainly affected by auditory comprehension. Results also showed the effectiveness of post-acute conventional rehabilitation in improving language functions.

We examined the effect of localized brain lesions on processing of the basic speech acts (BSAs) of question, assertion, request, and command. Both left and right cerebral damage produced significant deficits relative to normal controls, and left brain damaged patients performed worse than patients with right-sided lesions. This finding argues against the common conjecture that the right hemisphere of most right-handers plays a dominant role in natural language pragmatics. In right-hemisphere damaged patients, there was no correlation between location and extent of lesion in perisylvian cortex and performance on BSAs. By contrast, processing of the different BSAs by left hemisphere-damaged patients was strongly affected by perisylvian lesion location, with each BSA showing a distinct pattern of localization. This finding raises the possibility that the classical left perisylvian localization of language functions, as measured by clinical aphasia batteries, partly reflects the localization of the BSAs required to perform these functions.

In the clinical routine examination of patients with brain tumors, aphasic symptoms are often not recognized. In order to document the incidence of such symptoms, three diagnostic methods of testing for aphasia were compared: the Aachen aphasia test (AAT), which is the German standard aphasia test, clinical examination, and the Aachen aphasia bedside test (AABT), which was designed to test patients in the acute phases of illness. In the AAT, 50% of patients with left-sided tumors and 36% of those with right-sided tumors showed aphasic disturbances. The AAT results were defined as the gold standard. Clinical examination showed only low sensitivity; less than half of the aphasic patients were diagnosed as such. The AABT also detected only about half of the patients with aphasic disturbances. The low sensitivity is caused mainly by the results of the patients with right-hemisphere tumors, in which the mental set of the examiner during clinical examination (aphasic symptoms are not expected in patients with right-hemisphere lesions) and the pattern of disturbances in the AABT (deficits may be less severe and different in nature) may prevent detection of aphasic symptoms. Both clinical examination and AABT are thus not suitable for aphasia diagnostics in brain tumor patients. As the AAT is very time-consuming in everyday clinical routine, however, the development of an aphasia screening test seems desirable.

Object: The authors studied the neuropsychological correlates of stereotactically guided lesioning of the right and left posteroventral globus pallidus internus (GPi) in a prospective series of patients suffering from Parkinson's disease (PD)., Methods: Eighteen patients with PD who underwent stereotactically guided lesioning of the GPi (left side in 10 patients and right side in eight) completed neuropsychological evaluations before and after surgery. Patients served as their own controls. Multiple two-by-two repeated-measures analyses of variance were used to assess neuropsychological changes as a function of the side in which lesioning was performed (lesioning on the left side compared with that on the right) and surgery (presurgery compared with postsurgery). Relationships between cognitive variables and patient age at disease onset, age at surgery, and disease duration were examined using a linear regression model. The most striking findings were evident from results of a phonemic word fluency test in which patients in whom a left-sided pallidotomy had been performed achieved a mean performance score that was lower than the score of patients in whom a right-sided pallidotomy had been performed; this score declined even more as a result of surgery. Change in performance on the word fluency test across pre- and postoperative assessments was also related to patient age at onset of PD in those who had undergone left-sided pallidotomy, with patients of an older age at disease onset showing the greatest decline in performance., Conclusions: These preliminary findings indicate that the side on which surgery was performed and patient age at onset of PD are important in the prediction of postoperative cognitive outcome. The findings also indicate that stereotactically guided lesioning of the GPi presents a relatively mild cognitive risk.

The influence of both phonological and orthographic information on auditory lexical access was examined in left- and right-hemisphere-damaged individuals using a lexical decision paradigm. Subjects were presented with prime-target pairs that were either phonologically related (tooth-youth), orthographically related (touch-couch), both phonologically and orthographically related (blood-flood), or unrelated (bill-tent), at two inter-stimulus intervals (ISI)--100 ms and 750 ms--to tap more automatic versus more strategic processing. All groups demonstrated effects of orthography at both ISIs (facilitory at 100 ms ISI and inhibitory at 750 ms ISI), supporting the findings by Leonard and Baum (1997) that effects of orthography emerge independent of site of brain damage and suggesting that orthographic effects in auditory word recognition tend to be largely strategic. A facilitory effect of phonology was also found for all groups at both ISIs. The findings are discussed in relation to theories of lexical activation in brain-damaged individuals.

Objective: In spite of fundamentally improved medical management of subarachnoid hemorrhage (SAH), many patients remain mentally impaired. However, the causes of these disturbances are unclear. The present study was performed to elucidate the significance of the hemorrhage itself and related events in the neuropsychological performance of patients in the acute stage after SAH., Methods: A series of 51 patients were examined, by means of a battery of cognitive tests, 1 to 13 days (mean, 5.9 d) after SAH. Thirty-three patients had experienced ruptured aneurysms, and 18 had sustained SAH of unknown origin. Furthermore, 25 patients who had undergone surgical treatment (a mean of 5.0 d earlier) of prolapsed lumbar discs served as a control group., Results: The cognitive deficits of the patients after aneurysmal SAH proved to be comparable to those after spontaneous SAH of unknown origin, with the single exception of a significantly worse (P = 0.003) concentration capacity in the surgically treated group. The severity of SAH in computed tomographic scans correlated (up to r = 0.57, P < 0.001) with poor performance on tests of memory, concentration, divided attention, and perseveration. Frontal intracerebral hemorrhage led to significantly more errors in an aphasia screening test (P < 0.001) and a test of perseveration (P < 0.001). If acute hydrocephalus was present, the patients exhibited worse long-term memory (P < 0.001), showed slower reaction times (P = 0.01), and made more errors in the perseveration test (P = 0.004). Patients with intraventricular blood performed at significantly lower levels in the concentration (P = 0.001), divided attention (P = 0.01), long-term memory (P < 0.001), and perseveration (P = 0.003) tests., Conclusion: The results emphasize that the severity of SAH (Fisher score) is the most important factor related to cognitive dysfunction, but frontal hematoma, intraventricular hemorrhage, and acute hydrocephalus were also associated with cognitive deficits, compared with patients with SAH without these findings.

Diagnosis in acquired childhood aphasia (ACA) is a multi-stage process. After the medical condition has stabilised, the diagnostic evaluation requires careful assessment to establish a profile in the differential diagnosis of listening, understanding speaking, and gesture. Children with ACA were traditionally assessed on adapted batteries often used for adults. The Children's Acquired Aphasia Screening Test (CAAST) was specifically designed to evaluate linguistic and non-linguistic function in brain-damaged children aged between 3 and 7 years.

Aphasics, brain-damaged patients with no language deficit, neurologically intact elderly subjects, and university undergraduates matched pictures to sentences having compelling tacit implications (e.g., the sentence The fox grabs the hen strongly invites one to assume that the fox will eat the hen). All groups made, for the same sentences, qualitatively similar referential errors consisting in choosing a tacit implication picture. Two auxiliary experiments using the same target sentences in other interpretive situations permitted ruling out the possibility that these errors were due to the putative intrinsic semantic properties of the sentences, showing that the sentences which were most liable to elicit integrative error varied from task to task. These results are interpreted within the conceptual framework which posits that reliable directions for interpretation are couched by the speaker in the very structure of his utterances (the utterance's referential structure) providing the hearer with means to restructure the relevant personal knowledge integrated into the interpretive process in accordance with the speaker's communicative intent. The determination of the referential structure (RSD) of utterances thus seems critical to their correct or, more precisely, conventional interpretation, and, along with the tacit integration of relevant sources of personal knowledge, constitutes the principal cognitive device enabling us to understand each other. But this device appears to be easily corruptible. It is suggested that many errors made by aphasics in language interpretation are due to a failure to follow all referential instructions, but that qualitatively similar failures also occur in normal subjects, though to a lessen degree. Language interpretation is a fallible process and aphasic errors provide remarkable clues for the understanding of its subtle referential mechanisms.

Reduplicative paramnesia (RP) has drawn attention as a distinct behavioral syndrome caused by focal brain damage. To elucidate the pathogenesis of RP, we assessed its prevalence among patients with focal brain damage and followed those patients with typical RP. Seventy-seven patients with focal brain damage (47 with left hemispheric, 21 with right hemispheric, and 9 with bilateral damage) were assessed for the presence of RP using a questionnaire intended to elucidate this condition. Two patients showed typical RP for place, and four patients showed atypical RP (three for place and one for person); altogether, these six patients constituted 7.8% of the sample. In three patients, the lesions were situated in the right hemisphere; in two, the lesions were bilateral (right dominant); and in one, the lesions were in the left hemisphere, indicating the relative importance of right hemispheric damage and a possible contributory role of additional left hemispheric damage in RP. The case studies of patients with typical RP suggest the heterogeneity of the underlying cognitive factors in RP.

While verbal comprehension is often impaired in aphasia due to left hemispheric damage, the status of nonverbal conceptual knowledge of objects remains controversial. We tested 16 aphasic subjects for their comprehension of concrete single words. Eight showed significant impairment on word-to-picture matching, when distractors were semantically and not just perceptually confusable. These 8 also made errors in answering verbal probe questions concerning the same items. When tested on a nonverbal pictorial version of the same probe questions, however, 3 of these 8 improved their performance to the level of normal controls. The other 5 showed continuing impairment in indicating responses to pictorial probes. These 5 showed no evidence of generalized intellectual impairment, and it is concluded that they demonstrated a comprehension deficit not limited to the verbal domain. Unlike the other aphasic patients, these latter 5 also had CT scan lesions extending into the posterior left temporal lobe (involving Brodmann's areas 22, 21, and 37). They were also more impaired in terms of general aphasia severity. It is suggested that a nonverbal (as well as verbal) semantic memory deficit occurs in a subgroup of patients with single word comprehension disturbance due to aphasia, and this may reflect general severity of language impairment as well as damage to certain localized brain regions.

Intonational characteristics of Thai sentences were used to evaluate fundamental frequency (F(0)) control in brain-damaged patients with unilateral left and right hemisphere lesions. Subjects (n = 41) included 9 young and 10 old normal adults, 12 right hemisphere patients, and 10 left hemisphere aphasic patients (7 fluent and 3 nonfluent). Sentences were comprised of six words, three of which were keywords occurring in sentence-initial, -medial, and -final positions. All 125 possible sequences of three of the five Thai tones (mid, low, falling, high, rising) were superimposed on monosyllabic keywords. Utterances were produced at a conversational speaking rate. Average F(0) of keywords was analyzed as a function of sentence position, tone, and group. For both normal and brain-damaged speakers, results indicated that tones in sentence-final position were significantly lower in F(0) than in either sentence-initial or -medial position; falling and high tones were significantly higher in F(0) than mid, low, and rising tones. Findings are discussed in relation to issues pertaining to hemispheric specialization and the nature of F(0) deficits in nonfluent and fluent aphasic patients.

Ideomotor apraxia, disordered movement execution to command, commonly follows left-hemisphere damage, implying left-hemisphere dominance for certain kinds of movements. To delineate this dominance we used different command modalities to elicit meaningful movements and tested imitation of nonsense movements. Twenty-seven patients with unilateral hemispheric stroke and 10 age-matched controls were evaluated. Patients with left-hemisphere damage performed both meaningful and nonsense movements poorer than the other study groups; thus, the meaningfulness of the movements is irrelevant for the left-hemisphere motor dominance. The performance varied, however, with the command modality and movement type. Based on this and earlier studies we posit that the left-hemisphere motor dominance is determined by the artificiality of the test situation (it concerns movements performed to command and out of the natural context) and increased spatial and temporal complexity of the demanded movements. No association between the lesion locus within the left hemisphere and the severity of the ideomotor apraxia was found.

Script knowledge was examined in discourse produced by 15 mildly moderately impaired aphasics, 15 right-hemisphere-damaged (RHD) subjects. 15 neurological patients without central nervous system damage, and 30 normal controls. Experimental task were designed to elicit knowledge of particular scripts, various scripts from a category, metascripts, and plans. The results showed that the brain-damaged patients were able to produce information belonging to a given semantic category of scripts. Disorders demonstrated by both aphasics and RHD patients involved different discourse processes. Aphasics' impairment was mainly connected with discourse macroprocessing. Disturbances in the RHD subjects were found in text structures, contents, and macrostructure. The problem of the probable mechanisms of the observed discourse disturbances were discussed.

Semantic judgment tasks, based on antecedent pronouns and on word order, were presented to 16 aphasic adult subjects. Responses on the elicited imitation task were better than on comprehension tasks, a finding which parallels the language-acquisition behavior of children. Addition of features to a basic judgment of animate vs inanimate did not affect subjects' performance.

The incidence and course of aphasia, and its impact on vocational outcome, were determined in a group of 351 patients with severe traumatic brain injury (TBI). Aphasia was found in 11.1%, the common forms being amnestic (56%, 22/39), expressive (10.3%, 4/39) and receptive (10.5%, 8/39), as found on the first language assessment. No age difference was found between the aphasic and non-aphasic patients. Coma was more common in the aphasics than the non-aphasics (95% and 82%, respectively), although its mean duration was shorter. Aphasics had more severe locomotor deficits (p < 0.01, Fisher test) and tended towards more severe cognitive disorders (p = 0.07, Fisher test). There was no difference between the groups in incidence of behavioural disturbances or occupational outcome. Most of the aphasic patients improved after therapy, and two recovered completely. The presence of aphasia did not have negative prognostic implications for occupational outcome.

A patient with a selective impairment of speech output, associating phonemic paraphasias and pervasive preverbal pauses, it is described. Experimental data are discussed in relation to current models of speech production. On clinical evaluation, the pattern of paraphasias was strongly suggestive of a functional lesion affecting the output phonological buffer. This hypothesis received substantial support from a study of word and non-word repetition, as well as from a study of picture naming latencies, with various imposed delays between stimulus presentation and vocal response. In order to determine the origin of the preverbal pauses, the patient was also submitted to other timed motor tasks implicity probing higher levels of word production (gender decision and phonemic matching). We suggest that the pauses probably resulted from the conjunction of several mechanisms, including a general slowing apparent in all timed motor tasks, as well as a more specific time lag in speech initiation originating from the output buffer or from the articulator itself.

A 12-year-old girl developed Kluver-Bucy syndrome (KBS) following heat stroke. She demonstrated the features typical of human KBS, including visual agnosia, hypermetamorphosis, hypersexuality, language disorder with aphasia, hyperorality, placidity, flat affect, and memory dysfunction. Magnetic resonance imaging 11 1/2 months after onset disclosed mild, diffuse atrophy. Fourteen months after onset, she did not consistently respond to language or communicate verbally, and was dependent on others. A comparison is made with previously reported KBS cases in children.

There are few clinical tools available to assess communication skills following closed-head injury. This paper describes one such task in which the subject is required to explain a board game to a naive listener. The explanation is taped, transcribed and the content is quantified. Reliability studies demonstrated that the test can be consistently scored. A group of 43 normal subjects was investigated, and some variation in performance according to age and educational background was revealed. A group of 20 brain-injured male adults with executive-type deficits were then compared to a matched subgroup of the controls. The clinical group produced less essential information and relatively more unnecessary information than their non-brain-damaged counterparts. Qualitative features of discourse disorganization were also revealed.

Patients defined as having a moderate head injury on the basis of Glasgow Coma Scale scores within the ranges of 9 to 13 after acute nonsurgical procedures were selected. Almost 1600 cases were hospitalized in the Neurosurgery Department. The cases were admitted through the Emergency Unit of Gaz University Medical School, Ankara, Turkey during the period between 1979 and 1992. The group studied consisted of 231 selected patients assessed separately in paediatric, adult and elderly age groups. Possible risk factors such as: GCS score, anisocoria, unilateral or bilateral fixed pupils, impaired oculocephalic reflexes, presence of multiple systemic injuries, aetiology of head trauma, presence of linear or depressed skull fractures, space occupying mass on CT or operation was also assessed. Subarachnoid haemorrhage turned out to be the only independent significant risk factor in predicting mortality. The data about the patients who have "talked and deteriorated" were also reported so as to assisst physicians charged with the care of trauma victims.

Motor performance in 11 patients with ideomotor apraxia, 11 with aphasia without such apraxia, and 11 normal controls was compared. These three groups were matched on age, sex, education, severity of aphasia, intelligence, and size of lesion. Measures of aiming, tapping, line-following, and steadiness developed by Schoppe in 1974 were used. Both apraxic and aphasic groups showed difficulties with motor performance, and the data of the apraxic group were poorer than those of the aphasic group. These results were consistent with Liepmann's theory.

Idiopathic normal-pressure hydrocephalus remains difficult to treat. Controversy exists as to whether or not shunting can really improve cognitive functions and whether quantified intracranial pressure monitoring (ICP-Mo) can predict postoperative improvement rates. Several studies have drawn attention to the lack of a prospective study concerning the surgical outcome of this condition. We have performed such a study on idiopathic normal-pressure hydrocephalus patients shunted on the basis of ICP-Mo when "high" waves (amplitude > 9 mm Hg) were present. Twenty-three patients underwent surgery. The preoperative and postoperative clinical states were assessed by a quantitative procedure blind to the ICP-Mo results. A clear postshunting improvement was seen in 96% of the patients at 1 year with a statistically significant correlation between high wave relative frequency and the grade of improvement (P < 0.05). At the same time, 66.6% of shunted patients showed a significant improvement in cognitive functions. Complications of shunting were successfully managed without residual deficits in this series. We recommend the use of quantitative ICP-Mo as a criterion for surgery and to predict the improvement grade.

The language functioning of a group of adults who had sustained a severe closed-head injury in childhood was evaluated. The subjects were administered a battery of language assessments including measures of syntax, semantics and pragmatics, as well as a measure of metalinguistic ability. Performance of the experimental group was compared with that of a control group matched for age, sex and educational level. Results indicated that all areas of language competence assessed (syntax, semantics, pragmatics) appeared to be compromised by the childhood closed-head injury.

The effect on neuropsychological outcome of the number of acute haemorrhages, lesion volume, and lesion location in traumatic brain injury (TBI) was evaluated. Haemorrhagic lesion volume was associated with severity of injury. However, the number of petechial haemorrhages was not reliably associated with any of the clinical outcome measures. Likewise, despite the use of detailed morphometric methods to quantify volume, the acute lesion size did not significantly relate to neuropsychological sequelae. Furthermore, brain quadrant localization methods did not enhance outcome prediction. These results are discussed in the context of acute lesion analysis contrasted with chronic TBI-induced neuropathological changes associated with neuropsychological outcome.

This paper re-examines the theoretical concept of severe brain injury focusing on the duration of coma as a precise indicator of the clinical profile. A retrospective hospital chart study of 361 traumatic brain-injured patients was undertaken to determine the homogeneity of the subsample of the severely brain-injured (defined as 2 or more days of coma) with respect to the probability of four types of impairment: ataxia, contractures, paralysis and speech impairment. The current concept of severity assumes homogeneity among the 'severely brain-injured'. However, our results indicate significant differences in impairment within this population. The authors feel strongly that future studies must describe coma duration in finer gradations, and test for homogeneity within samples before inferences are made. Improvements in life-sustaining technologies have resulted in longer coma durations. The need to use coma days as an indicator of impairment rather than a broad category of severity is emphasized.

The relationships between hemispheric function and components of the imagery process were examined in patients with unilateral right and left brain damage and in intact adult subjects. In the image generation condition, subjects were required to mentally generate Katakana letters corresponding to Hiragana letters displayed on a CRT. The results for the intact adults suggested a left hemisphere superiority, but the unilaterally brain-damaged subjects showed no hemispheric difference in this task. In the imagery operation task (transformation or lateral translation), subjects were asked to find a genuine Kanji among distractors (pseudo-Kanji) that were constructed from two Kanji radicals (themselves real Kanji) that were either displayed in reverse order or shifted apart. The results for both intact adults and patients with unilateral brain damage suggest the superiority of the right hemisphere.

The recognition of handwriting is a specific achievement of the brain which need not be connected to understanding the written text itself. The goal of this study was to determine how this ability is impaired in patients with left- or right-sided lesions. Seventeen aphasic patients with lesions in the left hemisphere, 16 patients with lesions in the right hemisphere, and 15 normal controls (without CNS illness or damage) were investigated. They were asked to recognize the handwriting of a person well-known to them among a sample of ten different handwritten texts. The aphasic patients were able to recognize the handwriting of the familiar person either immediately or after some delay in 96%, the non-aphasic patients in only 44%, and the healthy controls in 100% of the cases. Results indicate that the recognition of handwriting represents a specific achievement which is independent of other verbal and lexical tasks. It is a task which involves the recognition of figural, geometric spatial patterns and, thus, an achievement of the non-dominant hemisphere.

The prosodic quality of speech comprises intonation, accent pattern, and rhythm. Among others, these dimensions contribute to the linguistic structure of an utterance and subserve emotional behaviour. Both cortical and subcortical dysfunctions can give rise to impaired speech prosody. The present paper reviews the clinical and linguistic features of the various dys- and aprosodic syndromes as well as their neuroanatomic substrates. 1. Sporadically, lesions of the left hemisphere present with dysprosody in terms of a "foreign accent". In most instances this syndrome seems to be due to apraxia of speech. 2. Some authors consider dysprosodic speech a characteristic feature of Broca's aphasia. The dysprosody of these patients predominantly reflects disturbed temporal organisation of speech utterances. Altered intonation contours, presumably, result from disordered sentence planning rather than from deficits of pitch processing. Wernicke aphasics may show increased variability of intonational patterns. 3. Impaired discrimination and identification of affective prosody has been observed in patients with temporoparietal lesion of the right hemisphere ("auditory affective agnosia"). With respect to linguistic prosody, controversial findings are reported on. Besides pitch extraction from acoustic signals the right hemisphere seems to provide categorical representations of emotional behaviour required for the "interpretation" of perceived intonation. 4. Damage to the right hemisphere can give rise to monotonous speech devoid of affective modulation ("motor aprosodia"). It is unsettled to which extent linguistic suprasegmental features are also distorted. The available data indicate an underlying dysfunction of basal ganglia loops and/or transcallosal projections. 5. Both Parkinson's and Huntington's disease may present with reduced prosodic modulation of speech. Probably, these deficits reflect disordered motor control of articulatory and phonatory functions. At least with respect to Parkinsonian patients perceptual and acoustic studies have so far failed to provide sufficient evidence of impaired prosodic planning.

An extensive naming battery was administered to ten patients representing classical aphasia syndromes. The battery included traditional performance measures and error scoring, phonological cuing, multiple-choice tasks tapping semantic and phonological knowledge, and word repetition tests. Differences in the patients' performance profiles were interpreted as reflecting lexical-phonological, phoneme assembly or multiple deficits. The results suggest that the hypothesized naming deficits have complex relationships to classical aphasia syndromes.

The effect of lateralized cerebral damage on free recall of items and recall of spatial location, under intentional and incidental learning conditions, was investigated. Eleven right brain-damaged (RBD) patients, 10 left brain-damaged (LBD) patients, 14 young and 11 elderly normal controls, participated in this study. The overall performance of the control groups was better than that of the patient groups. For all groups, free recall was better under intentional than under incidental learning condition. On recall of spatial location the learning condition had a differential effect on the groups. The RBD group performed better than the LBD group under intentional learning condition, while the reverse was found under incidental learning condition. The young-control group showed an advantage over the elderly-control group under intentional but not under incidental learning condition. The results are discussed in regard to different approaches to the distinction between automatic and effortful memory processes and their lateralization in the cerebral hemispheres.

Two patients with tactile naming disorders are reported. Case 1 (right hand tactile agnosia due to bilateral cerebral infarction) differentiated tactile qualities of objects normally, but could neither name nor categorize the objects. Case 2 (bilateral tactile aphasia after operation of an epidural left parietal haematoma) had as severe a tactile naming disturbance as Case 1, but could categorize objects normally, demonstrating that tactile recognition was preserved. Case 1 may be the first case of tactile agnosia clearly differentiated from tactile aphasia. CT scans of Case 1 revealed lesions in the left angular gyrus, and in the right parietal, temporal, and occipital lobes. Case 2 had lesions in the left angular gyrus and of posterior callosal radiations. Our findings suggest that tactile agnosia appears when the somatosensory association cortex is disconnected by a subcortical lesion of the angular gyrus from the semantic memory store located in the inferior temporal lobe, while tactile aphasia represents a tactual-verbal disconnection.

The performances of patients with stroke-produced unilateral hemispheric lesions on a test requiring the identification of lines were examined in the light of a recent report that contradicted previous observations. The study confirmed the results of earlier studies that patients with lesions of the right hemisphere show a remarkably high frequency of defective performances while those with lesions of the left hemisphere do not. Possible reasons for findings that deviate from this rule are discussed.

The Aachen Aphasia Bedside Test (AABT) has been developed in order to examine aphasic patients within the first 4 to 6 weeks after onset of illness. The psychometric properties of the AABT were established by repeated examination of 82 acute stroke patients, ratings by 20 raters on the basis of 10 videotapes, repeated examination of 28 chronic aphasics three times with an interval of 2 days, and parallel examination of 47 chronic aphasic patients with the AABT and the Aachen Aphasia Test (AAT), administered on the same day. Objectivity, reliability and validity of the AABT were highly rated, indicating its usefulness in acute stroke cases. Data on the 82 acute stroke patients showed that an initial prognosis can be made as early as the fourth day after the stroke.

In this paper communication disorders following closed head injury are described and various forms of language assessment techniques are reviewed. The usefulness of conventional, pragmatic and cognitive approaches is considered. A new cognitive-pragmatic approach is then advocated which is an amalgam of the last two approaches. From the examples given it is argued that such an approach is practical in terms of: 1) incorporating knowledge of co-existing cognitive deficits; and 2) focusing on normal everyday communication practices. It is also suggested that the use of a cognitive-pragmatic framework has potential in refining remediation and management strategies with the closed-head-injured population.

A patient is described with a rarely reported linguistic syndrome: he could repeat words but not nonwords. The patient produced semantic paraphasias in repetition and could read both words and nonwords flawlessly. His basic difficulties were localized in auditory phonological coding, identifying a clinical picture called "phonemic deafness." Short-term memory and verbal learning results suggested that a standard, selective short-term memory defect can be induced by auditory phonological coding deficits as well as by "pure" short-term memory capacity limitation and other phonological deficits. Findings also provided evidence that lexical-semantic code can allow normal verbal learning.

A detailed case study is reported of crossed aphasia (CA) in a dextral patient, bearing upon such controversial issues as intrahemispheric localisation of language function and hemispheric reversal of nonverbal function. DA, a man aged 37, developed a mild naming problem due to right temporal lobe haematoma. Apart from a mild acquired stutter, his continuous speech was fluent and had a normal proportion of open to closed class lexical items. His naming deficit appears to originate in the 'blocking' or 'disconnection' of the phonological lexicon: he could usually give a functional definition of un-named items and retrieve them with the help of a phonemic cue. Lexical retrieval appears his only language deficit, as he had no comprehension or phonological discrimination deficits. DA showed no visuo-spatial or auditory-nonverbal deficits, suggesting the complete reversal of hemispheric specialisation.

The ability to perceive and express emotional, as well as number of linguistic prosodic qualities of speech was tested in 20 Swedish-speaking patients with right-sided cortical, as well as purely subcortical brain infarcts, and in 18 normal controls. The infarcts were assessed by clinical neurological examination, and by CT, EEG, and measurements of regional cerebral blood flow (rCBF). In the patients the identification of emotional messages was disturbed, as well as the identification and production of several linguistic prosodic qualities. The study supports the claim that prosodic impairment could be linguistic in nature, and not secondary to affective disorder. The total degree of anatomical and functional disturbance of the right hemisphere played a role for both the ability to identify emotional messages and for identification of two of the linguistic prosodic qualities tested. However, it was not possible to find support for the hypothesis that the organization of prosody in the right hemisphere mirrors that of propositional speech on the left side.

Aspects of productivity, content, and cohesion in the narrative and procedural discourse of 11 closed head-injured (CHI) adults and 21 normal adults were examined. Two narrative tasks, one involving retelling a story heard and the other formulating a story based on a comic strip, and one procedural task of telling how to buy groceries were administered to each subject. CHI subjects consistently produced fewer words, spoke slower, used more mazes (dysfluencies), produced fewer target content units, and used fewer cohesive ties per utterance, as compared to the normal subjects. Other significant differences in discourse occurred between the two groups, but these varied from task to task. Normal subjects varied characteristics of their discourse performance according to the discourse task. Significant differences across tasks occurred on seven of the 13 discourse measures. The CHI subjects, however, showed more limited variation in that their performance varied on only three of the 13 measures. Correlations among discourse, language, and memory measures were examined and discussed. The results of this study indicate that analysis of CHI narrative and procedural discourse has important clinical and theoretical implications.

Forty-nine patients with recent right (RHD) and left (LHD) hemispheric vascular lesions were compared on a task of somesthetic-visual matching of meaningful objects and of meaningless shapes. A selective impairment for shapes was found in RHD subjects, while LHD patients were impaired in object matching. This double dissociation conforms to the classical distinction between apperceptive and associative agnosia, and extends to the somesthetic modality the "double dissociation" between left and right hemispheric lesions and associative and apperceptive recognition disorders, which has been found in other modalities of agnosia.

We compared the performance on test of language, apraxia, acalculia and intelligence of 32 children--age 5 to 16 years--and 31 adults, seen at our Aphasia Unit for the sequelae of a brain trauma. Logorrhea was never present among children who had nonfluent aphasia more frequently than adults. Apraxia and acalculia were equally present in the two groups. Twelve children and 15 adults of the first study were retested at variable distance from trauma. No group difference was found in the recovery of auditory comprehension (Token Test) or oral expression (oral confrontation naming and telling-of-an-event). On a battery of verbal and spatial memory tests 6 of the 12 children had pathological scores in one or more tests. Scholastic achievements were compared with those of the nearest kin. We conclude that while aphasia profiles are different in children and adults, the incidence of apraxia and acalculia and the recovery rate do not discriminate the two groups.

Four experimental procedures for assessing disorders of executive control (Nonverbal Continuous Performance, Graphic Pattern Generation, Sequence Generation Test, and Tower of Hanoi) were administered to 22 left-brain-damaged aphasic patients, 19 right-brain-damaged nonaphasic patients, and 49 healthy controls. Aphasic patients with frontal-lobe lesions were significantly more impaired on these tasks than aphasics with retrorolandic or mixed lesions in the left hemisphere. Patients with right-hemisphere lesions, especially those with frontal-lobe lesions, showed even greater impairments on these visual/spatial tasks. The results suggest that aphasics' impairments in executive control are independent of their linguistic and visuospatial deficits and are specific to lesions in left frontal and prefrontal regions. The clinical utility of the experimental procedures is discussed.

Two hundred-eighteen acutely brain-injured trauma patients with confirmed diagnosis of initial closed head injury completed two types of word fluency generation tasks, animal naming and single-letter-based word generation. Numbers of responses and inferred strategy utilizations were examined and compared with established norms for non-brain-injured individuals using frequency counts and chi 2 analyses. Significant differences were noted in response quantity and quality between closed head-injury patients and normals. A positive relationship was noted between level of cognitive functioning and number of word associates generated. Same initial consonant-vowel syllable (see-seed), semantic association (ship-sail), and same initial consonant-consonant blend (tree-trick) strategies were used by all subjects regardless of severity of injury. Quantitative and qualitative differences were noted as a function of severity of cognitive disruption.

This study used an Aphasia Screening Test (AST) abbreviated to its naming, pronunciation, and sentence interpretation items to compare groups of 60 learning-disabled (LD), 30 head-injured (HI), and 30 nondisabled (ND) young adults matched for FISQ and balanced for gender composition. The LD and HI, who did not differ, made significantly more AST errors than the ND. One-quarter to one-third of the LD and HI subjects exhibited language deficits. For the clinical groups only, AST errors, particularly pronunciation errors, were related negatively to WRAT reading and spelling scores. The Reitan and Wolfson (1988) severity ratings for AST items did not improve group discrimination.

The speech and language functioning of a group of 20 children (aged 8-17) who had sustained a closed head injury at least 12 months previously was assessed with the purpose of developing a comprehensive profile of the type and severity of the long-term speech/language disorders exhibited by this group. The same group of subjects was then re-evaluated 12 months after the initial testing to monitor progress of the closed head-injured group in relation to a group of non-neurologically impaired controls. The subjects were administered a battery of speech/language assessments including articulation/phonological assessment; oromotor assessment; overall language test; and specific language skills assessments. Initial and re-test performance of the head-injured group was compared to that of a group of non-neurologically impaired accident victims matched for age, sex and socioeconomic status. Comparison within the head-injured group of test and re-test performance was also carried out. Overall language performance scores of the head-injured group were found to be consistently significantly lower than achieved by the control group at both initial and re-test stages. Performance of the head-injured group had, however, improved significantly over the 12-month period.

The purpose of this study was to identify the passage dependency for three reading tests applied to the closed head injured (CHI) population and to determine whether reading the passage resulted in improved accuracy in responding to passage-related questions. Based on the performance of 10 CHI adults, passage dependency was low for all three tests. Only the Reading Comprehension Battery for Aphasia scores improved significantly when the subjects read the passages prior to responding. The results parallel those found with aphasic subjects and raise questions concerning the validity of these tests in assessing communication dysfunction post-CHI.

We are reporting on the case of a 7-year old, previously healthy boy with Schönlein-Henoch Purpura complicated by a severe encephalopathy: Two days after the initial abdominal symptoms he showed a prolonged cerebral convulsion followed by a 6-day semicomatous state, right-sided paralysis and aphasia. The typical skin lesions and joint swellings only appeared two days after the seizure. He was treated with acyclovir, followed by beta-interferon, both without apparent improvement. After initiating corticosteroids improvement of the neurological deficits was noticed. After 3 1/2 months he was still left with a right-sided spastic paralysis and mild aphasia. The cranial CT demonstrated initially a left-sided cerebral edema, later developing into a cerebral atrophy involving the periventricular structures as well as cortical regions predominantly of the left side.

Fifty-two aphasic patients were tested with a modification of part II of the Token Test. Three experimental variables were investigated: (a) the temporal sequence of information in the instructions, comparing instructions with preposition versus the ordinary postoposition of noun; (b) the spatial organization of the target objects, comparing an organization with color as the primary organizational factor to the ordinary organization primarily based on form; and (c) the specific timing of the presentation of instructions and tokens, comparing a successive presentation of instructions and tokens to the ordinary simultaneous presentation. Neither token organization nor instruction timing affected test performance. Sequence of information was important, however, and it is suggested that the effect can be explained by better opportunities for integration for preposition versus postposition instructions. The patients were also tested with several memory-span tests, and these results are related to those from the modified Token Test.