Aphasia and Related Cognitive-Communicative Disorders
G. Albyn Davis Adjunct Professor, New York University University of Massachusetts (Emeritus)
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Aphasia and Related Cognitive-Communicative Disorders
G. Albyn Davis Adjunct Professor, New York University University of Massachusetts (Emeritus)
Boston Bost on Col Colum umbu buss Ind India iana napol polis is Ne New w Yor Yorkk Sa Sann Fra ranc ncis isco co Up Uppe perr Sad Saddl dlee Ri Rive verr Amsterda dam m Cape Town Dub ubaai Lond ndon on Madr driid Milan Mun uniich Paris Mo Monntréal Toronto Dellhi Me De Mexi xico co Ci City ty Sã Sãoo Pau aulo lo Sy Sydn dney ey Ho Hong ng Kon ongg Se Seou oull Si Sing ngaapo pore re Tai aipe peii Tok okyyo
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Davis, G. Albyn (George Albyn). Aphasia and related cognitive-communicative disorders / G. Albyn Davis, Adjunct Professor, New York University, University of Massachusetts (Emeritus). — First edition. pages cm ISBN-13: 978-0-13-261435-1 ISBN-10: 0-13-261435-9 1. Aph phas asiia— a—T Text xtbo book okss. 2. La Lang ngua uage ge di diso sorrde ders rs—T —Teext xtbo book okss. I. Ti Titl tlee. RC425.D3787 2013 616.85'52—dc23 2013016486
10 9 8 7 6 5 4 3 2 1 ISBN 10: 0-13-261435-9 ISBN 13: 978-0-13-261435-1
ABOUT THE AUTHOR
G. Albyn Davis is
an adjunct professor of Communicative Sciences and Disorders at New York University and is professor emeritus for the University of Massachusetts at Amherst. He began his career as a speech-language pathologist at the Veterans Administration Medical Center in Pittsbur Pittsburgh gh and then t hen directed a VA-funded training program in clinical aphasiology at the University of Memphis. While at Memphis, he co-developed PACE therapy for aphasia and began writing texts with A Survey of Adult Aphasia. Dr. Davis has published articles and chapters ranging broadly from basic research to clinical essays, and he has presented his research internationally. He was an associate editor for the Journal of Speech, Language, and Hearing Research. He serves on the steering committee for the Clinical Aphasiology Conference (past chair) and served on the board of directors for the National National Aphasia Association. He is also a clinical research advisor to the Adler Aphasia Center. Center.
iii
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CONTENTS
Preface
1
xi
Int ntrrod oduc ucti tion on to Ac Acq qui uirred Lan ang gua uag ge Dis Disor orde derrs Diagnosing aphasia
1
Describing aphasia
7
Explaining aphasia
10
Studying aphasia
15
Treating aphasia
18
Summary and conclusions
2
22
Neu Ne urolo logi gica call and Me Med dic ica al Con onssid ider erat atio ions ns Neuroanato tom my, neu neurophysiology Ischemic stroke Hemorrhage Tumor
23
23
24 27
28
Focal cortical atrophy
30
Clin inic ica al neu neurological ex examination Clinical br brain imaging
32
Syndromes of ap aphasia
35
Exceptional aphasias
31
40
Summary and conclusions
3
1
42
Investig iga ating Language Impairm rmeents Word processing
43
43
Detecting sentence comprehension deficits Explaining sentence comprehension deficits Word finding and retrieval
47 50
58
v
Contents
vi
Sen ente tenc ncee produ duccti tion on and ag agrram amma mati tism sm Summary and conclusions
4
69
Inves esttig igat atin ing g Comm Commun unic ica ati tion on and and Pa Part rtic icip ipat atio ion n Cognitive pragmatics Prosody
70
73
Nonverbal modalities Discourse and text Conversation
74 76
82
Communication partners Life participation
87
89
Summary and conclusions
5
64
90
Clinical Assessment and Diagnosis The first visit
92
92
Standardized testing
93
Administering th the fo formal te test
95
Documenting sy syndromes: Th The Boston Ex Exam Syndromes quantified: The WAB-R
99
Psychometric Psych ometric constraints: The PICA United kingdom: CAT
103
106
Revival: Eisenson’s Examining for Aphasia Bed edsi side de sc scrree eeni ning ng an and d bri rief ef ba batt tter erie iess Diagnostic de decisions
Summary and conclusions
109
113
115
Supp Su pple leme men nta tall and Fun unct ctio iona nall Asse sesssme ment ntss Word comprehension
107
110
Aphasia in in bil biliingual in individuals
6
96
117
Model-based as assessment of of rea readin ing g
119
117
70
Contents
vii
Modular impairment: PALPA Sentence co comprehension Word retrieval
123
125
129
Ver erbs bs:: Co Comp mprreh eheens nsio ion n an and pr prod odu uct ctio ion n Speech disorders Severe aphasia
131
131 133
Fun unct ctio ion nal co comm mmun unic ica ati tion on and ou outc tcom omes es Overall fu functional ou outcome Life satisfaction
139
140
Summary and conclusions
7
142
Recovery and Prognosis Stroke
143
143
Recovery of la language
144
Approaches to to pr prognosis Type of stroke
150
151
Severity of of im impairment Type of im impairment Other factors
151 153
156
Bilingual recovery
159
The targeted prognosis Explaining recovery
160 161
Summary and conclusions
8
133
164
Treatment of of Lan Language Im Impairment Rehabili littation te team an and se settings Getting st started
165 165
166
Cognitive stimulation
168
Measurement an and ge generalization Word-finding and retrieval
175
173
Contents
viii
Computer-assisted treatment
182
Ef ficacy of impairment-based treatment The brain with treatment Health care topics
188
189
Summary and conclusions
9
193
Specialized Treatments for Impairments Studying individual cases Sentence production
197 205
Wernicke’s aphasia
206
Conduction aphasia
208 209
Reading impairments
210
Spelling impairments
212
Severe or global aphasia Medical treatments
213 215
Summary and conclusions
10
194
194
Asyntactic comprehension
Anomic aphasia
183
219
Functional Rehabilitation and Participation The clinical–functional gap Functional stimulation
220
220 222
Adaptive language strategies
224
AAC: Alternative and augmentative communication Interactive therapies Life participation
230 237
Psychosocial adjustment Summary and conclusions
245 249
226
Contents
11
ix
Right-Hemisphere Disorders Clinical neuropsychology
250 251
Primary cognitive impairments Secondary impairments
259
Cognitive pragmatics of RHD Discourse
266
Clinical assessment Treatment
268
270
Recovery and outcomes
276
Summary and conclusions
Traumatic Brain Injury Head trauma
277
278
278
Neuropsychological assessment
281
Primary cognitive impairments
283
Personality and behavior Insight
290
291
Language
291
Discourse
294
Cognitive rehabilitation
299
Recovery and outcomes
308
Summary and conclusions
13
261
263
Conversation
12
253
311
Dementias and Progressive Aphasias Diagnosis and assessment of dementia Alzheimer’s disease
314
312 312
x
Contents Other causes of dementia
316
Dementia of Alzheimer’s type (DAT) Language with DAT
317
322
Communicative and cognitive interventions Medical treatments
334
Primary progressive aphasia Summary and conclusions
References
341
Author Index
403
Subject Index
411
335 339
327
PREFACE
This is my fifth textbook about aphasia and related disorders. This one was rewritten entirely with students in mind. The style is more relaxed, as if talking over a cup of coffee. I wanted this book to have my classroom voice. Space is devoted to walking the reader slowly through key theories and methods. I am hoping that this enhances learning and provides a foundation for disciplined curiosity. The book is organized according to a logical progression. First, we try to understand a disorder. Our understanding then leads to assessment. Based on assessment, we treat the disorder. Running through these topics are some fundamentals that make the study of aphasia so fascinating, such as neurological foundations (Chapters 2, 7, 9, 12, and 13), psycholinguistic methodologies (Chapters 3, 8, 9, 11, and 13), and the pragmatics of linguistic communication (Chapters 4, 6, 10, 11, 12, and 13). The book includes research doing its normal work of substantiating claims and therapies. Some studies are like figures or photos in that they illustrate a principle that should be remembered. An experimental procedure can make a cognitive theory or process seem more concrete or comprehensible. I invite the reader to use these moments to work on understanding. The memory, if needed, will be there. It’s the way the mind works. Part of a narrative is the identification of “characters” by naming names and telling where the work was done. While location of past work will remain accurate, individuals move on. I apologize for any location that becomes obsolete over the life of this edition. I want to thank the members of the Adler Aphasia Center for their inspiration and the National Aphasia Association for allowing me to serve the aphasia public in a small way. My model audience was my students at the University of Memphis, University of Massachusetts, and Lehman College. I am currently enjoying the enthusiasm and grace of graduate students at New York University, including Melissa Chalef, who had the courage to critique my previous book for a class project, and Alvaro Heinig, who, among other things, discovered that I had been misspelling “gibberish” for 30 years. Also, I wish to thank everyone at Pearson Higher Education for overcoming my stressed out moments and being supportive and helpful. I would also like to thank the reviewers, including Barbara B. Shadden, University of Arkansas. Steve Dragin, executive editor, has been like a friend. Finally, my wife, Betsy Elias, has been all of the above and my favorite golf partner.
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1
CHAPTER
Introduction to Acquired Language Disorders
Sanjay Gupta, CNN’s medical expert, was reporting to Anderson Cooper early in 2012 about wounded Congresswoman Gabrielle “Gabby” Giffords’s communication dif ficulties. Dr. Gupta described her symptoms astutely but did not hint that they have a name. A similar omission had occurred in a 20/20 story a couple of months earlier (Simon, 2012). Most of us hear about “aphasia” in adults for the first time as we pass through college on our way to becoming speech-language pathologists. This chapter has one main goal and a subtext. The goal is to prepare the reader for what lies ahead by introducing the range of topics associated with the rehabilitation of persons with aphasia. The subtext is a foundation of thought that underlies studies of aphasia and related disorders.
Diagnosing Aphasia Responding to the referral of someone with brain damage, a speech-language pathologist (SLP) evaluates oral motor function and communicative capacity. The SLP also determines whether the patient has aphasia. The nature of aphasia has not changed over the years, but scientific progress has in�uenced the way we talk about this disorder, including the way we define it. One of these in�uences pertains to how we view the relationship between language and cognition (Davis, 2012). Aphasia can be defined as a selective impairment of the cognitive system specialized for comprehending and formulating language, leaving other cognitive capacities relatively intact. In addition to an obvious reference to cognition, the definition
omits a frequently included reference to etiology. Other definitions are likely to add “. . . caused by brain damage” to a statement about language impairment. A cause is indeed an important diagnostic clue, and SLPs expect that people with aphasia will have damage to a particular part of the brain. Yet the cause does not comprise the dysfunction. Let us put the definition to work for us. It implies that a diagnosis can be based on at least two comparisons. First, to identify impairment, we compare a client’s language behavior to a norm. Then, to identify aphasia, we compare language functions to other cognitive functions. The relationship between language and cognition 1
