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Language processing disorders
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CHAPTER
10
Language Processing Disorders
CHAPTER OUTLINE Tracy E. Love and Kathleen Brumm
Introduction Accounts of Language Deficits in Right Hemisphere Damage

A Historical Perspective Aphasia and Language Processing
Types of Aphasia Sentence-Level Processing in Wernicke’s Conclusions
Language Processing in Aphasia Aphasia
Methodologies Used to Study Language
Processing
Several principles guide the work of this chapter.

INTRODUCTION The first is that to understand the nature of language
In normal conversation, we tend to take the remarkable processing, one must first understand the various
processes of language comprehension and production methods that have been used by researchers in the
for granted. We are seemingly able to carry on conversa- field. We discuss those methods and consider their
tions rapidly and effortlessly, expressing ourselves to advantages and limitations for the study of language
others and understanding what others convey to us. Yet, processing.
comprehension and production are exceedingly com- The second principle of this chapter is that the brain
plex, using a multitude of processes that occur during can use a variety of techniques or approaches to process
normal language processing and spanning multiple lan- language. These include automatic processes, problem
guage levels from basic phonological processing, lexical solving, specialized strategies, meta-linguistic reflec-
access, syntactic analysis, and discourse level processing, tion, and others. We examine how language processing
among others. can go awry at any of a number of stages, from an ini-
Often, we are unaware of how complex and special- tial or automatic operation to the arrival of final under-
ized language processes must be until we or someone we standing. As this is a large area to cover (speech percep-
know experiences neural trauma. Scientists first began to tion through discourse, with all that comes between),
learn about these processes and the architecture of the we limit our focus to the lexical (word) and sentence
language system by examining language disorders in in- structure building portions of auditory language pro-
dividuals who have survived some type of neural injury. cessing, which are particularly germane to the disorders
Those early explorations led to broad behavioral descrip- found in the aphasias.
tions of the general components of language (produc- Finally, our third principle is that evidence from lan-
tion, comprehension) and, more recently, of the levels of guage disorders arising from localized, acquired neural
processing involved in each of these components. trauma (specifically stroke) can help illuminate the
The goal of this chapter is to examine the nature and functional roles of brain regions that are (critically)
time-course of language processing in individuals who involved in language processing (Box 10-1).
have survived brain damage. We discuss acquired lan-
guage disorders and their potential underpinnings from
a processing perspective. Our discussion is based upon 1
As discussed in Chapter 6, the sentence is often considered
an examination of the psychological evidence for disor- the basic unit of analysis in language processing, and as
dered sentence-level1 language processing in acquired discussed throughout this chapter, it is at the sentence level
language disorders. Alongside this evidence, we examine where language processing disorders are frequently observed
specific neural regions that, when damaged, lead to aber- (although difficulties can certainly span all levels, including
rant language processing. in discourse).
202
Chapter 10 ■
Language Processing Disorders 203
We then present the categories (types) of language process could lead to the development of specialized
disorders subsequent to stroke and discuss empirical evi- treatment protocols for individuals with language disor-
dence that addresses the relationship between brain and ders (see Chapter 14).
language. We also briefly discuss more subtle impair-
ments of language that can occur following damage to A Historical Perspective
the side of the brain that does not typically dominate A brief historical review of early research into language
language (in most individuals, the right hemisphere). processing disorders will help to illustrate how contempo-
What is to be gained by such explorations? By under- rary research in the field has emerged. Prior to the 1800s,
standing the different levels of language processing and there were numerous reports of language disturbances in
the neural and cognitive architectures underlying them, individuals who had sustained some type of brain injury.
we hope to learn how and when they interact in However, there was little attempt to correlate particular
the unimpaired listener. Such investigations aid us in disorders with specific injuries. Much of what we now
understanding how language processing is disrupted know about how the brain processes language first arose
once brain damage occurs, and may aid in refining neu- during the mid to late 1800s in published case and group
rologically informed models of language processing. study reports of individuals who had acquired language
A comprehensive and accurate model of the language impairments subsequent to a stroke. This language disorder
Box 10-1
Focal Versus Diffuse Neural Trauma and Language Disorders
ACQUIRED LANGUAGE DISORDERS

Acquired language disorders refers to language deficits that results from neural trauma (stroke, traumatic brain
injury) or neurological disease (e.g., Alzheimer, Parkinson, schizophrenia), all of which result in some degree of
language impairment.
STROKE
A disruption in blood supply can result in relatively focal death of brain cells. This can occur from a blockage (ischemic
stroke) or from a bleed (hemorrhagic stroke). Most aphasia research has been conducted with stroke survivors because
of the ability to link aberrant behavior to a certain area of compromised brain. Here, one can investigate the deficits
present after the stroke and assume the other regions of the brain, not affected by the blockage or bleed, are still
structurally and somewhat functionally intact.
Ischemic stroke Hemorrhagic stroke
A clot blocks blood flow Bleeding occurs inside or

A to an area of the brain around brain tissue
From Nucleus Medical Media www.nucleusinc.com Continued

204 Chapter 10 ■
Box 10-1
Focal Versus Diffuse Neural Trauma and Language Disorders—cont’d
TRAUMATIC BRAIN INJURY (TBI)

This is the most common form of brain damage in individuals under 40 years of age. TBIs are classified as either
“open” or “closed” head injuries, with the former resulting from a penetrating trauma (e.g., gunshot wound) and
the latter from accidents (e.g., car crash) where the brain ricochets inside the skull.
Mechanism of Closed Head Injury
i on Acce
e lerat lera
Dec tion
1
8
2
5
6
4
3
7
Head thrown backward Head thrown forward

B while brain hits front of skull while brain hits back of skull
Individuals who survive a TBI have numerous language and cognitive deficits. The underlying cognitive deficits can
exacerbate or even mimic a language problem.
From Brain Injury News and Information Blog http://braininjury.blogs.com
is now referred to as aphasia and is characterized by is also not due to muscle weakness or a general cogni-
an impaired ability to produce and/or comprehend lan- tive disorder, though there are those who suggest that
guage in the spoken, signed or written modalities (see cognitive processes such as attention and memory are
Appendix 10-1 for a more detailed timeline of the field). compromised in aphasia, as well as language (see
Aphasia arises secondary to neural trauma (typi- Chapters 8 and 9).
cally stroke) and impedes the proper functioning The study of aphasia through history, which can be
of brain regions that support language. In most indi- traced to as early as the Egyptian era (3000 to 2500 BC),
viduals, this involves damage to the left hemisphere has been an interesting, albeit winding road. Often
of the brain. Aphasia is not the result of deficits in influenced, and usually limited by, erroneous contem-
sensory, intellect, or with psychiatric functioning.2 It porary beliefs ranging from the functional roles of
human organs to explanations of human behavior, it is
not surprising that we find contradictory hypotheses.
2
Historically, this was not always the case. In the late 1800s,
Aristotle (c. 360 BC) linked the localization of mental
there was a movement in which intelligence, sensory function, function to the heart, although centuries earlier,
and psychiatric function were argued to be implicated in ancient Egyptians had already associated language
aphasia. (Goldstein, 1924-original citation; Head, 1926; Jackson, expression with head injuries (Edwin Smith Surgical
1878; Marie, 1906; Trousseau, 1865), see Appendix 10-1. Papyrus, see Breasted, 1930; Garcia-Albea, 1999). Still
Chapter 10 ■
others focused on the relationship between language characterized as a disorder of language comprehension
deficits and intelligence or general cognitive function following damage to the left superior temporal gyrus.
(see Appendix 10-1). It was the work of Broca and Wernicke that spurred
In 1861 French neurologist Dr. Paul Broca provided early investigations of brain injury and its effect on
perhaps the most well-known initial description of a lan- language (among other behaviors).
guage impairment subsequent to focal brain damage Two important observations should be noted
(Broca, 1861). In a now famous case, Broca described a regarding “aphasia” research during this time.3 First,
patient who had lost the ability to produce speech, with scientists were operating under the assumption that
the exception of a single word (“tan”), yet demonstrated particular language functions (e.g., production, audi-
spared comprehension. Upon the patient’s death and tory comprehension) were controlled by specific neu-
subsequent autopsy, Broca discovered damage to the left ral regions, and thus assumed that damage to that
inferior frontal region of this patient’s brain (Figure 10-1, region resulted in a specific language deficit. While
BA 44-45), and he therefore attributed speech output this characterization of brain–behavior relationships
abilities to this circumscribed neural region. In this way, is intuitively appealing, later in this chapter we will
“Broca’s aphasia” came to be known as primarily a speech discuss how a good deal of research has since shown
production disorder following damage to left inferior this line of thought to be inadequate. Language is
frontal regions of the brain. much more complex than a simple “input–output”
Ten years later, German neurologist Dr. Karl Wernicke system.
was also investigating the relationship between local- During the early era of aphasia research, the field
ized brain damage and language impairments (Wernicke, of aphasiology was descriptive—language disorders
1874). He noted that language deficits could occur were characterized based on direct observable behav-
following damage to parts of the brain other than iors (i.e., the patient’s overt symptoms). However,
the left inferior frontal region, and that symptoms several years after Broca and Wernicke described pat-
differed depending on the brain regions involved. terns of language impairment in their patients, the
Specifically, Wernicke posited a link between the left Wernicke-Lichtheim model was introduced (Lichtheim,
superior temporal gyrus and language comprehension 1885), which marked the first attempt to predict pat-
(see Figure 10-1), after observing that patients with terns of aphasia following stroke. This model, shown in
damage to this region demonstrated comprehension Box 10-2, anticipated aphasia subtypes, or groups, based
impairments. From this, “Wernicke’s aphasia” was on symptoms and site of neural trauma. Symptoms
were cast in terms of language activities, like speaking
and listening; “lesions” (injury) within the core areas
and the connections between them were used to pre-
dict patterns of language impairment in aphasia. For
8 4 example, damage to the motor center would yield
5
9 6 7 a Broca’s type of aphasia, while a lesion to the auditory
1,2,3
center would yield a Wernicke’s type of aphasia. A
46 lesion to the auditory-motor pathway would yield a
40 39 disconnection syndrome, such as conduction aphasia,
10
44 characterized by the inability to repeat what is heard.
45 43 19
47 41 42 Hence, this model ushered in an era of aphasiology that
11 22 18
17 could be characterized as “connectionism.4” During
21 37 this era, connectionism assumed that higher mental
38
20
Figure 10-1 Left hemisphere of brain with Brodmann area 3

The term “aphasia” is quoted because during the 1800s,
labels overlaid. German neurologist Korbinian Brodmann the literature is filled with writings strongly debating the
(1909) provided a roadmap for the organization of the human appropriate term to use to describe these disorders; see
brain by painstakingly mapping 52 cortical regions. Each area, Appendix 10-1.
4
now known as Brodmann areas (BA), is a region of the cerebral Note that connectionism in the late 1870s refers to something
cortex that is defined based on its cytoarchitecture, or organi- different than the way connectionism is used today.
zation of cells. Historically, regions which have been impli- Today, the term “connectionism,” (also known as parallel
cated in language processing are BA 44, 45, and 22, although distributed processing) refers to the use of artificial neural
a number of neural regions have now been demonstrated to networks, computers, to model cognition (Feldman
contribute to language performance. & Ballard, 1982).
206 Chapter 10 ■
major types/syndromes of aphasia, to set the stage for

Box 10-2 a discussion of processing differences between these
Adaptation of the Wernicke-Lechtheim syndromes.
Model of Language Disturbance in Aphasia
TYPES OF APHASIA
Concept In this section we present some of the major classifica-
center tions (or subtypes) of aphasia. Note here that we are
describing the prototype of each of the main subtypes
of aphasia. “Pure” cases of any given type of aphasia are
seldom observed.
Broca’s aphasia is typically characterized by halt-
Motor Auditory
center center ing, nonfluent speech. Grammatical function words
(such as “is,” “and,” “the”) and inflections (for tense,
agreement, number, gender), are often omitted in lan-
guage production (spoken or written), with mainly
root content words being produced. Someone with
Motor Auditory Broca’s aphasia may say “boy girl fall” to mean “The
output input boy and the girl are falling” (Figure 10-2, A, B). Lan-
guage production is therefore described as telegraphic
or agrammatic (“without grammar”). In the 1970s, it
was discovered that this agrammatic component of
Predicted
Pathway Broca’s aphasia also extends to comprehension. The
Deficit
failure to detect comprehension deficits in Broca’s
Auditory Auditory Auditory Concept
0 0 patients was likely due to the fact that comprehension
compre- input center center
of single words and simple sentences (mostly) appears
hension
relatively intact. We now know that language impair-
Voluntary Concept Motor Motor
0 0 ment in Broca’s aphasics extends to comprehension of
speech center center output
more complex sentence constructions such as nonca-
Repetition Auditory Auditory Motor Motor
0 0 0 nonical structures (i.e., passives and object-relatives,
input center center output
see Chapter 6). This impairment for noncanonical
sentences was investigated by Caramazza and Zurif
(1976), who noted that Broca’s patients demonstrated
poor comprehension for sentences containing reversible
functions were dependent on the connections between noun phrases (e.g., “The boy was chased by the girl,”
different centers in the cortex (Ahlsén, 2006). A where either of the nouns boy or girl can perform the
more modern proponent of connectionism, Norman action chase). This was in stark contrast to the group’s
Geschwind, advanced the theory that disconnections ability to understand noncanonical sentences that
between neural regions could lead to language distur- did not contain reversible constituents (e.g., in “The
bances (Geschwind, 1965). Connectionism remained ice cream was eaten by the boy,” only the animate
an important concept in aphasiology for many years noun boy can perform the action eat, thus reducing
(and variants of this work remain active topics of the likelihood that patients would believe ice cream to
research). be the subject of the sentence). This finding of Broca’s
The contemporary era of aphasia research (and the patients’ difficulty in understanding noncanonical
focus of this chapter) was ushered in by Caramazza sentence structures led to the term “overarching agram-
and Zurif (1976) and others, who examined the dis- matism,” which refers to the fact that the grammatical
sociation between different levels of language pro- constituents of language are not employed in either
cessing deficits in aphasia (see Accounts of Language the production or comprehension of sentences (this
Deficits in Aphasia later in this chapter). Indeed, will be discussed in more detail shortly). In addition
current research aims to uncover the processing defi- to agrammatism, repetition abilities may also be im-
cits in aphasia that may account for observable lan- paired in this group (Table 10-1).
guage deficits. Before we discuss this process-oriented Broca’s aphasia, and a subtype known as agrammatic
research, we first introduce and briefly describe the aphasia, commonly occur following damage to the left
Chapter 10 ■
Speech sample from a patient with Broca’s Aphasia

(Patient was shown a picture book of Cinderella and asked to retell the story).
Experimenter: Tell me the story.

Patient: Happy. B- all- ballerina. I can’t say it. Uh, name.
Experimenter: That’s OK. Just keep going.
Patient: Sisters two. Mother evil. Mop- ing. Dress. Bird and, uh, mouse. One, two, three. Uh, angels? Fairy! Crying and
uh, uh, mother uh, mother lock- ed it.
Experimenter: Oh.
Patient: Yeah! Mommy, mommy, mommy! And uh, horse and dog. Wands. Uh, uh, muck lock lop moppins [muffins].
And uh, mouse and birds or?
Experimenter: I don’t know.
Patient: Oh well. Uh, bored. Curl. Pretty. And, uh, twelve. Shoe. Uh, run- ning. Yeah. And uh, sisters. Um, shoe? One.
Shoe? Right there? Bigger. Uh, and uh, that’s right.
Experimenter: Hmm?
Patient: That’s right (motions putting on a shoe).
Experimenter: Fits right.
Patient: Yeah. And affer [ever] and ever.
Experimenter: Great job.
A
Figure 10-2 A, Speech sample from

an individual with Broca’s aphasia,
retelling the Cinderella story. B, Same
individual’s written description from the
Western Aphasia Battery. [A is Courtesy
of the Cognitive Neuroscience Labora-
tory, SDSU. B is from Kertesz, A. (1982).
Western Aphasia Battery. New York:
Grune and Stratton.]
B
208 Chapter 10 ■
Table 10-1 Types of Aphasia and Associated Symptomotology

Aphasia Types Production Comprehension Repetition Naming
Nonfluent
Broca’s Halting, agrammatic Impaired for noncanonical Poor Poor
syntax
Transcortical motor Halting, agrammatic Impaired for noncanonical Intact Poor
syntax
Global Severely impaired Severely impaired Poor Poor
Fluent
Anomia Fluent, with word-finding Intact Intact Moderate-poor
problems, circumlocutions
Wernicke’s Fluent, facile, paraphasias Poor Poor Poor
Transcortical sensory Fluent, facile, paraphasias Poor Intact Poor
Conduction Fluent, facile Intact Poor Intact
inferior frontal regions (Figure 10-3).5 However, there Neologisms are suggestive of either impaired word
have been reports of individuals with Broca’s-like behav- finding or semantic processing in Wernicke’s aphasia. As
iors who have sustained damage to other, subcortical, re- illustrated in Figure 10-3, damage to the posterior tempo-
gions (Alexander, Naeser, & Palumbo, 1987; Fridriksson, ral regions is most often implicated in this type of aphasia.
Bonilha, & Rorden, 2007), and inconsistencies of this sort Similar to Wernicke’s aphasia, transcortical sen-
make it difficult to precisely characterize brain–behavior sory aphasia consists of empty or jargon-filled speech.
relationships. People with this rare type of aphasia cannot compre-
Similar to Broca’s aphasia, patients with transcorti- hend what others say to them. Unlike Wernicke’s apha-
cal motor aphasia are nonfluent and may produce sia, however, these individuals can repeat words or
telegraphic or agrammatic speech. However, these indi- sentences. Lesions to areas of the brain near Wernicke’s
viduals, unlike those with Broca’s aphasia, typically dem- area often lead to this type of fluent aphasia.
onstrate intact repetition. Brain injury with this group Conduction aphasia was originally described by
tends to be in areas surrounding Broca’s area, in the ante- Wernicke. It is classically defined as a disorder of
rior superior frontal lobe. impaired repetition of auditory material. More recent
In contrast to the halting, agrammatic speech ob- research has indicated that word-finding is impaired in
served in Broca’s or transcortical motor aphasics, a the disorder, and that individuals with conduction
patient with Wernicke’s aphasia has facile language aphasia often produce phonemic paraphasias in ongo-
production and speech that contains grammatical ing speech (Baldo, 2008; Fridriksson, 2010). Injury
structure. In this type of fluent aphasia, the “pre- to the supramarginal gyrus (see Figure 10-1, BA 40) and
served” speech fluency originally led researchers to arcuate fasciculus is commonly associated with conduc-
regard Wernicke’s aphasia solely as an impairment of tion aphasia (see Figure 10-3).
comprehension. Research has since shown, however, Global aphasia is the most severe of the aphasia
that language production in this syndrome is also types, in which both language comprehension and pro-
impaired and typically contains many instances of duction are profoundly impacted, rendering the individ-
paraphasias, as exemplified in Table 10-2. ual severely impaired. Brain lesions typically span across
Paraphasias in Wernicke’s aphasia may include jargon the frontal and temporal lobes. By contrast, anomic
or neologistic paraphasias (among others), which are utter- aphasia, or “Anomia,” is perhaps the mildest form of
ances that sound like words of the speaker’s language, but the disorder and is characterized by problems recalling
are in fact not real words. For instance, a patient with words or names.5 Individuals with this impairment fre-
Wernicke’s aphasia may produce a neologism like “glick,” quently use circumlocutions (speaking in a roundabout
which is not a true word but conforms to phonological way) to express words that they cannot recall or produce.
rules of the language (Figure 10-4). Persons with anomic aphasia may not show other obvi-
ous signs of impairment and may in fact produce rela-
tively fluent speech. Comprehension may be mildly im-
5
Anomia is a prominent feature of many aphasia syndromes. pacted in this group with repetition most often intact.
Chapter 10 ■
Broca’s aphasia Transcortical motor aphasia
Wernicke’s aphasia Transcortical sensory aphasia
Conduction aphasia Anomic aphasia Global aphasia
Figure 10-3 An illustration of typical sites of neural injury resulting in aphasia. This illustration demonstrates the
typical 1:1 lesions associated with these syndromes. It is important to not confuse the correlation of structure with that
of function. There is considerable variability in lesion sites with respect to damage to cortical and subcortical tissue.
Table 10-2 Examples of Paraphasias

Paraphasia Type Description Example
Phonemic (Literal) Substitution of one phoneme for another /pun/ for /spun/
within a single word /tevilision/ for /television/
Neologistic (Jargon, Gibberish) Substitution of word sounds phonetically and /glick/ for /pencil/
semantically unrelated to the target words
Semantic (Verbal) Substitution of one word for another, but not /flew/ for /soared/
always semantically related
Lesion localization in this group is the least reliable of all symptomology, thus being descriptive in nature. The
the aphasias. Most often, there is injury affecting tempo- descriptive nature of this process, relying on overt re-
ral and parietal regions (Fridriksson, 2010). sponses during assessment, can result in overgeneralizing
Some words of caution: In any discussion of language a patient’s ability or inability. This can cause difficulty in
disorders resulting from neural trauma, it is important to the interpretation of patient performance on language
bear in mind that diagnoses and classifications (type and assessments as any one assessment may not capture the
severity of aphasia) are based primarily on a patient’s entirety of a language disorder. As an example, consider a
Speech sample from a patient with Wernicke’s aphasia
(Patient was shown a picture book of Cinderella and asked to retell the story.)
Experimenter: Are you ready? OK let’s hear it.

Patient: First I started with a s- little, small it was the lady’s little which wa- was thing that I wanted before I could
remember, but I can’t do it now. This uh- I look carefully about what he he looked around but he couldn’t really try it
about there. At the same time, all these things, at least one, two, three people. Which were clever to the people. This,
this and she supposed to do that. I don’t know, but anyway, they say thinking.
And I just couldn’t with him carrying from absolutely doing this. While I’m doing absolutely nothing, uh, that I made,
made, made him and I was pushing this stuff, all this stuff was going. And all this was going anyway. So I look at that
point and, um, at those points, I had put the, you know, the one, two, three of the people were doing this and putting
everything through it, which I did.
And, um, at that time, um, I clevered what how much that little thing she went right here. Which is fine. I did as much as
I could. At the same time, at the beginning, she started to look at the um, girl who is looking for all this stuff that was
going through while he was there and I watched and watched that stuff that was going and through I looked at the mice
doing that.
It was very good and so on and the first thing I saw them do was this lovely small little thing for of and I said ooh!
First, I could feel the other girls were playing there and I was trying as much as I could to do that I never as much as I
could and that’s probably tried.
A
Figure 10-4 A, Speech sample from an

individual with Wernicke’s aphasia, retelling
the Cinderella story. B, An individual with
Wernicke’s aphasia’s written description of
The Cookie Theft picture. [A is Courtesy of
the Cognitive Neuroscience Laboratory,
SDSU. B from Goodglass, H., & Kaplan, E.
(1972). Boston diagnostic aphasia examina-
tion. Philadelphia: Lea & Febiger.]
B
Chapter 10 ■
situation in which a researcher or clinician wishes to mea- approach took the form of an untimed meta-linguistic
sure a patient’s auditory language comprehension abilities task. Such a task measures language processing after
and uses a task known as sentence-picture matching. In- the event of interest (e.g., after an entire sentence
dividuals are presented with a sentence and two (or more) has been heard). These types of tasks are considered
pictures and are asked to choose the picture that matches “off-line” measures and reflect what listeners ulti-
the sentence. A patient with an underlying sentence com- mately understand a sentence to mean. They allow
prehension deficit may be able to use a strategy rather individuals to consciously reflect on the problem and
than his/her linguistic knowledge to correctly perform the use all the resources available to them at the time
task, and thus this task may underestimate the full mag- to determine the final meaning of a sentence. Exam-
nitude of a patient’s language comprehension deficit. As ples from aphasia research include sentence-picture
an illustration, recall the earlier discussions of overarching matching, grammaticality judgment, and paraphrasing
agrammatism; prior to Caramazza and Zurif’s work on (e.g., Caramazza & Zurif, 1976; Friedmann, 2006;
sentence comprehension in reversible sentence construc- Linebarger, Schwartz, & Saffran, 1983) (see Chapter 6,
tions, it was thought that Broca’s patients maintained Box 6-2, for additional discussion).
intact language comprehension, thus resulting in claims While off-line methodologies are informative in
that these individuals had a primary production problem providing information as to how individuals ultimately
with intact comprehension. We now know that these understand or interpret language, these tasks do not
claims were inaccurate and that many comprehension allow for an examination of the moment-by-moment
assessment results were based on the ability of Broca’s operations of sentence processing as they are occurring
patients to use world knowledge to figure out the mean- in real-time. In an off-line task, if an individual demon-
ing of certain sentences (e.g., ice cream cannot eat boys). strates poor sentence comprehension performance, it is
Another note of caution: research on the neural un- unclear why the individual could not accurately per-
derpinnings of language is still in its infancy. A great form the task. For instance, consider a sentence-picture
deal of research has shown that although a particular matching task in which an individual with Broca’s
area of the brain may be implicated in a specific lan- aphasia demonstrates poor performance with nonca-
guage function (either through patient studies or in nonical sentences. A number of factors could contrib-
functional neuroimaging experiments), one cannot as- ute to this end result: the individual might have an
sume that a particular brain region is solely responsible underlying lexical deficit (knowledge of word mean-
for the process under investigation (i.e., that a particu- ings); an underlying structure building deficit (inability
lar language function lives in a specific brain region). A to link the incoming words to build structural relation-
damaged brain region that is implicated in language ships among them); or an inability to retain the sen-
processing may have only been an important part of a tence and match it to the pictures (working memory
network of different brain regions that were critical to deficit). Thus, while informative, off-line methodolo-
that particular level of processing. Likewise, if experi- gies alone do not allow for precise characterization of
ments demonstrate a link between normal operation of the underlying processes that contribute to language
a specific language process and a region of the brain, impairments. Additionally, the task demands of off-line
this does not mean that this area exclusively serves that methodologies may draw the participant’s attention
process, to the exclusion of other cognitive processes. to the linguistic material under investigation, and in
Thus, localization of function is not as simple as assum- doing so alter the nature of the comprehension process.
ing a direct 1:1 relationship between specific brain From this point on, we limit our discussion of off-line
damage patterns and subsequent language impairment. tasks and focus primarily on evidence garnered from
We now turn to a discussion of language processing on-line experiments.
in aphasia and begin with a discussion of the different
techniques used to measure behavior. The Study of Language Processing
via On-line Methodologies
Language Processing in Aphasia To understand the complete details of the comprehen-
Methodologies Used to Study sion process, language scientists require methods that
Language Processing can capture the moment-by-moment unfolding of
The Study of Language Processing comprehension. “On-line” tasks do just this, and allow
via Off-line Methodologies researchers to observe language processing both while
Until the 1970s, it was standard practice to use one it is occurring and without conscious reflection on
methodological approach to examine language ability the part of the participant. With on-line experimental
in patients with language disorders. Typically, this techniques and the right kinds of experimental designs,
212 Chapter 10 ■
researchers can examine the individual stages or com- accounts will be discussed first, followed by processing
ponents of language processing, and in populations accounts.
with language disorders, investigate which of these
stages may be impaired. In keeping with the goals of Representational Accounts of Broca’s
this chapter, we briefly summarize on-line methodolo- Aphasia Deficits
gies that have been (and are currently) used to study Within this theoretical framework of aphasiology, re-
auditory sentence comprehension in Table 10-3 (see searchers make use of linguistic theory to account for
also Chapter 6, Box 6-1). patterns of deficits that are exhibited by patients with
Taken together, these on-line methodologies can aphasia. These accounts sometimes claim that patients
provide complementary evidence regarding the nature with aphasia are unable to mentally represent certain
of language processing. These methods have been critical linguistic elements during language processing, or
in the development of accounts of language deficits in alternatively, suggest that linguistic theory is neces-
aphasia. sary to describe the deficit patterns in production or
comprehension.
Accounts of Language Deficits in Aphasia Production. In the realm of production, the Tree Prun-
In this section we discuss different accounts that have ing Hypothesis is a predominant linguistically-motivated
been proposed to describe the observable language theory of production deficits in Broca’s aphasia. Within
deficits in aphasia. We focus on evidence from Broca’s this framework, production deficits are ascribed to
aphasia, as the majority of work has examined deficits impairment among Broca’s patients in the ability to
in patients aphasics of this type. We conclude with represent elements of a linguistic tree. Consider (1) and
a brief summary of sentence processing research in (2) (from Friedmann, 2006):
Wernicke’s aphasia. 1. Today the boy walks.
2. Yesterday the boys walked.
Representation and Processing Here, the verb walk is inflected for tense (e.g., present or
Theoretical accounts of sentence processing deficits in past), and must also agree with the person, gender or
Broca’s patients generally fall in to two categories: repre- number of the subject (e.g., the boy/boys). Now consider
sentational or processing theories. Representational ac- Figure 10-5, which represents a linguistic tree structure
counts attribute deficits to the inability to construct for such a phrase, and note that Agreement (Agr)
particular syntactic representations. Processing deficit and Tense (T) are represented by separate nodes (see
accounts suggest that aphasic patients maintain implicit Chapter 6 for a discussion of tree structure representa-
linguistic knowledge of a language, but are unable to tions; example from Friedmann, 2006; Pollock, 1989;
effectively make use of this knowledge. Representational additional reference from Grodzinsky, 2000a). Here, the
Table 10-3 Methodologies Commonly Used in the Study of Language Processing in Aphasia
Elements of Language
Methodology Processing Studied Strengths Limitations
Event-related • Various levels of • Good temporal resolution • Only indicates the signatures of language
potentials language processing: • No secondary task processing, not the processes themselves
phonological, lexical- required • Concern about participant attention if
semantic, syntactic, • Not limited to single data no secondary task used
discourse-level point per stimulus
Eye-tracking • Lexical integration • Good temporal resolution • Only indicates the signatures of
• Syntactic processing • No secondary task language processing, not the processes
• Discourse-level required themselves
processing • Not limited to single data • Concern about participant attention if
point per stimulus no secondary task used
• Possible use of strategy, may alter
comprehension processes
Cross-modal • Lexical access • Indicates precisely which • Only one data point per stimulus item
priming • Syntactic processing elements of the sentence • Dual-task demand may be difficult for
are processed (“activated”) some patients
at point of interest
Chapter 10 ■
CP
Milder
(Wh-question) C⬘
C TP
(complementizer)
T⬘ Figure 10-5 An illustration of the lin-

Severe
guistic tree (see Chapter 6) proposed by
T NegP the Tree Pruning Hypothesis of produc-
(tense) tion deficits in Broca’s aphasia. [From
Friedmann, N. (2006). Generalizations on
AgrP variations in comprehension and produc-
tion: A further source of variation and a
possible account. Brain and Language, 96,
Agr⬘ 151–153.]
Agr VP
(agreement)
NP V⬘
V NP
important element to note is that Tense is represented also in comprehension. Prior to that study, off-line
at a higher node than Agreement. Interestingly, a good sentence–picture matching studies presented nonre-
number of cross-linguistic studies (many in which versible sentences (such as (4)) to patients, in which
tense and agreement are more richly inflected than in the nouns in the sentence represent both inanimate
English), have demonstrated that individuals with Bro- (ice cream) and animate (man) constituents (Linebarger
ca’s aphasia show dissociation in the production of et al., 1983).
Agreement and Tense. For example, given the following 4. The ice cream was eaten by the man.
prompt in (3), participants should produce a verb Real world knowledge allows for the supposition that
that is inflected for tense and must agree with the sub- the only noun in the sentence which can perform the
ject (past tense, third-person feminine singular, e.g., eating action is the man, which is the animate noun.
“jumped”; from Friedmann & Grodzinsky, 1997): Hence, individuals with Broca’s aphasia correctly
3. The girl wanted to jump, so she stood on the choose man as the subject of the sentence.
diving board and __________. Caramazza and Zurif presented reversible sentences
Participants with aphasia tend to be impaired in their such as (5):
production of tense but not in agreement, both for these 5. The boy was chased by the girl.
types of sentence prompts and in elicited speech. At first Note that although both (4) and (5) make use of passive
glance this dissociation is surprising, since both of these sentence constructions, in which the recipient of the
elements are inflected on the verb and relate information action precedes the verb, there are semantic differences
about the nature of the action that is occurring. However, between them. In (4), a listener can use meta-cognitive
the Tree Pruning Hypothesis contends that individuals knowledge to determine that the man must perform
with Broca’s aphasia have an impairment in representa- the action in this sentence. However, the participants
tion and/or use of the higher nodes on the syntactic tree, in (5) (“boy” and “girl”) are semantically reversible.
which include the node for Tense. Meanwhile, the node That is, either the boy or the girl can perform the
for Agreement is intact, and Broca’s patients can thus action, so there are no semantic cues that a listener can
use this linguistic element during production. use to interpret the meaning of this sentence. When
Comprehension. As mentioned earlier, Broca’s apha- individuals with Broca’s aphasia were presented with
sia was originally thought to be a production deficit. semantically reversible sentences like (5), they demon-
Caramazza and Zurif’s (1976) demonstrated that Broca’s strated chance performance (statistically equivalent to
patients not only had deficits in speech production, but guessing) on a sentence-picture matching task.
214 Chapter 10 ■
Based on the results of this study, Caramazza and Zurif a discussion of the properties of traces). Unimpaired
introduced the term “overarching agrammatism” to de- individuals are able to successfully comprehend sen-
scribe the deficits in Broca’s aphasia. The authors argued tences like (6) and (7) by automatically linking the
that Broca’s patients were not only unable to produce moved element (boy) to the position from which it
fluent, grammatical sentences, but that syntactic abilities was displaced (the trace, immediately after the verb),
were globally impaired in this population, thus also thus allowing those two elements to “co-refer” (Frazier
affecting sentence comprehension. This combination of & d’Arcais, 1989; Garnsey, Tanenhaus, & Chapman,
deficits across production and comprehension modalities 1989; Hickok et al., 1992; McElree & Griffith, 1998;
gave rise to the notion of a central syntactic impairment Nicol, 1988; Sussman & Sedivy, 2003; Tanenhaus
in Broca’s patients that affected receptive and expressive & Trueswell, 1995; Traxler & Pickering, 1996; and
language in similar way (Berndt & Caramazza, 1980; many others).
Caramazza & Zurif, 1976). 6. Alyssa saw the boyi who the dancer kissed ____ i
Caramazza and Zurif’s study helped to usher in the on the cheek.
contemporary era of aphasia research, in which aphasic 7. The boyi was kissed ____ i by the dancer.
deficits are considered within a linguistically based Persons with Broca’s, or agrammatic aphasia, are unable
framework. A slightly later study by Bradley, Garrett, to comprehend these sentences correctly, according to
and Zurif (1980) hypothesized that Broca’s aphasics had this account, because traces are deleted from the lin-
lost the ability to understand and mentally represent guistic representation, resulting in the inability to prop-
closed class words; that is, the small function words of erly assign a thematic role to the moved constituent.
a language, such as “the, by, in, and.” Both the first noun, Alyssa and the second noun, the
Caplan and Futter (1986) proposed the linearity boy in (6) are assigned the thematic role of Agent, but
hypothesis, which claimed that Broca’s patients evince by different mechanisms. The first noun assignment is
difficulty in sentence comprehension because they lack the result of a cognitive (nonlinguistic) linear strategy
the syntactic information needed to properly assign simply because it appears first, the second noun (the
thematic roles (see Chapter 6 for details on thematic boy) is assigned agent status by the verb kissed, a proper
role assignment). As a result (and since they arguably structural assignment. Given that there are now two
only can label incoming lexical items), other cognitive agents in the structural representation, the person with
strategies are required for comprehension. Caplan and Broca’s aphasia guesses as to “who did what to whom,”
Futter suggested that Broca’s patients assign thematic resulting in random performance on, for example,
roles via a linear sequence of nouns and verbs instead sentence-picture matching tasks.
of building a hierarchical structure; that is, the first
noun phrase (NP) is always considered the agent of the Processing-Based Accounts of Broca’s
action described by the verb, and the second NP, the Aphasia Deficits
patient or theme of the action. The studies discussed earlier, which argue for a repre-
sentational basis of deficits in Broca’s aphasia, were
The Trace Deletion Hypothesis (TDH, also known certainly crucial for the advancement of the field. How-
as ‘movement theory’) ever, off-line tasks were primarily used, which disal-
Grodzinsky (1986, 1995, 2000b, 2006) and Hickok, lowed any examination into the multiple levels of
Conseco-Gonzalez, Zurif, and Grimshaw (1992) argued processing that occur during moment-by-moment sen-
against the linearity hypothesis by claiming that patients tence comprehension. More recent work has suggested
can construct a normal, albeit incomplete, syntactic a processing deficit that may underlie the inability to
representation. These researchers have argued that the understand sentences containing traces, particularly for
problem in comprehension arises from a deletion of individuals with Broca’s aphasia; we turn to this work
a syntactic component (trace). This theory stems from later in the chapter.
observations that Broca’s patients only exhibit compre- Production. There has been a relative dearth of on-
hension difficulties noncanonical constructions, those line studies of production deficits in aphasia. This is
constructions which contain the displacement or move- most likely due to the potential confounds of collect-
ment of a constituent from the underlying representa- ing time-sensitive productions from patients who
tion to a position earlier in the sentence. This move- may experience comorbidity of speech disorders (e.g.,
ment purportedly leaves an empty category (or trace) apraxia, dysarthria) alongside their aphasia. While
which allows for the linking between that original on-line production studies in healthy individuals
position and the moved constituent, and ultimately typically measure either reaction times or error pat-
the assignment of thematic roles (see Chapter 6 for terns during production of target sequences, these
Chapter 10 ■
measures would be inappropriate with aphasic indi- four or five decades. We discuss some of the main
viduals. It would be impossible to know whether dif- accounts later.
ferences in reaction times between conditions were The Mapping Hypothesis. The mapping hypothesis
due to processing differences between those conditions (Saffran, Schwartz, & Marin, 1980, Schwartz, Saffran, &
or rather due to speech-motor planning deficits. Error Marin, 1980) attributes comprehension deficits in agram-
patterns are also not a good measure of production matic patients to a deficit in mapping semantic roles
in aphasia, as again, it would be difficult to ascertain onto sentence constituents (see Chapter 6 for a discus-
whether the errors were due to issues with on-line sion of semantic/thematic roles). This theory asserts that
processing during production, or with motor plan- the comprehension deficits found in Broca’s patients are
ning or execution. We now briefly describe a model the result of an impairment in the final interpretative
of speech production and discuss how it may contrib- stage of processing. In a series of studies, Saffran and col-
ute to an understanding of aphasic processing for leagues demonstrated that Broca’s patients were able to
language production. identify grammaticality and plausibility violations in
One account of on-line production deficits in Broca’s aurally presented sentences via judgment tasks. It was
aphasia attributes agrammatic errors to timing prob- argued that Broca’s patients do not have difficulty with
lems during the synchronization of production processes complex syntax, but instead cannot map a verb’s the-
(Kolk, 1995). Based on computational modeling, this matic roles (e.g., agent, theme) onto sentence constitu-
account claims that sentence production occurs as a ents (i.e., they cannot map meaning to sentence struc-
series of processing stages. Briefly summarized, lexical ture) (Marshall, 1995). A main argument against this
access occurs, followed by the insertion of lexical approach has to do with the reliance on off-line tasks to
items into syntactic “slots” in order for production to infer intact syntactic parsing. Swinney and Zurif (1995)
occur. Kolk asserts that in individuals with Broca’s argued that in order to appropriately evaluate syntactic
aphasia, lexical access proceeds normally, but the root parsing, one must distinguish syntactic and semantic
form of the words cannot be inserted properly into systems via tasks sensitive to automatic processing levels.
their syntactic slots. This inability is not due to On-line Evidence for Processing-Based Account in
a competency deficit because aphasic individuals Aphasia. Recall our earlier discussion of the types of sen-
can properly establish a sentence’s syntactic frame- tences that typically pose a comprehension challenge for
work, but is instead due to a processing deficit in that individuals with Broca’s aphasia; that is, noncanonical
they are slower to insert appropriate lexical items into sentence constructions that involve displacement or
their slots. movement of an argument. Example (6), repeated here
In addition, Kolk adds that this syntactic slot filling for ease of reading, is an instance of such a sentence
is generally slower for complex sentence structures (here, an object-relative).
than for simple sentence constructions in unimpaired 6. Alyssa saw the boyi who the dancer kissed i(t) ___
speakers. If so, slower slot filling in Broca’s aphasia on the cheek.
would disproportionately affect production of complex Traces have been shown to have real time processing
sentences over simpler ones. Kolk further contends that consequences (Swinney & Fodor, 1989). Lexical prim-
agrammatic speech is a form of message simplification, ing research with unimpaired individuals demonstrates
resulting from these timing problems. He argues that a specific pattern of activation in these constructions:
the production systems of patients are always overbur- initial activation of the meaning of the displaced con-
dened and that their capacity to produce well-formed stituent (the object of this sentence, boy) and reactiva-
sentences is overwhelmed. Thus, he claims, aphasic tion at the offset of the verb kissed, its base-generated
speakers will simplify messages greatly to compensate position before it is displaced (Hickok et al., 1992; Love,
for this limited capacity. Kolk’s hypothesis may account 2007; Love, Swinney, Walenski, & Zurif, 2008; Love &
for the telegraphic speech that is a hallmark of Broca’s Swinney, 1996; Nicol, Fodor, & Swinney, 1994; Nicol &
aphasia, as well as for the observation that patients Swinney, 1989; Swinney & Osterhout, 1990; Tanenhaus,
typically fail in their production of noncanonical (more Boland, Garnsey, & Carlson, 1989). By contrast, Broca’s
complex) syntactic constructions. patients do not show reactivation of the object at
Comprehension. Unlike accounts that describe defi- the offset of the verb (in real time) (Love et al., 2008;
cits in linguistic representational terms, processing- Swinney, Zurif, Prather, & Love, 1996; Zurif, Swinney,
based accounts argue that core knowledge is intact but Prather, et al., 1993). This work has led to hypotheses
a person with aphasia cannot make use of that knowl- that aim to account for on-line sentence processing in
edge to support language function. There have been a this population, and we highlight some of the predomi-
number of processing theories put forth over the past nant theories here.
216 Chapter 10 ■
Lexical Hypothesis. In attempting to understand 300 msec after the word’s offset and 500ms after the
the underpinnings of aberrant patterns of co-reference offset of the verb. This demonstrated intact compre-
linking during sentence processing in Broca’s aphasia hension of lexical access and structure building, yet
(and off-line sentence comprehension impairments), only at delayed (later) time points. In other words, the
some theories have focused on possible lexical retrieval pattern of activation for this NP during sentence com-
impairments. The rationale for this argument is that a prehension was present, but temporally delayed in Bro-
sentence structure cannot be built properly without ca’s aphasia. Love et al. (2008) provided evidence that
the appropriate building blocks of a sentence (words). slowed lexical access/activation in Broca’s aphasia
Thus a lexical deficit will lead to a breakdown in compre- might be an underlying cause of sentence comprehen-
hension. Some studies have implicated ineffective sion deficits in this population.
or degraded lexical retrieval of function (e.g., closed Evidence from electrophysiological studies (ERP,
class) words (e.g., Bradley et al., 1980; Friederici, 1983; see Table 10-1) might also support the assertion that
Haarmann & Kolk, 1991), while others have implicated on-line lexical processing is slowed in aphasia. Swaab,
poor lexical access of content (e.g., open class) words (e.g., Brown, and Hagoort (1997) showed a delayed ERP
Utman, Blumstein, & Sullivan, 2001; Milberg, Blumstein, component that is related to lexical/semantic process-
& Dworetzky, 1987; Love et al., 2008; Prather, Zurif, Love, ing (N400) in Broca’s aphasia. The authors contended
& Brownell, 1997; Swinney et al., 1989; Zurif, Swinney, that this delay could be attributed to slowed lexical-
Prather, & Love, 1994; Zurif, Swinney, & Garrett, 1990). semantic integration processes (see also Hagoort,
The lexical slow rise hypothesis argues that the Brown, & Swaab, 1996; Swaab, Brown, & Hagoort,
underlying nature of language deficits in Broca’s pop- 1998). In addition, recent eye-tracking evidence has
ulation results from a slowed lexical access system provided support for the theory that lexical slowing
(also termed “lexical activation”). Similar to the in Broca’s aphasia might underlie sentence compre-
model proposed by Kolk in the production arena, this hension difficulties (e.g., Dickey & Thompson, 2009;
slow rise of lexical activation may result in lexical Thompson & Choy, 2009).
information “feeding” into syntactic processes too Syntax Hypothesis. In contrast to processing ac-
slowly, leading to breakdowns of automatic fast-acting counts that claim that lexical impairments underlie
structure-building, which eventually leads to the par- sentence comprehension deficits in Broca’s aphasia,
ticular syntactic deficits seen in Broca’s aphasia (e.g., another body of theories claims that the source
Love et al., 2008). Indeed, recent evidence from on- of impairment in this population lies within the
line studies using cross-modal lexical priming (CMLP, syntactic system itself. According to these theories,
see Table 10-3; see also Chapter 6) provides support termed “weak syntax” or “slow syntax,” lexical access
for the lexical slow rise hypothesis. Participants in is purported to proceed normally, but the pro-
Love et al. (2008) heard sentences such as (8), while cesses by which these lexical items are combined into
probe words were presented at one of a possible 5 time syntactic structures is slowed (see Avrutin, 2006;
points during the sentence (each probe position indi- Burkhardt, Avrutin, Piñango, & Ruigendijk, 2008;
cated by *) : Piñango, 2000).
8. The audience liked the wrestleri *1 that the *2 parish Piñango, Burkhardt, and colleagues argue for a
priest condemned_____ i *3 for *4 foul *5 language. slow syntax hypothesis whereby the nature of Broca’s
Here, the goal was to determine when healthy indi- comprehension deficit is driven by a delay in the
viduals and those with Broca’s aphasia would access the parser to combine syntactic categories during syntac-
direct object of the verb condemned (“wrestler”), both tic structure formation. Specifically, it is argued that
when it was first encountered at its displaced position, there is a breakdown in the sequencing of syntactic
and again at its base-generated position after the verb. linking (a fast acting process which ensures that argu-
As expected from previous work, unimpaired partici- ments are syntactically linked) and the semantic link-
pants showed access for the direct object at both its ing of thematic roles (a later occurring process which
structurally licensed positions in the sentence, that is, linearly assigns an agent thematic role to the first oc-
at the offset of the object itself (*1) and at the offset of curring noun phrase). Because thematic role assign-
the verb (*3). By contrast, participants with Broca’s ment is argued to depend on a fully formed syntactic
aphasia did not show evidence of activation of the ob- structure (especially in the case of noncanonical con-
ject at either of these test points. However, lexical acti- structions), delayed input from the syntactic system
vation among Broca’s patients was observed, albeit at results in the availability of two competing interpre-
probe positions further downstream (*2, *4). Specifi- tations, one from the intrusion of extrasyntactic in-
cally, Broca’s patients showed access of the object formation and the other from a protracted syntactic
Chapter 10 ■
analysis. In a cross-modal lexical decision task, sub- which may not be specific to language operations. A
jects were presented with sentences like: good deal of work in this area has examined short-term
9. The kid loved the cheesej which j/i the brand new or working memory systems in Broca’s aphasia, with an
mi*1crowave melted ___ti ye*2sterday *3afternoon eye toward uncovering how resource allocation deficits
while the entire family was watching TV. may underlie comprehension impairment for complex
Three probe positions were tested, a baseline position sentences (Caplan & Waters, 1999; Caplan, Waters,
(400 msec before the verb, *1), 100 msec after the offset DeDe, et al., 2007; see Chapters 9 and 13 in
of the verb (*2, where thematic assignment occurs due to the text).
structural linking of the object and the trace) and a point This work, collectively referred to as “resource allo-
650 msec from the offset of the verb (*3).6 Unimpaired cation deficit theories” by some researchers, refers to a
subjects showed the previously reported finding of acti- cognitive deficit that affects an entire set of cognitive
vation of the object (cheese) only at the offset of the verb operations, not just linguistic ones. The hypothesis
(melted, *2). Broca’s patients on the other hand showed within these theories is that individuals with Broca’s
activation of the object only at the latter, downstream aphasia can successfully comprehend and process sim-
probe position (*3).7 These results are in line with those ple, canonical sentences with the cognitive resources
reported by Love et al. (2008, described earlier). Critically, that are available to them. However, when sentences
however, one cannot rule out a lexical level deficit in this become more complex, the limited cognitive systems
study as activation for the object itself (cheese) was not within which language processing occurs is taxed to the
tested at the first instance of occurrence. point of breakdown, and comprehension fails.
Additionally, some ERP experiments lend support to
the theory that syntactic processing or structure build- Sentence-Level Processing
ing is aberrant in Broca’s aphasia. Friederici et al. (1998) in Wernicke’s Aphasia
presented participants with aphasia with sentences that While the majority of sentence processing work in
included semantic (10) or syntactic (11) violations. aphasia has focused on deficits and patterns of pro-
10. The cloud was buried. cessing in Broca’s aphasia, several intriguing studies
11. The friend was in the visited. have examined the nature of on-line processing in
The authors reported that a Broca’s patient failed to Wernicke’s aphasia as well. Such studies show that
show a commonly found electrophysiological compo- on-line processing deficits are not uniform across
nent (ELAN) to syntactic violations, but did show a later aphasia types (Swinney & Zurif, 1995; Zurif et al.,
occurring component for syntactic reanalysis (P600). This 1993). Although individuals with Broca’s aphasia
patient also demonstrated an intact semantic component show on-line processing deficits for sentences contain-
(N400), a finding contrary to Swaab et al. (1997) (see also ing syntactic dependencies, research has indicated
Friederici, von Cramon, & Kotz, 1999). The researchers that individuals with Wernicke’s aphasia are fully able
contended that the results indicate intact semantic, but to compute syntactic dependencies in real-time and to
disrupted syntactic processing in this individual. These link constituents in a sentence during comprehension
results agree with theories of abnormal syntactic process- of complex sentences (e.g., Swinney & Zurif, 1995).
ing in Broca’s aphasia, although some caution may be However, as mentioned in the discussion of aphasia
applied, as they represent findings from a single patient. types, language comprehension (as measured via off-
Cognitive Theories. Along with theories of disrupted line indices) is impaired in Wernicke’s aphasia, which
lexical or syntactic processing in Broca’s aphasia, some leads one to question how on-line sentence processing
researchers have attributed sentence processing deficits proceeds in this population.
to impairment of one or more cognitive abilities, In Wernicke’s aphasia, word-finding or semantic prob-
lems are theorized to be disordered and are thought to
contribute to comprehension problems in this popula-
6
The timing information for the three probe positions was tion. One of the few studies to examine on-line sentence
provided in Burkhardt et al. (2008), but the exact visual processing in Wernicke’s aphasia suggests a semantic-level
positions of the probe points for this example sentence were
deficit in this population (Shapiro et al., 1993). The
not provided in the article. The markings of the three probe
authors investigated on-line verb-argument structure
positions in the example sentence were inserted by the
authors to assist the reader.
processing in Wernicke’s aphasia. In short, verb argu-
7
We note that Broca’s patients were not tested at the ment structure concerns how many arguments are
verb offset (*2) as it is argued that published reports had required to accompany a verb in order to satisfy
shown that Broca’s patients do not evince activation that verb’s thematic structure (see Chapter 6). The verb
at verb offset. “hit” requires two (and only two) arguments: an “agent”
218 Chapter 10 ■
who performs the action and a “theme” who receives the Right Hemisphere Damage and Language
action. Argument structure is considered to be relevant to Processing
the conceptual semantics of verbs. It is well known from The overwhelming majority of research that has con-
work with unimpaired individuals that verb argument sidered the brain-behavior relationships underlying
structure impacts on-line sentence processing load; spe- natural language processing has focused on the role of
cifically, verbs with more complex argument structures the left hemisphere and its subregions. This work has
take longer to process than verbs with fewer arguments attempted to determine how different neuroanatomical
(Shapiro et al., 1987; Shapiro, Zurif, & Grimshaw, 1989). regions cooperate to allow both language production
This increase in processing load is thought to reflect and comprehension. This focus of this work has largely
exhaustive activation of a verb’s argument structure; been driven by the lesion literature, in which damage
thus, verbs with more complex argument structure to the left hemisphere has been shown to produce overt
will lead to greater processing load than verbs with less behavioral deficits in language, whereas damage to the
complex argument structures. right hemisphere seemingly produces cognitive deficits
Results from Shapiro and colleagues’ investigations (such as attention deficits), which were considered to
of aphasia (e.g., Shapiro & Levine, 1990; Shapiro, Gordon, be nonlanguage specific. More recently, however, the
Hack, & Killackey, 1993) indicated abnormal on-line verb role of the right hemisphere (RH) for efficient commu-
argument structure processing among individuals with nication has been recognized. The finding that RH
Wernicke’s aphasia, which is in contrast to the normal damage could influence language performance grew
sensitivity of argument structure evinced by Broca’s out of studies that used right hemisphere–damaged
patients and unimpaired participants. Importantly, the (RHD) patients as control subjects for aphasia studies.
insensitivity to argument structure in Wernicke’s patients Many studies discovered that while RH patients per-
was observed irrespective of the syntactic complexity of formed better than aphasics in some tasks, they were
the sentence in which the verbs were embedded. The not at the same level of performance as unimpaired
authors contend that these findings signify a semantic control subjects (Gardner, 1994). More recent research
processing deficit in Wernicke’s aphasia, but one that has expanded these initial observations and now it is
requires a linguistic description. widely accepted that patients with RHD have a variety
The results from Shapiro and colleagues are sup- of language processing difficulties (see Tompkins, 2008,
ported by Friederici et al. (1999) in their ERP study for an excellent review).
of syntactic and semantic on-line processing. The In the past few decades, researchers have embraced
authors report that their Wernicke’s patient showed an the role of prosody, nonliteral (figurative) interpretation,
expected ELAN response and a delayed P600 response pragmatics, discourse comprehension, humor/sarcasm
to syntactically anomalous sentences, yet in this same and inference, among others, as integral properties of
patient, no N400 was observed when the patient language. The existing evidence has often demonstrated
heard semantic violations in sentences. This study these language properties to be deficient in persons
therefore provides additional support for the theory who have sustained unilateral damage to the right, but
that real-time syntactic processing remains intact not the left, hemisphere. Thus, discovering the role of
in Wernicke’s aphasia, while semantic processing is the RH’s contribution to language can now be seen
disrupted. as central to any complete account of language compre-
Shapiro and Friederici’s studies, taken together with hension and production. This section will discuss some
findings from on-line studies of syntactic processing of these language disturbances and the accounts which
in Broca’s and Wernicke’s aphasia (e.g., Love et al., attempt to explain RHD comprehension deficits.
2008; Swinney & Zurif, 1995), suggest a dissociation in
real-time sentence processing deficits. Whereas indi- Overview of the Role of the RH
viduals with Broca’s aphasia demonstrate on-line pro- in Language Processing
cessing deficits in response to syntactic complexity, The overall view of the role of the RH in language pro-
individuals with Wernicke’s aphasia demonstrate real- cessing has led to a view of the role of the RH as being
time verb argument structure processing deficits. Note centered on the development and maintenance of
that these are not the only processing factors that un- “alternative” or “secondary” interpretations during
derlie each aphasic type and associated pattern of be- language comprehension (see e.g., Brownell, Potter, &
havior. Rather, the studies discussed here provide Michelow, 1984; Brownell & Joanette, 1993; Burgess &
compelling evidence for distinct real-time processing Simpson, 1988; Chiarello, 1988; Faust, 2006; Joanette
impairments in these two groups during isolable stages & Goulet, 1988; Tompkins, 1995). These characteristics
of sentence comprehension. of the right and left hemisphere have been described by
Chapter 10 ■
Beeman (1998) as consisting of an LH that can choose inability of these patients to maintain alternative in-
contextually relevant meanings (“fine coding”) and the terpretations of lexical items.
RH that activates and maintains more distantly related Taking these results one step further, Tompkins
meanings (“coarse coding”). (1990), in one of the few temporally “on-line” tasks of
Coarse coding is argued to provide input that may RH processing, has demonstrated that RHD patients
be important for updating and revising interpretations possess an intact unconscious representation of meta-
during comprehension (Beeman, 1998; Faust, Barak, & phors, one that is not available during “off-line” testing
Chiarello, 2006). Course coding has also been linked procedures. In this seminal work, an auditory list prim-
to one’s ability to derive figurative meanings and draw ing paradigm9 was used whereby participants (RHD,
inferences (Beeman, 1993, Beeman, Friedman, Grafman, LHD and unimpaired controls) were asked to make
et al., 1994). RHD patients have difficulties in all these lexical decisions to a list of successive auditorilly pre-
areas and this has led some researchers to argue that sented word and nonword strings. In some instances
RHD comprehension deficits reflect a coarse coding defi- the word preceding a target item (open for example) was
cit (Beeman, 1993; Brownell, 2000; but see Klepousniotou related to the literal (closed) meaning of the target. In
& Baum, 2005, and Tompkins, Baumgaertner, & Lehman, other cases the preceding word was related to the meta-
2000, for contrasting results). phorical (honest) meaning. All three populations studied
Being able to understand communication requires (RHD, LHD, and unimpaired controls) showed similar
the listener to go beyond the specifics of what was patterns of priming for target words when either a meta-
said and integrate all levels of information, thus phorical or literal item preceded them (see Chapter 6
allowing for the understanding of nonliteral lan- for a more detailed discussion on priming). In show-
guage, which is said to be one-third of all communi- ing that RHD patients showed facilitation for the
cation. RHD individuals do not appear to appreciate metaphorical meaning of words, the authors con-
the abstract meaning of figurative (nonliteral) lan- cluded that RHD patients’ access to metaphorical
guage (Kempler, 1999). Work with RHD patients has meaning is intact, but that RHD results in the inability
shown a pervasive literalness in their interpretation to consciously interpret language was proposed (see
of idiomatic and metaphorical expressions such as also Tompkins et al., 1992).
“He has a heavy heart” (e.g., Winner & Gardner, The inability of RHD patients to understand multiple,
1977).8 Interestingly, left hemisphere-damaged (here- sometimes competing, interpretations has been argued to
after, LHD) aphasic subjects who exhibit gross “lin- cause this group to be overly literal in situations requiring
guistic” deficits are not drawn to the incorrect (literal) access to alternate interpretations to assist in the under-
interpretation of these items. Brownell et al. (1984) standing of sarcasm, inferences, humor and so forth
presented patients with word triads (such as “loving- (see for example, Brownell, Bihrle, & Michelow, 1986;
hateful-warm”) and asked them to choose the two Kaplan, Brownell, Jacobs, & Gardner, 1990; Weylman,
words that were most closely related. RHD patients Brownell, Roman, & Gardner, 1989; Winner, Brownell,
responded along denotative lines (“loving-hateful”). Happe, et al., 1998). For example, Molloy, Brownell, and
This was in contrast to LHD aphasics, who typically Gardner (1990) showed that RHD patients are impaired
responded with connotative answers (“loving-warm”) in their ability to use new information to reinterpret an
and unimpaired controls, who responded about utterance, in this case, the punch-line of a joke. The au-
equally with both types of relationships. Thus, a thors argue that when listening to a joke, the listener
double disassociation was demonstrated between makes assumptions about where the story is going. When
these two groups, such that the RHD subjects tend to they hear the punch-line, they are forced to reinterpret
prefer the more literal (denotative) groupings, whereas their understanding during comprehension, since the
the LHD subjects choose the figurative (connotative) meaning of the jokes goes against initial assumptions.
groupings (Brownell et al., 1984). This deficit in RHD Similar deficits in pragmatics and discourse can
processing of figurative words has been linked to the be seen in a RHD patient’s difficulty in identifying
the main idea or “theme” during comprehension.
Brownell et al. (1986) described RHD patients as being
8
The overwhelming majority of research with RHD patients
has relied on off-line metalinguistic tasks. However, research
9
with less cognitively demanding on-line implicit measures In a list priming paradigm, words are presented in a
have demonstrated intact abilities that are not evident in continual fashion to reduce the use of strategies, expectan-
off-line tasks (see Tompkins & Baumgaertner, 1998; and cies, on the part of the subjects. See Prather et al. (1997) for
Tompkins & Lehman, 1998, for a summary). a detailed description of the list priming paradigm.
220 Chapter 10 ■
able to process single sentences but unable to combine In (12), only activation of the greeting card meaning
information across sentences (see also Hough, 1990). should be evident, whereas in (13), only the second
They provided subjects with two sentence vignettes for meaning should be accessed. In their study, the authors
which half the time, the second sentence did not fit with found that the unimpaired group showed this pattern.
the first (e.g., Sally brought a pen with her to meet the However, RHD patients never evinced activation for the
movie star. The article would include famous people’s second meaning, leading the authors to conclude that
opinions about nuclear power). The latter sentence should this group was insensitive to context effects.
provoke the listener to revise his/her initial interpretation. These results may help to explain why individuals
The RHD patients showed a failure to re-interpret, making with right hemisphere damage face discourse chal-
them less able to infer the main theme. lenges; patients are unable to access multiple possible
We now turn our discussion to studies that looked at meanings of a linguistic constituent. This group’s over-
whether RHD patients can use sentence context to aid in reliance on literal interpretations for nonliteral lan-
the activation and selection of the appropriate meaning guage, such as jokes, metaphors, and indirect request
of ambiguous words. Similar to how idioms and meta- may also be a result of such a deficit. Individuals with
phors can be argued to have multiple meaning represen- right hemisphere damage may have only one interpre-
tations, lexical ambiguities are single words in our lexicon tation available, thus not allowing them to “choose”
which may have multiple meanings (“bug” can mean between two possible interpretations for a given utter-
“insect” or “spy device”). Studies of lexical ambiguity ance. These individuals may then only be able to
processing in healthy individuals have indicated that rely on the most common construal of the linguistic
all meanings of a lexical ambiguity are activated immedi- information.
ately upon hearing it (e.g., Swinney, Onifer, Prather, &
Hirshkowitz, 1979). This immediate exhaustive activation
for meanings of a lexical ambiguity occurs regardless of
CONCLUSIONS
sentence context that might bias towards one meaning of Much of the literature described in this chapter also
the ambiguity. It is only shortly thereafter that the com- suggests that there are areas of the brain that are related
prehender uses context to “select” the correct interpreta- to particular levels of language ability. Specifically, the
tion of a lexical item.10 If it is the case that RHD individu- anterior regions of the left hemisphere (those typically
als cannot maintain multiple meanings of an item, RHD damaged in Broca’s aphasia) seem to play a critical role
patients should not show the availability of less frequent in the fast-acting process of parsing. This includes
meanings at later points in sentence processing even if the accessing the meanings of words and building sentence
context of the sentence is biased towards that less fre- structure. The posterior regions (those involved in
quent meaning. Wernicke’s aphasia) seem to be involved in the inter-
Grindrod and Baum (2003) used a cross-modal prim- pretation of the constructed constituents.
ing study with unimpaired individuals and RHD patients Individuals with Broca’s aphasia demonstrate aber-
to investigate on-line access patterns for sentence-final rant access to lexical items during auditory sentence
lexical ambiguities. These ambiguities were embedded in processing and show delayed structure building, which
sentence which biased towards one of two meanings of result in specific comprehension deficits. In contrast,
the lexical item (see (12) and (13) next). Among sentence- Wernicke’s patients demonstrate intact parsing with
final ambiguities that have equally frequent meanings, hyperactivation of lexical items. It has been argued
one predicts that context will be used to select the (e.g., Milberg, Blumstein, & Dworetzky, 1987) that
appropriate meaning of the lexical ambiguity. these patients rely on intact frontal areas to perform
12. After writing a long message, he looked at the syntactic structure building but are unable to integrate
CARD (First meaning bias) the semantics of the constituent components to inter-
13. Although trying not to cheat, he looked at the pret sentence meaning. Research in neuroimaging
CARD (Second meaning bias) has played a large role in exploring how Broca’s and
Wernicke’s brain regions interact and work together
(or compensate) for particular deficits. Readers who
10
are interested in this area are encouraged to consult
This pattern is found and predicted ONLY when the
ambiguous words are presented within an on-going
Crosson, McGregor, Gopinath, et al. (2007). And finally,
sentence, not at the end of the sentence. In the latter case, individuals with RHD evince deficits in the integration
end of sentence wrap up effects (see Chapter 6) encourage of lexical-semantic information, information that is
top down influences resulting in context driven access (see critical for the interpretation of figurative language,
Balogh, Zurif, Prather, et al., 1998, for a review). jokes, indirect requests, and so forth.
Chapter 10 ■
Throughout this chapter, we have demonstrated Beeman, M., Friedman, R., Grafman, J., Perez, E., Diamond, S.,
that a language disorder can manifest in a variety of & Beadle Lindsay, M. (1994). Summation priming and
ways, and also that language processing research can coarse semantic coding in the right hemisphere. Journal of
Cognitive Neuroscience, 6, 26–45.
provide insight into which levels of the language sys-
Berndt, R. S., & Caramazza, A. (1980). A redefinition of the
tem have become impaired in patients with aphasia
syndrome of Broca’s aphasia: Implications for a neuropsy-
(and right hemisphere damage). We have noted that chological model of language. Applied Psycholinguistics, 1,
evidence from language processing research, especially 225–278.
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language deficits that we see in our patients with deficits in Broca’s aphasia. In D. Caplan (Ed.), Biological
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et Destruction Partielle du Lobe Antérieur Gauche du Cerveau.
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better characterize and understand aphasia, which will Brownell, H. H. (2000). Right hemisphere contributions to
not only lead to a better understanding of the lan- understanding lexical connotation and metaphor. In
Y. Grodzinsky, L. Shapiro & D. Swinney (Eds.), Language and
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Speech and Language Disorders, 18, 45–54. Weylman, S. T., Brownell, H. H., Roman, M., & Gardner, H.
Tompkins, C., & Baumgaertner, A. (1998). Clinical value of online (1989). Appreciation of indirect requests by left- and right-
measures for adults with right hemisphere brain damage. brain-damaged patients: The effects of verbal context and
American Journal of Speech-Language Pathology, 7, 68–74. conventionality of wording. Brain and Language, 36, 580–591.
Tompkins, C., Baumgaertner, A., & Lehman, M. (2000). Mecha- Winner, E., Brownell, H., Happe, F., Blum, A., & Pincus, D.
nisms of discourse comprehension impairment after right (1998). Distinguishing lies from jokes: theory of mind
hemisphere brain damage. Journal of Speech, Language, and deficits and discourse interpretation in right hemisphere
Hearing Research 43, 62–78. brain-damaged patients. Brain and Language, 62, 89–106.
Tompkins, C., Boada, R., & McGarry, K. (1992). The access and Winner, E., & Gardner, H. (1977). The comprehension of meta-
processing of familiar idioms by brain-damaged and nor- phor in brain-damaged patients. Brain, 100, 717–729.
mally aging adults. Journal of Speech and Hearing Research, 35, Zurif, E., Swinney, D., & Garrett, M. (1990). Lexical processing
626–637. and syntactic comprehension in aphasia (3rd ed.). Hillsdale,
Tompkins, C., & Lehman, M. (1998). Interpreting intended NJ: Erlbaum.
meanings after right hemisphere brain damage: An analysis Zurif, E., Swinney, D., Prather, P., & Love, T. (1994). Functional
of evidence, potential accounts, and clinical implications. localization in the brain with respect to syntactic process-
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APPENDIX
10-1
Early Reports of Language Disorders
1600 1650 1700 1750 1800 1850 1900 1950
EGYPTIANS 17TH AND 18TH CENTURIES

• Edwin Smith Surgical Papyrus (c. 2500 BC), refers to • 1683, Peter Rommel: reports a case of “rare aphonia.”
“speechlessness” after head injury (Case 22) A case of nonfluent conversational speech with
spared “automatic” speech (e.g., the Lord’s Prayer).
• 1745, Olaf Dalin: Preserved ability to sing despite
GREEKS severe nonfluent aphasia
• Homer: two types of speechlessness: Aphasia (loss • 1762, Giovanni Morgagni—presented cases of speech-
of speech due to emotion; Aphonos (voiceless/ lessness in patients who have right side paralysis
soundless) (hemiplegia)
• Hippocrates (400 BC): APHONOS (loss of speech/ • 1770, Johann Gesner (Die Spracharnnesie, The lan-
voice) due to stroke guage amnesia): First clear description of fluent-type
• Aristotle: the faculty of speech is located in the aphasias, which he called “speech amnesia.” Deficits
heart, not the head were not due to intellectual decline or loss of general
memory, but to a specific impairment in verbal
memory.
ROMANS
• Valerius Maximus (around 30 AD) described a “very
learned man from Athens” whose head was hit by a 19TH AND 20TH CENTURIES
stone and who consequently suffered from a loss of • 1801, Franz Fall—first to describe behavior links
his “memories for letters”. to specific areas (organs) in the brain, birth of
• Galen (103-200 AD) was the first one to localize phrenology
thinking, perceiving and movement in the brain. • 1825, Jean-Baptiste Bouillaud—first to describe the
First description of alexia, first hints of the separa- concept of inner speech (linking ideas to words) and
tion of speech disturbance and paralysis (c. 30 AD) that of articulation. Argued that there are different
neural mechanisms involved in these processes
• 1825/1843, Jacques Lordat—introduced the term
15TH AND 16TH CENTURIES “alalia,” a complete inability to speak, and made the
(RENAISSANCE PERIOD) distinction between verbal amnesia (loss of memory
• Antonio Guainerio (1440s)—memory deficits result for words) and verbal asynergy (loss of the ability to
in language production problems pronounce words with the clear knowledge of what
• Paracelsus (1500s)—linked head injuries to speech is desired to be said and no evidence of paralysis of
disturbances—paralysis sometimes occurs the tongue)
• Nicolo Massa (late 1500s)—traumatic aphasia, or • 1836, Marc Dax—language was seated in the left
anarthrias (loss of the ability to produce speech) anterior frontal lobe
225
226 Appendix 10-1 ■
Early Reports of Language Disorders
• 1861/1866, Paul Broca: “Aphemia, disorder in the • 1956, Roman Jakobson—used linguistic terminology
faculty of language”—intelligence, hearing, compre- to define motor and sensory aphasia
hension, and thought are all intact. Linked to an • 1950s/1960s, Luria, Geschwind, Goodglass—
area in the brain circumscribed to the left inferior development of more refined aphasia classification
frontal region. systems and links to brain regions. Further interest
• 1864, Armand Trousseau: “Aphasia, not aphemia” in levels of language errors (phonemic—Blumstein,
—intelligence, memory and attention almost always 1973; word—Geschwind, 1972; sentence—Zurif and
affected Caramazzo, 1972, 1976).
• 1874, Karl Wernicke—fluent language disorder re-
lated to the left posterior part of the superior tempo-
ral gyrus REFERENCES AND SUGGESTED
• 1877, Lichtheim & Kussmaul—generated models/ READINGS
theories linking lesions in areas of language centers
(or connections between them) Benton, A. L., & Joynt, R. J. (1960). Early descriptions of aphasia,
from 400 B.C. til 1800. Archives of Neurology, 3, 205–222.
• 1882, John Hughlings Jackson—aphasia is a cogni-
Brown, J., & Chobor, K. (1992). Phrenological studies of aphasia
tive disorder, is the inability to provide information
before Broca: Broca’s aphasia or Gall’s aphasia? Brain and
(in speech or gesture) Language, 43, 475–486.
• 1906, Pierre Marie—aphasia is an intellectual im- Buckingham, H. (2006). A pre-history of the problem of Broca’s
pairment; there was no one area of the brain that aphasia. Aphasiology, 20, 792–810.
played a role in the function of language Code, C. H., & Tesak, J. (2007). Milestones in the history of aphasia.
• 1913, Arnold Pick— a psychological approach to the London: Psychology Press.
study of aphasia. Attempted to model agrammatism Eling, P. (1994). Reader in the history of aphasia: From Franz Fall to
• 1926, Henry Head—aphasia is a disorder in the sym- Norman Geschwind. Amsterdam: John Benjamins. An edited
bolic formulation and expression. There is no center volume of the mentioned period.
Finger, S. (2000). Minds behind the Brain. A History of the Pioneers
for speech, writing or reading. First to develop an
and their Discoveries. Oxford/New York: Oxford University
assessment battery with both verbal and nonverbal
Press.
tasks Henderson, V. (1990). Alalia, aphemia and aphasia, Archives of
• 1948, Kurt Goldstein—Gestalt approach to aphasia— Neurology, 47, 85–88.
aphasia is the inability to differentiate figure and Prins, R. S., & Bastiaanse, R (2006). Early history of aphasia.
background which results in an inability to abstract From 1700 B.C. till 1861. Aphasiology, 20, 761–792.
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Language processing disorders

Chapter · December 2012

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Introduction Accounts of Language Deficits in Right Hemisphere Damage

Several principles guide the work of this chapter.

ACQUIRED LANGUAGE DISORDERS

Ischemic stroke Hemorrhagic stroke

A clot blocks blood flow Bleeding occurs inside or

From Nucleus Medical Media www.nucleusinc.com Continued

TRAUMATIC BRAIN INJURY (TBI)

Mechanism of Closed Head Injury

Head thrown backward Head thrown forward

From Brain Injury News and Information Blog http://braininjury.blogs.com

Figure 10-1 Left hemisphere of brain with Brodmann area 3

major types/syndromes of aphasia, to set the stage for

Speech sample from a patient with Broca’s Aphasia

Experimenter: Tell me the story.

Figure 10-2 A, Speech sample from

Table 10-1 Types of Aphasia and Associated Symptomotology

Broca’s aphasia Transcortical motor aphasia

Wernicke’s aphasia Transcortical sensory aphasia

Conduction aphasia Anomic aphasia Global aphasia

Table 10-2 Examples of Paraphasias

Experimenter: Are you ready? OK let’s hear it.

Figure 10-4 A, Speech sample from an

T⬘ Figure 10-5 An illustration of the lin-

1600 1650 1700 1750 1800 1850 1900 1950

EGYPTIANS 17TH AND 18TH CENTURIES

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