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Sentence comprehension deficits in aphasia : additional insights from impairment-specific assessment / Sandra Hanne


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Sentence comprehension deficits in aphasia : additional insights from impairment-specific assessment / Sandra Hanne

Sentence comprehension deficits in aphasia : additional insights from impairment-specific assessment / Sandra Hanne. In "Perspectives neuropsycholinguistiques sur l'aphasie - NeuroPsychoLinguistic Perspectives on Aphasia", colloque international organisé par l'Unité de Recherche Interdisciplinaire Octogone de l'Université Toulouse II-Le Mirail (France). Toulouse, 21-23 juin 2012.

Theoretical background 
Despite good performances in oral comprehension of single words and irreversible sentences, comprehension of semantically reversible non-canonical and complex sentences can cause enormous difficulties in adults with aphasia (Mitchum & Berndt, 2008). As these impairments affect specific syntactic structures (Grodzinsky, 2000) and occur across various syndrome classifications (Dronkers et al., 2004), standardized aphasia batteries often fail to detect them. However, sentence comprehension deficits can have a considerable impact on participation in everyday life (WHO, 2001). Following this, sensitive and in-depth tasks are required in order to tap the underlying (syntactic) deficit, which is a prerequisite for impairment-specific treatment.

Goal 
The objective is to present data from individuals with aphasia investigated with an in-depth assessment tool for sentence comprehension using sentence-picture matching. The sentence comprehension test (Burchert et al., 2011) systematically comprises syntactic structures, which have been shown to be vulnerable to comprehension impairments.

Method 
We report a case series study including 5 individuals with aphasia (38-74 years; 5-18 years post-onset), all native speakers of German, classified as Broca (n=3) and amnesic (n=2). Participants had a unilateral lesion in their dominant hemisphere, reduced memory span and good performances in auditory discrimination and single-word comprehension. The sentence comprehension test included irreversible sentences (long, short), reversible canonical (SVO, SRC) and non-canonical sentence structures (OVS, ORC). SVO and OVS sentences contained either number- or case-marking cues, whereas relative clauses (SRC, ORC) were divided into right-branching and embedded structures. Thus, canonicity effects, the influence of morpho-syntactic variables and syntactic complexity effects can be investigated selectively.

Results 
According to the standardized test battery (AAT, Huber et al., 1983) language comprehension seemed relatively intact (see percentiles in table 1). However, results of the sentence comprehension test showed severe impairments as well as considerable heterogeneity in performances of the 5 participants (see table 1). Whereas all individuals performed well on irreversible and reversible SVO sentences (above chance; within the normal range), accuracy dramatically declined for OVS structures; reflecting a canonicity effect. Comprehension of RCs was impaired in all 5 participants and a more specific canonicity effect was observed for right-branching RCs for 2 participants (P4, P5). Finally, these participants also showed a syntactic complexity effect, with decreased performance on embedded SRCs as compared to right-branching SRCs.

Conclusion 
The present study indicates that adults with aphasia can have specific deficits in oral sentence comprehension even though their syndrome classification and percentiles in standardized aphasia batteries do not reveal any such severe impairment in comprehension. Furthermore, the results give insights into the selectivity of syntactic comprehension deficits and their heterogeneous manifestations across single cases. This enunciates the clinical importance of sensitive tools assessing sentence comprehension in order to develop evidence-based treatment programs.

 

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