Part I: Linguist Approaches to Aphasia
According to sociolinguistics, there is a study of society and its role in facilitating language use among individuals from different backgrounds (Burns et al., n.d). In exploring the approach, researchers delve into multilingualism, code switching, dialect, gender differences et al. Code switching is not only studied from a cultural context but, its tenets also bring about affiliation with linguistic perspectives. Alternatively known as language switching, it revolves around the process or concept of either altering or incorporating variety of languages in a given conversational exchange. Before switching these languages or codes, sociolinguists reiterate the necessity of ensuring that the listeners are aware of the newly grasped codes. Studies have upheld the sociolinguistic approach apropos of code switching because it accommodates language development from childhood to adulthood. From as early as two years old, it is possible for children emanating from bilingual homes to develop the skill of code switching.
Familiarizing oneself with the skill means that people should only alter the codes when the context allows. There are certain rules and regulations demarcated by sociolinguists in their attempt to delineate the sociolinguistic approach to aphasia. There is need to incorporate control while switching between various language so as to avoid meager errors. These bilingual speakers are supposed to learn the art of separating these languages, accordingly; so as to maintain control in speech. From this understanding, therefore, researchersenlighten individuals on the inability of aphasic patients to control two languages to the full capacity (Lorenzen & Murray, 2008). Due to failure of controlling the language systems and codes, speech that is elicited by aphasic patients remains disfluent and non-communicative. Since these aphasic patients cannot maintain control over their language systems, it is inevitable to witness difficulties in code switching. While attempting to understand the sociolinguistic approach to aphasia, different languages set apart the scope of dialectical innuendos (Burns et al., n.d). Dialect, being the specific mode of language in a given space, is given priority while exploring the scope of aphasia. Different dialects create room for the incorporation of first and second languages as well as their role in identifying the process of language production and development in one’s brain. Like ordinary, mundane and common words, speech from first languages; in comparison to second languages, are often stored in the long-term memory.
Additionally, sociolinguists attempt to probe further into the scope of aphasia through multilingualism (Burns et al., n.d). Unlike bilingual speakers, individuals speaking more than one language often experience more complicated effects after stroke (Lorenzen & Murray, 2008). Aphasia is among the detrimental brain disorders that affect one’s ability to regain all the lost languages after injuries. To gauge the chances of acquiring one’s languages, therapists delve into one’s language use before the stroke as well as the consistency of use during the recuperation process. Obviously, according to the sociolinguistic approach, if an individual was quite proficient in a language before the brain damage, there are higher chances of regaining their skill after recovery. Seeing as aphasia affects each language independently, persons that speak fewer languages are less affected by the disorder. According to parallel, differential and selective impairment; with aphasic symptoms, each of the languages is affected, one of the languages [out of the many] is affected more and only one language is affected, respectively. Insofar as one’s proficiency plays a significant role in the recovery, the extent of brain damage is also essential in assisting therapists to settle on the best treatment. There are different forms of recovery which touch on each of the languages in an independent manner. Apropos of aphasia and multilingualism; each language may improve [parallel recovery], only one language improves [differential recovery], a single language improves more than others [selective recovery], the languages are regained simultaneously [successive recovery] or one language improves while the other continues to deteriorate [antagonistic recovery]. Different studies have, however, concluded that parallel recovery is the most common after brain damage (Caplan et al., 1996). It is especially because most multilingual individuals use all languages to the maximum, therefore, easing the recuperation process. Regardless of the amount of time taken, there are high chances of aphasic patients recovering each language fully. Treatment of multilingual aphasia should be approached with an open mind because every person responds and recuperates differently depending on the damage, internal or external factors (Caplan et al., 1996). Gender differences are also part of the scope of this sociolinguistic approach to aphasic.Apart from age, there is the need to examine gender disparities in understanding aphasic speech and its detrimental nature apropos of language production.
Inasmuch as aphasia affects both males and females, there are certain forms that also affect these sexes independently. Before concluding that Broca’s aphasia is prevalent in both men and women, it is important to delineate male susceptibility to the symptoms of aphasia. Even if anomic, Broca’s and global aphasia are common in both females and males; the females suffering from intracerebal hemorrhage (ICH) have lower chances of eliciting aphasic signs and symptoms. Apart from deciphering its extremities, the virtue of either being male or female also influenced the recovery process of aphasic patients (King & Holmes, 2016). While speech disfluencies and disorders are prevalent in male individuals; the recovery process, in comparison to their female counterparts, is relatively slow. Sex hormones are responsible for the different structuring to people’s brains and language processing systems. The utilization of unilateral and bilateral cerebral hemispheres in male and females respectively has a role to play in the behavioral differences in diagnosing aphasia (Caplan et al., 1996). Both cerebral hemispheres and sex hormones are involved greatly in comprehending gender differences as per the sociolinguistic approach to aphasia. Their affiliation with bilateral cerebral hemispheres means that females boast larger areas of activation while handling language-related responsibilities (Caplan et al., 1996). From another perspective, research shows that the unhealthy livelihood of male persons elevates their susceptibility to aphasia. Overindulging in alcohol, cigarettes and other harmful drugs is classified under the bracket of risk factors for aphasic stroke. Even if there are females that live unhealthily, according to the sociolinguistic approach, it is men whose lifestyles are at stake. Presence of estrogen in the female reproductive system also acts as a protective hormone and prevents women from being prone to aphasic symptoms.
The relationship between functional communication and pragmatic performance in relation to linguistic competence is a critical approach to understanding the communicative environment. Sociolinguistic approach identified the linguistic competence as the factor that influences the relationship. In the evaluation of communication sociolinguistics scholars often find the distinction between linguistic competence and pragmatic competence inseparable to the principle of functional communication. The sociolinguistic approach approaches the research through the determination of how specific characteristics of the pragmatic behavior affect distinct spheres of functional communication. The sociolinguistic analysis of the speech patterns of the aphasic patients points out to lack of linguistic competence in the wake of existing communicative competence (Burns, Blonder, and Heilman, 1991). This means that the errors-grammatical, phonological and lexica-semantic in the speech of patients suffering from aphasia makes the conversation difficult to follow.
Focusing on functional communication, the profiling of particular strengths and weaknesses in the pragmatic competencies in the communication makes a provision that outlines the consequences of the communication in the daily interactions of aphasia patients. In the assessment of the pragmatic ability, the evaluation focuses on the speech act usage, capacity to take turns and lexical selection in the evaluation of the overall quality of communication n the real life activities. According to Burns, Blonder, and Heilman (1991), sociolinguistic research favors the multiple speaker interactions over single informant because of the communicative competencies where the cultural rules and social organization influence the conversational routine, speech register, and level of formalities and language choice. For researchers attempting to understand aphasia, the communicative competence facilitated by the illocutionary force that provides the intention to communicate and how it is affected by the conditions is an important point of the review.
Applying principles of Speech Function analysis, the conversational principles are analyzed to provide an examination of the speech functions, dialogues, and the effects of the syntactical and lexical limitation in the conversational context. Sociolinguist often categorizes the aphasia performance into fluent versus non-fluent. Notably, non-fluent aphasia provides a demonstration of normal patterns of communication in comparison to fluent aphasia. In this situation, the speech function analysis allows for the accommodation of crucial communication information such as gestures to provide the distinction and describe functional communication. However, the analysis provides a revelation for deficits in functional communication presented in linguistic constraint such as specificity, accuracy, pause time in turn taking, conciseness, fluency, and quantity. However, despite this, sociolinguistics apply the evaluation of these deficits in the analysis of the levels of pragmatic performance which in an indicative of the functional communication of the patient with aphasia. Avrutin (2001) points out that the relationship between the ability to understand the language rules-pragmatics and implement the rules actually when speaking directly to other individuals within a social context. The relationship of the pragmatic performance and functional communication makes provisions that sociolinguists apply to predict the severity of aphasia.
Societal aspects in sociolinguists should be taken into consideration because of the importance of language in the community. The sociolinguistic approach enlightens individuals on the relationship between culture and language in any given society. Delving further into the issue of competence in sociolinguistics, there is a focus on the difficulties that are accentuated by incorporating grammatical errors into speech. Other phonological, lexical and semantic errors also heighten the existence of these difficulties in speech production and delivery. Since sociolinguistics only focuses on language research, it is not an approach that applies cognitive tenets. Creating a relationship between sociolinguistics and neurolinguistics, therefore, gives rise to loopholes due to the former’s preference for non-cognitive ideas. The sociolinguist approach reminds individuals of the necessity to uphold these changes in speech, despite classifying them under the bracket of ‘speech deficiencies’. According to other social, linguistic and cultural contexts, instead of being related with speech disorders, the changes are embraced affirmatively. Assessment on psycholinguistic approaches emphasizes the necessity of competence in linguistics and its role in influencing one’s strategies for satisfactory speech production. From this approach, also, individuals become well-aware of the role of non-verbal cues, prosody and facial expressions in rectifying language-related disorders. Non-aphasic patients with damage to the right hemisphere and endowed with competence in linguistics, fail to comprehend these non-verbal cues [or forms of communication]. The sociolinguistic approach also addresses aphasic patients whose damage is specifically in the left hemisphere of the brain. In such a case, these language disorders do not affect their proper response to non-verbal communication.
Before delving further into the neurolinguistic approach and perspective to aphasia, there is a need to explore the relationship between language and one’s brain. They are interdependent on one another because the former functions to organize various structures in the brain. Despite the fact that neurolinguistics only previously examined adults; today, the approach also investigates aphasia and language detriments in children. From this approach, individuals understand that aphasia is more inclined toward the derogatory output of language rather than the processing of language. Without employing the tenets of neurolinguistics, there is a possibility of integrating errors and mistakes in one’s final utterances. In Wernicke’s aphasia, for instance, there is evidence of paraphasias which results from wrong word choices. The wrong sequence of words is, however, prevalent in Broca’s aphasia and like, paraphasias; these issues affect speech production. The neurolinguistic approach, in treating aphasia, emphasizes the importance of language in linguistic understanding. Unlike other approaches with focus on a variety of symptoms, neurolinguistic approaches are more inclined toward ensuring that the linguistic deficits are rectified accordingly. They depend solely on neurolinguistic tenets and principles so as to come up with therapeutic solutions for aphasic patients. Due to the versatility of linguistic complications, the neurolinguistic approach probes further into the specific linguistic issues before seeking solutions to the same. According to this approach, there is an examination of the different rehabilitation methods of treating aphasic speech. It is obvious to observe that individuals struggling with indistinguishable speech impairments are exposed to the same methods of treatment. The neurolinguistic approach, due to its affiliation with linguistic principles for treating aphasia, is set apart from other approaches to aphasia.
Offering rehabilitation and treatment through these [linguistic] principles makes it easier for individuals to pick out the neurolinguistic one from a variety of approaches. Nonetheless, it is important to understand that; in diagnosing and treating aphasia, the neurolinguistic approach is not tied down to these linguistic principles. Egon Weigl’s method of deblocking occupies a great part in the comprehension of the neurolinguistic approach. Apropos of aphasia, the patients are supposed to repeat certain words and phrases so as to deblock the damage depending on its severity. The method works best for individuals whose damage is not extreme. For this reason, therefore, aphasic speech can be deblocked because the patients have reparable damages. Aphasic patients often retain their competence in language despite the unfortunate association with damages in [brain] performance. In Broca’s aphasia, for example, the disruption of one’s performance does not affect their prowess and competence in a given language. Organization of language in neural networks also accentuates the necessity of the neurolinguistics approach in dealing with aphasic symptoms. Both phonological and semantic networks should function effectively and in a simultaneous manner so as to endorse the production of both written and spoken speech (Rider et al., 2008). The approach’s functional role in assessing aphasia offers relevant guidance which eradicates any impairments or deficits of language. Apart from eliminating them, the neurolinguistic approach strives to identify both the subtle and unsubtle problems in speech acquisition and production. Through this directive, it becomes easier to adopt a solid and effective foundation for language rectification through the neurolinguistic approach. Also, the approach cannot be utilized independently. There has to be an incorporation of both semantic and phonological ideologies so as to bring about positive changes in the scope language and its respective functions. Due to its association with linguistic principles, it is important to strengthen, elevate and activate the linguistic grasp so as to influence one’s speech production affirmatively.
Language exists as a modular construction where each linguistic function id dependent on the involvement of the components including concept retrieval, oral-motor programming, syntactical organization, and lexical selection with each of the subcomponents localized in different areas of the brain. With this in mind, neurolinguistic approaches have focused on understanding bilingualism as characteristics of aphasia. Applying the concepts of the distributed network approach, the temporal lobe is responsible for memorization, the parietal lobe makes provision for access to stored information and the frontal love allows for the creation of combinations in stored representations and provides the center for the synthesis of verbal information. Bilingual speaker’s exhibit a behavior identified as code switching that allows for the use of an individual’s language capabilities to make a provision for communication of intent, relaying emphasis and expressing emotional value. However, the principles identify the need for linguistic competence in the application for communicative interaction in the midst of constraints including social, personal and environmental factors, levels of education and grammatical principles(Avrutin, 2001).
In the determination of the types of aphasia, the neurological findings have proven to be more advanced that the classical Wernicke-Lichtheim model. The model proposes that the attributes the cause of aphasia to the damage of the white matter that limits the type of aphasia to Broca’s aphasia and Wernicke’s aphasia. However, Yourganov and Smith et al.(2015) points to the heterogeneity of brain damage especially in the analysis of conduction aphasia resulting from damage to the gray matter around the temporoparietal junction. Considering this complexity of aphasia as a condition, the neurolinguistics applies a multivariate approach focusing on the evaluation of the contribution of the brain locations- vowel or cortical regions simultaneously and their interaction in the application of the vowel-based lesion symptom mapping procedure(Yourganov and Smith et al., 2015). Neurolinguists in the analysis of aphasia require applying three components in the evaluation: spatial normalization of lesions; multivariate analysis of the type of aphasia through the application of a cross-valuations framework; and, segmentation of the area with a lesion applying the brain atlas (Yourganov and Smith et al., 2015). In the analysis of aphasia, the distributed network approach allows for the application of behavior-lesion association where the neuroanatomical models provide brain-behavior relations.
In the understanding of aphasia and language, neurolinguistics provides the amalgamated theory that makes suggestions of shared aspects of the brain with the retention of neural areas for different languages. With that in mind, neurolinguistics lay claim of laterality in the monolingual and bilingual speakers. However, evidence of this has yet to present such difference through neuroimaging investigations. However, the risk for aphasia onset increases with right hemisphere damage for bilingual speakers produced a similar pattern of cognitive-communication deficits experienced by monolingual speakers with the injury to the left hemisphere and increased for aphasia onset(Yourganov and Smith et al., 2015). Inasmuch as shared lateralization provides factors such as the age of acquisition, proficiency has been cited as an explanation for the existence of bilingual aphasia, and the convergence theory discredits the proposition by linking neuroanatomical convergence with levels of proficiency. Bilingual clients with the recovery patterns can only be evaluation regarding the relative impairments of the two languages that are distinctive from the normal recovery patterns in the monolingual speakers (Yourganov and Smith et al., 2015). The recovery is identified regarding recovery of expressive abilities where the capabilities in output, transition, and cognitive factors remain the focal principles as opposed to the comprehension (Yourganov and Smith et al., 2015). Neurolinguists when understanding aphasia focuses on the development of neurolinguistic models to explain the issues of relationships and nature of the lexical stores and cognate effects of retrieval.
An in-depth analysis of the neurolinguistic approach to aphasia enlightens individuals about treatment revolving around observations and tests, which assist the experts in realizing the aphasic severity in patients. Presently, treating aphasia requires face-to-face meetings to improve the intimacy between neuropsychologists [or therapists] and their patients. For aphasia, the therapist requires his/her patient to select a word and pair it with its respective pictorial representation. Complexity or ambiguity of the tests is dependent on the patient’s improvement ability. Inasmuch as most of these tests are reiterated for ultimate understanding, there are sharp aphasic patients that delineate improvements after a few tests. The neurolinguistic approach urges therapists to invest in devices such as touch-screens because of the difficulties that aphasic patients experience while using physical keyboards. State-of-the-art therapy in the neurolinguistic approach does not involve any limitation of technological devices or software.
Open-mindedness, as mentioned before, is a requisite factor in attempting to understand the neurolinguistic approach to aphasia. There are research studies that prove the existence of non-competence and loss of comprehension in Broca’s aphasia. Lack of specificity and embracement of generalities [and vagueness] has brought about debates and discombobulating issues in the comprehension of these neurolinguistic approaches to aphasia. There are no specific linguistic theories that are used to treat aphasic speech. In lieu, there are meager generalized theories that do not necessarily offer the individuals any opportunity of being familiar with the depth of neurolinguistic approaches. The vagueness is classified under the bracket of limitations associated with the perspective and approach to aphasia. Moreover, neurolinguistics is not an acceptable approach because it delineates the ability of dealing with assessing aphasia instead of handling the recuperation process. The linguistic principles incorporated in the approach are more inclined toward diagnosing the language impairments and not rectifying them. From a positive and progressive angle, therapists have encouraged the neurolinguistic approaches because of their precision in diagnosis and damage control.
Both clinicians and linguistics have adopted the tenets of psycholinguistic approach in dealing with aphasic speech. From this, it is quite evident that the approach functions on the bases of cognition and linguistics. Unlike other approaches and their fascination with language output, psycholinguistics focuses on the processing of language. It is an approach that does not specifically delve into the clinical symptoms of language impairment because of its affiliation with the step-by-step aspects of language processing. The psycholinguistic approach strives to delve into both etiology and linguistics while examining language development. Like sociolinguists, the approach is not discriminative and is also used in diagnosing and treating aphasic children. The approach adopts tenets of language processing models for the capability of separating these patients depending on the severity of their disorders. Most researchers, therefore, prefer the scope of psycholinguistics because it is more associated with specificities rather than generalities.
The psycholinguistic models of language processing are an explanation of stages and steps that make a contribution to the production and comprehension of language under the two levels of representation: lexical and conceptual (Lorenzen and Murray, 2008). While researching aphasia, psycholinguists make provision to understand the fluency of speech that identified unfilled pauses as an indication of breaks and hesitations. Understanding aphasic language involves a retrace of the thought process to provide an explanation for hesitation or word choices. Following an evaluation of these, the psycholinguistic can provide a degree of variability through a distinction in the levels of impairment within the aphasic patient (Yourganov and Smith et al., 2015). Psycholinguists make provisions that allow the evaluation of anomalies to prove evidence of the characteristics and its relation to abnormal language. There are of interest is in the comprehension of language in terms of the generative and transformational complexity to make provision for the type of aphasia and the features such as speech regression to understand the nature of aphasia. The ability of the psycholinguist to detect the linguistic anomaly in the language use provides accommodations to explain the nature of the deficit, the knowledge of relevant rules, limitation of processing in patients with aphasia.
Each aphasic patient, as per the language-processing model, is dealt with differently and all his or her symptoms assessed independently. Due to its individual-specific nature, the psycholinguistic approach is well-placed in the examination of aphasia and its related phenomena. The psycholinguistic perspective elevates the assessment of phonology apropos of both words and sentences, as a whole. Comparing the traditional approach to aphasia with the psycholinguistic approach, there are more accurate results that augur from specificity. It is impossible for the therapists using this approach to lose concentration by confusing the diagnosis for aphasia. The psycholinguistic approach is an enhancer [or influencer] of better models for processing language. It creates an avenue for experimenting with different models; a directive that leads to improvements in both language processing and the respective types of models. Due to the cognitive aspects incorporated in this approach, there is a relationship between neurolinguistics and psycholinguistics apropos of aphasic speech. The latter reiterates impossibilities in rectifying language and its tenets without exposure to cognitive capacities. These models that are connected in one’s cognitive area are supposed to be sustained so as to describe, analyze and assess the language disorder.
From another perspective, the psycholinguistic approach is not clinically applicable. The models fail to facilitate the treatment process for these language impairments. Even if they are more specific than other approaches, the psycholinguistic approach’s models are still not overly specific; to the point of treating aphasic speech. Evidently, there are limited research studies that interfere with the already existing specific nature of this approach. Without focusing on clinical results, therefore, the psycholinguistic approach offers a well-equipped description of the theoretical framework to treating aphasic symptoms. The psycholinguistic approach does not utilize tenets from the Chaos Theory because it focuses on the major language interferences rather than the minor ones. As an approach to aphasic speech, psycholinguistics stretches all the way to the assessment of individuals’ thought process. Since proper language development depends greatly on one’s organized thinking, the approach exposes its relevance in rectifying the symptoms of aphasia in different people. Specific deficiencies interfering with syntactic, semantics et al., are requisite in affirming the significance of psycholinguistics in tackling aphasic symptoms and other language-related disorders. Unlike individuals with non-aphasic speech, these aphasic patients are more inclined toward non-verbal cues, facial expressions and gestures. A study on Broca’s aphasia and global aphasia has proven the existence of [sociolinguistic] competence in aphasic speech because of these patients’ constant utilization of non-verbal cues. Being highly sensitive to nonverbal cues because of aphasia has led to appropriate use of strategies that influence speech production hence proper conversations.
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