Torino 29nov13 A multi-level approach to discourse analysis

Transcript

Narrative assessment in patients
with communicative disorders
Andrea Marini
Università di Udine IRCCS “E. Medea”, IRCSS Santa Lucia
!
[email protected]
1
Torino 29nov13 A multi-level approach to discourse analysis - 19 dicembre 2013
Overview of the presentation
Ø
Dimensions of linguistic analysis
!
Presentation of a multilevel approach to the analysis of
narrative language in patients with communicative disorders
!
Examples of the application of the method to adult patients
!
Rehabilitative perspectives
Ø
!
Present and future directions
Ø
Ø
Ø
2
Two dimensions of linguistic analysis
!
Microlinguistic dimension
!
!
Macrolinguistic dimension
(Glosser and Deser, 1990; Davies et al., 1997; Marini et al., 2005)
3
Microlinguistic dimension
ü
ü
ü
ü
ü
ü
ü
ü
Phonetic processing
!
Phonological processing
!
Morphophonological processing
!
Morphological processing
!
Lexico-Semantic processing
!
Morphosyntactic processing
!
Syntactic processing
!
Sentential-Semantic processing
4
!
Lexical processing
!
!
!
!
!
!
Grammatical processing
Macrolinguistic dimension
Ø Pragmatic
ü
ü
ü
processing
Linguistic contextualization
Informativeness
Generation of inferences
!
Ø Text-Discourse
ü
ü
processing
Structural processing of a discourse/written texts
Generation of mental models/situation models
5
APHASIOLOGY, 2011, iFirst, 1–21
A multi-level approach to the analysis of
narrative language in aphasia
Andrea Marini 1,2 , Sara Andreetta1 , Silvana del Tin3 , and
Sergio Carlomagno4
1
Dipartimento di Scienze Umane, University of Udine, Udine, Italy
IRCCS “E. Medea: La Nostra Famiglia”, San Vito al Tagliamento (Pn),Italy
3
IMFR Gervasutta, Udine, Italy
4
Dipartimento di Psicologia, Università di Trieste, Trieste, Italy
marini] at 08:13 12 October 2011
2
Background: Several studies have shown that traditional standardised aphasia tests may
not be sensitive enough to adequately assess linguistic deficits and recovery patterns in
persons with aphasia. As a result, both functional and structural methods for the analysis of connected language samples from people with aphasia have been devised (see
Armstrong, 2000; Prins & Bastiaanse, 2004).
Aims: The present article focuses on our attempt to provide a comprehensive, multi-level
procedure for both structural and functional analysis of narrative discourse produced
by speakers with brain damage. Accordingly, we will describe a method for analysis
of connected language samples elicited on single picture and cartoon story description
6
tasks. This method has proven sensitive in the assessment of language deficits in many
neurogenic populations.
Analysis of microlinguistic performance
Ø Productivity
l
l
l
Words
Speech Rate (words / minute)
Mean Length of Utterance (MLU)
Ø Lexical
l
l
l
processing
%Phonological errors
% Semantic paraphasias
% Paragrammatic errors (bound morph.)
7
Analysis of microlinguistic performance
Ø Grammatical
l
l
l
l
processing
% Substitution of function words
% Omission of Content Words
% Omission of Function Words
% Complete Sentences
8
Analysis of macrolinguistic performance
Ø Pragmatic-discourse
l
l
l
l
level of processing
% Cohesive errors
% Local coherence errors
% Global coherence errors
% Lexical informativeness
Ø Conceptual
l
l
processing
% Thematic selection
% Details to main themes
9
Assessment of linguistic and
communicative performance in nonaphasic TBI patients
10
N=14
N=14
NB à Severe non-aphasic TBI (in chronic phase
- normal performance at the AAT)
11
production that were found altered in the TBI patients (i.e. speech
rate, % cohesive errors, % global coherence errors, % lexical informativeness and the ratio of thematic density). The results failed to
show any significant correlation between these scores.
3.2.2. Macrolinguistic analysis
The mean values for each group on each macrolinguistic measure are reported in Table 4 together with data from the information
content analysis. The TBI participants produced significantly more
violations of both cohesion (F(1; 26 = 12.888); p < .001; partial
!2 = .331]) and global coherence ([F(1; 26) = 31.134; p = .000; partial
!2 = .553]) rules. However, the cohesion errors also included abrupt
interruption of utterances (Haravon et al., 1994). When these errors
were discarded from the computation, the other cohesive errors
(e.g. misuse of anaphoric pronouns, errors in number and gender
agreement between pronouns or noun phrases across utterances,
misuse of either cohesive function-words or semantically related
content words) did not differ in the two groups.
3.4. Principal component analysis of measures of informativeness
and macrolinguistic accuracy
Microlinguistic assessment
In order to examine if separate factors corresponding to
hypothesized components of micro- and macrolinguistic processing abilities could be empirically identified, data of each sample
concerning measures of informativeness (% lexical information
units and ratio of thematic density) entered a principal component analysis with Orthotran Varimax rotation together with the
main measures of impaired macrolinguistic processing (% cohesion
Table 3
Results of the microlinguistic analysis for the groups of TBI and healthy control participants.
Microlinguistic analysis
TBI
HC
Level of significance (p)
Effect size (partial !2 )
Words
Speech rate*
MLU
% Phonological selection
% Paragrammatic errors*
% Complete sentences
82.5 (31.3)
94.7 (29.7)
5.6 (1.1)
99.2 (1)
.8 (1.1)
1.4 (1.1)
57.9 (15.3)
80.9 (44.4)
129.5 (29.3)
6.9 (1.9)
99.6 (.8)
.1 (.4)
.2 (.6)
63.1 (23.1)
<.964
<.001
<.013
<.206
<.024
<.001
<.412
.000
.345
.213
.061
.181
.365
.026
*
When the group-related difference is significant after Bonferroni correction for multiple comparisons.
Table 4
Results of the analysis of the macrolinguistic and informative aspects of narrative production for the groups of TBI and healthy control participants.
Macrolinguistic and informative analysis
TBI
HC
% Cohesive errors*
% Global coherence errors*
% Lexical informativeness*
Thematic informativeness
Ratio of thematic density*
3.9 (1.9)
22.1 (11.1)
64.3 (10.7)
6 (2)
.4 (.2)
1.9 (.4)
3.8 (7.5)
84.5 (9.6)
7 (2)
1.2 (.6)
<. 001
.000
.000
<.037
.000
.331
.553
.585
.156
.576
*
12
were discarded from the computation, the other cohesive errors
(e.g. misuse of anaphoric pronouns, errors in number and gender
agreement between pronouns or noun phrases across utterances,
misuse of either cohesive function-words or semantically related
content words) did not differ in the two groups.
ing abilities could be empirically identified, data of each sample
concerning measures of informativeness (% lexical information
units and ratio of thematic density) entered a principal component analysis with Orthotran Varimax rotation together with the
main measures of impaired macrolinguistic processing (% cohesion
Table 3
Results of the microlinguistic analysis for the groups of TBI and healthy control participants.
Macrolinguistic assessment
Microlinguistic analysis
TBI
HC
Words
Speech rate*
MLU
% Phonological selection
% Paragrammatic errors*
% Complete sentences
82.5 (31.3)
94.7 (29.7)
5.6 (1.1)
99.2 (1)
.8 (1.1)
1.4 (1.1)
57.9 (15.3)
80.9 (44.4)
129.5 (29.3)
6.9 (1.9)
99.6 (.8)
.1 (.4)
.2 (.6)
63.1 (23.1)
<.964
<.001
<.013
<.206
<.024
<.001
<.412
.000
.345
.213
.061
.181
.365
.026
*
Table 4
Results of the analysis of the macrolinguistic and informative aspects of narrative production for the groups of TBI and healthy control participants.
Macrolinguistic and informative analysis
TBI
HC
% Cohesive errors*
% Global coherence errors*
% Lexical informativeness*
Thematic informativeness
Ratio of thematic density*
3.9 (1.9)
22.1 (11.1)
64.3 (10.7)
6 (2)
.4 (.2)
1.9 (.4)
3.8 (7.5)
84.5 (9.6)
7 (2)
1.2 (.6)
<. 001
.000
.000
<.037
.000
.331
.553
.585
.156
.576
*
>
13
If the interruptions of utterances were discarded
from the errors of cohesion the difference was
no longer significant!
It is then likely that the reduced speech rate was
due not to microlinguistic problems but to the
frequent interruptions in the flow of speech
It is a problem in the organization of information
14
Ø Is
it possible to explore the functional
problems of a macrolinguistic impairment?
!
Ø In
what terms a reduced macrolinguistic
ability determines reduced levels of
informativeness?
15
Subjects
Controls
(N = 44)
TBI
(N = 10)
Age
36.9 (13.1)
34.8 (9.9)
Education
10 (2.0)
10 (2.4)
16
Ø For
each story, a composite score of global and
local coherence errors was calculated
l
l
l
l
l
1 à severe (> 2 z-scores) + severe (> 2 z-scores)
2 à severe + moderate (1-2 z-scores)
3 à moderate + moderate
4 à moderate + absent
5 à absent + absent
17
This suggests that …
Ø Their
verbal poverty and confusion seems
linked to problems in the macrolinguistic
organization of their discourse
!
Ø This
narrative problem has a functional
consequence: reduced levels of
informativeness
18
Procedures of narrative analysis highlight
problems that are not detected by
traditional language assessment
19
Can this analysis be applied also to
persons with aphasia?
20
. Furthermore, the
at they produced
red as the number
g in their descripof both repetitions
rall, these results
omic aphasia may
aspects of macroar whether these
a macrolinguistic
of the underlying
at they may reflect
When the patient
con he/she simply
s a new argument
from Christiansen
omic aphasia and
descriptions. For
All participants released their written informed consent to participate to the
homepage:
www.elsevier.com/locate/neuropsychologia
study after all procedures had been journal
fully explained.
Approval
for the study had
previously been obtained from the local ethic committee.
Narrative discourse in anomic aphasia
2.2. Assessment
of narrative abilities
Sara Andreetta a, Anna Cantagallo b, Andrea Marini a,c,n
a
b
Dipartimento di Scienze Umane, University of Udine, Udine, Italy
Braincare, Padova, Italy
IRCCS ‘‘E. Medea: La Nostra Famiglia’’, San Vito al Tagliamento (Pn), Italy
All participants were asked to produce three narratives elicited with the help
of one single picture depicting a story (the scene of a ‘‘Picnic’’) and two cartoon
c
a r t i c l e
i n f o
a b s t r a c t
Article history:
Anomic aphasia is a disturbance affecting lexical retrieval. Nonetheless, p
Keywords:
Neuropsychology
Anomic aphasia
Language
Narrative analysis
lowered speech rate, reduced mean length of utterance, fewer gramma
more semantic paraphasias. The macrolinguistic analysis showed that th
of cohesion and global coherence and fewer lexical information units
thematic selection were normal. A bivariate correlational analysis showed
the production of errors of cohesion and production of complete sentenc
errors of global coherence and lexical information units. These correlation
to lexical retrieval may affect macrolinguistic processing during the cons
it is suggested that lexical deficits lead to two main consequences:
frequently interrupt the utterances they are producing and this red
completeness and the overall degree of cohesion across the utterances
to cope with the lexical impairment and produce a quantity of lexica
clustered in utterances, reduce the levels of global coherence.
& 2012 El
29 December 2011
also experience difficulties in the construction of coherent narratives. W
TableReceived
1
Received in revised form
of a macrolinguistic difficulty per se or reflects the lexical disorder is st
1
April
2012
MeansAccepted
(and standard
deviations)
of
demographic
and clinical
characteristics
of the on macrolinguistic processin
analyze
the effect
of the lexical impairment
4 April 2012
skills of a group of ten participants with chronic anomic aphasia with
groups of anomic and healthy control (HC) participants.
individuals matched for age and educational level. The anomic participa
Anomic
Mean (SD)
Age
50.5
Formal education (years)
12.8
Time after injury (months) 21.2
1.
HC
(Range)
Mean (SD)
(11.5) (28–64) 50.7
(3.8)
(5–17)
13
(19.5) (6–60)
–
(Range)
(10.4) (31–64)
(3.1)
(8–17)
–
–
Introduction
lexical problems experienced by person
occur at different stages of the proces
Goodglass & Wingfield, 1997), and this h
Anomic aphasia is a complex disorder affecting the process of
of three main typologies of anomic aph
lexical production (Laine & Martin, 2006; Cuetos, Monsalve, & Pérez,
form anomia and disordered phoneme asse
2005). A distinctive feature of this disorder is the inability to correctly
Semantic anomia may interfere with the
retrieve lexical items from the mental lexicon for specific referents.
(in terms of either prelinguistic conceptu
Some of the most influental models of linguistic production (e.g.,
tion of lexical concepts). Persons with
Frederiksen, Bracewell, Breuleux, & Renaud, 1990; Indefrey, 2011)
produce neologisms and semantic para
postulate that the process of lexical generation relies on three major
cally related to the target, but the outp
stages: (1) a pre-linguistic conceptual phase, where the speaker
preserved. Due to the semantic impairm
generates a mental plan of what he/she wants to say; (2) a phase
they also have difficulties in word compr
of linguistic formulation, where (a) the preverbal message is conmay affect the retrieval of word form (i
verted into a speech plan, (b) the lexical concepts trigger the process
logic information). In production tasks
of lexical selection, (c) the intended word is selected, and (d) the
anomia tend to produce circumlocution
system gains access to the information stored in the lexical repreAndreetta where
et al. / Neuropsychologia
50score
(2012)
1787–1793
but
within
normal range on tasks
sentation; and (3) a phase of linguistic S.
expression,
production
semantic association (e.g., Lambon Ral
actually takes place. Accordingly, it has been hypothesized that the
Disordered phoneme assembly may impa
fication and phonetic encoding that ar
21
Torino 29nov13 A multi-level approachproduce
to discourse
analysis - 19 dicembre 2013
the target word. As a result
n
Corresponding author at: University of Udine, Via Margreth, 3-33100 Udine,
phonological paraphasias due to the sub
Italy. Tel.: þ 39 335 5393224.
al. Narrative discourse in anomic aphasia. Neuropsychologia (2012), http://dx.doi.org/
Author's personal copy
1788
Despite their lexical impairment, persons with anomic aphasia
example, Coelho and Flewellyn (20
nsidered grammatically complete if all
nserted correctly in the body of the
stitutions of free or bound morphemes.
inguistic measures included indexes
rrors. An index of cohesiveness was
ties, including errors in anaphoric
between pronouns and nouns, misuse
tent words. Cohesive errors included
subsequent utterance complete the
topic shift would occur.
extent to which each utterance of the
revious one. Local coherence errors
lear referent and topic switching (for
e errors please see Appendix A). The
alculated by dividing the number of
terances and multiplying this value
roduction of utterances that may be
he story, propositional repetitions or
description and examples of global
he percentage of global coherence
er of global coherence errors by the
alue by 100.
e was evaluated in terms of number
sample and production of lexical
ned as a main idea or detail in the
vious study (Marini, Carlomagno,
participants did not produce more phonological errors ([F(1;
18¼3.968; p¼.062; partial eta squared¼.181]) but did produce
more semantic paraphasias ([F(1; 18¼10.188; p¼.005; partial eta
Table 2
Results of the microlinguistic analysis for the groups of anomic and healthy
control participants.
Microlinguistic
analysis
Anomic
HC
Level of
significance
Effect size
(partial Z2)
Words
109.5
(40)
51.1
(26.5)
4.2 (.8)
2.4 (3.3)
77.1
(32.2)
140
(32.5)
7.4 (1.8)
.3 (.4)
p o .061
.181
p ¼.000
.714
p ¼.000
p o .062
.589
.181
1.4 (1)
.3 (.4)
p o .005
.361
35.2
(12.7)
57.6
(18.1)
p o .005
.362
Speech rate*
MLU*
% Phonological
errors
% Semantic
paraphasias*
% Complete
sentences*
n
Indicate when the group-related difference is significant after Bonferroni
correction for multiple comparisons.
tta, S., et al. Narrative discourse in anomic aphasia. Neuropsychologia (2012), http://dx.doi.org/
04.003
% Complete Sentences & % Cohesion Errors (r = -.745; p<.014)
22
goals of the present study was to detect potential inter-relations
between the different levels of linguistic processing. Namely, we
focused (1) on the potential impact of altered lexical selection
Table 3
Results of the analysis of the macrolinguistic and informative aspects of narrative
production for the groups of anomic and healthy control participants.
Macrolinguistic and
informative analysis
Anomic
% Cohesion errors*
% Local coherence errors
% Global coherence
errors*
% Lexical
informativeness*
%Thematic
informativeness
HC
Level of
significance
Effect size
(partial Z2)
41.7 (10.6) 1.3 (.7)
16.9 (10.7) 5.9 (3.4)
28.8 (13.1) 7.9 (5.7)
p ¼ .000
p o .006
p ¼ .000
.889
.348
.544
57.9 (16.7) 80 (9.8)
p o .002
.420
47.9 (16.3) 51.9 (5.8)
p o .479
.028
n
Indicate when the group-related difference is significant after Bonferroni
correction for multiple comparisons.
levels of grammatical comp
production of cohesive erro
Bates, Hamby, & Zurif, 1983
the correlational analysis sh
cohesion errors were stron
further supported by the a
differences in the production
these interruptions were no
introduction of ambiguous
top-down difficulty in coher
in the contiguous utteranc
percentage of cohesive error
from the participants with
conceptual problem but wer
lexical retrieval. This is a
complex interactions occurr
tic processes. It also highligh
of multi-level procedures fo
patient’s linguistic abilities.
Please cite this article as: Andreetta, S., et al. Narrative discourse in anomic aphasia. Neurops
10.1016/j.neuropsychologia.2012.04.003
% Global Coherence Errors & % Lexical
Informativeness (r = -.900; p<.001)
23
How about the neural correlates of
these abilitites?
24
aphasiology. Austin, TX: Pro-Ed; 1993: 123–134.</edb>
<edb> 34. Cherney LR, Halper AS. A conceptual framework for the evaluation and treatment of
communication problems associated with right hemisphere damage. In: Halper A, Cherney L,
Burns M eds. Clinical management of right hemisphere dysfunction Gaithersburg, MD: Aspen;
1996: 21–29.</edb>
<bok> 35. Tompkins CA. Right hemisphere communication disorders: Theory and management. San
Diego, CA: Singular; 1995.</bok>
Table 1 Means (and Standard Deviations) of Demographic and Clinical
Characteristics of the Groups of Right Hemisphere Damaged (RHD) and
Healthy Control (HC) Participants
Age
RHD
HC
58.9 (12.4)
57.4 (12.4)
Formal education (years) 10.1 (3.9)
11.8 (4.6)
Time after injury (months) 14.2 (8.6)
–
Raven
30.1 (4.6)
30.1 (5.8)
MMSE
28.7 (1.5)
28.2 (1.2)
Table 2 Detailed Description of Each Participant with RHD
Page 11 of 13
25
10
64
Ischemic
Occipital
9
11
35
Ischemic
TemporoOccipital
9
12
69
Ischemic
Parietal
12
13
68
Ischemic
Parietal
24
14
56
Ischemic
Centrum
semiovalis
25
15
67
Ischemic
Caudate
nucleus
5
Table 3 Means (and Standard Deviations) obtained with the Microlinguistic
Analysis for the Groups of RHD and Healthy Control Participants
Microlinguistic
Analysis
RHD
HC
Level of
Significance
Effect Size
(Partial η 2)
Words
121.9 (64.9)
115.8 (52)
P < .751
.004
Speech Rate
121.4 (26.5)
118.7 (25.6)
P < .504
.017
6.3 (2.7)
99 (1.2)
P < .245
P < .130
.050
.083
.3 (.6)
P < .063
.122
.2 (.5)
P < .039
.149
71.4 (21.7)
P < .061
.124
MLU
5.8 (1.2)
% Phonological
99.4 (1.5)
Selection
% Semantic
.6 (1)
paraphasias
% Paragrammatic
.5 (.7)
Errors
% Complete Sentences 64.4 (16.1)
Page 12 of 13
26
Publisher: Thieme; Journal: SSL; Article Type: Review Article
Journal ISSN: 0734-0478; Article ID Number: SSL00471
Volume Number: 33; Issue Number: 1
*Indicate when the group-related difference is significant after Bonferroni correction for multiple comparisons.
Table 4 Means (and Standard Deviations) obtained with the Analysis of the
Macrolinguistic and Informative Aspects of Narrative Production for the
Groups of RHD and Healthy Control Participants
Macrolinguistic RHD
and Informative
Analysis
HC
Level of
Significance
Effect Size
(Partial η 2)
% Cohesive
3.5 (2.4)
Errors
% Local
13 (13.8)
Coherence Errors
3 (2.1)
p < .325
.036
6.8 (6.4)
p < .076
.112
% Global
22.5 (16.1)
Coherence
Errors*
% Lexical
74.3 (17.2)
Informativeness*
10.2 (9.8)
p < .003
.283
86.8 (8.7)
p < .004
.269
Two Subgroups of Individuals with RHD and the Group of Healthy Control
Participants (HC)
Anterior RHD
27
Posterior
RHD
HC
Level of
% Cohesive
3.5 (2.4)
Errors
% Local
13 (13.8)
Coherence Errors
3 (2.1)
p < .325
.036
6.8 (6.4)
p < .076
.112
% Global
22.5 (16.1)
Coherence
Errors*
% Lexical
74.3 (17.2)
Informativeness*
10.2 (9.8)
p < .003
.283
86.8 (8.7)
p < .004
.269
Two Subgroups of Individuals with RHD and the Group of Healthy Control
Participants (HC)
%Lexical
Informativeness
Anterior RHD
Posterior RHD
HC
Level of
Significance
71 (6.7)*
78.5 (16.6)
86.8 (8.7)
χ2 = 10.347; p <
.006
19 (15.2)
10.2 (9.8)
χ2 = 12.303; p <
.002
%Global
28.5 (5.7)*
coherence errors
*The asterisk indicates the group with the highest overall ranking on the Kruskal-Wallis Test.
28
The language of schizophrenia: An analysis of micro and macrolinguistic
abilities and their neuropsychological correlates
Andrea Marini a,b,⁎, Ilaria Spoletini b , Ivo Alex Rubino c , Manuela Ciuffa b , Pietro Bria d ,
Giovanni Martinotti d , Giulia Banfi b , Rocco Boccascino e , Perla Strom e ,
Alberto Siracusano c , Carlo Caltagirone b,c , Gianfranco Spalletta b,c
a
University of Udine, Udine, Italy
IRCCS Santa Lucia Foundation, Rome, Italy
c
Department of Neuroscience, University of Rome “Tor Vergata”, Rome, Italy
d
Institute of Psychiatry, Catholic University of the Sacred Heart, Rome, Italy
e
Department of Mental Health, ASL RMF, Rome, Italy
b
Received 17 December 2007; received in revised form 11 July 2008; accepted 20 July 2008
Available online 2 September 2008
Abstract
Language disturbance is one of the main diagnostic features in schizophrenia and abnormalities of brain language areas have
been consistently found in schizophrenic patients. The main aim of this study was to describe the impairment of micro and
macrolinguistic abilities in a group of twenty-nine schizophrenic patients during the phase of illness stability compared to fortyeight healthy participants matched for age, gender and educational level. Microlinguistic abilities refer to lexical and morphosyntactic skills, whereas macrolinguistic abilities relate to pragmatic and discourse level processing. Secondary aims were to detect
the effect of macrolinguistic on microlinguistic ability, and the neuropsychological impairment associated with the linguistic
deficit. The linguistic assessment was performed on story-telling. Three narratives were elicited with the help of a single-picture
stimulus and two cartoon stories with six pictures each. A modified version of the Mental Deterioration Battery was used to assess
selective cognitive performances. A series of t-tests indicated that all the macrolinguistic variables were significantly impaired in
schizophrenic patients in at least one of the three story-tellings. Furthermore, the limited impairment found in microlinguistic
abilities was influenced by macrolinguistic performance. Multivariate stepwise regression analyses suggested that reduced attention
performances and deficit in executive functions were predictors of linguistic impairment. Language production in schizophrenia is
impaired mainly at the macrolinguistic level of processing. It is disordered and filled with irrelevant pieces of information and
derailments. Such erratic discourse may be linked to the inability to use pragmatic rules and to cognitive deficits involving factors
such as attention, action planning, ordering and sequencing.
© 2008 Elsevier B.V. All rights reserved.
Keywords: Schizophrenia; Schizophasia; Language; Discourse analysis
1. Introduction
⁎ Corresponding author. Cattedra di Psicologia del Linguaggio,
Università di Udine, Via T. Petracco, 8-33100 Udine, Italy. Tel.: +39
335 5393224.
E-mail address: [email protected] (A. Marini).
Language disturbance is one of the main clinical
features in schizophrenia (Andreasen and Grove, 1986;
0920-9964/$ - see front matter © 2008 Elsevier B.V. All rights reserved.
doi:10.1016/j.schres.2008.07.011
"29
29
Atrophy of dorsal aspect of
lIFG (BA 44/45) linked to
reduced levels of lexical
informativeness
30
izes phonemes into morevidence on the association between brain volume change
(lexical processing) and
in the lIFG and the ability to retrieve appropriate words in
Please Get
to the
A Cortical
of
xt required by each word
patients
with Point!
mental disorders,
thisCorrelate
result is particularly
Linguistic
Informativeness
med sentences (syntactic
interesting.
Indeed,
it suggests that this part of the lIFG
imension selects the conmay play a major role in a wider network for the controlled
Andrea Marini
and Cosimo Urgesi
of a word or a sentence
selection of contextually adequate words from the mental
nects utterances by means
lexicon. Interestingly, in a single case study by Schwartz
Abstract
o formulate the
gist of a
and Hodgson (2002),left,
a but
patient
with moderately severe
not right, inferior frontal gyrus reduces the levels of lexi■ The production of informative messages is an effortful enØ is,
Type
ofonstudy
à
rTMS
cal informativeness and global coherence of narratives produced
deavor
relies
the interaction
between
microlinguistic
scourse, that
itsthat
mental
transcortical
motor aphasia
due to hemorrhagic infarction
by healthy individuals. Interestingly, levels of productivity and
(i.e., lexical and grammatical) and macrolinguistic (i.e., pragmicrolinguistic processing were unaffected by the stimulation.
matic and discourse) levels of processing. Although the neural
the have
leftbeen
dorsolateral
frontal
cortex
better
wordleft
These
results suggest
that showed
the dorsal aspect
of the anterior
of microlinguistic of
processing
extensively
!correlates
inferior frontal gyrus is an epicenter of a wider neural network
studied, investigation of the ability to organize the macrosubserving the
selection
of contextually
linguistic aspects
of message production
is scanty.
this article,
g number of studies
focusretrieval
on Instandard
naming
tests
than
it wasappropriate
in hersemantic
imrepresentations. ■
we show that repetitive TMS of the dorsal portion of the anterior
Subjects
12 healthy
Italian neuroimaging
speaking
veiled the Ø
existence
of an à
poverished
connectednative
speech. Notably,
participants
(5 women,
age:the
mean=21.9;
SD= 2.7)
e implemented
in an exevidence
has implicated
lIFG in several language
funcINTRODUCTION
and grammatical processing have been extensively investi(Indefrey, 2011;
Indefrey
tions. Indeed, in two seminal
papers, Blank et al. (Blank,
language is a complex cognitive system that
gated ( Vigneau et al., 2006), those underlying macro!Human
evolved to serve a specific function: the ability to exchange
linguistic (i.e., pragmatic and discourse level) processes
neural correlates
of lexical
Bird,
Tukheimer,
& Wise,
2003;
Blank,
Scott,
Murphy,
information
in a very efficient
way. However,
the produchave been
much less
explored. In
particular,
we are aware
tion
of
informative
messages
is
an
effortful
endeavor,
of only one study that explicitly assessed the neural corØ Tasks
Warburton,
& Wise, 2002)
have
speech
which requires the ability to
select lexical representations
relates
of theexplored
ability to selectconnected
pragmatically adequate
words
that are appropriate to a given context and organize them
from the mental lexicon (Spalletta et al., 2010). The
l Phonemic
production
in both healthy
individuals
andof patients
within
a communicative interaction
avoiding
unnecessary
authors found
that, in a group
persons withwith
schizofluency
test
derailments (Marini, Boewe, Caltagirone, & Carlomagno,
phrenia, the production of lexical information units (LIUs;
2005; Nicholas &La
Brookshire,
1993).lesions.
This ability relies
on
i.e., in
those
that had
been appropriately
selected and
brain
Namely,
awords
study
focusing
on healthy
“E. Medea: Associazione
l interaction
the
between several levels
of representation
used from a phonological, grammatical, pragmatic, and
Picture-stories
arrangement
(i.e., lexical, syntactic, pragmatic,
and discourse
ones)et textual
point of view)
significantlyin
correlated
with volume
mento (Pn), Italy
participants,
Blank
al. (2002)
identified
the lIFG
an
organized along two main dimensions (Marini, Andreetta,
changes in the dorsal aspect of the left inferior frontal
Technology
1,2
1,2
Single-picture and cartoon-story description task
l Tin, & Carlomagno, 2011; Glosser & Deser, 1990). A
del
microlinguistic dimension organizes phonemes into morphological strings and words (lexical processing) and
determines the syntactic context required by each word
for the generation of well-formed sentences (syntactic
processing). A macrolinguistic dimension selects the contextually appropriate meaning of a word or a sentence
(pragmatic processing) and connects utterances by means
31
of cohesive and coherent ties to formulate the gist of a
gyrus (lIFG). Even if this study provided only correlational
evidence on the association between brain volume change
in the lIFG and the ability to retrieve appropriate words in
patients with mental disorders, this result is particularly
interesting. Indeed, it suggests that this part of the lIFG
may play a major role in a wider network for the controlled
selection of contextually adequate words from the mental
lexicon.
Interestingly,
inapproach
a singletocase
study
by Schwartz
Torino 29nov13
A multi-level
discourse
analysis
- 19 dicembre 2013
and Hodgson (2002), a patient with moderately severe
Journal of Cognitive Neuroscience 24:11, pp. 2211–2222
Stimulation sites
32
Narrative analysis 1/2
33
Narrative analysis 2/2
34
Can all this be of any help for
rehabilitation?
35
HUMAN NEUROSCIENCE
ORIGINAL RESEARCH ARTICLE
published: 06 September 2013
doi: 10.3389/fnhum.2013.00539
tDCS over the left inferior frontal cortex improves speech
production in aphasia
Paola Marangolo 1,2*, Valentina Fiori 2 , Maria A. Calpagnano 2 , Serena Campana 2 , Carmelina Razzano 2 ,
Carlo Caltagirone 2,3 and Andrea Marini 2,4
1
2
3
4
Ø
Ø
Facoltà di Medicina, Università Politecnica Marche, Ancona, Italy
Department of Clinical and Behavioural Neurology, Istituto di Ricovero a Carattere Scientifico Fondazione Santa Lucia, Roma, Italy
Department of Neurology, Universitá di Tor Vergata, Roma, Italy
Dipartimento di Scienze Umane, Università di Udine, Udine, Italy
Edited by:
Carlo Miniussi, University of
Brescia, Italy
In this study, we investigated the combined effect of transcranial direct current stimulation
(tDCS) and an intensive Conversational therapy treatment on discourse skills in 12 persons
with chronic aphasia. Six short video clips depicting everyday life contexts were prepared.
Three videoclips were used to elicit spontaneous conversation during treatment. The
remaining three were presented only before and after the therapy. Participants were
prompted to talk about the contents of each videoclip while stimulated with tDCS (20 min
1 mA) over the left hemisphere in three conditions: anodic tDCS over the Broca’s area,
anodic tDCS over the Wernicke’s area, and a sham condition. Each experimental condition
was performed for 10 consecutive daily sessions with 14 days of intersession interval.
After stimulation over Broca’s area, the participants produced more Content Units, verbs
and sentences than in the remaining two conditions. Importantly, this improvement was
still detectable 1 month after the end of treatment and its effects were generalized also
to the three videoclips that had been administered at the beginning and at the end of the
therapy sessions. In conclusion, anodic tDCS applied over the left Broca’s area together
with an intensive “Conversational Therapy” treatment improves informative speech in
persons with chronic aphasia. We believe that positive tDCS effects may be further
extended to other language domains, such as the recovery of speech production.
Type of study à Behavioural treatment,
Transcranial anodic Direct Current Stimulation
(tDCS)
Reviewed by:
Stefano F. Cappa, Vita-Salute San
Raffaele University, Italy
Ana I. Ansaldo, Université de
Montréal, Canada
Bernhard Elsner, Technical
University Dresden, Germany
*Correspondence:
Paola Marangolo, Faculty of
Medicine, Università Politecnica
delle Marche, Via Tronto 10/A,
60020 Ancona, Italy
e-mail: [email protected]
Subjects à 8 non-fluent chronic aphasics with
ischemic lesion affecting the left hemisphere
Keywords: tDCS, speech production, aphasia recovery, stroke, language rehabilitation
Ø
Type of therapy à conversational therapy
treatment
INTRODUCTION
been challenged. Several studies have shown that traditional stanFailure to spontaneously produce fluent and informative speech dardized aphasia tests may not be sensitive enough to adequately
is the most persistent disabling consequence after stroke, par- assess linguistic deficits and recovery patterns in persons with
ticularly in persons with aphasia with left anterior hemispheric aphasia (Larfeuil and Le Dorze, 1997). As a result, both funclesions (SPREAD, 2012). Traditional linguistic-based therapies tional and structural methods for the analysis of connected lanhave proved reasonably effective (Jensen, 2000; Kemmerer and guage samples from people with aphasia have been proposed (see
Tranel, 2000; Raymer and Ellsworth, 2002; Wambaugh et al., Armstrong, 2000; Prins and Bastiaanse, 2004; Marini et al., 2011).
2002; Marangolo, 2012). However, in many cases a severe reduc- One procedure for quantifying information content was origition of the ability to produce informative speech does persist nally developed by Yorkston and Beukelman (1980). They admin(Basso, 2010; Marangolo, 2010; Andreetta et al., 2012). For this istered the Cookie Theft Picture description task (Goodglass and
reason, several efforts have been devoted to the development of Kaplan, 1972) to a group of participants with aphasia. The levTorino 29nov13
A multi-level
toquantified
discourse analysis - 19 dicembre 2013
of these
language approach
samples were
new approaches aimed at enhancing the use of language in daily-36 els of informativeness
life communicative situations (e.g., Ulatowska et al., 1983; Saffran in terms of Content Units (C-Units), clusters of elements and/or
37
38
39
8
9
10
11
12
13
14
Figure
15
Click here to download
high resolution image
16
17
Paola Marangolo1,2, Valentina Fiori2, Maria Antonietta Calpagnano2, Carlo Caltagirone2,3,
18
19
Andrea Marini 2,4
20
21
1 Facoltà di Medicina, Università Politecnica Marche, Ancona, Italy
22
23
24
2IRCCS Fondazione Santa Lucia, Roma, Italy
25
26
27
3Università di Tor Vergata, Roma, Italy
28
29
4Dipartimento di Scienze Umane, Università di Udine, Udine , Italy
30
31
32
33
34
35
36
37
38
39
Corresponding authors:
40
41
Prof. Paola Marangolo
42
43
Faculty of Medicine, Università Politecnica delle Marche
44
45
Ancona - Italia
46
47
Email: [email protected]
48
49
tel: 00390712206093, fax:00392206214
50
51
52
and
53
54
Dott. Andrea Marini (should be referred for linguistic analysis)
55
56
Dipartimento di Scienze Umane, Università di Udine, Italy
57
58
Email: [email protected]
59
40
60
61
Neuropsychologia, in press
Present and future directions …
Ø
An analysis of genetic and environmental factors affecting
language development in typically developing children and
children with Specific Language Impairment
Ø
Neuroimaging & Electrophysiologic studies
Ø
Awake neurosurgery
Ø
Ø
Crosslinguistic issues
Journal of Neurolinguistics 26 (2013) 327–334
Contents lists available at SciVerse ScienceDirect
BVL_4-12
Journal of Neurolinguistics
journal homepage: www.elsevier.com/locate/
jneuroling
Ø
What about language origins?
Ø
But this is another story …
Theoretical article
Keeping the route and speaking coherently: The hidden link
between spatial navigation and discourse processing
Francesco Ferretti a, *, Ines Adornetti b, Erica Cosentino c, Andrea Marini d
a
Department of Philosophy, University of Roma Tre, Via Ostiense 234/236, 00146 Rome, Italy
Department of Philosophical Researches, University of Rome Tor Vergata, Via Columbia 1, 00133 Rome, Italy
Department of Philosophy, University of Calabria, Via P. Bucci 18/c, 87036 Cosenza, Italy
d
Università di Udine, Udine Italy; IRCCS "E.Medea, Associazione La Nostra Famiglia", Via della Bonta’, 7 – 33078,
San Vito al Tagliamento (Pn), Italy
Journal of Neurolinguistics 26 (2013) 327–334
b
c
41
Torino 29nov13 A multi-level
approach
to discourse
analysis
- 19 dicembre 2013
Contents lists
available
at SciVerse
ScienceDirect
a r t i c l e i n f o
a b s t r a c t
Ne volete sapere di più?
2008
42
Thanks for your attention !!!
[email protected]
43

Torino 29nov13 A multi-level approach to discourse analysis

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