Characteristics and Assessment

Barbara Fernandes, M.S; CCC-SLP

}  Given the fact that each language has its own syntactic idiosyncrasies (Ardila et al.,2000 p.4) specific manifestation of aphasia differ depending on the structure of the individual’s native language.

�  1. to inform native Portuguese speaking clinicians about the

available resources and tools for the assessment and treatment; �  2. to provide information to clinicians serving these immigrants

around the world( bilinguals?); �  3. to enrich and increase our understanding of aphasia in

bilinguals and monolinguals in general;

}  Portuguese is spoken by 250 million speakers around the world;

}  it is ranked number 6 according to the number of speakers;

}  it is the language with the largest number of speakers in South America (Wikipedia, 2006);

}  The number of Portuguese speakers leaving abroad is between 2.3 to 3 million;

}  The Latin Language }  The earliest surviving records of a distinctively

Portuguese language – 9th century }  The 14th to the 16th century- Portuguese colonies }  The closest language to Portuguese is Galician, there

was a time they were one language. ( Wikipedia, 2007) }  Dialects and orthography– keeping it in mind during the

assessment.

}  Conveying emotional information through touch = a sign of friendship and concern;

}  Personal space? What is it? }  Women tend to touch more than man; }  kisses on both cheeks is cultural and expected; }   Men shake hands when greeting one another, while maintaining steady

eye contact. }  It is considered acceptable to interrupt someone who is speaking; }  Brazilians prefer face-to-face communication to written communication }  Extreme diglossia }  Expect to always be called by your first name regardless of your authority

power ◦  Brazilian Vernacular and standard Brazilian Portuguese

“According to the National Aphasia Association (1999), Aphasia is defined as an impairment of

language due to injury to the brain, affecting the production or

comprehension of speech and the ability to read and write.”

Languages of the world X Aphasia

}  Portuguese is a branch of the Romance languages (Columbia Encyclopedia, 2007)

}  Portuguese has both definite(a, o) and indefinite( uma, um) articles, articles may also be used in the plural (a rosa, as rosas) and are spcified by gender.

}  Articles are derived from the word form }  the gender of the noun is often predictable

based on its lexical form : –a, -ade, - ez,-ice,-gem,- ção, -ã, - são, - dão .

}  Portuguese belongs to the inflectional language group (Lecours, 2000)

}  Portuguese is a pro drop language

Mansur at all (2002) studied 192 Brazilians with speech and language disturbances; 133 of whom were

diagnosed with Aphasia. Patients were examined using the Boston Diagnostics Aphasia Examination, the Token Test and the Boston Naming Test. Results

from this study reveal that the reading comprehension tests yield worse performance in oral spelling errors.

What would be a good explanation for that?

Should this item be removed from the protocol?

}  The manifestations of agrammatism depend on the morphosyntactic characteristics of the language ( Ardila, 2006).

}  Understanding of Portuguese

syntax allows clinicians to observe the patterns that are exhibited in agrammatic individuals

}  The articles According to Bastiaanse et. Al.., (2003) a common

characteristic of agrammatic speakers is the difficulty with articles. According to the same author (2003), processing capacity decreases as the amount

of information to be coded increases.

What is it?

The hypothesis: null subjects in Brazilian Portuguese are mentally represented in two different ways: as pronouns in the 1st person and as variables in the 3rd person.

}  The degree of difficulty of native agrammatic patients of Brazilian Portuguese with null

subjects of different grammatical persons is also not uniform }  Novaes ( 2003) studied the pattern of subject deletion in aphasic individuals.

Normal Individuals : 29.5% Aphasic Individuals: 58.17%

83.64% “the production of null subjects in aphasic

individuals is significantly larger than in normal individuals.”( Novaes, 2003 p364)

Null Subject

}  Example of a null subject (of 1st person) produced by SS }  Interviewer: Qual o nome delas? }  (What the name of them?) }  “What are their names?” }  Aphasic: Agora, agora ec esqueci. }  (Now, now ec forgot.) }  “Now, I forgot”.

}  Example of a null subject (of 3rd person) produced by OL }  Interviewer: O que aconteceu com o Figueira? }  (What happened to Figueira?) }  “What happened to Figueira?” }  Aphasic: Ele caiu, ec caiu no carro, ec entrou no carro. }  (He fell, ec fell in the car, ec entered in the car.) }  “He fell, he fell in the car, he entered the car”.

Lima, Ricardo & Celso Novaes (2000) studied the grammatical judgment of two agrammatic Portuguese

speakers.

◦  Both speakers had been classified as agrammatic aphasics according to their performance on the BDAE

◦  The participants judged the grammar of 128 phrases containing the following violations: (1) NP-movement, (2)

Short Wh-movement, (3) Long Wh-movement, and (4) Double Wh-movement.

◦  The analysis of the participant’s behaviors indicated that both patients’ errors were concentrated in the structures containing violations involving traces of phrases and the

participants’ errors were concentrated on the misjudgment of ungrammatical phrases

}  According to Connor (2001) to possibility that the results of the low socioeconomic status subjects are interpreted as an apparently more severe speech disorder are higher when compared to subjects from a higher socioeconomic status.

}  Brazilian population involves a broad spectrum of educational levels.

}  A large segment of the population is socially disadvantaged, including individuals who are illiterate and who experience a high degree of socio-cultural deprivation.

}  The challenge “difficulties are related to the structure of the language and its peculiarities as well as the cultural context of each country.” Radanovic and Mansur (2001, pg 305)

}  Speech therapists should familiarize themselves with the manifestations of aphasia in Portuguese speakers;

}  The evaluation process }  The problem with standardized test

}  Developed by Jakubovicz in 1996 }  It is the only aphasia test created and validated for the Brazilian Population; “focus on identifying most preserved linguistic

structures and the ones that were more severely impaired in order to guide treatment, rather than identifying the type of aphasia” (Pacheco, 2004).

}  This test includes: ◦  a) a questionnaire for the family, ◦  b) a test of expressive language

(written and spoken), ◦  c) a categorization test, ◦  d) a test of organization of syntax, ◦  e) a test of linguistic transposition, ◦  f) a test of writing ability, ◦  g) test of reading abilities, and ◦  h) a test of expressive syntax

The Boston diagnostic Aphasia Examination (BDAE): The adaptation of the BDAE to Portuguese language

include replacement of stimuli with strong cultural connotations, and those which failed to fulfill the aims of the task after the translation (Radanovic,2002).

Radanovic and Mansur (2002) study: 1. this study reveal that the overall performance of the Brazilian population does not differ from the American or the Colombian population; 2. there was an influence of the schooling on performance on only two items (the word discrimination and the body parts identification).

}  Radanovic, Greco, and Araujo (2005) study: “cut off scores are a combination of body parts

identification, commands, and complex ideation material was the most efficient in differentiating normal individuals from aphasics.”

A paper based and computer based version of the Token test developed by Renzi and Vidalgo in 1962

were developed for the Brazilian population

Silva and Sousa (2007) translated and validated the GOAT to Portuguese. The results from their study

concluded that the Portuguese version of the GOAT is a valid instrument in assessing the orientation and amnesia level of brain injured Portuguese speakers.

The Galveston orientation and Amnesia Test (GOAT)

}  This test is a translated and adapted version of the PALPA to the Portuguese population developed by Kay, Lesser e Coltheart.

}  The WAB was translated to Portuguese; however, no information on translation, validation or normalization was found in the literature

Western Aphasia Battery

Versions of the pairs Portuguese-English

and Portuguese- Spanish are available. This test is useful for clinicians assessing bilingual Portuguese speakers around the

world.

The validation and standardization of the

German AAT to the Portuguese language (PAAT) maintained the same formal

structure as its original version. (Lauterbach, 2006)

The PAAT include a semi-structured interview, and a token test, as well as four

subtests: repetition, written language, naming, and a comprehension subtest.

Mansur,M.; Greco,T. & Araujo,G. (2006) evaluated the performance of the Brazilian population on the Portuguese version of the Boston

Naming test. Although the schooling variable had

the most influence on providing biased scores, the translated

version can be used without any adaptation for the Brazilian

population if the level of education is taken into

consideration.

Schooling issues…

a)  The Peabody Test, b)  The Token Test, c)  The Boston Diagnostic Aphasia

Examination, d)  d) The Boston Naming Test.

“ According to Macedo, Firmo, Duduchi, and Capovila (2007), the advantage of

computer-based over the paper-based examinations is that the former can

measure reaction time.”

}  Over 45 million words and allows for search for parts of speech, word frequency, and sorrowing words;

}  frequency and distribution of the words, phrases, and grammatical construction;

}  semantically-based queries }  Naming treatment

}  the vast majority of the research studies only corroborate findings from studies in other languages;

}  Specific characteristics of the symptomatology of aphasia in the Portuguese language still remain to be studied;

}  Scherer et al(2006) used imaging studies to study semantic and syntactic processing of bilinguals Portuguese/ French speakers

}  the activation map showed a common network involving Wernick’s and Broca’s areas for both syntax and semantics.

}  Meguro et al. (2003) conducted a study with four bilingual Japanese Portuguese patients with Alzheimer’s disease who demonstrated fluency aphasia.

}  Oral reading ability was most impaired in the case of Kanji (irregular words in Japanese), followed by irregular words in Portuguese; however comprehension of these words were not impaired.

As the scientific community becomes globalized and information from studies on the

manifestations of aphasia in different languages becomes available, our understanding of aphasia

expands. An increasing number of speech therapy face the challenges of a diverse society.

Therefore, information on available tools, research findings should be made available so that appropriate assessment and treatment can

be provided to speakers of all languages, monolinguals, bilinguals and multilingual.

}  Ardila, Rosseli & Ostrosky-Solis (2000) Syntactic Comprehension, Verbal Memory, and Calculation Abilities in

Spanish–English Bilinguals. Applied Neuropsychology, Vol 7, N.1, 3-16. }    }  Bastiaanse,R.; Jonkers,.R Ruigendijk,E. & Zonneveld,R. (2003). Gender and case in agrammatic production.

Cortex, 39, 405-417 }  Castro, S. L., Caló, S., Gomes, I., Kay, J., Lesser, R. & Coltheart, M. (2007). PALPA-P, Provas de Avaliação da

Linguagem e da Afasia em Português [Tasks for the assessment of language processing and aphasia in Portuguese, PALPA-P]. Lisboa: CEGOC.

}  Columbia Encyclopedia (2007) Portuguese Language Sixth Edition. Columbia University Press. New York. }  Connor, L.T., Obler, L. K.. Tocco, M., Fitzpatrick P.M. and Albert, M.L. (2001). Effect of socioeconomic status on

aphasia severity and recovery. Brain and Language, 78 , 254–257. }  Cortex (2003) }  Lauterbach,M. (2003) Influence of educational level in Aphasia testing: experiences from standardizing the

Portuguese version of AAT. JINS, 9 }  (4), 514-515. }  Lima, Ricardo & Celso Novaes (2000). Grammaticality judgments by agrammatic aphasics: Data from Brazilian-

Portuguese. Brain and Language, 74, 515–551. }    }  Luiz,E. ( 2005) Brazilians in America: 1.3 million and growing fast. Brazil Magazine. }  Macedo,E. Firmo,L., Duduchi,M. & Capovila (2007). Evaluating receptive language via token test: Computadorized

version versus traditional versions. Avaliacao psicologica, 6(1) 61-68 }  Mansur,M.; Greco,T. & Araujo,G. (2005) A study of the abilities in oral language comprehension of the Boston

Diagnostic Aphasia Examination - Portuguese Version : a reference guide for the Brazilian population. Braz J Med Bio Research 38 (2), 277-292

}  Mansur,:L., Radanovic,M., Ruegg,D., Mendonca,L. & Scaff,M. (2002). Descriptive study of 192 adults with speech disturbances. Sao Paulo Medical Journal. 120 (6) 170-4

}  Meguro,K.,Senaha,M.,Caramelli,P., Ishizaki,J., Chubacci,R., Megure,M., Ambo,H, Nitrin,R. & Yamadori,A. ( 2003). Language deterioration in four Japanese-Portuguese bilingual patients with Alzheimer’s disease: a trans-cultural study of Japanese elderly immigrants in Brazil. Psychogeriatrics. 3: 63-68

}  Monsur,L.; Radanovic,M. Araujo,G. Taquemori,.L & Greco,L. (2006). Boston naming test: performance of Brazilian population from Sao Paulo. Pro-Fono Revista de Atualiazacao Cientifica, Barueri (SP), 18, 13-20.

}  Novaes,,C. (2004). Neuropsychology and linguistic aphasiology: Evidence in favor of case studies. Brain and Cognition 55, 362-364.

}  Novaes,C. and Braga,M. (2003) Dissociation in Production of Null Subjects in Two Aphasic individuals. Toronto Working Papers in Linguistics 21: 89-102

}    }  Pacheco, R. (2004). Reabilitacao fonoaudiologica do afasico em uma perspective focalizada no cotidiano.

[Rehabilitation of the aphasic individual: a perspective focused on daily living]. }  Paradis, M., Simões, A. M. & Dillinger, M. (1987). Teste de Afasia para Bilíngües [Brazilian Portuguese version of the

Bilingual Aphasia Test]. Hillsdale, NJ: Lawrence Erlbaum }  Portuguese. Wikipedia. Retrieved April 26, 2008, from: http:// en.wikipedia.org/wiki/Portugue }  Radanovic et al ( 2001) Primary progressive Aphasia. Arq Neuropsiquiatria 59 (3-A): 512- 520. }  Radanovic and Masour (2002) performance of Brazilian population sample in the Boston Diagnostic Aphasia

Examination: A pilot study. Brazilian Journal of Medical and Biological Research 35: 305 -317. }  Scherer,L.,Giroux,F., Lesage,F., Noureddine,S. Benali, H., Ansaldo,A. (2006) An optical study of semantic and

syntactic processing by bilinguals. Brain and Language, 99 197-198. }  Vicente, S., Castro, S. L., & Walley, A. C. (2003). A developmental analysis of similarity neighborhoods in European

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