| Summary: | Recurring utterances (RUs) are the most challenging symptom for clinicians treating persons with global aphasia. The persistence of such utterances and their adaptability to intonational variation in communicative settings make them intriguing to analyze. Based on language data from 40 language therapy sessions administered to a chronic global aphasic – KB – changes in language performance observed in attempts to break through the RUs will be characterized. The main issue addressed is which linguistic features are systematically observed despite the overall severity of the impairment.
Methods
Participant
KB – male, 67 years old – suffered a massive left hemisphere stroke with basal ganglia and right hemisphere involvement. The initial diagnosis of global aphasia still applied at 29 MPO. The real word recurring utterance (RWRU) ‘the greatest’ and a non-meaningful recurring utterance (NMRU) ‘unterfiat’ are almost exclusively produced. All language modalities are impaired.
Procedure
Due to the severity of his overall impairment, language screening encompassed an interview, word and sentence comprehension, repetition of single words, confrontation naming to picture stimuli. Reading and writing were not testable.
Following several sessions in which various tasks were tried out, a therapy program was conceptualized consisting of repeating together the names of depicted objects and the production of a sentence to picture stimuli in which the depicted object was included and naming of objects and production of sentences from the former session(s). Each session ended with a comprehension check for the items worked on.
Data
In Table 1 examples from therapy sessions are given which document KB‘s changes in performance. They pertain to novel productions, paraphasias, perseveration of already worked on materials, completion phenomena.
Discussion
KB alternately produced two RUs in his oral production when spontaneously responding to a question or in response to presented picture stimuli. Although at 29 MPO his spontaneous production consists predominantly of ‘the greatest’ and ‘unterfiat’, changes in his language behavior within and across the therapy sessions are observable which reveal a degree of systematicity with regard to language processing. These include:
- Production of paraphasias either with the same initial phonemes or totally unrelated to the target
- Verbal perseveration of phonemes in initial position and of whole words.
- Production of an object name or part of a sentence worked on in earlier sessions
- Completion of a sentence with single correct target words
- Few neologisms
- Improved auditory comprehension
The most interesting phenomenon is KB’s production of words from former sessions indicating that they are still ‘active’ and the production of completely novel incorrect words. The observable features indicate that immediate auditory processing is possible in the form of repeating target words. However, as soon as KB must retrieve information from the (semantic) lexicon, even after being able to correctly ‘repeat’ the target word several times, he responds with a RU, perseveration, or paraphasia. Several of his productions can be characterized as aphasic confabulations which stem from a memory gap. Thus, although KB’s language impairment is severe, his responses across time indicate that step-by-step a breakthrough is being made.
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