When Words Betray Us: Language, the Brain, and Aphasia

137 Pages·2022·2.791 MB·

by  Sheila E. Blumstein

Sheila E. Blumstein
When Words
Betray Us
Language, the Brain, and Aphasia
When Words Betray Us
Sheila E. Blumstein
When Words Betray Us
Language, the Brain, and Aphasia
Sheila E. Blumstein
Cognitive, Linguistic & Psychological Sciences
Brown University
Providence, RI, USA
ISBN 978-3-030-95847-3 ISBN 978-3-030-95848-0 (eBook)
https://doi.org/10.1007/978-3-030-95848-0
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To all those, here and gone, who made a
difference in my life
The ASA Press
ASA Press, which represents a collaboration between the Acoustical Society of
America and Springer Nature, is dedicated to encouraging the publication of
important new books as well as the distribution of classic titles in acoustics. These
titles, published under a dual ASA Press/Springer imprint, are intended to reflect the
full range of research in acoustics. ASA Press titles can include all types of books
that Springer publishes, and may appear in any appropriate Springer book series.
Editorial Board
Mark F. Hamilton (Chair), University of Texas at Austin
James Cottingham, Coe College
Timothy F. Duda, Woods Hole Oceanographic Institution
Robin Glosemeyer Petrone, Threshold Acoustics
William M. Hartmann (Ex Officio), Michigan State University
Darlene R. Ketten, Boston University
James F. Lynch (Ex Officio), Woods Hole Oceanographic Institution
Philip L. Marston, Washington State University
Arthur N. Popper (Ex Officio), University of Maryland
Christine H. Shadle, Haskins Laboratories
G. Christopher Stecker, Boys Town National Research Hospital
Stephen C. Thompson, The Pennsylvania State University
Ning Xiang, Rensselaer Polytechnic Institute
Prologue
My first introduction to aphasia was personal. At the time I did not know what apha-
sia was. When I was 19, my grandmother had a stroke. Within days of her stroke, I
visited her in her home where she was lying in a hospital bed in her room. She could
no longer speak. Although she tried, what came out were incomprehensible sylla-
bles. Over time, I could tell from my visits that she was improving. But the improve-
ment was painfully slow. She could not walk on her own, she could say only a few
words, and it was not clear how much she understood. Unfortunately, her story did
not have a happy ending. She continued to have small strokes, and as a result, her
language declined until she ultimately stopped all communication.
At the time, no one gave a name to her disorder. It was not until I was in graduate
school that I made the connection when one of my professors, Roman Jakobson,
talked about the breakdown of language in adults as a result of brain injury. I real-
ized that my grandmother had had aphasia. It was then that I started reading and
wrote my first paper in that course about aphasia. My grandmother may have lost
her voice, but it has lived on as her legacy to me in my lifelong interest and commit-
ment to understanding language, the brain, and aphasia.
Having been in the field since 1967 (starting in my second year as a graduate
student), one has what I call the long view. Theories come and go, old theories are
rediscovered, and new theories are developed. Progress seems infinitely slow – but
with the long view, one can see that there is real and substantial change. And one
also develops a personal perspective. And that is what this book represents. It is not
intended to be a historical overview nor a critical analysis of the research of the
field, although my worldview has been influenced by and owes much to those before
me. It was written with the goal of making it accessible to the non-professional who
may have personal experience with someone with aphasia or who is simply inter-
ested in learning about how language works, how it breaks down, and how the
machinery of the brain makes it all happen.
There are many to thank for the support I have had throughout the years and who
have helped bring this book to fruition. The list of people included here is not
exhaustive, but it represents those who have deeply influenced and assisted me. First
to my mentors of years ago, Roman Jakobson and Harold Goodglass. They pro-
vided guidance and support as I learned about aphasia and started my research
career. In preparing this book, special thanks go to Carol Fowler and Donald
Shankweiler who read drafts of all of the chapters and provided many helpful
ix
x Prologue
comments and criticisms; to Ann Marie Clarkson, a talented artist, who drew many
of the figures included in the book; and to my colleagues David Badre, Elena Festa,
Bill Heindel, and Philip Lieberman and former students, now colleagues, Sara
Guediche, Allard Jongman, Sahil Luthra, Emily Myers, Rachel Theodore, and
Kathleen Kurowski for many helpful discussions and assistance. Thanks to the
Labites, the undergraduate and graduate students and the postdocs, who were part
of my lab at Brown University. Many thanks go to the team at Springer and espe-
cially to Sam Harrison, a great editor, who gave consistently helpful comments and
advice. Finally, my gratitude goes to the many persons with aphasia with whom I
worked and who were gracious participants in my research program and also to the
National Institutes of Health and the National Institute on Deafness and Other
Communication Disorders for supporting my research starting with a predoctoral
fellowship in 1968 and continuing throughout my career.
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.1 The Study of Aphasia: The Breakdown of Language . . . . . . . . . . . . 5
2.2 Some Preliminaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.3 Aphasia Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.3.1 Broca’s Aphasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.3.2 Wernicke’s Aphasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.3.3 Summary of Clinical Syndromes . . . . . . . . . . . . . . . . . . . . . . 9
2.4 A Brief Introduction to the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.4.1 Lesion Localization in Broca’s and Wernicke’s Aphasia . . . . 12
2.4.2 Some Caveats on the Neural Localization of Syndromes . . . 13
2.5 The Components of Language: Putting Language Together . . . . . . . 14
2.5.1 Interactivity: Information Flow in the Network . . . . . . . . . . . 17
2.6 When Language Meets Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.7 Ready to Go . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3 What’s Right and What’s Wrong with Speech Sounds . . . . . . . . . . . . . 21
3.1 The Sounds of Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.2 Saying What You Want to Say: Speech Production . . . . . . . . . . . . . . 23
3.2.1 The Speech Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.2.2 Where Sound Substitution Errors Come from . . . . . . . . . . . . 26
3.2.3 Speech Production Differences Between Broca’s
and Wernicke’s Aphasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.2.4 Planning Ahead Before We Speak . . . . . . . . . . . . . . . . . . . . . 32
3.3 Listen to Me: Speech by Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.3.1 Perceiving the Differences Between Sounds
of Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.3.2 Can You Understand if You Have a Speech
Perception Deficit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.4 What Does it All Mean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
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4 Words, Words, and More Words: The Mental Lexicon . . . . . . . . . . . . . 41
4.1 What’s in a Name?: Naming Deficits in Aphasia . . . . . . . . . . . . . . . . 43
4.2 Network Architecture of the Lexicon . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.3 Where Naming Errors Come from . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4.3.1 Naming in Aphasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4.3.2 It’s Right There on the Tip of My Tongue: And It Is! . . . . . . 48
4.4 Recognizing Words . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.4.1 The Eyes Have It . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
4.5 One More Word . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
5 Putting Words Together: Syntax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
5.1 Structure in the Strings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5.2 Problems with Grammar in Aphasia: Sentence Production . . . . . . . . 59
5.2.1 Agrammatism around the World . . . . . . . . . . . . . . . . . . . . . . 60
5.2.2 Problems with Grammar: Wernicke’s Aphasia . . . . . . . . . . . 63
5.3 Problems with Grammar in Aphasia: Sentence
Comprehension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5.4 Following the Clues: What Goes Wrong with
Syntax in Aphasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
5.5 The End of the Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
5.5.1 Vive la Difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
6 Why Two Hemispheres: The Role of the Right Hemisphere in
Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
6.1 Aphasia and the Right Hemisphere . . . . . . . . . . . . . . . . . . . . . . . . . . 75
6.2 Beyond Sounds, Words, and Syntax . . . . . . . . . . . . . . . . . . . . . . . . . 76
6.3 The Two Sides of the Brain Need Each Other . . . . . . . . . . . . . . . . . . 79
6.4 Split-Brain Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
6.4.1 A Brief Interlude on Brain Neuroanatomy . . . . . . . . . . . . . . 81
6.4.2 Language Processing in the Split Brain . . . . . . . . . . . . . . . . . 81
6.5 A Radical Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
6.6 It’s Still a Puzzle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
7 The Plastic Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
7.1 Language Plasticity After Brain Injury . . . . . . . . . . . . . . . . . . . . . . . 89
7.2 Speaking by Hand and Listening by Eye: Sign Language . . . . . . . . . 92
7.3 Reading by Touch: Language and the Brain in the Blind . . . . . . . . . 97
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
8 Beyond Aphasia: What More Do We Know . . . . . . . . . . . . . . . . . . . . . . 101
8.1 Distributed Neural Systems in Language. . . . . . . . . . . . . . . . . . . . . . 101
8.2 Functional Differences within Neural Areas
Processing Language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103