Perseverations in repetition, reading, naming and writing: two case-studies Anneline Huck1, Ernst G. de Langen2, Arpita Bose3, Ria De Bleser4 1Clinic
for Speech Therapy Schrick und Pietsch, Hamburg,2 Rehabilitation Centre Passauer Wolf, Bad Griesbach, 3 School of Psychology and Clinical Language Sciences, University of Reading 4 Institute of Linguistics, Faculty of Human Sciences, University of Potsdam
Introduction Perseveration, an unwanted repetition of a recent response (e.g., syllable, word), is a common error type in aphasia. The underlying nature of perseveration in aphasic speech continued to be debated in the literature, and it is unclear whether preservations are independent (e.g., Sandson & Albert, 1984) or dependent on the underlying language deficits (e.g., Cohen & Dehaene 1998, Moses, Sheard, & Nickels, 2007). The aim of this paper is to investigate if perseverations in spoken as well as in written language relate to the underlying language processing abilities/deficits.
Participants: 2 German aphasic right-handed individuals with normal or corrected vision (Table 1). Initials Gender Type of (Age) Aphasia
HS (62)
Results Participant Main level of impairment
Perseverations
CH
Dominance of BPs in all tasks
HS
Methods
CH (52)
Analysis: Perseverations produced during repetition (words and nonwords), reading (words and nonwords), writing (words and nonwords) and naming (oral and written) were compared and analyzed with respect to the patients’ individual language impairment.
Months post onset 27
Female Not classifiable (AAT; Alloc) Male Transcortical 5 sensory (clinical picture)
LeMo Etiology and lesion oral localization naming 35% Ischemia in left frontal stem ganglia 5%
Postlexical processing (Phonological/graphematic encoding) Lexical access (phonological and graphematic output lexicon) Orthographic processing (sublexical processing and graphematic encoding)
Table 3. Levels of impairment and perseverations
The analysis of perseverations shows that the number and type of perseverative error varies depending on the patient and tasks. The type of the perseveration corresponds to the type of representation (i.e. phoneme/ grapheme/word) at the deficient level. The example in Figure 1 shows BPs of graphemes produced by HS with severe deficits in graphematic encoding. These result in neologistic errors.
Hypertensive haemorrhage in left stem ganglia
AAT=Aachener Aphasia Test (Huber et al., 1983) Table 1. Overview of participants
Assessment: Neuropsychological assessments with LeMo-Lexikon Modellorientiert (De Bleser et al., 2004) were administered in order to analyze the individual levels of language-processing breakdown on the basis of the Logogenmodel. Tasks: Repetition, reading, naming and writing. Definition perseveration: Any wrong response that had been produced previously in the same test (cf. Santo Pietro & Rigrodsky 1982). Total Perseveration (TP): Repetition of a prior correct or incorrect response; also as one part of a new compound (Moses, Sheard, & Nickels, 2007)
Example:
Blended Perseveration (BP): Partial repetition of a prior response by sharing 50% of the phonemes/ graphemes in a similar order OR: (a) Sharing the initial/final phoneme/grapheme within five/three responses of the original utterance (b)Same main vowel/grapheme on consecutive responses (c) Any repetition of at least two letters in a row within five responses of the original utterance Example:
Auto ‘car’
Auto ‘car’
Pferd ‘horse’
Zug ‘train’
Auto ‘car’ (TP)
Hund ‘dog’
Table 2. Types of perseverations. Contact:
[email protected]
Pferd ‘horse’
Pfund (BP)
Dominance of TPs in lexicalsemantic tasks, i.e. reading words and oral naming; Dominace of BPs in writing
Figure 1. Example of written perseverations (HS)
Discussion (1) Results from this study support the assumption that perseverations
occur within the context of the language-processing impairment (Cohen & Dehaene 1998; Moses et al., 2007). (2) Results further reveal a direct link between perseverations in written language and the deficient level of the writing system. Thus, one has not to assume a separate mechanism generating written perseverations. (3) Results have implications for aphasia therapy: since the treatment focus should - within a cognitive oriented speech therapy - be on the source of the error and not the symptom, the treatment should target the specific functional deficit and not aim at the reduction of the perseveration itself (Cohen & Dehaene, 1998; Moses et al., 2004).
References Cohen, L., & Dehaene, S. (1998). Competition between past and present – Assessment and interpretation of verbal perseverations. Brain, 121, 1641–1659. De Bleser, R. Cholewa, J. Stadie, N., & Tabatabai, S. (2004). LEMO. Lexikon modellorientiert. Einzelfalldiagnostik bei Aphasie, Dyslexie und Dysgraphie. München: Urban & Fischer, Elsevier. Huber, W., Poeck, K., Weniger, D. & Willmes, K. (1983), Der Aachener Aphasie Test (AAT). Göttingen: Hogrefe. Moses, M. S., Nickels, L. A., & Sheard, C. (2004). That dreaded word perseveration. Understanding might be the key. Australian Communication Quarterly, 6(2), 70–74. Moses, M. S., Sheard, C., Nickels, L. A. (2007). Insights into recurrent perseverative errors in aphasia. A case series approach. Aphasiology, 21, 975–1001. Sandson, J., & Albert, M. L. (1984). Varieties of perseveration. Neuropsychologia, 22, 715– 732. Santo-Pietro, M. J., & Rigrodsky, S. (1982). The effects of temporal and semantic conditions on the occurrence of the error response of perseveration in adult aphasics. Journal of Speech and Hearing Research, 25, 184–192.
